Proksimal Femur Osteoid Osteoma Tedavisinde; Bt Eşliğinde Drilleme mi Yoksa Eksizyon mu?

ABSTRACTObjective:&nbsp;This study aims to report the results of 16 patients having proximal femur osteoid osteoma who were treated with CT guided mini-open excision, drilling, or x-ray guided excisionMethod:&nbsp;16 patients receiving surgical treatment (7 CT guided mini-open excision, 6 CT guided percutaneous drilling, 3 Scopy guided mini-open excision) who were followed for at least one year were evaluated. Preoperative and latest follow-up VAS pain scoring and degree (0-10 point) or level (1 ‘high to 4 ‘worse’) of patient satisfaction were analyzed.Results:&nbsp;Mean postoperative VAS pain score (0.7±1.1) was lower compared to pre-operative values (8±1) (p: 0.0004). The mean level and point of satisfaction were 1.3±0.6 and 8±2 points. There was no difference between CT-guided mini-open excision or Ct-guided percutaneous drilling for any parameter. There was not any recurrence or major complication during follow-up.Conclusion:&nbsp;Although histological verification of the lesion was more obvious in the CT-guided excision group, both groups resulted in similar relief of pain and high satisfaction at all patients with no recurrence of symptoms or major complications.Keywords:&nbsp;Osteoid osteoma, CT guided drilling, Proximal femur</div

Unstabil Torakolomber Vertebra Kırıklarının Tedavisinde Uygulanan Uzun Segment Tespitin Kırık Vertebraya Vida Konularak Kombine Edilmesinin Sonuçlara Etkisi

ABSTRACTObjective:&nbsp;There is some debate as to which is the best approach (decompression technique and how many levels of pedicle screws to use) in the surgical treatment of thoracolumbar fractures. Correction of thoracolumbar kyphosis without a neurological injury and prevention of mechanical problem should be the main concern. The aim of this study is to evaluate the advantages of long segment fusion with screws placed at the fracture level in unstable thoracolumbar vertebral fractures.Methods:&nbsp;Ninety-one patients with unstable T11-L2 burst fractures operated between January 2014 and March 2021 were included in the study. The patients were divided into two groups as those with screws placed in the fractured vertebra (group A: n: 61, age: 40.3) and those without (group B: n: 30, age: 38.9). All patients were followed up periodically with clinical and radiological evaluation. Vertebral compression angle (VCA), vertebral corpus height (VCH), intraoperative parameters (instrumentation time and intraoperative fluoroscopy number) and complications were compared between the groups.Results:&nbsp;There was no statistical difference with respect to age, sex, level of injury, AO classification, mechanism of injury and ASIA (American Spinal Cord Injury Association) classification&nbsp;between the groups. The both groups significantly restored VCA and VCH after operation (p &lt; 0.0001).&nbsp;Improvement in early postoperative VCA was statistically significantly better in Group A (p=0.0144).&nbsp;At the last follow-up, the Group A was significantly more succesful in restoration and protection of achieved correction of VCA (p = 0.0003).&nbsp;There was no difference between the two groups in terms of correction loss in VCA measured at the last follow-up. There was no statistically significant difference between the two groups in terms of postoperative VCH, VCH at the last follow- up, and correction loss in VCH. There was a statistical significant difference in operation time and intraoperative fluoroscopy numbers in group A compared to group B (p = 0.0443, p &lt; 0.0001 respectively). Implant failure occurred in two patients in group A and one patient in group B.Conclusion:&nbsp;Although it increases operative time, intraoperative blood loss, and the number of intraoperative fluoroscopy, the use of pedicle screw to fractured vertebra in long segment fusion is more effective in preventing mechanical problem in unstable burst fractures. It provides better postoperative correction in fractured vertebrae. However, there was no difference between the two groups in terms of loss of correction at follow-up.Keywords:&nbsp;Thoracolumbar fractures, long segment fixation, intermediate screw, pedicle screw fixation, fracture level .</div

The effect of the size of pedicle screw on the long-term radiological and clinical results of short-segment posterior instrumentation in the management of thoracolumbar vertebral fractures

Objective: It was aimed at evaluating the effect of the size of the pedicle screw placed on the fractured vertebra on the long-term radiological and clinical results of short-segment posterior instrumentation applied in the surgical treatment of thoracolumbar vertebral fractures. Methods: This retrospective study included 36 patients who underwent short-segment posterior instrumentation surgery for a single-level thoracolumbar (T11-L2) fracture between January 2015 and March 2021. The patients included in the study were divided into 2 groups according to the size of the pedicle screw placed in the fractured vertebra (group A: intermediate screw 4.5 mm, ≤35 mm + less than 50% of the vertebral corpus length, m/f: 13/4, n: 17, age: 36.5; group B: intermediate screw 5.5 mm, ≥40 mm + more than 70% of the vertebral corpus length, m/f: 11/8, n: 19, age: 42.6). All patients were periodically evaluated clinically and radiologically. Vertebral compression angle (VCA), anterior and posterior vertebral body height (ABH-PBH), intraoperative parameters (instrumentation time and intraopera-tive fluoroscopy number), and complications were compared between the 2 groups. Results: Both groups were comparable with respect to age, sex, level of injury, AO classification, mechanism of injury, and American Spinal Cord Injury Association impairment scale. Restoration of VCA and vertebral corpus heights was achieved sufficiently in both groups after operation (P < .0001). There was no significant difference between the 2 groups in terms of early postoperative VCA, VCA measured at final follow-up, or loss of correction in VCA. At the last follow-up, PBH was statistically significantly better preserved in group B (P = .0424). There was no difference between the 2 groups in terms of operation time and the number of intraoperative fluoroscopies. Implant failure was observed in 1 patient in group A. Conclusion: This study has revealed that using a long, thick pedicle screw placed in the fractured vertebra can better preserve the PBH at the final follow-up. No correlation was found between the size of the intermediate screw and the preservation of the correction in the postoperative vertebral heights and VCA during the follow-up. Level of Evidence: Level III, Therapeutic Study

Torakolomber Vertebra Kırıklarının Kısa Segment Pedikül Vidalama ile Yapılan Tedavisinde, Kırık Vertebraya Konulan Vidanın Boyutu Sonuçları Etkiler Mi?

Amaç:&nbsp;Torakolomber vertebra kırıklarının tedavisinde kullanılan kısa segment posterior entrümentasyonda kırık vertebraya konulan pedikül vidasının boyutunun sonuca etkisini değerlendirmek.Yöntem:&nbsp;Ocak 2015 ile Mart 2021 arasında tek seviye torakolomber vertebra (T11-L2) kırığı olan 33 hasta bu retrospektif çalışmaya dahil edildi. Hastalar kırık vertebraya konulan pedikül vidasının boyutuna göre iki gruba ayrıldı (grup A: &lt; 35mm, e/k: 9/6, n:15, yaş: 41.25 , grup B: &gt;35mm, e/k: 11/7 n: 18, yaş: 39,5. Tüm hastalar periyodik olarak klinik ve radyolojik değerlendirme ile takip edildi. Gruplar arasında Cobb açısı, vertebra korpus yüksekliği, operasyon süresi, operasyon içi kan kaybı, Denis ağrı skalası skorları ve komplikasyonlar karşılaştırıldı.Bulgular:&nbsp;Yaş, cinsiyet, kırık seviyesi, kırık tipi, ameliyat öncesi Denis ağrı ölçeği skorları, kifoz açısı ve vertebra yükseklikleri açısından 2 grup arasında istatistiksel fark yoktu. Erken postoperatif Cobb açıları ve vertebra yüksekliklerinde anlamlı bir fark yoktu. Grup B takipte elde edilen postoperatif Cobb açılarının ve vertebra yüksekliklerinin korunmasında anlamlı derecede daha başarılıydı. Gruplar arasında operasyon süresi, intraoperatif kan kaybı, Denis ağrı skalası skorları açısından son takipte istatistiksel fark bulunmadı. Gruon A’da İki hastada implant başarısızlığı görüldü.Sonuç:&nbsp;Kırık vertebraya konulan pedikül vidasının &gt;35mm kullanılması kırık vertebranın daha iyi redüksiyonu, takipte daha az korreksiyon kaybı ile ilişkilidir. Takipte postoperatif elde edilen Cobb açılarındaki ve vertebra yüksekliklerindeki düzeltmenin korunmasında daha etkilidir.Anahtar Kelimeler:&nbsp;‘’Torakolomber vertebra kırıkları’’, ‘’kısa segment fiksasyon’’, ‘’intermediate vida’’</div

Üreter Papı̇ller Karsı̇nomalı Hastanın Korakoklavı̇kular Eklemı̇ İçı̇ne Alan Metastatı̇k Tutulumu

Amaç: Ürotelyal karsinomlar; prostat (veya meme) kanseri, akciğer kanseri ve kolorektal kanserlerden sonra dünyada dördüncü sıklıkta görülen malign tümörlerdir. Primer üretelyal tümörlerin büyük çoğunluğu üreter epitelinden (ürotelyumdan) köken alır. Sıklıkla 6. Dekattan sonra üretalyal tümörler üreterden köken almaktadır. Bu tümörler genellikle yavaş büyüdüğünden sessiz seyreder ve tanı konulduğunda genellikle ipsilateral böbrekte fonksiyon kaybı vardır. Aynı zamanda metastatik olarak vertebra kemikleri tutulumu sık görülür. Bu olgumuzda ise klavikula ve çevre yumuşak doku kas ve tendon tutulumunun da olabileceği gösterilmiştir.Yöntem: 62 yaşında kadın hasta aralıklı makroskopik hematüri şikayeti üroloji polikliniğe başvurdu. Ultrasonografik inceleme, belirgin böbrek parankimiyle dikkat çekici derecede hidronefrozu görüldü. Abdominal bilgisayarlı tomografi taraması proksimal dilatasyon, hidronefroz ve işlevsiz ipsilateral böbrek ünitesi ile üreteral bir lezyon tanımlandı. Retrograd ürografide çoklu dolum kusurları ve düzgün konturlu 2,5 cm’lik bir lezyon görüldü. Bunun üzerine sol nefroüretektomi yapılarak patoloji sonucu üreter papilloma tanısı aldı. Hastanın sol omuzda da ağrı ve ele gelen fikse kitlesi mevcuttu.Sol omuz ağrısı için hastanede postop takip edilirken çekilen direkt grafide distal kesiminde yerleşim gösteren iç yapısı heterojen solid en geniş çapı 5 cm boyutunda ölçülen kitlesel lezyon ile uyumlu görünüm izlenmesi üzerine; manyetik rezonans ve bilgisayarlı tomografide çekilen hastanın radyoloji yorumu: ‘ Klavikula distalinde ilk planda metastatik vasıfta olduğu düşünülen ekspansil kitlesel lezyon, eşlik eden yumuşak doku ve kas ödemi ‘ sonucu çıktı. Hasta Kas ve İskelet Konseyinde değerlendirildi ve biyopsi kararı alındı. Yapılan tru-cut biyopsi de metastatik gelmesi üzerine hastanın operasyonu planlandı.Bulgular: Aralıklı makroskopik hematüri şikayeti, Abdomen BT’ de sol böbrekte ürotelyal neoplazi ile uyumlu, böbrek parankimine kıyasla hipovasküler yapıda kitlesel lezyon, sol klavikula üzerinde ele gelen fikse 5 cm boyutlarında omuz hareketlerini kısıtlayan kitle.Sonuç: Anestezi hazırlıkları sonrası hasta supin pozisyonda alındı. Hastanın ipsilateral sol bacağı ve sol omzu steril boyandı. Ardından sol klavıkula üzerinden insizyon yapılarak yumuşak doku ve metastatik kemik dokusu sinir ve damar yapıları korunarak rezeke edildi. Rezeke edilen 9 cm klavikulanın yerine sol kruris orta 1/3 luk kısımdan 9 cm fibula testere ile çıkarıldı. Çıkarılan fibula medialde kalan klavikulaya DCP ile sabitlendi. Distal kısım ise Hook plakla ve korakoklaviküler bağ stabilitesini sağlamak için endo-button yöntemi ile klavikuladan korakoide sabitlemesi yapıldı. Hastaya omuz askısı ile yara yeri takibi sonrası 2. Haftadan itibaren izometrik omuz egzersizlerine başlatıldı. Hastanın patoloji ye giden metaryeli metastatik üreteryalpapiller karsinom olarak sonuçlandı. Onkoloji Bölümüne yönlendirildi.</div

Kırk Yedi Hastada Fiksasyon veya Endoprotez ile Proksimal Femur Metastazı Tedavisi

ABSTRACTObjective:&nbsp;Purpose of the present study was to compare patients with proximal femur metastasis with actual or impending fractures who were treated by fixation or prosthetic hip replacement.Method:&nbsp;Twenty-seven patients underwent fixation treatment (IM nail, DHS), and 20 patients prosthetic (endoprosthesis or total hip arthroplasty) replacement. Data were analyzed regarding patient demographics, cancer type, localization and type of metastasis, actual or impending fracture, number of bone metastasis, presence of spinal or visceral metastasis and treatment data (ASA class, length of hospital stay or surgery or survival, cement usage, adjuvant treatment, postoperative walking status).Results:&nbsp;Fixation group (63 years) was younger than prosthesis group (70 years) (p: 0.03). Fixation was more preferred at subtrochanteric area (p˂0.001). Cementation of the lesion was more preferred and surgery time was longer at fixation group (p: 0.01). Greater number of complications (mostly medical) were more likely to be seen in the fixation group (6 ‘1 loosening’ vs 3 ‘1 dislocation’).Conclusion:&nbsp;It is not still clear whether one implant is clearly superior to other one, however it was revealed again that nailing was mostly preferred for the subtrochanteric area and tended to have more complications although mostly medical and unrelated to implant placement as previously reportedKeywords:&nbsp;proximal femur, metastasis, stabilization</div

Impact of graft width and chondrolabral junction preservation on labral suction seal integrity in bovine hip models

OBJECTIVE: This study investigates the biomechanical effects of graft width and chondrolabral junction (CLJ) preservation on the labral suction seal in a bovine hip model and aims to validate this model as a practical alternative for hip biomechanical research by comparing it with human cadaver studies. MATERIALS AND METHODS: Twenty hips from two-year-old male bovines were divided into two main groups: CLJ preserved (CLJ+) and CLJ excised (CLJ-). These groups were further divided into eight subgroups: Group 1 with an intact labrum; Group 2 with labrum excision preserving CLJ; Groups 3 and 4 with labral reconstruction on preserved CLJ using 4.5 mm and 9 mm grafts, respectively; Group 5 with a labral tear at 12 to 3 o'clock position without CLJ preservation; Group 6 with complete labrum excision without CLJ preservation; and Groups 7 and 8 with labral reconstruction on excised CLJ using 4.5 mm and 9 mm grafts. Mechanical tests measuring compression and distraction forces were conducted, recording force-displacement values. RESULTS: Both CLJ+ and CLJ- groups showed that labrum excision resulted in the lowest distraction forces, emphasizing labral integrity. Notably, reconstruction with 9 mm grafts improved distraction forces more than 4.5 mm grafts (p<0.001). The change in distraction forces from intact to excised stages was nearly significant between CLJ+ and CLJ- groups (Δ Intact- excised: CLJ+ vs. CLJ-: 92 N vs. 105 N, p=0.08). Distraction forces were measured at 206±27 Newtons in the CLJ preserved group and 186±24 Newtons in the resected group. CONCLUSIONS: This study demonstrates that increasing the width of the graft, despite being approximately half and a quarter of the native labrum's size, significantly enhances the distraction force in labral reconstruction within a bovine hip model. This improvement is more pronounced than the effects of preserving the CLJ, highlighting the critical role of graft size in maintaining the biomechanical integrity of the labral suction seal

Young Bovine Hip Model for Hip Arthroscopy Training

Hip arthroscopy is associated with risks for complications, especially for novice surgeons. The present article reports use of a young bovine hip as a valid educational tool for key components of arthroscopic treatment of femoroacetabular impingement syndrome, ie, labrum repair and cam excision. The purpose of this Technical Note is to describe the steps of arthroscopic femoroacetabular impingement treatment in the bovine hip

Eighty-One Percent of Unrepaired Interportal Capsulotomies Showed Healed Capsules on Magnetic Resonance Imaging 5 Years After Primary Hip Arthroscopy

Purpose: To evaluate whether unrepaired interportal capsulotomy presents with capsular defect on magnetic resonance imaging (MRI) 5 years after primary hip arthroscopy and to determine its effect on functional results and findings of osteoarthritis on radiographs or MRI scans. Methods: Patients with femoroacetabular impingement (without arthritis or dysplasia) were retrospectively reviewed after arthroscopic labral repair or debridement and femoroplasty through interportal capsulotomy without closure. Patients were assessed preoperatively and at a minimum of 5 years postoperatively using patient-reported outcomes (Hip Outcome Score–Activities of Daily Living scale, modified Harris Hip Score, and visual analog scale pain score), radiographic measures, and MRI scans. Results: Forty patients (42 hips) were deemed eligible for the study and were evaluated. Of the hips, 81% had healed capsules, whereas 8 (19%) had capsular defects on the latest MRI scan. There were 3 hips with subchondral edema in the defect group compared with 1 in the healed-capsule group (P = .01) on the latest MRI scan, which was not present on preoperative MRI (still positive on multivariate analysis when the preoperative alpha angle was also taken into consideration). Functional results did not differ between the groups (P > .05). Conclusions: In this study, 81% of interportal capsulotomies healed without repair at 5 years after primary hip arthroscopy. Clinical Relevance: Understanding the prevalence and implications of unhealed capsulotomies could encourage surgeons to be meticulous in capsular closure