[Retrospective analysis of AO 42A-B type tibia fractures treated with percutaneus locked plating and intramedullary nailing]. / AO 42A ve 42B tipi tibia kiriklarinda uyguladigimiz perkütan kilitli plak ve intramedüller çivi tespit sonuçlarinin geriye dönük analizi.

BACKGROUND: In this study, the results of AO 42A and 42B type tibia fractures treated with intramedullary nail (IMN) and percutaneus locking plate (PLP) were evaluated. The complications were examined, and it was questioned whether the type of fixation had an effect on union time and functional results. METHODS: Forty-two patients with extraarticular distal tibial fractures were enrolled in this retrospective study. Eighteen patients were treated with closed IMN (Group I) and 24 patients were treated with PLP fixation (Group II). Mean age was 41 (range: 16-70) years; thirty-two of the patients were men. Fractures were classified according to the AO classification system. Union time, functional results and complications (malunion, malalignment, infection) were compared. The American Orthopaedic Foot and Ankle Surgery (AOFAS) scoring was used to compare functional results. RESULTS: The average follow-up period was 20 (12-32) months for Group I and 23 (13-36) months for Group II. The average union time was 16 (12-24) weeks in Group I and 19 (range: 16-24) weeks in Group II (p=0.002). The AOFAS scoring was 85 (range: 69-100) points in Group I and 81 (range: 60-95) points in Group II. The difference in AOFAS scoring was not significant (p=0.06). Two patients had nonunion in Group II. Two patients in Group I and three patients in Group II had malalignment. DISCUSSION: We suggest that IMN can provide early healing time. Although it is not statistically significant, complication rate was lower and functional results were better in patients treated with IMN.

A comperative study between two different surgical techniques in the treatment of late-stage Freiberg's disease.

BACKGROUND: The aim was to evaluate the results of two different methods in surgical treatment for patients with late-stage avascular necrosis of the metatarsal head. METHODS: Between 2007 and 2012, fourteen consecutive patients (13 females, 1 male; mean age 29 yrs; range, 12-58 yrs) with metatarsal head infarction were enrolled for this study. The main presenting symptom was pain on walking or daily activities. According to the Smillie classification all of lesions were classified as in stage IV-V. Six patients had cheilectomy and microfracture procedure in Group A, 8 patients had received cheilectomy and dorsal crescentic osteotomy in Group B. Clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Metatarsal shortening and osteotomy-site healing were evaluated with AP and oblique view X-rays. RESULTS: The mean follow-up period was 22 months (range, 12-53). The clinical outcomes were excellent in 11(78%) patients and in the 3(22%) patients the results were good. The AOFAS scores increased from a mean of 66.3 points (range, 55-75) preoperatively to 92 points (range, 84-100) at last follow-up in Group A. The mean AOFAS score increased 55.8 points (range, 45-64) to 90.6 points (range, 84-95) in Group B. In the patients that osteotomy have been applied there were no limitation of movement or fixed deformity of the toe. DISCUSSION: These results suggest that both surgical techniques may provide significant improvement in pain and ROM of the MTP joint.