[A survey on knowledge, attitude, and practice of emergency department practitioners in musculoskeletal injuries]. / Acil pratisyen hekimlerinin kas-iskelet yaralanmalarinda bilgi, tutum ve davranislari üzerine bir anket çalismasi.

OBJECTIVES: A knowledge, attitude, and practice study was conducted in relation to musculoskeletal injuries among emergency department practitioners working in the town of Afyon, Turkey. METHODS: Of 40 practitioners working at emergency health services in Afyon, 32 (80%) responded to a 20-item questionnaire that inquired about their knowledge, attitude and practice. A 100-point scoring system was used for the first half of the questionnaire including 10 questions about their knowledge, and a total score of 60 or above was regarded as successful. Inquiry was focused on frequent emergency problems that require intervention by the emergency department practitioners, such as neck examination in trauma patients, treatment of open fractures, intervention to dislocations, treatment in gunshot injuries, and transportation of traumatic amputated organs. RESULTS: The mean duration of professional practice was 7.8+/-3.9 years. The mean achievement score was 66.6+/-15.8, without any significant difference among institutions. No significant relationship existed between the duration of professional practice and knowledge scores. Despite a success rate of 81.3% in knowledge scores, the following shortcomings were notable: neglect in the neurological examination of the lower extremity during neck examination, and inappropriate definitions and interventions in open fractures, tetanus prophylaxis, and antibiotic treatment. CONCLUSION: The survey showed that the practitioners in Afyon have sufficient knowledge levels; however, it seems apparent that there are shortcomings in their practice, which require continuing education for all the staff.

[Familial glomus tumor encountered in the same finger and localization in four family members]. / Ailenin dört üyesinde ayni parmak ve yerlesimde görülen glomus tümörü.

A 35-year-old man was referred to our clinic by a neurosurgeon for hypersensitivity and severe pain in his right middle finger. History showed that the symptoms had been present for three years and he had made several attempts to seek medical attention. A sensitive, very painful mass was palpated under the eponychium of his right middle finger. The tumor was surgically removed and histological examination confirmed the clinical diagnosis of a glomus tumor. Inquiry into the family history revealed that the same problem existed in the same localization with similar complaints in the father and two daughters. Both the records of the father's operation 10 years before and clinical-radiological findings of the daughters were consistent with a familial entity. In the presence of hypersensitivity and pain in the finger, family members should be inquired and a diagnosis of familial glomus tumor should be considered.

Radiographic evaluation and unusual bone formations in different genetic patterns in synpolydactyly.

OBJECTIVE: To compare the radiological findings of heterozygous and homozygous subjects with synpolydactyly (SPD) and to discuss their unusual bone formations. DESIGN AND PATIENTS: Families with hand and foot SPD were examined. Genetic analysis was performed with blood samples and the pedigree was constructed. The affected individuals, especially those with distinctive phenotypic features, were invited to our orthopaedics clinic for further diagnostic studies. All participants underwent detailed clinical and X-ray examinations. RESULTS: Of the invited patients, 16 (five female and 11 male; age range 4-37 years, mean age 10.75 years) were included in our study, and hand and foot radiographs were obtained. All subjects had bilateral hand radiographs (32 hands), and 14 had bilateral foot radiographs (28 feet). Genetic analysis revealed 12 heterozygote (75%) and four (25%) homozygote phenotypes. Among patients enrolled into the study nine (three homozygotes, six heterozygotes) had SPD of both hands and feet bilaterally (tetrasynpolydactyly). Six unusual bone formations were observed in the hands and feet: delta phalanx, delta metacarpal/metatarsal, kissing delta phalanx, true double epiphysis, pseudoepiphysis and cone-shaped epiphysis. There were major differences in radiological and clinical manifestations of homozygote and heterozygote phenotypes. The homozygous SPD presented with very distinctive unusual bone formations. CONCLUSION: The existence and variety of unusual bones may indicate the severity of penetrance and expressivity of SPD.

Hypoplastic synpolydactyly as a new clinical subgroup of synpolydactyly.

A large kindred which was first described in 1995 was investigated again. We present the clinical, radiological, genetic and surgical findings of the hand deformities found in homozygote individuals which we called "hypoplastic synpolydactyly". There were 125 affected (heterozygote or homozygote) people out of 245 subjects in the five last generations. We identified seven marriages of two affected people. Twelve offsprings, of these marriages had a homozygote genetic pattern and "hypoplastic synpolydactyly". From both the clinical and surgical perspectives, their hand deformity was distinctive from that of their parents. We surgically treated both hands of three individuals with this deformity. The hand deformity of these homozygotes was so complicated and distinctive that it can be evaluated as a new subgroup of synpolydactyly.