Yavuz Arikan

Chondroblastoma-like osteosarcoma: a case report and review

Chondroblastoma-like osteosarcomas are extremely rare malignancies having varying clinical, radiological and histological features. Their rarity causes challenges in both diagnosis and clinical management. They are often misdiagnosed as benign lesions. Their accurate diagnosis is important because they require adequate treatment. Misdiagnosed lesions or undertreatment may result in recurrences. We report a case of chondroblastoma-like osteosarcoma arising in the left first metatarsal bone with tarsometatarsal joint involvement in a 10-year-old boy for whom surgery with an original technique was planned after a multidisciplinary diagnostic review.

Comparison of phenol matricectomy and nail-splinting with a flexible tube for the treatment of ingrown toenails.

Background The treatment of ingrown toenail is usually bothersome for patients and doctors. Objectives To compare two treatment techniques of ingrown toenails—phenol matricectomy (PM) and nail‐splinting using a flexible tube (FT)—in terms of efficacy, postoperative pain, postoperative cosmetic satisfaction, amount of tissue damage, and recurrence. Methods and Materials One hundred twenty ingrown toenails were randomized and divided into PM and FT groups. All cases were evaluated 2 days and 1 and 6 months after treatment. Postoperative pain, cosmetic satisfaction, time to recovery, and recurrence rate were measured. Results Postoperative pain was less and cosmetic satisfaction was good in both groups (p <.001). Our recurrence rate was 8.4%. There were no statistical differences between groups in these measures. Tissue improvement rate was 6% in the PM group and 93% in the FT group 2 days after the procedures (p <.001). Conclusions Although FT provides faster recovery and less postoperative morbidity than PM, the techniques are equally effective in treating ingrown toenails.

Congenital bizarre parosteal osteochondromatous proliferation in unusual location and age: a case report

Bizarre parosteal osteochondromatous proliferation (BPOP, also known as Noras lesion) is a rare, benign, locally aggressive condition defined as osteochondromatous exostosis arising from the bony cortex. BPOP presents predominantly in the 2nd and 3rd decades of life, and commonly arises from the periosteum of metacarpals and metatarses, though rare locations have been reported, including the long bones, the maxillae, the bones of calvaria, and the sesamoids. The case of an osteochondromatous lesion in an infant with an intra-abdominal mass arising from the iliac wing, an atypical location of benign solitary lesions, is reported. Benign solitary lesions are exceptional in this age group. The parents of the patient, who was born in term at 3600 grams, discovered a mass in the left groin and observed decreased movement in the lower left extremity. No history of trauma was reported. When the patient was 5 months of age, AP pelvic X-ray, computed tomography, and magnetic resonance imaging revealed a bony mass displacing intra-abdominal organs anteromedially. Biopsy reported an osteocartilaginous lesion with calcified mature cartilaginous fragments surrounded by plasmacytoid, monotone, fibrinoid cells in myxoid background. Differential diagnosis included osteochondroma, osteochondromyxoma, BPOP, fibrocartilaginous mesenchymoma, chondromyxoid fibroma, periosteal chondroma, soft tissue chondroma, myositis ossificans, and juxtacortical chondroma. Biopsy of the resected specimen determined a diagnosis of BPOP. At 6-month postoperative follow-up, neither symptoms nor complaints related to the mass were present.

A rare knee extensor mechanism injury: Vastus intermedius tendon rupture

Highlights • The first case of isolated rupture of vastus intermedius tendon in the literature.• Partial quadriceps tendon rupture can be treated by conservative therapy.

Bilateral bucket handle medial meniscal tears of the knee: A case report

INTRODUCTION Meniscal tears may cause knee pain and functional impairment. Bilateral bucket-handle meniscal tears is an uncommon condition. PRESENTATION OF CASE This report presents the case of a 35-year-old male patient with bilateral bucket handle medial meniscal tears that occurred nonsimultaneously. The lesions were treated arthroscopically with partial resection in one knee and meniscal suture in the other. DISCUSSION Bucket handle meniscal tear of meniscus without underlying meniscal, ligamentous pathology or lower limb deformity is a rare condition. CONCLUSION To our knowledge, bilateral bucket handle medial meniscal tears without underlying meniscal anomalies have been reported in only two cases before, and our case is the third one.

Flexion-adduction-external rotation method for shoulder dislocations

OBJECTIVE The aim of this prospective study was to assess the effectiveness of the flexion-adduction-external rotation method in the reduction of acute anterior shoulder dislocations. METHODS The study included 128 patients (98 male, 30 female; mean age: 33, range: 19 to 81) with a history of acute anterior shoulder dislocation treated with the flexion-adduction-external rotation method. Neurovascular examination was performed before and after reduction. Reduction duration and patient responses regarding the reduction method were recorded. RESULTS First-time dislocation occurred in 92 patients and recurrent dislocation in 36. 111 patients had subcoracoid dislocations and 17 subglenoid dislocations. Fracture of the greater tubercle was present in 13 patients. Reduction was achieved in the first attempt in 104 patients and in the second in 12 patients. Mean reduction time was under 1.5 (range: 0 to 5) minutes. Reduction was unsuccessful in 12 patients and reduction under general anesthesia was performed. No patients experienced neurovascular injury after reduction. CONCLUSION The forward flexion-adduction-external rotation method is an effective and comfortable reduction method for the treatment of shoulder dislocation or fracture-dislocation.

Surface Aneurysmal Bone Cyst: Clinical and Imaging Features in 10 New Cases

Aneurysmal bone cyst originating from the surface of the bone, either within the cortex or subperiosteally, is an uncommon anatomic subtype. This article reports the clinical and radiologic evaluations and treatment outcomes of 10 patients with surface aneurysmal bone cysts that were surgically treated between 1982 and 2014. Mean age at the time of surgery was 22.4 years (range, 11-44 years). According to Capannas radiographic evaluation criteria, 6 of the lesions were classified as type V and 4 were classified as type IV. Radiographically, periosteal shell formation was observed to be complete in 4 patients, partial in 3, and absent in 3, and 6 patients had Codmans angle or buttress formation. In 1 patient, computed tomography scan showed birdcage-like ossification attached to the surface of bone. Magnetic resonance imaging showed fluid-fluid levels in 5 patients. All of the patients had standard curettage and high-speed burr application as an adjuvant. No patient had local recurrence at the end of the follow-up period of 98.4 months (range, 13-288 months). These findings show the importance of careful radiologic evaluation and biopsy to better plan a treatment strategy when surface aneurysmal bone cyst is included in the differential diagnosis. The finding of fluid-fluid levels on magnetic resonance imaging or computed tomography is not pathognomonic for primary aneurysmal bone cyst; however, the absence of this finding does not rule out the diagnosis. The rate of local recurrence after curettage plus high-speed burr is reasonably low, and other adjuvant procedures should be used whenever needed. [Orthopedics. 2016; 39(5):e897-e903.].

Efficacy of the Taylor spatial frame in the treatment of deformities around the knee.

OBJECTIVE The aim of this study was to determine whether the Taylor spatial frame (TSF) can precisely correct deformities around the knee and whether application of TSF is easy and safe for treatment of the deformities around the knee. METHODS This study included 50 retrospectively reviewed limbs of 37 patients (mean age: 23 years, range: 10 to 58 years) with deformity around the knee joint treated using the TSF. Thirty-three limbs had tibial and 17 femoral deformities. Preoperative standard anteroposterior, lateral radiographs and standing orthoroentgenographic measurements were taken for each patient. Mechanical axis deviation (MAD), leg-length discrepancy (LLD) and lateral femoral distal angle (LDFA) and medial proximal tibial angle (MPTA) were measured from standing orthoroentgenographics. All measurements were repeated after external fixator removal. RESULTS The frame was applied for an average of 20.3 (range: 4 to 36) weeks. Mean follow-up time following removal of external fixator was 32 (range: 15 to 54) months. An effective and accurate correction was achieved in all cases. Solid bone consolidation was obtained in all but two cases which underwent bone grafting. CONCLUSION Taylor spatial frame appears to be a safe and effective method for the gradual correction of the complex translational and rotational deformities around the knee.

Single-Stage Treatment of Aseptic Nonunion of the Humerus with Locking Plate Fixation and Autograft

Background: Locking and non-locking compression plates are widely used in different long bone fractures. Biomechanical and controlled studies have reported a higher stability and rate of union with the use of locking plates. Locking plates are safely used also in the treatment of humeral nonunions with varying rates of success. Aims: The aim of this study was to evaluate the radiological and clinical results of a single-stage surgical treatment with locking compression plates (LCPs) and autologous bone grafting in patients with aseptic nonunion of the humerus. Study Design: Level of Evidence IV, case control study. Methods: Twenty-four patients (17 males; mean age: 43.5 years) treated with LCPs and autologous bone grafts due to nonunion following humeral fractures were included in this study. Twelve patients had earlier been treated surgically while the remaining 12 had received non-surgical (conservative) treatment. Six patients had atrophic and 18 had oligotrophic nonunions. Functional evaluation was made using the Constant-Murley scoring system. Results: The mean follow-up period was 43.6 months. Radiological union was observed in all patients except one (95.8%) in an average period of 18.8 weeks. A mean shortening of 1.8 cm was performed on six patients with atrophic nonunion. Preoperative infection markers and intraoperative cultures were negative for infection. Four patients experienced delayed unions and one patient had transient radial nerve palsy. Ten patients had excellent, 12 had good, and two had fair scores. Conclusion: The management of humeral nonunions with single-stage surgical intervention performed using LCPs and autologous bone grafts, following adequate debridement, is an effective method with satisfactory radiological and clinical outcomes.

Biomechanical, histological, and radiological effects of different phosphodiesterase inhibitors on femoral fracture healing in rats

Purpose: To investigate the biomechanical, histological, and radiological effects of sildenafil and pentoxifylline on femoral fracture healing in rats. Methods: Forty-eight Sprague-Dawley rats were divided into three groups equally according to the pharmacological agents to be investigated. Femoral shaft fractures were formed in the left side. Group 1 (control group), group 2, and group 3 were administered with saline, sildenafil, and pentoxifylline during the fracture healing process, respectively. Eight rats from each group were euthanized on days 15 and 30. X-ray images of the rats were taken after euthanasia for radiographical examination. Femur samples were subjected to histopathological and biomechanical (three-point bending) examinations. Results: Radiologically, no difference between the Goldberg scores of the groups was found for day 15 (p > 0.05), while higher Goldberg scores were obtained from group 2 than that of group 1 (p > 0.05) and group 3 (p < 0.05) for day 30. In the biomechanical analysis, higher mean breaking forces were found both for day 15 and day 30 from group 2 than those obtained from group 1 (for day 15 p > 0.05 and day 30 p > 0.05) and group 3 (for day 15 p < 0.05 and day 30 p < 0.01). Higher mean absorbed energy values were obtained from group 2 than those obtained from group 1 (for day 15 p > 0.05 and day 30 p < 0.05) and group 3 (for day 15 p < 0.01 and day 30 p < 0.01). A significant difference was not found between the histological scores of all groups (p > 0.05) for day 15, while the histological score of group 1 on day 30 was found to be significantly lower than that of sildenafil and pentoxifylline groups (p < 0.05). Conclusion: Sildenafil had a positive effect on fracture healing, while pentoxifylline did not provide consistent positive effect.