The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities

Aim: To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame) in patients with lower extremity shortness and deformity.

Materials and methods: The study comprised 17 patients (14 male, 3 female) who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure’s level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes.

Results: The mean age of the patients was 24.58 years (range, 5–51 years). The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6–31 months) from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1–6 cm). The mean duration of fixator application was 202.7 days (range, 104–300 days). The mean External Fixator Index was 98 days/cm (range, 42–265 days/cm). The mean Distraction Index was 10.49 days/cm (range, 10–14 days/cm).

Conclusion: The computer-assisted external fixator system (spider frame) achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity.

Comparison of two different measurement methods to determine glenoid bone defects: area or width?

BACKGROUND

This study compared two different techniques that have been used to measure the glenoids of patients with recurrent anterior shoulder dislocation.

METHODS

We analyzed 36 patients who had received arthroscopic Bankart repair for anterior shoulder instability. Retrospectively, 3-dimensional computed tomography images of both shoulders were available for these patients. Two measurement methods were compared to determine the glenoid defects. One of these techniques is based on linear measurement, previously defined as the glenoid index. The other method is based on surface area measurement. Subsequently, 3 more diameters and the average values obtained from these diameters were compared with the surface measurement method. Pearson correlation coefficient (r) was assessed to determine the relationship.

RESULTS

There was an almost perfect relationship between measurement methods when the defect area was less than 6% of the inferior glenoid circle (r, 0.915; P < .001). This relation decreased and the difference became more pronounced (r, 0.343; P = .657) when the bone loss exceeded 14% of the inferior glenoid circle. The highest correlations with the actual defects were the average values obtained from 4 different diameters (r, 0.964; P < .001) and the 4-o'clock position of the single diameter measurements (r, 0.860; P = .001). In addition, 11 patients had crescent-like defects, demonstrating a relatively low correlation between the measurement methods (r, 0.679; P = .021).

CONCLUSION

Although the best correlation was achieved from average values obtained from different diameter positions, in practical use, we advise a linear measurement to estimate the glenoid bone loss at the 4-o'clock position to achieve a high correlation between the measurement techniques.

Synergistic Effect of TGF-β1 And BMP-7 on Chondrogenesis and Extracellular Matrix Synthesis: An In Vitro Study

Introduction:

The purpose of the present study seeks to determine the signal timing of BMP–7 and TGF-β1 from a novel chitosan based hydrogel system that may affect chondrocyte proliferation resulting in the presence of a synergism seen conspicuously in consecutive controlled delivery.

Methods:

Four groups of cultured chondrocytes were seeded on a novel designed chitosan based hydrogel. The hydrogel was left empty (control) in one group and loaded with BMP–7, TGF-β1 and their combination in the other groups, respectively. Hydrogel structure was analyzed with scanning electron microscope. The release kinetics of Growth Factors (GFs) was determined with ELISA. Chondrocyte viability and toxicity after being tested with MTS and collagen type II synthesis, were quantified with western blotting. Canonical regression analysis was used for measuring statistical evaluation.

Results:

Chitosan based hydrogel allowed controlled release of GFs in different time intervals for BMP–7 and TGF-β1. Double peak concentration gradient was found to be present in the group loaded with both GFs. In this group, substantially higher chondrocyte growth and collagen synthesis were also detected.

Conclusions:

We concluded that, chitosan based hydrogel systems may be adjusted to release GFs consecutively during biodegradation at the layers of surface, which may increase the cell number and enhance collagen type II synthesis.

Relationship between the size of bone marrow edema of the talus and ankle pain

BACKGROUND

We sought to determine the changes in the size of the edema observed on MRI scans and its relation to the patient's pain during activity and pain during rest in bone marrow edema.

METHODS

A total of 26 patients were followed up at 3-month intervals for a period of 1 year. During the follow-ups, magnetic resonance imaging scans of the patients' ankles were obtained; the scores obtained on the American Orthopaedic Foot and Ankle Society functional rating scale and visual analog scale were determined. The changes in these parameters and the correlation between them were examined.

RESULTS

The size of the edema as observed on magnetic resonance imaging scans decreased, and the pain during activity and rest decreased. Although there is a correlation between the decrease in the edema size observed on magnetic resonance imaging scans and decrease in the pain during activity, there is no correlation between the decrease in the edema size observed on magnetic resonance imaging scans and the decrease in pain during rest.

CONCLUSIONS

Patients can be informed more precisely, that the pain during rest and activity may not decrease after the third and sixth month, respectively. Magnetic resonance imaging may not alter after the ninth month, so it may not be necessary to be performed again.

The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis

BACKGROUND

An accepted comprehensive clinical approach to the deformed spine with tuberculous infection is still lacking. We aimed to determine the usage of a staged algorithm in the treatment of kyphotic spine with tuberculous infection and to present the clinical results of the patients treated with the help of this protocol.

MATERIALS AND METHODS

54 patients (28 females, 26 males) with a mean age of 39.2 (22-76) years. Preoperative, early postoperative, and followup clinical and radiologic results were evaluated retrospectively. The patients were classified into Kaplan A (kyphotic deformity <30°), Kaplan B (kyphotic deformity 30°-60°) and Kaplan C (kyphotic deformity >60°). They were operated by posterior instrument with anterior debridment (Kaplan A), debridment with anterior bone grafting (Kaplan B) and anterior column resection and bone grafting in Kaplan C.

RESULTS

Tuberculous involvement were seen at more than one level in 40 patients and paraspinal abscess were detected in 31. Preoperative focal kyphotic deformity was reconstructed with an average of 19 (9-38) degrees. Twenty-six patients had neurologic compromise with different severities and 12 of them improved after the surgical intervention. Improvement in work ability and pain status was detected in 52% and 61% of the patients, respectively. Wound complications responding to medical care were detected in nine patients. Initial kyphotic deformity was found as an important parameter in selecting the surgical procedure.

CONCLUSION

Regarding resected amount of infected osseous material, as planned preoperatively, have resulted with better concordance between anterior and posterior column heights and better sagittal alignment. We could correct kyphosis and improve sagittal balance with staged algorithm as used by us.

The efficacy of magnetic resonance imaging and x-ray in the evaluation of response to radiosynovectomy in patients with hemophilic arthropathy

Objective: We aimed to assess the role of Magnetic Resonance Imaging (MRI) and X-Ray in the evaluation of response to radiosynovectomy (RS) in patients with hemophilic arthropathy.

Material and Methods: Eleven patients who suffered from hemophilic arthropathy with a mean age of 11.7 (range between 7-15) were included in this study. 148-185 MBq Yttrium 90 silicate (Y-90) was administered intraarticularly to ten knee joints and one patient was treated with intraarticular 74 MBq Rhenium 186 (Re-186) injection into his ankle. Before radiosynovectomy, plain anteroposterior and lateral X-rays of the target joints were obtained by standard technique. The follow-up MRI and X-ray studies of the patients were done 6 months after RS. Pettersson hemophilic arthropathy scales were utilized to stage the condition of the joints on plain X-ray and classification of the investigated joints on MRI were done according to Denver score. The clinical assessment of the efficacy of the RS was made with the comparison of the average bleedings before and after the intervention.

Results: During the 6-month follow-up period after RS, an improvement in number of hemarthrosis 75% or greater compared with the prior six months occurred in six joints (54.5%). The Pettersson scores worsened in 1/11 (9%), remained unchanged in 9/11 (81.8%), and improved in 1/11 (9%) joints. At the 6-month follow-up, the MRI score worsened in one (9%) and was unchanged in 10/11 joints (90.9%).

Conclusion: MRI is a more sensitive tool than plain radiography for evaluating and follow-up of joint disease in persons with hemophilia, but both methods don’t show correlation with the therapeutic response

Conflict of interest:None declared.

Giant cell tumor of second and third metatarsals and a simplified surgical technique: report of two cases

Giant cell tumor (GCT) is a rare benign tumor that often arises in tendon sheath as well as long bones of the lower extremity in adults, although localization in the metatarsus is rare. In this report, the authors describe the rare case of GCT localized to the third metatarsal GCT in a skeletally mature 17-year-old girl, and also describe the results of distal metatarsal resection with Kirschner wire stabilization for the treatment of this condition.

[Crescentic distal metatarsal osteotomy for the treatment of hallux valgus: a prospective, randomized, controlled study of two different fixation methods]

OBJECTIVES

This study was designed to draw attention to a distal metatarsal osteotomy technique, which has been somewhat overlooked for the treatment of hallux valgus, and to compare the clinical and radiographic results of two different fixation methods.

METHODS

The study included 16 feet of 13 patients (11 women, 2 men) who were treated with crescentic distal metatarsal osteotomy for mild-to-moderate hallux valgus (<35 degrees ). The patients were randomized to two fixation methods with two cross K-wires (group 1; 7 patients, 8 feet) and a compressive screw (group 2; 6 patients, 8 feet). The results were evaluated using the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating scale for hallux, and a visual analog scale for pain. Radiographic measurements included the hallux valgus angle (HVA), first/second intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), before and 12 months after surgery.

RESULTS

There were no significant differences between the two groups with regard to pre- and postoperative AOFAS scores and pain scores, which showed significant improvements in both groups at the end of one-year follow-up (p<0.001). The HVA and IMA significantly decreased from 32 degrees to 19 degrees and from 12 degrees to 6 degrees in group 1, and from 30 degrees to 17 degrees and from 12 degrees to 8 degrees in group 2, respectively (p<0.001). A similar improvement was also seen in the DMAA (p<0.001). Postoperative radiographic improvements were similar in both groups. One patient in group 1 underwent revision surgery with the same technique due to recurrence, and one patient in group 2 had delayed union.

CONCLUSION

Crescentic distal metatarsal osteotomy may be an appropriate technique in the treatment of mild-to-moderate hallux valgus.

Is there any correlation between the preoperative parameters and correction loss in patients operated for hyperkyphosis?

OBJECTIVES

Preoperative, postoperative, and latest follow-up data of sagittal balance and spinopelvic parameters of our patients treated surgically for hyperkyphosis were evaluated retrospectively, to determine whether there is any correlation between the preoperative pelvic incidence and postoperative correction loss.

METHODS

Totally 33 patients (18 females) who were operated for hyperkyphosis and, were reached at the latest follow-up were included in the study. Age at operation, gender, date of operation, etiology and level of the deformities, instrumentation, and graft types were noted in detail. The kyphosis angles were measured by the Cobb method. The preoperative and postoperative spinopelvic parameters (pelvic incidence, sacral slope, and pelvic tilt) were recorded.

RESULTS

The average follow-up was 4 years (range 3-8 years). The mean age at operation was 21 years (range 14-40 years). Scheuermann kyphosis was diagnosed as the etiological factor in 18 patients (53%). The mean preoperative kyphosis angle was 76° (range 55-98°), which decreased postoperatively to 38° (range 20-55°) (p<0.05). The mean kyphosis angle two years postoperatively was 41° (p>0.05). Preoperative and latest follow-up spinopelvic parameters were also not significantly different. Furthermore, no correlation could be found between the age at operation, instrumentation level, spinopelvic parameters, and correction loss.

CONCLUSION

There is no correlation between the preoperative pelvic incidence and postoperative correction loss in patients treated surgically for hyperkyphosis. Further studies with larger sample size and longer follow-up should be conducted.

[Long-term results of conservative treatment for thoracolumbar compression fractures]

OBJECTIVES

We evaluated the radiologic and clinical outcomes of conservative treatment for thoracolumbar compression fractures.

METHODS

Forty-three patients (28 males, 15 females; mean age 39 years; range 24 to 54 years) were treated conservatively for 47 thoracolumbar compression fractures. All the patients were assessed by plain radiograms and computed tomography. According to the Denis classification, there were eight type A, 20 type B, 12 type C, and seven type D fractures. Involvement was at L1 in 30, L2 in five, and T12 in 12 fractures. There were no neurological deficits. Treatment involved use of a body cast for two months, followed by a thoracolumbosacral orthosis for four months. Radiographically, local kyphosis angle and sagittal index were measured before treatment, after casting, and at the final follow-ups. Pain and functional scales proposed by Denis et al. were also utilized. The mean follow-up was 7.5 years (range 6 to 11 years).

RESULTS

The mean local kyphosis angle and sagittal index were measured as 12.6 and 13.7 degrees before treatment, and 5.9 and 7.0 degrees after casting, respectively (p<0.05). However, both did not differ significantly from the baseline at the final measurements (12.7 and 13.9, respectively; p>0.05). The mean pain and functional scores were 1.4 and 1.6, respectively. Four patients had moderate to severe back pain despite mean kyphosis angles of 12 (baseline), 13.5 (after casting), and 14.8 (final). Two patients required substitution of the body cast for orthosis due to excessive sweating, and three patients received local treatment for skin problems secondary to the use of orthosis.

CONCLUSION

If the kyphosis angle is less than 30 degrees, compression fractures are supposed to be stable to be treated conservatively with satisfactory clinical results. Functional results seem to be unaffected from the fact that casting does not improve radiographic parameters in the long-term.

Distal first metatarsal dome (crescentic) osteotomy for repair of mild to moderate hallux valgus deformity

Hallux valgus is one of the most common foot deformities. Despite the large number of techniques described for hallux valgus correction, there has been much controversy regarding the best procedure to use. Distal osteotomies have long been done for mild to moderate deformities. Although presented previously, based on a review of the literature, this technique does not appear to be regularly used by many surgeons. This article presents a distal metatarsal osteotomy as easy to perform and useful for the repair of mild to moderate hallux valgus deformity, wherein the first metatarsal angle measures less than 14 degrees.

Thorax deformity, joint hypermobility, and anxiety disorders

OBJECTIVE

To evaluate the association between thorax deformities, panic disorder, and joint hypermobility

METHODS

The study includes 52 males diagnosed with thorax deformity, and 40 healthy male controls without thorax deformity, in Tatvan Bitlis and Isparta, Turkey. The study was carried out from 2004 to 2006. The teleradiographic and thoracic lateral images of the subjects were evaluated to obtain the Beighton scores; subjects' psychiatric conditions were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), and the Hamilton Anxiety Scale (HAM-A) was applied in order to determine the anxiety levels. Both the subjects and controls were compared in sociodemographic, anxiety levels, and joint mobility levels. In addition, males with joint hypermobility and thorax deformity were compared to the group with thorax deformity without joint hypermobility.

RESULTS

A significant difference in HAM-A scores was found between the groups with thorax deformity and without. In addition, 21 subjects with thorax deformity met the joint hypermobility criteria in the group with thorax deformity, and 7 subjects without thorax deformity met the joint hypermobility criteria in the group without thorax deformity, according to Beighton scoring. The Beighton scores of the subjects with thorax deformity were significantly different from those of the group without deformity. Additionally, anxiety scores of the males with thorax deformity and joint hypermobility were found higher than males with thorax deformity without joint hypermobility.

CONCLUSION

Anxiety disorders, particularly panic disorder, have a significantly higher distribution in male subjects with thorax deformity compared to the healthy control group. In addition, the anxiety level of males with thorax deformity and joint hypermobility is higher than males with thorax deformity without joint hypermobility.

[The results of curettage and bone cementing for enchondromas of the distal femur]

OBJECTIVES

We evaluated patients who were treated with curettage and cementing for enchondromas localized in the distal femur.

METHODS

The study included 13 patients (7 females, 6 males; mean age 54 years; range 43 to 65 years) who underwent surgery for enchondromatosis in the distal femur. Enchondromas were detected incidentally in 10 patients; of these, complaints of pain appeared afterwards in seven patients. Surgery involved curettage and cement filling of the defects. Preoperative biopsies were obtained in seven patients. Clinical evaluations were made with a visual analog scale. The mean follow-up period was four years (range 1 to 5 years).

RESULTS

Radiographically, the size of the lesions ranged from 3 cm to 6 cm (mean 4.5 cm). Computed tomography showed cortical extension in five patients and erosion leading to narrowing in the posterior cortex in one patient. The mean pain score decreased from 3.63 (range 0 to 7) to 0.54 (range 0 to 3) postoperatively (p<0.05). Histopathological diagnoses of surgical specimens were enchondroma in 12 patients and grade 1 chondrosarcoma in one patient. Postoperatively, only one patient who had erosion and narrowing in the posterior cortex required cast immobilization for three weeks. None of the patients had recurrence, sarcomatous changes, or infection. No functional loss developed after surgical treatment.

CONCLUSION

Treatment of femoral enchondromas with curettage and cementing yields successful functional and radiologic results.

Combined fibular and tarsal agenesis in a case of lower extremity hemimelia

Fibular hemimelia is a congenital disorder characterized by partial or total absence of the fibula. The appearance of the affected limb can range from barely detectable to severe deformity. An affected extremity typically displays a valgus foot and ankle, shortening of the leg, anterior bowing of the tibia and knee, tarsal coalition, as well as radiographic absence of 1 to several lateral rays (1, 2). We encountered an adult patient who displayed fibular agenesis in combination with absence of the ipsilateral talus and cuboid. Because of the rarity of this deformity, we believed that it was important to describe her case despite the fact that, after evaluation and discussion of treatment options, the decision was made to continue to accommodate the deformity with an orthosis.

[Arthroscopic rotator cuff repair: evaluation of outcomes and analysis of prognostic factors]

OBJECTIVES

The purpose of this study was to evaluate the results of arthroscopic rotator cuff repair of full-thickness tears and to determine prognostic factors.

METHODS

Forty-one shoulders of 40 patients (16 males, 24 females; mean age 56 years; range 39 to 72 years) unresponsive to conservative treatment were evaluated. The mean symptom duration was 15 months (range 2 to 24 months). Involvement was on the right in 34 shoulders, on the left in seven shoulders, 80% being on the dominant side. The range of motion was measured with a goniometer, muscle strength was measured manually. Clinical and functional evaluations were based on physical and radiological examinations, and the UCLA scale. The mean follow-up was 37 months (range 12 to 61 months). Prognostic factors included age, symptom duration, range of motion, muscle strength, tear size, retraction and quality of tendon, and fatty degenerative changes.

RESULTS

According to the UCLA scale, the results were satisfactory in 29 shoulders (70.7%), moderate in five (12.2%), and poor in seven (17.1%). Six shoulders (14.6%) required revision surgery. Postoperative improvements in forward flexion and muscle strength were significant (p<0.05), whereas change in external rotation was insignificant (p>0.05). Age, tear size, retraction and quality of tendon, and fatty degenerative changes were found to significantly affect unsatisfactory results (p<0.05). Preoperative symptom duration, range of motion, and muscle strength were not effective on the results (p>0.05).

CONCLUSION

Our results are not as successful as those obtained from open procedures. The results may be more satisfactory through improving arthroscopic skills and taking prognostic factors into consideration in patient selection.

[Arthroscopic treatment of anterior-inferior shoulder instability]

OBJECTIVES

We evaluated patients who underwent arthroscopic repair for posttraumatic, recurrent anterior-inferior glenohumeral instability with capsular laxity.

METHODS

Seventeen patients (4 females, 13 males; mean age 27 years; range 18 to 40 years) were treated with arthroscopic Bankart repair and posterior capsular plication for posttraumatic, recurrent anterior-inferior glenohumeral instability with capsular laxity. Involvement was on the right side in 11 patients, and on the left in six patients. The mean duration from the first dislocation to surgery was 5.2 years (range 1 to 11 years). All the patients received conservative treatment before surgery. Range of motion was measured with a goniometer and muscle strength was measured manually. Apprehension test, Jobe apprehension-relocation test, and posterior apprehension test were used to assess instability. Preoperatively, all the patients were examined by anteroposterior and axillary radiographs and magnetic resonance imaging. Shoulder functions were assessed with the Rowe rating scale for Bankart repairs. The mean follow-up was 35.6 months (range 24 to 50 months).

RESULTS

Instability recurred in three patients (17.7%). The Rowe score increased from a mean of 41 (range 15-45) to 78 (range 43-100) postoperatively. Functional results were excellent-good in 13 patients (76.5%), fair in one patient (5.9%), and poor in three patients (17.7%). One patient underwent arthroscopic revision following redislocation. Pre- and postoperative values for active forward flexion, external rotation, and internal rotation did not differ significantly (p>0.05).

CONCLUSION

The results of arthroscopic Bankart repair and posterior capsular plication are satisfactory in the treatment of anterior glenohumeral instability with capsular laxity. However, the use of capsular plication with arthroscopic Bankart repair should be considered in selected cases.

[Arthroscopic treatment of symptomatic loose bodies in osteoarthritic elbows]

OBJECTIVES

We evaluated functional and clinical results of patients who underwent arthroscopic surgery for symptomatic loose bodies in osteoarthritic elbow joint.

METHODS

Arthroscopic surgery was performed in 10 patients (6 males, 4 females; mean age 47 years; range 30 to 59 years) for symptomatic loose bodies in osteoarthritic elbow joint. Eight patients had a history of trauma. Involvement was on the right in seven patients, and on the left in three patients. Preoperatively, six patients had limited joint movements and locking, and five patients had pain. The presence and the number of loose bodies were investigated by standard radiographs and computed tomography preoperatively, and by radiographs and magnetic resonance imaging postoperatively. The range of motion was measured with a goniometer. Functional assessment was made with the use of the Broberg and Morrey's scoring system, and pain was assessed with a visual analog scale. The mean follow-up was 31 months (range 7-59 months).

RESULTS

The mean range of motion of the elbows increased from 100 degrees (range 55 degrees to 160 degrees) preoperatively to 115 degrees (range 70 degrees to 160 degrees) at the end of the follow-up (p=0.05). None of the patients developed valgus or varus instability. The mean preoperative and postoperative Broberg and Morrey's scores were 59 (range 45 to 80) and 86 (range 59 to 100), respectively (p<0.01). The results were excellent in five patients, good in three patients, and poor in two patients. The mean visual analog score decreased from 7 (range 5 to 10) preoperatively to 1 (range 0-4) postoperatively (p<0.01). Eight patients were satisfied with surgery and returned to normal activities after a mean of 16 days (range 1 to 60 days).

CONCLUSION

Arthroscopic surgery is effective in reducing pain in selected patients with symptomatic loose bodies in osteoarthritic elbows, with the advantages of low morbidity and rapid functional recovery.

[Early results of medial opening wedge osteotomy in varus gonarthrosis]

OBJECTIVES

We evaluated the efficacy and short-term results of medial opening wedge high tibial osteotomy with the use of a Puddu plate in patients with medial compartment gonarthrosis.

METHODS

The study included 15 knees of 12 female patients (mean age 50.6 years; range 45 to 63 years) who were treated with medial opening wedge high tibial osteotomy for varus knees with medial compartment gonarthrosis. The osteotomy sites were fixed with a Puddu plate followed by allograft application. The mean follow-up period was 30.7 months (range 19 to 40 months).

RESULTS

The mean consolidation time was 7.1 weeks (range 6 to 9 weeks). The mean preoperative and postoperative Lysholm scores were 54.1 (range 30 to 60) and 82 (range 67 to 95), respectively. The mean preoperative femorotibial angle was 3.5 degrees in varus malalignment (range 3 degrees valgus to 9 degrees varus). It was 7.3 degrees valgus postoperatively. The mean correction of the mechanical axis was 10.7 degrees , with no loss of correction during the follow-up period. No adverse effects were observed associated with allograft use. The lateral cortex was broken in one patient (6.7%) who was then treated with an Ilizarov external fixator due to pseudoarthrosis. All but this patient were satisfied with the treatment.

CONCLUSION

Compared with other osteotomy models, medial opening wedge osteotomy with the use of a Puddu plate offers advantages in terms of ease of application and maintenance of correction in the early follow-up period. With allograft application, consolidation is obtained without interfering with the rehabilitation period.

[Early results of treatment with expandable intramedullary nails in femur shaft fractures]

OBJECTIVES

We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of femur shaft fractures.

METHODS

The study included 20 patients (10 females, 10 males; mean age 31 years; range 15 to 75 years) who were treated with expandable intramedullary nails (Fixion intramedullary femur nail) for femur shaft fractures. All the fractures were closed and were rated as type 32 A or B according to the AO classification. The mean duration from injury to surgery was three days (range 4 hours to 8 days). The results were evaluated using the Thoresen criteria. The mean follow-up was 26 months (range 9 to 38 months).

RESULTS

The mean operation time was 79 minutes (range 45 to 120 min). Union was achieved in all the patients in a mean of 12.8 weeks (range 10 to 20 weeks). According to the Thoresen criteria, the results were excellent in 15 patients, good in one patient, fair in three patients, and poor in one patient. The results in all type A middle diaphyseal fractures were excellent. Of four patients with A2-3 distal metadiaphyseal fractures, one patient had a good result with a valgus of 5 degrees , and three patients had a fair result with a valgus ranging from 8 degrees to 10 degrees , one of which also had 8-mm shortening. Delayed union, early or late infections, compartment syndrome, or bone necrosis were not seen. Of six patients who completed a follow-up of two years, the nails were removed in five patients, whereas removal was not possible in one patient due to a break in the upper part.

CONCLUSION

Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in metadiaphyseal regions and in fractures with fragments greater than 50%.

[The results of arthroscopic repair in partial rotator cuff tears]

OBJECTIVES

We evaluated patients who underwent arthroscopic repair for partial rotator cuff tears less than 50% of tendon thickness with respect to the course of tears and functional results.

METHODS

Nineteen patients (10 women, 9 men; mean age 49 years; range 40 to 70 years) who did not benefit from conservative treatment for partial rotator cuff tears were treated with arthroscopic debridement with or without subacromial decompression. Twelve patients had a history of trauma before the appearance of complaints which had a mean duration of 12 months (range 7 to 24 months) before arthroscopic repair. Partial tears were on the articular side in 12 patients, and on the bursal side in seven patients. The patients were assessed with preoperative and postoperative physical examination, magnetic resonance imaging (MRI), and UCLA scores.

RESULTS

The mean preoperative and postoperative UCLA scores were 16.8 (range 10 to 20) and 29.0 (range 9 to 35), respectively (p<0.05). The results were excellent or good in 14 patients (73.7%), fair in two patients (10.5%), and poor in three patients (15.8%). One patient developed shoulder stiffness which improved following rehabilitation. Postoperative MRI showed persistence of partial tears in 13 patients, progression in five patients, and development of total rupture in one patient. Complaints of pain increased in severity in patients in whom partial tears manifested a progressive course. One patient with total rupture underwent mini-open rotator cuff repair in the postoperative sixth month.

CONCLUSION

Although clinical symptoms show improvement in most of the patients following arthroscopic treatment, partial rotator cuff tears do not heal completely in a considerable number of cases, and may progress to full-thickness tears in some.

[Early results of treatment with expandable intramedullary nails in tibia shaft fractures]

OBJECTIVES

We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of tibia shaft fractures.

METHODS

The study included 19 patients (8 females, 11 males; mean age 38 years; range 17 to 65 years) who were treated with expandable intramedullary nails (Fixion) for tibia shaft fractures. All the fractures were closed. Four patients had associated injuries. According to the AO classification, the fractures were type 42-A, B, or C. The mean duration from injury to surgery was 2.8 days (range 6 hours to 14 days). The results were evaluated using the Johner-Wruhs criteria. The mean follow-up was 23 months (range 9 to 39 months).

RESULTS

The mean operation time was 47 minutes (range 25 to 53 min). Union was achieved in all the patients in a mean of 11.5 weeks (range 8 to 18 weeks). According to the Johner-Wruhs criteria, the results were excellent in 17 patients (89.5%) and good in two patients (10.5%). Treatment of fragmented-oblique fractures of the distal metadiaphysis (42-B2) resulted in a valgus angulation of 5 degrees in two patients, and extremity shortening of 5 mm in one patient, both of whom had good results. Complications such as delayed union, early or late infections, or bone necrosis did not occur. The range of motion of the knee and ankle reached that of the contralateral side in all the patients.

CONCLUSION

Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in fractures with fragments greater than 50%.

[The results of arthroscopic Bankart repair with suture anchors]

OBJECTIVES

We evaluated the results of arthroscopic Bankart repair in patients with postraumatic recurrent anterior glenohumeral instability.

METHODS

Sixteen patients (1 female, 15 males; mean age 29 years; range 17 to 37 years) underwent arthroscopic Bankart repair with suture anchors for posttraumatic recurrent anterior glenohumeral instability. Involvement was on the right side in 11 patients, on the left in five patients, and on the dominant side in 14 patients. The range of motion was assessed with a goniometer and muscle strength manually. Pre- and postoperative evaluations included physical examination, the Rowe scale for shoulder functions, anteroposterior and axillary radiographs, and magnetic resonance imaging. The mean follow-up was 32.9 months (range 24 to 55 months).

RESULTS

The mean number of dislocations was eight (range 2 to 18) and the mean time from the first dislocation to surgery was 4.6 years (range 6 months to 18 years). The mean preoperative active forward elevation was 148 degrees , and active external rotation was 45 degrees , which increased postoperatively to 160 degrees and 48 degrees , respectively (p<0.05). According to the Rowe scale, the results were excellent or good in 12 patients (75.0%), fair in three patients (18.8%), and poor in one patient (6.3%). All the patients returned to work in a mean of 3.6 months (range 2 to 6 months). Thirteen patients (81.3%) were satisfied with the operation.

CONCLUSION

Successful results following arthroscopic Bankart repair with suture anchors are related to the restoration of the exact pathologic anatomy. Identification of patients with evident capsular laxity and addition of capsular plication to the procedure to eliminate this laxity may contribute to higher success rates.

[Arthroscopic-assisted mini-open repair of rotator cuff tears]

OBJECTIVES

We retrospectively evaluated the results of patients who underwent arthroscopic-assisted mini-open repair of rotator cuff tears.

METHODS

Twenty-three patients (7 males, 16 females; mean age 56 years; range 41 to 75 years) underwent arthroscopic-assisted mini-open repair for nonretracted rotator cuff tears. The right shoulder was involved in 15 patients and the left in eight patients; 83% being on the dominant side. The range of motion was measured with a goniometer, and muscle strength by manual examination. The patients were assessed by physical examination, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the UCLA scale, and magnetic resonance imaging (MRI). The mean follow-up was 32 months (range 12 to 61 months).

RESULTS

All the patients had medium-sized ruptures. Biceps tenotomy was performed in three patients for tears affecting more than 50% of the biceps tendon. The mean preoperative active forward flexion increased from 99 degrees to 161 degrees , and active external rotation from 28 degrees to 50 degrees postoperatively (p<0.05); the strength of the supraspinatus and infraspinatus muscles increased significantly (p<0.05). The mean UCLA score was found as 31.6, showing an excellent result in nine patients (39.1%), good in 12 patients (52.2%), moderate in one (4.4%), and poor in one patient. The mean preoperative ASES score increased from 23.7 to 92.4 (p<0.05). The mean healing time was 1.7 months (range 1.5 to 12 months). Twenty-one patients (91.3%) were satisfied with the outcome. Of 16 patients with postoperative MRI scans, three (18.8%) exhibited recurrent ruptures.

CONCLUSION

In selective cases, the clinical and functional results are successful following arthroscopic-assisted mini-open repair for rotator cuff tears.

[Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique]

OBJECTIVES

We evaluated the functional results of treatment with the selective capsular shift technique in patients with recurrent post-traumatic anterior-inferior glenohumeral instability.

METHODS

The study included 16 patients (15 males, 1 female; mean age 30 years; range 25 to 38 years) who underwent selective capsular shift operation for recurrent post-traumatic anterior-inferior glenohumeral instability. Dislocations occurred following severe (n=14) or mild (n=2) trauma. Preoperatively, the mean number of dislocations was 14 (range 4 to 45) and magnetic resonance imaging showed a Bankart lesion in all the patients and a Hill-Sachs lesion in 20%. The patients were evaluated according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Rowe's scoring for Bankart repair. Preoperative and postoperative anteroposterior and axillary x-rays were obtained from all the patients. Range of motion was measured with a goniometer and manual muscle strength tests were performed. The mean follow-up was 41 months (range 21 to 74 months). Statistical analysis was made using the t-test.

RESULTS

The mean preoperative and postoperative ASES scores differed significantly (63.2 vs 95.8; p<0.05). The mean Rowe score was 92.5 (range 70 to 100). Strength of the infraspinatus, supraspinatus, and subscapularis muscles increased significantly (p<0.05). The results were excellent in 12 patients (75%), good in two patients (12.5%), and fair in two patients. Fifteen patients (93.8%) expressed satisfaction with the operation and results.

CONCLUSION

Addition of the selective capsular shift technique to the Bankart repair procedure improves stability and preserves the range of motion of the glenohumeral joint in patients with anterior-inferior glenohumeral instability accompanied by a Bankart lesion and capsular injury or laxity.

[The results of arthroscopic repair of full-thickness tears of the rotator cuff]

OBJECTIVES

This study was designed to evaluate the functional results of arthroscopic repair of full-thickness tears of the rotator cuff and to investigate the degree of fatty degeneration of the rotator cuff muscles and recurrent ruptures by magnetic resonance imaging (MRI).

METHODS

Twenty-two patients (9 males, 13 females; mean age 56 years; range 38 to 71 years) underwent arthroscopic repair of full-thickness tears of the rotator cuff following conservative treatment for a mean of 15 months (range 45 days to 120 months). Involvement was in the right shoulder in 17 patients, being on the dominant side in 77%. The range of motion was measured with a goniometer, and muscle strength by manual examination. Clinical and functional evaluations were made by physical examination and according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and the UCLA scale. Fatty degeneration of the rotator cuff muscles and recurrence were analyzed by MRI. The mean follow-up was 24 months (range 12 to 36 months).

RESULTS

The mean active forward flexion and external rotation increased from 105 degrees to 160 degrees (p<0.05) and from 41 degrees to 44 degrees (p>0.05), respectively. The strength of the supraspinatus and infraspinatus muscles significantly increased (p<0.05). The mean ASES and UCLA scores significantly increased from 25.4 to 86.7 and from 10.6 to 25.6, respectively (p<0.05). The mean healing time was three months (range 1 to 12 months). Twenty patients (90.9%) were satisfied with the result of the treatment. On MRI scans, recurrent ruptures were detected in seven patients (31.8%); the extent of fatty degeneration of the rotator cuff muscles did not differ pre- and postoperatively (p>0.05).

CONCLUSION

Arthroscopic repair of full-thickness tears of the rotator cuff yields high clinical and functional success rates.

[Arthroscopic selective capsular release in the treatment of frozen shoulder]

OBJECTIVES

We evaluated the results of arthroscopic selective capsular release in patients with frozen shoulder.

METHODS

Sixteen patients (5 males, 11 females; mean age 51 years; range 25 to 73 years) underwent arthroscopic capsular release for frozen shoulder. The syndrome was due to trauma in two patients; nine patients had diabetes mellitus; no etiologic cause was found in three patients. Two patients had rotator cuff tendinitis. The mean duration of complaints was 14 months (range 3 to 36 months). The patients were treated conservatively for a mean of 9.5 months (range 3 to 12 months). The range of motion of the shoulder was measured with a goniometer. Functional evaluations were made according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES). Under general anesthesia, all the patients underwent arthroscopic capsular release, subacromial bursoscopy, and manipulation. Acromioplasty was performed in two patients with subacromial impingement. The mean follow-up was 14 months (range 4 to 25 months).

RESULTS

Compared to the healthy side, postoperative increments in flexion, adduction-external rotation, abduction-internal and external rotations were 38%, 47%, 43%, and 30%, respectively. The strength of the infraspinatus, supraspinatus, and subscapularis muscles significantly increased (p<0.05). The mean postoperative ASES score improved by 50 (p<0.05). The mean visual analog scale score decreased significantly with significant improvements in daily activities (p<0.05). Complaints of pain and limitation disappeared in a mean of 3.5 months (range 15 days-12 months) in 14 patients (87.5%) who were fully satisfied with the operation.

CONCLUSION

Patients with frozen shoulder unresponsive to conservative treatment can be effectively treated with arthroscopic selective capsular release and manipulation.

[Early treatment results with expandable intramedullary nails in lower extremity shaft fractures]

BACKGROUND

We investigated the use of expandable intramedullary nails, their efficacy, and short term results in the treatment of lower extremity shaft fractures.

METHODS

The study included 23 patients (10 females, 13 males; mean age 33 years; range 17 to 60 years) who were treated with expandable intramedullary nails (the Fixion nail) for the lower extremity shaft fractures. Fourteen patients had femoral, nine patients had tibial fractures, all of which were closed. Eight patients had associated injuries. The mean duration from injury to surgery was 3.2 days (range 24 hours to 14 days). The results were evaluated using the Kalström-Olerud criteria. The mean follow-up was 15.3 months (range 10 to 20 months) for tibial fractures, and 13.1 months (range 10 to 19 months) for femoral fractures.

RESULTS

Union was achieved in all the patients. In tibial fractures, the mean operation time was 50 minutes (range 25 to 90 min) and the mean time to union was 12 weeks (range 8 to 24 weeks). The results were excellent in six patients, and good in three patients. In femoral fractures, the mean operation time was 83.5 minutes (range 55 to 120 min) and the mean time to union was 13.2 weeks (range 10 to 20 weeks). The results were excellent in eight patients, good in three patients, fair in two patients, and poor in one patient. No complications were seen such as delayed union, early or late infections, compartment syndrome, or bone necrosis.

CONCLUSION

Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in metadiaphyseal regions and in fractures with fragments larger than 50 per cent.