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This study reports, first, on the preparation and cross-linking of multilayers composed of poly(2-isopropyl-2-oxazoline- co -ethyleneimine) (PiPOX-PEI) and tannic acid (TA). PiPOX was synthesized by cationic ring-opening polymerization (CROP) and partially hydrolyzed, yielding a random copolymer PiPOX-PEI. It was then coassembled at the surface with TA using the layer-by-layer (LbL) technique. Multilayers were exposed to NaIO 4 solution to induce covalent bond formation between PEI units of PiPOX-PEI and TA. Cross-linking with NaIO 4 enhanced the stability of the multilayers, especially under basic conditions. Second, the potential of PiPOX-PEI and TA multilayers as a stimuli-responsive dual drug-releasing platform was examined using curcumin (CUR) and doxorubicin (DOX) as model drugs. These drugs were chosen as they can act in a combinatorial manner to increase cell death. The surface of CUR-containing CaCO 3 microparticles was modified with PiPOX-PEI and TA multilayers and postloaded with DOX. We found that LbL particles could release DOX in a pH-responsive manner, whereas temperature-induced release was observed only when the temperature was raised above 40 °C. The DOX and CUR released from the LbL particles could act synergistically on HCT-116 cells. Cross-linking increased the DOX release from LbL particles but decreased the CUR release from the core. Corroborating the release data, the synergy observed with the non-cross-linked particles was lost with the cross-linked particles, and the decrease in the viability of HCT-116 cells was attributed mainly to the release of DOX. Overall, we describe here NaIO 4 -induced cross-linking of PiPOX-PEI/TA LbL films, the effects of pH, temperature, and cross-linking on DOX and CUR release from multilayers, and comparison of the combinatorial effect of DOX and CUR for cross-linked and non-cross-linked LbL microparticles through cell viability assays., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Background:  We compare the radiologic and clinical results between the short-segment fixation and the long-segment fixation in the thoracolumbar junction distraction fractures., Methods:  We retrospectively reviewed the prospectively recorded data of patients who underwent posterior approach and pedicle fixation treatment for thoracolumbar distraction fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association AO/OTA 5-B) with a minimum of 2 years of follow-up. A total of 31 patients were operated on; they were divided into two groups: (1) patients treated with short-level fixation (SLF; one level above and below the fracture level) and (2) patients treated with long-level fixation (LLF; two levels above and below the fracture level). The clinical outcomes were evaluated with the neurologic status, operation time, and time to surgery. The functional outcomes were evaluated with the Oswestry Disability Index (ODI) questionnaire and visual analog scale (VAS) at the final follow-up. Radiologic outcomes were measured with the local kyphosis angle, anterior body height, posterior body height, and sagittal index of the fractured vertebra., Results:  SLF was performed in 15 patients and LLF was performed in 16 patients. The average follow-up period was 30.13 ± 11.3 months for the SLF group and 35.3 ± 17.2 months for group 2 ( p  = 0.329). The two groups were similar in regard to age, gender, follow-up period, fracture level, fracture type, and pre- and postoperative neurologic status. The operating time was significantly shorter in the SLF group than in the LLF group. There were no significant differences between the groups in all radiologic parameters, ODI score, and VAS., Conclusion:  SLF was associated with a shorter operation time and allowed the preservation of two or more segments of vertebral motion., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: To determine whether synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children., Methods: Paediatric patients treated for pathological fractures of the proximal femur between 2013 and 2020 were evaluated retrospectively. 17 patients with a mean age of 10.7 years (range 6-16 years) were assessed. The definitive histopathological diagnoses were SBC (simple bone cyst) (12) and ABC (aneurysmal bone cyst) (5). The median duration of follow-up was 37 months (range 12-70 months)., Results: All patients returned to their normal daily routine within 3-8 months following surgery. The mean post-op recovery time was 3.2 months (range 3-6 months). Graft was incorporated at approximately 12 months. No significant radiographic healing was observed in 2 patients. In the remaining 15 patients, the mean duration of healing was 14 months (range 8-24 months)., Conclusion: Synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

BACKGROUND Suicide attempts that involve jumping from a great height may not be fatal but can result in lumbosacral facture-dislocations. This retrospective study aimed to present the experience from a single center in Turkey of 21 patients with lumbosacral facture-dislocations, or suicidal jumper fractures, treated with lumbosacral fixation between 2015 and 2022. MATERIAL AND METHODS The study included 21 patients. The diagnosis was established through X-ray and computed tomography (CT) examinations. Neurological damage was assessed using the Gibbons score. Among the patients, 2 were classified as Roy-Camille type 1, 12 as Roy-Camille type 2, and 7 as Roy-Camille type 3. Morphologically, 8 patients had H-type fractures, 7 had T-type fractures, and 6 had U-type fractures. Bilateral spinopelvic fixation was performed. Functional outcomes were evaluated using the Majeed score. RESULTS The average Injury Severity Score (ISS) was 31.6±12.2. The mean duration of surgery was 123.6±44.9 minutes. According to the Majeed score, excellent results were observed in 8 individuals (40%), good results in 5 individuals (25%), fair results in 5 individuals (25%), and poor results in 2 individuals (10%). Out of 18 patients with neurological deficits, 14 showed improvement after surgery, while 4 continued to experience deficits. CONCLUSIONS The findings from this study highlight the importance of obtaining a clear history of the cause of lumbosacral facture-dislocation, as attempted suicide by jumping from a height can cause specific types of injury to the lumbar spine and sacrum that require rapid diagnosis and management to reduce the incidence of permanent paraplegia.

BACKGROUND Non-union of distal tibia fractures is a challenge in orthopedic surgery and can be due to open fractures, osteopenia, infection, or failure of surgical devices. This retrospective study aimed to describe 8 patients with non-union of distal tibial fractures treated with distal tibial nail and screw fixation. MATERIAL AND METHODS According to the Gustilo-Anderson classification, 3 patients had type 2 open fractures, 1 had a type 3 open fracture, 1 had a type 1 open fracture, and 3 had closed fractures. The Association of Osteosynthesis AO classified 4 patients as A2, 2 as B2, and 2 as C2. Seven patients received distal supporting bolt-locking-screw nails (DSBLS) and 1 received DSBLS nail and plate in their most recent operation. Clinical outcomes were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and Olerud-Molander scores. RESULTS All 8 patients were male, with a mean age of 35.5±14.6 years. Six patients had atrophic non-union, 1 had hypertrophic non-union, and 1 had infected non-union. Union was achieved in all patients. The average union time was 25.1 (range, 12-60) months, and the follow-up duration was 3.6 (range, 2-6) years. The mean Olerud-Molander score was 92.5 (range 85-100), and the mean AOFAS score was 91.2 (range, 85-100). There was no evidence of rotational deformity or shortening. CONCLUSIONS Distal tibial non-unions benefit from nails with DSBLS system due to their excellent biomechanical properties. These nails facilitate union and allow patients to bear weight early in the postoperative period, enabling a quicker return to normal activities.

BACKGROUND This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. MATERIAL AND METHODS We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. RESULTS The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. CONCLUSIONS Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.

The objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location.

This study presents the outcomes of patients treated with non-union of femoral neck fractures healed with valgus osteotomy, fixed with a Dynamic Hip Screw (DHS). The study retrospectively evaluated 16 patients who, between 2007 and 2014, developed pseudarthrosis following treatment for a femoral neck fracture and who were treated with DHS-osteosynthesis, after a valgus subtrochanteric osteotomy. Postoperative clinical evaluation of the patients was done? using the Harris Hip Scoring (HHS) system. Union of both the fracture and the osteotomy site was achieved in 17.2 weeks (range: 14-24 weeks) in all patients. The average Pauwels angle decreased from 72o (range 62-80) preoperatively to 26o (range 20-50) postoperatively. All fractures were Pauwels type III preoperatively and 4 type II and 12 type I postoperatively. The average HHS increased from 26 (range 18-34) preoperatively to 85 (range 68-94) postoperatively. Of the patients who were followed up for a mean duration of 3.1 years (range: 1-5 years), four had 1-cm shortening. No patient developed postoperative AVN of the femoral head. For patients with non-union after femoral neck fracture, DHS-osteosynthesis after valgus osteotomy is a method with a shorter learning curve, which can be successfully performed.

Objective: The aim of our study is to evaluate the functional outcomes and quality of life in adult ipsilateral femur and tibia fractures., Methods: 26 patients (21 male, 5 female; mean age 30 years, range: 18 to 66) treated for adult ipsilateral femur and tibia fractures were evaluated retrospectively. For femur fractures, intramedullary nails were used in 15 patients (12 antegrade, 3 retrograde), plate in 11 patients (10 locked-plate, and 1 blade-plate with a 95 degree angle). For tibia fractures, locked-plate were used in 13 patients, intramedullary nails in 9 patients, external fixator in 3 patients and multiple screws in 1 patient. According to Blake and McBryde classification, 17 fractures were type I, 9 fractures were type II (7 type 2A and 2 type 2B). The functional outcomes were evaluated by Karlström and Olerud criteria, and quality of life was evaluated by Short Form-36. The mean follow-up duration was 4.4 years (range: 1.1 to 7.3 years)., Results: The functional outcomes were excellent in 6 patients, good in 8 patients, acceptable in 6 patients and poor in 6 patients. The mean values of quality of life scales were; physical function: 64.8, physical role limitation: 60.5, pain: 68.2, general health: 63.3, vitality: 58.4, social function: 68.2, emotional role limitation: 62.7, and mental health: 65.8., Conclusion: Adult ipsilateral femur and tibia fractures are severe injuries and adversely affect the quality of life and functional outcomes. The quality of life scales should be used along with functional outcome scores in evaluating these injuries., The Translational Potential of This Article: Adult ipsilateral femur and tibia fractures cause severe morbidity. Functional outcomes and quality of life scales should be used together to evaluate these fractures. Karlström and Olerud criteria for functional outcomes and Short Form-36 scales for quality of life are suitable methods to evalute these fractures.

Background: The treatment of diaphyseal forearm fractures using open reduction and plate fixation is generally accepted as the best choice in many studies. However, periosteal stripping, haematoma evacuation may result in delayed union, nonunion and infection. Refracture after plate removal is another concern. To overcome these problems intramedullary nails (IM) with different designs have been used with various outcomes. However previous IM nails have some shortcomings such is rotational instability and interlocking difficulties. We evaluated the results of newly designed IM nail in the treatment of diaphyseal forearm fractures in adults., Materials and Methods: 32 patients who had been treated with the interlocking IM nail for forearm fractures between 2011 and 2014 were included in this study. There were 23 males and 9 females with mean age of 36 years (range 18-68 years). 22 patients (68.8%) had both bone fractures. Nine patients (28.1%) had open fractures. The remaining ten patients (31.2%) had radius or ulna fractures. Grace and Eversmann rating system was used to assess functional evaluation. Patient reported outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores., Results: Union was achieved in all patients. The mean followup was 17 months (range 13 - 28 months). According to the Grace-Eversmann criteria, 27 patients (87.5%) had excellent or good results. The mean DASH score was 14 (range 5-36). Overall complication rate was 12.5%. Superficial infection was encountered in two patients. One patient had delayed union, however fracture healed without any additional surgical procedure. One patient who had open grade 3A, comminuted proximal third radius fracture developed radioulnar synostosis., Conclusions: The new design IM interlocking forearm nail provides satisfactory functional and radiological outcomes in the treatment of adult diaphyseal forearm fractures., Competing Interests: There are no conflicts of interest.

Background: There is no consensus on the materials and the techniques to use in fixing pathologic fractures secondary to osteomyelitis. This study reports the results of the fixation of pathologic fractures secondary to osteomyelitis using the "internal fixator technique.", Methods: The internal fixator technique was performed on 11 children and adolescents with fractures secondary to osteomyelitis between 2003 and 2010. A retrospective chart review was conducted to record the following: age, sex, the anatomic region of infection, the time delay from symptom onset to fracture, the classification of chronic osteomyelitis, the Cierny-Mader classification, the causative organism, surgeries, the length of hospitalization, the location and the pattern of fracture, the duration of infection, the length of follow-up, and complications., Results: The patients included 7 male and 4 female patients with a mean age of 8.7 (range, 6 to 13) years. Pathologic fractures were as follows: 7 femur and 4 tibia. Nine of them were in the metaphysis and 2 others were located in the diaphysis. The time delay from symptom onset to fracture was 3.36 (1 to 9) months. The anatomic region of infection was the diaphysis in 2 cases and the metaphysis in 9 cases. Fractures patterns were short oblique and transverse. The length of hospitalization was a mean of 7 days. The duration of infection ranged from 1 to 12 (mean, 4.38) months. The mean duration of follow-up was 57.09 (range, 36 to 73) months from the initial presentation. Only 2 patients developed shortening, for which no additional intervention was performed., Conclusions: This case series demonstrates that the "internal fixator technique" is an acceptable alternative to the management of pathologic fractures of the femur or the tibia in children and adolescents with unresolved acute and chronic osteomyelitis. Infections were resolved in all cases and fractures were sufficiently stabilized to allow union with a low complication rate., Level of Evidence: Level IV-therapeutic.

Purpose: The aim of this study was to compare CT-assisted percutaneous excision, which is a closed, economic method and a more cosmetic approach, and open surgery in the treatment of osteoid osteoma., Materials and Methods: Fifty-three patients (12 female and 41 male patients) who had percutaneous excision (n = 24) and open surgery (n = 29) were evaluated retrospectively. The mean age was 16.6 years and the mean duration of follow-up was 53.5 months. During percutaneous excision, a trephine was advanced through the labeling wire and the site, including the nidus, was excised en-bloc and the incision walls were curetted. During the open surgery, the localization of the nidus was marked using c-arm X-ray and the nidus was accessed by lifting the cortical bone, layer-by-layer, using burr. The nidus was excised and its cavity curetted., Results: The result was successful in 22 and a failure in three patients who had closed excision. The result was successful in 20 and a failure in nine patients who had open surgery. The mean duration of operation was 44.37 minutes in the percutaneous excision group and 80.6 minutes in the open surgery group. There was no difference in the pre-operative VAS values between the two groups, whereas the post-operative VAS values were statistically significantly different. There was also a statistically significant difference in the duration of the operation and the length of the hospital stay between the groups., Conclusion: Percutaneous excision with trephine is a more successful, effective, minimally invasive, safe and a better cosmetic approach in the treatment of osteoid osteoma. This method is also a cheap method that does not require expensive equipment.

Background: The common purpose of almost all methods used to treat the osteochondral injuries is to produce a normal cartilage matrix. However current methods are not sufficient to provide a normal cartilage matrix. For that reason, researchers have studied to increase the effectiveness of this methods using chondrogenic and chondroprotective molecules in recent experimental studies. Insulin-like growth factor-1 (IGF-1) and hyaluronic acid (HA) are two important agents used in this field. This study compared the effects of IGF-1 and HA in an experimental osteochondral defect in rat femora., Materials and Methods: The rats were divided into three groups (n = 15 per group) as follows: The IGF-1 group, HA group, and control group. An osteochondral defect of a diameter of 1.5 mm and a depth of 2 mm was created on the patellar joint side of femoral condyles. The IGF-1 group received an absorbable gelatin sponge soaked with 15 μg/15 μl of IGF-1, and the HA group received an absorbable gelatin sponge soaked with 80 μg HA. The control group received only an absorbable gelatin sponge. Rats were sacrificed at the 6(th) week, and the femur condyles were evaluated histologically., Results: According to the total Mankin scale, there was a statistically significant difference between IGF-1 and HA groups and between IGF-1 and control groups. There was also a significant statistical difference between HA and control groups., Conclusion: It was shown histopathologically that IGF-1 is an effective molecule for osteochondral lesions. Although it is weaker than IGF-1, HA also strengthened the repair tissue.

Objectives: The aim of this study is to investigate the effectiveness and reliability of limited-contact locking plates in minimally invasive percutaneous osteosynthesis (MIPO) of the lateral tibia., Design: A retrospective study., Patients and Methods: The retrospective study included 14 patients who were operatively treated with an MIPO technique due to open tibial fractures between 2006 and 2012. The patients were 11 males and 3 females with a mean age of 13.2 (range, 9 to 16) years. The patients were followed up for a mean period of 2.4 (range, 1 to 5) years. The mechanism of the injuries included a motor vehicle accident (n=11), a shotgun injury (n=2), and a fall from height (n=1). According to the Gustilo-Anderson classification, 10 patients had type I (72%), 2 had type II (14%), and 2 had type III (14%) open fractures., Results: The mean time to radiologic union was 18 (range, 11 to 32) weeks. No infection was detected that would require implant removal. No complications such as early epiphyseal closure, angulation, or limb-length inequality were observed., Conclusions: Limited-contact locking plates in MIPO of the lateral tibia is an effective alternative method in the treatment of open pediatric tibial fractures., Level of Evidence: Level IV-therapeutic.

Background: Freiberg's disease is an osteochondrosis most commonly seen in adolescent women and characterized by pain, swelling and motion restriction in the second metatarsal. The early stages of this disease can be managed with semirigid orthoses, metatarsal bars and short leg walking cast. Number of operative methods are suggested which can be used depending on the pathophysiology of the disease, including abnormal biomechanics, joint congruence and degenerative process. We evaluated the outcomes of the patients with Freiberg's disease who were treated with dorsal closing-wedge osteotomy and resection of the metatarsal head., Patients and Methods: 16 patients (11 female, 5 male) with a mean age of 24.5 (range 13-49 years) years who underwent dorsal closing wedge osteotomy or resection of the metatarsal head were included in this retrospective study. Second metatarsal was affected in 13 and third metatarsal in three patients. According to the Smillie's classification system, ten patients had type IV osteonecrosis and six patients had type V. The results of the patients were evaluated using the lesser metatarsophalangeal-interphalangeal (LMPI) scale., Results: According to the LMPI scale, the postoperative scores for the osteotomy and excision groups were 86 (range 64-100) and 72.6 (range 60-85), respectively. In the osteotomy group, mean passive flexion restriction was 18° (range 0°-35°) and mean passive extension restriction was 12° (range 0°-25°). Mean metatarsal shortening was 2.2 mm (range 2-4 mm) in the osteotomy group as opposed to 9.8 mm (range 7-14 mm) in the excision group. Significant pain relief was obtained in both groups following the surgery., Conclusions: The decision of performing osteotomy or resection arthroplasty in the patients with advanced-stage Freiberg's disease should be based on the joint injury and the patients should be informed about the cosmetic problems like shortening which may arise from resection.

Background: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures., Methods: Forty-two pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluation included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications., Results: In 27 patients, radial pulse was palpated following reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) who retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture, and the other two were managed with saphenous vein graft and primary repair., Discussion: It is vital to re-evaluate patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ischemia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

The aim of this study was to evaluate the outcomes of internal fixation with Non-Contact Plating (NCP) after deep infection caused by previous surgeries of the tibia or femur fractures. The study included 15 patients (4 female and 11 male). The mean age patients was 36.6 years (range, 21-64 years). There were 6 femur and 9 tibia fractures. The mean follow-up period was 25.7 months (range, 15-45 months). The study comprised 11 open and 4 closed fractures. External fixator was used in 3, plate in 4, and intramedullary nail in 8 patients for index surgery. Deep infection was diagnosed via clinical findings, laboratory parameters, and microbiological evaulation. Deep infection was diagnosed within a mean period of 5.5 weeks (range, 2-10 weeks). The infecting organism was methicillin-resistant staphylococcus aureus (MRSA) in 5, methicillin-sensitive staphylococcus aureus (MSSA) in 6, pseudomonas auroginosa in 2, and enterobacteriacea in 2 patients. Union achieved in all patients. Mean time to union was 17 (range, 11-38) weeks. Delayed union was observed in 3 patients who required additional surgeries. Of these one patient developed osteomyelitis. The NCP is an effective alternative method in the treatment of deep infection encountered after internal or external fixation for the tibia, or femur fractures.

Background: In this study, we evaluated the results of external bone transport, which was applied to 11 patients with traumatic bone loss who had not completed their bone development., Methods: The average age of the 9 male and 2 female patients was 10.6 (range, 8 to 16) years. Eight of the defects were located in the tibia, whereas the other 3 were in the femur. The average defect was 5.4 (range, 4.5 to 8.5) cm. External bone transport was applied in the early period in 7 patients, whereas in 4 patients it was performed due to nonunion. Bifocal osteosynthesis and single osteotomy were performed in 2 patients with type B2 nonunion. Compression to the nonunion region and lengthening in the osteotomy region were applied. In 2 patients with type B1 nonunion, and the other 9 patients who had external bone transport, the gap was eliminated by bifocal osteosynthesis, single osteotomy, and bone transport to the osteotomy line., Results: The mean follow-up period was 21 (range, 13 to 48) months. Complete union was achieved in all patients without any bone operation or graft application. No refracture was observed after the removal of the external fixator, and the average hospitalization time was 16 (range, 7 to 65) days. The average external fixation time was 4.2 (range, 3.5 to 5.5) months, and the mean external fixator index was 0.8 months (23 d/cm). The mean bone healing time was 5.1 (range, 4.6 to 6) months., Conclusions: To initially consider the open fractures with true or in situ bone loss in children as "anticipated nonunion," and determine the treatment strategies regarding this fact, may prevent nonunion and shorten the healing period. Bone transport in the treatment of traumatic bone defects in children is an easy biological procedure, with lower complications but higher success ratios., Level of Evidence: Level IV-therapeutic.

Introduction: The purpose of this study was to compare clinical and radiological outcomes of patients who underwent single-bundle anterior cruciate ligament (ACL) reconstruction with anteromedial portal (AMP) and transtibial (TT) techniques., Materials and Methods: Arthroscopic single-bundle ACL reconstruction was performed using AMP technique in 34 patients and TT technique in 30 patients. The patients were evaluated retrospectively. Aperture fixation was used for femoral fixation, and absorbable screws and U staples were used for tibial fixation of the graft. Pivot shift test, Lachman test, Lysholm, Tegner, and International Knee Documentation Committee (IKDC-2000) scoring systems were used in the clinical and functional evaluation of patients before and after the surgery. Time to return sports and activity level were assessed. In the radiological evaluation of non-anatomic bone tunnel placement, the criteria developed by lllingworth et al. were used. The mean duration of follow-up was 20.4 and 24.6 months in the AMP and TT groups, respectively., Results: There was a significant difference between the AMP group (86.7 %) and the TT (14.7 %) group in terms of anatomical placement of the femoral tunnels and grafts (p < 0.001). No significant difference was observed between the two groups in terms of the Pivot shift test, Lachman test, Lysholm, Tegner, and IKDC scores, and activity level (p > 0.05). The patients in the AMP group returned to sports 1.5 months earlier on average (p < 0.001)., Conclusions: It was shown that AMP technique was superior to the TT technique in providing anatomical placement of the graft and in recovery time to return sports; however, there was no difference between groups in early periods in terms of the clinical and functional outcomes.

The aim of this study was to investigate the safety of one-stage bilateral open reduction using the anterior approach in the treatment of patients with bilateral Tönnis Type III and IV Developmental Dysplasia of the Hip (DDH). Forty-six patients were retrospectively evaluated. Thirty-eight were female, eight were male. The mean age was 16.63 (11-29) months. The mean follow-up period was 27.18 (12-65) months. The mean hospitalization period after surgery was 1.91 (1-5) days. The mean pre-operative hematocrit level was 35.14% (28.1-44.1) and the mean pre-operative hemoglobin level was 11.75 g/dl (9.3-13.6). The mean post-operative hematocrit level was 32.54% (26.7-40.4) and the mean post-operative hemoglobin level was 10.80 g/dl (8.78-12.3). None of the patients required blood transfusion. The mean anesthesia duration was 133.30 (95-180) minutes, and the mean operation duration was 107.58 (70-145) minutes. According to the modified scoring system by Trevor et al, excellent results were obtained in 66 hips of 46 patients (71.8%), and good results were obtained in 26 hips (28.2%). Twenty two hips (23.91%), which developed acetabular dysplasia in the follow-up period required a secondary acetabular intervention. According to the Kalamchi and MacEwen classification, Type I avascular necrosis developed in ten hips, Type II in one hip, and Type IV in two hips. One-stage bilateral open reduction using the anterior iliofemoral approach in Tönnis Type III and IV DDH at walking age is a safe, time-saving treatment method that shortens the hospitalization and immobilization periods.

Background: The aim of the present study was to investigate the effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats., Methods: Thirty-two rats were divided as follows: nicotinized group (1), hyperbaric oxygen group (2), nicotinized + hyperbaric oxygen group (3), and control group (4). For 28 days, nicotine was administered in Groups 1 and 3. Then, a standard shaft fracture was induced in the left femur of rats. Groups 2 and 3 underwent hyperbaric oxygen therapy for 21 days. At the end of the experiment, fracture site, left femur and whole body bone mineral content and density were measured., Results: The radiological and histopathological scores of Group 1 were statistically significantly lower compared to Groups 2, 3 and 4, and there was no statistically significant difference between the Groups 2, 3 and 4. In a comparison between the groups, no statistically significant difference was found in terms of bone mineral content and density values measured at the fracture site, left femur and whole body., Conclusion: The negative effects of nicotine on fracture healing are eliminated with hyperbaric oxygen therapy, but hyperbaric oxygen alone does not cause significant changes in healing (radiologically and histopathologically).

In this study, clinical and radiological results were evaluated in patients with Legg-Calve-Perthes disease treated with Salter pelvic osteotomy. Between 2004 and 2008, 16 patients underwent a Salter osteotomy as treatment for Legg-Calve-Perthes disease (15 male, 1 female; 10 right hip, 6 left hip). The mean age at the time of surgery was 8.1 +/- 1.4 (range: 6 to 10) years. Surgical indications were : age between 6-10 years at the onset of the disease; Herring classification type B, B/C, or C; and at least one risk sign. 6-8 year old patients were classified as group I and 9-10 year olds were classified as group II. We investigated the effects of age and Herring classification on radiological outcomes. The final radiographic evaluation according to the Stulberg classification showed nine hips (56.25%) classified as good (Stulberg I/II), five (31.25%) as fair (Stulberg III); and two (12.5%) as poor (Stulberg IV). In group I, 7 patients (70%) had good results, while only 2 (33.3%) in group II. The results in group I were statistically better than group II (p < 0.05). Based on the Herring lateral pillar type, of the 12 patients classified as B or B/C, at final follow-up, 8 (66.6%) had a good outcome (Stulberg I/II), whereas in the four patients classified as type C, only one (25%) had a good outcome. The Salter pelvic osteotomy is an effective method of surgical treatment for Legg-Cave-Perthes in patients between 6-8 years of age.

Tibia fractures in children are generally treated successfully by conservative means. The aim of this study was to evaluate the efficacy and safety of fixation using Titanium elastic nails (TEN) in pediatric tibia fractures in which conservative measures failed or were deemed inapplicable. In this study, 30 patients who had tibia fractures and were fixated with TEN between 2007 and 2011 were analyzed retrospectively. The procedure was performed after poly-trauma in six patients, open fracture in seven, reduction loss in twelve, and unsuccessful closed reduction in five patients. The number of girls and boys was 3 and 27, respectively, with a mean age of 9.8 years. The evaluation criteria of Flynn et al. were used in the analysis of the results. The mean follow-up period was 18 months. The mean period of union was 8 weeks and 14 weeks in closed and open fractures, respectively. Epiphyseal damage, rotational deformity, need for reintervention, deep infection, implant failure, or recurrent fracture was not observed in any case. According to the Flynn evaluation system, 23 cases were evaluated as excellent, and 7 as good. Fixation with TEN is an easy, effective, and safe method that can be used in tibia fractures that are open, irreducible, or with loss of reduction and in cases with accompanying trauma, such as floating knee.

Objective: The aim of this study was to compare retrograde intramedullary nailing (RIMN) and bridge plating for the treatment of extra-articular distal femur fractures., Methods: The study retrospectively examined 15 patients (13 males and 2 females; mean age: 36 years, range: 17 to 55 years) who underwent bridge plating and 13 patients (11 males and 2 females; mean age: 31.1 years, range: 17 to 49 years) who underwent RIMN for the treatment of extra-articular distal femur fractures between 2007 and 2012. Functional results were evaluated using the Sanders criteria. The mean follow-up time was 31.3 (range: 20 to 46) months and 26.7 (range: 18 to 62) months in the plate and the nail groups, respectively., Results: Mean duration until union was 25.7 (range: 12 to 72) weeks in the plate group and 22.3 (range: 12 to 52) weeks in the nail group. Nonunion was observed in 2 patients in the plate group and in 1 in the nail group, delayed union in 3 patients in the plate and 2 in the nail groups, malalignment (>10°) in 2 patients in the plate group and 1 in the nail group and implant failure in 1 patient in the plate group. Excellent/good functional results were obtained in 12 and 10 patients in the plate and the nail groups, respectively. No significant difference was found between the groups in terms of duration of union, complications and functional results (p>0.05)., Conclusion: Bridge plating and RIMN have similar results in the treatment of extra-articular distal femur fractures. Both methods can be applied to all fractures, with the exception of Gustilo-Anderson Type 3B and C open fractures.

Objective: The aim of this study was to evaluate the effects of the antithrombotic agents enoxaparin and rivaroxaban on tissue survival following skin degloving injury in an experimental rat tail model., Methods: The study included 24 rats divided into three equal groups of 8; the enoxaparin group (Group 1), the rivaroxaban group (Group 2) and the saline control group (Group 3). A degloving injury was created by making a circular incision 5 cm distal to the base of the tail; manual traction was applied to the tail skin distal to the incision. After 15 minutes, the ends of the incision were sutured back in place. Antithrombotic agents were administered immediately after suturing and repeated once a day for 15 days. At the end of Day 15, the experiment was terminated. Gross morphological tissue survival and histopathology were evaluated., Results: Histopathological examination of the enoxaparin and rivaroxaban groups revealed that the skin was mostly normal or intact with minimal inflammation. The mean length of necrotic area was significantly higher in the saline group compared to the enoxaparin and rivaroxaban groups (p<0.05). No statistically significant differences were noted between the rivaroxaban and enoxaparin groups (p=0.451). The mean extent of skin necrosis was significantly higher in the control group than the study groups (p<0.05), while there was no significant difference in the length of necrotic area between Group 1 and 2 (p=0.722)., Conclusion: Rivaroxaban and enoxaparin improved tissue survival in skin degloving injuries in terms of gross morphological and histopathological findings in a rat tail model.

Although numerous studies have been conducted on supracondylar humerus fractures in children, there is only a limited number of studies regarding the outcome of open fractures. In this study, the early and late outcome of open supracondylar humerus fractures in children were evaluated. The outcome in 26 children (19 males, 7 females) treated for open supracondylar humerus fractures was evaluated retrospectively. The mean age was 73 years (range: 4 to 14) and the mean follow-up period was 43 years (range: 2-8). According to the Gustilo-Anderson classification, 18 patients (69%) had type 1 and 8 patients (31%) type 2 open fractures. Nine patients (34%) presented with a nerve injury. Distal pulses could not be detected in four patients (15%). Functional outcomes were evaluated according to the scoring criteria by Flynn et al. Pin tract infection developed in one patient (3%). Artery repair via an anterior approach was performed in one patient. In nine patients with neurological symptoms, nerve functions were restored within three to six months. The mean union time was six weeks (5-8 weeks). According to the scoring criteria by Flynn et al, an excellent outcome was achieved in 23 patients, and a successful outcome in 3 patients. According to these findings, although vascular and nerve injuries frequently accompany open supracondylar humerus fractures in children, the late radiological and functional outcome was as good as in closed fractures.

The authors retrospectively studied 43 children with femoral fractures, treated with titanium elastic nailing (TEN). Twenty-two underwent closed fluoroscopic reduction ( Group I), whereas the other 21 underwent mini-open reduction (Group II). The operation time averaged 71 minutes in group I, and 48 minutes in group II (p < 0.001). The mean fluoroscopy time was 793 seconds in group I, and 35.5 seconds in group II (p <0.001). However, blood loss and hospital stay were significantly higher in group II (p < 0.001 and p = 0.001 respectively). Time to full weight bearing, time to radiographic union and TEN outcome score did not differ significantly. Overall, no one technique was really superior. From a practical viewpoint, a mini-open reduction may be decided intra-operatively if closed reduction proves to be problematic. This decreases intra-operative radiation and length of the surgical procedure.

This study compares the results of the locking compression plate (LCP) and the dynamic compression plate (DCP) in the treatment of diaphyseal forearm fractures in adults and defines the indications for the use of the LCP. Forty-two patients with diaphyseal forearm fractures were retrospectively analyzed. Of those, 22 had been treated with the LCP (LCP group) and 20 had been treated with the DCP (DCP group). The AO/ASIF classification was used to classify the fractures. Patients were assessed using the Grace-Eversmann criteria and the Disabilities of the Arm and Shoulder and Hand questionnaire during the final follow-up. Mean follow-up was 21 months (range, 20-24 months) in the LCP group and 23 months (range, 19-26 months) in the DCP group. Union was achieved in all patients. Mean time to union was 15 weeks (range, 12-25 weeks) in the LCP group and 17 weeks (range, 13-24 weeks) in the DCP group. In each group, 1 patient experienced delayed union, which required no additional surgical intervention. No significant difference was found regarding the time to union between the groups (P>.05). No significant difference existed between the 2 groups in terms of Grace-Eversmann criteria and Disabilities of the Arm and Shoulder and Hand scores (both P>.05). The results of these different fixation methods for forearm fractures in adults are similar. As such, the correct selection and application of surgical technique is more important than the type of plate used., (Copyright 2013, SLACK Incorporated.)

Objective. The aim of this study was to determine, by plain radiography, if there is a relationship between sacralization and low back pain. Methods. Five hundred lumbosacral radiographs of low back pain patients and 500 control groups were examined. Data collection consisted of the subject's age at the time of imaging, gender, number of lumbar vertebral bodies, and bilateral height measurement of the lowest lumbar transverse process. Dysplastic transverse processes were classified according to the Castellvi radiographic classification system. The incidence of sacralization in patients and the control groups was reported, and the anomaly was compared according to the groups. Results. Of these patients groups, 106 were classified as positive for sacralization, which resulted in an incidence of 21.2%. The most common anatomical variant was Castellvi Type IA (6.8%). In the control group, 84 were classified as positive for sacralization, which resulted in an incidence of 16.8%. No statistically significant difference was found between the groups for having sacralization (P = 0.09). Discussion. The relationship between sacralization and low back pain is not clear. Because of this controversial future studies need to focus on identifying other parameters that are relevant to distinguishing lumbosacral variation, as well as corroborating the results obtained here with data from other samples.

Isolated medial cuneiform fractures are quite rare. Conservative treatment is adequate in most cases, while deplaced or unstable fractures are treated surgically. Nonunion is seen extremely rarely after medial cuneiform fractures. There is only one case report in the literature. This case presented here is a 62-year-old male patient who had an isolated medial cuneiform fracture resulting from the impact of a falling metal object. Conservative treatment was performed initially. The patient was diagnosed as nonunion after physical and radiological examinations nine months after he presented to the outpatient clinic. Internal fixation with a mini plate and one staple after reduction was performed surgically. Defective region was filled with a 2 mL of autograft, and the operation was terminated.

Objective: By using an endoscopic, video-assisted instrumentarium we harvested the great saphenous vein for peripheral bypass surgery through minimal skin incisions with the purpose to reduce the wound complications., Method: Endoscopic subcutaneous saphenous vein harvesting was performed in 15 patients who underwent peripheral bypass surgery for intermittent claudication. In 6 patients the vein was taken from the affected leg and in 9 patients the vein was harvested from the opposite leg., Results: In every case where the vein was taken from the affected leg we observed severe hematomas, which was in one case complicated by an abscess. Once we converted to the open procedure and in one patient endoscopic preparation led to a small vein injury. When the vein was harvested from the opposite leg no complications occurred., Conclusion: The endoscopic subcutaneous saphenous vein harvesting in peripheral bypass surgery with a special video-assisted instrumentarium is feasible. The cosmetic advantages of this procedure are associated with high costs and a long operating time. Although we were not able to demonstrate a reduction of wound complications in our patients, the endoscopic vein harvesting in peripheral bypass surgery should be considered a very promising procedure. Nevertheless we cannot recommend the method for a wide clinical use at this time.