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RAMP lesion, defined as peripheral detachment lesion of posterior horn of medial meniscus, has been shown to accompany anterior cruciate ligament (ACL) ruptures and is thought to play an important role in the knee joint stability. In this study, we aimed to present results of postoperative knee function scores and patient satisfaction after surgical repair of RAMP lesion. We included 15 patients who had undergone knee arthroscopy due to RAMP lesion in 2017. We recorded demographic data, diagnosis, pre- and postoperative International Knee Documentation Committee and Tegner–Lysholm scores of all patients. In this study, we included 15 patients: the number of male and female patients was eight and seven, respectively. The mean age of patients was 26.8 (18–35). Associated injuries included ACL rupture in 12 patients, additional medial meniscus lesion in 3 patients, lateral meniscus lesion in 3 patients, and superomedial patellar plicae syndrome in 2 patients. All patients had the same postoperative rehabilitation protocol. Mean preoperative Tegner–Lysholm knee score was 64.4 (53–75), while it was 82.5 (75–89) postoperatively, and mean preoperative and postoperative Visual Analogue Scale score at last postoperative follow-up were 5.26 (2–8) and 1.06 (0–2), respectively. All differences were found to be statistically significant. Meniscal RAMP lesions are commonly associated with ACL ruptures. RAMP repair significantly increases postoperative knee function scores and patient satisfaction following ACL reconstruction.

Background The present study evaluated the results obtained from the anatomical lateral frame plate treatment of displaced intraarticular calcaneus fractures. Methods Overall, 14 displaced intraarticular fractures of 13 patients (3 females, 10 males; Mean age, 37.5 years) were included in the present study. Surgery was performed using widened lateral approach and supported by auto grafts following joint line reduction in all patients. They were then fixated by anatomical lateral frame plate. All the joints were stabilized by casting after the operation. All patients were prescribed controlled and full weight bearing at 6-8th and 12th weeks, respectively. Results Mean follow-up of patients was 28 months. The fractures were classified according to Sanders system. Clinical scoring of the patients was performed according to American Orthopaedic Foot and Ankle Society, Creighton-Nebraska, and Maryland systems. According to these systems, the mean scores of the patients were 83.7, 75.7, and 88.5 respectively. Conclusion In the present study, we have defined the results of anatomical lateral frame plate treatment in patients with displaced intraarticular calcaneus fractures. We have obtained clinically and radiologically satisfactory results with the anatomical compatibility of plate to the lateral surface of the calcaneus.

Equestrian sports are known as potentially dangerous sports that are vulnerable to damage to the spine and extremities. The aim of this study is to characterize the type and localization of injuries and evaluate their relationship with occupational experience. In-between 2015-2017, records of orthopedic injuries during horse riding in jockeys were retrospectively evaluated. Patients were divided into 2 subgroups according to their professional experience. Winners up to 100 races were classified as amateur (apranti jockey), more than 100 race winners were classified as experienced (jockey). Localizations of injury types were divided into bones and soft tissue, and their relationship between age and experience were statistically evaluated. Eighty-five patients were included in this study. The mean age was 24.6 (17-32). Thirty-nine patients were classified as amateur and 46 patients were classified as experienced. Thirtytwo of 85 patients were treated conservatively. Of the eighty-five patients, 53 were treated with surgical methods. There is no statistically significant difference between experience, type and localization of injuries (p>0.05). The results of this study makes us think that horse sports are open to serious injuries that require surgical treatment and always requires high levels of attention independent from experience.

Purpose: Bone and soft tissue infections are among the least desired complications after orthopaedic surgery. This study analysed the in vivo effects of the local application of nano-silver particles (AgNPs) [1nm = 1 billionth of a meter] in soft tissue infections.Materials-Method: An experimental osteomyelitis model was formed by inoculating both tibias of 24 rats with methicillin-resistant Staphylococcus aureus. The rats were followed without treatment for 21 days. Blood samples and tibial x-rays at day 21 confirmed the development of infection. Then, the rats were divided randomly into two groups. One group (12 rats) underwent surgical debridement and received 21 days of teicoplanin therapy. The second group had the same treatment, with the addition of local nano-silver. All of the rats were sacrificed at day 42. Blood and wound swab samples were taken and the culture results were analysed.Results: No differences were observed between the groups in healing values at pathological examination, or in changes in the number of colonies at days 21 and 42. No differences in white blood cell count (WBC) were observed between the groups before and after the treatment.Conclusion: Although in vitro studies suggest the effectiveness of AgNPs on pathogens, we found that the application of nano-silver did not make any difference when used in addition to the classical osteomyelitis treatment with antibiotics and local surgical debridement. We believe that additional in vivo studies using repeated nano-silver application could be beneficial.

Highlights • Endometrial adenocarcinoma recurrence in tibia after 2 years of total abdominal hysterectomy and bilateral salpingo-oophorectomy. • Endometrial adenocarcinoma metastasis to skeletal system is extremely rare and mostly have been reported to be in axial skeleton. • Fresh frozen femoral allograft was used after wide resection for the metastatic adenocancer area of the tibia and provided the bone union. • Wide resection and reconstruction with an allograft might be an option to increase survival and possible cure of the patient as seen in our case., Introduction Metastatic bone disease at extremities is mostly associated with lung, liver, prostat, thyriod or breast malignancies. There for surgeons generally tends to seek for a primary tumor originating from these organs. Herein a case of endometrial adenocarcinoma recurrence that presented with symptoms of tibial pain is described. Presentation of case 59 year-old woman was admitted to our orthopaedic oncology unit with pain, swelling and tenderness at right cruris for two weeks without any trauma history. Her medical history revealed that she had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. During follow-ups no recurrence had been detected. Initial X-rays of the right tibia showed a lytic and expansile mass located at the shaft of the tibia suggesting metastasis. A wide resection of the lesion with clear margins was performed two weeks after first admittance. Resected area was replaced by fresh frozen femoral shaft allograft. At postoperative 17th month. X-rays obtained at last follow-up demostrated full healing and integration of allograft. Discussion Endometrial adenocarcinoma is a disease of postmenapousal women with 95% of the cases occurring after the age of 40 years. Patients with advanced or recurrent endometrial cancer often have distant metastases found within the lymph nodes, liver, and/or lung. Conclusion Recurrence of endometrial cancer as a solitary bone lesion is a rare situation. Wide resection and reconstruction with an allograft or an intercalar prosthesis might be an option to increase survival and possible cure of the patient.

Metatarsophalangeal joint dislocations are uncommon injuries. Herein, an irreducible dislocation of fifth metatarsophalangeal joint with fractures on the second, third, and fourth metatarsal head was reported. Joint reduction could not be achieved which necessitated open reduction. Six months after surgery the patient was walking and doing his daily activities without any complaints. He had returned to his pretrauma functional level.

Atay, Evren Fehmi (Arel Author), Purpose The purpose of this study was to compare the results of pedobarographic gait analysis between the patients treated by proximal femoral nail or bipolar partial hemiarthroplasty due to intertrochanteric fractures. Methods Thirty-seven patients with a minimum 1-year follow-up who had been operated for intertrochanteric fractures were evaluated clinically, radiologically and with pedobarographic gait analysis. Proximal femoral nail had been performed to 21 patients (group A), whilst 16 patients had been operated by partial bipolar hemiarthroplasty (group B). Pedobarographic analysis was performed by measuring plantar pressure, force and contact area values in both static and dynamic manner. Pedobarographic results of operated limb were compared among groups. Same data's also were compared between operated and uninjured limbs in each group to determine any asymmetry on weight-bearing. Results Average follow-up period in group A and group B was 36 (12–56) and 30 (12–48) months, respectively. There were no statistically significant differences among groups in terms of age, gender, body mass index, type and side of fracture, follow-up period, leg length discrepancy and postoperative hip scores. When the pedobarographic results of operated limb were compared, group B showed much more plantar force and pressure values than group A, on both static and dynamic evaluations. If the evaluation was taken into consideration to comparison of pedobarographic results between operated and uninjured limbs in each group, we found asymmetry in static load bearing, caused by higher load on uninjured limb in both groups. However, there was no statistically significant asymmetry between operated and uninjured limbs in respect to dynamic pedobarographic parameters for patients in group A. On the contrary, operated limbs in group B exposed much more plantar force and pressure values than uninjured limbs, which indicated asymmetric weight-bearing on dynamic evaluation. Conclusions Assessment of pedobarographic parameters can be another way of measuring the results of treatment in intertrochanteric fractures. Uninjured limbs of patients expose much more loading than operated limbs in postoperative static evaluation for both treatment options. However in dynamic evaluation, there is a better concordance of gait analysis between both limbs in patients operated by proximal femoral nail.

Introduction Intramuscular myxoma is a rare benign mesenchymal tumor. Myxomas most commonly occur in the heart. They may occur less frequently in aponeurotic tissues, bone, genitourinary tract, subcutaneous tissue and skin. Case presentation The case described here is a 44-year-old Turkish woman who presented with the complaint of a swelling in her right shoulder. A preoperative magnetic resonance imaging revealed a lobular contoured mass lesion in her deltoid muscle. The mass was marginally excised and pathology revealed intramuscular myxoma. Conclusion Intramuscular myxoma of the deltoid muscle is a very rare benign tumor. In the differential diagnosis, reactive lesions, myxoid nodular fasciitis and low -grade myxoid sarcomas should be kept in mind, upon which the treatment should be planned.

We assessed the accuracy of a new guide system that we developed to place lag screws in the proper position with the minimum number of attempts for operative treatment of trochanteric femoral fractures.A total of 55 consecutive trochanteric femoral fractures were treated with a cephalomedullary nail. The first 27 consecutive patients were treated with the standard operation (group A), while the new guide system was used in the last 28 consecutive patients (group B). The numbers of attempts to place K wires and the duration of surgery were noted. Accuracy of lag screw placement was evaluated by measuring the angle of deviation from the central axis of the femoral head.Deviation values ranged from -11̊ to +15̊ for the 27 cases in group A, with a median absolute deviation of 8̊±6̊. That in the 28 cases after the introduction of the new guide system (group B) ranged from -5̊ to +6̊, with a median absolute deviation of 0.5̊±3̊ (P0.001). The total numbers of attempts to place lag screws and mean operation time decreased significantly after introduction of the new guide system (P0.001).With this new guide system, we are able to insert lag screws successfully in the optimal position even in most unstable fractures. The present study indicated that this new guide system and nail facilitate accurate placement of lag screws in the appropriate position with the minimum number of attempts.

Objective: The aim of this study was to determine whether or not there is an association between attention deficit and hyperactivity disorder (ADHD) and Perthes disease.Methods: The study included 3 groups of patients: Perthes patients, trauma patients, and orthopedic patients without Perthes disease or history of trauma. Each group was comprised of 56 males and 4 females. Patients were evaluated for present or past diseases, exposure to second-hand smoke, the age at which they had begun to walk, history of trauma prior to Perthes diagnosis in the Perthes group, weight, height and body mass index (BMI). Eighteen questions on the DSM-4 (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition) ADHD checklist was used in the psychiatric evaluation of patients. The rate of ADHD was compared between groups.Results: Attention deficit and hyperactivity disorder was diagnosed in 7 patients in the Perthes group, 3 in the trauma group, and 3 in the non-trauma group; and this difference was not significant (p=0.160).Conclusion: There were no significant differences in the rate of ADHD between trauma and non-trauma groups of Perthes patients, which suggests no association between ADHD and Perthes disease., Amaç: Bu çalışmanın amacı dikkat eksikliği ve hiperaktivite bozukluğu (DEHB) ile Perthes hastalığı ile arasında bir ilişki olup olmadığının belirlenmesi idi.Çalışma planı: Hastalar 3 gruba ayrıldı. Birinci grup Perthes hastalarından, ikinci grup travma hastalarından ve üçüncü grup travması veya Perthes hastalığı olmayan ortopedi hastalarından oluşmaktaydı. Her grupta 56 erkek ve 4 kız yer almaktaydı. Hastalar mevcut ya da geçmiş hastalıkları, pasif sigara içiciliği, yürümeye başladıkları yaş, Perthes hastaları grubunda Perthes tanısı öncesi travma öyküsü, ağırlık, boy ve vücut kitle indeksi (VKİ) gibi faktörler ele alınarak değerlendirildiler. Hastaların psikiyatrik durum değerlendirmesinde DEHB için DSM-4 (Diagnostic and Statistical Manual of Mental Disorders - Dördüncü Baskı) kriterlerinde yer alan 18 soruluk listeden yararlanıldı. Elde edilen DEHB oranları gruplar arasında karşılaştırıldı.Bulgular: Perthes hastalarının 7’si, travma geçiren hastaların 3’ü ve travma geçirmeyen hastalarının 3’ünde DEHB saptanırken, gruplar arasındaki fark anlamlı bulunmadı (p=0.160).Çıkarımlar: Çalışmamıza göre travma geçiren ve geçirmeyen Perthes hastalarında DEHB görülme insidansı arasında anlamlı bir fark olmaması, DEHB ile Perthes hastalığı arasında bir ilişki olmadığını göstermektedir.

Schwannomas are rarely seen on the sciatic nerve and can cause sciatica. In this case report we aimed to present an unusual location of schwannoma along sciatic nerve that causes sciatica. A 60-years-old-man was admitted to us with complaints of pain on his thigh and paresthesia on his foot. Radiography of the patient revealed a solitary lesion on the sciatic nerve. The lesion was excised and the symptoms resolved after surgery.

Thyroid carcinoma is relatively uncommon, accounting for 2% of all cancers. Although they usually present as a neck lump, occasionally they may be presented with a distant metastasis. In this study, a 65 year-old woman was referred to our clinic with a pain on her left hip at both rest and walking. A lytic area at the inferior femoral neck was found with plain radiography. To clarify the characteristics of the lesion, left hip magnetic resonance imaging (MRI) had been performed displaying 3×5 cm hyperintense lesion extending from medial part of the left femoral neck to the left femoral head. Laboratory findings were normal. An open biopsy had then been performed from the left femoral neck with a suspicion of a metastatic tumor. After Immunohistochemical assesment diagnosis was consistent with metastatic thyroid papillary cancer. Proximal femoral resection with clear margins were achieved by proximal femur tumor endoprosthesis. In conclusion, papillary thyroid cancer have an excellent prognosis and doesn’t tend to metastese. But rarely, as seen in our case it can even present with syptoms of metastasic disease. Management strategy is the same as other solitary bone metastasis. Papillary thyroid cancer must be kept in mind as a differential diagnosis in solitary bone metatasis.

Objectives: The purpose of this case presentation is to report the results of physical therapy and conservative treatment of a rare clinical entity, isolated subtalar dislocation that occurred during triple jumping during which maximum compression forces act on the foot. Methods: A 20 years old national triple jumping athlete fell during daily sports exercises which consist of jumping to the medial and lateral side trying to catch a sports ball bouncing from the wall while his right foot was inverted and in plantar flexion. The patient was admitted to our emergency service. The physical examination revealed that the hindfoot was displaced medially. The neurological examination was intact and there was no sign of dermal injury. After the radiological examination the diagnosis was isolated subtalar dislocation. The dislocation was reduced with longitudinal traction with the knee was in flexion. The MR imaging did not reveal any chondral damage. The choice of treatment was conservative. After 4 days as the edema subsided, a short leg cast was applied for four weeks. Then, the cast was removed and active range of motion exercises were initiated. The first 25 days consisted of exercises with rubber band, bottle rolling under the foot. The second phase included walking in the pool and the patient was asked to start weight bearing partially. The patient went on with proprioception and strengthening exercises. Later, kinesiologic taping was also added to the therapy. He changed his jumping foot and started his routine training program with the team after 170 days. He participated in his first official competition 16 months after the injury. At the 28. month, he broke the national record in the National Interuniversities Athletics Games. 2 months later, he got the third place in the World Athletics Championship. Results: The follow up period was 4 years. AOFAS score was 76 at second month and 83 at the fourth. At the first and at the fourth year, AOFAS score was 100. No dermal lesions or joint stiffness or signs of arthritis was observed. Avascular necrosis of talus or complex regional pain syndrome was not encountered. Conclusion: Early return to sports activities is of tantamount importance as early reduction. Reduction can be carried out in an open or closed manner. For prevention of joint stiffness, immobilization period has to be short and active ROM exercises has to be initiated with partial weight bearing as soon as the joint stability and strength is adequate.