Bilateral congenital pseudarthrosis of the tibia with neurofibromatosis type 1

Neurofibromatosis type 1 is an autosomal dominant, common genetic disorder that affects many systems, including the skeleton and neurocutaneous system. Skeletal involvement is seen in 38% of patients with NF1. Bowing deformity and pseudarthrosis are observed in 5.7% of the long bones, most of which are common in the tibia. A 13-year-old Somalian girl visited our orthopaedic clinic with complaints of deformity, inability to walk and pain in both legs. The deformity in both legs was present at birth and progressed further. A pathological fracture in the right tibia and a wide range of pseudarthrosis, hamartomatous bone tissues, medullary canal and diaphyseal narrowing towards the pseudoarthrosis range and cortical thickening were observed on her radiographs. Ilizarov technique was used for the case in this study

Reliability and validity of the two-minute step test in patients with total knee arthroplasty

Purpose: To investigate the test-retest reliability and concurrent validity of 2MST for assessing the physical performance of patients with total knee arthroplasty (TKA). Materials and methods: Fifty-one patients with TKA, aged more than 18 years, of both sexes, and underwent a primary TKA at least six months ago, were included in this study. The intraclass correlation coefficient (ICC) and 95% confidence interval (CI), standard error of measurement (SEM), and minimum detectable change at the 95% confidence level (MDC95) were used to determine the reliability of 2MST. In the validity, the correlations of the 2MST between the six-minute walk test (6MWT) and the two-minute walk test (2MWT) were assessed. Results: The reliability of 2MST was excellent (ICC = 0.97, SEM = 2.76, MDC95 = 7.6). There was a moderate correlation between 2MST and 6MWT (r = 0.586; p = 0.000), as well as between 2MST and 2MWT (r = 0.633; p = 0.000). Conclusions: 2MST proved to be a reliable and valid physical performance test in patients with TKA. 2MST can be used to evaluate the physical performance of TKA patients. ClinicalTrials.gov Identifier: NCT05064943Implications for Rehabilitation The two-minute step test (2MST) is a reliable and valid test for the assessing the physical performance of patients with total knee arthroplasty (TKA). 2MST is an easy-to-administer, low-cost, and quick performance-based test that can be used routinely in any clinical setting to evaluate functional recovery after TKA. The changes of 8 or more steps for 2MST over time may represent a true change in the rehabilitation of patients with TKA

Dome-shaped high tibial osteotomy with semi-circular Ilizarov pin fixator: Mid- to long-term results of a novel technique

Background: The aim of this study was to assess the clinical and radiological results of the dome-shaped high tibial osteotomy (HTO) which was fixed with a novel construct comprised of semi-circular Ilizarov frames and pins. Methods: The patients with at least five years of follow-up were evaluated. One-hundred and thirty-two knees of 114 patients were included in the final analysis. The clinical evaluation included range of motion and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Anatomical femorotibial angle (aFTA), anatomical medial proximal tibial angle (aMPTA), tibial slope and Insall–Salvati ratio were calculated on standard weight-bearing radiographs. Results: The average aFTA was improved from 1.6° varus to 8.7° valgus (P < 0.001). The average WOMAC score (P < 0.001) and flexion value (P = 0.014) were improved at the latest follow-up (WOMAC: 17.2, flexion: 142.5) compared with the preoperative period (WOMAC: 59.6, flexion: 129.2). The sagittal radiological parameters were not significantly affected. The five-year survival was 96.2%, and 10-year survival was 83.3%. Conclusions: The semi-circular Ilizarov pin construct provided satisfactory outcomes both clinically and radiologically at mid- to long-term follow-up

Should we really compress the fracture line in the treatment of Salter-Harris type 4 distal femoral fractures? A biomechanical study

In this study, the indirect effect on physeal plate during interfragmentary compression of a Salter-Harris (SH) type 4 distal femoral fracture has been investigated. Three Dimensional (3D) model of a single configuration has been performed via SolidWorks. ANSYS Workbench software was used for numerical analyses. All boundary conditions have been defined in finite element analysis software. Since it is premature to state that compression created an additional stress load on the physeal plate in vivo, according to our results, it has been found that lateromedial compression in SH type 4 fracture of the distal femur caused an additional stress load on the physeal plate ex vivo. It is believed that screws need to be fixed without compression to avoid an additional iatrogenic physeal injury

Should you fix again? An unusual fracture of a distal epiphyseal radius fracture - A case report

Currently, Salter-Harris (SH) classification is generally used in physeal fractures, as it is reliable and valuable in many cases. Although this clasification system describes many different fracture configurations, still there is an unclassifed group of fractures. Here, we present the case of an 11-year-old boy who underwent surgery after fracture of distal radial epiphysis,of the type still unclassified according to SH classification. The main reason for ourresearch was that the line of treatment could not be decided initially after the first operation. The current classsifications that are close to SH and essentials on the neccesity of surgical approach were dicussed. Surgery must be attempted in cases in which it cannot be decided whether it is a SH type 2 or 3. Besides this situation, an attempt must be made for the classification of the fracture (Ogden tip 2b, Sferoupulos tip 3). Another important point is to decide where the fracture line goes in the layers of physis

CAN BE A PREFERABILITY BETWEEN INDUCTION ANESTHETIC AGENTS FOR FRACTURE SURGERY. HISTOPATHOLOGICAL AND BIOMECHANICAL APPROACH ON RATS

© 2023 World Scientific Publishing Company.As the effect of many medical agents such as nonsteroidal anti-inflammatory drugs or antibiotics were investigated on bone fracture healing, there is no study about the anesthetic agents when compared histopathologically and biomechanically. We asked the question that if a superiority can be between them since we operate many fractures and see the delayed or nonunions. Although different anesthetic agents are used in general anesthesia, the effects of these substances on bone fracture healing are not clear. Here, we intended to research different anesthetic agents on fracture union in rats. The study was done between January 2020 and November 2021 in a university animal research laboratory. Totally 48 male Wistar-Albino rats weighing 250-300g were seperated into 3 groups as Tiyopental Na in Group 1, Ketamin in Group 2 and Propofol in Group 3. For anesthesia; 40, 100, 100mg/kg of single dosages were injected intraperitoneally, respectively. A shaft fracture was created bilaterally to the tibia of all rats. Kirschner (K) wire is used for the fixation of fractures. Biomechanical and histopathological examination in bones is performed at the end of the first and second months in terms of fracture healing. It has been found that the fracture union in group 1 was statistically signifigant higher than group 3 at the end of the first and second months histopathologically (P = 0.006, P = 0.002). It is also found there is a statistically significant difference between groups 1 and 3 after the second month biomechanically (P = 0.013). Although the union was higher in group 1 than group 2 histopathologically and biomechanically after the first and second months, there was no statistically significant difference (P = 0.376, 0.039; P = 0.028, 0.867). There was a general trend in the decrease of union measurements starting from group 1 to 3 at the end of the first and second month both histopathologically and biomechanically. In this study, it is found that there was a positive consistency between histopathological and biomechanical results with respect to bone union. They supported each other. Fracture healing is stronger in rats that were anesthetized by using thiopental than those using ketamine and propofol, we think that this may affect the choice of anesthetic agent and further studies are needed

Histopathological and biomechanical investigation of the effect of momordica charantia on fracture healing, kidney, and liver: an experimental rat model

Momordica charantia (MC) is a plant belonging to the family Cucurbitaceae. MC has antidiabetic, antibacterial, antioxidant, antimutagenic, antiulcerative, antiinflammatory and antilipidemic effects. However, information on the effect of MC on fracture union is lacking. This study aimed to examine the effect of MC on fracture union histopathologically and biomechanically. A total of 42 male Wistar-Albino rats were randomly divided into 3 groups, 14 in each group. A diaphyseal fracture was created on the right tibia of all rats. All fractures were fixed with a Kirschner (K) wire. The rats in Group I did not undergo any further procedures (Control group). Group II rats were treated with 0.9% saline oral gavage at a dose of 500 mu L/day for 28 days [Saline (S) group]. The rats in Group III were given 300mg/kg MC extract per day, dissolved in 500 mu L 0.9% saline by oral gavage for 28 days [MC (Extract) group]. After 28 days, all rats were sacrificed. Each group was randomly divided into two subgroups. The histopathological examination was performed on the right tibia of rats in the first subgroup and the biomechanical examination in the second subgroup. The kidneys and livers of all rats were evaluated histopathologically. Fracture union was significantly better in the Extract group compared with the Control and S groups histopathologically. The fracture inflammation values were lower in the Extract group than in the other groups. No statistically significant difference was found between the groups in terms of possible side effects to kidneys and livers. In terms of biomechanics, fracture union was significantly better in the Extract group compared with the Control and S groups except yield displacement values. MC had a positive effect on fracture union histopathologically and biomechanically