Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3–14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn’s criteria. Results: The mean time to union was 10.85 ± 3.39 (range of 6–20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.

BACKGROUND:Surgical treatment of acetabular fracture and the anatomic reconstruction of the hip joint are difficult to achieve due to the complex pelvic anatomy, and surgical training requires a prolonged and steep learning curve. The aim of this stu...

Introduction Although closed reduction and percutaneous pinning are the accepted treatment approaches in pediatric humerus supracondylar fractures, the treatment approach in fractures without closed reduction remains unclear. This study compared the results of three different cross-pinning treatment methods. Materials and methods A total of 62 patients (1-13 years old) who were operated for Gartland type 3 humerus supracondylar fractures between 2007 and 2016 were evaluated retrospectively. Of the patients evaluated, 24 patients had closed reduction, 25 patients had direct reduction from the medial, and 13 patients had direct reduction from the lateral and cross-pinning. The functional and cosmetic results of the patients were evaluated according to Flynn's criteria. In addition, the Baumann angle, lateral capitellohumeral angle (LCHA), and postoperative complications were compared among groups. Results Both functional and cosmetic results and the Bauman and LCHA angles were similar in all three groups. In patients with open reduction, the control duration was significantly longer than that in patients with closed reduction, and this difference was due to a recent increase in the surgeons' preference for closed surgery. Two patients underwent pin site infection and two patients developed nerve palsy. Only the first patient who developed ulnar nerve palsy recovered during follow-up. Secondary surgery was applied to the other patient who developed brachial artery occlusion with ulnar and median nerve paralysis, and they recovered during follow-up. Three patients who underwent open surgery from the medial, along with the two patients who had undergone open surgery, developed pinhole infection. These patients were subsequently recovered with antibiotherapy without further complications. A patient who underwent open lateral surgery developed compartment syndrome and fasciotomy was performed. Conclusion Closed reduction and percutaneous pinning are generally accepted approaches in the treatment of pediatric humerus supracondylar type 3 fractures. However, in cases where closed reduction cannot be achieved, pinning with the medial approach and taking the ulnar nerve and medial colon is a reliable method to avoid both ulnar nerve injury and cubitus varus.

Background. Pulmonary embolism is a serious early complication of arthroplasty procedures that can develop after deep venous thrombosis. The present study aimed to compare rivaroxaban and enoxaparin in terms of preventing DV and PE, and also in this study, we compared the complications due to these drugs in patients undergoing elective arthroplasty. Materials and Methods. 214 patients were divided into three groups based on their treatment regimens. In group I, enoxaparin was used, in group II, rivaroxaban was used, and in group III, enoxaparin was used throughout hospitalization, and after hospital discharge, rivaroxaban was used. These three groups were compared according to the occurrence of deep venous thrombosis, pulmonary embolism, and major and minor complications. Results. Major postoperative complications occurred in 5, 15, and 6 patients in group I, II, and III, respectively. Minor postoperative complications occurred in 10, 24, and 11 patients in group I, II, and III, respectively. No significant difference was found among the three groups. Deep venous thrombosis or pulmonary embolism was not observed in any patient. Conclusion. Rivaroxaban was found to be as effective as enoxaparin in the prevention of deep venous thrombosis and other complications after arthroplasty. Moreover, oral rivaroxaban provided greater ease of use compared to subcutaneous enoxaparin. Based on these findings, we consider that rivaroxaban could be an effective alternative to enoxaparin.

Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients' life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients' social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.