The effect of high tibial osteotomy and unicompartmental knee arthroplasty on patellofemoral joint in young patients with medial knee arthrosis.

INTRODUCTION: Osteoarthritis of the knee is a debilitating disease. In most cases, only the medial compartments are affected. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are the two main procedures commonly used in the surgical treatment of unicompartmental knee osteoarthritis patients not responding to conservative treatment. The aim of our study was to compare UKA and biplanar medial open-wedge HTO in terms of patellofemoral changes and functional score in patients under 60 years of age with medial compartment arthrosis. MATERIALS AND METHODS: A retrospective study. A total of 79 patients (37 HTO, 42 UKA) who received one of the two treatments in a single center were examined preoperatively and at a single postoperative follow-up. Posterior tibial slope, lateral patellofemoral angle (LPFA), Q-angle, patellar height, Cincinnati Rating System and Knee Injury and Osteoarthritis Outcome Score (KOOS) functional scores were evaluated in all patients preoperatively and at the 6-month follow-up examination. RESULTS: Insall-Salvati ratio remained stable in the HTO group, while there was a minor decrease in the UKA group and the changes between the groups were not statistically significant. Caton-Deschamps ratio increased in the UKA group and decreased in the HTO group, and this change was statistically significant (p < 0.001). LPFA did not change in the UKA group in the postoperative period, while it increased in the HTO group (p < 0.001). Changes in Q angle and Cincinnati Rating System scores were statistically similar between the UKA and HTO groups (p = 0.827 and p = 0.340). CONCLUSIONS: In our study, biplanar medial open-wedge HTO and UKA performed with appropriate surgical technique had no negative effect on patellofemoral joint. In patients under 60 years of age with medial compartment osteoarthritis of the knee, both surgical treatments can be performed with appropriate patient selection.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

OBJECTIVES: The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. RESULTS: Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. CONCLUSION: Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Clinical and radiological comparison of bioactive glass and poly-L-lactic acid/hydroxyapatite bioabsorbable interference screws for tibial graft fixation in anterior cruciate ligament reconstruction.

BACKGROUND: Ligament reconstruction is still the main treatment modality for patients with a complete ligament rupture. The semitendinosus tendon, alone quadrupled or double folded and combined with the gracilis tendon, is still the most frequently used autologous graft for a reconstructive procedure. Absorbable interference screw usage has gained popularity in the past decade because they create less artifacts during MR imaging and tend to osteointegrate over the years, arguably leading to a more anatomic fixation. The purpose of this study was to compare the 5-year radiological and clinical results of two different tibial graft fixation screws. HYPOTHESIS: We hypothesized that bioabsorbable interference screws made of bioactive glass would lead to higher rates of osteointegration, better overall clinical results, less foreign body reaction rates and less tibial tunnel widening when compared to the poly-L-lactic acid/hydroxyapatite (PLLA-HA) screws. PATIENTS AND METHODS: Fifty-one patients treated with an anatomic single bundle ACL reconstruction between June 2015 and July 2016 at our institution were included in the study. The tibial graft was fixed with a bioactive glass screw in 24, and with a PLLA-HA in 27 patients. Tibial tunnel widening, foreign body reaction, osteointegration and resorption rates were evaluated and compared on a magnetic resonance scan at a minimum of 5 year postoperatively. Overall clinical results and side-to-side difference on KT-1000 were also analyzed in-between groups. RESULTS: Tibial tunnel widening was similar for both groups. Foreign body reaction, while not statistically significant, was less aggressive when bioactive glass screws were used. Osteointegration and resorption rates of the bioactive glass screws were significantly higher than the PLLA-HA group (p=0.000). While all patients showed an overall improvement on postoperative scores (p=0.000), patients with a bioactive glass interference screw had statistically higher translational stability with KT-1000, compared to the poly-L-lactic acid/hydroxyapatite group (p=0.001). DISCUSSION: At a minimum of 5 years, compared to conventional PLLA-HA interference screws, 45S5 bioactive glass screw provide higher resorption rates, are more highly biodegradable and provide overall good clinical results. LEVEL OF EVIDENCE: III.

Turkish Validity and Reliability Study of Scoliosis Research Society-30 Questionnaire in Adolescent Idiopathic Scoliosis Patients.

STUDY DESIGN: Methodological. OBJECTIVE: Turkish validity and reliability study of Scoliosis Research Society-30 (SRS-30) questionnaire. SUMMARY OF BACKGROUND DATA: SRS-30 is the most current questionnaire of SRS, which is widely used in the evaluation of the treatment of patients with idiopathic scoliosis. There is no validity and reliability study for the Turkish language. METHODS: All translation and cross-cultural adaptation stages of the SRS-30 English version to Turkish were implemented. SRS-30 Turkish and Short Form-36 questionnaires were administered to 96 patients with adolescent idiopathic scoliosis simultaneously. Two weeks later, the SRS-30-Turkish version was applied again. Internal validity was examined using the Rasch model, and external construct validity (convergent validity) was evaluated with the Spearman rho correlation test. Person Separation Index was used for reliability. The internal consistency was analyzed with Cronbach alpha. For test re-test reliability, intraclass correlation coefficient between the two measurements was calculated. RESULTS: As a result of the Rasch analysis, it was observed that the Turkish version of SRS-30 has a multidimensional structure and the disordered threshold problem was observed in some items. Overall fit is provided for each of the four sub-dimensions of SRS-30 Turkish. There was no difference in the functioning of the items in terms of gender and age groups. The lowest Person Separation Index value was obtained with 0.539 in the satisfaction of the treatment sub-dimension. Cronbach alpha values were over 0.70 for all domains. The intraclass correlation coefficient value was found in satisfaction with management dimension (0.463) and above 0.60 in other dimensions. CONCLUSION: It was concluded that the SRS-30 Turkish questionnaire was valid and reliable in evaluating the treatment of patients with adolescent idiopathic scoliosis. Considering the studies related to SRS scales in the literature, especially those applied Rasch analysis, it is seen that the reply categories of the items should be reviewed.Level of Evidence: 2.

The Change in Posterior Tibial Slope After Cementless Unicondylar Knee Arthroplasty.

BACKGROUND: The posterior tibial slope (PTS) is an important factor in patients undergoing unicondylar knee arthroplasty. It is an area subjected to high shear and compressive forces. Our objective is to investigate the changes taking place on the tibial slope of cementless unicondylar knee arthroplasties and define its relationship with functional scores. METHODS: Patients undergoing a cementless unicondylar knee arthroplasty between January 2011 and July 2019 were selected. Exclusion criteria were lack of at least 1 year of follow up, loss to follow-up for any reason, and revision of a metallic component. Overall, 161 cases were included. Patients were analyzed using standard radiographs for changes in PTS, coronal positioning of the implant, and overhanging. Function was analyzed using Oxford Knee Score, Tegner Activity Scale, and Knee Society Score. Changes of the PTS were analyzed for statistical significance and for correlations with all the other variables. RESULTS: All postoperative functional scores showed significant improvement (P < .05). Compared to the early postoperative values, increases of ≤5° were detected in 79% of all patients. The greater amount of slope change occurred during the first 6 months postoperatively. Statistical analysis revealed no significant relationship with functional scores of the knee, age, body mass index, overhanging, and coronal alignment of the tibial component. CONCLUSION: This study showed that, with time, minimal changes take place in the PTS of cementless unicondylar knee arthroplasty. The change mostly takes place during the first 6 months. These changes do not affect functional scores.

The comparison of single plate and double plate fixation methods for treatment of humeral shaft nonunions.

OBJECTIVES: This study aims to evaluate the early- and mid-term shoulder and elbow functions and compare the union rates after the application of single plate and double plate for the treatment of humerus shaft nonunions. PATIENTS AND METHODS: This retrospective study included 56 patients (36 males, 20 females; mean age 53.8±9.5; range, 28 to 68 years) treated with double plate (n=25) and single plate (n=31) osteosynthesis between October 2012 and January 2016. Surgical treatment of the nonunion was applied in the fourth month after the fracture at the earliest. Autograft taken from the iliac bone was applied during the surgery in all patients. Evaluation was performed using The University of California at Los Angeles (UCLA) Shoulder Score, Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), Constant Shoulder Score, and Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. RESULTS: The mean postoperative follow-up time was 40.7±9.6 (range, 25 to 58) months. No statistically significant difference was determined in respect of time to union, follow-up time, DASH questionnaire score, UCLA Shoulder Score, VAS, MEPS and Constant Shoulder Score after union in the comparison of the two groups (p>0.05). In the examination of postoperative early (three months) recovery phase of shoulder and elbow functions, statistically significant superior scores were obtained in the double plate group for MEPS (double plate median=85 [min 75-max 90], single plate median=75 [min 70-max 85]) and Constant Shoulder Score (double plate median=89 [min 85-max 92], single plate median=81 [min 75-max 90]) (p<0.001). CONCLUSION: There was no statistically significant difference in terms of time to union and union rates between single plate and double plate fixations for surgical treatment of humeral shaft nonunions. However, superior clinical results were obtained in the early recovery phase of shoulder and elbow functions with double plate fixation.

Does Malrotation After Minimally Invasive Plate Osteosynthesis Treatment of Distal Tibia Metaphyseal Fractures Effect the Functional Results of the Ankle and Knee Joints?

OBJECTIVES: To investigate whether rotational malalignment of tibia, after fracture management with minimally invasive plate osteosynthesis technique (MIPO), leads to impaired results in knee and ankle joint functional scores. DESIGN: Prospectively collected data were retrospectively analyzed for this study. SETTING: Level III academic trauma center. PATIENTS/PARTICIPANTS: Sixty-five consecutive patients who applied between October 2010 and January 2014 with a unilateral distal tibia fracture and had full bone union at their last visit were analyzed. Patients were excluded if they had a pathologic fracture, Gustilo-Anderson type II or III open fracture, additional ligamentous trauma, were pregnant, or had any deformity. A total of 27 patients were accepted into the study. INTERVENTION: All patients were treated with a MIPO technique after a mean of 2.8 days. The fibular fracture, when present, was fixed first. MAIN OUTCOME MEASUREMENTS: The main outcome of this study was the relation between tibial malrotation after a MIPO procedure, and Lower Extremity Functional Scale, American Orthopedic Foot and Ankle Society, KOOS scores, and range of motions of adjacent joints. RESULTS: Fourteen patients (51.8%) had a rotation higher than 10 degrees. The mean malrotation angle was 14.6 degrees. Concomitant fibular fractures were present in 13 patients, which did not seem to have a significant influence on malrotation. There was no significant difference between groups regarding functional scores and range of motions of the knee and ankle joints. CONCLUSIONS: Despite high rates of malrotation after tibial metaphyseal-diaphyseal fractures treated with MIPO technique, this finding does not seem to have a significantly negative effect on knee and ankle joint functions. Meticulous intraoperative evaluation, through a range of different techniques, should be performed to avoid malrotation. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of the clinical and radiological outcomes of arthroscopic transosseous and transosseous-equivalent double-row rotator cuff repair techniques.

OBJECTIVE: This study compared the clinical and radiological results of the arthroscopic transosseous (ATO) and transosseous-equivalent (TOE) double-row rotator cuff repair techniques. METHODS: Prospective data collected from patients treated with ATO (32 women and 7 men, mean age: 57.03±6.39 years) and TOE (36 women and 8 men; mean age: 57.86±7.81 years) techniques were retrospectively evaluated. The visual analog scale score, Constant score, and Oxford shoulder score were used to assess the clinical results. Anchor pullout on standard anteroposterior shoulder radiographs and rotator cuff re-tear on magnetic resonance images were examined at the final follow-up to evaluate the radiological results. Rotator cuff re-tears were graded as per the classification system described by Sugaya et al. Results: The mean follow-up duration was 33.3±11.8 months. No difference was observed in the demographic data of the two groups. Significant improvement was observed in the postoperative shoulder scores of the groups; however, no difference was observed between the groups. Re-tear was detected in 10 patients of the TOE group and 9 patients of the ATO group. Age, tear size, and retraction level could cause re-tear. CONCLUSION: In the treatment of rotator cuff tears, the ATO and TOE techniques may achieve considerable improvements in shoulder functions in the short term. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Is the use of headless compression screws appropriate in arthroscopic ankle arthrodesis?

OBJECTIVES: This study aims to evaluate whether the use of headless compression screws is appropriate in arthroscopic ankle arthrodesis. PATIENTS AND METHODS: Twenty-two feet of 22 patients (12 males, 10 females; mean age 43.7 years; range 21 to 63 years) in whom we applied arthroscopic ankle arthrodesis were examined retrospectively. Mean follow-up duration was 59.3 months (range 36 to 92 months). Coronal and sagittal plane alignment and concomitant pathologies were evaluated on patients' radiographs. Assessments related to pain and functionality were performed by the American Orthopaedic Foot and Ankle Society (AOFAS) scoring. RESULTS: Radiographic union was achieved in 21 of the total 22 ankles (95.4%). Mean time to union was 10.3±3.5 weeks (range 6.6 to 13.8 weeks). Mean AOFAS pain score increased from 8.1±10.2 to 35.0±6.3 and functional score increased from 21.3±5.5 to 43.4±3.8 (p<0.001). On coronal plane, preoperative tibiotalar angle of 6.6±5.5° decreased to 2.3±2.1° postoperatively. On sagittal plane, while preoperative tibiotalar angle was 17±4.9°, it was 17±4.5° postoperatively. One patient had subtalar pain and one patient had nonunion postoperatively. CONCLUSION: The use of headless compression screws is an appropriate choice in the ankle area owing to their advantages of providing successful fixation whilst not causing screw head irritation or pain.

Blood mean platelet volume and platelet lymphocyte ratio as new predictors of hip osteoarthritis severity.

Osteoarthritis (OA) is a low grade systemic inflammatory disease in which many inflammatory mediators are known to be elevated in the peripheric blood. Blood platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) are accepted as novel markers in many of the systemic inflammatory disorders, but have not been investigated in synovitis-free radiographic OA yet.The aim of this study was to evaluate the levels of blood PLR and MPV in radiographic hip OA. A total of 880 patients were evaluated retrospectively and after certain exclusion criteria, 237 of them who have primary hip OA were included. Age, sex, height, weight, body mass index, neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR), PLR, and MPV levels were recorded, Kellgren-Lawrence (KL) grading of the hip joints were performed. Patients were then divided into 2 groups as KL grades 1 to 2 (mild-moderate) and KL grades 3 to 4 (severe) hip OA.Mean age, mean neutrophil, lymphocyte and platelet counts, mean MPV, mean PLR, and mean ESR were statistically significantly different between mild/moderate hip OA group and severe hip OA group. In univariate analysis, older age and higher MPV, PLR, and ESR were severely associated with severe hip OA. In multiple logistic regression analysis, MPV, PLR, and ESR emerged as independent predictors of severe hip OA.The results of the present study, for the first time in the literature, suggest blood PLR and MPV as novel inflammatory markers predicting the radiographic severity of hip OA in the daily practice.

Nondrainage decreases blood transfusion need and infection rate in bilateral total knee arthroplasty.

This retrospective study enrolled 526 patients undergoing bilateral total knee arthroplasties at our institution. In nondrainage group (Group 1) of 255 patients (510 knees), a disposable elastic sterile exsanguination tourniquet (HemaClear), wound closure in layers and Jones Bandage, without pre-tourniquet removal hemostasis or Hemovac drain were used. In drainage group (Group 2) of 227 patients (454 knees), pneumatic tourniquet, post-deflation hemostasis, a Hemovac drain and Jones bandage were used. The maximal drop in hemoglobin was significantly greater in Group 2 than Group 1 (P < 0.001). Also infection rate was significantly lower in Group 1 (P = 0.017). The use of sterile tourniquet removed after wound closure without Hemovac drain decreases blood transfusion need, infection rate, tourniquet related pain and postoperative complications.

[Ilizarov external fixator in the management of tibial pilon fractures: ankle hinged vs ankle fixed frame]. / Tibia pilon kiriklarinin tedavisinde Ilizarov eksternal fiksatörü: Ayak bilegi eklemli mi yoksa sabit mi?

OBJECTIVES: In this study, we aimed to answer the following questions: (i) Do patients with tibial pilon fractures treated with an ankle hinge Ilizarov external fixator have a better ankle function versus ankle fixed? (ii) Is the incidence of posttraumatic arthrosis lower in patients treated with an ankle hinge Ilizarov external fixator? PATIENTS AND METHODS: Between April 2002 and January 2008, data of 34 patients (26 males, 8 females; mean age 36.9 years; range 20 to 78 years) who were treated with Ilizarov external fixator due to tibial pilon fracture were retrospectively evaluated. The patients were divided into two groups including those with an ankle hinged Ilizarov external fixator (group A, n=16) and an ankle fixed Ilizarov external fixator (group B, n=18). Preoperative and postoperative complications in the patients and quality of reduction were evaluated. In the last follow-up visit, ankle plantar and dorsiflexion range of motion and length of tibia were goniometrically measured. The functional assessment of the patients was performed using Teeny and Wiss scale. Posttraumatic arthrosis in the standard ankle X-rays was investigated. RESULTS: The mean degree of plantar flexion was significantly higher in group A (25° in group A, 12.4° in group B). In the last visit, satisfactory results were obtained in 62.5% patients of group A and in 38.8% patients of group B according to Teeny and Wiss scale. Repeated X-rays revealed posttraumatic arthrosis in 31.3% patients of group A (n=5) and in 55.5% patients of group B (n=10). CONCLUSION: The selection of an ankle hinged Ilizarov external fixator and early joint movement is an effective treatment method for the management of tibial pilon fractures usually accompanied by soft tissue injuries.

Use of contact pressure-sensitive surfaces as an indicator of graft tension in medial patellofemoral ligament reconstruction.

BACKGROUND: No previous description has been made about an objective method to test the graft resistance in MPFL reconstruction intraoperatively. In our study, we aimed to obtain intraoperative objective data about the graft resistance using contact pressure-sensitive surfaces and measuring pressure formed under the graft. MATERIALS AND METHODS: In 2012, double-layered contact pressure-sensitive Fuji Prescale Film bands were placed under MPFL in 15 fresh-frozen high above-knee amputates (Group 1) and under graft in 10 patients who underwent MPFL reconstruction (Group 2). Measured values at different flexion angles were compared between and in groups. RESULTS: Statistical analysis was performed by Student's t test. It has been found that the pressure under the graft was higher in patients having reconstruction as compared to the pressure under natural MPFL. Decreasing pressure values were observed with increasing flexion angles in both groups. CONCLUSION: Contact pressure-sensitive surfaces provided objective data when placed under the graft in natural MPFL and during surgery. Therefore, they may be used as an objective marker providing information about graft resistance.

Combined arthroscopic synovectomy and radiosynoviorthesis in the treatment of chronic non-specific synovitis of the knee.

INTRODUCTION: Chronic non-specific synovitis has a higher recurrence rate with arthroscopic synovectomy due to the insufficient removal of all pathological tissues. Neither has radiosynoviorthesis been sufficiently effective in treatment in contrast to cases of chronic specific synovitis such as rheumatoid arthritis. This study aimed to investigate the efficiency of combined arthroscopic and radionuclide synovectomy in chronic non-specific synovitis of the knee with the evaluation of clinical and radiological results. MATERIALS AND METHODS: 14 knees of 14 patients (11 female, 3 male) diagnosed as chronic non-specific synovitis were treated with arthroscopic subtotal synovectomy combined with radiosynoviorthesis. The efficiency was evaluated retrospectively by comparing preoperative and postoperative modified cincinnati knee score, Visual Analogue Scale, joint USG and MRI. The mean age was 29.2 ± 10.3 years and the mean follow-up period was 30.3 ± 3.7 months. RESULTS: Clinical parameters such as pain, limitation of motion and effusion were regressed. Daily activities at the final follow-up were significantly better than in the preoperative period. The mean modified cincinnati knee score of the patients increased from 25.8 ± 8.7 preoperatively to 67.8 ± 13.4 postoperatively (p = 0.002). The mean VAS score was 7.2 ± 1.1 preoperatively and 1.3 ± 0.8 postoperatively (p = 0.003). Clinically and radiologically on MRI there was no recurrence. Mean synovial membrane thickness was 4.5 ± 2.4 mm in the preoperative period. At the final follow-up, noticeable regression of synovial membrane thickness (2.1 ± 0.5 mm) was recorded in the knee joint USG (p = 0.015). No complications were observed. CONCLUSION: The combination of arthroscopic subtotal synovectomy and radiosynoviorthesis can be an effective treatment modality for chronic non-specific synovitis of the knee.

The effect of the Tscherne injury pattern on the outcome of operatively treated Lisfranc fracture dislocations.

BACKGROUND: Lisfranc fracture dislocations cause severe tarso-metatarsal malalignment. The research question of this study was to evaluate the severity of the soft tissue injury on the final clinical outcome and compare that with the effect of various determinants on the disability in daily living activities after open reduction and internal fixation of a Lisfranc injury. METHODS: This study consisted of a retrospective analysis of patients with Lisfranc fracture dislocations who were treated by open reduction and internal fixation beween 2004 and 2009. Evaluation focused mainly on the severity of the soft tissue injury, age, fracture classification, time to operation, posttraumatic osteoarthritis, and the results were compared with American Foot and Ankle Society (AOFAS) scores, and Foot and Ankle Disability Index (FADI). Eight patients had Tscherne Grade 1, 13 had Grade 2, and 11 had Grade 3 soft tissue injuries. Myerson classification revealed 11 type A, 8 type B and 13 type C fractures. Six patients' operations were delayed beyond 8h. RESULTS: Of the 38 patients treated in the study period, 32 patients (11 female, 21 male; <30 y-old: 14, >30 y-old: 18) were available for complete follow-up (average, 55.5 months). The comparison of treatment results revealed that those patients with high grade soft tissue injuries had lower AOFAS and FADI scores (43.8±15.9, 53.7±9.4, respectively) when compared to Tscherne Grade 1 injuries (82.8±6.1, 109±13.9, respectively) (p<0.001). The overall negative impact of the severity of soft tissue injury on functional outcomes had similar significance with regard to post-traumatic osteoarthritis, and fracture type. There was also a statistically significant difference between outcome measures and post-reduction quality (p=0.002). Patient age (p=0.9) and delayed surgery (p=0.5) had no statistically significant effect on the final outcome. CONCLUSIONS: Satisfactory results can be achieved with open reduction for Lisfranc injuries. However, despite this treatment, both the severity of the soft tissue injury and non-anatomic reduction are negative prognostic factors in the treatment of Lisfranc fracture dislocations.

Ilizarov external fixator for correction of complex foot deformities.

OBJECTIVES: This study aims to evaluate the outcomes of the Ilizarov external fixator for the correction of complex foot deformities. PATIENTS AND METHODS: Between January 2000 and September 2005, 29 feet of 25 patients (18 males, 7 females; mean age 13.7 years; range 5 to 24 years) who were applied Ilizarov external fixators due to complex foot deformities in our clinic were prospectively analyzed. Four patients had bilateral foot deformity. The distribution of the deformities was as follows: hindfoot inversion (calcaneovarus) in 29, forefoot equines (cavus) in 29, forefoot adductus in 28, forefoot and hindfoot supination in 27 and forefoot and hindfoot pronation in one foot. The mean length of hospital stay was 9.4 weeks (range, 6 to 18 weeks). Osteotomy was required in nine patients with ages ranging from 13 to 24. Middle subtalar osteotomy was applied on six patients, while three patients received subtalar osteotomy. In three patients, release was provided by removal of incision scar tissue. The mean follow-up was 48 months (range, 16-65 months). RESULTS: The mean treatment period was 21.6 weeks (range, 18-31 weeks). All patients walked better following treatment. According to Paley's criteria, 27 feet were evaluated as plantigrade (flat) and two as non-plantigrade (non-flat). Two patients suffered from pain. The success rate of the treatment was 86.2%. CONCLUSION: Ilizarov method appears to be an efficient approach thanks to the three dimensional characteristic of the foot and fixator in the correction of complicated foot deformities.

The comparison of plate-screw and tension band techniques in the osteosynthesis of Danis-Weber Type A and B lateral malleolar fractures.

OBJECTIVE: The aim of this study was to compare the clinical and radiological results of plate-screw and tension band fixation in isolated Danis-Weber Type A and B lateral malleolar fractures. METHODS: A total of 135 cases of lateral malleolar fractures (82 Danis-Weber Type B and 53 Type A) operated on in 4 different centers and 6 orthopaedic clinics between November 2005 and December 2010 were reviewed retrospectively. Eigthy-one patients (55 Type B and 26 Type A) had lateral 1/3 tubular plate and screw fixation (Group 1), while the remaining 54 patients (27 Type B and 27 Type A) were operated on with tension band technique (Group 2). The clinical and radiological results of the groups were compared. Student t test was used in statistical analysis. RESULTS: The mean length of surgical incision scar was 4.9 cm (4.5-5.4 cm) for Type A fractures and 6.8 cm (5.6-7.5 cm) for Type B in Group 1 and 4.0 cm (3.5-5.2 cm) for Type A and 5.3 cm (5.0-5.9 cm) for Type B fractures in Group 2. Radiological union was obtained at mean of 10 weeks (7-13 weeks) in Group 1 and 9 weeks (7-12) in Group 2. The implant had to be removed in 12 patients in Group 1 and in one patient in Group 2. The mean AOFAS Score was 90 (72-100) and 92 (70-100) in Groups 1 and 2, respectively. CONCLUSION: Both plate-screw and tension band techniques revealed excellent results in isolated Danis-Weber Type A and B fractures. The tension band technique may be an alternative fixation method in the treatment of these fractures.

Surgical technique: supine patient position with the contralateral leg elevated for femoral intramedullary nailing.

BACKGROUND: Intramedullary nailing can be performed with a fracture table or manual traction. Manual traction can be applied with the patient in either the supine or lateral decubitus (LD) position. However, in either of these positions, the reduction can be difficult because the fractured extremity is not positioned parallel to the floor and the contralateral leg on the operating room table overlaps the fractured limb while the fractured extremity is in full adduction. Therefore fluoroscopy time may be increased. Accordingly, we developed a technique with the patient supine and the contralateral leg elevated (SCLE). DESCRIPTION OF TECHNIQUE: We performed anterograde femoral intramedullary nailing with the patient in the supine position with the contralateral leg elevated to allow easy nail entry, reduction, and locking. In this position, the uninjured leg was placed on the leg holder in a semilithotomy position to allow full hip adduction. METHODS: We retrospectively reviewed 63 patients treated with intramedullary nailing: 30 with the SCLE position (mean age, 38 years; 30% female) and 33 with the LD position (mean age, 37 years; 36% female). From the medical records we extracted demographic information, fracture pattern, intramedullary nail diameter, duration of fluoroscopy and operation, and complications. At the last visit, extremity lengths, rotation, and alignment were determined. Minimum followup was 46 months (mean, 46 months; range, 20-72 months). RESULTS: The mean durations of surgery and fluoroscopy were shorter for the SCLE group than the LD group: 98 versus 108 minutes and 3.4 versus 3.8 minutes, respectively. The open reduction rate was less in the SCLE group when compared with the LD group: 10% versus 36%. CONCLUSIONS: We believe the SCLE technique is a reasonable treatment choice for femoral intramedullary nailing as it facilitates obtaining orthogonal views of the femur while possibly shortening surgery and fluoroscopy times. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cam impingement of the posterior femoral condyle in unicompartmental knee arthroplasty.

PURPOSE: There has been much emphasis on the importance of cam impingement, which is a cause of pain and knee hyperflexion restriction in unicompartmental knee arthroplasty (UKA). This study aimed to correlate cam impingement in the posterior femoral condyle with an α-angle showing the severity of the impingement. METHODS: The study groups consisted of 87 knees of 74 patients operated on with phase 3 medial Oxford UKA. Postoperatively, Group A (68 knees, 78.2 %) had no remnant of cam lesion; Group B (19 knees, 21.8 %) had cam lesion remnants. In Group C (18 knees, 20.7 %), which is a subgroup of Group A, cam lesions seen preoperatively were cleaned and not seen postoperatively. RESULTS: The mean increase in active flexion was 20.4° (± 7.3°) in Group A, 9.7° (± 6.1°) in Group B and 20.8° (± 7.3°) in Group C. The difference between Group A and Group B and between Group B and Group C was statistically significant (p < 0.001, p < 0.001). The mean decrease of α-angle was 11.2° (± 4.1°) in Group B, and 31.1° (± 3.4°) in Group C. The difference was statistically significant (p < 0.001). Mean Oxford Knee Scores were 24 preoperatively, 41 postoperatively in Group A; 22 preoperatively, 38 postoperatively in Group B; and 24 preoperatively, 40 postoperatively in Group C. The differences were not significant. CONCLUSIONS: Posterior condylar cam lesion is an impingement which limits hyperflexion and may be an early clinical finding prior to bearing dislocation and wear. The α-angle is a marker showing the severity of this cam lesion. This problem can be overcome using intraoperative fluoroscan views during cam excison and replacing the femoral component in 105° knee flexion.

Effects of custom-made insole on gait pattern of patients with unilateral displaced intra-articular calcaneal fracture: evaluation with computerized gait analysis.

OBJECTIVE: The aim of this study was to investigate whether use of custom-fabricated insoles improves the gait pattern in patients with displaced intra-articular calcaneal fractures. METHODS: Fourteen patients (7 female, 7 male; mean age: 39 ± 12 years) and 11 healthy individuals (mean age: 42 ± 13 years) were included in the study. Treatment protocol included conservative treatment involving immobilization, with or without closed reduction, active exercises, wear of a custom-fabricated insole and prospective follow-up. All patients were evaluated by physical examination, axial and lateral radiographs, computerized tomography, and computerized gait analysis. RESULTS: The use of custom-made insoles significantly improved step and stride lengths and the peak values of fore-aft component in the involved foot and tended to increase plantar flexor moment and total ankle power. The majority of patients (71%) continued to have substantial mechanical abnormalities by computerized gait analysis. Plantar flexion moment, total ankle power, vertical component of ground reaction forces (GRFs), and total sagittal plane excursion were significantly decreased in the involved foot when compared to the uninvolved foot. Plantar flexion moment, total ankle power, vertical, fore-aft and mediolateral components of GRFs were significantly decreased in the involved foot when compared to the healthy control group. CONCLUSION: Use of a custom-made insole improves advancement of limb and weight-bearing in patients with a displaced intra-articular calcaneal fracture. Nevertheless, mechanical abnormalities persist in the affected limb, which does not appear to recover a gait pattern similar to that of normal walking.