[Comparison of the mid-term results of complete subtalar release by the Cincinnati and the posteromedial incisions in clubfoot]. / Dogustan carpik ayakli olgularda Cincinnati ve posteromedial insizyonlar ile gerçeklestirilen tam subtalar gevsetmenin orta dönem sonuçlarinin karsilastirilmasi.

OBJECTIVES: Clinical and radiological results of complete subtalar release operations on idiopathic congenital clubfoot patients were compared for the Cincinati and the posteomedial incisions. PATIENTS AND METHODS: Twenty-six patients (40 feet) that underwent complete subtalar release using the Cincinnati incision (group 1; 18 patients, 27 feet [12 boys, 6 girls; mean age 7.4 +/-3.8 month; range 5-24 months]) and posteromedial incision (group 2; 8 patients, 13 feet [6 boys, 2 girls; mean age 10.1 +/- 4.3 month; range 4-16 months]) for idiopathic congenital clubfoot with at least one year followup were assessed. Tarsal bone problems, intraoperative and postoperative complications were analyzed separately. RESULTS: According to the Simon's criteria, the clinical results were successful in 27 feet (100%) in group 1 and in 11 feet (85%) in group 2 (p > 0.05). Radiological results were successful in 16 feet (59%) in group 1 and in two feet (15%) in group 2 (p< 0.05). Superficial skin necrosis occurred in five feet (18.5%) in group 1 at the early postoperative period and all resolved with conservative treatment. Skin necrosis did not occur in group 2 (p > 0.05). The cast was bivalved and opened due to soft tissue swelling at the early postoperative period in 21 feet (77.8%) in group 1 and only in one foot (7.6%) in group 2 (p < 0.05). CONCLUSION: Posteromedial incision is a suitable and safety incision for complete subtalar release.

Dynamics of the ulnar nerve after percutaneous pinning of supracondylar humeral fractures in children.

This prospective study was performed to evaluate and compare the morphological changes and dynamics of the ulnar nerve after percutaneous cross-pinning with Kirshner wire (group 1; 13, mean age 8.3 years, 10 male and three female children) and only lateral pinning (group 2; eight, mean age 7.6 years, six male and two female children) of displaced unilateral supracondylar fractures in children's elbows using ultrasonography in comparison with the contralateral healthy elbows. Postoperative evaluation revealed that ulnar nerve movement was reduced and the major axis diameter of elbow flexion and ulnar nerve was larger (P<0.05) than the major axis diameter in the elbow extension in group 1 than group 2. We think that the treatment of the displaced supracondylar fracture of the humerus in children with only a lateral Kirshner wire would be safer and more convenient.

[Venous thromboembolism prophylaxis in major orthopaedic surgery: A multicenter, prospective, observational study]. / Majör ortopedik cerrahilerde venöz tromboemboli profilaksisi: Cokmerkezli, prospektif, gözlem çalismasi.

OBJECTIVES: We investigated risk factors for venous thromboembolism (VTE), prophylaxis measures employed, and incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing major orthopaedic surgery (MOS). METHODS: An open, multicenter, prospective, observational study was conducted in 21 medical centers, comprising 899 patients. Of these, 316 patients (35.2%) underwent total hip arthroplasty (THA), 328 patients (36.5%) underwent total knee arthroplasty (TKA), and 255 patients (28.4%) underwent surgery for hip fractures (HF). Pharmacologic prophylaxis was employed in all the patients. RESULTS: Risk factors for VTE were seen in 73.2% of the patients, the most common being obesity (72%) and prolonged immobilization (36.3%). Low-molecular-weight heparin (91.1%) and fondaparinux (8.9%) were used for prophylaxis, which was short-term in 273 patients (30.4%) and long-term in 626 patients (69.6%). Mechanical prophylaxis was performed with compression stockings in 610 patients (67.9%) and by intermittent pneumatic compression in 67 patients (7.5%). During three-months of follow-up, symptomatic DVT and PE were seen in eight (0.9%) and four patients (0.4%), respectively. Mortality occurred in 10 patients (1.1%). Complications of major and minor bleeding were seen in eight (0.9%) and 40 (4.5%) patients, respectively. CONCLUSION: Effective VTE prophylaxis is associated with low risk of clinically apparent DVT and PE in MOS.

Variation of carrying angle with age, sex, and special reference to side.

We measured the carrying angle using a universal full-circle manual goniometer on the dominant and non-dominant extremity of the elbow in 1275 healthy volunteers (631 males, 644 females) with a mean age of 22.87+/-15.99 years (range: 2-91 years). In the right arm dominant group, right carrying angle was 11.25 degrees +/- 3.73 degrees and left carrying angle was 10.57 degrees +/- 3.63 degrees (P<.001). In left arm dominant group, right carrying angle was 10.65 degrees +/- 3.99 degrees and left carrying angle was 12.93 degrees +/- 4.22 degrees (P<.001). The carrying angle of dominant arm was found to be significantly higher than the non-dominant arm in both sexes. The carrying angle of dominant and non-dominant arms were found to be significantly higher in patients aged >14 years than that of patients aged < or = 14 years; females ranked higher than males.

[Treatment of femoral shaft fractures and pseudoarthrosis with compressive and interlocking intramedullary nailing]. / Femur cisim kiriklari ve psödoartrozlarinin kompresif, kilitli intramedüller çivileme ile tedavisi.

OBJECTIVES: We evaluated the results of compressive and interlocking intramedullary nailing in femoral shaft fractures. METHODS: Thirty-three femoral fractures of 30 patients (23 males, 7 females; mean age 36.9 years; range 14 to 80 years) were treated by compressive and interlocking intramedullary nailing. There were 26 closed and seven open (2 type II, 5 type IIIA) fractures. In three femurs, intramedullary nailing was performed due to pseudoarthrosis. According to the Winquist classification, there were 13, 8, 8, and 4 type I to IV fractures, respectively. Clinical, radiographic, and functional results were evaluated according to the Thoresen criteria. The mean follow-up was 29 months (range 6 to 29 months). RESULTS: The mean operation time was 105.7 minutes. Union was obtained in all the patients within a mean duration of 19.6 weeks. In six cases, dynamization was performed due to insufficient callus formation. The results were excellent in 17 patients (56.7%), good in eight patients (26.7%), fair in three patients (10%), and poor in two patients (6.7%). Complications included shortening (n=3; 2 to 4 cm), varus deformity (n=2; 8 and 11 degrees), external rotation (n=3), restriction in knee flexion (n=3), superficial infection (n=8), trochanteric bursitis (n=3), and irritation of the skin by distal screws (n=2). CONCLUSION: High rates of union with low complication rates makes interlocking intramedullary nailing an appropriate method in the treatment of femoral shaft fractures in adults. Compression with top screws contributes to the stability of fixation by eliminating any looseness through the fracture line.

Morphology and dynamics of the ulnar nerve in the cubital tunnel after percutaneous cross-pinning of supracondylar fractures in children's elbows: an ultrasonographic study.

After the 12.6-month (3-30) follow-up period, the morphology and dynamics of the ulnar nerve in the cubital tunnel were examined with ultrasonography on operated (group 1) and opposite (group 2) elbows of 13 children who had percutaneous cross-pin fixation for displaced supracondylar humerus fractures. When we compared group 1 and group 2, nerve morphology was similar (P>0.05), but nerve dynamics were found to be decreased or absent for seven (54%) elbows in group 1 (P<0.05). The medial K-wire may damage the ulnar nerve dynamics in the cubital tunnel.

[Pseudarthrosis of a calcaneus fracture: a case report]. / Kalkaneus kiriginda psödoartroz: olgu sunumu.

Nonunion after a calcaneus fracture is rare. A forty-two-year-old man presented with complaints of extreme left heel pain on weight-bearing, that required him to use crutches. Clinical and radiological studies yielded a diagnosis of calcaneal nonunion. He had a history of an open calcaneal fracture that occurred in a traffic accident eight months before, for which he received cast treatment. He underwent surgical treatment (curettage, bone graft, and internal fixation) for the nonunion of the calcaneus. Eight months after the operation, no problem was observed at the union site, and the patient returned to his normal activity levels. He had a slight heel pain appearing only after walking long distances, which was attributed to the subtalar joint.

[Solitary osteochondroma of the elbow causing ulnar nerve compression: a case report]. / Dirsekte soliter osteokondroma bagli gelisen ulnar sinir basisi: olgu sunumu.

We report ulnar nerve compression caused by solitary osteochondroma of the right elbow in a 34-year-old man. Two osteochondromas were detected originating from the olecranon and medial humeral epicondyle, respectively. The patient had severely restricted elbow motion, pain, and hypoesthesia of the forth and fifth fingers. The lesions were surgically removed, together with subcutaneous anterior transposition of the ulnar nerve. At the end of the postoperative eight months, complaints of the patient disappeared except for slight hypoesthesia in the fingers. Literature search revealed only a single case of solitary osteochondroma associated with peripheral nerve compression.

[Diffuse synovial hemangioma of the knee: a case report]. / Dizde yaygin sinovyal hemanjiyom: Olgu sunumu.

Synovial hemangioma is a rare benign tumor of joint cavities. It may be a cause of pain and recurrent joint swelling in children and young adults. Diffuse synovial hemangioma was diagnosed in a 25-year-old male patient with complaints of right knee pain and swelling of a 10-year history. Direct radiography, venography, magnetic resonance imaging, and diagnostic arthroscopy enabled the diagnosis. Surgical excision was not considered because of diffuse involvement and many pigmented areas in the skin; instead, the patient was monitored conservatively. At the end of a year, the severity of complaints and the size of the lesion did not increase. Since there is a high risk for recurrence following open synovectomy for diffuse synovial hemangiomas, conservative treatment may be an alternative approach in selected cases.

[Peroneal nerve palsy due to rare reasons: a report of three cases]. / Uç olguda nadir nedenlerle olusan peroneal sinir felci.

Peroneal nerve entrapment was diagnosed in three patients (2 males, 1 female) by clinical and electrophysiological studies. Of these, one patient had postural bilateral involvement due to prolonged squatting, while two patients had mechanically-induced entrapment. Initially, all the patients were treated conservatively with a drop-foot splint and vitamin B. One patient responded to treatment; in one patient with bilateral involvement, right-sided peroneal nerve palsy improved. Upon detection of no clinical and electrophysiological improvement after three months of conservative treatment, surgical decompression was performed in two patients, which resulted in a successful outcome in the patient with bilateral palsy. Incomplete recovery was obtained in the other patient with diabetic polyneuropathy.

[Early results of treatment for developmental dysplasia of the hip in children between the ages of one and four years]. / Yürüme çagindaki (1-4 yas) gelisimsel kalça displazili olgularda erken dönem tedavi sonuçlarimiz.

OBJECTIVES: We evaluated the early results of treatment for developmental dysplasia of the hip in children between the ages of one and four years. METHODS: Twenty-four patients were retrospectively divided into two groups according to whether they were below or above two years of age at the time of the initial treatment. Group I consisted of 13 patients (20 hips; mean age 19.1 months; range 14 to 24 months); 11 patients (15 hips; mean age 32.6 months; range 26 to 50 months) comprised group II. Initially, patients in group I were treated with closed or open reduction (12 hips) and open reduction with femoral and/or pelvic osteotomies (8 hips). Group II patients underwent open reduction with femoral and/or pelvic osteotomies. Clinical results were evaluated according to the modified McKay criteria, and radiographic results to the Severin classification. The mean follow-up periods were 29.1 months (range 12 to 60 months) and 37.3 months (range 12 to 66 months), respectively. RESULTS: Subsequent operations were performed in nine hips in group I, and in two hips in group II (p<0.05). Avascular necrosis of the femoral head was noted in six hips (30%) in group I and in none of the hips in group II (p<0.05). Excellent or good radiographic results accounted for 85% and 86%, and clinical results for 90% and 100% in groups I and II, respectively. CONCLUSION: The need for pelvic and/or femoral osteotomies should be considered in conjunction with closed or open reduction in the treatment of developmental dysplasia of the hip in children between the ages of one and four years.

Plasma total homocysteine level in mothers of children with clubfoot.

The pathogenesis of clubfoot is unknown despite numerous hypotheses. To clarify the relationship between the plasma total homocysteine level and congenital idiopathic clubfoot, blood samples from mothers of children with congenital idiopathic clubfoot (group 1) and mothers of children without congenital anomaly (group 2) were studied. Groups were the same for factors affecting the plasma total homocysteine level. Mean plasma total homocysteine level was 16.34+/-4.78 micromol/L in group 1 and 11.02+/-1.85 micromol/L in group 2, and there was significant statistical difference between the groups (P<0.05). Congenital idiopathic clubfoot showed a significant association with high plasma total homocysteine level. This study may be a step toward clarification of clubfoot pathogenesis.

Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint.

To evaluate the use of a two-prong splint for displaced, proximal, humerus, epiphyseal fractures, seven children with Neer-Horwitz Classification Type 3-4 fractures of the proximal humerus were retrospectively investigated. After closed reduction, fracture stabilization was accomplished with the use of a two-prong splint, and at an average follow-up of 54 months (range 48-62 months), all children were evaluated radiographically and functionally. There were no complications, and all patients had full painless range of shoulder and elbow motion, without malunion, joint incongruity, nonunion, avascular necrosis, and limb-length discrepancy. The results did not change over time. Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint gives satisfactory results while allowing immediate motion and gradual reduction of the fragments without anesthesia, and it may be the treatment of choice for such injuries in children.

Mechanical performance of hybrid Ilizarov external fixator in comparison with Ilizarov circular external fixator.

OBJECTIVE: The aim of this study was to determine the stiffness characteristics of the standard and hybrid Ilizarov fixators. DESIGN: Five different frame models (one standard and four hybrid Ilizarov) were designed. Four full rings were used in the standard Ilizarov frame. Two rings were placed proximal and two rings were placed distal to the osteotomy line with two wires at 90 degrees to each other on each ring. The distal tibial fixation of all the hybrid configurations and standard Ilizarov fixator were the same, and only the proximal fixations were different. In hybrid models, different numbers of 90 degrees femoral arches (1-3) were fixed to the proximal segment by using the half-pins with different numbers (2-4) and different angles to each other (45 degrees and 90 degrees ). BACKGROUND: Numerous investigations have been performed to compare the mechanical properties of different frames. The Ilizarov method of fracture fixation and limb lengthening has recently gained international recognition. But its application is difficult in some anatomic localization, so that hybrid ring fixation frames of various configurations are gaining clinical popularity. METHODS: Five different frame models were applied to the sheep tibial bones. The midpoint of the tibial bones was osteotomised and the osteotomy distracted for 2 cm. Four identical samples for each model were created and each identical sample of each model (n=1) were tested four times in axial compression, antero-posterior and medio-lateral bending, and torsion. RESULTS: In standard Ilizarov fixator, axial and bending stiffness was found to be more than all hybrid Ilizarov fixator models. Between the hybrid fixators, higher axial and bending stiffness was found when the number of femoral arches and half-pins were increased. Different angles between the half-pins formed 67% alteration in medio-lateral bending stiffness. No significant difference was found for torsional stiffness between the fixator models. CONCLUSIONS: For optimum fixator stiffness in hybrid fixators, at least three femoral arches and four half-pins must be used and these half-pins should be placed at 90 degrees angles and at different planes to each other. However, it should be remembered that, hybrid fixator models had less axial and bending stiffness than standard Ilizarov fixator model. RELEVANCE: For optimum fixator stiffness in hybrid fixators, at least three femoral arches and four half-pins must be used. However, it should be remembered that, hybrid fixator models had less axial and bending stiffness than standard Ilizarov fixator model.

Pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle.

We report the case of a 22-year-old woman with pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle. The patient was first seen at the age of 19 years and had no symptoms during the 3-year follow-up period. The diagnosis of pycnodysostosis was made by typical clinical and radiological findings. Bilateral painless mid-clavicular mass and plain radiograms confirmed the diagnosis of bilateral congenital pseudarthrosis of the clavicle. Surgery was not performed for pseudarthrosis of the clavicles, just observation was preferred.

[Early results of complete subtalar release in congenital clubfoot deformity]. / Dogustan çarpik ayakli olgularda komplet subtalar gevsetme uygulamalarimizin erken dönem sonuçlari.

OBJECTIVES: We evaluated the radiological and clinical results of complete subtalar release in patients with congenital clubfoot deformity. METHODS: We performed complete subtalar release in 30 feet of 20 patients (14 boys, 6 girls; mean age 8 months; range 3.5 to 18.5 months). We employed the Cincinnati incision in all cases. The results were evaluated according to the Simon's clinical and radiological criteria. Tarsal bone problems were analyzed separately. The mean follow-up period was 24.6 months (range 12 to 41 months). RESULTS: Clinical results were satisfactory in 24 feet (80%) and unsatisfactory in six feet (20%). Radiologically, satisfactory and unsatisfactory results were encountered in 19 feet (63%) and 11 feet (37%), respectively. Undercorrection occurred in 13 feet (43.3%) and overcorrection in one foot (1.4%). Revision surgery which was recommended for five undercorrected feet (16.6%) with unsatisfactory clinical and radiological results could be performed in four feet (13.3%). Deep skin necrosis that occurred in two feet (one with Achilles tendon necrosis) was treated surgically. Superficial skin necrosis developed in five feet and soft tissue infection in one feet, all of which responded well to conservative treatment. Other complications included talar head hypoplasia and navicular hypoplasia in two feet, respectively. CONCLUSION: Complete subtalar release allows to correct all components of clubfoot deformity in a single session. The results may appreciably be improved with enhanced surgical experience.

[One-bone forearm operation for defective ulna osteomyelitis: a case report]. / Defektif ulna osteomiyelitinde önkola tek kemik yapimi: Olgu sunumu.

A four-year-old boy with forearm instability secondary to defective ulna osteomyelitis underwent one-bone forearm operation in neutral supination-pronation position. A year after the operation, shortening (3 cm) of the forearm was detected. Radiographs showed delayed union; however, a stable and functional forearm was obtained. The patient was able to use his fingers.

Open fractures of the proximal humerus treated with the Ilizarov method: 12 patients followed 3-8 years.

We followed 12 patients who had been treated with the Ilizarov method for open proximal humeral fractures for more than 3 years. No wound infection occurred. Avascular necrosis and nonunion were each detected in 1 patient. According to Neer's criteria, the outcome was excellent or satisfactory in 8 patients.

Corona mortis: incidence and location.

The right hemipelvis of 98 patients was examined by angiography to determine the occurrence and location of the corona mortis artery. This arterial anastomosis was found in 28.5% (28 of 98). Its incidence was 30.5% (18 of 59) in men and 25.6% (10 of 39) in women; this difference was not significant ( p>0.05). The distance from the symphysis pubis to the anastomotic artery averaged 33.4 mm (range 21.4-41 mm). It was 31.8 mm (range 21.4-39.3 mm) in men and 36.2 mm (range 25-41 mm) in women; this difference was significant ( p<0.05).

[The results of surgical treatment in ankle fractures]. / Ayak bilegi kiriklarinda cerrahi tedavi sonuçlarimiz.

OBJECTIVES: We evaluated the results of surgical treatment for ankle fractures and the factors that play a role in these results. METHODS: The study included 31 patients (20 men, 11 women, mean age 38.2 years) who underwent surgical treatment for ankle fractures and had an adequate follow-up. According to the Lauge-Hansen classification, the mechanism of occurrence was supination-external rotation in 13 (42%), pronation-external rotation in two (26%), pronation-abduction in four (13%), and supination-abduction in four patients (13%). In two patients (6%), the fractures could not be classified. Most of the fractures occurred with falling in winter months. The majority of fractures (55%) was of bimalleolar type. The mean follow-up was 26 months. RESULTS: Union was obtained in all fractures. According to the objective criteria, the results were good, moderate, and poor in 18 (58%), eight (26%), and five (16%) patients, respectively. Subjective evaluation yielded good, moderate, and poor results in 17 (55%), eight (26%), and six (19%) patients, respectively. The results were poor especially in pronation-external rotation and fracture-dislocation type fractures. Two patients (6%) developed degenerative arthritis. CONCLUSION: In our opinion, the best anatomical reduction may be achieved by surgical treatment of ankle fractures that present with a talar tilt, fibular shortening, and injury to the syndesmosis.