Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken.

PURPOSE: Pentoxifylline (PTX) is a derivative of methylxanthine and is used in peripheral vascular and cerebrovascular diseases for its effect on the regulation of blood circulation. We investigated whether PTX could be beneficial for femoral head osteonecrosis associated with steroid through these effects. METHODS: Sixty mature Leghorn type chickens were chosen and divided into three groups. The 25 chickens in group A were given a weekly dose of 3 mg/kg/week methylprednisolone acetate intramuscularly. Four chickens in group B died after the first drug injection and were excluded from the study. Therefore, the remaining 21 chickens in group B were additionally given 25 mg/kg/day pentoxifylline intramuscularly, along with the steroid medication as given in group A. The ten chickens in group C were not given any injections, as they were accepted as the control group. After the sacrifice of the animals at week 14, both femoral heads were taken from each animal. The animals which died along the course of the study also underwent pathological examination but were not a part of the statistical analysis. RESULTS: In this study, steroid induced femoral head osteonecrosis has been experimentally observed in chickens after high doses of corticosteroid therapy. The chickens were given pentoxifylline in order to prevent the effects of steroid on bones and bone marrow. The results showed that chickens are suitable osteonecrosis models, and that steroid causes adipogenesis and necrosis in the bone marrow and the death of the subchondral bone. CONCLUSIONS: The results of this study hint at the assumption that PTX may have a positive benefit on ONFH. PTX seems to minimise the effects of the steroid and reduce the incidence of ONFH.

A complex variant of Lisfranc joint complex injury.

We report an unusual case of a variant of Lisfranc injury, plantar dislocation of the medial cuneiform with plantar fracture-dislocation of the intermediate cuneiform and dorsal fracture-dislocation of the lateral cuneiform, which has never been reported, to our knowledge. The entire pathologic abnormality was treated by open reduction and fixation with Kirschner wires, which were removed 8 weeks postoperatively because of pin-tract infection. Complex regional pain syndrome, which was a problem early in the recovery process, is now in remission, and at the 25-month follow-up examination, the patient was almost symptom free.

Minimally invasive treatment of pathological fractures of the humeral shaft.

Most patients with pathological fractures due to cancer metastasis have a limited life expectancy. Orthopaedic procedures, therefore, should be minimally invasive in order to avoid additional surgical morbidity. The purpose of this study was to analyse the results of minimally invasive approaches, including locked intramedullary nailing, followed by early postoperative radiation for pathological humeral shaft fractures. Twenty-four pathological fractures of the humerus diaphysis in 23 patients were treated with the prospective protocol, including antegrade unreamed intramedullary nailing and postoperative radiotherapy (20 Gy and five fractions). The patients and results of the surgery were evaluated by the Musculoskeletal Tumor Society upper extremity scoring system. All patients had a stable extremity, and the average function of 20 patients was 64% of the normal upper extremity function. Only one patient required revision surgery. The minimally invasive treatment of patients with pathological fractures of the humeral shaft with closed unreamed intramedullary nailing combined with adjuvant radiotherapy is an effective and safe procedure, even in seriously ill patients.

[Image-guided minimal invasive surgical resection of osteoid osteomas of the long bones]. / Uzun kemik yerlesimli osteoid osteomada görüntüleme yardimli minimal invaziv cerrahi.

OBJECTIVES: In this prospective study, we evaluated the efficiency of image-guided minimal invasive surgical resection of osteoid osteomas of the long bones. METHODS: Fourteen patients (11 males, 3 females; mean age 13 years; range 4 to 22 years) with osteoid osteoma of the long bones underwent image-guided minimal invasive intralesional extended curettage. Preoperatively, all the patients were evaluated by plain radiographs, computed tomography (CT), bone scintigraphy, and magnetic resonance imaging (MRI). Localization of the nidus was determined by measurements on thin-section (1-1.5 mm) CT scans and MR images and complete excision of the nidus was performed by image-guided minimal invasive technique. All the patients were evaluated by visual analog scale or faces pain scale to determine pain levels before and after surgery. The mean follow-up period was 17 months (range 13 to 31 months). RESULTS: The mean visual analog scale scores were 7.9+/-1.2 (severe pain) and 0.3+/-0.6 (no pain) before and after surgery, respectively (p<0.05). Bone grafting or internal fixation were not required during operations. No perioperative or postoperative complications or recurrences were encountered. Early mobilization was possible in all the patients. At the final follow-ups, all the patients were asymptomatic and had full functional use of their operated extremities. CONCLUSION: Image-guided minimal invasive surgery is effective in the local control of osteoid osteomas affecting the long bones and causes less morbidity. This technique also provides a good identification of the nidus intraoperatively.

[Can procalcitonin be used for the diagnosis and follow-up of postoperative complications after fracture surgery?]. / Kirik cerrahisi sonrasinda gelisen komplikasyonlarin tani ve takibi için prokalsitonin kullanilabilir mi?

OBJECTIVES: We investigated the effect of fracture surgery on serum procalcitonin levels and the value of procalcitonin in differentiating inflammatory reaction caused by fracture surgery from postoperative infective complications. METHODS: Twenty-one patients (8 women, 13 men; mean age 72.5 years; range 50 to 105 years) who underwent surgery for pertrochanteric hip fractures were evaluated according to the procedures employed, namely osteosynthesis, and hemiarthroplasty. Procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), and body temperature were measured before surgery and for five days postoperatively. RESULTS: No postoperative wound infections occurred. Seven patients developed complications. The mean preoperative CRP level was five times above the normal. It made a peak on the second day and then began to decrease, but still was four times higher than the preoperative level on the fifth day. Preoperatively, the mean PCT level was lower than the normal in all the patients. It made a peak on the first postoperative day without exceeding the normal range and returned to the preoperative level on the fifth day. In contrast to CRP levels which were above the normal in all the patients, PCT levels were higher than the normal only in patients who developed complications. Taking the cut-off value as = or >0.5 ng/ml, the sensitivity and specificity of PCT to determine systemic complications were 100% and 100% on the first day, and 100% and 50% on the second day, respectively. CONCLUSION: Procalcitonin may prove to be a useful parameter to identify early postoperative systemic complications after fracture surgery.

Superior dislocation of the patella with early onset patellofemoral arthritis: a case report and literature review.

Among the traumatic patellar dislocations, superior dislocation of patella without patellar ligament injury is very rare. We present in this article, a case of superior dislocation of the patella trapped by interlocked osteophytes in a 38-year-old female who had concurrent bilateral knee arthrosis. Successful reduction was achieved by closed manipulation without anesthesia. Neither redislocation nor symptoms of instability was seen after 36 months of follow-up, although some progression of arthritis was observed. A new classification including all traumatic patellar dislocation was also proposed.

[Treatment of medial epicondyle fractures accompanying elbow dislocations in children]. / Cocuklarda dirsek çikigina eslik eden medial epikondil kiriklarinin tedavisi.

OBJECTIVES: We evaluated the clinical and radiographic results of treatment for medial epicondyle fractures accompanying elbow dislocations in children. METHODS: The study included 10 children (9 boys, 1 girl; mean age 12 years; range 1.5 to 15 years) with medial epicondyle fractures accompanying elbow dislocations. Three patients had posteromedial and seven patients had posterolateral dislocations. Three patients were treated conservatively, while four patients and three patients underwent early and late surgical treatment before or after the seventh day of injury, respectively. Surgery was indicated due to entrapment of the medial epicondyle fragments in three patients, and to instability in four patients with more than 5 mm of displacement. At surgery, a posteromedial incision was used and ulnar nerve exploration was performed. The results were evaluated using the Mayo elbow performance score. The mean follow-up period was 28 months (range 3 to 103 months). RESULTS: Union of the medial epicondyle fractures was achieved between four to six weeks in all the patients. The mean Mayo elbow performance score was 93.5. Late surgery was associated with a score of 80 in two patients and 75 in one patient, the remaining patients had an excellent result (100 points). Full range of elbow motion was achieved in all the patients treated conservatively and with early surgery; however, following late surgery, two patients had extension and flexion losses of 5 degrees and 10 degrees , respectively. None of the patients had instability postoperatively. CONCLUSION: Patients with entrapment of the medial epicondylar fragment in the joint and with a displacement of more than 5 mm should undergo surgery, while those with a displacement of 5 mm or less can be treated conservatively.