[show abstract][hide abstract] ABSTRACT: Bisphosphonates are commonly used for the treatment of osteoporosis
and for reducing the risk of vertebra and hip fractures.
The optimum length of therapy for their use has not been
determined [1, 2]. In the literature, it is has been reported that
alendronate is effective in reducing the risk of fracture .
Among the side effects of bisphosphonates are esophageal
irritation, osteonecrosis of the jaw, atrial fibrillation, acute inflammatory
response, and severe musculoskeletal pain. The
effect of long-term alendronate use on bone metabolism is
unclear [3, 4]. In animal experiments, bisphosphonate treatment
is associated with the accumulation of microdamage and suppression
of the turnover in cortical rather than spongious bone,
resulting in reduced bone repair . There are many studies
about the potential link between prolonged bisphosphonate use
and low-energy femoral subtrochanteric/diaphysis stress fractures.
Specific radiographic description of these fractures, like a
stress fracture pattern, show external cortical reaction, transverse
fracture line, and medial cortical spike in the
subtrochanteric area [6–10]. There are two types of stress
fractures: fatigue fractures and insufficiency fractures. A fatigue
fracture occurs when abnormal and repetitive stress is applied to
the healthy bone. In contrast, an insufficiency fracture occurs
when normal stress is placed on a deficient bone, in which
prodromal thigh pain from the insufficiency changes may be
present. Clinical features of these fractures are delayed healing,
bilateral signs [11, 12] and symptoms, prodromal thigh pain
prior to fracture and a history of minimal or no trauma .
The cases of five women with low-energy subtrochanteric
or femoral shaft stress fractures while being on alendronate
therapy for more than 5 years are reported in this study.
European Journal of Orthopaedic Surgery & Traumatology 05/2013; · 0.18 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to identify the anatomic landmarks of ischial and pubic osteotomies performed as part of Bernese periacetabular osteotomy, measure the distances of these landmarks to the main neurovascular structures and determine whether these osteotomies can be performed and visualized using a medial approach.
The study included 20 hemipelvises of 10 formaldehyde-fixed cadavers. A medial surgical approach between the adductor longus and pectineus muscles was used, while protecting the obturator artery and nerve. The superior pubic ramus was subperiostally exposed to identify the anterior border of the anterior obturator tubercle and the projection point of the highest point of the obturator sulcus on the obturator crest as the two landmarks of pubic bone osteotomy. The line connecting the inferior border of the posterior obturator tubercle and the highest point of the ischial spine on the ischial bone was determined as the osteotomy line. Posterior dissection was carried out to measure the distance from the ischial osteotomy to the pudendal neurovascular structures. All measurements were performed using a digital caliper.
The mean distance from the obturator sulcus to the obturator nerve was 15.3 (range: 8.1 to 30.5) mm. The mean distance from the anterior obturator tubercle to the obturator nerve was 34.3 (range: 27.1 to 49.5) mm and to the obturator artery was 38.5 (range: 29.4 to 51.1) mm. The mean distance from the ischial osteotomy to the pudendal neurovascular structures was 13.6 (range: 11.2 to 17.6) mm.
The "pubic osteotomy line" connecting the anterior obturator tubercle and obturator crest, and the inferior border of the posterior obturator tubercle (the starting point of the ischial osteotomy line) can be approached and visualized safely using a medial incision in Bernese periacetabular osteotomy. Key words: Ischial osteotomy; medial approach; periacetabular; pubic osteotomy.
[show abstract][hide abstract] ABSTRACT: We evaluated short-term results of the Oxford phase 3 unicompartmental knee arthroplasty (UKA) in patients with medial compartment arthritis.
The study included 38 patients (28 females, 10 males; mean age 67 years; range 56 to 75 years) who underwent UKA for isolated medial knee osteoarthritis. At the time of surgery, 28 patients were in the age group of 56-64 years, and 10 patients were in the age group of 65-75 years. All the patients had Ahlbäck grade 2 primary medial compartment arthritis that had been unresponsive to conservative treatment. None of the patients had symptoms of patellofemoral arthrosis. Patients underwent UKA with the Oxford phase 3 cemented meniscal-bearing unicondylar prosthesis using minimally invasive surgery. The results were assessed preoperatively and at final controls according to the Knee Society clinical and functional rating system. Postoperative radiographic evaluations were made according to the Oxford criteria. The mean follow-up period was 24 months (range 18 to 32 months).
The mean preoperative active knee flexion increased from 121.8 degrees (range 110 degrees to 130 degrees ) to 130.9 degrees (range 120 degrees to 140 degrees) postoperatively (p<0.05). There was no limitation in knee extension both pre- and postoperatively. The mean preoperative and postoperative knee scores were 64.6 (range 47 to 80) and 97.5 (range 89 to 100), and the mean functional scores were 59.6 (range 45 to 80) and 92.1 (range 70 to 100), respectively (p<0.05). All the patients had an excellent knee score, while functional scores were excellent in 27 patients (71.1%) and good in 11 patients (28.9%). Postoperative radiographic measurements showed that the position of the femoral components was within acceptable ranges in all the patients with a mean of 3 degrees valgus (range 5 degrees valgus to 8 degrees varus) and 0.5 degrees extension (range 3 degrees extension to 2 degrees flexion). The positioning of the femoral components in relation to the mechanical axis was central in 30 patients and 2-mm lateral (range 2 mm medial to 4 mm lateral) in eight patients. The position of the tibial components was also within acceptable ranges in all the patients with a mean of 1.5 degrees varus (range 2 degrees varus to 2 degrees valgus) and a mean posterior inclination of 6.2 degrees (range 5 degrees to 7 degrees). All the tibial components showed full congruency with the medial, lateral, anterior, and posterior planes, except for one which had a 4-mm undersizing in the anterior plane. The polyethylene insert was central and parallel to the tibial component in all the patients. No osteophytes or cement debris that might lead to impingement were observed. All the components remained in position until the final controls. Complications such as insert dislocation, infection, pulmonary embolism, deep venous thrombosis, or neurovascular injury were not observed. None of the patients required revision surgery.
Our findings show that, with proper patient selection and strict adherence to the surgical technique, short-term results of the Oxford phase 3 unicompartmental knee prosthesis are excellent or good in the treatment of medial compartment osteoarthritis.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to assess the course of the superficial branch of the radial nerve (SBRN) at the level of the wrist and its branches in relation to wrist arthroscopy portals.
Dissections were performed on 11 hands from 6 cadavers in the section starting from the point where the SBRN begins to emerge and ending at the terminal branches of the dorsal hand. The distribution of the SBRN, the distance from the superficial branch to the dorsal portals used in wrist arthroscopy, and the distance from the superficial branch to the anatomic determinants (styloid process of the radius, Lister tubercle) were studied.
At the level of the wrist, the nerve bifurcated into 2 branches in 8 of 11 wrists (73%) and into 3 branches in 3 of 11 wrists (27%). The mean distance from the SBRN where it was first detected proximal to the Lister tubercle was 73 mm. The mean distance between the styloids was 52 mm; the distance between the Lister tubercle and styloid process of the radius was 23 mm. At the wrist level, the distance from the branch closest to the radial side to the Lister tubercle was 28 mm (L-D1), 21 mm (L-D2/3), and 7 mm (RS-D1). The distance of the closest nerve branch to the 3-4 portal was 9 mm. The distances of the other portals were 5 mm (1-2RMC-D1), 8 mm (1-2RMC-D2/3), 8 mm (1-2P-D1), and 9 mm (1-2P-D2/3).
The limited size of the area where portals can be positioned and the anatomic variations between individuals are major obstacles in developing a guideline for reducing the risk of SBRN injury in wrist arthroscopy.
Great care must be taken when using the 1-2 portal. We suggest making a skin-only incision for this portal and then using blunt dissection to help prevent injury to the SBRN.
Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2009; 25(11):1261-4. · 3.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: Our goal in this study was to propose an alternative closed reduction method to avoid open reduction in the management of pediatric supracondylar humerus fractures. A temporary Kirschner wire is inserted to the proximal part of the humerus to be used as a joystick to have a better control of the proximal fragment.
Twenty-three patients with closed Gartland type III extension fractures were operated between 2003 and 2007. Mean age of the patients was 6.7 (4-10) years.
Uninjured and fractured elbow's Bauman angles, lateral condylar angles, the carrying angles and ROM values were compared statistically according to independent samples t test.
At a mean follow-up 96.73 weeks (53-150), clinical results using the Flynn criteria were excellent in 21 (91.3%), good in 1(4.35%), fair in 1 (4.35%) patient.
These results suggest that the "joystick" reduction method is a reliable alternative when closed reduction itself is not successful.
Archives of Orthopaedic and Trauma Surgery 01/2009; 129(9):1225-31. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: The efficacy of the reverse Less Invasive Plating System in the management of unstable proximal femoral extracapsular fractures was retrospectively evaluated. Twenty-seven patients with complex proximal femoral fractures were identified. There were three open fractures. The mean age was 71 years (range; 65-79). The mean follow up was 24 months (range; 15-32). The main outcome measures were union, union time, requirement for secondary procedures, development of deep infection, pain, and functional impairment. Nonunion was observed in one patient. The average Harris hip score at the last assessment was 73 points (range 58-85). The outcome was adversely affected by concomitant medical problems, anatomical reduction and fixation of the plate. The use of this plate in the management of proximal femoral fractures of all types may be a safe and alternative method to other treatment options.
Hip international: the journal of clinical and experimental research on hip pathology and therapy 01/2009; 19(2):141-7. · 0.34 Impact Factor
[show abstract][hide abstract] ABSTRACT: The short-term results of middle-aged patients with severe developmental dysplasia of the hip treated with subtrochanteric femoral shortening and cementless large diameter metal-on-metal total hip arthroplasty were retrospectively evaluated. Clinical and radiological results of 15 hips of 13 patients with Crowe IV developmental dysplasia of the hip were enrolled in this study. The average follow-up period was 49 months (36-62 months). The average age of patients at the time of surgery was 45.5 years (range, 36-65 years). Radiographs were evaluated for component position, subsidence, loosening, and osteolysis. Intraoperatively, two patients had a small proximal femoral shaft split that was held with a cable wire. The average preoperative Harris hip score was 58; at 3 years, 82. Trendelenburg sign was negative in 11 hips at the last assessment. Loosening, subsidence, infection, dislocation, hypersensitivity and neurovascular complications were not observed. One hip had to be revised 1 year after surgery because of nonunion at the osteotomy site. Our study shows that large diameter metal-on-metal total hip arthroplasty, incorporating subtrochanteric femoral shortening, decreases dislocation rate and provides excellent results for the completely dislocated hip.
Hip international: the journal of clinical and experimental research on hip pathology and therapy 01/2009; 19(4):309-14. · 0.34 Impact Factor
[show abstract][hide abstract] ABSTRACT: We evaluated the effectiveness of extramembranous transfer of the tibialis posterior (TP) tendon for the treatment of drop foot deformity.
The study included 13 patients (6 females, 7 males; mean age 30 years; range 10 to 46 years) who underwent 15 tendon transfers for drop foot deformity. Ten patients (76.9%) had deformity due to unrepairable nerve injuries, which were associated with surgical procedures in six patients and trauma in the remaining four. In four feet (26.7%), the TP tendon was turned from the intero-anterior aspect of the tibia and fixed by tenodesis to the lateral cuneiform bone, while in 11 feet (73.4%), it was transferred to the extensor hallucis longus, extensor digitorum communis, and peroneus tertius tendons. The patients were assessed according to the Stanmore system questionnaire. The mean follow-up was 25.3 months (range 12 to 80 months).
According to the Stanmore system, the results were poor in two feet (13.3%), moderate in three feet (20%), good in three feet, and very good in seven feet (46.7%). All the patients were satisfied with the final outcome. The mean foot dorsiflexion was 5 degrees (range, -5 degrees to 10 degrees ), which was 10 degrees in four feet (26.7%), and 5 degrees to 10 degrees in six feet (40%). Apart from complaints of bulging in four patients (30.8%) in the dorsum of the foot due to tendon and suture material, no complications were seen during the early postoperative period.
Extramembranous transfer of the TP tendon for the treatment of drop foot deformity enables the patients to walk without the aid of orthosis and increases their quality of life.