Ahmet Y. Sarlak

The use of combined lateral and medial releases in the treatment of post-traumatic contracture of the elbow

Elbow stiffness is a common disorder, which restricts daily activities. Between 30° and 130° of elbow movement is usually enough to perform most daily activities. However, a 10° to 15° loss of elbow extension may be a problem when the patient is an athlete. From 1996 to 2004, 20 elbows of 20 patients (who were available for follow-up examination) were treated by lateral and medial release at Kocaeli University, for post-traumatic elbow contracture. Preoperative and the postoperative 12-month follow-up measurements were performed. The mean preoperative arc of motion was 35° and this value improved to 86.2°. The maximum improvement at the arc of motion was 105°. In an effort to understand the pathophysiology of the condition, surgical approaches may be used safely. The purpose of this study was to assess the functional outcome of the elbow joint after using a combination of lateral and medial approaches to treat elbow stiffness.RésuméLa raideur du coude est une pathologie fréquente qui restreint les activités quotidiennes. Pour celles-ci une mobilité de 30° à 130° est largement suffisante. Cependant un flessum de 10° à 15° peut être un problème quand le patient est un athlète. Revue d’une série de 20 patients (20 coudes) opérés de 1996 à 2004 par libération interne et externe pour une raideur post-traumatique. Les mesures étaient faites avant l’opération et 12 mois après. L’amplitude articulaire pré-opératoire moyenne était de 35° et était augmenté à 86,2°. Le maximum de gain était 105°.

A modified technique for transposition of the reverse sural artery flap

Background: Coverage of a soft-tissue defect of the lower third of the leg is a difficult problem. The reverse sural artery flap, first described by Masquelet, is a random type of flap, based on the superficial sural artery. Methods: We treated 10 patients with 11 reverse sural artery flaps. A modification of flap transposition through a subcutaneous tunnel with the aid of a soft-tissue expander was described to prevent venous congestion, especially in longer tunnels, for flap insetting. Results: Eight flaps survived completely. Distal tip and partial skin necrosis was observed in three flaps in two diabetic patients (27.2 percent). No venous congestion was observed after this modification. Conclusion: The reverse sural artery flap is a reliable alternative for small to moderate size defects and can be used with modifications of the original technique.

Tuberculous tenosynovitis of the anterior tibial and extensor hallucis longus tendons: case report.

In 1992, the World Health Organization estimated that one-third of the world’s population was infected with Mycobacterium tuberculosis.31 The incidence is highest in third world citizens of the Western Pacific region, Southeast Asia, and Africa. Even in the countries where tuberculosis is endemic, clinicians often miss the diagnosis of extrapulmonary tuberculosis. The purpose of this paper is to emphasize the importance of considering tuberculosis in the diagnosis of soft-tissue lesions of the foot.

Traumatic Dislocation of the First Metatarsophalangeal Joint with Entrapment of the Flexor Hallucis Longus Tendon

A case of traumatic dislocation of the first metatarsophalangeal joint with concomitant fibular sesamoid fracture and thoracic vertebral fracture is presented. The first metatarsophalangeal joint was repaired by means of open reduction with collateral ligament repair. At 12 months following the operation, the patient displayed nonpainful and unrestricted first metatarsophalangeal joint motion.

Double imaging for the diagnostic work-up of alveolar soft part sarcoma with Tc-99m MIBI

The authors report a case of alveolar soft-part sarcoma with lung metastases demonstrated by “double imaging” with Tc-99m HDP and Tc-99m BIBI. The tumor originated in the soft tissue with direct invasion to the right scapula, which was hypoactive on bone scan and hyperactive on Tc-99m MIBI images. A focus of dense accumulation of Tc-99m MIBI in the lungs, suggesting metastasis was also demonstrated.

The Height Gain in Scoliotic Deformity Correction: Assessed by New Predictive Formula

Height gain after scoliosis correction is of a special interest for the patient and family. Ylikoski was the first to suggest a formula predicting height loss in untreated scoliotic patients. Stokes has recently suggested a new formula by using Cobb angle to determine height loss in idiopathic curves. We hypothesized that new additional variables to Cobb angle such as apical vertebral translation (AVT), number of instrumented segments (N), and disc heights may increase the accuracy of predicted height gain. According to our findings simple expression for height gain by simplified version of the formula is: SPΔH = 0.0059X 1 θ 1 + 2.3(1 − (θ 2/θ 1))N, where θ 1 is preoperative Cobb angle, X 1 is preoperative AVT, θ 2 is postoperative Cobb angle, and N is the number of instrumented vertebra. The purpose of this study is to analyze a new mathematical formula to predict height gain after scoliotic deformity correction.

Utility of the omentum in sacral reconstruction following total sacrectomy due to recurrent and irradiated giant cell tumour of the spine

Reconstruction of the lumbosacral region after surgical excision of irradiated and recurrent spinal giant cell tumours remains a challenging problem. In this case report, we describe the use of the pedicled omentum flap in reconstruction of an irradiated and infected wide sacral defect of a 19-year-old male patient. The patient had radiotherapy and subsequent wide surgical resection after recurrence of the tumour. A myocutaneous flap from the gluteal area had failed previously. Local flap options could not be used because of the recent radiotherapy to the gluteal area. Since the patient had a laparotomy for tumour resection and a colostomy, abdominal muscles were not considered reliable for reconstructive procedures. A pedicled omentum flap was chosen as a reconstructive option because of its rich blood supply, large surface area, and angiogenic capacity. This report aims to describe the use of the pedicled omentum flap for reconstruction of the lumbosacral area following surgical resection of a spinal tumour, when gluteal and abdominal flap options for reconstruction are jeopardised.

Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

A comparison of two omental lengthening techniques by the pedicled omentum to close a knee disarticulation defect: a case report

Pedicled omental flaps have been used successfully for soft tissue reconstruction of complicated wounds. Distal reach and the lengthening technique of the pedicled omentum are less highlighted. Unestimated size availability of coverage by the lengthening technique has restricted common practice in clinical use. We have used the cadaveric scale of Das preoperatively to assess the distal reach and coverage on the lengthened pedicled omentum, this can correlate well intraoperatively.

The Central Dislocation of Femoral Head in the Transverse and Both Column Acetabular Fractures: Is It Really Medialized?

Purpose We hypothesized that the central dislocation of the femoral head does generally not occur in transverse acetabular fractures, although it does usually occur in both column fractures. Materials and Methods Fifty-two transverse and both column acetabular fracture cases were evaluated retrospectively. The distances between (a) the sciatic notch on the fracture side and the vertical axis of the pelvis (VA line) and (b) the contralateral intact sciatic notch and the VA line were measured. The a/b ratio corresponded to the superior iliac segment displacement or rotation. The ratio of the distance between the fracture side femoral head and the VA line (c) and the distance between the contralateral intact femoral head and the VA line (d) corresponded to the femoral head displacement. The width of ischium (e) on fractured side and (f) contralateral side were measured. The e/f ratio increment reflected ischiadic fragment mobility. Results The median value of femoral head displacement (c/d) of the transverse fracture group (n=25) was 1.02 (1.000-1.07). Ischiadic fragment rotation (e/f ratio) of the transverse fracture group was 1.000. The median value of femoral head displacement (c/d) of the both column fractures (n=27) was 0.78 (0.64-0.85). Ischiadic fragment rotation (e/f ratio) of the both-column group was 1.15 (1.06-1.23). The differences between groups according to measurements were statistically significant. Conclusion In contrary to Letournel description, our findings showed no medialization of femoral head in transverse acetabular fractures in general. This might be an illusion resulting from external rotation of the superior iliac segment.