A late hip pain after a gunshot wound: Treatment by mini - arthrotomy

ÖZET Kalça ağrısı yapan etiyolojik faktörler arasında eklem içi yabancı cisimler nadiren karşımıza çıkar. Tedavisinde son yıllarda kalça artroskopisi ön plana çıkmaktadır. Mini artrotomi de zor vakalarda tercih edilebilecek başarılı bir tedavi yöntemidir. 36 yaşında erkek hasta, 6 ay önce pelvis bölgesinden kurşunlanmış. Yaralanma sonrası ilk 4 ayda şikâyeti yokmuş. Son 2 aydır başlayan ayağa kalkma ve yürüme ile artan sol kalça ağrısı oluyormuş. Oturunca rahatlama hissediyormuş. Hastanın sol kalça direk grafisi ve pelvis tomografisi çekildi. Sol asetabulum duvarı içine saplanmış ve artrit bulgularına sebep olan kurşun çekirdeği saptandı. Sol kalçaya anteriordan mini artrotomi yapılarak kurşun çekirdeği saplandığı yerden çıkartıldı. Kalça ağrısı yapan nedenler arasında eklem içi yabancı cisimler göz ardı edilmemelidir. Kalça artroskopisi ve açık mini artrotomi yabancı cismi çıkartmak için cerrahi tedavi seçenekleridir. Hastanın durumu ve cerrahın deneyimine göre biri tercih edilir. Tedavi yapılmadığı takdirde komplikasyonlara davetiye çıkar. Özellikle kurşun gibi ağır bir metalin eklem içinde uzun süre kalması sistemik kurşun intoksikasyonuna; lokal kimyasal veya mekanik osteoartritlere neden olabilir. Eklem içinde yabancı cisim olarak kurşun görüldüğünde artroskopik yöntemle veya anterior mini artrotomi kullanılarak bir an önce çıkartılması hastayı bu tür komplikasyonlardan kurtaracaktırForeign body is rarely seen as an etiologic factor of the hip pain. Hip arthroscopy is the first choice as a treatment method on the last years. Mini arthrotomy is an alternative treatment option. 36-year-old man had gunshot wound to his posterior pelvic area six months ago. In the first 4 months he had no symptoms. For the last 2 months, a progressive left hip pain was started especially while he was walking or standing on. There was no pain while sitting. Left hip radiography and pelvic tomography were taken. A bullet fragment was embedded in the central wall of acetabulum caused osteoarthritic changes. A mini arthrotomy was performed by the anterior incision of the hip. Bullet was extracted where it was embedded. Foreign body in the hip joint must not be overruled as an etiologic factor of hip pain. Arthroscopy and mini arthrotomy are the treatment options according to the patients' position and the surgeon's skills. In case the treatment was not performed, several complications such as lead synovitis, local chemical and mechanic arthritis as well as systemic plumbism could be seen. Early extraction of the lead bullet from the joint with arthroscopically or anterior mini arthrotomy will prevent against such complications. © Gülhane Askeri Tip Akademisi 2014

The Use of Intralaminar Screws in Patients With Spinal Deformity

Study Design:Retrospective study.Objective:To demonstrate that intralaminar screws (ILS) can be used as supplements in spinal deformity surgery in the thoracic and lumbar levels in pediatric and adult patients.Summary of Background Data:Rigid posterior fixation of the spine is generally accomplished using pedicle screws, hooks, or wires. ILSs are useful tools when other spinal fixation techniques have failed or the bony anatomy precludes hook or screw placement.Materials and Methods:All spinal deformity patients (primary/revision) operated between 2007 and 2011 were retrospectively reviewed. The patients with ILS were included in the study. The anteroposterior and lateral standing x-rays were evaluated in terms of preoperative and postoperative coronal and sagittal deformities. The number and level of ILS, intraoperative complications, and postoperative complications were noted.Results:There were 20 patients (12 male and 8 female). The mean age was 21.75 years. The mean follow-up period was 17.4 months. Fifty-seven ILS were inserted. Seventeen screws were used in the uppermost to lowermost levels. Forty screws were used in the middle. There was 1 lamina fracture and screw pull out (1.75%). There were 3 canal violations (corrected intraoperative) and 2 instrument prominences which required implant removal. The mean preoperative/postoperative cobb angles were 78.5 degrees/27.8 degrees and the mean preoperative/postoperative kyphosis angles were 57.2 degrees/32.5 degrees, respectively. The loss of correction was 1.2 degrees. There were no neurological deficits and no instrument failures.Conclusions:ILS are safe and effective when used in deformity correction. However, biomechanical studies and randomized controlled trials are needed to conclude whether ILS will be considered a first-line technique, or will remain a technique for salvage situations

Kyphectomy for congenital kyphosis due to meningomyelocele: a case treated with a modified approach to skin healing

This study is a case report of a meningomyelocele patient with congenital kyphosis who was treated with kyphectomy and a special approach to soft tissue healing. The objective of this study is to show a step by step approach to surgical treatment and postoperative care of a meningomyelocele patient with congenital kyphosis. In meningomyelocele the incidence of kyphosis is around 12-20%. It may cause recurrent skin ulcerations, impaired sitting balance and respiratory compromise. Kyphectomy has first been described by Sharrard. This surgery is prone to complications including pseudoarthrosis, skin healing problems, recurrence of deformity and deep infections. A 15-year-old male presented with congenital kyphosis due to meningomyelocele. He had back pain, deformity and bedsores at the apex of the deformity. The wound cultures showed Staphylococcus epidermidis colonisation at the apex. He was given appropriate antibiotic prophylaxis. During surgery, the apex of the deformity was exposed through a spindle-shaped incision. After instrumentation and excision of the apex, correction was carried out by cantilever technique. Two screws were inserted to the bodies of L3 and T11. After the operation, the skin was closed in a reverse cross fashion. He was sent to hyperbaric oxygen treatment for prevention of a subsequent skin infection and for rapid healing of skin flaps post operation. The patient's deformity was corrected from a preoperative Cobb angle of 135 degrees 15 degrees postoperative. The skin healed without any problems. Preoperative culture and appropriate antibiotic prophylaxis, spindle-shaped incision, reverse cross-skin closure and postoperative hyperbaric oxygen treatment can be useful adjuncts to treatment in congenital kyphosis patients with myelomeningocele to prevent postoperative wound healing and infection problems. Reduction screws and intracorporeal compression screws help to reduce the amount of screws and aid in corection of the deformity

Convex Short Segment Instrumentation and Hemi-Chevron Osteotomies for Putti Type 1 Thoracic Hemivertebrae A Simple Treatment Option for Patients Under 5 Years Old

Study Design:A case series depicting the results of a novel surgical technique.Objective:To prove that a minimally invasive surgical technique can effectively control and even correct congenital scoliosis caused by a fully segmented hemivertebra.Summary of Background Data:Congenital hemivertebrae have been treated by anterior and posterior growth arrest with/without fusion, anterior and posterior hemivertebrectomy, transpedicular hemivertebra excision, and transpedicular hemiepiphysiodesis. These approaches are complex and require experience. There is a need for a simple treatment method to treat these deformities.Methods:Twelve patients under 5 years of age with Putti type1 hemivertebrae were treated by posterior convex short segment instrumentation, partial chevron osteotomies, and fusion. Scoliosis, segmental scoliosis, kyphosis, segmental kyphosis, trunk shift were measured both preoperatively and postoperatively.Results:The mean correction of the segmental curve was 6 degrees (21%) which was maintained at the latest follow-up. The average final correction of the main curve was 23%. The trunk shift was 1.8 cm (range, 1-3 cm) preoperative and 1.4 cm (range, 0-2.5 cm) at the latest follow-up. The segmental angle of kyphosis averaged 11 degrees (range, -12 to 20 degrees) preoperative, and 14 degrees (range, 0-29 degrees) at the latest follow-up assessment. The values of the total thoracic kyphosis (T2-T12) were 29.5 degrees (range, 10-46 degrees) preoperative, 31 degrees (range, 10-44 degrees) postoperative, and 32 degrees (range, 16-45 degrees) at the last follow-up resulting in a mean improvement of 2 degrees. This improvement continued at the latest follow-up with a mean increase of 3 degrees.Conclusions:Transpedicular instrumentation is ideal for early correction in young children. The new posterior approach is much less invasive than the combined approaches or other posterior vertebrectomies and is well tolerated even in very young patients. The fusion segment is kept short. The deformities seem to stop progressing and this can avoid development of severe local deformities and secondary curves

Tophaceous Gout with Atypical Localization without Hyperuricemia or an Inflammatory Gout Attack

Tophaceous gout which typically develops following recurrent acute attacks, accounts for 10% of all gout cases. Although gout is known as a condition which primarily affects male gender, 5% of the patients are women with the majority being postmenopausal during the first attack. Tophaceous gout is frequently polyarticular in women. A solitary tophus which is seen as a soft tissue mass without inflammatory joint disease can be confused with neoplastic conditions. In this article, we report a 30-year-old female case of tophaceous gout with atypical localization presenting without hyperuricemia or an acute inflammatory gout attack

Bilateral Congenital Undescended Scapula (Sprengel Deformity)

WOS: 000301389300013PubMed: 21904193

Palmar Subcutaneous Dermatofibroma: A Rare Localization: Case Report

WOS: 000313378300042Dermatofibrom (Benign Fibröz Histiyositom) sık görülen benign tümörlerden biri olup, fibroblastik ve histiyositik hücrelerden oluşur. Genellikle dermis yerleşimlidir. Subkütan dermatofibrom ise daha seyrek görülüp, sıklıkla ekstremite proksimalleri ve baş boyun bölgesine yerleşir. Başta dermatofibrosarkom protuberans olmak üzere çeşitli benign ve malign subkütan tümörler ile karışabileceğinden, ayırıcı tanıda immünohistokimyasal belirteçler önem taşır. Dermatofibromun CD34 ile negatif, Faktör XIIIa ile pozitif boyanması, dermatofibrosarkoma protuberanstan ayırt edilmesini sağlar. Dermatofibromun etiyolojisinde en sık travma yer almasına rağmen, el yerleşimli olgu sayısı hayli nadirdir. Burada künt travmadan sonra palmar bölgede ortaya çıkan subkütan kitle nedeniyle değerlendirilen ve klinik, radyolojik ve histopatolojik incelemeler sonucunda palmar subkütan dermatofibrom tanısı alan bir hasta sunulmaktadır. Şu anki bilgilerimize göre sunulan olgu, elde yerleşim gösteren ikinci subkütan dermatofibrom vakası olma özelliği taşımaktadır.Dermatofibroma (Benign Fibrous Histiocytoma) is among the common benign tumors and consists of fibroblastic and histiocytic cells. It is usually localized in the dermis. Subcutaneous dermatofibroma is a less frequent variant usually seen on proximal extremities and head and neck region. Immunohistochemical markers have an important place in the differential diagnosis because it can be confused with benign and malign subcutaneous tumors, especially dermatofibrosarcoma protuberance. Negative staining for CD34 and positive staining for factor XIIIa distinguish dermatofibroma from dermatofibrosarcoma protuberance. Subcutaneous dermatofibroma cases with palmar localization are extremely rare although trauma is a common etiologic factor. Here, we presented a case with a subcutaneous mass on his hand, which developed after a blunt trauma with a clinically, radiologically, and histopathologically diagnosis of palmar subcutaneous dermatofibroma. To our knowledge, this is the second case of subcutaneous dermatofibroma localized on the hand

A Late Hip Pain after a Gunshot Wound: Treatment by Mini - arthrotomy

Kalça ağrısı yapan etiyolojik faktörler arasında eklem içi yabancı cisimler nadiren karşımıza çıkar. Tedavisinde son yıllarda kalça artroskopisi ön plana çıkmaktadır. Mini artrotomi de zor vakalarda tercih edilebilecek başarılı bir tedavi yöntemidir. 36 yaşında erkek hasta, 6 ay önce pelvis bölgesinden kurşunlanmış. Yaralanma sonrası ilk 4 ayda şikâyeti yokmuş. Son 2 aydır başlayan ayağa kalkma ve yürüme ile artan sol kalça ağrısı oluyormuş. Oturunca rahatlama hissediyormuş. Hastanın sol kalça direk grafisi ve pelvis tomografisi çekildi. Sol asetabulum duvarı içine saplanmış ve artrit bulgularına sebep olan kurşun çekirdeği saptandı. Sol kalçaya anteriordan mini artrotomi yapılarak kurşun çekirdeği saplandığı yerden çıkartıldı. Kalça ağrısı yapan nedenler arasında eklem içi yabancı cisimler göz ardı edilmemelidir. Kalça artroskopisi ve açık mini artrotomi yabancı cismi çıkartmak için cerrahi tedavi seçenekleridir. Hastanın durumu ve cerrahın deneyimine göre biri tercih edilir. Tedavi yapılmadığı takdirde komplikasyonlara davetiye çıkar. Özellikle kurşun gibi ağır bir metalin eklem içinde uzun süre kalması sistemik kurşun intoksikasyonuna; lokal kimyasal veya mekanik osteoartritlere neden olabilir. Eklem içinde yabancı cisim olarak kurşun görüldüğünde artroskopik yöntemle veya anterior mini artrotomi kullanılarak bir an önce çıkartılması hastayı bu tür komplikasyonlardan kurtaracaktır.Foreign body is rarely seen as an etiologic factor of the hip pain. Hip arthroscopy is the first choice as a treatment method on the last years. Mini arthrotomy is an alternative treatment option. 36-year-old man had gunshot wound to his posterior pelvic area six months ago. In the first 4 months he had no symptoms. For the last 2 months, a progressive left hip pain was started especially while he was walking or standing on. There was no pain while sitting. Left hip radiography and pelvic tomography were taken. A bullet fragment was embedded in the central wall of acetabulum caused osteoarthritic changes. A mini arthrotomy was performed by the anterior incision of the hip. Bullet was extracted where it was embedded. Foreign body in the hip joint must not be overruled as an etiologic factor of hip pain. Arthroscopy and mini arthrotomy are the treatment options according to the patients' position and the surgeon's skills. In case the treatment was not performed, several complications such as lead synovitis, local chemical and mechanic arthritis as well as systemic plumbism could be seen. Early extraction of the lead bullet from the joint with arthroscopically or anterior mini arthrotomy will prevent against such complications

Intramuscular Hemangioma of Flexor Digitorum Brevis Muscle

WOS: 000309222100012PubMed: 21904191

Cohesive Taping and Short-Leg Casting in Acute Low-Type Ankle Sprains in Physically Active Patients

Conclusions: Each treatment method was effective in decreasing the edema and increasing the functional scores of the ankle. At the beginning of treatment, not only the level of edema but also the initial functional scores of the ankle and examinations are important in making decisions regarding the optimal treatment option. (J Am Podiatr Med Assoc 105(4): 307-312, 2015