Use of ultrasound for diagnosis of interposition of soft tissue in bone fracture line.

Ultrasound (US) has recently become a favorable diagnostic technique in orthopedics and traumatology, as well as in other medical sciences. We aimed to determine effectiveness of US in diagnosis of soft tissue interposition that impedes or delays the union of fracture. The present study included 55 acute fractures in 39 patients, in whom operation (open reduction and internal fixation) was scheduled because no closed reduction was achieved, in our department between January 1999 and December 2003. Before the operation, the fracture line in all patients was scanned by a 5- to 7-MHz linear probe of the US device. The data obtained by US examination were compared to findings obtained by surgical intervention with the McNemar test. These were calculated as positive predictive value and negative predictive value, with specificity and sensitivity. The difference between the study and control groups was not statistically significant (p = 0.625). These findings demonstrated that sensitivity value, specificity value, positive and negative predictive values were 96.9%, 86.3%, 91.4% and 95%, respectively. US is an efficient, safe and reliable diagnostic technique for detection of interposition of soft tissue in bone fracture line.

Aseptic necrosis of the hamate: a case report.

The case of a 25-year-old man with osteonecrosis of the hamate is reported. He had pain and swelling in his right wrist. The diagnosis was accomplished with plain radiographs as well as with MRI. The case was treated surgically that included resection of the necrotic bone. The occured cavity was filled with autogenous cancellous bone graft. In addition, capito-hamate arthrodesis was performed. Histopathological examination following the operation demonstrated avascular necrosis of the hamate. The arthrodesis was obtained four months after the operation.

Indirect spinal canal decompression of vertebral burst fracture in calf model.

INTRODUCTION: An experimental study of experimental burst fractures in bovine spinal specimens was conducted to analyze the effects of transpedicular short-segment posterior fixation followed by reduction on indirect spinal canal decompression. MATERIALS AND METHODS: For this purpose, experimental burst fractures were created in 11 bovine specimens with a hydraulic materials-testing machine. The specimens were evaluated with plain radiographs and CT scans before reduction. Thereafter, they were instrumented with titanium transpedicular screws and rods (short-segment posterior fixation); and reduction was achieved which included distraction and kyphosis correction maneuvers. RESULTS: Each spinal specimen was evaluated with plain radiographs and CT scans after reduction by applying distraction and kyphosis correction maneuvers. Plain radiographic analysis showed that the kyphosis angle and segmental height values improved. Furthermore, CT scans revealed that the spinal canal diameter values improved compared with those before reduction. The differences between before and after reduction in kyphosis angle, segmental height, anterior body compression, and percentage of retropulsion were statistically significant. CONCLUSION: Short-segment posterior fixation followed by indirect spinal canal decompression led to an improvement over spinal canal retropulsion in experimental burst fractures. Furthermore, the kyphosis angle and segmental height values improved following the reduction compared with those before reduction.

Autosomal recessive mesoaxial synostotic syndactyly with phalangeal reduction maps to chromosome 17p13.3.

Previously we have described a novel and distinct form of non-syndromic osseous syndactyly segregating in an autosomal recessive pattern in a consanguineous Pakistani family. The limb findings include mesoaxial reduction of the fingers, synostoses of the third and fourth metacarpals with associated single phalanges, fifth finger clinodactyly, and preaxial webbing of toes. We identified another published report of this phenotype in a large, inbred Turkish family. In the present study we mapped the phenotype in the Pakistani and Turkish families to chromosome 17p13.3 (multipoint LOD score 5.1). The identification of a single locus for this complex limb malformation in two families with distinct ethnic backgrounds supports the hypothesis that this is a distinct form of syndactyly. Since this form of syndactyly is phenotypically distinct from the previously described eight types, we propose to name this phenotype mesoaxial synostotic syndactyly with phalangeal reduction (MSSD, type IX syndactyly, Malik-Percin type).

The surgical treatment of developmental dislocation of the hip in older children: a comparative study.

The aim of this retrospective study was to compare simultaneous open reduction and Salter innominate osteotomy versus one-stage combined surgical treatment including femoral shortening. A total of 24 patients were studied. Group 1 included 16 hips in 14 patients treated by simultaneous open reduction and Salter innominate osteotomy; Group 2 included 13 hips in 10 patients treated by one-stage open reduction, Salter innominate osteotomy and femoral shortening. The average age at the time of operation was 4.1 years (range: 3.3 to 5.1). Average follow-up was 5.3 years (range: 2.7 to 9.0). Clinical and radiological assessment at final follow-up showed that the outcome was not significantly different between the two groups. The duration of operation, however, was significant different between the groups. Patients with DDH between 3 and 5 years of age were treated successfully with either simultaneous open reduction and Salter innominate osteotomy or a one-stage combined surgical procedure including femoral shortening. Clinical and radiological outcomes were similar. Nevertheless, after this follow-up period, the rate of avascular necrosis was slightly higher in Group 1; on the other hand, one-stage combined surgical treatment including femoral shortening significantly prolonged the operative time.

[Measurement of the carrying angle of the elbow in 2,000 children at ages six and fourteen years]. / Alti ve on dört yas grubundaki 2000 çocukta ölçülen dirsek tasima açisi degerleri.

OBJECTIVES: It is important to know the carrying angles of both elbows in the evaluation of deformities which may be seen after treatment of distal humerus fractures. This study was performed to determine the basal values of the carrying angle in specific age groups. METHODS: The carrying angles of both elbows were measured with the use of a goniometry in 2000 students of randomly selected primary schools in Sivas and its nearby districts. Measurements were performed in those who completed the ages of six (500 girls, 500 boys) and 14 (500 girls, 500 boys) years, with the elbow in full extension and forearm in supination. The mean carrying angles of dominant and non-dominant elbows were analyzed in eight groups. RESULTS: The mean angles measured from dominant arms were significantly greater than those of the contralateral side in both sexes and age groups (p<0.05). The mean angles of both elbows were greater in girls than those of the corresponding elbows in boys at six years of age, while vice versa was the case at 14 years of age; however, these differences did not reach significance (p>0.05). Finally, both boys and girls at 14 years of age had significantly greater angles in dominant and non-dominant elbows compared to corresponding sex and elbow side in six-year groups (p<0.001). CONCLUSION: Our results are consistent with the literature data showing that the carrying angle increases with age and that it is always greater on the dominant side.

Spondyloepiphyseal dysplasia tarda with progressive arthropathy.

Spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA) is a rare autosomal recessive skeletal dysplasia affecting primarily the articular cartilage. Here we present a nine-year-old girl from Middle Anatolia (Sivas) with SEDT-PA. Her complaints were pain and progressive deformity of the joints. She had a short stature with increased thoracic kyphosis and lumbar lordosis. The range of motion was limited in the spine and the peripheral joints and she had deformities. Radiologic examination revealed generalized platyspondyly and irregularity of the vertebral endplates. There was minimal joint space narrowing at proximal interphalangeal joints, but there were no bone erosions. Metaphyses were widened and epiphyses were squared in other joints with generalized osteopenia and severe osteoarthritic changes prominent in hips. Laboratory examination revealed a mild increase in acute phase reactants. Genetic disorders like SEDT-PA may also have rheumatological involvement, so they should be kept in mind in differential diagnosis of inflammatory joint diseases.