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Purpose: The aim of our study was to compare the absorbable and non-absorbable suture materials used in hand extensor tendon repairs in terms of reoperations related to suture reaction-irritation.Materials and Methods: Patients who admitted to our institute with extensor tendon injury of the hand and underwent surgical repair were evaluated retrospectively. Patients who met the inclusion criteria were divided into two groups according to the suture materials as absorbable suture (AS) (polydioxanone) group and non-absorbable suture (NAS) (polypropylene) group. Age, gender, side, and necessity of suture reaction related surgery were compared between groups. Repaired tendons and injury levels were enrolled for both groups. Cases with reoperation due to the suture reactions were assessed.Results: There were 250 tendons of 172 patients met the inclusion criteria. One hundred and three (59.9%) patients were in NAS group and 69 (40.1%) were in AS group. Distribution of age, gender, and side were similar in both groups. There were 31 cases required suture related reoperation during follow-up. 29 (93.5 %) patients were in NAS group and 2 (%6.5) were in AS group. %74.2 of the cases were seen at zone 5 and 6 level, and frequently after the repair of extensor tendons of 2nd and 3rd digits.Conclusion: We have found that NAS (polypropylene) suture use for extensor tendon repair increased the suture related reoperation risk. Hence, we thought that AS use for extensor tendon repair can be more appropriate since the soft tissue coverage is relatively weaker than the flexor site., Amaç: Çalışmamızın amacı, elde ekstensör tendon onarımlarında kullanılan emilebilen ve emilemeyen sütür materyallerinin sütür reaksiyonu-irritasyonu ile ilişkili reoperasyonlar açısından karşılaştırılmasıdır.Gereç ve Yöntem: Çalışmamızda elde akut ekstensör tendon kesisi nedeniyle tendon onarımı yapılan hastalar retrospektif olarak değerlendirildi. Çalışma kriterlerine uyan hastalar, kullanılan sütür materyaline göre absorbabl sütür (AS) (polidiakson) ve nonabsorbabl sütür (NAS) (polipropilen) olarak iki gruba ayrıldı. Her iki grup yaş, cinsiyet, taraf ve sütür reaksiyonu ilişkili reoperasyon açısından karşılaştırıldı. Ayrıca her iki grupta tamir edilen tendonlar ve tamir bölgeleri değerlendirildi. Sütür reaksiyonu gelişen olguların, tamir edilen tendon ve tamir bölgesine göre dağılımı değerlendirildi.Bulgular: Çalışmada 172 hastanın 250 ekstensör tendon tamiri değerlendirildi. Hastaların, 103(%59.9)’ü NAS, 69(%40.1)’u AS grubunda yer aldı. Her iki grup yaş, cinsiyet ve taraf açısından benzerdi. Sütür reaksiyonu sebepli reoperasyon uygulanan toplam 31 olgunun 29(%93.5)’unda NAS, 2(%6.5)’sinde AS kullanılmıştı. Sütür reaksiyonu gelişen olguların % 74.2’sinin Zon 5 ve 6’da yer aldığı ve sıklıkla 2 ve 3. parmak ekstensör tendon onarımlarından sonra geliştiği tespit edildi.Sonuç: Çalışmamızda ekstensör tendon onarımlarında NAS (polipropilen) kullanımının sütür reaksiyonu nedeniyle reoperasyon sayısını arttırdığını tespit ettik. Dolayısıyla yumuşak doku desteği açısından fleksör bölgeye göre zayıf olan el dorsalindeki ekstensör tendon onarımlarında AS ile onarımın daha uygun olduğunu düşünmekteyiz.

OBJECTIVES In this study, we aimed to investigate the effect of tranexamic acid (TXA) on osteotendinous junction healing in a rat model, both biomechanically and histologically. MATERIALS AND METHODS Sixty-four male Wistar-Albino rats weighing 450 to 600 g were used in this study. The rats were divided into two groups as the experimental (n=16) and control (n=16) groups. Achillotomy and subsequent repair site was exposed to 1 mL of TXA in the experimental group, while 1 mL of saline was given to the control group. For biomechanical and histopathological investigation, each group was further divided into two subgroups. At the end of four weeks, all rats were sacrificed. Biomechanical tests were performed using the M500-50CT device. The Bonar, Movin, and Nourissat bone-tendon junction scoring systems were used for histopathological evaluation. RESULTS There was no statistically significant difference in the elongation at a maximum point, maximum loading, and maximum stress variables in the biomechanical study (p=0.558 p=0.775, and p=0.558, respectively). In the histopathological evaluation, the collagen content and layout were close to the native tissue in the experimental group (p=0.047 and p=0.008, respectively). Vascularity, hyalinization, and glycosaminoglycan content were significantly lower in the experimental group (p=0.004, p=0.014, and p=0.026, respectively). The total Bonar and Movin scores were more favorable in the experimental group (p

Amaç: Bu çalışmanın amacı deplase distal radius kırıklarının redüksiyonu sırasında, analjezi amaçlı kullanılan hematom bloğu ve sedoanaljezi tekniklerinin redüksiyon kalitesi, hastanede kalış süresi ve ağrı kontrolü açısından retrospektif olarak karşılaştırılmasıdır.Gereç ve Yöntem: İzole deplase distal radius kırığı tanısı ile kapalı redüksiyon uygulanan 106 hasta değerlendirildi. Hastaların 45’ine hematom bloğu, 61’ine sedoanaljezi uygulandı. Sedoanaljezik olarak midazolam (0,1mg/kg) ve fentanyl (1 mcg/kg), lokal anestezik olarak da lidokain (10 ml %1) kullanıldı. Demografik veriler, Frykman sınıflamasına göre kırık tipleri ve travma mekanizmaları değerlendirildi. Hastaların ağrı değerlendirmesi Vizüel analog skala (VAS) ile yapıldı. Redüksiyon kalitesi Sarmiento kriterlerine göre değerlendirildi. Analjezi yöntemlerinin maliyet değerlendirilmesi prosedürlerin ücretleri, kullanılan ilaçlar ve medikal malzemeler üzerinden yapıldı.Bulgular: Her iki grup cinsiyet, yaş, kırık tipi ve etkilenen taraf açısından benzerdi. Hematom bloğu grubunda hastanede kalış süresi daha kısa idi ve VAS skoru belirgin olarak daha düşüktü. Redüksiyon kalitesi her iki grupta benzerdi. Hasta başı maliyet, sedoanaljezi grubunda hematom bloğu ile karşılaştırıldığında dört kat fazla idi.Sonuç: Hematom bloğu, distal radius kırıklarının redüksiyonu öncesi ağrıyı azaltmak için kullanılan kolay ve etkili bir yöntemdir. Özellikle sedoanaljezi yönteminin yan etkilerine daha hassas olan yaşlı hastalarda, analjezi sağlamak için daha güvenli bir yöntem olan hematom bloğu tercih edilebilir., Purpose: The aim of this study was retrospective assessment of the reduction quality, hospitalization time, and relief of pain in hematoma block assisted closed reduction versus sedoanalgesia assisted closed reduction.Materials and Methods: There were 106 patients included who diagnosed as isolated displaced distal fracture of radius and treated with closed reduction. Hematoma block was used in 45 patients and sedoanalgesia was used in 61 patients. Midazolam (0,1 mg/kg) and fentanyl (1 mcg/kg) combination was administered as the sedoanalgesic agent, and lidocaine (10 ml, 1%) as the local anaestetic. Demographic data, fracture type according to Frykman classification, and mechanism of trauma were noted. Pain status of patients were recorded by using the Visual analog scale (VAS). Sarmiento criteria was used for the evaluation of the reduction quality. Cost of the analgesic procedure was assessed based on the prices of the analgesia procedures, used pharmaceuticals and medical consumables.Results: Both groups were similar in terms of gender, age, fracture type and affected side., Hospitalization time was shorter in hematoma block group, and VAS was significantly lower. Quality of reduction was similar in both groups. Cost per patient was four times higher in sedoanalgesia group compare to hematoma block group.Conclusion: Hematoma block is an effective, easily performed method that can be used prior to the closed reduction of the distal radius fractures to relieve the pain. Older patients can be susceptible to adverse effects of sedoanalgesia and hematoma block can be chosen as a more reliable method to provide the analgesia.

Background: The clinical significance of gastrointestinal wall thickening (GWT) on abdominal computed tomography (CT) is not certain, yet. Despite the need for clinical guidelines describing the importance and evaluation of GWT on a CT scan, there have been few studies evaluating these incidental imaging abnormalities. The aim of this study is to endoscopically evaluate certain etiologies that cause incidental GWT found on CT. Methods: This retrospective cohort study was carried out with patients who had incidentally detected GWT on a CT scan at the Kanuni Sultan Suleyman Training and Research Hospital between February 2016 and December 2018. Results: A total of 129 patients (62 males and 67 females; mean age 57.5 years, range: 26-87 years) were included in the study. Abnormalities observed during endoscopy at the exact site of the GWT noted on a CT image were found in 114 patients (99%): upper endoscopy revealed malignancy in 33 (29%), gastritis in 63 (52%), hiatal hernia in 19 (16%), a gastric ulcer in 7 (6%), and alkaline gastritis in 3 (2%). Colonoscopy revealed malignancy in 4 (33%), benign polyps in 5 (35%), colonic ulcer in 2 (16%), and 2 patients (16%) had normal findings. Malignancy was detected more frequently in the cardioesophageal region compared with the antrum (P=0.020). Conclusion: In this study, detection of GWT on CT often indicated pathologies which were subsequently confirmed endoscopically. Pathological findings were detected in 83% of these patients, with approximately 30% determined to be malignant. Endoscopic evaluation is recommended when GWT is reported on a CT scan.

BACKGROUND: Laparoscopic cholecystectomy (LC) is the accepted standard treatment for acute cholecystitis (AC) in patients eligible for surgery. Percutaneous cholecystostomy (PC) can provide a permanent treatment for high-risk patients for surgery or act as a bridge for later surgical treatment. This study is an evaluation of the use of PC during the current coronavirus 2019 (COVID-19) pandemic at a single hospital. METHODS: Fifty patients with AC were admitted as of the start of the COVID-19 pandemic in Turkey through June 2020. Patients with pancreatitis, cholangitis, and/or incomplete data were excluded from the study. Data of the remaining 36 patients included in the study were recorded and a descriptive statistical analysis was performed. The patients were divided into three groups: PC (n=14), only conservative treatment with antibiotherapy (OC) (n=14), and LC (n=8). The findings were compared with a group of 70 similar patients from the pre-pandemic period. RESULTS: The mean age of the pandemic period patients was 53 years (range: 26-78 years). The female/male ratio was 1.11. PC was preferred in eight (11%) patients in the same period of the previous year, whereas 14 (39%) patients underwent PC in the pandemic period. Four of the 36 pandemic patients were positive for COVID-19, including one member of the PC group. There was one (7.1%) mortality in the pandemic-period PC group due to cardiac arrest. The length of hospital stay between the groups based on the type of treatment was not statistically significant. CONCLUSION: LC is not recommended during the pandemic period; PC can be an effective and safe alternative for the treatment of AC.

Background Acute biliary pancreatitis is one of the most frequently encountered diseases among general surgeons in emergency surgical diseases. Differences in diagnosis and treatment management of these patients, varying from physician to physician, are common in clinical practice. We aimed to present these differences and discuss the results in the light of current guidelines in the literature. Methods In this study, 21 questions were prepared regarding the physicians' approach in the diagnosis, follow-up and treatment of acute biliary pancreatitis (Appendix).The questionnaires were completed by face to face interviews with 94 general surgery specialists at the 20th National Surgery Congress. Results In this study, 38 (40%) of the physicians who answered the questionnaire were working in the Training and Research Hospital, 27 (29%) in the State Hospital, 19 (20%) in the University Hospital and nine in private health care was working in the establishment. 85% of the physicians were general surgery specialists with 10 years of experience. 53% (50) of the surgeons reported that they had less than five cases of acute biliary pancreatitis each month, and 35% (34) stated that they wanted amylase value daily for follow-up. Ultrasonography and computed tomography were the most commonly used imaging modalities and 15% of the respondents indicated that each patient underwent magnetic resonance cholangiopancreatography. 45% of surgeons stated that antibiotics were started at the time of diagnosis of pancreatitis. The percentage of surgeons who did not undergo cholecystectomy early in patients with mild to moderate pancreatitis was 60%. The reason for not preferring surgery in the early period was the most frequent operation difficulty with 40% and not supporting the operation in the early period. Conclusion According to the attitude survey results, there are differences between general surgery specialists in the diagnosis, follow-up and treatment of acute biliary pancreatitis.

Objective: Elastofibroma dorsi (ED) is a rare, benign, soft tissue tumor typically located between inferior corner of scapula and posterior chest wall causing mass, scapular snapping, and pain. When classic symptoms and localization are present, it is diagnosed without biopsy and treated with marginal resection. This study retrospectively analyzed patients operated on for ED to evaluate presenting symptoms, tumor size, complications, and clinical results, and to suggest optimal treatments. Methods: This study included 51 patients who underwent surgery for ED in 2 different clinics between 2005 and 2015. Patient age, gender, profession, side affected, symptoms, average duration of symptoms, and tumor size were researched. Radiological examinations of patients were evaluated. Patients with lesions larger than 5 cm in size were operated on. Postoperative complications, recurrence, and functional results were evaluated using Constant score and compared to preoperative values. Results: A total of 61 operated lesions of 51 patients clinically and radiologically diagnosed with ED were retrospectively evaluated. Average length of time patient experienced symptoms was 11.21 months. Lesions in 19 (37.2%) patients were bilateral, 10 of which were symptomatic and larger than 5 cm in size, meeting indication for surgery. Average lesion diameter was 8.7 cm. Average follow-up was 26.89 months. Average of preoperative Constant score of 67.28 subsequently increased to 92.88 (p

Objective: Giant cell tumor of bone (GCT) is a primary, osteolytic, benign tumor of the bone. Surgery isthe commonly used treatment; however, recurrence remains a problem. Receptor activator of nuclearfactor kappa B (RANKL) is responsible for the formation of osteoclastic cells. Discovery of RANKL and itshuman monoclonal antibody, denosumab, led to use of denosumab for treatment of GCT. The aim of thisstudy was to evaluate clinical and pathological results of treatment of GCT with denosumab and to assessadverse effect proŞle and recurrence rate.Methods: Thirteen patients with 14 lesions were enrolled in the study. Mean age was 38.3 years. Patientswere given subcutaneous injections of denosumab (120 mg) every 4 weeks (with additional doses ondays 0, 8 and 15 in cycle 1 only) and were radiologically evaluated for tumor response. Pain and functional status were measured using Visual Analog Score (VAS) and Musculoskeletal Tumor Society Score(MSTS). Adverse effects were analyzed after each cycle.Results: Participants were 5 men and 8 women. Mean follow-up was 17 months. One lesion was Campanacci grade I, 8 were grade II, and 5 were grade III. Eight lesions were recurrent, and remaining wereprimary lesions. After average of 9 cycles (range: 4e17 cycles), all tumors underwent radiologicalregression. Ten lesions were removed surgically. More than 90% of giant cells were found to haveregressed in all pathological specimens. On last follow-up, average VAS was 1 and MSTS was 87%. Fatigueand joint and muscle pain after injections was reported by 46% of patients, and mild hypocalcaemia wasseen in 1 patient.Conclusion: Denosumab has been shown to be a successful drug in treatment of GCT. Denosumab can beused as neoadjuvant for all recurrent lesions, grade II lesions with high surgical risk, grade III lesions, andmetastatic cases of GCT.Level of evidence: Level IV, Therapeutic study© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) Objective: Giant cell tumor of bone (GCT) is a primary, osteolytic, benign tumor of the bone. Surgery isthe commonly used treatment; however, recurrence remains a problem. Receptor activator of nuclearfactor kappa B (RANKL) is responsible for the formation of osteoclastic cells. Discovery of RANKL and itshuman monoclonal antibody, denosumab, led to use of denosumab for treatment of GCT. The aim of thisstudy was to evaluate clinical and pathological results of treatment of GCT with denosumab and to assessadverse effect proŞle and recurrence rate.Methods: Thirteen patients with 14 lesions were enrolled in the study. Mean age was 38.3 years. Patientswere given subcutaneous injections of denosumab (120 mg) every 4 weeks (with additional doses ondays 0, 8 and 15 in cycle 1 only) and were radiologically evaluated for tumor response. Pain and functional status were measured using Visual Analog Score (VAS) and Musculoskeletal Tumor Society Score(MSTS). Adverse effects were analyzed after each cycle.Results: Participants were 5 men and 8 women. Mean follow-up was 17 months. One lesion was Campanacci grade I, 8 were grade II, and 5 were grade III. Eight lesions were recurrent, and remaining wereprimary lesions. After average of 9 cycles (range: 4e17 cycles), all tumors underwent radiologicalregression. Ten lesions were removed surgically. More than 90% of giant cells were found to haveregressed in all pathological specimens. On last follow-up, average VAS was 1 and MSTS was 87%. Fatigueand joint and muscle pain after injections was reported by 46% of patients, and mild hypocalcaemia wasseen in 1 patient.Conclusion: Denosumab has been shown to be a successful drug in treatment of GCT. Denosumab can beused as neoadjuvant for all recurrent lesions, grade II lesions with high surgical risk, grade III lesions, andmetastatic cases of GCT.Level of evidence: Level IV, Therapeutic study© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Objective: The aim of our study is to retrospectively evaluate the patients who had digital nerve defective injuries of the hand which was reconstructed with the terminal branch of posterior interosseous nerve (PIN) for treatment. Methods: Twenty-three patients with digital nerve defective injuries, who applied late and were treated with PIN terminal branch grafting were included in the study. The mean age of the patients was 36.4 ± 8.1 years and the mean follow-up duration was 17.3 ± 3.2 months. The mean interval between the injury and the surgery was 5 (2-8) months, and the average gap in defective site was 19.7 ± 3.8 mm. Clinical assessment of the nerve healing was made with Semmes Weinstein Monofilament (SWM) test and Static 2 Point Discrimination (S2PD) test and, the results were classified according to the British Medical Research Council (BMRC) scoring system. Results: The mean SMW test result was determined as 2.8 (2.8-20) grams, and the mean S2PD test result as 6 (4-20) mm at the sensory area of reconstructed nerve. Accordingly, BMRC scoring system revealed that sensory improvement was S4 level in 15 (65.2%) patients, S3 + in 4 (17.4%), S3 in 3 (13%) patients, and S2 level in 1 (4.3%) patient. Neuroma was not detected at any of the patients within the donor site. Scar formation was detected at 6 (26.1%) patients. Conclusion: PIN terminal branch is an appropriate substitute for digital nerve reconstruction with minimum morbidity and acceptable efficiency. [Hand Microsurg 2021; 10(2.000): 152-159]

Aim: The aim of this study is to reveal the factors regarding patients, injury mechanism, and surgery which may affect the outcomes of the replantation at the distal level of finger. Material and Methods: Nineteen fingers of 12 patients regardless from the ages of the patients were included into the study. Patients ages, genders, affected side and finger, and repaired neurovascular structures were enrolled. Outcome of the surgery and its relationship with the repaired vascular structures, injury mechanism and the level of the replantation was noted. Findings: The mean age of the patients was 29.5 (13-66) years. Two (16.7%) patients were female, 10 (83.3%) were male and the average follow-up period was 13.1 ± 3.8 months. Sixteen (84.2%) of 19 replanted fingers were healed, and necrosis developed in 3 (15.8%) fingers. Only artery repair was performed in 10 (52.6%) fingers. In artery repair group, 5 of 7 fingers were succesful in Zone 1A and 1B, 2 of 3 fingers were succesful in Zone 1C and 1D. Vein repair was added in 9 (47.4%) fingers and all of these fingers were in Zone1C and 1D and successful results were obtained. There was no statistically significant difference was found in the comparison between performing artery or artery and vein repair, type of injury and level (respectively p = 0.211, p = 0.999, p = 0.523). Conclusion: Distal finger replantation is a successful intervention in terms of functional and cosmetic results, but various technical difficulties should be considered prior to the surgery. [Hand Microsurg 2021; 10(2.000): 88-95]

Reconstruction Methods for Fractures with Bone Defects, Vascular Injury, and Salvage Procedures

Tıp pratiğinde ekstremite kırıklarıyla şekil bozukluklarının yönetimi harici fiksatör adı verilen mekanik cihazlar yoluyla gerçekleştirilir. Ancak bu hizmetin kalitesi, bu tür ortopedik araçların akılcı ve etkin kullanımı için bir matematik kuram geliştirilmesinin gerekli olduğu biyomekanik yaklaşımla iyileştirilebilir. Temel sorun, yumuşak doku ve kemik koşullarını dikkate alan uygun bir çerçevenin karmaşık planlama gerektirmeksizin kırık bölgesine kolayca uygulanması ve daha sonra da ortaya çıkan kalıcı yer değiştirmelerin matematik kurama göre düzeltilmesidir. Uygun çerçeve olarak kemik parçalarına üç dönme ve üç öteleme olanağı sağlayan Gough-Stewart Platform Mekanizması harici fiksatör olarak kullanılmıştır. Matematik kuramın girdi ve çıktıları standart ve yeterli hassasiyette algılanarak ve elde edilen sonuçlar tekillik bakımından test edilerek kullanımı kolay ve stabil bir sistem geliştirilmiştir. Kuramda ihtiyaç duyulan parametrelerin röntgen filmleri üzerinden otomatik süreçle elde edilmesi ve çıktıların ortopedist tarafından kolayca algılanabilmesi için kuramla kullanıcı arasında değişik otomasyon seviyelerine sahip arayüzler oluşturulmuştur. Ayrıca sistemin başlangıçtaki kemik fragmanlarının ayrık olduğu durumdan başlanıp, bu arayüzlerin çıktılarının kullanılarak, anatomik eksene hizalandıkları tedavi süreci boyunca sistemin hareketi simülasyonla gösterilmiştir. Harici fiksatör cihazları tasarlanıp imal edilerek uygulamalar yapılmış ve kurulan sistemin işlerliği gösterilmiştir, In medical practice, management of limb fractures and deformities is carried out by mechanical devices named as external fixator. The quality of this service can be improved with biomechanical approaches which require development of a mathematicalmodel and efficient usage of the system. The main problem can be defined as using a proper frame which can easily be applied to the fracture site without any complex planning prior to the operation and by taking into account the condition of the soft tissue and the bone; and then displacing the bone fragments according to a developed mathematical model. Gough-Stewart platform, which gives three-translational and three- rotational degree of freedom to the bone fragments, is selected as the mechanical frame. A user friendly and stable system, which takes some standardized inputs for the mathematical model and makes singularity analysis of the produced output, is developed based on this platform. Two different graphical user interfaces with different automation levels are programmed to collect the needed parameters for the mathematical model from the X-ray images and give the obtained results to the orthopedist in an easily understandable way. Moreover the whole treatment process, from the initially unaligned state to the finally aligned state of the bone fragments which is obtained with the output of the developed graphical user interface, is visually simulated. The external fixator devices are designed and produced, then some experiments are done to test the developed system functionality

WOS: 000274445900007 PubMed: 20006508 Patients with sickle cell disease (SCD) who have deformities and vertebral fractures due to osteoporosis may require surgery. Spinal surgeons must become familiar with the vertebral morphometry of patients with SCD and to that aim we have examined the morphometry of the thoracolumbar spine in these patients. A cohort of 100 patients with SCD was examined using plain thoraco lumbar anteroposterior/lateral radiographs and dual energy X-ray absorptiometry (DEXA). Vertebral morphometry (vertebral body diameters, pedicle, spinal canal and deformity) was assessed for different age groups. Results were compared to published studies of healthy subjects. The vertebral dimensions for the 16-20-year and the 21+-year-old groups were significantly smaller for females than males at most spinal levels, while measurements in the 6-10 years and 11-15 years age groups were similar across both sexes at most levels. No significant statistical difference was found between the diameters of the right and left pedicles. With the exception of the sagittal diameter, most of the dimensions of the vertebral bodies measured in SCD patients were less than those of healthy individuals; multiple deformities were also observed. Low bone density was noted in 32 patients. Our data highlight the differences in vertebral bone mineral density, anatomy and deformities in patients with SCD compared to healthy individuals. When considering surgical intervention for patients with SCD, it is important that pre-operative radiography and planning is undertaken, and that the surgeon is familiar with the geometry of the pedicles of the thoracolumbar vertebrae necessary for the safe insertion of pedicle screws. Osteoporosis must be considered when planning surgical interventions in these patients. (C) 2009 Elsevier Ltd. All rights reserved.

PubMedID: 19440722 Introduction Five adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by the Ilizarov method of distraction osteogenesis. Method A standard technique was applied in all patients. The average follow-up was 28 (range, 24-38) months. Preoperati ve carrying angle ranged from 12° to 22° of varus (average 16.6°) and postoperative carrying angle ranged from 10° to 14° of valgus (average, 1.6°) equalized to the contralateral side. Result The outcome was rated as excellent in all patients. No complication was observed, except a grade-2 pin-tract infection in two patients. Conclusion Rigid fixation, early rehabilitation, precise correction, satisfactory cosmetic scars and functionally excellent results can be obtained with this method. © 2009 Springer-Verlag.

Isolated acute traumatic dislocation of the carpometacarpal joint of the thumb is a rare injury. Conservative and surgical measures have been described in a limited number of patients. We report a case treated by acute repair of dorsoradial ligament with review of the literature. The result obtained is successfull with congruent reduction and stability. Surgical repair of dorsoradial ligament and capsule should be considered in presence of instability.

WOS: 000245725900016 PubMed ID: 17424695 Modification of circular Ilizarov frames is necessary to overcome the difficulties in pin positioning due to unfavorable anatomic site or local soft-tissue conditions. Hybrid frame configurations consisting of half pins or full-threaded schanz screws are widely used in clinical practice. This study compared the mechanical performance of hybrid frames and a standard system. One standard and five modified hybrid systems were tested under axial compression, four-point bending, and torsional forces. Systems modified with full-threaded schanz screws showed a higher stiffness than half pin modifications and exhibited a similar mechanical performance of a standard system.

PubMedID: 17356322 [No abstract available]

External fixators are robotic devices widely used in orthopaedics. While bringing the bone fragments to a desired position, these devices should not present any threat to the patient health. One of the threat causes is singularity. In a singular position, stable structure of the fixator is lost and its top and bottom rings may move independently. In this work, singularity analysis is performed with a geometric method, closest points approach. It has been shown that results of this approach are consistent with the other singularity analysis methods.

Bu çalışmada, ortopedi alanında farklı amaçlar için kullanılmakta olan harici fiksatörlerin etkili kullanımını sağlayacak olan bir bilgisayarlı denetim sistemi tanıtılmıştır. Bu bilgisayar sistemiyle, çubuk boylarını faklı fonksiyonel modellere uygun olacak şekilde değiştirerek, fiksatörün tedavi süresince tekil konuma gelme ihtimali azaltılmıştır. Ayrıca öngörülen tedaviye ait olan 3-boyutlu simülasyon ile doktora, tedaviye başlamadan önce kemiğin izleyeceği yolu görselleştirme olanağı sağlanmıştır In this work, a computer aided control system enabling effective usage of external fixators that are widely utilized in orthopaedics for various purposes is presented. With this system, possibility for fixator to fall into a singular position througout the treatment is reduced by cahnging its rod lengths according to various functional models. Furthermore, a 3D simulation belonging to proposed treatment scheme is provided to allow the doctor visually inspect the treatment process before it is initialized

Centre for Robotics and Automation (CRA);Chiba Institute of Technology;City University of Hong Kong;IEEE Future Directions;Shenyang Institute of Automation Chinese Academy of Sciences 4th Annual IEEE International Conference on Cyber Technology in Automation, Control and Intelligent Systems, IEEE-CYBER 2014 --4 June 2014 through 7 June 2014 -- -- External fixators are widely used in the area of orthopedics to manage deformities and fractures. The historical trend in obtaining a mechanical infrastructure has shifted from simple devices like pins, rods, and hinges to more sophisticated frames involving parallel manipulators. Despite advantages of such robotic frames especially in removing stiffness issues, there are still problems associated with the reliable deployment of these modern devices. Problems like singularity, possibilities of guiding fragments along many different trajectories have been handled in this paper. A method has been shown how to detect singularity in displaced, aligned, and intermediate positions of the fragments. How the robotic system could be actuated according to different functions have been investigated, in addition to their effects on trajectories of distal fragment end. These considerations have been demonstrated on numerical examples. © 2014 IEEE.

PubMedID: 19331260 Case reports concerning rare complications of human bite injuries are uncommon in the literature. Further, rehabilitation of the resultant dysfunction is also hardly reported. A 41-year-old housewife who had had a human bite during an altercation 6 months ago was referred to the rehabilitation department with a nonfunctioning right hand. Twelve days after the injury she developed a compartment syndrome with complicating myonecrosis, which required fasciotomy and resulted in amputation of the fifth digit on the 17th day. Soft-tissue defects were reconstructed with skin grafts. Unfortunately, the patient did not attend follow- up visits, and 6 months after the initial injury she had to be admitted to the rehabilitation department with a nonfunctional hand. She had marked limitations of range of motion of the wrist and almost all finger joints. A rehabilitation program was initiated to improve the functional limitations of her hand. After the rehabilitation program, she was able to use her right hand in her daily routine activities. Rehabilitation can still be useful in order to avoid permanent disability even in late and complicated cases of bite injuries.

Ankilozan spondilite bağlı gelişen ilerleyici kifotik deformite, hastalarda postüral, psikolojik ve fonksiyonel bozukluklara yol açmaktadır. Hastalık, omurganın tüm bölgelerini etkilemekle birlikte, düzeltici girişim olarak lomber bölgede osteotomiler tercih edilmektedir. Bu çalışmada, ankilozan spondilit zemininde gelişen kifotik deformite nedeniyle lomber transpediküler kapalı kama osteotomisi ile tedavi edilen, takip süresi 2 yıl ve üzerinde olan 20 hasta, ameliyat öncesi ve sonrası sagittal eksen sapmaları, deformite açıları, düzelme oranları ve komplikasyonlar açısından incelendi. Ortalama total kifotik deformite ameliyat öncesi 68.7°, ameliyat sonrası 28.3° ve takipte 48.7° olarak ölçüldü. Total kifotik deformitenin takiplerdeki artışı istatistiksel olarak anlamlı bulundu Osteotomi bölgesi tek başına değerlendirildiğinde ortalama düzelme açısı 37.6° (28°-58°), takiplerdeki ortalama düzelme kaybı 3° (0°-10°) olarak tespit edildi. Mortalite ve nörolojik komplikasyon görülmedi. Ameliyat sonrası hastaların tümünde karşıya rahat bakış sağlandığı ve karındaki çizgilenmelerin kaybolduğu gözlendi. Takiplerde osteotomi proksimalinden deformite nüksü gelişen bir hastaya, tekrar lomber osteotomi uygulandı. Lomber transpediküler kapalı kama osteotomisiyle tedavi edilen hastaların takiplerinde osteotomi bölgesi dışında total kifotik deformitede ilerleme olmasına karşın hastaların ameliyat öncesi durumlarına dönmediği, yöntemin güvenli ve tatminkar olduğu sonucuna varıldı. Progressive kyphotic deformity leads to postural, emotional and functional impairment in patients with ankylosing spondylitis. Although the disease affects the whole spine, lumbar region is the site of choice for corrective osteotomy. In this study, 20 patients treated by lumbar transpedicular closing wedge osteotomy for kyphotic deformity due to ankylosing spondilytis were analyzed regarding sagittal alignment, deformity magnitude, amount of correction and complications, with a minimum follow-up of two years. Total kyphotic deformity averaged 68.7° preoperatively, 28.3° postoperatively and 48.7° at follow-up. The increase in total kyphotic deformity between the early postoperative period and the last follow-up was statistically significant (

Konjenital spinal deformiteli hastaların tedavisinde, yaygın kabul gören uygulama posterior füzyon ve enstrümantasyondur. Anterior füzyon ve enstrümantasyon idiopatik skolyoz hastalarında uygulanmasına karşın, konjenital deformitelerin tedavisinde kullanımı ile ilgili literatürde yeterli bilgi bulunmamaktadır. Bu çalışmada, anterior füzyon ve enstrümantasyonla tedavi edilen konjenital spinal deformiteli 16 hasta, retrospektif olarak incelenmiştir. Ameliyat sonrası ve son takipteki düzelme dereceleri, sagittal profildeki değişiklikler, spinal dizilim ve komplikasyonlar araştırılmıştır. 9 hastada skolyoz , 7 hastada ise kifoskolyoz deformitesi olduğu saptanmıştır. Hastaların ameliyat esnasındaki ortalama yaşları 12 (4-18) olduğu belirlenmiştir. Hastalar ortalama 52 (32-80) ay süreyle takip edilmiştir. Skolyoz hastalarında ameliyat öncesi koronal plan deformitesi ortalama 57° (44°-90°)’den, son takipte 35° (20°-60°)’ye gerilediği saptanmıştır (% 39 düzelme). Kifoskolyozlu hastalarda, sagittal plan deformitesi, ameliyat öncesi ortalama 68° (47°-90°) idi ve son takipte 41° (22°-62°)’ye gerilediği belirlenmiştir (% 38 düzelme). Kifoskolyoz hastalarının ameliyat öncesi ortalama 51° (16°-80°) olan koronal plan deformitesi ise son takipte 29° (8°-65°)’ye gerilediği saptanmıştır (% 44 düzelme). İki hastada komplikasyon görülmüştür. Nörolojik komplikasyon izlenmemiştir. Bu verilerin ışığı altında konjenital spinal deformiteli hastalarda, tek aşamada anterior füzyon ve enstrümantasyonun daha düşük implant maliyeti ile güvenli ve etkin düzelme sağlayan bir yöntem olduğu fikri elde edilmiştir. Common practice is posterior fusion and instrumentation for the treatment of congenital spinal deformities. Although anterior instrumented fusion has been used for idiopathic scoliosis, the literature lacks information about its use for the treatment of congenital deformities. In this study, 16 patients treated for congenital spinal deformities by anterior instrumented fusion were retrospectively reviewed. The amount of correction, changes in sagittal profile, spinal aligment and complications were assessed. The deformities were scoliosis in 9 and kyphoscoliosis in 7 patients. Average age at the time of surgery was 12 (4-18) years. Follow-up averaged 52 (32-80) months. In patients with scoliosis, average preoperative coronal curve changed from 57° (44°-90°) to 35° (20°-60°) at last follow-up (39 % correction). In patients with kyphoscoliosis, average preoperative kyphotic deformity changed from 68° (47°-90°) to 41° (22°-62°) (38 % correction) and average coronal deformity changed from 51° (16°-80°) to 29° (8°-65°) (44 % correction) at last follow-up. Complications were observed in two patients. No neurologic complication occured. It was concluded that as a standalone procedure, anterior instrumented fusion is a safe and effective method of treatment for congenital spinal deformities with lower implant costs.

PubMedID: 19577893 A new technique of femoral fixation that uses a transverse osteotomy for subtrochanteric shortening and derotation in total hip arthroplasty for Crowe type 3 to 4 dysplasia of the hip is described. This series included 21 cases in 12 women and 2 men, with a mean age of 42.3 years. Follow-up averaged 41.2 months. Bone pegs prepared from the resected femoral segment were seated in the medullary canal around the stem for femoral fixation. Merle d'Aubigné scores for pain, motion, and walking improved from 2.9, 4.4, and 3.7 to 5.2, 5.4, and 5.5, respectively. Radiographic union was detected within 12 ± 3.4 (range, 6-24) weeks in all cases. Complications were early dislocation in 2 cases. This technique allows correction of anteversion, provides excellent rotational stability, and eliminates the need for additional osteosynthesis regardless of the stem design. © 2010 Elsevier Inc.

Kemiğin farklı zamanlı çok merkezli dev hücreli tümörü (DHT) nadir bir durumdur. Küretajdan sonra yüksek tekrarlama oranı, endikasyon olduğunda en-blok rezeksiyonu da içeren çok daha agresif cerrahi uygulamalar zorunludur anlamına gelebilir. Biz sağ humerus üst uçta farklı zamanlı tekrarlayan iyi huylu DHT ile birlikte ikinci lezyonu aynı taraf radius distal metafizde yerleşik olan genç bir kadını sunduk. Hasta agresif cerrahi yaklaşımla (en-blok rezeksiyon) başarılı bir şekilde tedavi edildi., Metachronous multicentric giant cell tumor (GCT) of bone is a rare entity. The high recurrence rate after curettage may mean that more aggressive surgical management is mandatory, including en-bloc resection when indicated. We report a young woman presenting with metachronous recurrent benign GCT located at the right proximal humerus and a second lesion at the ipsilateral distal radial metaphysis. The case was successfully treated with an aggressive surgical approach (en-bloc resection).

PubMedID: 17027794 A 16-year-old boy was treated by a radial-shortening procedure for symptomatic stage IIIB Kienböck's disease with 4 mm negative ulnar variance. The osteotomy corrected the ulnar variance to negative 1 mm after surgery, but further negative ulnar variance of 9 mm occurred at follow-up evaluation as a result of radial overgrowth. The functional outcome was excellent with remodeling of the lunate. The possibility of overgrowth should be considered when contemplating a radial-shortening osteotomy for Kienböck's disease in skeletally immature patients. © 2006 American Society for Surgery of the Hand.

PubMedID: 16806939 Knee dislocations are rare injuries caused by violent trauma. Damage to soft tissues and ligament lesions almost always accompany the injury. Vascular compromise further complicates the situation. We report a case of bilateral posterior knee dislocation with traumatic rupture of both patellar tendons. Treatment consisted of external fixation of both knees. Vascular compromise resolved with reduction and traction pins were placed on both patellae which were connected to the external fixators on following days. Primary repair of patellar tendon was undertaken after gradual distal repositioning of patella. The result is successful with full range of motion. Rupture of patellar tendon should be considered with posterior dislocation of the knee. External fixators provide quick stabilization in case of vascular compromise and can be modified to provide a traction system for distal repositioning of patella which allows primary repair of the patellar tendon. © 2006 Elsevier B.V. All rights reserved.