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

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

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

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

Intramedullary skeletal kinetic distractor in lower extremity lengthening

[No Abstract Available

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

FRAX® Türkiye modeli yeterli mi? Türk toplumunda FRAX® ile osteoporotik kirik riski analizi]

Objectives: In this study, we aimed to evaluate the effectiveness of Turkish FRAX model in the prediction of osteoporotic fracture risk and to determine the factors that may affect the results in this model. Material and Methods: Data of 104 patients with hip fracture who had underwent bone densitometry scan between 2009-2012, in Kastamonu and Afyon cities in Turkey, were assessed in this study. Patients were divided into 3 groups. Group-1; patients with osteoporotic hip fractures (n=36), Group-2; patients with other osteoporotic bone fractures (n=33), Group-3; patients with no osteoporotic fracture history (n=35). The recent osteoporotic fractures in patients were ruled out and by noting the former fractures and previously determined risk factors, fracture risks were calculated by Frax method. The groups were compared on the basis of fracture risks, t-scores and demographical characteristics. Results: A statistically significant difference was found between the patients with major osteoporotic fracture (MOF) in Group-1 and Group-2 and patients with no MOF history in Group-3 (p 0.05). With respect to average age in patients, a significant difference was found between Group-1 and 3(p 0.05). Also, no statistically meaningful difference with regard to other risk factors was found between the groups (p> 0.05). Conclusion: Results of this study: previous MOFs, advanced age and a remarkable decrease in t-scores are the main risk factors in osteoporotic fractures. Turkish FRAX (R) model may be useful in the prediction of fracture risk in patients with increased risk factors in Turkish population. However, this study may not be adequate to rule out the concerns that Turkish Frax model must be revised to fulfill the expectations in determining osteoporotic fracture risk

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