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KESİMER, MEHMET DENİZ

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KESİMER

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MEHMET DENİZ

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Author: AKGÜLLE, AHMET HAMDİ ×

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    PublicationOpen Access
    Effect of rotational deformities after pediatric femoral fracture on clinical outcome
    (2022-03-01) AKGÜLLE, AHMET HAMDİ; KESİMER, MEHMET DENİZ; Igrek S., AKGÜLLE A. H., KESİMER M. D.
    Femoral shaft fractures are the most common pediatric injuries that require hospitalization. Early closed reduction and spica casting are one of the most popular treatment options. One of the significant complications of spica casting is rotational deformities of the fracture. The present study aimed to determine the potential effects of rotational deformities in pediatric patients who underwent early spica casting after a femoral shaft fracture. Pediatric patients who underwent early spica casting following femoral shaft fractures were screened retrospectively. Radiological measurements were made on the patients\" initial postop radiographs who could be measured rotationally according to the defined radiological method. Twenty-three patients with more than 10 degrees of rotation in their measurements were included in the study. Differences in leg length and rotation between both legs were calculated with clinical examination methods for all patients in the study. The gaits of the patients were observed; patient and family complaints were obtained. We found a strong and positive correlation between the rotational measurement made on the X-ray and the clinical measurement (R: 0.634, P: 0.001). For measurements made on X-ray, the mean rotational value was calculated as 27.2 +/- 6.9 degrees. After the patients\" clinical examination, an average of 3.0 +/- 1.7 degrees rotational difference was found between the broken limb and the healthy limb. No patient or family complained of trauma. Early spica casting, according to the age of the patient, is an effective treatment method. There may still be certain degrees of deformity after treatment, but patients well tolerate them even at high degrees. Accordingly, it was concluded that the rotational deformities less than 30 degrees would not cause clinical problems on children under 4 years of age which may require postoperative revisions or the use of various costly imaging techniques and include radiation.
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    Dorsal or Lateral Approach for Intramedullary Nailing Using Kirschner Wire in Pediatric Radius Diaphyseal Fractures: Does it really matter?
    (SPRINGER HEIDELBERG, 2021) AKGÜLLE, AHMET HAMDİ; Akgulle, Ahmet Hamdi; Onay, Tolga; Igrek, Servet; Kesimer, Mehmet Deniz; Topkar, Osman Mert; Sirin, Evrim
    Background Intramedullary nailing is the most preferred fixation method for diaphyseal radius and ulna fractures in the young age group. The aim of this study was to compare the dorsal and lateral entry points in the context of entry site-related complications, fracture union and functional results. Methods This retrospective comparative study included pediatric patients who underwent surgery for isolated diaphyseal radius or both bone forearm fractures with intramedullary nailing using Kirschner wire between January 2013 and January 2019. K-wire was introduced from the distal radius through dorsal entry (Group A) in 19 patients and lateral entry (Group B) in 18 patients. The mean follow-up was 37 months. Complications were noted and functional outcomes were evaluated according to the CHOP criteria. Results All fractures were healed. The functional results were determined to be excellent for 30, fair for 4, and poor for 3 patients. The overall complication rate was 18.9%, including distal radius fracture, mild pain in the wrist, and minor loss in ROM. No statistically significant differences were determined between the groups in respect of functional results and complication rates. Conclusion Good functional results and similar complication rates can be obtained with both dorsal and lateral entry approaches. Stainless steel K-wire is an inexpensive intramedullary fixation implant option, which provides strong stabilization. Distal radius fracture is a newly reported complication for forearm intramedullary nailing. Leaving the implant out of the skin seems safe with the benefit of avoiding a further surgical intervention to extract the implant.