ABS TRACT Insufficiency fractures occur when normal stress is applied to bone with low mineralization and elastic resistance. Postmenopausal osteoporosis, pregnancy, postpartum period, and sports activities can result in insufficiency fractures. Clinical suspicion is important in sacral insufficiency fractures. Computed tomography, scintigraphy, and magnetic resonance imaging are used in undiagnosed cases. Bed rest, analgesics, anti-inflammatory drugs, and physical therapy modalities can be used for pain control. Sacral insufficiency fracture should be kept in mind in elderly osteoporotic patients with low back and/or hip pain unresponsive to treatment. In this case report, we will present a 77-year-old patient with overlooked sacral insufficiency fracture. The patient, who had persistent low back and hip pain for three months, was misdiagnosed as sacroiliitis.

BackgroundPes anserine bursitis is a syndrome causing pain at the medial knee and the proximal medial tibia [1]. Sartorius, gracilis, and semitendinous tendons attach 5 cm distal to the medial knee joint line taking a shape is called pes anserinus. It is more common obese females with knee osteoarthritis between 50-80 years of age [1]. Rarely, tibial bone spurs present as rose thorns and cause pes anserinus bursitis and knee pain [2].ObjectivesIn this case report, we presented proximal tibial exostosis which randomly detected and resulting to pes anserinus syndrome in three patients.MethodsCase 1 (NB): A 58-years-old female patient was admitted to our outpatient clinic with right knee pain. She had pain for 2 months, increasing with standing and walking. In the physical examination, she did not describe any trauma, the area where the pes anserinus tendons attached to medial proximal tibia was painful. There was no swelling and redness on the skin. A bone spur from the proximal tibial metaphysis was seen in the right knee on direct radiography (Figure 1).Case 2 (BE): A female who 22 years-old, was admitted to our outpatient clinic with left knee pain, which was for 5 months. The skin appearance above the knee was normal. There was no swelling. Medial left proximal tibia was tender with palpation. Physical examination was normal. The blood tests of the patient were completely normal. A spur like as a rose thorn forming from the proximal tibial region was observed in the left knee, similar to the first case, on the direct radiography (Figure 2).Case 3 (GB): A 64-year-old female patient was admitted to our outpatient clinic with pain in the medial left knee. Her complaint was present for 6 months. There was no history of trauma. Knee joint range of motion was normal. There was no effusion in knees. Mc-Murray test was negative. There was a minimal sweelling and tenderness on pes anserine region. A bone exostosis was observed in the left medial tibia on the direct radiography requested from the patient.ResultsThe Case 1 was told to rest for two weeks and not to walk much. Non-steroidal anti-inflammatory drug therapy and 10 minutes cold application to the knee per 6 hours were recommended. At the follow-up one month later, the visual analog scale (VAS) score was regressed from 7 to 2. Non-steroidal anti-inflammatory drug was started to Case 2 and activity restriction was recommended. At the follow-up two weeks later, VAS score decreased from 6 to 4. 1 ml of methylprednisolone was injected locally to the pes anserinus region of Case 3. One month later, the patient’s VAS score decreased from 7 to 1.ConclusionRarely, pes anserine bursitis may be accompanied by medial tibial exostosis. The clinicians must be keep in mind proximal tibial spurs in patients presenting with knee pain and pes anserinus bursitis.References[1]Mohseni M, Mabrouk A, Graham C. Pes Anserine Bursitis. 2022 Nov 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan- 2022 Nov 23.[2]Tiwari V, Kumar VS, R Poudel R, Kumar A, Khan SA. Pes Anserinus Bursitis due to Tibial Spurs in Children. Cureus 2017;9(7):e1427. doi: 10.7759/cureus.1427.Figure 1.Figure 2.AcknowledgementsNone.Disclosure of InterestsNone Declared.

Objectives: This study aims to investigate the validity, reliability and clinimetric features of the Duruöz Hand Index (DHI) in patients with lateral epicondylitis. Patients and methods: Between October 2019 and January 2020, a total of 78 patients (28 males, 50 females; mean age: 46.4±9.4 years; range, 20 to 65 years) who presented with pain in the forearm and were diagnosed with lateral epicondylitis were included in the study. The patients were evaluated using the Visual Analog Scale (VAS), Health Assessment Questionnaire (HAQ), the Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEEQ), the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire at Weeks 0, 1 and 4. The DHI reliability (Cronbach alpha, intraclass correlation [ICC]), validity and factor analyses were performed with the data of 70 and 49 patients who attended to follow-up visit at Weeks 1 and 4. The effect size (ES), standard response mean (SRM), and minimum detectable change (MDC) values of the DHI were calculated. Results: Of the patients, 84.6% were right-handed. The ICC coefficients of DHI were found to be perfect with the test-retest method (ICC; total=0.943). It showed a well-excellent consistency with the internal consistency method (Cronbach alpha; total=0.90). In the structural validity of the DHI, it was very strongly correlated with the DASH (r=0.801; p<0.01), strongly correlated with the PRTEEQ and HAQ total scores (r=0.793; p<0.01; r=0.785; p<0.01), and acceptably correlated with PRTEEQ pain score (r=0.570; p<0.01). The DHI was acceptably correlated with the VAS and grip strength as measured by the hand dynamometer (p<0.05). In our study, three main factors were obtained and MDC and responsiveness sensitivity were found to be moderate (MDC=4.4; SEM=1.61; ES=0.246 p<0.001; SRM=0.538 p<0.001). Conclusion: Duruöz Hand Index is a reliable, valid, and practical functional assessment scale in patients with lateral epicondylitis.