Intraoperative Neurophysiological Monitoring in Total Hip Arthroplasty for Crowe Types 3 and 4 Hips.

Background: Crowe types 3 and 4 dysplastic hips usually need total hip arthroplasty (THA) with femoral shortening osteotomy (FSO) to facilitate reduction, equalize limb length, and decrease the traction stress in nerves. The frequency of peripheral nerve palsy after primary THA has been reported to range from 0.08% to 3.7%. Apart from direct trauma to the nerve, the excessive extension of the extremity is also reported as a common cause of nerve damage. The current study aimed to evaluate the outcomes of intraoperative neurophysiological monitoring (IONM) in THA for Crowe types 3 and 4 hips. Methods: The data of patients who underwent primary THA with IONM were retrospectively reviewed using our medical records. Patients with Crowe types 3 and 4 dysplastic hips were included in the study. Motor-evoked potentials and somatosensory-evoked potentials were assessed intraoperatively. Preoperative dislocation height and postoperative trochanter minor differences were measured using preoperative and postoperative radiographs. Results: Twenty-three hips of 19 patients (4 bilateral THAs) with a mean age of 45 years participated in the study. Ten hips (43%) were classified as Crowe type 4, whereas 13 hips (57%) were Crowe type 3. The mean preoperative dislocation height was 41.6 mm (range, 15-100 mm). Postoperatively, only 6 patients had a difference between trochanter minor levels with a mean of 8.5 mm (range, 3-17 mm). Three patients underwent a subtrochanteric FSO to achieve reduction. Postoperatively, no patient had any motor and sensory nerve dysfunction. Conclusions: According to the results acquired from this study, no nerve palsy was observed after THA for Crowe types 3 and 4 hips, and subtrochanteric FSO was not performed in all Crowe type 3 hips and 70% of Crowe type 4 hips with the aid of IONM.

A comparison of robotic-assisted and manual techniques in restricted kinematically aligned total knee arthroplasty: coronal alignment improvement with no significant clinical differences.

PURPOSE: The purpose of this study was to compare radiographic and clinical outcomes of robotic-assisted and conventional manual techniques in restricted kinematically aligned TKA. METHODS: Patients who underwent either manual or robotic-assisted restricted kinematically aligned TKA between 2019 and 2020 were included in this retrospective comparative study. Radiographic outcomes comprised coronal plane measurements performed through standing full-length anteroposterior radiographs. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford score, Visual Analog Scale pain and satisfaction score, and Forgotten Joint Score were used to determine the clinical outcome. The continuous data were compared by Student's t test according to the Kolmogorov‒Smirnov normality test. RESULTS: The manual group consisted of 46 patients (38 females, eight males) with a mean age of 68.1 years, and the robotic group consisted of 70 patients (58 females, 12 males) with a mean age of 65.7 years (n.s.). Preoperatively, no significant difference was observed between groups concerning demographic characteristics, radiographic measurements, and clinical scores except for the symptom and pain domains of the KOOS score, which was significantly worse in the manual group (p = 0.011 and 0.035, respectively). At the postoperative 2-year follow-up, we observed significant differences between groups with respect to the mean HKA angle, mMPTA, and mLDFA (p = 0.034, 0.041, and 0.005, respectively). A comparison of clinical scores at the postoperative 2-year follow-up demonstrated no significant differences between groups. CONCLUSION: The current study demonstrated that using robotic-assisted technique for restricted kinematically aligned total knee arthroplasty (TKA) resulted in significantly better outcomes compared to the conventional manual technique in achieving normal ranges of lower extremity coronal alignment measurements. While the robotic-assisted group demonstrated better clinical scores, there was no statistically significant difference in clinical outcomes between the robotic-assisted group and the control group at the two-year follow-up. Concerning clinical relevance, the restoration of original anatomy and coronal alignment, a crucial concern in restricted kinematically aligned TKA, may be better achieved by the robotic-assisted technique. LEVEL OF EVIDENCE: Level III (Retrospective cohort study).

Volumetric Analysis of Subacromial Space After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears.

Purpose: Subacromial volume measurement on magnetic resonance images is relatively new. It has been shown that decreased subacromial volume increases after surgical repair of full-thickness rotator cuff tears. There is no study examining subacromial volume changes after superior capsular reconstruction (SCR). The purpose of this study was to compare subacromial volume changes on magnetic resonance images (MRI) after superior capsular reconstruction performed for primary irreparable rotator cuff tears. Methods: Patients who underwent an SCR procedure between 2017 and 2019 with a minimum 2-year postoperative follow-up were included in this retrospective study. Subacromial volume was measured on MRI using software. The preoperative and postoperative acromiohumeral distance, Constant Scores, graft thickness, and Hamada grades of the patients were evaluated. Results: A total of 18 patients with a mean age of 59.7 years (range: 49-74 years) underwent an SCR for massive irreparable cuff tear. The mean preoperative subacromial volume was 3.54 ± 0.39 cm3 (range 2.88-4.36 cm3), which increased to 4.46 ± 0.39 cm3 (range 3.75-5.32 cm3) postoperatively (p = < 0.001). The increase in subacromial volume and acromiohumeral distance did not correlate with Constant scores and graft thickness. We observed a significantly higher subacromial volume increase among Hamada grade 1 patients, compared to those with Hamada grade 2 (p = 0.011). Conclusions: We observed that subacromial volume significantly increased after superior capsular reconstruction. However, the increase in subacromial volume did not correlate with clinical scores, acromiohumeral distance changes, or graft thickness.Level of evidence: Level III - Retrospective Cohort Study.

Preliminary outcomes of kinematically aligned robot-assisted total knee arthroplasty with patient-specific cartilage thickness measurement.

This study aimed to assess the preliminary outcomes of kinematically aligned robot-assisted total knee arthroplasty (TKA) with patient-specific cartilage thickness measurement. Patients who underwent kinematically aligned robot-assisted TKA were included in this study. Robot-assisted total knee arthroplasties were performed by NAVIO Surgical System (Smith & Nephew, Memphis, USA), an image-free handheld robotic system. The kinematic alignment technique was performed according to our intraoperative cartilage thickness measurement technique. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint-line orientation angle (JLOA), and joint-line convergence angle (JLCA) were measured through standing full-length anteroposterior radiographs. Knee Injury and Osteoarthritis Outcome Score, Oxford score, VAS pain and satisfaction score, and Forgotten Joint Score were used to assess clinical outcomes. A total of 142 knees of 109 patients (92 females and 17 males) were evaluated in this study. There was a significant correction in HKA, JLCA, and mMPTA postoperatively (p ≤0.001, < 0.001, and 0.029, respectively). We observed no significant change in mLDFA and JLOA measurements. All clinical scores significantly increased at the latest follow-up. Our results demonstrated that kinematically aligned robot-assisted TKA with patient-specific cartilage thickness measurement demonstrated no significant change in mLDFA and JLOA, as expected; however, significantly corrected the deformity in HKA, mMPTA, and JLCA measurements.

Prescription of knee braces after anterior cruciate ligament reconstruction: Fact or fiction?

Objectives: This study aims to compare the clinical results of patients rehabilitated with or without a rehabilitative knee brace (RKB) after anterior cruciate ligament (ACL) reconstruction. Patients and methods: This retrospective, comparative study was conducted at between January 2013 and December 2017. A total of 119 patients (112 males, 7 females; mean age: 32.0±8.6 years; range, 18 to 45 years) with acute ACL ruptures treated with arthroscopic ACL reconstruction and rehabilitated with (n=56) or without RKB (n=63) participated in the study. The minimum follow-up time was 24 months. The ACL quality of life (QoL) questionnaire, Lysholm Knee Scoring Scale, and Tegner Activity Level Scale were used for the evaluation of the QoL, knee function, and activity level, respectively. The time to return to sports was recorded. The side-to-side difference in the anterior translation of the tibia was measured using a KT-1000 arthrometer. Results: The mean follow-up time was 38.4±9.1 (range, 24 to 56) months. Baseline demographics and clinical characteristics were similar between groups. Regarding QoL, knee function, and activity level, no significant difference was observed between patients who used RKB and those who did not use it at the postoperative 12th month (p=0.95, p=0.56, p=0.98, respectively) and the latest follow-up (p=0.21, p=0.73, p=0.99, respectively). The mean time to return to sports (nearly 11 months for both groups) and side-to-side difference in the anterior tibial translation at the latest follow-up was also similar between groups (p=0.15 and p=0.15, respectively). There was no graft rupture during the follow-up in both groups. The complication rates were 7.9% and 7.1% for no brace and brace groups, respectively, without a statistically significant difference (p=0.87). Conclusion: According to the results of this study, there was no significant difference between the rehabilitative brace and no brace groups in clinical outcomes after ACL reconstruction.

Cervical and thoracic/lumbar motion and muscle strength in surgically treated adolescent idiopathic scoliosis patients.

BACKGROUND: To date, only one study assessed the spinal mobility and muscle strength of patients who were treated either with fusion or brace treatment. OBJECTIVE: The aim of this retrospective study was to evaluate the range of motion (ROM) and strength of the cervical and thoracic/lumbar spine in patients who underwent spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) in comparison to healthy individuals. METHODS: Patients (n= 28) who were treated surgically for AIS were included in the study. An age and gender matched control group (n= 22) was included that consisted of healthy individuals. DAVID® Lumbar/Thoracic Extension, Lumbar/Thoracic Rotation, and Cervical Extension/Lateral Flexion devices were used to measure cervical and lumbar/thoracic ROM as well as muscle strength. RESULTS: Significant differences were observed between groups in all ROM measurements except thoracic/lumbar sagittal flexion ROM measurement (p= 0.198). There were significant differences between groups in terms of muscle strength, except thoracic lumbar left rotation strength (p= 0.081). CONCLUSIONS: The findings of the current study demonstrated that cervical and thoracic/lumbar range of motion, as well as muscle strength, were significantly decreased in surgically treated adolescent idiopathic scoliosis patients compared to healthy counterparts. However, trunk (thoracic/lumbar) flexion range of motion and trunk left rotation muscle strength were not significantly different.

Open Double-Button Technique is Superior to Hook Plate in the Treatment of Acute Rockwood Type III/V Acromioclavicular Dislocations.

BACKGROUND: The aim of this study is to compare open double-button (DB) and hook plate (HP) techniques in the treatment of acromioclavicular joint dislocation (ACJD) in terms of clinical and radiological outcomes and to determine which method is superior. METHODS: This retrospective comparative study included patients with ACJDs (Rockwood Type III/V) who were treated with one of these implants (22 patients with HP, 21 patients with DB) between June 2014 and February 2018. RESULTS: A total of 43 patients (39 men and 4 women) with a mean age of 41.8±17.4 years have participated in this study. The mean follow-up time was 20.6±7.5 months. Mean times of fluoroscopy, operation, and return to work were shorter in the DB group. Compli-cation rates were 23.8% and 54.6%, reoperation rates (including mandatory implant removals [IR]) were 4.8% and 77.3%, mean constant scores were 92.1±3.4 and 88.3±4.2, and mean Visual Analog Scale scores were 0.8±1.0 and 1.5±1.0 for the DB and HP groups, respec-tively. IR was the main reason for reoperations in the HP group, whereas the DB group's only reoperation was caused by a coracoid cutout (due to coracoid tunnel malposition) leading to redislocation. AC joint arthritis (36.4%) and subacromial osteolysis (31.9%) were com-monly encountered in the HP group. The most frequent complication of the DB group was malreduction (initial undercorrection) (9.6%). CONCLUSION: DB was superior to HP in functional outcome, post-operative pain, complication and reoperation rates, operation and fluoroscopy times, and time to return to work. Besides, reoperation (for IR) was needed in most of the HP patients. Therefore, the open DB technique should be preferential to the HP procedure.

Functional and radiological comparison of three cephalomedullary nails with different designs used in the treatment of unstable intertrochanteric femur fractures of elderly.

BACKGROUND: The aim of this study to compare three cephalomedullary nails (CMNs) with different designs in terms of complica-tion, reoperation, implant failure, mortality rates, and functional outcomes in the treatment of unstable intertrochanteric fractures (UIFs). METHODS: This retrospective study included patients with UIFs (AO/OTA type 31-A2 and 31-A3) who were treated with one of these CMNs (74 patients with Talon-PFN, 70 patients with PFN-III, and 69 patients with Intertan) between October 2014 and October 2018. RESULTS: A total of 213 patients (122 females and 91 males) with a mean age of 81.0±9.3 years have participated in this study. The mean follow-up time was 26.1±6.3 months. Malfixation was the most common complication and the most common reason of reop-eration for each type of CMN. Complication and reoperation rates, post-operative functional status, mean union times, and overall mortality rates were similar between groups. Mean operation/fluoroscopy time and mean blood loss were low in the Talon-PFN group, whereas the highest means of these parameters were in the PFN-III group. There were six (8.2%) implant failures in the Talon-PFN group and one (1.5%) in PFN-III group. No implant failure was seen in the Intertan group. The highest rate (58.6%) of anatomic reduc-tion was detected in PFN-III group. CONCLUSION: Our study results showed that each implant type had its own advantages and disadvantages in the treatment of UIFs with similar functional and reoperation outcomes. Intertan was advantageous with its absence of implant failures. Talon-PFN decreased the operation/fluoroscopy time and intraoperative blood loss but had the highest implant failure rate. There was a need for more anatomic reduction to centralize two separate parallel lag screws in the femoral neck in PFN-III group, and that costs operation/fluo-roscopy time and blood loss. Malfixation, which was the most common cause of complications and reoperations, should be avoided.

For Intramedullary Nailing of Femoral Shaft Fractures, Talon Fixation is Helpful to Cope With the Troublesome Distal Locking, But Conventional Distal Locking With Screws Offers a More Stable Construct. Talon Femoral Nail Versus Conventional Femoral Nail

BACKGROUND: A novel-design femoral nail (FN) with distal talon deployment (Talon-FN) has emerged in the market to cope with problematic distal locking. We aimed to compare the radiological and functional outcomes of the Talon-FN with a conventional FN (Con-FN) for the treatment of femoral shaft fracture (FSFs). METHODS: This retrospective study included 85 patients (57 men, 28 women; mean age: 46.8±23.9 years) with FSFs (AO types 32-A and B) who were treated with FNs (Talon-FN: 41, Con-FN: 44) during October 2014-2018. Knee injury and Osteoarthritis Outcome Score Physical Function Shortform, Hip injury and Osteoarthritis Outcome Score Physical Function Shortform, Short musculoskeletal function assessment bother and dysfunction indexes were used for functional assessment. RESULTS: The mean follow-up time was 25.8±6.7 months. The complication rates were 19.6% and 20.5% for Talon-FN and Con-FN, respectively (p=0.92). Malunion was the most common complication for each FN type (Talon-FN: 9.8%, Con-FN: 9.1%). All of the Talon-FN group's malunions were axial (shortening and malrotation) and happened gradually. In contrast, the Con-FN group's malu-nions were angular (varus and valgus) and caused by initial malreduction. The Talon-FN group's two patients with shortening (4.9%) had AO 32-B type fractures, and the other two with malrotation (4.9%) had AO 32-A3 type fractures, all of four fractures were localized distal to the femoral isthmus. The post-operative functional outcomes were similar between the groups (all p>0.05). The mean op-eration/fluoroscopy time and the mean blood loss were lower in the Talon-FN group, while the mean union time was shorter in the Con-FN group (all p<0.01). No nonunion was noted in either group. The reoperation rates were similar at approximately 5% (p=0.95). CONCLUSION: Our study results revealed that the Talon-FN shortens the operation/fluoroscopy time and decreases the intra-operative blood loss with similar functional outcomes. However, the Con-FN seems to offer a more stable construct against axial malunion with a shorter bone union time. The Talon-FN should not be used in FSFs distal to the femoral isthmus with certain types of fractures prone to shortening and malrotation.

Comparison of Contemporary Surgical Indications for Revision Total Knee Arthroplasty between 2005-2011 and 2012-2017 in a Referral Center.

Background: Different causative factors for revision total knee arthroplasty (TKA) surgeries are elucidated in the arthroplasty registry data of different countries and the patient records at tertiary care centers. We aimed to determine the changes in the causes for revision TKAs before and after 2011 (The year that the Musculoskeletal Infection Society proposed a new definition for periprosthetic joint infection) and the changes in the demographics of patients who underwent revision TKAs during the same time intervals. Methods: Patients who underwent revision TKAs between 2004 and 2017 were evaluated. A total of 291 patients operated before (period 1, n = 139) and after (period 2, n = 152) 2011 were included, while 53 patients with inconclusive diagnoses were excluded. The demographic data of patients and the causes for revision TKAs were collected and compared between the two periods. Results: Infection was the most common cause of revision TKAs during periods 1 (58%) and 2 (48%). Aseptic loosening (46%) and infection (37%) were the 2 most common causes for late revisions during period 2. Aseptic loosening almost doubled during period 2 compared with that in period 1. Age, sex, and body mass index distribution in patients were similar across both the periods. Conclusion: Although the incidence of aseptic loosening has significantly increased since 2011, infection is still the most common cause for revision knee arthroplasty surgery.

Lesion size and varus malalignment are the major determinants leading to poorer clinical outcomes after combined microfracture treatment for focal cartilage lesions during anterior cruciate ligament reconstruction.

The purposes of this study were to evaluate the clinical effects of microfracture (MFX) performed for Outerbridge grade 3 or 4 focal cartilage lesion during the same surgery with arthroscopic anterior cruciate ligament (ACL) reconstruction and to analyze the major determinants of these potential effects on the clinical outcome. The clinical and radiographic data of 119 patients were evaluated. The mean follow-up time was 32.6 ± 6 months. Isolated arthroscopic ACL reconstruction was performed in 70 patients (Group 1), whereas MFX for Outerbridge grade 3 or 4 chondral lesion during ACL surgery was performed in 49 patients (Group 2). Visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the instruments used as outcome measures to evaluate the clinical status of the patients. Routine X-ray and MRI were also performed for all patients pre-operatively as well as at the latest follow-up visit. Lineer regression analysis was performed to determine major factors predicting the poorer clinical outcome. Clinical outcomes were similar between isolated ACL reconstruction and combined procedure. On the other hand, according to lineer regression analysis, cartilage lesion size > 2 cm2 and > 5 degrees of varus alignment were detected as the major determinants leading to poorer outcomes in combined ACL reconstruction and MFX.Level of evidence: III - Retrospective Comparative Study.

An evaluation of the characteristics of orthopedic pediatric traumas during the COVID-19 pandemic lockdown period.

BACKGROUND: The purpose of this study is to investigate the effects of implemented social isolation measures on the characteristics of orthopedic pediatric traumas during this COVID-19 pandemic lockdown period. METHODS: Patients who were admitted at our center between two time periods: April 3, 2019-May 31, 2019 (no lockdown period) and April 3, 2020-May 31, 2020 (lockdown period) were included to the study. Group 1 comprised 743 patients who were treated during no lockdown period, whereas Group 2 comprised 615 patients who were treated during lockdown period. Patients' medical records and radiographs were reviewed through our hospital's computer database. In addition, we recorded each patients' age and gender, their definite diagnosis, the anatomic location of the trauma, the type of trauma (fracture, dislocation, tendon injury, ligament injury, fracture dislocation, open fracture, etc.), the type of pediatric fracture (displaced fracture, torus fracture, epiphyseal fracture, pathological fracture, etc.), and the treatment method (non-operative/operative). RESULTS: The mean age of the patients was significantly lower in Group 2 (p<0.001). There were significant differences between the groups in terms of anatomic locations of the traumas (p<0.001). The types of the traumas, pediatric traumas, and treatment were significantly different between the groups (p<0.001, p<0.001, and p<0.001, respectively). The frequency of operative treatment was significantly higher in Group 2 (p<0.001). CONCLUSION: Our results demonstrated significant differences in patients' demographics as well as trauma characteristics during COVID-19 pandemic.

Evaluation of Serum Interleukin-38 Levels in Different Radiographic Grades of Idiopathic Knee Osteoarthritis.

The aim of this study was to assess interleukin-1ß (IL-1ß), IL-1Ra, IL-36, and IL-38 levels together with hs-CRP levels in patients with different radiographic grades of knee osteoarthritis (OA) in comparison to healthy individuals. Consecutive patients aged over 50 years who were admitted to our Orthopaedics and Traumatology department between November 2018 and March 2019 and diagnosed as knee OA according to the American College of Rheumatology criteria were included in this prospective case-control study. Patients with knee OA were staged according to radiographic Kellgren-Lawrence (K-L) classification and 20 patients were assigned to each group. An age and gender matched control group consisted healthy volunteers with no clinical and radiographic sign of arthritis were conducted as the control group. Venous blood samples were collected and assessed for hs-CRP, IL-1ß, IL-1Ra, IL-36, and IL-38 levels using the double-antibody sandwich ELISA method. The hs-CRP, IL-1ß, IL-36 and IL-38 levels did not significantly differ among controls and independent radiographic stage groups except IL-1Ra levels which was significantly higher in K-L grade 4 knee OA groups compared to healthy controls (P = 0.045). When we compared all patients with knee OA and healthy controls, we detected that IL-1 and IL-1Ra were significantly lower and IL-38 levels were significantly higher in healthy control group compared to patients with knee OA (P = <0.001, <0.001, and 0.019, respectively). According to results obtained from our study, IL-1ß, IL-1Ra, and IL-38 levels significantly differed between healthy individuals and patients with knee OA. However, we did not observe a significant difference and correlation between radiographic grade of knee OA and interleukin levels.

Foot orthoses use for pediatric flexible flatfoot: comparative evaluation of quality of life for children and parents.

This study aimed to comparatively evaluate the quality of life scores of patients with pediatric flexible flatfoot (PFF) according to the use of foot orthoses. We also aimed to compare quality of life scores of children and their parents. Nonobese children aged between 5 and 10 years old who were diagnosed as PFF according to physical and radiological examinations were included in this cross-sectional comparative study. All children and their parents completed the Turkish translation of Oxford ankle foot questionnaire (OxAFQ) which contains four domains (physical, school and play, emotional, and footwear). Patients were grouped according to the use of foot orthoses (group I: no foot orthoses group and group II: foot orthoses group). Comparison of OxAFQ scores demonstrated no significant differences between the two groups. However, the mean emotional scores of parents were significantly lower in group II (P = 0.007). In group I, the mean emotional score of children was significantly lower compared to their parents' scores (P = 0.001). In group II, the mean physical score of children was significantly lower compared to their parents' scores (P = 0.003). According to our results, we observed no significant difference in terms of quality of life scores between children using foot orthoses and not using foot orthoses. However, we observed significantly lower emotional scores in parents whose children were using foot orthoses. We recommend that physicians should be aware of low physical scores in children with PFF and should inform parents about this situation rather than considering foot orthoses to relieve parents' concern about foot deformity.

Femoral stem fractures after primary and revision hip replacements: A single-center experience.

OBJECTIVES: This study aims to present our experience in the management of fractured femoral stems after primary and revision hip replacements by evaluating the clinical and radiographic characteristics and determining the effectiveness of the extraction methods. PATIENTS AND METHODS: A total of 15 patients (5 males, 10 females; mean age 65.9 years; range, 49 to 87 years) who underwent revision hip replacement due to a fractured femoral stem between January 2005 and December 2019 were included in this retrospective study. The mechanisms and risk factors for failure as well as methods applied to extract fractured stem were analyzed through clinical and radiographic data. RESULTS: Nine patients had fractured cemented femoral stems, while six patients had fractured fully porous coated cementless revision stems. Lack of proximal buttress in distally fixed femoral stems was detected in 11 patients and identified as the predominant mechanism resulting in fracture. The proximal extraction method with conventional revision instrumentation, the cortical window technique, and extended trochanteric osteotomy (ETO) were used in three, seven, and five cases, respectively. CONCLUSION: Our results demonstrated that the lack of proximal buttress is the most common reason for femoral stem fracture. Moreover, the proximal extraction method was mostly ineffective in fully porous femoral stems. A step-by-step approach should be considered for the extraction of a broken stem. The cortical window method can be considered as the second step if proximal extraction methods fail, and ETO should be considered at the last step if all techniques fail.

Clinical and Magnetic Resonance Imaging Outcomes of Microfracture Plus Chitosan/Blood Implant vs Microfracture for Osteochondral Lesions of the Talus.

BACKGROUND: The aim of this study was to compare the clinical and magnetic resonance imaging (MRI) outcomes of arthroscopic microfracture (MF) plus chitosan-glycerol phosphate/blood implant and MF alone for the treatment of the osteochondral lesions of the talus (OCLTs). METHODS: Patients who underwent either MF plus chitosan (group 1, n = 32) or MF alone (group 2, n = 31) between 2015 and 2019 in 2 separate time periods were retrospectively analyzed. Visual analog scale (VAS) score and American Orthopaedic Foot & Ankle Society (AOFAS) score were used for clinical evaluation. The magnetic resonance observation of cartilage repair tissue (MOCART) system was used for MRI evaluation. The mean follow-up time was 32 ± 13 months (range, 12-61 months). RESULTS: Postoperatively, we detected significant improvements in both groups in terms of VAS and AOFAS scores. However, we observed no statistically significant difference between groups in terms of clinical scores, except the mean VAS function score, which was significantly higher in group 1 (P = .022). According to MOCART scale, complete repair with the filling of the chondral defect and intactness of the surface of the repair tissue were more common in group 1. However, these parameters did not significantly differ between groups (P = .257 and .242, respectively). CONCLUSION: Arthroscopic MF plus chitosan glycerol phosphate/blood implant did not result in better clinical and MRI outcomes compared with MF alone in the treatment of OCLTs. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Magnetic Resonance Imaging and Outcomes of Osteochondral Lesions of the Talus Associated With Ankle Fractures.

BACKGROUND: Osteochondral lesions of the talus (OCLTs) secondary to ankle fractures have previously been reported in the literature. However, no study has evaluated OCLTs using magnetic resonance imaging (MRI) following ankle fracture treatment. The purpose of our study was to investigate accompanying OCLTs in patients with an ankle fracture and evaluate its relationship with the clinical outcomes. METHODS: Fifty-six patients with ankle fractures who were treated with either a nonoperative or operative method at our center between June 2016 and February 2017 were included in this prospective comparative study (37 men and 19 women; mean age, 44.6 ± 13 years; range, 20-65 years). The mean American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate the clinical results in all patients in the second month and second year. The second-month ankle MR images were evaluated for OCLTs in all patients. Thirty patients were treated operatively and 26 nonoperatively. RESULTS: Accompanying OCLTs were detected in 19 of 56 patients (34%). Our results showed no statistically significant association between OCLT and fracture type, as well as the treatment type. In the second postoperative month, the mean AOFAS scores were 87.2 ± 10.8 and 77.6 ± 12.0 in patients with and without OCLTs, respectively (P = .005). In the second postoperative year, the mean AOFAS scores were 81.3 ± 6.8 and 86.2 ± 8.4 in patients with and without OCLTs, respectively (P = .031). The mean AOFAS score significantly decreased in the OCLT group in the second-year control, whereas a significant increase was observed in patients without OCLTs (P = .026 and P < .001, respectively). CONCLUSION: According to our results, the accompanying OCLTs were found in one-third of patients treated for ankle fractures. We observed a significant correlation between OCLT presence and the AOFAS score. According to the AOFAS score, OCLTs statistically significantly affected clinical results at 2 years. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Does Adductor Tenotomy Need During Closed Reduction Have a Prognostic Value in the Treatment of Developmental Dysplasia of the Hip Between 6 and 12 Months of Age? "Adductor Tenotomy in the Treatment of Developmental Dysplasia''.

BACKGROUND: Adductor tenotomy is needed for clinically complex hips with soft-tissue contractures. It may be proposed that the patients who need adductor tenotomy during closed reduction would have poorer prognosis than the ones without need for adductor tenotomy. The main purposes were to compare the normalization of acetabular index angle (AI), to determine the incidence of femoral head avascular necrosis (AVN), and to predict the need for any secondary surgical intervention between the patients who need adductor tenotomy and those who do not during closed reduction for developmental dysplasia of the hip. MATERIALS AND METHODS: The study group consisted of 65 hips treated between 6 and 12 months of age. The mean age at the time of surgery was 8.1 ± 1.4 (6-12) months and the mean follow-up was 4.2 ± 1.5 years. Improvement of AI, rate and severity of AVN, and need for secondary surgery with its predictors were evaluated. RESULTS: Adductor tenotomy was performed in 22 hips (Group 1), but not in 43 hips (Group 2). Normalization of the AI was - 14.8° ± 3.5° versus - 14.3° ± 3.2°. The overall incidence of AVN was 18.4%. The rate of secondary surgical intervention was higher in Group 1 (63.1% versus 36.9%) (p = 0.014). CONCLUSIONS: No significant difference was detected regarding the improvement of AI as well as the incidence of AVN between the groups. The need for adductor tenotomy during closed reduction was one of the main predictors of the possible secondary surgery.

Clinical outcomes of iatrogenic complex clubfoot treated with modified Ponseti method.

INTRODUCTION: There are not enough studies demonstrating the results of the modified Ponseti method on iatrogenic complex clubfoot that occurs due to errors during the application of the method for treating idiopathic clubfoot. The present study aimed to present the treatment results of the modified method reported by Ponseti for treating feet that became complex solely due to errors during casting. METHODS: Patients with the confirmed diagnosis of iatrogenic complex clubfoot were according to initial physicians' report and photographs were included in this retrospective case series study. Patients with congenital atypical feet, incomplete medical records, and accompanying pathologies were excluded from the study. Patients' clinical data and clinical scores were recorded at the initial visit and at the latest follow-up. RESULTS: There were 21 children (15 boys and 8 girls) with 32 complex clubfeet. Initial correction was achieved in all children, with an average of five serial casts (range 3 to 6 casts). At the last follow-up, ISGCF score of 25 feet (78.1%) was excellent and seven feet (21.9) was good. CONCLUSION: According to the results acquired from this study, an iatrogenic complex clubfoot can be successfully treated using the modified Ponseti method.

Clinical and radiological outcomes of patients treated with the talon distalfix proximal femoral nail for intertrochanteric femur fractures.

BACKGROUND: The Talon™ DistalFix™ Proximal Femoral Nail (Talon-PFN) is a new proximal femoral intramedullary nail designed for the treatment of intertrochanteric femoral fractures. This study aimed to report the clinical and radiological outcomes of patients treated using a proximal femoral intramedullary nail with a novel design. METHODS: Patients with either stable or unstable (AO/OTA type 31-A1, 2, 3) intertrochanteric fractures who were treated with the Talon-PFN between October 2014 and January 2018 in our department participated in this retrospective study. Patients' demographics, clinical characteristics, and functional and radiographical outcomes were evaluated. RESULTS: A total of 110 patients (65 females, 45 males) with a mean age of 80.6 ± 9.1 years participated in this study. The mean follow-up time was 24 ± 13.4 months. The overall mortality rate during follow-up was 50.48%. The most common perioperative complications were a malposition of the femoral neck screw and talon cutout, both of which occurred in 17 patients (15.5%). The most common complications observed during follow-up were a lesser trochanter nonunion/malunion in 34 patients (30.9%), valgus malunion in 18 patients 16.4%), lateral screw migration in four patients (3.6%), and varus malunion in 15 patients (13.7%). A late screw cutout through the femoral head was seen in four patients (3.6%). At least one complication was detected in 53 patients (48.2%). However, revision surgery was performed in only six of these cases (5.5%). CONCLUSION: According to the results obtained in this study, the Talon-PFN, which has similar clinical and radiological outcomes compared to other proximal femoral intramedullary nail designs according to the reported studies, can be a suitable alternative in the treatment of intertrochanteric fractures.