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Öğe Anterior Glenohumeral Instability: Classification of Pathologies of Anteroinferior Labroligamentous Structures Using MR Arthrography(Hindawi Ltd, 2013) Mutlu, Serhat; Mahirogullari, Mahir; Guler, Olcay; Ucar, Bekir Yavuz; Mutlu, Harun; Sonmez, Guner; Mutlu, HakanWe examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients' instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI.Öğe Clinical and radiological results of posterior instrumentation without fusion for thoracolumbar fractures(Academic Journals, 2011) Sargin, Serdar; Ucar, Bekir Yavuz; Necmioglu, Serdar; Bulut, Mehmet; Gem, MehmetA retrospective study of clinical and radiological results of nonfusion operative treatment for thoracolumbar fractures. In this study, we aimed to demonstrate that fusion was not always required in the surgical treatment with posterior instrumentation for thoracolumbar vertebral fractures and to show the success of surgical treatment without fusion. Fusion was added considering failure of the implant and inability to maintain the corrected kyposis angle after posterior instrumentation for thoracolumbar vertebral fractures. Fusion related problems such as the fusion-induced loss of stability in posterior elements, graft donor site problems, increased blood loss, allograft associated infections, and prolonged operation time, focus attention on surgical treatment without fusion. We intended to demonstrate the alignment and stability of the spine in the coronal and sagittal planes after treatment without fusion. Kyphosis angle and the extent of the collapse were measured in preoperative, postoperative and final examination films of 60 patients with thoracolumbar vertebral fractures. Based on the computerized tomography and magnetic resonance images of the patients, we evaluated intracanal fragments, the presence of pedicle and laminar fractures, posterior ligamentous complex status and the presence of medullary edema. With an aim to evaluate pain and quality of life of the patients, the oswestry disability index (ODI) and Roland morris disability questionnairre were tested. The obtained results were evaluated and the final postoperative conditions of the patients were investigated. For the statistical analysis of local kyphosis angle, sagittal index and percentage of anterior collapse that were measured in preoperative, postoperative and final examinations of the patients, descriptive analysis and one way analysis of variance for related samples were conducted. And Pearson's correlation test was used for the analysis of the relationship between radiological measurements and clinical functions. It can be concluded that the patients derived radiological and statistically significant benefit from the surgery in terms of restoration of anterior column height and that postoperative radiological values were maintained with minimal reduction until the final examination (p>0.05) and that the surgery was effective in remodeling of the vertebral body. When evaluated in terms of the clinical results, a negative relationship (r = 0.300) between Oswestry scores and percentage of anterior collapse was found to be statistically significant (p<0.05). Our findings that the patients derived statistically significant benefit radiologically, in terms of local kyphosis angle and sagittal index correction from the posterior instrumentation without fusion and that postoperative radiological values were maintained with minimal increase (p>0.05) until the final examination, support our conclusion that fusion is not required. Hence, we can eliminate complications of fusion surgery.Öğe Clinical and radiological results of posterior instrumentation without fusion for thoracolumbar fractures(Academic Journals, 2011) Sargin, Serdar; Ucar, Bekir Yavuz; Necmioglu, Serdar; Bulut, Mehmet; Gem, MehmetA retrospective study of clinical and radiological results of nonfusion operative treatment for thoracolumbar fractures. In this study, we aimed to demonstrate that fusion was not always required in the surgical treatment with posterior instrumentation for thoracolumbar vertebral fractures and to show the success of surgical treatment without fusion. Fusion was added considering failure of the implant and inability to maintain the corrected kyposis angle after posterior instrumentation for thoracolumbar vertebral fractures. Fusion related problems such as the fusion-induced loss of stability in posterior elements, graft donor site problems, increased blood loss, allograft associated infections, and prolonged operation time, focus attention on surgical treatment without fusion. We intended to demonstrate the alignment and stability of the spine in the coronal and sagittal planes after treatment without fusion. Kyphosis angle and the extent of the collapse were measured in preoperative, postoperative and final examination films of 60 patients with thoracolumbar vertebral fractures. Based on the computerized tomography and magnetic resonance images of the patients, we evaluated intracanal fragments, the presence of pedicle and laminar fractures, posterior ligamentous complex status and the presence of medullary edema. With an aim to evaluate pain and quality of life of the patients, the oswestry disability index (ODI) and Roland morris disability questionnairre were tested. The obtained results were evaluated and the final postoperative conditions of the patients were investigated. For the statistical analysis of local kyphosis angle, sagittal index and percentage of anterior collapse that were measured in preoperative, postoperative and final examinations of the patients, descriptive analysis and one way analysis of variance for related samples were conducted. And Pearson's correlation test was used for the analysis of the relationship between radiological measurements and clinical functions. It can be concluded that the patients derived radiological and statistically significant benefit from the surgery in terms of restoration of anterior column height and that postoperative radiological values were maintained with minimal reduction until the final examination (p>0.05) and that the surgery was effective in remodeling of the vertebral body. When evaluated in terms of the clinical results, a negative relationship (r = 0.300) between Oswestry scores and percentage of anterior collapse was found to be statistically significant (p<0.05). Our findings that the patients derived statistically significant benefit radiologically, in terms of local kyphosis angle and sagittal index correction from the posterior instrumentation without fusion and that postoperative radiological values were maintained with minimal increase (p>0.05) until the final examination, support our conclusion that fusion is not required. Hence, we can eliminate complications of fusion surgery.Öğe The effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats(Turkish Assoc Trauma Emergency Surgery, 2014) Demirtas, Abdullah; Azboy, Ibrahim; Bulut, Mehmet; Ucar, Bekir Yavuz; Alemdar, Celil; Alabalik, Ulas; Akpolat, VeysiBACKGROUND: The aim of the present study was to investigate the effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats. METHODS: Thirty-two rats were divided as follows: nicotinized group (1), hyperbaric oxygen group (2), nicotinized + hyperbaric oxygen group (3), and control group (4). For 28 days, nicotine was administered in Groups 1 and 3. Then, a standard shaft fracture was induced in the left femur of rats. Groups 2 and 3 underwent hyperbaric oxygen therapy for 21 days. At the end of the experiment, fracture site, left femur and whole body bone mineral content and density were measured. RESULTS: The radiological and histopathological scores of Group 1 were statistically significantly lower compared to Groups 2, 3 and 4, and there was no statistically significant difference between the Groups 2, 3 and 4. In a comparison between the groups, no statistically significant difference was found in terms of bone mineral content and density values measured at the fracture site, left femur and whole body. CONCLUSION: The negative effects of nicotine on fracture healing are eliminated with hyperbaric oxygen therapy, but hyperbaric oxygen alone does not cause significant changes in healing (radiologically and histopathologically).Öğe Effectiveness of Locking Versus Dynamic Compression Plates for Diaphyseal Forearm Fractures(Slack Inc, 2013) Azboy, Ibrahim; Demirtas, Abdullah; Ucar, Bekir Yavuz; Bulut, Mehmet; Alemdar, Celil; Ozkul, EminThis study compares the results of the locking compression plate (LCP) and the dynamic compression plate (DCP) in the treatment of diaphyseal forearm fractures in adults and defines the indications for the use of the LCP. Forty-two patients with diaphyseal forearm fractures were retrospectively analyzed. Of those, 22 had been treated with the LCP (LCP group) and 20 had been treated with the DCP (DCP group). The AO/ASIF classification was used to classify the fractures. Patients were assessed using the Grace-Eversmann criteria and the Disabilities of the Arm and Shoulder and Hand questionnaire during the final follow-up. Mean follow-up was 21 months (range, 20-24 months) in the LCP group and 23 months (range, 19-26 months) in the DCP group. Union was achieved in all patients. Mean time to union was 15 weeks (range, 12-25 weeks) in the LCP group and 17 weeks (range, 13-24 weeks) in the DCP group. In each group, 1 patient experienced delayed union, which required no additional surgical intervention. No significant difference was found regarding the time to union between the groups (P>.05). No significant difference existed between the 2 groups in terms of Grace-Eversmann criteria and Disabilities of the Arm and Shoulder and Hand scores (both P>.05). The results of these different fixation methods for forearm fractures in adults are similar. As such, the correct selection and application of surgical technique is more important than the type of plate used.Öğe Intramedullary Titanium Elastic Nailing in the Treatment of Paediatric Diaphyseal Femur Fractures(Aves, 2013) Sukur, Erhan; Azboy, Ibrahim; Demirtas, Abdullah; Bulut, Mehmet; Ucar, Bekir Yavuz; Alemdar, CelilObjective: We evaluated the clinical and radiographical outcomes in paediatric patients with diaphyseal femur fractures who were treated with intramedullary titanium elastic nails. Methods: Twenty-two patients (15 boys, 7 girls; mean age 7.6 years; range 6 to 12 years) with diaphyseal femur fractures who were treated with retrograde titanium elastic nailing (TEN) were evaluated in the study. 15 of the fractures were located mid-diaphyseally, 4 proximal diaphyseally and 3 distal diaphyseally. Open reduction via lateral incision was applied in cases in which closed reduction could not be achieved. Anterior-posterior and lateral radiographical views of the femur were used in the follow-up period. Gait patterns, range of motion of the knees and the hips, hospitalization time, time to union, limb length discrepancy between the lower extremities, and any complications were evaluated in the patients. Flynn's TEN scoring system was used to evaluate the outcomes. Results: Union was obtained in a mean of 6.8 weeks (range 5 to 11 weeks) in all of the patients. The anterior-posterior radiographs indicated that normal alignment was achieved in 19 patients. Two patients had a 5 degree varus malalignment and one had a 6 degree valgus malalignment. Two patients had a 6 degree anterior malalignment in the lateral radiographical view. Average limb length discrepancies of 7 mm were seen in 2 patients and of 6 mm were seen in 3 patients. Hip and knee motion were mildly restricted in one patient. Gait pattern was symmetric in all but one patient. Superficial wound infection was detected in one patient. None of the patients had nonunion, early closure of the epiphyseal plate or fracture following TEN extraction. Fifteen patients had excellent and 7 had good results according to Flynn's criteria. Mean hospitalization time was 4.2 days (range 3 to 9 days) and mean follow up period was 20.2 months (range 14 to 24 months). Conclusion: Intramedullary TEN is a successful method that yields good results for paediatric diaphyseal femoral fractures.Öğe Lengthening by distraction osteogenesis in congenital shortening of metacarpals(Turkish Assoc Orthopaedics Traumatology, 2013) Bulut, Mehmet; Ucar, Bekir Yavuz; Azboy, Ibrahim; Belhan, Oktay; Yilmaz, Erhan; Karakurt, LokmanObjective: The aim of this study was to present the results of seven cases of metacarpal lengthening by distraction osteogenesis and to discuss the ideal daily rate of distraction. Methods: Metacarpal lengthening was performed by distraction osteogenesis in the seven metacarpals of four patients (3 females, 1 male; mean age: 14.9 years). A unilateral external fixator was used for lengthening. Lengthening was initiated with a distraction rate of 2x0.5 mm/day in the patient with bilateral. involvement of the middle and ring metacarpals. On the tenth day of lengthening, distraction was discontinued due to pain and contracture. Then, distraction was continued with a rate of 2x0.25 mm/day. In all other cases, the distraction rate was 0.5 mm/day. Pre- and postoperative range of motion was measured with a goniometer. Patient satisfaction was evaluated with visual analog scale. Results: The mean pre- and postoperative metacarpal lengths were 34.6 pun (range: 33 to 37) and 49.7 mm (range: 47 to 52), respectively. The mean lengthening achieved was 15.1 mm (range: 14 to 17), while the Mean distraction rate was 0.55 mm/day (range: 0.48 to 0.63). No functional loss was observed in the fingers at the final check-up. The patients were happy with the functional and cosmetic results. Conclusion: Distraction osteogenesis is a safe method providing acceptable cosmetic and functional results in patients with congenital metacarpal shortness. The length of metacarpals and muscles that will be affected from lengthening should be considered when determining the daily rate of distraction.Öğe Nonunion of the Medial Cuneiform: A Rare Case(Hindawi Ltd, 2013) Alemdar, Celil; Ucar, Bekir Yavuz; Yildirmit, Azad; Kapukayal, AhmetIsolated medial cuneiform fractures are quite rare. Conservative treatment is adequate in most cases, while deplaced or unstable fractures are treated surgically. Nonunion is seen extremely rarely after medial cuneiform fractures. There is only one case report in the literature. This case presented here is a 62-year-old male patient who had an isolated medial cuneiform fracture resulting from the impact of a falling metal object. Conservative treatment was performed initially. The patient was diagnosed as nonunion after physical and radiological examinations nine months after he presented to the outpatient clinic. Internal fixation with a mini plate and one staple after reduction was performed surgically. Defective region was filled with a 2 mL of autograft, and the operation was terminated.Öğe Open Ankle Dislocations Without Associated Fracture(Sage Publications Inc, 2012) Ucar, Bekir Yavuz; Necmioglu, Serdar; Bulut, Mehmet; Azboy, Ibrahim; Demirtas, AbdullahBackground: This study aimed to clarify the intermediate followup results of reduction without soft tissue repair in open ankle dislocations without fracture. Methods: We retrospectively reviewed cases of open isolated ankle dislocations without associated fracture. Five male patients treated between January 2005 and July 2009 were enrolled in this study. Debridement and reduction with primary wound closure of the skin were performed without suture of the capsule or repair of the ligaments. The outcome was evaluated by the American Orthopaedic Foot & Ankle Society score (AOFAS). The time period for returning to previous level of activity was also recorded. Results: The average age of the patients was 34 (range, 27 to 44) years, and the average followup was 4 (range, 2 to 6) years. The average of the last control AOFAS score was 90 (range, 84 to 98) points. Two ankles were rated as excellent, and the other three were rated as good. Patients returned to their previous levels of physical activity at an average of 9 weeks. Conclusion: Favorable long-term results were obtained for reduction without ligament repair in pure ankle dislocations.Öğe Open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations(Sage Publications Inc, 2013) Kapukaya, Ahmet; Ucar, Bekir Yavuz; Gem, MehmetPurpose. To evaluate outcome of open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations. Methods. Records of 6 women and 14 men aged 7 to 60 (mean, 20) years who underwent open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations were reviewed. The dislocations were posterolateral (n=11), posterior (n=4), and posteromedial (n=5). No patient had a neurologic deficit. Elbow stiffness was the main indication for surgery. The duration of dislocation was 25 to 45 days in 11 patients and >45 days in 9; the mean was 47 days. The Mayo Elbow Performance Index (MEPI) was used to assess outcome at the final follow-up. The maximum score was 100. Scores of 90 to 100 were considered excellent, 75 to 89 good, 60 to 74 fair, and <60 poor. Results. The mean follow-up period was 39.1 months. At the final follow-up, the mean MEPI score was 79.3; outcome was excellent in 6 patients, good in 8, fair in 4, and poor in 2. The mean MEPI was 86.4 and 70.6 for patients with <= 45 and >45 days of dislocation, respectively. The mean range of movement improved from 20 degrees to 84.5 degrees (p<0.001). The 2 groups were significantly different in terms of MEPI (p=0.005) and range of movement (p=0.001). The MEPI correlated negatively with the duration of dislocation (r=-0.562, p=0.01). The range of movement correlated negatively with patient age (r=-0.649, p=0.002). Conclusion. Open reduction and Kirschner wire fixation with triceps lengthening, together with active postoperative elbow movements achieved favourable results for neglected elbow dislocations, especially in younger patients and those in whom the duration of dislocation was <45 days.Öğe Percutaneous Surgery: A Safe Procedure for Trigger Finger?(Medknow Publications & Media Pvt Ltd, 2012) Ucar, Bekir YavuzTrigger finger is relatively common problem among hand disorders. There are open and percutaneous surgical methods for the treatment. Aim: This study was designed to examine the mid-term results of the percutaneous surgical technique on patients with chronic trigger finger. Materials and Methods: We included 48 trigger fingers of 48 patients (36 females and 12 males). They were between the ages of 42-68 years (mean age, 52 years). We performed release of the trigger finger by using a 14-gauge needle via the percutaneous technique. We performed open surgery on the trigger fingers of 20 patients in order to evaluate the results obtained from percutaneous surgery. The patients were followed for 30 months on average (18-46 months) following the procedure. Results: Following the procedure, pain and locking of the fingers were resolved completely. On the fingers that had open surgery, we observed that the release of the pulley was successful. Only 2 patients had minor abrasions, without any tendon injury. During the follow-up period, no complications were reported in either of the patient groups. Conclusions: Percutaneous surgical technique in the treatment of trigger finger is an effective, convenient and cost-effective method with a low complication rate, and is therefore a preferable alternative to open surgery.Öğe The relationship between the quadriceps muscle strength and the anterior knee pain occurring after locked intramedullary nailing for tibial diaphysis fractures(Turkish Joint Diseases Foundation, 2011) Demirtas, Abdullah; Azboy, Ibrahim; Durakbasa, Mehmet Oguz; Ucar, Bekir Yavuz; Mercan, Ahmet Sukru; Cakir, Idris AhmetObjectives: The relationship between the quadriceps muscle strength and anterior knee pain occuring after locked tibial intramedullary nailing for tibial shaft (diaphysis) fracture was investigated. Patients and methods: Thirty-eight patients who were treated with locked intramedullary nailing for tibial shaft fractures were included in this study. The patients who had anterior knee pain before the surgery were excluded. All patients were operated on by splitting the patellar tendon in the middle and using superior approach. The fractures were all statically locked. Isometric quadriceps strengthening exercises were begun immediately in the postoperative period. The patients were divided into two groups whether they had anterior knee pain (group I; 01) or not (group 2; G2). There were 18 patients in G1 (12 males, 6 females; mean age 36.9 years) and 20 patients (14 males, 6 females; mean age 35.4 years) in G2. Quadriceps muscle strength was evaluated with using the Daniel ve Worthingham's manual grading criteria (0-5). The mean follow-up time was 27.4 months (range 11-51 months) in G1 and 30.5 months (range 12-59 months) in G2. Results: Decrease in quadriceps muscle strength was observed in eight patients in G1 and two patients in G2. The relation between anterior knee pain and decrease in quadriceps muscle strength was significant (p=0.02). Conclusion: Anterior knee pain after intramedullary nailing of tibial shaft fractures is related to quadriceps muscle weakness. However quadriceps muscle weakness is not the only effective factor that leads to anterior knee pain. Anterior knee pain can be reduced mostly with appropriate rehabilitation programme.Öğe Retrospective Cohort Study of the Prevalence of Lumbosacral Transitional Vertebra in a Wide and Well-Represented Population(Hindawi Ltd, 2013) Ucar, Demet; Ucar, Bekir Yavuz; Cosar, Yahya; Emrem, Kurtulus; Gumusssuyu, Gurkan; Mutlu, Serhat; Mutlu, BurcuPurpose. The aim of this study is to determine the prevalence of lumbosacral transitional vertebra (LSTV) in a well-represented general population. Methods. For a retrospective cohort study, abdominal radiographs of adult subjects were queried with clear visibility of the vertebral body articulation of the last rib, all lumbar transverse processes, and complete sacral wings. Exclusion criteria included any radiologic evidence of previous lumbosacral surgery that would block our view. A total of 6200 abdominal films were reviewed, and 3607 were identified as being suitable for the measurement of the desired parameters. Results. A total of 3607 subjects were identified as eligible for the study, and 683 (18.9%) were classified as positive for a lumbosacral transitional vertebra. The prevalence of sacralization and lumbarization was found as 17.2% and 1.7%, respectively. The average age at the time of the study was 39.5 +/- 15.2 years (18-86 years). Conclusions. As a result of different opinions, LSTV retains its controversial status. Our prevalence study of the general population will provide assistance for resolution of the controversy. Prevalence studies of the general population with a wide participation will shed light on comparative studies.Öğe Salter pelvic osteotomy in the treatment of Legg-Calve-Perthes disease : The medium term results(Acta Medica Belgica, 2014) Bulut, Mehmet; Demirts, Abdullah; Ucar, Bekir Yavuz; Azboy, Ibrahim; Alemdar, Celil; Karakurt, LokmanIn this study, clinical and radiological results were evaluated in patients with Legg-Calve-Perthes disease treated with Salter pelvic osteotomy. Between 2004 and 2008, 16 patients underwent a Salter osteotomy as treatment for Legg-Calve-Perthes disease (15 male, 1 female; 10 right hip, 6 left hip). The mean age at the time of surgery was 8.1 +/- 1.4 (range : 6 to 10) years. Surgical indications were : age between 6-10 years at the onset of the disease; Herring classification type B, B/C, or C; and at least one risk sign. 6-8 year old patients were classified as group I and 9-10 year olds were classified as group II. We investigated the effects of age and Herring classification on radiological outcomes. The final radiographic evaluation according to the Stulberg classification showed nine hips (56.25%) classified as good (Stulberg I/II), five (31.25%) as fair (Stulberg III); and two (12.5%) as poor (Stulberg IV). In group I, 7 patients (70%) had good results, while only 2 (33.3%) in group II. The results in group I were statistically better than group II (p < 0.05). Based on the Herring lateral pillar type, of the 12 patients classified as B or B/C, at final follow-up, 8 (66.6%) had a good outcome (Stulberg HI), whereas in the four patients classified as type C, only one (25%) had a good outcome. The Salter pelvic osteotomy is an effective method of surgical treatment for Legg-Cave-Perthes in patients between 6-8 years of age.Öğe Titanium elastic intramedullary nailing: closed or mini-open reduction ?(Acta Medica Belgica, 2013) Ucar, Bekir Yavuz; Gem, Mehmet; Bulut, Mehmet; Azboy, Ibrahim; Demirtas, Abdullah; Alemdar, CelilThe authors retrospectively studied 43 children with femoral fractures, treated with titanium elastic nailing (TEN). Twenty-two underwent closed fluoroscopic reduction (Group I), whereas the other 21 underwent mini-open reduction (Group II). The operation time averaged 71 minutes in group I, and 48 minutes in group II (p < 0.001). The mean fluoroscopy time was 79.3 seconds in group I, and 35.5 seconds in group II (p < 0.001). However, blood loss and hospital stay were significantly higher in group II (p < 0.001 and p = 0.001 respectively). Time to full weight bearing, time to radiographic union and TEN outcome score did not differ significantly. Overall, no one technique was really superior. From a practical viewpoint, a mini-open reduction may be decided intra-operatively if closed reduction proves to be problematic. This decreases intra-operative radiation and length of the surgical procedure.Öğe Treatment of Unicameral Bone Cysts: A Comparison on the Use of Steroid Injection and Open Surgery(Derman Medical Publ, 2015) Alemdar, Celil; Ozkul, Emin; Gem, Mehmet; Atic, Ramazan; Ucar, Bekir Yavuz; Kapukaya, AhmetAim: In this study we compared the clinical outcomes of the patients who underwent steroid injection and the ones who received additional local adjuvant therapy (cauterization + alcohol) following open surgery. Material and Method: The retrospective study included 73 patients who were diagnosed with unicameral bone cyst and underwent steroid injection or open surgery between 1995 and 2011. The patients comprised 23 (31.5%) females and 50 (68.5%) males, with a mean age of 9 (6-18) years and mean follow-up period of 4.71 (2-9) years. Open surgery was performed in 49 and steroid injection in 24 patients. In the open surgery group, local adjuvant treatment was added subsequently. In this group, healing was viewed radiologically. The patients were analyzed in three groups depending on the rate of the filling of the cystic area with a new bone: (I) complete healing, (II) residual healing, and (III) inadequate healing. Results: In the steroid injection group, complete healing was observed in 5 (20.8%), residual healing in 13 (54.1%), and complete failure in 6 (25%) patients. Average healing time was 32 (13-45) months. In the open surgery group, complete healing occurred in 24 (48.9%), residual healing in 20 (40.8%), and complete failure in 5 (10.2%) patients. Average healing time was 15 (10-29) months. Discussion: Steroid Injection is a practical and minimally-invasive method, yet it leads to a lower success rate when compared to open surgery combined with local adjuvant therapy.
