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Introduction: Rupture of the Achilles’ tendon is a common injury occurring particularly in middle-aged men due to sports trauma. Operative treatment is preferred generally due to lower risk of re-rupture. Possible complications of the operation include suture granulomas. Suture granulomas might represent a foreign body reaction, which itself is the end-stage response of the inflammatory wound-healing process to biomaterials. It may occur with both absorbable and non-absorbable suture materials such as silk in our case. The aim of this study is to present a case of a delayed foreign body reaction 30 years after open repair of the Achilles tendon with silk sutures. Case Report: Our case is a 38-year-old male who presented to our outpatient clinic with complaints of swelling and pain around the posterior region of the ankle for the past 3 months. He had a history of open Achilles tendon repair at the age of 3 at the site of complaints. Physical examination was positive for a mass under the incision scar. Magnetic resonance imaging report was positive for a granulomatosis formation. The patient was booked for an operation to remove the mass. Conclusion: Suture granuloma represents a tissue reaction against the suture material. Orthopedic literature is sparse for such cases and case reports. Both because of its rarity in orthopedic literature and the amount of time between the surgery and reaction, our report is a valuable addition to the literature.

Introduction: Multiple bone fractures in a newborn can be associated with osteogenesis imperfect (OI). OI is a rare genetic disorder that causes Type I collagen synthesis disturbance results in bone fragility. Case Report: We present a female newborn which had numerous fractures of the humerus, bilateral clavicle, and bilateral femur. Her delivery was at 36 weeks gestation by spontaneous vaginal delivery. She had has not any pathological symptom at 2 weeks after birth, the patient had a fracture of the humerus, bilateral clavicle, and femur without any trauma. Genetic analysis of the patient was reported and OI diagnosed. The patient was followed up for 8 months with regularly and without any complication. Conclusion: Multiple fractures with OI in an infant after birth may require an accurate orthopedic plan for diagnosing and treatment.

Background: Madelung deformity is a rare condition characterized by prematuregrowth arrest of the volar–ulnar aspect of the distal radius growth plate. Differentsurgical procedures are described in the literature. In this study, we aim topresent functional and clinical results of our technique in five wrists of 4patients.Methods: 5 wrists of 4 patients (3 females and 1 male) underwent surgery forMadelung deformity in our clinic between 2005-2014. Mean age of the patientswas 15,4 (14-17) and mean follow up duration was 65,6 months (29-111). Onepatient had bilateral deformity. Patients were evaluated with wrist ROM, DASHand VAS score pre and post-operatively. Corrective osteotomy to the radius,shortening osteotomy to the ulna and release of the Vickers ligament wereperformed on all patients.Results: Although there were no meaningful changes in the range of supination-pronation;palmar flexion was decreased; and dorsiflexion and radial deviation were significantlyhigher in the last follow-up compared to the preoperative values. Union wasachieved at the all osteotomy sites. All radiological parameters weresignificantly better in the last follow-up x-rays. Preoperative andpostoperative mean DASH score was 55,4 and 18,8, respectively and preoperativeand postoperative mean VAS score was 6 and 1, respectively.Conclusions:This surgical technique may be a good option forsevere Madelung deformity in terms of functional and radiological results and patientsatisfaction in the midterm follow-up. Pain and gross deformity were our mainsurgical indications., Amaç: Madelung deformitesi, radius distal büyüme plağının volar ve ulnartarafında erken büyüme duraklaması ile tanımlanan nadir bir deformitedir.Literaturde farklı cerrahi girişimler tanımlanmıştır. Bu çalışmada Madelungdeformitesinde kullandığımız cerrahi tekniğin klinik ve radyolojik sonuçlarınıdeğerlendirmeyi amaçladık. Gereç ve Yöntem: 2005-2014 yılları arasında kliniğimzide dört hastanın 5 elbileği (3 bayan, 1 erkek) Madelung deformitesinedeni ile opera edildi. Hastaların ortalama yaşı 15.4 (14-17) ve ortalam takipsüresi 65 (29-111) ay idi. Bir hastada bilateral deformite vardı. Hastalarameliyat öncesi ve sonrası eklem hareket açıklığı, DASH ve VAS skorları iledeğerlendirildi. Tüm hastalara radius düzeltici osteotomi, ulna kısaltıcıosteotomi ve vicker ligaman gevşetme ameliyatı yapıdı. Sonuçlar: Hastaların son kontrollerindeki eklem hareket açıklıkları ameliyatöncesi değerler ile karşılaştırıldığında; dorsifleksiyon ve radial deviasyonaralığı anlamlı olarak artarken palmar fleksiyon arkı azaldı. Supinasyon vepronasyon aralığında anlamlı bir değişiklik izlenmedi. Tüm osteotomi alanlarında kaynama izlendi. Son takipröntgenlerinde tüm radyolojik parametreler ameliyat öncesine göre anlamlıolarak daha iyiydi. Ameliyat öncesi ve sonrası ortalama DASH skoru sırasıyla55.4 ve 18.8 iken, ameliyat öncesi ve sonrası VAS skoru sırasıyla ortalama 6 ve1 idi. Çıkarımlar: İleri Madelung deformitesi olan hastalarda bu cerrahi teknik hastamemnuniyeti, fonksiyonel ve radyolojik sonuçlar bakımından iyi bir seçenekolabilir. Ağrı ve belirgin deformite bizim ana cerrahiendikasyonumuz oldu.

Spontaneous quadriceps tendon rupture is not rare in patients with chronic renal failure needing dialysis due to the impaired collagen maturation in tendons. With transpatellar tunnel technique, the repair of the impaired tendon and successful healing are reported. The aim of this study is evaluate the functional results, strength and endurance of the quadriceps tendons after repair with transpatellar tunnel technique in hemodialysis patients with spontaneous quadriceps tendon ruptures. Primary repair with transpatellar tunnel technique is performed in 15 spontaneously ruptured quadriceps tendons of 9 patients with the mean age of 50,1 (6 bilateral, 3 unilateral ruptures). After a mean follow-up of 48.7 months, patients were evaluated with Lysholm score for functional evaluation. Isokinetic quadriceps strength and endurance measurements were performed with computerized dynamometer (CYBEX HUMAC–USA) and compared with a control group of 10 volunteers with chronic renal failure needing hemodialysis without quadriceps rupture history. The demographics of the study group and the control group were comparable in terms of age, body weight and dialysis year. 1 patient was deceased during follow-up due to end-stage renal failure. Of the 13 repairs evaluated, 1 repair failed after 3 months and needed revision surgery. Although at the latest follow-up all patients were doing active knee extension against gravity with their repaired quadriceps tendons and walk independently, the Lysholm score of the repair group (mean 75.3) was significantly lower than the control group (mean 93,2) (p: 0.009). The strength (peak torque) of the repaired quadriceps tendon was 43,6 Nm and was significantly lower than the control group (90,6 Nm) (p: 0.001). The endurance of the repaired tendon was also found to be significantly lower than the control group. 259 Nm and 625 Nm respectively (p: 0.001). Primary repair with transpatellar tunnel technique after spontaneous quadriceps ruptures in hemodialysis patients can provide acceptable functional results with active knee extension and independent walking ability. However the strength and endurance of the repaired tendon might be significantly lower than a impaired but unruptured quadriceps tendon.

Objective: Compression of nerves by benign bone and soft tissuetumors comprise an uncommon cause of peripheral neuropathies. We aim to presentcases of peripheral nerve compression due to benign bone and soft tissue tumorstreated in our clinic.Methods: We report a case series with a total of 16 patientswho were treated in our clinic between 2010 and 2015. Mean age of the patientswas 28 (2,5-55). Six of the patients had osteochondroma of the fibular head. Theremaining 10 patients had various soft tissue tumors localized at differentlocations. Patients presented with pure sensory, pure motor, or mixed sensoryand motor deficits. Mean duration of follow-up was 38 (11-120) months. Results: All patients underwent surgical excision and weretreated additionally with vitamin supplements. All patients regained functionwithin 1 month post-operatively. There was no recurrence at the end of thefollow-up.Conclusions: Compression by tumors should be included in thedifferential diagnosis and work-up of peripheral neuropathies. Results areexcellent with prompt diagnosis and surgical intervention.Keywords: Benign tumors; nerve compression; neuropathies;osteochondorma., Amaç: Benign kemik veyumuşak doku tümörlerinin oluşturduğu sinir basıları nadir bir periferik nöropatisebebidir. Bu çalışmada kliniğimizde benign kemik ve yumuşak doku tümörünedeniyle oluşmuş periferik nöropatili hastalarda uyguladığımız cerrahitedavilerin sonuçlarını bildirmeyi amaçladık.Hastalar ve Metod: 2010 ve 2015 yılları arasında kliniğimizde tedavi edilen benigntümöre bağlı sinir basısı oluşmuş 16 hasta çalışmaya dahil edildi. Ortalamayaşları 28 (2,5- 55) idi. Altı hastada fibular sinire bası yapan fibula başıosteokondromu tespit edildi. Geriye kalan 10 hastada çeşitli yerlerde çeşitliyumuşak doku tümöleri tespit edildi. Hastalar ilk başvuruda pür duyusal, pürmotor yada her iki nörolojik deficit ile başvurdu. Ortalama takip süremiz 38(11-120) ay idi.Sonuçlar: Tümhastalar tümörün cerrahi eksizyonu ve ek olarak vitamin takviyesi ile tedaviedildi. Bütün hastalar ameliyat sonrası ortalama 1 ay içerisinde motor veduyusal fonksiyonu geri kazandılar. Hastaların son takiplerinde nüks izlenmedi.Çıkarımlar: Periferiknöropati ayırıcı tanısında sinir basısı yapan tümörler unutulmamalıdır. Erkentanı uygun cerrahi tedavi ile mükemmel sonuç elde edilebilir.Anahtar kelimeler: Nöropati; bening tümörler; osteokondroma; sinirbasısı.

A Rare Etiology of Acute Abdomen Syndrome: Perforation of The Small Intestinal Lymphoma Akut Batın Sendromunun Nadir Bir Etyolojisi: İnce Barsak Lenfoma Perforasyonu Fatih Altıntoprak, Enis Dikicier, Yusuf Yürümez, Osman Nuri Dilek

Amaç: Aşil tendon rüptürü sık rastlanan bir yaralanma türü olmasına rağmen tedavisi halen tartışmalıdır. Çalışmamızda Aşil tendon tamirinde kullanılan perkütan ve açık cerrahi tekniklerin fonksiyonel durumunu karşılaştırmak amaçlanmıştır. Gereç ve Yöntem: Çalışmamızda 33’ü perkütan (ortalama takip süresi 39 [16–49] ay), 57’si açık (ortalama takip süresi 44,16 [16–95] ay) teknikle tedavi edilmiş 90 hastanın sonuçları geriye dönük olarak karşılaştırıldı. Hastalar AOFAS skoru, ayakbileği eklem hareket açıklığı, dorsifleksiyon ve plantar fleksiyon gücü, işe ve spora yeniden başlama zamanları açısından değerlendirildi. Bulgular: Her iki grubun demografik özellikleri benzer olarak değerlendirildi ve yaş, cinsiyet, ortalama takip süreleri açısından fark yoktu. Fonksiyonel değerlendirmede AOFAS skorlarında (p=0.266), plantar fleksiyonda (p=0.106), dorsifleksiyonda (p=0.104), dorsifleksiyon (p=0.531) ve plantar fleksiyon (p=0.413) güçlerinde iki grup arasında istatistiksel olarak anlamlı fark yoktu. Grupların komplikasyon oranlarında anlamlı fark yoktu. Sonuç: Aşil tendon rüptüründe perkütan ve açık tekniklerin fonksiyonel sonuçları başarılıdır ve perkütan tekniğin erken iyileşme ve işe dönme açısından üstünlüğü gösterilememiştir. Background: Acute Achilles tendon rupture is a common injury for which recommended treatment is still controversial. The aim of the present study was to compare functional results of percutaneous and open surgical techniques of Achilles tendon repair. Methods: Ninety patients (33 percutaneous repairs with a mean follow-up of 39 [16–49] months, and 57 open repairs with a mean follow-up of 44.16 [16–95] months) were included in this retrospective, comparative study. Patients were evaluated for American Orthopaedic Foot and Ankle Society (AOFAS) scores, ankle range of motion (ROM), dorsiflexion and plantar flexion strength, and time of return to work and sports at last follow-up. Results: Both groups had similar demographic characteristics, and there were no differences in terms of age, gender, and mean follow-up. In functional assessment, there were no statistical differences in AOFAS scores (p=0.266), plantar flexion (p=0.106), dorsiflexion (p=0.104), plantar flexion (p=0.413), and dorsiflexion strength (p=0.531) between the 2 groups. Regarding complications, there were no statistical differences between the groups. Conclusion: Percutaneous and open Achilles repair can be performed with successful functional rates, and percutaneous technique did not show any superiority in terms of early recovery and return to work.

Amaç: Çalışmamızın amacı ultrasonografik taramanın seçilmiş hastalarda mı (risk faktörleri ya da muayene bulguları olan) ya da genel popülasyon üzerinde mi yapılması gerektiğini değerlendirmektir. Gereç ve Yöntem: Kliniğimize 2010-2012 gelişimsel kalça displazisi (GKD) taraması amacıyla başvuran 634 bebek çalışmaya dâhil edildi. Risk faktörleri olarak aile öyküsü, makat gelişi, tortikollis, ilk gebelik, oligohidramniyos, çarpık ayak, kız cinsiyet olarak belirlendi. Graf metodu ile yenidoğan kalçaları taranarak, hastalardaki risk faktörleri ve klinik muayene bulguları istatistiksel olarak duyarlılık ve özgüllük açısından karşılaştırıldı. Bulgular: Çalışmaya alınan 634 bebeğin 403'ü kız, 231'i erkekti. Hastaların ortalama yaşı 87,45±49,6 gündü. Ortalama anne yaşı 29,6±5,4 yıldı. Ultrasonografik tarama sonucunda 66 bebeğin 71 kalçası displazik bulundu. Bu kalçalardan 30'u Tip 2b, 8 kalça Tip 2c, 3 kalça Tip d, 23 kalça Tip 3, 7 kalça Tip 4 olarak tespit edildi. Sonuç: Çalışmamızda klinik bulguların GKD taraması açısından yeterli olmadığı sonucuna ulaşılmıştır. Bu nedenle de özellikle ülkemiz gibi GKD prevelansının sık görüldüğü ülkelerde seçilmiş hastalara ultrasonografik tarama yapmaktansa tüm popülasyonun ultrasonografik taramasının yapılması gerektiği düşüncesindeyiz. Objective: The aim of the study is to evaluate the efficacy of ultrasonographic screening in general population and selected patients (who had risk factors or clinical findings) for developmental dysplasia of the hip (DDH).Material and Methods: 634 babies who had been admittted to our clinic between 2010 and 2012 were included in the study. Family history, breech presentation, torticollis, first child, oligohydramnios, club foot, and female gender were accepted as risk factors. The newborns patients were evaluated with Graf method. Risk factors and clinical findings of the patients were compared with these results for sensitivity and specificity. Results: 403 patients were female and 231 patients were male. The mean age of the patients were 87.45±49.6 days and the mean maternal age was 29.6±5.4 years. In the screeening of the patients 66 babies with 71 hips were dysplasic (30 hips Type 2b, 8 hips Type 2c, 3 hips Type d, 23 hips Type 3, and 7 hips Type 4).Conclusion: According to our study, clinical examination of the patients is not sufficient for the screening of the babies for DDH. We think that the ultrasonographic screening of the babies for DDH is recommended for general population of high risk countries like Turkey.