Muhittin Sener

Arthrodesis of neuropathic ankle joint by Ilizarov fixator in diabetic patients.

BACKGROUND Fusion of the neuropathic ankle joint is extremely difficult and associated with many complications. The use of the Ilizarov fixator in ankle fusion for patients with neuropathic arthropathy is not clear. We aimed to evaluate the results of the Ilizarov method for ankle arthrodesis in diabetic patients with neuropathic arthropathy. METHODS We report the results of neuropathic ankle joint arthrodesis performed with the Ilizarov apparatus in 11 patients. The mean age of the patients was 51 years (range, 35-67 years), all patients were diabetic, and they all had a history of ankle trauma unresponsive to conservative treatment. Deformity and instability of the ankle resulting in a nonplantigrade foot was the operative indication. RESULTS Solid fusion was obtained in all patients except one, at an average of 16.1 weeks (range, 12-20 weeks). At final follow-up, excellent results were obtained in three patients, good in six, fair in one, and poor in one. No major complication occurred. CONCLUSIONS The Ilizarov fixator may be an alternative and effective means for neuropathic ankle arthrodesis, especially when the usage of internal fixation methods have some limitations.

Inter- and intra-tester reliability of sensibility testing in digital nerve repair

The aim of this study was to investigate the inter- and intra-tester reliability of the static two-point discrimination and Semmes–Weinstein monofilament tests in digital nerve repair. A total of 100 digital nerves from 67 patients were included into the study. An experienced orthopaedic surgeon and a physiotherapist examined the sensory nerve recovery. The reproducibility score of both tests was at a poor level, but the reliability of the Semmes–Weinstein monofilament test was higher than the static two-point discrimination test. These tests should not be used alone in the quantitative monitoring of sensory recovery, but should be interpreted with the clinical findings. Level 3 non-randomized controlled study.

An unusual Hodgkin's lymphoma case presenting with upper extremity multiple masses.

Almost always, Hodgkins lymphoma presents with lymph node involvement. Primary extranodal lymphoma is rare and mostly has a type of non-Hodgkins lymphoma. We present an unusual presentation of a Hodgkins lymphoma in a 33-year-old man. There were numerous soft tissue masses localized in the subcutaneous tissue of the left arm along the neurovascular bundle and the ipsilateral axillary region. We found only one Hodgkins lymphoma case that presented as an upper extremity mass reported in the literature. In cases where a great number of successively lined up soft tissue masses are detected on the extremity, lymphoma takes place among the differential diagnoses.

Retroperitoneal migration of a septically loose femoral component.

Migration of total hip arthroplasty components is generally associated with a medial acetabular wall defect and may cause various intrapelvic complications. This is often a result of the destructive bone loss that takes place with infection. To our knowledge, this is the first report that presents complete intrapelvic migration of a femoral stem of total hip arthroplasty due to septic loosening with an intact medial acetabular wall.

Delayed Radial Nerve Palsy Caused by Pin Migration in a Surgically Treated Proximal Humeral Fracture: A Case of Axonamonosis

Fractures of the proximal part of the humerus are common injuries that often occur in elderly osteoporotic patients. The decision process regarding the surgical technique is challenging because of the variety of treatment options1,2. Although locked plate fixation has become a popular surgical technique for many proximal humeral fractures, other techniques such as pinning, wiring, and intramedullary nailing are useful in certain situations. Less invasive techniques provide the advantage of incorporating the rotator cuff insertion to increase fixation in patients with poor bone quality, as well as preserving the soft-tissue envelope and vascularity to the humeral head. Closed or open-pin fixation techniques for proximal humeral fractures have potential pitfalls such as malunion, nonunion, loss of fixation, pin-track infection, and pin migration3. We describe a case of late radial nerve palsy caused by pin migration in a patient treated with multiple pin fixation and tension-band wiring for a proximal humeral fracture. We also review the potential pitfalls of pin fixation and the technical details that can help avoid these complications. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A sixty-one-year-old woman presented with right shoulder pain after a fall. After clinical and radiographic evaluation, she was referred to our hospital. Radiographs and computed tomography scans demonstrated a displaced four-part fracture of the proximal part of the humerus (Fig. 1). The patient was informed about the treatment alternatives including open reduction and internal fixation (ORIF), as well as hemiarthroplasty. Fig. 1 Preoperative anteroposterior radiograph shows a proximal humeral fracture. Surgical treatment with a deltopectoral approach was performed under general anesthesia with the patient in the …

Bilateral stress fractures of the distal fibula in a woman with osteoporosis: a case report.

Bilateral stress fractures of the fibula are very rare. We present an unusual case report of a 54-year-old osteoporotic woman with bilateral stress fractures involving the distal fibula. After conservative treatment, she made a good recovery with full motion and was free of pain.

The effects of suramin in prevention of peritendinous adhesions following flexor tendon injury in a chicken model.

Peritendinous adhesions are the most common complication of flexor tendon injuries. Overproduction of transforming growth factor Beta has been reported as a major cause of tissue fibrosis. This study investigated the effects of suramin, a known inhibitor of transforming growth factor Beta, on the formation of flexor tendon adhesions in a chicken model. Forty-two chicken flexor tendons that were divided partially were repaired using a modified Kessler technique. The chickens were divided into 3 groups. In group 1 (control), no suramin was administered to the tendon repair site; in group 2, 1 mg of suramin was injected around the tendon repair site; and in group 3, 2 mg of suramin was injected around the tendon repair site. At 6 weeks postoperatively, the animals were sacrificed, and functional, histologic, and biomechanical examinations were performed. There was no difference between the groups in terms of tendon excursion. Histologic evaluation showed adhesions were decreased in the groups treated with suramin. In the biomechanical evaluation, a statistically significant difference was present only between the group treated with 2 mg of suramin and the control group. Although suramin is effective in preventing peritendinous adhesions, it can reduce tendon strength as dose-dependent. Future studies should be performed with different doses to determine clinical application.

Extension block technique for mallet fractures: a comparison of one and two dorsal pins.

The aim of this study was to compare the clinical and radiological outcomes of one or two dorsal pins for extension blocking of mallet fractures. We treated 36 mallet fractures with the extension block technique. A single pin was used in 19 fractures (Group 1) and two pins in 17 fractures (Group 2). The mean age was 33.6 years and the mean follow-up time was 12.2 months. All patients were assessed by the Crawford outcome score. Extensor lag and other complications were noted. All fractures united with a mean time of 6.0 weeks (4–9) in Group 1, and 6.1 weeks (4–7) in Group 2. We obtained 74% and 71% excellent and good outcome scores in Group 1 and in Group 2, respectively. The final extension lag was 6° in Group 1, and 7° in Group 2. No difference was found between the two groups in terms of clinical outcomes, radiological values and complications. Level 3 non-randomized controlled study.

Sanders type 3–4 calcaneal fractures fixed with locking plate: does tri-cortical iliac bone autograft provide extra benefit for stabilization?

Objective The aim of this study was to determine whether tri-cortical iliac bone autografting provided extra benefit for the stabilization in Sanders Type 3–4 calcaneal fractures fixed with locking plate. Materials and methods The study included 29 calcaneal fractures (Sanders Type 3/4=15/14). All fractures were fixed with locking plate using the extended lateral approach. Bone grafts were used in 16 (Group A; Sanders Type 3/4=7/9) and not used in 13 (Group B; Sanders Type 3/4=8/5) calcaneal fractures. As a grafting material, only tri-cortical iliac crest bone autograft was used. All operations were performed by the same surgeon. The same locking plate was used in all fractures. Calcaneal height and angle of Bohler and Gissane were measured in early postoperative and final control radiographs in both groups. Clinical evaluations were performed using the American Orthopedic Foot and Ankle Society ankle hind foot scale. Results There was no difference between the groups in terms of clinical results. Radiologically, the degree of change in Bohler’s angle, Gissane’s angle, and calcaneal height was not different between the groups. Conclusion Bone grafting does not affect the clinical and radiologic outcomes in Sanders Type 3–4 calcaneal fractures fixed with locking plate, and they provide no extra benefit to the stabilization. We think that fixation using locking plate is adequate and there is no need for bone grafting.

Lunate excision with capitohamate fusion in the treatment of stage IIIB and IIIC Kienböck's disease

Objective The aim of this study was to report our results of lunate excision combined with capitohamate fusion in the treatment of Kienböcks stage IIIB/IIIC disease. Methods A total of 7 patients with a mean age 35.2 (SD 11.5) years were enrolled in the study. Pain was the principal reason for surgery. All operations were carried out by the same senior surgeon. Patients were evaluated in terms of range of motion, DASH and VAS scores, satisfaction, and grip/tip/palmar/key pinch strength compared with contralateral sides. Preoperative carpal height indexes and findings of osteoarthritis were determined radiographically and compared with postoperative evaluations. Results Mean duration of follow up was 15.2 months. Mean DASH and VAS scores were 13.8 2.7 and 2 1.1 respectively. The mean patient satisfaction score was 3.2 0.4 over 4 points. The mean grip strength in the operated hands was 66.4%, palmar pinch was 75.1%, tip pinch was 71.8% and key pinch was 70.4% when compared to the contralateral unaffected sides. The mean flexion range in the operated hands was 58.8%, extension range was 60.3%, radial deviation range was 65.2% and ulnar deviation range was 65.7% when compared to the contralateral sides. There was no significant difference between preoperative and postoperative carpal height ratios (p = 0.086). Conclusions Our early term results indicate that lunate excision combined with capitohamate fusion may be an alternative treatment option in patients with stage IIIB and IIIC Kienböcks disease. Level of Evidence Level IV, Therapeutic study.