IV.

IntroductionSynovial 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 caseA 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.DiscussionCases 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%.ConclusionArthroscopic 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.

The influence of anatomical or nonanatomical femoral tunnel position on tunnel widening and clinical outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction is not fully understood. This retrospective study examined the influence of tunnel width and placement on anterior knee stability and clinical outcomes after ACL reconstruction using the AperFix System (Cayenne Medical Inc, Scottsdale, Arizona), a direct expandable fixation technique with autologous hamstring grafts. The records of 80 patients (79 men and 1 woman) who underwent ACL reconstruction were evaluated. In 38 patients, anatomical femoral tunnel placement was performed via an accessory medial portal (anteromedial group); in the remaining 42 patients, the femoral tunnel was positioned nonanatomically using a transtibial technique (transtibial group). Mean follow-up was 40.7 months (range, 27-60 months). Postoperative knee kinetics were measured, and clinical outcomes were assessed using International Knee Documentation Committee, Lysholm, and Tegner scores. Femoral tunnel widening was measured by comparing postoperative radiographs with final follow-up radiographs. Femoral tunnel width was significantly greater (P<.001) and anterior knee translation was significantly higher (P=.01) in the transtibial group. Lysholm and Tegner scores were not significantly different (P>.05) between the 2 groups. These findings suggest that femoral tunnel widening is associated with increased anterior joint laxity when a direct fixation technique is used for ACL reconstruction, particularly in nonanatomically positioned femoral tunnels. Anatomical femoral tunnel placement provides better anterior stability and less tunnel widening than transtibial tunnel placement; however, these benefits did not produce a detectable advantage in clinical outcomes measures. [Orthopedics. 2017; 40(3):e532-e537.].

INTRODUCTIONLoose bodies within the joint because of any cause have the potential for continued growth.PRESENTATION OF CASEA 41-year-old man had suffered multiple recurrent dislocations of his left shoulder, accompanied with pain. His anterior apprehension and relocation tests were positive, but no other sign was noted on physical examination. On magnetic resonance imaging and at arthroscopy, two giant loose bodies were seen. They were in the axillary recess and were removed arthroscopically.DISCUSSIONMost authors recommend surgical removal of the cartilaginous loose bodies to ameliorate the symptoms. Furthermore, the majority of authors recommend a synovectomy to decrease the risk of recurrence. Depending on the size of the chondral loose bodies, removal can be performed via an arthrotomy, arthroscopy with mini-open arthrotomy, or arthroscopy.CONCLUSIONThe source of the loose body should be determined carefully. Other lesions may be associated with the loose body. Arthroscopic treatment is a good option for removing the loose body.

Background : Occult osseous knee injuries, such as bone bruises, can produce persistent pain and functional loss. Although bone bruises cannot be identified through direct examination or traditional radiographs, magnetic resonance imaging (MRI) has emerged as an effective diagnostic method. Nevertheless, the natural history of these injuries remains to be fully defined. Therefore, we used MRI to detect and follow bone bruise injuries secondary to knee trauma.Methods : We retrospectively reviewed knee MRIs from patients with bone bruising caused by trauma. Occult injuries were initially identified by MRI and subsequently rescanned for follow-up at 3 and 9 months. All patients underwent physical examinations, direct radiological imaging, and MRI.Results : Although direct radiographs showed no abnormalities, we used MRI to identify a total of 22 patients (age range: 19–42 years; mean: 28 years) with bone bruising. After 3 months, injuries remained detectable in 68.2% of the subjects, whereas 18.2% displayed bone bruising after 9 months. The majority of Type I lesions resolved spontaneously, whereas 80% of Type II injuries remained following 3 months, and 30% persisted at 9 months. Ligament and meniscal lesions were observed in 63.6% of patients with bone bruising and appeared to hinder recovery.Conclusion : Bone bruises generally resolved within 3 to 9 months in subjects with no soft tissue lesions and minor trauma. However, ligament and meniscal lesions were observed in the majority of patients, and these individuals required longer treatment and recuperation. Overall, these findings can contribute to improving the management of occult osseous knee injuries.

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 ± 3.19 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

Objective: The aim of this study is to investigate neurologic complications of closed wedge valgization osteotomy technique using electrophysiological methods.Methods: Eleven extremities of 11 patients (mean age 52.75±5.39) with medial gonarthrosis and varus deformity were included. All patients underwent closed wedge valgization osteotomy in order to correct varus deformity. Results:The post-operative amplitude of nervus peroneus superficialis significantly decreased when compared to pre-operative amplitude. The mean pre-operative N. peroneus superficialis amplitude was 12.77, whereas it reduced to 5.44 postoperatively (p<0.05). Other nerve conduction velocity investigations showed no significant differences between pre-and post-operative values. A Needle Electromyography (EMG) study demonstrated neurogenic involvement in 4 patients after surgery. All of these 4 patients had denervation in the m.extensor hallucis longus needle EMG study. In 2 patients, the musculus tibialis anterior needle EMG study showed neurogenic involvement. One of these had denervation. One patient showed denervation in the m.extensor digitorum brevis needle EMG study. Conclusion:Although fibula osteotomy used in the closed wedge osteotomy technique was applied from the safe zone, electrophysiological investigations suggested that this zone may, in fact, not be safe. (JAREM 2014; 1: 12-7) Key Words: Closed wedge, high tibial osteotomy, valgization osteotomy, peroneal nevre ÖZET Amaç: Bu çalışmanın amacı kapalı kama valgizasyon osteotomisi tekniğinin nörolojik komplikasyonlarını elektrofizyolojik yöntemlerle araştırmaktır.Yöntemler: Ortalama yaşları 52,75 (±5,39) olan varus deformitesi bulunan medial gonartrozlu 11 hastanın 11 ekstremitesi çalışmaya alınarak mevcut varus deformitelerini düzeltme amacıyla uygulanan kapalı kama valgizasyon osteotomisi uygulanan hasta grubu çalışmaya dahil edilmiştir. Bulgular: Nervus peroneus süperfisialis amplitüdü incelendiğinde ameliyat öncesine göre ameliyat sonrası ortalama olarak anlamlı şekilde azalma saptanmıştır. Ameliyat öncesi ortalama N. peroneus süperfisialis amplitüdü 12,77 iken ameliyat sonrası ortalama değer 5,44 olarak bulunmuştur (p<0,05). Diğer sinir ileti hızları incelemelerinde ise ameliyat öncesi ve sonrası arasında istatiksel olarak anlamlı fark saptanmamıştır. İğne Elektromyografi (EMG) çalışmasında ise 4 hastada ameliyat sonrası incelemede nörojen tutulum saptanmıştır. Dört hastanın tamamında m. ekstansör hallusis longus iğne EMG çalışmasında denervasyon saptanmıştır. İki hastanın musculus tibialis anterior iğne EMG çalışmasında nörojen tutulum saptanmıştır. Bunlardan birinde denervasyon saptanmıştır. Bir hastada m. ekstansör dijitorum brevis iğne EMG çalışmasında denervasyon saptanmıştır.Sonuç: Kapalı kama osteotomi tekniğinde kullanılan fibula osteotomisi güvenli bölgeden yapılmasına rağmen elektrofizyolojik inceleme sonuçları bu bölgenin güvenli olduğu konusunda şüphe uyandırmaktadır. (JAREM 2014; 1: 12-7) Anahtar Sözcükler: Kapalı kama, yüksek tibial osteotomi, valg...

The patellofemoral joint tends to develop osteoarthritis due to the high rates of anatomical abnormalities and exposure to large weights through relatively small areas. The rate of isolated patellofemoral arthrosis is 11% in men and 24% in women above 55 years of age. This gender difference may be due to the more frequent presence of patellar aligment problems and dysplasia in women. Although, patellofemoral arthrosis, in general, is treated by conservative methods, surgery should be considered for patients who have failed to benefit from weight loss, physical therapy and drug treatment because the disease leads to pain and loss of function. In the surgical treatment of patellofemoral arthrosis, methods such as arthroscopic debridement, management of loads that affect the patella, cartilage grafting, patellar resurfacing, patellafemoral arthroplasty (PFA), total joint replacement and patellectomy can be used. However, PFA has not been widely used. The reasons were problems with the initial design, and mistakes in patient selection, but those were reduced recently and this has led to increasing interest in the PFA. The current indications of PFA comprise of patients with little or no malalignment, and young patients with isolated patellofemoral disease who were planned for patellectomy due to symptom severity. Indeed, the outcomes from patients who were below 55 years of age with a 5-year follow up are promising. (JAREM 2014; 1: 1-3) Key Words: Patellafemoral joint, arthrosis, patellofemoral arthroplasty ÖZET Patellofemoral eklem büyük yüklerin dar temas alanları üzerinden etki etmesi ve nispeten anatomik anomali oranının sıklığı nedeniyle osteoartrite oldukça meyilli bir eklemdir. Tek başına patellofemoral artroz varlığı 55 yaş üstü erkeklerde %11, kadınlarda %24 oranında görülmekle birlikte bu cinsiyet farklılığının nedeni kadınlarda daha sık olan patellar dizilim bozukluğu ve displazi olabilir. Patellofemoral artroz genellikle konservatif yöntemler ile tedavi edilmeye çalışılsa da; tek başına ağrı ve fonksiyon kaybı yaratması nedeniyle kilo verme, fizik tedavi ve ilaç tedavisinden fayda görmeyen hastalar için cerrahi seçenekler gözönünde bulundurulmalıdır. Patellofemoral artroz cerrahi tedavisinde artroskopik debridman, patellayı etkileyen yüklerin düzenlenmesi, kıkırdak greftlemeleri, patellar yüzey yenilemeleri, Patellofemoral artroplasti (PFA), total eklem replasmanı ve patellektomiye uzanan yöntemler uygulanabilmektedir. Bununla birlikte PFA çok yaygın kullanım alanı bulamamıştır. Bunun nedeni olarak gösterilen ilk tasarımlardaki sorunlar ve hasta seçimindeki hata oranlarının azaltılması ile özellikle son yıllarda PFA'ye olan ilgi de artmıştır. PFA'nin günümüzdeki endikasyonları arasında yanlış dizilimin çok az olduğu ya da hiç olmadığı hastalar ve semptomların ciddiyeti nedeniyle patellektomi planlanan izole patellofemoral hastalığı olan genç hastalar vardır. Gerçekten de 55 yaş altı ve en az 5 yıllık takibi olan hastaların sonuçları cesaret vericidir. (JAREM 2014; 1: 1-3) Anahtar Sözcükler:...