Mid-Term Results of Two Different Fixation Methods for Chevron Osteotomy for Correction of Hallux Valgus.

We compared 2 different fixation methods (bioabsorbable pins and cannulated screws) after chevron osteotomy for the treatment of hallux valgus. We reviewed consecutive proximal chevron osteotomies in 80 patients (100 feet) performed by 2 surgeons. Of the 100 feet (80 patients), 48 feet (40 patients) were stabilized with bioabsorbable pins, and 52 feet (40 patients) were stabilized with cannulated screws. In the pin group, 8 patients were male (20%) and 32 were female (80%). In the screw group, 10 patients were male (25%) and 30 were female (75%). The mean patient age was 43.1 (range 24 to 60) years in the pin group and 43.5 (range 20 to 60) years in the cannulated screw group. The visual analog scale, intermetatarsal angle, and hallux valgus angle decreased significantly and the American Orthopaedic Foot and Ankle Society scores increased significantly in all patients in both groups after surgery (p < .05). No statistically significant differences were found between the 2 groups (p > .05). Both fixation methods were found to be safe and reliable under the appropriate conditions and when performed by an experienced surgeon.

Surgical treatment of type III acromioclavicular dislocation: Bosworth technique versus hook plating.

OBJECTIVE: In this study, it was compared the clinical results of the Bosworth technique and hook plating in acromioclavicular (AC) dislocations. METHODS: 44 patients are retrospectively evaluated in this study whom diagnosed as type III AC dislocations and treated by two different surgical methods in two different clinics. The patients were 30 males and 14 females with a mean age of 44 years (range, 18-80 years). The patients were divided into 2 groups according to the applied surgical technique. Group I comprised 25 patients to whom coracoclavicular fixation was applied by using the Bosworth technique. Group II comprised 19 patients to whom acromioclavicular fixation was applied by using hook plate. All patients are evaulated by The University of California at Los Angeles Shoulder Score (UCLA) and The disabilities of the arm, shoulder and hand (DASH) scoring system. RESULTS: The mean follow-up period was 23 months (range, 12-42 months). A statistically significant diffference was determined between the surgical groups in respect of the modified UCLA scale (p=0.012) and Quick DASH score (p=0.008). Hook plating group had better clinical results according to Bosworth group in terms of both UCLA and DASH score. A statistically highly significant negative correlation was determined between the UCLA and DASH scores (r=0.677, p=0.000). CONCLUSION: Although hook plating had better clinic outcomes compared to Bosworth technique, there is not seen difference between two groups in terms of the time of return to work. Treatment of the AC dislocation should perform early reconstruction for better reduction, fewer complications and higher levels of patient satisfaction.

Can a Biodegradable Implanted Bilayered Drug Delivery System Loaded with BMP-2/BMP-12 Take an Effective Role in the Biological Repair Process of Bone-Tendon Injuries? A Preliminary Report.

BACKGROUND: Use of biodegradable and biocompatible materials in the orthopedic surgery is gaining popularity. In this research, the rate of controlled release of a bilayered prototype biomaterial designed to promote osteoblastic and tenoblastic activity was calculated using pharmacochemical methods. METHODS: The first part of the design, composed of a sodium tetraborate, polyvinyl alcohol, and starch based hydrogel, was loaded with bone morphogenic protein-2. The second part which was composed of a sodium tetraborate, polyvinyl alcohol, and chitosan based hydrogel was loaded with bone morphogenic protein-12. Osteochondral and tendon tissue specimens were obtained from patients with a diagnosis of gonarthrosis and primary bone cells and tendon cells cultures were prepared following treatment with collagenase enzyme. Cell samples were collected from the groups by means of an invert light microscope and environmental scanning electron microscope underwent at the 1st and 21st days. The level of osteogenic differentiation was measured by the activity of alkaline phosphatase. For the statistical evaluation of the obtained data, groups were compared with post hoc Tukey test following analysis of variance. Level of significance was accepted to be <0,01. RESULTS: Both osteogenic and tenogenic stimulation were observed in the cultured specimens. In comparison to the control groups, the rate of proliferation of healthy cells was found to be higher in the groups to which the design was added (p < 0.01). CONCLUSIONS: Our research is a preliminary report that describes a study conducted in an in vitro experimental setting. We believe that such prototype systems may be pioneers in targeted drug therapies after reconstructional surgeries.

Internet and social media usage of orthopaedic patients: A questionnaire-based survey.

AIM: To evaluate social media usage of orthopaedic patients to search for solutions to their health problems. METHODS: The study data were collected using face-to-face questionnaire with randomly selected 1890 patients aged over 18 years who had been admitted to the orthopaedic clinics in different cities and provinces across Turkey. The questionnaire consists of a total of 16 questions pertaining to internet and social media usage and demographics of patients, patients' choice of institution for treatment, patient complaints on admission, online hospital and physician ratings, communication between the patient and the physician and its effects. RESULTS: It was found that 34.2% (n = 647) of the participants consulted with an orthopaedist using the internet and 48.7% (n = 315) of them preferred websites that allow users to ask questions to a physician. Of all question-askers, 48.5% (n = 314) reported having found the answers helpful. Based on the educational level of the participants, there was a highly significant difference between the rates of asking questions to an orthopaedist using the internet (P = 0.001). The rate of question-asking was significantly lower in patients with an elementary education than that in those with secondary, high school and undergraduate education (P = 0.001) The rate of reporting that the answers given was helpful was significantly higher in participants with an undergraduate degree compared to those who were illiterate, those with primary, elementary or high school education (P = 0.001). It was also found that the usage of the internet for health problems was higher among managers-qualified participants than unemployed-housewives, officers, workers-intermediate staff (P < 0.05). CONCLUSION: We concluded that patients have been increasingly using the internet and social media to select a specific physician or to seek solution to their health problems in an effective way. Even though the internet and social media offer beneficial effects for physicians or patients, there is still much obscurity regarding their harms and further studies are warranted for necessary arrangements to be made.

Treatment preferences in Turkey for open fracture of the tibial diaphysis.

OBJECTIVE: The purpose of this study was to investigate different treatment methods employed by orthopedic surgeons for open tibial fracture in adults. METHODS: Survey of 12 questions regarding treatment of open tibial fracture was conducted with 285 orthopedics and traumatology specialists in Turkey in personal interviews and using web-based technique. RESULTS: Of all survey participants, 99.6% responded that tetanus prophylaxis is necessary emergency procedure in cases of adult open tibial diaphysis fracture. In addition, 96.5% considered antibiotics administration necessary, 85.6% also selected irrigation with saline, 55.4% included debridement, and 45.3% temporary fixation. Only 4 (1.3%) respondents did not use aminoglycoside antibiotics. While 29.8% of those surveyed preferred external fixator as a definitive treatment method, 75.8% use intramedullary nail and 13.7% preferred plate method. CONCLUSION: A wide variation was observed among orthopedics and traumatology specialists in Turkey regarding treatment of open tibial diaphysis fracture in adults. Data obtained from this study together with the available literature may be useful to further develop therapeutic approaches.

Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options.

PURPOSE: This study was performed to compare the efficacy of treatment in three groups of patients with knee osteoarthritis (OA) given an intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid (HA) or ozone gas. METHODS: A total of 102 patients with mild-moderate and moderate knee OA who presented at the polyclinic with at least a 1-year history of knee pain and VAS score ≥4 were randomly separated into three groups. Group 1 (PRP group) received intra-articular injection of PRP × 2 doses, Group 2 (HA group) received a single dose of HA, and Group 3 (Ozone group) received ozone × four doses. Weight-bearing anteroposterior-lateral and Merchant's radiographs of both knees were evaluated. WOMAC and VAS scores were applied to all patients on first presentation and at 1, 3, 6 and 12 months. RESULTS: At the end of the 1st month after injection, significant improvements were seen in all groups. In the 3rd month, the improvements in WOMAC and VAS scores were similar in Groups 1 and 2, while those in Group 3 were lower (p < 0.001). At the 6th month, while the clinical efficacies of PRP and HA were similar and continued, the clinical effect of ozone had disappeared (p < 0.001). At the end of the 12th month, PRP was determined to be both statistically and clinically superior to HA (p < 0.001). CONCLUSION: In the treatment of mild-moderate knee OA, PRP was more successful than HA and ozone injections, as the application alone was sufficient to provide at least 12 months of pain-free daily living activities. LEVEL OF EVIDENCE: Therapeutic study, Level I.

Ten-year follow-up results of posterior instrumentation without fusion for traumatic thoracic and lumbar spine fractures.

BACKGROUND: This retrospective study aims to present and evaluate the long follow-up results of posterior instrumentation without fusion in patients with traumatic thoracic and lumbar fractures. METHODS: 45 patients were operated. The mean follow-up period was 147.6 months. Sagittal plane kyphosis (SPK) and anterior wedge angle (AWA) were evaluated in preoperative and follow-up. RESULTS: SPK and AWA improved significantly in the early postoperative. However, the correction was lost in the 10-year follow-up. The loss of correction was statistically significant in SPK and AWA. CONCLUSION: Posterior instrumentation without fusion is still among the most useful in treatment of traumatic thoracolumbar fractures.

Fabrication of naturel pumice/hydroxyapatite composite for biomedical engineering.

BACKGROUND: We evaluated the Bovine hydroxyapatite (BHA) structure. BHA powder was admixed with 5 and 10 wt% natural pumice (NP). Compression strength, Vickers micro hardness, Fourier transform infrared spectroscopy, scanning electron microscopy (SEM) and X-ray diffraction studies were performed on the final NP-BHA composite products. The cells proliferation was investigated by MTT assay and SEM. Furthermore, the antimicrobial activity of NP-BHA samples was interrogated. RESULTS: Variances in the sintering temperature (for 5 wt% NP composites) between 1000 and 1300 °C, reveal about 700 % increase in the microhardness (~100 and 775 HV, respectively). Composites prepared at 1300 °C demonstrate the greatest compression strength with comparable result for 5 wt% NP content (87 MPa), which are significantly better than those for 10 wt% and those that do not include any NP (below 60 MPa, respectively). CONCLUSION: The results suggested the optimal parameters for the preparation of NP-BHA composites with increased mechanical properties and biocompatibility. Changes in micro-hardness and compression strength can be tailored by the tuning the NP concentration and sintering temperature. NP-BHA composites have demonstrated a remarkable potential for biomedical engineering applications such as bone graft and implant.

A Comparison of the Effects of Neuronal Nitric Oxide Synthase and Inducible Nitric Oxide Synthase Inhibition on Cartilage Damage.

The objective of this study was to investigate the effects of selective inducible nitric oxide synthase and neuronal nitric oxide synthase inhibitors on cartilage regeneration. The study involved 27 Wistar rats that were divided into five groups. On Day 1, both knees of 3 rats were resected and placed in a formalin solution as a control group. The remaining 24 rats were separated into 4 groups, and their right knees were surgically damaged. Depending on the groups, the rats were injected with intra-articular normal saline solution, neuronal nitric oxide synthase inhibitor 7-nitroindazole (50 mg/kg), inducible nitric oxide synthase inhibitor amino-guanidine (30 mg/kg), or nitric oxide precursor L-arginine (200 mg/kg). After 21 days, the right and left knees of the rats were resected and placed in formalin solution. The samples were histopathologically examined by a blinded evaluator and scored on 8 parameters. Although selective neuronal nitric oxide synthase inhibition exhibited significant (P = 0.044) positive effects on cartilage regeneration following cartilage damage, it was determined that inducible nitric oxide synthase inhibition had no statistically significant effect on cartilage regeneration. It was observed that the nitric oxide synthase activation triggered advanced arthrosis symptoms, such as osteophyte formation. The fact that selective neuronal nitric oxide synthase inhibitors were observed to have mitigating effects on the severity of the damage may, in the future, influence the development of new agents to be used in the treatment of cartilage disorders.

Measurement of Malrotation on Direct Radiography in Pediatric Distal Radius Fractures: Prospective Observational Study.

UNLABELLED: The aim of this prospective study was to test a mathematical method of measuring the malrotation of pediatric distal radius fractures (PDRFs) from direct radiographs. A total of 70 pediatric patients who presented at the Emergency Department with a distal radius fracture were evaluated. For 38 selected patients conservative treatment for PDRF was planned. Anteroposterior and lateral radiographs were taken of all of the patients for comparison before and after reduction. Radius bone diameters were measured in the coronal and sagittal planes on the healthy and fractured sides. Using the diameter values on the healthy side and the new diameter values on the fractured side in the rotation formula, the degree of malrotation between the fracture ends was calculated. The mean follow-up period was 13.5 months. Patients' mean age was 10.00 ±â€Š3.19 years (range, 4-12 years). The rotation degree in the sagittal plane significantly differed between the proximal (26.52°±2.84°) and distal fracture ends (20.96°±2.73°) (P = 0.001). The rotation degree in the coronal plane significantly differed between the proximal (26.70°±2.38°) and distal fracture ends (20.26°±2.86°) (P = 0.001). The net rotation deformity of the fracture line was determined to be 5.55°± 3.54° on lateral radiographs and 5.44°± 3.35° on anteroposterior radiographs, no significant difference was observed between measurements (P >0.05). The malrotation deformity in PDRF occurs with greater rotation in the proximal fragment than in the distal fragment. The net rotation deformity created between the fracture ends can be calculated on direct radiographs. LEVEL OF EVIDENCE: Diagnostic, Level II.

A new method of calculating the rotation angle in pediatric forearm fractures using direct radiographs.

BACKGROUND: The aim of this study was to measure the rotational angle defect between fracture ends in paediatric forearm diaphyseal fractures on radiographs. METHODS: Evaluations were performed on 78 paediatric patients who presented at the emergency department with a diaphyseal forearm fracture during 2013-2014. Thirty-two patients who underwent conservative treatment and had < 10° of angulation and translation of not more than half the bone diameter after application of a plaster cast were included in the study. A rotational formula was used with diameter values to determine changes. The degree of rotation of both ends of the fracture line and the forearm rotational defect of the fracture line were calculated. FINDINGS: Fractures included an isolated radius in 16 cases, an isolated ulna in four cases, and both bones in 12 cases. The mean lateral angular (LAT-θ) value was 26.13 ± 5.93° on the proximal fracture end, and the distal mean LAT-θ was 30.29 ± 6.24° (p = 0.037).The mean proximal anteroposterior angular (AP-θ) value was 26.83 ± 5.75°, and the distal mean AP-θ was 30.58 ± 7.27° (p = 0.008). A significant correlation was detected between the AP-Δ and LAT-Δ measurements (p = 0.883). INTERPRETATION: The rotational defect was mathematically calculated directly from radiographs using a rotational measurement formula.

Concomitantly intra-articular fracture of proximal condylar second and third proximal phalanges: A rare case report.

INTRODUCTION: A rare case of proximal phalange fractures has been presented in this study. PRESENTATION OF CASE: A 29-year-old male patient from Turkey was admitted to the orthopedics and traumatology clinic with a complaint of left hand pain, which had persisted for 10days. He described a rotational trauma that had occurred right after hitting his hand on the wheel of a car as a result of an in-car traffic accident 10days ago. Radiological work-ups were requested. In the anteroposterior (AP) graph of the case in which the fracture line could not be observed in the oblique graph, unicondylar fractures in the proximal section of the second and third proximal phalanges have been observed. Surgical treatment was not planned because 10days had passed since the trauma. In the control graphs taken after 3 weeks, healing at the fracture site was observed, and he was referred to physiotherapy after the removal of the splint. A good result was observed after physiotherapy. DISCUSSION: Because of the extension of tendons is important over the bone, the goal of the treatment is not only to heal the fracture, but also to preserve the sliding mechanism of these tendons. Regarding to lack of soft tissue trauma, favored joint movements after the healing of the fracture can be achieved more easily with conservative treatment; however, the fracture must be closely followed up. CONCLUSION: Condylar fractures of proximal phalanges those nondisplaced can be conservatively treated with closed methods.

Middle and long term radiologic and functional results of childhood supracondylar humeral fractures operated in first 24 hours with limited medial approach.

OBJECTIVE: To investigate the middle- and long-term radiological and functional results of children with type III supracondylar humerus fractures treated with a limited medial approach and internal fixation. METHODS: The retrospective study was conducted at Department of Orthopaedics in Goztepe Training and Research Hospital, Istanbul, Turkey, and comprised data of children who underwent surgery between April 1991 and June 2009. Patients in group I underwent surgery within the first 8 hours after admission, and those in group II did so 8-24 hours after admission. Patients were evaluated according to the Flynn scoring system. RESULTS: Of the 79 patients, 52(65.8%) were male and 27(34.2%) were female. Fractures involved the left side in 49(62%) patients. Group I had 39(49.4%) patients and group II 40(50.6%). The overall mean age was 6.2±2.95 years (range: 2-13 years), and the mean follow-up was 53.2±14.9 months (range: 26-193 months). Functional scores were satisfactory (excellent, good and fair results) in all cases in both groups (100%), and the cosmetic results were satisfactory in 37(95%) in group I, and 39(97.5%) in group II (p>0.05). CONCLUSIONS: Limited medial approach to the treatment of supracondylar humerus fractures yielded successful functional and cosmetic results.

Brucellosis Suspicion is the Most Important Criterion for Diagnosis Particularly in Endemic Regions.

INTRODUCTION: Brucellosis is a zoonotic infectious disease that remains endemic in developing countries. The purpose of this study is to emphasize the need for considering brucellosis as a diagnosis, since this disease has a high risk of complications among young patients when not treated appropriately. METHODOLOGY: A total of 88 brucellosis cases with blood cultures that were positive for the pathogen were evaluated retrospectively in this study. RESULTS: The patients included 33 males (37.5%) and 55 females (62.5%) with a median age of 8.9 years (range: 5-14 years). A total of 43.1% (n=38) of the cases included occupational exposure to animals as a possible infection source. The consumption of raw milk products, especially cheese, was present in 52.2% (n=46) of the cases. Clinically, 55 of the cases were acute (62.5%), 23 of the cases were subacute (26.2%) and 10 of the cases were chronic (11.3%). The distribution of the joint pain complaints was as follows: 62.5% (n=55) of patients reported hip pain, 22.7% (n=20) of patients reported knee pain, 11.4% (n=10) of patients reported lumbar-back pain and 3.4% (n=3) of patients reported pain in other joints. A total of 59.1% (n=52) of the cases had been examined by another doctor at least once and mistreated. CONCLUSION: Complication rates and the rate of chronic infection increase with delayed diagnosis, and clinical doubt is the most important criterion for diagnosis, particularly in endemic regions.

Results of a universal ultrasonographic hip screening program at a single institution.

OBJECTIVE: The aims of the present study were to determine the prevalence of developmental dysplasia of the hip (DDH) in newborns screened by hip ultrasonography (US), to review outcome of follow-up and treatment of infants with DDH, and to evaluate the relationship between US-based diagnosis and risk factors. METHODS: A total of 9564 hips of 4782 newborns (2398 females, 50.1%) were evaluated with US. Risk factors for DDH and accompanying deformities were also recorded. Graf classification type IIa(-), IIb, IIc, D, and III hips were treated with Pavlik harnesses. RESULTS: Abnormal US findings (type IIa, IIc, or D hips) were detected in 475 newborns (9.9%). Risk factors and concomitant orthopedic deformities were similar in newborns with and without US abnormality and type I hips (p>0.05 for all). However, abnormal US findings were significantly more common in firstborn and female newborns. A total of 39 hips (5 bilateral, 20 left, 9 right) of 34 newborns (31 females) were placed in Pavlik harnesses. Twelve newborns had type IIc or D hips at initial evaluation, and 22 had type IIb or IIa(-) at follow-up. Mean recovery time was 12.5 (8-16) weeks for newborns with type IIc and D hips, 8.6 (8-12) weeks for those with type IIa(-) hips, and 11.2 (8-12) weeks for those with type IIb hips. CONCLUSION: DDH is still common among newborns in Turkey. Hip US is recommended for detection and follow-up of DDH in newborns.

Pedobarography in the Assessment of Postoperative Calcaneal Fracture Pressure With Gait.

The purpose of the present study was to evaluate the benefits and importance of pedobarography in the diagnosis and treatment of plantar pressure changes in the postoperative follow-up of calcaneus fractures treated with open reduction and internal fixation. The 28 patients included 23 males (82%) and 5 females (18%). The clinical evaluation was performed using the American Orthopaedic Foot and Ankle Society hindfoot scoring system. The Böhler and Gissane angles were measured on the preoperative and postoperative radiographs. In the postoperative follow-up period (mean ± standard deviation 22.25 ± 10.8 months), all the patients underwent analysis with a dynamic pedobarogram. Because the arch index of the operated feet was 29.73% and that of the nonoperated feet was 28.94%, a similar slightly low arch was seen in both feet (p = .078). When the plantar surface maximum pressures were evaluated, a significant reduction was seen in the operated feet in the second, third, fourth, and fifth metatarsals and the medial hindfoot (p < .05). Displaced intra-articular calcaneus fractures resulted in a significant reduction in maximum pressure of the second, third, fourth, and fifth metatarsals and the medial hindfoot. Also, the hindfoot pressure was lateralized. Pedobarography is a simple and useful method for the diagnosis of plantar pressure changes occurring postoperatively.

Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression.

PURPOSE: Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions. METHODS: Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients' Knee Society Score and Knee Society Functional Score records. RESULTS: A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2. CONCLUSION: Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression.

Ankle arthroplasty in a patient with bleeding diathesis and the mid-term clinical outcome of the case.

PURPOSE: The purpose of this report was to present the case of a patient with bleeding diathesis on whom we performed ankle arthroplasty for the first time. MATERIALS AND METHODS: A 29-year old male patient with bleeding diathesis, who had been treated and followed up over a long period, underwent ankle arthroplasty because of osteoarthritis of the ankle. The patient was prepared for surgery by the haematology department in accordance with the guidelines for surgical preparation, diagnosis and management of haemophilia. After ankle arthroplasty was performed, the preoperative and two-year postoperative clinical outcomes were evaluated using a subjective foot score and Maryland foot score. RESULTS: Preoperative factor VIII levels were raised to the target level of haemostasis prior to the surgical procedure. The factor VIII levels were maintained within the normal range up to postoperative day 14. The subjective foot score of the patient was 40 preoperatively and 85 postoperatively, whereas their Maryland foot scores were 33 preoperatively and 90 postoperatively. Both scoring systems indicate an excellent clinical outcome. CONCLUSION: As observed, the early and mid-term functional outcomes are promising for patients with bleeding diathesis who undergo ankle arthroplasty.

Isolated scapula fracture: Ice hockey player without trauma.

INTRODUCTION: Scapular fractures are generally occur from in high-energy traumas and are associated with a high incidence of morbidity and mortality. PRESENTATION OF CASE: We present an unusual scapular fracture that occurred with a rare mechanism. A 23-year-old male patient who led an active sports life for 10 years and played ice hockey for the last 5 years. In a competition, he felt a sudden pain in his right scapula after hit the puck. He did not experience any direct trauma to his shoulder and there was no evidence of any pathological fracture. The fracture was isolated in the scapular body and it was classified as type 4, according to Hardegger classification. The was patient immobilized with a Velpau bandage for three weeks and then treated with physiotherapy for shoulder rehabilitation. DISCUSSION: The fracture mechanism was likely a disharmonius contracture of the agonist and antagonist muscles of the shoulder joint while hitting the puck. CONCLUSION: Scapular fractures are generally seen along with other injuries, but in this case we wanted to emphasize that care has to been taken to diagnose an isolated scapular fracture while assessing shoulder pain.

Arthroscopic treatment of synovial chondromatosis of the shoulder: A case report.

INTRODUCTION: Synovial chondromatosis is a mono-articular arthropathy rarely seen in diarthrodial joints. The classic treatment for synovial chondromatosis is open arthrotomy, synovectomy and complete removal of the free fragments. With recent advances in arthroscopic techniques and methods, the indications for arthroscopic treatment have been extended. PRESENTATION OF CASE: A 33-year old female presented with complaints of pain in the right shoulder. On the radiological examination, there were seen to be multiple calcified radio-opaque lesions filling all area of the glenohumeral joint. On computed tomography (CT) examination, again multiple radio-opaque free fragments were determined. Arthroscopy was applied to the right shoulder. The free fragments were completely removed. Approximately 33 free fragments, ranging in size from 0.5 to 1.3 cm, were removed. DISCUSSION: Cases of synovial chondromatosis in the shoulder have been rarely reported in literature. Generally the disease is self-limiting. Clinically, symptoms are generally not specific. Restrictions in the joint range of movement occur associated with the mechanical effect of the free fragments and in periods of active use, local pain and swelling may be seen in the shoulder. Simple removal of the free fragments, others have stated that removal with synovectomy is necessary to prevent recurrence of the cartilaginous metaplastic focus. Recurrence rates vary from 0 to 31%. CONCLUSION: Arthroscopic surgery can be successfully applied in the treatment of synovial chondromatosis. The advantages of the method include good visualisation during surgery, low morbidity and early healing.