Surgical Treatment of Displaced Acetabular Fractures Using a Modified Stoppa Approach.

A retrospective evaluation was performed of 36 patients (25 males and 11 females; average age, 44 years) with displaced acetabular fractures who were treated with a modified Stoppa approach. Fractures included 18 anterior columns, 2 both columns, 8 anterior columns with posterior hemitransverse, 6 transverse, and 2 T-type, according to the Judet and Letournel classification. Range of motion, Harris Hip Scores, and Merle d'Aubigné scores were evaluated. Pre- and postoperative measurements taken included displacements and gaps on axial, coronal, and sagittal computed tomography (CT) images and postreduction quality assessed radiologically. Mean follow-up was 14.7 months. Mean perioperative bleeding was 970 cc (range, 800-1250 cc). Mean Harris Hip Score was 77.9, mean Merle d'Aubigné score was 16.4, mean flexion was 105.2°, and mean extension was 16.9°. Anatomical reduction of the acetabular fracture was achieved in 29 (80.5%) patients; it was satisfactory in 5 (13.8%) and poor in 2 (5%). Mean preoperative displacements on axial, coronal, and sagittal sections were 4.1, 3.6, and 3.1 mm, respectively, and mean postoperative displacements were 0.2, 0.3, and 0.2 mm, respectively. Mean preoperative gap distance was 14.5 mm, and mean postoperative gap distance was 1.1 mm. Postoperative foot drop was observed in 2 patients, obturator nerve damage in 1, partial iliac vein damage in 1, and avascular necrosis of the femoral head in 1. Despite a steep learning curve, the modified Stoppa approach is a good alternative to the ilioinguinal approach. It can be used to treat many complex acetabular fractures.

A detailed analysis of messages posted on the 'Turk-Orthopod' mailing list over a 13-year period.

OBJECTIVE: The objective of this study was to analyze the content of the 'Turk-Orthopod' mailing list between 2000 and 2013. METHODS: All messages posted to the 'Turk-Orthopod' mailing list were documented and categorized by 4 orthopedic surgeons who were active members of the mailing list into 11 categories based on the content of the messages. RESULTS: A total of 15,699 messages were evaluated and included in the analysis. The mean number of daily messages in 2000 was 0.98 messages/day and increased to 7.23 messages/day in 2013. The most common type of message was announcements (37.5%) about national or international congresses, conferences, symposia, meetings, and panels. The second most common type of message was condolence messages (11.7%). Case discussions and academic discussions comprised 6.3% and 4.5% of the messages, respectively. CONCLUSION: The 'Turk-Orthopod' mailing list serves primarily as an information board and a powerful social media platform for communication among Turkish orthopedic surgeons. However, scientific case discussions and other professional issues comprise a minority of the messages.

Modified medial Stoppa approach for acetabular fractures: an anatomic study.

BACKGROUND: The modified medial Stoppa approach is an alternative and new surgical approach to access to the internal pelvis and medial wall of the acetabulum. There is little information about the clinical anatomic specifications of exposure in the literature. In this study, the pertinent surgical anatomy that involved the modified medial Stoppa approach was further defined and the anatomic positions and variations of the structures seen in the surgical site were analyzed. METHODS: We dissected five formalized cadavers to present structures at risk in a standard modified medial Stoppa approach. The internal iliac artery and branches were colored with latex injection in formalized cadavers. Morphometrical measurements of the neurovascular structures adjacent to quadrilateral surface and their anatomic variations were noted. RESULTS: It was detected that the obturator vessels and nerve and the iliolumbar vessels were primarily the structures at risk. Obturator vessels and nerve were the most important structures to pay attention because of their direct contact to quadrilateral surface. There was communication (corona mortis) between obturator and inferior epigastric veins in 4 (40%) of 10 hemipelvises. CONCLUSIONS: Before clinical applications, performing cadaver dissection is important to minimize intraoperative complications. This study was the first anatomic study in the literature that reveals the structures that are at risk during surgical treatment of acetabular fractures, which was treated with the modified medial Stoppa approach.

[Comparison of K-wire fixation methods in terms of stability in Salter iliac osteotomies]. / Salter iliyak osteotomisinde K-teli ile yapilan tespit yöntemlerinin stabilite açisindan karsilastirilmasi.

OBJECTIVES: We compared the stability of K-wire fixation methods used in Salter iliac osteotomies in developmental dysplasia of the hip (DDH) to determine the most appropriate method for stabilization of the acetabular fragment. METHODS: The study included 425 hips of 331 patients (63 boys, 268 girls; mean age 23.3 months; range 17 to 35 months) who underwent iliac osteotomies for DDH with appropriate indications described by Salter. Fixation of the graft was made with the use of one or two K-wires. All the patients were assessed postoperatively with anteroposterior pelvic radiographs obtained before a hip spica cast was applied and after it was removed. The patients were divided into four groups based on the fixation methods used, namely, one or two K-wires directed either to the triradiate cartilage or to the roof of the acetabulum. On postoperative pelvic radiographs, we assessed the relation between the proximal and distal iliac fragments, position of the graft in the osteotomy area, medialization of the distal iliac bone corner at the sciatic notch, and coverage of the femoral head. RESULTS: Fixation with two K-wires resulted in no graft displacement. Of 381 hips in which a single K-wire was used, 15 hips (3.9%) exhibited graft displacement due to fixation instability. Orientation of the K-wire fixation was toward the triradiate cartilage in eight hips (2.9%), and toward the roof of the acetabulum in seven hips (6.4%). No significant differences were found between the four groups in terms of fixation instability. CONCLUSIONS: The absence of fixation failure with the use of two K-wires suggests that this method provides a more stable fixation of iliac osteotomy and bone graft.

Be aware of bone marrow edema syndrome in ankle arthroscopy: a case successfully treated with iloprost.

Bone marrow edema syndrome (BMES) is a nontraumatic syndrome characterized by disabling joint pain. The disease occurs especially in the hip joint, and the ankle joint has been reported in the English-language literature to be affected only rarely. We describe here the case of an adult with BMES in both ankle joints. She has been treated with nonsteroidal anti-inflammatory drugs and physical therapy, as well as ankle arthroscopy, all of which have been unsuccessful. BMES was diagnosed on the basis of clinical and magnetic resonance imaging (MRI) findings. The patient was treated with iloprost (Ilomedin; Schering AG, Berlin, Germany); the course of therapy consisted of 5 infusions of 40 microg of iloprost in 500 mL of sodium chloride solution, given over 6 hours on 5 consecutive days. MRI at the third monthly visit showed nearly complete resolution of bone marrow edema. The patient was followed for 2 years and 6 months and was completely asymptomatic. This case report suggests the need for orthopaedic surgeons to know about BMES. Before all-arthroscopic interventions are performed, MRI views should be evaluated carefully. Iloprost infusion therapy seems to be effective and safe in the management of BMES.

[Complications following surgical treatment of shoulder instability and revision interventions for stabilization]. / Omuz instabilitesi için yapilan cerrahi tedaviden sonra görülen komplikasyonlar ve tedavisi.

A successful surgical intervention to restore glenohumeral stability should be based on the detection of all the problems and on a plan to correct all those that are reparable. Contribution of arthroscopy to better understand the pathological anatomy and to evaluate coexisting intra-articular problems, and advances in imaging modalities and in implant technology have increased the success rates and decreased complications. The best way to avoid complications is to gather all the relevant data preoperatively and during surgery to draw the correct diagnosis and to employ the most appropriate approach or approaches accordingly. Complication rates are lower with open surgical techniques, where problems mainly arise from limited joint movements, implant deficiency, and degenerative changes. Although arthroscopic surgery is associated with significantly fewer complications seen with open techniques, it results in higher recurrence rates. Revision surgery for stabilization of the shoulder should be directed to well-defined pathologies using appropriate techniques. The most common complication encountered is the recurrence of instability, which should primarily be dealt with by open surgical techniques.

Primary echinococcus infestation of the bone and muscles.

Hydatid diseases of the bone and muscles are rare, generally are incurable, and have a high level of recurrence. We attempted to ascertain whether the recurrence rate decreased in patients with hydatid disease infestation of the bone and skeletal muscle who were treated with current surgical techniques and antihelminthic chemotherapy, and whether the outcomes for bone infestation were different when compared with outcomes for muscular infestation. We retrospectively reviewed 15 patients with hydatid disease of the bone (eight patients) and muscle (seven patients). The average followup was 30 months (range, 6-69 months). Recurrence was observed in four patients with bone involvement. No patient with muscle involvement had a recurrence after excision. Hydatid disease of the bone often is recurrent and progressive despite using advanced diagnostic studies, improved surgical techniques, and newly developed antihelminthic drugs. The disease status also was not as good as for patients with bone lesions when compared with patients with muscular lesions.

Minimally invasive treatment of simple bone cysts with percutaneous autogenous bone marrow injection.

Percutaneous autogeneic bone marrow injection is an effective method for managing simple bone cysts, and it might be considered before the application of more extensive procedures.

[A survey study on "Turk-Orthopod", a Turkish electronic discussion group in orthopedics and traumatology]. / Türk ortopedisinin elektronik haberlesme ve tartisma grubu "Türk-Ortopod" üzerine bir anket çalismasi.

OBJECTIVES: This study evaluated demographic data of Turk-orthopod members, an electronic mailing list organized for communication between Turkish speaking orthopedic surgeons, and the contribution of the mailing list to the academic improvement and education of its members. METHODS: A twenty-seven item questionnaire was prepared for online survey and an e-mail massage was sent to the members of the e-group asking them to respond to the questionnaire. RESULTS: The response rate was 33% (n=225; 224 males, 1 female; mean age 36.5 years; range 25 to 64 years). A great majority of the respondents (74.2%) worked in a teaching hospital as a member of active education; 104 respondents worked in a medical school, and 76 respondents (33.8%) had a faculty membership. Access to scientific information (55.1%) was the most frequent reason for using the Internet. Messages related to case discussions (60.9%) and scientific announcements (27.6%) received the most attention and interest. Of the participants, 56.4% reported to have read all the incoming messages, and 35.1% reported not to have sent any messages to the group. CONCLUSION: Our electronic discussion group, Turk-orthopod, has proved to be a quick communication tool, presenting a considerable potential to contribute to continuous medical education of Turkish orthopedists.

Effects of gamma-hydroxybutyrate on cerebrospinal fluid lactate and glucose levels after spinal cord trauma.

This study aims to evaluate the effects of gamma-hydroxybutyrate (GHB) after spinal cord trauma (SCT). Twenty rabbits were divided equally into four groups: group I was the sham-operated group, group II suffered from SCT but received no treatment, group III was given a dose of 400 mg/kg of GHB intravenously before SCT and group IV received the same dose after SCT. Cerebrospinal fluid (CSF) samples were obtained 30 min before SCT (T(0)), at 60 (T(1)) and 120 min (T(2)) after SCT. There was a threefold increase in lactate levels from baseline value at T(2) in group II, while statistically significant elevation of the lactate levels were not observed in groups III and IV. Glucose levels at T(1) and T(2) were significantly lower in groups III and IV compared with the control group. The findings of this study demonstrate that GHB can control the increase of CSF lactate and glucose levels following SCT and that this metabolic effect may be associated with neuroprotective physiological changes.

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up. Case report.

The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft-assisted fusion to achieve long-term stabilization.

[Classification of rotator cuff tears]. / Rotator manset yirtiklarinin siniflandirilmasi.

Classification of rotator cuff tears may yield useful information on diagnosis, treatment, prognosis, and evaluation of treatment results. The shape, localization, etiology, size, topography, pathology, and history of rotator cuff tears, together with the involvement of specific tendons in the occurrence of a tear may be of great value in the hand of expert interpreters. This article intends to give a brief description of rotator cuff tears by way of illustration.

The effects of dynamization and destabilization of the external fixator on fracture healing: a comparative biomechanical study in dogs.

This study compared the effects of axial dynamization and staged destabilization on fracture healing. Bilateral midshafts of canine tibiae were osteotomized and fixed with an external fixator. The hind limbs were divided into two groups: the destabilized group in which the fixator's stiffness was progressively reduced over time and the axially dynamized group in which the fixator was axially dynamized. The healed tibiae were tested for 3-point bending in the anteroposterior plane. The biomechanical tests performed 2 months postoperatively revealed that the side with the destabilized fixator was more rigid than the side with the axially dynamized fixator, but the differences were insignificant (P=.20). This study showed staged destabilization of the fixator's stiffness was as effective on the enhancement of fracture healing as axial dynamization.