Carpometacarpal dislocation of the thumb associated with fracture of the trapezium

WOS: 000216974100012PubMed ID: 24671487Carpometacarpal dislocation (CMC) of the thumb associated with fracture of trapezium is an extremely rare injury, with only 12 cases that sustained similar injuries reported in the literature. In this article, another patient with this rare injury was reported, and all previously published cases were extensively reviewed. The presented case and all previously published cases had a longitudinally oriented trapezium fracture, which is naturally unstable and almost always associated with dislocation of the CMC joint. In contrast to previous descriptions, we believe that CMC joint dislocation and trapezium fracture are not two distinct pathologies that occur simultaneously by chance but share cause and consequence

Compartment syndrome following arthroscopic removal of a bullet in the knee joint after a low-velocity gunshot injury

WOS: 000411019200017PubMed ID: 26929809Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome

Anatomy of master knot of henry: A morphometric study on cadavers

WOS: 000433350100010PubMed ID: 29366540Objective: The objective of this study was to evaluate the features of flexor hallucis longus (FHL), flexor digitorum longus (FDL) and flexor digitorum accessorius (FDA) muscles with relevance to the tendon grafts and to reveal the location of Master Knot of Henry (MKH). Methods: Twenty feet from ten formalin fixed cadavers were dissected, which were in the inventory of Anatomy Department of Medicine Faculty, Mersin University. The location of MKH was identified. Interconnections of FHL and FDL were categorized. According to incision techniques, lengths of FHL and FDL tendon grafts were measured. Attachment sites of FDA were assessed. Results: MKH was 12.61 +/- 1.11 cm proximal to first interphalangeal joint, 1.75 +/- 0.39 cm below to navicular tuberosity and 5.93 +/- 0.74cm distal to medial malleolus. The connections of FHL and FDL were classified in 7 types. Tendon graft lengths of FDL according to medial and plantar approaches were 6.14 +/- 0.60cm and 9.37 +/- 0.77cm, respectively. Tendon graft lengths of FHL according to single, double and minimal invasive incision techniques were 5.75 +/- 0.63cm, 7.03 +/- 0.86cm and 20.22 +/- 1.32 cm, respectively. FDA was found to be inserting to FHL slips in all cases and it inserted to various surfaces of FDL. Conclusion: The exact location of MKH and slips was determined. Two new connections not recorded in literature were found. It was observed that the main attachment site of FDA was the FHL slips. The surgical awareness of connections between the FHL, FDL and FDA, which participated in the formation of long flexor tendons of toes, could be important for reducing possible loss of function after tendon transfers postoperatively

An atypical presentation of myopericytoma in palmar arch and review of the literature

Introduction. Myopericytoma is a very rare perivascular tumor that can be presented with painful mass in lower extremities. We aimed to present an atypical presentation and location of myopericytoma. Presentation of Case. An 18-year-old otherwise healthy individual was admitted to outpatient clinic with complaints of numbness and pain in his right hand. He has had no trauma. On volar aspect of his right hand, a well-circumscribed, painful mass was palpated. MRI results were related to hemangioma. Surgical excision was planned and performed. Pathological investigation revealed the mass is myopericytoma. Discussion. This case demonstrates a rare location and presentation of myopericytoma. Reviewing the literature, discussion was made to expand the horizon for diagnosis and treatment of patients with similar symptoms. Conclusion. Myopericytoma can rarely present with numbness and pain in affected region. Surgical excision is helpful for definitive diagnosis and symptom relief

Soft tissue tumors

Soft tissue tumors constitute a large group of tumors with diverse histopathological types. Mesenchymal tissues such as fibrous, lipomatous, vascular, synovial, and muscular tissues are described within this group. Neural sarcomas of neuroectodermal origin are also considered in this group due to their similar clinical and pathological characteristics (Enzinger FM, Weis SW (1995) Soft tissue tumors, 3rd edn. Mosby, St Louis). Soft tissue tumors may present with different histological, clinical, radiological, and pathological features within a wide range of anatomical locations, and thus diagnosis and treatment of these tumors require a multidisciplinary approach. Diagnostic evaluation of soft tissue tumors is critical as many benign soft tissue lesions may be confused with rare sarcomas

Diagnostic value of elastography in the diagnosis of ıntermetatarsal neuroma

WOS: 000378071300006PubMed ID: 26964696The objective of the present study was to characterize the ultrasound and elastographic properties of intermetatarsal neuroma (interdigital neuroma) and their contribution to diagnosis. Eighteen patients with metatarsalgia, who had presented to an orthopedic clinic from April 2013 to February 2015, were diagnosed with 25 intermetatarsal neuromas (11 unilateral [61.11%], 7 bilateral [38.89%]). These patients underwent evaluation with ultrasonography and simultaneous ultrasound strain elastography to assess the elastographic properties of the tissues in the intermetatarsal space. The intermetatarsal neuroma diagnosis was confirmed by histopathologic inspection. The lesion contours, localization, dimensions, and vascularization were evaluated before surgical excision. The elasticity and strain ratio values were compared between the neuroma and adjacent healthy intermetatarsal space. Of the 25 intermetatarsal neuromas, 1 (4%) was not detected by ultrasonography (incidence of detection of 96%). The mean neuroma width was 6.35 (range 3.7 to 13) mm in the coronal plane, and the mean elasticity and strain ratio values were 3.44 (range 1.1 to 5.1) and 9.47 (range 2.3 to 19.3), respectively. The elasticity and strain ratio values were significantly greater in the presence of an interdigital neuroma than in the adjacent healthy intermetatarsal spaces (Z = - 3.964, p = .0001 and Z = -3.927, p = .0001, respectively). The diagnostic cutoff values were calculated as 2.52 for elasticity and 6.1 for the strain ratio. Four neuromas (16%) were not demarcated, and the elasticity and strain ratio values for these were lower than those for neuromas with demarcated contours but were greater than those for healthy intermetatarsal spaces (p < .006 and p < .005, respectively). Patients with clinically suspected intermetatarsal neuromas that do not show demarcation and with smaller lesions might benefit from the use of ultrasound elastography for diagnosis

Is denervation surgery possible in the treatment of hallux rigidus? An anatomic study of cadaveric specimens

Objective: The aim of this study was to provide anatomic considerations in the first metatarsophalangeal joint (FMPJ) innervation and to evaluate the feasibility of the denervation surgery in the treatment of hallux rigidus. Methods: In this cadaveric study, 14 fresh frozen cadaveric transtibial amputation specimens was used. For nerve dissection, dorsal and plantar longitudinal incision centered over the FMPJ were performed. Deep peroneal and dorsomedial cutaneous nerves were dissected in the dorsal aspect of the joint. Medial plantar nerve branches, medial and lateral hallucal nerves, were dissected in the plantar aspect of the joint. The presence, number, and location of articular branches to the FMPJ capsule were recorded. Dorsal and plantar incision length for proper dissection were also recorded. Results: Nerve dissection of the 14 specimens revealed the following number of articular branches from the relevant nerves: 14 from dorsomedial cutaneous nerves, 11 from deep peroneal nerves, 6 from medial hallucal nerve, and 5 from lateral hallucal nerve. Dorsal incision mean length was 60.53 (range, 42.48-85.12) mm, and the plantar incision mean length was 88.08 (range, 77.32-111.21) mm. Conclusion: Evidence from this study has shown that partial dorsal denervation of the FMPJ may be a technically feasible procedure along with the presence of superficially easily dissected nerves with relatively small incision

Surgical treatment of nail bed subungual exostosis

WOS: 000390309700009PubMed ID: 26778465INTRODUCTION A subungual exostosis (SE) is a bony overgrowth that is permanently attached to the tip of the distal phalanx. Its pathology differs from osteocartilaginous exostoses in that it mainly involves the overgrowth of normal bone, which may present beneath the toenail or on the sides of the toe. This retrospective study aimed to report the results of surgical treatment when the diagnosis of SE was delayed; the condition was initially considered to be another pathology affecting a different nail or the terminal toe. METHODS A total of 17 patients (12 female, five male) were included in the study. All surgical resections were performed by the same surgeon using the same surgical technique, with the patient under digital anaesthesia. The patients were evaluated pre- and postoperatively (on Weeks 1 and 6, the first year, and the last follow-up visit) using the American Orthopaedic Foot and Ankle Society questionnaire and the Visual Analogue Scale score. RESULTS The patients underwent surgery for SE removal between December 2009 and October 2012. Their mean age was 21.3 +/- 4.4 (range 14-29) years and the mean follow-up period was 27.1 +/- 7.8 (range 18-45) months. Clinical or radiological recurrence was not observed in any of the patients during the follow-up period. Four patients had superficial infections, which were treated using appropriate antibiotic therapies. CONCLUSION As SE is an uncommon benign lesion, its diagnosis may be delayed. Radiography may be useful in obtaining a differential diagnosis

An unusual site for renal metastasis: A pictorial presentation

WOS: 000346402700015PubMed ID: 24982001The differential diagnosis of shoulder pain and restricted motion includes primary or metastatic cancer. Common cancers, such as breast, prostate, thyroid, lung, and renal, frequently metastasize to bone [1]. Bone metastasis is rarely asymptomatic, rather triggering refractory and persistent bone pain. Osteolysis is accompanied by increased bone fragility and pathologic fractures. These typically occur in weight-bearing bones such as the femur or pelvis. Breast, lung, and renal metastases cause extensive bone destruction and pain [2]

Percutaneous plantar fascia release with needle: Anatomic evaluation with cadaveric specimens

Percutaneous plantar fascia release with needle is a novel procedure for the treatment of plantar fasciitis. The objective of this cadaveric study is to perform an anatomic evaluation of the percutaneous plantar fascia release method using a conventional hypodermic needle. In this study, we used 14 fresh-frozen cadaveric trans-tibial amputation specimens. Percutaneous plantar fasciotomy with a conventional hypodermic needle was performed. After a proper dissection, the width of the plantar fascia, the thickness of the medial border, and the width of the cut segment were measured and recorded. Any muscle damage on the flexor digitorum brevis and damaged area depth were recorded. Any damage on the lateral plantar nerve and the first branch of the lateral plantar nerve, also known as Baxter's nerve, and their distance to fasciotomy were also recorded. Mean width (± standard deviation) of the plantar fascia was measured as 20.34 ± 4.25 mm. The mean thickness of the medial border of the plantar fascia was 3.04 ± 0.54 mm. Partial fasciotomy was performed in all cadavers with 49.47% ± 7.25% relative width of the plantar fascia. No lateral plantar nerve, or its first branch Baxter's nerve, was damaged, and the mean distance from the deepest point of the fasciotomy up to the Baxter's nerve was 8.62 ± 2.62 mm. This cadaveric study demonstrated that partial plantar fasciotomy can be achieved via percutaneous plantar fascia release with a conventional hypodermic needle without any nerve damage