Gökhan Meriç

The BstUI and DpnII Variants of the COL5A1 Gene Are Associated With Tennis Elbow

Background: Tennis elbow entails pain and tenderness over the lateral epicondyle. The exact cause of the condition is not fully understood. Type V collagen is a minor fibrillar collagen that intercalates with type I collagen and forms collagen fibrils. It is encoded by the COL5A1 gene. Sequence variants within COL5A1 3′-UTR have been implicated in musculoskeletal diseases. Purpose: To determine whether rs12722 (BstUI C414T polymorphism) and rs13946 (DpnII C230T polymorphism) of the COL5A1 gene are associated with an increased risk of tennis elbow. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 152 patients with tennis elbow and 195 healthy participants were enrolled in this study. The rs12722 (BstUI C414T) and rs13946 (DpnII C230T) polymorphisms were investigated with the polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) method. Results: There was a significant difference in both BstUI and DpnII genotype frequencies between patients with tennis elbow and healthy participants. The A2 allele of BstUI and the B1 allele of DpnII were significantly underrepresented in the patient group. Conclusion: Individuals with the BstUI A1 allele and DpnII B2 allele of the COL5A1 gene have a high likelihood of developing symptoms of the tennis elbow. This is the first study reporting that rs12722 and rs13946 SNPs (single nucleotide polymorphisms) are genetic risk factors for tennis elbow.

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.

Review of techniques for the removal of trapped rings on fingers with a proposed new algorithm

Various removal techniques for rings trapped on the finger have been described in the current literature. However, despite this being a frequently encountered situation in emergency departments, there is no comprehensive algorithm to manage and follow these patients in the current literature. The purposes of this study were to describe the most commonly used ring removal techniques and to establish an algorithm for the removal of rings trapped on fingers. We performed a comprehensive literature search in several databases to identify all articles, case reports, letters, and book chapters that focus on ring removal techniques in English language from 1960 to the present. There are 2 methods of removal: (1) noncutting techniques in which the rings can be removed without breaking the integrity of the ring and (2) various ring-cutting equipments and tools. All these techniques are classified into distinct groups and described in detail with illustrations. Furthermore, an algorithm for handling such patients is established according to case-based patient care. Following an algorithm for the removal of trapped rings on the finger will be useful for patients and emergency physicians. It will also prevent possible complications and will save time.

Is Sp1 binding site polymorphism within COL1A1 gene associated with tennis elbow

Tennis elbow defines a condition of pain and tenderness over the lateral epicondyle of the humerus. The exact aetiology of the injury is not yet fully understood. The major constituent of tendons is type 1 collagen which is encoded by COL1A1 gene. The aim of the study was to determine whether Sp1 binding site polymorphism (SNP rs1800012; 1546G/T) within the intronic region of COL1A1 gene is associated with tennis elbow. One hundred and three tennis elbow patients and one hundred and three healthy subjects without any history of previous ligament or tendon injuries were recruited for this genetic association study. All participants were genotyped for the COL1A1 Sp1 binding site polymorphism by using PCR-RFLP method. There were no observed statistical differences in the genotype (p=0.17) or allele (p=0.11) distributions between the groups. G allele frequency in patients and controls was 82.5% and 76.21%, and T allele frequency was 17.5% and 23.79% respectively. This study has shown that there is no association between this polymorphism and tennis elbow within the population studied.

The complete type of suprapatellar plica and lipoma arborescens: a case report

Lipoma arborescens is a rare intra-articular benign lesion. It is characterized by villous lipomatous proliferation of the synovial tissue and its etiology is not certain. Clinical presentation is usually long-standing, painless and slowly progressive swelling of the related joint. Magnetic resonance imaging plays an important role in diagnosis. Diagnosis can be determined by hypertrophied synovial tissue with synovial lining cells containing adipose tissue on examination using a light microscope. The synovial plica of the knee is formed during the embryogenic phase of development. This development is incomplete in many individuals. When the synovial plica of the knee persists, it is transformed into an embryonic relic that is located in either the suprapatellar or midpatellar region of the knee. We present a rare case with both a complete type of suprapatellar plica and a symptomatic lipoma arborescens in the suprapatellar recess.

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.

Thenar Compartment Syndrome: What If a Compartment Pressure Measuring Device is Absent?

Compartment syndrome (CS) is a threatening condition characterized by excessive tissue pressure accumulation associated with acute trauma. Compartment syndrome causes a significant reduction in blood flow with subsequent muscle and nerve ischemic necrosis. Recently, reports have described the importance of intramuscular pressure measurements as a basis for CS diagnosis. Unfortunately, the measuring devices that were utilized produced results with unsatisfactory reliability, making a diagnosis and subsequent treatment challenging. Here, we report the use of an anesthesia pressure monitoring device with greater precision for pressure measurements, as well as real-time monitoring of intraoperative compartment pressure decompression efficacy. This device enabled the accurate diagnosis and rapid treatment of a thenar compartment syndrome (TCS) in the left hand of a diabetic female in an emergency setting. She presented extreme pain in the thumb flexion-extension (FE). Her condition was complicated by diabetic cellulitis, primarily of Staphylococcus aureus. Consequently, successful microsurgery in the thenar space, together with debridement, resulted in remarkable pain relief during FE of the thumb metacarpophalangeal (MCP) and interphalangeal (IP) joints, as well as the disappearance of the infection by Day 10. Subsequent one- to two-year follow-up assessments revealed marked recovery.

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.

Leech treatment for prolonged digital ischemia

A n ingrown toenail is a common problem that can be treated conservatively or surgically. Surgery is mostly performed under digital block anesthesia with the use of a digital tourniquet. Herein, we present an emergent case of a forgotten digital tourniquet that was used during the surgical treatment of an ingrown toenail and the subsequent treatment with hirudotherapy. Informed consent was obtained from the patient.

Utilization of the bicipital groove axis for confirming alignment of the humerus with transepicondylar and ulnar shaft axes during intramedullary nailing.

OBJECTIVE Intramedullary nailing is the preferred surgical treatment of humerus shaft fractures. The purpose of this study was to investigate the relationship between the bicipital groove and specific anatomical landmarks in achieving correct alignment of the humerus during intramedullary nailing, and to describe these anatomical landmarks. METHODS Thirty (15 right; 15 left) total upper cadaver extremities were used in this study. After the anatomical landmarks were identified and marked, humeral head axis, transepicondylar axis, ulnar shaft axis, bicipital groove axis, and angular measurements of these were obtained. RESULTS The mean angle between the bicipital groove axis and transepicondylar axis was 48.17°±12.35º (range: 20.10º to 74.6º). The mean angle between the bicipital groove axis and ulna diaphysis axis was 41.82º±11.56 º (range: 17.91º to 68.27º). The mean angle between the humeral head axis and bicipital groove axis was 20.53°±3.90º (range: 11.85º to 31.81º). The mean retroversion angle between the humeral head axis and transepicondylar axis was 27.52±11.37º (range: 4.26º to 49.36º). The mean angle between the humeral head axis and ulna diaphysis axis was 61.73º±12.08º (range: 33.97º to 86.37º). The mean torsion angle was 62.58º±11.28 º (range: 40.74º to 85.74º). CONCLUSION Measurement and utilization of the relationship between the bicipital groove, ulna diaphysis and transepicondylar axes may be used for restoring humeral rotation.