A rare complication of tension band fixation of olecranon osteotomy: Distal migration of K-wire.

Tension band wiring (TBW) is one of the most commonly used fixation techniques to fix olecranon osteotomies. Hardware prominence has been the most commonly reported complication of TBW. However, distal migration of Kirschner (K)-wire after TBW fixation for olecranon osteotomy has not been reported. In this case report, we presented distal migration of K-wire detected nine months after initial surgery in a 46-year-old male patient. The patient was operated on for an intraarticular distal humerus fracture using an olecranon osteotomy. The osteotomy was fixed with TBW fixation. The patient missed routine follow-ups and presented to the outpatient clinic with a complaint of skin irritation at the elbow nine months after the surgery. On radiological examination, distal migration of one K-wire was detected. The K-wire was surgically removed without any complication. Physicians should be aware of possible complications of TBW and remove fixation after fracture union to avoid unexpected complications.

Primary Negative Prognostic Factors in Pediatric and Adult Patients Undergoing Trigger Finger Surgery.

Objectives This study aims to investigate the negative prognostic indicators of pediatric and adult trigger finger surgery patients concerning complications, recurrence, and satisfaction. Methods A retrospective study was conducted on 61 patients with a total of 91 trigger fingers, including 31 in children and 30 in adult patients, all of whom were treated using a standardized surgical technique. The study considered several demographic and clinical factors, including age, gender, dominant hand, body mass index, occupation, history of trauma, single or multiple finger involvement, staging according to Green classification, diabetes mellitus, comorbidities, recurrence, revision surgery, utilization of non-surgical treatment methods, need for rehabilitation after surgery, time to return to work, the time interval from clinic initiation to the surgery, satisfaction and the duration of the follow-up period. In addition, the quick version of the disabilities of the arm, shoulder, and hand (QDASH); and the visual analog scale (VAS) were used to assess patients' data. Results In adult patients, a statistically significant relationship was observed between the increasing grade of the Green stage and complication rate (p<0.001), recurrence (p<0.001), and lower satisfaction (p<0.001). No statistically significant relationship was identified between Green's classification and complications (p=0.129), recurrence (p=0.854), or satisfaction (p=0.143) in pediatric patients. While a statistically significant relationship existed between the time interval from clinic initiation to surgery and complications (p=0.033) in adult patients, no significant relationships were observed for recurrence or satisfaction. Conversely, there was no statistically significant relationship between the time interval from clinic initiation to surgery and complications, recurrence, or satisfaction in pediatric patients. Conclusion This study demonstrates that increasing the grade of the Green stage and duration of symptoms before surgery were the substantial factors contributing to prognosis in adult patients but not in pediatric patients. These findings can assist physicians during patients' treatment management. We suggest that physicians consider these factors for patients' satisfaction.

Iliacus hematoma causing late femoral nerve palsy.

Femoral nerve palsy is rare and may progress insidiously, leading to late clinical presentation. Identifying the underlying cause is very important for treatment. An iliacus hematoma causing nerve palsy is perhaps the most innocent etiology. However, this hematoma sometimes causes only abdominal pain and may even be misdiagnosed as a late intra-abdominal pathology.

Common Peroneal Nerve Injury Caused by a Wild Boar Attack.

Wild boar-inflicted nerve injuries have been very rarely reported in the literature. A 62-year-old man was attacked by a wild boar in eastern Turkey and brought to the emergency department. He had 5 lacerations on the lower extremities and 2 on the posterior thoracic region. In addition to soft tissue lacerations, he sustained a complete laceration of the left common peroneal nerve with a foot drop. The common peroneal nerve was repaired primarily the day after the attack. The patient was discharged after a short hospital stay without any immediate complications; however, at the 10-mo follow-up, he still had a left foot drop.

Cerebrotendinous Xanthomatosis patients with late diagnosed in single orthopedic clinic: two novel variants in the CYP27A1 gene.

BACKGROUND: Cerebrotendinous Xanthomatosis (CTX) is a rare autosomal recessive lipid storage disorder caused by loss of function variants in the CYP27A1 gene which encodes sterol 27-hydroxylase, on chromosome 2q35. Although the symptoms begin commonly in infancy, CTX diagnosis is often delayed. The aim of this study is to review the orthopedic findings of the disease by providing an overview of the clinical features of the disease. It is to raise awareness of this condition for which early diagnosis and treatment are important. METHODS: We retrospectively evaluated the clinical, laboratory, radiological, and genetic findings of eight patients from four families who were admitted to our Orthopedics and Traumatology Department between 2017 and 2022 due to bilateral Achilles tendon xanthomas, were found to have high cholestanol and CYP27A1 gene mutations. RESULTS: The mean age of patients was 37, and five of them were male. The mean age at the onset of symptoms was 9.25 years. The mean age of initial diagnosis was 33.75 years. Between symptom onset and clinical diagnosis, an average delay of 24.5 years was observed. All patients had bilateral Achilles tendon xanthoma. Notably, a novel variant (c.670_671delAA) in CYP27A1 gene was identified in three patients who also presented with peripheral neuropathy and bilateral pes cavus. One patient had osteoporosis and four patients had osteopenia. Five patients had a history of bilateral cataracts. Furthermore, three of the patients had early-onset chronic diarrhea and three of the patients had ataxia. Two of the patients had epilepsy and seven of the patients had behavior-personality disorder. All patients had low intelligence, but none of them had cardiac disease. CONCLUSION: We present the diagnostic process and clinical features which the largest CTX case series ever reported from single orthopedic clinic. We suggest that patients with normal cholesterol levels presenting with xanthoma being genetically analyzed by testing at their serum cholestanol level, and that all siblings of patients diagnosed with CTX be examined.

Acute isolated volar distal radioulnar joint dislocation: first surgery or conservative?

Isolated distal radioulnar joint (DRUJ) dislocations are referred to as dorsal or volar of neglected isolated volar DRUJ dislocation which was detected at the second dislocations concerning the position of the ulnar head in relationship to the radius. In contrast to large joint dislocations such as a shoulder dislocation, the clinical picture may mimic a simple soft tissue injury and the dislocation may be missed. In this article, we aimed to present a case presentation to the emergency department. Our patient who had no complaint other than wrist pain was diagnosed with volar dislocation on lateral radiography and closed reduction was performed in the emergency department with sedation. There was no recurrence in the follow-up and we achieved a satisfactory result with a painless and unrestricted wrist joint at six months. DRUJ and the ligaments stabilize the joint work in anatomical coordination and play an important role in forearm rotation movement. Traumatic injuries to these structures range from isolated tears to severe fractured dislocations. Isolated DRUJ dislocations are rare. Initial treatment of this injury is closed reduction, post-reduction stability is important and fixation is required in case of instability. Although surgical treatment is performed in cases that cannot be closed reduced and in the presence of instability after reduction, it is possible to obtain successful results in acute cases with closed reduction performed with sedation in emergency departments. For this reason, a conservative approach should be tried before making a surgical decision in these injuries that require special attention in diagnosis.

Hair tourniquet syndrome of toe.

INTRODUCTION: Hair tourniquet syndrome (HTS) is a rare surgical emergency caused by a hair or thread wrapping around an appendage. We aimed to present our clinical experience with HTS of toes and attract physicians' attention to this rare entity. METHODS: Between January 2012 and September 2022; 26 patients (25 pediatric and one adult case) were treated for HTS. All pediatric cases were treated surgically under loop magnification. The adult patient was treated nonsurgically. The patient's age, gender, affected appendage and side, duration of symptoms, and postoperative complications were recorded. RESULTS: Thirty-six toes of 25 patients (13 boys, 11 girls, and a male adult) were included in the study. The mean age of pediatric patients was 126.6 days. The third toe was the most affected (n:16), followed by the fourth (n:8). In seven patients more than one was affected. CONCLUSION: HTS should be treated as soon as possible when diagnosed to prevent further complications including appendage loss.

The initial response of a local hospital in the earthquake zone during the February 6, 2023 Kahramanmaras earthquakes: Injuries and challenges.

OBJECTIVE: This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center. METHODS: Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded. RESULTS: The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department. CONCLUSION: This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned.

Extensor carpi radialis longus tendon ball interposition arthroplasty for treatment of late-stage Kienböck's disease: Short-term results of a novel technique.

PURPOSE: The aim of this study was to evaluate short-term clinical and radiological results of extensor carpi radialis longus (ECRL) tendon ball arthroplasty for treatment of late-stage Kienböck's disease. METHODS: We retrospectively reviewed data of 19 patients suffering from Kienböck's treated with ECRL tendon ball arthroplasty between December 2014 and December 2016. Patients' clinical functions were assessed using grip strength, range of motion (ROM) of the wrist, QuickDASH, Mayo wrist score, and visual analog scale score. Radiological examination was performed to assess carpal height ratio and progression of arthritis. RESULTS: The median follow-up was 30 months (range, 12-36 months). At final follow-up, ROM of operated wrist was 71% of the nonoperated side. Thirteen (86.6%) patients were pain free. Carpal height ratio was statistically significantly reduced compared with preoperative values. All patients declared their satisfaction with the results due to their preoperative status. CONCLUSIONS: ECRL tendon ball arthroplasty is a new and good option for treatment of late-stage Kienböck's disease with low complication rate.

Attritional rupture of the extensor pollicis longus tendon due to calcified extensor carpi radialis tendon group: a case report.

In this article, we report a case with spontaneous rupture of extensor pollicis longus tendon due to calcified extensor carpi radialis tendon group, which has not been published in the literature previously. Successful thumb extension was achieved in a 68-year-old male patient with the transfer of the extensor indicis proprius tendon at two months postoperatively. It appears that calcified extensor carpi radialis tendon group constitutes high risk for a possible attritional rupture of the extensor pollicis longus tendon.

Isolated Tuberculosis of Capitate and Triquetrum.

Musculoskeletal system is involved in about 20% of the patients diagnosed with tuberculosis. Although musculoskeletal tuberculosis generally affects spine and large joints (hip and knee), hand involvement of the tuberculosis is seen in 10% of the patients with musculoskeletal involvement and also isolated tuberculosis of hand or wrist is much rarer. In the following report, we discuss the case of a 23-year-old male patient who was diagnosed with isolated tuberculosis of the capitate and triquetrum bone. The patient presented with a nonhealing sinus on the left wrist joint. Imaging revealed lytic lesions of the capitate and triquetrum. The diagnosis of tuberculosis was confirmed by histopathological examination on the bone specimen obtained from the debridement and curettage. Antituberculosis therapy was started postoperatively and 1 month later, healing of the sinus was observed. There was no sign of reactivation seen at follow-up 22 months after treatment.