Mid-term implant survival, functional and radiological results and mechanical complications of mega-prosthetic reconstruction around the knee with the PENTA® system.

AIM: Mega-prosthetic reconstruction is the most common treatment method for massive osteoarticular defects caused by tumor resection around the knee. The new implant is a highly modular rotational-hinged megaprosthesis system with a distinct pentagonal stem geometry and variable implantation options. The aim of this study is to present the mid-term implant survival characteristics, functional and radiological results and mechanical complication profile of the new megaprosthesis. METHODS: One hundred and one mega-prosthetic knee reconstruction procedures in 90 patients (M/F: 51/39) utilizing the new implant system were retrospectively analyzed. In 68 patients, the megaprosthesis was used for primary reconstruction following tumor resection while it was used for revision of other implants in 22. The mean age was 28.5 (7-66) years and the mean follow-up was 59.2 (24-124) months. The most common primary pathology was osteosarcoma with 63-70% patients, the most common anatomical site of involvement was the distal femur with 56-62% patients. RESULTS: Henderson Type 2 failure (aseptic loosening) was seen in only 2-2.2% patients while Type 3 (structural failure) was seen in 29-32.2% Although the 5-year anchorage survival rate was 94.3%, overall mechanical implant survival was 76.1% at 5 years due to a relatively high failure rate in the first-generation hinge mechanism of the implant. The 5-year hinge survival rate demonstrated a significant improvement rate from 61.7% to 87.2% between the first and second generations of the implant (p = 0.027). The mean MSTS score was 24 out of 30 (14-29). The mean cumulative ISOLS radiographic score for index megaprosthesis operations was 19.7 (12-24), which corresponded to excellent outcome. CONCLUSION: The new megaprosthesis system is a reliable choice for the reconstruction of tumor-related massive osteoarticular defects around the knee. Although long-term follow-up is necessary for a definitive evaluation of the implant's survival characteristics, midterm follow-up yields exceptional anchorage properties related to pentagonal stem geometry with very good functional outcomes.

Foot and Ankle Osteoid Osteomas.

Foot and ankle osteoid osteomas (OOs) are often cancellous or subperiosteal and rarely present with a periosteal reaction. Additionally, the large number of disorders included in the differential diagnosis and the nonspecific findings on radiographs complicate the diagnosis. We performed a manual search of the senior surgeon's hospitals' operating room records for the terms "benign bone tumor," "foot," "ankle," and "osteoid osteoma" from January 2003 until December 2014. Of 87 surgically treated patients with lower extremity OOs, 9 patients (11%) with foot or ankle OOs were included. The mean age at presentation was 21 (range 6 to 30) years; all 9 (11%) patients were male. The patients were evaluated for swelling, pain, trauma history, night pain, response to pain relievers, duration of complaints, and interval to diagnosis. The mean follow-up period was 48 ± 24 months, and no recurrences had developed. The mean American Orthopaedic Foot and Ankle Society scale score was 59.04 ± 11 before surgery and 91.56 ± 6 after surgery. The difference was statistically significant at p ≤ .0003. Most previous studies have been limited to case reports. The need for findings from a case series was an essential determinant of our decision to report our results. Patients usually have been treated conservatively, often for a long period. However, delays in treatment cause social, economic, and psychological damage. In conclusion, the presence of atypical findings on radiographs has resulted in a preference for magnetic resonance imaging instead of computed tomography; however, the diffuse soft tissue edema observed on MRI can lead to the use of long-term immobilization and a delay in the diagnosis.

External validation of the PATHFx decision-support tool on Turkish patients with skeletal metastasis.

Objective: Accurate determination of life expectancy becomes very important when determining the treatment of patients with pathologic fractures. We aimed to investigate the predictive role of the PATHFx model in Turkish patients by estimating the area under curve (AUC) of the receiver operator characteristic (ROC) and externally validating the results of PATHFx on the Turkish population. Methods: The data of 122 patients who presented to one of four orthopaedic oncology referral centres in Istanbul (2010-2017) and underwent surgical management of pathologic fractures were retrospectively collected. Patients were evaluated according to age, sex, type of pathologic fracture, presence of organ metastasis, presence of lymph node metastasis, haemoglobin concentration at presentation, primary oncologic diagnosis, number of bone metastases, and Eastern Cooperative Oncology Group (ECOG) status. Estimations of the PATHFx program by months were statistically evaluated using ROC analysis. Results: In our study population (122 patients), all survived the first month, 102 survived the third month, 89 were alive at 6 months, and 58 patients survived at 12 months. At 18 and 24 months, 39 and 27 patients were alive, respectively. The AUC value was 0.677 at 3 months, 0.695 at 6 months, 0.69 at 12 months, 0.674 at 18 months, and 0.693 at 24 months. The 3-, 6-, 12-, 18-, and 24-month survival rates were statistically significant (P < 0.01 and P < 0.05). ECOG performance status was 0-2 points in 33 patients (Memorial Sloan-Kettering Cancer Center (MSKCC) data set: 93 cases, our data set: 33 cases). ECOG performance status was 3-4 points in 89 patients (MSKCC data set: 96 cases, our data set: 89 cases). Conclusions: The objective data used by PATHFx for prediction provided statistically accurate estimates on Turkish patients, who are presumed to have mixed genomes through history from both Europe and Asia, and demonstrates its applicability to the Turkish population.

Evaluation of patients with pathological fractures treated by standard trauma principles but neglecting the underlying malign bone disease.

INTRODUCTION: There are several studies in the literature about pathological fractures but almost no information about patients whose pathological fracture caused by a malignant lesion misdiagnosed and treated as a simple fracture. The aim of this study was to investigate patient and fracture characteristics, and outcomes in cases where fractures occurred in the presence of a malign pathology but were treated as simple fractures. PATIENTS AND METHODS: Cases of malign bone lesions between 2000 and 2020 were retrospectively reviewed. Patients with a final diagnosis of malign bone lesion but whose pathological fractures were treated ignoring the underlying malign bone disease were included. Demographic, clinical and outcome data were collected from patient's medical records and analyzed. RESULTS: Six patients met the inclusion criteria. Three of the patients were female and the cohort mean age was 56.8 ± 21.8 years at the time of admission. Patient diagnoses were: renal cell carcinoma metastasis (n = 1); colon cancer metastasis (n = 1); chondrosarcoma (n = 2); osteosarcoma (n = 1); and undifferentiated pleomorphic sarcoma of bone (n = 1). In all cases surgical management differed from those that should have been applied if the pathological fracture had been identified. Furthermore, surgical management after definitive histological diagnosis were more aggressive compared to if the malignancy had been identified at first admission. All patients died after a mean follow-up of 16.67 ± 11.7 months and the complication rate was 100%. CONCLUSION: When a pathological fracture is misdiagnosed and managed as a simple bone fracture, outcomes are extremely poor. In these situations, remedial surgery is more extensive, with increased complication rates and there is poor life expectancy.

Early Suspicion of Heparin-Induced Thrombocytopenia for Successful Free Flap Salvage: Reports of Two Cases.

Heparin-induced thrombocytopenia (HIT) is an underestimated complication of heparin treatment. Flap loss and related morbidity (even mortality) are caused by occlusion of the capillary vessels by a highly immunogenic complex formed by adherence of antiheparin antibodies to platelet factor 4. Early suspicion and effective treatment of HIT developing in two free flaps are described. We report on the management of two patients with HIT. Both patients were treated successfully by early suspicion and hematology consultation. Heparin products were discontinued; the patients were switched to a nonheparin anticoagulant. We emphasize the importance of early diagnosis, hematologist assessment, and a change to a nonheparin anticoagulant to prevent flap failure and possibly the catastrophic consequences of such failure.

Can the arterial clamp method be used safely where a tourniquet cannot be used?

BACKGROUND: Clamp application is safe and widely used in the visceral organs. This raises the question: why not use clamping in orthopaedic, oncological, fracture and revision surgeries of areas where tourniquets are not suitable. This experimental animal study aimed to compare tourniquet and arterial clamp applications with regard to their histological effects and inflammatory responses on a molecular level, on the artery, vein, nerve and muscle tissue. METHODS: Twenty-one rabbits were divided into three groups (group I: proximal femoral artery clamp; group II: proximal thigh tourniquet; and group III: control group). In the clamp group, the common femoral artery was clamped with a microvascular clamp for two hours. In the tourniquet group, a 12-inch cuff was applied to the proximal thigh for two hours at 200 mmHg. The common femoral artery, vein, nerve, rectus femoris and tibialis anterior muscles were excised and analysed in all groups. RESULTS: Artery and vein endothelial injuries were found in the clamp and tourniquet groups (relative to the control group, p ≤ 0.001 and p = 0.007, respectively). However, no difference was found between the clamp and tourniquet groups regarding vessel wall injury. CONCLUSIONS: We found there were no differences in incidence of vessel, muscle and nerve injury when comparing the tourniquet and clamp applications. For surgical procedures that are unsuited to a tourniquet, arterial clamping can be selected, resulting in close-to-tourniquet vessel injury rates but without tourniquet-related complications.

Benign bone tumors of hand and wrist: evaluation of diagnosis and treatment.

OBJECTIVES: This study aims to investigate the choice of graft or cement, the relationship between the graft types and union rates, functional results, and complications in hand and wrist benign bone lesions while also evaluating the diagnosis and treatment modalities of lesions with high recurrence potential like giant cell- containing lesions. PATIENTS AND METHODS: Between September 2005 and May 2016, 48 benign osseous hand and wrist tumors of 48 patients (22 males, 26 females; mean age 33±13.1 years; range, 11 to 70 years) were reviewed retrospectively. Patients were evaluated according to demographic data, complaints at admission, radiological findings, surgical methods, graft type, pathological diagnosis, and complications. RESULTS: Although not statistically significant, there were differences between cement, allograft, and autograft according to union time and loss of range of motion. There was no statistical difference between cement, allograft, and autograft according to complications. CONCLUSION: Autograft obtained percutaneously with a trephine needle may provide earlier union with minimal donor site morbidity. Wide resection and reconstruction options should be kept in mind in giant cell-containing tumors. Further investigations are needed about the relationship between soft tissue edema in magnetic resonance imaging and the recurrence risk in hand and wrist benign bone tumors.

Use of cement combined grafting in upper and lower extremity benign bone tumors.

OBJECTIVES: This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. PATIENTS AND METHODS: Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. RESULTS: Median tumor volume was 17.2 cm3 (range, 2.8 to 139.6 cm3), median area of the cortical window was 8.3 cm2 (range, 1.6 to 28.4 cm2), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r= -0.356) and mid-level negative correlation between cortical window size and functional scores (p=0.001, r= -0.577). CONCLUSION: Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.

[Treatment of adult tibial diaphysis fractures with reamed and locked intramedullary nailing]. / Tibia diyafiz kiriklarinin oymali kilitli intramedüller çivi ile tedavisi.

OBJECTIVES: We evaluated the results of reamed and locked intramedullary nailing for tibial diaphysis fractures. METHODS: The study included 73 patients (68 males, 5 females; mean age 31 years; range 17 to 68 years) who were treated with reamed and locked intramedullary nailing for tibial diaphysis fractures. There were 28 AO/ASIF type A, 29 type B, and 16 type C fractures. The fractures involved the proximal 1/3 (n=12), middle 1/3 (n=50), and distal 1/3 (n=11) of the tibial diaphysis. Twenty-eight fractures (38.4%) were closed. According to the Gustilo-Anderson classification, 30 patients (41.1%) had grade I, 10 patients (13.7%) had grade II, and five patients (6.9%) had grade IIIA open fractures. Intramedullary nailing was performed following open reduction in 17 patients (23.3%), and closed reduction in 56 patients (76.7%). The mean time to surgery was 3.4 days (range 2 to 11 days) and the mean follow-up was 48 months (range 24 to 60 months). The patients were evaluated with respect to range of motion, time to union, and complications. Functional results were assessed using the Johner-Wrush criteria. RESULTS: Union was achieved in all the patients within a mean of 18.2 weeks (range 8 to 52 weeks). Four patients required dynamization because of delayed union and grafting was performed in one patient. Transient sensorial deficit occurred in one patient after dynamization. One patient underwent revision surgery because of migration of the distal locking screws. The only limitation of range of motion was seen in flexion of two patients (2.7%) who developed anterior knee pain. According to the Johner-Wrush criteria, functional results were very good in 45 patients (61.6%), and good in 28 patients (38.4%). CONCLUSION: Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing is an appropriate choice with a low complication rate. It can be safely used in moderately contaminated open fractures.

Hand osteoid osteoma: evaluation of diagnosis and treatment.

BACKGROUND: OO (osteoid osteoma) is a common, osteoblastic, benign bone tumor but rarely seen in the hand region. There is still some debate about the diagnosis and treatment of hand OOs. In the present study, we aimed to evaluate the epidemiology, radiologic features, surgical treatment options and functional outcomes. METHODS: Between January 2003 and December 2014, surgically treated and pathologically verified 9 hand OO cases were investigated retrospectively. The preoperative and postoperative clinical outcome scores were calculated using the M2-DASH (Manchester-Modified Disabilities of Arm Shoulder and Hand) Score. RESULTS: Lesion locations were as follows: middle phalanx in 2/9 (22%) patients (2nd and 4th digit), proximal phalanx in 6/9 (67%) patients (one 4th, two 2nd and three 5th digits) and metacarpal (2nd) in 1/9 (11%) patient. Incidence of nidus formation was 6/9 (67%) on X-ray, 7/9 (78%) on CT imaging and 2/9 (22%) on MR imaging. The mean time to diagnosis was 13.22 ± 5.44 months. Preoperative mean M2-DASH score was 41 ± 6 and postoperative was 7.4 ± 8.6. CONCLUSION: Osteoid osteoma is usually seen below 25 years, and rarely found over 40 years of age. There is male dominance with a male to female ratio of 3:1. Delay of diagnosis may be encountered because of many differential diagnoses. When OO is suspected, CT imaging should be taken before the MR imaging. Because of superiority in soft tissue imaging, MR imaging should be an alternative tool in complex cases.

[Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape]. / Cocuklardaki deplase suprakondiler humerus kiriklarinin tedavisinde triseps kasinin ters V seklinde kesilmesiyle saglanan redüksiyon ve iki adet çapraz K-teli ile tespit.

OBJECTIVES: We evaluated the results of surgical treatment for pediatric displaced supracondylar humerus fractures. METHODS: The study included 98 pediatric patients (72 boys, 26 girls; mean age 7 years; range 3 months to 14 years). According to the Gartland classification, all the displaced supracondylar humerus fractures were type III, being of flexion type in 10 patients (10.2%), and extension type in 88 patients (89.8%). Five were Gustilo-Anderson type 1 open fractures. All fractures were approached posteriorly. Reduction was achieved by cutting the triceps muscle in a reverse V-shape, followed by fixation using two cross K-wires from the epicondyles. The results were assessed according to the criteria of Flynn et al. At final follow-ups, elbow range of motion, the strength of the triceps muscle and, on radiographs, the carrying angle of the elbow, Baumann angle, and lateral humerocapitellar angle were measured. The mean follow-up was 42.6 months (range 7 to 80 months). RESULTS: According to the criteria of Flynn et al., 95 patients (96.9%) had perfect or good cosmetic results, 84 patients (85.7%) had perfect or good functional results. Elbow angles, elbow range of motion, and the strength of the triceps muscle were similar to those measured on the normal side (p>0.05). Time from injury to surgery did not have a significant influence on cosmetic and functional results (p>0.05). None of the patients exhibited procedure-related pin tract infection or insufficient bone union. Three patients (3.1%) developed cubitus varus deformity. CONCLUSION: Reduction of pediatric displaced supracondylar humerus fractures may be achieved easily by the posterior approach, after cutting the triceps muscle in a reverse V-shape, and fixation with two cross-pinned K-wires provides adequate stability. This procedure does not result in weakness of the triceps muscle.

Comparison of the lateral and posterior approaches in the treatment of pediatric supracondylar humeral fractures.

This study explored the radiological, functional, and cosmetic results of treatment of supracondylar humeral fractures with open reduction and percutaneous pinning, comparing posterior triceps V-splitting (group I, n=22) and lateral (group II, n=25) approaches. The time to union, the functional and cosmetic results, and the flexor and extensor muscle strengths were measured and compared with the contralateral extremities. There were no statistical differences between the groups. The V-splitting posterior approach is as safe and effective as the lateral approach in the surgical treatment of pediatric supracondylar humeral fractures.

[Sarcomas of the hand]. / El sarkomlari.

OBJECTIVES: The hand is a very rare localization for sarcomas. We evaluated patients who underwent surgical treatment for sarcoma of the hand. METHODS: Between 1990 and 2006, eight patients (5 males, 3 females; mean age 39.6 years; range 26 to 67 years) with hand sarcoma received treatment at two centers. The lesions arose from soft tissue in five cases, and from bone in three cases. Localizations were fingers (n=3), carpal region (n=2), and the wrist (n=3). Radiologic assessments included plain radiographs, magnetic resonance imaging, and scintigraphy in all the patients, with addition of computed tomography for bone tumors. All the patients underwent biopsies for precise diagnosis. Staging was made according to the Enneking classification. Tumors involving the fingers were treated with digital amputation, while the rest were treated with wide resection. The mean follow-up was 48 months (range 6 to 123 months). RESULTS: Mortality occurred in two patients due to multiple metastases, who had synovial sarcoma in the carpal region and clear cell sarcoma in the wrist, respectively. Both patients had stage III disease on presentation. Of three patients with tumors localized in the fingers, two had stage IA, and one had stage IB disease. Apart from clear cell sarcoma, diagnoses of other wrist tumors were stage IIB epithelioid sarcoma and malignant fibrous histiocytoma. Of six patients who were alive, hand functions were sufficient in four, fair in one, and poor in one. None of the patients developed local recurrences. CONCLUSION: Due to rarity of malignant hand tumors, diagnosis and treatment require considerable attention. It was observed that patients maintained a good psychological status by avoiding complete amputation of the hand and performing an appropriate wide resection with reconstruction.

[Ossifying subperiosteal hematoma associated with neurofibromatosis type 1: a report of two cases]. / Tip 1 nörofibromatozise bagli ossifiye subperiosteal hematom: Iki olgu sunumu.

Neurofibromatosis may be associated with ossifying subperiosteal hematoma resulting in lower extremity hypertrophy. We presented two girls, aged 10 and 13 years, with neurofibromatosis type 1, who exhibited increased thigh girth on the right side. Plain radiographs showed an ossifying cystic formation. Magnetic resonance scans demonstrated a fluid-fluid level. Diagnosis of ossifying subperiosteal hematoma was confirmed with a biopsy in both cases. In the older patient, radiologic studies after 1.5 years showed an increase in the wall thickness of the femoral cyst from 3 mm to 5 mm. In the other patient, cystic formation surrounding the tibia became more prominent at the end of five years. This patient died from multiple lung metastases following chemotherapy and wide resection for Ewing's sarcoma that developed in the right shoulder.

An Unusual Localization of Intraosseous Schwannoma: The Hamate Bone.

Intraosseous schwannoma of the hamate bone presented in this case is a very rare benign tumor, and its diagnosis combined with clinical, imaging and needle biopsy is important to guide further therapy. The diagnosis of schwannoma of the hamate was proved histologically following its surgical treatment by curettage.

[Evaluation of pediatric patients with traumatic hip dislocation]. / Travmatik kalça çikigi nedeniyle tedavi edilen çocuk hastalarin degerlendirilmesi.

OBJECTIVES: We evaluated pediatric patients who were treated for traumatic dislocation of the hip. METHODS: Traumatic dislocation of the hip was detected in five children (all boys; mean age 9 years; range 7 to 13 years) between 1991 and 2005. Dislocations occurred in the right hip in four cases, and in the left hip in one, all of which had posterior localization. Etiology was fall during play in two children, and fall from height or car crash in three. One patient had posterior wall avulsion fracture of the acetabulum. Early radiologic follow-ups included conventional radiographs and computed tomography. Functional results were assessed with the Harris hip scoring system. Four patients had a sufficient follow-up period with a mean of 44 months (range 19 to 64 months). RESULTS: All the patients were treated with closed reduction under general anesthesia after a mean of 6.4 hours (range 2 to 16 hours) following trauma. Functional results were excellent in all the patients, with a mean Harris hip score of 92 (range 84 to 96). Based on early postoperative radiologic control with computed tomography, no surgical intervention was considered for posterior wall avulsion fracture of the acetabulum in one patient. At 40-month follow-up, he had no complaints, had a full range of motion and a hip score of 92. While no complications were observed in patients undergoing early reduction, one patient whose dislocation was reduced 16 hours after trauma developed avascular necrosis of the femur head 18 months after treatment, at which time his hip score was 84. CONCLUSION: Early reduction is of particular importance for the follow-up course of traumatic hip dislocations in childhood.

Metatarsal head resurfacing hemiarthroplasty in the treatment of advanced stage hallux rigidus: outcomes in the short-term.

OBJECTIVE: The aim of this study was to evaluate the short-term outcomes of metatarsal head metal resurfacing hemiarthroplasty in patients with advanced stage hallux rigidus. METHODS: The study included 14 feet (4 left, 10 right) of 12 patients (10 female, 2 male; mean age: 63 ± 5; range: 55 to 71 years) who underwent metatarsal head metal resurfacing hemiarthroplasty (HemiCAP(®)) between 2007 and 2010. Additionally, capsular release and periarticular osteophyte debridement were performed. Staging was made according to Coughlin and Shurnas' clinical and radiological grading system. Hallux valgus and intermetatarsal angles were measured using pre and postoperative standing AP and lateral foot views. Clinical assessment was made with first metatarsophalangeal joint range of motion, the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale and satisfaction level. RESULTS: Mean follow up was 19.5 (range: 14 to 26) months. Two patients had bilateral involvement. According to Coughlin and Shurnas' clinical and radiological grading system, nine feet were Stage 3 and five feet were Stage 4. According to the AOFAS scale, results of eight feet (57.1%) were excellent, four feet (28.6%) were good and two feet (14.3%) were moderate. Mean total AOFAS score increased by 26.2 points postoperatively (p<0.05). Mean range of motion of the first metatarsophalangeal joint improved significantly from a preoperative 22.2 ± 5.6 (range: 10 to 28) degrees to a postoperative 56.3 ± 9.6 degrees (p<0.05). Mean hallux valgus angle decreased from a preoperative 14.3 (range: 9 to 17) degrees to a postoperative 11.1 (range: 4 to 13) degrees and the mean intermetatarsal angle increased from a preoperative 10.5 (range: 8 to 14) degrees to a postoperative 10.8 (range: 8 to 15) degrees. Patient satisfaction levels were very good in 10 feet (71.4%), good in 3 (21.4%), and moderate in one (7.2%). Complications included metatarsalgia aggravated by long walks in one patient and hypoesthesia of the great toe in three patients. Push-off power of the great toes was measured as 4/5 in three cases, and 5/5 in others. CONCLUSION: Metatarsal head metal resurfacing hemiarthroplasty provides high patient satisfaction level and good functional outcome in the short-term, in the surgical treatment of advanced stage hallux rigidus refractory to conservative treatment options.

Osteoid osteoma of the cuboid bone: a rare cause of foot pain.

Osteoid osteoma, a common bone lesion of benign nature, is more rarely seen in feet. It most commonly involves the talus yet rarely the cuboid. The atypical symptoms of foot involvement may delay the diagnosis. Differential diagnosis most commonly includes ankle sprain, monoarticular arthritis, anterior impingement syndrome, tarsal spur, osteomyelitis, stress fracture, eosinophilic granuloma. The delay in diagnosis and treatment of osteoid osteoma in the foot may be a cause of chronic foot pain. In this study, we present a 17-year-old boy with osteoid osteoma in his right cuboid bone. The patient was undiagnosed during the first year of his symptoms. After surgical removal of the tumor, his complaints were resolved. The pathological examination confirmed the diagnosis of osteoid osteoma. Osteoid osteoma is an unusual bone tumor of the foot. It should be included in the differential diagnosis of patients exhibiting foot pain. In speculative cases with no obvious radiographic findings, further imaging studies, such as CT, should be considered.

A new index for the assessment of distal radius fractures involving the ulnar styloid.

OBJECTIVE: The aim of this retrospective study was to evaluate the relation between a new index we created for the assessment of distal radius fractures involving the ulnar styloid, and the clinical outcome. METHODS: We devised a radiographic separation index (RSI), to evaluate the displacement of the ulnar styloid. We used this index in 44 patients (28 men and 16 women; mean age: 43.2 years; range: 24-64 years) with distal radius fractures involving the the ulnar styloid. In all cases, the distal radius fracture was fixed using a volar locking plate. The styloid fracture was treated conservatively. The relation between the RSI value and clinical results was then investigated. RESULTS: In the 44 patients there were clinically 38 excellent, 4 good, and 2 moderate results. RSI ratios ranged from 2% to 11%. The patients with an excellent result had an RSI ratio of less than 5%. We found a significant correlation between the RSI ratio values and the clinical outcomes. CONCLUSION: Our results suggested that the RSI can be used as a predictor of the clinical outcome in patients with distal radius fractures involving the ulnar styloid.

[Results of limited open rotator cuff repair with partial acromioplasty for rotator cuff tears with subacromial impingement syndrome]. / Subakromiyal sikisma sendromu ile birlikte rotator manset yirtiginin, kismi akromiyoplasti ile sinirli açik rotator manset tamiri sonuçlari.

OBJECTIVES: Short term results of partial acromioplasty and rotator cuff repair with a limited open surgical technique were evaluated in patients with rotator cuff tears. PATIENTS AND METHODS: Forty-eight patients (16 males, 32 females; mean age 52 years; range 29 to 70 years) with rotator cuff rupture were recruited to the study between January 2001 and December 2006. A limited open rotator cuff repair along with partial acromioplasty (via rasper) was applied in all cases. The Constant-Murley shoulder score was used before and after surgery. RESULTS: Mean duration of follow-up was 38 months (range 14 to 70 months). Pre- and postoperative Constant-Murley scores averaged 44 (range 36 to 51) and 88 (range 75 to 96) respectively. Anchoring sutures were displaced in one subject (2%) and tendon insufficiency recurred, another two cases (4%) had impingement from secondary granulation tissue that developed due to sutures in the tendon repair site. CONCLUSION: We believe that minimal acromioplasty via a limited open surgical approach is an applicable technique with good results in the treatment of rotator cuff tears with subacromial impingement syndrome.