Gökhan Karademir

Hip fractures in patients older than 75 years old: Retrospective analysis for prognostic factors

BACKGROUND Proximal femoral fractures are often seen in older patients and are associated with high mortality. Introduction to old age population is latening due to advancements in medical sciences and increasing life expectancy. OBJECTIVES The aim of the study was to evaluate factors affecting mortality in patients above 75 years of age who had been operated because of proximal femur fractures. PATIENTS AND METHODS Patients with age 75 and over who suffers from post-fall proximal femoral fracture who underwent surgery with one of following three methods (hemiarthroplasty, proximal femoral nail or total hip arthroplasty) were evaluated retrospectively. Effects on mortality were examined for factors such as type of surgery, type of anesthesia, preoperative ASA score (American Society of Anesthesiologists Score), need for intensive care, need for blood transfusion, operation waiting time and hospitalization duration. 115 patients who met inclusion criterion were included in the study out of 224 overall. 75 patients were women and 40 were males. RESULTS Mortality rate after first year was found to be 40%. Patients over 85 years old had higher rates of mortality (p = 0,0003) than respectively younger patients (75-85). Sex was found to have no impact on mortality (p = 0.5039). There was no statistically significant difference in terms ASA score (p = 0.1518). Order of applied surgical methods with mortality risk rates was found to be total hip arthroplasty > hemiarthroplasty > proximal femoral nail (p = 0.0003). Type of anesthesia, the use of cement during arthroplasty, operation waiting time and hospitalization duration was not directly related with mortality rate (type of anesthesia p = 0.63, the use of cement during arthroplasty p = 0.223, operation waiting time p = 0.5 and hospitalization duration p = 0.19). CONCLUSIONS Age is the primary risk factor on first year mortality in patients older than 75 years old with hip fractures. Addition to older age, more need to blood transfusions, and arthroplasty are other risk factors for first year mortality. It should be kept in mind that after 75 years old first year mortality may be higher if the patient is treated with arthroplasty.

Pediatric open elbow dislocation without fracture: A case report.

INTRODUCTION Elbow dislocations in children are rare injuries. These injuries are often in the form of complex injuries that is accompanied by the median nerve damage and medial epicondyle fracture in the pediatric age group. Open elbow dislocation without fracture in the pediatric age group has been reported very rarely in the literature. PRESENTATION OF CASE The purpose of this study is to present an 8-year-old patient who has open elbow dislocation without fracture accompanying with brachial artery injury. In the clinical examination of the patient, there was an open wound in the transverse antecubital region. After repair of brachial artery injury, open reduction was performed under general anesthesia. In the postoperative clinical examination at 6 months, left elbow flexion was 140°, extension was full and there were no deficit in the supination and pronation of the forearm. DISCUSSION Elbow dislocation without fracture in pediatric patients is a very rare injury. Usually the trauma mechanism of elbow dislocation is falling on outstretched hand with elbow in approximately 30° of flexion. However our patient had fallen on outstretched hand with elbow in full extension. Although this type of trauma mechanism is typical for supracondylar humerus fractures in pediatric age group, in our patient an open posterior elbow dislocation without fracture had occurred. CONCLUSION Pediatric elbow dislocations are rare injuries and the management of these injuries can be technically demanding due to concurrent neurovascular injuries. An open dislocation without fracture is very rare and it should be treated with immediate intervention, an effective teamwork and good rehabilitation.

Patient compliance with touchdown weight bearing after microfracture treatment of talar osteochondral lesions

BackgroundThe aim of this study was to prospectively evaluate the compliance of our patients with a touchdown weight bearing (without supporting any weight on the affected side by only touching the plantar aspect of the foot to the ground to maintain balance to protect the affected side from mechanical loading) postoperative rehabilitation protocol after treatment of talar osteochondral lesion (TOL).MethodsFourteen patients, who had been treated with arthroscopic debridement and microfracture, were followed prospectively. The patients were evaluated for weight bearing compliance with using a stationary gait analysis and feedback system at the postoperative first day, first week, third week, and sixth week.ResultsThe mean visual analog scale (VAS) scores of the patients at the preoperative, postoperative first day, first week, third week, and sixth weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. The decrease in VAS scores were statistically significant (p < 0.0001). First postoperative day revealed a mean value of transmitted weight of 4.08% ±0.8 (one non-compliant patient). The mean value was 4.34% ±0.8 at the first postoperative week (two non-compliant patients), 6.95% ±2.3 at the third postoperative week (eight non-compliant patients), and 10.8% ±4.8 at the sixth postoperative week (11 non-compliant patients). In the analysis of data, we found a negative correlation between VAS scores and transmitted weight (Kendall’s tau b = −0.445 and p = 0.0228).ConclusionsAlthough patients were able to learn and adjust to the touchdown weight bearing gait protocol during the early postoperative period, most patients became non-compliant when their pain was relieved. To prevent this situation of non-compliance, patients should be warned to obey the weight bearing restrictions, and patients should be called for a follow-up at the third postoperative week.

Analysing the change of sagittal balance in patients with Lenke 5 idiopathic scoliosis

Objective The aim of this study was to evaluate preoperative and postoperative spinopelvic parameters and the influence of lowest instrumented vertebrae on sagittal parameters in Lenke 5 Adolescent Idiopathic Scoliosis (AIS) patients. Methods A total of 42 patients (37 females, 5 males; mean age: 16.71 ± 3.46 years) were included in the study. Preoperative and postoperative last follow up lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), pelvic incidence (PI) and sacral slope (SS) angles measured. By stopped fusion in L3, L4 or L5 we divided the group into three parts. Results Mean follow-up was 43 months. Preoperatively, the mean TK and LL were 36.8° and 55.3°. At the last follow up, the mean TK and LL were 27.1° and 49.0° degrees, respectively. Preoperatively, the mean PI, PT and SS were 53.3°, 16.1° and 37.4° degrees. At the last follow up, the mean PI, PT and SS were 52.7°, 19.9° and 33.0° respectively. Significant differences were observed for SS (p = 0.003), TK (p = 0.004), LL (p = 0.012) and PT (p = 0.013) postoperatively for all patients. According the L3 and L4 groups there is significant difference in SS, LL (p = 0.013) and PT (p = 0.018) which means a significant decrease occurs in SS and LL when the distal fusion level changes from L3 to L4 but significant increase in PT in L3 group to compensate spinopelvic change after surgery. Conclusion The selection of more distal level for fusion adversely affects the compensation mechanisms of sagittal balance in Lenke 5 AIS patients. Level of Evidence Level IV, Therapeutic study.

Adolescent Anterior Inferior Iliac Spine Avulsion Fracture Operative Treatment: A 14-Year Follow-Up Case Report

Objectives: Pelvic apophysis injuries are generally seen in adolescents and encountered in the form of avulsion fractures which occur with the short-term contractions of the muscles that hold apophysis, following a trauma. In general the iliac crest, the anterior superior iliac spine (ASIS) and the pubic bone fractures are frequently seen but anterior inferior iliac spine (AIIS) fractures are rare. These cases are often treated conservatively, surgical treatment is rarely necessary. In this presentation, AIIS avulsion fracture case that had undergone surgery and had been followed for 14 years was aimed to be stated. Methods: 16 year old male patient who was suffering from sports injuries that happened 40 days ago was admitted to our clinic in February 2000 with complaints about left hip and groin pain. Physical examination and radiographic evaluation of the patient identified left hip AIIS avulsion fracture. Due to more than 2 cm fracture fragment displacement and the patient being a professional football player who had high functional expectations, surgical treatment was planned. Under general anesthesia, after open reduction, internal fixation was performed with 1 cannulated screw. There were no complications observed at follow-up. Patient returned to training at 3 months postoperatively. 14 years after surgery, the patient admitted to a neurologist with complaints of headache and MRI was required to establish the cause. The patient admitted to our clinic in order to get the confirmation whether his implant was MRI compatible. Results: On clinical assessment, after 14 years, the patient didn’t have any complaints at left hip. Left hip flexion was 120°, extension was full, abduction was 40°, adduction was 20°, flexion internal rotation was 30° and flexion external rotation was 40°. Radiographs of the pelvis were normal. On the patients functional assessment, modified Harris Hip Score was 100. Conclusion: Pelvic apophysis injuries are rare injuries seen in adolescents usually as avulsion fractures. These injuries are often treated conservatively however may require surgical treatment for professional athletes with a high functional expectations. In this patient who underwent surgery, at the end of the 14-years long follow-up, functional results were found to be close to perfect.

Treatment of Intraarticular Joint Fractures of the Lower Extremity with External Fixators

Treatment of Distal Femur Intra-articular Fractures with Ilizarov Circular External Fixator Distal femoral fractures constitute 3–7% of all femoral fractures. The degree of intra-articular fractures varies from simple split fractures to wide intra-articular and fragmented fractures extending to the metaphysis. These fractures may be the result of high-energy trauma or a simple fall from a standing height. The amount of fragmentation is determined by the energy causing the fracture and by the individual’s bone quality. The age groups which have peak frequency of these injuries are elderly females and young males. In elderly patients, fractures more commonly occur as a result of indirect forces and result in a multi-fragmentary metaphyseal fracture and possible intra-articular extension. High-energy mechanisms may have quite complex articular involvement. These high-energy fractures may be seen together with fractures in other areas.

Does pedicle screw density matter in Lenke type 5 adolescent idiopathic scoliosis

Abstract The aim of this study is to compare the effects of high versus low implant density on correction in Lenke type 5 adolescent idiopathic scoliosis (AIS) patients. A retrospective study of 59 Lenke type 5 AIS patients treated at a single institution were divided into to 2 groups according to implant density. Implant density, preoperative, early postoperative, and last follow-up thoracolumbar/lumbar (TL/L) curves were measured. Thirty-one constructs were high and 28 constructs were low density. The groups were similar in terms of age, sex, Cobb angle, and follow-up time. Mean implant density in low density group and high density group was 75.4% and 96.6%, respectively. High versus low-density comparison showed that there is no significant difference with regard to curve correction in early postoperative and last follow-up periods. The results show that pedicle screw density being low or high, does not affect curve correction rates in the short and long term in our patients.

The great mimicker at thoracolumbar spine: Non-Hodgkin’s lymphoma

Highlights • Non-Hodgkin’s lymphoma’s vertebral involvement is quite common.• Diagnosis of the non-Hodgkin’s lymphomas that are localized in thoracolumbar spine often is missed or is delayed.• It was purposed to report two cases with non-Hodgkin’s lymphoma in thoracolumbar spine with different presentation.

Ipsilateral olecranon and distal radius fracture: A case report

Highlights • Concomitant ipsilateral olecranon and distal radius fracture are rare injuries.• A combination of ipsilateral olecranon and distal radius fractures in the same arm have been reported in a few patients worldwide indicating that this is an extremely rare trauma.• In addition, successful simultaneous treatment of these injuries increases the value of the article too.