Engin Çetinkaya

A rare knee extensor mechanism injury: Vastus intermedius tendon rupture

Highlights • The first case of isolated rupture of vastus intermedius tendon in the literature.• Partial quadriceps tendon rupture can be treated by conservative therapy.

Treatment of comminuted mid-diaphyseal clavicle fractures by plate fixation using a bridging technique

OBJECTIVE The aim of this study was to determine the healing and functional results of the treatment of comminuted mid-diaphyseal clavicular fractures using a bridging plate technique with minimal surgical dissection. METHODS This retrospective study included 23 patients (17 males and 6 females) with comminuted mid-diaphyseal clavicular fractures treated between 2004 and 2010. All fractures were operated on using a bridging plate technique with minimal surgical dissection. Patients were evaluated for function using the Constant shoulder scoring system. RESULTS Mean follow-up was 22 (range: 6 to 68) months and healing occurred in all patients after a mean of 13 (range: 8 to 20) weeks. No implant failures or superficial or deep infections were observed. Iatrogenic neurovascular damage was not observed in any patient. Two patients had clavicle length discrepancy in comparison with the healthy side. Range of motion was normal in all patients. The mean Constant score was 89.6 (range: 72 to 100) points. CONCLUSION The surgical treatment of mid-diaphyseal fractures with the bridging plate technique using locking plates provides good patient comfort, allows early mobility and has a low complication rate.

A suture technique for easier reduction and repair of bucket-handle meniscal tears while using the all-inside devices

Arthroscopic repair of bucket-handle meniscal tears is difficult due to their complex pathology. Many meniscal repair techniques such as all-inside, inside-out, and outside-in have been described for the treatment of these tears. Loss of reduction is a likely complication with the use of new-generation, all-inside suture instruments, as the tip of the needle is extracted following advancement of the first implant behind the capsule. The complication may be encountered quite often and renders the use of the meniscus repair instrument unusable and causes an irreparable iatrogenic injury in the meniscus. The application of a simpler and more efficient technique is necessary until surgical experience is gained. The aim of this study was to define a new, simpler, and more efficient combination of suturing method in the treatment of bucket-handle meniscal repairs and minimize the rate of complications which may be caused by this technique.

Flexion-adduction-external rotation method for shoulder dislocations

OBJECTIVE The aim of this prospective study was to assess the effectiveness of the flexion-adduction-external rotation method in the reduction of acute anterior shoulder dislocations. METHODS The study included 128 patients (98 male, 30 female; mean age: 33, range: 19 to 81) with a history of acute anterior shoulder dislocation treated with the flexion-adduction-external rotation method. Neurovascular examination was performed before and after reduction. Reduction duration and patient responses regarding the reduction method were recorded. RESULTS First-time dislocation occurred in 92 patients and recurrent dislocation in 36. 111 patients had subcoracoid dislocations and 17 subglenoid dislocations. Fracture of the greater tubercle was present in 13 patients. Reduction was achieved in the first attempt in 104 patients and in the second in 12 patients. Mean reduction time was under 1.5 (range: 0 to 5) minutes. Reduction was unsuccessful in 12 patients and reduction under general anesthesia was performed. No patients experienced neurovascular injury after reduction. CONCLUSION The forward flexion-adduction-external rotation method is an effective and comfortable reduction method for the treatment of shoulder dislocation or fracture-dislocation.

Cheilectomy as a First-Line Surgical Treatment Option Yields Good Functional Results in Grade III Hallux Rigidus

BACKGROUND This study aimed to analyze the functional results of cheilectomy in the surgical treatment of grade III hallux rigidus and to evaluate whether cheilectomy is a preferable first-line treatment over other surgical methods. METHODS Of 29 patients with moderate daily physical activity who underwent cheilectomy between 2009 and 2012 on being diagnosed as having grade III hallux rigidus according to the Coughlin-Shurnas grading system, 21 patients (14 women and 7 men; mean age, 59.2 years; age range, 52-67 years) (22 feet) with regular follow-up and complete medical records were included in the study. The patients were evaluated in the preoperative and postoperative periods using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society metatarsophalangeal assessment forms. RESULTS The preoperative mean American Orthopaedic Foot and Ankle Society score of 53 (range, 29-67) improved to 78 (range, 57-92) postoperatively (Wilcoxon test P = .001). The preoperative mean visual analog scale score of 89 (range, 60-100) improved to 29 (range, 0-70) in the postoperative period (Wilcoxon test P = .001). CONCLUSIONS As a simple and repeatable procedure that allows for further joint-sacrificing surgical procedures when required, cheilectomy is a preferable method to be applied as a first-line option for the surgical treatment of grade III hallux rigidus.

Is ‘Season’ a Risk Factor for Prosthetic Joint Infections?

Background: There are no clear data whether the season of arthroplasty has any demonstrable effect on the emergence of PJI. In the present study we aimed to explore the effect of the season of arthroplasty surgery on the PJI incidence, and to test if season of arthroplasty is a risk factor for PJI. Material & Method: Our study involved 174 (2.5%) patients with superficial and/or deep infection among 6902 patients who underwent arthroplasty procedure at Taksim First Aid Training and Research Hospital, Baltalimanı Bone Hospital and Medipol University Hospital during an approximately 10-year period between January 2006 and June 2015. Results: An analysis of the timing of the surgeries revealed that the first operations were most commonly performed in February (14.4%) and March (13.8%). The season in which most operations were performed was Spring (n=60; 34.5%) whereas Fall had the least number of operations (n=31; 17.8%) There were also no significant monthly or seasonal differences between the number of infections when separate analyses were done for hip joint (n=88) and knee joint replacements (n=86) (p>0.05) Discussion: Despite the lack of a definitive information about the seasonal predilection of prosthetic joint infections, Kane et al showed a significantly increased incidence of infection in summer months among 750 patients operated with arthroplasty, of whom 17 suffered such infection (15). In contrast, among 174 prosthetic joint infections, we found no significant monthly and/or seasonal difference in the incidence of prosthetic joint infections.Increased moisture and temperature increase bacterial colonization both in the outer environment and on the host’s skin, increasing the sensitivity to infections. Perspiration of the host, closed environmental conditions, and increased moisture are other important factors promoting bacterial colonization (16,17). However, appropriate care of the surgical field following surgery is the most important factor reducing bacterial colonization of skin. Another significant problem with arthroplasty surgery is patient satisfaction, which is promoted by as short as possible waiting times from the time of decision to operate to the time of procedure.In conclusion, the incidence of prosthetic joint infections is not increased after arthroplasty operation in summer when bacterial colonization is promoted by increased temperature and moisture. Therefore, season does not appear as a risk factor.

Surgical Repair of Neglected Bucket-Handle Meniscal Tears Displaced into the Intercondylar Notch: Clinical and Radiological Results

Abstract The literature contains very limited articles wherein the treatment results of bucket‐handle meniscal tears according to various types are evaluated and wherein results for repair of chronic tears are discussed. The objective of this study is a clinical and radiologic evaluation of arthroscopic repair for patients suffering flipped, neglected chronic bucket‐handle meniscal tear in the intercondylar notch. A total of 26 patients were evaluated retrospectively. The mean age at the time of surgery was 27 years (range, 16‐44). Mean period from meniscal injury to surgery was 28 months (range, 4‐96). The mean follow‐up period was 31 months (range, 11‐67). During the follow‐up, the patients were evaluated clinically, functional scores from the International Knee Documentation Committee (IKDC), Lysholm, and Tegner as well as magnetic resonance imaging (MRI). The mean preoperative Lysholm score of 24 increased to 85 postoperatively. Mean IKDC score was 56.3 preoperatively and 84.5 postoperatively. The mean Tegner score of 3.4 increased to 5.6 postoperatively. Mean Lysholm, IKDC, and Tegner scores in the first group were 84, 74, and 5.1, respectively, and in the anterior cruciate ligament (ACL) reconstruction group; 86, 85.9, and 5.8. While 20 (77%) out of 26 patients had none of the clinical findings, 6 patients (23%) presented with these findings. Postoperative MRI assessment revealed meniscal healing in 21 patients (27% complete, 54% partial healing) and no healing in 5 patients (19%). A clinical healing rate of 77% and a radiological healing rate of 81% along with statistically significant increases in Lysholm, IKDC, and Tegner scores prove that the repair option is effective for neglected, chronic bucket‐handle meniscal tears flipping to the intercondylar notch. This study showed that good results could be achieved with the repair of neglected, chronic period bucket‐handle meniscal tears flipping to the intercondylar notch, whether with an accompanying ACL tear or not.

Bosworth and modified Phemister techniques revisited. A comparison of intraarticular vs extraarticular fixation methods in the treatment of acute Rockwood type III acromioclavicular dislocations

Objective The aim of this study was to compare the long-term clinical and radiological results of Acromioclavicular (AC) fixation with K-wires (the modified Phemister procedure) and Coracoclavicular (CC) fixation with the Bosworth screw in the surgical treatment of Type 3 AC joint dislocations. Methods Thirty-two patients with complete set of medical records and who received surgical treatment between September 2005 and January 2009 due to acute Rockwood Type 3 AC joint dislocation and properly attended their follow-ups were retrospectively evaluated. Sixteen patients (13 males, 3 females; mean age: 38, range: 24–52 years) were treated with CC fixation with Bosworth screw (Group 1), and the other 16 (12 males, 4 females; mean age: 53.3, range: 38–64 years) with AC fixation using K-wires (Group 2). Results The mean follow-up time was 96 months for Group 1 and 93 months for Group 2 patients (p > 0.05). The mean Constant–Murley score at the final follow-up was 84.7 in Group 1 and 87.3 in Group 2 (p = 0.069). Radiological evaluation of the patients revealed AC arthrosis in 2 and 3 patients in Group 1 and 2, respectively. In Group 2, one patient had a recurrent dislocation, three patients had AC arthrosis and two patients had ossification in the CC ligament (Fig. 2). There was no superficial or deep wound infection in Group 1, while two patients from Group 2 had a superficial wound infection. Conclusions Our results suggest that both techniques are reliable and provide adequate reduction and similar outcomes in terms of functionality and pain levels, following the reduction of Type 3 AC joint dislocations. With lower rates of wound site infection in the early and AC arthrosis in the late postoperative period, CC fixation method with the Bosworth screw may be a better surgical option than AC fixation method with K-wires. Level of Evidence Level III, Therapeutic study.

Reliability of Computer-Assisted and Manual Measurement Methods for Assessment of Graf Type 1 and Type 2 Hip Sonograms.

The purpose of this study was to investigate the interobserver, intraobserver, and intermethod reliability of computer‐assisted digital and manual measurements of hip sonograms.

Chevron osteotomy in patients with scheduled osteotomy of the medial malleolus

OBJECTIVE The aim of the present study was to evaluate intermediate-term outcomes of Chevron osteotomy for treatment of osteochondral lesions of the talus with mosaicplasty and to assess its effect on surgery and whether it reduces complications that might occur intraoperatively. METHODS The present study included a total of 42 patients (31 men, 11 women) who underwent Chevron osteotomy of the medial malleolus and who had been followed for more than 2 years. Mean age of the patients was 34 years (range: 18-54 years). Preoperatively, size of the lesions was measured in millimeters in the coronal and sagittal planes using magnetic resonance imaging (MRI). The angle between the osteotomy with the long axis of the tibia was measured on the coronal plane, the angle between the arms and the angle for the screws to be directed to the osteotomy line were measured on the sagittal plane on the postoperative images. Nonunion, malunion, and complications from the screws were evaluated from X-ray images taken at the final follow-up. RESULTS Mean duration for follow-up was 31.4 years (range: 24-46). On the X-ray images taken at the final follow-up, no distraction, migration of the distal part, or rotation was observed. Only 1 patient experienced radiological non-union. Mean duration to union was 5.8 weeks (range: 4-14 weeks). Screws of 8 patients were removed at an average of 7.4 months (range: 5-11 months). The angle between the osteotomy line and long axis of the tibia was 29.0°±6.5°, the angel between the osteotomy arms on the sagittal plane was 74.7°±8.3°, and the direction angle of the screws on the coronal plane was 85.7°±5.9°. CONCLUSION Chevron osteotomy is an assistive surgical method used for treatment of osteochondral lesions located in the medial talar joint surface (TOL) which provides fast anatomical healing because it allows efficient fixation due to its geometry.