Efficacy of Single Titanium Elastic Nail in the Treatment of Child Femur Fractures.

BACKGROUND: Femoral shaft fractures in childhood constitute an important part of emergency visits to orthopedic clinics. The aim of this study was to investigate the efficacy and reliability of a method in the treatment of simple fractures in the middle of the femoral diaphysis in patients with multiple injuries or in the treatment of cases with a medullary canal that is too narrow for two nails, with a single stretch nail thicker than half the diameter of the canal. METHODS: Between July 2002 and November 2006, examinations were made of 11 femoral fractures in 11 patients who were admitted to the pediatric emergency department of Tepecik Training and Research Hospital with a diagnosis of femoral fracture and who were hospitalized and treated with a single flexible intramedullary titanium nail. RESULTS: In the follow-up, no problem was found in terms of union and length difference in any of the cases, except for a 10º varus deformity present after surgery in one case. CONCLUSIONS: Elastic intramedullary nailing is an effective method in the treatment of simple femoral fractures in children. A single elastic nail provides adequate stability following open reduction with minimal incision in patients whose short operating time must be kept short such as those with head trauma, thoracic trauma, or intra-abdominal pathology, or patients with a narrow medullary canal where two flexible nails cannot pass. We think that it is a feasible method because it causes minimal soft tissue damage.

Can titanium elastic nail be safely used for paediatric subtrochanteric femur fractures?

In this study, we aimed to show that subtrochanteric femur fractures, an uncommon type of fracture in the paediatric age group, can be treated with titanium elastic nailing (TEN). We reviewed the patients treated with TEN in the paediatric age group with subtrochanteric femur fractures who had been treated at the Orthopaedics and Traumatology Clinic of Izmir Tepecik Research and Training Hospital between January 2011 and December 2016 retrospectively. All fractures were fixed by retrograde nailing with supracondylar entry following reduction. Patients' demographics as well as data such as fracture type, fracture level, time of operation, reduction type, time to union, shortness, additional fixation, duration of additional fixation, Flynn scores and reduction loss were evaluated. The 20 patients included in our study were followed up for at least 1 year, had an age range of 54-173 months (mean, 104 ± 31.82 months) and were operated within 2-11 days after fracture. All patients had fracture union and only three patients had union with an angulation of less than 5°. None of the patients had limb length inequality. Fourteen patients underwent reoperation, all of these were routine operations for implant removal and no patients required reoperation for complications. We think that paediatric subtrochanteric femur fractures can be treated by TEN fixation using the proper technique, with a limited invasive intervention.

Viewing arthrography images affects treatment preferences for Legg-Calvé-Perthes disease among medical professionals.

OBJECTIVES: We explored how experience of arthrography affects treatment preferences for Legg-Calvé-Perthes disease (LCPD) patients. We also examined changes in surgical procedure preferences after examining arthrography images. In addition, we analysed the effect of experience with arthrography on treatment and surgical modality preferences. METHODS: A case-based questionnaire was completed by 26 participants. Information on age, symptoms, hip range of motion (ROM), and extremity length differences were provided for eight LCPD cases. Based on these data and roentgenography images of the cases, the respondents were questioned regarding diagnostic, treatment, and surgical preferences. A slide was shown of arthrography images of each case and the same questions were asked to determine any changes in treatment preferences. The participants were divided into arthrography-experienced (Group 1, n = 16) and -inexperienced (Group 2, n = 10) groups to determine differences in treatment preferences in association with experience. RESULTS: After the participants had examined the arthrography images, a significant decrease in the number of additional examination requests was observed (p < 0.001). A significant group difference was also found in the rate of change of preference in diagnostic modality (p < 0.001).After arthrography images were examined, the tendency towards a preference for surgery increased in all participants. However, no significant difference between the experience groups was observed (p = 0.193). In addition, after arthrography images were examined, there was an increased tendency towards a preference for femoral valgisation and Salter osteotomy among participants who chose surgical treatments (p = 0.408). The treatment preferences difference between the two experience groups were not significant, and nor was the preference regarding surgical procedures (p = 0.999). CONCLUSIONS: Previous studies have shown that arthrography is useful for planning treatment and informing decisions regarding surgical modality for LCPD. However, no study has explored changes in treatment preferences after viewing arthrography images. This study explored such changes in choices regarding the diagnostic method and treatment modality. Our study showed that experience with arthrography decreased the preference for additional diagnostic tests (p < 0.001). Experience of arthrography increased the preference for surgery, though not significantly (p = 0.193).

Pediatric Forearm Refracture with Intramedullary Nail Bending In Situ: Options for Treatment.

In this study, we present the case of a nine-year-old male patient who had initially presented to the emergency department with a right both-bone forearm fracture. He was treated with closed reduction and long-arm casting. The cast was applied for six weeks and then replaced with a short-arm cast for two weeks. The patient returned with a both-bone forearm refracture one and a half months after the removal of the cast. Surgical treatment was initiated and an intramedullary nail fixation was applied. The patient sustained a new trauma five months postoperatively. The condition was diagnosed to be a refracture of the both-bone forearm with an intramedullary nail in situ. Closed reduction was performed, but an acceptable level of reduction was not achieved. Subsequently, intramedullary nails were replaced with new nails. At the one year follow-up, the patient was observed to have a full range of motion and reported no pain or muscle weakness.

Is open reduction necessary for pediatric T-condylar fractures of the humerus?

The aim of this study was to investigate the outcomes of closed reduction and percutaneous pinning (Kirschner wire fixation) as a less invasive method for the treatment of pediatric T-condylar fractures of the humerus compared with open reduction and pinning. Among pediatric patients who were diagnosed with T-condylar fractures of the humerus between 2010 and 2017, those who underwent closed reduction and percutaneous pinning were retrospectively evaluated. The surgical technique used was to restore joint alignment through closed reduction and then to insert a pin parallel to the joint surface to stabilize the intercondylar fracture. Then, the supracondylar fracture was fixed with crossed pins. At 1-year follow-up, rotation, angulation, and joint range of motion were evaluated. Patient satisfaction was assessed subjectively using the visual analogue scale. Early and late postoperative Baumann angles were measured. All patients were male, and the mean age was 10.8 ± 4.6 years. The mean follow-up duration was 16.5 ± 7.2 months, and the mean union duration was 7.4 ± 2.3 weeks. None of the patients had any rotational deformities, but two had 5° of varus, one had 5° of valgus, two had a flexion contracture of 10°, and one had a flexion contracture of 40°. The only complication observed was a pin-tract infection, which developed in one patient. The mean visual analogue scale score was 9.25 ± 1. In pediatric patients with T-condylar humerus fractures, closed reduction and percutaneous pinning may be a good alternative to open reduction and pinning, because it is less invasive and does not cause additional complications.

Optimum Screw Configuration for the Fixation of Sanders Type IIC Tongue-Type Fractures? A Biomechanical Study.

BACKGROUND: The minimally invasive technique (percutaneous screw fixation) is one of the options for treating tongue-type IIC fractures successfully. The aim of this study was to assess the biomechanics of four different screw configurations used for the fixation of tongue-type IIC calcaneal fractures. METHODS: Identical osteotomies, recapitulating a type IIC injury, were created in synthetic calcaneus specimens using a saw. The specimens were randomly assigned to one of the four fixation groups (n = 7 per group): two divergent screws, two parallel screws, two parallel screws plus one screw axially oriented toward the sustentaculum tali, and three parallel screws. A load test was performed on all of the groups, and the specimens were then tested using offset axial loading until 2, 4, and 5 mm of fracture displacement occurred. RESULTS: Mean force values for the three-parallel screw construct at 2-, 4-, and 5-mm fracture displacements were found to be significantly higher compared with those for the other groups. CONCLUSIONS: The use of a three-parallel screw construct seems to provide more stability in the treatment of tongue-type IIC fractures.

Are the Appropriate Use Criteria for the management of pediatric supracondylar humerus fractures useful in clinical practice?

The aim of this study was to evaluate our treatment modalities in pediatric supracondylar humerus fractures according to the recently published Appropriate Use Criteria (AUC) by the American Academy of Orthopaedic Surgeons. A total of 991 patients with supracondylar humerus fractures were included. After reviewing medical records, 38 different clinical scenarios described in the AUC were observed. Of the 991 patients, 127 were type I, 423 were type II, and 405 were type III fractures according to the Gartland classification. The AUC was appropriate for 100% of type I, only 25 (5.9%) of type II, and 389 (96.0%) of type III fractures. Overall, the total appropriateness rate was 54.5%. We concluded that application of the AUC is useful but burdensome and that AUC provides important guidance especially for rarely encountered urgent clinical scenarios.

Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

OBJECTIVE: Closed reduction with percutaneous pinning is the treatment of choice for displaced supracondylar humerus fractures in children. In addition to configuration of pin fixation, many factors have been attributed to loss of reduction (LOR). The aim of the present study was to review potential factors that contribute to loss of reduction in the closed management of type III pediatric supracondylar fractures. METHODS: Treatment of 87 patients with type III supracondylar fractures was reviewed to determine factors associated with loss of reduction; 48 patients were treated with lateral pinning and 39 with crossed-pinning after closed reduction. Outcome parameters included radiographic maintenance of postoperative reduction. RESULTS: Lateral or crossed-pin configuration, pin spread at fracture site, pin-spread ratio (PSR), and direction of coronal displacement of the fracture were not associated with LOR. A significant difference (p = 0.01) was found between LOR rates of patients with medial wall communication and LOR. CONCLUSION: Medial wall communication is a contributing factor to LOR in the management of type III supracondylar fractures. Cross-pinning should be preferred when medial wall communication is present, to provide more stable fixation. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

How safe is the semi-sterile technique in the percutaneous pinning of supracondylar humerus fractures?

BACKGROUND: The purpose of the present study was to evaluate safety and efficiency of the semi-sterile technique used in recent years in treatment of pediatric supracondylar humeral fractures (SHF). METHODS: Total of 712 patients who were treated for SHF via closed reduction and percutaneous fixation with semi-sterile technique were enrolled in present study. Patients were evaluated for postoperative infection and other complications. Clinical and radiological assessments were also made. RESULTS: It was found that there were 52 (7.3%) pin tract infections, which responded to oral antibiotic administration and pin care without need for early pin removal (before 3 weeks). There were no deep infections. Loss of reduction was observed in 82 patients (11.5%). There were 59 iatrogenic nerve injuries (8.3%), of which 52 (7.3%) were ulnar palsy. Clinically apparent cubitus varus was observed in 29 (4.1%) patients. CONCLUSION: Though semi-sterile technique is an effective treatment in closed percutaneous pinning of SHF, increased pin tract infection risk is a matter of concern.

Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients.

INTRODUCTION: Mechanical complications, such as cut-out of the head-neck fixation device, are the most common causes of morbidity after trochanteric femur fracture treatment. The causes of cut-out complications are well defined in patients who are treated with sliding hip screws and biaxial cephalomedullary nails but there are few reports about the patients who are treated with proximal femoral nail antirotation. AIM: The purpose of this study was to evaluate the most important factor about occurance of cutout complication and also to evaluate the risks of the combination of each possible factors. PATIENTS AND METHODS: Overally 298 patients were enrolled in the study. Medical records were reviewed for patients' age, fracture type, gender, anesthesia type and occurance of cut-out complication. Postoperatively taken radiographs were reviewed for tip-apex distance, obtained collo-diaphyseal angle, the quadrant of the helical blade and Ikuta reduction subgroup. The most important factor (s) and also predicted probability of cut-out complication was calculated for each combination of factors. RESULTS: Cut-out complication was observed in 14 patients (4.7 %). The most important factor about occurrence of the cut-out complication was found as varus reduction (p: 0.01), the second important factor was found as implantation of the helical blade in the improper quadrant (p: 0.02). Tip-apex distance was found as third important factor (p: 0.10). The predicted probability of cut-out complication was calculated as 45.6 % when whole of the four surgeon dependent factors were improperly obtained. CONCLUSION: Althought obtaining proper tip-apex distance is important to prevent cutout complication in these fractures, if the fracture is not reduced in varus position and helical blade is inserted in the proper quadrant, possibility of cut-out complication is very low even in the patients with high tip-apex distance.

Flexion type supracondylar humerus fractures: 12 year experience of a pediatric orthopedics clinic.

OBJECTIVES: This study aims to review flexion type supracondylar humerus fractures in children and treatment options. PATIENTS AND METHODS: Forty-seven patients (26 males, 21 females; mean age 8.6±3.2 years; range 4 to 15 years) who admitted to and were hospitalized in a pediatric orthopedics clinic between January 2002 and January 2014 due to flexion type supracondylar humerus fracture were included in this retrospective study. Fractures were classified according to Wilkins modification of Gartland system. Closed reduction and percutaneous pinning (CRPP) were administered in all patients with type 2 and 3 fractures. An overhead traction or open reduction was applied when closed reduction could not be achieved with three manipulations. Patients were evaluated clinically and radiologically. The results were graded according to Flynn criteria. RESULTS: Four patients with type 1 fracture were treated conservatively. Of the remaining patients, we were able to perform CRPP successfully in 36 (83.7%). While six patients (14%) were treated with open reduction and internal fixation, one patient (2.1%) was treated with overhead traction. The results were excellent or good in 44 patients (93.7%). CONCLUSION: Compared with extension type fractures, these fractures are seen in older children and are rarer. One should be prepared to perform open reduction especially for type 3 fractures. In our study, results of patients with type 3 fractures treated with CRPP were superior.

Debridement, antibiotics, irrigation, and retention (DAIR) of the prosthesis after hip hemiarthroplasty infections. Does it work?

PURPOSE: Debridement, antibiotic, and implant retention (DAIR) is an attractive treatment modality after hip hemiarthroplasty (HA) infections. Data about the success of the procedure after acute onset infections is lacking. The aim of this study was to analyze the clinical outcome and associated risk factors. METHODS: A multicenter, retrospective cohort study was designed, including 39 patients with acute onset prosthetic infection who had undergone debridement and irrigation with prosthesis retention. The primary outcome measure was infection eradication without prosthesis removal. We also analyzed how the success rate was influenced by the length of the interval between implantation of the prosthesis and the beginning of the treatment. RESULTS: The overall success rate was 41%. Sedimentation rate over 60 mm/h and the longer duration (2 weeks) after prosthesis implantation were found as factors negatively influencing the success rate. CONCLUSIONS: Our results indicated limited success to DAIR- treated patients with infected HA. The high failure rate of DAIR treatment after 2 weeks from the implantation should be taken into consideration.

Medial percutaneous hemi-epiphysiodesis improves the valgus tilt of the femoral head in developmental dysplasia of the hip (DDH) type-II avascular necrosis.

BACKGROUND AND PURPOSE: Avascular necrosis (AVN) is a major cause of disability after treatment of developmental dysplasia of the hip (DDH), leading to femoral head deformity, acetabular dysplasia, and osteoarthritis in adult life. Type-II AVN is characterized by retarded growth in the lateral aspect of the physis or by premature lateral fusion, which produces a valgus deformity of the head on the neck of the femur. We investigated the effect of medial percutaneous hemi-epiphysiodesis as a novel technique in the treatment of late-diagnosed type-II AVN. PATIENTS AND METHODS: 9 patients (11 hips) with a diagnosis of type-II AVN who underwent medial percutaneous hemi-epiphysiodesis after the surgical treatment for DDH were included in the study. 10 patients (12 hips) with the same diagnosis but who did not undergo hemi-epiphysodesis were chosen as a control group. Preoperative and postoperative articulotrochanteric distances, head-shaft angles, CE (center-edge) angles, and physeal inclination angles were measured. The treatment group underwent medial hemi-epiphysodesis at a mean age of 8 years. The mean ages of the treatment group and the control group at final follow-up were 14 and 12 years respectively. The mean duration of follow-up was 5.7 years in the treatment group and 8.3 years in the control group. RESULTS: Preoperative articulotrochanteric distance, head-shaft angle, and functional outcome at the final follow-up assessment were similar in the 2 groups. However, preoperative and postoperative CE angles and physeal inclination angles differed significantly in the treatment group (p < 0.05). The final epiphyseal valgus angles were better in the treatment group than in the control group (p = 0.05). The treatment group improved after the operation. INTERPRETATION: Medial percutaneous epiphysiodesis performed through a mini-incision under fluoroscopic control is a worthwhile modality in terms of changing the valgus tilt of the femoral head.

Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table.

OBJECTIVE: The aim of this study was to evaluate whether intertrochanteric femur fractures can be reduced and nailed properly in the lateral decubitus position using Proximal Femoral Nail Antirotation (PFNA) as a fixation device without the use of a traction table. METHODS: The study included 207 patients (81 male and 126 female; mean age: 75 years, range: 22 to 95 years). According to the Evans classification, there were 7 Type 1, 40 Type 2, 33 Type 3, 38 Type 4, 61 Type 5 and 28 reverse oblique fractures. Radiographs were used to measure the tip-apex distance (TAD), the quadrant of the helical blade according to Cleveland and Bosworth, Ikuta's reduction subgroup, collodiaphyseal angle and reduction gaps postoperatively. RESULTS: Mean follow-up time was 20.4 (range: 6 to 38) months. According to Ikuta's classification, 176 (85%) reduced fractures were of subtype N, 15 (7.2%) subtype P and 16 (7.7%) subtype A. Good or acceptable reduction according to the Herman criteria was obtained in 99% of fractures. Mean TAD was 29.2 millimeters. Mean operation time was 57.2 minutes. Optimal blade position (center-center or inferior-center) was achieved in 53.5% of patients and was in the superior-posterior quadrants in only 2.4% of patients. Cut-out complication occurred in 9 patients (4.3%). CONCLUSION: While the nailing of intertrochanteric fractures in a lateral decubitus position does not provide ideal quadrant placement and TAD, results are encouraging probably due to the excellent stability that is provided by PFNA.

How are outcomes affected by performing a one-stage combined procedure simultaneously in bilateral developmental hip dysplasia?

PURPOSE: The aim of this study was to compare the outcomes of one-stage combined surgical treatment in children of unilateral and bilateral developmental hip dysplasia diagnosed after walking age. METHODS: We reviewed 24 patients who underwent one-stage combined surgery for DDH diagnosed after walking age. Group I consisted of 12 patients with bilateral disease who underwent bilateral operation at one operative setting. Group II consisted of 12 patients with unilateral disease. Pre-operatively the hips were classified according to Tönnis classification. Acetabular dysplasia was evaluated by measuring acetabular index (AI) angles pre-operatively. The acetabular improvements with time regarding AI was noted immediately postoperatively, every six months, and at the final follow-up examination. RESULTS: Mean follow up of the bilateral group I and group II were 54.8 months (range 20-84 months) and 52.6 months (24-80), respectively. There were no statistically significant differences between immediate postoperative and final follow up acetabular index improvement rates in both groups. Also there was no significant difference when both hips were compared in group I. The clinical final outcome of both groups and within group I was similar. CONCLUSIONS: Simultaneous combined surgery is a challenging but worthwhile procedure for late diagnosed patients with bilateral DDH. The short-mid term outcomes of the procedure are encouraging.

Radiological analysis of closed-wedge high tibial osteotomy.

OBJECTIVES: In this study, we aimed to evaluate changes in frontal plane (anatomical axis) and sagittal plane (tibial slope, patellar height) parameters following closed-wedge high tibial osteotomy (HTO) and possible correlations between them. PATIENTS AND METHODS: Between June 2003 and May 2007, 15 knees of the 13 female patients (mean age 52.6 years; range 45 to 64 years) who were followed on a regular basis in our outpatient clinic and underwent closed-wedge HTO were included. The mean follow-up was 49 months (range 29-75 months). Radiologic analysis was performed using pre- and postoperative anatomical axis, tibial slope, and patellar height measurements [Caton index (CI) and Insall-Salvati index (ISI)]. The findings were analyzed by using Wilcoxon matched pairs test and Pearson's correlation test. RESULTS: Preoperative varus deformity was 6.3° ± 2.7°, while it was measured as 7.2° ± 2.5° valgus in the last visit (p=0.0004). The pre- and postoperative CI were 0.97 ± 0.1 and 0.96 ± 0.1, respectively (p=0.85). The ISI decreased from 1.23 ± 0.15 to 1.14 ± 0.15 (p=0.012). Patella baja was observed in only one patient (ISI=0.77). Preoperatively tibial slope was 6.5° ± 2.4°, while it was measured as 0.06° ± 3.4° in the last visit (p=0.0001). There was no correlation between frontal plane angle change and tibial slope, also between patellar height and tibial slope. CONCLUSION: Closed-wedge HTO does not result in significant changes in patellar height. The risk of patella baja can be decreased through minimal dissection around patellar tendon. However, closed-wedge HTO reduces tibial slope significantly. Optimal resection from posterior tibia is necessary to prevent this condition. A possible loss of tibial slope should be considered in the further reconstructive procedures.

Evaluation of experienced surgeons' decisions regarding the need for secondary surgery in developmental dysplasia of the hip.

BACKGROUND: We aimed to evaluate experienced surgeons' decisions regarding the need for secondary surgery in developmental dysplasia of the hip (DDH) at 5 to 7 years of age. METHODS: We selected 21 hips from 17 patients who had mid-term and skeletally mature radiographs and who had neither had complications nor secondary surgery until skeletal maturity after having an initial soft tissue surgery for DDH before the age of 18 months. Twenty experienced orthopaedic surgeons evaluated the mid-term follow-up radiographs of these hips in terms of their need for secondary surgery. RESULTS: On the basis of management grading of the observers at mid-term follow-up, the risk of unnecessary surgical management was 12% in hips that would eventually be normal at skeletal maturity. The risk of not performing needed surgery was 40% in hips that would eventually become dysplastic at skeletal maturity. Experience of the surgeons in terms of years had no significant effect on the management decisions. The center-edge angle, the acetabular index angle (AIA), percentage of femoral head coverage, Shenton line, and the acetabular angle of Sharp were the 5 most commonly used radiographic parameters at mid-term follow-up to assess whether a secondary surgery would be needed. Center-edge angle, AIA, femoral head coverage, and Shenton line correlated, whereas the acetabular angle did not significantly correlate with surgeons' quantitative management decisions on the basis of mid-term radiographs. CONCLUSIONS: Experienced surgeons are more likely to opt for nonoperative management in hips that show no ischemic changes or instability at 5 to 7 years of age even in the presence of slightly abnormal radiographic measurements. AIA is considered the best radiographic parameter for making decisions regarding the need for secondary surgery in DDH at 5 to 7 years of age. LEVEL OF EVIDENCE: Level II prognostic study.

Surgical treatment of symptomatic discoid medial meniscus in childhood: a case report.

If the meniscus has a spherical shape and not a semilunary structure, it is called as discoid meniscus. This anomaly is generally seen in the lateral meniscus; however, it is rare in the medial meniscus. Although the discoid meniscus is usually asymptomatic in children and adolescents, it could present as a meniscal tear. An 11-year-old boy was admitted to our hospital with right knee pain and lack of extension of the knee joint. He was diagnosed as discoid medial meniscus. On physical examination, we observed tenderness at the knee joint line with an effusion of the knee and a restriction during the extension movement of the knee joint. McMurray test was positive. Conventional radiograms revealed widening of the medial joint line and cupping of the medial tibial plateau. Magnetic resonance imaging indicated a discoid meniscus image at sagittal slices. In this case, after the arthroscopic partial menisectomy, we obtained an excellent result at 2 years follow-up.

[Clinical and radiological results in distal tibial physeal injuries]. / Tibia alt uç büyüme plagi yaralanmalarinda klinik ve radyolojik sonuçlar.

BACKGROUND: In this study, we evaluated the clinical and radiological results of the distal tibial epiphyseal fractures in children treated with surgery. METHODS: We evaluated 59 patients (33 boys, 26 girls) retrospectively. Physeal fractures were classified according to the Salter-Harris classification: 4 fractures were type I, 22 type II, 29 type III, and the remaining 4 type IV. Closed reduction and internal fixation were performed in 29 patients, while open reduction and internal fixation were performed in 30 patients. Mean age at the time of trauma was 10.9 years (6-14). Patients were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: Patients were operated in a mean of 3.8 hours (3-72). Fixation was performed with Kirschner (K)-wire in 50 patients, with screw in 6 patients, and with both K-wire and screw in 3 patients. Mean follow-up time was 71.7 months (12-149). Due to premature physeal arrest, 1 cm shortening and valgus deformity were seen in only one patient. However, no infection, nonunion, or osteonecrosis was observed in any patient. Mean AOFAS score was 86.6 (65-100) at the last follow-up. CONCLUSION: Successful results with fewer complications could be obtained in ankle physeal fractures with early management through adequate reduction and stabilized fixation.

Is Kalamchi and MacEwen Group I avascular necrosis of the femoral head harmless in developmental dysplasia of the hip?

The aim of this clinical study was to evaluate the influence of Kalamchi and MacEwen group I avascular necrosis of the femoral head (AVN) on the radiographic and clinical outcomes in developmental dysplasia of the hip (DDH). Preoperative and follow-up (at 2-3, 4-6, 7-9 and 10-15 years of age) Sharp's acetabular angles (AA) and the final Wiberg's center-edge angles (CEA) and proximal femoral center-trochanter distances (CTD) of 13 hips with group I AVN (AVN group) were compared with measurements of 22 hips without AVN (control group). All hips were initially treated by the same soft tissue surgical procedure (posteromedial limited surgery) under the age of 18 months and were completely followed up to at least 10 years of age. Radiographic diagnosis of group I AVN was made between 6 and 12 months postoperatively. The period for complete radiographic recovery of group I ischemic changes was between 2 to 4.5 years. Preoperative mean AA values of both groups were similar. However, the mean AA was found to be worse in the AVN group than in the control group during follow-up. Control group hips had a better mean CEA and higher number of hips having normal CTD than the AVN group, at latest follow-up. In conclusion, when compared with uncomplicated hips, group I ischemic changes retard acetabular development and have quantitative unfavorable effects on lateral femoral head coverage and proximal femoral anatomy in DDH. In addition, the healing process in group I AVN patients is extended.