Single-stage medial open reduction and Pemberton acetabuloplasty in developmental dysplasia of the hip.

In this study, we aimed to evaluate the long-term clinical and radiological results of single-stage open reduction through a medial approach and Pemberton acetabuloplasty in developmental dysplasia of the hip. We treated 32 hips (22 patients) with developmental dysplasia by a single-stage open reduction through Ferguson's medial approach and Pemberton acetabuloplasty. The procedure was performed bilaterally in 10 patients. The mean age of the patients at the time of the operation was 19.8 months (16-24 months). The mean follow-up period was 10.9 years (7-19 years). Group I avascular necrosis according to the Kalamchi and MacEwen classification was observed in two hips and group II in one hip. Radiologically, 90.6% of the hips were classified as Severin class I and 9.4% of the hips were classified as Severin class II. At the latest follow-up, 30 hips were assessed clinically as excellent and two hips as good. No patient required subsequent surgery. We conclude that single-stage medial open reduction and Pemberton acetabuloplasty represent an effective method for developmental dysplasia of the hip in children older than 15 months of age.

Metal-on-metal dysplasia cup total hip arthroplasty for hip osteoarthritis secondary to developmental dysplasia of the hip.

OBJECTIVES: This study aims to evaluate the clinical and radiological results of metal-on-metal dysplasia cup total hip arthroplasty (THA) for hip osteoarthritis secondary to developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: Between May 2009 and October 2011, THA was performed on 27 hips (7 Crowe type II, 9 Crowe type III, 11 Crowe type IV) of 22 patients (2 males, 20 females; mean age 43 years; range 25 to 63 years) with hip osteoarthritis secondary to DDH. All patients were evaluated clinically and radiographically. RESULTS: Average follow-up period was 34.2 months (range 24-53 months). While mean Harris hip score (HHS) was 43 (range 30 to 72 points) preoperatively, it was 92 (range 87 to 98 points) at final follow-up. Two patients developed sciatic nerve palsy postoperatively. Recurrent dislocation occurred in one patient one year after the operation. Mean cup inclination was 45.6° (range 42°-51°). Heterotopic ossification developed in eight patients. No patient's acetabular and femoral component migrated or subsided significantly. None of the implants was revised. CONCLUSION: Early clinical and radiological results of metal-on-metal dysplasia cup THA in DDH are satisfactory.

Bilateral femoral neck insufficiency fractures in pregnancy.

Bilateral femoral neck insufficiency fracture due to osteomalacia in pregnancy is an extremely rare condition. In this article, we report a 22-year-old female case with bilateral femoral neck fractures in whom the diagnosis was delayed due to the avoidance of ionising radiation and managing hip complaints by conservatively in pregnancy. She was treated surgically with internal fixation using cannulated screws and received medical treatment for vitamin D deficiency.

[Chondroblastoma in the anterior cruciate ligament origo: a case report]. / Ön çapraz bag yapisma yerinde kondroblastom: Olgu sunumu.

Chondroblastoma is a rarely seen cartilage originated tumor. It is mostly localized in the epiphysis of long bones. In this article, we present an 18-year-old male case in whom the tumor was located in the right distal femoral lateral condyle and destroyed anterior cruciate ligament origo. The tumor was curetted and the cavity was filled with cement. Anterior cruciate ligament resection was mandatory for this treatment. The patient had no complaint in the postoperative period.

[The long-term results of brace treatment in Perthes disease]. / Perthes hastaliginda cihaz tedavisinin uzun dönem sonuçlari

OBJECTIVES: We evaluated the long-term radiological outcomes of the patients with Perthes disease who were conservatively treated with brace. PATIENTS AND METHODS: Thirty-three hips of 27 skeletally mature patients (21 males, 6 females; mean age 25.2±3.4 years; range 20 to 32 years) treated with modified Thomas splint were included in this study. The results were evaluated according to the Stulberg classification. RESULTS: The mean age of the patients was 6.3±2.2 (range 3-12) years at the onset of the disease and the mean follow-up was 18.6±3.2 (range 7.2-24.1) years. According to onset of the disease, good results were obtained for the patients who were less than six-years-old as 77.7%, between 6-9 years old as 84.2%, after nine years old as 40%. However, 100% of the Herring group A hips, 79.2% of the group B hips and 50% of the group C hips were healed with Stulberg class I or II results. CONCLUSION: We obtained satisfactory results after conservative treatment with Thomas splint in patients who were between 6-9 years old at onset of the disease with Herring group B involvement. It is hard to say whether the good results were stemmed from having good prognosis of these patients, or stemmed from positive effect of using brace on treatment.

Treatment of capitellar osteochondritis dissecans with a tendon graft: a case report.

A 14-year-old girl who was engaged in farming was admitted with the complaints of right elbow pain and limited range of motion in the elbow joint. Plain radiograph revealed capitellar osteochondritis dissecans. After the loose fragment was removed from the capitellum and the defect was curetted, a palmaris longus tendon graft harvested from the same hand was implanted into the capitellar defect. Elbow joint was immobilized for three weeks. Magnetic resonance imaging showed that tendon graft was successfully adapted into defect. The range of motion was preserved and she had no pain in the elbow joint. In conclusion, we suggest that tendon autograft can be used in the treatment of capitellar osteochondritis dissecans.

Comparison between conservative and surgical treatment in Perthes disease.

INTRODUCTION: The purpose of this study was to compare the results of conservative and surgical treatment in a homogeneous group constituted by patients between 6 and 8 years of age at onset of the Perthes disease with Herring B involvement. METHODS: Twenty-seven hips of 25 patients were evaluated radiologically and clinically. Patients were divided into two groups in terms of treatment type. In group I [16 hips of 14 patients], hips were treated conservatively using Thomas splints. The mean follow-up period was 21.5 (10-25) years. In group II [11 patients], hips were treated surgically using femoral osteotomy. The mean follow-up period was 14.3 (8-20) years. RESULTS: There was no statistically significant difference between the groups in terms of Stulberg classification, but surgically treated patients had more varus angle, more shortening, and more trochanteric overgrowth compared with the braced group. CONCLUSION: Non-surgical treatment with a brace is a reliable alternative to surgical treatment in Perthes disease between 6 and 8 years of age at onset with Herring B involvement. However, we could not know whether the good results were influenced by the brace or stemmed from having good prognosis of these patients.

[Effects of human amniotic fluid on posterolateral spinal fusion: an experimental preliminary study]. / Insan amniyon sivisinin posterolateral spinal füzyon üzerindeki etkileri: Deneysel bir ön çalisma.

OBJECTIVES: In this study, the effects of human amniotic fluid on posterolateral spinal fusion were investigated in a rat model. MATERIALS AND METHODS: Twenty-eight 20-week-old male Sprague Dawley rats were included in the study. The subjects were divided into two main groups as the control group and the amniotic fluid group. Posterolateral spinal fusion was performed by using autografts in all groups whereas 0.3 ml of centrifuged human amniotic fluid was added to the fusion area in amniotic fluid groups. Groups were further divided into subgroups each including seven rats and evaluated radiologically and histologically at the third and sixth weeks. RESULTS: The radiological fusion observed in the amniotic fluid group was significant at the sixth week when compared to that in the control group. The histological fusion quality was significant in the amniotic fluid groups both at the third and sixth weeks when compared to the control groups. CONCLUSION: We conclude that human amniotic fluid enhances posterolateral spinal fusion. We believe that the growth factors and hyaluronic acid present in the amniotic fluid played a role in this result.

Radiological evaluation of combined valgus extension osteotomy and tectoplasty for the treatment of Herring group C Perthes patients.

OBJECTIVES: In this study we evaluated the results of combined proximal femoral valgus extension osteotomy and tectoplasty in the treatment of Herring group C Perthes disease with hinge abduction. PATIENTS AND METHODS: This study was carried out in 11 male patients who underwent combined proximal femoral valgus extension osteotomy and tectoplasty for hinge abduction related to Perthes disease between January 2002 and February 2009. All patients were assessed as group C according to the Herring lateral pillar classification. The mean age at the time of surgery was nine years and one month with an age range of six years to 11 years and two months. All patients had pain and hinge abduction preoperatively. RESULTS: The mean follow-up was 65 months (range 26 to 111 months). In the patients who received a proximal valgus extension osteotomy and tectoplasty, the postoperative femoral head containment was significantly increased radiographically. The postoperative femoral head containment was evaluated on radiographs which were taken one and three months after the surgery. After healing of the osteotomy, one-year and final control graphies were evaluated. We carried out a comprehensive evaluation of preoperative and postoperative radiographs that included measuring; subluxation ratio, femoral head coverage ratio, femoral head size ratio, Sharp's angle, CE (center-edge) angle, neck-shaft angle, caput index and acetabular depth index. Consequently there were significant radiographic healing and improvements from time of initial follow-up to final follow-up. CONCLUSION: This study has shown that, in the short-term, combined valgus extension osteotomy and tectoplasty relived pain and corrected deformity in patients with hinge abduction. As growth continues the remodelling of hip joint is influenced in a positive way.

[Anterior cruciate ligament reconstruction with the peroneus longus tendon]. / Peroneus longus tendonu ile ön çapraz bag rekonstrüksiyonu.

OBJECTIVES: The aim of the study was to evaluate the results of anterior cruciate ligament (ACL) reconstruction using a peroneus longus tendon (PLT) autograft. METHODS: The study included 29 patients (27 males, 2 females; mean age 30 years; range 21 to 39 years) who underwent ACL reconstruction using a PLT autograft and interference nail fixation. Fourteen patients (48.3%) also had partial meniscectomy during surgery. The results were assessed according to the Lysholm scores and the International Knee Documentation Committee (IKDC) scale at the end of at least five years of follow-up. RESULTS: According to the IKDC scale, 17 patients (58.6%) were rated as normal or nearly normal, and 12 patients (41.4%) were rated as abnormal or severely abnormal. The mean Lysholm score was 83.7 (range 45 to 100), with excellent or good results in 23 patients (79.3%). Radiographic examination showed mild (n=10) or moderate (n=1) degenerative changes in the knee joint. Compared with the normal side, no flexion or extension losses occurred in the affected knees. Stability of the ACL was assessed by the Lachman test, which showed normal findings in 12 patients (41.4%), while nine patients had 1+, five patients had 2+, and three patients had 3+ anteroposterior laxity. Pivot-shift test was negative in 13 patients (44.8%); ten patients had 1+ pivot glide, and six patients had 2+ pivot shift. Two patients (6.9%) complained of mild to moderate pressure pain, paresthesia and dysesthesia at the donor site of PLT. No patient experienced ankle joint dysfunction or difficulty in sports activities due to PLT graft transfer. CONCLUSION: Our data show that PLT can be an appropriate autograft source for ACL reconstruction, avoiding potential complications of autografts obtained from the knee region.

Osteoid osteoma with a multicentric nidus: a case report and review of the literature.

To date, 23 cases with osteoid osteoma (OO) including multiple nidi in single bone have been reported in the world literature. A case report of an 18-year-old boy with an OO on his left femoral neck, which contained double nidi is presented. Plain radiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the proximal femur showed OO with a multicentric nidus. Bone scintigraphy demonstrated increased activity in the left femoral neck region. The tumor was removed with curettage and shaving using lateral approach. The patient was asymptomatic for 5 years after surgery.

[The results of open reduction through a medial approach for developmental dysplasia of the hip in children above 18 months of age]. / On sekiz aydan büyük gelisimsel kalça displazili çocuklarda medial yaklasimla açik redüksiyon sonuçlari.

OBJECTIVES: Open reduction through a medial approach for the treatment of developmental dysplasia of the hip has been advocated in children younger than 18 months of age. In this study, we evaluated the results of this technique in children above 18 months of age. METHODS: A retrospective evaluation of 34 hips (22 patients; 16 girls, 6 boys) was made, whose treatment was performed using open reduction through a medial approach between 1987 and 1997. Only typical dislocations were included. The ages of the patients at the time of surgery were either 18 months or above (mean age 23.7 months; range 18 to 54 months). Clinical and radiographic evaluations were made according to the modified McKay and Severin's criteria, respectively. The hips in which avascular necrosis developed were evaluated according to the Bucholz-Ogden classification. The mean follow-up was 10 years (range 5 to 14 years). RESULTS: Secondary interventions were required in 24 hips (70.6%). Avascular necrosis developed in nine hips (26.5%). Final clinical results, together with secondary procedures, were excellent in 18 hips (52.9%), good in 10 hips (29.4%), moderate in four hips (11.8%), and poor in two hips (5.9%). Radiographically, there were six hips in Severin class I (17.7%), 11 hips (32.4%) in class II, 10 hips (29.4%) in class III, six hips (17.7%) in class IV, and one hip (2.9%) in class V. CONCLUSION: These data show that, because of high rates of secondary interventions and ensuing avascular necrosis, open reduction through a medial approach cannot be considered to be successful for the treatment of developmental dysplasia of the hip in children above 18 months of age.

Tendon regeneration: an anatomical and histological study in sheep.

Utilization of the hamstring tendon in reconstruction of the anterior cruciate ligament (ACL) has become common in recent years. In MRI studies regeneration potential in harvested tendon has been observed. In the present study, 20 legs from ten sheep, which underwent 10 cm segment resection of tendon of musculus extensor digitalis lateralis (MEDL) were used. The sheep were killed 6 months after the operation and regenerated tendons were examined macroscopically and histologically. Dissection was performed in the tendon resection area and specimens were reharvested for histological examination. Regeneration of the tendon with normal anatomical topographies was found in all legs. Regeneration occurred on both sides of the resected tendon simultaneously. Regeneration was muscle-like in the proximal side but it was tendon-like in the distal side. The developed tendon was fused to the joint capsule and to the fascia at the joint line in all specimens. This study indicates that tendon has a potential for regeneration.

[Problems pertaining to the long head of the biceps brachii in subacromial impingement syndrome]. / Subakromiyal sikisma sendromunda biseps uzun basiyla ilgili sorunlar.

In this paper, we presented the pathological changes occurring in the long head of the biceps muscle in subacromial impingement syndrome, and evaluated treatment approaches in the light of the relevant data.