Factors Associated with Femoral Neck Shortening After Closed or Open Reduction and Screw Fixation.

PURPOSE: This study aimed to evaluate the incidence of femoral neck shortening (FNS) after the treatment of displaced and non-displaced femoral neck fractures with closed or open reduction internal fixation, and determine the independent factors associated with this condition. METHOD: The study included 81 patients who underwent internal fixation by closed or open reduction with multiple screws between 2013 and 2018 due to femoral neck fracture (FNF) and were followed up for at least 1 year. Patients were divided into two groups as with and without FNS. The patient, fracture, and surgical parameters compared between the two groups, and the factors affecting development of FNS were investigated. RESULTS: Internal fixation was applied by closed reduction in 56 patients (69.1%) and open in 25 (30.9%). FNS was detected in 41 patients (50.6%), with the mean shortening 6.3 ± 6.4 mm. Fracture union achieved in 72 patients (89%). The mean time to fracture union was 4.3 ± 2.3 months.No statistically significant relationship found between FNS and the parameters of gender, age, smoking, reduction type, number, type and orientation of screws, Singh index, and Garden fix index (p > 0.05).However, there was significant difference between two groups regarding energy of the fracture, fragmentation, coronal angulation, Garden type, and fixation with medial buttress plate (p < 0.05). CONCLUSION: FNS is an expected condition in FNF fixed by screws. Patients with high-energy traumas and advanced Garden types are more likely to have FNS. The use of medial plate may be effective in preventing FNS.

A comparison of clinical, radiological, and quality-of-life outcomes of double-plate internal and Ilizarov external fixations for Schatzker type 5 and 6 tibia plateau fractures.

PURPOSE: To compare clinical, functional, and radiological outcomes in patients with bicondylar tibial fractures treated with either double-plate or Ilizarov external fixation. METHODS: Patients with Schatzker type 5 and 6 tibial plateau fractures who were treated with double-plate (Group O) and Ilizarov external fixations (Group E) between March 2012 and April 2018 were selected. Demographic data and preoperative, intraoperative, and postoperative variables were analyzed and compared. In the last follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Knee Society Score-Knee (KSS-Knee), KSS-Function (KSS-F), and Short-Form Health Survey (SF-36) were used to measure clinical and functional outcomes. Treatment costs and complication rates were also recorded and compared. RESULTS: A total of 64 patients (43 men and 21 women) were included in the study (group O: 36, group E: 28). WOMAC, KSS-F, KSS-Knee, and OKS scores were similar between the two groups (P > 0.05). The role limitations due to emotional problems, emotional well-being, and social functioning domains of SF-36 were higher in group O (P < 0.001). Three (8.3%) deep infections occurred in group O, whereas no deep infection was observed in group E (P = 0.035). The treatment cost was higher in group O (P < 0.001). CONCLUSION: In bicondylar tibial plateau fractures, functional outcomes of ORIF and Ilizarov method milar were sibut, role limitations due to emotional problems, emotional well-being and social functioning domains of SF-36 score were higher in ORIF group. However, Ilizarov method is more cost-effective and related with lesser complications.

Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations.

BACKGROUND: To compare the efficacy, functional outcome, and complication frequency of splinting and external fixation in the initial treatment of ankle fracture-dislocations. METHOD: Ankles with poor soft tissue conditions who underwent temporary stabilization due to using a splint or external fixator due to an ankle fracture-dislocation between 2012 and 2019 were retrospectively evaluated. Ankles were divided into two groups as the splint (n=69) and external fixator (n=48). The time between the injury to definitive surgery, reduction loss, operation time, functional outcome, pain, and soft-tissue complication frequency before and after definitive surgery were compared. RESULTS: The frequency of reduction loss (25% vs. 4%, p=0.019) and skin necrosis (22% vs. 6%, p=0.028) were significantly higher in the splint group. Posterior malleolar fracture fragment ratio was calculated by dividing the fracture fragment axial length by the total axial length of the articular surface on computed tomography. Posterior malleolar fracture fragment ratio was found to be significantly higher in ankles with reduction loss in both the splint (25% vs 75%, p=0.032) and fixator groups (4% vs 96%, p=0.021). The mean time period between injury and definitive surgery was significantly shorter in the external fixator group (11±5 vs 7±4 days, p=0.033). Before definitive treatment, pin tract infection was observed in two ankles in the fixator group. CONCLUSION: Splint immobilization of ankle fracture-dislocations may predispose to reduction loss, soft tissue complications, and a longer time period between injury and definitive fixation. The risk of these potential complications can be reduced with the use of an external fixator.

Reconstruction of the Achilles tendon using quadriceps tendon graft in bilateral xanthomas secondary to familial hypercholesterolemia: A case report.

Achilles tendon xanthomas are rarely seen masses that are highly associated with hyperlipidemia. They are manifested in two types: Xanthomas developed secondary to familial hypercholesterolemia and cerebrotendinous xanthomatoses. In this report, we present a case of bilateral Achilles tendon xanthoma secondary to familial hypercholesterolemia and resection along with a portion of the Achilles tendon. The patient was a 49-year-old male who presented to our clinic with complaints of difficulty walking and swelling in both heels. The swellings had started insidiously without a trauma history. The xanthomas were operated at different time points, albeit with the same surgical technique. Quadriceps tendon graft and flexor hallucis longus transfer was used for autografting. Xanthoma should be considered in cases with swellings in the Achilles tendon. Total resection is necessary to avoid recurrence of the xanthomas. Large gaps formed after resection can be filled and reconstruction of the Achilles tendon can be realized using quadriceps tendon autografts (containing bony fragments) and the flexor hallucis longus tendon. We believe a functional ankle and an Achilles tendon can be achieved with the employment of this technique.

[Outcomes of four distinct fixation methods in the conservative treatment of fifth metacarpal neck fractures]. / Dört farkli tespit yöntemi ile konservatif olarak tedavi edilen besinci metakarp boyun kiriklarinin sonuçlari.

BACKGROUND: We evaluated four distinct fixation methods for the conservative treatment of neck fractures of the fifth metacarpal. METHODS: Patients in our clinics who were treated with non-surgical methods following closed reduction between 2008 and 2009 were evaluated prospectively. In this study consisting of 60 male patients, the following fixation methods were applied for four weeks: circular cast extending from the wrist to the distal interphalangeal (DIP) joint (Group A), circular cast covering semiflexed metacarpophalangeal (MCP) and DIP from the wrist to the DIP joint (Group B), circular self-adherent wrap covering metacarpal bones II-V, from the wrist to the DIP joint (Group C), and ulnar gutter splint covering semi-flexed IV-V MCP, proximal (PIP) and DIP joints (Group D). In patients who were followed up with anteroposterior (AP) and oblique radiography, angulations and metacarpal lengths were measured before and after reduction. RESULTS: Fifty-two patients with an average age of 30 (SD: 9) years completed the study. For fractures with radiographic angulation of 17 degrees (SD: 11) and 46 degrees (SD: 11.7) before treatment, union was achieved with an angulation of 5 degrees (SD: 5.9) and 27 degrees (SD: 10.5) after four weeks (p: 0.05). CONCLUSION: No statistically significant difference was found between the non-surgical methods applied for treatment of fifth metacarpal fractures.

Large diameter metal-on-metal total hip arthroplasty for Crowe IV developmental dysplasia of the hip.

The short-term results of middle-aged patients with severe developmental dysplasia of the hip treated with subtrochanteric femoral shortening and cementless large diameter metal-on-metal total hip arthroplasty were retrospectively evaluated. Clinical and radiological results of 15 hips of 13 patients with Crowe IV developmental dysplasia of the hip were enrolled in this study. The average follow-up period was 49 months (36-62 months). The average age of patients at the time of surgery was 45.5 years (range, 36-65 years). Radiographs were evaluated for component position, subsidence, loosening, and osteolysis. Intraoperatively, two patients had a small proximal femoral shaft split that was held with a cable wire. The average preoperative Harris hip score was 58; at 3 years, 82. Trendelenburg sign was negative in 11 hips at the last assessment. Loosening, subsidence, infection, dislocation, hypersensitivity and neurovascular complications were not observed. One hip had to be revised 1 year after surgery because of nonunion at the osteotomy site. Our study shows that large diameter metal-on-metal total hip arthroplasty, incorporating subtrochanteric femoral shortening, decreases dislocation rate and provides excellent results for the completely dislocated hip.

[Use of vacuum-assisted closure in the topical treatment of surgical site infections]. / Cerrahi alanda gelisen enfeksiyonlarin tedavisinde vakum yardimli örtüm sistemi uygulamalarimiz.

OBJECTIVES: This study was designed to evaluate the results of vacuum-assisted closure in the topical treatment of surgical site infections. METHODS: Vacuum therapy was performed in 17 patients (10 males, 7 females; mean age 60 + or - 20 years) using the VAC system (Vacuum-Assisted Closure, Kinetic Concept Inc) for the treatment of surgical site infections. Infective wounds were in the hip (n=6), crus (n=5), knee (n=3), sacrum (n=2), and hand (n=1). The causative organism for infections was gram-positive bacteria in 15 patients (88.2%), and six patients (35.3%) had nosocomial infections. The wounds were treated with a negative pressure of 100-125 mmHg applied continuously for the first two days, and then intermittently for the following days. The mean follow-up period was 11 + or - 6 months. RESULTS: The mean duration of vacuum therapy was 16 + or - 4 days and the mean length of hospitalization was 31 + or - 19 days. The patients underwent a mean number of three surgical procedures (range 1 to 6) before vacuum therapy. The mean amount of discharge from the wound was 500 + or - 150 ml. Tissue edema and discharge problems were resolved in all the wounds and a hygienic and dry-looking surgical site was attained. In 11 patients (64.7%), clinical and bacteriologic eradication of infections was achieved at the surgical site through antibiotic use and vacuum therapy. Six patients with nosocomial infections continued to receive antibiotic treatment following resolution of surgical site problems. The mean wound area showed a significant reduction from 36 + or - 14 cm(2) to 11 + or - 10 cm(2) following vacuum therapy (p<0.05). Only two patients (11.8%) required further surgical interventions for the closure of wound site. Two patients (11.8%) complained of pain associated with vacuum application. CONCLUSION: Besides its topical advantages in the care of infected wounds, vacuum-assisted closure provides a more rapid and comfortable treatment opportunity, representing a reliable alternative to conventional wound care methods.

[The results of non-surgical treatment for unstable distal radius fractures in elderly patients].

OBJECTIVES: This study was designed to evaluate anatomical and functional results of non-surgical treatment for unstable distal radius fractures in the elderly. METHODS: Twenty-nine patients (7 males, 22 females; mean age 72+/-2 years) aged = or > 65 years were treated with closed reduction and short-arm circular casting for unstable distal radius fractures. According to the AO classification, all patients had type C fractures. Anatomical and functional results were assessed using the Stewart criteria and Q-DASH (Quick-Disability of Arm, Shoulder and Hand) questionnaire, respectively. Bone mineral density measurements were performed. Grip strength and wrist range of motion were measured in comparison to the unaffected side. The mean follow-up was eight months (range 6 to 12 months). RESULTS: Union was achieved in all fractures within a mean of 4+/-1 weeks. Bone mineral density measurements showed osteoporosis in 22 patients (75.9%), and 26 patients (89.7%) had regional osteoporosis in cortical width measurements. After treatment, radiographic measurements showed the following: radius tilt angle +5.6+/-5.4 degrees , inclination angle 17+/-4.6 degrees , radial height 9+/-2.3 mm, and positive ulnar variance 2.8+/-2 mm. Five patients (17.2%) exhibited an articular step-off of less than 1 mm on the radial surface. According to the Stewart criteria, the results were good in 15 patients (51.7%), moderate in 12 patients (41.4%), and poor in two patients (6.9%). The mean Q-DASH score was 38+/-19.2 at three months, and 23+/-2.4 at final follow-up. Grip strength, extension/flexion, and pronation/supination were measured as 57.3+/-12.5%, 52+/-14%, and 75+/-16% of the unaffected side, respectively. Complications were seen in 11 patients (37.9%). Three patients (10.3%) developed malunion which required corrective osteotomy. CONCLUSION: Unstable distal radius fractures can be treated with closed reduction and cast application in low-demand elderly patients to avoid risks and complications of surgery.

Open minimally invasive Achilles tendon repair with early rehabilitation: functional results of 25 consecutive patients.

BACKGROUND: Various treatment techniques have been described for the treatment of acute Achilles tendon rupture. However, there is no consensus among orthopaedic surgeons regarding the surgical technique and the postoperative rehabilitation program. Mid-term functional outcome results of the patients who had undergone open minimally invasive repair of fresh Achilles tendon ruptures followed by an early rehabilitation programme were evaluated. METHODS: Twenty-five consecutive patients who underwent open minimally invasive repair of Achiles tendon ruptures during January 2004-October 2005 were independently reviewed at an average follow-up of 34 months (range 24-45 months). The mean age of the patients was 41 (35-47). A functional rehabilitation protocol based on early range of motion exercises was used after surgery. The American Orthopaedic Foot and Ankle Society score was used to evaluate the outcomes of the patients. Ankle range of motion; thigh, calf and ankle circumferences of the injured leg and the contralateral side, return to work and sports activities time were evaluated. RESULTS: One patient had a partial rerupture and one had superficial wound infection. The mean American Orthopaedic Foot and Ankle Society score was 93 (80-100). Patients returned to work at 3 weeks (range 1-5 weeks) and to preinjury sportive activities at 3 months (range 2-4 months). Ankle ROM and circumference measurements did not reveal a significant difference between the two sides. CONCLUSION: These results suggest that open minimally invasive Achilles tendon repair and an early rehabilitation programme provides satisfactory results with early return to previous functional status with low complication rates.

[Management of osteoporotic pertrochanteric fractures with external fixation in elderly patients]. / Osteoporotik yasli hastalarda pertrokanterik kiriklarin eksternal fiksasyonla tedavisi.

OBJECTIVES: We evaluated the results of osteosynthesis with external fixation for intertrochanteric hip fractures in elderly patients with a high anesthesia risk. METHODS: Fourteen ASA 4 patients (5 men, 9 women; mean age 75 years; range 65 to 81 years) with intertrochanteric hip fractures were treated with a unilateral external fixator under epidural anesthesia combined with mild sedation. According to the AO/OTA classification, six fractures were A1.2, seven fractures were A2.2, and one fracture was A3.1. All were closed fractures. The mean preoperative Singh index of the contralateral hip was 3.1 (range 3 to 5). Eleven patients received an AO tubular external fixator, and three patients received a unilateral external fixator. Final evaluations were made using the Parker-Palmer mobility score and Harris hip score. The mean follow up was 12 months (range 9 to 17 months). RESULTS: The mean operation time was 37 min (range 25 to 44 min), the mean fluoroscopy time was 1.5 min (1 to 2 min), and the mean hospital stay was seven days (5 to 15 days). None of the patients required blood transfusion. Bone union was obtained in all the patients in a mean of 4.1 months (3 to 5 months). The mean femoral shaft-neck angles in the early postoperative period and at the latest follow-up were 133 degrees (127 degrees to 139 degrees ) and 132 degrees (126 degrees to 138 degrees ), respectively. Five patients (35.7%) developed grade I pin-tract infection. Medial displacement of the distal fragment, limb shortening, or fixator failure were not seen. Three patients (21.4%) died within the first postoperative year due to associated diseases. The mean final Harris hip score was 61 (range 45 to 80) and the mean Parker-Palmer mobility score was 6.6 (range 5 to 8). CONCLUSION: Osteosynthesis with an external fixator in elderly patients with a high anesthesia risk is a fast, minimally invasive procedure in the treatment of pertrochanteric fractures, resulting in fewer pre- and postoperative complications.