Biomedical subjects
Publications and source records attributed to Gürsel Leblebicioğlu.
Triplication of the thumb is a rare condition described only in several case reports. Radial longitudinal deficiency is a relatively more common entity. These 2 congenital abnormalities generally do not occur within the same extremity. We present a patient with a combination of 3 thumbs (triplication of the thumb) and hypoplastic radius in the same limb.
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A two stage, controlled animal trial was designed to observe the effects on normal and manually damaged articular cartilage of the rat knee joint of colchicine (COL) and diclofenac sodium (DIC) added into washout solutions. In the first stage, 21 rats were randomized into three groups, and right knees of all groups were washed-out by either COL, DIC or physiologic saline (PS) solutions. The left side was kept as a paired control. After 18 months, all knees were evaluated macroscopically and microscopically for cartilage changes. In the second stage, 25 rats were randomized into four groups, and a 2 x 2 mm defect was created surgically on the medial condyle. The joints were washed out by either COL, DIC or PS solutions. At the end of the six months, macroscopic, microscopic and transmission electron microscopy (TEM) evaluations were performed to observe the changes to the defective area. The results showed that washout procedures with certain arthroscopic fluid modifications revealed macroscopically less fibrillation and surface changes for the COL and DIC groups in the first stage. Colchicine and diclofenac sodium solutions conducted a better effect on the thickness of the cartilage and gave better results according to Mankin's criteria for degeneration. In the second stage, COL and DIC groups showed better effects on the cartilage regeneration. The pharmacological agents added into the arthroscopic washout fluid may have an effect on the ultrastructure and biologic properties of the joint cartilage, and may improve the results of arthroscopic treatment in chondral pathologies, especially in secondary arthritis.
Young children and adolescents are becoming increasingly involved in recreational and professional sports. This inevitably leads to an increase in the number of sports-related injuries involving the hand and the wrist. Hence, physicians should have a good insight into macro- and microtraumas affecting the hand and the wrist. Prevention of injuries, correction of muscle-tendon imbalances, and maintenance of strength and flexibility are important issues for the prevention of disabilities in this age group.
A significant incidence of knee pain and disability arises from patellofemoral disorders. An accurate diagnosis relies both on a comprehensive history and a careful physical examination; radiologic modalities also play an important part in the diagnosis and follow-up. Most patellofemoral disorders can be examined in three groups: pain due to soft tissue abnormalities, patellar instability, and patellofemoral osteoarthritis. Conservative therapy can be successful in many patellofemoral disorders. Surgical treatment consists of lateral release, medial plication and reconstruction of the medial patellofemoral ligament, proximal and distal realignments, patellar osteotomies, and patellectomy. In traumatic dislocations primary reconstruction or arthroscopy assisted medial stabilization can be performed.
PURPOSE: The goal of this study was to compare the results of open scaphocapitate fusion and revascularization with the results of arthroscopic scaphocapitate fusion and capitate pole excision. TYPE OF STUDY: Prospective randomized study. METHODS: Between April 1997 and January 2000, 16 consecutive patients (5 men and 11 women with a mean age of 31 years [range, 18 to 61]) presenting with Kienböck's disease stage IIIA and stage IIIB were randomized to either open scaphocapitate fusion and lunate revascularization (group I) or fully arthroscopic scaphocapitate fusion and capitate pole excision (group II) groups. Cannulated 3.5-mm ASIF screws were used for the purpose of scaphocapitate fixation in both groups. Operation time, hospital stay, time to fusion, range of wrist motion at final follow-up, grip strength, and return to unrestricted activities of daily living were evaluated at 33 months' follow-up. RESULTS: The mean operating time (153 v 99 minutes), hospital stay (3.6 v 2.3 days), and return to unrestricted daily activities (15 v 5.8 weeks) were shorter in group II. Average time to radiographically evident fusion was shorter in group I (7.25 weeks v 9 weeks). There was a significant increase in grip strength and in range of motion at final follow-up in both groups, and the final grip strength and range of motion was not different between the groups. There were no major complications in either group. CONCLUSIONS: Although the number of patients was small and the follow-up period was short, arthroscopic scaphocapitate fusion and capitate pole excision in stage IIIA and IIIB Kienböck's disease resulted in shorter operating time, shorter hospital stay, earlier return to unrestricted daily activities, and equal range of motion and grip strength as compared with open scaphocapitate fusion and lunate revascularization. Determination of specific surgical indications for the benefits of arthroscopic treatment of Kienböck's disease must be analyzed in larger studies.
PURPOSE: The goal of this study was to evaluate arthroscopic partial resection of discoid lateral meniscus tears with an emphasis on radiographic evidence of degenerative changes after this procedure. TYPE OF STUDY: Retrospective clinical study. METHODS: Of 41 patients with an arthroscopic diagnosis of discoid meniscus over an 8-year period, 34 symptomatic lateral discoid meniscus tears in 33 patients were analyzed at an average follow-up of 5.6 years. The average age at operation was 19.8 years and most patients had vague and intermittent symptoms that caused delay in clinical diagnosis. RESULTS: Eight patients were lost to follow-up and were excluded from the study. Magnetic resonance imaging, performed in 12 cases, and arthroscopy in all of these patients provided the precise diagnosis. All of the knees with symptomatic torn discoid menisci underwent arthroscopic partial meniscectomy. Only 1 Watanabe Wrisberg ligament type of discoid meniscus with posterior instability was totally meniscected. Based on Ikeuchi's grading, 39% of the knees had an excellent result, 46% had a good result, and 15% had a fair result; none of the results was poor. CONCLUSIONS: At an average 5-year follow-up, partial meniscectomy in patients with a Watanabe complete or incomplete discoid meniscus showed 85% good or excellent clinical results. However, a significant percentage of patients show femoral condyle flattening on radiography.
A ring-shaped lateral meniscus is a very rare entity within the spectrum of abnormalities of lateral meniscus. We present the second case in the literature of a symptomatic ring-shaped lateral meniscus in combination with a meniscal cyst and in association with an osteochondritis dissecans lesion of the medial femoral condyle. A potential pitfall of magnetic resonance imaging (i.e., displaced meniscal tear) is addressed in the diagnosis of this entity, as well as the role of magnetic resonance imaging in revealing associated abnormalities.
An unusual type of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion in the superior, instead of the usual inferior, part of the anterior glenoid labrum is presented in a 33-year-old man who sustained a traumatic dislocation of his left shoulder. Magnetic resonance imaging raised the possibility of an ALPSA lesion and later arthroscopy confirmed the diagnosis. Arthroscopic repair of the lesion was performed after the labral avulsion was lateralized.
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We report an abnormally shaped lateral meniscus. As far as we know, the present case is the first description of partial deficiency of the lateral meniscus in the literature. Although it is a rare abnormality, arthroscopic surgeons should be familiar with this entity for the differential diagnosis of bucket-handle meniscal tears, not only for magnetic resonance imaging, but also for arthroscopic evaluation. This entity could also be an aggravating factor for instability symptoms of partial or total anterior cruciate ligament-deficient knees.
Seventeen patients (16 children, 1 adolescent) were reviewed 31 months to 71 months after sustaining the common childhood fracture of the eminentia intercondylaris of the tibia. The aim was to assess long-term results and prognosis by clinical and radiological examination and to discover whether conservative treatment was adequate for type I and type II fractures according to Meyers and McKeever. Early improvement occurred in all patients after conservative treatment, but long-term results were not satisfactory in displaced fractures,which were treated with closed reduction and immobilization in extension. Therefore, anatomic reduction and rigid fixation should be obtained for displaced fractures of the eminentia intercondylaris of the tibia.
Omphalocele, or exomphalos, is a rare defect of the periumbilical abdominal wall in which the coelomic cavity is covered with peritoneum only, resulting in congenital eventration of abdominal contents at the base of the umbilical cord. The etiology is still unknown. In this paper a new case of omphalocele with absence of the right thumb in a five-year-old boy is reported. A common etiology and a new terminology for this combination are suggested.
We report monozygotic twins with longitudinal radial hypoplasia and low (L5) spina bifida occulta, but with differing severity. There is only one previous report of similar twins. We report these identical twins with the expression of longitudinal radial hypoplasia with mirror image pattern on contralateral sides, and the association of low spina bifida occulta.