[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.

[Changes in patellar height and tibia inclination angle following open-wedge high tibial osteotomy]. / Açik kama yüksek tibia osteotomisi sonrasinda patella yüksekligi ve tibial egim açisindaki degisiklikler.

OBJECTIVES: We investigated changes in patellar height and tibial inclination angle after open-wedge high tibial osteotomy and the effect of these changes on patient satisfaction. METHODS: The study included 18 knees of 16 patients (4 males, 12 females; mean age 55 years; range 44 to 66 years) who underwent open-wedge proximal tibial osteotomy with autogenous bone graft and medial plate for medial compartment gonarthrosis. Nine knees (50%) had Ahlbäck grade I, eight knees (44.4%) had grade II, and one knee (5.6%) had grade III osteoarthritis. Pre- and postoperatively, femorotibial angle, tibial inclination angle, and patellar height were measured according to the Bauer, Harvey-Moore, and Blackburne-Peel methods, respectively. Clinical evaluations were made using the Lysholm-Gillquist score. Patient satisfaction was questioned with a 10-point scale. The mean follow-up was 54.2 months (range 25 to 96 months). RESULTS: Postoperatively, the mean correction of the femorotibial angle was 13.6 degrees (p<0.05), and the mean increase in the tibial inclination angle was 2.9 degrees (p<0.05). Fifteen knees (83.3%) exhibited a significant decrease in patellar height by a mean of 15% (p<0.05). The mean Lysholm-Gillquist score increased from preoperative 61 to 86 at the latest follow-up (p<0.05). The results were excellent in 11 knees (61.1%), good in six knees (33.3), and poor in one knee (5.6%). The mean patient satisfaction score was 8.1 (range 5 to 10). Changes in the femorotibial angle and Lysholm-Gillquist score were significantly correlated with patient satisfaction (p<0.05). Three patients had nonunion, perioperative intra-articular fracture, and superficial wound infection, respectively. CONCLUSION: Changes in the tibial inclination angle and patellar height following open-wedge tibial osteotomy do not have an adverse effect on short-term patient satisfaction.

[Surgical management of unstable both-bone forearm fractures in children]. / Cocuklarda instabil önkol çift kiriklarinin cerrahi tedavisi.

OBJECTIVES: We evaluated the results of two different surgical methods for the treatment of unstable both-bone forearm fractures in children. METHODS: Thirty-five children with unstable both-bone forearm fractures were retrospectively evaluated. Of these, 14 patients (group 1; 4 girls, 10 boys; mean age 13 years; range 10 to 15 years) underwent open reduction and plate-screw fixation, and 21 patients (group 2; 5 girls, 16 boys; mean age 11.5 years; range 8 to 13 years) underwent closed reduction and intramedullary fixation. All the fractures in group 1 were closed, while, in group 2, there were 15 closed and six type 1 open fractures. The mean time to surgery was 4.3 days in group 1, and 3.1 days in group 2. The results were assessed using the criteria of Price et al. The mean follow-up was 34 months in group 1, and 37 months in group 2. RESULTS: Nonunion was observed in only one patient in group 1. The mean time to union was 7.2 weeks (range 6 to 11 weeks) in group 1, and 6.5 weeks (range 6 to 10 weeks) in group 2. According to the criteria of Price et al., the results in group 1 were perfect in 11 patients (78.6%), good in two patients (14.3%), and fair in one patient (7.1%). In group 2, 18 patients (85.7%) had excellent, three patients (14.3%) had good results. Complications were major in three patients (21.4%) and minor in two patients (14.3%) in group 1, compared to one major (4.8%) and eight minor (38.1%) complications in group 2. None of the patients had limb-length discrepancy, joint deformity, angular or rotational deformity, or complications such as synostosis and infection. CONCLUSION: It was concluded that intramedullary nailing was safe, effective, and easy to perform in the management of unstable both-bone forearm fractures in children.