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    Deformity correction by Ilizarov distraction osteogenesis after distal radius physeal arrest
    (TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2011) Gundes, Hakan; Buluc, Levent; Sahin, Mustafa; Alici, Tugrul
    Objective: The aim of this study was to evaluate the results of osteotomy and distraction osteogenesis using Ilizarov circular external fixator to treat radial shortening and severe wrist deformity due to neglected post-traumatic distal radius physeal arrest. Methods: The study retrospectively reviewed 4 patients (4 males; average age: 16 years; range: 14 to 19 years) who underwent osteotomy and distraction osteogenesis to treat radial shortening and severe wrist deformity due to neglected distal radius physeal arrest. Mean interval between trauma and surgical intervention was 8 (range: 4 to 12) years and mean follow-up time was 83 (range: 40 to 126) months. Patients were evaluated with radiographic measurements (shortening and lengthening ratio, radioulnar joint leveling, distal radioulnar joint congruency), objective functional measurements (grip and pinch strength, range of motion measurements [ROM]) and subjective functional measurements (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire and Mayo wrist score). Statistical analysis was made using the Mann-Whitney U non-parametric test. Results: Radiographic measurements were obtained preoperatively and at the final follow-up. The mean shortening ratio of the radius was 14.6% (range: 9.3% to 18.7%) and mean lengthening ratio was 15.9% (range: 13.2% to 18.3%). Normal distal radioulnar joint leveling and distal radioulnar congruency resembling a joint was established in all but one patient with four millimeters of ulna plus deformity. According to the Mann-Whitney U non-parametric test, there was no statistical difference in grip and pinch power, ROM on flexion/extension, and ulnar/radial deviation axis between the operated and non-operated sides. There was statistically significant pronation/supination restriction between the operated and non-operated sides (p<0.04). Mean DASH score was 2.07 (range: 0.0 to 8.3) and the mean Mayo wrist score was 89 (range: 75 to 100) points. According to the Mayo wrist score, results were excellent in one patient, good in two patients, and satisfactory in one patient. Conclusion: The use of distal metaphyseal osteotomy and Ilizarov distraction osteogenesis is a viable treatment method for neglected physeal fractures of the distal radius as it establishes acceptable deformity correction and a functional wrist joint.
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    The use of combined lateral and medial releases in the treatment of post-traumatic contracture of the elbow
    (SPRINGER, 2007) Tosun, Bilgehan; Gundes, Hakan; Buluc, Levent; Sarlak, Ahmet Y.
    Elbow stiffness is a common disorder, which restricts daily activities. Between 30 degrees and 130 degrees of elbow movement is usually enough to perform most daily activities. However, a 10 degrees to 15 degrees loss of elbow extension may be a problem when the patient is an athlete. From 1996 to 2004, 20 elbows of 20 patients (who were available for follow-up examination) were treated by lateral and medial release at Kocaeli University, for post-traumatic elbow contracture. Preoperative and the postoperative 12-month follow-up measurements were performed. The mean preoperative arc of motion was 35 degrees and this value improved to 86.2 degrees. The maximum improvement at the arc of motion was 105 degrees. In an effort to understand the pathophysiology of the condition, surgical approaches may be used safely. The purpose of this study was to assess the functional outcome of the elbow joint after using a combination of lateral and medial approaches to treat elbow stiffness.