Ahmet Issin

Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia.

The purpose of this study was to review the outcomes of transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe Type-III or IV developmental dysplasia. Seventy-three osteotomies were included in our study. Mean follow-up was 61 months. Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy, and femoral component stability were the criteria for evaluation. All complications were noted. The mean Harris hip score improved from 38.6 points to 83.7 points. The mean leg length discrepancy decreased from 56.5 mm to 10.7 at the latest follow-up. The mean union time was 5.2 months. We observed 4 non-unions. Transverse subtrochanteric shortening osteotomy is an effective and reliable method in restoration of a more normal limb.

Results of Hyaluronic Acid–Based Cell-Free Scaffold Application in Combination With Microfracture for the Treatment of Osteochondral Lesions of the Knee: 2-Year Comparative Study

PURPOSEnTo determine the clinical and radiographic efficacy of hyaluronic acid-based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint.nnnMETHODSnClinical data of 43 patients between 24 and 55xa0years of age were evaluated. Hyaluronic acid-based cell-free scaffold was applied in combination with microfracture for 19 knees (group 1), whereas microfracture alone was the surgical intervention for 24 knees (group 2). All lesions were Outerbridge grade III or IV with a mean size of 3.6 ± 1.3xa0cm2. The mean follow-up time was 25.7xa0months. Visual analog scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments used to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue.nnnRESULTSnBetter VAS and Lysholm scores were detected in group 1 at 12 and 24xa0months (Pxa0= .019 and Pxa0= .025). According to the Tegner activity scale, group 1 had also better activity level at the end of 24xa0months after surgery (Pxa0= .020). The mean time from surgery to return to nonimpact sports activities was 7.8xa0months in group 1, whereas it was 9.2xa0months in group 2 (Pxa0= .013). Complete repair with the filling of the defect was achieved in 7 (36.8%) of the knees in group 1, whereas it was 4 (16.6%) of the knees in group 2 according to the MOCART system at 24xa0months.nnnCONCLUSIONSnSingle-stage regenerative cartilage surgery using hyaluronic acid-based cell-free scaffold in combination with microfracture for focal osteochondral lesions of the knee revealed promising clinical outcomes at 24xa0months of follow-up, but the clinical significance of the differences seen is simply not known.nnnLEVEL OF EVIDENCEnLevel III, retrospective comparative study.

Short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction

AbstractPurposenThis study aims to analyse the short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction surgery.MethodsClinical outcomes of 19 patients who had partial medial meniscectomy and anterior cruciate ligament reconstruction during the same surgery (Group 1) were compared with the outcomes of 25 patients who had also reconstruction but did not have any meniscal lesion (Group 2). Median follow-up time was 29xa0months (range 12–67xa0months) in Group 1 and 27xa0months (range 12–70xa0months) in Group 2. Feeling of apprehension in sports activities, International Knee Documentation Committee (IKDC) score, KT-2000 Arthrometer® measurements and post-operative time to return to sports activity were the criteria for data analysis.ResultsEight patients (42xa0%) in Group 1 and 5 patients (20xa0%) in Group 2 stated feeling of apprehension in sports activities. IKDC score improved to A in 11 patients (58xa0%) from Group 1, and 18 patients (72xa0%) from Group 2. Mean anterior translation according to KT-2000 arthrometer measurements was 5.2xa0±xa01.3xa0mm in Group 1, and 4.6xa0±xa01.3xa0mm in Group 2. Post-operative time to return to sports activity was 8.5xa0±xa03.0xa0months in Group 1, and 6.5xa0±xa02.2xa0months in Group 2.ConclusionPartial meniscectomy for irreparable medial meniscal tears, applied during the same surgery with anterior cruciate ligament reconstruction, negatively affects the clinical outcomes in the short-term follow-up. This study may be a reference for long-term clinical trials and also future investigations of new methods in the treatment of similar cases.Level of evidenceIV.

Cementless total hip arthroplasty in patients with Crowe type-4 developmental dysplasia

Background Developmental dysplasia of the hip is one of the most common causes of secondary osteoarthritis. The purpose of our study was to review clinical and radiological outcomes of reconstruction surgery using cementless total hip arthroplasty in patients with Crowe type-IV dysplastic hips. Methods This study included eighty-seven primary total hip arthroplasties performed between January 2005 and January 2010 at our clinic in 74 patients who had Crowe type-IV developmental dysplasia of the hip. Cementless total hip arthroplasty was applied in all hips. At the clinical status analysis, any limping, the Harris hip score, surgical approach, the use of bone grafts, the presence of femoral osteotomy, any component migration, union status of the osteotomy site (if present), and any osteolysis or heterotopic ossification were noted. Mean follow-up time was 4.8 years. Results Mean Harris hip score was improved from 41.8 points preoperatively to 86.2 points postoperatively (p<0.001). At the final clinical examination, none of the patients had severe limping. Restoration of the anatomical hip centre was achieved in all hips. Pseudoarthrosis of the femoral osteotomy site was seen in two hips (3.6%). Twelve hips (13.8%) underwent revision surgery. Neurological complications were seen in two hips (2.3%). Heterotopic ossification was detected in one hip. conclusion Cementless total hip arthroplasty with restoration of the anatomic hip centre resulted in satisfactory clinical outcomes in patients with secondary coxarthrosis due to Crowe type IV developmental dysplasia of the hip joint.

Comparison of open reduction alone and open reduction plus Dega osteotomy in developmental dysplasia of the hip.

In the treatment of developmental dysplasia of the hip, concentric reduction of the femoral head into the acetabular cavity plays a key role in the natural development of the acetabulum. However, there is still debate on the need for additional acetabular osteotomies and their timing. In this study, we compared open reduction (OR) alone with OR plus Dega osteotomy for acetabular index (AI) development. Twenty patients, 10 in each group, who underwent either OR alone or OR plus Dega osteotomy were studied retrospectively. All patients were diagnosed with developmental dysplasia of the hip and none of them received treatment previously. Preoperative, early postoperative, and follow-up radiographs were gathered, radiological grading was performed according to Tönnis, and AI angles were measured. The OR group had a mean age of 24.5 months, whereas the Dega group had a mean age of 24.8 months. The mean follow-up period of the OR group and Dega group was 57.8 and 66.6 months, respectively. In the OR group, the initial mean AI was 37.5° whereas in the Dega group it was 46°. After the follow-up, despite the acetabular development in the OR group being twice as fast, the final mean AI was 25.5, whereas it was 15.9 in the Dega group. The difference was statistically significant (P<0.05). Using Tönnis’ definition, the Dega group ended up with 70% normal hips, 20% mild dysplasia, and 10% severe dysplasia, whereas the OR group had 20% normal hips, 30% mild dysplasia, and 50% severe dysplasia at the final visit. There was no correlation between the initial radiological grading of dislocation and the final result. OR plus Dega osteotomy is a good option to regain acetabular coverage over the femoral head. It provides better radiographic results after a 5-year follow-up period in patients with a mean age of 25 months. OR alone should not be performed unless the child had mildly dysplastic acetabulum according to Tönnis’ definition. Level of evidence: Level III, retrospective comparative study.

Recurrent anterior shoulder instability: Review of the literature and current concepts

The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends on the procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.

Epidemiologic Properties of Pediatric Fractures in a Metropolitan Area of Turkey.

AbstractOccurrence of fractures is highly dependent on lifestyle. Domestic data should be used when needed. In this cross-sectional study, the authors aim to find the most recent distribution of pediatric fracture types and the attributes of fracture occurrence within a large sample size in a metropolitan area of Turkey.This study consists of 4879 pediatric age patients with a fracture who took advantage of the emergency service of a trauma center in a metropolitan area between March 2010 and December 2013 (1397 days). Date, hour, age, sex, fracture type, and social security status of the patients were studied.A total of 65% of the patients were men and 35% were women. A total of 81% of the fractures were in the upper extremities, whereas 19% of them were in the lower extremities. In 22 patients (0.5%), there were open fractures. Fractures showed some seasonal, daily, and circadian variations. Different types of fractures showed some specific patterns in different age groups. Ankle, elbow, and shoulder fractures were more common in girls, whereas wrist and forearm fractures were more in boys and the difference was statistically significant (Pu200a<u200a0.05).Fractures in pediatric ages vary depending on the age, sex, season, and the hour of the day. Types of fractures show some obvious patterns especially depending on the age. This data can be useful in making optimizations in fracture care units. Considering these specific patterns would enable more effective planning of providing preventive measures for pediatric injuries.

Local anaesthetic resistance in a young woman with history of scorpion bite

Sir, n nWe witnessed a case of a young woman who had obvious resistance to various local anaesthetics applied in various techniques during the different surgeries. Articles of Panditrao et al. that were published in your journal highlighted this phenomenon, and we wanted to contribute to the subject.[1,2,3] n nOur patient was a 21-year-old Caucasian female who was diagnosed with volar wrist ganglion and surgery was planned. Exsanguination was done using Esmarch bandage, and double bladder pneumatic tourniquet inflated to 250 mm Hg. Intravenous regional anaesthesia was performed using 200 mg lignocaine (%2 Aritmal, OSEL, Istanbul, Turkey) diluted with 0.9% saline in a total of 20 cc injector. Approximately 15 min later, we checked the anaesthesia with a soft touch and picking the skin with forceps and it seemed fine, then the first incision was made. The patient immediately reported pain. The operation was stopped and an additional 200 mg lignocaine was injected to the incision area subcutaneously. That injection ceased the pain for a couple of minutes then the patient reported mild to severe pain again. Sedation with midazolam was provided and surgery was finished speedily. n nThe same patient developed a keloid scar after a month. Corticosteroid injection was tried under local anaesthetic but patient felt excessive pain during the process, thus it could not be completed. Two months after the first surgery, the patient complained about the cosmetic problem and surgical removal of the keloid was recommended. Subcutaneous local anaesthesia was tried using 200 mg prilocaine (10 cc 2% Citanest, Eczacibasi, Kirklareli, Turkey). The patient reported severe pain a couple of minutes after the surgery began. Then an additional 50 mg bupivacaine (10 cc, 0.5% Marcaine, Zentiva, Kirklareli, Turkey) was injected to the edges of the incision. After this injection, a couple of minutes were painless but then she began to feel it again and wound closure was done rapidly. n nDetailed history of the patient revealed that she had ‘difficult’ epidural anaesthesia during caesarean section procedure previously and thus they switched to general anaesthesia. Because all the anaesthetics we used on the patient were amide type, we offered the patient to try further anaesthetic agents on her forearm skin to find out what works for her but she did not accept it. n nFailure of local anaesthesia is generally due to technical problems. Additional injections and adequate waiting time usually solves the problem. In our case, different techniques and anaesthetics were used; during all such attempts, it is difficult to attribute the problem due to technique and agents. After reading about scorpionism suspicion by Panditrao et al. (above) we contacted the patient and asked about it. Our patient was living in a region where scorpion encounters were very common. She told us that she had scorpion bites when she was younger but no history of being bitten recently. n nScorpion species differ among geographic and climatic regions. The region of Turkey where our patient lives has Androctonus crassicauda and Mesobuthus eupeus species dominantly, both are in Buthidae family. Even though topical lignocaine is found to be the most effective drug in reducing local pain after acute scorpion stings,[4] resistance might be a late onset entity and should be investigated. Scorpion venom is known to bind sodium channels, which play the main role in the mechanism of action of local anaesthetics. Any relation with specific scorpion venoms and local anaesthetics should be checked by controlled experiments. n nIn all reported cases, amide type local anaesthetics were used. Trying ester type of local anaesthetics on those patients who are suspected to be resistant would at least eliminate one variable about this phenomenon.

Predictors of the clinical outcome and survival without degenerative arthritis after surgical treatment of femoroacetabular impingement

BACKGROUNDnThe main purposes of the present study were to evaluate the functional improvement, to identify the predictors of the clinical outcome after open surgical management of femoroacetabular impingement (FAI) in mid-term, and to determine 5-year survival rate.nnnMETHODSnIn this retrospective study, the clinical data of 33 patients (34 hips) were evaluated. Sex, age, body mass index (BMI), type of FAI, duration of symptoms up to surgical treatment, internal rotation of the affected hip, improvement of the Harris hip score (HHS) in the first 2 years, joint space narrowing evaluated radiographically and classified according to Kellgren-Lawrence classification, and any labral tear were the independent variables. Harris hip score and degenerative arthritic changes at the latest follow-up were identified as outcome measures. Univariate and multivariate analyses were performed. The mean post-operative follow-up was 6 years.nnnRESULTSnHarris hip scores at the latest follow-up were significantly worse in patients with a pre-operative age >35 years, BMI ≥25xa0kg/m2, internal rotation of the hip ≤10°, grade 1 or 2 joint space narrowing, labral tear, and <15 points improvement of the HHS at the first 2 years follow-up. According to multivariate analysis; major predictors of the outcome were BMI, labral tear, and improvement of the HHS at the first 2 years.nnnCONCLUSIONSnA pre-operative BMI ≥25xa0kg/m2, labral tear, and <20 points improvement of the HHS in the first 2 years of surgery should be considered as the major predictors of the clinical outcome after open surgical management of idiopathic FAI.

Operative Treatment of the Ingrown Toenail With a Less-Invasive Technique: Flashback to the Original Winograd Technique

Objective: The aim of this study was to evaluate the results of the partial nail plate excision and curettage of nail bed and matrix (the original Winograd technique) in patients with ingrown toenail. Materials and methods:Patients with ingrown toenail who were treated surgically from May 2014 to June 2015, with a minimum follow-up of 1 year were included in this study. Those who had previous ingrown toenail surgery were excluded. Partial nail plate excision with curettage of nail bed and nail matrix was performed for all patients. Rifampicin soaked sterile gauze was placed onto the wounds after the procedure. Results:The study population included 100 males and 89 females with a mean age of 30 years. Eight patients (4.2%) had stage 1, 71 patients (37.6%) had stage 2, and 110 patients (58.2%) had stage 3 ingrown toenails. The mean operation time was 4.8 minutes. No complication occurred during the procedure. It was found that 15 patients (7.9%) had recurrence during the follow-up. Conclusion:The original Winograd technique is an efficient and less-invasive technique for the treatment of ingrown toenail, with lower rates of recurrence and complications. Levels of Evidence: Therapeutic Case Series Study, Level IV