Total Knee Arthroplasty for Neglected Patellar Dislocation

Neglected permanent post-traumatic patellar dislocation is rarely seen. In this group of patients, secondary osteoarthritis may develop within years, consequently, patients suffer from pain. In the literature, there have been a few cases treated with total knee arthroplasty. Although each surgeon’s treatment plan changes, no standard surgical technique has been adopted. The aim in these cases, is to keep the patella located in the femoral groove and to achieve full knee extension. In this paper, a patient with osteoarthritis due to post-traumatic patellar dislocation who has undergone total knee arthroplasty is evaluated in the light of the literature. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 140-3

Advantages of Pressurized-Spray Cryosurgery in Giant Cell Tumors of the Bone

Background: Giant Cell Tumor is considered a benign, local and aggressive tumor. Although considered a benign bone tumor, it is still the subject of discussion and research because of the associated local bone destruction, as well as high rates of recurrence and distant metastases. Options are being developed for both surgical techniques and adjuvant therapies. Aims: The present study evaluated the administration of cryotherapy via a pressurized-spray technique in giant cell tumors of the bone. Study Design: Cross-sectional study. Methods: The study included 40 patients who were treated with extensive curettage and cryotherapy at various locations during the period from February 2006 to December 2013. Informed consent forms were obtained from the participants and ethics committee approval was taken from the local ethics committee of Ondokuz Mayıs University. The pressurized-spray technique was performed using liquid nitrogen. The patients were evaluated with respect to age, gender, radiological appearance, treatment modality, duration of follow-up, skin problems and recurrence. Results: Twenty-one patients were female; 19 were male. The average age of the patients was 33 years (range: 16–72 years), and the average duration of follow-up was 43 months (range: 12–80 months). The average time from the onset of the complaints to the diagnosis was 6 months (range: 2–12 months). Based on the Campanacci classification: 9 patients were Grade I; 25 patients were Grade II; six patients were Grade III. The lesion was located in the femur in 14 patients, in the tibia in 11 patients, in the radius in 5 patients, in the pelvis in 4 patients, in the fibula in 3 patients, in the metatarsal in 2 patients and in the phalanges of the hand in one patient. One patient had postoperative early fracture. None of the patients had skin problems and infection. Three (7.5%) of the patients had recurrence. Conclusion: It was found that cryotherapy was highly effective in the lesions, especially those located in the femur and tibia and remained insufficient in the lesions expanded outside the cortex. Wound healing problems, infection and fracture risk are lower with this technique

Osteosarkom Tedavisinde Modüler Tümör Rezeksiyon Protezi

Amaç: Osteosarkom nedeniyle tümör rezeksiyon protezi uygulanan olguların değerlendirilmesi amaçlandı. Gereç ve Yöntem: Kliniğimizde 2000 ile 2012 yılları arasında Osteosarkom nedeniyle tümör rezeksiyon protezi uygulanan ve yeterli takipleri olan 14 olgu değerlendirildi. Olgular cinsiyet, yaş, yön, tümör yerleşimi, takip süresi, tedavi başarısı, komplikasyon, nüks ve sağkalım açısından incelendi. Elde edilen veriler SPSS 15.0 programına aktarılarak analiz edildi. Verilerin normal dağılıma uygunluğu Shapiro-Wilk testi ile değerlendirildi. Bulgular: 14 olgunun 8'i erkek, 6'sı kadın ve ortalama yaş 21.9±7.02 idi. Osteosarkom 9 (%64.3) hastada femur distalinde, 5 (%35.7) hastada tibia proksimalinde, 5 hastada sağ ve 9 hastada sol alt ekstremitede idi. Ortalama takip süresi 33 ay idi. Ortalama MSTS skoru 81.9 hesaplandı, 11 hastada (%78.6) mükemmel, 3 hastada (%21.4) yetersiz sonuç elde edildi. Komplikasyon olarak 3 olguda aseptik gevşeme, 2 olguda peroneal sinir felci, 2 olguda cilt nekrozu, 2 olguda periprostatik kırık, 1 olguda protez enfeksiyonu ve 1 olguda lokal nüks gözlendi. Peroneal sinir felci olan 2 olgu dısında komplikasyonlar sorunsuz iyileşti. Lokal nüks gelişen hasta akciğer metastazı nedeniyle kaybedildi. Tartışma: Osteosarkomun tümör rezeksiyon protezi ile tedavisi, uzun dönemde protezin sağkalımını etkileyecek olan olası komplikasyonlar nedeniyle kullanımında soru işareti yaratmaktadır. Ancak stabilite, erken yük verme ve osteosentez kaygısından uzak olması nedeniyle avantajlı ve amputasyona kıyasla psikolojik olarak yüz güldürücüdür.Aim: The aim of the study is to evaluate the cases who underwent tumor resection prosthesis due to osteosarcoma. Material and Method: 14 cases who underwent tumor resection prosthesis due to osteosarcoma in our clinic between 2000 and 2012 and who had sufficient follow-ups were evaluated. The cases were examined in terms of gender, age, direction, tumor location, follow-up time, success of the treatment, complication, recurrence, and survival. The data obtained were transferred to the SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with the ShapiroWilk test. Results: 8 of the 14 cases were male, 6 were female, and the average age of the cases was 21.9±7.02. Osteosarcoma was in the distal femur in 9 (64.3%) of the patients, in the proximal tibia in 5 (35.7%) of the patients, in the right lower extremity in 5 of the patients, and in the left lower extremity in 9 of the patients. Average follow-up time was 33 months (3-144 months range). Average MSTS score was found as 81.9 (53-96 range), perfect results were taken in 11 (78.6%) patients while insufficient results were taken in 3 (21.4%) patients. As for complications, aseptic softening was observed in 3 cases, peroneal nerve paralysis was observed in 2 cases, skin necrosis was observed in 2 cases, periprostatic fracture was observed in 2 cases, prosthesis infection was observed in 1 case, and local recurrence was observed in 1 case. Except for the two cases with peroneal nerve paralysis, cases with complications recovered without any problems. The patient who developed local recurrence was lost due to lung metastasis. Discussion: Treatment of osteosarcoma through tumor resection prosthesis raises question marks due to possible complications that can affect the survival of the prosthesis in the long term. However, this treatment method is favorable in terms of stability, early load efficiency, and causing less anxiety than osteosynthesis; it is also psychologically more pleasing than amputation

Soft tissue tumors

Soft tissue tumors constitute a large group of tumors with diverse histopathological types. Mesenchymal tissues such as fibrous, lipomatous, vascular, synovial, and muscular tissues are described within this group. Neural sarcomas of neuroectodermal origin are also considered in this group due to their similar clinical and pathological characteristics (Enzinger FM, Weis SW (1995) Soft tissue tumors, 3rd edn. Mosby, St Louis). Soft tissue tumors may present with different histological, clinical, radiological, and pathological features within a wide range of anatomical locations, and thus diagnosis and treatment of these tumors require a multidisciplinary approach. Diagnostic evaluation of soft tissue tumors is critical as many benign soft tissue lesions may be confused with rare sarcomas

Modular Tumor Resection Prosthesis in Osteosarcoma Treatment

WOS: 000376567100026Aim: The aim of the study is to evaluate the cases who underwent tumor resection prosthesis due to osteosarcoma. Material and Method: 14 cases who underwent tumor resection prosthesis due to osteosarcoma in our clinic between 2000 and 2012 and who had sufficient follow-ups were evaluated. The cases were examined in terms of gender, age, direction, tumor location, follow-up time, success of the treatment, complication, recurrence, and survival. The data obtained were transferred to the SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with the Shapiro-Wilk test. Results: 8 of the 14 cases were male, 6 were female, and the average age of the cases was 21.9 +/- 7.02. Osteosarcoma was in the distal femur in 9 (64.3%) of the patients, in the proximal tibia in 5 (35.7%) of the patients, in the right lower extremity in 5 of the patients, and in the left lower extremity in 9 of the patients. Average follow-up time was 33 months (3-144 months range). Average MSTS score was found as 81.9 (53-96 range), perfect results were taken in 11 (78.6%) patients while insufficient results were taken in 3 (21.4%) patients. As for complications, aseptic softening was observed in 3 cases, peroneal nerve paralysis was observed in 2 cases, skin necrosis was observed in 2 cases, periprostatic fracture was observed in 2 cases, prosthesis infection was observed in 1 case, and local recurrence was observed in 1 case. Except for the two cases with peroneal nerve paralysis, cases with complications recovered without any problems. The patient who developed local recurrence was lost due to lung metastasis. Discussion: Treatment of osteosarcoma through tumor resection prosthesis raises question marks due to possible complications that can affect the survival of the prosthesis in the long term. However, this treatment method is favorable in terms of stability, early load efficiency, and causing less anxiety than osteosynthesis; it is also psychologically more pleasing than amputation

Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

Pigmented villonodular synovitis (PVNS) is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

Intramedullary Nailing of Deformity and Fracture in a Patient with Osteogenesis Imperfecta

Osteogenesis imperfecta is a hereditary disorder characterized by increased bone fragility. The production of type I collagen and endochondral bone development are disturbed. The disease is also considered a systemic syndrome affecting several organs besides skeletal system. Here, we present a case of osteogenesis imperfecta in a 13-year-old child with femoral fracture after a minor trauma on his left femur and ipsilateral deformity that were treated simultaneously by locked intramedullary nailing. Furthermore, the deformity on the right femur was treated using the same technique three months later. In this paper, the treatment of fractures and deformity correction in patients with osteogenesis imperfecta using locked intramedullary nailing technique is discussed in the light of the literature. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 126-9