Onder Aydingoz

Spontaneous rupture of the tibialis anterior tendon in a patient with psoriasis.

A very rare case of spontaneous rupture of the tibialis anterior tendon diagnosed by MR imaging is presented. The tendon rupture occurred in a patient with recent onset psoriasis of both shins who used a corticosteroid cream (0.1% of methylprednisolone aceponate) for his skin lesions during the last 3 months before the incident causing tendon rupture. This is the first report of a spontaneous tendon rupture in a patient with psoriasis.

Shear wave elastography properties of vastus lateralis and vastus medialis obliquus muscles in normal subjects and female patients with patellofemoral pain syndrome

ObjectiveThe aim of our study was to define and compare the mechanical properties of the vastus lateralis (VL) and vastus medialis obliquus muscles (VMO) by the way of quantitative shear-wave elastography in male and female healthy control (HC) subjects, and in female patients with patellofemoral pain syndrome (PFPS).Materials and methodsTwenty-two healthy volunteers (11 male and 11 female) and 11 female patients with anterior knee pain were included in the study. The SWE examinations for VL and VMO were performed while the subjects were performing open kinetic chain exercises in neutral and 30° hip abduction. The contraction capacity (CC) and contraction ratio (CR) values were determined in resting and contraction phases in both hip positions.ResultsThe mean elasticity values in the CC for VL and VMO muscles were significantly higher in male HC subjects when compared to female HC subjects (p < 0.05). The CR of the VL muscle in female patients with PFPS was not significantly different than the female HC group. The CR for the VMO muscle was significantly lower in female patients with PFPS when compared to female HC subjects (p < 0.05).ConclusionsWe found a significant VMO weakness, and this method may provide quantitative data that might influence the diagnosis of muscle weakness, in female patients with PFPS.

Recesses along the posterior margin of the infrapatellar (Hoffa’s) fat pad: prevalence and morphology on routine MR imaging of the knee

The objective is to evaluate the prevalence and morphology of recesses along the posterior margin of the infrapatellar fat pad on routine MR imaging of the knee. MR images of 213 knees in 204 consecutive individuals were evaluated with regard to the prevalence and morphology of recesses (a “suprahoffatic” recess close to the inferior border of the patella and the previously described “infrahoffatic” recess anterior to the inferior portion of the infrapatellar plica). The recesses were analyzed with regard to synovial effusion and the condition of the anterior cruciate ligament (ACL). Anatomic dissection was made in 29 knees in 16 cadavers to verify the presence of the suprahoffatic recess. The infrahoffatic recess was present in 45% of the knees and mostly linear in shape (44%). The suprahoffatic recess was detected in 71% of the knees (45% in cadavers). Very weak to moderate positive correlation was found between the synovial effusion or the condition of the ACL and the presence and dimensions of the recesses. An awareness of the recesses in the infrapatellar fat pad is important in order to distinguish between pathology and anatomic variants on routine MR imaging of the knee.

Myositis ossificans in early childhood

A 5-year-old boy underwent arthroscopic surgery because of a lateral discoid meniscus, which was followed by an overly strenuous rehabilitation program. At 6-week follow-up, a painful mass at the distal part of the thigh and a flexion restriction of the operated knee were detected, caused by myositis ossificans inside the vastus medialis muscle. The symptoms disappeared with an appropriate rehabilitation program and the patient recovered.

The deep infrapatellar bursa: prevalence and morphology on routine magnetic resonance imaging of the knee.

Objective: To evaluate the presence, location, and dimensions of the deep infrapatellar bursa on routine magnetic resonance (MR) imaging of the knee. Methods: The study group consisted of 213 knees in 204 consecutive individuals who had undergone routine MR imaging examination of the knee within a 365-day period. Magnetic resonance examinations consisted of T1-, proton-density–, and T2-weighted sagittal; spectral presaturation inversion recovery coronal; and T2*-weighted transverse sequences. Exclusion criteria were previous knee arthroscopy or surgery or the presence of a mass lesion infiltrating the infrapatellar fat pad. The presence, location, and dimensions of the deep infrapatellar bursa were studied. The bursa was also analyzed with regard to knee joint synovial effusion (absent, mild, or marked). Results: The deep infrapatellar bursa was detected in 68% of the knees, most commonly on the lateral paramedian sagittal MR images. There was no statistically significant difference between male and female subjects or between the knee sides with regard to the detection of the deep infrapatellar bursa (P > 0.05). No correlation was found between synovial effusion and the presence of the deep infrapatellar bursa. The mean anteroposterior and craniocaudal dimensions of the deep infrapatellar bursa on sagittal T2-weighted MR images were 2.1–2.7 mm and 7.3–9.1 mm, respectively, on its lateral, central, or medial location within the sagittal MR image stack. Conclusion: An awareness of the dimensions and location of the deep infrapatellar bursa is important in distinguishing it from pathologic lesions (eg, bursitis).

A two-portal posterior endoscopic approach in the treatment of a complex talus fracture: a case report.

The two-portal hindfoot endoscopy is a relatively new technique that is becoming increasingly popular. It gives excellent access to the posterior ankle compartment, the subtalar joint, and extra-articular structures. We report a 24-year-old man with a complex talus fracture involving the posterior part of the talar body and posterolateral process. He was treated endoscopically, with a two-portal posterior approach to the hindfoot. This approach allowed a better visualization and treatment of accompanying pathologies. Combined excision of the posterolateral process and fixation of the fracture was performed with the two-portal hindfoot endoscopy, which has not been previously described to our knowledge. The two-portal posterior endoscopic approach can be an attractive treatment alternative for the posterior part fractures of the talus, which can in turn, be a new indication for this technique.

Effect of decortication on laminar strength during sublaminar wiring: an experimental study.

Eighty lumbar segments from 16 female sheep were used to investigate the effect of laminar decortication on the strength of the lamina during sublaminar wiring procedure. Sheep were 12-14 months old. Forty vertebrae from eight animals were decorticated before loading with sublaminar wire to failure, and 40 vertebrae from the remaining eight sheep were tested with the same procedure but intact. The effects of bone mineral density (BMD) and laminar dimensions on laminar strength in both decorticated and nondecorticated groups were also investigated. The failure force values of the laminae for decorticated and nondecorticated groups were 881.15 ± 36.86 and 298.48 ± 21.99 N, respectively (P < 0.001). There was a positive linear relationship between BMD and laminar strength in an intact lamina. In a decorticated lamina, no significant relationship existed between these variables. There was a negative linear relationship between mediolateral length of hemilamina and laminar strength in both intact and decorticated vertebra. Laminar strength after decortication was positively related to dorsoventral length of the remaining portion of the lamina. Decortication leads to a statistically significant decrease in laminar strength.

An ankylosing spondylitis patient ‘with no joints’

We describe a 32-year-old man with juvenile onset ankylosing spondylitis, whose first symptom was seen at 6 years of age. He was first diagnosed with oligoarticular, late-onset juvenile chronic arthritis. His diagnosis was re-evaluated when he showed bilateral sacroiliitis and positive HLA-B27. The motion capacity of the lower extremities diminished gradually following bilateral supracondylar femoral osteotomies for progressive valgus deformities and subsequent cast immobilization. For several reasons, mainly economic, his medical and orthopedic treatments were not performed until 2001. He was bedridden for 11 years and presented with no movement in the entire spinal column except for the cervical vertebrae. Radiographs revealed bony ankylosis of the hips, knees, ankles, wrists, left shoulder, left elbow, and the spinal column. Bilateral one-stage total hybrid-type hip arthroplasty and, after a rehabilitation period of 3 months, bilateral knee replacements with hinged resection prostheses were performed (Fig. 1). Twenty months after the last operation, hip function was 145 and 160 in the total range of motion. In addition to these movements, 50 and 90 of knee flexion provided him a significant improvement in his daily life. He can turn in bed, stand, and walk with crutches.

Evaluation of the orthopaedics and traumatology resident education in Turkey: A descriptive study.

Objective The objective of this study is to describe the current situation regarding the training, working conditions, future plans, fields of interest and satisfaction of orthopaedics and traumatology residents in Turkey. Methods A descriptive survey questionnaire consisting of 24 questions was designed to identify the problems and solution suggestions concerning training of orthopaedic residents. All orthopaedics and traumatology residents who took the 2013 Progress Testing for Speciality in Medicine (UEGS) held by Turkish Orthopaedics and Traumatology Education Council (TOTEK) were surveyed in the class at the end thereof as well as the young orthopaedic surgeons who were reached through the email groups of Turkish Society of Orthopaedics and Traumatology – Residents and Young Attendings Council (TOTBID-AGUH). Results A total of 725 residents and 132 young attendings were surveyed. The most outstanding answers are as follows: 62,7% of the respondents replied to the question “Is there a training program/Is it being applied” as “yes/yes”. It was found out that 94,3% of the respondents wanted to be involved in a rotation abroad. The “patient care” was the most common answer, with a ratio of 36,9%, to the question “Whats the priority of the department you are studying in?”. Regarding work conditions, “many emergency on-calls” was found to be the most important parameter affecting life conditions (p < 0.05). Conclusion Aiming to identify the challenges that orthopaedics and traumatology residents in Turkey face as regards their training, this survey stands as a pioneering study with a high participation rate. Analysis of survey data highlights the importance of several key factors such as the development of training programs and increasing the time spent with academicians as well as spreading and promotion of log book application.

Migraine vestibulopathy in three families with ıdiopathic scoliosis: a case series

IntroductionWe assessed clinical and etiological association between vestibular pathology and idiopathic scoliosis concerning seven members of three families with idiopathic scoliosis.Case presentationThe families were referred to neurotology center for evaluation of balance problems. Patients were evaluated thorough anamnesis to relevant vestibular and audiological studies in addition to idiopathic scoliosis assessment. All evaluated scoliotic patients had clinical manifestations of vestibular dysfunctions and migrainous headache. All of the scoliotic patients (seven patients) in these three families were diagnosed as migraine vestibulopathy.ConclusionWith the presentation of these three families, we discussed the probable role of the vestibular dysfunctions including migraine vestibulopathy in the development and progression of idiopathic scoliosis.