Tolga Onay

Treatment of pathological fractures due to simple bone cysts by extended curettage grafting and intramedullary decompression.

OBJECTIVE Effectiveness and morbidity of curettage grafting and intramedullary decompression in the treatment of pathological fractures due to simple bone cysts (SBCs) were evaluated. METHODS Between 2005 and 2012, 34 children with SBCs were treated with extended curettage grafting and intramedullary decompression. Average age of the patients (23 male, 11 female) at surgery was 11.7 years (range: 6-21 years). The lesions were localized in the humerus (19), femur (12), tibia (2), and ulna (1). Pathological micro- or displaced fractures occurred in 31 patients. Surgical procedure included extended curettage by using cauterization and high-speed burring, bone grafting, and intramedullary decompression with elastic nails. Six patients had been treated conservatively or surgically in other institutions previously. Radiographic and functional results were evaluated by Capanna criteria and MSTS scores respectively. Early and late complications and additional surgical procedures were recorded. RESULTS The average follow-up was 37 months (range: 18-89 months). The average time to heal for pathological fractures was 8 weeks (range: 6-12 weeks). Radiographic evaluation revealed Grade 1 healing in 28 patients (82%) and Grade 2 healing in 6 patients (18%). The average MSTS score based on final follow-up was 28.5 (range: 17-30); excellent (32 patients; 94%) and good (2 patients; 6%) functional results were obtained. There was no early or late infection, refracture or implant failure. Malunion developed following treatment of 2 humeral and 2 femoral lesions. With the exception of 2 implant removals, no patients required additional surgical intervention. CONCLUSION Complete cyst healing and satisfactory functional results can be obtained by curettage grafting and intramedullary decompression. This technique restores bone integrity by allowing early motion and prevents refracture and subsequent deformity in the majority of patients.

Influence of number and orientation of screws on stability in the internal fixation of unstable femoral neck fractures

OBJECTIVE The aim of this study was to biomechanically compare 3 different cannulated screw configurations used in internal fixation of unstable femoral neck fractures. METHODS The study included 28 synthetic left femurs randomly divided into 4 equal groups. Samples in the first 3 groups were osteotomized in the basicervical region to create Pauwels Type 3 fractures. Fixation was carried out using cannulated screws. In Group 1, four screws were used including 3 in an inverted triangle configuration in parallel with the neck and the fourth screw transversely into the calcar. In Group 2, three screws were used including 2 in parallel with the neck and the third transversely into the calcar. In Group 3, three screws were used in an inverted triangle configuration in parallel with the neck. No osteotomy or fixation was carried out in Group 4. Load test was performed on all the groups and the strength of the screw fixations against axial load and their amount of relocation were measured. RESULTS Average maximum strength was 36.1 ± 3.2 N/mm2 in Group 1, 27.3 ± 4.1 N/mm2 in Group 2 and 21.9 ± 3.2 N/mm2 in Group 3. The average relocation in the line of osteotomy in the moment of average maximum stress (21.9 ± 3.2 N/mm2) was 11.5 ± 2.1 mm in Group 3, 6 ± 1.3 mm in Group 2 and 5.8 ± 1.1 mm in Group 1 (p<0.05). It was also observed that while the relocation in the moment of average maximum stress (27.3 ± 4.1 N/mm2) was 9.1 ± 1.7 mm in Group 2, the deformation under the same stress value was 9 ± 1.7 mm in Group 1 (p>0.05). CONCLUSION The use of a transverse screw in the calcar in addition to cannulated screws parallel to the neck appear to provide stability benefit in the treatment of unstable femoral neck fractures.

A comparative study for the treatment of simple bone cysts of the humerus: open curettage and bone grafting either without instrumentation or with intramedullary nailing.

Functional and radiographic outcomes, in addition to complication and reoperation rates of open curettage and grafting without instrumentation or with intramedullary nailing, in the treatment of simple bone cysts (SBCs) of the humerus were compared. Thirty-seven children [25 males, 12 females; median age=9.5 years (range, 3–17 years)] with humeral SBC were treated with curettage and grafting without instrumentation (group 1, 21 patients) or with intramedullary nailing (group 2, 16 patients). The pathological fracture rate was 85.7% in group 1 and 87.5 in group 2. The follow-up duration ranged from 26 to 85 months. The average last follow-up Musculoskeletal Tumor Society functional scores for groups 1 and 2 were 28.9 and 29.5 (P>0.05). Higher, but statistically insignificant (P>0.05), complete or significant partial radiographic healing rates were achieved in group 2 (100%) compared with group 1 (76.2%). The overall complication rate of the entire study population was 21.6% (19%; 4/21 in group 1; 25%; 4/16 in group 2). The reoperation rates for groups 1 and 2 were 9.5% (2/21; one for partial cyst healing, one for recurrence) and 56.25% (9/16; one for surgical complication, eight for implant removal). Surgical intervention is indicated for selected patients with SBCs. Even though perfect functional results were possible with open curettage and grafting, continuous intramedullary decompression with elastic nails led to a higher radiographic healing rate in the treatment of humeral SBCs. Open curettage and grafting with or without intramedullary nailing was associated with a high number of complications, but the rate of reoperation for complications was very low.

Systematic Evaluation of Drug-Loaded Hydrogels for Application in Osteosarcoma Treatment

This is a literature review of studies focusing on the preparation of hydrogels for use as oncological drug delivery systems in the treatment of osteosarcoma (OS). The databases of the US National Library of Medicine National Institutes of Health, Embase, OVID, and Cochrane Library, and the references of retrieved studies, were traced from 1843 to December 21, 2015, without language restrictions. The obtained data were evaluated by complementary statistical methods. Potentially relevant studies were found and included in the analysis. OS-specific chemotherapeutic agents can be successfully embedded within the hydrogels and these drug-loaded hydrogels can be applied locally, rather than systemically, without organ tissue toxicity. Further, OS-specific drug-loaded hydrogels significantly increased tumor inhibition and decreased osteolysis and lung metastases. Drug-loaded hydrogels could be useful in the treatment of OS, although their development remains at the experimental phase. Following evaluation of their application in surgery and the completion of drug release kinetics studies, drug-loaded hydrogels could be tested on living mammals in large samples with the aim of applying these in clinical settings. In the future, development of such drug delivery systems and application of targeted approaches against osteosarcoma and other malignancies may render surgery, radiotherapy and chemotherapy unnecessary.

Late Developmental Dysplasia of the Hip That Was Sonographically Determined to Be Stable at First Examination: A Case Report

Developmental dysplasia of the hip (DDH) is the most common skeletal dysplasia in childhood1. If the diagnosis of DDH is not determined during the first months of life and therefore is left untreated, it can lead to permanent deformities and osteoarthritis in later years2. In infants, hips that are clinically and sonographically stable just after birth should develop normally as long as their evolution is not disrupted by neurologic, septic, or traumatic reasons. In the first six months after birth, ultrasonography of the hip is the most valuable method to diagnose DDH. Early diagnosis of DDH with sonographic screening programs and early treatment have reduced the rate of late-developing dysplasia1,2. This case report describes a patient who was assessed for DDH when she was eight weeks old. At that time, the hips were found to be clinically and sonographically stable. However, DDH was evident six months later. The patient’s parents were informed that data concerning the case would be submitted for publication, and they provided consent. A six-month-old baby girl was admitted to our clinic because of limited range of motion in the left hip. During the physical examination, skinfold asymmetry and limited abduction of the left hip …