Locked posterior dislocation of the shoulder is very rare. Seizures and trauma are the most common causes of this injury.There is no current benchmark treatment strategy for these rare cases.This study has shown that reconstruction of the shoulder joint in an anatomical way in acute and chronic cases up to 16 weeks provides good results.The purpose of this study is to evaluate the results of different treatment procedures with outcomes and to compare the results of the same procedures in acute and chronic cases.Cite this article: EFORT Open Rev 2017;3:15–23. DOI: 10.1302/2058-5241.3.160089.

Angiogenic effects of epidermal growth factor (EGF), a potent mitogen, have been demonstrated previously. Moreover, different in vitro studies showed that EGF affects processes associated with bone healing, such as osteoblast differentiation and bone resorption. The aim of this study was to investigate the effect of combined core decompression (CD) and recombinant human EGF (rhEGF) treatment on early-stage osteonecrosis of the femoral head (ONFH) surgically induced in rats. ONFH was induced by dissecting the cervical periosteum and placing a ligature tightly around the femoral neck. Thirty rats were assigned to one of the following groups (n = 10 each group): sham-operated control, CD, and CD+rhEGF group. rhEGF was injected intraosseously into infarcted areas 2 weeks after the surgery. Preservation of femoral head architecture was assessed at 8 weeks post treatment by radiographic and histomorphological analyses. Osteopontin (OPN) and cluster of differentiation 31 (CD31) were detected by immunochemistry, as indicators of bone remodeling and vascular density, respectively. Inter- and intra-group (non-operated left and operated right femur) differences in radiographic and histomorphological results were analyzed. The femoral head area and sphericity were more preserved in CD+rhEGF compared to CD and sham-control group. CD31 levels were significantly different between the three groups, and were higher in CD+rhEGF compared to CD group. OPN levels were increased in CD and CD+rhEGF groups compared to sham control, but with no significant difference between CD and CD+rhEGF groups. Overall, our results indicate that EGF promotes bone formation and microvascularization in ONFH and thus positively affects the preservation of femoral head during healing.

Even though PFLCP is not the first choice in management of unstable pertrochanteric fractures, it must be kept in mind as an alternative to the other conventional plates and intramedullary implants with the properties of an increased stability by multiaxial screw locking and the results are satisfactory when appropriate settlement achieved.

Purpose: Osteochondral lesions of the talus are lesions that are seen particularly in the young age group and are often related to sports injuries and trauma. These lesions, which show late symptoms radiologically, can be determined in the early stages with magnetic resonance imaging. The aim of this study was to present a new osteotomy technique to reduce the complications of mosaicplasty surgery to a minimum and provide an early return to work. Methods: A total of 11 patients who had cartilage lesions due to osteochondritis dissecans in the medial aspect of the talus underwent mosaicplasty after a triplanar osteotomy. The dimensions of the lesion and the depth of the triplanar osteotomy were determined preoperatively. Coronal, sagittal and transverse cuts were made at the depth defined arthroscopically. Following the osteotomy, an osteochondral graft taken from the ipsilateral knee was placed in the prepared area. Osteotomy side was fixed with one or two cannulated screws following mosaicplasty. Results: With this technique, weight-bearing can be immediate in cases with no need for osteotomy in the joint surface. In cases including the joint surface, partial weight-bearing is permitted after 4 weeks and can be increased as tolerated. In the 11 cases treated with this technique, full weight-bearing was achieved at mean 5 weeks (range, 5-8 weeks). No shift (upward displacement of osteotomized fragment) or non-union was seen in any patient. Conclusion: With the triplanar osteotomy technique described here, potential shift complications can be reduced to a minimum. As only the lesion region is targeted, the osteochondral surface formed by the fracture is much less. Study design: Case Series; Level of Evidence, 4.which show late symptoms on X-ray views, can be determined in the early stages with magnetic resonance imaging (MRI). 6,8 Therefore, MRI is applied to many cases with radiological suspicion. More than 60% of OCD lesions are seen in the medial dome of the talus. 6,9 A 9-zone grid plan was described by Raikin et al. for the localization of

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We aimed to investigate whether there is a change in the postoperative lateral and vertical femoral offset (FO) in patients who underwent bipolar straight stem hemiarthroplasty (SSHA) and calcar stem hemiarthroplasty (CRHA) and whether this change makes a difference in the comparison of both groups. Material and methodsThis study included 109 patients who met these criteria. Patients are divided into two groups according to treatment methods. There were 58 patients (group 1) who underwent SSHA due to intracapsular (AO type 31-B neck and 31-C head fracture) femur fracture, and there were 51 patients (group 2) who underwent CRHA due to extracapsular (AO type 31-A intertrochanteric) femur fracture. We analyzed femoral vertical and lateral femoral offset, Wiberg angle, and head-neck angle difference in both groups. ResultsThe median age was significantly higher in the CRHA group (p=0.042). The Harris hip score (HHS) was significantly higher in the SSHA group (p=0.023). The femoral offset difference was 5 mm in the SSHA group, while it was significantly lower (-6 mm) in the CRHA group (p<0.001). The Wiberg angle difference did not differ significantly between patient groups (p=0.214). The limb length difference was found to be similar in both surgical groups (p=0.483). ConclusionsThe study results show that there was no negative correlation between clinical and radiological outcomes in the SSHA group, whereas there was a negative correlation between clinical and radiological outcomes in the CRHA group. It is very difficult to control vertical and lateral offset reconstruction, especially in extracapsular hip fractures reconstructed by hemiarthroplasty. Deficiencies in lateral and vertical stabilization restoration may be associated with poor clinical outcomes in CRHA patients. Orthopedic surgeries should be performed carefully when restoring leg length and femoral offset, especially calcar replacement hemiarthroplasties.

AmputasyonlarVücutta kol, bacak ya da parmakların tamamının veya bir kısmının cerrahi olarak kesilerek çıkarılması işlemidir. Amaç sadece patolojik dokuların uzaklaştırılması değil, kalan doku desteğini ve örtünmeyi iyi sağlamaktır. Protez kullanımına uygun, basıya sebep olmayacak güdük yeri yapmak gerekir. Eğer bu kesme işlemi eklem seviyesinden yapılıyor ise buna "dezartikülasyon" adı verilir. Neolitik dönemlerden beri bilinen en eski cerrahi işlemlerden biridir. Amputasyon yapılan hasta sayısı yaşlanan popülasyona bağlı olarak artmaktadır. Batı dünyasında yapılan ampütasyonların % 90 üzerindeki sebep periferik arter hastalığıdır. Genç hastalarda en büyük sebep travmadır ve bunu tümörler takip etmektedir. Amputasyon için tek mutlak endikasyon, hastalıklı veya travmaya maruz kalan ekstremitenin geri dönüşümsüz iskemisidir. Amputasyon seviyesinin kesinleştirilmesi ise ayrı bir tartışma konudur. Yük taşıyacak plantar bölge gibi alanların planlaması iyi yapılmalıdır. Öncelikle plantar kesilerden kaçınılmalı ve inzisyon hattı öne taşınmalıdır. Seviyenin doğru tespit edilmesi reoperasyon ve mortaliteyi azaltacaktır. Bu nedenle bazı tetkik ve yöntemlerle seviye tespiti yapılmaktadır. Bunlardan bazıları; • Arteriografi: • Cildin kan basıncı: • Cilt kan akışının Xenon ile tespiti: • Transkutanöz oksijen basıncı (tcPO2): Lokal iskemiyi göstermede ve seviye belirlenmesinde iyi bir indikatördür[1]. • Radioaktif mikrokorpuskul: • Dopplaer Ultrason ile akım değerlendirme: • Eletromagnetik akım değerlendirme:

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