Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention.

Knee arthroscopy is one of the most common surgical procedures in orthopaedics and especially in sports medicine. Portal problems and effusion after knee arthroscopy have been reported. The fluid retention within the joint in knee arthroscopy can affect clinical outcomes, but there is no consensus on portal management. The studies of portal management in knee arthroscopy have mainly addressed wound healing and cosmetic problems. There is insufficient information in the literature about whether the irrigation fluid used in this effusion contributes to the process. This study investigates whether arthroscopic irrigation fluid is retained in the joint and whether portal-closure management has an effect on effusion. In this randomized, prospective study, 91 patients (46 [50.5%] sutured-portal group and 45 [49.5%] open-portal group) were included. Suprapatellar knee-diameter measurement and the number of times the dressing was changed were used to assess intra-articular fluid collection. The visual analog scale (VAS) score, Oxford knee score, and Knee Society score were used to evaluate knee problems. All portal wounds in both groups healed without any problems. Superficial or deep infection was not observed in either group. There was no statistically significant difference in VAS score, Oxford knee scores, and Knee Society scores between groups. Although there was a decrease in the knee diameter of both groups between the early postoperative period and first postoperative day, a statistically significant difference in knee diameter was found, especially in the open-portal group. There was a significant difference between the groups in terms of the number of dressings used in the first 24 hours after surgery. Leaving portals open may be effective in preventing intra-articular fluid retention. We thus advise leaving the arthroscopy portals open with just a simple dressing for selected patients.

Reproducible and Reliable Method for Syndesmotic Screw Fixation: An MRI-Based Cross-Sectional Image Analysis.

Ankle arthrosis may be an unexpected potential result in syndesmotic injuries because of instability and malreduction. For anatomical reduction and stabilization, a reliable and stable reference point is crucial to correctly place syndesmotic screw. The aim of this study was to determine a reliable reference point and to quantify the ideal angle for placement of the screw. In this prospective cohort study, 99 healthy volunteers underwent right ankle magnetic resonance (MR) imaging. On the axial sections, the ideal axis of the syndesmotic screw and other reference points were depicted with 4 lines and 2 angles which were evaluated at the level 2 cm above the tibial plafond. Values were recorded by 2 independent observers to assess for interobserver reliability. The mean value of syndesmotic screw position according to the ground line was 28° ± 6.4° like Arbeitsgemeinschaft für Osteosynthesefragen suggestion. Furthermore, it was determined that the syndesmotic screw could be placed more precisely in the position when placed at an angle of 26.2° ± 1.1° with the axis perpendicular to the line passing through the anterior tibial and Achilles tendons. Ideal syndesmotic screw positioning must be stable enough in case not to be affected by lower extremity alignment deficiencies or foot deformities. So, the anterior tibial and Achilles tendons can be used as reproducible and reliable landmarks for the placement of syndesmotic screws.

The effect of platelet-rich plasma on fracture healing in long-bone pseudoarthrosis.

PURPOSE: The aim of this study was to investigate the effects of platelet-rich plasma (PRP) on fracture union rate and fracture union time in pseudoarthrosis surgery and to evaluate the clinical and functional results of the patients. METHODS: The patients who were undergone pseudoarthrosis surgery between 2011 and 2014 were evaluated retrospectively. Twenty-four patients were included in the study. Patients were divided into two groups with used PRP and not used PRP during surgery. There were 14 patients in the PRP group and 10 patients in the control group. The two groups were compared in terms of demographic characteristics, fracture union time, and functional scores of the Lower Extremity Functional Scale and Upper Extremity Functional Index. RESULTS: Fractures were healed in both groups, and no complications were encountered. A statistically significant difference was found between the two groups in terms of fracture union time. The mean time of union was 5.3 months in the PRP group and 11.3 months in the control group (p: 0.000). There was no statistically significant difference between the two groups in terms of functional scores (p: 0.250). CONCLUSION: As a result of our study, we concluded that PRP is an effective and safe method in pseudoarthrosis surgery that reduces fracture union time. Controlled studies with more patient numbers are needed.

Effects of Different Therapeutic Radiation Doses on the Development of Neural Tube Defects in Chick Embryos and the Correlation with Bone Morphogenetic Protein 4 and 7 Expression Levels.

AIM: To investigate the effects of different therapeutic radiation doses on the prevalence of neural tube defects (NTDs) in chick embryos and bone morphogenetic protein (BMP) 4 and BMP7 expression levels. MATERIAL AND METHODS: The chick embryos (n=143) were derived from fertile, specific pathogen-free eggs of domestic fowl. The presence of NTDs was analyzed using a stereomicroscope, and BMP4 and BMP7 expression levels were assessed by immunohistochemical staining. The chick embryos were divided into five groups: control (no radiation exposure) (n=23), exposure to thorax computerized tomography (CT) (n=30); exposure to abdominopelvic CT (n=30), exposure to cranium CT (n=30), and exposure to brain perfusion CT (n=30). RESULTS: The prevalence of NTDs and BMP4 and BMP7 expression levels in the different groups were compared. In the cranium CT dose group, both the NTD prevalence (20%, p=0.002) and BMP7 (p=0.031) expression levels were significantly higher than those in the other groups. However, none of the medical doses of irradiation altered BMP4 expression levels (p=0.242). No NTDs were detected in the thorax CT and abdominopelvic CT groups. CONCLUSION: Exposure to irradiation at cranium CT doses may induce the development of NTDs and increase BMP7 expression. Dose radiation exposure using thorax CT and abdominopelvic CT protocols does not appear to induce NTDs.

Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique.

OBJECTIVE: The aim of the study was to compare the outcomes of the transtibial and anatomical femoral single tunnel surgical techniques in ACL reconstruction. METHODS: A total of 30 patients, with 16 patients (15 males and 1 female; mean age: 27.2 ± 7.04) with anatomical femoral single-tunnel technique (AFT) and 14 (12 males and 2 females; mean age: 29.4 ± 8.82) with transtibial technique (TT) were included into the study. All patients were evaluated with isokinetic tests at an angular velocity of 60°/s and 180°/s and the IKDC and Lysholm tests were performed preoperatively and in third, sixth, and 12th months postoperatively. The results were compared between the groups. The mean follow-up time was 17.1 ± 6.48 months. RESULTS: Postoperative third month changes in extension parameters of peak torque (AFT: -93.286, TT: -61.500), peak work (AFT: -77.071, TT: -47.500), peak torque ext/kg (AFT: -1.182, TT: -0.773), peak work ext/kg (AFT: -0.982, TT: -0.604), peak work (AFT: -55.143 TT: -33.063) at an angular velocity of 60°/s and postoperative third month change in extension parameter of peak power (AFT: -86.786 TT: -54.875) at an angular velocity of 180°/s were found to be better in the transtibial group (p < 0.05) and postoperative sixth month peak torque (AFT: 1.429, TT: -5.688) value at an angular velocity of 60°/s was found to be less in the anatomical femoral single-tunnel group (p < 0.05). The IKDC (AFT: 94.671, TT: 90.025) (p < 0.05) and Lysholm (AFT: 96.714, TT: 92.375) (p < 0.05) scores of the anatomical femoral single-tunnel group were better than the transtibial group regarding to the postoperative final follow-up. There are positive intermediate correlations between preoperative IKDC and Lysholm scores with preoperative and postoperative some isokinetic test ratio (r = 0.539; p = 0.031), and preoperative peak power extension (r = 0.541; p = 0.030) at the both angular velocity of 60°/s and 180°/s in the transtibial group. There was no significant difference between the two groups with regards to the Lachman, anterior drawer and pivot shift tests (p < 0.05). CONCLUSION: There were differences in terms of isokinetic parameters in early outcomes but there was no statistical difference between isokinetic parameters at the end of 1st year between two groups. There were some correlations between IKDC and Lysholm scores with some isokinetic parameters. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Endoscopic versus Open Bursectomy for Prepatellar and Olecranon Bursitis.

Objectives Bursitis of the olecranon and the patella are not rare disorders, and conservative management is successful in most cases. However, when patients do not respond to conservative treatment, open excisional surgery or, recently, endoscopic bursectomy, can be used. The aim of this study was to evaluate the results of open and endoscopic treatments of olecranon and prepatellar bursitis. Patients and methods Forty-nine patients (37 male and 12 female), who were treated with endoscopic bursectomy (25 patients) or open bursectomy (24 patients) were included in this study. Thirty patients had olecranon bursitis, while 19 patients had prepatellar bursitis. The patients' average age was 61.1 ± 12.3 (range 33-81) years. All of the patients' hospitalization and surgery times were recorded. The satisfaction of the patients was evaluated with a satisfaction scoring system, as well as by evaluating residual pain, the range of joint movement, and the cosmetic results of the procedure. Results The average follow-up time was 16 ± 9 months (range 12-27). The median operation time was 23.2 ± 3.5 minutes for the endoscopic bursectomy group and 26.4 ± 6.8 minutes for the open bursectomy group. The median hospitalization time was 0.56 ± 0.5 days (range 0-1 day) for the endoscopic group and 1 ± 0 days for the open bursectomy group (P<0.01). According to the patient satisfaction questionnaire, the endoscopic bursectomy group's score was 8.5 ± 1.3 (range 5-10), and the open bursectomy group's score was 5.29 ± 1.8 (range 1-9) (P<0.01). Conclusion Endoscopic bursectomy is a time-saving and efficient surgical treatment option for patients with prepatellar and olecranon bursitis.

Simultaneous Anterior Glenohumeral Dislocation and Ipsilateral Acromioclavicular Separation: A Dual Injury of the Shoulder.

Isolated acromioclavicular separations or shoulder dislocations are common injuries. However, a combination of complete acromioclavicular separation and anterior shoulder dislocation is extremely rare. Herein we present a combination of anterior shoulder dislocation and type III acromioclavicular separation that was succesfully treated conservatively. Orthopaedic surgeons should have a high clinical suspicion in daily practice. We believe that both pathologies can be treated conservatively.

Utilization of the bicipital groove axis for confirming alignment of the humerus with transepicondylar and ulnar shaft axes during intramedullary nailing.

OBJECTIVE: Intramedullary nailing is the preferred surgical treatment of humerus shaft fractures. The purpose of this study was to investigate the relationship between the bicipital groove and specific anatomical landmarks in achieving correct alignment of the humerus during intramedullary nailing, and to describe these anatomical landmarks. METHODS: Thirty (15 right; 15 left) total upper cadaver extremities were used in this study. After the anatomical landmarks were identified and marked, humeral head axis, transepicondylar axis, ulnar shaft axis, bicipital groove axis, and angular measurements of these were obtained. RESULTS: The mean angle between the bicipital groove axis and transepicondylar axis was 48.17°±12.35º (range: 20.10º to 74.6º). The mean angle between the bicipital groove axis and ulna diaphysis axis was 41.82º±11.56 º (range: 17.91º to 68.27º). The mean angle between the humeral head axis and bicipital groove axis was 20.53°±3.90º (range: 11.85º to 31.81º). The mean retroversion angle between the humeral head axis and transepicondylar axis was 27.52±11.37º (range: 4.26º to 49.36º). The mean angle between the humeral head axis and ulna diaphysis axis was 61.73º±12.08º (range: 33.97º to 86.37º). The mean torsion angle was 62.58º±11.28 º (range: 40.74º to 85.74º). CONCLUSION: Measurement and utilization of the relationship between the bicipital groove, ulna diaphysis and transepicondylar axes may be used for restoring humeral rotation.

Short-term clinical outcomes after first metatarsal head resurfacing hemiarthroplasty for late stage hallux rigidus.

The purpose of the present study was to evaluate the short-term results of metatarsal head resurfacing hemiarthroplasty in the treatment of advanced hallux rigidus. We reviewed 14 consecutive patients (5 males [35.71%], 9 females [64.29%]; mean age, 58.7 ± 7.4 years). These patients underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP(®)) for hallux rigidus from March 2010 to September 2012 at our institution. According to the Coughlin and Shurnas clinical and radiographic classification, 10 feet (71.43%) were classified as grade III and 4 (28.57%) as grade IV. We clinically rated all patients before surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scale, the visual analog scale for pain, and first metatarsophalangeal joint (MTPJ) range of motion. The mean follow-up duration was 24.2 ± 7.2 (range 12 to 36) months. The mean preoperative hallux metatarsophalangeal-interphalangeal scale score was 33.9 ± 9.8 (range 22 to 59), and it increased to 81.6 ± 10.1 (range 54 to 96; p < .05) postoperatively. The mean preoperative 10-cm visual analog scale for pain score was 8.4 ± 0.9 (range 7 to 10), which decreased to 1.21 ± 1.2 (range 0 to 5; p < .05) postoperatively. The mean preoperative MTPJ range of motion was 22.8° ± 7.7° (range 15° to 45°), which increased to 69.6° ± 11.8° (range 50° to 90°; p < .05) postoperatively. None of the 14 patients experienced component malalignment or loosening, infection, or neurovascular compromise during the follow-up period. One patient (7.14%) experienced postoperative pain and subsequently underwent first MTPJ arthrodesis. From the results of our investigation, first MTPJ arthroplasty is an effective treatment modality that can reduce pain and increase motion in the case of advanced hallux rigidus.