Joint Diseases and Related Surgery Case Reports Spontaneous bilateral Achilles tendon rupture is ... more Joint Diseases and Related Surgery Case Reports Spontaneous bilateral Achilles tendon rupture is a rare injury. There is an established association between Achilles tendon rupture and corticosteroid or fluoroquinolone use. However, a bilateral rupture in a pregnant patient stands as a rare condition. We present the case of a 28-year-old pregnant female patient with spontaneous bilateral Achilles tendon rupture. The patient had a history of bilateral Achilles tendinopathy. Conservative treatment was initially chosen due to pregnancy. The conservative treatment yielded a good result on the left side. The right side had no clinical improvement and was treated surgically 10 weeks after the injury. The Bosworth technique was used to reconstruct the right Achilles tendon. Clinical outcomes were excellent after two years of follow-up. In conclusion, caution is advised in pregnant patients with a history of Achilles tendinopathy, as conservative treatment does not always result in a good outcome.
Background: In our retrospective study, we evaluated pediatric femoral shaft fractures sustained ... more Background: In our retrospective study, we evaluated pediatric femoral shaft fractures sustained by children of five to fifteen years of age, all of whom were treated with elastic intramedullary nailing. Methods: Between 1990 and 2000, 32 femoral fractures of 30 children, 14 (47%) polytraumatized, with an average age of 9.9 (6-14), were treated with elastic intramedullary nailing. Results: Average follow-up was 105.3 (25-145) months. Three cases (9.3%) were re-operated due to developed angulations related to weight bearing in the early postoperative period. In three (9,3%) of our cases we diagnosed more than five degrees valgus deformity, in one (3.1%) anterior angulation and in 1 (3.1%) internal rotation. The average of absolute value of length discrepancies was determined as 9 mm (-15mm - +15mm). Conclusion: Elastic intramedullary fixation is a recommended method, especially for polytraumatized patients, because of facilitates of patient care, recovers social activity quickly, and causes minimal soft tissue damage. However angular or rotational deformations are also possible. Selection criteria and follow up period is important and treatment of the complications must be on time.
Turkish journal of trauma & emergency surgery, Apr 1, 2004
Background: The results of intracompartmental pressure monitoring were assessed in uncooperative,... more Background: The results of intracompartmental pressure monitoring were assessed in uncooperative, polytraumatized patients with tibial shaft fractures. Methods: The study included 29 tibial fractures of 26 polytraumatized patients (9 females, 17 males; mean age 36 years; range 15 to 75 years) admitted to the intensive care unit. The fractures were on the right side in eight patients, on the left in 15 patients. Three patients had bilateral involvement. All the patients were unconscious. Following trauma, absolute compartment pressures and ΔP (diastolic blood pressure - absolute compartment pressure) were monitored at 12-hour intervals for 72 hours via the intracompartmental pressure monitoring system. Patients whose ΔP values were 30 mmHg or below underwent fasciotomy. The mean follow-up period was 21.2 months (range 18 to 25 months). Results: The overall mean absolute compartment pressure was 30.25 mmHg, and the mean ΔP was 48.47 mmHg at the end of 72 hours. Fasciotomy was performed in two patients (7%) in whom a diagnosis of acute compartment syndrome was made depending on ΔP values less than 30 mmHg. None of the patients had complications associated with acute compartment syndrome. Union was achieved in all the patients without an additional intervention. The mean time to union was 5.21 months (range 3 to 9 months). Conclusion: Intracompartmental pressure monitoring should be considered for an early diagnosis of acute compartment syndrome in uncooperative, polytraumatized patients with tibial shaft fractures.
Background: In orthopaedic traumatology; acute compartment syndrome is a common complication asso... more Background: In orthopaedic traumatology; acute compartment syndrome is a common complication associated with tibial fractures. In our study, we investigate differences, if any, between open and closed tibialfractures in terms oftheir risk of compartment syndrome. Methods: Fourty-two tibial fractures of 39 patients, 29 (69%) closed and 13 (31%) open, having the risk of acute compartment syndrome according to the clinical examination, were monitored following traumas during which their DP (DP= Diastolic blood pressure -Absolute compartment pressure) and absolute compartment pressures were measured via intracompartmental pressure measuring equipment. Results: Average absolute compartment pressure was found to be 31.25 mmHg in open and 29,32 mmHg in closed fractures (p=O,484) whereas average DP was measured to be 47,46 mmHg in open and 49,66 mmHg in closedfractures (p=O,415). According to student's test, the difference between the two groups was not significant. We found the incidence of acute compartment syndrome as 7, 7% in open fractures, 6.9% in closed and 7, 1 % in overall tibial fractures andfasciotomy was carried out in those cases. Conclution: Statistically not significant difference between the pressure levels,found in open and closed tibialfractures, showed that open type oftibialfractures holds the risk of compartment syndrome as much as the closed one.
Objectives : To assess the results of our patients injured of intracapsular neck fracture of the ... more Objectives : To assess the results of our patients injured of intracapsular neck fracture of the femur osteosynthesed by cannulated screws; which could not have been operated within the ideal time because of various problems. Materials & Methods: Fifty-two patients are accepted to the study from September 1991 to January 2008 which they had intracapsular neck fractures of femur caused by an injury and treated with the cannulated screws after 24 hours from the injury. Of the 52 patients, 22 were women (42,3%) and 30 were men (57,7%). The mean postinjury time of the patients was 125,6 (26–360) hours. Four patients had Garden type 1 (7,7%), 13 patients had Garden type 2 (25%), 24 patients had Garden type 3 (46,2%), and 11 patients had Garden type 4 (21,1%) intracapsular neck fractures. Fourty-two patients (80,8%) had gone to closed reduction, and 10 patients (19,2%) had gone to open reduction and they all were osteosynthesed with the cannulated screws. The reduction success is assessed by the x-rays. The mean follow-up time was 92,2 (15–179) months. Results : The reduction success was moderate in 3 patients (5,8%), was good in 23 patients (44,2%), and was excellent in 26 patients (50%). There was no poor reduction success in any of the patients. The complications seen in the patients were; 6 AVN, 1 nonunion, 1 malunion, 2 reduction failure, 1 infection. Conclusion : The patients with the intracapsular neck fractures of the femur could not have been operated within the ideal time because of life threatening poly-traumas, the late reference of patients to our clinic, and failing to establish ideal implant and operation circumstances in a timely manner. We believe that osteosynthesis with cannulated screw should not be discarded as a method of treatment even postinjury time exceeds 6 hours in intracapsular femoral neck fractures.
Background and Aim: Applying Ilizarov fixator is an easier method compared with other methods in ... more Background and Aim: Applying Ilizarov fixator is an easier method compared with other methods in treating of tibial fractures. But it be used less frequently than others; yet, little information about it is available. The present study was performed to evaluate the results and complications of Ilizarov external fixator in type 3C Pilon fractures. Materials and Methods: In this retrospective study, 178 patients with type C3 pilon fractures, aged over 86-88 years, admitted to Poursina hospital in Rasht between 1998 and 2000 were included. Their follow-up lasted 24 months after surgery and they were then examined based on clinical and radiographic criteria and were finally evaluated on the basis of American Orthopedic Foot and Ankle Society (AOFAS) scoring criteria. Results: The criteria (AOFAS) showed that the average score obtained was 88±6. In 89 patients (i.e.55, 62%) the outcome was excellent, In 31 patients (20, 62%) it was good, in 32 cases (21, 87%) the result was moderate, and in 8 patients (5.69%) it was weak. Conclusion: According to the results obtained and comparing them with the results of other treatments, one can claim that this treating approach is better than the others for pilon fractures, particularly for type 3c pilon fractures.
Objective: Motorcycle injuries have shown a progression in last years in trauma patients admitted... more Objective: Motorcycle injuries have shown a progression in last years in trauma patients admitted to our clinic. The aim of this study is to evaluate statistically whether the motorcycle accidents incidence is really has a progression or not. Method: The study involved 180 patients (87 women, 93 men) operated for the fractures after a motorcycle crash between the first six months of 2002 and 2007. The injury patterns have been investigated if there was a significant increase or not. The mean age was 45.2 years (min. 1year-max. 87 years). In Group I; 50 patients (22 women, 28 men) were included which operated in the first 6 months of 2002. The mean age was 44.8 years (min.1 year-max. 85 years). In Group II; 130 patients (65 women, 65 men) were included which operated in the first 6 months of 2007. The mean age was 45.7 (min. 3 years-max. 87 years). Results: We compared two groups and found a significant 3.425 increase in motorcycle injuries contrary to 0.075 decreases in falls, 0.023 decrease in traffic accidents within the vehicle, 0.013 decreases in traffic accidents out of the vehicle, 0.616 decreases in sports injuries, 0.25 decreases in gunshot injuries. This increase in motorcycle injuries is statistically significant. Conclusion: We have found significant increase in motorcycle injuries statistically. The importance of this, it affects younger population, and they bring out high morbidity. Since; we think that motorcycle injuries must be stated especially in literatures. We must warn our colleagues to state these injuries, and must take precautions against this problem.
Results: 165 patients (82.4% women, mean age 67.5 ± 7.8 years) were recruited to the study. The p... more Results: 165 patients (82.4% women, mean age 67.5 ± 7.8 years) were recruited to the study. The patients generally had low scores for PDQ-Chi (mean 4.9 ± 3.9). Only one patient had neuropathic pain as classified by PDQ-Chi (score ≥19). The Cronbach's alpha of the 7-items and 9-items PDQ-Chi were 0.60 and 0.58 respectively. Factor analysis of the 7-items PDQ-Chi revealed a 2-factor structure that explained 48% of total variance. The 9-items total PDQ-Chi scores correlated with pain scores, but not pressure pain threshold of knee or forearm. The PDQ-Chi did not correlate with the hypothesized trait of measurement. 17 patients administered the PDQ-Chi a second time on the day of TKR. The ICC of the 7-items and 9-items PDQ-Chi was 0.59 and 0.50, respectively; while the classification consistency of the 9-items PDQ-Chi was 94%. Conclusions: In this group of patients with KOA enlisted for TKR, both the 7-items and 9-items of PDQ-Chi were suboptimal in internal consistency and hypothesis testing. Using the 9-items PDQ-Chi with cutoffs as screening instrument for neuropathic pain, it had good classification consistency. Further studies with larger sample size are required for criterion validity. References:
tarihleri arasmda humerus cerrahi boyun kmğı tanısı ile 13 (8 bayan,S erkek) olgu başvurdu. Yaş o... more tarihleri arasmda humerus cerrahi boyun kmğı tanısı ile 13 (8 bayan,S erkek) olgu başvurdu. Yaş ortalaması 47 (min. 30, maks. 78) olan olgularm 11 (%84) 'inde yaralanma nedeni Jrafik kazasıd/{. Skopi kontrolunda kapalı redüksiyon ve distal humerustan retrograd intramedüller çivileme ile yaralanma sonrası ortalama 8. (min. 2, Maks. 28) günde stabil internal tesbit gerçekleştirildi. Postoperatif ortalama iki hafta Velpeau bandajı uygulandıktan sonra omuz ve dirsek rehabilitasyonuna başlandı. Ortalama 5 (min. 3, mak. 14) ay izlenen olgularda kmk iyileşmesi radyolojik olarak, omuz ve dirsek hareket genişliği goniometrik olarak kaydedildi. Ortalama 3. (min. 2, maks. 5) ayda kmk aralığmm kallusla dolduğu gözlendi. Omuzlarda abdüksiyon genişliği ortalama 120 (min. 100, maks. 170), öne ffeksiyon genişliği ortalama 100 (Min. 90, Maks. 150) ve dirsek ekstansiyon ffeksiyon genişliği ortalama 120 (min. 100, maks. 150) derece olarak bulundu. Küçük cerrahi travma, girişim süresinin kısafiğı, erken postoperatif dönemde omuz hareketlerine izin vermesi, hızlı kemiksel iyileşme sağlaması ile bu yöntem, çok değişik tedavi seçeneklerinin önerildiği proksimal humerusun bu özel tip kmk/annda alman erken sonuç/an ile cesaret vericidir. Anahtar kelime/er: Humerus kmklan, intramedüller çivileme /ntramedullary nailing of surgica/ neck fractures of the humerus
Iı 'nda 9 (3 kadm, 6 erkek) subtrokanterik femur kmkıı olgu intrameduller Gamma çivisi ile tedavi... more Iı 'nda 9 (3 kadm, 6 erkek) subtrokanterik femur kmkıı olgu intrameduller Gamma çivisi ile tedavi edildi. Sheinsheim smıf/andtrmasma göre kmk dağılımı : 3 (%33) 2A, 2 (%22) 28, 4 (%44) 3A oldu. Olgulann 6 (%61)'smda açık redüksiyon ile intrameduller çivileme yapıldı. Yaş ortalaması 36 (min. 20, mak. 58) olan olgular ortalama 10 (min. 5, mak. 34) ay izlendi. Kmklarm tümü iyileşti. Kalça hareket genişliği ve Postel-Merle d'Aubigne kriterlerine göre olgularm 4 (%44)'ünde çok iyi, 4 (%44) 'ünde iyi, 1 (% ll)'inde orta sonuç almdı. Kı nk yerindeki parçalanmaya bakılmaksızm elde edilen stabil osteosentez ile erken dönemde yüklenmeye baş lanabilmesi; Gamma çivisi ile osteosentezin bu tip kmklarm tedavisinde etkin bir yöntem olduğunu göstermektedir. Anahtar kelimeler: Subtrokanterik femur kmklan, Gamma çivisi Gamma nailing for subtrochanteric fractures of the femur Subtrochanteric fractures especially comminuted ones have posed a challenge to orthopaedic surgeons.
bileği kmkıı 28 (15 erkek, 13 kadm) olguda AO Tip B dış ma/leol kmğı için posterior plak uyguland... more bileği kmkıı 28 (15 erkek, 13 kadm) olguda AO Tip B dış ma/leol kmğı için posterior plak uygulandı. Yaş ortalaması 39 (min. 23, mak. 67) olan olgular ortalama 9 (min. 6, mak. 16) ay izlendikten sonra yeniden değerlendirildi. Weber formuna göre 9 (%32) çok iyi, 17 (%60) iyi ve 2 (%7) yetersiz sonuç almdı. Posterior plaklamaya ait özel bir sorun ile karşılaşılmadı. Lateral plak uygu!aması ile kıyaslandığında, kısa cerrahi girişim süresi, plakta minimum bükme, implant boyutunda ve vida sayısmda azalma, distal vida uçlan ile eklem penetrasyon riskinin olmaması, plak kitlesinin cilt altmda ağnlı duyarlilık oluşturmaması, kmk yerinde yer değiştirmeyi önleyici etkisi ve erken dönemde rehabilitasyona izin vermesi gibi avantaj/an ve biomekanik üstünlüğü ile yöntem ayak bileği tip B kmklarmda ve özellikle osteoporotik yaşlı olgularda iyi bir tesbit sağlamıştır. Anahtar kelime/er: Ayak bileği kmklan, posterior plak The antiglide plate for the treatment of AD type 8 fractures of the distal fibula During the period from August 1990 to December 1991, 28 (15 male, 13 female) patients with AO Type-B fractures of the ankle were treated by the antiglide plate. We reviewed a/l the cases af ter an average fo/lowup of 9 (min. 6, max. 16) months. The average age in these cases is 39 (min. 23, max. 67) years. Using the ankle evaluation scale of Weber, 9 (32%) exce/lent, 17 (60%) good and 2 (7%) poor results were found. The use of antiglide plate has no effect in poor cases. Because the fractures were very complicated. The results of this series indicated that the use of the antiglide plate appeared to have distinct clinical advantage over especia/ly lateral plating system. These advantages include less operative time, minimum bending of the plate, with a minimum of material, no risk of a screw tip penetrating the ankle joint, no painfu/ly prominent under the skin and surgical scar. Early motion did not increases the incidence of wound complication or loss of fracture reduction. Stabilization is better for the treatment of oblique fractures and especia/ly in older patients with osteoporotic bone. Because of these advantages and the biomechanica/ly sound technique, the antiglide plate is recommended for stabilization of AO Type B fractures of the distal fibula
Turkish journal of trauma & emergency surgery, 2007
AMAÇ: Çocuklarda 30 dereceden fazla açılanma gösteren radius boyun kırıklarının tedavisi sorunlud... more AMAÇ: Çocuklarda 30 dereceden fazla açılanma gösteren radius boyun kırıklarının tedavisi sorunludur. Amacımız bu kırıkların tedavisinde Metaizeau tarafından 1980 yılında tanımlanan kapalı redüksiyon ve intramedüller tespitin etkinliğini belirlemektir. GEREÇ-YÖNTEM: Genel anestezi altında ve floroskopi kontrolünde, radius distal metafizi radial tarafında 1 cm boyunda insizyon yapıldı. Bir Kirşner teli şekillendirilip, 3-5 mm’lik uç bölümü yaklaşık 30 derece kadar büküldü. Bu tel medüller kanala sokulup, proksimale doğru kırılmış olan epifizin altına ulaşana kadar ilerletildi. Telin epifize doğru kaldırılması ve döndürülmesi ile anatomik redüksiyon elde edilmeye çalışıldı. Bu teknik 1996 ile 2003 yılları arasında dokuz hastada kullanıldı. BULGULAR: Çalışmaya katılan bir olgu dışındaki tüm olgularda çok iyi sonuçla, tam bir fonksiyonel iyileşme gözlendi. Herhangi bir komplikasyona rastlanmadı. SONUÇ: Tekniğin basit olması ve yüz güldürücü sonuçlar vermesi nedeniyle, çocuklardaki ayrılmış radius boyun kırıklarında bu kapalı tedavi yöntemini öneriyoruz.BACKGROUND: The treatment of radial neck fractures in children is difficult when the angular displacement exceeds 30 degrees. The authors report their experience with closed reduction of this fracture and intramedullary pinning which was described and popularized by Metaizeau et al. in 1980. METHODS: Under general anesthesia and guidance of an image intensifier, a 1 cm incision was made on the radial side of distal radial metaphysis. A Kirschner wire was contoured and then the last 3-5 mm were bent approximately 30 degrees. It was introduced into the medullary canal of the radius and by pushing it proximally until its point reaches the inferior aspect of the epiphysis to elevate and rotate to achieve an anatomic reduction. This technique was used in nine patients between 1996 and 2003. RESULTS: Full functional recoveries with excellent results were observed in all cases but one at the last follow-up. No complication was encountered. CONCLUSION: We recommend this closed technique as it is relatively simple and associated with encouraging results
Injury-international Journal of The Care of The Injured, Dec 1, 2016
Background: As the tibial bone defect increases in size, the problems in treatment also increase.... more Background: As the tibial bone defect increases in size, the problems in treatment also increase. The treatment may be problematic but different treatment approaches can be used. Among these approaches, distraction osteogenesis is a method an orthopedic surgeon with limited conditions can use although it has a longer treatment period. In our case series, we evaluated current treatment approaches. Method: Retrospective study based on patient records and radiographs. We evaluated our cases with tibial bone defects Type B and greater than 5 cm. Twenty four cases were operated between 1995 and 2013. Clinical follow-up consisted of physical examination, review of radiographs, and Association for the Study of the Method of Ilizarov (ASAMI) scoring system of bone and functional results. Results: The defects had an average lenght of 7.01 cm (SD:2.88) (range, 5-18). The mean follow-up time from removal of the apparatus to the time of the last clinic visit averaged 74.08 ± 24.17 months (range: 39-122). The Ilizarov frame was placed for transport and until bone was solid, average of 275.5 ± 70.6 days (range: 190-437 days). The mean external fixator time (EFT) was 350.91 ± 89.22 days (range: 261-627 days). The mean external fixator index (EFI) was 52 days/cm (range: 34.8-62.8 days/cm). Bone union was obtained in 23/24 (95.8%) patients. Seven patients suffered from stiffness (2 knee, 5 ankle) from which 3 patients developed equinus deformity and required tenoplasty (Achilles tendon lengthening at the time of frame removal. After reaching docking site, 5 patients needed intramedullary nailing to speed up union. Twelve (50%) cases had excellent radiological results, 8 (33%) cases had good, 2 (8%) cases fair and 2 (8%) cases had poor results. Regarding the functional ASAMI scoring system 14 (58%) cases had excellent, 9 (38%) cases had good and one case (4%) had fair result. Conclusion: According to our experience, the Ilizarov bone transport technique remains a reliable method to repair bone defects. However, the treatment time is lengthy with a considerable risk of complications. We found closed intramedullary nailing as an effective and easy solution for cases without pin tract infections to manage the nonunion problem of the docking site and this option should be considered where the surgeon envisages difficulties of healing or the patient has lost patience with the frame. Careful selection of case and patient profile can optimize the outcomes.
We studied 39 patients with 42 diaphyseal tibial fractures in whom we suspected a high risk for t... more We studied 39 patients with 42 diaphyseal tibial fractures in whom we suspected a high risk for the development of a compartment syndrome. We measured the anterior absolute compartment pressure (ACP) every 12 h for 72 h and also recorded the differential pressure (ΔP=diastolic blood pressure−ACP). Fasciotomy of the extremity was only performed when the differential pressure was less than 30 mmHg for more than 30 min. The highest values of the ACP were recorded between 24 h and 36 h after admission. Three fractures had a differential pressure less than 30 mmHg and all were treated by fasciotomy. In three fractures the ACP was equal to or higher than 50 mmHg, of which two had a differential pressure less than 30 mmHg. The patients were followed up for a mean of 36 months (29-45). All fractures healed, and none of our patients showed any sequelae of compartment syndrome at their last review. Résumé Nous avons étudié 39 malades avec 42 fractures tibiales diaphysaires que nous avons suspecté d'un syndrome compartimental. Nous avons mesuré la pression du compartiment antérieure (ACP) chaque 12 h pendant 72 h et avons aussi enregistré la pression différentielle (ΔP=tension diastolique−ACP). Une fasciotomie de la jambe a été exécutée seulement quand la pression différentielle était inférieure à 30 mmHg pendant plus de 30 min. Les plus hautes valeurs de l'ACP ont été enregistrées entre 24 et 36 h après l'admission. Trois fractures avaient une pression différentielle de moins de 30 mmHg et toutes ont été traitées par fasciotomie. Dans trois fractures l'ACP était égale ou supérieure à 50 mmHg , avec, pour deux, une pression différentielle de moins de 30 mmHg. Les malades ont été suivis pendant une moyenne de 36 mois (29-45). Toutes les fractures ont guéri et aucun de nos malades n'a montré de séquelle d'un syndrome de compartiment à la dernière révision.
Joint Diseases and Related Surgery Case Reports Spontaneous bilateral Achilles tendon rupture is ... more Joint Diseases and Related Surgery Case Reports Spontaneous bilateral Achilles tendon rupture is a rare injury. There is an established association between Achilles tendon rupture and corticosteroid or fluoroquinolone use. However, a bilateral rupture in a pregnant patient stands as a rare condition. We present the case of a 28-year-old pregnant female patient with spontaneous bilateral Achilles tendon rupture. The patient had a history of bilateral Achilles tendinopathy. Conservative treatment was initially chosen due to pregnancy. The conservative treatment yielded a good result on the left side. The right side had no clinical improvement and was treated surgically 10 weeks after the injury. The Bosworth technique was used to reconstruct the right Achilles tendon. Clinical outcomes were excellent after two years of follow-up. In conclusion, caution is advised in pregnant patients with a history of Achilles tendinopathy, as conservative treatment does not always result in a good outcome.
Background: In our retrospective study, we evaluated pediatric femoral shaft fractures sustained ... more Background: In our retrospective study, we evaluated pediatric femoral shaft fractures sustained by children of five to fifteen years of age, all of whom were treated with elastic intramedullary nailing. Methods: Between 1990 and 2000, 32 femoral fractures of 30 children, 14 (47%) polytraumatized, with an average age of 9.9 (6-14), were treated with elastic intramedullary nailing. Results: Average follow-up was 105.3 (25-145) months. Three cases (9.3%) were re-operated due to developed angulations related to weight bearing in the early postoperative period. In three (9,3%) of our cases we diagnosed more than five degrees valgus deformity, in one (3.1%) anterior angulation and in 1 (3.1%) internal rotation. The average of absolute value of length discrepancies was determined as 9 mm (-15mm - +15mm). Conclusion: Elastic intramedullary fixation is a recommended method, especially for polytraumatized patients, because of facilitates of patient care, recovers social activity quickly, and causes minimal soft tissue damage. However angular or rotational deformations are also possible. Selection criteria and follow up period is important and treatment of the complications must be on time.
Turkish journal of trauma & emergency surgery, Apr 1, 2004
Background: The results of intracompartmental pressure monitoring were assessed in uncooperative,... more Background: The results of intracompartmental pressure monitoring were assessed in uncooperative, polytraumatized patients with tibial shaft fractures. Methods: The study included 29 tibial fractures of 26 polytraumatized patients (9 females, 17 males; mean age 36 years; range 15 to 75 years) admitted to the intensive care unit. The fractures were on the right side in eight patients, on the left in 15 patients. Three patients had bilateral involvement. All the patients were unconscious. Following trauma, absolute compartment pressures and ΔP (diastolic blood pressure - absolute compartment pressure) were monitored at 12-hour intervals for 72 hours via the intracompartmental pressure monitoring system. Patients whose ΔP values were 30 mmHg or below underwent fasciotomy. The mean follow-up period was 21.2 months (range 18 to 25 months). Results: The overall mean absolute compartment pressure was 30.25 mmHg, and the mean ΔP was 48.47 mmHg at the end of 72 hours. Fasciotomy was performed in two patients (7%) in whom a diagnosis of acute compartment syndrome was made depending on ΔP values less than 30 mmHg. None of the patients had complications associated with acute compartment syndrome. Union was achieved in all the patients without an additional intervention. The mean time to union was 5.21 months (range 3 to 9 months). Conclusion: Intracompartmental pressure monitoring should be considered for an early diagnosis of acute compartment syndrome in uncooperative, polytraumatized patients with tibial shaft fractures.
Background: In orthopaedic traumatology; acute compartment syndrome is a common complication asso... more Background: In orthopaedic traumatology; acute compartment syndrome is a common complication associated with tibial fractures. In our study, we investigate differences, if any, between open and closed tibialfractures in terms oftheir risk of compartment syndrome. Methods: Fourty-two tibial fractures of 39 patients, 29 (69%) closed and 13 (31%) open, having the risk of acute compartment syndrome according to the clinical examination, were monitored following traumas during which their DP (DP= Diastolic blood pressure -Absolute compartment pressure) and absolute compartment pressures were measured via intracompartmental pressure measuring equipment. Results: Average absolute compartment pressure was found to be 31.25 mmHg in open and 29,32 mmHg in closed fractures (p=O,484) whereas average DP was measured to be 47,46 mmHg in open and 49,66 mmHg in closedfractures (p=O,415). According to student's test, the difference between the two groups was not significant. We found the incidence of acute compartment syndrome as 7, 7% in open fractures, 6.9% in closed and 7, 1 % in overall tibial fractures andfasciotomy was carried out in those cases. Conclution: Statistically not significant difference between the pressure levels,found in open and closed tibialfractures, showed that open type oftibialfractures holds the risk of compartment syndrome as much as the closed one.
Objectives : To assess the results of our patients injured of intracapsular neck fracture of the ... more Objectives : To assess the results of our patients injured of intracapsular neck fracture of the femur osteosynthesed by cannulated screws; which could not have been operated within the ideal time because of various problems. Materials & Methods: Fifty-two patients are accepted to the study from September 1991 to January 2008 which they had intracapsular neck fractures of femur caused by an injury and treated with the cannulated screws after 24 hours from the injury. Of the 52 patients, 22 were women (42,3%) and 30 were men (57,7%). The mean postinjury time of the patients was 125,6 (26–360) hours. Four patients had Garden type 1 (7,7%), 13 patients had Garden type 2 (25%), 24 patients had Garden type 3 (46,2%), and 11 patients had Garden type 4 (21,1%) intracapsular neck fractures. Fourty-two patients (80,8%) had gone to closed reduction, and 10 patients (19,2%) had gone to open reduction and they all were osteosynthesed with the cannulated screws. The reduction success is assessed by the x-rays. The mean follow-up time was 92,2 (15–179) months. Results : The reduction success was moderate in 3 patients (5,8%), was good in 23 patients (44,2%), and was excellent in 26 patients (50%). There was no poor reduction success in any of the patients. The complications seen in the patients were; 6 AVN, 1 nonunion, 1 malunion, 2 reduction failure, 1 infection. Conclusion : The patients with the intracapsular neck fractures of the femur could not have been operated within the ideal time because of life threatening poly-traumas, the late reference of patients to our clinic, and failing to establish ideal implant and operation circumstances in a timely manner. We believe that osteosynthesis with cannulated screw should not be discarded as a method of treatment even postinjury time exceeds 6 hours in intracapsular femoral neck fractures.
Background and Aim: Applying Ilizarov fixator is an easier method compared with other methods in ... more Background and Aim: Applying Ilizarov fixator is an easier method compared with other methods in treating of tibial fractures. But it be used less frequently than others; yet, little information about it is available. The present study was performed to evaluate the results and complications of Ilizarov external fixator in type 3C Pilon fractures. Materials and Methods: In this retrospective study, 178 patients with type C3 pilon fractures, aged over 86-88 years, admitted to Poursina hospital in Rasht between 1998 and 2000 were included. Their follow-up lasted 24 months after surgery and they were then examined based on clinical and radiographic criteria and were finally evaluated on the basis of American Orthopedic Foot and Ankle Society (AOFAS) scoring criteria. Results: The criteria (AOFAS) showed that the average score obtained was 88±6. In 89 patients (i.e.55, 62%) the outcome was excellent, In 31 patients (20, 62%) it was good, in 32 cases (21, 87%) the result was moderate, and in 8 patients (5.69%) it was weak. Conclusion: According to the results obtained and comparing them with the results of other treatments, one can claim that this treating approach is better than the others for pilon fractures, particularly for type 3c pilon fractures.
Objective: Motorcycle injuries have shown a progression in last years in trauma patients admitted... more Objective: Motorcycle injuries have shown a progression in last years in trauma patients admitted to our clinic. The aim of this study is to evaluate statistically whether the motorcycle accidents incidence is really has a progression or not. Method: The study involved 180 patients (87 women, 93 men) operated for the fractures after a motorcycle crash between the first six months of 2002 and 2007. The injury patterns have been investigated if there was a significant increase or not. The mean age was 45.2 years (min. 1year-max. 87 years). In Group I; 50 patients (22 women, 28 men) were included which operated in the first 6 months of 2002. The mean age was 44.8 years (min.1 year-max. 85 years). In Group II; 130 patients (65 women, 65 men) were included which operated in the first 6 months of 2007. The mean age was 45.7 (min. 3 years-max. 87 years). Results: We compared two groups and found a significant 3.425 increase in motorcycle injuries contrary to 0.075 decreases in falls, 0.023 decrease in traffic accidents within the vehicle, 0.013 decreases in traffic accidents out of the vehicle, 0.616 decreases in sports injuries, 0.25 decreases in gunshot injuries. This increase in motorcycle injuries is statistically significant. Conclusion: We have found significant increase in motorcycle injuries statistically. The importance of this, it affects younger population, and they bring out high morbidity. Since; we think that motorcycle injuries must be stated especially in literatures. We must warn our colleagues to state these injuries, and must take precautions against this problem.
Results: 165 patients (82.4% women, mean age 67.5 ± 7.8 years) were recruited to the study. The p... more Results: 165 patients (82.4% women, mean age 67.5 ± 7.8 years) were recruited to the study. The patients generally had low scores for PDQ-Chi (mean 4.9 ± 3.9). Only one patient had neuropathic pain as classified by PDQ-Chi (score ≥19). The Cronbach's alpha of the 7-items and 9-items PDQ-Chi were 0.60 and 0.58 respectively. Factor analysis of the 7-items PDQ-Chi revealed a 2-factor structure that explained 48% of total variance. The 9-items total PDQ-Chi scores correlated with pain scores, but not pressure pain threshold of knee or forearm. The PDQ-Chi did not correlate with the hypothesized trait of measurement. 17 patients administered the PDQ-Chi a second time on the day of TKR. The ICC of the 7-items and 9-items PDQ-Chi was 0.59 and 0.50, respectively; while the classification consistency of the 9-items PDQ-Chi was 94%. Conclusions: In this group of patients with KOA enlisted for TKR, both the 7-items and 9-items of PDQ-Chi were suboptimal in internal consistency and hypothesis testing. Using the 9-items PDQ-Chi with cutoffs as screening instrument for neuropathic pain, it had good classification consistency. Further studies with larger sample size are required for criterion validity. References:
tarihleri arasmda humerus cerrahi boyun kmğı tanısı ile 13 (8 bayan,S erkek) olgu başvurdu. Yaş o... more tarihleri arasmda humerus cerrahi boyun kmğı tanısı ile 13 (8 bayan,S erkek) olgu başvurdu. Yaş ortalaması 47 (min. 30, maks. 78) olan olgularm 11 (%84) 'inde yaralanma nedeni Jrafik kazasıd/{. Skopi kontrolunda kapalı redüksiyon ve distal humerustan retrograd intramedüller çivileme ile yaralanma sonrası ortalama 8. (min. 2, Maks. 28) günde stabil internal tesbit gerçekleştirildi. Postoperatif ortalama iki hafta Velpeau bandajı uygulandıktan sonra omuz ve dirsek rehabilitasyonuna başlandı. Ortalama 5 (min. 3, mak. 14) ay izlenen olgularda kmk iyileşmesi radyolojik olarak, omuz ve dirsek hareket genişliği goniometrik olarak kaydedildi. Ortalama 3. (min. 2, maks. 5) ayda kmk aralığmm kallusla dolduğu gözlendi. Omuzlarda abdüksiyon genişliği ortalama 120 (min. 100, maks. 170), öne ffeksiyon genişliği ortalama 100 (Min. 90, Maks. 150) ve dirsek ekstansiyon ffeksiyon genişliği ortalama 120 (min. 100, maks. 150) derece olarak bulundu. Küçük cerrahi travma, girişim süresinin kısafiğı, erken postoperatif dönemde omuz hareketlerine izin vermesi, hızlı kemiksel iyileşme sağlaması ile bu yöntem, çok değişik tedavi seçeneklerinin önerildiği proksimal humerusun bu özel tip kmk/annda alman erken sonuç/an ile cesaret vericidir. Anahtar kelime/er: Humerus kmklan, intramedüller çivileme /ntramedullary nailing of surgica/ neck fractures of the humerus
Iı 'nda 9 (3 kadm, 6 erkek) subtrokanterik femur kmkıı olgu intrameduller Gamma çivisi ile tedavi... more Iı 'nda 9 (3 kadm, 6 erkek) subtrokanterik femur kmkıı olgu intrameduller Gamma çivisi ile tedavi edildi. Sheinsheim smıf/andtrmasma göre kmk dağılımı : 3 (%33) 2A, 2 (%22) 28, 4 (%44) 3A oldu. Olgulann 6 (%61)'smda açık redüksiyon ile intrameduller çivileme yapıldı. Yaş ortalaması 36 (min. 20, mak. 58) olan olgular ortalama 10 (min. 5, mak. 34) ay izlendi. Kmklarm tümü iyileşti. Kalça hareket genişliği ve Postel-Merle d'Aubigne kriterlerine göre olgularm 4 (%44)'ünde çok iyi, 4 (%44) 'ünde iyi, 1 (% ll)'inde orta sonuç almdı. Kı nk yerindeki parçalanmaya bakılmaksızm elde edilen stabil osteosentez ile erken dönemde yüklenmeye baş lanabilmesi; Gamma çivisi ile osteosentezin bu tip kmklarm tedavisinde etkin bir yöntem olduğunu göstermektedir. Anahtar kelimeler: Subtrokanterik femur kmklan, Gamma çivisi Gamma nailing for subtrochanteric fractures of the femur Subtrochanteric fractures especially comminuted ones have posed a challenge to orthopaedic surgeons.
bileği kmkıı 28 (15 erkek, 13 kadm) olguda AO Tip B dış ma/leol kmğı için posterior plak uyguland... more bileği kmkıı 28 (15 erkek, 13 kadm) olguda AO Tip B dış ma/leol kmğı için posterior plak uygulandı. Yaş ortalaması 39 (min. 23, mak. 67) olan olgular ortalama 9 (min. 6, mak. 16) ay izlendikten sonra yeniden değerlendirildi. Weber formuna göre 9 (%32) çok iyi, 17 (%60) iyi ve 2 (%7) yetersiz sonuç almdı. Posterior plaklamaya ait özel bir sorun ile karşılaşılmadı. Lateral plak uygu!aması ile kıyaslandığında, kısa cerrahi girişim süresi, plakta minimum bükme, implant boyutunda ve vida sayısmda azalma, distal vida uçlan ile eklem penetrasyon riskinin olmaması, plak kitlesinin cilt altmda ağnlı duyarlilık oluşturmaması, kmk yerinde yer değiştirmeyi önleyici etkisi ve erken dönemde rehabilitasyona izin vermesi gibi avantaj/an ve biomekanik üstünlüğü ile yöntem ayak bileği tip B kmklarmda ve özellikle osteoporotik yaşlı olgularda iyi bir tesbit sağlamıştır. Anahtar kelime/er: Ayak bileği kmklan, posterior plak The antiglide plate for the treatment of AD type 8 fractures of the distal fibula During the period from August 1990 to December 1991, 28 (15 male, 13 female) patients with AO Type-B fractures of the ankle were treated by the antiglide plate. We reviewed a/l the cases af ter an average fo/lowup of 9 (min. 6, max. 16) months. The average age in these cases is 39 (min. 23, max. 67) years. Using the ankle evaluation scale of Weber, 9 (32%) exce/lent, 17 (60%) good and 2 (7%) poor results were found. The use of antiglide plate has no effect in poor cases. Because the fractures were very complicated. The results of this series indicated that the use of the antiglide plate appeared to have distinct clinical advantage over especia/ly lateral plating system. These advantages include less operative time, minimum bending of the plate, with a minimum of material, no risk of a screw tip penetrating the ankle joint, no painfu/ly prominent under the skin and surgical scar. Early motion did not increases the incidence of wound complication or loss of fracture reduction. Stabilization is better for the treatment of oblique fractures and especia/ly in older patients with osteoporotic bone. Because of these advantages and the biomechanica/ly sound technique, the antiglide plate is recommended for stabilization of AO Type B fractures of the distal fibula
Turkish journal of trauma & emergency surgery, 2007
AMAÇ: Çocuklarda 30 dereceden fazla açılanma gösteren radius boyun kırıklarının tedavisi sorunlud... more AMAÇ: Çocuklarda 30 dereceden fazla açılanma gösteren radius boyun kırıklarının tedavisi sorunludur. Amacımız bu kırıkların tedavisinde Metaizeau tarafından 1980 yılında tanımlanan kapalı redüksiyon ve intramedüller tespitin etkinliğini belirlemektir. GEREÇ-YÖNTEM: Genel anestezi altında ve floroskopi kontrolünde, radius distal metafizi radial tarafında 1 cm boyunda insizyon yapıldı. Bir Kirşner teli şekillendirilip, 3-5 mm’lik uç bölümü yaklaşık 30 derece kadar büküldü. Bu tel medüller kanala sokulup, proksimale doğru kırılmış olan epifizin altına ulaşana kadar ilerletildi. Telin epifize doğru kaldırılması ve döndürülmesi ile anatomik redüksiyon elde edilmeye çalışıldı. Bu teknik 1996 ile 2003 yılları arasında dokuz hastada kullanıldı. BULGULAR: Çalışmaya katılan bir olgu dışındaki tüm olgularda çok iyi sonuçla, tam bir fonksiyonel iyileşme gözlendi. Herhangi bir komplikasyona rastlanmadı. SONUÇ: Tekniğin basit olması ve yüz güldürücü sonuçlar vermesi nedeniyle, çocuklardaki ayrılmış radius boyun kırıklarında bu kapalı tedavi yöntemini öneriyoruz.BACKGROUND: The treatment of radial neck fractures in children is difficult when the angular displacement exceeds 30 degrees. The authors report their experience with closed reduction of this fracture and intramedullary pinning which was described and popularized by Metaizeau et al. in 1980. METHODS: Under general anesthesia and guidance of an image intensifier, a 1 cm incision was made on the radial side of distal radial metaphysis. A Kirschner wire was contoured and then the last 3-5 mm were bent approximately 30 degrees. It was introduced into the medullary canal of the radius and by pushing it proximally until its point reaches the inferior aspect of the epiphysis to elevate and rotate to achieve an anatomic reduction. This technique was used in nine patients between 1996 and 2003. RESULTS: Full functional recoveries with excellent results were observed in all cases but one at the last follow-up. No complication was encountered. CONCLUSION: We recommend this closed technique as it is relatively simple and associated with encouraging results
Injury-international Journal of The Care of The Injured, Dec 1, 2016
Background: As the tibial bone defect increases in size, the problems in treatment also increase.... more Background: As the tibial bone defect increases in size, the problems in treatment also increase. The treatment may be problematic but different treatment approaches can be used. Among these approaches, distraction osteogenesis is a method an orthopedic surgeon with limited conditions can use although it has a longer treatment period. In our case series, we evaluated current treatment approaches. Method: Retrospective study based on patient records and radiographs. We evaluated our cases with tibial bone defects Type B and greater than 5 cm. Twenty four cases were operated between 1995 and 2013. Clinical follow-up consisted of physical examination, review of radiographs, and Association for the Study of the Method of Ilizarov (ASAMI) scoring system of bone and functional results. Results: The defects had an average lenght of 7.01 cm (SD:2.88) (range, 5-18). The mean follow-up time from removal of the apparatus to the time of the last clinic visit averaged 74.08 ± 24.17 months (range: 39-122). The Ilizarov frame was placed for transport and until bone was solid, average of 275.5 ± 70.6 days (range: 190-437 days). The mean external fixator time (EFT) was 350.91 ± 89.22 days (range: 261-627 days). The mean external fixator index (EFI) was 52 days/cm (range: 34.8-62.8 days/cm). Bone union was obtained in 23/24 (95.8%) patients. Seven patients suffered from stiffness (2 knee, 5 ankle) from which 3 patients developed equinus deformity and required tenoplasty (Achilles tendon lengthening at the time of frame removal. After reaching docking site, 5 patients needed intramedullary nailing to speed up union. Twelve (50%) cases had excellent radiological results, 8 (33%) cases had good, 2 (8%) cases fair and 2 (8%) cases had poor results. Regarding the functional ASAMI scoring system 14 (58%) cases had excellent, 9 (38%) cases had good and one case (4%) had fair result. Conclusion: According to our experience, the Ilizarov bone transport technique remains a reliable method to repair bone defects. However, the treatment time is lengthy with a considerable risk of complications. We found closed intramedullary nailing as an effective and easy solution for cases without pin tract infections to manage the nonunion problem of the docking site and this option should be considered where the surgeon envisages difficulties of healing or the patient has lost patience with the frame. Careful selection of case and patient profile can optimize the outcomes.
We studied 39 patients with 42 diaphyseal tibial fractures in whom we suspected a high risk for t... more We studied 39 patients with 42 diaphyseal tibial fractures in whom we suspected a high risk for the development of a compartment syndrome. We measured the anterior absolute compartment pressure (ACP) every 12 h for 72 h and also recorded the differential pressure (ΔP=diastolic blood pressure−ACP). Fasciotomy of the extremity was only performed when the differential pressure was less than 30 mmHg for more than 30 min. The highest values of the ACP were recorded between 24 h and 36 h after admission. Three fractures had a differential pressure less than 30 mmHg and all were treated by fasciotomy. In three fractures the ACP was equal to or higher than 50 mmHg, of which two had a differential pressure less than 30 mmHg. The patients were followed up for a mean of 36 months (29-45). All fractures healed, and none of our patients showed any sequelae of compartment syndrome at their last review. Résumé Nous avons étudié 39 malades avec 42 fractures tibiales diaphysaires que nous avons suspecté d'un syndrome compartimental. Nous avons mesuré la pression du compartiment antérieure (ACP) chaque 12 h pendant 72 h et avons aussi enregistré la pression différentielle (ΔP=tension diastolique−ACP). Une fasciotomie de la jambe a été exécutée seulement quand la pression différentielle était inférieure à 30 mmHg pendant plus de 30 min. Les plus hautes valeurs de l'ACP ont été enregistrées entre 24 et 36 h après l'admission. Trois fractures avaient une pression différentielle de moins de 30 mmHg et toutes ont été traitées par fasciotomie. Dans trois fractures l'ACP était égale ou supérieure à 50 mmHg , avec, pour deux, une pression différentielle de moins de 30 mmHg. Les malades ont été suivis pendant une moyenne de 36 mois (29-45). Toutes les fractures ont guéri et aucun de nos malades n'a montré de séquelle d'un syndrome de compartiment à la dernière révision.
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