Mehmet Subasi

Traumatic shoulder fracture-dislocation in a 7-year-old child: a case report

IntroductionIn contrast to adults, traumatic glenohumeral dislocation is a rarely observed condition among children. In some cases, success in durable reduction with conservative methods, and achieving lasting treatment, may not be possible.Case presentationIn this study, the case of a 7-year-old Turkish girl with a Salter–Harris type II fracture and glenohumeral dislocation of the proximal humerus due to a fall from a height of 1.5 meters who underwent open reduction surgery is presented along with a review of the literature.ConclusionOrthopedic surgeons should consider glenohumeral dislocation which is an extremely rare condition when they encounter proximal humerus fractures in pediatric trauma.

Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres

Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. In total 56 patients met the inclusion criteria. The number of patients without additional injury was 22 out of which according to the Roberts criteria, 15 children (68%) had an excellent, four (18%) a good, one (5%) a fair, and two (9%) a poor outcome. From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes.

Intramedullary Nailing and Angulation Prevention in Distal Metaphyseal Tibial Fractures

Intramedullary nailing, which is preferred in tibial diaphyseal fractures, is also frequently used in distal third tibial fractures. Various angular deformities, including varus/valgus deformity, may be observed during postintramedullary nailing. Orthopedic surgeons use several methods to prevent this problem.In this study, at least 2 static locking screws were placed proximal and distal to the nail during intramedullary nailing of distal third tibial fractures. No additional supportive methods were used. The efficacy of this technique in the prevention of postoperative angular deformities was retrospectively investigated. Thirty-four patients with distal third tibial fractures who were treated with intramedullary nailing were included in the study. Angulations were measured in the anteroposterior and lateral planes on plain radiographs obtained preoperatively, on postoperative day 1, and after fracture union. Angulations measured on postoperative day 1 were compared with those measured after fracture union, and an increase was observed. Based on statistical analyses, the increase in the angulations was not significant.In distal third tibial fractures, when fixation was performed by placing 2 static screws distal and proximal to the intramedullary nail following adequate reduction, the angulations that developed during the period until union were not significant in terms of causing deformity, although additional fixation methods are not used.

Total hip replacement for an ochronotic patient: A technical trick.

Patient: Male, 46 Final Diagnosis: Akkaptonuria Symptoms: Hip pain Medication: — Clinical Procedure: Total hip replacement Specialty: Orthopedics and Traumatology Objective: Unusual or unexpected effect of treatment Background: Ochronosis is an inherited metabolic disease in which there is an accumulation of excessive amounts of homogentisic acid in the connective tissue. As the disease progresses, the chronic inflammation in the damaged tissue can cause degeneration and osteoarthritis. There is no specific treatment for ochronosis because it is a rare disease and arthroplasty is seldom performed. Case Report: We report the case of a 46-year-old male patient with ochronosis, who underwent an arthroplasty of the right hip due to osteoarthritis. The problems encountered during surgery are reported and discussed. Conclusions: Arthroplasty is a highly effective procedure for ochronotic patients. Particular attention to the surgical step is highly advised.

Isolated sacral dislocation in a 4-year-old child

Sacral dislocation is an uncommon form of injury in childhood. A 4-year-old girl who was injured in a motor vehicle accident was seen in the emergency room. On physical examination, ecchymosis and tenderness in the abdomen and sacral region was identified. Radiographs revealed no pelvic pathology. CT was performed owing to the patients sacral and abdominal tenderness. Dislocations were identified at the sacral third and fourth vertebrae without any fractures. The patient was discharged 10 days later with a recommendation for 6 weeks bed rest and an appointment for an outpatient follow-up examination. At the post-traumatic second-month examination, the patient was walking normally. In the radiograph and MRI that were taken a year later, the dislocation was observed to have fused completely, and no pressure was seen on any anatomical structure. No functional pathology was identified during the interview with the family

Grafting may effect the outcome in diaphyseal fractures of the humerus

Dear Editor, We have read the article entitled “Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study.” with great interest [1]. In their study, the authors compared the results of the humerus intramedullary nail (IMN) in 23 patients and the dynamic compression plate (DCP) in 24 patients for the management of diaphyseal fractures of the humerus. The patients were randomised into 2 groups prospectively and treated by open reduction and internal fixation technique. In their study, inclusion criteria were grade 1 or 2a compound fractures, polytrauma, early failure of conservative treatment and unstable fractures. Exclusion criteria were patients with pathological fractures, grade 3 open fractures, refractures and old neglected fractures. We would like to ask some questions of the authors regarding their study. Why was it necessary to use autograft for the treatment of these fresh fractures according to the inclusion criteria? Did using autograft (7 patients in DCP group, 12 patients in IMN group) affect the result? How did they randomise the patients, because some fractures need autograft others not? Were there any patients treated by using autograft in the nonunion group, because grafting may change the final outcome (fracture healing)? In the Results section, there were 3 patients with nonunion in both groups, but in the Discussion section, there were 2 patients with different percentages of nonunion compared to the Results section. Which is the correct one? In the Discussion, McCormack RG et al. was cited as Reference 15. But in the Reference list McCormack RG et al. was cited as Reference 11. Thus the References and citation numbers were different from each other. Why did the authors need to open reduction in all the fractures treated by using IMN? We wish to thank the authors for their invaluable contribution to the current literature. And we hope that the authors will answer our questions.