The results of Pemberton's pericapsular osteotomy in patients with developmental hip dysplasia.

OBJECTIVE: The aim of this study was to investigate the radiological and clinical outcomes of Pemberton's pericapsular osteotomy in toddlers and preschool children with developmental hip dysplasia. METHODS: Ninety-one hips of 86 patients (81 girls, 5 boys) with developmental hip dysplasia who underwent Pemberton's pericapsular osteotomy were included in this study. The mean age of the patients was 34 (range: 18 to 96) months. The mean duration of follow-up was 60 (range: 24 to 158) months. All patients underwent open reduction and Pemberton's pericapsular osteotomy, including 12 hips in which proximal femur osteotomy had been performed earlier. Clinical results were evaluated according to McKay's clinical evaluation criteria, radiological results according to Sever's radiological evaluation criteria, and the presence of avascular necrosis according to Kalamchi-MacEwen's classification criteria. RESULTS: At the final examinations the mean acetabular index was 12.04° (range: 5° to 24°) and the mean Wiberg's center-edge angle was 35.5° (range: 20° to 52°). Clinically, excellent results were obtained in 81 (89.0%) hips, good results were obtained in 2 (2.2%) hips, and fair results in 8 (8.8%) hips. Radiologically, excellent results were obtained in 79 (86.8%) hips, good results in 7 (7.7%) and fair results in 5 (5.5%) hips. Clinically and radiologically no poor results were noted. Type 1 avascular necrosis was detected in 9 (9.9%) hips, Type 2 in 7 (7.7%) hips, and Type 3 in one (1.1%) hip. There were no cases with Type 4 avascular necrosis. CONCLUSION: Pemberton's pericapsular osteotomy is a safe and effective procedure for the surgical treatment of developmental hip dysplasia in toddlers and preschool children.

Isolated carpal scaphoid dislocation.

Isolated scaphoid dislocations are very rare. Options for the treatment of dislocation of the scaphoid include closed reduction and casting, closed reduction and percutaneous pinning, and open reduction and ligament repair. We report a case of this rare injury which was treated with open reduction, pinning and ligament repair.

The Prevalence of Chronic Impingement Syndrome and SLAP Lesion and the Sensitivity of O'Brien's Test.

OBJECTIVE: In this study, we aimed to investigate the prevalence of SLAP lesions in patients with chronic impingement syndrome. We also examined the sensitivity of O'Brien's test. MATERIALS AND METHODS: The study included 48 patients with a preliminary chronic impingement syndrome diagnosis to whom arthroscopic decompression had been planned. All patients underwent preoperative Neer's, Hawkins' and O'Brien's tests. We performed shoulder arthroscopy on all patients and evaluated chronic impingement syndrome and SLAP lesions. Then, we compared the statistical sensitivities of these tests. RESULTS: The mean age of patients with chronic impingement was 45.8 years (range, 35-69 years). O'brien's test was positive in 34 (70.8%) of the patients, and Neer's test and Hawkins' test were positive in 46 (95.8%) of the patients before shoulder arthroscopy. Shoulder arthroscopy revealed that 44 (91.7%) of 48 patients had subacromial impingement; 32 (66.7%) had SLAP lesions and internal impingement. In chronic impingement syndrome, sensitivity rates were 95.6% for Neer's test and Hawkins' test, whereas in internal impingement syndrome and slap lesions, the sensitivity of O'brien's test was 94.1%. There was no statistical difference between the tests (p>0.05). CONCLUSION: 72.72% of the patients with chronic impingement syndrome had concomitant SLAP lesions. We suggest that O'Brien's test should be used with Neer's and Hawkins' tests for diagnosis of this condition.

The role of acromion morphology in chronic subacromial impingement syndrome.

This study investigated the role of acromion morphology in the aetiology of chronic subacromial impingement syndrome. Forty five patients with chronic subacromial impingement syndrome were included in the study. They were distributed into three groups according to their acromion types: six (13.3%) patients had type 1, 24 (533%) patients type 2 and 15 (333%) patients type 3 acromion. Constant scoring was used for clinical evaluation. Arthroscopic subacromial decompression was performed in all patients in the three groups, without performing any acromioplasty that would change the morphology of acromion. We then compared the average Constant scores changes in all three groups after arthroscopic subacromial decompression. The average follow-up was 28.6 months (range: 12-47). The average change in Constant score after arthroscopic subacromial decompression was 5830 in patients with type 1 acromion, 58.21 in those with type 2 and 54.07 in those with type 3. No significant difference was observed between the changes in the average Constant scores of the three groups (p > 0.005). The scores were significantly improved following arthroscopic subacromial decompression in all three groups (p < 0.005).In this study, acromion type was not found to have an important role in the aetiology of chronic impingement syndrome; arthroscopic subacromial decompression without simultaneous acromioplasty thus appears as an appropriate treatment.