Mustafa Yel

Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur

Our aim was to determine the clinical effectiveness and safety of Ilizarov external fixation for the acute treatment of severely comminuted extra-articular and intercondylar fractures of the distal femur. A total of 14 consecutive patients with complex fractures was treated. There were three type-A3, two type-C2 and nine type-C3 fractures according to the AO/ASIF system. The mean follow-up was 14 months. Most fractures (13) united primarily at a mean of 16 weeks. One patient with a type-IIIA open fracture had infection and nonunion. The mean range of flexion of the knee at the final follow-up was 105 degrees (35 to 130). We conclude that, in the treatment of comminuted fractures of the distal femur, the Ilizarov fixator is safe and effective in providing stability and allowing early rehabilitation.

Osteoid osteoma of the carpal bones

Abstract Osteoid osteoma is a benign bone tumor that rarely localizes in the hand or the carpal bones. We report two cases of osteoid osteoma localized in two different carpal bones. Unremitting wrist pain was a major clinical symptom. Surgical treatment including excision of the nidus was dramatically curative. In young patients, osteoid osteoma should be considered in the differential diagnosis of chronic wrist pain.

The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator

Abstract The purpose of this study was to evaluate the clinical and radiological results of unstable pelvic fractures treated with a new external fixation device. Between May 1992 and May 1998, 43 patients with unstable pelvic fractures were treated with a new anterior pelvic external fixator. Two died, and therefore 41 patients’ results were evaluated. There were 29 men and 12 women, and their average age was 34 years (range 12–70 years). Traffic accidents accounted for 34 injuries. Three patients fell from a height, 3 were injured in industrial accidents, and 1 was hit by a train. According to the Tile classification, there were 24 type B pelvic injuries and 17 type C. Associated injuries were observed in 21 patients. A considerable reduction of the pelvic pain was noted after application ¶of the fixator in all patients. Excessive blood transfusion was not required in any patient. The average follow-up was 24 months (range 12–50 months). Clinical results at final evaluation were good according to the criteria of Matta and Saucedo in 34 patients and poor in 7. In conclusion, the new pelvic external fixator is effective, safe, and easy to apply in the treatment of unstable pelvic fractures. The fixator can be used alone in patients with type B pelvic injuries such as open book and lateral compression. However, it does not provide sufficient stability for severely displaced type C injuries when applied alone. Nevertheless, it may be helpful for fixing type C injuries like a posterior iliac fracture without dislocation of the sacroiliac joint.

GIANT OSTEOCHONDRAL LOOSE BODY OF THE KNEE JOINT

A rare giant loose body in the knee joint and the treatment carried out were reported. Two loose bodies sized 5.5 and 1.5 cm were extracted from the knee of a patient who suffered from pain and knee motion restricted chronically. The histopathological evaluation revealed normal bone, hyaline cartilaginous tissue, and partly fibrocartilaginous tissue. These loose bodies suggested that they were separated in small pieces from the femoral condyles and were nourished by the synovial fluid. Over time, they adhered to each other in the knee joint.

An analysis of meniscal extrusion and associated knee joint lesionsby magnetic resonance imaging

OBJECTIVES We investigated the frequency of meniscal extrusion and associated knee joint lesions by magnetic resonance imaging (MRI) in patients with meniscal tears. METHODS We retrospectively evaluated MRI findings of 100 patients (41 males, 59 females; mean age 54 + or - 10 years; range 27 to 76 years) with meniscal tears in 126 knee joints. Using coronal images, extrusion was defined as a distance of = or > 3 mm between the peripheral border of the meniscus and the edge of the tibial plateau. All the knees were assessed with respect to the localization and type of meniscal tear and extrusion, accompanying joint effusion, cruciate ligament pathologies, and degenerative bone and cartilage changes. RESULTS Meniscal extrusion was detected in 31 knee joints (24.6%), with a mean extrusion of 3.72 mm. All extrusions were found to be in the posterior horn of the medial meniscus and were associated with radial tears (n=18, 58.1%), radial-oblique tears (n=9, 29%), complex tears (n=2, 6.5%), and flap tears (n=2, 6.5%). Meniscal tears with extrusion differed significantly from those without extrusion with respect to the localization of all the tears being in the posterior horn of the medial meniscus (100% vs. 60%) and the higher frequency (58.1% vs. 20%) of radial tears (p<0.05). There were no significant differences in the types and frequencies of accompanying pathologies seen in meniscal tears with and without extrusion (p>0.05). CONCLUSION Meniscal extrusion is a common finding particularly in osteoarthritis. It is mostly seen in the medial meniscus and accompanied by radial tears. Therefore, its presence should alert to the possibility of a radial tear extending to the meniscal root.

Reverse Segond Fracture Variant Without Posterior Cruciate Ligament Injury Report of an Extremely Rare Case

Objectives: Reverse Segond fracture, which was described as the association of an avulsion of deep capsular portion of medial collateral ligament and tears of both posterior cruciate ligament (PCL) and medial meniscus, is an extremely rare injury, unlike Segond fracture. The aim is to report successful surgical treatment of a case with “Reverse Segond Fracture” with intact PCL. Methods: The patient was a 16 years old male, who admitted to emergency department of our Level I trauma center after a pedestrian traffic accident. The main complaint was pain on left knee and shoulder. Physical examination revealed mainly limitation in range of motion (ROM) of relevant joints. Radiology revealed Reverse Segond fracture in the left knee and associated left clavicula mid-shaft fracture. Imaging with MRI and CT revealed neither PCL injury or additional ligamentous pathologies of knee. MRI only revealed medial meniscus tear. Results: In surgery, avulsed bony portion of Reverse Segond fracture was fixed to tibia with a suture anchor and a cannulated screw securely under medial meniscus. Peripheral longitudinal medial meniscus tear was fixed with a 2-0 absorbable suture. Clavicle was internally fixed meanwhile. Knee range of motion (ROM) was started early on postoperative first day, then augmented progressively. The patient was mobilized partially-weight bearing after 1.5 months and returned to his active daily life after 2.5 months. He was without any residual complaints after a final follow-up period of 26 months. Conclusion: This case report would be evaluated as a Reverse Segond Fracture variant, as no injury to PCL was noted, in contrast to its original definition in the relevant literature, which is also scarse. To the best of knowledge, this is the first report of successful surgical treatment of a case with Reverse Segond Fracture variant without PCL tear in the relevant literature.

Eş zamanlı bilateral tuberositas tibia avulsiyonu: Nadir bir kırık

Tibial tuberosity avulsion is a rare fracture in adolescence. Due to the shear forces on the immature epiphysis. Thirteen years old girl was admitted to the emergency department with knee pain and tenderness in both knees after jumping from a height of about one meter. In examination she had tenderness and swelling over both tibial tuberosities. The patient could not do active knee extension. Type IIA fracture on the left and type IIIA fracture on the right knee were detected. For the patient’s fractures, closed reduction and fixation with 3 smooth Kirschner wires was performed. After immobilization in long-leg brace for three weeks the brace was removed and she include in the rehabilitation program. In this report, we discuss similar cases in the literature and the results of the treatment applied to our patient.