10^th Global Orthopedicians Annual Meeting July 03-04, 2017 Kuala Lumpur, Malaysia

Statement: 5% of distal humeral fractures go onto nonunions. 50-70% will eventually heal and have a satisfactory outcome following multiple repeat osteosynthesis surgery. Remaining patients are left with painful, unstable elbow with limited function. Reconstructive options are limited due to the remaining poor bony and soft tissue envelopes and the fibrous nonunion tissue. We assessed outcomes for total elbow arthroplasty (TEA) as a salvage procedure for this group of patients. Methodology: 7 patients with mean nonunion time of 12 years (range 3-29 years) and mean of 4 previous failed surgeries prior to undergoing TEA as salvage procedure for distal humeral nonunion. Pre and postoperative Oxford Elbow Scores (OES) were used to assess functional outcome and all complications were reported at follow-up. Findings: Mean preoperative OES was 11.9 (range 6-18), at a mean follow up of 24.3 months (range 6-54), the mean OES was 37.7 (range 17-47), a mean 25.9 score improvement postoperatively (ttest p=0.00038). Preoperatively, all patients had painful unstable and restricted arcs of motion ranging from a flail elbow to at best 90 degrees of flexion. Postoperatively, all TEA had sagittal and coronal stability throughout an arc of motion of 20-140 degrees. 86% of our series had a good outcome (OES >38). 1 patient had metalwork removed for suspected infected non-union and ulna nerve neuropathy prior to TEA. Despite eradication and normal histology and blood markers prior to TEA this patient has a poor outcome score (OES 17), with the majority of symptoms relating to the preexisting ulna neuropathy. This patient is satisfied with the stability and function the TEA has provided which is not reflected in the OES. Conclusion: Our series shows that TEA is a good salvage option for chronic distal humeral nonunion, with good functional outcomes in patients who have never had an infected nonunion.

Statement: To analyse retrospectively the functional and radiographic outcome of patients undergoing distal interphalangeal joint arthrodesis at our institute. Methodology: Between 2010 and 2014, 46 distal interphalangeal joint arthrodesis were carried out in 31 patients at our institution. The case group consisted of 22 females and 9 males with an average age of 61 years (50 years to 75 years). Average follow up was 10 months (6 months to 31 months). 4 Patients had concomitant procedures e.g. lateral band transfer. Indications for surgery were: failure of conservative treatment; severe pain; and diminished thumb and finger function hampering everyday life. The technique is through dorsal incision over the joint surface and preparing the joint to accept the guide wire for a mini/micro Acutrak®. Hand therapist and consultant surgeon follow up on 2 and 6 weeks post-operation, after which on an individual basis. Findings: 4(12 fingers) patients underwent the procedure as part of rheumatoid hand reconstruction while 27(33 fingers) patients required the procedure due to osteoarthritis. There were 6 thumbs and 39 fingers operated upon. In 25 digits micro Acutrak® screw system was used and in 20 digits the mini Acutrak® screw system was used. Two digits required re-operation, one for infected non-union and the other simple non-union. Both the non-unions were in the micro Acutrak® screw. Three cases of superficial wound infection which settled down with antibiotics. Average screw size used 20mm. Clinically, 85% rated good, 10% fair, and 5% poor results. Conclusion: Our experience of arthrodesis using the Acutrak® system shows better results if compared to K wire fixation. However even within the Acutrak® system better results were noted in the mini Acutrak® group than the micro Acutrak® group. The practice of both the senior authors has now changed to using only the mini system for all their DIPJ arthrodesis

ReÅŸit Sevimli has his experience about orthopedic oncology and arthroplasty on knee and hip at Inonu University

In our study, 710 patients who were hospitalized in our department with pre-diagnosis of bone and soft tissue tumor within approximately last 16 years were evaluated. Cases were analyzed according to age, gender, tumor frequency and localization, and retrospective analyses of tumors are tried to be represented. After the approval of ethics committee number 2017/1-3 from Inonu University Committee on Scientific Research and Publication Ethics was obtained; following retrospective evaluation of 920 patients admitted to our department with prediagnosis of tumor between January 2000 and December 2016, 710 patients [275 M, 435 F; mean age: 30.67 (1-92)] were determined to be patients with bone and soft tissue tumors. For screening, operating theatre and ward records were reviewed. The patients were divided as benign and malignant bone and soft tissue tumors based on their pathology results and then examined in regard to age, gender, tumor frequency and localization. Metastatic tumors were excluded from the study. All data were analyzed by using SPSS v.15 (SPSS Inc., Chicago, IL, USA) statistical package program. 710 [275 M, 435 F; mean age: 30.67 (1-92)] of a total of 920 cases were diagnosed with tumor. Mean age of cases was 32.6 in males and 35.1 in females. In regard to localizations of tumors, tumors were recognized in hip, thigh, knee bones in 387 (54.5%), in shoulder, arm and elbow bones in 167 (23.5%) and in ankle and hand bones in 156 (21.9%) of the cases. In regard to screening results, of all cases, 336 patients [144 M-192 F, mean age: 22.79 (2-68)] were determined to have a benign bone tumor, 55 patients [35 F, 20 M, mean age: 43 (3-80)] were determined to have a malignant bone tumor and 293 patients [201 F, 92 M, mean age: 35.27 (1-92)] were determined to have a benign soft tissue tumor, whereas 26 patients [19 M, 7 F, mean age: 54.53 (12-84)] were determined to have a malignant soft tissue tumor. Extra-tumoral causes were determined in the 210 cases which were excluded from the study. Infection was the most common cause in 142 cases of 210 patients that were excluded from the study due to extra-tumoral causes, whereas it was observed that structures thought to be a lesion in 68 cases were normal tissues. In conclusion, data collected in our department seems to be similar with the literature generally. We suggest that formation of larger series through collection of such studies, which include demographical data, from centers where bone and soft tissue tumor surgeries are performed will provide beneficial information in regard to distribution of bone and soft tissue tumors in our country.

ReÅŸit Sevimli has his experience about orthopedic oncology and arthroplasty on knee and hip at Inonu University

Abstract Grafting in orthopaedic surgery is used generally for treating bone defects which develop during reconstructive procedures following musculoskeletal system tumor surgery, as well as for trauma, bone infections, congenital abnormalities and revision arthroplastic surgery. After the approval of ethics committee number 2017/1-6 from Inonu University, Committee on Scientific Research and Publication Ethics was obtained for this study. 45 (25 male, 20 female, median age: 34.50; min-max: 9-60) who were operated in our department due to oncological reasons between the years 2005-2015 were examined. For defects of the patients, reconstruction by using autogenous or allogenous bone graft was performed. Allograft was used for 24 of the patients and autograft was used for 21 of the patients. Lesions of the patients (median age: 34.1; min-max 9-60) for whom allograft was used were in various anatomical localizations from humerus to phalanges, and all were benign cavitary lesions. All of the allografts used in the surgery were first frozen and then dried. All were first kept within Ringer Lactate solution under room temperature and then applied. Iliac wing and metaphysic of radial distal edge were used as graft resources in 21 (median age: 34.76; min-max 18-60) for whom autograft was applied. Types of lesions were benign cavitary lesions, with simple bone cysts being the most common. 24 allografts and 21 autografts which were applied for 45 patients (25 male, 20 female; median age 34.50; min-max: 9-60) for which the follow-up duration was determined to be atleast twelve months were evaluated. All of the defects were cavitary. Information concerning age, gender, pathological diagnosis, anatomical localization and complications was obtained by examination of files and graphs of the patients. Mean follow-up duration was 21 months (18.2 months in allograft group, 22.3 months in autograft group). Obtained data were evaluated in SPSS 15.0 program by using Mann-Whitney U-test and chi-square test. During follow ups of the patients, union was radiologically observed in an average of 6.1 months in 43 (91%) patients (5.8 months in 21 autografts, 6.5 months in 22 allografts). Nonunion occurred in 2 (9%) patients. No statistically significant difference was determined between both groups for which allografts and autografts were applied (P>0.05). For these two patients which had persistent cavitary lesion until 1st year after application of allograft, allograft was re-applied in the second surgery and union was obtained. Infections did not occur in any of the patients as a complication.

ReÅŸit Sevimli has his experience in orthopedic oncology and arthroplasty of knee and hip.

Bone tumours seen in advanced ages are, unless otherwise proven, considered to be metastatic and its diagnostic and treatment algorithm are attempted to be developed. In our study, it was aimed to determine and introduce the most common causes of metastasi zing primary tumours, their localizations and the treatments that are administered, through evaluation of the patients with metastatic bone tumours who admitted to our clinic. After ethics committee approval numbered 2017/1-was obtained from the Inonu University Committee on Scientific Research and Publication Ethics for this study, data of 96 patients (51 males, 45 females; mean age 64.50; distribution 45 87) who were hospitalized due to diagnosis of metastatic bone tumour or whose treatment was planned in our clinic between 2000 and 2016 were evaluated. The most common cause of admission to our clinic due to metastatic bone lesions were pain and pathological fracture. Whereas 75 of the patients under went for a surgical intervention with fixation, there maining patients were followed-up with radio therapy. Breast (30 patients 32%) and lung (18 patients 18.5%) metastases were determined to be the most commonly metastasized primary organs. Inregard to the bone area involved, femur was the most commonly metastasized bone localization. Reconstruction surgery with internal fixation or prostheses was performed for all of 75 patients operated. Improvement of general condition of the patient with tumour with bone metastasis as to increase the quality of life of the patient by providing early mobilization of the patient should be attempted. Thus, planning of appropriate patient selection and proper internal fixation is essential. In conclusion, bone tumours seen in advanced ages are, unless otherwise proven, considered to be metastatic and then its treatment should be planned according to this fact. In treatment of metastatic tumours, orthopaedic surgical treatment is palliative and should have the aim of relieving of the pain and enabling early mobilization and general medical care for the patient.