Salter-Harris Type III and Type IV Combined Fracture of the Distal Femoral Epiphysis: A Case Report

Distal femoral physeal fractures are not common but have a high rate of complications. They generally follow one of the patterns described in the Salter-Harris classification. We present a case of combination of Salter-Harris type III and type IV injury. Our case was a 15-year-old boy who had a motor vehicle accident. There was swelling, ecchymosis, severe pain, and valgus deformity, because of medial proximal fracture fragment, on the left knee. We deemed that Salter-Harris type III and type IV combination fracture in our case has not been previously reported. We prepared this paper in consideration of its contribution to the literature

Türk Popülasyonunda Akromion Morfolojisinin Subakromial İmpingement ve Rotator Manşet Yırtıkları ile İlişkisi

Amaç: Akromion tipleri ve os akromiale varlığının subakromial impingement ve rotator manşet yırtıkları ile ilişkisini manyetik rezonans görüntüleme aracılığıyla incelemeyi amaçladık.Gereç ve Yöntem: 18-85 yaş arasında omuz MR çekimi olan hastalar n=573 çalışmaya dahil edildi ve cerrahi öyküsü bulunan hastalar n=34 , travma öyküsü ve fraktürü olanlar n=23 çalışamadan çıkarıldı. 516 hastanın 516 omuz MR çekiminde os akromiale varlığı ve akromion tipleri belirlendi. Supraspinatus kasında impingement bulgusu olarak proton ağırlıklı görüntülerde hiperintens sinyal artımı ve yırtıkları değerlendirildi. Os akromiale varlığı ve akromion tipleri, supraspinatus sinyal artımı ve yırtıkları her hasta için aynı radyolog tarafından belirlendi.Bulgular: Supraspinatus tendonundada sinyal artışı olanlarda os akromiale %4 görülürken, sinyal artışı olmayanlarda %0.008 görüldü. Supraspinatus tendonunda yırtığı olanlarda os akromiale %0.06 görülürken, yırtığı olmayanlarda %0.02 görüldü. Os akromiale ile supraspinatus yırtığı arasında anlamlı ilişki izlenmedi p=0.055 . Os akromiale ile supraspinatus sinyali arasında ise anlamlı ilişki mevcuttu p=0.043 . Akromion tiplerinden Tip I ve Tip III ile supraspinatus sinyal artışı arasında anlamlı ilişki mevcuttu sırasıyla; p=0.028, p=0.029 . Ayrıca, Tip I ve Tip III akromionun supraspinatus tendonu yırtığı ile de anlamlı ilişkisi mevcuttu sırasıyla; p=0.009, p=0.0061 .Sonuç: Tip I ve Tip III akromion subakromial impingement sendromu ve supraspinatus tendon yırtığı açısından risk oluşturmaktadır. Os akromiale varlığıda impingement açısından risk oluşturan bir anatomik varyasyondu

The new ultralow dose CT protocol for the diagnosis of fractures of the ankle: A prospective comparative study with conventional CT

Purpose: Computerized tomography (CT) imaging is increasingly being used to evaluate patients with ankle trauma. However, conventional CT (C CT) has a significantly higher radiation dose (RD) than plain radiography. This study aimed to evaluate the diagnostic accuracy and reliability of ultra-low-dose CT (ULDCT) protocol for ankle fractures. Methods: Ninety-eight consecutive patients who had ankle CT for suspected ankle fracture were included in our prospective study. C CT and ULDCT protocols were simultaneously performed on these 98 patients. Two observers independently evaluated ULDCT and C CT images. The effective RD of the ULDCT and C CT groups was calculated. Results: The interobserver agreement was 1 (perfect). ULDCT and C CT group images showed no significant difference in image quality. The effective RD of the ULDCT was significantly lower than the C CT (p < 0.001). Conclusions: By evaluating the results of this study, ULDCT proved to be a reliable diagnostic imaging method for fractures of the ankle. The satisfactory diagnostic image quality of the ULDCT protocol provides promising results. Level of Evidence: Level II/lesser quality RCT or prospective comparative study

Ultra-low-dose computed tomography and its utility in wrist trauma in the emergency department

Background: The use and frequency of computed tomography (CT) are increasing day by day in emergency departments (ED). This increases the amount of radiation exposed. Purpose: To evaluate the image quality obtained by ultra-low-dose CT (ULDCT) in patients with suspected wrist fractures in the ED and to investigate whether it is an alternative to standard-dose CT (SDCT). Material and Methods: This is a study prospectively examining 336 patients who consulted the ED for wrist trauma. After exclusion criteria were applied, the patients were divided into the study and control groups. Then, SDCT (120 kVp and 100 mAs) and ULDCT (80 kVp and 5 mAs) wrist protocols were applied simultaneously. The images obtained were evaluated for image quality and fracture independently by a radiologist and an emergency medical specialist using a 5-point scale. Results: The effective radiation dose calculated for the control group scans was 41.1 ± 2.1 µSv, whereas the effective radiation dose calculated for the study group scans was 0.5 ± 0.0 µSv. The effective radiation dose of the study group was significantly lower than that of the control group (P < 0.01). The CT images in the study group showed no significant differences in the mean image quality score between observer 1 and observer 2 (3.4 and 4.3, respectively; P = 0.58). Both observers could detect all fractures using the ULDCT images. Conclusion: ULDCT provides high-quality images in wrist traumas while reducing the radiation dose by approximately 98% compared to SDCT without any changes in diagnostic accuracy

3D volumetric Mr arthrographic assessment of shoulder joint capacity in patients with primary adhesive capsulitis

Objective To evaluate the three-dimensional (3D) volumetric MR arthrographic findings of shoulder joint capacity in patients with primary adhesive capsulitis. Methods Thin-section 3D volumetric MR arthrography sequences of the shoulder joint were obtained in 28 patients with clinically and radiologically proven primary adhesive capsulitis and in 25 controls. Volumetric measurements of the total glenohumeral joint capacity, extra-articular contrast material leakage, and the rotator interval, axillary recess, and biceps tendon sheath capacities were performed for the study and control groups. results Mean volume of the rotator interval was 7.67 ± 2.6 cm 3 in the study group, which was significantly lower than in the control group (12.31 ± 2.5 cm 3 ) (p < 0.0001). Mean volume of the bicipital groove was significantly decreased in the patient group compared to the control group (1.67 ± 0.9 cm 3 vs 2.88 ± 0.9 cm 3 ) (p ≤ 0.0001). Mean volume of extra articular contrast material extravasation was 9.93 ± 1.7 cm 3 in the patient group, which was significantly higher than in the control group (5.1 ± 1.4 cm 3 ) (p = 0.002). Mean total glenohumeral joint volume was 22.52 ± 1.1 cm 3 in the patient group and 26.01 ± 1.2 cm 3 in the control group (p = 0.003). conclusion On 3D volumetric MR arthrographic examination, obliterations in the biceps tendon sheath and rotator interval as well as decreased joint capacity may be useful imaging criteria for diagnosing primary adhesive capsulitis. advances in knowledge In the present study, MR arthrography showed contrast material extravasation in 71% of the patients and showed extra articular contrast material extravasation in 48% of the control subjects. On 3D volumetric MR arthrographic examination, obliterations in the biceps tendon sheath and rotator interval as well as decreased joint capacity may be useful imaging criteria for diagnosing primary adhesive capsulitis.In patients with primary adhesive capsulitis, thin-section 3D volumetric MR arthrography is a useful imaging modality to evaluate both joint capacity and capsular structure

Comparison of Open Bankart Repair versus Modified Bristow Operation for the Treatment of Traumatic Recurrent Anterior Dislocation and Capsular Laxity of the Shoulder

Objective: The purpose of this study was to compare the results of open Bankart repair versus those of modified Bristow operation in patients with recurrent anterior dislocations of the shoulder, the last of which was caused by a minor trauma. Materials and Methods: This study included 38 patients (34 (89.5%) male and 4 (10.5%) female) who presented recurrent dislocation of the shoulders with capsular laxity and who underwent an open Bankart repair or a modified Bristow operation. The mean age of the patients was 29.6 years (range, 17-60 years). The mean follow-up period was 5.5 years (range, 35 months to 9 years). A total of 25 patients (65.8%) underwent an open Bankart repair, whereas 13 (34.2%) underwent a modified Bristow operation. The treatment results were assessed using the Rowe score for instability. Results: Of the 38 shoulders assessed, 24 (63.1%) were right shoulders and 14 (36.9%) were left shoulders. Furthermore, 26 (68.4%) were the dominant shoulders of the patients, and 12 (31.6%) were the non-dominant shoulders. The mean time from the first dislocation was 3.8 years (range, 10 months to 11 years). The age at which the first shoulder dislocation occurred was 20 years or younger in 7 cases (18.4%), 21-30 years in 22 cases (57.9%), 31-40 years in 6 cases (15.8%) and 41 or older in 3 cases (7.9%). The patients had experienced 4-10 recurrent dislocations in 15 cases (39.5%), 10-20 recurrent dislocations in 10 cases (26.3%) and 20 or more recurrent dislocations in 13 cases (34.2%). The mean Rowe score was 85.6 following open Bankart repair and 81.9 following modified Bristow. No significant difference was observed between these good and excellent Rowe scores following the open Bankart repair and the modified Bristow operation (p>0.05). Conclusion: Proper patient selection for the open Bankart repair and the modified Bristow operation is crucial. When the proper patients have been selected for these procedures, both produce satisfactory results for the treatment of patients with capsular laxities

The efficiency of Polytendon Complex (PC) and St. John's Wort oil (Hypericum perforatum) on healthy Achilles tendon in rats

Aim: This experimental animal study aimed to investigate the effects of Tendoflex (R) (a polytendon complex) and St. John's wort oil (Hypericum perforatum) on healthy Achilles tendons in rats

The effects of Tendoflex (R) (polytendon complex) and Hypericum perforatum (St. John's wort oil) on repaired Achilles tendon healing in rats

Objectives: This experimental study aims to examine the effects of Tendoflex (R) and Hypericum perforatum on tendon healing in rat models undergoing iatrogenic Achilles tendon rupture and similar surgical treatments. Materials and methods: Eighty Wistar albino rats weighing 250 to 350 g were randomly divided into four groups. Group A: Tendoflex (R) was administered orally as 1 capsule/2.5 kg daily by gavage. Group B: Hypericum perforatum was administered orally as 300 mg/kg daily by gavage. Group C: Tendoflex (R) and Hypericum perforatum were co-administered orally by gavage at the prespecified doses. Group D: No medication was given to the control group. Five rats from each group were sacrificed weekly, and the tissue samples were examined histologically, followed by the biomechanical tests of the Achilles tendon. Results: In the mechanical testing, pulling forces were superior in all intervention groups and in all weeks over the control group. In particular, in the early periods (Weeks 1, 2, and 3), the mixed group showed the most favorable results, followed by the Hypericum perforatum group (p=0.010, p=0.591, and p=0.130, respectively). The most favorable collagen type I and type III expression values were found in the mixed and Hypericum perforatum groups at Weeks 2 and 3, respectively (p=0.025 and p=0.018). In the immunohistochemical and Western Blot examinations, extreme collagen type I and type III expression were detected in the mixed and Hypericum perforatum groups at Weeks 2, 3, and 4. Conclusion: Tensile strength of the Achilles tendon increased by using Hypericum perforatum and Tendoflex (R) following rupture and repair of the Achilles tendon in rats. The combined use of these two agents yielded the most favorable mechanical and histological results, particularly in the early period. This result may be related to the higher level of collagen type I and type III immunity in all groups, compared to the control group