Ahmet Harma

Evaluation of the gluteus medius muscle after a pelvic support osteotomy to treat congenital dislocation of the hip

BACKGROUND Many authors have reported that the pelvic support osteotomy prevents a Trendelenburg gait by restoring the biomechanics of the abductor muscle in patients with congenital dislocation of the hip. However, we are not aware of any studies in which the hip abductor muscles were examined following pelvic support osteotomy. The purpose of this study was, first, to use magnetic resonance imaging to measure alterations in the length and volume of the gluteus medius muscle after pelvic support osteotomy and, second, to determine which factors influence the results of the Trendelenburg test. METHODS Eleven patients with a history of congenital hip dislocation who had been treated with a pelvic support osteotomy were examined clinically with the Harris hip score and the Trendelenburg test, radiographically to measure limb-length discrepancy and valgus angulation of the proximal part of the femur, and with magnetic resonance imaging to measure changes in the gluteus medius length and volume. RESULTS The pelvic support osteotomy achieved a functional and painless hip in all eleven patients. Five of the eleven patients had a persistently positive Trendelenburg gait at the time of the last follow-up visit, at an average of three years after the osteotomy. The muscle volumes were restored to 43% to 89% of the muscle volumes on the normal contralateral side, and the postoperative muscle volume correlated significantly with the result of the Trendelenburg test (r = -0.63; p = 0.03). There was a positive association between age and the result of the Trendelenburg test (p = 0.01): four of the five patients who had a positive test were at least thirty-one years of age at the time of the operation. There was no correlation between the Trendelenburg test and the change in the length of the gluteus medius muscle, which averaged 19.2 mm in the patients with a positive test and 19.3 mm in those with a negative test. CONCLUSIONS Patient age at the time of the operation and the postoperative change in the volume of the gluteus medius muscle have a significant influence on the result of the Trendelenburg test after a pelvic support osteotomy. Moreover, our study demonstrated that restoration of the muscle volume after a pelvic support osteotomy is not sufficient to prevent a Trendelenburg gait in older patients with congenital dislocation of the hip. LEVEL OF EVIDENCE Therapeutic Level IV.

Successful treatment of high congenital dislocated hips in older children by open reduction, pelvic and femoral osteotomy with external fixator stabilization (average 8.2 years of age).

A new technique using a hinged external fixator to stabilize an open reduction with pelvic and femoral osteotomies has been developed for treating high-dislocated hips in older children with developmental dislocated hip (DDH). This technique was performed in 11 patients (12 hips) at a mean age of 8.2 years. At follow up, radiographic results showed no redislocation/subluxation and clinical results demonstrated 11 hips as excellent/good and only one hip as poor from persistent stiffness. In conclusion, this new technique produces acceptable results in the treatment of older children with high dislocation of the hip from DDH.

Isolated zone III vertical fracture of first sacral vertebra--a case report.

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Surgical management of transforaminal sacral fractures.

Fourteen patients with transforaminal sacral fractures were treated with posterior iliosacral instrumentation. Patients were assessed in terms of surgical technique and functional results. A subjective functional scoring with a five-point scale was performed at the last follow-up. Activity pain, pain at rest, limping and patient satisfaction were evaluated. By considering symptom and satisfaction scores, subjective functional assessment revealed that ten patients had excellent results, two good and two moderate. There were no patients with poor functional outcome. The surgical technique is not a new concept. Combining sacral bar and pediculo-iliac fixation methods, provides vertical as well as horizontal stability and allows early weight bearing, the methods has many advantages. However, vertical and horizontal stabilities achieved by this technique may require further assessment with comparative biomechanical studies.RésuméQuatorze malades avec des fractures sacrées transforaminales ont été traités avec une instrumentation iliosacrée postérieure. Les malades ont été étudiés en fonction de la technique chirurgicale, et des résultats fonctionnels. Une échelle fonctionnelle subjective à 5 points a été utilisée au dernier examen. La douleur à l’activité et au repos, la boiterie et la satisfaction des patients ont été évalué. En considérant les symptômes et le score fonctionnel, 10 patients avaient un résultat excellent, 2 un bon résultat et 2 un résultat moyen. Il n’y avait aucun mauvais résultat.La technique chirurgicale n’est pas un nouveau concept. En combinant une barre sacrée et les méthodes de fixation pédiculaires , la stabilité horizontale aussi bien que verticale est obtenue, et une remise en charge précoce est possible. Cependant, les stabilités verticales et horizontales obtenues par cette technique peuvent exiger une appréciation supplémentaire avec des études biomécaniques comparatives.

Interpedicular Approach in Percutaneous Sacroplasty for Treatment of Sacral Vertebral Body Pathologic Fractures

For this technique, bone needle is introduced into the S1 vertebral body through the interpedicular route by penetrating the central spinal canal at the level of S3-4 and passing through the vertebral body of S2-3 parallel to the anterior border of sacrum. With the interpedicular approach, two sacral vertebral bodies can be injected in one session and lower sacral body injection also is available. interpedicular technique is a safe, practical, and effective technique for the treatment of sacral vertebral body pathologic fractures.

An investigation of infection rate and seasonal effect level in total joint replacement cases

This study aims at evaluating gender, age range and seasonal differences in patients who developed articular infection after undergoing joint prosthesis in our clinic. This study is a retrospective screening of advanced articular arthrosis patients who had undergone total joint arthroplasty of the upper and lower extremities between 2009 and 2016. Of 504 patients who had been treated with total joint replacement, our study includes 468 patients we could follow up or contact by phone and who had been applied 559 primary or revision total knee arthroplasty. The mean age of these patients was 58.9 (ranging from 41 to 74). We detected infection in 22 (3.9%) total joint arthroplasty patients. Of these 14 (63.63%) were females and 8 (36.36) were males. There was no statistically significant difference between infection rates in terms of seasonal distribution nor gender or age range. In the light of our findings, we concluded that gender, age range and seasonal differences have no effect on infection rates in total joint replacement cases.

Effects of intraperitoneally administered folic acid on the healing of repaired tibial nerves in rats.

BACKGROUND Complete nerve regeneration and clinical healing remain a challenge despite considerable advances in the treatment of peripheral nerve injuries. To improve nerve regeneration, several experimental molecular procedures have been attempted. This study aimed to investigate the effects of folic acid on peripheral nerve healing after transection and end-to-end suture repair of the tibial nerve in rats. METHODS In this study, 20 adult male Wistar Albino rats weighing 225 to 250 g were used. The right tibial nerves of 20 rats were explored, transected, and sutured using the end-to-end technique. The rats were randomly allocated to either the intraperitoneally administered folic acid group (test group) or the control group. Preoperative and 6-week postoperative neurophysiological studies were performed by the same researcher. Myelin-sheathed axons were counted. RESULTS The results demonstrated that the folic acid-treated group exhibited improved electromyographic results compared with the control group. Histological evaluation revealed that the axons were well preserved and that the axon quantity and density were increased in the test group compared with the control group. Quantitative results also increased in the test group compared with the control group (p = 0.001). CONCLUSION In this study, 6-week intraperitoneal administration of 80 µg/kg of folic acid significantly improved peripheral nerve healing. Histological analysis of the group that received folic acid revealed increased axon myelination with little granular tissue or fibrosis. We propose that folic acid supplementation may be an effective component of peripheral nerve injury treatment.

Stabilization of Osteotomies in Children With Developmental Dislocated Hip Using External Fixation

Maintaining reduction and stabilization of pelvic and femoral osteotomies using external fixation allows good results in the treatment of children with developmental dislocated hip.

Delayed Reduction of Irreducible Chronic Posterolateral Dislocation of the Knee with Buttonholing of the Medial Femoral Condyle

Traumatic knee dislocations are relatively rare and almost always respond to closed reduction; however, a small percentage of knee dislocations are irreducible and in these cases open reduction is frequently required. A 65-year-old man with an unreduced posterolateral knee dislocation with laterally dislocated patella was seen 3 weeks after a motor vehicle accident. Medial femoral condyle was found buttonholed through the medial capsule together with the medial collateral ligament and lying in the medial joint space that allowed posterior rotary dislocation of the joint. Both cruciate ligaments and medial meniscus were torn. There was no evidence of any vascular or nerve injury. Reduction was accomplished by removal of the capsuloligamentous structures which were incarcerated in the trochlea and intercondylar notch and by excision of meniscal tear. Following posterior cruciate ligament reconstruction with patellar tendon autograft, lateral patellar release, vastus medialis advancement, and gracilis transfer were done.