The role of simple elbow dislocations in cubitus valgus development in children

We investigated the functional and radiological outcomes of conservatively treated simple traumatic elbow dislocations and subsequent incidence of cubitus valgus development in children. Eleven patients (one female, ten male; mean age 9.8 years, range seven to 12 years) who presented to our hospital with simple elbow dislocations and were conservatively treated between July 2008 and September 2010 were included in the study. All were posterolateral closed dislocations. None of the patients had accompanying elbow fractures. All patients had pre- and postoperative radiographic examinations. The carrying angle of the involved elbow was measured and compared to the contralateral non-injured elbow during follow-up. The incidence and severity of cubitus valgus development was assessed. The functional and clinical outcomes were evaluated using the Mayo Elbow Performance Scale. The mean monitoring period was 24.3 months (range 19-30 months). All patients had satisfactory good and excellent results (85-100 points; mean 96.8 points) according to the Mayo Elbow Performance Scale. The final average elbow flexion was 137A degrees (range, 130-145A degrees) and average extension was 8.6A degrees (range 0-20A degrees) with full supination and pronation in traumatic elbow. Four patients (36.4 %) had an average increase (cubitus valgus) of 14.5A degrees (10-20A degrees) in carrying angle compared to the other elbow. While isolated traumatic dislocation of the elbow is uncommon among children, it can be successfully treated by urgent closed reduction, proper fixation of the elbow and appropriate timely rehabilitation. However, it should be considered that some patients may develop cubitus valgus deformity in a later period. Therefore, each patient with a simple traumatic elbow dislocation should be followed, and the parents should be informed of the potential for any deformity development

Hindfoot valgus following interlocking nail treatment for tibial diaphysis fractures: Can the fibula be neglected?

Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level) managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI). Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean fibular shortening was 1.2 cm (range, 0.5-2 cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening

Radyosinovektomi Sonrası SPECT/BT ve Planar Görüntülemenin Karşılaştırılması

Amaç: Radyosinovektomi sonrası eklemlerin planar ve SPECT/BT görüntülemelerinin etkinliklerini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Ocak 2004-Aralık 2012 arasında hemofilik artropatili 6 hastaya kliniğimizde radyosinovektomi uygulandı. 5 diz, 1 dirsek ve 2 ayak bileği eklemine radyosinovektomi sonrası planar ve SPECT/BT görüntülemesi yapıldı. Bulgular: SPECT/BT ve planar görüntüleme yöntemleri arasında aktivitenin dağılım paterni değişim göstermedi. Bir hastada suprapatellar reseste SPECT/BT ile planar görüntülemede görülemeyen aktivite lokulasyonu görüldü. Sonuç: Postradyosinovektomi görüntüleme protokollerine SPECT/BT'nin eklenmesi lokal komplikasyonlar gelişme riski bulunan hastaların belirlenmesinde yararlı olabilir.Objective: We aimed to compare the efficacies of SPECT/CT and planar imaging of joints after radiosynovectomy. Material and Methods: Six patients with hemophylic arthropathy (HA) (5 hemophilia A, 1 hemophilia B) with a mean age 10.5 underwent radiosynovectomy in our clinic between January 2004-December 2012. Postradiosynovectomy planar and SPECT-CT imaging of 5 knee joints, 1 elbow joint and two ankle joints were obtained. Results: Distribution pattern of activity showed no difference between SPECT/CT and planar imaging methods. In one patient there was loculation of activity in suprapatellar recess detected with SPECT/CT which was not deliniated in planar image. Conclusion: Addition of SPECT/CT to the postradiosynovectomy imaging protocol might help in identification of those who are at risk for potentially serious local complications

The anatomical changes in the distal tibio-fibular joint in syndesmotic ınjuries: A fresh cadaveric study

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Bu çalışmada taze ayak bileği kadavra piyeslerinde, sindesmoz ligamanlarının yaralanmalarında oluşan distal tibio-fibular eklem değişiklikleri araştırıldı. Gereç ve Yöntemler: On adet taze kadavrada yirmi ayak bilek piyesi rastgele iki eşit gruba ayrıldı. Sindesmozu oluşturan bağlar diseke edilip kesilerek ayak bileğindeki değişiklikler anatomik ve radyolojik olarak incelendi. İlk grupta anteriorden başlanarak, ikinci grupta ise posteriordan başlanarak sırası ile sindesmoz ligamanları diseke edildi. Distal tibio-fibular eklemdeki anatomik ayrışma ölçüldü. Bu sırada alınan dinamik skopi görüntüleri ile de radyolojik ölçümler yapıldı.Objective: The aim of this study is to investigate the changes in the distal tibio-fibular joint during the syndesmotic ligamentous injuries in the fresh cadavers. Material and Methods: Twenty below knee specimens of ten fresh cadavers were randomly divided in two equal groups. Anatomical and radiological changes of the ankle joint were examined via the dissection of syndesmotic ligaments. In the first group by the anterior approach and in the second group by the posterior approach syndesmotic ligaments were disected respectively. The anatomical dissociation in the distal tibio-fibular joint was measured. Radiological measurement were achieved by dynamic flouroscopic views

The anatomical changes in the distal tibio-fibular joint in syndesmotic ınjuries: a fresh cadaveric study

Amaç: Bu çalışmada taze ayak bileği kadavra piyeslerinde, sindesmoz ligamanlarının yaralanmalarında oluşan distal tibio-fibular eklem değişiklikleri araştırıldı. Gereç ve Yöntemler: On adet taze kadavrada yirmi ayak bilek piyesi rastgele iki eşit gruba ayrıldı. Sindesmozu oluşturan bağlar diseke edilip kesilerek ayak bileğindeki deği- şiklikler anatomik ve radyolojik olarak incelendi. İlk grupta anteriorden başlanarak, ikinci grupta ise posteriordan başlanarak sırası ile sindesmoz ligamanları diseke edildi. Distal tibio-fibular eklemdeki anatomik ayrışma ölçüldü. Bu sırada alınan dinamik skopi görüntüleri ile de radyolojik ölçümler yapıldı. Bulgular: Diseksiyonun her aşamasında anatomik olarak eklemde ayrışma saptandı. İki grup arasında anlamlı fark tespit edilmedi. Tek ligaman sağlamken radyolojik olarak belirgin bir değişim saptanmadı. Her iki seride de kesi anterior-posterior tüm katları içerdiğinde distal tibiofibular ayrışmada belirgin artış görülmekle birlikte radyolojik olarak tibiofibuler açık alanda belirgin artış tespit edildi. Buna rağmen medial açık alan ve talo-krural açı değişimi saptanmadı. Sonuç: Sindesmoz ligamanlarından yalnızca bir tanesi kesildiğinde bile distal tibio fibuler eklem anatomisi laterale ayrışma şeklinde bozulmaktadır. Direkt grafi ile kısmi yaralanmalar saptanamadığından dolayı klinik şüphe varlığında MRG gibi radyolojik ilave tanı yöntemlerine başvurmak gereklidir.Objective: The aim of this study is to investigate the changes in the distal tibio-fibular joint during the syndesmotic ligamentous injuries in the fresh cadavers. Material and Methods: Twenty below knee specimens of ten fresh cadavers were randomly divided in two equal groups. Anatomical and radiological changes of the ankle joint were examined via the dissection of syndesmotic ligaments. In the first group by the anterior approach and in the second group by the posterior approach syndesmotic ligaments were disected respectively. The anatomical dissociation in the distal tibio-fibular joint was measured. Radiological measurement were achieved by dynamic flouroscopic views. Results: In all steps of the dissection, anatomical dissociation was observed in the joint. There was no significant difference between two groups. When one of the ligaments was intact there was no significant change radiographically. In both series since the incisions included all of the layers anterior to posterior, significant increase of distal tibio-fibular joint seperation was observed. In the meantime a significant increase was measured in tibiofibuler clear space radiologically. Despite this, medial clear space and talo-crural angle changes were not detected. Conclusion: Even when one of the syndesmotic ligaments is dissected, the anatomy of the distal tibio fibular joint is disrupted in the form of lateral separation which could not be imaged properly in X-Ray. Therefore, in the presence of clinical suspicion it is necessary to apply additional radiological diagnostic methods such as MRI

Osteoid Osteoma Treated with Radiofrequency Ablation

Purpose. Our aim is to evaluate the results of treatment with computed tomography (CT) guided percutaneous radiofrequency ablation for osteoid osteomas which were localized in a difficult area for operation. Materials and Methods. Glenoid, distal tibia, humerus shaft, proximal humerus, and in third finger of the hand proximal phalanx were involved in one patient. Proximal femur was involved in three patients, distal femur was involved in three patients, and proximal tibia was involved in two patients. 9 males and 4 females were aged 4 to 34 years (mean age: 18.5 years). All patients had pain and were evaluated with X-rays, CT, bone scintigraphy, and MRI. In all patients, RF ablation was performed with local anesthesia. The lesion heated to 90°C for 6 minutes. Results. All of the patients achieved complete pain relief after ablation and were fully weight bearing without any support. In all patients, there was soft tissue edema after the procedure. During follow-up, all patients were free from the pain and there was no sign about the tumor. There was no other complication after the process. Conclusion. CT guided RFA is a minimally invasive, safe, and cost-effective treatment for osteoid osteoma placed in difficult area for surgery

The role of simple elbow dislocations in cubitus valgus development in children

PURPOSE: We investigated the functional and radiological outcomes of conservatively treated simple traumatic elbow dislocations and subsequent incidence of cubitus valgus development in children. METHODS: Eleven patients (one female, ten male; mean age 9.8 years, range seven to 12 years) who presented to our hospital with simple elbow dislocations and were conservatively treated between July 2008 and September 2010 were included in the study. All were posterolateral closed dislocations. None of the patients had accompanying elbow fractures. All patients had pre- and postoperative radiographic examinations. The carrying angle of the involved elbow was measured and compared to the contralateral non-injured elbow during follow-up. The incidence and severity of cubitus valgus development was assessed. The functional and clinical outcomes were evaluated using the Mayo Elbow Performance Scale. The mean monitoring period was 24.3 months (range 19–30 months). RESULTS: All patients had satisfactory good and excellent results (85–100 points; mean 96.8 points) according to the Mayo Elbow Performance Scale. The final average elbow flexion was 137° (range, 130–145°) and average extension was 8.6° (range 0–20°) with full supination and pronation in traumatic elbow. Four patients (36.4 %) had an average increase (cubitus valgus) of 14.5° (10–20°) in carrying angle compared to the other elbow. CONCLUSIONS: While isolated traumatic dislocation of the elbow is uncommon among children, it can be successfully treated by urgent closed reduction, proper fixation of the elbow and appropriate timely rehabilitation. However, it should be considered that some patients may develop cubitus valgus deformity in a later period. Therefore, each patient with a simple traumatic elbow dislocation should be followed, and the parents should be informed of the potential for any deformity development