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.

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.

Free nerve endings and morphological features of the ligamentum capitis femoris in developmental dysplasia of the hip.

A conflict exists on whether the ligamentum capitis femoris has the neuro-morphological structures required for nociception or proprioception of the hip joint. Therefore, we investigated the morphological features and the presence of mechanoreceptors in 24 ligamentum capitis femoris biopsies obtained at open reduction in patients with developmental dysplasia of the hip. Of these 24 hips, 16 were completely dislocated and eight were subluxated. The mean age was 33.8 months (range 13-52 months) at the time of surgery. En bloc ligamentum capitis femoris and pulvinar were taken for biopsy specimen. Ligamentum capitis femoris was dissected and the weight of each ligament was determined using a highly sensitive balance. Specimens were stained with hematoxylin and eosin and Masson trichrome for routine histolopathological evaluation and examined immunohistochemically using monoclonal antibody against S-100 protein. All specimens were graded on a four-grade system according to the amount of coarse-thick collagen bundles and hyalinization. The mean number and type of mechanoreceptors of each specimen were recorded. When the mean age, the patient's weight and the ligamentum capitis femoris weight of each group (completely dislocated vs. subluxated) were compared, there were no significant differences. In the ligamentum capitis femoris of the dislocated hips, the cells were irregularly distributed, had different shapes, and appeared to be in different stages of functional activity. The collagen fiber bundles were thicker than in the subluxated hips, distributed and of varied thickness. The elastic fibers of the dislocated hips were thicker and more numerous than those in the subluxated hips. We found a significant difference between the two groups with regard to the grade of collagen and hyalinization of ligamentum capitis femoris (P<0.004). We found type IVa, free nerve endings in 16 of 24 samples of ligamentum capitis femoris. The 66.6% presence of free nerve endings in the ligamentum capitis femoris suggests a role in nociception/proprioception of the hip in developmental dysplasia of the hip. Interestingly, the percentage and the mean numbers of free nerve endings containing ligamentum capitis femoris were similar in completely dislocated hip group and the subluxated group (62.5 vs. 75%, 12.13+/-9.07 vs. 9.37+/-9.24, respectively). We conclude that the morphological features of ligamentum capitis femoris are influenced by the severity of developmental dysplasia of the hip, whereas the distribution of free nerve endings are not influenced.

Relationship between synovial fluid and plasma manganese, arginase, and nitric oxide in patients with rheumatoid arthritis.

Nitric oxide (NO) participates in the pathogenesis of inflammatory reactions in many autoimmune diseases such as rheumatoid arthritis (RA). There is a reciprocal pathway between arginase and nitric oxide synthase (NOS) for NO production, and Mn is required for arginase activity and stability. To investigate whether NO production related with the arginine-nitric oxide pathway in patients with RA, we measured synovial fluid and plasma nitrite (NOx) levels, arginase activities, and its cofactor manganese (Mn) concentrations in 21 RA patients and 13 healthy control subjects. Plasma albumin levels were measured as an index of nutritional status. NOx levels were determined after the reduction of nitrates to nitrites using the Griess reaction. Whereas, synovial fluid arginase activities and Mn levels were found to be significantly lower (p<0.001, p<0.001, respectively), plasma arginase activities and Mn levels were similar in patients with RA when compared to the control subjects. Plasma and synovial fluid NO levels were similar in patients with RA and in healthy subjects (p>0.05, p>0.05, respectively). There were significantly positive correlations between synovial fluid and plasma arginase activities vs Mn content (r=0.543, p=0.011; r=0.516, p=0.017, respectively) and significantly negative correlations between synovial fluid and plasma NO levels vs arginase activities (r=-0.497, p=0.022; r=-0.508, p=0.019 respectively) in the patients group. Our results indicate that the lower concentration of synovial fluid Mn could cause lower arginase activity and this could also upregulate NO production by increasing L-arginine content in patients with RA.

Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip.

Computed tomography measurements were made to quantify the relationship between the anteversion of the acetabulum and femoral neck in 27 early walking age patients (age range; 18-48 months) with developmental dysplasia of the hip. The centre-edge angle and acetabular index were measured in standard pelvis radiographs, and anteversion of acetabulum and femoral neck were measured by use of two-dimensional computed tomography in 25 complete dislocated, 19 subluxated and 10 unaffected hips (a total of 54 hips). The diagnosis of dysplasia, subluxation and complete dislocation of developmental hip dysplasia were determined radiographically using Ishida's criteria. There were statistically significant differences between the three groups for the centre-edge angle, the acetabular index, and acetabulum anteversion. There was no statistically significant difference between the three groups for femoral neck anteversion. The acetabular anteversion was found to be 13.4+/-2.8 degrees (mean+/-SD) in unaffected hips, 16.7+/-1.9 degrees in subluxated hips and 19.8+/-2.5 degrees in complete dislocated hips. There was statistically significant difference between the three groups, with a wide range of acetabular anteversion values noted in all groups (9-26 degrees ). The acetabular anteversion was increased on the dislocated side in each patient and we found no retroverted acetabulum. On the other hand there was no significant difference between the groups with regards to femoral neck anteversion. We conclude that confirming anteversion of the acetabulum and the femoral neck by two-dimensional computed tomography is needed in treatment planning of early walking age patients with developmental hip dysplasia.

Orthopaedic techniques of Sabuncuoglu in the 15th century Ottoman period.

Serefeddin Sabuncuoglu (1385-1468) was the author of the surgical textbook Cerrahiyyetü'l-Haniyye (Imperial Surgery). It was the first illustrated surgical textbook in the Turkish-Islamic medical literature. Cerrahiyyetü'l-Haniyye is significant because it includes Sabuncuoglu's color illustrations of surgical procedures, incisions, fracture dislocation reduction techniques, and instruments. There are only three handwritten copies. Two originally were written by Sabuncuoglu and are exhibited in Paris and Istanbul. The book was rediscovered in 1936, but some parts are suspected to be missing. The book currently consists of three chapters divided into 193 sections. The third chapter includes orthopaedics and traumatology, reduction techniques of lower and upper extremities, fractures and dislocations, and relevant Greek, Arabic, and Persian textbooks are cited. Sabuncuoglu also wrote about surgical treatment of congenital hand anomalies. He was the first to advise placing a wooden splint under the palmar side after hand surgery. We reviewed the sections of Cerrahiyyetü'l-Haniyye related to orthopaedics and traumatology. Compared with previous writings by Hippocrates, Ibn-i Sina, and Al-Zahrawi, there are no major differences in the treatment of fracture dislocations.

Plasma total antioxidant capacity, lipid peroxidation, and erythrocyte antioxidant enzyme activities in patients with rheumatoid arthritis and osteoarthritis.

OBJECTIVES: The metabolism of cells in inflammatory and noninflammatory arthritic joint diseases is subject to complex environmental controls. The aim of the present study was to investigate the total antioxidant capacity (TAC), levels of lipid peroxidation (LPO), and antioxidant enzyme activities in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). DESIGN AND METHODS: Plasma levels of TAC, malondialdehyde (MDA), the activities of some erythrocyte antioxidant enzymes, as well as erythrocyte sedimentation rates (ESR) were estimated in patients with RA and OA and compared with controls. RESULTS: The plasma TAC levels were significantly lower in the RA group than the OA and control group (P < 0.05). Plasma MDA concentrations were significantly higher in patients with RA than those with OA and healthy subjects (P < 0.05). Erythrocyte GSH-Px and CAT activities were found to be significantly lower in patients with RA than those with OA and healthy subjects (P < 0.05, P < 0.05, respectively). However, there were no significant differences in erythrocyte SOD activities between the groups (P > 0.05). ESR were significantly higher in RA patients than in healthy subjects and patients with OA (P < 0.01). Moreover, there were significant negative correlations between TAC vs. MDA, ESR vs. TAC, and a positive correlation between ESR vs. MDA in the RA group (r = -0.398, P < 0.05; r = -0.422, P < 0.05; r = 0.530, P < 0.05, respectively). CONCLUSIONS: Our results demonstrated that levels of LPO are increased in patients with RA compared to patients with OA. In addition, plasma TAC levels are decreased in RA due to its inflammatory character. We conclude that detecting plasma TAC levels with this novel method may be used as a routine and rapid test to verify the levels of oxidative stress in RA. Furthermore, correlating TAC and LPO levels with acute phase reactants such as ESR may give some clues about disease activity in RA.

Aplasia of the pubic bone in conjunction with hip dislocation.

We describe here unilateral left hip dislocation in a 2-year-old child in conjunction with ipsilateral absence of the pubic bone. He was admitted to our hospital at 1 year of age and diagnosed with teratogenic dislocation of the left hip, aplasia of the left pubic bone, an undescended palpable left testicle and hypospadias. We performed open reduction through an anterior approach with preliminary skin traction for 1 week and spica cast for 3 months. The acetabular index was high both on admission and in the last radiographic control. Computerized tomography demonstrated dysplasia of the acetabulum and absence of the pubic bone. We concluded that the congenital absence of the left pubis was the major cause of the residual acetabular dysplasia. To our knowledge the conjunction of hip dislocation, aplasia of pubic bone and genitourinary anomalies has not been reported in the orthopaedic literature previously.