Hakan Gürbüz

The effects of osteoporosis on functional outcome in patients with distal radius fracture treated with plate osteosynthesis.

OBJECTIVE The aim of this study was to evaluate the effect of osteoporosis on functional results in patients with distal radius fracture treated with plate osteosynthesis. METHODS The study included 37 female patients who underwent osteosynthesis using volar locking plate for distal radius fracture between 2006 and 2008. Diagnosis of osteoporosis was made with bone mineral density measurement. Patients were divided into two groups; Group 1 patients (20 patients; mean age: 56.5 years) had osteoporosis and a mean T-score of -2.6 SD, and Group 2 patients (17 patients; mean age: 37.1 years) did not have osteoporosis and had a T-score of -0.7 SD. Radiological results were evaluated according to the Stewarts criteria and activities of daily living were assessed with the modified Gartland and Werley score, the modified Mayo wrist scoring system, and the DASH scoring system. RESULTS According to the Stewarts radiological evaluation criteria and modified Gartland and Werley scores, there was no statistically significant difference between Group 1 and 2 (p>0.05). However, a statistically significant difference was found between Group 1 and 2 according to the modified Mayo wrist scoring system and DASH scoring system (p<0.05). CONCLUSION There was no radiological difference between the osteoporotic and non-osteoporotic patients with distal radius fractures treated with plate osteosynthesis. However, osteoporosis had a negative effect on the results and range of motion of the wrist, and activities of daily living were significantly restricted.

Anterograde Headless Cannulated Screw Fixation in the Treatment of Medial Malleolar Fractures: Evaluation of a New Technique and Its Outcomes.

Objective: To evaluate the functional and radiological outcomes of anterograde headless cannulated screw fixation for medial malleolar fractures. Subjects and Methods: This study included 12 patients (8 males, 4 females; age 27-55 years) with medial malleolar type B fractures according to the Herscovici fracture classification who had undergone anterograde headless cannulated screw fixation surgery between 2012 and 2014. Seven had an isolated medial malleolar fracture and 5 a bimalleolar fracture. All of the bimalleolar fractures were classified as 44-B2 based on the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification. Postoperatively, bone union was evaluated on direct radiographs at the final follow-up examination. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used for clinical evaluation. Results: The mean follow-up period was 17.2 ± 5.3 months (range 12-23). Full union was achieved in all fractures. The mean time to union was 3.4 ± 1.5 months (range 2-5). No instability, loss of reduction, non-union or infection was observed in any patient. The mean AOFAS score was 95.0 ± 5.4 (range 87-99). Based on the AOFAS score, 4 patients showed good results and 8 excellent results. The mean time to return to the previous level of activity was 4.0 ± 2.5 months (range 2-5). Conclusion: In this study, anterograde headless cannulated screw fixation yielded good clinical outcome in the surgical treatment of Herscovici type B fractures.

Infrapatellar Fat Pad Excision during Total Knee Arthroplasty Did Not Alter the Patellar Tendon Length: A 5-Year Follow-Up Study.

Abstract Partial or total resection of the infrapatellar fat pad (IPFP) helps surgeon improve access to lateral tibial plateau for better placement of the knee prosthesis. We aimed to investigate the effect of IPFP excision on clinical and radiologic outcomes including patellar tendon length (PTL), range of motion, and functional scores after total knee arthroplasty (TKA) at 5‐year follow‐up. We retrospectively evaluated postoperative first X‐rays (day 0) and postoperative final 5‐year control views of 228 knees in patients with primary osteoarthritis who underwent TKA between September 2006 and December 2009 in our hospital. Exclusion criteria were patients who had lateral release, patellar resurfacing, septic or aseptic loosening, fracture around the replaced knee, any other prior knee surgery, or any systemic inflammatory disease. IPFP was completely resected in all knees to enhance surgical exposure and patellar mobilization. Radiologic evaluation of PTL was performed in early postoperative and 5‐year control X‐rays comparatively. The mean early postoperative PTL was 47.4 ± 6 (range: 35‐72), the mean final postoperative PTL was 47 ± 6.3 (range: 33‐68) (p = 0.1). The average preoperative flexion was 115 ± 11 degrees, whereas it was 111 ± 4 degrees, postoperatively (p = 0.73). Both the clinical and functional outcome scores improved in all patients. IPFP excision during TKA did not alter PTL at 5‐year follow‐up. A focus on other surgical and/or host‐related factors may help clarify contradictory patellar tendon shortening reported in the literature.

Inferior hip dislocation after falling from height: A case report

Highlights • Traumatic inferior hip dislocations are high energy traumas with multiple organ damage.• Traumatic inferior hip dislocation is the least common of all hip dislocation.• The ischial type is more common than the obturator type.

Tratamento cirúrgico de fraturas em martelo por bloqueio da extensão com fio de Kirschner

OBJECTIVE: To evaluate the effectiveness of treating the mallet fracture with the Ishiguro extension block Kirschner wire method. METHODS: Thirty-eight patients were treated prospectively. The mean follow-up was 18 months and all patients were evaluated radiologically and clinically according to Crawford’s criteria. RESULTS: Union was obtained in all patients. The results obtained were satisfactory in 34 cases and unsatisfactory in four cases. CONCLUSION: We consider the extension block technique a safe and effective method that can be used in all mallet fractures. Level of Evidence IV, Case Series.Objective We use the extension block Kirschner wire method that orginated from Ishigura to treat mallet fracture and evaluate its efficiency. Methods 38 patients were treated prospectively. Mean follow-up was 18 months and all patients evaluated radiologically and clinically according to Crawfords criteria. Results Union was obtained in all patients. The results obtained were satisfactory in 34 cases, unsatisfactory 4 cases. Conclusion We think that extension block technique is a safe and effective method that can be used in all mallet fractures. Level of Evidence: Level IV, Case series.

Evaluation of the late neurologic deficits accompanied by hypertrophic scars and keloids in children with elbow fractures.

In this study, the relation between hypertrophic scar and keloid (HSc) lesions around incisions and late neurologic deficits was investigated in operated elbow fractures in children. Six elbow fracture patients with HSc lesions were evaluated for neurologic deficits with late onset. The fractures were all closed and treated with open reduction and internal fixation. No neurologic deficit was detected before surgery and in the early postoperative periods. Late neurologic deficits observed in these patients were evaluated according to British Medical Research Committee scoring scale on admission and after therapy. In the reoperations for neurologic deficits, the nerve segments were found to be compressed in intensive scar tissue. Typical pseudoneuromas were observed in the proximal part of compression; however, the corporal integrity of the nerves was not interrupted. External neurolysis were performed in all patients. Excellent improvements in sensory and motor functions were detected and no recurrence occurred in follow-up. Elbow fracture patients, especially those with HSc lesions around their incisions, should be followed up for possible neurologic deficits with late onset.

High Varus Angle and Lower Posterior Tibial Slope Associated with PCL Injury in Cruciate Retaining Total Knee Arthroplasty: An MRI Study

Abstract The posterior tibial slope (PTS) is important for performing a tibial cut that does not injure the posterior cruciate ligament (PCL). In this study, the amount of PCL fibers sacrificed under simulated tibial cuts with varying posterior inclinations was evaluated using magnetic resonance images (MRIs) of osteoarthritic varus knees. Knee X‐rays, orthoroentgenograms, and MRIs of 113 Kellgren and Lawrence grades 3 to 4 osteoarthritic knees were included. Four different simulated tibial cuts were performed at 0, 3, 5 degrees and parallel to the tibia plateau 3 mm below of the most defective part of the cartilage in the medial plateau. Correlations between the PCL avulsion amount and the PTS and varus alignment of the lower extremity were analyzed for all four simulated tibial cut levels. The maximum amount of PCL was preserved with a 0‐degree tibial cut in patients with a PTS of more than 8 degrees. With increased tibial cut angles, the posterior slope resulted in an increased amount of avulsed PCL. Although the amount of avulsed PCL was proportional with the varus alignment, it was inversely proportional with the sagittal slope. The number of injured PCLs also increased as the slope of the tibial cuts increased. Patients with mild varus alignments and high PTSs are more suitable for cruciate retaining total knee arthroplasty.

Surgical treatment of mallet fractures by extension block Kirschner wire technique surgical treatment of mallet fractures.

OBJECTIVE: To evaluate the effectiveness of treating the mallet fracture with the Ishiguro extension block Kirschner wire method. METHODS: Thirty-eight patients were treated prospectively. The mean follow-up was 18 months and all patients were evaluated radiologically and clinically according to Crawford’s criteria. RESULTS: Union was obtained in all patients. The results obtained were satisfactory in 34 cases and unsatisfactory in four cases. CONCLUSION: We consider the extension block technique a safe and effective method that can be used in all mallet fractures. Level of Evidence IV, Case Series.Objective We use the extension block Kirschner wire method that orginated from Ishigura to treat mallet fracture and evaluate its efficiency. Methods 38 patients were treated prospectively. Mean follow-up was 18 months and all patients evaluated radiologically and clinically according to Crawfords criteria. Results Union was obtained in all patients. The results obtained were satisfactory in 34 cases, unsatisfactory 4 cases. Conclusion We think that extension block technique is a safe and effective method that can be used in all mallet fractures. Level of Evidence: Level IV, Case series.

The relationship between morphometric parameters and Trendelenburg sign following the Hardinge incision

OBJECTIVES We evaluated the relationship between morphometric parameters such as height, weight, and body mass index with the development of the Trendelenburg gait following the Hardinge approach, which is one of the most commonly used approaches in total hip arthroplasty. METHODS The study included 59 patients (43 women, 16 men; mean age 55 years; range 37 to 74 years) who underwent total hip arthroplasty via the Hardinge approach for primary coxarthrosis. The patients were examined postoperatively at 15 days, and at the end of the first and third months. The mean follow-up period was 24.3 months (range 12 to 37 months). The height, weight, and body mass index values of the patients with and without a positive Trendelenburg sign were compared. RESULTS The Trendelenburg sign was positive in 19 patients (32.2%) following total hip arthroplasty with the Hardinge approach and persisted for a mean of 8.3 months (range 4-14 months). Patients with a positive Trendelenburg sign had a mean height of 157.4 cm (range 151 to 173 cm), mean weight of 82.5 kg (range 70 to 108 kg), and mean body mass index of 33.2 kg/m(2) (range 25.4 to 30.5 kg/m(2)). The corresponding figures in patients without a Trendelenburg sign were as follows: 166.3 cm (range 158 to 180 cm), 79.4 kg (range 72 to 94 kg), and 28.7 kg/m(2) (range 21.6 to 30.5 kg/m(2)). There was no significant difference between the two patient groups with respect to weight, but height and body mass index showed highly significant differences (p<0.0001). CONCLUSION Based on our finding that patients having a significantly shorter height and greater body mass index sustained Trendelenburg positivity for quite a long time, we recommend that these two factors be taken into consideration in the preoperative evaluation of patients for total hip arthroplasty with the Hardinge approach. Thus, the use of the Hardinge approach in total hip arthroplasty may not be convenient in short subjects having borderline obesity.

Mid-term functional results of surgically treated acetabulum fractures

The aim of the study was to evaluate the type of trauma, additional injury, age, additional diseases, need for ICU and blood transfusion, postoperative complications, mid-term patient satisfaction and hip functions of the patients who underwent surgical treatment for acetabulum fracture in our clinic. A total of 17 patients (15 males, 2 females, mean age 40,7 years ) who admitted to the emergency department between 2013 and 2016, and treated surgically due to acetabulum fractures were included in the study. According to Judet Letournel classification, 7 anterior wall fractures, 4 anterior column fractures, 3 posterior column fractures and 3 both column fractures were determined. Mean hospital stay was 14.5 days (range 3-45 days) and mean follow-up was 26 months (14 to 57 months). ICU needed in 3 (17.6%) cases, mean stay was 10.3 days (range 1-29 days). 6 (35.2%) patients required blood transfusion, mean amount was 4.1 units (range 2-6 units). Harris hip scores were excellent - good in 12 cases (70.5%) and 5 cases (29.5%) had moderate - poor results at 12th month. There was no statistically significant relationship between severity of trauma, type of injury, age, additional diseases, intensive care and blood transfusion requirements, postoperative complications and patient satisfaction (p> 0.05). In selected acetabular fracture cases with proper planning according to fracture type, in early period, surgery may lead to satisfactory results in terms of patient satisfaction and hip functions.