Mehmet Erdil

Apophyseal avulsion fractures of the anterior inferior iliac spine are rare; they are usually seen in adolescents as a result of sudden contraction of the rectus femoris muscle. Treatment is usually conservative, but surgical management may be necessary in certain circumstances. We present an unusual case of a 14-year-old male who was referred to our department for a suspicious pathological fracture of his right anterior inferior iliac spine; he was found to have an avulsion fracture of the anterior inferior iliac spine due to simple bone cyst. We discuss the treatment of this rare injury caused by a benign osseous tumour.

The aim of the study was to assess the early outcomes of the arthroscopic treatment of femoroacetabular impingement. Forty-two femoroacetabular impingement (FAI) patients (mean age: 35.1 years, range: 16 to 52 years) treated arthroscopically between 2006 and 2011 in our clinic were retrospectively analyzed. Twenty-five patients had Cam, 6 Pincer and 11 combined femoroacetabular impingement. Mean follow-up time was 28.2 (range: 10 to 72) months. Patients were assessed clinically and functionally using the Non-Arthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), Oxford Hip Score, WOMAC score, and Visual Analogue Scale (VAS) pain scores preoperatively and at the final follow-up. In clinical and functional assessments, there were increases of 24.8 points in mean NAHS, 23.3 in mHHS, 20.6 in WOMAC score and 9.6 in Oxford Hip Score. VAS pain score decreased by 4.9 points in comparison to the preoperative scores. There were no major complications. However, transient pudendal nerve neuropraxia was present in two patients, transient lateral femoral cutaneous nerve neuropraxia in one and asymptomatic heterotopic ossification in one patient. Short-term clinical results of the arthroscopic treatment of the FAI appear to be satisfactory.

Plantar fasciitis (PF)is the most common cause of plantar heel pain. Despite many treatment alternatives for heel spur, the association of calcaneal spur size with clinical and functional parameters is inconclusive. The objective of this study to investigate the correlation of calcaneal spur length with clinical findings and functional status documented with Foot Function Index in patients with plantar fasciitis. We performed power analysis for the sample size estimation. 87 patients with PF were scrutinized to reach the estimated patient number 75. Computer-aided linear measurements were done for spur length from tip to base in milimeters. Perceived pain intensity was evaluated by visual analog scale (VAS). Patients were asked to rate the pain experienced on a 10-cm VAS. Foot function index was applied to the patients to evaluate pain, disability and activity limitation of the patients. Of the 75 participants, 24 were males (32%) and 51 were females (68%). The mean age was 47 ± 10 years (range 30-65 years). The mean calcaneal spur length was 3.86 ± 3.36 mm (range between 0 and 12.2). Calcaneal spur length was significantly correlated with age (p = 0.003), BMI (p = 0.029), symptom duration, (p = 0.001) VAS (p = 0.003), and FFI total score (p < 0.001). Our study demonstrated that length of the calcaneal spur is significantly correlated with age, BMI, symptom duration, perceived pain, FFI pain and disability subscores, and FFI total scores. The size of the calcaneal spur is an important parameter correlated with pain and functional scores in PF.

We present a case of shoulder instability following a traffic accident. Allman Type I midshaft clavicle, Ideberg Type II glenoid and DeCloux Type I scapular body fractures were diagnosed following radiologic examination. There were no signs of ligamentous injury. Mechanical instability was noted at the shoulder due to breakage of the supportive bony skeleton. The patient was treated surgically with plate and screw fixation. Surgical fixation allowed early postoperative physiotherapy and rehabilitation. This rare injury and its treatment options are discussed in the light of current literature. floating shoulder, scapula, clavicle, glenoid, mechanical instability.

Freiberg's infraction is an osteochondrosis that is characterized by osteonecrosis of the metatarsal head, with pain and tenderness around the metatarsophalangeal joint. We sought to evaluate the outcome of joint debridement and metatarsal remodeling for the treatment of advanced-stage Freiberg's infraction. Between March 1, 2006, and April 30, 2011, 14 patients (eight females and six males) with symptomatic unilateral Freiberg's disease refractory to conservative treatment (Smillie stages IV and V) underwent joint debridement with metatarsal head remodeling by two surgeons. To evaluate functional outcome, American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey forms were completed by the patients preoperatively and postoperatively at months 3, 6, and 12. Active-assisted range-of-motion exercise was allowed after 4 weeks of short-leg walking cast wear, and weightbearing on the forefoot was allowed as tolerated. Mean patient age was 27.0 years (range, 16-53 years), and mean follow-up was 40.2 months (range, 14-54 months). Mean ± SD American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey scores were 46.8 ± 8.95 and 28.9 ± 4.3 preoperatively and 76.2 ± 9.5 and 45.6 ± 7.7 1 year after surgery, respectively. There was a significant increase in both scores (P ≤ .001). In advanced-stage Freiberg's infraction of the second metatarsal, joint debridement and metatarsal head remodeling is a safe and simple therapeutic option, and it provides better quality of life for patients.

PURPOSE: The purpose of this study was to evaluate the impact of body mass index (BMI) on early functional results of patients who undergo isolated partial meniscectomy. METHODS: The functional results for 1,090 patients who underwent partial meniscectomy, in 2 different orthopaedic clinics, were evaluated retrospectively. The study includes cases with arthroscopic partial meniscectomy for isolated meniscal tears; patients with concomitant knee pathology were excluded. Three hundred forty-one (31%) patients with isolated lateral meniscal tears, 628 (58%) patients with isolated medial meniscal tears, and 121 (11%) patients with both medial and lateral meniscal tears underwent arthroscopic partial meniscectomy. We divided these patients into 3 subgroups on the basis of their BMI; <26, between 26 and 30, ≥30. Preoperative functional results were compared with 1-year postoperative follow-up results using the International Knee Documentation Committee (IKDC),(26) Lysholm Knee Scale,(27) and Oxford Scoring System(28) scores. RESULTS: According to all 3 knee scales, age, side of lesion, and tear type had no effect on functional outcome. When compared with the group with BMI <26, the patients with BMI between 26 and 30 and the patients with BMI ≥30 had significantly worse outcomes as measured by the IKDC, Oxford Scoring System, and Lysholm Knee Scale scores. Patients with BMI between 26 and 30 and ≥30 did not have significantly different functional outcomes. CONCLUSIONS: Short-term outcomes after arthroscopic partial menisectomy reflect significant improvement in subjective outcome. However, patients with moderate or significant obesity (BMI >26) have inferior short-term outcomes compared with nonobese patients. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Acute mechanical symptoms due to excess retained cement in the posterior compartment of the knee joint following unicondylar knee arthroplasty (UKA) are uncommon. Infection, aseptic loosening, polyethylene wear and progressive arthritis are well-documented complications of UKA procedure. We present a patient with acute pain and 'clicking' sensation in the knee joint due to cement extrusion in the posteromedial compartment after UKA. Full functional recovery was achieved after arthroscopic removal of the cement debris. Of retrospectively screened 43 UKA cases, asymptomatic cement extrusion was detected in 8 patients in the posteromedial compartment on direct X-rays. Careful inspection of components is essential to minimize the risk of cement extrusion into the posterior compartment and perioperative fluoroscopy may be helpful during UKA procedure.