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Öğe Big and deep seated lipomatous tumours in children : results of surgical treatment(Acta Medica Belgica, 2021) Ozkul, Emin; Elci, Serhat; Elci, Muhsin; Alemdar, CelilThe objective of the study is to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location.Öğe Big and deep seated lipomatous tumours in children : results of surgical treatment(Acta Medica Belgica, 2021) Ozkul, Emin; Elci, Serhat; Elci, Muhsin; Alemdar, CelilThe objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location.Öğe Biomechanical properties of osteoporotic rat femurs after different hormonal treatments: genistein, estradiol, and estradiol/progesterone(Edp Sciences S A, 2016) Azboy, Ibrahim; Ozkaya, Mustafa; Demir, Teyfik; Demirtas, Abdullah; Arslan, Arslan Kagan; Ozkul, Emin; Akcan, AdnanIntroduction: The purpose of the study is to compare the effects of genistein, estradiol, estradiol/progesterone combination on the bone mineral density and biomechanical properties of ovariectomized rats' bone. Methods: 50 female adult Sprague-Dawley rats were divided into five groups. Bilateral ovaeriectomy were performed in all groups except the sham-operated group. Groups were a sham-operated group and a control group (water was given), estradiol treated group (17-b estradiol 0.015 mg/kg per day), genistein treated group (genistein 10 mg/kg per day), and an estradiol/progesterone combination group (17-b estradiol 0.015 mg/kg plus drosperinone 0.028 mg/kg per day). The water or hormones were implemented in relevant groups for eight weeks by orogasthric catheter. The bone mineral density and biomechanical properties of the femur were analyzed. Results: Genistein, estradiol, and estradiol/progesterone groups increased bone mineral density significantly compared to the control group. In diaphysis and metaphysis bending test, all groups had higher peak load values than the control group. There were statistically significant differences between the estrogen/progesterone group and control group in diaphysis bending with regard to peak load. There were statistically significant differences between the estradiol and control groups in metaphysis bending with regard to peak load. In axial rotation test, all groups had higher peak torque values than the control groups. Conclusions: Genistein, estradiol and estrogen/progesterone combination improved the biomechanical properties of the ovariectomized rat bone. Genistein which has less side effects may be considered as an alternative in the treatment of postmenopausal osteoporosis.Öğe Clinical and radiologic results of open reduction and fixation with locked plate screws in proximal humerus fracture-dislocation(Derman Medical Publ, 2019) Degnek, Orhan; Atic, Ramazan; Alemdar, Celil; Aydin, Abdulkadir; Yildirim, Azad; Ozkul, EminAim: Proximal fracture dislocations of the humerus are rarely seen in society compared to other fractures. In our study, we evaluated the clinical and radiological results of patients who underwent open reduction and locked plate-screw fixation with proximal humerus fracture-dislocation. Material and Method: Between January 2009 and January 2016, 17 patients were treated with open reduction and locking plate screws in the Department of Orthopedics and Traumatology at the Faculty of Medicine, Dicle University. Patients were divided into two groups according to age. Group 1 consisted of 6 patients over 65 years of age and the mean age was 77.5 (69-87). Group 2 consisted of 11 patients under 65 years of age and the mean age was 41.6 (24-60). Group 1 consisted of all female patients and Group 2 consisted of all male patients. Patient fractures were classified according to the Neer classification. Oxford Shoulder Scale, DASH Score, and Constant Murley Score were used in the clinical evaluation of the patients. Avascular necrosis phase was performed according to Cruess phase. Results: The mean follow-up period of the patients was 13.8 months (range 10-38). The mean duration of surgery was 1.11 days (range 0-4). According to the Neer classification, 11.8% of the cases were two-part fracture dislocation, 64.7% were three-part fracture dislocation, and 23.5% were four-part fracture dislocation. There was a statistically significant difference between Oxford and DASH scores in the clinical outcome according to age groups (p = 0.001, p=0.049). Avascular necrosis was observed in 14 of 17 (82.3%) patients. Additional complications such as wound infection, nonunion were not observed. Discussion: In proximal humerus fracture-dislocations, the first surgical choice should be open reduction and internal fixation in young patients, whereas internal fixation in addition to arthroplasty should be considered in elderly patients.Öğe Comparative Analysis of Percutaneous Excision and Radiofrequency Ablation for Osteoid Osteoma(Int Scientific Information, Inc, 2023) Atic, Ramazan; Alemdar, Celil; Elci, Serhat; Dusak, Abdurrahim; cacan, Mehmet Akif; Ozkul, Emin; Aytekin, Mahmut NedimBackground: This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. Material/Methods: We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. Results: The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. Conclusions: Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.Öğe A comparison of percutaneous trephine excision and open surgery in the treatment of osteoid osteoma(Springer, 2016) Alemdar, Celil; Cacan, Mehmet Akif; Dusak, Abdurrahim; Ozkul, Emin; Atic, Ramazan; Kapukaya, AhmetPurpose The aim of this study was to compare CT-assisted percutaneous excision, which is a closed, economic method and a more cosmetic approach, and open surgery in the treatment of osteoid osteoma. Materials and methods Fifty-three patients (12 female and 41 male patients) who had percutaneous excision (n = 24) and open surgery (n = 29) were evaluated retrospectively. The mean age was 16.6 years and the mean duration of follow-up was 53.5 months. During percutaneous excision, a trephine was advanced through the labeling wire and the site, including the nidus, was excised en-bloc and the incision walls were curetted. During the open surgery, the localization of the nidus was marked using c-arm X-ray and the nidus was accessed by lifting the cortical bone, layer-by-layer, using burr. The nidus was excised and its cavity curetted. Results The result was successful in 22 and a failure in three patients who had closed excision. The result was successful in 20 and a failure in nine patients who had open surgery. The mean duration of operation was 44.37 minutes in the percutaneous excision group and 80.6 minutes in the open surgery group. There was no difference in the pre-operative VAS values between the two groups, whereas the post-operative VAS values were statistically significantly different. There was also a statistically significant difference in the duration of the operation and the length of the hospital stay between the groups. Conclusion Percutaneous excision with trephine is a more successful, effective, minimally invasive, safe and a better cosmetic approach in the treatment of osteoid osteoma. This method is also a cheap method that does not require expensive equipment.Öğe Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur(Turkish Assoc Orthopaedics Traumatology, 2014) Demirtas, Abdullah; Azboy, Ibrahim; Ozkul, Emin; Gem, Mehmet; Alemdar, CelilObjective: The aim of this study was to compare retrograde intramedullary nailing (RIMN) and bridge plating for the treatment of extra-articular distal femur fractures. Methods: The study retrospectively examined 15 patients (13 males and 2 females; mean age: 36 years, range: 17 to 55 years) who underwent bridge plating and 13 patients (11 males and 2 females; mean age: 31.1 years, range: 17 to 49 years) who underwent RIMN for the treatment of extra-articular distal femur fractures between 2007 and 2012. Functional results were evaluated using the Sanders criteria. The mean follow-up time was 31.3 (range: 20 to 46) months and 26.7 (range: 18 to 62) months in the plate and the nail groups, respectively. Results: Mean duration until union was 25.7 (range: 12 to 72) weeks in the plate group and 22.3 (range: 12 to 52) weeks in the nail group. Nonunion was observed in 2 patients in the plate group and in 1 in the nail group, delayed union in 3 patients in the plate and 2 in the nail groups, malalignment (>10 degrees) in 2 patients in the plate group and 1 in the nail group and implant failure in 1 patient in the plate group. Excellent/good functional results were obtained in 12 and 10 patients in the plate and the nail groups, respectively. No significant difference was found between the groups in terms of duration of union, complications and functional results (p>0.05). Conclusion: Bridge plating and RIMN have similar results in the treatment of extra-articular distal femur fractures. Both methods can be applied to all fractures, with the exception of Gustilo-Anderson Type 3B and C open fractures.Öğe The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus(Turkish Assoc Trauma Emergency Surgery, 2016) Azboy, Ibrahim; Bulut, Mehmet; Ancar, Cahit; Demirtas, Abdullah; Ozkul, Emin; Gem, Mehmet; Karadeniz, HilmiBACKGROUND: This study aimed to evaluate the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy. METHODS: Forty patients with intra-articular distal humerus fractures were retrospectively analyzed. TRAP approach was used in 22 patients (12 males, 10 females; mean age 37.8 years, range 17-70), and olecranon osteotomy in 18 patients (11 males, 7 females; mean age 35.4 years, range 18-62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. RESULTS: The overall mean arc of elbow motion was 108 degrees (range 70 degrees-140 degrees) in the TRAP group, whereas that of the olecranon osteotomy group was 98 degrees (range 70 degrees-115 degrees). A significant difference was observed between the two groups in terms of overall mean arc of elbow motion (p=0.038). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.412, p=201, respectively). The overall complication rate was 27.2% in the TRAP group and 55% in the olecranon osteotomy group. CONCLUSION: TRAP is a succesful approach in the treatmet of intra-articular distal humerus fractures that provides better arc of elbow motion, reduces complications and reoperation rates.Öğe Cystic Tuberculosis of the Humerus(Soc Brasileira Medicina Tropical, 2022) Tekin, Rojbin Ceylan; Ozkul, Emin; Tekin, Recep[Abstract Not Available]Öğe Effect of insulin-like growth factor-1 and hyaluronic acid in experimentally produced osteochondral defects in rats(Medknow Publications & Media Pvt Ltd, 2016) Alemdar, Celil; Yucel, Istemi; Erbil, Baris; Erdem, Havva; Atic, Ramazan; Ozkul, EminBackground: The common purpose of almost all methods used to treat the osteochondral injuries is to produce a normal cartilage matrix. However current methods are not sufficient to provide a normal cartilage matrix. For that reason, researchers have studied to increase the effectiveness of this methods using chondrogenic and chondroprotective molecules in recent experimental studies. Insulin-like growth factor-1 (IGF-1) and hyaluronic acid (HA) are two important agents used in this field. This study compared the effects of IGF-1 and HA in an experimental osteochondral defect in rat femora. Materials and Methods: The rats were divided into three groups ( n = 15 per group) as follows: The IGF-1 group, HA group, and control group. An osteochondral defect of a diameter of 1.5 mm and a depth of 2 mm was created on the patellar joint side of femoral condyles. The IGF-1 group received an absorbable gelatin sponge soaked with 15 g/15 l of IGF-1, and the HA group received an absorbable gelatin sponge soaked with 80 g HA. The control group received only an absorbable gelatin sponge. Rats were sacrificed at the 6 (th) week, and the femur condyles were evaluated histologically. Results: According to the total Mankin scale, there was a statistically significant difference between IGF-1 and HA groups and between IGF-1 and control groups. There was also a significant statistical difference between HA and control groups. Conclusion: It was shown histopathologically that IGF-1 is an effective molecule for osteochondral lesions. Although it is weaker than IGF-1, HA also strengthened the repair tissue.Öğe Effectiveness of Locking Versus Dynamic Compression Plates for Diaphyseal Forearm Fractures(Slack Inc, 2013) Azboy, Ibrahim; Demirtas, Abdullah; Ucar, Bekir Yavuz; Bulut, Mehmet; Alemdar, Celil; Ozkul, EminThis study compares the results of the locking compression plate (LCP) and the dynamic compression plate (DCP) in the treatment of diaphyseal forearm fractures in adults and defines the indications for the use of the LCP. Forty-two patients with diaphyseal forearm fractures were retrospectively analyzed. Of those, 22 had been treated with the LCP (LCP group) and 20 had been treated with the DCP (DCP group). The AO/ASIF classification was used to classify the fractures. Patients were assessed using the Grace-Eversmann criteria and the Disabilities of the Arm and Shoulder and Hand questionnaire during the final follow-up. Mean follow-up was 21 months (range, 20-24 months) in the LCP group and 23 months (range, 19-26 months) in the DCP group. Union was achieved in all patients. Mean time to union was 15 weeks (range, 12-25 weeks) in the LCP group and 17 weeks (range, 13-24 weeks) in the DCP group. In each group, 1 patient experienced delayed union, which required no additional surgical intervention. No significant difference was found regarding the time to union between the groups (P>.05). No significant difference existed between the 2 groups in terms of Grace-Eversmann criteria and Disabilities of the Arm and Shoulder and Hand scores (both P>.05). The results of these different fixation methods for forearm fractures in adults are similar. As such, the correct selection and application of surgical technique is more important than the type of plate used.Öğe An evaluation of treating non-union of femoral neck fractures with valgus angulation osteotomy using sliding hip screws(Acta Medica Belgica, 2019) Ozkul, Emin; Necmioglu, Necdet Serdar; Ziyadanogullari, Mehmet Onur; Alemdar, Celil; Arslan, Huseyin; Uzel, KadirThis study presents the outcomes of patients treated with non-union of femoral neck fractures healed with valgus osteotomy, fixed with a Dynamic Hip Screw (DHS). The study retrospectively evaluated 16 patients who, between 2007 and 2014, developed pseudarthrosis following treatment for a femoral neck fracture and who were treated with DHS-osteosynthesis, after a valgus subtrochanteric osteotomy. Postoperative clinical evaluation of the patients was done? using the Harris Hip Scoring (HHS) system. Union of both the fracture and the osteotomy site was achieved in 17.2 weeks (range: 14-24 weeks) in all patients. The average Pauwels angle decreased from 72o (range 62-80) preoperatively to 26o (range 20-50) postoperatively. All fractures were Pauwels type HI preoperatively and 4 type II and 12 type I postoperatively. The average HHS increased from 26 (range 18-34) preoperatively to 85 (range 68-94) postoperatively. Of the patients who were followed up for a mean duration of 3.1 years (range: 1-5 years), four had 1-cm shortening. No patient developed postoperative AVN of the femoral head. For patients with non-union after femoral neck fracture, DHS-osteosynthesis after valgus osteotomy is a method with a shorter learning curve, which can be successfully performed.Öğe Gorham-Stout's disease in the metatarsus: a case report(Turkish Assoc Orthopaedics Traumatology, 2014) Gem, Mehmet; Ozkul, Emin; Arslan, HuseyinGorham-Stout disease (GSD) is a rare disease occurring in the bone tissue and is characterized by spontaneous, progressive resorption. The etiology and treatment of the disease remains unclear. This article presents a 53-year-old male patient diagnosed with GSD in the 3rd and 4th metatarsal of his right foot.Öğe How Safe is Titanium Elastic Nail Application in the SurgicalTreatment of Tibia Fractures in Children ?(Acta Medica Belgica, 2014) Ozkul, Emin; Gem, Mehmet; Arslan, Huseyin; Alemdar, Celil; Bogatekin, Ferit; Senturk, IhsanTibia fractures in children are generally treated successfully by conservative means. The aim of this study was to evaluate the efficacy and safety of fixation using Titanium elastic nails (TEN) in pediatric tibia fractures in which conservative measures failed or were deemed inapplicable. In this study, 30 patients who had tibia fractures and were fixated with TEN between 2007 and 2011 were analyzed retrospectively. The procedure was performed after poly-trauma in six patients, open fracture in seven, reduction loss in twelve, and unsuccessful closed reduction in five patients. The number of girls and boys was 3 and 27, respectively, with a mean age of 9.8 years. The evaluation criteria of Flynn et al. were used in the analysis of the results. The mean follow-up period was 18 months. The mean period of union was 8 weeks and 14 weeks in closed and open fractures, respectively. Epiphyseal damage, rotational deformity, need for reintervention, deep infection, implant failure, or recurrent fracture was not observed in any case. According to the Flynn evaluation system, 23 cases were evaluated as excellent, and 7 as good. Fixation with TEN is an easy, effective, and safe method that can be used in tibia fractures that are open, irreducible, or with loss of reduction and in cases with accompanying trauma, such as floating knee.Öğe How successful is synthetic graft treatment for children with pathological hip fractures?(Sage Publications Ltd, 2023) Elci, Serhat; Ozkul, Emin; Alemdar, Celil; Atic, Ramazan; Akar, Mehmet SaitPurpose: To determine whether synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children. Methods: Paediatric patients treated for pathological fractures of the proximal femur between 2013 and 2020 were evaluated retrospectively. 17 patients with a mean age of 10.7 years (range 6-16 years) were assessed. The definitive histopathological diagnoses were SBC (simple bone cyst) (12) and ABC (aneurysmal bone cyst) (5). The median duration of follow-up was 37 months (range 12-70 months). Results: All patients returned to their normal daily routine within 3-8 months following surgery. The mean post-op recovery time was 3.2 months (range 3-6 months). Graft was incorporated at approximately 12 months. No significant radiographic healing was observed in 2 patients. In the remaining 15 patients, the mean duration of healing was 14 months (range 8-24 months). Conclusion: Synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children.Öğe Hydatid Cyst of the Tibia(Soc Brasileira Medicina Tropical, 2022) Tekin, Recep; Ozkul, Emin; Ulus, Sait Anil[Abstract Not Available]Öğe Management of infectious fractures with Non-Contact Plate (NCP) method(Acta Medica Belgica, 2015) Alemdar, Celil; Azboy, Ibrahim; Atic, Ramazan; Ozkul, Emin; Gem, Mehmet; Kapukaya, AhmetThe aim of this study was to evaluate the outcomes of internal fixation with Non-Contact Plating (NCP) after deep infection caused by previous surgeries of the tibia or femur fractures. The study included 15 patients (4 female and 11 male). The mean age patients was 36.6 years (range, 21-64 years). There were 6 femur and 9 tibia fractures. The mean followup period was 25.7 months (range, 15-45 months). The study comprised 11 open and 4 closed fractures. External fixator was used in 3, plate in 4, and intramedullary nail in 8 patients for index surgery. Deep infection was diagnosed via clinical findings, laboratory parameters, and microbiological evaulation. Deep infection was diagnosed within a mean period of 5.5 weeks (range, 2-10 weeks). The infecting organism was methicillin-resistant staphylococcus aureus (MRSA) in 5, methicillin-sensitive staphylococcus aureus (MSSA) in 6, pseudomonas auroginosa in 2, and enterobacteriacea in 2 patients. Union achieved in all patients. Mean time to union was 17 (range, 1138) weeks. Delayed union was observed in 3 patients who required additional surgeries. Of these one patient developed osteomyelitis. The NCP is an effective alternative method in the treatment of deep infection encountered after internal or external fixation for the tibia, or femur fractures.Öğe Minimally Invasive Plate Osteosynthesis in Open Pediatric Tibial Fractures(Lippincott Williams & Wilkins, 2016) Ozkul, Emin; Gem, Mehmet; Arslan, Huseyin; Alemdar, Celil; Azboy, Ibrahim; Arslan, Seher G.Objectives: The aim of this study is to investigate the effectiveness and reliability of limited-contact locking plates in minimally invasive percutaneous osteosynthesis (MIPO) of the lateral tibia. Design: A retrospective study. Patients and Methods: The retrospective study included 14 patients who were operatively treated with an MIPO technique due to open tibial fractures between 2006 and 2012. The patients were 11 males and 3 females with a mean age of 13.2 (range, 9 to 16) years. The patients were followed up for a mean period of 2.4 (range, 1 to 5) years. The mechanism of the injuries included a motor vehicle accident (n=11), a shotgun injury (n=2), and a fall from height (n=1). According to the Gustilo-Anderson classification, 10 patients had type I (72%), 2 had type II (14%), and 2 had type III (14%) open fractures. Results: The mean time to radiologic union was 18 (range, 11 to 32) weeks. No infection was detected that would require implant removal. No complications such as early epiphyseal closure, angulation, or limb-length inequality were observed. Conclusions: Limited-contact locking plates in MIPO of the lateral tibia is an effective alternative method in the treatment of open pediatric tibial fractures.Öğe One-stage bilateral open reduction using the anterior iliofemoral approach in developmental dysplasia of the hip(Acta Medica Belgica, 2014) Gem, Mehmet; Arslan, Huseyin; Ozkul, Emin; Alemdar, Celil; Azboy, Ibrahim; Demrtas, AbdullahThe aim of this study was to investigate the safety of one-stage bilateral open reduction using the anterior approach in the treatment of patients with bilateral Tonnis Type III and IV Developmental Dysplasia of the Hip (DDH). Forty-six patients were retrospectively evaluated. Thirty-eight were female, eight were male. The mean age was 16.63 (11-29) months. The mean follow-up period was 27.18 (12-65) months. The mean hospitalization period after surgery was 1.91 (1-5) days. The mean pre-operative hematocrit level was 35.14% (28.1-44.1) and the mean pre-operative hemoglobin level was 11.75 g/dl (9.3-13.6). The mean post-operative hematocrit level was 32.54% (26.7-40.4) and the mean post-operative hemoglobin level was 10.80 g/dl (8.78-12.3). None of the patients required blood transfusion. The mean anesthesia duration was 133.30 (95-180) minutes, and the mean operation duration was 107.58 (70-145) minutes. According to the modified scoring system by Trevor et al, excellent results were obtained in 66 hips of 46 patients (71.8%), and good results were obtained in 26 hips (28.2%). Twenty two hips (23.91%), which developed acetabular dysplasia in the follow-up period required a secondary acetabular intervention. According to the Kalamchi and MacEwen classification, Type I avascular necrosis developed in ten hips, Type II in one hip, and Type IV in two hips. One-stage bilateral open reduction using the anterior iliofemoral approach in Tonnis Type III and IV DDH at walking age is a safe, time-saving treatment method that shortens the hospitalization and immobilization periods.Öğe Outcome of open comminuted tibial plateau fractures treated using an external fixator(Elsevier Science Bv, 2007) Subasi, Mehmet; Kapukaya, Ahmet; Arslan, Huseyin; Ozkul, Emin; Cebesoy, OguzBackground. The purpose of this study was to evaluate the outcome of open severe comminuted tibial plateau fractures treated with minimal internal fixation and circular external fixation frames. Methods. Fifteen open comminuted tibial plateau fractures were involved in this retrospective study. In eight knees, the fracture was reduced through an extended open traumatic wound. In seven patients, another limited incision over the major fracture line or area of comminution was performed to assist in reducing the articular reduction. Simultaneous bone grafting, soft tissue reconstruction, and stabilization of the fracture using a circular external fixator were carried out. Results. The patients were followed for an average of 32 months (range 24-54 months). The average time to union of the fractures and frame removal was 22.8 weeks (range 16-44 weeks). The quality of the reduction of the joint surface was rated as anatomical in four patients, good in five patients, fair in three patients, and poor in three patients. Four patients experienced loss of articular reduction. The Knee Society Clinical Rating scores indicated that three knees were excellent, seven were good, one was fair, and four were poor. Complications included one case of septic arthritis, one of osteomyelitis, one of malunion, and four with loss of reduction. Conclusions. This technique provided acceptable results for open severe comminuted fractures of the tibial plateau without comminuted posterior wall fractures. The most significant disadvantage of the technique is insufficient anatomical reduction and loss of reduction in comminuted posterior wall fractures in the coronal plane. This technique should be combined with a minimally invasive internal fixation method to prevent loss of reduction in open severe comminuted and irreducible tibial plateau fractures.
