A novel robot-assisted knee arthroplasty system (ROSA) and 1-year outcome: A single center experience.

BACKGROUND: Total knee arthroplasty is a successful procedure in the treatment of knee osteoarthritis. Searches in surgical technique have focused surgeons in particular on implant alignment. For this purpose, the use of robot-assisted total knee arthroplasty has become increasingly common in the last 10 years. METHODS: A total of 46 patients (66 knees) who were operated for knee osteoarthritis with Robotic Surgical Assistant (ROSA, Zimmer-Biomet, Warshaw, Indiana, USA) between 2021 and 2023 were included in the study. Preoperative planning and intraoperative incision time, total surgical time, range of motion and follow-up time recorded. Oxford knee scores and knee society scores (KSS) of the patients were compared before and after surgery. At the last follow-up Forgotten Joint Score and the sagittal and coronal plane alignments were evaluated. RESULTS: Preoperative mean Oxford score of the right knee of the patients was 18.5 ±â€…3.2, post-surgery mean Oxford score progressed to 43.5 ±â€…2.2. While the preoperative left knee Oxford score of the patients was 16.9 ±â€…2.3, the mean left knee Oxford score improved to 43.4 ±â€…2.2 postoperatively. The mean KSS score of the patients' right knee preoperatively was 49.7 ±â€…3.5, and progressed to 89.2 ±â€…4.7 postoperatively. While the preoperative mean left knee KSS score of the patients was 46.5 ±â€…4.3, the mean KSS score improved to 89.8 ±â€…3.2 postoperatively. The mean Forgotten Joint Score of the left knee at the last follow-up of the patients was 77.4 ±â€…3.8, while the mean Forgotten Joint Score of the right knee was 75.4 ±â€…5.9. CONCLUSION: The results of ROSA-supported knee arthroplasty found to be functionally successful.

Avulsion Fracture and Myositis Ossificans in a Professional Teenage Dancer: A Case Report.

Fractures of the transverse processes in the lumbar vertebrae occur as the result of major forces such as direct blunt trauma, violent lateral flexion-extension forces, avulsion of the psoas muscle, or Malgaigne fractures of the pelvis. Dancers make repeated and forceful hyperextension and flexions of the spine, which may cause fractures of the transverse processes of the lumbar vertebrae. Repeated trauma of muscles in dancers may cause avulsion fractures and myositis ossificans. Herein, we report MRI and CT findings of an avulsion from the right transverse process of the L2 and L3 vertebrae in a 16-year-old professional teenage dancer, who responded to conservative treatment.

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.

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.

The patellofemoral kinematics in patients with untreated developmental dislocation of the hip suffering from patellofemoral pain.

PURPOSE: This study reviews the dynamic patellofemoral CT results of 39 patients with untreated developmental dislocation of the hip who are suffering from knee pain. METHOD: The mean age of the patients with unilateral developmental dislocation of the hip was 33.3 (±7.9), for bilateral patients 36.2 (±11.3), and for the control group, it was 31.5 (±8.5). While 14 of them were bilateral, 25 were unilateral. The CT results of 24 asymptomatic adult knees served as the control group. The patellofemoral parameters of patients with unilateral and bilateral developmental dislocation of the hip, the control group's parameters and the effect of femoral anteversion, limb length discrepancy, severity of dislocation, the mechanical axis deviation on patellofemoral parameters were analyzed. RESULTS: In patients with unilateral untreated developmental dislocation of the hip, although the patella was located more laterally at initial flexion degrees, it was located more medially at 30° and 60° flexion with respect to the control group. For the involved extremity, the PTA angles at 15°, 30°, and 60° flexion were significantly higher than in the control group corresponding to medial patellar tilt. In patients with bilateral developmental dislocation of the hip, the course of the patella during tracking in terms of patellar shift was similar to that of the unilateral patients. The amount of leg length discrepancy and the severity of dislocation, as well as the mechanical axis deviation, did not affect the patellofemoral parameters. CONCLUSION: The patients with untreated developmental dislocation of the hip and suffering from knee pain should be analyzed not only for tibiofemoral abnormalities but also for patellofemoral malalignment. LEVEL OF EVIDENCE: Case-control study, Level III.

The results of nonoperative treatment for three- and four-part fractures of the proximal humerus in low-demand patients.

OBJECTIVE: To evaluate the results of nonoperative treatment of three- and four-part fractures of the proximal humerus in patients who refused surgery or could not undergo surgery because of medical conditions. DESIGN: Retrospective evaluation of prospective collected data. SETTING: Educational and research hospital. Level IV, therapeutic case series. PATIENTS: Eighteen patients (eight three- and 10 four-part fractures) were included. The mean age was 68.2 ± 13.8 years (range, 39-90 years). The mean follow-up was 39.1 ± 12.4 months (range, 24-60 months). Patients were grouped into two: Group A being younger than 65 years and Group B 65 years or older. INTERVENTION: Standardized nonoperative treatment and follow-up protocols were used. MAIN OUTCOME MEASUREMENTS: Functional and radiographic assessments were performed in posttreatment first year and at latest follow-up. Constant-Murley scores were also obtained for both shoulders. RESULTS: The mean Constant-Murley score was 61.3 ± 13.5 (range, 40-85) at latest follow-up. Osteonecrosis was detected in five patients. All patients had significantly lower SF-36 scores for all subscales except mental health than the normal Turkish population. There was no significant difference between three- and four-part fractures regarding age and Constant-Murley scores. The mean Constant-Murley score of the Group A patients with three-part fractures was significantly higher when compared with the Group A patients with four-part fractures. There was no significant difference between patients with and without osteonecrosis regarding fracture types or the Constant-Murley scores at the latest follow-up. CONCLUSIONS: Although the individual fracture type does not have an influence on functional results, these results are better in patients younger than 65 years with three-part fractures. The results of the nonoperative treatment of these fractures are satisfactory even in elderly patients. The radiographic appearances did not correspond with the functional results.

Plasma vascular endothelial growth factor levels are similar in subjects with and without osteoporosis.

OBJECTIVES: The relation between serum vascular endothelial growth factor (VEGF) level and bone mineral density (BMD) value was evaluated to investigate the role of VEGF at etiopathogenesis of the osteoporosis. PATIENTS AND METHODS: Bone scanning with dual energy X-ray absorptiometry (DEXA) was performed on a total of 276 patients more than 40 years of age between September 2007 and January 2008 in our hospital's radiology department. A total of 88 patients (44 females; mean age 62.8+/-12.2 year, 44 males; mean age 58.7+/-12.1 year) meeting the study criteria were included. These patients formed four groups; osteoporotic male patients (group MO, n=22, BMD< -2.5), normal males (group MN, n=22, BMD> -1), osteoporotic female patients (group FO, n=22, BMD< -2.5), and normal females (group FN, n=22, BMD> -1). Bone mineral density measurements were performed with DEXA. Serum VEGF level was determined by the endogenous human ELISA kit. The relationships between body mass index (BMI), age, BMD and serum VEGF levels were analyzed. RESULTS: The difference between male and female participants in terms of serum VEGF levels was not statistically significant (p>0.05). The differences in terms of mean VEGF values between the MO and MN groups and the FO and FN groups were not statistically significant (p>0.05). In MN cases, BMD was negatively correlated with VEGF levels (p<0.05). In MO group, the correlation between BMD and serum VEGF levels was not statistically significant (p>0.05). CONCLUSION: Although the plasma levels of osteoporotic subjects are relatively higher than in the normal groups, this was not statistically significant in either male or female subjects. The small sample size could be a reason for this insignificance. The negative correlation between serum VEGF and BMD levels in the MN group was not present in the MO group. When the various effects of serum VEGF on bone metabolism are taken into account, to clarify the pathophysiology of male osteoporosis, this association between BMD values and VEGF in male population must be investigated in further studies.

Role of pathophysiology of patellofemoral instability in the treatment of spontaneous medial patellofemoral subluxation: a case report.

INTRODUCTION: Medial patellar subluxation is usually seen after lateral retinacular release. Spontaneous medial subluxation of the patella is a very rare condition. There are few reports in the literature on the pathophysiology of iatrogenic medial patellar subluxation. To our knowledge, there are no reports of the pathophysiology of non-iatrogenic medial patellar subluxation in the English literature. In this study we present a case of spontaneous medial patellar instability that is more prominent in extension during weight bearing. We also try to define the treatment protocol based on pathophsiology. CASE PRESENTATION: We report the case of a 21-year-old Turkish man with spontaneous medial patellar instability. He had suffered right knee pain, clicking and popping sensation in the affected knee for three months prior to presentation. Clinical examination demonstrated medial patellar subluxation that is more prominent in extension during the weight bearing phase of gait and while standing. Increased medial tilt was observed when the patella was stressed medially. Conventional anterior to posterior, lateral and Merchant radiographs did not reveal any abnormalities. After three months of physical therapy, our patient was still suffering from right knee pain which disturbed his gait pattern. Throughout the surgery, medial patellar translation was tested following the imbrication of lateral structures. He still had a medial patellar translation that was more than 50% of his patellar width. Patellotibial ligament augmentation using an iliotibial band flap was added. When examined after surgery, the alignment of the patella was effectively corrected. CONCLUSIONS: Chronic imbalance between the strengths of vastus lateralis and vastus medialis results in secondary changes in passive ligamentous structures and causes additional instability. Physical therapy modalities that aim to strengthen the vastus lateralis might be sufficient for the treatment of spontaneous medial instability. There would be no need for any surgical intervention if spontaneous medial instability was recognized before the additional instability occured. If necessary, lateral imbrication followed by lateral patellotibial ligament augmentation can be performed, and these would effectively correct spontaneous medial patellofemoral instability.

Axial plane coverage and torsion measurements in primary osteoarthritis of the hip with good frontal plane coverage and spherical femoral head.

INTRODUCTION: Mechanical factors play a role in pathogenesis of primary osteoarthritis of the hip. Torsion measures were made to detect whether there is a causal relationship between increase or decrease of femoral anteversion, acetabular anteversion, and osteoarthritis. There are no studies in the literature indicating a relationship between axial plane coverage and osteoarthritis of the hip. Deficient axial plane coverage of femoral head may also play a role in pathogenesis of osteoarthritis. MATERIALS AND METHODS: Thirty patients with primary osteoarthritis of the hip and 29 control cases were included in the study. We used the method of Anda et al. (Acta Radiol Diagn 27:443-447, 1986; Comput Assist Tomogr 15:115-120, 1991) to measure axial plane anterior, posterior coverages in patients with primary osteoarthritis of the hip. The computerized tomography sections and pelvic radiographs indicated good frontal plane coverage and spherical femoral head. In addition to anterior acetabular sector angle, posterior acetabular sector angle, horizontal acetabular sector angles for axial plane coverage detection, femoral anteversion, acetabular anteversion, and McKibbin instability index were also measured. RESULTS: Posterior coverage was lower at osteoarthritic hips than the control group's hips (96.0 ± 16.7, 104.2 ± 10.6) (p < 0.05). CONCLUSION: The results may indicate that in addition to other mechanical factors, axial plane coverage, especially the posterior coverage deficiency, may play a role in the pathogenesis of hip osteoarthritis.

Single or double distal locking in intramedullary nailing of tibial shaft fractures: a prospective randomized study.

BACKGROUND: The number of distal locking screws may have an effect on union, complication rates and operation time. The purpose of this study was to determine the effect of one or two distal locking screws in unreamed intramedullary nailing of closed or grade 1 open, simple or wedge tibial shaft fractures on the incidence of malunion, delayed union, non-union, and screw failure. METHODS: Fifty-seven patients (39 male, 18 female; mean age 38.5+/-10.7 years) were randomized to two groups as either one or two distal locking screws and were evaluated prospectively for the incidences of malunion, delayed union, non-union, and screw failure. Twenty-nine patients were included in the two distal screws group and 28 patients in the single distal screw group. Groups were then subdivided to end fractures (proximal+distal end fractures) or mid-shaft fractures and reevaluated for the incidences of complications. Mann-Whitney U, chi-square and T tests were used for statistical analysis. RESULTS: Mean follow-up was 2.4 years (range, 1.5-4.7 years). There was no case of malunion in either group. The incidences of delayed union, non-union or screw failure were not different (p>0.05). However, complication rate for end fractures in the two screw group was higher than that in the one screw group (p:0.04). CONCLUSION: For non-complex, closed or grade 1 open tibial shaft fractures, locking of an intramedullary nail with a single distal screw is safe, and may help to decrease operation time and radiation exposure.

Quantitative gait characteristics of children who had successful unilateral clubfoot operation.

OBJECTIVES: In this study, we aimed to evaluate the functional results of patients operated for unilateral clubfoot who had good clinical outcome with gait analysis. We also investigated the deviation from the normal, and determined the compensation mechanisms by comparing this data with the unaffected feet and with the feet of healthy children. METHODS: Sixteen children [10 boys, 6 girls; mean age, 6.8 years (range 4-9 years)] with surgically treated unilateral clubfoot and 24 age-matched healthy children were included in the study. Foot length, calf circumference, ankle range of motion, and radiographic measurements were recorded. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle in sagittal, coronal and transverse planes), and kinetic (ground reaction forces, moments, and powers of hip, knee, and ankle) data were evaluated. RESULTS: Calf circumference and ankle range of motion of involved extremity were significantly less than the unaffected side (p<0.05). Quantitative gait data revealed that children with clubfoot had slower walking velocity (0.75±0.25 m/sec vs. 1.02±0.18 m/sec, p=0.01), shorter stride length (0.72±0.23 m vs. 0.91±0.05 m, p=0.01) than healthy children group. Affected foot of unilateral clubfoot patients had more toe-in than healthy children (-14.24±21.78° vs. 18.54±7.90°, p=0.001). Unaffected side showed increased pelvic excursions and medio-lateral ground reaction forces as well as decreased ankle and hip motion in sagittal plane. CONCLUSION: Even asymptomatic well-treated children with unilateral clubfoot may have gait deviations both in the affected and unaffected sides. These alterations may also be the result of the subclinical involvement of the so called healthy foot by disease (clubfoot) as well as the compensatory mechanisms.

The evaluation of hip muscles in patients treated with one-stage combined procedure for unilateral developmental dysplasia of the hip: part II: isokinetic muscle strength evaluation.

BACKGROUND: To assess the isokinetic muscle strength (IMS) of hip flexor and extensor muscles in patients treated with one-stage combined procedure for developmental dysplasia of the hip and analyze the effect of the status of hip muscles on IMS. METHODS: Twenty-two patients were included in the study. The mean age was 154.4+/-34.6 (110-216) months and the mean follow-up was 112.6+/-32.0 (68-159) months. All patients underwent complete tenotomy of the iliopsoas muscle to ease open reduction and had excellent results according to the modified McKay criteria of Barrett and type I hips according to the radiologic criteria of Severin. All patients had earlier magnetic resonance imaging examination that revealed reattachment of the iliopsoas in 7 (32%) patients. IMS measurements were performed at 120 degrees/s and 240 degrees/s. The peak torque (PT), PT angle, total work (TW), and average power (AP) values of operated and nonoperated hips were recorded separately for flexors and extensors. RESULTS: For flexors, TW and AP values were lower at the operated hip when compared with the nonoperated hip at both angular velocities. PT was only lower at the operated hip at 120 degrees/s. For extensor muscles, PT, TW, AP, and PT angle showed no statistically significant difference at either angular velocity. For flexors, the PT deficit between the operated and nonoperated hips at 120 degrees/s and 240 degrees/s was measured as 15.3% and 8.0%, respectively. There was no difference between the flexor muscles of operated and nonoperated hips considering PT, TW, and AP at both angular velocities in patients with reattachment. The IMS deficit of flexor muscles at 120 degrees/s was significantly higher in patients without reattachment of iliopsoas when compared with those with reattachment, and correlated to the widths of the iliopsoas muscle at levels II and III. CONCLUSIONS: Assessing the results of surgical treatment of DDH with conventional radiologic and functional criteria might be misleading in some patients with excellent results because some of these patients, particularly those without reattachment of the iliopsoas muscle, experience significant weakness in hip flexion.

The evaluation of hip muscles in patients treated with one-stage combined procedure for unilateral developmental dysplasia of the hip: part I: MRI evaluation.

BACKGROUND: To assess the status of hip flexor and extensor muscles with MRI in patients with unilateral developmental dysplasia of the hip (DDH) after walking age who were treated with one-stage combined procedure. METHODS: Twenty-two patients operated upon with one-stage combined procedure for unilateral DDH were included in this study. All patients underwent complete tenotomy of the iliopsoas muscle hindering open reduction. All patients showed excellent results according to the modified McKay criteria of Barrett and type 1 hips according to radiologic criteria of Severin at the latest follow-up. MRI assessment of iliopsoas, rectus femoris, tensor fasia lata, sartorius, and gluteus maximus muscles was performed and muscles of the hip that was operated upon were compared with the hip that was not. In addition, the iliopsoas muscle was examined for reattachment and the effect of reattachment was evaluated. RESULTS: Mean age was 154.4+/-34.6 (110 to 216) months. Mean follow-up was 112.6+/-32.0 (68 to 159) months. Reattachment of the iliopsoas was observed in 7 (32%) patients, with no significance in terms of age, postoperative follow-up period, or the duration of the postoperative period. Atrophy in the hip that was operated upon was significant in iliopsoas, rectus femoris, tensor fasia lata, and gluteus maximus muscles when compared with the hip that was not. No significance was detected in the sartorius muscle between hips that were operated upon and those that were not. Cross-sectional areas of tensor fascia lata, rectus femoris, sartorius, and gluteus maximus muscles were not significantly different between patients with and without reattachment of iliopsoas. The width of the iliopsoas muscle was significantly lowered in patients without reattachment. CONCLUSIONS: Patients with DDH treated with combined procedures including complete iliopsoas tenotomy do not have hip muscles similar to hip muscles that have not been operated upon, despite excellent radiologic and clinical results. These patients can be affected by muscular changes in the long term. Follow-up by conventional radiologic and clinical criteria alone may not be enough, and patients may have problems, as in our series, that cannot be detected by conventional radiologic and clinical assessments. LEVEL OF EVIDENCE: Level IV, Therapeutic case series.

Does Salter innominate osteotomy with transiliac lengthening effect triradiate cartilage or cause posterior coverage insufficiency?

INTRODUCTION: To treat neglected developmental dysplasia of the hip (DDH), we performed Salter innominate osteotomy with a modification of transiliac lengthening. We asked whether this modified technique caused posterior coverage problems and triradiate cartilage injury. METHODS: We retrospectively reviewed 45 patients with unilateral DDH treated by open reduction and femoral shortening and modified Salter innominate osteotomy. The age at operation was 38.44 +/- 19.79 months (mean +/- standard deviation). Minimum follow-up was 24 months (mean +/- standard deviation 49.84 +/- 27.73 months; range 24-112 months). We measured the tilt of the iliac bone (difference of preoperative and postoperative acetabular index values). We divided the hips into two groups. There were 29 hips in Group 1 (deviation amount <20 degrees ) and 16 hips in Group 2 (deviation amount > or =20 degrees ). At the latest follow-up, frontal and axial plane computed tomographic analyses were performed. We measured medial wall thickness, teardrop width, and hemipelvis heights to evaluate triradiate cartilage intactness indirectly. Posterior center edge angle, which reflects posterior coverage of the hip, was also measured. RESULTS: We found no differences between groups regarding all measured parameters. CONCLUSIONS: Modified Salter osteotomy with transiliac lengthening can be performed safely in the treatment of neglected DDH.

Immediate incorporated hip spica casting in pediatric femoral fractures: comparison of efficacy between normal and high-risk groups.

BACKGROUND: Immediate hip spica casting is the most commonly used method for the treatment of pediatric femoral fractures. The main disadvantage of the method is the unacceptable shortening (>25 mm), which may occur during the treatment. Buehler et al described the so-called telescope test to identify the cases with a relatively high risk of unacceptable shortening. On the basis of this test, patients with an overriding of the fracture ends of more than 30 mm have a 20.4 times higher risk of unacceptable shortening compared with those with an overriding of less than 30 mm. This relatively higher risk of unacceptable shortening may be avoided by a hip spica cast, which is incorporated to a distal femoral traction pin. METHODS: The study consists of 47 (26 boys and 21 girls) patients. Mean age was 40.3 months (range, 18 months to 6 years). Patients were divided into 2 groups according to the telescope test. Group 1 included patients with telescope test results of more than 30 mm. Group 2 included patients with telescope test results of 30 mm or less. All patients were treated with a hip spica cast, which is incorporated to a distal femoral traction pin within 8 hours of the initial trauma. During cast treatment, patients were followed up by weekly x-ray controls for the first month. Patients were assessed for unacceptable shortening and misalignment. RESULTS: Mean (SD) shortening during cast treatment was 2.9 (5.1) mm on the treated site. Shortening was detected in 16 patients (88.9%) in group 1 and in 7 patients (24.1%) in group 2. A significantly higher number (P < 0.001) of patients developed shortening in group 1. However, unacceptable shortening (>25 mm) did not develop in any patient in both groups. There was no significant frontal plane malalignment in both groups (P > 0.05). Sagittal plane malalignment was significantly higher in group 1 (P < 0.05). CONCLUSIONS: Hip spica cast, which is incorporated to a distal femoral traction pin, avoids unacceptable shortening and frontal plane malalignment in pediatric femoral fractures, which even have a relatively high risk of unacceptable shortening based on the so-called telescope test. However, the technique cannot avoid sagittal malalignment.

[The results of intramedullary nailing in children who developed redisplacement during cast treatment of both-bone forearm fractures]. / Alçi tedavisi sirasinda tekrar deplase olmus çocuk önkol kiriklarinda intramedüller çivileme sonuçlari.

OBJECTIVES: We assessed the results of intramedullary nailing in children who developed redisplacement during cast treatment of both-bone forearm fractures. METHODS: Twenty-eight children (19 boys, 9 girls; mean age 10.6 years; range 8 to 15 years) were treated with intramedullary fixation upon failure of initial reduction of both-bone forearm fractures after a mean of four weeks (range 3 to 6 weeks) of cast treatment. Intramedullary fixation was performed following closed (n=20) or open (n=8) reduction using K-wires in the first 10 cases, and titanium elastic nails in 18 cases. Single bone fixation was possible in four (14.3%) cases. For malunion assessment, the amount and location of the maximum radial bow were measured and compared with the normal side and with corresponding extremities of age-matched controls. Functional results were assessed using the Grace-Eversmann criteria. The mean follow-up was 14 months (range 12 to 18 months). RESULTS: Except for a nonunion of the ulna in one patient who underwent single bone fixation, all correction losses could be restored to normal alignment and united within a mean of seven weeks (range 6 to 8 weeks). The amount and location of the maximum radial bow did not differ significantly from those of the normal side and control extremities (p>0.05). Functional results were excellent in 25 patients (89.3%), good in two patients (7.1%), and unacceptable in one patient (3.6%). None of the patients developed infection, neurapraxia, or after removal of the nail, angulation, refracture, or extremity length discrepancy. CONCLUSION: Intramedullary fixation for correction losses during cast treatment of both-bone forearm fractures is a safe and inexpensive treatment, allowing early mobilization and providing excellent anatomic and functional results.

[The effectiveness of short-segment posterior instrumentation of thoracolumbar burst fractures]. / Torakolomber vertebranin patlama kiriklarinda kisa segment posterior enstrümantasyonun etkinligi.

OBJECTIVES: We evaluated the results of short-segment posterior instrumentation of thoracolumbar burst fractures and investigated correlations between radiographic and functional results as well as factors that affected correction losses. METHODS: We reviewed 48 patients (30 males, 18 females; mean age 40+/-14 years; range 18 to 67 years) who underwent short-segment posterior instrumentation with pedicle screws and fusion. The most common involvement was at L1 in 18 patients (37.5%), followed by T12 in 11 patients (22.9%). According to the Frankel grading system, six patients had complete, 14 patients had incomplete neurologic deficits. The Cobb angles were measured, and canal remodeling was assessed by computed tomography. Modified functional results were derived using the Denis pain and work scales. The mean follow-up was 21.7+/-9.1 months (range 12 to 48 months). RESULTS: The mean correction in the Cobb angle was 18.2+/-8.6 degrees (p<0.01), the mean correction loss was 7.4+/-5.7 degrees (p<0.01), and the mean canal remodeling was 51.3+/-9.3% (p<0.001). There was a significant correlation between Cobb angle correction and correction loss (r=0.38, p<0.01). An intraoperative correction of greater than 15 degrees was significantly associated with a greater correction loss (p<0.05). Patients with a correction loss of more than 10 degrees had a significantly poorer Denis pain score and modified functional result (p<0.05). Modified functional results were excellent in 16 patients (33.3%), good in 23 patients (47.9%), fair in seven patients (14.6%), and poor in two patients (4.2%). At final follow-ups, the Cobb angle was not correlated with functional results (p>0.05). All the patients having incomplete neurologic deficits improved by at least 1 Frankel grade. CONCLUSION: An intraoperative correction exceeding 15 degrees is significantly associated with a greater correction loss, which in turn has a significantly adverse effect on functional results.

Residual axial plane deformities after hip reconstruction for developmental dysplasia of the hip after walking age.

Children with developmental dysplasia of the hip after walking age can be treated with one-stage combined operations. In these procedures, complex deformity corrections at both frontal and axial planes are performed in the guidance of intraoperative stability tests. The reports about the results of these procedures focus on frontal plane assessments but neglect to assess axial plane corrections. We aimed to find out whether hips with unilateral developmental dysplasia of the hip, treated by one-stage combined procedures after walking age and which had good frontal plane containment at the last follow-up, had any axial plane deformities. Twenty-one patients were included in this study according to our described criteria. Mean age at the operation time was 38.04 months (range: 20-86 months), mean follow-up time was 55.54 months (range: 24-117 months) and mean age at latest follow-up was 93.46 months (range: 52-150 months). Femoral anteversions, acetabular anteversions and acetabular sector angles were measured bilaterally in the computed tomography examination. Operated hip measurements were compared with the contralateral hips. One-way variance analysis was used for statistical analysis. Femoral anteversion, acetabular anteversion and posterior acetabular sector angle values of the operated hips were found to be statistically lower than those of the contralateral hips. Our findings suggest that using the intraoperative stability test alone for planning osteotomies may lead to unsuitable femoral head coverage in axial plane although successful frontal plane containment can be obtained. We believe that strict preoperative planning that can be accomplished by a preoperative computed tomography examination should be performed in order to decide innominate osteotomy type and correction amounts.

[Cementless total hip arthroplasty in patients with avascular necrosis of the femoral head]. / Femur basi avasküler nekrozu olan hastalarda çimentosuz total kalça artroplastisi.

OBJECTIVES: We assessed the results of cementless total hip arthroplasty in patients with late-stage avascular necrosis of the femoral head. METHODS: Unilateral cementless total hip replacement was performed in 25 patients (19 males, 6 females; mean age 39.6 years; range 26 to 56 years) with avascular necrosis of the femoral head. A cementless acetabular cup with screws was used for the acetabulum with a cementless femoral component. Functional results were evaluated according to the Harris hip score. Radiographically, acetabular and femoral components were evaluated according to the criteria of Lins et al. and Engh et al., respectively. Heterotopic ossification was assessed according to the criteria of Brooker et al. The mean follow-up was 63.9 months (range 48 to 94 months). RESULTS: The mean Harris hip score increased from 41.5 (range 33 to 52) to 87.1 (range 74 to 96) after the treatment (p<0.001). No radiographic loosening was detected in 22 patients (88%). Radiolucent lines were observed in one acetabular and two femoral components, but no secondary interventions were performed as the patients were asymptomatic. Heterotopic ossification was observed in 13 patients, which was grade 1 in eight patients, grade 2 in two patients, and grade 3 in three patients. CONCLUSION: In general, patients who undergo total hip arthroplasty for avascular necrosis of the femoral head are younger and more active compared to those with osteoarthritis, showing a high likelihood of future revision procedures. Our results favor cementless applications as a more appropriate alternative in this patient group.

Bensahel et al. and International Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability.

In order to assess interobserver and intraobserver reliability of an evaluation system of the International Clubfoot Study Group, 30 children treated for unilateral clubfoot and their radiographs were examined by three different observers. The mean intraobserver kappa value was found to be 0.62. The mean interobserver kappa value was 0.73. These kappa values correlated with a substantial degree of agreement. Interobserver reliability for all subgroup evaluations (morphologic, functional and radiological) and total scores was 90% or over. This also indicates a good interobserver reliability. In conclusion, the Bensahel et al. and International Clubfoot Study Group outcome evaluation system may be used reliably for the assessment of outcome of the treatment of clubfoot.