[The results of intramedullary fixation with titanium elastic nails in children with femoral fractures]. / Cocuklardaki femur cisim kiriklarinda titanyum elastik çivilerle intramedüller tespit sonuçlari.

OBJECTIVES: We evaluated clinical and radiologic results of intramedullary fixation with titanium elastic nails (TEN) in children with femoral fractures. METHODS: The study included 35 femoral fractures of 34 patients (20 boys, 14 girls; mean age 8.3 years; range 5 to 14 years) who were treated by intramedullary fixation with TEN. The results were evaluated according to the scoring system proposed by Flynn et al. Time to union and residual angulations were assessed on anteroposterior and mediolateral radiographs. Femoral anteversion angles and limb lengths were measured in comparison with the normal side by computed tomography (CT) in 14 patients and the results were compared using the Wilcoxon test. The mean follow-up period was 28 months (range 4 to 48 months). RESULTS: According to the criteria by Flynn et al., the results were excellent in 25 fractures (71.4%), successful in nine fractures (25.7%), and poor in one fracture (2.9%). The mean time to union was 7.4 weeks (range 5 to 12 weeks). Mediolateral and anteroposterior radiographs showed an angulation of 10 degrees or less in three fractures and of 8 degrees in one fracture, respectively. Limb length discrepancy of less than 2 cm was detected in seven patients (20.6%). Femoral anteversion angles measured by CT revealed significant retroversions on the fractured sides (p<0.01). CONCLUSION: Intramedullary fixation with TEN may be the preferred method for the treatment of femoral fractures in children aged 5 to 15 years. However, residual rotation detected by CT seems to be a technical challenge to be improved.

Which one is at risk in intraoperative fluoroscopy? Assistant surgeon or orthopaedic surgeon?

BACKGROUND: Orthopaedic surgeons use intraoperative portable fluoroscopy and roentgenography. The present study was an attempt to find out if there is a difference between the occupational radiation exposure to the orthopaedic surgeon and assistant surgeon in the operating room while using intraoperative fluoroscopy or radiographic control and to measure it. METHODS: During a 3-month period, 107 consecutive operations were monitored for radiation exposure. At monthly intervals, the radiation doses were measured in millirem and recorded. The distance of the orthopaedic surgeon and the assistant surgeon from the X-ray source were noted in every fluoroscopic check. The orthopaedic surgeon was always at a safe distance (more than 90 cm), but the assistant surgeon always stood nearby (10 cm) the X-ray source for positioning of the patient. RESULTS: The radiation exposure according to the badge on the shoulder was consecutively 3, 4, 3 mrem for the orthopaedic surgeon and 20, 19, 22 mrem for the assistant surgeon. The radiation exposure according to the badges on the anaesthetic machine, in the room and under the apron of the orthopaedic surgeon were all zero, whereas the readings of the badge under the apron of the assistant surgeon were 7, 6, 5 mrem consecutively. CONCLUSION: Our findings show that although the radiation exposure during orthopaedic operations is below the recommendations of the European Committee on Radiation Protection, there is a higher risk of exposure for the assistant surgeon. It has to be kept in mind that there could be morphological and functional damage in cells exposed to radiation. Therefore, we should continue to use appropriate shielding precautions in view of the unknown long-term risks.

[Simultaneous asymmetric bilateral traumatic hip dislocation: a case report]. / Asimetrik iki tarafli travmatik kalça çikigi: Olgu sunumu.

Asymmetric bilateral (one side anteriorly, the other posteriorly dislocated) traumatic hip dislocations are very rare. We present a 21-year-old male patient who had simultaneous anterior and posterior traumatic hip dislocations due to a car crash. He also suffered from a tarsometatarsal (Lisfranc's) fracture-dislocation. The patient underwent conservative treatment and was followed-up for 44 months. Final evaluations with Thompson and Epstein radiologic and clinical criteria showed an excellent result. To our knowledge, this is the first report of a case with asymmetric bilateral traumatic hip dislocations associated with Lisfranc's injury.