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    Coronoid fractures and elbow instability, general review and clinical presentation
    (Springer, 2010) Türker, Mehmet; Derincek, Alihan; Çınar, Murat; Yalçımozan, Mehmet
    Elbow joint has three articulations: (1) ulnatrochlear, (2) radiocapitellar, and (3) radioulnar. The olecranon and coronoid fossa of distal humerus separate medial and lateral columns of the distal humerus. Medial column ends with spool-shaped trochlea, and lateral column ends with spherical capitellum. The irregularity of elbow joint in anatomic means is not an impediment for the joint to be congruent. Congruity of the ulna humeral articulation is the mainstay of the osseous stability and mobility in flexion and extension plane. Fracture dislocation of the elbow is a well-defined injury, but it is difficult to achieve satisfactory good results due to some pitfalls. Coronoid process, radial head and neck or both can be fractured. Treatment decision of uncomplicated elbow fractures depends on the stability after reduction. Understanding the anatomy and the biomechanics of elbow is crucial to diagnose and treat elbow instability. Treatment of fracture dislocation of the elbow is a challenge for the orthopedic surgeon. Here, we emphasized the anatomic and biomechanical knowledge about importance of the recognition, identification, and treatment of coronoid process in restoring the sufficient stability of the elbow to allow early mobilization with an excellent functional outcome.
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    Revision of the failed pedicle screw in osteoporotic lumbar spine: Biomechanical comparison of kyphoplasty versus transpedicular polymethylmethacrylate augmentation
    (Turkish Joint Diseases Foundation, 2012) Derincek, Alihan; Turker, Mehmet; Cinar, Murat; Cetik, Ozgur; Kalaycioglu, Baris
    Objectives: In this study, we aimed to compare of kyphoplasty versus transpedicular polymethylmethacrylate (PMMA) augmentation biomechanically in the revision of the failed pedicle screw in osteoporotic lumbar spine. Materials and methods: Bone mineral density (BMD) of, lumbar vertebrae collected from four bovines were measured., Each vertebra was decalcified with hydrochloric acid solution to obtain osteoporotic specimens. Primary polyaxial pedicle screws, were inserted into the pedicles and pulled out until they failed. The pullout strength results of all specimens were recorded. Revision pedicle screws were randomly inserted into the same pedicles by either pedicle hole PMMA augmented (group 1) or kyphoplasty (Xvoid (TM)) PMMA augmented pedicle screws (group 2). The pullout strength results of all specimens were re-recorded. Results: The mean BMD significantly decreased from 1.686 +/- 227.9 g/cm(2) to 1.432 +/- 157.1 g/cm(2) following decalcification (p<0.001). In group 1, the mean pullout strength of primary screws significantly decreased from 3443 +/- 1086 N/m(2) to 2088 +/- 924 N/m(2) following pedicle screw augmentation (p=0.006). In group 2 the mean pullout strength of primary screws decreased from 3702 +/- 1063 N/m(2) to 3664 +/- 1057N/m(2) following kyphoplasty augmentation (p=0.934). Pedicle screw augmentation group achieved significantly lower pullout strength values than kyphoplasty pedicle hole augmentation group (p=0.002). Conclusion: Although pedicle hole PMMA augmentation is the gold standard for the failed screws in an osteoporotic bone, kyphoplasty augmented pedicle screw seems to be more effective method increasing the pullout strength.