Halil Burç

Comparison of Lag Screw Versus Buttress Plate Fixation of Posterior Malleolar Fractures

Background: The goal of this study was to report the results of selective open reduction and internal fixation of fractures of the posterior malleolus with a posterolateral approach and to compare the results of the 2 techniques. Methods: We prospectively evaluated 40 patients who underwent posterior malleolar fracture fixation between 2008 and 2012. The patients were treated with a posterolateral approach. We assigned alternating patients to receive plate fixation and the next screw fixation, consecutively, based on the order in which they presented to our institution. Fixation of the posterior malleolus was made with lag screws in 20 patients and a buttress plate in 20 patients. We used American Orthopaedic Foot and Ankle Society (AOFAS) scores, range of motion (ROM) of the ankle, and radiographic evaluations as the main outcome measurements. The mean follow-up was 38.2 (range, 24-51) months. Results: Full union without any loss of reduction was obtained in 38 of the 40 patients. We detected a union with a step-off of 3 mm in 1 patient in the screw group and a step-off of 2 mm in 1 patient in the plate group. At the final follow-up, the mean AOFAS score of the patients regardless of fixation type was 94.1 (range, 85-100). The statistical results showed no significant difference between the patients regardless of the fixation type of the posterior malleolus in terms of AOFAS scores and ROM of the ankle (P > .05). Conclusions: Good (AOFAS score of 94/100) and equivalent (within 3 points) results were obtained using the 2 techniques (screws or plate) for fixation after open reduction of posterior malleolar fragments. Level of Evidence: Level II, prospective case series.

Can radiation exposure to the surgeon be reduced with freehand pedicle screw fixation technique in pediatric spinal deformity correction? A prospective multicenter study.

Study Design. Prospective multicenter study of patients who underwent pediatric spinal deformity correction with posterior spinal fusion and instrumentation. Objective. To quantify radiation exposure to the surgeon during pedicle screw fixation using the freehand technique in pediatric spinal deformity surgery. Summary of Background Data. Pedicle screw placement in thoracic and lumbar spine for spinal deformity is technically demanding and involves radiation exposure. Many experienced spinals surgeons use the freehand technique for pedicle screw fixation in spinal deformity surgery. There are no studies analyzing radiation exposure to the surgeon regarding freehand pedicle screw fixation technique. Methods. A prospective multicenter study was designed to evaluate radiation exposure to the operating spinal surgeon who uses the freehand pedicle screw fixation technique in pediatric spinal deformity correction. All of the operating surgeons placed a gamma radiation dosimeter on their chest outside the lead apron during surgery. Surgeons placed pedicle screws in the pediatric spinal deformity using the freehand technique. We included patients who had undergone correction with posterior spinal fusion and instrumentation with all pedicle screw constructs in this study. Results. We analyzed 125 patients with pediatric spinal deformity who were operated on between 2008 and 2012. The average fluoroscopic time was 40.5 ± 21 seconds. The overall average fluoroscopic time for placement of a single pedicle screw and per fixation level were 2.6 ± 1.7 seconds and 3.9 ± 2.5 seconds, respectively. In each surgery, the recorded radiation exposure to the surgeon was less than the minimum reportable dose (<0.010 mSv) with an average of 0.0005 ± 0.00013 mSv per surgery. Conclusion. The use of freehand technique for pedicle screw fixation in spinal deformity correction requires a minimum amount of fluoroscopic use, hence decreasing radiation exposure to the surgeon and patient. Level of Evidence: 4

Effect of Pentoxifylline on Spinal Fusion: An Experimental Study in Rabbits

Study Design. Randomized, double-blinded, animal model. Objective. The objective of this study is to evaluate the effect of pentoxifylline (PTX) on spinal fusion in a rabbit model. Summary of Background Data. Previous studies assert that PTX increases new bone formation. Because PTX seems to have these profound effects on bone metabolism, it may be hypothesized that it may enhance spinal fusion. Methods. Twenty-four New Zealand white rabbits were randomized and each received single-level posterolateral, inter-transverse process fusion with autologous iliac crest. In group 1, 12 male New Zealand white rabbits were treated with intravenous PTX treatment in 100-mg/kg/day dose after the surgical procedure. In group 2, 12 received no PTX medication and were accepted as the control group. Nine weeks after surgery, the animals were killed. The spines were tested via a manual palpation test, biomechanical testing, plain radiography, computed tomographic scans, and histomorphometric analysis. Results. The fusion rates of manual palpation were 40% in the control group and 80% in the PTX group (P = 0.17). Using a 5-grade radiographical system, the mean fusion grade was 2.4 in the control group and 3.1 in PTX group (P = 0.012). Total displacement of the fused level for the control group under flexion and extension was 0.2515 mm and was lower for the PTX-treated group: 0.1266 mm (P = 0.012). In the control group, the mean bone volume of the fusion mass determined from computed tomographic analysis was 4.0678 cm3, whereas in the PTX group it was 4.7802 cm3 (P = 0.009). The mean trabecular bone area was 14% and 19% for the control and PTX groups, respectively (P = 0.002). Conclusion. The differences between groups was statistically significant in terms of radiological fusion grading, biomechanical testing, volume of the fusion mass, and percentage of trabecular bone area. These results suggest that PTX may have a beneficial effect on spinal fusion. Level of Evidence: 2

SEREBRAL PALSİ'YE BAĞLI AYAK VARUS DEFORMİTELERİNDE KOMBİNE TİBİALİS ANTERİOR TENDONU SPLİT TRANSFERİ VE TİBİALİS POSTERİOR TENDONU'NUN İNTRAMUSKÜLER UZATILMASI SONUÇLARI

Results of combined split transfer of tibialis anterior tendon and intramuscular lengthening of tibialisposterior tendon for foot varus deformity because of cerabral palsyAim: The aim of the study is represent 3 years follow-up results after split transfer of tibialis anterior tendonand intramuscular lengthening of tibialis posterior tendon together for foot varus deformity due to cerabralpalsy. Patients and Method: Twelve patients who have foot varus deformity due to cerebral palsy wereincluded in the study between 2008-2012 prospectively. Mean age was 8.1. Secondary to combined splittransfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon percutaneousachilles lengthening for 9 patients and open achilles lengthening for 2 patients were applied simultaneously.Functions and clinical results were evaluated according to AOFAS (American Orthopaedic Foot and AnkleSociety) score and Kling et al scoring system respectively. Results: Mean follow-up was 29.3 months. Accordingto Kling et al score 7 patients were excellent, 4 were good and 1 were poor. Patients with excelent and goodresults had platigrade posture. Operated 17 feet at 12 patients had mean preop and last follow-up AOFASscore were 35.8 and 81.4 respectively. The diffence was statistically significant (p=0.023). Discussion: Combined split transfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon methodhas found as an effective technique for dynamic varus foot deformity of cerebral palsy during both stanceand swing phase of gait

Is Scintigraphy a Guideline Method in Determining Amputation Levels in Diabetic Foot

BACKGROUND In this study, we aimed to evaluate the potential use of a 3-phase bone scintigraphy method to determine the level of amputation on treatment cost, morbidity and mortality, reamputation rates, and the duration of hospitalization in diabetic foot. METHODS Thirty patients who were admitted to our clinic between September 2008 and July 2009, with diabetic foot were included. All patients were evaluated according to age, gender, diabetes duration, 3-phase bone scintigraphy, Doppler ultrasound, amputation/reamputation levels, and hospitalization periods. Patients underwent 3-phase bone scintigraphy using technetium-99m methylene diphosphonate, and the most distal site of the region displaying perfusion during the perfusion and early blood flow phase was marked as the amputation level. Amputation level was determined by 3-phase bone scintigraphy, Doppler ultrasound, and inspection of the infection-free clear region during surgery. RESULTS The amputation levels of the patients were as follows: finger in six (20%), ray amputation in five (16.6%), transmetatarsal in one (3.3%), Lisfranc in two (6.6%), Chopart in seven (23.3%), Syme in one (3.3%), below-the-knee in six (20%), above the knee in one (3.3%), knee disarticulation in one (3.3%), and two patients underwent amputation at other centers. After primary amputation, reamputation was performed on seven patients, and one patient was treated with debridement for wound site problems. No mortality was encountered during study. CONCLUSIONS We conclude that 3-phase bone scintigraphy prior to surgery could be a useful method to determine the amputation level in a diabetic foot. We conclude that further, comparative, more comprehensive, long-term, and controlled studies are required.

KORTİKOSTEROİD ENJEKSIYONUNA DİRENÇLİ KRONİK LATERAL DİRSEK EPİKONDİLİTİ OLGULARINDA TROMBOSİTTEN ZENGİN PLAZMA (TZP) UYGULAMALARININ SONUÇLARI

Results of Platelet-Rich Plasma (PRP) Applications for Chronic Lateral Elbow Epicondylitis That are Resistantto Corticosteroid Injections.Aim: The main goal of the study is to present 1-year follow-up results of patients with chronic lateralepicondylitis that are resistant to corticosteroid injections in whom we applied platelet rich plasma (PRP).Material and Methods: We applied PRP once to the patients who did not benefit from corticosteroid injections.We prospectively evaluated patients between 2010 and 2012. We evaluated patients with visual analog score(VAS) and patient rated tennis elbow evaluation (PRTEE) score at the pre-treatment once, post-treatment1st, 3rd, 6th and 12th month follow-ups. Results: Nine patients were female, three was male. The mean ageof patients was 48.6. The average pre-treatment VAS and PRTEE scores were 8.7 and 83 respectively. Theaverage VAS scores improved to 6.6, 3.8, 1.85, 1.47 at the post-treatment 1st, 3rd, 6th, and 12th month followups respectively. The average PRTEE scores improved to 61.3, 34.9, 19.8, 17.9 at the post-treatment 1st, 3rd,6th and 12th month follow-ups respectively. At the 12th month follow-up, six patients rated their treatmentas excellent, five as good, and one as poor. Discussion: There are promising results in the literature regardingPRP applications for lateral epicondylitis, plantar fasciitis, and chondral lesions. In this study, we observedthat pain and function scores of patients that are resistant to corticosteroid injections improved after PRPapplication