Ozkan Kose

The prevalence of absence of the palmaris longus: a study in Turkish population

IntroductionIt is well known that there is a wide variation in the reported prevalence of the palmaris longus (PL) absence in different ethnic groups. This prospective study was conducted to determine the prevalence of absence of PL and correlate it with gender and body side in Turkish population.MethodIn total, 1,350 randomly selected adult patients (675 men and 675 women) who admitted to our outpatient clinic were examined for the absence of PL using Schaeffer’s test and Mishra’s second test. The absence of PL on both sides, results of the first and second examination tests, age, gender and dexterity were recorded and analyzed statistically.ResultsThe overall prevalence of absence of PL (unilateral or bilateral) was 26.6% in Turkish population. The absence of PL in women was statistically more common than men. Bilateral absence of PL was statistically frequent than unilateral absence. The prevalence of absence of PL was statistically similar between the body sides.ConclusionMishra’s second test which involves resisted abduction of the thumb, may be better in demonstration of the PL where the muscle was feebly developed, particularly in women.

Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial.

Objectives The purpose of this study was to compare the efficiency of the hyperpronation and supination–flexion maneuvers in the reduction of the pulled elbow. Methods Sixty-six patients with pulled elbow were randomized for reduction with either hyperpronation or supination–flexion maneuvers. When the first attempt failed, a second attempt was performed with the same reduction maneuver. After failure of the second attempt the reduction maneuver was changed to the alternate method. The success rate of the reductions and the subjective rating on the difficulty of the reduction by the physician were recorded and analyzed statistically. Results Thirty-two of 34 patients (94%) in the hyperpronation group and 22 of 32 patients (69%) in the supination–flexion group were reduced at first attempt (P=0.007). Two patients in the hyperpronation group and seven patients in the supination–flexion group were reduced at the second attempt. Reduction rates were statistically similar (P=0.06). Three patients in the supination–flexion group had failed reduction at the second attempt and the reduction maneuver needed to be changed. They were successfully reduced with hyperpronation maneuver at the first attempt. Final success rate of the hyperpronation maneuver at the first attempt was statistically higher than the supination–flexion maneuver (P=0.004). Furthermore, the hyperpronation maneuver was rated significantly easier than the supination–flexion maneuver by physicians (P=0.003). Conclusion Although final reduction rates were similar, the hyperpronation maneuver was more efficient at the first attempt, easier for physicians and less painful for the children.

Use of the iPhone for radiographic evaluation of hallux valgus

ObjectiveThe purpose of this study was to compare the measurements made using a smartphone accelerometer and computerized measurements as a reference in a series of 32 hallux valgus patients.Materials and methodsTwo observers used an iPhone to measure the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (of anteroposterior foot radiographs in 32 patients with symptomatic hallux valgus on a computer screen. Digital angular measurements on the computer were set as the reference standard for analysis and comparison. The difference between computerized measurements and all iPhone measurements, and the difference between the first and second iPhone measurements for each observer were calculated. Inter- and intraobserver reliability of the smartphone measurement method was also tested.ResultsThe variability of all measurements was similar for the iPhone and the computer-assisted techniques. The concordance between iPhone and computer-assisted angular measurements was excellent for the HVA, IMA, and DMAA. The maximum mean difference between the two techniques was 1.25 ± 1.02° for HVA, 0.92 ± 0.92° for IMA, and 1.10 ± 0.82° for DMAA. The interobserver reliability was excellent for HVA, IMA, and DMAA. The maximum mean difference between observers was 1.31 ± 0.89° for HVA, 0.90 ± 0.92° for IMA, and 0.78 ± 0.87° for DMAA. The intraobserver reliability was excellent for HVA, IMA, and DMAA.ConclusionsWe conclude that the Hallux Angles software for the iPhone can be used for measurement of hallux valgus angles in clinical practice and even for research purposes. It is an accurate and reproducible method.

Osteolipoma independent of bone tissue: a case report

IntroductionLipomas are the most common benign soft tissue tumors and appear in any part of the body. They typically consist of mature adipose tissue. Osteolipoma is an extremely rare histologic variant of lipoma that contains mature lamellar bone within the tumor and osteolipoma independent of bone tissue are very rare. We report a case of histologically confirmed osteolipoma independent of bone located in the thigh.Case presentationA 47-year-old male presented with a progressively enlarging, painful mass which approximately 10 cm × 8 cm over the anteromedial aspect of his right thigh. Plain films, Computerized Tomography, Magnetic Resonance Imaging and ultrasound guided needle biopsy were performed. Given the benign imaging characteristics and fine needle aspiration, an excisional biopsy was undertaken. The definitive pathologic diagnosis was intramuscular osteolipoma without evidence of malignancy. No recurrence was observed after 18 months follow up.ConclusionAlthough ossifying lipomas are very rare, it is important to keep them in mind when a lesion with adipose tissue in combination with ossification is encountered.

Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations

PurposeThe aim of this prospective study was to evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) in detecting occult scaphoid fractures.Materials and methodsA total of 54 patients with a clinically suspected scaphoid fracture and negative initial conventional radiographs were evaluated with 64-row MDCT wrist examinations within 1 week of the trauma. The gold standard used was the diagnosis on MRI done within 1 week after MDCT. The sensitivity, specifi city, positive predictive value (PPV), and negative predictive value (NPV) of MDCT were calculated.ResultsMRI showed a total of 22 fractures in 20 of 55 (36%) wrists. Fractures included 14 scaphoid and 8 other carpal bones. MDCT showed a total of 19 fractures in 17 of 55 (30%) wrists. Two isolated scaphoid fractures and one trapezium fracture were missed on MDCT. The sensitivity, specificity, PPV, and NPV of MDCT were 86%, 100%, 100%, and 91%, respectively.ConclusionMDCT offers highly accurate results, especially concerning cortical involvement, and is a useful alternative in facilities lacking MRI.

Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?

ObjectiveNon-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot.Material and methodsA prospective study was performed on 61 consecutive patients with a diagnosis of calcaneal apophysitis in a single-surgeon practice. Standard anteroposterior and lateral weight-bearing foot radiographs were obtained for each patient. Seventy-one sets of foot radiographs were reviewed to determine whether radiographs had an impact on diagnosis and management. Patients with antecedent trauma, penetrating injury, foot deformity, achilles tendonitis, bursitis and infections were excluded from the study.ResultsSeventy foot radiographs were considered to be normal. The radiographs changed the diagnosis in only one patient, in whom a simple bone cyst of the calcaneous was seen.ConclusionCalcaneal apophysitis is a self-limiting disease, and patients can be treated conservatively. Neither the sclerosis nor the fragmentation of the apophysis could be used to establish the diagnosis of calcaneal apophysitis. Therefore, obtaining radiographs as an initial step in their evaluation does not seem to be justified.

Open versus percutaneous release for the treatment of trigger thumb.

The purpose of this retrospective study was to compare the outcomes and complications of conventional open surgical release and percutaneous needle release in the treatment of trigger thumb. The study comprised 87 patients with trigger thumb who were treated with either open pulley (n=52) or percutaneous (n=32) release between 2008 and 2011. All patients were reevaluated at a mean follow-up of 22.7±9.6 months (range, 9-44 months). Main outcome measures were the rate of recurrence, pain on movement or tenderness over the pulley, infection rate, digital nerve injury, tendon bowstringing, joint stiffness or loss of thumb range of motion, and patient satisfaction. The groups were statistically similar regarding age, sex, laterality, dominant side involvement, and trigger thumb grade on initial admission. At final follow-up, no patient had recurrence, tendon bowstringing, joint stiffness, or loss of thumb range of motion. No patients in the open pulley release group and 2 (5.7%) patients in the percutaneous release group had a digital nerve injury (P=.159). No statistical difference was found in the infection rate between groups (P=.354). A total of 98.1% of patients in the open pulley release group and 97.1% of patients in the percutaneous release group were satisfied with treatment (P=.646). Both techniques resulted in similar therapeutic efficacy, and the rate of potential complications was also statistically similar in each group. Although statistically insignificant, the authors believe that the 5.7% rate of iatrogenic digital nerve injury seen in the percutaneous release group is clinically significant and serious. Therefore, they advocate using open surgical release of trigger thumb.

Isolated Medial Cuneiform Fractures: Report of Two Cases and Review of the Literature

Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures. Level of Evidence: Therapeutic, Level IV

Phytocontact dermatitis due to Ranunculus arvensis mimicking burn injury: report of three cases and literature review

Ranunculus arvensis (corn buttercup) is a plant species of the genus Ranunculus that is frequently used in the Far East to treat rheumatic diseases and several dermatological disorders. In Turkey, the plant is seen in the eastern and southeastern Anatolian highlands, which are underdeveloped areas of the country. Herein, we report three patients who used Ranunculus arvensis for the treatment of arthralgia and osteoarthritis. A distinctive phytodermatitis developed on the right thumb in one patient (48-year-old male), on the anterior aspect of both knees in another patient (70-year-old female) and all around both knees in a third (59-year-old female). The patients were treated with topical antibiotics and daily wound dressing, and none of them experienced any complications. Ranunculus arvensis was confirmed as the cause of the phytodermatitis in the three cases. Poultices of plants applied to the skin demonstrate beneficial effects on many dermatological and rheumatic diseases; however, they have several adverse effects that should not be ignored. In this study, we also present a review of 25 cases reported in the literature.

Prediction of the quadruple hamstring autograft thickness in ACL reconstruction using anthropometric measures

OBJECTIVE The aim of this study was to determine whether simple anthropometric measurements, such as height, weight, body mass index (BMI), age, and thigh circumference can be used to accurately predict the diameter of hamstring tendons for anterior cruciate ligament (ACL) reconstruction surgery. METHODS One hundred sixty-four consecutive male patients who underwent ACL reconstruction using quadruple hamstring autograft between January 2010 and December 2011 were prospectively evaluated. Anthropometric measurements including height, weight, BMI, age and thigh circumference were recorded preoperatively. The thickness of the quadruple hamstring autograft was intraoperatively determined using sizing cylinders. Correlation coefficients (Pearsons r) and stepwise, multiple linear regression were used to determine the relationship between the outcome variable (hamstring graft diameter) and the predictor variables (age, height, weight, BMI, thigh circumference). RESULTS Correlation analysis revealed a positive relation between the height, weight and graft thickness (p=0.000 and p=0.002, respectively). Taller and heavier patients tended to have thicker quadrupled hamstring graft. However, age, thigh circumference, and BMI did not correlate with the graft thickness (p=0.700, p=0.290 and p=0.727, respectively). Stepwise, multiple linear regression indicated that height was statistically important as a predictor for hamstring graft diameter (R2=0.157, p=0.0001) and yielded the following regression equation for predicting quadrupled hamstring graft thickness: graft thickness = [(height in cm) x 0.052) - 1.07] mm. CONCLUSION Height can be used as a practical and accurate measurement to preoperatively predict quadruple hamstring graft diameter in male patients. Identification of possible hamstring tendon autograft insufficiency allows for preoperative determination of additional graft source possibilities, resulting in a more prompt surgical strategy.