No abstract

INTRODUCTIONNonpigmented villonodular synovitis (non-PVNS) is a benign proliferative disease involving the synovium. It is a rare condition that is little recognized. Non-PVNS has been reported as a cause of total knee replacement failure.PRESENTATION OF CASEWe report a case of extensive diffuse non-PVNS in a patient with tibial component loosening after total knee replacement and review the related literature.DISCUSSIONIt is reported that pigmented villonodular synovitis (PVNS) occurs less frequently than non-PVNS after knee replacement. However, there are many more case reports of PVNS than non-PVNS after knee arthroplasty in the English-language literature.CONCLUSIONPreviously, there were no reported cases of extensive diffuse non-PVNS after total knee arthroplasty (TKA). This case study highlights an unusual case of non-PVNS as a cause of TKA failure. We propose that non-PVNS should be considered as a differential diagnosis in patients after TKA who present with recurrent pain and effusion/hemarthrosis of the knee, and that it is one of the causes of implant loosening after TKA.

Background: There are many techniques that are used for limb lengthening. Lengthening a limb over a plate is an alternative choice used in children or when using an intramedullary nail is difficult. Objectives: In this study, we presented a new technique for tibial lengthening using a monolateral external fixator over a lengthening plate. Materials and Methods: For tibial lengthening, a monolateral external fixator was attached to the composite bone model medially. After a corticotomy was performed, the lengthening plate was placed laterally. Three locking screws were inserted proximally, and two cortical screws were inserted into a lengthening hole that was 1 cm below the osteotomy site. We avoided contact between the screws of the lengthening plate and the pins of the external fixator. During bone lengthening with the monolateral external fixator, the screws at the lengthening hole were able to slide distally with the distal segment of the tibia to allow for tibial elongation. Two locking screws were fixed at the distal locking holes of the plate when the bone elongation was complete. The external fixator was then removed. Results: The fixator-assisted lengthening plate allowed bone lengthening without malalignment. There were no mechanical problems associated with the external fixator during the lengthening process. Plate osteosynthesis was stable after the fixator was removed. There was no contact between the screws of plate and the Schanz pins of the external fixator under C-arm fluoroscopy. Conclusions:The fixator-assisted lengthening plate technique helps to maintain the stability and alignment at both sides of an osteotomy during tibial elongation. It allows the early removal of the external fixator immediately after lengthening is completed. This technique can be applied in children with open physes and in patients with a narrow medullary canal who are unsuitable for limb lengthening over an intramedullary nail.

There are many techniques for limb lengthening. Lengthening over a plate is an alternative choice of fixation in children or when nailing is difficult. We present a new technique for tibial lengthening with using a monolateral external fixator over a lengthening plate.Lengthening over an intramedullary nail is a commonly used method in patients with short stature or limb-length discrepancy. However, in patients with a narrow and excessively sclerotic intramedullary cavity in the pediatric age group where the skeletal system has not yet fully developed, difficulties have been observed in lengthening methods with nailing.Therefore, in these cases, the use of lengthening techniques over a plate is an alternative treatment option. Nevertheless, in lengthening techniques over a plate, if one side of the osteotomy area cannot be fixed, associated mechanical axis problems have been reported.We applied tibia lengthening with external fixator assistance over a custom-made lengthening plate in a patient with sequelae of poliomyelitis. This new lengthening technique applied over a plate could be the solution to the problems observed in other lengthening techniques over a plate.

IntroductionThere are many closure techniques available to cutaneous surgeons. One of them is the purse-string suture which is used to provide complete or partial closure of round skin defects. In our animal study; we closed skin defects with using subcuticular purse string suture technique by progressively cinching wound and we aim to more rapidly healing according to secondary healing.MethodsAfter anaesthetize, we created a 4 cm diameter circular full thickness skin defect on dorsal area of rats. In group 1, subcuticular purse string suture was applied by using a nonabsorbable and monofilament suture and a sliding arthroscopic knot was applied to both ends. Arthroscopic suture was shift 1 cm forward every day. In group 2 skin defect was leaved open and daily dressing was made and in both group defect diameters were measured every day and noted.ResultsThe skin defects were closed totally after 15 days in group 1 but in group 2 defects were reduced but still had a mean 1,5-cm diameter sircular defect.ConclusionClosing large circular wound with purse string suture and gradual tightening decreases the healing time and expand the skin tissue without using any tissue expander.