|
|
|
|
Objective: This study is an evaluation of the overall survival rate and factors affecting survival in patients with osteosarcoma,
chondrosarcoma, or Ewing’s sarcoma. This study aimed to determine the effect of factors related to the preoperative period,
patient, tumor, treatment, and postoperative period on survival.
Methods: A total of 114 patients (64 male and 50 female) with osteosarcoma, chondrosarcoma, or Ewing’s sarcoma treated between
2005 and 2013 were included in this study. All the patients received standard treatment and were followed up regularly. In all, 44
cases of (conventional and telangiectatic) osteosarcoma, 30 cases of Ewing’s sarcoma, and 40 cases of high-grade chondrosarcoma
were identified using the Bone and Soft Tissue Tumor Registry. Gender, age, tumor size and localization, pathological fractures,
histopathological type, grade, surgical treatment, adjuvant treatments, relapse of the disease, and postoperative complication data
were obtained from follow-up forms. The learning curve of institutional expertise was also evaluated. The patient survival rate was
calculated using the Kaplan-Meier method, and log-rank statistical methods were used to compare survival rates.
Results: The mean length of survival of the patients was 72 months. There was a 56% 5-year survival rate, and the event-free
survival rate was 53%. The survival of patients with Ewing’s sarcoma whose prodromal period was less than 12 weeks was
significantly higher than that of the other groups (p=0.031). The survival of patients with tumor size greater than 150 cc,
with local recurrence and distant metastases was low for all groups. Survival rates were significantly lower in osteosarcoma
and Ewing’s sarcoma patients with stage III tumor or metastasis at diagnosis. The survival of patients with osteosarcoma
diagnosed between 2010 and 2013 was significantly higher than that of the earlier group (p=0.02).
Conclusion: Decreasing the prodromal period (early diagnosis) can improve survival by preventing the local and systemic spread
of the tumor. Increase in the surgical experience is likely to have a positive effect on survival rates, especially for patients with
osteosarcoma. The relapse of the disease is a poor prognostic factor for survival despite aggressive surgery and adjuvant therapies.
|
Objective: The aim of this study was to evaluate clinical and functional outcomes in diabetic patients undergoing tibiocalcaneal
arthrodesis using a retrograde nail.
Methods: A total of 12 diabetic patients [8 men and 4 women; mean age at intervention: 56.8 years (range: 27-76 years)]
who underwent tibiocalcaneal arthrodesis by a retrograde nail were enrolled in this study. The indication for surgery was
massive talar osteonecrosis in four patients, Charcot arthropathy in another four patients, and various severe ankle/hindfoot
derangements in four patients. All surgeries were performed by the same surgeon. All patients were evaluated by their
American Orthopedic Foot and Ankle Score (AOFAS) score, and radiographic follow-up was performed.
Results: The mean follow-up time was 59.5 months (range: 27-121 months). Ten patients (83.3%) healed and were able to
walk with full weight bearing without crutches. Among them, nine patients (75%) achieved union with solid bone healing.
The mean overall improvement in the AOFAS score was 72.5% (preoperatively: 40 points vs postoperatively: 69 points;
p<0.001). We observe a complication in 50% of our patients. Minor complications included two cases of dehiscence of the
surgical wound, one case of soft tissue irritation owing to hardware protrusion, and one cause of lymphedema. Two patients
had deep infection and underwent surgical removal of hardware, debridement, and antibiotic treatment: one healed after
the treatment but never recovered full weight bearing and the other one died from other complications. These two deep
infections occurred after 23 months of follow-up.
Conclusion: Tibiocalcaneal arthrodesis using retrograde nails is a salvage technique extremely effective in ankle and hindfoot
disorders in a diabetic patient. This procedure allows good functional outcomes and pain relief. When correctly indicated,
it is a safe procedure with good clinical outcomes and low risk of below-knee amputation.
|
Objective: The aim of this study was to evaluate the results of the innervated digital artery perforator (IDAP) flap and to
analyze the relationship between patient satisfaction and outcome measures.
Methods: A total of 17 fingertips of 15 patients (14 men and one woman; mean age: 47.2 (26-62) years) were included in
this retrospective study. Patients’ injured finger and defect type were recorded. At the last follow-up, the static two-point
discrimination (s2PD) test, Semmes Weinstein monofilament (SWM) test, and range of motion of the affected finger were
analyzed. We interviewed patients to determine hand dominance, cold intolerance, and their satisfaction with the result. We
performed correlation and logistic regression analyses between patient satisfaction and outcome measures.
Results: The mean follow-up period was 13.8 (7-18) months. The mean range of motion was 77.3±3.5 (70-80) degrees for
the distal interphalangeal joints of affected fingers. The mean s2PD was 6.4 (3-10) mm, and the SWM records ranged from
2.83 to 4.93 monofilament markings. Cold intolerance was noted in seven fingers (41%). Patient satisfaction was negatively
correlated with cold intolerance, and cold intolerance decreased as the follow-up period extended.
Conclusion: IDAP flap satisfies both patient and surgeon, with the only significant problem being cold intolerance, regarding
which patients must be informed. Although cold intolerance is hard to treat, fortunately, it generally improves with time.
|
Objective: The aim of this study was to detect the relationship between the development of Schmorl’s nodes (SNs) and bone
mineral density (BMD) in young patients.
Methods: Computerized tomography (CT) images of the thoracolumbar vertebral column were retrospectively examined
by two experienced radiologists for SNs. The diagnostic criterion for SN was defined as a node size larger than one-third but
not more than two-thirds of the relevant vertebral endplate. Considering the eligibility criteria, a total of 74 individuals (60
males and 14 females; mean age: 24.3 years; age range: 18-40 years) with SN at the thoracolumbar vertebrae were included
in the patient group, and a total of 38 age- and gender-matched individuals (30 males and 8 females; mean age: 25 years)
with no evidence of SN were included in the control group. All these individuals were younger than 40 years. In the patient
group, SNs were assessed in terms of the distribution of the thoracolumbar vertebrae, the location of the upper and lower
endplates, and the total number of lesions. In all individuals included in the study, BMD was measured from the axial CT
sections by quantitative CT and then compared between the two groups.
Results: The distribution of age and gender was comparable between the two groups (p=0.438). A total of 208 SNs were
identified in the patient group. Of these, 92 (44%) were located at the thoracic vertebrae and 116 (56%) at the lumbar vertebrae.
The mean BMD was 131.6 g/cm3 in the patient group and 140.7 g/cm3 in the control group (p=0.03). There was no
significant relationship between the total number of SNs per patient and the mean BMD (p=0.156).
Conclusion: Evidence from this study revealed that low BMD may be a predisposing factor for the development of SNs in
patients younger than 40 years.
|
Objective: This study aimed to develop the Turkish version of Identification of Functional Ankle Instability (TV_IdFAI)
scale and evaluate its validity and reliability.
Methods: A total of 100 participants (54 men and 46 women; 50 volleyball players and 50 sedentary individuals) between 18
and 38 years of age were included this study. The construct validity, reference validity, sensitivity, specificity, and test–retest
reliability of TV_IdFAI were evaluated. For the test–retest reliability, the scale was applied to all participants again in 10–14
days. A correlation between the scale scores and test–retest results was examined with intraclass correlation coefficient. To
evaluate the construct validity, a factor analysis method was used. For reference validity, a sports physician evaluated all
participants and the clinical diagnoses were compared with total score of the scale. Sensitivity and specificity were calculated
to evaluate the classification success of the scale with specified cutoff.
Results: TV_IdFAI scale was grouped under two separate factors. It was determined that the variance for factor 1, factor
2 and for scale was 46.68%, 15.70%, and 62.38%, respectively. There was a statistically significant relationship 0.74 (95%
CI 0.64–0.84; p<0.001) between the physician’s diagnosis and TV_IdFAI in terms of reference validity. The sensitivity and
specificity of TV_IdFAI was 0.61 and 0.80, respectively. The reliability of TV_IdFAI was 0.94 (95% CI 0.92–0.96; p<0.001).
Conclusion: This study shows that TV_IdFAI is a simple, easy to apply, reliable, and valid scale to define functional ankle
instability in Turkish population.
|
|
|
Ali İhsan TUĞRUL, Yılmaz GÜNEY, Bahattin Kerem AYDIN, İbrahim AKEL, Fatih DURGUT, Hakan ŞENARAN
Ali İhsan TUĞRUL, Yılmaz GÜNEY, Bahattin Kerem AYDIN, İbrahim AKEL, Fatih DURGUT, Hakan ŞENARAN
Objective: The aim of this study was to determine the center-edge angle (CEA) values according to age, gender and side in healthy children between 5 and 14 years old in Turkey and to find out the angular limit values for mild and severe dysplasia. Methods: The data pool that was gathered to investigate the frequency of hip dislocation in children between 6 months and 14 years old in Turkey was used. The data pool consists of pelvis and lower abdomen radiographs obtained for reasons other than hip dysplasia. Lower abdomen/pelvis radiographies of children between 5 and 14 years old were extracted from the data pool and were evaluated. Distribution of CEA values according to age, gender and side was examined. Measurements were performed by a single investigator on computer by using a standard method. Reliability of the measurements was tested by three different investigators on randomly selected films by using the standard method. Results: CEA values of 3192 hips of 1596 children, who had no hip pathology, were measured. Mean CEA value was found as 26.2°±5.5°. The mean CEA was 26.2°±5.3° in males (%54) and 26.2°±5.7° in females (%46) (p=0.224). Mean values for the right and left hips were 25.7°±5.4° and 26.6°±5.6°, respectively. CEA value of 449 (14%) hips of 333 (20.8%) children was at the limit of mild dysplasia and CEA value of 70 (2.2%) hips of 58 (3.6%) children was at the limit of severe dysplasia. CEA values had increased by age and mild and severe dysplasia limits were determined for every age group. Conclusion: The mild and severe dysplasia values that are defined according to ages in Turkish population will guide the investigators in the diagnosis, follow-up and treatment planning of developmental dysplasia.
|
Objective: The aim of this study was to evaluate the long-term follow-up and functional and radiological outcomes of minimally invasive medial plate osteosynthesis in distal tibia fractures. Methods: From January 2011 to November 2015, we reviewed the medical records of 60 patients with 62 tibia fractures (41 men and 19 women; mean age: 45.3±14.9 years) who were treated with open reduction and internal fixation for distal tibia pilon fractures. The mean follow-up time after surgery was 42.7±4.6 months. Union time, coronal plan deformity, complication rates and AOFAS and Olerud-Molander functional outcome scores were evaluated. Results: According to the AO/OTA classification, there were thirty four (54.8%) type 43-A fracture, eight (12.9%) type 43-B fractures, twenty (32.3%) type 43-C fractures. The average time for fracture union was 16.1 weeks. The mean AOFAS score was 86.6±9.1. The mean Olerud-Molander score was 85.6±9.8. There were four patients (6.5%) with a varus of less than 5°, two patients (3.2%) with a valgus of less than 5°, 39 patients (62.9%) with recurvatum (34 of them less than 5°; five of them less than 10°), and 14 patients (22.6%) with procurvatum (12 of them less than 5°; two of them less than 10°). The AOFAS and Olerud-Molander scores in the smoker and diabetic patients were significantly lower than the non-smoker (p=0.002; p=0.005) and non-diabetic patients (p=0.022, p=0.002). The duration of union was significantly higher in both diabetic (p=0.025) and smoker patients (p=0.041). There was no association between the fracture type and the presence of varus, valgus, recurvatum and rotation deformity. The AOFAS score, Olerud-Molander score and plantar-flexion were significantly higher in type A fractures than in type C fractures (p=0.021; p=0.030, and p=0.033, respectively). AOFAS score, Olerud-Molander score, plantar-flexion value did not differ between type B and type C fractures. There was no significant difference among the dorsi-flexion (p=0.211), the follow-up time (p=0.531) and duration of union (p=0.908) of type A, type B and type C fractures. Three patients with open fracture had delayed wound healing. One patient developed skin necrosis. They were treated by local wound care. Conclusion: Minimally invasive medial plate osteosynthesis is a reliable method of treatment for tibial pilon fractures. This technique provides a high fracture healing rate and satisfying functional outcome with minimal wound healing complications. Sagittal plan deformity remains a common complication with minimally invasive medial plate osteosynthesis.
|
