Özal Özcan

Deleterious effects of local corticosteroid injections on the Achilles tendon of rats.

Abstract The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon.

Os vesalianum pedis

Os vesalianum pedis is an accessory bone located proximal to the base of the fifth metatarsal. Its prevalence has been reported to be from 0.1% to 1.0%. This bone is found within the peroneus brevis tendon and is considered to be asymptomatic in the majority of people. We describe a patient with os vesalianum pedis with a distinct mediocuboidal articulation. The radiologic differential diagnosis of the ossicle is discussed.

An investigation of consistency between posterior condylar axis +3 degree external rotation line and clinical transepicondylar axis line techniques in primary total knee arthroplasty.

OBJECTIVES This study aims to investigate discrepancy between posterior condylar axis (PCA)+3 degree external rotation (ER) line and clinical transepicondylar axis (cTEA) line and consistency between the both techniques in primary total knee arthroplasty. PATIENTS AND METHODS Thirty-six knees [Bilateral knees were operated simultaneously in 12 patients (50%)] in 24 patients [3 men (12.5%), 21 women (87.5%); average age 67 (59-80 age)] were included in the study. During surgery, PCA+3° ER line and cTEA line were drawn on the distal femoral cutting surface by electrocautery pencil following distal femoral cut. The both lines on distal femur were recorded by digital camera and relationship between lines was ascertained in reference to PCA+3° ER line [parallel, internal rotation (IR), ER]. Statistical analysis was performed by the McNamara chi square test and Kappa (κ) value. RESULTS Assessment of the images revealed that cTEA line in comparison to PCA+3° ER line was parallel in 22 knees (61.2%), but not parallel in 14 knees (38.8%) [IR in 10 knees (71.5%), ER in 4 knees (28.5%)]. There was a significant difference (McNamara chi square=12.7±1; p<0.001) and poor consistency (κ=0.00055) between both lines and techniques, respectively. CONCLUSION For determination of femoral component rotation in surgery setting, different results between cTEA and PCA+3° ER techniques possibly may due to disadvantages of techniques and anatomic variation of distal femur. Thus, using both techniques to check each others results seems unsafe.

Osteochondroma of the talus: an unusual location

Osteochondroma rarely affects talus although it is the most common primary bone tumor. We report a case of talar osteochondroma in a 6 year-old boy. There was no recurrence two years after the local resection of the lesion.

Accuracy of References in Journals of Hand Surgery

Three hundred randomly selected references collected from the Journal of Hand Surgery (American Volume), the Journal of Hand Surgery (British and European Volume), and the British Journal of Plastic Surgery, spanning the years 1998 to 2002, were evaluated for citation errors. Forty-four citations across all journals contained errors (14.6 per cent). None of the errors made the cited article impossible to retrieve. Ten of the forty-four inaccuracies were incorrect final page numbers.

Second-toe length and forefoot disorders in ballet and folk dancers.

BACKGROUND Although there is no ideal foot type for classical dancers, second-toe length seems to be a factor in the etiology of foot disorders in ballet dancers. METHODS We investigated the relationship between second-toe length and foot disorders in 30 ballet dance students and 25 folk dance students. Second-toe length in relation to the hallux (longer or equal/shorter), hallux deformities, first metatarsophalangeal joint inflammation, number of callosities, and daily pain scores were recorded in both groups and compared. RESULTS There was no statistically significant difference in toe length between the two groups (P>.05). Ballet dancers with equal-length or shorter second toes had lower pain scores, less first metatarsophalangeal joint inflammation, and fewer callosities in their feet compared with dancers with longer second toes. CONCLUSIONS Second-toe length seems to be a factor in the development of forefoot disorders in classical ballet dancers but not folk dancers. Dancers who have equal-length or shorter second toes in relation to the hallux may have fewer forefoot disorders as dance professionals.

The Biomechanical Effects of Talectomy on the Foot

The biomechanical effects of talectomy on the foot were investigated in seven fresh below-the-knee amputation specimens using pressure-sensitive films placed on the facets of the calcaneus, footprints, and loading-pattern diagrams in the intact foot and after talectomy with anterior and posterior displacement of the foot. Both talectomy techniques distorted the loads carried by the facets of the calcaneus. In the intact foot, 65.6% of the loads were carried by the posterior facet of the calcaneus and 34.4% by the anterior and middle facets. After talectomy with anterior displacement of the foot, although the loads carried by the anterior and middle facets decreased significantly (P = .018), the increase in the loads carried by the posterior facet was not significant compared with the intact foot (P = .176). Similarly, the loads carried by the posterior facet decreased significantly after talectomy with posterior displacement of the foot (P = .028), but the increases in the loads carried by the anterior and middle facets were not significant (P = .735). Comparing the two types of talectomy, the loads carried by each facet changed significantly (P = .018). Talectomy with posterior displacement of the foot also changed the loading patterns and resulted in significant pronation of the foot. These results suggest that talectomy should be performed only as a salvage procedure and that talectomy with anterior displacement of the foot may be preferred when talectomy is indicated.

VARUS DİZİLİM BOZUKLUĞU VE PRİMER OSTEOARTROZLU DİZLERDE TOTAL DİZ PROTEZİ SONRASI PROKSİMAL TİBİOFİBULAR KAYNAKLI AĞRI HASTA MUTSUZLUĞUNA NEDEN Mİ

AMAC: Ileri evre gonartrozlarda proksimal tibiafibular eklem (PTFE) ile tibiofemoral eklem (TFE) arasindaki klinik iliski daha once gosterilmemistir. Bu retrospektif calismanin amaci son evre gonartrozu olup diz protezi uygulanan genu varum deformiteli hastalarda PTFE’in klinik degerlendirmesidir. GEREC VE YONTEM: Ileri evre osteoartrozu olup diz protezi uygulanan genu varum deformiteli hastalar degerlendirmeye alindi. PTFE’in klinik muayene bulgulari ile PTFE tipi, hamstring gerginligi, ve lateral eklem araligi (LEA) hassasiyeti arasindaki iliski ki-kare testi kullanilarak arastirildi. Ayrica tanimlayici istatistikte kullanildi. BULGULAR: Calisma grubu (5 erkek ve 49 kadin; ortalama yas 62.7 yil; 46-81 arasinda) elli dort hastadan olus- maktadir. 30 hastanin (%55.6) her iki dizi ameliyat edildi. Ortalama takip suresi 21.6 ay (12-49 ay). PTFE hassasiyeti, hamstring gerginligi ve LEA hassasiyeti sirasiyla alti (%7.1), dort (%4.8), ve alti (%7.1) dizde tespit edildi. Alti dizde (%7.1) horizontal tip PTFE varken, yetmis sekiz dizde (%92.9) oblik tip PTFE vardi. Oblik tip PTFE olan dizlerde PTFE hassasiyeti (ki-kare testi, p=0.000) , LEA hassasiyeti (ki-kare testi, p=0.000), hamstring gerginligi (ki-kare testi, p=0.000) tespit edildi. SONUC: Varus dizilim kusuru olan ileri evre dejeneratif eklem hastaligi nedeniyle diz protezi yapilan hastalarda, PTFE’in ameliyat sonrasi lateral diz agrisinin kaynagi olmadigi ortaya konmustur. Bununla birlikte oblik tip PTFE bu dizlerde potansiyel agri kaynagi olabilecegi dusunulebilir

Comparison of two different suture-passing techniques with different suture materials and thicknesses: Biomechanical study of flexor tendons for yield points, gap formation and early post-operative status -

Objective: The purpose of this study was to evaluate the biomechanical characteristics of two different suture-passing techniques with different suture materials and thicknesses and assess whether they could with stand passive and/or active mobilization in the very early post-operative period. Materials and Method: 192 flexor digitorum profundus communis tendons of similar diameters were obtained from sheep front limbs. Each tendon was transected completely at a point 6 cm from the distal end and each repaired by one of the following suture materials: polyester suture (Ethilon 3.0 and 4.0 (Ethicon, U.S.)) and polypropylene monofilament (Polypropylene 3.0 and 4.0 (Ethicon, U.S.)). The repair of the tendons was performed through employing two different techniques with each suture material - the Bunnel and Modified Kessler. The primary outcome measures for each repair combination was suture material, suture-passing type and suture thickness. Regarding post-operative early motion, the yield point differences between the suture materials and techniques were compared. Results: There was a statistically significant difference between suture materials used for the repair. Tendons repaired with Ethibond needed significantly greater amounts of force for rupture compared with tendons repaired with Polypropylene. There was a statistically significant difference between Ethibond and Prolene for all study groups. Conclusion: The yield points with higher forces is expected to be preferred, but their thicknesses can be 3-0 or 4-0. Oblique suture passing should be preferred rather than longitudinal passing. Obviously, suture strengthening methods, like epitendineous running sutures and core sutures, should be used. Without these measures, even passive wrist motion can result in gap formation at the repair site. The results of this study showed that tensile properties of the repaired vary considerably with differences in suture material and design.

Total Diz Protezi Uygulaması Sonrası Arter Kan Basıncı Kontrolü Kan Kaybını Azaltır mı

Amac: Total diz protezi (TDP) uygulamasi sonrasinda kemik ve yumusak doku kaynakli belirgin kanama olusabilir. TDP uygulanan cogu hastanin ameliyat sonrasi donemde dusuk hemoglobin seviyesi nedeniyle kan transfuzyon ihtiyaci vardir. Kan transfuzyonu belirli riskler tasidigi icin bu hastalarin ameliyat sonrasi donemde kan kayiplarinin mumkun oldugunca azaltilmasi gerekir. TDP uygulamasini takiben ameliyat sonrasi donemde arter kan basincinin (AKB) kontrolu kan kaybini azaltabilir. Gerec ve Yontem: Ameliyat sonrasi AKB ve kan kaybi arasindaki iliskiyi arastirmak icin TDP uygulanmis olan 24 hastanin [20 kadin, 4 erkek; ortalama yas 69,8 (57–83 yas)] 27 dizinin ameliyat sonrasi durumu degerlendirildi. Ameliyat sonrasi AKB (kontrolsuz: ≥140/90mmHg veya kontrollu: < 140/90mmHg) ve cerrahi yara dreninden kan kaybi arasindaki iliski Mann-Whitney U testi kullanilarak analiz edildi. Bulgular: AKB ≥140/90mmHg olan hastalarin ortalama kan kaybi (610mL; 325-1440mL arasinda) AKB < 140/90mmHg olan hastalarinkinden (491mL; 250- 775mL arasinda; M-W U=66,0, p═0,44) farkli degildi.Tartisma: TDP ameliyati sonrasi AKB ve kan kaybi arasinda anlamli iliski tespit edilmedi. TDP ameliyati sonrasi AKB kontrolunun ameliyat sonrasi kan kaybinin onlenmesinde onemli oldugu varsayimi ret edilmeden once daha fazla prospektif calisma yapilmalidir.