No abstract

ÖZAmaç: Bu yazıda, sıra dışı yerleşimli osteokondromlu yedi olgunun klinik, radyolojik ve takip sonuçları bildirildi ve bu sıra dışı yerleşimli osteokondromların nadir ve sıra dışı özelliklerinin önemi vurgulandı. Şubat 2009 -Mart 2014 tarihleri arasında kliniğimizde (Antalya Memorial Hastanesi) tedavi edilen sıra dışı yerleşimli yedi osteokondromlu hasta bildirildi. Hastalar yerleşim yerlerine, bulgularına ve nörovasküler tutulum veya organ basısı varlığına göre sınıflandırıldı. Sonuçlar, mevcut literatür verileri eşliğinde tartışıldı. Hastalarımızın beşinde sıra dışı semptomatoloji vardı. Yedi hastanın altısına cerrahi eksizyon yapıldı. Bir hasta yalnızca planlı poliklinik viziti ile takip edildi. Klinik sonuçlarımız iyi ila mükemmeldi. Olgu serimizde, klavikula tutulumlu bir hastada omuz mekaniğinin bozulmasına bağlı omuz ağrısı; pubik tutulumlu bir diğerinde tıkalı idrar yolu bulguları ve dizüri vardı. Skapula tutulumlu bir hastada yalancı kanat skapula semptomları; fibula başı tutulumlu iki hastanın birinde peroneal sinir sıkışması ve diğerinde tibial sinir sıkışması semptomları vardı. İskiyal ramus tutulumlu bir hastada siyatalji; kaburga tutulumlu bir diğerinde ise herhangi bir semptom olmaksızın osteokondroma bağlı subklavyen arter basısının radyolojik bulguları vardı. Deneyimlerimize göre, fetal dönemde genellikle intramembranöz tipi kemikleşme yoluyla oluşan yassı kemikler (skapula, iliyum, pubik ramus, iskiyum ramus, kaburgalar ve klavikula dahil olmak üzere) nadiren çok daha az etkilenir ve sıklıkla sıra dışı semptomlar ile birlikte seyreder. Fibula başı kaynaklı osteokondromlar, ortopedi cerrahlarına masum görünebilir. Ancak, ortopedi cerrahları bu hasta grubunda tibiofibular sinositoz ve sinir basısına karşı uyanık olmalıdır.Anahtar sözcükler: Kemik doku; kıkırdak; eksizyon; neoplazma; osteokondrom. ABSTRACTHerein, we report clinical, radiological, and follow-up results of seven cases of extraordinary located osteochondromas and highlight the importance of rare and unusual properties of unusual locations of osteochondromas. Seven patients with extraordinary located osteochondromas were treated in our institution (Antalya Memorial Hospital) between the period of February 2009 and March 2014 were reported. The patients were classified according to the localization, symptomatology, and the presence of neurovascular involvement or organ compression. The results were discussed with the existing literature data. Five of our patients had unusual symptomatology. Surgical excision was performed on six of seven patients. One patient was followed with scheduled outpatient visits alone. Our clinical followup results were good to excellent. In our case series, one patient with clavicular involvement had impaired shoulder mechanic which resulted in painful shoulder, while another with pubic ramus involvement had obstructive urination symptoms and dysuria. One patient with scapular involvement had snapping scapula symptoms, while two patients with fibular head involvement had peroneal nerve compression and tibial...

BackgroundAssociated joint disorders with popliteal cysts were stated approximately between the ranges of 41–83 % in all reported cases. Combined treatment strategies that eliminate intra-articular pathologies and cyst- associated valve mechanisms are thought to be a good option in treatment of the disease. In this study, our main objective is to present clinical results of our combined treatment results, which includes posterior cyst excision with supine arthroscopic intervention, targeting intra-articular pathologies on recalcitrant cases.MethodsOne hundred three knees of 100 patients treated with posterior open cystectomy with valve and repair of posterior capsule, in addition to arthroscopic treatment of intra-articular lesions, were included in the study. Preoperative magnetic resonance imaging (MRI) studies were performed in order to evaluate location of Baker cysts behind the knee. Rauschning-Lindgren and Lysholm Knee Scoring Scales were used to assess pre/post-operative knee functions.Mann-Whitney U test was used to evaluate the differences between genders in comparison of Lysholm and Lindgren scores. Mean age within gender groups was compared using independent samples t-test. Wilcoxon test was used to compare the change in Lysholm and Lindgren scores. A p-value of less than 0.05 was considered to show a statistically significant result.Over the 1-year follow-up period, US and MR imaging was performed only with symptomatic patients.ResultsCyst recurrence was seen only in 2 (1.94 %) patients. Post-operative Lysholm Knee and Lindgren knee scores demonstrated improvement in knee function and general comfort level of the patients.ConclusionsOur midterm follow-up (Mean: 39 Months) results showed that open cyst excision with valve and capsule repair with knee arthroscopy that targets associated intra-articular pathologies reduced the pain and improved the knee function in those patients.Level of evidenceIV (Retrospective clinical study without comparison group).

Inferior shoulder dislocation also referred to as luxatio erecta is an unusual and rare type of shoulder dislocation. Its incidence is about 0.5% among all shoulder dislocations. After an exhaustive search of all the available literature we were unable to find a swimming accident case that did not have other associated injuries and an uneventful reduction. The mechanism of the injury was mostly related to direct axial loading and indirect hyperabduction lever arm. We would like to emphasize the importance of this being a swimming accident, a type of accident that requires awareness of the possibility of dangerous asphyxia injuries caused by panic in the water (swimming pool, river, lake, sea, etc.). We described the nature of the injury and review the literature concerning the mechanism of the injury and associated neurovascular impairment at admission time. We also presented a supplemental video to contribute to the education of young residents and orthopedic surgeons.

Our patient was a 76-year-old female who has been operated on 2 times in 8 years for pelvic chondrosarcoma. The patient came to our clinic with a large mass in left iliac region which extended into the paravertebral area. Physical examination and preoperative imagining studies revealed a mass at the left iliac area that infiltrated sciatic notch and extended from posterior iliac region towards the anterior side of iliac bone through the sciatic notch and an incisional hernia including descending colon. The mass was also penetrating the abdominal cavity through the hernia. Surgical intervention was planned. Since the tumor infiltrated the sciatic nerve, hemipelvectomy was indicated. Patient refused hemipelvectomy. Therefore, palliative debulking surgery was considered. We treated the case with marginal excision and abdominal wall reconstruction employing prolene and vicryl suture materials in order to prevent a postoperative visceral herniation and local invasion. At the latest follow-up appointment in 2 years, the patient still had no signs of tumor recurrence. This case showed us that an incisional hernia can serve as a pathway for the recurrence invasion of the chondrosarcoma.