Abdurrahman Özçelik

Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion

Abstract Thirty-two patients with radiographic evidence of scaphoid nonunion were preoperatively evaluated by magnetic resonance imaging (MRI), then observed intraoperatively for punctate bleeding of the fragments. Although MRI and intraoperative findings matched in 19 patients, there was no correlation in 13 patients. While 7 of these latter patients showed normal MRI but no punctate bleeding during the operation, the remaining 6 had preoperative MRI of avascularity but punctate bleeding during the operation. After internal fixation and bone grafting, all but 1 of these 13 patients achieved union. We conclude that the diagnosis of avascular necrosis should only be made when both MRI and intraoperative findings indicate avascularity.

Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures.

The aim of this study was to assess the correlation between the occurrence of iatrogenic ulnar nerve injury and frontal and saggital angular insertion of the medial pin in type 3 pediatric supracondylar humerus fractures treated by closed reduction and percutaneous fixation using a cross-pin configuration. Radiographs of 90 children were retrospectively reviewed and two radiographic parameters were measured. The frontal humerus–pin angle was formed between the long axis of the humerus shaft and the axis of the medial pin on an anteroposterior radiograph. The saggital humerus–pin angle was formed between the long axis of the humerus shaft and the axis of the medial pin on a lateral radiograph and expressed as positive and negative values if the insertion direction of the pin was anterior to posterior or posterior to anterior, respectively. There was a significant difference between the mean saggital humerus–pin angle values of ulnar nerve injury and no neurological complication groups (12.1° versus 1.6°, respectively; P=0.001). It was concluded that, anteroposterior insertion of the medial pin in the saggital plane, while the elbow was in hyperflexion, correlated with the occurrence of iatrogenic ulnar nerve injury.

Spontaneous bilateral hip fractures in a patient with steroid- induced osteoporosis-a case report

A 44-year-old man was referred to us because of pain in both hips for 3 preceding months. He had received daily doses of fluocortolone (ULTRALAN ORAL ®, Schering Turkey equivalent oral dose 5 mg) 100 mg for 3 days, 80 mg for 3 days, 60 mg for 3 days, 40 mg for 3 days and 20 mg for 18 days-1200 mg in 30 days-after a cataract operation, because of cystic macular edema 9 months before. 6 months after steroid therapy, he felt pain in his left hip which was aggravated by weight bearing and sometimes kept him awake at night. Radiographs of the hips 1 month later were reported to be normal. The patient had to use walking aids and 1 month later he developed pain in the right hip too and was referred to us.

Assessment of the use of hip ultrasonography by Graf's method between 1 and 6 years of age.

Ultrasonographic examinations of both hips of 133 children whose age ranged from 13 to 72 months were performed using the Grafs method. A standard plane which was mandatory prior to the hip typing could be obtained in 93, 91, 84, 79 and 66% of the sonograms for 13–24, 25–36, 37–48, 49–60 and 61–72 months age groups, respectively. The 61–72 months age group had the lowest percentage of valid sonograms and this difference was considered significant (P=0.001). It was concluded that plain radiography was still the gold standard imaging technique in developmental dysplasia of the hip, but hip ultrasonography by the Grafs method might be an alternative imaging technique in experienced hands for the evaluation of developmental dysplasia of the hip in children between 1 and 5 years of age.