Comparative Analysis of Percutaneous Excision and Radiofrequency Ablation for Osteoid Osteoma.

BACKGROUND This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. MATERIAL AND METHODS We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. RESULTS The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. CONCLUSIONS Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.

Does the magnetic-guided intramedullary nailing technique shorten operation time and radiation exposure?

AIM: The aim of this study is to show whether a new magnetic-guided locking technique is superior to a standard freehand technique in terms of operation time and radiation exposure. This treatment will be used for distal locking of the tibia during intramedullary nailing. METHODS: This randomized trial is done through 80 patients having tibial fractures with a mean age of 25 years (range 16-67 years). In the magnetic locking group, there were 20 fractures of the distal third, 16 of the shaft, and 4 of the proximal tibia; in the freehand group, these numbers were 15, 20, and 5, respectively. The parameters like operation time, distal locking time, radiation exposure duration, and dose were compared. RESULTS: We placed 100 distal locking screws in the magnetic locking group and 95 in the freehand group. Fluoroscopy was necessary only in the freehand group. All screws were correctly positioned the first time in both groups. The magnetic locking group had a shorter mean surgical time (52 ± 6.2 vs 70 ± 10.9 min; P < 0.01), a shorter mean distal locking time (5 ± 1.1 vs 16 ± 2.0 min; P < 0.01), and a shorter mean placement time for each screw (2 ± 0.5 vs 7 ± 1.2 min; P < 0.01). The magnetic locking group had lower mean radiation exposures (8 ± 4.5 vs 40 ± 7.6 s; P < 0.01) and mean radiation exposure (5.4 ± 2.5 vs 25 ± 6.8 mGy range; P < 0.01). CONCLUSIONS: For distal locking during tibial intramedullary nailing, the magnetic locking system is as accurate as the standard freehand technique, but it has lower operative times and radiation exposures compared to the standard freehand technique. Therefore, the magnetic locking system should be preferred to current standard freehand techniques.

Is surgical indication in multiple myeloma a poor prognosis sign? SEER database analysis.

AIM: This study aims to investigate demographic data, survival rates, and the relationship of these rates with surgery in a large case series including multiple myeloma (MM) patients. METHOD: MM cases were analyzed retrospectively using the latest version of the SEER database published in April 2020. This version covers January 1975 to December 2017. Patients were classified according to gender, age, and race/ethnicity. Tumors were classified according to their localization, grade, year of diagnosis, and follow-up results. RESULTS: There were 60,239 patients diagnosed with Plasma Cell Myeloma. While 670 patients (1.2%) were operated on, 43,976 patients (76.7%) did not indicate operation, and 12,670 patients (22.1%) could not be operated on despite the recommendation. The mean survival was 62 months in those without an indication for surgery, and 42 months in patients with an indication but could not be operated on, and the difference was significant (p = 0.001). The mean survival was 58 months in the operated patients, and 42 months in the patients who could not be operated on despite the indication, and the difference was significant (p = 0.001). There was no difference between those who did not indicate surgery and those who were operated on with an indication (p = 0.243). CONCLUSION: In multiple myeloma, the best prognosis is in the group of patients who received medical treatments without any indication for operation, while an indication for operation indicates a worse prognosis. A worse prognosis should be expected in patients who do not accept the operation or who cannot be operated on compared to the operated patients.

Do metastatic volumes measured in breast cancer patients with bone metastases correlate with the numbers of skeletal and extraskeletal events?

OBJECTIVES: The study aimed to investigate the relationship between metastatic volume measurement, skeletal-related events, and survival in women diagnosed with breast cancer and bone metastases. PATIENTS AND METHODS: This retrospective study was conducted with 82 female breast cancer patients (mean age: 53±14.3 years; range, 23 to 87 years) diagnosed, treated, and followed up between January 2005 and December 2019. The collected data included information on metastasis sites and the presence of skeletal-related events. Metastatic volume was measured in two ways: the number of metastases (high to low) and their localization (the first, second, and third groups). The first group consisted of vertebrae, ribs, sternum, and calvarial bones; the second group included scapula, clavicle, proximal humerus, and proximal femur regions; the third group consisted of femur and humerus diaphyseal and distal regions, as well as metastasis regions in other long bones. RESULTS: Sixty-three (76.8%) patients were diagnosed with ductal carcinoma. Half of the patients had bone metastases at the time of initial diagnosis, while 62 (75.6%) experienced skeletal-related events, with at least three events occurring in 30 (36.6%) patients. Bone pain was the most common skeletal-related event. No correlation was found between metastatic volume measurement based on the localization of bone metastases and the number of bones and the occurrence of skeletal-related events (p>0.05 for each). Patients' survival time spanned from one to 231 months (median: 56.8 months) from their first diagnosis. Patients with high metastatic volume, those in the third group, those whose pelvis and lung were involved, and elderly patients had a shorter survival time (p<0.05 for each). CONCLUSION: The study indicates that measuring metastatic volume may be a critical factor in evaluating the survival of breast cancer patients with bone metastases. Future prospective and randomized controlled studies can explore the potential of this measurement to create practical clinical tools.

Knowledge and attitudes of orthopedic surgeons regarding prosthesis joint infection.

BACKGROUND: Periprosthetic joint infection (PJI) is a critical complication after joint arthroplasty and is accompanied by increasing rates of morbidity and mortality. Several studies have aimed at preventing PJI. AIM: To research the knowledge level and attitudes of orthopedic surgeons, who play a key role in both preventing and managing PJI. METHODS: We conducted a web-based survey to evaluate orthopedic surgeons' knowledge level and attitudes regarding PJI. The Likert scale survey utilized consisted of 30 questions which were prepared based on the "Proceedings of the International Consensus on Periprosthetic Joint Infection". RESULTS: A total of 264 surgeons participated in the survey. Their average age was 44.8, and 173 participants (65.5%) had more than 10 years of experience. No statistically significant relationship was found between the PJI knowledge of the surgeons and their years of experience. However, participants who worked in training and research hospitals demonstrated higher levels of knowledge than the ones in the state hospitals. It was also noticed that surgeons' knowledge concerning the duration of antibiotic therapy and urinary infections was not consistent with their attitudes. CONCLUSION: Even though orthopedic surgeons have adequate knowledge about preventing and managing PJI, their attitudes might contradict their knowledge. Future studies are required to examine the causes and solutions of the contradictions between orthopedic surgeons' knowledge and attitudes.

Epidemiological Study of Adamantinoma from US Surveillance, Epidemiology, and End Results Program: III Retrospective Analysis.

OBJECTIVE: Adamantinomas are rare low-grade malignant bone tumors. This study aims to describe the demographic characteristics and survival rates of patients suffering from adamantinomas. METHODS: The National Institute of Cancer Surveillance, Epidemiology, and Recent Results (SEER) database was used, and patients diagnosed with adamantinoma between 1973 and 2016 were screened. Patients were classified according to sex, age, race/ethnicity, and marital status, and also tumors were classified according to year of diagnosis, laterality, type of treatment, and follow-up. RESULTS: The mean age of patients was 30.8 ± 16.7 (range: 4-75). A total of 92 patients were identified; of these, 43 were females and 49 were males. The mean follow-up period was 138.1 ± 90.3 (range: 1-156) months. Mean survival duration was 287.8 ± 15.4 (95% CI: 257.7-317.9) months. Five- and ten-year survival rates were 98.8% and 91.5%, respectively. Besides, survival time was also observed to be independent of gender, age groups, race, marital status, tumor location, and year of diagnosis. CONCLUSION: Adamantinoma is a very rare bone tumor that affects the long bones in lower extremities and is more common in men. Five- and 10-year survival prognoses are reasonably satisfactory. Also, survival time is independent of variables such as gender, age, and tumor location.

Epidemiology, incidence, and survival of synovial sarcoma subtypes: SEER database analysis.

BACKGROUND: Synovial sarcoma (SyS) is a rare malignancy that is typically located on the limbs and occurs predominantly in adolescents. A study in a large population for SyS comparing subtypes has not yet been reported. METHODS: National Cancer Institute's Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with SyS between January 1975 and December 2016. Patients were classified demographically according to gender, age, race/ethnicity, and marital status, and they were also classified by tumors, subtypes, localization, grade, year of diagnosis, laterality, type of treatment, and follow-up results. RESULTS: A total of 3228 patients were included, with a mean age of 39.3 ± 18.8 (range: 1-94), of which 1521 (47.1%) were females and 1707 (52.9%) were males. According to its subtypes, 47.2% were SyS not otherwise specified, 32.3% were spindle cell, 19.9% were biphasic, and 0.6% were epithelioid type. The overall survival period is 138.0 (95% confidence interval: 113.2-162.8) months. Survival duration was found to be significantly different between groups according to gender (log-rank test; p < 0.001), age groups (log-rank test; p < 0.001), race (log-rank test; p = 0.001), marital status (log-rank test; p < 0.001), tumor subtypes (log-rank test; p < 0.001), tumor location (log-rank test; p < 0.001), tumor laterality (log-rank test; p < 0.001), date of diagnosis (log-rank test; p = 0.025), tumor grade (log-rank test; p < 0.001), historic stage (log-rank test; p < 0.001), state of chemotherapy (log-rank test; p < 0.001), state of radiotherapy (log-rank test; p < 0.001), presence of metastasis (log-rank test; p < 0.001), and total number of malignant tumors (log-rank test; p < 0.001). CONCLUSION: Male gender, being colored individual, being over 35 years at the time of diagnosis, epithelioid type, non-head and neck region localization is associated with poor prognosis. While radiotherapy improves survival, benefit of chemotherapy is unclear. LEVEL OF EVIDENCE: III retrospective analysis.

Epidemiology, Incidence, and Survival of Rhabdomyosarcoma Subtypes: SEER and ICES Database Analysis.

Rhabdomyosarcoma is the most common soft-tissue sarcoma in children and adolescents and accounts for 3% of all pediatric tumors. Subtypes include alveolar, spindle cell, embryonal, mixed-type, pleomorphic, and rhabdomyosarcoma with ganglionic differentiation. The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database was queried for patients diagnosed with any type of rhabdomyosarcoma between 1973 and 2014. Patient demographics, tumor characteristics, and incidence were studied with χ2 analysis. Survival was modeled with Kaplan-Meier survival curves and Cox proportional hazards models were used to assess the effect of age and gender on survival. Pleomorphic subtype had higher grade and larger sized tumors compared to other subtypes (p < 0.05). Pleomorphic and alveolar rhabdomyosarcoma had the worst overall survival with a 26.6% and 28.9% 5-year survival, respectively. Embryonal rhabdomyosarcoma had the highest 5-year survival rate (73.9%). Tumor size was negatively correlated with survival months, indicating patients with larger tumors had shorter survival times (p < 0.05). Presence of higher-grade tumors and metastatic disease at presentation were negatively correlated with survival months (p < 0.05). No significant differences in the survival were found between gender or race between all of the subtypes (p > 0.05). This study highlights key differences in the demographic and survival rates of the different types of rhabdomyosarcoma that can be used for more tailored patient counseling. We also demonstrate that large, population-level databases provide sufficient data that can be used in the analysis of rare tumors. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2226-2230, 2019.

Stress fracture of the femoral neck as a complication of revision arthroplasty of the knee: a case report.

Stress fracture of the femoral neck is a rare complication of total knee arthroplasty. We report a case of femoral neck fracture following revision arthroplasty of the ipsilateral knee. Contributing factors may have been the patient's osteoporosis and a period of immobilisation before the revision arthroplasty. The patient was treated successfully with hemiarthroplasty of the hip. In patients who have undergone total knee arthroplasty, complaints of groin pain that radiates to the involved knee should alert to the possibility of a stress fracture of the femoral neck.

The effect of platelet-rich plasma in bone-tendon integration.

BACKGROUND: The operative reconstruction of a torn or insufficient anterior cruciate ligament has become a routine surgical procedure in orthopedics. The long-term success of an anterior cruciate ligament reconstruction depends on the ability of the graft to heal adequately in a bone tunnel. Investigators studying reconstructions described healing within a tunnel as osseous ingrowth and incorporation. In particular, helping the healing using autologous material for the best integration process was a new idea that helped us to set up this study. OBJECTIVES: The purpose of this study is to show the effect of platelet-rich plasma on bone-tendon healing. MATERIAL AND METHODS: Ten New Zealand rabbits were used. The study had 2 groups: (1) a study group including the right extremities of rabbits in which tendon-bone integration was strengthened by plateletrich plasma and (2) a control group including the left extremities of rabbits in which tendon-bone integration was without platelet-rich plasma. On the 56th day postoperatively, the portion of the distal femur containing the tunnel was amputated following the euthanization process for histological evaluation. RESULTS: In the histological evaluation of the tendon-integrated bone segments with platelet-rich plasma, the integration of tendon in the bone was successful without any necrosis formation in most of the tissues. However, in the control group without platelet-rich plasma, the integration was distorted in many zones and some cystic morphologies were present. CONCLUSIONS: The findings of this study showed that using platelet-rich plasma during tendon-to-bone implantation has positive effects histologically. In the literature, many studies are available that have investigated the effect of platelet-rich plasma on anterior cruciate surgery radiologically. However, the histological findings are more reliable than radiological findings because bone-tendon integration is a biological process.

Don't miss it, it might be a hydatid cyst in the gluteus.

Hydatid cyst is one of the five most diagnosed zoonotic diseases in the Mediterranean region. However, intramuscular localisation is very rare. It is reported that muscular involvement constitutes 1-5.4% of all Echinococcus infections. Here we would like to report an unusual case of hydatid cyst in the gluteus muscle, which had been treated with both surgical and medical treatment.

Immunohistochemical analysis of mechanoreceptors in transverse acetabular ligament and labrum: a prospective analysis of 35 cases.

OBJECTIVE: The labrum and transverse acetabular ligament (TAL) are classically described as distinct anatomical structures with abundant mechanoreceptors and free nerve fibers. They deepen the joint and act as natural barriers against dislocation, thus providing additional stability. We hypothesized that severe coxarthrosis leads to elimination of labrum and TAL mechanoreceptors. This study evaluated the microscopic anatomy of the labrum and TAL and specifically investigated the neurological status of these structures. METHODS: Labral and TAL specimens from 35 consecutive patients with coxarthrosis undergoing total hip arthroplasty were dissected into a total of 4 specimens per hip. Formaldehyde-fixed specimens were evaluated for the presence of mechanoreceptors and free nerve endings by neurofilament protein and S-100 protein immunohistochemistry and microscopy. RESULTS: Mechanoreceptors were identified in the labral (2.3/high power field) but not TAL specimens, with a sharp delineation between the tissues. In contrast, both labrum and TAL showed good vascularity with abundant free nerve fibers within fibrous connective tissue (mean, 2.6 sensory fibers/ high power field vs 3.1/high power field, respectively). CONCLUSION: This study demonstrated that the TAL lacks mechanoreceptors. However, TAL and labrum free nerve fibers suggest potential roles as hip pain generators.

Abnormal Development of the Femoral Head Epiphysis in an Infant with no Developmental Dysplasia of the Hip Apparent on Ultrasonography.

INTRODUCTION: In the investigation of hip development in newborns and infants, ultrasonography and radiography are widely used, but their optimal roles in this setting remain controversial. CASE REPORT: Here we describe an 8.5-month-old infant who had undergone hip radiography at a primary care facility and was referred to our hospital to be evaluated for developmental dysplasia of the hip. Ultrasonography showed no developmental dysplasia of the hip according to standard criteria, but developmental retardation of the femoral head was apparent on the radiograph. CONCLUSION: This patient's findings demonstrate that abnormalities in femoral head epiphysis development can go undetected during routine ultrasonographic evaluations for developmental dysplasia of the hip.

Tendon-holding capacities of two newly designed implants for tendon repair: an experimental study on the flexor digitorum profundus tendon of sheep.

BACKGROUND: Two main factors determine the strength of tendon repair; the tensile strength of material and the gripping capacity of a suture configuration. Different repair techniques and suture materials were developed to increase the strength of repairs but none of techniques and suture materials seem to provide enough tensile strength with safety margins for early active mobilization. In order to overcome this problem tendon suturing implants are being developed. We designed two different suturing implants. The aim of this study was to measure tendon-holding capacities of these implants biomechanically and to compare them with frequently used suture techniques. MATERIALS AND METHODS: In this study we used 64 sheep flexor digitorum profundus tendons. Four study groups were formed and each group had 16 tendons. We applied model 1 and model 2 implant to the first 2 groups and Bunnell and locking-loop techniques to the 3rd and 4th groups respectively by using 5 Ticron sutures. RESULTS: In 13 tendons in group 1 and 15 tendons in group 2 and in all tendons in group 3 and 4, implants and sutures pulled out of the tendon in longitudinal axis at the point of maximum load. The mean tensile strengths were the largest in group 1 and smallest in group 3. CONCLUSION: In conclusion, the new stainless steel tendon suturing implants applied from outside the tendons using steel wires enable a biomechanically stronger repair with less tendon trauma when compared to previously developed tendon repair implants and the traditional suturing techniques.

Giant epidermal cyst of the foot.

INTRODUCTION: Epidermoid inclusion cysts are usually composed of epidermal elements implanted into the dermal layers. Patients are seen in the outpatient clinics with a mass. Most of the complaints are mechanical and cosmetic problems. CASE OUTLINE: A 34-year-old female patient was admitted to our clinic because of swelling and pain in her right foot. A palpable mass was detected in the first web. On the x-rays of the foot no osseous lesion was detected.There was a soft tissue mass in the first web according to MRI report. Soft tissue mass was excised and sent to pathology. According to pathology report the mass was an epidermoid cyst 5 x 2 x 1.5 cm in size.There were no problems during follow-up of the patient for 6 months after surgery. The patient had no swelling in the foot and had no additional complaints on checkup. CONCLUSION: In the differential diagnosis, we should take into consideration epidermoid cyst of large soft tissue masses of the foot. Surgical excision should be done within the appropriate limits.

Distal radius measurements and efficacy of fixed-angle locking volar plates.

AIM: For surgical treatment of unstable distal radius fractures, fixed-angled locking volar plate fixation is becoming popular nowadays because of some advantages over other surgical techniques. In this article, we discuss the fitting of fixed-angle locking volar plates to the distal radius in relation to the changes in the distal radial angles. MATERIALS AND METHODS: First, we took conventional radiography images of 18 dried radii and later we measured the palmar subchondral angle, dorsal subchondral angle, mid-subchondral angle, and palmar cortical angle using lateral radiography. RESULTS: According to the measurements, the volar subchondral angles (alpha) ranged from 10.2 degrees to 28.1 degrees, the middle subchondral angles ranged from 55.9 degrees to 93.2 degrees, the dorsal subchondral angles ranged from 77 degrees to 109.6 degrees, and the volar cortical angles ranged from 134.5 degrees to 158.4 degrees. CONCLUSION: Although fixed-angle locking volar plates are accepted as anatomical, our measurements showed that volar cortical angles and the subchondral angles are variable. Therefore, the term "anatomic distal radius volar plate" should be discussed.

Anatomical Localization of Lister's Tubercle and its Clinical and Surgical Importance.

The dorsal tubercle of the radius, once called Lister's tubercle, is used as a landmark in wrist arthroscopy, wrist joint injections, and similar surgical and clinical procedures. However, there is no useful information in the reference anatomy books and literature. The aim of this study was to identify the anatomical localization of Lister's tubercle on the dorsum of radius in relation to the radial styloid process and the ulnar notch of radius and to demonstrate the clinical and surgical importance of these relationships. We studied 20 dried cadaver radius specimens. The distances from Lister's tubercle to the radial styloid process and to the ulnar notch were measured by using a digital micrometer caliber and the ratio of the two measures was calculated. The dorsal tubercle of the radius is variable in position and can be either closer to the radial styloid process or to the ulnar notch. The present study showed that in 11 of the radii the dorsal tubercle of the radius was nearer to the radial styloid process than the ulnar notch, while in 9 subjects it was nearer to the ulnar notch. This anatomical variation may be relevant for wrist injections, wrist artroscopy or wrist surgery.

Liberação percutânea do dedo em gatilho com micro bisturi oftalmológico vitreorretiniano de lâmina 19 / Percutaneous trigger finger release with microvitreoretinal 19 gauge ophtalmologic knife

OBJETIVO: Desenvolver uma nova técnica de liberação percutânea do dedo em gatilho, usando microbisturi oftalmológico vitreorretiniano (MVR) de lâmina 19. MÉTODO: O tratamento conservador do dedo em gatilho inclui, com frequência, injeção local de esteroide. Esse método apresenta alta taxa de falha, sendo necessárias injeções repetitivas. Quando o tratamento conservador falha, recomenda-se a liberação a céu aberto da polia A1. Foram relatados vários métodos que empregam diversos instrumentos. Usamos um microbisturi oftalmológico vitreorretiniano (MVR, de microvitreoretinal blade) de lâmina 19 na liberação percutânea do dedo em gatilho. RESULTADOS: Liberamos 50 dedos em gatilho por via percutânea com essa lâmina. CONCLUSÃO: Foram obtidos resultados satisfatórios em 45 deles (90 por cento). Nivel de Evidência VI, série de casos.

OBJECTIVE: Conservative treatment of trigger finger includes often local injection of steroid. This has a high rate of failure and repeated injections may be required.METHODS: When conservative treatment fails, open release of the A1 pulley is recommended. Various methods using various instruments have been reported. We used 19 gauge microvitreoretinal (MVR) ophthalmic knife in percutaneous release of trigger finger.RESULTS: We released 50 trigger fingers percutaneously with this knife. Satisfactory results were achieved in 45 of them (90%). Conclusion: Object of this study is to produce a new technique for percutaneous release of trigger finger using 19 gauge microvitreoretinal (MVR) ophthalmic knife.CONCLUSION: Satisfactory results were achieved in 45 of them (90%). Level of Evidence: Level IV cases series.