Scipedia: Collection of Orthopedic and Traumatological Proceeding

A giant clear cell sarcoma on right scapular: A case report

Scipedia content — Fri, 31 Mar 2017 11:04:55 +0200

Clear-cell sarcoma is a rare and malignant soft tissue tumor most commonly located at the distal end of extremities and rarely at the trunk. Data on the clinical features of the tumor is limited, complicating the analysis of prognosis and establishment of treatment protocols. In our study, we present a case diagnosed with clear-cell sarcoma in his right scapula and treated with tumor resection and chemotherapy, combination of dacarbazine, pharmorubicin and cisplatin. The patient died due to multiple organ failure eight months after operation. Early diagnosis, attentive care, and extended surgical resection combined with adjuvant therapy is of essence in treatment of clear-cell sarcoma.

Effects of two different degrees of lateral-wedge insoles on unilateral lower extremity load-bearing line in patients with medial knee osteoarthritis

Scipedia content — Fri, 31 Mar 2017 11:04:50 +0200

The aim of this study is to assess the effect of 5 and 10�� lateral-wedge insoles on unilateral lower extremity load carrying line in patients with medial knee osteoarthritis using the L.A.S.A.R. posture alignment system. Twenty subjects (10 females and 10 males, mean age 67.7 �� 5.4 years (range: 58�C78) with bilateral medial knee osteoarthritis were included in the study. The laser line projected on the person by the L.A.S.A.R. posture alignment system showed joint load carrying line. The location of the joint load carrying line in static standing with one foot on the force plate was assessed with barefoot, and 5�� and 10�� lateral-wedge insoles. Displacement of the load carrying line was measured using a ruler placed tangentially to the patella at the level of joint line. The load carrying lines measured with 5�� and 10�� lateral-wedge insoles were significantly laterally located compared to that without wearing insole (p

A mini-invasive procedure for treating arthrofibrosis of the knee

Scipedia content — Fri, 31 Mar 2017 11:04:45 +0200

The aim of this study was to introduce the results of a novel mini-invasive operative technique comprising mini-incision release, ��pie-crusting�� lengthening of the quadriceps extensor, and arthroscopic lysis in severe arthrofibrotic knees. From 2010 to 2014, 17 patients (12 males and 5 females with a mean age of 44 years (range, 19�C62 years)) with severely arthrofibrotic knees were treated with this operative technique. The mean follow-up duration was 23 months. The knee range of motion (ROM) was assessed with a goniometer. The functional outcomes were evaluated according to the Hospital for Special Surgery (HSS) score and Judets criteria. The ROM significantly improved from 29.7�� (range, 7��C56��) preoperatively to 127�� (range, 120��C136��) at the final follow-up in all patients (p 100��). The HSS score was improved from 70 points (range, 60�C85 points) preoperatively to 91 points (range, 84�C98 points) (p

Translation, cross-cultural adaptation, reliability and validity of the?Turkish version of the Olerud-Molander Ankle Score (OMAS)

Scipedia content — Fri, 31 Mar 2017 11:04:41 +0200

The aim of this study was to translate and culturally adapt the Olerud-Molander Ankle Score (OMAS) into Turkish and to assess its reliability and validity. The Turkish version of the OMAS (OMAS-Tr) was developed after the translation and back-translation, which included the stages recommended by Beaton. The OMAS-Tr was administered to one hundred patients (49 females, 51 males, average age: 42.3 �� 17.7, range 16�C81 years) with malleolar fractures. The OMAS-Tr was completed twice by each participant at 7- to 10-days intervals to assess test-retest reliability based on the interrater correlation coefficient, whereas Cronbachs alpha evaluated internal consistency. The external validity was evaluated with correlations between the Turkish version of the Foot and Ankle Ability Measure (FAAM) and the Turkish version of the SF-12 questionnaire. The distribution of floor and ceiling effects was also analyzed. The internal consistency (Cronbachs �� = 0.84) and the test-retest reliability (ICC = 0.98) were excellent. The mean interval between the two tests was 8.6 �� 1.4 days. The mean and standard deviation of the first and second assessments of the OMAS-Tr were 74.1 �� 23.7 and 75.7 �� 23.9, respectively. There was a strong correlation between the OMAS-Tr and the FAAM subscales on activities of daily living and sports (r = 0.86, r = 0.83, p

Patellar tendon mechanical properties change with gender, body mass index and quadriceps femoris muscle strength

Scipedia content — Fri, 31 Mar 2017 11:04:37 +0200

The purpose of this study is to assess the effect and correlation of gender, body mass index (BMI) and quadriceps femoris (QF) muscle strength on patellar tendon (PT) thickness and stiffness in healthy sedentary individuals. This study was carried out with 67 (36 female, 31 male) healthy sedentary individuals between the ages of 18�C44 (28.0 �� 7.5 years). The individuals included in the study were divided into two groups according to their gender and BMI (18.5

The effect of platelet-rich plasma on Achilles tendon healing in a rabbit model

Scipedia content — Fri, 31 Mar 2017 11:04:31 +0200

The aim of the present study was to evaluate the effects of PRP on Achilles tendon healing in rabbits during the inflammatory, proliferative, and remodeling phases by histological examination and quantitative assessments. Fifty mature male Japanese albino rabbits with severed Achilles tendons were divided into two equal groups and treated with platelet-rich plasma (PRP) or left untreated. Tendon tissue was harvested at 1, 2, 3, 4, and 6 weeks after treatment, and sections were stained with hematoxylin-eosin and monoclonal antibodies against CD31 and type I collagen. Collagen fibers proliferated more densely early after severance, and subsequent remodeling of the collagen fibers and approximation of normal tendinous tissue occurred earlier in the PRP group than in the control group. The fibroblast number was significantly higher in the PRP group than in the control group at 1 and 2 weeks. Similarly, the area ratio of CD31-positive cells was significantly higher in the PRP group than in the control group at 1 and 2 weeks. Positive staining for type I collagen was more intense in the PRP group than in the control group after 3 weeks, indicating tendon maturation. Administration of PRP shortened the inflammatory phase and promoted tendon healing during the proliferative phase.

Restore a 9?mm diameter osteochondral defect with gene enhanced tissue engineering followed mosaicplasty in a goat model

Scipedia content — Fri, 31 Mar 2017 11:04:25 +0200

The aim of this study was to evaluate the efficacy of gene enhanced tissue engineering followed mosaicplasty in a goat model. An acute cylindrical defect 9 mm in diameter was created in the weight bearing area of the medial femoral condyle in a goat model. Thirty-six medial femoral condyles were divided into 6 groups using different proportion of gene enhanced tissue engineering and mosaicplasty to restore the defects. The specimen received gross and histology observation, which was evaluated by the histological grading scale of O'Driscoll, Keeley and Salter. Transmission electron microscope observation was also performed. Two factors analysis of variance and Student-Newman-Kewls test were used to compare the specimen. The gross and histology observation revealed that each defects of six groups had different restoration. The scores of the reparative tissue of three groups with gene enhancement were significantly higher than those in other three groups without gene enhancement (p > 0.05). Gene enhanced tissue engineering followed mosaicplasty could restore a 9 mm diameter osteochondral defects in a goat model effectively. With the reduction of covering area of the graft, the advantages of the combined gene enhanced tissue engineering method can be better reflected.

Comparison of the chondroprotective effect of a novel hydrogel compound and traditional hyaluronate on rat cartilage in a papain-induced osteoarthritis model

Scipedia content — Fri, 31 Mar 2017 11:04:19 +0200

The aim of this experimental study is to evaluate the efficacy of a novel intraarticular drug in a papain induced osteoarthritis (OA) rat model and compare with the traditional hyaluronat (HA) visco supplementation. An early stage OA model was induced by the intra-articular injection of papain enzyme in the right knee joints of 44 Sprague-Dawley rats. Eleven rats (eleven right knees: papain group, 11 left knees: control group) were chosen randomly 28 days after the last injection and sacrificed for verifying OA. The remaining rats (n = 33) were randomly divided into 3 groups. Group 1 was injected 0, 2 mL of sterile saline solution (0, 9%), group 2 was injected 0, 2 mL HA and the group 3 was injected 0, 2 mL of HA-CSNAG (hyaluronat, chondritin sulfate, N-acetyl-d -glucosamine) combination in the right knees. Injections were performed on the 35th, the 42nd and the 49th days consecutively. Two weeks after the last injection, all groups were sacrificed to evaluate the severity of OA according to Mankin system. Early stage of OA was verified regarding total Mankin scores (p

Clinical and radiological results on the fixation of Neer type 2 distal clavicle fractures with a hook plate

Scipedia content — Fri, 31 Mar 2017 11:04:14 +0200

The aim of this study was to analyze the clinical and functional results of hook plate fixation in Neer type 2 distal clavicle fractures. We retrospectively analyzed 16 patients (11 males, 5 females) who were diagnosed with Neer type 2 distal clavicle fractures and treated with hook plate fixation between 2013 and 2014. Mean age was 38 (range: 27�C61), and mean follow-up time was 14.3 (range: 12�C18) months. Complications seen on radiographs were implant failure and subacromial osteolysis. The clinical results were evaluated with modified UCLA (University of California Los Angeles) scoring system. Bone union was achieved in all patients at the end of the first 4 months. Mean modified UCLA score was 32.75 (range 31�C35). In 12 patients (68%), the implants had to be removed due to complications. After removal, the complaints regressed and shoulders' range of motion increased. Clinical and radiological results on the fixation of Neer type 2 distal clavicle fractures with a hook plate are good in terms of fracture union and function. The major disadvantage of the method was the requirement of early implant removal due to the hardware related complications and good results can be achieved only after plate removal. Optimizing the length of hook plate may lower the rate of complications. Level IV, Therapeutic study.

Comparison of multimodal intraoperative neurophysiological monitoring efficacy in early childhood and school aged children undergoing spinal surgery

Scipedia content — Fri, 31 Mar 2017 11:04:10 +0200

The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age. 43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded and evaluated at specific time points for each patient. Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There was no false-negative whereas 9 false positive recordings due to physiological conditions that all recovered intraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosis component. The tcMEPs fully recovered by the end of the operation except for the patient with post-tuberculosis kyphosis. There was no statistically significant difference in the mean threshold values with regard to transcranial stimulus intensity for the tcMEPs between the two groups. Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM is effective for early childhood patients undergoing spinal surgery. Level III, Diagnostic Study.

Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results

Scipedia content — Fri, 31 Mar 2017 11:04:04 +0200

The aim of this study was to evaluate the clinical and radiological outcomes of total hip arthroplasty (THA) in patients with Ankylosing Spondylitis (AS). One hundred five hips of 61 AS patients (mean age: 41.3 �� 10.2 years) who underwent THA between 1997 and 2012 were included into the study. Dorrs classification of proximal femoral geometry, acetabular protrusio, bone ankylosis, acetabular protrusion, Brooker classification of heterotopic ossification (HO), Gruen and Charnley classifications of implant loosening were used in radiographic assessments. Patients were called back to return for an additional long-term follow-up for functional assessment. Cementless total hip arthroplasty was used in 83 hips (79%) and cemented TKA was used in 22 hips (21%). The overall rate of aseptic loosening was 7.6% at a mean follow-up of 5.4 years. Femoral loosening was statistically similar in cemented and cementless femoral components (14% vs. 8%, p = 0.089). Acetabular component loosening was statistically higher in patients with any degree of HO (p = 0.04). Regardless of the type of femoral implant (cemented or cementless), femoral component loosening was higher in Dorrs type C patients (p = 0.005). The average pre-operative HSS was 46.6 �� 16.3, and it improved to 80.7 �� 18.7 at last follow-up (p

Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Scipedia content — Fri, 31 Mar 2017 11:03:58 +0200

Closed reduction with percutaneous pinning is the treatment of choice for displaced supracondylar humerus fractures in children. In addition to configuration of pin fixation, many factors have been attributed to loss of reduction (LOR). The aim of the present study was to review potential factors that contribute to loss of reduction in the closed management of type III pediatric supracondylar fractures. Treatment of 87 patients with type III supracondylar fractures was reviewed to determine factors associated with loss of reduction, 48 patients were treated with lateral pinning and 39 with crossed-pinning after closed reduction. Outcome parameters included radiographic maintenance of postoperative reduction. Lateral or crossed-pin configuration, pin spread at fracture site, pin-spread ratio (PSR), and direction of coronal displacement of the fracture were not associated with LOR. A significant difference (p = 0.01) was found between LOR rates of patients with medial wall communication and LOR. Medial wall communication is a contributing factor to LOR in the management of type III supracondylar fractures. Cross-pinning should be preferred when medial wall communication is present, to provide more stable fixation. Level IV, Therapeutic study.

Prevalence of flatfoot among school students and its relationship with?BMI

Scipedia content — Fri, 31 Mar 2017 11:03:54 +0200

The aim of this study was to analyze the relation between the flat-footedness and obesity. A total of 1158 school children (653 male and 505 female) participated in this cross sectional descriptive study. According to their age, children were divided into three groups for each gender (6�C10, 11�C13, 14�C18 years old). Diagnosis and severity of flatfoot was assessed in using the Dennis method. BMI of children were calculated as body weight divided by height squared (kg*m?2 ). Majority (83.9%) of respondents had normal feet. The prevalence of flatfoot was 16.1% with a decreasing trend with age. Boys had a higher frequency of flatfoot than girls, however the difference was not significant (p > 0.05). The prevalence of flatfoot was 17.5% in boys and 14.5% in girls. The percentage of overweight and obese children was 10.3%. A significant difference in the prevalence of flatfoot occurred between, under-weight (13.9%), normal-weight (16.1%), overweight (26.9%), and obese (30.8%), children. The increasing prevalence of childhood obesity is one of the most serious health challenges across the globe, and a positive correlation between increased BMI, and flatfoot is one of the potential complications.

Treatment of post-traumatic elbow deformities in children with the Ilizarov distraction osteogenesis technique

Scipedia content — Fri, 31 Mar 2017 11:03:49 +0200

The present study assessed functional and radiographic outcomes of distraction osteogenesis treatment of post-traumatic elbow deformities in children. Eight children were treated between 2008 and 2013 for post-traumatic elbow deformities using distraction osteogenesis. Mean age at time of operation was 10.9 years. Six patients had varus and 2 had valgus deformity. Magnitude of correction, fixator index, complications, carrying angle, and elbow range of motion were assessed. Functional results were graded according to protocol of Bellemore et al. Mean follow-up was 43 months. Mean preoperative varus deformity in 6 patients was 29.2�� and valgus deformity in 2 patients was 28.5��. Preoperative flexion and extension of elbow were 123.8�� and ?10.6��, respectively. Mean carrying angle was 9�� valgus at last follow-up. Mean flexion and extension were 134.4�� and ?6.0��, respectively. Change in carrying angle was statistically significant (p = 0.002). There were 2 grade 1 pin tract infections and 1 diaphyseal fracture of humerus. Functional outcome was rated excellent in 7 patients and good in 1 patient. Ilizarov distraction osteogenesis is a valuable alternative in treatment of elbow deformities in children. The surgical technique is simple and correction is adjustable. Gradual correction prevents possible neurovascular complications and minimally invasive surgery produces less scarring. Compliance of patient and family is key factor in the success of the outcome. Level IV, therapeutic study

Tibiotalocalcaneal arthrodesis by using proximal humeral locking plate

Scipedia content — Fri, 31 Mar 2017 11:03:45 +0200

The aim of this study was to evaluate the short-term clinical and radiological results of tibiotalocalcaneal arthrodesis (TTCA) with proximal humeral locking plate. Eight patients (7 female, 1 male, average age 53 years (range: 24�C67)) who underwent TTCA with proximal humeral locking plate between 2009 and 2011, were retrospectively evaluated with AOFAS hindfoot scale and Maryland foot score system. The mean follow up was 32.6 months (range: 23�C54). Complete fusion was achieved in 7 patients. Soft tissue infection was observed in 2 patients and reflex sympathetic dystrophy in 3 patients. All patients recovered with medical treatment. At the final follow-up, mean AOFAS Hindfoot score was 60 (range: 41�C81) and Maryland Foot Score was 67.8 (range: 41�C85). The satisfactory rates of AOFAS and MFS were found as 12.5% (1/8) and 50% (4/8), respectively. One patient had an incomplete union with 5 degrees of heel varus deformity and 5 degrees of equinus deformity was observed in another. There were no implant failure or deformation of the plate during the follow-up period. Our study suggests that proximal humeral plate may be an alternative for fixation in tibiotalocalcaneal fusion surgery.

A rare complication of total knee arthroplasty: Type l complex regional pain syndrome of the foot and ankle

Scipedia content — Fri, 31 Mar 2017 11:03:40 +0200

Complex regional pain syndrome (CRPS) is a painful and disabling disorder that usually affects the extremities. This complication may affect the knee joint after total knee arthroplasty (TKA). We report a unique case of CRPS of the foot and ankle, which was an unusual involvement site for CRPS after TKA.

Midterm outcomes of high-flexion total knee arthroplasty on Japanese lifestyle

Scipedia content — Fri, 31 Mar 2017 11:03:34 +0200

To evaluate the clinical outcomes after total knee arthroplasty (TKA) using the Genesis II posterior stabilized prosthesis with a high-flex insert during the mid-term follow-up and to assess its effect on the Japanese lifestyle. Fifty-three consecutive patients (8 men and 45 women) underwent primary TKA. The mean follow-up time was 76 months (5�C9 years). Clinical results were assessed with the Japanese Orthopedic Association osteoarthritis knee rating score (JOA knee score), range of motion, and lifestyle changes. The postoperative JOA knee score improved significantly compared to the preoperative JOA knee score. The mean preoperative flexion range improved from 112�� to 123�� postoperatively (p

An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur

Scipedia content — Fri, 31 Mar 2017 11:03:29 +0200

The aim of this study was to analyze the changes in hemoglobin level and to determine a suitable timeline for post-operative hemoglobin monitoring in patients undergoing fixation of femoral neck fracture. Patients who underwent either dynamic hip screw (DHS) fixation (n = 74, mean age: 80 years) or hip hemiarthroplasty (n = 104, mean age: 84 years) for femoral neck fracture were included into the study. The hemoglobin level of the patients was monitored perioperatively. Analysis found a statistically and clinically significant mean drop in hemoglobin of 31.1 g/L over time from pre-operatively (D0) to day-5 post-operatively (p

Is there a correlation between the change in the interscrew angle of the eight-plate and the delta joint orientation angles?

Scipedia content — Fri, 31 Mar 2017 11:03:24 +0200

It is known that the screws of the eight-plate hemiepiphysiodesis construct diverge as growth occurs through the physis. Our objective was to investigate whether there is a correlation between the amount of change of the joint orientation angle (JOA) and that of the interscrew angle (ISA) of the eight-plate hemiepiphysiodesis construct before and after correction. After the institutional review board approval, medical charts and X-rays of all patients operated for either genu valgum or genu varum with eight-plate hemiepiphysiodesis were analyzed retrospectively. All consecutive patients at various ages with miscellaneous diagnoses were included. JOA and ISA were measured before and after correction. After review of the X-rays, statistical analyses were performed which included Pearson correlation coefficient and regression analyses. There were 53 segments of 30 patients included in the study. Eighteen were males, and 12 were females. Mean age at surgery was 9.1 (range 3�C17). Mean follow-up time was 21.5 (range, 7�C46) months. The diagnoses were diverse. A strong correlation was found between the delta JOA (d-JOA) and delta ISA (d-ISA) of the eight-plate hemiepiphysiodesis construct (r = 0.759 (0.615�C0.854, 95%CI), p

Fracture of the femoral component after a lightning strike injury: A case report

Scipedia content — Fri, 31 Mar 2017 11:03:19 +0200

A fracture of the stem in a total hip arthroplasty (THA) is an uncommon complication. We report a case of femoral stem fracture in a 55-year-old male patient after a lightning strike. A revision was conducted using a Wagner osteotomy and a revision prosthesis. Dall-Milles cerclages were used to close the osteotomy. The postoperative evolution was satisfactory, with an immediate partial weight bearing, consolidation of the osteotomy after three months and return to daily activity without pain.