Osteoid Osteoma of the Talus Mimicking Pigmented Villonodular Synovitis in a 15-Year-Old Male: A Case Report.

Osteoid osteoma is a benign tumor of the bone which tends to occur in diaphysis or metaphysis of the long bones. The lesion is generally intraosseous with vague clinical symptoms, hence given the name "great mimicker". When located subperiosteally and juxtaarticulary, atypical clinical presentation and radiological may lead to a delayed or missed diagnosis. Performing surgery with a misdiagnosis carries the risk of incomplete resection of the lesion and recurrence. We report the case of a 15-year-old male with a subperiosteal osteoid osteoma of the talus, who was misdiagnosed with pigmented villonodular synovitis and operated through anterior ankle arthrotomy. A nodular lesion 1 cm in diameter with hard rubber consistency was removed from the dorsal aspect of the talar neck. The pathological specimens were consistent with subperiosteal osteoid osteoma. The patient's symptoms resolved rapidly in the early postoperative period. The patient remained asymptomatic at the 20th-month follow-up and the control MRI revealed no signs of recurrence. Atypical radiological and clinical presentation of juxtaarticular subperiosteal osteoid osteomas cause misdiagnosis, delay in diagnosis, incomplete resection and recurrence. It is important to keep in mind "juxtaarticular subperiosteal osteoid osteoma" in the differential diagnosis of cases with suspected Pigmented Villonodular Synovitis.

The effect of cuff arthropathy stage on sleep disturbance and kinesiophobia in reverse shoulder arthroplasty patients.

BACKGROUND: The current study aimed to determine the changes in pre-and post-operative Pittsburg sleep quality index (PSQI) and Tampa scale of kinesiophobia (TSK) values ​​according to the Hamada classification in patients who underwent reverse shoulder arthroplasty (RSA) for rotator cuff tear arthropathy (RCTA). METHODS: One hundred and eight patients who underwent RSA for RCTA were reviewed retrospectively. The patients were divided into two groups with low grade (stages 1-2-3) (n = 49) and high grade (stages 4a-4b-5) (n = 59) according to the Hamada classification, which is the radiographic evaluation of RCTA. PSQI and TSK values ​​were calculated preoperatively, and post-operatively at the 6th week, 6th month, and 1st year. The change in PSQI and TSK values ​​between the evaluations and the effect of staging according to the Hamada classification on this change was examined. RESULTS: When compared in preoperative evaluations, PSQI and TSK scores were found to be lower in low-grade group 1 (7.39 ± 1.56, 51.88 ± 4.62, respectively) than in high-grade group 2 (10.47 ± 2.39, 57.05 ± 3.25, respectively) according to Hamada classification (both p < 0.001). In the postoperative evaluations, PSQI and TSK results decreased gradually compared to the preoperative evaluations, and there was a severe decrease in both parameters between the 6th-week and 6th-month evaluations (both p < 0.001). Preoperatively, 102 (95%) patients had sleep disturbance (PSQI ≥ 6), and 108 (100%) patients had high kinesiophobia (TSK > 37). In the 1st year follow-ups, sleep disturbance was observed in 5 (5%) patients and kinesiophobia in 1 (1%) patient. When the Hamada stages were compared, it was seen that there was a significant difference before the operation (both p < 0.001), but the statistically significant difference disappeared in the PSQI value in the 1st year (p = 0.092) and in the TSK value in the 6th month (p = 0.164) post-operatively. It was observed that Hamada staging caused significant differences in PSQI and TSK values ​​in the preoperative period but did not affect the clinical results after treatment. CONCLUSIONS: RSA performed based on RCTA improves sleep quality and reduces kinesiophobia. RCTA stage negatively affects PSQI and TSK before the operation but does not show any effect after the treatment.

Is there a relationship between dynamic thiol/disulfide homeostasis and osteoarthritis progression?

We aim to determine serum dynamic thiol/disulphide homeostasis with novel methods in early-stage osteoarthritis and late-stage osteoarthritis patients and investigated whether it was associated with the progression of osteoarthritis risk or not. One hundred eighteen patients were included in this prospective study. Osteoarthritis patients were divided into five stages, according to the Kellgren-Lawrence scale. Dynamic thiol/disulphide homeostasis was determined with a novel spectrophotometric method. Late-stage osteoarthritis patients had significantly lower levels of native and total thiol than the patients of early-stage osteoarthritis. Disulphide, index-1, index-2 levels, and WOMAC score of late-stage osteoarthritis patients were significantly higher than the ones belonging to patients of early-stage osteoarthritis. Decreased native thiol and total thiol levels and increased WOMAC score and disulphide levels were independently associated with increased risk of late-stage osteoarthritis. We suggest that both WOMAC score and dynamic thiol/disulphide homeostasis may be implicated in the pathogenesis and progression of osteoarthritis. We also recommend that dynamic thiol/disulphide homeostasis may have clinical utility as possible markers of differential diagnosis of early-stage and late-stage osteoarthritis.

The Association of Ischemia Modified Albumin with Osteoarthritis Progression.

BACKGROUND: We suggested a relationship between increased serum IMA (ischemia-modified albumin) levels and cartilage degeneration. We proposed that the increased serum levels of IMA was due to the oxidative stress mechanism against ongoing cartilage degeneration in osteoarthritis (OA) and thus may be associated with the progression of OA. We aimed to investigate serum IMA levels in OA patients and determine whether any changes in IMA levels are useful as a marker in increased OA. METHODS: A prospective case-control study was carried out, which included 110 patients (55 patients with OA and 55 healthy controls). Serum samples obtained from all participants and IMA levels were determined by spectrophotometric method. RESULTS: Compared with controls, OA had significantly higher IMA and IMA/albumin (IMAR) levels (0.732 ± 0.078 vs. 0.773 ± 0.080, p  = 0.008; 0.188 ± 0.20 vs. 0.176 ± 0.21; p = 0.011). Multivariable logistic regression analysis revealed rising IMA and IMAR levels were independently associated with OA (OR: 1.755, 95% CI: 0.655 - 4.700, p = 0.009 and OR = 3.021, 95% CI: 0.258 - 3.525, p = 0.015). CONCLUSIONS: The current study suggests that increased levels of IMA are associated with OA and are a probable predictive risk marker for the progression of OA.

Validity and Reliability of Turkish Version of Olerud-Molander Ankle Score in Patients With Malleolar Fracture.

The present study was planned to translate and culturally adapt the Olerud-Molander Ankle Score (OMAS) and assess the validity and reliability of the Turkish translation of the OMAS in patients with surgically treated malleolar fracture. The OMAS was adapted for use in Turkish by first translating it and then back-translating it in accordance with published guidelines. The final Turkish version of the OMAS was administered to 91 patients participating in the present study. The OMAS questionnaire was repeated 7 days later to assess test-retest reliability. Spearman's rank correlation analysis was used for each question's score and the total score, and the intraclass correlation coefficient was calculated for test-retest reliability. The internal consistency of the OMAS-TR was assessed using Cronbach's α. Concurrent validity was evaluated by comparing the OMAS with the Foot and Ankle Outcome Score and global self-rating function (GSRF). The GSRF has 5 options: very good, good, fair, poor, and very poor. These are assessed using a 5-point Likert scale. Before validity analysis, the GSRF score was reduced to 3 groups. In the test-retest reliability assessment, the OMAS showed high correlation (r = 0.882). The intraclass correlation coefficient was 0.942. Cronbach's α was 0.762 and 0.731 at days 1 and 7 (adequate internal consistency). The correlation coefficients versus the 5 subscales of the Foot and Ankle Outcome Score ranged from r = 0.753 to r = 0.809 (p = .000) and versus the GSRF was r = -0.794 (p = .000). According to results of the present study, the Turkish version of the OMAS demonstrated adequate test-retest reliability, excellent internal consistency, and evidence of validity for Turkish-speaking patients treated surgically for ankle fracture.

Preoperative and postoperative serial assessments of postural balance and fall risk in patients with arthroscopic anterior cruciate ligament reconstruction.

BACKGROUND: Impaired postural balance due to somatosensory data loss with mechanical instability has been shown in patients with ACL deficiency. OBJECTIVE: To assess postural balance in patients with ACL insufficiency prior to surgery and following reconstruction with serial evaluations. METHODS: Thirty patients (mean age of 27.7 ± 6.7 years) who underwent arthroscopic reconstruction of ACL with bone-patellar tendon-bone autograft were examined for clinical and functional variables at preoperative day and postoperative 12th week. Posturographic analysis were performed by using Tetrax Interactive Balance System (Sunlight Medical Ltd, Israel) at preoperative day, at 4th, 8th, and 12th weeks following reconstruction. Data computed by posturographic software by the considerations of the oscillation velocities of body sways is fall risk as a numeric value (0-100, lower values indicate better condition). RESULTS: All of the patients (mean age of 27.7 ± 6.7 years) had significant improvements for clinical, functional evaluations and fall risk (p< 0.05). Mean fall risk was within high-risk category (59.9 ± 22.8) preoperatively. The highest fall risk was detected at postoperative 4th week. Patients had high fall risk at 8th week similar to preoperative value. Mean fall risk decreased to low level risk at 12th week. Preoperative symptom duration had relationships with preoperative fall risk and postoperative improvement of fall risk (p= 0.001, r= -0.632, p= 0.001, r= -0.870, respectively). The improvement of fall risk was higher in patients with symptoms shorter than 6 months (p= 0.001). CONCLUSIONS: According to these results, mean fall risk of patients with ACL insufficiency was within high risk category preoperatively, and fall risk improves after surgical reconstruction, but as the duration of complaints lengthens especially longer than 6 months, the improvement of fall risk decreases following reconstruction.

Comparison of effects of supervised physiotherapy and a standardized home program on functional status in patients with total knee arthroplasty: a prospective study.

[Purpose] The aim of this study was to determine the functional differences between total knee arthroplasty (TKA) patients who were treated with supervised physiotherapy or a standardized home program and perform a cost analysis. [Subjects and Methods] Patients who received total knee arthroplasty between January 2009 and June 2011 were enrolled in this study; those with mean ages of 64.25±3.86 (60-68) years (n=18) and 68.08±6.25 (61-79) years (n=16) were placed in the supervised physiotherapy and standardized home program groups, respectively. All patients were evaluated by the same researcher before and after surgery, and the therapy programs were applied by another physiotherapist. All patients were evaluated for joint range of motion (ROM), pain, functional status (WOMAC), overall quality of life (SF-36), and depressive symptoms (BECK Depression Scale). [Results] A significant clinical improvement was observed in postoperative assessments. A statistically significant difference could not be found between ROM and functional levels of the patients in both groups. [Conclusion] No difference was found between the patients performing supervised or standardized home program with respect to the effects on functional status. A home exercise program can be used in the rehabilitation of patients with TKA, and implementation of home exercise programs can also reduce health-care spending.

Middle-term therapeutic effect of the sacroiliac joint blockade in patients with lumbosacral fusion-related sacroiliac pain.

OBJECTIVE: The aim of this study was to compare the therapeutic effect of sacroiliac (SI) blockade in patients with and without lumbosacral fusion. METHODS: This study included 72 patients diagnosed with SI pain and who received blockade injection (methylprednisolone and lidocaine). Patients were divided into 2 groups; 22 patients in the fusion group who underwent previous lumbosacral fusion and 50 patients in the non-fusion group. Average follow-up was 17.7 (range: 6 to 30) months. All patients were evaluated before and after intervention using the Visual Analog Scale (VAS), Oswestry Disability Index, Rivermead Mobility Index and SF-36. Results were statistically analyzed. RESULTS: Activity pain (a component of VAS) was significantly better in the non-fusion group than the fusion group (p=0.042). No other statistically significant differences were observed between groups (p>0.05). CONCLUSION: Sacroiliac blockade has a similar therapeutic effect on patients who underwent lumbosacral fusion surgery as on non-operated patients in the middle-term. Therefore, alternative treatment options are not necessary in patients with fusion.

[Functional outcomes and quality of life in patients with proximal row carpectomy]. / Proksimal sira karpektomili hastalarda fonksiyonel sonuçlar ve yasam kalitesi.

OBJECTIVES: This study aims to assess pain, functional status, patient satisfaction, and quality of life in patients with proximal row carpectomy. PATIENTS AND METHODS: Between December 2007 and November 2011, demographic, clinical, and operational data, and physical therapy program of 16 patients (11 males, 5 females; mean age 41.4±16.6 years; range 19 to 77 years) with proximal row carpectomy were recorded. Pain (0-no pain, 10-severe pain), and patient satisfaction (0-not satisfied, 10-very satisfied) were assessed with visual analog scale (VAS). Wrist range of motion, and hand grip strength were evaluated. The quick-disabilities of the arm, shoulder and hand (Q-DASH), and Mayo wrist score were used for functional evaluation of the upper limb. Short form-36 (SF-36) was used for the evaluation of quality of life. RESULTS: Postsurgical duration was 20.6±16.4 (range; 6-56) months. Complex regional pain syndrome (CRPS) was detected in two patients (%12.5). The mean session numbers of physical therapy were 16.7±9.4 (range; 0-30), satisfaction VAS was 8.4±2.1, rest VAS 0.8±0.9, activity VAS was 2.3±2.2, grip strength of operated side 82% of nonoperated side, Q-DASH score was 13.4±16.5 (substantially good), and Mayo wrist score was 80.0±19.4 (good). Significant improvement was detected in postoperative flexion-extension arc compared to preoperative status (p=0.001). A correlation was detected between hand grip strength percentage and session numbers of physical therapy (p=0.025, r=0.558). Relationships between quality of life-pain subscore and activity pain (p=0.001, r= -0.819), Q-DASH (p=0.003, r= -0.698), and Mayo wrist score (p=0.037, r=0.525) were detected. The presence of complication was the only independent variable for prediction of functional status in multivariate linear regression analysis. CONCLUSION: Increased number of physical therapy session results in improved hand grip strength following the proximal row carpectomy, while CRPS complication which can be seen after surgery affects the functional status adversely.