Irreducible dorsal distal radius fracture-dislocation with accompanying dorsal displacement of flexor tendons and median nerve: A rare type of injury

AbstractINTRODUCTIONHigh energy distal radius fractures may cause significant soft tissue injuries. Dorsal displacement of median nerve and flexor tendons to dorsal compartment between distal radioulnar joint was an unreported type of soft tissue injury.PRESENTATION OF CASE35-Year male admitted following fall from height diagnosed as closed distal radius fracture with dorsal displacement. The patient had no flexion and extension of all fingers with loss of sensation. Radial artery pulse was not palpable. Radiography and CT imaging revealed distal radius fracture with dorsal displacement with dorsal carpal dislocation. After failure of closed reduction, operative treatment was performed. At surgery, flexor tendons and median nerve was found to be placed at dorsal compartment. Reduction of the soft tissues was facilitated by distraction of distal radioulnar joint.DISCUSSIONDorsal displacement of volar structures as the result of fracture dislocation was found to be an unreported type of injury. Difficulty during reduction of dorsally displaced structures is an important feature of the case.CONCLUSIONFor severely displaced and deformed distal radial fractures and fracture dislocations, threshold for operative treatment should be kept low

The Relationship Between Arthroplasty Surgeons' Experience Level and Optimal Cable Tensioning in the Fixation of Extended Trochanteric Osteotomy

Introduction: In this study, our aim was to examine the relationship between the arthroplasty surgeons' experience level and their aptitude to adjust the cable tension to the value recommended by the manufacturer when asked to provide fixation with cables in artificial bones that underwent extended trochanteric osteotomy (ETO). Materials and Methods: A custom-made cable tensioning device with a microvoltmeter was used to measure the tension values in Newtons (N). An ETO was performed on 4 artificial femur bones. Surgeons at various levels of experience attending the IXth National Arthroplasty Congress were asked to fix the osteotomized fragment using 1.7-mm cables and the tensioning device. The participants' demographic and experience data were investigated and recorded. The surgeons with different level of experience repeated the tensioning test 3 times and the average of these measurements were recorded. Results: In 19 (35.2%) of the 54 participants, the force applied to the cable was found to be greater than the 490.33 N (50 kg) value recommended by the manufacturer. No statistically significant difference was determined between the surgeon's years of experience, the number of cases, and the number of cables used and the tension applied over the recommended maximum value (P = .475, P = .312, and P = .691, respectively). Conclusions: No significant relationship was found between the arthroplasty surgeon's level of experience and the adjustment of the cable with the correct tension level. For this reason, we believe that the use of tensioning devices with calibrated tension gauges by orthopedic surgeons would help in reducing the number of complications that may occur due to the cable

Open tibial pilon fractures: treatment with ankle-spanning Ilizarov fixator

Objectives. The aim of this retrospective study was to report the treatment results obtained with the ankle- spanning Ilizarov fixator technique in the treatment of complex OTA/AO type 43C3 open tibial pilon fractures. Methods. A total of 14 patients with open OTA/AO type 43C3 tibial pilon fractures were evaluated. The demographics and fracture characteristics, preoperative and postoperative radiological evaluations, duration of follow-up (months), time to union (months) and complications were recorded. After collection of operative data, patients were invited for functional and radiological outcome evaluation. American Orthopaedic Foot and Ankle Society (AOFAS) scores and range of movement (ROM) of the ankle joint were investigated. Also radiologically the ankle osteoarthritis level according to the Bargon et al. criteria was noted. Results. The mean age of the patients was 48.7 years (range, 26-72 years). The mean follow-up period was 32 months (range, 25- 46 months). The clinical and radiological time to union was mean 6.5 months (range, 5-11 months). On the postoperative ankle CT images, the separation within the ankle was measured as 2mm. Following removal of the external fixator, dorsiflexion was measured as mean 15.5° (range, 0°-23°) and plantar flexion as mean 26.14° (range, 13°-36°). The mean AOFAS was 80.35 (range, 56-92). Conclusion. Satisfactory results can be obtained with the Ilizarov external fixator passing the ankle in the permanent treatment of AO-43C3 type open tibial pilon fractures

Comparison of Three Surgical Treatment Methods in Acute Septic Arthritis of the Knee in Adults

Introduction: The aim of this study was to evaluate and compare patients with acute septic arthritis of the knee treated using arthroscopic method as well as 2 forms of arthrotomy. Materials and Methods: Adult patients with the diagnosis of acute septic arthritis treated at our hospital with arthroscopy, conventional arthrotomy or mini arthrotomy between 2008 and 2016 were retrospectively reviewed. Clinical findings, laboratory results, hospitalization time and functional outcomes were evaluated and compared. Results: Thirty-three patients were included into the present study, on whom, arthroscopic method (n= 13; 39.3%), mini-arthrotomy (n= 9; 27.2%), and conventional arthrotomy (n= 11; 33.3%) were performed. Seven of our patients required secondary surgical intervention, and our therapeutic success rate was 78%. Median hospitalization duration was 18 days (range: 7-45 days) in the arthroscopic intervention group, 16 days (range: 9-32 days) in the mini-arthrotomy group, and 11 days (range: 7-23 days) in the conventional arthrotomy group without any significant difference. Range of motion of the knee joint at the latest follow-up was similar in all groups (p= 0.736). Conclusion: According to our results all 3 methods can be applied in treatment

Erişkin Dizin Akut Septik Artrit Tedavisinde Üç Cerrahi Yöntemin Karşılaştırılması

Introduction: The aim of this study was to evaluate and compare patients with acute septic arthritis of the knee treated using arthroscopic method as well as 2 forms of arthrotomy. Materials and Methods: Adult patients with the diagnosis of acute septic arthritis treated at our hospital with arthroscopy, conventional arthrotomy or mini arthrotomy between 2008 and 2016 were retrospectively reviewed. Clinical findings, laboratory results, hospitalization time and functional outcomes were evaluated and compared. Results: Thirty-three patients were included into the present study, on whom, arthroscopic method (n= 13; 39.3%), mini-arthrotomy (n= 9; 27.2%), and conventional arthrotomy (n= 11; 33.3%) were performed. Seven of our patients required secondary surgical intervention, and our therapeutic success rate was 78%. Median hospitalization duration was 18 days (range: 7-45 days) in the arthroscopic intervention group, 16 days (range: 9-32 days) in the mini-arthrotomy group, and 11 days (range: 7-23 days) in the conventional arthrotomy group without any significant difference. Range of motion of the knee joint at the latest follow-up was similar in all groups (p= 0.736). Conclusion: According to our results all 3 methods can be applied in treatment.Giriş: Bu çalışmanın amacı artroskopik veya iki farklı artrotomi yöntemi ile dizde akut septik artrit tedavisi yapılan hastaları retrospektif değerlendirmek ve karşılaştırmaktır. Materyal ve Metod: Hastanemizde 2008 ile 2016 tarihleri arasında akut septik tanısı nedeniyle artroskopi, geleneksel artrotomi veya mini artrotomi yöntemlerinden biriyle tedavi edilen erişkin hastalar geriye dönük olarak araştırıldı. Klinik bulgular, laboratuvar sonuçları, hospitalizasyon zamanı ve fonksiyonel sonuçlar değerlendirildi ve karşılaştırıldı. Bulgular: Otuz üç hasta (33 diz) çalışmaya dahil edildi. 13 hasta (39.3%) artroskopik yöntemle tedavi edilirken, 9 hasta (27.2%) mini-artrotomi, 11 hasta (33.3%) ise geleneksel artrotomi yöntemi ile tedavi edildi. Yedi hastamızda ikinci bir cerrahiye ihtiyaç duyuldu ve tedavi başarı oranımız %78 idi. Ortalama hastanede kalış süresileri arasında anlamlı fark olmamakla beraber artroskopi grubunda 18 gün (aralık; 7-45 gün), mini-artrotomi grubunda 16 gün (aralık; 9-32 gün) ve geleneksel artrotomi grubunda ise 11 gün (aralık; 7-23 gün) idi. Son takiplerinde tüm grupların eklem hareket açıklıkları benzer idi (p=0.736). Sonuç: Sonuçlarımıza göre tedavide her üç yöntem de uygulanabilir

Do the Loss of Thigh Muscle Strength and Tibial Malrotation Cause Anterior Knee Pain after Tibia Intramedullary Nailing?

Purpose. Anterior knee pain (AKP) is a common complication after tibia intramedullary nailing surgery, but yet the etiology is not fully revealed. Our study had two hypotheses. The first one is “after tibia intramedullary nailing with transtendinous approach, thigh muscles strength decreases and this loss of muscle strength causes AKP.” Secondly, “lower extremity rotational profile is affected after tibia intramedullary nailing.” Methods. Our study was planned retrospectively and included 40 patients, who underwent tibia intramedullary nailing surgery. Mean follow-up time was 22.5 months. Tegner Lysholm knee scoring scale was applied to evaluate postoperative functional outcomes of all patients. Isometric muscle strengths of bilateral knee extensor and flexor muscle groups were compared with hand-held dynamometer. In addition, bilateral lower extremity Staheli rotational profile angles (foot progression angle (FPA), thigh-foot angle (TFA), and transmalleolar angle (TMA)) were compared. Results. Lysholm knee score was evaluated as excellent in 28 patients. AKP were detected in 15 patients and there was no significant difference between the injured limb with contralateral quadriceps mean muscle strength (injured limb mean (ILM) = 201.97 Newton (N) – contralateral mean (CM) = 205.4 N). However, there was a significant difference (p<0,05) between injured limb with contralateral extremity hamstring mean muscle strength (ILM = 153.2 N– CM=158.95 N). Although there was a significant difference between the two extremities’ rotational profile angles, there was no significant correlation between the rotational profile angles and knee pain. Conclusion. As a result of our study, AKP appears to be significantly related to the loss of hamstring muscle strength. We suppose that hamstring exercises will gain importance in rehabilitation programs of tibia intramedullary nailing surgery in future

Amputation for upper extremity ischemia following shoulder dislocation: case report and a review of literature

Injury of the axillary artery following glenohumeral dislocation is a very rare situation. The mechanisms for arterial injuries are lacerations, rupture, avulsion of main branches or intimal tears and pseudo aneurysm formations. In this report we present an upper extremity ischemia following shoulder dislocation resulting with loss of extremity. Our aim was to highlight the importance of the third part of axillary artery and consequences of underestimation of vascular pathologies following shoulder injuries.Injury of the axillary artery following glenohumeral dislocation is a very rare situation. The mechanisms for arterial injuries are lacerations, rupture, avulsion of main branches or intimal tears and pseudo aneurysm formations. In this report we present an upper extremity ischemia following shoulder dislocation resulting with loss of extremity. Our aim was to highlight the importance of the third part of axillary artery and consequences of underestimation of vascular pathologies following shoulder injuries

Chondral Lesion of the Capitellum Humeri Accompanying a Radial Head Fracture: A Case Report

In this case report we present a case of a full thickness chondral lesion of the anterior-distal surface of the capitellum humeri, accompanying an intraarticular radial head fracture. The importance of this case is the resemblance of the chondral injury to a Lorenz-Kocher lesion of the humerus and atypical displacement of chondral fragments. A 32-year-old man was admitted to the emergency room after a fall on his right upper extremity. X-ray and Computed Tomography (CT) scan of the elbow revealed a minimally displaced radial head fracture (Mason type 2), with a 4 mm step (depression) at the joint surface. During the operation, at the anterior surface of the distal humerus, a full thickness chondral lesion was encountered.After removal of chondral fragments from the fractured radial head surface, it was seen that these fragments were of capitellar origin. Following radial head fixation, early active assistive motion was started. At the 6 month visit, the patient was painfree with full participation in activities of daily livingwith a DASH score of 12.5. This injury is important due to demonstration of such an extensile injury in spite of benign looking radiology. Although radial head fractures were described, these type of occult injuries may be responsible for unexplainable and unfavorable outcomes following low energy radial head fractures treated conservatively.In this case report we present a case of a full thickness chondral lesion of the anterior-distal surface of the capitellum humeri, accompanying an intraarticular radial head fracture. The importance of this case is the resemblance of the chondral injury to a Lorenz-Kocher lesion of the humerus and atypical displacement of chondral fragments. A 32-year-old man was admitted to the emergency room after a fall on his right upper extremity. X-ray and Computed Tomography (CT) scan of the elbow revealed a minimally displaced radial head fracture (Mason type 2), with a 4 mm step (depression) at the joint surface. During the operation, at the anterior surface of the distal humerus, a full thickness chondral lesion was encountered.After removal of chondral fragments from the fractured radial head surface, it was seen that these fragments were of capitellar origin. Following radial head fixation, early active assistive motion was started. At the 6 month visit, the patient was painfree with full participation in activities of daily livingwith a DASH score of 12.5. This injury is important due to demonstration of such an extensile injury in spite of benign looking radiology. Although radial head fractures were described, these type of occult injuries may be responsible for unexplainable and unfavorable outcomes following low energy radial head fractures treated conservatively

Nora’s disease: a series of six cases

Objectives. Nora’s disease is a mesenchymal bone tumor with controversial diagnosis and treatment due to the benign but locally aggressive course and high recurrence rates. Methods. A retrospective analysis was made of patients diagnosed with Nora’s Disease at Ankara University Orthopedics and Traumatology Clinic. The evaluation was made of the age of the patient, gender, symptoms, lesion location, trauma history, treatment choice and recurrence rates during follow-up. Results. Excision was applied to 6 patients diagnosed with Nora’s disease, and in 1 patient an additional autograft and internal fixation were required. Recurrence was observed in 3 patients, 2 of whom underwent revision surgery and one who did not as there no patient complaints. Conclusions. Nora’s disease is problematic for orthopedic surgeons as there are difficulties in diagnosis, there is no absolute treatment algorithm, recurrence potential is high, and there are limited additional treatment choices. Therefore, treatment and follow-up at clinical center’s dealing with orthopedic tumor surgery can be considered appropriate.Objectives. Nora’s disease is a mesenchymal bone tumor with controversial diagnosis and treatment due to the benign but locally aggressive course and high recurrence rates. Methods. A retrospective analysis was made of patients diagnosed with Nora’s Disease at Ankara University Orthopedics and Traumatology Clinic. The evaluation was made of the age of the patient, gender, symptoms, lesion location, trauma history, treatment choice and recurrence rates during follow-up. Results. Excision was applied to 6 patients diagnosed with Nora’s disease, and in 1 patient an additional autograft and internal fixation were required. Recurrence was observed in 3 patients, 2 of whom underwent revision surgery and one who did not as there no patient complaints. Conclusions. Nora’s disease is problematic for orthopedic surgeons as there are difficulties in diagnosis, there is no absolute treatment algorithm, recurrence potential is high, and there are limited additional treatment choices. Therefore, treatment and follow-up at clinical center’s dealing with orthopedic tumor surgery can be considered appropriate

Comparison of three posterior malleolar fixation methods in trimalleolar ankle fractures

WOS: 000482219000012PubMed: 30462604This study aimed to compare the results of AP screws, PA screws and posterior buttress plate used in posterior malleolar fixation of trimalleolar fractures. In this study, the data of 104 trimalleolar fracture cases treated surgically between October 2011 and January 2014 were extracted from hospital records. Patient demographics (age, gender, body mass index), the presence of syndesmotic injury, fracture type (according to the Lauge-Hansen classification), the size of posterior malleolar fragment (measured on lateral radiographs) were recorded. The patients requiring postoperative care for at least a year were invited to attend an evaluation of functional and radiological outcomes. At the final follow-up examination the functional evaluation was made by using AOFAS scores, VAS scores during walking, and dorsiflexion restrictions as compared with the unaffected side. As for the radiological evaluation, the patients were assessed according to the presence of a gap or step by the direct use of graphies following the fixation and with regard to the osteoarthritic development in alignment with the Bargon criteria. A total of 67 patients met the study inclusion criteria; 20 cases in the AP screw, 13 cases in the PA screw and 34 cases in the plate group. The mean follow-up period was 14.4 +/- 2.23 months in AP, 16.3 +/- 2.56 months in PA and 17.1 +/- 3.01 months in the plate group. Better AOFAS scores were obtained in the PA group and the plate group compared to the AP screw group (p < 0.001). No statistically significant difference was found between the groups in respect of VAS scores during walking and dorsiflexion restriction. Better radiological reduction was observed in the PA screw group and the plate group (p < 0.001). PA screw and posterior buttress plate fixation with direct reduction via posterolateral approach demonstrated better radiological and functional outcomes than AP screw fixation