How reliable are the synovial cell count and blood parameters in the diagnosis of septic arthritis?

OBJECTIVES: This study aims to investigate the reliability of the joint fluid cell count and blood parameters compared to the culture results in the diagnosis of septic arthritis (SA). PATIENTS AND METHODS: A total of 192 patients (112 males, 80 females, mean age: 60.3±19.2 years; range, 18 to 98 years) who presented with SA between January 2018 and July 2022 were evaluated retrospectively. The recorded joint fluid cell count, complete blood count (CBC), white blood cell (WBC) count, serum erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) and culture results were analyzed comparatively according to SA diagnosis. RESULTS: The most commonly involved joint was the knee joint (82.3%), which was affected in 158 patients. Thirty-six (18.8%) of the patients who underwent joint aspiration had positive culture result. The cultures were positive in 10 (35.7%) of 28 patients with synovial WBC value greater than 50,000/mm3, while 26 (15.9%) of 164 patients with a synovial WBC value less than 50,000/mm3 had positive culture results (p=0.013). CONCLUSION: Patients with SA may present variable blood and synovial parameters. Making decision based on the commonly used synovial WBC count cut-off value of 50,000/mm3 may lead to misdiagnosis. To avoid misdiagnosis or delay in treatment, it is of utmost importance not to exclude the diagnosis acutely, and suspicion of SA should remain even with unlikely values.

S-allylcysteine inhibits chondrocyte inflammation to reduce human osteoarthritis via targeting RAGE, TLR4, JNK, and Nrf2 signaling: comparison with colchicine.

The discovery of new pharmacological agents is needed to control the progression of osteoarthritis (OA), characterized by joint cartilage damage. Human OA chondrocyte (OAC) cultures were either applied to S-allylcysteine (SAC), a sulfur-containing amino acid derivative, or colchicine, an ancient anti-inflammatory therapeutic, for 24 h. SAC or colchicine did not change viability at 1 nM-10 µM but inhibited p-JNK/pan-JNK. While SAC seems to be more effective, both agents inhibited reactive oxygen species (ROS), 3-nitrotyrosine (3-NT), lipid hydroperoxides (LPO), advanced lipoxidation end-products (ALEs as 4-hydroxy-2-nonenal, HNE), advanced glycation end-products (AGEs), and increased glutathione peroxidase (GPx) and type-II-collagen (COL2). IL-1ß, IL-6, and osteopontin (OPN) were more strongly inhibited by SAC than by colchicine. In contrast, TNF-α was inhibited only by SAC, and COX2 was only inhibited by colchicine. Casp-1/ICE, GM-CSF, receptor for advanced glycation end-products (RAGE), and toll-like receptors (TLR4) were inhibited by both agents, but bone morphogenetic protein 7 (BMP7) was partially inhibited by SAC and induced by colchicine. Nuclear factor erythroid 2-related factor 2 (Nrf2) was induced by SAC; in contrast, it was inhibited by colchicine. Although they exert opposite effects on TNF-α, COX2, BMP7, and Nrf2, SAC and colchicine exhibit anti-osteoarthritic properties in OAC by modulating redox-sensitive inflammatory signaling.

TLR4, RAGE, and p-JNK/JNK mediated inflammatory aggression in osteoathritic human chondrocytes are counteracted by redox-sensitive phenolic olive compounds: Comparison with ibuprofen.

Osteoarthritic chondrocytes show an over-activity of inflammatory catabolic mediators, and olive products have attracted attention because they were discovered to have some benefits on osteoarthritis patients. We investigated the mechanisms of action of olive leaf polyphenolic compounds in osteoarthritic chondrocytes (OACs) using a standardized leaf extract, ZeyEX, and its main phenolic component, oleuropein, also compared with anti-inflammatory drug ibuprofen. OACs, isolated from joint-cartilages of Grade 4 OA patients, were found to express COMP and MMP-9 throughout their culture period. ZeyEX, oleuropein, and ibuprofen increased cell viability at concentrations of 1-100 nM, did not change at 500 nM-50 µM, but inhibited at ≥100 µM. The adherence profile of OACs increased with 1 µM of ibuprofen or ZeyEX and 10 nM-1 µM oleuropein. Although the markers for oxidative and nitrosative stresses (ROS and 3-NT) generally inhibited by three agents, the inhibitory effect of ZeyEX on 3-NT emerged dramatically (1 nM-10 µM). Lipid-hydroperoxides and HNE-adducts were also inhibited by each agent, but AGE-adducts unchanged by oleuropein while reduced by ZeyEX and ibuprofen. Inflammatory biomarkers, IL-1ß, IL-6, Casp-1/ICE, and TNF-α, were inhibited by three agents, however osteopontin and GM-CSF by only ZeyEX and ibuprofen. A decreased COMP, TLR4, and RAGE expression levels were observed by three agents, but only the effects of ZeyEX was concentration-dependent. In particular, ZeyEX and oleuropein improved COL2, inhibited p-JNK/JNK, and increased GPx. COX2 was only inhibited by ibuprofen. The results indicate that polyphenolic-olive compounds counteract redox-sensitive inflammatory aggressions in osteoarthritic chondrocytes that may stop the progression of pathology and allow regeneration.

Lower extremity alignment due to patellofemoral syndrome and dynamic postural balance.

STUDY DESIGN: This study is a prospective study. AIM: Lower extremity malalignment is an important etiologic factor in patellofemoral pain syndrome (PFPS). We hypothesized that lower limb malalignment may affect dynamic balance and physical function. This prospective study was conducted to investigate the relationship between the lower limb alignment and the dynamic balance and physical function in patients with PFPS. METHODS: The study included 62 individuals with unilateral PFPS. Pain severity was assessed by the numerical pain scale and the pain duration was recorded. Lower extremity bone alignment was evaluated by the lateral distal femoral angle (LDFA) and the medial proximal tibia angle. Dynamic postural balance was assessed by the star excursion balance test. The functional status of the patients was evaluated by the 30-second chair stand test. RESULTS: The mean duration of the pain was 24.2 ± 31.5 months and the mean pain severity was 8.1 ± 1.4. Although there was a significant difference found between the affected and unaffected LDFA values of lower extremities (p < 0.05), there was no difference found with regard to the dynamic balance values of the lower extremities (p > 0.05). However, significant changes of posterolateral balance were identified at a painful side without causing a postural dynamic imbalance (p < 0.05). CONCLUSION: In our study, we found a valgus deformity as a deterioration in the lower limb alignment of patients with PFPS which may cause a deterioration of posterolateral balance only. However, no change in postural dynamic balance was observed in the comparison of affected side and unaffected side. Dynamic postural balance has been influenced by many kinematic changes related to lower extremities including pelvis, hip, and ankle. Thus, reciprocal mechanisms in the anatomical structures may compensate the postural balance dynamically.

The Role of Surgical Closure Position in Total Knee Arthroplasty: Flexion versus Extension-A Randomized Prospective Study.

We aimed to investigate the effect of the knee position during the surgical closure on isokinetic muscle strength, clinical score, and range of motion in total knee arthroplasty. Seventy-five eligible patients were enrolled in the study and randomly divided into two groups; wound closure was performed with the knee flexed at 90° in group 1 and knee extended in group 2. All the surgeries were performed by the same surgeon and by the same prosthesis type. All the patients received the same rehabilitation program postoperatively. The primary outcomes were the knee flexion degrees and the American Knee Society Score values at preoperative and postoperative 6 weeks, 3, and 6 months. The secondary outcome was the isokinetic muscle strength measurements of both knees before the surgery and after 6 months. There were no significant differences in the American Knee Society Scores and knee flexion degrees between the flexion and extension groups. However, a significant decrease was found in the extensor muscle strength in the extension group after 6 months of the surgery. The findings of our study are that the closing of the knee in flexion or extension does not affect the postoperative knee flexion degrees and scores in total knee arthroplasty. However, quadriceps strength recovers early if the knee closure is performed in flexion position.

Subacromial space volume in patients with rotator cuff tear: The effect of surgical repair.

OBJECTIVE: The aim of this study was to evaluate the effect of the rotator cuff tear repair on subacromial space volume. METHODS: We retrospectively identified 21 eligible patients (5 males and 16 females; mean age: 56.4 (range; 46-71) years) who had shoulder arthroscopy for unilateral full-thickness small to medium rotator cuff tear and normal controlateral shoulder joint. The mean follow-up time was 16.1 (range; 12-25) months. Preoperative and postoperative 1 year bilateral shoulder MRIs and Constant scores were reviewed. Subacromial volume was calculated by using Osirix software. Pre-, postoperative and healthy side (contralateral control group) subacromial volumes were recorded. Paired sample and t-tests were used to compare the pre- and postoperative groups. Independent sample t-tests were used to compare the healthy and pre- and postoperative groups. The correlation between the changes in the subacromial volume and the shoulder Constant score were analyzed using Pearson correlation analyses. RESULTS: The mean subacromial volume of the preoperative group was 2.95 cm3 (range; 1.53-4.23) and the postoperative group was 3.59 cm3 (range; 2.12-4.84). The volume increase was statistically significant (p < 0.05). The mean subacromial volume of the control group was 3.93 cm3 (range; 2.77-5.03), and the difference between the preoperative group and the control group was statistically significant. There was no significant difference found between the postoperative group and the control group (p = 0.156). There was no significant correlation found between the volume and the constant score changes (r = 0.170, p = 0.515). CONCLUSION: The subacromial space volume significantly decreases in full-thickness rotator cuff tears smaller than 3 cm and the surgical repair increases the subacromial volume significantly. LEVEL OF EVIDENCE: Level IV; Diagnostic Study.

Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella.

PURPOSE: The aims of this study were to evaluate sagittal plane alignment in patients with chondromalacia patella via magnetic resonance imaging (MRI), analyse the relationships between the location of the patellar cartilaginous lesions and sagittal alignment and finally investigate the relationships between the sagittal plane malalignment and patellofemoral loadings using by finite element analysis. METHODS: Fifty-one patients who were diagnosed with isolated modified Outerbridge grade 3-4 patellar chondromalacia based on MRI evaluation and 51 control subjects were evaluated. Chondromalacia patella patients were divided into three subgroups according to the chondral lesion location as superior, middle and inferior. The patella-patellar tendon angle (P-PT) was used for evaluation of sagittal alignment of patellofemoral joint. Each subgroup was compared with control group by using P-PT angle. To investigate the biomechanical effects of sagittal plane malpositioning on patellofemoral joint, bone models were created at 30°, 60° and 90° knee flexion by using mean P-PT angles, which obtained from patients with chondromalacia patellae and control subjects. The total loading and contact area values of the patellofemoral joints were investigated by finite element analysis. RESULTS: The mean age of all participants was 52.9 ± 8.2 years. The mean P-PT angle was significantly lower in chondromalacia group (142.1° ± 3.6°) compared to control group (144.5° ± 5.3°) (p = 0.008). Chondral lesions were located in superior, middle and inferior zones in 16, 20 and 15 patients, respectively. The mean P-PT angles in patients with superior (141.8 ± 2.7) and inferior subgroups (139.2 ± 2.3) were significantly lower than the values in the control group (p < 0.05). The contact area values were detected higher in models with chondromalacia than in the control models at the same flexion degrees. There were increased loadings at 30° and 90° flexions in the sagittal patellar tilt models. CONCLUSION: This study revealed that sagittal plain malpositioning of the patellofemoral joint might be related to chondromalacia, especially in the presence of lesions in the upper and lower part of the patella. This condition leads to supraphysiological loadings on the patellofemoral joint. Sagittal patellar tilt should be considered in the evaluation and management of patellar cartilage defects. Taking sagittal plane malalignment into consideration in patellofemoral joint evaluation will enable us to design new physical and surgical modalities. LEVEL OF EVIDENCE: IV.

Gartland Type 3 Supracondylar Humeral Fractures in Children: Which Open Reduction Approach Should Be Used After Failed Closed Reduction?

OBJECTIVES: For displaced supracondylar humeral fractures in children, in the event of closed reduction failure, anatomic reduction is achieved via open reduction techniques; however, there are no confirmative reports among the published open reduction approaches that deliver the best functional and cosmetic results. Here, we compared long-term functional and cosmetic results of different surgical approaches. DESIGN: Retrospective cohort study. SETTING: Ankara Education and Research Hospital/Turkey. Secondary care hospital and trauma center. PATIENTS/PARTICIPANTS: We evaluated 70 surgically treated Gartland type 3 supracondylar humeral fractures. Patients, with detailed history record, were divided into 5 groups with respect to surgery methods. INTERVENTION: All patients were treated surgically using closed reduction and percutaneous pinning or 4 different open reduction approaches and percutaneous pinning. MAIN OUTCOME MEASURES: Flynn cosmetic and functional score results were compared between surgical groups. RESULTS: Posterior open reduction and triceps transection groups showed worst results, whereas medial and lateral open reduction groups showed good to excellent results similar to closed reduction group. CONCLUSION: Medial and lateral approaches demonstrated better functional results than posterior and triceps transection approaches. Posterior approaches lead to restrictions in extension and poor functional results. In the posterior approach, transecting triceps from olecranon does not benefit from fracture reduction but results in loss of triceps strength and should be avoided. In failed closed reduction, medial and lateral open reduction approaches lead to similar cosmetic outcomes and functional results that are only slightly worse compared with those in closed reduction. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study.

PURPOSE: The aim of this study was to evaluate the effect of knee position during wound closure (flexed vs. extended) in total knee arthroplasty on knee strength and function, as determined by knee society scores and isokinetic testing of extensor and flexor muscle groups. METHODS: In a prospective, randomized, double-blind trial, 29 patients were divided in two groups: for Group 1 patients, surgical closing was performed with the knee extended, and for Group 2 patients, the knee flexed at 90°. All the patients were treated with the same anaesthesia method, surgical team, surgical technique, prosthesis type, and rehabilitation process. American Knee Society Score values and knee flexion degrees were recorded. Isokinetic muscle strength measurements of both knees in flexion and extension were taken using 60° and 180°/s angular velocity. The peak torque and total work values, isokinetic muscle strength differences, and total work difference values were calculated for surgically repaired and healthy knees. RESULTS: No significant difference in the mean American Knee Society Score values and knee flexion degrees was observed between the two groups. However, using isokinetic evaluation, a significant difference was found in the isokinetic muscle strength differences and total work difference of the flexor muscle between the two groups when patients were tested at 180°/s. Less loss of strength was detected in the isokinetic muscle strength differences of the flexor muscle in Group 2 (-4.2%) than in Group 1 (-23.1%). CONCLUSION: For patients undergoing total knee arthroplasty, post-operative flexor muscle strength is improved if the knee is flexed during wound closure. LEVEL OF EVIDENCE: II.

Arthroscopic treatment of a case with concomitant subacromial and subdeltoid synovial chondromatosis and labrum tear.

Synovial chondromatosis is a disease that seldomly seen in shoulder joint and is related to benign synovial proliferation and synchronous chondral tissue formation within the joint cavity. Patients suffer from progressive restriction of range of motion and shoulder pain. Extra-articular involvement is an extremely rare condition. Degenerative osteoarthritis, joint subluxation, and bursitis are common complications in untreated patients. Open or arthroscopic surgery is suitable while there is no consensus related to superiority of different approaches. We presented an arthroscopic treatment of a male patient, 48 years old with labrum tear and synovial chondromatosis localized in subacromial and subdeltoid region. Advantages of arthroscopic surgery in the presence of intra- and extra-articular combined pathologies are also discussed.

The patellofemoral kinematics in patients with untreated developmental dislocation of the hip suffering from patellofemoral pain.

PURPOSE: This study reviews the dynamic patellofemoral CT results of 39 patients with untreated developmental dislocation of the hip who are suffering from knee pain. METHOD: The mean age of the patients with unilateral developmental dislocation of the hip was 33.3 (±7.9), for bilateral patients 36.2 (±11.3), and for the control group, it was 31.5 (±8.5). While 14 of them were bilateral, 25 were unilateral. The CT results of 24 asymptomatic adult knees served as the control group. The patellofemoral parameters of patients with unilateral and bilateral developmental dislocation of the hip, the control group's parameters and the effect of femoral anteversion, limb length discrepancy, severity of dislocation, the mechanical axis deviation on patellofemoral parameters were analyzed. RESULTS: In patients with unilateral untreated developmental dislocation of the hip, although the patella was located more laterally at initial flexion degrees, it was located more medially at 30° and 60° flexion with respect to the control group. For the involved extremity, the PTA angles at 15°, 30°, and 60° flexion were significantly higher than in the control group corresponding to medial patellar tilt. In patients with bilateral developmental dislocation of the hip, the course of the patella during tracking in terms of patellar shift was similar to that of the unilateral patients. The amount of leg length discrepancy and the severity of dislocation, as well as the mechanical axis deviation, did not affect the patellofemoral parameters. CONCLUSION: The patients with untreated developmental dislocation of the hip and suffering from knee pain should be analyzed not only for tibiofemoral abnormalities but also for patellofemoral malalignment. LEVEL OF EVIDENCE: Case-control study, Level III.

Plasma vascular endothelial growth factor levels are similar in subjects with and without osteoporosis.

OBJECTIVES: The relation between serum vascular endothelial growth factor (VEGF) level and bone mineral density (BMD) value was evaluated to investigate the role of VEGF at etiopathogenesis of the osteoporosis. PATIENTS AND METHODS: Bone scanning with dual energy X-ray absorptiometry (DEXA) was performed on a total of 276 patients more than 40 years of age between September 2007 and January 2008 in our hospital's radiology department. A total of 88 patients (44 females; mean age 62.8+/-12.2 year, 44 males; mean age 58.7+/-12.1 year) meeting the study criteria were included. These patients formed four groups; osteoporotic male patients (group MO, n=22, BMD< -2.5), normal males (group MN, n=22, BMD> -1), osteoporotic female patients (group FO, n=22, BMD< -2.5), and normal females (group FN, n=22, BMD> -1). Bone mineral density measurements were performed with DEXA. Serum VEGF level was determined by the endogenous human ELISA kit. The relationships between body mass index (BMI), age, BMD and serum VEGF levels were analyzed. RESULTS: The difference between male and female participants in terms of serum VEGF levels was not statistically significant (p>0.05). The differences in terms of mean VEGF values between the MO and MN groups and the FO and FN groups were not statistically significant (p>0.05). In MN cases, BMD was negatively correlated with VEGF levels (p<0.05). In MO group, the correlation between BMD and serum VEGF levels was not statistically significant (p>0.05). CONCLUSION: Although the plasma levels of osteoporotic subjects are relatively higher than in the normal groups, this was not statistically significant in either male or female subjects. The small sample size could be a reason for this insignificance. The negative correlation between serum VEGF and BMD levels in the MN group was not present in the MO group. When the various effects of serum VEGF on bone metabolism are taken into account, to clarify the pathophysiology of male osteoporosis, this association between BMD values and VEGF in male population must be investigated in further studies.

Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older.

PURPOSE: The aim of this study was to compare the functional and radiographic outcomes of dorsally displaced distal radius fractures treated by closed reduction plaster cast fixation (CRPCF) and external fixation (EF) in patients 65 years and older. METHODS: This retrospective and nonrandomized study comprised 46 consecutive patients older than 65 years who had distal radial fractures. Patients were divided into 2 groups according to treatment: a CRPCF group and an EF group. All the fractures were dorsally displaced and AO/ASIF type A or C, without articular stepoff or gap. Cases were evaluated based on the criteria of Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, wrist range of motion, and radiologic results. RESULTS: The mean follow-up period was 25.1 months. Union was achieved in all cases. Although it was not a statistically significant difference, posttreatment complications were more common in the CRPCF group (10 patients) than in the EF group (7 patients). In the CRPCF group, most complications were discomfort from the cast, whereas in the EF group, most were pin site infections. The average wrist extension and ulnar deviation (clinically) and palmar tilt and radial height (radiologically) were statistically better in the EF group at the final follow-up. The mean DASH scores were 20.3 in the CRPCF group and 21.9 in the EF group. There was no statistically significant difference in the DASH scores; in wrist flexion, radial deviation, pronation, supination, grip strength, or pinch strength (clinically); or in ulnar variance or radial inclination (radiologically). There was no correlation between the DASH scores and palmar tilt and ulnar variance. CONCLUSIONS: We concluded that both CRPCF and EF are useful methods for distal radius fractures in elderly patients. The results showed significant differences in wrist extension and ulnar deviation.

The relationship between serum adiponectin level and anthropometry, bone mass, osteoporotic fracture risk in postmenopausal women.

OBJECTIVES: The aim of the present study was to evaluate the possible correlation between bone mass and serum adiponectin levels, and the correlation between adiponectin levels and osteoporotic fracture risk in a prospective clinical trial. PATIENTS AND METHODS: Postmenopausal non-diabetic 105 women (mean age 63.4+/-8.1; range 52 to 64 years) with hip fracture were evaluated. Of these 105 patients, 46 had trochanteric fractures, 24 had subtrochanteric fractures and 35 had femoral neck fractures. Anthropometric measurements were performed. Serum adiponectin level was measured by means of ELISA. Total bone mineral density and bone mineral content of lumbar spine and proximal femur were measured by dual-energy X-ray absorptiometry (DEXA). RESULTS: Lumbar bone mineral density and proximal femoral bone mineral density were not correlated with serum adiponectin levels. Serum adiponectin level was not found to have any significant effect on bone mass. Serum adiponectin levels were not significantly different between the patients with osteoporotic fractures and those with non-osteoporotic fractures. CONCLUSION: Our study showed that serum adiponectin level is not associated with bone mass and osteoporotic fracture risk. Investigation of local adiponectin levels in bony tissue is needed to clarify the possible relation between adiponectin and bone mass, and risk of fractures associated with osteoporosis.

Range of motion of the first metatarsophalangeal joint after chevron procedure reinforced by a modified capsuloperiosteal flap.

BACKGROUND: This study analyzed the range of motion of the first metatarsophalangeal joint following the chevron procedure with increased stabilization using a modified capsuloperiosteal flap in the treatment of hallux valgus cases. MATERIALS AND METHODS: Forty-three feet of 40 patients were treated with modified chevron osteotomies. The patient selection criteria included failure of conservative treatment, painful deformity, age between 18 and 50, hallux valgus and intermetatarsal angles less than 40 degrees and 17 degrees, respectively, and no osteoarthritic changes of the metatarsophalangeal joint. The passive range of motion of the first metatarsophalangeal joint was compared to the hallux valgus and intermetatarsal angles. RESULTS: The mean age of patients was 30.9 +/- 9.0 (range, 18 to 46) years. The preoperative mean hallux valgus angle was 32.2 (range, 22 to 40 degrees), whereas postoperatively it was 13.1 (range, 3 to 22 degrees). The preoperative mean passive total range of motion, dorsiflexion and plantar flexion were found to be 80.2 (range, 71 to 99 degrees), 66.8 (51 to 86) degrees and 13.4 (range, 7 to 23 degrees), respectively, whereas postoperatively these values were 69.2 (range, 48 to 85 degrees), 58.6 (range, 43 to 75) degrees and 10.8 (range, 1 to 20 degrees). According to Bonney and MacNab subjective scores, the feet were evaluated as follows: 12 as excellent, 26 as good, and 5 as moderate. According to objective scores, the evaluation was as follows: 27 as excellent, 14 as good, 1 as moderate, and 1 as poor. CONCLUSION: We believe that the chevron procedure reinforced by modified capsuloperiosteal flap causes minimal irritation and damage to adjacent soft tissues. Furthermore, we conclude that this method is a benefical means of managing moderate hallux vagus deformities by decreasing the stiffness after surgery.

Intrathoracic humeral head fracture-dislocation: is removal of the humeral head necessary?

Intrathoracic fracture dislocation of the humeral head due to a blunt trauma is very rare. It may be accompanied by local and systemic injuries associated with high-energy trauma. Because a limited number of cases were reported, appropriate treatment modality remains unclear. A case of intrathoracic humeral head fracture-dislocation caused by a high-speed motor vehicle accident is presented herewith, along with the treatment methods used within the scope of the current literature.

[Flexible intramedullary nailing of children]. / Cocuk femur cisim kiriklarinda esneyebilen intramedüller çivi uygulamasi.

BACKGROUND: Various methods are being used in the treatment of femur diaphysial fractures in children aged between 6 to 12 years. Titanium elastic nailing is one of the alternatives. We evaluated our experience in flexible intramedullary nailing. METHODS: We investigated 21 patients with femur diaphysial fractures who were with titanium elastic nailing. RESULTS: The mean age of the patients was 9.6+/-2.4 (range between 5.1-14.7 years) and all the fractures were at the diaphysis. The fracture pattern was as following: 9 (42.9%) transverse, 7 (33.3%) oblique, 5 (23.8%) spiral. Fixations were performed with two nails which were implanted in retrograde manner. The average time of follow-up was 29+/-11.6 months (range; 9-48 month). The mean time to fracture union was 13+/-11.9 weeks (4-52). Implant removal was performed after a mean time of 7+/-2.2 months (range; 6-16 month). Patients's hip and knee range of motions were complete and clinically there were no angular or rotational deformity at postoperative one year. There were radiologically 11+/-1.7 (range; 10-15) degrees of varus valgus malalignment in 8 patients; these angles were reduced to 5+/-1.9 (range; 3-9) degrees at the follow of two years. CONCLUSION: The results of the flexible titanium nailing in femur diaphysial fractures of the children, aged between 6 to 12 years, suggest that this method may be a first choice therapy in this particular group of patients.

[The role of functional bracing in the treatment of humeral shaft fractures]. / Humerus cisim kiriklarinda fonksiyonel breys tedavisinin yeri.

OBJECTIVES: We evaluated clinical, radiographic, and functional results of patients treated with functional bracing for humeral shaft fractures. METHODS: Humeral shaft fractures of 30 patients (19 males, 11 females; mean age 34 years; range 18 to 64 years) were treated with functional bracing. Fractures were on the right in 18 patients, on the left in 12 patients. All were closed fractures, being spiral in 10, comminuted in nine, transverse in six, and oblique in five patients. Humeral fractures were in the upper third, middle third, and distal third in 16, 8, and 6 patients, respectively. Functional brace was applied after a mean of six days (range 0 to 16 days) and was worn throughout day and night until radiographic signs of sufficient union and healing was observed. Functional assessment was made according to the Hunter criteria. The mean follow-up was 20 months (range 10 to 58 months). RESULTS: Union was achieved in 24 patients (80%) after a mean of 14 weeks (range 11 to 21 weeks). Six fractures (20%) failed to unite and were subsequently treated with surgery. According to the Hunter criteria, 24 patients (80%) were evaluated as good (G3-4), and six patients (20%) as excellent (G5). The mean varus-valgus rotation was 6 degrees , the mean anterior-posterior translation was 8 degrees in patients who had union with functional bracing. Four patients developed skin macerations secondary to brace use. Limb shortening of 1.7 cm occurred in one patient whose fracture was united with bracing. CONCLUSION: Our clinical and radiographic results suggest that, based on proper indications, functional bracing applied after regression of edema may be the treatment of choice in humeral shaft fractures.

[The efficacy of non-operative treatment of burst fractures of the thoracolumbar vertebrae]. / Torakolomber vertebra burst kiriklarinda konservatif tedavinin etkinligi.

OBJECTIVES: We evaluated the efficacy of non-operative treatment of thoracolumbar burst fractures. METHODS: The study included 26 patients (19 males, 7 females; mean age 36 years; range 18 to 67 years) who underwent conservative treatment for single-level thoracolumbar fractures without posterior column involvement. None of the patients had neurologic deficits and canal encroachment was 50% or less in all fractures. Functional results were evaluated with the use of Denis' pain and work scales. Relationships were sought between functional results and follow-up time, progression in kyphosis angle, residual kyphosis, and residual canal stenosis, and between radiologic parameters. RESULTS: Functional results were excellent or good in 65.3%, and poor in 7.7%. Three patients required surgery because of pain. Final follow-up evaluations showed a significant progression in the mean Cobb angle (p<0.001) and a significant remodelization in the mean canal encroachment (p<0.001). No significant correlations were found between progression in kyphosis, residual kyphosis, residual canal stenosis, and functional results (p>0.05). The mean initial Cobb angle was correlated with the mean initial canal encroachment (p<0.05). There was also a correlation between the initial canal encroachment and final remodelization (p<0.001). CONCLUSION: Although non-operative management of thoracolumbar fractures has considerable efficacy, it may yield poor results in a small percentage of patients, some of whom require surgery because of pain. Thus, further prospective, randomized, and comparative studies with longer follow-up periods are required to define prognostic factors that may predict poor results following non-operative treatment.

[The results of acetabular shelf procedures in Legg-Calve-Perthes disease]. / Legg-Calve-Perthes hastaliginda asetabuler çati ameliyati sonuçlarimiz.

OBJECTIVES: We evaluated the results of acetabular shelf procedures performed for the treatment of Legg-Calve-Perthes (LCP) disease. METHODS: The study included 14 patients (17 hips) with LCP disease, who were treated with acetabular shelf operation. The mean ages at the time of diagnosis, operations, and final examinations were 7 years (range 5 to 9 years), 8 years (range 6 to 10 years), and 12 years (range 10 to 16 years), respectively. The mean follow-up was five years (range 3 to 9 years). Before surgery, all patients had Catterall 3-4 hips, and at least two risk factors were identified. On pre- and postoperative anteroposterior and lateral radiograms, the Mose sphericity indices and CE angles were measured. In addition, the presence of hinge abduction was evaluated by dynamic arthrography preoperatively, and on direct radiograms and clinically during final examinations. The hips were graded according to a modified Stulberg classification on final direct radiograms. Clinical evaluation was made with the use of the Iowa hip scores. RESULTS: The Mose measurements did not yield significant improvement on anteroposterior radiograms (p>0.05), whereas postoperative improvement was significant on lateral views (p<0.05). Improvement in CE angles was also statistically significant (p<0.001). According to the Stulberg classification, 10 hips (58.8%) (Stulberg 1-2) were successful, three hips (17.6%) (Stulberg 3) were discussible, and four hips (23.5%) (Stulberg 4-5) were failures. Of four failures, three patients were at the age of 9 years or above. The final Iowa hip scores ranged from 65 to 99 (mean 88.2). Hinge abduction disappeared postoperatively in seven hips (7/13, 53.8%). CONCLUSION: Acetabular shelf operation following dynamic arthrography may be an alternative treatment option for hips with hinge abduction in LCP disease; however, it does not alter the natural course of the disease as the age increases.