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Posteriyor glenohumeral eklemdeki gangliyon kistinin supraskapular sinire basısı nadiren karşılaşılan bir omuz ağrısı nedenidir. Bu çalışmada supraskapular sinir sıkışmasına neden olan gangliyon kistlerine yönelik farklı tedavi yöntemlerinin uygulanabilirliğini ilgili literatür ışığında tartışmayı amaçladık. Manyetik rezonans (MR) görüntülemede travma öyküsü olmayan ve omuz ağrısından yakınan üç hastada sağ glenohumeral eklem arkasında gangliyon kisti görünümü ile uyumlu kistik yapı gözlemledik. Glenohumeral eklemde ağrı ve güçsüzlüğe neden olan gangliyon kistleri için literatürde konservatif ve cerrahi tedavi yöntemleri önerilmiştir. Medikal tedaviye yanıtsız hastalarda supraskapular sinirin dekompresyonu için kist nedeninin artroskopik tamirinin veya ortadan kaldırılmasının başarılı sonuçlar verdiği gözlenmiştir. Artroskopik teknik daha az morbidite görülmesi, fonksiyonların daha hızlı düzelmesi, eklem içi patolojilerin daha kolay tespit ve tedavi edilebilmesi nedeniyle açık cerrahiye göre daha avantajlıdır., Pressure by a ganglion cyst in the posterior glenohumeral joint on the suprascapular nerve is a rare cause of shoulder pain. In this paper, we aimed to discuss in light of the literature the applicability of various treatment modalities for ganglion cysts compressing the suprascapular nerve. In magnetic resonance (MR) imaging, we observed cystic structures compatible with a ganglion cyst behind the right glenohumeral joint in three patients who had been complaining of shoulder pain with no history of trauma. Conservative and surgical methods have been suggested in the literature to treat ganglion cysts that cause pain and weakness in the glenohumeral joint. It has been observed that arthroscopic repair or removal of the cause of the cyst is successful in decompressing the suprascapular nerve in patients unresponsive to medical treatment. Arthroscopic technique is more advantageous than open surgery, providing less morbidity, faster restoration of functionality, and easier detection and treatment of intraarticular pathologies.

Posteriyor glenohumeral eklemdeki gangliyon kistinin supraskapular sinire basısı nadiren karşılaşılan bir omuz ağrısı nedenidir. Bu çalışmada supraskapular sinir sıkışmasına neden olan gangliyon kistlerine yönelik farklı tedavi yöntemlerinin uygulanabilirliğini ilgili literatür ışığında tartışmayı amaçladık. Manyetik rezonans (MR) görüntülemede travma öyküsü olmayan ve omuz ağrısından yakınan üç hastada sağ glenohumeral eklem arkasında gangliyon kisti görünümü ile uyumlu kistik yapı gözlemledik. Glenohumeral eklemde ağrı ve güçsüzlüğe neden olan gangliyon kistleri için literatürde konservatif ve cerrahi tedavi yöntemleri önerilmiştir. Medikal tedaviye yanıtsız hastalarda supraskapular sinirin dekompresyonu için kist nedeninin artroskopik tamirinin veya ortadan kaldırılmasının başarılı sonuçlar verdiği gözlenmiştir. Artroskopik teknik daha az morbidite görülmesi, fonksiyonların daha hızlı düzelmesi, eklem içi patolojilerin daha kolay tespit ve tedavi edilebilmesi nedeniyle açık cerrahiye göre daha avantajlıdır.

Objectives: When the risk factors of symptomaticosteoarthritis (OA) are evaluated, it has been shownthat increased body mass index, lowereducational levels and social support, depressive mood areassociated with reporting more pain. Theaim of this study was to investigate the relationship withradiological grade of osteoarthritis ofknee at symptomatic obese patients and body mass index,functional status.Materials and Methods: Forty‐one patients whose BMI was more than30 kg/m2 and diagnosed asprimary knee OA due to knee pain complaintswere included in the study. The anatomic tibiofemoralangle (aTFA) was measured on orthoro‐entgenography by Picture Archiving Communication Systems(PACS). Western Ontario McMasterOsteoarthritis Index (WOMAC) and knee Visual Analogue Scale(VAS) were evaluated according to the kneewhich has more pain complaint.Results: A statistically significant correlation inthe positive direction was found between the decreasein BMI and the decrease in the Lumbar VAS(Initial‐3rd month difference). However, there was acorrelation between the decrease in BMI andthe decrease in knee function and VAS which was notstatistically significant.Conclusion: It is suggested that short term knee paindue to knee OA is not directly associated withweight loss and irreversible mechanicalfactors (knee varus, cartilage damage in knee joint) caused byobesity can be the effective factor., Amaç: Semptomatik osteoartrit(OA) ‘in risk faktörleri değerlendirildiğinde yüksek vücut kitle indeksi (VKİ) ‘nin,düşük eğitim düzeyi ve sosyal desteğin, depresif durumun daha fazla ağrıbildirilmesi ile ilişkili olduğu görülmüştür. Bu çalışmanın amacı, obez vesemptomatik diz osteoartriti ve bel ağrısı olan hastalarda; radyolojik evre vevücut kitle indeksi ile fonksiyonel durum arasındaki ilişkiyi değerlendirmekti.Materyal ve Metot: Çalışmaya diz ağrısıyakınması nedeniyle başvuran primer diz OA tanısı alan VKİ 30 kg/m2üstü 41 hasta dahil edildi. Anatomiktibiofemoral açı (aTFA), ortoröntgenografiler üzerinde Resim Arşivlemeİletişim Sistemleri (PACS) ile ölçüldü. Ağrı yakınması daha çok olan dize göreWestern OntarioMcMaster Osteoartrit Indeksi (WOMAC) ve görsel ağrı skalası (VAS) ile değerlendirildi.Bulgular: VKİ’deki düşme ile bel ağrısıVAS’daki (0‐3.Ay Fark) düşme arasında pozitif yönde istatistiksel olarak anlamlıkorelasyon gözlenmiştir. Fakat VKİ’deki değişim ile diz fonksiyonları ve VASarasında pozitif yönde düşme gözlenirken istatistiksel olarak anlamlı bulunmamıştır.Sonuç: Obez diz osteoartiritine bağlıkısa dönem diz ağrılarının kilo vermek ile direk bağlantısı olmayıp, fazlakilonun yol açtığı geri dönüşümü olmayan mekanik faktörlerin (dizin aşırıvarusu, diz eklemindeki kıkırdak hasarı) etken olduğunu düşündürmüştür.

Background Forearm fractures constitute approximately 40% of all pediatric fractures. Generally, in conservative treatment,a plaster cast is applied with the elbow in 90° flexion. Success of the treatment depends on theprevention of the reduction in the correct position and suitable duration of the plaster cast. Failure, or the risk of angulation within the cast, is associated with movement within the cast. The aim of this study was to evaluate the applicability of the Cast Index (CI) and Three-Point Index (TPI) measurements, which indicate the loss of reduction, in pediatric mid-third forearm fractures. The hypothesis of the study was that as edema decreases and deformity of the plaster cast occurs after fracture reduction, TPI and CI should be examined during follow-up, as they indicate shifting due to movement within the plaster cast. Methods This retrospective study included a total of 48 patients, who were treated with closed reduction and long-arm plaster cast for a mid-third forearm diaphyseal fracture at our Emergency Polyclinic between March and September 2014. The mean age of the patients was 8.15±3.19 years (range, 5-14 years). Patients were excluded from the study if they had isolated radial or ulnar fracture, open fractures, concomitant fracture or systemic disease (bone metabolism disease, etc), and Results In the AP plane, compared with TPI values after reduction, statistically significant increases were observed in TPI values 10 days after reduction (p 0.05). Although there was a statistically significant increase in TPI values 15 daysafter reduction compared with the values immediately after reduction, a significant difference between those with and without reduction loss was observed only on lateral TPI. Conclusion In cases of pediatric forearm diaphyseal fracture, ulnar TPI examined in the lateral plane can be used in monitoring the fracture in a plaster cast applied after the reduction.

BACKGROUND: Treatment of the distal tibial fractures are challenging due to the limited soft tissue, subcutaneous location and poor vascularity. In this control-matched study, it was aimed to compare the traditional open reduction and internal fixation with minimal invasive plating (MIPO). We hypothesized that superior results may be achieved with MIPO technique. METHODS: 22 patients treated with traditional open reduction and internal fixation were matched with 22 patients treated with closed reduction and MIPO on the basis of age (±3), gender, and fracture pattern (AO classification). Evaluation was assed according to the wound problems, the American Orthopaedic Foot and Ankle surgery (AOFAS) scoring, radiological union, malunion, delayed union, hospitalisation time, time from injury to surgery, and operation time. RESULTS: There was no significant difference in the distribution of AO/OTA classification, age, gender, AOFAS score, time from injury to operation, follow-up, bone union time, delayed union, malunion and infection (p>0.05). The operation time was significantly longer in the open group than in the MIPO group: 69.59±7.21 min. for the ORIF, and 61.14±5.61 for the MIPO group (p

Simultaneous bilateral locked posterior dislocation of the shoulder is a rare injury. Herein, we present a 59-year-old male case with a three-month history of an irreducible locked bilateral posterior dislocation of the shoulders with an associated large impression fracture on the anteromedial aspect of both humeral heads after a grand mal type epileptic seizure. Plain X-ray and computed tomograph revealed a defect on the right side more than 40% of the articular surface, and on the left side, 30%. He was treated with a one-stage operation with a reconstruction of femoral head osteochondral allograft on the right side and transfer of the osteotomized tuberculum minus with its attached subscapularis tendon into the defect (modified McLaughlin technique) on the left side. At 14 months during follow-up, the patient was pain-free with stable shoulder joints and satisfactory functionality.

Two drilling techniques of the femoral tunnel are commonly used in anterior cruciate ligament (ACL) reconstruction: through the transtibial (TT) portal or through the anteromedial (AM) portal. The aim of the present study is to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using AM and TT portal techniques for drilling the femoral tunnel in nonprofessional athletes.A retrospective review was made of 44 nonprofessional athletes undergoing ACL reconstruction using AM and TT techniques between 2011-2013. The femoral tunnel clock position on axial magnetic resonance imaging (MRI) and the anterior-posterior position of the tibial tunnel on sagittal-cut MRI scan were measured. Radiological femoral tunnel and tibial tunnel anterior-posterior inclination angles were assessed. At final follow-up, the Lachman test and pivot-shift test were used in the evaluation of the anterior-posterior stability of the knee and the rotational stability of the knee. For clinical and functional evaluation, the modified Cincinnati knee grading system, Lysholm knee scoring scale, and International Knee Documentation Committee (IKDC) form were used.No statistically significant difference was determined between the groups in terms of patient age, follow-up period, gender, and affected side distribution. There were 6 outliers in the TT group due to the clock face position. The mean femoral tunnel inclination angle was 31.07°±8.44° in the AM group and 19.02°±8.93° in the TT group. The tibial tunnel inclination angle was 21.08°±5.42° in the TT group and 16.58°±7.02° in the AM group. A statistically significant difference was determined between the 2 groups. No statistically significant difference was observed between the 2 groups in terms of Lachman test, pivot-shift test, Lysholm score, IKDC score, and modified Cincinnati score results.The AM technique has no clinical superiority compared to the TT technique in ACL reconstruction in nonprofessional athletes.

Objective: Two drilling techniques of the femoral tunnel are commonly used in anterior cruciate ligament (ACL) reconstruction: through the transtibial (TT) portal or through the anteromedial (AM) portal. The aim of the present study is to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using AM and TT portal techniques for drilling the femoral tunnel in nonprofessional athletes. Methods: A retrospective review was made of 44 nonprofessional athletes undergoing ACL reconstruction using AM and TT techniques between 2011–2013. The femoral tunnel clock position on axial magnetic resonance imaging (MRI) and the anterior-posterior position of the tibial tunnel on sagittal-cut MRI scan were measured. Radiological femoral tunnel and tibial tunnel anterior-posterior inclination angles were assessed. At final follow-up, the Lachman test and pivot-shift test were used in the evaluation of the anterior-posterior stability of the knee and the rotational stability of the knee. For clinical and functional evaluation, the modified Cincinnati knee grading system, Lysholm knee scoring scale, and International Knee Documentation Committee (IKDC) form were used. Results: No statistically significant difference was determined between the groups in terms of patient age, follow-up period, gender, and affected side distribution. There were 6 outliers in the TT group due to the clock face position. The mean femoral tunnel inclination angle was 31.07°±8.44° in the AM group and 19.02°±8.93° in the TT group. The tibial tunnel inclination angle was 21.08°±5.42° in the TT group and 16.58°±7.02° in the AM group. A statistically significant difference was determined between the 2 groups. No statistically significant difference was observed between the 2 groups in terms of Lachman test, pivot-shift test, Lysholm score, IKDC score, and modified Cincinnati score results. Conclusion: The AM technique has no clinical superiority compared to the TT technique in ACL reconstruction in nonprofessional athletes.

Objective: The aim of this study is to report our institution’s experience regarding the use of open tibial inlay technique in patients undergoing single-stage combined posterior cruciate ligament (PCL) reconstruction.Methods: Records of 17 patients who underwent PCL reconstruction with tibial inlay technique were retrospectively reviewed. Patients with ipsilateral femoral or tibial osteochondral avulsion fractures or ipsilateral concomitant tibia and femur shaft fractures were excluded. Out of these 17 patients, six cases underwent anterior cruciate ligament (ACL) + PCL reconstruction, nine cases underwent ACL+ PCL + posterolateral corner reconstruction, one case underwent ACL + PCL + MCL reconstruction and one case underwent ACL+ PCL + posterolateral corner + MCL reconstruction. Mean follow-up was 14.27±6.77 (range: 6–30) months.Results: In preoperative assessments, all patients had 3+ posterior laxity in posterior drawer test; at final follow-up, 6 patients had 0 laxity, 7 patients had 1+ laxity, and 4 patients had 2+ laxity (p, Amaç: Açık tibiyal inley tekniği ile izole ya da tek aşamalı kombine arka çapraz bağ rekonstrüksiyonu uygulanan hastalarda klinik deneyimlerimizi sunmayı amaçladık.Çalışma planı: Tibiyal inley tekniği ile AÇB rekonstrüksiyonu uygulanan 17 hastanın kayıtları retrospektif olarak değerlendirilmiştir. Tek taraflı femoral ya da tibial osteokondral kopma kırığı ya da tek taraflı eşzamanlı tibia ve femur şaft kırığı olan hastalar çalışma dışı bırakılmıştır. İki hastada izole arka çapraz bağ rekonstrüksiyonu gerçekleştirilirken, 10/17 hastada posterolateral köşe rekonstrüksiyonu, 14/17 hastada ön çapraz bağ rekonstrüksiyonu ve 2/17 hastada mediyal kollateral bağ rekonstrüksiyonu ile birlikte yapılmıştır. Tüm hastalar ortalama 14.27±6.77 (6–30) ay süreyle izlenmiştir.Bulgular: Cerrahi öncesi değerlendirmelerde tüm hastalarda arka çekmece testinde arkaya gevşeklik 3 + iken son takipler sırasında yapılan değerlendirmelerde arka çekmece testi skoru 6 hastada 0 gevşeklik, 7 hastada + 1 gevşeklik ve 4 hastada + 2 gevşeklik olarak belirlenmiştir (p

Objective: The aim of this study is to report our institution’s experience regarding the use of open tibial inlay technique in patients undergoing single-stage combined posterior cruciate ligament (PCL) reconstruction. Methods: Records of 17 patients who underwent PCL reconstruction with tibial inlay technique were retrospectively reviewed. Patients with ipsilateral femoral or tibial osteochondral avulsion fractures or ipsilateral concomitant tibia and femur shaft fractures were excluded. Out of these 17 patients, six cases underwent anterior cruciate ligament (ACL) + PCL reconstruction, nine cases underwent ACL+ PCL + posterolateral corner reconstruction, one case underwent ACL + PCL + MCL reconstruction and one case underwent ACL+ PCL + posterolateral corner + MCL reconstruction. Mean follow-up was 14.27±6.77 (range: 6–30) months. Results: In preoperative assessments, all patients had 3+ posterior laxity in posterior drawer test; at final follow-up, 6 patients had 0 laxity, 7 patients had 1+ laxity, and 4 patients had 2+ laxity (p

Objectives: Purpose of this study is to as certain consistency between posterior condylar axis (PCA) + 3˚ external rotation line and clinical transepicondylar axis (cTEA) line in primary total knee arthroplasty cases. Materials-Methods: During surgery, following distal femoral cut PCA +3 degree external rotation line and cTEA line drawn on the distal femoral cutting surface by ruler and pencil. The both lines on distal femur were recorded by digital camera and relationship between lines was ascertained in reference to PCA +3 degree external rotation [parallel (P), Internal rotation (IR) and External Rotation (ER)]. Results: 9 knees of 9 patients [1 men, 8 women; average age 67 (59-80 age)] were constituted the study group. Evaluation results of the photographs revealed that clinical TEA line in comparison PCA +3 degrees external rotation line was ER in 9 knees (100%) whose mean angles 2.7˚ (1-6) and detected external roation with mean angle 4.7˚ (2-7) in 9 knees. Conclusion:: For determination of FC rotation in surgery setting, different results between cTEA and PCA + 3 degrees techniques possibly may due to disadvantages of techniques and anatomic variation of distal femur. Thus, using both techniques for check each other’s results seems unsafe. In custom made prosthesis, which can be done in the future it will be measured by CT. Keywords: Total knee arthroplasty, femoral component, rotational alignment, femoral transepicondylar axis, posterior condylar axis

Objectives: PCL reconstruction research has shown that the tibial inlay and transtibial tunnel procedures offer similar biomechanical results. The purpose of this study was to evaluate the early results of PCL reconstruction using a single-bundle Achilles allograft and tibial inlay fixation. Methods: We retrospectively studied 14 patients who had undergone PCL reconstruction using the direct tibial inlay fixation technique from 2009 to 2013, with a mean follow-up of 13.4 months. (6-28 months). The patients were 11males and 3 females with an average age of 29.2 years (17-41 years). Ipsilateral femoral shaft fractures were determined in 2 cases, ipsilateral trochanteric fracture in 1 case and popliteal artery injury in 1 case. Surgery was performed within 2-4 weeks. Spanning-joint external fixation was applied to 2 patients because of gross instability with failure to maintain reduction in a brace. Combined reconstructions involving the posterolateral corner (9/14), anterior cruciate ligament (ACL (11/14)), or medial collateral ligament (MCL (1/14)) were performed. All PCL reconstructions were performed with Achilles allograft. In 1 case with arterial injury, the repair was made by a cardiovascular surgeon. In 2 case, deep infection developed, which was controlled with debridement and antibiotic treatment. Superficial peroneal nerve injury in 1 case was treated with tenolysis in the 6th month, then partial healing was seen at 18 months. In all patients, the preoperative posterior drawer (PD) examination was positive. All patients were evaluated with preoperative and postoperative examination and x-rays. The International Knee Documentation Committee (IKDC) evaluation was applied to all patients at the final follow-up. Results: Postoperative PD examination demonstrated the following: 0 (normal) in 4 patients, 1+ in 7 patients, and 2+ in 3 patients, compared to the preoperative PD of 3+ or greater in all patients. Preoperative IKDC objective evaluation rated all knees as severely abnormal based on instability. The final follow-up objective IKDC evaluation distribution was as follows: A, 4 knees; B, 6 knees; C, 3 knees and D, 1 knee, compared to D in all 14 knees preoperatively. The average final follow-up IKDC subjective score was 74.1 (20-100). Conclusion: Despite transtibial PCL reconstruction being advocated by several authors, it has technical difficulties of the arthroscopic approach to the posterior compartment of the knee. In the open inlay technique, posterior arthrotomy allows accurate placement of the tibial PCL insertion, avoiding the killer curve and more closely duplicating the normal PCL anatomy. Based on our initial experience with this technique at early follow-up, we continue to use the tibial inlay technique as our preferred technique for isolated or combined reconstruction of the PCL.

Objectives: Two different approaches for drilling the femoral tunnel are commonly used in single-bundle anterior cruciate ligament (ACL) reconstruction: creating the femoral tunnel through the tibial tunnel or drilling the tunnel through a low anteromedial portal. The purpose of this retrospective study was to compare the radiological and clinical outcomes of hamstring ACL reconstruction using the transtibial (TT) versus the anteromedial portal (AM) technique for drilling the femoral tunnel by two different surgeons in non-professional athletes. Methods: Using the elevator system with hamstring tendons, single-bundle ACL reconstruction was applied to 24 patients with the TT technique and to 15 patients with the AM technique. Radiological outcome was evaluated by the postoperative X-rays and MRI images at the 6-9 month and clinical outcomes by the modified Cincinnati Knee Score. The angle made by the tunnel with the anatomic axis of the femur (FTA) and the angle made by the tunnel with the anatomic axis of the tibia (TTA) were examined on direct radiographs and the angular difference between the tunnels was evaluated. On MRI, evaluation was made of the anterior length in the sagittal plane of the exit point of the tibial tunnel in the joint (TAS) in ratio to the whole plateau (TSR) and the posterior length in the sagittal plane of the entrance point of the femoral tunnel in the femoral lateral condyle (FPS) in ratio to the anterior posterior diameter of the whole condyle (FCR) and the height of the lateral condyle location in the sagittal plane (FH). Results: The FH height ratio of the TT group was statistically significant when compared to the AM group (p0.05). The mean femoral tunnel angle of the AM group was statistically significant compared to that of the TT group (p0.05). Conclusion: When using a transtibial drilling technique, the location of the femoral tunnel is restricted by the angulation of the tibial tunnel in the coronal plane and may lead to a high placement of the femoral tunnel in a non-anatomical position. The use of the anteromedial portal (AMP) for the femoral drilling provides the surgeon with more freedom to anatomically place the tunnel in the natural femoral ACL footprint, thus improving rotational stability. In this early stage study of individuals not participating in professional sports, although a significant difference was seen in favour of the anatomic group, in the radiological measurements between the anatomic and transtibial groups, no significant difference was determined in respect of clinical results. This can be considered to be due to a low requirement for rotational stability in individuals who do not participate sports.

Highlights • We examine changes in the treatment of scaphoid fractures. • In this case, the patient presented with what was considered to be a rare case of a stress fracture of both scaphoid bones secondary to repetitive dorsiflexed movements. • It was aimed to present an unusual cause of chronic wrist pain due to the bilateral stress fractures of the scaphoid bone., Introduction Bilateral scaphoid stress fractures are uncommon, and rarely presented with chronic wrist pain. Most fractures of the scaphoid heal with immobilization. Presentation of case The case presented here is of a bilateral stress fractures of the carpal scaphoid in a 19-year-old male.The patient had been playing as a goalkeeper and presented with a 4-year history of chronic pain in both wrists. We had a successful result in the treatment of these stress fractures with long- arm thumb plaster cast.Discussion Most fractures of the scaphoid in the immature skeleton heal with immobilization. Approximately 88–95% of acute scaphoid fractures are said to heal with conservative treatment using cast immobilisation. Non-surgical treatment is successful for scaphoid fractures in children and for those fractures which are non-displaced, stable, and where there is no damage to other bones or ligaments. In stable fractures, union is achieved within 8–12 weeks.Conclusion Bilateral stress fractures of the scaphoid can be considered for the wrist pain, especially for the patients that had repetitive minor wrist trauma, and in spite of developments in surgical techniques and materials used, treatment by plaster casting should still be considered initially for non-displaced, stable scaphoid stress fractures.