Serkan Bayram

Tuberculosis tenosynovitis with multiple rice bodies of the flexor tendons in the wrist: A case report

Highlights • Therefore, although a rare diagnosis, tuberculosis of the tendon sheath should be kept in mind in developing countries. The reason is that the presentation and lab findings of tendon sheath tuberculosis are non-specific, making it hard to differentiate from other causes for this condition. For example a wrist tuberculosis may present with carpal tunnel symptoms. While MR sequences, especially T2, may give hints of tuberculosis, these can be easily misinterpreted as pigmented villonodular synovitis.• All these may cause a delay in diagnosis. In order to prevent any delay in diagnostic evaluation, all steps should be taken carefully.• Wide debridements to alleviate the symptoms of wrist tuberculosis is not enough a treatment. It is true that wide debridements quickly lessens the symptoms; however, the actual treatment of the condition is antituberculosis treatment directed at the causative organism. Antituberculosis medications are needed to decrease recurrence levels and avoid complications.

Calcaneal Ewing's Sarcoma With Skip Metastases to Tarsals and Lymph Node Involvement: A Case Report

Ewings sarcoma (ES) represents the second most common primary malignant tumor of bone of children and occurs rarely in the bones of the foot. Dissemination to regional lymph nodes and skip metastases to adjacent bones are thought to be uncommon. We report a case of a 19-year-old female with the diagnosis of ES of the right calcaneus. Six months earlier, she had presented to the hospital with a history of ankle sprain and was treated with analgesics and ice application. Despite the treatment, the pain over the ankle persisted, her foot swelled progressively, and a mass evolved on the lateral side of the foot. She was referred to our clinic for further treatment options. Radiography and magnetic resonance imaging revealed an expansile mass originating from the calcaneus with talar and cuboidal skip metastases, with concomitant popliteal and inguinal lymph node involvement. The diagnosis was confirmed by histopathologic evaluation after Tru-Cut biopsy. Below-the-knee amputation with popliteal and inguinal lymph node dissection was performed after neoadjuvant chemotherapy. The postoperative first-year follow-up data for the patient showed no evidence of metastasis. The calcaneus is a rare location for the development of ES. A few patients with ES will present with skip metastases to adjacent juxtaarticular bones or regional lymph node involvement. Therefore, the present study has presented a unique case of ES with a rare anatomic location and an unusual metastatic pattern.

Periprostetic Joint Infection Caused by Salmonella: Case Reports of Two Azathioprine and Prednisolone Induced-immunocompromised Patients

Periprosthetic joint infection (PJI) due to Salmonella is rare. It frequently occurs patients receiving immunosuppressive medicine. We describe two periprosthetic Salmonella infection of two immunocompromised patients. Both of patients were receiving azathioprine and prednisolone therapy. First patient presented six years after total hip arthroplasty with a huge abscess on her right thigh that was reached to femoral component through the lytic area of lateral femur. Second patient presented with drainage from his hip and he had undergone two-step revision surgery for PJI 3 months ago. There is no consensus in the treatment of periprosthetic salmonella infections. We prefer two-step revision surgery for these infections as previously described in the literature.

Arthroscopic versus open release of internal rotation contracture in the obstetrical brachial plexus paralysis (OBPP) sequela

BACKGROUND Latissimus dorsi (LD) and teres major (TM) tendon transfers are effective surgical procedures to improve shoulder abduction and external rotation for children with obstetrical brachial plexus palsy (OBPP). Open pectoralis major (PM) tendon Z-plasty and arthroscopic subscapularis (SS) release are 2 options for the release of internal rotation contractures to enhance muscle transfers. This study compared the functional results of LD and TM tendon transfers with open PM tendon Z-plasty or arthroscopic SS release. METHODS The study included 24 patients who underwent LD and TM tendon transfers for OBPP (9 arthroscopic SS release, 15 open PM tendon Z-plasty) with a mean follow-up of 41.33 months (range, 36-60 months) and 47.2 months (range, 36-60 months), respectively. Functional evaluation was made according to range of motion and Mallet scoring system. RESULTS Shoulder abduction-external rotation degrees and scores in all sections of the Mallet scoring system significantly increased in both groups (P < .001). Postoperatively, the arthroscopic SS release group had significantly better abduction degrees (P = .003), total Mallet scores (P < .001), and superior abduction (P = .043), active external rotation (P = .043), hand-to-head (P = .043), and hand-to-mouth (P < .001) scores for the Mallet scoring system. DISCUSSION Transfer of LD together with TM tendons combined with one of the internal rotation contracture release procedures yielded good clinical and functional results in patients younger than age 7, regardless of the type of release method. However, arthroscopic SS release, although requiring an experienced surgeon, revealed better clinical and functional outcomes and is considered to be a less invasive and superior method.

Simultaneous Bilateral Quadriceps Tendon Rupture in a Patient with Diffuse Idiopathic Skeletal Hyperostosis after Minimal Trauma: Eight-Year Follow-Up

Introduction The purpose of this report was to describe a very rare case of simultaneous bilateral quadriceps tendon rupture seen in a patient who was diagnosed as having diffuse idiopathic skeletal hyperostosis. Case Presentation A man aged 64 years presented to the emergency department with bilateral quadriceps tendon rupture. Surgical repair was performed with suture anchors and a stainless steel cable. His legs were immobilized in casts for six weeks. After removal of the casts, physiotherapy was started. Four months after surgery, he was able to walk with 0°–120° range of motion and active extension. He was followed up for 8 years without rerupture or other complications. Conclusion Bilateral rupture of the quadriceps tendon is a rare condition and generally related to metabolic disorders. Diffuse idiopathic skeletal hyperostosis is a metabolic disorder that causes bilateral quadriceps tendon rupture, and it accounted for the differential diagnosis of the underlying condition.

TOPUK AĞRISININ NADİR BİR NEDENİ, KALKANEUS YERLEŞİMLİ İNTRAOSSEÖZ LİPOM: 9 OLGUNUN RETROSPEKTİF ANALİZİ ve LİTERATÜR DERLEMESİ

Amac: Intrakalkaneal lipom nadir gorulur ve siklikla asemptomatiktir. Semptomatik olan vakalarda ise cogunlukla ilk ve en sik sikâyet basit topuk agrisidir. Bu calismanin amaci, topuk agrisi sebebiyle basvurduklari kliniklerde cesitli on tanilar alarak cerrahi disi yontemler ile tedavi edilmeye calisilan ve klinigimizde cerrahi olarak basariyla tedavi edilmis 9 olgunun retrospektif analizini ve literatur derlemesini sunmaktir. Gerec ve Yontem: Klinigimizde 2008 ve 2015 yillari arasinda intrakalkaneal lipom tanisi ile ameliyat edilen 9 hasta (4 kadin, 5 erkek) calismaya dahi edildi. Ortalama yas 40,6 (19-70) yil idi. Ortalama takip suresi 50,4 (12-114) ay idi. Baslangictaki yanlis tani ile gercek tani arasindaki sure 20,8 (12-48) ay idi. Hastalar klinigimize basvurmadan once, Achilles tendiniti, epin kalkanei, retrokalkaneal bursit ve plantar fasiit tanilari almis ve tedavi edilmeye calisilmistir. Bulgular: Yedi hasta kuretaj & kemik grefti ve 2 hasta kuretaj & kemik sementi ile tedavi edildi. Tum hastalar ortalama 5 (3-11) ayda tamamen agrisiz iyilesti. Kemik greftlerinin tam olarak konsolidasyonu ortalama 6 (5-9) ayda goruldu. Ortalama AOFAS skoru ameliyat oncesi 80,4 ten birinci yilda 95,3’e yukseldi. Sonuc: Topuk agrisi olan hastalarda intrakalkaneal lipom ayirici tanida dusunulmelidir. Kuretaj ve kemik grefti ile grefonaj agrili ve kritik boyutta intrakalkaneal lipomlar icin iyi bir cerrahi tedavi secenegi olabilir. Anahtar kelimeler: Topuk agrisi; kemik ici lipomlar; kalkaneus.

The effectiveness of the Latarjet procedure for shoulder instability in patients with epilepsy

INTRODUCTION Powerful contractions during epileptic seizures may cause shoulder dislocation and instability. The aim of the study is to evaluate the functional and radiographic results of the Latarjet procedure for anterior shoulder dislocation in patients with epilepsy and compare the functional results of these patients with the results of patients without epilepsy. HYPOTHESIS Is latarjet procedure effective in epileptic patients as non-epileptic patients with anterior shoulder instability? MATERIAL AND METHOD Eleven shoulders of 9 patients with epileptic seizures causing anterior shoulder instability were evaluated retrospectively. All patients had a Latarjet procedure after neurologic evaluation and treatment arrangement. Epileptic seizures after the operation and shoulder dislocation after a seizure were investigated. For functional evaluation, ROWE, ASES and Constant scores were utilized whereas standard X-ray views were used for radiologic evaluation. The results of epileptic patients with Latarjet procedure were compared with non-epileptic patients (53 patients, 54 shoulders) for anterior shoulder instability. RESULTS Three (33%) of the 9 epileptic patients had recurrent seizures after Latarjet procedure, whereas 1 of the 11 shoulders (9%) had dislocation after an epileptic seizure. Functional scores were found to be significantly improved in epileptic (P<0.001) and non-epileptic patients (P<0.001). No significant differences for functional results were found between epileptic and non-epileptic patients after Latarjet procedure for anterior instability (P>0.05). One shoulder of 11 in the patients with epilepsy group (9%) and one shoulder of the 54 shoulders non-epileptic patients group (1.8%) had a redislocation. The rate of postoperative redislocation was significantly higher in patients with epilepsy (P=0.008). DISCUSSION Epileptic patients have a high rate of recurrent seizures even with proper medical treatment. Significant functional improvements and shoulder stability may be achieved after Latarjet procedure in epileptic patients. These functional results were comparable with those of non-epileptic patients with Latarjet procedure for anterior shoulder instability. LEVEL OF EVIDENCE III (case-control study).

Primary repair for spontaneous quadriceps tendon rupture in patients with hemodialysis: How strong is the repaired tendon?

Spontaneous quadriceps tendon rupture is not rare in patients with chronic renal failure needing dialysis due to the impaired collagen maturation in tendons. With transpatellar tunnel technique, the repair of the impaired tendon and successful healing are reported. The aim of this study is evaluate the functional results, strength and endurance of the quadriceps tendons after repair with transpatellar tunnel technique in hemodialysis patients with spontaneous quadriceps tendon ruptures. Primary repair with transpatellar tunnel technique is performed in 15 spontaneously ruptured quadriceps tendons of 9 patients with the mean age of 50,1 (6 bilateral, 3 unilateral ruptures). After a mean follow-up of 48.7 months, patients were evaluated with Lysholm score for functional evaluation. Isokinetic quadriceps strength and endurance measurements were performed with computerized dynamometer (CYBEX HUMAC–USA) and compared with a control group of 10 volunteers with chronic renal failure needing hemodialysis without quadriceps rupture history. The demographics of the study group and the control group were comparable in terms of age, body weight and dialysis year. 1 patient was deceased during follow-up due to end-stage renal failure. Of the 13 repairs evaluated, 1 repair failed after 3 months and needed revision surgery. Although at the latest follow-up all patients were doing active knee extension against gravity with their repaired quadriceps tendons and walk independently, the Lysholm score of the repair group (mean 75.3) was significantly lower than the control group (mean 93,2) (p: 0.009). The strength (peak torque) of the repaired quadriceps tendon was 43,6 Nm and was significantly lower than the control group (90,6 Nm) (p: 0.001). The endurance of the repaired tendon was also found to be significantly lower than the control group. 259 Nm and 625 Nm respectively (p: 0.001). Primary repair with transpatellar tunnel technique after spontaneous quadriceps ruptures in hemodialysis patients can provide acceptable functional results with active knee extension and independent walking ability. However the strength and endurance of the repaired tendon might be significantly lower than a impaired but unruptured quadriceps tendon.

Conservative management equally effective to new suture anchor technique for acute mallet finger deformity: A prospective randomized clinical trial

Study Design: Prospective randomized controlled trial. Purpose of the Study: This study was designed to compare our new suture anchor technique with conservative management in acute Wehbe‐Schneider type I A‐B and II A‐B mallet fingers. Methods: Twenty nine patients who presented to our clinic between 2013 and 2015 were randomized for surgical or conservative treatment. Wehbe‐Schneider subtype C fractures were excluded. Fourteen were treated with surgery, and 15 were treated with conservative treatment. Primary outcomes were visual analog scale score, active distal interphalangeal (DIP) joint flexion, return to work, extension deficit and DIP joint degeneration. Follow‐up time was 12 months. Results: The mean visual analog scale was 2.0, and return to work was on average in 63.2 days in the surgical group and 1.47 and 53.7 days in the conservative group. Extension deficit was 8.1° in the surgical group and 6.1° in the conservative group. The mean DIP flexion at final follow‐up was 54.5° (40–65) in the surgery group and 58.3° (45–70) in the conservative group. DIP joint degeneration was observed with X‐rays in 4 patients in surgical group, and none of the patients in the conservative group had DIP degeneration at 1 year after treatment. Conclusions: The therapeutic effectiveness of suture anchor technique was not statistically different from conservative treatment. Subluxation seen after fixation treatment with suture anchors may be due to inadequate anchor fixation. DIP joint degeneration was seen significantly more in the surgical group. Our study suggests that the new suture anchor technique is not superior to conservative treatment. Level of Evidence: Ib.

Uzun Kemik Osteomiyelitinin Nadir Bir Etkeni: Fusobacterium necrophorum / An Uncommon Pathogen Causing Long Bone Osteomyelitis: Fusobacterium necrophorum

Osteomiyelite yol acan patojenler cesitlilik gostermekle birlikte, bagisikligi baskilanmis hastalarda daha nadir gorulen mikroorganizmalar da etken olabilmektedir. Bu calismada nadir bir vaka olarak, Fusobacterium cinsi bir bakterinin sebep oldugu osteomiyelitten muzdarip bir hastanin tani ve tedavisini sunmayi amacladik. 48 yasindaki kadin hasta sol uylugunda uc aydir mevcut olan agri ve sislik sikayetiyle bize basvurdu. Cekilmis olan MR goruntulerine gore malign kemik tumoru on tanisi alarak klinigimize sevk edilmisti. Hastanin skleroderma nedeniyle immunosupresif ilac kullanma hikayesi mevcuttu. Ilk basvurudan iki gun sonra patolojik femur kirigi geciren hastaya osteomiyelitin cerrahi tedavisi olarak apse drenaji, debridman ve kirik icin de antibiyotikli sement kapli intrameduller civi ile osteosentez ameliyati yapildi. Ameliyat oncesinde alinan orneklerin kulturunde Fusobacterium necrophorum uredi. Yatisi sirasinda vakum yardimli kapama ile takip edilen hasta, akut faz reaktanlari normale dondukten ve IV antibiyotik tedavisi tamamlandiktan sonra taburcu edildi. Immun sistemi baskilanmis hastalarda Fusobacterium cinsi bakterilerin osteomiyelit etkeni olabilecegi ve kemikteki litik lezyonlarin ayirici tanisinda osteomiyelit olasiligi akilda tutulmalidir. Anahtar Kelimeler: Fusobacterium necrophorum; osteomiyelit; sement kapli civi Abstract Although pathogens causing osteomyelitis vary, relatively uncommon microorganisms can cause osteomyelitis in immunosuppressed patients. In this study we aimed to present the diagnosis and treatment of a patient with a rare case of osteomyelitis due to infection with a species of Fusobacterium. A 48-year-old female patient complaining of swelling and pain in her left thigh for the last three months was referred to our clinic with a prediagnosis of bone malignancy based on the MRI findings. The patient had a history of immunosuppressive drug use for scleroderma. The patient suffered a pathological femoral fracture two days after her first visit to us. Abscess drainage and debridement were performed to treat her osteomyelitis, and an osteosynthesis including antibiotic cement-coated intramedullary nail insertion was performed for the fracture. Fusobacterium necrophorum grew in the culture of the preoperative specimens. The patient for whom vacuum-assisted closure was used during her hospitalization was discharged after the acute phase reactants returned to normal and the IV antibiotic treatment was completed. It should be noted that bacteria from the genus Fusobacterium can cause osteomyelitis in immunosuppressed patients, and that while making the differential diagnosis of the lytic lesions of bones osteomyelitis is one of the possibilities. Key Words: Fusobacterium necrophorum; osteomyelitis; cement-coated nail