[Show abstract][Hide abstract] ABSTRACT: The aim of this experimental study was to determine the effects of adjunctive hyperbaric oxygen therapy (HBO) on atrophic tibial nonunion treatment using Ilizarov external fixator.
Twenty New Zealand white rabbits were randomly divided into two equal groups. A circular external fixator was applied to the right tibia of all the rabbits. A 5-mm bone block was resected and a tibial pseudarthrosis was obtained after a 6-month waiting period. The experimental group rabbits (n=10) underwent daily 2.5 ATA HBO therapy for 2 hours for 20 days and the control group rabbits (n=10) did not receive any corresponding treatment. Osteoblastic activity was evaluated with bone scintigraphy on days 30 and 90. Fracture healing was evaluated by plain radiographs on days 30 and 90.
On Day 30, radiological scores were statistically similar in both groups (p=0.167). However, on Day 90, the experimental group displayed significantly higher radiological scores (p<0.001). Osteoblastic activity was also higher in the experimental group on both scintigraphic assessments (p=0.005 and p=0.001).
The results of this study suggest that HBO can be used as a supplementary therapy in the management of atrophic tibial nonunion.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to report our functional results after an intramedullary Kirschner wires (K-wires) and tension band wiring combination for the treatment of a large group of humeral head fractures was performed.
Seventy-four patients (54 females, 20 males; mean age 42 years; range 24 to 73 years) who had proximal humerus fractures were treated with an intramedullary K-wire and tension band technique and were retrospectively analyzed. Fracture patterns were according to Neer classification type II in 43 patients, type III in 23 patients and type IV in five patients. The Constant-Murley shoulder score test was used to evaluate the function of both shoulders. The outcome was graded according to Neer's criteria. The pain score was determined with a 10-point visual analog scale.
All fractures were healed (radiologically and clinically) within 3.6 months (range 2.5 to 4.7 months) after the surgery. In one patient, the cerclage wire was broken and in eight patients, K-wires produced impingement like symptoms that required a second procedure (wire removal) after healing. The results of the patients with regard to Constant-Murley score and Neer criteria were indifferent when the 6th and the 12th month data were compared (p<0.05). Visual analog scale scores of the patients between the two control visits were significant different (p>0.05).
The type of fixation depends on the bone quality and the degree of comminution. But the recent trend is towards osteosynthesis -the limited, less invasive technique- which is performed with minimal soft tissue dissection and minimal osteosynthesis. It allows less stripping of bone and therefore preservation of the blood supply to the humeral head. This procedure is simple to perform and provides good postoperative results.
Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery. 08/2010; 21(2):62-7.
[Show abstract][Hide abstract] ABSTRACT: Complete absence or variations of extensor pollicis brevis and abductor pollicis longus; absence of the extrinsic extensors, abductor pollicis longus, thenar muscles along with congenital hypoplasia of the thumb; absence of flexor pollicis brevis and abductor pollicis brevis; and bilateral absence of extensor pollicis have been reported previously. Those cases mainly comprised absence/variations of the first extensor compartment either with or without thumb anomalies. This article presents a case of a patient in which the constituents of the first and third compartments (extensor pollicis brevis, abductor pollicis longus and extensor pollicis longus) were absent unilaterally. Herewith, we also highlight the role of static/dynamic sonography for prompt imaging in this regard.A 24-year-old man presented with difficulty using the left thumb. He reported no trauma and had not used the affected thumb since childhood. On physical examination, the left thumb was observed to be in flexion and opposition. He was unable to perform active extension and abduction but passive motion was free. Neurological examination of the left upper extremity was unremarkable. No organ anomaly was present on systemic examination. Radiographs of the left hand revealed no joint problems or hypoplasia. Ultrasonographic evaluation was consistent with absence of the first and third extensor compartment tendons. Tendon transfer was recommended but the patient refused surgery.
[Show abstract][Hide abstract] ABSTRACT: In this study we evaluated the stability and effectiveness of the double tension band osteosynthesis technique compared to the double plate osteosynthesis technique used for fixation of distal humerus fractures.
The study was performed on two groups, and in each group eight cadaveric, elderly (mean age 70-80) human humeri was used. An osteotomy was performed in the supracondylar region using a manual saw. The first group (group 1) was fixed with double 3.5 mm reconstruction plates, while the second group (group 2) was fixed with the double tension band technique, using crossing Kirschner wires. The osteotomy was designed so that the distal fragment would allow only a single screw per plate. The constructs were evaluated using a material testing machine. A linear non-cyclic load was applied until the failure of the constructs. The force which produced a 3 mm gap (3 mm gap strength), as detected visually with the aid of operating loupes, and the maximum load prior to failure of the fixation (maximum force) were measured from all tests.
The mean value for the 3 mm gap strength was 1356.29+/-226.97 N for group 1 and 882.63+/-305.21 N for group 2. The mean value of the maximum load strength was 1487.13+/-298 N for group 1 and 1232+/-107.62 N for group 2. There were significant differences in 3 mm gap strengths of the two groups (p=0.005). There was also a significant difference in the maximum load between the two groups (p=0.016).
Double plate osteosynthesis technique is superior to double tension band osteosynthesis for the fixation of distal humerus fractures.
Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery. 04/2010; 21(1):44-9.
[Show abstract][Hide abstract] ABSTRACT: Our aim was to evaluate the outcomes of combined hamstring release and rectus transfer in children with crouch gait using physical examination and gait analysis.
A total of 19 patients (38 knee joints) with crouch were evaluated by static examination and computerized analysis with dynamic EMG. The Ely test was positive together with prolonged and increased activity in the rectus muscle bilaterally in all patients. These patients underwent hamstring release and rectus transfer. Intensive rehabilitation was provided following the surgery and the patients were evaluated again by static examination and gait analysis after an average of 6.3 (4-7.5) months after surgery. The preoperative and postoperative static examination findings, knee and ankle joint kinematics and time-distance parameters were compared in 19 children.
There was a significant improvement in static examination findings, knee and ankle kinematics and time-distance parameters. However, there was no significant difference between the preoperative and postoperative swing phase peak knee flexion.
This study demonstrated that static parameters, time-distance parameters, knee and ankle kinematics were improved following combined hamstring release and rectus transfer in children with cerebral palsy without any cases of stiff knees.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare results of transtibial amputations performed using the Burgess or Modified Burgess techniques with those performed using the Bruckner technique. Transtibial amputation (TTA) was performed in 117 patients with Fontaine phase IV chronic arterial occlusion. Fifty-six patients with a mean age of 51.4 years were amputated by the Burgess technique between March 2000 and January 2003; and 61 patients with a mean age of 47.8 years were amputated by Modified Burgess technique between February 2003 and March 2006. In the Burgess technique, all muscles in the amputation region were preserved and the stump was closed by a long posterior flap; whereas the entire tibialis anterior muscle and part of the soleus muscle distal to the amputation level were removed in the modified Burgess procedure. Stump revision was performed in nine cases (17.3%) amputated by the Burgess technique due to necrosis at the incision site and drainage caused by the peroneal and tibialis anterior muscles; however, two cases (3.6%) of the modified Burgess procedure required stump revision. The prosthesis caused skin maceration at the lateral side of the stump in five cases (9.6%) operated with the Burgess technique and in eight cases (14.5%) operated with the modified Burgess procedure. After the rehabilitation period, 43 patients (82.6%) in the Burgess group were mobilized without crutches in an average of 162.5 days; on the other hand 51 patients (% 92.7) in the modified Burgess group were similarly mobilized in an average of 101.5 days. Our retrospective study showed that the modified Burgess technique, with its advantages and disadvantages forms an alternative to the Burgess and Bruckner techniques regarding TTAs.
Prosthetics & Orthotics International 04/2009; 33(1):25-32. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ankle fractures and fracture dislocations are common injuries in orthopaedic practice however pure ankle dislocation without an associated fracture is extremely rare. There are a few cases reporting such a lesion in the literature. Also this injuries are generally open high energy trauma injuries. Closed treatments are reported to be effective and ligament injuries are generally not reported. In this study, we report a closed pure posteromedial ankle dislocation with anterior talofibular ligament rupture and its treatment and outcome in a 12 year-old boy. We think that this is an extremely rare lesion.
[Show abstract][Hide abstract] ABSTRACT: Transscaphoid perilunate fracture-dislocations are complex injuries. The aim of this study is to discuss and compare open reduction and internal fixation for acute and delayed transscaphoid perilunate fracture-dislocations and review the literature.
The design of this study is retrospective and randomized.
Gülhane Military Medical Academy, Department of Orthopedics and Traumatology.
Twelve cases (6 acute and 6 delayed) of dorsal stage 2 fracture-dislocations were involved in the study.
Scaphoid fractures were treated with reduction and internal fixation by using either a cannulated screw or a Herbert screw. Temporary triquetrocapitate and lunotriquetral fixation were performed in all cases using two 1.8-mm Kirschner wires after reduction of the dislocations.
Range of motion (flexion and extension), grip strength evaluation with Jamar dynamometer, comparison of preoperative and early postoperative average of scapholunate (SL) and radiolunate angle (RL), and revised carpal height ratio were used for outcomes assessment. Clinical evaluation was performed according to the clinical scoring system modified from Green and O'Brien. Revised carpal height ratio, SL angle, RL angle, and appearance of midcarpal arthritis were used for radiologic analysis.
Average follow-up period was 45 months (23-70). Mean clinical score of early treated group and delayed treated group was 89.2 (good) and 72.5 (fair), respectively, according to clinical scoring system of Green and O'Brien. The overall clinical score of all cases was 80.8 (good). Two of the 6 cases in the delayed group developed posttraumatic midcarpal arthritis. Mean range of motion (flexion and extension) was 129.5 +/- 20.42 degrees in the early treated group and 95.5 +/- 18.08 degrees in the delayed group. Four of the 6 patients treated in the acute group gained normal grip strength, but 2 patients had more than 50% loss in grip strength compared with the contralateral wrist. Two of the 6 patients in the delayed group had normal grip strength, and 4 patients had more than 50% loss in grip strength compared with the contralateral wrist. The mean grip strength of the normal hands of all patients was 43.75 +/- 7.71 kg. The mean grip strength of the early treated group was 34.00 +/- 12.83 kg, whereas the mean grip strength of the delayed treated group was 26.33 +/- 13.48 kg. Average SL and RL angle in the early postoperative period were 47.5 and -9.40 degrees, respectively. At the last follow-up, average SL and RL angle were 55.5 and 5.43 degrees, respectively. The revised carpal height ratio was 1.51 in the early postoperative period and decreased to 1.45 at the last follow-up.
We recommend open reduction and internal fixation for early and delayed transscaphoid perilunate fracture-dislocations.
Journal of orthopaedic trauma 10/2008; 22(8):535-40. · 1.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to present the mid-term results of hallux valgus patients who underwent a modified chevron osteotomy.
Fifty-six patients (73 feet) with mild to moderate hallux valgus underwent a modified chevron osteotomy and Stoffella pin fixation between January 1999 and December 2004. Patients were evaluated clinically by the American Orthopedic Foot and Ankle Society (AOFAS) score. Pre- and postoperative radiographs were evaluated for the hallux valgus and intermetatarsal angles and sesamoid position.
An improvement of 44.8 points in the AOFAS score was found. A change of 17.4 degrees in the hallux valgus angle and by 5.3 degrees in the intermetatarsal angle was achieved (p < 0.05). The change in the sesamoid position was significantly improved. Superficial skin infection in 3 cases, transient hypoesthesia in 2 cases, and bursitis due to screw irritation in 4 cases were the complications.
Stable and rigid fixation by modified chevron osteotomy using Stoffella pins allows early mobilization and weightbearing without a cast. We believe early mobilization of the joint provides better functional outcomes with fewer complications compared to other fixation techniques.
Foot & Ankle International 06/2008; 29(5):478-82. · 1.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Most gunshot injuries to the hand involve a combination of tissue types. The goal of this study is to report the results of early definitive treatment in extra-articular metacarpal and proximal phalangeal fractures due to low velocity gunshot wounds and to analyse their outcomes. A retrospective analysis of 51 metacarpal and 41 proximal phalangeal fractures of 76 patients due to low velocity gunshot wounds treated between January 2001 and December 2004 was carried out. We applied acute fixation in the first 24 hours. The patients were evaluated with total active motion scores, radiographic control, complication rate and the need for revision surgery. The infection frequency was 10.5% and the need for a revision surgery was 7%. The plate fixation group had significantly higher total active motion scores than the external fixation group. The K wire group had the highest revision rate. The bone grafting group was associated with good total active motion scores and low complication rates. The majority of the low velocity gunshot injuries are surgically clean wounds which allow not only early fracture fixation, but also early bone grafting and soft tissue reconstruction. Plate and screw fixation is associated with significantly better functional outcomes than the minimal fixation group.
International Orthopaedics 05/2008; 32(2):257-62. · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Disarticulation of the thumb at the metacarpophalangeal joint level is not beneficial either aesthetically or functionally without additional surgery because it requires a bulky and an unacceptable prosthesis to be made for this amputation level. In this study, the authors have presented our experience of 12 metacarpal distractions in thumb amputated patients. Twelve male patients who had thumb amputation due to gunshot wounds were included in the study. Before the operation, aesthetic hand prostheses were made for 5 of the 12 patients. Callus distraction was performed with the use of a mini Ilizarov type external fixator in 7 cases and uniplanar dynamic mini external fixator in 5 cases too. External fixators were removed after the completion of the radiographic consolidation. Five patients whose prosthesis had been made before the operation wore their prosthesis for an average 6.8 months (5 - 14) due to poor appearance and poor construction. Union of the lengthened segment was observed in all cases. Average lengthening was 28.9 mm (range from 25 - 37). Average healing time was 2.1 months (range from 1.8 - 2.5). Average healing index was 0.73 month/cm (range from 0.65 - 0.88). Pin tract infection was seen in 7 cases (58.3%). Volar angulation developed after removing the external fixator in 1 case. Webplasty was performed in all cases. Patients were evaluated by means of Disability of the Arm, Shoulder and Hand (DASH) score and pick-up test. It was concluded that the metacarpus lengthening by callus distraction technique may be a functionally and cosmetically effective reconstruction method for traumatic thumb amputations. It is believed that the possibility for a functionally and aesthetically acceptable fabrication of a thumb prosthesis, by providing a suction suspension with distraction and/or webplasty procedures.
Prosthetics & Orthotics International 04/2008; 32(1):50-6. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the results of ankle arthrodesis performed with circular external fixators (CEF) in those patients who had developed tibiotalar arthritis secondary to a landmine or a gunshot injury.
Nineteen ankles in 19 patients were fused using CEF. All patients had approximately 3 (range, 1 to 5) operations for bone and soft tissue reconstruction preceding the arthrodesis. Ankle arthrodesis was performed an average of 2.3 (range, 1 to 7) years after the initial trauma. The mean age at operation was 22 (range, 20 to 31) years old and all patients were male.
The average time spent in the CEF was 3.5 (range, 2 to 7) months. The mean followup was 59 (range, 31 to 90) months. Successful arthrodesis was achieved in all patients in an acceptable position. Clinically, 6 patients were assessed as excellent, 9 patients as good, 3 patients as fair, and 1 patient had a poor result. Twelve patients reported no pain postoperatively, 4 patients reported reduced to mild and/or occasional pain, 2 patients reported moderate pain, and 1 patient reported persistent pain. Sixteen patients described their outcome as satisfactory, one was somewhat satisfied, and two were dissatisfied. There were pin track infections in 10 patients and ring sequestration in one patient.
Patients who have degenerative ankle arthritis due to gunshot wounds and land-mine injuries with poor bone quality and soft tissue conditions at the distal tibia can be successfully managed by using CEF.
Foot & Ankle International 03/2008; 29(2):178-84. · 1.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the results of arthroscopically assisted circular external fixation in bicondylar tibial plateau fractures.
The study included 13 patients (12 males, 1 female; mean age 27 years; range 18 to 37 years) who were treated with circular external fixation under arthroscopic control for bicondylar tibial plateau fractures. The causes of fractures were traffic accidents in nine cases, sport injuries in two cases, and fall from height in two cases. Eight patients had open fractures. The mean time from injury to presentation was two days. Soft tissue injuries were treated with curettage and excision. The fractures were classified according to the Schatzker's system. Functional results were assessed using the knee scoring system of Lysholm and Gillquist. The mean follow-up period was 35 months (range 16 to 38 months).
There was no neurovascular pathology in any of the cases preoperatively and postoperatively. Lysholm and Gillquist knee scores were very good in two patients, good in six patients, moderate in four patients, and poor in one patient. The mean knee score was 82.46. The patient with the poor result had significant limitation in knee extension and flexion. Postoperative complications included superficial soft tissue infection in two patients and pin tract infection in six patients.
Arthroscopically assisted circular external fixation of bicondylar tibial plateau fractures is efficient to obtain satisfactory functional results.
[Show abstract][Hide abstract] ABSTRACT: Comminuted fractures of the patella are traditionally treated by internal fixation. The modified tension-band technique is widely accepted for internal fixation. The management of comminuted fractures often requires additional K-wire and/or circlage material and wide surgical exposure. Therefore, symptoms and complications related to the stainless steel wire are not uncommon in these cases. We present a new alternative treatment technique for comminuted patellar fractures.
Five comminuted patellar fractures of four patients were treated by circular external fixator (CEF) under arthroscopic control. The mean patient age was 32.5 (range 24-41) years and mean follow-up was 22 (range 20-28) months.
In four cases, union was completed by the sixth week; in the other case, union was completed by the eighth week. The frames were removed after union of the fracture was documented. When the CEF was removed, full knee range of motion was observed full in all patients, and the patients returned to their normal activities of living in a few days. The mean Lysholm score was 94 (range 85-100) after treatment.
CEF application under arthroscopic control can help avoid some complications of the traditional treatment methods, particularly in comminuted fractures of the patella. The most important advantage of this technique is to allow active knee motion in the early postoperative period so patients can return to activity of daily living soon after the implant removal. In addition, arthroscopic examination of the knee joint provides an assessment of any other intra-articular lesions. This technique allows healing of the fracture with low morbidity.
The Journal of trauma 04/2006; 60(3):659-63. · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the results of treatment with the Ilizarov circular external fixator for limb length inequality and deformities in patients with type IA, IB, and type II fibular hemimelia.
Tibial corticotomy and distraction osteogenesis with the Ilizarov technique were performed in five male patients (mean age 11.4 years; range 4 to 20 years). According to the classification of Achterman and Kalamchi, fibular hemimelia was type IA, IB, and II in three patients, one patient, and one patient, respectively. Involvement was on the right in three patients, and on the left in two patients. Two patients had equinus and one patient had valgus deformities. No instability existed in the ankle and knee joints. The mean leg discrepancy was 8.7 cm (range 3 to 16.5 cm), and the mean lengthening index was 1.6 cm/month (range 1.4 to 2 cm). The mean follow-up was 33 months (range 15 to 68 months).
On final examinations, full range of motion of the knee was obtained. A plantigrade foot was achieved in three feet, while two sustained an equinus deformity of 17 and 15 degrees, respectively. Pin tract infections were observed in four patients, all of which were treated with oral antibiotics and dressing. During distraction, three patients had pain. Two patients had a limited range of motion of the ankle joint, without instability or subluxation of the ankle and knee joints. These joint problems were successfully dealt with by physical exercises.
The Ilizarov technique is a convenient method in the correction of angular and rotational deformities while enabling distraction in type I and type II fibular hemimelia.