An uncommon injury: Motorcycle chain injury of the hand, its socioeconomic outcome, and prevention.

INTRODUCTION: The aim of the study was to define the characteristics of motorcycle chain injuries leading to serious limb loss, evaluating its socioeconomic outcome. HYPOTHESIS: The severity of injury with motorcycle chain is associated with hospitalization day and morbidity. MATERIAL AND METHODS: Total of 3486 patients applied to the two Centers of the Hand Surgery Clinic and 42 of them with injuries originating from squeezed hands between the motorcycle chain and the rear sprocket were included. Injured extremities were evaluated with the MHISS. In the retrospective analyses, patients were divided into groups according to the severity of injury and compared and patients who underwent replantation, flap and primary repair treatment protocols were also compared. RESULTS: The number of patients with dominant hand injuries was 33 patients (78.5%). Inquiry of education level revealed that 24 (57.1%) patients graduated from primary school. According to MHISS, 76.2% of patients had major and severe injuries (mean: 95.05). Mean hospitalization time was 2.83 (range: 1-8) days. Mean time to returning to work was 2.71 (range: 1-5) months. The hospitalization days and return to work were longer in patients have major injury according to MHISS (p=0.006). The necrosis was observed three of the 9 (33.3%) replanted fingers. Flap necrosis was observed in two of the 15 (13.3%) cases. DISCUSSIONS: Most of these injuries are severe and major according to MHISS. As the severity of the injury increases, the duration of hospital stay and the return to work are prolonged. LEVEL OF EVIDENCE: IV; Economic/Decision Analysis.

Effect of boric acid on cartilage formation of osteochondral defects in rabbit knee: An experimental study.

BACKGROUND: The present study aimed to investigate the healing of articular cartilage with boric acid (BA) injection in an experimental cartilage defect model of rabbit knee. METHODS: Nine skeletally mature female New Zealand White rabbits were used. The right knees of the rabbits were assigned as the study group and injected with the BA solution and the left knees of the rabbits as the control group. Under anesthesia, a cylindrical full-thickness osteochondral defect (4 mm in diameter and 3 mm in depth) was formed using a drill on the anterior side of the articular surface of the medial femur condyle. The BA solution was administered to the right knees of rabbits in the form of an intra-articular injection (8 mg/kg) for 6 weeks, at the same day and hours each week. The animals were euthanized at the end of the 2nd month. RESULTS: In both macroscopic evaluation and microscopic evaluation, statistically significant differences were observed in the BA injection group compared with the control group (p<0.05). In the macroscopic examination of the defect area, statistically significant differences were observed between the groups in terms of degree of defect repair, integration to border zone, and macroscopic appearance (p<0.05). The averaged results of all evaluated parameters of the International Cartilage Repair Society visual histological assessment score were better for the BA group. CONCLUSION: The healing process of the cartilage injury could be improved by BA injection administration. In future, BA may safely be used as an additional treatment modality in clinical practice to enhance the healing process of cartilage injuries, which are commonly observed orthopedic problem.

Efficacy of calcium phosphate cementing in the surgical treatment of Sanders Type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

OBJECTIVE: This study aimed to determine the effectiveness of calcium phosphate cementing in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach. METHODS: In this retrospective study, 85 feet of 84 patients (74 males, 10 females; mean age 43 [17-61] years) in whom screw fixation was performed using the sinus tarsi approach for Sanders type II or III calcaneal fractures were included. The mean follow-up was 28 (14-39) months. Patients were categorized into 2 groups on the basis of whether calcium phosphate cement (CPC) was used. Group 1 had 37 patients with CPC (38 calcaneal fractures) and group 2 had 47 patients without CPC (47 calcaneal fractures). In the clinical assessment, the American Orthopedic Foot Ankle Society (AOFAS) hind foot score and the Maryland Foot Score (MFS) were used at the final follow-up. In the radiological assessment, Bohler's angle on plain radiograph and posterior facet step-off on computed tomography were measured pre-and postoperatively. RESULTS: At the final follow-up, the mean Bohler's angle was 26.2° (20°-33°) in group 1 and 26° (17°-30°) in group 2 (P = 0.85). The mean posterior facet step-off was 1.6 (0-5) mm in group 1 and 1.5 (0-5) mm in group 2 (P = 0.85). The mean AOFAS score was 83.8 (59-100) in group 1 and 85.8 (60-100) in group 2 (P = 0.5). The mean MFS was 86.3 (66-100) in group 1 and 87.7 (66-100) in group 2 (P = 0.62). CONCLUSION: Evidence from this study have shown that CPC may have no significant effect on clinical and radiological outcomes in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate.

Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17-88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

The effect of implant choice on varus angulation and clinical results in the management of subtrochanteric fractures.

INTRODUCTION: The aim of this study was to evaluate the effects of implant choice on varus angulation in the management of subtrochanteric fractures. METHODS: Between 2011 and 2016, 58 patients were included in the study and femur locking plate (PF-LCP; Group 1 = 27) and proximal femoral nails (PFN; Group 2 = 31) were compared retrospectively. RESULTS: In group 1, femoral NSA was measured 131,37 ± 1,95 and last follow-up angle was 127,33 ± 2,40. (p = 0,025). The mean Harris hip score was 67.59 ± 17.74 and 63.29 ± 13.83 in Group 1 and Group 2, respectively (p = 0.406). CONCLUSIONS: Plate fixation is not as successful as proximal nails at preventing varus angulation.

Lateral Locked Plating or Dual Plating: A Comparison of Two Methods in Simple Bicondylar Tibial Plateau Fractures.

BACKGROUND: In this study, our aim was to compare the results of the dual locking plate fixation technique and lateral locking plate fixation technique for tibial bicondylar plateau fractures without posteromedial fragment. METHODS: We evaluated 20 patients who underwent surgical treatment due to bicondylar tibial plateau fracture between 2010 and 2015. Ten patients were included in group 1, in which a dual locking plate was employed, whereas 10 patients were included in group 2, in which a lateral locking plate was used. In both groups, functional and clinical outcomes after treatment were rated according to the Knee Society Knee Scoring System, Rasmussen functional score, and Rasmussen radiological score. RESULTS: The mean follow-up time was 24 months. There were no significant differences between the groups with respect to functional and radiographic outcomes at the final follow-up. CONCLUSIONS: In bicondylar tibial plateau fractures without posteromedial fragment, the lateral locking plate fixation technique showed the similar clinical and radiological outcomes as the dual locking plate fixation technique.

Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

BACKGROUND: The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. MATERIAL AND METHODS: Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. RESULTS: Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). CONCLUSION: Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

Corrective Osteotomy for Coronal Plane Malunion of the Medial Femoral Condyle.

Medial femoral condyle malunion in the coronal plane is a very rare injury. In this presented case, we performed intra-articular corrective osteotomy for a malunited medial femoral condyle in the coronal plane of a 22-year-old man and obtained good functional and radiographic results. Corrective osteotomy for a malunited medial Hoffa fracture is technically very challenging, but intra-articular corrective osteotomy for these malunited fractures offers a good outcome and should be considered as a salvage treatment.

PRP on Prevention of Tunnel Enlargement in ACL Reconstruction.

BACKGROUND: The purpose of this study is to describe the role of Platelet Rich Plasma in preventing tunnel enlargement in anterior cruciate ligament reconstruction with a hamstring autograft Material and methods. Forty-four patients who underwent transtibial reconstructive surgery with a hamstring tendon autograft between March 2014 and July 2015 were included in this study. This study involved two groups. Group A consisted of 18 patients who underwent PRPadministration into the femoral and tibial tunnel. Group B was a control group that included 26 patients who underwent ACL reconstruction surgery with a hamstring autograft without PRP. The patients were evaluated preoperatively and postoperatively with the IKDC score, Lysholm score, Tegner activity scale and a KT-1000 arthrometer device. The diameter of the tibial and femoral tunnels of the operated knees was measured on the first day and at three months postoperatively using CT. Measurements carried out for tomography standardization of the patients were evaluated on coronal, sagittal and axial images from 64-slice MSCT scans. RESULTS: On comparison of radiological data between both groups, there was less tunnel enlargement in PRP-administered group for the femoral tunnel, but the result was not statistically significant. No difference was seen between clinical examination results and the grading scales used. CONCLUSIONS: 1. The radiological findings of our study indicated that while there was less tunnel enlargement in the PRP group, there was no statistically significant difference between the groups. 2. Similarly, clinical exa-mination results and scoring scales used did not de-monstrate any intergroup difference. 3. As a result, we donot recommend routine use of PRP for the prevention of tunnel enlargement after ACL reconstruction.

Comparison of Simple Decompression and Anterior Subcutaneous Transposition of the Ulnar Nerve for the Treatment of Cubital Tunnel Syndrome.

BACKGROUND: In this study, we aim to evaluate clinical and functional results in patients with cubital tunnel syndrome who were treated with subcutaneous anterior transposition vs simple decompression of the ulnar nerve. MATERIAL AND METHODS: Fifty-five patients were separated into two groups according to surgical technique. Group 1 comprised 35 patients (23 males, 12 females; mean age, 42.1 years; range, 28-56 years) who underwent anterior subcutaneous transposition of the ulnar nerve, whereas Group 2 included 20 patients (11 males, 9 females; mean age, 47.4 years; range, 25-59 years) who underwent simple decompression of the ulnar nerve. RESULTS: The mean modified Bishop scores were 7.26 and 7.85 in Group 1 and Group 2, respectively (P< .05). The mean Q-DASH scores were 16.94 in Group 1 and 15.80 in Group 2 (P> .05). Postoperatively, paraesthesia regressed in 17 (85.7%) and 30 (85%) patients in Group 1 and Group 2, respectively (P> .05). Both groups demonstrated improvement in ulnar nerve function in comparison with the preoperative period, and ulnar nerve paralysis was not seen in any of our patients. A postsurgical incision scar developed in six (17.1%) and three patients (15%) in Group 1 and Group 2, respectively. CONCLUSION: Both simple decompression and anterior subcutaneous transposition of the ulnar nerve are effective and safe for the treatment of cubital tunnel syndrome, so we would favour simple decompression as it is a less extensive procedure.

Subchondral raft construction with locking plates for the treatment of Schatzker type II fractures.

OBJECTIVES: To evaluate the functional and radiological results of Schatzker type II fractures treated via subchondral raft screws combined with locking plates. METHODS: Twenty-four individuals were enrolled in this study between 2010 and 2014. The depressed joint line was elevated and the defect was filled with allograft. Next, two or three subchondral screws were placed in combination with a locking plate. At the last follow-up, clinical and radiological data were recorded. RESULTS: The mean follow-up period was 21.4 months (12-39). The mean Knee Society Score (KSS) and Rasmussen clinical scores were 91.5 (range, 77-100) and 16.75 (range, 14-18), respectively. The mean Rasmussen radiological score was 27.9 (range, 24-30) during the follow-up. There was no statistically significant difference between injured and non-injured sides with respect to the mechanical axis, the proximal medial tibial angle, and tibial slope. In addition, arthritis showed no difference on the non-injured side, although follow-up was short. CONCLUSIONS: The periarticular raft construction combined with the locking plate helps surgeon to maintain the anatomic line of the joint and the mechanical axis obtained during the surgery. Secondary arthritis seems to be major complication after fractures of the tibial plateau, although the functional results were satisfactory. Level of Evidence IV, Case Series.

OBJETIVOS: Avaliar os resultados funcionais e radiológicos das fraturas de Schatzker tipo II tratadas com parafusos de plataforma subcondral em combinação com placas de trava. MÉTODOS: Vinte e quatro indivíduos foram selecionados para este estudo entre 2010 e 2014. A linha articular deprimida foi elevada e o defeito foi preenchido com aloenxerto. A seguir, dois ou três parafusos subcondrais foram colocados em combinação com uma placa de trava. No último acompanhamento, foram registrados os dados clínicos e radiológicos. RESULTADOS: O período médio de acompanhamento foi 21,4 meses (12-39). A média do Knee Society Score (KSS) e dos escores clínicos de Rasmussen foram 91,5 (faixa, 77-100) e 16,75 (faixa, 14-18), respectivamente. A média do escore radiológico de Rasmussen foi 27,9 (faixa, 24-30) durante o acompanhamento. Não houve diferença estatisticamente significante entre o lado com lesão e sem lesão, com relação ao eixo mecânico, ao ângulo medial proximal da tíbia e à inclinação tibial. Além disso, a artrite não apresentou diferença no lado sem lesão, embora o acompanhamento tenha sido curto. CONCLUSÕES: A construção de plataforma periarticular combinada com placa de trava ajuda o cirurgião a manter a linha anatômica da articulação e o eixo mecânico obtido durante a cirurgia. A artrite secundária parece ser uma complicação importante depois de fraturas do platô tibial, embora os resultados funcionais sejam satisfatórios. Nível de Evidência IV, Série de Casos.

Subchondral raft construction with locking plates for the treatment of Schatzker type II fractures / Construção de plataforma subcondral com placas de trava para o tratamento de fraturas do tipo II de Schatzker

ABSTRACT OBJECTIVES: To evaluate the functional and radiological results of Schatzker type II fractures treated via subchondral raft screws combined with locking plates. METHODS: Twenty-four individuals were enrolled in this study between 2010 and 2014. The depressed joint line was elevated and the defect was filled with allograft. Next, two or three subchondral screws were placed in combination with a locking plate. At the last follow-up, clinical and radiological data were recorded. RESULTS: The mean follow-up period was 21.4 months (12-39). The mean Knee Society Score (KSS) and Rasmussen clinical scores were 91.5 (range, 77-100) and 16.75 (range, 14-18), respectively. The mean Rasmussen radiological score was 27.9 (range, 24-30) during the follow-up. There was no statistically significant difference between injured and non-injured sides with respect to the mechanical axis, the proximal medial tibial angle, and tibial slope. In addition, arthritis showed no difference on the non-injured side, although follow-up was short. CONCLUSIONS: The periarticular raft construction combined with the locking plate helps surgeon to maintain the anatomic line of the joint and the mechanical axis obtained during the surgery. Secondary arthritis seems to be major complication after fractures of the tibial plateau, although the functional results were satisfactory. Level of Evidence IV, Case Series.

RESUMO OBJETIVOS: Avaliar os resultados funcionais e radiológicos das fraturas de Schatzker tipo II tratadas com parafusos de plataforma subcondral em combinação com placas de trava. MÉTODOS: Vinte e quatro indivíduos foram selecionados para este estudo entre 2010 e 2014. A linha articular deprimida foi elevada e o defeito foi preenchido com aloenxerto. A seguir, dois ou três parafusos subcondrais foram colocados em combinação com uma placa de trava. No último acompanhamento, foram registrados os dados clínicos e radiológicos. RESULTADOS: O período médio de acompanhamento foi 21,4 meses (12-39). A média do Knee Society Score (KSS) e dos escores clínicos de Rasmussen foram 91,5 (faixa, 77-100) e 16,75 (faixa, 14-18), respectivamente. A média do escore radiológico de Rasmussen foi 27,9 (faixa, 24-30) durante o acompanhamento. Não houve diferença estatisticamente significante entre o lado com lesão e sem lesão, com relação ao eixo mecânico, ao ângulo medial proximal da tíbia e à inclinação tibial. Além disso, a artrite não apresentou diferença no lado sem lesão, embora o acompanhamento tenha sido curto. CONCLUSÕES: A construção de plataforma periarticular combinada com placa de trava ajuda o cirurgião a manter a linha anatômica da articulação e o eixo mecânico obtido durante a cirurgia. A artrite secundária parece ser uma complicação importante depois de fraturas do platô tibial, embora os resultados funcionais sejam satisfatórios. Nível de Evidência IV, Série de Casos.

Atypical femoral shaft fractures secondary to long-term bisphosphonate therapy.

BACKGROUND: Bisphosphonates (BPs) are one of the most commonly used agents in the treatment of post-menopausal osteoporosis and other metabolic bone diseases. METHODS: Between 2010 and 2015, data of 22 osteoporotic women with femoral fractures due to low-energy trauma who received BPs previously were analysed. RESULTS: The mean duration of BP therapy was 7.6 years. The mean duration of union was 7.4 months. Five patients had non-union. Stress reaction was observed in the contralateral femur in 11 patients. CONCLUSION: Radiographic studies should be performed on a regular basis to prevent atypical femoral fractures in patients on long-term BP therapy.

Micro-computed tomography and mechanical evaluation of trabecular bone structure in osteopenic and osteoporotic fractures.

PURPOSE: Osteopenia and osteoporosis are the two most common musculoskeletal disorders in the elderly population. We determined whether osteopenic and osteoporotic patients with fractures exhibit differences in trabecular morphology and biomechanical properties of bone. METHODS: Fourteen osteopenic patients and 28 osteoporotic patients with hip fractures who underwent hemiarthroplasty for proximal femoral fractures caused by low-energy injury were included. Bone mineral density (BMD) measurements were performed. Compression tests and high-resolution micro-computed tomography were used to assess cancellous bone samples obtained from the principal compressive region of the femoral head. RESULTS: The BMD values were lower in the osteoporotic patients than in the osteopenic patients ( p < 0.05). There was a significant difference in the yield stress values between the groups ( p < 0.05). However, no significant differences in the strain energy density, stiffness and Young's modulus were observed between the groups ( p > 0.05). The mean maximum stress was significantly higher in the osteoporotic patients than in the osteopenic patients ( p < 0.05). Although structural parameters, including bone volume (BV), BV fraction, trabecular thickness, trabecular connectivity density and trabecular number, were higher in the osteopenic patients, the differences were not significant ( p > 0.05). Trabecular separation values were significantly higher in the osteoporotic patients ( p < 0.05). CONCLUSION: Our results showed that the trabecular morphology and biomechanical properties of bone were not significantly different between osteopenic and osteoporotic patients in terms of some parameters.

Screening for postoperative delirium in patients with acute hip fracture: Assessment of predictive factors.

AIM: The aim of the present study was to estimate the incidence and risk factors of delirium during the early postoperative period after hip fracture surgery. Furthermore, we investigated the accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for detection and assessment of delirium in orthopedic patients. METHODS: We consecutively recruited patients aged 65 years or older undergoing hip fracture surgery. The presence of delirium was determined daily by two of the authors according to the CAM-ICU criteria. A further evaluation was made with the reference standard Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria for delirium. Their cognitive function was evaluated with the Mini-Mental State Examination, and possible depressive mood with the Beck Depression Inventory. Baseline characteristics, as well as the American Society of Anesthesiologists classification and clinical outcomes, were analyzed for a correlation with accompanying delirium. RESULTS: Among 109 patients, 20 (18.3%) were diagnosed with delirium. The concurrent validity of CAM-ICU was good (kappa = 0.84). Specificity was 98.9%, and sensitivity was 80%. Multivariate regression analysis showed that Mini-Mental State Examination (P = 0.001; odds ratio 0.75, 95% confidence interval 0.65-0.86) and Beck Depression Inventory scores (P = 0.001; odds ratio 1.13, 95% confidence interval 1.05-1.22) correlated with the occurrence of delirium. CONCLUSIONS: The present results show that CAM-ICU is highly sensitive and specific to identify delirium in hip fracture patients in the postoperative period. Among all of the risk factors, cognitive impairment and depressive mood were strongly associated with postoperative delirium. We suggest that a preoperative assessment of cognition and depression might be useful for identifying patients with a higher risk of postoperative delirium. Geriatr Gerontol Int 2017; 17: 919-924.

Radiofrequency Thermal Lesioning and Extracorporeal Shockwave Therapy: A Comparison of Two Methods in the Treatment of Plantar Fasciitis.

We compared the results of radiofrequency thermal lesioning (RTL) and extracorporeal shockwave therapy (ESWT) in patients with chronic plantar fasciitis. This prospective study included 56 patients diagnosed with plantar fasciitis who had complaints for ≥6 months: 40 (group 1) underwent ESWT and 16 (group 2) underwent RTL. The presence of calcaneal spurs was investigated with imaging studies. All patients were followed up clinically at baseline and 1, 3, and 6 months after treatment. Clinical evaluations were performed by the visual analog scale (VAS) and the modified Roles-Maudsley (RM) scoring system. There was no significant difference in the age, sex, body mass index, and side of involvement between the groups (all P > .05). Radiographic evaluation showed calcaneal spurs in 22 patients (55%) in group 1 and 7 patients (43%) in group 2. There was no significant difference in the baseline and posttreatment values between the groups; however, group 2 had significantly different RM values at 1 month than group 1 ( P < .05). In both groups, the VAS scores significantly decreased at 1, 3, and 6 months after treatment ( P < .05). The RM scores at 1, 3, and 6 months after treatment significantly decreased in both groups, except for the RM values at 1 month after treatment in group 1 ( P < .05). Our study results suggest that RTL and ESWT are safe and effective treatments in patients with chronic plantar fasciitis. LEVELS OF EVIDENCE: Level II: Therapeutic study.

Total Matricectomy and V-Y Advancement Flap Technique in the Treatment of Onychogryphosis.

BACKGROUND: Onychogryphosis is manifested by irregular thickening and curving of nails and the nailfold, resulting in ram horn appearance. No therapeutic modality that can normalize nails with onychogryphosis is yet available. Recommended therapies include palliative measures and various surgical interventions. OBJECTIVE: The authors reviewed the outcomes of total matricectomy and V-Y advancement flap technique used for nail removal in patients with onychogryphosis at the big toe. MATERIALS AND METHODS: The authors evaluated 14 patients with onychogryphosis, including 8 men and 6 women (15 big toes; 10 at the right foot and 5 at the left foot), who underwent total matricectomy and V-Y advancement flap technique. The general complaints included repeated nail removal, pain, cosmetic complaints, and difficulty in wearing shoe and footwear. RESULTS: Mean age of the patients was 42.4 years. Mean follow-up was 13.5 months. Clinical history revealed at least 2 previous nail removals. No complications were observed during the follow-up period. Mean time to return to daily activities was 4.5 weeks. Patient satisfaction was rated as very good in 9 patients and good in 5 patients. CONCLUSION: The surgical technique employed in patients with onychogryphosis is a safe treatment option with a high success rate.

[Comparison of 90° and 180° plate constructions for comminuted distal humerus fractures in adults, and effects on clinical results]. / Eriskin humerus alt uç eklem içi parçali kiriklarda 90° ve 180° plak uygulamalarinin karsilastirilmasi ve klinik sonuçlar üzerine etkisi.

BACKGROUND: The present objective was to compare 90° and 180° double-plate constructions for complex distal humerus fractures, as well as to evaluate superiority of construction type. METHODS: Retrospectively evaluated were 17 patients treated for type C distal humerus fracture according to AO/ASIF classification between January 2009 and January 2013. All attended minimum 6-month follow-up. Elbow function was assessed with anteroposterior and lateral x-ray, and Mayo elbow performance score evaluation at outpatient clinics. RESULTS: Patient population included 14 males (82.3%) and 3 females (17.7%). Mean patient age was 40.5 years. According to AO/ASIF distal humerus classification, 3 (17.7%) type C1, 9 (52.9%) type C2, and 5 (29.4%) type C3 fractures were included. Six were open fractures (35.3%). According to Gustilo-Anderson classification, 4 (23.5%) fractures were type 1, and 2 (11.7%) were type 2. Construction performed was 90° in 11 cases (64.7%) and 180° in 6 cases (36.3%). Chevron osteotomy was performed in all cases. Mean follow-up period was 25.6 (6-52) months. Upon final examination, mean elbow flexion was 105º (85º-130º), and mean extension loss was 10º (0º-20º). According to Mayo elbow performance scoring system, 12 (70.5%) results were excellent, and 5 (29.5%) were good. No statistically significant clinical difference was found between 90° and 180° plate construction groups (p=0.169). DISCUSSION: Surgeons should determine the construction type appropriate to individual cases of adult distal humerus type C fractures using preoperative x-rays and intraoperative means. Choice of construction type has particular importance in cases of lateral columnar fracture complexity. If no comminution is present in the lateral column, 90º double-plating leads to satisfactory outcome, while 180º plating leads to satisfactory outcome when comminution is present in the lateral column.

Total hip arthroplasty in the developmental dysplasia of the hip using transverse subtrochanteric osteotomy.

BACKGROUND: We assessed the results of the transverse subtrochanteric femoral shortening osteotomy technique and the cementless THA process applied to Crowe type III and IV patients with developmental dysplasia of the hips. METHODS: We retrospectively evaluated 25 patients (32 hips) between 2006 and 2014. RESULTS: The mean follow-up time was 5.1 years. The mean preoperative Harris hip score was 49.5, which increased to 87.1 postoperatively. The mean preoperative leg-length discrepancy was 3.6 cm; the mean postoperative discrepancy was 0.5 cm. CONCLUSION: THA with subtrochanteric femoral shortening osteotomy technique is an effective technique for treating developmental dysplasia of the hip.

Migration of a Broken Kirschner Wire after Surgical Treatment of Acromioclavicular Joint Dislocation.

Kirschner wire (K-wire) is one of the commonly used implants in orthopaedics practice. Migration of the wire is one of the most frequently reported complications after fixation by the K-wire. In particular, it has been reported that a greater range of motion in the shoulder, negative intrathoracic pressure associated with respiration, gravitational force, and muscular activities may cause migration from the upper extremities. In general, thin and long foreign bodies with smooth surfaces that are localized within the tendon sheath and at an upper extremity can migrate more readily and can reach longer distances. Here, we present a patient with long-term migration of a broken K-wire who underwent fixation for acromioclavicular joint dislocation 5 years ago.