Bahtiyar Demiralp

Bilateral femoral insuffiency fractures treated with inflatable intramedullary nails: a case report

Stress fractures could be classified as fatigue fractures and insufficiency fractures (IF). Fatigue fractures occur when abnormal mechanical stress is applied to a normal bone, on the other hand insufficiency fractures occur when normal to moderate pressure is applied to a bone that has decreased resistance (Daffner and Pavlov in Am J Radiol 159:242–245, 1992). IF have been observed mainly in patients with postmenopausal osteoporosis, and are becoming more common with the increase of elderly population (Daffner and Pavlov in Am J Radiol 159:242–245, 1992). Other systemic and metabolic conditions that can result in osteopenia and IF include osteomalacia, hyperparathyroidism, hyperthyroidism, rheumatoid arthritis, fluoride treatment, diabetes mellitus, fibrous dysplasia, Paget’s disease, irradiation and mechanical factors (Daffner and Pavlov in Am J Radiol 159:242–245, 1992; Soubrier et al. in Joint Bone Spine 70:209–218, 2003; Epps et al. in Am J Orthop 33:457–460, 2004; Austin and Chrissos in Orthopedics 28:795–797, 2005). In this case report, the authors present an osteoporotic woman who developed bilateral insufficiency fracture of the femoral shaft after longstanding steroid, thyroxine replacement and alendronate therapy due to partial empty sella syndrome and osteoporosis, resulting in the treatment of the fracture by inflatable intramedullary nailing.

High-velocity gunshot wounds of the tibial plafond managed with Ilizarov external fixation: A report of 13 cases

Objective To report the results of using Ilizarov fixation for the treatment of open tibial plafond fractures caused by high-velocity gunshot injuries. Design Retrospective review of consecutive patients. Setting Military academic hospital. Patients Using the AO classification, three type C1, five type C2, and five type C3 open tibial plafond fractures due to high-velocity gunshot injuries were treated with irrigation, débridement, primary closure, and Ilizarov fixation. Eleven of the fractures were type IIIA, and the remaining two were type IIIB according to the Gustilo-Anderson classification. There were also multiple traumas in one case. Methods Plafond fractures were treated by Ilizarov technique in all 13 cases. In three of the cases, additional osseous transport to eliminate a skeletal defect was performed. Main Outcome Measures Results were evaluated according to Bones clinical grading system. Results Average follow-up was 38.4 months (range 26 to 50 months). Callus began to form in 21 to 35 days (average 27.9 days). The fractures united in 126 to 154 days (average 137.6 days), and the apparatus was removed from the limb at that time. There were six good, three fair, and four poor results. Minimal skin necrosis around the wound was seen in four cases, wound infection and purulent discharge were seen in two cases, and angular deformity was seen in two cases. Delayed union and reflex sympathetic dystrophy were not seen in any cases. Although tibiotalar narrowing was seen in four cases, no cases required tibiotalar arthrodesis or subsequent bony reconstruction at the time of their most recent follow-up. The average residual ankle range of motion was plantar flexion 18.5° and dorsiflexion 11.5°. Conclusions Early aggressive débridement of nonviable tissues, stabilization with an Ilizarov external fixator, and either primary or delayed primary closure followed by early ankle range of motion and weight bearing is an alternative treatment method of these injuries.

Skin problems in amputees : a descriptive study

Background  Skin problems are common in amputee patients. These problems may restrict the normal use of a prosthetic limb. We aimed to determine the range, incidence, causes and patterns of dermatological problems seen in a population of amputees.

Bilateral lower limb amputations as a result of landmine injuries

Landmine explosions cause most of the war injuries in the battlefield. Amputations resulting from severe injuries reveal serious problems despite the improvements in surgery. Bilateral lower limb amputations have more impact than unilateral on social life. Some 29 cases with lower limb amputations due to landmine injuries were treated in the Department of Orthopaedics and Traumatology, Gülhane Military Medical Academy between January 1992 and December 1996. Amputation levels were as follows: 1 case had hip disarticulation and a trans-femoral amputation, 6 had bilateral trans-femoral amputations, 6 had trans-femoral and trans-tibial amputations, 12 had bilateral trans-tibial amputations, 1 had trans-femoral and Chopart amputations and the remaining 3 cases had trans-tibial and Chopart amputations. The initial treatment was done for all cases in the first 6–8 hours after injury at the field hospitals. Aggressive debridement, excision and primary closure were performed. None of the stumps required reamputations and/or revision. No case had gas gangrene or tetanus. Postoperative, pre-prosthetic training programme which ranged between 30–120 days with an average 48 days; and prosthesis fitting and adequate post-prosthetic training programme which ranged 32–126 (average 94) days was applied. All the cases were followed-up with a mean of 38.5 months (14–72 months). Nine (9) cases (31%) returned to their previous occupation, while 20 (69%) cases had to change their jobs.

Use of the iPhone for radiographic evaluation of hallux valgus

ObjectiveThe purpose of this study was to compare the measurements made using a smartphone accelerometer and computerized measurements as a reference in a series of 32 hallux valgus patients.Materials and methodsTwo observers used an iPhone to measure the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (of anteroposterior foot radiographs in 32 patients with symptomatic hallux valgus on a computer screen. Digital angular measurements on the computer were set as the reference standard for analysis and comparison. The difference between computerized measurements and all iPhone measurements, and the difference between the first and second iPhone measurements for each observer were calculated. Inter- and intraobserver reliability of the smartphone measurement method was also tested.ResultsThe variability of all measurements was similar for the iPhone and the computer-assisted techniques. The concordance between iPhone and computer-assisted angular measurements was excellent for the HVA, IMA, and DMAA. The maximum mean difference between the two techniques was 1.25 ± 1.02° for HVA, 0.92 ± 0.92° for IMA, and 1.10 ± 0.82° for DMAA. The interobserver reliability was excellent for HVA, IMA, and DMAA. The maximum mean difference between observers was 1.31 ± 0.89° for HVA, 0.90 ± 0.92° for IMA, and 0.78 ± 0.87° for DMAA. The intraobserver reliability was excellent for HVA, IMA, and DMAA.ConclusionsWe conclude that the Hallux Angles software for the iPhone can be used for measurement of hallux valgus angles in clinical practice and even for research purposes. It is an accurate and reproducible method.

Osteolipoma independent of bone tissue: a case report

IntroductionLipomas are the most common benign soft tissue tumors and appear in any part of the body. They typically consist of mature adipose tissue. Osteolipoma is an extremely rare histologic variant of lipoma that contains mature lamellar bone within the tumor and osteolipoma independent of bone tissue are very rare. We report a case of histologically confirmed osteolipoma independent of bone located in the thigh.Case presentationA 47-year-old male presented with a progressively enlarging, painful mass which approximately 10 cm × 8 cm over the anteromedial aspect of his right thigh. Plain films, Computerized Tomography, Magnetic Resonance Imaging and ultrasound guided needle biopsy were performed. Given the benign imaging characteristics and fine needle aspiration, an excisional biopsy was undertaken. The definitive pathologic diagnosis was intramuscular osteolipoma without evidence of malignancy. No recurrence was observed after 18 months follow up.ConclusionAlthough ossifying lipomas are very rare, it is important to keep them in mind when a lesion with adipose tissue in combination with ossification is encountered.

Neglected patellar tendon rupture: a case of reconstruction without quadriceps lengthening

Neglected rupture of the patellar tendon is a rare, can be easily missed in a group of patients. We present a 24 year old, male patient who sustained right femoral diaphyseal and tibial plateau fractures and a patellar tendon rupture following a motor vehicle accident. The fractures were treated by open reduction internal fixation but the patellar tendon rupture was missed and the diagnosis was delayed by 7 months. Patella was migrated proximally. It was moved distally to the original location and neglected patellar tendon rupture treated successfully with modified Ecker technique. Neither preoperative traction nor additional intraoperative procedures were performed to relocate the patella to its anatomic position in the extended knee and good functional result was achieved with intensive rehabilitation.

Benign fibrous histiocytoma of the lumbar vertebrae

Benign fibrous histiocytoma is an extremely rare spinal tumor with ten reported cases in the literature. Benign fibrous histiocytoma constitutes a diagnostic challenge because it shares common clinical symptoms, radiological characteristics, and histological features with other benign lesions involving the spine. We present a case of benign fibrous histiocytoma of the lumbar spine and discuss its differential diagnosis and management.

First ray reconstruction with distraction osteogenesis

Disarticulation of the thumb at the metacarpophalangeal joint level is not beneficial either aesthetically or functionally without additional surgery because it requires a bulky and an unacceptable prosthesis to be made for this amputation level. In this study, the authors have presented our experience of 12 metacarpal distractions in thumb amputated patients. Twelve male patients who had thumb amputation due to gunshot wounds were included in the study. Before the operation, aesthetic hand prostheses were made for 5 of the12 patients. Callus distraction was performed with the use of a mini Ilizarov type external fixator in 7 cases and uniplanar dynamic mini external fixator in 5 cases too. External fixators were removed after the completion of the radiographic consolidation. Five patients whose prosthesis had been made before the operation wore their prosthesis for an average 6.8 months (5 – 14) due to poor appearance and poor construction. Union of the lengthened segment was observed in all cases. Average lengthening was 28.9 mm (range from 25 – 37). Average healing time was 2.1 months (range from 1.8 – 2.5). Average healing index was 0.73 month/cm (range from 0.65 – 0.88). Pin tract infection was seen in 7 cases (58.3%). Volar angulation developed after removing the external fixator in 1 case. Webplasty was performed in all cases. Patients were evaluated by means of Disability of the Arm, Shoulder and Hand (DASH) score and pick-up test. It was concluded that the metacarpus lengthening by callus distraction technique may be a functionally and cosmetically effective reconstruction method for traumatic thumb amputations. It is believed that the possibility for a functionally and aesthetically acceptable fabrication of a thumb prosthesis, by providing a suction suspension with distraction and/or webplasty procedures.

An unusual cause of foot pain in a child: osteochondrosis of the intermediate cuneiform.

UNLABELLED Osteochondrosis of the intermediate cuneiform is a rare entity that may cause foot pain and limping in children. We report a case of osteochondrosis of the intermediate cuneiform in a child who underwent a spontaneous recovery after conservative treatment. LEVEL OF CLINICAL EVIDENCE 4.