Peroneus longus tendon autograft versus allograft in revision ACLR: A retrospective comparison.

PURPOSE: The use of peroneus longus tendon (PLT) autografts in primary anterior cruciate ligament reconstruction (ACLR) has increased recently, but there is a lack of research on its use in revision ACLR. This study aimed to compare the clinical outcomes and complications between revision ACLR using allografts and PLT autografts. MATERIALS AND METHODS: Fifty-nine patients who underwent arthroscopic revision of ACLR with complete clinical follow-ups between 2012 and 2021 were retrospectively reviewed. Allograft was used in 44 of these patients, and PLT autograft was used in 15 of them. Lysholm knee score, Tegner activity score, Lachman, and anterior drawer tests were performed after a mean follow-up of 60months (range: 19-116). The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to evaluate the donor ankle functions. Clinical outcomes and complications were compared between groups. RESULTS: Both groups showed significantly improved functional outcomes compared to their preoperative assessments. However, both groups had similar clinical results at the final follow-up, including Lysholm knee score, Tegner activity scale, knee range of motion, return to sports, time to return to daily activities, and rate of re-rupture. No major complications were seen in any of the patients. The AOFAS score was 99.13±2.64 in the PLT autograft group without loss of ankle muscle strength, deformity, instability, and permanent iatrogenic neurovascular injuries. The cumulative cost of the allograft group was significantly higher than the PLT autograft group. CONCLUSIONS: The PLT autograft might be an alternative autograft option to allografts due to similar clinical outcomes, low donor site morbidity, and reduced cost in ACLR revisions, especially if the primary ACLR was performed using grafts harvested around the knee. LEVEL OF EVIDENCE: III; retrospective comparative study.

Comparison of infraclavicular brachial plexus block versus wide-awake local anesthesia no-tourniquet technique in the management of radial shortening osteotomy.

OBJECTIVES: The aim of this study was to evaluate the feasibility of the wide-awake local anesthesia no-tourniquet (WALANT) technique in radial shortening osteotomy and to compare it with the infraclavicular brachial plexus block (IBPB). PATIENTS AND METHODS: Between January 2020 and January 2021, a total of 26 patients (16 males, 10 females, mean age: 40±4.9 years; range, 29 to 45 years) with Kienbock's disease who underwent radial shortening osteotomy were retrospectively analyzed. The patients were divided into two groups according to the type of anesthesia as WALANT (Group 1, n=11) and IBPB (Group 2, n=15) anesthesia. Visual Analog Scale (VAS) during surgery, time from anesthesia to surgical incision, surgical time, overall patient satisfaction regarding the anesthesia was assessed. The Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and handgrip strengths were compared at the final follow-up and short-term outcomes were analyzed. RESULTS: Age (p=0.896), sex (p=1.000), and dominant side involvement (p=1.000) were similar between the groups. Waiting time to start surgery in both groups was similar (27 vs. 25 min; p=0.053). Intraoperative VAS-pain scores and the satisfaction from the anesthesia type of both groups were also similar (p=0.546 and p=0.500). CONCLUSION: The WALANT may be another anesthesia technique for radial shortening osteotomy with favorable outcomes. This technique adequately allows the surgeon to perform osteotomy and obtain a stable reduction without undue risk of tourniquet pain and palsy.

Efficiency of Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures.

Eighty-seven osteoporotic vertebral fractures of 82 patients were treated with balloon kyphoplasty. Preoperative, postoperative and follow-up outcomes of functional impairment, pain scores and vertebral height restorations of the patients were recorded and evaluated statistically. Seventy-two of the patients were female (87.8%) and 10 (12.2%) were male. Mean age of all patients were 66.4 years. Preoperative mean Anterior Vertebral Body Height of 48.20±13.94 % and Middle Vertebral Body Height of 59.40±14.26 % were recorded as 79.91±9.50 % and 86.90±8.38 % respectively postoperatively and noted to be 73.26±8.59 % and 84.65±8.19 % at last controls respectively. The mean Oswestry Disability Index and Visual Analog Pain Scale also improved significantly. Local Kyphosis of all the patients were also evaluated and a significant improvement was noted postoperatively. The long term results of this study suggest that balloon kyphoplasty is an effective and safe treatment option in osteoporotic vertebral fractures and should be considered for functional improvement, pain relief and height restoration.

The prevalence of functional absence of flexor digitorum superficialis to the little finger: a study in a Turkish population.

This prospective study was conducted to determine the prevalence of absence of flexor digitorum superficialis (FDS)-V tendon and to investigate the clinical usefulness of symmetry patterns, differences between sex, laterality, and dexterity in a Turkish population. Four hundred randomly-selected adult patients were examined for the absence of FDS-V function. The absence of FDS-V on both sides, results of the examination tests, age, sex, and dexterity were recorded and analysed statistically. The overall prevalence of absence of FDS-V was 18.5% in the Turkish population. The prevalence of functional absence of FDS-V was statistically similar between the body sides and sex (p = 0.258 and p = 0.333). The prevalence of symmetric occurrence of the variations in both hands was 87.2%. If a functional FDS is demonstrated in one hand, the probability of having a functional FDS-V in the contralateral hand is 91.8%. However, when the FDS-V is absent in one hand, the probability of having an absent FDS-V in the contralateral hand is 51.1%. The symmetric occurrence of variations was equally distributed in both sex and dexterity (p = 0.223 and p = 0.201). Prediction of FDS-V function in one hand through examining the opposite hand may cause false negative or false positive results. However, if the uninjured hand has independent FDS-V function, the inability to flex the PIP joint in the injured hand can be accepted as an injury to the FDS and surgical exploration should be performed. However, if the uninjured hand has an absent function, assumption of symmetric distribution should not be used.

Inter- and intraobserver reliability of the Crowe and Hartofilakidis classifications in the assessment of developmental dysplasia of the hip in adult patients.

BACKGROUND: The purpose of this study is to investigate the inter- and intraobserver reliability of Crowe and Hartofilakidis classifications in the assessment of developmental dysplasia of the hip in adult patients. MATERIALS AND METHODS: Two consultant orthopedic surgeons classified 141 dysplastic hips on 103 standard anterior-posterior pelvis radiographs according to the Crowe and Hartofilakidis classifications. Assessments were performed in random order by each observer on two separate occasions, at least 4 weeks apart. Kappa statistics were used to establish a relative level of agreement between observers for the two readings and between separate readings by the same observer. RESULTS: At the first readings, interobserver reliability analysis revealed kappa coefficient of 0.71 for the Crowe classification and 0.54 for the Hartofilakidis classification. At the second reading, the kappa coefficient was 0.72 for the Crowe classification and 0.75 for the Hartofilakidis classification. Intraobserver reliability analysis revealed kappa coefficients of 0.71 for the Crowe and 0.80 for the Hartofilakidis classification for observer A, and 0.76 and 0.70 for observer B. CONCLUSIONS: In conclusion, we have found substantial inter- and intraobserver agreement for Crowe classification and substantial to moderate agreement for Hartofilakidis classification in this study. Both classification systems assess the different aspects of developmental dysplasia of hip in adults. Each system has advantages and disadvantages. We suggest using both of these classifications together to increase the accuracy.

Treatment of high hip dislocation with a cementless stem combined with a shortening osteotomy.

INTRODUCTION: The purpose of this study was to review the clinical and radiographic outcomes and report the major complications in a group of hips with Crowe type IV developmental dysplasia that underwent reconstruction with a cementless total hip arthroplasty and a transverse subtrochanteric shortening osteotomy fixed with locking compression plate and screws. METHOD: Fifteen consecutive patients (21 hips) who had coxarthrosis secondary to Crowe Group IV developmental dysplasia of the hip were treated with a cementless prosthesis and a transverse subtrochanteric osteotomy fixed with locking compression plates at a mean age of 41. The mean follow-up period was 5 years. The acetabular cup was placed in the position of the anatomical hip center in every patient. Subtrochanteric femoral shortening osteotomy was fixed with plates and screws in all patients. RESULTS: The mean Harris hip score improved from 36.2 ± 9.8 points to 90.8 ± 2.5 points. Trendelenburg sign was positive in seven hips and two patients complained about continuing anterior thigh pain at the final follow-up. There was no infection. No cases of nonunion were encountered. Two patients had dislocation on early postoperative period (15th and 20th postoperative day). Of these patients, femoral head was changed to 28 mm with stem revision in one patient, and one had acetabular component revision with use of constrained acetabular liner. There was one permanent sciatic nerve palsy. One patient had implant related pain during lying laterally. Plate and screws were removed at postoperative 16th month. CONCLUSION: Cementless total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of patients with Crowe Group IV developmental dysplasia of the hip is an effective technique to reduce the hip to its original acetabular location and restore the rotational deformities. Plate and screw fixation is a viable option for a secure and stable fixation of femoral stem after subtrochanteric osteotomy.

Cosmetic results of wedge resection of nail matrix (Winograd technique) in the treatment of ingrown toenail.

OBJECTIVE: The purpose of this retrospective study is to evaluate the cosmetic results of wedge resection of the nail matrix (Winograd technique) in the treatment of ingrown toenail. MATERIALS AND METHODS: This study retrospectively reviewed medical charts of 68 patients with 75 ingrown toenails who underwent surgical correction with the Winograd technique between January, 2008, and December, 2009, at the Orthopaedics and Traumatology Department, Antalya Education and Research Hospital. For the final follow-up, patients were contacted by telephone and completed a telephone questionnaire. Recurrence, cosmetic results, and satisfaction of the patients were the major outcome measures. RESULTS: There was recurrence in 9 patients (13.2%). The mean recurrence time was 6.7 months (range = 2-12 months). All recurrences involved the lateral border of the toenail. Cosmetic ratings were statistically lower in female patients (P = .005). The reasons for poor and acceptable cosmetic results were proximal-incision scar and narrowing of the nail plate. CONCLUSION: Wedge resection of nail matrix has a considerably high recurrence rate. Furthermore, narrowing of the nail plate is a disadvantage of this procedure. All patients should be informed about the possibility of recurrence and disfigurement in their toenails (narrow nail plate). Particularly, female patients who care about the cosmesis may be dissatisfied with this surgical technique.

Isolated medial cuneiform fractures: report of two cases and review of the literature.

Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures.

Proximal realignment surgery for unilateral chronic patella dislocation in Morquio syndrome: a case report.

Mucopolysaccharidosis IVA (MPS IVA: Morquio A syndrome) is a lysosomal storage disorder caused by a deficiency of N-acetylgalactosamine-6-sulfate sulfatase. Patients with MPS IVA appear healthy at birth. Morquio-specific radiographic changes can be observed prior to clinical signs and symptoms. Patients are usually affected by a severe joint degeneration from the 2nd or 3rd decade. Hyperlaxity of the joints is prominent due to the excess of intermediate metabolites. We report a patient with inherited dwarfism, in which a proximal soft tissue realignment procedure was performed to treat chronic patellar dislocation.

[Midterm results of Oxford phase 3 unicondylar knee arthroplasty for medial osteoarthritis]. / Medial gonartrozda Oxford faz 3 unikondiler diz artroplastisinin orta dönem sonuçlari.

OBJECTIVES: We evaluated midterm results of Oxford phase 3 unicondylar knee arthroplasty (UKA) in patients with medial osteoarthritis. METHODS: Twenty-seven patients (24 females, 3 males; mean age 57 years; range 47 to 73 years) underwent Oxford phase 3 UKA with the diagnosis of medial knee osteoarthritis. All patients had primary osteoarthritis but one with spontaneous osteonecrosis. Nine knees were Ahlback grade 2, and 18 knees were grade 3. All femoral and tibial components were cemented and mobile tibial polyethylene inserts were used in all the patients. Pre- and postoperative evaluations were made using the Knee Society clinical rating system. The mean follow-up was 28 months (range 24 to 36 months). RESULTS: Compared to the preoperative values, significant improvements were obtained in the following at final follow-up (p<0.05): knee flexion (106.4 degrees and 117.4 degrees , respectively), tibiofemoral angle (7 degrees varus and 1 degrees valgus), knee score (47.5 and 78.9), and functional knee score (48.7 and 83.6). Only two patients needed blood transfusion. No major complications occurred including infection, deep vein thrombosis, pulmonary emboli, and neurovascular injury. Two patients underwent revision surgery at postoperative 8 and 10 months, respectively, because of progressive collapse of the tibial plateau. Knee Society clinical scores were excellent or good in 21 (77.8%), moderate in four (14.8%), and poor in two (7.4%) patients. The corresponding figures for functional results were 23 (85.2%), 2 (7.4%), and 2 (7.4%). CONCLUSION: Our results demonstrate that Oxford phase 3 UKA is effective with considerable success in the treatment of medial osteoarthritis.