Comparison of the Miniaci and Dugdale techniques on functional outcomes in medial open wedge high tibial osteotomy.

PURPOSE: To compare the correction angles determined by the Miniaci and Dugdale techniques in patients treated with medial open wedge high tibial osteotomy (MOWHTO) and show their impact on clinical outcomes. METHODS: Seventy-four patients constituted the study group. The correction angles in Group 1 were measured using the Miniaci technique, and those in Group 2 were measured using the Dugdale technique. The clinical evaluations included the Tinetti Gait and Balance Assessment (TGBA), the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores, and the Visual Analogue Scale (VAS). The effect of the correction angle on the patient's clinical outcomes was evaluated. Measurement techniques were also changed between groups for comparison. RESULTS: Seventy-four patients (62 females, 12 males) with a mean age of 53.7 ± 4.9 years were followed up for a mean of 67.4 ± 5.5 months. The TGBA, WOMAC, and VAS scores were improved at the last follow-up compared to the preoperative scores (p < 0.05). The preoperative TGBA and WOMAC scores were not significantly different between the two groups, but the last follow-up TGBA and WOMAC scores in Group 2 were worse than those in Group 1 (p < 0.05). When measuring techniques were changed, the preoperative correction angle (PCA) value and the last follow-up correction angle (LFCA) value were lower in Group 1 measured with the Dugdale technique but higher in Group 2 measured with the Miniaci technique (p < 0.05). CONCLUSION: Since the correction angle values measured with the Miniaci technique in MOWHTO are higher than those measured with the Dugdale technique; the functional results are better. LEVEL OF EVIDENCE: Retrospective cohort study, III.

The feature assessment of the bone fractures in 1020 children and review of the literature.

OBJECTIVE: This study aims to collect data, which is a risk factor on bone fractures in children. METHODS: The study group consisted of 1020 children (n=282; 28% girls and n=738; 72% boys, with a mean age of 8.3 years) with a bone fracture. The age, gender, the month and the time of the day the fracture was sustained, mechanism of injury, feature of the fracture, the presence of coexisting injuries, and the method of treatment were recorded. RESULTS: Boys had approximately three times more fractures than girls. The fractures were found to be more prevalent in upper extremities (76.6%) and on its left side (56.0%), and the most commonly fractured bone was isolated radius (n=304; 32.1%); most frequently distal radius). The most prevalent lower-extremity fractures were to the femur (n=92; 31.7%). It was found that fractures occurred most frequently between the ages 3 and 6 (23.6%), and fractures in boys were most common among 13 to 15-year-old patients (n=216; 23.9%), whereas girls aged 3-6 years suffered the most fractures (n=103; 30.8%). The fractures were more common in spring (n=384; 31.0%) and summer (n=365; 29.5%). The time slot bone fractures occurred the most was from 12:00 pm to 5:00 pm (n=824; 66.6%). The most common reasons for fractures were outdoor falls (n=705; 57.0%), and indoor falls (n=239; 19.3%), respectively. Bone fractures co-occurred with head trauma the most (n=30; 42.3%). Fifty-nine patients (5.8%) had epiphysis fracture. 51 patients (5.0%) had open fractures. Five hundred ninety-two patients (58.0%) were given outpatient treatment. CONCLUSION: Child bone fractures are most frequently seen in the left upper extremity in 10-15-year-old boys, occurring as a result of outdoor falls in the afternoon in the spring and summer months. Bones located in the wrist, hand, and elbow have been found to be much more vulnerable to fractures. Many of the fractures were treated by conservative methods. Creating a safe environment for children is the most effective method of injury control. Necessary arrangements should be made for the safety of children in the environment and at home. Continuing education and legal regulations play an active role in injury control.

Comparison of Magnetic Resonance Imaging and Computed Tomography Scans of the Glenoid Version in Anterior Dislocation of the Shoulder.

The glenoid version is an important factor in the etiology of anterior dislocation of the shoulder and the planning of shoulder surgery. Few reports compare the magnetic resonance imaging (MRI) measurements of the glenoid version with those of computed tomography (CT). This study aimed to show that it is possible to use MRI instead of CT, which is accepted as the gold standard today for the evaluation of the glenoid version. A total of 55 patients with a history of 1 nonsurgically treated unilateral anterior dislocation of the shoulder who had both MRI and CT records for the dislocated shoulders constituted the study group. The glenoid version was measured in the axial plane on MRI and CT. Mean glenoid version measured by the observers was -1.6°±4.7° (95% confidence interval, -2.3° to -0.8°) and -1.8°±4.3° (95% confidence interval, -2.5° to -1.2°) by CT and MRI, respectively (P=.126). The evaluation of the CT and MRI measurements made by the 3 observers (X, Y, and Z) revealed no significant difference, as the P values of X CT - X MRI, Y CT - Y MRI, and Z CT - Z MRI were .550, .406, and .238, respectively. Interclass correlation among the 3 observers for CT and MRI was 0.996 and 0.981, respectively. The imaging methods of MRI and CT can be interchangeably used in the evaluation of the glenoid version in cases of anterior dislocation of the shoulder. [Orthopedics. 2017; 40(4):e687-e692.].

Evaluation of vitamin D levels in patients with chronic low back-leg pain.

OBJECTIVE: We aimed to examine the relationship between the levels of vitamin D and patients with chronic low back-leg pain (CLBLP) and to investigate its effects on pain and functional capacity. METHODS: 145 patients (female/male:103/42) with CLBLP, aged between 35 and 65 years (mean age: 53,06 ± 8,14), participated in the study. Visual Analog Pain Scale (VAS) was used to measure the state of pain. Pain-related functional capacity was evaluated through Oswestry Disability Index (ODI). Patients were classified into three groups based on their serum vitamin D levels: normal (≥30 ng/ml), vitamin D insufficiency (21-29 ng/ml), and vitamin D deficiency (≤20 ng/ml). RESULTS: We found that 22,8% of patients (n:33) had vitamin D deficiency, 42,8% (n:62) had vitamin D insufficiency, and 34,5% (n:50) had normal levels of vitamin D. VAS scores were 4,75 ± 0,93; 4,66 ± 0,97 and 4,52 ± 0,90 for patients with vitamin D deficiency, vitamin D insufficiency, and normal levels of vitamin D, respectively. We found that there was no significant relationship between vitamin D level and VAS score (p>0,05). ODI scores were 18,78 ± 7,89; 15,46 ± 5,57 and 14,52 ± 7,19 for patients with vitamin D deficiency, vitamin D insufficiency, and normal levels of vitamin D, respectively. CLBLP-related functional capacity was found to be significantly lower in patients with vitamin D deficiency when compared to other two groups (p < 0,05). CONCLUSION: Vitamin D deficiency may lead to lower functional capacity, and clinically, Vit D levels should be checked in musculoskeletal pain patients at risk of Vit D deficiency. LEVEL OF EVIDENCE: Level IV, Diagnostic study.

The importance of glenoid version in patients with anterior dislocation of the shoulder.

BACKGROUND: Although increased retroversion of the glenoid has been shown to be an important factor in posterior instability of the shoulder, there are few studies reporting glenoid bone structure as a risk factor in anterior dislocation of the shoulder. This study aimed to compare glenoid version in patients with anterior dislocation of the shoulder and individuals in a control group with no shoulder problems before undergoing computed tomography and to assess a possible relationship between demographic characteristics and glenoid version angle. METHODS: The study group comprised 63 patients (12 women and 51 men; mean age, 35.71 years) with 1 or multiple unilateral anterior dislocations of the shoulder (dislocated group), whereas 63 individuals (11 women and 52 men; mean age, 35.38 years) with no history of shoulder complaints and no signs of instability constituted the control group. The glenoid version angle was measured on an axial cut of the computed tomography scan. RESULTS: The glenoid version angles on the dislocated side in the study group were significantly more anteverted than those of the dominant (P < .001) and nondominant (P = .023) shoulders of the control group. The version angles of dislocated shoulders significantly differed from those of nondislocated shoulders of both men (P = .041) and women (P = .049). There was no significant relationship between the glenoid version angle on the dislocated side and dislocation mechanism (P = .883), age group (P = .356), or number of dislocations (P = .971). CONCLUSIONS: Glenoid version is an important factor for the development of anterior dislocation of the shoulder.

Simultaneous Bilateral FractureUnilateral Dislocation of the Talus.

In this study, we present the case of a 42-year-old man with a fracture and dislocation of the left talus neck, and a fracture of the right talus neck due to a fall. This kind of fracture can be considered rare, and thus few cases have been reported. Fracture fixation was provided through cannulated screws on either side. Splints were removed after 6 weeks, and passive/active joint movement exercises were started. The patient was able to walk with partial weightbearing at 2 months and with full weightbearing at 3 months. The magnetic resonance imaging scan at 1 year postoperatively revealed the presence of avascular necrosis on the left, whereas it did not exist on the right. Range of motion in both of the ankles was satisfactory. The patient expressed that he was able to perform daily activities without any difficulty and run for 30 minutes without pain. In this case report, in addition to providing a review of the relevant literature on the subject, we set out to show the importance of rigid fixation and early mobilization in these rare injuries.

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.