Burkay Kutluhan Kaçira

BIOMECHANICAL FIXATION STRENGTH COMPARISON OF ILIOINGUNIAL AND MEDIAL STOPPA APPROACHES ON ANTERIOR COLUMN FRACTURES

Background: Both the ilioinguinal and Stoppa approaches have been used as standard methods for treating anterior column fractures of the pelvis. Objective: We aimed to compare the rigidity of pelvises that were treated using these two approaches. Methods: Fifteen synthetic pelvises were used as test models. Of these, 5 pelvises did not undergo any treatment (control group), and 10 pelvises underwent treatment of one column using the ilioinguinal approach and the other using the medial Stoppa approach (treated group). The compression test was performed on all pelvises, and rigidity of the pelvises was compared between the control and treated groups. Results: A statistical difference was found in the angle between the center of the femoral head and the line from the pubic symphysis to load application between the control and treated groups, using the ilioinguinal approach. The parametric displacement was greater in the treated group using the ilioinguinal approach than in the control group. There were no si...

Spinal Cord Injury Without Radiological Abnormality (SCIWORA): Is It Still a Notable Definition?

The developing Magnetic Resonance Imaging technologies have led to significant changes in the radiological diagnostic criteria of the Spinal Cord Injury without Radiological Abnormality (SCIWORA). Moreover, some authors even introduced alternative definitions for this specific disease recently. The aims of this study were to report an adolescent case with pure SCIWORA and to clarify its definition in the literature. A 16 year-old adolescent patient with thoracolumbar SCIWORA together with a pelvic fracture after a vehicle accident was presented in this case report. In neurological examination, both extremities were graded as Frankel type A. The X-ray and Magnetic Resonance Imaging revealed the right ischium-superior pubic ramus fracture and only edema of the spinal cord at T12, L1 and L2 vertebral levels, subsequently. A high dose of methyl-prednisolone was administered. Pelvic fracture was promptly fixed with an external fixator. After a follow-up period of two years, the neurological status of the patient showed progression to Frankel B. The patient continues to his life with wheelchair. In conclusion, an adolescent case with SCIWORA that fulfills all its original criteria was reported and a review of the literature was discussed in this study. In order to describe this special pathology, SCIWORA seems still to be the best ideal term.

Femur Distal Diafiz Kırıklarının İntramedüller Çivi ile Tedavisinde Dizilimin Değerlendirilmesi

Amac: Distal femur kiriklari hem genc hem de yasli nufusta sik gorulmektedir. Tum femur kiriklarinin % 7’sini olusturmaktadir. Kirik sonrasi dizilimin saglanmasi, deformite ve kisalik gelismemesi icin onemlidir. Bu calismada eklem icine uzanmayan distal femur diafiz kiriklari tedavisinde uygulanan intrameduller civi (IMC) yonteminin dizilime etkisinin olup olmadiginin arastirilmasi amaclanmistir. Hastalar ve Yontem: 2010-2016 yillari arasinda, femur distal diafiz kirigi tanisiyla, IMC ile tedavi edilmis 62 hasta degerlendirildi. Hastalarin takip suresi en az 1 yildi. Hastalar kirik hattinin ekleme olan mesafesine gore 3 gruba ayrildi ( 130 mm). Her grubun civi-eklem mesafesi (CEM), kirik hatti-eklem mesafesi (KEM), kirik-civi mesafesi (KCM), ayrica translasyon miktari ve dizilim bozuklugu miktari degerlendirildi. Bulgular: Grup 1’de; CEM 17,1±6,8 mm, KEM 78,4±17,6 mm, KCM 60,8±15,9 mm, translasyon miktari 4±1,3 mm ve dizilim bozuklugu 2,9±1,7° olarak bulundu. Grup 2’de; CEM 19±6,8 mm, KEM 119,5±8 mm, KCM 100,6±8 mm, translasyon miktari 3,9±1,7 mm ve dizilim bozuklugu 3±1,7° olarak bulundu. Grup 3’de; CEM 25,2±8,7 mm, KEM 143,3±7,8 mm, KCM 118,1±11,7 mm, translasyon miktari 3,5±1,8 mm ve dizilim bozuklugu 2,5±1,4° olarak bulundu. Sonuc: Yaptigimiz calismada kirik ile eklem arasi mesafe azaldikca dizilim bozuklugunun ve translasyon miktarinin arttigini, civi distali ile eklem mesafesi arasi 20 mm altinda tutuldugunda dizilim bozuklugunun ve translasyon miktarinin azaldigini gorduk. IMC ile tedavi uygulanacak ekleme yakin distal femur diafiz kiriklarinda, dizilim bozuklugu ve translasyon acisindan dikkatli olunmasi gerekmektedir. Ozellikle kirikeklem mesafesi 100 mm’nin altinda olan olgularda civi distali ile eklem arasindaki mesafenin 20 mm’nin altinda tutulmasi, translasyon miktarini ve dizilim bozuklugunu minimum duzeyde tutacaktir.

The Comparison of Results of Early and Late Rehabilitation Following Arthroscopic Bankart Repair with Knotless Anchor in Recurrent Traumatic Anterior Shoulder Dislocation

Objectives: The aim of this study was to compare the clinical and functional results of early and late rehabilitation of patients who had undergone arthroscopic Bankart repair with knotless anchor for recurrent shoulder dislocation and to define the most appropriate rehabilitation time and the effect of this on recurrence. Methods: 34 patients (32 male and 2 female) were included in this study. The patients were diagnosed with recurrent anterior shoulder dislocation with Bankart lesion in our institution. The exclusion criteria in this study were multi-directional shoulder instability, wide osseous Bankart lesion, wide Hill-Sachs lesion or rotator cuff tear. All patients underwent arthroscopic Bankart repair. Knotless anchor was used in all patients. The patients were grouped into 2 groups postoperatively according to the immobilization period and rehabilitation regimen. Both groups equally consisted of 17 patients. (Group 1; early rehabilitation group, Group 2; late rehabilitation group) All patients were examined retrospectively. Gender, age, dislocated side, dominant hand, recurrence, presence of additional pathologies, time of first and last dislocations preoperatively and numbers of dislocations were the demographic data recorded. At the final follow-up; the restriction in external rotation was measured by comparative goniometry and clinical evaluation was made using the Constant and Rowe scores. One-sample T-test, Mann-Whitney U Test, Crosstabs Chi Square Test and Shapiro-Wilk Tests used for statistical analysis. Results: The mean age of the patients in Group 1 was found to be 25.1 ± 6.5 ( 17-43) years and in Group 2, 30.8 ± 6.8 (21-46) years. After a mean follow-up period of 14.7 months, no patients in Group 1 experienced a recurrence, whereas in Group 2 over the mean follow-up period of 38.5 months, there was dislocation, following episodes of subluxation, in only 1 patient (5.8%). When the parameters of first dislocation, last dislocation and number of dislocations were evaluated separately in two groups, no statistical difference was observed between the groups in the relevant parameters (n.s.). A statistically significant difference was determined between the groups in respect to the restriction in external rotation (p<0.05). There was no statistically significant difference between the groups in respect to the Constant and Rowe scores (n.s.). Conclusion: The most important result of this study was that the early beginning of rehabilitation yielded less external rotation restriction than late beginning of rehabilitation. The absence of recurrence in the group of early beginning of rehabilitation reminds the question “does early rehabilitation reduce recurrence rates?” The findings in this study should be confirmed with further prospective, randomized and longer follow-up studies.

Medial Opening Wedge High Tibial Osteotomy Fixation with Short Plate without any Graft, Synthetic Material or Spacer.

Objectives: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee relocates to the lateral compartment with this procedure. A gap occurs on the proximal tibia during the correction of varus deformity. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing nonunion or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials. Methods: We evaluated 41 MOWHTOs performed between 2009 and 2012 with no use of bone grafts, synthetic materials or spacers. Age of the patients ranged from 43 to 67. Thirty five of the patients were female and 3 of them were male. The follow-up time was 6 months. Results: There were no any non-unions or loss of correction. The mean bone union time was 12,8 weeks. No major complications were seen. Conclusion: The results of our study has shown that achieve satisfactory results can be obtained in MOWHTO without using any bone graft, synthetic materials or spacer.

Eş zamanlı bilateral tuberositas tibia avulsiyonu: Nadir bir kırık

Tibial tuberosity avulsion is a rare fracture in adolescence. Due to the shear forces on the immature epiphysis. Thirteen years old girl was admitted to the emergency department with knee pain and tenderness in both knees after jumping from a height of about one meter. In examination she had tenderness and swelling over both tibial tuberosities. The patient could not do active knee extension. Type IIA fracture on the left and type IIIA fracture on the right knee were detected. For the patient’s fractures, closed reduction and fixation with 3 smooth Kirschner wires was performed. After immobilization in long-leg brace for three weeks the brace was removed and she include in the rehabilitation program. In this report, we discuss similar cases in the literature and the results of the treatment applied to our patient.