Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aimed to present a new modification of the modified Kessler tendon repair technique and share results of an animal study scrutinizing mainly the biomechanical properties and comparing it to other techniques.

Methods: Eighteen New Zealand rabbits were used and divided into 3 groups: 1 experiment and 2 control groups. Four-strand modified Kessler and 6-strand Tang repairs were used for the control groups. The new modification was used in the experiment group. Two surgeries were conducted 8 weeks apart, repairing 1 Achilles tendon in the first, repairing the contralateral tendon and harvesting specimens in the second. The repair times were recorded. In addition, biomechanical tests were conducted to determine mechanical strength.

Results: There was a statistically significant difference between the 3 groups in load-to-failure values for the strength after repair model, with the experiment group superior to the other 2 (P = .002; P < .05). Although there was a noticeable difference between the mean loadto- failure values of each group in the healing model, we could not demonstrate a statistically significant difference(P > .05). The new modification took significantly less time than the other 2 techniques (P = .001).

Conclusion: Our new modification was biomechanically stronger and faster than the other 2 techniques. The technique offers a new, suitable, practical option for human flexor tendon repair.

Objective: The aim of this study was to evaluate the outcomes of pediatric patients who were treated for olecranon and displaced radial neck fractures with absorbable rods and Kirschner wires.

Methods: Thirty-one patients (20 male, 11 female), aged from 3 to 13 years old with olecranon and displaced radial neck fractures treated with absorbable rods and Kirschner wires, were included in this retrospective, single-center study. All radial neck fractures were Judet type IV, and there were 17 type C and 14 type D olecranon fractures. The follow-up time ranged from 26 to 56 months (average 35.8 months). The Boyd approach was used first to reduce olecranon fractures and fix them with Kirschner wires. Thereafter, radial neck fractures were reduced and fixed with absorbable rods. Patients' functional outcomes were assessed using the Mayo Elbow Performance Index score.

Results: Results were excellent in 19 patients, good in 8 patients, fair in 2 patients, and poor in 2 cases according to the Mayo Elbow Performance Index score. The rate of excellent and good outcomes was 87.1%. The average Mayo Elbow Performance Index score was 91.5 points. Three patients showed radial nerve injuries preoperatively, which were assessed intraoperatively. No nerve repair was required, and all nerve injuries recovered within 3 months.

Conclusion: This study has shown us that using a Boyd approach for open reduction and fixation with absorbable rods and K-wires is feasible for olecranon and severely displaced radial neck fractures in pediatric patients.

Level of evidence: Level IV, Therapeutic study.

Objective: The study aimed to investigate the polymorphism of fibrillin-2 (FBN2) and elastin genes in patients with Achilles tendon rupture and to compare the results with a control group of participants who did not experience such an injury.

Methods: In this prospective study, 106 consecutive patients in whom traumatic Achilles tendon rupture was diagnosed and treated were included. The control group consisted of randomly selected 92 athletes (10 women and 82 men) 85 of whom had practiced sports in the past, aged 40-76 years, who during their sports career did not experience Achilles tendon ruptures. Material for genetic tests was obtained by the swab from the oral cavity epithelium of all the study population.

Results: 102 (96%) of patients with traumatic Achilles tendon ruptures were people with polymorphism B or heterozygotes for the elastin gene. 97 (92%) of patients with traumatic Achilles tendon ruptures were people with polymorphism B and heterozygotes for the FBN2 gene. Patients with homozygote A of the elastin gene and homozygote A of the FBN2 gene demonstrated a considerably lower incidence rate of sport-related Achilles tendon rupture. The type of sport that led to the Achilles tendon rupture and the amount of experience practicing it, as well as BMI and drug usage, did not contribute to a higher rate of incidence of any additional musculoskeletal problems or a longer time to return to their pre-injury sports activity. Polymorphisms of the fibrillin 2 (P=.0001) and elastin (P=.0009) genes impact the occurrence of traumatic injury to the Achilles tendon. However, it does not affect the length of full recovery time (P =.2251).

Conclusion: Minimally invasive and, above all, safe collection of genetic material from the epithelium of the oral cavity in order to assess the polymorphic state of the FBN and elastin genes may allow the identification of a group of players at risk of Achilles tendon rupture resulting in long-term injury, which will significantly affect their sports career in the future.

Level of evidence: Level II, Prognostic Study.

Objective: This study aimed to introduce a minimally invasive technique in correcting residual zigzag deformities after early treatment of thumb duplication followed by fixation with a cemented frame.

Methods: Nineteen patients (14 males, 5 females; mean age, 12 years; age range, 8-14 years) with residual zigzag thumb deformities were treated with the minimally invasive technique from 2017 to 2019. The function and cosmesis of the thumbs were assessed using the Japanese Society for Surgery of the Hand.

Results: The mean period between the first and the second operations was 35 months (range, 12-84 months). There were Wassel types III (n=4), IV (n=13), and V (n=2) residual zigzag thumb deformities. Preoperatively, the mean alignment deformities of the interphalangeal and metacarpophalangeal joints were 23° (12-42°) and 18° (11-33°), respectively. The mean function and cosmesis of the thumbs were 12 points (range, 8-14 points). There were 1 fair and 18 poor scores. At the final follow-up (mean, 28 months; range, 24-33 months), the mean alignment deformities of the interphalangeal and metacarpophalangeal joints were 1° (0-4°) and 18° (0-4°), respectively. The mean function and cosmesis of the thumbs were 18 points (range, 16-20 points). There were 5 excellent results, 13 good results, and 1 fair result.

Conclusion: Residual zigzag thumb deformities can be successfully corrected with the minimally invasive technique, resulting in good functional and cosmetic outcomes. The technique can be used as an alternative in selected cases.

Level of evidence: Level IV, Therapeutic Study.

Nonunion of the femoral neck represents the main complication following fractures at this location. Few studies have documented the application of 3-dimensional printing technology for the surgical treatment of postoperative nonunion of femoral neck fractures. The present manuscript describes a case of a particular 3-dimensional printing technology method for designing a custom-made guide plate for revision surgery. A 46-year-old man suffered a nonunion of the femoral neck following an internal fracture fixation. Using 3-dimensional printing technology, we preoperatively printed a femur model and a custom-made guide plate. Using the model, we performed a simulated operation before the surgery, and the guide plate was used for accurate osteotomy during the operation. With this method, we achieved the desired results: the fracture healed, the operation time was shortened, and there was no femoral head necrosis. Our case suggests that 3-dimensional printing technology provides an effective aid in the treatment of patients with nonunion following a femoral neck fracture and recommends 3-dimensional printing technology for such cases.

Objective: This study aimed to compare the outcomes of medial, lateral, posterior, and anterior approaches in pediatric Gartland type 3 supracondylar humerus fractures treated with open reduction and pinning.

Methods: Gartland type 3 supracondylar humeral fractures treated by open reduction and pinning in 4 different centers with different surgical approaches were divided into 4 groups according to the surgical approach. Each trauma center applied the surgical approaches with which it had the most experience. Specifically, patients treated with medial, lateral, posterior, and anterior approaches were classified as groups 1, 2, 3, and 4, respectively. The demographic characteristics of the patients and the complications were compared. The findings were evaluated according to the Flynn criteria.

Results: A total of 198 pediatric patients, 114 (57.6%) male and 84 (42.4%) female, with a mean age of 6.27 ± 2.03 (range = 1-12) years, were included in this study. They were all treated with open reduction and pinning, 51 (25.8%) by the medial approach, 49 (24.7%) by the lateral approach, 66 (33.3%) by the posterior approach, and 32 (16.2%) by the anterior approach. No significant differences in age, gender, side, or complication status were found between the groups (P > .05). There were also no significant differences between the groups regarding the Flynn cosmetic and functional criteria (P > .05).

Conclusions: Superior functional and cosmetic results can be achieved with fewer complications with surgical techniques applied by experienced surgeons in the open reduction of supracondylar humeral fractures in children. It is recommended that surgeons choose the approach with which they have the most experience.

Level of evidence: Level III, Therapeutic study.

Cervical myelopathy is a condition that is rarely reported in pediatric patients who have movement or neuromuscular disorders. We, herein, present a rare case of cervical myelopathy observed in a 14-year-old patient, who was previously a healthy boy treated with cervical laminoplasty, which was caused by cervical spinal canal stenosis based on multiple level disc herniation. The patient presented to the clinic with spastic and ataxic gait with previous diagnostic challenges. Magnetic resonance imaging showed cervical degenerative changes mainly marked at the C3-C4 and C4-C5 levels, along with canal narrowing and a central high signal cord abnormality on T2-weighted images. A C3-C4 open-door laminoplasty surgery technique was performed. The neurological symptoms and signs improved dramatically following surgery. Subsequently, cervical computed tomography and magnetic resonance imaging showed good decompression of the cervical spinal cord during the 5 years of follow-up with the preservation of the range of movement. We concluded that though it is pretty rare, cervical myelopathy should be considered in diagnosing adolescent patients with gait and balance disorders.

Extensor pollicis longus tendon ruptures are rarely reported after traumatic events, especially after distal radius fractures. Its classical presentation is a late-onset and unilateral rupture after a non-displaced distal radius fracture. In this case report, we present the treatment of a patient with acute bilateral extensor pollicis longus tendon ruptures after bilateral displaced distal radius fractures. The patient was treated with bilateral open reduction and volar plate fixation via a volar Henry approach for distal radius fractures and bilateral extensor indicis proprius tendon transfer for extensor pollicis longus tendon ruptures. We achieved satisfactory results, and no complications were reported with these treatment approaches. However, this case report demonstrates that extensor pollicis longus tendon rupture may occur at the time of fracture; thus, clinicians should be aware of this issue.

Objective: This study aimed to determine the effects of cam and pincer morphology on the hamstring injury rate, treatment duration, and recurrence number of elite young male football players.

Methods: Seventy-five elite young male football players were included in this study. Participants were evaluated physically and radiologically for femoroacetabular impingement during pre-season or pre-transfer routine health examinations. Athletes' injury and treatment data for 6 seasons were then collected prospectively and evaluated retrospectively. Athletes were divided into 2 groups: patients with cam and pincer morphology (group 1) and those without (group 2). Both groups were compared regarding the number of hamstring injuries, treatment duration, and recurrence numbers.

Results: The mean age was 20.35 ± 1.37 in group 1 (n = 23) and 18.92 ± 1.48 in group 2 (n = 52). There was a significant difference between the 2 groups regarding age and body weight. The rate of hamstring injuries in group 1 was higher than in group 2, and this difference was statistically significant. Although the recurrence rate (group 1-35.7%, group 2-27.8%) and treatment duration (group 1: 18.4 ± 10.1 days, group 2: 12.1 ± 6.2) in group 1 were higher than in group 2, there was no statistical significance between 2 groups.

Conclusion: The present study has shown that hamstring injuries are more common in elite young male football players with cam and pincer morphology than those without. Therefore, further studies of musculoskeletal dysfunctions of femoroacetabular origin should be considered in the programs prepared to prevent and treat hamstring injuries.

Level of evidence: Level III, Prognostic Study.