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Öğe Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures(2003) Kesemenli C.C.; Subaşi M.; Arslan H.; Necmioglu S.; Kapukaya A.OBJECTIVES: The results of open reduction and internal fixation of humeral shaft fractures by either an intramedullary nail or a dynamic compression plate were compared. METHODS: The study included 60 patients (43 males, 17 females; mean age 38 years; range 19 to 61 years) with humerus fractures. Thirty-three patients were treated with intramedullary nails and 27 patients with dynamic compression plates. Functional results were evaluated according to the Stewart and Hundley's criteria. The two methods were compared. The mean follow-up period was 42 months (range 28 to 72 months). RESULTS: Healing times did not differ between the two treatment groups (p>0.05). Radial nerve palsy occurred only in the dynamic compression plate group, with four patients being affected. On the other hand, the rate of non-union was significantly higher in patients treated with intramedullary nailing (p<0.05). CONCLUSION: No ideal fixation technique exists in the treatment of humerus fractures. Despite higher non-union rates, intramedullary nailing may be the method of choice in the treatment of humerus fractures because of such advantages as low morbidity, small dissection of soft tissues, and greater ease of application.Öğe Early prophylactic autogenous bone grafting in type III open tibial fractures(2004) Kesemenli C.C.; Kapukaya A.; Subaşi M.; Arslan H.; NecmioğLu S.; Kayikçi C.The authors report the results achieved in patients with type III open tibial fractures who underwent primary autogenous bone grafting at the time of debridement and skeletal stabilisation. Twenty patients with a mean age of 35.8 years (range, 24-55) were treated between 1996 and 1999. Eight fractures were type IIIA, 11 were type IIIB, and 1 was type IIIC. At the index procedure, wound debridement, external fixation and autogenous bone grafting with bone coverage were achieved. The mean follow-up period was 46 months (range, 34-55). The mean time to fixator removal was 21 weeks (range, 14-35), and the mean time to union was 28 weeks (range, 19-45). Skin coverage was achieved by a myocutaneous flap in 2 patients, late primary closure in 4, and split skin grafting in 14. One (5%) of the patients experienced delayed union, and 1 (5%) developed infection. In tibial type III open fractures, skin coverage may be delayed, using the surrounding soft tissue to cover any exposed bone after thorough debridement and wound cleansing. Primary prophylactic bone grafting performed at the same time reduces the rate of delayed union, shortens the time to union, and does not increase the infection rate.Öğe The floating knee in adults: twenty-four cases of ipsilateral fractures of the femur and the tibia(2003) Arslan H.; Kapukaya A.; Kesemenli C.C.; Necmioglu S.; Subaşi M.; Coban V.OBJECTIVES: We evaluated the presenting features of ipsilateral femoral and tibial fractures in adults, and the effects of both fracture type and severity of skeletal injury on the results. METHODS: The study included 24 patients (22 men, 2 women; mean age 38 years; range 17 to 75 years). According to the classification by Letts et al., the types of the fractures were as follows: type A (7), type B (2), type C (5), type D (7), and type E (3). Femur fractures were treated by locked intramedullary nails, AO plates, plate-screws, unilateral external fixator, or dynamic condylar screws, and tibia fractures by external fixator, plate-screws, locked intramedullary nailing, or with conservative methods. Amputation at the fracture level was required in a patient with type 3C open tibia fracture. The mean follow-up was 3.2 years (range 1.3 to 7 years). RESULTS: According to the criteria by Kalström and Olerud, the results were excellent in three patients, good in nine patients, fair in five patients, and poor in six patients. The mean skeletal injury scores were 4.4 and 3 in patients having fair and poor results and in those with good and excellent results, respectively. Fair and poor results corresponded to type A (1 patient), type C, type D, or type E fractures. Five patients with type 3 open fractures had fair or poor results. Thirteen patients (54%) had at least one complication. CONCLUSION: Patients with type C, D, or E fractures and those with greater skeletal injury scores are more likely to have fair or poor results due to the open nature of the fracture and to increased involvement of the knee joint. Although there is not an ideal method, rigid internal fixation seems to be more appropriate in fractures other than type 3 open tibia fractures.Öğe The middle period outcome of partial patellectomy for the treatment of comminuted patella fractures(2001) Kesemenli C.C.; Subaşi M.; Kirkgöz T.; Arslan H.; Necmioglu S.The fracture of the biggest sesamoid bone patella is encountered at a rate of 1% of all skeletal injuries. Partial patellectomy is advised in the treatment of comminuted fractures of patella. In this retrospective study, we evaluated 18 of 25 patients who had partial patellectomy in our clinic between 1986-1997. Five patients were female (%27.8) and 13 were male (%72.2). The mechanisms of injuries were as follows: 11 (%61) motor vehicle accidents; 4 (%22) falls from flat-roofed house; 2 (%11) gunshot; and 1 (%5) subsidence. The mean age of the patients was 34.3 (range, 13-65). Ten left (%55) and eight right (%45) partial patellectomy were performed. Ten (%55) patients had also additional pathologies. The median follow-up time was 5.2 years (range, 2-11 years). Patients were very well in the last follow-up. According to Cincinnati Knee Score, which was improved by Noyes, 5 patients (%30) had excellent, 8 (%42) good 3(%17) moderate and 2 (%11) bad results. In conclusion, in the following years, enlargement in patellar articular surface and ossification, which is developed compensationally in the extensor mechanism may be detected and misevaluated as osteoarthrosis. Hence, we determined that they had not restricted knee joint functions in our cases.Öğe Treatment of humeral diaphyseal nonunions by interlocked nailing and autologous bone grafting(2002) Kesemenli C.C.; Subasi M.; Arslan H.; Necmioğlu S.; Kapukaya A.Twenty seven patients with humeral diaphyseal nonunion treated with interlocked nailing and autogenous bone grafting were retrospectively assessed. The mean age was 37 years (28 to 59 years). There were 16 women and 11 men. An average of 11 months (8 to 36 months) had elapsed between the initial trauma or treatment and presentation in our clinic. The nonunion site was in the distal third of the humerus in 18 patients (66%) and in the middle third in 9 (34%). Seventeen (73%) had hypertrophic and 10 (37%) atrophic nonunion. Patients were treated with locked intramedullary nailing and autogenous cancellous bone grafting. The mean follow-up was 42 months (28 to 62 months), and the mean time to union was 4.8 months (2.5 to 11 months). Three patients developed superficial infection. Union was achieved in all cases but one, in which there was multiple nerve injury. According to Steward and Hundley's scoring, results were good in 24 patients, fair in 2, and poor in one. Interlocked nailing and autologous bone grafting has a good rate of union provided nails of appropriate diameter are used and distal and proximal locking is performed correctly. We think that its low rate of infection, low risk of injury to the radial nerve, and low requirement for soft tissue dissection make it a suitable choice in the treatment of nonunions of the humeral diaphysis.Öğe Treatment of refracture occurring after external fixation in paediatric femoral fractures(2004) Kesemenli C.C.; Necmioğlu S.; Kayikçi C.With a mean follow-up of four years, we assessed the outcomes of 11 refractures which occurred following paediatric femoral fractures treated by external fixation; the refractures were treated conservatively with simple immobilisation in a spica cast. A total number of 104 children with a femoral fracture were treated with external fixation between 1993 and 2000 in our institution. Refracture occurred in 11 cases after fixator removal. These patients were immediately placed in a hip spica cast. All 11 patients were boys, with a mean age of 7.3 years (range: 6 to 9), and the mean follow-up time was 4 years (range: 2 to 7). Mean hospitalisation time after refracture was 2 days (range: 0 to 4). Refractures occurred an average of 8 days (range: 1 to 21) after fixation removal. The mean time to union after refracture was 55 days (range: 35 to 62). On final evaluation, a mean limb length discrepancy of 0.9 cm (range: 0 to 2.5) was noted. Radiological study showed a mean lateral angulation of 5.6° (range: 0 to 17) and a mean anterior angulation of 7.4° (range: 0 to 20). Based on these findings, we believe that closed reduction and spica cast immobilisation is sufficient in cases with refracture of the femur after external fixation, but the option of surgical treatment should be considered when satisfactory anatomic reduction is not achieved.
