A rare complication after intertrochanteric fracture treated with proximal femoral nail: femoral neck insufficiency fracture.

We present a case, 82-year-old woman, sustaining intertrochanteric fracture treated with proximal femoral nail. Up to 14 months postoperatively, everything went on seamlessly. Then, there was a rapid onset of worsening of the functional capacity. She came to outpatient clinic by using wheelchair. Plain X-rays revealed a femoral neck fracture on the operative side with no history of trauma. Laboratory studies showed no significant abnormalities but vitamin D [25 (OH) D] level was 14.82 ng/ml. X-ray survey of skeletal system was not indicative of osteomalacia. We performed total hip replacement instead of internal fixation due to patient's age. Vitamin D replacement therapy was launched. Three months later, she was totally satisfactory with clinical result and 25 (OH) D level increased to 53.68 ng/ml. At the last visit, the patient was pain free and active in all her recreational activities.

Retroperitoneal migration of a septically loose femoral component.

Migration of total hip arthroplasty components is generally associated with a medial acetabular wall defect and may cause various intrapelvic complications. This is often a result of the destructive bone loss that takes place with infection. To our knowledge, this is the first report that presents complete intrapelvic migration of a femoral stem of total hip arthroplasty due to septic loosening with an intact medial acetabular wall.

Fracture dislocation of sacroiliac joint associated with triradiate cartilage injury in a child: a case report.

We report a very rare injury of a 8-year-old girl with sacroiliac fracture dislocation and triradiate cartilage separation. After the restoration of the sacroiliac joint by open means, reduction of the separated cartilage was seen. At 20 months follow-up, an osseous bridging at the triradiate cartilage and mild coxa valga deformity developed. We think that every child with serious sacroiliac joint injury should be evaluated for associated triradiate cartilage injury and followed to skeletal maturity for late complications such as acetabular dysplasia, hip subluxation and pelvic asymmetry.

Iloprost and pentoxifylline attenuate ischemia-reperfusion injury in skeletal muscle in rabbit model.

BACKGROUND: We investigated the effects of iloprost and pentoxifylline on skeletal muscle ischemia-reperfusion injury in a rabbit model. METHODS: Forty New Zealand white rabbits were grouped into four. In Group 1, iloprost was continuously infused starting half an hour before the reperfusion following a 2-hour ischemia formed by abdominal aortic occlusion, and it was continued during the 4-hour reperfusion period. Group 2 was treated with pentoxifylline, and Group 3 received saline solution. Group 4 was the sham group. Malondialdehyde levels and edema scores in gastrocnemius muscle were evaluated. RESULTS: Edema score was significantly lower in Group 1 when compared with the control group (Group 1 vs Group 3, p=0.040; Group 2 vs Group 3, p=0.145; Group 1 vs Group 2, p=0.580). Malondialdehyde levels of the medicated groups were significantly lower when compared with the control group (Group 1: 60+/-11 nmol/g tissue, Group 2: 74+/-11 nmol/g tissue, Group 3: 95+/-10 nmol/g tissue; Group 1 vs Group 2, p=0.010; Group 1 vs Group 3, p<0.001; Group 2 vs Group 3, p<0.001; Group 1 vs Group 4, p<0.001; Group 2 vs Group 4, p<0.001; Group 3 vs Group 4: p<0.001). CONCLUSION: Acute skeletal muscle ischemia is a common problem. We are of the opinion that in the early phase of skeletal muscle ischemia, iloprost and pentoxifylline medication may reduce ischemia-reperfusion injury.

[Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure]. / Kronik renal yetmezlikli bir hastada femur boyun kirigi ve iki tarafli kuadriseps tendon kopmasi.

Simultaneous bilateral quadriceps tendon rupture is a very rare injury mostly seen in patients with chronic renal failure or other systemic chronic diseases. Metabolic acidosis in chronic renal failure predisposes these patients to tendon degeneration. A 37-year-old woman who received hemodialysis for chronic renal failure for two years presented with complaints of severe pain in the left hip and inability to walk. She had a history of two consecutive falls in the past two months. On physical examination, there were joint spaces in both suprapatellar areas, active extension of both knees was inhibited, and movements of the left hip were quite painful. Knee ultrasonography and magnetic resonance imaging showed bilateral quadriceps tendon rupture from patellar attachment. At surgery, full-thickness quadriceps tendon tears were repaired with Tycron transpatellar suture anchors. Internal fixation was not considered for hip fracture due to the presence of chronic renal failure, so hemiarthroplasty with bipolar endoprosthesis was performed in the same session for femoral neck fracture. Six months after the operation, the patient was able to walk without support and almost regained her normal knee functions.

[Factors associated with failure in the surgical treatment of shoulder instability]. / Omuz instabilitesinde cerrahi tedavilerin basarisizlik nedenleri.

Open and arthroscopic surgical techniques are used to treat shoulder instability. There may be various reasons of failure related to these techniques, the understanding of which may increase success rates. In this paper, we evaluated the factors associated with failure in open and arthroscopic surgical repairs of anterior, posterior, and multidirectional instability, together with possible solutions.

A case of myositis ossificans as a complication of tetanus treated by surgical excision.

Myositis ossificans is a heterotopic ossification of skeletal muscles which is commonly seen after trauma. However, it is rarely seen as a complication of tetanus. We report a case of myositis ossificans following tetanus in a female adult patient presenting with ankylosis of both elbows in extension.

The effect of early weight-bearing on comminuted calcaneal fractures treated with locking plates.

OBJECTIVES: This study aims to evaluate the possible effects of early weight-bearing on clinical and radiological outcomes of comminuted calcaneal fractures treated with locking plates. PATIENTS AND METHODS: This retrospective study included 15 patients (12 males, 3 females; mean age 40.1 years; range 18 to 55 years) with comminuted calcaneal fractures between October 2010 and April 2012. Standard lateral extensile approach was carried out for surgical exposure. A corticocancellous allograft was used to fill the defect following the reduction and fixation of posterior facet. Titanium locking plates and screws were used to maintain reduction. The patients were encouraged for a limited weight-bearing at six weeks postoperatively, if tolerated. All patients were able to full weight-bear at 12 weeks postoperatively. Clinical and radiological assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) and Maryland scores. RESULTS: The mean follow-up was 19 months (range, 12 to 27 months). The AOFAS and Maryland scores were 89 and 88.46 points, respectively. The Böhler's angle showed 0.3° loss from early post-surgery to the last visit. Among the workers, all returned to work but one with Sanders type IV fracture and all retired patients returned to their daily activities. The functional status of the patient with Sanders type IV fracture was poor according to the AOFAS and Maryland criteria. CONCLUSION: Based on radiographic and clinical assessment, there was no unfavorable effect of early weight-bearing after calcaneal fracture surgery. Therefore, these results suggest that sufficient stability can be achieved by locking plates in comminuted calcaneal fractures, when early weight-bearing is recommended, even.

Relationship between clinical and electrophysiological results in surgically treated carpal tunnel syndrome.

OBJECTIVES: In this study, relationship between clinical and electrophysiological results of decompression via mini incision technique was investigated. PATIENTS AND METHODS: Thirty-nine hands of 38 patients (35 females, 3 males; mean age 54.8 years; range 33 to 81 years) with carpal tunnel syndrome who were treated surgically in our clinic between April 2004 and February 2009 were included into the study. Patients were evaluated clinically and electrophysiologically both in pre- and postoperative period. RESULTS: There was a difference between pre- and postoperative clinical results (p=0.00). Clinically, the mean symptom severity and functional status scores were decreased in 36 hands (92.3%). Postoperative electrophysiological grades were significantly improved compared to the preoperative ones. There was a significant difference between the pre- and postoperative clinical scores in all of the preoperative electromyography grades, except for the moderate grades. However, no relation was found between the electrophysiological grades and the clinical results in both pre- and postoperative period. CONCLUSION: This study shows that in spite of clinical improvement after carpal tunnel syndrome surgery through mini incision technique, electrophysiological findings were still suggesting the presence of varying degrees of carpal tunnel syndrome in postoperative period.

[Mortality and morbidity in elderly patients who underwent partial prosthesis replacement for proximal femoral fractures]. / Parsiyel protez ile tedavi edilen yasli femur ust uç kiriklarinda mortalite ve morbidite iliskisi.

OBJECTIVES: The purpose of this study was to evaluate mortality and morbidity correlation in elderly patients who underwent partial prosthesis replacement for proximal femoral fractures. PATIENTS AND METHODS: The study was conducted in patients over 65 years of age who were admitted to the Izmir Atatürk Training and Research Hospital from 2002 to 2007 for the surgical treatment of proximal femoral fracture. All the patients were treated with hemi-arthroplasty. Among 1275 patients 280 patients (115 males, 165 females; mean age 75.2; range 65 to 99 years) followed up for at least one year were included in the study. A regression analysis was performed to investigate the effects of preoperative and postoperative walking capacity, duration of hospitalization, co-morbidities, age and the time of the operation on mortality. RESULTS: Mortality was significantly higher among patients who had more co-morbid factors, long delay between the time of the fracture and the operation, advanced age and poor walking ability after operation. CONCLUSION: Special attention should be given to the associated co-morbid factors, walking capacity and operation time during treatment planning of hip fractures in elderly patients.