Snapping scapula syndrome caused by subscapular osteochondroma.

OBJECTIVES: This study aims to evaluate the results of surgical excisions of subscapular exostoses which caused snapping scapula syndrome. PATIENTS AND METHODS: Between September 1980 and January 2010 30 patients with scapular osteochondromas which caused snapping, were treated surgically in our clinic. Fifteen patients (9 males, 6 females; mean age 15.6 years; range 6 to 29 years) in whom we were able to contact following treatment were clinically evaluated. The mean follow-up was 13.7 years (range 1 to 31 years). The initial examination included radiographs and computed tomography. The clinical results were evaluated with a simple shoulder test at their last follow-up. RESULTS: The preoperatively most common complaint was winging of the scapula in all patients (100%), followed by pain in 12 patients (80%), and crepitus with scapulothoracic motion in 10 patients (66.6%). None of the patients had any clue in favor of snapping after surgical treatment. According to the responses to the simple shoulder test, none of the patients had any restriction of motion on their operated shoulders. They didn't give us a history about recurrence of the lesion. CONCLUSION: Excision is an appropriate treatment for osteochondromas. In this retrospective analysis, complete relief following excision of the exostosis was achieved in all patients. No patient had any complaint or recurrence.

Ponseti management of clubfoot after walking age.

BACKGROUND: With an incidence of 1-2 per 1000 live births, clubfoot is one of the commonest congenital deformities. Deformity has four components: equinus, hindfoot varus, forefoot adductus, and cavus. The Ponseti method for the treatment of clubfoot has been shown to be effective in children up to one year of age. Even with this effective method, late-presenting cases are still challenging. The aim of this study is to evaluate the corrective effect of the Ponseti method on different components of clubfoot after walking age and to find how the patient's age relates to this correction. METHODS: From 2003 to 2005 we treated 31 feet of 27 patients with clubfoot with a mean age of 21 months (12-72 months) with the Ponseti method. Average follow up was 42 months. All of the patients were evaluated before and after treatment for Dimeglio scores. Patients in the first group, aged less than 20 months, were compared with those in the second group, who were older than 20 months. The corrections for each component of the deformity were analyzed separately. RESULTS: All deformities showed significant correction. Improvements for each separate component were found to be statistically significant. Patients older than 20 months improved less for the components of varus, medial rotation of calcaneopedal block and adductus compared to younger patients. CONCLUSIONS: The Ponseti method is effective in correcting deformities of clubfoot, even after walking age, but affectivity may decrease with age.

Intermediate-term results after uncemented total hip arthroplasty for the treatment of developmental dysplasia of the hip.

OBJECTIVES: We aim to evaluate the restoration of the hip and limb length in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH) using total hip arthroplasty (THA). PATIENTS AND METHODS: Between February 1996 and September 2001, 65 hips in 55 patients (2 males, 53 females; mean age 48.6 years; range 37 to 60 years) with advanced osteoarthritis secondary to DDH underwent uncemented THA. According to the Hartofilakidis classification, 20, 27, and 18 hips were evaluated types I (dysplasia), II (subluxation), and III (dislocation), respectively. All of the acetabular cups were reconstructed in the original anatomic location. Structural autografts were used in seven hips to supplement the acetabular coverage. We evaluated all patients clinically and radiographically. RESULTS: All of the patients were followed up for 7-12 years. Preoperatively, the Harris score averaged 52.5, 48.41, and 45.28 in types I to III, respectively. At the final follow-up, the Harris score averaged 89.65, 87.44, and 83.28, respectively. The difference between the pre- and postoperative scores was significant (p=0.0001). Preoperatively, 26 patients (47.27%) had slight limps (length difference <1 cm), eight (14.55%) had moderate limps (length difference 1-3 cm), and 21 (38.18%) had severe limps (length difference >3 cm). At their final follow-up, four (7.27%) had severe limps. The limps of all of the patients improved significantly (McNemar's test p=0.0001). We observed aseptic loosening and subsidence in six hips. In seven hips, we used a femoral head autograft for the superior acetabular defect. We performed femoral shortening osteotomies only for two (3.07%) type III hips. CONCLUSION: In addition to the standard procedure, structural bone autografting, medialization of the cup, and placing the acetabular component in the true acetabulum are important factors for successful intermediate-term results.

Irreducible fracture dislocation of the ankle caused by tibialis posterior tendon interposition.

A patient with severe irreducible open fracture dislocation of the ankle was admitted to our emergency department. After wound irrigation and debridement, skeletal traction was applied to the calcaneus to minimize soft tissue injury and swelling. The patient was followed in traction for 1 week, after which reduction and fixation of the fibula was attempted but not achieved. We extended the incision distally, visualized the ankle, and located the tibialis posterior tendon between the distal tibia and fibula, thereby inhibiting the reduction. The tendon coursed into the tibiotalar joint anteriorly and pushed the talus anterolaterally. After manipulation of the tendon to its anatomically correct location, the ankle was easily reduced. The wound at the medial side was closed with a fasciocutaneous rotational flap. The ankle was then immobilized for 6 weeks postoperatively. The patient regained her full range of motion, and there were no problems with the tibialis posterior tendon, such as rupture or insufficiency. Isolated tibialis posterior tendon interposition between the distal tibiofibular and tibiotalar joints has rarely been reported, and can inhibit anatomical reduction of the fractured ankle.