Analysis of predictive factors for post-traumatic osteoarthritis and poor outcomes in acetabular fractures treated surgically.

OBJECTIVE: The aims of this study were (i) to assess the radiological and functional outcomes of surgically treated displaced acetabular fractures and (ii) to analyze the predictive factors of poor outcomes following surgery. METHODS: A total of 119 patients (24 female, 95 male) who were operated between 2009 and 2019 were included in the study. The mean age was 47.5 years (range=18-61). The mean follow-up was 92.3 months (range=24-120). Failure to preserve the biological hip joint, as treated with total hip replacement or the Girdlestone procedure, was defined as a poor outcome. Patients' demographic information, comorbidities, fracture types, surgical approach, concomitant injuries, reduction quality, and complications were analyzed. Computed tomography was utilized to evaluate the fracture type and quality of reduction. Factors affecting poor outcomes were analyzed by logistic regression analysis. The modified Harris Hip Score was also used to evaluate the functional status. RESULTS: The poor outcome rate was 10.1%. Multivariate logistic regression analysis revealed that dislocation (odds ratio: 44.87, confi- dence interval: 3.18-633.22, P=.005), wound site problems (odds ratio: 9.09, confidence interval: 1.01-81.12, P=.04), reduction quality (odds ratio: 77.88, confidence interval: 5.95-1019.07, P = .001), and diabetes (odds ratio: 7.29, confidence interval: 1.01-52.07, P = .04) were associated with poor outcomes. Eight of the 12 patients with poor outcomes had a fair Harris Hip Score, and 4 had a poor Harris Hip Score. The relationship between poor outcomes and Harris Hip Score was found to be significant (P < .001). CONCLUSION: For a favorable functional outcome in acetabular fractures, preservation of the biological hip joint should be a top priority. The accompanying dislocation and the patient's diabetes appear to be uncontrollable factors for the poor prognosis. Good reduction qual- ity and wound infection protection are modifiable factors. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Comparison of exosomes secreted by synovial fluid-derived mesenchymal stem cells and adipose tissue-derived mesenchymal stem cells in culture for microRNA-127-5p expression during chondrogenesis.

This study aimed to investigate the differences between the exosomal microRNA-127-5p expression profiles of human adipose tissue-derived mesenchymal stem cells (hAT-MSCs) and human synovial fluid-derived mesenchymal stem cells (hSF-MSCs) during chondrogenesis in terms of regenerative treatment of cartilage. Synovial fluid-derived mesenchymal stem cells, adipose tissue-derived mesenchymal stem cells, and human fetal chondroblast cells (hfCCs) were directed to chondrogenic differentiation. Alcian Blue and Safranin O stainings were performed to detect chondrogenic differentiation histochemically. Exosomes derived from chondrogenic differentiated cells and their exosomes were isolated and characterized. microRNA-127-5p expressions were measured by Quantitative reverse transcription PCR (qRT-PCR). Significantly higher levels of microRNA-127-5p expression in differentiated hAT-MSCs exosomes, similar to human fetal chondroblast cells, which are the control group in the chondrogenic differentiation process, were observed. hAT-MSCs are better sources of microRNA-127-5p than hSF-MSCs for stimulating chondrogenesis or in the regenerative therapy of cartilage-related pathologies. hAT-MSCs exosomes are rich sources of microRNA-127-5p and can be an essential candidate for cartilage regeneration treatments.

Predictive factors associated with thirty-day mortality in geriatric patients with hip fractures.

OBJECTIVE: This study aimed to determine the predictive factors affecting the 30-day mortality in geriatric hip fractures, investigate the effect of the timing of surgery, and thus determine the optimum cut-off time in delaying the surgery. METHODS: A total of 596 patients(205 men, 391 women; mean age = 78.3 years) were included in this retrospective study. All possible predictive factors encountered in the literature review, including age, sex, fracture type, comorbidities, American Society of Anesthesiologists (ASA) score, surgical delay time, anaesthesia type, surgery type, need for erythrocyte replacement, postoperative complications, and the need for postoperative intensive care were analyzed. The predictive factors that were found to be significant as a result of the univariate analysis were included in the multivariate logistic regression analysis. RESULTS: The reason for surgery was an extracapsular fracture in 359 patients (60.2%) and an intracapsular fracture in 237 (39.8%). Arthroplasty was performed in 256 patients (43%), while proximal femoral nails were used in 251 (42.1%), dynamic hips screws in 68 (11.4%), and cannulated screws in 21 (3.5%). 523 (87.8%) of the patients had an ASA score of 1 or 2, and 73 (12.2%) had an ASA score of 3 or 4. General anaesthesia was performed on 35.2% of the patients, while regional anaesthesia was administered to 64.8%. Major complications developed in 42 patients (7%), while minor complications were observed in 143 (24%). The mean surgical delay time was 3.21 days (1-9 days). The ASA score (P <0.001, OR: 56.83, CI: 5.26-2.820), anesthesia type (P = 0.036, OR: 3.225, CI: 0.079-2.264), surgical delay time (P <0.001, OR: 2.006, CI: 1.02-0.372) and major complication (P = 0.002, OR: 6.41, CI: 0.661-3.053) were determined to be predictive factors of 30-day mortality. CONCLUSION: This study found the median surgical delay time as three days in surviving patients and five days in deceased ones. Thus, a 3-day surgical delay may be acceptable and sufficient for medical optimization and the consensus of the multidisciplinary team. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Preliminary results of a new intercalary modular endoprosthesis for the management of diaphyseal bone metastases.

OBJECTIVES: This study aims to evaluate functional outcomes of patients and to analyze complication rates of modular intercalary endoprosthetic reconstruction after resection of metastatic diaphyseal bone lesions. PATIENTS AND METHODS: Between December 2017 and February 2020, 22 patients (15 males, 7 females; median age: 64.2 years; range, 49 to 91) who underwent reconstruction with modular intercalary endoprostheses for metastatic bone tumors at five different centers were retrospectively analyzed. Age, sex, diagnosis, follow-up duration, previous treatments of patients, and resection lengths were recorded. The Musculoskeletal Tumor Society Scores (MSTS) were used to assess functional status of available patients at the final follow-up. Failures were categorized according to the Henderson classification. RESULTS: Locations of the resected tumors included 10 humeri (45.5%), five tibiae (22.7%), and seven femurs (31.8%). The length of the resected tissues ranged from 35 mm to 180 mm. Seven patients (31.8%) died of disease, and one patient died of pneumonia within follow-up period. The functional outcomes of surviving patients were satisfying with a median MSTS score of 86.9% (range, 70 to 100%) at a median follow-up of 17 (range, 8 to 26) months. There were two cases of type II (9%), one cases of type IIIa (4.5%), two cases of type IIIb (9%), and one case of type IV (4.5%) failure. Complications were most commonly observed in tibial reconstructions. CONCLUSION: The good short-term functional results were achieved in surviving patients. Uncomplicated patients were able to perform daily living activities without limitations. The overall rate of complications was relatively low and, among them, mechanical problems were the most commonly encountered problems.

Correlation of 3-T MRI and CT findings with patient symptoms and treatment outcome in radiofrequency ablation of osteoid osteoma.

OBJECTIVE: The aim of this prospective study was to evaluate pre- and post-treatment MRI and CT findings of osteoid osteoma (OO) patients treated with radiofrequency thermo-ablation (RFTA) and to compare these findings with visual analog scale (VAS) scores. METHODS: Sixteen patients (4 females and 12 males; mean age of 18.87 ± 8.75 years (range: 8-37)) with OO were examined with CT and MRI, at baseline and at an average of 3 months following the procedure. On pre- and post-procedural CT and MRIs, OO-related findings were recorded. Treatment success was evaluated with VAS scores. RESULTS: Baseline VAS scores were 8 or 9 and follow-up scores were 0 or 1, indicating no early recurrences. Nidus diameters decreased significantly after the procedure (p = 0.027, p = 0.002, and p = 0.002; and p = 0.001, p = 0.001, p = 0.001 for AP, ML and CC nidus diameters for CT and MRI, respectively). The mean nidus volume were significantly decreased after the procedure (p = 0.001, for CT and MRI). On post-procedural images, cortical thickening, the signal intensity and contrast enhancement of the nidus and the extent of periostitis were significantly decreased (p = 0.019, p = 0.001, p = 0.001 and p = 0.034, respectively). There was no significant change in nidus calcification, perinidal cortical and intramedullary sclerosis, periosteal reaction, bone deformity, bone marrow and soft tissue edema, joint effusion and synovitis after the procedure (p = 0.253, p = 0.062, p = 0.245, p = 1, p = 1, p = 0.429, p = 0.371, p = 0.625, p = 1). CONCLUSION: Although the changes in imaging findings may be helpful in early follow-up of OO patients treated with RFTA, these changes alone cannot be used with accuracy in predicting treatment response. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Prevalence of elastofibroma dorsi on CT: Is it really an uncommon entity?

OBJECTIVE: The aim of this study was to determine the prevalence, demographic data of elastofibroma dorsi (ED) in adult population who had undergone chest CT examination and to discuss clinical, and radiological presentations, and treatment options of ED. METHODS: We retrospectively reviewed 4074 chest CT examinations for ED from July 2014 to April 2015. Lesion size, side, and patient demographics were analyzed for positive cases of ED. The initial radiology reports of patients with ED were also reviewed. RESULTS: Of the 4074 patients, 111 patients (2.73%) (77 women and 34 men; mean age: 68.2 years; range: 35-91 years) had a total of 168 ED. The females had a 1.96 -fold higher prevalence of ED than the males (OR, 1.96; 95% CI, 1.481-2.59). The mean lesion thickness was found to be significantly greater in the female patients compared with the male patients (p = 0.001). The prevalence of the disease was estimated to be 4.98 times higher in patients aged 65 years or older (CI 95%, 3.25-7.36). In 111 ED patients, the lesions were only noted in 9 patients' initial radiology report. CONCLUSION: Here, we present a prevalence study with the largest population in the literature concerning ED. Our study shows that ED is not as uncommon as previously thought and should be especially suspected in females and older age groups. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Open reduction and internal fixation in AO type C distal humeral fractures using olecranon osteotomy: Functional and clinical results.

BACKGROUND: To investigate the outcomes of patients undergoing open reduction and internal fixation with olecranon osteotomy due to AO type13C fractures of the distal humerus. METHODS: Data of 39 patients (mean age, 44.7 years; males, 56.4%) undergoing surgery with the diagnosis of AO type 13C distal humeral fractures were retrospectively evaluated. Patients' demographic characteristics, medical history, and radiological and functional outcomes were recorded. The patients were evaluated at the final follow-up according to the Mayo Elbow Performance Index (MEPI). RESULTS: The mean degrees of flexion and extension loss were 102.2 degrees (range, 60-120 degrees) and 11.4 degrees (range, 0-25 degrees), respectively, at the final follow-up. According to the MEPI score, outcomes were excellent in seven, good in 12, fair in 13, and poor in seven patients. All patients achieved a radiological union of the fracture site within the first postoperative six months. It was found that the loss of extension was more severe, the range of flexion was decreased, and the mean MEPI score was lower in the patients with type C3 fractures than in those with type C1 and type C2 fractures. No significant difference was determined between fixation techniques (tension band vs. cannulated screw) regarding the functional outcomes. CONCLUSION: Our results revealed better prognosis in AO type C1 and type C2 fractures than in AO type C3 fractures and no different effects of two fixation techniques in olecranon osteotomy on the outcomes.

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults.

OBJECTIVES: This study aims to assess the experience gained in a single institution in the treatment of mixed type femoroacetabular impingement (FAI) using safe surgical hip dislocation (SSHD) technique. PATIENTS AND METHODS: In this study, 22 hips of 21 patients (7 males, 14 females; mean age 33.8±10.6 years; range 19-52 years) treated by SSHD technique in our clinic between October 2009 and October 2014 were retrospectively evaluated. Preoperative and final Harris hip scores (HHS) and alpha angles were compared. Age, gender, laterality, impingement tests, preoperative HHS, cam and pincer type FAI radiographic indicators and intraoperative articular findings were assessed in terms of their influence to the final functional outcomes. RESULTS: Mean duration of the symptoms was 29.5 months. Groin pain, activated by flexion and internal rotation of the hip, was the main symptom. A radiographic diagnosis of "mixed type FAI" was made in all hips. Mean follow-up duration of 22 hips was 48 months. The difference between the mean preoperative and latest HHS was statistically significant (60.0 vs. 87.6 points, p<0.001). The treatment was considered satisfactory in 17 of 22 hips (77%) having a mean HHS of 95.0 points. Hips having a preoperative HHS of less than 60 points were more prone to unsatisfactory outcome. Among the investigated patient-dependent, clinical, radiographic variables and intraoperative articular findings, coxa profunda sign in a plain radiograph was found correlated with a higher rate of unsatisfactory outcome (p=0.040). CONCLUSION: Safe surgical hip dislocation procedure has a success rate of 77% after a mean follow-up of four years. Coxa profunda sign is associated with the unsatisfactory clinical outcome. Preoperative HHS of less than 60 points seems to be a negative predictive variable on the clinical outcome.

Pulled elbow in children: a case series including 66 patients.

The aim of this case series was to assess the data of 66 children (mean age 28 months) with a diagnosis of pulled elbow. The most common time interval of injury was 12-6 p.m. and spring was the peak season. Children younger than 2 years of age had a higher rate of atypical injury history. A successful reduction by supination and flexion maneuver was achieved at the first attempt in 57 of 66 patients. The patients admitted to the hospital within the first 2 h following the injury had a higher rate of successful reduction at the first attempt. The rate of radiographic examination was considerably high and a well-defined algorithm to avoid the complicacy in ordering a plain radiograph in such cases was suggested. All patients achieved full clinical recovery after a mean follow-up of 2 years, and recurrence was observed in 16 of 66 children.

Definition of a quantitative measurement method for acetabular version in a plain radiograph in the healthy adult hip.

OBJECTIVES: This study aims to define a quantitative measurement method for acetabular version in a standard anteroposterior hip radiograph, assess the intraobserver and interobserver agreements of this method, and compare it with the gold standard computed tomography (CT). PATIENTS AND METHODS: Anteroposterior standard hip radiographs and simultaneously taken transverse acetabular CT sections of 78 hips of 39 patients (10 males, 29 females; mean age 60 years; range 40 to 81 years) were used in the study. In standard anteroposterior hip radiographs, "acetabular anterior wall line" was identified as the line between the most lateral edge of the acetabulum and the inferolateral edge of the teardrop. "Acetabular posterior wall line" was identified as the line between the most lateral edge of the subchondral sclerosis and the outmost point of acetabulum posterior lunate surface sclerosis. To assess the reliability of this technique, mentioned angles in 78 hips were measured by two authors independently two weeks apart. Direct radiographic values were compared with the acetabular version measurement values in CT examination. RESULTS: Mean acetabular version angles of 78 hips in plain radiographs and CT were 18.0° (9-25°) and 17.2° (12-25°), respectively. Mean intraobserver measurement differences were 1.3° (0-5°) and 1.5° (0-6°). Mean interobserver measurement difference was 1.4° (0-5°). The mean difference between plain radiography measurements and CT measurements was 2.5° (0-6°). A significant correlation was detected between plain radiographic measurements and CT measurements. CONCLUSION: By this quantitative method, acetabular morphology may be measured less invasively, easily, quickly and reliably in plain radiograph in transverse plane.

Evaluation of Labral Pathology and Hip Articular Cartilage in Patients with Femoroacetabular Impingement (FAI): Comparison of Multidetector CT Arthrography and MR Arthrography.

BACKGROUND: To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods. MATERIAL/METHODS: Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference. RESULTS: While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p<0.05). The same values for acetabular cartilage assessment were 89/56, 40/60, 71/71 (p>0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (κ=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (κ=0.76 for MRa and κ=0.86 for CTa). CONCLUSIONS: Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology.

A new syndrome mimicking Jaffe-Campanacci syndrome: a case report.

Jaffe-Campanacci syndrome (JCS) is a well-known condition with its clinical and radiological characteristics. Extraskeletal congenital anomalies of this syndrome include café-au-lait spots, mental retardation, cardiovascular abnormalities, ocular deformities, hypogonadism or cryptorchidism. Multiple non-ossifying fibromas are also characteristic bone lesions. In this article, we present a new syndrome mimicking JCS, which is characterized by a simple bone cyst and extraskeletal lesions.

Ultrasonographic Graf type IIa hip needs more consideration in newborn girls.

PURPOSE: According to hip ultrasonography by Graf's method, the type IIa hip has a certain degree of physiological delay in ossification of the bony acetabular roof. The aim of this case-control study was to evaluate the natural history of the type IIa hip. METHODS: Four hundred and thirty-one type IIa hips were identified in 312 of 1,690 ultrasonographically screened newborns with a mean age of 27 days. Parents were accurately informed about the prognosis of such a hip condition and invited for ultrasonographic re-examination at 6-7 weeks of age. RESULTS: Type IIa hip was more common in newborn girls than in boys (P < 0.001). Among 431 type IIa hips, 146 (34 %) missed the follow-up examination at 6-7 weeks of age. Among the completely followed 285 hips, 225 (79 %) developed into a normal hip at 6-7 weeks of age. Newborn boys' hips had a higher rate of spontaneous normalization than girls' hips at 6-7 weeks of age (P = 0.006). All but one type IIa(+) hip became type I without any treatment. According to our management protocol, 35 type IIa(-) hips and one type IIa(+) hip, which later became type IIb, underwent treatment. The rate of treatment was higher in newborn girls' hips than in boys' hips (P = 0.019). CONCLUSIONS: As Graf type IIa hip is more common, has a lower rate of spontaneous normalization and higher rate of treatment in newborn girls than in boys, we recommend paying more attention the type IIa hip in newborn girls. The rate of missing the required follow-up is unacceptably high due to parents' insensitivity regarding the type IIa hip.

Inherited thrombophilia may be a causative factor for osteonecrosis of femoral head in male patients with developmental dysplasia of the hip: a case series.

PURPOSE: The aim of this case series was to assess the effect of two common causes of inherited thrombophilia, factor V Leiden (FVL) and prothrombin mutation (PTM) on the development of osteonecrosis of the femoral head (ONFH) following the treatment of developmental dysplasia of the hip (DDH). METHODS: FVL and PTM analysis of 58 patients (45 females and 13 males; mean age 12.2 years) with ONFH due to DDH treatment was done. RESULTS: Rate of inherited thrombophilia (FVL plus PTM) was 15.5 %. Inherited thrombophilia was nearly four times higher in male patients than in female patients and this difference was mainly due to FVL (P < 0.05). This finding was against the common belief that, coagulation abnormalities were equally distributed across the sexes in normal population. Rates of overall inherited thrombophilia, FVL and PTM were not correlated with the type of ONFH (P > 0.05). CONCLUSION: Hereditary thrombophilia, especially FVL, may be one of the causative factors for the development of ONFH following DDH treatment in male patients. Further prospective, controlled studies are needed to undoubtedly enlighten this issue.

Incomplete left-hand and complete right-hand pisiform and hamate coalition: multidetector computed tomography findings.

Pisiform-hamate coalition is a rare form of carpal coalition. Only 14 cases of pisiform-hamate coalition have been reported in the English-language literature. We present a case of asymptomatic bilateral pisiform-hamate coalition in a 16-year-old boy. We also review the embryology, pathogenesis, and clinical features of pisiform and hamate coalition, along with the associated multidetector computed tomography findings.

Preoperative hematological assessment of pediatric patients with cerebral palsy.

OBJECTIVES: Nutritional deficiencies and use of antiepileptic drugs can lead to alterations in the hematological status of children with cerebral palsy (CP), which may increase the risk of intraoperative or postoperative hematological complications. In this retrospective study, we evaluated the preoperative routine blood tests of CP patients with different levels of walking ability, who were scheduled to undergo orthopedic procedures. METHODS: Hemoglobin level, hematocrit, red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width, white blood cell count, platelet count, prothrombin time, activated partial thromboplastin time, and plasma fibrinogen concentration were compared between 62 consecutive CP patients [28 girls, 34 boys; mean age 8.8 years (range 2-16 years)] and 130 consecutive orthopedic patients as control [64 girls, 66 boys; mean age 9.2 years (range 2-16 years)] who did not have any skeletal, cranial, thoracic, abdominal or major soft tissue injuries, or any other infectious, metabolic, hematological or malignant tumor disorders. RESULTS: CP and control groups were similar with regard to the above-mentioned hematological parameters. In the CP group, no difference was found between Gross Motor Function Classification System for Cerebral Palsy (GMFCS) level I/II patients and GMFCS level III/IV patients in terms of these hematological parameters. CONCLUSION: Preoperative blood tests results of pediatric CP patients, walking with or without any supportive devices and undergoing orthopedic interventions, are similar to those of other orthopedic patients. Advanced preoperative hematological tests can only be recommended for CP patients with abnormal blood test results.

Early clinical results of cementless, bipolar hemiarthroplasty in intracapsular femur neck fractures.

OBJECTIVES: In this study we report our initial experience with the use of cementless, bipolar hemiarthroplasty in elderly patients with intracapsular femur neck fractures. PATIENTS AND METHODS: We operated 67 consecutive patients (39 females, 28 males; mean age 74.4±11.0 years; range 41 to 99 years) who admitted to our clinic June 2007 and November 2009, due to intracapsular femur neck fracture and implanted cementless, rectangular, dual-taper, straight femoral stem (Zweymüller stem) with bipolar head prosthesis. All patients were allowed to full weight bearing with a walker within the first postoperative 48 hours. RESULTS: According to the Garden's classification, there were nine type II, 53 type III and five type IV fractures. Twelve patients were lost to follow-up and 21 deceased during the postoperative follow-up period. Among 34 patients with complete follow-up, 30 were evaluated for the clinical outcome. The mean follow-up time and Harris hip score of the evaluated patients were 19.4 months and 79.4 points, respectively. It was seen that, the patient age significantly correlated with the clinical outcome and a better mean hip score was obtained in the '70 years and younger age group' (83.6 points) as compared to the 'older than 70 years age group' (75.6 points) (p=0.014). Mortality rate was found to be higher in patients older than 70 years (47% vs. 18%; p=0.036) and with displaced fractures (45% vs. 0%; p=0.018). CONCLUSION: Zweymüller cementless bipolar hemiarthroplasty may be an alternative treatment method for intracapsular femur neck fractures especially in the patients under the age of 70 years.

Percutaneous release for trigger thumbs in children: improvements of the technique and results of 31 thumbs.

PURPOSE: Trigger thumb is a relatively uncommon condition in children. If it occurs or persists after 1 year of age, surgical release is the most traditional treatment method. The aim of this prospective study is to describe a technique for the percutaneous release of trigger thumb and to assess the clinical outcome of the presented technique in the pediatric age group. METHODS: This study includes 31 thumbs of 26 consecutive children with a mean age of 2.6 years. An 18-gauge needle that was connected to 10-cc saline filled syringe was used as the surgical instrument for release. Contrary to the earlier reports, the A1pulley was cut from distal pole of the Notta nodule towards the proximal direction. RESULTS: Mean follow-up period was 2.5 years. A successful release without any complication was obtained in all (97% of thumbs) but 1 thumb. Recurrence was seen in only 1 thumb at postoperative 3 weeks. CONCLUSION: The presented minimal invasive surgical procedure has a high rate of satisfactory outcome, a minimal rate of complications, and a high rate of parent satisfaction. As percutaneous release has satisfactory and encouraging results, it can be a preferred method by the parents for trigger thumb release. STUDY LEVEL: III.

Pediatric femur neck fractures: a retrospective analysis of 39 hips.

PURPOSE: The aim of this retrospective study was to analyze the radiological and clinical results of pediatric femur neck fractures. METHODS: This study included 39 children (mean age 11.1, range 4 to 16 years) who had a femur neck fracture and had at least one year of complete follow-up. The most common etiological factor was traffic accident and the most common associated skeletal injury was pelvis fracture. RESULTS: According to Delbet's classification system, there were no type I (transepiphyseal) fractures and 21 type II (transcervical), 14 type III (cervicotrochanteric), and four type IV (intertrochanteric) fractures. The mean follow-up was 3.4 (1-9.5) years. A satisfactory outcome according to Ratliff's radiological and clinical criteria was obtained in 28 (72%) hips. Avascular necrosis (AVN) of the femoral head was seen in 11 (28%) hips and the rate of satisfactory outcome was significantly higher in hips without AVN than in hips with AVN (P < 0.001). Transcervical fractures had the worst outcome (P = 0.014) and the highest rate of AVN (P = 0.077) when compared with cervicotrochanteric and intertrochanteric fractures. No significant correlation was found between both the outcome and development of AVN and age, gender, laterality, amount of fracture displacement, treatment time, and the type of reduction (open/closed) (P > 0.05). CONCLUSIONS: It has been concluded that the development of AVN primarily influences the outcome in pediatric femur neck fractures and that fracture type is essentially correlated with the development of AVN and outcome.