Treatment of distal femur fractures with retrograde locked intramedullary nailing yields satisfactory results in adults.

A high rate of complications is associated with open reduction and internal fixation of Sanders type 4 fractures of the calcaneum. We assessed the long-term outcome of 83 Sanders type 4 comminuted intra-articular fractures of the calcaneum in 64 patients who underwent non-operative treatment between 1999 and 2005. Each fracture was treated by closed reduction and immobilisation in a long leg cast. Patients were reviewed every three months in the first year, and every six months thereafter. At each visit, the involved ankles were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) criteria. The degree of fracture healing and the presence of osteoarthritis were assessed. At a mean follow-up of 51 months (24 to 70) the mean AOFAS score was 72 (52 to 92). Osteoarthritis was scored radiologically using Graves' classification and was evident in the subtalar joints of 75 ankles (90%) on x-ray and in all ankles on CT scans, of which 20 were grade 0 or 1, 39 grade 2, and 24 grade 3. A non-operative approach to treating these fractures may be simpler, less expensive, easier to administer with fewer complications, and may be better tolerated than surgery, by many patients.

An anatomical reduction is essential in mallet finger deformities. Open reduction and internal K-wire fixation can be preferred due to its low complication rate and ease of application in patients whose mallet deformity cannot be treated by closed reduction.

For distal locking during tibial intramedullary nailing, the magnetic locking system is as accurate as the standard freehand technique, but it has lower operative times and radiation exposures compared to the standard freehand technique. Therefore, the magnetic locking system should be preferred to current standard freehand techniques.

Our results suggested that the RSI can be used as a predictor of the clinical outcome in patients with distal radius fractures involving the ulnar styloid.

Several problems are encountered with pelvic osteotomy in hip dysplasia including insufficient coverage, avascular necrosis, graft instability and fixation of secondary bone grafts. We evaluated results of pelvic osteotomy in 4-8 year olds in our institution. 44 cases of developmental dysplasia of the hip between 1994 and 1999 were reviewed. 14 hips in 12 patients were treated with a step-cut osteotomy and the results are discussed. The mean age was 5.6 (range: 4-8) years, and mean follow up was 87.7 months (60-120). The patients were followed up according to the Severin clinical assessment criteria, and their radiological findings were evaluated and classified in accordance with the Tonnis criteria. Radiologically, a marked correction was obtained in center-edge angle, which was increased to 22.30 from the preoperative value of -11.20. No graft shift or loss was observed in any cases. There was also no loss in coverage achieved by surgical intervention. Coxofemoral positioning was found to be normal in eighty percent of cases. 8% of cases had avascular necrosis. Full range of hip motion was achieved in 84% of cases, and 84% of cases exhibited negative Trendelenburg's sign. The modified osteotomy we describe eliminated the need for fixation and secondary surgery. Graft stability and bone conservation were achieved.

Öz Purpose: The aim of this study is to make prospective randomized comprehensive analysis of treatment results between the retrograde interlocking femoral nail and the percutan plate osteosynthesis in distal femoral fractures. Material and Methods: Forty seven patients (34M, 13F) underwent surgical treatment in our clinic with distal femoral fractures were evaluated. While 23 patients underwent retrograde interlocking femoral nailing, 24 patients underwent percutan plate osteosynthesis. Patients fractures were classified according to the AO Classification. The patients had open fractures were classified according to Gustilo Anderson. The patients were evaluated about functional fracture healing, union time and complication rates. Results: The mean union times were 25.3±5.7 weeks to 22.3±9 weeks. There were 8 excellent, 6 good, 7 moderate, 2 fair results in retrograde nail group and 12 excellent, 9 good, 3 moderate results in percutanous plate group. The mean joint range of motion was 102.6±16.5° in the retrograde nail group and 115.8±18.3° in the percutan plate group. Conclusion: Although union times are similar in both groups , percutan plate osteosynthesis is significantly superior than retrograde interlocking femoral nails about functions. Percutan plate osteosynthesis is significantly superior than retrograde interlocking femoral nail about complications. Amaç: Distal femur kırıklarında retrograde kilitli intramedüller çivi uygulaması ile minimal invazif perkutan plakla osteosentez uygulamasının prospektif randomize olarak karşılaştırmalı analizi amaçlandı. Gereç ve Yöntem: Distal femur kırığı nedeniyle kliniğimizde cerrahi tedavi uygulanan 47 hasta (34 E, 13K) değerlendirmeye alındı. Hastaların ortalama yaşı 40 (22-69 arası) idi. 23 hastaya retrograde kilitli intramedüller çivi , 24 hastaya ise perkutan plakla osteosentez uygulandı. Hastaların kırıkları AO sınıflamasına göre sınıflandırıldı. Açık kırığı olan hastalar Gustilo Anderson sınıflamasına göre sınıflandırıldı. Hastalar fonksiyonel kırık iyileşmesi, kaynama süresi ve komplikasyonlar açısından değerlendirildi. Bulgular: Ortalama kaynama süreleri retrograd çivi yapılanlarda 26 hafta, perkutan plak yapılanlarda 22 hafta idi. Retrograd çivi yapılan hastalarda 8 mükemmel, 6 iyi, 7 orta, 2 kötü sonuç elde edilirken perkutan plak yapılan hastalarda 12 mükemmel, 9 iyi, 3 orta sonuç elde edildi. Retrograd çivi yapılan hastaların ortalama diz eklem hareket açıklığı 100 derece idi. Perkutan plak yapılan hastaların ortalama diz eklem hareket açıklığı 115 dereceydi. Sonuç: Kaynama süreleri açısından her iki grupta da sonuçlar benzer olsa da perkutan plakla osteosentez fonksiyonel açıdan (retrograd kilitli intramedüller çiviye göre anlamlı olarak üstündür. Komplikasyonlar açısından da perkutan plakla osteosentez retrograd kilitli intramedüller çiviye göre anlamlı olarak üstündür.

The aim of this study was to evaluate the results of dorsal close wedge osteotomy in addition to the debridement application on Freiberg disease in terms of functional recovery and pain relief. Material and Methods: Sixteen patients diagnosed with Freiberg disease (11 female,5 male) were included in the study and their articular surfaces were evaluated using direct roentgenogram and magnetic resonance imaging following the physical examination. The evaluation of the patients' articular surface was based on Smilie Classification. The cases were evaluated previous to surgery and in the 12th week of the postoperative period using visual analogue scale (VAS) to determine pain levels and using American Orthopaedic Foot and Ankle Society score (AOFAS) score to assess their functional recovery. Results: According to Smilie Classification, two cases were grade 2, six cases were grade 3, seven cases were grade 4 and one case was grade 5. The average dorsiflexion amount of the patients was 22 degrees (between 0 and 38) in preoperative period. It increased to 42 degrees on average (between 20 and 70) in the 12th week after the operation. The enlargement in arthroses and the swelling in metatarsophalangeal arthrosis due tosynovitis improved aesthetically in the 12th week after the operation. Conclusion: The application of dorsal close wedge osteotomy in addition to debridement in the case of Freiberg disease is effective in the adjustment of the articular surface, in maintaining metatarsal length, in increasing the articular's functionality.