Person: GÜRKAN, VOLKAN
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The Use of Intramedullar Vascularized Fibular Flap and Recycling of Resected Bone for Long Bone Reconstruction Following Sarcoma Resection
An Unusual Localization of Intraosseous Schwannoma: The Hamate Bone.
Intraosseous schwannoma of the hamate bone presented in this case is a very rare benign tumor, and its diagnosis combined with clinical, imaging and needle biopsy is important to guide further therapy. The diagnosis of schwannoma of the hamate was proved histologically following its surgical treatment by curettage.
Early Suspicion of Heparin-Induced Thrombocytopenia for Successful Free Flap Salvage: Reports of Two Cases
Heparin-induced thrombocytopenia (HIT) is an underestimated complication of heparin treatment. Flap loss and related morbidity (even mortality) are caused by occlusion of the capillary vessels by a highly immunogenic complex formed by adherence of antiheparin antibodies to platelet factor 4. Early suspicion and effective treatment of HIT developing in two free flaps are described. We report on the management of two patients with HIT. Both patients were treated successfully by early suspicion and hematology consultation. Heparin products were discontinued; the patients were switched to a nonheparin anticoagulant. We emphasize the importance of early diagnosis, hematologist assessment, and a change to a nonheparin anticoagulant to prevent flap failure and possibly the catastrophic consequences of such failure.
The influence of fraction internal rotation radiograph on the classification and treatment options of intertrochanteric femoral fractures
Aim. In this prospective randomized study with intraobserver and interobserver assessment, we aimed to compare the classifications and operative decisions of intertrochanteric fractures realized by orthopedic surgeons with standard radiographs and traction internal rotation radiographs by intraobserver and interobserver assessment.
Evaluation of patients with pathological fractures treated by standard trauma principles but neglecting the underlying malign bone disease
Introduction: There are several studies in the literature about pathological fractures but almost no in-formation about patients whose pathological fracture caused by a malignant lesion misdiagnosed and treated as a simple fracture. The aim of this study was to investigate patient and fracture characteristics, and outcomes in cases where fractures occurred in the presence of a malign pathology but were treated as simple fractures. Patients andMethods: Cases of malign bone lesions between 20 0 0 and 2020 were retrospectively re-viewed. Patients with a final diagnosis of malign bone lesion but whose pathological fractures were treated ignoring the underlying malign bone disease were included. Demographic, clinical and outcome data were collected from patient\"s medical records and analyzed.Results: Six patients met the inclusion criteria. Three of the patients were female and the cohort mean age was 56.8 +/- 21.8 years at the time of admission. Patient diagnoses were: renal cell carcinoma metas-tasis ( n = 1); colon cancer metastasis ( n = 1); chondrosarcoma ( n = 2); osteosarcoma ( n = 1); and undif-ferentiated pleomorphic sarcoma of bone ( n = 1). In all cases surgical management differed from those that should have been applied if the pathological fracture had been identified. Furthermore, surgical man-agement after definitive histological diagnosis were more aggressive compared to if the malignancy had been identified at first admission. All patients died after a mean follow-up of 16.67 +/- 11.7 months and the complication rate was 100%.Conclusion: When a pathological fracture is misdiagnosed and managed as a simple bone fracture, out-comes are extremely poor. In these situations, remedial surgery is more extensive, with increased com-plication rates and there is poor life expectancy.(c) 2022 Elsevier Ltd. All rights reserved.
Mid-term implant survival, functional and radiological results and mechanical complications of mega-prosthetic reconstruction around the knee with the PENTA® system
© 2021, The Author(s).Aim: Mega-prosthetic reconstruction is the most common treatment method for massive osteoarticular defects caused by tumor resection around the knee. The new implant is a highly modular rotational-hinged megaprosthesis system with a distinct pentagonal stem geometry and variable implantation options. The aim of this study is to present the mid-term implant survival characteristics, functional and radiological results and mechanical complication profile of the new megaprosthesis. Methods: One hundred and one mega-prosthetic knee reconstruction procedures in 90 patients (M/F: 51/39) utilizing the new implant system were retrospectively analyzed. In 68 patients, the megaprosthesis was used for primary reconstruction following tumor resection while it was used for revision of other implants in 22. The mean age was 28.5 (7–66) years and the mean follow-up was 59.2 (24–124) months. The most common primary pathology was osteosarcoma with 63–70% patients, the most common anatomical site of involvement was the distal femur with 56–62% patients. Results: Henderson Type 2 failure (aseptic loosening) was seen in only 2–2.2% patients while Type 3 (structural failure) was seen in 29–32.2% Although the 5-year anchorage survival rate was 94.3%, overall mechanical implant survival was 76.1% at 5 years due to a relatively high failure rate in the first-generation hinge mechanism of the implant. The 5-year hinge survival rate demonstrated a significant improvement rate from 61.7% to 87.2% between the first and second generations of the implant (p = 0.027). The mean MSTS score was 24 out of 30 (14–29). The mean cumulative ISOLS radiographic score for index megaprosthesis operations was 19.7 (12–24), which corresponded to excellent outcome. Conclusion: The new megaprosthesis system is a reliable choice for the reconstruction of tumor-related massive osteoarticular defects around the knee. Although long-term follow-up is necessary for a definitive evaluation of the implant\"s survival characteristics, midterm follow-up yields exceptional anchorage properties related to pentagonal stem geometry with very good functional outcomes.
Results of the Local Steroid Injections in the Simple Bone Cyst
Objective: Steroid injections represent one of the simple treatment alternatives for simple bone cysts (SBC). The aim of this study was to evaluate the results of local steroid injections in the treatment of SBC. Methods: Seventeen patients (11 males, 6 females; mean age 12.4 years; range=2 to 39 years) with SBC were treated with injection of methylprednisolone acetate (MPA) with the use of the two-needle technique. The cysts were localized in the proximal humerus (n=6), the calcaneus (one patient had bilateral lesions) (n=2), proximal femur (n=7) and the tibia (n=2). Pathological fractures occurred in three patients before steroid injection. These three patients with pathological fractures were treated with injection of MPA after fractures healed. Each patient received a maximum of four injections at eight week intervals, each consisting of 40-160 mg of MPA. The patients were followed up with plain radiographs obtained in the first month, third month, sixth month, and at the end of a year. After the first year, patients were followed up with plain radiographs once a year. The mean follow-up duration was twenty two months (range=3 to 48 months). Cyst healing was assessed according to the modified Neer classification. Results: Treatment with MPA resulted in complete recovery in ten cysts (55%) and recovery with residual lesions in three cysts (17%). Three cysts (17%) did not respond to steroid treatment and two patients (11%) developed recurrence. The results were satisfactory (72%) in patients with complete recovery and partial recovery with residual lesions, and unsatisfactory in five patients (28%). The patients with recurrence were treated with curettage and grafting or cementation. No procedure-related complications were encountered. Conclusion: Our findings suggest that, the treatment with local steroid injection in SBC provides satisfactory results, thus this treatment with low morbidity can be applied to these patients before aggressive treatment.
Osteoid osteoma of the cuboid bone: a rare cause of foot pain.
Osteoid osteoma, a common bone lesion of benign nature, is more rarely seen in feet. It most commonly involves the talus yet rarely the cuboid. The atypical symptoms of foot involvement may delay the diagnosis. Differential diagnosis most commonly includes ankle sprain, monoarticular arthritis, anterior impingement syndrome, tarsal spur, osteomyelitis, stress fracture, eosinophilic granuloma. The delay in diagnosis and treatment of osteoid osteoma in the foot may be a cause of chronic foot pain. In this study, we present a 17-year-old boy with osteoid osteoma in his right cuboid bone. The patient was undiagnosed during the first year of his symptoms. After surgical removal of the tumor, his complaints were resolved. The pathological examination confirmed the diagnosis of osteoid osteoma. Osteoid osteoma is an unusual bone tumor of the foot. It should be included in the differential diagnosis of patients exhibiting foot pain. In speculative cases with no obvious radiographic findings, further imaging studies, such as CT, should be considered.
Use of cement combined grafting in upper and lower extremity benign bone tumors
Objectives: This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. Patients and methods: Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. Results: Median tumor volume was 17.2 cm 3 (range, 2.8 to 139.6 cm 3 ), median area of the cortical window was 8.3 cm 2 (range, 1.6 to 28.4 cm 2 ), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r= -0.356) and mid -level negative correlation between cortical window size and functional scores (p=0.001, r= -0.577). Conclusion: Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.
Metatarsal head resurfacing hemiarthroplasty in the treatment of advanced stage hallux rigidus: outcomes in the short-term
Objective: The aim of this study was to evaluate the short-term outcomes of metatarsal head metal resurfacing hemiarthroplasty in patients with advanced stage hallux rigidus. Methods: The study included 14 feet (4 left, 10 right) of 12 patients (10 female, 2 male; mean age: 63 ± 5; range: 55 to 71 years) who underwent metatarsal head metal resurfacing hemiarthroplasty (HemiCAP(®)) between 2007 and 2010. Additionally, capsular release and periarticular osteophyte debridement were performed. Staging was made according to Coughlin and Shurnas' clinical and radiological grading system. Hallux valgus and intermetatarsal angles were measured using pre and postoperative standing AP and lateral foot views. Clinical assessment was made with first metatarsophalangeal joint range of motion, the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale and satisfaction level. Results: Mean follow up was 19.5 (range: 14 to 26) months. Two patients had bilateral involvement. According to Coughlin and Shurnas' clinical and radiological grading system, nine feet were Stage 3 and five feet were Stage 4. According to the AOFAS scale, results of eight feet (57.1%) were excellent, four feet (28.6%) were good and two feet (14.3%) were moderate. Mean total AOFAS score increased by 26.2 points postoperatively (p<0.05). Mean range of motion of the first metatarsophalangeal joint improved significantly from a preoperative 22.2 ± 5.6 (range: 10 to 28) degrees to a postoperative 56.3 ± 9.6 degrees (p<0.05). Mean hallux valgus angle decreased from a preoperative 14.3 (range: 9 to 17) degrees to a postoperative 11.1 (range: 4 to 13) degrees and the mean intermetatarsal angle increased from a preoperative 10.5 (range: 8 to 14) degrees to a postoperative 10.8 (range: 8 to 15) degrees. Patient satisfaction levels were very good in 10 feet (71.4%), good in 3 (21.4%), and moderate in one (7.2%). Complications included metatarsalgia aggravated by long walks in one patient and hypoesthesia of the great toe in three patients. Push-off power of the great toes was measured as 4/5 in three cases, and 5/5 in others. Conclusion: Metatarsal head metal resurfacing hemiarthroplasty provides high patient satisfaction level and good functional outcome in the short-term, in the surgical treatment of advanced stage hallux rigidus refractory to conservative treatment options.