Aziz Atik

Short-Term Clinical Outcomes After First Metatarsal Head Resurfacing Hemiarthroplasty for Late Stage Hallux Rigidus

The purpose of the present study was to evaluate the short-term results of metatarsal head resurfacing hemiarthroplasty in the treatment of advanced hallux rigidus. We reviewed 14 consecutive patients (5 males [35.71%], 9 females [64.29%]; mean age, 58.7 ± 7.4 years). These patients underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP(®)) for hallux rigidus from March 2010 to September 2012 at our institution. According to the Coughlin and Shurnas clinical and radiographic classification, 10 feet (71.43%) were classified as grade III and 4 (28.57%) as grade IV. We clinically rated all patients before surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scale, the visual analog scale for pain, and first metatarsophalangeal joint (MTPJ) range of motion. The mean follow-up duration was 24.2 ± 7.2 (range 12 to 36) months. The mean preoperative hallux metatarsophalangeal-interphalangeal scale score was 33.9 ± 9.8 (range 22 to 59), and it increased to 81.6 ± 10.1 (range 54 to 96; p < .05) postoperatively. The mean preoperative 10-cm visual analog scale for pain score was 8.4 ± 0.9 (range 7 to 10), which decreased to 1.21 ± 1.2 (range 0 to 5; p < .05) postoperatively. The mean preoperative MTPJ range of motion was 22.8° ± 7.7° (range 15° to 45°), which increased to 69.6° ± 11.8° (range 50° to 90°; p < .05) postoperatively. None of the 14 patients experienced component malalignment or loosening, infection, or neurovascular compromise during the follow-up period. One patient (7.14%) experienced postoperative pain and subsequently underwent first MTPJ arthrodesis. From the results of our investigation, first MTPJ arthroplasty is an effective treatment modality that can reduce pain and increase motion in the case of advanced hallux rigidus.

Total Knee Arthroplasty in A Patient With Neglected Congenital Patellar Dislocation

Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of 56-year-old woman with advanced osteoarthritis due to right neglected congenital patellar dislocation treated with total knee arthroplasty (TKA) with release of the lateral retinaculum and proximal extensor mechanism realignment. One year later, the patient had improvement of her Knee Society scores and painless function, stability, and better extensor strength. A literature search revealed a limited number of similar cases in which congenital patellar dislocation was treated with TKA. Total knee arthroplasty provides a valid treatment option for adults with congenital patellar dislocation who have absence of the femoral sulcus and associated osteoarthritis. Total knee arthroplasty has the ability to correct the pathologies seen with congenital patellar dislocation, eg, external tibial rotation, absence of femoral groove, and patellar hypoplasia. Realignment of extensor mechanism restores quadriceps strength, normal knee biomechanics, and may prevent complications such as dislocation.

Isolated slipped-retroverted osteochondral fracture of second metatarsal head

Although metatarsal fractures are common, isolated intraarticular metatarsal head fractures are rare, and retroversion of the fracture segment is even rarer. Herein, a retroverted fracture of the second metatarsal head, which happened with a direct trauma from jumping from a height, was discussed with treatment options and finally a simple surgical trick was advised. There are only a few cases of isolated osteochondral and retroverted fractures of the metatarsal head in literature. The following is a rare case report of such an injury in a 19-year-old male.

Primary synovial osteochondromatosis of the ankle.

A 35-year-old man presented with an 18-month history of chronic left ankle pain and swelling. The pain was a dull ache and present throughout the day. On examination, there was swelling of the left ankle, more anteriorly, with palpable loose bodies. There was associated terminal restriction of motion. Radiographs of the left ankle revealed multiple subcentimeter osseous structures in the anterior of the tibiotalar joint (figure 1 …

Endoscopic versus Open Bursectomy for Prepatellar and Olecranon Bursitis

Objectives Bursitis of the olecranon and the patella are not rare disorders, and conservative management is successful in most cases. However, when patients do not respond to conservative treatment, open excisional surgery or, recently, endoscopic bursectomy, can be used. The aim of this study was to evaluate the results of open and endoscopic treatments of olecranon and prepatellar bursitis. Patients and methods Forty-nine patients (37 male and 12 female), who were treated with endoscopic bursectomy (25 patients) or open bursectomy (24 patients) were included in this study. Thirty patients had olecranon bursitis, while 19 patients had prepatellar bursitis. The patients’ average age was 61.1 ± 12.3 (range 33-81) years. All of the patients’ hospitalization and surgery times were recorded. The satisfaction of the patients was evaluated with a satisfaction scoring system, as well as by evaluating residual pain, the range of joint movement, and the cosmetic results of the procedure. Results The average follow-up time was 16 ± 9 months (range 12–27). The median operation time was 23.2 ± 3.5 minutes for the endoscopic bursectomy group and 26.4 ± 6.8 minutes for the open bursectomy group. The median hospitalization time was 0.56 ± 0.5 days (range 0-1 day) for the endoscopic group and 1 ± 0 days for the open bursectomy group (P<0.01). According to the patient satisfaction questionnaire, the endoscopic bursectomy group’s score was 8.5 ± 1.3 (range 5-10), and the open bursectomy group’s score was 5.29 ± 1.8 (range 1-9) (P<0.01). Conclusion Endoscopic bursectomy is a time-saving and efficient surgical treatment option for patients with prepatellar and olecranon bursitis.

Prevalence of pedal symphalangism in Turkish population. A radiographic survey

Objective: The purpose of this study is to investigate the prevalence of biphalengeal toes in Turkish population and to analyze the differences between genders and symmetry patterns. Material and methods: Bilateral foot radiographs of 279 subjects with a mean age of 40.7±16.3 (range, 18-78) years were reviewed to detect presence of pedal biphalangism. There were 146 (52.3%) female and 133 (47.7%) male subjects. Results: The overall prevalence of biphalangeal 3rd toe was 0.9%, 4th toe was 2.5% and 5th toe was 45.5%. The frequency of biphalangeal 3rd and 4th toe was statistically similar between genders (p=0.456 and p=0.163 respectively); however the biphalengeal 5th toe was more frequent in female subjects (p=0.004). In 138 (49.5%) subjects 5th toe was normal bilaterally. 113 (40.5%) subjects had bilateral 5th biphalangeal toe, and 28 (10.5%) subjects had biphalangeal 5th toe on one side (asymmetric pattern). 270 (96.8%) subjects had bilateral normal 4th toe, 5 (1.8%) subjects had bilateral biphalangeal 4th toe, and 4 subjects (1.4%) had asymmetric pattern. 276 (98.9%) subjects had bilateral normal 3rd toe, 2 (0.7%) had bilateral bipahangeal 3rd toe, and 1 subject (0.4%) had asymmetric pattern. The symmetric occurrence of biphalangeal toe in 3rd, 4th and 5th toes were equally distributed in both genders (p=0.061, p=0.227 and p=0.477 respectively). Conclusion: The present study represents the first report on the prevalence and distribution of biphalengeal toes in Turkish society. The prevalence of biphalengeal toes in Turkish population is considerably different from the Asian and Japanese population, but rather resembles European and North American populations.

Simultaneous Anterior Glenohumeral Dislocation and Ipsilateral Acromioclavicular Separation: A Dual Injury of the Shoulder

Isolated acromioclavicular separations or shoulder dislocations are common injuries. However, a combination of complete acromioclavicular separation and anterior shoulder dislocation is extremely rare. Herein we present a combination of anterior shoulder dislocation and type III acromioclavicular separation that was succesfully treated conservatively. Orthopaedic surgeons should have a high clinical suspicion in daily practice. We believe that both pathologies can be treated conservatively.

Congenital Pseudarthrosis of Index Metacarpal Bone Treated with Distraction Osteogenesis Followed by Autologous Grafting.

The term “congenital pseudoarthrosis” refers to the semblance of a false joint formation which is present from birth. The soft tissue at the pseudoarthrotic site is composed of a variable admixture of fibrous tissue, fibrocartilage, and hyaline cartilage with evidence of enchondral ossification. Spaces and clefts are lined by a synovial-like tissue [1]. Congenital pseudoarthrosis is mostly seen in the lower extremity, particularly involving the tibia, fibula and femur [2]. In upper extremities, it may also involve clavicle and one or both bones of the forearm [3, 4]. However, metacarpal bone involvement is exceedingly rare with only three previous case reports in current literature [5–7]. But, to the best of our knowledge, there have been two cases of bilateral congenital pseudarthrosis of index metacarpals reported in literature up to date [5, 6]. Congenital pseudoarthrosis is usually associated with genetic syndromes and presented as a component of several other abnormalities [2]. In 1950, Aegerter suggested a possible relationship between neurofibromatosis, congenital pseudarthrosis, and fibrous dysplasia [8]. In 1949, Moore stated that “the treatment of congenital pseudarthrosis will probably never be entirely effective until the etiology has been determined. Osteosynthesis by bone-grafting still offers the principal means of attacking the problem” [9]. The treatment of congenital pseudoarthrosis is challanging because achieving complete union of pseudoarthrosis site, providing an acceptable alignment and functional extremity is difficult and refracture rate is high. This is probably due to low osteogenic capacity of the affected whole segment. The principle of the treatment is complete resection of the pseudoarthrosis, grafting the bone defect and ensure bony union either with internal or external fixation. Currently Ilizarov external fixation has gained wide acceptance as a gold standard treatment for the management of congenital tibial pseudoarthrosis [2]. Herein, we intend to present a rare case of bilateral congenital pseudoarthrosis involving bilateral index metacarpal bones. This is not a unique case and previously two other cases has been published. But what makes our case different than previous cases is the treatment of choice. We have treated this patient with excision of the pseudoarthrosis, gradual distraction to overcome the short metacarpal length without neurovascular compromise, followed by tricortical grafting and internal fixation.

Glenohumeral dislocation with a proximal humerus physeal fracture.

We kindly disagree with their claims and statements. We believe that the problem was the diminished growth along the distal medial femoral physis, related to the pathological process of Trevor’s disease, not overgrowth. This was clearly documented, with progressive varus at the distal medial femur before any surgical intervention. This progressive varus was not secondary to the hemiepiphysiodesis of the proximal medial tibia. The staple from this anatomical location was removed even before full correction of the valgus deformity was achieved, knowing about the already existing distal femoral varus deformity. In addition, the proximal tibial physis remained open and functional throughout the patient’s follow-up, according to serial radiographs taken over the years, disproving any possible growth-related complication following hemiepiphysiodesis of the proximal medial tibial physis.

Femoral vein injury from a trochanteric hip fracture

(2015),http://dx.doi.org/10.1016/j.injury.2015.06.014This is a PDF file of an unedited manuscript that has been accepted for publication.As a service to our customers we are providing this early version of the manuscript.The manuscript will undergo copyediting, typesetting, and review of the resulting proofbefore it is published in its final form. Please note that during the production processerrors may be discovered which could affect the content, and all legal disclaimers thatapply to the journal pertain.