Rahmi Can Akgun

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.

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears.

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up, 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest follow-up was 28.5 and mean Constant score was 80.3. Constant scores were found to be significantly low for the failed group. Age was found to be significantly related to failed repair. Fatty infiltration stage in the failed repair group was significantly high, and a strong positive correlation for both groups existed pre and postoperatively. When both groups were compared, the failed group was found to have significantly low measurements at extension and internal rotation. Despite high failure rates, functional results were satisfactory. Increased age and fatty infiltration stage decrease success.

A glomus tumor anterior to the patellar tendon: a case report

Glomus tumors are benign neoplasms originating from the glomus body. They are most frequently found in the nail bed of the hands, and their occurrence in other parts of the body is rare. A 75-year-old man presented with left anterior knee pain of 30-year history, that became more intense with light touch or clothing and increased in severity despite medical treatment. Physical examination showed a painful, soft, mobile, red-purple colored mass, 2 x 2 cm in size, at the inferior border of the patella. Plain radiographs showed no pathology other than mild degenerative changes. Magnetic resonance imaging revealed a mass lesion, 1.5 x 1.1 x 2 cm in size, located at the anterior border of the patellar tendon, which showed hypointensity on T1A-weighted sequences and hyperintensity on T2-weighted sequences and T2-weighted sequences with fat saturation. The mass was excised and the histopathological diagnosis was reported as glomangioma. Postoperatively, the patient had no complaint of pain and no recurrence was observed during a two-year follow-up.

Comparison of repair techniques in small and medium-sized rotator cuff tears in cadaveric sheep shoulders

OBJECTIVE The aim of this study was to compare new knotless single-row and double-row suture anchor techniques with traditional transosseous suture techniques for different sized rotator cuff tears in an animal model. METHODS The study included 56 cadaveric sheep shoulders. Supraspinatus cuff tears of 1 cm repaired with new knotless single-row suture anchor technique and supraspinatus and infraspinatus rotator cuff tears of 3 cm repaired with double-row suture anchor technique were compared to traditional transosseous suture techniques and control groups. The repaired tendons were loaded with 5 mm/min static velocity with 2.5 kgN load cell in Instron 8874 machine until the repair failure. RESULTS The 1 cm transosseous group was statistically superior to 1 cm control group (p=0.021, p<0.05) and the 3 cm SpeedBridge group was statistically superior to the 1 cm SpeedFix group (p=0.012, p<0.05). The differences between the other groups were not statistically significant. CONCLUSION No significant difference was found between the new knotless suture anchor techniques and traditional transosseous suture techniques.

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).

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.