Erhan Sesli

A Bilateral Traumatic Hip Obturator Dislocation

A case of a bilateral simultaneous traumatic obturator dislocation of both hip joints in an 18-year-old young man following a traffic accident is presented. We reduced the dislocated femoral heads immediately under general anesthesia followed by passive and active exercises and early full-weight bearing mobilization. After 5 years, the result was excellent.

Triggering of the finger at the wrist due to a leiomyoma arising from the lumbrical muscle of the middle finger.

Kakel R, Van Heerden P, Gallagher B, Verniquet A. Pediatric trigger thumb in identical twins: Congenital or acquired? Orthopedics. 2010, 10: 205–8. Khoshhal KI, Jarvis JG, Uhthoff HK. Congenital trigger thumb in children: electron microscopy and immunohistochemical analysis of the first annular pulley. J Pediatr Orthop B. 2012, 21: 295–9. Shah AS, Bae DS. Management of pediatric trigger thumb and trigger finger. J Am Acad Orthop Surg. 2012, 20: 206–13. Thomas SR, Dodds RD. Bilateral trigger thumbs in identical twins. J Pediatr Orthop B. 1999, 8: 59–60.

Femur nail-cortex contact length and aging

Aims: For prevention of interfragmentary shear motion in intramedullary nailing, the nail-cortex contact (N-CC) length should be long enough. This study was designed to assess the N-CC length changes related to the aging process. Materials and Methods: Femur anteroposterior (AP) radiograms of 204 patients older than 20 years were reamed virtually to be 13-mm, 14-mm, and 15-mm diameter artificial medullary cavities. Patients were divided into two major groups (males and females). Each group was subdivided into four subgroups - 20-39 years, 40-59 years, above 60 years, and above 70 years. The N-CC lengths of the femur diaphysis were measured in all groups and changes were compared between the groups. Results: For the 13-mm diameter artificial medullar cavity in female groups, the mean N-CC length value in the 20-39 years age group was 13.8 ± 4 cm, mean N-CC length value in the 40-59 years group was 11.6 ± 4.3 cm, mean N-CC length value in the above 60 years group was 9.4 ± 5.3 cm, and mean N-CC length value in the above 70 years age group were 8.8 ± 3 cm. A significant 48.6% decrease of N-CC length between 20-39-year and 40-59-year aged female groups was noticed (Z = −2.423; P = 0.015), whereas in the male groups, the significant N-CC length decrease (86%) was between the 40-59 years age group and above 70 years age group (Z = −4.279; P = 0.001). Conclusion: As N-CC length decreases after the age of 40 years in women and after the age of 70 years in men, thicker intramedullary nails should be used in these age groups for long N-CC area.

The best location for proximal locking screw for femur interlocking nailing: A biomechanical study

Background: Proximal locking screw deformation and screw fracture is a frequently seen problem for femur interlocking nailing that affects fracture healing. We realized that there is lack of literature for the right level for the proximal locking screw. We investigated the difference of locking screw bending resistance between the application of screws on different proximal femoral levels. Materials and Methods: We used a total of 80 proximal locking screws for eight groups, 10 screws for each group. Three-point bending tests were performed on four types of screws in two different trochanteric levels (the lesser trochanter and 20 mm proximal). We determined the yield points at three-point bending tests that a permanent deformation started in the locking screws using an axial compression testing machine. Results: The mean yield point value of 5 mm threaded locking screws applied 20 mm proximal of lesser trochanter was 1022 ± 49 (range 986–1057) (mean ± standard deviation, 95% confidence interval). On the other hand, the mean yield point value of the same type of locking screws applied on the lesser trochanteric level was 2089 ± 249 (range 1911–2268). Which means 103% increase of screw resistance between two levels (P = 0.000). In all screw groups, on the lesser trochanter line we determined 98–174% higher than the yield point values of the same type of locking screws in comparison with 20 mm proximal to the lesser trochanter (P = 0.000). Conclusion: According to our findings, there is twice as much difference in locking screw bending resistance between these two application levels. To avoid proximal locking screw deformation, locking screws should be placed in the level of the lesser trochanter in nailing of 1/3 middle and distal femur fractures.

The treatment of focal dystonia of index finger of the hand with tendon transfer

Dystonia is a disorder of motion; accompanied by unintentional muscle spasms leading to repetitive movements and/or aberrant posture that appears during a specific activity. Examples of focal task-specific dystonia (TSD) are “writer’s cramp” and “musician’s dystonia”, and it specifically involves the hand. A 54-year-old male presented with a complaint that the index finger of his right hand moved repetitively that scratched the wrist and palm when he shook hands. He could not find a solution to his problem through non-surgical treatment options. Based on the fact that the problem was limited to the index finger, non-progressive (stable) and refractory to non-surgical treatment, it was attempted to treat the patient with a tendon transfer as a last option. A case of focal TSD of the right index finger treated with tenotomy and tendon transfer is presented here.

A new femoral nail with single distal locking screw for maximum interfragment rotational stability

OBJECTIVE One of the problems for interlocking nailing of the femur is interfragment rotation motion, affecting fracture healing. The nails with single distal locking screw are advantageous for decreasing operation time and radiation exposure. We investigated which single distal screw nail is the best for interfragment rotational stability. METHODS We used a total of 30 composite femurs, ten for each group. We determined interfragment rotational displacement of composite femurs with three types of single distal screw nails (10 interlocking nails, 10 compression nails and 10 Mehmet anti-rotation nails compressed by tube) at 6-Nm external- 6 Nm internal and 10 Nm extern- 6 Nm internal torques, which imitating respectively the level walking and descending stairs, using an axial distraction testing machine and a custom designed rotation apparatus. RESULTS Between 10 Nm external and 6 Nm internal torques with single distal locking screw, the interfragment rotational displacement in the Mehmet nail compressed by the 8 Nm torque wrench was mean 1.14 mm and 540% less than mean 7.31 mm in interlocking nails and 400% less than 5.72 mm in compression nails compressed by the 2.5 Nm torque wrench. CONCLUSION The single distal screw Mehmet nail is superior than other single (or even some double) distal screw nails for maximum rotational stability, with no interfragment distraction gap, no superior nail migration, decreased operation time, and less radiation exposure in axially stable transverse and short oblique femur fractures in daily activities like stair descending or level walking.

Reliability of threaded locking screws

OBJECTIVE A frequent problem for interlocking nailing that affects the treatment of the fracture is locking screw deformation. The aim of this study is to determine whether bending resistance is different between high, low, and unthreaded locking screws of interlocking femoral nails. METHODS Ninety screws were used in this experimental study, with 10 screws used in each of 9 groups. Three-point bending tests were performed on 6 groups of 5 mm screws (titanium, stainless steel, crossed with unthreaded, low threaded, and high threaded) and the same 3 thread types of 5.5 mm stainless steel screws in a 30-mm inner diameter steel tube, imitating the level of the lesser trochanter. An axial compressor was used to determine the yield points for permanent deformation in the locking screws by way of 3-point bending tests. RESULTS The mean yield point value of the 3-point bending tests of 5-mm low threaded stainless steel locking screws was 2071 N, 53% less than that of unthreaded screws (3169 N). The mean yield point value of 5-mm high threaded stainless steel locking screws was 556 N, 272% less than that of low threaded screws (2071 N). CONCLUSION To avoid locking screw deformation, high threaded screws must not be used as locking screws. In cases of unreliable patients, 5-mm low threaded screws should not be used in the nailing of comminuted or oblique femur shaft fractures. All 5-mm unthreaded screws and 5.5-mm low threaded stainless steel screws can be used safely in full weight-bearing conditions of unreliable patients.

Pulmonary Embolism after Knee Arthroscopy in 57-Year-Old Woman

Objectives: Pulmonary embolism (PE) after knee arthroscopy is even a rare occurrence in older patients. In this report, we present an unusual case of PE following knee arthroscopy. Methods: A 57-year-old woman normally active patient presented to the orthopaedic clinic has been suffering a right knee pain responseless to the medical treatment for a year. Hystory was unremarkable with the exception of hypertension and cervical biopsy. Results: An arthroscopic meniscectomy was received under spinal anesthesia after the application of an Esmarch and pneumatic tourniquet. Post-operatively first day, she was discharged. While transporting, she developed dyspnea, weakness and low-right breast pain. An immediate pulmonary angiography and cardiac echograpy demonsrated the obstruction in the right common pulmonary artery and subsegmentary occlutions in the left side. Conclusion: After a 24-hour streptokinase therapy(ST), coumadine was started. Near the end of ST, she complained a severe knee pain healed by the punctures. Because of a severe epigastric pain unable to control by gastric prophilaxy and therapy.The patient was consulted by a gastroenterology specialist and gastric endoscopy showed an acute gastritis. A control pulmonary angiography on eighth day demonstrated no thrombus including right common pulmonary artery. The patient was successfully discharged on the 11th day.