Comparison of Surgical Results of Modified Stoppa and Ilioinguinal Approach in Patients with Acetabular Fractures Involving Quadrilateral Surface Fractures.

Objectives: The aim of this study was to evaluate the results of surgical treatment in patients with acetabular fractures with a fractured quadrilateral surface treated using two different approaches. Methods: The study included 106 patients who were operated on with ilioinguinal (group A) or modified Stoppa (group B) technique for acetabular fracture with a fractured quadrilateral surface between 2011 and 2020 in our clinic. The quality of reduction was evaluated according to Matta criteria and postoperative pelvic (anteroposterior, external oblique, iliac oblique) radiographs. Evaluation of hip function was recorded using the Merle d'aubigne and Postel Score and Harris Hip Score. Results: Among the patients included in the study, there were 45 patients in group A and 61 patients in group B. When the group data were compared, it was seen that the modified Stoppa approach was superior in terms of intraoperative reduction quality, radiological data, Harris hip score, Merle d'aubigne and PostelScore. (Respectively p=0.40, p=0.49, p=0.040, p=0.028). Conclusion: : Modified Stoppa approach has successful clinical and radiological outcomes and better reduction quality and hip scores than ilioinguinal approaches in acetabular fractures involving quadrilateral plates.

Fracture mapping of adult femoral neck fractures with three dimensional computed tomography.

PURPOSE: Femoral neck fractures (FNFs) are a commonly encountered injury in orthopaedic practice. It is essential that surgeons recognize specific fracture patterns to effectively manage these fractures. The purpose of this study was to analyze the fracture morphology of FNFs by three-dimensional (3D) mapping of the fracture. METHODS: The fracture line location and distribution of 120 FNFs were identified using computed tomography reconstructions. After segmentation and virtual reduction, the fracture line was revealed. The femoral neck region was divided into zones according to anatomical localization, and the zones through which the fracture lines passed were recorded. All fracture lines are superimposed on the standard model to create fracture mapping. RESULTS: A total of 120 patients with FNFs were analyzed. The mean age of the patients was 67 (18-96) years. Of all patients, 59 were male, and 61 were female. The most affected region was Zone 4. The least affected region was Zone 6. The displacement in Zone 1 and Zone 4 was found to be significantly higher. The displacement in patients under 65 years was found to be significantly higher. Zone 2 and Zone 5 involvement was significantly higher in patients under 65 years. CONCLUSION: The fracture map showed fracture patterns of FNFs. It was found that fracture displacement and transcervical region involvement were more common in patients under 65 years. It was also found that the displacement rate was high in fractures of the subcapital region.

Collagen/Nano-hydroxyapatite Composite Scaffold Application with Exchange Reamed Nailing Accelerates Bone Union and Improves Quality of Life in Atrophic Femoral Shaft Nonunions: A Retrospective Comparative Study.

BACKGROUND: Our aim in this study was to evaluate the effect of exchange intramedullary nailing in femoral shaft atrophic nonunions and the use of collagen/nano-hydroxyapatite composite scaffold applied in addition to the cancellous iliac crest autograft on the union, return to work, and quality of life. MATERIALS AND METHODS: Fifty-four patients with an atrophic nonunion in the isthmic region of the femoral shaft were included in the study. The patients were divided into two groups. Group A consisted of 24 patients who underwent collagen/nano-hydroxyapatite composite scaffold in addition to exchange intramedullary nailing and iliac autograft, while group B consisted of 30 patients without scaffold. Short Form-36 (SF-36) questionnaire scores, union rates, time to union, return to work were complications were compared. RESULTS: Mean age of patients was 47.5 ± 14.1. The mean follow-up period was 3.56 ± 1.88 years. There was no statistically significant difference between Group A and B in terms of age, gender, smoking and alcohol use, and trauma mechanism. Time to union and return to work were statistically significantly shorter in Group A than in Group B (p = 0.004, p = 0.001). All of the SF-36 survey scores at month six were better in Group A. In the first year, mental health and general health perception were still statistically better in group A (p = 0.009, p = 0.008). CONCLUSION: In the treatment of atrophic nonunions of the femoral shaft isthmic region, the use of collagen/nano-hydroxyapatite composite scaffolds together with exchange intramedullary nailing affects the union positively. This positive effect also brings about earlier return to work and better quality of life.