The Diagnostic Role of Adding the Hoffman Reflex for L5 Radiculopathy in the Electrodiagnostic Laboratory: A Cross-sectional Study.

OBJECTIVES: To investigate changes in the H-reflex in patients with monoradiculopathies involving L5 or S1 levels by stimulating the sciatic nerve and recording simultaneously from the tibialis anterior (TA), peroneus longus (PL), and soleus (S) muscles. METHODS: Patients with unilateral radicular back pain with L5 or S1 root compression on MRI, participated in this cross-sectional study. The H-reflex over the TA, PL, and S muscles was simultaneously recorded by sciatic nerve stimulation. The H-reflex latency was compared with that of the contralateral extremity. RESULTS: Fifty-eight patients (29 patients L5; 29 patients S1 radiculopathy) were included in the study. There were significant delays in the latency of the H-reflex over TA (30.95±2.31-29.21±1.4) and PL (31.05±2.85-29.02±1.99) muscles on the affected side in patients with L5 radiculopathy. However, the latency of the S H-reflex was similar on both sides. In contrast, in patients with S1 radiculopathy, there was a significant delay in the latency of soleus H reflex (32.76±3.45-29.9±3.19), while the significant delay was not detected in the TA and PL muscles. However, the cutoff values for the H-reflex latency of all muscles were not found to have clinical significance. CONCLUSIONS: The study presents that the H-reflex study, recorded from the TA, PL, and S muscles by sciatic nerve stimulation, is of interest but has minimal contribution to radiculopathy diagnosis in conventional electrodiagnostic tests.

Which factor is more reliable considering prophylactic pinning of contralateral hip of unilateral SCFE patients?

BACKGROUND: This study evaluates the radiological parameters of developing subsequent contralateral slips in unilateral slipped capital femoral epiphysis (SCFE) patients at the time of initial presentation. METHODS: The study group included the review of unilateral SCFE patients treated between June 2007 and August 2018. Age, gen-der, side, stability, posterior slope angle, grade of slip, modified Oxford bone age score (mOBAS), the Risser classification, and the ap-pearance of the triradiate cartilage were evaluated retrospectively. Data were analyzed between two groups: subsequent contralateral SCFE (SCFESC) patients that developed contralateral slip during follow-up and unilateral SCFE (SCFEU) patients that did not develop contralateral slip up to skeletal maturity. Descriptive statistics were used to compare risk factors between groups. RESULTS: This study included 48 patients and 6 patients (12.5%) developed a SCFESC. Only mOBAS was significantly different be-tween groups. The mOBAS scores in SCFESC were 18 in 2 patients (33.3%), 19 in 4 patients (66.7%). The mOBAS scores in SCFEU were 18 in 1 patient (2.4%), 19 in 24 patients (57.1%), and >20 in 17 patients (40.5%). In the SCFESC group, all patients had a Risser score of 0 and all had open triradiate cartilage. CONCLUSION: Patients with unilateral SCFE are at risk for SCFESC, and the mOBAS is the best predictor of risk assessment. We agree that mOBAS score of 16,17 or 18 patients' contralateral hips can be prophylactically pinned. We also suggest pinning or close screening of mOBAS 19 patients that some carry relatively high risk of subsequent contralateral slip.

Comparison of the Isolated Plantar Fascia Release Versus Plantar Fascia Release Combined With Calcaneal Decompression in Management of the Patients With Resistant Heel Pain.

We aimed to compare isolated percutaneous plantar fascia release by using a needle versus percutaneous plantar fascia release combined with calcaneal decompression in treatment of the patients with resistant heel pain. We reviewed the prospectively recorded data of patients who treated and follow-up for resistant heel pain (treated more than 6 months with other treatment modalities) with a minimum 1-year follow-up. Twenty patients were treated with plantar fascia release using a needle (group 1) and 21 patients were treated with a similar percutaneous release combined with calcaneal decompression (group 2). Functional outcomes were evaluated using visual analog scale (VAS) and Foot Function Index (FFI) pre- and postoperatively. No significant differences were observed between both groups in terms of age (44.3 years in group 1 vs 46.8 years in group 2), gender (18 females and 2 males in group 1 vs 19 females and 3 males in group 2), body mass index (25.1 in group 1 vs 26.3 in group 2), and follow-up (14.6 months in group 1 vs 15.7 months in group 2). The decrease in postoperative FFI and VAS scores compared with preoperative VAS scores was statistically significant in both groups. However, improvement of FFI and VAS score was significantly higher in group 2 than group 1. Although both methods are very effective in the treatment of persistent heel pain, the group 2 has a better improvement in functional scores than group 1 with a mean 15 months following the procedure.

Translation, cultural adaptation, and validation of the Turkish-specific acromioclavicular score.

OBJECTIVE: The Specific Acromioclavicular Score (SACS) is a questionnaire that assesses functional outcomes for Acromioclavicular Joint (ACJ) pathologies. The aim of this study was to evaluate the ease of use, reliability, and validity of the Turkish-translated and culturally adapted form of the SACS. METHODS: The SACSwas translated into Turkish according to Beaton's recommendations. Seventy-eight patients were included in this study (67 with acute or chronic AC instability and 11 with symptomatic ACJ arthritis). The mean interval between test and retestwas 13.2 ± 4.6 days. The reliability of the tools was measured with the intraclass correlation coefficient. External validity was evaluated using correlations between the SACS,Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Shoulder score, and the SF-36 version 2 (SF-36v2). Floor and ceiling effects were also analyzed. RESULTS: The mean time to complete the Turkish SACS was 3 min 18 s (range, 1 min 40 s to 7 min 9 s). The test-retest reliability was excellent (ICC, 0.988). There was a very good correlation between SACS,OSS, SPADI, and ASES scores (r = 0.645, 0.645, and -0.682, respectively, P < 0.05). A poor correlationwas observed between SACS and subscales of SF-36v2 (P > 0.05). No floor or ceiling effects were detected. CONCLUSION: The Turkish version of the SACS is a reliable and valid tool tomeasure outcomes after various types of acromioclavicular joint pathologies. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

The Effects of Different Screw Combinations on the Initial Stability of Ankle Arthrodesis.

Background: The literature is scanty regarding the biomechanical effects of different thread configurations on the initial stability of ankle arthrodesis. This study aims to compare the initial stability of tibiotalar fusion site in ankle arthrodesis using cannulated screws with different thread designs. Methods: We biomechanically tested under cyclic loading the effects of different screw combinations on the initial stability of ankle arthrodesis. A total of 28 synthetic ankle models were divided into four groups: two partially threaded cancellous screws (group A), partially and fully threaded cancellous screws (group B), a partially threaded cancellous screw with a headless compression screw (group C), and a fully threaded cancellous screw and a headless compression screw (group D). Biomechanical variables including ultimate failure load, initial stiffness, ultimate stiffness, and failure angulation were analyzed. Results: There were no differences in any of the biomechanical variables among the four groups (P = .41 for ultimate failure load, P = .079 for initial stiffness, P = .084 for ultimate stiffness, and P = .937 for failure angulation). Conclusions: Combinations of different cannulated screws showed similar results in terms of the stability and stiffness of the tibiotalar fusion site.

Quality of Life Evaluation Following Limb Lengthening Surgery in Patients with Achondroplasia.

BACKGROUND: The primary objective of this study was to evaluate the quality of life following limb lengthening surgery in patients with achondroplasia. The complications and different lengthening techniques have and effects on mid-term results were also investigated. METHODS: We performed a retrospective, multicenter study by evaluating the records of patients with achondroplasia operated in our clinic between 1999 and 2014 for limb lengthening with a minimum follow-up of 3 years. Forty nine patients were underwent bilateral lower limb lengthening surgery and 21 of 49 patients underwent bilateral humerus lengthening surgery. Patients were evaluated by the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales to assess the health-related quality of life (HRQOL) of children. Twenty patients with achondroplasia who had no lengthening surgery history were also evaluated with the PedsQL score as the control group. RESULTS: The average age at the time of first surgery was 6.17 years. The average follow-up period was 100.2 months. The average age at the time of study 14.70 ± 2.44 (11-18) years. There were significant differences between the patients with humeral lengthening and patients who did not undergo humeral lengthening in all scores. Transient complications had minimal effects on scores. Although all scores in the operated group were higher than non-operated patients with achondroplasia, there were no significant differences. CONCLUSION: Quality of life was significantly improved as a result of humerus lengthening surgery of patients with achondroplasia, despite minor complications compared with Lower limb lengthening surgery. LEVEL OF EVIDENCE: Level III, case control study.

Reliability of RUST and Modified RUST Scores for the Evaluation of Union in Humeral Shaft Fractures Treated with Different Techniques.

BACKGROUND: The study aimed to evaluate the agreement between the radiographic union scale (RUST) and modified RUST (mRUST) in humeral shaft fractures treated with different techniques, and the effect of surgeons' experience and thresholds for determining bone union. MATERIALS AND METHODS: A total of 20 orthopedic surgeons reviewed and scored radiographs of 30 patients with humeral shaft fractures treated by external fixation, intramedullary nailing, and plating using the RUST and mRUST on the 0 day, 6 weeks, 12 weeks and 24 weeks follow-up radiographs. Bone healing, interrater agreement between RUST and mRUST scores, and the threshold for radiographic union were evaluated. RESULTS: The intraclass correlation coefficient (ICC) was slightly higher for the mRUST score than the RUST score (0.71 versus [vs.] 0.67). There was substantial agreement between the mRUST and RUST scores for external fixation (0.75 and 0.69, respectively) and intramedullary nailing (0.79 and 0.71); there was moderate agreement between them for plating (0.59 and 0.55). Surgeons with varying experience had a similar agreement for both scores and scores for each humeral cortex. The external fixation and intramedullary nailing group had higher RUST and mRUST scores than the plating group. The ICC for union was substantial (0.64; external fixation: 0.68, intramedullary nailing: 0.64, and plating: 0.61). More than 90% of the reviewers recorded scores of 10/12 for RUST and 13/16 for mRUST at the time of union. CONCLUSIONS: RUST and mRUST scores can be used reliably for the evaluation of bony union in humeral fractures treated with an external fixator and intramedullary nailing. In cases of humeral plating, a more sensitive tool for evaluation of fracture union is needed.

Acute correction and intramedullary nailing of aseptic oligotrophic and atrophic tibial nonunions with deformity.

OBJECTIVES: This study aims to describe the important points for treatment of aseptic tibial oligotrophic and atrophic nonunions by intramedullary nailing (IMN). PATIENTS AND METHODS: The retrospective study included 17 biologically nonactive nonunion patients (12 males, 5 females; mean age 36.4 years; range, 19 to 49 years) operated between February 2010 and November 2017 by deformity correction, static IMN and autografting. The mean follow-up time was 4.2 (range, 3 to 7) years. The initial fracture management was external fixator for all patients. Fourteen patients had open fractures initially. Six patients had valgus, four patients had varus, three patients had oblique plane, and four patients had external rotational deformity. Nonunion diagnosis was established on the basis of the patient history and physical examination based on plain radiographs, computed tomography or both. All patients were evaluated by the same protocol to exclude any infection. RESULTS: The median time from injury to nailing was mean 10.3 (range, 6.1 to 36.5) months. Radiologic and clinical union was achieved in all patients. The mean union time was 3.64 (range, 3 to 6) months. Three patients had positive intraoperative bacteriological culture. In four patients, dynamization was necessary for consolidation. Late deep infection developed in three patients after union, and all infected cases were operated by implant removal, debridement, and appropriate antibiotics. CONCLUSION: Intramedullary nailing and autografting after external fixator provide good results for the treatment of aseptic biologically nonactive nonunions with deformity. Reamed IMN ensures sufficient deformity correction, biological environment, and mechanical stability. The infection risk should always be kept in mind and patients should be followed-up closely to prevent complications.

Relationship of Postoperative Achilles Tendon Elongation With Plantarflexion Strength Following Surgical Repair.

BACKGROUND: Little data exist regarding the adverse effects of Achilles tendon (AT) elongation after rupture repair on plantarflexion strength. This study aimed to investigate the effect of AT elongation measured using AT resting angle (ATRA) on the plantarflexion strength in patients with surgically treated acute AT rupture. METHODS: A retrospective chart review was performed on 40 patients (15 female and 25 female) who underwent open operative repair due to an acute AT rupture. At the final follow-up, AT elongation was assessed using ATRA. Plantarflexion strength (peak torques and angle-specific torques) was measured using an isokinetic dynamometer. All variables were obtained from the operated and unoperated contralateral ankles of the patients. RESULTS: The mean ATRA was greater in the operated ankles (mean, 57 degrees; range, 39-71 degrees) compared with the unoperated ones (mean, 52 degrees; range, 36-66 degrees; P = .009). Except the plantarflexion torque at 20 degrees of plantarflexion (P = .246), all the other angle-specific torques were lower in the operated ankles (P < .05). Peak flexion torque at 30 degrees/s was lower in the operated ankle (P = .002). A negative correlation was found between operated/unoperated (O/N) ATRA and O/N plantarflexion torque ratios at 0 degrees (r = -0.404; P = .01), 10 degrees (r = -0.399; P= .011), and 20 degrees (r = -0.387; P = .014). CONCLUSION: Postoperative AT elongation measured using ATRA may have a deleterious effect on the plantarflexion strength in patients with surgically treated acute AT rupture. LEVEL OF EVIDENCE: Level IV, case series.

Repair within the first 48 h in the treatment of acute Achilles tendon ruptures achieves the best biomechanical and histological outcomes.

PURPOSE: To compare the biomechanical and histological properties of Achilles tendons repaired at different time points during the acute injury period. METHODS: Thirty-six skeletally mature Sprague-Dawley rats underwent bilateral mid-substance Achilles tenotomy. The Achilles tendons were repaired either in the first 24 h (group 1), 24-48 h (group 2), 48-72 h (group 3), or > 72 h (mean: 120 ± 5.2 h) (group 4) after tenotomy. Six weeks after repair, nine tendons per group were assessed biomechanically and histologically. The Stoll histological scoring system was used for histological examination. The groups were compared with each other and native tendons (control group). The correlations between biomechanical and histological results were analysed. RESULTS: There were no significant differences between groups 1, 2 and 3 regarding the mean load to failure; it was significantly lower in group 4. Healed tendons in groups 1, 2 and 3 had significantly greater stiffness than native tendons and group 4 tendons. All healed tendons had a larger cross-sectional area than native tendons. There was no significant difference in tendon length between the groups. There was no significant difference in Young's modulus between the groups; Young's modulus was lower in all the groups than in the control group. Group 1 had significantly higher extracellular matrix organization, cell alignment, cell distribution and nucleus morphology scores and total scores than group 4. Group 1 had significantly higher extracellular matrix organization, cell distribution, vascularization and inflammation scores and total scores than group 3. A significant positive correlation was detected between the maximum load to failure and total histological score. CONCLUSION: Repair of acute Achilles tendon rupture within 48 h, and especially in the first 24 h, provides better biomechanical and histological outcomes. In the clinical practice, the data could be used to decrease re-rupture rates, to achieve more anatomical tendon healing and to implement more effective post-operative rehabilitation programme.

Unprecedented recurrence of carpal tunnel syndrome by metaplastic synovial cyst in the carpal tunnel.

Metaplastic synovial cyst (MSC) is a benign cystic lesion observed after surgical intervention and recurrent skin trauma. Because of its rarity, the etiology is not fully understood. The most emphasized etiologic factors are recurrent surgical procedures and cutaneous pathologies, which cause cutaneous fragility and abnormal wound formation. In the literature, MSC is exemplified as a mass that can be observed by the naked eye and palpated. All patients had a history of previous surgical procedures in the area. In the present case, we report a 48 -year-old woman with recurrent carpal tunnel syndrome due to a MSC. This report showed that MSC can be detected at deeper locations than the regions described in the literature. To our knowledge, this is the first report of MSC causing carpal tunnel syndrome recurrence. It is thought that previous operations are the most important etiologic factor in MSC occurrence.

Treatment of Graf Type IIa Hip Dysplasia: A Cut-off Value for Decision Making

Background: The rate of spontaneous normalization in type IIa hips is reported to be high, whereas dysplsia persists or worsens in 5%-10% of cases. Aims: To evaluate the natural course of type IIa hips using Graf's own perspective of physiological immaturity and maturational deficit. Study Design: A single center, retrospective cohort study. Methods: This was an institutional review board-approved retrospective review of all patients diagnosed with type IIa hip dysplasia at a single institution from 2012 to 2014. All patients included in the study had hip ultrasonography at about 6 weeks and 3 months of age. To assess reliability in α and ß angles, ultrasonography measurements were carried out on the same image individually by all observers. The α and ß angles were used as the main outcome measurements to evaluate hip maturation at the last follow-up. A receiver operating characteristics curve was drawn at the 3 month ultrasonography to evaluate the cut-off values for α and ß angles for persistent dysplasia. Results: Sixty-four patients and 88 affected hips (63% unilateral and 37% bilateral) were included. The mean age at diagnosis was 6.4±2.7 weeks. Fifty-four hips were type IIa(+) (physiologically immature) and 34 hips were type IIa(-) (maturational deficit) at the initial ultrasonography evaluation. Improvement to type I was seen in 52 type IIa(+) and 17 type IIa(-) hips. Receiver operating characteristic analyses showed that patients do well if the α angle was >55° (area under the curve: 0.86; p<0.001 for the left hip and area under the curve: 0.72; p=0.008 for the right hip). Conclusion: The cut-off α angle value of 55° on initial ultrasonography should be considered to prevent future dysplasia. An α angle <55° on the initial ultrasonography was an independent predictor of worsening sonographic findings.

Efficacy of Pulsed Radiofrequency Therapy to Dorsal Root Ganglion Adding to TENS and Exercise for Persistent Pain after Total Knee Arthroplasty.

The majority of patients achieve substantial pain relief and improved function after total knee arthroplasty (TKA), but a proportion continues to experience life-disturbing persistent postsurgical pain (PPSP) in the months and years after surgery. This study aimed to assess the efficacy of transcutaneous electrical nerve stimulation (TENS), exercise, and pulsed radiofrequency (PRF) treatment on pain severity, neuropathic pain, knee flexion range of motion (ROM), functional status, and patient satisfaction in patients with PPSP after TKA. This is a retrospective study of prospectively collected data. Patients who were identified retrospectively from hospital charts were divided into two groups: group 1 (n = 17) received TENS and exercise treatment and group 2 (n = 22) received TENS, exercise, and PRF application to the dorsal root ganglion (DRG). The following procedure-related parameters were collected from the special registry form: visual analog scale (VAS), Douleur Neuropathique 4 (DN4) questionnaire, knee flexion ROM, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and patient satisfaction scale scores. The mean follow-up was 253.8 ± 109 days. When the two groups were compared, a significant difference of at least 50% improvement in the VAS (activity) and a significant reduction in the DN4 scores following the last control examination were found in group 2. There was a significant reduction in total WOMAC scores in group 1 compared with group 2 for the four study periods. Higher scores for the patient satisfaction scale were found in group 1 compared with group 2 following the last control examination. Adding PRF to TENS and exercise therapy is useful in reducing the degree of pain and the neuropathic component of PPSP in patients with PPSP.

The Usefulness of Employing an Electronic Traction Table to Determine Flexibility in Adolescent Idiopathic Scoliosis.

AIM: The aim of the study was to develop new equipment for the assessment of the flexibility of the spine with different forces. This new system should provide a different perspective to adolescent idiopathic scoliosis (AIS) for the selection of fusion levels and surgical success. MATERIAL AND METHODS: Eighteen patients suffering from AIS who were scheduled to undergo posterior instrumented spinal fusion in our clinic were recruited in this study. The Electronic Traction Table (ETT) that was designed in our clinic was used to evaluate the radiogical and clinical parameters of the spine. RESULTS: The significant prescriptive angle of major Cobb angles between postoperative angles were longitudinal traction and lateral pushing Cobb angles. Longitudinal traction and lateral pushing angles were more correlated with correction ratios. There was a significant difference between longitudinal traction minor Cobb angle, longitudinal traction lateral pushing minor Cobb angle and postoperative minor Cobb angles. CONCLUSION: The deformity is needed to balance both tractional and rotational forces and useful technique to evaluate curve flexibility before the operation. Electronic traction table is a new device for determining preoperative flexibility with longitudinal traction and lateral pushing radiographs. It can be useful for choosing selective fusion levels at the proximal and distal end of the vertebral column.

Total Knee Arthroplasty due to Knee Osteoarthritis: Risk Factors for Persistent Postsurgical Pain.

OBJECTIVE: The aim of this study was to identify whether different patient characteristics and clinical factors can be risk factors in patients with persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). METHODS: Patients who underwent TKA due to knee osteoarthritis were divided into two groups: those who experienced no or mild PPSP (Numerical Rating Scale [NRS] ≤ 3) (group 1, n = 91) and those who experienced moderate to severe PPSP (NRS > 3) (group 2, n = 183). Information on the characteristics of patients, comorbid diseases and pre-surgical NRS scores were obtained retrospectively from hospital charts. The follow-up time; pre-surgical and last control time walking distance; and ratings on the NRS, Pain DETECT Questionnaire (PDQ) and patient satisfaction scales were recorded from the standard questionnaire presented to patients during the telephone interview. RESULTS: The mean follow-up time was 22.8 ± 12.3 months. The rate of moderate to severe PPSP among patients amounted to 66.7% after TKA. No neuropathic pain was found in Group 1. In Group 2, 22.9% of patients experienced neuropathic pain, the results for 18% of patients were uncertain, and 59% of patients did not experience neuropathic pain. Group 2 had worse scores on the patient satisfaction scale following the last control time compared with Group 1. Being widowed, having a low education level, being a housewife, having employment that requires physical effort, pre-surgical pain intensity at rest and pre-surgical restricted walking distance are risk factors for Group 2. CONCLUSIONS: PPSP and the neuropathic component in PPSP after TKA are not underestimated for pain management and patient satisfaction. Subgroups of patients, particularly widowers, having a primary school education level or under, housewives, people with jobs that require physical effort, individuals with intense pre-surgical pain during rest and those suffering from pre-surgical restricted walking distance, are at higher risk of developing PPSP following TKA.

Intracompartmental pressure changes after anterolateral bridge plating of tibial fractures.

OBJECTIVE: Compartment syndrome is one of the most devastating complications in orthopedics both for the patient and the treating physician. Among the many causes, trauma and its treatment are the most common reasons for compartment syndrome, which most frequently occurs in the lower leg following tibial fractures. Since bridge plating of difficult metadiaphyseal tibial fractures is becoming increasingly popular, serious concerns have been raised about the increased intracompartmental pressures and possible compartment syndrome. METHODS: This study investigated the intracompartmental pressure changes in anterolateral compartment of the leg during and immediately after anterolateral bridge plating of tibial fractures. Intracompartmental pressures were measured before and during plate application, just after the completion of fixation, and immediately and 4-5 min after the tourniquet release in 22 isolated closed comminuted tibial fractures. RESULTS: Baseline anterolateral compartment pressures were higher than those on the uninjured side (9.3 vs 27.8 mmHg). Pressures were 69.5, 57.4, 65.8, and 56.8 mmHg, respectively, for the other measurements times. None of the patients received prophylactic fasciotomy, and none developed clinical compartment syndrome. CONCLUSION: We found that anterolateral compartmental pressures were higher than pressures on the uninjured side in all patients. Although there is a considerable increase in intracompartmental pressures during and immediately after anterolateral percutaneous bridge plating of comminuted tibial fractures, intraoperative prophylactic fasciotomy is not routinely needed. One should monitor the patients on the first postoperative day for signs of compartment syndrome. Fasciotomy decisions should be based on both clinical symptoms and serial intracompartmental pressure measurements rather than a single measurement.

The association between bone mineral density, quality of life, quality of sleep and fatigue.

OBJECTIVES: This study was undertaken to examine quality of life (QoL), the quality of sleep and fatigue level in postmenopausal women with osteoporosis (OP) but without fractures, to assess the associations between these parameters and to compare the results with those for subjects who have osteopenia or normal bone mineral density (BMD). METHODS: In this study, 113 postmenopausal osteoporosis (PMO) subjects without fractures, 172 subjects with osteopenia and 102 subjects with normal BMD were included. The severity of pain, QoL, quality of sleep and fatigue were assessed using the visual analogue scale (VAS), the QoL Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41), the Pittsburgh Sleep Quality Index (PSQI) and the Checklist of Individual Strength (CIS) questionnaire. RESULTS: No statistically significant differences between the three groups were found in terms of VAS and QUALEFFO-41 total scores (p > 0.05). On the other hand, PSQI and CIS total scores were significantly different in the PMO and osteopenia groups (P = 0.015 and 0.007, respectively) compared to the group with normal BMD. CONCLUSIONS: During the follow-up and treatment of women with PMO or osteopenia, QoL, quality of sleep and fatigue should be assessed and incorporated into treatment decisions, even in the absence of fractures.

Differences between the alpha angles measured manually and digitally from paediatric hip ultrasonograms.

The aim of this study was to reveal whether a meaningful difference is caused by measuring the alpha angle in hip ultrasonography manually or digitally to help the early diagnosis and treatment of DDH and observe the treatment implications of any such difference. All ultrasound images were obtained by same orthopaedist, and each hip was measured twice by two investigators with different levels of experience. Standard images were taken, and a printout of the standard images were obtained. The alpha angle was measured digitally by using the sonography device. The alpha angle was also measured by pencil, ruler and goniometer on the printout after 2 days. One hundred and two hips of 51 babies, at a mean age of 14 weeks, were assessed. The mean alpha angle measured manually with a goniometer was 64.4° (±1.6°), while that measured on the ultrasonography device was 65.3° (±0.9°). This difference was found to be statistically different (p = 0.016). Typology changes occurred in a total of 10 hips out of 102 as a result of manual and digital measurements. However, this study showed reduction in alpha angle variation and considerable advantages for manual alpha angle measurement with pencil and goniometer on a printout compared to computer-based measurement; future studies are needed to understand these differences caused by each measurement method.

Radiological results of modified Dega osteotomy in Tönnis grade 3 and 4 developmental dysplasia of the hip.

Dega acetabuloplasty at the time of open reduction is effective in improving the acetabular coverage of the femoral head, hence improving the stability of reduction and preventing possible surgery in the future for residual acetabular dysplasia in older children with Tönnis grade 3 and 4 developmental dysplasia of the hip (DDH). The aim of this study was to assess the radiological results of open reduction combined with Dega osteotomy in DDH. Twenty-two children's 26 hips were operated on at a mean age of 38±20.4 SD months and followed up for an average of 42 (range 24-108) months. Thirteen hips (50%) were operated on with concomitant open reduction and capsulorrhaphy, and 13 hips (50%) were treated with concomitant open reduction, capsulorrhaphy and femoral shortening osteotomy. Radiological examination included acetabular index (AI) and centre edge angle measurements. The mean preoperative AI was 39.4±6.9° SD, which improved to 18.3±4.5° SD postoperatively, and AI was measured as 15±3.5° SD at the latest follow-up. There was a significant difference in the mean AI values between the last follow-up and the preoperative measurements (P<0.05). The mean centre edge angle was 31±5.6° SD postoperatively, and it was 31±6.2° SD at follow-up. There was no significant difference between the two values. Two hips were noted to have lateralization of the femoral head due to coxa valga anteverta. One of them was operated with a femoral varus osteotomy. The Dega osteotomy combined with anterior open reduction and femoral osteotomies is a safe and effective acetabular osteotomy for surgical treatment of severe DDH such as Tönnis grade 3 and 4 dislocations.

[Superfluous computed tomography utilization for the evaluation of the pelvis and spinal column in an orthopedic emergency department]. / Acil ortopedi ve travmatoloji polikliniginde omurga ve pelvis degerlendirmesi için gereksiz bilgisayarli tomografi kullanimi.

OBJECTIVES: This study was designed to investigate the frequency of requests for computed tomography (CT) examination of the spinal column and pelvis in our emergency orthopedic department, the reasons of requests, and the rates of positive and negative CT examinations. METHODS: We retrospectively reviewed patients for whom a request for CT examination was made by the emergency orthopedic department within a year (September 2005- 2006). The reasons for CT requests, findings in CT reports, and age and sex of the patients were recorded. Findings unrelated and related to the original request denoted a negative and positive CT examination, respectively. RESULTS: Of 24,378 admissions to our emergency orthopedic department, a CT scan was requested in 1,295 patients (5.3%). In 817 patients (63.1%), CT examination involved the pelvis or the spinal column. Of these, 418 CT scans (51.2%) yielded a negative result. The mean age of the patients with a negative CT scan was significantly lower than those having a positive CT scan (40.7 vs 45.1 years; p=0.001). There was no significant difference with respect to sex between patients having negative and positive CT findings (p=0.670). Compared to pelvis CT scans, the frequency of negative CTs was significantly higher for spinal column examinations (p<0.001). The incidence of negative CT scans for upper thoracic and cervical vertebrae was significantly higher than that found for lower thoracic and lumbar regions (p<0.001). CONCLUSION: The high incidence of negative CT scans documented for pelvic and spinal column examinations underlines the need for measures to avoid superfluous CT requests in emergency departments.