Fracture line and comminution zone characteristics, and rotator cuff footprint involvement in OTA/AO 11C3-type proximal humeral fractures: complex proximal humerus fracture map.

PURPOSE: To identify fracture characteristics and zones of comminution as well as the relationship with anatomic landmarks and rotator cuff footprint involvement in OTA/AO 11C3-type proximal humerus fractures. METHODS: Computed tomography images of 201 OTA/AO 11C3 fractures were included. Fracture lines were superimposed to a 3D proximal humerus template, created from a healthy right humerus, after fracture fragment reduction on 3D reconstruction images. Rotator cuff tendon footprints were marked on the template. Lateral, anterior, posterior, medial, and superior views were captured for the interpretation of fracture line and comminution zone distribution as well as to define the relationship with anatomic landmarks and rotator cuff tendon footprints. RESULTS: A total of 106 females and 95 males (mean age = 57.5 ± 17.7 [range 18-101] years) with 103 C3.1-, 45 C3.2-, and 53 C3.3-type fractures were included. On the lateral, medial, and superior humeral surfaces, fracture lines and comminution zones were distributed differently in 3 groups. Tuberculum minus and medial calcar region were significantly less severely affected in C3.1 and C3.2 fractures than C3.3 fractures. The supraspinatus footprint was the most severely affected rotator cuff footprint area. CONCLUSIONS: Specifically defining the certain differences for repeatable fracture patterns and comminution zones in OTA/AO 11C3-type fractures and the relationship between the rotator cuff footprint and the joint capsule may contribute to the decision-making process of surgeons.

Fracture lines and comminution zones of traumatic sacral fractures.

BACKGROUND: Sacral fractures are uncommon and understanding three-dimensional morphology is needed to obtain proper treatment. The purpose of this study was to identify the repeatable fracture patterns and comminution zones for traumatic sacral fractures and create fracture maps. METHODS: Computerized tomography images of 72 patients with traumatic sacral fracture were included in the study. For each fracture, fracture lines were identified and digitally reduced. All fractures were superimposed over a template and fracture maps; comminution zones and heatmaps were created for each zone. RESULTS: There were 40 males and 32 females with a mean age of 46.5±19.9. Fifty-three (73.6%) patients sustained major trauma, and 19 (26.4%) had minor trauma. There were 37 (51.4%) Zone 1, 22 (30.6%) Zone 2, and 13 (18.1%) Zone 3 fractures. Each Denis zone showed certain fracture patterns. In Zone 1 fractures, most of the fracture lines were vertical and oblique (up to 45°) orientation on both sides. In Zone 2 fractures, fracture lines were concentrated on the S1 and S2 levels. Anterolateral and posterolateral parts of the sacrum were less affected in right-side fractures. In Zone 3 fractures, fractures were concentrated in S1, S2, and S3 levels around the sacral canal. The median sacral crest and midline remained mostly unaffected. CONCLUSION: Sacral fractures showed specific repeatable patterns for each zone. These findings may be helpful for pre-operative planning, placement of fixation material, design of new implants, and modification of current fracture-classification systems.

Less malunion and shorter bone union time with titanium elastic nail treatment for isolated femoral shaft fractures in three- to six-year-old children.

PURPOSE: Titanium elastic nail (TEN) is a good option for femoral shaft fractures in school-age children, whereas a spica cast is favored for younger patients. We aimed to compare these treatment modalities in a group of children aged three to six years. METHODS: 34 patients aged 3-6 years with an isolated closed femoral shaft fracture treated with TEN or one-leg spica cast immobilization were retrospectively assessed. Age, gender, weight, mechanism of injury, hospital stay time, bone union time, radiographic shortening, malunion, and complications were compared between the treatment groups. RESULTS: 16 (47.1%) patients who were treated with TEN (Group T) and 18 (52.9%) patients with spica casting (Group S) were included with a mean of 51 (24-94) months follow-up. The mean age was 4.98 years and statistically similar between both groups (mean, 5.2 vs. 4.8 years; p = 0.234). The patients in Group T were heavier (mean, 19.3 vs. 17.2 kg; p < 0.001) and were more likely to have a higher-energy mechanism of injury (p = 0.006). The mean late femoral shortening of Group S patient's was 6.5 ± 3.5 mm and significantly higher than Group T, which was 2.0 ± 2.9 (p = 0.050). However, effective late femoral shortening rates were not statistically different between groups (p = 0.347). Malunion was seen in six (33.3%) patients in Group S, whereas none of the patients in Group T had malunion at the last follow-up examination and were statistically different (p = 0.011). CONCLUSION: Our study identified radiographic evidence favoring TEN over spica cast immobilization in treating preschool-age children with an isolated femoral shaft fracture in terms of malunion.

Forearm Compartment Pressure Change in Children Operated for Supracondylar Humerus Fracture.

BACKGROUND: The aim of this study is to examine the preoperative and postoperative forearm compartment pressures in patients treated operatively for Gartland type III extension type supracondyler humerus fractures and understand the course of these values over postoperative period. METHODS: Deep volar compartment pressure of 31 patients were measured in the proximal one third of the forearm preoperatively, and measurements were continued every 4 hours for the first 24 hours after the operation with a catheter. Type of the reduction technique (open reduction vs. closed reduction), duration of surgery, the time from the injury to surgery were all evaluated. RESULTS: In the measurements made immediately after the operation (0 h), a sudden increase in the compartment pressure was detected in all patients (15.0±5.9 to 27.9±7.5 mm Hg) independent of the reduction technique and gradually decreased over time. The mean compartment pressure at the 12th hour postoperatively was higher in the open reduction group than in the CR group (24.5±3.4, 20.7±6.7 mm Hg, respectively) ( P =0.044). The mean preoperative compartment pressure was 17.7±5.8 mm Hg in patients with a time from injury to surgery longer than 12 hours, and 12.4±4.8 mm Hg in patients with 12 hours or less ( P =0.006). The postoperative 0-, 12-, and 20-hour pressure values were higher in the >1 hour operation time group than in the ≤1 hour group and the differences were statistically significant ( P =0.046, 0.016, and 0.032, respectively). CONCLUSIONS: In pediatric supracondylar humeral fractures, those who underwent open reduction had higher preoperative and postoperative compartment pressures. The reduction attempt was found to be a factor that increased the compartment pressure and after the operation, the compartment pressure values decrease gradually. Prolonged operative time (>1 h) and increased time from injury to operative fixation (>12 h) were associated with higher compartment pressures. LEVEL OF EVIDENCE: Level II-prospective study.

The effect of postoperative sling immobilization and early mobilization on clinical and functional outcomes after arthroscopic rotator cuff repair: A propensity score-matched analysis.

BACKROUND: Optimal postoperative management is controversial after arthroscopic rotator cuff repair (ARCR). OBJECTIVE: The aim of the study was to evaluate outcomes of patients with and without postoperative sling immobilization after undergoing arthroscopic RCR rotator cuff repair. METHOD: 369 arthroscopic full thickness superior rotator cuff tears (RCT) with a minimum follow-up of 6 months were included in this study. Propensity score matching was performed for age, sex, BMI, and tear size. Pain (VAS score), shoulder range of motion (ROM), functional outcome (ASES, Constant-Murley [CM] and Oxford shoulder score [OSS]), and health related quality of life (SF-36) scores were compared between patients with and without sling immobilization. RESULTS: According to the propensity match score, 92 patients (50 sling immobilization and 42 no sling immobilization) were matched to be almost identical in age (62.5 ± 8.0 vs. 61.8 ± 5.9), sex (female 78% vs. 76.2%), BMI (28.1 ± 2.8 vs. 27.8 ± 2.6), and tear size (2.7 ± 1.1 vs. 2.9 ± 0.8). The postoperative physical functioning domain of SF-36 scores was found to be significantly higher in the no sling group (p= 0.034). CONCLUSION: Early mobilization after arthroscopic small and medium sized full thickness superior rotator cuff repair is associated with improved ROM and quality of life scores.

Correlation between Harris, modified Harris hip, and Oxford hip scores of patients who underwent hip arthroplasty and hemiarthroplasty following hip fracture.

BACKGROUND: Harris hip score (HHS), modified HHS (MHHS), and Oxford hip score (OHS) were designed to determine the functional outcomes after primary total hip arthroplasty (THA). The aim of this study was to evaluate the correlation between MHHS, HHS, and OHS in different populations of arthroplasty such as primary THA, revision THA, THA for Crowe Type IV developmental dysplasia of the hip (DDH), and hip hemiarthroplasty (HA). METHODS: A total of 399 patients (254 females and 145 males) that included 128 cases of primary THA, 36 of revision THA, 200 of HA, and 35 of THA with femoral shortening osteotomy with a minimum of 24 months of follow-up were included. HHS, MHHS, and OHS were calculated for each patient and the correlation between theses scores was evaluated for each subgroup. RESULTS: The overall mean age was 67.5±14.3 years. The mean HHS, MHHS, and OHS were 74.9±17.9, 75.7±18.7, and 38.7±12.5, respectively. A very strong correlation was observed between HHS and MHHS (r=0.995, p=0.000) as well as between HHS and OHS (r=0.845, p=0.003) in the general study population. In subgroup analysis, there was a very strong correlation between HHS and MHHS in primary THA, revision THA, THA in hip HA, and Crowe Type IV DDH groups (r=0.984, p=0.000; r=0.977, p=0.000; r=0.984, p=0.000; and r=0.995, p=0.000; respectively). However, there was a significant correlation between HHS and OHS in these groups except revision THA group (r=0.851, p=0.023; r=0.587, p=0.069; r=0.989, p=0.002; and r=0.965, p=0.000; respectively). CONCLUSION: This is the first study to investigate the usefulness of MHHS and OHS in hip HA and THA in patients with Crowe Type IV DDH. Our findings suggest that MHHS and OHS are useful for evaluating functional outcomes with HA, primary and revision THA, and THA with femoral shortening osteotomy for Crowe type IV DDH.

The effect of watching shoulder ROM changes on functional outcome and quality of life following arthroscopic rotator cuff repair.

PurposeThis study aimed to evaluate the effectiveness of watching video records of their shoulder motion changes on functional outcomes and quality of life after arthroscopic rotator cuff repair (ARCR). Methods The patients were divided into two groups. In Group 1, video records of pre- and postoperative shoulder motions were recorded and showed. In Group 2, no video was showed to the patients. In Group 1, the first postoperative evaluation was done before video watching, and the second evaluation was done just after watching video records. In Group 2, the first and second postoperative measurements were performed with 10-20 days interval. The Constant Murley score (CS), the American Shoulder and Elbow Surgeons score (ASES), the Short-Form 36 (SF-36) score, and active shoulder range of motion (ROM) values were used as an outcome tool. Results A total of 196 patients (Group 1; 76 patients and Group 2; 120 patients) with a mean age of 62.06 ± 7.17 years were included. There was a significant improvement in postoperative scores of SF-36 subscales (except emotional well-being and energy/fatigue), ASES, CM scores, and joint ROM values when compared to preoperative values for both groups (p < .001). The first postoperative outcomes were similar between groups (p > .05). In the second postoperative evaluation, emotional role functioning, energy/fatigue, emotional well-being, health change subscales of SF-36, and ASES scores were significantly higher in Group 1 compared with Group 2 (p < .05). Conclusion When patients watch the pre- and postoperative video records of their shoulder ROM after ARCR, patients' satisfaction and well-being perception increase in the short-term despite unchanged shoulder ROM.

Comparison of Computed Tomography, Traction, and Inverted Grayscale Radiographs for Understanding Pilon Fracture Morphology.

BACKGROUND: There have been no studies evaluating the usefulness of grayscale radiographs in extremity fractures. We aimed to compare the ability and reliability of traction radiographs vs traction grayscale inversion radiographs to detect fracture fragment and comminution zones in comminuted tibia pilon fractures. METHODS: Plain radiographs and grayscale inversion images of 60 patients with Orthopaedic Trauma Association/AO Foundation type C3 fracture were evaluated by 20 observers (15 orthopaedic surgeons and 5 radiologists) after traction had been applied. The anterolateral, posterolateral, and medial malleolar fragments, as well as the lateral, central, and medial column comminution zones, were identified by all physicians. Computed tomography scan images were used as the "gold standard" against which plain radiographs and grayscale inversion image interpretation were measured. Intra- and interobserver reliability and correct identification of fracture fragments and comminution zones were evaluated. RESULTS: The interobserver reliability for 3 of the fracture fragments and comminution zones on the traction plain radiographs was moderate, whereas it was substantial on traction grayscale inversion radiographs. The lateral comminution zones (P = .001) and presence or absence of posterolateral fragments (P < .001) were significantly better identified in grayscale inversion radiographs compared to standard radiographs. CONCLUSION: After traction was applied, we found grayscale inversion radiographs are superior to plain radiographs in the identification of posterolateral fragment and lateral zone of comminution in comminuted intraarticular pilon fractures. LEVEL OF EVIDENCE: Level III, retrospective case series.

A comparison of clinical, radiological, and quality-of-life outcomes of double-plate internal and Ilizarov external fixations for Schatzker type 5 and 6 tibia plateau fractures.

PURPOSE: To compare clinical, functional, and radiological outcomes in patients with bicondylar tibial fractures treated with either double-plate or Ilizarov external fixation. METHODS: Patients with Schatzker type 5 and 6 tibial plateau fractures who were treated with double-plate (Group O) and Ilizarov external fixations (Group E) between March 2012 and April 2018 were selected. Demographic data and preoperative, intraoperative, and postoperative variables were analyzed and compared. In the last follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Knee Society Score-Knee (KSS-Knee), KSS-Function (KSS-F), and Short-Form Health Survey (SF-36) were used to measure clinical and functional outcomes. Treatment costs and complication rates were also recorded and compared. RESULTS: A total of 64 patients (43 men and 21 women) were included in the study (group O: 36, group E: 28). WOMAC, KSS-F, KSS-Knee, and OKS scores were similar between the two groups (P > 0.05). The role limitations due to emotional problems, emotional well-being, and social functioning domains of SF-36 were higher in group O (P < 0.001). Three (8.3%) deep infections occurred in group O, whereas no deep infection was observed in group E (P = 0.035). The treatment cost was higher in group O (P < 0.001). CONCLUSION: In bicondylar tibial plateau fractures, functional outcomes of ORIF and Ilizarov method milar were sibut, role limitations due to emotional problems, emotional well-being and social functioning domains of SF-36 score were higher in ORIF group. However, Ilizarov method is more cost-effective and related with lesser complications.

Impact of the COVID-19 pandemic on orthopedic fracture characteristics in three hospitals in Turkey: A multi-center epidemiological study.

OBJECTIVES: The aim of this study was to evaluate the impact of novel coronavirus-2019 (COVID-19) on the epidemiological characteristics of orthopedic fractures. PATIENTS AND METHODS: A total of 2,960 patients (1,755 males, 1,205 females; mean age: 39.6 years; range, 1 to 98 years) with orthopedic fractures were included in the study: 552 patients during the pandemic period (March 10th and July 1st, 2020) and 1,158 control patients in the same period 2019 and 1,250 control patients in 2018. Epidemiological characteristics, injury mechanisms, fracture locations and treatment details of the patients were analyzed and compared between 2018, 2019 and 2020 for adult and pediatric populations. RESULTS: Of a total of 552 patients, 485 were adults and 67 were pediatric patients. In the control groups, of 1,158 patients (2019), 770 were adults and 378 were pediatric patients and, of 1,250 patients (2018), 857 were adults and 393 were pediatric patients. The proportion of proximal femur and hand fractures significantly increased during the pandemic period (p=0.025 and p=0.038, respectively). The most frequent surgical indication in the pandemic period was proximal femoral fracture. The proportion of home accidents as an injury mechanism significantly increased in the pandemic period compared to 2018 and 2019 (48.5% vs. 18.6% and 20.6%, respectively; p=0.000). The proportion of female pediatric patients significantly increased during the pandemic period compared to 2018 and 2019 (44.8% vs. 25.4% and 27.2%, respectively, p=0.004). The proportion of forearm fractures (p=0.001) also increased, and the proportion of tibia-fibula fractures (p=0.03) decreased. The most frequent surgical indication in pediatric patients was distal humeral fracture in both groups. CONCLUSION: During the pandemic period, proximal femoral fractures in the elderly remained a concern. In-home preventative strategies may be beneficial to reduce the incidence of hip fractures in the elderly.

Effect of muscle atrophy and fatty infiltration on mid-term clinical, and functional outcomes after Achilles tendon repair.

OBJECTIVES: Muscle atrophy is one of the most common problems after Achilles tendon repair. The aim of this study was to evaluate the effect of gastrosoleus muscle atrophy and fatty infiltration on clinical, and functional outcomes after Achilles tendon repair. MATERIAL AND METHODS: A total of 46 patients (mean age = 39.3 ± 7.4 years) who underwent open Achilles tendon repair were included in the study. During the clinical evaluation of muscle atrophy, ipsilateral and contralateral calf circumference (CC), maximum heel rise (HR), and ankle range of motion measurements were recorded. Functional outcomes were assessed via The Achilles tendon Total Rupture Score (ATRS), the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Leppilahti score. Muscle volume (MV), cross-sectional area (CSA), and percent of fatty infiltration (FI) were measured via magnetic image resonance. RESULTS: The functional outcome scores were excellent: ATRS = 98.1 ± 2.2; AOFAS = 97.3 ± 4.1; Leppilahti score = 95.8 ± 5.1. There were significant differences detected between injured and non-injured legs regarding CC, HR, MV, CSA, and FI. Additionally, there were significant negative correlations between CSA and MV loss with all functional outcome scores. FI was correlated with only the AOFAS ankle-hindfoot score. CONCLUSIONS: Significant muscle atrophy was measured after a mean follow-up period of 7.4 (range 2.0-12.6) years post-surgery and negatively correlated with clinical outcomes. CC is an easy and cost-effective measurement method to predict MV during the follow-up of Achilles tendon repairs.

Minimally invasive plate osteosynthesis for short oblique diaphyseal tibia fractures: does fracture site affect the outcomes?

OBJECTIVE: To report the results of patients with short oblique diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO). The secondary aim was to understand the effect of fracture location (midshaft or distal 1/3) on outcomes. METHODS: Twenty-eight patients with short oblique (>30°) tibial shaft fractures (AO/OTA 42A2) treated with plate and MIPO technique between 2015 and 2019 were retrospectively assessed. Age, gender, follow-up time, fracture type (open or closed), operation time, postoperative infection rate, union time, ankle joint range of motion, and complications were analyzed. Patients' radiographs at a minimum 1-year follow-up were evaluated for malunion, nonunion, and implant-related complications. RESULTS: Mean age and follow-up time were 47.0 ± 15.7 years and 18.3 ± 12.1 months, respectively. Mean bone union time was 3.66 ± 1.04 months in middle 1/3 diaphysis and 4.23 ± 1.48 months in distal 1/3 tibia fractures. Seven (25%) patients developed superficial infections. Mean union time, malunion rate, coronal and sagittal angulation, operation length, and infection rate were similar between the groups. CONCLUSION: MIPO is an effective method for treatment of short oblique diaphyseal tibia fractures, and results in few complications. Both distal and midshaft fractures have similar union and malunion rates.

Treatment of Periarticular Fractures of the Knee Using the Less Invasive Stabilization System: A Retrospective Clinical Trial.

Introduction Periarticular fractures of the knee in adults are generally treated with internal fixation. The Less Invasive Stabilization System (LISS) plate, developed by Arbeitsgemeinschaft Osteosynthesefragen (AO)/Association for the Study of Internal Fixation (ASIF) in the late 1990s, allows reduction and biological fixation through smaller incisions without violating periosteal blood supply. It offers several advantages for the treatment of complex periarticular fractures of the knee. In this study, we have aimed to report the results of a single series of these fractures. Materials and methods Forty-eight patients with AO type 33 and AO type 41 periarticular knee fractures who were operated between 2009 and 2014 at a single institution were included in this retrospective study. Patient demographics, fracture epidemiology, intraarticular extension, concomitant injuries, American Society of Anesthesiologists (ASA) score, time to union, the average time from admission to surgery, and the mean time from operation to patient discharge were noted. The effect of patient and fracture-related factors on length of hospital stay were evaluated. Results The mean follow-up time was 23.7 (12-48) months. The average time from admission till surgery and from surgery till discharge was 10.2 (1-39) and 9.7 (2-35) days, respectively. The average time for union was 6.8 months. Femur fractures healed in mean 6.6 months whereas tibia fractures took 7.1 months to heal. Time from admission to surgery and postoperative hospital stay was longer in patients with higher ASA scores (p<0.01) and open fractures (p<0.001). Patients' body mass index (BMI) and intraarticular extension of the fracture did not cause an increase in either preoperative or postoperative hospital stay (p>0.05). The presence of concomitant major injuries caused a delay in operation (p<0.05), whereas postoperative hospital stay was not different (p>0.05). Conclusion LISS plating provides good stability through a small incision, permits biological fracture healing, may be used in multifragmentary fractures and has low complication rates. It is a good alternative for the treatment of periarticular fractures of the knee.

Delayed or neglected meniscus tear repair and meniscectomy in addition to ACL reconstruction have similar clinical outcome.

PURPOSE: To compare the clinical outcomes of meniscus repair and meniscus resection with concurrent anterior cruciate ligament (ACL) reconstruction in patients with ACL rupture and neglected or delayed medial meniscus tears. METHODS: Thirty patients with ACL ruptures and unstable vertical longitudinal medial meniscus tears were included. Patients were divided into two groups. Group I included 15 patients who underwent meniscal repair and Group II included 15 patients who underwent meniscectomy. The knee range of motion, McMurray test, Lachman test, pivot shift test, Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) Questionnaire, Hospital for Special Surgery (HSS) Knee score, and Tegner activity (TA) scale were used to assess all patients. RESULTS: The median follow-up time was 3.6 (0.5-6.5) years. Median age was 28 (16-36) years. Fourteen patients (93.3%) in Group I and six patients (40%) in Group II returned to their preinjury sport activity level (P = .007). Median maximum knee flexion was 132° (121°-140°) in Group I and 134° (121°-139°) in Group II (n.s.). All patients had full knee extension and negative McMurray test results. Lachman and pivot shift test results were similar between groups. The median IKDC Questionnaire score was 99 (86-100) in Group I and 93 (70-100) in Group II (P = .016). The difference in Lysholm Knee Scoring Scale, HSS knee, and TA scale score between groups were not significant. CONCLUSION: Clinical outcomes of patients that underwent meniscus repair were better than those that underwent meniscus resection with concurrent ACL reconstruction. The technically complicated and costly meniscus repair may achieve better clinical outcomes than meniscectomy when treating a neglected or delayed meniscal tear with a concurrent ACL tear. LEVEL OF EVIDENCE: III.

The comparison of the results after spinal fusion with or without iliac screw insertion in the treatment of neuromuscular scoliosis.

INTRODUCTION: Neuromuscular scoliosis leads to a wide range of spinal disorders which disturb the musculoskeletal system. The aim of this study is to compare the clinical and radiological results of posterior spinal fusion with and without extending the instrumentation to iliac bones in treatment of neuromuscular scoliosis. METHODS: Medical records and radiographies of 36 patients with neuromuscular scoliosis who underwent posterior instrumentation between 2011 and 2015 were reviewed. Age and body mass index at time of surgery, underlying diagnosis, gender, postoperative infection rates, perioperative and postoperative blood transfusion, duration of surgery, complication rates were identified for each patient retrospectively. SF-36 physical questionnaire was applied to all patients. Surgery was performed in each patient and included posterior spinal fusion with pedicle screws from the proximal thoracic spine (T2 or T3) to S1 (Group A) or extension of distal instrumentation to pelvis by bilateral iliac screws (Group B). RESULTS: A total of 23 patients in group A were compared with 13 patients in group B. Median age was 14 (9-38) years for group A and 16 (12-25) years for group B. Median follow-up period was 20 (12-66) months. Preoperative median Cobb angles were 66° and 60° and postoperative Cobb values were 33° and 31° in group A and B respectively. Median Cobb angle reduction was 40° and 34° for group A and B. We are able to see in this study that the usage of illiac screws do not increase implant failure and help achieve better functional results. CONCLUSION: This study shows that the extention of instrumentation to the pelvis with illiac screws can be beneficial in terms of functional and complicational incidences. LEVEL OF EVIDENCE: Level III, therapeutic study.

Total hip arthroplasty for acetabular fractures: "Early Application".

BACKGROUND: The aim of this study was to evaluate the functional and clinical results of early total hip arthroplasty performed to treat acetabulum fracture. METHODS: Evaluation of 17 patients who were diagnosed with acetabulum fracture and treated with early total hip arthroplasty between January 2008 and October 2013 was performed. In all, 14 patients were male, and 3 were female, with mean age of 52 years (range: 29-80 years). Time elapsed between trauma and operation was mean of 13 days (range: 2-21 days). Observation period was average of 48.2 months (range: 24-70 months). Mean Harris Hip Score was 89.6 (range: 70-100). RESULTS: In 13 patients, score was good or excellent. Total of 7 of 10 patients had returned to their pre-trauma jobs. Mean length of time for return to work was determined to be 7.2 months (range: 1.5-24 months). Of the total, 9 (52.9%) patients were diagnosed with heterotopic ossification according to Brooker Classification. CONCLUSION: After acetabulum fracture, early total hip arthroplasty with the correct indications and appropriate patient can result in functional, pain-free hip joint with the advantages of early mobilization, early return to work, and decrease in reoperation risk. Heterotopic ossification prophylaxis should be considered in the presence of 1 or more risk factors, such as a head injury, high-energy trauma, or associated musculoskeletal injuries.

Short-term results of the management of severe bone defects in primary TKA with cement and K-wires.

OBJECTIVE: The aim of this study was to evaluate the results of cement and kirschner wire augmentation in the management of bone defects in primary TKA. METHODS: Twenty-four patients (10 male, 14 female; mean age: 66 years) with uncontained unilateral medial tibial articular bone defect who underwent TKA between 2010 and 2014 were included in this study. The average follow up time was 33.7 months. Patients were divided to two groups according to the size of the bone defect (Group 1: <20 mm, Group 2: >20 mm). The tibial defect was reconstructed by using cement and K-wires. We used posterior stabilized prosthesis with no tibial stem extension. RESULTS: The preoperative and postoperative lower extremity mechanical axis in Group I was in a mean varus of 15° and mean varus of 3°, respectively (p < 0.001). The preoperative and postoperative lower extremity mechanical axis in Group 2 was in a mean varus of 20° and mean varus of 3° respectively in Group II (p < 0.001). None of the patients neither suffered from failure of K-wires nor loosening. CONCLUSION: The use of cement and K-wires augmentation appears to be a simple and cost-effective treatment option for the tibial bone defects in primary TKA. LEVEL OF EVIDENCE: Level IV, Therapeutic study.