The surgery outcomes of pediatric femoral shaft fractures and comparision of radiation risks.

INTRODUCTION: To show midterm results and compare the two methods utilized in pediatric femoral diaphysis fractures fixation and the risks of radiation. METHODS: We conducted retrospective studies of 60 children and adolescent between the age of 6 to 16 years who were exposed to traumatic femoral shaft fractures and treated with methods of fixation titanyum elastic nail (EN), submuscular bridge plating (SBP) Twenty eight (18 males and 10 females) were treated with SBP (group 1), and 32 patients (18 males and 14 females) were treated with EN (group 2). RESULTS: The mean age of the patients was 10,3 years. Duration of follow-up was 29.8 months. Mean union time was 7,4 weeks (range, 6-10 weeks). Operative time was on average 60.6 minutes. Considering Flynn's criteria, the results of treatment was excellent in 50, good in 4 and poor in 6 cases. CONCLUSIONS: In the surgical treatment of pediatric femoral shaft fractures, fixation techniques such as submuscular bridge platingand elastic nails were found to have similar fracture healing and complication rates. An orthopaedic surgeon must protect himself, his personnel and the patient from radiation exposure. Open reduction internal plate fixation can be chosen as an alternative treatment for children who do not cause radiation exposure to the femoral fracture.

Rehabilitation of neglected Monteggia fracture: Dislocations in children.

PURPOSE: There are limited studies related to the rehabilitation of neglected Monteggia fracture-dislocations. This study reports the results of the rehabilitation of neglected Monteggia fractures and dislocations and the best treatment options available. MATERIAL AND METHODS: Thirteen children were rehabilitated between 2009 and 2012. A retrospective chart review was conducted to record the following: age, gender, anatomic region of fractures, time delay from symptom onset to fracture, Bado classification, Mayo Elbow Performance Index (MEPI) which includes pain, range of motion and daily life comfort, surgeries, length of hospitalization, location and pattern of fracture, length of follow-up and complications. RESULTS: The study group included thirteen children and adolescents; eleven males and two females with a mean age of 8.5 (range 2-15) years. According to the Bado classification, 11 patients had type 1, one had type 3 and one had type 4 fracture-dislocations. For Mayo Elbow Performance Index (MEPI) scales, patients that were less than ten years old had greater mean scores. Two patients had superficial infection, one had subluxation, one had osteoarthritis, one had delayed bone union and two had rigidity at the elbow. CONCLUSION: The goals of elbow rehabilitation following Neglected Monteggia cases include restoring function by restoring motion and muscle performance; influencing scar remodeling and preventing joint contracture; and restoring or maintaining joint stability. Patients aged younger than 10 years and intervals of less than one-year, between trauma and diagnosis, as well as early and effective rehabilitation were found as important parameters regarding favorable outcomes.

Management of open fractures using a noncontact locking plate as an internal fixator.

BACKGROUND: The treatment of open fractures leads to major problems which may be due to various reasons. It mainly causes soft tissue problems due to the absorption of a large amount of energy by the soft tissues and bone tissues. Although some recent treatment protocols have eliminated many problems regarding delayed soft tissue closure, it still remains a big challange. This study uses a method called the internal fixator technique with noncontact locking plate (NC-LP) which involves the use of a combination of advantages of open and closed fixation techniques. MATERIALS AND METHODS: 42 patients (32 men and 10 women) having a mean age of 34.11 years (range 17-56 years) with open fractures operated using internal fixator technique between 2007 and 2012 were included in this study. A retrospective chart review was conducted to record the following: age, gender, anatomic region of fractures, fracture etiology, classification of open fractures by Gustilo-Anderson and AO classification, surgeries, length of hospitalization, location and pattern of fracture, length of followup, and complications. RESULTS: The fractures were caused by traffic accidents, shotgun injuries, falls from heights, and industrial crush injuries. Based on the Gustilo-Anderson classification, 31 fractures were Type III and 11 were Type II, where 23 were localized in the tibia and 19 in the femur. Patients delay for a mean of 13.5 h (range 6-24 h) for operation and the mean followup interval was 27.8 months (range 16-44 months). The mean union time was 19.7 weeks (range 16-29 weeks). One patient had delayed union and implant failure, one patient had osteomyelitis, five suffered from surface skin necrosis, and one patient had an angulation of 17° in the sagittal plane, for which no additional intervention was performed. CONCLUSIONS: This case series demonstrates that an "internal fixator technique" is an acceptable alternative to the management of open fractures of the femur or tibia in adult patients. The NC-LP method provided opportunities to achieve a stable fixation with noncontact between the implant and the bone tissues, and the fractures were sufficiently stabilized to allow union with a low complication rate.

The Use of an "Internal Fixator Technique" to Stabilize Pathologic Fractures Developing Secondary to Osteomyelitis.

BACKGROUND: There is no consensus on the materials and the techniques to use in fixing pathologic fractures secondary to osteomyelitis. This study reports the results of the fixation of pathologic fractures secondary to osteomyelitis using the "internal fixator technique." METHODS: The internal fixator technique was performed on 11 children and adolescents with fractures secondary to osteomyelitis between 2003 and 2010. A retrospective chart review was conducted to record the following: age, sex, the anatomic region of infection, the time delay from symptom onset to fracture, the classification of chronic osteomyelitis, the Cierny-Mader classification, the causative organism, surgeries, the length of hospitalization, the location and the pattern of fracture, the duration of infection, the length of follow-up, and complications. RESULTS: The patients included 7 male and 4 female patients with a mean age of 8.7 (range, 6 to 13) years. Pathologic fractures were as follows: 7 femur and 4 tibia. Nine of them were in the metaphysis and 2 others were located in the diaphysis. The time delay from symptom onset to fracture was 3.36 (1 to 9) months. The anatomic region of infection was the diaphysis in 2 cases and the metaphysis in 9 cases. Fractures patterns were short oblique and transverse. The length of hospitalization was a mean of 7 days. The duration of infection ranged from 1 to 12 (mean, 4.38) months. The mean duration of follow-up was 57.09 (range, 36 to 73) months from the initial presentation. Only 2 patients developed shortening, for which no additional intervention was performed. CONCLUSIONS: This case series demonstrates that the "internal fixator technique" is an acceptable alternative to the management of pathologic fractures of the femur or the tibia in children and adolescents with unresolved acute and chronic osteomyelitis. Infections were resolved in all cases and fractures were sufficiently stabilized to allow union with a low complication rate. LEVEL OF EVIDENCE: Level IV-therapeutic.

Four decades without diagnosis: Sheehan's syndrome, a retrospective analysis.

AIM: Sheehan's syndrome (SS) remains a frequent cause of hypopituitarism in undeveloped and developing countries, but due to improvements in obstetric care, it is rare in developed countries. We aimed to share the results of a retrospective study analyzing the demographic, clinical, imaging, and hormonal characteristics of a large group of patients with SS, and also increase awareness of this syndrome especially in developed countries. METHODS: The medical records of 124 patients with SS patients who were followed up in the Endocrinology Department of Dicle University between 1995 and 2015 were assessed retrospectively. RESULTS: The mean period of diagnostic delay was 20.37 ± 8.34 years on average. 5.7% of patients with SS were literate; 62% of patients delivered at home. Anemia was identified in 64.5% of SS patients. Mean blood sodium levels were 129.8 ± 11.3 mEq/L. The mean urine densities were 1013 ± 6.5. Osteoporosis and osteopenia were found in 44 (35.4%) and 71 (57.2%) patients, respectively, According to pituitary magnetic resonance imaging (MRI) analyses, 92 (74.2%) patients with SS had completely empty sella, 29 (23.3%) had partially empty sella, and 1 patient had microadenoma, and 2 had normal pituitary MRI results. CONCLUSIONS: Improved obstetric care and effective interventions for postpartum hemorrhage have limited the prevalence of SS in developed countries. However, in developing countries like Turkey, SS due to postpartum bleeding remains common. Thus, physician's awareness of the symptoms of SS is urgently required to avoid the associated morbidity and mortality.

Nonunion of the medial cuneiform: a rare case.

Isolated medial cuneiform fractures are quite rare. Conservative treatment is adequate in most cases, while deplaced or unstable fractures are treated surgically. Nonunion is seen extremely rarely after medial cuneiform fractures. There is only one case report in the literature. This case presented here is a 62-year-old male patient who had an isolated medial cuneiform fracture resulting from the impact of a falling metal object. Conservative treatment was performed initially. The patient was diagnosed as nonunion after physical and radiological examinations nine months after he presented to the outpatient clinic. Internal fixation with a mini plate and one staple after reduction was performed surgically. Defective region was filled with a 2 mL of autograft, and the operation was terminated.

Evaluation of postoperative early mobilization in patients with repaired flexor tendons of the wrist, the spaghetti wrist.

PURPOSE: The hands and wrists are very important for performing the activities of daily life independently. The spaghetti wrist may involve major nerves and arteries, as well as the wrist and finger flexors. The purpose of this study was to evaluate the rehabilitation results of postoperative early mobilization in patients with repaired flexor tendons of the wrist. METHODS: Thirty-three patients with repaired flexor tendon injuries were included. Patients were divided into two groups due to ethylogy. Group 1 included 23 patients who incurred tendon injuries during fights with their family members or friends or due to broken glass after fighting. Two patients had cut their hands with a razor. The other patient had cut his hands during discussion. The Group 2 included 10 patients. The injuries in this group were due to work and home accidents. RESULTS: The functional result was excellent in 46% of fingers, good in 22%, fair in 17%, and poor in 15% in the Group 1 patients. The results were excellent in 55% of fingers, good in 17%, fair in 18%, and poor in 10% in the Group 2 patients. CONCLUSION: Early primary repair and effective rehabilitation are of great importance during the postoperative period for successful results in the treatment of extensive volar wrist lacerations.