Self-locking tension band technique. A new perspective in tension band wiring.

After experiencing some complications with the AO modified tension band technique, we have made a small modification to prevent proximal migration of the Kirschner wires. In this modification, the proximal ends of the wires are bent to form a loop and the cerclage wire passed through them. In this way, Kirschner wires and cerclage wire lock each other, preventing migration. We have treated 51 patients with this technique, including 22 transverse patellar, 11 olecranon, 3 medial and 5 lateral malleolar fractures, 3 acromioclavicular separations, 4 olecranon chevron osteotomy fixations and 3 trochanter major fixations. Fracture union occurred in 8 weeks (mean). We did not see any postoperative complications or implant failures. Rigid fixation allows early mobilization which quickly restores functional status.

Management of distal humerus fractures in adults.

From January 1992 to May 1997, 46 distal humeral fractures were treated by open reduction and internal fixation. Among these, 30 were intra-articular, which were managed by the transolecranal approach, routine ulnar nerve transposition, 3.5-mm dual-plate fixation and early active mobilisation. We encountered 2% non-union, 2.2% fixation failure, 11.1% nerve complications, 28.2% overall heterotopic ossification and 11.1% poor range-of-motion rates.

Medial subtalar dislocation.

We report a medial subtalar dislocation without fracture in an eighteen year old male injured during basketball game. He was successfully treated with closed reduction and cast immobilization. At one year follow-up he was symptomless.

Repair of neglected Achilles tendon ruptures: procedures and functional results.

Surgical repair of neglected Achilles tendon ruptures presents the challenge of restoring the function of the Achilles tendon complex while repairing the large defect that is created by the delay in appropriate treatment. We present our preferred technique for delayed repair and the results of six patients who were available for complete follow-up evaluation. The combined surgical technique includes: V-to-Y gastrocnemius recession or advancement, excision of the fibroadipose defect, end-to-end anastomosis, gastrocnemius aponeurotic flap to reinforce the anastomosis. Each of six patients were interviewed and examined clinically and by Cybex II isokinetic strength testing. All six patients have been able to return to their pre-injury activities. Cybex II isokinetic strength testing demonstrated peak torque deficiencies in plantar flexion ranging from 2.5%-22% as compared with the unaffected limb. The overall results of the technique described indicate that very satisfactory functioning of a neglected Achilles tendon rupture can be obtained.

Osteoid osteoma of the pubic bone. Report of a case.

Osteoid osteoma involves the pubic bone in exceptional cases. In this case report, a 23 year-old male patient with osteoid osteoma of the pubic bone, was presented. He was complaining of right groin pain, occurring nocturnally and being relieved by rest and analgesics. Radiographic examination revealed a small lesion in the right pubic bone. The patient was treated surgically, and the nidus was excised. The result of the histopathological examination was "osteoid osteoma". At 1 year postoperatively, recurrence was not seen. It was concluded that, if osteoid osteoma was located in an unusual site, more detailed radiographic examination should be done for exact localization, before the operation.

Medial approach open reduction for congenital dislocation of the hip using the Ferguson procedure. A review of 31 hips.

Between January 1979 and October 1984, 31 congenitally dislocated hips in 19 patients were treated using open reduction via the medial approach, as described by Ferguson, at the Ankara University Faculty of Medicine. Patient age at operation ranged from 3 to 33 months (mean 12.1 months). The average follow-up was 94.7 months. All hips were evaluated both radiographically and clinically. Avascular necrosis of the femoral head was observed in 9.7% and slight, transient ischaemic radiographic changes of the femoral head in 22.6% of the hips; 25.8% of the hips have already undergone or are due to undergo subsequent surgery due to an insufficient radiographic result. The medial approach was found to be a reliable procedure for infants who have not had extensive previous conservative treatment and who are between 7 and 18 months of age.