Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures: decision making with MRI.

PURPOSE: The purpose of the present study is to evaluate scaphoid delayed fractures or nonunions treated by percutaneous fixation with MRI correlations. METHODS: We evaluated 33 consecutive scaphoid delayed unions or nonunions treated by dorsal percutaneous fixation at a mean 16 months (range, seven to 48 months) after the operation. There were 31 male and two female patients with an average age of 29 years (range, 25-33 years). RESULTS: Pre-operative MRI revealed no signs of avascular necrosis. At the latest follow-up, all patients had good or excellent results. CONCLUSION: We suggest dorsal percutaneous screw fixation for scaphoid delayed fractures or nonunions after eliminating the presence of AVN by pre-operative MRI examination.

Scapholunate dissociation associated with distal radius fractures.

OBJECTIVE: The exact prevalence of scapholunate dissociation (SLD) associated with distal radius fracture (DRF) and the effect of persistent SLD on the function of the wrist are not known. So, we examined the association between SLD and DRF and the effects of treatment on clinical outcomes. METHODS: Eight hundred and twenty-nine patients with 839 DRF were included in the study. The radiographs of the patients were examined with special reference to SLD both in pre- and post-reduction period. Persistent SLD cases were evaluated by the scoring system of Green and O'Brien at least 2 years after the fracture. RESULTS: Of the 839 fractures, 215 had SLD after the injury. When post-reduction radiographs were examined, SLD persisted in 98, but in 14 SLD was detected in the post-reduction period while not apparent in initial radiographs. So, a total of 112 patients (13.4%) had persistent SLD. Nineteen patients were lost to follow-up and remaining 93 wrists examined clinically. Seventy-nine had pain on the scapholunate joint and 14 had not. When these patients were evaluated by Green and O'Brien system, symptomatic patients had fair or poor results but asymptomatic had good. The association between DRF and SLD is 13.4%. CONCLUSIONS: Severity of the distal radius fractures is not associated with SLD. Intra-articular fractures were associated with significant increase in the prevalence of SLD. In some cases, SLD may appear after reduction in distal radius. Most cases with SLD are symptomatic, and this may be the reason of poor cases following distal radius fracture.

Endoscopic versus open in situ decompression for the management of cubital tunnel syndrome.

OBJECTIVE: This study aimed to compare the results of endoscopic in situ decompression (EISD) versus open in situ decompression (OISD) in the management of cubital tunnel syndrome (CUTS). METHODS: In this retrospective study, 32 patients who underwent either OISD or EISD for the treatment of CUTS between 2012 and 2019 were identified and divided into one of the two groups: Group I consisted of 13 patients undergoing EISD and group II consisted of 19 patients receiving OISD. Patients were queried regarding the presence of preoperative and postoperative paresthesia. Electromyography (EMG) was performed on all patients preoperatively and at the final control. Preoperative and postoperative pain with palpation were evaluated over the cubital tunnel. The Dellon classification was used for preoperative evaluation of patient symptoms, and the Bishop classification was used for postoperative evaluation. Hand grip strength was measured with a dynamometer. At the preoperative and postoperative final follow-up, the palmar, key, and tip pinches were measured with a pinchmeter. The surgical incision length was measured with a ruler at the end of the operation in all patients. The operation duration was recorded as the time interval between the beginning of the incision and the end of the tourniquet. RESULTS: The overall mean age was 43.8 (range; 22 to 66) years. Nine patients were female, and 23 patients were male. No Dellon I patients were present in either group. Overall, 68.75% of the patients were Dellon II and 31.25% were Dellon III. According to the Bishop score, excellent and good results were obtained in 84.6% of the patients in Group I and 73.7% of the patients in Group II. The final follow-up examination found continued paraesthesia in 6 (18.75%) patients. Comparison of the improvement in the postoperative NCV value showed a statistically significantly superior improvement in Group I compared to Group II. The postoperative palmar pinch and tip pinch tests results were statistically significantly better in group I than in group II. CONCLUSION: Although EISD had better results clinically, no statistically significant difference was found between the two techniques in terms of Bishop scores and complications. Examination of the electrophysiological results suggested a better outcome in patients who underwent EISD. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Percutaneous Grafting and Screw Fixation in Patients with Scaphoid Nonunion.

Objective The aim of the present study was to analyze the clinical and radiological results of patients with type-V cystic scaphoid nonunion who were treated with percutaneous grafting and screw. Methods A total of 11 patients were treated with a percutaneous bone graft with screw fixation. The criteria for inclusion in the study were a type-V scaphoid nonunion and age > 18 years old. Those with humpback deformity, arthritis, ligament damage determined on magnetic resonance imaging, or avascular necrosis (AVN) in the nonunion fragment were excluded from the study. Results The mean follow-up time was 36 months (range: 15-53 months). At the final follow-up examination, the mean visual analogue scale score was 1.06 (range: 0-2.3). Postoperatively, the mean extension was 61.6° (44-80°), flexion 66° (60-80°), radial deviation 12° (7-20°), and ulnar deviation 25° (20-34°). The mean grip strength of the operated hand was found to be 94%, compared with the healthy side. The results obtained in the Mayo Modified Wrist Score were poor in 2 patients, good in 2 and excellent in 7 (64%). With the exception of 2 patients, union was obtained radiologically in 9 patients, with a mean of 12.6 weeks (range, 8-16 weeks). Conclusion Percutaneous grafting and screw fixation cannot replace open surgery in cases with deformity, shortening, humpbacking, or in long term nonunions; however, it is a reliable and effective treatment method in selected cases, such as Slade & Dodds type-V cystic nonunion.

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.

Comparison of various surgical methods in the treatment of implant-related infection.

The treatment of implant-related infections is troublesome. This study was conducted to compare the effectiveness of three different surgical modalities in the treatment of implant-related infection. A total of 32 Wistar albino rats were randomised into four groups after the establishment of implant-related infection: no treatment, surgical débridement, antibiotic-loaded bone cement and antibiotic-loaded autogenous bone. Microbiological colony counts were made at the sixth week in order to evaluate the effectiveness of of the treatments. The antibiotic-loaded bone cement group revealed superior results compared with the other groups in terms of reduction of microbiological colonies. Three animals in the bone cement group revealed extensive infection. Although antibiotic-loaded bone cement showed superiority over other treatment modalities, it should be employed after an unsuccessful trial of débridement because of the risk of extensive infection.

Functional and radiological results of partial capitate shortening osteotomy in the treatment of Kienböck's disease.

This study assessed the functional and radiological results of partial capitate shortening osteotomy in the treatment of Lichtman stage 2 and 3A Kienböck's disease. Nineteen patients who underwent partial capitate shortening osteotomy between 2014 and 2017 were included. Functional and radiological parameters were assessed both pre- and postoperatively. The mean age was 35 years and the mean follow-up was 16 months. Pain scores, wrist range of motion, hand and finger strength, carpal height ratio and lunate height were significantly improved compared with their preoperative values. Sixteen patients were able to return to work. Ten of them had complete and six had partial revascularization. The mean time taken to return to work was 62 days. No vascularity was achieved in three patients who were unable to return to work. Partial capitate shortening osteotomy is effective in the treatment of stage 2 and 3A Kienböck's disease with successful results both functionally and radiologically. Level of evidence: IV.

Operative management of type III extension supracondylar fractures in children.

The purpose of this study was to compare primarily open versus primarily closed surgical treatment of Gartland type III extension supracondylar fractures in children. Also the outcomes of different pinning techniques in open surgery were evaluated retrospectively. Eighty displaced type III extension supracondylar fractures treated consecutively at two different centres were included. The treatment protocol of one institute was primarily closed reduction and percutaneous cross-pinning (n = 43). The treatment protocol of the other institute was primarily open reduction and internal fixation (n = 37) with two lateral parallel pins (n = 11), cross pins (n = 11) and two lateral and one medial pin (n = 15) according to the stability and configuration of the fracture. According to Flynn's criteria the outcomes of the open and closed reduction groups were not statistically significant (P > 0.05). Although the outcomes of closed reduction showed no superiority over open reduction, it should be the first choice of treatment due to its low morbidity and short hospital stay.

Arthrodesis of neuropathic ankle joint by Ilizarov fixator in diabetic patients.

BACKGROUND: Fusion of the neuropathic ankle joint is extremely difficult and associated with many complications. The use of the Ilizarov fixator in ankle fusion for patients with neuropathic arthropathy is not clear. We aimed to evaluate the results of the Ilizarov method for ankle arthrodesis in diabetic patients with neuropathic arthropathy. METHODS: We report the results of neuropathic ankle joint arthrodesis performed with the Ilizarov apparatus in 11 patients. The mean age of the patients was 51 years (range, 35-67 years), all patients were diabetic, and they all had a history of ankle trauma unresponsive to conservative treatment. Deformity and instability of the ankle resulting in a nonplantigrade foot was the operative indication. RESULTS: Solid fusion was obtained in all patients except one, at an average of 16.1 weeks (range, 12-20 weeks). At final follow-up, excellent results were obtained in three patients, good in six, fair in one, and poor in one. No major complication occurred. CONCLUSIONS: The Ilizarov fixator may be an alternative and effective means for neuropathic ankle arthrodesis, especially when the usage of internal fixation methods have some limitations.

Bilateral stress fractures of the distal fibula in a woman with osteoporosis: a case report.

Bilateral stress fractures of the fibula are very rare. We present an unusual case report of a 54-year-old osteoporotic woman with bilateral stress fractures involving the distal fibula. After conservative treatment, she made a good recovery with full motion and was free of pain.

Predatory journal preference in the field of Orthopaedics and Traumatology in Turkey.

OBJECTIVE: The aim of this study was to determine the prevalence of predatory journals in Orthopedics and Traumatology and to investigate the relationship of these publications with the regulations of scientific fields made in recent years in Turkey. METHODS: The journals and publishers between the years 2000-2018 were screened and websites visited one by one on the basis of the orthopedic journals and publishers list determined as predators or possible predators. Orthopedic publications originated from Turkey was detected in these predatory journals. Article admissions, article processing charges, editorial and referee average response times were reviewed from the websites of journals. In addition, the effect of changing associate professorship application requirements and academic incentive regulation on the preference of predatory journals was examined. RESULTS: Between 2000 and 2018 years 1626 issues which can be reached in 282 journals were examined. 4795 articles were screened in 29 journals which have articles originated from Turkey. One hundred and six (2.21%) articles which originated from Turkey was reached in these publications. Average article processing charge was $865 ($ 0-1819). Fifty-nine of 106 (55%) articles originated from Turkey were found in only 4 journal. Journals which have articles originated from Turkey were not on the Web of Science list. The response time to the articles was between 2 and 6 weeks in these journals. After the change criteria in associate professorship in 2016, 3.32 fold increase in annual average number of publications originated from Turkey have been identified in predatory journals. After the change criteria in academic incentive regulation in 2015, 4.76 fold increase in annual average number of publications originated from Turkey have been identified in predatory journals. CONCLUSION: The number of articles in predatory journals is increasing all over the world. This situation also valid in the field of Orthopaedics and Traumatology in Turkey. Authors should pay attention regarding predatory journals not only article processing charges but also very short evaluation period.

Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older.

OBJECTIVE: The aim of this study was to evaluate the efficacy of conservative treatment (cast immobilization) for complex intra-articular distal radius fractures (AO type C) in elderly patients and to determine whether or not the application of a volar locking plate (VLP) is necessary. METHODS: A retrospective study on patients treated at two different clinics was conducted between 2014 and 2016. A total of 49 elderly patients ≥60 years old were treated either operatively with volar locking plate fixation (n = 25; 7 males and 18 females; mean age: 66.6 ± 7.4 years) or conservatively with cast immobilisation (n = 24; 7 males and 17 females; mean age: 68.9 ± 8.7 years) for complex intra-articular distal fractures. Clinical, functional and radiological evaluations were conducted at the final follow-up examinations of the patients. RESULTS: There was no statistically significant difference between the two groups of patients with respect to the follow-up periods, gender, age and fracture type (p > 0.05). At the end of mean follow-up time of 16 months the grip strength (p = 0.03), radial tilt (p = 0.06), radial inclination (p = 0.01), radial height (p = 0.01) and articular step-off (p = 0.02) were significantly better in the volar locking plate group, while there was no significant difference between the functional results (based on the Quick Disabilities of the Arm, Shoulder and Hand score) (p = 0.8) and range of motion. The grip strength was significantly higher in the VLP group when compared to the cast group (p = 0.03). CONCLUSION: The results of this study suggest that the locking plate fixation for the complex intra-articular distal radius fractures provides better results for the grip strength and radiographic parameters than cast immobilization in patients ≥60 years old, while no difference was found between the clinical and functional results. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders-A Comparative Study With Systematic Review of the Literature.

BACKGROUND: Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the contribution of such combination to results isn't known well. OBJECTIVES: We performed a comparative study to evaluate the effects of PIN neurectomy for PRC and a systematic review of the literature was performed to identify whether such combination has an advantage. METHODS: Patients with wrist diseases who underwent PRC were evaluated retrospectively. Patients without PIN neurectomy (group 1, n = 7) and with PIN neurectomy (group 2, n = 8) were compared in respect of mean age, follow-up, gender, Q-DASH, VAS, MAYO wrist scores, flexion-extension/radial-ulnar deviation range of motion at final follow-up. The MEDLINE database was searched for studies published between 2005 and 2015, as the second part of the study. The following keywords were used: "proximal," "row," "carpectomy." Studies, which met the inclusion criteria, were evaluated in terms of such combination. RESULTS: There were no significant difference between the groups in regard with age (P = .463), follow-up period (P = .728), the ranges of flexion-extension (P = .431) and radio-ulnar deviation (P = .689), Q-DASH (P = .452), and MAYO scores (P = .728). In the second part of the study, 12 studies met the inclusion criteria and none of them was specifically evaluating such combination. Only one study had specific comments on PRC with PIN neurectomy. CONCLUSION: According to our study (which, to our knowledge, was the first comparative study in the literature), we advocate not to combine PRC with PIN neurectomy for such an approach has no advantage.

HISTORIQUE: La résection interosseuse postérieure (IOP) combinée à la carpectomie proximale (CTP) est favorisée pour stimuler une convalescence rapide. Cependant, on en connaît mal l'apport sur les résultats. OBJECTIFS: Les auteurs ont procédé à une étude comparative pour évaluer les effets de la neurectomie IOP pour la CTP et à une analyse bibliographique systématique pour déterminer si cette combinaison comportait des avantages. MÉTHODOLOGIE: Les chercheurs ont soumis les patients ayant une maladie du poignet qui avaient subi une CTP à une évaluation rétrospective. Ils ont comparé les patients sans neurectomie IOP (groupe 1, n = 7) à ceux en ayant subi une (groupe 2, n = 8) pour ce qui est de l'âge moyen, du suivi, du sexe, des scores du poignet Q-DASH, VAS et MAYO, ainsi que de l'amplitude de flexion­extension et de déviation radio-ulnaire au suivi final. Dans la deuxième partie de l'étude, ils ont effectué des recherches dans la base de données MEDLINE pour en extraire les études publiées entre 2005 et 2015. Ils ont utilisé les mots-clés suivants: proximal, row, carpectomy. Ils ont évalué les études qui respectaient les critères d'inclusion en fonction de cette combinaison. RÉSULTATS: Les chercheurs n'ont constaté aucune différence significative entre les groupes pour ce qui est de l'âge (p = 0,463), de la période de suivi (p = 0,728), de l'amplitude de flexion­extension (p = 0,431) et de déviation radio-ulnaire (p = 0,689), ainsi que des scores Q-DASH (p = 0,452) et MAYO (p = 0,728). Dans la deuxième partie de l'étude, 12 études respectaient les critères d'inclusion et aucune n'évaluait expressément cette combinaison. Une seule étude incluait des commentaires sur la CTP combinée à la neurectomie IOP. CONCLUSION: D'après la présente étude, qu'ils croient être la première étude comparative sur le sujet, les chercheurs préconisent de ne pas combiner la CTP à la neurectomie IOP, car elle ne comporte aucun avantage.

Partial Capitate Shortening Osteotomy and Its Impact on Lunate Revascularization: Mid-Term Results.

BACKGROUND: Treatment of Kienböck disease is still a clinical challenge. The treatment used in each instance is decided according to stage of the disease at presentation. Good clinical and radiological results could be obtained with partial capitate shortening osteotomy. However, mid-term results of this technique and its effect on lunate revascularization are not well known. OBJECTIVES: The aim of this study was to report our results of partial capitate shortening osteotomy in the treatment of stage II and IIIA Kienböck disease. METHODS: Ten patients were enrolled in the study with a mean age of 37.7 years old (standard deviation [SD] = 9.6). Patients were evaluated clinically in terms of range of motion, DASH and VAS scores, satisfaction with the outcome, and grip/tip/palmar/key pinch strength compared to the contralateral side. Radiological evaluation consisted of Lichtman staging on plain radiographs and lunate revascularization on magnetic resonance imaging (MRI) at both preoperative and postoperative evaluations. RESULTS: The mean duration of follow-up was 55.2 (SD = 24) months. The mean DASH and VAS scores were 14.3 (SD = 6.7) and 1.5 (SD = 1.3), respectively. For patient satisfaction, the mean score was 3.6 (SD = 0.6). The Lichtman stage of 7 patients remained unchanged. Lunate revascularization was detected with MRI in 6 patients. CONCLUSIONS: Although the number of patients in the study prevents more strict conclusions, our results are promising, and the technique presented offers minimally but observable lunate revascularization and high success rates in preventing the progression of the disease.

HISTORIQUE: Le traitement de la maladie de Kienböck demeure un défi clinique. Dans chaque situation, le traitement dépend de la phase de la maladie à la consultation. On peut obtenir de bons résultats cliniques et radiologiques grâce à une ostéotomie partielle de raccourcissement du capitatum. On connaît toutefois mal les résultats à moyen terme de cette technique et ses effets sur la revascularisation de l'os semi-lunaire. OBJECTIFS: La présente étude visait à rendre compte des résultats de l'ostéotomie partielle de raccourcissement du capitatum dans le traitement de la maladie de Kienböck de stade II et IIIA. MÉTHODOLOGIE: Dix patients d'un âge moyen de 37,7 ans (ÉT 9,6) ont participé à l'étude. Les chercheurs ont évalué l'amplitude de mouvement de ces patients, leurs scores DASH et VAS, leur satisfaction envers les résultats et leur force de préhension des doigts, de la paume et de la pince sub-termino-latérale par rapport au côté controlatéral. Ils ont procédé à une évaluation radiologique préopératoire et postopératoire au moyen de la classification de Lichtman par radiographie classique et de la revascularisation de l'os semi-lunaire par imagerie par résonance magnétique (IRM). RÉSULTATS: Le suivi avait une durée moyenne de 55,2 mois (ÉT 24). Les scores DASH et VAS moyens s'élevaient à 14,3 (ÉT 6,7) et à 1,5 (ÉT 1,3), respectivement. Le score moyen de satisfaction des patients était de 3,6 (ÉT 0,6). Le stade de Lichtman de sept patients est demeuré stable. Chez 6 patients, l'IRM a révélé une revascularisation de l'os semi-lunaire. CONCLUSIONS: Même si le peu de patients à l'étude empêche les auteurs de tirer des conclusions plus rigoureuses, les résultats sont prometteurs. La technique utilisée entraîne une revascularisation de l'os semi-lunaire minime, mais observable, et empêche l'évolution de la maladie dans une grande proportion des cas.

Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study.

When performing a medial opening wedge upper tibial osteotomy, a fracture into the lateral cortex can lead to loss of stability of the construct. The aim of this study was to assess different intra-operative techniques to overcome this problem, and test the stability under axial compression. Twenty eight calf tibias had a medial opening wedge osteotomy and lateral cortical fracture created and then were tested in four groups depending on how this fracture was fixed; none, a plate and screws, two staples, and a circular external fixator. Loss of medial height of the osteotomy line and lateral cortex micromotion was evaluated under maximal axial loading of 2,500 N. No fixation had significantly inferior results compared with the other three types. The plate and screws and staples showed better results than circular external fixation in terms of preserving the medial height, whereas the plate and screws and circular external fixator showed better results compared with staples in terms of lateral cortex stability. This study suggests that plate and screw fixation for lateral cortex disruption during the medial opening wedge upper tibial osteotomy has better stability under axial compression than staples or a circular external fixator.

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.

The effects of suramin in prevention of peritendinous adhesions following flexor tendon injury in a chicken model.

Peritendinous adhesions are the most common complication of flexor tendon injuries. Overproduction of transforming growth factor Beta has been reported as a major cause of tissue fibrosis. This study investigated the effects of suramin, a known inhibitor of transforming growth factor Beta, on the formation of flexor tendon adhesions in a chicken model. Forty-two chicken flexor tendons that were divided partially were repaired using a modified Kessler technique. The chickens were divided into 3 groups. In group 1 (control), no suramin was administered to the tendon repair site; in group 2, 1 mg of suramin was injected around the tendon repair site; and in group 3, 2 mg of suramin was injected around the tendon repair site. At 6 weeks postoperatively, the animals were sacrificed, and functional, histologic, and biomechanical examinations were performed. There was no difference between the groups in terms of tendon excursion. Histologic evaluation showed adhesions were decreased in the groups treated with suramin. In the biomechanical evaluation, a statistically significant difference was present only between the group treated with 2 mg of suramin and the control group. Although suramin is effective in preventing peritendinous adhesions, it can reduce tendon strength as dose-dependent. Future studies should be performed with different doses to determine clinical application.

[In vitro evaluation of gentamicin and teicoplanin release from cancellous human bone]. / Insan süngerimsi kemiginden gentamisin ve teikoplanin saliniminin in vitro degerlendirilmesi.

OBJECTIVES: This study was designed to determine the in vitro antibacterial activity of gentamicin- or teicoplanin-impregnated human cancellous bone as a local antibiotic carrier. METHODS: The study samples were obtained from human cancellous bone within the femur head in seven patients who underwent partial or total hip arthroplasty. Bone specimens were processed and incubated with gentamicin or teicoplanin for an hour. Control bone specimens were soaked in sterile saline solution for the same duration. Antibiotic release of bone specimens was assessed by the disc diffusion technique after 1, 3, 7, 10, 14. 18, and 21 days of antibiotic impregnation, with seven samples in each group. The test strains were E. coli ATCC 25922 for gentamicin, and S. aureus ATCC 25923 for teicoplanin. In vitro antibiotic efficacy was defined as an inhibition zone diameter of = or >15 mm for gentamicin, and = or >14 mm for teicoplanin. RESULTS: Evaluation of inhibition zone diameters showed that bone-teicoplanin complexes had a longer duration of antibiotic release than that of bone-gentamicin complexes (12 to 18 days vs 7 to 10 days). There was no inhibition in the control group. There were no significant differences in inhibition zone diameters of teicoplanin- and gentamicin-treated specimens on the first and third days; however, teicoplanin exhibited significantly greater zone diameters on the seventh (p=0.008) and tenth (p=0.003) days. CONCLUSION: Our data show that, under appropriate conditions, human cancellous bone incorporates a considerable amount of teicoplanin and exhibits effective antibiotic release for approximately two weeks.