Open repair of Bankart lesions using suture anchors in hard workers.

The surgical techniques applied to recurrent anterior dislocation of the shoulder, especially in hard working patients, must reconstruct a stable shoulder joint with a good range of motion, which will not re-dislocate, so the patients can return to their hardworking duties. The aim of this study was to evaluate the results of open Bankart repairs with suture anchors, in high-demand sportsmen and hard workers with recurrent anterior shoulder dislocation. Thirty shoulders of 29 patients were included in the study. All patients were active hard workers. A modified deltopectoral incision was used and Mitek GII Suture Anchors were implanted with 7-10 mm intervals into the bone-cartilage zone of the glenoid rim. Average follow-up time was 30 months (range, 22-38). Postoperative results were analysed according to the Rowe Scoring System. We obtained good and excellent results in 93.3% of cases. The open Bankart repair using suture anchors appeared in this study as a reliable technique for hard workers or physically high-demand patients.

Osteochondral multiple autograft transfer (OMAT) for the treatment of cartilage defects in the knee joint.

The ideal articular cartilage repair tissue should be durable and well-integrated. We have been performing osteochondral multiple autograft transfers (OMAT) since 1996 with the experience we had using carbon fiber implants. We call this technique OMAT instead of mosaicplasty because we use uniform osteochondral autografts. Osteochondral multiple autograft transfer (OMAT) was performed either by arthrotomy or arthroscopy on 12 patients (6 male and 6 female) for the treatment of cartilage defects in the knee joint. The patients ranged in age from 20 to 63 years (mean: 38 years). All had weightbearing-related pain or decrease in the range of motion. None had instability or malalignment. The average follow-up time was 4 years (range: 2 to 8 years). Clinical results were satisfactory. All of the paients were improved initially by the procedure and 85% are still pain free. The mean Lysholm knee rating score was 56 points preoperatively and 86 points postoperatively. Second-look arthroscopy (five patients) demonstrated a normal shiny appearance and color of the grafted area. We observed slight joint effusion postoperatively that disappeared in two months. There was no donor site morbidity. OMAT is a promising surgical technique for the treatment ofarticular cartilage defects. Long-term follow-up with more patients and histological and biomechanical evaluation of chondral interfaces are the subjects of our continuing study.

Immunohistological analysis of normal and osteoarthritic human synovial tissue.

Intercellular communication mediated by cell surface antigens is important in the maintenance of synovial tissue (ST) integrity. Chronic inflammation is a common feature of osteoarthritis (OA). Cellular attachment to and migration into ST is one of the critical aspects of chronic inflammation. This study was undertaken to examine the tissue distribution of a broad spectrum of monoclonal antibodies (mAbs) containing tetraspan antigens (CD9, CD63, CD151), endothelial cell antigens (CD31, CD36, CD105, CD106, CD146), integrins (CD49a-f, CD29, CD41, CD51, CD61), CD39, CD98, CD99, CD143 and, CD147 supplied from fifth and sixth international workshops and conferences on human leukocyte differentiation antigens in a comparative manner in human OA and normal synovium. Ten primary OA patients and six normal individuals were included in this study. The average age of the patients was 65.0 +/- 8.3 years and the average age of the controls was 31.8 +/- 5.3 years. Sections were screened using an indirect immunoperoxidase method. Tetraspan antigens and CD98 presented rather unique staining pattern in OA synovium suggesting special roles for each antigen on the synovial lining layer (SLL). Endothelial cells and type A synoviocytes expressed CD31 and CD36 in OA, but only endothelium in normal subjects. Integrins presented a uniform staining pattern in both groups. There was a positive reaction in some of the ST stromal elements for CD143 in all specimens. In conclusion, human normal and OA synovium were comparatively reviewed by a broad spectrum of mAbs with special attention being given to their functional aspects. This data suggests a significant difference in antigenic phenotype of SLL cells in OA and ST not to be considered at a normal-like state in OA. The fact that their activation was independent of the degree of lymphocyte infiltration further emphasizes the possible central importance of SLL.

Surgical management of bone metastases from urological malignancies: an analysis of 70 cases.

OBJECTIVE: The purpose of this study was to evaluate symptomatic bone metastases from urological malignancies and the efficacy of surgical treatment of bone metastases in achieving local tumor control. METHODS: This was a retrospective observational study of patients diagnosed with bone metastases from urological malignancies who died from their diseases between 2002 and 2013. Data on clinicopathology, number and sites of bone metastasis, time to first and subsequent metastasis, survival after metastasis, nature of metastasis (blastic, mixed, lytic), type of surgical reconstruction, systemic affections, and visceral organ metastasis for 70 bone metastases from deceased urological malignancies patients (55 male, 15 female) with evidence of bone metastasis were statistically analyzed. RESULTS: Forty-three patients (61.42%) had renal cell carcinoma (RCC), 15 patients (21.43%) had prostate cancer, and 12 patients (17.15%) had bladder carcinoma as primary diagnosis. Osteolytic lesions were most prevalent (n=61; 87%). The most common surgical modality for extremities was wide resection with prosthetic replacement (42 patients), followed by wide resection or wide resection with bone cement application with internal fixation (21 patients); 65 patients were treated with limb salvage procedures, and 2 patients were treated with amputation. Overall median survival was 13 months for RCC, 16 months for prostate carcinoma, and 11 months for bladder carcinoma patients. CONCLUSION: Detection of bone metastases in patients with urological malignancies influences the treatment strategy. Diagnosis of bone metastases may be delayed in urologic malignities; thus, these patients receive long-term clinical follow-up.

Ultrasonographic findings in pediatric fractures.

The aim of this study was to document and analyze ultrasonographic (US) findings in different types of pediatric fractures. Thirty-nine patients, aged between 1 and 14 years, with a fracture were included in the study. Patients were classified as complete or incomplete fractures. Greenstick fractures, torus fractures and plastic deformations were considered as incomplete fractures. Ultrasonographic findings (subperiosteal hematoma, bending, cortical disruption, and reverberating echo) were analysed for each type of fracture. Subperiosteal hematoma was present in all patients in the study. Bending sign was present in all patients in the incomplete fracture group, but not present in complete fractures. Cortical disruption and reverberating echo were present in all patients with complete and greenstick fractures. In conclusion, whether the fracture is complete or incomplete, subperiosteal hematoma, together with a cortical disruption, bending sign, or reverberating echo shown on US can confirm the fracture diagnosis in children.

[Determination of the effect on the proximal femoral load distribution of diaphyseal cement support in femoral intertrochanteric fractures with calcar defect by finite element analysis]. / Kalkar defekti olan femur intertrokanterik kiriklarinda diafizer çimento desteginin femur üst uç yük dagilimina etkisinin sonlu element analizi ile tayini.

OBJECTIVES: This study aims to investigate biomechanically positive and negative aspects of arthroplasties in combination with diaphyseal cement support as an alternative to calcar supported prosthesis on the proximal femoral load distribution, using finite element analysis method in a virtual environment in intertrochanteric fractures with calcar femoral defect. MATERIALS AND METHODS: Three femur models were created using the ANSYS method. These were named as a intertrochanteric fracture model without calcar defect, an intertrochanteric fracture model with thick cement mantle and calcar defect, and an intertrochanteric fracture model with thin cement mantle and calcar defect. In the finite element analysis setting, two regions were analyzed for load distributions. The first one was the whole femur, while the other one was the region starting from trochanter minor and extending distally to the 5 cm area. RESULTS: In the trochanteric fracture model without calcar defect, the stress value in the whole femur was found to be 22.9 MPa; whereas it was 29.2 MPa in the 5 cm long section starting at the trochanter minor. The stress values were 23.6-29.9 MPa in the intertrochanteric fracture model with thick cement mantle and 24.2-32.1 MPa in the intertrochanteric fracture model with thin cement mantle and calcar defect. The statistical analysis was performed using t-test and a p value of >0.005 was found in all. CONCLUSION: Our study results showed that forming a type of calcar to be used in a hemiarthroplasty surgery and shaping of this region with bone cement does not produce further stress on the cement/bone intersection in intertrochanteric fractures with defected calcar region.

Children with fractures show higher levels of impulsive-hyperactive behavior.

Children with fractures have been reported to have impulsive-hyperactive behavior problems although whether they exhibited such behavior more often than children with other orthopaedic conditions is unknown. We investigated whether impulsivity-hyperactivity was more prominent in children with extremity fractures than in children with orthopaedic conditions not involving a fracture. From outpatient clinical intakes, we recruited 39 consecutive children with extremity fractures and 33 children with orthopaedic conditions not involving a fracture. We used the Conners' Parent Rating Scale to detect behavioral symptoms in children with and without extremity fractures. Children who were treated for extremity fractures had higher mean scores for impulsivity-hyperactivity than those treated for nontrauma-related reasons. Additionally, more children in the fracture group reached impulsive-hyperactive behavior scores high enough to warrant additional psychiatric evaluation. In terms of injury prevention, the orthopaedic surgeon should be familiar with problem behaviors of children, particularly impulsivity and hyperactivity, to be able to make appropriate referrals for psychiatric evaluation and treatment.

Computerized tomography scout view for determining distal femoral resection angle in intramedullary instrumentation of total knee arthroplasty.

This study aims to investigate the results of distal femoral resection by determining the difference between mechanical and anatomical axes of femur using computerized tomography (CT) scout views in pre-operative planning of total knee arthroplasty. CT scout view of the lower extremities was taken before and after the operation in 16 patients undergoing total knee arthroplasty. Distal femoral resection was performed according to the previously determined ideal resection angle (IRA) using intramedullary instrumentation. At post-operative scanogram, femoral component deviation (FCD) was measured. The results were statistically analyzed. The average IRA was 6.95 (5-9) degrees. At post-operative measurements, the average FCD was 0.63 (0-3) degrees. CT scout films improve the accuracy in distal femoral resection and femoral component alignment.

Simultaneous bucket handle tear of both medial and lateral menisci of a knee with chronic anterior cruciate ligament deficiency.

Bucket handle meniscus tears constitute about 10% of all meniscal tears. Bucket handle tears of medial meniscus is three times more than lateral meniscus. Most of these tears are associated with anterior cruciate ligament (ACL) deficiency. Lateral meniscus lesions are more common with acute ACL deficiency, where medial meniscus lesions are more associated with chronic ACL deficiency. We identified bucket handle tears of each meniscus of a 30-year-old male patient while performing diagnostic arthroscopy during ACL reconstruction procedure. We present an ACL deficient knee with bucket handle tears of medial and lateral meniscus of the same knee and discuss the treatment.

Etiology of senile osteoporosis: a hypothesis.

UNLABELLED: Osteoporosis is a major health problem characterized by compromised bone strength predisposing patients to an increased risk of fracture. It may cause morbidity and mortality in elderly men and women. The etiologic factors that lead to senile osteoporosis still are unclear. Based on the available experimental and clinical evidence, we update our earlier proposal that zinc deficiency plays a role in the pathogenesis of senile osteoporosis. However, the mechanism of zinc deficiency in osteoporosis remains unclear. Zinc deficiency may lead to the increase of endogenous heparin probably causing degranulation of mast cells and release of endogenous heparin, and an increase in the bone-resorbing effect of prostaglandin E2. Endogenous heparin and prostaglandin E2 are probably cofactors of parathyroid hormone and may have a role in the pathogenesis of senile osteoporosis enhancing the action of parathyroid hormone. Therefore, zinc replacement by dietary zinc supplementation might be valuable to prevent or treat senile osteoporosis. Additional studies are necessary for the evaluation of the possible role of zinc in the etiology of senile osteoporosis. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.

Localized pigmented villonodular synovitis of the knee: acute onset in pregnancy.

A pregnant patient in the first trimester presented with acute onset knee pain and effusion. As the clinical status was mimicking septic arthritis, surgery was performed. Arthroscopy demonstrated a local synovial tumor and excision was performed with arthrotomy. Microscopic evaluation revealed localized pigmented villonodular synovitis. Due to the presence of necrosis and hematoma in the tumor, we hypothesize that, that torsion or bleeding of the tumor in the presence of physiological pregnancy- related metabolic changes might have been the cause of acute presentation.

Quadrilateral space syndrome caused by a humeral osteochondroma: a case report and review of literature.

Quadrilateral space syndrome (QSS) is a rare condition in which the posterior humeral circumflex artery and the axillary nerve are entrapped within the quadrilateral space. The main causes of the entrapment are abnormal fibrous bands and hypertrophy of the muscular boundaries. Many other space-occupying causes such as a glenoidal labral cyst or fracture hematoma have been reported in the literature. However, we could not find a report on classical QSS caused by an osteochondroma. The aim of this case report is to attract attention to an unusual etiology of shoulder pain, and to emphasize the importance of physical examination and x-ray imaging before performing more complex attempts for differential diagnosing.

Experience with the surgical treatment of radial polydactyly in adults.

PURPOSE: The aim of this study is to investigate the functional and cosmetic outcome after surgical reconstruction in adult patients. METHODS: Eleven hands of the 10 adult patients with radial polydactyly were treated surgically. Clinical and radiologic examination was performed and cases were classified according to the Wassel system. The outcome was evaluated according to the Modified Wood criteria. RESULTS: Average age of the patients was 20 years (range, 19-23 years) and all patients were male. All of the patients were admitted with the social consequences of the cosmetic problems resulting from the anomaly. Cosmetic and functional results were excellent in 9 cases and good in 2 cases. CONCLUSION: The findings of this study revealed that radial polydactyly can be surgically reconstructed satisfactorily in adulthood. However, the fact that these patients were mainly admitted as a result of the psychosocial consequences of the cosmetic aspect of the anomaly, we concluded that regardless of age, surgery should not be delayed after diagnosis.

Contrary intermittent skin release of complete syndactyly without skin graft in adults.

INTRODUCTION: There are many different surgical treatment techniques of complete syndactyly. Most of them are techniques involving using skin grafts. We developed a surgical technique that does not require skin grafts, which cause problems in the distal nail border pulp and interdigital web space. MATERIALS AND METHODS: Syndactyly release was performed in 12 web spaces of 11 adult male patients. The average age was 21. In addition to a zig-zag incision, contrary intermittent skin release was performed. Primary coverage of the interdigital web space and nail border pulp was achieved without skin graft. RESULTS: We obtained good results by the contrary intermittent skin release method that we developed, in adult complete syndactyly patients who had no chance for the surgical treatment due to several reasons, previously. CONCLUSION: With such a surgical technique, in our cases we obtained successful results, both cosmetic and functional. The presented technique is an alternative method for syndactyly release without using skin graft in adult patients.

Chondroitin sulfate-coated polyhydroxyethyl methacrylate membrane prevents adhesion in full-thickness tendon tears of rabbits.

Polyhydroxyethyl methacrylate (pHEMA) membranes coated on one side with chondroitin sulfate (CS) were used to block adhesion physically and to reduce friction between healing flexor tendons and the surrounding tissue in rabbit forepaws after surgical repair. Digits with pHEMA-only, standard tendon sheath repair, and with no sheath repair were the controls. Over 12 weeks the CS-coated membranes were evaluated for joint flexion, adhesion limitation, and tendon healing progress. The membranes initially allowed for better flexion (ie, for 6 weeks), but their relative superior effectiveness faded afterward. Histology showed that adhesions were less severe and healing was better in the CS-pHEMA membranes at 3 and 6 weeks. If further studies determine precise amounts or thicknesses of CS coats that will maximize its healing properties, CS-pHEMA should prove useful in clinical settings in which restoration of tendon sheath integrity with a minimum of adhesions is not possible.

Reliability of the safe area for the superior gluteal nerve.

The authors investigated the reliability of the safe area, which previously was defined to prevent injury to the superior gluteal nerve during the lateral approach to the hip, and its relation to body height. The distance between the point of entry of the superior gluteal nerve into the gluteus medius muscle and the greater trochanter, in the regions which were defined as the anterior and posterior halves of the muscle, were measured in 23 cadaveric hips. There was a significant correlation between the height of the cadavers and the distance in the anterior and posterior regions. In all of the anterior regions and 78% of the posterior regions of the hips, the superior gluteal nerve as found to be in the safe area. The current study showed that the average distance between the innervation point of the gluteus medius muscle and the greater trochanter might change as a function of body height. The risk of damage to the superior gluteal nerve may be higher if the direct lateral approach to the hip is used. These data show that it is possible that the safe area is not always safe.

Histological alterations after irradiation of cartilage using Ho:YAG laser.

OBJECTIVE: The authors carried out an experimental study to evaluate the histological alterations after irradiation of cartilage using Holmium:YAG (Ho:YAG) laser VersaPulse Select 60 watts and Infra Tome Delivery Systems 30 degrees Handpiece (spot size at fiber tip 0.4 mm; Coherent Medical, Palo Alto, CA). BACKGROUND DATA: Recently, some authors reported cases with articular cartilage damage following arthroscopic laser surgery in the knee joint for the treatment of articular cartilage or meniscal pathology. MATERIALS AND METHODS: The cartilage specimens immersed in saline were exposed to Ho:YAG laser irradiation. The laser wavelength was 2.1 microm, and pulse duration was 250 microsec. Power settings were 0.2-1 joules per pulse and 10-15 Hz. Total laser energy used in these procedures was 1.5 K joules. During the procedures, the handpiece was used at an angle of 30 degrees and at a distance of 1 mm. RESULTS: Electron microscopic evaluation demonstrated that the ultrastructure of the cartilage is preserved in both experiment and control groups. CONCLUSION: When Ho:YAG laser is used in optimal dosage (optimal joule and Hertz) with optimal technique (keeping the handpiece at an appropriate angle and distance) and avoiding overtreatment, it does not cause cartilage damage.