Mahir Gulsen

Angular shortening and delayed gradual distraction for the treatment of asymmetrical bone and soft tissue defects of tibia: a case series.

BACKGROUND Acute shortening is reported to be an effective method for the treatment of open fractures with bone and soft tissue defects. Little is known about primary skin closure with angulation to the side of the defect and distraction at the fracture site. METHODS We present a series of three cases treated for defective fractures of tibia by angular shortening and delayed gradual distraction with hinged circular external fixator. Two cases were type IIIB open fractures and one case was an infected nonunion. Bone and soft tissue defects were managed by adaptation of edges and primary skin closure with angulation to the side of the defect. Axial alignment was restored by gradual distraction after a 2 to 3 weeks interval. Residual limb length discrepancy was lengthened through a separate corticotomy in two cases. RESULTS Bone formation at both the fracture and corticotomy sites were sufficient to achieve union in all patients. Fixation time averaged 261 (182-392) days and average bone healing index was 42 days/cm. No further surgical intervention was necessary for soft tissue reconstruction after primary skin closure. Infection was eradicated in the case of infected nonunion. CONCLUSIONS Angular compression to the side of the defect is a safe and reliable method of treatment for asymmetrical bone or soft tissue defects of tibia. It eliminates the need for complex soft tissue reconstruction procedures. Unnecessary debridement of bone is prevented by angular adaptation of edges. Definitive treatment of complex injuries is possible with a circular external fixator.

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.

Comparison of mechanical performance among different frame configurations of the Ilizarov external fixator : Experimental study

The circular frame of the Ilizarov fixator can be modified to reflect anatomic variations and treatment aims. However, these modifications in the frame system cannot always achieve the mechanical performance of the standard frame system. A standard system has two rings in each bone fragment connected by four longitudinal bars on each side of the ring. In this study, the mechanical performances of one standard and eight modified frame systems were compared. Each system was loaded on a material testing machine, with calculation of axial compression, four-point bending, and torsion. As a result, systems that were modified with drop wires and Schanz screws 45 degrees oblique to the wires on the proximal ring provided a mechanical performance closer to the standard system than systems with other modifications.

Results of using Ilizarov distraction osteogenesis technique for the treatment of cubitus varus deformities in adults

IntroductionFive adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by the Ilizarov method of distraction osteogenesis.MethodA standard technique was applied in all patients. The average follow-up was 28 (range, 24–38) months. Preoperative carrying angle ranged from 12° to 22° of varus (average 16.6°) and postoperative carrying angle ranged from 10° to 14° of valgus (average, 11.6°) equalized to the contralateral side.ResultThe outcome was rated as excellent in all patients. No complication was observed, except a grade-2 pin-tract infection in two patients.ConclusionRigid fixation, early rehabilitation, precise correction, satisfactory cosmetic scars and functionally excellent results can be obtained with this method.

Definitive Surgery for Open Fractures of the Long Bones with External Fixatıon

Reconstruction Methods for Fractures with Bone Defects, Vascular Injury, and Salvage Procedures

Computer-Assisted Fixators for Deformity Surgery

Extremity discrepancies, short stature, pseudoarthrosis, infections such as chronic osteomyelitis, acute trauma with bone loss, and deformities either in the bones or joints are routine problems dealt with in daily practice. In the majority of these problems, an Ilizarov external fixator (EF) is used, often as the first choice or for revision of previously unsuccessful surgery (as reported by Ilizarov (Clin Orthop Relat Res 280: 7–10, 1992)). The Ilizarov EF is highly modular, which increases the chance of success, but also entails a long learning curve. Especially in multiplanar deformities, because of the hinge positioning difficulties, lengthening and translations are made with different apparatus thus the system requires frequent revision (as reported by Mutlu (J Eng Math 54:119, 2006)). This situation creates anxiety in the patient and is time-consuming for the physician. Therefore, the use of circular Ilizarov external fixator is gradually being replaced by computer-assisted fixators.

Treatment of post-traumatic elbow deformities in children with the Ilizarov distraction osteogenesis technique

Objective The present study assessed functional and radiographic outcomes of distraction osteogenesis treatment of post-traumatic elbow deformities in children. Methods Eight children were treated between 2008 and 2013 for post-traumatic elbow deformities using distraction osteogenesis. Mean age at time of operation was 10.9 years. Six patients had varus and 2 had valgus deformity. Magnitude of correction, fixator index, complications, carrying angle, and elbow range of motion were assessed. Functional results were graded according to protocol of Bellemore et al. Results Mean follow-up was 43 months. Mean preoperative varus deformity in 6 patients was 29.2° and valgus deformity in 2 patients was 28.5°. Preoperative flexion and extension of elbow were 123.8° and −10.6°, respectively. Mean carrying angle was 9° valgus at last follow-up. Mean flexion and extension were 134.4° and −6.0°, respectively. Change in carrying angle was statistically significant (p = 0.002). There were 2 grade 1 pin tract infections and 1 diaphyseal fracture of humerus. Functional outcome was rated excellent in 7 patients and good in 1 patient. Conclusion Ilizarov distraction osteogenesis is a valuable alternative in treatment of elbow deformities in children. The surgical technique is simple and correction is adjustable. Gradual correction prevents possible neurovascular complications and minimally invasive surgery produces less scarring. Compliance of patient and family is key factor in the success of the outcome. Level of evidence Level IV, therapeutic study