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Aim of this study was to investigate the effects of thromboprophylactic agents at pre-anastomotic period of thrombosis in gluteus maximus muscle flaps. Forty five male Sprague-Dawley rats that have 289 g average weight were randomly diveded into 9 experiment groups and, each group was consisted of five rats. The first group was a control (sham) and not treated with antithrombotic agents. The other groups were consisted of rats treated with SC heparin, SC LMWH, oral aspirin and the combinations of these groups with IV heparin, and only treated with IV heparin and flaps of these groups were washed with % 10 heparin solution. For the ninth group, we didn\'t give any thromboprophylactic agents but washed flaps with % 10 heparin solution. The presence of fibrinogen, vWf and the thrombomoduline were investigated in the flap tissues. A diffuse thrombosis was evaluated in the sham group. There was found the lowest thrombosis findings in SC heparin group. A mild to moderate degree of thrombosis was seen in the SC LMWH, oral aspirin or IV heparin injected group. In this animal model, preoperative SC heparin treatment has significant thrombroprophylactic effect when used alone but not in combination. [Med-Science 2012; 1(2.000): 90-102]

OBJECTIVE: Kienböck's disease is a commonly seen posttraumatic avascular necrosis characterized by avascular necrosis of the lunate bone of the wrist which involves the dominant hand. In our study, we aimed to present midterm outcomes of 12 cases treated with radial metaphyseal core decompression. PATIENTS AND METHODS: In our clinic, 12 patients who applied to our outpatient clinic with intractable pain despite at least six weeks of conservative treatment were previously diagnosed and evaluated as Kienböck's disease between the years 2006 and 2014. Patients at early stage received radial metaphyseal core decompression. RESULTS: The patients were evaluated as postoperative grip strength, flexion-extension gap, ulnar-radial deviation gap, VAS, Quick DASH and MAYO wrist scoring and patient satisfaction. CONCLUSIONS: We determined that interventions performed for Kienböck's disease cannot halt radiological progression. We are of the opinion that radial metaphyseal core decompression, aiming at increasing blood perfusion, improve early diagnosis and treatment of Kienböck's disease, increasing the patient satisfaction. [ABSTRACT FROM AUTHOR]

The article presents the results of a study which investigated the effects of treadmill training exercise on bone mineral density (BMD) in rats. Dual-energy X-ray absorptiometry (DEXA) was used to measure the BMD of the rats' tibias. A significant increase in the BMD was observed for rats which were exercised for only 30 minutes a day, but this benefit declined as the exercise time was increased.

Background: Many authors have reported that the pelvic support osteotomy prevents a Trendelenburg gait by restoring the biomechanics of the abductor muscle in patients with congenital dislocation of the hip. However, we are not aware of any studies in which the hip abductor muscles were examined following pelvic support osteotomy. The purpose of this study was, first, to use magnetic resonance imaging to measure alterations in the length and volume of the gluteus medius muscle after pelvic support osteotomy and, second, to determine which factors influence the results of the Trendelenburg test.Methods: Eleven patients with a history of congenital hip dislocation who had been treated with a pelvic support osteotomy were examined clinically with the Harris hip score and the Trendelenburg test, radiographically to measure limb-length discrepancy and valgus angulation of the proximal part of the femur, and with magnetic resonance imaging to measure changes in the gluteus medius length and volume.Results: The pelvic support osteotomy achieved a functional and painless hip in all eleven patients. Five of the eleven patients had a persistently positive Trendelenburg gait at the time of the last follow-up visit, at an average of three years after the osteotomy. The muscle volumes were restored to 43% to 89% of the muscle volumes on the normal contralateral side, and the postoperative muscle volume correlated significantly with the result of the Trendelenburg test (r = -0.63; p = 0.03). There was a positive association between age and the result of the Trendelenburg test (p = 0.01): four of the five patients who had a positive test were at least thirty-one years of age at the time of the operation. There was no correlation between the Trendelenburg test and the change in the length of the gluteus medius muscle, which averaged 19.2 mm in the patients with a positive test and 19.3 mm in those with a negative test.Conclusions: Patient age at the time of the operation and the postoperative change in the volume of the gluteus medius muscle have a significant influence on the result of the Trendelenburg test after a pelvic support osteotomy. Moreover, our study demonstrated that restoration of the muscle volume after a pelvic support osteotomy is not sufficient to prevent a Trendelenburg gait in older patients with congenital dislocation of the hip.Level Of Evidence: Therapeutic Level IV. [ABSTRACT FROM AUTHOR]

Measurement of grip strength is an important component in hand evaluation. It assesses the patient's initial limitations and provides a quick reassessment of patient's progress throughout the treatment. This investigation was conducted to examine the determinants of hand dominance of average versus maximum grip strength, body mass index (BMI) and age for hand evaluation. Subjects were 877 apparently healthy male adult volunteers from the Inonu University - students and personnel; average age 21.14+/-2.09 (19-40 years). A good correlation was found between the BMI hand strength measures. Grip strength was measured instrumentally. The rule 'dominant hand (DH) is approximately 10% stronger than the non-dominant hand (NDH)' was found to be valid for left handed persons only (7%) otherwise these measures should be considered equivalent in both hands. The difference between maximum and average of three consecutive measurement of grip strength was found significant for both hands. As the significant difference was found between RGSmax (Maximum Grip Strength of Right Hand) and RGSav (Average Grip Strength of Right Hand); LGSmax (Maximum Grip Strength of Left Hand)/LGSav (Average Grip Strength of Left Hand) measures for RDH. RGSmax and LGSmax where correlated only for LDH. Therefore, average of three consecutive measurement of grip strength is more consistent for standard hand evaluation. [ABSTRACT FROM AUTHOR]

In this study, we investigated the effects of different skills of sport on electromyography (EMG) of limb muscles in sportsmen. Two different skill groups of sport consisted of 10 soccer players who use extensively lower limb, and 10 handball, basketball and volleyball players with selectively high usage of the upper limb. Surface EMG (sEMG) were recorded from the abductor pollicis brevis and gastrocnemius muscles of subjects. In addition, Hoffmann reflex (H-reflex) were recorded from the lower limb of participants. EMG findings of two groups were compared with each other and age-sex matched sedentary controls. Amplitude and area of sEMG recorded from gastrocnemius muscle of handball-basketball-volleyball players were significantly higher than those of soccer players (p<0.01 and p<0.05), whereas not significantly different based on the abductor pollicis brevis (p>0.05 in both). F-response of both muscles and H-reflex of handball-basketball-volleyball players were also significantly higher from those of soccer players and control group (p<0.05 for all), whereas only F-response of gastrocnemius muscle of soccer player was significantly lower than that of control group (p<0.05). We conclude that EMG amplitude of gastrocnemius muscle, F-response and H-reflex times of lower limbs increase in handball-basketball-volleyball players due to the nature of training skills. Volleyball, handball or basketball training contributes to neuromuscular differences in both upper and lower extremities more than football training because both extremities are extensively used in these sport categories. [ABSTRACT FROM AUTHOR]

Measurement of grip and pinch strength is an important component in hand evaluation. It assesses the patient's initial limitations and provides a quick reassessment of patient's progress throughout the treatment. This investigation was conducted to examine the effects of hand dominance, body mass index (BMI) and age on grip strength (GS) and pinch strength (PS) tasks. Subjects were 365 apparently healthy young male adults (19-33 years). No correlation was found between the BMI hand strength measures. Grip and pinch strength were measured instrumentally. The rule 'dominant hand (DH) is approximately 10% stronger than the nondominant hand (NDH)' was found to be valid for left handed persons only (11.2%), otherwise these measures should be considered equivalent in both hands in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to evaluate microvascular changes using nailfold capillaroscopy in patients who underwent digit replantation and revascularization., Patients and Methods: A total of 46 patients (34 males, 12 females; mean age: 45.8±17.6 years; range, 18 to 75 years) who underwent replantation or revascularization procedures between February 2012 and May 2023 were retrospectively analyzed. Nailfold capillaroscopy images were assessed for various parameters including capillary count, diameter, dilatation, presence of giant capillaries, capillary disarrangement, microhemorrhages, neoangiogenesis, subpapillary plexus appearance, crossing capillaries, tortuosity, and microaneurysm. We investigated the association between microvascular alterations and clinical outcomes., Results: Of 46 patients, 25 patients underwent replantation and 21 patients underwent revascularization. Significant microvascular changes, including subpapillary venous plexus, microvascular enlargement, microhemorrhages, neoangiogenesis, and tortuosity were observed in replantation patients (p=0.000 b , p=0.020, p=0.021 b , p=0.001, and p=0.004, respectively). However, these changes were not significant in revascularization patients. Revascularization patients exhibited an increase in capillary diameter and disarrangement (p=0.019 and p=0.016 b , respectively). A significant negative correlation existed between digital nerve repairs and microvascular enlargement in replantation patients. Hyperesthesia was significantly correlated with neoangiogenesis and capillary disarrangement, while a statistically significant positive relationship was found between subpapillary venous plexus and patient satisfaction in replantation patients., Conclusion: Our study showed that replantation patients who underwent two nerve repairs exhibited a well-regulated microvascular tone. However, we did not observe a statistically significant relationship between the number of nerve repairs and cold intolerance. Based on these findings, we highlight the potential of nailfold capillaroscopy in detecting microvascular changes following replantation and revascularization, which may contribute to a better understanding of the etiology of neurovascular complications.

Background: Humeral lateral condyle fracture is the most common elbow fracture in children after supracondylar fractures. Non-union of these fractures may cause ulnar nerve deficit, deformity and loss of joint motion, which are difficult to manage. Treatment of lateral condyle non-union can be done in two stages or one stage. However, despite all types of treatment, the chance of success is very variable. Many complications such as avascular necrosis, loss of motion, non-union, chronic pain, and heterotopic ossification have been reported as a result of surgeries performed for lateral condyle pseudoarthrosis., Objective: In this article, we applied two-stage surgical treatment to a pediatric patient who developed ulnar neuropathy and elbow valgus deformity as a result of lateral condyle non-union., Case Report: A 8-year-old boy with lateral condyle nonunion presented to our clinic with pain and deformity. After initial examination, two-stage surgical treatment was planned to achieve union and deformity correction. In the first stage, we performed pseudoarthrosis surgery and ulnar nerve anterior transposition, and in the second stage, we performed elbow valgus deformity correction surgery. In three year follow-up, the range of elbow was 130/5/0 flexion/extension, with full supnation and pronation. Carrying angle was same with the opposite side., Conclusion: Pediatric humeral lateral condyle nonunions cause deformity, pain, loss of motion, instability and neuropathy. Surgical treatment of nonunions with a careful planning provide excellent clinical and functional results., Competing Interests: Conflict of interestNone of the authors received any type of financial support that could be considered potential conflict of interest regarding the manuscript or its submission., (© Indian Orthopaedics Association 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives This study aims to investigate the negative prognostic indicators of pediatric and adult trigger finger surgery patients concerning complications, recurrence, and satisfaction. Methods A retrospective study was conducted on 61 patients with a total of 91 trigger fingers, including 31 in children and 30 in adult patients, all of whom were treated using a standardized surgical technique. The study considered several demographic and clinical factors, including age, gender, dominant hand, body mass index, occupation, history of trauma, single or multiple finger involvement, staging according to Green classification, diabetes mellitus, comorbidities, recurrence, revision surgery, utilization of non-surgical treatment methods, need for rehabilitation after surgery, time to return to work, the time interval from clinic initiation to the surgery, satisfaction and the duration of the follow-up period. In addition, the quick version of the disabilities of the arm, shoulder, and hand (QDASH); and the visual analog scale (VAS) were used to assess patients' data. Results In adult patients, a statistically significant relationship was observed between the increasing grade of the Green stage and complication rate (p<0.001), recurrence (p<0.001), and lower satisfaction (p<0.001). No statistically significant relationship was identified between Green's classification and complications (p=0.129), recurrence (p=0.854), or satisfaction (p=0.143) in pediatric patients. While a statistically significant relationship existed between the time interval from clinic initiation to surgery and complications (p=0.033) in adult patients, no significant relationships were observed for recurrence or satisfaction. Conversely, there was no statistically significant relationship between the time interval from clinic initiation to surgery and complications, recurrence, or satisfaction in pediatric patients. Conclusion This study demonstrates that increasing the grade of the Green stage and duration of symptoms before surgery were the substantial factors contributing to prognosis in adult patients but not in pediatric patients. These findings can assist physicians during patients' treatment management. We suggest that physicians consider these factors for patients' satisfaction., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Köroğlu et al.)

Objective: This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center., Methods: Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded., Results: The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department., Conclusion: This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned.

Competing Interests: Declaration of competing interest The authors declare no conflict of interest.

Ischemia of an appendage caused by dressing, tourniquet or hair is a rare, but devastating clinical entity. A six-year-old girl presented to the emergency department with necrosis of her right thumb caused by compressive dressing for four days. The patient was treated with an immediate surgical decompression and the thumb was saved. The patient had a full range of the thumb at 10 months of follow-up. In conclusion, instead of waiting for full demarcation, timely surgical interventions may protect the fingers from being amputated.

Objectives: This study aims to investigate the prevalence and location of the metacarpophalangeal (MCP) sesamoid bones using computed tomography (CT) images., Patients and Methods: A total of 767 hands of 735 patients (503 males, 232 females; mean age: 36.9±17.0 years; range, 18 to 105 years) obtained from picture archiving and communication system were retrospectively analyzed between January 2016 and December 2019. The sesamoid bones of MCP joints I, II, III, IV, and V were recorded. Data including age, sex, side, number, pathologies, and location of the sesamoid bones were recorded., Results: The prevalence of sesamoid bones was found to be 100%, 37.61%, 1.17%, 0.5%, and 80% in MCP I, II, III, IV, and V, respectively. There was no significant correlation between the sex of the patient and presence of sesamoid bone at MCP II or MCP V (p>0.970 and p=0.176, respectively). The presence of sesamoid bone at MCP II was statistically significantly correlated with the presence of sesamoid bone at MCP V (p<0.001). There was no statistically significant difference in the side and sesamoid prevalence in the remaining 703 patients (p>0.05)., Conclusion: The prevalence of MCP V sesamoid bone is higher than previous studies from our country. The CT of hand can be used to determine sesamoid fractures and degenerative conditions of sesamoids.

Objectives: This study aims to present the early-period outcomes of patients with Dupuytren's contracture (DC) treated with percutaneous needle aponeurotomy technique., Patients and Methods: This retrospective study included 28 patients (20 males, 8 females; mean age 63 years; range, 44 to 88 years) (75 fingers) treated with percutaneous aponeurotomy due to DC between November 2011 and December 2015. Patients were evaluated according to their demographic characteristics, presence of additional disease, family history, history of drug use, complication rate, recurrence development, postoperative patient satisfaction, reoperational request, postoperative Disability of Arm Shoulder and Hand Questionnaire and visual analog scale scores., Results: Mean follow-up duration was 29 months (range, 12 to 60 months). In the postoperative satisfaction questionnaire, 92.9% (n=26) of patients stated that they were satisfied. In the questionnaire of reoperation request, 82.1% (n=23) of patients accepted the reoperation. While the complication rate was 39.3%, recurrence rate was 35.7%., Conclusion: Percutaneous needle aponeurotomy technique may be an effective, simple, and safe method for the treatment of DC.

Objectives: We aimed to present preliminary result of one portal endoscopic assisted release of first dorsal compartment at wrist in a case series with de Quervain disease as a minimal invasive surgical method., Materials and Methods: The patients, who underwent an endoscopic-assisted release of the first extensor compartment for de Quervain's disease by same hand surgeon between 2015 and 2017, were retrospectively analyzed. Operative treatment was considered if the patients did not respond to non-operative treatment including oral anti-inflammatory medications, splinting, and steroid injection. Surgical release was recommended after minimum four months of unsuccesful non-operative treatment, including a steroid injection. 10 wrists were treated with one portal endoscopic assisted release. All patients were evaluated at an average of 16.1 months follow-up using visual analog scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score., Results: The mean operating time was 13.9 min (range, 10-21min). The mean VAS and DASH scores were improved from 8.2 to 1.9 and 70.51 to 2.81 respectively. No significant difference was found between operated and non-operated arms in postoperative pinch and strengths. Transient superficial radial nerve paresthesia (two wrists) and significant scar tenderness (one) were identified in three cases. There was no patient that complain of unsightly scar and tendon subluxation., Conclusions: One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments., Level of Evidence: Level IV Therapeutic Study., (Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Introduction Loss of function and pain are the main complaints at the time of hospital admission for patients with a stiff elbow. In this study, we present mid-term radiological and functional results for the use of the arthroscopic release technique in patients admitted to the outpatient clinic with a stiff elbow. Methods A total of 22 patients (six females, 16 males; mean age: 36 years, range: 18 to 56 years) who underwent an arthroscopic intervention for traumatic or non-traumatic stiff elbow and arthrosis between January 2005 and November 2015 were included in the study. All patients started elbow movement after the first day following surgery. Pre- and postoperative radiological evaluations of patients were carried out, in addition to functional evaluation to measure the range of motion of the elbow joint and the Disabilities of the Arm, Shoulder and Hand (DASH) scores before and after surgery. Results The mean follow-up was 28.4 (range: 21 to 118) months. The mean preoperative flexion-extension arc of the patients was 89° (range: 0° to 115°), and the mean flexion-extension arc increased to 103.5° (range: 52° to 128°) at the final follow-up visit (p < 0.05). The mean preoperative DASH score was 42.17 (range: 33 to 81), decreasing to 30.35 (range: 9.7 to 41.3) postoperatively (p<0.05). In the final visit, none of the patients were found to require additional surgical interventions for the elbow. Conclusions Arthroscopic release can be considered a safe and effective option to obtain range of motion in joints in post-traumatic stiff elbow cases., Competing Interests: The authors have declared that no competing interests exist.

Purpose: The aim of this study was to evaluate short-term clinical and radiological results of extensor carpi radialis longus (ECRL) tendon ball arthroplasty for treatment of late-stage Kienböck's disease., Methods: We retrospectively reviewed data of 19 patients suffering from Kienböck's treated with ECRL tendon ball arthroplasty between December 2014 and December 2016. Patients' clinical functions were assessed using grip strength, range of motion (ROM) of the wrist, QuickDASH, Mayo wrist score, and visual analog scale score. Radiological examination was performed to assess carpal height ratio and progression of arthritis., Results: The median follow-up was 30 months (range, 12-36 months). At final follow-up, ROM of operated wrist was 71% of the nonoperated side. Thirteen (86.6%) patients were pain free. Carpal height ratio was statistically significantly reduced compared with preoperative values. All patients declared their satisfaction with the results due to their preoperative status., Conclusions: ECRL tendon ball arthroplasty is a new and good option for treatment of late-stage Kienböck's disease with low complication rate.

In this article, we report a case with spontaneous rupture of extensor pollicis longus tendon due to calcified extensor carpi radialis tendon group, which has not been published in the literature previously. Successful thumb extension was achieved in a 68-year-old male patient with the transfer of the extensor indicis proprius tendon at two months postoperatively. It appears that calcified extensor carpi radialis tendon group constitutes high risk for a possible attritional rupture of the extensor pollicis longus tendon.

Purpose: To compare the effectiveness of intraarticular (IA) multiple and single platelet-rich plasma (PRP) injections as well as hyaluronic acid (HA) injections in different stages of osteoarthritis (OA) of the knee., Methods: A total of 162 patients with different stages of knee OA were randomly divided into four groups receiving 3 IA doses of PRP, one dose of PRP, one dose of HA or a saline injection (control). Then, each group was subdivided into two groups: early OA (Kellgren-Lawrence grade 0 with cartilage degeneration or grade I-III) and advanced OA (Kellgren-Lawrence grade IV). The patients were evaluated before the injection and at the 6-month follow-ups using the EuroQol visual analogue scale (EQ-VAS) and International Knee Documentation Committee (IKDC) subjective scores. Adverse events and patient satisfaction were recorded., Results: There was a statistically significant improvement in the IKDC and EQ-VAS scores in all the treatment groups compared with the control group. The knee scores of patients treated with three PRP injections were significantly better than those patients of the other groups. There was no significant difference in the scores of patients injected with one dose of PRP or HA. In the early OA subgroups, significantly better clinical results were achieved in the patients treated with three PRP injections, but there was no significant difference in the clinical results of patients with advanced OA among the treatment groups., Conclusion: The clinical results of this study suggest IA PRP and HA treatment for all stages of knee OA. For patients with early OA, multiple (3) PRP injections are useful in achieving better clinical results. For patients with advanced OA, multiple injections do not significantly improve the results of patients in any group., Level of Evidence: I.

Musculoskeletal system is involved in about 20% of the patients diagnosed with tuberculosis. Although musculoskeletal tuberculosis generally affects spine and large joints (hip and knee), hand involvement of the tuberculosis is seen in 10% of the patients with musculoskeletal involvement and also isolated tuberculosis of hand or wrist is much rarer. In the following report, we discuss the case of a 23-year-old male patient who was diagnosed with isolated tuberculosis of the capitate and triquetrum bone. The patient presented with a nonhealing sinus on the left wrist joint. Imaging revealed lytic lesions of the capitate and triquetrum. The diagnosis of tuberculosis was confirmed by histopathological examination on the bone specimen obtained from the debridement and curettage. Antituberculosis therapy was started postoperatively and 1 month later, healing of the sinus was observed. There was no sign of reactivation seen at follow-up 22 months after treatment.

Objectives: This study aims to present our clinical results obtained in arthroscopic limited intercarpal fusion performed without using bone graft in patients with Kienböck's disease., Patients and Methods: The study included 11 patients with Kienböck's disease (6 males, 5 females; mean age 28.9 years; range 14 to 51 years) who were performed arthroscopic lunate excision and scaphocapitate fusion between November 2012 and December 2013. Bain and Begg Arthroscopic Classification was used for the staging of Kienböck's disease. Quick Disabilities of Arm, Shoulder and Hand and Mayo Wrist scorings were used for clinical evaluation., Results: Intercarpal fusion was achieved in approximately 7.2 weeks. There was a statistically significant difference in Mayo Wrist scores of postoperative third and sixth months and pre- and postoperative Quick Disabilities of Arm, Shoulder and Hand scores. There was no postoperative complication., Conclusion: According to our study findings, arthroscopic limited intercarpal fusion without using bone graft may be performed in patients with Kienböck's disease. Satisfactory clinical and functional results were obtained as a result of treatment with this method in stage 3 and 4 Kienböck's disease.

Introduction: Injuries of the posterolateral corner (PLC) of the knee are rare. They are difficult to diagnose and can cause severe disability. This study presents the 20- to 70-month clinical and radiological outcomes of the anatomical reconstruction technique of LaPrade et al., Materials and Methods: Twenty-one patients with chronic PLC injuries underwent anatomical PLC reconstruction. The anatomical locations of the popliteus tendon, fibular collateral ligament, and popliteofibular ligament were reconstructed using a 2-graft technique. The patients were evaluated subjectively with the Tegner, Lysholm, and International Knee Documentation Committee (IKDC) subjective knee scores and objectively with the IKDC objective scores; additionally, varus stress radiographs were taken to evaluate knee stability., Results: Significant (p < 0.05) improvements were observed in the postoperative Lysholm, IKDC-s, and Tegner scores compared with preoperatively. The IKDC objective subscores (lateral joint opening at 20° of knee extension, external rotation at 30° and 90°, and the reverse pivot-shift test) had improved significantly at the time of the final 40.9 ± 13.7-month follow-up. Lateral compartment opening on the varus stress radiographs had decreased significantly in the postoperative period. However, there was still a significant difference compared with the uninjured knee. There was no significant improvement in the IKDC-s, Lysholm, or Tegner scores between the nine patients with isolated PLC injuries and twelve with multi-ligament injuries., Conclusions: Significant improvement in the objective knee stability scores and clinical outcomes with anatomical reconstruction showed that this technique can be used to treat patients with chronic PLC injured knees. However, longer-term multicentre studies and studies with larger groups comparing multiple techniques are required to determine the best treatment method for PLC injuries.

Background: Hyaluronic acid and glycosaminoglycans have shown positive effects in improving lateral epicondylitis and other tendinosis conditions. Therefore, we designed a prospective, randomized study to compare the effects of a combined sodium hyaluronate and chondroitin sulfate (HA + CS) injection versus a triamcinolone injection in the treatment of lateral epicondylitis., Methods: In total, 57 consecutive patients with clinically diagnosed lateral epicondylitis were divided randomly into two groups. In the HA + CS group, 25 patients received a single injection of a solution containing an HA + CS combination and prilocaine HCl, while the 32 patients in the triamcinolone group received a single injection of a solution of triamcinolone and prilocaine HCl. We evaluated the pain and function outcome measures using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at the beginning of the study, and 3 and 6 months after the injection. Additionally, the Minimum Clinically Important Difference values and percentage changes in the PRTEE subscale scores between the assessments were calculated., Results: No serious adverse events were reported throughout the study. The mean pain and function scores for the HA + CS and triamcinolone groups had significantly improved at 3 months, but the mean function scores in the HA + CS group were statistically significantly better when compared to the triamcinolone group. At 6 months, both groups had significantly improved mean pain and function scores, compared to the baseline scores; however, the mean pain and function scores in the 6-month HA + CS treatment group were better than in the 6-month triamcinolone group. The relative change for the mean total score in the HA + CS group was much better when compared with the triamcinolone group, and the HA + CS treatment group showed clinically significant improvement when compared with triamcinolone group at 3 and 6 months., Conclusions: This study supports the idea that for a single injection treatment of patients with lateral epicondylitis, a combination injection of HA + CS may offer better pain benefits for 6 months after injection, when compared to triamcinolone., Type of Study/level of Evidence: Level II, Randomized Clinical Trial, Prospective Comparative Study.

Objective: The aim of this study is to evaluate the functional results of arthroscopic lateral epicondylitis (LE) treatment in patients in whom conservative treatment proved insufficient., Methods: Between 2011-2014, 29 patients with LE (15 women, 14 men; mean age: 46 years; range: 33-79) who received at least 6 months of conservative treatment methods and did not achieve full recovery and thus underwent arthroscopic surgery were included in this study., Results: One patient was excluded from the functional assessment. Mean follow-up was 20.5 months (range: 7-42). Mean preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores were 81.1±17.5 and 34.7±26.8 (p<0.0001), respectively, and Mayo Elbow Performance Scores (MEPS) were 48.5±11.5 and 101.2±22.9 (p<0.0001), respectively. Twenty-one patients (75%) were satisfied with the functional outcome., Conclusion: As a result, LE treated with the arthroscopic method, with its low complication rate, successful degenerated tendon debridement, and decortication of the lateral epicondyle, is a useful method for intervention in pathologies such as annular plica, loose body, synovial hypertrophy, and radiocapitellar chondropathy.

Thrombotic thrombocytopenic purpura is an acute syndrome with abnormalities in multiple organ systems, which becomes manifest with microangiopathic hemolytic anemia and thrombocytopenia. The hereditary or acquired deficiency of ADAMTS-13 activity leads to an excess of high molecular weight von Willebrand factor multimers in plasma, leading to platelet aggregation and diffuse intravascular thrombus formation, resulting in thrombotic thrombocytopenic purpura. Thrombotic lesions occurring in TTP leads to ischemia and convulsion. Depending on the properties of the bony tissue, fractures are divided into three groups as traumatic, pathological, and stress fractures. A pathologic fracture is a broken bone caused by disease leading to weakness of the bone. This process is most commonly due to osteoporosis, but may also be due to other pathologies such as cancer, infections, inherited bone disorders, or a bone cyst. We herein report a case with a pathologic fracture due to convulsion secondary to thrombotic thrombocytopenic pupura. Thrombotic lesions occurring in TTP may lead to ischemia and convulsion, as in our patient and pathological fractures presented in our case report may occur as a result of severe muscle contractions associated with convulsive activity. Thrombotic thrombocytopenic pupura is a disease that involves many organ systems and thus may have a very wide spectrum of clinical presentations., (Copyright © 2014. Published by Elsevier Ltd.)

Objectives: This study aims to evaluate clinical and radiological findings of a series of patients with avascular necrosis of the femur head (ANFH) treated by core decompression and vascular pedicled iliac crest grafting., Patients and Methods: This retrospective study included 26 hips of 22 patients (14 males, 8 females; mean age 36 years; range 16 to 48 years) with ANFH using the vascularized iliac bone grafting between March 2003 and July 2010 in our clinic. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system., Results: The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement., Conclusion: Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.