Cengiz Tuncay

Treatment of Scaphoid Nonunions with a Vascularized Bone Graft Based on the First Dorsal Metacarpal Artery

Four patients with chronic nonunion of the scaphoid were treated by a vascularized bone graft based on first dorsal metacarpal artery. The mean duration of the nonunion was 28.5 months (range 12–48 months). There was avascular necrosis in all patients confirmed by magnetic resonance imaging (MRI). None of the patients had previous attempts at surgical reconstruction. Two fractures were localized at the waist one in the distal part and one at the proximal pole. Osseous union of the scaphoid was confirmed by X-ray in all patients in an average of 2.1 months. We recommend this technique for the treatment of established scaphoid pseudoarthrosis with avascular necrosis since it is associated with minimal morbidity and predictable good results.

Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review.

OBJECTIVE AND IMPORTANCE: This report presents a case in which cerebellar hemorrhage occurred after lumbar decompression surgery that was complicated by dural tear and prolonged cerebrospinal fluid leakage. Remote cerebellar hemorrhage after spinal surgery is extremely rare. Our objective is to describe this unusual complication, discuss the possible mechanisms of remote cerebellar hemorrhage, and review the literature. CLINICAL PRESENTATION: A 73-year-old woman underwent surgery for lumbar spinal stenosis. A dural tear occurred during decompression, and the patient developed remote cerebellar hemorrhage on postoperative Day 2. INTERVENTION: The cerebellar hemorrhage was treated surgically, and a biopsy of hemorrhagic brain parenchyma revealed an arteriovenous malformation. CONCLUSION: Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.

Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery.

This study assessed the effect of fracture displacement and elapsed time before surgery on the development of avascular necrosis and nonunion after internal fixation of femoral neck fractures. Twenty-eight patients with 30 femoral neck fractures who underwent internal fixation and completed a minimum of 2 years’ follow-up were retrospectively analyzed. The rates of avascular necrosis and nonunion were 12.5% and 25%, respectively, among patients who underwent surgery before 12 hours had elapsed and 14% and 27% among those who underwent surgery after that time. The rates of avascular necrosis and nonunion associated with fracture displacement were 6% and 18%, respectively, among patients with undisplaced (Garden stages 1 and 2) fractures and 23% and 38% among those with displaced (Garden stages 3 and 4) fractures. Nonunion and avascular necrosis led to the necessity for additional surgery in 11 of 30 (36%) hips. Internal fixation of femoral neck fractures is associated with a high initial complication rate, but if successful, the procedure ensures an excellent long-term outcome. Internal fixation should be considered the treatment of choice in young patients with nondisplaced fractures.

Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies

OBJECTIVES The purpose of this study to compare clinical and isokinetic results of patients who underwent biceps tenotomy or tenodesis for chronic tenosynovitis. METHODS Arthroscopic biceps tenotomy, arthroscopy assisted or arthroscopic biceps tenodesis were done in 20 patients who had diagnosis of chronic tenosynovitis and in whom conservative treatment was not helpful. Rotator cuff repair and acromioplasty was performed in 18 patients and acromioplasty alone in two patients in addition to biceps surgery. Arthroscopic biceps tenotomy was done in 10 patients (5 female, 5 male; mean age 63, range 53-75), 10 patients underwent tenodesis out of which arthroscopy assisted biceps tenodesis was done in 8 patients and all arthroscopic biceps tenodesis was done in 2 patients (4 female, 6 male; mean age 57, range 49-66). All patients were evaluated with Constant and UCLA scores preoperatively and postoperatively. The average follow-up of the patients 3,1 years (between 1-8 years). Isokinetically elbow flexion and forearm supination were compared using the Cybex (Biodex 3, Cybex Biomedical System, NY, USA) machine. Pre-operative results of each group were compared with the postoperative results, using Mann-Whitney U test. RESULTS Preoperative average constant scores of tenotomy group were 64.40, whereas postoperative scores were 89.50 (p=0.002), and preoperative average constant scores of tenodesis group were 62.80, whereas postoperative scores were 86.70 (p=0.003). Preoperative average UCLA scores of tenotomy group were 23.20 whereas postoperative UCLA scores 22.60 (p=0.003), preoperative average UCLA scores of tenodesis group were 30.00 whereas postoperative UCLA scores was 29.20 (p=0.004). In both groups statistically significant improvement of UCLA and Constant scores was detected. Comparison between Constant, UCLA scores and isokinetic measurements of both groups showed no statistically significant difference (p>0.05). No complication was noted. CONCLUSION In the treatment of chronic tenosynovitis, biceps tenodesis and tenotomy of long head of biceps showed similar clinical, functional, isokinetic and cosmetic results. No Popeye deformity was seen in the tenotomy group.

Computer-assisted diagnosis of osteoartrithis on hip radiographs

Hip osteoarthritis (OA) can be highly disabling and eventually may necessitate total replacement of the joint. Studies with computer-based analysis of the hip OA may give new insight both in imaging and clinical evaluation of the disease. In this study, new acetabular angle measurement methods of femoral head-neck-shaft angle (CCD), center-edge angle (CE) and acetabular depth-to-width ratio (ADR) are reconstructed via a computer based analysis technique for robust detection of OA on anteroposterior (AP) hip radiographs. The evaluation and validation of this computer-assisted system is performed by comparing these new automated methods with those of traditional manual measurement methods done by one orthopaedist and one radiologist. The 50 adult hip AP radiographs with OA are used and overall measurements are produced for both sides of the hip on radiographs separately. The mean average difference between these two measurement methods for CCD angle is found 1°±1,2°, for CE angle 1°±1,5° and for ADR ratio 1±1,4 respectively. The results show that this new automated angle and ratio measurement system can be found feasible and user friendly by clinicians owing to the similarity between the comparative results of two measurement methods statistically.

A novel computer-based method for measuring the acetabular angle on hip radiographs

Objective The aim of this study was to propose a new computer based method for measuring acetabular angles on hip radiographs and to assess its practicality, sensitivity and reliability for acetabular angle measurement. Methods A total of 314 acetabulum were assessed on 157 pelvic X-ray images. Acetabular angles were measured with both the conventional method (Method 1) and our proposed method (Method 2). All the Acetabular Index (AI) angle, Acetabular Angle (AA) and Acetabular Center (ACM) angle were measured with both methods. Results The mean AI angle for Method 1 is 11.02° ± 2.7° and the mean AI angle for Method 2 is 10.08° ± 1.88°, the mean AA angle for Method 1 is 39.5° ± 5.3° and the mean AA angle for Method 2 is 39.36° ± 4.68°, the mean ACM angle for Method 1 is 50.5° ± 6.01° and the mean ACM angle for Method 2 is 55.42° ± 12.43°. Conclusion Our novel automated method appear to be reliable and practical for acetabular angle measurement on hip radiographs. Level of Evidence Level III, Diagnostic study

Bone pulsating metastasis due to renal cell carcinoma

Pulsation on the bone cortex surface is a rare condition. Pulsative palpation of the superficial-located bone tumors can be misperceived as an aneurysm. Fifty-eight-year-old man is presented with pulsating bone mass in his proximal tibia. During angiographic examination, hypervascular masses were diagnosed both at right kidney and at right proximal tibia. Renal cell carcinoma was diagnosed after abdominal CT scan. Proximal tibia biopsy was complicated with projectile bleeding.