Publications by authors named "Yunus Imren"

32 Publications

Does Sectioning and Then Repairing of the Calcaneofibular Ligament at Subtalar Approach Lead to Residual Lateral Ankle Instability?

Arch Bone Jt Surg 2022 Apr;10(4):347-352

Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey.

Background: The calcaneofibular ligament is cut to increase vision in surgical field in minimally invasive surgery of displaced intraarticular calcaneus fractures with subtalar incision. We aimed to investigate whether this causes talar tilt instability in ankle stress radiographs due to the calcaneofibular ligament deficiency in postoperative period.

Methods: The files of 38 patients who were operated with the diagnosis of displaced calcaneus fracture between 2013 and 2018 were examined retrospectively. All the cases underwent with subtalar approach and the calcaneofibular ligament was repaired after the operation. The age, sex, injury mechanism, follow-up length, type of fracture by the Sanders classification, preoperative and postoperative Bohler's and Gissane's angle measurements, talar tilt measurements of intact and fractured side, postoperative calcaneal length, calcaneal height and calcaneal width of the cases were recorded. The obtained data were evaluated statistically.

Results: 31 (81.6%) of the cases were men, seven (18.4%) were women. The average age was 31.92±7.95 years. The average follow-up time was 15.82±3.33 months. The preoperative Bohler's angle was 14.16±3.67 degree, while the postoperative Bohler's angle was 31.53±4.60 degree (). The average talar tilt was 0.96±0.87 degrees on the intact side and 1.19±1.12 degrees on the fractured side (). Although the talar tilt values were statistically higher on the fractured side than the intact side, no radiological instability finding was found in any case. The average postoperative Gissane's angles were 126.45±6.69 degrees. The calcaneal length (), calcaneal width () and calcaneal height () were statistically similar between the postoperative fractured foot and intact foot.

Conclusion: Sectioning of the calcaneofibular ligament in the surgical treatment with subtalar approach does not cause lateral ankle instability in stress radiographs but may cause laxity. Possible postoperative lateral ankle injuries can be prevented by ankle proprioception exercises.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22038/ABJS.2021.54080.2702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169731PMC
April 2022

Effect of psoas and gluteus medius muscles attenuation on hip fracture type.

Hip Int 2022 Jun 5:11207000221101169. Epub 2022 Jun 5.

Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.

Introduction: Sarcopenia is defined as a progressive loss of muscle mass and function with increased age. The measurement of muscle mass and attenuation on the axial computed tomography (CT) scan has been reported to be a good indicator for sarcopenia in previous literature. This study aimed to compare muscle mass between the intertrochanteric fracture and femoral neck fracture groups by accurately measuring muscle mass around the hip joint using a CT scan.

Methods: The cases were matched according to age and gender on a 1-to-1 basis. As a result, a total of 400 patients, 200 patients in each group with the same age and gender characteristics, were included in the study. At the disc of L4-L5 level, the cross-sectional area (CSA) of the psoas muscle was evaluated, and at the disc of L5-S1 level, the CSA of the psoas, iliacus and gluteus medius muscles were evaluated. In addition, attenuation was evaluated using the average Hounsfield Unit (HU) for the specific area.

Results: The mean age of 400 patients (262 females, 138 male) included in the study was 78.49 ± 7.67 years. It was observed that the mean HU values of the patients in the femoral neck fracture group were significantly higher than the intertrochanteric fracture group ( < 0.001,  = 0.008; respectively). At the same time, the mean HU values of the gluteus medius muscle were higher in the femoral neck fracture group ( < 0.001), but in contrast with the psoas muscle, the CSA values of gluteus medius muscle were significantly higher in the intertrochanteric fracture group ( = 0.017).

Conclusions: Fatty degeneration of the psoas muscle among the muscles around the hip may affect the type of hip fracture. Elderly patients with strong psoas muscles may experience femoral neck fracture due to contraction and torsion during falling.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/11207000221101169DOI Listing
June 2022

Kinesiotaping therapy for midshaft clavicular fractures: a randomised trial study.

Acta Orthop Belg 2022 Mar;88(1):143-150

Midshaft clavicle fractures with shortening by less than 2 cm or minimal displacement without neurovascular injury can be treated conservatively. We hypothesized that kinesiotaping reduces the disadvantages of conservative treatment, such as early-phase pain, high nonunion rates, and a prolonged time to return to work, and yields better clinical and functional outcomes. Forty patients were randomly divided into the arm slings only (group S) or arm sling with kinesiotaping therapy group (group K). The outcome measures included the visual analog scale (VAS) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, union time, magnitude of shortening, and time to return to work. The mean follow-up period of the study was 8.5 (6- 10) months. The ASES and Constant scores were significantly better in group K than in group S in the 3rd month. The mean union time was 8.60 (8-12) weeks in group S and 8.25 (6-12) weeks in group K. The mean time to return to work was 7.23 (4-12) weeks in group S and 5.37 (2-10) weeks in group K, and the difference was statistically significant (p <0.05). There was no significant difference in terms of shortening between the two groups. Compared with an arm sling only, an arm sling with kinesiotaping can yield better clinical functional results, higher union rates, and a shorter the time to return to work due to the early control of pain and edema.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.52628/88.1.18DOI Listing
March 2022

Kinesiotaping therapy for midshaft clavicular fractures: a randomised trial study.

Acta Orthop Belg 2022 Mar;88(1):143-150

Midshaft clavicle fractures with shortening by less than 2 cm or minimal displacement without neurovascular injury can be treated conservatively. We hypothesized that kinesiotaping reduces the disadvantages of conservative treatment, such as early-phase pain, high nonunion rates, and a prolonged time to return to work, and yields better clinical and functional outcomes. Forty patients were randomly divided into the arm slings only (group S) or arm sling with kinesiotaping therapy group (group K). The outcome measures included the visual analog scale (VAS) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, union time, magnitude of shortening, and time to return to work. The mean follow-up period of the study was 8.5 (6- 10) months. The ASES and Constant scores were significantly better in group K than in group S in the 3rd month. The mean union time was 8.60 (8-12) weeks in group S and 8.25 (6-12) weeks in group K. The mean time to return to work was 7.23 (4-12) weeks in group S and 5.37 (2-10) weeks in group K, and the difference was statistically significant (p <0.05). There was no significant difference in terms of shortening between the two groups. Compared with an arm sling only, an arm sling with kinesiotaping can yield better clinical functional results, higher union rates, and a shorter the time to return to work due to the early control of pain and edema.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.52628/88.1.18DOI Listing
March 2022

Does forearm position matter in subpectoral biceps tenodesis? A randomised controlled trial.

Arch Orthop Trauma Surg 2022 Jan 21. Epub 2022 Jan 21.

University of Health Sciences, Cemil Tascioglu City Hospital, Department of Physical Therapy and Rehabilitation, Darulaceze Street No. 25 Sisl, Istanbul, Turkey.

Introduction: The optimal position of the elbow and forearm during biceps tenodesis is a debated topic. The aim of our study was to compare two different forearm positions, pronation-extension (PE) or neutral, for fixation of the long head of the biceps tendon (LHB) in biceps tenodesis.

Materials And Methods: Fifty patients who underwent shoulder arthroscopy between February 2016 and January 2019 were included in our study. After diagnostic arthroscopy, the LHB was cut from its origin with a thermal ablator. The LHB was then tenodesed beneath the inferior border of the pectoralis major tendon for 25 patients in the PE position and for 25 patients in the neutral position. Patients were evaluated preoperatively and 3rd, 6th and 12th months postoperatively according to the visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) shoulder and Constant scores. Flexion and supination force measurements were made with a digital dynamometer device, compared to the healthy side for both groups.

Results: ASES and VAS scores were statistically better in the PE group compared with the neutral group (p < 0.05), but there was no statistically significant difference between Constant scores at 3 and 6 months (p > 0.05). No significant difference was found in both groups for 3 scores at 12 months. Comparison of the PE group with the contralateral extremity and comparing the neutral group with the contralateral extremity in terms of flexion strength showed no statistically significant difference. No statistically significant difference was found between the supination powers of both comparative groups.

Conclusion: Functional scoring in the PE position is better at 3 and 6 months because patients experience less pain at 3 and 6 months. The simple change of the fixation position causes patients to feel less pain in the early period.

Level Of Evidence: 1.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-021-04295-zDOI Listing
January 2022

The Effect of Syndesmotic Screw Level on Postoperative Syndesmosis Malreduction.

J Foot Ankle Surg 2022 May-Jun;61(3):482-485. Epub 2021 Sep 22.

Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.

Tibiofibular injury repair of ankle fractures may result in over-compression when performed via a partially threaded screw depending on its placed level. We aimed to examine the relationship between the screw level relative to the tibiotalar joint and syndesmosis malreduction in postoperative radiographs of ankle fractures treated with partially threaded screws. We retrospectively analyzed 129 patients who underwent surgery due to lateral malleolar fractures between 2011 and 2019. We measured the distance between the screw and the tibiotalar joint and stratified the patients per their screw level as either trans-syndesmotic or suprasyndesmotic. According to Lauge-Hansen, 83 cases were supination-external rotation type (64.3%), and the remaining were pronation-external rotation type (35.7%) injuries. We found postoperative syndesmosis malreduction in 20 cases (15.5%). Eight (6.2%) cases had medial clear space mismatch. As the distance of the screw to the joint increased, postoperative medial clear space values increased (rho: 0.190, p = .031). The relationship between postoperative syndesmosis mismatch and the level of the syndesmotic screw was statistically significant (p = .044). In syndesmosis repair with a partially threaded screw, as the distance of the screw from the joint increases, the over-compression caused by the screw may cause an increase in postoperative syndesmotic malreduction rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.jfas.2021.09.022DOI Listing
May 2022

Retrospective analysis of 35 pediatric femoral neck fractures.

Eur J Orthop Surg Traumatol 2021 Sep 20. Epub 2021 Sep 20.

Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.

Objective: Pediatric proximal femur fracture is extremely rare trauma comparing to other fractures. The proximal femur fracture is 1% of all pediatric fractures. The aim of current study is to compare the incidence of early complications and outcomes of pediatric proximal femur fractures regarding fracture types retrospectively.

Design: Our study includes 35 cases which are criticized by Delbet classification system, modalities of treatment, duration of waiting for surgery, duration of follow-up and also complications. Our inclusion criteria are age below 16 years old, proximal femur fractures with no evidence of tumoral, romathologic and methabolic conditions. Age, sex and surgery type (open-closed) were noted, and the data were statistically assessed. Assessment of the final outcome was made at the last follow-up visit using the Ratliff's method.

Results: The mean of age of patients in our study is 9.5 ± 5.06 years. The average follow-up was 25.6 ± 13.2 months. 15 patients (42.9%) are type 2 Delbet fracture, 5 patients (14.2%) are Delbet type 3 and 15 patients (42.9%) are Delbet type 4 fracture. Using the Ratliff's method, 25 patients (71.4%) had satisfactory outcomes. Ten patients (28.6%) had unsatisfactory outcomes. The complications as AVN, coxa vara and premature closure of physis, non-union and postoperative infections have been detected in this study. AVN was seen in four (11.4%) patients. In addition, coxa vara was seen in six (17.2%) patients.

Conclusion: Pediatric femoral neck fractures are extremely rare fractures and can be treated with low complication rates in cases with early treatment and anatomic reduction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00590-021-03126-6DOI Listing
September 2021

The effect of gluteus maximus tenotomy in primary total hip arthroplasty with posterior approach: Kinematic analysis of hip extensor strength.

J Orthop Surg (Hong Kong) 2021 Jan-Apr;29(1):23094990211003349

Department of Orthopedics and Traumatology, HSU Prof. Cemil Tascioglu City Hospital, Istanbul, Turkey.

Background: The posterior approach (PA) is the most commonly used surgical approach for total hip arthroplasty (THA), but the proximity of the sciatic nerve may increase the likelihood of sciatic nerve injury (SNI). Gluteus maximus tenotomy can be performed to prevent SNI because tenotomy increases the distance between the femoral neck and sciatic nerve and prevents compression of the sciatic nerve by the gluteus maximus tendon (GMT) during hip movements. We aimed to kinematically compare the postoperative hip extensor forces of patients who have and have not undergone gluteus maximus tenotomy to determine whether there is a difference in hip extensor strength.

Methods: Seventy-two patients who underwent gluteus maximus tenotomy during THA were included in the group 1, and 86 patients who did not undergo tenotomy were included in group 2. The Harris hip score, body mass index and hip extensor forces were measured both preoperatively, and 6 months after surgery with an isokinetic dynamometer and compared.

Results: The mean age was 64.6 ± 2.3 years in group 1 and 63.8 ± 2.1 in group 2. Mean body mass index was 25.7 ± 1.1 in group 1, and 25.5 ± 1.3 in group 2. Baseline Harris hip score (HHS) was 42.36 ± 12 in group 1 and 44.07 ± 9.4 in group 2 (p = 0.31), whereas it was 89.1 ± 7.8 and 88.4 ± 8.1 at 6 months after surgery, respectively. Baseline hip extensor force (HEF) was 2 ± 0.4 Nm/kg in group 1, and 2.1 ± 0.7 Nm/kg in group 2 (p = 0.28), while it was 2.4 ± 0.6 Nm/kg, and 2.5 ± 0.5 Nm/kg, respectively at 6 month follow-up (p = 0.87). Both groups had significantly improved HHS and HEF when comparing baseline and postoperative measurements (p < 0.0001). No cases of sciatic nerve palsy were noted in group 1, whereas there were two (2.32%) cases in group 2, postoperatively.

Conclusion: The release of the GMT during primary hip arthroplasty performed with the PA did not lead to significant decrease in hip extension forces. Hip extensor strength improves after THA regardless of tenotomy. Gluteus maximus tenotomy with repair does not reduce muscle strength and may offer better visualization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/23094990211003349DOI Listing
July 2021

Mini-plate fixation via sinus tarsi approach is superior to cannulated screw in intra-articular calcaneal fractures: A prospective randomized study.

J Orthop Surg (Hong Kong) 2018 May-Aug;26(3):2309499018792742

1 Department of Orthopaedics and Traumatology, Okmeydani Training and Research Hospital, Istanbul, Turkey.

Objective: Intra-articular displaced calcaneal fractures are common fractures and are often treated with surgical interventions. Sinüs tarsi approach provides secure access to lateral wall and joint facets. The aim of the study is to compare cannulated screw (CS) fixation and mini-plate (MP) fixation via sinus tarsi approach with Sanders types 2 and 3 fracture of calcaneus.

Methods: Sixty patients with Sanders types 2 and 3 calcaneal fracture underwent surgical intervention were randomly allocated into two groups as group MP fixation and group CS fixation regarding osteosynthesis method for 5-year period. Open reduction via sinüs tarsi approach was performed in both groups. Demographic variables, time to surgery (TS), operation duration (OD), length of hospital stay (LOS), surgical complications, and reoperations were recorded. Pre- and postoperative Gissane and Böhler angles; calcaneal length, height, and width; ankle anterior-posterior (AP) and lateral X-rays; and computed tomography were also recorded for radiological evaluation and fracture characteristics. Maryland Foot Score (MFS) was used to evaluate functional outcomes.

Results: Preoperative age, type of fracture, calcaneal length, height, and Gissane and Böhler angles, TS, LOS, and OD were not different between the groups. The postoperative calcaneal widening was significantly better restored in group MP compared with that of group CS. The incidence of reoperation and algoneurodystrophy was statistically higher in group CS than group MP. MFS in group MP was also higher than group CS at final visit.

Conclusion: MP fixation via sinus tarsi approach is superior to CS fixation in Sanders types 2 and 3 calcaneal fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2309499018792742DOI Listing
October 2019

Compatibility of Lauge-Hansen Classification Between Plain Radiographs and Magnetic Resonance Imaging in Ankle Fractures.

J Foot Ankle Surg 2018 Jul - Aug;57(4):712-715. Epub 2018 Apr 19.

Professor, Department of Orthopedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey.

We evaluated the accuracy of the predictive injury sequences of the Lauge-Hansen (L-H) classification using magnetic resonance imaging (MRI) in patients with ankle fractures and determined the possible causes of mismatch. Sixty-five patients with ankle fractures who had a complete series of anteroposterior, lateral, and oblique radiographs and ankle MRI studies available were included. The fracture pattern was assigned by 2 senior orthopedic surgeons according to the L-H classification system. The syndesmotic ligaments, lateral collateral ligaments, and medial deltoid complex ligaments were evaluated on the preoperative MRI scans. Comparisons were performed between the predicted ankle ligamentous injury based on the radiographic L-H classification and preoperative MRI analysis. Of the 65 feet in 65 patients, 50 feet (76.9%) were classified as having a supination-external rotation (SER) fracture, 6 feet (9.2%) as having a pronation-external rotation fracture, 4 feet (6.2%) as having a supination adduction fracture, and 2 feet (3.1%) as having a pronation abduction fracture. The overall compatibility of the radiologic classification with the MRI classification was 66.1%. In the evaluation of 50 feet with the MRI SER designation, maximum compatibility was found for stage 4 (77.3%). The main cause for the discrepancy in the SER designation was missing the presence of deltoid ligament disruption on the plain radiographs, especially in the stage 2 and 3 SER fracture pattern. In the evaluation of deltoid complex injuries, all injuries were localized to the anterior part of the medial deltoid complex. The validity of the L-H classification system was low. A new classification system is needed to address the medial malleolus fracture or deltoid complex injuries without posterior injury. Also, stress radiographs could be added to standard radiographs for the classification to address deltoid complex injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.jfas.2017.12.009DOI Listing
December 2018

Arthroscopy-assisted versus standard intramedullary nail fixation in diaphyseal fractures of the humerus.

J Orthop Surg (Hong Kong) 2017 Sep-Dec;25(3):2309499017727949

Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey.

Purpose: The aim of this study was to assess applicability of arthroscopic technique in intramedullary nail fixation of humerus shaft fractures and to compare with conventional nailing in terms of its effects on perioperative and postoperative intra-articular complication rates as well as on clinical and functional outcomes.

Methods: This prospective randomized controlled clinical trial included 40 patients (12 females and 28 males) indicated for surgery between either undergo arthroscopy-assisted (Arthroscopy-assisted intramedullary nailing [AIMN]; n = 20) or conventional (Intramedullary nailing [IMN]; n = 20) anterograde intramedullary nailing. Two groups were compared in terms of mean number of fluoroscopic shootings until the guide wire was inserted, time for union, length of hospital stay, and complication rates. Shoulder functions were assessed by Constant and American Shoulder and Elbow Surgeons (ASES) score.

Results: Groups did not significantly differ in terms of age, gender, and mechanism of injury, length of hospital stay, union rate, and mean union time ( p > 0.05). Mean ASES and Constant scores were found to be statistically significantly higher in AIMN group than that in IMN group ( p = 0.000 and p = 0.002, respectively). Mean number of fluoroscopic shootings until the guide wire was inserted was 2.15 in AIMN group, which was significantly lower compared to 4.2 of IMN group ( p = 0.000).

Conclusions: Arthroscopy-assisted technique may be an applicable and safe method owing to its cosmetic advantages and more satisfactory postoperative shoulder functions subsequent to less injury to deltoid, rotator cuff, and other soft tissue, as compared to conventional anterograde approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2309499017727949DOI Listing
April 2018

High Varus Angle and Lower Posterior Tibial Slope Associated with PCL Injury in Cruciate Retaining Total Knee Arthroplasty: An MRI Study.

J Knee Surg 2018 Mar 23;31(3):277-283. Epub 2017 May 23.

Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey.

The posterior tibial slope (PTS) is important for performing a tibial cut that does not injure the posterior cruciate ligament (PCL). In this study, the amount of PCL fibers sacrificed under simulated tibial cuts with varying posterior inclinations was evaluated using magnetic resonance images (MRIs) of osteoarthritic varus knees. Knee X-rays, orthoroentgenograms, and MRIs of 113 Kellgren and Lawrence grades 3 to 4 osteoarthritic knees were included. Four different simulated tibial cuts were performed at 0, 3, 5 degrees and parallel to the tibia plateau 3 mm below of the most defective part of the cartilage in the medial plateau. Correlations between the PCL avulsion amount and the PTS and varus alignment of the lower extremity were analyzed for all four simulated tibial cut levels. The maximum amount of PCL was preserved with a 0-degree tibial cut in patients with a PTS of more than 8 degrees. With increased tibial cut angles, the posterior slope resulted in an increased amount of avulsed PCL. Although the amount of avulsed PCL was proportional with the varus alignment, it was inversely proportional with the sagittal slope. The number of injured PCLs also increased as the slope of the tibial cuts increased. Patients with mild varus alignments and high PTSs are more suitable for cruciate retaining total knee arthroplasty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1603334DOI Listing
March 2018

Mid-Term Results of Minimally Invasive Plate Osteosynthesis and Circular External Fixation in the Treatment of Complex Distal Tibia Fractures.

J Am Podiatr Med Assoc 2017 Jan;107(1):3-10

Background: The treatment of pilon tibia fractures is challenging. Anatomical reduction of the joint surface is essential. Excessive soft-tissue dissection may interfere with the blood supply and can result in nonunion. We sought to compare the outcomes of distal tibia fractures treated with medial locking plates versus circular external fixators.

Methods: We retrospectively evaluated 41 consecutive patients with closed pilon tibia fractures treated with either minimally invasive locking plate osteosynthesis (n = 21) or external fixation (EF) (n = 20). According to the Ruedi and Allgower classification, 23 fractures were type B and 18 were type C. Soft-tissue injury was evaluated according to the Oestern and Tscherne classification. Time to fracture union, complications, and functional outcomes were assessed annually for 3 years with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score.

Results: Mean ± SD values in the plate group were as follows: age, 42.4 ± 14 years; union time, 19.4 ± 2.89 weeks (range, 12-26 weeks); and AOFAS ankle scores, 86.4 ± 2.06, 79.5 ± 1.03, and 77.9 ± 0.80 at 1, 2, and 3 years, respectively. Four patients in the plate group needed secondary bone grafting during follow-up. In the EF group (mean ± SD age, 40.7 ± 12.3 years), all of the patients achieved union without secondary bone grafting at a mean ± SD of 22.1 ± 1.7 weeks (range, 18-24 weeks). In the EF group, mean ± SD AOFAS ankle scores were 86.6 ± 1.69, 82.1 ± 0.77, and 79.7 ± 1.06 at 1, 2, and 3 years, respectively. There were no major complications. However, there were soft-tissue infections over the medial malleolus in five patients in the plate group and grade 1-2 pin-tract infections in 13 patients and grade 3 pin-tract infections in one patient in the EF group. Post-traumatic arthritis was detected in eight plate group patients and seven EF group patients.

Conclusions: Minimally invasive plating and circular EF methods have favorable union rates with fewer complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7547/14-120DOI Listing
January 2017

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures.

J Orthop Surg (Hong Kong) 2017 01;25(1):2309499016684722

2 Department of Orthopaedics and Traumatology, Giresun University Hospital, İstanbul, Turkey.

Aim: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle.

Material And Methods: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1.

Results: Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays.

Conclusion: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2309499016684722DOI Listing
January 2017

Infrapatellar Fat Pad Excision during Total Knee Arthroplasty Did Not Alter the Patellar Tendon Length: A 5-Year Follow-Up Study.

J Knee Surg 2017 Jun 29;30(5):479-483. Epub 2016 Sep 29.

Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey.

Partial or total resection of the infrapatellar fat pad (IPFP) helps surgeon improve access to lateral tibial plateau for better placement of the knee prosthesis. We aimed to investigate the effect of IPFP excision on clinical and radiologic outcomes including patellar tendon length (PTL), range of motion, and functional scores after total knee arthroplasty (TKA) at 5-year follow-up. We retrospectively evaluated postoperative first X-rays (day 0) and postoperative final 5-year control views of 228 knees in patients with primary osteoarthritis who underwent TKA between September 2006 and December 2009 in our hospital. Exclusion criteria were patients who had lateral release, patellar resurfacing, septic or aseptic loosening, fracture around the replaced knee, any other prior knee surgery, or any systemic inflammatory disease. IPFP was completely resected in all knees to enhance surgical exposure and patellar mobilization. Radiologic evaluation of PTL was performed in early postoperative and 5-year control X-rays comparatively. The mean early postoperative PTL was 47.4 ± 6 (range: 35-72), the mean final postoperative PTL was 47 ± 6.3 (range: 33-68) ( = 0.1). The average preoperative flexion was 115 ± 11 degrees, whereas it was 111 ± 4 degrees, postoperatively ( = 0.73). Both the clinical and functional outcome scores improved in all patients. IPFP excision during TKA did not alter PTL at 5-year follow-up. A focus on other surgical and/or host-related factors may help clarify contradictory patellar tendon shortening reported in the literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0036-1593360DOI Listing
June 2017

Inferior hip dislocation after falling from height: A case report.

Int J Surg Case Rep 2016 31;22:62-5. Epub 2016 Mar 31.

Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey. Electronic address:

Introduction: Traumatic inferior hip dislocation is the least common of all hip dislocations. Adult inferior hip dislocations usually occur after high-energy trauma, very few cases are reported without fracture.

Presentation Of Case: A 26-year-old female was brought to the emergency department with severe pain in the left hip, impaired posture and restricted movement following a fall from 15m height. The hip joint was fixed in 90° flexion, 15° abduction, and 20° external rotation. No neurovascular impairment was determined. On radiologic examination, a left ischial type inferior hip dislocation was detected. Hemorrhagic shock which developed due to acute blood loss to thoracic and abdominal cavity and patient died at third hour after she was brought to the hospital.

Discussion: Traumatic hip dislocations have high morbidity and mortality rates due to multiple organ damage, primarily of the extremities, chest and abdomen. In the treatment of traumatic hip dislocation, closed reduction is recommended through muscle relaxation under general anesthesia or sedation. This procedure should be applied before any intervention for concomitant extremity injuries. A detailed evaluation on emergency presentation, a multi-disciplinary approach and early diagnosis with the rapid application of imaging methods could be life-saving for such patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijscr.2016.02.041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832043PMC
April 2016

Effect of both preoperative andpostoperative cryoceutical treatment on hemostasis and postoperative pain following total knee arthroplasty.

Int J Clin Exp Med 2015 15;8(10):19150-5. Epub 2015 Oct 15.

Department of Orthopaedics and Traumatology, Cerrahpaşa Medical Faculty, İstanbul University İstanbul, Turkey.

Aim: We aimed to evaluate the hemostatic effects and the clinical outcomes of preoperative and postoperative cryoceutical treatment (C-tx) following total knee arthroplasty.

Patients And Method: 42 patients received C-tx both preoperatively, and postoperatively. In the control group, 45 patients did not receive any C-tx. Amount of bloody drainage and verbal rating pain scores were noted.

Results: We found significant difference in both the preoperative and postoperative hemoglobin levels and blood drainage (P<0.001). However, there was no significant difference in the average verbally rated pain scores (P>0.05).

Conclusion: C-tx performed preoperatively and postoperatively for total knee arthroplasty is effective in decreasing perioperative and postoperative hemorrhage. However, it had no superior effect on the control of postoperative pain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694447PMC
January 2016

Clinical results of cementless total hip arthroplasty with shortening osteotomy for high dislocation with developmental dysplasia.

Acta Orthop Belg 2015 Mar;81(1):30-5

Total hip arthroplasty for severe developmental dysplasia of the hip is a technically challenging procedure. Subtrochanteric femoral osteotomy enables reducing the femoral head and restoring abductor muscle strength without compromising proximal femoral bone stock in advanced dysplasia.We aimed to retrospectively evaluate Crowe type III or IV developmental dysplasia of the hip who underwent reconstruction with cementless total hip arthroplasty combined with a transverse subtrochanteric femoral osteotomy. Sixty hips of 52 patients (11 male, 49 female) with Crowe type III (n: 37) or IV (n: 23) developmental dysplasia of the hip were included. The average age was 51.4 years. Surgery was performed in lateral decubitis position with posterolateral approach. Subtrochanteric transverse femoral osteotomy were used with cementless components. 40 of the femoral components were Secur-Fit type, and 20 of them were secur-fit plus max type. Ceramic-ceramic coupling was used in 24 cases and metal-polyethylene coupling was used in 36 cases. Merle D'Aubigne and Harris Hip score were used to rate the clinical outcome at the final follow up. All femoral shortening osteotomies were united at a mean of 5.7 months. Mean Merle D'Aubigne pain score was increased from 3.1 to 5.4, and mean Harris Hip score improved from 39 to 92.8, postoperatively (p<0.01). There was no significant difference in time to union between different types of stems. 4 femoral stems had asymptomatic radiolucent lines. There was no significant difference in time to union between different types of stems.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2015

Effects of hyaluronic acid (Hyalonect) on callus formation in rabbits.

Acta Orthop Traumatol Turc 2015 ;49(3):319-25

İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pathology, İstanbul, Turkey.

Objective: Bone fragment and graft stabilization are important during reconstructive surgery of cases with comminuted fractures and bone defects. We examined the effect of Hyalonect surgical mesh on the healing dynamics of metaphyseal bone defects created in rabbit tibiae.

Methods: Approximately 5-mm defects were created on the anterior aspect of the proximal tibial metaphysis of 80 male rabbits. The rabbits were randomly assigned to four groups: Group I, bone defects left alone (control group); Group II, bone defect covered with Hyalonect; Group III, bone defect filled with allograft; and Group IV, bone defect filled with allograft and covered with Hyalonect.

Results: No significant histological differences were noted between Groups II and III or Groups III and IV at 3 and 6 weeks. At 3 weeks, Groups II, III, and IV had significantly better healing than Group I (p<0.05). In addition, Group IV showed significantly better healing than Group II at 3 and 6 weeks. At 6 weeks, only Group IV showed better healing than Group I (p<0.05). Radiologically, Groups II, III, and IV showed better healing than Group I at 3 and 6 weeks (p<0.05).

Conclusion: Hyalonect application and bone grafting significantly accelerated the healing process when used alone or together. Hyalonect application along with bone grafting resulted in better early radiological healing than bone grafting alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3944/AOTT.2015.14.0231DOI Listing
May 2016

Quality of Life Following Treatment of Trochanteric Fractures with Proximal Femoral Nail versus Cementless Bipolar Hemiarthroplasty in Elderly.

Clin Invest Med 2015 Apr 8;38(2):E63-72. Epub 2015 Apr 8.

.

Purpose: There is currently no gold standard treatment for unstable intertrochanteric fractures of the elderly. Internal fixation and hemiarthroplasty are two common treatment methods but studies comparing the functional outcomes of these procedures in the elderly are limited. This study evaluates the functional outcomes of hip fracture patients treated either with internal fixation or hemiarthroplasty.

Methods: Eighty-six elderly (>60 years) patients who presented with isolated, unstable intertrochanteric fractures between 2009 and 2013 were included in the study. According to the classification of Association for Osteosynthesis/Orthopaedic Trauma Association; 12 of the patients had a 31A1.3 fracture type, 36 of the patients had 31A2.2 and 19 had 31A2.3 fracture type, 12 had 31A3.1 and seven had 31A3.3 fracture. Forty-two of 86 hip patients (Group 1) were treated with intramedullary nailing and antirotator proximal femoral nail implant (TST, Turkey), and 44 (Group 2) were treated with cementless bipolar hemiarthroplasty. Preoperative social function (Jensen) score, EQ-5D index score and mobility (Palmer/Parker) scores were obtained. Five dimensions of EQ-5D were obtained at every follow-up visit until 24 months postoperative.

Results: There was no statistically significant difference between two groups according to preoperative demographic variables, including mean age and sex and Jensen, Palmer/Parker,EQ-5D index, five dimensions of EQ-5D and American Society of Anesthesiologists scores. At end of 24 months follow-up, health-related quality of life had increased more in Group 1 and they reported better social functioning and mobility scores (p<0.01).

Conclusion: Internal fixation resulted in better social functioning and mobility scores compared with cementless bipolar hemiarthroplasty at the end of 24 months in treatment of unstable pertrochanteric hip fracture in the elderly.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.25011/cim.v38i1.22577DOI Listing
April 2015

Relationship between axillary nerve and percutaneously inserted proximal humeral locking plate: a cadaver study.

Acta Orthop Traumatol Turc 2014 ;48(5):553-7

MS Baltalimanı Bone Diseases Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.

Objective: The aim of this study was to investigate the relationship between the axillary nerve and the percutaneously inserted proximal humeral locking plate and to evaluate the risk of axillary nerve injury during percutaneous plate insertion.

Methods: The study included 50 shoulders of 25 fresh frozen cadavers. A 5 cm incision was made from the anterolateral border of the acromion to the arm and a 5-hole 3.5-mm proximal humeral plate was inserted. The axillary nerve was then dissected. Plate holes which crossed the axillary nerve were noted. The distance between the axillary nerve and the lateral edge of the acromion and the length of the arm were measured and their relations evaluated with a correlation test.

Results: The average arm length was 319 mm. The average distance between the axillary nerve and the lateral edge of the acromion was 60 mm. There was a significant correlation between the arm length and acromion-axillary nerve distance (p<0.05). The plate was inserted under the deltoid fascia in all shoulders except one. There were no axillary nerve lesions. In 1 case, the distal end of the plate was inserted in the deltoid muscle. No constant relationship between the plate holes and the axillary nerve was detected.

Conclusion: There is a risk of axillary nerve injury during percutaneous plate insertion. It must be ensured that the plate is inserted under the deltoid fascia during the surgery. The axillary nerve must be visible during application of the screws due to the impossibility of knowing which holes cross the axillary nerve.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3944/AOTT.2014.13.0083DOI Listing
August 2015

The effect of inferomedial screw on postoperative shoulder function and mechanical alignment in proximal humerus fractures.

Eur J Orthop Surg Traumatol 2014 Oct 12;24(7):1055-9. Epub 2013 Dec 12.

Department of Orthopaedics and Traumatology, Ondokuz Mayıs University, Samsun, Turkey,

Aim: The aim of the study was to evaluate the clinical and radiologic results of locking plate fixation with or without inferomedial screw (IMS) in surgically treated proximal humerus fractures.

Patients And Methods: Thirty-six patients with displaced proximal humerus fractures from two centers were operated using locking plate. All of the fractures were classified according to the Neer classification. In 18 of the cases, an additional IMS running through the medial curvature of the surgical neck was used. There was no significant difference among both groups in terms of height, gender, weight, and mechanism of injury. The fractures were evaluated according to the radiographic and functional findings during follow-up period of 14 months in average (range 8-32 months). At the end of first year, shoulder radiographs were received and shoulder examinations were performed using ASES scores. Humeral head-shaft angles were measured by true AP projections. Head-shaft angle measurements were categorized as varus if <125, normal if between 125 and 145, and valgus if >145.

Results: Mean time for fracture healing was 18 weeks. Complete union was achieved in 35 patients by the end of 6 months. In one of the 18 displaced proximal humerus fractures of IMS (+) group, the head-shaft angle was measured to be <125, whereas six patients had varus deviation in IMS (-) group at follow-up (p < 0.05). Mean ASES scores of IMS (+) group and IMS (-) group were 58.21 ± 5.82 and 38.61 ± 3.44, respectively (p < 0.001).

Conclusion: Use of inferomedial screw running through the medial curvature of surgical neck prevents varus deformity and improves functional outcome after surgical treatment for proximal humerus fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00590-013-1391-yDOI Listing
October 2014

Comparison of mechanoreceptor quantities in hip joints of developmental dysplasia of the hip patients with normal hips.

Hip Int 2014 Jan-Feb;24(1):44-8. Epub 2013 Oct 8.

1 Department of Orthopaedics and Traumatology, Üsküdar State Hospital, I?stanbul - Turkey.

Background: Joint mechanoreceptors are afferent neural elements involved in pain sensation and tactile sense.

Questions/purposes: We aimed to detect the free nerve endings (FNE) and other types of mechanoreceptors and to compare their quantities in human hip joint capsule (HJC) and ligamentum capitis femoris (LCF) of babies with developmantal dysplasia of hip (DDH) and intrauterine ex foetuses (control group) to find out whether there is an increase in the amount of mechanoreceptors in hip joint due to the occured anatomical chages.

Patients And Methods: We took 15 LCF and HJC biopsies from 15 patients undergoing hip surgery for DDH, and 15 HJC and LCFs from intrauterine ex fetuses. Total of 60 specimens were investigated. The mean age of the babies was 10.3 months (6-18 months) at the time of surgery. Full thickness 1 × 1 cm HJC and LCF portions were taken as biopsy specimens. An immunohistochemical technique was performed for neurogenic protein S-100 and examined under light microscopy.

Results: FNEs were detected in all four different tissues (type IVa). Other types of mechanoreceptors (Type I-II and III) were not detected in any of the specimens. The positive rates of FNE staining in the control group were % 2.60 ± 1.24 for the LCF and % 2.67 ± 1.11 for the HJC respectively and FNE staining in the DDH group were found to be % 2.67 ± 1.11 for the LCF and % 2.73 ± 1.16 for the HJC. We did not find a statistically significant difference in number of FNEs between the specimens of the DDH group and the control group (p>0.05), also there was no statistically significant difference in number of FNEs between the HJC and LCF within each group (p>0.05).

Conclusion: Our results suggest that the number of FNEs does not increase in HJC and LCF of DDH patients even though LCF hypertrophy and capsular elongation occurs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/hipint.5000091DOI Listing
December 2014

Excess retained cement in the posteromedial compartment after unicondylar knee arthroplasty.

Acta Orthop Traumatol Turc 2013 ;47(4):291-4

Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey.

Acute mechanical symptoms due to excess retained cement in the posterior compartment of the knee joint following unicondylar knee arthroplasty (UKA) are uncommon. Infection, aseptic loosening, polyethylene wear and progressive arthritis are well-documented complications of UKA procedure. We present a patient with acute pain and 'clicking' sensation in the knee joint due to cement extrusion in the posteromedial compartment after UKA. Full functional recovery was achieved after arthroscopic removal of the cement debris. Of retrospectively screened 43 UKA cases, asymptomatic cement extrusion was detected in 8 patients in the posteromedial compartment on direct X-rays. Careful inspection of components is essential to minimize the risk of cement extrusion into the posterior compartment and perioperative fluoroscopy may be helpful during UKA procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3944/aott.2013.3043DOI Listing
April 2014

Joint debridement and metatarsal remodeling in Freiberg's infraction.

J Am Podiatr Med Assoc 2013 May-Jun;103(3):185-90

Department of Orthopaedics and Traumatology, Bezmialem Vakif University Hospital, Istanbul, Turkey.

Background: Freiberg's infraction is an osteochondrosis that is characterized by osteonecrosis of the metatarsal head, with pain and tenderness around the metatarsophalangeal joint. We sought to evaluate the outcome of joint debridement and metatarsal remodeling for the treatment of advanced-stage Freiberg's infraction.

Methods: Between March 1, 2006, and April 30, 2011, 14 patients (eight females and six males) with symptomatic unilateral Freiberg's disease refractory to conservative treatment (Smillie stages IV and V) underwent joint debridement with metatarsal head remodeling by two surgeons. To evaluate functional outcome, American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey forms were completed by the patients preoperatively and postoperatively at months 3, 6, and 12. Active-assisted range-of-motion exercise was allowed after 4 weeks of short-leg walking cast wear, and weightbearing on the forefoot was allowed as tolerated.

Results: Mean patient age was 27.0 years (range, 16-53 years), and mean follow-up was 40.2 months (range, 14-54 months). Mean ± SD American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey scores were 46.8 ± 8.95 and 28.9 ± 4.3 preoperatively and 76.2 ± 9.5 and 45.6 ± 7.7 1 year after surgery, respectively. There was a significant increase in both scores (P ≤ .001).

Conclusions: In advanced-stage Freiberg's infraction of the second metatarsal, joint debridement and metatarsal head remodeling is a safe and simple therapeutic option, and it provides better quality of life for patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7547/1030185DOI Listing
January 2014

Cerebrotendinous xanthomatosis presenting with bilateral achilles tendon xanthomata: a case report.

J Am Podiatr Med Assoc 2013 Mar-Apr;103(2):152-5

Department of Orthopaedics and Traumatology, Vakif Gureba Research and Training Hospital, Istanbul, Turkey.

Xanthomas are described as deposits in the skin and subcutaneous tissues. Mostly known as pseudotumors, xanthomas consist of connective tissue containing mainly cholesterol, triglycerides, and numerous foamy macrophages. Bilateral Achilles tendon xanthomata is pathognomonic for cerebrotendinous xanthomatosis in the case of normal cholesterol levels but increased cholestanol levels in serum. In this article, we present findings regarding bilateral xanthomas of Achilles tendons in a patient with cerebrotendinous xanthomatosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7547/1030152DOI Listing
December 2013

Domestic electric drills in the service of orthopaedic surgery: a potential and preventable source of surgical site infections.

Acta Orthop Traumatol Turc 2012 ;46(6):455-9

Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey.

Objective: We aimed to assess the contamination potential of the exhaust air from venting ports of running domestic electric drills which are commonly used in orthopaedic surgeries by means of both microbiological sampling and particle counting.

Methods: In an empty operating room, the exhaust air from five running sterile domestic electric drills measured using a particle counter and microbiological sampling was made via aspirating isolator with colony formations noted for a 2-week period. International Organization for Standardization (ISO) 14644 criteria were implemented with respect to the sterility standards.

Results: All of the drills produced statistically significantly higher levels of particles than the ambient air (p<0.01). There was no statistically significant difference in the number of collected particles among drills (p>0.05). No bacterial growth was detected in microbiological sampling via blood agar medium in the ambient air. Conversely, Staphylococcus epidermidis, Micrococcus luteus, and Staphylococcus capitis were isolated from the exhaust air of all running drills. There was no correlation between the number of particles produced by drills and the microbiological sampling.

Conclusion: Domestic electric drills are not safe and may be a direct source of surgical site infection, as the use or re-use of these drills during orthopaedic surgery increases the risk of infection with contaminated aerosols that are produced by these devices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3944/aott.2012.2794DOI Listing
August 2013

Gouty arthritis at interphalangeal joint of foot after sildenafil use: A case report.

Int J Surg Case Rep 2013 28;4(1):11-4. Epub 2012 Sep 28.

Department of Orthopaedics and Traumatology, Maltepe University, Istanbul, Turkey. Electronic address:

Introduction: Interphalangeal joint of foot is a very unusual location for gouty arthritis and sildenafil use may cause this phenomenon.

Presentation Of Case: A 58-year-old hypertensive man was admitted to hospital with pain and swelling over interphalengeal joint of his right great toe. His health history included the use of diuretics for a long time and his last gout attack was two years ago at first metatarsophalengeal joint of right foot. Sildenafil, a selective inhibitor of phosphodiesterase type 5 (PDE5), was administered in case of erectile dysfunction for two months. Subsequently, he had several episodes of pain and swelling at first interphalangeal joint of right great toe. Both the onset and recurrence of symptoms were just seen the day after sildenafil use. The patient was free of symptoms after discontinuation of the drug. After an initial evaluation, gout was diagnosed on the basis of synovial fluid analysis.

Discussion: This case demonstrates a rare location of gouty arthritis with an uncommon etiology: sildenafil. Regarding the clinical data, the discussion was made to expand the horizon for diagnosis of patients with similar symptoms, to identify risk factors for gout relevant to elderliness, and to review the management of gout.

Conclusion: Sildenafil use may cause gouty arthritis, and surgical decompression may be helpful for definitive diagnosis and symptom relief in atypical presentation of gout.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijscr.2012.08.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537936PMC
January 2013

Metatarsal head resurfacing hemiarthroplasty in the treatment of advanced stage hallux rigidus: outcomes in the short-term.

Acta Orthop Traumatol Turc 2012 ;46(4):281-5

Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey.

Objective: The aim of this study was to evaluate the short-term outcomes of metatarsal head metal resurfacing hemiarthroplasty in patients with advanced stage hallux rigidus.

Methods: The study included 14 feet (4 left, 10 right) of 12 patients (10 female, 2 male; mean age: 63 ± 5; range: 55 to 71 years) who underwent metatarsal head metal resurfacing hemiarthroplasty (HemiCAP(®)) between 2007 and 2010. Additionally, capsular release and periarticular osteophyte debridement were performed. Staging was made according to Coughlin and Shurnas' clinical and radiological grading system. Hallux valgus and intermetatarsal angles were measured using pre and postoperative standing AP and lateral foot views. Clinical assessment was made with first metatarsophalangeal joint range of motion, the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale and satisfaction level.

Results: Mean follow up was 19.5 (range: 14 to 26) months. Two patients had bilateral involvement. According to Coughlin and Shurnas' clinical and radiological grading system, nine feet were Stage 3 and five feet were Stage 4. According to the AOFAS scale, results of eight feet (57.1%) were excellent, four feet (28.6%) were good and two feet (14.3%) were moderate. Mean total AOFAS score increased by 26.2 points postoperatively (p<0.05). Mean range of motion of the first metatarsophalangeal joint improved significantly from a preoperative 22.2 ± 5.6 (range: 10 to 28) degrees to a postoperative 56.3 ± 9.6 degrees (p<0.05). Mean hallux valgus angle decreased from a preoperative 14.3 (range: 9 to 17) degrees to a postoperative 11.1 (range: 4 to 13) degrees and the mean intermetatarsal angle increased from a preoperative 10.5 (range: 8 to 14) degrees to a postoperative 10.8 (range: 8 to 15) degrees. Patient satisfaction levels were very good in 10 feet (71.4%), good in 3 (21.4%), and moderate in one (7.2%). Complications included metatarsalgia aggravated by long walks in one patient and hypoesthesia of the great toe in three patients. Push-off power of the great toes was measured as 4/5 in three cases, and 5/5 in others.

Conclusion: Metatarsal head metal resurfacing hemiarthroplasty provides high patient satisfaction level and good functional outcome in the short-term, in the surgical treatment of advanced stage hallux rigidus refractory to conservative treatment options.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3944/aott.2012.2795DOI Listing
January 2013

Total hip arthroplasty in a patient with congenital insensitivity to pain: a case report.

J Med Case Rep 2012 Jul 9;6:190. Epub 2012 Jul 9.

Orthopedics and Traumatology Department, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

Introduction: Congenital insensitivity to pain, a rare neurological entity, is characterized by varying degrees of sensory loss and autonomic dysfunction. Orthopedic manifestations of congenital insensitivity to pain include delayed diagnosis of fractures, nonunions, malunions, Charcot arthropathy, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification and joint dislocations. We here report the case of a patient with congenital insensitivity to pain who had multiple lower extremity fractures at varying intervals, the most recent being a femoral neck fracture managed by total hip replacement. To the best of our knowledge, this is the first report of cementless hip arthroplasty in such a patient.

Case Presentation: A 37-year-old Caucasian woman was admitted to our hospital complaining of painless swellings in her lower limb and limping. She had been diagnosed with multiple lower extremity fractures at different times. On physical examination, we found multiple perioral mucosal ulcers, shortening of her nails and acro-osteolysis, a prematurely aged facial appearance, undersized skeletal structure, Charcot arthropathy of her right ankle, anosmia, insensitivity to temperature differences and evidence of mild intellectual disability. A right subtrochanteric femur fracture was treated with an intramedullary nail. Eighteen months later, she presented with similar symptoms and we diagnosed a right femoral neck fracture. We removed the nail and performed cementless total right hip arthroplasty.

Conclusions: Congenital insensitivity to pain is a rare condition that is associated with severe orthopedic problems. This case report, which will be of particular interest to orthopedic surgeons, presents several difficulties in the management of patients with congenital insensitivity to pain and notes the importance of close follow-up and early recognition of complications. Cementless total hip arthroplasty may be a good therapeutic option for femoral neck fracture in these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1752-1947-6-190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419663PMC
July 2012
-->