Aim: To compare the radiological and functional outcomes of compression type thoracolumbar vertebral fractures treated with cloth-type thoracolumbar orthosis fitted with steel plates and bed rest.

Methods: This prospective comparative study was done between July 2004 and January 2007. Twenty three patients (17 male, 6 female) with compression type (Magerl A1) thoracolumbar vertebral fractures were included. No patient had associated neurogical findings or additional injury. Eleven patients were treated with cloth-type thoracolumbar orthosis and 12 patients with only bed rest. Bed rest group cases were instructed to stand up and walk around as possible as they tolerated after pain relief just only in the house under the supervision of it’s relates. All cases were evaluated at last follow-up with SF-36 questionaire, clinical and radiological examination.

Results: There was no significant difference between two groups with regard to demographic data. Radiological parameters including anterior compression angle, local kyphosis angle, sagittal index and anterior vertebral height were measured and compared on initial admittion, on the third month and at the last visit showing no significant difference (p> 0.05). Clinical evaluation was performed via work and pain criteria described by Denis. We found no significant difference between both groups for functional criteria (p> 0.05). Mental and physical points of SF-36 questionaire were recorded and compared dispaying no difference (pmental=0.15, pphysical=0.44).

Conclusion: Magerl type A1 thoracolumbar fractures can be treated via bed rest by allowing controlled ambulation in home without bracing. This functional therapy can prevent complications due to absolute bed rest or related to bracing. However patient’s cooperation is the most important factor while choosing functional therapy.

Background: In this retrospective study our purpose was to compare two treatment alternatives clinically.

Methods: Forty-five patients having grade I or II open tibia fractures were consisted in this study. Twenty-five of them, treated via minimal invasive plate osteosynthesis (MIPO), comprised group I. The latter 20 cases, treated via partial reamed intramedullary nailing (PR-IMN), called as group II. Aggressive debridement of all necrotic soft tissue and bone was performed primarily for all cases in the emergency room at admission to hospital. Definitive fixation was performed on average 3rd days (0 – 5) for group I and 2.5th days (0 – 4) for group II. Clinical evaluation was made on the basis of modified Ketenjian’s criteria.

Results: There were no significant differences between groups for demographic data (age, gender) and fracture type (p> 0.05). Full weight bearing periods of the group I and II were 21 and 22.4 weeks respectively. Non-union in one case of group I was revised by using circular external fixator. In another case implant removal was performed due to chronic osteomyelitis. Mal-union was detected in another case.

In group II, two cases needed implant revision with intramedullary nail in one and circular external fixator in another for non-union. Mal-union in one case and chronic osteomyelitis in another were late complications of group II. At the last follow up satisfaction rates were as; 21/25 in group I and 18/20 in group II clinically. There was no significant difference between both groups with regard to clinical evaluation (p> 0.05).

Conclusion: The clinical results of both groups were similar to each other. Although intramedullary nailing is the first choice, MIPO can be an alternative method for open tibia fractures.

Objectives: Nonsteroid antiinflamatory drugs have been widely used and recommended for ankle sprains despite the fact that they are also known to lead significant adverse effects especially to the gastrointestinal system. The aim of this study is to assess the efficacy of acetaminophen in comparison with diclofenac sodium.

Patients and Methods: In this prospective, double blinded, parallel group study, one hundred patients suffering from first or second degree lateral ankle sprain within 48 hours of administration were comprised. Patients with bilateral injury, ipsilateral knee injury, trird degree sprain, previous sprain within 6 months and ankle pain less than 45 according to visuel analogue score (VAS) were excluded. In addition; history including gastrointestinal, renal or hepatic disease was the reason for exclusion. Prior to enrollment cases underwent physical examination. Patients rated pain on a 100 VAS, representing 0 no pain, 100 maximal pain. After enrollment patients were randomized (1:1); diclofenac sodium 150 mg/day or acetaminophen 1500 mg/day for 5 days. Patients tretaed by diclofenac sodium were called as group I and the others were group II. In addition; cases were prescribed other intervention modalities as RICE (rest, ice, compression, elevation) and crutches. Clinical assessments were carried out at baseline; on second, tenth days and sixth weeks (end of study). In each visit, VAS and adverse effects of medication were questioned.

Results: The mean VAS of the GI and GII at the first visit were 81, 82.3 respectively. These scores decreased to 20.7, 9.9, 4.6 and 11.9, 6.3, 3 at the second, tenth days and last examination. Similar reductions in pain were observed at the last visit (p> 0.05) in both groups. However; cases treated by acetaminophen showed accelerated decrease in VAS at day 2 and 10 in comparison with GI (p< 0.05). Regarding the ankle ROM there was similar increase in both groups (38.9°, 36.9°) respectively. There was no significant difference between groups with regard to ankle ROM at the last control (p> 0.05). The incidence of gastrointestinal adverse effects of GI was much more than GII. However there was no significant difference (p> 0.05).

Conclusion: It was concluded that diclofenac sodium and acetaminophen are effective and well tolarated short term treatment alternatives for acute ankle injuries.

Objectives: The comminuted supracondylar femur fractures are resulted from high energy trauma. Infection and union problems are common complications. LISS is a new generation implant leading to decrease these complications. The aim of this prospective study is to compare the outcomes of distal femoral fractures treated by LISS (Less Invasive Stabilization System) of the multiple injured and isolated fractured cases.

Patients and Methods: This prospective study comprised of twentysix patients, sixteen men and ten women, who had 27 distal femoral fractures. Patients were divided as having multiple injury (group I) or isolated femur distal fractures (group II). There were fourteen supracondylar (AO type A) and thirteen intercondylar (AO type C) fractures. The average Injury Severity Scores (ISS) of group I and II were 26.7 and 9 respectively. Operations were performed according to biological fixation principles by means of submuscular manner. No grafting was performed to enhance the healing. The cases were evaluated based on the criteria of Schatzker–Lambert and modified Hospital for Special Surgery (HSS) scoring system.

Results: The mean hospitalization time was 16 days (range 13–46) in GI mainly depended on the presence of concomitant injuries and 8 days (range 6–12) in GII. The mean age of the patients was 49 years (range 26–80) (51.6 in GI and 45.6 in GII). The mean follow up period was 25.8 months. Union was achieved in all cases. Two cases required debridement procedures due to deep infection in group I. One of them healed completely but the other not resulted in chronic ostemyelitis. Revision surgery was carried out in one case due to screw pull out at second weeks postoperatively.

The average range of knee motion of the group I and II at the last control were 112.8°, 121.8 respectively. The mean modified HSSs were 73.9 and 79.9 respectively. There was no significant difference for HSS scores and range of knee motion (p> 0.05). Based on the criteria described by Schatzker and Lambert, the outcomes were assessed as excellent in 3 cases, good in 8, fair in 3, and poor in 2 in GI and as excellent in 3, good in 7 and fair in 1 in GII. Poor results of GI were because of osteomyelitis in one case and 15° varus deformity in another. The full weight bearing time was longer in group II depending on the concomitant injuries.

Conclusion: We concluded that LISS is effective method to yield satisfactory results for comminuted supracondylar fractures with multi trauma, even if their final results seem to be lower in comparison to isolated femur fractures.

Purpose: The aim of this prospective controlled study was to assess the natural history of acetabular development in D.D.H. treated under 18 months of age.

Method: For this purpose, patients who were treated using a posteromedial approach soft tissue surgical procedure due to unilateral D.D.H., had intraoperative radiographic anatomic reductions, had neither any type of avascular necrosis of the femoral head nor breakage of the Shenton’s line during the follow-up period, had complete follow-up till at least 10 years of age and had normal center-edge angles at the latest follow-up were selected from a prospective series that started in December 1993. Unaffected contrlateral hips were used as controls. Fourteen hips of 14 patients (13 females and 1 male) met the above mentioned strict criteriae and included the study. Acetabular angle of Sharp (AA) was measured to assess the acetabular slope in the frontal plane preoperatively and during follow-up. A paired t-test was used for the statistical analysis of the data and a P value less than 0.05 was considered significant.

Conclusion: In anatomically reduced and uncomplicated dysplastic hips which have been treated under 18 months of age, acetabular slope in the frontal plane tends to improve continuosly till at least 10 years of age and reaches to similar angular values as in the unaffected hips at nearly 7 years of age. In such hips, it may not be appropriate to make a final decision on whether the acetabular development is sufficient or not before 7 years of age.