Internet and social media preferences of orthopaedic patients vary according to factors such as age and education levels.

BACKGROUND: Patients can often access the internet and social media for health information but it is not clear how much they trust and use the information retrieved. OBJECTIVE: To investigate the social media and internet use rates and preferences of orthopaedic patients, to reveal to what extent they self-treat, and to probe the affecting factors. METHODS: Two thousand fifty-eight patients admitted to an orthopaedic polyclinic were asked to fill out a survey (voluntarily) consisting of 15 items, to collect demographic data, preference for platforms and sources used, trusted sources, and the extent to which information obtained was used for self-care. RESULTS: The most preferred and most trusted sources of information were Google and other search engines, and physicians' personal websites (p < 0.001). DISCUSSION: Variables such as age, gender, educational level and occupation affect the research preferences. Reliance on social media decreases with increasing educational levels (p < 0.001). CONCLUSION: Health information and knowledge services should work with health professionals to improve aspects of health literacy among orthopaedic patients.

Bilateral Involvement in Developmental Dislocation of the Hip: Analysis of 561 Patients Operated on Using the Limited Posteromedial Approach.

Our objective was to scrutinize the risk factors related to bilateral involvement in the developmental dysplasia of the hip (DDH) and to inspect the impact of bilaterality on the enduring results of the DDH. All patients, aged between 6 and 18 months, who underwent surgery using the limited posteromedial approach (734 hips from 561 patients), were included in this study. The number of births, birth type, history of consanguineous marriage, family history, and swaddling were analyzed. Physical examination and complaints of the patients were evaluated, and direct radiographs were examined in terms of the redislocation, avascular necrosis, and residual acetabular dysplasia. Among the 561 patients, bilateral DDH was observed in 173 patients (30.8%). The use of swaddling was found to be statistically significant between groups (p = 0.012). The use of swaddling for more than one month was associated with a higher odds ratio for bilaterality (p = 0.001, OR = 1.56, 95% CI: 1.2-2.0). Furthermore, bilaterality was associated with a higher risk for redislocation in DDH (p = 0.001, OR = 4.25, 95% CI: 1.6-11.2). The study concludes that swaddling for over a month is strongly linked with the bilateral involvement in DDH. It is important to note that bilaterality plays a crucial role in the development of redislocation after open reduction in DDH.

Redislocation After Posteromedial Open Reduction in Developmental Dysplasia of the Hip: Analyzing the Risk Factors and Determining the Optimal Treatment Method.

BACKGROUND: Redislocation, which is one of the most serious problems in developmental dysplasia of the hip (DDH), might occur because of several reasons. Regardless of the treatment, redislocations are reported to be associated with high complication rates in the literature. Our objective was to identify the risk factors for redislocation in the patients treated for DDH and to determine the optimal treatment method for redislocations. METHODS: Patients with DDH who were treated with the limited posteromedial approach in our clinic between 1993 and 2021 and followed up prospectively were examined in this single-centered study. The participants were assigned into 2 groups: a study group consisting of 25 hips of 17 patients with redislocation and a control group consisting of 502 hips of 390 patients without redislocation. To determine the risk factors for redislocation, demographic data, known risk factors for DDH, preoperative Tönnis stage, and whether the capsule was opened or not were evaluated. To determine the optimal treatment method, a subgroup analysis based on applied treatment (closed reduction and cast replacement vs. repeating open reduction) was conducted, and recurrent redislocation, complication, and secondary surgery rates were evaluated. RESULTS: Bilaterality and high-grade hip dislocations were found to be associated with higher odds ratio (OR) for redislocation [ P =0.007, OR=3.64, 95% confidence interval (CI), 1.3 to 8.8; and P =0.006, OR=4.52, 95% CI, 1.37 to 14.91, respectively]. Recurrent redislocation and complication rates were found to be significantly higher in redislocations treated with closed reduction and cast replacement ( P =0.007 and P =0.015, respectively). CONCLUSIONS: Bilaterality and higher preoperative Tönnis stage are critical risk factors for redislocation after open reduction in DDH. It should be kept in mind that closed reduction and cast replacement is associated with higher rates of recurrent redislocation and complications, and redislocation cases should be treated by repeating open reduction. LEVEL OF EVIDENCE: Level II-therapeutic study.

Searching for a New Parameter in the Healing of Tibia Pilon Fractures: Fracture Area Measurement.

BACKGROUND: Tibia pilon fractures are associated with high complication rates, decreased quality of life, and low patient satisfaction. Although many factors such as reduction quality and soft-tissue coverage have been identified, researchers continue to investigate the factors that affect healing in tibia pilon fractures. Our objective was to investigate the effect of initial fracture crack width and displacement degree on clinical functional results in tibia pilon fractures. METHODS: In this retrospective cohort study, 40 patients with Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association type 43B and 43C tibia pilon fractures and operated on through the extensile anteromedial approach were analyzed. The demographic data of the patients, injury mechanisms, fracture type, reduction quality, clinical results, and postoperative complications were recorded. To evaluate the objective quantity of initial fracture crack width and displacement, a new parameter was defined: "fracture area." All measurements were conducted using a feature from the picture archiving and communication system on anteroposterior and lateral radiographs taken separately in standard fashion. RESULTS: With an average follow-up period of 29.2 months (range, 24-40 months), 34 patients (85%) had excellent or good results, whereas only two patients (5%) had poor clinical results. Age, injury mechanism, and reduction quality have a significant relationship with Maryland Foot Score (P < .001, P < .037, and P < .001, respectively). Preoperative fracture area, measured on both the anteroposterior and the lateral views, are significantly related to both Ovadia-Beals Score and Maryland Foot Score (P < .001 for each). CONCLUSIONS: Preoperative fracture area measurement has a major effect on healing of tibia pilon fractures. Increased initial fracture area is correlated with poor clinical functional results. High-energy injuries, older age, and poor reduction quality are also related to worse clinical outcomes.

Single versus double plating for bicondylar tibia plateau fractures: Comparison of range of motion, muscle strength, clinical outcomes and accelerometer-measured physical activity levels.

BACKGROUND: Optimal treatment of bicondylar plateau fractures is still a matter of debate. Accelerometer-measured physical activity levels may help us to obtain objective information regarding the quality of life of patients. The aim of this study was to compare the physical activity levels, objective and subjective functional results and stabilities of fixations of patients with treated bicondylar plateau fractures. METHODS: In this cross-sectional study of 23 patients, accelerometer-measured physical activity levels, daily energy consumption and measurements of knee joint range of motion (ROM) and muscle strength were measured. While Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as a patient-reported outcome measurement, Rasmussen Radiological Score was used for radiological evaluation. RESULTS: There was no significant difference between the groups in terms of physical activity levels and daily energy consumption (P = 0.667). While Total KOOS, Symptom and Stiffness and Sports Activities scores were higher in patients with a single plate (P = 0.034, P = 0.003 and P = 0.014, respectively), knee flexion and extension ROM and flexor and extensor muscle strength were similar between groups (P = 0.405, P = 0.095, P = 0.982 and P = 0.988, respectively). CONCLUSIONS: While patient-reported outcome measurements were better with single plating, there was no difference between the groups in terms of physical activity levels, ROM, muscle strength and radiological results. Although it should be kept in mind that the choice of the primary surgeon, the condition of the soft tissue and the fracture geometry are also effective in the decision-making process, single plating seems to be a valid surgical option in the treatment of bicondylar plateau fractures.

Primary total knee replacement leads to an increase in physical activity but no changes in overall time of sedentary behaviour: a retrospective cohort study using an accelerometer.

INTRODUCTION: There is no consensus between patient-reported subjective scores and objectively measured physical activity (PA) behaviour after total knee arthroplasty (TKA). The aim of this study was to understand the volume and pattern of physical activity and daily energy consumption after total knee arthroplasty for osteoarthritis. METHOD: Physical activity patterns of 36 patients (31 female, 5 male) with an average age of 67.3 ± 6.7 (50-81) years and end-stage gonarthrosis were investigated using an accelerometer (ActiCal) for seven consecutive days prior to and six months after total knee arthroplasty. Knee Society scores, Oxford knee scores, range of motion, and muscle strength around knee were also recorded. RESULTS: Sedentary behaviour did not change after total knee arthroplasty (p = 0.975). Increases in light physical activity time (p = 0.005) and moderate-vigorous physical activity time (p = 0.006) were found significant. In the post-operative period, light PA awake time increased 25% and moderate-vigorous PA awake time increased four times compared with the pre-operative value. In addition, a significant increase was observed in the amount of daily energy expenditure after TKA (p = 0.001). The subjective functional scores were increased in the post-operative period compared with baseline values (p < 0.001). While a significant increase in knee flexion angle was found after TKA (p = 0.01), there was no increase in muscle strength around the knee (p = 0.096). CONCLUSION: Accumulation patterns of activity evaluated by using an accelerometer objectively can give a new insight to realize the behavioral changes after total knee arthroplasty. Daily life style changes can be encouraged by means of objective evaluations.

Is male gender a prognostic factor for developmental dysplasia of the hip? Mid-long-term results of posteromedial limited surgery.

OBJECTIVE: The aim of this study was to determine if male sex is a poor prognostic factor for developmental dysplasia of the hip (DDH) and to determine the mid-long-term radiological and clinical results of male patients in comparison with female patients following an open reduction with posteromedial limited approach. METHODS: We examined 54 hips of 41 male patients (12.38 ± 4.82 months) and 96 hips of 82 female patients (11.11 ± 4.93 months) with DDH. All the patients underwent open reduction with posteromedial limited approach. The average follow-up time was 108 months for the male patients and 110 months for the female patients. The Tönnis grade, acetabular index, Kalamchi and MacEwen classification, and Severin classifications were determined for all patients. The Mc Kay classification system was used to evaluate the functional results. RESULTS: From the total, 25 (60%) male and 70 (85%) female patients had satisfactory radiographic outcomes (Severin Ia, Ib, or II) according to the Severin classification. There was a significant difference between the two groups in terms of the Severin classification (P = 0.04). Residual acetabular dysplasia (RAD) was observed in 12 (15%) female and 17 (41%) male patients (P = 0.001). Grade 2 or higher osteonecrosis was observed in 7 (9%) patients in female and 6 (15%) patients in male group. The clinical outcomes in terms of the Mc Kay classification showed satisfactory outcomes in 72 (87%) female and 34 (82%) male patients. Further, 8 (9.7%) female patients and 6 (14.6%) male patients underwent a second operation. However, there was no difference between the two groups in terms of postoperative osteonecrosis presence (P = 0.982), functional outcomes (P = 0.571), and secondary operation rates (P = 0.298). Male sex was associated with poor outcomes in terms of the Severin classification (P = 0.04) and RAD (P = 0.001). CONCLUSION: Although our results indicated that male sex is a poor prognostic factor for radiological results and RAD, there was no difference between male and female patients in terms of osteonecrosis, redislocations, and functional outcomes. Secondary surgical interventions should not be delayed in the absence of the spontaneous development of acetabulum. LEVEL OF EVIDENCE: Level III, prognostic study.

Evaluation of the anterolateral ligament of the knee by magnetic resonance imaging in patients with chronic anterior cruciate ligament rupture.

OBJECTIVE: The purpose of this study was to evaluate the visibility of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in patients with chronic anterior cruciate ligament (ACL) rupture. MATERIALS AND METHODS: This retrospective case - control study compared 1.5 - T MRI scans for 50 patients with a chronic ACL rupture with those of a control group of 50 patients with an intact ACL. The ALL was evaluated in three portions: femoral, meniscal, and tibial. The status of each portion was classified as visualized or non-visualized. Two radiologists separately reviewed all the MRI scans to evaluate interobserver reliability. RESULTS: At least one portion of the ALL was visualized in 100% of the control group and 72% of the chronic ACL rupture group. All three portions of the ALL were identified in 72% of the control group but only 10% of the chronic ACL rupture group. In both groups, the most commonly visualized portion was the meniscal portion and the least visualized was the tibial portion. In 18% of the chronic ACL rupture group, no portion of the ALL was visualized. CONCLUSIONS: The visibility of the ALL of the knee was significantly lower in patients with a chronic ACL rupture than in those with an intact one.

Evaluation of cartilage coverage with magnetic resonance imaging in residual dysplasia and its impact on surgical timing.

OBJECTIVE: The aim of this study was to measure the cartilaginous coverage of the acetabulum using magnetic resonance imaging (MRI) and to analyze its effect on the timing and necessity of secondary operations in residual acetabular dysplasia (RAD). METHODS: The MRI results of 33 children (30 girls and 3 boys) aged between 5 and 9 years who were operated on unilaterally via a posteromedial limited approach were compared with the radiographical findings of acetabular dysplasia at follow-up. The acetabular index (AI) and the center-edge (CE) angles were measured. MRI was used to measure the osseous acetabular index (OAI), cartilage acetabular index (CAI), and cartilaginous center-edge angles (CCE). The Children's Hospital's Oakland Hip Evaluation Score (CHOHES) was used for the assessment of clinical and functional results. The Severin scoring system was used to evaluate the radiographic results. The Mann-Whitney U test and Spearman correlation tests were used for statistical analysis. RESULTS: In all, 30 (90.9%) girls and 3 (9.1%) boys with an average age of 7.4 years (range: 5-9 years) and a mean follow-up period of 6.1 years (range: 4-8 years) were included. While there was a significant difference between non-dislocated hips and operated hips in 3 measurements (AI, Wiberg CE, and Ogata CE) using X-rays (p < 0.05), no significant difference was found in the MRI measurements (OAI, CAI, and CCE) (p > 0.05). The CAI values were lower than the AI measured on X-ray (p = 0.035). The mean CCE was higher than the mean CE (p = 0.022). The mean CHOHES score was 83.1 (range: 52-100) and the score of 62% patients was above 90. There was no significant difference in terms of CHOHES score according to age at the time of operation (p = 0.43). Three (9.1%) patients were Severin class I, 8 (24.3%) patients were class II, 12 (36.3%) patients were class III and 10 (30.3%) patients were class IV. There was no correlation between preoperative hip dislocation and Severin score (p = 0.056). No significant difference was found between the ambulatory and non-ambulatory groups in terms of Severin classification (p = 0.063). CONCLUSION: Cartilaginous acetabulum should be taken into account in RAD measurements. MRI may be a more appropriate option for the evaluation of acetabular cartilaginous coverage in the evaluation of RAD and the decision to perform surgery, though X-rays are currently the most used method. The results revealed no effect on functional or radiological scores as a result of being of walking age. LEVEL OF STUDY: Level III, Diagnostic Study.

The long-term outcomes of posteromedial limited surgery for developmental dysplasia of the hip: a mean 17.3-year follow-up.

The objectives of this retrospective study were to evaluate long-term functional and radiological outcomes of 102 dislocated hips of 79 patients treated with the modified medial approach and to compare them with respect to both of our short-term and mid-term outcomes and also with the current literature. The mean age at operation was 11.3±4.3 months (range: 3-18 months), with a minimum follow-up of 15 years (range: 15-23 years). It was determined that 94.1% of mean hip scores were either good or excellent. Avascular necrosis, subluxation/redislocation, and secondary surgeries were 14.8, 6.9, and 7.8%, respectively. We believe this modified procedure requiring no routine arthrotomy is safe and effective.

Does THA Improve Social Status Among Turkish Women With Developmental Dysplasia of the Hip?

BACKGROUND: In traditional societies, patients who reach adulthood with developmental dysplasia of the hip (DDH) may be labeled "disabled" and may be considered "defective," causing them psychologic pain and problems with social interactions. In some patriarchal societies, women disproportionately experience these problems, because they may be seen as insufficient in terms of marriage and sexual intercourse owing to hip-related limitations, and they may be married through arranged marriages to people who also have disabilities. This patriarchal structure limits the ways women can engage in society and may lower their quality of life (QOL). The degree to which THA can improve the lives of women in these specific ways in a patriarchal culture has not, to our knowledge, been studied. QUESTIONS/PURPOSES: (1) Does THA improve the social standing of young women with DDH in Turkey? (2) Does THA improve QOL of young women with DDH in Turkey? (3) Does THA improve pain and physical function in these patients? METHODS: This study was a retrospective, comparative study performed at Karabük University Research and Training Hospital in Karabük, Turkey, from 2012 to 2017. A total of 217 women with DDH were followed at our center between the study dates. All of these patients were evaluated for inclusion into the study. Among these, 175 women with DDH (aged 20-45 years) were included in the study according to inclusion/exclusion criteria. We offered THA to all patients in whom surgery was technically feasible; 84 chose to undergo THA, whereas 91 declined the procedure. Whether THA had any effects on the study questions was determined by comparison of the following findings at baseline and after intervention. The social standing of patients was assessed through their marital status and proportions of employment and depression; the patients' QOL was assessed with the SF-36 at baseline for all patients and at 1 year postoperatively for those who underwent THA; and pain and dysfunction were evaluated by determination of the proportion of patients who had scoliosis, knee valgus, and knee and lumbar pain. At baseline, patients were not different in regard to all parameters except knee and lumbar pain, which were greater in those who had decided to undergo THA. The SF-36 scores of patients who underwent THA were compared with their postoperative scores as well as with the baseline scores of patients who did not undergo THA. RESULTS: In terms of measures of social standing, women who underwent THA appeared better at followup than did the patients who did not undergo THA. Those who underwent THA had higher percentages of marriage and employment and less depression. Regarding QOL, postintervention comparisons revealed that women who underwent THA had higher SF-36 scores compared with the initial results of women who did not have surgery. Compared with preoperative scores, the highest improvements were found in social role function (mean difference ± standard error [SE] = 58.64 ± 0.88; 95% confidence interval [CI], 56.91-60.37; p < 0.001) and mental health (mean difference ± SE = 53.00 ± 0.86; 95% CI, 51.31-54.69; p < 0.001) subdimensions of the SF-36. Finally, patients who underwent THA had improvements in pain and function as measured by Harris hip score than did patients who did not undergo THA. At initial evaluation, two groups were found to be similar in terms of Harris hip scores (THA: 61.6 ± 7.4 versus non-THA: 63.7 ± 7.6, p = 0.066), whereas the THA group was found to be superior at followup evaluation (THA: 83.5 ± 6.2 versus non-THA: 62.1 ± 7.8, p = 0.001). CONCLUSIONS: Young women with DDH are severely affected by social and cultural norms in Turkey, which is an example of a patriarchal culture. We believe that in this setting, some patients who improve their appearance, gait, and physical function through THA may benefit from a better social perception and higher self-esteem, which may, in turn, increase their QOL and provide more freedom in terms of life choices. LEVEL OF EVIDENCE: Level III, therapeutic study.

The Fate of Iliopsoas Muscle in the Long-term Follow-up After Open Reduction of Developmental Dysplasia of the Hip by Medial Approach. Part 1: MRI Evaluation.

BACKGROUND: There has been little information about the long-term status of the iliopsoas, which is the main flexor of the hip, after iliopsoas tenotomy in the treatment of developmental dysplasia of the hip (DDH). The aim of this study was to assess the status of the iliopsoas muscle and other flexors and extensors of the hip in long-term follow-up with magnetic resonance imaging after complete iliopsoas tenotomy in patients with unilateral DDH treated with open reduction with a medial approach. METHODS: The study included 20 patients who underwent open reduction with a medial approach for unilateral DDH and had long-term follow-up. Magnetic resonance imaging assessment of iliopsoas, rectus femoris, tensor fasia lata, sartorius, and gluteus maximus muscles was applied and the muscles of the hip that was operated on were compared with the unoperated hip. In addition, the iliopsoas muscle was examined for reattachment and the effect of reattachment was evaluated. RESULTS: The mean age at the time of operation was 10.53±3.61 months (range, 5 to 18 mo), and mean follow-up was 16.65±2.16 years (range, 13 to 20 y). Spontaneous reattachment of the iliopsoas was observed in 18 patients (90%), either in the lesser trochanter (65%) or the superior part of it (25%). There was no significant difference between the hips that were operated on and those that were not with regard to the mean cross-sectional areas (CSA) of the tensor fascia lata, rectus femoris, sartorius, and gluteus maximus muscles. The CSA of the tensor fascia lata, rectus femoris, sartorius, and gluteus maximus muscles showed no significant difference (P>0.05); however, CSA of iliopsoas muscle was significantly reduced in the operated hip (P<0.001). CONCLUSIONS: Although the iliopsoas tendon was atrophied after complete iliopsoas tenotomy, it was reattached in 90% of the patients spontaneously in long-term follow-up. There was no statistically significant compensatory hypertrophy in any muscles in response to iliopsoas atrophy. LEVEL OF EVIDENCE: Level IV-Therapeutic.

The Fate of the Iliopsoas Muscle in Long-term Follow-up After Open Reduction With a Medial Approach in Developmental Dysplasia of the Hip. Part 2: Isokinetic Muscle Strength Evaluation.

BACKGROUND: The impact on long-term weakness of hip flexion of complete iliopsoas tenotomy during open reduction of developmental hip dysplasia with a medial approach has not yet been fully clarified. The purpose of this study was to investigate the isokinetic muscle strength (IMS) of hip flexor and extensor muscles in these patients and also to analyze the effect of spontaneous reattachment of the iliopsoas muscle on IMS measurements. METHODS: The study included 20 patients. Earlier magnetic resonance imaging examination of all the patients revealed spontaneous reattachment of the iliopsoas in 18 (90%) patients. IMS measurements were performed at 60 and 150 degrees/s. The peak torque, total work (TW), average power (AP), work fatigue, and agonist to antagonist muscle ratio of the operated and nonoperated hips were recorded separately for flexors and extensors. The effect of iliopsoas reattachment on IMS was also evaluated. RESULTS: The mean follow-up period was 16.65±2.16 (13 to 20) years. Total work (P=0.013) and average power (P=0.009) of the flexor muscles and work fatigue of the extensor muscles (P=0.030) of the operated hip were significantly decreased when compared with the nonoperated hips at 150 degrees/s. There was no significant difference between the flexor muscles of the operated and nonoperated hips (P<0.05) at 60 degrees/s and extensor muscles (P<0.05) at 150 degrees/s. In addition, patients without reattachment had lower IMS in the operated hips. DISCUSSION: Flexor muscle strength was decreased in the operated hip against low resistance in long-term follow-up after iliopsoas tenotomy. This may reflect that hip muscle strength was decreased after prolonged activities such as sports. However, in forceful activities flexor muscle strength was retained due to iliopsoas reattachment. On the basis of this study we thought that spontaneous reattachment of the iliopsoas tendon substantially preserves muscle strength. Nonetheless possible efforts should be made to surgically reattach the psoas tendon to preserve strength of the muscle. LEVEL OF EVIDENCE: Therapeutic level IV.

The effects of the sagittal plane malpositioning of the patella and concomitant quadriceps hypotrophy on the patellofemoral joint: a finite element analysis.

PURPOSE: Anterior knee pain is a common symptom after intramedullary nailing in tibia shaft fracture. Moreover, patellofemoral malalignment is also known to be a major reason for anterior knee pain. Patellofemoral malalignment predisposes to increased loading in patellar cartilage. In the previous study, we have demonstrated the quadriceps atrophy and patellofemoral malalignment after intramedullary nailing due to tibia shaft fracture. In this study, our aim was to clarify the effects of quadriceps atrophy and patellofemoral malalignment with the pathologic loading on the joint cartilage. METHODS: Mesh models of patellofemoral joint were constructed with CT images and integrated with soft tissue components such as menisci and ligaments. Physiological and sagittal tilt models during extension and flexion at 15°, 30° and 60° were created generating eight models. All the models were applied with 137 N force to present the effects of normal loading and 115.7 N force for the simulation of quadriceps atrophy. Different degrees of loading were applied to evaluate the joint contact area and pressure value with the finite element analysis. RESULTS: There was increased patellofemoral contact area in patellar tilt models with respect to normal models. The similar loading patterns were diagnosed in all models at 0° and 15° knee flexion when 137 N force was applied. Higher loading values were obtained at 30° and 60° knee flexions in sagittal tilt models. Furthermore, in the sagittal tilt models, in which the quadriceps atrophy was simulated, the loadings at 30° and 60° knee flexion were higher than in the physiological ones. CONCLUSIONS: Sagittal malalignment of the patellofemoral joint is a new concept that results in different loading patterns in the patellofemoral joint biomechanics. This malalignment in sagittal plane leads to increased loading values on the patellofemoral joint at 30° and 60° of the knee flexions. This new concept should be kept in mind during the course of diagnosis and treatment in patients with anterior knee pain. Definition of the exact biomechanical effects of the sagittal tilting will lead to the development of new treatment modalities.

Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing.

PURPOSE: The aim of the study was to analyse the patellofemoral alignment in the sagittal plane following tibial fracture surgery with intramedullary nailing and its relationship to parapatellar muscle status. METHODS: The patellofemoral MRI results of 27 patients (15 males and 12 females) treated with locked intramedullary nailing following tibia shaft fracture were reviewed. The mean age of the patients was 41.8 (±15) years. The patella-patellar tendon angle (P-PT) and the distance between the inferior patellar pole and the tibial tubercle (DP-TT) were evaluated for both the operated extremity and the contralateral normal side. MRI assessment of the infrapatellar fat pad, quadriceps, sartorius, gracilis, semi-membranosus muscles and biceps muscles was also carried out. The correlation between the changes in skeletal muscle mass, the volume of the infrapatellar fat pad and the alterations in the DP-TT distances and P-PT angles were analysed. RESULTS: The quadriceps muscle cross-sectional diameter had a mean of 157.2 mm(2) (115.6/319.5) in the operated extremity, and it was 193 mm(2) (77.6/282.2) in the non-operated normal side (p = 0.001). For the Gracilis muscle, the mean was 84.4 mm(2) (19.7/171) at the operated extremity and 75.7 mm(2) (26.9/238.2) on the normal side (p = 0.05). The cross-sectional areas of the semi-membranosus, sartorius and biceps muscles in the operated and non-operated extremity were not noticeably different (n.s). The P-PT angle was 153° (129.7/156.4) in the operated extremity and 145.7° (137.6/163.4) in the non-operated normal extremity (p < 0.05). While DP-TT distance was 11.4 mm (9.4/20.4) in the operated extremity, it was 14.1 mm (7.3/17.1) in the non-operated extremity (p = 0.001). The correlation analyses revealed that the quadriceps hypotrophy negatively correlated (r = -0.4, p = 0.02) with the P-PT angle but positively correlated with the increase in gracilis muscle volume (r = 0.4, p = 0.03). CONCLUSION: This study revealed that patellofemoral joint kinematics in the operated extremity was diminished in the sagittal plane correlating with the quadriceps muscle volume loss and gracilis muscle hypertrophy. The modalities focused on both preventing and treating the hypotrophy of the quadriceps muscle following the surgical treatment of tibial fracture, which may help to overcome this quite common pathology.

Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study.

PURPOSE: The aim of this study was to evaluate the effect of knee position during wound closure (flexed vs. extended) in total knee arthroplasty on knee strength and function, as determined by knee society scores and isokinetic testing of extensor and flexor muscle groups. METHODS: In a prospective, randomized, double-blind trial, 29 patients were divided in two groups: for Group 1 patients, surgical closing was performed with the knee extended, and for Group 2 patients, the knee flexed at 90°. All the patients were treated with the same anaesthesia method, surgical team, surgical technique, prosthesis type, and rehabilitation process. American Knee Society Score values and knee flexion degrees were recorded. Isokinetic muscle strength measurements of both knees in flexion and extension were taken using 60° and 180°/s angular velocity. The peak torque and total work values, isokinetic muscle strength differences, and total work difference values were calculated for surgically repaired and healthy knees. RESULTS: No significant difference in the mean American Knee Society Score values and knee flexion degrees was observed between the two groups. However, using isokinetic evaluation, a significant difference was found in the isokinetic muscle strength differences and total work difference of the flexor muscle between the two groups when patients were tested at 180°/s. Less loss of strength was detected in the isokinetic muscle strength differences of the flexor muscle in Group 2 (-4.2%) than in Group 1 (-23.1%). CONCLUSION: For patients undergoing total knee arthroplasty, post-operative flexor muscle strength is improved if the knee is flexed during wound closure. LEVEL OF EVIDENCE: II.

A comparison of ultrasonography and radiography in the management of infants with suspected developmental dysplasia of the hip.

The aim of this study was to determine the sensitivity and specificity of plain radiography in the detection of developmental dysplasia of the hip, using hip ultrasonography as a reference standard. A retrospective review was made in 44 infants ranging in age from 4 weeks to 50 weeks (mean age: 21.7 weeks). Both radiographic and ultrasonographic images were obtained for 86 hips. Radiography and ultrasonography were found to be significantly correlated in terms of classification of developmental dysplasia of the hip presence or absence (p < 0.0001, Fisher's exact test). With ultrasonography accepted as the standard for the diagnosis of developmental dysplasia of the hip, radiography had a sensitivity of 61% and a specificity of 87%. The results of this study suggest that the two imaging methods give similar overall results, but that low grade dysplasia detected on ultrasonography may go undetected on radiography.

The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture.

OBJECTIVE: The purpose of this study was to investigate the effect of rotational deformities on patellofemoral alignment using the dynamic magnetic resonance imaging method on patients whose femur fractures were treated with intramedullary locking nails. METHODS: The dynamic patellofemoral magnetic resonance imaging results of 33 patients (5 females and 28 males) were reviewed. The mean age of the patients was 36.3 (range 19-61) years. The mean follow-up was 30.2 months (range 24-38). All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Those with less than 10° of rotational deformity in either direction were classified as Group A, those with more than a 10° of internal rotation deformity as Group B and more than a 10° of external rotation deformity as Group C. The three groups were then compared regarding to clinical scores. Patellofemoral parameters of operated and contralateral side were also compared in each group. RESULTS: There were 14 (42.4 %) patients in Group A, 12 (36.4 %) patients in Group B and 7 (21.2 %) patients in Group C. The mean patella score in Group C (74 ± 7.02) was significantly lower when compared with Group B (87.6 ± 9.9) and group A (90.6 ± 6.1) (p < 0.05). In Group C patients, medial patellar tilt was detected when compared with the intact side. There were no significant changes in patellofemoral position in either Group A or Group B. CONCLUSION: The results of this study revealed that more than 10° of external rotation deformity could cause a detoriation in the patellofemoral scores. Anatomic reduction of the fracture site should be performed as soon as possible and external rotational deformities should especially be avoided in order to prevent patellofemoral malalignment.

The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis.

INTRODUCTION: In this study, the results of local injection of platelet-rich plasma (PRP) and corticosteroids in the treatment of plantar fasciitis were compared. PATIENTS AND METHODS: Sixty patients who were diagnosed as plantar fasciitis and treated conservatively for at least 3 months and had no response to conservative treatment modalities were involved in this study. The first 30 consecutive patients were treated by local injection of 2 mL of 40 mg Methylprednisolone with 2 mL of 2% prilocaine (metilprednizalone) and the second 30 patients were treated by injecting 3 mL PRP after 2 mL of 2% prilocaine injection. Patients were evaluated according to the modified criteria of the Roles and Maudsley scores and visual analog scale before injection and 3 weeks and 6 months following injection. RESULTS: The mean VAS heel pain scores measured 6 months after treatment were 3.4 in steroid group and 3.93 in PRP group, and the scores in both groups were significantly lower when compared with pretreatment levels (6.2 in steroid group and 7.33 in PRP group). There was no significant difference between steroid and PRP groups in visual analog scale scores and modified criteria of the Roles and Maudsley scores measured at 3 weeks and 6 months (P > 0.05). CONCLUSION: Our results revealed that both methods were effective and successful in treating plantar fasciitis. When the potential complication of corticosteroid treatment was taken into consideration, PRP injection seems to be safer and at least having same effectivity in the treatment of plantar fasciitis.