Fehmi Kuyurtar

Nerve entrapment in painful heel syndrome.

Subcalcaneal heel pain is one of the most common foot ailments, yet the exact etiology is still controversial. Nerve entrapment has been suggested as one of the possible causes of this painful condition in recalcitrant cases. The purpose of this study is to determine the role of nerve entrapment in painful heels. Twenty patients with heel pain (25 heels) were compared with an age and body mass index-matched control population using electrodiagnostic methods. The results of the study revealed 22 heels (88%) with heel pain had lateral plantar nerve entrapment signs with or without medial plantar nerve findings on EMG. There were no abnormal values in the control group. Nerve entrapment syndrome has previously been considered only in cases with intractable heel pain, but this study suggests that it may play a role the early phases of painful heel syndrome.

Involvement of the proximal tibiofibular joint in osteoarthritis of the knee

This study was performed to evaluate the possible involvement of the proximal tibiofibular joint in primary osteoarthritis of the knee. A total of 40 patients with primary osteoarthritis of the knee who had magnetic resonance imaging scans were reexamined for proximal tibiofibular joint involvement. The patient was questioned if pain was present in the proximal tibiofibular joint while at rest, when walking and climbing stairs. Symptoms were evaluated by applying moderate compression over the proximal tibiofibular joint during active ankle and knee motions. Magnetic resonance imaging scans were reexamined by two radiologists. Three of the 40 patients had minimal or moderate pain in the proximal tibiofibular joint during stair-climbing and on clinical examination. Magnetic resonance imaging scans of these three patients revealed osteophyte or subchondral cyst formation, or both. Degenerative changes in the proximal tibiofibular joint may be evident in association with osteoarthritis of the knee and may result in lateral-sided pain at the knee.

Evaluation of cyanoacrylate augmentation of transpedicular screw pullout strength

Purpose: Pedicle screw fixation of osteoporotic bone in the elderly is a challenge. Various augmentation methods have been studied by many authors. Although polymethylmethacrylate (PMMA) augmentation is believed to be a standard method, its usage is fraught with complications. Butyl-2-cyanoacrylate is an alternative to PMMA as it is bioresorbable, biocompatible, inexpensive, and noninfective. The objective of the current study was to determine the pullout strength of the pedicle screws when butyl-2-cyanoacrylate is used for augmentation. Methods: Fresh calf lumbar vertebrae were obtained from male calves weighing 100-120 kg and implanted with pedicle screws. The screws were placed in native, unaugmented bone (group 1), butyl-2-cyanoacrylate-augmented bone (group 2), and PMMA-augmented bone (group 3). Axial pullout tests were done by an Instron 4411 universal testing machine. Statistical analysis was performed using the SPSS 9.0 for Windows program. Paired samples t test was used, and P < 0.05 was considered significant. Results: The mean bone mineral density of the vertebrae was 1.6 ± 0.1 g/cm2. The mean pullout strengths were 1.55 ± 0.23 kN for group 1, 1.62 ± 0.42 kN for group 2, and 2.55 ± 0.22 kN for group 3. There was no statistically significant difference between groups 1 and 2. PMMA augmentation increased the pullout strength significantly when compared with butyl-2-cyanoacrylate augmentation and native bone (P = 0.002 and P = 0.001, respectively). Conclusions: The results of this study show that butyl-2-cyanoacrylate has no contribution to the augmentation of pedicle screw fixation in a calf model when compared with native bone or PMMA augmentation. Further studies are required to evaluate the effectiveness of butyl-2-cyanoacrylate in osteoporotic specimens and under cyclic loading in calf vertebra and animal and cadaver models before dispensing with its utility as an augmentation method in the clinical setting.

Measurement of the humeral head retroversion angle: A new radiographic method

Abstract Background. In this study, a simple and reliable radiographic method is described to determine the torsional profile of the humeral head. Methods. First, by using a specially developed frame, the humeral head retroversion angles (HRAs) of 20 dry humeri were measured by an anatomist and an orthopedist. Then the HRA of these humeri were measured by two orthopedists on radiographs taken in semi-axial view when the humeri were in 20° abduction. Results. The results were assessed with the SPSS 9.05 program, and the repeatability coefficient of both methods was 98%. The average difference in angle determination between the two methods was 0.9°; the maximum difference was 3°. After that, posteroanterior semi-axial radiographs of both humerus bones of 40 healthy volunteers were taken by positioning their arms in 20° abduction to the X-ray axis. The mean HRA difference between the right and left sides was 0.4° (maximum difference 3°) and is of no clinical significance. It was determined that left and right HRAs can be taken as a reference to each other. For measurement of the HRA in the planning of proximal humeral rotation osteotomy and prosthesis replacement arthroplasty, the presented radiographic method can be used with a high rate of accuracy.

Intra-articular Injection of Tenoxicam in Osteoarthritic Knee Joints With Effusion

Thirty patients who had grade II to III osteoarthritis according to Kellgren-Lawrence system and presenting with acute effusion of the knee joint were randomly assigned to 2 groups. All patients were treated with aspiration of the synovial fluid, cold application, and rest. Fifteen patients received an intra-articular injection of tenoxicam 20 mg following aspiration. The other group was administered oral tenoxicam 20 mg a day for 10 days. Patients were examined at 2, 4, and 8 weeks and then in 3-month intervals. At followup visits, pain was assessed using visual analog scale: range of motion, and effusion of the knee joint were recorded. A repeated measure test was used to determine the significance of changes in pain and mobility between the groups. Students Neyman Keuls test was used to determine the significance of differences within the groups. Chi-square test was used for the number of episodes. The intra-articular injection group had more rapid pain relief than the oral treatment group (P < .01). At the end of 1 year, the number of effusions was significantly lower in the intra-articular treatment group (P < .01). These results indicate that intra-articular injection of tenoxicam provides rapid pain relief in the patients with acute flare-up of knee osteoarthritis and helps to prevent effusion.

Injection-induced contracture of the quadriceps femoris muscle in children.

Contracture of the quadriceps femoris in children leads to limited knee flexion.1 Fairbank and Barret2 and Hnevkovsky3 believed the contracture was congenital or secondary to progressive idiopathic fibrosis of the vastus intermedius. Lloyd-Roberts and Thomas4 stipulated that multiple injections into the thigh might cause the contracture. Proximal release in the early stage and distal release in the late stage are the recommended treatments.5 Concomitant proximal and distal release in the early stage has not been reported previously. This article presents a case of quadriceps contracture due to multiple thigh injections in a young patient.

Head Injury-Associated Bone Fractures Induce Bacterial Translocation : An Experimental Study

Objectives To determine whether long bone fractures cause bacterial translocation and to investigate the effect of concomitant head trauma on this process. Design An in vivo animal model. Setting Animal Laboratory, University of Mersin School of Medicine, Mersin, Turkey. Subjects Male Sprague-Dawley rats (n = 60). Intervention Sixty male Sprague-Dawley rats were divided into five groups: (1) anesthesia only (control group, n = 12); (2) anesthesia and tibia fracture (n = 12); (3) anesthesia, tibia fracture, and femur fracture (n = 12); (4) anesthesia, tibia fracture, femur fracture, and moderate head trauma (n = 12); and (5) moderate head trauma only (n = 12). After 24 hours, mesenteric lymph nodes, liver, spleen, ileum, and systemic blood samples were quantitatively cultured for aerobic organisms. Main Outcome Measurements Colony-forming unit per gram for bacteria count. Results The incidence of bacterial translocation was higher in groups that had fractures (4/12 in group 2; 5/12 in group 3) than in the control group (2/12); however, this did not reach statistical significance. There was a significant increase in the number of subjects with bacterial translocation in group 4 (9/12) compared with the control group and group 5 (3/12) (P = 0.0123, P = 0.0391). Conclusions Multiple fractures of long bones associated with head injury promote bacterial translocation.

The anterior center edge angle: a study of 102 volunteers.

OBJECTIVES To measure the anterior center edge (VCE) angle that reflects anterior coverage of the femoral head. PATIENTS AND METHODS False profile views of both hips of 102 volunteers, 23 male and 79 female, were taken between October 2000 and October 2001. Radiographs with evidence of degenerative hip disease and those with poor image quality were excluded from the study. This left 181 radiographs. RESULTS An orthopedic surgeon and a radiologist used a standard protractor to examine each of the 181 radiographs twice, at an interval of 24 h. The mean VCE angle was 49.27 +/- 7.77 degrees (range, 24.75-68.75), a value different from those found in previous studies. No significant intraobserver or interobserver differences were found. CONCLUSIONS Our findings may contribute to the determination of a new parameter for evaluating anterior femoral head covering. In patients with acetabular dysplasia and deficient anterior coverage, this parameter may prove useful for selecting patients for surgery, planning the procedure, and evaluating postoperative results.

Effect of patient age and symptom duration on subjective and objective outcomes of carpal tunnel surgery

This study prospectively examined the relationship between patient age and symptom duration on surgical outcome of carpal tunnel syndrome. Surgical outcomes were evaluated using both subjective and objective measures and statistical analysis was performed using canonical analysis. The result revealed patient age and symptom duration have significant effects on bot subjective and objective outcomes of carpal tunnel surgery.