Erdinç Esen

Evaluation of the medial longitudinal arch: a comparison between the dynamic plantar pressure measurement system and radiographic analysis

OBJECTIVES The measurement of the medial longitudinal arch (MLA) of the foot is a controversial issue in orthopedics. Several methods have been developed to define and determine the MLA, but none of them are universally accepted. The purpose of this study was to compare some statically obtained radiographic angles with the dynamic plantar pressure distribution measurement system for the evaluation of the MLA in healthy individuals. METHODS A total of 95 subjects (72 females, 23 males; mean age 37.8 years; range 11 to 85 years) were retrospectively evaluated. All the subjects were referred to the pedobarography laboratory for varying causes, had foot radiographies, and were evaluated as having normal feet. On standard lateral weight-bearing radiographs of the foot, the lateral talocalcaneal angle, talo-first metatarsal angle, talohorizontal angle, and calcaneal pitch angle were measured. The plantar pressure distribution was measured by the EMED-SF system. To evaluate the MLA, the arch index method was used. The arch index was calculated by the ratio of the pressure area of the midfoot to the sum of the forefoot, midfoot, and the hindfoot areas. Correlations between the radiographic angles and the arch index were analyzed by the Pearson correlation test. RESULTS The mean values of the lateral talocalcaneal angle, talo-first metatarsal angle, talohorizontal angle, and calcaneal pitch angle were 43.2, 7.2, 29.5, and 41 degrees, respectively. The mean value of the arch index was 0.12 (range 0.04 to 0.17). There was no significant correlation between the arch index and gender (r=-0.10, p>0.05). The talo-first metatarsal (r=0.38) and talohorizontal (r=0.19) angles were found to be in significant correlation with the arch index (p<0.05), whereas the talocalcaneal (r=-0.16) and calcaneal pitch (r=-0.10) angles did not show correlation with the arch index (p>0.05). CONCLUSION The arch index method is a simple and reproducible pedobarographic measurement for the evaluation of the MLA. However, the angles measured on statically obtained radiographs and showing correlations with the arch index may give similar results concerning the MLA. Both static and dynamic methods can be utilized in the evaluation of the MLA.

Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: A retrospective study in 42 patients

AIM Our study reports long-term results and factors related to patient satisfaction in the case of primary hemiarthroplasty for humeral proximal end fractures. PATIENTS AND METHODS We retrospectively evaluated 42 patients with humeral proximal end fractures who underwent primary hemiarthroplasty in our clinic from February 1994 to March 2004. Of the 42 patients, 14 (33%) were male and 28 (67%) female. The mean age was 68.9+/-5.57 years (age range: 59-81 years). The mean follow-up period was 78.8+/-26.6 months (range: 48-118 months). We evaluated the following parameters: fracture type according to the Neer classification, the time interval between the fracture and the operation, postoperative radiological examination, the Neer outcome assessment criteria for patient satisfaction and functions, according to the Constant and Murley Scoring (CMS) system. RESULTS We found good-to-excellent outcomes in 36 (85.7%) and poor outcome in six (14.3%) patients according to the Neer criteria. The average values for CMS score, anterior elevation and external rotation were 73.59+/-17.95 (25-94), 121.30+/-42.99 degrees (range: 30-170 degrees ) and 30 degrees (range: 0-80 degrees ), respectively. The patients who had been operated in the early period (within 2 weeks) had better functional outcomes (p<0.001) and had significant pain relief. There was a strong positive correlation between the humeral offset (distance between the head and the tuberosities) and the degree of elevation (r=0.872, p<0.001). There was a strong negative correlation between the height of the humeral head and the degree of elevation (r=-0.853, p<0.001). CONCLUSION In humeral proximal end fractures, primary hemiarthroplasty in the early period with the anatomic reconstruction of bone and soft tissues of the shoulder joint and long-term regular rehabilitation programme are important factors contributing to increased patient satisfaction.

Validation of the VISA-A questionnaire for Turkish language: the VISA-A-Tr study

Objectives To evaluate the validity and reliability of the Turkish version of the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire for patients with Achilles tendinopathy. Design Fifty-five patients with a diagnosis of Achilles tendinopathy and 55 healthy subjects were included in the study. VISA-A questionnaires were translated and culturally adapted into Turkish. The final Turkish version (VISA-A-Tr) was tested for reliability on healthy individuals and patients. Tests for internal consistency, validity and structure were performed on 55 patients. Results The VISA-A-Tr showed good test–retest reliability (Pearsons r=0.99, p<0.001). The patients with Achilles tendinopathy had a significantly lower score (p<0.001) than the healthy individuals. The VISA-A-Tr score correlated significantly with the Stanish tendon grading system (Spearmans r=−0.86; p<0.001). Conclusion The VISA-A-Tr is a valid and reliable tool for evaluating the severity of Achilles tendinopathy.

Lipoma arborescens of the peroneus longus and peroneus brevis tendon sheath: case report.

Lipoma arborescens is an uncommon pseudotumoral synovial lesion usually located in the suprapatellar pouch of the knee. Lipoma arborescens involving the synovial sheaths of the tendons is exceedingly rare. This diagnosis should be considered, particularly in patients with chronic joint effusion. We report a case with lipoma arborescens affecting the synovial sheaths of the peroneal tendons without involvement of the adjacent ankle joint. To our knowledge, this is the second reported case of lipoma arborescens involving tenosynovial sheaths of tendons around the ankle joint without ankle joint involvment.

[Is intraarticular administration of tranexamic acid efficient and safe as systemic administration in total knee arthroplasty? Single center, randomized, controlled trial].

OBJECTIVES This study aims to compare the efficiency and safety of intraarticular and intravenous tranexamic acid administration in patients who were performed primary total knee arthroplasty. PATIENTS AND METHODS This single center, randomized, controlled trial included 60 patients (8 males, 52 females; mean age 67.8 years; range 53 to 87 years) who were performed primary total knee arthroplasty by three surgeons due to a diagnosis of primary osteoarthritis between January 2015 and June 2015. Patients were separated into three groups. Patients in group 1 and group 2 were administered 2 g intravenous tranexamic acid and 2 g intraarticular tranexamic acid, respectively. Patients in group 3 were not administered tranexamic acid. Pre- and postoperative hemoglobin difference, volume of blood collected in drains, and transfusion rate were analyzed. RESULTS Compared with the control group, there was no significant difference between group 1 and group 2 in terms of total blood loss from the drain, pre- and postoperative hemoglobin difference, and the need for blood transfusion. CONCLUSION Both intraarticular and intravenous administrations reduce blood loss and need for transfusion and there is no significant difference between the two techniques in terms of safety.

Effects of a single application of extractum cepae on the peritendinous adhesion: an experimental study in rabbits.

Peritendinous adhesion is an important cause of poor functional outcome after flexor tendon repair. The objective of this study was to investigate the effect of a single intraoperative application of extractum cepae, an extract of dietary onion, on the peritendinous adhesion, using a rabbit model of flexor tendon injury. The first, second, and third digits of the right hind paw of 18 rabbits were used for tendon operations. A standard partial division of the synovial sheath and flexor tendon was done at zone II to stimulate the adhesion formation. In the treatment group (n = 9 rabbits, 27 tendons), the flexor tendon sheath was treated with 50 mg/mL of extractum cepae which was applied locally and allowed to infiltrate for 5 minutes, the skin was sutured without suturing the sheath and the tendons. The same operation was done for the control group (n = 9 rabbits, 27 tendons) and 1 mL of normal saline solution was applied locally. Biomechanical and histologic evaluations of the specimens were done after 3 weeks. Tendons from the first toes were used for biomechanical studies. The second and third toe tendons were used for histopathologic evaluation. We have compared the peritendinous adhesions and the ultimate forces in the control and treated tendons. There were no statistically significant differences between the 2 groups with respect to the ultimate loads. Adhesion formation was absent in 1 tendon (5.5%), slight in 8 (44.4%), moderate in 6 (33.3), and severe in 3 tendons (16.7%) in the extractum cepae treated group (n = 18); while in the control group (n = 18), it was absent in 1 tendon (5.5%), slight in 1 tendon (5.5%), moderate in 3 (16.6%), and severe in 13 (72.4%) tendons. There was a significant reduction (P = 0.01) in the peritendinous adhesion in the treated group comparing to the control group. The problem of adhesion formation may be minimized using a single intraoperative application of extractum cepae.

[The effect of low-molecular-weight heparin on rat tendon healing].

OBJECTIVES We investigated the effect of low-molecular-weight heparin (LMWH) on the healing of tendons. METHODS Forty-five adult Wistar rats weighing 300 g were randomized into three groups equal in number. All the rats underwent full-thickness surgical incision of the Achilles tendon followed by primary repair. After the operation, two groups received daily subcutaneous LMWH injections (nadroparin calcium) for four weeks at high or low doses (group I, 6 mg/kg, 170 IU AXa; group II, 3 mg/kg, 85 IU AXa). Group III remained untreated as the control group. Histologically, the specimens were examined under light and electron microscopy with regard to the amount of fibrillar collagen synthesis, mitochondrial degeneration, and the composition of the extracellular matrix collagen. Biomechanically, maximum load to failure and correspondent elongation of the tendons were measured. RESULTS Compared to the control group, histologically, both LMWH-treated groups exhibited increased number of fibroblasts, increased fibrillar collagen formation in the extracellular matrix, and higher counts of granular endoplasmic reticula in cytoplasmic contents of fibroblasts as well as decreased mitochondrial vacuolization and degeneration. Biomechanical assessments showed that tendons in group I had significantly higher maximum load to failure and elongation values than group II and III (31 N vs. 24.6 N and 23.1 N; 25 mm vs. 19.6 mm and 17.3 mm, respectively; p<0.05). Groups II and III did not differ significantly in this respect (p>0.05). CONCLUSION Daily administration of single dose LMWH improves tendon healing through increasing the number of fibroblasts and fibrillar collagen synthesis and decreasing mitochondrial degeneration.

Comparison of radiation exposure times in the treatment of pediatric supracondylar humeral fractures with open-closed reduction and internal fixation

OBJECTIVES We compared open reduction-internal fixation (ORIF) and closed reduction-internal fixation (CRIF) with respect to operation and radiation exposure times in the treatment of displaced supracondylar humeral fractures in children. METHODS This retrospective study included 124 children (76 boys, 48 girls) who underwent surgical treatment for displaced supracondylar humeral fractures (Gartland type 3). Of these, 52 patients (mean age 7.5 + or - 2.8 years) underwent ORIF, and 72 patients (mean age 6.1 + or - 2.5 years) underwent CRIF. Operation and fluoroscopy times were recorded in both groups. Final assessments included range of motion, varus- valgus angulation, neurovascular findings, and cosmetic appearance. Functional and cosmetic results were assessed using the criteria of Flynn et al. after a mean follow-up period of 49.3 + or - 18.6 months and 50.4 + or - 17.9 months in the ORIF and CRIF groups, respectively. RESULTS Radiographical union was obtained in all the patients within six weeks postoperatively. The two groups did not differ with respect to functional and cosmetic results (p>0.05), with excellent-good results accounting for 90.3% in the CRIF group, and 86.6% in the ORIF group. The mean operation times were 44.2 + or - 12.6 and 28.3 + or - 8.2 minutes, and the mean fluoroscopy times were 36.0 + or - 15.3 and 11.7 + or - 4.5 seconds, in the CRIF and ORIF groups, respectively, both being significantly longer in the former (p=0.000). CONCLUSION As extended fluoroscopy use increases radiation exposure, ORIF sems to be more convenient for the treatment of displaced supracondylar humeral fractures.

Periosteal adventitia is a valuable bone graft alternative

Background Periosteal adventitia is believed to consist of fibrous tissue without any regenerative potential. This theory results in the assumption that surgically stripped periosteum which is also adventitial has no bone regeneration potential. We decided to test whether the periosteal adventitia is osteoinductive and whether it is suitable for a commonly faced clinical situation in an animal model. Methods This study used 24 femurs from 12 rabbits, which were separated into 3 groups. Lateral femoral condylar cavitary defects were created with a 5 mm drill bit. In group I, the defects were left empty as the control. In group II, the defects were only filled with ceramic graft particles. In group III, the defects were filled with a mixture of ceramic graft particles and autogenous, adventitial, periosteal particles. All animals were sacrificed at the end of the 6th week and were evaluated histologically. Results The microscopy of 3 different histologists suggested that group III had far superior healing when compared to the control group and group II. The statistical evaluation of the histomorphometrically gathered quantitative results revealed a meaningful increase in woven bone and a decrease in fibrous tissue in group III, confirming the histological analysis. Conclusions In this study we observed that the composite graft obtained by mixing ceramics and free adventitial periosteal grafts offers healing potential surpassing both the ceramic-only group as well as the control group. We conclude that adventitial periosteal graft greatly facilitates new bone formation.

The evaluation of two different surgical approaches in total hip arthroplasty according to the patient satisfaction, plantar pressure distribution and trendelenburg sign

The aim of this prospective study was to analyze the results of two different surgical aproaches for total hip arthroplasty as Trendelenburg sign, plantar pressure distribution with the help of dynamic pedobarography and clinical results by Harris Hip Score. A total of 28 patients who underwent unilateral total hip arthroplasty using two different types of lateral approach as conventional lateral Hardinge approach and intermuscular Hardinge approach described by Pai were included in this study. Plantar pressures have maesured by EMED-SF pedobarography device and analysed by the help of a commercial software; that seperates the foot to the four different parts which are called masks. TrendelenburgÂ’s sign has been estimated as grade 1 and grade 2 by the method which was described by Hardcastle and Nade. Clinical outcome was measured by comparing Harris Hip Scores pre-operatively and postoperatively at last clinic visit. In both groups after the two years from the surgery; total contact time has increased at the operation side when the results were compared before the surgery at the same side and at the other side after the surgery. Also when we looked at the first and second masks which show the significant part of the stance phase; contact areas have similarly increased and the changes at the peak pressures were similar as contact areas. In both groups Harris Hip score was increased significantly after the operation. This is the first study to compare two different lateral approaches by pedobarographic analysis, clinical evaluation and functional scoring. The fuctional and clinical early results are similar in both lateral hip approaches for total hip arthroplasty when superior gluteal nerve protection, conjuant tendon repair and postoperative rehabilitation have done well.