Factors affecting the return to work of total hip arthroplasty due to of developmental hip dysplasia in in young patients.

INTRODUCTION: The aim of this study was to examine the factors affecting return to work after Total hip arthroplasty (THA) applied for coxarthrosis due to developmental hip dysplasia (DDH). METHODS: The study included 51 patients aged <60 years in the period 2004-2010. The demographic information was recorded for all patients and the pre-postoperative Modified Harris score, EQ-5D, EQ-5D VAS and Grimby activity score. With an evaluation of the current employment status at the final follow-up examination. RESULTS: Preoperatively, 21 patients were employed, 16 were unemployed and 14 were housewives, none of whom were able to perform housework tasks. Postoperatively, 30 patients were employed and 10 were unemployed. One of the previously employed patients decided preoperatively to retire and was therefore not employed postoperatively. Of the 14 housewives, 9 were able to undertake the housework themselves postoperatively. The mean time of return to work was 13.4 weeks. Factors affecting finding work postoperatively were determined to be body mass index, National Occupational Level, whether or not osteotomy was applied and the preoperative duration of unemployment. CONCLUSIONS: As coxarthrosis associated with DDH develops earlier than primary coxarthrosis, these patients undergo surgery at a younger age and the vast majority are of working age. THA applied for coxarthrosis on the basis of DDH enables most patients to return to their preoperative work and offers the opportunity of finding work to some of those who were unemployed. This increases the contribution of these patients to the national economy.

An Unusual Disengagement of the Humeral Head Component after Hemiarthroplasty: A Case Report Presentation.

INTRODUCTION: Proximal humeral fractures account for 4% to 5% of all fractures. Complex proximal humeral fractures with displaced three- and four-part fragments, humeral head splits and fracture-dislocations are more difficult to treat. In older patients, because of poor bone quality, hemiarthroplasty is often the indicated treatment. CASE REPORT: One such case of a 73-year-old woman is presented here. The patient presented with a four-part fracture of the proximal humerus, with displacement of the humeral head. Hemiarthroplasty was done in the right shoulder. At postoperative 20 days, during physical therapy, the humeral head component of the prosthesis disengaged and a second operation was necessary. A deltopectoral approach was repeated using the previous incision. The humeral stem was seen to be well-fixed into the bone so the humeral head was changed for a new one of the same size. At two years, the dominant right side had active, painless ROM. CONCLUSION: The management and two-year follow-up of this case is reported here, which was the first to occur at our institution.

Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study.

We evaluated the gait characteristics of patients who had short or long-segment fusion after thoracolumbar burst fractures. The study included 12 patients (5 male, 7 female) who had vertebral fusion after traumatic thoracolumbar region (T12-L2) burst fractures. Patients were divided into two groups based on fixation type (short or long segment). Twelve healthy age and sex-matched subjects (seven male, five female) served as controls. Quantitative gait data, including all time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle), and kinetic data (moments of hip in sagittal and coronal plane) were collected. Three patients had a T12, six patients an L1, and three patients had an L2 lesion. Patients in the two groups were similar in terms of age, sex, and time since operation. No significant differences were found in the time-distance, kinematic, and kinetic gait characteristics between the two groups. This preliminary study reveals that the gait characteristics of patients with short and long-segment fusion after thoracolumbar burst fractures were similar to those of healthy subjects and did not differ from each other. However, the present results should be interpreted with caution due to the small sample size. Future studies with larger groups are needed to provide additional data to validate these findings.

Age-related changes in human tendo calcaneus collagen fibrils.

OBJECTIVE: The ruptures of tendo calcaneus often occur between the age of 30-45 years as described by several textbooks. It is also described that some diseases and drugs are said to be responsible in the etiology; however, there are no studies related with the detailed histological structure of collagen fibrils found in the tendon in the age groups of humans. In view thereof, this study was aimed to obtain further information on the etiology and to find an answer regarding the frequency of the ruptures occurring between the age of 30-45 years in humans. METHODS: In the study, the biopsy specimens taken from 28 patients (ages 1-68 year) who had undergone surgery due to tendo calcaneus ruptures or achilloplasty operation were examined by transmission electron microscope. All the specimens were prepared according to routine electron microscopic tissue preparation technique. The patients were divided into 7 age groups (1-9, 10-19, 20-29, 30-39, 40-49, 50-59, >60 years) and there were 4 patients in each group. The transverse diameters of collagen fibers were measured from the ultra thin sections and statistical analysis of the results were performed. The study was carried out in the electron microscopy laboratory of the Anatomy Department of Hacettepe University, Ankara, Turkey between January 2004 and September 2004. RESULTS: The diameters of the collagen fibers were higher in the 20-29 year-old group compared to other groups and it showed a statistically significant difference. In patients who were in the 30-39 year-old group or older, the diameters of the collagen fibers were lesser than the 20-29 year-old group. However, an increase was observed in the collagen fibril concentration of these groups. In examination of the specimens of patients who were under 20-year-old, the diameter of the collagen fibers were less than the 20-29 year-old group. The electron microscopic appearance of the tissue sample of a one-year-old patient had a specific organization and in this patient, both the diameters and concentration of collagen fibers were less. CONCLUSION: We believe that the decrease in the diameters of collagen fibers of 30-45 year-old patients who are in the active period of their life, can play a role in the etiology of the frequency of tendo calcaneus ruptures similar to other etiologic factors.

Fibular lengthening procedure: treatment for lateral instability of the ankle caused by fibular insufficiency in Melnick-Needles syndrome.

The Melnick-Needles syndrome (MNS) is a rare bone dysplasia with characteristic clinical and radiologic diagnostic findings. The diagnosis of MNS was made for the patient reported in this paper clinically and radiologic confirmation was done afterwards. Her left fibula was shorter than the right one. She had lateral insufficiency in her left ankle and could not bear weight on her left foot. A fibular length discrepancy of 2 cm was assessed. Her ankle-hindfoot score was 49 according to the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating system for ankle and hindfoot. Simple fibular lengthening was performed with a unilateral external fixator. Two centimetres of fibular lengthening was obtained in 14 weeks. Her AOFAS ankle-hindfoot score was 82 after 27 months of follow-up. Ankle stability and plantigrade foot were achieved and the result was satisfactory.