Metin Doğan

Synovial chondromatosis of four compartments of the knee: medial and lateral tibiofemoral spaces, patellofemoral joint and proximal tibiofibular joint

A case of synovial chondromatosis of the proximal tibiofibular joint in addition to lateral and medial tibiofemoral spaces and patellofemoral joint has been presented.

Nondrainage Decreases Blood Transfusion Need and Infection Rate in Bilateral Total Knee Arthroplasty

This retrospective study enrolled 526 patients undergoing bilateral total knee arthroplasties at our institution. In nondrainage group (Group 1) of 255 patients (510 knees), a disposable elastic sterile exsanguination tourniquet (HemaClear), wound closure in layers and Jones Bandage, without pre-tourniquet removal hemostasis or Hemovac drain were used. In drainage group (Group 2) of 227 patients (454 knees), pneumatic tourniquet, post-deflation hemostasis, a Hemovac drain and Jones bandage were used. The maximal drop in hemoglobin was significantly greater in Group 2 than Group 1 (P < 0.001). Also infection rate was significantly lower in Group 1 (P = 0.017). The use of sterile tourniquet removed after wound closure without Hemovac drain decreases blood transfusion need, infection rate, tourniquet related pain and postoperative complications.

One-stage treatment of congenital severely dislocated hips in older children through various acetabuloplasty techniques: 22 children followed for 1-5 years.

Background There is no consensus regarding the best treatment for children with late diagnosis of congenital hip dislocation. Patients and methods This retrospective study involved 29 hips in 22 children (19 girls) with an age range of 3–14 years, who had been operated with various techniques for congenital hip dislocation between 1998 and 2002. 6 patients had right, 9 patients had left, and 7 patients had bilateral congenital hip dislocation. The mean length of follow-up was 3 (1–5) years. Results While the mean acetabular index was 53°(35–65) preoperatively, at the last follow-up it was 30° (15–50). 27 hips were type 4 and 2 hips were type 3 by Tönnis criteria. Satisfactory reduction (Severin Class I) had been achieved in 19 hips at the follow-up radiography, and they developed no osteonecrosis. The outcome was successful in children under 7 years of age, but problems encountered in those over 7 increased unless sufficient reduction had been achieved. Interpretation Age at treatment of late-diagnosed congenital hip dislocation appears to be important for outcome.

Evaluation of antiseptic use in plastic and hand surgery.

Despite the growing complexity of plastic surgical cases, antiseptics available for preoperative preparation do not always prove effective. In addition to the varied sites of plastic surgery, there is a likelihood of considerable contamination with microorganisms since surgical gloves are frequently punctured during surgical procedures. With an aim to find a solution to all of these problems, a study was conducted in 2 stages. First, antimicrobial effects on the normal flora of hands of 4 different surgical handwashing procedures, which consist of scrubbing with 7.5% povidone-iodine (PI) scrub by using the sponge/brush, 7.5% PI scrub alone, 0.5% benzalkonium chloride (BC) solution, and 0.1% BC solution, were compared. In the second stage, bacteriological samplings were obtained from fingertips of the operating team during the surgical procedure. At the end of the study, the following results were obtained: (1) scrubbing with 7.5% PI detergent by using a scrub sponge was significantly more effective than without using a scrub sponge (P < 0.05). (2) There was no statistically significant difference in scrubbing when povidone-iodine detergent and 0.5% benzalkonium chloride solution (P > 0.05) were compared. (3) At the end of the surgery lasting 1–5 hours, hands were found to be cleaner than previously washed hands for preoperative preparation, which was considered a consequence of the sustained effect of PI. (4) There was a statistically significant difference between the cultures taken from the gloves at the end of the operation and from the hands after the gloves were taken off (P < 0.01). At the end of the operation, the gloves themselves were found to be extremely dirtier than the hands inside them. As a conclusion, bacterial escape due to glove perforation occurs from outside of the glove to the inside, contrary to the generally accepted concept.

Treatment of missed posterior dislocation of the shoulder by delayed open reduction and glenoid reconstruction with corticocancellous iliac bone autograft

This is a report of a 2-year follow-up of a missed posterior shoulder disclocation treated with open reduction and glenoid reconstruction with corticocancellous iliac bone autograft. In such cases, this treatment option may be an alternative to hemiarthroplasty of the shoulder.

Anatomy of The Posterior Iliac Crest as a Reference to Sacral Bar Insertion

There are no detailed anatomic studies focusing on the posterior iliac crest although it frequently is used for posterior stabilization of unstable pelvic fractures. Anatomic dissections were done to evaluate the size of the extraarticular region of the posterior iliac crest and its relationship to the lumbosacral lamina and to show on cadavers the level of sacral bar placement that offers safe and solid fixation. Sixty cadavers were dissected bilaterally. Fifty-one were male and nine were female. The distance between the posterior wall of the sacral canal and the tip of the iliac crest was measured at various levels between the level of the upper border of L5 lamina to the level of the posterosuperior iliac spine. In all the dissections the greatest distances were at the level of the L5-S1 junction, which consequently is the safest level for good bony purchase. The entire length of the posterior iliac crest from the level of the upper border of L5 lamina to the posterosuperior iliac spine was shown to be appropriate for safe and solid bar fixation because all of the distance measurements were greater than 13 mm, which is the smallest safe distance. Below the posterosuperior iliac spine level, insertion of the sacral bars was dangerous because the average measured distance was only 10.38 mm.

Glenoid axis is not related with rotator cuff tears—a magnetic resonance imaging comparative study

PurposeThe relationship between glenoid version angle and rotator cuff pathology has been described. However, the effect of glenoid version angle on rotator cuff pathology is still unknown. The aim of this study was to investigate whether there is an impact of glenoid version angle on rotator cuff pathology.MethodsAll shoulder MRI examinations performed in the study centres between August 2008 and August 2009 were evaluated retrospectively. Shoulder MRI examinations having rotator cuff pathology such as trauma, degeneration, and acromion type 2-3-4 reported in previous studies were excluded from the study. Sixty-two shoulder MRIs with rotator cuff pathology having type 1 acromion morphology and 60 shoulder exams without rotator cuff pathology were included in the study. Glenoid version angle was calculated in axial images. Rotator cuff was evaluated in fat-suppressed T2-weighted and proton density-weighted images.ResultThe mean values for glenoid version angle were 2.41° and 0.61° in the control and the study groups, respectively. No statistically significant difference was found between the two groups (p > 0.05). In addition, 26.6% and 33.8% of the glenoids were retroverted and 73.4% and 66.2% were anteverted in the control and the study groups, respectively (all p > 0.05).ConclusionThis study demonstrated no significant relationship between glenoid version angle and rotator cuff pathology. Therefore, the pathologies that can be related to the cuff itself should be investigated if the pathology cannot be explained by an extrinsic cause in subjects with rotator cuff pathology.

The impact of proximal fibula fractures in the prognosis of tibial plateau fractures: a novel classification

Fifty-five patients who presented with the complaint of tibia plateau fractures between January 1998 and November 2001 were retrospectively evaluated. The evaluation was based on their treatment modality. Twenty-five conservatively-treated patients (group 1) and 30 surgically-treated patients (group 2) were evaluated. In group 1, seven patients with proximal fibula fractures had lateral hamstring tightness. Five out of these seven patients had concomitant lateral knee pain. Similarly, nine patients with proximal fibula fractures in group 2 had lateral hamstring tightness, and seven patients in the same group suffered from lateral knee pain. The patients with no fibula proximal fracture in both groups had no hamstring tightness or lateral knee pain. The proximal fibula in the knee joint and its anatomical structures are of utmost importance for the anatomical integrity of the knee and its normal functions. The fibula has rich anatomical relations, some of which are important structures of the knee. These anatomical structures and the fibula provide stability of the knee joint and its functions as well as being an important mechanical support to the knee joint. Therefore, the knee joint will receive the negative effects from the pathologies of the bone or soft tissue that may occur in fibula fractures.

The effect of morphometric relationship between the glenoid fossa and the humeral head on rotator cuff pathology

OBJECTIVE The aim of this study was to investigate the impact of the morphometric association between the glenoid fossa and the humeral head on rotator cuff pathology. METHODS Shoulder MRI examinations performed for any cause in study centers between August 2008 and August 2009 were retrospectively evaluated. Shoulder MRI exams having rotator cuff pathology, such as trauma, degeneration, and acromion Type 2, 3 and 4 were excluded. The study included 62 shoulder exams with rotator cuff pathology having Type 1 acromion morphology and 60 shoulder exams without rotator cuff pathology (control group). Glenoid anteroposterior distance and the humeral head diameter in axial images, humeral head diameter and glenoid articular surface diameter in coronal images and their ratios were measured in both groups. Subacromial distance was measured using sagittal images. The rotator cuff was evaluated in fat-suppressed T2-weighted and proton density-weighted images. RESULTS The difference between subacromial distances in the rotator cuff pathology group (8.94 ± 1.43 mm) and control group (10.96 ± 1.62 mm) was statistically significant (p<0.001). There was no statistical significance between the two groups in humeral head diameter, glenoid articular surface diameter, glenoid anteroposterior distance and their ratios (p>0.05). CONCLUSION There is no association between the humeral head and the glenoid articular surface which can result in rotator cuff pathology. The glenohumeral joint was determined as a compatible joint morphometrically. Therefore, if they cannot be explained by an extrinsic cause, pathologies related to the rotator cuff itself should be investigated in subjects with rotator cuff pathology.

A case of ancient schwannoma of the great toe

Ancient schwannoma (degenerated neurilemmoma) is a rare form of schwannoma characterized by calcification and cystic degeneration. A 42-year-old male patient presented with a mass in the base of the left great toe, which had existed for eight years and undergone significant enlargement for the past six months. On physical examination, there was a mass, 3x2x2 cm in size, in the lateral aspect and base of the left great toe. Radiographic appearance of the feet was normal. The mass was removed by blunt dissection. No postoperative problems were seen. The histopathological diagnosis of the specimen was made as ancient schwannoma.