Simultaneous bilateral tibal tubercle avulsion: A rare fracture

Tibial tuberosity avulsion is a rare fracture in adolescence.Due to the shear forces on the immature epiphysis. Thirteenyears old girl was admitted to the emergency departmentwith knee pain and tenderness in both knees afterjumping from a height of about one meter. İn examinationshe had tenderness and swelling over both tibial tuberosities.The patient could not do active knee extension. TypeIIA fracture on the left and type IIIA fracture on the rightknee were detected. For the patient’s fractures, closedreduction and fixation with 3 smooth Kirschner wires wasperformed. After immobilization in long-leg brace for threeweeks the brace was removed and she include in therehabilitation program. In this report, we discuss similarcases in the literature and the results of the treatment appliedto our patient.Key words: Tuberositas tibia, avulsion fracture, percutaneouspinnin

Asetabulum kırıklarının cerrahi tedavisinde modifiye medial stoppa yaklaşımı;klinik anatomi çalışması

Bir adet taze ve beş adet formalize kadavraya, standart Modifiye Medial StoppaYaklaşımı uygulandı. nternal iliak arter ve dalları diseke edilerek lateks enjeksiyonu ilerenklendirildi. Quadrilateral yüzey komşuluğundaki nörovasküler yapıların konumunu tamolarak belirlemek üzere, planlanan morfometrik ölçümler yapıldı ve anatomik varyasyonlarnot edildi.Modifiye Medial Stoppa Yaklaşımı ile asetabulum kırıklarının tedavisi sırasındaöncelikle risk altında olan nörovasküler yapıların; obturator arter-ven ve obturator sinir,iliolumbar arter-ven ve internal iliak arter ve iliak ven olduğu görüldü. Quadrilateral yüzey iledirek ilişkisi nedeniyle obturator damarlar ve sinirin dikkat edilmesi gereken en önemliyapılar olduğu tespit edildi. Bölgede oldukça sık varyasyonlar saptandı. Diseksiyonu yapılan12 hemipelvisin 4'ünde (%33.3) internal ve eksternal iliak damarlar arasında kominikasyon(corona mortis) olduğu görüldü.Modifiye Medial Stoppa Yaklaşımı'nın, anatomik yapıların kolay diseksiyonunaimkan vermesi ve içpelviste, simfizis pubisden sakro-iliak ekleme kadar geniş bir alanaulaşım imkanı sunmasından dolayı, quadrilateral yüzeyi ilgilendiren asetabulum kırıklarınıncerrahi tedavisinde oldukça etkili ve uygulanabilir bir cerrahi teknik olduğu görülmüştür.We performed standart Modified Medial Stoppa Aproach to one fresh and fiveformalized cadavers. nternal iliac artery and branches were dissected and colored with latexinjection. To determine the neurovascular structures adjacent to quadrilateral surface,morfometrical measurements that we planned were done and anatomic variations were noted.It has been detected that obturatory artery-vein and obturatory nevre, iliolumbarartery-vein, internal iliac artery and vein were the structures that are primarily at risk duringsurgical treatment of acetabular fractures via a Modified Medial Stoppa Aproach. Obduratoryvessels and nerve were the most important structures to pay attention because of their directcontact to quadrilateral surface. Highly frequent variations were detected at this region. 4 ofthe 12 hemipelvises (33.3%) dissected have communications between eksternal and internaliliac vessels (corona mortis).We have seen that, Modified Medial Stoppa Aproach is very effective and applicablesurgical technic at surgical treatment of acetabular fractures envolving quadrilateral surfacebecause dissection of anatomical structures are easy and acces to a wide region at inner pelvisfrom pubic symphysis to sacroiliac joint is possible

Sacroiliac Joint Hydatidosis Mimicking Ankylosing Spondylitis: A Case Report

Hydatid cyst disease caused by Echinococcus granulosus is common in Mediterranean sheep-raising countries. Spinal involvement in hydatid cyst cases is very rare. The disease mainly affects the lungs and liver and, to a lesser extent, the brain and bones. Depending on location, the disease may mimic soft tissue and bone tumors. Osteolytic and inflammatory changes may imitate osteomyelitis and malignancies or rheumatologic diseases of the affected area. In this article, we report an unusual case of hydatid disease of the sacroiliac joint who was misdiagnosed with ankylosing spondilitis and under follow-up for two years. We also discuss the differential diagnosis of mass lesions of the sacroiliac joint. Hydatid cysts should be considered in the differential diagnosis in patients living in endemic countries

Sakroiliak eklemi tutan sakrum kist hidatiği: Olgu sunumu

Amaç: Ciddi ve ilerleyici bel ağrısına neden olan ve yanlış tanı almış nadir görülen bir kist hidatik vakasını tanımlamak. Giriş: Hidatik hastalık ya da hidatidozis dünyada yaygın bir insan sestod enfeksiyonudur ve karakteristik coğrafi k bir dağılıma sahiptir. Karaciğer ve akciğerler en sık tutulur. Vakalarda kemik tutulumu %4den daha azdır. Vertebral hidatik hastalık nadirdir. Sakroiliak eklem bulguları ve bel ağrısı ayırıcı tanıyı zorlaştırır ve bu nadir durum yanlış tanıya neden olabilir. Olgu Sunumu: Sakrum ve pelvisin sekonder hidatit kistlerinin kalça ağrısına neden olduğu 21 yaşında bayan hasta sunuldu. Başka bir merkezde sakroileit ve siyatik ağrısı tanısı almış ve tedavisi başarısız olan hasta kliniğimize sevk edildi. Fizik muayenesi ve radyolojik testleri sol sakrumdan başlayıp sakroiliak kemiğe uzanan iliak kemik lezyonlarını açığa çıkardı. Sonuç: Medikal tedaviyi takiben, küretaj ve greftleme uygulandı. Lezyondan çıkarılan materyalin makroskopik görünümü ve histopatolojik değerlendirilmesi hidatit hastalık ile uyumluydu. 11 aylık takibinde nüks gözlenmedi ve hasta semptomsuzdu. Tartışma: Erken dönemlerinde kemik hidatik hastalığı yanlış tanı alabilir. Hastalık ilerler ve kemiği destrükte eder. Hidatitk hastalık öyküsü olan ve kas-iskelet şikâyetleri olan hastalarda hidatik kist hastalığı ihtimali akılda tutulmalıdır. Debride edilen vertebrada kalan kavitenin kemik greftiyle doldurulmasının daha güvenilir olduğuna inanıyoruz.Objective: To describe a rare instance of hydatid cyst that caused severe and progressive low-back pain and misdiagnosed as sacroili itis. Introduction: Hydatid disease or hydatidosis is a serious human cestode infection in the world and has a characteristic geographic distribution. The liver and lungs are most frequently involved organs. Bone involvement is less than 4% in cases. Vertebral hydatid disease is uncommon. Signs of sacroiliac joint and low-back pain cause dif fi culties in diff erential diagnosis and this rare condition may be mis diagnosed. Case Report: A case of a 21-year-old woman with hip pain had been caused by a secondary hydatid cyst of the sacral and pelvic areas. Patient was diagnosed sacroiliitis and sciatica in another center. As treatment for these failed, the patient referred to our clinic. Physical examination and radiological tests revealed iliac bone lesions, which is starting from left sacral area and extending to sacroiliac joint. Results: Following medical treatment, curettage and grafting were performed. Macroscopic image and histopathological evaluation of the material which removed from lesion fi eld was consistent with hydatid disease. No recurrence was detected and patient was symp tom free at 11 months follow up. Conclusions: Bone hydatid disease is misdiagnosed in early periods. It progresses and the bone is de structed. In patients with a history of hydatid disease and with mus culoskeletal complaints, a possible disease of hydatid cyst should be should be kept in mind. And which is safer in management of re maining cavity, bone grafting or acrylic cement? We think that bone grafting is safe in management of remaining cavity

Morphometric Analysis of the Sacral Canal and Hiatus using Multidetector Computed Tomography for Interventional Procedures

AmAÇ: Yakın zamanda sakral kanal, omurga hastalıklarının minimal invaziv tanı ve tedavi işlemleri için "bir koridor olarak" sıkça kullanılmaya başlanmıştır. Çalışmanın amacı sakral kanalın, hiatusun ve çevre yapıların farklı yaş gurupları ve cinsiyete göre morfometrik analizlerinin çok kesitli bilgisayarlı tomografi yöntemiyle incelenmesidir. yÖNTem ve GeReÇLeR: Üç farklı yaş grubuna (20-80 yaş arasında) ayrılan 300 yetişkin (150 kadın ve 150 erkek; 20-80 yaş) hastanın multiplanar rekonstrüksiyon görüntüleri kaydedildi ve geriye dönük olarak incelendi. Sakral hiatus ve çevre yapılar ile sakral kanala ait çeşitli anatomik ölçümler yapıldı. Sakral kurvatür açısı ve lumbosakral lordotik açı kaydedildi. BuLGuLAR: Bazı olgularda hiatus yokluğu (%0,3), komplet agenezis (%1) ve kemik septum (%2,6) gibi kemik anomalilerine rastlandı. Anteroposterior (AP) Hiatus çapı olguların %5'sinde 2 mm nin altındaydı. Tüm yaş gruplarında, hiatus AP çapı ve hiatus alan ve "sakral kanal AP çapının en kısa mesafesinin" ortalaması, 60-80 yaş grubunda, 20-40 yaş grubuna göre daha kısaydı (p0,01). Sakral kanal AP çapın en küçük olduğu lokalizasyon, en çok olguların %59,2'unda S2 ve %33,9'unda S3 seviyesinde idi. Maksimum kurvatür seviyesi olguların %63,3'ün de S3 ve %26,7'sin de S2 seviyesinde idi. Sakral kürvatur açı ve lumbosakral lordotik açı sırayla 164 and 134 olarak ölçüldü. soNuÇ: Sakral yapılarda anatomik varyasyonlar sık görünür. Anatominin ayrıntılı analizi, girişimsel işlemlerin başarısını ve güvenilirliğini artırabilir.AIm: The sacral canal has been frequently used as "a passage" for minimally invasive diagnostic and therapeutic procedures for spinal diseases. The aim of the present study was to investigate morphometric analyses of the sacral canal, hiatus, and surrounding structures according to different age groups and gender by using the "multidetector computed tomography" method. mATeRIAL and meTHods: Multiplanar-reconstructed images from 300 adult (150 females and 150 males, between 20 and 80 years old) were divided into three groups according to age and retrospectively examined. Various anatomic measurements of the sacral hiatus, surrounding structures, and sacral canal were performed. Sacral curvature angle and lumbosacral lordotic angle were noted. ResuLTs: Bony anatomic abnormalities such as absent hiatus (0.3%), complete agenesis (1%), and bony septum (2.6%) were detected in some cases. The anteroposterior (AP) diameter of the hiatus was less than 2 mm in 5% of cases. In all groups, the mean values of the hiatus AP diameter and area, and the shortest distance of the sacral canal AP diameter were shorter in the 60-80 years age group when compared with those in 20-39 years age group (p0.01). The shortest sacral canal AP diameter was commonly located at the S2 and S3 levels in 59.2% and 33.9% of cases, respectively. The levels of maximum curvature were at S3 and S2 in 63.3% and 26.7% of cases, respectively. Median sacral curvature angles and lumbosacral lordotic angles were measured as 164° and 134°, respectively. CoNCLusIoN: Sacral structures have morphometric variations. Understanding of the detailed anatomy may improve the reliability of interventional procedures

Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture

The purpose of this study was to investigate the mechanical strength of both monoplanar and biplanar medial opening-wedge high tibial osteotomy (MOWHTO) procedures and assess the risk of lateral cortex disruption for both techniques. Twelve synthetic tibia models with cortical shells were used as test models. Saw cuts for monoplanar MOWHTO and biplanar MOWHTO were generated on the test models in equal numbers (n = 6 for both groups). Wedge opening load and wedge gap distance were evaluated via compressive tests. The mean gap distance just before the lateral cortex fracture in the monoplanar group was 14.7 +/- 2.9 mm, which was significantly narrower than that in the biplanar group of 19.1 +/- 2.0 mm (p = 0.015). The mean load just before the occurrence of lateral cortex fracture of 32.4 +/- 3.2 N in the monoplanar osteotomy group was significantly lower than that in the biplanar osteotomy group of 111.8 +/- 9.3 N (p = 0.009). Performing a MOWHTO via the biplanar rather than the monoplanar technique allows larger-sized wedges to be opened with less risk of lateral cortical fracture. Thus, larger gaps can be opened and higher angle corrections can be achieved using the biplanar osteotomy procedure. From a clinical viewpoint, the biplanar osteotomy technique reduced the risk of lateral cortical hinge fracture during MOWHTO