Tackin Ozalp

Tumeur à cellules géantes de la main: Résultats du traitement : 5 cas au recul moyen de 7,8 ans

PURPOSE OF THE STUDY Giant-cell bone tumors are benign but have great potential for recurrence. Frequently observed in epiphyseal areas of tubular bones, these tumors are rarely found in hand localizations. We examined the characteristic features of giant-cell tumors of the hand and analyzed the pertinence of surgical treatment. We noted complications, consequences of recurrence and later operations on the same tumor site in five cases. CASE REPORTS Five patients treated between 1973 and 2000 for giant-cell tumors involving the hand bones were reviewed retrospectively. Mean age was 41.6 years and mean follow-up was 7.8 years. The surgical procedure was curettage for two, curettage with bone graft for two and amputation for one. The Enneking score was noted. RESULTS Pain was the main symptom, with local swelling in several cases. At 7.8 years follow-up recurrence was noted for four of the five tumors. Two patients were treated for a second recurrence. Amputation of the forearm was required for one recurrence affecting soft tissue. Mean time between two consecutive recurrences was three months. In all six episodes of recurrent tumor were treated. These five patients had a total of ten operations. There were no cases of metastasis nor multicentric foci. DISCUSSION Treatment of giant-cell tumors involving the hand bones is designed to eradicate the tumor and also protect hand function while keeping in mind the aggressive nature of these benign tumors. Surgical alternatives for radical treatment can include wide resection, resection of the ray and amputation.

Scaphoid nonunion treated with vascularised bone graft from dorsal radius

INTRODUCTION The main aim of this retrospective study was to present our experience on scaphoid nonunion treated with vascularised bone graft. METHODS Between 2006 and 2012, 58 patients presenting with symptomatic scaphoid nonunion were eligible to participate in this study. Topography of the nonunion included 29 proximal, 25 waist and 4 distal scaphoid nonunions. Vascularised bone graft from distal dorsal radius was used in all cases which were stabilised with the headless cannulated compression screws. Scapholunate angles, Natrass carpal height ratio were evaluated pre and postoperatively. Range of motion of the affected side was compared to that of the contralateral side after the surgery. RESULTS Radiographic union was achieved in 50, out of 58 cases with an average time of 9.9 weeks (range, 6-18 weeks). Out of all the non-united cases, four of them were in proximal, three in the waist and one was in distal scaphoid. In nine proximal nonunions treated by 4+5 ECA graft all but one were united. The mean follow up was 21.7 months (12-62 months). The flexion was 91.6%, the extension was 91.5%, the radial deviation was 81.2%, and the ulnar deviation was 89.5% compared to the other side. The grip strength was 93%. Preoperative DASH score was 61.5 diminishing to 28.7 postoperatively. There was no significant change in Natrass carpal height ratio but a slight improvement occurred in scapholunate angles both pre and postoperatively. CONCLUSION Vascularised bone graft is a good solution for scaphoid nonunion to enhance the healing rate especially in the presence of avascular necrosis. Proximal pole nonunions, humpback deformity and smoking are important negative factors for scaphoid nonunion despite the use of a vascularised bone graft. A trapezoidal wedge graft is necessary for the volar type nonunions with humpback deformity. 1,2 ICSRA offer an advantage with its proximity to scaphoid in all nonunion locations. Nonetheless, 4+5 ECA graft is also a good solution for proximal nonunions.

Fracture bilatérale de l'os pisiforme

Resume L’os pisiforme est tres rarement fracture par rapport aux autres os carpiens ; la lesion est souvent meconnue en urgence a cause de l’anatomie complexe de la region carpienne. Chute au sol poignet en hyperextension, accident de la voie publique et traumatisme direct sont les circonstances habituelles de la fracture. Le but de ce travail etait de presenter un cas de fracture bilaterale de l’os pisiforme, rare par le mecanisme etiologique et la bilateralite. Une patiente âgee de 34 ans s’est presentee avec des douleurs sur les bords ulnaires des deux poignets suite a une chute. Le mecanisme fracturaire avait ete un traumatisme direct sur les deux mains etendues en inclinaison radiale. Le diagnostic en a ete tardif et le traitement conservateur, apres une immobilisation simple de six semaines, le resultat clinique et fonctionnel a ete excellent. La situation anatomique du pisiforme fait qu’il est expose aux traumatismes et un diagnostic tardif pourrait exposer a des sequelles arthrosiques sur l’articulation pisotriquetrale.

The role of creating a biological membrane in expediting nerve regeneration for peripheral nerve repairs

OBJECTIVES Nerve guidance channels are natural or synthetic tubular conduits used to bridge the gap between the nerve stumps. Creation of a biological membrane may be a simple and cheaper way to obtain a nerve guidance channel. The goal of this study was to examine the role of a biological membrane in expediting nerve regeneration. METHODS Twenty adult male Wistar albino rats weighing 200 to 250 g were divided into two groups equal in number. All the animals underwent median nerve dissection to create a 5-mm gap. In the first group, the defect was repaired with a graft obtained from the contralateral median nerve, while in the second group, a silicon implant was sutured and anastomosed between the stumps. After five weeks, the silicon implant was removed and a nerve graft taken from the contralateral median nerve was anastomosed inside the neoformed biological membrane. Recovery of muscular function indicating nerve regeneration was assessed by the prehension test proposed by Bertelli and Mira. In both groups, measurements were started after five weeks of grafting and continued for 12 weeks. RESULTS Rats in the second group exhibited an accelerated recovery and nerve regeneration compared to the first group. Nerve regeneration was completed at 10 weeks in the second group, whereas the recovery rate was 90.2% at 12 weeks in the first group (p<0.05). CONCLUSION The use of autogenous grafts is still the gold standard in nerve repair. This biological membrane not only expedites nerve regeneration, but also facilitates surgery and reduces operating time because it requires small incisions at the two ends. Considering these advantages, it may prove to be a good alternative to other techniques.

The analysis of functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fractures.

INTRODUCTION Burst fractures of the low lumbar spine constitute approximately one percent of all lumbar fractures. There is still no consensus on the optimal treatment of low lumbar burst factures. We aimed to evaluate the functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fracture. METHODS 15 patients (11 males, 4 females; mean age 32±8) who had low lumbar spine burst fracture treated with a custom-moulded thoracolumbosacral orthosis (TLSO) with a thigh extension were enrolled. The mean follow-up period was 22±6 months. 14 patients were neurologically intact and one had isolated nerve root injury. There were 24% type A fractures and 76% type B fractures according to the Denis classification system. Functional outcomes were evaluated by using Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and Visual Analogue Scale (VAS). Radiographic outcome was analyzed by measuring anterior vertebral height loss, kyphosis angle, amount of canal retropulsion. Functional and radiographic outcomes were reviewed initially and at 1, 3, 6, 12 months, and at the latest follow-up. Functional and radiographic improvements were analyzed statistically. RESULTS The mean bracing period was 11.9±1.7 weeks. The mean initial ODI, SF-36, and VAS score of the patients was 78.3±9.6, 23.7±8.9, and 8.7±0.7, respectively. The mean ODI, SF-36, and VAS score of the patients at the final follow-up was 26.4±6.5, 68.1±11.2, and 2.8±1.7, respectively. The improvement in functional outcomes was measured to be significant (p<0.05 for ODI, SF-36 and VAS). The mean initial anterior vertebral height loss, kyphosis angle, amount of canal retropulsion was found to be 27.2%±9.6%, -6.8°±3.2°, 37.4%±10.2%, respectively. The mean anterior vertebral height loss, kyphosis angle, and amount of canal retropulsion at the final follow-up was 23.1%±.6.7%, -4.2°±2.4°, 19.6%±7.7%, respectively. Among the radiographic outcomes, only the amount of canal retropulsion improved statistically (p=0.042). CONCLUSION Conservative treatment using a custom-moulded thoracolumbosacral orthosis with a thigh extension is a safe and effective method in patients with low lumbar spine burst fractures and can improve functional and radiographic outcomes.

Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients

Objectives: To evaluate the clinical outcome after medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability in skeletally immature patients. Methods: Study participants were 8 patients ( median age, 10 years; range, 5-14 and one male , others female) who had suffered from persistent patellofemoral instability. Our technique preserves femoral and patellar insertion anatomy of MPFL using a free semitendinosus autograft, together with tenodesis to the adductor magnus tendon thus sparing the open physis of distal femur and the patellar attachment of MPFL. The clinical results were evaluated preoperatively and the final follow-up period using the Kujala patellofemoral score. Patellar shift, tilt and height were measured preoperatively and on the latest follow-up on plain radiographs. Results: At average 42 months follow-up ( range, 16 to 56), %80 of patients were satisfied with the treatment. Redislocation or instability symptoms occurred in two patients. No apprehension signs or redislocations were seen in the remanining six patients. A significant improvement (p‹0.05) in Kujala score (from 36 to 77) was found. Patellar shift & tilt decreased to anatomic values in six patients but patella alta persisted. Conclusion: The result of this study show that MPFL reconstruction with our technique seems to be an effective treatment for recurrent and habitual patellofemoral dislocation in skeletally immature patients; leading to significant increases in stability and functionality.