Ismet Tan

Central acetabular fracture-dislocation following electroconvulsive therapy: report of two similar cases.

Acetabular fracture-dislocations usually occur as a result of high velocity trauma. Such fractures following electroconvulsive therapy are extremely rare. In this report, two similar cases of acetabular fractures and central fracture-dislocations following ECT are presented. This rare complication could be eliminated easily by using short-acting anaesthetic agents and muscle relaxants.

Arthroscopy of the knee in pre-adolescent children

Introduction: Arthroscopic operations performed in the pediatric age group constitute less than 5% of all arthroscopies. Diagnostic accuracy is reported to be lower than the procedures in adult patients. The incidence of pathologies also varies in the literature. We aimed at assessing the diagnostic accuracy of arthroscopy and review the incidence of pathologies in pre-adolescent patients. Materials and methods: In the period April 1990–January 2002, 50 pre-adolescent patients underwent knee arthroscopy after clinical and radiological assessment. Average age was 10.24 (1–13) with a male-to-female ratio of 34:16. Results: Discoid lateral meniscus was found to be the most common pathology encountered in 17 cases followed by infection and synovitis in 8 cases each. Diagnostic accuracy of arthroscopy correlated with preoperative clinical and radiologic evaluation was 90%. Arthroscopy findings were negative in two cases. Two cases of plica syndrome and one case of chondral injury were mistaken for medial meniscal tear. Final diagnosis was familial Mediterranean fever in one case of synovitis and knee fusion was performed at follow-up due to progressive degenerative changes. No other patient required reoperation. Conclusion: Arthroscopy is a safe procedure with minor morbidity allowing treatment of various intraarticular knee disorders. Diagnostic accuracy of the procedure may increase with careful preoperative work-up.

Functional outcomes of minimal invasive percutaneous plate osteosynthesis (MIPPO) in humerus shaft fractures: a clinical study

OBJECTIVE We aimed to evaluate the objective and subjective outcomes of humerus shaft fractures treated with minimal invasive percutaneous plate osteosynthesis and emphasize points which may enhance clinical outcomes and simplify the procedure. METHODS The retrospective study included 14 patients (mean age: 41.7 years; range: 19 to 66 years) with humerus mid-shaft fractures treated with the MIPPO technique between 2009 and 2011. 4.5-mm locking plates were applied via an anterior approach and advanced antegradely (proximal to distal) to protect the integrity of the deltoid insertion. Fracture healing was evaluated using plain radiographs. OBJECTIVE outcomes were assessed in terms of range of motion and subjective outcomes using the American Shoulder and Elbow Society (ASES), University of California, Los Angles (UCLA), Mayo Elbow Performance Index (MEPI) and The Disability of The Arm, Shoulder and Hand (DASH) scores. RESULTS Satisfactory outcomes with successful union were obtained within a mean of 17.8 (range: 13 to 30) months. While the average active forward flexion of shoulder was 163.9°±5.6°, the mean abduction was 87.8°±3.77°. Mean elbow flexion and extension loss was 134.6°±41.16° and 3.9°±6.25°, respectively. Mean ASES and UCLA scores were 90.2±4.76 and 31.8±1.56 and mean MEPI and DASH score were 93.6±4.12 and 4.6±2.19, respectively. CONCLUSION Minimal invasive percutaneous plate osteosynthesis appears to be a successful technique for the treatment of humerus shaft fractures. The procedure may be simplified and outcomes improved by engaging the plate with the anterior surface of the humerus during advancement, antegrade advancement of the plate to protect deltoid insertion and using of a minimum of 6 cortices for each side of the fracture to provide stable fixation.