Syndesmotic screw fixation in tibiofibular diastasis.

BACKGROUND: In chronic instability of syndesmosis, osteoarthritis and poor functional outcome were seen more prevalently. To avoid diastasis of ankle joint, the affected distal tibiofibular syndesmosis should be restored. We evaluated the clinical and radiological results of operative treatment of ankle fractures in patients who required syndesmotic stabilization. MATERIALS AND METHODS: Twenty-one patients operated for ankle fracture were evaluated. Patients were followed up for 12 to 81 months, with a mean value of 49 months. Anteroposterior (AP), lateral, and mortise radiographs were taken at the follow-up period, and AP tibiofibular distance, lateral fibular distance, and medial mortise distance were measured on the preoperative, postoperative, and last follow-up radiographs. At the last follow-up, patients were evaluated clinically with Hannover scoring system. RESULTS: The decrease in AP tibiofibular distance was statistically significant postoperatively in Weber Type B and C fractures. The mean preoperative AP tibiofibular distance which was 7.1 mm decreased to 3.6 mm after operation. There was no statistically significant relation between the amount of decrease and fracture type, either Weber B or C. At the same time, the AP tibiofibular distance did not change at the last follow-up. At the last follow-up clinical evaluation, patient scores were ranging from 74 to 94, with a mean value of 86, which was designated as a fair result. CONCLUSION: In ankle fractures, if diastasis of distal tibiofibular joint is present, syndesmosis should be fixed for both Weber Type B and C fractures. The most important predictor of good clinical outcome is accurate reduction of the syndesmosis.

Comparision of the expandable nail with locked nail in the treatment of closed diaphyseal fractures of femur.

BACKGROUND: Expandable nails achieve stability only by hydraulic expansion; therefore suggest less radiation exposure and operation time. In this study, we aimed to compare the results of expandable femoral nails with locked intramedullary nails in the treatment of diaphyseal fractures of femur. MATERIALS AND METHODS: Isolated closed AO = Arbeitsgemeinschaft für Osteosynthesefragen type 32.A or 32.B unilateral femoral shaft fractures operated with expandable or locked nail were evaluated retrospectively. We match patients who undergone expandable nail fixation with patients of the same-sex, age, and fracture type who undergone locked nailing. A match was done for 31 expandable nail. At follow up, healing was assessed radiologically and clinically. Outcome measures included duration of hospital stay, time taken to achieve bony union, and participation in full activities. RESULTS: The average duration of surgery in the expandable group was 60.9 min and in the locked group was 82.4 min. In the expandable group, the average clinical healing time was 15.5 weeks and radiographic healing time was 21.7 weeks. In the locked IMN group, the average clinical healing time was 18.4 weeks and the average radiographic healing time was 24.1 weeks. We observed seven (22.6%) non-union in expandable group and four (12.9%) non-union in locked group. In the expandable group, type of the fracture was AO 32.B in all of the non-union patients. We achieved union in all of non-unions of the locked group only with dynamization. In the expandable IMN group, five (16.1%) patients required major surgery, in the locked group none of the patients required major surgery. CONCLUSION: Non-union rate of the expandable nail is higher than that of the locked nail for femoral diaphyseal fractures. It may be a treatment option in simple fractures like AO 32.A and in patients where rapid fixation is demanded. It has advantages of reduced operative time and less radiation exposure in comparison with reported series of conventional nails.

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.

Comparison of intracompartmental pressures in a rabbit model of open and closed tibial fractures: an experimental study.

We compared the intracompartmental pressures (ICPs) of open and closed tibial fractures with the same injury pattern in a rabbit model. In all, 20 six-month-old New Zealand White male rabbits were used. They were randomised into two equal groups of ten rabbits; an open fracture group (group 1) and a closed fracture group (group 2). Each anaesthetised rabbit was subjected to a standardised fracture of the proximal half of the right tibia using a custom-made device. In order to create a grade II open fracture in group 1, a 10 mm segment of fascia and periosteum was excised. The ICP in the anterior compartment was monitored at six-hourly intervals for 48 hours. Although there was a statistically significant difference in ICP values within each group (both p < 0.001), there was no significant difference between the groups for all measurements (all p ≥ 0.089). In addition, in both groups there was a statistically significant increase in ICP within the first 24 hours, whereas there was a statistically significant decrease within the second 24 hours (p < 0.001 for both groups). We conclude that open tibial fractures should be monitored for the development of acute compartment syndrome to the same extent as closed fractures.

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.

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.

Synovial fluid and plasma selenium, copper, zinc, and iron concentrations in patients with rheumatoid arthritis and osteoarthritis.

In recent years, a great number of studies have investigated the possible role of trace elements in the etiology and pathogenesis of rheumatoid arthritis (RA) and osteoartritis (OA). We studied synovial fluid and plasma concentrations of selenium (Se), zinc (Zn), copper (Cu), and iron (Fe) in patients with RA and OA and compared them with sex- and age-matched healthy subjects. Plasma albumin levels were measured as an index of nutritional status. Plasma Se, Cu, and Zn concentrations were determined by atomic absorption spectrophotometry and Fe concentrations were determined by the colorimetric method. Although plasma and synovial fluid Se concentration were found to be significantly lower (p < 0.05, and p < 0.05, respectively), Cu concentrations were significantly higher in patients with RA than those of healthy subjects and OA (p < 0.05 and p < 0.05, respectively). There were no significant differences in plasma and synovial fluid Zn concentrations and albumin levels among three groups (p > 0.05). On the other hand, synovial fluid Cu and Fe concentrations were significantly higher in patients with OA than those of healthy subjects (p < 0.05). There was a significantly positive correlation between synovial fluid Se-Cu values and Zn-Fe values in patients with RA. Our results showed that synovial fluid and plasma trace element concentrations, excluding Zn, change in inflammatory RA, but not in OA. These alterations in trace element concentrations in inflammatory RA might be a result of the changes of the immunoregulatory cytokines.

The values of talonavicular angles in patients with pes planus.

Talonavicular angles of 42 patients with flatfeet were measured using their weightbearing and nonweight-bearing anteroposterior and lateral radiographs. These patients were divided into two subgroups depending on the presence of pain. The normal feet of 22 people were included in this study to establish the control group. It was observed that, at the weightbearing position, the talonavicular angle increases. The talonavicular angle decreases in pes planus on the lateral radiographs. In patients presenting painful flatfeet, the talonavicular angle significantly reduces in the nonweightbearing anteroposterior x ray. The reason for pain may be enlargement of the medial border of the navicular bone or the presence of an accessory navicular bone. Relief of pain was observed in four patients following removal of the accessory navicular bone.

Tetra-oligodactyly with bilateral aplasia and hypoplasia of long bones of upper and lower limbs: a variable manifestation of the syndrome of ectrodactyly with tibial aplasia.

We present, a family manifesting a variation of the syndrome of ectrodactyly with tibial apasia. The principal case in the family showed the most severe bilateral skeletal malformations of this syndrome. The hand changes of this case (tetra-oligodactyly with missing 5th rays) and of a relative (oligodactyly with the last 3 rays being affected) reflected a variable manifestation of "ectrodactyly". Additionally, a review of the relevant literature is presented for further delineation of various aspects of this syndrome.