Treatment of Recalcitrant Isolated Congenital Fibular Pseudarthrosis: Fibular Segment Transfer and Tibiofibular Synostosis with Unilateral External Fixator.

Isolated congenital pseudarthrosis of the fibula is a rare entity with a limited number of cases reported in the literature. Treatment is challenging because of recalcitrant nonunion and because no consensus about the best treatment plan exists. We report a case of isolated congenital fibular pseudarthrosis with valgus deformity of the ankle. The patient had a history of two failed operations. We used a novel surgical plan that combined tibiofibular synostosis with fibular segment transfer through a unilateral external fixator. The patient showed good early results with fibular union. We advocate the combination of tibiofibular synostosis and fibular segment transfer to restore the integrity and stability of the ankle in recalcitrant isolated congenital fibular pseudarthrosis cases with a history of failed surgery.

Femoral Head Perforation After Primary Hip Arthroplasty: Unseen Complication of Ceramic-on-Ceramic Interface: A Case Report.

CASE: A 33-year-old woman, who underwent bilateral ceramic-on-ceramic total hip arthroplasty 3 years previously, presented with right groin pain and mechanical grinding without a history of trauma. Radiographs revealed luxation of the femoral head, and computerized tomography showed perforation of the ceramic femoral head. The patient underwent revision with a metal-on-polyethylene articulation and retained femoral stem. Two years of follow-up yielded good clinical outcome with no evidence of osteolysis or polyethylene wear. CONCLUSION: The perforation of a ceramic femoral head should be kept in mind as one of the possible implant failure mechanisms after primary hip arthroplasty.

Early Disassembly of Femoral Head and Neck Components After Total Hip Arthroplasty Revision.

Modular femoral and acetabular components are frequently used in hip arthroplasty. Although the use of modular components offers many advantages, the increased number of components leads to a high risk of disassembly. Disassociation of the femoral head and neck is a rarely reported complication in the literature. This case report depicts a patient with non-traumatic early disassociation of the femoral head and neck components following total hip revision arthroplasty. Femoral head-neck disassembly in early postoperative period may occur due to manufacturing error or insufficient impaction. If sufficient impaction is thought to be achieved, manufacturing errors should be kept in mind as potential underlying reasons for femoral head-neck dissociation.

Dome-shaped high tibial osteotomy with semi-circular Ilizarov pin fixator: Mid- to long-term results of a novel technique.

BACKGROUND: The aim of this study was to assess the clinical and radiological results of the dome-shaped high tibial osteotomy (HTO) which was fixed with a novel construct comprised of semi-circular Ilizarov frames and pins. METHODS: The patients with at least five years of follow-up were evaluated. One-hundred and thirty-two knees of 114 patients were included in the final analysis. The clinical evaluation included range of motion and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Anatomical femorotibial angle (aFTA), anatomical medial proximal tibial angle (aMPTA), tibial slope and Insall-Salvati ratio were calculated on standard weight-bearing radiographs. RESULTS: The average aFTA was improved from 1.6° varus to 8.7° valgus (P < 0.001). The average WOMAC score (P < 0.001) and flexion value (P = 0.014) were improved at the latest follow-up (WOMAC: 17.2, flexion: 142.5) compared with the preoperative period (WOMAC: 59.6, flexion: 129.2). The sagittal radiological parameters were not significantly affected. The five-year survival was 96.2%, and 10-year survival was 83.3%. CONCLUSIONS: The semi-circular Ilizarov pin construct provided satisfactory outcomes both clinically and radiologically at mid- to long-term follow-up.

Comparison of Trochanteric Slide and Subtrochanteric Shortening Osteotomy in the Treatment of Severe Hip Dysplasia: Mid-Term Clinical Outcomes of Cementless Total Hip Arthroplasty.

BACKGROUND: The aim of this study is to compare clinical results of Crowe type III-IV developmental dysplasia of the hip (DDH) patients who underwent total hip arthroplasty with either trochanteric slide osteotomy (TSO) or subtrochanteric shortening osteotomy (SSO). METHODS: The patients who underwent cementless total hip arthroplasty with femoral shortening osteotomy due to Crowe type III/IV DDH between 2004 and 2014 and completed at least 5 years of follow-up were retrospectively analyzed. The patients were grouped according to the type of shortening osteotomy as either TSO or SSO. Preoperative and postoperative clinical evaluation included Harris Hip Score, Visual Analogue Scale pain, leg length discrepancy, and the presence of Trendelenburg sign. The clinical outcome measures and complication rates were compared in terms of osteotomy type. RESULTS: The TSO group consisted of 34 patients (43 hips) and the SSO group consisted of 40 patients (51 hips). The SSO group (96.1%) had a slightly higher 5-year survival of the implant compared to TSO (93%) without statistical significance (P = .18). No significant difference was detected between the groups in terms of clinical outcomes. Complication rates did not significantly differ between the groups except for the lack of bony union which was significantly higher in TSO (P = .006) but this difference did not transform into clinical significance since 5 of 6 patients who did not have a bony union in the TSO group were symptom-free with a fibrous union. CONCLUSION: TSO and SSO provide similar clinical outcomes at mid-term follow-up in the management of Crowe III-IV DDH by cementless total hip arthroplasty. Both techniques can be used safely depending on the surgeon's preference. LEVEL OF EVIDENCE: Level III, Therapeutic, Case-control study.

Medial Migration of a Broken Trochanteric Cable.

BACKGROUND: Cerclage wires or cables are commonly being used in hip reconstruction procedures like primary (especially in patients with developmental hip dysplasia) or revision arthroplasty. Local or distant migration of a broken cable or wire is a complication that might lead to devastating situations depending on the route of migration. CASE PRESENTATION: We report a case of a 40-year-old female who underwent bilateral total hip arthroplasty surgery due to bilateral developmental hip dysplasia. Trochanteric osteotomy was needed in her right hip to advance trochanter major distally. Trochanteric fixation was achieved by a cerclage cable system. Four years after the surgery, the patient referred to the hospital with a prominence and pain in her right inguinal area. Radiographies revealed medial migration of a broken trochanteric cable part. The possible route of the cable was through medial adductor muscles, posterior to the femoral neurovascular bundle and anterior to the sciatic nerve. Both migrated and remaining parts of the cable were extracted under general anesthesia. CONCLUSION: Broken cables should be followed carefully due to their sharpness and possible serious complications secondary to distant migration. Extraction might be inevitable in case of a close relation with neurovascular structures.

[The treatment of displaced supracondylar fractures of the humerus in children (an evaluation of three different treatment methods)]. / Cocuk deplase suprakondiler humerus kiriklarinin tedavisi (üç farkli tedavi yönteminin incelenmesi).

BACKGROUND: Supracondylar fractures of the humerus are the most common fracture pattern of the elbow in childhood. They require close follow-up subsequent to successful treatment, because of having a great risk of many complications. Many treatment methods have been described for the treatment of displaced supracondylar fractures of the humerus, however it has not been reached a consensus for the choice of the treatment. The purpose of this study is to investigate the late results of three different treatment methods; closed reduction+cast immobilization, skeletal traction+cast immobilization and open reduction+internal fixation by K-wires. We also aimed to compare these methods with the results of current literature. METHODS: Fifty-three (41 boys and 12 girls) displaced supracondylar humerus fractures were treated between January 1986 and March 1999. The average age was 8.0 years. We evaluated the results of patients according to Flynn's criterias. RESULTS: According to the results of the study, we obtained 31 excellent, 9 good, 5 fair and 8 poor results. The ratio of poor results of closed reduction+cast immobilization, skeletal traction+cast immobilization and open reduction+internal fixation by K-wires were 28.6%, 14.3% and 12.8%, respectively. CONCLUSION: The datas in our study show that closed reduction+cast immobilization results in the most poorest outcome in the treatment of displaced supracondylar humerus fractures.

[Comparison of autograft, coralline graft, and xenograft in promoting posterior spinal fusion]. / Posterior spinal füzyon olusturmada otogreft, koral greft ve ksenogreft etkinliklerinin karsilastirilmasi.

OBJECTIVES: Bone grafting constitutes a vital component in many reconstructive orthopaedic surgical procedures. They are widely used in patients undergoing thoracolumbar spinal surgery. The three choices of bone are autograft, coralline graft, and xenograft. The purpose of this study was to evaluate the contribution of autograft, coralline graft, and xenograft to spinal fusion. METHODS: Thirty-six New Zealand albino rabbits were divided into four groups of equal size. Decortication of posterior structures of the thoracal 10-12th vertebrae was performed in all rabbits. No graft material was used in group I (controls). The remaining three groups received autologous iliac crest bone graft, coralline graft, and xenograft dehydrated by solvents, respectively. The rabbits were sacrificed eight weeks postoperatively for manual, radiologic, histologic, and biomechanical evaluations. RESULTS: Manual and radiologic evaluations showed no fusion in the control group in which the lowest histologic and biomechanical scores were obtained. Manually and radiologically, fusion was found in 85.7% and in 78.5% with autologous iliac crest bone graft; in 61.1% and 61.1% with coralline graft, and in 55.5% and 50.0% with xenograft, respectively. CONCLUSION: Our data substantiates the use of coralline graft and xenograft as appropriate and efficient materials alternative to autografts in obtaining posterior spinal fusion.