Hamza Ozer

The rolimeter: a new arthrometer compared with the KT-1000.

Abstract A new simple and portable arthrometer, the Rolimeter, was used to assess the anterior laxity of knees in 20 normal subjects and 18 subjects with chronic anterior cruciate ligament (ACL) deficiency. The subjects were tested by one examiner using maximum manual force. In order to assess the reliability of the device the same subjects were tested with the KT-1000. In ACL-deficient knees the absolute translation and the side-to-side difference did not differ significantly between the devices. In normal knees the Rolimeter measured slightly smaller translations than the KT, but with a high degree of correlation between devices. If a 3-mm or greater side-to-side difference is considered indicative of ACL deficiency, both arthrometers were successful in diagnosing 16 of 18 cruciate ruptures (sensitivity 89%) and 19 of 20 normal knees (specificity 95%). We conclude that the Rolimeter, when compared with the KT-1000, provides a valid measure of anterior knee laxity.

Compartment syndrome in the hand due to extravasation of contrast material

Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. Most extravasations result only in minimal swelling or erythema; however, severe skin necrosis, ulceration and compartment syndrome may occur with extravasation of large volumes. This article presents a patient in whom extravasation developed after computed tomography (CT) contrast material was injected intravenously in the dorsum of the hand. Compartment syndrome was diagnosed, and the patient underwent fasciotomy. In follow-up, the patient regained full use of the hand. Although the use of contrast material has significantly improved the diagnostic accuracy of CT, anaphylaxis and contrast material extravasation are important complications. Selection of non-ionic contrast material, careful evaluation of the intravenous administration site and close monitoring of the patient during contrast material injection may help minimize or prevent extravasation injuries.

Rehabilitation of avulsion fracture of the tibial tuberosity following Osgood-Schlatter disease

A sixteen-year-old boy suffered from sharp pain in the knee during a jump while playing basketball. He had a positive history of Osgood Schlatter disease. Radiographic evaluation demonstrated an avulsion fracture of the tibial tuberosity Type III according to the classification of Watson-Jones. Rehabilitation after avulsion fracture of the tibial tuberosity is an important consideration for this relatively uncommon adolescent injury. In such avulsion fractures, landing on the ground with the knee fully extended after a jump is the most likely cause. This case report reviews the rehabilitation program, and selected functional outcome measures after rehabilitation are reported. The patient returned to sporting activity after 12 months.

Opposite-direction bilateral fracture dislocation of the shoulders after an electric shock.

Injuries after an electric shock, such as dermal burns, motor and sensory nerve deficits, fractures and dislocations, are reported in the literature. Posterior dislocation of the shoulder after electric-shock is the common musculoskeletal injury. Bilateral dislocation, either anterior or posterior, is rarely seen and reported. We report a case of bilateral shoulder fracture dislocation in opposite directions following an electric-shock and discuss the mechanism, the diagnosis and the treatment.

Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft

OBJECTIVE The aim of this study was to compare the effects of Endobutton post-fixation and femoral (TransFix) transfixation in ACL reconstruction on lower extremity muscle strength, joint position sense, and knee stability. METHODS Subjects who had undergone ACL reconstruction with hamstring tendon using Endobutton post-fixation (n=20, mean age: 26.5 years) or femoral transfixation (n=20, mean age: 29.9 years) were recruited to an ACL rehabilitation program. Twelve months after surgery, quadriceps and hamstring torque values were recorded using an isokinetic dynamometer. Computerized coordination and proprioception tests (Functional Squat System; Monitored Rehab System) were performed to determine the deficits in joint position sense. The anterior translation test was performed using a Kneelax 3 arthrometer to determine knee laxity. RESULTS Side-to-side differences between groups for hamstring and quadriceps muscle strength, concentric and eccentric motor coordination and anterior tibial laxity were not significantly different (p>0.05). CONCLUSION No statistically significant differences in functional outcome were found 1 year after the ACL reconstruction using Endobutton post-fixation and femoral transfixation with hamstring tendon graft. Deficits in hamstring-quadriceps muscle strength, motor coordination and proprioception were still found in both groups. We therefore recommend that long-term follow-up and rehabilitation including neuromuscular exercises should be continued for longer than one year after ACL reconstruction.

Avulsion of the tibial tuberosity with a lateral plateau rim fracture: case report

An avulsion fracture of tibial tuberosity with an unusual articular involvement was treated with open reduction and internal fixation. Although the mechanism of tibial tuberosity fracture is described as passively flexing the knee while active quadriceps femoris contraction, the weight transmitted from the menisci on the lateral side of the knee joint may cause an epiphyseal disruption. We report a case of tibial tuberosity fracture with lateral plateau rim fracture in a young male adolescent, which has not been published previously in the literature.

A clinical case and anatomical study of the innervation supply of the vastus medialis muscle

The innervation supply to the vastus medialis (VM) muscle, a component of quadriceps femoris (QF), is provided by a branch of the femoral nerve (FN) running along the muscle. The course of the nerve from lumbar roots to the muscle has been described by many researchers. It is known to ride along the femoral vein, artery and saphenous nerve and enter the adductor canal (Hunters canal), and then to divide into branches that supply vastus medialis and the knee joint. Femoral mononeuropathy is uncommon, and is usually due to compression in the spinal level. Hematoma in the psoas and iliacus muscles, drug abuse, lithotomy position and limb lengthening are the other associated reasons for a mononeuropathy of the femoral nerve. Isolated vastus lateralis (VL) atrophies have been reported by a few authors, suggesting that compression of the nerve and direct violation of the nerve with injections might be the reason for mononeuropathy. Isolated VM atrophy has not been previously reported. The purpose of the study was to identify the anatomical structures around the FN branch which innervates the VM muscle.

Giant cell tumor of the talar neck.

We describe a patient with a giant cell tumor in the talar head and neck of the left foot who was diagnosed as having osteochondritis dissecans and treated with arthroscopic drilling in this same location 3 years earlier. Giant cell tumors can be confused with several conditions, including giant cell reparative granulomas, brown tumors, and aneurysmal bone cysts. Giant cell tumors of bone typically occur in the epiphysis of long bones, including the distal femur and proximal tibia. They are uncommonly found in the small bones of the foot or ankle, and talar involvement is rare. Despite this rarity, the radiographic appearance and clinical signs of talar lesions should be considered in the differential diagnosis of nontraumatic conditions in the foot.

Ray amputation with limited incision: clinical tip.

Ray amputation consists of excision of a toe and its metatarsal. This is generally performed for localized gangrene or resistant localized osteomyelitis of a metatarsal. In the classic approach, a ‘tennis-racquet’ incision is made circumferentially around the toe, with a single limb over the dorsum of the involved metatarsal.1-3 However, the proximal extension of the incision may jeopardize incisions for more proximal amputations if the initial procedure fails. We describe a more conservative incision for ray amputation that decreases the dorsal soft-tissue dissection necessary to expose the metatarsal.

Quadriceps and Hamstring Strength Recovery During Early Neuromuscular Rehabilitation After ACL Hamstring-Tendon Autograft Reconstruction

CONTEXT There is lack of information related to quadriceps and hamstring strength recovery during the early period of rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring-tendon graft (HTG). OBJECTIVE To investigate quadriceps and hamstring isometric strength at 4-, 8-, and 12-wk time points after ACLR and to document the strength changes of these muscles over time. DESIGN Longitudinal study. PARTICIPANTS 24 patients (age 28.1 ± 8.1 y) who underwent unilateral single-bundle anatomic ACLR with 4-strand semitendinosus and gracilis tendon graft. MAIN OUTCOME MEASURES The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at a 60° knee-flexion angle 4, 8, and 12 wk after surgery. RESULTS Quadriceps and hamstring strength significantly increased over time for both the involved limb (quadriceps F2,46 = 58.3, P < .001; hamstring F2,46 = 35.7, P < .001) and uninvolved limb (quadriceps F2,46 = 17.9, P < .001; hamstring F2,46 =56.9, P = .001). Quadriceps and hamstring indexes significantly changed from 4 wk (QI 57.9, HI 54.4) to 8 wk (QI 78.8, HI 69.9) and from 8 wk to 12 wk (QI 82, HI 75.7) (P < .001); however, there was no difference between indexes at the 12-wk time point (P = .17). CONCLUSIONS The results of this study serve as a reference for clinicians while directing a rehabilitation protocol for HTG ACLR patients to better appreciate expected strength changes of the muscles in the early phase of recovery.