Correlations of proximal junctional kyphosis with radiographic measurements, spinopelvic parameters, and health-related quality of life in Lenke type V adolescent idiopathic scoliosis.

OBJECTIVES: This study aims to investigate the effects of radiographic measurements, spinopelvic parameters, and Scoliosis Research Society-22r (SRS-22r) subscales on proximal junctional kyphosis (PJK) in patients with Lenke type V adolescent idiopathic scoliosis operated with only a posterior all-pedicle-screw instrumentation technique. PATIENTS AND METHODS: Between January 2011 and March 2019, data of 115 patients (17 males, 98 females; mean age: 14.6±2.9 years; range, 10 to 18 years) with Lenke type V AIS who were operated with posterior fusion were retrospectively analyzed. Proximal junctional angle (PJA) was measured as a Cobb angle (CA) between the inferior endplate of the upper instrumented vertebra and the superior endplate of the second suprajacent vertebra. A ≥10° PJA and being ≥10° greater than its preoperative value was defined as PJK. Radiographic measurements, SRS-22r scores, and correlations with the PJA were evaluated for PJK and non-PJK groups. RESULTS: The prevalence of PJK was 35.6%. There were statistically significant differences between the groups in terms of preoperative CA (p=0.002), preoperative thoracic kyphosis angle (TKA) (p<0.001), postoperative TKA (p=0.001), PJA (p<0.001), postoperative pelvic tilt (p=0.038), preoperative pain (p=0.005), preoperative self-image (SI) (p=0.045), preoperative subtotal score (p=0.006), preoperative total score (p=0.007), and sex distribution (p=0.002). No statistically significant differences were detected for other parameters (p>0.050). Positive correlations were found between PJA and preoperative TKA (p=0.042), postoperative TKA (p=0.002), preoperative sagittal balance (SB) (p=0.015), preoperative SI (p=0.012), postoperative SI (p=0.032), postoperative mental health (p=0.011), postoperative subtotal score (p=0.018), postoperative total score (p=0.014), and postoperative sacral slope (SS) (p=0.015). A negative correlation was found between PJA and preoperative satisfaction (p=0.044). CONCLUSION: The occurrence of PJK is multifactorial, including clinical, surgical, and radiographic factors. Male patients with higher pre and postoperative TKA, preoperative SB, and postoperative SS and patients with lower satisfaction have a higher risk of PJK development.

Formulae derived from Anthropometric Measurements to Estimate Ideal Tibial Nail Length.

INTRODUCTION: Ideal Nail Length (INL) provides better outcomes after Intramedullary Nailing (IMN) of Tibia Shaft Fractures (TSF). Intraoperative methods do not allow for preoperative planning. Changing the nail may cause complications. X-rays are commonly used, but displacement or magnification errors may occur. Forearm measurements may be benefical in bilateral TSF. We aim to examine correlations of anthropometric measurements (AMs) and INL and use them to obtain formulae. MATERIALS AND METHODS: Tuberositas Tibia-Medial Malleolus (TM), Tuberositas Tibia-Ankle joint (TA), knee-ankle joint (JJ), and olecranon tip-5th Metacarpal head (OM) distances were evaluated in 76 IMN patients. Correlation analyses were performed and the results used to create formulae. RESULTS: The correlations between INL and TM-left, TM-right, TA-left, TA-right, OM-left, OM-right, JJ-left, JJ-right were 0.81, 0.83, 0.77, 0.77, 0.82, 0.80, 0.90, 0.91 respectively for males; and 0.93, 0.89, 0.88, 0.86, 0.80, 0.82, 0.90, 0.89 respectively for females. AMs show excellent correlation in both sexes (p<0.0001). Regression analysis was statistically significant in all formulae. The most compatible correlations in males were JJ-right and JJ-left; and in females, TM-left, TM-right, and JJ-right. CONCLUSION: The most compatible correlations wth INL were JJ in males, and TM and JJ in females. OM can be used in the presence of bilateral TSF, edema, wounds and obesity. AMs are useful preoperatively. The formulae can be used to ensure INL and reduce errors, time and radiation. Level of Evidence: Level I, Testing of previously developed diagnostic criteria on consecutive patients (with the universally applied reference gold standard).

INTRODUÇÃO: O comprimento ideal da haste (CIH) proporciona desfechos melhores depois da colocação de haste intramedular (HIM) em fraturas da diáfise da tíbia (FDT). Os métodos dessa cirurgia não permitem o planejamento pré-operatório. A troca da haste pode causar complicações. Em geral, são usadas radiografias, mas podem ocorrer erros de deslocamento ou de tamanho. As medições do antebraço podem ser benéficas nas FDTs bilaterais. Nosso objetivo é examinar as correlações das medidas antropométricas (MAs) e CIH e usá-las para obter fórmulas. MATERIAIS E MÉTODOS: As distâncias entre Tuberosidade da tíbia-Maléolo medial (TM), Tuberosidade da tíbia-Articulação do tornozelo (TT), Articulações do joelho e do tornozelo (JT) e extremidade do olécrano-cabeça do 5o metacarpal (OM) foram avaliadas em 76 pacientes com HIM. Foram realizadas análises de correlação e os resultados foram usados para criar fórmulas. RESULTADOS: As correlações entre CIH e TM-esquerda, TM-direita, TT-esquerda, TT-direita, OM-esquerda, OM-direita, JT-esquerda, JT-direito foram 0,81, 0,83, 0,77, 0,77, 0,82, 0,80, 0,90, 0,91 para homens e 0,93, 0,89, 0,88, 0,86, 0,80, 0,82, 0,90, 0,89 para mulheres. As MAs tiveram excelente correlação em ambos os sexos (p < 0,0001). A análise de regressão foi estatisticamente significativa em todas as fórmulas. As correlações mais compatíveis em homens foram JT-direita e JT-esquerda; nas mulheres, foram TM-esquerda, TM-direita, e JT-direita. CONCLUSÃO: As correlações mais compatíveis com CIH foram JT em homens e TM e JT em mulheres. A OM pode ser usada em FDT bilateral, edema, feridas e obesidade. As MAs são úteis no pré-operatório. As fórmulas podem ser usadas para garantir o CIH e reduzir erros, tempo e radiação. Nível de evidência: Nível I, Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de referência "ouro" aplicado).

Effect of Instrumentation Level on Mental Health Subscale of Scoliosis Research Society Outcomes Questionnaire in Adolescent Idiopathic Scoliosis.

Introduction Adolescent idiopathic scoliosis (AIS) surgery aims to obtain a flexible and stable spine, correct axial rotation and halt curve progression by fusing the least number of motion segments. Longer fusions can improve deformity correction, but late decompensation and lumbar degeneration may occur. Even some daily issues can be problematic in some scoliosis patients. Reduction in mobility, segmental mobility adjacent to fusion, degeneration of junctional unfused levels and low-back pain (LBP) results in poor outcomes. It is reported that AIS patients have more mental and psychological problems including depression. Preoperative concerns due to deformity may continue postoperatively as instrumentation fuses motion segments. We wanted to present the relationship between the remaining mobile segments and Scoliosis Research Society-22r (SRS-22r) mental health (MH) scores of AIS patients. Methods It is a retrospective study of 110 posterior fusion AIS patients, age between 10 and 18 years, and followed-up for at least two years who filled SRS-22r forms both preoperatively and in postoperative second year (POY2). Patients are grouped according to the lowest instrumented vertebra (LIV) as LIV L5: group 1, LIV L4: group 2, LIV L3 and above: group 3. Results A statistically significant difference (SSD) was not found in preoperative and POY2 comparison of truncal shift (TTS), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal balance (SB) in group 1; SB in group 2, and LL in group 3 (p>0.05). SSD was found in all other radiologic measurements of groups and in all patients. No SSD was found in function and MH in group 1, in function and pain in group 2 and in pain in group 3 and all patients (p>0.05). SSD was found in the remaining SRS-22r subscales. There was an SSD between groups 1 and 2 in terms of instrumentation level (p=0.013). SSD was found between groups 1 and 2 in preoperative Cobb angle (p=0.016). SSD was found between groups 2 and 3 in POY2 Cobb angle (p=0.025). SSD was found between groups 2 and 3 in POY2 apical vertebral translation (p=0.01). There was no SSD in other radiological parameters (p>0.05). SSD was found between groups 1 and 2 (p=0.02) and between groups 1 and 3 (p=0.037) in terms of POY2 MH, but no SSD was found between groups 2 and 3 (p>0,05). There was no SSD in other preoperative or POY2 SRS-22r subscales (p>0.05). Conclusion More distal LIV is associated with a reduction of mobility and SRS scores. The self-image scores of groups were not statistically different. However, in group 1, MH was significantly lower. With the improvement of body images, patients start to worry about mobility instead of cosmesis. Higher depression has been reported in AIS patients. In POY2, there was no SSD between groups in terms of pain, function and satisfaction in addition to the self-image score as indicated in the literature. We especially recommend that L5 LIV patients should receive psychiatric support in order to prevent anxiety, and inform and support them that they are not different in terms of pain, self-image and function scores compared to more proximal LIV patients, and also we recommend encouraging L5 LIV patients that POY2 SRS22-r pain, self-image, satisfaction, subtotal and total scores are improved. As reported in the literature which shows increased suicidal thoughts and depression in scoliosis patients; our findings regarding MH are important and considerable.

Formulae derived from Anthropometric Measurements to Estimate Ideal Tibial Nail Length / Fórmulas derivadas de medidas antropométricas para estimativa do comprimento ideal da haste tibial

ABSTRACT Introduction: Ideal Nail Length (INL) provides better outcomes after Intramedullary Nailing (IMN) of Tibia Shaft Fractures (TSF). Intraoperative methods do not allow for preoperative planning. Changing the nail may cause complications. X-rays are commonly used, but displacement or magnification errors may occur. Forearm measurements may be benefical in bilateral TSF. We aim to examine correlations of anthropometric measurements (AMs) and INL and use them to obtain formulae. Materials and methods: Tuberositas Tibia-Medial Malleolus (TM), Tuberositas Tibia-Ankle joint (TA), knee-ankle joint (JJ), and olecranon tip-5th Metacarpal head (OM) distances were evaluated in 76 IMN patients. Correlation analyses were performed and the results used to create formulae. Results: The correlations between INL and TM-left, TM-right, TA-left, TA-right, OM-left, OM-right, JJ-left, JJ-right were 0.81, 0.83, 0.77, 0.77, 0.82, 0.80, 0.90, 0.91 respectively for males; and 0.93, 0.89, 0.88, 0.86, 0.80, 0.82, 0.90, 0.89 respectively for females. AMs show excellent correlation in both sexes (p<0.0001). Regression analysis was statistically significant in all formulae. The most compatible correlations in males were JJ-right and JJ-left; and in females, TM-left, TM-right, and JJ-right. Conclusion: The most compatible correlations wth INL were JJ in males, and TM and JJ in females. OM can be used in the presence of bilateral TSF, edema, wounds and obesity. AMs are useful preoperatively. The formulae can be used to ensure INL and reduce errors, time and radiation. Level of Evidence: Level I, Testing of previously developed diagnostic criteria on consecutive patients (with the universally applied reference gold standard).

RESUMO Introdução: O comprimento ideal da haste (CIH) proporciona desfechos melhores depois da colocação de haste intramedular (HIM) em fraturas da diáfise da tíbia (FDT). Os métodos dessa cirurgia não permitem o planejamento pré-operatório. A troca da haste pode causar complicações. Em geral, são usadas radiografias, mas podem ocorrer erros de deslocamento ou de tamanho. As medições do antebraço podem ser benéficas nas FDTs bilaterais. Nosso objetivo é examinar as correlações das medidas antropométricas (MAs) e CIH e usá-las para obter fórmulas. Materiais e métodos: As distâncias entre Tuberosidade da tíbia-Maléolo medial (TM), Tuberosidade da tíbia-Articulação do tornozelo (TT), Articulações do joelho e do tornozelo (JT) e extremidade do olécrano-cabeça do 5o metacarpal (OM) foram avaliadas em 76 pacientes com HIM. Foram realizadas análises de correlação e os resultados foram usados para criar fórmulas. Resultados: As correlações entre CIH e TM-esquerda, TM-direita, TT-esquerda, TT-direita, OM-esquerda, OM-direita, JT-esquerda, JT-direito foram 0,81, 0,83, 0,77, 0,77, 0,82, 0,80, 0,90, 0,91 para homens e 0,93, 0,89, 0,88, 0,86, 0,80, 0,82, 0,90, 0,89 para mulheres. As MAs tiveram excelente correlação em ambos os sexos (p < 0,0001). A análise de regressão foi estatisticamente significativa em todas as fórmulas. As correlações mais compatíveis em homens foram JT-direita e JT-esquerda; nas mulheres, foram TM-esquerda, TM-direita, e JT-direita. Conclusão: As correlações mais compatíveis com CIH foram JT em homens e TM e JT em mulheres. A OM pode ser usada em FDT bilateral, edema, feridas e obesidade. As MAs são úteis no pré-operatório. As fórmulas podem ser usadas para garantir o CIH e reduzir erros, tempo e radiação. Nível de evidência: Nível I, Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de referência "ouro" aplicado).

Urine in the thigh, an extraordinary complication of pelvic fracture: Vesicocutaneous fistula.

We present a case of a 67-year-old woman who was initially treated conservatively for pelvic fracture. After 4 weeks, she was admitted to our clinic with swelling and pain in the distal part of her right thigh. Ultrasonography and magnetic resonance imaging showed accumulation of fluid between the subcutaneous adipose tissue and fascia. Urine was detected by a puncture. Bladder injury was detected in the left anterolateral wall using computed tomography. A fistula tract was observed from the right side of the bladder neck in cystogram, which confirmed the diagnosis of vesicocutaneous fistula. Bladder drainage was achieved using a urethral catheter, and the fistula was closed without any complication. The control cystogram showed healing of the bladder. All the patients with pelvic fractures should be evaluated by urine analysis and examined for associated urethral or bladder injury using retrograde urethrography and cystography.

Alpha-Tocopherol and Cyanocobalamin Combination Accelerates Peripheral Nerve Healing: An Experimental Animal Study.

AIM: To evaluate the functional and histopathological results of alpha-tocopherol (vitamin E) and vitamin B12 on an experimental rat model of peripheral nerve injury. MATERIAL AND METHODS: This research included 32 Wistar Hannover rats. The sciatic nerves of the animals were crushed using an aneurysm clamp. The rats were divided into 4 groups, as group 0 (the controls; no treatment), and groups B12, E, and B12+E, respectively. The rats were analyzed functionally, using the sciatic functional index (SFI), and histopathologically. RESULTS: In the functional analysis, it was determined that vitamin E was as influential as B12. Concomitant use of these 2 vitamins was found to be more beneficial. The SFI was significantly higher in the B12+E group when compared with that of the B12 group, which indicated that vitamin E improved the healing effects of vitamin B12. In the histopathological evaluation, vitamin E was not effective in the treatment of axonal degeneration (AxD) or edema/inflammation (EI) by itself. Although vitamin B12 was effective in the treatment of EI, it was ineffective in the treatment of AxD. However, the combination of these vitamins decreased both AxD and EI, which showed that the additive effects of these vitamins could reverse neurological injury when used together. CONCLUSION: Vitamins B12 and E were effective in the functional recovery of peripheral nerve injury (PNI). Neither vitamin B12 nor E was effective in the treatment AxD; however, their combination was effective in the treatment of AxD. The results suggested that vitamin E was effective in the treatment of PNI, especially when combined with vitamin B12. It is our belief that the combination of these vitamins could be used in the treatment of PNI, especially after future studies have been conducted on humans.

Can Ellipsoid Sign be One of the Earliest Findings of the Medial Femoral Condyle Chondromalacia of Knee Antero Posterior X-Ray?

BACKGROUND/PURPOSE OF THE STUDY: Aim of the study was to investigate whether ellipsoid sign (ES) in the region corresponding to the cartilaginous facet of the medial femoral condyle (MFC) indicates early cartilage lesion. The finding has not been defined in the literature yet. METHODS: The study was performed retrospectively with 50 patients who underwent articular cartilage examination and arthroscopy between 2015 and 2018. Patients were divided into two according to the presence or absence of ES. There were 24 patients in case group (Group A) and 26 patients in controls (Group B). Weight-bearing cartilage areas of MFC in the region where ES was found in both groups were classified according to arthroscopic Outerbridge classification (OC) and compared statistically with each other. RESULTS: There was no significant difference in terms of age, gender and alignment between Group A and Group B (p > 0.05). All OC grades were higher in Group A (p < 0.001). Positive correlation between ES and MFC chondromalacia grade was detected (r: 0.671, t: 6.266, p < 0.05). CONCLUSION: ES, which refers to the difference in bone density in MFC seen in antero-posterior (AP) X-Ray, is a result of changes in subchondral bone due to chronic cartilage loss. ES detected on AP X-Ray may help in early diagnosis of medial femoral articular cartilage chondromalacia, even at grade 0 or 1. We recommend searching for ES, as the earliest symptom of chondromalacia, which occurs even before MRI lesions. Future studies may reveal additional information about ES.

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.

Early Reduction of Pediatric Traumatic Posterior Hip Dislocation Is Much More Important Than the Treatment Procedure.

Traumatic hip dislocations are very rare in the pediatric population, and they are real emergent cases that can occur with minimal trauma. If they are not diagnosed immediately and reduction is not performed as soon as possible, they may cause problems such as avascular necrosis and degenerative arthritis. Performing reduction within the first 6 hours is of vital importance.We aim to present the functional outcomes and radiographic results of 2 pediatric traumatic hip dislocation cases with 36 months of follow-up who were treated with abduction orthosis after the reduction. We want to emphasize the importance of reduction time in the outcome of posterior traumatic hip dislocations followed with abduction orthesis even if there is a trend and suggestion to treat these patients with spica cast with the review of the recent literature.

Osteoprotegerin and 25-hydroxy vitamin D levels in patients with diabetic foot.

OBJECTIVES: This study aims to compare the levels of osteoprotegerin (OPG) and 25-hydroxy vitamin D (25(OH)D) in patients with diabetic foot and patients with newly diagnosed type 2 diabetes mellitus (DM) and to investigate the prevalence and severity of 25(OH)D insufficiency in patients with diabetic foot. PATIENTS AND METHODS: This prospective study was conducted on 105 patients including 58 patients with diabetic foot (42 males, 16 females; mean age 63.6 years; range, 31 to 90 years), who applied to our hospital between June 2014 and May 2015, and 47 newly diagnosed type 2 DM patients (27 males, 20 females; mean age 51.4 years; range, 29 to 85 years) (control group). 25(OH)D and osteoprotegerin serum levels in both groups were measured and compared. RESULTS: Osteoprotegerin levels in diabetic foot group were significantly higher than the control group (p<0.05). The 25(OH)D levels in diabetic foot group were significantly lower than the control group (p<0.05). There were positive correlations between OPG levels and C-reactive protein (CRP) and creatinine levels in patients with diabetic foot. CONCLUSION: Elevated levels of OPG in patients with diabetic foot may display the severity of the clinical status due to its positive correlation with CRP and creatinine. We detected severe 25(OH)D deficiency in the majority of diabetic foot patients. Vitamin D supplementation may be required in diabetic foot patients to prevent unfavorable immunologic alterations.

Liposclerosing myxofibrous tumor: a rare tumor of proximal femur.

Liposclerosing myxofibrous tumor is a very rarely observed benign fibro-osseous lesion, which contains complex histological structures. It was first described in the year 1986. Histopathological examination of the lesion may show myxoid areas, osteoclastic activity, bone trabeculae similar to fibrous dysplasia, fat necrosis, ischemic ossification and rarely cartilage components. This lesion, which is particularly localized to the proximal femur, is thought to be associated with fibrous dysplasia. In this case report, we aim to present a liposclerosing myxofibrous tumor case, which was treated surgically, in light of the literature review. The patient who was treated with curettage, grafting and 95-degree dynamic condylar screw-plate system was asymptomatic at the 16th month control and recurrence was not detected.

Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2).

OBJECTIVE: The aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2). METHODS: Seventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group. RESULTS: Functional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000). CONCLUSION: Simple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature; however, successful results have been obtained with IMN in this fracture pattern. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

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.

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.

[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.

Localized giant cell tenosynovial tumor seen in the knee joint.

Tenosynovial giant cell tumor is a locally aggressive tumor arising from the synovia of the fibrous tissue surrounding the joints, tendon sheaths, mucosal bursas, and tendons. Although it is often to be observed at the hand, localized form is very rare in the knee joint. In this case report, we aimed to present a very rare case of a surgically treated intra-articular giant cell tenosynovial tumor arising from the hoffa's infrapatellar fat pad of a 19-year-old male patient, by reviewing the literature. The patient we have treated with marginal excision was asymptomatic at the 14th month in the controls and recurrence was not detected.