Comminuted Distal Radial Fracture with Large Rotated Palmar Medial Osteochondral Fragment in the Joint.

INTRODUCTION: Intra-articular distal radius fractures have long been massively discussed in the literature, but regarding to fractures that possess rotated volar medial fragment in the joint a few amount papers has been written. In this article, we would like to emphasize the significance of the rotated palmar medial (lunate facet) fragment. CASE REPORT: A 39-year-old man fell from a height of about 3 m and landed on his right outstretched hand; within 40 min, he arrived at our clinic presenting with a severe pain and swelling in his right wrist. Initial X-rays of the wrist revealed dorsal subluxation of the radiocarpal joint with dorsal comminution of the radial articular surface and fracture of the radial styloid process, with (nearly inverted) ~ 140-150° rotation of the palmar medial fragment. With an additional volar approach, the fragment reduced and stabilized with two K-wires and wrist immobilized in external fixator. The patient returned to daily activities without any discomfort and pain after the 1 year from the surgery. CONCLUSION: Overlooking of palmar rotated osteochondral fragment will cause deficiency to build proper pre-operative strategy to approach the reduction of the fragment. The incompetence of reduction will deteriorate the articular surface and lead to early osteoarthritis of the wrist. The surgeon should detect this fragment and should be familiar with volar approaches of the wrist. Above average surgical experience would be needed for successful reduction.

Intra-Articular Osteoid Osteoma as a Cause of Anteromedial Knee Pain.

A 32-year-old male patient presented to our clinic with chronic left knee pain that was ongoing for about 1.5 years. The patient visited several times our clinic and the other clinics; conservative treatment (including rest, knee brace, and ice application with NSAIDs) was recommended by various different doctors. The anamnesis, physical examination, and plain radiography were nonspecific. Early MRI findings mislead us to believe it is bone marrow edema. One and half years with noneffective treatment, the knee pain persisted. At the latest visit intra-articular osteoid osteoma was suspected and the knee MRI with CT was employed. Even though the diagnosis of intra-articular osteoid osteoma often presents a challenge for the surgeons, with a present awareness of intra-articular osteoid osteomas which lack the characteristic sclerotic lesions and nidus on plain X-rays and the aid of multislice CT, a correct diagnosis which warrants proper treatment can be achieved. The possibility of osteoid osteomas, especially in young adults with persistent knee pain with unknown reasons that show normal plain radiographs results, must not be overlooked. The treatment method of these lesions should be customized depending on the location of the lesion, experience of the surgeon, and cost of method.

The relationship between medial meniscal subluxation and stress distribution pattern of the knee joint: Finite element analysis.

BACKGROUND: Degenerative changes of the knee joint and clinical follow-up after meniscal subluxation are well documented. In the current study three-dimensional (3D) finite element analysis (FEA) of human lower limb was used to investigate the effect medial meniscal subluxation on the loadings of the knee structures. METHODS: Apart from the reference model, a total of ten 3D models were created, according to amount of medial meniscal subluxation. ANSYS® 14 was used to analyze the stress/load distribution, that is to say the maximum equivalent stress (MES) (von Mises stress) on bones, cartilages, ligaments and menisci. MES was expressed as Newton/mm(2) = Megapascal (MPa). RESULTS: In a static and standing upright position the MES on all knee structures were evaluated in the reference model. Although MES increased in all structures with the increase of medial meniscal subluxation degree, tibia cartilage was found to be the most affected structure with an increase of 22.73-fold in the 10 mm subluxation model when compared with references values. CONCLUSION: This study showed that medial meniscus subluxation is associated with increased loadings on all knee structures especially the tibia cartilage. Also the degree of the medial meniscal subluxation correlates with distribution and the amount of loadings on tibia cartilage which may be a prominent feature of knee osteoarthritis.

Osteochondromas originating from unusual locations complicating orthopedic discipline: case series.

Herein, we report clinical, radiological, and follow-up results of seven cases of extraordinary located osteochondromas and highlight the importance of rare and unusual properties of unusual locations of osteochondromas. Seven patients with extraordinary located osteochondromas were treated in our institution (Antalya Memorial Hospital) between the period of February 2009 and March 2014 were reported. The patients were classified according to the localization, symptomatology, and the presence of neurovascular involvement or organ compression. The results were discussed with the existing literature data. Five of our patients had unusual symptomatology. Surgical excision was performed on six of seven patients. One patient was followed with scheduled outpatient visits alone. Our clinical follow-up results were good to excellent. In our case series, one patient with clavicular involvement had impaired shoulder mechanic which resulted in painful shoulder, while another with pubic ramus involvement had obstructive urination symptoms and dysuria. One patient with scapular involvement had snapping scapula symptoms, while two patients with fibular head involvement had peroneal nerve compression and tibial nerve compression symptoms in each. One patient with ischial ramus involvement had sciatica, whereas another with first rib involvement had radiological evidences for subclavian artery compression due to osteochondroma without any symptom. Based our experience, the flat bones which are usually ossified by intramembranous type of ossification during the fetal period (including the scapula, ilium, pubic ramus, ischium ramus, ribs and clavicle) are much less commonly affected and often have unusual symptoms. The osteochondromas originating from the fibular head may seem innocent to an orthopedic surgeon. However, an orthopedic surgeon should be alert to tibiofibular synostosis and nerve compression in this patient population.

Degenerative arthritis of pseudoarticulation between the os peroneum and cuboid: a rare cause of lateral foot pain.

The painful os peroneum syndrome is widely recognized. It is often the result of trauma. However degenerative changes between the os peroneum and the articular facet is much rarer and we could only find two other case reports in the literature. This report concerns a middle aged woman with chronic plantar-lateral foot pain and a limp secondary to degenerative changes between the os peroneum and its articular facet with cuboid. The aim of this study is to remind to orthopaedic surgeons about painful os peroneum syndrome and to highlight the rarity of our case. In our case the mid term result of the excision of the os peroneum with painful articulation appear good, providing symptomatic pain relief with little alteration in the function of the foot.

Luxatio erecta humeri: Report of a swimming injury with analysis of the mechanism of the injury and associated injuries in literature.

Inferior shoulder dislocation also referred to as luxatio erecta is an unusual and rare type of shoulder dislocation. Its incidence is about 0.5% among all shoulder dislocations. After an exhaustive search of all the available literature we were unable to find a swimming accident case that did not have other associated injuries and an uneventful reduction. The mechanism of the injury was mostly related to direct axial loading and indirect hyperabduction lever arm. We would like to emphasize the importance of this being a swimming accident, a type of accident that requires awareness of the possibility of dangerous asphyxia injuries caused by panic in the water (swimming pool, river, lake, sea, etc.). We described the nature of the injury and review the literature concerning the mechanism of the injury and associated neurovascular impairment at admission time. We also presented a supplemental video to contribute to the education of young residents and orthopedic surgeons.

Recurrence of Pelvic Chondrosarcoma through Fascial Defect into Abdominal Cavity.

Our patient was a 76-year-old female who has been operated on 2 times in 8 years for pelvic chondrosarcoma. The patient came to our clinic with a large mass in left iliac region which extended into the paravertebral area. Physical examination and preoperative imagining studies revealed a mass at the left iliac area that infiltrated sciatic notch and extended from posterior iliac region towards the anterior side of iliac bone through the sciatic notch and an incisional hernia including descending colon. The mass was also penetrating the abdominal cavity through the hernia. Surgical intervention was planned. Since the tumor infiltrated the sciatic nerve, hemipelvectomy was indicated. Patient refused hemipelvectomy. Therefore, palliative debulking surgery was considered. We treated the case with marginal excision and abdominal wall reconstruction employing prolene and vicryl suture materials in order to prevent a postoperative visceral herniation and local invasion. At the latest follow-up appointment in 2 years, the patient still had no signs of tumor recurrence. This case showed us that an incisional hernia can serve as a pathway for the recurrence invasion of the chondrosarcoma.

Popliteal entrapment syndrome. A systematic review of the literature and case presentation.

Popliteal artery entrapment syndrome (PAES) is rare in young adults. Claudication of the young patient, which is often overlooked, is a very rare symptom for orthopedic surgeons. In elder patients, the physician might expect atherosclerotic claudication, however in young patients, popliteal artery entrapment syndrome (PAES) should be considered as a possibility in the cases of claudication. Here, an unusual presentation of an uncommon disease that is not widely known by orthopedic surgeons is reported.

Proximal humerus head-splitting fracture associated with single-part anterior dislocation.

Fractures that split the humeral head are extremely rare, and usually, the split part is posteriorly dislocated. However, in our case, the split part was anteriorly dislocated and trapped between the anterior glenoid and the subscapularis muscle. In this case, the acquisition of preoperative CT results was vital to plan the exposure and reduction strategies. Open anatomic reduction and internal fixation should be considered as the first treatment of choice in young active adults.

Comment to: Haque S, Khan A, Sharma A, Sundararajan S: Technical tip: tightrope fixation of neer type II distal clavicle fracture supported by a case series. Pol Orthop Traumatol, 2014; 79: 19-22.

Additional suture anchor fixation to coracoclaviculer area with precountered distal clavicle locking plate allows an anatomic reduction with bone-bone contact and gives additional neutralisation effect with coracoclavicular suture anchor fixation against the trapezius muscle pulling effect .Event though the effeciency of this technique reported by other authors,still there is a few articles and cases reported.In the terms of proving the efficiency of the combination technique we would like to stress to contribute the published article by Haque et al.

Myositis ossificans circumscripta, secondary to high-velocity gunshot and fragment wound that causes sciatica.

This report concerns an unusual cause of sciatica. The case presented is of a young man with myositis ossificans that resulted in sciatica and was treated with en bloc excision and low-dose radiotherapy and indomethacine. The aim of this study was to explain the different diagnostic properties of myositis ossificans around the hip and non-classic causes of sciatica.

Solitary osteochondroma of ischial ramus causing sciatic nerve compression.

We present a 25-year-old male case of osteochondroma originating from ischial ramus which causes sciatica. The pelvic involvement is rare. Iliac crest of the pelvis is often involved. Ischial ramus involvement is extremely rare. In this article, we presented a rare case of ischial ramus involvement that misleading the physician to L4-L5-S1 radiculopathy.

Trevor's disease: mimicking anterior ankle impingement syndrome: case report.

This report concerns an unusual cause of anterior ankle impingement. The case of a young male with Trevor's disease mimicking an anterior spur of the ankle that resulted in anterior impingement and treated with ankle arthroscopy is presented. The aim of this study is to explain the different diagnostic properties of Trevor's disease from a classic anterior spur. Level of evidence IV.

Solitary synovial osteochondroma of the knee: mimicking a giant loose body.

Solitary synovial osteochondromas are rarely seen. Usually arising from the juxta-articular soft tissues without attaching to the bone, these lesions can be large and show clinical and radiological features of a malignant process. This report is about a 64-year-old woman with no history of trauma. She had a history of dull pain and a progressive limited range of motion that had been ongoing for 3 years. An unusual presentation of an uncommon disease that is not widely known by orthopedic surgeons is reported.

Dysplasia epiphysealis hemimelica of the ankle joint: a case report.

Dysplasia epiphysealis hemimelica is a rare non-hereditary epiphyseal disease that mimics synovial chondromatosis of the joints. The disease mainly targets long bones of the lower extremities and tarsal bones. We report one such case manifesting in the lateral tibia of a 13-year-old boy. He presented with a 7-month history of pain and a bony mass (3x4 cm) at the right ankle. The mass restricted ankle dorsiflexion over the lateral malleolar area. It was ossific with a lobulated appearance and reached the marrow with the underlying epiphysis and adjacent bones. The mass was excised completely from the epiphysis. The detached syndesmos was sutured anatomically.

Relation of discoid lateral meniscus and cord-like anterior intermeniscal ligament: morphological and clinical study.

Discoid lateral meniscus is a rare disorder and its association with other variations in the knee joint has been reported. The anterior intermeniscal ligament has also been described as connecting the anterior convex margin of the lateral meniscus to the anterior horn of the medial meniscus. In the normal population, it was observed at 53-94%. Although the functional properties of the anterior intermeniscal ligament are not yet clarified, two distinct types of the ligament have been described according to their morphological characteristics as cord-like and membranous types. The purpose of this study was to evaluate any possible association between morphologic types of anterior intermeniscal ligament and discoid lateral meniscus. A retrospective study was designed; 20 discoid lateral menisci were operated using routine arthroscopic examination. Upon arthroscopic examination the thickness of the ligament and associated morphological changes were recorded systematically. The cord-like anterior intermeniscal ligament was an associated structure in 15 of the 20 knees with discoid lateral meniscus (75%). Patients with discoid lateral meniscus apparently have cord-like type anterior intermeniscal ligament, thus we conclude that cord-like type of anterior intermeniscal ligament is a frequent accompanying structure to discoid lateral meniscus and may have a potential stabilizing effect on its anterior stability.

[An optical method for investigation of thickness of damaged articular cartilage]. / Hasarlanmis eklem kikirdagi kalinliginin optik bir yöntemle arastirilmasi.

OBJECTIVES: The aim of this study was to develop an optical system to measure damaged cartilage thickness in-vivo and real time using an optical fiber probe and conducting ex-vivo elastic light-scattering spectroscopy experiments on different thicknesses of damaged calf's patella cartilage. MATERIALS AND METHODS: An elastic light-scattering spectroscopy system was assembled with a miniature UV-VIS spectrometer, halogen-tungsten light source, laptop and optical fiber probe. Elastic light-scattering spectra were taken on the control and damaged calf's patella cartilages of 40 samples. The samples were grouped into four; in the first group cartilages were not damaged, in the 2nd, 3rd and 4th groups cartilage thickness was reduced approximately 25%, 50% and 100% respectively. The probe consisted of six fibers; one for light delivery and the other five to detect diffuse back-reflected light from the cartilage. Diameter of the fibers was 400 microm, and distance of the detector fibers from the source fibers were 0.8, 1.6, 2.4, 3.2, 4.0 mm. RESULTS: Our results showed a correlation between cartilage thickness and hemoglobin absorption in the wavelength range of 500-600 nm. We defined an absorption index using the spectral data of the diffuse back-reflected light to make a correlation between the thickness of the cartilage and absorption of hemoglobin. The index is inversely proportional to the thickness of the cartilage and can be used to estimate the cartilage thickness. CONCLUSION: This study showed that measuring elastic light-scattering spectra utilizing the designed optical fiber probe can be used to estimate cartilage thickness. The effect of variation of hemoglobin content of subchondral bone on the estimated cartilage thickness was not clearly known. More ex-vivo experiments should be conducted to test the system efficiency in defining cartilage thickness. The system has the potential to be used in practice as a new product for non-invasively measuring cartilage thickness in-vivo.