Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients.

BACKGROUND: The objective of the arthroscopic treatment in tibial spine avulsion fractures (TSAF) is to achieve firm reduction and strong internal fixation while still having the patient undergo a minimally invasive procedure. MATERIAL AND METHODS: The study was performed on 12 young patients with avulsion fracture of the anterior tibial spine. All 12 patients had type 3 Modified Meyers and McKeever fractures. The injury mechanism was direct anterior to posterior trauma in full leg length hyperextension with sport trauma reported in all cases. The physical examination revealed decreased range of motion, extension deficit, and pain during walking. Radiology, MRI, and CT pathologic findings described complete fracture of the anterior tibial spine with no clear signs of callus formation at the time of examination. All patients underwent arthroscopic suture surgical treatment. The Tegner, the Lysholm, and the International Knee Documentation Committee (IKDC) scores were used to evaluate subjective outcomes at three and six months after the surgery. Radiographs were used to assess callus formation and healing status of the fracture. RESULTS: The mean IKDC score was 33.4 ± 23.3 (p = 0.032) preoperatively and 84.2 ± 14.3 at final follow-up (p = 0.0032, CI = 95%). The mean Tegner score improved from 3.8 ± 1.1 pre-operatively to 6.7 ± 2.2 at six months follow-up (p = 0.0231, CI = 95%). The Lysholm score differed significantly at baseline compared to final follow-up (53.7 ± 17.3 vs. 87.7 ± 9.9; p = 0.0066, CI = 95%). In all cases (n = 12), the radiographs taken after six months revealed the healing of the fracture in the anatomic position without secondary displacement. No functional knee instability was detected at the end of the study. CONCLUSIONS: The study provides preliminary promising results regarding fracture healing, knee stability, and functional subjective scores. Patient selection was a major factor of success prediction for this technique.

Treatment Efficacy with a Novel Hyaluronic Acid-Based Hydrogel for Osteoarthritis of the Knee.

Background: Prior trials investigating the treatment of symptomatic osteoarthritis (OA) with hyaluronic-acid-derived products injections have provided optimistic results. The study was directed to assess the effectiveness of an innovative hyaluronic-acid-based hydrogel (Hymovis®) in the treatment of symptomatic knee OA. Methods: A prospective, single-center, clinical trial was performed. Thirty-five patients with degenerative knee OA were included. Inclusion criteria were: age between 45-80, radiographic Kellgren grade II or III osteoarthritis, minimum 35 mm score on the Visual Analogue Scale (VAS), pain for at least 6 months and agreement to participate in the study. Patients received two injections at a one-week interval. The evaluator assessed the patients using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and VAS. Evaluation was performed before, at 2 and 6 months after the injections. Results: A significant improvement on the WOMAC Index pain subscale was observed at 6 months after the injection. At two months, pain subscale score decreased from 10.34 to 9.34. At six months, a significant decrement in pain parameters compared to baseline was observed (from 10.34 to 7.72; p = 0.0004). Median points on VAS significantly ameliorated after 6 months (from 74.2 to 57.3 cm; p < 0.0001). Regarding physical function, a statistically significant difference compared to baseline was observed at the end of the study (from 29.74 to 25.18; p = 0.0025). WOMAC Index stiffness component did not differ from baseline at any time during follow-up. Conclusions: Pain relief installed with a delayed on-set but had a prolonged duration. The novel hyaluronic acid-based hydrogel (Hymovis®) had effective results, particularly after six months post-injections and offers a therapeutic advancement in the treatment of moderate to severe osteoarthritis.

[Traumatic asphyxia with permanent visual loss. Case report]. / Traumás asphyxia maradandó látásvesztéssel.

Traumatic asphyxia is a rare condition that occurs after compressive thoracoabdominal trauma, which is characterized by subconjunctival hemorrhage, cervicofacial cyanosis, edema and petechiae. Serious life-threatening thoracic and abdominal injuries may coexist. After conservatory treatment in most cases complete recovery is achieved, but in isolated cases permanent neurological lesions may occur. We present the case of the 39-year-old male patient who suffered a compressive thoracoabdominal trauma. The physical examination showed the characteristic "ecchymotic mask". After surgical treatment of the abdominal injuries and intensive therapy the patient was discharged with permanent vision loss. The high retrograde venous pressure in the head and neck may be associated with neuronal ischemia, which can lead to irreversible optic nerve atrophy. It is therefore important to carry out an early, routine and complete ophtalmologic examination, especially in the intubated and poorly cooperative patients. Orv Hetil. 2017; 158(22): 864-868.

Clinico-radiological diagnosis and grading of rapidly progressive osteoarthritis of the hip.

Due to the current lack of standard definitions for rapidly progressive osteoarthritis of the hip (RPOH) in the literature, this observational study aimed to describe new diagnostic criteria and a grading system for the disease.From a consecutive series of patients undergoing total hip replacement, 2 groups were selected: 1 with RPOH and 1 with primary hip osteoarthritis (POH), and their clinical, paraclinical, and demographic data were compared. The newly proposed clinico-radiological diagnostic criteria are based on characteristics of pain, joint mobility, and radiological assessment. The radiological grading system's inter- and intraobserver reliability was assessed through serial evaluations by 2 blinded reviewers.From the total 863 cases, 82 cases (9.5%) of RPOH were identified and compared with 107 cases of POH. Mean age and disease bilaterality were similar, with a predominance of female patients in the RPOH group (P = 0.03). There were significant differences between the 2 groups in disease onset and aggravation, and intraoperative blood loss. The grading system showed significant inter- and intraobserver agreement (weighted kappa 0.93, and 0.89).Our study presents distinctive, easily recognizable clinico-radiological characteristics of RPOH and confirmed the inter- and intraobserver reliability of the newly proposed grading system.

[Van Neck-Odelberg disease. Report of two cases]. / A van Neck-Odelberg-betegség bemutatása két eset kapcsán.

Osteochondritis ischiopubica or van Neck-Odelberg disease is characterized by atypical ossification of the ischiopubic synchondrosis. Clinical symptoms are usually pain, limping and limited range of motion of the hip joint. Radiologic images may be confused with the possibility of fracture, tumor or inflammation. In some cases it may be difficult to set up the accurate diagnosis, and during the diagnostic process it is essential that van Neck-Odelberg disease should be considered. In this paper the authors draw attention to this rare disorder and they present the history of two patients who posed diagnostic difficulties.

Acetabular reconstruction with a reinforcement device and bone grafting in revision arthroplasty-a mean five years of follow-up.

PURPOSE: To evaluate the clinical and radiological outcomes of acetabular reconstruction using a reinforcement device (RD) in combination with bone grafting in Paprosky type 2 and 3 acetabular bone defects. METHODS: Morselised bone grafts were used to fill cavitary defects and a structural graft placed in the superior part of the acetabulum in cases of cranial bone defects, with a proximally fixed RD (Protetim, Hódmezovásárhely, Hungary) implanted in all cases. Construct stability, device positioning, hip centre of rotation and medial acetabular wall thickness were evaluated radiologically. Survival rates were estimated with aseptic loosening and revision for any reason as endpoints. RESULTS: The 28 patients (29 hips) were followed for 4.8 ± 2.7 years (range, 2-10.4 years). Hip centre of rotation was lowered in all cases, with no significant differences between the mean values obtained post-operatively and at the last follow-up. Medial acetabular wall thickness and RD abduction angle were maintained up to the last evaluation. Bone grafts integrated by two years post-operatively in the majority of cases. Kaplan-Meier survival rates were 85.2 % and 82.1 % for the two endpoints at ten years. CONCLUSIONS: Acetabular reconstruction using a proximally fixed RD in combination with bone grafting offered good mid-term results in the treatment of acetabular bone defects. In cases of severe bone loss, the structural allograft allowed placement of the RD with ischial contact, rendering survival rates similar to RDs with both iliac and ilioischial fixation. The technique was successful in restoring and maintaining medial acetabular bone stock and construct stability for up to ten years.

Human vomeronasal epithelium development: An immunohistochemical overview.

The vomeronasal organ (VNO) is the receptor structure of the vomeronasal system (VNS) in vertebrates. It is found bilaterally in the submucosa of the inferior part of the nasal septum. There are ongoing controversies regarding the functionality of this organ in humans. In this study we propose the immunohistochemical evaluation of changes in components of the human vomeronasal epithelium during foetal development. We used 45 foetuses of different age, which were included in three age groups. After VNO identification immunohistochemical reactions were performed using primary antibodies against the following: neuron specific enolase, calretinin, neurofilament, chromogranin, synaptophysin, cytokeratin 7, pan-cytokeratin and S100 protein. Digital slides were obtained and following colorimetric segmentation, surface area measurements were performed. The VNO was found in less than half of the studied specimens (42.2%). Neuron specific enolase and calretinin immunoexpression showed a decreasing trend with foetal age, while the other neural/neuroendocrine markers were negative in all specimens. Cytokeratin 7 expression increased with age, while Pan-Ctk had no significant variations. S100 protein immunoexpression also decreased around the VNO. The results of the present work uphold the theory of regression of the neuroepithelium that is present during initial stages of foetal development.

Acetabuloplasty with bone grafting in uncemented hip replacement for protrusion.

PURPOSE: This retrospective study investigated midterm outcomes of uncemented total hip replacement with acetabuloplasty using impacted bone grafts in acetabular protrusion or primary hip arthritis with an inadequate thickness of the medial acetabular wall. METHODS: The medial acetabular wall was augmented by impaction bone grafting, and an uncemented cup was implanted in all cases. Hip centre of rotation, medial acetabular wall thickness and cup positioning were evaluated radiologically, with the Harris Hip Score determined at each follow-up. RESULTS: A total of 32 patients (39 hips) were followed for a mean of 4.5 years, with significant improvement of the Harris Hip Score at the last follow-up. Hip centre of rotation was restored close to the optimal position. Medial acetabular wall thickness and cup position obtained immediately postoperatively were maintained up to the last follow-up, without statistically significant differences. Bone graft integration was observed in all cases by one or two years postoperatively, with no signs of loosening or cup migration at the last follow-up. Heterotopic ossification was identified in 15.4% of cases, without clinical evidence of hip mobility impairment or pain. CONCLUSIONS: Impaction bone grafting for acetabuloplasty, associated with the implantation of an uncemented cup, yields good midterm results in patients with acetabular protrusion and with primary hip arthrosis with a thinned medial acetabular wall. The restored bone stock and medial acetabular wall thickness enable the placement of the hip centre of rotation close to the optimal location, which could offer further long-term benefits.

Reliability of radiographic landmarks in medial patello-femoral ligament reconstruction in relation to the anatomical femoral torsion.

PURPOSE: Anatomically correct graft positioning at the femoral insertion site is a key factor in surgical reconstruction of the medial patello-femoral ligament (MPFL). Basically there are two techniques to define this point in fluoroscopy during surgery. The role of the anatomical femoral torsion on the accuracy and reproducibility of both procedures has not been clarified. METHODS: Twenty human anatomical leg specimens were dissected. The femoral insertion of the MPFL was marked by two K-wires. The position of the ligament insertion was determined fluoroscopically in the true lateral view as used in routine clinical practice. The anatomical MPFL insertion was compared to the radiographic landmarks which were recommended by two previous studies. The anatomical femoral torsion of the specimens was assessed by computed tomography scans. RESULTS: In true lateral view fluoroscopy, the mean distance of the femoral MPFL insertion was -0.2 mm distal to the vertical reference line intersecting the posterior point of Blumensaat's line. In the anteroposterior direction, the mean distance was -2.0 mm posterior to the femoral cortex reference line. There was no correlation between anatomical femoral torsion and the distance of the femoral MPFL insertion to the posterior cortex. CONCLUSIONS: The results of this study strongly recommend use of a vertical line intersecting the most posterior point of Blumensaat's line as a reference to identify the MPFL insertion in the craniocaudal direction. In the anteroposterior direction, the femoral MPFL insertion showed distinctive variation and was found -2.0 mm posterior to the femoral cortex reference line without being influenced by the anatomical femoral torsion.

The in vitro antibacterial effect of S53P4 bioactive glass and gentamicin impregnated polymethylmethacrylate beads.

Osteomyelitis is a disease that is still difficult to treat, with considerable morbidity and associated costs. The current "gold standard" in treatment - debridement and implantation of antibiotic impregnated polymethylmethacrylate (PMMA) beads - presents the disadvantage of a second surgical intervention required for the removal of the beads. We comparatively investigated the in vitro antibacterial effect of S53P4 bioactive glass (BAG) and gentamicin impregnated PMMA beads. Bacterial viability was assessed hourly by Standard Plate Count during 24 hours of incubation, by determining the number of colony forming units (CFU) of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Klebsiella pneumoniae. Both tested materials showed an antibacterial effect on all studied bacteria. In case of S. aureus, BAG granules were almost as effective as gentamicin impregnated PMMA beads, with no statistically significant differences. In contrast, PMMA beads had a superior antibacterial effect on S. epidermidis and K. pneumoniae. The antibacterial effect of BAG was greatly influenced by granule size and contact time. There was a statistically significant correlation between pH values and the number of CFU in the case of S53P4 BAG granules. As a biocompatible and biodegradable bone substitute, S53P4 bioactive glass can be a good alternative in the local management of osteomyelitis.

Femoral rotation in ligament balanced knee arthroplasty: a prospective clinical study.

Rotational alignment of the femoral component is an important factor to achieve beneficial results in total knee arthroplasty. Femoral rotation pre versus post surgery was prospectively assessed in 40 patients who underwent ligament balanced knee arthroplasty. Computerized tomography of the knee was performed before and after the surgery to determine the femoral rotation. In 36 out of 40 patients the rotation of the femoral implants differed compared to the preoperative femur (P > 0.001). After surgery the rotational alignment of the femoral component ranged from -3° (internal rotation) to 7° (external rotation). Increased external rotation was found in 33 out of 40 patients ranging from 1° to 7°. These results highlight the importance of individually determined femoral rotation in ligament balanced knee arthroplasty.

Implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths in antegrade and crossover procedures: midterm results.

The aim of this study was to evaluate the technical performance of the implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths. Thirty-three lesions (24 stenoses, 9 occlusions) in 32 patients (mean age 67 years) were stented. Selective stent implantation was performed after unsatisfactory percutaneous transluminal angioplasty result with an antegrade access in 21 patients and through a crossover sheath in 11 patients. A total of 36 stents were implanted. Stent delivery was successful in all cases (stent diameter 5 or 6 mm, stent length 11-38 mm). In none of the cases was stent dislodgement from the balloon observed. Stent placement was optimal without residual stenosis in 30 cases. In 1 case the stent was chosen too short requiring implantation of a second stent. In 1 patient distal embolization was observed which was treated with catheter embolectomy. Nine-month primary and secondary patency rates were 79+/-8.7 and 86+/-7.7%, respectively. Implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths is safe in antegrade and crossover procedures.