Does cranial bone ossification differ in children with developmental dysplasia of the hip?

OBJECTIVES: This study aims to compare cranial bone ossification between patients with developmental dysplasia of the hip (DDH) and healthy individuals. PATIENTS AND METHODS: Between September 2021 and April 2022, a total of 60 healthy female individuals (median age: 24.5 months; range, 18 to 36 months) and 56 female DDH patients (median age: 23 months; range, 18 to 35 months) were included. Age, head circumference, weight, height, and patency of the anterior fontanel were measured in groups. Percentiles were classified as very low, low, normal, high and very high. All patients were female and those with abnormal thyroid function test, vitamin D, calcium, phosphate and alkaline phosphatase values were not included in the study. For those diagnosed with DDH, they were included in the group regardless of the type of treatment. RESULTS: No statistically significant difference was found between the groups in terms of age and weight (p>0.05). The very low and very high head circumferences were more frequent, and the normal head circumferences were less frequent in the DDH group (p<0.05). There was no significant difference between groups in terms of fontanel closure (p>0.05). In open fontanels, no significant difference was found in both groups in terms of age (p>0.05). CONCLUSION: Our study results showed no significant difference between the fontanel ossifications of children with and without DDH; however, we found that the ossification of the skull bones of children with DDH was different compared to healthy children.

Long-term Functional Difference between the First and Second Knees in Simultaneous Bilateral Total Knee Arthroplasty.

OBJECTIVE: To compare the long-term functional results of the first and second knees in simultaneous bilateral total knee arthroplasty. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Gulhane Education and Research Hospital, Ankara, Turkey from January 2003 to December 2010. METHODOLOGY: A total of 47 patients with at least 10 years of follow-up after simultaneous bilateral total knee arthroplasty were included in the study. The range of motion, forgotten joint score (FJS), Oxford knee score (OKS), and Western Ontario McMaster university osteoarthritis index (WOMAC) were compared between the first and the second knees. The Dependent t-test and the Wilcoxon Sign test were used to determine the significance. Whether there was a statistically significant correlation, so Spearman's correlation test and Bonferroni correction were used. RESULTS: WOMAC total scores both knees were 13 (p=0.755). The average OKS of the first operated knees was 40.53 ± 4.44, while it was 40.28 ± 4.59 in the second knees (p=0.239). The FJS of the first and second operated knees were 69.36 ± 21.97 and 69.02 ± 21.89, respectively (p=0.321). As the age increased, the ROM was decreased. As the patient age increased, WOMAC pain scores were found to decrease. CONCLUSION: The functional scores of the first and the second operated knees in SBTKA were similar in the long term. Although no correlation was found between age and the functional scores, these results complied with the previous information about the effect of age on TKA results. Key Words: Simultaneous total knee arthroplasty, Bilateral, Clinical outcome, Osteoarthritis.

Mid-term Clinical and Radiological Results of Oxford Phase 3 Medial Unicompartmental Knee Arthroplasty.

Introduction The popularity of unicompartmental knee arthroplasty (UKA) for the treatment of isolated compartment osteoarthritis of the knee has risen over the past two decades. Currently, UKA covers a considerable amount of all knee arthroplasties worldwide. The aim of this study was to present the clinical and radiological outcomes of UKA in patients with medial compartment osteoarthritis. Methods Between January 2010 and January 2014, mobile-bearing UKA was applied to 44 knees of 37 (three men, 34 women) patients with isolated medial compartment osteoarthritis. The mean age, body mass index (BMI), and follow-up were 54 ± 6.1, 26.3± 2.2, and 48 ± 9.4, respectively. Oxford Knee Score (OKS), Knee Society Score (KSS), visual analog scale (VAS), and range of motion (ROM) were used for clinical assessment, and the Oxford Radiological Evaluation Criteria were used for radiological assessment. Results Compared to preoperative values, knee flexion increased from 116° to 123° (p<0.001). Statistically significant increases in OKS and KSS and decrease in VAS was obtained postoperatively (p<0.001). All of the components were aligned within the acceptable ranges radiologically. One bearing dislocation was revised and one conversion to TKA was performed during the 5.9-year follow-up. No major complications occurred, including infection, deep vein thrombosis, pulmonary emboli, and neurovascular injury. Conclusion The mid-term clinical and radiological outcomes of UKA were excellent in this study, and our results demonstrate that Oxford mobile-bearing UKA for the proper indication is effective, with considerable success in the treatment of medial compartmental knee osteoarthritis, regardless of age.

Total hip arthroplasty with rectangular stems and subtrochanteric transverse shortening osteotomy in Crowe type IV hips: a retrospective study.

BACKGROUND: The complexity of femoral and acetabular anatomy and restoring anatomic center of hip rotation in Crowe type IV developmental dysplasia of the hip (DDH) complicates standard reconstruction. The aim of this study is to evaluate surgical techniques and clinical outcomes of subtrochanteric transverse shortening osteotomy with the use of cementless rectangular cross-section femoral implants in Crowe IV dysplastic hips. METHODS: A total of 26 hips of 25 consecutive patients with Crowe type IV DDH who underwent cementless total hip arthroplasty with subtrochanteric femoral transverse shortening osteotomy were retrospectively analyzed. The Harris Hip Score, Visual Analog Scale-pain, leg length discrepancy, and vertical and lateral migration of hip rotation center were recorded. RESULTS: Mean age, follow-up, and time of union were 41 ± 9.7 years, 7.1 ± 1.2 years, and 3.7 ± 1.1 months, respectively. Mean Harris Hip Score significantly improved from 38 ± 5.7 to 86 ± 6.1 points postoperatively (P < .01). Mean leg length discrepancy and Visual Analog Scale significantly decreased from 4.3 ± 1.3 to 1.2 ± 0.6 cm, and 6.4 ± 1.2 to 1.8 ± 0.8 points, respectively (P < .01). One female patient had a dislocation due to acetabular liner wear, which was managed by liner and head change. One patient had Sudeck's atrophy, while another had pain on the lateral thigh, both of which were resolved with conservative management. CONCLUSIONS: Combined transverse subtrochanteric femoral osteotomy and cementless total hip arthroplasty with rectangular cross-section femoral implants is technically demanding, effective, and safe in femoral shortening for treatment of Crowe type IV DDH.

Lightbulb technique for the treatment of osteonecrosis of the femoral head.

INTRODUCTION: The aim of this study was to report the clinical and radiological outcomes for 21 patients (28 hips) treated for osteonecrosis of the femoral head using the lightbulb technique, a nonvascularised bone grafting technique. METHODS: The study group included 14 men and 7 women, with a mean age of 33.2 (range 22-50) years, presenting with avascular necrosis of the femoral head of stage 4a or earlier, according to the Steinberg classification. Patients were treated using the nonvascularised lightbulb bone grafting technique. The primary clinical outcome was the Harris Hip Scores (HHS), while primary outcomes of treatment effectiveness and disease progression were based on radiographic evidence of disease progression and the need for total hip replacement. The rate of treatment success and failure was evaluated using the Kaplan-Meier survival analysis. RESULTS: The mean HHS increased from 52.66 to 74.33 after treatment, with excellent-to-good outcomes obtained in 21 (75%) of the cases. Fair-to-poor results were obtained in 7 (25%) of the cases, with total hip arthroplasty subsequently required in 5 of these cases. The radiological failure rate was 50% among cases treated in Steinberg stage 1 (1/2), 42% in stage 3 (5/12), and 100% in stage 4 (2/2). CONCLUSIONS: The lightbulb technique can provide a clinically acceptable rate of successful treatment of osteonecrosis of the femoral head when used in the early stages of the disease, prior to collapse of the femoral head.

The Effect of Administration Protocol of Subcutaneous Enoxaparin Injection on Formation of Ecchymosis.

Subcutaneous heparin administration is routinely used for many patients in orthopaedic clinics. Nurses frequently encounter ecchymosis formation with heparin administration. Previous research indicates that the administration protocol may have effect on ecchymosis formation. The study was performed to determine and compare the effect of three different approaches of subcutaneous enoxaparin injection on ecchymosis formation in patients who underwent joint replacement surgery. Three protocols were compared: (1) injecting enoxaparin in 10 seconds, (2) injecting enoxaparin in 30 seconds, and (3) injecting enoxaparin in 30 seconds and waiting for an additional 10 seconds before withdrawing the needle. Ecchymosis formation was assessed in both size and frequency. Descriptive statistics, Kruskal-Wallis analysis, Mann-Whitney U test, and Spearman rank correlation test were used to assess the data. The ecchymosis frequency was higher in the 10-second administration. Ecchymosis size was smaller when the enoxaparin was administered in 30 seconds and the needle was kept in the tissue for 10 seconds after injection. The enoxaparin should be administered in a longer duration (30 seconds). Keeping the needle in the tissue for 10 seconds may further decrease the size but not the incidence of ecchymosis.

Correction of Length Discrepancy of Radius and Ulna with Distraction Osteogenesis: Three Cases.

Objectives. The aim of the study was to investigate the results of patients with isolated length discrepancy between ulna and radius who underwent distraction osteogenesis with unilateral external fixator. Material and Methods. A patient with ulna shortening due to multiple enchondromatosis, a patient with ulna shortening due to ulnar club hand, and a patient with radial shortening due to radial club hand were included in the study. The patients underwent ulna and radial distraction osteogenesis with unilateral external fixator. Range of wrist and forearm motion, deformities, and length discrepancy of ulna and radius were compared at preoperative and postoperative. Results. Duration of external fixation and followup were 2.6 and 23.3 months, respectively. Mean distraction osteogenesis was 1.66 cm. No patient reached the length of normal side. Range of rotation of forearm was increased by 15°. Range of ulnar-radial deviation was increased by 21.6°. Deformity of 15° at patient with multiple enchondromatosis was corrected. Conclusion. Isolated ulna or radius shortening may reduce with distraction osteogenesis by unilateral external fixator to prevent serious deformity.

The accuracy of two different extra-medullary tibial cutting guides for posterior tibial slope in total knee arthroplasty.

OBJECTIVES: This study aims to evaluate the effectiveness of two different external tibial cutting guides with and without a spike anchoring to the intercondylar eminentia to achieve a desired posterior tibial slope. PATIENTS AND METHODS: Between January 2008 and December 2011, 120 posterior cruciate ligament protecting total knee arthroplasty (TKA) surgeries of 83 patients in which two different external tibial cutting guides used were included. Fifty-nine knees were included into the spiked and 61 knees were included into the spikeless cutting guide group. Posterior tibial slope angles were measured using the postoperative X-rays. RESULTS: There was no significant difference between two groups in terms of age, sex, and body mass indexes (p<0.05). While the mean postoperative slope angle was 2.66°±2.001°(range 0°-7°) in spiked group, it was 2.46°±2.277° (range 0°-7°) in spikeless group. Both systems had identical accuracy, indicating a low rate. The comparison of variances of two groups showed that both cutting guides had similar precision (p=0.234). There was no effect of body mass index on the results in both groups. CONCLUSION: Although different extra-medullary tibial cutting guides with and without a spike can reproducibly impart a desired posterior tibial slope in TKA, we concluded that a spiked guide was considered user-friendly.

Late tourniquet release and drain clamping reduces postoperative blood loss in total knee arthroplasty.

BACKGROUND: Many studies have investigated the effect of tourniquet release time and closed suction drainage in total knee arthroplasty (TKA). However, controversy remains as to the advisability of preclosure tourniquet release and the advisability of closed suction drain use following total knee arthroplasty. QUESTIONS/PURPOSES: The aim of the study was to investigate if there is a benefit of performing tourniquet release after skin closure, along with drain clamping, for the first 6h following TKA. METHODS: Ninety-six patients underwent TKA between May 2009 and April 2010. Fourteen of these were excluded because of systemic diseases and simultaneous bilateral TKA. Twenty-nine of these were excluded due to use of a patellar component and posterior cruciate ligament (PCL)-sacrificing systems. Thus, 53 patients that underwent PCL-retaining cemented TKA were reviewed retrospectively. In the control group (group C), the tourniquet was released before skin closure, an attempt at hemostasis was made, and a compressive bandage was applied. The drain was not clamped in these patients. The test group of 23 patients (group T) had tourniquet release after skin closure and after the compressive bandage was applied. The drain was clamped for the first 6h after surgery. The two groups were compared as to the amount of drained blood, postoperative change in hemoglobin, postoperative complications, and knee function. RESULTS: We found that drained blood and hemoglobin drop were significantly lower in group T compared with group C. There was no difference regarding postoperative complications and knee function. CONCLUSION: We conclude that tourniquet release after skin closure and compressive dressing followed by 6h of drain clamping reduces postoperative blood loss in TKR surgery.

Hip problems in cerebral palsy: screening, diagnosis and treatment.

PURPOSE OF REVIEW: Spastic type is the most common form of cerebral palsy. The purpose of this review was to evaluate recent literature for current trends in the surveillance and treatment of spastic hip problems in cerebral palsy. RECENT FINDINGS: Cerebral palsy is still the most common physical disability in childhood in developed countries. Surveillance programs have had promising results in the detection of 'at risk' patients. However, neither regular radiographic screening nor surgical treatment indications and procedures have shown any progression in the last decade. In addition, recent studies have focused heavily on nonoperative treatment strategies to improve gait. SUMMARY: Cerebral palsy is a static encephalopathy causing myostatic contractures especially in the knee and hip. Unbalanced hip contractures can lead to silent hip dislocation. Surgical and rehabilitative approaches such as soft tissue lengthening and proximal femoral and pelvic osteotomies can help patients maintain function and comfort. Selective dorsal rhizotomy or Intrathecal Baclofen Pump insertion or, recently, noninvasive techniques such as neurodevelopmental therapy may help patients and caregivers cope with what is still a devastating and inexorably progressive disorder.

[A comparison of the efficacy of bupivacaine and levobupivacaine in patient-controlled epidural analgesia for postoperative pain in patients undergoing knee arthroplasty]. / Diz artroplastisi yapilan hastalarda ameliyat sonrasi agri için hasta kontrollü epidural analjezide bupivakain ve levobupivakainin etkinliginin karsilastirilmasi.

OBJECTIVES: In this study, we aimed to compare the efficacy of bupivacaine and levobupivacaine in the patient-controlled epidural analgesia (PCEA) in patients who underwent total knee arthroplasty (TKA), particularly with cardiac diseases. PATIENTS AND METHODS: Forty-four patients (16 males, 28 females; mean age 70.2±6.3 years; range 18 to 80 years) who were scheduled for TKA surgery under combined spinal and epidural anesthesia were included. Patients were randomly divided into two groups. Bupivacaine 15 mg 0.5% for group 1 (n=23) and levobupivacaine 15 mg 0.5% for group (n=23) were administered via spinal route. The amount of local anesthetics, PCEA starting times and bolus/demand ratio of local anesthetics were recorded. The level of pain, need for additional analgesic, total amount of analgesic, degree of motor block, complications were asked for patient satisfaction at postoperative 6, 12, 24 and 48 hours. RESULTS: No statistical differences were determined between group 1 and group 2 in terms of the operation times, PCEA starting times, bolus number/demand ratios, visual analog scale (VAS) scores and numerical rating scores (NRS) at the postoperative 6, 12, 24 and 48 hours, need for additional analgesic, total amount of analgesic, degree of motor block and patient satisfaction. Although the incidence of side effects was lower in the group 1 compared to group 2, it was not statistically significant. CONCLUSION: We concluded that it would be proper using levobupivacaine rather than bupivakaine for patients with cardiac diseases, as the cardiotoxic and neurotoxic effects of levobupivacaine is lower then bupivacaine with a similar analgesic efficacy.

Bilateral femoral neck stress fracture following bilateral total knee arthroplasty: a case report.

In the treatment of degenerative knee arthritis, total knee arthroplasty is a commonly performed surgery. After knee replacement, stress fractures at lower extremity may rarely occur due to changes in lower extremity alignment and biomechanical axis. We report an 82-year-old woman with a bilateral femoral neck stress fracture 3 years after bilateral total knee replacement. Physicians should be aware of this rare complication and these fractures should be treated without any surgical delay.

Ilizarov external fixation without removal of plate or screws: effect on hypertrophic and oligotrophic nonunion of the femoral shaft with plate failure.

Patients with hypertrophic and oligotrophic nonunion of the femoral diaphysis associated with plate failure can be treated by Ilizarov external fixation without plate removal. Advantages of this technique include a lack of damage to the blood supply and simultaneous deformity correction.

Effect of alpha-tocopherol on bone formation during distraction osteogenesis: a rabbit model.

PURPOSE: The purpose of this study was to evaluate the effects of alpha-tocopherol on distraction osteogenesis. MATERIALS AND METHODS: Right tibias of 30 New Zealand white rabbits were distracted at a rate of 0.5 mm/day for 20 days with a circular external fixator. Experimental group rabbits (n = 15) were administered i.m. 20 mg/kg/day alpha-tocopherol for 30 days. Radiographic examinations were performed at the 20th, 30th and 40th days. Bone scintigraphy was performed at the 5th and 20th days. Serum total antioxidant capacity (TAC) was measured at the 5th and 30th days. All animals were sacrificed and the right tibias of all animals were harvested for histopathologic examination at the 40th day. RESULTS: Radiologic scores were statistically similar at the 20th day. However, the experimental group demonstrated higher radiologic scores at the 30th and 40th days. A scintigraphic baseline study at the 5th day of the study showed statistically similar osteoblastic activities in both groups. However, at the 20th day, osteoblastic activity was significantly higher in the experimental group. Serum TAC values were also significantly higher in the experimental group at the 30th day. At necropsy, histopathologic examination revealed statistically significantly higher scores in the experimental group. CONCLUSION: The results of this study show that alpha-tocopherol has beneficial effects on new bone formation during distraction osteogenesis.

[Outcomes of multilevel orthopedic surgery in children with cerebral palsy]. / Serebral palsili çocuklarda çok seviyeli ortopedik cerrahi tedavinin sonuçlari.

OBJECTIVES: Outcomes of single-event bilateral multilevel orthopedic surgery in children with cerebral palsy were retrospectively investigated by physical findings, and gross motor function measurement (GMFM) score in all patients and additionally by joint kinematics, and time-distance parameters in ambulatory patients. PATIENTS AND METHODS: A total of 24 patients (17 ambulatory; 7 non ambulatory; mean age 12 years; range 5 to 19 years) treated with multilevel orthopedic surgery between December 2003 and December 2005 were included in the study. Patients were evaluated with physical examination and GMFM score. In addition, computed gait analysis was used to evaluate joint kinematics and time-distance parameters in ambulatory children. The following surgeries were performed on the children in the study cohort: adductor tenotomy (n=24); psoas lengthening (n=14); hamstring lengthening (n=46); distal rectus femoris transfer (n=18); bilateral Achilles tendon lengthening (n=22); distal femoral derotation osteotomy (n=1); open reduction and Dega osteotomy (n=1), and proximal femur resection (n=2). Patients were evaluated with the same parameters after an average of eight months postoperatively. The pre- and postoperative results were statistically compared. RESULTS: Improvements were achieved in the lying-rolling (7%), sitting (9%), crawling-kneeling (7%), standing (5%), and walking-running-jumping (5%) activities of GMFM score. An increase in hip abduction angle and external rotation and a decrease in the Thomas test results were observed. A decrease in popliteal angle and an increase in active and passive knee extension were provided. Active and passive ankle dorsiflexion increased. In the kinematic parameters, the minimum hip and knee flexions in the stance phase were significantly decreased, while no significant decrease was seen in the maximum hip and knee flexion in the swing phase. Both the ankle dorsiflexion in the stance and swing phase and the time-distance parameters consist of walking velocity, stride length and the cadence were significantly improved. CONCLUSION: Single-event bilateral multilevel orthopedic surgery performed in the right indication was shown to be effective with improvements in physical examination findings GMFM scores, joint kinematics and time-distance parameters in children with cerebral palsy.

The role of preconditioning and N-acetylcysteine on oxidative stress resulting from tourniquet-induced ischemia-reperfusion in arthroscopic knee surgery.

BACKGROUND: The aim of this study was to investigate the effects of ischemic preconditioning (IPC) and N-acetylcysteine (NAC) on oxidative stress resulting from tourniquet-induced ischemia-reperfusion (IR) period in arthroscopic knee surgery. METHODS: Forty-five patients who had arthroscopic knee surgery for meniscal and chondral lesions and for pathologic medial plica were included in this study. They were assigned to the following treatment groups: control (group C; n=15), IPC (group P; n=15), and NAC (group N; n=15). Subjects in the control group underwent routine surgical procedures. Subjects in the preconditioning group were subjected to temporary ischemia, with tourniquet performed by three compression cycles of 5 minutes followed by 5 minutes of reperfusion just before the application of tourniquet inflation. Subjects in the NAC group received 10 mg/kg NAC dissolved in 100 mL 0.9% normal saline intravenously 30 minutes before tourniquet inflation. An hour before the tourniquet was applied (preischemia) and 2 hours after tourniquet was removed (reperfusion), blood samples (to test for metabolites) were obtained. Levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidant capacity (TAC), and total oxidant status (TOS) were measured in all serum samples. Results were compared between preischemia and reperfusion in three groups. RESULTS: MDA in the control group was found to be increased significantly compared with preischemia, whereas MDA in IPC and NAC groups did not change insignificantly. SOD and GSH activities in the control group were found to be increased significantly, whereas SOD and GSH activities in IPC and NAC groups did not change significantly after reperfusion. TAC in the control group was found to be decreased and TOS was found to be increased significantly, but TAC and TOS in IPC and NAC groups were not significantly different after reperfusion. Mean serum MDA, TOS, SOD, and GSH-Px levels were lower in group P than group C at reperfusion period (p<0.05). Mean serum SOD levels were lower in group P than group N at reperfusion period (p<0.05). CONCLUSIONS: Tourniquet-induced IR period in routine arthroscopic knee surgery resulted in oxidative stress by increasing MDA, SOD, GSH-Px, TOS and decreasing TAC. NAC and IPC had protective effect on occurrence of oxidative stress resulting from IR period by preventing MDA, SOD, GSH-Px, TAC, and TOS changes in routine arthroscopic knee surgery.

AO tension band technique application in proximal humerus fractures.

OBJECTIVES: The aim of this study was to report our functional results after an intramedullary Kirschner wires (K-wires) and tension band wiring combination for the treatment of a large group of humeral head fractures was performed. PATIENTS AND METHODS: Seventy-four patients (54 females, 20 males; mean age 42 years; range 24 to 73 years) who had proximal humerus fractures were treated with an intramedullary K-wire and tension band technique and were retrospectively analyzed. Fracture patterns were according to Neer classification type II in 43 patients, type III in 23 patients and type IV in five patients. The Constant-Murley shoulder score test was used to evaluate the function of both shoulders. The outcome was graded according to Neer's criteria. The pain score was determined with a 10-point visual analog scale. RESULTS: All fractures were healed (radiologically and clinically) within 3.6 months (range 2.5 to 4.7 months) after the surgery. In one patient, the cerclage wire was broken and in eight patients, K-wires produced impingement like symptoms that required a second procedure (wire removal) after healing. The results of the patients with regard to Constant-Murley score and Neer criteria were indifferent when the 6th and the 12th month data were compared (p<0.05). Visual analog scale scores of the patients between the two control visits were significant different (p>0.05). CONCLUSION: The type of fixation depends on the bone quality and the degree of comminution. But the recent trend is towards osteosynthesis -the limited, less invasive technique- which is performed with minimal soft tissue dissection and minimal osteosynthesis. It allows less stripping of bone and therefore preservation of the blood supply to the humeral head. This procedure is simple to perform and provides good postoperative results.

Percutaneous radiofrequency epiphysiodesis in a rabbit model: a pilot study.

BACKGROUND: Techniques for epiphysiodesis have evolved from open surgical techniques requiring direct observation of the physis to percutaneous techniques performed with fluoroscopy. QUESTIONS/PURPOSES: Our purposes were to (1) describe a new minimally invasive surgical technique used to achieve epiphysiodesis using radiofrequency ablation, (2) document the effect of radiofrequency ablation on tibia length at 2, 6, and 12 weeks after ablation in a skeletally immature rabbit model, and (3) assess the effects of radiofrequency ablation on the histologic appearance of the proximal tibia physis and proximal tibia articular cartilage. MATERIALS AND METHODS: We performed epiphysiodesis of the rabbit proximal tibia on 15 skeletally immature male New Zealand White rabbits using a 22-gauge radiofrequency probe. The probe was positioned percutaneously and heated to 90 degrees C for 4 minutes on the medial and lateral (1/2) of the physis. The opposite tibia was used as a control. Five animals were sacrificed at 2, 6, or 12 weeks postoperatively. Tibia length was compared using Faxitron(R) radiographs and electronic calipers. Histology of the growth plate was assessed with light microscopy. RESULTS: We observed differences in tibia length between 4.16 mm and 11.59 mm (average 7.86 mm) at 12 weeks. The proximal tibia physis closed radiographically and histologically in all animals by 12 weeks. Histologic analysis showed no evidence of articular cartilage injury. CONCLUSIONS: This technique was reproducible and resulted in bone fusion of the rabbit proximal tibial growth plate. The use of radiofrequency ablation as described in this report may be used as an alternative to other surgical epiphysiodesis techniques. CLINICAL RELEVANCE: This technique may be useful for epiphysiodesis of small tubular bones of the hands and feet in humans.

Osteopetrosis and congenital hypothyroidism complicated by slipped capital femoral epiphysis.

OBJECTIVE: To describe a 13-year-old girl with unilateral slipped capital femoral epiphysis (SCFE), who presented with an acute onset limp during follow-up for congenital hypothyroidism and osteopetrosis. METHODS: We present a case report detailing the patient's history as well as clinical, laboratory, and imaging findings and discuss the related literature. RESULTS: The patient had been diagnosed elsewhere with congenital hypothyroidism, and levothyroxine therapy was initiated when she was 20 days of age; however, adherence to the treatment was irregular. Both her weight and her height were below the 5th percentile, her breast development and pubic hair were consistent with Tanner stage 1, and she had mental retardation and atypical facies. Her gait was antalgic; no muscle atrophy or shortness in the affected leg was present. On laboratory investigation, thyroid function tests were concordant with primary hypothyroidism. Her bone age was estimated as 8 years. Dual-energy x-ray absorptiometry revealed increased bone mineral density. Radiographic studies disclosed striking opacity of the bones of the pelvis and sclerosis at the skull base. Computed tomography of the affected left lower limb showed a fragmented appearance of the capital femoral epiphysis and thickening and irregularities of the physis line on the left, consistent with SCFE. CONCLUSION: We underscore the possible facilitator role of osteopetrosis in the pathogenesis of SCFE, suggest the need to consider SCFE in the differential diagnosis when a lower extremity abnormality is detected in patients with congenital hypothyroidism or delayed puberty (or both), and emphasize this association with osteopetrosis.

Effect of hyperbaric oxygen and ozone preconditioning on oxidative/nitrosative stress induced by tourniquet ischemia/reperfusion in rat skeletal muscle.

OBJECTIVES: The aim of the study was to investigate the effect of hyperbaric oxygen-preconditioning (HBO-PC) and ozone-preconditioning (O3-PC) on oxidative/nitrosative stress induced by tourniquet ischemia/reperfusion (I/R) in rat skeletal muscle. METHODS: Thirty-two Wistar-Albino-type male rats included in the study were divided into four groups of equal number: 1) sham operation, 2) I/R, 3) I/R+HBO-PC, or 4) I/R+O3-PC. One session of 3-4 L/min 100% oxygenation for 60 min at 3 absolute atmosphere (ATA) was defined as one dose of HBO; in total, 7 doses of HBO-PC were administered before ischemia. One dose of O3 comprised 0.7 mg/kg ozone/oxygen mixture, administered intraperitoneally; a total of 4 doses of O3-PC were administered before ischemia. The I/R model was performed in anesthetized rats by clipping right femoral artery to induce 2 h ischemia followed by 22 h of reperfusion. The right gastrocnemius muscle and venous blood samples were harvested. Tissue was assayed for levels of malondialdehyde (MDA), inducible nitric oxide synthase (iNOS), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). Serum was assayed to measure the level of nitrite-nitrate (NOx). RESULTS: Tissue MDA level, SOD activity, and serum NOx level were increased, whereas GSHPx was decreased in the I/R group. MDA and NOx levels were decreased, whereas GSH-Px activity was increased in both the I/R+HBO-PC and I/R+O3-PC groups. SOD activity was increased in the I/R+O3-PC group, but did not change significantly in the I/R+HBO-PC group. iNOS staining score and intensity were lower in the I/R+HBO-PC and I/R+O3-PC groups than I/R group. CONCLUSION: Both O3-PC and HBO-PC reduced tissue lipid peroxidation, NOx levels, and iNOS staining scores in the experimental I/R model. Our data suggest that HBO-PC and O3-PC protect against oxidative/nitrosative stress induced by I/R in rat skeletal muscle.