Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations

Background: Performing a total hip arthroplasty for a high hip dislocation is technically demanding and presents several challenges, with appropriate evaluation of the bone morphology of the hip and proper implant selection being critical for successful outcomes. Objective: The purpose of our study was to evaluate the clinical and radiographic outcomes of cementless modular total hip arthroplasty for the treatment of high hip dislocations with sub-trochanteric transverse shortening osteotomy. Methods: Sixty-eight hips with a high hip dislocation, were treated using a sub-trochanteric transverse shortening osteotomy and cementless modular total hip arthroplasty, retrospectively reviewed. Hip function was assessed using the Harris hip score, with hip abduction strength evaluated using the Trendelenburg test. Radiographic assessment included the measurement of leg length discrepancy, identification of implant loosening, localization of the hip center, and union at the osteotomy site. Results: The mean follow-up period was 12.9 (range 5.2–16.8) years. The mean Harris hip score improved from a pre-operative score of 48.6 ± 3.6 to 82.4 ± 4.2 (p < 0.05). The hip was within the true acetabulum in all patients, postoperatively. Osteotomy union was achieved in 67 of the 68 hips (98.5%) in a mean latency of 12.5 ± 0.6 weeks. The mean length of femoral shortening was 66.5 ± 4.5 mm, with a mean pull-down length of the proximal part of 35.5 ± 3.5 mm. Conclusion: For the treatment of high hip dislocations with satisfactory clinical outcomes, the modular stem offers an adjustable anteversion angle to restore sufficient rotational stability and the transverse osteotomy provides sufficient compression pressure across the osteotomy site to facilitate union. Trial registration It was a retrospective study and approved by Istanbul Research and Training Hospital institutional Ethics Review Board (772-05/02/2016)

Worldwide arthroplasty research productivity and contribution of Turkey

WOS: 000452634300010PubMed ID: 29980409Purpose: Bibliometrics is increasingly used to assess the quantity and quality of scientific research output in many research fields worldwide. However, to the best of our knowledge, no studies have documented the main characteristics of arthroplasty publications from different countries. This study aimed to evaluate the worldwide research productivity and status of Turkey in the field of arthroplasty using bibliometric methods and to provide an insight into the arthroplasty research for surgeons and researchers. Methods: The Web of Science database was searched to identify arthroplasty articles published between 2006 and 2016. The contributions of countries were evaluated based on publication count, citation average, h-index and publication rate in the top 10 ranked journals. Each countries publication output was adjusted according to population size. Results: A total of 26.167 articles were identified. World arthroplasty publications were increased significantly over time (p < .005). The United States was the most productive country with 9007 articles (34,4% of total) followed by England with 2939 articles (11,4 of total) and Germany with 1881 articles (7,1% of total). According to average citations per item, Scotland was in the first place followed by Denmark and Sweden, whereas in the first place according to publication output adjusted by population size was Switzerland followed by Denmark and Scotland. The United States was also in the first place according to h-index and publication rate in the top 10 ranked journals. Founding average was 28,8% (7539 of 26164) for the arthroplasty articles that were analyzed in the study. Conclusion: There is a rapid increase in the number of articles in arthroplasty research from 2006 to 2016. The United States was the most productive country as measured by total publications in the arthroplasty field. However, some small European countries with high in-come have higher quality of articles and better productivity when adjusted for population. Gross domestic product (GDP) per capita and research foundation had positive affect on arthroplasty publications, both qualitatively and quantitatively

The surgical overcorrection of lenke type 1 deformities with selective fusion segments: What happens to the coronal balance?

Purpose: The aim of our study is to determine the alterations on coronal balance after overcorrection of Lenke type 1 curve, retrospectively. Methods: Datas of 34 patients (29 female, 5 male patients; mean age, 16.3±3.3 years; range, 13-24 years) surgically treated for scoliosis between 2004 and 2010 were reviewed, retrospectively. The adolescent idiopathic scoliosis patients with Lenke type 1 curve treated with only posterior pedicle screw and postoperative thoracic curves less than 10° by Cobb method on frontal plane were enrolled in this study. Mean follow-up period was 52.5±29.7 months. Results: The mean amount of the preoperative thoracic curves was measured as 41.2°±6.1° (range, 30°-56°). The mean amount of the early postoperative thoracic curves was measured as 6.5°±1.8° (range, 3°-9°). The mean amount of the thoracic curves was measured as 8.5°±4.6° (range, 3°-22°) during the last follow-up (p=0.01). The mean preoperative coronal balance was measured as 8.5 mm (range, 1-30 mm). The mean early postoperative coronal balance was measured as 3.5 mm (range, 0-36 mm). The mean coronal balance was measured as 5.5 mm (range, 0-38 mm) during the last follow-up (p>0.05). Conclusion: We suggest that Lenke type 1B and 1C should be carefully evaluated and the fusion levels should be accurately selected in order to maintain the correction of coronal balance. We suggest that selective fusion with overcorrection in Lenke type 1A are applied to curves that can be corrected lumbar curve at the preoperative bending radiograph and curves that not have coronal decompensation and >10° distal junctional kyphosis, preoperatively

A comparison of the effects of two different techniques on shoulder balance in the treatment of congenital scoliosis: Vertical expandable prosthetic titanium rib and dual growing rod

Purpose: The purpose of this study is to compare the effects of two different growth guidance techniques (dual growing rod and vertical expandable prosthetic titanium rib [VEPTR]) on shoulder balance, in the surgical treatment of congenital scoliosis. Materials and Methods: Thirteen patients who were operated due to congenital scoliosis are divided into two groups. The coracoid height difference and clavicular tilt angle difference were measured on standing anteroposterior X-ray images in the preoperative, early postoperative periods, and during the last follow-up. Results: Clinical improvement in shoulder balance was obtained in VEPTR during the last follow-up, but there was no significance in the comparison among the two groups during the last follow-up. Conclusion: The effect of the growth guidance techniques on shoulder balance positively contributes in the surgical treatment of congenital scoliosis

Using DNA typing methods to identify dental specimens exposed to different environmental conditions

The term identification explained the recognition and definition of a person living or dead and to reveal the features that distinguish it from other people. This study presents the findings on the validity and feasibility of DNA extraction analysis on tooth specimens which subjected to different environmental conditions (submerged in sea water, buried underground for some time) and teeth which are burned/ subjected to extreme thermal injury. The motivators behind these is to aid in the STR profiling; identifying individuals to which these specimens belong, and propose a standard for forensics methods for recovered field tissue samples; i.e. teeth

Unilateral Carpal Tunnel Syndrome Caused by an Occult Ganglion in the Carpal Tunnel: A Report of Two Cases

Carpal tunnel syndrome (CTS) usually presents bilaterally and a secondary nature should be suspected in patients with unilateral symptoms, especially those with a long-standing history, and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Space-occupying lesions are known to cause CTS and the incidence of space-occupying lesions in unilateral CTS is higher than that of bilateral CTS. It is easy to detect a mass when it is palpable; however, occult lesions are usually overlooked. Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This study presents two cases with an occult ganglion in the carpal tunnel compressing the median nerve and causing unilateral symptoms of CTS. We stress on the importance of imaging studies in patients with unilateral symptoms that are usually not used in CTS. The reported patients were evaluated and magnetic resonance images revealed an intratunnel space-occupying lesion

Atypically localized glomus tumor causing anterior interosseous nerve syndrome: A case report

This article presents a 48-year-old male patient who presented with pain in the left forearm and weakness and clumsiness in the left hand of 6 months' duration. Flexor motor strength loss of the thumb and the index finger was present and neurophysiologic tests showed findings compatible with axonal injury in the anterior interosseous nerve (AIN) innervated muscles. Magnetic resonance imaging revealed a space-occupying lesion in the proximal forearm resembling a glomus tumor. Excision of the mass and release of the AIN were performed. Histopathology confirmed a glomus tumor, and the patient remains asymptomatic at 1 year postoperatively. We stress the importance of imaging studies in patients when a suspected secondary nature of nerve entrapment is present. Keywords: Glomus tumor, Anterior interosseous nerve syndrom

Academic productivity and obstacles encountered during residency training: A survey among residents in orthopedics and traumatology programs in Turkey

Objective: This study aimed to investigate the academic productivity of and the obstacles encountered by orthopedic residents in Turkey. Methods: Overall, 220 orthopedic specialists who were registered in the Ministry of Health and had started orthopedic residency between 2009 and 2010 were invited to participate in a survey through e-mail. The survey comprised a total of 19 questions to evaluate the academic works conducted and obstacles encountered during residency. Academic work was defined as an article published in the peer-reviewed journals as well as an oral or poster presentation at a national or international congress. Case reports, letters to the editor, and technical notes were excluded. Results: Data were obtained from 116 respondents who completed the survey. In peer-reviewed journals in Science Citation Index (SCI) or SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.09 and 0.73, respectively. In peer-reviewed journals other than those in SCI and SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.37 and 1, respectively. The mean number of oral and poster presentations per resident at national and international congresses was 2.63 and 4.67, respectively. No significant difference in the number of academic works was noted between the regions and institutions (p>0.05). A significant positive correlation was observed between the number of associate professors and assistant professors in the clinic and the total number of academic works (article plus presentation) (p<0.01 and p=0.017, respectively). Regarding encouragement and support to academic works, 6.9% of the respondents found the clinic to be excellent, 20.7% good, 24.1% moderate, and 48.3% bad. No significant difference in encouragement and support to academic works was noted among the institutions (p=0.115). The most common obstacle encountered in conducting academic works was long working hours (74.5%). Conclusion: Regardless of the region and institution, the participation of orthopedic residents in academic works is low in Turkey. Several obstacles were encountered in conducting academic works, with the most common being long working hours

Total joint replacement for neglected posterior knee dislocation following septic arthritis after arthroscopy

This report presents the first case of a knee dislocation following septic arthritis after arthroscopy. A 65-year-old woman had an arthroscopy with irrigation and debridement (I&D) of the joint and microfracture for the chondral lesions. She had complaints of postarthroscopic infection but non-steroidal anti-inflammatory medication and local ice compression was recommended. She revisited her physician twice and at the last visit she had a large purulent effusion in her knee. The gram stain of the joint fluid aspirate demonstrated gram-positive cocci and the cultures grew methicilline-sensitive Staphylococcus aureus. She underwent arthroscopic assisted I&D and received intravenous antibiotics. I&D was repeated after two weeks. Intravenous antibiotherapy was continued for one more week and was changed to oral antibiotherapy for six weeks. At the third month visit's physical examination, a deformity at the knee was noticed and was referred to us for further treatment. A posterior knee dislocation with no neurovascular deficit was detected. The patient had a history of knee sprain but did not seek medical advice immediately. The blood samples showed no abnormality. The patient underwent a surgery with a cemented hinged revision total knee prosthesis following the exclusion of the active knee joint infection. Intraoperative frozen sections were also taken to exclude the active infection. The patient's knee is pain-free with full range of motion after 3 years. The objective of this report was to highlight the importance of early diagnosis, prompt appropriate treatment of septic arthritis following arthroscopy and the awareness of the knee dislocation as a rare dreadful complication of postarthroscopic infection particularly in elderly patients. Keywords: Knee dislocation, Septic arthritis, Arthroscopy, Total knee arthroplast

Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer

Objective: Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure. Materials and methods: Thirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism. The mean age was 67 (range 38–84) years. The mean follow up period was 12,5 months. The patients were evaluated radiologically for the presence of adjacent level fractures postoperatively. Complications were recorded. Results: The mean VAS score decreased from 7,5 to 3,5 during the last follow-up. Symptomatic silicone pulmonary embolism was not encountered in any patients. Leakage was observed in 5 (13%) cases. There was an adjacent level fracture in 1 case and another fracture which was not at the adjacent level in another one. A hematoma occurred in the needle entry site in a patient with trombocytopenia (<70,000). Conclusions: Elastoplasty is a safe, promising technique in the treatment of vertebral compression fractures (VCFs). Symptomatic silicone pulmonary embolism is not observed. The material's stiffness is close to intact vertebrae. Therefore, elastoplasty may be a good viable option in the treatment of VCFs as it cause less complications and can prevent adjacent level fractures. Level of evidence: Level IV, therapeutic study. Keywords: Elastoplasty, Vertebroplasty, Silicone, PMMA, Vertebral compression fractur