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    Persistent posttraumatic wrist pain: complex regional pain syndrome? Mycobacterium tuberculosis infection should be in the differential diagnosis
    (SPRINGER, 2007) Gundes, Hakan; Tosun, Bilgehan; Gundes, Sibel; Tosun, Alptekin; Muezzinoglu, Bahar
    It is a common algorithm for hand surgeons to diagnose and treat persistent post-traumatic wrist pain as complex regional pain syndrome ( CRPS). Although it works for many patients, some conditions that affect the wrist don't fall in this category and worsen with this treatment practice. We present a single-handed patient who had had a non-displaced distal radius fracture and was treated as CRPS for the next three months. He was eventually diagnosed with late tuberculous tenosynovitis of the wrist and a total wrist arthrodesis was performed. We believe that Mycobacterium tuberculosis infection should be in the differential diagnosis of persistent post-traumatic joint pain. This is especially important as Mycobacterium infections are becoming more common due to an increase in patients with chronic immunosuppression and definitive diagnosis and treatment of tuberculous tenosynovitis needs a high index of clinical suspicion.
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    TOTAL DESTRUCTION OF THE FOURTH METACARPAL BONE BY ANEURYSMAL BONE CYST: RECONSTRUCTION WITH STRUT FIBULAR GRAFT: A CASE REPORT
    (World Scientific Publ Co Pte Ltd, 2005) Gündeş, Hakan; Tosun, Bilgehan; Muezzinoğlu, Bahar; Tosun, Alptekin
    Total destruction of the fourth metacarpal bone by aneurysmal bone cyst is presented. Despite the benign nature of the lesion on plain radiograms, magnetic resonance imaging (MRI) has revealed total destruction of metacarpal bone with shelling off the articular cartilages on both ends of the metacarpal. Both adjacent dorsal interosseous muscles were also involved with tumour. After removal of the metacarpal bone and third and fourth interossei, fibular bicortical strut graft was used for reconstruction. Arthrodesis was done both at the carpometacarpal and metacarpophalangeal (MCP) joints. The follow-up radiograms at one year revealed excellent incorporation of the graft with no evidence of local recurrence. A careful pre-operative work-up including MRI seems necessary even in lesions that look typically benign with intraosseous location on plain radiograms. This approach may prevent unpredicted morphologic picture during surgery, high recurrence rate and the number of operations.