Mesih Kuskucu

Comparison between the results of open and arthroscopic repair of isolated traumatic anterior instability of the shoulder

OBJECTIVES The aim of this study was to compare the early postoperative results of open and arthroscopic Bankart repair for isolated traumatic anterior instability of the shoulder. METHODS The study included 64 male patients who underwent surgery for traumatic recurrent anterior shoulder instability. Of these, 30 patients (mean age 25.1 years) underwent open Bankart repair and 34 patients (mean age 25.8 years) underwent arthroscopic Bankart repair. All the patients had labral tears on preoperative magnetic resonance scans and had complaints of instability even during daily activities. Patients with at least six dislocations were included in the study; patients with multidirectional instability were excluded. The mean time from the first trauma to surgical intervention was 4.4 years (range 1 to 24 years) in the open surgery group, and 3.8 years (range 1 to 17 years) in the arthroscopy group. Decision for surgical treatment was made based on limitation of activities because of fear of having a dislocation and on positive results of instability tests. Repair was performed using metal anchors in both groups. The clinical results were evaluated using the Rowe scale. The severity of pain on the first postoperative day was assessed using a visual analog scale (VAS). The mean follow-up period was 26.1 months (range 12 to 52 months) in the open surgery group, and 26.6 months (range 12 to 51 months) in the arthroscopic repair group. RESULTS The mean duration of operation was 2 hours for open surgery, and 2.5 hours for arthroscopic repair. The size of the incision was approximately 8 cm in the open surgery group, and 3 cm in the arthroscopic repair group. The mean Rowe scores were 90.2 and 91.6, being higher in the arthroscopic repair group. Clinical results of open surgery were excellent in 21 patients (70%), good in eight patients (26.7%), and poor in one patient (3.3%). In the arthroscopic repair group, the results were excellent in 27 patients (79.4%), good in five patients (14.7%), and poor in two patients (5.9%). All the patients with a poor result experienced redislocations due to traumatic falls 5 to 18 months after surgery. The mean VAS score was 5.0 ± 1.3 in the open surgery group, and 4.4 ± 1.3 in the arthroscopic repair group. Loss of external rotation was observed in 15 patients (20° in 8 patients, 10° in 4 patients, 5° in 3 patients) in the open surgery group, and in nine patients (20° in 3 patients, 10° in 6 patients) in the arthroscopic repair group. There were no significant differences between the two groups with respect to Rowe scores, VAS scores, range of motion, apprehension test results, and the incidence of recurrent instability. CONCLUSION Although, in the past, the results of arthroscopic repair were less satisfactory compared to open surgery, this condition has changed remarkably. The results of arthroscopic repair in our study were similar to those of open repair. We believe that, with enhanced experience and advances in arthroscopic repair techniques, arthroscopic treatment may outweigh open surgery.

Comparison of outcomes of two different surgeries in regarding to complications for chronic anterior shoulder instability

IntroductionThe purpose of this study is to compare the early clinical results of two techniques in regarding to complications in the patients who suffered from chronic anterior traumatic isolated shoulder instability.MethodEighty-five patients underwent reconstructive procedures due to chronic isolated traumatic shoulder instability in our clinic between 1990 and 2002. Sixty-four patients in whom preoperatively Bankart lesion were detected with MRI and who participated in the regular follow-up were included in the study. Thirty-four patients were treated with Bankart repair (Group I) and 30 patients were treated with Modified Bristow procedure (Group II). Mean follow-up period was 25 (24–39) months for group I and 28 (24–96) months for group II. All cases were evaluated preoperatively and postoperatively according to Rowe scoring system.ResultsMean Rowe scores were 90 and 88.1 for group I and II, respectively. Due to recurrent dislocation, four revision surgeries (one in group I, three in group II) were performed. Surgical complications were encountered in group II, just as fracture at the bone block in four cases, nonunion in five cases and removal of loose screw in one case.DiscussionAccording to clinical outcomes, both the techniques are useful and feasible for the treatment of the chronic traumatic isolated anterior shoulder instability; however, complication rate is higher in the Modified Bristow technique and, Bankart repair is directed to the anatomic repair of the original pathology.

Report of eight cases of humeral fracture following the throwing of hand grenades

A series of eight cases is presented in which similar fractures of the shaft of the humerus occurred during the throwing of hand grenades. Transient paresis of the radial nerve accompanied the fracture in one patient. In seven patients, the fracture healed without complication. In the remaining case, non-union developed, and surgical treatment was instituted. The mechanism of the fracture is discussed with reference to the literature.

Treatment of Rupture of the Achilles Tendon with Fibrin Sealant

Background: The optimal management strategy for acute Achilles tendon ruptures is controversial. These injuries historically were treated by nonoperative methods (cast immobilization, bandaging); however, operative repair of the ruptured tendon has become popular. Methods: Thirty-two patients who had rupture of the Achilles tendon were treated operatively with use of fibrin sealant, and clinical and functional performance measures were assessed after a mean followup of at least 6 months between November, 1998, and July, 2003. All of the patients were male. Average age was 38.18 (30 to 45) years. All of the patients were followed for at least 18 months after surgery. Average followup time was 22.4 (18 to 56) months. We evaluated all patients according to the scoring system of Thermann et al.Results: Our results were excellent in 24 patients and good in eight patients. One patient had rerupture 3 weeks after surgery. Conclusion: Fibrin sealants are biologically compatible, hemostatic agents derived from human plasma that can be used instead of suture or suture support. We think that the treatment of rupture of the Achilles tendon with fibrin sealant is a useful treatment, and there is less risk of complications, such as deep infection, than in other operative procedures. We had no wound closure problems, the incision size was small, and the operating time was short. However, it must be remembered that the risk of disease transfer by fibrin sealant application is still present.

Missed talar neck fractures in ankle distortions

OBJECTIVES Thirty-nine percent of the ankle and midfoot fractures in ankle distortions could be missed during initial evaluation in emergency department because of inadequate clinical and radiological evaluation in a limited time. We aimed to evaluate the follow-up and treatment outcomes of subjects with missed fractures, which were not diagnosed with plain radiographs obtained for ankle distortion, but with advanced imaging studies. METHODS Eight patients (4 females, 4 males) who were initially treated with a diagnosis of ankle distortion due to trauma between 2004 and 2008 were included in the study. Since there were no fractures in the initial radiographs reported by radiologists, conservative treatment was applied. However, the pain and swelling around the ankle were sustained and advanced imaging studies revealed talus fracture. All patients were evaluated with the scoring system of American Orthopedic Foot and Ankle Society (AOFAS). RESULTS Mean age of the patients was 22.37 years (range 20-40 years) at the initial fracture diagnosis. The talar neck fracture was diagnosed with computed tomography (CT) in 1 patient and with magnetic resonance imaging (MRI) in the remaining 7 patients. Mean follow-up time was 6 months (range 3-8 months), and mean AOFAS score at last follow-up was 93.7 (range 80-100). CONCLUSION Talus fractures can lead to serious complications because of its anatomical localization. Areas with edema, tenderness or pain should be defined on physical examination, and deep palpation should be applied on the lateral aspect of the talar neck. If there is pain in this area at late examination and no fracture was reported with conventional radiographs, the possibility of missed talar fracture should be considered and the patient should be evaluated with CT or MRI.

Chair method: a simple and effective method for reduction of anterior shoulder dislocation

OBJECTIVE The ideal reduction method for anterior shoulder dislocation is defined as a practical technique applied without any assistance and minimizing patient interference. The aim of this study was to evaluate the outcomes of patients with shoulder dislocations reduced using the chair method in the emergency department and show that the chair method is one of the ideal methods. METHODS Seventy-four patients with anterior shoulder dislocation were treated using the chair method. Data from patients were recorded and analyzed. RESULTS All dislocated shoulders were successfully reduced using the chair method without any complication or difficulty. Thirty patients had first time dislocation and 44 patients had previous dislocation. Mean duration between dislocation and reduction was 3 (range: 1 to 6) hours. Mean duration of reduction was 13.9 (range: 3 to 45) seconds. CONCLUSION The chair method is an effective and successful reduction method for shoulder dislocation. We believe that orthopedists and emergency department physicians should be familiar with this simple technique which does not have to be performed under general anesthesia.

Treatment of a Unicameral Bone Cyst of Calcaneus with Endoscopic Curettage and Percutaneous Filling with Corticocancellous Allograft

The surgical procedures for unicameral solitary calcaneal bone cysts have ranged from simple curettage and grafting to subperiosteal resection with internal fixation and grafting. In this article, an endoscopically assisted technique is proposed for the curettage of a simple calcaneal cyst that takes advantage of direct visualization of the cyst wall and contents and permits accurate assessment of the extent of the lesion. After curettage, percutaneous filling of the defect with corticocancellous allograft makes the technique a complete, minimally invasive surgical approach for this condition. The technique uses 2 lateral portals, one for viewing and the other for manipulation, both of which are created under fluoroscopic control. Once the cyst has been located, the 30 degrees arthroscope is used to evacuate fluid, after which more solid cyst contents are fragmented and removed. Thereafter, curettage of the inner surface of the cavernous cyst wall is performed. Finally, complete packing of the previously cystic cavity with crushed corticocancellous allograft is performed under endoscopic visualization and confirmed radiographically.

Giant Solitary Osteochondroma Arising from the Fifth Metatarsal Bone: A Case Report

Accounting for 20% to 50% of all benign forms, solitary osteochondroma is the most common bone tumor. The long bones of the lower extremity are most frequently affected, whereas the small bones of the hands, feet, pelvis, scapula, and spine are less common locations. Osteochondromas are benign osseous neoplasms with a distinct hyaline cartilage cap originating from the physis, and they cease to grow with skeletal maturity. Treatment of osteochondroma is usually conservative, unless symptoms, usually pain, are progressive or the lesion demonstrates rapid or new growth, or if enlargement after skeletal maturation is noted or malignant transformation is suspected. In this report, we describe the case of an adult with a giant, symptomatic osteochondroma localized to the fifth metatarsal. The lesion was treated with excision, and after more than 2 years of follow-up, no evidence of recurrence was noted. This case demonstrated that, despite the benign nature of the lesion, a large osteochondroma could localize to a metatarsal.

The results of reconstruction of the ACL using the cross-pin femoral system and four-strand hamstring tendon autografts.

OBJECTIVE The aim of this study was to evaluate the results of ACL reconstruction using a cross-pin femoral fixation system and hamstring autografts. METHODS The study included 49 men and one woman (mean age: 27.4 years; range: 15 to 44 years) with chronic ACL ruptures operatively treated between 2003 and 2006. Involvement was in the right knee in 27 patients, and the left knee in 23. There were no professional athletes included in the study. Patients with chondral lesions of the knee treated by microfracture or drilling or operated previously were excluded from the study. All patients had an ACL reconstruction with an autogenous four-strand hamstring graft. Thirty-five patients received treatment for other meniscal pathologies. All patients followed a similar accelerated rehabilitation program after surgery. Final evaluations were made using the Lysholm and International Knee Documentation Committee (IKDC) scoring systems and the Tegner activity rating system in the final follow-up. RESULTS Mean follow-up time was 43.9 (range: 29-57) months. Lysholm scores were good or excellent for 47 patients. IKDC scores were either Grade A or B for 48 patients. The mean Tegner activity score was 5.9 (range: 4-9) in the preoperative and 5.4 (range: 2-9) in the late postoperative period. CONCLUSION Reconstruction of the ACL using four-strand hamstring tendons and cross-pin femoral fixation may be a safe and effective method, resulting in considerably high success rates.