Cengiz Sen

The Microfracture Technique for the Treatment of Full-Thickness Articular Cartilage Lesions of the Knee : Midterm Results

PURPOSE The purpose of this study was to determine the effectiveness of the microfracture technique in the treatment of full-thickness articular cartilage lesions of the knee. METHODS In this study the midterm results of 90 patients (47 women and 43 men) with focal full-thickness articular cartilage lesions who had been managed with the microfracture technique are presented. The mean age of our patients was 34.5 years (range, 20 to 58), and 51 right and 39 left knees were treated. All of the articular lesions involved medial femoral condyles. RESULTS On the basis of follow-up at a mean of 68 months (range, 24 to 108 months), mean improvements in Lysholm knee scores (from 54.2 to 84.6 points), Tegner activity scale scores (from 2.6 to 5.2 points), and Oxford knee interrogation scores (from 23.1 to 44.8 points) were observed (P < .0001). Moreover, there was a strong and significant correlation between functional results and age younger than 35 years, size of defect less than 2 cm(2), non-weight-bearing surface, and body mass index lower than 25 kg/m(2), respectively (P < .001). CONCLUSIONS According to our midterm results, the microfracture technique is quite effective with regard to the improvement of daily activities with a favorable impact on pain relief and better functional results. Furthermore, we found that there was a correlation between functional results and age, size of defect, location of defect, and body mass index as prognostic parameters. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail

BACKGROUND Callus distraction over an intramedullary nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical débridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an intramedullary nail for the treatment of bone defects and limb-shortening resulting from radical débridement of chronic osteomyelitis. METHODS Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical débridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an intramedullary nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. RESULTS The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days per centimeter, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. CONCLUSIONS This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation.

Ultrasonographic appearance of the plantar fasciitis

PURPOSE To study high frequency sonographic in the examination of plantar fasciitis (PF), which is a common cause of heel pain. MATERIALS AND METHODS Our study was done with 25 PF (21 unilateral, 4 bilateral) and 15 control cases of similar age, weight and gender. In this study, the plantar fascial thickness (mainly), fascial echogenity and biconvexity were examined using 7.5 MHz linear phase array transducer. Perifascial fluid collection, fascial rupture and fascial calcification that are rarely seen were also examined. RESULTS The fascial thickness ranges for the PF cases: for the symptomatic heels: 3.9-9.1 mm (mean: 4.75 +/- 1.52 mm), for the asymptomatic heels: 2.0-5.9 mm (mean: 3.37 +/- 1.0 mm) and for the control group: 2.1-4.7 mm (3.62 +/- 0.68 mm). The results were significantly different in Group I for symptomatic heels and the control group statistically for PF (P < .05). The echogenity of plantar fascia and biconvexity of plantar fascia were the major criteria for symptomatic heels. In three heels (10%), perifascial fluid was diagnosed, in three heels (10%) fascial calcification, in one heel (3%) partial fascial rupture. Subcalcaneal spur was encountered sonographically in both cases of Groups I and II. CONCLUSION Ultrasonography (US) is the first step for PF, because of its easy and quick performance, availability and high sensitivity of diagnosis, low-cost and free radiation.

An alternative method for the treatment of nonunion of the tibia with bone loss

In this retrospective study we evaluated the method of acute shortening and distraction osteogenesis for the treatment of tibial nonunion with bone loss in 17 patients with a mean age of 36 years (10 to 58). The mean bone loss was 5.6 cm (3 to 10). In infected cases, we performed the treatment in two stages. The mean follow-up time was 43.5 months (24 to 96). The mean time in external fixation was 8.0 months (4 to 13) and the mean external fixator index was 1.4 months/cm (1.1 to 1.8). There was no recurrence of infection. The bone evaluation results were excellent in 16 patients and good in one, while functional results were excellent in 15 and good in two. The complication rate was 1.2 per patient. We conclude that acute shortening and distraction osteogenesis is a safe, reliable and successful method for the treatment of tibial nonunion with bone loss, with a shorter period of treatment and lower rate of complication.

Correction of ankle and hindfoot deformities by supramalleolar osteotomy.

Ankle and hindfoot deformities in 11 patients with a mean age of 15 (range, four to 35) have been gradually corrected by an Ilizarov external fixator. In all patients, supramalleolar osteotomy was utilized by percutaneous drilling and osteotomy technique. The patients were evaluated clinically by the AOFAS scoring system and radiologically by malorientation and malalignment tests described by Paley. The purpose of the current study is to evaluate the efficacy of supramalleolar osteotomy and correction by an Ilizarov device in treating hindfoot and ankle deformities. The mean external fixation period was five (2.5 to eight) months. The mean interval between the operation and last follow-up examination was 19 (13 to 26) months. The patients improved an average of 30 points after the operation regarding to AOFAS score. A plantigrade foot was achieved in the whole group. Radiologically, no malalignment or malorientation was measured. Equal leg lengths were achieved in all nine patients with one exception. Complications were graded after Paley as minor problems in 11 patients and as obstacles requiring surgical interventions in four patients. Sequelae remained in only one patient. Ankle and hindfoot deformities caused by various etiologies are complicated by poor soft tissue condition and a short foot. A supramalleolar osteotomy and Ilizarov external fixator can safely and effectively correct these deformities.

Combined technique for the correction of lower-limb deformities resulting from metabolic bone disease

We present the results of the surgical correction of lower-limb deformities caused by metabolic bone disease. Our series consisted of 17 patients with a diagnosis of hypophosphataemic rickets and two with renal osteodystrophy; their mean age was 25.6 years (14 to 57). In all, 43 lower-limb segments (27 femora and 16 tibiae) were osteotomised and the deformity corrected using a monolateral external fixator. The segment was then stabilised with locked intramedullary nailing. In addition, six femora in three patients were subsequently lengthened by distraction osteogenesis. The mean follow-up was 60 months (18 to 120). The frontal alignment parameters (the mechanical axis deviation, the lateral distal femoral angle and the medial proximal tibial angle) and the sagittal alignment parameters (the posterior distal femoral angle and the posterior proximal tibial angle) improved post-operatively. The external fixator was removed either at the end of surgery or at the end of the lengthening period, allowing for early mobilisation and weight-bearing. We encountered five problems and four obstacles in the programme of treatment. The use of intramedullary nails prevented recurrence of deformity and refracture.

Arthroscopic excision of the osteoid osteoma at the distal femur

Osteoid osteoma is a benign, osteoblastic and painful tumoral lesion. Apart from en-bloc resection, intralesional resection and percutaneous excision or destruction of the nidus, arthroscopic removal of the lesion in intraarticular locations have been reported. We present a patient with osteoid osteoma at distal femur which is accessible through knee joint, treated by arthroscopic complete excision.

Osteoid Osteoma of the Trapezium: Case Report

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.