Syndesmotic screw fixation in tibiofibular diastasis.

BACKGROUND: In chronic instability of syndesmosis, osteoarthritis and poor functional outcome were seen more prevalently. To avoid diastasis of ankle joint, the affected distal tibiofibular syndesmosis should be restored. We evaluated the clinical and radiological results of operative treatment of ankle fractures in patients who required syndesmotic stabilization. MATERIALS AND METHODS: Twenty-one patients operated for ankle fracture were evaluated. Patients were followed up for 12 to 81 months, with a mean value of 49 months. Anteroposterior (AP), lateral, and mortise radiographs were taken at the follow-up period, and AP tibiofibular distance, lateral fibular distance, and medial mortise distance were measured on the preoperative, postoperative, and last follow-up radiographs. At the last follow-up, patients were evaluated clinically with Hannover scoring system. RESULTS: The decrease in AP tibiofibular distance was statistically significant postoperatively in Weber Type B and C fractures. The mean preoperative AP tibiofibular distance which was 7.1 mm decreased to 3.6 mm after operation. There was no statistically significant relation between the amount of decrease and fracture type, either Weber B or C. At the same time, the AP tibiofibular distance did not change at the last follow-up. At the last follow-up clinical evaluation, patient scores were ranging from 74 to 94, with a mean value of 86, which was designated as a fair result. CONCLUSION: In ankle fractures, if diastasis of distal tibiofibular joint is present, syndesmosis should be fixed for both Weber Type B and C fractures. The most important predictor of good clinical outcome is accurate reduction of the syndesmosis.

Comparison of medial and posterior surgical approaches in pediatric supracondylar humerus fractures.

OBJECTIVES: The aim of the current study was to compare the clinical results of pediatric supracondylar humerus fracture cases requiring open reduction through medial approach with posterior approach. PATIENTS AND METHODS: Retrospective cohort of 67 cases of pediatric supracondylar fractures was reviewed. Thirty-three patients (20 males, 13 female, average age: 8.3 ± 3.131) were treated with medial approach were compared with 34 patients (19 males, 15 females, average age: 7.5 ± 3.146) treated with posterior exposure. Median follow-up period of the first group was 35.04 months (range: 17-76 months) and of the second group was 36.04 (range: 16-65 months). Radiological evaluation included Baumann angle, carrying angles, and lateral humero-capitellar angles. Functional and cosmetic evaluation was assessed with range-of-motion measurements and the criteria defined by Flynn et al. RESULTS: No differences between groups were noted regarding gender, age, and follow-up periods. Operative time was significantly shorter in medial approach group [60.0 ± 14.5 vs. 75.8 ± 17.6 min (P = 0.002)]. Radiological measurements (Baumann, humero-capitellar, and carrying angles) were also similar between groups. When evaluated patients according to Flynn's criteria, for medial group, 31 cases (93.9%) had good-perfect result regarding ROM loss, whereas for posterior group 33 cases (97%) had good-perfect result. Regarding carrying angle change and posterior group were slightly better than medial group (perfect result observed in 91.1% vs 81.8%, respectively). The differences did not show statistical significance. CONCLUSION: In the treatment of supracondylar humerus fractures in children, both surgical approaches revealed similar functional and radiological outcomes with shorter operative time when medial approach was utilized.

Comparision of the expandable nail with locked nail in the treatment of closed diaphyseal fractures of femur.

BACKGROUND: Expandable nails achieve stability only by hydraulic expansion; therefore suggest less radiation exposure and operation time. In this study, we aimed to compare the results of expandable femoral nails with locked intramedullary nails in the treatment of diaphyseal fractures of femur. MATERIALS AND METHODS: Isolated closed AO = Arbeitsgemeinschaft für Osteosynthesefragen type 32.A or 32.B unilateral femoral shaft fractures operated with expandable or locked nail were evaluated retrospectively. We match patients who undergone expandable nail fixation with patients of the same-sex, age, and fracture type who undergone locked nailing. A match was done for 31 expandable nail. At follow up, healing was assessed radiologically and clinically. Outcome measures included duration of hospital stay, time taken to achieve bony union, and participation in full activities. RESULTS: The average duration of surgery in the expandable group was 60.9 min and in the locked group was 82.4 min. In the expandable group, the average clinical healing time was 15.5 weeks and radiographic healing time was 21.7 weeks. In the locked IMN group, the average clinical healing time was 18.4 weeks and the average radiographic healing time was 24.1 weeks. We observed seven (22.6%) non-union in expandable group and four (12.9%) non-union in locked group. In the expandable group, type of the fracture was AO 32.B in all of the non-union patients. We achieved union in all of non-unions of the locked group only with dynamization. In the expandable IMN group, five (16.1%) patients required major surgery, in the locked group none of the patients required major surgery. CONCLUSION: Non-union rate of the expandable nail is higher than that of the locked nail for femoral diaphyseal fractures. It may be a treatment option in simple fractures like AO 32.A and in patients where rapid fixation is demanded. It has advantages of reduced operative time and less radiation exposure in comparison with reported series of conventional nails.

The value of proton MR-spectroscopy in the differentiation of brain tumours from non-neoplastic brain lesions.

PURPOSE: Our aim was to evaluate the efficacy of Proton-MR Spectroscopy for the differentiation of cranial masses from non-neoplastic brain disorders. MATERIAL AND METHOD: 33 patients with intracranial mass lesions, 29 patients with non-neoplastic brain lesions: Ischemic-demyelinating-metabolic-benign cystic mass group; As a whole 62 patients: 30 males and 32 females were included in this study. RESULTS: In brain tumours, average Cho/NAA ratio 2.84-NAA/Cr ratio was 0.97, Cho/Cr ratio 2.42 and Cho/MI ratio was 3.51. In non-neoplastic group; NAA/Cr ratio was extremely higher than tumour group, the other ratios were far lower than cranial mass lesions. Average Cho/NAA ratio: 0.50 +/- 0.15, Cho/Cr ratio: 1.05 +/- 0.14, Cho/MI ratio: 1.07 +/- 0.73. CONCLUSION: Higher Cho/NAA and Cho/MI ratios with lower NAA/Cr ratio were most likely to be malignant. Additional lipid and lactate peaks were generally seen in malignant group.