Tolga Tuzuner

Primary subcutaneous cyst hydatic disease in proximal thigh: an unusual localisation: a case report

BackgroundMusculoskeletal hydatidosis is very rare and represents 1% – 5.4% of all cases of echinococcosis. On clinical basis, infection mimics a soft-tissue tumor, and the preoperative radiological diagnosis is very important to avoid biopsy.Case PresentationWe report an unusual case of primary subcutaneous hydatidosis in proximity to vastus lateralis muscle. It was diagnosed according to the computed tomography appearance, clinical and pathological findings. A 43 year old female patient was admitted with a history of pain at proximal thigh for the last 30 days. On physical examination, a mass which was 4 × 5 cm in diameter, painful and erythamatous, was palpated over greater trochanter. Sedimentation rate was 40 mm in the first hour. CT (Computed Tomography) scan demonstrated, a soft tissue mass with central cystic component in the subcutaneous tissue near vastus lateralis muscle.Histopathological examination of the specimen revealed a pericystic structure, which consisted of connective tissue and scattered hyaline cells showing a necrotic basophilic structure that resembled a cuticular membrane. Treatment with high dose albendazole was conducted for 4 weeks.ConclusionsThis case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when they occur in areas where the disease is endemic.

In vivo evaluation of teicoplanin- and calcium sulfate-loaded PMMA bone cement in preventing implant-related osteomyelitis in rats.

Abstract The objective of this study was to evaluate the efficacy of teicoplanin- and calcium sulphate-loaded polymethylmethacrylate (PMMA) bone cements in preventing experimental implant-related osteomyelitis in rats. Four groups of antibiotic-loaded rods were prepared and were implanted into the lateral condylus of the rat femur after inoculation of Staphylococcus aureus. The effectiveness of these were assessed microbiologically, radiographically, and histopathologically. Radiographic evaluation revealed a significant reduction of periostal reaction and osteolysis in rats that received calcium sulphate- and teicoplanin-loaded rods. Histopathological evaluation confirmed these results. Acute infection and bone necrosis were found to be significantly lower in rats that had received calcium sulphate- and teicoplaninloaded rods. The addition of calcium sulfate to teicoplanin-loaded PMMA bone cement appeared satisfactory as an antibiotic-carrying system for prophylaxis of experimental implant-related osteomyelitis, but further investigations are needed to reach definitive statements for clinical applications.

Is external fixation in pediatric femoral fractures a risk factor for refracture

The aim of this study was to investigate whether external fixation is a risk factor for refracture by comparing the outcomes of children who received three different forms of treatment of femoral fractures. One hundred ninety-two patients treated for femoral fracture between 1990 and 1999 who underwent final examination were assessed. One hundred were treated with hip spica casting after traction, 57 with closed reduction and external fixation, and 35 with open reduction and external fixation. Morbidity results such as time to union, length of hospital stay, refracture, and wire site infection were statistically evaluated. Patients undergoing open reduction had a greater time to union and length of hospital stay and a higher refracture rate. The difference was statistically significant. Wire site infection occurred in all three groups; there was no statistically significant difference between groups. The authors concluded that external fixation is not a risk factor for refracture in the treatment of pediatric closed femoral diaphyseal fractures, and that it may be used with ease in clinics with shortages of personnel and space.

In vitro bacterial adherence to teicoplanin and calcium sulfate-soaked bone cement.

Abstract The aim of this study was to assess In Vitro the improvement in release kinetics for teicoplanin and the inhibition of bacterial adhesion on calcium sulfate-soaked PMMA discs. Calcium sulfate has been used in vivo and shown to be biocompatible, and prevention of bacterial adhesion may be expected with calcium sulfatesoaked polymethylmethacrylate (PMMA). Discs were made by adding teicoplanin and calcium sulfate in powder form to PMMA powder. The antibiotic concentration eluted from PMMA discs was assayed by agar diffusion assay. Nonadherent bacteria were removed by washing and adherent bacteria were detached by sonication. The suspension including nonadherent bacteria was seeded on sheep blood agar plate and incubated for 24 h at 37°C for the growth of microorganisms. The teicoplanin released from discs containing calcium sulfate was higher than that released from discs which had not been soaked with calcium sulfate. The count of bacteria adhering to the calcium sulfate-soaked discs was lower than that from the discs without calcium sulfate. In conclusion, the addition of calcium sulfate to teicoplanin-loaded PMMA bone cement may provide local antibiotic concentrations higher than MIC values due to increased antibiotic release. Furthermore, calcium sulfate was found to be effective in reducing bacterial adherence to treated discs.

Mosaicplasty technique in the treatment of osteochondral lesions of the knee

OBJECTIVES We evaluated early results of patients undergoing mosaicplasty for full-thickness cartilage lesions of the knee. METHODS The study included 24 patients (8 females, 16 males; mean age 39 years; range 17 to 52 years) with full-thickness cartilage lesions on the weight-bearing surface of the lateral (n=6) and medial (n=8) femoral condyles. Mosaicplasty was performed with open surgery. All grafts were harvested from the ipsilateral femoral condyle at the level of the sulcus terminalis and transplanted with the mosaicplasty technique to the defect area. The mean defect diameter was 13.5 mm (range 8 to 27 mm), and the mean number of grafts used was 1.5 (range 1 to 4). Final clinical assessments were made using the Lysholm and ICRS (International Cartilage Repair Society) scoring systems. Radiological evaluations were made according to the Kellgren-Lawrence criteria. Donor-site morbidity was evaluated according to the Bandi scoring system. The mean follow-up was 30.5 months (range 13 to 47 months). RESULTS The mean pre- and postoperative Lysholm knee scores were 46 (range 28 to 64) and 86 (range 76 to 100), respectively. ICRS scores were grade I in 16 patients (66.7%), grade II in six patients (25%), and grade III in two patients (8.3%). Five patients (20.8%) had slight donor-site disturbance which regressed within six months to a level that did not restrict daily physical activities. All the patients returned to preinjury activity levels. Postoperative magnetic resonance imaging showed no signs of graft loosening or collapse. According to the Kellgren-Lawrence criteria, 20 patients (83.3%) were free from any signs of osteoarthritis, whereas four patients (16.7%) exhibited early osteoarthritic changes. CONCLUSION Mosaicplasty is a reliable procedure in the treatment of full-thickness chondral lesions because it is minimally invasive, can be performed at a single session, and has a low complication rate and low cost.

Subungual osteochondroma: a diagnostic dilemma.

Osteochondroma is the most common skeletal neoplasm of all benign bone tumors. However, it rarely occurs subungually. In this location, the lesion may penetrate the skin, causing nail deformity, and can easily be misdiagnosed. We report two cases of subungual osteochondroma of the distal phalanges of the first toes with cutaneous penetration and discuss the clinical, histologic, and radiographic features and the treatment options.

Subcoracoid dislocation of the acromioclavicular joint.

Subcoracoid acromioclavicular dislocations are rarely seen injuries of the shoulder. We present a patient with multiple injuries and a subcoracoid acromioclavicular dislocation resulting from a falling injury. Physical examination revealed painful mechanical block at 90 degrees of abduction and swelling in the acromioclavicular region. Diagnosis was made with direct radiographs and computerized tomography. Treatment consisted of distal clavicular resection and coracoclavicular reconstruction with the transfer of the coracoacromial ligament over the clavicle. The patient had a pain-free shoulder after two years and was capable of performing daily activities despite the presence of coracoclavicular ossification.

The Surgical Overcorrection of Lenke Type 1 Deformities with Selective Fusion Segments: What Happens to the Coronal Balance?

Purpose The aim of our study is to determine the alterations on coronal balance after overcorrection of Lenke type 1 curve, retrospectively. Methods Datas of 34 patients (29 female, 5 male patients; mean age, 16.3±3.3 years; range, 13-24 years) surgically treated for scoliosis between 2004 and 2010 were reviewed, retrospectively. The adolescent idiopathic scoliosis patients with Lenke type 1 curve treated with only posterior pedicle screw and postoperative thoracic curves less than 10° by Cobb method on frontal plane were enrolled in this study. Mean follow-up period was 52.5±29.7 months. Results The mean amount of the preoperative thoracic curves was measured as 41.2°±6.1° (range, 30°-56°). The mean amount of the early postoperative thoracic curves was measured as 6.5°±1.8° (range, 3°-9°). The mean amount of the thoracic curves was measured as 8.5°±4.6° (range, 3°-22°) during the last follow-up (p=0.01). The mean preoperative coronal balance was measured as 8.5mm(range, 1-30mm). The mean early postoperative coronal balance was measured as 3.5mm(range, 0-36 mm). The mean coronal balance was measured as 5.5mm(range, 0-38mm) during the last follow-up (p>0.05). Conclusion We suggest that Lenke type 1B and 1C should be carefully evaluated and the fusion levels should be accurately selected in order to maintain the correction of coronal balance. We suggest that selective fusion with overcorrection in Lenke type 1A are applied to curves that can be corrected lumbar curve at the preoperative bending radiograph and curves that not have coronal decompensation and >10° distal junctional kyphosis, preoperatively.

Multiple Simultaneous Metatarsal Stress Fractures in the Same Foot

Metatarsal stress fractures are common overuse injuries in athletes, military recruits, and ballet dancers, usually occurring in the second, third, and fourth metatarsals, respectively. Such fractures may also occur in a variety of other individuals, regardless of demographic characteristics, sex, or profession, and they are highly associated with excessive activity. Moreover, these types of fractures are usually diagnosed late and have poor outcomes. To our knowledge, there has been only one case report of an individual with stress fractures of all three central metatarsals in the same foot. We describe herein a racehorse training jockey who presented with multiple simultaneous metatarsal stress fractures in the same foot. We also discuss the possible mechanisms by which this entity occurred, as well as its management and outcome.

Is anterolateral ligament rupture a reason for persistent rotational instability after anterior cruciate ligament reconstruction

BACKGROUND The aim of the present study was to evaluate the clinical role of anterolateral ligament (ALL) rupture and its impact on rotational stability by comparing the clinical results and rotational stability between reconstructed anterior cruciate ligament (ACL) with intact ALL knees and reconstructed ACL with ALL injured knees. METHODS A total of 69 patients who had undergone surgery for ACL reconstruction and had received a minimum of two years of follow-up were included. Patients were divided into two groups with respect to the presence of ALL rupture on knee magnetic resonance imaging. Patients were assessed preoperatively and at final follow-up with physical examination findings and functional outcomes. Rotational stability was measured by a non-invasive rotameter-like device at the final follow-up at different torque values of 5 Nm (newton metres), 10 Nm and 15 Nm, and compared between the two groups. RESULTS The ALL was considered to be ruptured in 45 cases, named Group I (65.2%). The ALL was considered to be intact in 24 cases, named Group II (34.8%). No significant difference was found between the groups regarding the improvement of the clinical scores and physical examination findings (P > 0.05). Group I showed significantly higher internal rotation difference compared with Group II in all torque values (P < 0.05). CONCLUSION The difference found on rotational measurement is possibly under the value of minimal clinical important difference and does not have a clinical effect, therefore ALL reconstruction is not recommended as a standard treatment in all patients.