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Treatment of tibial nonunion with bone loss is extremely difficult. A variety of techniques have been described, but each has shortcomings, in particular prolonged external fixation time as well as serious complications such as nonunion and infection. Accordingly, we developed a technique that seeks to reduce these complications by using a circular external fixator in addition to an intramedullary nail to achieve union, limb lengthening, and stability of the regenerated segment.First, the pseudoarthrosis area is resected, and acute compression is continued until bone contact at the docking site was achieved. Then primary grafting is applied to the docking site using a graft harvested from the patient's iliac bone, and the predrilled nail holes localized on the middle segment of the tibia are locked with a free-hand technique. Finally, lengthening is performed to overcome the leg-length discrepancy with an external fixator.Between 2008 and 2011, this technique was used to treat five patients with tibial nonunion with bone loss. All patients were available for a minimum of a 14-month followup (mean, 30 months; range, 14-58 months). General indications for the procedure were age older than 16 years, tibial nonunion with bone loss, and the absence of any psychiatric disorder. We evaluated external fixation time, external fixation index (defined as the duration of external fixation in months divided by the total amount of bone transported and/or the amount of lengthening in centimeters), and time to union on plain radiographs, clinical results using the Paley bone and functional assessment scores, and postoperative complications from chart review.The external fixation time was 4 months (range, 3-5 months), and the average external fixation index was 0.4 months/cm. The mean time to bone union was 4.6 months (range, 3.5-5.5 months). All angles were determined to be in the normal range. No patients developed refracture or malalignment either on the docking site or the osteotomy site. Paley bone evaluation results were excellent in all five patients, and Paley functional results were excellent in four and good in one. We observed 10 pin-site infections as minor complications, and one patient was left with a residual equinus deformity of 5° as a major complication according to the Paley classification.Our technique combining acute shortening and distraction osteogenesis had promising results for the treatment of tibial nonunion with bone loss in a small group of patients. However, future studies directly comparing available approaches to this difficult problem are required. Because this problem is uncommon, these studies will almost certainly require the cooperation of multiple large participating centers.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

One of the important factors in a successful arthroplasty is component alignment. The primary objective of this study was to determine whether the fibular shaft reference technique is beneficial for the tibial component position on the postoperative plain radiograph after total knee arthroplasty.A total of 42 patients between 2009 and 2011 were analysed retrospectively. The surgeon prepared the tibia using an extramedullary cutting guide and set the posterior tibial slope with respect to the fibular reference rod. In the postoperative radiographic measurements, a true anteroposterior and lateral radiograph of the lower leg covering the whole length of the tibia was used.Five patients were excluded as they did not meet the inclusion criteria, four patients were excluded due to improper radiographs and the study group was reduced to 33 patients and 35 knees. The mean preoperative tibiofibular angle was 2.1° ± 0.8°. The mean postoperative tibial sagittal angle measurements were 83.3° ± 1.4° (81°-86°). 33 (94 %) Knees gained the desired tibial sagittal angle within the desired alignment (5° ± 3°). The mean postoperative tibial coronal angle was 89.3° ± 1.5°. The tibial component coronal angle of two knees was more than 3 alignment from the neutral mechanical axis.The major clinical relevance of the technique described in the present study is cost-effectiveness, and it does not require any extra time or surgical equipment. This method can be used as an alternative choice for bulky extremities which is a cause of malalignment of the components.Retrospective case series, Level IV.

Introduction The treatment goal for diaphyseal forearm fractures in adults is to restore axial and rotational stability. The treatment of these fractures with intrmaedullary locked nailing remains sparse. We therefore evaluated IM nails for treating forearm diaphyseal fractures in adults. Methods We retrospectively reviewed adult patients with isolated unilateral or bilateral fractures of the radius, ulna, or both, who were treated with closed or mini open reduction with a new IM nail between May 2008 and January 2012 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. Primary outcomes were Grace and Eversmann rating, Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results The 43 enrolled patients (mean age, 37 years; 32 men) had 59 forearm fractures: 14 isolated radius fractures, 17 isolated ulna fractures (2 bilateral), and 28 fractures of both the radius and ulna. Mean time to fracture union was 13 weeks (range 10–14 weeks) for ulnar fractures and 12 weeks (range 10–13 weeks) for radial fractures. No patient had nonunion, deep infections, or radioulnar synostosis. Followup ranged from 12 to 44 months. Grace and Eversmann ratings were excellent in 38 patients and good in 5. Mean DASH score was 6.5 points (range 0–13.3). Conclusions Intramedullary nailing of adult forearm diaphyseal fractures appears to be a good alternative to plate osteosynthesis. The advantages are short operative time, minimal invasive techniques, and sufficient stability in all planes that allows early motion without additional fracture support.

Objective:The aim of this study was to evaluate the outcome of tricorticocancellous autologous bone grafting with intramedullary forearm nails in the treatment of radius or ulna aseptic nonunion.Methods: The study included 8 patients (mean age: 39 years; range: 19 to 55 years) who underwent plate-screw osteosynthesis for the treatment of nonunion (6 ulna, 2 radius) following forearm fracture. In all cases, the length of the applied tricortical graft was below 3 cm. Patients were evaluated using the visual analog scale, Grace and Eversmann scale and DASH score. Wrist flexion and extension and postoperative hand and forearm grip strength were assessed.Results: Graft incorporation and union was completed at a mean of 22 (range: 18 to 28) weeks. No patient had nonunion, deep infection or radioulnar synostosis. Follow-up ranged from 18 to 52 months. Radiographic union was achieved in all patients. Mean visual analog scale pain score was 1 (range: 0 to 3). Grace and Eversmann ratings were excellent in 5 and good in 3 patients. Mean DASH score was 10.7 (range: 1.7 to 21.7) points.Conclusion: Intramedullary nailing and tricorticocancellous iliac bone block grafting appears to be a technically easy and reliable procedure that enables early postoperative rehabilitation in the treatment of nonunion of the forearm., Amaç:Bu çalışmanın amacı radius veya ulnada aseptik kaynamama gelişen olguların intramedüller ön kol çivileri ve trikortikokansellöz otolog kemik grefti ile tedavisinin sonuçlarını değerlendirmekti.Çalışma planı: Çalışmaya ön kol kırığı sonrası kaynamama (6 ulna, 2 radius) nedeniyle plak-vida ile osteosentez uygulanan 8 hasta (ortalama yaş: 39, dağılım: 19-55) alındı. Uygulanan trikortikal greftin uzunluğu tüm olgularda 3 cm’nin altında idi. Hastalar görsel analog skala, Grace ve Eversmann skalası ve DASH skoru ile değerlendirildiler. Bilek fleksiyon ve ekstansiyonu ile ameliyat sonrası el ve ön kol kavrama kuvvetleri incelendi.Bulgular: Greft inkorporasyonu ve kaynamanın 22 (dağılım: 18-28) haftada tamamlandığı görüldü. Hastaların hiçbirinde kaynamama, derin enfeksiyon veya radyoulnar sinostoz bulgusu yoktu. Takip süresi 18 ile 52 ay arasındaydı. Kaynama tüm hastalarda radyografilerle doğrulandı. Ortalama görsel analog skala ağrı puanı 1 (dağılım: 0-3) olarak belirlendi. Grace ve Eversmann skorları 5 hastada mükemmel, 3 hastada iyi idi. Ortalama DASH skoru ise 10.7 (dağılım: 1.7-21.7) olarak kaydedildi.Çıkarımlar: Ön kol kaynamamalarının intramedüller çivi ve trikortikokansellöz iliak kemik blok greftlemesi ile tedavisi teknik açıdan basit, ameliyat sonrası erken dönemde rehabilitasyona olanak sağlayan, güvenilir bir yöntemdir.

Objectives: In this study we aimed to present our treatment results of intramedullary nailing of femoral shaft fractures with compressive nailing using proximal static hole and only distal dynamic hole with one screw. Methods: Forty-three patients who had a fracture of the femoral shaft were managed between 2005 and 2008 with intramedullary nailing and the use of only one screw for distal interlocking. Prospectively we evaluated the union time, possible reoperation, fixation and fracture alignment, range of knee motion and complications. Results: Union occurred within a mean duration of 18.7 weeks. No failures of the fixation and fracture alignment and no more than 1 cm shortness were detected. The knee range of motion was all more than 90 degree. Only one deep venous thrombosis was detected as complication. Conclusions: Compressive nailing using proximal hole and only distal dynamic hole with one screw is a convenient technique for femur fractures.

The goal of the radius diaphysis fractures in surgical treatment is restoration of bone length, rotation correction and to secure fixation that allows early mobilization. The purpose of this study is evaluating the results of intramedullary (IM) radius nail for the treatment of isolated adult diaphyseal fractures of the radius.We retrospectively reviewed adults with isolated fractures of the radius, who were treated with closed or mini open reduction with a IM radius nail between May 2008 and November 2011 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture, or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. Primary outcomes were Grace and Eversmann rating, Disabilities of the Arm, Shoulder and Hand (DASH) scores.Twenty-three enrolled patients (mean age 34 years; 17 men) had 23 isolated radius fractures. Mean time to fracture union was 12 weeks (range 10-13 weeks) for radius fractures. No patient had nonunion, deep infections, or radioulnar synostosis. Follow-up ranged from 12 to 42 months. Grace and Eversmann ratings of 21 patients were excellent or good, and 2 patients were medium. Mean DASH score was 4.2 points (range 0-13.3).Our experience indicates that this new IM radius nail may be considered as an alternative to plate osteosynthesis for fractures of the radius diaphysis in adults. IM nailing of radius fractures provides reliable bony union and excellent postoperative clinical results in adults.

Objectives This study aims to investigate the efficacy of screw length measurement through drilling technique on the reduction of intraarticular screw penetration and fluoroscopy time in osteosynthesis of proximal humerus fractures. Patients and methods Between January 2008 and June 2012, 98 patients (34 males, 64 females; mean age 64.4 years; range 35 to 81 years) who underwent osteosynthesis using locking anatomical proximal humerus plates (PHILOS) in our clinic with the diagnosis of Neer type 2, 3 or 4 were included. Two different surgical techniques were used to measure proximal screw length in the plate and patients were divided into two groups based on the technique used. In group 1, screw length was determined by a 3 mm blunt tipped Kirschner wire without fluoroscopic control. In group 2, bilateral fluoroscopic images for each screw at least were obtained. Results Intraarticular screw penetration was detected in five patients (10.6%) in group 1, and in 19 patients (37.3%) in group 2. The mean fluoroscopic imaging time was 10.6 seconds in group 1 and 24.8 seconds in group 2, indicating a statistically significant difference. Conclusion Screw length measurement through the drilling technique significantly reduces the intraarticular screw penetration and fluoroscopy time in osteosynthesis of proximal humerus fractures using PHILOS plates.

In the treatment protocol of fractures of the fifth metacarpal, closed reduction and immobilization is generally recommended. This study aimed to compare the radiological and functional results of short-arm plaster cast and a forearm U-splint. Between January 2011 and June 2012, the study comprised a total of 122 cases with 64 (52.4 %) in the cast group and 58 (47.6 %) in the splint group. The cases were 92 (75.4 %) males and 30 (24.6 %) females with a mean age of 30.56 ± 12.27 years (range 10–66 years). Two groups were formed according to the surgical treatment plans of the two surgeons who were to follow up the patients. No statistically significant difference was found between the groups in terms of age, duration of the cast or splint and follow-up period (p > 0.05). The grip strength of Group A was determined as 90.38 ± 1.77 % of the healthy side and Group B as 90.58 ± 1.65 %. No statistically significant difference was seen between the groups in respect of grip strength (p > 0.05). The degree of dorsal angulation pre-application, post-application and after removal of the groups showed no statistically significant difference between the groups (p > 0.05). No superiority was seen in the clinical and radiological results of the two different treatment protocols applied to fractures of the fifth metacarpal. However, when the complications created by a plaster cast and pressure wounds are taken into consideration, the application of a short-arm U-splint can be said to be a better option.

The purpose of this study was to compare the results of hemiarthroplasty with those of treatment internal fixation devices for stable intertrochanteric fractures in patients with moderate and severe cognitive dysfunction. 155 patients were evaluated retrospectively. 54 patients were treated with proximal femoral nail (PFN), 57 with dynamic hip screw (DHS) and 44 were underwent hemiarthroplasty (HA). Activities of daily living (ADL) were evaluated with the Barthel Activity Index (BI) score and the Health Related Quality of Life (HRQoL) with the Euroquol-5D (EQ-5D) test. The BI scores in HA patients were found to be at significantly high compared to the PFN and DHS groups both at the one and two years. A significant difference was also found in the EQ-5D scores in favor of HA group at one year. The most common complications in internal fixation patients were malunion (7/54 for PFN, 9/57 for DHS group), fixation failure (8/54 for PFN, 12/57 for DHS group) and dislocation (10/44), deep infection (8/44) for HA group. The strong predictive variables on ADL in dementia patients were, duration time to surgery and pre-operative MMSE score. In conclusion, HA is the prefered treatment for stable intertrochanteric fractures but that the dislocation (10/44) and infection rates (8/44) are very high in dementia.

BACKGROUND In this report, the surgical treatment results of distal tibia (pilon) fractures are analyzed radiologically and clinically. METHODS Between 2002 and 2009, 32 feet of 31 patients (25 males, 6 females; mean age 46 years; range 17 to 72 years) who were treated surgically for tibial pilon fractures were evaluated. Open reduction and internal fixation were applied to 24 and external fixation to 8 fractures. The patients were evaluated according to the Teeny-Wiss functional ankle score, and overall assessment of reduction was calculated radiographically according to the criteria of Ovadia and Beals. RESULTS While excellent results were achieved in 9 (47.4%) type 2, 5 type 1 (26.3%), and 5 (26.3%) type 3 fractures, fair/poor outcomes were obtained in 9 (69.2%) type 3 and in 2 (15.4%) types 1 and 2 fractures each (p

Objectives: Recent studies have demonstrated that ACL reconstruction via anatomic tunnel placement would provide superior stability. In order to achieve an anatomic femoral tunnel, accessory anteromedial portal (three-portal tecnique) and medial Hoffa excision is necessary. Femoral tunnel drilling through a far anteromedial portal facilitates anatomic tunnel placement but can also results in shorter femoral tunnel and articular cartilage damage of the medial femoral condyle. Our purpose in this study was to evaluate whether an anatomic single bundle ACL reconstruction can be performed with the use of the two standart portals (anteromedial and anterolateral). Methods: Fifty seven patient underwent single bundle ACL reconstruction in our clinic between 2012-2014, with the use of either standart portals or three-portal tecnique. We measured the tunnel length and and femoral tunnel angle in coronal plane to assess the reconstruction. Two portals group included thirty -three patients (twenty-nine males, four females with a mean age of 27±2,4) and three portals group included twenty–four patients (twenty-three males, one female with a mean age of 26±2,9). All patients were evaluated with computerized tomography (CT) scans to determine femoral tunnel length and obliquity. Tunnel length was defined as the distance between the intra-articular and extra-articular tunnel apertures in coronal sections. Femoral tunnel angle was measured in the coronal plane on AP radiographs of the knee. For statistical analysis, student t test was used for normal categorical data. A p value of Results: Average tunnel length was 44.2 ±6.8 mm (range: 32.6-55.2) in two portals group and 32.8±7.9 mm (range: 24.8-43.2) in three portal group. The average tunnel length in three portal group was significantly smaller (pConclusion: Femoral tunnels drilled with standart two-portal tecnique were longer than three-portal tecnique. However, femoral tunnel angles was not different in two groups. Tunnel characteristic in terms of anatomic position was obtained with standart two-portal tecnique. Consequently, femoral tunnels can be placed anatomically with standart portals.

İntroduction: The radiological and functional results of surgical treatment in intraarticular calcaneal fractures are presented in this study. Method: 27 feet of 26 patients with displaced intraarticular fractures were treated surgically in our clinic between November 2003 and May 2009. 21 patients were male (81%), and 5 were female (19%). The average age was 29.2 (range, 18-61 years) at the time of the surgical treatment. Open reduction internal fixation was performed by using a calcaneal plate. Results: The results were evaluated according to the Maryland foot score and Creighton-Nebraska scores.The radiological evaluation was made according to the mean value changes of Böhler and Gissena angles. The mean follow-up period was 34.4 months (range, 19 to 85 months). Except for 3 patients with Sanders type-4 fractures, good results were obtained with surgical treatment. Conclusion: We conclude, open reduction and internal fixation methods yield reasonable outcome, even in patients with Sanders type 4 intraarticular fractures of the calcaneus. Keywords: Calcaneus fracture, Sanders classification, calcaneal plating, intraarticular fracture.

Objective: The aim of this study was to compare the short-term results of total knee arthroplasty (TKA) surgeries performed with minimally invasive mini-midvastus (MMV) incision and the standard medial parapatellar technique (ST).Methods: Twenty patients (18 males, 2 females; mean age: 67.25±6.70) operated with the ST and 19 patients (4 males, 15 females; mean age: 64.53±7.53) operated with the MMV approach were retrospectively evaluated. The surgery time, blood loss, time to straight leg raise (SLR) postoperatively, range of motion (ROM) and Knee Society (KSS) score and Hospital for Special Surgery (HSS) score were compared between the groups. Radiological evaluation was made with standing orthoroentgenographs both pre- and postoperatively. Mean follow-up time was 29.4±8.2 months in the ST and 17.7±11.1 months in the MMV group.Results: In the early postoperative period (10th day), the MMV group was significantly better than the ST group in terms of ROM. Time to SLR and blood loss values were also significantly better in the MMV group. However, there was no significant difference between the groups after the sixth month, for ROM, KSS and HSS values (p>0.05). Surgery time was significantly longer (with a mean difference of 22 minutes) in the MMV group. Radiological examination revealed ideal alignment in both groups. No deep or superficial infection was detected. Two patients in the MMV group had skin problems which healed after clinical follow-up.Conclusion: Our results suggested that functional results of TKAs performed via the MMV approach are better in the first six months when compared to those of the ST., Amaç: Çalışmada minimal invazif midvastus insizyon (MMV) tekniği ve standart medial parapatellar teknikle (ST) yapılan total diz protezlerinin (TDP) kısa dönem sonuçlarının karşılaştırılması amaçlandı. Çalışma planı: Çalışmada TDP ameliyatı ST ile yapılan 20 hasta (18 erkek, 2 kadın; ort. yaş 67.25± 6.7) ile MMV yöntemle yapılan 19 hasta (4 erkek, 15 kadın; ort. yaş 64.53±7.53) geriye dönük olarak değerlendirildi. İki grup ameliyat süresi, kan kaybı, ameliyat sonrası düz bacak kaldırmaya başlama zamanı (DBK), eklem hareket açıklığı ve Knee Society (KSS) ve Hospital for Special Surgery (HSS) skorları yönünden karşılaştırıldı. Radyolojik olarak ise ameliyat öncesi ve sonrası ayakta çekilen boy filmleriyle değerlendirme yapıldı. Ortalama takip süresi ST grupta 29.4±8.2 ay, MMV grupta ise 17.7±11.1 aydı. Bulgular: Ameliyat sonrası erken dönemde (10. gün), eklem hareket açıklığı (EHA) yönünden MMV grubunun ST grubundan anlamlı derecede üstün olduğu gözlendi. DBK zamanı ve kan kaybı yönünden de MMV grubu anlamlı olarak üstündü. Bununla birlikte 6. aydan sonra EHA, KSS ve HSS değerleri açısından iki grup arasında anlamlı fark olmadığı saptandı (p>0.05). Ameliyat süresi MMV grubunda anlamlı olarak, ortalama 22 dakika daha uzundu. Radyolojik olarak ise her iki grupta da ideal dizilimin sağlandığı görüldü. Derin veya yüzeyel enfeksiyon saptanmazken, MMV gruptaki iki hastada klinik takiplerle düzelen cilt problemi gözlendi. Çıkarımlar: Standart teknikle kıyaslandığında MMV yaklaşımı ile yapılan TDP ameliyatı erken dönemde fonksiyonel olarak daha iyi sonuçlar vermekte, ancak 6. ay sonrasında her iki tekniğin sonuçları da benzer olmaktadır.

PubMed: 23959034 Introduction: At first presentation of paediatric humeral lateral condyle fractures, radiological methods such as computerised tomography, ultrasonography, magnetic resonance imaging, arthrography, and internal oblique radiography are used to determine stability. Very few studies show which radiological method should be used to evaluate displacement at follow-up for conservatively treated patients. This study aimed to show that internal oblique radiography is a simple, effective method to determine the subsequent development of fracture displacement in patients with an initially non-displaced or minimally displaced fracture. Materials and methods: In this retrospective study, 27 paediatric patients with non-displaced or minimally displaced (2 mm as a result of the evaluation of the internal oblique radiography and underwent surgery. At follow-up, 2 of 11 patients were defined with displacement from anteroposterior and internal oblique radiographs and 4 from the internal oblique radiographs and underwent surgery. Conservative treatment was applied to 5 patients. Conclusions: Internal oblique radiography is the best imaging showing subsequent fracture displacement in initially non-displaced or minimally displaced humerus lateral condyle fractures. At the first week follow-up, anteroposterior and particularly internal oblique radiographs should be taken of conservatively treated patients. © 2013, Springer-Verlag France.

Purpose Humeral capitellum fractures comprise approximately 1% of all elbow fractures. In this study, we examined the clinical, radiographic, and functional outcomes following operative stabilization of Bryan and Morrey type IV fractures of the capitellum in adolescents. We applied headless cannulated screws in a posteroanterior direction without damaging the articular cartilage surface of the fractures. Methods Eight adolescent patients (six male, two female) with a mean age of 15 ± 2.1 years (range 13–18 years) were treated for type IV (McKee) humerus capitellum fractures. In the preoperative radiological evaluation, anteroposterior and lateral radiographs and computed tomography (CT) images were performed. A lateral surgical approach was used, and cannulated fully threaded headless screws were applied in a posteroanterior direction as fixation materials in the fracture reduction. The Mayo Elbow Performance Score was used in the evaluation of elbow joint functions. Results Patients were followed up for a mean of 24.6 months. Fracture union was achieved at a mean of 5 ± 0.92 weeks (range 4–6 weeks). The mean elbow extension flexion arc was 135 ± 13.47 (range 110– 1508) and the mean pronation supination arc was 156 ± 4.43 (150–160). In one patient, there was nonconformity in the humerus trochlea and in another patient, there was keloid formation on the surgical scar. All patients attained excellent results according to the Mayo Elbow Performance Score. Conclusions In the treatment of type IV capitellum fractures in adolescents, open reduction with a lateral surgical approach and fixation using posteroanterior directed, cannulated, fully threaded, headless screws is a reliable method to achieve a pain-free functional elbow joint.

Introduction: The treatment goal for diaphyseal single and both bone fractures in adults is to restoration of bone length, provide axial and rotational stability, and to secure fixation that allows early mobilization. Intramedullary (iM) nails are not routinely used in the surgical treatment of forearm fractures. However, this trend has started to change with the newly designed interlocking iM nails. We evaluated a new iM nails for treating forearm diaphyseal fractures in adults. Materials and Methods: We retrospectively reviewed adults with single and both bone fractures, who were treated with a new iM radius and ulna nails between May 2008 and May 2011 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. The results were evaluated according to Grace–Eversmann and DASH scores. Results: The 61 enrolled patients (mean age, 37 years; 32 men) had 83 forearm fractures: 23 isolated radius fractures, 18 isolated ulna fractures (2 bilateral), and 40 fractures of both the radius and ulna. Mean time to fracture union was 13 weeks (range, 10 to 14 weeks) for ulnar fractures and 12 weeks (range, 10 to 13 weeks) for radial fractures. No patient had non-union, deep infections, or radioulnar synostosis. Followup ranged from12 to 38months. Grace–Eversmann ratingswere excellent in 53 patients, good in 5,medium in 2 and poor in 1. Mean DASH score was 6.5 points (range, 0 to 13.3). Conclusion: The new intramedullary nail systemsmay be considered as a good alternative to both classical intramedullary nails and plate osteosynthesis in adult forearm diaphyseal fractures. The advantages are short operative time, insertion by closed and minimal invasive techniques mostly, the use of a minimally scope, smaller operative scar and sufficient stability in all planes that allows early motion without additional support. T1.2 Acromioclavicular reconstruction using hook plate and anterior tibial tendon allograft with triple tunnel: can it be considered as an alternative surgical technique? A. Deveci1, A. Firat2, S. Yilmaz1, K.O. Unal1, H.I. Acar3, A.O. Yildirim1, M. Bozkurt4. 1Ankara Numune Education and Research Hospital, 2Ankara Kecioren Education and Research Hospital, 3Ankara University Department of Anatomy, 4Ankara Ataturk Education and Research Hospital, Ankara, Turkey

Introduction Both the isolated distal femoral epiphysiolysis and the isolated proximal tibial epiphysiolysis are the least common epiphyseal injuries. Even though they are uncommon, they have a high incidence rate of complications. Case presentation We present a case with Gustilo-Anderson grade 3b open and Salter-Harris type 1 epiphysiolysis of the distal femur and proximal tibia caused by a farm machinery accident. The patient was a 10-year-old boy, treated by open reduction and internal fixation. Conclusion Although distal femoral and proximal tibial growth plate injuries are rarely seen benign fractures, their management requires meticulous care. Anatomic reduction is important, especially to minimize the risk of growth arrest and the development of degenerative arthritis. However, there is a high incidence of growth arrest and neurovascular injury with these type of fractures.

OBJECTIVE: Clinical and radiological results were evaluated of surgery to paediatric unstable forearm diaphyseal double-bone fractures, treated as both bones open, both bones closed and one open, one closed.METHODS: 63 children treated with intramedullar nailing for an unstable forearm mid 1/4 fracture were retrospectively evaluated. Group A comprised 3 females, 10 males mean age 10 years and underwent open reduction on both bones. Group B comprised 4 females, 23 males mean age 11 years and underwent closed reduction on both bones. Group C comprised 3 females, 20 male mean age 11 years, and underwent open reduction on one bone and closed reduction on the other. The Gustilo-Anderson classification showed 15 patients Type 1 and 2 patients Type 2 open fractures. Mean time to surgery was 4, 2, 2 days for Groups A,B, C. K-wires were used on all patients. Fixation was applied to both the radius and ulna. Mean follow-up periods were 38, 34, 39 months for Groups A, B, C. RESULTS: Union was achieved on mean Day 47, 45, 46 in Groups A,B, C. Nails were removed on mean Day 53, 82 and 67 respectively. No statistically significant difference was determined between the groups in terms of age, time to surgery, nail removal and follow-up period, gender, side, etiology or complications p>0.05 . No significant complications developed.CONCLUSION: In intramedullar fixation of paediatric unstable forearm diaphyseal fractures with K-wire, open or closed fracture reduction showed no statistical effect on the functional and radiological results., AMAÇ: Stabil olmayan çocuk önkol diyafiz çift kırıklarının cerrahisinde, kırık redüksiyonu her iki kemiği açık, her iki kemiği kapalı ve bir kemiği açık diğeri kapalı yapılan hastaların klinik ve radyolojik sonuçları değerlendirildi.YÖNTEMLER: İnstabil önkol 1/4 orta cisim kırığı nedeniyle intramedüller çivileme yöntemiyle tedavi edilen 63 çocuk geriye dönük değerlendirildi. Hastaların 13’üne Grup A; 3 kız, 10 erkek; ort. yaş 10; dağılım;5-15 her iki kemiğe açık yerleştirme; 27’sine Grup B; 4 kız, 23 erkek; ort. yaş 11; dağılım;5-16 her iki kemiğe kapalı yerleştirme; 23’üne Grup C; 3 kız, 20 erkek; ort. yaş 11; dağılım;7-14 bir kemiğe açık diğerine kapalı redüksiyon uygulandı. Gustilo-Anderson sınıflamasına göre 15 hastada tip1, iki hastada tip 2 açık kırık vardı. Yaralanmadan cerrahiye kadar geçen süre grup A’da 4, grup B’de 2, grup C’de 2 gündü. Hastalarda Kirschner teli kullanıldı. Hastaların hepsinde hem radius hem ulna tespit edildi. Ortalama takip süresi grup A’da 38, grup B’de 34, grup C’de 39 aydı.BULGULAR: Grup A’da ortalama 47, grup B’de 45, grup C’de 46 günde kaynama sağlandı. Çivilerin çıkarılma süreleri grup A’da ortalama 53, grup B’de 82, grup C’de 67 gündü. Gruplar arasında yaş, yaralanmadan cerrahiye kadar geçen süre, tel çıkarma ve takip süresi, cinsiyet, taraf, etiyoloji, komplikasyon dağılımlarında istatiksel anlamlı farklılık saptanmadı p>0.05 . Epifiz hasarı, redüksiyon kaybı, refraktür, derin enfeksiyon, kaynamama, nörovasküler yaralanma, Kirschner teli migrasyonu, sinostoz, angular ya da rotasyonel deformite ve anestezi komplikasyonu gelişmedi.SONUÇ: Çocuklarda instabil önkol diyafiz kırıklarının Kirschner teliyle intramedüller tespitinde açık veya kapalı kırık redüksiyonunun fonksiyonel ve radyolojik sonuçlar üzerine etkisi olmadığını istatistiksel olarak gösterildi.