Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing.

PURPOSE: In the surgical treatment of paediatric forearm fractures, plate-screw and titanium elastic nails are used. During the transformation of ligamento-osseous structures from adolescence form into adult form, more stable fixation is required. The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures. METHODS: A retrospective examination was made on 36 adolescent patients who underwent surgery with locked intramedullary nail fixation due to a forearm fracture. The included patients were in the adolescent age group (12-17 years), did not meet conservative follow-up criteria and had unstable fractures (>10° angulation and <50% cortex continuity after plaster casting). Patients were excluded from the study if they were aged >18 years or <12 years, had Gustilo-Anderson type 2/3 open fractures, multi-trauma, history of physeal injuries or could not be contacted during follow-up. Patients' age, gender, body mass index, affected side, and the pronation and supination values during follow-up were noted. Functional evaluation of the patients was performed with disabilities of the arm, shoulder and hand score and the surgical outcomes were evaluated according to the Price criteria. The time to union, infection during follow-up, re-fracture and vascular nerve damage were also examined. Data were analyzed using SPSS 22 Windows package program software. RESULTS: The patients comprised 30 males and 6 females (ratio, 5:1) with a mean age of (14.7 ± 2.1) years (range, 12-18 years). According to the Price criteria, the results of 33 patients were excellent, 3 were good and there were no moderate or poor cases. The mean disabilities of the arm, shoulder and hand score was 11.2 ± 6.1 (range, 4-28). The mean time to union was (8.7 ± 2.2) weeks (range, 6-14 weeks), while patients aged >15 years had prolonged time to union ([11.1 ± 1.8] weeks). There were no non-unions, re-fractures or infections. No complications were observed during implant removal. None of the patients had sensorial radial nerve injury or tendon damage. CONCLUSION: The locked intramedullary nailing technique, which is minimally invasive and provides biological fixation, was found to be successful and safe in the treatment of adolescent forearm fractures.

Distal radius correction osteotomy with tricortical bone graft is a successful method in heavy smokers.

BACKGROUND: Corrective osteotomy is a technically challenging surgical option to improve wrist function in tilted distal radius malunions. However fracture healing in smokers is adversely affected. The aim of this study was to evaluate the clinical and radiological effect of cigarettes on bone union in heavy-smokers who underwent corrective osteotomy with a triangular bone graft harvested from the iliac crest. METHOD: Fifteen patients, who were treated using trapezoidal block grafts taken from the iliac crest, who were smokers of 20 or more cigarettes daily (heavy smokers) with no chronic disease, and who consented to participate in the study. Fifteen non-smoker patients of the same age group were determined as the control group. Radiological measurements were made to include radial inclination and ulnar variance in pre-operative and post-operative radiographs. Functional evaluation was performed using Q-DASH and MAYO hand-wrist scores. RESULTS: In both groups, the mean age of the patients was 49,1 ±â€¯3,92 years. Smokers group the bone union in the osteotomy line was observed after 16,63 (12-24 h) weeks, non-smokers grup 14.1 (12-24) weeks (p = 0.06). Range of motion is found similar clinic between in groups (p > 0.05). Q-DASH for group smokers was 17.54 ±â€¯1.85, nonsmokers 17.20 ±â€¯1.24 (p = 0,878); MAYO was 82.27 ±â€¯6.06 for 82.00 ±â€¯7.74 (p = 0.874). for group B. No statistically significant difference was noted between the groups. CONCLUSION: Our study showed that cigarette smoking did not have negative effect on union time in the metaphyseal region after correction osteotomy. The time of bone-union in heavy-smokers was 2.5 weeks more than that of non-smokers.

Higher reliability of triple-phase bone scintigraphy in cementless total hip arthroplasty compared to cementless bipolar hemiarthroplasty.

PURPOSE: Periprosthetic infection is one of the main reasons for revision surgery after hip arthroplasty. The purpose of the present study is to compare the reliability of triple-phase bone scintigraphy (TPBS) in the diagnosis of periprosthetic infection between cementless total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA). METHODS: In this retrospective study, 52 patients were analyzed; 33 of them were performed with THA and 19 of them were performed with BHA. The exclusion criteria were cementation in previous surgery, romatological joint disorders, periprosthetic fracture and malignancy history. C reactive protein (CRP) and erythrocyte sedimentation (ESR) rate results were recorded preoperatively. Tissue samples from the different areas periprosthetic tissue were obtained for histopathological examination and sample tissue culture. RESULTS: In the present study, the sensitivity, specificity and accuracy were 90.9%, 77.3% and 81.8%, respectively, for THA and 77.8%, 60.0% and 68.4%, respectively, for BHA. Positive predictive values for THA and BHA were 66.7% and 63.6%, and negative predictive values were 94.4% and 75.0%, respectively. CONCLUSIONS: Due to the higher sensitivity, specificity and accuracy, TPBS has a more reliable diagnostic value for cementless THA in the diagnosis of periprosthetic infection compared to cementless BHA.

Fracture of the cemented femoral component following hemiarthroplasty in physically active patient: A case report.

INTRODUCTION: Fracture of the femoral stem following hip arthroplasty has become very rare since the developments in modern prosthetic designs. Prevention by identifying the risk factors is the best way to overcome these complex problems, as treatment is difficult. CASE REPORT: Femoral component fracture after cemented hemiarthroplasty in a physically active 64-year-old, male patient is reported in this present article. CONCLUSION: The present case emphasizes the importance of preserving the joint after hip fracture and avoidance of using mono block prosthesis in younger patients. If the patient is physically active, he/she should be advised to limit her/his daily activities to moderate intensity after hemiarthroplasty surgery.