The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case control study assessing blood loss complications and function outcomes.

BACKGROUND: The modified Stoppa approach was introduced to manage fracture of the anterior column instead of the ilioinguinal approach to reduce morbidity. However there is no clinical evidence to confirm its efficiency. Therefore this study was designed to ascertain: (1) if the Stoppa approach versus ilioinguinal allows less blood loss, (2) if functional and radiological results are superior to that of the ilioinguinal approach, (3) if the rate of complication was different. HYPOTHESIS: The modified Stoppa approach allows less blood loss than the ilioinguinal in management of fractures of the anterior column of the acetabulum. PATIENTS AND METHODS: Nineteen patients who were treated with the ilioinguinal approach (Group A) at a mean follow-up of 33 months and 17 patients who were treated with the modified Stoppa approach (Group B) at a mean follow-up of 28.9 months were retrospectively reviewed. Patients were called to the final follow-up examination, mean follow-up durations were set and the functional evaluation of patients was made with measurement of range of motion, Harris Hip Scores (HHS), and Merle D'Aubigné score. RESULTS: Average blood loss was determined at a mean 1170 mL (range, 750-2150 mL) in Group A and at a mean 1110 mL (range, 450-2000 mL) in Group B (P=0.168). The mean HHS (group A=89.4 [73-99] and group B=88.4 [75-97]) and Merle D'Aubigné scores (group A=16.8 [13-18] and group B=16.5 [13-18]) showed no significant difference between the groups (P=0.169). At the final follow-up, the mean hip flexion was found to be 106.83 ± 12.47 and the hip extension was 10.33 ± 6.12 in Group A, while these values were 103.71 ± 14.32 and 10.69 ± 8.17 in Group B (NS between groups regarding flexion [P=0.678] and extension [P=0.445]). The complication rate was 31% in Group A (6 patients) and 23% in Group B (4 patients) (P>0.05). DISCUSSION: Both surgical approaches give successful results in the treatment of acetabular fractures. Contrary to expectations, there was no difference in the amount of bleeding at the wound site from the Stoppa technique, even though it is minimally invasive, compared to the ilioinguinal approach. LEVEL OF EVIDENCE: Level III retrospective case control study.

One-stage treatment of open tibial fracture in a child using a distally based sural artery flap: a case report.

Open fractures in children have a high level of morbidity and require early treatment. This case describes the successful treatment of a child who sustained an open tibial fracture with soft tissue loss. The fracture was stabilized with a monolateral external fixator devised in our clinic, and the soft tissue loss was covered with a distally based sural artery flap. The flap is simple, can be done quickly, and a surgeon does not need microsurgical or specialty training to perform the operation. This combined use of external fixation and distally based sural artery flap is a straightforward technique in distal tibial open fractures of children with soft tissue loss.

Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur.

Our aim was to determine the clinical effectiveness and safety of Ilizarov external fixation for the acute treatment of severely comminuted extra-articular and intercondylar fractures of the distal femur. A total of 14 consecutive patients with complex fractures was treated. There were three type-A3, two type-C2 and nine type-C3 fractures according to the AO/ASIF system. The mean follow-up was 14 months. Most fractures (13) united primarily at a mean of 16 weeks. One patient with a type-IIIA open fracture had infection and nonunion. The mean range of flexion of the knee at the final follow-up was 105 degrees (35 to 130). We conclude that, in the treatment of comminuted fractures of the distal femur, the Ilizarov fixator is safe and effective in providing stability and allowing early rehabilitation.

The de Barsy syndrome.

We report a child with de Barsy syndrome, which is a very rare, genetically transmitted clinical entity associated with mental and growth retardation, severe cutis laxa, joint laxity and various ocular and skeletal system findings. The patient was operated to treat her orthopedic disabilities. Typical findings of this case with eight-year follow-up beginning from birth are described and compared with previously reported cases. The main aim of this paper was to describe the diagnostic and therapeutic difficulties of this rarely encountered syndrome.

Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure?

BACKGROUND: The purpose of this study was to determine the safety of early weight-bearing after statically locked reamed nailing of comminuted fractures of the femoral diaphysis, and to assess the rate of implant failure and fracture healing. METHODS: Thirty consecutive patients with comminuted diaphyseal femur fractures (Winquist type II, III, and IV) were treated with statically locked reamed intramedullary nailing. Six patients were lost to follow-up, and the remaining 24 patients were followed at least 1 year. Early weight-bearing was allowed and encouraged in the first 2 weeks after the operation. The nail diameters were 13 mm in 16 patients, 12 mm in 6 patients, and 14 mm in 2 patients. RESULTS: Most of the patients could start weight-bearing between the first 2 and 4 weeks postoperatively. None of the patients, except one, were using any walking aids at the second month postoperatively. All the fractures healed without any significant complications. Nail bending or breakage did not occur in any patients, but there was slight bending in one distal interlocking screw and one proximal interlocking screw. The fractures of the patients with bent screws healed uneventfully. CONCLUSION: This study showed that early weight-bearing after reamed static interlocking nailing of Winquist type II, III, and IV femoral fractures is a safe and effective method, and the risk of implant failure does not preclude the procedure.

An easy and versatile method of coverage for distal tibial soft tissue defects.

BACKGROUND: The distally based superficial sural artery flap, first described as a distally based neuroskin flap by Masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. In the difficult area of defects in the lower leg and the ankle and heel region, it has a wide variety of indications, even in the vascularly compromised patients. It has the largest arc of rotation of all flaps that have been described in this region. The most important advantage is that it does not compromise a major artery. It is simple to dissect and has a low donor morbidity. METHODS: We reported our experience with this new flap in 15 cases and also described a new indication for the patients with neglected ruptures of the Achilles tendon. RESULTS: In 13 patients, the flap was successfully transferred. In two cases, partial necrosis of the flap ensued, which healed with secondary intention. CONCLUSION: This flap deserves a high degree of interest in the reconstructive armamentarium of the trauma surgeon.

Easily removed drill guide for pin insertion during external fixation.

A new guide for tissue protection while drilling and inserting screws in external fixation without taking down the system is presented. It can be used for pin insertion in both unilateral and ring-type external fixators. The external fixator is used as a template guide, and pin insertion can be easily performed with the fixator in place. With its use, operative time is decreased, and tissue protection is achieved for all pin insertions in any part of the musculoskeletal system.

Normal development of the tibiofemoral angle in children: a clinical study of 590 normal subjects from 3 to 17 years of age.

In evaluation of genu varum-genu valgum, tibiofemoral (TF) angle and intercondylar (IC) or intermalleolar (IM) distance are commonly measured. In this study, we determined mean values and normal limits for TF angle and IC/IM distance in 590 normal Turkish children (287 girls and 303 boys) aged from 3 to 17 years using clinical methods. We noted a significantly higher degree of valgus angle than that in previous reports. The maximal mean valgus angle was 9.6 degrees at 7 years for boys and 9.8 degrees at 6 years for girls. These differences were considered racial differences between Turkish children and those of other races. Turkish children, aged between 3 and 17 years, exhibited < or =11 degrees physiologic valgus. A measurable varus angle or a valgus higher than 11 degrees during this period should be considered abnormal.

Osteoid osteoma of the carpal bones.

Osteoid osteoma is a benign bone tumor that rarely localizes in the hand or the carpal bones. We report two cases of osteoid osteoma localized in two different carpal bones. Unremitting wrist pain was a major clinical symptom. Surgical treatment including excision of the nidus was dramatically curative. In young patients, osteoid osteoma should be considered in the differential diagnosis of chronic wrist pain.

The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator.

The purpose of this study was to evaluate the clinical and radiological results of unstable pelvic fractures treated with a new external fixation device. Between May 1992 and May 1998, 43 patients with unstable pelvic fractures were treated with a new anterior pelvic external fixator. Two died, and therefore 41 patients' results were evaluated. There were 29 men and 12 women, and their average age was 34 years (range 12-70 years). Traffic accidents accounted for 34 injuries. Three patients fell from a height, 3 were injured in industrial accidents, and 1 was hit by a train. According to the Tile classification, there were 24 type B pelvic injuries and 17 type C. Associated injuries were observed in 21 patients. A considerable reduction of the pelvic pain was noted after application of the fixator in all patients. Excessive blood transfusion was not required in any patient. The average follow-up was 24 months (range 12-50 months). Clinical results at final evaluation were good according to the criteria of Matta and Saucedo in 34 patients and poor in 7. In conclusion, the new pelvic external fixator is effective, safe, and easy to apply in the treatment of unstable pelvic fractures. The fixator can be used alone in patients with type B pelvic injuries such as open book and lateral compression. However, it does not provide sufficient stability for severely displaced type C injuries when applied alone. Nevertheless, it may be helpful for fixing type C injuries like a posterior iliac fracture without dislocation of the sacroiliac joint.

The Monteggia lesion and ipsilateral supracondylar humerus and distal radius fractures.

Ipsilateral elbow and forearm fractures are quite rare in children. We present a Monteggia lesion with ipsilateral supracondylar humerus fracture in a 13-year-old girl. Through early surgical management, a successful result was achieved. We believe that, to minimize any initial or subsequent complications in such fractures, early surgical management should be the first treatment choice.