Comparison of non-compression and compression interlocking intramedullary nailing in rabbit femoral shaft osteotomy model.

OBJECTIVES: This study aims to compare non-compression and compression intramedullary nailing in an experimental femoral shaft osteotomy model in terms of radiological, histological, and biomechanical aspects. MATERIALS AND METHODS: Twenty-four white New Zealand rabbits (average weight 4.3 kg; range 4 to 4.8 kg) were divided into three groups. A right femoral osteotomy was performed in all rabbits and all femurs were fixed with titanium compression interlocking intramedullary nail. After locking of nails, no compression was performed in group 1 while 0.5 mm and 1 mm compressions were performed in group 2 and 3, respectively. All rabbits were sacrificed four weeks after operation. Fracture sites were examined histologically and radiologically. Finite element analyses were performed. RESULTS: Radiological scores of groups 2 and 3 were significantly higher than group 1. There was no significant difference between groups 2 and 3 radiologically. Best histological scores were achieved in group 2. According to finite element analyses, osteotomy site in group 2 was exposed to 1240 N of load and 34.5 MPa of mean stress. CONCLUSION: Compression interlocking intramedullary nailing provides faster fracture healing than non-compression interlocking intramedullary nailing. Best histological fracture healing scores were obtained with 0.5 mm compression performed at the fracture site.

A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules.

INTRODUCTION: The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma. METHODS: This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture. RESULTS: A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%. CONCLUSION: With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.

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.

Determination of radiography requirement in wrist trauma.

OBJECTIVES: The purpose of this study was to evaluate predetermined physical examination and function tests recommended to identify severe injury among patients presenting with wrist injury to the emergency department and to establish a reliable clinical decision rule capable of determining the need for radiography in wrist injuries. MATERIALS AND METHODS: This was a multicenter prospective derivation study of wrist injuries. All patients were assessed in terms of mechanism of trauma, inspection findings, heart rate, sensitivity at palpation, presence of pain with active movement, grasp strength, and functional tests using an examination form under main headings. Sensitivity, specificity, and positive and negative predictive values were expressed for each sign and each examination finding. RESULTS: One hundred nineteen adult patients were enrolled during the 6-month study period. Fracture was identified in 24.3% (n = 29). Presence of pain on the radial deviation, dorsal flexion, distal radioulnar drawer, and axial compression tests exhibited high sensitivity (82.8%, 89.7%, 82.8%, and 86.2%, respectively) and high negative predictive values (88.6%, 81.3%, 87.5%, and 93.6%, respectively) for wrist fracture. Sensitivity of 96.6% was observed when these 4 tests were evaluated together. CONCLUSIONS: The presence of one of these examination findings increases the likelihood of fracture and is adequate to recommend wrist radiography. In addition, there is a strong possibility of radiography being unnecessary if all 4 test results are negative in patients presenting with wrist injury, potentially preventing many nonessential radiographs being performed.

Giant cell tumor of the metacarpal bone in children: free osteoarticular metatarsal transfer: case report.

We present a successful total resection of metacarpal bone and nonvascularized joint transfer in a giant cell tumor of the fourth metacarpal bone in a 13-year-old girl. At the 6-year follow-up, a good functional outcome was achieved, with 85° range of motion of the metacarpophalangeal joint and no clinical or radiographic evidence of tumor recurrence and no signs of degeneration of the joint.

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.

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.