Collection of Acta Orthopaedica et Traumatologica Turcica

The collection is a repository of the open access articles published in Acta Orthopaedica et Traumatologica Turcica journal. Acta Orthopaedica et Traumatologica Turcica (AOTT) publishes diagnostic, treatment, and prevention methods related to orthopedics and traumatology and original studies in related disciplines. Contributions may be in the form of clinical and basic research articles, case reports, personal clinical and technical notes, systematic reviews, meta-analyses and letters to the Editor. The Journal also publishes brief reports on original studies or evaluations, book reviews, and ... show more

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A giant clear cell sarcoma on right scapular: A case report
X. Zhang, C. Hu, L. Cai

(2016). Vol. 50 pp. 473-476

Abstract
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.
Abstract
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 [...]
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Effects of two different degrees of lateral-wedge insoles on unilateral lower extremity load-bearing line in patients with medial knee osteoarthritis
B. Yılmaz, S. Kesikburun, O. Köroğlu, E. Yaşar, A. Göktepe, K. Yazıcıoğlu

(2016). Vol. 50 pp. 405-408

Abstract
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: 58–78) 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 < 0.001). 10° lateral-wedge insole caused a significant more lateral shifting of the load carrying line than 5° lateral-wedge insole (p < 0.001). Both wedge insoles was effective in moving of the unilateral lower extremity load carrying line to the lateral. Lateral wedged insoles are biomechanically effective and reduce loading of the medial compartment in patients with medial knee osteoarthritis.
Abstract
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 [...]
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A mini-invasive procedure for treating arthrofibrosis of the knee
H. Xu, J. Ying

(2016). Vol. 50 pp. 424-428

Abstract
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, 19–62 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°–56°) preoperatively to 127° (range, 120°–136°) at the final follow-up in all patients (p < 0.001). According to Judets criteria, all patients achieved excellent results (ROM > 100°). The HSS score was improved from 70 points (range, 60–85 points) preoperatively to 91 points (range, 84–98 points) (p < 0.001) at the final follow-up. No extension lag, skin necrosis, quadriceps weakness, wound dehiscence or quadriceps tendon rupture occurred. Mini-invasive quadricepsplasty-associated arthroscopic lysis and manipulation of the knee in flexion is simple and easy and should be considered as a legitimate treatment for arthrofibrosis of the knee.
Abstract
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 [...]
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Translation, cross-cultural adaptation, reliability and validity of the Turkish version of the Olerud-Molander Ankle Score (OMAS)
E. Turhan, M. Demirel, A. Daylak, G. Huri, M. Doral, D. Çelik

(2017).

Abstract
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 16–81 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 α = 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 < 0.001, respectively). The OMAS-Tr displayed very good to good correlation with the SF-12 physical component score and the SF-12 mental component score (r = 0.72, r = 0.60, p < 0.001, respectively). OMAS-Tr was a valid and reliable tool to assess ankle fracture-related problems. Nonetheless, further studies are needed to assess its responsiveness. Level III, diagnostic study.
Abstract
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 [...]
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Patellar tendon mechanical properties change with gender, body mass index and quadriceps femoris muscle strength
S. Taş, S. Yılmaz, M. Onur, A. Soylu, O. Altuntaş, F. Korkusuz

(2017). Vol. 51 pp. 54-59

Abstract
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 18–44 (28.0 ± 7.5 years). The individuals included in the study were divided into two groups according to their gender and BMI (18.5 < BMI < 25 and 25 < BMI). The body composition was determined with Tanita Body Composition Analyser. PT thickness and stiffness was measured with ACUSON S3000 Ultrasonography Device using 9L4 ultrasonography probe. QF concentric muscle strength of the individuals was measured with Biodex® System 4 Dynamometer at 60°/sec angular speed. It was found that PT stiffness was higher in males compared to females (p < 0.001). It was found that PT stiffness was lower in obese individuals compared to individuals with normal weight (p = 0.017). A negative and weak correlation was found between BMI and PT stiffness (r = −0.26, p = 0.032), whereas a negative and moderate correlation was found between fat percentage and PT stiffness (r = −0.50, p < 0.001). A moderate correlation was found between BMI and PT thickness (r = 0.54, p < 0.001). It was found that peak torque at 60°/sec angular speed had a moderate correlation with PT stiffness (r = 0.44, p < 0.001) and PT thickness (r = 0.45, p < 0.001). PT stiffness is correlated and affected by gender, BMI and QF muscle strength whereas PT thickness is correlated and affected only to BMI and QF muscle strength.
Abstract
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 [...]
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The effect of platelet-rich plasma on Achilles tendon healing in a rabbit model
M. Takamura, T. Yasuda, A. Nakano, H. Shima, M. Neo

(2017). Vol. 51 pp. 65-72

Abstract
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.
Abstract
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 [...]
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Restore a 9 mm diameter osteochondral defect with gene enhanced tissue engineering followed mosaicplasty in a goat model
J. Sun, X. Hou, Y. Zheng

(2016). Vol. 50 pp. 464-469

Abstract
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.
Abstract
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 [...]
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Comparison of the chondroprotective effect of a novel hydrogel compound and traditional hyaluronate on rat cartilage in a papain-induced osteoarthritis model
E. Şükür, C. Talu, Y. Akman, E. Çirci, Y. Öztürkmen, T. Tüzüner

(2016). Vol. 50 pp. 458-463

Abstract
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 < 0.05). There was statistically significant difference between Group 1 and Group 2 (p < 0.05), between Group 1 and Group 3 (p < 0.05) on the 63th day regarding total Mankin scores. Group 3 showed statistically significant improvement in terms of proteoglycan content of matrix when compared to Group 2 (p < 0, 05). HA-CS-NAG compound in hydrogel form is more chondroprotective to rats' cartilage when compared to HA during the early stages of OA.
Abstract
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 [...]
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Clinical and radiological results on the fixation of Neer type 2 distal clavicle fractures with a hook plate
E. Şükür, Y. Öztürkmen, Y. Akman, M. Güngör

(2016). Vol. 50 pp. 489-493

Abstract
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: 27–61), and mean follow-up time was 14.3 (range: 12–18) 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 31–35). 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.
Abstract
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 [...]
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Comparison of multimodal intraoperative neurophysiological monitoring efficacy in early childhood and school aged children undergoing spinal surgery
A. Şenköylü, M. Zinnuroğlu, A. Börçek, E. Aktaş, İ. Güngör, M. Beyazova

(2017). Vol. 51 pp. 49-53

Abstract
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.
Abstract
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, [...]
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Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results
Y. Sağlam, I. Ozturk, M. Cakmak, M. Ozdemir, O. Yazicioglu

(2016). Vol. 50 pp. 443-447

Abstract
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 < 0.01). Revision incidence was similar in between ankylosed and non-ankylosed hips. While complication rates are high, significant functional improvement can be achieved after THA in patients with AS.
Abstract
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 [...]
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Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?
A. Reisoglu, C. Kazimoglu, E. Hanay, H. Agus

(2017). Vol. 51 pp. 34-38

Abstract
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.
Abstract
Closed reduction with percutaneous pinning is the treatment of choice for displaced supracondylar humerus fractures in children. In addition to configuration of pin fixation, [...]
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Prevalence of flatfoot among school students and its relationship with BMI
M. Pourghasem, N. Kamali, M. Farsi, N. Soltanpour

(2016). Vol. 50 pp. 554-557

Abstract
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 (6–10, 11–13, 14–18 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.
Abstract
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 [...]
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Treatment of post-traumatic elbow deformities in children with the Ilizarov distraction osteogenesis technique
C. Özkan, M. Deveci, M. Tekin, Ö. Biçer, K. Gökçe, M. Gülşen

(2017). Vol. 51 pp. 29-33

Abstract
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
Abstract
The present study assessed functional and radiographic outcomes of distraction osteogenesis treatment of post-traumatic elbow deformities in children. Eight children were [...]
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Tibiotalocalcaneal arthrodesis by using proximal humeral locking plate
D. Özer, A. Bayhan, A. Keskin, S. Sarı, M. Kaygusuz

(2016). Vol. 50 pp. 389-392

Abstract
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: 24–67)) 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: 23–54). 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: 41–81) and Maryland Foot Score was 67.8 (range: 41–85). 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.
Abstract
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 [...]
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A rare complication of total knee arthroplasty: Type l complex regional pain syndrome of the foot and ankle
G. Söylev, H. Boya

(2016). Vol. 50 pp. 592-595

Abstract
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.
Abstract
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 [...]
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Midterm outcomes of high-flexion total knee arthroplasty on Japanese lifestyle
H. Ohno, M. Murata, S. Ozu, N. Matsuoka, H. Kawamura, H. Iida

(2016). Vol. 50 pp. 527-532

Abstract
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 (5–9 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 < 0.05). Additionally, our findings showed that 39% of patients enjoyed a floor-sitting life preoperatively, but only 30% of patients enjoyed floor-sitting life postoperatively. The postoperative range of knee motion and JOA knee score improved after TKA using the Genesis II posterior stabilized prosthesis with a high-flex insert, but the number of patients who enjoyed floor-sitting life decreased from 39% to 30% because of feelings of fear and discomfort. Level of Evidence : Level IV, Therapeutic study
Abstract
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 [...]
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An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur
N. Nagra, D. Popta, S. Whiteside, E. Holt

(2016). Vol. 50 pp. 507-513

Abstract
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 < 0.001), with significant reductions from D0 to day-1 and day-1 to day-2 (p < 0.001). At each post-operative time point, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p = 0.046). The decrease in hemoglobin in the first 24-h post-operative period (D0 to day-1) is an underestimation of the ultimate lowest value in hemoglobin found at day-2. Relying on the day-1 hemoglobin could be detrimental to patient care. We propose a method of predicting patients likely to be transfused, and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring. Level IV Prognostic study.
Abstract
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 [...]
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Is there a correlation between the change in the interscrew angle of the eight-plate and the delta joint orientation angles?
S. Marangoz, K. Buyukdogan, S. Karahan

(2017). Vol. 51 pp. 39-43

Abstract
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 3–17). Mean follow-up time was 21.5 (range, 7–46) 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 (0.615–0.854, 95%CI), p < 0.001). This correlation was independent of the age and gender of the patient. There is a strong correlation between the d-ISA and the d-JOA. The d-ISA follows the d-JOA at a predictable amount through formulas which regression analysis yielded. This study confirms the clinical observation of the diverging angle between the screws is in correlation with the correction of the JOA. Level IV, Therapeutic study.
Abstract
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 [...]
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Fracture of the femoral component after a lightning strike injury: A case report
X. Lizano-Díez, E. Alentorn-Geli, A. León-García, F. Marqués-López

(2017). Vol. 51 pp. 84-87

Abstract
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.
Abstract
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 [...]
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Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95,484 patients during 2006–2010
S. Lee, I. Chen, Y. Li, C. Chiang, C. Chang, P. Hsieh

(2016). Vol. 95 pp. 437-442

Abstract
The aim of the study is was to determine the incidence and mortality of second hip fracture using a nationwide database. A nationwide epidemiological study was conducted using the Taiwan National Health Insurance Research Database from 2001 to 2011. Patients older than 50 years with hip fractures from 2006 to 2011 were included in the study. A total of 95, 484 hip fractures were identified, with subsequent second hip fracture occurred in 4102 of them. The incidence rate ratio of second hip fracture showed a 7.13 fold of risk of further hip fracture in 3 months, 5.21 fold in one year, and remained more than 2 fold in the end of 6th year when compared with the general population. The 6-year cumulative incidence of a second hip fracture was higher in female (8.0%) than in male (6.2%). A significantly higher 1-year mortality rate was seen after a second hip fracture (18.8%) compared to the first hip fracture (14.1%) (p < 0.05). Men had higher 1- and 5-year mortality rates after second hip fractures (12.1% and 41.2%, respectively) than women (17.4% and 47.3%, respectively). Patients with hip fractures would have a 2–7 fold of risk of a second fracture within 6 years. Women were more prone to a second hip fracture than men but men had a higher mortality rate.
Abstract
The aim of the study is was to determine the incidence and mortality of second hip fracture using a nationwide database. A nationwide epidemiological study was conducted using [...]
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A novel intramedullary nail for use in the treatment of supramalleolar malunion and nonunion: A preliminary report of three cases
F. Küçükdurmaz, N. Sağlam, T. Kurtulmuş, F. Akpınar

(2016). Vol. 50 pp. 578-583

Abstract
The fractures around the supramalleolar region are difficult to manage and deformities may occur following insufficient or inadequate treatment attempts. The treatment of those deformities is even more challenging. The available options for surgical fixation have inherent problems considering the soft tissue problems, infection and compliance of the patients. In this study, we report the preliminary outcome of new IMN system in use of supramalleolar deformities. Three patients with supramalleolar deformities were recruited for this study. Two patients had periarticular distal tibia malunions and one patient had nonunion in same region. All patients were operated with using newly designed intramedullary nail system with a unique distal interlocking bolt screw. The outcome for each patient was followed-up and evaluated with using AOFAS score. The patients were followed up for 3 years, 3 months, and 6 months, respectively. The AOFAS scores were 36, 33, and 21 preoperatively, and 75, 68, and 75 postoperatively in Patients 1, 2 and 3, respectively. In our patient series, adequate fixation following correction of the deformity was seen. Although the number of the cases are limited this study provides encouraging results regarding the outcome of new IMN system in use of supramalleolar deformities.
Abstract
The fractures around the supramalleolar region are difficult to manage and deformities may occur following insufficient or inadequate treatment attempts. The treatment of [...]
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Reverse Segond fracture and associated knee injuries: A case report and review of 13 published cases
O. Kose, S. Ozyurek, A. Turan, F. Guler

(2016). Vol. 50 pp. 587-591

Abstract
Reverse Segond fracture is originally described as an indirect radiographic clue for a specific injury complex of the knee joint that includes posterior cruciate ligament (PCL) rupture and medial meniscal tear. Herein, we describe a case with reverse Segond fracture associated with PCL avulsion fracture instead of PCL rupture. According to current literature review, reverse Segond fracture is not only associated with PCL and medial meniscal injuries, but also frequently associated with anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries. Furthermore, medial meniscus and PCL may remain intact.
Abstract
Reverse Segond fracture is originally described as an indirect radiographic clue for a specific injury complex of the knee joint that includes posterior cruciate ligament [...]
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An analysis of orthopaedic theses in Turkey: Evidence levels and publication rates
K. Koca, S. Ekinci, S. Akpancar, M. Gemci, Ö. Erşen, F. Akyıldız

(2016). Vol. 50 pp. 562-566

Abstract
The aim of this study was to present characteristics and publication patterns of studies arise from orthopedic theses obtained from National Thesis Center, database in terms of publication years, study types, topics, level of evidence between 1974 and 2014. Firstly, National Thesis Center database was searched for orthopedics and Traumatology theses. The theses, which their summary or full text were available were included in the study. The topics, study types and quality of study designs were reviewed. Then theses were searched in the PubMed database. Journals of published theses were classified according to category, scope and impact factors of the year 2014. 1508 theses were included into the study. Clinical studies comprised 71, 7% of the theses, while 25, 6% of the theses were non-clinical experimental and 2, 7% of the theses were observational studies. Clinical studies were Level I in 8, 6% (n = 93) and Level II in 5, 8% of the theses (n = 63). A total of 224 theses (14, 9%) were published in the journals indexed in PubMed database from 1974 to 2012. Fifty-two (23, 2%) were published in SCI, 136 theses (60, 7%) were published in SCI-E journals and 36 theses (16%) were published in other Journals indexed in PubMed. The quantity and quality of published theses need to be improved and effective measures should be taken to promote quality of theses. Theses from universities and Training hospitals which did not allow open access, and, incomplete records of the National Thesis Center database were major limitations of this study.
Abstract
The aim of this study was to present characteristics and publication patterns of studies arise from orthopedic theses obtained from National Thesis Center, database in terms [...]
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Osteoid osteoma of the pisiform: A case report
G. Kaynak, M. Guven, O. Erdal, H. Botanlioglu, M. Babacan, S. Dervisoglu

(2016). Vol. 50 pp. 477-479

Abstract
Osteoid osteoma is an uncommon benign bone-forming tumor of the musculoskeletal system but it is the most common primary bone tumor of the carpal region. However, only seven cases of its pisiform involvement have been described. We present a 19 year-old male patient with osteoid osteoma of the pisiform which initially could not be detected in any diagnostic study for long standing wrist pain. The patient was treated with excision and curettage. In 1 year of follow-up, the patient was asymptomatic without recurrence. In cases with long standing ulnar wrist pain, one should consider osteoid osteoma of the pisiform in differential diagnosis. If an OO is suspected, thin slice CT scan in initial evaluation would be valuable in preventing the patient from misdiagnosis or delay in diagnosis.
Abstract
Osteoid osteoma is an uncommon benign bone-forming tumor of the musculoskeletal system but it is the most common primary bone tumor of the carpal region. However, only seven [...]
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Long-term result of arthroplasty in the treatment of a case of ochronotic arthropathy
S. Karaoğlu, F. Karaaslan, M. Mermerkaya

(2016). Vol. 50 pp. 584-586

Abstract
Alkaptonuria is a rare metabolic disease caused by a partial or total deficiency of homogentisic acid oxidase, which results in excess homogentisic acid (HGA) levels. Homogentisic acid and its oxidation products can accumulate in hyaline cartilage, tendons, and ligaments. A 55-year-old male was admitted complaining of worsening chronic pain in his left knee. A radiographic evaluation showed tricompartmental end- stage osteoarthritis. A cemented total knee replacement was performed. At the 10-year follow-up, he had returned to full activity, had no knee pain, and was very satisfied with the outcome. No abnormality was observed in the femoral, tibial, or patellar components on radiography. We believe that total knee replacement is a good option in a patient with marked degenerative arthritis secondary to ochronotic arthritis.
Abstract
Alkaptonuria is a rare metabolic disease caused by a partial or total deficiency of homogentisic acid oxidase, which results in excess homogentisic acid (HGA) levels. Homogentisic [...]
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Dual plating for fixation of humeral shaft fractures: A mechanical comparison of various combinations of plate lengths
A. Karakaşli, O. Başçı, F. Ertem, E. Sekik, H. Havitçioğlu

(2016). Vol. 50 pp. 432-436

Abstract
The role of plate configuration was found inconclusive on the biomechanical effects of the plate size and hole number for dual plate constructions in humeral shaft fractures. The purpose of this study was to test the biomechanical stability of various dual plate constructions. Twenty-four left humeri (4th Generation Composite Humerus, Sawbones, Malmö, Sweden) with comminuted midshaft humeral fracture were used. Four groups of plate constructs were tested: laterally fixed 8-hole locking plate and screws were combined with anteriorly locking plates containing 0, 4, 6, or 8 holes in groups I, II, III, and IV, respectively. The alterations in axial, bending, and torsional angles were recorded. There were no fixation failures during axial, bending, or torsional stiffness testing within the elastic behavior limits. Axial stiffness was highest in Group IV. Torsional stiffness, posterior-to-anterior bending stiffness, lateral-to-medial bending stiffness, and medial-to-lateral bending stiffness were lowest in Group I. The similar stiffness values for the 8-to-4 hole and 8-to-6 hole plate constructions indicate that the 8-to-4 hole construction is an option in young adults, while the stiffest 8-to-8 hole combination may be an option for osteoporotic patients.
Abstract
The role of plate configuration was found inconclusive on the biomechanical effects of the plate size and hole number for dual plate constructions in humeral shaft fractures. [...]
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Iatrogenic lateral meniscus anterior horn injury in different tibial tunnel placement techniques in ACL reconstruction surgery – A cadaveric study
A. Karakaşli, N. Acar, O. Başçı, A. Karaarslan, M. Erduran, E. Kaya

(2016). Vol. 50 pp. 514-518

Abstract
The aim of this study was to analyze the effect of tibial tunnel positioning in single bundle and double bundle ACL reconstructions on lateral meniscus anterior root. Twelve single knee cadavers were used, 6 for a single bundle ACL reconstruction, which were reamed gradually starting from 8 mm, 9 mm and ended with a 10 mm reamers, while the other 6 were prepared for a double bundle ACL reconstruction in which 7 mm reamer for the AM tunnel and 6 mm reamer for the PL tunnel were used. After drilling, changes of lengths and thicknesses of anterior horns of the lateral menisci were recorded. Before drilling, the groups were homogenous for the lateral menisci dimensions. After drilling, no statistically significant difference was noticed between the two groups. However, in single bundle group, 2 anterior horns width injury (1.44 mm and 2.13 mm) with the 9 mm reamer and 3 anterior horns width injury (2.51 mm, 3.55 mm and 4.28 mm) with the 10 mm reamer were recorded. However in double bundle group a single anterior horn width injury (2.82 mm) was recorded. Using a greater size reamer in single bundle reconstruction, causes a relatively higher risk of lateral meniscal anterior root injury. Lateral meniscus stability should be examined arthroscopically after reaming with large reamers.
Abstract
The aim of this study was to analyze the effect of tibial tunnel positioning in single bundle and double bundle ACL reconstructions on lateral meniscus anterior root. Twelve [...]
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Discrepancy between cervical disc prostheses and anatomical cervical dimensions
S. Karaca, A. Akpolat, A. Oztermeli, M. Erdem, M. Aydogan

(2016). Vol. 50 pp. 544-547

Abstract
The aim of this study was to assess appropriateness of the sizes of available cervical disc prostheses based on tomographic measurement of human cervical vertebrae. The anatomic dimensions of the C3–C7 segments were measured on 50 patients (age range 26–47 years) with computerized tomography scan and compared with the sizes of the popular cervical total disc prostheses (CTDP) at the market [Bryan (Medtronic), Prodisc-C (Synthes), Prestige LP (Medtronic), Discover (DePuy)]. The mediolateral and anteriorposterior diameters of the upper and lower endplates were measured with a digital measuring system. Overall, 43.7% of the largest implant footprints were smaller in the anterior-posterior diameter and 42.6% in the mediolateral diameter were smaller than cervical endplate measurements. Discrepancy of the level C5/C6 and C6/C7 was calculated as 56.2% at the anteroposterior diameter and 43.8% at the center of mediolateral diameter. Large disparity has been found between the sizes of devices and cervical anatomic data. Companies that produce CTDP should take care of the anatomical dimensions and generate different sizes of CTDP. Spine surgeon should be familiar with the size mismatch in CTDP that may affect the clinical and radiological outcome of the surgery.
Abstract
The aim of this study was to assess appropriateness of the sizes of available cervical disc prostheses based on tomographic measurement of human cervical vertebrae. The anatomic [...]
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Clinical outcomes of operative repair of complete rupture of the proximal interphalangeal joint collateral ligament: Comparison with non-operative treatment
S. Lee, J. Lee, I. Hwang, J. Kim, J. Lee

(2017). Vol. 51 pp. 44-48

Abstract
The purpose of this study was to compare the outcomes of non-operative treatment and operative repair of grade III injuries with complete rupture of the collateral ligament of the proximal interphalangeal (PIP) joint. Seventeen patients with grade III injuries with at least 6 months of follow-up were included. Seven patients underwent non-operative treatment and 10 patients underwent operative treatment. We evaluated the following clinical outcomes after treatment: 1) range of motion of the PIP and distal interphalangeal (DIP) joints, 2) joint stability, 3) pain score, and 4) amount of fusiform deformity of the PIP joint. There was no instability in the lateral stress test in either group. The ranges of motion of the PIP and DIP joints were not statistically different between the two groups at final follow-up. However, the ranges of motion recovered more quickly in the operative group than the non-operative group within the first 3 months after treatment. Patients in the operative group had less pain and better cosmetic appearance of the PIP joint. Our results suggest that operative repair of the PIP collateral ligament can provide good joint stability, rapid functional recovery, and minimize fusiform deformity of the PIP joint. Level III, Therapeutic study.
Abstract
The purpose of this study was to compare the outcomes of non-operative treatment and operative repair of grade III injuries with complete rupture of the collateral ligament [...]
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Evaluation of the orthopaedics and traumatology resident education in Turkey: A descriptive study
G. Huri, Y. Cabuk, S. Gursoy, M. Akkaya, S. Ozkan, V. Oztuna, O. Aydingoz, A. Senkoylu

(2016). Vol. 50 pp. 567-571

Abstract
The objective of this study is to describe the current situation regarding the training, working conditions, future plans, fields of interest and satisfaction of orthopaedics and traumatology residents in Turkey. A descriptive survey questionnaire consisting of 24 questions was designed to identify the problems and solution suggestions concerning training of orthopaedic residents. All orthopaedics and traumatology residents who took the 2013 Progress Testing for Speciality in Medicine (UEGS) held by Turkish Orthopaedics and Traumatology Education Council (TOTEK) were surveyed in the class at the end thereof as well as the young orthopaedic surgeons who were reached through the email groups of Turkish Society of Orthopaedics and Traumatology – Residents and Young Attendings Council (TOTBID-AGUH). A total of 725 residents and 132 young attendings were surveyed. The most outstanding answers are as follows: 62, 7% of the respondents replied to the question “Is there a training program/Is it being applied” as “yes/yes”. It was found out that 94, 3% of the respondents wanted to be involved in a rotation abroad. The “patient care” was the most common answer, with a ratio of 36, 9%, to the question “Whats the priority of the department you are studying in?”. Regarding work conditions, “many emergency on-calls” was found to be the most important parameter affecting life conditions (p < 0.05). Aiming to identify the challenges that orthopaedics and traumatology residents in Turkey face as regards their training, this survey stands as a pioneering study with a high participation rate. Analysis of survey data highlights the importance of several key factors such as the development of training programs and increasing the time spent with academicians as well as spreading and promotion of log book application.
Abstract
The objective of this study is to describe the current situation regarding the training, working conditions, future plans, fields of interest and satisfaction of orthopaedics [...]
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The new intra-articular calcaneal fracture classification system in term of sustentacular fragment configurations and incorporation of posterior calcaneal facet fractures with fracture components of the calcaneal body
T. Harnroongroj, T. Harnroongroj, T. Suntharapa, M. Arunakul

(2016). Vol. 50 pp. 519-526

Abstract
The aim of this study was to develop a new calcaneal fracture classification system which will consider sustentacular fragment configuration and relation of posterior calcaneal facet to calcaneal body. The new classification system used sustentacular fragment configuration and relation of posterior calcaneal facet fracture with fracture components of calcaneal body as key aspects of main types and subtypes. Between 2000 and 2014, 126 intraarticular calcaneal fractures were classified according to the new classification system by using computed tomography images. The new classification system was studied in term of reliability, correlation to choices of treatment, implant fixation and quality of fracture reduction. Types of sustentacular fragment comprised type A, B and C. Type A sustentacular fragment included sustentacular tali containing middle calcaneal facet. In Type B and C fractures sustentacular fragment included medial aspect and entire posterior calcaneal facet as a single unit, respectively. The fractures with type A, B and C sustentacular fragments were classified as main type A, B and C intra-articular calcaneal fractures. The main type A and B comprised 4 subtypes. Subtypes A1, A3, B1, and B3 associated with avulsion and bending fragments of calcaneal body. Subtype A2, B2, and B4 associated with burst calcaneal body. Subtype B4 was not found in the study. Main type C had no subtype and associated with burst calcaneal body. The data showed good reliability. The study showed that our new intra-articular calcaneal fracture classification system correlates to choices of treatment, implant fixation and quality of fracture reduction. Level of Evidence: Level IV, Study of Diagnostic Test
Abstract
The aim of this study was to develop a new calcaneal fracture classification system which will consider sustentacular fragment configuration and relation of posterior calcaneal [...]
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The primary factor for suture configuration at rotator cuff repair: Width of mattress or distance from tear edge
O. Hapa, A. Karakaşli, O. Başçı, H. Cici, B. Çeçen, H. Havitçioğlu

(2016). Vol. 50 pp. 448-451

Abstract
The aims of this study was first to investigate whether the bite size or the bite distance from the tear edge is of primary importance in mattress suture configuration for rotator cuff repair. Secondly, whether the use of a 450 left side bent Arthro-Pierce™ (Smith & Nephew, Andover, USA) during suture passage can be more effective on the strength of the configuration compared to a straight Arthro-Pierce™. Twenty-eight bovine infraspinatus muscle tendons were randomized into four groups. Group 1, 5 mm wide ‘bite size’ × 15 mm length ‘distance from the tear edges mattress’, Group 2: 7.5 mm × 10 mm, Group 3: 15 mm × 5 mm ‘using straight Arthro-Pierce™’ and Group 4: 5 mm × 15 mm using left sided 450 bent Arthro-Pierce™. The repair specimens underwent cyclic loading prior to loading the failure testing. Cyclic elongation (mm), peak-to-peak displacement (mm), ultimate load (N), stiffness (N/mm) and failure mode were recorded for each specimen. The mean ultimate load in Group 1 was higher compared to group 3. The peak to peak displacement was higher in Group 4 compared to Group 1 (p < 0.05). The predominant failure mode in Groups 1, 2 and 4 was suture rupture. The Group 3 most specimens failed due to suture cut through the tendon. Bite size from the edge of the tendon seems to be more important than the width of the mattress. The curve of the suture passing device may also have an effect on the strength of the suture tendon interface.
Abstract
The aims of this study was first to investigate whether the bite size or the bite distance from the tear edge is of primary importance in mattress suture configuration for [...]
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Comment on: Measurement of the knee joint line in Turkish population
H. Gungor, N. Ok, K. Agladioglu

(2016). Vol. 50 pp. 480-481
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The effects of low-dose radiotherapy on fresh osteochondral allografts: An experimental study in rabbits
U. Gönç, M. Çetinkaya, M. Atabek

(2016). Vol. 50 pp. 572-577

Abstract
The aim of this study was to investigate the effects of low-dose fractionated radiotherapy on cartilage degeneration after distal femoral fresh massive osteochondral allograft transplantation. Twenty-four New Zealand White rabbits were divided into three groups of 8 rabbits each. All rabbits underwent distal femoral medial condyle fresh massive osteochondral allograft transplantation from California rabbits. The group 1 underwent transplantation without any preliminary process. The group 2 underwent fractionated local radiotherapy of 100 cGy for five days starting on the transplantation day. The group 3 included the rabbits to which the grafts transplanted after radiating in vitro by a single dose radiation of 1500 cGy. The hosts were sacrificed twelve weeks later. Anteroposterior and lateral radiographs were taken. Synovial tissue, cartilaginous tissue, and subchondral bone were assessed histopathologically. Nonunion was present in three cases of group 2 and one of group 3 in which cartilage degeneration was more severe. Synovial hypertrophy and pannus formation were more obvious in non-radiated rabbits. Hypocellularity and necrosis of the subchondral bone were rare in group 2. More cartilage tissue impairment was present in group 3 compared to group 1. In osteochondral massive allograft transplantations, the immune reaction of the host could be precluded with radiotherapy, and the side-effects can be prevented by low-dose fractionated regimen. The total dose of fractionated radiotherapy for an immune suppression should be adjusted not to damage the cartilage tissue, but to avoid articular degeneration in the long term.
Abstract
The aim of this study was to investigate the effects of low-dose fractionated radiotherapy on cartilage degeneration after distal femoral fresh massive osteochondral allograft [...]
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Minimally invasive plate osteosynthesis with PHILOS plate for proximal humerus fractures
U. Gönç, M. Atabek, K. Teker, A. Tanrıöver

(2017). Vol. 51 pp. 17-22

Abstract
The aim of the present study was to evaluate results, including clinical and radiological outcomes and number of complications, following minimally invasive plate osteosynthesis (MIPO) of proximal humerus fractures, using the PHILOS® proximal humerus internal locking system (Synthes Holding AG, Solothurn, Switzerland). Retrospectively evaluated were 31 patients treated with MIPO (12 male, 19 female, average age: 58.4 years). Four patients had 2-part fractures, 14 patients had 3-part fractures, and 13 patients had 4-part fractures, according to Neer classification. Healing, complications, and head-shaft angle (HSA) were radiographically evaluated. Clinical outcomes were assessed at 1-year follow-up with Constant score. Average Constant scores for fractured and normal shoulders were 73.2 ± 10.9 and 84.8 ± 5.1, respectively. Varus progression, fracture type, and age had no significant effect on functional outcome. Average postoperative and follow-up HSAs were 130.80 ± 7.70 and 128.80 ± 10.00, respectively. Significant varus progression was observed during follow-up (p = 0.01). Varus progression was more prominent in patients with postoperative HSA < 130° (p < 0.001). Inferomedial calcar screw usage, fracture type, and age had no significant effect on varus progression. Complications included 2 implant failures, 1 case of avascular necrosis (AVN), 1 primary screw cut-out, 1 axillary nerve injury, and 1 radial nerve injury (22.6% overall). MIPO is a safe and effective option for the treatment of proximal humerus fractures, with good functional recovery and fewer complications, which are typically technique dependent. Reduction may be difficult, resulting in varus progression. Another disadvantage is risk of axillary nerve injury. Careful surgical technique and correct implant selection is important in the prevention of nerve injury. Level IV, Therapeutic study.
Abstract
The aim of the present study was to evaluate results, including clinical and radiological outcomes and number of complications, following minimally invasive plate osteosynthesis [...]
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The comparative efficacy of kinesio taping and local injection therapy in patients with subacromial impingement syndrome
H. Göksu, F. Tuncay, P. Borman

(2016). Vol. 50 pp. 483-488

Abstract
The aim of this study was to compare the therapeutic effects of kinesio taping (KT) and local subacromial injection in patients with subacromial impingement, syndrome (SIS) with regard to pain, range of motion (ROM) and disability. Sixty-one patients (48 females and 13 males, mean age: 43.04 ± 6.31, years) with SIS were enrolled into the study. The patients were randomized into two treatment groups receiving either a single corticosteroid and local anesthetic (LA) injection, or kinesio taping performed three times by intervals of 3 day. Visual analog scale (VAS) was used to assess pain intensity, range of motion (ROM) degrees of, shoulder were recorded and Shoulder Pain and Disability Index (SPADI) was, performed to evaluate functional disability, before treatment, at the first and fourth, weeks after therapies. A exercise program was prescribed for both groups including pendulum, active range of motion (ROM) and strengthening exercises. Pain, functional outcome measures were determined to have improved significantly in both groups at the end of therapies at first and fourth weeks (p < 0.05), but these improvements were more significant in the injection group than in kinesio taping group (p < 0.05). The improvements in pain at rest, shoulder abduction degrees, and SPADI scores at first and fourth weeks were statistically higher in injection group than in kinesio taping group. Although the improvement in pain intensity at rest, ROM and disability were better with local injection, KT may be an alternative noninvasive method to local subacromial injection for patients suffering from subacromial impingement syndrome. Level I, Therapeutic study.
Abstract
The aim of this study was to compare the therapeutic effects of kinesio taping (KT) and local subacromial injection in patients with subacromial impingement, syndrome (SIS) [...]
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Total hip arthroplasty-related pelvic pseudotumor: Unusual presentation with hydronephrosis
Z. Kilicoglu, O. Kilicoglu, M. Simsek

(2016). Vol. 50 pp. 470-472
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Anterior tibial artery pseudoaneurysm due to interlocking bolt of tibial nail: A case report and review
N. Gahlot, R. Kanojia

(2017). Vol. 51 pp. 77-83

Abstract
Vascular injuries associated with the tibial nailing have been reported in few case reports. We here report a unique case of anterior tibial artery (ATA) pseudoaneurysm caused by the second proximal coronal interlocking bolt. We found that the position of interlocking bolts on the nail brings them very close to the anatomical positions of arteries in leg. The reports of ATA injury by interlocking bolts highlight the need for reconsidering the nail design and screw hole positions.
Abstract
Vascular injuries associated with the tibial nailing have been reported in few case reports. We here report a unique case of anterior tibial artery (ATA) pseudoaneurysm caused [...]
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Minimally invasive intramedullary nailing of clavicular fractures by a new titanium elastic nail
B. Fu

(2016). Vol. 50 pp. 494-500

Abstract
The aim of this study was to evaluate clinical results of a new design titanium elastic nail (TEN) for displaced midshaft clavicular fractures. Between February 2012 and December 2013, a total 36 patients with displaced midshaft clavicular fractures were treated with intramedullary nailing stabilization with our new design TEN. Blood loss, mean times of operation, postoperative complications, hospital stays and time to bone union was recorded. The outcomes were evaluated with radiographic assessment, visual analog scale (VAS) score, the Constant-Murley, and the disabilities of the arm, shoulder, and hand (DASH) scores. The mean blood loss was 50.278 ± 10.753 ml, while the mean operation, hospital stay and bone union times were 46.417 ± 9.232 min, 10.056 ± 2.672 days and 11.583 ± 2.729 weeks, respectively. After removal of the TENs at a mean of 10.2 months (range, 8-13 months) after surgery, no re-fracture and nonunion was found in any patient. Two cases of shoulder back stabbing pain were spontaneously resolved later. The mean fracture healing time was 12 weeks. The VAS score and motion ranges of shoulder joint were significantly improved postoperatively (P < 0.001). The shoulder function recovery showed the excellent results with the mean Constant-Murley score of 93.389 ± 2.749 and DASH scores of 2.528 ± 1.567. Our new TEN design used in intramedullary fixation might be a safe and effective technique for treatment of displaced midshaft clavicular fractures. Level of evidence: Level IV, therapeutic study .
Abstract
The aim of this study was to evaluate clinical results of a new design titanium elastic nail (TEN) for displaced midshaft clavicular fractures. Between February 2012 and December [...]
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Soft-tissue osteoma of the thenar eminence
B. Ersoy

(2017). Vol. 51 pp. 91-93

Abstract
The development of osteoma in soft tissues without a direct contact with the adjacent osseous and articular structures is a very rare event. The involvement of the hand is even rarer, with only two previous cases reported so far. A 25-year-old man presented with a painless solid mass in the thenar region of his right palm, which appeared almost 2 years ago and showed a progressive enlargement in the last months. Under regional anesthesia an excisional biopsy was performed and the histopathological evaluation of the lesion confirmed the diagnosis of soft tissue osteoma. The postoperative follow-up period was uneventful without any complication or recurrence. Following a brief period of hand physiotherapy the patient has returned to normal daily activities.
Abstract
The development of osteoma in soft tissues without a direct contact with the adjacent osseous and articular structures is a very rare event. The involvement of the hand is [...]
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Cartilage repair strategies in the knee: A survey of Turkish surgeons
N. Elmalı, R. Tandoğan, M. Demirel, M. Bozkurt, T. Beyzadeoglu

(2016). Vol. 50 pp. 533-538

Abstract
The purpose of this study was to analyze the trends in cartilage repair strategies among Turkish orthopedic surgeons for isolated focal (osteo)chondral lesions of the knee joint. A web-based survey of 21 questions consisting of surgical indications, techniques and time to return to sports was developed to investigate the preferences of members of the TOTBID and the TUSYAD. A total of 147 surgeons answered the questionnaire.70% of the respondents were TUSYAD members. 82% of respondents had at least five years experience in arthroscopy. Half of the surgeons indicated that patient age of 50 was the upper limit for cartilage repair. Irrespective of activity level, microfracture (60–67%) was the most frequently used technique for lesions smaller 2.5 cm2 . In lesions larger than 4 cm2, MACI was the most commonly advocated procedure (67%). In patients with high activity levels, mosaicplasty was the first choice (69%) for lesions between 2.5 and 4 cm2 in size, followed by MACI (27%). Patient age, activity level, BMI and lesion size were important determinants for the choice of treatment of isolated chondral lesions in the knee. These results reflect the choices of experienced knee surgeons in the country. Although not widely performed in Turkey and has limited reimbursement by the health care system, the first choice for defects over 4 cm2 was second generation ACI. Third party payers & health reimbursement authorities should take into account that large defects require methods which are relatively expensive and need high technology. Cross-sectional survey, Level II.
Abstract
The purpose of this study was to analyze the trends in cartilage repair strategies among Turkish orthopedic surgeons for isolated focal (osteo)chondral lesions of the knee [...]
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Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study
M. Elmadağ, G. Uzer, F. Yıldız, H. Ceylan, M. Acar

(2016). Vol. 50 pp. 409-414

Abstract
The aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO). The Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. After the osteotomy, the acetabulum was medialized and redirected anterolaterally, and fixed with 2 screws. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomy and anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascular and joint penetrations. After the osteotomy, the mean CE angle was improved from 19.8° to 25.2°, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciatic notch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerves was detected in any of the cadavers. Bilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incision in the same session using this approach. Quadrilateral surface of the acetabulum can be directly seen using this approach and the osteotomy can be safely performed.
Abstract
The aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO). The Ganz PAO was performed on 10 hemipelvises [...]
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Evaluation of the informed consent procedure for total knee arthroplasty patients in Turkey
P. Ekmekci, A. Ekmekci, Ö. Karakaş, A. Kulduk, B. Arda

(2016). Vol. 50 pp. 400-404

Abstract
The purpose of this research is to evaluate the ethical aspects of informed consent process of total knee arthroplasty (TKA) patients in Turkey. The study included 50 patients undergoing TKA in Gazi Mustafa Kemal State Hospital Orthopedics Clinic. A face to face survey was conducted to determine the ethical appropriateness of the main components of informed consent process such as, disclosure of material information about the disease and alternative treatment options, understanding the disclosed information, comprehending the written consent form and voluntariness in deciding. The survey revealed that all TKA patients signed informed consent form, 80% of the participants received material information about their disease, 62% were disclosed information about TKA operation, 56% read (in personal or with the assistance of a relative) the written informed consent form, 28% received information regarding possible complications of TKA and 85% were not given any information about the alternative treatments. Informed consent process in TKA patients have flourished compared to previous years, but still there are some aspects in need of improvement. Using short and understandable language, developing multi-media sources and involving patients to informed consent form development process would contribute to the process.
Abstract
The purpose of this research is to evaluate the ethical aspects of informed consent process of total knee arthroplasty (TKA) patients in Turkey. The study included 50 patients [...]
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Effects of immobilization and whole-body vibration on rat serum Type I collagen turnover
G. Dönmez, M. Doral, Ş. Suljevic, M. Sargon, H. Bilgili, H. Demirel

(2016). Vol. 50 pp. 452-457

Abstract
The aim of this study was to investigate the effects of short-term, high-magnitude whole-body vibration (WBV) on serum type I collagen turnover in immobilized rats. Thirty Wistar albino rats were randomly divided into the following 5 groups: immobilization (IS), immobilization + remobilization (IR), immobilization + WBV (IV), control (C), and WBV control (CV). Immobilization was achieved by casting from the crista iliaca anterior superior to the lower part of the foot for 2 weeks. The applied WBV protocol involved a frequency of 45 Hz and amplitude of 3 mm for 7 days starting a day after the end of the immobilization period. Serum type I collagen turnover markers were measured by using ELISA kits. Serum NH2-terminal propeptide of type I collagen (PINP) levels were significantly lower in the immobilization groups (p < 0.02) compared with the control groups. Although WBV improved PINP levels in the control groups, there were no differences in PINP levels among the immobilization groups. Similarly, serum COOH-terminal telopeptide of type I collagen (CTX) levels were higher in the WBV controls than their own controls (p < 0, 05). Immobilization led to deterioration of tendon tissue, as observed by histopathological analysis with a transmission electron microscope. Although 1 week of WBV had a positive effect on type I collagen turnover in controls, it is not an efficient method for repairing tissue damage in the early stage following immobilization.
Abstract
The aim of this study was to investigate the effects of short-term, high-magnitude whole-body vibration (WBV) on serum type I collagen turnover in immobilized rats. Thirty [...]
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Acro-osteolysis and calcinosis in patient with scleroderma: A case report
W. Choi, S. Park, Y. Ban, J. Kim

(2017). Vol. 51 pp. 88-90

Abstract
Acro-osteolysis is a rare disease characterized by bone resorption involving the distal phalanges of the hand. We present a unique case of progressive acro-osteolysis of the distal phalanges and articular calcifications in a patient with scleroderma. The calcified deposit in a proximal interphalangeal joint was excised under local anesthesia. The medical treatment was arranged under the supervision of a rheumatologist.
Abstract
Acro-osteolysis is a rare disease characterized by bone resorption involving the distal phalanges of the hand. We present a unique case of progressive acro-osteolysis of the [...]
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Discriminative ability of calcaneal quantitative ultrasound compared with dual-energy X-ray absorptiometry in men with hip or distal forearm fractures
F. Cesme, S. Esmaeilzadeh, A. Oral

(2016). Vol. 50 pp. 548-553

Abstract
The aim of this case–control study was to compare the discriminatory ability of bone mineral density (BMD) measurements and calcaneal quantitative ultrasound (QUS) parameters for fractures and to determine fracture thresholds for each variable in men with hip or distal forearm fractures. A total of 20 men with hip and 18 men with distal forearm fractures and 38 age-matched controls were included in this study. Dual-energy X-ray absorptiometry (DXA) BMD (spine and hip) and calcaneal QUS measurements were made. Area under the curves (AUCs) were calculated to assess fracture discriminatory power of DXA and QUS variables. Quantitative Ultrasound Index (QUI) T-score and Speed of Sound (SOS) were found to be the best parameters for the identification of hip and distal forearm fractures, respectively, with AUCs greater than those of DXA BMD and other QUS parameters. While a QUI T-score of ≤−1.18 could identify and rule out hip fracture cases with approximately 80% sensitivity and specificity, a SOS value of ≤1529.75 reached to almost 90% for ruling in and out distal forearm fractures. The discriminatory performance of calcaneal QUS variables between fractured and non-fractured men was as good as those of the DXA BMD and even better. Since men appear to sustain fractures at closer QUS variable levels than those of the DXA BMD regardless of the fracture type, it may be speculated that calcaneal QUS may be more helpful in predicting the risk of fractures when BMD alone does not demonstrate impaired bones. Level of Evidence: Level III, Study of Diagnostic Test
Abstract
The aim of this case–control study was to compare the discriminatory ability of bone mineral density (BMD) measurements and calcaneal quantitative ultrasound (QUS) parameters [...]
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Short Form Health Survey version-2.0 Turkish (SF-36v2) is an efficient outcome parameter in musculoskeletal research
D. Çelik, Ö. Çoban

(2016). Vol. 50 pp. 558-561

Abstract
Although the Short Form Health Survey version-2.0 (SF-36v2) is widely used since 2000, the researchers and clinicians in Turkey have been still using the original version. However, the original version includes many deficiencies and the SF-36v2 was introduced aiming to correct these deficiencies. The purpose of this study is to indicate differences between SF-36 and SF-36v2 and the present cross cultural adaptation, reliability and validity of the SF-36v2. The SF-36v2 was cross culturally adapted to Turkish and the measurement properties of the Turkish version of the SF-36v2 were tested in 50 patients (19 males, mean ± SD age: 36.9 ± 14.6 years, range: 16–65 years, BMI, 24.1 ± 4.6) with a variety of musculoskeletal pathologies. Intraclass correlation coefficients (ICC) were used to estimate the test-retest reliability. Construct validity was analyzed with SF-36v2 and EuroQol Group (EQ-5D). The distribution of ceiling and floor effects was determined. During the cross-cultural adaptation process many changes were made. The Turkish SF-36v2 subscales showed excellent test-retest reliability which was ranged 0.80 to 0.95. The highest correlation was found between SF-36v2-PCS and SF-36v2-PF (r = 0.75), the lowest correlation was found between SF-36v2-PCS and SF-36v2-MH (r = 0.05). The correlations between EQ-5D and SF-36v2 subscales ranged from 0.10 (SF-36v2 –VT) to 0.46 (SF-36v2 –RE). We observed no ceiling and floor effects. The cultural adaptation of the SF-36v2 was successful. The SF-36v2 has sufficient reliability and validity to measure a variety of musculoskeletal pathologies for Turkish-speaking individuals.
Abstract
Although the Short Form Health Survey version-2.0 (SF-36v2) is widely used since 2000, the researchers and clinicians in Turkey have been still using the original version. [...]
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An anatomic study of the lateral patellofemoral ligament
S. Capkin, G. Zeybek, I. Ergur, C. Kosay, A. Kiray

(2017). Vol. 51 pp. 73-76

Abstract
The lateral patellofemoral ligament (LPFL) is part of the lateral retinaculum cut during arthroscopic or open release. We investigated its anatomic and morphometric characteristics. We identified the LPFL insertion point on the condyle in vertical and sagittal planes in 32 adult cadaveric knees. We measured its length and width at the insertion point. We located the midpoint of this point and measured from it to the distal and posterior condylar ends. We measured anterior-posterior and proximal-distal lateral condylar lengths. We evaluated the insertion point shape on the lateral femoral condyle. Degree of relationship between variables was assessed using Pearsons correlation coefficient. p < 0.05 was considered statistically significant. The LPFL mean length was 23.2 mm, and mean width at the insertion point was 15.6 mm. Regarding its insertion into the lateral condyle, central insertions were more frequent (vertical plane: 53.1% central and sagittal plane: 75% central). A significant positive correlation was evident between the LPFL length and width at the insertion point (p = 0.05). Thus, the LPFL length was proportional to its width at the insertion point. A significant positive correlation was found between the anterior-posterior condylar length and width of the LPFL at the insertion point (p = 0.017). Therefore, greater anterior-posterior condylar length equates to a larger area of insertion on the condyle. Greater width of the LPFL at the insertion point corresponds to greater LPFL and anterior-posterior lateral condylar lengths.
Abstract
The lateral patellofemoral ligament (LPFL) is part of the lateral retinaculum cut during arthroscopic or open release. We investigated its anatomic and morphometric characteristics. [...]
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Peritoneum and omentum are natural reservoirs for chondrocytes of osteochondral autografts: A comparative animal study
K. Buyukdogan, M. Doral, O. Bilge, E. Turhan, G. Huri, M. Sargon

(2016). Vol. 50 pp. 539-543

Abstract
The purpose of this study was to investigate the effects of the omentum, peritoneum, paratenon and skeletal muscle on the proliferation of the cartilage tissue using rabbit model as an in vivo culture medium. 6 months old forty-five New Zealand rabbits were randomized into omentum, peritoneum, muscle, and Achilles paratenon groups. Standard sized osteochondral grafts were harvested from right knees and immediately placed into the specified tissues. Control group was fresh cartilage at the end of follow-up. After five months, samples were collected and evaluated macroscopically by measuring their dimensions (vertical = D1, horizontal = D2, and depth = D3) and volumes, and histologically by counting the chondrocyte number using camera lucida method. Macroscopically, increase in mean values for D1 and D2 dimensions of specimens from paratenon and omentum compared to pretransplant dimensions was statistically significant (p < 0.05). Although, volume measurements were higher in omentum and peritoneum group compared to pretransplant dimensions, increase was not significant (p > 0.05). Histologically, mean chondrocyte count was 14.0 ± 0.6 in fresh articular cartilage. Mean chondrocyte counts were 14.4 ± 0.9 in omentum group, 15.4 ± 1.0 in peritoneum group, 9.7 ± 1.3 in muscle group and 9.2 ± 0.4 in Achilles paratenon group respectively. However, mean chondrocyte counts were higher in samples of omentum and peritoneum group compared to fresh articular cartilage, increase was not statistically significant (p > 0.05). Transplantation of the cartilage grafts into mesothelium enhanced the chondrocyte counts and volumes compared with the pretransplant measurements. Mesothelium may have the potential to be used as an in vivo culture medium for osteochondral tissue growth.
Abstract
The purpose of this study was to investigate the effects of the omentum, peritoneum, paratenon and skeletal muscle on the proliferation of the cartilage tissue using rabbit [...]
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Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2)
O. Beytemür, A. Barış, C. Albay, S. Yüksel, S. Çağlar, E. Alagöz

(2017). Vol. 51 pp. 12-16

Abstract
The aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2). Seventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group. Functional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000). Simple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature, however, successful results have been obtained with IMN in this fracture pattern. Level III, Therapeutic Study.
Abstract
The aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple [...]
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Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: Results of 7.6-year follow-up
M. Ünal, E. Cansu, F. Parmaksızoğlu, H. Cift, S. Gürcan

(2016). Vol. 50 pp. 501-506

Abstract
The aim of this study was to determine long term follow up of the patients who had femoral head osteonecrosis and had been treated with free vascularized fibular grafting. We retrospectively reviewed 28 hips of 21 patients who had undergone free vascularized fibular grafting for the treatment of osteonecrosis of femoral head. There were 16 male and 5 female patients. The mean age of the patients at the time of surgery was 30.7 years (between 15 and 53 years). The mean follow-up time was 7.6 years (between 5 years and 9.2 years). During follow-up, one patient died because of leukemia, and one patient was lost. The remaining 26 hips of 19 patients were evaluated. According to the Ficat classification, at the time of surgery, 17 hips were in grade 2 and 9 hips were in grade 3. The post-operative Harris hip scores in grade II disease were excellent in 12 patients, good in 3 patients, and fair in 1 patient. In grade III disease, 1 patient was excellent, 5 patients were good, and 1 patient was fair. There was a significant increase in HHS scores (61 ± 9.7 vs 84 ± 17.8, p < 0.001). Free vascularized fibular grafting yields extremely good results, particularly in pre-collapse stages of disease in young patients. The operation time does not mark increased if the surgical team is “familiar” with the procedure, and the residual fibular defect of the donor site does not impair the functions of daily living. Level IV, Therapeutic study.
Abstract
The aim of this study was to determine long term follow up of the patients who had femoral head osteonecrosis and had been treated with free vascularized fibular grafting. [...]
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Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures
A. Atalar, O. Tunalı, A. Erşen, M. Kapıcıoğlu, Y. Sağlam, M. Demirhan

(2017). Vol. 51 pp. 23-28

Abstract
In intraarticular distal humerus fractures, internal fixation with double plates is the gold standard treatment. However the optimal plate configuration is not clear in the literature. The aim of this study was to compare the biomechanical stability of the parallel and the orthogonal anatomical locking plating systems in intraarticular distal humerus fractures in artificial humerus models. Intraarticular distal humerus fracture (AO13-C2) with 5 mm metaphyseal defect was created in sixteen artificial humeral models. Models were fixed with either orthogonal or parallel plating systems with locking screws (Acumed elbow plating systems). Both systems were tested for their stiffness with loads in axial compression, varus, valgus, anterior and posterior bending. Then plastic deformation after cyclic loading in posterior bending and load to failure in posterior bending were tested. The failure mechanisms of all the samples were observed. Stiffness values in every direction were not significantly different among the orthogonal and the parallel plating groups. There was no statistical difference between the two groups in plastic deformation values (0.31 mm–0.29 mm) and load to failure tests in posterior bending (372.4 N–379.7 N). In the orthogonal plating system most of the failures occurred due to the proximal shaft fracture, whereas in the parallel plating system failure occurred due to the shift of the most distal screw in proximal fragment. Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models.
Abstract
In intraarticular distal humerus fractures, internal fixation with double plates is the gold standard treatment. However the optimal plate configuration is not clear in the [...]
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Elastofibroma dorsi: Clinical evaluation of 61 cases and review of the literature
M. Deveci, H. Özbarlas, K. Erdoğan, Ö. Biçer, M. Tekin, C. Özkan

(2017). Vol. 51 pp. 7-11

Abstract
Elastofibroma dorsi (ED) is a rare, benign, soft tissue tumor typically located between inferior corner of scapula and posterior chest wall causing mass, scapular snapping, and pain. When classic symptoms and localization are present, it is diagnosed without biopsy and treated with marginal resection. This study retrospectively analyzed patients operated on for ED to evaluate presenting symptoms, tumor size, complications, and clinical results, and to suggest optimal treatments. This study included 51 patients who underwent surgery for ED in 2 different clinics between 2005 and 2015. Patient age, gender, profession, side affected, symptoms, average duration of symptoms, and tumor size were researched. Radiological examinations of patients were evaluated. Patients with lesions larger than 5 cm in size were operated on. Postoperative complications, recurrence, and functional results were evaluated using Constant score and compared to preoperative values. A total of 61 operated lesions of 51 patients clinically and radiologically diagnosed with ED were retrospectively evaluated. Average length of time patient experienced symptoms was 11.21 months. Lesions in 19 (37.2%) patients were bilateral, 10 of which were symptomatic and larger than 5 cm in size, meeting indication for surgery. Average lesion diameter was 8.7 cm. Average follow-up was 26.89 months. Average of preoperative Constant score of 67.28 subsequently increased to 92.88 (p < 0.05). Seroma and hematoma were observed in 11.5% of patients. Generally, good clinical results can be obtained with marginal resection without requiring a biopsy, considering classic complaints and radiological appearance of ED. Level IV, Therapeutic study.
Abstract
Elastofibroma dorsi (ED) is a rare, benign, soft tissue tumor typically located between inferior corner of scapula and posterior chest wall causing mass, scapular snapping, [...]
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Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases
M. Deveci, S. Paydaş, G. Gönlüşen, C. Özkan, Ö. Biçer, M. Tekin

(2017). Vol. 51 pp. 1-6

Abstract
Giant cell tumor of bone (GCT) is a primary, osteolytic, benign tumor of the bone. Surgery is the commonly used treatment, however, recurrence remains a problem. Receptor activator of nuclear factor kappa B (RANKL) is responsible for the formation of osteoclastic cells. Discovery of RANKL and its human monoclonal antibody, denosumab, led to use of denosumab for treatment of GCT. The aim of this study was to evaluate clinical and pathological results of treatment of GCT with denosumab and to assess adverse effect profile and recurrence rate. Thirteen patients with 14 lesions were enrolled in the study. Mean age was 38.3 years. Patients were given subcutaneous injections of denosumab (120 mg) every 4 weeks (with additional doses on days 0, 8 and 15 in cycle 1 only) and were radiologically evaluated for tumor response. Pain and functional status were measured using Visual Analog Score (VAS) and Musculoskeletal Tumor Society Score (MSTS). Adverse effects were analyzed after each cycle. Participants were 5 men and 8 women. Mean follow-up was 17 months. One lesion was Campanacci grade I, 8 were grade II, and 5 were grade III. Eight lesions were recurrent, and remaining were primary lesions. After average of 9 cycles (range: 4–17 cycles), all tumors underwent radiological regression. Ten lesions were removed surgically. More than 90% of giant cells were found to have regressed in all pathological specimens. On last follow-up, average VAS was 1 and MSTS was 87%. Fatigue and joint and muscle pain after injections was reported by 46% of patients, and mild hypocalcaemia was seen in 1 patient. Denosumab has been shown to be a successful drug in treatment of GCT. Denosumab can be used as neoadjuvant for all recurrent lesions, grade II lesions with high surgical risk, grade III lesions, and metastatic cases of GCT. Level IV, Therapeutic study
Abstract
Giant cell tumor of bone (GCT) is a primary, osteolytic, benign tumor of the bone. Surgery is the commonly used treatment, however, recurrence remains a problem. Receptor [...]
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Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study
T. Akgül, M. Büget, A. Salduz, İ. Edipoğlu, M. Ekinci, S. Küçükay, C. Şen

(2016). Vol. 50 pp. 429-431

Abstract
The aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total knee arthroplasty (TKA). 70 patients (65.5 ± 8.1 years old) that have undergone TKA were divided in two groups. The 20 mg/kg IV TXA was given before the skin incision to one group (study group). On the control group, TKA was performed without TXA. The demographic data, body mass index, amount of bleeding and erythrocyte infusion during the operation, hemoglobin and hematocrit values (preoperative and 48th hour), the amount of drainage after the operation were compared between the groups. The total amount of bleeding in the study group was 634.03 ± 182.88 ml and 1166.42 ± 295.92 ml in the control group (p < 0.001). Perioperative bleeding was 252.01 ± 144.13 ml in the study group and 431.33 ± 209.10 ml in the control group (p = 0.018). The drainage after the operation was 311.11 ± 141.64 ml at the 24th hour in the study group, 640.74 ± 279.43 ml at the 24th hour in the control group (p < 0.001). The drainage after 24th hour was 97.96 ± 115.86 ml in the study group and 112.96 ± 64.43 ml in the control group (p = 0.584). A high, single dose of TXA intravenously given to the patient prior to the TKA significantly reduces the bleeding during the operation and within the postoperative 24 h. There is no significant change in the bleeding amount after the 24th hour following the operation.
Abstract
The aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total [...]
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Influence of patient training on persistence, compliance, and tolerability of different dosing frequency regimens of bisphosphonate therapy: An observational study in Turkish patients with postmenopausal osteoporosis
Ü. Akarırmak, H. Koçyiğit, N. Eskiyurt, S. Esmaeilzadeh, Ö. Kuru, E. Yalçinkaya, Ö. Peker, A. Ekim, N. Özgirgin, M. Çalış, A. Rezvani, A. Çevikol, S. Eyigör, Ö. Şendur, J. İrdesel

(2016).

Abstract
In our study, we aimed to evaluate the influence of training on compliance and persistence with bisphosphonate treatment given on a weekly vs. monthly basis in postmenopausal osteoporosis patients. A total of 979 patients with postmenopausal osteoporosis (mean age: 63.2 ± 7.2 years) were included in this national, multicenter, prospective non-interventional observational cohort registry study. Patients were randomized into training (n = 492, 50.3%, mean age: 63.4 ± 7.2 years) and control (n = 487, 49.7%, mean age: 63.0 ± 7.1 years) groups. Patients in each intervention group were given weekly (44.9% and 44.6% for training and control subjects, respectively) or monthly (55.1% and 55.4%, respectively) bisphosphonate regimens. After the initial visit, patients were followed up at three-month intervals throughout 12 months of treatment for evaluation of persistence, compliance and adverse events. On average, 79.4% of the patients were persistent with the treatment with a mean of 350.4 days of duration during the 12-month follow-up period. The mean compliance in the compliant and fully compliant group remained at an average of 86.6%. No significant difference was detected between the training and control groups in terms of compliance and persistence. Significantly longer persistence (360.0 ± 89.0 vs. 345.0 ± 108.0 days, p = 0.035), higher percentage of persistent patients (83.4% vs. 74.2%, p = 0.012) and higher compliance rates (88.8% vs. 83.3%, p = 0.002) were noted in monthly regimen patients in comparison to those given weekly regimen. Our findings revealed remarkably high rates for persistence and compliance with bisphosphonate treatment in postmenopausal osteoporosis, with no impact of training on compliance and persistence rates. Longer persistence and better compliance rates were achieved with the monthly bisphosphonate regimen when compared to the weekly regimen.
Abstract
In our study, we aimed to evaluate the influence of training on compliance and persistence with bisphosphonate treatment given on a weekly vs. monthly basis in postmenopausal [...]
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Retraction notice to “A new femoral nail with single distal locking screw for maximum interfragment rotational stability” Acta Orthop Traumatol Turc 2016;50(1):89–96
A. Karaarslan, H. Aycan, Y. Örgen, A. Karakaşli, F. Ertem, E. Sesli

(2016). Vol. 50(1) pp. 89-96
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Augmentative locking plate with autologous bone grafting for distal femoral nonunion subsequent to failed retrograde intramedullary nailing
J. Ru, C. Yu, S. Dai, Y. Lu, N. Yun-fei

(2016). Vol. 50 pp. 393-399

Abstract
To explore the indications and efficacy of augmentative locking compression plate(LCP) or less invasive stabilization system(LISS)with autogenous bone grafting(BG) in treating distal femoral nonunion subsequent to failed retrograde intramedullary nailing (RIN). A retrospective study was performed for 21 patients with distal femoral nonunion subsequent to failed RIN ,who received therapy with either augmentative LCP (n=11) or LISS with autogenous BG (n=13). Operation time, time to union,union rate, time to renonunion,complication rate and SF-36 scores a year after hardware removal were compared between the two groups. The bone union occurred in 13/13(100%) cases in augmentative LISS group versus 9/11(81.8%) cases in augmentative LCP group [odds ratio (OR)=3.21, 95 % confidence interval (CI) 0.7-13] . Time to union,time to renonunion, complication rate of the augmentative LCP group were significantly more than that of the augmentative LISS with autogenous BG group (p=0.023, p=0.021 and p=0.033 ). No significant difference was found in the average operation time of two groups (p=0.121).At the follow-up a year after hardware removal, statistically significant HRQOL improvement in the augmentive LISS group was measured at the level of pain(p=0.003) and general health perception (p=0.011),as compared to the augmentive LCP group. We suggest augmentative LCP ,for distal femoral nonunios after RIN ,may be optimal for that of typeAO33A fractures, whereas augmentative LISS for that of typeAO33C fractures more.
Abstract
To explore the indications and efficacy of augmentative locking compression plate(LCP) or less invasive stabilization system(LISS)with autogenous bone grafting(BG) in treating [...]
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