Reliability of preoperative CT and intraoperative manual tests in syndesmosis injury.

OBJECTIVE: We always confirm the diagnosis of syndesmotic injury with a Hook test for all ankle fractures and fixed if necessary. Then, we noticed a discrepancy between preoperative radiology and the Hook test. Moreover, we want to report the reliability of syndesmotic fixation decisions with Hook test and preoperative radiology. METHODS: A total of 37 surgically treated patients with isolated Weber type C ankle fractures were included in the study. In all patients, the syndesmosis joint was injured in preoperative computed tomography and X-ray imaging. However, only patients with (+) Hook tests had undergone a syndesmosis fixation. Patients were divided into two groups: Group A: Hook tests (+) and Group B: Hook test (-). Also, the groups were compared according to clinical outcomes with the Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), and foot and ankle disability index (FADI) scores. RESULTS: The mean participant age was 39 (19-80) years, and the mean follow-up period was 47.27 (22-68) months. Groups A and B consisted of 17 (45.9%) and 20 (54.1%) patients, respectively. The mean VAS, AOFAS, and FADI scores were 17.7±14.3, 90.32±8.06, and 92.9±6.88, respectively. "Excellent" and "good" results were found in 34 (%91.8) patients according to AOFAS nad FADI. The malreduction rate was 8.1% in all patients, 5% in group A, and 11.8% in group B. No statistically significant differences in final functional scores were found between groups A and B. CONCLUSION: Hook test is reliable and adequate for evaluating the stability and quality of syndesmosis reduction. Weber type C lateral malleolar fractures in the decision of syndesmosis fixation; although syndesmosis injury is diagnosed in preoperative radiology, we recommend that the diagnosis be confirmed with the Hook test.

Utility of the Three-Point Index in the determination of reduction loss during the conservative treatment of pediatric forearm mid-third fractures.

BACKGROUND: Forearm fractures constitute approximately 40% of all pediatric fractures. Generally, in conservative treatment,a plaster cast is applied with the elbow in 90° flexion. Success of the treatment depends on theprevention of the reduction in the correct position and suitable duration of the plaster cast. Failure, or the risk of angulation within the cast, is associated with movement within the cast. The aim of this study was to evaluate the applicability of the Cast Index (CI) and Three-Point Index (TPI) measurements, which indicate the loss of reduction, in pediatric mid-third forearm fractures. The hypothesis of the study was that as edema decreases and deformity of the plaster cast occurs after fracture reduction, TPI and CI should be examined during follow-up, as they indicate shifting due to movement within the plaster cast. METHODS: This retrospective study included a total of 48 patients, who were treated with closed reduction and long-arm plaster cast for a mid-third forearm diaphyseal fracture at our Emergency Polyclinic between March and September 2014. The mean age of the patients was 8.15±3.19 years (range, 5-14 years). Patients were excluded from the study if they had isolated radial or ulnar fracture, open fractures, concomitant fracture or systemic disease (bone metabolism disease, etc), and <10° fracture angulation in the ulna and radius on the initial radiograph and if they did not followup. TPI and CI values were calculated on anterioposterior (AP) and lateral radiographs in the Picture Archiving Communication Systems. RESULTS: In the AP plane, compared with TPI values after reduction, statistically significant increases were observed in TPI values 10 days after reduction (p<0.01). However, no significant difference was observed between those with and without reduction loss in TPI values in the AP plane (p>0.05). Although there was a statistically significant increase in TPI values 15 daysafter reduction compared with the values immediately after reduction, a significant difference between those with and without reduction loss was observed only on lateral TPI. CONCLUSION: In cases of pediatric forearm diaphyseal fracture, ulnar TPI examined in the lateral plane can be used in monitoring the fracture in a plaster cast applied after the reduction.

Surgical treatment of distal tibia fractures: open versus MIPO.

BACKGROUND: Treatment of the distal tibial fractures are challenging due to the limited soft tissue, subcutaneous location and poor vascularity. In this control-matched study, it was aimed to compare the traditional open reduction and internal fixation with minimal invasive plating (MIPO). We hypothesized that superior results may be achieved with MIPO technique. METHODS: 22 patients treated with traditional open reduction and internal fixation were matched with 22 patients treated with closed reduction and MIPO on the basis of age (±3), gender, and fracture pattern (AO classification). Evaluation was assed according to the wound problems, the American Orthopaedic Foot and Ankle surgery (AOFAS) scoring, radiological union, malunion, delayed union, hospitalisation time, time from injury to surgery, and operation time. RESULTS: There was no significant difference in the distribution of AO/OTA classification, age, gender, AOFAS score, time from injury to operation, follow-up, bone union time, delayed union, malunion and infection (p>0.05). The operation time was significantly longer in the open group than in the MIPO group: 69.59±7.21 min. for the ORIF, and 61.14±5.61 for the MIPO group (p<0.01).The hospitalisation time was significantly longer in the open group than in the MIPO group: 7.64±4.71 days for the MIPO, and 10.18±4.32 days for the ORIF group (p<0.05). CONCLUSION: MIPO technique can be beneficial for the treatment of distal tibia AO/OTA A and B type fractures with reduced hospital stay, cost-effectiveness, and infection rate.

ISCHIOFEMORAL IMPINGEMENT: ASSESSMENT OF MRI FINDINGS AND THEIR RELIABILITY.

OBJECTIVE: To evaluate the Magnetic Resonance Imaging (MRI) findings and their validity in patients with ischiofemoral impingement syndrome (IFI) . METHODS: We retrospectively analyzed 55 hips. MRI findings of 30 hips were consistent with IFI syndrome. Twenty five hips had no MRI findings consistent with IFI syndrome. We compared the ischiofemoral space (IFS), quadratus femoris space (QFS), ischial angle (IA) and femoral neck angle (FNA) between the age and gender matched groups. We also analyzed edema, fatty replacement and partial or total rupture of quadratus femoris muscle. Mann Whitney U test was used to compare the data. RESULTS: We observed atrophy in eight, fatty replacement also in eight and edema in all of the quadratus femoris muscle. QFS (p<0.001) and IFS (p<0.001) were significantly lower in patients as compared to the control group. IA (p=0.012) and FNA (p=0.010) values were significantly higher in patients compared with the control group. CONCLUSION: MRI findings of IFI include narrowing of QFS and IFS and increase in IA and FNA. This condition should be kept in mind for patients with hip pain. Level of Evidence III, Retrospective Study.

Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries.

OBJECTIVE: The aim of this study is to report our institution's experience regarding the use of open tibial inlay technique in patients undergoing single-stage combined posterior cruciate ligament (PCL) reconstruction. METHODS: Records of 17 patients who underwent PCL reconstruction with tibial inlay technique were retrospectively reviewed. Patients with ipsilateral femoral or tibial osteochondral avulsion fractures or ipsilateral concomitant tibia and femur shaft fractures were excluded. Out of these 17 patients, six cases underwent anterior cruciate ligament (ACL) + PCL reconstruction, nine cases underwent ACL+ PCL + posterolateral corner reconstruction, one case underwent ACL + PCL + MCL reconstruction and one case underwent ACL+ PCL + posterolateral corner + MCL reconstruction. Mean follow-up was 14.27±6.77 (range: 6-30) months. RESULTS: In preoperative assessments, all patients had 3+ posterior laxity in posterior drawer test; at final follow-up, 6 patients had 0 laxity, 7 patients had 1+ laxity, and 4 patients had 2+ laxity (p<0.001). International Knee Documentation Committee (IKDC) objective evaluation showed severe disability in all patients preoperatively, whereas 5 knees were grade A, 8 knees were grade B, 3 knees were grade C, and 1 knee was grade D at final follow-up. Mean IKDC subjective score was 75.22±7.53 at final follow-up. Postoperatively, mean side-to-side difference in KT-1000 arthrometer measurement was 2.45±1.80 mm. At final follow-up, mean range of motion (ROM) was 0º on extension and 123.56±6.31º on flexion. CONCLUSION: Open tibial inlay approach is beneficial during PCL reconstruction. Further study is warranted to establish its effectiveness on functional outcomes and prevention of complications.

Does the anteromedial portal provide clinical superiority compared to the transtibial portal in anterior cruciate ligament reconstruction in nonprofessional athletes in short-term follow-up?

OBJECTIVE: Two drilling techniques of the femoral tunnel are commonly used in anterior cruciate ligament (ACL) reconstruction: through the transtibial (TT) portal or through the anteromedial (AM) portal. The aim of the present study is to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using AM and TT portal techniques for drilling the femoral tunnel in nonprofessional athletes. METHODS: A retrospective review was made of 44 nonprofessional athletes undergoing ACL reconstruction using AM and TT techniques between 2011-2013. The femoral tunnel clock position on axial magnetic resonance imaging (MRI) and the anterior-posterior position of the tibial tunnel on sagittal-cut MRI scan were measured. Radiological femoral tunnel and tibial tunnel anterior-posterior inclination angles were assessed. At final follow-up, the Lachman test and pivot-shift test were used in the evaluation of the anterior-posterior stability of the knee and the rotational stability of the knee. For clinical and functional evaluation, the modified Cincinnati knee grading system, Lysholm knee scoring scale, and International Knee Documentation Committee (IKDC) form were used. RESULTS: No statistically significant difference was determined between the groups in terms of patient age, follow-up period, gender, and affected side distribution. There were 6 outliers in the TT group due to the clock face position. The mean femoral tunnel inclination angle was 31.07°±8.44° in the AM group and 19.02°±8.93° in the TT group. The tibial tunnel inclination angle was 21.08°±5.42° in the TT group and 16.58°±7.02° in the AM group. A statistically significant difference was determined between the 2 groups. No statistically significant difference was observed between the 2 groups in terms of Lachman test, pivot-shift test, Lysholm score, IKDC score, and modified Cincinnati score results. CONCLUSION: The AM technique has no clinical superiority compared to the TT technique in ACL reconstruction in nonprofessional athletes.

One-stage surgical treatment of neglected simultaneous bilateral locked posterior dislocation of shoulder: a case report and literature review.

Simultaneous bilateral locked posterior dislocation of the shoulder is a rare injury. Herein, we present a 59-year-old male case with a three-month history of an irreducible locked bilateral posterior dislocation of the shoulders with an associated large impression fracture on the anteromedial aspect of both humeral heads after a grand mal type epileptic seizure. Plain X-ray and computed tomograph revealed a defect on the right side more than 40% of the articular surface, and on the left side, 30%. He was treated with a one-stage operation with a reconstruction of femoral head osteochondral allograft on the right side and transfer of the osteotomized tuberculum minus with its attached subscapularis tendon into the defect (modified McLaughlin technique) on the left side. At 14 months during follow-up, the patient was pain-free with stable shoulder joints and satisfactory functionality.

Chronic wrist pain in a goalkeeper; bilateral scaphoid stress fracture: A case report.

INTRODUCTION: Bilateral scaphoid stress fractures are uncommon, and rarely presented with chronic wrist pain. Most fractures of the scaphoid heal with immobilization. Presentation of case The case presented here is of a bilateral stress fractures of the carpal scaphoid in a 19-year-old male.The patient had been playing as a goalkeeper and presented with a 4-year history of chronic pain in both wrists. We had a successful result in the treatment of these stress fractures with long- arm thumb plaster cast.Discussion Most fractures of the scaphoid in the immature skeleton heal with immobilization. Approximately 88-95% of acute scaphoid fractures are said to heal with conservative treatment using cast immobilisation. Non-surgical treatment is successful for scaphoid fractures in children and for those fractures which are non-displaced, stable, and where there is no damage to other bones or ligaments. In stable fractures, union is achieved within 8-12 weeks.Conclusion Bilateral stress fractures of the scaphoid can be considered for the wrist pain, especially for the patients that had repetitive minor wrist trauma, and in spite of developments in surgical techniques and materials used, treatment by plaster casting should still be considered initially for non-displaced, stable scaphoid stress fractures.