The volar surgical approach in complex dorsal metacarpophalangeal dislocations.

OBJECTIVE: To describe the surgical treatment of complex dorsal metacarpophalangeal dislocations, emphasising the volar approach. METHODS: Seven cases of isolated, closed, complex dorsal metacarpophalangeal dislocation, treated surgically using the volar approach, were retrospectively evaluated. The median follow-up period was 91 months. RESULTS: Five of the injuries involved children. The thumb was involved in four cases and the index finger in three. The volar plate was found to impede reduction in all cases. The operated joint was immobilised in a functional brace for a median of 3 weeks. At final follow-up (median 91 months), the metacarpophalangeal range of motion, grip power, stability and sensation were normal. CONCLUSIONS: Using the volar surgical approach, the strangulated metacarpal head can be directly visualised and the volar plate, which is longitudinally split for reduction, can be repaired. Reduction should be performed within the first day from injury, and the joint should be immobilised in a functional position no more than 3 weeks.

[Factors affecting the results of treatment in traumatic dislocation of the hip]. / Travmatik kalça çikiginda tedavi sonucunu etkileyen faktörler.

OBJECTIVES: We evaluated the long-term results of conservative and surgical treatment and the effect of prognostic factors on these results in patients with traumatic dislocation of the hip. METHODS: The study included 30 patients (27 males, 3 females; mean age 35 years; range 16 to 69 years) with traumatic hip dislocations. The most common cause was traffic accidents (80%). Fifteen patients underwent closed reduction for posterior (n=10), anterior (n=2), and central (n=3) dislocations, of which eight were isolated and seven were fracture dislocations. Open reduction was performed in 15 patients with posterior (n=14) and central (n=1) dislocations. Of these, five patients had isolated hip trauma and 10 patients had multiple trauma. Surgery was performed within the first 24 hours (n=6) or between five and 21 days (n=9). Posterior, central, and anterior dislocations were classified according to the Thompson-Epstein, Judet, and Epstein classification systems, respectively. The Pipkin classification was also used for dislocations with femoral head fractures. The results were evaluated according to the criteria proposed by Matta. The mean follow-up was 49 months (range 16 to 84 months). RESULTS: Following closed reduction, the results were satisfactory (very good or good) in 11 patients (73.3%, all isolated dislocations and three posterior fracture dislocations) and unsatisfactory (moderate or poor) in four patients (26.7%). Following open reduction, nine patients (60%) with posterior fracture dislocations had satisfactory and six patients (40%) had unsatisfactory outcome. The results were unsatisfactory in all the central dislocations. One patient developed avascular necrosis of the femur head and four patients developed degenerative arthritis following closed reduction. Degenerative arthritis was seen in six patients after surgical treatment, two of whom also had avascular necrosis. CONCLUSION: Our data may provide insight into the factors affecting the prognosis of traumatic hip dislocations treated by closed or open reduction.

[The measurement of wrist kinematics in children 4 to 16 years old and the comparison of the scapholunate distance with adult values]. / Cocuklarda (4-16 yas) el bilegi kinamatigi ve skafolunat mesafenin eriskin degerleriyle karsilastirilmasi.

OBJECTIVES: We sought to determine the position and values of the kinematic indices of the wrist (center of rotation, carpal height, carpal-ulnar distance), the third metacarpal length, and the scapholunate distance for children and compared the results with those reported for adults. METHODS: The study included 41 children (24 girls, 17 boys; age range 4 to 16 years) who presented with wrist and/or forearm injuries, and whose radiographs of the other wrist had been obtained for comparison. The children were divided into six age groups separated by 2-year intervals regardless of gender or the side of the wrists involved. Measurements were made on standard posteroanterior radiographs of healthy wrists and the mean values obtained were statistically analyzed. RESULTS: The carpal height, carpal-ulnar distance and the third metacarpal length were significantly different in all age groups. The ratios of the carpal height and the carpal-ulnar distance to the third metacarpal length were similar both in the age groups and to those reported for the adult values. However, the scapholunate distance exhibited significant differences between the age groups and from the standard adult value. CONCLUSION: The adult values given for the ratios of the carpal height and the carpal-ulnar distance to the third metacarpal length can be adopted as standard values for children. However, determination of the scapholunate dissociation in children should not be based on the normal range given for adults.

[Surgical treatment of elbow fracture-dislocations seen in children and adolescents]. / Cocukluk ve adölesan dönemlerinde görülen dirsek kirikli çikiklarinin cerrahi tedavisi.

OBJECTIVES: We evaluated surgical indications and radiologic features of elbow fracture-dislocations in children and adolescents. METHODS: Thirteen patients (12 boys, 1 girl; mean age 13 years; range 6 to 17 years) with elbow fracture-dislocations were treated surgically. Coexisting fractures included medial epicondyle fractures (n=5), medial and lateral epicondyle fractures (n=3), radial head and olecranon fractures (n=2), radial head and medial epicondyle fractures (n=1), lateral condyle fracture (n=1), and fracture of the coronoid process (n=1). Eleven dislocations were closed, two were open. Open reduction and Kirschner wire fixation were performed in all the patients. Posterior (n=6), medial (n=5), anteromedial, and lateral incisions were used. Active range of motion exercises were initiated following the removal of sutures. Above-elbow cast was applied for three weeks. The mean follow-up period was 38 months (range 7 to 58 months). The results were evaluated with the use of the Mayo elbow performance score. RESULTS: Ten patients had satisfactory (very good or good) results, while two patients with open dislocations and ipsilateral major injuries, and one patient who developed myositis ossificans postoperatively had unsatisfactory (moderate or bad) results. No postoperative nerve injuries were detected. CONCLUSION: The surgical indications for fracture-dislocations of the elbow in children and adolescents are the presence of intraarticular loose bodies or instability after reduction. The presence of open dislocation or ipsilateral major injuries are associated with unsatisfactory results.

[Intramedullary nailing of adult femoral fractures]. / Eriskin femur cisim kiriklarinin intramedüller çivilerle tedavisi.

OBJECTIVES: We evaluated the results of treatment of adult femoral fractures treated by intramedullary nails. METHODS: Sixty-two patients (15 females, 48 males; mean age 29 years; range 16 to 62 years) with 64 femoral fractures were treated by intramedullary nailing. Eighty-three percent of the fractures was closed and 17% was open. According to the Winquist (W) classification, there were 16 (25%) W0, 22 (34%) W1, nine (14%) W2, nine (14%) W3, and eight (13%) W4 fractures. The mean duration between trauma and surgery was 18 days (range 4 to 130 days), and the mean hospital stay was 25 days (range 11 to 142 days). Open and closed techniques were employed in 62 (97%) and two (3%) fractures, respectively. Nine fractures were unlocked; dynamic and static locking were performed in 39 and 16 fractures, respectively. In the open technique, secondary procedures involved grafting in 14 cases, cerclage in eight cases, grafting and cerclage in 10 cases, and grafting and screw fixation in one case. The results were assessed according to the criteria by Thoresen et al. The mean follow-up was 28 months (range 7 to 62 months). RESULTS: Fifty-one patients (80%) had satisfactory, 13 patients (20%) had poor outcome. All proximal locking screws (n=20) were successfully inserted, whereas 23 (24%) of 95 distal screws missed the nail holes. Complications included superficial infection (n=3), osteomyelitis (n=4), trochanteric bursitis (n=1), irritation of the skin by the distal screws (n=4), heterotopic ossification (n=6), shortening more than 1 cm (n=8), rotational malalignment greater than 10 degrees (n=2), migration of the nail through the knee joint (n=2), drill breakage while preparing the distal holes (n=2), knee range of motion below 100 degrees (n=6), and delayed union (n=2). CONCLUSION: Intramedullary nailing should be the primary indication for stable and unstable femoral fractures.