Metin Manouchehr Eskandari

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.

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.

Retinacular band excision improves outcome in treatment of plica syndrome

Mild symptoms usually continue after excision of the medial patellar plica. We noticed that the palpable tender cord, located on the anteromedial aspect of the knee in patients with plica syndrome, did not disappear completely after excision of the synovial fold. Beneath all plicae, a retinacular band was visible, and only after excisions of this band did the cord become impalpable. We conducted a study to determine the role of these medial retinacular bands in the symptomatology of the disorder. Twenty-four knees of 22 patients diagnosed with medial patellar plica syndrome were divided into two groups. In the first group, arthroscopic excision of the synovial plica was performed. In the second group, retinacular bands beneath the plica were additionally excised. When Lysholm scores were compared, we found that the second group showed significantly greater improvement. We believe that the retinacular bands play a role in the symptomatology and the pathophysiology of plica syndrome and that excision improves the outcome.RésuméHabituellement des symptômes discrets persistent après excision du plica médiopatellaire. Nous avons constaté que le cordon palpable présent dans la partie antéromédiale du genou chez les malades avec un syndrome de plica n’a pas complètement disparu après excision du repli synovial. Sous tous les plicas une bande retinaculaire était visible et seulement après excision de cette bande le cordon est devenu impalpable. Nous avons conduit une étude pour déterminer le rôle de ces bandes rétinaculaire médiales dans la symptomatologie persistante. Vingt-quatre genoux de 22 malades présentant un syndrome du plica médio patellaire ont été divisés en 2 groupes. L’excision arthroscopique du plica synovial était faite dans le premier groupe et dans le deuxième groupe la bande rétinaculaire sous le plica a été excisée en plus. Quand les scores de Lysholm ont été comparés nous avons vu que le deuxième groupe avait une meilleure amélioration, statistiquement significative. Nous croyons que cette bande rétinaculaire joue un rôle dans la symptomatologie et la physiopathologie du syndrome du plica et que son excision améliore le résultat.

Addition of Fusidic Acid Impregnated Bone Cement to Systemic Teicoplanin Therapy in the Treatment of Rat Osteomyelitis

Abstract We compared the efficacy of the combination of fusidic acid impregnated bone cement and systemic teicoplanin to systemic teicoplanin alone in implant-related osteomyelitis model in the rats. Foreign bodies were implanted into the medullary channels of 30 rat tibias after intramedullary inoculation of methicillin-resistant Staphylococcus aureus. Following proof of induction of osteomyelitis in the rats on the 21st day, a bone cement rod including 1/40 ratio of fusidic acid was inserted into the medullary channel of the tibias in the study group. Teicoplanin was administered i.m. at 20 mg/kg/day for 14 days to both the study and control groups. At the end of the treatment, the tibias were examined macroscopically, microbiologically and histopathologically. The elimination rate with the teicoplanin+fusidic acid combination was 81.8%, while with teicoplanin alone was 55.6% (p=0.33). Although the difference between the two groups was not statistically significant, the combination treatment had a positive effect in eliminating the microorganism.

Cyanoacrylate adhesive provides efficient local drug delivery.

Biodegradable drug delivery systems have advanced treatment of a wide spectrum of musculoskeletal problems. However, their lack of availability and cost can restrict use. To find an easily available and inexpensive biodegradable implant, we tested a widely used tissue adhesive, n-butyl-2-cyanoacrylate, as a drug-trapping material. We tested vancomycin with commercially available absorbable gelatin-sponge pieces as the scaffold. We evaluated the in vitro and in vivo drug release profiles and in vivo inflammatory response. A mouse muscle pouch model was used for in vivo evaluations. The released vancomycin level was measured by fluorescence polarization immunoassay technique, and a leukocyte count-based grading system was used to evaluate inflammatory response. Our findings suggest the proposed implant provides effective drug release for as much as 42 days in vitro and 14 days in vivo. The presence of n-butyl-2-cyanoacrylate led to a local inflammatory response which decreased after 3 weeks in the group with less adhesive. These results showed that n-butyl-2-cyanoacrylate could efficiently trap and slowly release a drug when used in the structure of a biodegradable local drug delivery device.

Early internal fracture fixation prevents bacterial translocation.

The aim of our study was to determine whether early internal fixation of major bone fractures helps prevent bacterial translocation in patients with multitrauma. Thirty-seven Sprague-Dawley rats were divided into three groups: (1) anesthesia only (n = 12); (2) the trauma group: tibia and femur fractures and moderate head trauma under anesthesia (n = 14); and (3) the fixation group: fixation of tibia and femur fractures and moderate head trauma under anesthesia (n = 11). After 24 hours, mesenteric lymph nodes, liver, spleen, and systemic blood samples were quantitatively cultured. The terminal ileum was assessed histopathologically. The incidence of bacterial translocation was less in the anesthesia group (two of 12 rats) and the fixation group (two of 11 rats) than in the trauma group (10 of 14 rats). The number of organs containing viable bacteria was significantly lower in the fixation group than in the trauma group. Histopathologically, villous architecture was preserved mostly in the fixation group; however, marked mucosal damage was detected in the trauma group. Our data suggest early internal fixation of long bone fractures in polytraumatized experimental animals with head injury results in preservation of the intestinal mucosal barrier and decreased bacterial translocation from the gut.

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.

LATE PSYCHOSOCIAL EFFECTS OF CONGENITAL HAND ANOMALY

Lifetime-standing psychosocial effects of congenital hand anomalies are inevitable in patients who have not received a comprehensive treatment with appropriate timing and approach. Herein, two adult cases of untreated thumb polydactyly are presented. Both of them had hands with striking appearance and late consequent psychosocial problems.