THE EFFICACY OF 1,2- INTERCOMPARTMENTAL SUPRARETINACULAR ARTERY PEDICLED VASCULARISED BONE GRAFT FOR SCAPHOID PROXIMAL END NON-UNION AND AVASCULAR NECROSIS

  Purpose:To show the efficacy of 1,2-intercompartmental supraretinacular artery pedicled vascularised bone graft in treatment of scaphoid non-union with concomitant proximal end avascular necrosis retrospectively. Methods:Twentytwo cases of scaphoid nonunion with concomitant proximal end avascular necrosis were evaluated. Radiographic evaluation was made with radiographs, computed tomography, and magnetic resonance imaging. Clinical evaluation was made according to the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Mayo wrist score, and the Short Form-36. Results:Union was achieved in 18 81.8%. The mean age was 31.13±5.29 years and the mean follow-up was 34.95±16.87 months. The median wrist flexion-extension range was 123.5° (100°-144°) preoperatively and 128° (82°-146°) postoperatively. The median radial-ulnar deviation was measured as 41.5° (24°-55°) preoperatively and 42° (24°-58°) postoperatively. The dominant hand was measured as 92% (p=0.061) grip strength compared to the healthy side and the non-dominant side as 74% (p=0.012). Improvement was observed in all patients in SF-36,DASH,Mayo score and in patients with union (p<0.001).Conclusion:The radiological and clinical results of this study showed that 1,2- intercompartmental supraretinacular artery pedicled vascularised bone graft is an effective method in the treatment of scaphoid nonunion with concomitant proximal end avascular necrosis. 

Pleural angiosarcoma presenting with spontaneous hemothorax

Angiosarcomas (ASs) are very rare and constitute 1-2% of soft tissue malignancies. Primary pleural AS (PPAS) is a very rare neoplasm, with only 50 cases reported in the literature, and is a tumor with a high tendency for local recurrence and metastasis, with an aggressive course and a generally poor prognosis unless diagnosed early. It originates from the endothelial cells of small blood vessels and therefore can affect many organs. The etiology and definitive method in the treatment is still unclear. Patients usually present with nonspecific symptoms such as cough, dyspnea, chest pain, and hemoptysis. Recurrent exudative or hemorrhagic pleural effusion may develop due to its pleural location. The diagnosis can be made by histopathological and immunohistochemical examinations of excisional biopsy specimens. The effectiveness of chemotherapy and radiotherapy is weak and can be applied for palliative purposes. Surgical approach can be used for diagnostic and palliative purposes. Due to the high degree of malignancy and insidious course of PPAS, patients usually die within months after diagnosis. In these patients, surgical exploration is important for the diagnosis and palliative/definitive treatment of the disease. We present a 61-year-old male patient who presented with dyspnea, chest pain, and massive pleural effusion findings in the left hemithorax and was diagnosed with PPAS as a result of pleural biopsy

A COMPARISON OF ORTHOPAEDIC TRAUMA CASES OPERATED ON DURING THE COVID-19 PANDEMIC WITH DIFFERENT PERIODS: A SINGLE CENTRE STUDY

Introduction: To compare orthopaedic trauma cases treated surgically in our clinic during the COVID-19 pandemic in Turkey with surgically-treated trauma cases in previous periods, and to discuss these in the light of literature. Materials and Methods: Patient data of 3 different periods were compared. Group 1 included cases in the time period 11 March - 30 May, when the hospital was operating as a pandemic hospital for the COVID-19 pandemic in Turkey. Group 2 included cases from the equivalent time period the year before the pandemic, thought to have similar patient characteristics, and Group 3 covered the time period immediately before 11 March when COVID-19 was known in the world but there had not been any cases diagnosed in Turkey. Operations were performed in our clinic because of orthopaedic trauma to 186 patients in Group 1, to 262 patients in Group 2, and to 261 patients in Group 3. Results: A decrease of 29% was observed in trauma cases during the pandemic. In Group 1, 62 of 186 patients were aged >65 years, and 43 of these (69%) had a hip fracture. In Group 2, 33 (58%) patients aged >65 years underwent surgery for hip fracture and in Group 3, 60 (75%) patients. The time from hospital admission to surgery was mean 3.76±3.55 days in Group 1, 3.18±3.08 days in Group 2, and 2.68±2.33 days in Group 3 (p=0.017). The number of cases of attempted suicides was 6, 3, 3, respectively in the three groups (p=0.184). 30-day mortality was determined in 5, 3, and 4 cases, respectively (p=0.460). Conclusions: A decrease in the number of trauma cases was observed during the pandemic. However, there was no such decrease in hip fractures in elderly patients despite the quarantine of those aged >65 years. The workforce of the clinic was divided up during the pandemic for the diagnosis and follow-up of COVID-19 cases and thus there was no reduction in the workload of orthopedists as trauma surgery continued at the rate of 71%. Therefore, it can be considered very important to apply strict regulations which will decrease the risk of the spread of infection, and implement a multidisciplinary work flow for the more rapid discharge of trauma patients