Radiological and Clinical Outcomes of Pediatric Patients With a Supracondylar Humerus Fracture Surgically Treated With Closed Reduction and Percutaneous Pinning.

OBJECTIVES: It was aimed to evaluate the clinical and radiological results of patients operated on with closed reduction and pinning due to pediatric supracondylar humerus fractures. MATERIALS AND METHODS: The radiological and clinical results of 100 patients operated on with closed reduction and percutaneous pinning for pediatric supracondylar humerus fractures in the Department of Orthopedics and Traumatology were examined between January 2015 and February 2022. Clinical results were evaluated by performing cosmetic and functional scores defined by Flynn. Closed reduction and percutaneous pinning techniques were used in surgical treatment. RESULTS: In our study, 59 patients were male (59%), and 41 were female (41%). The average age of all patients is 6.21 ± 2.85 years. According to the Gartland classification, 21 patients' fractures were type IIA (21%), 12 patients' fractures were type IIB (12%), 51 patients' fractures were type III (51%), and 16 patients' fractures were type IV (16%). The average number of pins used in the treatment is 2.55 ± 0.50. The elbow bearing angle of the operated side of the patients was an average of 6.53 ± 3.29 degrees, the humerocapitellar angle was an average of 41.97 ± 3.08 degrees, and the lateral humerocapitellar angle was an average of 50.17 ± 3.58 degrees. Fifty-one patients had stage 0 (51%), 23 patients had stage 1 (23%), 23 patients had stage 2 (23%), and three patients had stage 3 (3%) residual sagittal plane deformity. According to the Flynn criteria, 92 patients had excellent functional results (92%), seven patients had good results (7%), and one patient had fair results (1%). Regarding cosmetic results, 91 patients had excellent results (91%), six patients had good results (6%), and three patients had fair results (3%). CONCLUSION: Supracondylar humerus fractures are common in children and can cause serious complications. Closed reduction and percutaneous pinning techniques are effective treatment methods in the treatment of displaced supracondylar humerus fractures.

Subperiosteal hemorrhage due to a distal femoral physeal fracture in a neonate.

Femoral physeal fractures have been rarely reported as a birth-related injury. As the plain radiograph findings are variable, the diagnosis may be challenging. In this case report, we describe a male neonate presenting with periosteal elevation at the left distal femur. A radiological evaluation demonstrated posteromedial displacement of the distal femoral epiphysis. The final diagnosis was subperiosteal hemorrhage due to a distal femoral physeal fracture.

Quadriceps Tendon Rupture due to Postepileptic Convulsion.

We present a case of quadriceps tendon (QT) rupture. QT ruptures can occur in all ages. The cause is mostly traumatic in origin. Spontaneous ruptures that are thought to result from predisposing conditions are rare. Post-convulsion QT ruptures lacking traumas in their history can be overlooked in clinical examinations. This should be born in mind by the attending physician, as early diagnosis and treatment of the condition can lead to satisfactory outcomes.

Fibular collateral ligament-biceps femoris calcific bursitis causing flexion contracture in the knee, external rotation in the leg, and equinus deformity in the ankle.

OBJECTIVE: The fibular collateral ligament (FCL)-biceps femoris (BF) bursa is not a commonly known location for calcific bursitis. A case of FCL-BF calcific bursitis is presented. CLINICAL FEATURES: An 18-year-old man had a blunt trauma on the lateral side of his right knee approximately 1 year before his examination. The pain and physical distortion developed in the trauma region over time. Physical examination revealed a 30 degrees flexion contracture and slight valgus deformity in the right knee. There was 30 degrees of external rotation in the leg and a 15 degrees equinus deformity in the ankle. The patient had toe-toe gait. There was a tender swelling 3 x 4 cm in size on the posterolateral aspect of the right knee. INTERVENTION AND OUTCOME: Plain radiography and computed tomography revealed a calcific mass, approximately 1.5 x 4 cm in size, between soft tissues adjacent to the posterolateral side of the right lateral femoral condyle. There were articular cartilage thinning and joint space narrowing at the lateral site of the knee joint, and magnetic resonance imaging showed bone marrow edema at the lateral condyles of the tibia and femur. The enlarged calcified bursa was excised. A segment of the contracted iliotibial tract was excised, and a fractional lengthening was performed on the BF tendon. CONCLUSION: This case report revealed that calcific bursitis can occur in the FCL-BF bursa, which may lead to complications when neglected.

Time-dependent changes in serum nitric oxide levels after long bone fracture.

Nitric oxide (NO) is a free radical of physiological significance. The changes in the production of NO during the fracture healing process are not well known. This clinical prospective study was planned to determine these changes in patients with fractured long bone(s), who underwent surgery in the 3rd week after fracture. The patients were divided into two groups: 20 patients with an isolated femoral fracture and 20 patients with multiple fractures, including a femoral fracture. Venous blood was drawn from the healthy volunteers (n = 20) once, and from the patients seven times during 21 days after fracture. NO level was measured as nitrite in each serum sample. The serum NO levels at all measurements of the patients were significantly higher than those of the control subjects. The time-dependent changes in the NO levels were similar in both patient groups. The serum NO levels were highest in the first 6 hrs, and then decreased to the lowest level on the 3rd day. Subsequently, there was an increasing trend on the 5th, 7th and 14th days. At all times of the measurements, the NO levels were higher in patients with multiple fractures than in those with the femoral fracture, with the significant difference observed at the 6 hrs and on the 7th day. The NO levels were decreased on the 21st day after surgery. The present study suggests that NO production may be increased in considerable amounts during the first 2 weeks of fracture healing, particularly in the first 6 hrs.

Experimental comparison of bovine-derived xenograft, xenograft-autologous bone marrow and autogenous bone graft for the treatment of bony defects in the rabbit ulna.

OBJECTIVES: The purpose of this study was to determine whether bone marrow grafted percutaneously has an effect on the healing of bony defects filled with bone-derived xenografts. MATERIALS AND METHODS: Eighty New Zealand albino rabbits with an average age of approximately 1 year were divided into 4 groups, each consisting of 20 animals. Bony defect was induced in the ulnas of all rabbits by excising a 1-cm-long bone segment from the 3-cm proximal segment of the right distal radioulnar joint. Bone defects were treated simultaneously with bovine-derived xenograft, a combination of xenograft and bone marrow or on the 5th day following the filling of the segment with the xenograft and autogenous bone graft. Treatment results obtained for each application type were compared with each other with regard to the radiological, biochemical and histological criteria. RESULTS: No significant statistical differences were determined between the groups in their 15th-day radiographs. The group treated with only xenograft from the first month onwards presented with the worst results and was significantly different from the other groups with respect to all evaluation criteria. No statistically significant difference was determined between rabbits treated with xenograft and bone marrow combination and with autogenous bone graft. CONCLUSIONS: This study revealed that when xenografts are combined with autologous bone marrow, their incorporation into the host bed accelerates significantly.

[Old unreduced traumatic patellar dislocation]. / Yerine konmamiseski travmatik patella çikigi.

The old unreduced traumatic patellar dislocation is very rare and the results of the treatment are not always satisfactory. We report a 11 year-old boy with an unreduced patellar dislocation and a healed ipsilateral femoral fracture. The dislocation was reduced by an operative procedure. A long leg cast was applied for 6 weeks then the knee exercises were started. One year after surgery, he still has satisfactory results. This case suggests that if the dislocation is not of long duration and degenerative changes are absent in the patella and the knee joint, open reduction may be helpful in the treatment of old unreduced traumatic patellar dislocations. .

Bilateral congenital diastasis of the inferior tibiofibular joint.

Bilateral congenital inferior tibiofibular diastasis is an extremely rare anomaly of unknown etiology. A few cases have been reported previously. The author presents a case in which bilateral tibiofibulotalar arthrodesis was performed.

Familial multiple lipomatosis.

BACKGROUND: Familial multiple lipomatosis is an extremely rare disease. The disease usually does not affect the daily life of FML victims, but they may experience difficulty in performing everyday physical tasks if the lipomas are multiple and large. Inheritance is frequently by autosomal dominant transmission, although cases with recessive inheritance have also been reported. OBJECTIVES: To determine the pattern of inheritance of the disease in a family with 83 members spanning three generations. METHODS: A complete family analysis was performed and all surviving members of the family were examined. Laboratory investigations were conducted in those with FML, including serum lipid, cholesterol and glucose levels, white blood cell count, hemoglobin, erythrocyte sedimentation rate, and renal and hepatic function tests. RESULTS: There were no consanguineous relationships between spouses in the family. The disease was first seen on the neck of the (male) index patient. This patient had 4 sons, 8 daughters and 60 grandchildren. The disease was established in four of his daughters and two of his sons. One of the female grandchildren whose mother has the disease was also affected. The laboratory findings were normal for all patients. CONCLUSION: Our findings showed that a) the disease is transmitted by the autosomal dominant route of inheritance; and b) lipomas observed at an early age may be numerous and large, may diffuse, and sometimes have to be excised surgically.