Is there a safe area for the axillary nerve in the deltold muscle - Reply

WOS: 000246377400037

Second-look arthroscopy after arthroscopy-assisted treatment of tibial plateau fractures

WOS: 000247242700010PubMed: 17225173The only way to show the healing potential in hyaline cartilage after the treatment of tibial plateau fractures in humans is the second-look arthroscopy. Our aim is to examine the healing potential of the hyaline cartilage in tibial plateau fractures treated with arthroscopy-assisted surgery. We applied second-look arthroscopy to the 12 patients out of 52 who had tibial plateau fractures treated by arthroscopy-assisted surgery. The mean age was 41. The tibial plateau fractures were classified according to Schatzker classification. The period between the primary surgical treatment and second-look arthroscopy was on an average of 19 months. Step-off was detected in 3 out of 12 patients. Hyaline cartilage of nine patients who did not have step-off was found obviously on the fracture line. None of them had displacement. Three patients out of 12 were above 50 years old and the average follow-up period was 26 months. Grade II-III chondral defect was detected on the fracture line and femoral condyle in patients above 50 years. For patients below 50 years old, the follow-up period was 21 months and grade I-II chondral defect was detected on the fracture line and femoral condyle. Until now in literature, tibial plateau fractures have been evaluated clinically and radiologically, but in our cases we directly saw the lesion. Cartilage healing is limited in human beings. On the fracture line, cartilage defect continues, although anatomic reduction has been achieved. Moreover, if there is step-off, insufficient healing potential appears. Although we did not have enough cases, we can say that in tibial plateau fractures anatomic reduction is mandatory. Contrary to the common idea, step-off is not tolerated by hyaline cartilage

The relationship between Hill-Sachs lesion and recurrent anterior shoulder dislocation

WOS: 000254244600004PubMed: 17515227The relationship between the number of shoulder dislocations and the depth and percent of head involvement of the Hill-Sachs lesions was investigated in this study. Thirty patients with recurrent anterior dislocation of the shoulder were divided into three groups according to the numbers of dislocations they had presented : Group 1 : 1 to 5 dislocations; Group 2 : 6 to 20 Group 3 : over 20. The mean percentage of head involvement was 11.9% in the first group, 25.4% in the second group and 26% in the third group of patients with Hill-Sachs lesions. The average depth of the Hill-Sachs lesions was 4.14 mm in the first group, 5.13 mm in the second group and 4.38 mm in the third group. Based on these findings, it appears that there is a correlation between the number of dislocations and the extent and depth of the Hill-Sachs lesions. Surgical treatment should therefore be performed as early as possible in patients with recurrent anterior dislocation of the shoulder, in order to prevent progression of the Hill-Sachs lesion which can become by itself a cause of instability

Risk of osteonecrosis of the femoral condyle after arthroscopic chondroplasty using radiofrequency: a prospective clinical series

Cirpar, Meric/0000-0001-9669-6513WOS: 000262438700005PubMed: 18758748Radiofrequency (RF) energy can be used for treatment of intraarticular pathologies in knee joint. RF energy was found to be superior to mechanical techniques in smoothening the articular surface (chondroplasty), shortening the operation time and reducing the blood loss. As RF produces thermal energy it has been reported to be responsible for the postoperative osteonecrosis however, there is no clinical evidence in the literature supporting that RF causes osteonecrosis. The current study searches for an answer whether surgical arthroscopic modalities using RF energy causes osteonecrosis. We hypothesize in the presented study that chondroplasty with RF has no effect on increasing the incidence of osteonecrosis in knee joint. In a prospective clinical trial, arthroscopic chondroplasty was performed in 50 patients with degenerative changes of the articular cartilage, stage II and III according to Outerbridge. To be included in the study, the patients had to meet the following criteria: (1) Preoperative MRI and plain film radiographs showing no evidence of osteonecrosis. (2) Patients had to be symptomatic for at least 6 weeks before the preoperative MRI. (3) Arthroscopically confirmed stage II or III. Preoperative MRI was taken in all patients. For chondral lesions bipolar RF energy system (VAPR-DePuy Mitek, Norwood, USA) was used. The patients were examined at the end of the sixth month and we performed MRI. Fifty patients with an average of age 45.54 (between 18 and 64) (SD, 10.63). During arthroscopy, together with chondropathy 22 patients pure medial meniscus tears, 7 patients medial and lateral meniscus tears, 7 patients pure lateral meniscus tears, 2 patients medial plica, and 3 patients synovial hypertrophy were detected. Among all 50 patients, osteonecrosis were detected at only 2 (4%) in the postoperative period. Until now it was not clear that RF energy causes osteonecrosis; however, according to this study if proper method is used, bipolar RF energy used for arthroscopic chondroplasty does not causes subchondral osteonecrosis

Rotational deformity affects radiographic measurements in distal radius malunion

Malunited distal radius fractures are 3D deformities. The preoperative evaluation of the deformity and surgical planning are usually depended on plain radiographic measurements for corrective osteotomies. In most of the cases, the rotational deformity is disregarded in preoperative planning. We aimed to clarify the effect of rotational deformity on radial inclination and dorsal or volar tilt measurements, which are commonly used as radiologic parameters. This study was performed on standard left radius saw bone models. The malunion models were prepared according to AO distal radius fracture classification system in four main and seventeen subgroups. The differences between the mean radial inclination, volar or dorsal tilt measurements performed on plain radiographies and gold standard values were statistically analyzed. Results showed that rotational deformity causes faulty measurements of radial inclination and dorsal tilt on plain radiographies which may be a contributing factor for unsatisfactory clinical results of corrective osteotomy. We suggest 3D preoperative evaluation of the deformity if possible

Localized pigmented villonodular synovitis of the knee: acute onset in pregnancy

WOS: 000240536900020PubMed: 16708212A pregnant patient in the first trimester presented with acute onset knee pain and effusion. As the clinical status was mimicking septic arthritis, surgery was performed. Arthroscopy demonstrated a local synovial tumor and excision was performed with arthrotomy. Microscopic evaluation revealed localized pigmented villonodular synovitis. Due to the presence of necrosis and hematoma in the tumor, we hypothesize that, that torsion or bleeding of the tumor in the presence of physiological pregnancy- related metabolic changes might have been the cause of acute presentation

Revision of the failed pedicle screw in osteoporotic lumbar spine: Biomechanical comparison of kyphoplasty versus transpedicular polymethylmethacrylate augmentation

Conclusion: Although pedicle hole PMMA augmentation is the gold standard for the failed screws in an osteoporotic bone, kyphoplasty augmented pedicle screw seems to be more effective method increasing the pullout strength

The Effectiveness of Botulinum Toxin Type A Injections in the Management of Sialorrhea

WOS: 000443089700011PubMed ID: 30197810Objective: The aim of this study was to evaluate the effect of Botulinum toxin type A by injecting in the submandibular and parotid glands on the frequency and severity of sialorrhea. Methods: Pediatric patients who were referred to our department with sialorrhea were evaluated using their parents' frequency and severity scores of sialorrhea with visual analog scales before and after 3 months of botulinum toxin type A injections. Bilateral submandibular and parotid glands were injected with Botulinum toxin type A. Results: Twenty-seven pediatric patients who were referred to our department with a complaint of sialorrhea were included in this study. Seventeen patients were female and 10 were male. Severe sialorrhea with cerebral palsy was present in all the patients. There were no complications after the procedure. Conclusion: Botulinum toxin A injected in the major salivary glands in pediatric patients with neurological disorders is a safe and effective method

Postarthroscopy osteonecrosis of the knee

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Revision of the failed pedicle screw in osteoporotic lumbar spine: Biomechanical comparison of kyphoplasty versus transpedicular polymethylmethacrylate augmentation

WOS: 000307145800010PubMed: 22765490Objectives: In this study, we aimed to compare of kyphoplasty versus transpedicular polymethylmethacrylate (PMMA) augmentation biomechanically in the revision of the failed pedicle screw in osteoporotic lumbar spine. Materials and methods: Bone mineral density (BMD) of, lumbar vertebrae collected from four bovines were measured., Each vertebra was decalcified with hydrochloric acid solution to obtain osteoporotic specimens. Primary polyaxial pedicle screws, were inserted into the pedicles and pulled out until they failed. The pullout strength results of all specimens were recorded. Revision pedicle screws were randomly inserted into the same pedicles by either pedicle hole PMMA augmented (group 1) or kyphoplasty (Xvoid (TM)) PMMA augmented pedicle screws (group 2). The pullout strength results of all specimens were re-recorded. Results: The mean BMD significantly decreased from 1.686 +/- 227.9 g/cm(2) to 1.432 +/- 157.1 g/cm(2) following decalcification (p<0.001). In group 1, the mean pullout strength of primary screws significantly decreased from 3443 +/- 1086 N/m(2) to 2088 +/- 924 N/m(2) following pedicle screw augmentation (p=0.006). In group 2 the mean pullout strength of primary screws decreased from 3702 +/- 1063 N/m(2) to 3664 +/- 1057N/m(2) following kyphoplasty augmentation (p=0.934). Pedicle screw augmentation group achieved significantly lower pullout strength values than kyphoplasty pedicle hole augmentation group (p=0.002). Conclusion: Although pedicle hole PMMA augmentation is the gold standard for the failed screws in an osteoporotic bone, kyphoplasty augmented pedicle screw seems to be more effective method increasing the pullout strength