Don't miss it: Extremity-located cyst hydatid may mimic soft tissue tumors

OBJECTIVES

In this study, we present our experience in patients with hydatid cysts located intramuscularly.

PATIENTS AND METHODS

Between May 2018 and May 2023, a total of 11 patients (3 males, 8 females; mean age: 29.1±13.6 years; range, 8 to 56 years) with intramuscular hydatid cysts were retrospectively analyzed. Demographic data, laboratory values, serological test results, location and size of the cyst, radiological imaging findings, and complications were recorded.

RESULTS

The mean follow-up was 44.3±17.3 (range, 5 to 60) months. The mean mass size at the time of admission was 5.4±3.3 (range, 2 to 14) cm. Serologic tests were positive in the majority of cases (72.7%). Eosinophilia was negative in 72.7% patients. The rate of isolated muscle involvement was 81.8%. The rate of lower extremity involvement was 72.7%. The most common involvement was leg (36.4%), thigh (18.2%), and shoulder (18.2%). One patient developed compartment syndrome after cyst rupture during neoadjuvant antihelmintic therapy. There was no recurrence in any of the patients.

CONCLUSION

Hydatid cysts should be considered in the differential diagnosis of slowly growing, deeply located, painless soft tissue masses, particularly in endemic areas. Although it is a rare complication, compartment syndrome may develop after spontaneous cyst rupture. Neoadjuvant antihelmintic chemotherapy can reduce complications. The combination of total surgical excision and chemotherapy yields successful results in the treatment of hydatid cysts located in the muscle.

Comparison of the effectiveness of the WALANT method in soft tissue and bone tissue surgeries in lower extremities

OBJECTIVES

This study aims to investigate the effectiveness of wide-awake local anesthesia with no tourniquet (WALANT) technique in both bony and soft tissue procedures in lower extremities.

PATIENTS AND METHODS

Between January 2021 and December 2022, a total of 29 patients (20 males, 9 females; mean age: 34.6±20.2 years; range, 14 to 82 years) who were operated for lower extremity pathologies with the WALANT technique in our clinic were included. The patients were divided into two groups: lower extremity soft tissue surgeries in Group A (n=10) and bone tissue surgeries in Group B (n=19). Postoperative pain onset time, pain score, the amount of intraoperative bleeding, need for additional solution, use of cautery, and the amount of bleeding in the surgical field were compared within groups. The Visual Analog Scale (VAS) was used to evaluate pain.

RESULTS

There was no significant difference between the two groups in terms of age (p=0.265), sex (p=0.107), and surgical side (p=0.700). There was no significant difference between the two groups in terms of intraoperative bleeding at the discretion of the surgeon (p=0.701). There was no significant difference in the use of additional solution (p=0.105), cautery usage (p=0.522), pain onset time (p=0.636), and VAS scores (p=0.735) between the two groups.

CONCLUSION

Our study results suggest that the WALANT technique is an effective and safe method in selected lower extremity surgeries. It is of utmost importance to apply the technique correctly to prevent complications that may occur.

Evaluation of oxidative stress in degenerative rotator cuff tears

BACKGROUND

Oxidative stress occurs as a result of the disruption of the balance between the formations of reactive oxygen species and antioxidant defense mechanisms during the conversion of nutrients into energy. Increased body oxidative stress has been reported to be involved in the etiology of several degenerative and chronic diseases. We hypothesized that the body oxidative stress level is higher in patients with atraumatic degenerative rotator cuff tear than that in healthy individuals.

METHODS

The patients who underwent arthroscopic repair for atraumatic, degenerative rotator cuff tear were prospectively evaluated. A total of 30 patients (group 1, 19 females and 11 males; mean age: 57.33 ± 6.96 years; range: 50-77 years) and 30 healthy individuals (group 2, 18 females and 12 males; mean age: 56.77 ± 6 years; range: 51-72 years) were included in the study. The Constant and American Shoulder and Elbow Surgeons scoring systems were used to evaluate the clinical outcomes. Serum oxidative stress parameters of the patients and the control group were biochemically evaluated. Accordingly, thiol/disulfide (DS) balance (DS/native thiol [NT], DS/total thiol [TT]), Total Oxidant Status (TOS), oxidative stress index, and nuclear factor erythroid-2-associated factor-2 values were used as the biochemical parameters indicating an increase in the serum oxidative stress level. Total antioxidant status and NT/TT values served as the biochemical parameters indicating a decrease in the serum oxidative stress level.

RESULTS

The study follow-up duration was 12 months. A statistically significant increase was observed in American Shoulder and Elbow Surgeons and Constant scores of patients who underwent arthroscopic rotator cuff repair relative to that during the preoperative period (P = .01). The values of biochemical parameters (DS/NT, DS/TT, TOS, oxidative stress index, and nuclear factor erythroid-2-associated factor-2), which indicated an increase in the serum oxidative stress, were significantly higher in preoperative patients than those in postoperative patients, albeit the control group values were significantly lower than those of the postoperative patients. The biochemical parameters (NT/TT and total antioxidant status) indicating a decrease in the serum oxidative stress levels were significantly higher in the postoperative patients than those in the preoperative patients and significantly lower than those in the control group.

CONCLUSION

High levels of markers indicating an increase in the serum oxidative stress in patients with degenerative rotator cuff rupture suggested that TOS may be involved in the etiopathogenesis of rotator cuff degeneration. Although the oxidative load decreases during the postoperative period, the fact that it is still higher than that in healthy individuals supports this claim.

Evaluation of avascular necrosis risk factors after closed reduction for developmental dysplasia of the hip before walking age

Avascular necrosis (AVN) of the femoral head is one of the most important complications after closed reduction and spica cast application in developmental dysplasia of the hip (DDH) treatment. This study aims to put forth the impact of closed reduction age and other factors which can cause AVN. Inclusion criteria of the study were: closed reduction and spica cast application before walking age (12 months) and minimum 2 years duration of follow-up. The presence of femoral head ossific nucleus, International Hip Dysplasia Institute (IHDI) score, acetabular indices and AVN were evaluated from radiographies. Hip abduction angles were evaluated on CT images. The absence of the ossific nucleus at the closed reduction time and preoperative IHDI grade were not significant risk factors for AVN (respectively OR = 2.83; 95% CI, 0.99-8.07; P = 0.052; OR = 2.5; 95% CI, 0.85-7.32; P = 0.094). For the patients older than 10 months, (1) the absence of the ossific nucleus was a significant risk factor for grade 2 or higher AVN according to the Bucholz Ogden criteria (P = 0.020) and (2) the higher preoperative IHDI grade (IHDI 3-4) was a significant risk factor for AVN (P = 0.032). AVN of the femoral head was a significant risk factor for fair or poor clinical outcome (P = 0.001). It is not reasonable to wait for radiological visibility of the ossific nucleus to prevent femoral head AVN before applying closed reduction and spica cast, irrespective of the age interval.

Effects of developmental dysplasia of the hip screening program on the treatment strategies: A retrospective study from a tertiary care hospital in the southeast region of Turkey

OBJECTIVE

The aim of this study was to investigate the effects of the developmental dysplasia of the hip screening program on the treatment procedures in a tertiary health care center.

METHODS

We retrospectively reviewed all the DDH patients between 2012 and 2019 from the operating theatre records. The patients were separated based on the year of treatment. The rates of each treatment modality were determined respectively from 2012 to 2019, and Pavlik harness usage of the patients were queried. The changes in the rates of several surgical interventions after the start of screening program were identified.

RESULTS

Between 2012 and 2019, 831 interventions were applied to 711 DDH patients. Closed Reduction (CR) is the least invasive treatment method, and it increased significantly from 20% to 46%. The rate of Open Reductions (OR) also increased from 3% to 9% at this time period, but it was statistically insignificant. Conversely, Pemberton-Salter Osteotomy (PSO) and Dega-Chiari Osteotomy (DCO) rates decreased significantly (41% to 28% and 9% to 0%, respectively). The rate of Pemberton- Salter osteotomy with femoral shortening (PSO-FS) rate decreased insignificantly from 27% to 20%. In patients that used Pavlik harness, the most common intervention was CR (83%). In CR group, the screened newborn rate increased more than two times from 2012 to 2019.

CONCLUSION

The results of this study have shown that after the initiation of the screening program for DDH, less invasive treatment modalities such as CR and OR interventions increased, and major bony procedures such as PSO, PSO-FS and DCO interventions decreased. Furthermore, as the screening program advanced, CR rate and the use of Pavlik harness rate in CR interventions increased.

LEVEL OF EVIDENCE

Level IV, Therapeutic Study.

Patellar Fixation With Suspensory Fixation Device in Single-Tunnel Medial Patellofemoral Ligament Reconstruction

The medial patellofemoral ligament (MPFL) is the primary soft-tissue stabilizer of the patellofemoral joint. Among the patellofemoral instability surgery options, MPFL reconstruction is the most preferred soft-tissue procedure. There is no gold-standard surgical treatment method in MPFL reconstruction, and many surgical methods have been described. We describe our surgical technique for MPFL reconstruction wherein the semitendinosus autograft is fixed to a single tunnel opened in the patella with a suspensory fixation device and only a single interference screw on the femoral side.

Investigation of sensory nerve endings in pulvinar, ligamentum teres, and hip joint capsule: A prospective immunohistochemical study of 36 cases with developmental hip dysplasia

OBJECTIVE

The aim of this study was to immunohistochemically identify and characterize the presence of sensory nerve endings (SNEs) in pulvinar, ligamentum teres (LT), and hip joint capsule (HJC) of children with developmental dysplasia of the hip (DDH).

METHODS

Pulvinar, LT, and HJC specimens were obtained from 38 hips of 36 children (31 girls, five boys; mean age=49 months; age range=18-132 months) during open reduction surgery for DDH. All specimens underwent subsequent routine tissue processing (formalin fixation and paraffin embedding). To determine tissue morphology, haematoxylin and eosin staining was used. SNEs were analyzed immunohistochemically using a mouse monoclonal antibody against S-100 Beta Protein based on the classification of Freeman and Wyke including four types of SNEs including mechanoreceptors: type I Ruffini corpuscles, type II Pacini corpuscles, type III Golgi organs, and type IVa unmyelinated free nerve endings (FNEs). Additionally, children were sorted into three groups based on their age at the time of surgery: Group 1 (age <3 years; 19 hips of 18), Group 2 (age: 3-5 years; 10 hips of 10 children), and Group 3 (age >5 years; 9 hips of 8 children).

RESULTS

Although no Type I, II, or III SNEs were identified in any specimen, type IVa mechanoreceptor (FNEs) was immunohistochemically characterized in 13 (34%) pulvinar, 19 (50%) LT, and 16 (42%) HJC specimens. The total density of FNEs was 3.31±5.70)/50 mm2 (range 0-21) in pulvinar specimens, 3.18 ± 5.92)/50 mm2 (range 0-24) in HJC specimens, and 4.51±6.61/50 mm2 (range 0-22) in LT specimens. Furthermore, the operated side, gender, and the number of FNEs in specimens did not differ significantly among the age groups (p>0.05 for all), and the number of FNEs was not significantly correlated with age, gender, or the operated side (p>0.05 for all).

CONCLUSION

Evidence from this study revealed that pulvinar, LT, and HJC include only FNEs, which play a role in pain sensation, among mechanoreceptors. Surgical excision of these tissues may not cause a significant loss of sensory function in the hip joint of children with DDH.

LEVEL OF EVIDENCE

Level II, Therapeutic Study.

Comparison of efficacy between combined periarticular and incisional injections versus periarticular injection alone of bupivacaine for pain control after total knee arthroplasty: A prospective randomized controlled trial

OBJECTIVE

The aim of this study was to compare the efficacy of combined periarticular and incisional injections versus periarticular injection alone of bupivacaine in reducing post-operative pain after total knee arthroplasty (TKA).

METHODS

In this prospective, randomized, double-blind comparative study, 90 patients with primary osteoarthritis who underwent TKA were enrolled. The patients were then randomly divided into 3 groups (30 in each): group 1, without injection; group 2, with periarticular injection of 20 mL 0.5% bupivacaine hydrogen chloride (HCl) (100 mg) after implantation; and group 3, periarticular injection of 20 mL 0.5% bupivacaine HCl (100 mg) after implantation and incisional injection of 10 mL 0.5% bupivacaine HCl (50 mg) before wound closure. Post-operative pain levels were measured using a 100-mm visual analogue scale (VAS) (0 mm: no pain and 100 mm: worst pain) at 30 min and 1, 2, 4, and 6 h, post-operatively.

RESULTS

The mean VAS score in group 3 (the combined group-periarticular and incisional injections) within the first 4 h was lower than that in group 1 and group 2 (p<0.001). The mean VAS scores at the first 30 min were 65.21±9.46 in group 1, 51.86±5.96 in group 2, and 29.33±8.55 in group 3 (p<0.001). The mean VAS scores at the first 1 h were 64.43±9.32 in group 1, 47.26±4.77 in group 2, and 31.66±7.37 in group 3 (p<0.001). The mean scores at the 2 h were 61.46±8.62 in group 1, 48.33±4.66 in group 2, and 30.83±6.76 in group 3 (p<0.001). The mean scores at the 4 h were 64.72±8.91 in group 1, 47.53±4.35 in group 2, and 34.36±6.64 in group 3 (p<0.001). The differences were not significant at 6 h between group 2 (44.91±4.12) and group 3 (41.83±6.71) (p>0.001). However, the values were significantly lower than those of the control group (63.56±9.73) (p<0.001). In addition, VAS scores at all follow-up times were significantly higher in the control group compared with the other groups (p<0.001).

CONCLUSION

Evidence from this study revealed that the combined injection of bupivacaine is more effective than its periarticular injection alone and provides effective post-operative pain management after TKA.

LEVEL OF EVIDENCE

Level I, Therapeutic study.

The effect of 2 different surgical methods on intracompartmental pressure value in tibial shaft fracture: An experimental study in a rabbit model

BACKGROUND

Intracompartmental pressure (ICP) monitoring is a widely used modality, particularly after intramedullary nailing of tibial shaft fractures. It was hypothesized that ICP value in fracture fixed with Ilizarov circular fixator (ICF) might be lower than in fracture fixed with intramedullary pin (IMP). The present study is a comparison of ICP value in tibial fractures in a rabbit model fixed with ICF and IMP.

METHODS

Twenty male New Zealand White rabbits were randomly divided into 2 groups of equal size: ICF group (Group 1) and IMP group (Group 2). Under anesthesia, half of proximal part of the right tibia of all rabbits was fractured. Tibial fractures were fixed with ICF in Group 1 and IMP in Group 2. ICP values were monitored at 6-hour intervals for 48 hours.

RESULTS

There was statistically significant difference in ICP value between groups (p<0.001). While there was statistically significant increase in ICP values 24 hours post surgery, there was statistically significant decrease during second 24 hours following surgery. Most importantly, ICP values of ICF group were significantly lower than those of IMP group at 30, 36, and 42 hours post surgery (p<0.05).

CONCLUSION

At 24th hour after fixation, ICP values measured in ICF group were lower compared with those of IMP group. These results indicate that use of ICF in tibial fractures provides additional decompression in the anterior compartment. In light of these findings, ICF may be preferable for treatment of tibial fractures with high risk for compartment syndrome.

Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?

PURPOSE

A local injection of corticosteroid-lidocaine into the periarticular soft tissue structures is used commonly for rapid pain relief. It is hypothesized that knee pain associated with knee osteoarthritis would be relieved quickly and effectively in patients receiving intraarticular hyaluronic acid combined with a periarticular lidocaine-corticosteroid injection. To test this hypothesis, the clinical effect of the combined treatment with hyaluronic acid injection alone in patients with symptomatic knee osteoarthritis as compared in this prospective single-blinded randomized trial.

METHODS

This study included 70 patients. Group 1 (n = 35) received intraarticular hyaluronic acid injections only, whereas group 2 (n = 35) received intraarticular hyaluronic acid injections combined with a single local injection of corticosteroid-lidocaine. Injections were administered to the most painful areas of the anterior or posterior medial condyle of the femur or tibia. The outcome was measured by independent assessors (blinded to treatment) using a linear VAS pain scale and WOMAC and HSS knee scores. Assessments were performed at baseline and at 1, 3, 6, 12, 26, and 52 weeks.

RESULTS

During the first 3 weeks, group 2 patients showed significantly better all scores than did group 1 patients (p < 0.01). However, no significant differences were detected at 6, 12, 26 or 52 weeks (n.s.).

CONCLUSION

The combined treatment may lead to earlier pain relief compared with intraarticular hyaluronic acid alone in patients with knee osteoarthritis and can be considered a useful adjunctive treatment modality. This combined method may provide early return to patient's daily activity.

LEVEL OF EVIDENCE

Therapeutic study, Level I.

Serum prolidase activity and oxidative-antioxidative status in patients with developmental dysplasia of the hip and its relationship with radiographic severity

BACKGROUND

We aimed to investigate serum prolidase activity and to investigate its association with oxidative-antioxidative status in patients with developmental dysplasia of the hip (DDH).

METHODS

Oxidative status parameters, including lipid hydroperoxide (LOOH), total oxidant status (TOS), and the oxidative stress index (OSI), and antioxidative status parameters, free sulfhydryl groups (Total -SH), and total antioxidative capacity (TAC), as well as serum prolidase activity were assessed in patients with DDH (n = 93), and in healthy controls (n = 82). The severity of dysplasia was evaluated according to the Tonnis grading system.

RESULTS

Serum prolidase activity and the oxidant parameters (LOOH, TOS, and OSI) were significantly higher and the antioxidant parameters (Total -SH and TAC) were significantly lower in patients with DDH compared to the controls (P < 0.005 for all). Serum prolidase activity was positively correlated with the Tonnis grade of DDH and LOOH, TOS, and OSI levels (P < 0.001 for all), but inversely correlated with total -SH and TAC levels (P < 0.001 for all).

CONCLUSION

Increased levels of serum prolidase activity, LOOH, TOS, and OSI, and decreased levels of total -SH and TAC, may be associated with DDH, and these parameters may be useful adjunctive tools to assess the severity of DDH.

The body composition of patients with knee osteoarthritis: relationship with clinical parameters and radiographic severity

BACKGROUND AND AIMS

We investigated body composition in knee osteoarthritis (OA) patients and evaluated its relationship with clinical parameters and radiographic severity.

METHODS

Sixty-four patients with knee OA (52 females and 12 males with a mean age of 57.7 ± 8.6 years) and thirty healthy volunteers (20 females and 10 males with a mean age of 56.3 ± 9.5 years) were evaluated. Controls were selected among similar to demographic and hematologic characteristics of patients. Body compositions were assessed via bioelectrical impedance analysis (BIA). Each patient was clinically evaluated by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). In addition, radiographic severity was classified according to Kellgren-Lawrence's criteria.

RESULTS

Phase angle, body capacitance, resistance, reactance, lean body mass, and intracellular water values of the patients with knee OA were found to be significantly lower than those of the controls (p < 0.05). Furthermore, fat mass and extracellular water levels were significantly higher in the patients compared to the controls (p < 0.05). Lean body mass was inversely correlated with WOMAC score (r = -0.716, p < 0.001), whereas fat mass was moderately correlated with WOMAC score (r = 0.281, p < 0.05) in bivariate analysis. However, with respect to the body composition, there was no significant difference between early grades and late grades in the knee OA with patients (p > 0.05).

CONCLUSION

Body composition assessed using BIA might be associated with knee OA, and be a noninvasive tool for diagnosis of knee OA. However, body composition may not be predictive of the progression of knee OA.

Bipolar dislocation of the forearm (floating forearm)

Bipolar dislocation of the forearm (floating forearm) is an unusual injury and is therefore often overlooked. We report a 28-year-old male patient who presented at another center with a history of a fall while climbing a tree. The patient's left elbow was treated with closed reduction and immobilization with a long-arm cast brace due to elbow dislocation. However, the patient was admitted with pain and swelling of the wrist to our emergency department the following day. Physical and radiological examination revealed dorsal trans-scaphoid perilunate dislocation. A dorsal incision was performed for open reduction and internal fixation to provide wide surgical exposure. Concomitant occurrence of elbow dislocation and fracture-dislocation of the perilunate is infrequent. Therefore, physicians should be aware of possible additional injuries and current recommended treatment methods.

Primer hydatid cyst of the deltoid muscle

A primary intramuscular hydatid cyst should be considered for the differential diagnosis of cystic soft tissue masses especially in endemic areas, although primary muscular hydatidosis is a rare clinical entity. A case of a 48-year-old male patient with a primary intramuscular hydatid cyst located in the deltoid muscle is reported.

Do additional intramedullary elastic nails improve the results of definitive treatment with external fixation of open tibia fractures? A prospective comparative study

PURPOSE

External fixation has been associated with a high incidence of complications and poor outcomes due to the instability and difficulty in treating open tibia fractures. We use intramedullary (IM) elastic nails to supplement the external fixator. We compared the results of fractures treated by external fixation with and without IM-elastic nail.

HYPOTHESIS

The combination of external fixation with IM-elastic nails may be used as an alternative to solve problems due to the external fixators alone in open tibia fractures.

METHODS

Group 1 included prospectively 26 cases (15 males and 11 females, mean age 37.5 ± 12.4 years) treated with external fixation and IM-elastic nails, whereas group 2 consisted of 28 cases (23 males and five females, mean age 30.7 ± 14.0 years) treated with standard external fixation. Functional and bone results were made using the criteria proposed by ASAMI.

RESULTS

The mean follow-up period was 3.96 ± 2.0 years in group 1 and 3.32 ± 2.1 years in group 2. The mean duration to external fixation and mean time to union were significantly lower in group 1 (P<0.001). In addition, bone and functional results were significantly higher in group 1 (P<0.01), however, pin track infections were lower in group 1 (P<0.01).

CONCLUSION

Our results showed the improvement in outcomes with IM-elastic nails: decreased duration of external fixation need and decreased bone healing delay. Therefore, this method may be a superior alternative for preventing complications related to external fixation in open tibia fractures.

LEVEL OF EVIDENCE

Level III: prospective comparative study.

The effect of extracorporeal shockwaves on cartilage end-plates in rabbits: a preliminary MRI and histopathological study

OBJECTIVE

The aim of this study was to examine the changes in the lumbar intervertebral area after extracorporeal shockwave therapy (ESWT) at different energy levels in a rabbit model using magnetic resonance imaging (MRI) and histopathological evaluation.

METHODS

The study included 30 male New Zealand white rabbits divided randomly into five groups: Groups A and C received 1,000 shockwave impulses at an intensity of 14 kV, Groups B and D received 1,000 impulses at 21 kV, and Group E was a sham group. Side effects such as subcutaneous and paravertebral soft-tissue injuries were evaluated using MRI one day after ESWT administration. Neovascularization, edema and fibroblast activity in the intervertebral area were evaluated histopathologically.

RESULTS

No change was observed in any group on MRI. Histopathologically, Groups A and C showed no change, whereas Groups B and D showed edema, fibroblast activity and significant neovascularization at the intervertebral end-plate (p<0.05).

CONCLUSION

Our findings indicate that ESWT caused dose-dependent changes in the intervertebral end-plate. This study constitutes a preliminary evaluation of shockwave therapy to the intervertebral area in an animal model. High-dose ESWT may stimulate angiogenesis at cartilage end-plates in rabbits.

Mitchell's osteotomy with mini-plate and screw fixation for hallux valgus

BACKGROUND

The aim of this study was to evaluate the use of mini-plate and screw fixation to stabilize the first metatarsal osteotomy in patients undergoing Mitchell bunionectomy, with the outcomes of interest being radiological alignment and the time to bony union.

METHODS

We used mini-plates and screws in 43 feet of 25 patients to avoid cast immobilization and prevent osteotomy displacement. The mean age at operation was 45.4 ± 13.4 years (range, 17.0-65.0 years). The mean follow-up was 16.9 ± 3.6 months (range, 12.0-30.0 months). The hallux valgus angles, intermetatarsal angles, and American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores were evaluated preoperatively and at postoperative month 12.

RESULTS

The mean preoperative value for the hallux valgus angle was 35.9 ± 4.4 degrees (range, 26.0-45.0 degrees) and for the intermetatarsal angle was 12.1 ± 1.4 degrees (range, 10.0-15.0 degrees). The mean postoperative value for the hallux valgus angle was 16.0 ± 2.12 degrees (range, 12.0-20.0 degrees) and for the intermetatarsal angle was 7.7 ± 1.2 degrees (range, 5.0-10.0 degrees). The mean AOFAS score was 50.5 ± 12.8 points (range, 30.1-76.0 points) preoperatively and 75.9 ± 11.3 points (range, 43.3-92.3 points) at postoperative month 12. Improvement of range of motion of the metatarsophalangeal joint, pain relief, and satisfactory alignment of the first ray were achieved in 41 feet (95.3%).

CONCLUSIONS

We recommend this fixation for Mitchell's bunionectomy because it provided stable fixation without the need for casting.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study

BACKGROUND

Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years.

HYPOTHESIS

Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing.

PATIENTS AND METHODS

Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain.

RESULTS

Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group.

DISCUSSION

Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing.

LEVEL OF EVIDENCE

Level II: low-powered prospective randomized trial.

Bioelectrical impedance analysis of basal metabolic rate and body composition of patients with femoral neck fractures versus controls

OBJECTIVES

In this study, we aimed to compare basal metabolic rate and body composition in patients with femoral neck fractures and controls.

PATIENTS AND METHODS

Sixty-eight consecutive patients with femoral neck fractures (36 males, 32 females; mean age 73.9 ± 7.1 years, range 65 to 93 years) and 71 controls (33 males 38 females; mean age 72.1 ± 5.9 years; range 65 to 90 years) were prospectively analyzed. The controls were matched with the patients in terms of sex, age, and body mass index. The findings were assessed by bioelectrical impedance analysis (BIA).

RESULTS

The phase angle, body capacitance, resistance, reactance, body cell mass, lean body mass, basal metabolic rate, and intracellular water values of the patients were found to be significantly lower, compared to the controls. Extracellular mass, fat mass, extracellular mass/body cell mass and extracellular water levels were significantly higher in the patients, compared to the controls. There was no significant difference between the patient and control group in terms of the total body weight/lean body mass ratio.

CONCLUSION

Although it is not clear whether these physiological changes are an exact cause of a predisposition for simple falls, the assessment of basal metabolic rate and body composition by BIA may be a useful adjunctive tool for the evaluation of physiological changes in the routine health screening of elderly people.

De Quervain's disease treatment using partial resection of the extensor retinaculum: A short-term results survey

BACKGROUND

Several operative methods have been described for de Quervain's disease, but no definite consensus has emerged in the literature. Sometimes simple release of the extensor retinaculum can cause incomplete relief, whereas re-adhesion and excessive excision of the extensor retinaculum can cause volar subluxation of the abductor pollicis longus and extensor pollicis brevis tendons. In this prospective study, we evaluated the early results of operative treatment with one-quarter partial resection of the extensor retinaculum when conservative methods have failed.

HYPOTHESIS

We hypothesized that partial removal of the extensor retinaculum may be used as an alternative to solve problems such as incomplete release or re-adhesion and volar subluxation of the tendons.

PATIENTS AND METHODS

Thirty-four patients (36 hands; 30 females and four males; mean age: 48.2 years; range: 20 to 75 years) with de Quervain's disease were surgically treated. The surgical procedure was performed under local infiltration anesthesia. One-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist was performed. During the clinical follow-up period, treatment results, a patient-based scoring system and visual analogue scale were used. The mean follow-up duration was 23.7 months (range: 12 to 71 months).

RESULTS

Two patients with wound infections were treated with adapted antibiotics. All patients were relieved of their symptoms; no triggering, recurrence or volar subluxation of the tendons of abductor pollicis longus or extensor pollicis brevis occurred. With this partial resection technique and according to a treatment scoring system described by Sawaizumi et al., 23 hands had excellent results, 11 hands had good results, and two hands had fair results; no hand exhibited a poor result. The mean visual analogue scale score was 1.8 (range: 0-6).

DISCUSSION

Our results showed that one-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist can be safely used for the operative treatment of de Quervain's disease with satisfactory short-term clinical results and no serious complications.

LEVEL OF EVIDENCE

Level IV: low-power prospective study.

The use of Ender nail in intertrochanteric fractures supported with external fixation

BACKGROUND

Intramedullary Ender nailing in intertrochanteric fractures was very popular in the past. However, this method has fallen in favor over time, due to complications. The purpose of this study was to evaluate results with this method and possible ways to prevent these complications, including the use of unilateral fixators to support the Ender nails.

METHODS

This technique (Ender nailing and external fixator) was used in 39 patients (17 M/22 F, mean age: 71.4 years). The preoperative mean American Society of Anesthesiologists (ASA) score was 1.84 (range: 1-4) for all the patients. AO/OTA classification of fractures was used. In our surgery, we used an external fixator to support the intramedullary nails. All patients were evaluated with Parker-Palmer mobility score and with the Harris hip score.

RESULTS

The follow-up period was 29.2 months (20-56). Two patients experienced nail migration in the knees, two patients had varus deformation with a reduction in length of 2 cm, and seven patients developed pin-track infection. The average Harris score and Parker-Palmer score of the 14 patients who presented for their last follow-up examination were 64 and 6.8, respectively.

CONCLUSION

This method demonstrated several advantages, in that it allows the patient to put weight on the extremity after a shorter period of time and enables the fracture to heal rapidly without any serious complications.

One-stage treatment of developmental dysplasia of the hip in untreated children from two to five years old. A comparative study

A total of 38 children (49 hips) were retrospectively investigated to assess the efficacy and safety of one-stage treatment of developmental dysplasia of the hip (DDH) in untreated children from two to five years of age. Our method consisted of open reduction, Salter innominate osteotomy, femoral shortening and derotation osteotomy. The patients were distributed into two groups according to the age at which they were operated: Group I included 19 patients aged < 3 years (24 hips) and Group II included 19 patients aged > or = 3 years (25 hips). Mean follow-up was 5.08 years for Group I and 5.76 years for group II. Clinical and radiological assessment at final followup showed that the outcome was not significantly different between the two groups. Furthermore, after this follow-up period, the rates of avascular necrosis were similar. Children with DDH between two and five years of age were treated successfully with one-stage treatment.

Mini-open versus closed reduction in titanium elastic nailing of paediatric femoral shaft fractures: a comparative study

The purpose of this study is to compare retrospectively intraoperative fluoroscopy time and clinical-radiological results in pediatric femoral shaft fractures treated with titanium elastic nailing (TEN), with a mini-open "blind-hand" technique versus closed reduction. The study included 87 children (18 girls and 69 boys) who underwent surgical treatment with TEN for femoral shaft fractures. Patients were divided into two groups. Group 1 included 42 patients (mean age : 83 +/- 2.7 years) treated with a mini-open "blind-ha nd" technique (a 2-3 cm lateral incision at the level of the fracture ; reduction achieved with one or two fingers, without visualization of the fracture). Group 2 consisted of 45 patients (mean age: 8.8 +/- 2.6 years) treated with a closed reduction technique. Duration of surgery and intraoperative fluoroscopy time were recorded in both groups. Clinical and radiologic results were assessed using the TEN scoring system after mean follow-up periods of 213 +/- 5.8 months and 193 +/- 5.6 months in group 1 and group 2, respectively. Mean duration of surgery was 31.7 +/- 7.6 and 52.1 +/- 14.4 minutes, and mean fluoroscopy time 32.9 +/- 22.1 and 75.1 +/- 31.5 seconds in group 1 and group 2, respectively. Both surgical and fluoroscopy time were significantly longer in group 2 (p < 0.001). There was no significant difference between the two groups in terms of clinical and radiological results. All fractures healed with solid union, and there was no complication that was expected to cause permanent disability. Although successful clinical and radiological results were obtained with both techniques, duration of surgery and intraoperative fluoroscopy time were significantly higher in the closed reduction group 2. We suggest the "blind-hand" technique as an alternative to closed reduction to prevent extensive intraoperative radiation exposure and to decrease the length of the surgical procedure.

[Bipolar hemiarthroplasty for the treatment of femoral neck fractures and the effect of surgical approach on functional results]

OBJECTIVES

This study aimed to evaluate the effect of an anterior versus posterior surgical approach for bipolar hemiarthroplasty on postoperative functional results of patients treated for femoral neck fractures.

PATIENTS AND METHODS

Among the 196 patients over the age of 65 treated with cemented bipolar prosthesis for femoral neck fracture in our clinic between May 2000 and November 2008, 76 patients who followed up for at least one-year were retrospectively evaluated. The average follow-up period was 18.7 months (range 12 to 40 months). All fractures were Garden's type III or IV. The patients were divided into two groups according the surgical approach: posterior in 52 patients (Group 1; 25 males, 27 females; mean age 73.8 years; range 65 to 88 years) and anterior in 24 patients (Group 2; 14 males, 10 females; mean age 71.4 years; range 67 to 94 years). Cement was applied by hand in 62 cases and with a cement gun in 14 cases.

RESULTS

Mean Harris scores were 84.7±10.3 in group 1 and 85.8±7.1 in group 2. According to the Harris scoring system, the results were very good in 26 cases; good in 40 cases; fair in six cases; and poor in four cases. While early dislocation was observed in 9.6% of patients with the posterior approach, it was not observed in any patients treated with the anterior approach. There was no significant difference with regard to functional scores or early dislocations between group 1 compared to group 2 (p>0.05).

CONCLUSION

Based on our results, bipolar prothesis is an appropriate and effective treatment option for patients with femoral neck fracture to obtain early return to daily activity. The surgical approach does not affect the functional results. Although not statistically significant, it was concluded that the anterior approach is more reliable for early dislocation.