Improving Osteoporosis Prediction Using Vertebral Bone Quality Score and Paravertebral Muscle Measurements From Lumbar MRI Scans.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: This study aims to use a novel method of combining vertebral bone quality score with paravertebral cross-sectional area measurements to improve the accuracy of predicting individuals with total hip T-scores <-2.5. SUMMARY OF BACKGROUND DATA: Osteoporosis is a prevalent skeletal condition associated with decreased bone density and increased fracture risk. Dual-energy x-ray absorptiometry (DXA) is the conventional method for diagnosing osteoporosis, but it has limitations. Opportunistic osteoporosis screening techniques using lumbar magnetic resonance imaging (MRI), particularly the vertebral bone quality (VBQ) score, have shown promise. This study aims to improve the accuracy of predicting individuals with low total hip T-scores using a novel method that combines VBQ scores with paravertebral cross-sectional area (CSA) measurements. METHODS: A retrospective cohort of 98 patients with DXA and lumbar MRI scans was analyzed. VBQ scores were calculated based on lumbar MRI images, and CSA measurements of paravertebral and psoas muscles were obtained. Threshold-based logistic regression was used to identify optimal thresholds for predicting total hip T-scores <-2.5. RESULTS: The combined model incorporating the VBQ score and paravertebral muscle percent achieved an accuracy of 96.9% for predicting total hip T-scores <-2.5, compared to 81.6% when using the VBQ score alone. Incorporating paravertebral muscle measurements significantly improved the accuracy of identifying osteoporotic individuals. CONCLUSIONS: The combination of VBQ score and paravertebral muscle measurements enhances the accuracy of predicting individuals with low total hip T-scores. Lumbar MRI scans provide valuable information beyond opportunistic osteoporosis screening, and the inclusion of paravertebral muscle measurements could aid in identifying at-risk individuals more accurately.

Publication Trends in the Pelvic Parameter Related Literature between 1992 and 2022 : A Bibliometric Review.

OBJECTIVE: This study aimed to conduct a bibliometric analysis on pelvic parameter related research over the last 30 years, analyzing trends, hotspots, and influential works within this field. METHODS: A comprehensive Web of Science database search was performed. The search yielded 3249 results, focusing on articles and reviews published from 1992 to 2022 in English. Data was analyzed using CiteSpace and VOSviewer for keyword, authorship, and citation burst analysis, co-citation analysis, and clustering. RESULTS: The number of publications and citations related to pelvic parameters has increased exponentially over the last 30 years. The USA leads in publication count with 1003 articles. Top publishing journals include the European Spine Journal, Spine, and Journal of Neurosurgery: Spine, with significant contributions by Schwab, Lafage V, and Protoptaltis. The most influential articles were identified using centrality and sigma values, indicating their role as key articles within the field. Research hotspots included spinal deformity, total hip arthroplasty, and sagittal alignment. CONCLUSION: Interest in pelvic parameter related research has grown significantly over the last three decades, indicating its relevance in modern orthopedics. The most influential works within this field have contributed to our understanding of spinal deformity, pelvic incidence, and their relation to total hip arthroplasty. This study provides a comprehensive overview of the trends and influential research in the field of pelvic parameters.

Vertebral bone quality score for opportunistic osteoporosis screening: a correlation and optimal threshold analysis.

PURPOSE: This study investigated the vertebral bone quality (VBQ) score as a potential tool for opportunistic osteoporosis screening and its correlation with dual-energy X-ray absorptiometry (DXA) values. METHODS: In a single-center retrospective cohort of 130 patients, VBQ and DXA measures were compared using various statistical analyses. The optimal VBQ threshold for predicting osteoporosis was determined using receiver operating characteristic (ROC) analysis. RESULTS: VBQ exhibited a significant negative association with DXA values, suggesting that higher VBQ scores are indicative of lower bone density. Age and VBQ were significant predictors of osteoporosis, with both increasing the log-odds of the condition. An optimal VBQ threshold of 2.7 was determined, demonstrating fair discriminatory power and high negative predictive value. CONCLUSION: The study highlighted the potential of VBQ as a diagnostic tool for osteoporosis with high intra- and inter-observer reliability. The optimal VBQ threshold of 2.7 can aid in ruling out osteoporosis and identifying individuals for further evaluation.

Factors Influencing the Clinical Outcomes of Two-Stage Re-Implantation in Patients With Periprosthetic Joint Infection After Total Knee Arthroplasty.

Introduction Infection is one of the most distressing complications of total knee arthroplasty (TKA), requiring a long treatment process and may negatively affect patient satisfaction. All surgeons aim to achieve infection-free survival, painless, functional, and stable knee after treatment of periprosthetic joint infection (PJI) with two-stage revision treatment. Many factors play a role in determining clinical outcomes. We aimed to evaluate the factors influencing the clinical outcomes of patients undergoing two-stage revision knee arthroplasty for PJI. Methods Forty-nine patients were retrospectively evaluated. Forty-four patients met the inclusion criteria. Spacer types, growth rates in culture, types and amount of antibiotics added to the cement, and intervals between stages were evaluated. Pre- and post-treatment infection parameters, changes in the range of motion (ROM), clinical and functional (C&F) Knee Society Score (KSS) results, and complications were also studied. Results After a mean follow-up of 48.8 ± 16.5 months, re-infection was detected in five out of 44 patients (10.4%). No significant difference was noted regarding C&F KSS when comparing time intervals between the two stages, whether they were shorter or longer than 10 weeks. However, better ROM results were obtained in patients with less than 10 weeks between stages. The relationship between spacer type, ROM, and C&F KSS was not found to be significant. Particularly, the addition of 4g of teicoplanin to the cement shortened the time between the two stages. Conclusion C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels can be considered safe parameters for diagnosis, reimplantation timing, and follow-up. The use of dynamic spacers or reimplantation performed within 10 weeks after the first stage is associated with better ROM outcomes. Additionally, the addition of teicoplanin to the cement shortened the duration of antibiotic therapy.

Is Tranexamic Acid an Effective Prevention in the Formation of Epidural Fibrosis? Histological Evaluation in the Rats.

OBJECTIVE: The present study aimed to determine the topical and systemic efficacy of tranexamic acid (TXA) on epidural fibrosis in a rat laminectomy model. METHODS: Thirty-two 12-month-old adult Sprague-Dawley rats were used in this study. Each rat underwent bilateral laminectomy at the L1 and L2 vertebral levels. Rats were divided into four groups : in group I (control group, n=8), a laminectomy was performed and saline solution was applied into the surgical space. In group II (topical group, n=8), laminectomy was performed and 30 mg/ kg TXA was applied to the surgical site before skin closure. In group III (systemic group, n=8), 30 mg/kg TXA was administered intravenously via the tail vein in the same session as the surgical procedure. In group IV (topical and systemic group, n=8), TXA was administered 30 mg/kg both topical and intravenous. The rats were sacrificed at 4 weeks postoperatively. Masson's trichrome and hematoxylin and eosin were used to assess acute inflammatory cells, chronic inflammatory cells, vascular proliferation, and epidural fibrosis. RESULTS: Epidural fibrosis, acute inflammation, chronic inflammation, and sum histologic score value were significantly lower in the systemic TXA group, systemic and topical TXA groups than in the control group (p<0.05). In addion, the sum histologic score was significantly lower in the topical TXA group than in the control group (p<0.05). CONCLUSION: In this study, epidural fibrosis formation was prevented more by systemic application, but the topical application was found to be effective when compared to the control group. As a result, we recommend the systemic and topical use of TXA to prevent epidural fibrosis during spinal surgery.

Minimally invasive medial plate osteosynthesis in tibial pilon fractures: Longterm functional and radiological outcomes.

OBJECTIVE: The aim of this study was to evaluate the long-term follow-up and functional and radiological outcomes of minimally invasive medial plate osteosynthesis in distal tibia fractures. METHODS: From January 2011 to November 2015, we reviewed the medical records of 60 patients with 62 tibia fractures (41 men and 19 women; mean age: 45.3±14.9 years) who were treated with open reduction and internal fixation for distal tibia pilon fractures. The mean follow-up time after surgery was 42.7±4.6 months. Union time, coronal plan deformity, complication rates and AOFAS and Olerud-Molander functional outcome scores were evaluated. RESULTS: According to the AO/OTA classification, there were thirty four (54.8%) type 43-A fracture, eight (12.9%) type 43-B fractures, twenty (32.3%) type 43-C fractures. The average time for fracture union was 16.1 weeks. The mean AOFAS score was 86.6±9.1. The mean Olerud-Molander score was 85.6±9.8. There were four patients (6.5%) with a varus of less than 5°, two patients (3.2%) with a valgus of less than 5°, 39 patients (62.9%) with recurvatum (34 of them less than 5°; five of them less than 10°), and 14 patients (22.6%) with procurvatum (12 of them less than 5°; two of them less than 10°). The AOFAS and Olerud-Molander scores in the smoker and diabetic patients were significantly lower than the non-smoker (p=0.002; p=0.005) and non-diabetic patients (p=0.022, p=0.002). The duration of union was significantly higher in both diabetic (p=0.025) and smoker patients (p=0.041). There was no association between the fracture type and the presence of varus, valgus, recurvatum and rotation deformity. The AOFAS score, Olerud-Molander score and plantar-flexion were significantly higher in type A fractures than in type C fractures (p=0.021; p=0.030, and p=0.033, respectively). AOFAS score, Olerud-Molander score, plantar-flexion value did not differ between type B and type C fractures. There was no significant difference among the dorsi-flexion (p=0.211), the follow-up time (p=0.531) and duration of union (p=0.908) of type A, type B and type C fractures. Three patients with open fracture had delayed wound healing. One patient developed skin necrosis. They were treated by local wound care. CONCLUSION: Minimally invasive medial plate osteosynthesis is a reliable method of treatment for tibial pilon fractures. This technique provides a high fracture healing rate and satisfying functional outcome with minimal wound healing complications. Sagittal plan deformity remains a common complication with minimally invasive medial plate osteosynthesis. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

The effectiveness of extracorporeal shockwave treatment in subacromial impingement syndrome and its relation with acromion morphology.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of the extracorporeal shock wave therapy in the subacromial impingement syndrome and its relationship with the acromion morphology. METHODS: Thirty patients (24 women, 6 men) with subacromial impingement were evaluated. The average age of patients was 53.6 ± 9.8 years (range 39-80). Patients were divided into 3 groups according to the acromion morphology. ESWT 1500 at 0.12 am mL/mm2 violence was applied once a week for 3 weeks. Shoulder pain and disability index (SPADI) was used to assess function and pain scores of the patients. The evaluations were made prior to and 12 weeks after the ESWT. RESULTS: Thirteen shoulders had type 1 acromion, 11 shoulders type 2 acromion and 6 shoulders type 3 acromion. After ESWT, the SPADI pain score decreased from 16.1 ± 5.1 (7-25) to 10.4 ± 4.9 (1-20); SPADI functional score decreased from 37.3 ± 19.8 (5-70) to 26.7 ± 17.5 (1-60); SPADI total score decreased from 53.4 ± 24.5 (14-95) to 37.1 ± 21.6 (2-74) (p < 0.05; paired t test). In each group better functional outcomes were achieved after ESWT (p < 0.05; paired t test). There were no differences between the groups according to functional outcome both before and after the ESWT treatment (p > 0.05, one way ANOVA test). CONCLUSION: ESWT was found to be effective in the treatment of impingement syndrome both for pain and functional outcome in the early period regardless of acromion morphology. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Arthroscopic excision of an intra-articular osteoid osteoma in the elbow joint.

An osteoid osteoma is a rare, small, benign and painful tumour occurring in the extra-articular portion of long bones seen most commonly in the lower extremities. This is a case report of a 23-year-old female patient who underwent arthroscopic resection of an intra-articular osteoid osteoma. The nidus was completely removed by arthroscopic excision. The diagnosis was confirmed by postoperative histopathological analysis. In the case presented we have shown that intra-articular arthroscopy can be successful in the surgical management of benign bony lesions involving the elbow joint. We also present a review of the literature which reports on similar cases or intra-articular disease, preferred methods of surgical management and limitations in histopathological specimen acquisition for diagnosis.

A comparison of the open reduction-internal fixation and resection arthroplasty techniques in treatment of Mason Type 3 radial head fractures.

OBJECTIVE: The aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or early resection arthroplasty due to isolated comminuted radial head fractures. METHODS: Between the years 2009 and 2013, 34 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 19 patients, resection arthroplasty in 15 patients). The mean age of the patients in the ORIF group was 38.5 years and 54 years in the resection group. The carrying angle (CA) and ulnar variance were measured bilaterally, and radiographs were reviewed for degenerative elbow arthritis. The Mayo elbow performance score, Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-T) and visual analog scale (VAS) were used to evaluate the clinical results. RESULTS: The mean follow-up period in the ORIF group was 40.2 months and 44.4 months in the resection group. In the ORIF group, 11 patients were clinically rated excellent, six good, and two fair. In the resection group, seven patients had excellent, five had good, and two had fair scores. We did not find a statistically significant difference between the ORIF and resection groups regarding the clinical and radiological outcomes. CONCLUSION: With these short-term results, resection arthroplasty may be considered an effective method in the treatment of isolated comminuted radial head fractures, as it is less technically demanding and it also allows for early postoperative motion. However, the patients should be evaluated in detail, regarding ligamentous injuries prior to resection arthroplasty. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Results of arthroscopic treatment in unresolved Osgood-Schlatter disease in athletes.

AIM OF THE STUDY: In this study we aimed to determine outcomes following arthroscopic ossicle excision in athletes with unresolved Osgood-Schlatter disease (OSD). METHOD: Arthroscopy was performed on 11 patients (11 knees) with OSD between September 2008 and November 2014. Surgical treatment inclusion criteria were determined as: failure of conservative treatment; isolated pain over the tibial tubercle and distal patellar tendon; pain limiting sporting performance at a competitive level. All patients had a documented history of OSD; the mean duration of persistent pain over the tibial tubercle was 15.5 months. The mean age was 23 years. The mean follow-up period was 66.1 months. RESULTS: The mean latency in returning to sports related training activities after the surgery was 6.7 weeks. The mean Kujala patello-femoral score improved from 82.9 points pre-operatively, to 98.5 points at the final follow-up (p < 0.01). The mean Lysholm knee scale score was 87.5 points in the pre-operative period, increasing to a score of 96.9 points at final follow-up (p < 0.01). The mean Tegner activity level score was 7.5 in the pre-operative period, increasing to 8.5 post-operatively (p < 0.01). DISCUSSION: We investigated the functional outcomes after arthroscopic treatment of unresolved OSD in athletes. All athletes with OSD showed satisfactory functional recovery following arthroscopic treatment. All patients were able to return to the same level of athletic activity. CONCLUSION: Arthroscopic surgery for unresolved OSD has the major advantage of faster recovery and avoiding damage to the patellar tendon.

Comparison of the chondroprotective effect of a novel hydrogel compound and traditional hyaluronate on rat cartilage in a papain-induced osteoarthritis model.

PURPOSE: The aim of this experimental study is to evaluate the efficacy of a novel intraarticular drug in a papain induced osteoarthritis (OA) rat model and compare with the traditional hyaluronat (HA) visco supplementation. METHODS: An early stage OA model was induced by the intra-articular injection of papain enzyme in the right knee joints of 44 Sprague-Dawley rats. Eleven rats (eleven right knees: papain group, 11 left knees: control group) were chosen randomly 28 days after the last injection and sacrificed for verifying OA. The remaining rats (n = 33) were randomly divided into 3 groups. Group 1 was injected 0,2 mL of sterile saline solution (0,9%), group 2 was injected 0,2 mL HA and the group 3 was injected 0,2 mL of HA-CSNAG (hyaluronat, chondritin sulfate, N-acetyl-d-glucosamine) combination in the right knees. Injections were performed on the 35th, the 42nd and the 49th days consecutively. Two weeks after the last injection, all groups were sacrificed to evaluate the severity of OA according to Mankin system. RESULTS: Early stage of OA was verified regarding total Mankin scores (p < 0.05). There was statistically significant difference between Group 1 and Group 2 (p < 0.05), between Group 1 and Group 3 (p < 0.05) on the 63th day regarding total Mankin scores. Group 3 showed statistically significant improvement in terms of proteoglycan content of matrix when compared to Group 2 (p < 0,05). CONCLUSION: HA-CS-NAG compound in hydrogel form is more chondroprotective to rats' cartilage when compared to HA during the early stages of OA.

Impact of platelet-rich plasma injection timing on healing of Achilles tendon injury in a rat model.

OBJECTIVE: The aim of this study was to evaluate the impact of the timing of platelet-rich plasma (PRP) application on the healing of Achilles tendon injury in a rat model. METHODS: Fifty-four female Sprague-Dawley rats were divided into 4 groups: PRP preparation group (n=6); Achilles tendon tear and 150 µL of PRP received on the day following the injury (PRP day 0, group 1, n=16); Achilles tendon tear and 150 µL of PRP received on the third day following injury (day 3 , group 2, n=16); Achilles tendon tear and 150 µL of saline received on the day following injury (PRP day 0, group 3, n=16). Rats were sacrificed at 3 weeks. Consequently, biomechanical and histologic analyses were performed. RESULTS: According to histological evaluation, inflammation, fibroblast density, epitenon thickness, and collagen fiber were significantly higher in group 1 than in group 2 (p<0.05). Biomechanical testing results of group 1 and group 2 were inferior to the control group, while the differences were not significant (p>0.05). CONCLUSION: Based on histological criteria, results of the present study suggest that immediate injection of PRP for tendon injury improves tendon healing in rats. Although the use of PRP is well recognized in orthopedic surgery, we aimed to highlight the importance of immediate application of PRP for acute tendon injury.

Locked hip joint: an uncommon presentation of localized pigmented villonodular synovitis.

We report a 24-year-old male who was admitted to the emergency department with an unusual complaint of locked hip joint. Magnetic resonance imaging (MRI) showed a 3-cm intra-articular synovial nodular mass and a 3.0x2.4x1.6-cm yellow-brownish colored pediculed synovial nodular mass was excised with hip arthroscopy. Pathological examination confirmed the diagnosis of pigmented villonodular synovitis. Excision of the mass allowed prompt resolution of the symptoms and there was no sign of recurrence at 3-year follow-up.

Simultaneous ACL-PCL reconstructions with high tibial osteotomy: salvage for an unstable arthritic knee.

We present a case of a 28-year-old man with a severe osteoarthritic varus knee after a neglected multiligamentous injury sustained 10 years prior. Simultaneous anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions with high tibial osteotomy (HTO) were performed at a single stage. Five years after surgery, there were no signs of effusion and no instability, and the patient could easily kneel down without any discomfort. We think that salvage procedures and biological reconstructions would be the primary choice of surgical treatment in young patients to delay arthroplasty, and it is possible to perform simultaneous reconstructions of ACL and PCL with HTO in a single stage.

Superior Labrum Anterior Posterior Lesions and Associated Injuries: Return to Play in Elite Athletes.

BACKGROUND: Superior labrum anterior posterior (SLAP) lesions often cause shoulder pain, dysfunction, and instability. Professional athletes require a high level of shoulder function for competition and overhead activities. PURPOSE: To evaluate elite athletes who had arthroscopic surgery for common shoulder pathologies and SLAP lesions with a follow-up of more than 3 years. The associated intra-articular pathologies and return to play were documented. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-five shoulders in 34 elite athletes (4 women and 30 men; mean age, 25 years [range, 18-32 years]) had arthroscopic repair of SLAP lesions and accompanying Bankart or rotator cuff tears between January 2008 and November 2011. The documentation included patient symptoms, physical examination, radiological analysis with radiographs, and magnetic resonance imaging. Shoulder function was evaluated preoperatively and at follow-up using American Shoulder and Elbow Surgeons (ASES) and Kerlan Jobe Orthopaedic Clinic (KJOC) scores. The mean follow-up was 52 months. RESULTS: Isolated SLAP lesions were seen in 17.1% of patients, SLAP lesions and partial cuff tear occurred in 25.7%, associated Bankart lesions in 37.1%, full-thickness rotator cuff tears in 8.6%, Bankart and posterior labrum lesions in 8.6%, and Bankart and full-thickness rotator cuff tears in 2.9%. Return to play was a mean 6.4 ± 1.5 months. The mean postoperative ASES and KJOC scores were 89.6 ± 4.6 and 80.9 ± 6.8, respectively, compared with preoperative scores of 64.0 ± 7.2 and 50.5 ± 10.3 (t test, P < .01). CONCLUSION: The majority (88.2%) of professional athletes returned to their preinjury levels. SLAP lesions may frequently occur with Bankart lesions and rotator cuff tears. A high rate of return to sport at the same level of athletic performance can be achieved by anatomic repair and effective rehabilitation.

Modified Simmonds-Menelaus procedure for moderate or severe adult hallux valgus.

OBJECTIVE: The purpose of this study was to present the clinical and radiological results of modified Simmonds-Menelaus technique, performed as a proximal, medially-based, open-wedge osteotomy of the first metatarsal, in cases of moderate or severe adult hallux valgus deformity. METHODS: Fifty-one feet of 47 patients underwent surgery due to hallux valgus. Mean age was 41.2±14.0 years, and mean follow-up period was 99.5±36.0 months. Patients were evaluated with standing anteroposterior (AP) and lateral radiographies obtained in the preoperative and early postoperative periods, and during final follow-up. The parameters of hallux valgus angle (HVA), intermetatarsal angle (IA), metatarsal distal phalangeal angle (MDPA), and first metatarsal length (ML) were measured. For clinical evaluation, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) scale was used. RESULTS: Mean preoperative HVA was 36.9°±7.3°, mean early postoperative HVA was 16.6°±6.2°, and mean final postoperative HVA was 28.9°±11.5°. Mean preoperative IA was 17.3°±4.5°, mean early postoperative IA was 8.8°±3.6°, and mean final postoperative IA was 14.3°±4.9°. Mean AOFAS hallux MTP-IP score was 71.9±20.1 at final follow-up. CONCLUSION: From studies in the available literature, it is not clear whether the proximal open-wedge osteotomy technique itself is unsuccessful in adults or the lack of internal fixation led to failure. Application of an adequate fixation material should be used in order to avoid the collapse of the graft and to maintain the correction of the radiological parameters.

The effects of extracorporeal shock waves on carrageenan-induced Achilles tendinitis in rats: a biomechanical and histological analysis.

OBJECTIVE: The aim of this study was to investigate the influence of low-dose extracorporeal shock waves (ESW) on the healing potential of Achilles tendinitis in the rat. METHODS: The 36 adult Sprague-Dawley rats used in this study were randomly divided into four groups. Group A (n=10) were injected with carrageenan, Group B (n=10) were injected with carrageenan and received ESW, Group C (n=10) received ESW only, and Group D (n=6) was a sham group. Rats were injected with 10 microliters of 3% carrageenan or a saline solution eight times during a one-week period with a subcutaneous needle. One week following the final injection, ESW was applied at a rate of 500 impulses in 5 minutes at 2 bars (comparative to 0.09 mJ/mm²) to rats in Groups B and C. Rats were sacrificed three weeks later. Tensile strength, inflammation, and vascularity and collagen density were measured. RESULTS: Failure of the tendon ultimate loads was significantly lower in the study groups than in the control group (p<0.05). Collagen fiber density was higher in the control group than in the other groups (p=0.59). No other histological differences were found. CONCLUSION: Low-dose ESW has a negative effect on tendon tensile strength in this animal model.

The effect of oophorectomy on epidural fibrosis after laminectomy: an experimental study in rats.

OBJECTIVE: The aim of this study was to examine the effect of oophorectomy in the formation of epidural fibrosis in a rat laminectomy model. METHODS: Thirty-six 12-month-old adult female Sprague-Dawley rats were used in this study. Rats were evenly divided into two groups; oophorectomized and sham-operated. Bilateral oophorectomy was performed on the 18 rats in the oophorectomized group. Three weeks after oophorectomy, rats in both groups underwent complete bilateral laminectomy at the L2 and L3 vertebral levels. Rats were divided into 3 equal groups and sacrificed in groups of 4 at the 4th, 8t, and 12th weeks postoperatively and the lumbar spine excised en bloc, fixed and decalcified. Sections were stained with hematoxylin and eosin and Masson's trichrome were used to evaluate epidural fibrosis, acute inflammation, chronic inflammation, and vascular proliferation. RESULTS: The mean histological sum grade of the epidural fibrosis was greater in the oophorectomized group (p>0.05). CONCLUSION: Endogenous estrogen could have an effect on epidural fibrosis formation after lumbar laminectomy in rats.

A lipoma causing separation of toes in the second web space of the foot.

Lipomas are common and benign soft tissue neoplasms which are composed of fat cells. These tumors often develop where adipose tissue is present; however, they can be rarely found in the foot. In this article, we present a 55-year-old male case with a lipoma leading to separating toes in the second web space of the foot and mechanical discomfort.

Extracorporeal shock waves in articular cartilage defects in the rats.

Thirty adult Sprague-Dawley rats were used to assess the nature of healing tissues in hyaline cartilage defects and to compare the healing in defects treated with shock waves, with those in defects without treatment. A 2 × 2 mm cartilage defect with exposed cancellous bone was created in a nonweight-bearing area of each medial femoral condyle. Each right knee defect was received extracorporeal shock waves (Swiss Dolorclast) of 500 impulses in 5 min at 2 bar (comparative to 0.09 mJ/mm(2)), and the left knee defects were assigned as controls. The rat groups were sacrificed at 6 and 12 weeks postsurgery. Sections from each knee were stained with hematoxylin-eosin to analyze synovial adhesion, synovial thickness, bone maturation, and chondroid metaplasia and with masson trichrome to analyze collagen fiber intensity. There was not a significant difference found between the study and control groups (P > 0.05). Extracorporeal shock waves did not effect healing of the chondral defects.