Serdar Sargın

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.

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.

Comparison of Knee Proprioception Between Blind and Healthy Sportsmen.

Objectives: Visual sense and proprioception have a big role in motion control. Visual communication ensures the data in proprioceptive period. The other senses of blind people are improved because of the lack of the visual ability but there are not enough data for the proprioceptive quality. The purpose of this study is to compare the knee joint proprioception of the blind and normal sportsmen and figure out the prorioceptive quality. Methods: 16 visually-challenged sportsmen (12 males and 4 females) with an average age 23.6 ±3.1(ranging from 20 to 30), and 16 healthy sportsmen (12 males and 4 females) with an average age 23.5 ±3.5 (ranging from 20 to 29) from the same sport branches were included in the study. Knee joint proprioception of the subjects in the target angle was measured. Angle repeating test was used via digital goniometer which was sensitive to 1 degree. For the statistical analyses of the data Mann-Whitney U, Wilcoxon Signed Ranks tests were used. Results: There were no differences between knee proprioceptions of dominant and non-dominant extremities in both groups. When dominant extremities were compared, blind athletes got less wrong in 15 degrees measurements statistically (p<0.05). All other comparisons revealed no statisticaly significant difference in both groups. Conclusion: It has been determined that the knee joint proprioception of the visually-challenged sportsmen are better than the normal sportsmen. If the normal sportsmen do the training with their eyes closed, the quality of their knee joint proprioception may improve.

Unusual Iatrogenic Complication of ACL Surgery: On the Cartilage Placement of Fixation Material

Objectives: Anterior cruciate ligament (ACL) ruptures constitute the most common ligament injury of the knee, and ACL reconstruction is a commonly performed procedure in orthopedic sport medicine. We report a case of on-the-cartilage placement of EndoButton for ACL reconstruction and its treatment with arthroscopic removal. The rehabilitation method was successful, resulting in excellent function and range of motion of the knee. The aim of this study was present an unusual case of iatrogenic complication of ACL reconstruction and to highlight to the surgeons about this complication. Methods: A 22-year-old male patient administered to our outpatient clinic with a history of trauma to his left knee in a soccer game 2 years ago. He underwent arthroscopic transtibial ACL reconstruction using hamstring tendons and EB system in another facility 19 months ago. At the time of initial administration he complained about pain and friction on his left knee, especially when he was running. In his physical examination patellar friction, anterior drawer and lachman tests were pathological which reminded us rerupture of ACL. Knee movements were in normal limits, but he felt pain especially during flexion and extension. Results: We used standard anteromedial and anterolateral portals and an accessory portal for excision of EB. When we explored the knee arthroscopically, we observed the EB misplaced on femoral groove. Firstly the loop of EB was cut then the EB was removed from superolateral portal. Loop remnant was cauterized with RF probe. The knee was irrigated and portals were sutured. The operation was finished without complication. The knee was dressed and the patient was kept in an adjustable knee brace. There was no complaint of crepitation and the range of motion (ROM) of knee was in normal limits. We offered revision operation again but the patient didn’t accept this suggestion. Conclusion: EB is a good and a commonly used option in ACL reconstruction surgery. Even the complication rates seem much more acceptable when compared to other fixation methods; misplacement of fixation device can be seen. In such a situation it is believed that, surgeons must not hesitate for arthroscopic removal and revision surgery.

Post-traumatic Median Nerve Neuroma in Wrist. A Case Report and brief review of Literature

Introduction: Distal median nerve masses may be developed post-traumatic or non-traumatic. In this paper, we aim to present a 52 year old female case with a postraumatic neuroma of the median nerve in the left wrist. Case Series: A 52-year-old female patient had accidental incised wound over her left wrist which was primarily sutured. She presented 6 months later with unrelieved pain and growing swelling at the wrist. USG showed solid mass of size 2x3 cms. Intraoperatively the mass was seen to arise from medial nerve and careful excision was done protecting the nerve. At one year follow up the patient is relived of her symptoms with no sensorimotor deficit. Conclusion: Post traumatic neuroma present as unrelieved pain and progressive swelling. A high index of suspicion should be kept in cases of wound that are primarily sutured over an area with superficial nerves. Careful excision of the lesion is very effective in relieving patients symptoms