Osman Aynaci

Three-headed reversed palmaris longus muscle : a case report and review of the literature

The palmaris longus muscle (PLM) is extremely variable both in number and form. We present the first reported case of three-headed reversed PLM in a 36-year old woman. The relevant literature is reviewed. Variations of the muscles of the forearm and specifically the PLM are not uncommon. However, different rates are given for the types and agenesis of PLM. In one study, the incidence of agenesis was 12.8% and other anomalies were 9%. 15 cases of reversed PLM have been reported in the literature. In our case, the three-headed PLM was resected. The patient’s symptoms resolved and at 1-year follow-up she remains symptom-free.

Effects of Human Amniotic Fluid on Fracture Healing in Rat Tibia

BACKGROUND Human amniotic fluid (HAF), including hyaluronic acid (HA) and several growth factors, has been used experimentally in tendon, nerve, and cartilage regeneration and in bone defects because of its positive stimulating effects on regeneration potential. This study was performed to investigate whether HAF was effective on fracture healing. MATERIALS AND METHODS We created 36 tibial fractures in 20-week-old Wistar rats that were divided into three groups. In group 1, fracture lines were instilled with HAF collected at 18th week of the gestation and, in group 2, fracture lines were instilled with HAF obtained at the end of the gestation. HAF which was collected from different period of gestation was used, because the concentration of HA and growth factors in HAF varies considerably during gestation. Group 3 was used as an operative control group. RESULTS Fracture-healing score was highest in group 1 radiologically at the 3rd and 5th week (P = 0.037, P = 0.018, respectively). In the scintigraphic evaluation, metabolic activity at the fracture site was observed in group 1 more than the others at the 3rd week (P = 0.010). Histologically, the highest scores were obtained from group 1 as compared to other groups at the 3rd and 5th week. In the 5th week, predominant cartilage with some woven bone was observed in group 3, while predominantly woven bone with some cartilage was observed in group 1 (P = 0.036). CONCLUSIONS Our data suggest that HAF had a positive effect on fracture healing in rat tibia, and also this positive effect was observed more in group 1.

Bilateral Hip Arthroplasty for Ochronotic Arthropathy

Abstract: Ochronosis is a musculoskeletal manifestation of alkaptonuria, a rare hereditary metabolic disorder characterised by the absence of the enzyme homogentisic acid oxidase and associated with various systemic abnormalities related to the deposition of homogentisic acid pigment (ochronotic pigment). In this report, we describe a 53-year-old, HLA-B27(+) woman with ochronotic arthropathy. In addition to the typical clinical features of the disorder, she had bilateral hip involvement, which was improved by cementless total hip prosthesis.

Intraarticular fibroma of the tendon sheath arising from the infrapatellar fat pad in the knee joint

We report a rare case of fibroma of the tendon sheath arising from the fat pad in the knee. To our knowledge, only four previous cases of fibroma of the tendon sheath in the knee have been reported in the English literature. In our case, magnetic resonance imaging showed low signal intensity in the mass on T1- and T2-weighted images. The mass was excised by mini arthrotomy.

Stress hormones during the wake-up test in scoliosis surgery

STUDY OBJECTIVE To compare hemodynamic and endocrine stress responses of two anesthetic regimes during intraoperative wake-up tests in scoliosis surgery. DESIGN Randomized, controlled clinical study. SETTING University hospital. PATIENTS 40 ASA physical status I and II teenage patients scheduled for scoliosis surgery. INTERVENTION Patients were randomly divided into two groups: the propofol group (Group P) and the sevoflurane group (Group S). In Group P, anesthesia was induced with propofol and remifentanil and was maintained with infusions. Sevoflurane and remifentanil were used in Group S. After surgical instrumentation, patients were awakened, and the wake-up times were recorded. To determine the stress responses, blood samples were taken before induction, 10 minutes after surgical incision, before the wake-up test, during the wake-up test, and 10 minutes after the wake-up test. Cortisol, epinephrine, and norepinephrine concentrations, and hemodynamics all were recorded at the same time. MEASUREMENTS AND MAIN RESULTS The times from discontinuation of anesthetics to eye opening and movement were similar in both groups. Epinephrine and norepinephrine concentrations during the wake-up test were significantly higher than pretest results in both groups (p < 0.001). There were no statistically significant differences between groups in heart rate or blood pressure. CONCLUSIONS Propofol-remifentanil anesthesia is equivalent to sevoflurane-remifentanil anesthesia for a wake-up test. Both the propofol- and sevoflurane-based anesthetic regimens abolish hemodynamic and endocrine stress responses to incision for scoliosis surgery in teenagers. Intraoperative wake-up testing is associated with substantial catecholamine stress despite virtually unchanged mean arterial pressure and heart rate.

The effect of ultrasound on the healing of muscle-pediculated bone graft in spinal fusion.

Study Design. A rabbit model of posterolateral intertransverse process spine arthrodesis with and without the application of low-intensity ultrasound was used. Objective. To determine the effects of low-intensity ultrasound on the healing of muscle-pediculated bone graft. Summary of Background Data. Earlier animal and clinical studies demonstrated the efficacy of low-intensity ultrasound stimulation in the acceleration of osteogenesis and fracture healing. This is the first study in which the beneficial effects of ultrasound on the healing of muscle-pediculated bone graft in spinal fusion have been assessed. Methods. In this study, 20 New Zealand rabbits were randomly assigned to two groups to undergo either spinal fusion using muscle–pedicle bone graft with ultrasound (ultrasound group) or muscle–pedicle bone graft without ultrasound (control group). Muscle-pediculated bone grafts were prepared from the posterosuperior iliac crest, erector spine muscle, and internal and external oblique muscle. This graft was placed bilaterally between the L5 and L6 transverse processes. Ultrasound was performed 20 minutes per day over the rabbits’ lumbar spine. The rabbits were killed 6 weeks after surgery. The lumbar spines were evaluated radiologically, macroscopically, and histologically. Results. By macroscopic and radiologic findings, fusion was detected in 11 control group rabbits (55%) of the control group, and in 17 ultrasound group rabbits (85%). The fusion success rate for the rabbits treated with low-intensity ultrasound were statistically higher (P <0,05) than that for the control group. Histologic specimens showed increased bone formation in the fusions exposed to ultrasound. Mature fusions were present in rabbits that received ultrasound. Conclusion. Low-intensity ultrasound in white rabbits increased the rate and quality of spinal fusion using muscle-pediculated bone grafts.

Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

PURPOSE The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. METHODS AND MATERIALS Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. RESULTS The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). CONCLUSION This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.

Synovial chondromatosis of the subtalar joint: a case report and review of the literature.

Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules within the synovium and most commonly affects large joints, such as the knee and hip. Diagnosis in synovial chondromatosis is generally confirmed by histology after clinical and radiologic examination. Diagnosis may sometimes be difficult because synovial chondromatosis resembles a soft-tissue mass and may give no radiologic findings. We describe a case of synovial chondromatosis stemming from the subtalar joint, in which diagnosis was difficult clinically and radiologically. The patient presented with pain in the ankle and with a soft-tissue mass. This case is presented with a review of the literature on subtalar joint involvement of synovial chondromatosis.

Treatment of osteochondral defects with tendon autografts in a dog knee model.

Abstract Tendon autograft was used for the treatment of osteochondral defects induced experimentally in dogs’ knees. Osteochondral defects were created on the femoral condyles in both knees of five dogs. The tendon was harvested from the anterior cruris, and a knot was tied in the middle. Then two tunnels were bored in the medial condyle. The free ends of the tendon were individually inserted into the tunnels and pulled from the openings on the medial recessus side so that the knot itself sat within the osteochondral defect. The lateral condyle was left untreated for comparison. At 24 weeks postoperatively, the dogs were killed and macroscopical and histological examinations were performed. A congruous articular surface had formed, and the grafted tendon was bonded into the defect. The tendon was not degraded, and was covered with reparative tissue as seen microscopically. Despite weight-bearing being allowed in the early stages after the operation, no sign of degradation was noted in the tendon.

A new interference nail fixation for anterior cruciate ligament soft tissue grafts.

Abstract We present a new device for femoral and tibial fixation in anterior cruciate ligament reconstruction using soft tissue. We evaluated the method biomechanically in pullout tests using human cadaver knee joints. Fixation strengths ranged from 300 ± 60 to 600 ± 50 N (mean 400 ± 50 N). This corresponds to loads in the graft during aggressive rehabilitation although cadaveric specimens were used. With respect to primary fixation strength this implant is a reasonable alternative for anterior cruciate ligament graft fixation.