A new point of view for mosaicplasty in the treatment of focal cartilage defects of knee joint: honeycomb pattern

Background: A focal full thickness cartilage lesion of knee joint is one of the commonly seen intraarticular pathologies among the joint cartilage problems. Osteochondral autograft transfer mosaicplasty is a method which has satisfactory outcomes among the treatment preferences of cartilage defects. In spite of the favorable clinical results there are some pitfalls of mosaicplasty treatment especially in cases of large defects. One of the major problems of the classical OAT mosaicplasty is the gap spaces between the plugs. The objective of the present study is to report the early clinical and radiological outcomes and to evaluate the clinical application of a new hexagonal osteochondral graft system (HOGS) with the hypothesis of improvement of the OAT mosaicplasty method with the use of hexagonally shaped plugs. The study has intended to answer two questions. (1) Does mosaicplasty with the new HOGS has favorable early clinical outcomes? (2) Is it possible to arrange the osteochondral autografts without leaving gap spaces by using hexagonal pattern in OAT mosaicplasty? Patients and methods: We designed a retrospective study to report analysis of early outcomes of the initial case series of OAT mosaicplasty by using a new HOGS. Six male individuals with the diagnosis of osteochondral defect and treated with HOGS and reached sixth month follow-up formed the basis of the study. The clinical status of the patients were evaluated with IKDC score. The radiological evaluations were carried out with direct X-rays and magnetic resonance imaging (MRI) studies. The mosaicplasty procedures were carried out via standard surgical method of classical OAT mosaicplasty by using the HOGS following a diagnostic arthroscopy in the same session. The inclusion criteria was a full thickness osteochondral lesion of femoral condyle between 1.5 and 6 cm(2) and completion of 6 month follow-ups. The patients having deformities around the knee or major ligament lesions were excluded. MOCART scoring system was used for the evaluation of follow-up MRI findings. The clinical status of the patients were evaluated with IKDC scores. Results: The mean age of the patients was 40.8 (+/- 5.2) years and the mean duration of the symptoms on presentation was 16 (+/- 4.3) months. On the initial MRI studies mean defect area was measured 3.7 cm(2) (+/- 0.9) which was compatible with arthroscopic findings. During the surgical procedures it was possible to fill the defect area completely. The mean number of plugs in this series was 4.8 (+/- 1.1). We did not faced with insufficient donor reserve problem in any of the cases. On the sixth month follow-up physical examination there was no limitation of the knee joint range of motion in the cases. All patients were able to bear weight on to their operated extremities without pain. The mean postoperative IKDC score improvement was 70.2 (+/- 3.5) which shows significant improvement compared to preoperative scores. On the control MRI studies the bone integration of the hexagonal plugs were complete the cartilage continuity of the articular surfaces were intact and the grafts were well incorporated in all cases. The mean MOCART score on the 6th month MRI studies was 65.8 (+/- 4.1). Conclusion: The early outcomes of OAT mosaicplasty with HOGS are comparable to studies on the classical mosaicplasty. According to our observations in this study we can say that the gap space left between the cylindrical plugs can be solved by using hexagonal prism shaped plugs

Konservatif tedavi edilen bir izole kapitatum kırığı: Olgu sunumu

Kapitatum kırıkları karpal kemik kırıklarının %1'ini oluşturmaktadır. İzole kapitatum kırığı nadir olarak görülür ve literatürde olgu sunumları olarak yer almaktadır. Kapitatum kırıklarının tanısındaki gecikmeler kaynamama, avasküler nekroz ve sekonder artroza neden olabilir. Bu yazımızda tanısında gecikme olan ve konservatif tedavi ettiğimiz bir izole kapitatum kırığının erken dönem sonuçlarını bildirerek nadir görülen bu kırığın tanı ve tedavisinin önemini vurgulamak istedikCapitatum fractures contributes 1% of all carpal bone fractures. Isolated fracture of capitatum is a rare entity which is seen in the literature as case reports. Any delay in diagnosis can cause complications such as nonunion, avascular necrosis, malunion and secondary arthrosis. We present in this paper the early result of the conservative treatment of an isolated nondisplaced capitatum fracture which was diagnosed late and emphasize the importance of the diagnosis and treatment of capitatum fracture

The importance of reaming the posterior femoral cortex before inserting lengthening nails and calculation of the amount of reaming

Background: Lengthening nails have been used to correct limb length discrepancy caused by different etiologies, as well as for post-traumatic reasons. Two important lengthening nail-related complications are damage to the distraction mechanism and femoral fractures around the nail tip. As a result of the curved anatomy of the femur, straight nails impinge on the anterior cortex. Therefore, proper reshaping of the medullary canal to accommodate straight lengthening nails is crucial for the prevention of this problem. Reaming the dense posterior cortex is important when aiming to insert a lengthening nail without incurring anterior cortex nail tip impingement-related complications. Posterior femoral cortex over-reaming is a solution to this situation. Methods: Sixty patients received lengthening nails during 2008-2013, (ISKD, Fitbone, Precice). Posterior cortex rigid-reaming technique was used successfully in 45 retrograde femoral lengthening cases. The preoperatively planned posterior cortex amount was reamed until the impingement was overcome during the operation under fluoroscopic control for each case. Since the preoperative determination of posterior cortex reaming amount is time consuming and operator dependent, we evaluated the X rays of the patients with computer software and conventional paper-based measurements. The effect of reaming the posterior cortical wall on the inclination of the nail tip to the anterior femoral cortex was detected with measurements on the preoperative and postoperative lateral femoral X-rays by using the CorelDRAW (R) Graphic Suite X6 software package (Corel, Inc., Ottawa, Ontario, Canada) software. On the same software, X-rays and the posterior reaming amount were also calculated. Results: The mean age of the patients was 27 years (11-42), while the mean lengthening was 5.9 cm (2-14). The mean consolidation index was 1.05 (0.75-1.62), and the mean follow-up period was 31 months (range, 18-45 months). The mean distance of the osteotomy site to the intercondylar notch of the femur was 81.2 mm (+/- 16.92). The mean displacement of the nail tip position was 15.42 mm (+/- 4.77) on the measurements on the postoperative X-rays after nail insertion compared to the preoperative simulations on the templates. The mean posterior cortex reaming thickness was 3.68 mm (+/- 1.02). Conclusions: We derived a formula that allows the required amount of optimal posterior cortex reaming to be determined. No impingement-related complications or nail damage were observed

İhmal edilmiş dirsek çıkıklarının menteşeli eksternal fiksatör yardımı ile tedavisi: 2 olgu sunumu

Dirsek çıkığı hemen tedavi edilmesi gereken acil bir durumdur. Gözden kaçırılmış dirsek çıkıkları nadiren görülür ve tedavileri akut olgulara nazaran daha komplikedir. Bu yazımızda açık redüksiyon ve menteşeli eksternal fiksatör ile tedavi ettiğimiz atlanmış iki dirsek çıkığı olgusunu sunuyoruz1. Olgu: 23 yaşında bayan hasta trafik kazası sonrası ipsilateral humerus diafiz kırığının eşlik ettiği atlanmış bir sol posterior dirsek çıkığı olgusu. Hasta kliniğimize travma sonrası 3. Ayda başvurdu. Çıkık açık olarak redükte edildi ve menteşeli bir eksternal fiksatör ile tespit edildi. Humerus diafiz kırığı da menteşeli fiksatöre ilave edilen parçalar ile eksternal olarak tespit edildi.2. Olgu: 33 yaşında erkek hasta dirsek çevresi geniş yumuşak doku ve kemik defekti olan atlanmış bir sol medial dirsek çıkığı olgusuydu. Yumuşak doku örtüm cerrahileri geçiren hasta kliniğimize 2 aylık bir gecikme ile refere edildi. Hastaya açık redüksiyon uygulandı humerus distalindeki kemik defekti otojen greft ile rekonstrükte edildikten sonra menteşeli eksternal fiksatör ile tespit yapıldı.Sonuç: Atlanmış dirsek çıkığı olgularının tedavisi oldukça zordur. Bu olgularda açık redüksiyon ve eksternal fiksatör tatbiki erken rehabilitasyona da izin vermesi ile tatminkâr sonuçlar vermektedir. Bu yöntem böyle olguların tedavisinde bir seçenek olarak değerlendirilebilir.Elbow dislocations are cases that have to be treated in emergency conditions. Neglected elbow dislocations are seen very rarely and the treatment of such cases are more complicated than acute cases. We present two cases of neglected elbow dislocations treated with open reduction and hinged external fixators.Case 1: 23 year old female patient had a neglected posterior dislocation of left elbow with ipsilateral humeral shaft fracture caused by car accident. The patient was treated after 3 months of initial trauma. We have performed open reduction for the joint. After that we fixed the joint whit a hinged external fixator. The humeral shaft fracture was also fixed with the components of the external fixator.Case 2: 33 year male patient had a large bone and soft tissue defect around the left elbow accompanying with neglected medial elbow dislocation. He presented to our clinic with a delay of 2 months. The patient was treated with open reduction and hinged external fixator after reconstruction of bone defect of distal humerus.Conclusion: The treatment of neglected cases is quite challenging. Open reduction and external fixation has satisfactory results in treatment of late cases of elbow dislocation with the possibility of early rehabilitation. This method can be considered as an option for such cases

Basketbol alt yapıda uygulanan kombine teknik antrenmanların bazı fiziksel, kuvvet ve teknik özellikler üzerine etkisi

Aim, it is the research about the effects of  combined technics traınıng on some physical, strength and technical features  that is applied to basketball players who are in basic  technich  development . Method, twenty-five (n:25) male volunteers  attended to this research who are the students of primary school.Two group was formed. The  first group went into combined technics training (KTA n.13, age 9.7+/-0.4 year, height 142.7+/-5.8cm, body weight 34+/-5.2 kg), the second group went into normal technics training (NTA n.12, age 10.5+/-0.5 year, height 147.7+/-0.5 cm, body weight 38.1+/-0.7 kg) it is organised like this. Measurement of the physical environment, vertical jump test, right-left hand gripping strength, back strength, the basic technich tests (dribbling,changing hands from behind, reverse,  right–left  tourniquet) were done. Training was programmed to be in eight weeks, five days in a week and 1.5 hour. Two  tests were applied to the children before and after the training. Descriptive statistics and t-test  were performed from the data that was obtained through the research. Findings, among the test measurment results after training  important  differences were found between combined technical training group (KTA) and normal technical training group (NTA) in arm, double-leg vertical jump, left-right one foot vertical jump as well as  the technical tests such as (dribbling, changing hands behind, reverse, right-left tourniquet) (p<0.05). Results, in terms of  technical development in basketball, combined technical group (KTA) had a very important degree of development. Basketball players have also developed the technical testing of computer-aided analysis program can be a practical field conditions can be reported.Amaç; Basketbol alt yapıda, basketbolcu çocuklara uygulanan kombine teknik antrenmanların bazı fiziksel, kuvvet ve teknik özellikleri üzerine olan etkilerinin araştırılmasıdır. Metot; Çalışmaya İlköğretim okullarında okuyan 25 erkek öğrenci gönüllü olarak katıldı. İki grup oluşturuldu. Birinci grup kombine teknik antrenman yapan (KTA n.13; yaş 9.7±0.4 yıl, boy 142.7±5.8 cm., vücut ağırlığı 34.7±5.2 kg.), ikinci grup da normal teknik antrenman yapan grup (NTA n.12; yaş 10.5±0.5 yıl, boy 147.7±0.5 cm., vücut ağırlığı 38.1±0.7 kg.) şeklinde organize edildi. Fiziksel kas çevre ölçümleri, kuvvet testlerinden dikey sıçrama, sağ-sol el kavrama kuvveti, sırt kuvveti, temel teknik testlerden de (top sürme, bacak arası, arkadan el değiştirme, reverse, sağ-sol turnike) testleri yapıldı. Antrenmanlar sekiz hafta, haftada 5 gün ve günde de 1.5 saat olarak programlandı. Araştırmaya katılan çocuklara antrenmanlardan önce ve sonra iki test uygulandı. Araştırmadan elde edilen veriler üzerinden tanımlayıcı istatistikleri ve t-testi yapıldı. Bulgular; Kombine teknik antrenman yapan grupla (KTA), normal teknik antrenman yapan (NTA) grubun, antrenman sonrası yapılan test ölçüm değerleri arasında fiziksel çevre ölçümlerinden kol, kuvvet testlerinden çift ayak dikey sıçrama,  sağ-sol tek ayak dikey sıçrama ve teknik testlerden de (top sürme, bacak arası, arkadan el değiştirme, reverse, sağ-sol turnike) önemli farklılıklar bulundu (p<0.05). Sonuç; Kombine teknik antrenman yapan grubun (KTA) basketbol teknik gelişimleri açısından önemli bir gelişim sağladığı belirlendi. Ayrıca basketbolcuların teknik testlerinin belirlenmesinde geliştirmiş olduğumuz bilgisayar destekli basketbol analiz programı saha şartlarında pratik kullanılabileceği görülmüştür

Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures (Treat with Veronail)

Aim:The aim of this study is to report outcomes of 59 patients with intertrochanteric femoral fractures treated with a proximal femoral nail (Veronail)..Materials and Methods:We have treated 59(28 female, 31 male) patients with intertrochanteric femoral fractures by using proximal femoral nail (veronail) between years 2011 and 2012. The mean age of patients was 69.1(±13.3). The fractures were classified according to AO system. The most common fracture type was A3(n=25), followed by A1 (n=20) and A2 (n=14). The early postoperative direct radiograms and the X-rays of third month were evaluated.Results:In 52 of the 59 cases complete union of the fractures were achieved. One patient had a malunion that was treated with proximal femoral osteotomy. We notice in 6 of the cases proximal screw cutout on the follow up radiograms. The mean age of these patients were 77 (±7.4) years. There were two A1, two A2 and two A3 fractures according to AO system. All of these patients were revised with partial hip replacements.Conclusion:In our series, of the 6 patients with cutouts 2 had type A1, 2 had type A2 and 2 had type A3 fractures. The type of the fracture had no significant effect on the cutout rates. The major factor effective on the development of cutout was the osteoporosis that increases with age of the patients. Proximal femoral nail (Veronail) is a suitable device that can be used in treatment of the intertrochanteric femoral fractures safely independent of the fracture type

Early clinical and radiological results of minimally invasive total hip replacement

Introduction It is critical to achieve both proper component positioning and intact muscle balance if satisfactory results are to be attained after total hip replacement (THR). There have been fewer studies on minimally invasive (MI) THR than standard approaches. The objective of this paper is to present the early clinical and radiological results of posterolateral MI THR. Materials and methods The retrospective analysis of the records of patients undergoing posterolateral MI THR surgery between 2011 and 2014 was the basis of this study. 73 hips of 68 patients were included in the study. The acetabular component and femoral stem positions were measured on plane X-rays. Data on preoperative and postoperative hemoglobin and hematocrit values, as well as transfusion amounts, were also studied. The clinical evaluations were carried out with Harris Hip Scores. Results The mean HHS at the 3rd postoperative month was 87.60 (±7.70). Of the 73 cases, 61 were within the Lewinnek safe zone. The mean PMFA was 88.12 (±7.63°), which is within the normal ranges. The mean postoperative hemoglobin value was 9.7 g/dl (±1.3) and the mean postoperative hematocrit value was 29.8% (±3.8). A nondisplaced proximal femoral fracture line was evident on the early postoperative X-ray of one patient. One patient experienced early dislocation caused by acetabular component malpositioning and an early acetabular cup revision was necessary. Conclusion MI posterior approach for THR is a method in which the prosthetic components can be properly placed. Posterolateral MI approaches are safe when THR is performed, and afford satisfactory results. © 2016 Delhi Orthopedic Associatio

An analysis of language and speech disorders in preschool children in Turkey: The case of Beypazarı

The children with early language and speech delay have the risk to face with learning disabilities as well as psychological and behavioral adjustment problems in the preschool period. The aim of this study to analyse the language and speech disoders in the children aged between 3 and 6 years who attend kindergarden. 503 children who attend the kindergarden were determined in Beypazarı. However, 101 children were out of study for various reasons (N:402). The implementation of the study consists of two stages. In the first stage, the language and speech development of the children was questioned. The Turkish Preschool Language Scale–5 (TPLS-5) test was administered to the risky children in the second stage. A moderate (0,300) and a significant correlation (p0) and significant correlation (p<0,01) was found between the chronological and expressive language of the children. The language and speech disorder has an important potential negative effect on families and societies both in the short and the long term. For this reason, it is quite important to follow the language and speech development of children closely in the preschool period

Damage Control Surgery

Objective: The basis of damage control surgery rests on quick control of life-threatening bleeding, injuries, and septic sources in the appropriate patients before restoring their physiological reserves as a first step followed by ensuring of the physiological reserves and control of acidosis, coagulopathy, and hypothermia prior to complementary surgery