Results of Tönnis-type acetabuloplasty in patients with developmental hip dysplasia.

AIM: The aim of this prospective study was to evaluate the outcome of open reduction and Tönnis acetabuloplasty as the first method of treating developmental dysplasia of the hip (DDH) in children in early childhood at walking age. MATERIALS AND METHODS: Between 2005 and 2009, 34 hips of 34 children were operated on with the aforementioned method. Mean age was 25.6 (range 12-44) months, and mean follow-up was 3.6 years. During the follow-up period ,the hips were evaluated using the acetabular index and for development of avascular necrosis and redislocation. Functional evaluation was also conducted. RESULTS: Clinically, 97.3 % of patients had excellent and good results. The acetabular angle decreased from 45° preoperatively to 21° early postoperatively and at the last follow-up had improved to 18°. In two hips, type 2 avascular necrosis developed. Hip instability was not observed, and no additional surgery was performed. CONCLUSION: Tönnis acetabuloplasty is a powerful tool to increase primary stability of the hip when acetabular coverage is inadequate in DDH. Besides its acute correction ability, when performed properly, it has no unwanted effects on acetabular growth. As an isolated procedure or as a part of combined open reduction and/or femoral osteotomy, Tönnis type acetabuloplasty is a safe and effective method.

Ochronosis: complicated tear of black meniscus.

We describe a case of a previously healthy 35-year-old man who presents with meniscal symptoms, and present the arthroscopic findings of a complicated tear of black lateral meniscus. Investigations revealed that he had underlying alkaptonuria, which was previously undiagnosed without any other findings. After the surgical treatment, the patient's complaints were alleviated and almost no complaints were registered, during the next follow-up.

[Superfluous computed tomography utilization for the evaluation of the pelvis and spinal column in an orthopedic emergency department]. / Acil ortopedi ve travmatoloji polikliniginde omurga ve pelvis degerlendirmesi için gereksiz bilgisayarli tomografi kullanimi.

OBJECTIVES: This study was designed to investigate the frequency of requests for computed tomography (CT) examination of the spinal column and pelvis in our emergency orthopedic department, the reasons of requests, and the rates of positive and negative CT examinations. METHODS: We retrospectively reviewed patients for whom a request for CT examination was made by the emergency orthopedic department within a year (September 2005- 2006). The reasons for CT requests, findings in CT reports, and age and sex of the patients were recorded. Findings unrelated and related to the original request denoted a negative and positive CT examination, respectively. RESULTS: Of 24,378 admissions to our emergency orthopedic department, a CT scan was requested in 1,295 patients (5.3%). In 817 patients (63.1%), CT examination involved the pelvis or the spinal column. Of these, 418 CT scans (51.2%) yielded a negative result. The mean age of the patients with a negative CT scan was significantly lower than those having a positive CT scan (40.7 vs 45.1 years; p=0.001). There was no significant difference with respect to sex between patients having negative and positive CT findings (p=0.670). Compared to pelvis CT scans, the frequency of negative CTs was significantly higher for spinal column examinations (p<0.001). The incidence of negative CT scans for upper thoracic and cervical vertebrae was significantly higher than that found for lower thoracic and lumbar regions (p<0.001). CONCLUSION: The high incidence of negative CT scans documented for pelvic and spinal column examinations underlines the need for measures to avoid superfluous CT requests in emergency departments.

[Comparison of plate-screw fixation and intramedullary fixation with inflatable nails in the treatment of acute humeral shaft fractures]. / Akut humerus cisim kiriklarinin cerrahi tedavisinde plak vida ile sisebilen intramedüller çivi yöntemlerinin karsilastirilmasi.

OBJECTIVES: We compared the results of plate-screw fixation and intramedullary fixation with inflatable nails for the treatment of acute humeral diaphyseal fractures. METHODS: The study included 34 patients (20 females, 14 males; mean age 36.4 years; range 18 to 62 years) who were selected from patients treated with plate-screw fixation or inflatable intramedullary nails. The groups were matched for age, sex, severity of fracture, and the type of humeral fracture. Eighteen fractures were treated in each group. Classification of humeral fractures and open fractures were made according to the AO and Gustilo-Anderson systems, respectively. Functional evaluations were made at postoperative six and 12 months using Constant shoulder and Mayo elbow performance scores. All the patients were administered the Short-Form 36 (SF-36) questionnaire at 12 months. The two groups were compared with respect to operation time, perioperative need for blood transfusion, time to union, complications, and shoulder and elbow functions. RESULTS: The mean operation time was significantly shorter (25.3 min vs 66.1 min; p<0.001) and the need for blood transfusion was significantly less (p=0.001) with inflatable intramedullary nails. Constant shoulder and Mayo elbow scores did not differ significantly between the two groups. Implant failure was only encountered with plate-screw fixation in three patients. Union problems were observed in five patients (3 plate-screw, 2 intramedullary nail). Following plate-screw fixation, two patients developed superficial infection, two patients developed transient radial paralysis. CONCLUSIONS: Inflatable intramedullary nails can be used safely in the treatment of acute humeral diaphyseal fractures without increasing union problems and complications.

The Usefulness of Employing an Electronic Traction Table to Determine Flexibility in Adolescent Idiopathic Scoliosis.

AIM: The aim of the study was to develop new equipment for the assessment of the flexibility of the spine with different forces. This new system should provide a different perspective to adolescent idiopathic scoliosis (AIS) for the selection of fusion levels and surgical success. MATERIAL AND METHODS: Eighteen patients suffering from AIS who were scheduled to undergo posterior instrumented spinal fusion in our clinic were recruited in this study. The Electronic Traction Table (ETT) that was designed in our clinic was used to evaluate the radiogical and clinical parameters of the spine. RESULTS: The significant prescriptive angle of major Cobb angles between postoperative angles were longitudinal traction and lateral pushing Cobb angles. Longitudinal traction and lateral pushing angles were more correlated with correction ratios. There was a significant difference between longitudinal traction minor Cobb angle, longitudinal traction lateral pushing minor Cobb angle and postoperative minor Cobb angles. CONCLUSION: The deformity is needed to balance both tractional and rotational forces and useful technique to evaluate curve flexibility before the operation. Electronic traction table is a new device for determining preoperative flexibility with longitudinal traction and lateral pushing radiographs. It can be useful for choosing selective fusion levels at the proximal and distal end of the vertebral column.

Alternative reliable techniques in femoral torsion measurement.

The clinical and conventional bi-planar determinations of femoral torsion were compared with the tomographic technique, the reliability of which was confirmed. Femoral torsions were measured with the trochanteric prominence angle test, the sinus-wave bi-planar conventional radiographic technique, the modified Hermann bi-planar conventional radiographic technique and the limited three-dimensional volumetric tomography technique in 34 femora of 17 patients. There was a strong correlation between the modified Hermann and the limited tomography techniques for 14 intact and 20 fractured femora. If limited three-dimensional volumetric tomography cannot be obtained, the modified Hermann bi-planar conventional radiographic technique must be used in patients who have scarring about the proximal femur and obesity. Otherwise use of the trochanteric prominence angle test is much more cost-effective and is as accurate as the limited three-dimensional volumetric tomography technique.

Effects of hypertonic dextrose on injured rat skeletal muscles.

OBJECTIVE: Histological examination of proliferative therapy effects on the healing process of muscular injury. METHODS: We performed this study between March and August 2002 at Ankara University, School of Medicine, Laboratory of Animal Experiments, Ankara, Turkey. We used an experimental animal model by conducting a standardized cut injury of the gastrocnemius muscle in 30 adult male albino rats, which we divided into 2 groups; proliferative therapy group and control group. We evaluated the injured rat muscles by light microscopy on the fifth, eight, and twelfth day of injury. RESULTS: The muscular regeneration process began at day 5 in both the control and proliferative therapy groups. The proliferative therapy group revealed a prominent inflammatory reaction, fibroblast migration, and necrosis with accompanying regeneration and excessive connective tissue formation. CONCLUSION: We cannot consider proliferative therapy an appropriate treatment modality for muscular injuries, unless there is evidence of normal muscle physiology and biomechanics post traumatically.

Intracompartmental pressure changes after anterolateral bridge plating of tibial fractures.

OBJECTIVE: Compartment syndrome is one of the most devastating complications in orthopedics both for the patient and the treating physician. Among the many causes, trauma and its treatment are the most common reasons for compartment syndrome, which most frequently occurs in the lower leg following tibial fractures. Since bridge plating of difficult metadiaphyseal tibial fractures is becoming increasingly popular, serious concerns have been raised about the increased intracompartmental pressures and possible compartment syndrome. METHODS: This study investigated the intracompartmental pressure changes in anterolateral compartment of the leg during and immediately after anterolateral bridge plating of tibial fractures. Intracompartmental pressures were measured before and during plate application, just after the completion of fixation, and immediately and 4-5 min after the tourniquet release in 22 isolated closed comminuted tibial fractures. RESULTS: Baseline anterolateral compartment pressures were higher than those on the uninjured side (9.3 vs 27.8 mmHg). Pressures were 69.5, 57.4, 65.8, and 56.8 mmHg, respectively, for the other measurements times. None of the patients received prophylactic fasciotomy, and none developed clinical compartment syndrome. CONCLUSION: We found that anterolateral compartmental pressures were higher than pressures on the uninjured side in all patients. Although there is a considerable increase in intracompartmental pressures during and immediately after anterolateral percutaneous bridge plating of comminuted tibial fractures, intraoperative prophylactic fasciotomy is not routinely needed. One should monitor the patients on the first postoperative day for signs of compartment syndrome. Fasciotomy decisions should be based on both clinical symptoms and serial intracompartmental pressure measurements rather than a single measurement.

[Importance of lumbar vertebra transverse process fractures in multitrauma patients who had undergone emergent laparotomy]. / Acil laparotomi yapilan multitravmali hastalarda lomber vertebra transvers çikinti kiriklarinin önemi.

BACKGROUND: To evaluate the incidence and importance of lumbar vertebra transverse process fractures in polytraumatized patients who had undergone emergent laparatomy, and to find out the relevant risk factors. METHODS: The medical records of 312 laparotomized trauma patients who referred to our emergency department between January 2001 and January 2002 were retrospectively assessed. Hundred and six cases who met inclusion criteria were investigated. Data relevant to the trauma, demographics, hemoglobine levels, additional system traumas, complications were recorded. Correlations between collected data and the fractures were investigated. Results were evaluated statistically using SPSS 11,0 software package program. RESULTS: Lumbar vertebra transverse process fractures were detected in 58,5 % of the cases. They were more frequently encountered in women, elderly and after falls or traffic accidents.. Abdominal organ injuries were more common in these cases. These fractures are associated with hepatic and splenic injuries. Their presence also increases the risk of vertebra corpus fractures seven fold. CONCLUSIONS: Lumbar vertebra transverse process fractures usually occur after higher energy traumas They must be evaluated as serious findings which might lead to potential organ injuries. Once these fractures were detected in trauma patients, every attempt should be made to exclude probably fatal and more serious additional organ injuries.

[The effect of long- or short-arm casting on the stability of reduction and bone mineral density in conservative treatment of Colles' fractures]. / Colles kiriklarinin konservatif tedavisinde kisa veya uzun kol alçilamanin kemik mineral yogunlugu ve redüksiyon üzerine etkisi.

OBJECTIVES: We evaluated the effect of long- or short-arm casting on the stability of reduction and bone mineral density (BMD) in the forearm in patients treated conservatively for Colles' fractures (CF). METHODS: Eighty-three patients (48 females, 35 males; mean age 53 years; range 30 to 76 years) with an isolated unilateral CF underwent closed reduction followed by a randomly assigned long-arm (n=44) or short-arm (n=39) casting. Fractures were classified according to the Frykman's system. After reduction, radiographs of both forearms were taken, on which radial height and inclination, and volar tilt were measured and assessed according to the criteria by Sarmiento et al. In the first week, BMD measurements were made on the unaffected side to obtain reference values from four sites of the forearm, namely ultradistal, 1/3 proximal, middle diaphysis, and total. Following removal of the casts (mean 45.3 days; range 40 to 55 days), radiographic and BMD assessments were repeated. Osteoporosis was defined according to the criteria of the World Health Organization. RESULTS: The two casting groups were similar with respect to age, sex, Frykman's classification, involved side, and the dominant extremity. Osteoporosis was detected in 20% according to the T scores. All the sites in the fractured forearm showed density losses, but the difference was significant only in the middle diaphysis (p<0.05). No significant relationship was found between BMD losses and the cast type. Angular measurements showed significant deterioration after union; however, none was found to be related to the cast type (p>0.05). CONCLUSION: Our results show that BMD losses and deterioration in reduction following treatment of CF occur irrespective of which type of casting is used.

[The development of osteosarcoma following radiotherapy for fibrous dysplasia]. / Radyoterapi uygulanan fibröz displazili bir olguda osteosarkom gelisimi.

Sarcoma arising from fibrous dysplasia (FD) is rare and it is more common in polyostotic type. In this case report, we present a 41-year-old male patient who developed osteosarcoma of the left tibia 28 years after the initial diagnosis and 20 years after radiation therapy for FD. He underwent above-knee amputation, but died eight months after surgery. This case suggests that radiotherapy has no beneficial effect in the treatment of FD and that it may be associated with the development of sarcoma.

[Short-term results of treatment of humeral and tibial fractures with new inflatable intramedullary nails]. / Sisirilebilen intramedüller çivi kullanilarak tedavi edilen humerus ve tibia diafiz kiriklarinda kisa dönem sonuçlar.

OBJECTIVES: We evaluated the effectiveness of a new inflatable intramedullary nail system in the treatment of tibial and humeral fractures. METHODS: The study included seven patients (4 men, 3 women; mean age 37.5 years; range 27 to 48 years) whose humeral or tibial fractures were treated by new inflatable intramedullary nails. Five fractures were in the tibial diaphysis; three were humerus fractures. One patient had bilateral involvement. All tibial fractures and one humeral fracture were fresh, whereas two patients presented with delayed union. Treatment consisted of closed reduction and antegrade intramedullary nailing, with the addition of bone grafting in delayed unions. The patients were evaluated with regard to operation duration, healing periods, complications, and final clinical and radiologic findings. The mean follow-up period was 15.3 months (range 12 to 20 months). RESULTS: Operation time for both tibial and humeral fractures was less than that with other internal fixation techniques. The need for fluoroscopic monitoring decreased appreciably, as well. Healing times were similar to those of other intramedullary nailing systems. No complications occurred related to the use of the inflatable intramedullary nail system. CONCLUSION: The use of inflatable intramedullary nails may have significant implications in selected fractures, allowing easier stabilization of long bone fractures and saving valuable operation time.

[Real angulation degree in fifth metacarpal neck fracture]. / Besinci metakarp boyun kiriginda gerçek açilanma degeri.

OBJECTIVES: This study investigated whether the confusion about the acceptable angulation value in fifth metacarpal neck fractures results from the hand radiographs taken at non-standard oblique position. MATERIALS AND METHODS: In this experimental study two Kirshner wires representing the intramedullary axis of the two fracture fragments were placed on a platform prearranged with an angle of 50 degrees between them. The radiographs of the wires were taken on the platform (horizontal) at angles of 0, 30, 45 and 60 degrees. The radiographs were taken without changing the cassette location and the position of the radiography device. RESULTS: The known volar angulation (50 degrees) was measured on the radiographs as 50, 36, 30 and 23 degrees, respectively. CONCLUSION: The main debate about the fifth metacarpal neck fracture is over the acceptable distal fragment volar angulation degree. This degree of angulation is between 30 and 70 degrees in the studies. The presence of such different and inaccurate results in the literature results from the use of non-standard oblique hand radiographs. Standardized radiographs are required in fifth metacarpal neck fractures.

Comparison of knee function after antegrade and retrograde intramedullary nailing for diaphyseal femoral fractures: results of isokinetic evaluation.

OBJECTIVE: To evaluate knee function in patients having femoral diaphyseal fractures treated with antegrade or retrograde intramedullary nail insertion. DESIGN: Prospective. SETTING: Level I referral center. PATIENTS AND METHODS: Seventy patients having 71 OTA 32 fractures were randomly allocated into 2 groups to be treated with either antegrade or retrograde intramedullary nails inserted with reaming. INTERVENTION: Antegrade nail in 41 fractures and retrograde femoral intramedullary nails in 30 fractures. MAIN OUTCOME MEASURES: Postoperative knee range of motion, Lysholm Knee Score, and isokinetic knee muscle function testing at least 6 months after documented fracture healing, minimum 1 year postoperatively. RESULTS: Groups had similar data with regard to demographics and injury patterns. Mean follow-up time was 44 (range: 25-80) months. Mean knee flexion angle was 132 and 134 degrees, and mean Lysholm Score was 84 and 83.1 in antegrade and retrograde groups, respectively (P = 0.893 and P = 0.701). Isokinetic evaluation revealed similar results for peak torque deficiencies at 30 and 180 degrees per second and total work deficiencies at 180 degrees per second (P > 0.05). Age affected the knee functioning as the higher the age of the patient is, the lower the Lysholm Score and knee flexion angle (r = -0.449, P = 0.0321 and r = -0.568, P = 0.001, respectively). CONCLUSIONS: Knee function seems to have similar clinical results after either antegrade or retrograde nail insertion for femoral diaphyseal fractures when knee range of motion, Lysholm Scores, and isokinetic knee evaluation are considered as outcome measures. With increasing patient age, a decrease in knee functioning should be anticipated in patients with femoral fractures treated with intramedullary nails regardless of technique.

[An alternative fixation method for the treatment of unstable distal clavicle fractures: locked distal radius plate]. / Distal klavikula ayrismali kiriklari için yeni bir tespit yöntemi: Kilitli distal radius uç plagi.

OBJECTIVES: Optimal surgical fixation method for displaced distal clavicle fractures should not impose limitations on neighboring joint movements. We evaluated the results of surgical treatment of displaced distal clavicle fractures using locked distal radius plates. METHODS: Displaced distal clavicle fractures of 14 consecutive patients (11 men, 3 women; mean age 30 + or - 9 years; range 19 to 51 years) were treated using open reduction and locked distal radius plates. Before final fixation, one patient underwent K-wire fixation with tension band at another center, resulting in nonunion. Except for two cases with late presentation, the mean time to surgery was 5.3 days (range 1 to 17 days). According to the Neer classification, fresh fractures were type II in 10 patients and type III in three patients. Shoulder examinations and functional evaluations were made at 3, 6, and 12 months postoperatively. Functional assessment included the Modified Shoulder Rating Scale and Constant score. RESULTS: All patients achieved full range of motion of the shoulder at six weeks postoperatively. The mean modified shoulder score was 18.7 + or - 1.5 and the mean Constant score was 95.4 + or - 3.0 at 12 months. None of the patients developed implant failure, loss of reduction, skin breakdown, or infection. CONCLUSION: In selected acute fractures and nonunions of the distal clavicle, excellent clinical results are easily achievable with locked distal radius plate fixation because it allows early shoulder movements without necessitating implant removal.