ÖZ ABSTRACTSpina iliaka anterior superior (SİAS) avülsiyon kırıkları nadir ve acil servis değerlendirmesinde gözden kaçabilecek yaralanmalardır. SİAS, kalça fleksör kaslarından olan tensor fasia lata ve sartorius kaslarının başlangıç bölgesidir. Özellikle adölesanlarda topa vurma esnasında bu kasların kuvvetli kontraksiyonlarıyla avülsiyon kırıkları gözlemlenebilir. Olgumuz, 16 yaşında erkek sporcu, futbol oynarken topa vurma sonrası sol kalçasında ani ağrı başlayan, topallamaya neden olacak ağrı ve hareket kısıtlılığı nedeniyle acil polikliniğe başvurmuş ve fizik muayenede yumuşak doku travması olarak değerlendirilmiştir. Tarafımıza başvuran hastanın poliklinik kontrollerinde çekilen grafilerinde SİAS avülsiyon kırığı tanısı konuldu. Hastaya non-steroidal anti-enflamatuvar ilaç, tam yük vermeden koltuk değnekleriyle mobilizasyon ve soğuk uygulama ile yaklaşık 4 hafta konservatif tedavi uygulandı. Birinci ay kontrolünde tam ve ağrısız eklem hareket açıklığı olduğu ve palpasyonda ağrı olmadığı saptandı. SİAS avülsiyon kırıkları çoğunlukla konservatif olarak tedavi edilse de iyi fizik muayene yapılmadığında yumuşak doku travması ile karışabilmekte ve özellikle deplasman miktarı fazla olan kırıklar klinik sorunlara sebep olabilmektedir.Anahtar Sözcükler: Avülsiyon kırığı, pelvis, apofiz, spina iliaka anterior superior Spina iliaca anterior superior (SIAS) avulsion fracture is a type of injury that is rare and possible to be overlooked in emergency services. SIAS is the insertion area of the Tensor fascia lata and Sartorius muscles, which are two of the hip flexor muscles and forceful contractions of these muscles which can be observed while kicking a ball, can lead avulsion fractures of SIAS, especially among adolescents. In our case, a 16-year-old male athlete attended the emergency service with a movement restriction and severe pain causing limping that started as an instant pain in the left hip after kicking the ball during a soccer game. It was misdiagnosed as soft tissue injury and no radiological imaging was performed. After plain radiography of the hip was performed in control appointment, the patient was diagnosed as having SIAS avulsion fracture, and a complete and pain-free range of motion was achieved after a conservative treatment of nonsteroid anti-inflammatory drugs, three weeks rest along with cold therapy and walking with crutches without full weight bearing. Even though SIAS fractures are generally treated with conservative methods, they can be misdiagnosed as soft tissue injury in case of poor physical examination and especially displaced fractures may cause clinical problems.

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Purpose This study compared the functional and radiological outcomes and complications of single- (SS) and two-stage (TS) bilateral high tibial osteotomy (HTO). Methods From 2014 to 2018, 48 patients underwent bilateral HTO surgery for osteoarthritis. The outcomes of SS in 28 knees and TS in 32 knees were compared using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) as functional outcomes, and the medial proximal tibial (MPTA), hip-knee-ankle (HKA), tibial slope (TSA) angles, and mechanical axis deviation (MAD) as radiological outcomes. We also evaluated the estimated blood loss (EBL). Results No significant differences in the pre- and postoperative mean OKS and KOOS were found between the groups. There was a significant difference between the groups in the last postoperative HKA angle (− 0.9 ± 3.9 and 1.8 ± 4.3°, respectively). In SS and TS, the respective total mean surgical time was 108 ± 28 and 143 ± 36 min (p < 0.001). The mean calculated EBL was 612 ± 267 and 544 ± 357 mL, respectively, (p = 0.5), and the mean length of stay (LOS) was 2.2 ± 0.83 and 3.5 ± 1.0 days, respectively, (p = 0.01). Conclusion SS bilateral HTO is a safe reasonable option for certain patients with bilateral knee osteoarthritis because it involves a single hospitalization, one-time exposure to anesthesia risks, accelerated rehabilitation, earlier return to expected life status, reduced total hospital stay, and a likely decrease in total cost.

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