Ahmet Salduz

Functional results of the parallel-plate technique for complex distal humerus fractures

OBJECTIVES We evaluated functional results of patients treated with open reduction and internal fixation with the parallel-plate technique for complex distal humerus fractures. METHODS Twenty-one patients (14 males, 7 females; mean age 47 years; range 16 to 85) underwent open reduction with olecranon osteotomy and internal fixation with the parallel-plate technique for distal humerus fractures accompanied by highly intra-articular or metaphyseal comminution (n=10), intra-articular comminution and osteoporosis (n=7), and intra-articular and metaphyseal comminution with bone loss (n=4). According to the AO classification, there were 12 C3, six C2, and three C1 type fractures. Eight patients had open fractures. The mean time to surgery was six days (range 1 to 17 days). Functional results were evaluated using the Mayo elbow performance score, Jupiter elbow score, and DASH (Disabilities of the Arm, Shoulder and Hand) score. The mean follow-up was 28 months (range 12 to 48 months). RESULTS The mean total range of motion was 90.2+/-31.1 degrees, flexion was 118.1+/-17.4 degrees, and extension was 27.8+/-17.4 degrees. The mean Mayo elbow performance score and DASH score were 86.1+/-12.6 and 7.6+/-9.5, respectively. According to the Jupiter elbow scores, the results were excellent in seven patients, good in 11 patients, moderate in two patients, and poor in one patient. Radiographically, solid union was achieved in all the patients. Heterotopic ossification of varying degrees was seen in seven patients, two of whom underwent resection of heterotopic ossification due to severe limitation of movement. Debridement was performed in one patient due to the development of deep infection. Chondrolysis of the elbow occurred in one patient. Patients with open fractures had significantly lower range of motion than those with closed fractures (p<0.05), but the Mayo elbow performance score and DASH score did not differ significantly in this respect (p>0.05). CONCLUSION Functional results are satisfactory in distal humerus fractures treated with stable osteosynthesis and parallel-plate technique that allow early active motion.

Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study

Objective The aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total knee arthroplasty (TKA). Material and method 70 patients (65.5 ± 8.1 years old) that have undergone TKA were divided in two groups. The 20 mg/kg IV TXA was given before the skin incision to one group (study group). On the control group, TKA was performed without TXA. The demographic data, body mass index, amount of bleeding and erythrocyte infusion during the operation, hemoglobin and hematocrit values (preoperative and 48th hour), the amount of drainage after the operation were compared between the groups. Results The total amount of bleeding in the study group was 634.03 ± 182.88 ml and 1166.42 ± 295.92 ml in the control group (p < 0.001). Perioperative bleeding was 252.01 ± 144.13 ml in the study group and 431.33 ± 209.10 ml in the control group (p = 0.018). The drainage after the operation was 311.11 ± 141.64 ml at the 24th hour in the study group, 640.74 ± 279.43 ml at the 24th hour in the control group (p < 0.001). The drainage after 24th hour was 97.96 ± 115.86 ml in the study group and 112.96 ± 64.43 ml in the control group (p = 0.584). Conclusion A high, single dose of TXA intravenously given to the patient prior to the TKA significantly reduces the bleeding during the operation and within the postoperative 24 h. There is no significant change in the bleeding amount after the 24th hour following the operation.

Stiff elbow: Distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results

OBJECTIVE The aim of this study was to evaluate the long-term radiological and functional results of distraction interposition arthroplasty using an Achilles tendon allograft. METHODS The study included 5 patients (3 females and 2 males; mean age: 31 years, range: 25 to 41 years) who underwent distraction interposition arthroplasty for stiff elbow and arthrosis due to intrinsic factors between 2001 and 2010. Interposition with fresh-frozen Achilles allograft and collateral ligament reconstruction were performed in all patients. Mean follow-up period was 87.6 (range: 40 to 131) months. Mean distraction time with an external fixator was 7 (range: 6 to 8) weeks. Elbow motion was allowed in the first postoperative day in all patients. Radiological evaluation was performed pre- and postoperatively. Elbow ROM, and the Mayo Elbow Performance Score (MEPS) and DASH scores were recorded for functional evaluation. RESULTS Mean preoperative flexion-extension range was 24° (range: 0° to 80°) and mean supination-pronation range was 15°. Two patients had elbow ankylosis in 90° and 60° of flexion at the preoperative examination. Mean postoperative flexion-extension range increased significantly to 81° (range: 50° to 110°) (p<0.05). Mean preoperative DASH score improved from 75.3 (range: 53 to 89) to 18.9 (range: 6.7 to 45.8) postoperatively (p<0.05). Mean postoperative MEPS were poor (mean: 25, range: 20 to 35) while postoperative MEPS were good (mean: 71, range: 70 to 75) in 4 patients and fair in 1 (p<0.05). No patient experienced elbow instability at the final follow-up and none required revision. CONCLUSION Distraction interposition arthroplasty is a salvage procedure which appears to have good long-term functional results, especially in patients in which elbow arthroplasty is not suitable. The use of Achilles allograft for interposition can protect the joint space in the long-term.

Long-term result of treatment for paraspinal and extradural hydatid cyst: a case report

Hydatid cyst is a zoonosis affecting any part of the body and presenting difficulty in diagnosis and treatment. Primary bone involvement seen in about 2% of the cases is accompanied by spinal involvement in 50%. A 41-year-old female presented with low back pain radiating to the left leg. After physical examination, radiologic and laboratory investigations, a diagnosis of spinal hydatid cyst was made with intraspinal extradural, vertebral, and paravertebral involvement. The patient was treated with two-staged posterior and anterior surgical resections with addition of pre- and postoperative antihelminthic therapy. No recurrences developed within a follow-up of 5.5 years. Recurrences can be reduced by initiation of antihelminthic therapy preoperatively, perioperative injection of scolicidal agents into the cyst, and careful excision of the cyst without spread to neighboring tissues.

Reverse shoulder arthroplasty: radiological and clinical short–term results

OBJECTIVE The aim of this study was to examine the radiological and clinical short term results of the patients who underwent reverse shoulder arthroplasty for rotator cuff arthropathy. METHODS The study included 14 (2 male, 12 female) patients who underwent reverse shoulder arthroplasty for rotator cuff arthropathy between 2009 and 2010. The mean age of the patients was 74 (57-80) years and the mean follow-up period was 32 (21-40) months. Radiological methods as well as the range of motion, Quick DASH, Constant and VAS scores were used for the evaluation of patients preoperatively and at last the follow-up. RESULTS Mean active forward flexion, abduction and external rotation increased respectively from 44, 41 and 21 degrees preoperatively to 149, 105 and 37 degrees at the last follow-up. The mean Quick-Dash score was 59.1 degrees preoperatively, and 36.1 degrees at the last follow-up visit. The mean Constant score increased from 20.7 preoperatively to 58.9 at the last follow-up visit. The mean VAS score decreased from 7 preoperatively to 1.2 at the last follow-up visit. The mean acromion-humeral head distance increased from 5.3 mm preoperatively to 23.1 mm postoperatively. None of the patients had major complications. CONCLUSION Reverse shoulder arthroplasty in patients with advanced stage rotator cuff tear arthropathy ensure significant improvement in terms of pain and function with the help of an appropriate rehabilitation protocol.

Intraneural ganglion cyst of the ulnar nerve in an unusual location: A case report

Highlights • Intraneural ganglion cysts are benign, mucinous, non-neoplastic lesions of the peripheral nerves that arise from the epineurium.• An intraneural ganglion cyst involving the superficial branch of the ulnar nerve is a unique presentation.• Regarding etiopathogenesis of the intraneural ganglion cysts, the latest and most affirmed theory is the unifying articular (synovial) theory.• It is important to realize a related articular branch, otherwise the origin of cyst formation remains, and this may cause other para-articular cysts.• Use of new 3-dimensional fast-spin echo-extended echo train MRI sequences may provide better visualization of the intraneural ganglions.

A rare cause of 'drop foot' in the pediatric age group: Proximal fibular osteochondroma a report of 5 cases.

INTRODUCTION The fibular nerve is the most frequent site of neural entrapment in the lower extremity and the third most common site in the body, following the median and ulnar nerves. The peroneal nerve is commonly injured upon trauma. Additionally, a dropped foot might be a symptom related to the central nervous system or spinal pathologies in pediatric patients. Entrapment of the peripheral nerve as an etiologic cause should be kept in mind and further analyzed in orthopedic surgery clinics. PRESENTATION OF CASE In this study, the evaluation and treatment results of five patients with no history of trauma, who underwent diagnostic procedures and treatment in various clinics (physical therapy and rehabilitation and neurosurgery), are reported. The patients underwent several treatments without diagnosis of the primary etiology. Upon initial consultation at our department, osteochondroma at the proximal fibula was detected after physical examination and radiologic assessment. During surgery, the peroneal nerve was dissected, starting from a level above the knee joint. Following nerve release, the osteochondroma was removed, including its cartilage cap. Consequently, recovery was observed in all five cases after surgery. DISCUSSION Many factors may cause non-traumatic neuropathies. However, due to their rare occurrence, lesions such as osteochondromas may be overlooked at non-orthopedic clinics. Nerve entrapment due to proximal fibular osteochondroma is rare. Surgical treatment planning plays a critical role in nerve entrapment cases. CONCLUSION Despite its frequent occurrence, a drop foot associated with peroneal nerve entrapment by an osteochondroma is not easily remembered and diagnosed. Especially in pediatric cases, inadequate clinical consultation and a lack of appropriate radiologic studies may result in a delay in diagnosing peroneal nerve lesions.

Calcaneal Ewing's Sarcoma With Skip Metastases to Tarsals and Lymph Node Involvement: A Case Report

Ewings sarcoma (ES) represents the second most common primary malignant tumor of bone of children and occurs rarely in the bones of the foot. Dissemination to regional lymph nodes and skip metastases to adjacent bones are thought to be uncommon. We report a case of a 19-year-old female with the diagnosis of ES of the right calcaneus. Six months earlier, she had presented to the hospital with a history of ankle sprain and was treated with analgesics and ice application. Despite the treatment, the pain over the ankle persisted, her foot swelled progressively, and a mass evolved on the lateral side of the foot. She was referred to our clinic for further treatment options. Radiography and magnetic resonance imaging revealed an expansile mass originating from the calcaneus with talar and cuboidal skip metastases, with concomitant popliteal and inguinal lymph node involvement. The diagnosis was confirmed by histopathologic evaluation after Tru-Cut biopsy. Below-the-knee amputation with popliteal and inguinal lymph node dissection was performed after neoadjuvant chemotherapy. The postoperative first-year follow-up data for the patient showed no evidence of metastasis. The calcaneus is a rare location for the development of ES. A few patients with ES will present with skip metastases to adjacent juxtaarticular bones or regional lymph node involvement. Therefore, the present study has presented a unique case of ES with a rare anatomic location and an unusual metastatic pattern.

Effects of NSAIDs and hydroxyapatite coating on osseointegration: Biomechanical and histological study on rabbits

Purpose: The aim of our study is to investigate the bone ongrowth of two different alternative surfaces and the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on osseointegration. Methods: Hips of 40 New Zealand white rabbits were operated bilaterally. Hydroxyapatite (HA)-coated titanium rods were implanted into the right femur, and grit-blasted titanium rods were implanted into the left femur. They were divided into three groups. At the end of 8 weeks, both femora of the rabbits were removed and investigated biomechanically and histologically. Results: HA-coated implants had a significantly better failure load and “percentage of bone–implant contact” than grit-blasted implants. There was no significant difference between the medication groups as a result of the biomechanical and histologic investigations. Conclusions: Our results indicate that NSAIDs did not have any negative effect on the osseointegration. HA-coated implants may provide more tensile strength and greater bone–implant contact rate in comparison with grit-blasted implants.

Surgical Treatment of an Infected Nonunion of the Middle Third of the Femur Associated with Femoral Shortening in a Hemophilia Patient

The management of nonunion and limb length discrepancy has remained a constant challenge in hemophilic patients. In this study, we aimed to present the treatment of femur infected nonunion and limb length discrepancy in a twenty-seven-year-old patient with hemophilia type A. A 27-year-old male patient with hemophilia type A referred to our institution for the treatment of right femur infected nonunion and 10 cm shortness of the femur. Resection of the nonunion site and bone-to-bone fixation with autologous bone grafting were performed. Compression to the pseudoarthrosis site and distraction from new osteotomy site were applied with the unilateral external fixator. Union was achieved, and 6 cm lengthening was obtained according to the initial length. Patient was followed up for 7 years. After this treatment, the patient is able to walk with full weight bearing on the affected extremity with 4 cm shortening which is compensated by the heel lift. The results of this case indicate that limb lengthening and treatment of nonunion with the external fixation could be reliable and effective method for hemophilic patients.