Comparison of Pain Catastrophic Scale and Anxiety in Patients With Boxer's Fracture and Other Types of Hand Fractures.

OBJECTIVE:  The Pain Catastrophic Scale (PCS) is generally associated with high and low post-recovery satisfaction and measures the pain perception of patients in the literature. This study aims to evaluate the association of deliberate (as in a fight or anger causing punching a wall) boxer's fractures with catastrophic pain compared to accidental (as in a fall, accidental knocking it against a wall, etc.) fractures and evaluate the effect of anxiety about fracture union and functional recovery on clinical outcomes. MATERIALS AND METHODS:  A total of 62 male patients with metacarpal fractures, 31 as a result of deliberate punching (1st group) and 31 with metacarpal fractures as a result of an accident (2nd group), who applied to the emergency department or orthopedic clinic with the diagnosis of metacarpal fracture between January 2021 and October 2022, were included in the study. All patients were selected from patients who were followed up with conservative plaster/splint. The PCS scores of the patients were evaluated comparatively with the clinical results measured after at least six weeks. RESULTS:  The mean age of the patients was 30.8 (18-50) in the 1st group and 34.8 (18-64) in the 2nd Group, and no statistically significant difference was found (p=0.274). While the median PCS score was 10.5 (interquartile range {IQR}: 12.3) for the 1st group, the median PCS score was 17.5 (IQR: 14.5) for the 2nd group, and the PCS score was statistically significantly lower in group 1 (p=0.009). While the median Visual Analogue Scale (VAS) value was 0 (IQR: 0.3) for the 1st group, the median VAS value was 1 (IQR: 2.0) for the 2nd group, and the VAS score was statistically significantly lower in the 1st group (p<0.001). While the median 'quick disabilities of the arm, shoulder, and hand' (Q-DASH) value was 0 (IQR:2.3) for the 1st group, the median Q-DASH value was 3.4 (IQR:6.3) for the 2nd group, and the Q-DASH score was statistically significantly lower in the 1st group (p=0.001). No significant difference was observed between the 1st and 2nd groups in terms of grip strength values (p=0.815). CONCLUSION: The etiology of patients presenting with a boxer's fracture should be well understood, and if necessary, these patients should be treated multidisciplinary, with psychiatric help. Better satisfaction can be achieved with lower results in patients whose PCS scoring system has lost its eigenvalue.

The Effect of Hallux Valgus Surgery on Quality of Life.

BACKGROUND: Health-related quality of life (QOL) is defined as a patient's subjective perception of his or her own health. Insufficient data exist on QOL of patients who undergo a hallux valgus (HV) operation. We used a 36-item short form survey (SF-36) to measure QOL of such patients. Our aim was to evaluate the effect of HV on QOL and to identify QOL determinants. METHODS: Fifty patients who underwent surgery for HV between 2015 and 2017 were included in the study. The SF-36 questionnaire was applied to the patients before and after surgery. Patients' medical records were examined to identify possible factors affecting QOL such as age, gender, body mass index, duration of symptoms, or smoking. RESULTS: The mean age of the patients was 55.6 ± 3.8 years, and 42 of the 50 patients were women. The mean duration of disease was 12 ± 3.7 years. The surgery improved QOL scores for general health, emotional well-being, role limitations due to personal or emotional problems, physical functioning and bodily pain. However, the changes in scores for vitality and social functioning were not statistically significant. Lower postoperative QOL scores for emotional well-being and bodily pain were significantly associated with age and duration of the symptoms. Compared to the mean QOL of healthy adult Turkish population, all scores in subdimensions were lower. CONCLUSIONS: This study shows that HV in adults has a negative impact on general health, bodily pain, physical functioning, physical and emotional well-being rather than social well-being and vitality.

Does THA Affect Sexual Dysfunction in Female Patients With DDH?

BACKGROUND: Sexual health, aside from reproduction, plays an important role in physical, intellectual, emotional and social facets of life. Developmental dysplasia of the hip (DDH) is a chronic orthopedic disease that has negative physical, social, and mental/spiritual effects, and lowers quality of life. However, no studies exist in the literature that focus on sexual function and health in patients with DDH. METHODS: The preoperative and postoperative 6th month and 1st year sexual functions of women who underwent surgical treatment (total hip arthroplasty) for DDH (Crowe 1-4) (n:50) and their spouses (n:30) were evaluated with Arizona Sexual Experience scale (ASEX) questionnaire which evaluates sexual function in 5 categories such as desire, arousal, erection/lubrication, orgasm, and satisfaction. RESULTS: The ASEX scores were 22.3 ± 3.5 preoperatively, 17.8 ± 2 at the 6th postoperative month, and 14.8 ± 1.3 at the 1st postoperative year. The decrease in the average score showed that sexual dysfunction existed in the preoperative period and sexual function was positively affected in the postoperative period over time. The ASEX scores of the patients younger than 35 in the postoperative 6th month had higher scores (P = .29). The sexual life of the husbands was not affected by the wives' surgery, even though their spouses had a chronic condition causing functional difficulties. CONCLUSION: This study showed that the sexual life of women with DDH, who had been treated with total hip arthroplasty, was positively affected, whereas their husbands were unaffected. Further studies focusing on the effect of physiological and emotional factors, in addition to the surgical treatment, on sexual function are needed.

Stabilization of chevron osteotomy with a capsuloperiosteal flap: Results in 15 years of follow-up.

PURPOSE: Distal chevron osteotomy (DCO) is used more frequently than other methods for the correction of mild-to-moderate hallux valgus deformity because it is markedly more stable. Here, we evaluated the use of a capsuloperiosteal flap to stabilize DCO and presented our last longer follow-up. METHODS: This study included a total of 57 patients (86 feet) made up of 50 women (79 feet) and 7 men (7 feet) with a mean age of 37.8 years who were diagnosed with hallux valgus and met the inclusion criteria. These patients received treatment using a capsuloperiosteal flap to stabilize DCO from 1994 to 2000. Clinical outcomes of the patients were assessed using the American Orthopaedic Foot and Ankle Society hallux scale. RESULTS: The mean follow-up duration was 14.8 years. The score increased from a preoperative mean of 52 points to a mean of 90.5 points at last follow-up. The mean hallux valgus angle changed from 30.3° preoperatively to 14.4° postoperatively at the last follow-up. The first to second intermetatarsal angle changed from 13.6° preoperatively to 10.5° postoperatively. The correction in the range of motion proved to be consistent with only an average of 1° correction loss and 5.5° loss. Eighty-four feet (97.6%) were pain-free. Discomfort with shoe wear was absent in 82 feet (95.3%) postoperatively, and 23 of 24 (95.8%) patients were fascinated cosmetically. CONCLUSION: Correction of mild-to-moderate hallux valgus deformity with the use of capsuloperiosteal flap for stabilization of DCO provided findings comparable with the literature regarding clinical and radiological outcomes at long-term follow-up. Level of Evidence: IV, Retrospective Case Series.

Post operative pain management in shoulder surgery: Suprascapular and axillary nerve block by arthroscope assisted catheter placement.

BACKGROUND: Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia. MATERIALS AND METHODS: 24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2. RESULTS: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P < 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively. CONCLUSION: These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients' satisfaction could be improved.

Long-term Results of Chronic Achilles Tendon Ruptures Repaired With V-Y Tendon Plasty and Fascia Turndown.

BACKGROUND: This study aimed to evaluate the long-term follow-up results of V-Y tendon plasty with fascia turndown, for repairing chronic Achilles tendon ruptures. METHODS: Seventeen patients (12 males, 5 females), who were diagnosed with chronic Achilles tendon rupture and met the inclusion criteria, were included in the study. These patients received treatment by means of V-Y tendon plasty with fascia turndown from January 1995 to December 2001. Clinical outcomes of the patients were assessed by using isokinetic strength testing, questioning the patient regarding residual discomfort, pain, or swelling and having the ability to perform heel rises and using American Orthopaedic Foot & Ankle Society's (AOFAS's) Ankle-Hind Foot Scale score. Mean follow-up duration was 16 years (13-18 years). RESULTS: Mean time from the injury to operative treatment was 7 months. Mean operative defect of Achilles tendon in neutral position after debridement was 6 cm. During the follow-up, the mean calf atrophy was 3.4 cm. The mean 30 degrees/s plantarflex and 120 degrees/s plantarflex peak torques were 89 and 45 Nm, respectively. The mean 30 degrees/s plantarflex peak torque deficiency was 16%. The mean 120 degrees/s plantarflex peak torque deficiency was 17%. The average peak torque deficiency was 17%. The pre- and postoperative mean AOFAS Ankle-Hindfoot Scale scores were 64 and 95, respectively. No patient had a rerupture. Superficial wound infection was treated with oral antibiotic therapy in 2 patients (11%). CONCLUSIONS: The V-Y tendon plasty with fascia turndown for repairing chronic Achilles tendon ruptures yielded results comparable with the literature regarding clinical outcomes. This method did not require synthetic materials for augmentation and was an economic alternative compared to other repair methods. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

The triangle between the anterior and posterior cruciate ligaments: an arthroscopic anatomy study.

OBJECTIVE: The goal of anterior cruciate ligament (ACL) reconstruction is to place the graft in closest proximity to the native ACL anatomy. This study aims to examine the angular relation between intact anterior and posterior cruciate ligaments (PCL) from an arthroscopic perspective. METHODS: Forty patients (20 male, 20 female) with a mean age of 35.12 (range: 18-40) years that underwent knee arthroscopy for reasons other than ACL rupture were included in the study. Following diagnostic examination and repair of the primary pathology, the triangle between ACL and PCL was seen at different flexion degrees of the knee joint (120, 90, 60, and 30°) through standard anterolateral (AL) and anteromedial (AM) portals. The narrow top angle of the triangle between the long intersecting axes of ACL and PCL was measured using recorded images by 3 blind observers. RESULTS: The average ACL-PCL angle was 61°, (standard deviation±2°) at 90°of knee flexion. The angles were narrower when viewed through the AM portal. The degree of the angles was not affected by age, sex, body mass index (BMI), or the side (right or left) on which the procedure was performed. There was good-to-excellent intra- and interobserver reliability. CONCLUSION: The angular relation between intact ACL and PCL has the potential to provide a better view of the anatomy during arthroscopic ACL surgery. To perform better anatomic reconstructions, it is important to create a 60° angle between the ACL graft and PCL (as viewed through AL portal) at 90°of knee flexion.

Cementless total hip arthroplasty in developmental dysplasia of the hip with end stage osteoarthritis: 2-7 years' clinical results.

Between 2006 and 2011, 102 hips of 78 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) underwent cementless total hip arthroplasty (THA). According to the Crowe's classification, 22 hips (21%) were type 1, 19 hips (18%) were type 2, 22 hips (21%) were type 3 and 39 hips (38%) were type 4 respectively. Functional and clinical analyses were performed by Harris Hip Scores (HHS). There were 73 (71%) excellent or good results according to HHS. The postoperative HHS was significantly lower in patients who underwent femoral shortening (p<0.01). We observed 25 (24.5%) complications in total, 15 (14.7%) of which required revision surgery. The authors concluded that THA for DDH is a safe and a reliable procedure with good clinical outcomes.

Outcomes for revision total knee replacement after unicompartmental knee replacement.

OBJECTIVE: The aim of this retrospective, observational study was to describe the outcomes of total knee replacement (TKR) after failed Oxford phase 3 medial unicompartmental knee replacement (UKR). METHODS: The study included 24 revision TKRs (20 females, 4 males; mean age: 61 years) performed following failed aseptic UKR. Outcomes were assessed using the Knee Society Score (KSS). RESULTS: The most common causes for revision were mobile bearing dislocation and unexplained pain. Mean preoperative KSS was 50.3 (range: 37 to 66) and 82.2 (range: 58 to 97) after TKR. There were 17 excellent, 4 good, 2 fair and 1 poor results. CONCLUSION: The type of UKR performed (cemented versus uncemented) had no effect on TKR success. Revision for failed UKR with TKR appears to be a technically straightforward procedure with satisfactory early clinical results.

Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference?

Purpose. The use of uncemented unicompartmental knee prostheses has recently increased. However, few studies on the outcomes of uncemented unicompartmental knee prostheses have been performed. The purpose of this study was to compare the outcomes of cemented and uncemented Oxford unicompartmental knee arthroplasty. Materials and Methods. This retrospective observational study evaluated the clinical and radiological outcomes of 263 medial Oxford unicompartmental prostheses (141 cemented, 122 uncemented) implanted in 235 patients. The mean follow-up was 42 months in the cemented group and 30 months in the uncemented group. Results. At the last follow-up, there were no significant differences in the clinical results or survival rates between the two groups. However, the operation time in the uncemented unicompartmental knee arthroplasty group was shorter than that in the cemented unicompartmental knee arthroplasty group. In addition, the cost of uncemented arthroplasty was greater. Conclusion. Despite the successful midterm results in the uncemented unicompartmental knee arthroplasty group, a longer follow-up period is required to determine the best fixation mode.

Stabilization of chevron bunionectomy with a capsuloperiosteal flap.

BACKGROUND: Distal chevron osteotomy (DCO) for mild to moderate hallux valgus deformity is inherently more stable than the other forms of distal metatarsal osteotomy, but complications such as loss of correction, infection, joint stiffness, delayed union, malunion and nonunion can occur. In this study, we evaluated the use of a capsuloperiosteal flap for stabilization of DCO in the treatment of hallux valgus. MATERIALS AND METHODS: A retrospective study was conducted on 59 patients (88 feet) that underwent distal Chevron osteotomy stabilized only with a capsuloperiosteal flap for mild and moderate hallux valgus deformity with a mean followup of 11.3 years. Clinical evaluation was calculated using the hallux score of the American Orthopaedic Foot and Ankle Society (AOFAS). RESULTS: The score improved from a preoperative mean of 52 to a mean of 91.5 points at last followup. Average hallux valgus angle changed from 30.3 degrees preoperatively to 14.2 degrees postoperatively at the last followup. Intermetatarsal angle 1-2 changed from 13.6 degrees preoperatively to 10.2 degrees postoperatively. The correction proved to be consistent with only an average of 3.4-degree correction loss and 4.9-degree loss in the range of motion. Eighty-six feet (97.7%) were pain free. Discomfort with shoewear was absent in 84 feet (95.5%) postoperatively and 24 of 25 (96%) patients were satisfied cosmetically. CONCLUSION: Capsuloperiosteal flap stabilization of distal chevron osteotomy for mild-moderate hallux valgus yielded excellent clinical results at long-term followup.

Evaluation of the two bundles of the anterior cruciate ligament with 1.5 tesla magnetic resonance imaging.

OBJECTIVES: Studies on the anatomy of the anterior cruciate ligament (ACL) have shown that the normal ACL consists of two functional bundles named as anteromedial (AM) and posterolateral (PL) bundles. In this study, we evaluated the AM and PL bundles of the ACL using 1.5 tesla magnetic resonance imaging (MRI), which is routinely used in clinical practice. METHODS: The study included 150 patients (96 females, 54 males; mean age 33.4+/-11.6 years; range 18 to 59 years) who did not have any signs of ACL insufficiency and whose knees were examined by MRI for other reasons. Standard magnetic resonance images (77 right, 73 left) were evaluated independently by an orthopedist and a radiologist in terms of distinguishable ACL bundles. The angle between the ACL (and each bundle) and the tibial plateau was measured on sagittal and coronal sections. Arthroscopic surgery was performed in 64 patients (42.7%) for primary diagnoses and arthroscopic and MRI findings were compared. RESULTS: Magnetic resonance imaging showed an intact ACL in all the patients. The ACL was assessed as a single bundle in the axial, coronal, and sagittal planes in 93 patients (62%). A double-bundle appearance was noted in 57 patients (38%), involving all three planes in 14 patients (9.3%), axial and coronal planes in 41 patients (27.3%), coronal and sagittal planes in one patient (0.7%), and only coronal plane in one patient (0.7%). On MRI sections showing a single bundle ACL, the mean angle between the ACL and the tibial plateau was found as 55.3 degrees in the sagittal plane, and 70.3 degrees in the coronal plane. On sections with a double-bundle appearance, the mean angles between the AM bundle and the tibial plateau were 70.1 degrees and 55.1 degrees in the coronal and sagittal planes, respectively. The corresponding angles for the PL bundle were 81 degrees and 53.5 degrees . The incidence of double bundle ACL appearance in coronal, sagittal, and axial MRI sections was not influenced by sex and side (p>0.05). The number of bundles identified in each plane did not show a significant difference between the two observers (p>0.05). During arthroscopic surgery, both bundles were identified with normal integrity and function of the ACL in all the patients. Of these, MRI could depict a double-bundle appearance in one or more planes in only 42.2% of the patients. CONCLUSION: Even though standard 1.5 tesla MRI, routinely used in clinical practice, has a very high success rate in demonstrating the ACL, it can visualize the two-bundle structure only in about one-third of the patients.

[Osteochondritis dissecans occurring in the patella and medial femoral condyle in the same knee]. / Ayni dizde patella ve medial femoral kondilde görülen osteokondritis dissekans.

Osteochondritis dissecans (OCD) is a condition in which a portion of articular cartilage separates from the bone together with the underlying subchondral bone. Its classical localization is the medial femoral condyle. We presented a 14-year-old boy who had OCD lesions in both the medial femoral condyle and patella in the same knee joint. He presented with complaints of pain, swelling, and locking following sports activities. Magnetic resonance imaging showed completely detached loose bodies causing instability. Arthroscopic treatment was performed including in situ fixation of the condylar lesion and debridement of patellar lesions. At six-month follow-up, he had full range of motion of the knee joint, with some pain in the patellar grind test.

Ipsilateral teratologic high hip dislocation, femoral hypoplasia and below-knee hemimelia associated with contralateral fibular hemimelia: report of a case with functional result.

In this case report, we present a patient with right teratologic high hip dislocation, femoral hypoplasia and below-knee hemimelia associated with left fibular hemimelia. Combined open reduction, proximal femoral osteotomy and a Dega acetabuloplasty were performed in the right hip. Closed tibial wedge osteotomy and centralization of the foot with lateral release and Achilles tendon lengthening were performed for the left side. The patient was able to walk with her prosthesis successfully within the first six postoperative months.

[Midterm results of total knee arthroplasty in degenerative knee joint diseases with severe deformity]. / Ileri derecede deformiteye yol açan dejeneratif diz eklemi hastaliklarinda total diz artroplastisinin orta dönem sonuçlari.

OBJECTIVES: We evaluated the midterm results of total knee arthroplasty in degenerative knee joint diseases with severe deformity. METHODS: Total knee arthroplasty was performed in 125 knees of 86 patients (75 women, 11 men; mean age 69 years; range 39 to 85 years) with degenerative knee joint diseases accompanied by severe deformity. Almost all the patients had osteoarthritis (100 knees, 80%) or rheumatoid arthritis (22 knees, 17.6%). Thirty-nine patients with bilateral involvement underwent single-stage (n=20) or two-stage (n=19) surgery. During surgery, the posterior cruciate ligament was sacrificed in 108 knees and retained in 17 knees. Pre- and postoperative assessments were made according to the Knee Society clinical scoring system. The mean follow-up was 53 months (range 24 to 96 months). RESULTS: The results were excellent or good in 80.2% of the knees. Nine knees (7.2%) required revision surgery, of which preoperative diagnosis was rheumatoid arthritis in five. The reasons for revision were infection-related problems (n=5), aseptic loosening (n=3), and periprosthetic fracture (n=1). Compared with preoperative values, the mean knee score increased by 60.9 (from 26.2 to 87.1), and the mean functional score increased by 42.6 (from 33.2 to 75.8) (p<0.05), with a mean range of knee joint motion of 93.2 degrees . The mean preoperative and postoperative alignments were 17.8 degrees of varus and 4.1 degrees of valgus (range 0 degrees to 6 degrees ), respectively. The number of knees with a flexion contracture decreased from 68 (mean 28.8 degrees ) to 8 (mean 8.4 degrees ), all of which had a flexion contracture angle below 10 degrees . CONCLUSION: Total knee arthroplasty performed in degenerative knee joint diseases with severe deformity significantly improves patients' complaints and functional results.

[Evidence-based current concepts in the radiological diagnosis and follow-up of developmental dysplasia of the hip]. / Gelisimsel kalça displazisinin radyolojik tani ve izleminde kanita dayali yeni görüsler.

This review summarizes some new concepts introduced in the past five years for the radiological diagnosis and follow-up of developmental dysplasia of the hip (DDH). It has been found that the rates of obtaining a standard plain in hip ultrasonography using the Graf method range from 66% to 93% between 1 and 6 years, being greater than 90% between 1 and 3 years. It has been reported that taking the lateral point of acetabular subchondral sclerosis as the measuring point, instead of the lateral point of the acetabular roof, while measuring both the Sharp's angle and the center-edge angle could better define the global hip pathology. To define the pathology more accurately, two alternative methods have been developed to measure the MZ distance that delineates the congruency between the centers of the acetabulum and the femoral head. Measurement of the acetabular anteversion angle on standard anteroposterior pelvis radiography have been defined, that would otherwise be measured only on computed tomography. This angle is measured between the anterior and posterior acetabular wall lines on a plain radiograph, yielding very close values to those obtained by computed tomography. The other method measures the center-trochanter distance in millimeters between the center of the femoral head and the uppermost point of the greater trochanter to evaluate the proximal femur. As the Severin classification proved to be insufficient for the radiographic evaluation of the treatment results in DDH, a new radiographic classification and scoring system has been developed, that numerically evaluates acetabular inclination, shape of the proximal femur, and the relation between the acetabulum and the proximal femur. These evidence based new concepts are considered useful in the clinical practice.

Medial and lateral malleolar arteries in ankle arthroscopy: a cadaver study.

Neurovascular injury may occur during ankle arthroscopy. The majority of complications are neurological injuries; however, vascular injuries do exist. Neurovascular structures are especially vulnerable during portal placement and debridement of anterior structures. Routine anteromedial and anterolateral portals are generally accepted to be safe; this is different from the anterocentral portal, which is associated with a higher risk of injury. However, injuries may occur in these relatively safe portals. The purpose of this cadaver study was to examine other relatively minor neurovascular structures such as medial and lateral malleolar arteries and to determine how these portals can be more safely placed. The distance between standard anteromedial, anterolateral portals and the medial and lateral malleolar arteries was measured in 18 ankles from 9 cadavers. These distances varied with the position of the ankle during portals placement, and measurements were obtained in both flexion and extension. The average distance in flexion and extension was 6.41 to 2.47 mm on the lateral side and 4.73 to 1.58 mm on the medial side. The distances significantly increased with ankle flexion and decreased with extension (P < .005). The current study demonstrated that there were other minor vascular structures at risk other than tibialis anterior artery and proper positioning of the ankle during portal placement, and that injury risk may be associated with ankle position. Ankle flexion may decrease the risk of damage to malleolar arteries and decrease minor vascular complications such as postoperative bleeding and hematoma.

Aneurysmal bone cyst recurrence in children: a review of 56 patients.

BACKGROUND: Aneurysmal bone cysts (ABCs) are benign lesions that are usually treated with intralesional procedures. The clinical behavior of ABCs is reported to be more aggressive in younger patients, with high recurrence rates after surgical treatment by several authors. The purpose of this study was to review longitudinally the demographic data and outcome of current surgical techniques in children with ABC treated at a single institution and to determine the possible risk factors for recurrence, which may be detected at initial examination, including age, presenting complaint, and radiological characteristics. METHODS: The authors performed a retrospective, pediatric population-based (< or =16 years) analysis of 56 cases of ABCs with more than 2 years' follow-up. The subjects were studied and classified on the basis of their age group (< or =5, 5-10, and >10 years of age). The possible risk factors for recurrence were analyzed initially with Student t test and Pearson chi2 test, then a logistic regression analysis model was used for multivariate analysis. RESULTS: Nine patients were younger than 5 years, 17 were between 5 and 10 years old, and 30 were older than 10 years. The most frequent location of the lesion was the humerus (11 cases) followed by proximal femur and fibula. Curettage was the most common treatment modality followed by resection. Recurrence of the lesion occurred in 5 children in the younger age group and in 4 children in the older age group. The difference in persistence or recurrence rates based on age (< or =5 years) and previous surgery was statistically significant. In addition, we have found no significant implication of physeal contact and size of the lesion on recurrence. CONCLUSIONS: The recurrence rates of primary ABC seemed to be higher in younger children. Considering the high cure rates with intralesional procedures even after recurrence, we suggest less aggressive intralesional procedures even in patients with mentioned risk factors; however, the patients' family should be informed about the high probability of recurrence.

[Osteoid osteoma in the hand: an evaluation of eight patients]. / El yerlesimli osteoid osteomlu sekiz olgunun degerlendirilmesi.

OBJECTIVES: We retrospectively evaluated patients with osteoid osteoma localized in the hand, which is a rare location for this lesion. METHODS: Eight patients (5 females, 3 males; mean age 23 years; range 13 to 31 years) underwent surgery for osteoid osteoma localized in the hand. Involvement was in the right hand in five patients, and in the left hand in three patients, being in the proximal phalanges in all the patients. The affected fingers were the fourth in five patients, and the first, second, and third in the remaining three patients, respectively. Five patients presented with pain responsive to salicylates. The mean duration of symptoms before diagnosis was 20 months (range 12 to 36 months) and the mean follow-up was 38 months (range 15 to 86 months). RESULTS: Direct radiographs enabled the diagnosis in four patients. Computed tomography was utilized in four patients, two of whom required scintigraphy and magnetic resonance imaging. Computed tomography showed intraosseous involvement in three patients, but failed to demonstrate the nidus in one patient due to extreme sclerosis. The nidus was removed with excision and curettage in all the cases, combined with cancellous autografting in five patients. Five patients had complete recovery. One patient had stiffness of the adjacent joints, which responded well to rehabilitation. Plain x-rays showed a subcortical sclerotic zone in one patient who had persistent pain for a year postoperatively. Due to inadequate excision, recurrence occurred in one patient 18 months after surgery; revisional excision and bone grafting were performed, resulting in complete recovery. CONCLUSION: Satisfactory results are obtained with excision, curettage, and bone grafting of osteoid osteomas located in the hand.