Does rotational deformity cause poor outcomes after pediatric supracondylar humerus fractures?

BACKGROUND: We aimed to show the effect of rotational deformity on the development of cubitus varus deformity (CVD) com-plication after supracondylar humerus fracture surgery. METHODS: Patients with Gartland type II, and more severe fractures treated with Closed reduction and percutaneous pinning alone were included in the study. Rotational deformity was assessed with the formula described by Henderson et al. Patients with rotational deformity >10° were included in Group 1, and patients with deformity <10° in Group 2. In terms of CVD development, patients were evaluated with the Baumann angle measurements made on the carrying angle and final follow-up radiographs. Patients who developed CVD were divided into two groups: Group A included patients who developed CVD and Group B included patients who did not develop CVD. The cosmetic and functional results were evaluated using Flynn criteria. RESULTS: Eighty-eight patients who met the inclusion criteria were enrolled in the study, 32 were female and 56 were male. The mean age at the time of surgery was 6.0±2.8 years and the mean follow-up time was 5.1±2.5 years. Based on measurements, Group 1 had 13 patients and Group 2 had 75 patients. Only four of the 88 had developed CVD. Three of these patients had a rotational deformity of ≥20°. The mean age of patients in group A was 2.1 years and the mean carrying angle was 5.7°±1.5° varus (P<0.001). According to the Flynn cosmetic criteria, Group A and Group 1 had significantly worse outcomes (P<0.001). CONCLUSION: In conclusion, fixation of the distal fragment in rotation may be associated with CVD and intraoperative assessment is of great value to avoid long-term deformity and cosmetic degradation.

Arthroscopic Treatment of Femoral Condyle Chondral Lesions: Microfracture Versus Liquid Bioscaffold.

Purpose: This study aims to compare the microfracture (MF) technique with the bioscaffold solution application (BST-CarGel) in treating femoral chondral lesions. Methods: Thirty-eight patients ages 18-45 with isolated single femoral condyle full-thickness (ICRS grade 3-4) chondral lesions were included in the study. Patients were divided into two groups as MF applied (Group I = 21) and bioscaffold combined with MF (Group II = 17). The visual analog scale (VAS), Western-Ontario, and McMaster Osteoarthritis Index (WOMAC) were used in clinical evaluation. The location, size, and depth of lesions were evaluated with preoperative magnetic resonance imaging (MRI). Magnetic resonance observation of cartilage repair tissue (MOCART) score was used for postoperative evaluation. Results: The mean age was 32.5 (range 19-44) years. Mean follow-up was 14.9 months (range 12-24). Lesion size was 3 cm2 in group I and 2.9 cm2 in group II. There were no differences between groups regarding demographic characteristics but BMI (Body Mass Index) was lower in group II which was significant. The duration of surgery was longer in group II (p < 0.001). Postoperative statistical significant improvements were found in WOMAC and VAS scores in groups, but there was no statistical difference. Although there was no significant radiological difference in the group II according to the MOCART score, higher scores were obtained compared to group I. Conclusion: No difference was found, clinical and radiological, in terms of short-term outcomes. MF is a method to be applied as a primary treatment with its cost-effective, simple and short surgery technique, and effective clinical results up to 4 cm2. Level of Evidence: Level III: retrospective comparative study.

The prevalence of fabella and its relationship with the lateral posterior condylar offset and lateral posterior tibial slope values.

OBJECTIVES: This study aims to analyze whether the lateral posterior condylar offset (LPCO) and lateral posterior tibial slope (LPTS) values are associated with the presence of fabella by evaluating the frequency of fabella, its location, and whether it is bilateral and the relationship of the fabella with age, sex, and the presence of osteoarthritis. PATIENTS AND METHODS: Between January 2016 and December 2020, computed tomography (CT) scans including 1,952 knee regions of 1,220 patients (861 males, 359 females; mean age: 54.5±19.7 years; range, 10 to 98 years) were retrospectively analyzed. Age, sex, and the presence of fabella whether unilateral (left or right) or bilateral were recorded. Of the patients with a bilateral knee CT, those with fabella on one side and without on the other were studied further to investigate the effect of fabella on the posterolateral corner (PLC). In these patients, the LPCO and LPTS values, presence of knee osteoarthritis, fabella-femoral distance, and sagittal anterior-posterior diameter of the fabella were evaluated. RESULTS: While there was no evidence of fabella in 867 (71.1%) patients, it was present in 353 (28.9%) patients. The linear correlation analysis revealed that the correlations between the right LPCO and the right LPTS (r=-0.295; p<0.001) and between the left LPCO and the left LPTS (r=-0.574; p<0.001) were significant. It was observed that LPTS decreased with increasing LPCO. According to the results of the point biserial correlation analysis, there was a significant correlation between the presence of fabella on the right side and the right LPCO value (r=-0.643; p<0.001) and between the presence of fabella on the left side and the left LPCO (r=-0.284; p=0.024). When the two knees were compared, fabella was less present in the knee whose LPCO was higher than that of the other knee, whereas it was more common in the knee whose LPCO was lower than that of the other knee. We found a significant correlation between each side's fabella and LPCO values and between the presence of fabella on the left side and the left LPTS. CONCLUSION: The presence of fabella in the knee joint may be associated with LPCO and LPTS values of the knee. The comparison of the two knees of the same patient may reveal that if a fabella is present in a knee, the LPCO value of that knee is lower than that of the other knee. We believe that the reason for this is that the presence of fabella increases the distance to the center of rotation of the knee joint.

Surgical Treatment With Titanium Elastic Nail (TEN) for Failed Conservative Treatment of Acute Monteggia Lesions in Children.

BACKGROUND: This study evaluated the results of intramedullary osteosynthesis with titanium elastic nail (TEN) in the surgical treatment of Monteggia lesions in children aged 12 and under. METHODS: Patients who underwent surgery with the TEN method between 2013 and 2019 were screened retrospectively. The inclusion criteria were patients who failed conservative treatment, a history of acute trauma (<14 d after injury), age 12 years and under, patients who underwent intramedullary osteosynthesis with TEN when surgical treatment is required, a follow-up period of over 12 months, absence of congenital upper extremity and bone anomalies, and no history of trauma to the ipsilateral elbow. For functional classification, the Grace and Eversmann Criteria were used to evaluate union, pronation, and supination, while the Mayo Elbow Performance Score was used to assess overall elbow function and limitations. RESULTS: Thirty-eight patients (26 male/12 female) were included in the study. The median age was 8.0 (6 to 10) years old and follow-up period was 26.0 (16 to 39) months. The mean value of the Mayo Elbow Performance Score was 97.1, 32 cases were excellent and 6 cases had good results. While the average age was 9.4 years in patients with mobility limitations, it was 7.1 years in patients without mobility limitations. Statistically, less movement restriction was observed in patients of younger age. CONCLUSION: Length unstable ulnar fracture pattern for Monteggia lesions and those with secondary loss of reduction, intramedullary stabilization of the ulna fracture with TEN helps to achieve good functional and radiologic outcomes. LEVEL OF EVIDENCE: Level III.

The Safety and Efficacy of Using Drainage in Arthroscopic Rotator Cuff Repair.

PURPOSE: This study aimed to evaluate the effects of not using a drain or placing a drain in the glenohumeral (GH) or subacromial (SA) joint spaces on fluid retention and pain in the early postoperative period and late clinical outcomes. METHODS: Patients who underwent arthroscopic rotator cuff repair between 2018 and 2020 were included in the study. Before the operation, demographic data, range of motion (ROM), visual analog scale (VAS) scores, Constant-Murley scores has documented. Deltoid muscle diameter (DMD) were measured. The total amount of irrigation used during the surgery and the operation duration were recorded, and the active amount of fluid coming from the drain in patients with a drain was recorded. The first postoperative DMD measure was made in the operating room and accepted as day 0. DMD measurements repeated postoperative first and second day. VAS assessments were performed on the postoperative first and second days. At the outpatient clinic, these measurements were repeated on the first and second weeks after discharge. Functional evaluations were made with ROM and Constant-Murley scores at the final follow-up examination. RESULTS: There was no difference in the amount of drainage between the two groups in which a drain was used. When the three groups were compared among themselves regarding preoperative and postoperative VAS scores, Constant-Murley scores, and DMD, no significant difference was found. CONCLUSIONS: We do not recommend the routine use of drains after arthroscopic rotator cuff surgery in terms of cost-effectiveness. LEVEL OF EVIDENCE: Level II: Prospective Cohort Study.

No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders-A Comparative Study With Systematic Review of the Literature.

BACKGROUND: Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the contribution of such combination to results isn't known well. OBJECTIVES: We performed a comparative study to evaluate the effects of PIN neurectomy for PRC and a systematic review of the literature was performed to identify whether such combination has an advantage. METHODS: Patients with wrist diseases who underwent PRC were evaluated retrospectively. Patients without PIN neurectomy (group 1, n = 7) and with PIN neurectomy (group 2, n = 8) were compared in respect of mean age, follow-up, gender, Q-DASH, VAS, MAYO wrist scores, flexion-extension/radial-ulnar deviation range of motion at final follow-up. The MEDLINE database was searched for studies published between 2005 and 2015, as the second part of the study. The following keywords were used: "proximal," "row," "carpectomy." Studies, which met the inclusion criteria, were evaluated in terms of such combination. RESULTS: There were no significant difference between the groups in regard with age (P = .463), follow-up period (P = .728), the ranges of flexion-extension (P = .431) and radio-ulnar deviation (P = .689), Q-DASH (P = .452), and MAYO scores (P = .728). In the second part of the study, 12 studies met the inclusion criteria and none of them was specifically evaluating such combination. Only one study had specific comments on PRC with PIN neurectomy. CONCLUSION: According to our study (which, to our knowledge, was the first comparative study in the literature), we advocate not to combine PRC with PIN neurectomy for such an approach has no advantage.

HISTORIQUE: La résection interosseuse postérieure (IOP) combinée à la carpectomie proximale (CTP) est favorisée pour stimuler une convalescence rapide. Cependant, on en connaît mal l'apport sur les résultats. OBJECTIFS: Les auteurs ont procédé à une étude comparative pour évaluer les effets de la neurectomie IOP pour la CTP et à une analyse bibliographique systématique pour déterminer si cette combinaison comportait des avantages. MÉTHODOLOGIE: Les chercheurs ont soumis les patients ayant une maladie du poignet qui avaient subi une CTP à une évaluation rétrospective. Ils ont comparé les patients sans neurectomie IOP (groupe 1, n = 7) à ceux en ayant subi une (groupe 2, n = 8) pour ce qui est de l'âge moyen, du suivi, du sexe, des scores du poignet Q-DASH, VAS et MAYO, ainsi que de l'amplitude de flexion­extension et de déviation radio-ulnaire au suivi final. Dans la deuxième partie de l'étude, ils ont effectué des recherches dans la base de données MEDLINE pour en extraire les études publiées entre 2005 et 2015. Ils ont utilisé les mots-clés suivants: proximal, row, carpectomy. Ils ont évalué les études qui respectaient les critères d'inclusion en fonction de cette combinaison. RÉSULTATS: Les chercheurs n'ont constaté aucune différence significative entre les groupes pour ce qui est de l'âge (p = 0,463), de la période de suivi (p = 0,728), de l'amplitude de flexion­extension (p = 0,431) et de déviation radio-ulnaire (p = 0,689), ainsi que des scores Q-DASH (p = 0,452) et MAYO (p = 0,728). Dans la deuxième partie de l'étude, 12 études respectaient les critères d'inclusion et aucune n'évaluait expressément cette combinaison. Une seule étude incluait des commentaires sur la CTP combinée à la neurectomie IOP. CONCLUSION: D'après la présente étude, qu'ils croient être la première étude comparative sur le sujet, les chercheurs préconisent de ne pas combiner la CTP à la neurectomie IOP, car elle ne comporte aucun avantage.