Goksel Dikmen

Does Obesity Negatively Affect the Functional Results of Arthroscopic Partial Meniscectomy? A Retrospective Cohort Study

PURPOSE The purpose of this study was to evaluate the impact of body mass index (BMI) on early functional results of patients who undergo isolated partial meniscectomy. METHODS The functional results for 1,090 patients who underwent partial meniscectomy, in 2 different orthopaedic clinics, were evaluated retrospectively. The study includes cases with arthroscopic partial meniscectomy for isolated meniscal tears; patients with concomitant knee pathology were excluded. Three hundred forty-one (31%) patients with isolated lateral meniscal tears, 628 (58%) patients with isolated medial meniscal tears, and 121 (11%) patients with both medial and lateral meniscal tears underwent arthroscopic partial meniscectomy. We divided these patients into 3 subgroups on the basis of their BMI; <26, between 26 and 30, ≥30. Preoperative functional results were compared with 1-year postoperative follow-up results using the International Knee Documentation Committee (IKDC),(26) Lysholm Knee Scale,(27) and Oxford Scoring System(28) scores. RESULTS According to all 3 knee scales, age, side of lesion, and tear type had no effect on functional outcome. When compared with the group with BMI <26, the patients with BMI between 26 and 30 and the patients with BMI ≥30 had significantly worse outcomes as measured by the IKDC, Oxford Scoring System, and Lysholm Knee Scale scores. Patients with BMI between 26 and 30 and ≥30 did not have significantly different functional outcomes. CONCLUSIONS Short-term outcomes after arthroscopic partial menisectomy reflect significant improvement in subjective outcome. However, patients with moderate or significant obesity (BMI >26) have inferior short-term outcomes compared with nonobese patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Antibiotic-coated nail for fusion of infected charcot ankles.

Background: Treating infected ankles in patients with neuropathy is difficult, and complications are frequently encountered. Eradication of infection and effective arthrodesis are required for a successful outcome. The purpose of this study was to evaluate the outcomes of patients with Charcot neuropathy whose infected ankles were treated with a retrograde, antibiotic-coated, locked intramedullary nail. Methods: We analyzed 5 patients with infected neuroarthropathy of the ankle joint. Three patients had failed treatment with the circular external fixator for infected neuroarthropathy of the ankle. The other 2 were treated primarily by this technique. All patients were treated with surgical nonunion repair, arthrodesis, and insertion of an antibiotic-coated, locked intramedullary nail. The average age was 59 years (range, 46 to 82 years). The average follow up period was 18 months (range, 12-24 months). Results: The average time taken for radiological healing was 4.1 months (range, 4-4.5 months). In all patients, bony union was achieved and infection was eradicated. There were no cases of hardware failure. Conclusion: Antibiotic-coated nails were used to treat infected ankle nonunions and infected distal tibial fractures in Charcot patients with successful bony union, fusion, and eradication of infection. Level of Evidence: Level IV, therapeutic study.

The effect of strut allograft and its position on Vancouver type B1 periprosthetic femoral fractures: a biomechanical study.

The aim of this study is to assess the biomechanical advantage of adding strut allograft and the effect of its position on the construct in Vancouver type B1 fractures. Fifteen forth-generation synthetic femurs were used and created a fracture model at the tip of prosthesis, and subsequently fixated with a lateral plate only, lateral plate and medial strut, lateral plate and anterior strut. Rotational and axial tests were performed. In all loading tests, the plate with medial strut group was stiffer than the other constructs and had higher failure load values and had less displacement in the fracture site. A combination of a plate with a medial strut allograft provides more mechanical stability on periprosthetic femoral fractures near the tip of a total hip arthroplasty.

Arthroscopic labral repair versus labral debridement in patients with femoroacetabular impingement: a minimum 2.5 year follow-up study

Purpose To compare the clinical results of labral repair with labral debridement in patients undergoing arthroscopy for femoroacetabular impingement. Methods Between July 2008 and December 2011, 67 patients (73 hips) underwent arthroscopic treatment for femoroacetabular impingement. The repair group consisted of 33 patients; 18 hips with pincer only, 1 with CAM only and 15 with combined impingement. The debridement group contained 34 patients; 6 with pincer only, 5 with CAM only and 28 with combined type. The mean age in the repair group was 33.5 years (range, 30-61) and in the debridement group was 39.5 years (range, 18-59 y). At the time of last follow-up, patients hip function was evaluated with ROM of the hip; daily Hip Outcome scores (dHOS) and Visual Analogue Score (VAS). Results The mean follow-up was 45.2 month in the repair group and 47.2 month in debridement group. Daily hip outcome scores were significantly improved from preoperatively to last follow-up in both groups (p<0.05). However, there were no statistical significant difference in dHOS between repair and debridement groups (p>0.05) at last follow-up. 2 patients in the repair group and 1 patient in the debridement group had undergone total hip replacement at an average of 16 months (range, 4-32 m) after arthroscopic treatment. Hip joint instability occurred in 1 patient in the repair group due to aggressive capsular resection. This was treated by a periacetabular osteotomy. Conclusions No difference in hip functional outcomes was observed between labral debridement and labral repair in arthroscopic treatment of femoroacetabular impingement.

Arthroscopic treatment of femoroacetabular impingement: early outcomes

OBJECTIVE The aim of the study was to assess the early outcomes of the arthroscopic treatment of femoroacetabular impingement. METHODS Forty-two femoroacetabular impingement (FAI) patients (mean age: 35.1 years, range: 16 to 52 years) treated arthroscopically between 2006 and 2011 in our clinic were retrospectively analyzed. Twenty-five patients had Cam, 6 Pincer and 11 combined femoroacetabular impingement. Mean follow-up time was 28.2 (range: 10 to 72) months. Patients were assessed clinically and functionally using the Non-Arthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), Oxford Hip Score, WOMAC score, and Visual Analogue Scale (VAS) pain scores preoperatively and at the final follow-up. RESULTS In clinical and functional assessments, there were increases of 24.8 points in mean NAHS, 23.3 in mHHS, 20.6 in WOMAC score and 9.6 in Oxford Hip Score. VAS pain score decreased by 4.9 points in comparison to the preoperative scores. There were no major complications. However, transient pudendal nerve neuropraxia was present in two patients, transient lateral femoral cutaneous nerve neuropraxia in one and asymptomatic heterotopic ossification in one patient. CONCLUSION Short-term clinical results of the arthroscopic treatment of the FAI appear to be satisfactory.

Treatment of infected nonunion of the juxta-articular region of the distal tibia

OBJECTIVE The purpose of this study was to summarize our clinical results with distraction osteogenesis for the treatment of infected tibial nonunion around the ankle joint. METHODS Between 1994 and 2009, 13 patients with a mean age of 50 years (range: 27-79 years) underwent tibial reconstruction for the treatment of infected nonunion of the distal tibia, with a mean bone loss of 4.8 cm (range: 1-7 cm). Lengthening over an intramedullary nail as a second procedure was used in 2 patients, bifocal compression and distraction technique in 5 cases, compression with Ilizarov external fixator in 5 cases, and Taylor Spatial Frame (TSF, Smith Nephew, Memphis, TN, USA) in 1 case. At final follow-up, functional and radiographic results were evaluated according to Paleys bone and functional healing criteria. RESULTS Mean duration of follow-up was 36 months. Mean external fixation time was 198 days, and mean external fixation index was 29 days/cm. According to Paleys bone healing criteria, there were 10 excellent, 2 good, and 1 poor result(s); additionally, according to Paleys functional healing criteria, there were 5 excellent, 6 good, and 2 fair results. There were 11 problems, 5 obstacles, and 1 sequel according to Paleys classification of complications. There was 1 persisting nonunion, which underwent revision with a retrograde intramedullary nail. CONCLUSION External fixator and/or combined treatment are effective and reliable methods to treat infected nonunion of the distal tibia. Every patient should be evaluated according to their infection level and bony defects for reconstruction.

Effects of demineralized bone matrix on tendon-bone healing: an in vivo, experimental study on rabbits

OBJECTIVE The aim of this study was to investigate the effects of demineralized bone matrix (DBM) on tendon-bone healing. METHODS The extensor digitorum longus tendon was fixed with pegged suture technique in a tunnel at the proximal tibia in both legs of 12 New Zealand rabbits. Rabbit DBM was applied in the tunnel on the right limbs before fixation (study group), while the fixation was performed without DBM in the left legs (control group). Randomly, four rabbits were sacrificed at the 3rd, four rabbits at the 6th and the remaining four rabbits at the 9th week with an intravenous high dose (200 mg/kg) pentothal and both legs were collected for histological analysis. Each specimen was blindly and independently examined to assess fibrocartilage formation, new bone formation, tendon graft bonding to adjacent tissue and Sharpeys fiber formation. A scoring system was used for quantification of histopathological analysis. RESULTS The DBM group showed higher number of Sharpeys fibers, slightly increased fibrocartilage formation and new bone formation scores than the control group in the 3rd week. All histological scores were similar in both groups in the 6th and 9th weeks (p>0.05). CONCLUSION DBM increased new bone formation and the number of Sharpeys fibers in a bone tunnel animal model within the first three weeks of tendon-bone healing process.

Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients

OBJECTIVE The aim of this study was to analyze the results and complications of simultaneous bilateral femoral and tibial lengthening in achondroplastic patients. METHODS The study included the 44 femora and 44 tibiae of 22 achondroplastic patients (16 females, 6 males; mean age: 6.36 years, range: 3 to 11 years) that underwent simultaneous lengthening. Orthofix LRS monolateral fixators were used for femoral lengthening and either Ilizarov-type or hexapod-type circular external fixators for tibial lengthening. Tenotomies of the hip flexors and the Achilles tendon were performed to prevent injury to the growth plates and to prevent joint contractures. Results and complications were evaluated according to Paleys scoring and complication systems. RESULTS Average follow-up time was 35 (range: 26 to 76) months. The femora were lengthened by an average of 7.07 cm (46.1%), and the tibiae by an average of 6.64 cm (52.9%). Patients gained an average of 16.9 cm in height, including physiological growth. The mean bone-healing index (BHI) was 31.2 days/cm for the femora (range: 17.4 to 43.3 days/cm) and 34.3 days/cm for the tibiae (range: 19.5 to 60.0 days/cm). Complications included 3 delayed maturations, 3 pin track infections, 5 transient fibular paralyses, 5 regenerate fractures, 1 late varus deformity, 1 knee contracture and 1 knee contracture secondary to knee dislocation. Functional scores were excellent in 78 segments, good in 8, fair in 1 and poor in one. There was no growth inhibition related to the lengthening. CONCLUSION Bilateral simultaneous lengthening of the femora and tibiae in achondroplastic patients provided a reduction in total treatment and external fixation time, with a low rate of complications.

Analysis of the cause, classification, treatment, outcome and associated injuries of pediatric pelvic ring fractures.

BACKGROUND Although pediatric pelvis fractures are relatively uncommon, long-term consequences and associated life-treating injuries often have a substantial impact for the rest of a childs life. The prognosis of pediatric pelvic fractures is better than that of the adults because of their greater elasticity, healing capacity and re-modelling. Fractures through the physis may lead to growth disturbance and/or acetabular dysplasia. Non-union is rare and mal-union is usually well-tolerated. The purpose of this study was to evaluate the results of a single trauma center and review the literature approach to pediatric pelvic fractures. METHODS Medical records were analyzed for diagnosis, the mechanism of injury, additional injuries, treatment methods, and complications. The types of fractures were classified according to Torode and Zieg classification. Patients were called back and seen at the clinic as a last follow up visit. RESULTS Twenty eight skeletally immature patients, under the age of 12, were treated for pelvic fracture from 1997 to 2012. Mean age was 6.8±2.4 years. Three children with an unstable pelvic ring injury required pelvic external fixation. One patient died due to pelvic hemorrhage postoperatively. Mean follow up was 5.3±3.6 years. CONCLUSION Pediatric pelvic fractures are rare but life-threating injuries. Overall good or excellent long-term results can be expected in most cases with appropriate timing and treatment.

Mid-term results of pediatric vascular injured supracondylar humerus fractures and surgical approach.

The purpose of this study was to describe our experience with poorly perfused hands after supracondylar fracture of the humerus (SFH) in children and to present mid-term outcomes of a single trauma center. This is a retrospective analysis of SFH patients with vascular injuries, conducted from 2003 to 2012. Nine patients (2.1% of all SFH patients) underwent vascular reconstruction with no hand perfusion after adequate reduction and fixation at a mean age of 8.3 years (±1.8, range 4–12 years). No amputation was needed, and satisfactory elbow and hand functions were obtained. Immediate close anatomic reduction and pinning with re-evaluation of hand perfusion is mandatory for SFH patients with suspected vascular injury before vascular exploration.