Ahmet Köse

Os subtibiale: Mimicking medial malleolar fracture a report of three cases and review of literature

There are numerous sesamoids and accessory ossicles around the foot which can easily be misdiagnosed as fractures. Os subtibiale is a very rare normal variant of the medial malleolus which is usually diagnosed incidentally in routine ankle radiographs. In this report, we present a case series of 3 patients with os subtibiale who were admitted to the emergency department with ankle sprains and misdiagnosed as medial malleolar fractures. We would like to raise awareness to the very rare and usually asymptomatic os subtibiale as a diagnostic pitfall.

Treatment of Ipsilateral Distal Humerus and Diaphyseal Ulna Fractures by Using an Olecranon Osteotomy and Intramedullary Nail.

Objective: To evaluate the results of treatment of an osteotomy of the olecranon and an ulnar diaphyseal fracture with a single nail, in cases with an ipsilateral ulnar diaphyseal fracture and a comminuted fracture of the distal humerus. Design: Retrospective clinical study. Setting: University-affiliated teaching hospital. Patients: Eight patients with comminuted fractures of the distal humerus and ipsilateral ulnar diaphyseal fractures were included. Intervention: Using a transolecranon approach, internal fixation of the distal humeral fracture with medial and lateral plates was performed. The ulnar diaphyseal fracture and additional osteotomy were fixed using a locked intramedullary nail. Subjective pain assessment was performed by using a visual analog scale (VAS). Results: There were 6 (75%) male and 2 (25%) female patients, with a mean age of 40.9 (range, 32–56) years. The mean follow-up period was 24.6 (range, 12–36) months. All patients achieved union of the ulnar diaphyseal fracture and olecranon osteotomy. Union of the distal humeral fracture was observed in 7 (87.5%) patients. The mean time to union was 16.3 (range, 12–22) weeks, mean visual analog scale score was 1.8 (range, 0–3), median elbow performance score was 85 (range, 70–95), and median disabilities of the arm, shoulder, and hand score was 17.9 (range, 5–45.8). Conclusions: Osteotomy of the olecranon and ulnar diaphyseal fracture using an intramedullary nail was a cosmetically advantageous and safe technique that enabled rehabilitation during the early postoperative period. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures

BACKGROUND We compared the union and functional results of intramedullary nailing and open reduction internal fixation treatment applied to adults with a forearm diaphysis fracture (fracture of the radius and/or ulna). METHODS We retrospectively examined 90 patients with completed skeletal maturation who were surgically treated for a forearm diaphyseal fracture. Patients with a Monteggia Galeazzi and ipsilateral upper extremity fracture and those with an open epiphyseal line, Type 3 open fracture, pathological fracture, or brain trauma were excluded from the study. Open reduction and internal fixation (ORIF) was applied to 42 patients (plate group), and intramedullary nailing was performed in 48 patients (intramedullary nailing group). Both treatment groups were compared with respect to time to union, joint range of motion, operating time, grip strength, Grace-Eversman criteria, and complications. RESULTS The mean operating time was 63.29 (range, 40-100) min in the plate group and 46.02 (range, 17-85) min in the intramedullary nailing group. The mean time to union was 13.19 (range, 10-20) and 10.85 (range, 8-20) weeks, respectively. While a statistically significant difference was determined between groups with respect to operating time and time to union, no difference was determined in the Grace-Eversman evaluation criteria, forearm supination, pronation degrees, and grip strength. CONCLUSION The results of this study showed a significant difference in the intramedullary nailing treatment with respect to time to union, operating time, and amount of bleeding compared with the ORIF treatment. However, no difference was determined in the functional evaluation criteria. Thus, both treatment methods are acceptable in the treatment of forearm diaphyseal fractures in adults with skeletal maturation.