Advantages of single-stage surgical treatment with salter innominate osteotomy and Pemberton pericapsular osteotomy for developmental dysplasia of both hips.

OBJECTIVE: This study retrospectively compared the clinical and radiological outcomes of patients with bilateral developmental dysplasia of the hip who underwent either a single-stage operation (using a Salter innominate osteotomy for one hip and a Pemberton pericapsular osteotomy for the other hip) or a two-stage procedure comprising consecutive operations. METHODS: Extensive pre- and postoperative clinical, surgical and radiological examinations were undertaken. RESULTS: A total of 63 patients received the single-stage operation (group A), and 55 patients received consecutive operations (group B). There were no significant between-group differences in acetabular index or centre-edge angle correction. Group A had significantly reduced anaesthetic exposure, duration of hospitalization, blood transfusion volume, antibiotic costs and hospitalization costs. Group A also had a lower rate of surgical complications and avascular necrosis than group B. CONCLUSIONS: The single-stage surgical procedure was more economical and allowed more rapid recovery than two consecutive operations. The surgical and anaesthesia team must be highly proficient in order to perform single-stage operations successfully.

Comparisons of analgesic effects of different doses of morphine and morphine plus methylprednisolone after knee surgery.

BACKGROUND: In this double-blind randomized study, the analgesic effects of morphine alone and with methylprednisolone were examined in 72 patients undergoing arthroscopic knee surgery. METHODS: At the end of arthroscopy, patients were allocated randomly to one of four groups to receive intra-articular administrations of saline, morphine 1 mg, morphine 5 mg or morphine 1 mg with methylprednisolone 40 mg. Preoperative and postoperative pain levels at rest and during movement (active flexion of the knee) were measured by a visual analogue scale (VAS). Postoperative analgesic requirements to alleviate pain were evaluated. RESULTS: Pain scores were significantly lower for the patients who received 5 mg morphine and 1 mg morphine with 40 mg methylprednisolone than for those who received saline or 1 mg morphine. This was accompanied by a decrease in the postoperative consumption of analgesics and prolongation of the duration of pain relief. CONCLUSIONS: This study confirms that the analgesic effect of morphine given intra-articularly is dose dependent and that combination of methylprednisolone with morphine has an additive effect on analgesia.

Spinal Brucellosis with Paraspinal Abscess Formation Treated with CT Guided Percutaneous Abscess Drainage.

SUMMARY: Although brucellosis may be present in various systems, osteoarticular brucellosis is a serious complication of human brucellosis. We present two cases of Brucellar spondylitis (BS) having paraspinal abscess with epidural extension. The first case of non-complicated paraspinal abscess was treated effectively with percutaneous abscess drainage and antibrucellar chemotherapy. However, the second case with disseminated BS and multiseptated large abscess did not respond to needle drainage with medical treatment. Because of the persistence and re-growth of the abscess, he was treated with percutaneous catheter drainage using the Seldinger technique. They showed adequate radiological and clinical response to drainage and antibrucellar chemotherapy.

Effects of Salter innominate osteotomy on the sacroiliac joint in patients with developmental hip dysplasia.

The pressure effects of Salter innominate osteotomy (SIO), a surgical treatment for developmental hip dysplasia (DHD), on the sacroiliac joint were investigated in a retrospective study. Pre- and post-operative direct anteroposterior pelvic radiographs of 60 cases with unilateral DHD treated by SIO were examined. The mean age at surgery was 27.7 months (range 18-48 months). The distance from the posterior inferior iliac spine to the midline (from the middle of the first sacral vertebra to the symphysis pubis) was measured. No difference was found between pre- and post-operative distances on the normal, non-operated side. On the operated side, no change was observed in 10 cases (16.7%), but the distance increased by 2 mm or 3 mm in 50 cases (83.3%) post-operatively. This increase was statistically significant, but not related to age at surgery. These findings indicate that SIO creates pressure on the inferior part of the sacroiliac joint, resulting in some displacement. Such irreversible changes may eventually lead to joint degeneration and pain.

Association of sister chromatid exchange frequencies in patients with ankylosing spondylitis with and without HLA-B27.

BACKGROUND: The analysis of sister chromatid exchange (SCE) is a cytogenetic technique used to show DNA damage due to an exchange of DNA fragments between sister chromatids. OBJECTIVE: To determine whether HLA-B27 positive patients with ankylosing spondylitis (AS) were associated with higher SCE frequencies than patients without B27. METHODS: Lymphocytes from 38 patients with AS (15 women, 23 men) and 34 control subjects were examined. Peripheral lymphocytes were cultured in darkness for 72 hours in BrdU added culture. Metaphase chromosomes were stained with a fluorescence and a Giemsa stain after a standard harvest procedure. RESULTS: The frequency of SCE was significantly increased in patients with AS compared with controls (p<0.001). Furthermore, the SCE frequencies in patients with positive HLA-B27 was much higher than in patients with negative HLA-B27 (p<0.001). The difference between SCE frequencies in the control groups with and without HLA-B27 was not significant. CONCLUSION: There is a strong association between HLA-B27 and the frequencies of SCE in patients with AS.

Primary hydatidosis of the gracilis muscle in a girl.

Primary muscle hydatidosis is very rare. Rupture and spreading of the cyst contents by improper handling may later cause secondary cyst or allergic reactions. Preoperative recognition of a hydatid cyst is therefore critical. It often presents as a soft-tissue mass, however, and pre-operative recognition of this rare entity is clearly difficult. Here, a case of primary hydatidosis affecting the gracilis muscle is presented, and the magnetic resonance imaging, clinical and pathological findings are described.

[Rotational deformities as the complication of the conservative treatment of children's femoral shaft fractures (apparent cycles and clinical results)]. / Cocuk femur cisim kiriklarinin konservatif tedavisinin bir komplikasyonu olarak görülen rotasyonal deformiteler (görülme sikligi ve klinik sonuçlar).

In this study, we tried to determine the frequency and violence of rotational deformities and evaluated their clinical results by the physical examination findings and the foot-progression angle in children's femoral shaft fractures to which it was applied the conservative treatment. In the Department of Orthopaedics and Traumatology of Atatürk University Medical School, between 1992-1999 years, of 82 children who were treated with traction and spica cast, 50 who could be controls and had unilateral fracture were included into this study. Of these cases, 11 (22%) were females and 39 (78%) males. The average age was 4.2 years, ranging from 4 days to 13 years. The traction period was 10-25 (average 18.1) days, and the cast period was from 20 days to 12 weeks (average 8.4 weeks). The cases were followed up with an average period of 3.5 years (5 months-6 years). The foot-progression angle increased in 21 cases (42%) as average 2.1 degrees and decreased in 26 cases (52%) as average 4.9 degrees. The change amount in angle was excessive in the elder children, the proximal femoral fractures and the cases whose the follow-up was smaller than 1 year (p < 0.01). However, in the final control, none of the cases and their parents had complaint, and physical and walking examinations were normal. In the result of this study, it was concluded that the rotational deformities that were symptomatic and required treatment were not the common complication after the conservative treatment in children's femoral shaft fractures.

[Outcome for acute grade III acromioclavicular dislocations using Neviaser's method for surgical treatment]. / Neviaser yöntemi ile tedavi edilen akut grade III akromioklavikular çikiklarda sonuçlar.

There are the different opinions on the methods used in the treatment of acute grade III acromioclavicular dislocations and their results. In this study, the results of 10 patients treated with Neviaser's method and followed in The Department Orthopaedics and Traumatology of Atatürk University Medical School were evaluated. All patients were males and the average age was 36.5 (25 to 45) years. The causes of dislocations were falls on the shoulder in 5 cases (50%), traffic accidents in 4 cases (40%) and direct trauma to the shoulder in 1 case (10%). The mean interval between injury and operation time was 10.2 (5 to 20) days. The cases were followed up with an average period of 13.1 months (6 months 2 years). The excellent and good results were obtained in 9 cases (90%) and the complication was observed in not one of the patients. We consider that Neviaser's method is a good alternative in the treatment of acute grade III acromioclavicular dislocations that operation is indicated.

Congenital bilateral short femur complicated by stress fracture. A case report.

Congenital malformation of the femur is an uncommon but complex problem. Short femur with proximal deficiency (Kalamchi type III) is part of this congenital anomaly. If the precautions associated with progressive coxa vara and bowing in the femoral shaft are not taken, stress fractures may occur in the femoral neck and the femoral shaft. We report on a 38-year-old female with type III-A congenital malformation of both femurs who presented the complications mentioned and had not been treated before. This case is instructive because it illustrates the complications developed in patients who have not been treated.