Adolescent in conservative treatment of avulsion fracture of ınferior anterior ıliac spine (two cases report)

Spina Iliaka Anterior Inferior (SIAI) avülsiyon kırıkları pelvik kemiklerin çok sık görülmeyen yaralanmalarındandır. Genelde futbolcularda sut çekme esnasında tanımlanmıstır. Olgularımızın ikisi de amatör futbol onayan sporculardı. Her iki olguda futbol maçı esnasında sut çektikten sonra baslayan kalça agrısı nedeniyle poliklinigimize basvurdular. Her iki olgudada SIAI avülsiyon kırıgı saptandı. Yük vermeden yürüme ve steroid olmayan antiinflamatuar ilaçlar ile dört hafta istirahat ettirildiler. Dört haftanın sonucunda yapılan fizik muayenelerinde pasif kalça hareket açıklıkları tam ve agrısız olarak degerlendirildi. Altıncı haftanın sonunda yapılan fizik muayenelerinde aktif ve agrısız olarak tam eklem hareket açıklıgına ulasılmıstı. Çalısmamızda futbolcularda daha çok rastlanabilecek SIAI avülsiyon kırıklarının koservatif tedavi sonuçlarının yeterli oldugu sonucuna vardık.Avulsion fractures of spina iliaca anterior inferior (SIAI) are among the infrequent injuries of pelvic bones, which are usually described during shooting in football players. Both of our cases were amateur football players, presented to our clinic with pelvic pain which began just after shooting during a football game. Both cases were detected to have SIAI avulsion fractures. They were offered rest for 4 weeks with non-weight bearing plus nonsteroidal anti-inflammatory drugs. At the end of four weeks, physical examination revealed complete and painless passive range of motion of hip. Upon further physical examination at the end of sixth weeks, active, painless and complete range of motion were achieved. In our study, we concluded that results of conservative treatment were satisfactory in avulsion fractures of SIAI that may commonly be encountered in football players

A Very Rare Fracture: Isolated Fresh Lunate Fracture

Lunate fractures are rare and usually occur together with other fractures, dislocations, or ligament disruptions. We want to report an acute fresh isolated lunate fracture without additional ligamentous injury fixated with early surgical intervention. A 23-year-old right-hand-dominated male patient was admitted to our hospital after falling from 1.5-meter ladder over right hand’s palmar face. Standard radiographs diagnosed a displaced lunate fracture. In the intraoperative evaluation, it was observed that there was only lunate dislocation, and there was no ligament lesion or other carpal bone pathology. Fracture was fixed with a headless cannulated screw. Radiographs showed bony union at 6-week follow-up. There was no evidence for Kienböck’s disease 6 months after surgery. Case report regarding fresh isolated lunate fracture that results in clinical success with early intervention without developing avascular necrosis as in our report is extremely rare. In conclusion, satisfying results can be obtained in these patients with careful surgical intervention

Mini-plate fixation via sinus tarsi approach is superior to cannulated screw in intra-articular calcaneal fractures: A prospective randomized study

WOS: 000441599800001PubMed ID: 30101667Objective: Intra-articular displaced calcaneal fractures are common fractures and are often treated with surgical interventions. Sinus tarsi approach provides secure access to lateral wall and joint facets. The aim of the study is to compare cannulated screw (CS) fixation and mini-plate (MP) fixation via sinus tarsi approach with Sanders types 2 and 3 fracture of calcaneus. Methods: Sixty patients with Sanders types 2 and 3 calcaneal fracture underwent surgical intervention were randomly allocated into two groups as group MP fixation and group CS fixation regarding osteosynthesis method for 5-year period. Open reduction via sinus tarsi approach was performed in both groups. Demographic variables, time to surgery (TS), operation duration (OD), length of hospital stay (LOS), surgical complications, and reoperations were recorded. Pre- and postoperative Gissane and Bohler angles; calcaneal length, height, and width; ankle anterior-posterior (AP) and lateral X-rays; and computed tomography were also recorded for radiological evaluation and fracture characteristics. Maryland Foot Score (MFS) was used to evaluate functional outcomes. Results: Preoperative age, type of fracture, calcaneal length, height, and Gissane and Bohler angles, TS, LOS, and OD were not different between the groups. The postoperative calcaneal widening was significantly better restored in group MP compared with that of group CS. The incidence of reoperation and algoneurodystrophy was statistically higher in group CS than group MP. MFS in group MP was also higher than group CS at final visit. Conclusion: MP fixation via sinus tarsi approach is superior to CS fixation in Sanders types 2 and 3 calcaneal fractures

Nadir bir dirsek ağrısı nedeni: Hegemann hastalığı

WOS: 000376564200037Non-traumatic elbow pain is rarely seen in children and pre-adolescents. Osteochondral lesions may be the source of chronic elbow pain, swelling, and loss of motion in children or adolescents. Osteochondritis dissecans (OCD) is described as a lesion of subchondral bone resulting in separation of the articular cartilage and subchondral bone. It is found primarily in the knee, ankle, and elbow joints. Since osteochondrosis of the elbow primarily involves capitellum, few papers involving osteonecrosis of the trochlea have been reported. This paper discusses a pre-adolescent boy with clinical and radiographic signs consistent with unilateral osteochondral lesion of the trochlea humeri, with no history of recent trauma. The patient had insidious onset of right elbow pain during daily activities for the last 3 weeks. After usage of long arm splint for 2 weeks, persistence of the symptoms necessitated MRI of the affected elbow. After the diagnosis, non-operative management was achieved. Care should be taken for the affected children to recognize any residual deformity and to treat it properly at follow up.Travma olmaksızın dirsek ağrısı çocuklarda ergenlik öncesi dönemde nadir görülür. Bu dönemde kronik dirsek ağrısı, şişlik ve eklem hareket kaybı osteokondral lezyonlara bağlı olabilir. Osteokondritis dissekans, subkondral kemik ile eklem kıkırdağının subkondral kemikteki bir lezyona bağlı ayrışması olarak tanımlanır. Özellikle diz, ayak bileği ve dirsek eklemlerinde görülür. Dirsek osteokondrozunda birincil olarak kapitellum etkilenmekteyken, troklea osteonekrozu ile ilgili az sayıda olgu bildirilmiştir. Bu yazıda yakın zamanda travma öyküsü olmayan, ergenlik öncesi dönemde bulunan, klinik ve radyolojik olarak tek taraflı troklea osteokondral lezyonu ile uyumlu olan bir olgu sunulmuştur. Hastada son 3 haftadır daha önce belirti vermeyen, günlük aktivitelerde ortaya çıkan sağ dirsek ağrısı mevcuttu. 2 hafta uzun kol atelde takip edilen hastada şikayetlerin devamı üzerine dirsek MR görüntülemesine ihtiyaç duyuldu. Tanı konduktan sonra cerrahi dışı tedavi ile başarılı sonuç elde edildi. Çocuklarda rezidüel deformitenin tanınması ve uygun tedavisi için takipte dikkatli olunmalıdır

Effect of both preoperative and postoperative cryoceutical treatment on hemostasis and postoperative pain following total knee arthroplasty

Aim: We aimed to evaluate the hemostatic effects and the clinical outcomes of preoperative and postoperative cryoceutical treatment (C-tx) following total knee arthroplasty. Patients and method: 42 patients received C-tx both preoperatively, and postoperatively. In the control group, 45 patients did not receive any C-tx. Amount of bloody drainage and verbal rating pain scores were noted. Results: We found significant difference in both the preoperative and postoperative hemoglobin levels and blood drainage (P 0.05). Conclusion: C-tx performed preoperatively and postoperatively for total knee arthroplasty is effective in decreasing perioperative and postoperative hemorrhage. However, it had no superior effect on the control of postoperative pain

Idiopathic talipes equinovarus with preaxial polydactyly of the foot: a case report

The aim of this study is to report an unusual combination of congenital idiopathic talipes equinovarus with preaxial polydactyly of the foot. A newborn infant was brought to the polyclinic at the age of 1 week. In the right foot, preaxial polydactyly was seen in addition to the club foot deformity. The preaxial polydactyly of the patient was surgically excised. The sutures were then removed and a series of plaster casts were applied according to the Ponseti method Then a Dennis-Brown brace was applied with both feet. This case shows that combination of congenital idiopathic talipes equinovarus with preaxial polydactyly of the foot can be treated succesfully by apply the standard Ponseti method after the surgical excision of the polydactyly. [Med-Science 2017; 6(4.000): 767-770

Congenital Insensitivity to Pain with Anhidrosis (CIPA) Manifested with Chronic Osteomyelitis; A Case Report

Chronic osteomyelitis is a very rare entity among children. Also congenital insen-sitivity to pain with anhidrosis (CIPA) is a very rare autosomal-recessive disease of the nervous system which is one of the hereditary sensory and autonomic neuropathies (HSAN). Loss of pain, fever due to anhidrosis, recurrent fractures, chronic osteomyelitis, mental retardation, self mutilation, wound ulcers can be seen. We present a 10-year-old boy with loss of generalized pain sensation, chronic osteomyelitis on his right distal femur, bilateral corneal opacities, and decreased mental capacity

Gouty arthritis at interphalangeal joint of foot after sildenafil use: A case report

INTRODUCTION: Interphalangeal joint of foot is a very unusual location for gouty arthritis and sildenafil use may cause this phenomenon. PRESENTATION OF CASE: A 58-year-old hypertensive man was admitted to hospital with pain and swelling over interphalengeal joint of his right great toe. His health history included the use of diuretics for a long time and his last gout attack was two years ago at first metatarsophalengeal joint of right foot. Sildenafil, a selective inhibitor of phosphodiesterase type 5 (PDE5), was administered in case of erectile dysfunction for two months. Subsequently, he had several episodes of pain and swelling at first interphalangeal joint of right great toe. Both the onset and recurrence of symptoms were just seen the day after sildenafil use. The patient was free of symptoms after discontinuation of the drug. After an initial evaluation, gout was diagnosed on the basis of synovial fluid analysis. DISCUSSION: This case demonstrates a rare location of gouty arthritis with an uncommon etiology: sildenafil. Regarding the clinical data, the discussion was made to expand the horizon for diagnosis of patients with similar symptoms, to identify risk factors for gout relevant to elderliness, and to review the management of gout. CONCLUSION: Sildenafil use may cause gouty arthritis, and surgical decompression may be helpful for definitive diagnosis and symptom relief in atypical presentation of gout

Quality of Life Following Treatment of Trochanteric Fractures with Proximal Femoral Nail versus Cementless Bipolar Hemiarthroplasty in Elderly

Purpose: There is currently no gold standard treatment for unstable intertrochanteric fractures of the elderly. Internal fixation and hemiarthroplasty are two common treatment methods but studies comparing the functional outcomes of these procedures in the elderly are limited. This study evaluates the functional outcomes of hip fracture patients treated either with internal fixation or hemiarthroplasty. Methods: Eighty-six elderly (>60 years) patients who presented with isolated, unstable intertrochanteric fractures between 2009 and 2013 were included in the study. According to the classification of Association for Osteosynthesis/Orthopaedic Trauma Association; 12 of the patients had a 31A1.3 fracture type, 36 of the patients had 31A2.2 and 19 had 31A2.3 fracture type, 12 had 31A3.1 and seven had 31A3.3 fracture. Forty-two of 86 hip patients (Group 1) were treated with intramedullary nailing and antirotator proximal femoral nail implant (TST, Turkey), and 44 (Group 2) were treated with cementless bipolar hemiarthroplasty. Preoperative social function (Jensen) score, EQ-5D index score and mobility (Palmer/Parker) scores were obtained. Five dimensions of EQ-5D were obtained at every follow-up visit until 24 months postoperative. Results: There was no statistically significant difference between two groups according to preoperative demographic variables, including mean age and sex and Jensen, Palmer/Parker,EQ-5D index, five dimensions of EQ-5D and American Society of Anesthesiologists scores. At end of 24 months follow-up, health-related quality of life had increased more in Group 1 and they reported better social functioning and mobility scores (