Bahattin Kerem Aydin

Short-term functional outcomes of first metatarsophalangeal total joint replacement for hallux rigidus.

Background: Although metatarsophalangeal (MTP) arthrodesis has been advocated by many authors, implant arthroplasty appears to be successful option in advanced hallux rigidus (HR). The aim of our study was to evaluate the early results of the ToeFit-Plus prosthesis for the treatment of HR. Methods: Between December 2007 and January 2011, a total of 26 toes of 24 patients with MTP arthritis of the great toe were treated with ToeFit-Plus implant. The average follow-up time was 29.9 (range: 25 to 62) months. All patients were evaluated clinically and radiographically. Postoperative satisfaction and function were scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Pain was assessed with the use of a visual analogue scale. Results: Mean preoperative AOFAS score improved from 42.7 (range: 36 to 59) to 88.5 (range: 59 to 98) at the final follow-up (P < .01). Preoperative average visual analogue scale pain scores improved from 7.4 preoperatively to 1.9 at the final follow-up (P < .01). The average MTP joint range of motion improved from 25.9 degrees preoperatively to 53.8 degrees at the final follow-up. No radiologic loosening was found, but radiolucency was observed in 2 patients with this implant. No revision was required for any of the patients during the follow-up period. Conclusions: This total first MTP joint prosthesis yielded good functional outcome and high patient satisfaction level with low early complication rate. Preservation of joint movement and good pain relief with early mobilization were the advantages of this procedure. Salvage arthrodesis remains an option if future revisions are indicated. Level of Evidence: Level IV, retrospective case series.

Patients with black hip and black knee due to ochronotic arthropathy: case report and review of literature.

Ochronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis.

Intraarticular local anesthetics: primum non nocere

We are following with interest that the papers concerning the use of intraarticular local anesthetics during arthroscopic procedures in Knee Surgery Sports Traumatology Arthroscopy [2, 4]. The study by Campo et al. [2] re-ignites the debate on the safety of intraarticular local anesthetics. The authors claim that, ‘‘If the effect of the intra-articular anaesthetic is proven not clinically relevant this would be a definite argument to stop the administration of these agents’’. Their results show small improvement on patient comfort; therefore, they advise to use systemic anesthetic instead of intraarticular bupivacaine or ropivacaine for pain relief after knee arthroscopy. We appreciate Campo et al. [2] for their efforts for better patient safety. However, we have substantial concerns on the issue and feel very strongly to ask what was the need for further research when some evidence is so obvious? Firstly, as Campo et al. [2] state there is no level 1 evidence in current literature about the effectiveness of intraarticular local anesthetic administration on postoperative pain in patients undergoing arthroscopy. Secondly, the safety of intraarticularly administered local anesthetics is a major concern. Farkas et al. [3] report that bupivacaine is cytotoxic, because it induces almost 100% cell necrosis after 24 h of exposure in cultured human chondrocytes. Likewise the two distinct steroid preparations, betamethasone and prednisolone show similar characteristics in inducing cell death, reaching 20% of cell death by 24 h. Finally, in the clinical setting, concern has been raised following reports of dramatic chondrolysis following shoulder arthroscopy in which infusion of the local anesthetic was employed [1]. We are in the opinion that, bearing in mind the risk of cell necrosis, intraarticalar local anesthetics should only be used for circumstances like arthroplasty and grade IV osteoarthritis in which the hyaline articular cartilage has been destroyed considerably. Until further evidence, we should think twice before using bupivacaine for arthroscopic procedures or designing such research.

The need for Achilles tenotomy in the Ponseti method: Is it predictable at the initiation or during the treatment?

The aim of this study was to determine whether the need for tenotomy can be predicted at the initiation or during the treatment of the clubfoot treatment according to the Ponseti method. One hundred and eight feet of 77 babies who required tenotomy and who did not were compared statistically according to the parameters of sex, side, bilaterality, presentation day, number of casts, Pirani scores, and the percentage change in Pirani scores, respectively. The mean number of casts required, the initial Pirani scores, and the percentage change in Pirani scores were significantly different between the groups that required tenotomy and the groups that did not (P=0.0001). Pirani scores at the beginning and the percentage change in Pirani scores during the treatment can be used to estimate the need for Achilles tenotomy.

Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast.

AbstractRandomized controlled clinical trial.The main purpose of the present study was to comparatively analyze the effectiveness, advantages, and the complications of using semirigid synthetic softcast with respect to plaster of Paris (POP) during the treatment of clubfoot deformity.The study group consisted of 196 babies (249 feet). A total of 133 feet treated by an orthopedic referral center using semirigid synthetic softcast were included in group A whereas the other 116 feet treated by another orthopedic clinic using POP cast were included in group B. The Pirani scores, number of cast applications, time period until Achilles tenotomy, any skin problems due to the cast itself, and/or cast removal were recorded. A final parent satisfaction score was also obtained.The mean Pirani sores were significantly improved from the first administration to the time before Achilles tenotomy in both groups. There was no significant difference according to the number of casts applied until tenotomy. The slippage of the cast and skin lesions was significantly more common in group B. Higher parent satisfaction levels were detected in group A.Semirigid softcast has been found as superior to POP in the aspects of parent satisfaction and cast-related complication rates.

The life–saving little tip: intraosseous gas

A case is presented of an-aerobic osteomyelitis with intraosseous gas resulting in the extension of gas in soft tissue structures in a patient with diabetes mellitus. The finding of intraosseous gas and its extension into the pubic joint and the left anterior abdominal wall is depicted. Intraosseous gas is a rare but worrying finding for osteomyelitis in the absence of a penetrative wound, recent surgery, biopsy or fracture.

Should orthopedic surgeons consider the effects of gabapentin administration on bone healing while treating a long bone fracture: experimental study in a rat model

Objective: The main purpose of the present study was to assess the radiographic, histological, and mechanical effects of gabapentin on fracture healing in a rat model of femur fracture. Materials and methods: A standard transverse fracture of the mid-diaphysis was created. A total of 60 female Wistar-Albino rats with the mean age of 13.5 ± 1.2 weeks were used for this experimental trial. The rats were randomized into four groups with 15 animals included in each group. Group A and B were the control groups whereas C and D were the treatment groups. Drugs were delivered by oral gavage twice a day with the daily dosage calculated according to body surface area conversion to the human equivalent dosing regimen of 1200 mg/day. Radiographic, histological, and biomechanical evaluation was performed. Results: We could not detect any statistically significant difference between the control and gabapentin treatment groups according to the comparative assessment of radiographic scores on the 15th and 30th days. Although no significant differences were found between the groups on the 15th day, histological scores were better in the control group on the 30th day. According to the results of biomechanical testing, the fractured femurs resected from the control group exhibited significantly more strength on the 30th day. Conclusions: According to the data we acquired during the present study, administration of gabapentin negatively affects the fracture healing process especially in the aspects of histological progression as well as the biomechanical strength of the callus in a rat model.

Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report

OBJECTIVE Complex regional pain syndrome (CRPS) is a painful and disabling syndrome in which the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Polio paralysis is caused by the damage or destruction of motor neurons in the spine, which lead to corresponding muscle paralysis. This report is a case report on the application of a pulsed radiofrequency (PRF) current to dorsal root ganglia (DRG) for the treatment of CRPS type 1 in an adolescent patient. DESIGN Single case report. SETTING Selcuk University Hospital. PATIENT A 16-year-old girl who suffered from CRPS type 1 secondary to surgeries for the sequelae of poliomyelitis. INTERVENTIONS PRF current application to the lumbar 4 and lumbar 5 DRG. OUTCOME MEASURES Pain reduction. RESULTS The patient had complete resolution of her symptoms, which was maintained at a 6-month follow-up. CONCLUSIONS This case illustrates that PRF applied to lumbar 4 and lumbar 5 DRG may play a significant role in CRPS type 1 management after the surgical treatment of poliomyelitis sequelae in adolescent patients. Further randomized, controlled studies are needed to support this argument.

Complex Regional Pain Syndrome in a Patient with Muscular Dystrophy

Dear Editor We describe an adolescent patient with Becker muscular dystrophy (BMD) who exhibited complex regional pain syndrome type I (CRPS I) in both lower extremities that developed after instrumentation for scoliosis, together with bilateral achilloplasty. This patient was successfully treated with physical and massage therapy after a lumber epidural block via a caudally inserted epidural catheter. A 16-year old, 55 kg, 160 cm with the diagnosis of BMD was admitted to the orthopedic clinic with 90 degrees of thoracolumbar scoliosis and a disturbed body balance. He had not been able to walk for 6 years, and he underwent posterior instrumentation and fusion with lumbosacral fixation, together with bilateral achilloplasty, followed by bilateral below-knee casts for 3 weeks. After cast removal, the pharmacological therapies that were attempted included the analgesic tenoxicam (1 × 20 mg) and the co-analgesics amitriptyline (1 × 10 mg) and pregabalin (2 × 75 mg). Physical therapy was not attempted because of the patients severe pain. At the second postoperative appointment, throracolumbosacral radiographies and computed tomography images were taken to rule out any hardware failure or malposition of pedicle screws, and serological tests were also repeated to rule out any infection secondary to the operation as he had complaints of pain of his both lower extremities that began during the postoperative period. He was admitted …

Left femoral vein is a better choice for cannulation in children: a computed tomography study.

Central venous catheters are often required in emergency rooms and intensive care and/or those undergoing major surgical procedures. In this study, we aimed to gain a better understanding of the anatomy of the femoral vessel in relation to central venous cannulation.