Antero-posterior axis of the tibia is a better landmark for tibial component rotation in Oxford medial unicompartmental knee arthroplasty.

BACKGROUND: This retrospective study compares tibial component rotations and radiological and functional outcomes in patients who underwent Oxford medial unicompartmental knee arthroplasty (UKA), using the antero-posterior (AP) tibia axis or anterior superior iliac spine (ASIS) as the landmarks for the direction of the vertical cut. METHODS: A total of 86 patients, who underwent Oxford medial UKA were divided into 2 groups, each consisting of 43 patients, according to the use of AP axis (group I) or ASIS (group II) as landmarks for the rotation of vertical tibial cut and compared for the radiological and functional outcomes. Tibial component rotations (α-angle), involvement of the posterior cruciate ligament (PCL) fossa, and instant bearing position (IBP) were measured on computed tomography (CT) images. Functional outcomes were evaluated using Oxford knee score (OKS) and Knee Society score (KSS). RESULT: The median α­angle was significantly smaller in group I than group II (2.5°, range -4-5.5° vs. -6°, range -13-0.5°, p < 0.001). The rates of PCL fossa involvements were 14 (32.6%) and 17 (39.5%, p = 0.7). The median flexion angle of the femoral component (7° vs. 10.5°) and posterior tibial slope (6° vs. 8°) were significantly lower in group I than group II (p = 0.001). All other radiological parameters, preoperative and final OKS and KSS were statistically similar in both groups. CONCLUSION: Taking the AP tibial axis as a landmark for vertical tibial cut rotation provides more neutral tibial component rotation in Oxford medial UKA compared to ASIS; however, this difference may not influence the clinical outcomes.

Is Only Peripheral Hip Arthroscopy Enough for Selected Patients with Femoroacetabular Impingement Syndrome?

Background: Peripheral compartment hip arthroscopy has gained popularity over central compartment hip arthroscopy as peripheral compartment arthroscopy does not cause perineal post compression, prolonged lower extremity traction and thus complications such as acetabular labrum and articular cartilage injuries. The study, in essence, aims to emphasize that peripheral hip arthroscopy (OPHA) alone is sufficient without an additional surgical method in the treatment of femoroacetabular impingement syndrome (FAI). Methods: A total of 35 patients, being 21 female and 14 male, among a group of patients who were suffering from FAI syndrome and applied to private hip conservatory centers and has undergone hip arthroscopy at a later stage by a senior surgeon (I.T.) were selected from the medical-based software of the hospital. Patients with intra-articular pathology as a result of magnetic resonance imaging (MRI) were excluded from the study. The group had a mean age of 40.6, youngest being 17 and oldest 69, while the mean observation period was 26.6 months, varying between shortest 6 months and longest 63. In order to assess the patient satisfaction as well as clinical outcomes, Postel Merle d'Aubigné (PMA) score was used. Results: When patient satisfaction was evaluated, overall decrease in pain was found and when gait characteristics were evaluated together with movement, an increase in overall satisfaction was found (P<0.05). Secondary arthroscopic procedures was not required in any of the patients included in this study. A group of three patients only needed some additional surgical interventions like stem cell therapy, hip arthroplasty and pelvic osteotomy. Conclusion: OPHA can provide adequate treatment in selected FAI patients as it allows us to avoid critical complications such as damage to the cartilage, avascular necrosis, complications caused by traction and prolonged operation times seen in central compartment arthroscopy.

An unusual injury of pediatric both forearm fractures: Distraction epiphysiolysis: A case report.

INTRODUCTION AND IMPORTANCE: Pediatric both forearm fractures are one of the common traumas we encounter in clinical practice. We aimed to show a complication not shown in the literature, its possible cause and management of this complication in the surgery of these fractures. CASE PRESENTATION: 9 years old girl applied to emergency orthopedics unit after fall. Both forearm fracture was appeared after X-ray. Due to reduction loss in the control X-ray of the first week, closed reduction and intramedullary K wire were planned. The prebent K-wire was tried to be sent as intramedullary. While attempting to advance the K-wire, loss of intramedullary resistance was felt. When controlled with fluoroscopy, type 1 epiphysiolysis was observed in the distal radius. Open anatomical reduction was performed on distal radius epiphysis. Two K wires were placed so that crossed the physis line. In 2-year follow-up, there was no length discrepancy or limitation of movement between the left and right radius. CLINICAL DISCUSSION: Intramedullary fixation is first choice for surgery in pediatric both forearm fractures. There are 2 opinions for K-wire entering point: proximal and distal of physis. The biggest concern about transphyseal transmission of the K wire is that this conduction may cause physeal damage or arrest. However, physeal damage or arrest could not be shown in the literature. On the other hand, transphyseal application provides convenience in terms of surgical applicability. CONCLUSION: In our opinion, it will be more appropriate and safe to send the K wire transphyseal over the styloid for pediatric population have both forearm fractures.

The reliability of use of WhatsApp in type 1 and type 2 pediatric supracondylar fractures.

OBJECTIVES: This study aims to evaluate the reliability of the assessment of radiological X-ray images of traumatic injuries in the elbows of children using WhatsApp application, compared to true-size images on a Picture Archiving and Communication System (PACS) screen. PATIENTS AND METHODS: Between November 2017 and March 2018, X-ray images of a total of 90 pediatric patients (53 males, 37 females; mean age 6.2 years; range, 2 to 10 years) with an elbow injury were retrospectively evaluated. The images were captured and sent to three orthopedic surgeons via the WhatsApp instant messaging application on an iPhone 7S smartphone. Observers were asked to diagnose and classify for each case over their personal smartphones. The three observers independently assessed the images with a seven-day interval. Following one-week interval, revaluation was conducted using the PACS. Intra- and interobserver reliability were calculated by Cohen Kappa statistics. RESULTS: There was a good agreement between the first and second evaluations by the physicians via WhatsApp (k=0.74). The intraobserver reliability was very good (k=0.8), moderate (k=0.55), and good (k=0.67). There was no significant difference in the intra- and interobserver reliability between the groups. CONCLUSION: Using WhatsApp for consulting is a reliable method which can be used in the emergency setting for decision-making. Using WhatsApp can improve the efficacy of medical assessment and reduce waiting time in emergency admissions, although this method is not a substitution for evaluation of the images using computer-based PACS.