Metin Kucukkaya

The Role of a Posteriorly Positioned Fibula in Ankle Sprain

Background Specific anatomic variations of the ankle mortise may predispose people to ankle sprains. Hypothesis There is a correlation between a higher malleolar index (posteriorly positioned fibula) and incidence of ankle sprain. Study Design Prospective case control study. Methods We compared the malleolar index (transverse plane of the talus) on computerized axial tomographic images of 61 patients with ankle sprain with that of 101 normal controls. A positive number for the malleolar index meant that the lateral malleolus was posterior to the plane of the medial malleolus. A negative number meant that the lateral malleolus was actually anterior to the plane of the medial malleolus. Results The average malleolar index of the patients with ankle sprain was +11.5° with a standard deviation of 7°. Malleolar relationships varied from —6° to +39°, a range of 45°. The average malleolar index in the control group was +5.85° with a standard deviation of 4.9°, which varied from —8° to +16°. However, there was no correlation between recurrence of sprains and malleolar index values. Conclusion Patients with an ankle sprain were more likely to have a posteriorly positioned fibula, possibly predisposing them to ankle sprain.

Open reduction and plate fixation of femoral shaft fractures in children aged 4 to 10

A retrospective review of 40 children aged 4 to 10 years with 46 femur fractures treated with open reduction and plate fixation is presented. Follow-up time was 6.3 years (range 2.5–17.5). There were no nonunions. One case of osteomyelitis and one refracture occurred. Leg-length discrepancy averaging 1.2 cm (range 0.4–1.8), with lengthening on the operated side, was observed in 15 patients. Although there is some risk for complications, and although good early results have been reported with elastic intramedullary nails, plate fixation continues to be a viable alternative in the surgical treatment of femoral shaft fractures in children aged 4 to 10.

The application of open intramedullary fixation in the treatment of pediatric radial and ulnar shaft fractures.

Objectives This retrospective review evaluates the efficiency of standard intramedullary Kirschner wires for the treatment of unstable diaphyseal forearm fractures in children. Design Retrospective review. Setting Large teaching and research hospital in Turkey. Patients Thirty-one patients with diaphyseal forearm fractures were treated by surgical method between 1988 and 1998. The mean age was 12.3 years (range 7 to 17 years). The mean follow-up period was 4.2 years (1 to 6.2 years). Intervention The method of treatment of each forearm fracture was open reduction and intramedullary Kirschner wire fixation using a mini-incision. Main Outcome Measurements Fracture union, growth disturbance of the forearm, and complications were evaluated. Results Union was obtained in all cases except two (6.4 percent). No forearm inequality was observed. Conclusions Intramedullary fixation is a useful technique for unstable shaft fractures of the forearm in children that can not be treated by closed manipulation.

Avascular necrosis of the femoral head in childhood: the results of treatment with articulated distraction method.

The treatment of avascular necrosis of the femoral head in children is still being debated. We performed articulated distraction in 11 children with avascular necrosis of the femoral head between March 1994 and February 1997. The reasons for avascular necrosis were: Perthes disease in eight patients, fracture of the femoral neck in two, and complication arising because of treatment of developmental hip dysplasia in one. Mean age was 7.9 years. Fixator duration time was 3.5 months and mean follow-up was 32 months. At follow-up, the femoral head was spherical and congruent in four patients, aspherical and congruent in five, and aspherical and incongruent in two according to Stulbergs criteria. The aim of the articulated distraction method is to neutralize muscle and weight-bearing forces, to prevent stress fractures of subchondral immature bone, to encourage synovial circulation, and to promote creeping substitution.

Management of childhood chronic tibial osteomyelitis with the Ilizarov method

The efficacy of the Ilizarov method in the management of the long bone defect is well established. There have been rare reports about the use of the Ilizarov method in the bone defect caused from childhood osteomyelitis. In this article, the authors present results of seven patients with childhood chronic hematogenous osteomyelitis of the tibia who were treated with the Ilizarov method. The treatment protocol also included sequestrectomy and debridement, appropriate antibiotic therapy, and bifocal treatment with the Ilizarov method. The mean age was 7.2 years old (range 6–8). After sequestrectomy and debridement, all cases were classified as B1 infected pseudoarthrosis according to Paleys criteria. All patients had active infection at the beginning of the treatment. The mean bone defect was 7.4 cm (range 3.5–12). Follow-up time was 4.6 years (range 2.7–5.8). At the time of fixator extraction, complete consolidation was obtained in all the patients. Healing index was 32.3 days/cm (range 28–44). Bone grafting was not required at the docking site in any of the patients. Functional and radiologic results were judged excellent according to Paleys criteria in all patients at the last follow-up. This study indicates that the bifocal method of the Ilizarov treatment is the best alternative for the bone defect caused by chronic hematogenous osteomyelitis in children.

Management of the Neuromuscular Foot Deformities with the Llizarov Method

Nine feet of eight patients with neurologic foot deformities caused from poliomyelitis, Charcot-Marie-Tooth disease, and traumatic nerve injury were treated with V-osteotomy and the llizarov method. A painless and plantigrade foot was obtained in all but one patient. A residual deformity occurred in this case because of the soft-tissue problems during the correction period. No major complication had been encountered by the latest follow-up at a mean of 42 months. The results of the current study indicate that the V-osteotomy and the llizarov method, while technically difficult, is an effective method for correcting neurologic foot deformities and obtaining a stable, plantigrade, painless foot, especially when complicated with other lower leg problems (i.e., leg length discrepancy, joint contractures).

The new intramedullary cable bone transport technique.

Traditional segment transport methods pose major soft tissue and bone problems related to the pin or K wire that fixes the transported bone segment through the soft tissue, especially excursion of the K wire. We designed the cable bone transport technique to prevent these problems and to increase patient comfort. Thirteen patients with bone defects (11 in the tibia and 2 in the femur) were treated successfully with the new method. Because the transported segment is not fixed externally in the cable bone transport method, docking site troubles, such as soft tissue invagination and malalignment, and skin problems due to excursion of the K wire are prevented, which in turn reduces other difficulties that might arise from alternative procedures.

Lengthening Over a Retrograde Nail Using 3 Schanz Pins.

SUMMARY:: The technique of lengthening over an antegrade nail is used widely for distraction osteogenesis of the femur. Most reported complications of this technique are related to Schanz pins. We hypothesized that reducing the number of Schanz pins would enable successful distraction with fewer complications. To this purpose, we describe a new technique for lengthening over a retrograde nail using only 1 proximal and 2 distal Schanz pins.

Correcting and lengthening of metatarsal deformity with circular fixator by distraction osteotomy: a case of longitudinal epiphyseal bracket.

The condition known as longitudinal epiphyseal bracket or delta phalanx is a rare congenital anomaly that affects the tubular bones of hand or foot. Metatarsal epiphyseal bracket restrains longitudinal growth, causing progressive deformity and resulting in a short, broad metatarsal and a medially deviated metatarsophalangeal joint and hallux magnus. Although there are some case series describing metatarsal lengthening with the unilateral fixator in the literature, we could not find any case that combines both metatarsal lengthening and deformity correction with the circular external fixator. Gradual lengthening and deformity correction without bone grafting and soft-tissue modification were carried out in a case with bilateral longitudinal epiphyseal bracket of the first metatarsals of the foot. A literature review and treatment method for epiphyseal bracket in a 9-year-old boy is presented. Excellent clinical, and functional results were obtained with circular and semicircular fixators.

Calculating the mounting parameters for Taylor Spatial Frame correction using computed tomography.

The Taylor Spatial Frame uses a computer program-based six-axis deformity analysis. However, there is often a residual deformity after the initial correction, especially in deformities with a rotational component. This problem can be resolved by recalculating the parameters and inputting all new deformity and mounting parameters. However, this may necessitate repeated x-rays and delay treatment. We believe that error in the mounting parameters is the main reason for most residual deformities. To prevent these problems, we describe a new calculation technique for determining the mounting parameters that uses computed tomography. This technique is especially advantageous for deformities with a rotational component. Using this technique, exact calculation of the mounting parameters is possible and the residual deformity and number of repeated x-rays can be minimized. This new technique is an alternative method to accurately calculating the mounting parameters.