Onder Yazicioglu

The effect of strut allograft and its position on Vancouver type B1 periprosthetic femoral fractures: a biomechanical study.

The aim of this study is to assess the biomechanical advantage of adding strut allograft and the effect of its position on the construct in Vancouver type B1 fractures. Fifteen forth-generation synthetic femurs were used and created a fracture model at the tip of prosthesis, and subsequently fixated with a lateral plate only, lateral plate and medial strut, lateral plate and anterior strut. Rotational and axial tests were performed. In all loading tests, the plate with medial strut group was stiffer than the other constructs and had higher failure load values and had less displacement in the fracture site. A combination of a plate with a medial strut allograft provides more mechanical stability on periprosthetic femoral fractures near the tip of a total hip arthroplasty.

Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results

Introduction The aim of this study was to evaluate the clinical and radiological outcomes of total hip arthroplasty (THA) in patients with Ankylosing Spondylitis (AS). Patients and methods One hundred five hips of 61 AS patients (mean age: 41.3 ± 10.2 years) who underwent THA between 1997 and 2012 were included into the study. Dorrs classification of proximal femoral geometry, acetabular protrusio, bone ankylosis, acetabular protrusion, Brooker classification of heterotopic ossification (HO), Gruen and Charnley classifications of implant loosening were used in radiographic assessments. Patients were called back to return for an additional long-term follow-up for functional assessment. Results Cementless total hip arthroplasty was used in 83 hips (79%) and cemented TKA was used in 22 hips (21%). The overall rate of aseptic loosening was 7.6% at a mean follow-up of 5.4 years. Femoral loosening was statistically similar in cemented and cementless femoral components (14% vs. 8%, p = 0.089). Acetabular component loosening was statistically higher in patients with any degree of HO (p = 0.04). Regardless of the type of femoral implant (cemented or cementless), femoral component loosening was higher in Dorrs type C patients (p = 0.005). The average pre-operative HSS was 46.6 ± 16.3, and it improved to 80.7 ± 18.7 at last follow-up (p < 0.01). Conclusion Revision incidence was similar in between ankylosed and non-ankylosed hips. While complication rates are high, significant functional improvement can be achieved after THA in patients with AS.

A unilateral atypical cleft foot

Abstract A 4-year-old girl with unilateral cleft foot deformity and the treatment is reported. In this case, cleft foot, which is a rare deformity, is not associated with other congenital deformities and the deformity is not hereditary. A syndactilization procedure was applied to the patient.

Periprostetic Joint Infection Caused by Salmonella: Case Reports of Two Azathioprine and Prednisolone Induced-immunocompromised Patients

Periprosthetic joint infection (PJI) due to Salmonella is rare. It frequently occurs patients receiving immunosuppressive medicine. We describe two periprosthetic Salmonella infection of two immunocompromised patients. Both of patients were receiving azathioprine and prednisolone therapy. First patient presented six years after total hip arthroplasty with a huge abscess on her right thigh that was reached to femoral component through the lytic area of lateral femur. Second patient presented with drainage from his hip and he had undergone two-step revision surgery for PJI 3 months ago. There is no consensus in the treatment of periprosthetic salmonella infections. We prefer two-step revision surgery for these infections as previously described in the literature.

Bilateral femoral neck fractures secondary to chronic carbamazepine use treated by bilateral dynamic hip screw: A case report.

Highlights • Insufficiency fractures due to antiepileptic drug use is one of the rare cause.• Insufficiency fractures should be kept in mind for joint and bone pain with a history of long term anti-epileptic drug use.• Carbamazepine could be a result of insufficiency fracture.

Adolescent Anterior Inferior Iliac Spine Avulsion Fracture Operative Treatment: A 14-Year Follow-Up Case Report

Objectives: Pelvic apophysis injuries are generally seen in adolescents and encountered in the form of avulsion fractures which occur with the short-term contractions of the muscles that hold apophysis, following a trauma. In general the iliac crest, the anterior superior iliac spine (ASIS) and the pubic bone fractures are frequently seen but anterior inferior iliac spine (AIIS) fractures are rare. These cases are often treated conservatively, surgical treatment is rarely necessary. In this presentation, AIIS avulsion fracture case that had undergone surgery and had been followed for 14 years was aimed to be stated. Methods: 16 year old male patient who was suffering from sports injuries that happened 40 days ago was admitted to our clinic in February 2000 with complaints about left hip and groin pain. Physical examination and radiographic evaluation of the patient identified left hip AIIS avulsion fracture. Due to more than 2 cm fracture fragment displacement and the patient being a professional football player who had high functional expectations, surgical treatment was planned. Under general anesthesia, after open reduction, internal fixation was performed with 1 cannulated screw. There were no complications observed at follow-up. Patient returned to training at 3 months postoperatively. 14 years after surgery, the patient admitted to a neurologist with complaints of headache and MRI was required to establish the cause. The patient admitted to our clinic in order to get the confirmation whether his implant was MRI compatible. Results: On clinical assessment, after 14 years, the patient didn’t have any complaints at left hip. Left hip flexion was 120°, extension was full, abduction was 40°, adduction was 20°, flexion internal rotation was 30° and flexion external rotation was 40°. Radiographs of the pelvis were normal. On the patients functional assessment, modified Harris Hip Score was 100. Conclusion: Pelvic apophysis injuries are rare injuries seen in adolescents usually as avulsion fractures. These injuries are often treated conservatively however may require surgical treatment for professional athletes with a high functional expectations. In this patient who underwent surgery, at the end of the 14-years long follow-up, functional results were found to be close to perfect.

Charcot arthropathy of the knee after unsuccessful spinal stenosis surgery: A case report

Highlights • We report here a case of a 62 years old patient with charcot arthropathy at her left knee developed one year after spinal stenosis surgery.• The patient’s knee joint was already beyond the fragmentation and coalescence stages at the moment of physical examination.• Unsuccessful spinal surgery affected polyneuropathy and migrated the level of the sensorineural loss proximally.• Elevated level of sensorineural loss resulted in Charcot knee joint in a short period of time.

The quality of life analysis of knee prosthesis with complete microprocessor control in trans-femoral amputees

Objective The aim of this study was to analyze the patient demographics, etiology of limb loss as well as reporting SF-36 scores for microprocessor prosthesis users in Turkish population. Methods We reviewed 72 patients (61 male and 11 female; mean age: 37.7 ± 10.7) with uni-lateral, above knee amputation and a history of regular and microprocessor prosthesis use. All patients were called back for a last follow-up and they were asked to fill a self-administered general health status questionnaire (SF-36). Results According to the SF-36 results; physical component score (PCS) score was 46 ± 7.3 and mental components summary (MCS) score was 46.5 ± 9.1. These scores have statistical similarity with Turkish healthy controls, except SF (social functioning) sub-dimension. PCS score for women microprocessor users were significantly lower than men (43.3 vs. 48.7, p = 0.03), but MCS scores were similar in between genders (46 vs. 48.2, p = 0.13). Conventional prostheses usage time was positively correlated with physical function (PF) scores (r = 0.322, p = 0.010). Microprocessor prosthesis usage time was negatively correlated with role limitations due to emotional problem (RE) scores (r = −0,313, p = 0.009). Conclusion The quality of life surveys were showed that the loss of an extremity have higher physical and psychological impact on womens physical scores. Overall, SF-36 results were similar in microprocessor using amputees and Turkish normal controls. Level of evidence Level IV, therapeutic study.

Osteomalacia and coxa vara. An unusual co-existence for femoral neck stress fracture

Highlights • Femoral neck stress fractures are not uncommon.• Osteomalacia is a common cause of insufficiency fractures.• Coxa vara is a rare cause of femoral neck stress fractures.• Co-existence of osteomalacia and coxa vara is a rare condition.

Evaluation of Proximal Junctional Kyphosis following Posterior Thoracic Instrumentation: The Effect of Posterior Anatomical Structures and Facet Joints: A Biomechanical Analysis on Fresh Sheep Spine

Introduction Proximal junctional kyphosis (PJK) has traditionally been defined by a 10 degree or greater increase in kyphosis at the proximal junction as measured according to Cobb method. Especially patients who have advanced spine deformity are prone to PJK and it is related with aggressive treatment protocols. In this biomechanical study, we aimed to evaluate interspinous ligament complex disruption and facet joint degeneration on PJK development. Material and Methods Randomly selected 21 sheeps were operated via posterior approach and pedicle screws were instrumented from T2 to T7. Three groups with seven samples were established to create junctional disruption. First group selected as control group (CG), of which posterior soft tissue and facet joints were preserved intact. In the second group (spinous group, SG), interspinous ligament complex which one segment cranial to UIV has been transected, and third group (facet group FG) where facet joint excision was performed. 25 N, 50 N, 100 N, 150 N, and 200 N forces applied at frequency of 5 Hz as 100 cycles axial to the samples. To determine strength of proximal junctional area in static loading 250 N, 275 N, and 300 N forces was applied. Changes in the proximal junctional region were defined radiologically. Lateral X-ray views were taken to measure interspinous distances, kyphosis angles, and discus heights. Abnormal PJK was defined by a proximal junctional angle greater than 10 degree and at least 10 degree greater than the corresponding preoperative measurement. Results In CG group, average interspinous distance was 6.6 ± 1.54 mm and kyphosis angle was 2.2 ± 0.46 degree before biomechanical testing, and they were measured as 9.4 ± 1.21 mm and 3.3 ± 0.44 degree respectively after forces applied to samples. In SG group, average interspinous distance was 6.2 ± 1.71 mm and kyphosis angle was 2.7 ± 1.09 degree before the experiment, and they were measured as 20.8 ± 5.66 mm and 15.1 ± 2.33 degrees, respectively, after biomechanical testing. In FG group, average interspinous distance was 4.8 ± 1.15 mm and kyphosis angle was −1 ± 4.14 degree before experiment, and they were measured as 11.1 ± 1.96 mm and 11 ± 2.87 degree, respectively, after forces applied to samples. Statistically significantly junctional kyphosis development was detected on both FG and SG group than group control group (p < 0.05). PJK was seen significantly more frequently on SG group than FG group (p < 0.05). Disc distances were similar in all groups (p > 0.05). Conclusion Protecting interspinous ligament complex and facet joint on surgical treatment of spine deformity is mandatory to prevent PJK. To our knowledge, this is the first biomechanical study that reveals that the interspinous ligament complex is more effective in preventing PJK development than facet joints.