Does the Sleeper Plate Application for Temporary Epiphysiodesis Make Life Easier or Complicated? Increased Risk of Tethering.

BACKGROUND: The present study aims to investigate the frequency of recurrence and tethering effect after only metaphyseal screw removal (sleeper plate technique) compared with the conventional complete plate removal in the treatment of lower extremity deformities with guided growth surgery. METHODS: Seventy-two patients (107 limbs) treated by an 8-plate hemiepiphysiodesis technique around the knee joint were evaluated. After the desired correction, only metaphyseal screw was removed (sleeper plate group) in 35 limbs (25 patients), whereas both screws and plate were removed (plate removal group) in 72 limbs (47 patients). An increase of 5 degrees or more in joint orientation angles in the direction of the initial deformity was considered as recurrence. The rate of rebound, tethering, and maintenance of correction in groups was analyzed at the latest follow-up (mean of 49 mo). RESULTS: The mean age of the patients was 97 months (range: 80 to 129 mo) at the time of index surgery. After a mean of 49 months (range: 16 to 86), 17 (48.5%) limbs maintained the desired stable correction in the sleeper plate group compared with 59 stable limbs (72.2%) in the plate removal group ( P <0.001). There was no statistically significant difference regarding recurrence between the sleeper plate group and the plate removal group (34.3% vs. 27.8%, respectively) ( P =0.216). Reinsertion of the metaphyseal screw was possible 8/12 limbs, and the remaining 4 limbs underwent further surgeries. There were 6 limbs (17.3%) of tethering in the sleeper plate group, and 4/6 limbs required further corrective surgeries. The remaining 2 limbs with slight tethering did not require further surgeries. CONCLUSIONS: Removing only metaphyseal screw increases the risk of tethering. In addition, reinsertion of the screw may not be possible in all cases due to bony growth, and further corrective surgeries may be necessary. Close follow-up is required if the sleeper plate technique is to be applied. LEVEL OF EVIDENCE: Level III.

Recovery of the shoulder kinematics after reverse shoulder arthroplasty.

BACKGROUND: There is very limited information about the changes in shoulder kinematics in patients with reverse shoulder arthroplasty. The aim of the study was to investigate the changes in the scapulohumeral rhythm and shoulder kinematics over time after the reverse shoulder procedure. METHODS: Nineteen patients with reverse shoulder arthroplasty (age: 65.8 ± 10.3 years) were included to the study. During arm elevation in the sagittal and scapular planes, operated shoulder kinematics (humerothoracic elevation, glenohumeral elevation, scapulohumeral rhythm, and scapular rotations) were assessed using an electromagnetic tracking system at the postoperative 3rd, 6th, and 18th months. Asymptomatic shoulder kinematics were also assessed at the postoperative 18th month. Shoulder function was assessed using The Disabilities of the Arm Shoulder and Hand score at the postoperative 3rd, 6th, and 18th months. FINDINGS: Maximum humerothoracic elevation increased from 98° to 109° over the postoperative period (p = 0.01). The scapulohumeral rhythm was similar on the operated and asymptomatic shoulders at the final follow-up (p = 0.11). Both the operated and asymptomatic shoulder demonstrated similar scapular kinematics at the postoperative 18th month (p > 0.05). The Disabilities of the Arm Shoulder and Hand score decreased over time in the postoperative period (p < 0.05). INTERPRETATION: Shoulder kinematics may be improved after reverse shoulder arthroplasty in the postoperative period. Focusing on scapular stabilization and deltoid muscle control in the postoperative rehabilitation program may enhance the shoulder kinematics and upper extremity function.

The Fate of Overcorrection After Hemiepiphysiodesis in Valgus Deformities Around the Knee.

BACKGROUND: Tension band plating is widely used in the surgical treatment of coronal plane deformities around the knee. The rebound phenomenon after implant removal is a common complication of this technique. Overcorrection of joint orientation angles is a method to minimize the effect of the rebound phenomenon. This study aims to investigate the natural course of overcorrected joint orientation angles after plate removal in patients with genu valgum deformity. METHODS: Patients who underwent hemiepiphysiodesis with tension band plating due to genu valgum deformity between 2010 and 2019 were retrospectively analyzed. Mechanical lateral distal femoral angles (mLDFA) and mechanical medial proximal tibial angles were calculated before plate application, before implant removal, and at the last follow-up. At the implant removal, mLDFA>90 degrees and mechanical medial proximal tibial angles <85 degrees were accepted as overcorrected. RESULTS: Seventy-two segments from 45 patients were included. For femoral valgus deformities (n=59), the mean mLDFAs at index surgery, implant removal, and the last follow-up were 79.8±3.9 degrees, 95.5±3.7 degrees, and 87.3±5.1 degrees, respectively. In the more and less than 10 degrees rebound groups, the median age of patients at index surgery were 66 and 101 months ( P =0.04), the mLDFA during implant removal were 97.8 degrees and 94.4 degrees ( P =0.005), and the mean amount of correction in mLDFA was 17 degrees and 13 degrees ( P =0.001), respectively. At the last follow-up, joint orientation angles were found to be still overcorrected in 16 (22%), within normal limits in 36 (50%), and undercorrected in 20 (28%) segments. Ten (13%) segments required additional surgery due to residual deformity. CONCLUSIONS: Overcorrection with tension band plating is an effective modality in the treatment of genu valgum deformity. Rebound after plate removal increases as the age at index surgery decreases and the amount of conscious overcorrection increases. Most segments return to normal joint orientation angle limits after overcorrection. We recommend a mean of 5 degrees routine overcorrection in patients with genu valgum deformity to overcome the rebound phenomenon and to make future interventions easier if ever needed. LEVEL OF EVIDENCE: Level III.

Outcomes of Limb Lengthening With Computer-assisted Hexapod External Fixators in the Treatment of Fibular Hemimelia.

BACKGROUND: Fibular hemimelia (FH) represents the most common deficiency of the long bones and is associated with multiple deformities. Reconstructive treatment with external fixators in FH restores normal lower extremity alignment and length with plantigrade feet for a balanced and effective gait. The aim of this study is to evaluate the outcomes of lower limb lengthening and simultaneous tri-plane deformity correction with a computer-assisted hexagonal external fixator in children with FH. METHODS: A retrospective review was performed for FH cases treated with a computer-assisted hexagonal external fixator in a tertiary referral center. Leg length discrepancy (LLD), interphyseal angles, tibiocalcaneal distances, healing index (HI), and callus shapes were analyzed for radiologic evaluation, and the Pediatric Quality of Life Inventory (PedsQL) was used for functional assessment. Limbs with HI <50 days/cm, PedsQL >75, and without regenerate fractures were considered successful lengthenings. RESULTS: Twenty-four limbs of 23 patients were included. The limbs were lengthened for a mean of 7.24 cm (range, 4.7 to 15.6). The initial LLD of 5.6 cm (range, 0.5 to 19 cm) increased to 1.7 cm (range, 0.1 to 6 cm), and the mean interphyseal angle was 12.7 degree (range, 1.5 to 54.2 degree), tibiocalcaneal distance was 0.85 cm (range, 0.1 to 1.7) at final follow-up. The most common regenerated bone morphology was cylindrical, as seen in 11 limbs (45.8%). The average PedsQL score was 83.5 (range, 69.5 to 96.7). Sixteen limbs (66.7%) had successful lengthening at their first, and 4 limbs (80%) had successful lengthening at their second surgeries. Seven limbs had complications requiring surgical intervention (29.1%), with 3 (12.5%) regenerate fractures after external fixators removal. CONCLUSIONS: Limb reconstruction with computer-assisted hexapod fixators is a successful and reliable option for the treatment of LLD in FH, and patients demonstrate good functional outcomes. Surgeons should be aware of potential complications and should utilize prophylactic measures when necessary. LEVELS OF EVIDENCE: Level III, retrospective comparative study.

Axillary Artery Transection and Brachial Plexus Injury After Open Inferior Glenohumeral Dislocation: A Case Report.

CASE: A judo athlete presented with an open inferior shoulder dislocation that occurred during competition. Examination revealed a transection of the axillary artery and neuropraxia of the posterior cord. Neuropraxia was resolved within 2 weeks. The axillary artery was repaired with a femoral vein graft. He regained full strength, range of motion, and function at 8 months. CONCLUSION: Inferior glenohumeral dislocations are rare, and their management can be complicated by vascular and neurological injuries. We emphasize the importance of examination, diagnosis, and treatment of neurovascular pathologies to avoid catastrophic outcomes.

Joint awareness after fixed and mobile-bearing total knee arthroplasty with minimum 12 years of follow-up: A propensity matched-pair analysis.

BACKGROUND: Many comparative articles studied mobile-bearing (MB) and fixed-bearing (FB) total knee arthroplasties (TKAs). Meta-analyses found no difference in survival or biomechanical outcome. This study aimed to compare long-term clinical results between fixed-bearing (FB) and mobile-bearing (MB) total knee arthroplasty (TKA) as well as patients' adaptation to their artificial joints. METHOD: TKAs performed with the same surgical protocol divided into categories according to the insert design preferred. 70 MB design TKAs were compared with 70 FB design TKAs utilizing propensity matching for parameters; gender, age, body mass index, coronal plane deformity, range of motion (ROM) and appropriateness criteria. Forgotten Joint Score-12 (FJS-12) was used to assess patients' ability to forget their artificial joints in daily life. RESULTS: Patients had a mean follow-up of 15.6 (±2.2) years. No difference was observed between groups for post-operative ROM, WOMAC, Knee Society Knee and Function Scores. The FJS-12 in the MB and FB groups were 66.1 and 72.8, respectively (P = 0.026). There was no significant difference in survival between both designs. CONCLUSION: This study suggests that in TKA, joint awareness is higher in MB compared to FB design. FJS-12 appears to be a sensitive measuring tool when comparing two designs and should be implemented in long-term follow-up.

Reliability and validity of the Turkish version of the Kyphosis specific spinal appearance questionnaire in adolescents with moderate hyperkyphosis.

BACKGROUND: Hyperkyphosis cause poor posture, self-image, clinical or cosmetic deformity and well-being. Therefore, it is important to evaluate patients' perception of appearance in the rehabilitation process of individuals with hyperkyphosis. Recently Kyphosis Specific Spinal Appearance Questionnaire (KSAQ) has been developed for the assessment of appearance in hyperkyphosis patients. OBJECTIVE: To test validity and reliability of the Turkish version of the KSAQ. METHODS: Sixty-two patients with hyperkyphosis (curve above 50º), ranging in age between 12 and 22 years, was included in this study. Turkish translation/back-translation of the KSAQ was done by an expert committee. Internal consistency was analyzed using Cronbach's alpha. Validity was assessed by correlating the KSAQ with the Scoliosis Research Society-22 (SRS-22) Questionnaire. Its reliability was assessed using the test-retest method with two-week interval (Pearson's correlation coefficient) on 44 of these patients. RESULTS: Mean kyphosis angle was 60º ± 8.9º. KSAQ total scores showed excellent internal consistency (Cronbach's α = 0.944) and test-retest reliability (ICC = 0.890). Moderate to strong associations were found between KSAQ total score, each item scores and self-image domain of SRS-22 (r -0.299 to -0.730, p < 0.05). KSAQ total score had moderate correlation with SRS-22 total score (r 0.423, p 0.001). Overall, the KSAQ scale showed good validity. CONCLUSION: The Turkish version of the KSAQ is a reliable and valid patient reported outcome measure of kyphosis-specific aspects of appearance in patients with moderate hyperkyphosis.

Comparison of surgical treatment options in periprosthetic shoulder infections: a systematic review from 2016 to 2022.

Background: Periprosthetic shoulder infection (PSI) management proves to be challenging because of patient morbidity, poor outcomes and need for reoperations. Different surgical treatment methods have been defined; however, a prominent method could not be determined. This systematic review investigated the most recent articles about various treatment modalities used in the surgical treatment of PSI to find the most effective method in terms of infection clearance and function. Methods: The keywords were searched using PubMed (MEDLINE), ScienceDirect (Elsevier), and Google Scholar databases on September 30, 2022. Studies which report on operative treatment and have longer than 2-year follow-up were included in this review. Of the 555 studies in total, 16 were reviewed. The absence of symptomatic persistent infection (PI) during follow-up was regarded as a satisfactory outcome. Functional outcomes were analyzed according to the reported mean pooled Constant and Murley Score (CMS) and shoulder forward elevation degree (FE) for each treatment group. Results: A total of 339 patients (139 female, 197 male) with 342 shoulders from sixteen studies were included. The mean age of the patients was 67.5±3.8 years, mean follow-up duration was 53.3±19.5 months. In total, 217 shoulders were treated with two-stage revision, 59 were treated with one-stage revision, 37 were treated with definitive spacer, 23 were treated with debridement, antibiotics, and implant retention (DAIR), and 6 were treated with resection arthroplasty. The PI rate in whole treatment groups was 9.9%. The PI rate was significantly highest in the DAIR group (30.4%, P=0.001), while there was no significant difference between other treatment groups (P=0.23). CMS and FE were available for 156 and 190 shoulders, respectively. CMS was highest in the one-stage revision group (63.4±5.9, P=0.001), and FE was highest in the DAIR group (119.3°±28.5°, P=0.001). Conclusions: The revision surgeries (one-stage and two-stage revision) were more effective than the non-revision surgeries in functional outcomes. In terms of infection clearance, revision procedures were more successful. Surgeons should prefer revision methods over non-revision procedures when feasible.

Osseous Ilio-Trochanteric Bars as an Etiology of Hip Contracture in a Child with Congenital Contractures: A Case Report.

CASE: A 5-month-old female patient presented with bilateral lower-limb deformities. Hips were fixed at 100° abduction, 15° flexion and 45° external rotation, flexion contracture in the knees, and bilateral teratologic equinovarus deformities. Radiographs revealed ilio-trochanteric osseous bars as the etiology of hip contractures. Staged surgeries were undertaken. At 4 years of age, she could stand upright with orthoses and sit without support. CONCLUSION: This is the first study to report bilateral congenital ilio-trochanteric osseous bars, which were resected without recurrence. Even with a very low potential of walking, release of the contractures allows for better function and possible wheelchair-dependent mobility in the future.