Devrim Özer

Detection of Normal Plantar Fascia Thickness in Adults via the Ultrasonographic Method

BACKGROUND Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. METHODS We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18-65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. RESULTS The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4-5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5-5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8-4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8-4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8-5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8-5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. CONCLUSIONS The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures

OBJECTIVE The objective of this study was to evaluate the radiological and clinical outcomes of treatment of subtalar arthrodesis in patients developing talocalcaneal arthrosis secondary to intra-articular calcaneal fractures. METHODS The study included 20 patients (21 feet) who underwent subtalar arthrodesis due to symptomatic subtalar arthrosis following conservative treatment for intra-articular calcaneal fracture between 2005 and 2011. Autograft or allograft was used in 11 patients. Patients were evaluated clinically using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score. Hindfoot alignment, quality of subtalar fusion and arthritis occurring in other joints were used for the radiological evaluations. RESULTS Mean duration of follow-up was 43 (range: 21 to 83) months. Mean preoperative AOFAS score was 61.7 (range: 40 to 67) and mean postoperative AOFAS score was 84.2 (range: 65 to 94). The difference between scores was statistically significant (p=0.001). Six patients had excellent, 8 good and 6 fair results. Complete fusion was achieved in 19 patients (20 feet). In 2 patients, arthritic changes were radiologically observed in the midtarsal joints. These changes were not symptomatic. There were no statistically significant differences between pre- and postoperative radiological measurements. No patients experienced malunion. CONCLUSION While subtalar arthrodesis appears to provide radiological and clinical benefits, it may cause moderate and asymptomatic osteoarthritis in the midtarsal joints.

Tibiotalocalcaneal arthrodesis by using proximal humeral locking plate

Objectives The aim of this study was to evaluate the short-term clinical and radiological results of tibiotalocalcaneal arthrodesis (TTCA) with proximal humeral locking plate. Material and methods Eight patients (7 female, 1 male; average age 53 years (range: 24–67)) who underwent TTCA with proximal humeral locking plate between 2009 and 2011, were retrospectively evaluated with AOFAS hindfoot scale and Maryland foot score system. The mean follow up was 32.6 months (range: 23–54). Results Complete fusion was achieved in 7 patients. Soft tissue infection was observed in 2 patients and reflex sympathetic dystrophy in 3 patients. All patients recovered with medical treatment. At the final follow-up, mean AOFAS Hindfoot score was 60 (range: 41–81) and Maryland Foot Score was 67.8 (range: 41–85). The satisfactory rates of AOFAS and MFS were found as 12.5% (1/8) and 50% (4/8), respectively. One patient had an incomplete union with 5 degrees of heel varus deformity and 5 degrees of equinus deformity was observed in another. There were no implant failure or deformation of the plate during the follow-up period. Conclusion Our study suggests that proximal humeral plate may be an alternative for fixation in tibiotalocalcaneal fusion surgery.

Surgical Treatment of Confirmed Intraosseous Lipoma of the Calcaneus: A Case Series

ABSTRACT Intraosseous lipoma of the calcaneus is a benign lesion formed by mature adipose tissue. When the lesion is symptomatic, the most frequent presentation is localized pain and soft tissue swelling. Because these lesions can regress spontaneously, conservative treatment methods are recommended. Operative excision is mostly required for painful lesions and pathologic fractures. The data from 14 patients with calcaneal intraosseous lipoma, who had undergone surgery in our clinic, were evaluated retrospectively. Using Milgrams classification system, 9 lesions were classified as stage 1, 4 as stage 2, and 1 as stage 3. All lesions were occupying 100% of intracalcaneal cross‐section in the coronal plane and >30% in the sagittal plane of magnetic resonance imaging sections. The mean preoperative visual analog scale score was 5.29 ± 1.14 (range 4 to 7), and the mean postoperative visual analog scale score at the last follow‐up visit was 1.14 ± 0.36 (range 1 to 2), which was significantly better (p < .01). The mean Maryland foot score at the last follow‐up visit was 97.71 ± 2.02 (range 95 to 100). The mean American Orthopaedic Foot and Ankle Society Ankle‐Hindfoot scale score was 97.86 ± 2.11 (range 94 to 100) at the last follow‐up visit. The differences between the pre‐ and postoperative values were statistically significant (p < .01). No recurrence had been detected within a median follow‐up period of 84 months. Operative management of symptomatic lesions related to intraosseous lipoma of the calcaneus provides better results compared with the preoperative state.

Surface Aneurysmal Bone Cyst: Clinical and Imaging Features in 10 New Cases

Aneurysmal bone cyst originating from the surface of the bone, either within the cortex or subperiosteally, is an uncommon anatomic subtype. This article reports the clinical and radiologic evaluations and treatment outcomes of 10 patients with surface aneurysmal bone cysts that were surgically treated between 1982 and 2014. Mean age at the time of surgery was 22.4 years (range, 11-44 years). According to Capannas radiographic evaluation criteria, 6 of the lesions were classified as type V and 4 were classified as type IV. Radiographically, periosteal shell formation was observed to be complete in 4 patients, partial in 3, and absent in 3, and 6 patients had Codmans angle or buttress formation. In 1 patient, computed tomography scan showed birdcage-like ossification attached to the surface of bone. Magnetic resonance imaging showed fluid-fluid levels in 5 patients. All of the patients had standard curettage and high-speed burr application as an adjuvant. No patient had local recurrence at the end of the follow-up period of 98.4 months (range, 13-288 months). These findings show the importance of careful radiologic evaluation and biopsy to better plan a treatment strategy when surface aneurysmal bone cyst is included in the differential diagnosis. The finding of fluid-fluid levels on magnetic resonance imaging or computed tomography is not pathognomonic for primary aneurysmal bone cyst; however, the absence of this finding does not rule out the diagnosis. The rate of local recurrence after curettage plus high-speed burr is reasonably low, and other adjuvant procedures should be used whenever needed. [Orthopedics. 2016; 39(5):e897-e903.].

The incidence and distribution of primary fibula tumors and tumor-like lesions: A 35-year experience

Purpose: Primary bone tumors of the fibula are rare. There are only a few studies reporting the incidence, histologic, and anatomic distribution of primary fibula tumors. This study aimed to comprehensively report the incidence, presenting symptoms, and histologic tumor types with the anatomic and histologic distribution of primary bone tumors of the fibula. Methods: Between January 1983 and December 2017, 6457 primary bone tumors and tumor-like lesions were diagnosed and treated in our musculoskeletal oncology surgery clinic. Of these, 264 (4.08%) were primary bone tumors and tumor-like lesions of the fibula. We retrospectively reviewed patients’ records, histopathology records, and radiologic images regarding age, gender, anatomic localization, histopathologic diagnosis, and treatment methods. Results: There were 209 (79.2%) benign and 55 (20.8%) malignant lesions. The most common benign and malignant tumors were osteochondroma (51 of 209; 24.4%) and chondrosarcoma (16 of 55; 29.1%). The proximal fibula was the most common location for both benign and malignant tumors (141 of 209; 67.5% and 45 of 55; 81.8%, respectively), followed by the distal fibula (52 of 209; 24.9% and 8 of 55; 14.5%, respectively) and the diaphysis (17 of 209; 8.14% and 2 of 55; 3.64%, respectively). Conclusion: The incidence of primary bone tumors is higher than that reported in previous studies. Benign lesions constitute the majority of cases. One-fifth of all cases are malignant. The most common anatomic site involving the primary fibula tumors is the proximal fibula. Level of evidence: III.

Chondroblastoma: An evaluation of the recurrences and functional outcomes following treatment

Objective Chondroblastoma is a benign aggressive tumor which needs surgical treatment and has a recurrence rate up to 35%. Extended (aggressive) curettage is the mainstay of treatment and local adjuvants have been reported to decrease the recurrence rate. Methods The recurrence rates and the functional results of 14 patients who were treated in our institution and 2 other patients who were treated elsewhere between the years 2004–2016 were evaluated. Seventeen cases (13 male, 3 female; mean age: 17.1 [range: 13 to 32] years) who had been diagnosed, treated and followed up in our hospital between 2004 and 2016 were evaluated in terms of recurrence rates and functional outcomes. The average follow-up period was 41.6 (range: 12 to 132) months. Results Five cases of recurrence were observed. Two cases had undergone their primary treatment in another institution. Seven cases were performed curettage alone whereas nine others were administered adjuvant treatments. One of the five recurrence patients was advised to undergo disarticulation. Another was treated with curettage and grafting and the remaining three patients with curettage and cementing. No recurrence was observed in their follow-up period. Their mean MSTS score was 27.3 (range: 4 to 30) over a maximum of 30 points and their functional results were good. Conclusion Chondroblastoma is a tumor with high recurrence rates in the post-treatment period. However, good functional outcomes can be achieved with early diagnosis and appropriate treatment even after recurrence. Level of evidence: Level IV, therapeutic study.

Primary Tumor and Tumor-Like Lesions of Bones of the Foot: Single-Center Experience of 166 Cases

ABSTRACT Primary bone tumors of the foot are rare lesions. The purpose of the present study was to evaluate the clinical manifestations, treatment modalities, and recurrences of various primary bone tumors of the foot from a specialized center for orthopedic oncology. Among 3681 musculoskeletal tumor cases, which were diagnosed and surgically treated in our hospital from 1983 to 2013, 166 primary tumor and tumor‐like bone lesions of the foot (4.5%) were retrospectively reviewed regarding age, gender, localization, biopsy‐revealed diagnosis, applied treatment modalities, follow‐up period, and recurrence, if any. Of the 166 primary bone tumors of the foot, 155 (93.4%) were benign and 11 (6.6%) were malignant. The most common primary benign bone tumor was a unicameral bone cyst (57 of 155; 36.8%), and the most common malignant tumor was chondrosarcoma (7 of 11; 63.6%). The hindfoot was the most common location for both primary benign (104 of 155; 67.1%) and malignant (6 of 11; 54.5%) bone tumors of the foot. The results of our study have confirmed that the radiologic findings can be confusing owing to the structural and histopathologic features of the bones of the foot; thus, histopathologic diagnosis should be considered for foot involvement. Because the characteristics of the compartments in the foot allow for the rapid spread of malignant lesions, aggressive surgical management and wider resection are recommended to prevent recurrence and further spread.