Serhat Mutlu

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.

Tourniquet use during total knee arthroplasty does not offer significant benefit: A retrospective cohort study

INTRODUCTIONnTourniquets are routinely employed during total knee arthroplasty; however, their use remains controversial.nnnMETHODSnThis study investigates the efficacy and safety of this practice. A retrospective analysis of 186 patients was performed to assess benefits and/or risks associated with tourniquet use during knee arthroplasty. Total knee arthroplasty was performed using the Biomet Vanguard(®) PCL Prosthesis (Biomet, Warsaw, IN, USA). In total, 126 patients who had undergone total knee arthroplasty were included in our final analysis.nnnRESULTSnPatients with tourniquets had significantly less intraoperative blood loss than patients without (P < .001); patients without tourniquets required more blood transfusions (P = .551), and had significantly longer surgical times (P = .011). However, patients with tourniquets had more postoperative blood loss (P < .001), longer hospital stays (P = .013), and more frequent complications (P = .571). Blood transfusion requirement was significantly associated with complications (P < .001).nnnCONCLUSIONSnTourniquet use provided no overall benefit.

Arthroscopic treatment of synovial chondromatosis of the shoulder: A case report

Introduction Synovial chondromatosis is a mono-articular arthropathy rarely seen in diarthrodial joints. The classic treatment for synovial chondromatosis is open arthrotomy, synovectomy and complete removal of the free fragments. With recent advances in arthroscopic techniques and methods, the indications for arthroscopic treatment have been extended. Presentation of case A 33-year old female presented with complaints of pain in the right shoulder. On the radiological examination, there were seen to be multiple calcified radio-opaque lesions filling all area of the glenohumeral joint. On computed tomography (CT) examination, again multiple radio-opaque free fragments were determined. Arthroscopy was applied to the right shoulder. The free fragments were completely removed. Approximately 33 free fragments, ranging in size from 0.5 to 1.3 cm, were removed. Discussion Cases of synovial chondromatosis in the shoulder have been rarely reported in literature. Generally the disease is self-limiting. Clinically, symptoms are generally not specific. Restrictions in the joint range of movement occur associated with the mechanical effect of the free fragments and in periods of active use, local pain and swelling may be seen in the shoulder. Simple removal of the free fragments, others have stated that removal with synovectomy is necessary to prevent recurrence of the cartilaginous metaplastic focus. Recurrence rates vary from 0 to 31%. Conclusion Arthroscopic surgery can be successfully applied in the treatment of synovial chondromatosis. The advantages of the method include good visualisation during surgery, low morbidity and early healing.

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

OBJECTIVEnThe 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.nnnMETHODSnFifty-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.nnnRESULTSnAlmost all values in both Group A and Group B were significantly improved at Weeks 2, 12, and 24 compared to the baseline values.nnnCONCLUSIONnESWT 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.

Retrospective Cohort Study of the Prevalence of Lumbosacral Transitional Vertebra in a Wide and Well-Represented Population

Purpose. The aim of this study is to determine the prevalence of lumbosacral transitional vertebra (LSTV) in a well-represented general population. Methods. For a retrospective cohort study, abdominal radiographs of adult subjects were queried with clear visibility of the vertebral body articulation of the last rib, all lumbar transverse processes, and complete sacral wings. Exclusion criteria included any radiologic evidence of previous lumbosacral surgery that would block our view. A total of 6200 abdominal films were reviewed, and 3607 were identified as being suitable for the measurement of the desired parameters. Results. A total of 3607 subjects were identified as eligible for the study, and 683 (18.9%) were classified as positive for a lumbosacral transitional vertebra. The prevalence of sacralization and lumbarization was found as 17.2% and 1.7%, respectively. The average age at the time of the study was 39.5 ± 15.2 years (18–86 years). Conclusions. As a result of different opinions, LSTV retains its controversial status. Our prevalence study of the general population will provide assistance for resolution of the controversy. Prevalence studies of the general population with a wide participation will shed light on comparative studies.

Nail Braces as an Alternative Treatment for Ingrown Toenails: Results From a Comparison With the Winograd Technique

Ingrown toenails are one of the most frequent nail disorders and can be treated with conservative or surgical approaches. Although discovered a long time ago, the available data are still very limited on the potential effectiveness of nail braces for ingrown toenail treatment. In the present retrospective study, we compared nail braces with surgical wedge excision using the Winograd technique with respect to the time to return to work, recurrence, interval to recurrence, and patient satisfaction. A total of 159 patients were divided into the nail brace (n = 74; mean age 29.51 ± 8.48 years) and Winograd technique (n = 85; mean age 26.95 ± 8.06 years) groups. In the nail brace group, the mean time to return to work (4.15 ± 1.07 days) was significantly shorter than that in the Winograd technique group (13.8 ± 2.26 days; p < .001). Patient satisfaction was significantly greater in the nail brace group (94.6%) compared with the Winograd technique group (82.4%; p = .018). Of the 159 patients, 6 (8.1%) in the nail brace group and 8 (9.4%) in the Winograd technique group developed recurrence; however, this difference was not statistically significant (p > .05). A statistically significant difference was observed in the mean interval to recurrence (12.46 ± 1.60 versus 13.24 ± 2.48 months, respectively; p = .031). The progression-free follow-up periods for the nail brace and Winograd technique groups were 15.45 ± 0.22 months (95% confidence interval 15.02 to 15.88) and 17.18 ± 0.29 months (95% confidence interval 16.61 to 17.84), respectively. We have concluded that the use of nail braces is an appropriate alternative treatment of ingrown toenails with high patient satisfaction, fast recovery times, and a low recurrence rate.

Anterior Glenohumeral Instability: Classification of Pathologies of Anteroinferior Labroligamentous Structures Using MR Arthrography.

We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI.

Factors affecting postoperative mortality in patients older than 65 years undergoing surgery for hip fracture.

BACKGROUNDnThe aim of this study was to determine the factors affecting postoperative mortality in patients older than 65 years of age undergoing surgery for hip fracture.nnnMETHODSnA total of 308 patients (219 males and 89 females) were included into the study. Spinal-epidural anaesthesia was administered in 203 patients and general anaesthesia in 105 patients. In the evaluation of the patients regarding ASA, two groups were determined ASA 1-2 and ASA 3-4. Systemic diseases present in the patients were determined preoperatively.nnnRESULTSnSeventy-seven (25%) of the total 308 patients died. In addition, patients with preoperative cardiac disease, patients on whom general anaesthesia was administered, patients in the ASA 3-4 group, and age were found to be significantly higher in mortality. When logistic regression analysis was performed for these four efficient factors, age, general anaesthesia, presence of cardiac disease were effective in mortality. However, ASA score changed depending on the age and cardiac disease.nnnCONCLUSIONnIn case of presence of multiple risk factors, it is necessary to determine which factor is, in fact, more effective. Age, ASA score, type of anaesthesia, and presence of cardiac disease are effective in mortality. However, ASA score affects mortality depending on the cardiac disease and age.

Efficacy of periarticular injection applied trough knee other than posterior capsule in simultaneous bilateral total knee arthroplasty

BACKGROUNDnWe aimed to evaluate periarticular multimodal drug injection (PMDI) in bilateral total knee arthroplasty.nnnMETHODSnIn 154 knees of 77 patients, PMDI was administered intraoperatively through the regions other than posterior capsule to one knee; other knee was control.nnnRESULTSnDrug-injected knees had lower visual analog scale scores and higher passive range of motion postoperatively (pxa0<xa00.05). The active straight leg raise was higher in drug-injected knees (47 [61%] vs 19 [24.7%], pxa0=xa00.001).nnnCONCLUSIONSnPMDI is a safe and effective method of early postoperative pain management in total knee arthroplasty when applied through regions other than posterior capsule.

Hydatid cyst of biceps brachii associated with peripheral neuropathy

Highlights • Hydatidosis represents the most significant parasitic disorder in the Mediterranean countries.• Localization of the primary cyst hydatid infection in the extremity is rare.• Primary musculoskeletal cyst hydatid generally affects the proximal muscle groups.• Due to the fact that it leads to a mass formation, hydatid cysts may be mistaken for soft tissue tumors.• MR is the golden standard of diagnosis and detection of multilocular polycystic lesions.• Cases of concomitant neurologic findings and complaints secondary to peripheral nerve compression are very rare.