How should open tibia fractures be treated? A retrospective comparative study between intramedullary nailing and biologic plating.

BACKGROUND: In this retrospective study, our purpose was to compare two treatment alternatives clinically. METHODS: Forty-five patients who had grade I or II open tibia fractures were included. Twenty-five of them, treated via minimally invasive plate osteosynthesis (MIPO), comprised group I. The latter 20 cases, treated via partial reamed intramedullary nailing (PR-IMN), comprised group II. Clinical evaluation was made on the basis of modified Ketenjian's criteria. RESULTS: Full weight-bearing periods in groups I and II were 21 and 22.4 weeks, respectively. Non-union in one case of group I was revised with circular fixator. In another case, implant removal was needed due to chronic osteomyelitis. Mal-union was detected in another. In group II, two cases needed implant revision with intramedullary nail in one and circular fixator in another for non-union. Mal-union in one case and chronic osteomyelitis in another were the late complications in group II. At the last follow-up, satisfaction rates were: 21/25 in group I and 18/20 in group II. There was no significant difference between groups (p>0.05). CONCLUSION: The clinical results of both groups were similar. Although intramedullary nailing is the first choice, MIPO is an alternative method for open tibia fractures.

[Avascular necrosis of the third metacarpal head: a case report]. / Uçüncü metakarp basinin avasküler nekrozu: Olgu sunumu.

Avascular necrosis of the third metacarpal head is a rare entity. It may remain asymptomatic, but may also be painful and lead to restricted range of motion. A-thirteen-year-old male patient presented with a painful and restricted range of motion in the third metacarpophalangeal (MCP) joint. There was no history of any trauma or a predisposing factor such as systemic lupus erythematosus or steroid use. The range of motion of the involved joint was minimally restricted (flexion range, 10 to 80 degrees). Mild tenderness was found on palpation over the dorsal aspect of the third MCP joint. Radiographs showed flattening and sclerosis of the third metacarpal head together with cystic lesions. The symptoms were controlled with non-steroidal anti-inflammatory drugs and splinting for four weeks. The range of motion of the MCP joint increased, along with regression on radiographs.

[Correlation of clinical and radiologic results of complete subtalar release in congenital clubfoot]. / Tam subtalar gevsetme uygulanan dogustan çarpik ayakli olgularda radyolojik ve klinik sonuçlarin uyumu.

OBJECTIVES: We evaluated the mid-term results in patients who underwent complete subtalar release with the use of the Cincinnati incision for congenital clubfoot. METHODS: Complete subtalar release was performed in 30 feet of 23 patients (16 boys, 7 girls; 7 bilateral cases). The mean age at surgery was 17.5 months (range 2 to 84 months). Clinically, cosmetic appearance, adduction of the forefoot, the range of motion of the ankle joint, and muscle strength were evaluated. Radiologic evaluations included talocalcaneal angles on antero-posterior and lateral views, talocalcaneal index, talar-first metatarsal angles, calcaneal-fifth metatarsal angles, and Bohler angles. Talar and navicular bone lengths were compared with the other side in unilateral patients. The results were evaluated according to the Simons' criteria. The mean follow-up was 9 years and 8 months (range 7 years to 14 years). RESULTS: The mean range of motion of the ankle joint was measured as 47 degrees (range 10 degrees to 60 degrees ). The parents of three patients were not satisfied with the clinical results. Clinically, six patients had metatarsus adductus. Radiologically, flattening of the talar head (7 patients) and the talar dome (2 patients) were detected in unilateral patients. Navicular dorsal subluxation was found in seven feet. Compared to the normal side, the mean navicular shortening was 2.6 mm (range 0 to 4 mm), the mean talar shortening was 4.8 mm (range 2 to 11 mm). According to the Simons' criteria, the results were satisfactory in 27 feet (90%) and unsatisfactory in three feet (10%). CONCLUSION: Our results suggest that complete subtalar release for the treatment of clubfoot enables correction of all components of the deformity at a single session, and that its clinical results are more favorable than radiologic results, without requiring a close cooperation of the parents.

[Clinical results of tibial pilon fractures treated by open reduction and internal fixation]. / Açik redüksiyon ve internal fiksasyon uygulanan tibia pilon kiriklarinda klinik sonuçlar.

OBJECTIVES: We evaluated the results of pilon fractures treated by open reduction and internal fixation. METHODS: The study included 18 patients (mean age 36 years; range 19 to 56 years) with pilon fractures. According to the Ruedi and Allgower's classification, there were three type I, nine type II, and six type III fractures. Five fractures were open including three of Gustilo-Anderson type II, and two fractures of type III. The results were assessed using the Burwell-Charnley criteria. The mean follow-up was 54 months (range 9 to 86 months). RESULTS: According to the Burwell-Charnley criteria, the results were good in 12 patients (66%), fair in three patients (17%), and poor in three patients (17%). The most common complication was posttraumatic degenerative arthritis, followed by wound infection (22%), Sudeck atrophy (22%), delayed union (17%), and angulation (11%). CONCLUSION: Early anatomical reduction, a stable fixation, early mobilization, and delayed weight-bearing seem to improve long-term results of treatment in pilon fractures caused by high energy trauma.

The importance of surgeons' experience on intraobserver and interobserver reliability of classifications used for Perthes disease.

The objective of this study was to evaluate the percentage agreement and intraobserver and interobserver reliability for the Catterall, Salter-Thompson, Herring, and Stulberg classification systems, with special reference to the experience of surgeons. AP and frog-leg radiographs of 10 patients were evaluated by 18 reviewers with three levels of experience on two occasions. Each patient had three sets of radiographs of different stages of disease (initial stage, fragmentation phase, and healed phase). The interobserver percentage agreement rates were 28% for residents, 42% for senior surgeons, and 51% for pediatric orthopaedists for the Catterall classification in the initial stage; 63%, 46%, and 68% for the Salter-Thompson classification; 44%, 44%, and 61% for the Herring classification; and 34%, 37%, and 43% for the Stulberg classification at skeletal maturity. The Catterall, Herring, and Salter-Thompson classifications have a learning curve, and pediatric orthopaedists have better intra- and interobserver reliability. The Stulberg classification system when used at skeletal maturity consistently gave the best results for intraobserver and interobserver reliability for residents, senior surgeons, and pediatric orthopaedists. These results suggest that although the reliability of these classification systems improves with the experience of the observer, inter- and intraobserver error is generally high even among experienced pediatric orthopaedists.