Femoral bowing plane adaptation to femoral anteversion.

BACKGROUND: Femoral bowing plane (FBP) is the unattended subject in the literature. More over the femoral shaft with its bowing is neglected in established anteversion determination methods. There is limited information about the relationship between FBP and anteversion. Thus we focused on this subject and hypothesized that there could be an adaptation of FBP to anteversion. MATERIALS AND METHODS: FBP is determined on three-dimensional solid models derived from the left femoral computerized tomography data of 47 patients which were taken before for another reason and comparatively evaluated with anteversion. There were 20 women and 27 men. The mean age of patients was 56 years (range 21-84 years). RESULTS: The anteversion values were found as the angle between a distal condylar axis (DCA) and femoral neck anteversion axis (FNAA) along an imaginary longitudinal femoral axis (LFA) in the true cranio-caudal view. The FBP was determined as a plane that passes through the centre-points of three pre-determinated sections on the femoral shaft. The angles between DCA, FNAA and FBP were comparatively evaluated. The independent samples t-test was used for statistical analysis. At the end, it was found that FBP lies nearly perpendicular to the anteversion axis for the mean of our sample which is around 89° in females and 93° in males (range 78-102°). On the other hand, FBP does not lie close to the sagittal femoral plane (SFP); instead, there is an average 12.5° external rotation relative to the SFP. FBP is correlated well with anteversion in terms of FBP inclination from SFP and femoral torsion (i.e., angle between FBP and femoral neck anteversion axis (P < 0.001; r = 0.680 and r = -0.682, respectively). Combined correlation is perfect (R2 = 1) as the FBP, SFP, and posterior femoral plane forms a triangle in the cranio-caudal view. CONCLUSIONS: We found that FBP adapts to anteversion. As FBP lies close to perpendicularity for the mean, femoral component positioning perpendicular to the FBP can be an alternate way in the replacement surgeries. In addition, it has been found that FBP lies externally rotated relative to the SFP.

Relationship of side dominance and ultrasonographic measurements of pronator quadratus muscle along with handgrip and pinch strength.

AIMS: We ascertained effects of hand dominance in both right and left-handed volunteers on the thickness and cross sectional area (CSA) of pronator quadratus (PQ) muscle as measured by the axial and sagittal views of ultrasound imaging. Secondly, we also aimed to document the extent of the relationship between the PQ measurements and handgrip. MATERIALS AND METHODS: Healthy adults from the volunteer medical staff were included in the study. Handedness was assessed via The Flinders Handedness survey. The sonographic appearance of the PQ was evaluated on sagittal and axial images for both hands. CSA of PQ muscle was digitally drawn and calculated on the axial plane. Handgrip was measured by using adjustable-handle dynamometer. RESULTS: Eighty-nine healthy volunteers were included (54 right and 35 left-handed). Significant difference was detected between dominant and non-dominant hands in CSA and muscle thickness in both right and left-handed volunteers (p<0.05). These measurements were correlated with the handgrip strength (p<0.05, r=0.55, and r=0.43 for right-handed volunteers, r=0.67 and r=0.48 for left-handed volunteers, respectively). There were also significantly high correlations between the measurements of CSA and PQ thickness of the corresponding extremity in both right-handed and left-handed volunteers (p<0.05). CONCLUSIONS: A statistically significant difference exists between dominant and non-dominant hands in CSA and muscle thickness measured by US in both right and left handed volunteers, and this is correlated with handgrip strength. Hand dominance should be considered to compare healthy and affected sites during US of PQ while investigating for occult fractures of distal forearm or PQ atrophy due to anterior interosseous nerve injury.

Ultrasonographic measurement of the distal femoral cartilage thickness in patients with unilateral transtibial amputation.

BACKGROUND: Lower limb amputation sometimes predisposes to degenerative secondary disorders. OBJECTIVES: To evaluate the distal femoral cartilage thicknesses of patients with unilateral transtibial amputations using ultrasound and to investigate the relationship between cartilage thickness and disease-related parameters. STUDY DESIGN: Cross-sectional study. METHODS: Twenty-four unilateral transtibial amputees (mean age: 46.4 ± 8.5 years, range: 28-60 years) were evaluated. Duration of prosthesis use (years) and daily walking time with prosthesis (hours) were recorded. Functional status was assessed by gate velocity (m/s), and 6-min walking distance (m) with prosthesis. Ultrasound was used to measure distal femoral cartilage thicknesses bilaterally at medial/lateral condyles and the intercondylar areas. The percentages of cartilage loss (of the amputee-side in comparison with the nonamputee-side) were calculated. RESULTS: Compared to the nonamputee-sides, distal femoral cartilage was significantly thinner at lateral condyles and the intercondylar areas on the amputee-sides (p < 0.05). Significant positive correlations were detected between the percentage of cartilage loss (at all three sites of measurement) and gate velocity, 6-min walking distance, and daily walking time with prosthesis (all p < 0.05). CONCLUSIONS: Future prospective controlled studies are warranted to determine the principles of optimum prosthetic use regarding its possible effects on the femoral cartilage of amputee patients. CLINICAL RELEVANCE: The correlations between the cartilage loss in the amputee extremity with faster gait and longer daily prosthetic use suggest that abnormal gait patterns might increase the loading on the amputated extremity.

[Functional outcomes and quality of life in patients with proximal row carpectomy]. / Proksimal sira karpektomili hastalarda fonksiyonel sonuçlar ve yasam kalitesi.

OBJECTIVES: This study aims to assess pain, functional status, patient satisfaction, and quality of life in patients with proximal row carpectomy. PATIENTS AND METHODS: Between December 2007 and November 2011, demographic, clinical, and operational data, and physical therapy program of 16 patients (11 males, 5 females; mean age 41.4±16.6 years; range 19 to 77 years) with proximal row carpectomy were recorded. Pain (0-no pain, 10-severe pain), and patient satisfaction (0-not satisfied, 10-very satisfied) were assessed with visual analog scale (VAS). Wrist range of motion, and hand grip strength were evaluated. The quick-disabilities of the arm, shoulder and hand (Q-DASH), and Mayo wrist score were used for functional evaluation of the upper limb. Short form-36 (SF-36) was used for the evaluation of quality of life. RESULTS: Postsurgical duration was 20.6±16.4 (range; 6-56) months. Complex regional pain syndrome (CRPS) was detected in two patients (%12.5). The mean session numbers of physical therapy were 16.7±9.4 (range; 0-30), satisfaction VAS was 8.4±2.1, rest VAS 0.8±0.9, activity VAS was 2.3±2.2, grip strength of operated side 82% of nonoperated side, Q-DASH score was 13.4±16.5 (substantially good), and Mayo wrist score was 80.0±19.4 (good). Significant improvement was detected in postoperative flexion-extension arc compared to preoperative status (p=0.001). A correlation was detected between hand grip strength percentage and session numbers of physical therapy (p=0.025, r=0.558). Relationships between quality of life-pain subscore and activity pain (p=0.001, r= -0.819), Q-DASH (p=0.003, r= -0.698), and Mayo wrist score (p=0.037, r=0.525) were detected. The presence of complication was the only independent variable for prediction of functional status in multivariate linear regression analysis. CONCLUSION: Increased number of physical therapy session results in improved hand grip strength following the proximal row carpectomy, while CRPS complication which can be seen after surgery affects the functional status adversely.

Distribution of the metatarsophalangeal sesamoids in Turkish subjects.

No statistically significant pattern of metatarsophalangeal sesamoid distribution has been reported in the literature in relation to genetic pool or group, unilaterality or bilaterality, or sesamoid division. A study was undertaken to evaluate the presence and distribution of the metatarsophalangeal sesamoid bones of the foot in Turkish subjects. A total of 602 foot radiographs from 371 patients without forefoot complaints other than those of the hallux were included in the study. Absence or hypoplasia of the first-ray sesamoids was seen on 0.7% of the radiographs, and second-, third-, fourth-, and fifth-ray sesamoids were present on 2.8%, 0.5%, 1.0%, and 15.1% of the radiographs, respectively. Fifth-ray sesamoids were more prevalent in men (odds ratio, 2.71; 95% confidence interval, 1.52-4.84). The frequency of a normal foot profile (two sesamoids in the first ray) was 83.2%. Divisions of the sesamoids were seen on 4.0% of the radiographs at the first ray and on 20.9% at the fifth ray. Distribution and division of sesamoids were predominantly bilateral (kappa = 0.91, 0.91, and 0.95 for the first, second, and fifth digits, respectively; P < .001).

Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial.

In a prospective randomized study of plantar heel pain, 44 patients were treated with injection of 1 mL of 2% prilocaine using the peppering technique, 1 mL of 2% prilocaine combined with 2 mL of autologous blood, or 1 mL of 2% prilocaine mixed with 40 mg of methylprednisolone acetate. At 6-month follow-up, clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society. Results were analyzed using sample t-tests within groups and repeated-measures analyses of variance between groups. Mean +/- SD visual analog scale scores in the peppering technique, autologous blood injection, and corticosteroid injection groups improved from 6.4 +/- 1.1, 7.6 +/- 1.3, and 7.28 +/- 1.2 to 2.0 +/- 2.2 (P < .001), 2.4 +/- 1.8 (P < .001), and 2.57 +/- 2.9 (P < .001), respectively. Mean +/- SD rearfoot scores in the same groups improved from 64.1 +/- 15.1, 71.6 +/- 1, and 65.7 +/- 12.7 to 78.2 +/- 12.4 (P = .018), 80.9 +/- 13.9 (P = .025), and 80.07 +/- 17.5 (P = .030), respectively. There were no statistically significant differences among the groups. Good outcomes have been documented using the peppering technique and autologous blood injection for the treatment of lateral epicondylitis. Although the curative mechanisms of both injection modalities are based on a hypothesis, they seem to be good alternatives to corticosteroid injection for the treatment of plantar heel pain.

The relation of joint laxity and trunk rotation.

A study was designed to evaluate the joint laxity during scoliosis screening, and to show if there is a relation of joint laxity values to the trunk rotation. One thousand, two hundred and seventy-three children (598 females, 675 males) with an average age of 10.4 years were screened with a scoliometer and forward bending for trunk rotations. Scapular and shoulder elevations, flexible pes planus were recorded and joint laxity was evaluated with the Beighton score. There was high inter-observer and intra-observer reliability for both scoliometer and Beighton scores. In 41 children (3.2%) with Beighton score 7 or higher, trunk rotation measurements were higher than for the rest of the children. Trunk rotation measurements of 7 degrees or higher were found in 30 children, who were more lax than the rest of the group and were invited for radiography, with a detection of curves between 11 and 18 degrees in 10 of them. The Beighton score is a practical and reliable method for defining joint laxity. Although the number of patients with scoliosis was limited, there are findings supporting the relation between joint laxity and scoliosis. Moreover, there was increased laxity in children with increased trunk rotations. Ligamentous laxity may be one of the causes changing the contour of the back.

The acetabular teardrop and ultrasonography of the hip.

The acetabular teardrop is an important tool for the diagnosis of acetabular dysplasia. Since it was first described by Köhler its widespread use has not become established due to the relative subjectivity in classification of the types. The acetabular teardrop angle (ATA) is proposed for this purpose, and to show the teardrop's direct relation to acetabular development by correlating it with hip ultrasonography results. Patients (51 male, 53 female) included in this study received hip ultrasonography and concomitant pelvic radiography. In the 296 hips, alpha and beta angles were measured from ultrasonography, whilst the acetabular index (AI), ATA, teardrop distance and the transverse diameter of the most upper, most widened part of the teardrop were measured from the radiographs. The enlarged, and triangle-shaped teardrop is seen later than normal ones, and the triangle-shaped-teardrop hips have a higher AI than the normal hips. The ATA is in good correlation with the widest diameter, showing this to be a reliable tool for describing the teardrop. The ATA also has a positive correlation with the beta angle denoting its significance to acetabular development. High-risk babies should be followed-up primarily with ultrasonography wherever possible. The AI from radiographs and the acetabular teardrop may be used as a helper tools in decision-making, with the guides of the ATA and the transverse diameter of the most upper, most widened part of the teardrop, as proposed in this study.

A new technique for creating an abdominal window in a hip spica cast.

Opening an abdominal window in a hip spica type of cast can be a troubling maneuver for both orthopaedic surgeon and patient. We present a simple device to create an abdominal window more easily.

Biomechanical evaluation of flexor tendon function after hamate hook excision.

PURPOSE: Hamate hook fractures are uncommon injuries for which treatment is controversial. Excision of the hamate hook is considered to be the preferred method of treatment but the effects of hamate excision are not clearly delineated. The purpose of this study was to determine what effect, if any, excision of the hamate has on flexor tendon function. METHOD: The biomechanical effects of hamate hook excision on flexor tendon function were studied in fresh cadaveric forearm specimens with wrists fixed in 3 positions (neutral, 30 degrees extension, 30 degrees extension with 30 degrees ulnar deviation). Flexor tendon force, flexor tendon excursion, and flexor tendon shift were evaluated. RESULTS: Flexor tendon force decreased after hamate hook excision (11% in neutral, 14% in 30 degrees extension, and 15% in 30 degrees extension with 30 degrees ulnar deviation). The flexor profundus tendons had a 7- to 11-mm increase in proximal tendon excursion after hamate hook excision depending on the position of the wrist, and the flexor profundus tendons of the small finger shifted 4 to 5 mm in ulnar direction. CONCLUSIONS: The hamate hook provides some biomechanical advantage for flexor tendon function and cadaveric changes in tendon force after its excision suggest that power grip may be decreased after hamate hook excision.

The use of amniotic membrane in flexor tendon repair: an experimental model.

BACKGROUND: The objective of this study was to investigate the use of amniotic membrane as a long-term bioprosthesis in hand surgery. The role of the amniotic membrane was investigated in chickens with regard to the prevention of adhesion formation following tendon repair in zone II. METHODS: In the control group, the flexor tendon sheath was excised and the tendon repaired. In group II, both the flexor digitorum profundus tendon and its sheath were repaired. In group III, the repaired tendon was covered with amniotic membrane. Histological evaluation of the repaired tendons were done at 3, 6 and 12 weeks. RESULTS: Results of histologic examination demonstrated that use of the amniotic membrane significantly reduced the amount of adhesion compared with the other groups. Three months after implantation no remnants of amniotic membrane could be identified at the tendon repair site. CONCLUSIONS: Amniotic membrane is easily prepared, and because of its cost effectiveness, its use in the prevention and treatment of adhesions should always be kept in mind.

[Stress fracture of the fifth metatarsophalangeal sesamoid bone: a case report]. / Besinci metatarsofalengeal eklem sesamoidinin stres kirigi.

There is a paucity of published literature on the injuries of the lesser toe sesamoids of the foot. A fifty-six-year-old male patient without a major trauma history was diagnosed as having a stress fracture of the fifth metatarsophalangeal joint medial sesamoid bone. Conservative treatment was employed and the patient was followed-up for 25 months without any complaints. The sesamoid bone injury of the fifth toe should be included in the differential diagnosis of lateral forefoot pain.

Hamstring shortening in healthy adults.

Hamstring shortening (HS) causes changes in the posture and walking ability in spastic children, however, there are no studies defining the abnormalities in patellar alignment in individuals with HS.Twenty-five patients with a primary complaint of anterior knee pain, having HS detected at physical examination, and 11 healthy individuals without any HS or knee discomfort as a control group are included in this study. Serial x-rays of the spine, pelvis and knee are taken and knee x-rays are evaluated for the position of the patella in both groups.In patients with Knee Extension Deficit (KED) ≥ 60°, the Blackburne-Peel ratio is lower and the Insall-Salvati ratio is higher than the other groups, denoting a cephalic location of the patella (p < 0.05). There are no changes in the congruency and sulcus angles between the HS and control groups. Vertebral and pelvic changes correlate well with the literature, confirming that significant alterations occur after 60° of KED in adults.The extensor mechanism of the knee is affected and patella is located higher than normal in patients with severe HS, which may be a cause for knee discomfort. In the light of these findings, a routine knee extension deficit examination can be suggested in the initial evaluation of knee discomfort.