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The sinus tarsi approach (STA) is a relatively novel and minimally invasive procedure that reduces soft tissue complications during surgery for displaced intra-articular calcaneal fractures (DIACF). We aimed to evaluate the effectiveness of this approach by comparing the functional and radiographic outcomes obtained after the STA and the extensile lateral approach (ELA) in DIACF. The medical records of 73 patients underwent surgery for displaced intra-articular calcaneal fractures between 2013 and 2018 were retrospectively analyzed. The cases were divided into two groups. The first group classified as STA (n: 39) and the second one classified as ELA (n: 34). Pre-Postoperative Boehler-Gissane angle, calcaneal length, height and width, postoperative AOFAS scores, and postoperative complication rates for each case were recorded and statistically compared. The AOFAS score was 82.5±4.4 points in the STA group whereas it was 79.5±5.4 points in the ELA group (p: 0.01). According to AOFAS scoring, 74.4% of patients in the STA group had an excellent-good outcome, whereas it was 55.9% in the ELA group. The postoperative Boehler angles were 28.5±8.4 degrees in the STA group and 26.3±8.3 degrees in the ELA group (p: 0.26). The postoperative Gissane angles were 122.2±8.9 degrees in the STA group and 128.7±10.5 degrees in the ELA group (p:0.005). Superficial infection was observed in one patient in STA group. Wound infections and necrosis in four patients and non-union was seen in one patient in ELA group. Minimally invasive surgery with STA is a feasible and effective surgical treatment method that provides adequate postoperative radiological alignment and functional results and minimizes soft tissue dissection in DIACFs. [Med-Science 2021; 10(3.000): 752-57]

The aim of the study was to evaluate the type of trauma, additional injury, age, additional diseases, need for ICU and blood transfusion, postoperative complications, mid-term patient satisfaction and hip functions of the patients who underwent surgical treatment for acetabulum fracture in our clinic. A total of 17 patients (15 males, 2 females, mean age 40,7 years ) who admitted to the emergency department between 2013 and 2016, and treated surgically due to acetabulum fractures were included in the study. According to Judet Letournel classification, 7 anterior wall fractures, 4 anterior column fractures, 3 posterior column fractures and 3 both column fractures were determined. Mean hospital stay was 14.5 days (range 3-45 days) and mean follow-up was 26 months (14 to 57 months). ICU needed in 3 (17.6%) cases, mean stay was 10.3 days (range 1-29 days). 6 (35.2%) patients required blood transfusion, mean amount was 4.1 units (range 2-6 units). Harris hip scores were excellent - good in 12 cases (70.5%) and 5 cases (29.5%) had moderate - poor results at 12th month. There was no statistically significant relationship between severity of trauma, type of injury, age, additional diseases, intensive care and blood transfusion requirements, postoperative complications and patient satisfaction (p> 0.05). In selected acetabular fracture cases with proper planning according to fracture type, in early period, surgery may lead to satisfactory results in terms of patient satisfaction and hip functions. [Med-Science 2018; 7(3.000): 668-71]

BACKGROUND Soft tissue injuries may co-occur with tibial plateau fractures. These injuries may include medial or lateral ligament ruptures, peroneal nerve lesions, anterior cruciate ligament ruptures, and meniscus tears. OBJECTIVE The aim of this study was to investigate the frequency of meniscus tears in lateral tibial plateau fractures and to evaluate the clinical and radiological results of meniscus repairs. MATERIALS AND METHOD The study included 19 patients who underwent surgery for a closed lateral tibial plateau fracture. Anteroposterior and lateral radiographs of the knee, followed by magnetic resonance imaging (MRI) examinations, were undertaken for all cases. The clinical and radiological evaluation of the surgical treatment results was performed according to the Rasmussen criteria. RESULTS Meniscus lesions were found in 10 (52.6%) patients. Nine meniscus tears were found in patients with type 2 fractures, and one meniscus tear was found in a patient with a type 3 fracture. All of the menisci were separated from the peripheral capsule adhesion point. On the MRI examination during follow-up, all of the repaired lateral menisci were determined to be in their original anatomic location. CONCLUSION For successful outcomes in lateral plateau fractures, it is essential to determine whether there is a meniscus tear. In cases with meniscus tears, meniscus repair can be easily performed and should be considered because it has a positive impact on the treatment outcome.

Partial or total resection of the infrapatellar fat pad (IPFP) helps surgeon improve access to lateral tibial plateau for better placement of the knee prosthesis. We aimed to investigate the effect of IPFP excision on clinical and radiologic outcomes including patellar tendon length (PTL), range of motion, and functional scores after total knee arthroplasty (TKA) at 5-year follow-up. We retrospectively evaluated postoperative first X-rays (day 0) and postoperative final 5-year control views of 228 knees in patients with primary osteoarthritis who underwent TKA between September 2006 and December 2009 in our hospital. Exclusion criteria were patients who had lateral release, patellar resurfacing, septic or aseptic loosening, fracture around the replaced knee, any other prior knee surgery, or any systemic inflammatory disease. IPFP was completely resected in all knees to enhance surgical exposure and patellar mobilization. Radiologic evaluation of PTL was performed in early postoperative and 5-year control X-rays comparatively. The mean early postoperative PTL was 47.4 ± 6 (range: 35–72), the mean final postoperative PTL was 47 ± 6.3 (range: 33–68) (p = 0.1). The average preoperative flexion was 115 ± 11 degrees, whereas it was 111 ± 4 degrees, postoperatively (p = 0.73). Both the clinical and functional outcome scores improved in all patients. IPFP excision during TKA did not alter PTL at 5-year follow-up. A focus on other surgical and/or host-related factors may help clarify contradictory patellar tendon shortening reported in the literature.

Impaired proprioception accuracy of the knee has been proposed as a local factor in the onset and progression of knee osteoarthritis. Patients with decreased numbers of mechanoreceptors could be more likely to develop arthrosis due to a loss in proprioception of the joint. We aimed to identify and quantify the mechanoreceptors of the posterior cruciate ligament (PCL), the anterior capsule (AC) and the medial meniscocapsular junction (MCJ) in knee arthrosis. PCLs, ACs and MCJs were harvested from 30 patients with Kellgren and Lawrence grades 3 and 4 osteoarthritis (OA), and ten knees taken from five cadavers without OA were used as a control group. PCL degeneration was evaluated with haematoxylin & eosin, and the types and numbers of mechanoreceptors were evaluated using S100 immunostaining. The patient ages in the OA and control groups (n.s.) did not differ. PCL degeneration was more severe in the gonarthrosis group than in the control group (p = 0.04). The numbers of Golgi corpuscles, Ruffini corpuscles, free nerve endings, total nerve endings and small vessels of the PCL were low in the OA group, as were the numbers of Golgi corpuscles, free nerve endings and total nerve endings of the AC. No significant correlation was found regarding the mechanoreceptors of the MCJ between the two groups. The numbers of mechanoreceptors in patients with OA were low in the PCLs and ACs. A loss in proprioception could be a local risk factor in OA. The proprioceptive impact of preserving PCL while performing total knee arthroplasty may not be exaggerated as its thought. Prognostic study, Level I.

Objective: To evaluate the functional and radiological outcomes of anterograde headless cannulated screw fixation for medial malleolar fractures. Subjects and Methods: This study included 12 patients (8 males, 4 females; age 27-55 years) with medial malleolar type B fractures according to the Herscovici fracture classification who had undergone anterograde headless cannulated screw fixation surgery between 2012 and 2014. Seven had an isolated medial malleolar fracture and 5 a bimalleolar fracture. All of the bimalleolar fractures were classified as 44-B2 based on the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification. Postoperatively, bone union was evaluated on direct radiographs at the final follow-up examination. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used for clinical evaluation. Results: The mean follow-up period was 17.2 ± 5.3 months (range 12-23). Full union was achieved in all fractures. The mean time to union was 3.4 ± 1.5 months (range 2-5). No instability, loss of reduction, non-union or infection was observed in any patient. The mean AOFAS score was 95.0 ± 5.4 (range 87-99). Based on the AOFAS score, 4 patients showed good results and 8 excellent results. The mean time to return to the previous level of activity was 4.0 ± 2.5 months (range 2-5). Conclusion: In this study, anterograde headless cannulated screw fixation yielded good clinical outcome in the surgical treatment of Herscovici type B fractures.

Objectives Osteoarthritis (OA) and vitamin D deficiency are common health conditions in older people. Whether vitamin D concentration is associated with knee OA is controversial. In this study, we aimed to determine the association between serum concentrations of vitamin D and osteoarthritic knee pain. Subjects and Methods Vitamin D concentrations were measured with the 25 hydroxyvitamin D test in patients presenting with clinical symptoms of primary knee osteoarthritis. Osteoarthritis was graded on the Kellgren-Lawrence grading scale from anteroposterior and lateral radiographs. Height, weight, and body mass index (BMI) were recorded. Patients completed a 10-cm visual analogue scale (VAS) for indicating pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Vitamin D concentration was defined as severely deficient ( Results Of 149 patients (133 women), the mean age was 63.6 years. Mean vitamin D concentration was 11.53 ng/mL, and 90% patients were vitamin D deficient. Mean WOMAC score was 57.2, and VAS pain score was 7.5. Kellgren-Lawrence grade was 2 for 10 patients, grade 3 for 61, and grade 4 for 88. Mean BMI was 33.4. Mean values of VAS, WOMAC, and BMI did not differ by vitamin D status. Conclusion Serum vitamin D concentration is not associated with knee pain in patients with osteoarthritis.

Objective: The aim of this study was to retrospectively assess treatment of humerus simple cysts in the childhood period with 3 methylprednisolone injections at monthly intervals. Material and Method: A total of 38 patients with simple humerus bone cyst were included in the study. Twenty patients were girls and 18 were boys. The mean age was 7.8 (4-14) years. Under anesthesia patients had methylprednisolone administered three times at the thinnest point of the cortex under fluoroscopy control. Early movement was begun and they were discharged on the same day. Healing was assessed according to the Neer classification. Results: Patients were monitored for mean 32 months (12- 60). Thirty-one (81.5%) patients recovered. 21 were classified as Neer type 1, 10 were Neer type 2, and 6 were Neer type 3. A fracture developed in a patient classified as Neer type 4. Three patients developed color changes on the skin after the 3rd injection. Two patients (5%) were identified to have unequal upper extremity lengths. Conclusions: The low cost and complication rate and short hospital stay have added to the popularity of humerus simple cyst treatment with methylprednisolone injection. With different administration forms, 3 methylprednisolone treatments at one month intervals is a very effective method. Amaç: Bu çalışmanın amacı, çocukluk döneminde basit humerus kistlerinin aylık aralıklarla 3 metilprednizolon enjeksiyonu ile tedavisini geriye dönük olarak değerlendirmekti. Gereç ve Yöntem: Basit humerus kemik kisti olan toplam 38 hasta çalışmaya dahil edildi. Yirmi hasta kız, 18’i erkekti. Ortalama yaş 7,8 (4-14)’di. Anestezi altında tüm hastalara floroskopi kontrolü altında korteksin en ince noktasında üç kez metilprednizolon enjeksiyonu yapıldı. İlgili ekstremiteye erken hareket başlandı ve hastalar aynı gün taburcu edildi. İyileşme, Neer sınıflamasına göre değerlendirildi. Bulgular: Hastalar ortalama 32 ay (12-60) izlendi. Otuz bir (%81,5) hasta iyileşti. Olguların 21’i Neer tip 1, 10’u Neer tip 2 ve 6’sı Neer tip 3 idi. Neer tip 4 olarak sınıflandırılan bir hastada kırık gelişti. Üç hastada 3. enjeksiyondan sonra deride renk değişiklikleri görüldü. İki hastada (%5) üst ekstremite uzunluk eşitsizliği olduğu tespit edildi. Tartışma: Düşük maliyet ve komplikasyon oranı ve kısa hastanede kalış, metilprednizolon enjeksiyonu ile humerus basit kist tedavisinin popülaritesini arttırmıştır. Farklı uygulama şekilleri ile, bir ay aralıklarla 3 metilprednizon tedavisi çok etkili bir yöntemdir.

Objectives. Exposure to ambient metals and air pollutants in urban environments has been associated with impaired lung health and inflammation in the lungs. Fractional exhaled nitric oxide (FeNO) is a reliable marker of airway inflammation. In this study, we aimed to compare the FeNO levels of three schools that have different distances from iron and steel industry zone for assessing the effects of heavy metals and air pollution on their respiratory health. Methods. Pulmonary function test and FeNO measurements were evaluated in 387 adolescents in three schools which have different distance from plant. Results. FeNO levels were significantly higher in School I (n=142; 18.89±12.3 ppb) and School II (n=131; 17.68±7.7 ppb) than School III (n=114; 4.28±3.9 ppb). Increased FeNO concentration was related to the distance of iron and steel industry zone in young adults. Conclusion. The FeNO concentrations in school children were inversely proportional to the distance from the steel mill. There are needed some studies that can evaluate the safe distance and legislation must consider these findings.

Aim: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. Material and methods: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. Results: Mean age was 39 (range: 21–60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30–55 min). Mean union time was found to be 14 weeks (range: 7–21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9–88.3) and 82.2 (71–100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. Conclusion: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

Background: Knowing the configuration of a meniscus tear is important for planning the treatment protocol. Objectives: The aim of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in determining meniscus tear configurations through a retrospective assessment of MR images from patients who underwent arthroscopy for an initial diagnosis of meniscus tear. Patients and Methods: A retrospective comparison was made between MRI findings and arthroscopic results of patients to whom arthroscopy was applied by a single experienced surgeon for an initial diagnosis of meniscus tear. The MR images were taken with a 1.5 Tesla unit. The meniscus tears were classified in subgroups as horizontal, longitudinal, radial, flap, bucket handle, and complex. Results: In 60 knees of 57 patients, 32 lateral meniscus and 48 medial meniscus lesions were identified by MRI. Of these tears, 33 were complex, 15 longitudinal, 13 radial, 11 bucket handle, 5 flap, and 3 horizontal. For the total 80 meniscus tears, MRI gave the same diagnosis as arthroscopy in 60 (75%). Longitudinal and flap tears had low sensitivity (79% in medial and 50% in lateral meniscus for longitudinal tears; 33% to 57%, respectively, for flap tears) but high specificity. Conclusion: MRI is an important tool in the imaging of meniscus tears, but for longitudinal and flap tear configurations that require arthroscopy, MRI diagnostics are especially insensitive. Nonetheless, MRI evaluation paired with good clinical evaluation can be considered useful when planning a surgical protocol and when defining the postoperative prognosis.

An intraosseous lipoma is a rare benign bone lesion that proliferates from mature lipocytes. It occurs most frequently in the lower limb, particularly in the calcaneus. The talus is an unusual location for this rare lesion. A review of the literature produced only two reports with talar intraosseous lipomas under the name of intraosseous lipomatosis, which described multiple lipomas in different areas. We describe a 38-year-old male patient who had an isolated intraosseous lipoma with an osteochondral defect in the talus and was treated with autologous osteochondral graft transplantation by medial malleolar osteotomy. He could walk with full weightbearing without any assistance at the end of 12 months. Intraosseous lipoma localized in the talus may be confused radiologically with other bone lesions, especially with unicameral bone cyst, if it is associated with an osteochondral defect. Autologous osteochondral graft transplantation is a successful treatment method for talar intraosseous lipoma. (J Am Podiatr Med Assoc 101(3): 269–274, 2011)

Lindgren–Turan osteotomy used in hallux valgus deformity is a subcapital, transverse displacement osteotomy of the first metatarsal without any additional capsular repair. The aims of this study are to describe a transosseous capsuloplasty technique in this procedure and evaluate whether capsuloplasty would improve the clinical and radiological outcomes in patients with moderate to severe hallux valgus deformity. Twenty-three feet operated by Lindgren–Turan osteotomy (Group B) and 25 feet operated by the same osteotomy combined with transosseous capsuloplasty (Group A) were evaluated retrospectively for the correction of the hallux valgus, intermetatarsal and distal metatarsal articular angles, sesamoid reduction, American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Scale as well as patient satisfaction. The mean postoperative follow-up was 14 (range 12–28) months. All radiological parameters improved considerably as a result of both groups. However, postoperative improvements in intermetatarsal and distal metatarsal articular angles were greater in Group A. Complete reduction of medial sesamoid was achieved in 52% of patients in Group A, whereas 17.4% of patients in Group B had complete reduction. AOFAS scores and number of patients with complete satisfaction in Group A were significantly greater than that in Group B. Better clinical and radiological outcomes can be achieved in patients with moderate to severe hallux valgus deformity operated by Lindgren–Turan distal metatarsal osteotomy, when it combines with transosseous capsuloplasty.

Focal fibrocartilaginous dysplasia is an uncommon, benign bone lesion that causes deformity of the long bones in young children. It has most commonly been encountered in the proximal tibia, and very rarely in the long bones of the upper limb, that is, the proximal humerus, distal radius, ulna, and proximal phalanx. Only one case of focal fibrocartilaginous dysplasia of the proximal humerus has been reported previously. The present study reports two such additional cases that were diagnosed in late childhood. The clinical presentation and radiographic findings are described with an emphasis on the natural evolution of the disease. Limb-length discrepancy is anticipated in these children in the long-term follow-up and, therefore, surgical intervention should be considered in the treatment.

Objective: In tibial fractures, the use of an external fixator (EF) may be associated with sexual dysfunction (SD) in sexually active male patients. We aimed to investigate the influence of EF applied for tibial fracture on the sexual life in male patients.Methods: We retrospectively evaluated 137 male patients who presented with tibial fractures and underwent surgical intervention with unilateral or circular EF. The patients completed the Brief Sexual Function Inventory (BSFI) form during the interview. We evaluated the incidence of the development of SD and the severity of SD with the use of an EF, and the relation with the type of EF and SD was investigated. The responses were compared with the results of the completed BSFI forms of 119 male patients who were treated with internal fixation (IF) for tibial fractures.Results: In total, 108 patients (mean age, 42.8 years) treated with EF accepted the invitation and filled the form. The score of those patients were worse compared with that of the patients who were treated with IF (P < 0.001). Postoperative sexual functions were the same with the preoperative sexual function in 12 patients (11%). However, the postoperative scores were decreased in 96 (89%) patients, which meant that the sexual functioning was impaired. None of the patients reported persistent SD.Conclusion: EF in the cruris may impair sexual functions in males. The rate of SD was higher in male patients who were treated with EF. Thus, SD might be associated with physical, psychological, and social limitations caused by EF.

The Salter innominate osteotomy has been used successfully for many years in the treatment of developmental dysplasia of the hip. One of its main drawbacks is the need for internal fixation with pins and their subsequent removal. We describe a modification of this osteotomy that does not require pin fixation and secondary removal. We retrospectively reviewed 114 hips in 94 patients who had been operated on by a single surgeon. An oblique rather than the original horizontal osteotomy was used without internal fixation. There were 80 female and 14 male patients. The mean age at operation was 25 months (18 to 84) and the mean follow-up was 30 months (12 to 88). Most patients required additional open reduction and capsuloplasty. The mean pre-operative acetabular index was 37.9 degrees (24 degrees to 54 degrees ), which decreased to 19.9 degrees (7 degrees to 29 degrees ) in the immediate post-operative period, and improved to 14.6 degrees (5 degrees to 25 degrees ) at the final follow-up (student's t-test, p < 0.0001). We believe that by changing the direction of the osteotomy line, it is possible to avoid pin fixation. The radiological outcomes are comparable to those of the original technique, but longer follow-up will be necessary.

In a 7-year old patient with a right cruris Grade 1 open fracture, an external fixator was applied using hydroxyapatite-covered Schanz screws. After 6 weeks the fixator and screws were removed. Two months after the removal of the fixator, the patient presented with pain in the proximal of the medial pin site and osteomyelitis was determined in the proximal right cruris. Surgical debridement was applied and from the pathology examination of material taken intraoperatively, osteomyelitis was determined. As a result of culture implantation, methicillin-sensitive staphylococcus aureus was reproduced. Treatment was applied of antibiotic sensitive to that micro-organism. In a 1-year postoperative follow-up, the patient was seen to recover.

Objective: The aim of the present study was to determine the knee joint line level by its distance to the adductor tubercle and the apex of the fibular head in the Turkish population.Methods: The study included 117 knees of 108 patients (63 males, 45 females; mean age: 31.3 years, range: 16 to 82 years). Femoral width and the distance from the apex of the fibular head to the joint line as well as the distance from the adductor tubercle to the joint line were measured on anteroposterior radiographs.Results: Mean femoral width was 87.2 mm. The average distance from the adductor tubercle to the joint line was 47.9 mm and from the fibular head to the joint line was 20.5 mm. A linear correlation was found between the distance from the adductor tubercle to the joint line and femoral width, with a ratio of 0.55. There was no significant correlation between the distance from the fibular head to the joint line and femoral width.Conclusion: There was a linear correlation between the femoral width and the adductor tubercle-joint line distance irrespective of any factors such as age, gender and height. Therefore, the adductor tubercle can be used as a reliable landmark to determine the joint line level for easy evaluation and measurement during surgery., Amaç: Total diz protezi özellikle de revizyon diz protezi sırasında eklem çizgisinin tespiti diz biyome¬kaniğinin sağlanması için çok önemlidir. Bu çalışmada, diz eklem çizgisinin yeri addüktör tüberkül ve fibula başına olan mesafeler ile tespit edilmeye çalışıldı.Çalışma planı: Yüz sekiz hastanın 117 dizi çalışmaya dahil edildi. Anteroposterior diz grafisinde fe¬mur genişliği ile fibula başından eklem çizgisine olan mesafe ve addüktör tüberkülden eklem çizgisine olan mesafe ölçüldü.Bulgular: Ortalama yaş 31.3 yıl (dağılım, 16-82 yıl) idi. Hastaların 63’ü erkek, 45’i kadın idi. Orta¬lama femur genişliği 87.2 mm ölçüldü. Addüktör tüberkül-eklem çizgisi mesafesi ortalama 47.9 mm, fibula başı-eklem çizgisi mesafesi ortalama 20.5 mm idi. Addüktör tüberkül –eklem çizgisi arası me¬safe ile femur genişliği arasında doğrusal bir korelasyon bulundu (oran 0.55). Fibula başı-eklem çizgisi arası mesafe ile femur genişliği arasında bir korelasyon tespit edilemedi.Çıkarımlar: Çalışmamızda Türklerde daha önceki yayınlara benzer şekilde; yaş, cinsiyet, boy gibi fak¬törlerden etkilenmeyen femur genişliği ile addüktör tüberkül-eklem çizgisi mesafesi arasında doğrusal korelasyon bulundu. Bu yüzden eklem çizgisi seviyesini belirlemek için ameliyat esnasında dahi yerini rahatlıkla belirleyip ölçüm yapabileceğimiz, addüktör tüberkülü güvenilir bir belirteç olarak kullana¬biliriz.

Aim. To evaluate whether aseptic hypertrophic nonunion in the long bones of the lower extremity can be treated successfully with LISS applied with closed methods without grafting. Materials and Methods. The study included 7 tibias and 9 femurs of 16 patients. All cases had hypertrophic nonunion. Initial surgical treatment was with intramedullary nailing in 14 cases, 6 of which had required an exchange of intramedullary nail. All the patients were treated with LISS plate with closed methods. Results. Union was obtained at mean 7 months in all patients. No implant loosening or breakage of the implant was observed and there was no requirement for secondary surgery. Conclusion. Cases of hypertrophic nonunion have excellent blood supply and biological potential. Therefore, there is no need for bone grafting and the addition of fracture stability is enough to achieve full union. Using a limited approach and percutaneous screw insertion, LISS provides fracture stabilization with soft tissue protection.

BackgroundThe purpose of this study was to report the management and outcomes of ten patients with chronic Achilles tendon rupture treated with a turndown gastrocnemius-soleus fascial flap wrapped with a surgical mesh (Hyalonect).MethodsTen men with neglected Achilles tendon rupture were treated with a centrally based turndown gastrocnemius fascial flap wrapped with Hyalonect. Hyalonect is a knitted mesh composed of HYAFF, a benzyl ester of hyaluronic acid. The Achilles tendon ruptures were diagnosed more than 1 month after injury. The mean patient age was 41 years. All of the patients had weakness of active plantarflexion. The mean preoperative American Orthopaedic Foot and Ankle Society score was 64.8.ResultsThe functional outcome was excellent. The mean American Orthopaedic Foot and Ankle Society score was 97.8 at the latest follow-up. There were significant differences between the preoperative and postoperative scores. Ankle range of motion was similar in both ankles. Neither rerupture nor major complication, particularly of wound healing, was observed.ConclusionsFor patients with chronic Achilles tendon rupture with a rupture gap of at least 5 cm, surgical repair using a single turndown fascial flap covered with Hyalonect achieved excellent outcomes.

Objective: The aim of this study was to evaluate union rates and complications of Hyalonect, a knitted mesh composed of HYAFF, a benzyl ester of hyaluronic acid, and a naturally occurring constituent of the extracellular matrix, for the treatment of pseudarthrosis.Methods: The study included 11 patients (8 male, 3 female; mean age: 44.6 years; range: 23 to 57 years) operated for pseudarthrosis using Hyalonect. Average time between initial treatment and surgical procedure was 12.9 (range: 8 to 48) months. Pseudarthrosis of the tibia, femur and humerus was present in 4, 2 and 5 patients, respectively. All patients had undergone prior surgery (1 to 6 times). Each patient underwent open reduction and internal fixation. Allograft was applied to the pseudarthrosis area and covered with Hyalonect. Mean follow up period was 31 (range: 12 to 48) months.Results: Union was achieved in all patients after an average of 6 (range: 4 to 8) months. One patient had a discharge for two weeks. Another developed an infection which responded well to appropriate antibiotic treatment. No malunion or implant failure was observed. One patient with pre-existing radial nerve palsy maintained the condition.Conclusion: Use of Hyalonect appears to be a safe method with a positive impact on union in the surgical treatment of pseudarthrosis, particularly in the absence of any infection., Amaç: Bu çalışmamızda, ekstrasellüler matrisin doğal bir bileşeni olan, hyaluronik asidin benzil esteri HYAFF’tan oluşan ve örgülü yapıda bir malzeme olan Hyalonect’in psödoartroz tedavisinde kullanımına dair kaynama oranları ve komplikasyonları değerlendirildi. Çalışma planı: Çalışmaya, psödoartrozun tedavisi için Hyalonect ile cerrahi girişimde bulunulan ve yaş ortalaması 44.6 (dağılım: 23-57) olan 11 hasta (8 erkek, 3 kadın) dahil edildi. İlk tedavi ile cerrahi girişim arasında geçen süre ortalama 12.9 (dağılım: 8-48) ay idi. Dört hastada tibiada, 2 hastada femurda ve 5 hastada humerusta psödoartroz mevcuttu. Hastalara daha evvel 1 ila 6 kez cerrahi girişim uygulanmıştı. Tüm hastalara açık redüksiyon ve internal tespit yapıldı. Kırık bölgesine allogreft uygulandı ve etrafı Hyalonect ile sarıldı. Ortalama takip süresi 31 (dağılım: 12-48) ay olarak kaydedildi.Bulgular: Tüm olgularda ortalama 6 (dağılım: 4-8) ayda kaynama elde edildi. Hastaların birinde yaklaşık 2 hafta kadar süren bir akıntı saptandı. Enfeksiyon gelişen diğer bir hasta uygun antibiyotik tedavisine cevap verdi. Kötü kaynama veya implant yetersizliği gözlenmedi. Bir hastada daha önceden var olan radyal sinir felcinin devam ettiği görüldü. Çıkarımlar: Özellikle enfekte olmayan psödoartrozların cerrahi tedavisinde Hyalonect kullanımının güvenilir olduğu ve kaynama üzerine pozitif etkisi olduğu düşünülmektedir.

Open calcaneal fractures are high morbidity injuries and the risk of complications depends on the concomitant injuries, on the size and the position of the traumatic wound. A 53-year-old male patient with bilateral open calcaneal fractures and associated concomitant lower extremity injuries such as subtalar dislocation, talonavicular dislocation and open distal tibial metaphyseal fracture was immediately operated by percutaneous Kirschner wire fixation combined with external fixators. He was able to walk with full weight bearing without any assistance at the end of the first postoperative year. Early aggressive debridement and irrigation followed by fixation with percutaneous Kirschner wires and external fixator can supply bony alignment in open comminuted calcaneal fractures associated with concomitant lower extremity injuries and should be considered for the healthy and active patients before primary arthrodesis.

We investigated the functional and radiological outcomes of conservatively treated simple traumatic elbow dislocations and subsequent incidence of cubitus valgus development in children. Eleven patients (one female, ten male; mean age 9.8 years, range seven to 12 years) who presented to our hospital with simple elbow dislocations and were conservatively treated between July 2008 and September 2010 were included in the study. All were posterolateral closed dislocations. None of the patients had accompanying elbow fractures. All patients had pre- and postoperative radiographic examinations. The carrying angle of the involved elbow was measured and compared to the contralateral non-injured elbow during follow-up. The incidence and severity of cubitus valgus development was assessed. The functional and clinical outcomes were evaluated using the Mayo Elbow Performance Scale. The mean monitoring period was 24.3 months (range 19-30 months). All patients had satisfactory good and excellent results (85-100 points; mean 96.8 points) according to the Mayo Elbow Performance Scale. The final average elbow flexion was 137A degrees (range, 130-145A degrees) and average extension was 8.6A degrees (range 0-20A degrees) with full supination and pronation in traumatic elbow. Four patients (36.4 %) had an average increase (cubitus valgus) of 14.5A degrees (10-20A degrees) in carrying angle compared to the other elbow. While isolated traumatic dislocation of the elbow is uncommon among children, it can be successfully treated by urgent closed reduction, proper fixation of the elbow and appropriate timely rehabilitation. However, it should be considered that some patients may develop cubitus valgus deformity in a later period. Therefore, each patient with a simple traumatic elbow dislocation should be followed, and the parents should be informed of the potential for any deformity development.

Akut batın ön tanısıyla ameliyat edilen ve perfore kist hidatik saptanan 14 yaşında kız olgu sunulmuştur. Kist hidatik Türkiye’de özellikle Doğu ve Güneydoğu bölgelerinde endemiktir. En sık yerleşim lokalizasyonu karaciğerdir. Ultrasonografi ve bilgisayarlı tomografi kist hidatiğin tanısında kullanılabilir. Kistin kendiliğinden periton içine rüptürü ciddi anaflaktik reaksiyonlara ve safra peritonitine neden olabilen oldukça ender ancak ciddi bir komplikasyondur. Çok az olgu bildirilmiştir. Nadir olmasına rağmen, rüptüre kist hidatik endemik bölgede bulunan bir hastada akut karın ayırıcı tanısında düşünülmelidir., A 14-year-old female patient with abdominal pain diagnosed as acute abdomen was operated on; a perforated hydatid cyst was found. Hydatid cysts are endemic in Turkey, especially in the eastern and southeastern regions. The liver is the most common location. Ultrasonography and computed tomography can be used in the diagnosis hydatid cysts. Spontaneous intraperitoneal rupture of a hydatid cyst is rare, but it can cause severe anaphylactic reactions and biliary peritonitis. Very few cases have been reported. Though rare, a ruptured hydatid cyst should be considered in the differential diagnosis of acute abdomen in a patient residing in the endemic zone

The rotator cuff tear etiology is still unclear. Especially for atraumatic ruptures, degenerative processes come into prominence. This study aims to correlate between four most commonly-seen sleeping positions and patients with rotator cuff pathology. 87 patients who applied to the institute for suffering from shoulder pain for more than 6 months without a trauma and 93 voluntary people (as control group) above the age of 50 who applied to the institution for reasons other than shoulder pain included in the study. Rotator cuff ruptures and acromion types of the patients are diagnosed via magnetic resonance imaging. In face-to-face interviews, all the patients are asked to show their favorite sleeping positions on the visual cards and also questioned about their smoking habits and overhead activities. There are not any statistically substantive parameters between the patients and the control group in terms of age and sex. 83.9% of the patients with rotator cuff rupture have stated preferring lateral decubitus position while this rate is 61.3% among the control group (p=0.003). Atraumatic rotator cuff tears are increase with age. The increase pressure in the subacromial space can lead distribution in microvascular circulation of rotator cuff. Decrease in the microvascular circulation also affects the regeneration potential of rotator cuff. Laboratory studies demonstrated that lateral decubitus position has the most prominent increase in the subacromial pressure over all sleeping positions. We consider that sleeping in the lateral decubitus position causes long-term high subacromial pressure, leading to a microcirculatory disorder in the rotator cuff, which is a risk factor for the rotator cuff etiology. Keywords: Rotator cuff, risk factors, tendinopathy, sleeping position, subacromial pressure, etiology