Akın Üzümcügil

Intraneural hemangioma of digital nerve diagnosed with MR imaging

Hemangioma may occur at any location. Although the imaging findings of hemangioma are well known, it may be difficult to differentiate this entity from other soft-tissue tumors. Intraneural hemangiomas are extremely rare. We present a girl with a painful swelling in the fourth web space of her right hand. Since it was painful, the referring clinician considered the possibility of a glomus tumor. However, demonstration of dilated feeding or draining vessels suggested the diagnosis of hemangioma. At surgery a hemangioma of the ulnar digital nerve of the ring finger was resected marginally.

[Intra-articular sodium hyaluronate injections after arthroscopic debridement for osteoarthritis of the knee: a prospective, randomized, controlled study].

OBJECTIVES The purpose of this study was to evaluate the effect of intra-articular hyaluronic acid (HA) injections after arthroscopic debridement on pain and functional parameters in patients with mild-to-moderate knee osteoarthritis. METHODS Sixty-seven patients (21 men, 46 women; mean age 56 years; range 40 to 65 years) who underwent standard arthroscopic debridement for primary knee osteoarthritis of Kellgren-Lawrence grade II-III were randomly assigned to HA injections (n=33) or to only follow-up as controls (n=34). Intra-articular sodium hyaluronate injections (Orthovisc) were started three weeks after arthroscopic debridement, totaling three injections interspersed with a week. The two groups were evaluated with the pain and physical function subscales of the WOMAC osteoarthritis index before and after 6, 12, and 24 weeks of arthroscopic debridement. RESULTS Improvement in pain scores at 6 weeks did not differ between the two groups (HA 21%, control 16%; p=0.478), whereas improvement in function scores was significantly higher in the HA group (23% vs 9.2%; p=0.018). The rates of improvement in pain and function scores increased in subsequent evaluations, but these did not differ significantly between the two groups. The percentages of patients who exhibited at least 30% and 40% improvement from baseline function scores were significantly greater in the HA group only at six weeks (p=0.025 and p=0.038, respectively). CONCLUSION Intra-articular HA injections after arthroscopic debridement provide additional short-term benefits, but this combination therapy should be justified by further controlled studies with longer follow-up and larger patient groups.

Recovery of upper extremity function following endoscopically assisted contralateral C7 transfer for obstetrical brachial plexus injury.

Transfer of the contralateral C7 nerve for reconstruction of the brachial plexus in infants with obstetrical brachial plexus injury has rarely been reported. We developed a new endoscopy-assisted technique via the prevertebral (retroesophageal) route for the transfer of the contralateral C7 nerve in reconstruction of the brachial plexus. The reconstruction was performed in 20 infants (14 boys and six girls). Motor recovery was assessed using the Gilbert and Raimondi scales. The Narakas Sensory Grading System was used to evaluate hand sensation. The mean follow-up period was 45 months (SD 18.2). Of the 20 children, nine had contralateral C7 transfer to lower nerve roots, two had transfer to upper nerve roots and nine had transfer to both upper and lower roots. The postoperative shoulder and elbow functions were good or satisfactory according to the Gilbert classification in all children whose preoperative scores were poor. All patients with lower roots reconstruction (9) had satisfactory hand function. A total of 15 children had a Narakas score of S3. Our technique enables safe contralateral C7 transfer to the avulsed roots in severe obstetrical brachial plexus injury infants with a satisfactory functional recovery. Level of evidence: Level IV

The epidemiology and cost analysis of patients presented to Emergency Department following traffic accidents

Background Traffic accidents are ranked first as the cause of personal injury throughout the world. The high number of traffic accidents yielding injuries and fatalities makes them of great importance to Emergency Departments. Material/Methods Patients admitted to Hacettepe University Faculty of Medicine Adult Emergency Department due to traffic accidents were investigated epidemiologically. Differences between groups were evaluated by Kruskall-Wallis, Mann-Whitney, and Wilcoxon tests. A value of p<0.05 was accepted as statistically significant. Results We included 2003 patients over 16 years of age. The mean age was 39.6±16.1 and 55% were males. Admissions by ambulance and due to motor vehicle accidents were the most common. In 2004 the rate of traffic accidents (15.3%) was higher than the other years, the most common month was May (10.8%), and the most common time period was 6 pm to 12 am (midnight). About half of the patients (51.5%) were admitted in the first 30 minutes. Life-threatening condition was present in 9.6% of the patients. Head trauma was the most common type of trauma, with the rate of 18.3%. Mortality rate was 81.8%. The average length of hospital stay was 403 minutes (6.7 hours) and the average cost per patient was 983±4364 TL. Conclusions Further studies are needed to compare the cost found in this study with the mean cost for Turkey. However, the most important step to reduce the direct and indirect costs due to traffic accidents is the prevention of these accidents.

Endoscopy and Percutaneous Suturing in the Achilles Tendon Ruptures

Achilles tendon ruptures commonly occur during sportive activities and there is a tendency of increasing in the incidence of ruptures because of “weekend warriors” who are over 30 years of age. These pathologies are the third most frequent major tendon ruptures after rotator cuff and quadriceps ruptures. Various modalities have been recommended as appropriate treatment options for Achilles tendon ruptures. Nevertheless, there is no consensus on the treatment method, and it is still determined by the surgeon and the patient. Open surgical repair of the Achilles tendon carries specific risks including adhesions between the tendon and the skin, infection, and particularly wound breakdown. Therefore, to avoid these complications the percutaneous repair technique has been described and has become popular. Endoscopy-assisted percutaneous suturing of the Achilles tendon under infiltration anesthesia proffers a rational alternative for the treatment of both athletic and non-athletic individuals. This technique resulted in a cosmetic wound appearance, endurable to early active mobilization and satisfactory clinical recovery without any severe complication. Furthermore, this procedure protects the paratenon and thus blood supplies of the tendon, and enhances biologic recovery. Also direct visualization and manipulation of the tendon ends provides a precise apposition of the ruptured tendon, thus diminishing the handicaps of the single percutaneous technique. In this chapter we described our Achilles tendon repair technique under local anesthesia without tourniquet and with cooperation of the patient, and the results of our clinical experiences under the lights of literature.

Minimal Invasive Technique in Capitellum Fracture Treatment

The humeral capitellum fractures are rare, and surgical management of these fractures is difficult. The surgeon must achieve anatomic reconstruction with a reliable fixation allowing mobilization of the joint for early rehabilitation. Arthroscopic approach to capitellum fractures allows visualization of the articular surface without the soft tissue dissection required with open approaches. Here, we present a case of type 1 capitellum fracture of humerus that was fixed through arthroscopic assistance.

Magnetic Resonance Imaging (MRI) of Snapping Scapula in a 10-Year-Old Boy

Summary Background Snapping scapula syndrome, also known as scapulothoracic crepitus or bursitis, is a manifestation of a mechanical abnormality of the scapulothoracic joint. In addition to characteristic findings on physical examination, magnetic resonance imaging (MRI) exquisitely reveals soft tissue changes such as muscle edema and scapulothoracic bursitis. Case Report We present a case of a 10-year-old boy who had snapping scapula syndrome of the right scapula that was associated with edema of the serratus anterior muscle at the scapulothoracic interface and with scapulothoracic, specifically supraserratus, bursitis on MRI. Conclusions MRI in snapping scapula syndrome, which is a clinical diagnosis, exquisitely reveals soft tissue changes such as muscle edema and scapulothoracic bursitis. Such soft tissue findings of snapping scapula syndrome need to be kept in mind while evaluating routine shoulder and/or scapular region MRI, especially in the absence of relevant clinical information at the time of the imaging study.

Triangular Fibrocartilage Complex Tears in the Athlete

It is essential for the athlete to maximize performance in sports that require full, pain free range of motion at the forearm, wrist, and hand. Injury to the triangular fibrocartilage can occur as a result of athletic activity ranging from racquet sports to basketball to contact sports like judo. Patients suffering from triangular fibrocartilage complex (TFCC) injury often experience discomfort and pain on the ulnar corner of the wrist which is worse on active grip, rotation, and ulnar deviation. Traumatic patterns of TFCC tears include central perforations (Class lA), ulnar avulsions (Class lB), distal avulsions (Class lC), and radial avulsions (Class 1D). Arthroscopic debridement of central tears of TFCC tears in the athlete with neutral or negative ulnar variance is the treatment of choice.

Chronic Elbow Instabilities: Medial and Lateral Instability

Elbow stability relies on a complex interaction between the bony articulations of the elbow joint, the capsuloligamentous structures, and dynamic muscle restraints. Elbow instability presents a spectrum from minor subluxation to dislocation. This review discusses the anatomy of the elbow joint, the mechanism and classification of elbow instability, and outlines treatment options available for acute and chronic elbow instability.

Arthroscopic Patellar Instability Surgery

Biomechanically, knee joint as a motion complex includes gliding, rolling, translation, and rotation during its extension to flexion. A significant incidence of knee pain and disability arises from patellofemoral disorders in elderly ages. Patellar instability is a subjective term that defines pain, blockage, and twisting clinically due to deterioration of static and dynamic knee extensor mechanism. An accurate diagnosis relies both on assessing soft tissues and bony tissues together and considering pelvic and spinal stabilizers with the knowledge of distal alignment reaches from L5 to S1 vertebrae. Under the title of patellar instability, arthroscopic medial plication technique and the importance of medial patellofemoral ligament in this approach will be discussed.