Peroneal nerve palsy secondary to prolonged squatting in seasonal farmworkers.

OBJECTIVE: The aim of this study was to evaluate the follow-up and treatment results of peroneal nerve palsy secondary to prolonged squatting for working and to determine an approach for its treatment and prevention. METHODS: The study retrospectively evaluated 16 patients (7 males, 9 females; mean age: 23.6 years) diagnosed with peroneal nerve palsy due to squatting for work. Clinical and neurological evaluations were performed and weight and height were measured. Lesion site was determined using electrophysiological testing. After diagnosis, medical and orthotic treatment was initiated and rest was advised. Patients were followed until motor symptoms were resolved. RESULTS: Clinical and neurophysiological evaluations were consistent with isolated peroneal nerve palsy. The left side was affected in seven patients, the right side in seven and both sides in two. Average onset of the symptoms was 3.3 (range: 1 to 6) weeks and average daily squatting period was 6.8 (range: 6 to 8) hours. Average healing time was 7.4 (range: 3 to 16) weeks. None of the patients was obese or overweight. All patients healed with conservative treatment and no surgical treatment was necessary. CONCLUSION: Working conditions and duties should be considered in the evaluation of peroneal nerve palsy. In peroneal nerve palsy secondary to squatting, healing should be expected with conservative treatment, resting and close follow-up.

Bilateral acute tibial osteomyelitis in a patient without an underlying disease: a case report.

INTRODUCTION: The simultaneous presentation of osteomyelitis in more than one bone is rare and is commonly accompanied by a chronic disease. Even in such cases, other conditions that arise commonly in the long bones of children--such as chronic recurrent multifocal osteomyelitis and Ewing's sarcoma--must be ruled out. CASE PRESENTATION: We present the case of a 5-year-old boy with bilateral acute tibial osteomyelitis without an underlying chronic disease who was treated with surgical debridement. We also review the pertinent literature. CONCLUSION: Early diagnosis, appropriate antibiotic therapy, and timely surgical intervention--including proactive efforts to prevent fractures--all increase the chance of a successful outcome for these patients.

Bipolar dislocation of the forearm (floating forearm).

Bipolar dislocation of the forearm (floating forearm) is an unusual injury and is therefore often overlooked. We report a 28-year-old male patient who presented at another center with a history of a fall while climbing a tree. The patient's left elbow was treated with closed reduction and immobilization with a long-arm cast brace due to elbow dislocation. However, the patient was admitted with pain and swelling of the wrist to our emergency department the following day. Physical and radiological examination revealed dorsal trans-scaphoid perilunate dislocation. A dorsal incision was performed for open reduction and internal fixation to provide wide surgical exposure. Concomitant occurrence of elbow dislocation and fracture-dislocation of the perilunate is infrequent. Therefore, physicians should be aware of possible additional injuries and current recommended treatment methods.

[Diffuse pigmented villonodular synovitis in the shoulder joint and the biceps tendon: a case report]. / Omuz eklemi ve biseps tendonunda yaygin pigmente villonodüler sinovit: Olgu sunumu.

Pigmented villonodular synovitis (PVNS) is a benign proliferative disease of synovium frequently most frequently seen in the knee joint and hand tendon synovial tissues; shoulder involvement is extremely rare. It can be seen in joints in two forms as nodular or diffuse involvement. The clinical and radiological symptoms are not specific to the disease and usually mimic other joint diseases. The general complaint of the patients is long-lasting painful swelling that could not be diagnosed. In magnetic resonance imaging it is observed as soft tissue mass. Pigment deposition and histiocytic cell infiltration in the villous synovial projections are the major histological findings. Synovectomy is performed for treatment and the incidence of recurrence is high. In this article, we report a 23-years-old male patient with diffuse PVNS in the shoulder joint and biceps tendon which are rarely involved in PVNS.

Early results of total knee arthroplasty performed through the midvastus approach.

OBJECTIVES: The aim of this study was to evaluate the early results of total knee arthroplasty (TKA) performed through the midvastus approach. METHODS: This retrospective study included 48 knees of 42 patients (29 females, 13 males; mean age 69 years; range 54 to 82 years) who underwent TKA for grade 4 knee osteoarthritis. All TKA operations were performed by the same orthopedic surgeon through the midvastus approach. Preoperatively, 40 patients (95.2%) had primary osteoarthritis, and two patients (4.8%) had rheumatoid arthritis. In all cases, a posterior stabilized cemented prosthesis with a fixed insert was used. Patellar resurfacing was performed in seven knees (14.6%). All the knees were rated according to the Knee Society knee and function scores before surgery and at the final follow-up. Postoperative radiographic evaluations were performed on anteroposterior and lateral radiographs according to the Knee Society TKA Roentgenographic Evaluation and Scoring System. The mean follow-up period was 26 months (range 12 to 49 months). RESULTS: The mean knee score significantly improved from 49.0+/-9.3 preoperatively to 87.5+/-9.9 postoperatively (p=0.000). The corresponding increase in the knee function score was from 48.8+/-9.9 to 79.6+/-14.0 (p=0.000). The mean increases in the knee and function scores were 38.5 and 30.8 points, respectively. The knee and function scores were excellent or good in 46 knees (95.8%) and 42 knees (87.5%), respectively. The mean knee flexion significantly increased by 28.6 degrees , from 84.3+/-14.7 degrees preoperatively to 112.9+/-11.9 degrees postoperatively (p=0.000). Among patients with bilateral osteoarthritis, the knee function scores were significantly higher in patients who had undergone bilateral versus unilateral TKA (90.0+/-11.5 and 78.8+/-10.8, respectively; p=0.007). None of the patients had patellar tracking abnormality intraoperatively; thus, there was no need for lateral retinacular release. Postoperative clinical and radiographic assessments showed no signs of instability or loosing. Clinical and radiographic loosening of the patella and osteolysis were not observed in patients who had undergone patellar replacement. No changes were observed in the tracking and position of the protheses. Neurovascular injury did not occur. One patient who developed early infection of the knee that required a two-stage revision was assessed as failure. CONCLUSION: In our study, lateral retinacular release was not needed due to achievement of proper patellar tracking in TKA operations with the midvastus approach, and satisfactory clinical and radiographic results were obtained.