Treating symptomatic flexible flatfoot deformities. a novel technique: comparison of uc berkeley laboratory foot orthosis with and without kinesio taping in juvenil athletes.

PURPOSE: Symptomatic flexible pes planus (SFPP) can cause pain and discomfort when walking or engaging in sportive activities in children and adolescents. SFPP can be treated conservatively with foot orthoses, such as the University of California Berkeley Laboratory (UCBL) foot orthosis, which can improve foot function and reduce pain. Kinesio Tape (KT) has also been used as an adjunct to foot orthoses in the treatment of pes planus. This study aims to compare the effectiveness of the UCBL foot orthosis with and without KT in the treatment of SFPP among amateur juvenile and adolescent athletes. METHODS: Fifty patients with SFPP were included in the study. In 27 patients UCBL foot orthosis with KT (group 1) was used whereas in 23 UCBL (group 2) was preferred only. The patients were evaluated with AOFAS and radiological measurements. RESULTS: The mean follow-up period was 28.6 ± 4.3(26) months. At the final follow-up AOFAS of group 1 was significantly higher than group 2. In group 2, 12 patients (%52,17) had pressure sores that caused superficial dermabrasion. Lateral TFMAs and talocalcaneal angle in group 1 was significantly better than group 2. CONCLUSIONS: This study attempted to determine if using KT with the UCBL foot orthosis was beneficial to the treatment of SFPP compared to simply wearing the orthosis. Our results suggest that KT is effective in reducing pronation and improving the AOFAS score. The use of UCBL with KT seems to be preferable in children and adolescents with SFPP since it is associated with a lower rate of complication, a higher degree of patient compliance and faster improvement in the radiological and clinical findings, compared to the use of the UCBL orthosis alone.

Effect of transported segment size on the new bone formation of the rabbit femur in the Ilizarov bone transport method.

OBJECTIVE: This study aimed to compare histological and radiological union in the bone transport of 3 segments of different sizes to reconstruct the rabbit femur's bone defects. METHODS: Thirty rabbits were divided into 3 groups; a 1-cm defect was created in the femur in all rabbits. The length of the segment to be transferred was 10% of the femur length in group 1, 15% in group 2, and 20% in group 3. All defects were reconstructed by applying bone transport. At the end of the consolidation period, the distraction zone was compared radiologically and histologically. RESULTS: While there was no radiological difference between the groups, the highest histological scores were obtained from group 3. Osteocalcin staining revealed similar involvement in groups 2 and 3, butless involvement in group 1. CONCLUSION: Evidence from this study has shown that as the size of the segment used for bone transport increases, more stable fixation and better histological union tissue can be obtained in the rabbit femoral defect model.

Comparison of three different approaches for anterior knee pain after tibia intramedullary nailing.

PURPOSE: The aim of this study was to compare anterior knee pain and functional outcomes in patients who underwent intramedullary tibial nailing using transpatellar, medial parapatellar or suprapatellar nail entry methods. METHODS: We retrospectively reviewed patients who underwent tibial fracture repair in our clinic between January 2010 and March 2017. After applying the exclusion criteria, 58 patients were included in the study. Patients were divided into 3 groups based on the nailing approach: medial parapatellar, transpatellar or suprapatellar. Age, body mass index, follow-up duration, Kujala Score, Lysholm Knee Score, anterior knee pain, length of hospitalization and surgical duration were assessed. RESULTS: Of the 58 patients studied, 21 underwent a transpatellar (TP) approach, 16 a medial parapatellar (MP) approach, and 21 a suprapatellar (SP) approach. The mean Kujala Score of patients who had the TP approach was 80 ± 7.15 (72-93) and the average Lysholm Knee Score was 80.23 ± 8.74 (70-95). There was no statistically significant difference between Kujala Scores (p = 0.38) or Lysholm Knee Scores (p 0.06) among the groups; similarly, no statistically significant difference was found among the three groups in terms of anterior knee pain, length of hospitalization or surgical duration (p > 0.05). CONCLUSION: The suprapatellar tibia nailing method is as safe and reliable as transpatellar and medial parapatellar methods in terms of effect on postoperative anterior knee pain and functional outcomes. LEVEL OF EVIDENCE: Level 3 case-control study.

Primary bone tumors and tumor like lesions of the ulna.

OBJECTIVE: The aim of this study was to discuss the diagnosis and surgical management and their results according to stage of primary bone tumors at ulna and to share our experience on this exceptional location for bone tumors. METHODS: We have retrospectively reviewed our clinics database and identified 23 cases (14 males and 9 females, mean age was 28.9 (range 4-77)) with primary bone tumors and tumor like lesion involvement of ulna. The patients were evaluated according to complaints, type and grade of tumor, treatment, recurrence and functional status. RESULTS: The most common first referral complaint was constrictive pain in 52.1% of the cases, benign tumors and tumor like lesions of the bone constituted 73.9% whereas malignant bone tumors were 26.1%, 39.1% of the lesions were located in distal end of ulna and the mean follow up was 33.8 months (range 8-172 months). Local recurrence has unexpectedly occurred in 3 benign lesions (13.1%). CONCLUSION: Benign bone lesions tend to involve distal and proximal ends, malign bone lesions involve diaphysis mostly. Both benign and malignant diaphyseal lesions of the ulna have better postoperative results regarding the lesions at both ends of ulna. One should also take care of recurrences even after a decade from the primary surgery. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Surgical Treatment of Confirmed Intraosseous Lipoma of the Calcaneus: A Case Series.

Intraosseous lipoma of the calcaneus is a benign lesion formed by mature adipose tissue. When the lesion is symptomatic, the most frequent presentation is localized pain and soft tissue swelling. Because these lesions can regress spontaneously, conservative treatment methods are recommended. Operative excision is mostly required for painful lesions and pathologic fractures. The data from 14 patients with calcaneal intraosseous lipoma, who had undergone surgery in our clinic, were evaluated retrospectively. Using Milgram's classification system, 9 lesions were classified as stage 1, 4 as stage 2, and 1 as stage 3. All lesions were occupying 100% of intracalcaneal cross-section in the coronal plane and >30% in the sagittal plane of magnetic resonance imaging sections. The mean preoperative visual analog scale score was 5.29 ± 1.14 (range 4 to 7), and the mean postoperative visual analog scale score at the last follow-up visit was 1.14 ± 0.36 (range 1 to 2), which was significantly better (p < .01). The mean Maryland foot score at the last follow-up visit was 97.71 ± 2.02 (range 95 to 100). The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score was 97.86 ± 2.11 (range 94 to 100) at the last follow-up visit. The differences between the pre- and postoperative values were statistically significant (p < .01). No recurrence had been detected within a median follow-up period of 84 months. Operative management of symptomatic lesions related to intraosseous lipoma of the calcaneus provides better results compared with the preoperative state.

Is intact fibula a disadvantage in treatment of tibial diaphysis fracture with intramedullary nailing?

BACKGROUND: The aim of this study was to compare solitary tibial diaphysis fractures and tibial diaphysis fractures associated with fibula fracture treated with the intramedullary nailing method. METHODS: Records of 254 patients diagnosed with tibial diaphysis fracture and treated with intramedullary nailing between 2010 and 2013 were examined and 30 patients were included in the study. Group 1 comprised patients with solitary tibial diaphysis fracture, and Group 2 was made up of patients with tibial diaphysis fractures associated with fibula fracture. Patients in both groups were compared in terms of time to surgery, duration of surgical tourniquet, time to union, and varus, valgus, recurvatum, and antecurvatum deformities of the tibia at final follow-up. RESULTS: No statistically significant difference was found between the 2 groups in time to surgery, duration of surgical tourniquet, time to union, or varus, valgus, recurvatum, and antecurvatum deformities. CONCLUSION: Results indicated that intact fibula in tibial diaphysis fracture treated with intramedullary nailing was not a disadvantage; it did not affect rate of union or lead to loss of reduction, non-union, or malunion.

Simultaneous bilateral correction of genu varum with Smart frame.

PURPOSE: The aim of this study is to evaluate clinical and radiological results of simultaneous bilateral correction of genu varum with Smart frame. METHODS: Between 2011 and 2015, a total of 25 patients (10 females, 15 males) who had bilateral genu varum deformity were operated bilaterally with tibial and fibular osteotomy in the same session, using Smart frame. The mean follow-up period was 28.7 (range, 13-45) months. All patients had bilateral tibial varus deformity. Femoral deformity was corrected in an earlier session in nine patients. Mechanical axis deviation (MAD), mechanical lateral distal femoral angle, mechanical medial proximal tibial angle (mMPTA) and posterior proximal tibial angle (PPTA) were measured preoperatively and postoperatively. Short Form-36 questionnaire was filled by the patients preoperatively and during the last follow-up. RESULTS: The mean preoperative MAD was 37.6 mm (range, 9-98 mm), which improved to 8.4 mm (range, 3-44 mm) postoperatively ( p < 0.05). The mean preoperative mMPTA was 76°, which improved to 89° ( p < 0.05). The mean preoperative PPTA was 75.5°, which improved to 80.3 ( p < 0.05). Ten problems (20%), two obstacles (4%) and no sequelae occurred in 50 legs of 25 patients. CONCLUSIONS: In conclusion, Smart frame is an accurate and reliable method for performing bilateral simultaneous deformity correction in patients with bilateral genu varum deformity. It can be applied for various childhood-induced severe tibial deformities such as achondroplasia, rickets, skeletal dysplasia and Blount's disease.

Use of a magnetic bone nail for lengthening of the femur and tibia.

PURPOSE: To report our experience with the PRECICE nail for limb lengthening in 23 patients. METHODS: Records of 15 female and 8 male patients aged 14 to 38 (mean, 23.6) years who underwent lengthening of the tibia (n=6) or femur (n=21) using the PRECICE nail were reviewed. The reasons for lengthening included trauma (n=7), hemihypertrophy (n=2), focal femoral deficiency (n=2), Ellis-van Creveld syndrome (n=1), hip septic arthritis sequelae (n=1), hereditary multiple exostosis (n=1), club foot sequela (n=1), congenital tibial pseudoarthrosis (n=1), fibrous dysplasia (n=1), idiopathic limb length discrepancy (n=7), and cosmetic (n=1). RESULTS: The mean follow-up duration was 20.72 months. The mean lengthening was 48.20 mm, and the mean acute angular correction was 15.5º. The mean time to full weight-bearing was 5.15 months, and the mean consolidation index was 1.12 months/cm. The mean maturation index was 0.78 months/cm. One patient had nail breakage during the consolidation phase. The nail was replaced by an intramedullary nail until consolidation, after which another PRECICE nail was used to treat the residual shortening. Eight patients had over-lengthening and the nails were driven back to the desired length. No patient had infection. CONCLUSION: The PRECICE nail is a viable option for lengthening of the femur and tibia.

Percutaneous radiofrequency ablation for osteoid osteoma under guidance of threedimensional fluoroscopy.

PURPOSE: To evaluate the outcome of percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy in 17 patients with osteoid osteoma. METHODS: Records of 11 male and 6 female consecutive patients aged 4 to 28 (mean, 13.8) years who underwent radiofrequency ablation under guidance of 3-dimensional fluoroscopy for osteoid osteoma and were followed up for a mean of 15.8 (range, 12-28) months were reviewed. All patients had been treated with analgesics but failed to achieve lasting pain relief. Visual analogue score (VAS) for pain was assessed pre- and post-operatively. Absence of pain was considered recovery. RESULTS: The mean operating time was 55 (range, 20-95) minutes, and the mean length of hospital stay was 2.8 (range, 2-7) days. The mean amount of radiation was 390.2 (range, 330.5-423.6) mGy/cm. Relief of pain occurred within the first 24 hours in 11 patients and by the end of the first week in 3 patients. Pain persisted in 3 patients at one month; they underwent revision surgery and achieved complete recovery. The mean VAS for pain was 7.2 (range, 6-9) in 17 patients preoperatively and decreased to 0.64 (range, 0-2) in the 14 patients with pain relief and 0.66 (range, 0-1) in the 3 patients after revision surgery. Two patients had severe discharge from the wound secondary to fat necrosis, which resolved within a week with antibiotics and local dressings. No patient had cellulitis, vasomotor instability, neurovascular injury, fracture, or deep infection. CONCLUSION: Percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy is a viable treatment option for osteoid osteoma.

The effect of simple local resection on pain and scoliotic curve in patients with scoliosis secondary to osteoid osteoma and osteoblastoma in the spine.

OBJECTIVE: The aim of this study was assess the results of local resection without instrumentation in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma. METHODS: The review of our database revealed 176 cases of osteoid osteomas and 18 of osteoblastomas. Painful scoliosis was seen in 5 out of 6 cases. The lesion was found on the posterior part of the apical vertebra in the concave side of the scoliotic curve. Surgical treatment consisted of simple en bloc excision. Mean period between diagnosis and operation was 2.6 years, mean age at the time of surgery was 12.5 years, and mean preoperative major Cobb angle was 37.2°. RESULTS: Four patients with a mean follow-up of 4.3 years were included in the study. At final follow-up, Cobb angle was 7.6°, and the average percentage of correction was 79.6%. Coronal decompensation was corrected by 87.7%. Pelvic tilt and shoulder imbalance were corrected by 15% and 74.5%, respectively. The preoperative mean Visual Analog Scale score was 9 before the treatment and 0 at the final follow-up. CONCLUSION: Our results suggested that simple en bloc resection may be a safe and effective treatment option in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma, if patient less than 16 years, with major Cobb angle less than 40°, and duration of complaint less than 22 months.

[Retrospective analysis of AO 42A-B type tibia fractures treated with percutaneus locked plating and intramedullary nailing]. / AO 42A ve 42B tipi tibia kiriklarinda uyguladigimiz perkütan kilitli plak ve intramedüller çivi tespit sonuçlarinin geriye dönük analizi.

BACKGROUND: In this study, the results of AO 42A and 42B type tibia fractures treated with intramedullary nail (IMN) and percutaneus locking plate (PLP) were evaluated. The complications were examined, and it was questioned whether the type of fixation had an effect on union time and functional results. METHODS: Forty-two patients with extraarticular distal tibial fractures were enrolled in this retrospective study. Eighteen patients were treated with closed IMN (Group I) and 24 patients were treated with PLP fixation (Group II). Mean age was 41 (range: 16-70) years; thirty-two of the patients were men. Fractures were classified according to the AO classification system. Union time, functional results and complications (malunion, malalignment, infection) were compared. The American Orthopaedic Foot and Ankle Surgery (AOFAS) scoring was used to compare functional results. RESULTS: The average follow-up period was 20 (12-32) months for Group I and 23 (13-36) months for Group II. The average union time was 16 (12-24) weeks in Group I and 19 (range: 16-24) weeks in Group II (p=0.002). The AOFAS scoring was 85 (range: 69-100) points in Group I and 81 (range: 60-95) points in Group II. The difference in AOFAS scoring was not significant (p=0.06). Two patients had nonunion in Group II. Two patients in Group I and three patients in Group II had malalignment. DISCUSSION: We suggest that IMN can provide early healing time. Although it is not statistically significant, complication rate was lower and functional results were better in patients treated with IMN.

Prospective comparative study of two methods for fixation after distal femur corrective osteotomy for valgus deformity; retrograde intramedullary nailing versus less invasive stabilization system plating.

INTRODUCTION: The aim of this study was to compare the radiological and functional results of two different methods of fixation for the correction of femoral valgus deformities. METHODS: Patients who had undergone osteotomy and correction of a valgus deformity from 2007 to 2013 were prospectively followed. Thirty three patients (20 females, 13 males) with 39 lower limbs were included in the study. Seventeen lower limbs were treated with retrograde intramedullary nailing (IMN) and 22 with less invasive stabilization system plating. Standing orthoroentgenograms of the lower limbs were taken pre-operatively and at the final follow-up. mLDFA, aLDFA, mechanical axis deviation (MAD) were measured in this orthoroentgenograms. Knee osteoarthritis outcome score (KOOS) and knee range of motion were used pre-operatively and at the final follow-up as part of the evaluation of the clinical results. All patients duration of surgery, length of hospital stay were assessed. Operations were performed by two orthopedic surgeons. The choice of correction method for each patient was determined by the surgeon. Pre-operative and post-operative values were simultaneously measured by two additional orthopedic surgeons. RESULTS: The mean age of the patients was 26.2 years (18.0-51.0) in the plating group and 29.3 years (18.0-55.0) in the nailing group. Patients in the plating and nailing groups were followed up for 24.0 (12.0-60.0) and 27.8 (12.0-60.0) months. All patients were followed for a minimum of 12 months. No significant differences were observed between the groups in terms of age, sex, or duration of follow-up (p > 0.05) Comparison of the pre- and post-operative mLDFA, aLDFA, MAD, length of hospital stay, and duration of surgery between the plating group and nailing group, no significant difference was observed between the groups (p > 0.05). However, patients treated with retrograde IMN had significantly better post-operative results in terms of the KOOS and range of motion of the knee according to plating group (p < 0.05). CONCLUSION: Retrograde IMN does not provide a radiological advantage over the LISS plating technique for valgus deformity but retrograde IMN and correction offered better functional results in cases of femoral valgus deformity than did the LISS plating method.

Cheilectomy as a First-Line Surgical Treatment Option Yields Good Functional Results in Grade III Hallux Rigidus.

BACKGROUND: This study aimed to analyze the functional results of cheilectomy in the surgical treatment of grade III hallux rigidus and to evaluate whether cheilectomy is a preferable first-line treatment over other surgical methods. METHODS: Of 29 patients with moderate daily physical activity who underwent cheilectomy between 2009 and 2012 on being diagnosed as having grade III hallux rigidus according to the Coughlin-Shurnas grading system, 21 patients (14 women and 7 men; mean age, 59.2 years; age range, 52-67 years) (22 feet) with regular follow-up and complete medical records were included in the study. The patients were evaluated in the preoperative and postoperative periods using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society metatarsophalangeal assessment forms. RESULTS: The preoperative mean American Orthopaedic Foot and Ankle Society score of 53 (range, 29-67) improved to 78 (range, 57-92) postoperatively (Wilcoxon test P = .001). The preoperative mean visual analog scale score of 89 (range, 60-100) improved to 29 (range, 0-70) in the postoperative period (Wilcoxon test P = .001). CONCLUSIONS: As a simple and repeatable procedure that allows for further joint-sacrificing surgical procedures when required, cheilectomy is a preferable method to be applied as a first-line option for the surgical treatment of grade III hallux rigidus.

Congenital bizarre parosteal osteochondromatous proliferation in unusual location and age: a case report.

Bizarre parosteal osteochondromatous proliferation (BPOP, also known as Nora's lesion) is a rare, benign, locally aggressive condition defined as osteochondromatous exostosis arising from the bony cortex. BPOP presents predominantly in the 2nd and 3rd decades of life, and commonly arises from the periosteum of metacarpals and metatarses, though rare locations have been reported, including the long bones, the maxillae, the bones of calvaria, and the sesamoids. The case of an osteochondromatous lesion in an infant with an intra-abdominal mass arising from the iliac wing, an atypical location of benign solitary lesions, is reported. Benign solitary lesions are exceptional in this age group. The parents of the patient, who was born in term at 3600 grams, discovered a mass in the left groin and observed decreased movement in the lower left extremity. No history of trauma was reported. When the patient was 5 months of age, AP pelvic X-ray, computed tomography, and magnetic resonance imaging revealed a bony mass displacing intra-abdominal organs anteromedially. Biopsy reported an osteocartilaginous lesion with calcified mature cartilaginous fragments surrounded by plasmacytoid, monotone, fibrinoid cells in myxoid background. Differential diagnosis included osteochondroma, osteochondromyxoma, BPOP, fibrocartilaginous mesenchymoma, chondromyxoid fibroma, periosteal chondroma, soft tissue chondroma, myositis ossificans, and juxtacortical chondroma. Biopsy of the resected specimen determined a diagnosis of BPOP. At 6-month postoperative follow-up, neither symptoms nor complaints related to the mass were present.

Femoral lengthening and deformity correction using the Fitbone motorized lengthening nail.

BACKGROUND: This study reports our results with retrograde Fitbone insertion in patients with femoral shortening and deformity. We also present our experience regarding the benefits, complications, and factors associated with complications of the Fitbone technique. METHODS: Twelve males and ten females had femoral shortening and deformities treated using the retrograde Fitbone technique between 2009 and 2012. The etiologies were post-traumatic in 12 patients, poliomyelitis in four, cosmetic in two, congenital hypoplasia in two, achondroplasia in one, and Perthes sequela in one. RESULTS: The follow-up time was 30.8 months. The mean lengthening was 5.8 (range 2-14) cm. The degree of acute angular correction was 9° (5-22°) in nine cases. The time to full weight-bearing was 5.9 months. The consolidation index was 1.07 (0.75-1.62) months/cm. Complete consolidation was obtained in all cases except two. Running back was observed in two cases. CONCLUSIONS: The Fitbone technique allows accurate deformity correction. The rigid reamers allow the surgeon to use the Fitbone even in patients with a narrow medullary canal. As this might result in poor bone regeneration, thinner lengthening nails should be considered.

Tourniquet use in orthopedic surgery: a descriptive survey study among Turkish orthopedic surgeons and residents in Istanbul.

OBJECTIVE: The aim of this study was to investigate and interpret the trends in tourniquet use and the accuracy of knowledge among Turkish orthopedic physicians through face-to-face survey. METHODS: Turkish orthopedic physicians actively practicing operative orthopedics were questioned in a 12 question face-to-face survey. Personal information of physicians, preferred cuff pressure (CP) and tourniquet inflation time (TIT) and the source of the information for these preferences were questioned. Answers gathered were analyzed statistically. RESULTS: The survey was completed by 211 orthopedic physicians. Mean preferred CP and TIT was 247.1 mmHg and 108.6 minutes, respectively, in the upper limb (UL) and 345.02 mmHg and 122.4 minutes, respectively, in the lower limb (LL). A statistically significant correlation was found between the amount of pressure preferred in the LL and the years of practice; longer the years in practice, higher the amount of pressure preferred (r=0.144, p=0.04). Tourniquets were used for a maximum period of 120 minutes for the UL by 95.7% of participants and for the LL by 84.8%. CONCLUSION: The amount of CP used by the orthopedic physicians surveyed is inconsistent with the literature with frequent use of CP higher than those scientifically recommended. The outcomes of the survey should be cautionary for orthopedic physicians to review the current utilization and replace personal teachings and experience-based methods with evidence-based best practices for tourniquet application.

Perioperative versus postoperative measurement of Taylor Spatial Frame mounting parameters.

OBJECTIVE: The aim of this study was to determine the differences, if any, between application parameters for the Taylor Spatial Frame (TSF) system obtained during surgery under fluoroscopy and after surgery from digital radiography. METHODS: This retrospective study included 17 extremities of 15 patients (8 male, 7 female; mean age: 21.9 years, range: 10 to 55 years) who underwent TSF after deformity and fracture. Application parameters measured by fluoroscopy at the end of surgery after mounting the fixator were compared with parameters obtained from anteroposterior and lateral digital radiographs taken 1 day after surgery. RESULTS: Fixator was applied to the femur in 8 patients, tibia in 6 and radius in 3. Mean time to removal of the frame was 3.5 (range: 3 to 7) months. Mean perioperative anteroposterior, lateral and axial frame offsets of patients were 9.1 (range: 3 to 20) mm, 18.1 (range: 5 to 37) mm and 95.3 (range: 25 to 155) mm, respectively. Mean postoperative anteroposterior, lateral and axial frame offset radiographs were 11.8 (range: 2 to 30) mm, 18 (range: 6 to 47) mm and 109.5 (range: 28 to 195) mm, respectively. There was no statistically significant difference between the groups (p>0.05). CONCLUSION: While measurements taken during operation may lengthen the duration in the operation room, fluoroscopy may provide better images and is easier to perform than digital radiography. On the other hand, there is no difference between measurements taken during perioperative fluoroscopy and postoperative digital radiography.

Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures.

OBJECTIVE: The objective of this study was to evaluate the radiological and clinical outcomes of treatment of subtalar arthrodesis in patients developing talocalcaneal arthrosis secondary to intra-articular calcaneal fractures. METHODS: The study included 20 patients (21 feet) who underwent subtalar arthrodesis due to symptomatic subtalar arthrosis following conservative treatment for intra-articular calcaneal fracture between 2005 and 2011. Autograft or allograft was used in 11 patients. Patients were evaluated clinically using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score. Hindfoot alignment, quality of subtalar fusion and arthritis occurring in other joints were used for the radiological evaluations. RESULTS: Mean duration of follow-up was 43 (range: 21 to 83) months. Mean preoperative AOFAS score was 61.7 (range: 40 to 67) and mean postoperative AOFAS score was 84.2 (range: 65 to 94). The difference between scores was statistically significant (p=0.001). Six patients had excellent, 8 good and 6 fair results. Complete fusion was achieved in 19 patients (20 feet). In 2 patients, arthritic changes were radiologically observed in the midtarsal joints. These changes were not symptomatic. There were no statistically significant differences between pre- and postoperative radiological measurements. No patients experienced malunion. CONCLUSION: While subtalar arthrodesis appears to provide radiological and clinical benefits, it may cause moderate and asymptomatic osteoarthritis in the midtarsal joints.

Treatment of comminuted mid-diaphyseal clavicle fractures by plate fixation using a bridging technique.

OBJECTIVE: The aim of this study was to determine the healing and functional results of the treatment of comminuted mid-diaphyseal clavicular fractures using a bridging plate technique with minimal surgical dissection. METHODS: This retrospective study included 23 patients (17 males and 6 females) with comminuted mid-diaphyseal clavicular fractures treated between 2004 and 2010. All fractures were operated on using a bridging plate technique with minimal surgical dissection. Patients were evaluated for function using the Constant shoulder scoring system. RESULTS: Mean follow-up was 22 (range: 6 to 68) months and healing occurred in all patients after a mean of 13 (range: 8 to 20) weeks. No implant failures or superficial or deep infections were observed. Iatrogenic neurovascular damage was not observed in any patient. Two patients had clavicle length discrepancy in comparison with the healthy side. Range of motion was normal in all patients. The mean Constant score was 89.6 (range: 72 to 100) points. CONCLUSION: The surgical treatment of mid-diaphyseal fractures with the bridging plate technique using locking plates provides good patient comfort, allows early mobility and has a low complication rate.

Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise.

BACKGROUND: In this study, we aimed to compare the functional and radiological results of intramedullary nailing and plate fixation techniques in the surgical treatment of distal tibia diaphyseal fractures close to the ankle joint. METHODS: Between 2005 and 2011, 55 patients (32 males, 23 females; mean age 42 years; range 15 to 72 years) who were treated with intramedullary nailing (21 patients) or plate fixation (34 patients) due to distal tibia diaphyseal fracture were included in the study. The average follow-up period was 27.6 months (range, 12-82 months). The patients were evaluated with regard to nonunion, malunion, infection, and implant irritation. The AOFAS (American Orthopaedic Foot and Ankle Society) scale was used for the clinical evaluation. RESULTS: No statistically significant difference was found between the two surgical methods with respect to unification time, AOFAS score, accompanying fibula fracture, material irritation, and malunion. Nine patients had open fractures, and these patients were treated with plate fixation (p=0.100). Nonunion developed in three patients who were treated with plates. Infection occurred in one patient. Anterior knee pain was significantly higher in patients who were treated with intramedullary nails. There was no malunion in any patient. CONCLUSION: As the distal fragment is not long enough, plate fixation technique is usually preferred in the treatment of distal tibia diaphyseal fractures. In this study, we observed that if the surgical guidelines are followed carefully, intramedullary nailing is an appropriate technique in this kind of fracture. The malunion rates are not significantly increased, and it also has the advantages of being a minimally invasive surgery with fewer wound problems.