Augmented repair of acute tendo Achilles ruptures with gastrosoleus turn down flap.

BACKGROUND: We present the results of primary repair of acute tendo Achilles (TA) rupture augmented with gastrosoleus turn down flap technique. PATIENTS AND METHODS: 78 consecutive patients with a complete acute rupture of the Achilles tendon operated between 1993 and 2004 were included in study. We performed a modification of the Lindholm technique in which the primary Kessler suture repair of the tendon was augmented by a turn-down ~3 cm × 10 cm gastrosoleus aponeurosis flap. In all cases, a short-leg circular walking cast was applied at 90° of the ankle dorsiflexion for 3 weeks and all the patients were encouraged to full weightbearing ambulation immediately. After removal of the cast, isometric and isokinetic ankle exercises were performed for 3 weeks. Modified Rupp Score was used to evaluate the subjective satisfaction. RESULTS: All of patients returned to daily activity and 54 (69%) of them returned to previous sport activity. The tendon repair failed in two patients and they were reoperated with an allograft. Three patients developed infection and one of them required débridement. One developed deep venous thrombosis and two permanent sural nerve injuries were encountered. One of the patients had a severe skin necrosis, which was treated with rotation flap. The mean Rupp score was 29 (3-33). CONCLUSION: Primary repair of acute tendo Achilles rupture augment with gastrosoleus turn down flip technique in combination of immediate weightbearing ambulation provides a good outcome, but is associated with similar complication rates to the previous literature.

Asymmetrical bilateral traumatic hip dislocation in an adult with bilateral acetabular fracture.

This case report aims at presenting a unique case of simultaneous bilateral traumatic dislocation with right side anterior and the left side posterior together with bilateral acetabular fracture. Under general anesthesia, closed reduction of both hips was carried out. The case presented represents an unusual, severe combination of injuries resulting from a high-speed motor-vehicle accident. Traumatic hip dislocation represents a true orthopedic emergency. Given the severity of the associated complications, every effort should be made to ensure prompt diagnosis and immediate therapy.

Morel-Lavallee lesion. Results of surgical drainage with the use of synthetic glue.

OBJECTIVE: To evaluate the results of surgical drainage and use of synthetic glue in Morel-Lavallee lesions. METHODS: We treated 7 Morel-Lavallee lesions in Ankara Bayindir Hospital, Ankara, Turkey between April 2003 and June 2004. These lesions developed in 5 male patients due to crush under a vehicle or a traffic accident. The mean age was 32.8 years; range 16-55. All lesions were localized in thigh. One patient had surgery due to acetabulum fracture and one had an urological operation for urethral rupture. All patients were operated 6-48 hours after the injury. After surgical drainage, soft tissues were attached with the use of synthetic glue and compressive bandage was applied. We defined healing as the loss of fluctuation and elicitation of the normal mobility of the injured skin on manual examination. The mean follow-up was 11.6 months (range 8-20 months). RESULTS: One patient was operated for acetabulum fracture and had a bilateral Morel-Lavallee lesion 2 days after the operation. This patient was reoperated for drainage. All lesions were healed with a mean of 5 weeks (range 3-8 weeks). No infection, necrosis or recurrences were detected during the follow-up. CONCLUSION: Results of the treatment with the use of synthetic glue and surgical drainage in Morel-Lavallee lesion are satisfactory with early healing time without recurrence.

Surgical treatment of skier's thumb injuries: case report and review of the literature.

Inappropriate treatment of skier's thumb injuries has been reported to result in chronic painful instability, weakness of pinch, and arthritis. Therefore, surgical treatment is recommended for those fractures with 2 mm or more of displacement, or significant articular involvement with incongruency or rotation. The goal of surgery is restoration of anatomy with stable fixation. In this study we present some cases managed with internal fixation of the injury. This technique has the advantage of anatomic stable fixation with good outcome.

Arthroscopically assisted intra-articular lateral femoral condyle fracture surgery.

As with any other intra-articular fracture, the distal intra-articular femoral fracture has always been a challenge for orthopaedic surgeons because of the wide variety of trauma with which it is associated, and because associated soft-tissue injuries further augment its complexity. In articular fractures of the distal femur, arthroscopy allows rinsing of the articulation to visualize and also to assess intra-articular meniscal or ligamentous lesions, as well as the quality of the reduction. After a fall from a ladder, a 34-year-old man experienced a distal femoral intra-articular fracture (type B1) on the left side. Standard arthroscopic portals were used and the joint was irrigated and blood clots were evacuated. Through a lateral incision, 2 guidewires were placed perpendicular to the fracture. Cannulated 6.5-mm screws with washers were threaded over the guidewires and compression and anatomic reduction of the fracture site was obtained. The reduction quality was confirmed arthroscopically after irrigation. The fracture was shown to have healed radiographically and clinically by 3 months and the patient was back to work without limitations. Instead of using an arthrotomy for Müller type B1 lateral femoral condyle fractures, internal fixation assisted with arthroscopy will be a valuable technique with the advantage of identifying associated intra-articular pathology.