Hydatid bone disease of the femur.

Osseous hydatid disease is caused by the parasitic tapeworm Echinococcus. The species most responsible for hydatid disease is Echinococcus granulosus, endemic especially in sheep-rearing districts like Mediterranean countries and Australia. In Turkey, the exact incidence of human hydatid disease is not known, but < or =34% of asymptomatic farmers have positive serology. Bone hydatidosis is rare, making up 0.5% to 4% of all cases. Patients usually present with pain, swelling, or pathological fracture. There are no specific radiographic signs in affected bone. In the later stages, lytic lesions with a trabeculated pattern, with or without sclerosis, may be seen. Computed tomography (CT) is still the best method for diagnosis and posttherapy follow-up of osseous hydatidosis. On CT, skeletal cystic hydatidosis appears as one or several closely related, well-defined, osteolytic lesions. There may be bone expansion, cortical thinning, cortical destruction, sclerosis, honeycomb appearance, and extension into adjacent soft tissues.

Complication following intramedullary fixation with a Fixion nail in a patient with osteogenesis imperfecta: a case report.

Osteogenesis imperfecta (O.I.) is a genetic disorder with increased bone fragility and low bone mass. We report the history of a 17-year-old male patient with O.I. who presented a fracture of his left femoral shaft. He had osteogenesis imperfecta type I A according to Silence. He had presented two years previously an ipsilateral cervical fracture of the femur which had healed. Intramedullary fixation with a Fixion intramedullary nail was elected. While the Fixion nail was being inflated to 70 bars with saline, a longitudinal fracture occurred in the femoral shaft. A conventional intramedullary nail and cerclage wire were applied for fixation. The fracture healed without complication in 10 weeks. Based on this observation, we do not recommend using the Fixion IM nail for fracture fixation in patients who have abnormal bone fragility such as in osteogenesis imperfecta.

[The effect of definitive continuous distraction employed with the Ilizarov type external fixation system on fracture healing: an experimental rabbit model]. / Ilizarov tipi eksternal fiksatörle belirli sürekli distraksiyonun kirik iyilesmesi üzerine etkisi: Tavsanda deneysel çalisma.

OBJECTIVES: The objective of this study was to evaluate the effect of definitive continuous distraction (DCD) employed through an Ilizarov type external fixator on fracture healing in a rabbit tibia model. METHODS: Fifteen mature New Zealand white rabbits weighing 2.8 to 4.0 kg were randomly assigned to three groups following osteotomy of the tibia and fibula. The first group (controls) was treated only with the Ilizarov type external fixator while the second and third groups were subjected to DCD amounting to 10% and 30% of the body weight, respectively, being employed through modulated springs on the Ilizarov external fixation system. All the rabbits were evaluated by radiographs on the 12th, 21st, 28th, and 35th days following surgery and were sacrificed on the 45th day. Radiographic evaluations were made according to the Lane and Sandhu's scoring system, and histologic evaluations according to the scoring system proposed by Heiple et al. The results were analyzed using the Kruskal-Wallis test. RESULTS: The highest radiographic and histologic scores were obtained from the second group, being 8.6 and 11.6, respectively (p<0.05). Radiographic and histologic scores of the third group were lower than those of the control group. CONCLUSION: Application of DCD of 10% of body weight through modulated springs on the Ilizarov external fixator improves fracture healing while a greater amount of instability results in delayed healing.

[School screening for scoliosis in Sivas, Turkey]. / Sivas il merkezinde skolyoz için okul taramasi.

OBJECTIVES: We investigated the prevalence of scoliosis among primary school students in Sivas, Turkey. METHODS: To determine the prevalence of scoliosis among primary school students in the age bracket of 10 to 15 years, 11 primary schools were selected with systematic sampling. A total of 3,175 students (1,538 girls, 1,637 boys) of grades 6 to 8 were selected from 16,103 students using a stratified sampling method. Examination for scoliosis was made by the forward bend test and palpation of the spine. RESULTS: Fifteen children (0.47%) were found to have scoliosis, including 10 girls (66.7%) and five boys (33.3%). The prevalence of scoliosis was significantly higher in girls (0.65% vs. 0.31%; p<0.05). The mean lateral curvature of the spine was 6.9 degrees (range 5 degrees to 20 degrees ), being 7.9 + or - 4.6 degrees in girls, and 5.4 + or - 0.9 degrees in boys. The mean age was 13.5 + or - 1.2 years (range 12-15 years). The severity of the curvature showed no significant relationship with gender and age groups (p>0.05). The levels of involvement were lumbar vertebrae in 73.3% (n=11), thoracic vertebrae in 13.3% (n=2), and thoracolumbar vertebrae in 13.3% (n=2). Spinal curvature was to the right side in 12 cases (80%), and to the left in three cases (20%). Girls and boys did not differ significantly with respect to the severity and direction of the curvature (p>0.05). During a two-year follow-up of children with scoliosis, no progression of the curvature was observed, including one child who wore a Milwaukee brace. CONCLUSION: School screenings may be performed as part of prevalence studies; however, routine school screening for scoliosis is debatable.

Extreme complications of Fixion nail in treatment of long bone fractures.

The authors present their experience related to extreme complications in treatment of diaphyseal fractures of the long bones with application of the Fixion expansion intramedullary nail in a total of 48 surgeries. We have encountered six (12.5%) extreme complications in the management of fractures of 3 humeral, 2 tibial, and 1 femoral bones during its application procedure and postoperative follow-up. Of six cases, two with humeral and tibial fractures developed nonunion and rotational instability because of failure of inflation of the Fixion nail. One of the Fixion nail in humerus was broken spontaneously, and one of the Fixion nail deflated at the follow-up and pseudoarthrosis developed in this patient. In a patient with osteogenesis imperfecta, during the inflation of the nail for the treatment of femur fracture, a new longitudinal fracture occurred and conventional non-locking intramedullary nail was inserted. In a patient with a tibia fracture that was treated with the Fixion nail, new fracture occurred due to its bending after weight bearing in the postoperative period. The Fixion nail application is a new technique for the intramedullar fixation of long bones. It is considered as an effective method for the selective fracture types of long bones. Application may need special training. Since the Fixion has not got rotational stability and rigidity as conventional nailing systems, bending and breaking of the nail may occur during postoperative period in patients with over obesity and hyperactivity. In patients with osteogenesis imperfecta, it may not be the first choice as a nailing system.