A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures.

BACKGROUND: We compared the union and functional results of intramedullary nailing and open reduction internal fixation treatment applied to adults with a forearm diaphysis fracture (fracture of the radius and/or ulna). METHODS: We retrospectively examined 90 patients with completed skeletal maturation who were surgically treated for a forearm diaphyseal fracture. Patients with a Monteggia Galeazzi and ipsilateral upper extremity fracture and those with an open epiphyseal line, Type 3 open fracture, pathological fracture, or brain trauma were excluded from the study. Open reduction and internal fixation (ORIF) was applied to 42 patients (plate group), and intramedullary nailing was performed in 48 patients (intramedullary nailing group). Both treatment groups were compared with respect to time to union, joint range of motion, operating time, grip strength, Grace-Eversman criteria, and complications. RESULTS: The mean operating time was 63.29 (range, 40-100) min in the plate group and 46.02 (range, 17-85) min in the intramedullary nailing group. The mean time to union was 13.19 (range, 10-20) and 10.85 (range, 8-20) weeks, respectively. While a statistically significant difference was determined between groups with respect to operating time and time to union, no difference was determined in the Grace-Eversman evaluation criteria, forearm supination, pronation degrees, and grip strength. CONCLUSION: The results of this study showed a significant difference in the intramedullary nailing treatment with respect to time to union, operating time, and amount of bleeding compared with the ORIF treatment. However, no difference was determined in the functional evaluation criteria. Thus, both treatment methods are acceptable in the treatment of forearm diaphyseal fractures in adults with skeletal maturation.

Treatment of Ipsilateral Distal Humerus and Diaphyseal Ulna Fractures by Using an Olecranon Osteotomy and Intramedullary Nail.

OBJECTIVE: To evaluate the results of treatment of an osteotomy of the olecranon and an ulnar diaphyseal fracture with a single nail, in cases with an ipsilateral ulnar diaphyseal fracture and a comminuted fracture of the distal humerus. DESIGN: Retrospective clinical study. SETTING: University-affiliated teaching hospital. PATIENTS: Eight patients with comminuted fractures of the distal humerus and ipsilateral ulnar diaphyseal fractures were included. INTERVENTION: Using a transolecranon approach, internal fixation of the distal humeral fracture with medial and lateral plates was performed. The ulnar diaphyseal fracture and additional osteotomy were fixed using a locked intramedullary nail. Subjective pain assessment was performed by using a visual analog scale (VAS). RESULTS: There were 6 (75%) male and 2 (25%) female patients, with a mean age of 40.9 (range, 32-56) years. The mean follow-up period was 24.6 (range, 12-36) months. All patients achieved union of the ulnar diaphyseal fracture and olecranon osteotomy. Union of the distal humeral fracture was observed in 7 (87.5%) patients. The mean time to union was 16.3 (range, 12-22) weeks, mean visual analog scale score was 1.8 (range, 0-3), median elbow performance score was 85 (range, 70-95), and median disabilities of the arm, shoulder, and hand score was 17.9 (range, 5-45.8). CONCLUSIONS: Osteotomy of the olecranon and ulnar diaphyseal fracture using an intramedullary nail was a cosmetically advantageous and safe technique that enabled rehabilitation during the early postoperative period. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Osteochondral Lesions of Major Joints.

This paper provides information about osteochondral lesions (OCL) and example cases of OCL occurring in major joints, some of which are rarely seen. This simple tutorial is presented in question and answer format.

Treatment with Carnitine Enhances Bone Fracture Healing under Osteoporotic and/or Inflammatory Conditions.

The aim of this study was to examine the effects of carnitine on bone healing in ovariectomy (OVX) and inflammation (INF)-induced osteoporotic rats. The rats were randomly divided into nine groups (n = 8 animals per group): sham-operated (Group 1: SHAM); sham + magnesium silicate (Mg-silicate) (Group 2: SHAM + INF); ovariectomy (Group 3: OVX); ovariectomy + femoral fracture (Group 4: OVX + FRC); ovariectomy + femoral fracture + Mg-silicate (Group 5: OVX + FRC + INF); ovariectomy + femoral fracture + carnitine 50 mg/kg (Group 6: OVX + FRC + CAR50); ovariectomy + femoral fracture + carnitine 100 mg/kg (Group 7: OVX + FRC + CAR100); ovariectomy + femoral fracture + Mg-silicate + carnitine 50 mg/kg (Group 8: OVX + FRC + INF + CAR50); and ovariectomy + femoral fracture + Mg-silicate + carnitine 100 mg/kg (Group 9: OVX + FRC + INF + CAR100). Eight weeks after OVX, which allowed for osteoporosis to develop, INF was induced with subcutaneous Mg-silicate. On day 80, all of the rats in groups 4-9 underwent fracture operation on the right femur. Bone mineral density (BMD) showed statistically significant improvements in the treatment groups. The serum markers of bone turnover (osteocalcin and osteopontin) and pro-inflammatory cytokines (tumour necrosis factor α, interleukin 1ß and interleukin 6) were decreased in the treatment group. The X-ray images showed significantly increased callus formation and fracture healing in the groups treated with carnitine. The present results show that in a rat model with osteoporosis induced by ovariectomy and Mg-silicate, treatment with carnitine improves the healing of femur fractures.

Extra-articular contrast material leaks into locations unrelated to the injection path in shoulder MR arthrography.

OBJECTIVES: To evaluate the localisation, frequency and amount of extravasation in patients with extra-articular contrast material leak into locations unrelated to the injection path in shoulder magnetic resonance (MR) arthrography and associated shoulder disorders. METHODS: The sites of extravasation were determined on the shoulder MR arthrography of 40 patients. The extravasations were measured on three vertical planes of the MR arthrography. Sufficient joint distension was assessed according to the transverse diameters of the axillary recess on coronal MR images. RESULTS: Extravasation of the contrast material occurred through the subscapular recess, the synovium of the biceps, and the axillary recess. In four cases, extravasations were observed in more than one anatomic location. The most common site of extravasation was along the subscapularis muscle. Superior labrum anterior-posterior (SLAP) lesions were found to be most frequently associated with extravasations. The amount of extravasation was significantly higher in patients with adhesive capsulitis compared with the patients with a different diagnosis (p = 0.022). CONCLUSIONS: The extravasations adjacent to the axillary recess do not always indicate glenohumeral ligament pathology. Massive subscapular extravasations were most frequently associated with adhesive capsulitis and SLAP lesions, and might be considered in the MR arthrography report. KEY POINTS: • Contrast material extravasation may reduce the diagnostic value of shoulder MR arthrography. • The extravasations may occur into locations unrelated to the injection path. • The extravasations adjacent to axillary recess can be misleading for HAGL lesion. • Massive subscapular extravasations were frequently associated with adhesive capsulitis and SLAP lesions.

Early and late-term results of arthroscopic surgery on patients with gonarthrosis.

OBJECTIVE: To provide guidance in the selection of the appropriate patient for arthroscopic debridement. MATERIALS AND METHODS: Ninety patients who were diagnosed with gonarthrosis according to modified American College of Rheumatology (ACR) criteria and who underwent arthroscopic debridement and meniscectomy were evaluated. Functional assessment of patients was made based on preoperative as well as 1 month and 1 year postoperative results of the Lysholm Knee Score and the Visual Analog Scale (VAS). One year postoperatively, the Tapper-Hoover Scoring System was used to calculate long-term results. Analyses were conducted using SPSS 18 software. For this study ethics committee approval was received from the ethics committee of Ataturk University Medical Studies Department Head on 08.10.2010 at the 6th meeting with regards to the document written on 16.06.2010 with number 998. RESULTS: Differences between preoperative and 1-month and 1-year postoperative values in the Western Otorino and McMaster Universities Osteoarthrosis (WOMAC) Index, Lysholm and VAS were found to be statistically significant (p<0.001) (Table 1). According to Tapper-Hoover results, 82.8% of patients benefited from arthroscopic debridement in the long term (Table 2). Among body mass index (BMI) groups, the WOMAC, Lysholm and VAS values of obese patients were worse than those of normal weight and underweight patients, and the difference was statistically significant (p<0.005). Late-term results of patients younger than 55 were superior to those over 55. CONCLUSION: In the treatment of patients with gonarthrosis, arthroscopic debridement is a good option. Patients who have a low BMI and are younger than 55 years old experience more benefit from arthroscopic debridement.

Isolated carpal scaphoid dislocation.

Isolated scaphoid dislocations are very rare. Options for the treatment of dislocation of the scaphoid include closed reduction and casting, closed reduction and percutaneous pinning, and open reduction and ligament repair. We report a case of this rare injury which was treated with open reduction, pinning and ligament repair.

Magnetic resonance arthrography of the glenohumeral joint: ultrasonography-guided technique using a posterior approach.

OBJECTIVE: The purpose of this study was to assess the efficacy and feasibility of ultrasound (US)-guided magnetic resonance (MR) arthrography of the glenohumeral joint via a posterior approach. MATERIALS AND METHODS: Thirty-four patients (18 males and 16 females) who were suspected to have glenohumeral joint pathology were examined using MR arthrography. The patients ranged in age from 21 to 85 years, and the average age was 45±15.9 years. A Toshiba Xario US unit was utilized. Ultrasonography examinations were conducted using a broad-band 5-12 MHz linear array transducer. Gadolinium was injected into the shoulder joint using an 18-20 gauge needle. MR imaging was performed within the first 30 min after the injection. RESULTS: The injection of gadolinium into the shoulder joint was successfully accomplished in all 34 patients. Major contrast media extravasation outside the joint was depicted in only two patients (5.9%). No major complications were encountered. CONCLUSION: Ultrasonography is an effective alternate guidance technique for the injection of gadolinium into the glenohumeral joint for MR arthrography. US-guided arthrography via a posterior approach to the glenohumeral joint is safe, accurate, well tolerated by patients and easy to perform with minimal training.

The role of acromion morphology in chronic subacromial impingement syndrome.

This study investigated the role of acromion morphology in the aetiology of chronic subacromial impingement syndrome. Forty five patients with chronic subacromial impingement syndrome were included in the study. They were distributed into three groups according to their acromion types: six (13.3%) patients had type 1, 24 (533%) patients type 2 and 15 (333%) patients type 3 acromion. Constant scoring was used for clinical evaluation. Arthroscopic subacromial decompression was performed in all patients in the three groups, without performing any acromioplasty that would change the morphology of acromion. We then compared the average Constant scores changes in all three groups after arthroscopic subacromial decompression. The average follow-up was 28.6 months (range: 12-47). The average change in Constant score after arthroscopic subacromial decompression was 5830 in patients with type 1 acromion, 58.21 in those with type 2 and 54.07 in those with type 3. No significant difference was observed between the changes in the average Constant scores of the three groups (p > 0.005). The scores were significantly improved following arthroscopic subacromial decompression in all three groups (p < 0.005).In this study, acromion type was not found to have an important role in the aetiology of chronic impingement syndrome; arthroscopic subacromial decompression without simultaneous acromioplasty thus appears as an appropriate treatment.

Vertical mattress suture technique: an alternative vascular anastomosis.

The objective of this study was to introduce the vertical mattress (VM) suture technique and compare its patency and postoperative healing with other commonly used suture techniques. Thirty-two Sprague-Dawley rats were randomly assigned to one of four suture techniques to be applied to both femoral arteries: continuous (C), interrupted (I), VM, and VM with flap (VMF) sutures. The operating time and the degree of postanastomotic leakage were recorded. The milking test was employed 5 and 15 minutes and 14 days after the operation to attain patency. Blood flow velocity was determined using ultrasonography at 1 hour and on days 1 and 14 postoperation. Rats then were sacrificed, and anastomotic lining tissues were harvested for histopathologic examination. Anastomoses by C and I were executed in 12.06 and 18.31 minutes. Modified suture techniques took longer to execute anastomosis (23.09 minutes for VM and 32.44 minutes for VMF). VM suture technique was superior to other suture techniques in terms of anastomotic leakage, quality of filling, and blood flow velocity. Also, absence of the luminal closure or constriction, intimal injury and hyperplasia, foreign body inflammation, and inversion were noted in histopathology. In conclusion, the VM suture technique could be considered for microvascular surgery.

Analgesic effects of intraarticular sufentanil and sufentanil plus methylprednisolone after arthroscopic knee surgery.

UNLABELLED: We studied the effect of intraarticular saline, sufentanil, or sufentanil plus methylprednisolone after knee arthroscopic meniscectomy. In a double-blind randomized study, 60 patients undergoing knee arthroscopic meniscectomy were allocated to groups receiving intraarticular saline, intraarticular sufentanil 10 microg, or sufentanil 10 microg plus methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. Postoperatively, pain levels at rest and during movement (i.e., active flexion of the knee) were measured by a visual analog scale and were significantly decreased in the sufentanil and sufentanil plus methylprednisolone groups compared with the control group. Moreover, we found that there was a significant reduction in intraarticular sufentanil and sufentanil plus methylprednisolone in the postoperative consumption of analgesics. We also found that the use of intraarticular sufentanil or sufentanil plus methylprednisolone after knee arthroscopic meniscectomy decreases the amount of supplementary analgesic needed for pain relief during the early postoperative period. In addition, we detected that sufentanil provided prolonged pain relief up to 24 h when compared with control, whereas when we combined sufentanil plus methylprednisolone, we found that it further reduced pain and use of analgesics when compared with sufentanil. IMPLICATIONS: The combined use of intraarticular sufentanil (10 microg) and methylprednisolone (40 mg) in arthroscopic meniscectomy surgery reduced both postoperative pain scores and the use of additional analgesics.