Percutaneous reduction of irreducible forearm fractures in children.
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Adolescent↗
Biomedical subjects
Izge Günal
Publications and source records attributed to Izge Günal.
Stress views in the radiography of scapholunate instability.
AIM: On the suspected carpal instabilities stress views are recommended but not often used. The present study evaluates the reliability of the dorsal and volar stress radiographs on patients with posttraumatic wrist pain. PATIENTS AND METHODS: Stress radiographs of the wrists were examined in 22 patients with chronic wrist pain and the results were compared with scaphoid shift test and standard and positional views. The stress examination consists of applying to the wrist dorsal and volar stresses on the hand. RESULTS: Static scapholunate instability was diagnosed in 4 patients in whom 3 of them had positive scaphoid shift test sign as well. There were, however, 18 patients with dynamic scapholunate instability in whom the standard films were normal but dorsal stress radiography showed gap greater than 3mm between the scaphoid and lunate. CONCLUSION: Stress tests may provide considerable information in the evaluation of a patient who has a painful wrist in whom routine and special views do not demonstrate scapholunate dissociation.
Adult↗
Wrist ligaments: their significance in carpal instability.
BACKGROUND: Understanding the exact contribution of the supporting ligaments to the functional integrity of the wrist is crucial for the diagnosis and treatment of carpal instabilities. The present study evaluates functional significance of the wrist ligaments with respect to carpal instabilities. MATERIALS AND METHODS: Sixteen fresh cadaver wrists were dissected. Extrinsic and intrinsic ligaments of the wrists (ligamentum radioscaphocapitatum, ligamentum radiolunotriquetrum and ligamentum triquetrohamatocapitatum) were sectioned sequentially. After sectioning of each ligament, the wrist was examined for clinical signs of instability such as misalignement of carpal bones, limited range of motion and dorsal translation. When instability was suspected, radiographs were taken and if instability was confirmed, then the ligament was repaired. RESULTS: Although none of the dorsal ligaments sectioning resulted in instability, sectioning of ligamentum scaphotrapeziotrapezoideum, ligamentum radioscaphocapitatum, ligamentum radiolunotriquetrum and ligamentum triquetrohamatocapitatum displayed scaphotrapeziotrapezoidal, dorsal intercalated segment, lunotriquetral and capitohamate instability respectively. In two wrists with arthrosis, sectioning of all ligaments didn't lead to any instability. CONCLUSION: Instability of the wrist can be classified on anatomical basis after the name of these four ligaments involved i.e. l. scaphotrapeziotrapezoideum, l. radioscaphocapitatum, l. radiolunotriquetrum and l. triquetrohamatocapitatum respectively . This approach clarifies the etiology and treatment of carpal instabilities.
Cadaver↗
[Biomechanical analysis of load transmission characteristics of limited carpal fusions used to treat Kienböck's disease].
OBJECTIVES: Although limited carpal fusions used in the treatment of Kienböck's disease are thought to act by decreasing the loads on the lunate, biomechanical studies show that capitohamate fusion acts oppositely to what is expected. This experimental study was designed to resolve this paradox. METHODS: In a biomechanical cadaveric study, load transmissions at the radioulnacarpal joint were investigated under 140 and 210 newtons of load with three wrist postures, namely, neutral, ulnar and radial deviations, in five intact wrists and after scaphotrapeziotrapezoid, capitohamate, and scaphocapitate fusions. RESULTS: Under 140 newtons of load, the loads imposed to the lunate decreased following scaphotrapeziotrapezoid and scaphocapitate fusions, but increased after capitohamate fusion. However, when the load was increased to 210 newtons, there were no differences between intact wrists and limited carpal fusions in respect to the loads exerted on the lunate. In all the situations, the lunate was subjected to a significantly greater load in ulnar deviation. CONCLUSION: These results suggest that limited carpal fusions do not alter load transmission characteristics of the wrist joint under 210 newtons of load. The etiology of the Kienböck's disease seems to be related to an overload in ulnar deviation and the beneficial effect of limited carpal fusions seems to be associated with restricted ulnar deviation of the wrist rather than load transmission characteristics.
Arthrodesis↗
The evaluation of the proximal tibiofibular joint for patients with lateral knee pain.
In contrast to important functions of the proximal tibiofibular joint (PTFJ), there appear a few clinical and radiological studies concerning the PTFJ pathologies. Although almost all of the joints have been investigated in detail by MRI, review of the literature reveals none on the pathologies of PTFJ. Thirty-eight knees of 32 patients with lateral knee pain were evaluated clinically and radiologically. All had tenderness over the PTFJ and lateral hamstring tightness. MRI examination revealed effusion of the PTFJ in 22 knees and partial ruptures of anterior or posterior tibiofibular ligament, lateral collateral ligament or biceps femoris tendon in 25 knees. All patients were treated by manipulative physiotherapy of the PTFJ and strengthening and stretching exercises of the surrounding structures. All patients were followed-up 12-36 months (mean 28 months) after the treatment protocol, and complete relief of the symptoms was recorded in 28 of the 38 knees. Although spontaneous pain was not present in five patients, there was tenderness over the PTFJ by palpation. No change in the symptoms was recorded in five patients. These results suggest that PTFJ pathologies should be kept in mind in the evaluation of lateral knee pain and MRI examination provides useful information.
Adolescent↗
Medial approach without opening the joint capsule for developmental dislocation of the hip.
Seventy-one developmentally dislocated hips in 47 children with an average age of 11 months (range 4-16 months) were treated by the medial approach without opening the capsule followed by 6 months of hip spica-cast immobilization. At the latest follow-up 63 hips were rated excellent and good, and 8 hips showed subluxation. No avascular necrosis had occurred. It is concluded that this approach is safe and effective for treating developmental dislocation of the hip. Moreover, opening the capsule is not only an unnecessary task in this age group but also should be avoided to prevent avascular necrosis.
Bone Diseases, Developmental↗
The proximal tibiofibular joint: an anatomic study.
In the first stage of the current study, 14 fresh specimens from above-the-knee amputations were examined by magnetic resonance imaging arthrography. In the second part of the study, these amputation specimens and 38 embalmed knees from cadavers were dissected. The types of the joint and insertion of the biceps femoris tendon and the other structures were observed. Of 14 fresh specimens from above-the-knee amputations examined by magnetic resonance imaging arthrography, nine had a clear communication between the proximal tibiofibular joint and the knee. It was difficult to distinguish the anterior tibiofibular ligament in 30 specimens as a separate band because it was fused intimately with the biceps femoris tendon. Of these specimens, 24 had an oblique type of joint. Because of this communication, the proximal tibiofibular joint might be construed as the fourth compartment of the knee to explain subtle knee problems.
Amputation, Surgical↗
Treatment of tibia vara by the Ilizarov method.
Sixty-nine lower extremities of 45 patients (mean age, 10 years 8 months) with tibia vara were treated with the Ilizarov circular external fixator and distraction osteogenesis. Twenty-four of the patients had bilateral involvement, six of whom had simultaneous surgery and the remaining 18 had staged operations 8 to 12 months apart. In 11 limbs with femoral valgus deformity greater than 10 degrees simultaneous corrections were done. Active movements of the joints of the extremity were encouraged the day after surgery and partial weightbearing began 2 days later. All patients were followed up 27 to 178 months (mean, 80 months) after surgery. No neurovascular complications, delayed union, or nonunions were observed. The mean 28.6 degrees varus tibiofemoral angle preoperatively (range, 15 degrees -45 degrees ) improved to 7.5 degrees valgus (range, 0 degrees -18 degrees ) postoperatively. The preoperative internal torsion angle also improved from 20.7 degrees (range, 0 degrees -48 degrees ) to 3.5 degrees external torsion (range, 0 degrees -9 degrees ) postoperatively. Residual deformity was seen in six patients, and they had successful revision surgery using the same technique. The Ilizarov method allows early weightbearing and motion and allows all components of the deformity to be corrected.
Adolescent↗
[The accuracy of references in Turkish journals in orthopedics and traumatology].
OBJECTIVES: The accuracy of references was assessed in Turkish journals of orthopedics and traumatology. METHODS: All references cited in four journals (Acta Orthopaedica et Traumatologica Turcica, Arthroplasty Arthroscopic Surgery, Hacettepe Journal of Orthopaedic Surgery, and The Journal of Turkish Spinal Surgery) throughout 1995 to 1999 were numbered consecutively. One percent of references from each journal was randomly selected to be evaluated in comparison with primary sources. Errors were classified in three categories. Another randomized selection was made to check 50 references from each journal. The results were assessed by the t-test. RESULTS: Of 18,193 references cited in four journals, 182 references were checked. Errors were found in 117 references (63%), seven of which were major errors that prevented location of the primary source. When 50 references were checked from each journal, the mean inaccuracy rate was 60%. No significant differences were found between the journals with respect to the frequency of erroneous references. CONCLUSION: The high rate of inaccuracy emphasizes the need for greater care in the use of references on the part of authors, journal editors, and reviewers.
Authorship↗
Bilateral congenital subluxation of the proximal tibiofibular joint with magnetic resonance imaging findings: a case report.
There appear to be no criteria in the differential diagnosis of traumatic and congenital subluxation of the proximal tibiofibular joint in the literature. We report a case with bilateral congenital subluxation of the proximal tibiofibular joint and describe the magnetic resonance imaging features for the differential diagnosis.
Cartilage, Articular↗
Endoscopy, assisted percutaneous repair of the Achilles tendon ruptures: a cadaveric and clinical study.
Endoscopy-assisted percutaneous repair of Achilles tendon ruptures were investigated in a cadaveric and clinical study. Sixteen above-knee fresh amputation specimens in which different types of Achilles tendon ruptures were created were repaired percutaneously with the visualization of the tendon ends by endoscopy. Neither malalignment nor damage to the neurovascular structures was observed. Eleven patients were treated in this way. No reruptures, wound problems, or neurovascular injury were observed. All patients returned to daily activities 10-11 weeks after the repair. This technique seems to overcome certain problems of conservative, surgical, or percutaneous repair of the Achilles tendon ruptures.
Achilles Tendon↗
Os vesalianum pedis.
Os vesalianum pedis is an accessory bone located proximal to the base of the fifth metatarsal. Its prevalence has been reported to be from 0.1% to 1.0%. This bone is found within the peroneus brevis tendon and is considered to be asymptomatic in the majority of people. We describe a patient with os vesalianum pedis with a distinct mediocuboidal articulation. The radiologic differential diagnosis of the ossicle is discussed.
Adult↗
Relationship between onychocryptosis and foot type and treatment with toe spacer. A preliminary investigation.
The relationship between onychocryptosis and foot type was investigated in a series of 512 patients. Of these patients, 124 had signs or a history of onychocryptosis. Among the nine foot types identified by digital and metatarsal formulas, the Greek index minus and squared index minus types showed the strongest association with onychocryptosis, which was present in more than one-third of such feet. When anteroposterior radiographs of each type of foot were taken after binding the first and second toes together to simulate a tight shoe, the enlargement of bony structures of the second toe at the distal interphalangeal level in the Greek and squared index minus feet moved toward the distal enlargement of the distal phalanx of the first toe where the ingrowing occurs. Ten cases of stage I and four cases of stage II onychocryptosis were treated by placing a toe spacer between the first and second toes; all healed in about 3 weeks, suggesting that counterpressure of the second toe in tight shoes is a factor in the development of onychocryptosis.
Foot↗