Abstract Arthroscopic treatment in gonarthrosis Gonarthrosis is a progressive degenerative disease of the knee joint and treated at the early phases conservatively. Surgery is applied when conservative measures are not effective. ln Iast years, arthroscopic treatment modalities have been used in cases with degenerative joint disorders which are not so serious that need total knee arthroplasties. With this purpose, between January 1990 and January 1995, arthroscopic debridement, abrasion arthroplasty and abrasion arthroplasty plus drilling were applied in 447. cases. Mean age was 56 years (range 30 to 80 years) and average follow-up was 38.7 months (range 12.5 to 62 months). The patients were evaluated according to The Hospital for Special Surgery Knee Scoring System. ln the group of abrasion arthroplasty; 51% excellent and good, 14% fair and 35% poor results, in the group of arthroscopic debridement; 68% excellent and good, 11% fair and 21% poor results were obtained. Although the results of Iong period follow-up are not known, arthroscopic treatment in gonarthrosis with satisfactory preliminary results have been used with increasing popularity. Özet Gonartroz diz ekleminin ilerleyici bir dejeneratif hastalığıdır ve erken dönemlerinde tedavisi konservatiftir. Konservatif tedaviye cevap vermeyen durumlarda cerrahi tedavi gündeme gelir. Total diz artroplastisi gerektirecek derecede ciddi eklem bozukluğu olmayan olgularda son yıllarda artroskopik tedaviler kullanılmaya başlanmıştır. Bu amaçla kliniğimizde Ocak 1990-Ocak 1995 tarihleri arasında 447 olguda artroskopik debridman, abrazyon artroplastisi, abrazyon artroplastisi+drilleme yöntemlerini uyguladık. En genç 30 ve en yaşlı 80 olmak üzere 56 yaş ortalamasına sahip olan vakalarımızın, ortalama takip süresi (en erken 12.5 ay ve en geç 62 ay) 38.7 ay idi. Klinik sonuçları The Hospital for Special Surgery Knee Scoring System e göre değerlendirdiğimizde; abrazyon artroplastisi grubunda, %51 çok iyi ve iyi %14 orta ve %35 kötü sonuç; artroskopik debridman grubunda ise %68 çok iyi ve iyi %11 orta ve %21 kötü sonuç elde edildi. Gonartrozda artroskopik tedavi uzun süreli takip sonuçları henüz bilinmemekle birlikte kısa dönemdeki tatminkar sonuçlar nedeniyle günümüzde giderek popülarite kazanmaktadır.

PURPOSE OF THE STUDY The aim of this study was to investigate the culture results of children undergoing debridement for suspected septic arthritis or acute osteomyelitis and to compare the laboratory parameters and clinical characteristics of culture-positive and culture-negative patients. MATERIAL AND METHODS Patients who underwent surgery in our hospital for septic arthritis and acute osteomyelitis between 2011 and 2019 were retrospectively analyzed. Seventy-two of 96 patients were included in the study. The patients had documented joint swelling, redness, pain with joint movement and weight-bearing failure. Fever was assessed preoperatively. Sedimentation rate, C-reactive protein level, white blood cell count and the leukocyte count in aspiration material as well as complications were evaluated preoperatively and 3 months postoperatively. RESULTS Twenty patients underwent surgery of the hip; 39 of the knee; 7 of the foot, ankle and distal tibia; 1 of the elbow; and 1 of the distal radius. Additionally, 4 patients had septic arthritis and acute osteomyelitis of the femur. The mean age of the patients was 7.8 years (1-16). The mean follow-up period was 16.2 months (3-42). Preoperative aspiration was performed in 44 of 72 patients. Thirty of 72 patients had positive cultures. No statistically significant difference in age, preoperative duration, C-reactive protein, sedimentation, white blood cell count, preoperative fever or complications was found when compared between patients with culture growth and those without reproduction (p > 0.05). There was a significant difference between the leukocyte count in the aspiration material (p < 0.05). CONCLUSIONS Prediagnosis of septic arthritis or acute osteomyelitis in pediatric patients is important in terms of future joint health and sepsis. According to our findings an inability to obtain bacteria does not exclude septic arthritis as a diagnosis. Empirical antibiotic therapy with a wide postoperative spectrum is important for joint health in these patients. Preoperative serum parameters cannot predict the agent needed for treatment. Key words: septic arthritis, osteomyelitis, pediatric septic arthritis, pediatric joint infection, pediatric infection.

Abstract Vascular insufficiency and ischemic gangrene of the extremity is a rare, but serious complication seen in newborns. We present a newborn who developed ischemic gangrene of the left lower extremity due to prematurity, umbilical artery catheterization and septicemia, requiring a below knee amputation. Inadequate initial management, parental neglect and delayed diagnosis were other contributing factors for the undesirable outcome. Recognition of predisposing factors and identification of the high risk neonates are the major prerequisites for either appropriate measures or a successful outcome. In case of failure despite all supportive measures and proper management, amputation should be delayed until a clear demarcation has occurred. During surgery, the adjacent proximal physis should be preserved. Özet Arteryel kanlanmanın yetersizliği sonucunda ekstremitenin iskemik kangreni yenidoğanlarda nadir görülen ancak ciddi bir komplikasyondur. Erken doğum ve umbilikal arter kateterizasyonu sonrasında yenidoğan bir kız çocuğun sol alt ekstremitesinde gelişen iskemik kangren diz altı amputasyonla tedavi edildi. Erken dönemdeki tanı ve tedavi yaklaşımının yetersizliği, aile bireylerinin ihmali ve geç tanı gibi etkenler de kötü sonuca katkıda bulunmuştur. Predispozan etkenlerin bilinmesi ve yüksek risk içeren yenidoğanların belirlenmesi önlemlerin alınabilmesi ya da tedavinin iyi sonuçlanması için önkoşuldur. Uygun yaklaşım ve destek tedavisine karşın başarısız kalındığında, amputasyon olabildiğince ve temiz bir demarkasyon hattı belirene kadar geciktirilmeli; cerrahide proksimal fiz korunmalıdır.

The phase change behavior of vanadium dioxide (VO2) has been widely explored in a variety of optical and photonic applications. Commonly, its optical parameters have been studied in two extreme regimes: hot (metallic) and cold (insulating) states. However, in the transition temperatures, VO(2)acts like an inherent metamaterial with mixed metallic-insulating character. In this range, the portions of metallic and insulating inclusions are tuned by temperature, and therefore a gradual change of optical parameters can be achieved. In this paper, a universal hybrid modeling approach is developed to model VO(2)in the intermediate region. For this aim, the measured reflectivity data, is analyzed and matched through the transfer matrix method (TMM) simulations where an effective medium theory (EMT) is employed. Based on the findings of this approach, not only the relative portions of inclusions are tailored but also their grain shapes are significantly altered in the transition range. Finally, the modeling approach is testified by experimental findings through dynamic device applications operating at short and mid infrared wavelengths. In addition, the hysteretic behaviors on electrical, optical, and structural parameters of the VO(2)film along the heating and cooling cycles are demonstrated by the experiments and scrutinized by the simulations.

PURPOSE OF THE STUDY The prevalence of complications in surgical units is available in the literature. The aim of this study was to compare the "rotational" (more than one surgeon) and "full-time single surgeon" use of the orthopedic theater. MATERIAL AND METHODS We retrospectively evaluated patients who underwent orthopedic surgery in 2016 in different theaters. A total of 604 of 1973 patients were excluded from the study, and 1369 patients were analyzed. The follow-up period was 1 year. While evaluating the cases, the duration and order of each case, the total operation time on the table, the number of surgeons, the total number of cases, the number of residents, and the experiences of the surgeons were investigated, and the effects of these parameters on the complication rates were analyzed. The Dindo-Clavien system was used to classify the complications. RESULTS When comparing the methods, the complication rate of the full-time single-surgeon method (12.9%) was less than that of the rotational method (21.7%) (p: 0.022). A higher rate of complications (8.5%) was observed in operations with a duration of 115 minutes or more compared to other operations (p <0.001). A higher complication rate (23.7%) was observed in cases lasting more than 345 minutes (p = 0.002). CONCLUSIONS According to our study, full-time use of the orthopedic theater by a single surgeon was found to be safer than rotational use. In addition, the duration of surgeries lasting longer than 115 minutes or longer than 345 minutes during the day increased the rate of surgical complications.

Giriş: Bu çalışmamızda, kübital tünel sendromu (KTS) tanısı ile in situ ulnar sinir dekompresyonu yapılan hastaların fonksiyonel sonuçlarını değerlendirdik. Gereç ve Yöntem: Ocak 2006 ile Aralık 2010 tarihleri arasında 43 hastadan yeterli takibi yapılan ve çağrıya cevap veren 32 hasta geriye dönük olarak değerlendirildi. Hastaların ameliyat öncesi klinik durumları McGowan derecelendirme sistemine göre ve ameliyat sonrası durumları ise Wilson & Krout derecelendirme sistemine göre belirlendi. Çalışmaya muayene ve elektromiyelografiyle (EMG) kübital tünel sendromu tanısı konulan, en az 6 ay konservatif olarak tedaviye cevap vermeyen, in situ dekompresyon prosedürü uygulanan, daha önce kübital tünel sendromu nedeniyle ameliyat edilmeyen hastalar dahil edildi. Bulgular: Ameliyat öncesi 24 hastada evre 2, 8 hastada evre 3 nöropati mevcuttu. Ameliyat sonrası 22 hastada mükemmel, 7 hastada iyi, 2 hastada makul, 1 hastada kötü sonuç elde edildi. Kötü sonuç elde edilen tek hastanın ameliyat öncesi evre 3 nöropatisi mevcuttu. Şikayetlerinin tekrarlaması sebebiyle hiçbir hastaya tekrar cerrahi tedavi uygulanmadı. Tartışma Sonuçlar: Kübital tünel sendromunda in situ dekompresyon ulnar sinir bütünlüğü korunmuş ve ulnar sinir subluksasyonu görülmeyen olgularda düşük komplikasyon oranlarıyla etkili, basit, güvenilir bir yöntemdir.

Oxidized zirconium (OxiniumTM; Smith& Nephew, Memphis, TN, USA) articulated with polyethylene in total hip arthroplasty (THA) appeared to have the potential to reduce wear dramatically. The thermally oxidized metal zirconium surface is transformed into ceramic-like hard surface that is resistant to abrasion. The exposure of soft zirconium metal under hard coverage surface after the damage of oxidized zirconium femoral head has been described. It occurred following joint dislocation or in situ succeeding disengagement of polyethylene liner. We reported three cases of misuse of OxiniumTM (Smith and Nephew, Memphis, TN, USA) heads. These three cases resulted in catastrophic in situ wear and inevitable failure. Although there was no advice, indication nor recommendation for this use from the manufacturer.

Oxidized zirconium (Oxinium™; Smith & Nephew, Memphis, TN, USA) articulated with polyethylene in total hip arthroplasty (THA) appeared to have the potential to reduce wear dramatically. The thermally oxidized metal zirconium surface is transformed into ceramic-like hard surface that is resistant to abrasion. The exposure of soft zirconium metal under hard coverage surface after the damage of oxidized zirconium femoral head has been described. It occurred following joint dislocation or in situ succeeding disengagement of polyethylene liner. We reported three cases of misuse of Oxinium™ (Smith & Nephew, Memphis, TN, USA) heads. These three cases resulted in catastrophic in situ wear and inevitable failure although there was no advice, indication or recommendation for this use from the manufacturer.

Amaç: Pelvis kırıkları, yüksek enerjili künt travmalar sonucu oluşur ve yüksek mortaliteyle seyreder.Bu yazıda, künt travmaya bağlı pelvis kırıklarında

Humeral capitellum fractures comprise approximately 1% of all elbow fractures. In this study, we examined the clinical, radiographic, and functional outcomes following operative stabilization of Bryan and Morrey type IV fractures of the capitellum in adolescents. We applied headless cannulated screws in a posteroanterior direction without damaging the articular cartilage surface of the fractures.

Seymour’s fracture is an extra-articular, transverse, physeal, and juxta-epiphyseal open fracture of the distal phalanx seen in childhood. In this study, we present 10 adult cases of fractures localized to the metaphyseal region, 1–2 mm distal to the insertion of the extensor tendon. Mean age was 38 years. Four patients were treated conservatively with a mallet finger splint. Closed reduction and osteosynthesis with Kirschner wires (K-wires) was performed in three of the patients. Three of the patients had open fractures in whom closed reduction could not be performed. They underwent open reduction and osteosynthesis with K-wires. We recommend that extra-articular distal phalanx fractures mimicking mallet finger in adults are called Seymour-type fracture to establish a common language among clinicians to define this type of fracture. These fractures generally occur by hyperflexion of the distal phalanx and can be treated by conservative or surgical methods. The outcomes of conservative and surgical management of Seymour-type fractures depend on the appropriate reduction as well as efficient physical therapy.

Introduction: The treatment goal for diaphyseal single and both bone fractures in adults is to restoration of bone length, provide axial and rotational stability, and to secure fixation that allows early mobilization. Intramedullary (iM) nails are not routinely used in the surgical treatment of forearm fractures. However, this trend has started to change with the newly designed interlocking iM nails. We evaluated a new iM nails for treating forearm diaphyseal fractures in adults. Materials and Methods: We retrospectively reviewed adults with single and both bone fractures, who were treated with a new iM radius and ulna nails between May 2008 and May 2011 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. The results were evaluated according to Grace–Eversmann and DASH scores. Results: The 61 enrolled patients (mean age, 37 years; 32 men) had 83 forearm fractures: 23 isolated radius fractures, 18 isolated ulna fractures (2 bilateral), and 40 fractures of both the radius and ulna. Mean time to fracture union was 13 weeks (range, 10 to 14 weeks) for ulnar fractures and 12 weeks (range, 10 to 13 weeks) for radial fractures. No patient had non-union, deep infections, or radioulnar synostosis. Followup ranged from12 to 38months. Grace–Eversmann ratingswere excellent in 53 patients, good in 5,medium in 2 and poor in 1. Mean DASH score was 6.5 points (range, 0 to 13.3). Conclusion: The new intramedullary nail systemsmay be considered as a good alternative to both classical intramedullary nails and plate osteosynthesis in adult forearm diaphyseal fractures. The advantages are short operative time, insertion by closed and minimal invasive techniques mostly, the use of a minimally scope, smaller operative scar and sufficient stability in all planes that allows early motion without additional support. T1.2 Acromioclavicular reconstruction using hook plate and anterior tibial tendon allograft with triple tunnel: can it be considered as an alternative surgical technique? A. Deveci1, A. Firat2, S. Yilmaz1, K.O. Unal1, H.I. Acar3, A.O. Yildirim1, M. Bozkurt4. 1Ankara Numune Education and Research Hospital, 2Ankara Kecioren Education and Research Hospital, 3Ankara University Department of Anatomy, 4Ankara Ataturk Education and Research Hospital, Ankara, Turkey

OBJECTIVE The aim of this study was to analyze the diagnostic and therapeutic challenges during the removal of foreign bodies in extremities, and to provide relevant tips and tricks. METHODS The medical records of 295 patients (150 men, 145 women; mean 26.82 ± 16.84 years; range: 3 to 79 years) who underwent foreign body removal from their limbs between February 2005 and July 2011, were retrospectively reviewed. Side of the extremity, foreign body type, location, complaints, imaging technique, the season of injury, the effects of foreign body in the body, the time between injury and extraction, indication for extraction, type of anesthesia, the use of fluoroscopy during the surgical procedure, and complications of surgical intervention were analyzed. RESULTS The injury was in the right limb in 157 patients and in the left limb in 138 patients. Foreign bodies were in the elbow in 4 cases, in the forearm in 6, in the wrist in 6, in the hand in 75, in the hip in 1, in the thigh in 7, around the knee joint in 11, in the knee joint in 6, in the lower leg in 10, in the ankle in 8, and in the foot sole in 161. The season of injury was summer in 148 cases, winter in 107, spring in 35, and autumn in 5. The removed foreign bodies were needles in 216 cases, metallic objects in 33, pieces of glasses in 28, pieces of wood in 10, pieces of plastic in 4, and pieces of stone in 4. The time between the injury and foreign body removal was 1 day in 135 cases, 2 to 10 days in 114, 11 to 30 days in 22, and 30 to 365 days in 13. The removal time was longer than 1 year such in 11 cases. CONCLUSION Foreign body injuries may result in serious complications such as infection, migration and joint stiffness. A throughout history and physical and radiological examinations are of tremendous importance to achieve the best outcome in these patients.