Mehmet Kocaoglu

Knee flexion contracture in haemophilia: treatment with circular external fixator.

Haemophilia, a bleeding disorder, causes recurrent intra‐articular bleeding of the joints result‐ing in chronic haemophilic arthropathy with fixed knee flexion deformity. Mid‐long‐term results (between 2002 and 2006) of deformity correction in haemophilic patients with Ilizarov type circular external fixators were retrospectively evaluated. There were six patients (five haemophilia A and one haemophilia B). The mean age was 14.7 years (range, 8–22 years) at the time of initial surgery. The mean knee flexion contracture was 45 degrees (range, 30–75 degrees). The mean arc of motion was 58.3 degrees (range, 40–100) before the surgery. The mean duration of follow‐up was 8 years (range, 5.5–10 years). The mean duration of external fixation was 4.4 months (range, 2.5–10.5 months). Full extension of the knee joint was obtained in all patients in the early postoperative period. No bleeding, neurological or vascular complications were encountered. The mean amount of recurrence in knee flexion contracture was 10 degrees (range, 0–15 degrees). The amount of the correction was significant (P = 0.0012) and the mean arc of motion was 51.6 degrees (range, 25–90 degrees) that show a decrease of 6.7 degrees (P = 0.04) at the end of follow‐up. The circular external fixator is an important, safe and less invasive alternative surgical treatment modality with low recurrence rate. Using the external hinges and distraction during the correction has a protective effect on the joint. It requires a team‐work consisting of a haematologist, an orthopaedic surgeon and a physical therapist.

Bilateral humeral lengthening in achondroplasia with unilateral external fixators: is it safe and does it improve daily life?

A retrospective study was performed in 18 patients with achondroplasia, who underwent bilateral humeral lengthening between 2001 and 2013, using monorail external fixators. The mean age was ten years (six to 15) and the mean follow-up was 40 months (12 to 104). The mean disabilities of the arm, shoulder and hand (DASH) score fell from 32.3 (20 to 40) pre-operatively to 9.4 (6 to 14) post-operatively (p = 0.037). A mean lengthening of 60% (40% to 95%) was required to reach the goal of independent perineal hygiene. One patient developed early consolidation, and fractures occurred in the regenerate bone of four humeri in three patients. There were three transient radial nerve palsies. Humeral lengthening increases the independence of people with achondroplasia and is not just a cosmetic procedure.

Nonunion and Osteomyelitis Following Fractures

Natural disasters generate often high-energy trauma, leading to fractures of the bones and significant damage to the surrounding soft tissues. Bone is the only tissue that can heal without scar formation; however, this prerequisites optimum conditions. The higher the energy of the trauma, the less optimum conditions for healing occur. Knowledge of normal bone healing and the reasons for nonunion and osteomyelitis may help the surgeon to better plan the management of these complications. The lack of a normal healing process during the inflammation phase leads to an atrophic nonunion, whereas it leads to a hypertrophic nonunion if it occurs during the bone healing repair phase.

Hindfoot Reconstruction by the Combined Technique

Numerous techniques have been introduced for ankle arthrodesis. All has its own advantages and disadvantages, requiring personalized treatment approach. Utilization of external fixator with combination of intramedullary nail is a recently introduced advanced technique with securing the versatility of Ilizarov, avoiding its many complications. This chapter covers indications, technique, and outcomes of hindfoot reconstruction by the combined technique.

Reconstruction of Segmentary Defects in Chronic Osteomyelitis Using the Combined Technique

Musculoskeletal infections remain a common problem, and the frequency of posttraumatic osteomyelitis continues to increase, despite recent improvements in orthopedic implant technologies and treatment techniques. In the modern world, individuals are exposed to high-energy traumas, such as gunshot, motor vehicle accident, and armed conflict injuries. Due to the existence of improved staging systems, antibiotics, and adjuvant treatment modalities, such as hyperbaric oxygen, the treatment strategy for chronic osteomyelitis has changed significantly over recent decades.

Femoral and Tibial Deformity Correction and Consecutive Lengthening over an Intramedullary Nail (FAN-LON)

Lengthening over an intramedullary nail (LON) for the treatment of limb-length discrepancies (LLDs) and fixator-assisted nailing (FAN) for the treatment of deformities of long bones, such as the tibia and the femur, can provide satisfactory results (Bilen et al., J Bone Joint Surg Br 92:146–152, 2010; Eralp et al., J Bone Joint Surg Br 86:1065–1068, 2004, J Bone Joint Surg (Am) 90:181–194, 2008; Herzenberg and Paley, Tech Orthop 12:250–259, 1997; Kocaoglu et al., J Bone Joint Surg Am 88:2137–2145, 2006; Kocaoglu et al., J Bone Joint Surg Am 91:152–159, 2009; Paley, Clin Orthop 250:81–104, 1990; Paley et al., Tech Orthop 12:260–275). Both techniques have the advantage of intramedullary nailing, as they prevent fracture of the regenerated bone or loss of correction and/or lengthening. External fixators are commonly used for the treatment of patients with concomitant limb-length discrepancy and deformity. We combined fixator-assisted nailing and lengthening over an intramedullary nail for the treatment of this specific group of patients.

Combined Technique: Correction of Long Bone Deformities Using Fixator-Assisted Nailing

Deviation of the mechanical axis (MAD) results primarily in deformities of the long bones, which result in the development of secondary osteoarthritis of the hip, knee, and/or ankle joints. Orthopedic surgeons have utilized many different procedures to correct these deformities to prevent secondary osteoarthritis. However, these techniques generally result in low patient comfort and lack accuracy. A comprehensive technique termed “fixator-assisted nailing” (FAN) was developed by Dror Paley in 1993 and was first described by Paley et al. in 1997. Its goal was to combine the accuracy and minimal invasiveness of external fixation with the convenience of internal fixation. Internal fixation prevents the recurrence of the deformity and allows early mobilization of joints and quicker rehabilitation.

Bone Transport Over a Nail for Infected Tibial Nonunion and Bone Defect

Chronic bone infections should be managed similar to neoplasms: all of the infected and nonviable bone and soft tissues are resected, leaving a viable tissue environment for reconstruction. Following such resections, significant bone defects occur and require reconstructive procedures such as grafting or bone transport. 1 Brief Clinical History • A 46-year-old male patient presented to our clinic with purulent discharge and atrophic changes on the skin of his left tibia (Fig. 1). He had undergone three previous unsatisfactory surgical interventions. • Clinically he was suffering from chronic pain, limb length discrepancy causing a limp, and purulent discharge. 2 Preoperative Clinical Photos and Radiographs See Figs. 1, 2, 3, and 4. 3 Preoperative Problem List (a) Bone infection (left tibia) (Cierny-Mader type IVA) (b) Infected nonunion at the mid-diaphyseal level of the tibia (Fig. 2) (c) Varus deformity (Fig. 3) (d) Limb length discrepancy of 2.5 cm (Fig. 4) 4 Treatment Strategy (a) First session (resection and debridement): (i) Resection of the infected nonunion site along with the overlying infected soft tissues (amount of resection 12 cm) (Fig. 5a, b). (ii) Deep tissue samples are obtained for cultures, sensitivities, and Gram staining. *Email: drmehmetkocaoglu@gmail.com Limb Lengthening and Reconstruction Surgery Case Atlas DOI 10.1007/978-3-319-02767-8_173-1 # Springer International Publishing Switzerland 2014

Advanced techniques in limb reconstruction surgery

Advanced techniques in limb reconstruction surgery / , Advanced techniques in limb reconstruction surgery / , کتابخانه دیجیتال جندی شاپور اهواز