Does Electrocauterization of the Matrix After the Wedge Resection of the Toe-Nail Affect Recurrence in Discrete Age Groups Differently? A Retrospective Analysis.

The onychocryptosis, also known as ingrown toe-nails, is a painful, common disorder which is less common in children than in adults. The purpose of the present study was to focus on the effect of electrocautery matricectomy on recurrence rate and clinical outcomes in different age groups. We performed a retrospective assessment of 189 consecutive ingrown toe-nails surgeries. Electrocautery matricectomy was performed in 68 (49.2%) of 138 (73%) adults, 25 (49%) of 51 (27%) adolescents. Recurrence was observed in 11 (21.5%) adolescent patients, while recurrence was observed in 12 (8.6%) adult patients. Recurrence was observed in 9 (9.6%) of 93 patients in whom cautery was used, while 14 (14.5%) recurrences were observed in 96 patients who did not use cautery. When the adolescent patient group was evaluated separately, recurrence was observed in 2 (8%) of 25 patients in the cautery group, while recurrence was observed in 9 (34.6%) of 26 patients in the other group. EM addition to the wedge excision does not affect the results in adult patients, but it significantly reduces recurrence in adolescent patients. Especially in younger patients, it is recommended to complete the matricectomy with electrocoagulation.

Pins and rubber band traction for treatment of comminuted intra-articular fractures in the hand.

PURPOSE: To determine the efficacy of pins and rubber band traction for treatment of comminuted intra-articular fractures in the hand. METHODS: We performed a retrospective study from 1994 to 2013 to evaluate 33 patients in whom pins and rubber band traction was employed. We clinically evaluated the active range of motion of the affected fingers after surgery. Eleven of the 33 fractures were at the proximal interphalangeal joint, 10 at the distal interphalangeal joint, 5 at the thumb interphalangeal joint, and 2 at the metacarpophalangeal joint of the thumb. The remaining 5 patients had complex fracture-dislocation of the proximal interphalangeal joints. RESULTS: The mean follow-up period was 24 months. The average active motion of the metacarpophalangeal joints of the fingers was 91° (range, extension 0°-10°/flexion 85°-90°), proximal interphalangeal joints was 92° (range, extension/flexion 0°-10°/85°-100°), and distal interphalangeal joints was 73° (range, extension/flexion 0°-10°/60°-80°). The overall average of all active motion of the injured fingers except thumbs was 255° (range, 240°-270°). The average active motion of the of the thumb metacarpophalangeal joint was 56° (range, extension 5°-10°/flexion 50°-55°), and interphalangeal joint was 74° (range, extension 0°-10°/flexion 75°-80°). The average of active motion of the injured thumb metacarpal and interphalangeal joints combined was 130° (range, 125°-135°). CONCLUSIONS: Pins and rubber band traction is a treatment option for comminuted displaced intra-articular fractures of the digits that offers satisfactory clinical results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The self-assessment of newly graduated orthopedic surgeons on essential surgical procedures.

OBJECTIVE: The aim of this study was to assess the self-confidence of newly graduated orthopedic surgeons on performing essential surgi- cal procedures. METHODS: The study included 151 orthopedics and traumatology surgeons who had completed their (orthopedics and traumatology) training within the last year. They were asked to complete an online questionnaire which was available from February 2020 to May 2021. In the questionnaire, newly graduated orthopedic surgeons were asked whether they could do the 18 listed essential adult and 8 listed essential pediatric cases independently. They were asked about patient follow-up systems and who these were supervised by, the demo- graphic data of the city and about the institution they were trained in, and how many times they performed the listed surgeries during their training. RESULTS: 74 (49%) of the participants received their training in training and research hospitals, 69 (45.7%) in state university hospitals, and 8 (5.3%) in foundation university hospitals. More than 80% of the participants answered, "I can do it independently" for 13 (81.6%) out of 16 adult cases and 7 (87.5%) out of 8 paediatric cases. The average self-efficacy score of the participants was 32.22 out of 36 for adult cases and 15.3 out of 16 for paediatric cases. The total average self-efficacy score was 47.52 out of 52. CONCLUSION: This study has shown us that newly graduated orthopedic surgeons have the self-confidence to handle many of the essential types of cases independently.

Is there any clinical significance of axillary nerve electrophysiological changes in the deltoid split approach?

Purpose: The clinical effects of axillary nerve injury in the deltoid splitting approach are controversial. This study investigated the axillary nerve function with clinical and electrophysiologically in proximal humeral fracture patients with internal fixation using the deltoid split approach. We also aimed to investigate the effects of this damage on deltoid muscle volume and discuss the effects of volumetric changes and nerve damage on patients' clinical outcomes. Methods: study designed prospectively with 25 consecutive patients who received open reduction and internal fixation of proximal humerus fracture through a deltoid splitting approach. We performed clinical, electrophysiological, and radiological examinations during minimum follow-up time of 24 months. Electrophysiological examination comprised electromyoneurography (EMNG). Functional results followed by Constant-Murley and Disabilities of the Arm, Shoulder, and Hand scores. Deltoid volumes were evaluated with magnetic resonance imaging. Results: Twenty-five patients operated on with open reduction internal fixation were prospectively observed. In the EMNG measurements of the patients on the 45th postoperative day, partial degeneration was observed in the anterior part of the axillary nerve in all cases (100%). In the control EMNG measurements performed at the 12th month, normal values were obtained for 15 (60%) of the patients, while findings of ongoing regeneration were detected for 10 (40%) of the patients and normal values at all patients at the 24th month. The difference between abnormal and normal EMNG groups' on 12th month Constant-Murley scores was not statistically significant in any period. Only anterior muscle thickness was statistically higher in the normal patient group than with abnormal EMNG results. Conclusions: In proximal humeral fractures treated with the deltoid split approach, there may be iatrogenic damage of the anterior branch of the axillary nerve. Axillary nerve damage does not affect the patients' clinical scores in the early and mid-terms. Level of evidence: LEVEL III.

Delayed osteochondral fracture fixation of the knee in a pediatric patient.

The frequency of osteochondral fractures in the knee joint in the pediatric population is not clearly known. Although fragment fixation is generally considered to be the ideal treatment method in acute injuries, the data of the results of late fixation in neglected and/or late-diagnosed cases are very limited. In this paper, we report our findings regarding the fixation of a delayed large osteochondral fracture in lateral femoral condyle in a pediatric patient.

Computerised Tomography Analysis of Pelvic Inlet and Outlet Fluoroscopic View Angles.

BACKGROUND: Pelvic inlet and outlet fluoroscopy views are routinely used in operative treatment of posterior pelvic ring injuries. In this study, we aimed to evaluate the angles of pelvic inlet and outlet fluoroscopic view, their differences with hip flexion and the correlation of these differences with sacral slope changes. MATERIALS AND METHODS: Sagittal reconstructions of 100 lumbopelvic CT were used to measure sacral slope, pelvic inlet and outlet view angles. The range of pelvic inlet-outlet view angles and their relation with age, sex and sacral slope were analyzed. In ten of these 100 patients, who were undergone a second CT imaging, hips were passively flexed to 60° to change pelvic tilt. The difference in sacral slope and pelvic inlet-outlet view angles in different positions were compared. RESULTS: Mean angles for inlet view, outlet view and sacral slope were 28.9, 41.4 and 37.0, respectively. There was no difference between males and females (p > 0.05). Pelvic outlet angles had a negative correlation with age (p < 0.05). Sacral slope changes with hip flexion showed a negative correlation with inlet angles and positive correlation with outlet angles (p < 0.05). The differences in sacral slope, pelvic inlet and outlet view angles between two measurements were equal. CONCLUSIONS: The pelvic inlet and outlet view angles shows a wide range without a standard so we suggest preoperative CT scan to plan the optimal angles before pelvic ring surgery. The difference in these angles due to pelvic tilt during the surgery may be corrected by measuring the sacral slope difference.

Tibial tubercle-trochlear groove (TT-TG) distance is a reliable measurement of increased rotational laxity in the knee with an anterior cruciate ligament injury.

BACKGROUND: The aims of this study were: 1. To evaluate the use of the tibial tubercle-trochlear groove (TT-TG) distance as a measurement showing rotational instability after anterior cruciate ligament (ACL) injury. 2. To determine the effect of concomitant anterolateral ligament (ALL) injury on TT-TG distance. METHODS: Knee magnetic resonance (MR) images of 251 patients were retrospectively evaluated to compare the study group (131 patients) who underwent ACL reconstruction due to acute complete ACL injury and the control group (120 patients) without any trauma and/or patellofemoral instability. The rate of secondary signs of ACL injury (Anterolateral ligament injury, Kissing lesion, Anterior tibial translocation, Buckling of the posterior cruciate ligament (PCL)) in the study group was noted. The relationship between the TT-TG distance and other secondary signs was examined. RESULTS: TT-TG distance was measured as 10.83 ± 1.2 mm, 12.88 ± 1.1 mm, 14.17 ± 1.5 mm in control, isolated ACL and ACL + ALL groups, respectively (p < 0.05). TT-TG distance was significantly higher in the patients with ALL injury and kissing lesions than the patients without these lesions (p Ë‚ 0.05). TT-TG distance did not differ significantly between the patients with and without anterior tibial translocation or buckling of the PCL (p Ëƒ 0.05). TT-TG distance measurements showed significant interobserver 0.994 (0.992-0.996) and intraobserver 0.997 (0.996-0.998) correlation. CONCLUSIONS: TT-TG distance measurement can be used as a reliable quantitative measure of the increased rotational instability after ACL injury. TT-TG distance increases significantly if there is an ALL injury accompanying the ACL injury.

Objective Measurement of Medial Joint Space Widening with Percutaneous "Pie Crust" Release of Medial Collateral Ligament during Knee Arthroscopy.

Knee arthroscopy may be called the most commonly and increasingly performed orthopaedic procedure. Posterior medial compartment visualization may be quite challenging. The aim of the present study is to detect objective measurement of medial joint space widening with percutaneous "pie crust" release of medial collateral ligament (MCL) during knee arthroscopy. We used this technique for all knees that require any intervention in the posteromedial compartment and for tight knees in which adequate visualization of the posteromedial compartment cannot be obtained. Eighteen patients (18 knees) were included in this study. Patients were evaluated clinically with the Lysholm and Tegner scores at the final office visit. Joint balance, valgus instability, pain or tenderness on MCL region, and numbness over the medial side of the joint were also noted. Measurements of medial joint space (mm) were obtained at three different times with perioperative C-arm images: normal, controlled valgus force, and after pie crusting. The median follow-up time was 9 (6-12) months. Final follow-up Lysholm (p < 0.05) and Tegner scores (p < 0.05) increased significantly compared with preoperative scores. At the final follow-up, there was no pain or tenderness over MCL and there were no signs of saphenous nerve or vein injury. Medial joint space values in after pie crusting increased significantly (p < 0.05) compared with neutral position measurements and controlled valgus force application (p < 0.05). Controlled release of the MCL in knees provided ∼2.45 times wider visualization place. Furthermore, pie crusting of MCL is a safe and effective technique that provides enough space for visualization and instrumentation in knees. This is a Level IV study.

Grade 2 Chondrosarcoma of the Great Toe: An Unusual Location.

Enchondroma is the most common benign cartilage bone tumor of the toes. In contrast, the foot is a rare region for chondrosarcoma, and the involvement of phalanges is extremely rare. In this article, we report an unusual case of intermediate chondrosarcoma involving the proximal phalanx of the great toe of a 52-year-old woman who was previously treated with curettage and bone grafting because of misinterpretation of enchondroma at a local hospital. She presented complaining of pain and swelling that she had experienced for a period of 1 year after the first operation. Radiography revealed a lytic lesion with a subtle punctuate calcification and endosteal scalloping in the proximal phalanx of the great toe. Gadolinium-enhanced magnetic resonance imaging confirmed soft-tissue involvement and cortical destruction. Staging evaluation with computed tomographic scan of the chest, abdomen, and pelvis was performed to ensure that there was no metastatic disease. Subsequently, a bone biopsy was performed, and the diagnosis was grade 2 chondrosarcoma. The patient was informed about the recurrence of the lesion and the clinical context on the basis of tumor biology of chondrosarcoma and was offered the option of either amputation or wide resection. She preferred the latter. The patient was treated with wide resection and underwent reconstruction with cement and Kirschner wire. She remains free of disease after 1 year of follow-up.

Medial Swivel Dislocation of the Talonavicular Joint with Associated Cuboid Fracture.

Medial talonavicular dislocation associated with cuboid fracture is rare. We report an 18-year-old man with this injury who exhibited excellent results after open reduction and stabilization of the joint with temporary Kirshner wires.

Acute traumatic open posterolateral dislocation of the ankle without tearing of the tibiofibular syndesmosis ligaments: a case report.

Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5 degrees in dorsiflexion, 10 degrees in plantarflexion, 5 degrees in inversion, and 0 degrees in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability.

Prophylactic intramedullary nailing in monostotic fibrous dysplasia.

Fibrous dysplasia of bone is an enigma with no known cure. Treatment currently consists of curettage and bone-grafting in an attempt to eradicate the lesion and to prevent progressive deformity. This study presents the results of prophylactic intramedullary nailing in 10 patients with monostotic fibrous dysplasia, pain increasing with movement, and scintigraphically established activity. Ten patients with monostotic fibrous dysplasia in their upper or lower extremities treated between 2001 and 2003 were included in the study. Seven patients were male and 3 were female; their mean age was 26.9 years. The mean duration of follow-up was 33.5 months. Closed intramedullary nail without reaming was used in all cases. Bone grafting was not performed. Patients were allowed full weight bearing on the affected extremities on the second postoperative day. Mean VAS for functional pain was 5.33 +/- 0.65 preoperatively and 2.26 +/- 0.57 at final follow-up (p < 0.05). Radiographs showed no changes in lesion size, and the intramedullary fixation appeared to be stable. Prophylactic intramedullary nailing appeared to be beneficial in monostotic fibrous dysplasia with scintigraphically proven activity and functional pain. It also avoids problems that may occur following pathological fracture.

An uncommon presentation of malignant fibrous histiocytoma of the calcaneus.

Malignant fibrous histiocytoma of bone is the osseous counterpart of the tumor in soft tissue. It is a rare primary bone tumor, and there have been conflicting reports on its grades of malignancy. The appendicular skeleton, especially the femur, is the most common site of involvement, whereas the calcaneus is rarely involved. We describe a primary malignant fibrous histiocytoma of the calcaneal bone in a 21-year-old man. The patient underwent neoadjuvant and adjuvant chemotherapy and below-the-knee amputation, and no local recurrence or metastasis was noted after 2 years of follow-up.

Type 1 neurofibromatosis and adult extremity sarcoma. A report of two cases.

We report two cases of malignant soft-tissue tumours--one myxoid malignant fibrous histiocytoma and one pleomorphic rhabdomyosarcoma--which were diagnosed in two young adult patients with type 1 neurofibromatosis (NF 1). The patients were evaluated with criteria for Neurofibromatosis 1 and NF 1 gene analysis was performed. Four of seven criteria were found in both patients. The tumours were stage II and III respectively. Both patients were treated with radiotherapy or chemotherapy and surgical intervention. Diagnoses of myxoid malignant fibrous histiocytoma and pleomorphic rhabdomyosarcoma in adult NF 1 patients are exceedingly rare. Thus detection of subtypes of rhabdomyosarcoma and malignant fibrous histiocytoma with immunohistochemistry may be helpful for the management of these tumours among other pleomorphic sarcomas that may occur in type 1 Neurofibromatosis.

[Psychological evaluation of patients with benign musculoskeletal system tumors]. / Benign kas-iskelet sistemi tümörü olan hastalarda psikolojik durum degerlendirmesi.

OBJECTIVES: This study was designed to determine to what extent psychological status was affected by sociodemographic characteristics and by being informed about the diagnosis in patients with benign musculoskeletal tumors. METHODS: The study included 112 male patients (mean age 23.8 years; range 20 to 35 years) who were hospitalized for benign tumors of the musculoskeletal system. A questionnaire was administered to all the patients concerning their sociodemographic characteristics and the status of their knowledge about the diagnosis. Psychological status was assessed by the Hamilton Depression Evaluation Scale. RESULTS: The depression level was not correlated with the localization (upper or lower extremity) of the musculoskeletal system tumor, the marital status of the patient, and the presence or absence of knowledge of the patient about the diagnosis (p>0.05). Educational status was the only factor that was found to be in correlation with the depression level (p<0.05). CONCLUSION: Lack of correlation between sociodemographic characteristics and the psychological status suggests that informing the patients with special attention to their physical and psychological integrity may contribute positively to the patients' psychiatric status.

[The treatment of avascular necrosis of the femoral head with vascularized fibular grafting: a report of three cases]. / Femur basi avasküler nekrozu tedavisinde vaskülarize fibula grefti uygulamasii: Uç olgu sunumu.

Three male patients aged 21, 21, and 24 years were treated with vascularized fibula grafting for avascular necrosis of the femoral head. The disease was found idiopathic in two cases, while one patient was on steroid therapy. According to the Pennsylvania University Staging System, preoperative radiologic stages were 2a, 2b, and 2c. At the end of a mean follow-up period of 31 months (range 30 to 32 months), there was no progression in two patients, whereas the patient with stage 2c disease was found as stage 3b. The mean Harris hip score increased from preoperative 54 (range 52 to 58) to postoperative 93.3 (range 86 to 100). Vascularized fibula grafting may be an alternative method for early stages of avascular necrosis of the femoral head especially in young patients, because it prevents subchondral collapse, delays total hip arthroplasty, and offers a high success rate.

Treatment of proximal fibular tumors with en bloc resection.

Proximal fibular tumor resection has always been a challenge to an orthopedic surgeon due to the proximity of two major structures; the peroneal nerve and anterior tibial artery. Extra-articular resection of the proximal tibiofibular joint, sacrificing of peroneal nerve and split resection of lateral tibial wall are major points of debate. Malawer described two types of resection for aggressive benign and malignant tumors of the proximal fibula, type I for benign and type II for malignant tumors. Between 1992 and 2002, nine male patients with proximal fibula tumors were treated by en-bloc resection as described either by Malawer and or by one of two new resection techniques. Of the nine tumors, six were diagnosed as giant cell tumor (one of them recurrent), two as osteosarcoma and one as benign fibrous histiocytoma. The mean age of the patients was 23.6 (20-48) years. The mean follow up period was 42.8 months (15-117). There were no complications leading to a secondary surgical procedure+no local recurrence. Tumor volume was over 250 ml in two GCT cases, so the deep peroneal nerve was sacrificed to provide a wide margin. Iatrogenic peroneal nerve palsy developed in two patients. Late tendon transfers were performed for the management of drop foot. Our results indicate that if tumor is recurrent or has a large volume, wide resection (including deep peroneal nerve) should be done. Despite satisfactory tumor management, functional outcomes turned out to be variable, therefore precise ligament and muscle reconstruction is recommended.

Rupture of the pectoralis major muscle in a paratrooper.

Rupture of the pectoralis major muscle is a very rare injury. Excessive contraction of muscle fibers during certain forms of sports, such as weightlifting and bench pressing, is the most common cause. Among the 150 reported cases in the literature, in only 1 case did the injury happen during the landing phase of parachuting. Here we report a case of pectoralis major muscle rupture caused by a different mechanism than published previously. A paratrooper was injured during a tactical jump out of an aircraft after becoming entangled with the risers. The mechanism of injury was excessive traction and malpositioning of his shoulder when the parachute deployed. A three-phase conservative treatment regimen was performed and results were assessed by dynamometry. The patient was satisfied with the treatment and the dynamometric results were good at 9 mo after injury and at the end of a 20-mo follow-up period. We suggest that three-phase rehabilitation can be an effective treatment option for pectoralis major muscle rupture in selected patients. Prevention of this type of altitude injury would be possible by applying the fundamentals of parachuting.

Giant cell tumor of tendon sheath simulating giant cell tumor of bone: report of a case.

A 24-year-old male patient presented with a painful eccentric lytic lesion of the proximal tibial epiphysis with a soft tissue component. Clinical and radiological assessment led to the tentative diagnosis of aggressive giant cell tumor of bone. The patient was treated with curettage, high-speed burr, and cementation after intraoperative pathology consultation. The final pathological report indicated that the tumor was giant cell tumor of the tendon sheath with bone invasion. Although uncommon, GCTTS should be considered in the differential diagnosis of such lesions when there is a prominent soft tissue component. Although the resection was intralesional, the thermal effect of the cementation of the involved cavity and complete removal of the tendon sheath may allow successful local control conjecture of lesions that otherwise present with clinical and radiographic findings suggesting giant cell tumor of the bone.

Chondroblastoma of the distal femur. A case report.

The authors report a case of chondroblastoma which was localised in the distal femoral epiphysis in a 16-year-old boy. The lesion was large, rapidly expanding and extended into the knee joint. After diagnostic evaluation including tru-cut biopsy, the lesion was treated surgically with curettage and grafting with coralline hydroxyapatite. Four months after surgery the patient had no pain and had nearly full range of motion of the left knee. He was followed up for thirty-five months with routine radiographs and physical examination. He had no recurrence, no pain, and regained full range of motion of his knee. Most chondroblastomas involve the medullary cavity; they may rarely involve the cortex but to the best of our knowledge, no cases with soft tissue involvement have been reported in the literature.