Minimial clinically important difference values in distal metaphyseal ulnar shortening for ulnar impaction syndrome and assessment of the relationship between level of the osteotomy and bone union time.

OBJECTIVE: We aimed to define minimal clinically important difference (MCID) values of patient-reported outcome measures (PROMs) for distal metaphyseal ulnar shortening and to assess the relationship between level of the osteotomy and time to bone union. METHODS: 20 patients who had distal metaphyseal ulnar shortening osteotomies due to ulnar impaction syndrome and had at least 6 months of follow-ups were included in this study. The mean follow-up period was 12.3 ± 7.01 months. The PROMs which consisted of patient-rated wrist evaluation (PRWE) and quick disabilities of arm, shoulder, and hand (QDASH) were recorded on the day before the surgery and at follow-up assessments. Grip strength and range of motion were recorded for operated and contralateral wrists at postoperative assessments. Postoperative radiological evaluations of distance of the osteotomy from the distal ulnar articular surface (osteotomy level), the union of osteotomy site; preoperative and postoperative evaluations of styloid-triquetral distance, and ulnar variance were performed using AP wrist x-rays. The MCID values for PRWE and QDASH were calculated using ROC curve analysis. RESULTS: Mean PRWE and QDASH scores decreased statistically significantly. The mean grip strength of contralateral wrists was higher. Mean ulnar variance decreased, whereas styloid-triquetral distance increased postoperatively. Patients with osteotomy levels of greater than 13.7 mm had a longer time from surgery to bone union. Furthermore, patients with time from surgery to bone union shorter than 7 weeks had an osteotomy closer to the ulnar articular surface. The MCID values for PRWE and QDASH were analyzed and calculated through the ROC curve as 22.25 and 20.45, respectively. CONCLUSION: This study has shown us that the osteotomy level affects the time to bone union and an osteotomy closer than 13.7 mm to the ulnar articular surface seems to result in shorter union time. Furthermore, MCID values were defined for PRWE and QDASH as 22.25 and 20.45, respectively. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

A Novel Plate for Vertical Shear Fractures of Medial Malleolus: A Biomechanical Study.

BACKGROUND: This study aims to evaluate and compare stiffness and the load to failure values of our novel medial malleolus compression plate (MP) and 3,5mm 1/3 tubular plate (TP) in the treatment of vertical shear fractures of medial malleolar fractures. METHODS: Fourteen identical synthetic third generation composite polyurethane bone models of right distal tibia were randomly separated into two groups. Fracture models were created with a custom-made osteotomy guide to provide the same fracture characteristics in every sample (AO OTA type 44A2). Fractures were reduced and novel medial malleolus compression plate was applied to bone models in MP group and tubular plate was applied to TP group. All samples were evaluated biomechanically, force/displacement and the load to failure values were recorded. RESULTS: The force required to create displacement in MP group was twice of that of the TP group. There was a significant difference between two groups in all amounts of displacement (p = .006, p = .005, p = .007 and .015 for 0.5, 1.0, 1.5, and 2.0 mm, respectively). CONCLUSIONS: In the treatment of vertical shear fractures of the medial malleolus, the strength of fixation with the novel medial malleolar compression plate is biomechanically higher than the one-third semi-tubular plate.

Acute kidney injury after major orthopedic surgery: A retrospective study of frequency and related risk factors.

OBJECTIVE: This study aimed to analyze the frequency of postoperative kidney injury, the related factors, and its effect on outcomes in major orthopedic surgery cases treated in the postanesthesia intensive care unit (PACU). METHODS: Major orthopedic surgery cases treated in the PACU were included in this study retrospectively. Demographic, operation, and anesthesia characteristics, CCI, ASA risk classes, preoperative biochemistry, and hemogram results of the patients were recorded. Postoperative serum creatinine level, urine output, renal replacement therapy requirement, and hemoglobin levels were recorded. The kidney damage of the patients was evaluated with RIFLE and AKIN criteria. Postoperative complications were recorded. RESULTS: The frequency of kidney injury in the early postoperative period was 7.1%. When only arthroplasty cases were taken, the frequency was 11%. It was determined that there was a correlation between preoperative ASA, CCI, BMI, K levels, lactate levels, and postoperative kidney damage (P <0.05). It was determined that the frequency and duration of inotropic use, the frequency and duration of noninvasive mechanical ventilation, and the duration of hospitalization increased in patients with postoperative kidney damage, and the frequency of pneumonia, wound infection, atelectasis, sepsis, arrhythmia, atrial fibrillation and mortality increased in the postoperative period (P <0.05). CONCLUSION: There is a need for further studies on the relationship between ASA, CCI, BMI, K, and lactate values and postoperative kidney damage. Postoperative kidney injury is associated with prolonged hospitalization and increased morbidity and mortality. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Biomechanical Comparison of a Closed-Loop Double Endobutton to a Lag Screw in Fixation of Posterior Malleolar Fractures.

Anteroposterior (AP) lag screw, posteroanterior (PA) lag screw, or posterior buttress plate are usually performed for posterior malleolar fixation, but the biomechanically strongest technique is unclear. The aim of our study was to biomechanically compare 3 different fixation methods for posterior malleolar fractures; AP lag screw, PA lag screw, and closed-loop double endobutton. Fracture models were created using a thin blade power saw after drawing the fracture line. The resultant fracture involved 30% of the joint on the distal tibial joint surface and extends with an angulation of approximately 50 degrees using 15 tibia composite bone samples. After anatomical reduction, fixation was achieved with 3.5 mm cortical screw in PA direction and in AP direction for group PA and AP, respectively. In Group DL, fixation was achieved with a closed-loop double endobutton (double lift loop, Orthomed, Turkey). The highest compression force to generate all displacement amounts was required for the double loop group (Group DL). The strongest fixation against compression was a double loop. The PA group was the second strongest fixation, and the AP group was the biomechanically weakest among these 3 fixation techniques. The closed-loop double endobutton technique was found biomechanically superior to anterior to posterior or posterior to anterior screw fixation techniques for posterior malleolar fracture.

Scapular spine base fracture with long outside-in superior or posterior screws with reverse shoulder arthroplasty.

BACKGROUND: The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of the scapular spine in a fresh cadaveric scapular model. METHODS: Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulars to the study group (spine base fixation with a four long screws, three with both long superior and long posterior screws). RESULTS: The failure load was lower in the spine fixation group (long screw, 869 N vs. short screw, 1,123 N); however, this difference did not reach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine. CONCLUSIONS: The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superior or posterior screw is inserted into the scapular spine base.

Effect of adjuvant hyperbaric oxygen on healing of cartilage lesions treated with microfracture: an experimental study in rats.

PURPOSE: The purpose of this experimental study was to investigate the effect of hyperbaric oxygen (HBO2) therapy combined with microfracture technique in the treatment of cartilage lesions. METHODS: Adult Wistar rats (n=44) were divided into six groups. In Groups A, B, C and D, ICRS* (* International Cartilage Repair Society) grade 4 cartilage lesions were made on the femoral sulcus of both knees. Lesions were microfractured on the left knees; the right knees had no further procedure. Groups E and F had no surgery. Groups A, C and E received HBO2 therapy once a day, six days a week postoperatively. Groups B, D and F had no HBO2 therapy. The animals in Groups A, B, E and F were sacrificed after two weeks; Groups C and D were sacrificed after four weeks. Semiquantitative scale - including filling of defect (microfracture hole), reparative tissue thickness, cell morphology and subchondral bone maturation - was used for evaluation. The Mann-Whitney test was used to compare individual and total scores. RESULTS: Total scores of the two-week group with adjuvant HBO2 therapy were significantly higher (P=0.0007) than the two-week standard treatment group. Except for subchondral bone maturation, individual scores were significantly higher in the two-week group with adjuvant HBO2 therapy. Total scores of the four-week groups were similar. Among individual scores of the four-week groups, filling of the defect (microfracture hole), and subchondral bone maturation were significantly higher (P=0.01, P=0.03) in groups with adjuvant HBO2 therapy. CONCLUSIONS: Adjuvant HBO2 therapy accelerates the healing process of cartilage lesions treated with microfracture in rats.

Emergency physician accuracy using ultrasonography to diagnose lateral malleolar fracture.

OBJECTIVE: Many studies in the literature related to the investigation of the sensitivity and specificity of ultrasound examinations in lateral malleolar fractures is limited. The aim of this study is to investigate the sensitivity and specificity of ultrasound examinations performed by emergency physicians in fractures who are presented to the emergency department with blunt lateral malleolar trauma. METHOD: Patients over 18years of age who were admitted to the ED with lateral malleolar tenderness were enrolled to this study with convenience sampling. Ultrasonographic examination was performed by emergency physicians. Following the ultrasound examination, a two-sided X-ray was performed. In the case of inconsistency between the US exam and the X-ray evaluated by the emergency physician, a CT was performed on the patients. The X-ray or CT imaging evaluation of an orthopedic surgeon was accepted as the gold standard. RESULTS: A hundred-twenty patients were included in the study. Fractures in the lateral malleolus were detected in 47 patients. The sensitivity of X-ray in the diagnosis of lateral malleolar fractures was 92.8%, (95% CI, 79.4-98.1) and the specificity was 100% (95% CI, 89.5-100), while the sensitivity of US exam was 100% (95% CI, 94.1-100), and the specificity was 93% (95% CI, 85-97.6). X-ray gave false negative results in 3 patients, whereas US gave false positive results in 5 patients. CONCLUSION: In patients admitted to ED with lateral malleolus tenderness, the sensitivity of the ultrasound examination performed by emergency physicians regarding diagnosis of lateral malleolar fracture is higher than X-ray.

Aneurysmal bone cyst healing response with intramedullary lengthening nail.

We report the treatment process of a pediatric patient with deformity and shortening in the arm after a recurrent aggressive aneurysmal bone cyst (ABC) in the proximal humerus. The patient was treated with curettage of the lesion and lengthening on an intramedullary nail following an osteotomy just distal to the ABC. The period of lengthening was approximately 50 days. At the end of the treatment the lengthening goal was achieved without any neurovascular complication. There was a minimal loss in shoulder hyperabduction due to the deformity of the humeral head.

Femur can be lengthened over nail, along its mechanical axis : a modified lengthening over nail technique.

The theoretical risk of medialisation of the knee joint and the lateral shift of the lower extremity mechanical axis, due to achievement of lengthening along the anatomical axis is present in the process of lengthening with elongation nails and the "lengthening over nail" technique. With this new technique described in this study we aimed to prove that lengthening over nail can be performed along the mechanical axis of the femur. Six lower-limb models were used to perform three different lengthening techniques. In group 1, lengthening was achieved along the anatomical axis with an external fixator. In group 2, the clamps of the external fixator were adjusted at 6° to achieve lengthening along the mechanical axis. In group 3, eight different sized nails were applied with an external fixator (angle adjustable clamps were at 6°) to achieve lengthening along the mechanical axis by LON technique. Photographs were taken after each cm of lengthening and the distance from the mechanical axis line were measured. The modified LON technique described in this study provided lengthening along the mechanical axis. One of the main advantages of the procedure described in our study is the chance for reconsideration and revision of unforeseen angulations and malalignments, via the help of the distal angular adjustable clamps; during the time of the surgery for external fixator removal before application of the poller screws.

Iatrogenic lateral meniscus anterior horn injury in different tibial tunnel placement techniques in ACL reconstruction surgery - A cadaveric study.

OBJECTIVES: The aim of this study was to analyze the effect of tibial tunnel positioning in single bundle and double bundle ACL reconstructions on lateral meniscus anterior root. MATERIALS: Twelve single knee cadavers were used, 6 for a single bundle ACL reconstruction, which were reamed gradually starting from 8 mm, 9 mm and ended with a 10 mm reamers, while the other 6 were prepared for a double bundle ACL reconstruction in which 7 mm reamer for the AM tunnel and 6 mm reamer for the PL tunnel were used. After drilling, changes of lengths and thicknesses of anterior horns of the lateral menisci were recorded. RESULTS: Before drilling, the groups were homogenous for the lateral menisci dimensions. After drilling, no statistically significant difference was noticed between the two groups. However, in single bundle group, 2 anterior horns width injury (1.44 mm and 2.13 mm) with the 9 mm reamer and 3 anterior horns width injury (2.51 mm, 3.55 mm and 4.28 mm) with the 10 mm reamer were recorded. However in double bundle group a single anterior horn width injury (2.82 mm) was recorded. CONCLUSION: Using a greater size reamer in single bundle reconstruction, causes a relatively higher risk of lateral meniscal anterior root injury. Lateral meniscus stability should be examined arthroscopically after reaming with large reamers.

The primary factor for suture configuration at rotator cuff repair: Width of mattress or distance from tear edge.

OBJECTIVES: The aims of this study was first to investigate whether the bite size or the bite distance from the tear edge is of primary importance in mattress suture configuration for rotator cuff repair. Secondly, whether the use of a 450 left side bent Arthro-Pierce™ (Smith & Nephew, Andover, USA) during suture passage can be more effective on the strength of the configuration compared to a straight Arthro-Pierce™. MATERIALS AND METHODS: Twenty-eight bovine infraspinatus muscle tendons were randomized into four groups. Group 1; 5 mm wide 'bite size' × 15 mm length 'distance from the tear edge's mattress'; Group 2: 7.5 mm × 10 mm; Group 3: 15 mm × 5 mm 'using straight Arthro-Pierce™' and Group 4: 5 mm × 15 mm using left sided 450 bent Arthro-Pierce™. The repair specimens underwent cyclic loading prior to loading the failure testing. Cyclic elongation (mm), peak-to-peak displacement (mm), ultimate load (N), stiffness (N/mm) and failure mode were recorded for each specimen. RESULTS: The mean ultimate load in Group 1 was higher compared to group 3. The peak to peak displacement was higher in Group 4 compared to Group 1 (p < 0.05). The predominant failure mode in Groups 1, 2 and 4 was suture rupture. The Group 3 most specimens failed due to suture cut through the tendon. CONCLUSION: Bite size from the edge of the tendon seems to be more important than the width of the mattress. The curve of the suture passing device may also have an effect on the strength of the suture tendon interface.

Dual plating for fixation of humeral shaft fractures: A mechanical comparison of various combinations of plate lengths.

OBJECTIVE: The role of plate configuration was found inconclusive on the biomechanical effects of the plate size and hole number for dual plate constructions in humeral shaft fractures. The purpose of this study was to test the biomechanical stability of various dual plate constructions. METHODS: Twenty-four left humeri (4th Generation Composite Humerus, Sawbones, Malmö, Sweden) with comminuted midshaft humeral fracture were used. Four groups of plate constructs were tested: laterally fixed 8-hole locking plate and screws were combined with anteriorly locking plates containing 0, 4, 6, or 8 holes in groups I, II, III, and IV, respectively. The alterations in axial, bending, and torsional angles were recorded. RESULTS: There were no fixation failures during axial, bending, or torsional stiffness testing within the elastic behavior limits. Axial stiffness was highest in Group IV. Torsional stiffness, posterior-to-anterior bending stiffness, lateral-to-medial bending stiffness, and medial-to-lateral bending stiffness were lowest in Group I. CONCLUSION: The similar stiffness values for the 8-to-4 hole and 8-to-6 hole plate constructions indicate that the 8-to-4 hole construction is an option in young adults, while the stiffest 8-to-8 hole combination may be an option for osteoporotic patients.

Biomechanical Performance of Hip Labral Repair Techniques.

PURPOSE: To determine the strength of various suture techniques and the impact of suture passer size on cyclically loaded hip labra. METHODS: We assigned 63 bovine hip labra to 9 simple knotless suture technique groups using OrthoCord suture: (1) penetrating grasper (2.6 mm)-placed horizontal mattress, (2) penetrating grasper-placed vertical mattress, (3) SutureLasso (1.8 mm)-placed vertical mattress, (4) penetrating grasper-placed oblique repair, (5) penetrating grasper-placed vertical mattress plus radiofrequency, (6) SutureLasso-placed horizontal mattress, (7) SutureLasso-placed oblique mattress, (8) SutureLasso-placed horizontal mattress plus radiofrequency, and (9) SutureLasso-placed oblique mattress plus radiofrequency. After 20 cycles of uniaxial tensile loading (5 to 80 N), destructive testing was performed. RESULTS: Penetrating grasper-placed horizontal mattress sutures showed lower ultimate failure loads than vertical and oblique mattress sutures (P < .05). Penetrating grasper-placed vertical mattress sutures had higher peak-to-peak displacement than SutureLasso-placed vertical mattress sutures (P = .04). SutureLasso-placed oblique mattress sutures had a higher ultimate load (P < .01) and stiffness (P = .04) than SutureLasso-placed horizontal mattress sutures. SutureLasso-placed horizontal mattress sutures had lower cyclic elongation than penetrating grasper-placed horizontal mattress sutures (P = .01) and lower ultimate load (P < .01) and stiffness than SutureLasso-placed vertical mattress sutures (P < .01). Horizontal mattress sutures with radiofrequency had a higher ultimate load (P = .02), stiffness, and cyclic elongation (P < .01) than without radiofrequency. CONCLUSIONS: A horizontal mattress hip labrum stitch shows a lower ultimate failure load than vertical or oblique mattress stitches. Smaller-diameter suture-passing devices show less cyclic displacement and elongation than larger-diameter devices. Radiofrequency labral treatment does not alter vertical stitch strength but does alter horizontal mattress stitch strength. CLINICAL RELEVANCE: Vertical and oblique stitches are stronger than horizontal stitches. A 1.8-mm passing device shows a better cyclic loading performance than a 2.6-mm device.

Biomechanical determination of the relationship between femoral neck lesion size and the risk of pathological fracture.

PURPOSE: Half of the pathological fractures of the proximal femur occur in the neck region. We evaluate the relationship between the defect size within the femoral neck and the risk of pathological fracture. METHODS: After creating metastasis-like lesions in the neck regions of 21 human cadaver femurs, compression was applied to simulate single-limp stance type loading. First, a loading of 600 Newtons (N) was applied to the 35%-defected femoral necks. If the bone fracture did not occur, the defect size was increased to 45% and the 600 N force was applied again. If no fracture was observed then the defect size was increased to 55% and the bones were loaded again. The 55%-defected bones with no fractures were loaded until a fracture was detected. RESULTS: There were no fractures with the 35%- and 45%-defected femurs until 600 N was applied. However, when the defect size was increased to 55%, 3 bones were fractured before reaching 600 N. The fractures occurred at an average of 455 N in the 3 bones. At a compression of 600 N, 18 bones (84%) were intact, and the loading was continued. 18 femurs with 55%-defected neck regions had an average endurance of 1270 N compression (range 750-2800 N). CONCLUSIONS: This study showed that even very osteoporotic bones with large metastases can withstand high forces of compressive loading.

The effects of blood transfusion on renal functions in orthopaedic surgery.

OBJECTIVE: The effects of perioperative blood transfusion on renal functions have been studied in various studies. In this study, we investigated the effects of blood transfusion on postoperative kidney functions in patients who underwent orthopaedic surgeries. METHOD: Total 136 patients who were operated for several orthopedic pathologies between June 2013 and December 2014 were evaluated. The patients were divided into two groups according to the amounts of blood transfusion. Ninety five patients (69.8%) who were transfused less than 3 units were included in Group 1 and 41 patients (30.2%) who received 3 and more units of blood were included in Group 2. RESULTS: There were no statistical difference between the two groups in terms of preoperative gender, hypertension, diabetes mellitus, chronical renal failure and smoking habbits (P > 0.05). No statistical differences between the groups were seen in terms of postoperative hospital stay, pulmonary and other complications as well as mortality (P > 0.05). When the two groups were compared for blood parameters showing postoperative renal and other system functions, no statistical differences were detected (P > 0.05). CONCLUSION: Blood transfusion does not have negative effects on postoperative BUN and creatinine levels in patients operated for orthopaedic pathologies.

Mid-term radiological and functional results of biological reconstructions of extremity-located bone sarcomas in children and young adults.

Biological reconstruction is a useful option for reconstruction following bone sarcoma resection in children. The mid-term functional and radiological outcomes of biological reconstructions after resection of bone sarcomas in children are presented in this study. Eighteen patients [average age 12.5 years (range 4-22 years)] with primary sarcomas of long bones underwent wide surgical resection and biological reconstruction. The bone defects were managed by intercalary (n=14), osteoarticular (n=3) reconstructions and arthrodesis (n=1) with a vascularized fibular graft (VFG). VFG was combined with a massive allograft in seven lower extremity reconstructions. The average follow-up was 45.7 months (range 25-78 months). Graft union and graft hypertrophy was observed in 17 (94.4%) of 18 patients at 12 months. The VFG-allograft osteointegration rate was 100% at 24 months. The average final follow-up Musculoskeletal Tumor Society (MSTS) scores for lower and upper extremity reconstructions were 79.7% (range 66.6-90%) and 80.9% (range 53.3-100%), respectively. Four (22.2%) complications, including nonunion (n=1), implant failure (n=1), infection (n=1) and skin necrosis (n=1), required reoperation. The disease relapsed in three (16.6%) patients. Defect size and VFG length did not correlate with MSTS scores and radiological parameters (P>0.05). Biological reconstruction with VFG can provide permanent stability and progressively increasing functional and radiological results.

Combination of anatomical locking plate and retrograde intramedullary nail in distal femoral fractures: comparison of mechanical stability.

OBJECTIVES: This study aims is to investigate mechanical properties of intramedullary (IM) nailing and anatomical locking plate in a bone model based on the hypothesis that their combined usage increases safety of fixation stabilization. MATERIALS AND METHODS: Twenty-one left distal femoral fracture models were used in the study. Bones were divided into three equal groups. Group 1 specimens were fixed laterally by distal femoral anatomical locking plate. Group 2 specimens were fixed with retrograde distal femoral IM nail. Group 3 specimens were fixed with both distal femoral anatomical locking plate and retrograde distal femoral IM nail. In mechanical tests, alterations in axial loading, torsion angles, and load to failure values were measured and compared between groups. RESULTS: Compared to group 1, group 2 was relatively more resistant in axial load tests (p=0.225), and significantly more resistant in load to failure tests (p=0.048). Group 1 was relatively more resistant in torsional load tests (p=0.949) compared to group 2. Group 3 was significantly more resistant than group 1 in axial (p=0.001), torsional (p=0.012) load tests and load to failure tests (p=0.008). Group 3 was significantly more resistant compared to group 2 in axial (p=0.003), torsional (p=0.008) load tests, and relatively more resistant (p=0.059) in load to failure tests. CONCLUSION: Thanks to its high mechanical strength and early mobilization capability, distal femoral anatomical locking plate and IM nail combination might be a choice of treatment in complicated osteoporotic or distal femoral fractures from high-energy trauma in young adults.

Distal femoral derotational osteotomy with external fixation for correction of excessive femoral anteversion in patients with cerebral palsy.

Patients with cerebral palsy (CP) disorder often develop rotational hip deformity. Increasing deformities impair already diminished walking abilities; femoral osteotomies are often performed to maintain and improve walking abilities. Fixation of osteotomies with condylar plates has been used successfully, but does not often enable immediate postoperative full weight-bearing. To avoid considerable postoperative rehabilitation deficit and additional bone loss because of inactivity, a postoperative treatment with full weight-bearing, is therefore, desirable. Self-tapping Schanz screws with a unilateral external fixator crossing the knee joint providing stronger anchoring in osteopenic bone might fulfill these demands. A retrospective study was carried out on 27 ambulatory CP patients, mean age 17.5 years (range 9-22 years); 11 patients with bilateral severe intoeing deformities underwent a supracondylar femoral osteotomy between September 2008 and April 2012. All patients were allowed to bear their full weight postoperatively. The aim of this study was to describe the technique, the results of this technique, to evaluate the time required for bone healing, and the type of complications associated with a distal derotational femoral osteotomy fixed with a uniaxial external fixator crossing the knee joint. A total of 27 patients were studied [mean weight 48.8 kg (range 29.8-75 kg)]. The mean preoperative rotation included internal rotation of 69° and external rotation of 17°. All patients were evaluated clinically and radiographically for a minimum of 1 year after surgery. There was a significant decrease in the mean medial rotation from 69° to 32° (P=0.00034). The lateral rotation increased significantly from preoperative 17° to postoperative 45° (P=0.0011). The femoral anteversion decreased significantly from a mean of 55° preoperatively to a mean 17° postoperatively (P=0.030). All patients, except one, achieved solid fusion uneventfully. One patient was a 16-year-old female who had sustained a knee flexion contracture of 30° because of a delay in the physiotherapy program. One 13-year-old female patient with a bilateral osteotomy had a nondisplaced fracture in her right femur after a direct trauma 2 weeks after removal of an external fixator, and was treated by a cast. Another 17-year-old male patient developed a nonunion because of loosening of two pins and achieved solid union after revision by dynamic compression plate plating. Besides four cases with superficial pin-tract infection, no other complications were documented. Minimally invasive supracondylar femoral derotational osteotomy fixed with a unilateral external fixators crossing the knee joint is a reliable procedure in CP patients. Most patients can be treated with early postoperative full weight-bearing. However, removal of the knee joint crossing fixator should be performed as early as possible to achieve a full range of motion.

Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with mini plate plus screw or screw only.

INTRODUCTION: We aimed to compare results of treatment of oblique-spiral metacarpal and phalangeal fractures with screw only or mini plate plus screw, respectively. METHODS: A total of 43 patients who were operated with a diagnosis of displaced, irreducible, unstable, rotational oblique-spiral metacarpal and proximal phalangeal fracture between 2007 and 2010 were included in this study. The mean age of patients with a phalangeal fracture was 33.8 years (range 20-50 years; 4 females, 18 males), and the mean age of patients with a metacarpal fracture was 29.6 years (range 18-45 years; 3 females, 18 males). Mini plate plus screw or screw only was used for internal fixation of these fractures. The patients were followed up for 19.2 ± 5.4 months in the phalangeal fracture group and 20.9 ± 7.3 months in metacarpal fracture group. Of the metacarpal fractures, 14 were oblique and 10 spiral, whereas 14 of the phalangeal fractures were oblique and 8 spiral. The patients were evaluated according to total range of motion of the finger, grasping strength and Q-DASH score. RESULTS: For patients treated with mini plate plus screw after metacarpal and phalangeal fractures, the time to return to work was significantly shorter in comparison to patients treated with screws only. There was no significant difference between patients with metacarpal fractures treated with mini plate plus screw and patients treated with screw only in terms of total range of motion and Q-DASH results at last on control examination, while results of patients with phalangeal fractures treated with screw only were significantly better. There was no significant difference between these two treatments in phalangeal fractures in terms of grasping strength of the finger in early (1st month) and late (last control examination), whereas patients with metacarpal fractures treated with mini plate plus screw reached higher grasping strength earlier. CONCLUSION: Treatment with mini plate plus screw should be avoided in spiral and oblique phalangeal fractures, and fixation should be done with screw only with a short surgical incision and dissection. On the other hand, treatment with mini plate plus screw should be preferred in patients with spiral and oblique metacarpal fractures, especially in those who work in occupations requiring higher physical strength.

Tendon-holding capacities of two newly designed implants for tendon repair: an experimental study on the flexor digitorum profundus tendon of sheep.

BACKGROUND: Two main factors determine the strength of tendon repair; the tensile strength of material and the gripping capacity of a suture configuration. Different repair techniques and suture materials were developed to increase the strength of repairs but none of techniques and suture materials seem to provide enough tensile strength with safety margins for early active mobilization. In order to overcome this problem tendon suturing implants are being developed. We designed two different suturing implants. The aim of this study was to measure tendon-holding capacities of these implants biomechanically and to compare them with frequently used suture techniques. MATERIALS AND METHODS: In this study we used 64 sheep flexor digitorum profundus tendons. Four study groups were formed and each group had 16 tendons. We applied model 1 and model 2 implant to the first 2 groups and Bunnell and locking-loop techniques to the 3rd and 4th groups respectively by using 5 Ticron sutures. RESULTS: In 13 tendons in group 1 and 15 tendons in group 2 and in all tendons in group 3 and 4, implants and sutures pulled out of the tendon in longitudinal axis at the point of maximum load. The mean tensile strengths were the largest in group 1 and smallest in group 3. CONCLUSION: In conclusion, the new stainless steel tendon suturing implants applied from outside the tendons using steel wires enable a biomechanically stronger repair with less tendon trauma when compared to previously developed tendon repair implants and the traditional suturing techniques.