Kürşad Aytekin

Minimally invasive surgical approach using the equal size plate as an external guide to lateral malleoler fractures

BACKGROUND Minimally invasive percutaneous plate osteosynthesis (MIPPO) has begun to be used in fractures of the lateral malleolus surgeries in recent years as for fractures in other regions. However, for MIPPO techniques applied to fractures of the lateral malleolus there is no external guide for plate insertion, determining the incision and inserting the screws as used for fractures in other regions. With the MIPPO technique fluoroscopy exposure is unavoidable. The MIPPO technique is advantageous for patients; however the unavoidable problem with this treatment method for the surgical team is exposure to fluoroscopy with every case. To expose the surgical team to least radiation, we used a technique with an equal-sized plate used as an external guide for treatment of patients and we aimed to present the results of cases treated with our technique. METHODS Cases with isolated lateral maleolar fracture diagnosis, operated with MIPPO technique using an equal-sized anatomic lateral maleolar plate as external guide were retrospectively investigated. On the 1st day after surgery the VAS pain scale at final check-up the AOFAS scores were noted. RESULTS A total of 26 patients were included in the study. Average follow-up time (month) was 42.46±14.11. Mean VAS scores on the 1st day postoperative were 3.76±2.58. On final check-up, prominent implant was identified in 2 patients, with AOFAS average 98±2.17. Apart from prominent implant, no other complications were observed. CONCLUSIONS The use of an equal-sized plate as external guide may ensure less use of fluoroscopy while determining the incisions. Until an external guide is produced commercially for minimally invasive fixation of lateral maleolar fractures, this method ensures determination of incisions and insertion of screws without requiring the use of fluoroscopy and may be reliably used for minimally invasive surgery.

Giant Peroneal Ganglion Cyst: Imaging and Clinical Findings

A ganglion cyst is the cystic lesion originates from the joint capsule or tendon sheath. This lesion is the most common soft tissue tumors of hand, wrist, and foot, and frequently observed in women between 30-50 years. A peroneal ganglion cyst is an uncommon lesion and rarely composes peroneal neuropathic symptoms. We report a 37-year-old man with swelling at the lateral portion of knee below, foot pain, loss of sensation at the lateral portion of left inferior cruris. Ultrasound (US) and magnetic resonance imaging (MRI) findings demonstrated a large cystic lesion in the peroneal muscle, and preliminary diagnosis of peroneal ganglion cyst was proved by cytology. The patient was asymptomatic one month after surgery. There was no evidence of residue or recurrence on US imaging after 6 months.

Caecum location in laboratory rats and mice: an anatomical and radiological study

Intraperitoneal (i.p.) injection is the most frequently used method for implementing parenteral therapies in rats and mice. Whether the caecum is located in the right caudal quadrant or left caudal quadrant in the abdominal cavity is not clear. For that reason, we have developed a method for identifying the location of the caecum in rats and mice and thus revealed the most reliable location for i.p. injection in these animals. Two hundred Wistar albino rats and 100 BALB/c mice were used. The location of the caecum was determined by revealing the intra-abdominal organs immediately following euthanasia, photographing the organs, and archiving the images. Both digital photographic images and computed tomographic (CT) sections were analysed in terms of caecum morphology and location. In both rats and mice, the caecum was most commonly located on the animal’s left side. It was less frequently located on the right side or in the centre. The caecum was typically comma-shaped, but it was round or S-shaped in some animals. The direction of rotation of the caecum from the basis to the apex was mostly counterclockwise. Additionally, the apex showed a tendency to be evenly centred. This study demonstrated that the caecum was mostly located on the animal’s left side; and for that reason, the most suitable location for i.p. injection in these animals was understood to be the right caudal quadrant. Furthermore, when we compared the CT images and autopsy findings, the caecum did not change location in the abdominal cavity postmortem.

Congenital insensitivity to pain syndrome accompanied by neglected orthopedic traumas and complications

Pain is a protective mechanism. Congenital insensitivity to pain syndrome is a very rare disease in which there is no ability to feel physical pain. It has been reported that it occurs with an incidence of 1 in 125 million newborn. Patients with congenital insensitivity to pain may have various orthopedic complications such as recurrent fractures, osteomyelitis and neuropathic joints. The most frequently affected body parts are lower extremities. Besides, curvature of spine can be seen. Injuries in epiphyseal points may cause incompatibility of extremity. Charcot joints may develop, which can lead to neuropathic arthropathy as a result of insensitivity to pain. Here, we present a patient with traumatic fracture-dislocation on left hip that neglected the treatment, had a bilateral femur fracture and then had septic arthritis of knee.

Denosumab Therapy in Giant Cell Bone Tumor: Review of Literature

Denosumab is an effective and usefull drug for managing the giant cell bonetumor. It is considered the gold standard for treatment of the inoperable or metastatic giant cell tumors. Theefficacy of denosumab in giant cell bone tumors has been demonstrated in prospective randomized trials. Neoadjuvant therapy with denosumab may facilitate intralesional surgery in giant cell tumor instead of resection leading to more morbidity in a large giant cell tumor close to the neurovascular structure. It should not be forgotten that pseudosarcomatous changes in biopsies may ocur after denosumab treatment due to different reasons. Giant cell tumor may result in dense cortex after denosumab treatment and local tumor recurrence after concealment of tumor cells within the subchondral bone. Denosumab is associated with jaw osteonecrosis formation. In this article, guidelines for systematic evaluation, risk factors, diagnostic-therapeutic usefullness and treatment options for patients treated with denosumab are presented.

Autologous Blood Injection Works for Recalcitrant Lateral Epicondylitis

BACKGROUND Recalcitrant lateral epicondylitis may be a disabling condition. Treatment of this condition is still controversial. AIMS In the present prospective study, we evaluated the long-term results of autologous blood injection for the treatment of recalcitrant lateral epicondylitis. STUDY DESIGN Prospective clinical study. METHODS A total of 42 elbows of 40 consecutive patients (28 female, 12 male) were enrolled in this prospective study. Seven patients left the study (3 patients moved to another city, 1 patient died in the second week due to a heart condition, 1 patient quit the study because of the resolution of pain in the fourth week and 2 patients did not agree to the second injection). Thirteen patients were lost to third year follow-up. Therefore, a total of 21 elbows of 20 patients with 3 years of follow-up were included in this study. The mean age of the patients was 47.25 years (range, 20-68 years). RESULTS Visual analogue scale (VAS), Nirschl score and grip strength were significantly improved after injections when compared to before treatment. The best improvement in terms of grip strength, Nirschl score and VAS score was detected at the one year follow-up. The improvement in Nirschl and VAS score sustained until the third year. CONCLUSION We suggest that autologous blood injection for the treatment of recalcitrant lateral epicondylitis is an effective, safe and successful procedure in the long-term.

Redüksiyon Sırasında Yaşın Gelişimsel Kalça Displazisi Kapalı Redüksiyon Tedavisine Etkisi

Amac: Bu calismada klinigimizde kapali reduksiyon pelvipedal alci ile tedavi edilen hastalarin reduksiyon sirasindaki yasinin kisa donemde klinik ve radyolojik sonuclara etkisini tartismayi amacladik. Yontem: Nisan 2004-Aralik 2011 tarihleri arasinda kapali reduksiyon ve pelvipedal alci uygulamasi ile tedavi edilmis GKD’li 81 hastanin 126 kalcasi degerlendirildi. Tedaviye baslanildiginda 0-6 ay arasinda olanlar grup 1.6-12 ay arasinda olanlar grup 2, 12-18 ay arasinda olanlar grup 3 ve 18 aydan buyuk olanlar grup 4 olarak adlandirildi. Gruplar kapali reduksiyonun elde edilmesi, yeniden cikik gelisimi, takiplerinde asetabuler displazi nedeni ile pelvik osteotomi uygulanmasi, son kontrollerindeki fizik muayene ve radyoloji bulgulari dikkate alinarak Mc Kay siniflandirma sistemi ve Tonnis’in tariffledigi asetabuler displazi acisindan kendi aralarinda karsilastirildi. Bulgular: Tedaviye baslanildiginda hastalarin ortalama yaslari 11.5 ay ve ortalama takip suremiz 35.1 ay idi. Grup 1’de24 kalca (%19.1), grup 2’de43 kalca (%34.1), grup 3’de 28 kalca (%22.2) ve grup 4’de 31 kalca (%24.6) mevcuttu. Grup 1 ve 2’deki hastalarin hepsinde kapali reduksiyon elde edilirken, grup 3’de 2 kalcada (%5.6), grup 4’de ise 4 kalca-da (%12.9) kapali reduksiyon elde edilemedi. Tum gruplarda birer hastada takiplerinde yeniden cikik gelisti. Yeniden cikik gelisme orani gruplara gore sirasi ile %4.1; %2.3; %3.5 ve %3.2 idi. Takiplerinde asetabuler displazinin devam etmesi nedeni ile grup 1’ de 1 (%4.1), grup 2’ de 4 (%9.3), grup 3’ de 2 (%7.1) ve grup 4’ de 6 kalcada (%19.3) pelvik osteotomi uygulandi. Mc Kay siniflandirma sistemine gore grup 1’deki kalcalarin 18’inde (%81.8) cok iyi, 4’unde (%18.2) iyi; grup 2’deki kalcalarin 33’unde (%86.8) cok iyi, 5’inde (%13.2) iyi; grup 3’deki kalcalarin 20’sinde (%87) cok iyi, 3’unde iyi (%13) ve grup 4’deki kalcalarin 14’unde (%70) cok iyi, 3’unde (%15) iyi ve 3’unde (%15) orta sonuc mevcuttu. Tonnis’ in tarif ettigi asetabuler displazi derecelendirmesine gore 27 kalcada evre 4 displazi mevcuttu. Ciddi, evre 4 displazili kalca sayisi grup 1’de 2 (% 8.7); grup 2’de 5 (%11.9), grup 3’de 5 (%20) ve grup 4’de 15 (%57.7) idi. Tum hastalarda reduksiyon oncesine gore son kontroldeki grafilerde asetabular indeks acisindan anlamli fark mevcuttu (p < 0.001). Kapali reduksiyon elde edilememe acisindan grup 3 ve 4 diger gruplardan anlamli farklilik gosteriyordu (p=0.005). Klinik parametreler acisindan yaslar arasinda istatiksel olarak anlamli fark mevcuttu (p=0.039). Displazi acisindan yaslar arasinda istatiksel olarak anlamli fark mevcuttu (p=0.001). Cikarimlar: Bir yasindan sonra tedaviye baslanilan kalcalarda calismamizda kapali reduksiyon elde edememe, asetabuler displazinin duzelmemesine bagli pelvik osteotomi uygulanma orani daha yuksek bulunmustur. Daha iyi sonuclar elde edebilmek icin tedaviye erken donemde baslanilmali ve bir yasin uzerinde tedaviye baslanilan hastalar asetabular displazinin varligini surdurmesi acisindan yakindan takip edilmelidir.