Bonesetter interventions and consequences.

OBJECTIVE: Delaying the treatment of bone and tendon injuries may cause unmanageable complications. Bonesetters continue to cause delays in treatment. The purpose of this study was to analyze the medical outcomes of delay due to bonesetter intervention and factors affecting patient treatment preference. METHODS: Among outpatients treated at our clinic between January 2010-December 2012, bonesetter-intervened patients were included, and patient demographics, clinical outcomes, and possible social factors were retrospectively analyzed. Clinical examinations and radiological screening measurements were used to evaluate outcomes. RESULTS: Of the 162 patients, 97 (59.8%) were male, and mean age was 27.5±9.4 years. Eighty-nine (54.9%) of the patients lived in a rural area, and 108 (66.7%) underwent surgery. Bonesetter preference was dictated primarily by elderly relatives (47.6%) or neighbors (33.3%). Patients with a primary school education and unemployed patients mostly preferred bonesetters (p=0.03 and p<0.01, respectively), the explanation for which was the long treatment period and concern of being disabled (p=0.04). Complication rate among patients who were evaluated at a hospital was 33.9%. CONCLUSION: Despite being medically unreliable and often times harmful, bonesetting is still accepted as an alternative treatment modality among uneducated patient and thus remains an ongoing problem in Turkey. Improvements in average education level and increased dissemination of accurate information via various media and non-governmental organizations will be effective in the correction and prevention of the afore-mentioned complications regarding bonesetter interventions.

Total hip replacement for an ochronotic patient: A technical trick.

PATIENT: Male, 46 FINAL DIAGNOSIS: Akkaptonuria Symptoms: Hip pain Medication: - Clinical Procedure: Total hip replacement Specialty: Orthopedics and Traumatology. OBJECTIVE: Unusual or unexpected effect of treatment. BACKGROUND: Ochronosis is an inherited metabolic disease in which there is an accumulation of excessive amounts of homogentisic acid in the connective tissue. As the disease progresses, the chronic inflammation in the damaged tissue can cause degeneration and osteoarthritis. There is no specific treatment for ochronosis because it is a rare disease and arthroplasty is seldom performed. CASE REPORT: We report the case of a 46-year-old male patient with ochronosis, who underwent an arthroplasty of the right hip due to osteoarthritis. The problems encountered during surgery are reported and discussed. CONCLUSIONS: Arthroplasty is a highly effective procedure for ochronotic patients. Particular attention to the surgical step is highly advised.

Isolated sacral dislocation in a 4-year-old child.

Sacral dislocation is an uncommon form of injury in childhood. A 4-year-old girl who was injured in a motor vehicle accident was seen in the emergency room. On physical examination, ecchymosis and tenderness in the abdomen and sacral region was identified. Radiographs revealed no pelvic pathology. CT was performed owing to the patient's sacral and abdominal tenderness. Dislocations were identified at the sacral third and fourth vertebrae without any fractures. The patient was discharged 10 days later with a recommendation for 6 weeks bed rest and an appointment for an outpatient follow-up examination. At the post-traumatic second-month examination, the patient was walking normally. In the radiograph and MRI that were taken a year later, the dislocation was observed to have fused completely, and no pressure was seen on any anatomical structure. No functional pathology was identified during the interview with the family.

Traumatic shoulder fracture-dislocation in a 7-year-old child: a case report.

INTRODUCTION: In contrast to adults, traumatic glenohumeral dislocation is a rarely observed condition among children. In some cases, success in durable reduction with conservative methods, and achieving lasting treatment, may not be possible. CASE PRESENTATION: In this study, the case of a 7-year-old Turkish girl with a Salter-Harris type II fracture and glenohumeral dislocation of the proximal humerus due to a fall from a height of 1.5 meters who underwent open reduction surgery is presented along with a review of the literature. CONCLUSION: Orthopedic surgeons should consider glenohumeral dislocation which is an extremely rare condition when they encounter proximal humerus fractures in pediatric trauma.

Intramedullary nailing and angulation prevention in distal metaphyseal tibial fractures.

Intramedullary nailing, which is preferred in tibial diaphyseal fractures, is also frequently used in distal third tibial fractures. Various angular deformities, including varus/valgus deformity, may be observed during postintramedullary nailing. Orthopedic surgeons use several methods to prevent this problem.In this study, at least 2 static locking screws were placed proximal and distal to the nail during intramedullary nailing of distal third tibial fractures. No additional supportive methods were used. The efficacy of this technique in the prevention of postoperative angular deformities was retrospectively investigated. Thirty-four patients with distal third tibial fractures who were treated with intramedullary nailing were included in the study. Angulations were measured in the anteroposterior and lateral planes on plain radiographs obtained preoperatively, on postoperative day 1, and after fracture union. Angulations measured on postoperative day 1 were compared with those measured after fracture union, and an increase was observed. Based on statistical analyses, the increase in the angulations was not significant.In distal third tibial fractures, when fixation was performed by placing 2 static screws distal and proximal to the intramedullary nail following adequate reduction, the angulations that developed during the period until union were not significant in terms of causing deformity, although additional fixation methods are not used.

Extra-articular Tenosynovial Chondromatosis Mimicking a Neoplastic Disease in the First Web Space of the Hand.

Tenosynovial chondromatosis is a very rare disease. The most common symptom is a slowly enlarging soft tissue mass, which may be painful or cause limitation of joint motion. Plain radiograph may appear normal during early phases of the disease, but subsequent imaging may be necessary to exclude other pathologies. Nonoperative treatment may be elected for some patients, but a synovectomy and the removal of loose bodies are indicated for persistent symptoms. This report describe a case with a multinodular cartilaginous proliferation and rice body in the first web space of the hand, similar to synovial chondromatosis, but arising in the tenosynovial membranes.

Compartment syndrome on a patient's forearm related to carbon monoxide poisoning.

Carbon monoxide (CO) is a colorless, odorless, nonirritating, toxic gas produced by the incomplete oxidation of hydrocarbons. Common sources of CO include motor vehicles, house fires, furnaces/heaters, and wood-burning stoves. It is a serious health problem resulting in approximately 50,000 visits to the emergency department and is responsible for 3500 deaths annually in the United States. Besides accidental exposure, CO is also one of the leading causes of death by suicide. In the present study, we discuss compartment syndrome caused by CO poisoning in a 15-year-old boy. To our knowledge, this is the first CO poisoning case causing compartment syndrome.

Outcome in unilateral or bilateral DDH treated with one-stage combined procedure.

UNLABELLED: The surgical treatment of patients with neglected developmental dysplasia of the hip (DDH) has been the subject of controversy. We asked if age affected outcome in patients with neglected DDH with unilateral or bilateral dislocation who underwent one-stage combined procedures. We retrospectively reviewed the results of 40 patients (51 hips) treated with a one-stage combined procedure consisting of open reduction, pelvic osteotomy, and femoral shortening. The average age at the time of surgery was 5.4 years for Group I (bilateral dislocation, 22 hips) and 6.7 years for Group II (unilateral dislocation, 29 hips). Mean followup was 5.4 years for Group I and 6.7 years for Group II. According to the modified score system of Trevor et al, 13 hips rated excellent, three were good, and six were fair in Group I; the ratings were 14, nine, and six hips respectively in Group II. Four patients had a limb-length discrepancy of approximately 1.5 cm in Group I. Twelve hips in Group I and 18 hips in Group II had osteonecrosis of varying severity. Our data suggest the outcomes of the children who were 5.5 years or younger in Group I and 8 years or younger in Group II were better. LEVEL OF EVIDENCE: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

Successful treatment of hemophilic hand pseudotumors by only radiotherapy.

Hemophilic pseudotumor is a rare complication of hemophilia. We describe a 14-year-old young male with hemophilic pseudotumor in the second and fifth fingers of the left hand. We treated him only with radiotherapy. A total dose of 2000 cGy in 10 fractions was administered in 2 weeks. Factor VIII was not given. After 4 months, complete healing was seen. The patient was followed up at 24 months, and there was no evidence of recurrence and no bone growth disturbance. Based on our experience and a review of the literature, radiotherapy can be an effective alternative modality in treating hemophilic pseudotumor.

Outcome of open comminuted tibial plateau fractures treated using an external fixator.

BACKGROUND: The purpose of this study was to evaluate the outcome of open severe comminuted tibial plateau fractures treated with minimal internal fixation and circular external fixation frames. METHODS: Fifteen open comminuted tibial plateau fractures were involved in this retrospective study. In eight knees, the fracture was reduced through an extended open traumatic wound. In seven patients, another limited incision over the major fracture line or area of comminution was performed to assist in reducing the articular reduction. Simultaneous bone grafting, soft tissue reconstruction, and stabilization of the fracture using a circular external fixator were carried out. RESULTS: The patients were followed for an average of 32 months (range 24-54 months). The average time to union of the fractures and frame removal was 22.8 weeks (range 16-44 weeks). The quality of the reduction of the joint surface was rated as anatomical in four patients, good in five patients, fair in three patients, and poor in three patients. Four patients experienced loss of articular reduction. The Knee Society Clinical Rating scores indicated that three knees were excellent, seven were good, one was fair, and four were poor. Complications included one case of septic arthritis, one of osteomyelitis, one of malunion, and four with loss of reduction. CONCLUSIONS: This technique provided acceptable results for open severe comminuted fractures of the tibial plateau without comminuted posterior wall fractures. The most significant disadvantage of the technique is insufficient anatomical reduction and loss of reduction in comminuted posterior wall fractures in the coronal plane. This technique should be combined with a minimally invasive internal fixation method to prevent loss of reduction in open severe comminuted and irreducible tibial plateau fractures.

Osseous lipoma: eleven new cases and review of the literature.

This study describes the clinical features, radiological appearance, and treatment of 11 new cases of osseous lipoma and reviews 301 other cases in the literature. Osseous lipomas are classified by the site of origin: either within bone (intraosseous lipoma) or on the surface of bone (juxtacortical). Intraosseous lipomas include intramedullary and intracortical lesions. Surface lipomas include subperiosteal and parosteal lesions. The authors added their cases to those found in the literature. Intramedullary osseous lipoma (n=262) : the most common presenting symptoms were pain and swelling (69%). The most frequent localisations were the calcaneus (24%) and the femur (22%). On plain radiographs, these lesions consisted of a well-circumscribed radiolucent area with central calcification and a sclerotic rim, occasionally with cortical expansion. Computed tomography (CT) and magnetic resonance imaging (MRI) showed that the lesions had attenuation values and a signal intensity identical to that of adipose tissue. In symptomatic lesions and in cases with impending fracture, operative treatment was indicated. Parosteal lipoma (n=47): the most common presenting symptoms were local swelling and pain (58%). This lesion was most frequent in the radius (31%) and in the femur (23%). The classic radiographic appearance of parosteal lipoma was that of an exostosis-like bony prominence capped with a radiolucent layer of fat. CT-scan and MRI showed similar features. Intracortical (n=2) and subperiosteal lipomas (n=11): only a few cases were found in the literature. Their localisation differs from that of the other osseous lipomas. The differential diagnosis of osseous lipoma in general is extensive and should include benign and malignant tumours. Combination of radiological and histological data is essential to determine whether an osseous lipoma is actually present.

Technique and complications of callus distraction in the treatment of bone tumors.

INTRODUCTION: This study investigated the effects of chemotherapy, defect length, and patient age on the outcome and complications of callus distraction as a limb salvage technique in 17 patients. MATERIALS AND METHODS: The mean patient age was 18.4 years (range 7-47). Of 17 patients, 8 received chemotherapy and the remaining 9 patients did not. The mean defect length after excision of the lesion was 13 cm (range 8-20). The mean follow-up period for the patients whose treatments were completed was 55 months (range 20-90), the mean distraction index was 12.55 days/cm (range 11-15.7), and the mean external fixation index was 34.73 days/cm (range 30-41). RESULTS: In two patients, local recurrence occurred before distraction was completed. Two patients died, and one of them was a patient in whom local recurrence had occurred. Complications included non-union in one patient, osteomyelitis in one patient, and premature callus, osseous bridge, and varus of the femur in one patient. The extremity functional score was 80% (range 26-100). Chemotherapy and defect length had no significant effect on the distraction or external fixation indices. In contrast, the increase in the external fixation index in those over 20 years old was significant (P=0.043). CONCLUSION: We found that chemotherapy and defect length have no significant effect on the outcome and complications with this technique, which was more successful in patients younger than 20 years.

Electrocution-related mortality: a review of 123 deaths in Diyarbakir, Turkey between 1996 and 2002.

Electrical burns are responsible for considerable morbidity and mortality, and are usually preventable with simple safety measures. We conducted a retrospective study of non-lightening electrocution deaths in Diyarbakir, Turkey between 1996 and 2002. All 123 deaths investigated were accidental. The age range was 2 to 63 years with a mean age of 20.7 +/- 15.3 years. Eighty-six victims (69.9%) were male. The upper extremity was the most frequently involved contact site in 96 deaths (48%). No electrical burn mark was present in 14 (11.4%) cases. Home accidents were responsible for 56 cases deaths (45.5%). Deaths were caused most frequently by touching an electrical wire (52 cases, 42.3%). There was an increase in electrocution deaths in the summer (47 cases, 38.2%). One hundred one cases (82.1%) were dead on arrival at hospital. The unique findings of our study include younger age (0-10 years) of victims (39 cases, 31.7%) and a means of electrocution (electrical water heaters in bathroom) in 23 cases (18.7%). Rate of deaths due to electrocution among all medicolegal deaths was found higher in our study than in previous studies. The public should be educated to prevent children to play near electrical appliances and to avoid electrical heaters in the bathroom.