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    Intracompartmental pressure changes after anterolateral bridge plating of tibial fractures
    (Turkish Assoc Orthopaedics Traumatology, 2016) Daglar, Bulent; Delialioglu, Onder Murat; Bayrakci, Kenan; Tezel, Kerem; Gunel, Ugur; Ceyhan, Erman
    Objective: Compartment syndrome is one of the most devastating complications in orthopedics both for the patient and the treating physician. Among the many causes, trauma and its treatment are the most common reasons for compartment syndrome, which most frequently occurs in the lower leg following tibial fractures. Since bridge plating of difficult metadiaphyseal tibial fractures is becoming increasingly popular, serious concerns have been raised about the increased intracompartmental pressures and possible compartment syndrome. Methods: This study investigated the intracompartmental pressure changes in anterolateral compartment of the leg during and immediately after anterolateral bridge plating of tibial fractures. Intracompartmental pressures were measured before and during plate application, just after the completion of fixation, and immediately and 4-5 min after the tourniquet release in 22 isolated closed comminuted tibial fractures. Results: Baseline anterolateral compartment pressures were higher than those on the uninjured side (9.3 vs 27.8 mmHg). Pressures were 69.5, 57.4, 65.8, and 56.8 mmHg, respectively, for the other measurements times. None of the patients received prophylactic fasciotomy, and none developed clinical compartment syndrome. Conclusion: We found that anterolateral compartmental pressures were higher than pressures on the uninjured side in all patients. Although there is a considerable increase in intracompartmental pressures during and immediately after anterolateral percutaneous bridge plating of comminuted tibial fractures, intraoperative prophylactic fasciotomy is not routinely needed. One should monitor the patients on the first postoperative day for signs of compartment syndrome. Fasciotomy decisions should be based on both clinical symptoms and serial intracompartmental pressure measurements rather than a single measurement.
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    Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach
    (Lippincott Williams & Wilkins, 2019) Serbest, Sancar; Tiftikci, Ugur; Coban, Mehmet; Cirpar, Meric; Daglar, Bulent
    Objectives: To evaluate the effects of intramedullar nailing of the tibia using a suprapatellar (SP) approach with respect to pain and function of the knee. Design: Prospective clinical investigation. Setting: Academic level I trauma center. Patients/Participants: Twenty-one patients with tibial shaft fractures (Orthopaedic Trauma Association 42A-B-C) with a minimum of 12-month follow-up. Intervention: Locked intramedullary nailing using a SP approach. Main Outcome Measurements: Radiographic evaluation for nail position proximally, tibial shaft alignment and union, anterior knee pain using the visual analog scale, and knee function evaluation using the Lysholm and SF-36 scores. Examination of intra-articular damage was performed using intraoperative patellofemoral arthroscopy before and after nail insertion. Results: The mean age of the patients was 35.4 +/- 12.4 years (range, 18-63 years), and the mean follow-up period was 15.+/- 2 6 3.2 months (range, 12-21 months). The visual analog scale score for anterior knee pain was a mean of 1.0 +/- 1.3 (range, 0-4). The SF-36 physical score was mean 45.1 +/- 9, and the SF-36 mental score was a mean of 51.7 +/- 9.9. The knee joint range of movement was measured as 133.1 +/- 87 degrees on the affected extremity side and 134.05 +/- 8.4 degrees on the unaffected side. The mean Lysholm knee score was 95.7 +/- 6 4. No intra-articular pathology was seen on arthroscopy after nail insertion. Conclusions: The SP approach for intramedullar nailing for tibial shaft fractures was not associated with either anterior knee pain or functional limitations of the knee in our series.
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    Rafting technique without bone grafting in reverse Hill-Sachs lesions
    (Turkish Joint Diseases Foundation, 2017) Cirpar, Meric; Oktas, Birhan; Daglar, Bulent
    In this article, we report a case of bilateral posterior shoulder instability, having reverse Hill-Sachs lesions of 25 to 50% of the articular surface on the right side, and of 50% on the left side. The defects were anatomically reconstructed after tuberculum minus osteotomy by elevation of the articular surface and buttressing with raft screws without graft usage. Early rehabilitation with pendulum shoulder exercises was started at third postoperative day. At postoperative sixth week, patient had full range of motion without instability and pain. At postoperative 18th month, the patient had normal physical examination and the constant shoulder score was 86, which was 92.4% of the age-and gender-matched population. Rafting technique without bone grafting may be a treatment alternative with satisfactory clinical results for medium to large sized reverse Hill-Sachs lesions of posterior shoulder instability.
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    Results of Tonnis-type acetabuloplasty in patients with developmental hip dysplasia
    (Elsevier Science Bv, 2012) Gunel, Ugur; Daglar, Bulent; Tasbas, Bulent A.; Delialioglu, Onder; Bayrakci, Kenan
    The aim of this prospective study was to evaluate the outcome of open reduction and Tonnis acetabuloplasty as the first method of treating developmental dysplasia of the hip (DDH) in children in early childhood at walking age. Between 2005 and 2009, 34 hips of 34 children were operated on with the aforementioned method. Mean age was 25.6 (range 12-44) months, and mean follow-up was 3.6 years. During the follow-up period ,the hips were evaluated using the acetabular index and for development of avascular necrosis and redislocation. Functional evaluation was also conducted. Clinically, 97.3 % of patients had excellent and good results. The acetabular angle decreased from 45A degrees preoperatively to 21A degrees early postoperatively and at the last follow-up had improved to 18A degrees. In two hips, type 2 avascular necrosis developed. Hip instability was not observed, and no additional surgery was performed. Tonnis acetabuloplasty is a powerful tool to increase primary stability of the hip when acetabular coverage is inadequate in DDH. Besides its acute correction ability, when performed properly, it has no unwanted effects on acetabular growth. As an isolated procedure or as a part of combined open reduction and/or femoral osteotomy, Tonnis type acetabuloplasty is a safe and effective method.