Erhan Bayram

Short-term Results of Robinson Type 2B2 Clavicular Fractures Treated Conservatively or Surgically

The most frequently treated injuries, representing approximately 82% of all clavicular fractures, involve the midshaft clavicle. Historically, most acute displaced midshaft clavicular fractures were treated nonsurgically. However, the outcomes of nonsurgical treatment have recently been thought to be not as good as expected in the past, and the trend is to treat these fractures surgically. The goal of this study was to evaluate the short-term clinical outcomes of Robinson type 2B2 clavicular fractures treated conservatively vs with locked plate fixation. Among 59 patients included in the study, 30 patients (mean age, 45±13.7 years; range, 30-62 years) treated conservatively were designated as group A, and 29 patients (mean age, 38.8±11.1 years; range, 20-60 years) treated with locked plate fixation were designated as group B. All patients were evaluated using Oxford and Constant scoring systems at final follow-up. Mean follow-up was 18 months (range, 12-24 months). In group A, mean Constant score was 70.5±15.1 (range, 98-43) and mean Oxford score was 46.6±1.3 (range, 49-44) at final follow-up. In group B, mean Constant score was 89.2±8 (range, 100-77) and mean Oxford score was 46.5±1.2 (range, 48-44) at final follow-up. Callus was detected radiographically in both groups at 6-week follow-up. Patients in groups A and B started active range-of-motion exercises at weeks 6 and 3 after treatment, respectively. Locked plate fixation of Robinson type 2B2 clavicular fractures can be the first treatment option because of good clinical results, low complication rates, and good cosmesis.

Diyabetik ayak yaraları ve klinik deneyimimiz

Diabetic foot lesions and clinical experience Objective: Although some diabetic foot undergone amputation because of progressive wound others heal without complication. This study evaluates the risk factors for amputation of diabetic foot. Material and Methods: This study include 104 patients (77 males, 27 females; mean age 62.3 years; range 23 to 90 years) who had diabetic foot ulcers and treated between 2008 and 2011. Data on age and sex, type and time of diabetes, complications and treatment type were recorded. Results: 36.5% of patients had no any antidiabetic medicine. The frequencies of diabetes related complications in descending order were as follows; 44.2% retinopathy, 16.3% polyneuropathy, 11.5% nephropathy, 3.8% Charcot joint. According to Wagner Classification most of the patients (n=100) stages found in two to four. Total 82 patients undergone surgical treatment. Conclusion: We consider that multidisciplinary treatment strategy in which orthoapedic surgeons have an important and special mission decreases amputation rate in diabetic foot.

Comparison of Short Term Results of Type IIB2 Middle Third Clavicular Fractures Treated with Figure of Eight Bandage and Locked Plate Fixation.

Objectives: Most acute displaced midshaft clavicular fractures conventionally have been treated nonoperatively with the expectation of a high probability of fracture union, good functional outcomes, and a high level of patient satisfaction . However, the outcome of nonoperative treatment is not as favorable as once thought and there has been a growing trend to treat these fractures surgically We aimed to evaluate and compare the short term results of conservative treatment and locked plate fixation in the treatment of type IIB2 clavicula fractures according to Robinson classification in this study. Methods: Thirty eight patients with type IIB2 clavicula fractures according to Robinson classification were retrospectively reviewed. 20 patients who were treated conservatively were enrolled as group A and 18 patients who were operated with locked plate and screws were enrolled as group B. All patients were evaluated with Constant and Oxford scores in their last follow up control. For the patients that were treated conservatively (Group A) figure of eight bandage were applied for six week. Patients (Group B) were operated under general anesthesia in the beach chair position. A straight incision was made over the fracture line. Butterfly or free fragments in comminuted fractures were fixed to the main fragment with a lag screw in 3 patients before fracture reduction and plate fixation. Fracture reduction was performed with taking care of minimal periosteal stripping. After reduction of the main fragments, titanium alloy, locked anatomic compression plate were applied on the superior surface of the clavicle. A minimum of six cortexes were fixed with 3.5 mm locked cortical screws on the medial and lateral sides of the fracture. We did not need any Auto- or allografts during the surgery. Statistical analysis was performed between the scores of two groups. Conservative and surgical treated groups Oxford scores and Constant scores had normal distribution. For this reason Students t test, and Non-parametric version of Student’s t test Mann Whitney U test were performed. 95% confidence interval and p <0.05 was considered significant as statistically. Results: Mean follow up period is 18 months (12-24 months). At the last follow-up, mean Constant score is 79.5 (98-43) and mean Oxford score was 46.35(49-44) for group A. In group B mean Constant score is 89.3(100-77) and mean Oxford score is 46,6(48-44) at the last follow-up. There were no patients who require any revision surgery in group B. Bone healing was detected in all fractures radiologically in both groups. There was no statistically significant difference between Oxford scores of the two groups (p=0,570). There was statistically significant difference between Constant scores of the two groups whereas results of Group B were better than group A (p=0,013) Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes. Conclusion: Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes.