Birol Gulman

Salter's innominate osteotomy in the treatment of congenital hip dislocation: a long-term review.

We reviewed 39 patients with 52 congenitally dislocated hips, all managed by open reduction and Salters innominate osteotomy. Mean follow-up period was 13 years (range, 8 to 25 years); 78.9% of the hips had a good or excellent clinical result, and 71.1% were good or excellent radiologically. The patients who underwent Salters innominate osteotomy before the age of 4 had better clinical and radiological results (88.4 and 81.4%, respectively). The radiographs of the unilateral normal hips were compared to the surgically treated hips according to their acetabular index angles, center-edge angles of Wiberg, and femoral neck-shaft angles. No statistical differences were found between these two groups. The Bucholz-Ogden classification was used for the diagnosis and classification of avascular necrosis. The late radiographic signs of types 2, 3, and 4 avascular necrosis were seen in 34.6% of this series. The results show that Salters innominate osteotomy provides good lateral coverage of the femoral head. The results are better if the operation is performed between the ages 18 months and 4 years.

Morphologic Variants of Acromion in Neonatal Cadavers

In this study, the morphology of the acromion in neonatal cadavers was investigated. The hooked-type acromions (Bigliani and Morrison type III), which are said to be responsible for rotator cuff lesions in adults, were found to have a very low incidence in this age group (5%). This finding challenges the validity of the assumption that some individuals have a congenital tendency for rotator cuff lesions, depending on their acromion types.

A further morphological study of the persistent median artery in neonatal cadavers

Persistent median artery was studied in 60 upper limbs of 30 neonatal cadavers. It was found in 12 (20%) specimens while partial atrophy in the distal part of the median artery was detected in 9 (15%) specimens. These findings correlated well with those of other series including the authors’ previous study which covered both adults and neonates. There was no significant difference statistically between the authors’ current and previous studies (p>0,05). Therefore both studies were combined. The incidence of persistent median artery in this enlarged series (100 specimens) was 17%. This rate of persistent median artery was higher than those of most other published series. We believe this may be due to evolutionary and racial trends; the neonatal origin of our specimens would be another differing factor. Partial atrophy of the median artery, and the different incidences in neonates and adults raised the possibility that the median artery regresses at a later age, possibly during perinatal and early infancy period.

Sagittal contour restoration and canal clearance in burst fractures of the thoracolumbar junction (T12-L1) : the efficacy of timing of the surgery

Summary: The efficacy of timing of surgery (short segment fixation using transpedicular screws), in burst fractures of thoracolumbar spine was evaluated between May 1993 and October 1994. The patients were divided into two groups according to time elapsed between injury and operation. Cases operated on within the first 24 h were taken as the early surgery group (n=10) and cases operated on later than 24 h after the injury were considered as the late surgery group (n=8). The efficacy of treatment was assessed by evaluation of the sagittal index (SI) restoration and reduction of canal compromise. The preand postoperative values for SI and canal narrowing (CN) for both groups are as follows: Early preoperative SI — 23.40°, late preoperative SI — 24.50°, p=0.53; early preoperative CN — 0.47, late preoperative CN 0.52, p=0.33; early postoperative SI -4.20°, late postoperative SI-13.50°, p=0.0001; early postoperative CN -0.10, late postoperative CN -0.39, p=0.0000. There is still controversy concerning the relationship between canal narrowing and neurologic deficit, and the effect, if any, of decompression on neural recovery. Nevertheless, if the main aim of the surgical procedure is to restore the SI and decompress the neural canal, then other alternatives of decompression and realignment should be preferred to indirect reduction using short segment transpedicular fixation in cases to be operated on later than 24 h after injury.

Late detachment modular femoral component after primary total hip replacement

Abstract Three years after total hip replacement surgery, a patient’s modular femoral head separated from the stem portion of a primary total hip replacement while the patient was rising from a chair. The modular femoral head was in a polyethylene acetabular socket. Modular femoral and acetabular components now widely are used in hip replacement. The use of modular components greatly increases the flexibility during primary or revision total hip arthroplasty, but introduces the risks of component dissociation and intraoperative errors in matching. We report an unusually late dislocation of a primary modular total hip replacement.

Anatomic variations of the coracoacromial ligament in neonatal cadavers: a neonatal cadaver study.

One of the most common causes of pain and disability in the upper limb is inflammation of the rotator cuff tendons. When no significant bony abnormality exists in the surrounding structures, the coracoacromial ligament has been implicated as a possible cause of impingement on the cuff tendons and various morphological variants of the ligament have so far been claimed to be either the cause or the result of impingement. In this study, 110 shoulders from 60 neonatal cadavers that were preserved in a preparation of formaldehyde were dissected. Anatomic variations of coracoacromial ligaments were investigated with metric and histologic analysis. Three main ligament types were identified: quadrangular, broad band and U-shaped. The multiple banded ligament was not found. Histologic analysis showed that in U-shaped ligaments a thin tissue existed in the central part of the ligament close to the coracoid. Comparing our data with the adult measurements of a previous study we suggest that the primordial ligament is broad shaped, but assumes a quadrangular shape due to the different growth rates of the coracoid and acromial ends. We also suggest that broad and U-shaped ligaments account for the primordial and quadrangular and Y-shaped ligaments account for the adult types of the single or double banded anatomic variants respectively. Our results show that various types of the coracoacromial ligament are present at the neonatal period and that the final shape of the ligament should be defined by developmental factors, rather than degenerative changes.

Treatment of U-shaped Bone Ankylosis of the Knee with the Ilizarov Method: A Case Report

Osseous ankylosis following thermal burns is an uncommon but disabling problem1,2. There are two different types of bone ankylosis. The first type is due to extra-articular bridging heterotopic ossification with preservation of the underlying joint. This type typically responds to physical therapy and other treatment modalities, including surgical excision. The second type of bone ankylosis is intraarticular and occurs most commonly at the interphalangeal joints, resulting in serious functional and cosmetic problems2. There are several alternatives for treatment, including arthrodesis, osteotomy, arthroplasty, and amputation. However, treatment is always very difficult and the outcomes can be discouraging2,3. We present the case of a patient who had intra-articular bone ankylosis of the right knee joint in full flexion that was treated with the Ilizarov method4,5. To our knowledge, this is the first time that such a case, in terms of both the clinical presentation and the method with which it was treated, has been reported in the literature. Our patient was informed that data from the case would be submitted for publication. Aforty-seven-year-old woman presented with a 160° fixed flexion deformity of the right knee that was very disabling. She had sustained a third-degree thermal burn involving the right lower extremity when she was seven years old. There was circumferential scarring of the skin about the knee, and the right thigh appeared to be adhered to the leg. She required the use of crutches for mobility. A lateral radiograph showed that the right femur and tibia were almost parallel to each other and the knee was ankylosed (Fig. 1). We …

Distribution and evaluation of bone and soft tissue tumors in the middle Black Sea Region

OBJECTIVE The aim of this study was to evaluate the characteristics of bone and soft tissue tumors operated on at the Department of Orthopedics and Traumatology at Ondokuz Mayıs University Faculty of Medicine Hospital between January 1987 and January 2012. METHODS This descriptive study retrospectively evaluated 1,925 patients hospitalized with a preliminary diagnosis of tumor. Patients were analyzed for age, gender, tumor incidence and localization. Three hundred and forty-nine patients found to have non-tumor causes. The 94 patients discharged at their own request or deceased during follow-up were not included in the tumor group. RESULTS Of the 1,482 (76.9%) patients diagnosed with tumor, 687 (46.4%) were bone tumors, 586 (39.5%) soft tissue tumors and 209 (14.1%) metastatic tumors. The most common benign bone tumor was osteochondroma (118; 25%), followed by enchondroma (68; 14.4%) and giant cell tumor (59; 12.5%), and the most common malignant bone tumor was osteosarcoma (58; 27%), followed by chondrosarcoma (36; 16.7%) and Ewings sarcoma (33; 15.3%). The most common benign soft tissue tumor was cystic hygroma (96; 22%), followed by lipoma (75; 17.2%) and hemangioma (52; 11.9%), and the most common malignant soft tissue tumors were pleomorphic cell tumor (29; 19.3%) and liposarcoma (29; 19.3%), followed by pleomorphic undifferentiated sarcoma (21; 14%). Seventy (33.5%) of the metastatic tumors were of pulmonary origin, 36 (17.2%) were of breast origin and the primary site of the tumor was not clearly determined in 58 (27.8%) patients. CONCLUSION The distribution of bone and soft tissue tumors appear to have certain characteristics but can show regional differences. We believe that the establishment of a larger series through the collection of these types of studies from centers in which bone and soft tissue tumor surgery is performed will provide important information on the epidemiological features of bone and soft tissue tumors.

Effects of circulating endothelial progenitor cells, serum vascular endothelial growth factor and hypogammaglobulinemia in Perthes disease

OBJECTIVE The aim of this study was to investigate Legg-Calvé-Perthes disease (PD) pathogenesis by comparing absolute circulating endothelial progenitor cell (EPC) counts, serum levels of vascular endothelial growth factor-A (VEGF-A) and immunoglobulins between PD patients and controls. METHODS The study included 28 PD cases (mean age: 8 ± 3.8) and 25 healthy age-matched control subjects. EPC, serum VEGF-A and immunoglobulin levels were measured in peripheral blood samples. Comparisons and correlation analysis were performed. RESULTS In the PD group, 17 subjects were in the fragmentation stage and 11 in the healing stage. Four patients had bilateral disease and 14 had hypogammaglobulinemia. Median EPC count of the PD group was 80 and was significantly higher than those of the control group (p=0.011). No significant difference was determined in serum VEGF-A levels (p=0.354). EPC count were inversely correlated with serum IgG levels of the PD group (r=0.403, p=0.03). Absolute EPC count was also significantly higher in the fragmentation stage than in the healing stage and were also greater in bilaterally affected than in unilaterally affected patients. Circulating EPC count was correlated to the serum VEGF-A levels in patients with fragmentation stage of PD (r=0.605, p=0.01) and in those with hypogammaglobulinemia (r=0.599, p=0.001). CONCLUSION High EPC count at the fragmentation stage of PD and relatively higher counts in bilateral disease suggest that EPC may be a valuable marker in the diagnosis and follow-up of PD. Additional studies are needed to explain the strong correlation between EPC and serum VEGF-A level in the fragmentation stage and in the presence of hypogammaglobulinemia.

Mesh repair of a pelvic bone defect caused by a migrated acetabular cup

Abstract. Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intraoperative injury to iliac vessels. We present a case of a migrated acetabular cup, in which we used a combined preperitoneal and acetabular approach for its removal. With a bimanual approach, the procedure was safer and easier and allowed mesh repair of the pelvic bone defect. The preperitoneal mesh repair is a well-known method for inguinofemoral hernias. However, it has not been used before in the repair of an acetabular defect after removal of a migrated cup.