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Closed total talar extrusion after ankle sprain.

Closed total talus dislocation from tibiotalar, subtalar, and talonavicular joints is a very rare injury. A 25-year-old young man, who had severe ankle distortion while walking down a flight of stairs, was brought to the emergency room complaining of a deformity and pain in his ankle joint. Roentgenographies revealed total talar body extrusion. The patient was treated urgently with open reduction in the authors’ clinic. Tibialis posterior tendon might prevent closed reduction so open reduction with retraction of the tendon may be necessary. Level of Evidence : Therapeutic Level IV

Sciatica due to Schwannoma at the Sciatic Notch

Schwannomas are rarely seen on the sciatic nerve and can cause sciatica. In this case report we aimed to present an unusual location of schwannoma along sciatic nerve that causes sciatica. A 60-years-old-man was admitted to us with complaints of pain on his thigh and paresthesia on his foot. Radiography of the patient revealed a solitary lesion on the sciatic nerve. The lesion was excised and the symptoms resolved after surgery.

Chondroprotective effect of salicylate and chloroquine in pyogenic septic arthritis

IntroductionThis study aims to investigate the effectiveness of salicylate (Aspisol®; Bayer AG, Leverkusen, Germany) and chloroquine on preventing cartilage damage in septic arthritis.MethodsA septic arthritis model was created by inoculating the knee joint of young rabbits (n=21) with Staphylococcus aureus. Some rabbits with inflicted septic arthritis did not undergo any treatment and served as the control group (n=7). The second group (n=7) was started on salicylate on day 2 to investigate the effects of salicylate on joint cartilage. The third group (n=7) was started on chloroquine on day 2 to investigate the effects of chloroquine on joint cartilage. All three groups underwent arthrotomy, drainage and synoviectomy on day 7 of the experiment. Animals were sacrificed on day 14 and the joint cartilages were extracted. Histopathology, determination of local prostaglandin (PGE)-like activity, and evaluation of hyaluronic acid loss were performed on all samples.ResultsThe control group and the salicylate group were similar in the extent of joint damage. Salicylate did not prevent joint cartilage damage despite inhibiting PGE synthesis. Chloroquine, despite not inhibiting PGE synthesis, did prevent cartilage destruction.ConclusionIf supported by larger-scale studies, chloroquine could be added to the antibiotic regimen in the treatment of septic arthritis to prevent cartilage damage.

Effects of Local Application of Nano-silver on Osteomyelitis and Soft Tissue Infections: An Experimental Study in Rats

Purpose: Bone and soft tissue infections are among the least desired complications after orthopaedic surgery. This study analysed the in vivo effects of the local application of nano-silver particles (AgNPs) [1nm = 1 billionth of a meter] in soft tissue infections. Materials-Method: An experimental osteomyelitis model was formed by inoculating both tibias of 24 rats with methicillin-resistant Staphylococcus aureus. The rats were followed without treatment for 21 days. Blood samples and tibial x-rays at day 21 confirmed the development of infection. Then, the rats were divided randomly into two groups. One group (12 rats) underwent surgical debridement and received 21 days of teicoplanin therapy. The second group had the same treatment, with the addition of local nano-silver. All of the rats were sacrificed at day 42. Blood and wound swab samples were taken and the culture results were analysed. Results: No differences were observed between the groups in healing values at pathological examination, or in changes in the number of colonies at days 21 and 42. No differences in white blood cell count (WBC) were observed between the groups before and after the treatment. Conclusion: Although in vitro studies suggest the effectiveness of AgNPs on pathogens, we found that the application of nano-silver did not make any difference when used in addition to the classical osteomyelitis treatment with antibiotics and local surgical debridement. We believe that additional in vivo studies using repeated nano-silver application could be beneficial.

RETRACTED ARTICLE: Biceps tendon interposition in two-part fracture of the humeral surgical neck

Long head of the biceps tendon (LHB) is an obstacle to closed reduction in two-part fracture of the humeral surgical neck if the distal humeral shaft is displaced into the axilla in anteroposterior X-ray examination. Among 36 proximal humeral fractures, 10 two-part humeral surgical neck fractures which were displaced into the axilla in anteroposterior X-ray views and classified as 11-A3.2 were included in this study. In all of these fractures, closed reduction attempts were unsuccessful. All of the cases were treated surgically. In all of the cases, the humeral shaft was in the axilla in anteroposterior X-ray examination. It was found intraoperatively that the humeral shaft was also displaced more than 100% anteriorly and the LHB was interposed in the fracture site. Traction applied to the shaft of humerus enhanced the ‘bowstringing’ effect of the LHB making closed reduction impossible. The fracture could only be reduced by open reduction. The LHB entrapment is released by pushing the humeral head upwards by a periosteal elevator. LHB entrapment in the fracture site should be strongly suspected in two-part fracture of the humeral surgical neck if the humeral shaft is displaced into the axilla in AP X-ray examination and more than 100% anteriorly in the sagittal plane. The classic closed reduction maneuver enhances the strangulation of the LHB and reduction could only be achieved by surgery.