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The necessity of quick surgical treatment of acute ruptured cerebral aneurysms was demonstrated in large studies by the ISAT and ISUIA, which also proved the advantage of the endovascular method over the surgical one. Ballonassistence is widely used in treatment of aneurysms with wide neck and unfavorable vascular anatomy, but the radicality of the treatment is insufficient. The aim of this study was to demonstrate the efficacy and safety of stent-assisted embolization of «acute» cerebral aneurysms. Material and methods. A retrospective analysis of the treatment of 234 patients with «acute» cerebral aneurysms was carried out. Results. Only coils were used in 40.6 % of cases (n = 95), balloon-assistance, in 40.2 % of cases (n = 94), and stent-assistance, in 19.2 % of cases (n = 45). There were 11.5 % (n = 27) clinically significant complications. Total aneurysm occlusion (Raymond-Roy I) was achieved in 187 cases (79.9 %); the radicality at the control examination was 67.1 % (157 patients). Discussion. The radicality of the treatment with stents was slightly higher then with balloons and coils at the end of operation (84.4 %, n = 38 and 78.8 %, n = 149, p > 0.05), but it was significantly higher at the control examination (80.0 %, n = 36 and 60.8 %, n = 115, respectively, p Conclusions. Intracranial stents allow achieving good results of the embolization of complex aneurysms in the acute period of intracranial hemorrhage without increasing the risk of surgical treatment.

Introduction To provide an overview of the experience of endovascular treatment for traumatic thoracic aortic lesions (TTAL). Thoracic aortic injury secondary to high-energy chest trauma constitutes an emergency situation with potentially devastating outcome. In the present time, the majority of patients are treated with thoracic endovascular aortic repair. The aim of this study was to provide a systematic overview of endovascular aortic repair in patients with TTAL with special attention to perioperative mortality, paraplegia, stroke, influence of left subclavian artery (LSA) coverage herein, and long-term stent-related complications. Evidence acquisition PubMed and Embase were searched for studies describing endovascular treatment of TTAL in the period between January 1st, 2000 and January 30th, 2016. The methodological quality of articles was assessed using the MINORS score and PRISMA guidelines. Data on early mortality, perioperative complications, and long-term stent-related complications were extracted. Evidence synthesis A total of 2005 reports were screened, and 74 publications were finally included in the analysis describing treatment of 1882 patients. Early mortality rate, paraplegia rate, and stroke rate were 7.5%, 0.4%, and 1.5%, respectively. LSA coverage did not increase the risk of stroke. The severity of injuries had a positive association on early mortality. Late stent related mortality and morbidity were uncommon. Conclusions TTAL can be treated endovascularly with low mortality and (neurological) morbidity. LSA coverage does not increase the risk of neurological complications but is associated with a moderate risk of left arm ischemia. Long-term stent-related complications are rare, but the available data is limited.

Introduction Very distal tears of the Achilles tendon are uncommon, and poor quality tendinous tissue of the calcaneal stump can compromise healing. Little has been published about the characteristics and surgical management of such injuries. We present a surgical technique, developed by the senior author, to restore continuity of the gastrosoleus-Achilles tendon-calcaneus complex using a free ipsilateral semitendinosus graft, and clinical outcomes of a case series of 28 consecutive patients. Our hypothesis was that this is a safe technique, and patients can return to pre-injury occupation and athletic activities. Patients and Methods A total of 28 patients (mean age 46 years) underwent minimally invasive reconstruction using a free ipsilateral semitendinosus graft for acute insertional rupture of tendo Achillis. The procedure required two small incisions along the course of the Achilles tendon, and one posteromedial incision at level of the ipsilateral knee to harvest the semitendinosus tendon. Patients were assessed at minimum 2 years (range, 2–2.5 years) following the index procedure. Results The median Achilles tendon Rupture Score (ATRS) at the latest follow-up was 88. Two patients developed a superficial wound infection. All patients returned to their preinjury occupation, whilst 22 out of 28 patients (79%), returned to their preinjury level of physical activity at a mean of 6.7 months after surgery, reporting good or excellent overall satisfaction in 88.5% of cases. Conclusion This minimally invasive technique was safe, and allowed most of patients to return to preinjury daily and sport activities within 9 months from surgery.

Introduction Acute patellar tendon rupture is easy to diagnose but is still often overlooked. The aim of this study was to assess early and late results of surgical treatment of acute patellar tendon rupture. Our hypothesis was that functional outcome is satisfactory. Methods A retrospective study included 38 knees in 37 patients (4 female, 33 male). Mean age was 42.6 ± 9.9 years (range, 23–81 years). Lesions comprised 15 tendon body ruptures, 20 avulsions from the tip of the patella and 3 avulsions from the anterior tibial tuberosity. Tendon repair was protected in more than 95% of cases by a reinforcement frame: hamstring (21 cases), synthetic ligament (12 cases) or metallic wire (3 cases). Results were evaluated in 2 steps: on patient files at a mean follow-up of 7.1 months (range, 3–24 months) to assess complications and early functional and radiological results; and by phone at a mean follow-up of 9.3 years (range, 19–229 months) in order to assess long-term functional outcome on Lysholm score and patient satisfaction. Results Thirty-one knees were assessed at a mean 7.1 months. Mean knee flexion was 128.5° ± 7.5° (range, 85°–150°), extension −1° (range, −15° to 0°) and Caton-Deschamps index 0.96 (range, 0.57–1.29). Twenty-three knees were further assessed at a mean 9.3 years. Mean Lysholm score was 93.7 points (range, 61–100). Ninety-six percent of patients were satisfied or very satisfied with the result. All had returned to their previous job, and 20 had returned to sports activities, including 8 at pretrauma level. Conclusion Patellar tendon rupture has good prognosis if diagnosis and surgical treatment is early. Level of evidence IV: retrospective study.

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures.

Fatih Karaaslan,1 Musa Uğur Mermerkaya,1 Alper Çıraklı,2 Sinan Karaoğlu,3 Fuat Duygulu21Department of Orthopaedics and Traumatology, Faculty of Medicine, Bozok University, Yozgat, Turkey; 2Department of Orthopaedics and Traumatology, Kayseri Training Hospital, Kayseri, Turkey; 3Department of Orthopaedics and Traumatology, Memorial Kayseri Hospital, Kayseri, TurkeyIntroduction: Controversy remains regarding the optimal treatment method and postoperative rehabilitation of acute Achilles tendon ruptures. In this study, pedobarographic assessments of surgical and conservative treatments were compared.Material and methods: A prospective assessment was made of 16 patients (eight surgical, eightconservative) and eight healthy controls using a plantar pressure measurement system. Biomechanical gait parameters were obtained using the Footscan dynamic gait analysis system. Kruskal–Wallis and Mann–Whitney U-tests were used for the evaluation of data.Results: Nineteen males and five females were assessed, with an average age of 42.0±11.9 years. Follow-up was completed in 16 patients. No statistically significant difference was determined between the two treatment groups with regard to the gait analysis, but a difference was observed with the control group (P

Introduction Patellar tendon rupture is an uncommon injury requiring immediate repair to restablish knee extensor continuity and to allow early motion. The aim of this study was to evaluate the clinical outcomes of surgical repair of patellar tendon rupture and compare the evolution of two groups (acute and chronic ruptures). Materials and methods This was a retrospective study of 25 cases operated for patellar tendon rupture and followed in our department. Functional knee evaluation and quality of life were performed. Results There were 21 men and 4 women. The average age was 33.60 years. The ruptures were fresh in 17 cases and neglected in 8 cases. There was a significant difference between the range of motion, IKS knee and IKS function when the injured leg was compared to the non-injured leg. In comparison between group with acute rupture and the other with chronic rupture, no significant difference was found in IKS knee, IKS function, SF 12 PCS, SF 12 MCS, pain score and satisfaction. Only the ROM of the knee was significantly different between two groups. Discussion/conclusion Patellar tendon ruptures are usually complete and long-term follow-up results indicate excellent function with early repairs. Direct repair of the rupture with cerclage stabilization demonstrates good intermediate to long-term results.

El objetivo de nuestro trabajo fue comparar los resultados de la cirugía percutánea según la técnica de las 5 incisiones (sutura percutánea [SP] modificada de MA y Griffith) y la cirugía abierta en la rotura del tendón de Aquiles en pacientes intervenidos de 2005 a 2007 en el Hospital Universitario 12 de Octubre (Madrid). Para ello se realizó un estudio retrospectivo de 50 casos, 25 SP y 25 suturas abiertas (SA) con un seguimiento mínimo de un año y un seguimiento medio de 27 meses.La evaluación clínica se realizó según la escala funcional de Boyden y Kitaoka: en el grupo de SP, 23 pacientes (92%) con satisfacción personal excelente y 2 pacientes (8%) con buena; En el grupo de SA, 22 pacientes (88%) tuvieron satisfacción personal excelente, 2 pacientes (8%) satisfacción buena, y 1 paciente (4%) grado de satisfacción malo, sin existir diferencias significativas entre ambos grupos. Ningún paciente presentó restricciones en la actividad diaria ni en el calzado. Todos finalizaron con una movilidad activa completa o con limitación de los últimos grados del tobillo afecto. Las complicaciones presentadas fueron disestesias en el territorio del nervio sural, infección superficial, infección profunda, rerrotura fibrilar parcial, adherencias, etc.The aim of our study was to compare the results of a group undergoing percutaneous surgery following the “five-incision” technique with a second group undergoing open surgery for Achilles tendon rupture during the period between 2005 through 2007 at the University Hospital 12 de Octubre (Madrid). A retrospective study of 50 cases was conducted, with 25 patients in the group of percutaneous suture (PS) and the remaining 25 cases belonging to the group of the open surgery (OS), with a minimum follow-up of one year and a mean follow-up of 27 months.The clinical assessment was performed using the Boyden and Kitaoka Scale. In the PS group, 23 patients (92%) had excellent personal satisfaction and 2 patients (8%) had a good result, while in the OS group 22 patients (88%) scored excellent in the personal satisfaction question, 2 patients (8%) scored good and 1 (4%) was unsatisfied without statistically significant differences between both groups. There wasn’t any patient with limitation for daily activities or shoe wear. All of them ended up with a full active mobility or with a restriction in the last degrees of the normal range of movement. The following complications were found: neuropathic pain in the sural nerve territory, superficial wound infection, deep infection, partial re-rupture, adhesions, etc.