Total Matricectomy and V-Y Advancement Flap Technique in the Treatment of Onychogryphosis.

BACKGROUND: Onychogryphosis is manifested by irregular thickening and curving of nails and the nailfold, resulting in ram horn appearance. No therapeutic modality that can normalize nails with onychogryphosis is yet available. Recommended therapies include palliative measures and various surgical interventions. OBJECTIVE: The authors reviewed the outcomes of total matricectomy and V-Y advancement flap technique used for nail removal in patients with onychogryphosis at the big toe. MATERIALS AND METHODS: The authors evaluated 14 patients with onychogryphosis, including 8 men and 6 women (15 big toes; 10 at the right foot and 5 at the left foot), who underwent total matricectomy and V-Y advancement flap technique. The general complaints included repeated nail removal, pain, cosmetic complaints, and difficulty in wearing shoe and footwear. RESULTS: Mean age of the patients was 42.4 years. Mean follow-up was 13.5 months. Clinical history revealed at least 2 previous nail removals. No complications were observed during the follow-up period. Mean time to return to daily activities was 4.5 weeks. Patient satisfaction was rated as very good in 9 patients and good in 5 patients. CONCLUSION: The surgical technique employed in patients with onychogryphosis is a safe treatment option with a high success rate.

Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures: decision making with MRI.

PURPOSE: The purpose of the present study is to evaluate scaphoid delayed fractures or nonunions treated by percutaneous fixation with MRI correlations. METHODS: We evaluated 33 consecutive scaphoid delayed unions or nonunions treated by dorsal percutaneous fixation at a mean 16 months (range, seven to 48 months) after the operation. There were 31 male and two female patients with an average age of 29 years (range, 25-33 years). RESULTS: Pre-operative MRI revealed no signs of avascular necrosis. At the latest follow-up, all patients had good or excellent results. CONCLUSION: We suggest dorsal percutaneous screw fixation for scaphoid delayed fractures or nonunions after eliminating the presence of AVN by pre-operative MRI examination.

A rare complication after intertrochanteric fracture treated with proximal femoral nail: femoral neck insufficiency fracture.

We present a case, 82-year-old woman, sustaining intertrochanteric fracture treated with proximal femoral nail. Up to 14 months postoperatively, everything went on seamlessly. Then, there was a rapid onset of worsening of the functional capacity. She came to outpatient clinic by using wheelchair. Plain X-rays revealed a femoral neck fracture on the operative side with no history of trauma. Laboratory studies showed no significant abnormalities but vitamin D [25 (OH) D] level was 14.82 ng/ml. X-ray survey of skeletal system was not indicative of osteomalacia. We performed total hip replacement instead of internal fixation due to patient's age. Vitamin D replacement therapy was launched. Three months later, she was totally satisfactory with clinical result and 25 (OH) D level increased to 53.68 ng/ml. At the last visit, the patient was pain free and active in all her recreational activities.

The effect of comorbid factors and amputation level on mortality in geriatric patients with diabetic foot.

OBJECTIVES: The aim of this study was to evaluate the factors that influenced one-year and five-year mortality and to compare major and minor amputations in diabetic patients with comorbidities. PATIENTS AND METHODS: Between February 2008 and November 2014, a total of 201 type 2 diabetic foot patients (147 males, 54 females; median age: 65.99 years; range, 50 to 92 years) who underwent amputation were retrospectively analyzed. The patients were divided into two groups according to their initial amputation level: Group 1 (n=100), minor amputation group, which included the distal region of the ankle joint and Group 2 (n=101), major amputation group, which included trans-tibial amputation, trans-femoral amputation and hip disarticulation. Clinical data including patients' demographic features, re-amputation degree, length of hospitalization, hyperbaric oxygen therapy, comorbidities, blood parameters, and survival rates were recorded. RESULTS: The regression analysis of one-year mortality found that the presence of cerebrovascular disease increased death by 2.463 times (p=0.002). Minor amputation increased mortality by 2.284 (p=0.006), and each unit increase in patient age increased mortality by 1.05 (p=0.008). Chronic renal failure increased death by 3.164 times (p<0.001) in the five-year mortality regression analysis. CONCLUSION: Minor amputations have an effect on one-year mortality, as do cerebrovascular disease and age. On the other hand, chronic renal failure has a negative impact on five-year mortality. Minor amputations may have a detrimental effect on mortality due to the ongoing progression of diabetic foot disease and the involvement of comorbidities. Comorbidities associated with amputations of the diabetic foot have a significant impact on mortality.

Efficacy of calcium phosphate cementing in the surgical treatment of Sanders Type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

OBJECTIVE: This study aimed to determine the effectiveness of calcium phosphate cementing in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach. METHODS: In this retrospective study, 85 feet of 84 patients (74 males, 10 females; mean age 43 [17-61] years) in whom screw fixation was performed using the sinus tarsi approach for Sanders type II or III calcaneal fractures were included. The mean follow-up was 28 (14-39) months. Patients were categorized into 2 groups on the basis of whether calcium phosphate cement (CPC) was used. Group 1 had 37 patients with CPC (38 calcaneal fractures) and group 2 had 47 patients without CPC (47 calcaneal fractures). In the clinical assessment, the American Orthopedic Foot Ankle Society (AOFAS) hind foot score and the Maryland Foot Score (MFS) were used at the final follow-up. In the radiological assessment, Bohler's angle on plain radiograph and posterior facet step-off on computed tomography were measured pre-and postoperatively. RESULTS: At the final follow-up, the mean Bohler's angle was 26.2° (20°-33°) in group 1 and 26° (17°-30°) in group 2 (P = 0.85). The mean posterior facet step-off was 1.6 (0-5) mm in group 1 and 1.5 (0-5) mm in group 2 (P = 0.85). The mean AOFAS score was 83.8 (59-100) in group 1 and 85.8 (60-100) in group 2 (P = 0.5). The mean MFS was 86.3 (66-100) in group 1 and 87.7 (66-100) in group 2 (P = 0.62). CONCLUSION: Evidence from this study have shown that CPC may have no significant effect on clinical and radiological outcomes in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

Effect of boric acid on cartilage formation of osteochondral defects in rabbit knee: An experimental study.

BACKGROUND: The present study aimed to investigate the healing of articular cartilage with boric acid (BA) injection in an experimental cartilage defect model of rabbit knee. METHODS: Nine skeletally mature female New Zealand White rabbits were used. The right knees of the rabbits were assigned as the study group and injected with the BA solution and the left knees of the rabbits as the control group. Under anesthesia, a cylindrical full-thickness osteochondral defect (4 mm in diameter and 3 mm in depth) was formed using a drill on the anterior side of the articular surface of the medial femur condyle. The BA solution was administered to the right knees of rabbits in the form of an intra-articular injection (8 mg/kg) for 6 weeks, at the same day and hours each week. The animals were euthanized at the end of the 2nd month. RESULTS: In both macroscopic evaluation and microscopic evaluation, statistically significant differences were observed in the BA injection group compared with the control group (p<0.05). In the macroscopic examination of the defect area, statistically significant differences were observed between the groups in terms of degree of defect repair, integration to border zone, and macroscopic appearance (p<0.05). The averaged results of all evaluated parameters of the International Cartilage Repair Society visual histological assessment score were better for the BA group. CONCLUSION: The healing process of the cartilage injury could be improved by BA injection administration. In future, BA may safely be used as an additional treatment modality in clinical practice to enhance the healing process of cartilage injuries, which are commonly observed orthopedic problem.

The effect of implant choice on varus angulation and clinical results in the management of subtrochanteric fractures.

INTRODUCTION: The aim of this study was to evaluate the effects of implant choice on varus angulation in the management of subtrochanteric fractures. METHODS: Between 2011 and 2016, 58 patients were included in the study and femur locking plate (PF-LCP; Group 1 = 27) and proximal femoral nails (PFN; Group 2 = 31) were compared retrospectively. RESULTS: In group 1, femoral NSA was measured 131,37 ± 1,95 and last follow-up angle was 127,33 ± 2,40. (p = 0,025). The mean Harris hip score was 67.59 ± 17.74 and 63.29 ± 13.83 in Group 1 and Group 2, respectively (p = 0.406). CONCLUSIONS: Plate fixation is not as successful as proximal nails at preventing varus angulation.

Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate.

Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17-88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

How should open tibia fractures be treated? A retrospective comparative study between intramedullary nailing and biologic plating.

BACKGROUND: In this retrospective study, our purpose was to compare two treatment alternatives clinically. METHODS: Forty-five patients who had grade I or II open tibia fractures were included. Twenty-five of them, treated via minimally invasive plate osteosynthesis (MIPO), comprised group I. The latter 20 cases, treated via partial reamed intramedullary nailing (PR-IMN), comprised group II. Clinical evaluation was made on the basis of modified Ketenjian's criteria. RESULTS: Full weight-bearing periods in groups I and II were 21 and 22.4 weeks, respectively. Non-union in one case of group I was revised with circular fixator. In another case, implant removal was needed due to chronic osteomyelitis. Mal-union was detected in another. In group II, two cases needed implant revision with intramedullary nail in one and circular fixator in another for non-union. Mal-union in one case and chronic osteomyelitis in another were the late complications in group II. At the last follow-up, satisfaction rates were: 21/25 in group I and 18/20 in group II. There was no significant difference between groups (p>0.05). CONCLUSION: The clinical results of both groups were similar. Although intramedullary nailing is the first choice, MIPO is an alternative method for open tibia fractures.

Leg length discrepancies in adult femoral shaft fractures treated with intramedullary nailing.

BACKGROUND: To evaluate the leg length discrepancy (LLD) retrospectively in adult femoral shaft fractures treated with intramedullary nailing (IMN). METHODS: Sixty-three patients (58 male, 5 female; mean age 29.9+/-12.4; range 15 to 77 years) were included in the study. Fractures were identified according to the Winquist-Hansen (W) system and AO classification. 16 W0, 18 WI, 16 WII, 7 WIII, and 6 WIV fractures and 35 type A, 22 type B, and 6 type C fractures were repaired. Thirty-one (49.2%) patients had multiple injuries. Fourteen patients sustained an open fracture. LLDs were measured on physical examination and using orthoroentgenography. RESULTS: The mean follow-up was 90.2+/-29.9 (39-193) months. The mean LLD was 12.3+/-15.2 [12-(-60)] mm using orthoroentgenography and 12.9+/-13.7 [10-(-60)] mm according to manual measurement. In seven cases, no LLD was observed. Twenty-seven shortenings and one lengthening were observed in the 28 femurs with a discrepancy greater than 10 mm (44.4%). There was no statistical correlation between LLD and open or closed fracture (r=0.02, p=0.86), polytrauma (r=-0.09, p=0.47), or delayed surgery (p=0.31), but there was a tendency to a greater discrepancy in comminuted fractures (WIII, IV) (r=0.33, p=0.007). CONCLUSION: LLD may be seen in high rates in adult femoral shaft fracture cases treated with IMN. Static IMN following absolute restoration of the length may prevent this problem in femoral diaphysis fractures, especially comminuted WIII and IV types.

Overlooked posterior shoulder dislocation: preoperative and postoperative CT studies (a case report).

Posterior shoulder dislocation is an extremely rare injury. A radiograph of the dislocated shoulder is generally accepted as normal owing to several traps. Therefore if the clinician is not suspicious, this injury can easily be overlooked. Most of the cases described in the literature were overlooked dislocations reported as case reports or series. We aimed to present a case of sustained posterior shoulder dislocation. The injury was initially overlooked, the patient was admitted 1 month later and treated by modified McLaughlin procedure.

Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

BACKGROUND: The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. MATERIAL AND METHODS: Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. RESULTS: Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). CONCLUSION: Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

Lateral Locked Plating or Dual Plating: A Comparison of Two Methods in Simple Bicondylar Tibial Plateau Fractures.

BACKGROUND: In this study, our aim was to compare the results of the dual locking plate fixation technique and lateral locking plate fixation technique for tibial bicondylar plateau fractures without posteromedial fragment. METHODS: We evaluated 20 patients who underwent surgical treatment due to bicondylar tibial plateau fracture between 2010 and 2015. Ten patients were included in group 1, in which a dual locking plate was employed, whereas 10 patients were included in group 2, in which a lateral locking plate was used. In both groups, functional and clinical outcomes after treatment were rated according to the Knee Society Knee Scoring System, Rasmussen functional score, and Rasmussen radiological score. RESULTS: The mean follow-up time was 24 months. There were no significant differences between the groups with respect to functional and radiographic outcomes at the final follow-up. CONCLUSIONS: In bicondylar tibial plateau fractures without posteromedial fragment, the lateral locking plate fixation technique showed the similar clinical and radiological outcomes as the dual locking plate fixation technique.

Arthroscopically assisted percutaneous osteosynthesis of lateral tibial plateau fractures.

BACKGROUND: The aim of our study was to evaluate the results of lateral tibial plateau fractures treated with arthroscopically assisted percutaneous osteosynthesis (AAPO). METHODS: Twenty-one patients (14 men and 7 women) with a mean age of 41 years underwent AAPO to repair low-energy Schatzker I-III tibial plateau fractures. Under pneumatic tourniquet, we reduced and fixed the fracture with 1 or 2 subchondral cannulated screws. Accompanying lesions included 10 meniscus tears, which we partially excised in 9 patients and repaired in 1 patient. On the second postoperative day, patients began range-of-motion exercises. We encouraged partial and full weight-bearing by the sixth and tenth weeks, respectively. The mean follow-up period was 38 (range 12-96) months, and we evaluated the patients using Rasmussen's clinical and radiologic criteria. We used a t test for statistical analysis. RESULTS: There were 13 excellent (62%), 6 good (28%) and 2 fair (10%) clinical results, and 11 excellent (52%), 7 good (33%) and 3 fair (14%) radiologic results. We observed mild or moderate arthritic changes in 5 patients (24%). There were no infection or wound problems, but we removed hardware in 4 patients. CONCLUSION: Arthroscopically assisted treatment of lateral tibial plateau fractures yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.

The role of biological fixation with bridge plating for comminuted subtrochanteric fractures of the femur.

BACKGROUND: The surgical outcomes of comminuted subtrochanteric fractures result in high incidence of nonunion and malunion due to high energy trauma. Biological fixation offers decrease in these complications while preserving soft tissue vascularity. The aim of this study was to evaluate the results of patients treated with bridge plating for comminuted subtrochanteric femoral fractures retrospectively. METHODS: Ten patients with comminuted subtrochanteric femoral fractures between 1996 and 2002 were included into this study. All patients were male and mean age was 46+/-15.2 years (range: 29-76 years). Six patients had C-3-1 and four patients had C-3-2 type fractures according to AO/OTA classification. Bridge plating under fluoroscopy control, according to biological fixation principles was carried out on all patients. Pain, walking capacity, functionality, motion, daily activities, radiological assessment for Sander's criteria and shaft-neck angles of both fractured and the other sides were recorded for statistical analysis, at the last follow-up. RESULTS: Mean follow-up period was 62+/-20.9 months (range: 37-104 months). Partial and full weight-bearing were recommended at an average period of 3.3+/-1.1 (range: 1.5-4.5 months) and 4.8+/-1 months (range: 3-6 months) respectively (range: 3-6 months). There were eight excellent (80%), one good (10%) and one poor (10%) results according to Sanders' criteria. There was no statistically significant difference between the healthy and fractured sides with respect to femoral shaft-neck angles. CONCLUSION: We have concluded that biological fixation applied with bridge plating offered an alternative method in the treatment of comminuted subtrochanteric femoral fractures.

Complications of internally fixed femoral neck fractures.

BACKGROUND: Femoral neck fractures in young patients are the emergent injuries that require precise reduction and stable fixation. Despite all advances, nonunion and avascular necrosis (AVN) of the femoral head are the major complications necessitating salvage procedures. In this retrospective series, we evaluated the complications of internally fixed femoral neck fractures. METHODS: This study consisted of 32 cases that had displaced femoral neck fractures. Although some of them admitted to hospital more than 8 hours after initial trauma, all underwent internal fixation as early as possible. All the fractures were reduced and fixed by closed reduction under fluoroscopy control. However, 5 cases needed open reduction. AVN was determined by using Ficat and Arlet criteria. Clinical evaluation was performed based on the scoring system described by Harris. RESULTS: Mean follow-up period was 49+/-29 months (range 24-126). AVN of the femoral head was observed in 13 cases (40%). However, only 5 of them had unsatisfactory clinical results requiring salvage surgery as total hip replacement. Nonunion of fracture was seen in 5 cases. In the statistical analysis, a negative correlation was observed between the degree of AVN and clinical findings. We found no correlation between the duration of the preoperative period and late complications. CONCLUSION: AVN is the most common complication of displaced femoral neck fractures. However, less than half of these cases require salvage procedures. Total hip replacement is the preferred treatment option for these cases.

Simultaneous bilateral quadriceps tendon rupture in a patient on chronic haemodialysis. (Short-term results of treatment with transpatellar sutures augmented with a quadriceps tendon flap).

Quadriceps tendon ruptures are rare orthopaedic injuries. Although they are generally seen after the age of 50, they may occur in younger patients with certain underlying conditions, including chronic haemodialysis. Several repair techniques have been proposed but the choice of the best method is still a matter of controversy. This paper presents the case of a renal failure patient with 10 years' history of haemodialysis treatment suffering from bilateral quadriceps tendon rupture. The treatment was with transpatellar sutures augmented with a reverse quadriceps tendon flap. His short-term clinical and radiological results are satisfactory.

PRP on Prevention of Tunnel Enlargement in ACL Reconstruction.

BACKGROUND: The purpose of this study is to describe the role of Platelet Rich Plasma in preventing tunnel enlargement in anterior cruciate ligament reconstruction with a hamstring autograft Material and methods. Forty-four patients who underwent transtibial reconstructive surgery with a hamstring tendon autograft between March 2014 and July 2015 were included in this study. This study involved two groups. Group A consisted of 18 patients who underwent PRPadministration into the femoral and tibial tunnel. Group B was a control group that included 26 patients who underwent ACL reconstruction surgery with a hamstring autograft without PRP. The patients were evaluated preoperatively and postoperatively with the IKDC score, Lysholm score, Tegner activity scale and a KT-1000 arthrometer device. The diameter of the tibial and femoral tunnels of the operated knees was measured on the first day and at three months postoperatively using CT. Measurements carried out for tomography standardization of the patients were evaluated on coronal, sagittal and axial images from 64-slice MSCT scans. RESULTS: On comparison of radiological data between both groups, there was less tunnel enlargement in PRP-administered group for the femoral tunnel, but the result was not statistically significant. No difference was seen between clinical examination results and the grading scales used. CONCLUSIONS: 1. The radiological findings of our study indicated that while there was less tunnel enlargement in the PRP group, there was no statistically significant difference between the groups. 2. Similarly, clinical exa-mination results and scoring scales used did not de-monstrate any intergroup difference. 3. As a result, we donot recommend routine use of PRP for the prevention of tunnel enlargement after ACL reconstruction.

Comparison of Simple Decompression and Anterior Subcutaneous Transposition of the Ulnar Nerve for the Treatment of Cubital Tunnel Syndrome.

BACKGROUND: In this study, we aim to evaluate clinical and functional results in patients with cubital tunnel syndrome who were treated with subcutaneous anterior transposition vs simple decompression of the ulnar nerve. MATERIAL AND METHODS: Fifty-five patients were separated into two groups according to surgical technique. Group 1 comprised 35 patients (23 males, 12 females; mean age, 42.1 years; range, 28-56 years) who underwent anterior subcutaneous transposition of the ulnar nerve, whereas Group 2 included 20 patients (11 males, 9 females; mean age, 47.4 years; range, 25-59 years) who underwent simple decompression of the ulnar nerve. RESULTS: The mean modified Bishop scores were 7.26 and 7.85 in Group 1 and Group 2, respectively (P< .05). The mean Q-DASH scores were 16.94 in Group 1 and 15.80 in Group 2 (P> .05). Postoperatively, paraesthesia regressed in 17 (85.7%) and 30 (85%) patients in Group 1 and Group 2, respectively (P> .05). Both groups demonstrated improvement in ulnar nerve function in comparison with the preoperative period, and ulnar nerve paralysis was not seen in any of our patients. A postsurgical incision scar developed in six (17.1%) and three patients (15%) in Group 1 and Group 2, respectively. CONCLUSION: Both simple decompression and anterior subcutaneous transposition of the ulnar nerve are effective and safe for the treatment of cubital tunnel syndrome, so we would favour simple decompression as it is a less extensive procedure.

Corrective Osteotomy for Coronal Plane Malunion of the Medial Femoral Condyle.

Medial femoral condyle malunion in the coronal plane is a very rare injury. In this presented case, we performed intra-articular corrective osteotomy for a malunited medial femoral condyle in the coronal plane of a 22-year-old man and obtained good functional and radiographic results. Corrective osteotomy for a malunited medial Hoffa fracture is technically very challenging, but intra-articular corrective osteotomy for these malunited fractures offers a good outcome and should be considered as a salvage treatment.