Placement of Standard Sized Acetabular Cup Between True and False Acetabulum in Patients with Crowe III/IV Dysplasia: A Safe Option in THA Without Femoral Osteotomy.

Introduction: There is no consensus in literature on the surgical treatment of patients with Crowe type III/IV patients. Each arthroplasty procedure has its own advantages and disadvantages. In this study by placing the acetabular cup between the true and false acetabulum, we aimed to share our experience about criteria of patient selection, surgical technique, and mid-term results of THA (total hip arthroplasty) in which the risk of dislocation was minimized using a standard-sized acetabular cup. Materials and Methods: We reviewed the clinical and radiographic data of the patients with Crowe type III/IV treated by cementless THA without femoral shortening osteotomy from January 2015 to January 2020. The clinical (Harris hip score, Trendelenburg sign, limb lengths) and radiographic (AP/L hip X-ray, 3D CT) examinations before surgery; 1, 3 months and 1 year after the surgery were evaluated. All postsurgical complications were noted. Results: Among all, 268 patients met the inclusion criteria. Thirty-two patients (11.9%) were male and 236 (88.1%) were female. Mean age was 46.8 years. Mean follow-up duration was 42.4 (26-57) months. Mean Harris Hip score (HHS) was 49.7 and Trendelenburg sign was positive in all patients preoperatively. In the final evaluation, mean HHS significantly improved to 80.2 (p < 0.005) and none of the patients had Trendelenburg sign. Mean lengthening of the operated leg was 4.3 cm. Conclusion: Total hip arthroplasty with placement of acetabular cup between true and false acetabulum can be successfully preferred in selected patients with Crowe III/IV dysplasia.

Comparison of Treatment Options of Three- and Four-Part Humerus Proximal Fractures in Patients Over 50 Years of Age.

Introduction Our aim was to evaluate different treatment methods including conservative treatment (CT), locking-plate osteosynthesis (OS) and hemiarthroplasty (HA) in three- and four-part humeral fractures in patients older than 50 years. Methods Forty-seven patients that have at least one year of follow-up were divided into three groups: 18 patients treated with OS, 14 patients treated conservatively and 15 patients treated with HA. For further evaluation, constant shoulder score, disabilities of the arm, shoulder and hand score (DASH), American Shoulder and Elbow Society (ASES) score had been used. Shoulder range of motion was also assessed. Results OS and CT groups had better scores than HA group. In OS group, average Constant score was 71.6 ± 16.2, DASH score was 12.1 (5.2-24.2) and ASES score was 77.5 (50.8-96.6). In CT group, average Constant score was 69.6 ± 19.2, DASH score was 16.4 (12.5-36.7) and ASES score was 76.6 (45.4-87.9). DASH scores (p = 0.032), Constant scores (p = 0.001), forward elevation (p < 0.001), abduction (p < 0.001), internal (p = 0.022) and external rotation (p = 0.048) were significantly improved in OS and CT groups than HA group. Conclusions HA should not be considered a priority in surgical planning in Neer three-part and four-part proximal humerus fractures. CT is superior for patients with additional morbidity and advanced age. But in patients who are younger and can tolerate the surgical procedure, the priority should be OS.

Focal metallic inlay resurfacing prosthesis in articular cartilage defects: short-term results of 118 patients and 2 different implants.

BACKGROUND: The goal of this study was to share our experience with two different inlay metallic implants in the treatment of knee cartilage defects and to analyze their effects on functional scores. METHODS: This retrospective study included 118 patients operated on for focal full-thickness knee cartilage lesions, who were treated with a focal metallic inlay resurfacing prosthesis. A cobalt-chromium (Co-Cr) resurfacing implant was applied to 73 patients with a knee chondral lesion, and a biosynthetic implant was applied to 45. All patients were evaluated preoperatively and postoperatively using the KOOS, VAS, and Tegner activity scores. RESULTS: The group with the Co-Cr-resurfacing implant showed a significantly greater improvement (p < 0.001) in the Tegner and VAS scores at the 2-year follow-up examination. The KOOS scores were similar in both groups. Median patient age was similar in both groups. All patients had a follow-up of at least 2 years. The preoperative and postoperative scores were compared and significant improvements (p < 0.001) were observed. The biosynthetic implant had a higher revision rate. In the univariate analysis, age and type of implant were significantly associated with revision surgery. In the multivariate Cox-regression analysis model, the type of implant was significantly associated with revision surgery. CONCLUSION: All the patients operated with the above-mentioned implants showed significant improvements in pain and activity scores. Despite the overall good clinical results, 17% of patients with a biosynthetic implant and > 6% of patients with Co-Cr-resurfacing implant required revision surgery. Age and implant type were the main risk factors associated with revision.

Total hip arthroplasty without subtrochanteric femoral osteotomy is possible in patients with Crowe III/IV developmental dysplasia: total hip arthroplasty without femoral osteotomy.

BACKGROUND: We aimed to present our THA technique without femoral shortening osteotomy that we perform for the treatment of coxarthrosis on Crowe type III/IV developmental dysplasia of the hip and to present the early clinical outcomes of our patients. METHODS: 77 patients with Crowe type III/IV developmental dysplasia of the hip, who had admitted to our clinic between 2013 and 2017, and had undergone cementless THA without femoral shortening by a single surgeon, were retrospectively evaluated. Patients were called for a final evaluation and assessed by Harris Hip Score. Trendelenburg sign was observed. For radiological evaluation, routine anteroposterior and lateral hip radiography and orthoroentgenogram was used. RESULTS: Mean duration of follow-up was 38.2 (22-52) months. Pre-operative mean Harris Hip Score was 53.9 (49-62) and post-operative mean value was 82.7 (76-95). Mean duration of operation was 44.9 (39-57) min. In post-operative final evaluation only three patients (3.8%) had positive Trendelenburg sign. 3 patients (3.8%) had early dislocation. No sciatic palsy was observed in any of the patients. Revision with acetabular cage was performed for one (1.2%) patient due to protrusion development in the acetabular cup. The mean prosthesis survival rate was 98.8%. CONCLUSIONS: Total hip arthroplasty without femoral osteotomy can be considered as a successful method in selected patients with Crowe III/IV coxarthrosis. It provides good clinical outcomes in the early period, reduces surgery duration, has acceptable complication rates, has high prosthesis survival rates.

The Combination of Inlay Patellofemoral Arthroplasty and Medial Unicompartmental Knee Arthroplasty Versus Total Knee Arthroplasty for Mediopatellofemoral Osteoarthritis: A Comparison of Mid-Term Outcomes.

BACKGROUND: To the best of our knowledge, there have been no studies in the literature related to the use of second-generation inlay patellofemoral arthroplasty and unicompartmental knee arthroplasty combination (inlay PFA/UKA) in the treatment of mediopatellofemoral osteoarthritis (MPFOA). The aim of this study is to evaluate the efficacy of inlay PFA/UKA in MPFOA. METHODS: The study included 49 patients applied with inlay PFA/UKA because of MPFOA and 49 patients applied with TKA, matched one-to-one according to age, gender, body mass index, follow-up period, preoperative Knee Society Score, and range of motion. All the patients were evaluated clinically using the Knee Society Score, Knee Injury Osteoarthritis Outcome Score, and range of motion, and were also evaluated radiologically. Complication rates and length of hospital stay were compared. RESULTS: The mean follow-up period was 54 ± 4 and 54.4 ± 3.9 months in inlay PFA/UKA and TKA groups, respectively. (P = .841). No statistically significant difference was determined between the 2 groups in respect of the mean clinical scores at the final follow-up examination (P ≥ .129). Total complications were fewer and length of hospital stay was shorter in the inlay PFA/UKA group than in the TKA group (P = .037 and P = .002). There was no radiographic evidence of progression of lateral compartment osteoarthritis according to Kellgren-Lawrence in any patient in the inlay PFA/UKA group. CONCLUSION: In selected patient groups, inlay PFA/UKA is an alternative to TKA, with lower complication rates, shorter length of hospital stay, and clinical and functional results similar to those of TKA without osteoarthritis progression in the unresurfaced lateral compartment in the mid-term. LEVEL OF EVIDENCE: III.

Predatory journal preference in the field of Orthopaedics and Traumatology in Turkey.

OBJECTIVE: The aim of this study was to determine the prevalence of predatory journals in Orthopedics and Traumatology and to investigate the relationship of these publications with the regulations of scientific fields made in recent years in Turkey. METHODS: The journals and publishers between the years 2000-2018 were screened and websites visited one by one on the basis of the orthopedic journals and publishers list determined as predators or possible predators. Orthopedic publications originated from Turkey was detected in these predatory journals. Article admissions, article processing charges, editorial and referee average response times were reviewed from the websites of journals. In addition, the effect of changing associate professorship application requirements and academic incentive regulation on the preference of predatory journals was examined. RESULTS: Between 2000 and 2018 years 1626 issues which can be reached in 282 journals were examined. 4795 articles were screened in 29 journals which have articles originated from Turkey. One hundred and six (2.21%) articles which originated from Turkey was reached in these publications. Average article processing charge was $865 ($ 0-1819). Fifty-nine of 106 (55%) articles originated from Turkey were found in only 4 journal. Journals which have articles originated from Turkey were not on the Web of Science list. The response time to the articles was between 2 and 6 weeks in these journals. After the change criteria in associate professorship in 2016, 3.32 fold increase in annual average number of publications originated from Turkey have been identified in predatory journals. After the change criteria in academic incentive regulation in 2015, 4.76 fold increase in annual average number of publications originated from Turkey have been identified in predatory journals. CONCLUSION: The number of articles in predatory journals is increasing all over the world. This situation also valid in the field of Orthopaedics and Traumatology in Turkey. Authors should pay attention regarding predatory journals not only article processing charges but also very short evaluation period.

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.

Partial Capitate Shortening Osteotomy and Its Impact on Lunate Revascularization: Mid-Term Results.

BACKGROUND: Treatment of Kienböck disease is still a clinical challenge. The treatment used in each instance is decided according to stage of the disease at presentation. Good clinical and radiological results could be obtained with partial capitate shortening osteotomy. However, mid-term results of this technique and its effect on lunate revascularization are not well known. OBJECTIVES: The aim of this study was to report our results of partial capitate shortening osteotomy in the treatment of stage II and IIIA Kienböck disease. METHODS: Ten patients were enrolled in the study with a mean age of 37.7 years old (standard deviation [SD] = 9.6). Patients were evaluated clinically in terms of range of motion, DASH and VAS scores, satisfaction with the outcome, and grip/tip/palmar/key pinch strength compared to the contralateral side. Radiological evaluation consisted of Lichtman staging on plain radiographs and lunate revascularization on magnetic resonance imaging (MRI) at both preoperative and postoperative evaluations. RESULTS: The mean duration of follow-up was 55.2 (SD = 24) months. The mean DASH and VAS scores were 14.3 (SD = 6.7) and 1.5 (SD = 1.3), respectively. For patient satisfaction, the mean score was 3.6 (SD = 0.6). The Lichtman stage of 7 patients remained unchanged. Lunate revascularization was detected with MRI in 6 patients. CONCLUSIONS: Although the number of patients in the study prevents more strict conclusions, our results are promising, and the technique presented offers minimally but observable lunate revascularization and high success rates in preventing the progression of the disease.

HISTORIQUE: Le traitement de la maladie de Kienböck demeure un défi clinique. Dans chaque situation, le traitement dépend de la phase de la maladie à la consultation. On peut obtenir de bons résultats cliniques et radiologiques grâce à une ostéotomie partielle de raccourcissement du capitatum. On connaît toutefois mal les résultats à moyen terme de cette technique et ses effets sur la revascularisation de l'os semi-lunaire. OBJECTIFS: La présente étude visait à rendre compte des résultats de l'ostéotomie partielle de raccourcissement du capitatum dans le traitement de la maladie de Kienböck de stade II et IIIA. MÉTHODOLOGIE: Dix patients d'un âge moyen de 37,7 ans (ÉT 9,6) ont participé à l'étude. Les chercheurs ont évalué l'amplitude de mouvement de ces patients, leurs scores DASH et VAS, leur satisfaction envers les résultats et leur force de préhension des doigts, de la paume et de la pince sub-termino-latérale par rapport au côté controlatéral. Ils ont procédé à une évaluation radiologique préopératoire et postopératoire au moyen de la classification de Lichtman par radiographie classique et de la revascularisation de l'os semi-lunaire par imagerie par résonance magnétique (IRM). RÉSULTATS: Le suivi avait une durée moyenne de 55,2 mois (ÉT 24). Les scores DASH et VAS moyens s'élevaient à 14,3 (ÉT 6,7) et à 1,5 (ÉT 1,3), respectivement. Le score moyen de satisfaction des patients était de 3,6 (ÉT 0,6). Le stade de Lichtman de sept patients est demeuré stable. Chez 6 patients, l'IRM a révélé une revascularisation de l'os semi-lunaire. CONCLUSIONS: Même si le peu de patients à l'étude empêche les auteurs de tirer des conclusions plus rigoureuses, les résultats sont prometteurs. La technique utilisée entraîne une revascularisation de l'os semi-lunaire minime, mais observable, et empêche l'évolution de la maladie dans une grande proportion des cas.

Does inflammatory joint diseases affect the accuracy of infection biomarkers in patients with periprosthetic joint infections? A prospective comparative reliability study.

BACKGROUND: The diagnosis of periprosthetic joint infections (PJI) in patients with inflammatory joint diseases (IJD) could be challenging. Several tests used for diagnosing PJI may be inaccurate due to baseline inflammatory characteristics of such diseases. We aimed to evaluate the accuracy of several infection biomarkers, in a specific subgroup of patients with PJI and IJD. METHODS: From January 2014 to August 2017, patients with resisting pain at the relevant site, following total knee arthroplasty were evaluated prospectively. A total of 38 patients were undergone revision arthroplasty. Patients were categorized in terms of MSIS criteria: Patients with PJI (Group 1, n = 17) and patients without PJI (Group 2, n = 21). Serum ESR, CRP, Procalcitonin, synovial cell count, percentage of neutrophils in synovial fluid, synovial CRP, Lactoferrin, ELA-2, Thiol - Disulphide levels, BPI and the Alpha defensin test results were obtained. The results of two groups were compared and the diagnostic accuracy of each variable was evaluated. RESULTS: There were 22 women, 16 men with a mean age of 67.8 ± 6.9 years. The differences were significant in all evaluated biomarkers in terms of PJI (p values of all biomarker were <0.001). Alpha defensin, Lactoferrin, ELA-2, BPI, Procalcitonin and synovial CRP were the most accurate tests with area under curve >0.90. CONCLUSIONS: Our results demonstrated that IJD may not affect the accuracy of infection biomarkers in patients with PJI. Alpha defensin test, Lactoferrin, ELA-2, BPI, Procalcitonin and synovial CRP can be used in the diagnosis of PJI in patients with IJD.

Sonoelastography of the knee joint.

Magnetic resonance imaging (MRI) is generally the preferred method for assessing lesions of the knee cartilage and subchondral bone. There have been a few cartilage imaging studies using real-time elastosonography (RTE), which has increased in importance and range of use in recent years. The aim of this cadaveric study was to assess the efficacy of a new diagnostic method combining USG and RTE and also to perform intra-articular examinations together with arthroscopy. A total of 12 fresh unpaired human knees were examined. The laparoscopic ultrasound transducer was deployed using standard anteromedial and anterolateral arthroscopic portals. Iatrogenic defects were examined using mosaicplasty tools in healthy-looking areas of cartilage, and strain in those areas was measured using RTE. The median strain value of the pathological femoral cartilage region was significantly higher than that of the normal cartilage region (1.23 [0.71-2.24] vs. 0.01 [0.01-0.01], P = 0.002, respectively). Arthroscopic study of cartilage using RTE can be a guide for orthopedic surgeons and use of intra-articular probes could be universalized. Clin. Anat. 32:99-104, 2019. © 2018 Wiley Periodicals, Inc.

Fixed-bearing unicompartmental knee arthroplasty tolerates higher variance in tibial implant rotation than mobile-bearing designs.

BACKGROUND: UKA necessitates a learning period. From this point of view, it would be logical to prefer the design that tolerates suboptimal tibial rotations better, especially for inexperienced surgeons. The aim of this study was to evaluate and compare the clinical and radiological results of mobile-bearing and fix-bearing UKA designs in case of suboptimal tibial rotations. METHODS: A retrospective case-control evaluation was made of all the patients with medial compartment osteoarthritis, treated between January 2011 and January 2015. 324 patients ideal femoral rotation were enrolled in the study. 153 patients (Group 1) were treated with fix-bearing design with a mean 28.8 ± 11.3 month follow-up and 171 patients (Group 2) were treated with mobile-bearing design with a 31 ± 14.3 month follow-up. Each patient in groups was subdivided into (A): optimal tibial rotation, (B): external rotation of tibial component > 5°, (C): internal rotation of tibial component > 5° subgroups. WOMAC and KSS scores of each patient at preoperative and postoperative final control were compared between groups and subgroups. RESULTS: No significant differences were determined between the groups in terms of mean follow-up time (p = 0.0612), preoperative WOMAC, and KSS scores (p = 0.754 and p = 0.832, respectively). No significant differences were determined between subgroups 1A and 2A in terms of WOMAC and KSS scores at the final evaluation (p = 0.314 and p = 0.546, respectively). A significant difference was determined between subgroups 1B and 2B in terms of WOMAC and KSS scores (p = 0.021 and p = 0.012, respectively). In addition, the difference between subgroups 1C and 2C was significant (p = 0.047 and p = 0.034, respectively) at the final evaluation. CONCLUSION: Both mobile- and fix-bearing designs are beneficial in the treatment of medial compartment osteoarthritis of the knee. However, in case of both tibial internal or external suboptimal tibial rotations, fix-bearing design have better results compared to mobile-bearing design. STUDY DESIGN: Level III retrospective comparative clinical study.

Soft tissue reconstruction of foot and ankle defects with reverse sural fasciocutaneous flaps.

OBJECTIVE: This study presents the results of 25 consecutive patients and evaluates the success of reverse sural fasciocuteneous flap (RSFF) on coverage of the foot and ankle region. METHODS: A total of 25 patients with soft tissue defects in the lower leg, foot, or ankle were treated with RSFF, from January 2010 to January 2017. In the evaluation of patients, the form prepared by the clinic was used and the following data were collected: age, follow-up, gender, etiology, defect size, complications, and patient satisfaction rates. RESULTS: Mean follow up time was 18 months. In all patients, the defects were fully covered. Three patients developed partial necrosis due to venous congestion. There was no complete flap loss in any of the patients. Patient satisfaction was excellent in all cases. CONCLUSION: RSFF is quick, versatile, and easy to apply; it also provides safe soft tissue coverage, requires no microvascular repair, and provides an alternative to microsurgical reconstruction.

OBJETIVO: Este estudo apresenta os resultados de 25 pacientes consecutivos e avalia o sucesso do retalho fasciocutâneo sural de fluxo reverso (RFSR) na cobertura da região do pé e tornozelo. MÉTODOS: Foram analisados 25 pacientes com defeitos de partes moles na parte inferior da perna, pé ou tornozelo com RFSR, de janeiro de 2010 a janeiro de 2017. Na avaliação dos pacientes, o formulário preparado pela clínica foi utilizado e os seguintes dados foram coletados: idade, seguimento, sexo, etiologia, tamanho do defeito, complicações e grau de satisfação do paciente. RESULTADOS: O tempo médio de seguimento foi de 18 meses. Em todos os pacientes, os defeitos foram totalmente cobertos. Três pacientes desenvolveram necrose parcial devido à congestão venosa. Não houve perda total do retalho em nenhum dos pacientes. O grau de satisfação dos pacientes foi excelente em todos os casos. CONCLUSÃO: O retalho fasciocutâneo sural reverso é rápido, versátil e fácil de aplicar. Além disso, fornece uma cobertura de tecidos moles segura, não requer reparo microvascular e é uma alternativa à reconstrução microcirúrgica.

Soft tissue reconstruction of foot and ankle defects with reverse sural fasciocutaneous flaps / Reconstrução do tecido mole de defeitos do pé e do tornozelo com retalhos fasciocutâneos surais de fluxo reverso

ABSTRACT Objective This study presents the results of 25 consecutive patients and evaluates the success of reverse sural fasciocuteneous flap (RSFF) on coverage of the foot and ankle region. Methods A total of 25 patients with soft tissue defects in the lower leg, foot, or ankle were treated with RSFF, from January 2010 to January 2017. In the evaluation of patients, the form prepared by the clinic was used and the following data were collected: age, follow-up, gender, etiology, defect size, complications, and patient satisfaction rates. Results Mean follow up time was 18 months. In all patients, the defects were fully covered. Three patients developed partial necrosis due to venous congestion. There was no complete flap loss in any of the patients. Patient satisfaction was excellent in all cases. Conclusion RSFF is quick, versatile, and easy to apply; it also provides safe soft tissue coverage, requires no microvascular repair, and provides an alternative to microsurgical reconstruction.

RESUMO Objetivo Este estudo apresenta os resultados de 25 pacientes consecutivos e avalia o sucesso do retalho fasciocutâneo sural de fluxo reverso (RFSR) na cobertura da região do pé e tornozelo. Métodos Foram analisados 25 pacientes com defeitos de partes moles na parte inferior da perna, pé ou tornozelo com RFSR, de janeiro de 2010 a janeiro de 2017. Na avaliação dos pacientes, o formulário preparado pela clínica foi usado e os seguintes dados foram coletados: idade, seguimento, sexo, etiologia, tamanho do defeito, complicações e grau de satisfação do paciente. Resultados O tempo médio de seguimento foi de 18 meses. Em todos os pacientes os defeitos foram totalmente cobertos. Três pacientes desenvolveram necrose parcial devido à congestão venosa. Não houve perda total do retalho. O grau de satisfação dos pacientes foi excelente em todos os casos. Conclusão O retalho fasciocutâneo sural reverso é rápido, versátil e fácil de aplicar. Além disso, fornece uma cobertura de tecidos moles segura, não requer reparo microvascular e é uma opção à reconstrução microcirúrgica.

Lunate excision with capitohamate fusion in the treatment of stage IIIB and IIIC Kienböck's disease.

OBJECTIVE: The aim of this study was to report our results of lunate excision combined with capitohamate fusion in the treatment of Kienböck's stage IIIB/IIIC disease. METHODS: A total of 7 patients with a mean age 35.2 (SD 11.5) years were enrolled in the study. Pain was the principal reason for surgery. All operations were carried out by the same senior surgeon. Patients were evaluated in terms of range of motion, DASH and VAS scores, satisfaction, and grip/tip/palmar/key pinch strength compared with contralateral sides. Preoperative carpal height indexes and findings of osteoarthritis were determined radiographically and compared with postoperative evaluations. RESULTS: Mean duration of follow up was 15.2 months. Mean DASH and VAS scores were 13.8 2.7 and 2 1.1 respectively. The mean patient satisfaction score was 3.2 0.4 over 4 points. The mean grip strength in the operated hands was 66.4%, palmar pinch was 75.1%, tip pinch was 71.8% and key pinch was 70.4% when compared to the contralateral unaffected sides. The mean flexion range in the operated hands was 58.8%, extension range was 60.3%, radial deviation range was 65.2% and ulnar deviation range was 65.7% when compared to the contralateral sides. There was no significant difference between preoperative and postoperative carpal height ratios (p = 0.086). CONCLUSIONS: Our early term results indicate that lunate excision combined with capitohamate fusion may be an alternative treatment option in patients with stage IIIB and IIIC Kienböck's disease. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Inter- and intra-tester reliability of sensibility testing in healthy individuals.

Static two-point discrimination (S2PD) and Semmes-Weinstein monofilament (SWM) tests are the most widely used tests for evaluation of sensory deterioration. It is a necessity to know the inter- and intra-tester reliability of these tests to determine the suitability of method. Another important point in evaluation of sensory deterioration is whether or not there is a reference point which can be compared with the test results. So, it is important to know the reliability of sensory evaluation tests on the healthy extremities. The aim of this study was to evaluate the inter- and intra-tester reliability of the S2PD and SWM tests applied to the fingers of healthy individuals. One hundred and sixty three healthy fingers from 83 individuals were included into the study. An experienced orthopaedic surgeon and a physiotherapist examined all the individuals separately. The reliability of the S2PD test was found to be little and low. The reliability of the SWM test was determined as low and moderate. The reproducibility scores of both tests were at a poor level. Therefore, in the evaluation of states with sensory deterioration, the use of the healthy contralateral extremities as a standard reference point could be considered unreliable. Prognosis, grading or follow-up of treatment should not be made according to the results of the S2PD and SWM tests only. It would be more correct to use these tests as a diagnostic tool rather than quantitative follow-up for neurological function in pathological conditions.

Good clinical results can be obtained along with reduced risk of tunnel communication with a new technique in concomitant meniscus transplantation and ACL reconstruction.

PURPOSE: The purpose of this study was to introduce our technical modification for concomitant meniscus transplantation and ACL reconstruction with preliminary results of our cases. METHODS: The current study comprised of two sections: first is the cadaveric study of 20 specimens. The distances between tunnel entry and exit points of tunnels for 27 meniscal transplants and ACL reconstruction in CT slices were measured. The second section was evaluation of our cases including six patients. The selected patients were scored preoperatively and post-operatively with KOOS, Lysholm and VAS Scoring systems, joint ROM and stability. RESULTS: In cadaveric study section, the minimum distance between tunnels was found 1.9 ± 0.4 cm on tibia plateau and 1.8 ± 0.9 cm on tibial crest. No overlapping or communication of the tunnels was seen on any CT slice. In case series section, the mean age of patients was 36 ± 12.7 years and mean follow-up period was 30.8 ± 11.3 months. The KOOS total, VAS and Lysholm scores of the patients were significantly increased (p = 0.012, 0.036 and 0.001, respectively). The stability of operated knees was normal or near normal. CONCLUSION: The results of this study have demonstrated that our technical modification seems to be an effective method in concomitant medial meniscus transplantation and ACL reconstruction. There is a reduced risk of tunnel communication, and the medial bone stock is protected so the risk of potential fracture in the medial tibia plateau and revision rates may be reduced. Although it seems successful in respect of the short-term results, further studies with a greater number of patients would provide clearer results.

Primary repair of Achilles tendon avulsions: Presentation of a novel technique and its comparison with suture anchor repair.

PURPOSE: We aimed to present our novel technique in the surgical treatment of Achilles tendon avulsions and compare the clinical results of such technique with the repair method using suture anchors. METHODS: A retrospective study was made of patients with Achilles tendon sleeve avulsion and patients where distal portion of the tear prohibited primary repair, surgically treated between January 2009 and January 2013. Twenty-one patients who met the criteria were examined and called for final examination: 9 patients were treated with the novel technique (group 1) and 12 patients were treated with suture anchor repair (group 2). Data were gathered from patient registry and final evaluation. The patients of both groups were compared in respect of mean age, follow-up, gender and AOFAS and VAS scores at final evaluation. RESULTS: There was no significant difference between two groups in terms of follow-up period ( p = 0.478) and mean age ( p = 0.274). Three of 9 patients in group 1 and 4 of 12 patients in group 2 were female. A significant clinical difference was determined between two groups according to the AOFAS and VAS scores ( p = 0.034 and p = 0.043, respectively). CONCLUSIONS: Both techniques are beneficial in the treatment of avulsion injuries of Achilles tendon. Better clinical results can be obtained with the presented novel technique and such technique can be considered for the surgical fixation of Achilles tendon avulsions.

Tibial Base Plate for Total Knee Arthroplasty: Symmetric or Asymmetric?

BACKGROUND: Ideal positioning and best coverage of the tibial base plate are essential in total knee arthroplasty. There are 2 types of tibial base plates: symmetric and asymmetric. The superiority of one to the other is still controversial. The aim of this study was to compare symmetric and asymmetric tibial base plates for total knee arthroplasty in terms of rotational alignment and coverage. METHODS: The study was conducted on a total of 80 cadaveric tibial bones. Two surgeons were asked to place 20 symmetric (group 1) and 20 asymmetric (group 2) tibial base plates taking care to ensure the best coverage that they were able to determine. Afterwards, the rotational errors and coverage were assessed with reference to the posterior tibial margin and posterior condylar axis on the three-dimensional computed tomography (3D CT) scan. In the second part of the study, the surgeons were asked to place 20 symmetric (group 3) and 20 asymmetric (group 4) base plates taking care to ensure the best rotational alignment. The rotational errors and the areas uncovered or overstuffed after the application were measured on the 3D CT scan. RESULTS: On the comparison of rotational errors, while there was no significant difference between group 1 and group 2 in terms of coverage (p = 0.624), the mean external rotation error was significantly greater in group 2 (p = 0.034). On the comparison of coverage, while there was no significant difference between group 3 and group 4 in terms of rotation (p = 0.36), the mean ratios of the uncovered tibial surface to the total tibial surface (p = 0.041) and also the overstuffed area to the total base plate surface (p = 0.029) were significantly greater in group 4. CONCLUSIONS: The determination of correct size and rotation of the tibial component is essential for favorable outcomes of total knee arthroplasty. In this study, the symmetric tibial base plate design was more effective than the asymmetric design in providing the ideal tibial rotation and coverage.

Arthroscopic treatment of osteochondral lesions of the talus: Nanofracture versus hyaluronic acid-based cell-free scaffold with concentration of autologous bone marrow aspirate.

PURPOSE: We aimed to evaluate the early clinical and radiological outcomes of arthroscopic one-stage treatment with hyaluronic acid-based cell-free scaffold (HACS) in combination with a concentration of autologous bone marrow aspirate (CBMA) technique compared to nanofracture (NF). METHODS: A retrospective evaluation was made of all the patients with focal osteochondral lesions of the talus that were treated between January 2012 and January 2015. Ninety-eight patients met the criteria and were enrolled in the study. Forty-six patients (group 1) were treated with arthroscopic one-stage treatment with CBMA in combination with an HACS. Fifty-two patients (group 2) were treated with NF. Patient demographics and cartilage defect characteristics, the AOFAS and VAS scoring systems were compared between groups. In the evaluation of cartilage repair tissue, the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used. RESULTS: No significant differences were determined between the two groups in terms of age ( p = 0.874), body mass index ( p = 0.621), defect size ( p = 0.485), defect depth ( p = 0.674), follow-up time ( p = 0.512). A significant clinical difference was determined between the two groups according to the AOFAS and VAS scores ( p = 0.028, p = 0.046, respectively). The mean MOCART score of group 1 was significantly higher ( p = 0.041). CONCLUSIONS: Both NF and HACS with CBMA techniques are beneficial in treatment of osteochondral lesions of the talus. Better clinical and radiological results, in addition to higher cartilage quality, could be obtained with HACS with CBMA technique compared to NF.

Results of endoscopically-assisted cubital tunnel release without using any specific instrument.

BACKGROUND: We aimed to report the clinical and electrophysiological results of patients who were treated with an endoscopically assisted in situ release technique for cubital tunnel syndrome and to show safety and efficacy of this procedure. MATERIALS AND METHODS: Twenty nine patients were included into the study. 13 patients (44.8%) were female, 16 patients (55.2%) were male. The mean age was 44.4 years (range; 22-66 years). Mean follow up period was 16.0 months (range; 7-42 months). We used Dellon classification for preoperative staging, and modified Bishop rating system for the evaluation of postoperative clinical results. Dynamometric and electromyographic measurements were obtained preoperatively and at final control. RESULTS: Preoperative Dellon's classification revealed 3 patients grade 1, 14 grade 2, and 12 grade 3. Modified Bishop score was very good for 21 patients (72.4%), good for 4 patients (13.8%), fair for 3 patient (10.3%), and poor for 1 patient (3.4%). At final control; the mean proportion of grip power and pinch strength of the affected hand to the contralateral normal hand was improved, and also nerve conduction velocity were improved in all patients. As complication, hematoma formation developed in two cases. CONCLUSION: Our study showed that endoscopically assisted decompression technique without using any special instruments can be performed successfully with a low complication rate. It is a safe and effective method in the treatment of cubital tunnel syndrome. LEVEL OF EVIDENCE: Level IV, Therapeutic study.