Long-Term Results of Total Hip Arthroplasty with Step-Cut Osteotomy in Crowe Type IV Dysplastic Hips.

Objective: The purpose of this study was to evaluate the long-term results of sub-trochanteric step-cut shortening osteotomy (SSCO) used in the total hip arthroplasty (THA) procedure for treatment of Crowe type IV dysplastic hips. Materials and Methods: Crowe type IV dysplastic 35 hips of 31 patients were treated with cementless THA. Patients were followed up meanly 9.2 years (range 4-18). SSCO was applied to all hips to reduce the femoral head into the true acetabulum. Autologous bone grafts which were obtained by shortening the femur and cable cerclage wires were used for fixing the osteotomy site. The results were evaluated clinically and radiologically. In clinical evaluation, Harris hip score (HHS) and d'Aubigne hip evaluation criteria were used. Results: The mean HHS increased from 40.6 to 92.5. Merle d'Aubigne hip evaluation score was increased on average from 1.76 to 5.8 in terms of pain and from 2.9 to 5.5 in terms of range of motion. In 9 hips (25.7%), medialization was achieved by creating a controlled fracture in the acetabulum. The hip rotation center was lowered by an average of 5.7 cm. The average leg lengthening was 3.4 cm. No more than 4 cm lengthening was made. Dislocation did not develop in any of the patients. Conclusion: It was concluded that the long-term results were found to be successful in the THA with SSCO in Crowe type IV dysplastic hips, since nerve complications were reduced, leg-lengthening was achieved, and a painless and mobile hip joint could be achieved.

An evaluation of the results of locked plate osteosynthesis applied without the use of bone graft in Sanders type III and IV intra-articular calcaneus fractures.

PURPOSE: The clinical and radiological results of locked plate osteosynthesis with an extensive lateral approach without bone graft in Sanders type III and IV intra-articular calcaneus fractures and the factors affecting these results were evaluated retrospectively. METHODS: A total of 61 patients with Sanders type 3 and 4 calcaneus fractures who underwent a lateral approach with locked plate osteosynthesis were included in the study. The mean follow-up was 44.8 months. RESULTS: The mean pre- and post-operative Gissane and Bohler's angles were 113.5° ± 13.9° and 106.7° ± 13.6° (p = 0.006) and 2.8° ± 14.1° and 19.6° ± 13.1° (p < 0.001), respectively. The mean post-operative AOFAS scores, SF-36, and Maryland were 80.5 ± 13.6 in type IIIAB, 89.4 ± 6.3 in IIIAC, and 82.4 ± 12.5 in IV; 58.6 ± 14.5 in type IIIAB, 60.3 ± 11.7 in IIIAC, and 58.0 ± 15.6 in IV; and 63.8 ± 7.2 in type IIIAB, 64.3 ± 7.1 in IIIAC, and 62.8 ± 11.7 in IV (p = 0.173, p = 0.932, p = 0.824, respectively). Wound problems were observed in 15 (28.6%) patients. Deep infection was not observed in any patient. CONCLUSION: The clinical results were similar in type III and IV intra-articular calcaneus fractures applied with locked plate osteosynthesis in an extensive lateral approach and without the use of bone graft. Intra-articular calcaneus fracture fixation with a lateral locked plate is an effective treatment method.

Medium-term results of single-stage posteromedial release and triple arthrodesis in treatment of neglected clubfoot deformity in adults.

OBJECTIVE: This study aimed to evaluate the implementation, in a single session, of both massive posteromedial release and triple arthrodesis for rigid neglected clubfoot deformities in adult patients, and its effects on clinical and radiological results. METHODS: The procedures were performed in one session on 15 feet of 11 patients [7 male, 4 female; mean age 26 (range: 15 to 50)]. Staples were used for fixation in all patients. For clinical assessment, the AOFAS (American Orthopaedic Foot and Ankle Society) ankle- hindfoot scale was used. Anteroposterior/lateral side talocalcaneal and talus-1st metatarsal angles were used as radiographic parameters. The mean follow-up was 7.5 years (range: 6 to 11). RESULTS: The mean AOFAS score rose from a preoperative 39 (range: 15 to 52) to 88 (range: 76 to 94) in the final follow up (p<0.0001). Among the 15 feet, 9 were evaluated as excellent, 5 as good, and 1 as fair. Significant clinical improvement was obtained between preoperative and postoperative surgical periods (p<0.05). Significant improvements were observed in radiographic parameters (p<0.0001). At final follow-up, radiographic values were within normal physiological limits. Average union time was 12.4 (range: 7 to 36) weeks. While pseudoarthrosis was not observed in any patients, delayed union developed in 2 cases, and talus avascular necrosis in 1. In the preoperative period, 5 patients had various degrees of degenerative changes. Nine patients developed degenerative changes in different joints and of different degrees. CONCLUSION: The authors believe that massive soft tissue release and triple arthrodesis performed in a single session yields satisfactory results cosmetically and functionally in neglected clubfoot cases with severe deformities.

Long-term results of surgical treatment of pigmented villonodular synovitis of the knee.

OBJECTIVES: The aim of this study was to evaluate the long-term results of total synovectomy in pigmented villonodular synovitis of the knee (PVNS). METHODS: Open total synovectomy was performed for 19 patients (9 men, 10 women; mean age: 42.8 years) with PVNS. Of these patients, 15 had diffuse and 4 localized PVNS. The patients were followed for an average of 80.2 months and the average time between the onset of complaints and surgery was 23 months. In 4 patients, PVNS was identified during total knee replacement (TKR) performed due to gonarthrosis. Radiotherapy was performed as an adjuvant treatment in one patient with recurrence. Puncture was performed in 11 patients due to effusion and 8 to 70 cc of fluid was aspirated. Diagnosis was made during the exposure for TKR in 4 patients, by a biopsy in 2 and based on joint puncture and MRI findings in the rest. RESULTS: Recurrence occurred in 5 patients. A second total synovectomy was performed in 4 patients. Radiotherapy was used for the remaining one patient. Two patients were operated three times. During the follow-up, TKR was performed in 7 of the 19 patients. None of the patients developed infection and hemarthrosis requiring puncture nor required amputation or arthrodesis. Three patients had a postoperative knee joint stiffness of 10 to 25 degrees. The patients were evaluated according to the Knee Society Score and 8 (42.2%) had perfect, 9 (47.3%) good and 2 (10.5%) bad results. CONCLUSION: PVNS is a disease with a high risk of recurrence. No individual or combined treatment method can offer a definitive solution. Open or arthroscopic radical synovectomy is still considered as the gold standard. If necessary, adjuvant intraarticular or extraarticular radiotherapy can be added to the treatment.

Ipsilateral combination of Galeazzi and Monteggia fractures in a ten-year-old patient: a case report.

Galeazzi fractures represent approximately 3 to 6 percent of forearm fractures, whereas Monteggia fractures represent 1 to 2 percent. The combination of these injuries in the same extremity is an exceedingly rare occurrence. We report a case of ipsilateral combination of Galeazzi and Monteggia fractures in a ten-year-old patient. The patient was treated with closed reduction and internal fixation with Kirschner pins. The distal radioulnar and radiocapitellar joint relationships were restored and the fractures healed. The patient proceeded to obtain a satisfactory functional result three years later. Internal fixation is a safe method for such complex forearm fractures in older children and allows post-operative rehabilitation with the advantage of early mobilization.

Comparison of long-term results of dynamic hip screw and AO 130 degrees blade plate in adult trochanteric region fractures.

OBJECTIVES: The aim of this study was to compare the long-term results of two groups of patients with trochanteric fractures of the femur treated with either dynamic hip screw (DHS) or AO angled blade plate (AP) insertions. METHODS: A total of 157 patients with trochanteric fractures were included in the study, and 82 patients underwent dynamic hip screw insertion, and 75 underwent AO angled blade plate insertion. The mean follow-up period was 8 years (range 2.3-11.7 years) in the DHS group, and 8.5 years (2.4-12.5 years) in the AP group. RESULTS: According to the Boyd and Griffin classification, there were 37 stable fractures (45%) and 45 unstable fractures (55%) in the DHS group, whereas there were 42 stable fractures (56%) and 33 unstable fractures (44%) in the AP group. According to Clawson's functional classification, 64% of patients in the AP group and 81% in the DHS group had good or excellent function (p<0.05). Similarly, according to Foster's classification, 68% of patients in the AP group, and 85% in the DHS group had good to excellent results (p<0.05). CONCLUSION: DHS yields better long-term results in trochanteric fractures than do AO angled blade plates by providing earlier mobilization of the patient, better stability, and earlier union.