Yavuz Kabukcuoglu

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.

Fine Needle Aspiration of Malignant Bone Lesions

OBJECTIVE To determine the role of fine needle aspiration (FNA) cytology in the early diagnosis of malignant bone lesions. STUDY DESIGN Thirty-eight bone lesions that were considered malignant clinically and radiographically were evaluated by FNA. The results were compared with the histopathology of the subsequent open biopsies. RESULTS An accuracy rate of 89.5% was achieved by FNA. Eighty-four percent of the cases were consistent with the clinical and radiographic findings. Chondrosarcoma gave the greatest diagnostic difficulty in the differential diagnosis with other chondroid tumors. Giant cell tumor cases also produced some difficulty when the cytology was hemorrhagic and low in cellularity, displaying features of other benign bone lesions containing giant cells. Ewings sarcoma and multiple myeloma could be identified when interpreted with their coexistent clinical findings. The metastatic carcinoma cases were also easy to define, forming another group with a high rate of accuracy. CONCLUSION FNA plays a valuable role in the initial diagnosis of malignant bone lesions. Cytologic assessment with the clinical and radiologic findings, together with the experience of the cytopathologist, can yield almost the same diagnostic accuracy in the majority of the lesions.

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 ANK Device: A New Approach in the Treatment of the Fractures of the Lateral Malleoulus Associated with the Rupture of the Syndesmosis

The ANK device was developed for the treatment of fractures of the lateral malleolus occurring with rupture of the syndesmosis. While it provides the anatomic reduction of the fracture and the syndesmosis, it allows the physiologic movements of the fibula. It is not used for comminuted fractures of the lateral malleolus and in cases where fibular medullary canal is narrow. We included forty-nine patients who had the ANK device applied and at least 2 years follow-up. The mean follow-up was 41 months (range 24–124). The fractures were evaluated according to the Lauge Hansen classification; 25 cases were evaluated as supination-external rotation, 11 cases were pronation-abduction, and 13 cases were pronation-external rotation type fractures. There were also 46 fractures of the medial malleolus and three ruptures of the deltoid ligament. Twenty-nine (59,2%) patients were evaluated as excellent, 12 (24,5%) as good, 5 (10.2%) as fair and 3 (6.1%) as poor. Arthrosis was observed in 3 (6.1%) of the patients.

Mazabraud’s syndrome: Intramuscular myxoma associated with fibrous dysplasia

The association of fibrous dysplasia and intramuscular myxoma is a rare disease known as Mazabraud’s syndrome. Both lesions tend to occur in the same anatomical region. The relationship between fibrous dysplasia and myxoma remains unclear, where an underlying localized error in tissue metabolism has been proposed to explain this occasional coexistence. Another example of this syndrome in a 52 year-old woman is reported. The patient presented with a soft tissue mass at the anteromedial mid part of the left thigh. After excision of the mass, three separate bone lesions were detected in her control MRI. The soft tissue mass was misdiagnosed as liposarcoma in another center, and the bone lesions were interpreted as metastasis. The hypocellularity and the indistinct vascular pattern of the lesion were consistent with myxoma. The Jam-Shidi needle biopsies of the osseous lesions were diagnosed as fibrous dysplasia. The recognition of this entity is important for appropriate management of the patient. Patients with soft tissue myxomas should be thoroughly examined for fibrous dysplasia. The greater risk of sarcomatous transformation in fibrous dysplasia with Mazabraud’s syndrome should also be kept in mind. (Pathology Oncology Research Vol 10, No 2, 121–123)

Comparison between locked intramedullary nailing and plate osteosynthesis in the management of adult forearm fractures

OBJECTIVES We evaluated the results of two different surgical methods for the treatment of adult diaphyseal fractures of both forearm bones. METHODS Forty-two adult patients with forearm fractures were retrospectively evaluated. Of these, 22 patients (7 women, 15 men; mean age 32 years; range 18 to 69 years) underwent open reduction and plate-screw fixation, and 20 patients (6 women, 14 men; mean age 33 years; range 18 to 70 years) underwent closed reduction and locked intramedullary nail fixation. The fractures were classified according to the AO/OTA system. The patients were assessed using the Grace-Eversmann criteria and the DASH (Disability of the Arm, Shoulder and Hand) questionnaire. The mean follow-up was 30 months (range 12 to 45) with plate-screw fixation, and 23 months (range 12 to 34) with intramedullary nailing. RESULTS The mean operation time was 65 minutes (range 40 to 97 min) with plate-screw fixation, and 61 minutes (range 35 to 90 min) with intramedullary nailing (p>0.05). The mean time to union was significantly shorter with intramedullary nailing (10 weeks vs. 14 weeks; p<0.05). According to the Grace-Eversmann criteria, the results were excellent or good in 18 patients (81.8%) and acceptable in four patients (18.2%) treated with plate-screw fixation, compared to 18 patients (90%) and two patients (10%), respectively, treated with intramedullary nailing. The mean DASH scores were 15 (range 4 to 30) and 13 (range 3 to 25), respectively. The two groups did not differ significantly with respect to functional results and DASH scores (p>0.05). Postoperative complications were seen in three patients (13.6%) and two patients (10%) with plate-screw fixation and intramedullary nailing, respectively. CONCLUSION The two fixation methods yield similar results in terms of functional healing and patient satisfaction in the management of adult forearm fractures.