Celal Baki

Replantation in children

The rates of survival of the amputated part and the functional outcomes were studied retrospectively after 13 replantations and 12 revascularizations in 25 children. The ages of the patients ranged from 2 to 15 years (mean, 6.4 years). The average duration of follow‐up was 4.2 years (range, 2 to 7 years). The survival rate was higher after revascularization (94.6%) than after replantation (84.6%). Sensory recovery of all digits was satisfactory. The mean growth rate of replanted digits relative to contralateral digits was 80%. Functional results were rated as excellent in 11 cases, good in 8 cases, moderate in 2 cases, and poor in 1 case. In order to prevent functional and growth disturbances and due to cosmetic reasons, replantation or revascularization should definitely be tried for children.

Single-stage open reduction through a medial approach and innominate osteotomy in developmental dysplasia of the hip

We treated 15 hips (15 patients) with developmental dysplasia by a single-stage combination of open reduction through a medial approach and innominate osteotomy. The mean age of the patients at the time of operation was 20 months (13 to 30). The mean follow-up period was 9.6 years (4 to 14). At the final follow-up, 14 hips were assessed clinically as excellent and one hip as good. Radiologically, ten hips were rated as class I, four as class II and one as class III according to the criteria of Severin. No avascular necrosis was seen. No patient required subsequent surgery. Our results indicate that satisfactory results can be obtained with the single-stage combination of open reduction by the medial approach and innominate osteotomy for developmental dysplasia of the hip in a selected group of children older than 12 months. To our knowledge, no similar combined technique has been previously reported.

Bilateral traumatic hip dislocation with bilateral sciatic nerve injury

Bilateral traumatic dislocation of the hip is a rare injury. In fact, only about 50 cases have been reported previously. We report a case of traumatic bilateral posterior hip dislocation with bilateral sciatic nerve damage suffered in a traffic accident by a 65-year-old woman.

Isolated dislocation of all five carpometacarpal joints

Fracture-dislocation of all five carpometacarpal joints is extremely rare, only ten cases having been reported since 1873. A case of isolated dislocation of all five carpometacarpal joints is presented. A good result was obtained 1 year after open reduction and internal fixation. This case is the only isolated dislocation of all five carpometacarpal joints in the English literature.

The comparison of patellar tendon–bone autografting and free flexor-tendon autografting in infraspinatus defect of the shoulder: biomechanical and histological evaluation in a sheep model

The purpose of this study was to investigate the biomechanical and histological features of patellar tendon–bone autografting and free flexor-tendon autografting, which were fixed by two different techniques at the tendon–bone junction in reconstruction of an infraspinatus defect in sheep. Merino type sheep (n=10) were divided into two groups. Following a defect in the infraspinatus tendon, in group I (flexor-tendon autografting) the free end of the flexor tendon was passed through the holes in the greater tuberosity for fixation. In group II (patellar tendon–bone autografting), fixation was obtained by impaction of the tibial bone plug to the greater tuberosity. Twelve weeks later, animals were sacrificed and specimens were evaluated biomechanically and histologically. Recovery of tensile mechanical properties was achieved to a level of approximately 50% in Group I and 70% in Group II at the end of the 12th week. No difference in the stiffness values was found. In group I, there was a difference between operated and contralateral (non-operated) tendons for the ultimate tensile strength values, but no difference was found in group II. Histologically, in group I, the defective area, which filled with a hypercellular connective tissue, could hardly be differentiated from the normal tendon tissue. In group II, complete incorporation of the bone block was seen in all specimens. These results suggested that patellar tendon–bone autografting is more advantageous than free flexor-tendon autografting in infraspinatus defect, providing rapid healing and better mechanical properties, especially in the early period of healing.

Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip.

In this study, we aimed to evaluate the long-term clinical and radiological results of single-stage open reduction through a medial approach and Pemberton acetabuloplasty in developmental dysplasia of the hip. We treated 32 hips (22 patients) with developmental dysplasia by a single-stage open reduction through Ferguson’s medial approach and Pemberton acetabuloplasty. The procedure was performed bilaterally in 10 patients. The mean age of the patients at the time of the operation was 19.8 months (16–24 months). The mean follow-up period was 10.9 years (7–19 years). Group I avascular necrosis according to the Kalamchi and MacEwen classification was observed in two hips and group II in one hip. Radiologically, 90.6% of the hips were classified as Severin class I and 9.4% of the hips were classified as Severin class II. At the latest follow-up, 30 hips were assessed clinically as excellent and two hips as good. No patient required subsequent surgery. We conclude that single-stage medial open reduction and Pemberton acetabuloplasty represent an effective method for developmental dysplasia of the hip in children older than 15 months of age.

The Treatment of Sudeck's Syndrome in the Upper Extremities with Sympathetic Blockage by Using Ultrasound

DOI: http://dx.doi.org/10.5915/23-4-15414 Sudecks syndrome is a disease of pain, swelling, hyperesthesia, hyperhydrosis and trophic changes in the skin and bone of the affected distal extremity. A number of diseases, precipitating events, and drugs have been associated with Sudecks syndrome. It is usually believed that the etiological factors produce pathologic changes in the neuro-vascular system. The vicious cycle of pain-spasm-anoxia causes the problem to become chronic. In therapy, it is believed that if the pain disappears, the pathophysiological vicious cycle has been stopped. For this reason, a number of medical therapy modalities and physical therapies can be used. In this study we used the ultrasound as a sympathetic ganglion blocker for the therapy for patients with Sudecks syndrome.

Familial juvenile polyposis coli with congenital heart disease

Seven cases of familial juvenile polyposis coli (FSPC) and one case of familial adenomatous polyposis coli (FAPC) were described in two generations of a family. Of five siblings, one had FJPC with mitral insufficiency, one had Fallots tetralogy, and the other three, also with FJPC, had had pulmonic stenosis and died. Congenital heart disease was observed in neither the father nor the aunt. The grandfather also had FAPC, without congenital heart disease. To the best of our knowledge, this association has not previously been reported in the literature. For this paper members of the family were studied and the literature was reviewed.

Amelia, hypoplasia of iliac bone, and absence of ischium and ramus pubis in the VATER association

A 1-day-old female presented with hypoplasia of the iliac bone and absence of the ischium and ramus pubis in the VATER association. To our knowledge, these skeletal anomalies have not been previously reported with the VATER association.