Eyup S. Karakas

One-stage treatment of congenital dislocation of the hip in older children.

We reviewed the results of a primary one-stage combined operation in 47 patients (55 hips) who were > or = 4 years and had congenital dislocation of the hip. At a mean follow-up of 7.5 years (2-16 years), 67% of the whole series had good or excellent clinical results, and 65% were good or excellent radiologically. Avascular necrosis occurred in four patients, and redislocation also occurred in four patients. We concluded that most of the children who are > or = 4 years and who have congenital dislocation of the hip can successfully be treated with an extensive one-stage operation consisting of open reduction combined with innominate osteotomy and femoral varus, derotation, and shortening osteotomy.

Closed Ender nailing of adolescent femoral shaft fractures

Twenty-seven adolescents with 29 femoral shaft fractures, between the ages of 10 and 16 years, were treated with closed flexible Ender intramedullary nailing from 1989 to 1992 in our clinic. In one patient who had a fracture of the distal third of the femoral shaft, the nail was inserted proximal to distal (antegrade nailing). In the other patients, the nails were inserted distal to proximal (retrograde nailing). Clinical and radiological follow up averaged 32 months (18-56 months). Hospitalization averaged 15 days (7-28 days). All fractures healed with one significant leg length discrepancy of 1.7 cm in a patient who had developed osteomyelitis. There was no significant angulation or malrotation. All patients had a normal gait and were able to participate in full activities. There was one deep wound infection in a patient with an open fracture of the femoral shaft. There were no non-unions, delayed-unions or psychological complications. For this age group, this treatment of femoral shaft fracture should be considered owing to the functional recovery with low morbidity and cost, providing early ambulation, early discharge from hospital and early return to school.

Femoral shaft fractures in children treated by closed reduction and early spica cast with incorporated supracondylar Kirschner wires: a long-term follow-up results.

38 children between 1 and 10 years of age with femoral shaft fractures were treated by closed reduction and early spica cast with incorporated supracondylar Kirschner wires and followed up prospectively. Overrides of maximum 15 mm, medial and anterior angulations less than 15 degrees and lateral angulation up to 5 degrees were considered acceptable. Posterior angulation and malrotation were not accepted. Of the 38 children examined at a mean of 65.6 months (range, 58-80 months) after fracture, none had any residual skeletal deformity and joint stiffness. At long-term follow-up, maximal shortening was 11 mm and overgrowth was 6 mm. The only factor associated with unacceptable shortening was shortening > 15 mm at the time of spica cast application. We believe that close follow-up during the first 3 weeks after cast application is important in order to achieve an acceptable final outcome. On the other hand this method of treatment is simple, safe and effective. It dramatically decreases hospital stay and cost of treatment and allows rapid return of the patients to their family environment.

Mathematical model governing laser-produced dental cavity

Formation of dental cavity may be improved by using a laser beam. This provides nonmechanical contact, precise location of cavity, rapid processing and increased hygienity. Further examination of interaction mechanism is needed to improve the application of lasers in density. Present study examines the tenperature rise and thermal stress development in the enamel during Nd YAG laser irradiation. It is found that the stresses developed in the enamel is not sufficiently high enough to cause crack developed in the enamel.