A serious case of anthrax associated with compartment syndrome.

Compartment syndrome linked to skin anthrax is a rare complication that may develop and it should be noted that the disease may progress in spite of medical drug treatment. Our case was a farmer who was exposed after slaughtering a dead animal, a time delay for treatment hided this history and then developed compartment syndrome. In anthrax cases with delayed treatment and aggressive progression, circulation in the extremities should be carefully noted. We believe that the cases with compartment syndrome progressing in spite of medical drug treatment may be assessed for fasciotomy as a treatment approach.

Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis.

Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure.

The long-term effects of extracorporeal shock waves on the epiphysis of the adolescent rat.

BACKGROUND: Extracorporeal shock waves (ESW) have been successfully used to treat musculoskeletal injuries, tendinopathy, and plantar fasciitis. Different side effects of high-energy ESWT on bones, tendons, nerves, epiphysis, and cartilage have been discussed. Although the effects of ESW on the epiphysis in animal models have been described, no studies have investigated the long-term effect of ESW on the immature epiphysis in an animal model. The purpose of this study was to investigate the long-term effects of ESW on the immature epiphysis in rats. METHODS: Sixteen 4-week old Wistar albino rats, average weight 116.3 grams (109.6-120.2 g) were used for these experiments. The rats were randomly divided into two groups, the ESW 1500 pulses (ESW1500p) group (n = 8) and the ESW 3000 pulses (ESW3000p) group (n = 8). In the ESW1500p group, 1500 pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. In the ESW3000p group, 3000 pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. The right knees (n = 16) of the rats in the two groups were used as the controls. The animals were sacrificed after an 8-month follow-up period. Femoral epiphyses were assessed by use of histology. The femoral length (FL), tibial length (TL), and femoral supracondylar medio-lateral width (MLW) were measured. RESULTS: There was no statistically significant difference between FL, TL, and MLW for the three groups (P > 0.05). The average histological scores were 8.8 (7-10), 17.8 (15-22), and 2.7 (0-4) in the ESW1500p, the ESW3000p groups, and the controls, respectively. The average histological score for the ESW3000p group was significantly higher than those for the ESW1500p group and the controls (P < 0.001). The average histological score for the ESW1500p group was significantly higher than that for the controls (P < 0.001). CONCLUSIONS: The histological findings of this study indicate that ESW increased the cellularity and basophilia of the extracellular matrix (ECM) in the adolescent rat epiphysis and there were no negative effects on extremity measurements in the long term.

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip before the age of 18 months.

PURPOSE: The purpose of this study is to evaluate the results of arthroscopy assisted surgical treatment of developmental dislocation of the hip (DDH). METHODS: Arthroscopic assisted surgical treatment was performed on nine hips of nine female children with DDH using our method, published previously, between January 2001 and December 2005. Their ages ranged from 9 to 16 months. Percutaneous adductor tenotomies were performed in seven cases. A spica cast and abduction splint were used for 11-17 weeks postoperatively. Acetabular index and Shenton line were used for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively with respect to range of motion restriction, and the leg length discrepancy. RESULTS: The average follow-up was 47.7 months (range 22-79 months). Acetabular index measurements of cases in the preoperative/postoperative periods were as follows: preoperative mean angle 39.9° (range 34°-52°)/postoperative mean angle 26° (range 22°-34°). Hip joint restriction and leg length discrepancy were not observed postoperatively. However, two patients had acetabular dysplasia. Acetabular dysplasia was completely resolved in one patient in the third year of follow-up, whereas Salter innominate osteotomy, required in another patient, was in the second year of follow-up. The latter patient was the oldest case (16-month-old) in our series. CONCLUSIONS: Based on the results of this study, treatment of developmental hip dysplasia with arthroscopic-assisted surgical treatment technique may be safe and effective method. Further clinical studies will be required to confirm this study.

Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty.

OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.

An investigation of the effect of acrylamide on fracture healing in rats.

BACKGROUND: The aim of this study was to investigate the effects of acrylamide (AA) on fracture healing histologically, biochemically, and radiologically in a rat femur fracture model. METHODS: Scanning electron microscopy (SEM) imaging and Fourier transform infrared spectroscopy (FTIR), and UV (ultraviolet)-Vis (visible) spectrophotometer examination were performed for acrylamide characterization. In this study, after the femur fracture model was created, the groups were formed to include eight rats in each group (G) as follows: G1: 15th-day control, G2: 15th-day AA, G3: 30th-day control, G4: 30th-day AA. In G2 and G4, 5mg/kg acrylamide was administered 3 times a week by gastric gavage. The fracture was evaluated radiologically according to Lane-Sandhu scoring and histologically according to Huo scoring. The weight changes of the rats were recorded. Albumin, total protein, cholesterol, HDL, LDL, triglyceride, ALP, LDH, vit. D, PTH, Ca, P, WBC, Hb, Plt values were examined in the blood samples. The data were analyzed using the SPSS program. RESULTS: The characterization properties of acrylamide were confirmed. No significant weight change was observed in the rats during the study. When blood values were compared, a statistically significant difference was determined between albumin, total protein, phosphorus, white blood cell (WBC), and hemoglobin groups (p=0.41, p=0.00, p=0.003, p=0.019, and p=0,017, respectively). According to the histological score comparisons, G3 was significantly different from G1, G2, and G4 (p<0.05), and G4 was significantly different from G1 and G2 (p<0.05). According to Lane-Sandhu scoring, there was a significant difference between G2 and G3 and G4 (p: 0.0, p: 0.034), G1 and G3 (p: 0.001), respectively. CONCLUSION: AA adversely affects fracture healing even at low doses, as in the present study. According to the results of this study, the authors recommend a diet poor in acrylamide during fracture treatment. Therefore, further human studies are required to find out the complex effect of AA on bone healing and the body.

Effect on mortality of treatment method and surgery time for hip fracture patients aged over 65 years.

BACKGROUND: This study aimed to evaluate the effects on mortality of implant selection used and time to surgery in patients aged over 65 years operated for hip fractures. METHODS: A total of 301 patients aged over 65 years were investigated in this study. Patients were divided into three groups as follows: Group 1 cemented hemiarthroplasty (CH), Group 2 cementless hemiarthroplasty (CLH), and Group 3 proximal femoral nail (PFN). Time of surgery, fracture and demographic information were retrospectively recorded. RESULTS: After removing 59 patients with missing information, this study included 242 patients. Mean age of patients was 80.5 years. When patient groups were examined according to treatment method, Group 1 (n=146) comprised 60.3%, Group 2 (n=54) comprised 22.3% and Group 3 (n=42) comprised 17.4% of the study group. There was no significant difference in survival between the patients operated in the first 48 hours and the patients operated later (p=0.834). There was an effect on the survival of treatment implant selection (p=0.016). Patients with CH were observed to survive longer than patients with CLH and PFN. CONCLUSION: Operation in the first 48 hours was not observed to affect mortality. Additionally, while sex and age were found to be effective on mortality, implant selection was also concluded to affect mortality.

Total hip arthroplasty after hip joint gunshot injury.

BACKGROUND: Gunshot injury of the hip joint was reported to constitute 2-17% of all extremity firearm injuries. However, there are few studies in the literature related to gunshot injuries of the hip joint. The aim of the current study was to present the results of 10 cases treated with arthroplasty following a gunshot injury to the hip joint together with the recommended treatment algorithm. METHODS: Patients with a previous medical history of hip joint region gunshot injury who underwent total hip arthroplasty were retrospectively evaluated. Those with incomplete medical records or who were lost to follow-up were excluded. Patients were classified according to the severity of the previous gunshot injury to the hip joint region. Harris hip score (HHS) and Short Form-12 quality of life score were the main outcome measurements. Postoperative complications encountered during follow-up were recorded. RESULTS: The mean age of the patients at the time of surgery was 29.9 years. The mean preoperative HHS was 25.2 points and it was 65.8 at the final follow-up. Patients with bullet fragments in the hip joint, classified as group 1, had better HHS, whereas those with contaminated hip joint with intestinal flora, classified as group 3, had worst HHS. CONCLUSION: Hip arthroplasty after hip joint gunshot injury is a good treatment choice in young patients to reduce pain and regain functions. However, very high infection rates can be seen in patients with accompanying intestinal injury.

Pigmented villonodular synovitis managed by Yttrium 90 after debulking surgery.

The goal of this study was to evaluate outcome of patients with pigmented villonodular synovitis (PVNS) managed by Yttrium90 (90Y) after debulking surgery. Seven patients (3 males and 4 females) with PVNS were studied retrospectively. Mean follow-up was 47.8 months (range 24-97 months). Mean age was 44.8 years (range 20-68 years. Debulking surgeries via arthroscopic synovectomy were performed in 4 cases and in 3 cases via mini arthrotomy. After 90Y injection was applied. Magnetic resonance imaging (MRI) included measurement of synovial thickness in preoperative and at last control. Main musculoskeletal tumor society score was 26 (range, 23-29), main MTS rating was 70.4% (range, 38.5-86.2%). Mean preoperative synovial thickness was 14.9mm range 20-12mm. Synovial thickness was completely disappeared at last MRI examination. There was diffuse joint effusion preoperatively, decreasing at last control. No cases of PVNS recurrence were found. Although we had a small number of cases, we believe that combination of debulking surgery with intra-articular injection of 90Y for PVNS of knee joint is an effective and safe treatment method.

FOXP3 rs3761548 polymorphism is associated with knee osteoarthritis in a Turkish population.

AIM: Functional polymorphisms located in FOXP3 intron 1 was recently found to be associated with rheumatoid arthritis (RA). Although RA is an autoimmune disease, there is supporting evidence that activated maladaptive responses including pro-inflammatory pathways play roles in osteoarthritis (OA), similar to RA. The aim of this study was to explore the relationship between rs2232365 (-924A/G) and rs3761548 (-3279A/C) polymorphisms as well as possible changes in the 600 bp promoter region of FOXP3 and knee OA. METHODS: Patients with primary knee OA (n = 300) and healthy individuals (n = 300) were examined for rs3761548 and rs2232365 FOXP3 gene polymorphisms by the polymerase chain reaction-restriction fragment-length polymorphism method. The 600 bp promoter region (between -500 and +100) of the gene was also sequenced with direct sequencing in 50 knee OA patients and 50 healthy individuals. RESULTS: There were no sequence variants in the promoter region tested both in OA patients and healthy controls. The SNP rs2232365 showed no association with OA susceptibility and severity and the results of other genetic models were also nonsignificant. On the other hand, rs3761548 AC (P = 0.003), AA + CC (P = 0.0014) as well as AC + AA (P = 0.40) genotypes showed association with Grade 4 knee OA patients. CONCLUSION: Our findings indicated that the association between FOXP3 rs2232365 polymorphism and knee OA tended to yield negative results but the FOXP3 rs3761548 C allele was associated with elevated risk of OA in Grade 4 knee OA patients in a Turkish population.

Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty

SUMMARY OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.

Comparison of the diagnosis of plain radiography ultrasonography and magnetic resonance imaging in early diagnosis of acute osteomyelitis experimentally formed on rabbits.

PURPOSE: We have compared the sensitivities of MRI, US and radiography which are some of the radiologic modalities used in the early diagnosis of acute osteomyelitis. MATERIALS AND METHODS: After 1 week care and research on 20 New Zealand rabbits (average weight: 2.5 kg) in animal laboratory, study was begun. Six rabbits died after anesthesia and surgical procedure. There were 14 rabbits remaining and 10 of them formed the study group. Four of them were used as the control group. Fresh mouse feces was inoculated into the bone marrow of 20 tibia under general anesthesia and during the following 15 days, MRI, US and radiographic researches were made everyday. RESULTS: According to the results that we got at the end of the 15-day period, MRI was found as the most sensitive method in describing early diagnosis of infection in the bone marrow and also in showing the extension of the infection to the soft tissue. Although US showed the findings later than MRI, it was determined that its sensitivity was less than but near MRI's in detecting subperiosteal fluid in short term period. Radiographic research gives acute osteomyelitis diagnosis latest, so it was determined as the modality that has the lowest sensitivity. CONCLUSION: MRI which is one of the radiologic modalities among other diagnostic radiologic modalities that can be used in early diagnosis of acute osteomyelitis, has the highest sensitivity. Ultrasonography is the second most sensitive modality. Radiographic analysis has the least sensitivity among other modalities. As a result, first MRI then US and after that plain radiography should be used for the early diagnosis of acute osteomyelitis.

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip.

PURPOSE: Treatment of developmental dislocation of the hip (DDH) includes surgical management in older children or in those who cannot be treated conservatively. However, complication rates of surgical treatment are quite high. The purpose of this report is to introduce our new surgical technique that can eliminate existing pathologic changes in DDH. TYPE OF STUDY: A small case series. METHODS: We performed arthroscopic-assisted surgical treatment in 4 hips of 4 female children who had DDH and no previous treatment. Their ages ranged from 11 to 14 months. Closed reduction under general anesthesia was tried just before the surgical intervention, but it failed in all of them. Tightness of the iliopsoas tendon was released followed by dissection of capsular adhesions using an anterolateral mini-incision. Excision of the hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue was carried out using a double-portal arthroscopic procedure. We performed percutaneus adductor tenotomies in 2 cases. A spica cast and abduction splint were used for 12 to 17 weeks postoperatively. The follow-up of the patients was a minimum of 1 year. Although a 1-year follow-up period is adequate to evaluate the short-term results, it has been considered that there is a need for further studies that include long-term follow-up. We used the acetabular index and Shenton's line for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively in respect to range of motion restriction and the leg length discrepancy. RESULTS: The mean follow-up was 13.7 months (range, 12 to 16 months). Acetabular index measurements of the cases in the preoperative/postoperative periods were as follows: in the first case, 34 degrees/27 degrees; in the second case, 35 degrees/22 degrees; in the third case, 52 degrees/39 degrees; and in the fourth case, 40 degrees/28 degrees. Hip joint restriction and leg length discrepancy were not observed postoperatively. CONCLUSIONS: All the intra-articular structures (hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue) in the acetabulum that impede the reduction of the femoral head have been eliminated by using the arthroscopic technique. The arthroscopic-assisted surgical treatment of DDH is successful in the short-term follow-up period. LEVEL OF EVIDENCE: Level IV, Case Series.

Complication following intramedullary fixation with a Fixion nail in a patient with osteogenesis imperfecta: a case report.

Osteogenesis imperfecta (O.I.) is a genetic disorder with increased bone fragility and low bone mass. We report the history of a 17-year-old male patient with O.I. who presented a fracture of his left femoral shaft. He had osteogenesis imperfecta type I A according to Silence. He had presented two years previously an ipsilateral cervical fracture of the femur which had healed. Intramedullary fixation with a Fixion intramedullary nail was elected. While the Fixion nail was being inflated to 70 bars with saline, a longitudinal fracture occurred in the femoral shaft. A conventional intramedullary nail and cerclage wire were applied for fixation. The fracture healed without complication in 10 weeks. Based on this observation, we do not recommend using the Fixion IM nail for fracture fixation in patients who have abnormal bone fragility such as in osteogenesis imperfecta.

The surgical treatment of developmental dislocation of the hip in older children: a comparative study.

The aim of this retrospective study was to compare simultaneous open reduction and Salter innominate osteotomy versus one-stage combined surgical treatment including femoral shortening. A total of 24 patients were studied. Group 1 included 16 hips in 14 patients treated by simultaneous open reduction and Salter innominate osteotomy; Group 2 included 13 hips in 10 patients treated by one-stage open reduction, Salter innominate osteotomy and femoral shortening. The average age at the time of operation was 4.1 years (range: 3.3 to 5.1). Average follow-up was 5.3 years (range: 2.7 to 9.0). Clinical and radiological assessment at final follow-up showed that the outcome was not significantly different between the two groups. The duration of operation, however, was significant different between the groups. Patients with DDH between 3 and 5 years of age were treated successfully with either simultaneous open reduction and Salter innominate osteotomy or a one-stage combined surgical procedure including femoral shortening. Clinical and radiological outcomes were similar. Nevertheless, after this follow-up period, the rate of avascular necrosis was slightly higher in Group 1; on the other hand, one-stage combined surgical treatment including femoral shortening significantly prolonged the operative time.

[The effect of definitive continuous distraction employed with the Ilizarov type external fixation system on fracture healing: an experimental rabbit model]. / Ilizarov tipi eksternal fiksatörle belirli sürekli distraksiyonun kirik iyilesmesi üzerine etkisi: Tavsanda deneysel çalisma.

OBJECTIVES: The objective of this study was to evaluate the effect of definitive continuous distraction (DCD) employed through an Ilizarov type external fixator on fracture healing in a rabbit tibia model. METHODS: Fifteen mature New Zealand white rabbits weighing 2.8 to 4.0 kg were randomly assigned to three groups following osteotomy of the tibia and fibula. The first group (controls) was treated only with the Ilizarov type external fixator while the second and third groups were subjected to DCD amounting to 10% and 30% of the body weight, respectively, being employed through modulated springs on the Ilizarov external fixation system. All the rabbits were evaluated by radiographs on the 12th, 21st, 28th, and 35th days following surgery and were sacrificed on the 45th day. Radiographic evaluations were made according to the Lane and Sandhu's scoring system, and histologic evaluations according to the scoring system proposed by Heiple et al. The results were analyzed using the Kruskal-Wallis test. RESULTS: The highest radiographic and histologic scores were obtained from the second group, being 8.6 and 11.6, respectively (p<0.05). Radiographic and histologic scores of the third group were lower than those of the control group. CONCLUSION: Application of DCD of 10% of body weight through modulated springs on the Ilizarov external fixator improves fracture healing while a greater amount of instability results in delayed healing.

Doping and performance enhancing drug use in athletes living in sivas, mid-anatolia: a brief report.

The aim of this study was to determine the rate of doping and performance enhancing drug use in athletes in Sivas, Turkey, and to analyze the main reasons for the use. This was a cross-sectional study based on a self-report questionnaire. The subjects filled the questionnaires under the supervision of the investigators during interviews. This questionnaire included 24 items describing the population in terms of demographics, sport practice, doping in sport and substance use. Moreover, we assessed the frequency of doping drug use. The number of respondents was 883, of which 433 athletes and 450 healthy non-athletes (control group). The mean age of the total volunteers was 21.8 ± 3.7 yrs. The male and female ratios were 78.2% and 21.8% respectively. Doping and performance enhancing drug usage rate was 8.0% (71cases in 883 subjects). Doping drug use among the athletes was significantly (p < 0.05) higher (14.5%) compared with the non-athletes (1.8%). The agents used were anabolic steroids in 60.5%, l-carnitene in 12.7%, erythropoietin in 5.4%, Na-bicarbonate in 11.3% and creatinine in 14.1% of 71 cases. The reasons for doping use were to have a better body condition in 34 cases (47.9%) and to solve weight (gaining or loosing) problems in 8 (11.3%) cases. Since the potential side effects of doping drugs are not satisfactorily familiar to the most users, the education of athletes on the matter must be a top priority. Key PointsDoping and performance enhancing drug use was 71 (8.0%) in 883 subjects, and it was significantly higher (14.5%) in the athletes compared with the non-athletes (1.8%) in Sivas, Turkey.The rate of athletes who experienced such drugs at least once in their life was 29.0%.The 52.4% of doping and performance enhancing drug users accepted that they were unaware of the drugs full and/or potential side effects.

Treatment of Bifocal Cyst Hydatid Involvement in Right Femur with Teicoplanin Added Bone Cement and Albendazole.

Although bone involvement associated with cyst hydatid is rarely seen, it can cause unintended results such as high recurrence rate, infection, sepsis, or amputation of relevant extremity. Because of this reason, its treatment is difficult and disputed. In the case of bifocal bone cyst hydatid in right femur, along with albendazole treatment, result of resecting cyst surgically and its treatment with teicoplanin with added bone cement is given. In conclusion, since the offered treatment method both supports bone in terms of mechanical aspect and also can prevent secondary infection, the method is thought to be a good and safe treatment approach.

The measurement of the rotational deformities with computed tomography in femoral shaft fractures of the children treated with early spica cast.

Twenty-eight children with femoral shaft fractures, treated with early spica cast, were evaluated with computed tomography (CT), for their femoral shaft rotational deformities. The femoral torsion angles were measured on both sides. If the torsion angle of the fractured side was more than the other side, it was considered as an internal rotational deformity and if it was less, it was considered as an external rotational deformity. Internal rotational deformities were detected in nine cases and external rotational deformities were detected in 17 cases. Rotational deformity was not observed in two cases. Four cases, with a rotational deformity more than 10 degrees, were corrected with a gypsotomy through the level of the fracture. We concluded that a rotational deformity, which is an important complication in conservative treatment of the femoral shaft fractures in children, can be determined exactly with CT and corrections on the spica cast can be made with a gypsotomy.

Lipoma arborescens; successfully treated by yttrium-90 radiosynovectomy.

Although radiosynovectomy (RS) applications have been carried out for many years, clinical indications of this non-invasive procedure is thought to be limited probably due to the lack of information of clinicians. Clinicians' preferential indication for RS is the treatment-resistant synovitis of individual joints, i.e. despite systemic pharmacotherapy and intra-articular steroid injections. We present here a case of "lipoma arborescens" treated by yttrium-90, which is a rare intra-articular lesion characterized by villous proliferation of the synovial membrane and hyperplasia of subsynovial fat. The results of clinical, biochemical and hematological examinations, magnetic resonance (MR) imaging, arthroscopy and histological analysis have shown that the etiology was lipoma arborescens in a female patient, aged 36 having swelling and sometimes associating pain at her right knee for 4 years. We have applied to our patient's right knee RS with 185 MBq yttrium-90 colloid together with 40 mg of methylprednisolone acetate, although in our literature survey we have not met any similar case being treated with such indication. Even a year after the application, the patient has absolutely benefited from the treatment clinically, and this was also confirmed by comparative MR images (pre- and post-treatment). Consequently, we consider that Y-90 treatment might be applicable in suitable cases with lipoma arborescens.