Orcun Sahin

Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review.

OBJECTIVE AND IMPORTANCE: This report presents a case in which cerebellar hemorrhage occurred after lumbar decompression surgery that was complicated by dural tear and prolonged cerebrospinal fluid leakage. Remote cerebellar hemorrhage after spinal surgery is extremely rare. Our objective is to describe this unusual complication, discuss the possible mechanisms of remote cerebellar hemorrhage, and review the literature. CLINICAL PRESENTATION: A 73-year-old woman underwent surgery for lumbar spinal stenosis. A dural tear occurred during decompression, and the patient developed remote cerebellar hemorrhage on postoperative Day 2. INTERVENTION: The cerebellar hemorrhage was treated surgically, and a biopsy of hemorrhagic brain parenchyma revealed an arteriovenous malformation. CONCLUSION: Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.

Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis.

BACKGROUND Hip fractures in patients with end-stage renal disease are associated with frequent complications. This study analyzed clinical outcomes for patients on chronic hemodialysis who sustained hip fractures and were treated with a variety of fracture repair methods. METHODS Twenty-nine patients with thirty-two hip fractures were analyzed in three groups. Group 1 consisted of eleven hips in eleven patients with an intertrochanteric fracture that was treated with internal fixation; Group 2, thirteen hips in ten patients with a femoral neck fracture that was treated with screw fixation; and Group 3, eight hips in eight patients with a femoral neck fracture that was treated with hemiarthroplasty. The outcomes and early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were compared. RESULTS In Group 1, eight complications occurred in six hips and nonunion developed in five hips. In Group 2, sixteen complications developed in eleven hips. Union was achieved in two of the thirteen hips, nine hips had nonunion, and two hips had osteonecrosis develop. In Group 3, only one hip had early complications, there were no late complications, and three patients died. The mean duration of follow-up was twenty-three months, and the overall mortality rate was 45%. There were no significant differences among the groups with respect to the cumulative survival proportions. Regression analysis of age, sex, and total hemodialysis duration in relation to mortality risk revealed that only age had a significant influence on mortality (p = 0.019). CONCLUSIONS Surgical treatment of hip fractures in patients with end-stage renal disease who are on chronic hemodialysis is associated with frequent complications and a high mortality rate. Osteosynthesis is an acceptable option for treating intertrochanteric fractures and nondisplaced femoral neck fractures, but displaced femoral neck fractures should be treated with hemiarthroplasty.

Analysis of Modified Oblique Keller Procedure for Severe Hallux Rigidus

Background: Several procedures have been described for treating hallux rigidus, but all have limitations. The purpose of this study is to evaluate the clinical and radiologic results of a modified oblique Keller procedure for treating hallux rigidus. Materials and Methods: Eleven patients (13 feet) with Grade III or IV hallux rigidus were treated by modified oblique Keller procedure. Average age was 64.7 years and followup was 27.2 months. Outcomes including range of motion (ROM) of first metatarsophalengeal joint, complications, American Orthopaedic Foot and Ankle Society (AOFAS) scores, satisfaction, osteophyte recurrence, osteonecrosis, and shortening were analyzed. Preoperative and postoperative values were statistically compared. Results: Mean preoperative and postoperative ROMs were 6.5 degrees and 51.9 degrees, respectively (p < 0.005). Two feet had numbness on the dorsum of the first toe. Transfer metatarsalgia occurred in one patient. Mean preoperative and postoperative AOFAS scores were 29.1 points and 93.6 points, respectively (p < 0.005). All patients had good or excellent results. There was no recurrence of the dorsal osteophyte. One patient had radiographic mottling of the first metatarsal head. Average preoperative and postoperative first toe length was 124.3 mm and 123.1 mm, respectively. Conclusion: This technique was a good treatment alternative for patients with end-stage hallux rigidus. It was a safe and reliable procedure that preserved range of motion and has good outcomes.

The effects of two different continuous passive motion protocols on knee range of motion after total knee arthroplasty: a prospective analysis

OBJECTIVES We prospectively evaluated the effects of continuous passive motion (CPM) started after two different time intervals following total knee arthroplasty (TKA) on short- and long-term results, in comparison with standard physical therapy. METHODS Eighty-six patients were randomized to three groups following TKA for primary osteoarthritis. The control group (n=28) received only conventional physical therapy. Group I and II, each consisting of 29 patients, were treated with conventional physical therapy combined with CPM that was started on the first and third postoperative days, respectively, and continued until discharge with three one-hour sessions daily. Preoperative and postoperative measurements of the knee range of motion were recorded. Clinical and functional results were assessed using the Knee Society rating system. The patients were followed-up for at least two years (range 26 to 52 months). RESULTS The duration of CPM was 22 hours in group I, and 19 hours in group II (p>0.05). Knee flexion values measured in the CPM groups on day 3 and at discharge showed significant differences with those of the control group, but no significant differences were found between the groups after the first postoperative month in this respect (p>0.05). The mean duration to reach 100 degrees of passive knee flexion (p=0.03) and the mean length of hospital stay (p=0.04) in the CPM groups were shorter by three and two days compared to the control group, respectively. Clinical and functional knee scores showed significant improvements in all the groups postoperatively (p<0.001), but there were no significant differences between the groups with respect to pre-and postoperative knee scores (p>0.05). CONCLUSION Even though CPM protocols applied following TKA may shorten the length of hospital stay, CPM applications do not offer additional short- and long-term benefits over standard physical therapy with respect to knee flexion and clinical and functional results.

Consanguineous marriage and increased risk of idiopathic congenital talipes equinovarus: a case-control study in a rural area.

Background: The purpose of this study is to evaluate if there is any relationship between consanguineous marriages and idiopathic congenital talipes equinovarus (CTEV). Methods: A case-control study on CTEV screening was conducted in a rural eastern city of Turkey between 2009 and 2011 and a total of 28 cases (infants with idiopathic CTEV) and 575 controls (healthy infants) were recruited. Sociodemographic status of the infants, including gestational age and birth weights, maternal characteristics and, if any, the degree of consanguinity, were recorded. As an inclusion criterion, only singleton, full-term, live births were accepted. A backward stepwise logistic regression model was used to evaluate the relationship between idiopathic CTEV and parental consanguinity. Unadjusted and adjusted odds ratios (OR) with 95% confidence interval (CI) were calculated. Results: Among maternal and infant characteristics, significant risk factors for idiopathic CTEV in the regression analysis were work status (employed), consanguineous marriage, sex (male), and gestational age (>42 wk). Babies born to first-cousin parents had >4 times the risk of idiopathic CTEV [OR, 4.138, (95% CI, 1.484, 11.538)] and the risk for those born to distant relatives was 2.9 times higher [OR, 2.941, (95% CI, 1.070, 8.087)] than for children of unrelated parents. Conclusions: Consanguineous marriage was significantly associated with an increased risk of idiopathic CTEV. This association remained significant even after adjusting for potential confounding variables. To obtain more accurate results, a population-based screening study with an increased number of cases and controls should be performed in future studies. Level of Evidence: Case-control study investigating the effect of a patient characteristic on the outcome of disease (level-III).

Metatarsal transfer for the treatment of post-axial metatarsal-type foot synpolydactyly: A new technique that allows for comfortable shoe wearing

We analysed the clinical and radiological outcomes of a new surgical technique for the treatment of heterozygote post-axial metatarsal-type foot synpolydactyly with HOX-D13 genetic mutations with a mean follow-up of 30.9 months (24 to 42). A total of 57 feet in 36 patients (mean age 6.8 years (2 to 16)) were treated with this new technique, which transfers the distal part of the duplicated fourth metatarsal to the proximal part of the fifth metatarsal. Clinical and radiological assessments were undertaken pre- and post-operatively and any complications were recorded. Final outcomes were evaluated according to the methods described by Phelps and Grogan. Forefoot width was reduced and the lengths of the all reconstructed toes were maintained after surgery. Union was achieved for all the metatarsal osteotomies without any angular deformities. Outcomes at the final assessment were excellent in 51 feet (89%) and good in six (11%). This newly described surgical technique provides for painless, comfortable shoe-wearing after a single, easy-to-perform operation with good clinical, radiological and functional outcomes.

Internal fixation of bilateral sacroiliac dislocation with transiliac locked plate: a biomechanical study on pelvic models

OBJECTIVE The purpose of this study was to analyze and compare the mechanical characteristics of a new iliosacral fixation technique (bilateral S1 pedicle fixation through a transiliac locked plate) for bilateral sacroiliac dislocations with other previously described methods. METHODS Bilateral sacroiliac dislocations were created in 21 pelvic models and divided into three different fixation method groups. Group 1 was fixed using posterior tension band plating with a 3.5 mm locked plate combined with fixed-angle locked 3.5 mm screw fixation of bilateral S1 vertebra pedicles through suitable holes of the plate. Group 2 underwent posterior tension band plating with a 3.5 mm locked plate combined with bilateral spongious iliosacral screw fixation and Group 3 bilateral iliosacral spongious screw fixation alone. The ultimate load to failure and load for 10 mm of displacement for all three groups were compared. RESULTS The average loads to failure for Groups 1, 2 and 3 were 1775, 2084 and 2230 N, respectively, and average loads for 10 mm of displacement were 1033, 1884 and 2013 N, respectively. Group 2 and 3 had the strongest fixation constructs although there was no statistically significant difference between these two groups (p=0.452). Group 2 and 3 were superior to Group 1 in terms of loads for 10 mm of displacement. There was no significant difference between Group 2 and 3 in this regard (p=0.397). CONCLUSION Iliosacral screws are superior to bilateral S1 pedicle fixation through posterior tension band plating. However, the combination of tension band plating with iliosacral screw fixation does not improve the stability of the posterior pelvic ring.

Sacral hemivertebra: a case report

Hemivertebrae are most commonly seen in the thoracic and lumbar regions but sacral hemivertebrae are very rarely seen. While performing a radiographic search for a study on congenital scoliosis in patients with congenital heart disease, an 11-month-old boy who was treated surgically for congenital heart disease in 1997 was found to have a sacral hemivertebra with no thoracic or lumbar scoliosis. He was almost symptom free and had no complaint regarding his sacral hemivertebra including back-pain in this 7-year period. In the radiographic study, sacral 2–3 hemivertebrae with segmentations were detected which did not cause thoracic or lumbar scoliosis.RésuméLes hémivertèbres le plus généralement sont vues dans les régions thoraciques et lombaires alors que les hémivertèbres sacrées sont très rarement rencontrées. Lors d’une recherche radiographique sur la scoliose congénitale chez des patients ayant une cardiopathie congénitale, un nourrisson âgé de 11 mois qui avait été traité chirurgicalement pour sa cardiopathie congénitale en 1997, s’est avéré être porteur d’une hémivertèbre sacrée en dehors de toute scoliose thoracique ou lombaire. Il était presque sans symptômes et n’a eu aucune plainte concernant son hémivertèbre sacrée, ni même des lombalgies basses pendant une période d’observation de sept ans.. Dans l’étude radiographique, des hèmivertèbres S2-S3 furent trouvées, avec segmentation mais sans scoliose thoracique ou lombaire.

Platelet-rich plasma decreases fibroblastic activity and woven bone formation with no significant immunohistochemical effect on long-bone healing: An experimental animal study with radiological outcomes

Purpose: This study aimed to analyze the immunohistochemical effect of platelet-rich plasma (PRP) on healing of long-bone fractures in terms of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF), the Ki-67 proliferation index, and radiological and histological analyses. Methods: Sixteen adult rabbits, whose right femoral diaphysis was fractured and fixed with Kirschner wires, were randomly divided into two groups, control and PRP (groups A and B, respectively). PRP was given to group B at 1 week postoperatively, and all animals were euthanized after 12 weeks. Radiographic evaluations were performed periodically. Cortical callus formation, chondroid and woven bone area percentages, osteoblastic and fibroblastic activities, and mature bone formation were examined. The depths of BMP-2 and VEGF staining were measured. The Ki-67 proliferation index was also calculated. Results: The mean radiological union score of group B was significantly higher than that of group A. There were also statistically significant differences between groups A and B in terms of cortical callus formation, woven bone area percentage, fibroblast proliferation, and mature bone formation. Group B had significantly more cortical callus and mature bone formation with less woven bone and fibroblast proliferation. Immunohistochemical analysis revealed no statistically significant difference between the groups in terms of BMP-2 and VEGF staining and the Ki-67 index. Conclusions: PRP had no effect on BMP-2 or VEGF levels with no increase in the Ki-67 proliferation index, although its application had a positive effect on bone healing by increasing callus and mature bone formation with decreased woven bone and fibroblast proliferation.

Computer-assisted diagnosis of osteoartrithis on hip radiographs

Hip osteoarthritis (OA) can be highly disabling and eventually may necessitate total replacement of the joint. Studies with computer-based analysis of the hip OA may give new insight both in imaging and clinical evaluation of the disease. In this study, new acetabular angle measurement methods of femoral head-neck-shaft angle (CCD), center-edge angle (CE) and acetabular depth-to-width ratio (ADR) are reconstructed via a computer based analysis technique for robust detection of OA on anteroposterior (AP) hip radiographs. The evaluation and validation of this computer-assisted system is performed by comparing these new automated methods with those of traditional manual measurement methods done by one orthopaedist and one radiologist. The 50 adult hip AP radiographs with OA are used and overall measurements are produced for both sides of the hip on radiographs separately. The mean average difference between these two measurement methods for CCD angle is found 1°±1,2°, for CE angle 1°±1,5° and for ADR ratio 1±1,4 respectively. The results show that this new automated angle and ratio measurement system can be found feasible and user friendly by clinicians owing to the similarity between the comparative results of two measurement methods statistically.