Is there still an indication for the Birmingham Hip Resurfacing in femoral head osteonecrosis?

PURPOSE

Osteonecrosis of the femoral head (ONFH) is a progressive hip disease. Hip resurfacing arthroplasty (HRA) is a preferred surgical procedure among hip arthroplasty performed in young patients. The aim of this study is to show the long-term clinical and radiological results of HRA procedures performed for patients suffering from ONFH.

METHODS

Forty-five patients who underwent hip resurfacing with the diagnosis of femoral head osteonecrosis were included in the study. The Harris Hip Score (HHS) was used for clinical scoring of the patients. The blood chromium, cobalt, white blood cell (WBC) count, and CRP levels of patients were checked. Ultrasonography (USG) was performed for all patients at mid-term control checked for pseudo-tumours. For the radiological evaluation, acetabular inclination, stem shaft angle, prothesis-to-neck ratio, osteolysis zones, and heterotopic ossification were used.

RESULTS

The mean age of the patients was 46.6 ± 9.3 years, and the mean follow-up period was 11.83 ± 2.9 years. The mean HHS was 90.3 ± 12.8 for final follow-up. The mean WBC value was 8.2 109/L, mean CRP value was 6.3 mg/L, mean chromium value was 4.9 µg/L, and mean cobalt value was 1.8 µg/L. Inclination changing 0.2°(p = 0.788), stem shaft angle changing 0.7°(p = 0.424), and neck-to-prosthesis ratio changing 0.01°(p = 0.075). No pseudo-tumours were detected in any patients in USG examination.

CONCLUSION

HRA provides long-term implant survival and excellent clinical outcomes for end-stage ONFH patients with low complication rates.

Relationship between graft failure following anterior cruciate ligament reconstruction and hamstring autograft diameter

With the increase in the number of individuals participating in sports, anterior cruciate ligament (ACL) injuries are also increasing gradually and the number of patients requiring surgical treatment is increasing in parallel. The primary aim of this study was to investigate the relationship between the need for revision surgery and graft diameter following primary ACL reconstruction (ACLR) using hamstring autografts. The secondary aim of the study was to clarify relationships between anthropometric characteristics and graft diameter. Patients who underwent ACLR with hamstring autografts were included in this retrospective study. The age, body mass index, height, and weight of all patients were recorded preoperatively and the diameters of the grafts were recorded during surgery. The relationship between revision rate and graft diameter and the relationships between anthropometric measurements and graft diameter were investigated for these patients at least one year after surgery. This study included 58 people with graft diameters of ≤7 mm and 261 people with graft diameters of >7 mm. A statistically significant difference was found between the graft diameters of the group that needed revision surgery and the group that did not (p<0.001). A positive relationship was also found between the patient's height and graft diameter (r=0.168). In this study, it was found that the risk of ACL revision surgery increased by 5.5 times among patients with graft diameters of ≤7 mm. The positive relationship between the patient's height and graft diameter can make a significant difference in terms of the need for revision surgery.

Comparison of the WALANT and the PFNB techniques in the surgical treatment of unimalleolar fractures: a prospective study

The popliteal fossa nerve block (PFNB) technique is one of the most popular anesthesia method in the foot and ankle surgery. The wide awake local anesthesia no tourniquet (WALANT) technique is an local anesthetic method and it has been gaining popularity in orthopedic surgery in recent years. Our aim is to compare the efficacy of the WALANT and the PFNB techniques in pain management. This prospective study included 40 patients with lateral malleolar and medial malleolar fractures. The first group was anesthetized using the WALANT technique; in the second group, PFNB was performed. All patients were evaluated for intrasurgical bleeding amounts, mean arterial pressure, surgery time and VAS scores for presurgical pain, pain during the local anesthetic injection sequence, mean intrasurgical pain, mean postsurgical pain. A total of 40 patients in both groups were successfully operated on with the WALANT and the PFNB techniques. When the two groups were compared, statistically significant differences were observed for mean intrasurgical VAS (p = 0.033), mean postsurgical VAS (p = 0.038) and intrasurgical bleeding (p = 0.006). No significant difference was found in pain scores during anesthetic injection (p = 0.529), mean arterial pressure (p = 0.583) and surgery time (p = 0.277). The PFNB technique is more successful in pain management in the treatment of the unimalleolar fractures. Intrasurgical bleeding amounts were less detected in the WALANT tech- nique. The both techniques are a reliable and suitable anesthetic method in the surgical treatment of uni- malleolar fractures.

Comparative Analysis of Single Lateral Locked Plate and Double Locked Plate Application in the Treatment of Bicondylar Tibial Plateau Fractures

Background and objective

Bicondylar tibial plateau fractures (BTPFs) have been controversial in terms of surgery planning, due to articular joint surface comminution, severe soft tissue injury, and the risk of complications. The aim of this study was to conduct a clinical, functional, and radiologic comparison of the dual locked plate (DLP) and single lateral locked plate (SLLP) techniques.

Methods

Retrospectively analysed were 54 patients who underwent surgical treatment with DLP or SLLP due to the diagnosis of BTPFs, between January 2018 and June 2020. Patients were evaluated in the clinic with regard to their demographic characteristics, mechanisms of injury, follow-up periods, measurement of the range of motion degrees, functional scores, and radiographic parameters. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Score (Lysholm) and Oxford Knee Score (OKS) were chosen as the functional scores. The condylar width, medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and fracture union time were calculated radiographically.

Results

The patients in the DLP group achieved significantly higher scores for all three scales when the KOOS, Lysholm, and OKS, respectively (P = 0.008, P = 0.048, P = 0.006), were compared. Radiographically, the mean increase in the condylar width of 1.72 mm in the DLP group and 2.59 mm in the SLLP group was measured (P = 0.010, P = 0.010, respectively). The mean decrease in MPTA was 1.75° in the DLP group and 3.54° in the SLLP group, which was statistically significant (P = 0.005, P = 0.001, respectively). An increase in the posterior tibial slope was measured at a mean of 1.8° in the DLP group and 1.4° in the SLLP group (P = 0.001, P = 0.008, respectively). On the other hand, when the condylar width, MPTA and PTS between the DLP and SLLP groups were compared, no significant difference was found (P = 0.179, P = 0.247, P = 0.611, respectively).

Conclusion

Better results were obtained in patients who underwent the DLP procedure when compared to those who had the SLLP. There was no radiographic difference between the two surgical procedures. Although DLP is an effective and reliable method in the treatment of BTPFs, the SLLP procedure also provides satisfactory results in patients with appropriate indications.

Evaluation of Different Intraarticular Injection Therapies with Gait Analysis in a Rat Osteoarthritis Model

OBJECTIVE

Osteoarthritis (OA) is a degenerative disease that causes serious damage to joints, especially in elderly patients. The aim of study was to demonstrate the effectiveness of intraarticular therapies that are currently used or recently popularized in the treatment of OA.

DESIGN

The baseline values were determined by walking the rats on the CatWalk system. Afterwards, a monosodium iodoacetate (MIA)-induced knee OA model was created with intraarticular MIA, and the rats were walked again on the CatWalk system and post-OA values were recorded. At this stage, the rats were divided into 4 groups, and intraarticular astaxanthin, intraarticular corticosteroid, intraarticular hyaluronic acid, and intraarticular astaxanthin + hyaluronic acid were applied to the groups, respectively. The rats were walked once more and posttreatment values were obtained. Nine different dynamic gait parameters were used in the comparison.

RESULTS

Significant changes were measured in 6 of the 9 dynamic gait parameters after the MIA-induced knee OA model. While the best improvement was observed in run duration (P = 0.0022), stride length (P < 0.0001), and swing speed (P = 0.0355) in the astaxanthin group, the results closest to basal values in paw print length (P < 0.0001), paw print width (P = 0.0101), and paw print area (P = 0.0277) were seen in the astaxanthin + hyaluronic acid group.

CONCLUSION

Astaxanthin gave better outcomes than corticosteroid and hyaluronic acid in both dynamic gait parameters and histological examinations. Intraarticular astaxanthin therapy can be a good alternative to corticosteroid and hyaluronic acid currently used in intraarticular therapy to treat OA.

Comparison of a manual walking platform and the CatWalk gait analysis system in a rat osteoarthritis model

BACKGROUND

Effects of osteoarthritis (OA) are observed in experimental animal models using different gait analysis systems.

OBJECTIVES

The aim of this study was to determine whether the Noldus CatWalk XT v. 10.9 gait analysis system (CatWalk) device can be used effectively in a chemically induced rat OA model and to reveal the strengths and weaknesses of the system compared to manual gait analysis.

MATERIAL AND METHODS

Ten Wistar rats were run on a manual walking platform as well as on the CatWalk and the basal values were recorded. For OA induction, monosodium iodoacetate (MIA) was injected into the left knee of all rats under anesthesia. After a period of 4 weeks for OA development, the rats were again run on both the manual and CatWalk gait platforms. For manual gait analysis, the stride length, paw print width and paw print length were measured on both knees. In addition to these parameters, the average run speed, run duration, maximum contact intensity, paw print area, mean stance, and swing speed were measured on the left knee (affected knee) using the CatWalk device.

RESULTS

Significant differences were observed in the stride width (p = 0.0272), left stride length (p = 0.0344), and left paw print length (p = 0.0233) recorded before and after OA via the manual walking platform. For CatWalk, a significant difference was detected in the left knee's average run speed (p = 0.0010), maximum contact intensity (p = 0.0155), paw print length (p = 0.0058), paw print width (p = 0.0324), and swing speed (p = 0.0066) based on data obtained before and after OA.

CONCLUSIONS

The CatWalk gait analysis system is suitable for the evaluation of OA rat models and related interventions. It also provides additional parameters compared to the manual system and minimizes human-related variation.

Comparison of tension band wiring and plate fixation in Mayo type 2A olecranon fractures

OBJECTIVES

This study aims to compare clinically and functionally patients who had previously undergone tension band wiring (TBW) or plate fixation (PF) procedure due to the diagnosis of Mayo type 2A olecranon fracture in our clinic.

PATIENTS AND METHODS

Data of 92 patients (51 males, 41 females; mean age 42.3±12.6 years; range, 16 to 75 years) operated on for olecranon fractures between January 2014 and December 2018 were recorded retrospectively. Forty-four patients received TBW and 48 patients received PF treatment. Their Disabilities of the Arm, Shoulder, and Hand (DASH) and Mayo scores and elbow range of motion (ROM) measurements were used for clinical and functional evaluations. Data including the time to return to work, revision rate, and follow-up time were also recorded.

RESULTS

The mean follow-up time was 38.2±17.2 months. Patients returned to work in 9.2±4.1 weeks in the TBW group and 7.8±3.6 weeks in the PF group (p=0.279). The revision rate was 14% in the TBW group and 2% in the PF group (p=0.335). The mean DASH score was 10.0±1.8 in the TBW group and 7.7±1.2 in the PF group (p=0.001). The mean Mayo score was 84.0±9.3 in the TBW group and 88.3±9.1 in the PF group (p=0.049). For elbow flexion-extension ROM, 4° of difference was measured in favor of the PF group (p=0.043). Mean Mayo score, mean DASH score, and mean flexion-extension ROM values were statistically significantly different between the two groups.

CONCLUSION

Both surgical techniques are suitable and reliable in the treatment of olecranon fractures. Although TBW treatment is low-cost and simple to apply, its biggest disadvantage is a high rate of secondary surgery for implant removal due to irritation of the skin.

Orthognathic surgery with two-segment le fort i and sagittal split ramus osteotomies of open bite deformity in an amelogenesis imperfecta patient via virtual planning: A case report

Amelogenesis imperfecta (AI) is an enamel defect and is often associated with the anterior open bite (AOB) and transverse maxillary deficiency. It is known that in such cases when AI and AOB appeared together, posterior maxillary impaction with or without bilateral mandibular ramus osteotomies is a frequently preferred treatment option. Virtual planning is more reliable rather than the conventional model surgery planning, especially for complicated cases. Usage area of virtual 3D anatomical models reconstructed from Cone Beam Computed Tomography (CBCT) data is expanding day by day for both diagnosis and surgical planning. The aim of this study is to present a patient with AI and AOB and transverse maxillary deficiency and management of this case with virtually planned two-segment Le fort I and sagittal split ramus osteotomies followed by prosthetic rehabilitation.

Comparison of the clinical and radiological outcomes of arthroscopic transosseous and transosseous-equivalent double-row rotator cuff repair techniques

OBJECTIVE

This study compared the clinical and radiological results of the arthroscopic transosseous (ATO) and transosseous-equivalent (TOE) double-row rotator cuff repair techniques.

METHODS

Prospective data collected from patients treated with ATO (32 women and 7 men, mean age: 57.03±6.39 years) and TOE (36 women and 8 men; mean age: 57.86±7.81 years) techniques were retrospectively evaluated. The visual analog scale score, Constant score, and Oxford shoulder score were used to assess the clinical results. Anchor pullout on standard anteroposterior shoulder radiographs and rotator cuff re-tear on magnetic resonance images were examined at the final follow-up to evaluate the radiological results. Rotator cuff re-tears were graded as per the classification system described by Sugaya et al. Results: The mean follow-up duration was 33.3±11.8 months. No difference was observed in the demographic data of the two groups. Significant improvement was observed in the postoperative shoulder scores of the groups; however, no difference was observed between the groups. Re-tear was detected in 10 patients of the TOE group and 9 patients of the ATO group. Age, tear size, and retraction level could cause re-tear.

CONCLUSION

In the treatment of rotator cuff tears, the ATO and TOE techniques may achieve considerable improvements in shoulder functions in the short term.

LEVEL OF EVIDENCE

Level III, Therapeutic study.

An evaluation of the effect on lower extremity fracture healing of collagen-based fusion material containing 2 different calcium phosphate salts: An experimental rat model

BACKGROUND

Collagen-based synthetic bone grafts which contain tricalcium phosphate (TCP) and hydroxyapatite (HA), and collagen-based synthetic bone grafts containing only TCP have some advantages compared to autografts. Therefore, these grafts are frequently used to fill bone defects and pseudoarthrosis.

OBJECTIVES

The aim of this study was to evaluate and compare the clinical, radiological and histopathological effects of TCP-HA and TCP alone + Type-1 collagen in healing lower extremity fractures in a pseudoarthrosis model in rat femurs.

MATERIAL AND METHODS

A total of 36 female Wistar rats were randomly separated into 4 groups. Group 1 (n = 10) was the control group. A femur pseudoarthrosis model was created in Groups 2, 3 and 4. On the 90th day after the 1st surgery in Group 2 (n = 10), TCP-HA + Type-1 collagen was applied, in Group 3 (n = 10), TCP alone + type-1 collagen was applied, and in Group 4 (n = 6, the placebo group), saline solution was applied. Fixation was performed with an intramedullar pin. After 60 days and clinical and radiological scoring, all animals were sacrificed and a histopathological evaluation of the pseudoarthrosis areas was conducted.

RESULTS

In all the clinical, radiological and histopathological measurements used in the evaluations of the differences between the groups, a higher rate of union was determined in Group 2 (TCP-HA). No significant difference was determined between Group 3 and Group 4 in terms of union rates.

CONCLUSIONS

The clinical, radiological and histopathological results of this study showed that TCP alone was less effective than TCP-HA in the union of a femur pseudoarthrosis model in rats. The reason for this difference was considered to be hydroxyapatite (HA).

Effects of Artcure Diffusional Patch application on pain and functional status in lumbar disc herniation patients: a prospective randomized controlled study

BACKGROUND/AIM

The aim of this study was to assess the efficacy of the Artcure Diffusional Patch, which contains a mixture of 6 herbal oils (oleum thymi, oleum limonis, oleum nigra, oleum rosmarini, oleum chamomilla, oleum lauriexpressum) and has a hypoosmolar lipid structure, in the conservative treatment of lumbar disc herniation patients and to show the advantages and/or possibility of using this as an alternative method to surgery.

MATERIALS AND METHODS

Of the 120 patients enrolled, 79 clinically diagnosed patients were included in the study. Clinical evaluations were performed on patients who had findings of protrusion or extrusion in their magnetic resonance results. The treatment group was treated with the Artcure Diffusional Patch while the control group received a placebo transdermal diffusional patch. The functional state of patients was measured using the Oswestry Disability Index and pain intensity was measured with a visual analog scale as primary outcomes. Secondary outcomes of the study were Lasegue's sign, the femoral stretching test, and paravertebral muscle spasm.

RESULTS

The treatment group showed a dramatic recovery in the first month following the application in regards to Oswestry Disability Index scores and visual analog scale values. The patients treated with the Artcure Diffusional Patch showed a statistically significant difference in recovery as compared to the control group.

CONCLUSION

These findings suggest that the Artcure Diffusional Patch may be an alternative for the conservative treatment of lumbar disc herniation with radiculopathy.

Effect of Topical and Intravenously Applied Tranexamic Acid Compared to Control Group on Bleeding in Primary Unilateral Total Knee Arthroplasty

We aimed to answer the following three questions in this study: (1) Does tranexamic acid (TA) reduce the amount of bleeding in total knee arthroplasty (TKA)? (2) Does TA reduce requirement for blood transfusion? (3) Is there any difference on reliability and efficacy between topical and intravenous (IV) applications of TA? Patients were allocated into three groups randomly by a software program as topical, IV, and control group. TA was applied as 20 mg/kg to the IV group and as 3 g/100 mL saline to the topical group. The hemoglobin values were recorded preoperatively and postoperatively on the same day and on day 1 and day 2. Removal of the drain postoperatively and length of hospital stay, as well as any complications such as pulmonary embolism or deep venous thrombosis, were also noted. The study comprised 40 patients in the IV group, 42 in the topical group, and 41 in the control group. The drain output values were similar in the IV and topical groups (p = 0.161), while those of the control group were significantly higher than both the IV and topical groups (p < 0.001 and < 0.001). Transfusion was applied to 19.5% of cases in the control group, 4.8% in the topical group, and 5.1% of the IV group (χ² = 6.522; p = 0.038). The results of the study showed that 20 mg/kg single-dose IV bolus or 3 g topical TA application reduced blood loss and transfusion requirement without increasing the rate of thromboembolic complications in unilateral primary TKA.

Immunohistochemical analysis of mechanoreceptors in transverse acetabular ligament and labrum: a prospective analysis of 35 cases

OBJECTIVE

The labrum and transverse acetabular ligament (TAL) are classically described as distinct anatomical structures with abundant mechanoreceptors and free nerve fibers. They deepen the joint and act as natural barriers against dislocation, thus providing additional stability. We hypothesized that severe coxarthrosis leads to elimination of labrum and TAL mechanoreceptors. This study evaluated the microscopic anatomy of the labrum and TAL and specifically investigated the neurological status of these structures.

METHODS

Labral and TAL specimens from 35 consecutive patients with coxarthrosis undergoing total hip arthroplasty were dissected into a total of 4 specimens per hip. Formaldehyde-fixed specimens were evaluated for the presence of mechanoreceptors and free nerve endings by neurofilament protein and S-100 protein immunohistochemistry and microscopy.

RESULTS

Mechanoreceptors were identified in the labral (2.3/high power field) but not TAL specimens, with a sharp delineation between the tissues. In contrast, both labrum and TAL showed good vascularity with abundant free nerve fibers within fibrous connective tissue (mean, 2.6 sensory fibers/ high power field vs 3.1/high power field, respectively).

CONCLUSION

This study demonstrated that the TAL lacks mechanoreceptors. However, TAL and labrum free nerve fibers suggest potential roles as hip pain generators.

Comparison of early postoperative period electrophysiological and clinical findings following carpal tunnel syndrome: is EMG necessary?

BACKGROUND

In this study, we aimed to compare the clinical findings and ENMG results of the patients who underwent surgery due to CTS, in the preoperative and early postoperative period.

METHODS

33 wrists of 29 patients who underwent open carpal tunnel surgery in our clinic due to CTS, between 2009 and 2011, were evaluated. Electrophysiological progress was evaluated with ENMG and clinical state with Boston scale.

RESULTS

A significant decrease was observed in the postoperative BS symptomatic (SSS) and functional (FSS) scores of patients as compared to preoperative period (P=0.00), In the electrophysiological findings, statistically significant improvement was observed in all groups but very severe CTS group (P<0.05). When preoperative and postoperative EMG findings were compared, changes in DSL and DSA values were statistically significant (P<0.05). However, no statistically significant difference was seen between DML (P=0.085) and DMA (P=246) values on the 3rd month. When an examination was conducted on the patients whose DML and DSL values could not be obtained in the preoperative EMG, DML values were obtained in the early postoperative period in 6 of 7 cases (85.71% P<0.001), and DSL values were obtained in 17 of 24 cases (70.8% P<0.000).

CONCLUSIONS

Sensory nerve findings were more significant, showed faster recovery compared to motor nerve findings, and accompanied the clinical recovery. Performance of an EMG test, especially on sensory nerves, will be more effective in patients selected in the early period, with the exception of patients with very severe CTS.

Comparison of early postoperative period electrophysiological and clinical findings following carpal tunnel syndrome: is EMG necessary?

In this study, we aimed to compare the clinical findings and ENMG results of the patients who underwent surgery due to CTS, in the preoperative and early postoperative period.

METHODS

33 wrists of 29 patients who underwent open carpal tunnel surgery in our clinic due to CTS, between 2009 and 2011, were evaluated. Electrophysiological progress was evaluated with ENMG and clinical state with Boston scale.

RESULTS

A significant decrease was observed in the postoperative BS symptomatic (SSS) and functional (FSS) scores of patients as compared to preoperative period (P=0.00). In the electrophysiological findings, statistically significant improvement was observed in all groups but very severe CTS group (P<0.05). When preoperative and postoperative EMG findings were compared, changes in DSL and DSA values were statistically significant (P<0.05). However, no statistically significant difference was seen between DML (P=0.085) and DMA (P=246) values on the 3rd month. When an examination was conducted on the patients whose DML and DSL values could not be obtained in the preoperative EMG, DML values were obtained in the early postoperative period in 6 of 7 cases (85.71%, P<0.001), and DSL values were obtained in 17 of 24 cases (70.8%, P<0.000).

CONCLUSIONS

Sensory nerve findings were more significant, showed faster recovery compared to motor nerve findings, and accompanied the clinical recovery. Performance of an EMG test, especially on sensory nerves, will be more effective in patients selected in the early period, with the exception of patients with very severe CTS.

The role of bilirubin and its protective function against coronary heart disease

BACKGROUND

Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality both in industrialized and developing countries. Atherosclerosis is a chronic inflammatory disease of the arterial wall, which also involves deposition and peroxidation of lipids. Bilirubin, an important endogenous antioxidant, may limit lipid peroxidation and retard the progression of atherosclerosis. Previous studies have reported an inverse relationship between serum bilirubin levels and the risk of coronary artery disease (CAD). Taking into account that atherosclerosis is a complex process that is initiated and accelerated by diverse risk factors, we aimed to test the antiatherosclerotic effects of bilirubin in a population with multiple risk factors for CAD.

METHODS

The study included 221 patients who underwent coronary angiography owing to symptoms suggestive of ischemia and/or positive noninvasive stress test results. Of the patients, 76 had normal coronary angiograms and served as the control group. The remaining 145 patients with documented CAD and two or more cardiovascular risk factors constituted the study group. The study group (n=145) was further classified according to the Gensini score as follows: group 1 if Gensini score was 1-19 (minimal CAD, n=82), and group 2 if Gensini score was 20 or higher (significant CAD, n=63). Biochemical assessments including total and direct serum bilirubin levels were carried out using standard methods in automated systems.

RESULTS

All of the cardiovascular risk factors were found significantly more frequently in the study group (groups 1 and 2) than in the control group. Total and direct serum bilirubin levels did not differ significantly between the control group, group 1, and group 2. There was a moderate and significant positive correlation between direct bilirubin levels and the Gensini score (r = 0.158, p = 0.019). There was no significant correlation between total bilirubin levels and the Gensini score.

CONCLUSION

In conclusion, our findings suggest that in the presence of multiple risk factors, similar concentrations of serum bilirubin may not confer the same level of protection against CAD as in an individual with a more favorable risk profile. The relationship between direct bilirubin levels and the Gensini score is unlikely to be causative, given the established antiatherosclerotic effects of bilirubin.

Does the magnetic-guided intramedullary nailing technique shorten operation time and radiation exposure?

AIM

The aim of this study is to show whether a new magnetic-guided locking technique is superior to a standard freehand technique in terms of operation time and radiation exposure. This treatment will be used for distal locking of the tibia during intramedullary nailing.

METHODS

This randomized trial is done through 80 patients having tibial fractures with a mean age of 25 years (range 16-67 years). In the magnetic locking group, there were 20 fractures of the distal third, 16 of the shaft, and 4 of the proximal tibia; in the freehand group, these numbers were 15, 20, and 5, respectively. The parameters like operation time, distal locking time, radiation exposure duration, and dose were compared.

RESULTS

We placed 100 distal locking screws in the magnetic locking group and 95 in the freehand group. Fluoroscopy was necessary only in the freehand group. All screws were correctly positioned the first time in both groups. The magnetic locking group had a shorter mean surgical time (52 ± 6.2 vs 70 ± 10.9 min; P < 0.01), a shorter mean distal locking time (5 ± 1.1 vs 16 ± 2.0 min; P < 0.01), and a shorter mean placement time for each screw (2 ± 0.5 vs 7 ± 1.2 min; P < 0.01). The magnetic locking group had lower mean radiation exposures (8 ± 4.5 vs 40 ± 7.6 s; P < 0.01) and mean radiation exposure (5.4 ± 2.5 vs 25 ± 6.8 mGy range; P < 0.01).

CONCLUSIONS

For distal locking during tibial intramedullary nailing, the magnetic locking system is as accurate as the standard freehand technique, but it has lower operative times and radiation exposures compared to the standard freehand technique. Therefore, the magnetic locking system should be preferred to current standard freehand techniques.

The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures

OBJECTIVE

The aim of this study was to evaluate the time to union and complications in cases of tibial diaphysis and distal tibial fractures fixed with a minimally invasive percutaneous plate.

METHODS

Thirty-five patients (23 males, 12 females) were operated on using minimally invasive percutaneous plate osteosynthesis (MIPPO) principles for tibial diaphysis and distal tibial fractures. Twenty-eight were closed and seven were open fractures. After direct or indirect fracture reduction, the plate was advanced through a submuscular extraperiosteal tunnel through the distal incision without opening the fracture line. The plate was fixed with screws through the proximal and distal incisions. Clinical and radiological evaluations were made at four to six week intervals after surgery. Full weight-bearing was allowed after an average of 14.43 (range: 12 to 20) weeks and 15.39 (range: 8 to 32) weeks in open and closed fractures, respectively. Duration of the union and complications were analyzed.

RESULTS

The mean duration of the union was 20.7 (range: 16 to 28) weeks and 17.96 (range: 10 to 36) weeks in open and closed fractures, respectively. All cases showed union except one who had an implant failure. Necrosis at the wound developed in one case and infection in another.

CONCLUSION

MIPPO is an effective alternative treatment for tibial diaphysis and distal tibia fractures with low complication and high union rates.

Anatomy of the lateral complex of the ankle joint in relation to peroneal tendons, distal fibula and talus: a cadaveric study

OBJECTIVES

The anatomy of the lateral complex of the ankle joint comprises multiple ligaments and muscles. This study aims to demonstrate the complexity of the lateral ankle structures in detail.

MATERIALS AND METHODS

The study was performed on 11 cadavers (22 ankles) fixed in 10% formaldehyde, and 24 free talus specimens. The detailed course and attachments of each ligament was observed and noted with the ankle in neutral position. Talar measurements were applied to 46 specimens including the dissected cadavers and free talus ones. This study also investigated the relationships between these ligaments and gross morphologic pattern of lateral complex and talus, including the morphological pattern of the peroneal groove and the relationship between the peroneal tendons before and after the peroneal groove.

RESULTS

The whole relationship of lateral ankle structures including anatomic and morphologic patterns and talus were evaluated. No morphologic variation was found concerning peroneus brevis and longus muscles. Although the existence of peroneus quartus muscle has been reported to be 6.6%, we detected it in two of our dissections (9%). We found a peroneus quinti in four of our dissections. We also found an extraordinary ligamentous structure that runs between the distal lateral process of the calcaneus and the inferior peroneal retinaculum in 12 of our dissections. A single form of the anterior talofibular ligament (ATFL) was observed in 23%, a bifurcate ATFL in 59% and the trifurcate ATFL in 18% of the dissected ankles in this study.

CONCLUSION

Understanding the detailed anatomy of lateral ligament complex of the ankle joint with their relationships to the osseous structures and biomechanics of the ankle can help increase the success of treatment on ankle pathologies.

Modified Evans technique improves plantar pressure distribution in lateral ankle instability

OBJECTIVES

Efficiency of the modified Evans technique based on clinical and radiological evaluations was determined by plantar pressure measurement.

PATIENTS AND METHODS

Eleven patients (2 females, 9 males; mean age 29 years; range 19 to 39 years) with chronic lateral ankle instability were surgically treated using the modified Evans technique. Plantar pressures of nine patients were measured pre- and post-operatively.

RESULTS

Plantar pressure below the first metatarsal head decreased in seven of the patients after surgery. Furthermore, in all of the patients, the time of initial contact decreased significantly and the pathology returned to normal limits in the postoperative period.

CONCLUSION

Modified Evans technique, despite its controversial long-term outcomes in lateral ankle instability, decreases first metatarsal head pressure and initial contact time significantly.

[A case of ancient schwannoma of the great toe]

Ancient schwannoma (degenerated neurilemmoma) is a rare form of schwannoma characterized by calcification and cystic degeneration. A 42-year-old male patient presented with a mass in the base of the left great toe, which had existed for eight years and undergone significant enlargement for the past six months. On physical examination, there was a mass, 3x2x2 cm in size, in the lateral aspect and base of the left great toe. Radiographic appearance of the feet was normal. The mass was removed by blunt dissection. No postoperative problems were seen. The histopathological diagnosis of the specimen was made as ancient schwannoma.

The removal of lignin and phenol from paper mill effluents by electrocoagulation

This study aims to investigate the treatment of paper mill effluents using electrocoagulation. Removal of lignin, phenol, chemical oxygen demand (COD) and biological oxygen demand (BOD) from paper mill effluents was investigated at various current intensities by using different electrodes (Al and Fe) and at various electrolysis times (1.0, 2.5, 5.0 and 7.5min). It was observed that the experiments carried out at 12V, an electrolysis time of 2min and a current intensity of 77.13mA were sufficient for the removal of these pollutants with each electrode. The removal capacities of the process using an Al electrode were 80% of lignin, 98% of phenol, 70% of BOD, and 75% of COD after 7.5min. Using an Fe electrode the removal capacities were 92%, 93%, 80% and 55%, respectively. In addition, it was found that removal of lignin, phenol, BOD and COD increased with increasing current intensity. In the experiments carried out at different current intensities, higher removal can be explained through a decrease in intra-resistance of solution and consequently an increase at the transfer speed of organic species to electrodes. It was also found that Al electrode performs higher efficiency than Fe electrode except for COD removal. However, the time required for removal of BOD was more than that of COD. The results suggest that electrocoagulation could be considered as an effective alternative to paper mill effluents treatment.

Synovial chondromatosis of four compartments of the knee: medial and lateral tibiofemoral spaces, patellofemoral joint and proximal tibiofibular joint

A case of synovial chondromatosis of the proximal tibiofibular joint in addition to lateral and medial tibiofemoral spaces and patellofemoral joint has been presented.

[Is there a correlation between severity of trauma and serum trace element levels?]

OBJECTIVES

Trace elements zinc and copper are effective in wound and fracture healing. In this prospective study, correlations between mangled extremity severity score (MESS) and mangled extremity syndrome index (MESI) and serum zinc and copper levels were investigated in trauma patients.

METHODS

Seventeen trauma patients (11 females, 6 males; mean age 41.6 years; range 11 to 73 years) were evaluated with respect to MESS and MESI scores. On the seventh day of trauma, serum samples were obtained to determine zinc and copper levels by atomic absorption spectrophotometry.

RESULTS

Serum levels of zinc and copper showed significant negative correlations with both MESS (r=-0.65 and r=-0.76, respectively) and MESI (r=-0.83 and r=-0.77, respectively) scores (p<0.05).

CONCLUSION

The severity of trauma is associated with significant decreases in serum levels of trace elements. Thus, trace element supplementation may be an important aspect of treatment in trauma patients.

[Evaluation of functional results in conservatively treated boxer's fractures]

OBJECTIVES

The aim of this study was to evaluate the effect of dorsal angulations up to 30 degrees on the grip strength in conservatively treated boxer's fractures.

METHODS

The grip strength of 18 patients was evaluated with the Jamar dynamometer following conservative treatment for neck fractures of the fifth metacarpal. All the patients were males with a mean age of 30.5 years. The results were compared with those of intact hands and a control group of 18 subjects (mean age 31.2 years). The mean follow-up period was 20 months (range 4 to 48 months).

RESULTS

The mean dorsal angulations before and after closed reduction were 46 degrees (range 35 degrees -55 degrees ) and 28 degrees (range 10 degrees -30 degrees ), respectively. Compared to the grip strength of intact hands and controls, no statistically significant functional loss was found in conservatively treated hands (p>0.05).

CONCLUSION

Since no significant functional loss occurs in the fifth metacarpal neck fractures having an angulation less than 30 degrees, the appropriate treatment seems to be conservative whenever this range of reduction is likely to be achieved.

Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications

BACKGROUND

The nature of polypoid lesions of the gallbladder is difficult to define before operation, and surgical indications still remain controversial. The aim of this study was to identify characteristics of each type of polypoid lesion of the gallbladder and indications for surgery.

METHODS

Clinical data were retrospectively correlated with the histopathologic characteristics of polypoid lesions in 100 patients who had cholecystectomy.

RESULTS

There were 74 benign polypoid lesions, including 39 cholesterol polyps, 20 adenomas, and 15 with adenomyomatous hyperplasia and 26 malignant polypoid lesions. Twenty-seven percent of patients with benign polyps and 73 percent of patients with malignant polyps were over 60 years of age. Polypoid lesions of the gallbladder were diagnosed by preoperative ultrasonography in only 36 patients (36%). All types of polypoid lesions of the gallbladder, whether benign or malignant, were frequently solitary, and gallstones coexisted in the majority of patients with all polypoid lesions of the gallbladder except cholesterol polyps. The lesions were > 10 mm in 88% of the malignant polyps and in only 15% of the benign polyps.

CONCLUSIONS

The risk factors for malignancy were the age of the patient ( >60 years), the coexistence of gallstones, and the size of the polypoid lesions (>10 mm in diameter). In asymptomatic patients, cholecystectomy can be justified if there are risk factors for malignancy.

Meat production characteristics of Turkish native breeds: I. Fattening, slaughter and carcass traits of lambs

The present study was conducted to determine the slaughter and carcass traits of male lambs of the Akkaraman (A), Morkaraman (M), Awassi (IW), Karayaka (KR), Kıvırcık (KV) and Middle Anatolian Merino (MAM) sheep breeds. Fattening of all lambs started when they were at 90 days at weaning and finished when they reached bodyweight of 40 kg. The cold dressing percentage of lambs of A, M, and IW breeds were significantly lower than those of KV, KR and MAM. Fat depth and muscle area were significantly greater in KV and MAM lambs than those of the other breeds. There were significant differences among breeds in shoulder, leg and lean weights. Weights of back loin in KV and MAM lambs were significantly greater than those of the other breeds. The highest values for carcass fleshiness were obtained in MAM and IW lambs, but they had a significantly lower carcass fatness score. There were significant differences among the breeds in carcass compactness and leg conformation. The results of the present study indicated that A and MAM breeds could be recommended for desirable carcass characteristics.Keywords: Carcass cuts, indigenous sheep breed, intensive lamb finishing, meat formation, SEUROP classification