Tibial torus and toddler's fractures misdiagnosed as transient synovitis: a case series

<p>Abstract</p> <p>Introduction</p> <p>The high incidence of transient synovitis in early childhood makes it the first suspected pathology in a limping child. Trauma, which has long been regarded as a causative factor for transient synovitis, may be underestimated in a non-cooperative toddler.</p> <p>After excluding most serious conditions, such as septic arthritis, a speculative diagnosis of transient synovitis can be made, and this can easily mask a subtle musculoskeletal injury.</p> <p>Case presentations</p> <p>We report the cases of three Caucasian patients (two boys, aged 20-months- and three-years-old, and one girl, aged two-years-old), with tibial torus and toddler's fractures which were late-diagnosed due to an initial misdiagnosis of transient synovitis of the hip.</p> <p>Conclusion</p> <p>In a non-cooperative child musculoskeletal trauma can be mistaken as a simple causative factor for transient synovitis of the hip and this can easily prevent further investigation for a possible subtle musculoskeletal injury of the lower extremities.</p> <p>Our experience with the presented cases suggests the need to be more vigilant in the differential diagnosis of transient synovitis in young children.</p

An unusual complication after syndesmotic injury: retrotibial heterotopic ossification

A 27-year-old male patient sustained an isolated syndesmotic injury in the right ankle following a fall. His complaints subsided gradually within the first six weeks of conservative treatment. At the end of the third month, he returned to follow-up with posterior ankle pain. Radiological examinations revealed heterotopic ossification adjacent to the posterior inferior tibiofibular ligament and posterior capsule. His complaints disappeared only after local excision of the ossification. Heterotopic ossification may be a cause of persistent pain after ankle ligament injuries

Results of surgical management of valgus-impacted proximal humerus fractures with structural allografts

Objective: The aim of this study was to clinically and radiologically evaluate patients treated with plate osteosynthesis with structural allografts for severely valgus-impacted fractures of the proximal humerus

Treatment of Tibial and Femoral Bone Defects With Bone Transport Over an Intramedullary Nail

Objectives: To evaluate the results of the bone transport over an intramedullary nail (BTON) technique for the treatment of segmental bone defects. Design: Retrospective review of case series. Setting: Level 1 trauma center. Patients/Participants: We included 40 patients who underwent reconstruction of the lower limb with BTON technique between 2000 and 2018. The technique was performed in the tibial segments in 21 patients and in the femoral segments in 19 patients. Intervention: The surgical technique was performed in 2 stages for patients with infected nonunion. Infection was eradicated in all patients at the first stage. For the BTON at the second stage, monolateral external fixators and circular external fixators were used for femoral and tibial defects, respectively. In cases of defects without any infection, debridement with a single-stage BTON was performed. Main Outcome Measurements: Complications as well as radiological and clinical results were evaluated according to the criteria of Paley-Maar. Results: Minor complications occurred in 11 patients: pin site problems (9), cellulitis (1), and skin detachment due to Schanz screw (1). Major complications occurred in 8 patients: docking site nonunion (4), early consolidation and Schanz screw failure (1), knee flexion contracture (1), and ankle equinus contracture (2). Four patients had osteomyelitis as residual sequelae. Bone score was excellent in 27 patients. Excellent functional results were obtained in 31 patients. Conclusions: The BTON technique is associated with low cost because of the short treatment period, low complication risk, and rapid rehabilitation and is not limited by the amount of bone transport

Recovery of acids from anaerobic acidification broth by liquid-liquid extraction

In this study, anaerobic acidification of sugar beet processing wastes and subsequent liquid-liquid extraction of produced fermentation metabolites were investigated. The aim of extraction experiments was to asses the influence of pH and extractant (trioctylphosphine oxide (TOPO) in kerosene) concentrations on the recovery of volatile fatty acids (VFAs) from fermentation broth. The effect of TOPO in kerosene concentration was as crucial as the effect of pH on the recovery of VFAs via extraction. Consequently, pH 2.5 was determined as optimum. At this pH, percent recoveries of VFAs were changed from 43% to 98%, depending on the type of the acid extracted (acetic, butyric, propionic and valeric acids) and the concentration of TOPO in kerosene (5-20%). As the concentration of TOPO in kerosene was increased, efficiency of extraction was increased. As a result, highest VFA recoveries (61-98%) were observed at 20% TOPO in kerosene with distribution ratio values ranging between 1.54 and 40.79. At pH 2.5, the increase in TOPO concentration directly increased the chemical oxygen demand (COD) removal efficiencies, as it does for total VFA recovery. Up to 72% COD removals were achieved, at 20% TOPO in kerosene at pH 2.5, while the removal efficiencies remained between 19% and 22% at pH 5.5

The calcaneal angles in the Turkish population

Objectives: The purpose of this study was to determine the calcaneal angles on radiograms of individuals without a calcaneal fracture

Microfluidics and nanoparticles based amperometric biosensor for the detection of cyanobacteria (Planktothrix agardhii NIVA-CYA 116) DNA

Some of the cyanobacteria produce protease inhibitor oligopeptides such as cyanopeptolins and cause drinking water contamination; hence, their detection has great importance to monitor the well-being of water sources that is used for human consumption. In the current study, a fast and sensitive nucleic acid biosensor assay has been described where cyanopeptolin coding region of one of the cyanobacteria (Planktothrix agardhii NIVA-CYA 116) genome has been used as target for monitoring of the fresh water resources. A biochip that has two sets of Au electrode arrays, each consist of shared reference/counter electrodes and 3 working electrodes has been used for the assay. The biochip has been integrated to a microfluidics system and all steps of the assay have been performed during the reagent flow to achieve fast and sensitive DNA detection. On-line hybridization of the target on to the capture probe immobilized surface resulted in a very short assay duration with respect to the conventional static assays. The binding of the avidin and enzyme modified Au nanoparticles to the biotinylated detection probe and the subsequent injection of the substrate enabled a real-time amperometric measurement with a detection limit of 6 x 10(-12) M target DNA (calibration curve r(2)=0.98). The developed assay enables fast and sensitive detection of cyanopeptolin producing cyanobacteria from freshwater samples and hence shows a promising technology for toxic microorganism detection from environmental samples. (C) 2015 Elsevier B.V. All rights reserved

Effect of energy-based devices on voice quality after total thyroidectomy

Voice alteration is an important complication of thyroid surgery and is closely related to patients' quality of life. There are no studies analyzing effect of energy-based devices (EBD) on voice quality (VQ). Aim of this prospective study is to evaluate impact of sutureless total thyroidectomy performed with EBDs on objective voice parameters of patients without recurrent laryngeal nerve (RLN) and/or external branch of superior laryngeal nerve (EBSLN) injury. Sixty patients underwent total thyroidectomy with meticulous dissection of EBSLN. Patients were assigned to Group L (Ligasure (TM)), Group H (Harmonic), or Group C (Conventional) through random ballot. For analysis of alteration in VQ, digital videolaryngostroboscopy (VLS), voice handicap index (VHI), multidimensional voice program (MDVP), and electroglottography (EGG) were used. VLS was performed by 70A degrees-angled indirect laryngoscopy and evaluation was standardized by VLS scale and laryngeal function scoring. This study is registered on clinicaltrials.gov with number NCT01865006. Forty eight patients were female. There was no difference on demographic data. On post-operative laryngoscopic examination, none of the patients had vocal fold palsy. When mean VHI scores at post-operative 1st week and 2nd month were compared to pre-operative values for each groups, groups L and H demonstrated a significant increase in VHI in the early post-operative evaluation, while there was no significant increase for group C. No significant increase was seen in late post-operative period compareYd to pre-operative period for any groups. In the early post-operative period, VQ is better with the conventional technique than EBDs; however, in late post-operative period, VQ is detected better in EBDs (especially in Group L) than the conventional technique, but no statistical difference was observed