Cuneyt Tamam

Ischiofemoral space decompression through posterolateral approach: cutting block technique.

Ischiofemoral space impingement has become an increasingly recognized extracapsular cause of atypical hip, deep gluteal, and groin pain that can be treated endoscopically. We present a minimally invasive posterolateral technique that preserves the attachment of the iliopsoas tendon and quadratus femoris insertion while decompressing the ischiofemoral space by resecting the lesser trochanter. Furthermore, we present tips to perform this technique in a manner that minimizes the potential for damage to the sciatic nerve. This technique also allows the surgeon to treat concurrent hip pathology arthroscopically.

Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors

BACKGROUND AND OBJECTIVES Pain caused by medial superior cluneal nerve entrapment (MSCNE) is an infrequent cause of unilateral low back pain. There is limited information about this neuropathy in the literature. In this study, the etiologic factors leading to this clinical entity were evaluated and also the clinical and imaging findings were examined. MATERIAL AND METHOD The study was conducted in 3 groups. The study group included 25 patients with MSCNE, the hernia group included 25 patients with herniated nucleosus pulposus and the control group included 25 healthy subjects. The initial evaluation included lumbar computerized tomography (CT) and magnetic resonance imaging (MRI) in the study and the hernia groups. The comparisons between these two groups were made by using clinical assessment questionnaires (SF-36 mental and physical health scores and Oswestry scale). Additionally, all three groups were compared by lumbosacral radiographies and low back superficial ultrasonographies. As treatment, 1 ml of prilocaine combined with 1 ml of steroid injection was used in the study group. RESULTS In the study group, there was no disc herniation, facet joint problems, spinal stenosis or spondylolisthesis detected by CT or MRI. The SF-36 mental health score before treatment was lower in the study group than in the hernia group. The ultrasonographic examination detected a paravertebral hypoechogenic globular-shaped muscle disorganization associated with lipomatous degeneration exclusively localized to the trigger point in the study group. Both the mean soft tissue and the periiliac band thickness were significantly higher in the study group than in the other two groups. The lumbosacral radiographies did not show any significant difference in either the degree of lumbar spinal lordosis or the intercristal line levels among the three groups. CONCLUSION This prospective study depicts the etiologic factors, ultrasonographic features and treatment protocol of MSCNE which is usually an underestimated cause of the low-back pain. LEVEL OF EVIDENCE Diagnostic study, Level I-1 (prospective study).

Retrospective Clinical and Radiological Outcomes after Robotic Assisted Bicompartmental Knee Arthroplasty.

Purpose. Bicompartmental knee arthroplasty (BiKA) is a favorable alternative to total knee arthroplasty for degenerative disease limited to two knee compartments. Recently developed robotic-assisted systems improved the clinical efficacy of unicompartmental knee arthroplasty by providing enhanced component positioning with dynamic ligament balancing. The purpose of this study was to evaluate the short-term outcomes of patients, undergoing bicompartmental knee arthroplasty at a single institution by a single surgeon using a robotic-assisted system. It was hypothesized that robotic assisted BiKA is a prevailing choice for degenerative disease limited to two knee compartments with good functional results. Methods. A search of the institutions joint registry was conducted to identify patients that underwent robotic-assisted BiKA of the patellofemoral compartment and the medial or lateral compartment. Results. A total number of 29 patients (30 BiKA) with a mean age of 63.6 years were identified who received a patellofemoral resurfacing in combination with medial or lateral compartment resurfacing. Twenty-four out of 29 patients had good to excellent outcome. Conclusion. Robotic assisted bicompartmental arthroplasty using broad indications and only excluding patients with severe deformity and those that have less than 4 mm of joint space in the surviving compartment demonstrated 83% good to excellent results.

Robotic-assisted unicompartmental knee arthroplasty.

In recent years, development of computer graphics and haptic feedback technology enabled the use of virtual reality. Virtual reality provides the opportunity to combine 3D visual imagery with interactivity, visual, and tactile realism. Robotic-assisted orthopedic surgery is defined as the use of computers and robotic technology to assist the orthopedist in providing musculoskeletal care, in which machine has the capability of precision and accuracy. Robotic-assisted orthopedic surgery is used in simulating diagnosis, preoperative and intraoperative planning, and actual surgery. One of the main areas for computer-assisted surgical applications is unicompartmental or bicompartmental knee arthroplasty, in which the clinical efficacy is improved by providing enhanced component positioning with dynamic ligament balancing.

Arthroscopic Excision of Acetabular Osteoid Osteoma: Computer Tomography–Guided Approach

Osteoid osteoma is a benign osteoblastic tumor that occurs in the subcortical shaft and metaphysis of the long bones of the lower extremities; however, intra-articular lesions are also possible. Intra-articular osteoid osteomas are rare, and clinical symptoms are often less specific and, thereby, may lead to misdiagnosis. The definitive treatment for osteoid osteoma is the excision of the nidus. We present the case of a 23-year-old man with a 4-year history of right anterior hip pain, subsequently diagnosed with a subarticular osteoid osteoma located in the right anterior acetabulum. Hip arthroscopic excision of the juxta-articular osteoid osteoma is presented as an effective treatment, with the advantage of less potential damage to normal bone and cartilage, as well as the additional benefits available with hip arthroscopy.

Tc-MDP bone scintigraphy in a case with sporodical tumoral calcinosis

Tumoral calcinosis is an uncommon and benign condition characterized by the presence of large calcific soft tissue deposits occurring predominantly in a periarticular location. It generally occurs as a complication of renal dialysis or trauma, and is rarely seen in familial and sporadic cases. Bone scintigraphy is a sensitive method for diagnosing tumoral calcinosis. A 28-year-old female patient with a history of operation due to tumoral calcinosis located bilateral hips, referred to our department. She had a tender palpable mass in the right knee and a fistulized incisional scar overlying the bilateral hip joints. A sporadic case of tumoral calcinosis with relapses was presented.

Three‐dimensional scanning with dual‐source computed tomography in patients with acute skeletal trauma

OBJECTIVE: The aim of this study was to compare the efficiency of multiplanar reformatted images and three‐dimensional images created after multidetector computed tomography examination in detecting acute post‐traumatic osseous pathology of the skeletal system. METHOD: Between October 2006 and December 2008, 105 patients with a history of acute trauma were referred to our service. Patients were evaluated with multidetector computed tomography using multiplanary reconstructed images initially (R‐I), and six months after this initial evaluation, three‐dimensional images were assessed of each patient (R‐II). Axial images were used for guiding as a reference Data obtained was recorded and graded according to importance levels of the pathologies. RESULTS: The R‐II score was higher in the non‐articular and highest in periartricular fractures of the extremities, and thoracic and pelvic cage injuries. For the spinal column, while R‐I data was more significant In patients referred with polytrauma, R‐II data, was more statistically significant, for short processing and adaptation time to acquiring immediate critical information. For all cases it was seen that three dimensional scans were more efficient in providing the orientation, within a short time. CONCLUSION: By dual source multidedector tomography systems trauma patients may be evaluated by multiplanary and three dimensionally reconstructed images. When used correctly, three dimensional imaging is advantageous and can help determine the exact nature and extension and also importance of osseous injuries.

The Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Bone Lesions of Undetermined Origin.

The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.

Diagnostic value of single-photon emission computed tomography combined with computed tomography in relation to MRI on osteochondral lesions of the talus.

BACKGROUND Osteochondral lesion of the talus (OLT) involves the separation of a fragment of articular cartilage, as defined by Kappis in 1922. MRI is the current standard for noninvasive diagnosis of OLT. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) provides both morphologic and functional information. The purpose of the study was to compare SPECT/CT with MRI for image interpretation and treatment decision making in talar osteochondral lesions. MATERIALS AND METHODS A total of 21 patients (four bilateral) were evaluated with MRI and SPECT/CT. Diagnostic arthroscopy was performed to validate the indication by identifying unstable cartilage areas. Activation was assessed in nine regions of interest, as described by Elias and colleagues. SPECT/CT findings were assessed by the modified scoring system of Hart and colleagues, and MRI findings with the modified classification system of Hepple and colleagues. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for SPECT/CT and MRI. RESULTS A total of 25 lesions were identified. Seventeen lesions were located on the medial third of the talar dome, eight on the lateral third, and seven on the central third. Four patients revealed diffuse uptake on more than one zone on SPECT/CT. SPECT/CT identified two subchondral lesions, which were not visualized on MRI. CONCLUSION MRI is the current standard for OLT diagnosis. SPECT/CT allows a three-dimensional localization of scintigraphic osteoblastic activity in the area of interest, providing additional information about the involvement of the subchondral bone and the vitality of the osteochondral lesion and the location of multiple lesions. We recommend the use of SPECT/CT and MRI together for comprehensive diagnostic assessment of OLT.

Extracardiac Uptake on Myocardial Perfusion Imaging in a Patient With Diaphragmatic Paralysis and Chilaiditiʼs Sign

We present a rare case of extracardiac activity in right hemitorax secondary to the Chilaiditi sign and diaphragmatic paralysis due to right hemiplegia identified incidentally during myocardial perfusion scintigraphy. A 77-year-old man with right hemiplegia suspected of having ischemic heart disease, was admitted for myocardial perfusion scintigraphy studies. On raw data images, intense bowel uptake in the right hemithorax was visualized. Chest radiography and CT images of the patient were evaluated and Chilaiditi sign was found. This sign is a relatively rare condition with an incidence ranging between 0.025% and 0.28%, considered as a normal variant.