Prognosis and risk factors of nerve injuries in displaced pediatric supracondylar humerus fractures.

BACKGROUND: Supracondylar humerus (SCH) fractures are serious injuries due to the neighborhood of critical neural and vascular structures. One of the most devastating complications of SCH fractures is neurological damage, since it may cause permanent disability. The aim of this study is to categorize neurological complications, to report long-term functional outcomes, and to determine risk factors associated with childhood SCH fractures. METHODS: The records of 375 children were reviewed retrospectively. Data about amount and direction of displacement, the shape of the fracture, age at the time of fracture, gender, time from impaction to surgery, time of surgery, type of neurological injury, and recovery time were recorded. RESULTS: Neurological complications were seen in 37 (9.85%) children. Thirteen (35.1%) of the children had an iatrogenic nerve injury. All iatrogenic injuries were fully recovered in this study. However, 2 children who had combined neurological injury of radial, ulnar, and median nerves did not recover. Nearly 95% of all children who had neurological injury recovered fully. An anterior long and sharp bone fragment (spike) was observed in most of the children with neurological injury, and this spike was seen in 14 (58.3%) patients who had a trauma-related injury (n = 24). CONCLUSION: The prognosis of these nerve injuries is excellent, especially the iatrogenic ones. A long and sharp bone fragment (spike) may be responsible for nerve injuries in some children. Surgical exploration is not necessary after an iatrogenic nerve injury when there is no neurotmesis. Patience and care are utmost needed to handle neurological complications.

Effects of the incision preference in acetabular surgery on the postoperative functional outcomes.

BACKGROUND: Many factors are known to affect the functional outcomes of the acetabular surgery. The aim of this study is to evaluate the effects of incision preferences and number of incision on scores and clinical functional outcomes. PATIENTS AND METHODS: Forty-seven adult patients who had undergone acetabular surgery and had been followed up for at least 1 year in our clinic were included in the study. Demographic data, trauma type, acetabular fracture type based on the Judet ve Letournel classification, presence of any additional traumatic fractures, time to surgery, operation duration, surgical technique, and postoperative complications were recorded. Range of motion measurements, SF-36 and Harris Hip function scale score, and full weight-bearing times were evaluated on the postoperative first year follow-up and reviewed retrospectively. RESULTS: Our study suggests that use of double incisions in the surgery of associated fractures shortens the full weight-bearing time. The localization and the number of incisions were found to be unrelated with the Harris Functional Hip scale, SF-36 (PCS, physical component score), and SF-36 (mental component score, MCS) scores. CONCLUSION: Incision type and number of incisions must be determined based on the fracture type and fracture localization for better functional outcomes. The factors that have the most effects on the functional outcomes are the type and the localization. In associated fractures, performing multiple incisions reduces the time for full weight bearing and enables patients to return to their daily routine early but have no effect on the functional outcomes.

Sexual dysfunction of male, after pelvic fracture.

PURPOSE: Pelvic fractures are usually the result of high-energy trauma, and sexual dysfunction after a pelvic fracture is an often complication. Though organic pathologies can be the reason for sexual disorders, psychological factors following a trauma may also be linked to sexual problems. We aimed to evaluate the frequency of sexual dysfunction after pelvic fractures, and help these patients with their usually undisclosed sexual problems, and offer them support. MATERIALS AND METHODS: During a 4-year period, between June 2008 and May 2012, 40 male patients (out of 57) with a mean age of 42.6 years (range 18-65 years) were evaluated retrospectively. Patients having organic pathologies (vascular, neural, and urogenital system pathologies) were excluded from the study. Patients were requested to complete the Arizona Sexual Experience Scale (ASEX), which is a 5-item self-evaluation scale. According to the results of the questionnaire, patients needing supportive treatment were referred to the psychiatry department. RESULTS: Twenty-two patients (55 %) scored 10 points or less in the ASEX questionnaire (normal). Eighteen patients (45 %) had 11 points or more (can be problematic). Four of these 18 patients had a score of 19 points or more (needing psychiatric evaluation). Patients with a score of ≥19 points, for any one item with a score of 5 or 6 points, or any three or more items with a score of 4 points were considered to have a high probability of sexual dysfunction after psychiatric evaluation. CONCLUSION: The frequency of sexual dysfunction in pelvic fractured patients was tested, and the need for investigating sexual disorders is stressed. This study attracts attention to sexual dysfunction after pelvic fractures and the necessity of referring these patients to the related clinics, for treatment. LEVEL OF EVIDENCE: Retrospective case series.

Hydatid Disease of the Femur with an Extraosseous Extent due to a Former Biopsy Complicated by a Pathological Fracture.

Hydatid disease of the bone represents about 1-2.5% of all human hydatid disease. Spine is the most affected part of the skeleton with 50% incidence of all bone hydatidosis. Extraspinal bone hydatidosis is much rare. Diagnosis is difficult in the bone hydatid disease. Bone tumors, tumor-like lesions, and specific and nonspecific infections should be considered in the differential diagnosis. Radiological, laboratory, and clinical findings combined with strong element of suspicion are the key for diagnosis. Bone biopsies should be avoided because of the danger of anaphylaxis, sensitization, and spread. This paper describes the management of a patient with primary hydatidosis of the femur, which had been complicated by an extraosseous involvement, cortical erosion, and a pathological fracture due to a former needle biopsy.

Percutaneous Kirschner Wire fixation in distal radius metaphyseal fractures in children: does it change the overall outcome?

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the effect of Kirschner wire fixation after closed reduction of radial metaphyseal fractures with high risk of redisplacement. PATIENTS AND METHODS: In this retrospective study 40 cases were studied in two groups. In group 1 (n=20, average age 11.2 years), K-wire fixation was performed after closed reduction. In group 2 (n=20 average age 10.1 years), only plaster immobilization was applied following closed reduction. The compared clinical and radiological parameters were, pain, limb deformitiy, range of motion of the wrist, angulation of the fracture site, radial distal epipihyseal angle and severity of translation. RESULTS: Redisplacement rate was 10% in group 1 and 50% in group 2. This shows, Kirschner wire fixation has a positive effect in the maintanence of the initial reduction (p<0.05). Age, gender, reduction quality had no effect on redisplacement (p>0.05). Concerning the severity of translation, the risk of redisplacement increases in stage 3 (50%- 100%) and stage 4 (>100%) fractures (p<0,05). Concomitant complete ulnar fracture has also redisplacement risk (p<0.05). Redisplacement risk increases when the distance of fracture line to epiphyseal line was between 11-20 mm (p<0.05). There was no significiant difference between two groups after last evaluation based on radiological parameters and clinical results (p>0.05). CONCLUSIONS: This study shows that Kirschner wire fixation prevents redisplacement in early follow-up of first three weeks but there is no superiority after 20 months follow-up in distal metaphyseal fractures of children.

Avulsion fractures of both anterior and posterior cruciate ligament tibial insertions.

Ipsilateral femur fracture, patellar fracture, and tibial avulsion fractures of anterior and posterior cruciate ligament injuries are reported. We know of no other report of an injury such as this in the literature. We sutured the tibial avulsion fractures by transtibial suturing technique and internally fixated the femur by intramedullary interlocking nailing 2 weeks after the trauma. After 1 year the results were evaluated as very good. Early surgical repair is valuable in these injuries.

Arthroscopic mediopatellar plicaectomy and lateral retinacular release in mechanical patellofemoral disorders.

Arthroscopy was performed on 168 knees of 164 patients with anterior knee pain by a single arthroscopic surgeon between April 1993 and March 2000, with a mean follow-up of29 months. There were 168 mediopatellar plicae, 16 infrapatellar plicae, 8 suprapatellar plicae, and 30 lateral plicae, and all plicae were excised. Lateral retinacular release was performed in 74 patients with patellar lateral compression syndrome, patellar lateralization, and patellar lateral subluxation through anterolateral portal without using a third portal with the help of a hook knife. Débridement and drilling were performed in type 3 and 4 chondropathies (Outerbridge classification), and cartilage débridement was performed in type 2 chondropathies. We examined the effect on morbidity and prognosis of the arthroscopic lateral retinacular release through the standard anterolateral portal; the results of condylar chondropathies and débridement and drilling applied to the chondropathies were also evaluated. Mediopatellar plica was seen to play a mechanical role in the development of medial femoral chondropathy, which confirms that excision of plica is a prophylactic procedure. A further successful method is lateral retinacular release applied through the standard anterolateral portal with conventional methods without using a third portal at the cases with patellar lateral compression syndrome, patellar lateralization, and patellar lateral subluxation. Classical débridement and drilling methods are cheap and easy for the treatment of chondropathy. We consider these methods still to be useful methods of treatment.

Reliability of radiological parameters measured on anteroposterior pelvis radiographs of patients with developmental dysplasia of the hip.

In order to evaluate the reliability of radiological parameters, we retrospectively reviewed the anteroposterior pelvic x-rays of 30 hips in 15 patients with developmental dysplasia of the hip. The following parameters were studied: acetabular index, center-edge angle, c/b ratio, Sharp's angle and teardrop figure. Each of the two authors measured the parameters twice on two separate days. Statistical assessment of the interobserver and intraobserver reliability was performed. The measurements of acetabular index and c/b ratio were reliable according to both intra- and interobserver reliability analysis, whereas center-edge angle, teardrop figure and Sharp's angle evaluations were reliable in the intraobserver comparisons but not in the interobserver comparisons. In conclusion, both acetabular index and c/b ratio may be used safely in the evaluation of developmental dysplasia of the hip.