Comparison of the Isolated Plantar Fascia Release Versus Plantar Fascia Release Combined With Calcaneal Decompression in Management of the Patients With Resistant Heel Pain.

We aimed to compare isolated percutaneous plantar fascia release by using a needle versus percutaneous plantar fascia release combined with calcaneal decompression in treatment of the patients with resistant heel pain. We reviewed the prospectively recorded data of patients who treated and follow-up for resistant heel pain (treated more than 6 months with other treatment modalities) with a minimum 1-year follow-up. Twenty patients were treated with plantar fascia release using a needle (group 1) and 21 patients were treated with a similar percutaneous release combined with calcaneal decompression (group 2). Functional outcomes were evaluated using visual analog scale (VAS) and Foot Function Index (FFI) pre- and postoperatively. No significant differences were observed between both groups in terms of age (44.3 years in group 1 vs 46.8 years in group 2), gender (18 females and 2 males in group 1 vs 19 females and 3 males in group 2), body mass index (25.1 in group 1 vs 26.3 in group 2), and follow-up (14.6 months in group 1 vs 15.7 months in group 2). The decrease in postoperative FFI and VAS scores compared with preoperative VAS scores was statistically significant in both groups. However, improvement of FFI and VAS score was significantly higher in group 2 than group 1. Although both methods are very effective in the treatment of persistent heel pain, the group 2 has a better improvement in functional scores than group 1 with a mean 15 months following the procedure.

The Effects of Different Screw Combinations on the Initial Stability of Ankle Arthrodesis.

Background: The literature is scanty regarding the biomechanical effects of different thread configurations on the initial stability of ankle arthrodesis. This study aims to compare the initial stability of tibiotalar fusion site in ankle arthrodesis using cannulated screws with different thread designs. Methods: We biomechanically tested under cyclic loading the effects of different screw combinations on the initial stability of ankle arthrodesis. A total of 28 synthetic ankle models were divided into four groups: two partially threaded cancellous screws (group A), partially and fully threaded cancellous screws (group B), a partially threaded cancellous screw with a headless compression screw (group C), and a fully threaded cancellous screw and a headless compression screw (group D). Biomechanical variables including ultimate failure load, initial stiffness, ultimate stiffness, and failure angulation were analyzed. Results: There were no differences in any of the biomechanical variables among the four groups (P = .41 for ultimate failure load, P = .079 for initial stiffness, P = .084 for ultimate stiffness, and P = .937 for failure angulation). Conclusions: Combinations of different cannulated screws showed similar results in terms of the stability and stiffness of the tibiotalar fusion site.

Quality of Life Evaluation Following Limb Lengthening Surgery in Patients with Achondroplasia.

BACKGROUND: The primary objective of this study was to evaluate the quality of life following limb lengthening surgery in patients with achondroplasia. The complications and different lengthening techniques have and effects on mid-term results were also investigated. METHODS: We performed a retrospective, multicenter study by evaluating the records of patients with achondroplasia operated in our clinic between 1999 and 2014 for limb lengthening with a minimum follow-up of 3 years. Forty nine patients were underwent bilateral lower limb lengthening surgery and 21 of 49 patients underwent bilateral humerus lengthening surgery. Patients were evaluated by the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales to assess the health-related quality of life (HRQOL) of children. Twenty patients with achondroplasia who had no lengthening surgery history were also evaluated with the PedsQL score as the control group. RESULTS: The average age at the time of first surgery was 6.17 years. The average follow-up period was 100.2 months. The average age at the time of study 14.70 ± 2.44 (11-18) years. There were significant differences between the patients with humeral lengthening and patients who did not undergo humeral lengthening in all scores. Transient complications had minimal effects on scores. Although all scores in the operated group were higher than non-operated patients with achondroplasia, there were no significant differences. CONCLUSION: Quality of life was significantly improved as a result of humerus lengthening surgery of patients with achondroplasia, despite minor complications compared with Lower limb lengthening surgery. LEVEL OF EVIDENCE: Level III, case control study.

Acute correction and intramedullary nailing of aseptic oligotrophic and atrophic tibial nonunions with deformity.

OBJECTIVES: This study aims to describe the important points for treatment of aseptic tibial oligotrophic and atrophic nonunions by intramedullary nailing (IMN). PATIENTS AND METHODS: The retrospective study included 17 biologically nonactive nonunion patients (12 males, 5 females; mean age 36.4 years; range, 19 to 49 years) operated between February 2010 and November 2017 by deformity correction, static IMN and autografting. The mean follow-up time was 4.2 (range, 3 to 7) years. The initial fracture management was external fixator for all patients. Fourteen patients had open fractures initially. Six patients had valgus, four patients had varus, three patients had oblique plane, and four patients had external rotational deformity. Nonunion diagnosis was established on the basis of the patient history and physical examination based on plain radiographs, computed tomography or both. All patients were evaluated by the same protocol to exclude any infection. RESULTS: The median time from injury to nailing was mean 10.3 (range, 6.1 to 36.5) months. Radiologic and clinical union was achieved in all patients. The mean union time was 3.64 (range, 3 to 6) months. Three patients had positive intraoperative bacteriological culture. In four patients, dynamization was necessary for consolidation. Late deep infection developed in three patients after union, and all infected cases were operated by implant removal, debridement, and appropriate antibiotics. CONCLUSION: Intramedullary nailing and autografting after external fixator provide good results for the treatment of aseptic biologically nonactive nonunions with deformity. Reamed IMN ensures sufficient deformity correction, biological environment, and mechanical stability. The infection risk should always be kept in mind and patients should be followed-up closely to prevent complications.

Relationship of Postoperative Achilles Tendon Elongation With Plantarflexion Strength Following Surgical Repair.

BACKGROUND: Little data exist regarding the adverse effects of Achilles tendon (AT) elongation after rupture repair on plantarflexion strength. This study aimed to investigate the effect of AT elongation measured using AT resting angle (ATRA) on the plantarflexion strength in patients with surgically treated acute AT rupture. METHODS: A retrospective chart review was performed on 40 patients (15 female and 25 female) who underwent open operative repair due to an acute AT rupture. At the final follow-up, AT elongation was assessed using ATRA. Plantarflexion strength (peak torques and angle-specific torques) was measured using an isokinetic dynamometer. All variables were obtained from the operated and unoperated contralateral ankles of the patients. RESULTS: The mean ATRA was greater in the operated ankles (mean, 57 degrees; range, 39-71 degrees) compared with the unoperated ones (mean, 52 degrees; range, 36-66 degrees; P = .009). Except the plantarflexion torque at 20 degrees of plantarflexion (P = .246), all the other angle-specific torques were lower in the operated ankles (P < .05). Peak flexion torque at 30 degrees/s was lower in the operated ankle (P = .002). A negative correlation was found between operated/unoperated (O/N) ATRA and O/N plantarflexion torque ratios at 0 degrees (r = -0.404; P = .01), 10 degrees (r = -0.399; P= .011), and 20 degrees (r = -0.387; P = .014). CONCLUSION: Postoperative AT elongation measured using ATRA may have a deleterious effect on the plantarflexion strength in patients with surgically treated acute AT rupture. LEVEL OF EVIDENCE: Level IV, case series.

Unprecedented recurrence of carpal tunnel syndrome by metaplastic synovial cyst in the carpal tunnel.

Metaplastic synovial cyst (MSC) is a benign cystic lesion observed after surgical intervention and recurrent skin trauma. Because of its rarity, the etiology is not fully understood. The most emphasized etiologic factors are recurrent surgical procedures and cutaneous pathologies, which cause cutaneous fragility and abnormal wound formation. In the literature, MSC is exemplified as a mass that can be observed by the naked eye and palpated. All patients had a history of previous surgical procedures in the area. In the present case, we report a 48 -year-old woman with recurrent carpal tunnel syndrome due to a MSC. This report showed that MSC can be detected at deeper locations than the regions described in the literature. To our knowledge, this is the first report of MSC causing carpal tunnel syndrome recurrence. It is thought that previous operations are the most important etiologic factor in MSC occurrence.

Treatment of Graf Type IIa Hip Dysplasia: A Cut-off Value for Decision Making

Background: The rate of spontaneous normalization in type IIa hips is reported to be high, whereas dysplsia persists or worsens in 5%-10% of cases. Aims: To evaluate the natural course of type IIa hips using Graf's own perspective of physiological immaturity and maturational deficit. Study Design: A single center, retrospective cohort study. Methods: This was an institutional review board-approved retrospective review of all patients diagnosed with type IIa hip dysplasia at a single institution from 2012 to 2014. All patients included in the study had hip ultrasonography at about 6 weeks and 3 months of age. To assess reliability in α and ß angles, ultrasonography measurements were carried out on the same image individually by all observers. The α and ß angles were used as the main outcome measurements to evaluate hip maturation at the last follow-up. A receiver operating characteristics curve was drawn at the 3 month ultrasonography to evaluate the cut-off values for α and ß angles for persistent dysplasia. Results: Sixty-four patients and 88 affected hips (63% unilateral and 37% bilateral) were included. The mean age at diagnosis was 6.4±2.7 weeks. Fifty-four hips were type IIa(+) (physiologically immature) and 34 hips were type IIa(-) (maturational deficit) at the initial ultrasonography evaluation. Improvement to type I was seen in 52 type IIa(+) and 17 type IIa(-) hips. Receiver operating characteristic analyses showed that patients do well if the α angle was >55° (area under the curve: 0.86; p<0.001 for the left hip and area under the curve: 0.72; p=0.008 for the right hip). Conclusion: The cut-off α angle value of 55° on initial ultrasonography should be considered to prevent future dysplasia. An α angle <55° on the initial ultrasonography was an independent predictor of worsening sonographic findings.

Differences between the alpha angles measured manually and digitally from paediatric hip ultrasonograms.

The aim of this study was to reveal whether a meaningful difference is caused by measuring the alpha angle in hip ultrasonography manually or digitally to help the early diagnosis and treatment of DDH and observe the treatment implications of any such difference. All ultrasound images were obtained by same orthopaedist, and each hip was measured twice by two investigators with different levels of experience. Standard images were taken, and a printout of the standard images were obtained. The alpha angle was measured digitally by using the sonography device. The alpha angle was also measured by pencil, ruler and goniometer on the printout after 2 days. One hundred and two hips of 51 babies, at a mean age of 14 weeks, were assessed. The mean alpha angle measured manually with a goniometer was 64.4° (±1.6°), while that measured on the ultrasonography device was 65.3° (±0.9°). This difference was found to be statistically different (p = 0.016). Typology changes occurred in a total of 10 hips out of 102 as a result of manual and digital measurements. However, this study showed reduction in alpha angle variation and considerable advantages for manual alpha angle measurement with pencil and goniometer on a printout compared to computer-based measurement; future studies are needed to understand these differences caused by each measurement method.

Radiological results of modified Dega osteotomy in Tönnis grade 3 and 4 developmental dysplasia of the hip.

Dega acetabuloplasty at the time of open reduction is effective in improving the acetabular coverage of the femoral head, hence improving the stability of reduction and preventing possible surgery in the future for residual acetabular dysplasia in older children with Tönnis grade 3 and 4 developmental dysplasia of the hip (DDH). The aim of this study was to assess the radiological results of open reduction combined with Dega osteotomy in DDH. Twenty-two children's 26 hips were operated on at a mean age of 38±20.4 SD months and followed up for an average of 42 (range 24-108) months. Thirteen hips (50%) were operated on with concomitant open reduction and capsulorrhaphy, and 13 hips (50%) were treated with concomitant open reduction, capsulorrhaphy and femoral shortening osteotomy. Radiological examination included acetabular index (AI) and centre edge angle measurements. The mean preoperative AI was 39.4±6.9° SD, which improved to 18.3±4.5° SD postoperatively, and AI was measured as 15±3.5° SD at the latest follow-up. There was a significant difference in the mean AI values between the last follow-up and the preoperative measurements (P<0.05). The mean centre edge angle was 31±5.6° SD postoperatively, and it was 31±6.2° SD at follow-up. There was no significant difference between the two values. Two hips were noted to have lateralization of the femoral head due to coxa valga anteverta. One of them was operated with a femoral varus osteotomy. The Dega osteotomy combined with anterior open reduction and femoral osteotomies is a safe and effective acetabular osteotomy for surgical treatment of severe DDH such as Tönnis grade 3 and 4 dislocations.