Mert Özcan

United unresorbed medial and lateral plicae as anterior mesenchymal synovial septal remnant

Abstract. Mesenchymal tissue that forms compartments in the knee joint begins to be resorbed in the 8th week of embryologic life. Unless these mesenchymal tissues are totally resorbed, they remain as septal remnants, and are termed mediopatellar, infrapatellar, suprapatellar, and lateral plicae. We report a case of united anterior plica; the inferior part of the anterior mesenchymal septum at the back of the patellar tendon was unseparated and unresorbed, and one-half of the superior part of the septum beginning from the inferior pole of the patella formed the V-shaped medial and lateral plicae such that their opening looked upwards.

Late-diagnosed bilateral intertrochanteric femur fracture during an epileptic seizure

Although spontaneous and simultaneous bilateral hip fractures without trauma are seen rarely, epileptic seizures may lead to these fractures. We present an 82-year-old female patient with poor bone quality and a 20-year history of epilepsy. She had been using anticonvulsant drugs for almost 20 years. Following a convulsive epileptic attack, bilateral intertrochanteric femur fractures occurred (causing bilateral hip pain), which was diagnosed on the 12th day. An earlier pelvic anteroposterior roentgenogram would be helpful for early diagnosis. It should not be forgotten that bone fractures may be observed without trauma in epilepsy patients.

Major Extremity Injuries Associated with Farmyard Accidents

Background. The aim of the study is to analyze the major agricultural injuries related to the extremities. Patients. We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period. Results. Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60–360). Mean length of stay was 24 days (4–150), and mean number of operations during hospitalization was 2.4 (1–30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%). Conclusions. Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall.

Simultaneous occurrence of acute posterior shoulder dislocation and posterior shoulder-fracture dislocation after epileptic seizure.

Int J Shoulder Surg April-June 2009 / Volume 3 / Issue 2 ♦ Physical examination revealed a large ecchimosis around both shoulders; left shoulder was in internal rotation position, he had pain and limitation of motion and right shoulder had severe pain, crepitation and limitations of movements in all directions. The patient had painful restriction of both active and passive glenohumeral movements in all directions. No neurovascular impairment was found. Plain radiographs showed posterior shoulder dislocation with a bone defect of the anteromedial humeral head on the left side and multiple fragmented proximal humerus fracture with posterior dislocation on the right side. Computed tomography showed many pieces of proximal humerus with posterior dislocation of the right shoulder [Figure 1] and locked posterior dislocation with reverse Hill Sachs lesion (approximately 30% of the humeral head) of the left shoulder [Figure 2].

Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index.

Background: Ultrasonography is accepted as a useful imaging modality in the early detection of developmental dysplasia of the hip (DDH). Early detection and early treatment of DDH prevents hip dislocation and related physical, social, economic, and psychological problems. The purpose of this study was to evaluate the reliability of ultrasonographic and roentgenographic measurements measured by seven different observers. Materials and Methods: The alpha angles of 66 hips in 33 patients were measured using the Graf method by seven different observers. Acetabular index degrees on plane roentgenograms were measured in order to assess the correlation between the ultrasonographic alpha angle and the radiographic acetabular index, which both show the bony acetabular depth, retrospectively. Results: The interclass correlation coefficient, measuring the interobserver reliability, was high and statistically significant for the ultrasonographic measurements. There was a negative correlation between the alpha angle and the acetabular index. Conclusions: Ultrasonography, when applied properly, is a reliable technique between different observers, in the diagnosis and follow up of DDH. When assessed concomitantly with the roentgenographic measurements, the results are reliable and statistically meaningful.

Isolated synovial chondromatosis of the proximal tibiofibular joint

Synovial chondromatosis is a chronic, progressive disease of the synovial tissue where free chondral loose bodies are formed after metaplasia. It is mostly seen as a monoarticular disease in the knee, hip, shoulder, ankle, and elbow joints. To our knowledge, isolated synovial chondromatosis of the proximal tibiofibular joint has not been reported. A 36-year-old male patient presented with a complaint of pain on the lateral side of the right knee, whose severity gradually increased within the past two years. Radiological findings were suggestive of synovial chondromatosis of the proximal tibiofibular joint. The patient was treated with resection of the fibular head, including the satellite lesions. Histopathological examination confirmed the diagnosis. At one-year follow-up, the patient was symptomless, had full range of motion of the knee without pain, and had no problems in maintaining daily activities. Pathologies of the proximal tibiofibular joint must be kept in mind in patients with lateral knee pain.

Non-Operative Treatment in Children and Adolescents with Atlantoaxial Rotatory Subluxation

OBJECTIVE Atlantoaxial rotatory subluxation (AARS) is an uncommon lesion seen mainly in children and adolescents. A retrospective analysis of 12 patients with AARS treated non-operatively is presented in this study. MATERIAL AND METHODS Twelve patients with AARS who were treated non-operatively were evaluated retrospectively in terms of recent trauma and respiratory tract infection history, accompanying injuries, radiological findings, duration of symptoms, amount and duration of traction and clinical results of the treatment. RESULTS Traumatic AARS was present in 8 patients. No evidence of trauma was found in 4 patients. Type I subluxations in 10 and type II subluxations in 2 patients were found according to the Fielding and Hawkins classification. All patients were treated using bed-side mentooccipital tractions. The mean duration of bed-side mentooccipital traction was 3,75 days and the mean amount of load was 1.8 kg. All patients were kept in Philadelphia collars for additional 3 weeks after the clinical recovery. No limitations and pain in head movements were present in any patient at the sixth month follow-up examinations. CONCLUSION Paediatric patients with neck pain and torticollis should be investigated concerning trauma and recent respiratory tract infection history in order to avoid any delay in diagnosis of a possible AARS.

Postoperative evaluation of quality of life in lumbar spinal stenosis patients following instrumented posterior decompression

OBJECTIVES Spinal stenosis is a clinical condition in which bone and soft tissues compress the spinal canal, neuronal foramina and nerve roots. In this study, we aimed to evaluate the effectiveness of surgical treatment on patient satisfaction. Our sample included 64 patients with degenerative lumbar spinal stenosis on whom posterior decompression and instrumentation was applied. METHODS In this retrospective study, files of 64 patients who underwent posterior decompression surgery with instrumentation for degenerative lumbar spinal stenosis between March 2004 and April 2008 were examined. Patients were evaluated with Japanese Orthopaedic Association (JOA) form, form of degenerative lumbar spinal stenosis and the most recent postoperative orthopedic inspection findings for a minimum of one year after surgery. RESULTS Mean age of patients was 59.9 years and mean follow-up was 27.9 months. When evaluated using the Japanese Orthopaedic Association form, postoperative scores in 63.5% of the patients improved. Based on this postoperative improvement; Japanese Orthopaedic Association scores were found statistically significant (p<0.001). Gender (p=0.651), age (p=0.192), with the length of complaint (p=0.095), time passed after surgery (p=0.933), number of laminectomy level (p=0.997), deformity before operation (p=0.773) and systemic disease were not statistically correlated with improvement based upon Japanese Orthopaedic Association scores (p=0.052). But Japanese Orthopaedic Association scores were found to have improved (83%) in cases with no systemic diseases. CONCLUSION Our findings show that posterior decompression surgery with instrumentation is a useful treatment modality for patients with severe degenerative lumbar spinal stenosis. There is no secondary factor affecting improvement and instability after surgery is not observed in patient groups.

Osteosarcoma of the lumbar vertebra: case report and a review of the literature

Classic osteosarcoma (OS) is a highly malignant sarcoma with the production of osteoid matrix. The most common sites of origin are the metaphyseal regions of the distal femur, proximal tibia, and proximal humerus, although the tumor can develop in any bone. Flat bone involvement is very rare (8%). Vertebral involvement is also very rare with 2–4% of all cases. In this report, we presented a 27-year-old woman with OS of the fourth lumbar vertebra. She was treated with surgical debulking and posterior enstrumentation, followed by radiotherapy and chemotherapy. She is now in the 15th year postoperatively and still alive without any neurological impairment. This case has the longest survival reported in the literature with primary vertebral osteosarcoma.

Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression.

Purpose: Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions. Methods: Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients’ Knee Society Score and Knee Society Functional Score records. Results: A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2. Conclusion: Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression.