Brucella Prosthetic Infection in a Patient with Total Knee Prosthesis.

Brucella infection is often an occupational disease of veterinarians, agricultural workers, and slaughterhouse workers. The infection is generally spread by contact of broken skin (open cuts or wounds) with infected animal tissues or by ingesting unpasteurized milk and dairy products from the infected animals. Brucellosis, which can have many different clinical presentations, may rarely cause joint prosthesis infection. There is not enough literature about the treatment of such infection which should be kept in the differential diagnosis, especially in endemic regions. We aim to present diagnostic and treatment approach of Brucella prosthetic infection in a 70-year woman with total knee arthroplasty. Key Words: Brucella, Prosthesis, Infection, Total knee arthroplasty.

Is there a correlation between the femoral anteversion angle and the elasticity of the hip muscles in cases of intoeing gait due to increased femoral anteversion angle?

Purpose: One of the common causes of gait disturbance in children is increased femoral anteversion. There are not enough publications in the literature on muscles related to the hip joint in increased femoral anteversion. The aim of this study was to evaluate the relationship between the femoral anteversion angle and hip muscle elasticity in children walking inward, using shear wave elastography (SWE). Material and methods: Seventeen children with bilateral increased femoral anteversion angle in computed tomography were prospectively included in this study. Elasticity values of the hip muscles (adductor magnus (adductor), iliopsoas (flexor), gluteus medius (abductor), gluteus maximus (extensor) muscles) were evaluated by ultrasound elastography by two observers. Quantitative measurements of the shear wave velocities were performed using virtual touch tissue imaging quantification. Results: There was excellent harmony between the femoral anteversion angle measurements performed by the two observers and a good congruence between the muscle elastography evaluations. While there was a moderate significant correlation between the femoral anteversion angle and the elasticity values of the iliopsoas and adductor magnus muscles, no significant correlation was found with other muscle elasticity measurements. Conclusion: Iliopsoas muscle and adductor magnus muscle elasticity are correlated with the femoral anteversion angle. With further studies, we think that physical therapy methods for the elasticity of the muscles associated with the femoral anteversion angle can reduce the complaints of the patients.

Should you fix again? An unusual fracture of a distal epiphyseal radius fracture - A case report.

Currently, Salter-Harris (SH) classification is generally used in physeal fractures, as it is reliable and valuable in many cases. Although this clasification system describes many different fracture configurations, still there is an unclassifed group of fractures. Here, we present the case of an 11-year-old boy who underwent surgery after fracture of distal radial epiphysis,of the type still unclassified according to SH classification. The main reason for ourresearch was that the line of treatment could not be decided initially after the first operation. The current classsifications that are close to SH and essentials on the neccesity of surgical approach were dicussed. Surgery must be attempted in cases in which it cannot be decided whether it is a SH type 2 or 3. Besides this situation, an attempt must be made for the classification of the fracture (Ogden tip 2b, Sferoupulos tip 3). Another important point is to decide where the fracture line goes in the layers of physis.

Comparison of Biomechanical Effects of Different Configurations of Kirschner Wires on the Epiphyseal Plate and Stability in a Salter-Harris Type 2 Distal Femoral Fracture Model.

BACKGROUND: We sought to investigate the different configurations of Kirschner wires used in distal femur Salter-Harris (SH) type 2 epiphyseal fracture for stabilization after reduction under axial, rotational, and bending forces and to define the biomechanical effects on the epiphyseal plate and the fracture line and decide which was more advantageous. METHODS: The SH type 2 fracture was modeled using design software for four different configurations: cross, cross-parallel, parallel medial, and parallel lateral with two Kirschner wires, and computer-aided numerical analyses of the different configurations after reduction were performed using the finite element method. For each configuration, the mesh process, loading condition (axial, bending, and rotational), boundary conditions, and material models were applied in finite element software, and growth cartilage and von Mises stress values occurring around the Kirschner wire groove were calculated. RESULTS: In growth cartilage, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration. In Kirschner wires, the stresses were highest in the cross configuration and lowest in the cross-parallel and parallel lateral configurations. In the groove between the growth cartilage and the Kirschner wire interface, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration. CONCLUSIONS: The results showed that the cross configuration is advantageous in fixation. In addition, in the SH type 2 epiphyseal fracture, we believe that the fixation shape should not be applied in the lateral configuration.

Ultrasound-guided Mid-humeral Radial Nerve Block Provides Sufficient Surgical Anesthesia at Hand Dorsum: A Novel Method and Report of Three Cases.

A peripheral nerve block is a sufficient anesthesia method for hand surgeries, as it protects the patient from the complications of general anesthesia and provides postoperative analgesia. We report the first use of an ultrasound-guided mid-humeral radial nerve block in three cases of ganglion cyst excision from hand dorsum. The block provided efficient surgical anesthesia and postoperative analgesia for the excision of ganglion cysts at the hand dorsum.

Comparison of effects of different screw materials in the triangle fixation of femoral neck fractures.

In this study, biomechanical behaviors of three different screw materials (stainless steel, titanium and cobalt-chromium) have analyzed to fix with triangle fixation under axial loading in femoral neck fracture and which material is best has been investigated. Point cloud obtained after scanning the human femoral model with the three dimensional (3D) scanner and this point cloud has been converted to 3D femoral model by Geomagic Studio software. Femoral neck fracture was modeled by SolidWorks software for only triangle configuration and computer-aided numerical analyses of three different materials have been carried out by AnsysWorkbench finite element analysis (FEA) software. The loading, boundary conditions and material properties have prepared for FEA and Von-Misses stress values on upper and lower proximity of the femur and screws have been calculated. At the end of numerical analyses, the best advantageous screw material has calculated as titanium because it creates minimum stress at the upper and lower proximity of the fracture line.

Presentation of a Humeral Shaft Fracture Treated by Locked Intramedullary Nailing With Unlocked Technique.

INTRODUCTION: Although intramedullary nailing (IMN) is used in a reamed or unreamed fashion for treatment of long bone fractures, the locked nails may also be used in the unlocked form if so decided by the orthopedic surgeon. CASE PRESENTATION: We describe a 50-year-old man who had a shaft fracture of his right humerus. The fracture was treated with a reamed, locked IMN using unlocked technique. CONCLUSIONS: The functional outcome 22 months post injury showed that although primary treatment method uses locked IMN in humeral shaft fractures, unlocked IMN can be used in appropriate cases. Less injury risk to the axillary and radial nerve, short period of surgery, and less radiation can be considered as advantages of this technique.

The Influence of Different Nonsteroidal Anti-Inflammatory Drugs on Alveolar Bone in Rats: An Experimental Study.

THE AIM: The aim of this study was to investigate the effect of dexketoprofen trometamol, meloxicam, diclofenac sodium on any untreated alveolar bone when they are used as drugs for another indication. MATERIALS AND METHODS: Twenty eight male Spraque-Dawley rats were randomized into four groups as dexketoprofen trometamol (Group I), meloxicam (Group II), diclofenac sodium (Group III) and control group. Nonsteroidal anti-inflammatory drugs (NSAID) were administered after a fibula fracture for 10 days. Untreated alveolar bone was histopathologically examined for spongious bone density, osteoclastic density and osteoblastic density. RESULTS: Spongious bone density was lower in study groups (Group I, group II and group III) than the control group (p<0.05). In contrast, the increase in osteoclastic density was observed in other groups apart from the control group (p<0.05). Osteoblastic density was evaluated and it was determined that group II and group III had lower results than the control group (p<0.05) but group I was equal to the control group. CONCLUSION: This study showed that systemically administrated NSAIDs have the potential to affect untreated alveolar bone. This should also be considered in long term use of NSAIDs.

Locations of lesser tuberosity cysts and their association with subscapularis, supraspinatus, and long head of the biceps tendon disorders.

BACKGROUND: Humeral head cysts are not uncommon in individuals with rotator cuff disorders. The cysts are usually considered an indicator of rotator cuff pathologies; however, they may have different meanings in different regions. PURPOSE: To determine the frequency of cysts within and adjacent to the lesser tuberosity and the relationship between these cysts and subscapularis, supraspinatus, and long head of the biceps tendon (LHBT) disorders. MATERIAL AND METHODS: We retrospectively reviewed 760 consecutive shoulder magnetic resonance imaging (MRI) examinations. Among these MRIs, we selected a group of patients with cysts located around the lesser tuberosity. The study population was also divided into two subgroups, patients with cysts within the lesser tuberosity and those with cysts adjacent to the lesser tuberosity. In addition to the number and size of cysts, the MRI appearance of the tendons was evaluated. RESULTS: Eighty-one (10.7%) patients had cysts within and/or adjacent to the lesser tuberosity, 34 (42%) patients had cysts within the lesser tuberosity, and 47 (58%) patients had cysts adjacent to it. LHBT and subscapularis tendon disorders were significantly related to more than one cyst. In a univariate analysis, cysts within the lesser tuberosity were significantly associated with LHBT and subscapularis tendon disorders; however, multivariate analyses showed that only LHBT disorders were significantly associated with cysts within the lesser tuberosity. CONCLUSION: Cysts within the lesser tuberosity were less common than cysts adjacent to it. LHBT and subscapularis tendon disorders were more frequently found in patients with more than one cyst within and/or adjacent to the lesser tuberosity. In addition, cysts within the lesser tuberosity were associated with LHBT disorders.

Comparison of the biomechanical effects of pertrochanteric fixator and dynamic hip screw on an intertrochanteric femoral fracture using the finite element method.

BACKGROUND: This study was conducted to examine and compare the pertrochanteric fixator (PTF) and dynamic hip screw (DHS). METHODS: AnsysWorkbench, a commercial finite element based program, was used to investigate the biomechanical parameters of femoral fractures and implants. The human femoral model was scanned and a femoral intertrochanteric fracture was created. Von Mises stress, von Mises strain, and shear and deformation forces on the upper and lower parts of the fracture line; and the von Mises stress, von Mises strain parameters of the screws and implant bodies during axial loading were calculated and compared. RESULTS: It was determined that the magnitude of displacement forces along the fracture line was lower in PTF. Regarding the von Mises stress and von Mises strain values on the implant bodies, the DHS body had higher levels compared with the PTF body. CONCLUSION: This study demonstrated that PTF is more favorable than DHS for early axial loading and ambulation.

A pediatric comminuted talar fracture treated by minimal K-wire fixation without using a tourniquet.

BACKGROUND: Pediatric comminuted talar fractures are reported to be rare, and treatment options such as minimal internal K-wire fixation without using a tourniquet to prevent avascular necrosis have not previously been investigated. CASE DESCRIPTION: We report a case of a comminuted talar body and a non-displaced neck fracture with dislocation of the tibiotalar, talonavicular and subtalar joints with bimalleolar epiphyseal fractures in an 11-year-old boy due to a fall from height. We present radiological findings, the surgical procedure and clinical outcomes of minimal internal K-wire fixation without using a tourniquet. LITERATURE REVIEW: Avascular necrosis rates are reported to be between 0 % and 66 % after fractures of the neck of the talus and the talar body in children. The likelihood of developing avascular necrosis increases with the severity of the fracture. CLINICAL RELEVANCE: To avoid avascular necrosis in a comminuted talar fracture accompanied by tibiotalar, talonavicular, subtalar dislocations and bimalleolar epiphyseal fractures, a minimal internal K-wire fixation without the use of a tourniquet was performed. The outcome was evaluated by the American Orthopedic Foot and Ankle Society score (AOFAS). A score of 90 (excellent) was found at the end of the second year of follow up. Radiology revealed preservation of the joint with no evidence of avascular necrosis, and clinical findings revealed a favorable functional outcome after two years. LEVEL OF EVIDENCE: 4.

Comparison of the effects of dexketoprofen trometamol, meloxicam and diclofenac sodium on fibular fracture healing, kidney and liver: an experimental rat model.

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly used in patients with bone fractures, but there are limited studies on whether one NSAID is superior to another. In this study, we used histopathological and biochemical parameters to determine whether there are differences between the effects of the administration of clinical doses of dexketoprofen trometamol (DEXT), meloxicam (MEL) and diclofenac sodium (DIC) on the healing of closed fibular fractures and the toxicity of both the liver and kidney. METHODS: Twenty-eight male Sprague-Dawley rats were randomly divided into four groups of seven each. Closed diaphyseal fractures were formed in the left fibulas of all of the rats. The NSAIDs dexketoprofen trometamol (DEXT) (Arveles(®)), meloxicam (MEL) (Melox(®)) and diclofenac sodium (DIC) (Voltaren(®)) were intramuscularly administered to Groups I, II, and III, respectively, for a period of 10 days after the fibular fractures were performed. No pharmacological agents were administered to Group IV (Control group). Blood samples were collected from all of the rats after the fractures were performed, and the rats were sacrificed on day 28. The histopathological findings were compared, and the blood samples were evaluated to determine any differences between the levels of superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA). RESULTS: Our results suggest that DEXT and MEL impair the healing of bone fractures and that DIC does not histopathologically affect the healing process of bone fractures. We also found that DEXT, MEL, and DIC impaired the renal histopathology compared with the control group. However, the liver histopathological analysis showed that DEXT and MEL caused a higher degree of parenchymal necrosis compared with DIC. CONCLUSION: Based on our results, DIC can be considered a relatively safe medication in patients with fractures.

An unusual variety of simultaneous fracture dislocation pattern: medial swivel dislocation of talonavicular joint with displaced fractures of the fourth and fifth metatarsals.

In published studies, a very rare, special type of Chopart dislocation termed a swivel dislocation has been reported. This injury is characterized by dislocation of the talonavicular joint, but the calcaneocuboid joint remains intact. The foot creates a typical rotational movement without inversion or eversion. The axis of rotation is the interosseous talocalcaneal ligament, which remains intact. We report the case of an 18-year-old male who had experienced a medial swivel dislocation of the talonavicular joint associated with displaced fractures of the fourth and fifth metatarsals. The occurrence, features, and method of treatment of this rare injury are presented.

Pin site care during circular external fixation using two different protocols.

OBJECTIVES: Treatment of tibial fractures with Ilizarov external fixation is a valuable treatment alternative; however, development of problems at the pin site is one of the major drawbacks of this technique. Moreover, there is no general agreement regarding pin site care. The purpose of this study was to compare the efficacy of two different pin site care techniques after treatment of tibial fractures with an Ilizarov external fixator. DESIGN: Prospective randomized study. SETTING: Department of Orthopaedic Surgery of education and research hospital. PATIENTS AND METHODS: In this prospective randomized study, we followed up 610 pin sites in 39 cases using two different pin site care protocols. INTERVENTION: For the first 15 days, patients in both groups cleaned each pin site using sterile gauze impregnated with 10% polyvinylpyrrolidone iodine (Polyod) every 3 days. After 15 days, patients in group 1 (20 cases, 310 pin sites) were advised to perform pin care by daily showering and brushing the pin sites with soap and an ordinary soft toothbrush, whereas patients in group 2 (19 cases, 300 pin sites) were advised to perform pin care by daily showering and cleaning the crusts using sterile gauze impregnated with 10% polyvinylpyrrolidone iodine (Polyod). Each pin site was denominated according to location. MAIN OUTCOME MEASUREMENTS: Pin sites were inspected and graded on a scale of 0 to 5 according to slight modification of the system of Dahl described by Gordon et al during outpatient visits on the 5th, 10th, 15th, 30th, 45th, 60th, 75th, 90th, 120th, and 150th days of follow up after the operation until fixator removal. Grade 1 and grade 2 infections were categorized as minor infection not requiring any extra pin site care and grade 3 and above infections as major infection. RESULTS: Minor infection rate of all pin sites was determined as 50.7% in group 1 and 43.6% in group 2. Major infection rate was determined as 3.5% in group 1 and 3.7% in group 2. No statistically significant difference was noted between the two groups (all P > 0.05). CONCLUSION: Pin site care can be performed without impairing patient comfort and without prohibition of showering. Pin site care can be self-managed by the patients without complex sterilization techniques.

Comparison of two different anesthesia techniques for tourniquet pain with the use of forearm tourniquet.

PURPOSE: The purpose of this prospective, randomized study was to compare the effectiveness of two different anesthesia techniques for tourniquet pain in minor surgeries of the hand with the use of the forearm tourniquet. METHODS: In group 1, the area under the tourniquet was anesthetized circumferentially using a cream composed of 5% lidocaine and 5% prilocaine (Emla Astra). In group 2, the area under the tourniquet was anesthetized with a ring-type infiltration of the skin and subcutaneus tissues using 50% diluted Citanest solution using 22 G x 3 1/2'' size spinal needle (Sujia) with three injections. RESULTS: There were no statistically significant differences between the means of the two groups with respect to both tests (p value = 0.18 [t-test], p = 0.951 [Mann-Whitney test]). Tourniquet related anesthesia technique discomfort was higher in group 2 (p = 0.001). CONCLUSIONS: The tourniquet placed at the distal forearm is an effective, safe, and useful technique for hand surgery. Anesthesia using Emla cream is equally effective and less disturbing than using the injection technique (subcutaneus ring anesthesia).