The Buford complex: prevalence and relationship with labral pathologies.

BACKGROUND: This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined. METHODS: A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. The relationships between the Buford complex and SLAP lesions, as well as instability, were evaluated statistically. RESULTS: The Buford complex was observed in 83 shoulders (2.65%). SLAP lesions were significantly more frequent in patients with the Buford complex than in those without it (81.9% vs. 33.1%, P < .001) Shoulders with the Buford complex presented a lower frequency of anterior instability (10.8% vs. 19.3%, P = .052) and a higher frequency of posterior instability (1.2% vs. 0.9%, P = .789). The prevalence of the Buford complex in patients with and without labral pathologies was 4.6% and 0.3%, respectively (P < .001). CONCLUSIONS: This study, to our knowledge, includes the largest cohort in the literature reporting the prevalence of the Buford complex (2.65%). In the 1461 patients without labral tears or multidirectional instability, the prevalence of the Buford complex was 0.3%. This result suggests that the real prevalence of the Buford complex might be lower than that reported previously. In addition to the aforementioned conclusions, the identification of the Buford complex should prompt a thorough evaluation for concomitant SLAP lesions.

Arthroscopic treatment of intra-artricularly localised pigmented villonodular synovitis of the ankle: 4 cases with long-term follow-up.

BACKGROUND CONTEXT: Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive benign proliferative pathology of synovial tissue. Lesions are classified regarding location as diffuse or localised which are same as histologically. Intra-articularly localised type is relatively rare, especially in the ankle joint. Because of the high recurrence rate and aggressive nature, localised lesions should be excised totally. PURPOSE: We performed a retrospective study of 4 patients with intra-articularly localised PVNS in the ankle joint who were treated by total arthroscopic excision and evaluated for functional results and recurrence rate. STUDY DESIGN: Case series. PATIENT SAMPLE: The mean age of the patients was 27 (17-46) years at the time of arthroscopic surgery. The mean follow-up time was 33 (24-48) months. METHODS: Functional evaluation according to the Musculoskeletal Tumour Society Score was performed, and patients were evaluated for recurrence by MR imaging. RESULTS: In all patients, functional results were excellent and there was no recurrence. CONCLUSIONS: This study demonstrates that the intra-articularly localised PVNS can be successfully treated with arthroscopic procedures without recurrence.

Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear.

BACKGROUND: The purpose of this study was to investigate the role of coracoacromial ligament degeneration and specific anatomic parameters in the etiology of partial-thickness rotator cuff tears. MATERIALS AND METHODS: This study retrospectively assessed 96 patients (mean age, 50.1 years [17-76]; 34 men, 62 women) diagnosed with bursal-side and articular-side rotator cuff tears with a history of failed conservative treatment and persistent shoulder pain who underwent arthroscopic surgery. Video records of the surgery were used to evaluate the type of cuff tear, grade of coracoacromial ligament degeneration, and associated pathologic changes; preoperative magnetic resonance images were used to measure acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. RESULTS: Most of the patients with articular-side tears demonstrated grade 0 and grade 1 coracoacromial ligament degeneration, whereas patients with bursal-side tears had grade 1 and grade 2. There was a significant positive correlation between the grade of coracoacromial ligament degeneration and bursal-side partial rotator cuff tears, whereas no correlation was observed with articular-side tears. There was no significant difference between bursal-side and articular-side partial cuff tears regarding acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. CONCLUSIONS: Grade 1 and grade 2 coracoacromial ligament degeneration is a strong predictive factor for impingement syndrome in the etiology of bursal-side partial cuff tears and can guide the surgeon to consider ligament release and débridement or acromioplasty in these patients.

Novel radiographic hip fat thickness ratio correlates with early re-operation following total hip arthroplasty.

INTRODUCTION: Obesity is thought to lead to increased failure rates following total hip arthroplasty (THA). Site-specific fat distribution has been suggested to be a better indicator of risk, compared to body mass index. Fat thickness measurement methods were developed for total knee arthroplasty, however, there is limited data on the methods for THA. The aim of this study was to assess the interobserver and intraobserver reliability of a newly defined radiographic subcutaneous fat thickness ratio and investigate the correlation of this ratio with early failure following THA. METHODS: 321 patients who underwent primary THA at a single institution between 2014 and 2017, with at least 1-year of follow-up and a preoperative pelvis anteroposterior x-ray radiograph were included in this study. A high hip fat thickness ratio (HFTR) was arbitrarily defined as ⩾2. Early failure was defined as revision or re-operation for any reason and death related to operation first year following THA. RESULTS: The HFTR was shown to have excellent intraobserver and interobserver reliability. High HFTR was associated with higher risk of early failure following THA (odds ratio 3.8, [95% confidence interval, 1.2-12.1], p < 0.05). The same association persisted when HFTR was analysed as a continuous variable (p < 0.01) and in multivariate analysis (p < 0.05). CONCLUSIONS: HFTR can be used to assess periarticular soft tissue distribution and may be regarded as a useful and reproducible tool for assessing risk of early failure following THA.

Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios.

OBJECTIVES: This study aims to assess the mortality and morbidity rates of patients with intertrochanteric femoral fractures who were performed proximal femoral nail-antirotation (PFNA) or cemented, bipolar hemiarthroplasty with calcar replacement. PATIENTS AND METHODS: A total of 127 patients (42 males, 85 females; mean age 79.2 years; range 55 to 98 years) who were treated due to proximal femoral fracture between January 2008 and January 2011 were compared retrospectively in terms of intraoperative mortality, total mortality, and monthly distribution of mortality rates. Of these 127 patients, 92 (28 males, 64 females; mean age 80.24 years; range 55 to 94 years) who were alive, who achieved at least a 12-month follow-up, and could walk and fulfil daily activities in preoperative period were included in the study. Patients were divided into two groups as PFNA group (n=34) and cemented, bipolar hemiarthroplasty with calcar replacement group (hemiarthroplasty group; n=58). Both groups were compared in terms of duration of operation, requirement for intraoperative blood transfusion, duration of hospital stay, functional outcomes, quality of life, complication and revision rates, and costs of operation. RESULTS: Patients in both groups had the same type of fracture. Bone mineral densitometry results and the type and risk of anesthesia of both groups were similar. No significant difference was detected between two groups in terms of intraoperative mortality, total mortality, and monthly distribution of mortality rates (p>0.05). Mean durations of operation were 54.85 minutes (range 40-110 minutes) and 74.66 minutes (range 55-120 minutes) in the PFNA and hemiarthroplasty groups, respectively. Mean durations of hospital stay were 5.91 days (range 5-12 days) and 9.41 days (range 6-16 days) in the PFNA and hemiarthroplasty groups, respectively. In the PFNA group, durations of operation and hospital stay were shorter and functional results were superior (p<0.05). Requirement for blood transfusion was lower in the PFNA group. CONCLUSION: Both PFNA and cemented, bipolar hemiarthroplasty with calcar replacement are good techniques in treatment of intertrochanteric femoral fractures. Internal fixation may be more appropriate for elderly patients due to shorter duration of operation and lower risk of reoperation.

Surgical treatment of bilateral femoral stress fractures related with long-term alendronate therapy.

A 67-year-old female patient admitted to our outpatient clinic suffering from pain in both thighs for one year without any history of trauma. Patient was receiving alendronate therapy for five years. Physical examination revealed pain increasing with weight-bearing in both thighs with full range of hip and knee movements. Radiographs showed an area of thickened cortex of middle femoral diaphysis in both femurs, but no fracture. Bone scan showed a single area of increased uptake of radioisotope. These images were compatible with stress fractures of both femurs. Dual-energy X-ray absorptiometry revealed a T-score of -3.2 for the lumbar spine and -3.5 for the hip. Alendronate treatment was ceased. Calcium and vitamin D treatment were started. Patient was performed prophylactic surgical stabilization by titanium elastic nails in May 2009. On first day after the surgery, unsupported mobilization and weight-bearing activities were started. Upon persistence of pain on left thigh, plate fixation was performed for the nonunion in June 2012. Patient is now pain-free and able to walk with full weight-bearing without any complications.

[A comparison of the measurements with biochemical markers of bone turnover and bone mineral density in the assessment of the efficiency of osteoporosis treatment]. / Osteporoz tedavisinin etkinliginin degerlendirilmesinde kemik döngüsü biyokimyasal belirteçleri ve kemik mineral yogunlugu ölçümlerinin karsilastirilmasi

OBJECTIVES: This study aims to compare the measurements using biochemical markers of bone turnover and bone mineral density (BMD) in the assessment of the efficiency of osteoporosis treatment. PATIENTS AND METHODS: Between March 2006 and December 2008, 166 patients with osteoporosis in our clinic were included. Patients who were out of contact due to death or other reasons during follow-up were excluded. We compared the measurements of urinary biochemical markers of bone turnover using cross-linked N-telopeptide (Ntx) values and BMD in 60 patients (49 females, 11 males; mean age: 65.7 years; range: 42 to 87 years) with osteoporosis who were treatment-naive and completed study. RESULTS: Twenty-nine (48.3%) of the patients received surgical treatment, while 31 (51.7%) received conservative therapy. Urine NTx values of the patients decreased 38.82% at three months; 51.99% at six months and 66.41% at 12 months. Lumbar vertebra BMD increased by 20.7% and femur neck BMD increased by 11.9% at the end of the first year. CONCLUSION: Urine NTx values respond to osteoporosis treatment faster than BMD measurements; thereby it may be suitable to use this parameter for the monitorization of the treatment efficiency.