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ABSTRACT: The aim of this study is to evaluate the efficacy of the central (transpatellar tendon) portal technique for the treatment of isolated medial bucket-handle type meniscal tears with the arthroscopic menisectomy procedure.
In this study, fifty patients with isolated medial bucket-handle type meniscal tears were evaluated. They were divided into two groups with 25 patients in each group. In the first group, the three portal (including central portal) technique was used and in the second group, the two portal technique was used. The results of the two groups were compared in terms of (i) operation times; (ii) changes in Insall-Salvati ratios postoperatively; (iii) postoperative Cincinatti scores; (iv) quadriceps muscle strengths; (v) the presence of anterior knee pain and; (vi) complication rates, in order to determine the significance of adding a central portal to the standard anterolateral and anteromedial portals in the menisectomy procedure.
There was no significant difference between the two groups in terms of Cincinnati clinical scores, quadriceps muscle strenghts and complication rates. However, the operation time values of the first group were significantly shorter than the second group (p<0.001). The postoperative changes in Insall-Salvati ratio values were significantly higher in the first group than the second group (p<0.002). This results show us that the first group had a significant decrease in patellar tendon length whereas the second group had no change in size postoperatively.
We suggest that the use of the central portal for viewing and instrumentation is a safe and quick technique in the menisectomy procedure for medial bucket-handle type meniscal tears, due to its unexpected lower complication rates and shorter operation times. While it causes patellar tendon shortening, this does not effect the clinical outcomes.
Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery. 04/2010; 21(1):38-43.
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ABSTRACT: We evaluated short-term results of the Oxford phase 3 unicompartmental knee arthroplasty (UKA) in patients with medial compartment arthritis.
The study included 38 patients (28 females, 10 males; mean age 67 years; range 56 to 75 years) who underwent UKA for isolated medial knee osteoarthritis. At the time of surgery, 28 patients were in the age group of 56-64 years, and 10 patients were in the age group of 65-75 years. All the patients had Ahlbäck grade 2 primary medial compartment arthritis that had been unresponsive to conservative treatment. None of the patients had symptoms of patellofemoral arthrosis. Patients underwent UKA with the Oxford phase 3 cemented meniscal-bearing unicondylar prosthesis using minimally invasive surgery. The results were assessed preoperatively and at final controls according to the Knee Society clinical and functional rating system. Postoperative radiographic evaluations were made according to the Oxford criteria. The mean follow-up period was 24 months (range 18 to 32 months).
The mean preoperative active knee flexion increased from 121.8 degrees (range 110 degrees to 130 degrees ) to 130.9 degrees (range 120 degrees to 140 degrees) postoperatively (p<0.05). There was no limitation in knee extension both pre- and postoperatively. The mean preoperative and postoperative knee scores were 64.6 (range 47 to 80) and 97.5 (range 89 to 100), and the mean functional scores were 59.6 (range 45 to 80) and 92.1 (range 70 to 100), respectively (p<0.05). All the patients had an excellent knee score, while functional scores were excellent in 27 patients (71.1%) and good in 11 patients (28.9%). Postoperative radiographic measurements showed that the position of the femoral components was within acceptable ranges in all the patients with a mean of 3 degrees valgus (range 5 degrees valgus to 8 degrees varus) and 0.5 degrees extension (range 3 degrees extension to 2 degrees flexion). The positioning of the femoral components in relation to the mechanical axis was central in 30 patients and 2-mm lateral (range 2 mm medial to 4 mm lateral) in eight patients. The position of the tibial components was also within acceptable ranges in all the patients with a mean of 1.5 degrees varus (range 2 degrees varus to 2 degrees valgus) and a mean posterior inclination of 6.2 degrees (range 5 degrees to 7 degrees). All the tibial components showed full congruency with the medial, lateral, anterior, and posterior planes, except for one which had a 4-mm undersizing in the anterior plane. The polyethylene insert was central and parallel to the tibial component in all the patients. No osteophytes or cement debris that might lead to impingement were observed. All the components remained in position until the final controls. Complications such as insert dislocation, infection, pulmonary embolism, deep venous thrombosis, or neurovascular injury were not observed. None of the patients required revision surgery.
Our findings show that, with proper patient selection and strict adherence to the surgical technique, short-term results of the Oxford phase 3 unicompartmental knee prosthesis are excellent or good in the treatment of medial compartment osteoarthritis.
acta orthopaedica et traumatologica turcica 01/2010; 44(2):135-42. · 0.34 Impact Factor
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ABSTRACT: We evaluated the functional results of open reduction and internal fixation with a locking plate in patients with three- or four-part fractures of the proximal humerus.
We reviewed 32 consecutive patients (22 women, 10 men; mean age 63 years; range 29 to 82 years) who were treated with open reduction and internal fixation using the PHILOS locking plate for comminuted proximal humeral fractures. According to the Neer classification, 12 patients (mean age 56 years) had three-part fractures, 19 patients (mean age 67 years) had four-part fractures, and one patient had a four-part fracture dislocation. Ten patients were in the age group of <60 years, 22 patients were in the age group of 60=or>years. All the patients were evaluated with plain radiographs preoperatively; in addition, computed tomography was used in 14 patients in whom articular surface and tuberculum displacement could not be assessed adequately. The operation was performed through a standard deltopectoral approach, and minimal soft tissue dissection was used aiming not to impair vascularization of the fracture fragments. A cerclage wire was used to help reduction in 12 patients. An oblique screw was inserted to stabilize the medial colon in cases in which medial cortical contact was insufficient. Bone grafting was not used in any of the patients. Active-assisted and passive exercises of the shoulder were initiated on the second postoperative day. Active abduction to 90 degrees was allowed two weeks after surgery. During follow-up, implant failure, loss of reduction, malunion, and bone healing were assessed on plain radiographs. Bone scintigraphy was performed after 12 postoperative months for the detection of avascular necrosis. The results were assessed using the Constant shoulder score. The mean follow-up period was 25 months (range 18 to 36 months).
An anatomic or near-anatomic reduction was obtained in 29 patients (90.6%). In two patients, the fractures were fixed in a varus position, and in one patient, the greater tubercle was displaced proximally. All fractures united in a mean of three months (range 2 to 5 months). The mean Constant score of the patients was 79.5 (range 50 to 100). The results were excellent in 13 patients (40.6%), good in nine patients (28.1%), fair in eight patients (25%), and poor in two patients (6.3%). The mean Constant scores were 88.3 (range 69 to 100) and 74.2 (range 50 to 100) in three-part and four-part fractures, and 88.3 (range 71 to 100) and 75.5 (range 50 to 100) in the age groups of <60 years and =or>60 years, respectively. Constant scores showed significant differences with respect to the number of comminution and age groups (p=0.03). Avascular necrosis was observed in two patients. None of the patients had reduction loss, implant failure, deep infection, or neurovascular injury, and none required implant removal.
Preservation of humeral head vascularity through minimal soft tissue dissection, fixation with a locking plate, and early postoperative motion were effective in decreasing potential complications following surgical treatment of three- and four-part proximal humeral fractures. The degree of fracture comminution and age of the patients affect functional results significantly.
acta orthopaedica et traumatologica turcica 01/2010; 44(2):97-104. · 0.34 Impact Factor
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ABSTRACT: We compared the clinical results of open reduction with a mini incision and closed reduction in pediatric unstable diaphyseal forearm fractures treated with intramedullary nailing.
We retrospectively evaluated 45 children who were treated with intramedullary nailing for unstable middle third diaphyseal forearm fractures. Before intramedullary nailing, 24 patients (group 1; 5 girls, 19 boys; mean age 10 years; range 5 to 14 years) underwent open reduction with a mini incision, and 21 patients (group 2; 5 girls, 16 boys; mean age 11.5 years; range 8 to 13 years) underwent closed reduction. There were 16 closed, seven Gustilo-Anderson type 1, and one type 2 open fractures in group 1, and 15 closed and six type 1 open fractures in group 2. The mean time to surgery was 5 days (range 1 to 20 days) in group 1, and 3.1 days (range 1 to 5 days) in group 2. Rush rods or Kirschner wires were used for fixation. In group 1, both radius and ulna were fixed in all the patients, whereas fixation involved both bones in 18 patients, and only ulna in three patients in group 2. Functional results were evaluated according to the criteria of Price et al. The mean follow-up period was 33 months (range 12 to 89 months) in group 1, and 37 months (range 14 to 52 months) in group 2.
Union was obtained in a mean of 7.1+/-1.0 weeks (range 6 to 9 weeks) in group 1, and 6.5+/-1.0 weeks (range 6 to 10 weeks) in group 2. The implants were removed after a mean of 7.2+/-1.7 weeks (range 6 to 10 weeks) in group 1, and 8.1+/-0.4 weeks (range 8 to 10 weeks) in group 2. The two groups differed significantly with respect to union and implant removal times (p=0.036 and p=0.002, respectively). According to the criteria of Price et al., the results were excellent in 19 patients (79.2%) and 18 patients (85.7%), and good in five patients (20.8%) and three patients (14.3%) in group 1 and 2, respectively. There was no significant difference between the functional results of the two groups (p>0.05). Complications showed a similar profile in the two groups, being one major (4.2%) and seven minor (29.2%) in group 1, one major (4.8%) and eight minor (38.1%) in group 2. None of the patients had complications such as limb-length discrepancy, epiphyseal damage, angular or rotational deformity, synostosis, or limited elbow or forearm range of motion.
Closed reduction or open reduction with a mini incision before intramedullary nailing yield similar functional results, with a similar complication profile in the treatment of pediatric unstable diaphyseal forearm fractures.
acta orthopaedica et traumatologica turcica 01/2010; 44(1):7-13. · 0.34 Impact Factor
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ABSTRACT: The aim of this study was to assess the course of the superficial branch of the radial nerve (SBRN) at the level of the wrist and its branches in relation to wrist arthroscopy portals.
Dissections were performed on 11 hands from 6 cadavers in the section starting from the point where the SBRN begins to emerge and ending at the terminal branches of the dorsal hand. The distribution of the SBRN, the distance from the superficial branch to the dorsal portals used in wrist arthroscopy, and the distance from the superficial branch to the anatomic determinants (styloid process of the radius, Lister tubercle) were studied.
At the level of the wrist, the nerve bifurcated into 2 branches in 8 of 11 wrists (73%) and into 3 branches in 3 of 11 wrists (27%). The mean distance from the SBRN where it was first detected proximal to the Lister tubercle was 73 mm. The mean distance between the styloids was 52 mm; the distance between the Lister tubercle and styloid process of the radius was 23 mm. At the wrist level, the distance from the branch closest to the radial side to the Lister tubercle was 28 mm (L-D1), 21 mm (L-D2/3), and 7 mm (RS-D1). The distance of the closest nerve branch to the 3-4 portal was 9 mm. The distances of the other portals were 5 mm (1-2RMC-D1), 8 mm (1-2RMC-D2/3), 8 mm (1-2P-D1), and 9 mm (1-2P-D2/3).
The limited size of the area where portals can be positioned and the anatomic variations between individuals are major obstacles in developing a guideline for reducing the risk of SBRN injury in wrist arthroscopy.
Great care must be taken when using the 1-2 portal. We suggest making a skin-only incision for this portal and then using blunt dissection to help prevent injury to the SBRN.
Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2009; 25(11):1261-4. · 3.02 Impact Factor
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ABSTRACT: We evaluated the results of two different surgical methods for the treatment of adult diaphyseal fractures of both forearm bones.
Forty-two adult patients with forearm fractures were retrospectively evaluated. Of these, 22 patients (7 women, 15 men; mean age 32 years; range 18 to 69 years) underwent open reduction and plate-screw fixation, and 20 patients (6 women, 14 men; mean age 33 years; range 18 to 70 years) underwent closed reduction and locked intramedullary nail fixation. The fractures were classified according to the AO/OTA system. The patients were assessed using the Grace-Eversmann criteria and the DASH (Disability of the Arm, Shoulder and Hand) questionnaire. The mean follow-up was 30 months (range 12 to 45) with plate-screw fixation, and 23 months (range 12 to 34) with intramedullary nailing.
The mean operation time was 65 minutes (range 40 to 97 min) with plate-screw fixation, and 61 minutes (range 35 to 90 min) with intramedullary nailing (p>0.05). The mean time to union was significantly shorter with intramedullary nailing (10 weeks vs. 14 weeks; p<0.05). According to the Grace-Eversmann criteria, the results were excellent or good in 18 patients (81.8%) and acceptable in four patients (18.2%) treated with plate-screw fixation, compared to 18 patients (90%) and two patients (10%), respectively, treated with intramedullary nailing. The mean DASH scores were 15 (range 4 to 30) and 13 (range 3 to 25), respectively. The two groups did not differ significantly with respect to functional results and DASH scores (p>0.05). Postoperative complications were seen in three patients (13.6%) and two patients (10%) with plate-screw fixation and intramedullary nailing, respectively.
The two fixation methods yield similar results in terms of functional healing and patient satisfaction in the management of adult forearm fractures.
acta orthopaedica et traumatologica turcica 01/2009; 43(1):14-20. · 0.34 Impact Factor
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ABSTRACT: This study was designed to evaluate anatomical and functional results of non-surgical treatment for unstable distal radius fractures in the elderly.
Twenty-nine patients (7 males, 22 females; mean age 72+/-2 years) aged = or > 65 years were treated with closed reduction and short-arm circular casting for unstable distal radius fractures. According to the AO classification, all patients had type C fractures. Anatomical and functional results were assessed using the Stewart criteria and Q-DASH (Quick-Disability of Arm, Shoulder and Hand) questionnaire, respectively. Bone mineral density measurements were performed. Grip strength and wrist range of motion were measured in comparison to the unaffected side. The mean follow-up was eight months (range 6 to 12 months).
Union was achieved in all fractures within a mean of 4+/-1 weeks. Bone mineral density measurements showed osteoporosis in 22 patients (75.9%), and 26 patients (89.7%) had regional osteoporosis in cortical width measurements. After treatment, radiographic measurements showed the following: radius tilt angle +5.6+/-5.4 degrees , inclination angle 17+/-4.6 degrees , radial height 9+/-2.3 mm, and positive ulnar variance 2.8+/-2 mm. Five patients (17.2%) exhibited an articular step-off of less than 1 mm on the radial surface. According to the Stewart criteria, the results were good in 15 patients (51.7%), moderate in 12 patients (41.4%), and poor in two patients (6.9%). The mean Q-DASH score was 38+/-19.2 at three months, and 23+/-2.4 at final follow-up. Grip strength, extension/flexion, and pronation/supination were measured as 57.3+/-12.5%, 52+/-14%, and 75+/-16% of the unaffected side, respectively. Complications were seen in 11 patients (37.9%). Three patients (10.3%) developed malunion which required corrective osteotomy.
Unstable distal radius fractures can be treated with closed reduction and cast application in low-demand elderly patients to avoid risks and complications of surgery.
acta orthopaedica et traumatologica turcica 01/2009; 43(3):229-34. · 0.34 Impact Factor
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ABSTRACT: The aim of this study was to evaluate early results of open mosaicplasty for the treatment of talus osteochondral lesions associated with chronic complaints.
The study included eight patients (1 male, 7 females; mean age 35 years; range 18 to 74 years) with osteochondral lesions of the talar dome. The mean duration of symptoms was 11 months and the mean lesion size was 17 x 9 mm. The lesions were of medial localization in five patients, and lateral localization in three patients. According to the Bristol classification, the stages of the lesions were as follows: stage IIa (n=2), IIb (n=1), III (n=2), IV (n=1), and V (n=2). Mosaicplasty was performed via a mini arthrotomy with osteotomy. Functional assessments were made using the AOFAS (American Orthopaedic Foot & Ankle Society) scoring system pre- and postoperatively. Pain was assessed using a visual analog scale. Regeneration of new cartilage tissue at the lesion site was monitored by magnetic resonance imaging. The mean follow-up was 17 months (range 8 to 34 months).
The osteotomy site healed in a mean of six weeks in all the patients. The mean pre- and postoperative AOFAS scores were 58 (range 40-68) and 89 (range 80-97), respectively (p<0.005). Pain scores decreased from a mean of 8 (range 5 to 10) to 2 (range 1 to 4; p<0.005). Surgery-related complication was seen in one patient. All the patients returned to preoperative levels of activity and occupation. Magnetic resonance imaging showed graft incorporation in all the patients.
Open mosaicplasty is a simple, safe, and effective alternative in the treatment of cartilage losses of the talar dome, in particular those of cystic type and exceeding 10 mm in size.
acta orthopaedica et traumatologica turcica 01/2009; 43(3):235-42. · 0.34 Impact Factor
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ABSTRACT: We evaluated the results of osteosynthesis with external fixation for intertrochanteric hip fractures in elderly patients with a high anesthesia risk.
Fourteen ASA 4 patients (5 men, 9 women; mean age 75 years; range 65 to 81 years) with intertrochanteric hip fractures were treated with a unilateral external fixator under epidural anesthesia combined with mild sedation. According to the AO/OTA classification, six fractures were A1.2, seven fractures were A2.2, and one fracture was A3.1. All were closed fractures. The mean preoperative Singh index of the contralateral hip was 3.1 (range 3 to 5). Eleven patients received an AO tubular external fixator, and three patients received a unilateral external fixator. Final evaluations were made using the Parker-Palmer mobility score and Harris hip score. The mean follow up was 12 months (range 9 to 17 months).
The mean operation time was 37 min (range 25 to 44 min), the mean fluoroscopy time was 1.5 min (1 to 2 min), and the mean hospital stay was seven days (5 to 15 days). None of the patients required blood transfusion. Bone union was obtained in all the patients in a mean of 4.1 months (3 to 5 months). The mean femoral shaft-neck angles in the early postoperative period and at the latest follow-up were 133 degrees (127 degrees to 139 degrees ) and 132 degrees (126 degrees to 138 degrees ), respectively. Five patients (35.7%) developed grade I pin-tract infection. Medial displacement of the distal fragment, limb shortening, or fixator failure were not seen. Three patients (21.4%) died within the first postoperative year due to associated diseases. The mean final Harris hip score was 61 (range 45 to 80) and the mean Parker-Palmer mobility score was 6.6 (range 5 to 8).
Osteosynthesis with an external fixator in elderly patients with a high anesthesia risk is a fast, minimally invasive procedure in the treatment of pertrochanteric fractures, resulting in fewer pre- and postoperative complications.
acta orthopaedica et traumatologica turcica 02/2008; 42(4):246-51. · 0.34 Impact Factor
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ABSTRACT: We investigated changes in patellar height and tibial inclination angle after open-wedge high tibial osteotomy and the effect of these changes on patient satisfaction.
The study included 18 knees of 16 patients (4 males, 12 females; mean age 55 years; range 44 to 66 years) who underwent open-wedge proximal tibial osteotomy with autogenous bone graft and medial plate for medial compartment gonarthrosis. Nine knees (50%) had Ahlbäck grade I, eight knees (44.4%) had grade II, and one knee (5.6%) had grade III osteoarthritis. Pre- and postoperatively, femorotibial angle, tibial inclination angle, and patellar height were measured according to the Bauer, Harvey-Moore, and Blackburne-Peel methods, respectively. Clinical evaluations were made using the Lysholm-Gillquist score. Patient satisfaction was questioned with a 10-point scale. The mean follow-up was 54.2 months (range 25 to 96 months).
Postoperatively, the mean correction of the femorotibial angle was 13.6 degrees (p<0.05), and the mean increase in the tibial inclination angle was 2.9 degrees (p<0.05). Fifteen knees (83.3%) exhibited a significant decrease in patellar height by a mean of 15% (p<0.05). The mean Lysholm-Gillquist score increased from preoperative 61 to 86 at the latest follow-up (p<0.05). The results were excellent in 11 knees (61.1%), good in six knees (33.3), and poor in one knee (5.6%). The mean patient satisfaction score was 8.1 (range 5 to 10). Changes in the femorotibial angle and Lysholm-Gillquist score were significantly correlated with patient satisfaction (p<0.05). Three patients had nonunion, perioperative intra-articular fracture, and superficial wound infection, respectively.
Changes in the tibial inclination angle and patellar height following open-wedge tibial osteotomy do not have an adverse effect on short-term patient satisfaction.
acta orthopaedica et traumatologica turcica 02/2008; 42(4):265-71. · 0.34 Impact Factor
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ABSTRACT: We evaluated the effectiveness of extramembranous transfer of the tibialis posterior (TP) tendon for the treatment of drop foot deformity.
The study included 13 patients (6 females, 7 males; mean age 30 years; range 10 to 46 years) who underwent 15 tendon transfers for drop foot deformity. Ten patients (76.9%) had deformity due to unrepairable nerve injuries, which were associated with surgical procedures in six patients and trauma in the remaining four. In four feet (26.7%), the TP tendon was turned from the intero-anterior aspect of the tibia and fixed by tenodesis to the lateral cuneiform bone, while in 11 feet (73.4%), it was transferred to the extensor hallucis longus, extensor digitorum communis, and peroneus tertius tendons. The patients were assessed according to the Stanmore system questionnaire. The mean follow-up was 25.3 months (range 12 to 80 months).
According to the Stanmore system, the results were poor in two feet (13.3%), moderate in three feet (20%), good in three feet, and very good in seven feet (46.7%). All the patients were satisfied with the final outcome. The mean foot dorsiflexion was 5 degrees (range, -5 degrees to 10 degrees ), which was 10 degrees in four feet (26.7%), and 5 degrees to 10 degrees in six feet (40%). Apart from complaints of bulging in four patients (30.8%) in the dorsum of the foot due to tendon and suture material, no complications were seen during the early postoperative period.
Extramembranous transfer of the TP tendon for the treatment of drop foot deformity enables the patients to walk without the aid of orthosis and increases their quality of life.
acta orthopaedica et traumatologica turcica 02/2008; 42(5):310-5. · 0.34 Impact Factor
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ABSTRACT: We evaluated the results of two different surgical methods for the treatment of unstable both-bone forearm fractures in children.
Thirty-five children with unstable both-bone forearm fractures were retrospectively evaluated. Of these, 14 patients (group 1; 4 girls, 10 boys; mean age 13 years; range 10 to 15 years) underwent open reduction and plate-screw fixation, and 21 patients (group 2; 5 girls, 16 boys; mean age 11.5 years; range 8 to 13 years) underwent closed reduction and intramedullary fixation. All the fractures in group 1 were closed, while, in group 2, there were 15 closed and six type 1 open fractures. The mean time to surgery was 4.3 days in group 1, and 3.1 days in group 2. The results were assessed using the criteria of Price et al. The mean follow-up was 34 months in group 1, and 37 months in group 2.
Nonunion was observed in only one patient in group 1. The mean time to union was 7.2 weeks (range 6 to 11 weeks) in group 1, and 6.5 weeks (range 6 to 10 weeks) in group 2. According to the criteria of Price et al., the results in group 1 were perfect in 11 patients (78.6%), good in two patients (14.3%), and fair in one patient (7.1%). In group 2, 18 patients (85.7%) had excellent, three patients (14.3%) had good results. Complications were major in three patients (21.4%) and minor in two patients (14.3%) in group 1, compared to one major (4.8%) and eight minor (38.1%) complications in group 2. None of the patients had limb-length discrepancy, joint deformity, angular or rotational deformity, or complications such as synostosis and infection.
It was concluded that intramedullary nailing was safe, effective, and easy to perform in the management of unstable both-bone forearm fractures in children.
acta orthopaedica et traumatologica turcica 02/2008; 42(3):188-92. · 0.34 Impact Factor
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ABSTRACT: Epithelioid hemangioendothelioma is a low-grade malignant tumor with a histologic appearance and clinical course between that of a hemangioma and angiosarcoma. It is rarely encountered in the bone. A 48-year-old woman was examined following trauma. A cystic lesion was noted on a plain radiograph of the left foot, destructing the diaphysis of the first metatarsal bone. Magnetic resonance imaging showed a solid intramedullary lesion involving a large part of the bone. Scintigraphic examination showed uptake in the diaphysis of the left tibia and the first metatarsal bone of the left foot. Histopathologic examination showed a neoplastic lesion consisting of atypical endothelial cells lining vascular structures or forming solid nests in a myxoid stroma. The tumor was immunoreactive for factor VIII, CD31, CD34, and vimentin. A diagnosis of epithelioid hemangioendothelioma was made and the patient underwent subtotal resection of the metatarsal bone with reconstruction of the fibula, and a wide resection of the tibial lesion. No recurrences or metastasis were observed during a four-year follow-up.
acta orthopaedica et traumatologica turcica 02/2006; 40(4):324-8. · 0.34 Impact Factor
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ABSTRACT: We evaluated radiographic and functional results of volar locking plate fixation of unstable distal radius fractures.
The study included 27 patients (15 males, 12 females; mean age 45 years; range 18 to 77 years) who were treated with volar locking plate fixation for unstable distal radius fractures. Twenty-two patients (81.5%) had AO type C and five (18.5%) had type B fractures. Two patients (7.4%) had type I open fractures. Dorsal and volar angulation were present in 21 (77.8%) and six (22.2%) fractures, respectively. Four patients (14.8%) also had elbow dislocation and/or fracture and nine patients (33.3%) had disruption of the distal radioulnar joint. Autologous iliac crest graft was used in 10 patients (37%). Postoperative assessments included range of movement and grip strength measurements, and radiographic parameters using the Stewart criteria. Functional results were assessed using the Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) questionnaire and the Gartland-Werley scale. The mean follow-up was 18 months (range 12 to 34 months).
All fractures united without a problem within a mean of 6.5 weeks (range 6 to 8 weeks). The following parameters became equal to the unaffected side: ulnar variance (n=21, 77.8%), radial inclination angle (n=13, 48.2%), radial tilt angle (n=8, 29.6%), and radial height (n=11, 40.7%). The mean radiographic Stewart score was 0.5 (range 0 to 3). The mean grip strength of the operated side was 72.4% (18 kg) of the normal side. The mean Q-DASH and Gartland-Werley scores were 8.3 (range 0 to 70.5) and 4.7 (range 0 to 16), respectively. According to the Gartland-Werley scale, the results were excellent in 12 patients (44.4%), good in 12 patients, and moderate in three patients (11.1%). Three complications (11.1%) occurred, including loss of alignment in two patients, and screw-related discomfort in one patient.
Volar locking plate fixation is an effective treatment in the anatomical and functional restoration of unstable distal radius fractures.
acta orthopaedica et traumatologica turcica 43(4):303-8. · 0.34 Impact Factor
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ABSTRACT: This study was designed to evaluate the results of vacuum-assisted closure in the topical treatment of surgical site infections.
Vacuum therapy was performed in 17 patients (10 males, 7 females; mean age 60 + or - 20 years) using the VAC system (Vacuum-Assisted Closure, Kinetic Concept Inc) for the treatment of surgical site infections. Infective wounds were in the hip (n=6), crus (n=5), knee (n=3), sacrum (n=2), and hand (n=1). The causative organism for infections was gram-positive bacteria in 15 patients (88.2%), and six patients (35.3%) had nosocomial infections. The wounds were treated with a negative pressure of 100-125 mmHg applied continuously for the first two days, and then intermittently for the following days. The mean follow-up period was 11 + or - 6 months.
The mean duration of vacuum therapy was 16 + or - 4 days and the mean length of hospitalization was 31 + or - 19 days. The patients underwent a mean number of three surgical procedures (range 1 to 6) before vacuum therapy. The mean amount of discharge from the wound was 500 + or - 150 ml. Tissue edema and discharge problems were resolved in all the wounds and a hygienic and dry-looking surgical site was attained. In 11 patients (64.7%), clinical and bacteriologic eradication of infections was achieved at the surgical site through antibiotic use and vacuum therapy. Six patients with nosocomial infections continued to receive antibiotic treatment following resolution of surgical site problems. The mean wound area showed a significant reduction from 36 + or - 14 cm(2) to 11 + or - 10 cm(2) following vacuum therapy (p<0.05). Only two patients (11.8%) required further surgical interventions for the closure of wound site. Two patients (11.8%) complained of pain associated with vacuum application.
Besides its topical advantages in the care of infected wounds, vacuum-assisted closure provides a more rapid and comfortable treatment opportunity, representing a reliable alternative to conventional wound care methods.
acta orthopaedica et traumatologica turcica 43(4):336-42. · 0.34 Impact Factor
