Tibial slope changes following guided growth by the eight-plate: A retrospective comparative study.

OBJECTIVE: The aims of this study were (1) to investigate the tibial slope (TS) changes following guided growth by the eight-plate and to determine the relationship between the TS change in the sagittal plane and the plate position. METHODS: In this retrospective study, children who underwent guided growth by the eight-plate for genu varum or valgum were included. Thirty-eight extremities of 23 children (14 girls and 9 boys; mean age = 9.2 years, age range = 3-17 years) were then divided into two groups according to the plate location in the sagittal plane (anterior or midline). Preoperative and postoperative TS were measured from the medial and lateral tibial plateaus separately. RESULTS: The mean follow-up was 34.3 (range = 12-96) months. The mean preoperative and postoperative medial TS were 4.05 ± 5.65 and 0.83 ± 3.91 degrees, respectively, in 18 patients in whom anterior epiphyseal plates were placed (P = 0.004). The mean preoperative and postoperative lateral TS were 4.88 ± 5.33 and 0.11 ± 3.34 degrees, respectively, in 18 patients in whom anterior epiphyseal plates were placed (P < 0.001). The mean preoperative and postoperative medial TS were 4.2 ± 5.19 and 4.9 ± 6.02 degrees, respectively, in 20 patients in whom midline epiphyseal plates were placed (P = 0.532). The mean preoperative and postoperative lateral TS were 5 ± 5.51 and 4.8 ± 5.7 degrees, respectively, in 20 patients in whom midline epiphyseal plates were placed (P = 0.871). Postoperative TS was decreased in anteriorly located eight-plates, and medial and lateral plateau measurement was significant (P = 0.004 and P < 0.001, respectively). Postoperative TS changes in midline-placed eight-plates were not significant regarding the medial and lateral plateaus (P = 0.532 and P = 0.871, respectively). CONCLUSION: The results of this study have shown that TS decreases following guided growth by the eight-plate in children in whom plates are placed at the anterior epiphysis. To prevent TS changes, the eight-plate should be placed in the midline position at the sagittal plane. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Arthroscopic evaluation of failed primary type II SLAP lesion repair in patients with high physical activity over 40 years of age and the outcomes of tenotomy.

OBJECTIVES: In this study, we aimed to examine patients over 40 years of age who underwent failed primary isolated type 2 superior labrum anterior posterior (SLAP) repair arthroscopically and to evaluate the outcomes of tenotomy. PATIENTS AND METHODS: Between March 2011 and December 2019, a total of 32 patients (19 males, 13 females; median age: 55.1 years; range, 41 to 59 years) who underwent primary repair for SLAP due to high activity levels and in whom the treatment failed were retrospectively analyzed. Biceps tenotomy was applied to all patients. The Constant-Murley Score (CMS), Visual Analog Scale (VAS) pain scores, and muscle strength before and after re-arthroscopy were compared. RESULTS: The median follow-up time was 27 (9-84) months after biceps tenotomy. During arthroscopy, failure was detected in three (9.37%) patients and additional pathologies were detected in five (15.62%) patients. Patients with biceps tenosynovitis were 29 (90.62%). The mean pre- and postoperative CMS scores were 40.5±11.1 and 86.3±8.1, respectively (p<0.001). The mean pre- and postoperative VAS-pain scores were 7.3±1.5 and 2.1±0.8, respectively (p<0.001). CONCLUSION: Although the primary repair technique has been successfully performed in patients with SLAP lesions over 40 years of age and high physical activity, the clinical outcomes are unsatisfactory. Biceps tenotomy improves functional and clinical results in patients with SLAP lesions who do not benefit from primary repair.

Clinical and radiological results of three different techniques for fixation of the olecranon osteotomy in the surgical treatment of distal humerus fractures: A retrospective comparison of plate-screw, tension band and intramedullary nail.

OBJECTIVE: The aim of this study was to compare clinical and radiological results of three different techniques (plate-screw, tension band, and intramedullary nail) in the fixation of olecranon osteotomy in patients with intercondylar fracture of the distal humerus surgically treated by the olecranon osteotomy approach. METHODS: Between January 2010 and December 2018, the study was initiated with 52 patients who underwent an olecranon osteotomy approach for an AO Type C distal humerus fracture. Thirty-seven patients (19 male, 18 female) who had regular control data and a final control examination were included in the study. In osteotomy fixation, we used tension band (K wire cerclage + Screw cerclage) in 20 patients, plate-screw in eight patients, and intramedullary nail fixation in nine patients. The functional evaluation included a measurement of the range of joint motion (flexion, extension, supination, pronation); MAYO elbow performance score; disabilities of the arm, shoulder, and hand (DASH) score; and comparative grip strength measurement, and a subjective pain assessment was performed using the visual analogue scale. RESULTS: The mean duration of follow-up was 44 (12-84) months. The mean time to union was 14 (7-32) weeks in patients that achieved union. The mean DASH score was 22 (0-72.7), the meanMAYOelbow performance score was 84 (35-100), and the mean VAS score was 3 (1-7). The mean grip strength was 32 (8-64) kgw in the treated extremity and 37 (17-70) kgw in the intact extremity. No statistically significant difference was detected between olecranon osteotomy fixation methods (tension band, plate-screw osteosynthesis, and intramedullary nailing) in terms of union time, DASH score, MAYO scale score, VAS score, extension, supination, and pronation (P > 0.05). The average grip strength (kgw) was lower than that in the uninvolved extremity, and this ratio was statistically significant (P = 0.04). CONCLUSION: The results of this study have shown that successful and comparable radiological and functional outcomes can be obtained by all the three different olecranon osteotomy techniques in the surgical treatment of intercondylar fracture of the distal humerus. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Outcomes of Surgical Management of Acetabular Fractures Treated with Anterior Approaches.

OBJECTIVE: In this study we aimed to evaluate the outcomes of anterior and combined approaches for treatment of acetabular fractures. MATERIALS AND METHODS: Thirty-seven acetabular fractures in 35 patients treated with an anterior approach were evaluated retrospectively. Fractures were classified according to Judet-Letournel. Early and final radiological evaluation was based on Matta's criteria. Modified Merle d'Aubigne and Postel criteria were used for functional assessment. RESULTS: Eleven (30%) fractures were simple type and 26 (70%) were mixed type. Two (18%) of the simple fractures were transverse and 9(82%) were anterior column fractures. Fourteen (54%) of the mixed type fractures were both column fractures, 5 (19%) were transverse+posterior wall, 5 (19%) were T shaped and 2 (8%) were anterior column+posterior hemitransverse fractures. Surgical approach was ilioinguinal in 15 (43%) patients, Stoppa in 9 (26%) and combined11 (31%). Our functional outcomes were perfect in 10 (27%) hips, good in 20 (54%), moderate in 4 (10%) and poor in 3 (8%). Our radiological results were perfect in 15 (40.5%) hips, good in 15 (40.5%), moderate in 4 (11%) and poor in 3 (8%). CONCLUSION: Anterior surgical approaches provide satisfactory outcomes in appropriate fracture types. Posterior approach can be combined in certain fracture types. We think that rate of the requirement for a concomitant posterior approach for certain fractures of the acetabulum will decrease as experience increases.

Effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome.

BACKGROUND/AIM: To investigate the effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome. MATERIALS AND METHODS: Sixty-eight patients having stage 2 shoulder impingement syndrome and treated with arthroscopic subacromial decompression were included in the study. We divided these patients into 2 groups, whereby 32 (47%) patients received conservative therapy before arthroscopic subacromial decompression and 36 (53%) patients did not receive conservative therapy. We compared both groups in terms of the the Constant, UCLA, and VAS scores for shoulder pain before and after arthroscopic subacromial decompression. RESULTS: Constant, UCLA, and VAS scores were statistically significantly improved in both groups after arthroscopic subacromial decompression (P <0.001). Constant, UCLA, and VAS scores before arthroscopic subacromial decompression were statistically better in Group 1 than in Group 2 (P < 0.001). No statistically significant difference was found between the groups in terms of Constant, UCLA, and VAS scores after arthroscopic subacromial decompression (P > 0.05). CONCLUSION: Conservative therapy applied in patients with stage 2 shoulder impingement syndrome before arthroscopic subacromial decompression does not have a positive contribution on the clinical outcome after arthroscopic subacromial decompression.

Extramembranous transfer of the tibialis posterior tendon for the treatment of drop foot deformity in children.

BACKGROUND: To study the efficacy of extramembranous transfer of the tibialis posterior (posterior tibial) tendon for the treatment of drop foot deformity in children. MATHERIALS AND METHODS: This study included 24 patients (11 girls and 13 boys) with drop foot deformity, who underwent tibialis posterior tendon transfer. The mean age was 12.33 years (range: seven to18 years), and the mean follow-up period was 32.54 months (range: 24 - 55 months). Drop foot developed due to different levels of nerve injury associated with trauma or surgical operation in 18 (75 %) patients, and due to meningomyelocele in six (25 %) patients. Tibialis posterior tendon was flipped from the anteromedial aspect of the tibia and transferred to the lateral cuneiform bone. The patients were evaluated via the Stanmore system questionnaire. RESULTS: Evaluating the outcomes by the Stanmore system, poor results in two feet (8.3 %), fair in two feet (8.3 %), good in eight feet (33.3 %), and excellent in 12 (50 %) feet were obtained. All patients were satisfied with the postoperative outcomes. The mean active ankle dorsiflexion was 8.96 degrees (range: zero to 20 degrees). CONCLUSIONS: Extramembranous transfer of the tibialis posterior tendon is a quite successful method in retrieving active dorsiflexion of the foot in patients with drop foot deformity. It is a method which eliminates the need for orthosis and enhances the quality of life of patients.

The results of Pemberton's pericapsular osteotomy in patients with developmental hip dysplasia.

OBJECTIVE: The aim of this study was to investigate the radiological and clinical outcomes of Pemberton's pericapsular osteotomy in toddlers and preschool children with developmental hip dysplasia. METHODS: Ninety-one hips of 86 patients (81 girls, 5 boys) with developmental hip dysplasia who underwent Pemberton's pericapsular osteotomy were included in this study. The mean age of the patients was 34 (range: 18 to 96) months. The mean duration of follow-up was 60 (range: 24 to 158) months. All patients underwent open reduction and Pemberton's pericapsular osteotomy, including 12 hips in which proximal femur osteotomy had been performed earlier. Clinical results were evaluated according to McKay's clinical evaluation criteria, radiological results according to Sever's radiological evaluation criteria, and the presence of avascular necrosis according to Kalamchi-MacEwen's classification criteria. RESULTS: At the final examinations the mean acetabular index was 12.04° (range: 5° to 24°) and the mean Wiberg's center-edge angle was 35.5° (range: 20° to 52°). Clinically, excellent results were obtained in 81 (89.0%) hips, good results were obtained in 2 (2.2%) hips, and fair results in 8 (8.8%) hips. Radiologically, excellent results were obtained in 79 (86.8%) hips, good results in 7 (7.7%) and fair results in 5 (5.5%) hips. Clinically and radiologically no poor results were noted. Type 1 avascular necrosis was detected in 9 (9.9%) hips, Type 2 in 7 (7.7%) hips, and Type 3 in one (1.1%) hip. There were no cases with Type 4 avascular necrosis. CONCLUSION: Pemberton's pericapsular osteotomy is a safe and effective procedure for the surgical treatment of developmental hip dysplasia in toddlers and preschool children.

The Prevalence of Chronic Impingement Syndrome and SLAP Lesion and the Sensitivity of O'Brien's Test.

OBJECTIVE: In this study, we aimed to investigate the prevalence of SLAP lesions in patients with chronic impingement syndrome. We also examined the sensitivity of O'Brien's test. MATERIALS AND METHODS: The study included 48 patients with a preliminary chronic impingement syndrome diagnosis to whom arthroscopic decompression had been planned. All patients underwent preoperative Neer's, Hawkins' and O'Brien's tests. We performed shoulder arthroscopy on all patients and evaluated chronic impingement syndrome and SLAP lesions. Then, we compared the statistical sensitivities of these tests. RESULTS: The mean age of patients with chronic impingement was 45.8 years (range, 35-69 years). O'brien's test was positive in 34 (70.8%) of the patients, and Neer's test and Hawkins' test were positive in 46 (95.8%) of the patients before shoulder arthroscopy. Shoulder arthroscopy revealed that 44 (91.7%) of 48 patients had subacromial impingement; 32 (66.7%) had SLAP lesions and internal impingement. In chronic impingement syndrome, sensitivity rates were 95.6% for Neer's test and Hawkins' test, whereas in internal impingement syndrome and slap lesions, the sensitivity of O'brien's test was 94.1%. There was no statistical difference between the tests (p>0.05). CONCLUSION: 72.72% of the patients with chronic impingement syndrome had concomitant SLAP lesions. We suggest that O'Brien's test should be used with Neer's and Hawkins' tests for diagnosis of this condition.

The role of acromion morphology in chronic subacromial impingement syndrome.

This study investigated the role of acromion morphology in the aetiology of chronic subacromial impingement syndrome. Forty five patients with chronic subacromial impingement syndrome were included in the study. They were distributed into three groups according to their acromion types: six (13.3%) patients had type 1, 24 (533%) patients type 2 and 15 (333%) patients type 3 acromion. Constant scoring was used for clinical evaluation. Arthroscopic subacromial decompression was performed in all patients in the three groups, without performing any acromioplasty that would change the morphology of acromion. We then compared the average Constant scores changes in all three groups after arthroscopic subacromial decompression. The average follow-up was 28.6 months (range: 12-47). The average change in Constant score after arthroscopic subacromial decompression was 5830 in patients with type 1 acromion, 58.21 in those with type 2 and 54.07 in those with type 3. No significant difference was observed between the changes in the average Constant scores of the three groups (p > 0.005). The scores were significantly improved following arthroscopic subacromial decompression in all three groups (p < 0.005).In this study, acromion type was not found to have an important role in the aetiology of chronic impingement syndrome; arthroscopic subacromial decompression without simultaneous acromioplasty thus appears as an appropriate treatment.