Evaluation of Serum Interleukin-38 Levels in Different Radiographic Grades of Idiopathic Knee Osteoarthritis.

The aim of this study was to assess interleukin-1ß (IL-1ß), IL-1Ra, IL-36, and IL-38 levels together with hs-CRP levels in patients with different radiographic grades of knee osteoarthritis (OA) in comparison to healthy individuals. Consecutive patients aged over 50 years who were admitted to our Orthopaedics and Traumatology department between November 2018 and March 2019 and diagnosed as knee OA according to the American College of Rheumatology criteria were included in this prospective case-control study. Patients with knee OA were staged according to radiographic Kellgren-Lawrence (K-L) classification and 20 patients were assigned to each group. An age and gender matched control group consisted healthy volunteers with no clinical and radiographic sign of arthritis were conducted as the control group. Venous blood samples were collected and assessed for hs-CRP, IL-1ß, IL-1Ra, IL-36, and IL-38 levels using the double-antibody sandwich ELISA method. The hs-CRP, IL-1ß, IL-36 and IL-38 levels did not significantly differ among controls and independent radiographic stage groups except IL-1Ra levels which was significantly higher in K-L grade 4 knee OA groups compared to healthy controls (P = 0.045). When we compared all patients with knee OA and healthy controls, we detected that IL-1 and IL-1Ra were significantly lower and IL-38 levels were significantly higher in healthy control group compared to patients with knee OA (P = <0.001, <0.001, and 0.019, respectively). According to results obtained from our study, IL-1ß, IL-1Ra, and IL-38 levels significantly differed between healthy individuals and patients with knee OA. However, we did not observe a significant difference and correlation between radiographic grade of knee OA and interleukin levels.

Multiple Subscapularis Tendon Sign: A New Risk Factor for Recurrence After Arthroscopic Anterior Shoulder Instability Surgery.

BACKGROUND: Being able to predict recurrence after the treatment of shoulder instability would be helpful in planning the appropriate treatment. PURPOSE: To define the multiple subscapularis tendon sign (MSTS) as a novel anatomic variant and a possible risk factor for the recurrence of shoulder instability after anterior stabilization and to evaluate it, together with the other risk factors as described in the literature. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 87 patients met the study criteria and underwent arthroscopic stabilization for anterior shoulder instability. The MSTS was evaluated in this study group. Age, sex, hand dominance, number of preoperative shoulder dislocations, history of overhead or contact sports participation, type of labral lesion, number of anchors used in surgery, presence of the drive-through sign, presence of the MSTS, Oxford Shoulder Score results, and the association of these parameters with recurrence were assessed. The mean follow-up time was 81.0 ± 27.9 months (range, 48-139 months). RESULTS: Nine (10.3%) patients experienced recurrent instability. The presence of the MSTS (P = .009), existence of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion (P = .04), and history of overhead or contact sports participation (P = .04) were significant risk factors for recurrence. The recurrence rates were as follows: 30.7% with the MSTS; 40% with the MSTS and an ALPSA lesion; and 75% with the MSTS, an ALPSA lesion, and a history of overhead or contact sports participation. CONCLUSION: The MSTS is a variation of the anterior shoulder joint capsule. It is a sign of capsular insufficiency or thinning, which may be a risk factor for recurrence after anterior stabilization. Considering the low success rates of anterior capsulolabral repair in patients participating in overhead or contact sports, especially when an ALPSA lesion is present, encountering the MSTS during surgery in this at-risk group may be an indicator for the surgeon to choose the surgical procedure more carefully.

Functional outcomes and quality of life in adult ipsilateral femur and tibia fractures.

OBJECTIVE: The aim of our study is to evaluate the functional outcomes and quality of life in adult ipsilateral femur and tibia fractures. METHODS: 26 patients (21 male, 5 female; mean age 30 years, range: 18 to 66) treated for adult ipsilateral femur and tibia fractures were evaluated retrospectively. For femur fractures, intramedullary nails were used in 15 patients (12 antegrade, 3 retrograde), plate in 11 patients (10 locked-plate, and 1 blade-plate with a 95 degree angle). For tibia fractures, locked-plate were used in 13 patients, intramedullary nails in 9 patients, external fixator in 3 patients and multiple screws in 1 patient. According to Blake and McBryde classification, 17 fractures were type I, 9 fractures were type II (7 type 2A and 2 type 2B). The functional outcomes were evaluated by Karlström and Olerud criteria, and quality of life was evaluated by Short Form-36. The mean follow-up duration was 4.4 years (range: 1.1 to 7.3 years). RESULTS: The functional outcomes were excellent in 6 patients, good in 8 patients, acceptable in 6 patients and poor in 6 patients. The mean values of quality of life scales were; physical function: 64.8, physical role limitation: 60.5, pain: 68.2, general health: 63.3, vitality: 58.4, social function: 68.2, emotional role limitation: 62.7, and mental health: 65.8. CONCLUSION: Adult ipsilateral femur and tibia fractures are severe injuries and adversely affect the quality of life and functional outcomes. The quality of life scales should be used along with functional outcome scores in evaluating these injuries. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Adult ipsilateral femur and tibia fractures cause severe morbidity. Functional outcomes and quality of life scales should be used together to evaluate these fractures. Karlström and Olerud criteria for functional outcomes and Short Form-36 scales for quality of life are suitable methods to evalute these fractures.

A Newly Designed Intramedullary Nail for the Treatment of Diaphyseal Forearm Fractures in Adults.

BACKGROUND: The treatment of diaphyseal forearm fractures using open reduction and plate fixation is generally accepted as the best choice in many studies. However, periosteal stripping, haematoma evacuation may result in delayed union, nonunion and infection. Refracture after plate removal is another concern. To overcome these problems intramedullary nails (IM) with different designs have been used with various outcomes. However previous IM nails have some shortcomings such is rotational instability and interlocking difficulties. We evaluated the results of newly designed IM nail in the treatment of diaphyseal forearm fractures in adults. MATERIALS AND METHODS: 32 patients who had been treated with the interlocking IM nail for forearm fractures between 2011 and 2014 were included in this study. There were 23 males and 9 females with mean age of 36 years (range 18-68 years). 22 patients (68.8%) had both bone fractures. Nine patients (28.1%) had open fractures. The remaining ten patients (31.2%) had radius or ulna fractures. Grace and Eversmann rating system was used to assess functional evaluation. Patient reported outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. RESULTS: Union was achieved in all patients. The mean followup was 17 months (range 13 - 28 months). According to the Grace-Eversmann criteria, 27 patients (87.5%) had excellent or good results. The mean DASH score was 14 (range 5-36). Overall complication rate was 12.5%. Superficial infection was encountered in two patients. One patient had delayed union, however fracture healed without any additional surgical procedure. One patient who had open grade 3A, comminuted proximal third radius fracture developed radioulnar synostosis. CONCLUSIONS: The new design IM interlocking forearm nail provides satisfactory functional and radiological outcomes in the treatment of adult diaphyseal forearm fractures.

Effects of local vibration and pulsed electromagnetic field on bone fracture: A comparative study.

The effectiveness of various therapeutic methods on bone fracture has been demonstrated in several studies. In the present study, we tried to evaluate the effect of local low-magnitude, high-frequency vibration (LMHFV) on rat tibia fracture in comparison with pulsed electromagnetic fields (PEMF) during the healing process. Mid-diaphysis tibiae fractures were induced in 30 Sprague-Dawley rats. The rats were assigned into groups such as control (CONT), LMHFV (15 min/day, 7 days/week), and PEMF (3.5 h/day, 7 days/week) for a three-week treatment. Nothing was applied to control group. Radiographs, serum osteocalcin levels, and stereological bone analyses of the three groups were compared. The X-rays of tibiae were taken 21 days after the end of the healing process. PEMF and LMHFV groups had more callus formation when compared to CONT group; however, the difference was not statistically significant (P = 0.375). Serum osteocalcin levels were elevated in the experimental groups compared to CONT (P ≤ 0.001). Stereological tests also showed higher osteogenic results in experimental groups, especially in LMHFV group. The results of the present study suggest that application of direct local LMHFV on fracture has promoted bone formation, showing great potential in improving fracture outcome. Bioelectromagnetics. 38:339-348, 2017. © 2017 Wiley Periodicals, Inc.

Candida arthritis in a patient diagnosed with spondyloarthritis.

Candida arthritis is an unusual manifestation that usually affects the knees. A 35-year-old man presented with a 2-month history of pain and swelling in the right knee. Swelling persisted after anti-inflammatory treatment. Peripheric spondyloarthritis was considered, but methotrexate, sulfasalazine, and methylprednisolone did not reduce the swelling. Direct examination of synovial fluid and a culture were positive for Candida albicans. Intravenous and intra-articular amphotericin-B were administered. The arthritis regressed and a culture and direct staining showed negative results. Candida arthritis should be considered in patients with arthritis that is resistant to treatment and prolonged, even if risk factors are absent.

Candida arthritis in a patient diagnosed with spondyloarthritis

Abstract Candida arthritis is an unusual manifestation that usually affects the knees. A 35-year-old man presented with a 2-month history of pain and swelling in the right knee. Swelling persisted after anti-inflammatory treatment. Peripheric spondyloarthritis was considered, but methotrexate, sulfasalazine, and methylprednisolone did not reduce the swelling. Direct examination of synovial fluid and a culture were positive for Candida albicans. Intravenous and intra-articular amphotericin-B were administered. The arthritis regressed and a culture and direct staining showed negative results. Candida arthritis should be considered in patients with arthritis that is resistant to treatment and prolonged, even if risk factors are absent.

The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus.

BACKGROUND: This study aimed to evaluate the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy. METHODS: Forty patients with intra-articular distal humerus fractures were retrospectively analyzed. TRAP approach was used in 22 patients (12 males, 10 females; mean age 37.8 years, range 17-70), and olecranon osteotomy in 18 patients (11 males, 7 females; mean age 35.4 years, range 18-62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. RESULTS: The overall mean arc of elbow motion was 108° (range 70°-140°) in the TRAP group, whereas that of the olecranon osteotomy group was 98° (range 70°-115°). A significant difference was observed between the two groups in terms of overall mean arc of elbow motion (p=0.038). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.412, p=201, respectively). The overall complication rate was 27.2% in the TRAP group and 55% in the olecranon osteotomy group. CONCLUSION: TRAP is a succesful approach in the treatmet of intra-articular distal humerus fractures that provides better arc of elbow motion, reduces complications and reoperation rates.

[Vascular injury following supracondylar humerus fractures in children]. / Çocuklarda suprakondiller humerus kirigi sonrasi damarsal yaralanmalar.

BACKGROUND: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures. METHODS: Forty-two pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluation included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications. RESULTS: In 27 patients, radial pulse was palpated following reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) who retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture, and the other two were managed with saphenous vein graft and primary repair. DISCUSSION: It is vital to re-evaluate patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ischemia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

Results of two different surgical techniques in the treatment of advanced-stage Freiberg's disease.

BACKGROUND: Freiberg's disease is an osteochondrosis most commonly seen in adolescent women and characterized by pain, swelling and motion restriction in the second metatarsal. The early stages of this disease can be managed with semirigid orthoses, metatarsal bars and short leg walking cast. Number of operative methods are suggested which can be used depending on the pathophysiology of the disease, including abnormal biomechanics, joint congruence and degenerative process. We evaluated the outcomes of the patients with Freiberg's disease who were treated with dorsal closing-wedge osteotomy and resection of the metatarsal head. PATIENTS AND METHODS: 16 patients (11 female, 5 male) with a mean age of 24.5 (range 13-49 years) years who underwent dorsal closing wedge osteotomy or resection of the metatarsal head were included in this retrospective study. Second metatarsal was affected in 13 and third metatarsal in three patients. According to the Smillie's classification system, ten patients had type IV osteonecrosis and six patients had type V. The results of the patients were evaluated using the lesser metatarsophalangeal-interphalangeal (LMPI) scale. RESULTS: According to the LMPI scale, the postoperative scores for the osteotomy and excision groups were 86 (range 64-100) and 72.6 (range 60-85), respectively. In the osteotomy group, mean passive flexion restriction was 18° (range 0°-35°) and mean passive extension restriction was 12° (range 0°-25°). Mean metatarsal shortening was 2.2 mm (range 2-4 mm) in the osteotomy group as opposed to 9.8 mm (range 7-14 mm) in the excision group. Significant pain relief was obtained in both groups following the surgery. CONCLUSIONS: The decision of performing osteotomy or resection arthroplasty in the patients with advanced-stage Freiberg's disease should be based on the joint injury and the patients should be informed about the cosmetic problems like shortening which may arise from resection.

Minimally Invasive Plate Osteosynthesis in Open Pediatric Tibial Fractures.

OBJECTIVES: The aim of this study is to investigate the effectiveness and reliability of limited-contact locking plates in minimally invasive percutaneous osteosynthesis (MIPO) of the lateral tibia. DESIGN: A retrospective study. PATIENTS AND METHODS: The retrospective study included 14 patients who were operatively treated with an MIPO technique due to open tibial fractures between 2006 and 2012. The patients were 11 males and 3 females with a mean age of 13.2 (range, 9 to 16) years. The patients were followed up for a mean period of 2.4 (range, 1 to 5) years. The mechanism of the injuries included a motor vehicle accident (n=11), a shotgun injury (n=2), and a fall from height (n=1). According to the Gustilo-Anderson classification, 10 patients had type I (72%), 2 had type II (14%), and 2 had type III (14%) open fractures. RESULTS: The mean time to radiologic union was 18 (range, 11 to 32) weeks. No infection was detected that would require implant removal. No complications such as early epiphyseal closure, angulation, or limb-length inequality were observed. CONCLUSIONS: Limited-contact locking plates in MIPO of the lateral tibia is an effective alternative method in the treatment of open pediatric tibial fractures. LEVEL OF EVIDENCE: Level IV-therapeutic.

Hydatid cysts in muscles: clinical manifestations, diagnosis, and management of this atypical presentation.

INTRODUCTION: Hydatid cysts are rarely detected in muscle tissue (0.7-0.9%), even in endemic countries. The aim of this study was to present information regarding the clinical manifestations, diagnosis, and management of muscle echinococcosis. METHODS: Twenty-two patients with hydatid cysts in the muscle were followed from January 2006 through December 2014. RESULTS: Twenty-four sites of muscle involvement were observed in the 22 patients. Fifteen (68%) of our patients were women, while seven (32%) were men. The mean age was 28.1 ± 15.4 (6-61) years. The most frequent locations were the thigh (27.2%) and the paravertebral region (13.6%). Most patients reported a painless slow-growing mass with normal overlying skin. Most (90.2%) cases were treated by surgical excision and fine-needle aspiration. CONCLUSIONS: Primary muscle hydatid cyst should be considered in the differential diagnosis in cystic masses of the muscular system without pain and localized enlargement of soft tissue, especially in endemic areas. Hydatid cyst should be investigated using serological tests and imaging modalities. If possible, total surgical excision of hydatid cyst in the muscle should be performed.

Management of infectious fractures with "Non-Contact Plate" (NCP) method.

The aim of this study was to evaluate the outcomes of internal fixation with Non-Contact Plating (NCP) after deep infection caused by previous surgeries of the tibia or femur fractures. The study included 15 patients (4 female and 11 male). The mean age patients was 36.6 years (range, 21-64 years). There were 6 femur and 9 tibia fractures. The mean follow-up period was 25.7 months (range, 15-45 months). The study comprised 11 open and 4 closed fractures. External fixator was used in 3, plate in 4, and intramedullary nail in 8 patients for index surgery. Deep infection was diagnosed via clinical findings, laboratory parameters, and microbiological evaulation. Deep infection was diagnosed within a mean period of 5.5 weeks (range, 2-10 weeks). The infecting organism was methicillin-resistant staphylococcus aureus (MRSA) in 5, methicillin-sensitive staphylococcus aureus (MSSA) in 6, pseudomonas auroginosa in 2, and enterobacteriacea in 2 patients. Union achieved in all patients. Mean time to union was 17 (range, 11-38) weeks. Delayed union was observed in 3 patients who required additional surgeries. Of these one patient developed osteomyelitis. The NCP is an effective alternative method in the treatment of deep infection encountered after internal or external fixation for the tibia, or femur fractures.

Hydatid cysts in muscles: clinical manifestations, diagnosis, and management of this atypical presentation

ABSTRACTINTRODUCTION: Hydatid cysts are rarely detected in muscle tissue (0.7-0.9%), even in endemic countries. The aim of this study was to present information regarding the clinical manifestations, diagnosis, and management of muscle echinococcosis.METHODS: Twenty-two patients with hydatid cysts in the muscle were followed from January 2006 through December 2014.RESULTS: Twenty-four sites of muscle involvement were observed in the 22 patients. Fifteen (68%) of our patients were women, while seven (32%) were men. The mean age was 28.1 ± 15.4 (6-61) years. The most frequent locations were the thigh (27.2%) and the paravertebral region (13.6%). Most patients reported a painless slow-growing mass with normal overlying skin. Most (90.2%) cases were treated by surgical excision and fine-needle aspiration.CONCLUSIONS: Primary muscle hydatid cyst should be considered in the differential diagnosis in cystic masses of the muscular system without pain and localized enlargement of soft tissue, especially in endemic areas. Hydatid cyst should be investigated using serological tests and imaging modalities. If possible, total surgical excision of hydatid cyst in the muscle should be performed.

Segmental bone loss in pediatric lower extremity fractures: indications and results of bone transport.

BACKGROUND: In this study, we evaluated the results of external bone transport, which was applied to 11 patients with traumatic bone loss who had not completed their bone development. METHODS: The average age of the 9 male and 2 female patients was 10.6 (range, 8 to 16) years. Eight of the defects were located in the tibia, whereas the other 3 were in the femur. The average defect was 5.4 (range, 4.5 to 8.5) cm. External bone transport was applied in the early period in 7 patients, whereas in 4 patients it was performed due to nonunion. Bifocal osteosynthesis and single osteotomy were performed in 2 patients with type B2 nonunion. Compression to the nonunion region and lengthening in the osteotomy region were applied. In 2 patients with type B1 nonunion, and the other 9 patients who had external bone transport, the gap was eliminated by bifocal osteosynthesis, single osteotomy, and bone transport to the osteotomy line. RESULTS: The mean follow-up period was 21 (range, 13 to 48) months. Complete union was achieved in all patients without any bone operation or graft application. No refracture was observed after the removal of the external fixator, and the average hospitalization time was 16 (range, 7 to 65) days. The average external fixation time was 4.2 (range, 3.5 to 5.5) months, and the mean external fixator index was 0.8 months (23 d/cm). The mean bone healing time was 5.1 (range, 4.6 to 6) months. CONCLUSIONS: To initially consider the open fractures with true or in situ bone loss in children as "anticipated nonunion," and determine the treatment strategies regarding this fact, may prevent nonunion and shorten the healing period. Bone transport in the treatment of traumatic bone defects in children is an easy biological procedure, with lower complications but higher success ratios. LEVEL OF EVIDENCE: Level IV-therapeutic.

Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur.

OBJECTIVE: The aim of this study was to compare retrograde intramedullary nailing (RIMN) and bridge plating for the treatment of extra-articular distal femur fractures. METHODS: The study retrospectively examined 15 patients (13 males and 2 females; mean age: 36 years, range: 17 to 55 years) who underwent bridge plating and 13 patients (11 males and 2 females; mean age: 31.1 years, range: 17 to 49 years) who underwent RIMN for the treatment of extra-articular distal femur fractures between 2007 and 2012. Functional results were evaluated using the Sanders criteria. The mean follow-up time was 31.3 (range: 20 to 46) months and 26.7 (range: 18 to 62) months in the plate and the nail groups, respectively. RESULTS: Mean duration until union was 25.7 (range: 12 to 72) weeks in the plate group and 22.3 (range: 12 to 52) weeks in the nail group. Nonunion was observed in 2 patients in the plate group and in 1 in the nail group, delayed union in 3 patients in the plate and 2 in the nail groups, malalignment (>10°) in 2 patients in the plate group and 1 in the nail group and implant failure in 1 patient in the plate group. Excellent/good functional results were obtained in 12 and 10 patients in the plate and the nail groups, respectively. No significant difference was found between the groups in terms of duration of union, complications and functional results (p>0.05). CONCLUSION: Bridge plating and RIMN have similar results in the treatment of extra-articular distal femur fractures. Both methods can be applied to all fractures, with the exception of Gustilo-Anderson Type 3B and C open fractures.

Gorham-Stout's disease in the metatarsus: a case report.

Gorham-Stout disease (GSD) is a rare disease occurring in the bone tissue and is characterized by spontaneous, progressive resorption. The etiology and treatment of the disease remains unclear. This article presents a 53-year-old male patient diagnosed with GSD in the 3rd and 4th metatarsal of his right foot.

One-stage bilateral open reduction using the anterior iliofemoral approach in developmental dysplasia of the hip.

The aim of this study was to investigate the safety of one-stage bilateral open reduction using the anterior approach in the treatment of patients with bilateral Tönnis Type III and IV Developmental Dysplasia of the Hip (DDH). Forty-six patients were retrospectively evaluated. Thirty-eight were female, eight were male. The mean age was 16.63 (11-29) months. The mean follow-up period was 27.18 (12-65) months. The mean hospitalization period after surgery was 1.91 (1-5) days. The mean pre-operative hematocrit level was 35.14% (28.1-44.1) and the mean pre-operative hemoglobin level was 11.75 g/dl (9.3-13.6). The mean post-operative hematocrit level was 32.54% (26.7-40.4) and the mean post-operative hemoglobin level was 10.80 g/dl (8.78-12.3). None of the patients required blood transfusion. The mean anesthesia duration was 133.30 (95-180) minutes, and the mean operation duration was 107.58 (70-145) minutes. According to the modified scoring system by Trevor et al, excellent results were obtained in 66 hips of 46 patients (71.8%), and good results were obtained in 26 hips (28.2%). Twenty two hips (23.91%), which developed acetabular dysplasia in the follow-up period required a secondary acetabular intervention. According to the Kalamchi and MacEwen classification, Type I avascular necrosis developed in ten hips, Type II in one hip, and Type IV in two hips. One-stage bilateral open reduction using the anterior iliofemoral approach in Tönnis Type III and IV DDH at walking age is a safe, time-saving treatment method that shortens the hospitalization and immobilization periods.

Should routine pelvic osteotomy be added to the treatment of DDH after 18 months?

The treatment of developmental dysplasia of the hip (DDH) between ages 1-3 years is controversial. Particularly controversial is the age after which pelvic osteotomy should be added to the treatment. In the present study, the outcomes of DDH patients aged 1-3 years treated with anterior open reduction alone were evaluated, and the relationship between inadequate acetabular development, the need for secondary pelvic osteotomy, and age was investigated. A total of 53 patients (70 hips) who had begun walking, who had undergone open reduction through an anterolateral approach, who had a follow-up period of at least 2 years, and who had Tönnis grade III and IV hip dysplasia were included in the study. They were grouped according to treatment age (pre-18 months: Group I; post-18 months: Group II), and the two groups were compared with regard to radiological and functional outcomes and the need for a secondary acetabular procedure. In Group I there were 29 hips (mean age: 16.09 months) and in group II there were 41 hips (mean age: 23.1 months), and the mean follow-up period was 48.9 months. According to the modified Trevor score, in Group I outcomes were excellent in 23 hips (79.3%) and good in 6 hips (20.7%), while in group II outcomes were excellent in 30 hips (73.2%), good in 10 hips (24.4%), and fair in 1 hip (2.1%). The difference between outcomes was not significant (P > 0.05). Inadequate acetabular development was determined in 11 hips in group I (37.9%) and in 16 hips in group II (39%). There was no difference between groups in terms of inadequate acetabular development or the need for acetabular prodecures (p > 0.05). No significant difference was determined between DDH patients treated before 18 months and those treated after 18 months with regard to unsatisfactory acetabular development or the need for secondary acetabular procedures. According to these results, reduction prior to 18 months does not always achieve satisfactory acetabular development, and secondary acetabular procedures are not always necessary in patients who undergo reduction after 18 months. In the treatment of DDH, the decision to perform primary pelvic osteotomy in addition to open reduction should be made not according to whether the patient is older or younger than 18 months, but according to stability, and all patients should be followed closely with regard to the need for pelvic osteotomy.

How safe is titanium elastic nail application in the surgical treatment of tibia fractures in children?

Tibia fractures in children are generally treated successfully by conservative means. The aim of this study was to evaluate the efficacy and safety of fixation using Titanium elastic nails (TEN) in pediatric tibia fractures in which conservative measures failed or were deemed inapplicable. In this study, 30 patients who had tibia fractures and were fixated with TEN between 2007 and 2011 were analyzed retrospectively. The procedure was performed after poly-trauma in six patients, open fracture in seven, reduction loss in twelve, and unsuccessful closed reduction in five patients. The number of girls and boys was 3 and 27, respectively, with a mean age of 9.8 years. The evaluation criteria of Flynn et al. were used in the analysis of the results. The mean follow-up period was 18 months. The mean period of union was 8 weeks and 14 weeks in closed and open fractures, respectively. Epiphyseal damage, rotational deformity, need for reintervention, deep infection, implant failure, or recurrent fracture was not observed in any case. According to the Flynn evaluation system, 23 cases were evaluated as excellent, and 7 as good. Fixation with TEN is an easy, effective, and safe method that can be used in tibia fractures that are open, irreducible, or with loss of reduction and in cases with accompanying trauma, such as floating knee.