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Osteoid osteoma (OO) is a relatively common benign skeletal neoplasm of unknown etiology that is composed of osteoid and woven bone. Although, the clinical, radiological and scintigraphic features of OO have been well described, these features may be misleading or altered in the cases of intra-articular involvement. The acetabulum is a relatively uncommon location for OO with a few number of cases reported up to date. We reported a case of a 28-year-old man with intra-articular OO of the hip, located beneath the acetebular rim. Computed tomography, magnetic resonance imaging and bone scans were all nonspecific and confusing. We could show the nidus with the help of PET/CT. The final diagnosis and surgical excision can be made 6 months after the first on set of complaints. Intraarticular OO can mimic lots of pathologic entities related to the affected joint, and presents a diagnostic challenge and cause a delay in the diagnosis. The delays in the diagnosis and treatment can be avoided with a high index of suspicion. Furthermore, PET/CT is a useful imaging modality to demonstrate the tumor especially in the intraarticular location even in the absence of a characteristic nidus. Treatment should be individualized according to the surgeon’s preference and the characteristics of the case. [Med-Science 2012; 1(2.000): 131-140]

Background/aim: One of the functions of fetuin-A is the restriction of formation and expansion ofextraosseous hydroxyapatite crystals. TIhe exact correlation of fetuin-A with bone mineral density (BMD) has not been clearly elucidated yet. In this study, we aimed to assess the relationship between BMD and fetuin-A in postmenopausal women., Materials and Methods: Fifty postmenopausal women (25 with osteoporosis, 25 healthy controls) were included in the study. All participants were comparable for age and body mass index. None of the osteoporotic patients had received any medical treatment for osteoporosis. Serum fetuin-A levels were measured by ELISA method., Results: BMD scores of the groups were statistically significant (P < 0.001). Serum fetuin-A levels of the osteoporosis group were significantly lower compared to the control group (P = 0.009). Additionally, there was there was a mild to moderate positive correlation between fetuin-A and lumbar (r = 0.381, P = 0.06) and femoral (r = 0.143, P = 0.50) BMD in the osteoporotic group, though it did not reach statistical significance., Conclusion: Decreased fetuin-A levels in women with postmenopausal osteoporosis suggest that fetuin-A may have a role in the development of osteoporosis. Further studies are required to define the exact role of fetuin-A in bone metabolism.

Objectives: This study aims to evaluate the effectiveness of two different external tibial cutting guides with and without a spike anchoring to the intercondylar eminentia to achieve a desired posterior tibial slope., Patients and Methods: Between January 2008 and December 2011, 120 posterior cruciate ligament protecting total knee arthroplasty (TKA) surgeries of 83 patients in which two different external tibial cutting guides used were included. Fifty-nine knees were included into the spiked and 61 knees were included into the spikeless cutting guide group. Posterior tibial slope angles were measured using the postoperative X-rays., Results: There was no significant difference between two groups in terms of age, sex, and body mass indexes (p<0.05). While the mean postoperative slope angle was 2.66°±2.001°(range 0°-7°) in spiked group, it was 2.46°±2.277° (range 0°-7°) in spikeless group. Both systems had identical accuracy, indicating a low rate. The comparison of variances of two groups showed that both cutting guides had similar precision (p=0.234). There was no effect of body mass index on the results in both groups., Conclusion: Although different extra-medullary tibial cutting guides with and without a spike can reproducibly impart a desired posterior tibial slope in TKA, we concluded that a spiked guide was considered user-friendly.

Limb salvage for severe trauma has been replaced amputation as the primary treatment in many trauma centers. However, the long-term outcomes after limb reconstruction or amputation have not been fully evaluated. In this report, we present the treatment results of limb salvage surgery using Ilizarov external circular frame in a male case who had a-22-cm bone loss on the left distal femur and left proximal tibia and large soft tissue defect around the knee due to stepping on a landmine with his knee. The decision to amputate a severely injured limb, being irreversible, is challenging and significantly affects the body image and the patient. Extremity salvage surgery should be considered initially when evaluating patients with high-energy injured limbs at high risk for amputation.

Objectives: In this study, we aimed to compare the efficacy of bupivacaine and levobupivacaine in the patient-controlled epidural analgesia (PCEA) in patients who underwent total knee arthroplasty (TKA), particularly with cardiac diseases., Patients and Methods: Forty-four patients (16 males, 28 females; mean age 70.2±6.3 years; range 18 to 80 years) who were scheduled for TKA surgery under combined spinal and epidural anesthesia were included. Patients were randomly divided into two groups. Bupivacaine 15 mg 0.5% for group 1 (n=23) and levobupivacaine 15 mg 0.5% for group (n=23) were administered via spinal route. The amount of local anesthetics, PCEA starting times and bolus/demand ratio of local anesthetics were recorded. The level of pain, need for additional analgesic, total amount of analgesic, degree of motor block, complications were asked for patient satisfaction at postoperative 6, 12, 24 and 48 hours., Results: No statistical differences were determined between group 1 and group 2 in terms of the operation times, PCEA starting times, bolus number/demand ratios, visual analog scale (VAS) scores and numerical rating scores (NRS) at the postoperative 6, 12, 24 and 48 hours, need for additional analgesic, total amount of analgesic, degree of motor block and patient satisfaction. Although the incidence of side effects was lower in the group 1 compared to group 2, it was not statistically significant., Conclusion: We concluded that it would be proper using levobupivacaine rather than bupivakaine for patients with cardiac diseases, as the cardiotoxic and neurotoxic effects of levobupivacaine is lower then bupivacaine with a similar analgesic efficacy.

We report a case of recurrent, resistant, huge, multilocular intraosseous ganglia cyst localized at the distal femur. A 25-year-old man presented with left knee pain. Imaging studies and histological analysis confirmed the diagnosis. Treatment was curettage and bone grafting. Long-term follow-up revealed degenerative changes at radiographs and MRI. This case may contribute to make distinction between degenerative subchondral cyst and intraosseous ganglia cyst and help to understand pathogenesis of this entity.

Objectives: Outcomes of single-event bilateral multilevel orthopedic surgery in children with cerebral palsy were retrospectively investigated by physical findings, and gross motor function measurement (GMFM) score in all patients and additionally by joint kinematics, and time-distance parameters in ambulatory patients., Patients and Methods: A total of 24 patients (17 ambulatory; 7 non ambulatory; mean age 12 years; range 5 to 19 years) treated with multilevel orthopedic surgery between December 2003 and December 2005 were included in the study. Patients were evaluated with physical examination and GMFM score. In addition, computed gait analysis was used to evaluate joint kinematics and time-distance parameters in ambulatory children. The following surgeries were performed on the children in the study cohort: adductor tenotomy (n=24); psoas lengthening (n=14); hamstring lengthening (n=46); distal rectus femoris transfer (n=18); bilateral Achilles tendon lengthening (n=22); distal femoral derotation osteotomy (n=1); open reduction and Dega osteotomy (n=1), and proximal femur resection (n=2). Patients were evaluated with the same parameters after an average of eight months postoperatively. The pre- and postoperative results were statistically compared., Results: Improvements were achieved in the lying-rolling (7%), sitting (9%), crawling-kneeling (7%), standing (5%), and walking-running-jumping (5%) activities of GMFM score. An increase in hip abduction angle and external rotation and a decrease in the Thomas test results were observed. A decrease in popliteal angle and an increase in active and passive knee extension were provided. Active and passive ankle dorsiflexion increased. In the kinematic parameters, the minimum hip and knee flexions in the stance phase were significantly decreased, while no significant decrease was seen in the maximum hip and knee flexion in the swing phase. Both the ankle dorsiflexion in the stance and swing phase and the time-distance parameters consist of walking velocity, stride length and the cadence were significantly improved., Conclusion: Single-event bilateral multilevel orthopedic surgery performed in the right indication was shown to be effective with improvements in physical examination findings GMFM scores, joint kinematics and time-distance parameters in children with cerebral palsy.

Objectives: The aim of this study was to report our functional results after an intramedullary Kirschner wires (K-wires) and tension band wiring combination for the treatment of a large group of humeral head fractures was performed., Patients and Methods: Seventy-four patients (54 females, 20 males; mean age 42 years; range 24 to 73 years) who had proximal humerus fractures were treated with an intramedullary K-wire and tension band technique and were retrospectively analyzed. Fracture patterns were according to Neer classification type II in 43 patients, type III in 23 patients and type IV in five patients. The Constant-Murley shoulder score test was used to evaluate the function of both shoulders. The outcome was graded according to Neer's criteria. The pain score was determined with a 10-point visual analog scale., Results: All fractures were healed (radiologically and clinically) within 3.6 months (range 2.5 to 4.7 months) after the surgery. In one patient, the cerclage wire was broken and in eight patients, K-wires produced impingement like symptoms that required a second procedure (wire removal) after healing. The results of the patients with regard to Constant-Murley score and Neer criteria were indifferent when the 6th and the 12th month data were compared (p<0.05). Visual analog scale scores of the patients between the two control visits were significant different (p>0.05)., Conclusion: The type of fixation depends on the bone quality and the degree of comminution. But the recent trend is towards osteosynthesis -the limited, less invasive technique- which is performed with minimal soft tissue dissection and minimal osteosynthesis. It allows less stripping of bone and therefore preservation of the blood supply to the humeral head. This procedure is simple to perform and provides good postoperative results.

Objectives: An effective rehabilitation program is essential to prevent joint stiffness and regain range of motion after surgical treatment of intra-articular fractures of the distal humerus. We evaluated the effect of a physiotherapy program on functional results, that involved passive resistive stretching exercises performed under axillary brachial plexus block after radiographic observation of bone union of intra-articular fractures of the distal humerus treated with open reduction and internal fixation., Methods: The study included 21 patients (7 females, 14 males; mean age 34+/-5 years; range 21 to 57 years) who underwent open reduction and internal fixation for intra-articular fractures of the distal humerus. All the patients had closed fractures. Six patients had AO type C1, six patients had C2, and nine patients had C3 fractures. Surgical treatment consisted of a posterior incision, olecranon osteotomy, and fixation of the metaphyseal fragments using two reconstruction plates placed medially and laterally. Active range of motion exercises were started on the third postoperative day. To prevent early development of heterotopic ossification, passive range of motion exercises were avoided. Active stretching exercises were initiated three weeks after surgery. Upon radiographic observation of bone union, axillary brachial plexus block was performed. The physiotherapy program involved passive stretching exercises during nerve block, and active weight exercises after recovery from motor block. The catheter remained in the axillary region for three months, during which functional rehabilitation was continued 2-3 times a week on an outpatient basis. Functional results were evaluated according to the criteria of Jupiter et al. after a mean follow-up period of 31 months (range 24 to 46 months)., Results: All fractures united within a mean of 11.9 weeks (range 9 to 17 weeks) except for one type C3 fracture. Functional results were excellent in 10 patients (47.6%), good in eight patients (38.1%), moderate in two patients (9.5%), and poor in one patient (4.8%). Two patients with a moderate outcome had associated multiple fractures in the ipsilateral extremity. Distribution of the functional results according to the type of fractures were 4 excellent, 2 good in type C1; 4 excellent, 2 good in C2; and 2 excellent, 4 good, 2 moderate, and 1 poor in C3 fractures. The mean loss of elbow extension was 16 degrees. The mean elbow flexion, pronation, and supination were measured as 131 degrees, 90 degrees, and 75 degrees, respectively. None of the patients had nonunion at the olecranon osteotomy site, superficial or deep infection, or heterotopic ossification. Three patients developed transient ulnar nerve neuropraxia that resolved spontaneously during the follow-up period. There were no complications related to axillary catheterization., Conclusion: Following surgical treatment of intra-articular fractures of the distal humerus, a regular and pain-free physiotherapy program performed under axillary brachial plexus block on an outpatient basis increases patient compliance and enables early return to daily activities.

Background: Our aim was to evaluate the outcomes of combined hamstring release and rectus transfer in children with crouch gait using physical examination and gait analysis., Materials and Methods: A total of 19 patients (38 knee joints) with crouch were evaluated by static examination and computerized analysis with dynamic EMG. The Ely test was positive together with prolonged and increased activity in the rectus muscle bilaterally in all patients. These patients underwent hamstring release and rectus transfer. Intensive rehabilitation was provided following the surgery and the patients were evaluated again by static examination and gait analysis after an average of 6.3 (4-7.5) months after surgery. The preoperative and postoperative static examination findings, knee and ankle joint kinematics and time-distance parameters were compared in 19 children., Results: There was a significant improvement in static examination findings, knee and ankle kinematics and time-distance parameters. However, there was no significant difference between the preoperative and postoperative swing phase peak knee flexion., Conclusions: This study demonstrated that static parameters, time-distance parameters, knee and ankle kinematics were improved following combined hamstring release and rectus transfer in children with cerebral palsy without any cases of stiff knees.

Objectives: The purpose of this study was to compare the efficiency of the hyperpronation and supination-flexion maneuvers in the reduction of the pulled elbow., Methods: Sixty-six patients with pulled elbow were randomized for reduction with either hyperpronation or supination-flexion maneuvers. When the first attempt failed, a second attempt was performed with the same reduction maneuver. After failure of the second attempt the reduction maneuver was changed to the alternate method. The success rate of the reductions and the subjective rating on the difficulty of the reduction by the physician were recorded and analyzed statistically., Results: Thirty-two of 34 patients (94%) in the hyperpronation group and 22 of 32 patients (69%) in the supination-flexion group were reduced at first attempt (P=0.007). Two patients in the hyperpronation group and seven patients in the supination-flexion group were reduced at the second attempt. Reduction rates were statistically similar (P=0.06). Three patients in the supination-flexion group had failed reduction at the second attempt and the reduction maneuver needed to be changed. They were successfully reduced with hyperpronation maneuver at the first attempt. Final success rate of the hyperpronation maneuver at the first attempt was statistically higher than the supination-flexion maneuver (P=0.004). Furthermore, the hyperpronation maneuver was rated significantly easier than the supination-flexion maneuver by physicians (P=0.003)., Conclusion: Although final reduction rates were similar, the hyperpronation maneuver was more efficient at the first attempt, easier for physicians and less painful for the children.

Objectives: Efficiency of the modified Evans technique based on clinical and radiological evaluations was determined by plantar pressure measurement., Patients and Methods: Eleven patients (2 females, 9 males; mean age 29 years; range 19 to 39 years) with chronic lateral ankle instability were surgically treated using the modified Evans technique. Plantar pressures of nine patients were measured pre- and post-operatively., Results: Plantar pressure below the first metatarsal head decreased in seven of the patients after surgery. Furthermore, in all of the patients, the time of initial contact decreased significantly and the pathology returned to normal limits in the postoperative period., Conclusion: Modified Evans technique, despite its controversial long-term outcomes in lateral ankle instability, decreases first metatarsal head pressure and initial contact time significantly.

Palmar plates are being used as a source of graft in radial or ulnar collateral ligament reconstruction, pulley reconstruction, and volar plate arthroplasty. The purpose of this study is to determine morphometric and major histological differences of palmar plates in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints among fingers, and supply sufficient data which would be useful in reconstruction procedures. Ninety-six MCP and 96 PIP palmar plates of 12 well-preserved formalin-fixed cadavers were measured focusing on their length, width, central thickness, and lateral thickness and statistically analyzed using ANOVA. Randomized three male and three female cadavers' specimens were examined histologically after staining with Masson's trichrome. For central thickness of the PIP joint level, there was significant difference among fingers, caused by the middle and little fingers. For lateral thickness of the PIP joint level, there was significant difference which was originated from little fingers. MCP palmar plates were significantly thicker than PIP joint levels for most of the fingers. There were thicker and denser collagen bands in MCP than PIP palmar plates. The relation of size-related parameters was not close with the thickness parameters. The predicted sizes and thicknesses of palmar plates vary according to fingers. The data collected for each finger in this study should be used as a guide in reconstructive procedures that use palmar plates as source of graft.

Background: We evaluated the results of ankle arthrodesis performed with circular external fixators (CEF) in those patients who had developed tibiotalar arthritis secondary to a landmine or a gunshot injury., Materials and Methods: Nineteen ankles in 19 patients were fused using CEF. All patients had approximately 3 (range, 1 to 5) operations for bone and soft tissue reconstruction preceding the arthrodesis. Ankle arthrodesis was performed an average of 2.3 (range, 1 to 7) years after the initial trauma. The mean age at operation was 22 (range, 20 to 31) years old and all patients were male., Results: The average time spent in the CEF was 3.5 (range, 2 to 7) months. The mean followup was 59 (range, 31 to 90) months. Successful arthrodesis was achieved in all patients in an acceptable position. Clinically, 6 patients were assessed as excellent, 9 patients as good, 3 patients as fair, and 1 patient had a poor result. Twelve patients reported no pain postoperatively, 4 patients reported reduced to mild and/or occasional pain, 2 patients reported moderate pain, and 1 patient reported persistent pain. Sixteen patients described their outcome as satisfactory, one was somewhat satisfied, and two were dissatisfied. There were pin track infections in 10 patients and ring sequestration in one patient., Conclusion: Patients who have degenerative ankle arthritis due to gunshot wounds and land-mine injuries with poor bone quality and soft tissue conditions at the distal tibia can be successfully managed by using CEF.

The aim of this study was to determine the effect of stability and glenopolar angle on the clinical outcome of conservatively treated scapular neck fractures. Eighteen patients with scapular neck fractures were treated with conservative treatment. Twelve of the 18 patients had surgical neck fractures, whilst six of them had anatomical neck fractures. Anteroposterior radiographs and computerised tomography were performed for each patient. Glenopolar angle was measured through anteroposterior radiographs in the scapular plane. After 3-5 weeks of immobilisation, a rehabilitation programme was started, throughout which all the patients were treated in a 3-phase rehabilitation programme. The mean follow-up was 25 months, and the Constant score was 78.83+/-8.12 point (range: 68-94 points). Patient gender and the type of scapular neck fractures had no effect on functionality or clinical outcome (p>0.05), whilst associated injuries significantly affected the clinical outcome (p<0.05). There was a positive correlation between the Constant score and glenopolar angle (r=0.891, p<0.05) and between the age and glenopolar angle (r=0.472, p<0.05).

Objectives: We evaluated the results of treatment with the Ilizarov circular external fixator for limb length inequality and deformities in patients with type IA, IB, and type II fibular hemimelia., Methods: Tibial corticotomy and distraction osteogenesis with the Ilizarov technique were performed in five male patients (mean age 11.4 years; range 4 to 20 years). According to the classification of Achterman and Kalamchi, fibular hemimelia was type IA, IB, and II in three patients, one patient, and one patient, respectively. Involvement was on the right in three patients, and on the left in two patients. Two patients had equinus and one patient had valgus deformities. No instability existed in the ankle and knee joints. The mean leg discrepancy was 8.7 cm (range 3 to 16.5 cm), and the mean lengthening index was 1.6 cm/month (range 1.4 to 2 cm). The mean follow-up was 33 months (range 15 to 68 months)., Results: On final examinations, full range of motion of the knee was obtained. A plantigrade foot was achieved in three feet, while two sustained an equinus deformity of 17 and 15 degrees, respectively. Pin tract infections were observed in four patients, all of which were treated with oral antibiotics and dressing. During distraction, three patients had pain. Two patients had a limited range of motion of the ankle joint, without instability or subluxation of the ankle and knee joints. These joint problems were successfully dealt with by physical exercises., Conclusion: The Ilizarov technique is a convenient method in the correction of angular and rotational deformities while enabling distraction in type I and type II fibular hemimelia.

Objectives: We compared the electrophysiologic and histopathologic results of grafting and distraction methods in the treatment of defective peripheral neural injuries., Methods: Thirty male white rabbits (age 6 months) were divided into three groups and a circular external fixator (CEF) was applied to the right tibias. In group I (primary repair), the right deep peroneal nerve was cut without inducing any defect and a tibial osteotomy was performed. The remaining groups underwent bone and nerve excision of about 1 cm in the middle third of the tibia. In group II, the defect area was closed acutely with the CEF and the continuity of the nerve was restored. In group III, a nerve graft obtained from the left side was placed in the defect area and an epiperineural repair was made. Group II underwent distraction 21 days after surgery for 10 days with a rate of 0.25 mm four times a day. Electrophysiological studies were performed in the 12th and 24th weeks and nerve biopsies were obtained in the 32nd week for histopathologic examination., Results: Electrophysiological studies in the 12th week did not show any significant differences in nerve conduction between the three groups; however, in the 24th week, amplitude and latency values of the graft group were 50% lower than those of the primary repair and distraction groups (p<0.05). On histological examination, the results were good in group I and II, but poor in group III with respect to nerve fiber density, thickness of the myelin sheath, degenerative changes in the myelin sheath, and average axon number., Conclusion: Our data demonstrate that treatment of neural defects by the distraction method results in much better results than the grafting method.

Objectives: We evaluated the results of combined treatment with closed reduction, grafting, K-wires, and external fixation in patients with fractures of the distal end of the radius., Methods: Of 24 patients (15 males, 9 females; mean age 34 years; range 21-73), 16 patients had C2, eight patients had C3 fractures according to the AO classification. Three patients had open fractures, and four patients had signs of median nerve compression. Treatment included closed reduction, autologous grafting (16 cases) followed by fixation with 2 to 5 K-wires, and an external fixator. Clinical and radiographic results were assessed according to the Gartland-Werley's and Stewart's criteria, respectively, and degenerative changes to the Knirk-Jupiter's criteria. The mean follow-up was 35 months (range 25 to 52 months)., Results: All of the 19 patients who were employed returned to preinjury working conditions in a mean of 3.5 months. Radial length was preserved to a great extent. The mean amount of collapse of the joint surface was 1.4 mm. The mean loss was 6.7% in radial inclination, and 17.6% in the volar tilt. According to the Stewart's criteria, the results were good, moderate, and poor in 12, nine, and three patients, respectively. Flexion-extension (75%), supination-pronation (70%), and radial-ulnar deviation (75%) were preserved to a great extent. Grip force amounted to 70% of the healthy side. According to the Gartland-Werley criteria, three patients had excellent, eight patients had good, 10 patients had moderate, and three patients had poor results. According to the Knirk-Jupiter's criteria, degenerative changes were slight in 11 patients, moderate in six patients, and severe in one patient. Six patients had no signs of degeneration. Complications included pin track infections (n=4), early transient reflex sympathetic dystrophy (n=2), and hypoesthesia along the superficial branch of the radial nerve (n=2)., Conclusion: Treatment of the distal end fractures of the radius (AO type C2-C3) with a combination of external fixation, grafting, and percutaneous K-wires provides almost normal radiologic and clinical parameters.

Objectives: The Ilizarov technique limits daily activities of patients and may cause psychiatric symptoms. We investigated psychiatric symptoms associated with the use of an Ilizarov circular external fixator (CEF) and the relationship between symptoms and duration of CEF application in adult patients., Methods: The study included 40 adult male outpatients (mean age 26.4 years; range 20 to 40 years) who were treated with a CEF. The participants were administered a questionnaire on sociodemographic and clinical characteristics. Psychiatric symptoms were assessed using the Symptom Check List (SCL-90-R). Data were compared with those of a control group consisting of 30 healthy males with similar sociodemographic features., Results: Significant differences were found between the patient and control groups with regard to somatization (p=0.03), interpersonal sensitivity (p=0.027), depression (p=0.003), anxiety (p=0.025), hostility (p=0.004), paranoid ideation (p=0.021), additional scale (p=0.000), and overall symptom (p=0.024) scores. There was at least one psychiatric symptom in 52.5% of the subjects treated with a CEF. Hostility, interpersonal sensitivity, sleep disturbances, obsessive-compulsive signs, and anxiety were detected in 37.5%, 35%, 32.5%, 20%, and 20%, respectively. The duration of CEF application was positively correlated with depression and interpersonal sensitivity (p=0.000), and negatively correlated with anxiety (p=0.001)., Conclusion: Our data demonstrate that, during treatment with a CEF, psychiatric problems emerge, which warrant careful evaluation of the psychiatric condition of the patients.

Resection of the whole femur, together with endoprosthetic replacement is a major limb-salvaging procedure. We performed total femoral resection and endoprosthetic replacement with TMTS (Turkish Musculoskeletal Tumor Society) prosthesis in two young (20 years old) male patients with stage-IIB osteosarcoma. Postoperative complications were only temporary sciatic nerve neuropraxia and minor skin necrosis around the surgical wound. After a four-staged individualized rehabilitation program, both patients were able to walk without any support or limitation. At the end of a follow-up period of 22 and 26 months, both patients achieved a nearly full range of motion of the knee and the hip, with Enneking functional scores being excellent. Endoprosthetic total femoral reconstruction results in satisfactory oncologic and functional outcome in selected patients.

Dislocation that lasts longer than 3 weeks is called chronic or unreduced shoulder dislocation. Treatment alternatives can be closed reduction, open reduction, resection arthroplasty, prosthesis, arthrodesis, and no therapy. The English-language literature includes no evidence on arthroscopic reduction for the treatment of unreduced shoulder dislocation. The goal of our study was to present our technique and period results on the arthroscopic reduction we performed in 2 cases 4 and 5 weeks after anterior shoulder dislocation. Reduction could not be achieved by closed reduction under anesthesia. With arthroscopic visualization, adhesions within the joint were released with blunt dissection. Repeat reduction attempts were unsuccessful in these 2 cases. Labroligamentous lesions of the inferior glenohumeral ligament were repaired using 3 absorbable tacks. On the second day after the surgery, isometric exercises were started. The results were evaluated using a 100-unit test recommended by Rowe and Zarins (80 units in case 1; 85 units in case 2). Reduction of chronic unreduced shoulder dislocations using arthroscopy is an alternative technique for selected patients. It also allows repair and treatment of the intra-articular pathology in the joint and makes early postoperative rehabilitation possible.

Objectives: We evaluated the effects of surgical margins and other prognostic factors on local control and survival in extremity soft tissue sarcomas., Methods: The study included 40 patients (34 males, 6 females; mean age 45 years; range 13 to 77 years) who underwent treatment for extremity soft tissue sarcomas. Of these, 14 patients presented with recurrences following treatment elsewhere. Preoperatively, nine patients and eight patients; postoperatively, 35 patients and 25 patients received radiotherapy and chemotherapy, respectively. Limb-salvaging surgery was performed in 35 patients (87.5%), of whom 28 patients (70%) received an extended resection, and seven patients received a marginal resection. Five patients (12.5%) required amputation. Negative surgical margins were achieved in 34 patients (85%), while six patients (15%) had positive surgical margins. The mean follow-up period was 58 months (range 13 to 124 months)., Results: Five patients (12.5%) developed local recurrences following marginal resection (n=4), and amputation. No local recurrences were seen in patients receiving an extended resection or in those having negative surgical margins. Five-year survival rates were 51% and 49% in patients whose initial diagnoses were made in our department and elsewhere, respectively. Significant correlations were found between extended resection (p=0.0001) and negative surgical margins (p=0.0001) and local control; and between tumor grade and survival (p=0.002). Positive surgical margins and local recurrences did not decrease survival., Conclusion: Achievement of negative surgical margins promotes local control in extremity soft tissue sarcomas. A careful preoperative planning and utilization of neoadjuvant therapies highly increase the possibility of negative surgical margins.

A total of 142 patients with 163 Gustilo-Anderson type IIIa limb fractures resulting from high-velocity gunshot wounds were treated with primary delayed closure and Ilizarov fixation in our department between 1988 and 1998. Average follow-up was 72.4 months. The average union period in fractures without bone loss was 16.8 weeks. It took 2 months for each 1 cm of bone defect to heal in fractures with bone loss. All fractures healed with good anatomic alignment and functional outcomes. Complications included pin-track infection in 72 fractures (50.7%), post-traumatic osteomyelitis in 5 tibial fractures without bone loss (3.1%), delayed union in 25 fractures (15.3%), nonunion in 10 (4 with bone loss) fractures (6.1%), and refracture in 4 fractures (2.4%). Our results indicate that type IIIa limb fractures caused by high-velocity gunshot wounds can be treated with Ilizarov fixation and primary delayed closure with a low overall complication rate and a remarkably low infection rate.

Injuries due to accidents in children and adolescents, who are more sensitive to different risk factors in their social and physical environments, play an important part in mortality and morbidity. Fractures are the most commonly seen problems among these injuries. This cross-sectional study was carried out in a two-year vocational military school in Ankara between 1-10 May 2000. All, 2720 students in the school were included and data were collected via a questionnaire distributed to the students. It was found that 418 (17%) out of 2,461 students we could interview had had a fracture. No statistically meaningful relationship was found between the frequency of having fractures and the educational status of the parents or employment status of the mother. However, it was seen that the frequency of fractures increased as the economical status of the parents increased. The high frequency of fractures in childhood and adolescence in young males, and the traditional practice of going to unlicensed and medically untrained adults, and "bonesetters" (27% of those surveyed) are two important findings that should be taken into consideration.

Four calcanei, which were massively destroyed as a result of blasting injuries from land mines, and 18 severely comminuted calcaneal fractures with bony defects (in one patient, both feet), also from land mines, were treated using a circular external fixator for reconstruction by osteogenic distraction. Because of the severe destruction of tissue to be treated, definitive orthopaedic treatment was delayed for 3 to 28 months (average, 10.1 months) after injury. Time from first use of the circular external fixator to removal of the apparatus ranged from 110 to 175 days (average, 143.7 days). Mean follow-up was 18 months. Of the 22 calcaneal injuries, 4 had excellent results, 11 good, 5 fair, and 2 had poor results. Better results were achieved in cases with lesser defects in bone and where definitive orthopaedic treatment was delayed until problems in soft tissue could be treated.