[An optical method for investigation of thickness of damaged articular cartilage]. / Hasarlanmis eklem kikirdagi kalinliginin optik bir yöntemle arastirilmasi.

OBJECTIVES: The aim of this study was to develop an optical system to measure damaged cartilage thickness in-vivo and real time using an optical fiber probe and conducting ex-vivo elastic light-scattering spectroscopy experiments on different thicknesses of damaged calf's patella cartilage. MATERIALS AND METHODS: An elastic light-scattering spectroscopy system was assembled with a miniature UV-VIS spectrometer, halogen-tungsten light source, laptop and optical fiber probe. Elastic light-scattering spectra were taken on the control and damaged calf's patella cartilages of 40 samples. The samples were grouped into four; in the first group cartilages were not damaged, in the 2nd, 3rd and 4th groups cartilage thickness was reduced approximately 25%, 50% and 100% respectively. The probe consisted of six fibers; one for light delivery and the other five to detect diffuse back-reflected light from the cartilage. Diameter of the fibers was 400 microm, and distance of the detector fibers from the source fibers were 0.8, 1.6, 2.4, 3.2, 4.0 mm. RESULTS: Our results showed a correlation between cartilage thickness and hemoglobin absorption in the wavelength range of 500-600 nm. We defined an absorption index using the spectral data of the diffuse back-reflected light to make a correlation between the thickness of the cartilage and absorption of hemoglobin. The index is inversely proportional to the thickness of the cartilage and can be used to estimate the cartilage thickness. CONCLUSION: This study showed that measuring elastic light-scattering spectra utilizing the designed optical fiber probe can be used to estimate cartilage thickness. The effect of variation of hemoglobin content of subchondral bone on the estimated cartilage thickness was not clearly known. More ex-vivo experiments should be conducted to test the system efficiency in defining cartilage thickness. The system has the potential to be used in practice as a new product for non-invasively measuring cartilage thickness in-vivo.

Surgery is not always necessary in intraosseous lipoma.

Intraosseous lipoma is the rarest primary bone tumor, is usually asymptomatic, and is often discovered incidentally during unrelated investigations. Lipomas usually undergo varying degrees of involution, with necrosis, cyst formation, and calcification. Careful radiological-pathological correlation is required to avoid misinterpretation. This study describes 12 intraosseous lipomas in 11 patients (6 men, 5 women; mean age, 36 years [range, 25-50 years]; mean follow-up, 5 years [range, 2-11 years]). The lesions were located in the calcaneus in 7 patients (bilaterally in 1 patient), the tibia in 2, the femur in 1, and the ilium in 1. All lesions were asymptomatic and discovered incidentally except in 4 patients (5 lesions). Curettage and bone grafting were performed after biopsy in 4 lesions; and in 1 patient, curettage, bone grafting, and reconstructive surgery were performed after pathologic fracture. The remaining 7 patients were followed up conservatively. Although definite diagnosis of an intraosseous lesion is possible only by histopathologic examination, computed tomography and magnetic resonance imaging findings of intraosseous lipoma are typical, and most patients' symptoms are relieved by conservative means. For this reason, we believe that in patients with no signs of an impending pathologic fracture or suspicion of malignancy, clinical and radiological follow-up is sufficient. However, since intraosseous lipoma is an uncommon bone tumor, physicians should be familiar with the radiological features of this lesion for the correct diagnosis.

Proprioceptive comparison of allograft and autograft anterior cruciate ligament reconstructions.

The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P < 0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P < 0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia.

[Chondropenia: early-stage degenerative disease]. / Kondropeni: Erken evre dejeneratif hastalik.

Chondropenia is defined as loss of the articular cartilage volume. It is the early stage of degenerative joint disease. Risk factors include advanced age, obesity, overuse (activity-related injury), menopause, and trauma. Early detection of chondropenia is important with regard to recognition of its causes and assessment of the efficacy of treatment. Magnetic resonance imaging is the most potential tool for noninvasive assessment of articular cartilage. Arthroscopy provides information about the size, surface features, and anatomic localization of cartilage lesions, and the features of the adjacent cartilage. By arthroscopy, tissue thickness and in vivo volume of the cartilage can be measured. Studies have given weight to mechano-acoustic diagnosis and optical tools (optical coherence tomography, reflectance spectroscopy). These studies are based on the relationship between the structural and mechanical features of the cartilage. Determination of breakdown products of cartilage is another potentially important method for assessment.

[Osteochondral allograft transplantation in the knee]. / Dizde osteokondral allogreft transplantasyonu.

Despite significant improvements for the past 20 years in the treatment of full-thickness chondral defects with the use of chondroprotective biological methods (microfracture, autologous chondrocyte transplantation, osteochondral autograft, and periosteal graft), the treatment of large osteochondral defects in young and physically active population is still challenging. Alternatives for the treatment of chondral defects exceeding 3 cm in size are limited, and among them, allografts have been used longer than any other treatment methods with the most favorable results. The success rates for osteochondral allograft transplantation have been reported as 95%, 71%, and 66% at 5, 10, and 20 years, respectively. Factors that adversely affect long-term results include advanced age, allograft transplantation to both sides of the joint, inappropriate loading, osteoarthritis, and osteonecrosis due to steroid use. Today, as a result of improvements in tissue-organ transplantation, increased availability of fresh tissue from donors, and increased demand from patients and physicians, there has been growing interest in the use of osteochondral allografts in selected patients to delay arthroplasty for chondral defects.

Posterior spinal epidural abscess: an unusual complication of vertebroplasty.

OBJECTIVE: Complications after vertebroplasty are rare. There are few reported infectious complications requiring surgical management such as corpectomy with anterior reconstruction and posterior stabilization, although we have not seen any reports about epidural abscess in the literature. We present a patient in whom posterior epidural abscess developed after vertebroplasty in which drainage and antibiotherapy were required for treatment. METHODS: A 70-year-old female with a painful T12 osteoporotic compression fracture underwent percutaneous vertebroplasty using polymethylmethacrylate without complication. One week after vertebroplasty, however, she had fever and increased back pain. On clinical examination, soft tissue abscess formation was determined at the vertebroplasty site. This was drained surgically and antibiotic treatment was started. At follow-up, she had progressive neurological deterioration (paraparetic) on the 18th day after abscess drainage. MRI of the thoracolombar spine revealed posterior spinal epidural abscess at the T11/12 level. Partial laminectomy and drainage were performed. She had complete neurological recovery in the follow-up period. CONCLUSION: An epidural abscess, which is an unusual complication of vertebroplasty, represents a medical and surgical emergency. Treatment is generally urgent surgical drainage combined with antibiotics. The patient should be evaluated in detail for systemic infectious disease and comorbid conditions before the vertebroplasty procedure.

Irreducible posterolateral knee dislocation resulting from a low-energy trauma.

A small amount of knee dislocations is included in the irreducible knee dislocations group. In such instance, medial femoral condyle is buttonholed through the gap formed by medial retinacular and capsular structures and this prevents reduction. In this study, we present two cases in which there were irreducible posterolateral knee dislocations resulting from a low-energy trauma. In both cases, dimple sign produced by the invagination of the medial retinacular structures and capsule and ecchymosis medially were noted. Soft tissue invaginated between the trochlea and intercondylar notch was extracted by open reduction.

[Avulsion injuries of the pelvis in adolescents]. / Ergenlik döneminde görülen pelvik halkanin avulsiyon yaralanmalari.

Avulsion fractures of the apophyses of the pelvis are common in adolescent athletes. They usually occur as a result of trauma or overuse, involving especially the anterior inferior iliac spine, anterior superior iliac spine, anterior third of the iliac crest, tuber ischiadicum, and the symphysis pubis. The majority of these injuries occur during vigorous sports, with a male preponderance. They are often mistaken for muscle or tendon injuries. History, physical examination, and radiologic modalities are often helpful in diagnosis. Treatment may vary depending on the localization of the injury and the extent of fragment dislocation, but mainly remains conservative including bed rest, medications, and rehabilitation. Some patients may require surgical treatment, though.

Anastomotic vessels in the retropubic region: corona mortis.

Anastomosis between the pubic rami of the inferior epigastric and the obturator arteries has been referred to as the corona mortis. Because anomalous vessels in the retropubic region are at risk in groin or pelvic surgeries, they have an importance not only for general surgery but also for orthopaedics. Because it is hard to distinguish these vessels, they can be injured during ilioinguinal incision, which can lead to massive uncontrolled bleeding. For this purpose, 54 cadaver halves were dissected to determine the occurrence and location of the corona mortis anastomosis. We found venous corona mortis in 11 halves (20.37%). Additionally, in 8 halves (14.81%), the obturator artery originated from the inferior epigastric artery.

A different treatment modality for trochanteric fractures of the femur in surgical high-risk patients: a clinical study of 44 patients with 21-month follow-up.

INTRODUCTION: To assess the effectiveness of a modular axial fixator as an alternative method in surgically high-risk patients with trochanteric fractures of the femur. MATERIALS AND METHODS: In a prospective, uncontrolled clinical study, 44 high-risk patients (ASA grade 3 or 4) with trochanteric femoral fractures were treated by a modular axial fixator. They were prospectively followed up for 21 months (range 14-30 months) and evaluated using Foster's criteria. RESULTS: All of the fractures healed, and mean time to union was 10.9 weeks. Three types of complications were noticed. These were infections, varus alignment and shortening. Results were anatomically excellent in 35 patients, good in 9, and functionally excellent in 36, good in 8. CONCLUSION: The modular axial fixator is a reliable alternative for treating frail patients with trochanteric fractures of the femur.

Tarsal tunnel syndrome - the effect of the associated features on outcome of surgery.

Between 1989 and 2000, 16 patients underwent surgery for tarsal tunnel syndrome; 12 patients (13 feet) were available for follow-up at a mean of 83 (12-143) months. The symptoms had resolved in six feet, were improved in four, were unchanged in two and recurred after five years in one. Better results are obtained in patients who have space occupying lesions than in those in whom the aetiology is idiopathic or post-traumatic or those with foot deformities.

[The relationship between the thickness and elasticity of the heel pad and heel pain]. / Topuk yag yastigi kalinligi ve elastisitesi ile topuk agrisi arasindaki iliski.

OBJECTIVES: We investigated the factors affecting the thickness and elasticity of the heel pad and sought relationship between the heel pad thickness and elasticity and heel pain. METHODS: Of 182 patients who presented with a complaint of heel pain over a three year period, 50 patients (38 females, 12 males; mean age 46 years; range 23 to 73 years) met specific criteria for the study. A combined treatment modality was conducted throughout a year which consisted of non-steroidal anti-inflammatory drugs, contrast baths, stretching exercises, and changes in footwear design. At the end of a year, the results were assessed according to the criteria proposed by Wolgin et al. Measurements of heel pad thickness were performed according to the technique described by Jorgensen: compressibility index of the heel pad was calculated on anteroposterior and lateral radiographs of the heel, loaded and unloaded by body weight. RESULTS: The results were good in 35 patients (70%), fair in 12 patients (35%), and poor in three patients (6%). Four patients (8%) developed recurrences. Increased heel pad thickness, decreased elasticity, and delayed healing were observed in males, in patients above 40 years of age, in obese patients, in those with a pretreatment symptom duration exceeding 12 months, and in those with a greater subcalcaneal spur. CONCLUSION: The thickness of heel pad increases in relation to age and weight, resulting in decreased elasticity. In addition, subcalcaneal spur may be involved in heel pain induction through decreasing heel pad elasticity.