Alpaslan Öztürk

Osteochondral autografting (mosaicplasty) in grade IV cartilage defects in the knee joint: 2- to 7-year results

The use of autologous osteochondral grafts (mosaicplasty) to repair articular cartilage defects is a well-established technique. Between 1998 and 2003, 19 patients with grade IV cartilage defects in the knee joint were treated by mosaicplasty. The average age of these 13 men (68%) and six women (32%) was 33.1 years (20–46). The mean follow-up was 32.4 months (84–24). The mean preoperative and postoperative Lysholm score was 45.8 (21–60) and 87.5 (74–100), respectively (p<0.001). Postoperative evaluation showed significant improvement. The results at the last follow-up were excellent in seven patients (27%), good in 11 patients (58%) and fair in one patient (15%). Preoperative complaints of pain, crepitation and locking disappeared in all patients. Magnetic resonance imaging (MRI) examination at the last follow-up visit revealed that congruency was restored in 16 (84.2%) without any signs of fissuring or delamination but in three patients (15.8%) a 1-mm difference between graft and recipient surface was detected. No complications were observed in the patients. Mosaicplasty is a really effective method of treatment for grade IV cartilage lesions in the knee joint.RésuméLa technique de la mosaïc–plastie utilisant des greffes ostéocartilagineuses autologues pour réparer les dommages articulaires est une technique actuellement bien établie. Entre 1998 et 2003, 19 patients avec des lésions cartilagineuse de grade IV au niveau de l’articulation du genou, ont été traités par mosaïc–plastie. L’âge moyen de cette population (13 hommes 68% et 6 femmes 32%) était de 33,1 ans (20–46), le suivi moyen a été de 32,4 mois (84–24). Le score de Lysholm pré–op et post–op a été de 45,8 (21–60) et 87,5 (74–100) (p<0,001). L’évaluation post–opératoire a montré une amélioration significative, avec un résultat excellent chez 7 patients (27%), bon chez 11 patients (58%) et médiocre chez 1 patient (15%). La symptomatologie préopératoire (douleurs, craquements et blocages) a disparu chez tous les patients. L’examen IRM au dernier contrôle a montré que la cicatrisation était bien restaurée chez 16 patients (84.2%), sans signe de fissuration ni de délamination mais avec, chez 3 patients (15,8%) une différence d’un millimètre entre la greffe et le site receveur. Aucune complication n’a été observée chez ces patients. La mosaïc–plastie est une technique sûre et efficace du traitement des lésions cartilagineuses de grade IV au niveau du genou.

The effects of human amniotic membrane and periosteal autograft on tendon healing: experimental study in rabbits

In this study, the effects of periosteal autograft and human amniotic membrane on tendon healing were compared. Forty-two New Zealand rabbits were divided into three groups. Flexor digitorum fibularis tendons were cut and repaired with a modified Kessler technique and circumferential sutures in all groups. Tendon repair alone was carried out in group 1, tendon repair and application of human amniotic membrane was done in group 2 and tendon repair and application of periosteal autograft was done in group 3. Biomechanical and histopathological examinations were done 2 and 6 weeks postoperatively. Biomechanical examination showed that group 3 was the strongest at weeks 2 and 6. Adhesion, inflammation and new bone formation showed no difference between groups at week 2. However, adhesion formation was found to be less in groups 2 and 3 than group 1 at week 6. The application of periosteal autograft might be useful in repair of tendon injuries.

Interpositional Arthroplasty with Extensor Digitorum Brevis Tendon in Freiberg's Disease: A New Surgical Technique

Background: Freibergs infraction is an osteochondrosis of a lesser metatarsal head resulting in joint degeneration. There is no consensus regarding the management of these lesions. Here, we describe an interpositional arthroplasty using extensor digitorum brevis tendon as a solution for Freibergs disease. Materials and Methods: Between 2003 and 2006, 6 women and 4 men with Freibergs disease unresponsive to conservative treatment were operated with interpositional arthroplasty with extensor digitorum brevis tendon. Mean age was 34 (range, 20 to 48) years and followup time 24.6 (range, 12 to 36) months. The transferred tendon was passed through a tunnel, centered, stabilized and rolled into a ball following the debridement of joint. According to the Smillie classification, there were 3 grade II, 5 grade III, and 2 grade IV. The AOFAS scoring system was used for clinical assesment. Results: The mean preoperative and postoperative AOFAS scores were 58.3 (range, 44 to 77) and 80.4 (range, 67 to 100), respectively. The complaint of pain with joint motion was decreased in all patients except one. The postoperative passive range of motion of joints did not differ significantly. We found 4 excellent (40%), 5 good (50%) and 1 poor (10%) result. Conclusion: We recommend our technique of interpositional arthroplasty with the extensor digitorum brevis tendon because it is free of additional donor site morbidity. It can be performed easily without specialized instruments. Also, the use of natural tissue eliminates potential foreign body reactions and risk of infection.

Nonunion of a Hoffa fracture in an adult

The coronal fractures of femoral condyles, known as Hoffa fractures, are a rarity. Conservative management often leads to unsatisfactory results and nonunion. In this study, we present a case of a 35-year-old patient with an established nonunion of medial Hoffa fracture of right knee treated with open reduction and internal fixation.

Foot mobility and plantar fascia elasticity in patients with plantar fasciitis

OBJECTIVES In this study, we investigated the radiologic changes of feet in sagittal plane under weightbearing either with or without plantar fasciitis. METHODS The study includes 64 feet of the 42 subjects with heel pain (Group 1: 32 women, 10 men, mean age 48 years, range 33-57 years) and 80 feet of the 40 patients (Group 2: 30 women, 10 men, mean age 47.2 years, range 35-56 years) without heel pain. Calcaneal inclination angle (CIA), calcaneal-first metatarsal angle (CMA), and plantar fascia length (PFL) were measured in the lateral radiographs of the weightbearing and non-weightbearing foot. The values of Group 1 and Group 2 were compared. RESULTS The mean CIA was 26° (range 18-35°), CMA was 121° (range 115-133°), and PFL was 131 mm (range 110-158 mm) in non-weightbearing position for Group 1. The mean CIA was 27° (range 17-38°), CMA was 122° (range 110-135°), and PFL was 136 mm (range 120-155 mm) in non-weightbearing position for Group 2. The mean CIA was 13.6° (range 5-25°), CMA was 138° (range 130-153°), and PFU was 143.8 mm (range 118-158 mm) in weightbearing position for Group 1. The mean CIA was 9.9° (range 4-25°), CMA was 145° (range 130-155°), and PFU was 151.4 mm (range 137-167 mm) in weightbearing position for Group 2. The difference between CIA, CMA, and PFL values were -13°, 17°, and 12 mm under condition of weightbearing and nonweightbearing position values for Group 1; and -17°, 23°, and 15 mm for Group 2. The differences were significant between weightbearing and non-weightbearing position values (p<0.05). CONCLUSION The reduced CIA, CMA, and PFL changes during weight bearing might show reduced foot mobility and plantar fascia elasticity, which may lead to posterior heel pain syndrome.

Subperiosteal Osteoid Osteoma in the Hallux of a 9-year-old Female

Osteoid osteoma arising in the phalanx is rather uncommon, and although the clinical and radiographic findings can be characteristic, the diagnosis is not always clear. In this article, we describe the case of a 9-year-old female who presented with a painful toe that, after careful evaluation and excisional biopsy, was determined to be caused by subperiosteal osteoid osteoma. The lesion was treated successfully with excision of the nidus.

Functional and radiological results of percutaneous K-wire aided Métaizeau technique in the treatment of displaced radial neck fractures in children

Objectives The aim of the present study was to determine the radiological and functional results and the efficiency of paediatric radial neck fracture fixation following reduction with the Métaizeau technique together with percutaneous K-wire applied under fluoroscopy to ensure minimum soft tissue damage. Methods The study included 20 patients with Judet Type 3, Type 4a and Type 4b fractures operated on with the Métaizeau technique aided by percutaneous K-wire between 2007 and 2014. The mean age of the patients was 9.75 years (range, 4–13 years). Mean preoperative angulation was measured as 52.4° (range, 35°–85°). The average postoperative follow-up time was 34.65 months (range, 13–84) months. Postoperative radiological evaluations were made according to the Ursei classification and functional assessment with the Tibone – Stoltz classification system. Results Radiologically, the difference between preoperative and postoperative radius head angulation was found statistically significant (p0.001). In the clinical assessment of injured and uninjured arms, there was no statistically significant difference between flexion-extension (p = 0.330) and supination-pronation range of motion (p = 0.330) and carrying angles (p = 0.094). According to the radiological Ursei evaluation, 17 (85%) patients were in perfect condition and 3 (15%) were good. In the classification of Tibone – Stoltz, 16 (80%) patients were evaluated as perfect, 3 (15%) as good and 1 (5%) as fair. Conclusion From the results of this study and related literature, the use of the Métaizeau technique in displaced radial neck fractures requiring surgical treatment in children can be recommended since it creates minimum damage to the soft tissue, is easy to apply and the results are satisfactory. Level of evidence Level IV, therapeutic study.

Scarf osteotomy or Mau osteotomy for correction of moderate to severe hallux valgus deformity: a prospective, randomized study

Objective. The aim of this study was to compare the clinical and radiological results of Mau osteotomy and Scarf osteotomy with a modified McBride procedure to patients with moderate to severe hallux valgus deformity. Methods. The study included 40 feet which patients were separated into 2 groups followed up for 5 months. Scarf osteotomy was applied to 20 patients including 16 females and 4 males (Scarf group)) and a Mau osteotomy to 20 patients including 17 females and 3 males (Mau group). Radiological measurements were taken preoperative, postoperative and at the final follow-up examination of the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), metatarsocuneiform angle (MCA), the 1 st metatarsophalangeal joint congruity, 1 st metatarsal length, fibular sesamoid subluxation rate. Clinical evaluation was made according to the American Orthopaedic Foot and Ankle Society (AOFAS) and the severity of pain was assessed with the visual analog scale (VAS). Results. There was n o difference between the groups in term of the mean HVA, IMA, MCA and DMAA values in preoperative and postoperative measurements. A significant improvement was determined in all the angle values in Scarf and Mau group ( p < 0.001). A significant increase in DMAA and shortening in the metatarsal length were determined in Mau group compared to Scarf group ( p < 0.001). An improvement in joint congruity was seen in the goups ( p < 0.001). There was a significant improvement in term of the AOFAS and VAS values in the groups ( p < 0.001). Conclusion. Scarf and Mau osteotomies can provide the desired level of improvement in the short-term follow-up results of moderate to severe hallux valgus deformity, taking into consideration the clinical importance that complications are not formed.

Simultaneous posterior dislocation of primary total knee arthroplasty with ipsilateral tibial shaft fracture: A case report and review of literature

Dislocation following total knee arthroplasty (TKA) is a rare but serious complication. Here, a 74-year-old woman with posterior dislocation of her right cruciate-retaining TKA and ipsilateral tibia diaphysis fracture was presented. She only slipped down on the ground with a quick twist of her right leg. She underwent revision semiconstrained TKA and osteosynthesis of tibial fracture with plate and screw. Her partially avulsed patellar tendon was repaired as well. She was ambulatory with a cane and satisfied with revision operation at last control. Extensor mechanism and functional posterior cruciate ligament is especially important in patients receiving cruciate-retaining TKA. As far as we know, simultaneous dislocation of TKA with fracture of tibia diaphysis has never been reported before.

A new method to correct rotational malalignment for closed reduction and percutaneous pinning in pediatric supracondylar humeral fractures

Open reduction is often necessary for the treatment of supracondylar humeral fractures in children in which rotational malalignment cannot be corrected by closed means. We introduce a new closed reduction technique for the correction of this deformity using a Kirschner wire as a joystick.