Ozcan Pehlivan

Treatment of Fractures of the Humeral Capitellum Using Herbert Screws

Isolated fractures of the capitellum are rare injuries and account for 1% of all elbow injuries. The purpose of this study is to evaluate the clinical outcomes of 11 Type I capitellum fractures treated by open reduction and internal fixation using at least two standard Herbert screws between 1998 and 2003. The average age of the patients was 27.5 years. The mean follow-up time was 23.4 months. The final postoperative assessment was made at the 12th month. The results were evaluated according to the Mayo Elbow Performance Index. We obtained excellent result in eight patients and good result in three patients. We recommend open reduction and fixation with Herbert screws inserted from the posterior surface of the lateral epicondyle and early mobilization in Type I fractures of the capitellum.

Radiographic correlation of symptomatic and asymptomatic flexible flatfoot in young male adults

The purpose was to evaluate the value of radiology to distinguish between symptomatic and asymptomatic flexible flatfeet in young male adults. Among young male army recruits, 56 feet of 28 recruits were diagnosed as otherwise normal, flexible flatfoot with invisible longitudinal arch on stance and either symptomatic or asymptomatic unilaterally or bilaterally. The talus-first metatarsal and calcaneal pitch angles were measured on weight-bearing lateral radiographs, and the results were evaluated statistically. The talus-first metatarsal angle showed statistical significance in both non-parametric and logistic regression tests, but the calcaneal pitch angle showed statistical significance only in non-parametric test between symptomatic and asymptomatic flatfoot groups. Although the single gender and number of samples limit the applicability of our study, these results caused us to make an interpretation that increased talus-first metatarsal angle might be an important risk factor of being symptomatic in otherwise normal flexible flatfoot.RésuméLe but de cette étude est d’évaluer la valeur de la radio dans les pieds plats d’adultes jeunes qu’il soit symptomatique ou asymptomatique.Matériel et méthode : parmi des sujets recrutés dans l’armée, 56 pieds sur 28 recrues ont été considérés comme plats avec ou sans symptômes, qu’ils soient uni ou bilatéraux. L’angle astragale premier métatarse et le calcanéum a été mesuré en charge sur des radiographies de profil.Résultats : cet angle a une valeur significative seulement dans le test non paramétrique entre le groupe des pieds plats symptomatiques et des pieds plats asymptomatiques.Conclusion : ces résultats nous permettent de penser que l’aggravation de cet angle est un important facteur de risques d’évolution symptomatique chez les sujets avec pieds plats normaux, asymptomatiques.

Comparison of outcomes of two different surgeries in regarding to complications for chronic anterior shoulder instability

IntroductionThe purpose of this study is to compare the early clinical results of two techniques in regarding to complications in the patients who suffered from chronic anterior traumatic isolated shoulder instability.MethodEighty-five patients underwent reconstructive procedures due to chronic isolated traumatic shoulder instability in our clinic between 1990 and 2002. Sixty-four patients in whom preoperatively Bankart lesion were detected with MRI and who participated in the regular follow-up were included in the study. Thirty-four patients were treated with Bankart repair (Group I) and 30 patients were treated with Modified Bristow procedure (Group II). Mean follow-up period was 25 (24–39) months for group I and 28 (24–96) months for group II. All cases were evaluated preoperatively and postoperatively according to Rowe scoring system.ResultsMean Rowe scores were 90 and 88.1 for group I and II, respectively. Due to recurrent dislocation, four revision surgeries (one in group I, three in group II) were performed. Surgical complications were encountered in group II, just as fracture at the bone block in four cases, nonunion in five cases and removal of loose screw in one case.DiscussionAccording to clinical outcomes, both the techniques are useful and feasible for the treatment of the chronic traumatic isolated anterior shoulder instability; however, complication rate is higher in the Modified Bristow technique and, Bankart repair is directed to the anatomic repair of the original pathology.

Biodegradable implants in the treatment of scaphoid nonunions

We reviewed 12 male patients with scaphoid nonunions treated by open reduction, bone grafting, and internal fixation with biodegradable implants made of self-reinforced poly-l-lactic acid. Mean patient age was 22.5 (20–25) years. Ten patients had type D2 scaphoid nonunions with a fracture line in the middle one third, one patient had type D2 nonunion with a fracture line in the proximal one third, and one patient had type D1 distal one-third fibrous union. The mean wrist score (modified Mayo wrist score) was 20.8 (10–40) preoperatively and improved after 22–80 months (55–90). All nonunions healed, and the mean solid union time was 4.5 (3.5–7) months. We obtained excellent results in five patients, good results in four, fair results in two, and a poor result in one. The results of this study offer a valid alternative in the fixation of scaphoid nonunions. The major advantage of biodegradable materials is to eliminate the requirement for the removal of the fixation material.RésuméNous avons examiné douze malades de sexe masculin avec une non-consolidation du scaphoïde traitée par réduction ouverte, greffe osseuse et fixation interne avec des implants biodégradables faits d’acide poly-l-lactique auto-renforcé (SR-PLLA). L’âge moyen des malades était de 22.5 ans (20–25). Dix malades avaient une non-consolidation de type D2 avec le trait de fracture dans le tiers central, un malade avait le type D2 avec un trait de fracture dans le tiers proximal et un malade avait le type distal D1 avec union fibreuse. Le score moyen du poignet (Mayo wrist score modifié) était 20.8 (10–40) en préopératoire et amélioré après 22 mois à 80 (55–90). Toutes les nonunions ont consolidées dans un temps moyen de 4.5 mois (3.5–7). Nous avons obtenu d’excellents résultats chez cinq malades, de bons résultats chez quatre, des résultats médiocres chez deux et un résultat mauvais pour une. Les résultats de cette étude offrent une alternative valide pour la fixation des non-consolidations du scaphoïde. L’avantage majeur des matières biodégradables est d’éliminer l’exigence d’ablation du matériel d’ostéosynthèse.

Medial peritalar dislocation

Abstract. In this paper, a case of closed medial subtalar dislocation and accompanying talar head fracture in a 22-year-old man which occurred while walking on a downhill road is reported. Closed reduction under general anesthesia was unsuccessful. The obstacle for closed reduction was determined at surgery for open reduction and internal fixation as buttonholing of the talar head through the extensor retinaculum. At the 26-month follow-up, he was pain-free in his daily activities.

Proximal oblique crescentic osteotomy in hallux valgus.

Twenty-six patients with moderate-to-severe hallux valgus deformities were evaluated before and after treatment. All of the patients had incongruent great toe joints. The patients underwent modified proximal crescentic osteotomy, which was termed proximal oblique crescentic osteotomy. The results were evaluated at an average follow-up time of 55 weeks. Objective criteria were hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal, and angulation at the osteotomy site. Clinical evaluation was made according to the rating system of the American Orthopaedic Foot and Ankle Society. The mean correction of the hallux valgus and intermetatarsal angles was 22.1 degrees and 9.9 degrees, respectively. Short-term results indicate that proximal oblique crescentic osteotomy is effective in the treatment of hallux valgus; its advantages over other procedures include its technical ease and low rate of complications.

Tension Band Wiring of Unstable Transverse Fractures of the Proximal and Middle Phalanges of the Hand

Twenty-three isolated, unstable and closed transverse middle and proximal phalangeal shaft fractures in 23 patients were treated by tension band wiring. The tension band was applied with two transverse Kirschner wires that did not cross the fracture line. All of the fractures united and achieved satisfactory functional outcomes. No patient required either physiotherapy or tenolysis or capsulotomy surgery.

Management of the bilateral congential dislocation of the hip and knee: a case report.

Congenital dislocation of the knee (CDK) is a rare disease and may be associated with other congenital and musculoskeletal disorders. We report our result in the treatment of a patient with CDK and DDH that treated with serial casting and Pavlik harness. Early diagnosis of the CDK is very important non operative treatment usually provides more stabile, greater range of motion and much more quadriceps strength than the surgical treatment. Early reduction of dislocation prevents formation of the knee contracture.

Soft tissue necrosis following using calcium phosphate cement in calcaneal bone cyst: case report

Calcium phosphate cements have received widespread attention for their possible role as bone-grafting material and bone fillers in skeletal defects. They were evaluated as a biomaterial in many aspects. No serious harmful effects such as foreign body reaction and tissue necrosis against to calcium phosphate cements have been reported yet. They were accepted as highly biocompatible materials. In this paper, we represent a patient who had soft tissue necrosis around lateral malleolar region, following using percutaneous calcium phosphate cement as a filler bone substitute in calcenous bone cyst. The possible mechanisms were discussed.