Background: The literature comparing open and arthroscopic repair of subscapularis tendon (ST) tears is insufficient. Purpose: To compare the clinical results of open versus arthroscopic repair of ST tears with or without concomitant supraspinatus tears. Study Design: Retrospective cohort study. Methods: We retrospectively evaluated 70 patients treated for isolated ST tears and ST tears with concomitant supraspinatus tendon tears at a single center between 2011 and 2019. Patients were divided into 2 groups: those who underwent open ST repairs (group O) and those with an arthroscopic ST repair (group A). Range of motion (ROM), liftoff and belly-press tests, and Constant-Murley (CM) scores were included in the pre- and postoperative functional evaluations. The minimal clinically important difference was calculated using the anchor-based method for changes in CM score. Tear size was evaluated according to the Lafosse classification. The categorical data were assessed using the Pearson chi-square, Fisher exact, and Fisher-Freeman-Halton tests. The parametric and nonparametric data were evaluated using the Student t test and Mann-Whitney U test, respectively. The dependent groups (for nonnormally distributed data) were evaluated using the Wilcoxon signed rank test. Results: Group O included 34 patients, and group A included 36 patients. The mean age was 62.9 years, and the mean follow-up period was 66.7 months. Even though group O exhibited a significantly better preoperative CM score (53.7 ± 4.6 vs 48.9 ± 6.8 [mean ± SD]; P = .001), group A had a significantly better postoperative CM score (88.7 ± 4.7 vs 84.6 ± 2.9; P < .001). Our measurements revealed a minimal clinically important difference of 11.5 points for the CM score. Group A had significantly greater postoperative ROM in abduction (153° vs 143.9°; P = .005) and forward elevation (159.1° vs 149.7°; P = .005), as well as significantly greater postoperative improvement in positive belly-press test results ( P = .028). Complications occurred in 4 patients in group O and in 1 patient in group A. Conclusion: The study findings indicated that arthroscopic ST repair was more advantageous than open repair in terms of ROM and functional outcomes.

Background: This study evaluated the results of intramedullary osteosynthesis with titanium elastic nail (TEN) in the surgical treatment of Monteggia lesions in children aged 12 and under. Methods: Patients who underwent surgery with the TEN method between 2013 and 2019 were screened retrospectively. The inclusion criteria were patients who failed conservative treatment, a history of acute trauma (< 14 d after injury), age 12 years and under, patients who underwent intramedullary osteosynthesis with TEN when surgical treatment is required, a follow-up period of over 12 months, absence of congenital upper extremity and bone anomalies, and no history of trauma to the ipsilateral elbow. For functional classification, the Grace and Eversmann Criteria were used to evaluate union, pronation, and supination, while the Mayo Elbow Performance Score was used to assess overall elbow function and limitations. Results: Thirty-eight patients (26 male/12 female) were included in the study. The median age was 8.0 (6 to 10) years old and follow-up period was 26.0 (16 to 39) months. The mean value of the Mayo Elbow Performance Score was 97.1, 32 cases were excellent and 6 cases had good results. While the average age was 9.4 years in patients with mobility limitations, it was 7.1 years in patients without mobility limitations. Statistically, less movement restriction was observed in patients of younger age. Conclusion: Length unstable ulnar fracture pattern for Monteggia lesions and those with secondary loss of reduction, intramedullary stabilization of the ulna fracture with TEN helps to achieve good functional and radiologic outcomes.

BACKGROUND: We aimed to show the effect of rotational deformity on the development of cubitus varus deformity (CVD) complication after supracondylar humerus fracture surgery. METHODS: Patients with Gartland type II, and more severe fractures treated with Closed reduction and percutaneous pinning alone were included in the study. Rotational deformity was assessed with the formula described by Henderson et al. Patients with rotational deformity >10° were included in Group 1, and patients with deformity <10° in Group 2. In terms of CVD development, patients were evaluated with the Baumann angle measurements made on the carrying angle and final follow-up radiographs. Patients who developed CVD were divided into two groups: Group A included patients who developed CVD and Group B included patients who did not develop CVD. The cosmetic and functional results were evaluated using Flynn criteria. RESULTS: Eighty-eight patients who met the inclusion criteria were enrolled in the study, 32 were female and 56 were male. The mean age at the time of surgery was 6.0±2.8 years and the mean follow-up time was 5.1±2.5 years. Based on measurements, Group 1 had 13 patients and Group 2 had 75 patients. Only four of the 88 had developed CVD. Three of these patients had a rotational deformity of ≥20°. The mean age of patients in group A was 2.1 years and the mean carrying angle was 5.7°±1.5° varus (P<0.001). According to the Flynn cosmetic criteria, Group A and Group 1 had significantly worse outcomes (P<0.001). CONCLUSION: In conclusion, fixation of the distal fragment in rotation may be associated with CVD and intraoperative assessment is of great value to avoid long-term deformity and cosmetic degradation.

No abstract

ÖZETDenosumab kemik dev hücreli tümörünü yönetmek için etkili ve kullanışlı bir ilaçtır. İnoperable veya metastatik dev hücreli tümörlü hastalar için birinci basamak tedavide altın standart olarak düşünülmektedir. Dev hücreli kemik tümöründe denosumabınetkinliği prospektifrandomize çalışmalarda kanıtlanmıştır. Nörovasküler yapılara yakın büyük dev hücreli tümörde daha fazla morbiditeye yol açaçak rezeksiyona yönelmek yerine denosumab ile neoadjuvan tedavi dev hücreli tümörde intralezyonel cerrahiyi kolaylaştırabilir. Farklı sebeplerden dolayı tedaviyi bıraktıktan sonra yapılan biyopside psödosarkomatöz değişiklikler görülebileceği unutulmamalıdır. Dev hücreli tümörde denosumab tedavisi sonrası kalınlaşmış korteks ve subkondral kemik içerisinde tümör hücrelerinin gizlenmesi sonucu lokal tümör rekürrensi görülebilir. Denosumab çenede osteonekroz oluşumu ile ilişkilendirilmiştir. Bu makalede denosumab tedavisi alan hastaların sistematik değerlendirilmesi,risk faktörleri, tanı-tedavi yararlığı, tedavi seçeneklerini öngören kılavuzlar sunulmuştur. Anahtar Kelimeler: denosumab, dev hücreli tümörü, cerrahi ABSTRACT Denosumab is an effective and usefull drug for managing the giant cell bonetumor. It is considered the gold standard for treatment of the inoperable or metastatic giant cell tumors. Theefficacy of denosumab in giant cell bone tumors has been demonstrated in prospective randomized trials. Neoadjuvant therapy with denosumab may facilitate intralesional surgery in giant cell tumor instead of resection leading to more morbidity in a large giant cell tumor close to the neurovascular structure. It should not be forgotten that pseudosarcomatous changes in biopsies may ocur after denosumab treatment due to different reasons. Giant cell tumor may result in dense cortex after denosumab treatment and local tumor recurrence after concealment of tumor cells within the subchondral bone. Denosumab is associated with jaw osteonecrosis formation. In this article, guidelines for systematic evaluation, risk factors, diagnostic-therapeutic usefullness and treatment options for patients treated with denosumab are presented. Keywords: denosumab, giant cell bone tumor, surgery GirişDev hücreli kemik tümörü benign fakat lokal olarak agresif davranış gösteren ve genellikle genç erişkinleri etkileyen bir lezyondur (1). Dev hücreli kemik tümöründen etkilenen hastaların % 1-4 ünde çoğu benign olmak üzere akciğer metastazı görülür (2, 3). Dev hücreli kemik tümörleri tüm primer kemik tümörlerinin % 4-5'ini ve tüm benign tümörlerin % 20'sini oluşturur. Kadınlarda 1,5-2 kat daha fazla görülür ve genellikle genç kadınları (20-40 yaş arası) etkiler (1, 4). Dev hücreli kemik tümörünün distal femur, proksimal tibia, distal radius ve proksimal humerus en sık rastlanan tutulum yeridir (5). Aksiyel iskelette en fazla sakrumda görülür (1,4,5). Kemiğin korteksini genellikle inceltir, çoğunlukla ekspanse olur. Yumuşak doku genişlemesi ile veya yumuşak doku genişlemesi olmadan kortekste lizis yapabilir (6). Anterior vertebral kolon tutulumu sıklıkla ...