The early radiological effects of Dega and Pemberton osteotomies on hip development in children aged 4-8 years with developmental dysplasia of the hip.

We aimed to investigate the early radiological effects of Dega and Pemberton iliac osteotomies that were performed in patients aged 4-8 years with developmental dysplasia of the hip on development of hip joint. Dega osteotomy or Pemberton osteotomy was performed in 76 hips of 58 patients because of developmental dysplasia of the hip between September 2011 and June 2015 and were evaluated retrospectively. Of a total of 76 hips, Pemberton osteotomy was performed on 39 (19 unilateral) and Dega osteotomy was performed on 37 (21 unilateral). In all hips, the acetabular index, acetabular depth ratio, centre-edge angle of Wiberg, and Reimer's index values were recorded preoperatively and at the final follow-up. We measured the surface areas of the femoral head ossific nucleus in patients with unilateral dysplastic hips and compared results before both osteotomy procedures and at the final follow-up. There were no statistically significant differences between the groups in terms of the acetabular index and acetabular depth ratio values (P>0.05) preoperatively and at the final follow-up, but the mean centre-edge angle of Wiberg and Reimer's index values showed significant statistical differences in favor of the Dega procedure (P<0.05). There was a statistically significant difference in favor of the Pemberton procedure when the mean ratio of the surface area of the femoral head ossific nucleus on the dysplastic side in relation to the normal side was compared preoperatively (P=0.042) and at the final follow-up (P=0.027) in unilateral hips. Although Dega and Pemberton osteotomies produce satisfactory radiological outcomes at early stages in children aged 4-8 years with developmental dysplasia of the hip, a higher rate in the surface area of the femoral head ossific nucleus was observed in the Pemberton osteotomy group, which also had a lower mean age than the Dega osteotomy group.

Hounsfield unit comparison of grafted versus non-grafted extraction sockets.

Volumetric changes of the alveolar ridge after socket preservation with various techniques have been investigated frequently. However, changes in bone density and quality of bone within the extraction sockets have seldom been studied. The purpose of this study was to evaluate the bone quality of grafted versus non-grafted socket sites prior to dental implant placement using Hounsfield unit (HU) values derived from cone-beam computed tomography (CBCT) imaging. The data was collected from 39 healed extraction sites reviewed over a one-year period. Subjects eligible for the study had a bone replacement graft and barrier membrane. Both study and control groups had CBCT scans performed immediately after extraction and four to five months after extraction for planning implant placement. HU values were measured from the CBCT scans and compared between groups. Intragroup variability was assessed utilizing standard deviation and standard error of the mean. Intergroup differences were evaluated using unpaired t-test. A generalized lack of significant difference in bone quality was observed between groups with the only statistically significant difference observed in the posterior maxilla. Future radiographic and histologic assessments of bone quality after socket preservation are required to determine the 'ideal' approach to preserve an extraction socket prior to implant placement.

A radiological comparison of Salter and Pemberton osteotomies to improve acetabular deformations in developmental dysplasia of the hip.

We investigated whether the following acetabular scores influence operative outcomes in patients with developmental dysplasia of the hip who underwent Salter innominate osteotomy (SIO) or Pemberton osteotomy (PO): the acetabular depth ratio (ADR), the acetabular index, the center-edge (CE) angle of Wiberg, and the femoral head migration rate (Reimer's index). A total of 47 hips were treated with SIO and 50 hips were treated with PO. Changes in ADR were greater in children who underwent PO compared with those who underwent SIO. However, the acetabular index, the center-edge angle, and Reimer's index did not differ between the groups at final follow-up. Children who underwent PO achieved an improved radiological ADR compared with those who underwent SIO on an average follow-up of 5 years after innominate osteotomy.

Medial open reduction of developmental dysplasia of the hip using the Weinstein-Ponseti approach.

OBJECTIVE: To evaluate the efficacy and safety of medial open reduction using the Weinstein-Ponseti approach to treat developmental dysplasia of the hip (DDH). METHODS: In this retrospective study, 35 hips were treated in 24 children (one boy and 23 girls, mean age 10.8+/-2.82 months, range 6-16 months) in the Department of Orthopedic Surgery, Medical Faculty, Harran University, Sanliurfa, Turkey, between April 1997 and February 2009. We evaluated radiologically the patient's hip pre-operatively using the Tonnis grading system and acetabular index. Group 1 included 13 patients aged younger than 12 months (19 hips) and Group 2 included 11 patients aged 12 months or older (16 hips). Clinical and radiographic evaluations were made according to the McKay and Severin's criteria, respectively. Avascular necrosis (AVN) was evaluated according to the Kalamchi and Mac Ewen's classification. RESULTS: The average follow-up period was 5.6 +/-3.1 years (range, 2-12 years). Five hips (14.2%) required a second procedure. Avascular necrosis was observed in 6 hips (17.1%). Clinical and radiological assessments showed that the outcome was not significantly different between the 2 groups. Furthermore, after this follow up period, the rates of AVN were similar. CONCLUSION: Analyzing retrospectively after comparison of this method before and after the age of 12 months, we found no difference between the 2 groups. Children with DDH can be successfully treated by this method up to 16 months.

A preliminary study pointing out the role of serum prolidase activity and oxidative-antioxidative status parameters during the treatment process of patients with idiopathic clubfoot.

BACKGROUND: We aimed to investigate serum prolidase activity and to find out its association with oxidative-antioxidative status in patients with idiopathic clubfoot and during the course of the disease. MATERIAL AND METHODS: Oxidative status parameters, including total free sulfhydryl groups (-SH), total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI), as well as serum prolidase activity were assessed at the beginning of the treatment in patients with idiopathic clubfoot (n = 38), at the end of 3 months during the treatment of the disease and in healthy controls (n = 40). All patients were managed with the Ponseti method and severity of the foot deformity was evaluated according to the Pirani Severity Score. RESULTS: Serum prolidase activity, TOS and OSI values of the patients at the beginning of the treatment were found to be significantly higher but -SH and TAC values were found to be significantly lower as compared to controls. In the treatment process, a significant decrease in serum prolidase activity, TOS and OSI values and Pirani Severity Score of the patients was observed, however a significant increase in -SH and TAC values of the patients was observed at the end of 3 months during the treatment of the disease as compared to the beginning of the treatment. CONCLUSION: Elevated levels of serum prolidase activity, TOS and OSI, and decreased levels of -SH and TAC may be associated with idiopathic clubfoot, and that these parameters may be useful adjunctive tools for follow-up in patients with idiopathic clubfoot.

Comparison of traditional and Dorgan's lateral cross-wiring of supracondylar humerus fractures in children.

OBJECTIVE: To evaluate the outcomes of traditional medial-lateral and Dorgan's lateral cross-wiring of supracondylar humerus fractures in children. METHODS: In our retrospective study, we evaluated 51 children in the Department of Orthopedic Surgery, Harran University Medical Faculty, Sanliurfa, Turkey between February 2005 and January 2009. Group 1 (traditional) included 25 (16 male and 9 female, mean age 6.5 +/- 3.3 years) and group 2 (Dorgan's lateral) included 26 (19 male and 7 female, mean age 7.1 +/- 2.8 years) patients. Functional and cosmetic results were evaluated according to Flynn et al's criteria. Preoperative and postoperative neurologic examination was performed. The mean follow-up periods were 18.4 +/- 1.7 months in group 1 and 16.3 +/- 1.7 months in group 2. RESULTS: The neurologic, functional, and cosmetic results of 51 patients were reviewed. There were no statistically significant differences found between the groups for gender, age, follow-up periods, fracture types, neurological or function, and cosmetic results. Although postoperative iatrogenic ulnar nerve injuries occurred in 2 (8%) patients treated with the traditional medial-lateral (group 1) cross-wiring technique, no nerve injury occurred in the Dorgan's lateral group (group 2). CONCLUSION: We recommend Dorgan's lateral cross-wiring technique as it is as effective as the traditional medial-lateral cross-wiring technique, and prevents iatrogenic ulnar nerve injuries.

The comparison of patellar tendon-bone autografting and free flexor-tendon autografting in infraspinatus defect of the shoulder: biomechanical and histological evaluation in a sheep model.

The purpose of this study was to investigate the biomechanical and histological features of patellar tendon-bone autografting and free flexor-tendon autografting, which were fixed by two different techniques at the tendon-bone junction in reconstruction of an infraspinatus defect in sheep. Merino type sheep ( n=10) were divided into two groups. Following a defect in the infraspinatus tendon, in group I (flexor-tendon autografting) the free end of the flexor tendon was passed through the holes in the greater tuberosity for fixation. In group II (patellar tendon-bone autografting), fixation was obtained by impaction of the tibial bone plug to the greater tuberosity. Twelve weeks later, animals were sacrificed and specimens were evaluated biomechanically and histologically. Recovery of tensile mechanical properties was achieved to a level of approximately 50% in Group I and 70% in Group II at the end of the 12th week. No difference in the stiffness values was found. In group I, there was a difference between operated and contralateral (non-operated) tendons for the ultimate tensile strength values, but no difference was found in group II. Histologically, in group I, the defective area, which filled with a hypercellular connective tissue, could hardly be differentiated from the normal tendon tissue. In group II, complete incorporation of the bone block was seen in all specimens. These results suggested that patellar tendon-bone autografting is more advantageous than free flexor-tendon autografting in infraspinatus defect, providing rapid healing and better mechanical properties, especially in the early period of healing.