Comparison of the clinical and sonographic effects of ultrasound therapy, extracorporeal shock wave therapy, and Kinesio taping in lateral epicondylitis

Background/aim: The aim of this study was to compare the clinical and sonographic effects of the ultrasound (US) therapy, extracorporeal shock wave therapy (ESWT), and Kinesio taping (KT) in the lateral epicondylitis (LE). Materials and methods: A total of 40 patients with LE were included in the present study. The patients were randomly assigned to 3 treatment groups: US (n = 13), ESWT (n = 14), and KT (n = 13) groups. Results: The visual analog scale (VAS) scores significantly decreased in all groups (P < 0.05). Grip strength significantly increased after 8 weeks in only the KT group (P < 0.05). The Patient-Rated Tennis Elbow Evaluation Scale (PRTEE) scores significantly decreased after 2 weeks and after 8 weeks in the US group and ESWT groups, and after 8 weeks in the KT group (P < 0.05). Common extensor tendon (CET) thicknesses significantly decreased after 8 weeks in only the ESWT group (P < 0.05). Conclusion: The US therapy, KT, and ESWT are effective in reducing pain and improving functionality. However, none of these treatment methods were found to be superior to others in reducing the pain and improving functionality.

Are unilateral or staged bilateral total knee arthroplasty really safer than simultaneously bilateral TKA, or is it a myth?

The purpose is to evaluate feasibility of simultaneous TKA in comparison with staged and unilateral procedures. Number of patients included: 72 simultaneous bilateral, 61 staged bilateral and 222 unilateral TKAs were included. The mean age in the simultaneous group was lower than the other groups. Heart failure as comorbidity was observed less in the simultaneous TKA group than the other two groups. There was no significant difference between simultaneous and staged groups with respect to postoperative WOMAC and SF36 scores. Rates of thrombotic complications and mortality were not different. There was no significant difference in terms of wound healing, periprosthetic infection and TKA revision rates. Younger age and heart failure as a comorbidity were found to be decisive in the selection of simultaneous procedure. Thus, in the case of advanced bilateral knee osteoarthritis, simultaneous bilateral TKA should be performed after a proper preoperative risk assessment when there is a medical rationale, or the patient's personal preference. In the light of aforementioned conditions, hesitancy about simultaneous TKA seems unnecessary.

Isokinetic performance of hip muscles after revision total hip arthroplasty via previous anterolateral approach.

We investigated the isokinetic performance of hip muscles and clinical outcomes after revision total hip arthroplasty (THA) via same anterolateral approach used in primary surgery. Thirty patients who had undergone previous THA via an anterolateral approach underwent both acetabular and femoral component revision after aseptic loosening. The Harris Hip Score (HHS) was evaluated during a minimum 2-year follow-up. The isokinetic muscle strength of the operated and nonoperated hips was assessed 1 year after surgery. The HHS improved from 49.0 to 77.4. Operated and nonoperated hips exhibited similar isokinetic performance during all measurements (flexion, extension, and abduction) (p>0.05). This prospective study showed that the anterolateral approach preserves abductor strength after revision THA in aseptic cases with acceptable functional and clinical results. The main clinical relevance of this study is that the same anterolateral approach used in previous primary THA is also safe and viable for revision THA.

No difference in blood loss between posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-stabilized total knee arthroplasties.

PURPOSE: Posterior-cruciate-ligament-retaining (PCR) and posterior-cruciate-ligament-stabilized (PS) arthroplasties are two major common practices in total knee arthroplasty (TKA). The hypothesis of the present study was that compared with the PCR technique, the PS technique is associated with a higher amount of postoperative blood loss and greater need for blood transfusion in cemented TKA. METHODS: In this prospective, randomized study, 100 patients diagnosed with primary knee osteoarthritis were randomly assigned to either the PCR group (Group I) or the PS group (Group II). The exclusion criteria were rheumatological joint disease, previous knee surgery, anticoagulant therapy and hypertension. There were no significant differences in age, body mass index and gender, between the groups. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on postoperative days 1, 3 and 5. The postoperative suction drainage and blood transfusion volumes were also recorded. RESULTS: There were no statistically significant differences in haemoglobin or haematocrit levels between the groups on postoperative days 1, 3 and 5. There were also no statistically significant differences in the total measured blood loss volume, postoperative drainage amounts or transfusion rates between the groups. CONCLUSION: Use of the PS technique during cemented TKA does not appear to influence the amount of perioperative blood loss or the need for postoperative blood transfusion in general. The clinical relevance of this study is that the difference in blood loss between the PCR and PS techniques does not need to be considered by surgeons when performing TKA.

What if an articular bone fragment drops on the floor in the course of osteosynthesis? An experimental study.

OBJECTIVES: This study aimed to evaluate the effectiveness of a 1-min 10% povidone-iodine immersion in the decontamination of dropped osteochondral fragments. MATERIALS AND METHODS: Forty-eight sets of sterile osteochondral bone fragments, each consisting of three samples, were prepared from removed femoral heads that would otherwise be discarded during different hip replacement surgeries. Immediately afterward, each set was dropped on the floor right behind the surgeon in another operating room in which fracture fixation operations were being performed. Samples were picked up with sterile gloves. A swab culture of the floor was taken. One of the three pieces was kept as the control group. The second one (saline group) was washed with saline and subsequently soaked in saline for 1 min. The last one (treatment group) was first immersed in a 10% povidone-iodine solution for 1 min, then rinsed with saline and soaked in saline for 1 min. The samples were cultured in nutrient media, and microorganisms were identified at the microbiology laboratory. The groups were compared in terms of positive culture rates. RESULTS: The positive culture (contamination) rates were 100%, 58.3%, 39.6%, and 10.4% for the swab samples, control group, saline group, and treatment group respectively. The decontamination ratio in the treatment group was significantly more than both the control group (p<0.001) and the saline group (p=0.001). Handling only with saline did not significantly decontaminate compared to the control group (p=0.066). CONCLUSION: Immersing the dropped osteochondral fragments in 10% povidone-iodine solution for 1 min and then rinsing with saline may provide statistically significant decontamination but cannot be accepted to be safe enough for clinical practice. Further studies are needed to find the optimal time needed for safe decontamination without compromising the viability of cartilage tissue.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

OBJECTIVES: The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. RESULTS: Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. CONCLUSION: Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty.

Although there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50-89 years) and mean follow-up time was 19 ± 7.8 months (range, 6-39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2-23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27-48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

Ipsilateral simultaneous inferior shoulder dislocation and posterior elbow dislocation: A case report.

This case report presents a 21-year-old male construction worker with ipsilateral inferior shoulder and posterior elbow dislocations, accompanied with other injuries. Such a combination of injury undoubtedly occurs; however, to the best of our knowledge, this is the first reported case. The prompt closed reductions without waiting for anesthesia were accomplished without the help of an assistant using a novel technique. The patient returned to his job with considerable recovery of motion and strength despite his permanent paralysis of the deltoid muscle and he was still employed as a worker after four years. He was abducting his arm by using his accessory muscles, which contribute to abduction when arm is externally rotated. The maneuver described in the report can be used to reduce all inferior shoulder dislocations and it is worth to know that working at a job requiring high level of activity is still possible despite a permanent loss of axillary nerve function.

Fit assessment of two different anatomically contoured distal femur plate sets on cadaveric bones.

OBJECTIVES: This study aims to investigate the fitness of two anatomic distal femoral plates with cadaveric femurs and to show whether current plates optimally match each femur. MATERIALS AND METHODS: Two different sets of plates with five, seven and nine shaft holes were applicated on 62 cadaveric femurs. Ball clay was molded onto the entire inner surfaces of the plates and then the plates were fixed to the bones using two self-locking nylon cable zip ties. The volume of ball clay sandwiched in between the plate and bone was calculated and used as a quantitative fit parameter. Data of each plate were analyzed separately. RESULTS: Using Double Medical Technology IncorporatedTM plates, the mean plate to bone volumes were calculated as 8.4 mL (range, 5-14 mL), 10.0 mL (range, 6-17 mL), and 13.1 mL (range, 7-25 mL) in five, seven and nine-hole plates, respectively. Using Zimmer Biomet IncorporatedTM plates, the mean volumes were 10.5 mL (range, 6-21 mL), 12.7 mL (range, 7-22 mL) and 16.3 mL (range, 8-30 mL) in five, seven and nine-hole plates, respectively. Within each group, the measurements were significantly correlated positively with femoral length. CONCLUSION: Optimal fit may not be achieved in each femur using current distal femoral plate implant sets. Thus additional sizes of plates should be supplied in the implant sets.

Early improvement in physical activity and function after total hip arthroplasty: Predictors of outcomes.

OBJECTIVES: This study aims to assess early changes in physical activity and function after total hip arthroplasty (THA) using both subjective and objective methods, and to identify predictors of outcomes of THA. PATIENTS AND METHODS: Between October 2014 and October 2015, a total of 50 patients (14 males, 36 females; mean age 57.1±13.0 years; range, 31 to 75 years) with end-stage primary hip osteoarthritis who were scheduled for THA and 50 age- and sex-matched controls (10 males, 40 females; mean age 52.9±9.3 years; range, 36 to 75 years) were included in the study. Pain was evaluated using the Numeric Rating Scale (NRS), physical function using the Lequesne Index, physical capacity using the Six-Minute Walking Test (6MWT), and physical activity using both International Physical Activity Impact Questionnaire Short Form (IPAQ-SF) and step count monitor. Data at baseline and six weeks and six months were recorded. RESULTS: Pain severity was significantly lower after THA at six weeks and six months (NRS scores: 2.83 and 0.82, respectively; p<0.001), compared to baseline. Physical function, capacity, and activity significantly improved after THA at six weeks and six months with a mean Lequesne Index score of 2.62 and 1.02, respectively. The mean 6MWT distance was 272.62 at six weeks and 326.16 at six months. The mean IPAQ and 6MWT results were similar between the patient and control groups at six weeks and six months. Age, presence of comorbidities, and baseline Lequesne Index score were found to be effective on functional outcomes of THA. Age and baseline 6MWT scores were correlated with physical capacity after THA. CONCLUSION: Our study showed a significant early improvement in pain severity and physical activity and function at six weeks and six months after THA, compared to baseline values. Baseline values and age were the positive predictors of improved postoperative function and physical capacity.

Range of motion of the first metatarsophalangeal joint after chevron procedure reinforced by a modified capsuloperiosteal flap.

BACKGROUND: This study analyzed the range of motion of the first metatarsophalangeal joint following the chevron procedure with increased stabilization using a modified capsuloperiosteal flap in the treatment of hallux valgus cases. MATERIALS AND METHODS: Forty-three feet of 40 patients were treated with modified chevron osteotomies. The patient selection criteria included failure of conservative treatment, painful deformity, age between 18 and 50, hallux valgus and intermetatarsal angles less than 40 degrees and 17 degrees, respectively, and no osteoarthritic changes of the metatarsophalangeal joint. The passive range of motion of the first metatarsophalangeal joint was compared to the hallux valgus and intermetatarsal angles. RESULTS: The mean age of patients was 30.9 +/- 9.0 (range, 18 to 46) years. The preoperative mean hallux valgus angle was 32.2 (range, 22 to 40 degrees), whereas postoperatively it was 13.1 (range, 3 to 22 degrees). The preoperative mean passive total range of motion, dorsiflexion and plantar flexion were found to be 80.2 (range, 71 to 99 degrees), 66.8 (51 to 86) degrees and 13.4 (range, 7 to 23 degrees), respectively, whereas postoperatively these values were 69.2 (range, 48 to 85 degrees), 58.6 (range, 43 to 75) degrees and 10.8 (range, 1 to 20 degrees). According to Bonney and MacNab subjective scores, the feet were evaluated as follows: 12 as excellent, 26 as good, and 5 as moderate. According to objective scores, the evaluation was as follows: 27 as excellent, 14 as good, 1 as moderate, and 1 as poor. CONCLUSION: We believe that the chevron procedure reinforced by modified capsuloperiosteal flap causes minimal irritation and damage to adjacent soft tissues. Furthermore, we conclude that this method is a benefical means of managing moderate hallux vagus deformities by decreasing the stiffness after surgery.

Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type III supracondylar humerus fractures.

The results of closed and open reduction via posterior approach with percutaneous pinning of posteromedial displaced supracondylar humerus fractures in children were evaluated. Fifty-five consecutive patients with Gartland type III fractures were reviewed. The mean follow-up period was 22 months (12-48 months). The closed reduction group consisted of 32 patients and the open reduction group with the posterior approach using the triceps-sparing method consisted of 23 patients. Both groups were stabilized with cross Kirschner wire fixation and followed the same protocol. In comparison with closed reduction, despite the fact that better bone alignment was obtained with open reduction, longer union time (7 vs. 5.8 weeks), significantly reduced range of motion of the elbow (12.3 degrees vs. 3.8 degrees), poorer functional outcomes and bad cosmetics because of hypertrophic scar tissue of the skin were found. The patients were analyzed according to their Bauman angle and Flynn criteria: good or excellent functional and cosmetic results were 91% in the closed reduction group but 52% in the open reduction group. On the basis of results of this study, closed reduction and percutaneous fixation of the posteromedial totally displaced fractures are preferable to open reduction with posterior approach.

[Chondroblastoma of the metatarsal bone and its 17-year follow-up]. / Metatarsal yerlesimli kondroblastom ve 17 yillik takibi.

Chondroblastoma is a rare bone tumor of cartilaginous origin. Metatarsal involvement is very rare, with a few cases. We presented a case of chondroblastoma localized in the fourth metatarsal bone. The patient presented with persistent pain of eight-month duration on the lateral side of his foot, which developed after an inversion ankle sprain. Radiological examination showed a large osteolytic lesion with sclerotic margins in the fourth metatarsal bone. The lesion was treated with extra-articular curettage and autogenous bone grafting. During a 17-year follow-up, the patient had no complaints, and there were no clinical or radiological findings of local recurrence or metastasis.

Is it Possible to Recover Cardiac Functions After Total Knee Arthroplasty?

BACKGROUND: Patients suffering from knee osteoarthritis lead a less active life than their healthy peers. It is well known that insufficient physical activity is the most common cause of chronic diseases. However, there is not enough research to enlighten the effect of increased functional capacity on cardiac functions after Total Knee Arthroplasty (TKA). This study aimed to investigate whether the orthopedic surgeons can predict that the patients will be healthier after TKA in terms of cardiac functions or not? METHODS: 109 patients who underwent TKA were prospectively followed for one year. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short form 36 (SF-36) surveys, BMI measures, average step count per day, the six-minute walking test (6MWT), the Five-Times-Sit-to-Stand Test (FTSST) and Doppler echocardiography were performed both in the preoperative and postoperative period. RESULTS: After TKA, there was a substantial improvement in terms of WOMAC and SF36 survey scores. The average step count increased from 2199.6±690.8 steps/day to 4124.3±1638.8 steps/day. 6MWT and FTSST improved significantly as well. The average brisk walking time was 174.23±95.11 minutes/week. The means of early and late mitral inflow velocity ratios (E/A and Em/Am ratios) increased from 0.71±0.12 to 0.77±0.13 and from 0.66±0.13 to 0.76± 0.15 at the first year follow-up visit, respectively (p<0.001). CONCLUSION: In the first year, objective physical capacity measures increased together with the expected improvements in disease-specific and generic measures. After TKA, left ventricular diastolic functions may be considered to have recovered in the light of the healing signs via echocardiography.

The importance of costoclavicular space on possible compression of the subclavian artery in the thoracic outlet region: a radio-anatomical study.

OBJECTIVES: The purposes of this study were to identify possible compression points along the transit route of the subclavian artery and to provide a detailed anatomical analysis of areas that are involved in the surgical management of the thoracic outlet syndrome (TOS). The results of the current study are based on measurements from cadavers, computed tomography (CT) scans and dry adult first ribs. METHODS: The width and length of the interscalene space and the width of the costoclavicular passage were measured on 18 cervical dissections in 9 cadavers, on 50 dry first ribs and on CT angiography sections from 15 patients whose conditions were not related to TOS. RESULTS: The average width and length of the interscalene space in cadavers were 15.28 ± 1.94 mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43 mm) were significantly narrower than the widths and lengths of the interscalene space in cadavers (P < 0.05). The average width and length of the interscalene space (groove for the subclavian artery) in 50 dry ribs were 15.53 ± 2.12 mm and 16.12 ± 1.95 mm, respectively. In CT images, the widths of the costoclavicular passage were also significantly narrower than those of the interscalene space (P < 0.05). The measurements from cadavers, dry first ribs and CT images were not significantly different (P > 0.05). CONCLUSIONS: Our results showed that the costoclavicular width was the narrowest space along the passage route of the subclavian artery. When considering the surgical decompression of the subclavian artery for TOS, this narrowest area should always be kept in mind. Since measurements from CT images and cadavers were significantly similar, CT measurements may be used to evaluate the thoracic outlet region in patients with TOS.

[Flexible intramedullary nailing of children]. / Cocuk femur cisim kiriklarinda esneyebilen intramedüller çivi uygulamasi.

BACKGROUND: Various methods are being used in the treatment of femur diaphysial fractures in children aged between 6 to 12 years. Titanium elastic nailing is one of the alternatives. We evaluated our experience in flexible intramedullary nailing. METHODS: We investigated 21 patients with femur diaphysial fractures who were with titanium elastic nailing. RESULTS: The mean age of the patients was 9.6+/-2.4 (range between 5.1-14.7 years) and all the fractures were at the diaphysis. The fracture pattern was as following: 9 (42.9%) transverse, 7 (33.3%) oblique, 5 (23.8%) spiral. Fixations were performed with two nails which were implanted in retrograde manner. The average time of follow-up was 29+/-11.6 months (range; 9-48 month). The mean time to fracture union was 13+/-11.9 weeks (4-52). Implant removal was performed after a mean time of 7+/-2.2 months (range; 6-16 month). Patients's hip and knee range of motions were complete and clinically there were no angular or rotational deformity at postoperative one year. There were radiologically 11+/-1.7 (range; 10-15) degrees of varus valgus malalignment in 8 patients; these angles were reduced to 5+/-1.9 (range; 3-9) degrees at the follow of two years. CONCLUSION: The results of the flexible titanium nailing in femur diaphysial fractures of the children, aged between 6 to 12 years, suggest that this method may be a first choice therapy in this particular group of patients.

[The role of functional bracing in the treatment of humeral shaft fractures]. / Humerus cisim kiriklarinda fonksiyonel breys tedavisinin yeri.

OBJECTIVES: We evaluated clinical, radiographic, and functional results of patients treated with functional bracing for humeral shaft fractures. METHODS: Humeral shaft fractures of 30 patients (19 males, 11 females; mean age 34 years; range 18 to 64 years) were treated with functional bracing. Fractures were on the right in 18 patients, on the left in 12 patients. All were closed fractures, being spiral in 10, comminuted in nine, transverse in six, and oblique in five patients. Humeral fractures were in the upper third, middle third, and distal third in 16, 8, and 6 patients, respectively. Functional brace was applied after a mean of six days (range 0 to 16 days) and was worn throughout day and night until radiographic signs of sufficient union and healing was observed. Functional assessment was made according to the Hunter criteria. The mean follow-up was 20 months (range 10 to 58 months). RESULTS: Union was achieved in 24 patients (80%) after a mean of 14 weeks (range 11 to 21 weeks). Six fractures (20%) failed to unite and were subsequently treated with surgery. According to the Hunter criteria, 24 patients (80%) were evaluated as good (G3-4), and six patients (20%) as excellent (G5). The mean varus-valgus rotation was 6 degrees , the mean anterior-posterior translation was 8 degrees in patients who had union with functional bracing. Four patients developed skin macerations secondary to brace use. Limb shortening of 1.7 cm occurred in one patient whose fracture was united with bracing. CONCLUSION: Our clinical and radiographic results suggest that, based on proper indications, functional bracing applied after regression of edema may be the treatment of choice in humeral shaft fractures.

Chemotherapy in primary osteogenic sarcoma in patients over the age of forty.

OBJECTIVE: In this study, we sought to review the clinical and histopathological features and the chemotherapy regimens in osteogenic sarcoma in patients over 40 years of age, and we aimed at identifying the possible prognostic factors in this particular group of patients. METHODS: We reviewed 287 patients with osteosarcoma treated between the year 1986 and 2010. Patients from this group who met the following criteria were considered eligible for our study; presence of primary OS, had typical histological and radiographic features of OS, no prior history of cancer or any treatment elsewhere and no prior history of preexisting bone abnormalities. RESULTS: The Kaplan-Meier survival curve for the entire group, with a 95% confidence interval, at two and five years showed the survival rates as 76.2% and 72.8% respectively. The surgical margin was a significant factor affecting the survival. Presence of a pathological fracture also had a significant effect on the survival rate. CONCLUSION: Osteogenic sarcoma remains a challenging disease to treat. Despite the expectation that elderly patients may not tolerate aggressive modern chemotherapy as the younger patients, we believe that patients with primary OS over the age of 40 should be treated aggressively with effective chemotherapy and complete surgical excision whenever possible. LEVEL OF EVIDENCE: Level IV, therapeutic study.

[Capsuloperiosteal flap application for the stabilization of chevron osteotomy]. / Chevron osteotomisinin stabilizasyonu amaciyla kapsüloperiosteal flep uygulamasi.

OBJECTIVES: We retrospectively analyzed the results of capsuloperiosteal flap application to stabilize modified distal chevron osteotomy in patients with mild to moderate intermetatarsal and hallux valgus angles. METHODS: Modified chevron osteotomy was performed in 27 feet of 25 patients (14 females, 11 males; mean age 30.4 years; range 19 to 43 years) with hallux valgus. The study group was comprised of patients unresponsive to conservative treatment for painful deformity, at ages 18 to 50 years, and having an intermetatarsal angle less than 17 degrees, hallux valgus angle less than 40 degrees, and no osteoarthritic changes in the metatarsophalangeal joint. The patients were evaluated clinically and radiographically preoperatively and in the early postoperative period, in the sixth week, and once in every six weeks. Clinical assessments were made using the subjective and objective evaluation systems of Bonney and Macnab. The mean follow-up was 22 months (range 8 to 67 months). RESULTS: The mean preoperative hallux valgus angle, which was 31.4 degrees (range 23 degrees to 40 degrees), decreased to 12.8 degrees (4 degrees-22 degrees) postoperatively, with a corresponding decrease in the intermetatarsal angle from 14.2 degrees (11 degrees-17 degrees) to 9.6 degrees (7 degrees-14 degrees). Conformity of the first metatarsophalangeal joint was complete in all the cases. According to the Bonney and Macnab subjective scores, the results were excellent in seven feet (25.9%), good in 17 feet (63%), and moderate in three feet (11.1%). On objective evaluations, the results were excellent in 14 feet (51.9%), good in 11 feet (40.7%), moderate in one foot (3.7%), and poor in one foot. CONCLUSION: Our results suggest that modified chevron procedure whose stability is improved by the use of a capsuloperiosteal flap without using any internal fixation material is an effective alternative for the treatment of patients with moderate degrees of hallux valgus without metatarsophalangeal joint degeneration.

COMBINED INSIDE-OUT AND ALL-INSIDE TECHNIQUE IN BUCKET-HANDLE MENISCUS TEARS.

OBJECTIVE: To determine the outcomes after combined inside-out and all-inside repair technique of bucket-handle meniscus tears. METHODS: A retrospective review was made of patients with bucket-handle meniscus tears repaired with combined techniques, using the all-inside technique in posterior meniscal tears and the inside-out technique in the middle part of the meniscal tears. Meniscal healing was assessed clinically using Barrett's criteria and MRI. RESULTS: The study comprised 52 patients with a mean age of 28.4 years old (range, 19-52 years old). The mean follow-up period was 31.3 months (range, 24-59 months). Two patients had ACL re-rupture, and complete meniscal healing was achieved in all but one patient. Although improved from preoperative status, Tegner and Lysholm scores were lower in the ACL reconstructed patients than in the intact ACL patients. CONCLUSION: Combined inside-out and all-inside meniscal repair technique is a successful and cost-effective treatment method in bucket-handle meniscus tears. Level of Evidence IV, Therapeutic Study.