Volkan Oztuna

Nerve entrapment in painful heel syndrome.

Subcalcaneal heel pain is one of the most common foot ailments, yet the exact etiology is still controversial. Nerve entrapment has been suggested as one of the possible causes of this painful condition in recalcitrant cases. The purpose of this study is to determine the role of nerve entrapment in painful heels. Twenty patients with heel pain (25 heels) were compared with an age and body mass index-matched control population using electrodiagnostic methods. The results of the study revealed 22 heels (88%) with heel pain had lateral plantar nerve entrapment signs with or without medial plantar nerve findings on EMG. There were no abnormal values in the control group. Nerve entrapment syndrome has previously been considered only in cases with intractable heel pain, but this study suggests that it may play a role the early phases of painful heel syndrome.

Involvement of the proximal tibiofibular joint in osteoarthritis of the knee

This study was performed to evaluate the possible involvement of the proximal tibiofibular joint in primary osteoarthritis of the knee. A total of 40 patients with primary osteoarthritis of the knee who had magnetic resonance imaging scans were reexamined for proximal tibiofibular joint involvement. The patient was questioned if pain was present in the proximal tibiofibular joint while at rest, when walking and climbing stairs. Symptoms were evaluated by applying moderate compression over the proximal tibiofibular joint during active ankle and knee motions. Magnetic resonance imaging scans were reexamined by two radiologists. Three of the 40 patients had minimal or moderate pain in the proximal tibiofibular joint during stair-climbing and on clinical examination. Magnetic resonance imaging scans of these three patients revealed osteophyte or subchondral cyst formation, or both. Degenerative changes in the proximal tibiofibular joint may be evident in association with osteoarthritis of the knee and may result in lateral-sided pain at the knee.

Comparison of the Efficacy of Tigecycline and Teicoplanin in an Experimental Methicillin-Resistant Staphylococcus aureus Osteomyelitis Model

Abstract We evaluated the efficacy of tigecycline and teicoplanin in a rat model of MRSA osteomyelitis. Osteomyelitis was induced with an intramedullary injection of 108 colony-forming units (cfu) of MRSA. After osteomyelitis formation was confirmed on Day 14, infected rats were randomly divided into three groups: tigecycline (n=13), teicoplanin (n=13), and no-treatment control (n=14). A 28-day antibiotic therapy with a subcutaneous injection of tigecycline (14 mg/kg twice daily) or intramuscular administration of teicoplanin (20 mg/kg daily) was administered. Rats were then sacrificed, and the tibias were harvested. The bones were weighed and then cultured. Our results indicated that bacterial growth was significantly reduced in teicoplanin and tigecycline groups, compared to the control group (p=0.019 and p=0.006, respectively). However, no difference was detected between the two antibiotic groups (p=1.000). No bacterial growth was detected in 7 out of 13 and 9 out of 13 specimens of the teicoplanin and tigecycline treated groups, respectively. Although this result was numerically in favor of tigecycline, the difference was not statistically significant (p=0.427). In conclusion, tigecycline, a novel antibiotic, appears as an effective alternative to teicoplanin in the treatment of osteomyelitis caused by MRSA.

Measurement of the humeral head retroversion angle: A new radiographic method

Abstract Background. In this study, a simple and reliable radiographic method is described to determine the torsional profile of the humeral head. Methods. First, by using a specially developed frame, the humeral head retroversion angles (HRAs) of 20 dry humeri were measured by an anatomist and an orthopedist. Then the HRA of these humeri were measured by two orthopedists on radiographs taken in semi-axial view when the humeri were in 20° abduction. Results. The results were assessed with the SPSS 9.05 program, and the repeatability coefficient of both methods was 98%. The average difference in angle determination between the two methods was 0.9°; the maximum difference was 3°. After that, posteroanterior semi-axial radiographs of both humerus bones of 40 healthy volunteers were taken by positioning their arms in 20° abduction to the X-ray axis. The mean HRA difference between the right and left sides was 0.4° (maximum difference 3°) and is of no clinical significance. It was determined that left and right HRAs can be taken as a reference to each other. For measurement of the HRA in the planning of proximal humeral rotation osteotomy and prosthesis replacement arthroplasty, the presented radiographic method can be used with a high rate of accuracy.

Intra-articular Injection of Tenoxicam in Osteoarthritic Knee Joints With Effusion

Thirty patients who had grade II to III osteoarthritis according to Kellgren-Lawrence system and presenting with acute effusion of the knee joint were randomly assigned to 2 groups. All patients were treated with aspiration of the synovial fluid, cold application, and rest. Fifteen patients received an intra-articular injection of tenoxicam 20 mg following aspiration. The other group was administered oral tenoxicam 20 mg a day for 10 days. Patients were examined at 2, 4, and 8 weeks and then in 3-month intervals. At followup visits, pain was assessed using visual analog scale: range of motion, and effusion of the knee joint were recorded. A repeated measure test was used to determine the significance of changes in pain and mobility between the groups. Students Neyman Keuls test was used to determine the significance of differences within the groups. Chi-square test was used for the number of episodes. The intra-articular injection group had more rapid pain relief than the oral treatment group (P < .01). At the end of 1 year, the number of effusions was significantly lower in the intra-articular treatment group (P < .01). These results indicate that intra-articular injection of tenoxicam provides rapid pain relief in the patients with acute flare-up of knee osteoarthritis and helps to prevent effusion.

Addition of Fusidic Acid Impregnated Bone Cement to Systemic Teicoplanin Therapy in the Treatment of Rat Osteomyelitis

Abstract We compared the efficacy of the combination of fusidic acid impregnated bone cement and systemic teicoplanin to systemic teicoplanin alone in implant-related osteomyelitis model in the rats. Foreign bodies were implanted into the medullary channels of 30 rat tibias after intramedullary inoculation of methicillin-resistant Staphylococcus aureus. Following proof of induction of osteomyelitis in the rats on the 21st day, a bone cement rod including 1/40 ratio of fusidic acid was inserted into the medullary channel of the tibias in the study group. Teicoplanin was administered i.m. at 20 mg/kg/day for 14 days to both the study and control groups. At the end of the treatment, the tibias were examined macroscopically, microbiologically and histopathologically. The elimination rate with the teicoplanin+fusidic acid combination was 81.8%, while with teicoplanin alone was 55.6% (p=0.33). Although the difference between the two groups was not statistically significant, the combination treatment had a positive effect in eliminating the microorganism.

Injection-induced contracture of the quadriceps femoris muscle in children.

Contracture of the quadriceps femoris in children leads to limited knee flexion.1 Fairbank and Barret2 and Hnevkovsky3 believed the contracture was congenital or secondary to progressive idiopathic fibrosis of the vastus intermedius. Lloyd-Roberts and Thomas4 stipulated that multiple injections into the thigh might cause the contracture. Proximal release in the early stage and distal release in the late stage are the recommended treatments.5 Concomitant proximal and distal release in the early stage has not been reported previously. This article presents a case of quadriceps contracture due to multiple thigh injections in a young patient.

Head Injury-Associated Bone Fractures Induce Bacterial Translocation : An Experimental Study

Objectives To determine whether long bone fractures cause bacterial translocation and to investigate the effect of concomitant head trauma on this process. Design An in vivo animal model. Setting Animal Laboratory, University of Mersin School of Medicine, Mersin, Turkey. Subjects Male Sprague-Dawley rats (n = 60). Intervention Sixty male Sprague-Dawley rats were divided into five groups: (1) anesthesia only (control group, n = 12); (2) anesthesia and tibia fracture (n = 12); (3) anesthesia, tibia fracture, and femur fracture (n = 12); (4) anesthesia, tibia fracture, femur fracture, and moderate head trauma (n = 12); and (5) moderate head trauma only (n = 12). After 24 hours, mesenteric lymph nodes, liver, spleen, ileum, and systemic blood samples were quantitatively cultured for aerobic organisms. Main Outcome Measurements Colony-forming unit per gram for bacteria count. Results The incidence of bacterial translocation was higher in groups that had fractures (4/12 in group 2; 5/12 in group 3) than in the control group (2/12); however, this did not reach statistical significance. There was a significant increase in the number of subjects with bacterial translocation in group 4 (9/12) compared with the control group and group 5 (3/12) (P = 0.0123, P = 0.0391). Conclusions Multiple fractures of long bones associated with head injury promote bacterial translocation.

LATE PSYCHOSOCIAL EFFECTS OF CONGENITAL HAND ANOMALY

Lifetime-standing psychosocial effects of congenital hand anomalies are inevitable in patients who have not received a comprehensive treatment with appropriate timing and approach. Herein, two adult cases of untreated thumb polydactyly are presented. Both of them had hands with striking appearance and late consequent psychosocial problems.

Augmentation of Shoulder Contour Using a Calf Implant

Abstract. Sprengel deformity is a rare orthopedic condition that is associated with functional and cosmetic impairment. Results of orthopedic procedures are usually inconsistent and cosmetic results are far from satisfactory in these patients. A silicone-gel-filled calf prosthesis was used to correct the shoulder contour in a patient with Sprengel deformity. Cosmetically the deformity can be restored by using a calf implant for patients in whom orthopedic procedures are not likely to yield a satisfactory outcome.