Serkan Sipahioglu

Value of bone scintigraphy in patients with carpal trauma.

ObjectiveWe planned this study to evaluate the role of bone scintigraphy in patients with suspected carpal fracture and normal or suspicious radiographs following carpal injury.MethodsThree-phase bone scintigraphy using Tc-99m-MDP was performed on 32 patients with negative radiographs but clinically suspected fracture at two weeks after the trauma. Focally increased radiophar-maceutical uptake was interpreted as a fracture. The final diagnosis was established with clinical follow-up.ResultsTwelve (38%) patients had a normal scan excluding fracture. Twelve patients had a single fracture. Multifocal fracture was present in 8 (25%) patients. Eight patients showed scaphoid fractures; of these three showed single scaphoid fracture, and the other five patients revealed accompanying fractures. Distal radius fractures and carpal bone fractures other than scaphoid were both observed in 12 patients. These were eleven fractures of distal radius; three fractures of pisiform; two fractures of hamate; and single fractures of lunate, trapezium and triquetrum. In one patient there was fracture of a first metacarpal bone.ConclusionIn patients with suspected carpal bone fracture and normal or suspicious radiographs, bone scintigraphy can be used as a reliable method to confirm or exclude the presence of a scaphoid fracture and to detect clinically unsuspected fractures of distal radius and other carpal bones.

Red cell distribution width and mortality in patients with hip fracture treated with partial prosthesis

OBJECTIVE This study aimed to determine the relationship between red cell distribution width (RDW) and mortality in patients that received a partial hip prosthesis. METHODS The study included 316 patients (183 female and 133 male) that underwent surgery due to hip fracture and were followed up for ≥1 year. Mean age of the male and female patients was 77.50 years (range; 65-95) and 78.23 years (range; 65-100), respectively. The relationship between the RDW level at the time of presentation and mortality was evaluated. RESULTS There was a significant relationship between mortality, and age (median age for man 77.50 and for woman 78.23) trochanteric fracture, and a high RDW level (>14.5%). In patients with these 3 characteristics the mortality rate was 2.8-fold higher than in the other patients. CONCLUSION RDW is a parameter measured via routine blood testing. We think that RDW measurement should be used in the planning of the treatment of hip fractures and in scoring systems used to estimate post-operative mortality.

[The effect of low-molecular-weight heparin on rat tendon healing].

OBJECTIVES We investigated the effect of low-molecular-weight heparin (LMWH) on the healing of tendons. METHODS Forty-five adult Wistar rats weighing 300 g were randomized into three groups equal in number. All the rats underwent full-thickness surgical incision of the Achilles tendon followed by primary repair. After the operation, two groups received daily subcutaneous LMWH injections (nadroparin calcium) for four weeks at high or low doses (group I, 6 mg/kg, 170 IU AXa; group II, 3 mg/kg, 85 IU AXa). Group III remained untreated as the control group. Histologically, the specimens were examined under light and electron microscopy with regard to the amount of fibrillar collagen synthesis, mitochondrial degeneration, and the composition of the extracellular matrix collagen. Biomechanically, maximum load to failure and correspondent elongation of the tendons were measured. RESULTS Compared to the control group, histologically, both LMWH-treated groups exhibited increased number of fibroblasts, increased fibrillar collagen formation in the extracellular matrix, and higher counts of granular endoplasmic reticula in cytoplasmic contents of fibroblasts as well as decreased mitochondrial vacuolization and degeneration. Biomechanical assessments showed that tendons in group I had significantly higher maximum load to failure and elongation values than group II and III (31 N vs. 24.6 N and 23.1 N; 25 mm vs. 19.6 mm and 17.3 mm, respectively; p<0.05). Groups II and III did not differ significantly in this respect (p>0.05). CONCLUSION Daily administration of single dose LMWH improves tendon healing through increasing the number of fibroblasts and fibrillar collagen synthesis and decreasing mitochondrial degeneration.

Effects of salmon calcitonin treatment on serum and synovial fluid bone formation and resorption markers in osteoporosis patients

OBJECTIVE This study aimed to evaluate the effects of salmon calcitonin, and calcium and vitamin D treatment on bone mineral density, serum and synovial fluid bone formation and resorption markers in patients with osteoporosis. METHODS The study was completed with twenty-five osteoporosis patients divided into two groups: The 15 patients comprising Group I (1 male and 14 females; mean age: 67.0±12.0) were administered calcitonin treatment in addition to calcium and vitamin D. The 10 patients in Group II (3 males and 7 females; mean age 68.0±16.0) were administered calcium and vitamin D only. Serum and synovial fluid calcium phosphorus, alkaline phosphatase, calcitonin, C-telopeptide (CTx), N-telopeptide (NTx) and sialoprotein levels, and bone densitometries were determined at the beginning and at the end of one year of treatment. RESULTS In the calcitonin and calcium and vitamin D treatment group (Group I), femoral neck density scores were decreased and vertebrae scores were increased after one-year treatment. Both scores were increased in the non-calcitonin group (Group II). In Group I, synovial fluid levels of calcitonin, sialoprotein and NTx were decreased, and synovial fluid CTx levels showed no change. The only decrease that was statistically significant was that in calcitonin levels. In Group II, synovial fluid calcitonin levels were decreased, synovial fluid CTx levels were increased and synovial fluid NTx and sialoprotein level were unchanged. These changes were not statistically significant. Serum changes in the parameters were not statistically significant in either group. CONCLUSION In osteoporosis, salmon calcitonin treatment affects synovial fluid bone formation and absorption marker levels. Advanced studies are needed to evaluate the mechanisms by which this takes place, and to explain the relationship between osteoporosis and articular cartilage metabolism.

Early results of total knee arthroplasty performed through the midvastus approach

OBJECTIVES The aim of this study was to evaluate the early results of total knee arthroplasty (TKA) performed through the midvastus approach. METHODS This retrospective study included 48 knees of 42 patients (29 females, 13 males; mean age 69 years; range 54 to 82 years) who underwent TKA for grade 4 knee osteoarthritis. All TKA operations were performed by the same orthopedic surgeon through the midvastus approach. Preoperatively, 40 patients (95.2%) had primary osteoarthritis, and two patients (4.8%) had rheumatoid arthritis. In all cases, a posterior stabilized cemented prosthesis with a fixed insert was used. Patellar resurfacing was performed in seven knees (14.6%). All the knees were rated according to the Knee Society knee and function scores before surgery and at the final follow-up. Postoperative radiographic evaluations were performed on anteroposterior and lateral radiographs according to the Knee Society TKA Roentgenographic Evaluation and Scoring System. The mean follow-up period was 26 months (range 12 to 49 months). RESULTS The mean knee score significantly improved from 49.0+/-9.3 preoperatively to 87.5+/-9.9 postoperatively (p=0.000). The corresponding increase in the knee function score was from 48.8+/-9.9 to 79.6+/-14.0 (p=0.000). The mean increases in the knee and function scores were 38.5 and 30.8 points, respectively. The knee and function scores were excellent or good in 46 knees (95.8%) and 42 knees (87.5%), respectively. The mean knee flexion significantly increased by 28.6 degrees , from 84.3+/-14.7 degrees preoperatively to 112.9+/-11.9 degrees postoperatively (p=0.000). Among patients with bilateral osteoarthritis, the knee function scores were significantly higher in patients who had undergone bilateral versus unilateral TKA (90.0+/-11.5 and 78.8+/-10.8, respectively; p=0.007). None of the patients had patellar tracking abnormality intraoperatively; thus, there was no need for lateral retinacular release. Postoperative clinical and radiographic assessments showed no signs of instability or loosing. Clinical and radiographic loosening of the patella and osteolysis were not observed in patients who had undergone patellar replacement. No changes were observed in the tracking and position of the protheses. Neurovascular injury did not occur. One patient who developed early infection of the knee that required a two-stage revision was assessed as failure. CONCLUSION In our study, lateral retinacular release was not needed due to achievement of proper patellar tracking in TKA operations with the midvastus approach, and satisfactory clinical and radiographic results were obtained.

Injury of the infrapatellar branch of the saphenous nerve due to hamstring graft harvest: A prospective comparative study of two different incisions

Purpose: Sensory disturbance around the surgical incision due to injury of the infrapatellar branch of the saphenous nerve can be seen in the anterior cruciate ligament reconstruction. In this research, we aimed to compare the incidence, extent of sensory loss, its clinical effect, and natural course caused by two different skin incisions used for hamstring graft harvest. Methods: Vertical incision for 36 patients and oblique incision for 42 patients used for graft harvest were included in this study. Sensory loss areas were documented at 6th week, 3rd month and 6th month. Pin prick examination is used to detect the change in sensation. Digital photographs of hypaesthesia were taken and analysed by computer for area detection. The length of incision and subjective complain of sensory loss were also noted. Results: At 6th month, 77% (28/36) of the vertical incisions were associated with persistent sensory loss when compared to the oblique incision (45%, 19/42). The measured area of hypaesthesia was significantly higher in vertical incision (42.4 ± 22.3 cm2) than that in oblique incision (9.3 ± 15.3 cm2) at 6th month. The area of hypaesthesia gradually shrunk in size from distal to proximal in direction. Also, subjective cutaneous anaesthesia was higher in vertical incision (15/36, 41%) than oblique incision (6/41, 14%) at 6th month. Conclusion: Oblique incision with less risk of nerve damage is better for graft harvesting. Area of hypaesthesia gradually reduces with time and even recover totally. As a possible complication, nerve injury and its benign prognosis should be explained to the patient before surgery.

Peroneal nerve palsy secondary to prolonged squatting in seasonal farmworkers

OBJECTIVE The aim of this study was to evaluate the follow-up and treatment results of peroneal nerve palsy secondary to prolonged squatting for working and to determine an approach for its treatment and prevention. METHODS The study retrospectively evaluated 16 patients (7 males, 9 females; mean age: 23.6 years) diagnosed with peroneal nerve palsy due to squatting for work. Clinical and neurological evaluations were performed and weight and height were measured. Lesion site was determined using electrophysiological testing. After diagnosis, medical and orthotic treatment was initiated and rest was advised. Patients were followed until motor symptoms were resolved. RESULTS Clinical and neurophysiological evaluations were consistent with isolated peroneal nerve palsy. The left side was affected in seven patients, the right side in seven and both sides in two. Average onset of the symptoms was 3.3 (range: 1 to 6) weeks and average daily squatting period was 6.8 (range: 6 to 8) hours. Average healing time was 7.4 (range: 3 to 16) weeks. None of the patients was obese or overweight. All patients healed with conservative treatment and no surgical treatment was necessary. CONCLUSION Working conditions and duties should be considered in the evaluation of peroneal nerve palsy. In peroneal nerve palsy secondary to squatting, healing should be expected with conservative treatment, resting and close follow-up.

Results of anterior and posterior capsular approaches in bipolar hemiarthroplasty patients with femoral neck fractures

BACKGROUND We evaluated the functional status and postoperative complications of bipolar hemiarthroplasty patients with femoral neck fractures, which we operated using anterior and posterior approaches. MEHTOHDS Between November 2007 and February 2011, 224 patients were evaluated according to their surgical exposure type in two groups. The first group, which was approached anteriorly to the joint capsule, included 92 patients, and the second group, approached posteriorly, included 132 patients. The mean follow-up period for group 1 was 16.4 months and for group 2 was 18.9 months. RESULTS Harris hip score of group 1 was 81.7 and of group 2 was 79.2. In group 1, 19 patients had very good, 52 patients good, 15 patients moderate, and 6 patients insufficient results. In group 2, 29 patients had very good, 74 patients good, 21 patients moderate, and 8 patients insufficient results. Although we had higher hip dislocation and infection rates in group 2, there were no statistical differences between the two groups. DISCUSSION Surgical exposure type does not affect functional outcome in bipolar hip arthroplasty patients. Although statistically insignificant, we had higher hip dislocation and infection rates using the posterior approach in the selected femoral neck fracture patients. An anterior approach to the joint capsule appears to be more reliable.

Clear cell chondrosarcoma of the proximal femur with intrapelvic extension

Clear cell chondrosarcoma is a rare tumor that can be easily confused with benign tumors. The aim of this report is to present a case that is rare, initially diagnosed as aneurysmal bone cyst and then chondroblastoma, and has an interesting extension pattern. A 41-year-old male patient was treated for an apparently benign cystic lesion of the right proximal femur by intralesional excision and bone grafting. The pathological diagnosis was aneurysmal bone cyst. Two years later, the patient presented with a pathological fracture at the same site and a total hip arthroplasty was performed. The pathological specimen was diagnosed as chondroblastoma. Three years later, clinical and radiological examination of the patient revealed a large mass located on the intrapelvic side of the acetabulum. There was no evidence of distant metastases. Both tumors were resected with a wide margin on the femoral side and a marginal margin on the intrapelvic side. The extremity was reconstructed with a resection-type total hip prosthesis. Again, the pathological diagnosis was chondroblastoma. The patient developed a deep infection that was treated by antibiotic therapy and surgical debridement. One year later, there was recurrence of the femoral and intrapelvic masses and right hemipelvectomy was performed; the specimen was reported as clear cell chondrosarcoma. Since then, the patient has been leading an active life, and there is no evidence of local recurrence or distant metastasis. Clinically and pathologically, clear cell chondrosarcoma may be confused with benign bone tumors. This caused a delay in the final diagnosis of this patient and he received inadequate surgical treatment, leading to a hemipelvectomy. We also found that the intrapelvic mass seemed to have developed independently on the intrapelvic side of the acetabulum. We were unable to find an exact explanation for this finding and postulated that tumor cells might have been seeded into the inner wall of the acetabulum during acetabular preparation of the total hip prosthesis.

İzole Tip 2 Slap Lezyonu Nedeniyle Artroskopik Tamir Uygulanan Hastaların Kısa Dönem Klinik Sonuçlarının Değerlendirilmesi

Amac: Bu calismada, izole tip 2 superiorlabrumanteriorposterior (SLAP) lezyonu nedeniyle artroskopik SLAP tamiri uygulanan hastalarinkisa donem kliniksonuclarinin degerlendirilmesi amaclandi. Yontemler: Konservatif tedaviye cevap vermeyenve izole tip 2 SLAPlezyonu olan hastalar retrospektif olarak degerlendirildi. Hastalar klinik olarak Constant-Murleyskorlama sistemive vizuel analog skala (VAS) sistemine gore degerlendirildi. Ameliyattan once ve son takiptehastalarin aktif ve pasifeklem hareket acikliklari olculdu. Bulgular:Toplam 19 hasta degerlendirildi. Hastalarin 15’ierkek 4’u ise kadindi. Ortalama yas31.5(23-45)olarak tespit edildi. Ortalama takip suresi 16.8ay (8-26) idi. Ameliyat oncesi Constant-Murleyskorlari ortalama57 (40-71 )iken; son takipte ortalama 81 ( 66- 98) olarak saptandi. VAS degerleri ameliyat oncesi7 (6-9) iken;son takipte 2 (0- 5) olarak tespit edildi. Her iki skorlama sisteminde de ameliyat oncesi doneme kiyasla son takiplerde istatistiksel olarakanlamli degisiklikler saptandi (p < 0.001). Sonuc:Izole tip 2 SLAPlezyonu nedeniyle artroskopik SLAP tamiri uygulananhastalarda,kisa donemde klinik acidan tatmin edici sonuclar elde edilebilmektedir.