Effect of Weather Conditions on the Pediatric Supracondylar Humerus Fracture Incidence.

BACKGROUND: Some environmental factors pose as risk factors for children's supracondylar humerus fractures. This study aimed to evaluate the relationship between weather conditions and pediatric supracondylar humerus fracture incidence. METHODS: A total of 310 patients aged <16 years, admitted to our hospital with supracondylar humerus fractures, were evaluated. We evaluated patients' age, and also, season, day, and weather conditions. The Turkish State Meteorological Service database was used for meteorological data and data was analysed statistically. RESULTS: Most cases occurred in the spring (28.1%, n=87) and summer (27.1%, n=84). Cases of older children (aged six years and older) with supracondylar humerus fractures were recorded in the summer season, while fracture cases in preschool-aged (younger than six years old) children were seen in the winter season. CONCLUSION: We found that the overall incidence of pediatric supracondylar humerus fractures increased in spring and summer seasons. In addition, the fracture incidence in preschool- and school-aged children differed according to the season and temperature. Hence, the management of these fractures could also include the significance of weather conditions, making preventive measures more critical in the spring and summer seasons.

Effects of social stress and fluoxetine treatment on fracture healing in a rat femur fracture model.

BACKGROUND: Mental stress and depressive disorders have negative effect on bone biology and increase fracture risk. Fluoxetine is a widely used selective serotonin reuptake inhibitor in the treatment of these disorders. We aimed to evaluate the effects of social stress and fluoxetine treatment on fracture healing. METHODS: This study was performed with 32 male Sprague-Dawley® rats. Rats were randomly divided into four groups with eight rats in each group. Social stress regimen was performed in groups 3 and 4 for 15 days. Placebo for groups 1 and 3 and fluoxetine for groups 2 and 4 was administrated. Rat femur open (osteotomy) fracture model was performed. Placebo and fluoxetine were continued to be given to the same groups for four weeks until sacrification of animals. Sacrificed right femurs of subjects were evaluated histologically and radiologically. The obtained data were statistically analyzed using the SPSS 23 (Statistical Package for the Social Sciences) program. RESULTS: Fracture healing score that evaluates the fracture healing quantitatively based on histological scale and bone mineral density of group 3 were significantly lower than other groups, and there was no significant difference between other groups. Inflammation score of group 2 was significantly lower than group 3. Group 1 had higher new callus formation/original cortex volume than group 2 and group 3. In immunohistochemical evaluation, the H-score of BMP-7/osteoblast in group 3 was lower than in group 1. The H-score of CD34 in group 3 was lower than in group 1. DISCUSSION: The positive and negative effects of fluoxetine, which is used in the treatment of depressive disorders, on wound, tendon, or bone healing have been shown in the literature. In this study, we showed the negative effects of depression on the early stages of fracture healing. Although fluoxetine had no detrimental effect on fracture healing in non-depressive rats, impaired fracture healing was reversed and better radiological and histological findings were obtained in depressive rats treated with fluoxetine. Our findings indicate that fluoxetine, which minimizes the negative effects of social stress on bone healing, can be used safely in the treatment of depressive disorders in patients with fractures.

Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model.

BACKGROUND AND PURPOSE: Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. METHODS: Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. RESULTS: SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. CONCLUSION: B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.

A new method for the assessment of reduction tension during open reduction in patients with developmental dysplasia of the hip.

OBJECTIVES: This study aims to describe our standardized method for evaluating the tension of reduction around the hip joint during open reduction in patients with developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: We retrospectively evaluated 67 pediatric patients (8 males, 59 females; mean age 21.9±11.1 months; range, 9 to 67 months) who were performed open reduction or open reduction with concomitant pelvic and/or femoral osteotomy for DDH at our clinic between January 2009 and March 2014. The amount of distraction between femoral head and acetabulum was measured to evaluate the tension of reduction during surgery. Factors associated with avascular necrosis (AVN) such as age at reduction, presence of concomitant pelvic and/or femoral shortening osteotomy, and severity of dislocation were determined. RESULTS: Statistically significant association was found between the presence of femoral osteotomy, severity of dislocation, and amount of distraction and AVN. The incidence of AVN was 38.8% (10 grade I, 12 grade II, 3 grade III, and one grade IV AVN). Cut-off value for the amount of distraction to prevent the development of AVN was calculated as 4 mm. CONCLUSION: According to our study findings, we advise using our technique for the evaluation of the tension of reduction around the hip joint and performing tension free reduction in the treatment of DDH to minimize the risk of AVN development.

EFFECTS OF HIGH-DOSE VITAMIN C AND HYALURONIC ACID ON TENDON HEALING.

OBJECTIVE: To assess the histopathologic and biomechanical effects of hyaluronic acid (HA) and high-dose vitamin C (VC) on rat Achilles tendon healing. METHODS: Forty-eight Sprague-Dawley rats were randomized to HA and VC and control groups with equal numbers. Each group was further divided into two subgroups to be sacrificed on Day 15 (n=8) and Day 30 (n=8). The Achilles tendons were cut and repaired. While the control rats remained untreated, HA and VC were administered after repair. The repaired tendons were removed for biomechanical and histopathologic analyses. In the biomechanical tests, the tendons were stretched to failure and maximum forces were measured. For histopathologic examination, the specimens were interpreted semiquantitatively using Movin's grading scale and Bonar scores. RESULTS: The highest mean forces were obtained in the HA group on Day 15 and in the VC group on Day 30, with a significant difference between HA and VC on Day 15 between control and VC on Day 30 (p<0.05). Histological examination showed both Movin and Bonar scores decreased in all groups on Day 30, with significant improvements in the HA and VC groups (p<0.05). CONCLUSION: Our results demonstrated that both VC and HA had therapeutic effects on tendon healing, especially in the late phase. Level of Evidence I; High quality randomized trial with statistically significant difference.

OBJETIVO: Avaliar os efeitos histopatológicos e biomecânicos do ácido hialurônico (AH) e altas doses de vitamina C (VC) na cicatrização do tendão do calcâneo em ratos. MÉTODOS: Quarenta e oito ratos Sprague-Dawley foram randomizados em grupo AH, grupo VC e grupo controle, iguais em número. Cada grupo foi dividido em dois subgrupos a serem sacrificados no Dia 15 (n = 8) e no Dia 30 (n = 8). Os tendões do calcâneo foram cortados e reparados. Enquanto os ratos do grupo controle permaneceram não tratados, os do grupo AH/VC receberam AH e VC após o reparo. Os tendões reparados foram removidos para análises biomecânicas e histopatológicas. Nos testes biomecânicos, os tendões foram estirados até a falha e as forças máximas foram medidas. No exame histopatológico, as amostras foram interpretadas semiquantitativamente usando os escores de Movin e de Bonar. RESULTADOS: As forças médias mais altas foram obtidas no grupo AH no Dia 15 e no grupo VC, no Dia 30, com diferença significativa entre os grupos HA e VC no Dia 15 e entre os grupos controle e VC (p < 0,05). No exame histológico, os escores de Movin e Bonar diminuíram em todos os grupos no dia 30, com melhora significativas nos grupos AH e VC (p < 0,05). CONCLUSÕES: Nossos resultados demonstraram que tanto a VC quanto o AH tiveram efeitos terapêuticos sobre cicatrização do tendão, especialmente na fase tardia. Nível de Evidência I; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significante.

Comparison of four parameters to assess acetabular dysplasia and acetabular dysplasia rates in primary hip osteoarthritis patients: A study in Turkish population.

INTRODUCTION: Hip osteoarthritis is an important orthopedic problem frequently observed in the elderly. Acetabular dysplasia (AD) is one of the pathologies that cause coxarthrosis. Nearly 20-45% of primary or idiopathic hip osteoarthritis is linked to AD. In our country, there are few studies on this topic. We measured the center-edge (CE) angle, Sharp's angle, acetabular depth, and femoral head coverage ratio on pelvis anteroposterior radiographs of patients with primary coxarthrosis and calculated the dysplasia rates. PATIENTS AND METHOD: Age at surgery and sex of the patients; and CE angle, Sharp's angle, acetabular depth, and femoral head coverage ratio for both operated and opposite hips were evaluated in 223 total hip prosthesis-performed patients with coxarthrosis. Also the distribution of mean age at surgery, sex of patients, dysplasia rates of operated hips, and bilateral dysplasia rates were calculated. RESULTS: The right to left ratio of operated hips was 104/119. Female to male ratio was 163/60 (2.7/1), for those with CE angle below 20° it was 123/30 (4.1/1), and it was 40/30 (1.3/1) with CE angle above 20°. Mean age of patients at surgery was 56.9 (±11.4) years. CE angle less than 20° was found in 68.6% of patients, acetabulum depth less than 9 mm was found in 75.3%, Sharp's angle was more than 45° in 65.9%, and femoral head coverage ratio was less than 70% in 70.3% of patients. CONCLUSIONS: We identified a high rate of AD in primary coxarthrosis patients undergoing total hip arthroplasty in the study population.

Effects of high-dose vitamin c and hyaluronic acid on tendon healing / Efeitos de altas doses de vitamina c e ácido hialurônico sobre a cicatrização do tendão

ABSTRACT Objective: To assess the histopathologic and biomechanical effects of hyaluronic acid (HA) and high-dose vitamin C (VC) on rat Achilles tendon healing. Methods: Forty-eight Sprague-Dawley rats were randomized to HA and VC and control groups with equal numbers. Each group was further divided into two subgroups to be sacrificed on Day 15 (n=8) and Day 30 (n=8). The Achilles tendons were cut and repaired. While the control rats remained untreated, HA and VC were administered after repair. The repaired tendons were removed for biomechanical and histopathologic analyses. In the biomechanical tests, the tendons were stretched to failure and maximum forces were measured. For histopathologic examination, the specimens were interpreted semiquantitatively using Movin's grading scale and Bonar scores. Results: The highest mean forces were obtained in the HA group on Day 15 and in the VC group on Day 30, with a significant difference between HA and VC on Day 15 between control and VC on Day 30 (p<0.05). Histological examination showed both Movin and Bonar scores decreased in all groups on Day 30, with significant improvements in the HA and VC groups (p<0.05). Conclusion: Our results demonstrated that both VC and HA had therapeutic effects on tendon healing, especially in the late phase. Level of Evidence I; High quality randomized trial with statistically significant difference.

RESUMO Objetivo: Avaliar os efeitos histopatológicos e biomecânicos do ácido hialurônico (AH) e altas doses de vitamina C (VC) na cicatrização do tendão do calcâneo em ratos. Métodos: Quarenta e oito ratos Sprague-Dawley foram randomizados em grupo AH, grupo VC e grupo controle, iguais em número. Cada grupo foi dividido em dois subgrupos a serem sacrificados no Dia 15 (n = 8) e no Dia 30 (n = 8). Os tendões do calcâneo foram cortados e reparados. Enquanto os ratos do grupo controle permaneceram não tratados, os do grupo AH/VC receberam AH e VC após o reparo. Os tendões reparados foram removidos para análises biomecânicas e histopatológicas. Nos testes biomecânicos, os tendões foram estirados até a falha e as forças máximas foram medidas. No exame histopatológico, as amostras foram interpretadas semiquantitativamente usando os escores de Movin e de Bonar. Resultados: As forças médias mais altas foram obtidas no grupo AH no Dia 15 e no grupo VC, no Dia 30, com diferença significativa entre os grupos HA e VC no Dia 15 e entre os grupos controle e VC (p < 0,05). No exame histológico, os escores de Movin e Bonar diminuíram em todos os grupos no dia 30, com melhora significativas nos grupos AH e VC (p < 0,05). Conclusões: Nossos resultados demonstraram que tanto a VC quanto o AH tiveram efeitos terapêuticos sobre cicatrização do tendão, especialmente na fase tardia. Nível de Evidência I; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significante.

Effects of low molecular weight heparin and rivaroxaban on rat Achilles tendon healing.

OBJECTIVES: This study aims to compare the histopathological and biomechanical effects of low molecular weight heparin (LMWH) and rivaroxaban, which are frequently used in orthopedic surgery for thromboembolic prophylaxis, on rat Achilles tendon healing. MATERIALS AND METHODS: In the study, 36 adult, male Sprague Dawley rats weighing between 300 g and 400 g were used. Three groups were formed including 12 rats in each. Achilles tendons of all rats were cut and repaired. Nadroparin calcium was administered subcutaneously for 21 days at a dose of 170 IU AXa to the first group (LMWH group). Rivaroxaban was administered daily at a dose of 3 mg/kg for 21 days as gastric lavage to the second group (rivaroxaban group). The third group was identified as the control group and no medication was administered in this group. At the end of three weeks, tendons extracted from the groups were examined histopathologically and biomechanically. RESULTS: Bonar's and Movin's scores obtained as a result of histopathological examination were statistically significantly higher in the control group (p=0.003 and p=0.004, respectively) (high scores indicate that tendon healing is not sufficient). When type I and type III collagen ratios were examined, type I collagen ratio, which should be found at a higher ratio in mature tendon, was statistically significantly higher in rivaroxaban and LMWH groups compared with the control group (p=0.002). As a result of biomechanical examination, higher mean maximum force values were obtained from the rivaroxaban group compared with the LMWH group (p=0.31). Mean maximum force values obtained from the control group were higher than those obtained from the LMWH group (p=0.03) and the rivaroxaban group (p=0.18). CONCLUSION: Histopathological examination revealed that both LMWH and rivaroxaban have positive effects on tendon healing. However, the same positive effects were not detected in biomechanical examination.

Volar dislocation of the metacarpophalangeal joint of the thumb: A case report.

We present an 18 year-old patient with a volar dislocation of the metacarpophalangeal joint of the thumb. Open reduction was performed through a dorsal incision. Because of the soft tissue interposition such as dorsal capsule, volar plate, dislocated extensor pollicis longus and brevis tendons, ruptured ulnar collateral ligament; open reduction, soft tissue and ligament repair are recommended for this type of thumb dislocations.

Is intramedullary nailing applicable for distal tibial fractures with ankle joint extension?

OBJECTIVES: This study aims to evaluate the functional and radiographic results and treatment complications of AO/OTA (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association) type 43C1 and C2 fractures treated with intramedullary nailing. PATIENTS AND METHODS: We retrospectively evaluated 35 AO/OTA type 43C1 and C2 patients (26 males, 9 females; mean age 39.8±16.9 years; range 19 to 82 years) treated with intramedullary nailing. Two interfragmentary screws out of nail were applied in 10 patients (29%), while one interfragmentary screw out of nail was applied in 17 patients (49%). Intramedullary nailing was applied in eight patients (23%) without external screws. Fracture union, union time, alignment problems, and complications were evaluated. Clinical evaluation of patients was conducted using the Olerud and Molander score and by measuring the ankle joint range of motion. RESULT: Union was achieved in all 35 patients. Mean union time was 16.5±2.8 weeks (range 12 to 24 weeks) and mean Olerud and Molander score was 88±8.24. Varus deformity was detected in one patient, valgus deformity was detected in two patients, and rotation deformity was detected in one patient. Superficial infection was detected in three patients (9%). Deep infection was not detected in any patient. CONCLUSION: Intramedullary nailing is not contraindicated for simple intra-articular distal tibial fractures. In these fractures, intramedullary nailing performed in accordance with its technique, with an additional percutaneous screw if necessary, is a successful treatment option with high fracture union rates, high functional results, and low complication rates.

Open Galeazzi fracture with ipsilateral elbow dislocation.

Combination of the Galeazzi fracture and dislocation of the elbow joint in same extremity is very rare. In this article, we report a 26-year-old male patient with a posterolateral dislocation of the elbow and ipsilateral volar type Galeazzi fracture. We performed closed reduction for the elbow dislocation during admission to the emergency department. Patient was taken to the operating room in the sixth hour of his application to emergency department and open wound on the ulnovolar region of the wrist was closed primarily after irrigation and debridement. We performed open reduction and internal fixation of the radial fracture with a dynamic compression plate. After fixation, we evaluated the stability of the elbow joint and distal radioulnar joint. Distal radioulnar joint was unstable under fluoroscopic examination and fixed with one 1.8 mm Kirschner wire in a pronated position. Then, elbow joint was stable. One year after surgery, patient had no pain or sings of instability. At the last follow-up, range of motion of the elbow was 10°-135° and forearm pronation and supination were 70°.

Comparison of the early period effects of bone marrow-derived mesenchymal stem cells and platelet-rich plasma on the Achilles tendon ruptures in rats.

INTRODUCTION: This study aims to histopathologically, biomechanically, and immunohistochemically compare the fourth-week efficiencies of local platelet-rich plasma (PRP) and bone marrow-derived mesenchymal stem cell (rBM-MSC) treatments of the Achilles tendon ruptures created surgically in rats. MATERIALS AND METHODS: The study included 35 12-month-old male Sprague Dawley rats, with an average weight of 400-500 g. Five rats were used as donors for MSC and PRP, and 30 rats were separated into MSC, PRP, and control groups (n = 10). The Achilles tendons of the rats were cut transversely, the MSC from bone marrow was administered to the MSC group, the PRP group received PRP, and the control group received physiological saline to create the same surgical effect. In previous studies, it was shown that this physiological saline does not have any effect on tendon recovery. Thirty days after the treatment, the rats were sacrificed and their Achilles tendons were examined histopathologically, immunohistochemically, and biomechanically. RESULTS: The use of rBM-MSC and PRP in the Achilles tendon ruptures when the tendon is in its weakest phase positively affected the recovery of the tendon in histopathologic, immunohistochemical, and biomechanical manners compared to the control group (p < 0.05). While the levels of pro-inflammatory cytokines TNF-α, IFNγ, and IL 1ß were significantly low, the levels of anti-inflammatory cytokines and growth factors playing key roles in tendon recovery, such as IL2, VEGF, transforming growth factor-beta, and HGF, were significantly higher in the MSC group than those of the PRP and control groups (p < 0.05). In the MSC group, the [Formula: see text] (mm) value was significantly higher (p ˂ 0.05) than that in the PRP and control groups. CONCLUSION: rBM-MSC and PRP promote the recovery of the tendon and increase its structural strength. The use of PRP and MSC provides hope for the treatment of the Achilles tendon ruptures that limit human beings' functionalities and quality of life, particularly for athletes. It is thought that the use of MSC can be more effective for tendon healing; hence, more extensive and advanced studies are needed on this topic.

Glomus tumor located in deltoid muscle.

Glomus tumors are benign soft tissue neoplasms arising from the glomus body, which are primarily found under the nail bed of the fingers. They are rarely located in other parts of the body. Only 8 cases of glomus tumors around the shoulder have been published in the literature. The purpose of this study was to present a glomus tumor located in the deltoid muscle in a 68-year-old male patient that was surgically treated by marginal excision. The patient remained asymptomatic, and no recurrence was detected at 2-year follow up.

Migration of a toothpick along the flexor tendon sheath in a lower extremity.

The most common foreign bodies seen in the foot are sewing needles, toothpicks, glass, and materials such as sand or silica. Foreign bodies in the foot are usually embedded, and surgical exploration and removal is usually necessary. Penetrating foreign bodies in the foot-particularly of organic origin, like wood-can cause cellulitis, osteomyelitis, abscess formation, and pseudotumor formation. Identification of foreign bodies in the foot can be challenging because they are often not radiopaque. However, foreign bodies in the foot do not migrate, in contrast to upper extremities, where foreign bodies are known to migrate. We report a case of a toothpick penetrating a child's foot and moving proximally along the tendon sheath.

Effect of platelet-rich plasma for treatment of Achilles tendons in free-moving rats after surgical incision and treatment.

OBJECTIVE: The purpose of this study is to investigate, both histopathologically and biomechanically, the effect of platelet-rich plasma (PRP) on surgically repaired Achilles tendon rupture recovery in rats. METHODS: The study included 25 17-month-old male Sprague-Dawley rats with an average weight of 500-550 g. Five rats were used as donors, while 20 rats were separated as PRP group (n=10) and control group (n=10). The Achilles tendons of the rats were cut transversely, and PRP was administered to the PRP group, while the control group received serum physiologically to create the same surgical effect. In previous studies, it was shown that this serum does not affect tendon recovery. Fifteen and 30 days post-treatment, the rats were sacrificed, and their Achilles tendons were extracted and examined histopathologically and biomechanically. RESULTS: Based on the obtained findings, it was observed that the histopathologic Movin and Bonar scores of PRP group on the 15th and 30th day post-treatment were significantly lower than those of the control group (p=0.019, p=0.017, respectively), while no significant difference was found in maximum force (Fmax) values in biomechanical measures on the 15th and 30th day post-treatment. CONCLUSION: It is thought that PRP use in Achilles tendon ruptures positively affects histopathological recovery in the early period, but that it does not produce the same biomechanical effect. We believe that PRP use for qualified tendon recovery is histopathologically beneficial.

Effects of hyaluronic acid (Hyalonect) on callus formation in rabbits.

OBJECTIVE: Bone fragment and graft stabilization are important during reconstructive surgery of cases with comminuted fractures and bone defects. We examined the effect of Hyalonect surgical mesh on the healing dynamics of metaphyseal bone defects created in rabbit tibiae. METHODS: Approximately 5-mm defects were created on the anterior aspect of the proximal tibial metaphysis of 80 male rabbits. The rabbits were randomly assigned to four groups: Group I, bone defects left alone (control group); Group II, bone defect covered with Hyalonect; Group III, bone defect filled with allograft; and Group IV, bone defect filled with allograft and covered with Hyalonect. RESULTS: No significant histological differences were noted between Groups II and III or Groups III and IV at 3 and 6 weeks. At 3 weeks, Groups II, III, and IV had significantly better healing than Group I (p<0.05). In addition, Group IV showed significantly better healing than Group II at 3 and 6 weeks. At 6 weeks, only Group IV showed better healing than Group I (p<0.05). Radiologically, Groups II, III, and IV showed better healing than Group I at 3 and 6 weeks (p<0.05). CONCLUSION: Hyalonect application and bone grafting significantly accelerated the healing process when used alone or together. Hyalonect application along with bone grafting resulted in better early radiological healing than bone grafting alone.

[Acute myeloid leukemia diagnosed with soft tissue mass in the right thigh]. / Sag uylukta yumusak doku kitlesi ile tani konulan akut miyeloid lösemi.

Myeloid sarcoma is a very rare solid tumor which frequently accompanies myeloproliferative disorders and consists of immature myeloid cells. A 47-year-old male patient admitted to our clinic with complaints of swelling and pain in the right thigh. After diagnosis of myeloid sarcoma was made with tru-cut biopsy, acute myeloid leukemia was diagnosed by hematology clinic as a result of peripheral smear and bone marrow biopsy. No surgical intervention was performed. Patient was treated with chemotherapy for acute myeloid leukemia, and allogeneic bone marrow transplantation. In the follow-up period, patient was asymptomatic at 14 months and magnetic resonance imaging showed almost complete regression of the tumor.

A rare cartilaginous tumor in the phalangeal bone: enchondroma protuberans.

Enchondroma protuberans is a very rare benign cartilage tumor. Unlike intramedullary enchondromas; they originate from medulla and expands exophytically outside the cortex. We presenet a 19-year-old male patient with an enchondroma protuberans treated surgically, with excision and intramedullary curettage. The patient was asymptomatic and no recurrence was recorded in the 1 year follow-up.

Bilateral asymmetric traumatic hip dislocation with bilateral acetabular fracture: case report.

Bilateral traumatic hip dislocation is a very rare condition. Simultaneous anterior and posterior traumatic dislocation of both hips is even more unusual. A case report of a bilateral asymmetrical hip joint dislocation with bilateral acetabular fracture in a 28-year-old man is presented.