Selami Cakmak

Reduction of anterior shoulder dislocations by Spaso technique: clinical results.

The Spaso technique consists of forward flexion, external rotation, and gentle traction for the reduction of anterior shoulder dislocations with the patient in the supine position. The aim of this prospective study was to assess clinical efficacy of the Spaso technique and to evaluate its complications. We prospectively evaluated 52 shoulder dislocations using the Spaso technique. All reductions were performed by residents in training. Rescue methods if initial reduction was unsuccessful were at the discretion of the treating physician. Fifty-two patients were enrolled and 39 (75%) dislocations were successfully reduced without anesthesia or assistance. The mean reduction time was 3.2 min, and 87% of successful reductions occurred in less than 5 min. If we exclude the first 20 cases as a learning period, the success rate increases up to 87.5%. There were no complications associated with using the Spaso technique in this series. Patients with concomitant greater tuberosity fractures and late presentation had a lower success rate, although this was not statistically significant. The Spaso method is effective in reducing anterior shoulder dislocations without anesthesia or assistance and may decrease reduction time and length of stay in the Emergency Department.

Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures

17 patients with ankle syndesmosic injury were treated with a 4.5mm single cortical screw fixation (passage of screw 4 cortices) and 15 patients were treated with single-level elastic fixation material. All patients were evaluated according to the AOFAS ankle and posterior foot scale at the third, sixth and twelfth months after the fixation. The ankle range of movement was recorded together with the healthy side. The Students t test was used for statistical comparisons. No statistical significant difference was observed between the AOFAS scores (p>0.05). The range of dorsiflexion and plantar flexion motion of the elastic fixation group at the 6th and 12th months were significantly better compared to the screw fixation group (p<0.01). Elastic fixation is as functional as screw fixation in the treatment of ankle syndesmosis injuries. The unnecessary need of a second surgical intervention for removal of the fixation material is another advantageous aspect of this method of fixation.

Long-term outcome of Osgood-Schlatter disease: not always favorable

Osgood-Schlatter disease (OSD), which named for the doctors that first described it in 1903, is a disease of preadolescent children (usually boys with 11–15 years of age) whereby tractional injury of the tibial tuberosity leading to avulsion of a proximal part of it occurs [1, 2]. Clinically, it is characterized by pain, swelling and enlargement of the proximal tibia at the site of the patellar tendon’s insertion. The prognosis of OSD is usually self-limiting course. Long-term outcome is good for the majority of the patients. Complications (i.e., pseudarthrosis, genu recurvatum, patella alta, fragmentation/migration of the ossicle) potentially leading to early osteoarthritis can occur in the chronic stage [3]. Although OSD disease is a well-known clinical entity, management with long-term follow-up remains controversial. In this report, we presented the long-term outcome of a patient with untreated OSD. A 21-year-old man was seen for mild swelling in his left knee (that did not affect his daily activities) for the last 10 years. He denied any episode of trauma and the medical history was otherwise noncontributory. Physical examination revealed tenderness and swelling at the left knee. Both active and passive knee motions provoked pain. Moderate restriction of movement in the left knee (30 of flexion and 5 of extension lag) was present. Neurological examination was unremarkable. Current and past knee radiographs of the patient are seen in Fig. 1, which showed a major fragmented bone of a proximal part of the tibial tuberosity. The patient was consulted to the orthopedic surgeons, and they suggested surgery due to the presence of limitations in his knee motions, but the patient did not accept surgery. In the relevant literature, there seems to be a single study that has reported on the long-term follow-up of OSD patients [4]. Fifty subjects with 69 affected knees had been followed for 9 years (range 3–30). During the acute phase of OSD, the patients were reevaluated and followed under conservative treatment. Forty-seven subjects had various degrees of knee limitations, and only three patients had no limitation in the acute phase, and at the end of their study, all patients were free of any limitations. On the other hand, presenting our patient, we imply that despite its mild symptoms (not affecting patients’ daily activities), OSD may cause knee joint

Are the leading drugs against Staphylococcus aureus really toxic to cartilage

Many studies have shown that the toxic effects of local antibiotics on bone and cartilage limit orthopedic surgeons. In this study, we evaluated three antibacterial agents used locally to treat highly mortal and morbid diseases in the field of orthopedics, such as septic arthritis. Are vancomycin, teicoplanin, and linezolid, which are archenemies of Staphylococcus aureus, really toxic to chondrocytes? The purpose of the study was to investigate the effects of antibiotics, which are used against S. aureus, on human chondrocytes in vitro. Primary cell cultures obtained from gonarthrosis patients were divided into two main groups. One of these groups was designated as the control chondrocyte culture. The other group was divided into three subgroups, and each group was exposed to vancomycin, teicoplanin, or linezolid. Cell culture samples were characterized by immunophenotyping following incubation with the three different antibiotics. Before and after the agents were administered, the cultures were subjected to inverted and environmental scanning electron microscopy. The number of live cells and the proliferation rate were monitored with the MTT-assay. We found that vancomycin, teicoplanin, and linezolid do not have chondrotoxic effects. Vancomycin, teicoplanin, and linezolid had no chondrotoxic activity during in vitro culture, which supports the argument that these agents can safely be used in orthopedic surgery, especially against methicillin-resistant S. aureus agents.

Are biological agents toxic to human chondrocytes and osteocytes

PurposeThe aim of the present study is to investigate the effects of biological agents (BAs) on human chondrocytes and osteocytes in vitro.MethodsPrimary cell cultures obtained from gonarthrosis patients were divided into four groups, two of which were designated as control cultures of chondrocyte and osteocyte, and the other two groups were exposed to BAs administered via the culture medium. Cultured cells were characterized by immunophenotyping. Before and after administration of the agents, the cultures were observed by inverted and environmental scanning electron microscopy (ESEM). The number of live cells and the proliferation rate were monitored by MTT assay.ResultsRituximab and adalimumab were the least toxic agents to chondrocytes, whereas adalimumab and etanercept were to osteocytes.ConclusionDuring periods of intense active inflammation, the concentration of the preferred BAs after inhibition of inflammation needs to be emphasized when their effects on cartilage and bone tissue are considered at the cellular level if the clinical practice is to continue.

Chair method: a simple and effective method for reduction of anterior shoulder dislocation

OBJECTIVE The ideal reduction method for anterior shoulder dislocation is defined as a practical technique applied without any assistance and minimizing patient interference. The aim of this study was to evaluate the outcomes of patients with shoulder dislocations reduced using the chair method in the emergency department and show that the chair method is one of the ideal methods. METHODS Seventy-four patients with anterior shoulder dislocation were treated using the chair method. Data from patients were recorded and analyzed. RESULTS All dislocated shoulders were successfully reduced using the chair method without any complication or difficulty. Thirty patients had first time dislocation and 44 patients had previous dislocation. Mean duration between dislocation and reduction was 3 (range: 1 to 6) hours. Mean duration of reduction was 13.9 (range: 3 to 45) seconds. CONCLUSION The chair method is an effective and successful reduction method for shoulder dislocation. We believe that orthopedists and emergency department physicians should be familiar with this simple technique which does not have to be performed under general anesthesia.

Management of the bilateral congential dislocation of the hip and knee: a case report.

Congenital dislocation of the knee (CDK) is a rare disease and may be associated with other congenital and musculoskeletal disorders. We report our result in the treatment of a patient with CDK and DDH that treated with serial casting and Pavlik harness. Early diagnosis of the CDK is very important non operative treatment usually provides more stabile, greater range of motion and much more quadriceps strength than the surgical treatment. Early reduction of dislocation prevents formation of the knee contracture.

Comparison of four different reduction methods for anterior dislocation of the shoulder

BackgroundShoulder dislocations account for almost 50 % of all major joint dislocations and are mainly anterior.ObjectiveThe aim is a comparative retrospective study of different reduction maneuvers without anesthesia to reduce the dislocated shoulder.MethodsPatients were treated with different reduction maneuvers, including various forms of traction and external rotation, in the emergency departments of four training hospitals between 2009 and 2012. Each of the four hospitals had different treatment protocols for reduction and applying one of four maneuvers: Spaso, Chair, Kocher, and Matsen methods. Thirty-nine patients were treated by the Spaso method, 47 by the Chair reduction method, 40 by the Kocher method, and 27 patients by Matsen’s traction-countertraction method. All patients’ demographic data were recorded. Dislocation number, reduction time, time interval between dislocation and reduction, and associated complications, pre- and post-reduction period, were recorded prospectively. No anesthetic method was used for the reduction.ResultsAll of the methods used included traction and some external rotation. The Chair method had the shortest reduction time. All surgeons involved in the study agreed that the Kocher and Matsen methods needed more force for the reduction. Patients could contract their muscles because of the pain in these two methods. The Spaso method includes flexion of the shoulder and blocks muscle contraction somewhat. The Chair method was found to be the easiest because the patients could not contract their muscles while sitting on a chair with the affected arm at their side.ConclusionsWe suggest that the Chair method is an effective and fast reduction maneuver that may be an alternative for the treatment of anterior shoulder dislocations. Further prospective studies with larger sample size are needed to compare safety of different reduction techniques.

Comparison of extracorporeal shock wave therapy in acute and chronic lateral epicondylitis.

OBJECTIVE The aim of this study is to evaluate and compare the results of extracorporeal shock wave therapy (ESWT) in the treatment of acute (<3 months) lateral epicondylitis (LE) and chronic (>6 months) LE groups. METHODS Fifty-four patients who were diagnosed with LE and treated with BTL-5000 SWT Power (BTL Türkiye Medikal Cihazlar, Ankara, Turkey) ESWT were included in the study. Twenty-four patients who had symptoms for <3 months were defined as the acute LE group (Group A), and 30 patients who had symptoms for >6 months were defined as the chronic LE group (Group B). All cases were evaluated pretherapy and at Weeks 2, 12, and 24 posttherapy according to pain while resting, pain while stretching, pain when pressed, pain while lifting chair, pain while working, nighttime pain on LE zone. RESULTS Almost all values in both Group A and Group B were significantly improved at Weeks 2, 12, and 24 compared to the baseline values. CONCLUSION ESWT is equally effective in the treatment of acute LE and chronic LE. In addition, the current data suggest the progression of LE cases from acute phase to chronic phase may be prevented by treatment with ESWT.

Bilateral low-energy sequential femoral shaft fractures in patients on long-term bisphosphonate therapy

OBJECTIVE The aim of this study was to evaluate the demographic characteristics of patients with bilateral bisphosphonate-related low-energy femoral shaft fractures. METHODS The clinical registry was reviewed for patients with bisphosphonate-related low-energy fractures localized at femoral shaft between January 2008 and January 2012. Patients with a diagnosis of postmenopausal osteoporosis, bisphosphonate usage of at least 5 years and prodromal pain prior to fracture were included the study. RESULTS Five women met the inclusion criteria. All patients had bilateral low-energy sequential femoral shaft fractures. Fracture patterns were similar and atypical (transverse-short oblique fractures with lateral cortical thickening). Mean period of bisphosphonate treatment was 8.6 years. Mean patient age was 76.2 years. Union time of three patients was between 20 and 28 weeks. The remaining two fractures were revised for delayed union or nonunion. CONCLUSION Long-term (over 5 years) use of bisphosphonates may cause insufficiency fractures due to increased fragility and brittleness which have a close relationship with depressed bone remodeling. While there is still no causal relationship between bisphosphonates and atypical, low-energy femoral shaft fractures, we have some concerns about the optimal usage time and long-term safety of bisphosphonate drugs.