Seref Aktas

Open Versus Minimal Invasive Repair With Achillon Device

Background: We prospectively analyzed and compared the functional and clinical results of patients with standard open and minimally invasive repair with the Achillon suture system at mid-term followup. Materials and Methods: From February 2004 to May 2007, 40 consecutive patients were operated for the treatment of acute Achilles tendon rupture with two different methods. None of the cases required adjunctive procedures like plantaris, flexor hallucis longus or gastrocnemius augmentation (Lindholm, Bosworth) to allow for acceptable end to end apposition. The patients were divided equally into two groups. In Group 1, only Krakow end-to-end suturing technique and in Group 2, Minimal invasive repair with Achillon suture system (Integra Life Sciences Corporation, Plainsboro, NJ) was used respectively. The average age of the patients was 40 years. Patients in study groups were followed up at mean of 22.4 (range, 10 to 48) months after surgery. At the end of the followup time, functional outcome scores and complications were evaluated. Results: The AOFAS hindfoot clinical outcome scores were 98.7 in Group 1, 96.8 in Group 2. Although there was a numerical increase in AOFAS Scores in Group 1, there was no significant difference. The surgical outcome concerning local tenderness, skin adhesions, scar and tendon thickness was better in Group 2 than in Group 1 with statistical significance. Conclusion: Although functional outcomes of both treatment groups were the same, minimally invasive repair with the Achillon suture system provided safe, reliable and practical treatment with low risk of complications in the treatment of acute Achilles tendon ruptures.

Incidence of Chondral Lesions of Talar Dome in Ankle Fracture Types

Background: Although the surgical treatment of ankle fractures is well known, a paucity of literature exists correlating chondral lesions with ankle fracture types. Materials and Methods: This study is a retrospective review of patients with absence or presence of chondral lesions that underwent arthroscopically assisted open reduction and internal fixation between June 2002 and April 2005. There were 38 female and 48 male patients (mean age, 41.4 years; mean followup, 33.9 months), and all had an Ankle-Hindfoot Scale score. The relationship between fracture types and presence of lesions was evaluated. Results: Four of 27 fractures with chondral lesions consisted of the bimalleolar type, 6 of 15 fractures with chondral lesions consisted of the trimalleolar type, and 14 of 20 distal fibula fractures had chondral lesions. There was significant greater incidence of chondral lesions associated with distal fibula fractures. The mean AOFAS score was 95.6 among all fractures. Conclusion: There is clear evidence that despite anatomic reduction, postoperative results of ankle fracture repair are not free of complications. We believe inspection of the talar dome should be routinely considered in the surgical repair ankle fractures.

Capitellar cartilage injuries concomitant with radial head fractures.

PURPOSE To evaluate the incidence and types of capitellar cartilage injuries associated with higher-grade radial head fractures. METHODS Fifty-one consecutive patients with operatively treated, unstable, displaced Mason type II to III radial head fractures were identified. Ten of 51 patients had capitellar cartilage injuries concomitant with these fractures. All cartilage injuries were identified at the time of surgery except in 1 patient whose injury was determined via computed tomography. There were 8 men and 2 women with an average age of 33 years (range, 24-39 years). Lesions were seen with direct inspection and recorded by location, size, and thickness. RESULTS The incidence of capitellar chondral lesions concomitant with operatively treated Mason type II to III radial head fractures appeared in 10 of 51 patients. The average size was 5 x 5 mm (range, 2 x 2 mm to 10 x 10 mm). Four patients had Mason type II and 6 had Mason type III radial head fractures. The average surface of the cartilage injury was 6 x 7 mm (range, 3 x 6 mm to 10 x 10 mm) for Mason type II fractures and 4 x 4 mm (range, 2 x 2 mm to 5 x 10 mm) for Mason type III fractures. Two Mason type III fractures had full-thickness cartilage lesions, and 4 Mason type III fractures had partial-thickness cartilage lesions. Two Mason type II fractures had full-thickness cartilage lesions and the other 2 had partial-thickness cartilage lesions. CONCLUSIONS Capitellar cartilage lesions frequently occurred concomitantly with higher-grade radial head fractures. The incidence of these lesions increased with greater severity of radial head fractures. Low-grade radial head fractures created higher-grade cartilage lesions as the intact radial head can cause more damage to the capitellum. Careful evaluation of the joint should be performed for these subtle injuries. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.

Magnetic resonance imaging in follow-up of treated clubfoot during childhood

In this study, we evaluated the short-term results of surgically treated clubfoot with magnetic resonance imaging (MRI). T1- and T2-weighted MRI images with 4-mm slices in the standard anatomic sagittal, transverse, and coronal planes were obtained in seven cases of clubfoot aged 4--11 years (mean 5.6 years old). The mean follow-up period was 3.6 years (ranged between 2 and 6 years). Sagittal talocalcaneal angle, talar head and neck axis internal rotation, calcaneal axis internal rotation, transverse talar neck and head/calcaneus angle and posterior calcaneus external rotation were measured. Three cases with dorsal talonavicular subluxation and a case of calcaneocuboid luxation were demonstrated by MRI. It was concluded that MRI may help to understand results of surgically-treated clubfoot by revealing hindfoot articular relationships and many complications.

Fibro-Osseous Pseudotumor of the Digits: A Rare Tumor in an Unusual Location

Fibro-osseous pseudotumor of the digits (FOPT) is a rare benign lesion of the hand. When FOPT originates in an unusual anatomic region (other than the digits), it can imitate a malignant neoplasm, and consequently surgical treatment can be improper. This report describes a case of FOPT that developed in an unusual anatomic region: the first dorsal-extensor compartment of the wrist.

A positioning technique for closed intramedullar nailing of tibia fractures.

BACKGROUND We described a method of positioning the patient on the standard operation table that enables manual traction and equipment that is available in almost all operating theaters and compared it with regular positioning technique. METHODS Eighty two patients with unstable unilateral tibia fractures were evaluated and treated in the authors clinic between July 2002 and June 2006. The average age of the patients was 40.6 (29-65) years. The surgical indications included uncomplicated closed fractures, fractures in patients with multiple injuries, and inability to maintain a satisfactory closed reduction. Forty-two fractures that were operated with the new technique and meet these criterias were included in the study. All operations were performed on normal operation tables. RESULTS There was not any case of failure related with the nailing and the presented positioning technique. Intraoperative reduction was achieved with closed method in all patients. In 10 patients, satisfactory reduction was achieved with the help of polar screws in 2 patients and cable system in 8 patients. Anatomic reduction was obtained in the rest of 32 patients. There were no cases of compartment syndrome diagnosed postoperatively in both injured and uninjured side. There were also no neurologic complications and postoperative infection formation related to surgery. CONCLUSION The advantages of this technique is that, it allows precise reduction, control of rotation, and easy imaging access, without increasing operating or screening time and complication.

Early mobilization after sliding and Z-lengthening of heel cord: a preliminary experimental study in rabbits

Abstract Sliding lengthening and Z-lengthening techniques are widely used in heel cord lengthening. Even though most surgeons performing these procedures apply a short leg cast after surgery, their postoperative immobilization intervals vary from 3 to 7 weeks. Nather et al. showed that there was no need for immobilization after the musculotendinous lengthening of long, deep flexor tendons. In the present study, we aimed to show the healing process of heel cords lengthened by sliding and Z-plasty lengthening in rabbits that did not undergo any postoperative immobilization. We performed sliding lengthening in the right heel cords of the rabbits and Z-lengthening in the left heel cords. We compared these two techniques radiographically, biomechanically, and histopathologically. Even though the biomechanical study showed superior results in the sliding lengthening group on the 7th day, elongation of the tendons at both sites was seen radiographically. There was no statistically significant difference between the sites according to the biomechanical study done on the 28th day. We concluded that the ankle should be immobilized in the early healing phase and that both types of lengthening gain a similar level of strength by the 4th week.

Patterns of single segment non-physeal extremity fractures in children

Five hundred and fifteen children with single segment non-physeal extremity fractures were retrospectively reviewed. The male to female ratio was 2.7:1. The average age of study group was 9.9±4.7 years; 273 fractures (53 %) were on the left, 242 (47 %) were on the right. A fall was the main cause of the injury in most of the cases (80%). The forearm was the most commonly seen fracture site. Summer was the season when the fracture incidence was the highest. Highest surgical treatment rate (50%) was seen in supracondylar humerus fractures. It has been stated in the literature that non-physeal fractures are far more common than physeal fractures. We assume that this study not only will help understanding of the injury patterns of single segment non-physeal fractures in children but also, be a base for future studies in prevention and treatment of this type of fracture.Résumé Travail portant sur 515 enfants ayant présenté une fracture mono-segmentaire non épiphysaire. La proportion garçons – filles était de 2,7 pour 1. L’âge moyen du groupe examinéétait de 9,9±4,7 ans. 273 fractures étaient du côté gauche (53 %) tandis que 242 étaient du côté droit (47 %). Le facteur étiologique principal (80 %) était une chute de I’enfant. Fracture survenant surtout 1’été, atteignant l’avant-bras le plus souvent. La moitié des interventions chirurgicales ont concerné des fractures supra-condyliennes de l’humérus. D’aprés la littérature, les fractures n’atteignant pas le cartilage de conjugaison, sont beaucoup plus fréquentes que celles l’atteignant. Nous pensons que ce travail aidera à la compréhension des fractures n’atteignant pas le cartilage de conjugaison et sera une base pour des études futures concernant la prévention et le traitenient de ces lésions.