Vacuum-assisted closure versus moist dressings in the treatment of diabetic wound ulcers after partial foot amputation: A retrospective analysis in 65 patients.

PURPOSE: Changes in weight-bearing patterns after partial foot amputations may lead to new localized high-pressure points and keratosis due to ulcerations in patients with neuropathies and hypovascular limbs. As a result, diabetic foot ulcers (DFUs) after partial foot amputations are very complex. The aim of this study was to compare the effectiveness of vacuum-assisted closure (VAC) therapy with conventional moist wound dressings in the treatment of diabetic wound ulcers after partial foot amputations. METHODS: Sixty-five diabetic patients with a DFU, who had previously undergone partial foot amputation surgery, were assigned to treatment with VAC (group A: 31 patients) or conventional wound moist dressing (group B: 34 patients). The final results were considered as failed treatment if reamputation was required. Conversely, reaching 90% of wound granulation was considered to be a successful endpoint. RESULTS: The average time to reach 90% granulation tissue was significantly lower in group A (7.8 ± 1.2 weeks vs. 11.1 ± 1.2 weeks; p < 0.001). However, there was no significant difference regarding the reamputation requirements; 38.7% (12 patients) in group A and 41.2% (14 patients) in group B, ( p = 0.839). CONCLUSION: The results of this study allowed us to conclude that VAC therapy system appears to be an effective treatment for patients with complex DFUs who had previously undergone partial foot amputation.

The effect of N-acetylcysteine on mechanical fatigue resistance of antibiotic-loaded bone cement.

BACKGROUND: This biomechanical study evaluates the effect of N-acetylcysteine alone and in combination with the most commonly used antibiotic-loaded bone cement mixtures. METHODS: We mixed eight bone cement mixture groups including combinations of N-acetylcysteine, gentamicin, teicoplanin, and vancomycin and applied a four-point bending test individually to each sample on days 1 and 15 using an MTS Acumen test device. RESULTS: The result was less than 50 MPa-the limit declared by the ISO (International Standards Organization)-in only the "gentamicin + bone cement + N-acetylcysteine" group. Mechanical fatigue resistance of the bone cement decreased significantly with the addition of N-acetylcysteine both on day 1 and day 15 (p <  0.001). With the addition of N-acetylcysteine into the "gentamicin + bone cement" and "vancomycin + bone cement" mixtures, a significant decrease in mechanical fatigue resistance was observed both on day 1 and day 15 (p <  0.001). In contrast, with the addition of N-acetylcysteine into the "teicoplanin + bone cement" mixture, no significant difference in mechanical fatigue resistance was observed on days 1 and 15 (p = 0.093, p = 0.356). CONCLUSION: Preliminary results indicate that adding N-acetylcysteine to teicoplanin-loaded bone cement does not significantly affect the cement's mechanical resistance, potentially leading to a new avenue for preventing and treating peri-prosthetic joint infection. N-acetylcysteine may, therefore, be considered as an alternative agent to be added to antibiotic-loaded bone cement mixtures used in the prevention of peri-prosthetic joint infection.

Non Traumatic Fracture of Pedunculated Osteochondroma: Conservative Management of a Rare Case.

Fracture of a pedunculated osteochondroma is a rare complication for which surgical treatment is usually advocated. In this report, we present the functional and radiological outcomes of a case of a conservatively treated fracture of a pedunculated osteochondroma. A 26-year-old man with no history of trauma presented with acute onset of left knee pain, oedema, and limited range of motion. Radiological assessment revealed a fracture of a pedunculated osteochondroma. It was treated conservatively with an elastic bandage and non-steroidal anti-inflammatory drugs, and union was achieved by the 12-week follow-up, with no complications. Although surgical treatment is usually advocated for a pedunculated osteochondroma fracture, conservative treatment should be the first approach to avoid complications of surgical intervention.

Displaced acromion fracture: A rare injury, case report.

INTRODUCTION: Acromion fractures are extremely rare. There are no common accepted treatment schemes and fixation methods We aimed to present a case which may contribute to the diagnosis and treatment of acromion fracture in a patient with polytrauma. PRESENTATION OF CASE: Acromion fracture associated with scapula and clavicle fractures was diagnosed in 40 years old patient and treated with open reduction and cannulated screw fixation. The fracture healing was completed without causing subacromial impingement. DISCUSSION: In patients with polytrauma, diagnosis and treatment of acromion fractures can be delayed or overlooked. In improperly treated acromion fractures; pain, movement restriction, subacromial impingement, rotator cuff injury and symptomatic nonunion can occur. CONCLUSION: We recommend early surgical treatment for displaced acromion fractures, reduction of subacromial space and disruption of the superior shoulder suspensory complex.

Osteoid Osteoma at the Proximal Diaphysis of the Fifth Metatarsal.

The foot is rarely the focus of osteoid osteoma, and only a few of those cases are related to the fifth metatarsal. The present case demonstrates that atypical symptoms with suspicious findings on plain radiographs that are not associated with trauma must be analyzed carefully to determine the nature of the lesion and perform the precise treatment to obtain and sustain the cure. A 29-year-old man presented to the outpatient clinic with a 2-year history of chronic pain in the lateral aspect of his left forefoot. The onset was not related to trauma, surgery, local infection, osteomyelitis, or another entity regarding the proximal fifth metatarsal. The patient noted that the pain was aggravated at night and typically subsided with the use of salicylates or other nonsteroidal anti-inflammatory drugs. Initial plain radiographs demonstrated cortical thickening and a lytic lesion at the proximal diaphysis of the fifth metatarsal. Because the pain relief was transient, we suspected an osteoid osteoma lesion, and subsequent magnetic resonance imaging manifested pathognomonic signs of subperiosteal osteoid osteoma. Diagnosis was followed by planning of the surgery that ended the patient's symptoms.

Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Among the many factors that determine the outcome following anterior cruciate ligament (ACL) reconstruction, the position of the femoral tunnel is known to be critically important and is still the subject of extensive research. OBJECTIVE: We aimed to retrospectively compare the outcomes of arthroscopic ACL reconstruction using transtibial (TT) or anteromedial (AMP) drilling techniques for femoral tunnel placement. METHODS: ACL reconstruction was performed using the TT technique in 49 patients and the AMP technique in 56 patients. Lachman and pivot-shift tests, the Lysholm Knee Scale, International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analog scale (VAS) were used for the clinical and functional evaluation of patients. Time to return to normal life and time to jogging were assessed in addition to the radiological evaluation of femoral tunnel placement. RESULTS: In terms of the Lysholm, IKDC, Tegner score, and stability tests, no significant differences were found between the two groups (p > 0.05). Statistical analysis revealed reduced time to return to normal life and jogging in the AMP group (p < 0.05). The VAS score was also significantly reduced in the AMP group (p < 0.05). The position of the femoral tunnel was anatomically appropriate in 51 patients in the AMP group and 5 patients in the TT group. CONCLUSION: The AMP technique is superior to the TT technique in creating anatomical femoral tunnel placement during single-bundle ACL reconstruction and provides faster recovery in terms of return to normal life and jogging at short-term follow-up.