Clinical Examination Findings Can Accurately Diagnose Developmental Dysplasia of The Hip-A Large, Single-Center Cohort.

BACKGROUND: Physical examination findings such as limited hip abduction (LHA), asymmetric skin creases (ASC), and a popping sensation in the hip facilitate the diagnosis of developmental dysplasia of the hip (DDH). Screening with a simple physical examination during the first weeks of infancy is important for early detection of the condition, and a wide range of medical professionals, including general practitioners, obstetricians, pediatricians, and orthopedic surgeons etc. are involved in this process. The aim of this study was to determine the correlation between easily recognizable physical examination findings such as LHA, thigh/groin ACSs, and Ortolani and Barlow tests with ultrasound findings for the diagnosis of DDH. METHODS: This study included 968 patients undergoing routine hip ultrasonography between December 2012 and January 2015. All patients were examined by an experienced orthopedic surgeon who was not the physician who performed the ultrasound examination to exclude bias between physical examination findings and ultrasound findings. Asymmetric skin folds (thigh and groin), limited abduction, Barlow and Ortolani tests were recorded. The relationship between the physical examination findings, ultrasound findings, and developmental dysplasia was investigated. RESULTS: Of the 968 patients, 523 were female (54%) and 445 were male. On ultrasonography examination, 117 patients were found to have DDH. The sensitivity, specificity and negative predictive values of patients who were found to have both LHA and thigh/groin ASCs in all three physical examinations were high (83.8%, 70.2%, and 96.9%, respectively) while positive predictive values were found to be low (27.8%). CONCLUSION: Asymmetric skin creases on the thigh and groin and limited hip abduction, when evaluated together, have high sensitivity and specificity with additional high negative predictive values and could help during the initial screening process of DDH.

Ageostrophic Frontal Processes Controlling Phytoplankton Production in the Catalano-Balearic Sea (Western Mediterranean).

Buoyancy-induced unstable boundary currents and the accompanying retrograde density fronts are often the sites of pronounced mesoscale activity, ageostrophic frontal processes, and associated high biological production in marginal seas. Biophysical model simulations of the Catalano-Balearic Sea (Western Mediterranean) illustrated that the unstable and nonlinear southward frontal boundary current along the Spanish coast resulted in a strain-driven frontogenesis mechanism. High upwelling velocities of up to 80 m d(-1) injected nutrients into the photic layer and promoted enhanced production on the less dense, onshore side of the front characterized by negative relative vorticity. Additional down-front wind stress and heat flux (cooling) intensified boundary current instabilities and thus ageostrophic cross-frontal circulation and augmented production. Specifically, entrainment of nutrients by relatively strong buoyancy-induced vertical mixing gave rise to a more widespread phytoplankton biomass distribution within the onshore side of the front. Mesoscale cyclonic eddies contributed to production through an eddy pumping mechanism, but it was less effective and more limited regionally than the frontal processes. The model was configured for the Catalano-Balearic Sea, but the mechanisms and model findings apply to other marginal seas with similar unstable frontal boundary current systems.

Fueling plankton production by a meandering frontal jet: a case study for the Alboran Sea (Western Mediterranean).

A three dimensional biophysical model was employed to illustrate the biological impacts of a meandering frontal jet, in terms of efficiency and persistency of the autotrophic frontal production, in marginal and semi-enclosed seas. We used the Alboran Sea of the Western Mediterranean as a case study. Here, a frontal jet with a width of 15-20 km, characterized by the relatively low density Atlantic water mass, flows eastward within the upper 100 m as a marked meandering current around the western and the eastern anticyclonic gyres prior to its attachment to the North African shelf/slope topography of the Algerian basin. Its inherent nonlinearity leads to the development of a strong ageostrophic cross-frontal circulation that supplies nutrients into the nutrient-starved euphotic layer and stimulates phytoplankton growth along the jet. Biological production is larger in the western part of the basin and decreases eastwards with the gradual weakening of the jet. The higher production at the subsurface levels suggests that the Alboran Sea is likely more productive than predicted by the satellite chlorophyll data. The Mediterranean water mass away from the jet and the interiors of the western and eastern anticyclonic gyres remain unproductive.

Evaluation of shoulder and elbow functions after treatment of humeral shaft fractures: a 20-132-month follow-up study.

OBJECTIVE: The aim of this study was to evaluate the long-term results of shoulder and elbow functions in humeral shaft fractures treated with functional brace, plate and screw osteosynthesis or intramedullary nailing. METHODS: The study included 128 patients treated for humeral shaft fracture. The patients were divided into three groups according to treatment method: Group 1 (n=62) received functional brace, Group 2 (n=36) plate and screw osteosynthesis and Group 3 (n=30) intramedullary nailing. Coronal and sagittal humeral angulations were measured radiologically during the final follow-up. Shoulder and elbow functions were evaluated using the Constant shoulder score, the Mayo Elbow Performance Scoring and range of movement measurements. RESULTS: The mean follow-up time was 74 (range: 20 to 132) months. Mean Constant shoulder scores were 92.4 in Group 1, 85.6 in Group 2 and 74 in Group 3. A statistically significant difference was detected between the Constant shoulder scores of Groups 2 and 3 (p<0.05). In the last follow-up, the mean Mayo Elbow Performance Score of Group 1 was 96.9, Group 2 was 95.7 and Group 3 was 89.2. Statistically significant differences were not detected between the Group 2 and 3 (p>0.05). In the statistical evaluation of the Constant shoulder scores, a statistically significant difference was detected between the Constant scores of patients with a varus angulation greater than 20° and those with neutral alignment. CONCLUSION: Functional results of humeral shaft fractures treated with functional brace appear to be satisfactory. Varus and antecurvatum may affect shoulder and elbow function. In the presence of surgical indications, plate and screw fixation technique is the most effective method in terms of shoulder and elbow functions.

[Ultrasonographic measurement of the effect of rotatory cuff repair with coracoacromial ligament transfer on humeral head migration]. / Korakoakromiyal bag transferiyle rotator kilif tamirinin humerus basi migrasyonuna etkisinin ultrasonografi ile ölçülmesi.

OBJECTIVES: In this study we evaluated whether ligament transfer caused humeral head migration in patients whose massive rotator cuff ruptures were repaired with total or partial coracoacromial ligament (CAL) transfer. The necessity of harvesting the ligament totally or partially in massive rotator cuff repairs was investigated with respect to the effect of the excision and transfer of the CAL on humeral head migration. PATIENTS AND METHODS: Forty patients (12 males, 28 females; mean age 54.3 years; range 39 to 66 years) operated on with free CAL transfer for massive rotator cuff rupture between January 2003 and June 2008 were included in the study. The operations were performed by obtaining total CAL grafts in the first 13 cases and partial CAL grafts in the other 27 cases. Mean follow-up period was 26.5 months (range 12 to 52 months). Twenty-nine patients had the rupture on the right side and 11 patients had the rupture on the left side. In 31 patients the dominant side was affected. RESULTS: In the early postoperative period (3-6 weeks) adequate acromiohumeral (AH) distance could not be obtained in patients underwent total excision and transfer of CAL (mean 9 mm; range 8.6 to 9.2 mm). Humeral migration was found to be regressed three months after active motion and recovery of normal cuff strength. During the follow-up the mean AH distance was found to be 10 mm (range 8 to 10.5 mm). Humeral head migration was not detected by ultrasonography in the early postoperative period in patients who underwent repair with partial CAL transfer. CONCLUSION: Functionally good results have been obtained in the rotatory cuff repairs performed by CAL excision and transfer. Although humeral head migration was not detected ultrasonographically in the patients who had partial CAL excision and transfer at the early postoperative period, we observed a decrease in the AH distance in the patients who had total CAL excision and transfer. This migration was regressed and the cuff strength was recovered after intense rehabilitation with strengthening exercises and active motion.

[Total hip arthroplasty in patients with osteoarthritis secondary to developmental dysplasia of the hip: results after a mean of eight-year follow-up]. / Gelisimsel kalça displazisi zemininde gelisen osteoartritli hastalarda total kalça artroplastisinin ortalama sekiz yillik sonuçlari.

OBJECTIVES: We evaluated eight-year results of total hip arthroplasty in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH). METHODS: Total hip arthroplasty was performed in 31 hips of 29 patients (25 females, 4 males; mean age 54 years; range 35 to 78 years) with osteoarthritis secondary to DDH. According to the classification by Hartofilakidis et al., there were 13 type 1 hips, 13 type 2 hips, and five type 3 hips. The acetabular component was placed in the true acetabulum in all the hips. Hybrid and uncemented prostheses were used in six hips and 25 hips, respectively. Eight patients with severe acetabular deficiency required augmentation with an autogenous bone graft. Soft-tissue releases were performed in seven hips. Femoral shortening osteotomy was performed for high hip dislocations. All the patients were evaluated using the Merle d'Aubigne and Harris hip scores. The mean follow-up period was eight years (range 1 to 10 years). RESULTS: According to the postoperative Merle d'Aubigne and Harris hip scores, the results were excellent in eight hips (25.8%), good in 17 hips (54.8%), fair in five hips (16.1%), and poor in one hip (3.2%). The mean length discrepancy between the two extremities was 1.7 cm (range 0.5 to 2.5 cm). Complications included nonunion of the acetabular graft in one patient and superficial wound infection in two patients. Neurologic complications did not occur. Three patients required revision for loosening of the acetabular (n=2) or femoral (n=1) components. CONCLUSION: Successful results can be obtained with good planning and proper surgical procedures in the treatment of osteoarthritis secondary to DDH.

[Surgical treatment of type III acromioclavicular joint dislocations by a modified Bosworth technique]. / Tip III akromiyoklaviküler eklem çikiklarinin modifiye Bosworth teknigi ile cerrahi tedavisi.

BACKGROUND: We evaluated the results of surgical treatment of type III acromioclavicular joint dislocations by a modified Bosworth technique. METHODS: Thirty-four patients (9 females, 25 males; mean age 35 years; range 20 to 53 years) were treated with a modified Bosworth technique for type III acromioclavicular joint dislocations. Dislocations were caused by falls (n=18), traffic accidents (n=8), and during contact sports (n=8). Involvement was on the right side in 23 patients, and on the left side in 11 patients. The mean time to operation was two days (range 1 to 4 days). Functional evaluations were made with the use of the Constant scores. The mean follow-up was 35 months (range 12 to 57 months). RESULTS: The mean postoperative Constant score was 93 (range 46 to 96). No complications were seen during operation. The results were excellent in 24 patients (70.6%), good in seven patients (20.6%), and poor in three patients (8.8%). None of the patients had to change their jobs or give up any previous sports activities. Radiographically, the distal clavicle appeared normal in 32 patients, atrophied in one patient, and enlarged in another. Functional results were good in 12 patients (35.3%) in whom calcifications were detected in the coracoclavicular ligament. Dislocations recurred in three patients (8.8%). Two patients developed superficial infections. CONCLUSION: Surgical treatment of acromioclavicular joint dislocations by the modified Bosworth technique is a convenient option with regard to short- and long-term results.