Özgür Karakoyun

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.

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.

Intramedullary skeletal kinetic distractor in lower extremity lengthening.

OBJECTIVE The aim of this study was to report the clinical and radiological results of patients with Intramedullary Skeletal Kinetic Distractor (ISKD) lengthening. METHODS Ten femoral and 2 tibial lengthening were performed in 12 patients (7 male, 5 female; mean age: 27 years (13-40)) by using ISKD nail. The mean limb length discrepancy of the patients was 4.41 cm (2-7). On the postoperative 7th day the patients were trained about lengthening and the lengthening started. Follow-up X rays were taken weekly during the distraction period and every second weeks during the consolidation period. One patient with tibia lengthening was lost to follow-up after completing the distraction period. RESULTS The planned lengthening amounts were achieved in all of the cases. The mean lengthening was 4.41 cm (2-7). The mean bone healing index was 37.8 day/cm (28.5-78.0). There were uncontrolled distractions in 4 cases. Autogenous bone grafting was necessary in a case with incompetent bone formation. The kinetic nail was locked and failed to distract in a patient, in which the problem was solved with closed manipulation under anesthesia. No patient had a joint stiffness. CONCLUSION Intramedullary extensible nails decrease the risk of joint contractures and infection. This procedure can be well tolerated by the patients and they can return to their daily activities earlier.

Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis

OBJECTIVE Lengthening after acute correction has a negative effect on bone healing during distraction osteogenesis. In this study, we investigated whether correcting an acute deformity prior to lengthening resulted in a negative effect on bone healing. METHODS Patients with shortened femora were assigned to 3 matched groups. Retrograde femoral nailing after distal metaphyseal-diaphyseal osteotomy was used in all cases. Group 1 (9 femora) included cases of lengthening >4 cm using intramedullary distraction devices after acute correction. Group 2 (16 femora) included pure lengthening cases of ≥4 cm using intramedullary distraction devices. Group 3 (13 femora) included cases of lengthening ≥4 cm with lengthening and the retrograde nailing method (LORN) following acute correction. RESULTS Healing indices and full weight-bearing times of patients were evaluated. Mean lengthening values were 6.6 (range: 4-14 cm), 5.7 (range: 4-8 cm), and 5.2 cm (range: 4-6.5 cm) in Groups 1-3, respectively, and mean radiographic consolidation index and full weight-bearing times were 31.0±8.2, 30.2±5.5, and 39.0±5.0 day/cm in Groups 1-3, respectively. The consolidation index was significantly better in the Groups 1 and 2 compared to that in Group 3, but no difference was detected between Groups 1 and 2. CONCLUSION Acute correction had no negative effect on bone healing after distraction osteogenesis using new-generation intramedullary distraction devices. We suggest that the negative impact on healing and the prolonged consolidation index in patients undergoing LORN may be due to impaired periosteal blood supply due to fixator pins.

İhmal edilmiş dirsek çıkıklarının menteşeli eksternal fiksatör yardımı ile tedavisi: 2 olgu sunumu

Elbow dislocations are cases that have to be treated in emergency conditions. Neglected elbow dislocations are seen very rarely and the treatment of such cases are more complicated than acute cases. We present two cases of neglected elbow dislocations treated with open reduction and hinged external fixators. Case 1: 23 year old female patient had a neglected posterior dislocation of left elbow with ipsilateral humeral shaft fracture caused by car accident. The patient was treated after 3 months of initial trauma. We have performed open reduction for the joint. After that we fixed the joint whit a hinged external fixator. The humeral shaft fracture was also fixed with the components of the external fixator. Case 2: 33 year male patient had a large bone and soft tissue defect around the left elbow accompanying with neglected medial elbow dislocation. He presented to our clinic with a delay of 2 months. The patient was treated with open reduction and hinged external fixator after re construction of bone defect of distal humerus. Conclusion: The treatment of neglected cases is quite challenging. Open reduction and external fixation has satisfactory results in treatment of late cases of elbow dislocation with the possibility of early rehabilitation. This method can be considered as an option for such cases. J Clin Exp Invest 2014; 5 (2): 307-312

Bone Mineral Density Value in Kastamonu and Area of Turkish Society Women

1 Ahmet Aslan1, Emin Uysal2, Özgür Karakoyun3, 1Ortopedi ve Travmatoloji Kliniği, Afyonkarahisar Devlet Hastanesi, Afyonkarahisar, 2Acil Servis Kliniği, Bağcılar Eğitim Araştırma Hastanesi, İstanbul, 3Ortopedi veTravmatoloji Kliniği, Dr. Münif İslamoğlu Kastamonu Devlet Hastanesi, Kastamonu, Türkiye Türk Kadınında Kemik Mineral Yoğunluğu / Bone Mineral Densıty in Turkısh Women Bone Mineral Density Value in Kastamonu and Area of Turkish Society Women

Use of a magnetic bone nail for lengthening of the femur and tibia

Purpose To report our experience with the PRECICE nail for limb lengthening in 23 patients. Methods Records of 15 female and 8 male patients aged 14 to 38 (mean, 23.6) years who underwent lengthening of the tibia (n=6) or femur (n=21) using the PRECICE nail were reviewed. The reasons for lengthening included trauma (n=7), hemihypertrophy (n=2), focal femoral deficiency (n=2), Ellis-van Creveld syndrome (n=1), hip septic arthritis sequelae (n=1), hereditary multiple exostosis (n=1), club foot sequela (n=1), congenital tibial pseudoarthrosis (n=1), fibrous dysplasia (n=1), idiopathic limb length discrepancy (n=7), and cosmetic (n=1). Results The mean follow-up duration was 20.72 months. The mean lengthening was 48.20 mm, and the mean acute angular correction was 15.5°. The mean time to full weight-bearing was 5.15 months, and the mean consolidation index was 1.12 months/cm. The mean maturation index was 0.78 months/cm. One patient had nail breakage during the consolidation phase. The nail was replaced by an intramedullary nail until consolidation, after which another PRECICE nail was used to treat the residual shortening. Eight patients had over-lengthening and the nails were driven back to the desired length. No patient had infection. Conclusion The PRECICE nail is a viable option for lengthening of the femur and tibia.

Effect of cable cerclage on regional blood circulation in rabbits: a scintigraphic study

Purpose To evaluate changes in blood circulation of the femoral cortex in rabbits using scintigraphy before and after cable cerclage alone or combined with an intramedullary Kirschner wire. Method Ten New Zealand rabbits were used. For the right femur, a 2-mm-thick cable was placed around the mid-diaphyseal region and squeezed with a 400-N force and locked with a clip. For the left femur, a 1.8-mm Kirschner wire was inserted retrogradely into the medullary canal, and a 2-mm-thick cable was applied using the same technique. The blood perfusion ratio of the region of interest (ROI) before and after surgery was evaluated using scintigraphy. Results For the right femurs, the mean ROI perfusion ratio decreased by 45% from 2.51 to 1.37 after intervention (p=0.001). For the left femurs, the mean ROI perfusion ratio decreased by 56% from 2.12 to 0.92 after intervention (p<0.001). The mean ROI perfusion ratio post-intervention was higher in the right than left femurs (p=0.017). Conclusion Cable cerclage around the femoral cortex significantly decreased blood circulation in the area.

Efficacy of the Taylor spatial frame in the treatment of deformities around the knee.

OBJECTIVE The aim of this study was to determine whether the Taylor spatial frame (TSF) can precisely correct deformities around the knee and whether application of TSF is easy and safe for treatment of the deformities around the knee. METHODS This study included 50 retrospectively reviewed limbs of 37 patients (mean age: 23 years, range: 10 to 58 years) with deformity around the knee joint treated using the TSF. Thirty-three limbs had tibial and 17 femoral deformities. Preoperative standard anteroposterior, lateral radiographs and standing orthoroentgenographic measurements were taken for each patient. Mechanical axis deviation (MAD), leg-length discrepancy (LLD) and lateral femoral distal angle (LDFA) and medial proximal tibial angle (MPTA) were measured from standing orthoroentgenographics. All measurements were repeated after external fixator removal. RESULTS The frame was applied for an average of 20.3 (range: 4 to 36) weeks. Mean follow-up time following removal of external fixator was 32 (range: 15 to 54) months. An effective and accurate correction was achieved in all cases. Solid bone consolidation was obtained in all but two cases which underwent bone grafting. CONCLUSION Taylor spatial frame appears to be a safe and effective method for the gradual correction of the complex translational and rotational deformities around the knee.

Kalça kırığı ve koksartrozda piyüri

Accompanying systemic pathologies and other risk factors can be found in the most elderly patients who treated for hip fracture or coxarthrosis. All of these can cause urinary tract infection and colonization of bacteria in the urinary tract. Pyuria and urinary tract infection could pose a risk after the orthopedic implant surgery and is a frightening complication of surgical site wound infection. In this study, we investigated that the relationship between preoperative pyuria and postoperative surgical site infections, affect the risk factors in patients who underwent hip implant surgery or hip arthroplasty because of hip fracture or coxarthrosis. The period between 1994-2008, 563 patients with at least one year follow-up records were reviewed retrospectively. Working group was comprised of 38 cases detected preoperative pyuria (urine microscopy >10 white blood cell/field), the 62 patients that were randomly selected among the rest of 525 patients constituted the control group. Groups of age, gender, etiology, fever, hemoglobin, sedimentation rate, Creactive protein, white blood cell, albumin, preoperative period of time, diabetes, co-morbidities, urine culture in terms of reproductive and post-operative surgical site infection were compared. In the study group, blood albumin level was lower than the control group. In addition, the preoperative period and postoperative surgical site infection, urine culture positivity were higher than the control group. There was statistical difference between groups (p0.05). The results of this study, preoperative length of time, culture positivity and low level of albumin show significant risk factors for postoperative surgical site infection. In addition to the preoperative symptomatic urinary tract infection seems associated with surgical wound infection after surgery. Orthopedic surgery can be delayed until the preoperative treatment of symptomatic urinary tract infection, however we think that there is no correlation between preoperative asymptomatic pyuria and postoperative surgical site infection. And it is not necessary to delay orthopedic surgery in patients with asymptomatic pyuria.