Hakan Kinik

Management of distal humerus fractures in adults.

Abstract From January 1992 to May 1997, 46 distal humeral fractures were treated by open reduction and internal fixation. Among these, 30 were intra-articular, which were managed by the transolecranal approach, routine ulnar nerve transposition, 3.5-mm dual-plate fixation and early active mobilisation. We encountered 2% non-union, 2.2% fixation failure, 11.1% nerve complications, 28.2% overall heterotopic ossification and 11.1% poor range-of-motion rates.

The contribution of vitamin C to healing of experimental fractures.

Abstract The benefits of various minerals and vitamins on fracture healing have been demonstrated in animal models. Vitamin C is an essential substance in fracture healing but has not been studied previously on an experimental basis. Sixteen rats were grouped randomly into control and vitamin C-supplemented groups. The right tibias of all rats were fractured by digital manipulation. One group received single high dose of vitamin C intramuscularly. On the 5th, 10th, 15th, and 20th days, two rats from each group were killed and the tibias examined under light microscopy. It was seen that the vitamin C-supplemented group went through the stages of fracture healing faster compared with the control group.

Medial subtalar dislocation

Abstract We report a medial subtalar dislocation without fracture in an eighteen year old male injured during basketball game. He was succesfully treated with closed reduction and cast immobilization. At one year follow-up he was symptomless.Résumé Nous rapportons une luxation sous-astragalienne interne sans fracture, survenue au cours d’un jeu de basket-ball chez un homme de 18 ans. Il a été traité avec succès par réduction fermeé et immobilisation plâtreée. Au délais d’un an, il était asymptomatique.

Comparison of prilocaine and bupivacaine for post-arthroscopy analgesia: A placebo-controlled double-blind trial

Arthroscopic surgery requires early postoperative analgesia for early discharge and early rehabilitation of patients. To accomplish the effectiveness of intraarticular application of local anesthetics, a placebo-controlled double-blind trial was performed. Results were evaluated using the visual analog scale on a blind basis. The mean pain scores were generally lower in the bupivacaine group than in the control or prilocaine group. There were no statistically significant differences between the oral intake of analgesics and the level of analgesia obtained in all three groups. We consider the local application of analgesics to be ineffective for post-arthroscopy analgesia.

Venous thromboembolism prophylaxis in major orthopaedic surgery: A multicenter, prospective, observational study

OBJECTIVES We investigated risk factors for venous thromboembolism (VTE), prophylaxis measures employed, and incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing major orthopaedic surgery (MOS). METHODS An open, multicenter, prospective, observational study was conducted in 21 medical centers, comprising 899 patients. Of these, 316 patients (35.2%) underwent total hip arthroplasty (THA), 328 patients (36.5%) underwent total knee arthroplasty (TKA), and 255 patients (28.4%) underwent surgery for hip fractures (HF). Pharmacologic prophylaxis was employed in all the patients. RESULTS Risk factors for VTE were seen in 73.2% of the patients, the most common being obesity (72%) and prolonged immobilization (36.3%). Low-molecular-weight heparin (91.1%) and fondaparinux (8.9%) were used for prophylaxis, which was short-term in 273 patients (30.4%) and long-term in 626 patients (69.6%). Mechanical prophylaxis was performed with compression stockings in 610 patients (67.9%) and by intermittent pneumatic compression in 67 patients (7.5%). During three-months of follow-up, symptomatic DVT and PE were seen in eight (0.9%) and four patients (0.4%), respectively. Mortality occurred in 10 patients (1.1%). Complications of major and minor bleeding were seen in eight (0.9%) and 40 (4.5%) patients, respectively. CONCLUSION Effective VTE prophylaxis is associated with low risk of clinically apparent DVT and PE in MOS.

Self-locking tension band technique. A new perspective in tension band wiring.

Abstract After experiencing some complications with the AO modified tension band technique, we have made a small modification to prevent proximal migration of the Kirschner wires. In this modification, the proximal ends of the wires are bent to form a loop and the cerclage wire passed through them. In this way, Kirschner wires and cerclage wire lock each other, preventing migration. We have treated 51 patients with this technique, including ¶22 transverse patellar, 11 olecranon, 3 medial and 5 lateral malleolar fractures, 3 acromioclavicular separations, 4 olecranon chevron osteotomy fixations and 3 trochanter major fixations. Fracture union occurred in 8 weeks (mean). We did not see any postoperative complications or implant failures. Rigid fixation allows early mobilization which quickly restores functional status.

Self locking tension band technique in transverse patellar fractures

Summary. Following tension band wiring of fractures of the patella, proximal K-wire migration is a common complication. To prevent this we have devised the ‘self locking tension band’ technique. The proximal K-wire ends are bent to form a loop and the cerclage wire passed through them. This prevents subsequent migration of the K-wires. We have treated 15 fractures using this technique. At a mean follow up of 30 months, no postoperative complications were found.Résumé. La migration proximale des broches de Kirschner-certainement dûc à une mobilisation précoce- n’est pas une complication rare de l’ostéosynthèse par la technique du haubannage dans le traitement des fractures transversales de la rotule. Pour éviter cette complication, nous avons légèrement modifié la technique originale. L’extrêmité proximale des broches est recourbée en anneau dans lequel passe le fil de cerclage. Ainsi le cercle et les broches se verrouillent mutuellement. Entre Septembre 92 et Septembre 95, nous avons ainsi traité 15 patients. Le suivi moyen est de 30 mois et les résultats prometteurs.

Slipped capital femoral epiphysis in osteopetrosis: an unusual case

Abstract. We report on a 9-year-old boy who has type II autosomal dominant osteopetrosis associated with a chronic grade II slipped capital femoral epiphysis. He was treated with a single cannulated screw. This rare association has been reported only once.

Orthotic variations in the management of infantile tibia vara and the results of treatment

Background: Infantile tibia vara is an acquired form of tibial deformity associated with tibial varus and internal torsion. Several methods have been described for orthotics treatment. The purpose of this study was to determine the effectiveness of orthotics treatment in infantile tibia vara. Study design: Controlled trial. Objective: The aim of this study was to compare the effect of different types of orthoses and correction methods on decreasing the curve in children with severe genu varum. Methods: Three different types of knee–ankle–foot orthoses were applied to 35 lower extremities of 22 pediatric participants who were 19–38 months of age. The same orthotic design principles were used to correct the femur, while different designs were applied to correct the tibia. The orthoses used on 20 participants were evaluated for differences among them and their effects on the treatment process. In addition, methods used in the treatment, problems encountered, production of different types of orthoses, convenience of application of the orthoses, and degree of patients satisfaction are discussed in this article. Results: The mean duration of treatment of the participants until completion of treatment was 25.3 ± 9.7 weeks with a minimum of 9 weeks and a maximum of 41 weeks. No statistically significant correlation was found between the duration of orthotic use in patients with a successful outcome and percentile height and percentile weight. When the duration of treatment using the different types of orthoses was analyzed, significant differences were found between Type 1 and Type 2, and Type 1 and Type 3 orthoses (p < 0.05), while no difference was observed between Type 2 and Type 3 orthoses (p > 0.05). Conclusion: We found that bracing is an effective form of treatment for infantile tibia vara up to 38 months of age. We conclude that full-time use of knee–ankle–foot orthoses exerting corrective forces from five points along the full length of the limb was effective. Clinical relevance: The localization of the distal tibial correction, the quality of the midtibial correction band, and the importance of the application of corrective forces from five points with rigid methods were found.

Elbow Orthosis to Re-establish Elbow Extension Motion

This study describes a uniaxial elbow orthosis designed at Ankara University Department of Prosthetics and Orthotics as a custom-molded orthosis to improve elbow extension. Five children with post-traumatic elbow flexion contracture were treated using the static progressive elbow orthosis for a mean of 2.2 ± 0.8 months. None of the patients received any physical therapy or surgical treatment for flexion contracture. At the 18-month follow-up evaluation, the median correction was measured at 35° in active extension limitation and 15° in passive extension limitation. The findings show that the elbow orthosis is a safe and effective treatment to consider for children who present with elbow flexion contracture.