Elastic Stable Intramedullary Nailing for Pediatric Forearm Fractures: A Retrospective Analysis of Thirty Four Cases

Aim: The purpose of this investigation was to present our institutional experience of 34 pediatric both bone forearm fractures treated with titanium elastic intramedullary nails. Methods: Thirty-four patients, who were treated with titanium elastic nail for both bone forearm fractures diagnosis between 2011 and 2016, were included in the study. Clinical and radiological evaluation of the patients was retrospectively analyzed. Results: Bone healing process was completed for all patients at a mean of 6.6 weeks. The implants were removed at a mean time of 9.7 months from the index operation. Complications, including skin infections at the entry side of the nail, were recorded in three (8.82%) patients. These three patients had type 1 open fracture according to the Gustilo-Anderson classification and were treated with first generation cephalosporins. In a subjective measure of outcome during follow-up, it was observed that 33 patients (97.06%) were very satisfied and one (2.94%) was satisfied; no patient reported being not satisfied. Conclusion: Since titanium elastic nailing is a safe and effective method of treatment with advantages of easy implantation and removal as well as excellent cosmetic and functional results, elastic stable intramedullary nailing is the first treatment option that should be considered in pediatric both bone forearm fractures

Comparison of extension block pinning technique versus pin orthosis-extension block pinning technique for acute mallet fractures: a prospective randomized clinical trial

Introduction: The extension block pinning technique (EBPT) is a popular surgical treatment for mallet fractures; however, it has several drawbacks. The purpose of this randomized clinical trial was to compare EBPT to the pin orthosis-extension block pinning method (PO-EBPT) in the treatment of mallet fractures involving more than one-third of the joint surface but without primary joint dislocation. Materials and methods: Sixty-five patients with mallet fractures were randomized into two groups between June 2017 and January 2020: Group I (33 patients) was treated with EBPT and group II (32 patients) was treated with PO-EBPT. Five patients were lost to follow up due to lack of follow-up and death. There were no significant differences in the clinical and demographic characteristics of both groups. Patients were evaluated according to fracture union, extension lag, distal interphalangeal (DIP) joint range of motion, Crawford’s criteria, and complication rates. The patients were followed-up post-operatively at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. Results: A total of 60 patients were randomized into two groups: one (30 patients) was treated with EBPT and the second (30 patients) with PO-EBPT. There were no significant differences between the two groups in terms of fracture union and active DIP joint flexion (P = 0.743 and P = 0.059, respectively). The mean extension lag of the DIP joint in the EBPT group was significantly greater than the PO-EBPT group (10° ± 9.47° vs. 4.17° ± 7.2°, P = 0.009). According to the Crawford criteria, the PO-EBPT group showed significantly better outcomes (P = 0.005). The complication rates were similar between groups (P = 0.45). Conclusion: In comparison to the EBPT technique, the group of patients operated with PO-EBPT had superior clinical outcomes and less loss of extension at the DIP joint according to the Crawford’s criteria

Evaluation of bilateral acromiohumeral distance on magnetic resonance imaging and radiography in patients with unilateral rotator cuff tears

Introduction The aim of this study was to evaluate the difference in the acromiohumeral distance (AHD) between the shoulders with full-thickness rotator cuff tear and contralateral healthy shoulders of the same patients on magnetic resonance imaging (MRI) and radiograph. Materials and methods We included 49 patients with unilateral full-thickness rotator cuff tears. The mean age of the patients (29 women and 20 men) was 54.57 +/- 7.10 years. The shoulders were divided into those with a full-thickness rotator cuff tear and healthy shoulders. The mean AHDs on radiograph and MRI were calculated by two radiologists experienced in the musculoskeletal system. Shoulders with rotator cuff tears on coronal plane and sagittal MRI were divided into 3 (Patte I, II, III) and 4 subgroups (S: superior, AS: anterosuperior, PS: posterosuperior, APS: anteroposterosuperior), respectively. The relationship between the groups and the subgroups was statistically investigated. Results The mean AHDs on radiograph were 6.93 and 9.11 mm and on MRI were 5.94 and 7.46 mm in the patient and control groups, respectively. The mean AHDs were 6.47, 6.03, and 4.95 mm in Patte I, II, and III, respectively. The difference between the subgroups was statistically significant. According to the sagittal plane topography, the mean AHDs (mm) were 6.39, 6.44, 5.8, and 4.6 mm in the superiorly, anterosuperiorly, posterosuperiorly, and anteroposterosuperiorly localized lesions, respectively. The relationship between S and AS was not statistically significant, and those between S and PS, AS and PS, S and APS, and PS and APS were significant. Conclusions In patients with unilateral full-thickness rotator cuff tear, AHD narrowing was observed on the tornekler side after evaluating the bilateral acromiohumeral distance on MRI and radiograph. AHD was significantly reduced by increasing the degree of supraspinatus tendon retraction in the coronal plane MRI and by the posterosuperior and anteroposterosuperior location of the rotator cuff tear in the sagittal plane MRI

Kemiksel çekiç parmak tedavisi için ekstansiyon blok pinleme: Transfiksasyon pini gerekli mi?

BACKGROUND: Extension-block pinning is a popular treatment for mallet fractures, but it is associated with several pitfalls. of note, transfixation Kirschner wires used to fix the distal interphalangeal (DIP) joint may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. the objective of this study was to determine whether a transfixation pin was necessary for extension-block pinning in the treatment of bony mallet fracture. METHODS: Patients were treated with a pin-orthosis extension-block technique if they had been diagnosed with a type IVB mallet fracture according to Doyle’s classification. Radiological outcomes were evaluated based on postoperative X-ray results, and functional outcomes were evaluated using Crawford’s criteria. RESULTS: Thirteen patients (9 males and 4 females) with a mean age of 26 years were included. the mean time between the injury and surgery was 3.3 days, and the mean follow-up period was 8.2 months (range: 4–12 months). Radiographic bone union was achieved in all patients within an average of 5.1 weeks (range: 5–6 weeks). At the final follow-up, the DIP joint had an average degree of flexion of 76.1° (range: 65°–80°) and an average extension deficit of 3.84° (range: 0°–15°). According to Crawford’s criteria, 8 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. No patient reported pain at the final follow-up. CONCLUSION: Satisfactory clinical and radiological outcomes were obtained with the pin-orthosis extension-block technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.AMAÇ: Kemiksel çekiç parmak yaralanmalarının tedavisinde popüler bir tedavi yöntemi olan ekstansiyon blok pinleme yönteminde kullanılan transfiksasyon pininin gerekliliğini araştırmak. GEREÇ VE YÖNTEM: Doyle sınıflamasına göre tip 4B çekiç parmak yaralanması olan hastalar tariflediğimiz pin-ortez ekstansiyon blok yöntemi ile tedavi edildi. Radyolojik sonuçlar ameliyat sonrası çekilen röntgenlerle, fonksiyonel sonuçlar Crawford kriterlerine göre değerlendirildi. BULGULAR: Yaş ortalaması 26 olan 13 hasta (9 erkek, 4 kadın) çalışmaya dahil edildi. Yaralanma ile cerrahi arasında geçen ortalama süre 3.3 gün, ortalama takip 8.2 ay (dağılım, 4–12 ay) dı. Tüm hastalarda ortalama 5.1 haftada (dağılım, 5–6 hafta) radyolojik kemik kaynaması elde edildi. Son kontrollerde ortalam aktif distal interfalangeal eklem fleksiyonu 76.1° (dağılım, 65°–80°) ve ortalama ekstansiyon kaybı 3.84° (dağılım, 0°–15°) di. Crawford kriterlerine göre, sekiz hastada mükemmel sonuç, dört hastada iyi sonuç, bir hastada kötü sonuç elde edildi. Son kontrollerde hiç bir hastada ağrı yoktu. TARTIŞMA: Kullandığımız pin-ortez ekstansiyon blok tekniğinde tatmin edici klinik ve radyolojik sonuçlar elde ettik. Randomize kontrollü ve ileriye yönelik çalışmalar ile tekniğin etkinliği teyit edilecekti

A new modified pararectus approach and visualization: an anatomical study

Introduction: The aim of our study was to visualize all the windows used in the pararectus approach with detailed cadaver images to facilitate better understanding of orthopedic surgeons and, in addition, was to modify the incision used in the pararectus approach to a more cosmetic bikini incision. Materials and methods: In total, 20 cadavers fixed in 10% formalin were used in this study. Of these cadavers, 14 were male and six were female, with a mean age at death of 57 (42-82 years). The four windows were defined as follows in all the cadavers: pubic, quadrilateral, sacroiliac, and iliac windows. Results: The most important structure at risk in the pubic window was the corona mortis, as it was observed in 12 (60%) cadavers. In men, the spermatic cord was an important structure at risk in the pubic window. The obturator vessels and nerves were the structures at most risk in the quadrilateral window due to their close location with the quadrilateral surface. The obturator nerve on the medial side and at the entrance of the pelvis through the linea terminalis and lumbosacral truncus were the structures at most risk close to the sacroiliac joint in the sacroiliac window

Short-Term Results of Shoulder Instability Surgery

Aim: In this study, we aimed to discuss the result of arthroscopic surgery for shoulder instability and we planned to show the value of instability tests for determining success of surgery. Methods: Patients, who were operated for shoulder instability between 2008 and 2013, were included in this study. Visual analogue scale, Rowe and Oxford shoulder scores of the patients were recorded preoperatively and at the final follow-up visit. Physical examination finding were noted at the final follow-up visit. Results were analyzed using SPSS. Results: Twenty one patients were included in this study. Re-dislocation was detected in two patients. There was no re-dislocation in patients with an osseous Bankart lesion. All clinical scores improved in all patients, however those with a negative apprehension test had better clinical scores. Conclusion: Arthroscopic Bankart repair is an effective procedure for the treatment of shoulder instability. Presence of osseous Bankart lesion plays an important role in the prognosis. Apprehension test is useful for assessing shoulder stability in the postoperative follow-up

Clinical and Radiological Evaluation of Surgically Treated Acetabulum Fractures

Aim: Acetabular fractures were evaluated by Judet and Letournel in two main groups as elementary and associated fractures. There are publications in the literature that the results are worse as the complexity of the fracture increases. The aim of this study was to evaluate whether clinical outcomes are worse in associated fractured patients.Material and Methods: The study included 48 acetabular fractures admitted to the emergency room and treated surgically between December 2011 and October 2020. Patient’s trauma, additional injuries, surgical method, early or late complications, and range of motion at the last follow-up were documented. Clinical and radiological results of the patients were evaluated by modified Merle d'Aubigné, functional capacities by Harris hip scoring systems.Results: There were 25 elementary fractures and 23 associated fractures in patients. When the complication rates were examined, the rate of those without complications was 52.0% (n=13) among elementary fractures, while the rate was 34.8% (n=8) in associated fractures. When the fracture types were evaluated according to the Harris hip score, elementary fractures have better score than associated fractures, but no statistically significant difference was observed between them (p=0.056). When evaluated according to Merle d'Aubigne score, it was observed that elementary fractures had significantly better scores (p=0.004).Conclusion: As the complexity of the fracture increases, it can be predicted that the clinical outcomes of the patient will be worse. It is also concluded that the elementary fracture type had better clinical outcomes than the associated fracture type in our own surgically treated acetabular fractures

A Rare Complication of Arthroplasty: Metallosis

Metallic prosthetic materials are used in place of bones and joints that have lost their function. Metallosis is a rare complication of the arthroplasty where metallic prostheses are used. It is defined as the infiltration of friction-related metallic debris into periprosthetic bones and soft tissues. Its histology is characterized by widespread lymphoplasmacytic and histiocytic infiltration around metal debris, foreign body giant cells, metal particles, extracellular metal deposits and intracytoplasmic debris in giant cells. Since it can be confused with malignant melanoma due to the presence of pigment as well as, giant cell tumors of the soft tissues and bones, care should be taken in the examination of post-arthroplastic materials. For this reason, we found it worthwhile to present two rare cases of post-arthroplasty metallosis, one developed in the knee joint and the other in the hip joint