Introduction: Compartment syndrome is one of the most devastating complications in orthopaedic trauma cases. The aim of this study is to investigate whether the intra-compartmental pressure changes rise and stay above the dangerous limits during percutaneous bridge plating of tibial shaft fractures necessitating fascial release or not.

Patients and Methods: Between January 2007 and April 2009 17 isolated tibial fractures of the 17 patients were treated with percutaneous bridge plating technique by a single orthopaedic trauma surgeon. During the operation before, during and after the plating leg compartmental pressures were measured by using invasive blood pressure monitor. Demographic, trauma and fracture related data were also recorded. Analyses were performed by using SPSS 13.

Findings: Mean age was 32 (19–55) years. Mean of ISS was 14 (10–27). Plating was performed at a mean of 3,3 (1–6) days after the trauma. Means of difference between systolic and diastolic blood pressure and leg anterior compartment pressures just before the plate insertion were 42 and 25,5 (16–32) mmHg respectively. During plating compartmental pressures rose to a mean of 51,5 mmHg (p=0,001) and dropped to 50 mmHg 10 minutes after implantation. Mean delta P was – 7 mmHg for the leg antertior compartment ten minutes after plating. No correlation was found between the blood pressure differences; ISS; age; type of anesthesia and delta P (r< 0,1 and p> 0,05). Although there is a trend of having decreased delta P with earlier surgery difference was not significant (r=0,18; p=0,058).

Conclusion: Anterolateral percutaneous bridge plating of tibial shaft fractures significantly increases intracom-partmental pressures. Physician should carefully judge the risk of compartment syndrome in each patient separately and should not hesitate to perform percutaneous fascial release intraoperatively.

Aim: Supine lateral bending radiographs are the standard methods of evaluating curve flexibility before surgery in idiopathic scoliosis. Supine traction radiographs have also been used at the authors’ institution in addition to the supine lateral bending radiographs before surgery, believing that it is usually more helpful to analyze the response of the main and compensatory curves to corrective forces. The purpose of this prospective study was to use and evaluate the results of traction radiographs taken before general anesthesia (BGA) and under general anesthesia (UGA).

Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. We designed a new electronic traction table in order to take the longitudinal traction and three-points lateral pressure radiographs. We situated the patient on the table and measured the patient’s weight. Then we made a longitudinal and lateral traction while asking the possible neurologic symptoms. If there was not any symptom we stopped at the seventy percent of the patient’s weight for the longitudinal and at the fifty percent for the lateral pressure. These radiographs had been taken before and under general anesthesia (UGA). The influence of the traction radiographies on the decision for surgery and its correlation with postoperative result was examined.

Results: Longitudinal traction radiographs taken consciously provided the best amount of flexibility, with no significant difference from traction with the patient UGA (p = 0.17) but with significant difference from bending radiographs (p < 0.002). No significant difference was demonstrated between the traction radiographies taken before and under general anesthesia and postoperative correction (P = 0.14).

Conclusion: The curve flexibility in supine traction films taken with the patient BGA was nearly equal to the curve flexibility in supine traction films taken with the patient UGA in all patients and all types of curves. Thus, there is no need to obtain a normal supine traction film for flexibility analysis under general anesthesia. By this way; the surgeons will be able to give the patient a definitive plan before surgery because the decision can be finalized after seeing the traction radiographs with the patient before the general anesthesia and operation time will be shorter.

Aim: Assessment of curve flexibility is important in decision making before surgical correction of scoliosis. Supine bending radiographs are presently the gold standard technique by which flexibility is assessed, but their reliability has been questioned. Our aim was to compare the usefulness of supine side bending and traction radiographs (with new electronic traction table) in assessing curve flexibility, examining the correlation of each technique with postoperative correction, determining fusion levels in patients undergoing posterior spinal fusion.

Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. Preoperative radiologic evaluation consisted of standing anteroposterior, lateral, supine lateral bending and traction graphs by electronic traction table.

We designed a new electronic traction table in order to take the longitudinal traction and three-points lateral pressure radiographs. We situated the patient on the table and measured the patient’s weight. Then we made a longitudinal and lateral traction while asking the possible neurologic symptoms. If there was not any symptom we stopped at the seventy percent of the patient’s weight for the longitudinal and at the fifty percent for the lateral pressure. These radiographs had been taken before and under general anesthesia (UGA).

The correction obtained in the Cobb angle between the bending and traction radiographs was compared. The influence of the traction radiography on the decision for surgery and its correlation with postoperative result was examined.

Results: Longitudinal traction radiographs taken consciously provided the best amount of flexibility, with no significant difference from traction with the patient UGA (p = 0.17) but with significant difference from bending radiographs (p < 0.002). Better flexibility in traction radiographs helped us eliminate the need for anterior release in 5 patients. We decreased the fusion levels proximally or distally after all in 12 patients. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.14).

Conclusion: Flexibility obtained at traction radiographs with the patient conscious and UGA is clearly better in numerical values, and closer to the amount of surgical correction than the amount of flexibility at three-points lateral pressure radiographs and side-bending radiographs

This method benefits patients by allowing them to avoid anterior release surgery, assessing the fusion levels and helps predict postoperative correction. Longer follow ups are needed to see whether there is decompensation or not.

Aim: Accurate placement of the distal screws into the interlocking nails is a demanding procedure due in part to inaccuracy of the targeting device supplied with the system and to deformation of the nail during insertion. Distal locking can be time consuming and expose the surgeon to unnecessary increased ionization radiation. The described technique allows the distal femoral screw holes to be localized accurately with minimal radiation exposure. Our technique requires no aiming device and no assistant. The only equipment needed is another IM nail at the same length.

Materials and Methods: We describe our new protocol in a subgroup of 20 patients, among those attended to our institution during the last 1.5 years treated with reamed, locked intramedullary nailing. After placement of the nail in a tibia or femur, a second interlocking nail at the same length is placed along side the limb. Using the proximal insertion jig provided with the system, proximal holes of the internal nail are locked with long screws passing through the nail-mounted outrigger to the far cortex. After avoiding the outrigger motion and rod torsion, distal screws are locked. Proximal holes’ locking is then accomplished.

Results: In 20 consecutive distally locked nailing (eight tibiae and 12 femora), the technique was easily mastered. In the operation, there had been taken antero-posterior and lateral graphies in order to evaluate the reduction, the length of the nail and the screws.

Conclusion: The advantages of this protocol are; decreasing the roentgenogram exposure and minimizing the operating time when compared to freehand techniques. This technique can be a safe alternative to the common distal targeting techniques. It can be used when an image intensifier is unavailable.

Aim To find out how does the late surgical treatment of DDH after walking age affects quality of life at adulthood.

Patients and Methods 157 adults with 220 dysplastic hips were evaluated by physical examination, short-form 36 health questionnaire, WOMAC, Harris Hip Scoring, X-rays, computed tomography (CT) and magnetic resonance imaging (MRI). Additional hip scores were applied. Data analyzed by using SPSS 11.0.

Results 39 hips of 24 patients were treated with open reduction (OR) (n=6), OR+femoral osteotomy (n=4), OR+iliac osteotomy (n=6), OR+femoral+iliac osteotomy (n=23) at a mean age of 7 years. 181 hips in 133 patients received no treatment for DDH. Mean age at evaluation was 38±13,6 years. No difference was found between treated and untreated groups in respect to SF-36 and WOMAC responses. Mean Total Harris Hip Score was slightly lower in untreated group (63 vs. 70, p=0,049). 74% of all cases have low back pain (LBP). LBP rate was not different for treated and untreated groups (80% vs. 73%, p=0,505). Interestingly, LBP was found to begin at an earlier age in treated group (23 vs. 32 years, p=0,000).

Conclusion This study failed to show that surgical treatment of DDH after walking age improves adulthood quality of life. Treatment for DDH should be performed before walking age to prevent progressive degenerations at many different joints, like; sacroiliac, lumbosacral and intervertebral joints besides the hips and knees.

Aim: To quantify the gait characteristics of the children with a history of treated femoral shaft fracture, and compare the outcome of three different treatment methods (spica cast, plate fixation, and flexible intramedullary nailing) in terms of kinematic and kinetic characteristics of gait.

Material and Methods: Fifteen children (9 boys, 8 girls), admitted to our hospital for unilateral (n=12) and bilateral (n=3) femoral fracture were evaluated in this study. The average age was 9.4 years (range 5–15 years). They were treated by three different methods: spica cast (n=5 ), plate fixation (n= 5), flexible intra-medullary nailing (n= 5). The cases were followed up with an average period of 23 months (6–48 months). At the end of the follow up period quantitative gait analysis was performed using Vicon 370 system with five cameras and two Bertec force plates. For each assessment, a typical walk was selected for each limb on the basis of consistency of time-distance characteristics. Kinematic and kinetic gait characteristics were compared using MANOVA, post hoc Tukey and LSD tests.

Results: Gait characteristics of the patients were significantly different than normal, however, the difference between spica cast, plate fixation, and flexible intra-medullary nailing groups in terms of kinematic and kinetic characteristics of gait were not statistically significant. Older children treated by spica cast showed the best gait characteristics among the others.

Conclusion: Femoral shaft fractures during childhood causes significant deviations of gait characteristics even though treated by spica cast, plate fixation, or flexible intra-medullary nailing. These children need novel treatment options to prevent gait pathologies, and further evaluation to understand the compensatory mechanisms of gait deviations.

Aims: To investigate the clinical importance of the fracture of lumbar vertebral transverse processes and to þnd out if any correlations exists between the side and the level of the transverse processes fractures and speciþc intraabdominal organ injuries. Methods: 106 patients, sustained different kinds of trauma between January 2000 and January 2001, were included in the study. All patients were operated for intra abdominal causes. Of these 62 (%58) had one or more fractured lumbar transverse processes documented (group I) and remaining 44 had not (group II). Age, gender, additional skeletal and intra abdominal injuries, ISS, laboratory tests results at presentation, transfusion needs and the end results were compared using SPSS 10,0 package. Results: Patients with transverse process fractures were older (38 versus 27, p=0,001). Trauma causes, ISS, additional systemic traumas, skeletal traumas were not different between groups (p values are; 0,148, 0,125, 0,423, 0,673 respectively). However, hemoglobin levels, intra abdominal organ injuries, total hospital stay and end results were signiþcantly different in group I (p= 0,005, 0,042, 0,002 and 0,012). Left sided fractures were well correlated with the spleen, and right sided fractures were similarly correlated with the presence of hepatic injuries. Conclusions: Although lumbar transverse process fractures do not directly relate with vertebral stability, the presence of such a fracture should alert physicians. Especially in multiply injured patients, lumbar vertebra transverse process fracture predisposes more serious intra or retroperitoneal organ injuries.

Aims: To compare clinical results of three different þxation combinations used for the treatment of ipsilateral hip and femoral diaphysial fractures. Methods: Between March 1999 and May 2001, 17 patients with ipsilateral hip and femur diaphysis fractures treated either by using cannulated screws for hip and plate-screw osteosynthesis for diaphysis (GroupI, 5 patients), dynamic hip screw for hip and plate-screws for diaphysis (Group II, 4 patients) and cannulated screws for hip and retrograde intramedullary nailing for diaphysis (Group III, 8 patients). Mean follow up was 24,4 months (16–33). All data retrospectively reviewed and compared using SPSS 10,0 package. Results: Age, sex, Injury Severity Scores, additional traumas, causes of trauma, þrst hemoglobine levels and complications were not different for either three groups. However, Group III had much lower operation times, perioperative transfusion needs and healing times for the diaphysial fractures compared to Groups I and II. All varus angulations at hip fractures observed in Groups I and III. We did not observe any avascular necrosis of the femoral head at latest follow up in either groups. Conclusions: All above mentioned þxation combinations can be used for the treatment of this difþcult fracture combination. However, by using retrograde nailing for the diaphysis and cannulated screws for the hip fracture, one can decrease operation times, blood transfussion needs and time to full weight bearing without increasing complications. We propose that, retrograde nailing combined with percutaneous screws should be the choice of treatment with decreased soft tissue dissection, accelerated rehabilitation and possible increased rate of healing.