The role of simple elbow dislocations in cubitus valgus development in children

We investigated the functional and radiological outcomes of conservatively treated simple traumatic elbow dislocations and subsequent incidence of cubitus valgus development in children. Eleven patients (one female, ten male; mean age 9.8 years, range seven to 12 years) who presented to our hospital with simple elbow dislocations and were conservatively treated between July 2008 and September 2010 were included in the study. All were posterolateral closed dislocations. None of the patients had accompanying elbow fractures. All patients had pre- and postoperative radiographic examinations. The carrying angle of the involved elbow was measured and compared to the contralateral non-injured elbow during follow-up. The incidence and severity of cubitus valgus development was assessed. The functional and clinical outcomes were evaluated using the Mayo Elbow Performance Scale. The mean monitoring period was 24.3 months (range 19-30 months). All patients had satisfactory good and excellent results (85-100 points; mean 96.8 points) according to the Mayo Elbow Performance Scale. The final average elbow flexion was 137A degrees (range, 130-145A degrees) and average extension was 8.6A degrees (range 0-20A degrees) with full supination and pronation in traumatic elbow. Four patients (36.4 %) had an average increase (cubitus valgus) of 14.5A degrees (10-20A degrees) in carrying angle compared to the other elbow. While isolated traumatic dislocation of the elbow is uncommon among children, it can be successfully treated by urgent closed reduction, proper fixation of the elbow and appropriate timely rehabilitation. However, it should be considered that some patients may develop cubitus valgus deformity in a later period. Therefore, each patient with a simple traumatic elbow dislocation should be followed, and the parents should be informed of the potential for any deformity development

Case Report Bilateral Simultaneous Heterotopic Ossification of the Reflected Head of Rectus Femoris Muscle: A Case Report and Review of the Literature

Lamellar bone formation in an abnormal location is defined as heterotopic ossification. It commonly occurs around the hip joint and most often involves the abductor muscles. It is a benign condition; however, its etiology remains largely unknown. Most previously reported cases have been due to trauma or intramuscular hemorrhage. In this paper, we present a case of bilateral heterotopic ossification of the reflected head of rectus femoris muscle without antecedent trauma or any other known cause, as the first and unique case in the literature. She was treated by excision of the right symptomatic bony mass via a modified SmithPetersen approach. Postoperatively, she received 75 mg indomethacin daily for six weeks. She was pain-free and obtained full range of motion 3 weeks after the first intervention

Bilateral Simultaneous Heterotopic Ossification of the Reflected Head of Rectus Femoris Muscle: A Case Report and Review of the Literature

Lamellar bone formation in an abnormal location is defined as heterotopic ossification. It commonly occurs around the hip joint and most often involves the abductor muscles. It is a benign condition; however, its etiology remains largely unknown. Most previously reported cases have been due to trauma or intramuscular hemorrhage. In this paper, we present a case of bilateral heterotopic ossification of the reflected head of rectus femoris muscle without antecedent trauma or any other known cause, as the first and unique case in the literature. She was treated by excision of the right symptomatic bony mass via a modified Smith-Petersen approach. Postoperatively, she received 75 mg indomethacin daily for six weeks. She was pain-free and obtained full range of motion 3 weeks after the first intervention

Tohma çayı yukarı havzasının (kangal batısı) jeomorfolojisi

This study focus on geomorphological properties of Tohma Stream’s Upper Basin and its’ morphological development. Study area consist of west half of Kangal Basin which constitutes eastern part of Uzunyayla Plateau. Kangal Basin on Late Miocene-Pliocene which are surrounded by highland, are a structural plateau area. Because of the fact that the highland in North and South has been limited by the thrust and reverse faults, the research area is the intermontane basin. This types of basin which had been formed in neo orogenical zones, are called Piggy-back basin in geology. Highland, plateau and valleys are main morphological units in the research area in which its height is approximately 1650 m. Left lateral faults in the strike of northeast-southwest and right lateral faults in the strike of northwest-southeast which cut the left lateral fault, vertically, developed as secondary faults in the north and south of basin. Offset ridge and valley, fault scarps, sag-pond, triangular facets, and big mass movements have been seen throughout fault zones. Geomorphological units can be seen in curled, faulty, horizontal and monoclinal structure at the Basin which is important in terms of morphological and tectonic. Typical karstic units developed on limestones based on Mesozoic, Miocene and Pliocene. The Basin which was the sedimentation area throughout Late Miocene-Pliocene had been bounded to the external drainage by dried up lakes in Quaternary. Rivers which sink deeply into their beds on the basin gangue, epirogeneticly, had constituted important gorges.1980 Bu çalışmada, Tohma Çayı Yukarı Havzası’nm jeomorfolojik özellikleri ve havzanın morfolojik gelişiminin ortaya konulması amaçlanmıştır. İnceleme alanı, Uzunyayla Platosu’nun doğu bölümünü oluşturan, Kangal Havzası’mn batı yarısını kapsamaktadır. Üst Miyosen-Pliyosen yaşlı Kangal Havzası dağlık alanlarla çevrelenmiş bir yapısal plato alanıdır. Kuzey ve güneydeki dağlık alanlar bindirme ve ters faylarla sınırlandırılmış olduğundan inceleme alanı bir dağ arası havzasıdır. Genç orojenik kuşaklarda oluşan bu tip havzalara jeolojide piggy-back havza denilmektedir. Ortalama 1650 m yükseltilerinde bir yapısal platoya karşılık gelen inceleme alanında dağlık alanlar, platolar ve vadiler ana jeomorfolojik birimlerdir. Havzanın kuzey ve güneyinde KD-GB doğrultulu sol yanal atımlı faylar ve bu fayları dikine kesen KB-GD doğrultulu sağ yanal atımlı ikincil faylar gelişmiştir. Fay hatları boyunca, ötelenmiş sırt ve vadiler, fay diklikleri, fay façetaları, fay basamakları, fay gölleri ve kütle hareketleri görülmektedir. Ayrıca, kıvrımlı, kırıklı, bindirmek, yatay ve monoklinal yapıda tipik yapısal şekiller gelişmiştir. Geniş alanlarda yüzeyleyen Mesozoyik- Pliyosen kireçtaşları üzerinde tipik karstik şekiller oluşmuştur. Üst Miyosen-Pliyosen boyunca sürekli sedimantasyon alanı olan havza, Kuvaterner’de dış drenaja açılmıştır. Bölgesel ölçekli yükselmelere bağlı olarak havza dolgularını yaran akarsular epijenik boğazlar oluşturmuştur

Comparison of two different measurement methods to determine glenoid bone defects: area or width?

Background: This study compared two different techniques that have been used to measure the glenoids of patients with recurrent anterior shoulder dislocation. Methods: We analyzed 36 patients who had received arthroscopic Bankart repair for anterior shoulder instability. Retrospectively, 3-dimensional computed tomography images of both shoulders were available for these patients. Two measurement methods were compared to determine the glenoid defects. One of these techniques is based on linear measurement, previously defined as the glenoid index. The other method is based on surface area measurement. Subsequently, 3 more diameters and the average values obtained from these diameters were compared with the surface measurement method. Pearson correlation coefficient (r) was assessed to determine the relationship. Results: There was an almost perfect relationship between measurement methods when the defect area was less than 6% of the inferior glenoid circle (r, 0.915; P < .001). This relation decreased and the difference became more pronounced (r, 0.343; P=.657) when the bone loss exceeded 14% of the inferior glenoid circle. The highest correlations with the actual defects were the average values obtained from 4 different diameters (r, 0.964; P < .001) and the 4-o'clock position of the single diameter measurements (r, 0.860; P=.001). In addition, 11 patients had crescent-like defects, demonstrating a relatively low correlation between the measurement methods (r, 0.679; P=.021). Conclusion: Although the best correlation was achieved from average values obtained from different diameter positions, in practical use, we advise a linear measurement to estimate the glenoid bone loss at the 4-o'clock position to achieve a high correlation between the measurement techniques. Level of evidence: Level III, Diagnostic Study. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees

Newborn hip ultrasonography: Not challenging with interest, knowledge, training and experience

Amaç: Tüm yenidoğanlara uyguladığımız kalça ultrasonografisi sonuçlarımızı inceleyerek elde ettiğimiz verileri literatürle karşılaştırmayı ve konuya dikkat çekmeyi amaçladık. Gereç ve Yöntemler: Tüm yenidoğanlar, tarama programına alınarak fizik bakı ve ultrasonografi ile kalça eklemleri incelendi. Ebeveynler, gelişimsel kalça displazisi (GKD) hakkında bilgilendirildi. Pediatrik Ortopedi Derneğince tavsiye edilen Kalça Ultrasonografi Kayıt Formu dolduruldu. Bebeklere, Grafın statik kalça ultrasonografi metodu uygulandı. Ortolani ve Barlow testleri yapıldı ve abdüksiyon kısıtlılığı, Allis bulgusu ve pili asimetrisi varlığı araştırıldı. Geç dönemde ilk bulgularımız hastaların tekrar değerlendirilmesiyle doğrulandı. Bulgular: Altmış bebeğin (29 erkek, 31 kız) 120 kalçası çalışmaya dahil edildi. Fizik bakıda hiçbir hastada patolojik veri elde edilmedi. Ultrasonografik incelemeler ortalama 3,5 dk. sürdü. Ortalama anne yaşı 25 (19-38) yıldı. Pozitif aile öyküsü ve kundaklama öyküsü oranları % 3tü. Ortalama hamilelik süresi 38.5 (35-40) haftaydı. Bebeklerin başvuru süresindeki ortalama yaşı 20 (1-153) gündü. Ultrasonografik inceleme sonucunda, tüm kalça tipleri Tip 1b olarak ölçüldü. Ortalama 4,5 yıl sonra klinik ve radyolojik tetkiklerle kalçaların hiçbirinde patoloji saptanmadı. Sonuç: GKD erken tanısında kalça ultrasonografisi, fizik bakıyla beraber en güvenilir yöntemdir. Tüm yenidoğan kalçalarının ultrasonografik olarak taranması en idealidir. Ülkemiz koşullarında bunun maliyeti düşünüldüğünde, en azından riskli yenidoğanların ve pozitif fizik bakı bulgusu bulunan bebeklerin kalça eklemleri kesinlikle ultrasonografik olarak incelenmelidir.Objective: We analyzed the results of hip ultrasonography we performed on all newborns in our institution, and tried to to compare our results with the literature, and to take attention to the subject. Material and Methods: All newborns included in the screening program were evaluated by sonograms of their hip joints and physical examination. Parents were informed about developmental hip dysplasia (DDH). Hip Ultrasonography Registration Forms recommended by Pediatric Orthopedics Society, were filled. Static hip ultrasonography, introduced by Graf, were done to all babies. Ortolani and Barlow s tests were applied and abduction restriction, Allis sign and pilli asymetry were sought. We verified our data with late term re-evaluations of the patients. Results: 120 hips of 60 babies (29 male, 31 female) were included in the study. Physical evaluation did not reveal any pathologic finding. The mean duration of the ultrasonographic examinations was 3.5 minutes. The mean maternal age was 25 (range, 19-38) years. Positive familial history, and evidence of swaddling were found in 3 % of the newborns. The mean gestational period was 38.5 (range, 35-40) months. The mean age of the babies examined by US was 20 (range, 1-153) days. Ultrasonographically, all hips were found to be type 1b. After a 4.5 year average follow-up there were no pathology in any hips as assessed by clinical and radiological evaluations. Conclusion: Hip ultrasonography and physical examination are the most reliable methods in the early diagnosis of DDH. The most ideal method is US screening of all newborns. In our country, because of its costs, at least, newborns under risk and those with positive physical findings must be evaluated by ultrasonography

Giant Cell Tumor of Second and Third Metatarsals and a Simplified Surgical Technique: Report of Two Cases

Giant cell tumor (GCT) is a rare benign tumor that often arises in tendon sheath as well as long bones of the lower extremity in adults, although localization in the metatarsus is rare. In this report, the authors describe the rare case of GCT localized to the third metatarsal GCT in a skeletally mature 17-year-old girl, and also describe the results of distal metatarsal resection with Kirschner wire stabilization for the treatment of this condition. (C) 2011 by the American College of Foot and Ankle Surgeons. All rights reserved

Intra-Articular Polyacrylamide Hydrogel Injections Are Not Innocent

Osteoarthritis is a chronic disorder characterized by joint cartilage degeneration with concomitant changes in the synovium and subchondral bone metabolism. Many conservative treatment modalities, one of which is intra-articular injections, have been described for the treatment of this disorder. Traditionally, hyaluranic acid and corticosteroids are the agents that have been used for this purpose. Recently, polyacrylamide hydrogels are being used widely. Biocompatibility, nonbioabsorbability, and anti-infectious effect obtained by silver addition made polyacrylamide hydrogels more popular. In this paper, we present a case and the method of our management, in whom host tissue reaction (foreign body granuloma, edema, inflammation, and redness induration) has been observed, as the first and unique adverse effect reported in the literature

Thorax deformity, joint hypermobility, and anxiety disorders

Objective: To evaluate the association between thorax deformities, panic disorder, and joint hypermobility

The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis

Background: An accepted comprehensive clinical approach to the deformed spine with tuberculous infection is still lacking. We aimed to determine the usage of a staged algorithm in the treatment of kyphotic spine with tuberculous infection and to present the clinical results of the patients treated with the help of this protocol. Materials and Methods: 54 patients (28 females, 26 males) with a mean age of 39.2 (22-76) years. Preoperative, early postoperative, and followup clinical and radiologic results were evaluated retrospectively. The patients were classified into Kaplan A (kyphotic deformity <30°), Kaplan B (kyphotic deformity 30°-60°) and Kaplan C (kyphotic deformity >60°). They were operated by posterior instrument with anterior debridment (Kaplan A), debridment with anterior bone grafting (Kaplan B) and anterior column resection and bone grafting in Kaplan C. Results: Tuberculous involvement were seen at more than one level in 40 patients and paraspinal abscess were detected in 31. Preoperative focal kyphotic deformity was reconstructed with an average of 19 (9-38) degrees. Twenty-six patients had neurologic compromise with different severities and 12 of them improved after the surgical intervention. Improvement in work ability and pain status was detected in 52% and 61% of the patients, respectively. Wound complications responding to medical care were detected in nine patients. Initial kyphotic deformity was found as an important parameter in selecting the surgical procedure. Conclusion: Regarding resected amount of infected osseous material, as planned preoperatively, have resulted with better concordance between anterior and posterior column heights and better sagittal alignment. We could correct kyphosis and improve sagittal balance with staged algorithm as used by us