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Genç hastalarda eş zamanlı iki taraflı femur boyun stres kırığı (FBSK) çok nadir görülür. Bununla ilgili literatürde sınırlı sayıda olgu bildirilmiştir. Bu olgular çoğunlukla yüksek fiziksel aktivite altında kalan askerler ve atletler, epilepsi gibi nöbet geçirenler, yaşlı veya metobolik kemik hastalığı olan orta yaş hastalardır. Bizim olgumuz sporcu olmayan sağlıklı genç bir maden işçisinin geç tanı konulan eş zamanlı bilateral femur boyun kırığı nedeniyle literatürden farklıdır. Bu olguyu genç maden işçilerindeki iki taraflı femur boyun stres kırığında, tanı koymanın zorluğunu ve acil müdahele süresi (24-48 saat) geçmiş olsa da, stabil kırık fiksasyonu ile femur başı avasküler nekrozu gelişmeden kırığın iyileşebileceğini vurgulamak için sunduk. Concurrent two-sided femoral neck stress fracture (FNSK) is very rare in young patients. A limited number of cases have been reported in the literature. The majority of them are; soldiers, athletes, epileptic patients, and elderly/middle-aged patients with bone pathology. Our case differs from literature due to a concurrent bilateral femur neck fracture diagnosed late of a healthy young mine worker who is not an athlete. This report aims to emphasize the challenge of diagnosing bilateral femoral neck fractures in young miners and demonstrating excellent healing (without avascular necrosis) of the head with stable fixation even though the critical period of 48 hours has been spent.

Concurrent two-sided femoral neck stress fracture (FNSK) is very rare in young patients. A limited number of cases have been reported in the literature. The majority of them are; soldiers, athletes, epileptic patients , and elderly/middle-aged patients with bone pathology. Our case differs from literature due to a concurrent bilateral femur neck fracture diagnosed late of a healthy young mine worker who is not an athlete.This report aims to emphasize the challenge of diagnosing bilateral femoral neck fractures in young miners and demonstrating excellent healing (without avascular necrosis) of the head with stable fixation even though the critical period of 48 hours has been spent., Genç hastalarda eş zamanlı iki taraflı femur boyun stres kırığı (FBSK) çok nadir görülür. Bununla ilgili literatürde sınırlı sayıda olgu bildirilmiştir. Bu olgular çoğunlukla yüksek fiziksel aktivite altında kalan askerler ve atletler, epilepsi gibi nöbet geçirenler, yaşlı veya metobolik kemik hastalığı olan orta yaş hastalardır. Bizim olgumuz sporcu olmayan sağlıklı genç bir maden işçisinin geç tanı konulan eş zamanlı bilateral FBSK nedeniyle literatürden farklıdır. Bu olguyu genç maden işçilerindeki iki taraflı fFBSK' da, tanı koymanın zorluğunu ve acil müdahele süresi (24-48 saat) geçmiş olsa da, stabil kırık fiksasyonu ile femur başı avasküler nekrozu gelişmeden kırığın iyileşebileceğini vurgulamak için sunduk.

We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia).

Objectives: While anterior ankle arthroscopy is a widely accepted technique, posterior ankle/hind foot arthroscopy is still a relatively new procedure. The arthroscopic visualisation was often initially limited and vulnerabilty of the posteromedial neurovascular structures to injury scared orthopaedic surgeons. The goal of this review is to highlight the indications, and to present the long term follow up results of posterior ankle/hind foot arthroscopy. Methods: The study included 21 ankles in 21 patients (12 male and 9 female ).The mean age was 37.7 , the mean duration of preoperative symptoms 12.8 months . Arthroscopy performed with the patient prone , under general and spinal anesthesia with tourniquet hemostasis . Preoperative intravenous antibiotic prophylaxis is performed (cefazolin 1g) , sand bag placed under ipsilateral anteresuperior iliac spine to correct natural external rotated posture of the ankle and ankle is left hanging of the table so that it can moved freely during surgery. We applied noninvasive distraction method with simple rope which tied and knotted waist of the surgeon . The posterolateral and posteromedial portals which described by Van Dijk was utilized . The arthroscopic visualisation was often initially limited and careful debritement of some adipose tissue of the kager fat pad (Kager's fat pad, also known as the pre-Achilles fat pad) was necessary to create more space to aid visualization .The most valuable point to stay clear from trouble is to understand , know and aware where the flexor hallucis longus tendon exist .So neurovascular structures located beyond this tendon. Principally the process must advance into lateral to medial manner. The mean follow up period was 55 months. The most common preoperative diagnoses were osteochondral lesions of talus (ten ),painful os trigonum syndrome with (five )or without (three) FHL tenosynovitis (total eight ), posterior talofibular ligament thickenning (two ), Haglund’s deformity (one ) Results: The mean pre operative AOFAS score was 50.75, the mean post operative AOFAS score was 93.75. Complications were noted. Complex regional pain syndrome (CRPS) and oedema was diagnosed during early post operative period in one patient (%4.7), resolved with physical therapy. Conclusion: The most common procedures were osteochondral lesion debritement and curettage with multidrilling /microfracture (10), isolated os trigonum excision (2), tenolysis of the flexor hallucis longus tendon with os trigonum excision (6 ), debritment of the thickened posterior talofibular ligament (2), endoscopic partial calcanectomy for Haglund’s deformity (1) . Our experience demostrated that posterior ankle and hind foot arthroscopy can be performed with low rate of major postoperative complication.

Our patient was a 76-year-old female who has been operated on 2 times in 8 years for pelvic chondrosarcoma. The patient came to our clinic with a large mass in left iliac region which extended into the paravertebral area. Physical examination and preoperative imagining studies revealed a mass at the left iliac area that infiltrated sciatic notch and extended from posterior iliac region towards the anterior side of iliac bone through the sciatic notch and an incisional hernia including descending colon. The mass was also penetrating the abdominal cavity through the hernia. Surgical intervention was planned. Since the tumor infiltrated the sciatic nerve, hemipelvectomy was indicated. Patient refused hemipelvectomy. Therefore, palliative debulking surgery was considered. We treated the case with marginal excision and abdominal wall reconstruction employing prolene and vicryl suture materials in order to prevent a postoperative visceral herniation and local invasion. At the latest follow-up appointment in 2 years, the patient still had no signs of tumor recurrence. This case showed us that an incisional hernia can serve as a pathway for the recurrence invasion of the chondrosarcoma.

Peridural fibrozis, laminektomi ve diskektomi sonrası gelişebileceği gibi hiç ameliyat geçirmemiş kişilerde dejeneratif bel hastalığının bir parçası olarak da gelişebilir. Bu yolla gelişen peridural fibrozisin nedeni olarak peridural venlere osteofît ve disk basısı gösterilmekteydi. Bizce peridural fibrozisin nedeni peridural venlere osteofît ve diskin yaptığı bası değil, vertebral instabilitedir. Bu çalışmanın amacı vertebral instabilite yaratılan tavşanlarda, elektrik stimülasyonu yöntemiyle belirli bir zamanda aşırı kullanım oluşturarak (instabilitenin kronik etkilerini taklit ederek), instabilite ile peridural fibrozis arasındaki ilişkiyi ortaya koymaktır. Oluşturduğumuz instabilite modeli ile yaptığımız çalışma göstermektedir ki, aşırı kullanım ile oluşan vertebral instabilite peridural fibrozise yol açmaktadır. Peridural fibrosis may develop following laminectomy or discectomy; but it may also occur as a result of degenerative disc disease in individuals who have not undergone any surgical procedures at all. In the previous studies, osteophytic or disc pressure were implicated in the occurrence of peridural fibrosis. In our opinion, vertebral instability rather than osteophytic or disc pressure plays a major role in the etiology of peridural fibrosis. This study was designed to demonstrate, in a rabbit model, a causal relationship between instability caused by electrically induced overuse and peridural fibrosis. Our results show that vertebral instability caused by overuse may lead to peridural fibrosis. 27

Dynamic compression plate with screw ostesynthesis is still the gold standard for the surgical approach to humeral diaphysis fractures. However, inflatable intramedullary nails are now preferred by surgeons as they offer the technical advantage of not using a distal locking bolt. The aim of this study was to present a didactic case of humeral non-union that occurred after inflatable nail fixation and to share the implications of this case with a systematic review of the literature regarding inflatable intramedullary choices for humeral diaphysis fracture, Humerus diafiz kırıklarının cerrahi tedavisinde halen altın standart plaklı osteosentezdir, ancak intramedüller şişebilen çivilemenin geliştirilmesi skopi kontrolündeki anterotasyon distal vida konulmasının teknik zorluğunu ortadan kaldırabildiği için cerrahlar tarafından tercih edilir olmuştur. Bu makalede humeral diafiz kırığı nedeni ile şişebilen intramedüller çivi ile opere edilmiş bir didaktik olgunun sunulması ve literatürün gözden geçirilip elde edilen bulguları ve bu olgunun bize verdiği klinik dersi okuyucuyla paylaşmayı hedefledik

Objective: In-grown nail is the most common problem that causes pain and discomfort in the foot.If the conservative treatment fails, the surgery is the option of the treatment. Modifi ed Winograd technique is the popular and the preffered surgical treatment method nowadays.21 documented patients with 24 nails were operated with the modifi ed Winograd technique. We aimed to evaluate the clinical results, satisfaction rate, and recurrence rate of the patients in this study. Material and Methods: The patients who were resistant to conservative treatment were included in this study. The modifi ed Winograd technique was utilized in a total of 21 patients female 12/male 9 .The mean follow-up period was 20 months Min/Max: 6/63 months .Pre /Post operative changes in VAS scores were evaluated with the Wilcoxon signed Rank test. The existence of a difference in Pre /Post operative VAS scores linked with gender were evaluated by the Mann-Whitney U test. The correlation between the Pre /Post operative VAS scores and age was evaluated with the Pearson correlation test. The recurrence rate and dissatisfaction from the surgery were reported directly Results: The mean pre-operative VAS score was 7.48 SD:1.159 , The mean Post -operative VAS score was 1.48 SD:1.05 . The mean age was 35.44 SD:11.67 . The mean change in pre/post operative VAS score was found to be statistically signifi cant Wilcoxon signed Rank test, P, Amaç: Tırnak batması ingrown nail , günümüz toplumunda ayağın en fazla ağrı ve rahatsızlıkla sonuçlanan, iş gücü kaybına yol açan durumudur.Tırnak batması konservatif tedavi yöntemleri ile tedavi edilemezse cerrahi tedavi seçeneği önemli bir alternatiftir. Modifi ye winograd tekniği son yıllarda populer olmuş önemli bir cerrahi tedavi yöntemidir.Makalede dokümente edilen 21 olgunun 24 tırnağına uygulanan modifi ye Winograd tekniğinin klinik sonuçlarını, nüks şeklini, oranını ve hasta memnuniyetini değerlendirmeyi amaçladık.Gereç ve Yöntemler: Tırnak batması şikayeti ile başvurup konservatif tedaviye yanıt vermeyen, 21 hastanın 12 kadın /9 erkek 24 tırnağına winograd tekniği ile kısmi tırnak çekimi ve yatak revizyonu uygulandı. Hastalar ortalama 20 Min/Maks: 6 / 63 ay ay takip edildi.Pre/Post operatif VAS skorları Wilcoxon Signed Ranks Test ile değerlendirildi. Pre/Post operatif VAS skorlarının cinsiyete göre farklılık gösterip göstermediği Mann Witney U testi ile değerlendirildi. Pre/Post operatif VAS skorlarının yaş ile bağıntısı Pearson Korelasyon testi ile değerlendirildi. Nüks ve memnuniyetsizlik oranları ortalama değer olarak sunuldu.Bulgular: Preoperatif ortalama VAS skorlaması 7,48 SD: 1,159 , Postoperatif ortalama VAS skorlaması 1,48 SD: 1,05 , ortalama yaş 35,44 SD:11,67 . Pre/Postoperatif VAS skorları arasındaki düşüşün istatistiki olarak anlamlı olduğu saptandı Wilcoxon Signed Ranks Test, p