[Rotational alignment of the lower extremity in adults: no relationship with osteoarthritis of the knee was proved]. / Eriskinlerde alt ekstremitenin rotasyonel dizilimi: Diz osteoartritiyle iliskisi ortaya konamamistir.

OBJECTIVES: In this study the relationship between knee osteoarthritis and rotational alignment of the lower limb was prospectively evaluated. PATIENTS AND METHODS: We evaluated the computed tomographic (CT) scans and conventional radiographs of 85 patients (69 females, 16 males; mean age 60.1; range 43 to 81 years) with knee pain for measurement of acetabular anteversion, femoral torsion, rotation of the knee, and tibial torsion and femoro-tibial alignment. Modified Kellgren-Lawrence classification was used to evaluate knee osteoarthritis in the patients. RESULTS: There was no osteoarthritis in 68 knees. Thirty-one knees had grade I, 37 knees had grade II and 34 knees had grade III osteoarthritis. In the CT examinations of the patients the mean acetabular anteversion was 18.5 degrees for both extremities. The mean femoral torsion was 8.3 degrees on the right extremity and 10.2 degrees on the left extremity. The mean knee torsion was 2.2 degrees on the right extremity and 1.3 degrees on the left extremity. The mean tibial torsion was 30.9 degrees on the right extremity and 31.3 degrees on the left extremity. On the plain X-rays, anatomical axis was 0 degrees on the right extremity and -0.6 degrees on the left extremity. No significant relationship between knee osteoarthritis and rotational alignment of the lower limb was found (p>0.05). CONCLUSION: Often thought to be idiopathic, primary osteoarthritis of the knee joint may occur secondary to mechanical stresses. Although valgus and varus deformities of the knee joint investigated extensively the effects of rotational deformities have not been investigated enough. Our study was not able to show any association between knee osteoarthritis and rotational alignment of the lower limb.

Percutaneous release for trigger thumbs in children: improvements of the technique and results of 31 thumbs.

PURPOSE: Trigger thumb is a relatively uncommon condition in children. If it occurs or persists after 1 year of age, surgical release is the most traditional treatment method. The aim of this prospective study is to describe a technique for the percutaneous release of trigger thumb and to assess the clinical outcome of the presented technique in the pediatric age group. METHODS: This study includes 31 thumbs of 26 consecutive children with a mean age of 2.6 years. An 18-gauge needle that was connected to 10-cc saline filled syringe was used as the surgical instrument for release. Contrary to the earlier reports, the A1pulley was cut from distal pole of the Notta nodule towards the proximal direction. RESULTS: Mean follow-up period was 2.5 years. A successful release without any complication was obtained in all (97% of thumbs) but 1 thumb. Recurrence was seen in only 1 thumb at postoperative 3 weeks. CONCLUSION: The presented minimal invasive surgical procedure has a high rate of satisfactory outcome, a minimal rate of complications, and a high rate of parent satisfaction. As percutaneous release has satisfactory and encouraging results, it can be a preferred method by the parents for trigger thumb release. STUDY LEVEL: III.

Effects of intraarticular contrast media on synovial membrane and cartilage. An electron microscopic evaluation in rabbit knees.

OBJECTIVE: To evaluate the histological and ultrastructural alterations in rabbit knee joint cartilage and synovia induced by intraarticular injections of 2 water soluble contrast agents. METHODS: The study was conducted at the Department of Orthopedics and Traumatology, Medical Faculty, Osmangazi University, Eskisehir, Turkey in January 2002. To examine the effect of contrast agents on articular cartilage and synovial membrane, rabbit model was used. Specimens from 62 knee joints were examined by light microscopy and transmission electron microscopy one hour, one day, one week and 2 weeks after intraarticular administration of gadolinium-diethylenetriamine pentaacetic acid, iopromide or saline. RESULTS: In the knees injected with saline, light microscopic changes of the synovium consisted of edema only. Edema and hyperemia were seen in contrast agent injected knees. Ultrastructurally, numerous and large pinocytotic vesicles in A cells of the synovial membrane were seen in contrast agent injected groups. In the knees injected with saline the cartilage were ultrastructurally normal but contrast agent injected knees showed increased activation of chondrocytes with increase of dense glycogen accumulation, large lipid vacuoles and matrix material. There were very rare pycnotic cells in these samples. The rating scale has been used and the means of the total scores were determined for the groups. CONCLUSION: The effects of contrast agents reduced gradually on the cartilage and synovium in general but did not become completely normal in the observation period.

[Our three-year experience with an ultrasonographic hip screening program conducted in infants at 3 to 4 weeks of age]. / Uç-dört haftalik bebeklerde yürütülen ultrasonografik kalça taramasi programinda üç yillik deneyimimiz.

OBJECTIVES: The aim of this study was to evaluate the results of a newborn ultrasonographic hip screening program conducted at 3-4 weeks of life, and to assess its utility and feasibility in Turkey. METHODS: During a three-year period, parents of 1440 newborns were interviewed within 48 hours following birth to be informed in detail about developmental dysplasia of the hip (DDH) and its risk factors. They were asked to bring their infants for clinical and ultrasonographic examinations of the hips 3 to 4 weeks after birth. RESULTS: A total of 975 infants (67.7%; 488 girls, 487 boys; mean age 26 days; range 17 to 34 days) were available on the day of screening. According to the Graf's classification, 1664 hips (85.3%) were considered type I. Immediate treatment was initiated for 22 hips (1.2%) which were considered type IIc, D, or IIIa. All but one hip were found to be type I after eight weeks of treatment. Among type IIa hips with a complete follow-up, 12% required treatment. In total, 45 hips (2.3%) of 35 infants (3.6%) were treated preferably with a Pavlik harness. Of these, 10 infants (28.6%) had at least one risk factor for DDH, the most common being a positive family history (n=7, 20%). Of 45 treated hips, 12 hips (26.7%) exhibited positive clinical findings, the most common being asymmetry of the thigh/inguinal folds. CONCLUSION: Ultrasonographic hip screening program conducted at the age of 3 to 4 weeks is effective for early diagnosis and successful treatment of DDH. However, nearly one-thirds of the infants were not available at the appointed date, despite transmission of detailed information to the parents just after birth.

Assessment of the correlation between commonly used radiographic parameters in normal, subluxated and dislocated hips.

The correlations between the commonly used radiographic parameters, center-edge angle (CEA), acetabular-head index (AHI), acetabular index angle (AIA), acetabular angle (AA) and ACM angle, in normal, subluxated and dislocated hips were investigated in the radiographs of 364 normal, 23 subluxated and 19 dislocated hips of patients between 5 and 18 years of age. A significant correlation was observed between all the parameters in normal hips. A significant correlation between AIA and the other four parameters, and between CEA-AHI and AA-ACM, was noted in subluxated hips. AIA-AA and AIA-ACM had significant correlations in dislocated hips. It was concluded that measurement of more than one radiographic parameter might be better to exactly evaluate the radiographic hip anatomy in developmental dysplasia of the hip.

Wrist ligaments: their significance in carpal instability.

BACKGROUND: Understanding the exact contribution of the supporting ligaments to the functional integrity of the wrist is crucial for the diagnosis and treatment of carpal instabilities. The present study evaluates functional significance of the wrist ligaments with respect to carpal instabilities. MATERIALS AND METHODS: Sixteen fresh cadaver wrists were dissected. Extrinsic and intrinsic ligaments of the wrists (ligamentum radioscaphocapitatum, ligamentum radiolunotriquetrum and ligamentum triquetrohamatocapitatum) were sectioned sequentially. After sectioning of each ligament, the wrist was examined for clinical signs of instability such as misalignement of carpal bones, limited range of motion and dorsal translation. When instability was suspected, radiographs were taken and if instability was confirmed, then the ligament was repaired. RESULTS: Although none of the dorsal ligaments sectioning resulted in instability, sectioning of ligamentum scaphotrapeziotrapezoideum, ligamentum radioscaphocapitatum, ligamentum radiolunotriquetrum and ligamentum triquetrohamatocapitatum displayed scaphotrapeziotrapezoidal, dorsal intercalated segment, lunotriquetral and capitohamate instability respectively. In two wrists with arthrosis, sectioning of all ligaments didn't lead to any instability. CONCLUSION: Instability of the wrist can be classified on anatomical basis after the name of these four ligaments involved i.e. l. scaphotrapeziotrapezoideum, l. radioscaphocapitatum, l. radiolunotriquetrum and l. triquetrohamatocapitatum respectively . This approach clarifies the etiology and treatment of carpal instabilities.

Giant cystic lymphangioma cavernousum of lower limb with overlying lymphangioma circumscriptum.

Lymphangiomas arising outside of the cervicofacial, thoracic, and abdominal areas are extremely rare. We describe a child with a giant cystic lymphangioma cavernousum occurring in the lower leg with overlying lymphangioma circumscriptum, along with its magnetic resonance imaging findings.

[The efficacy of pulsed electromagnetic fields used alone in the treatment of femoral head osteonecrosis: a report of two cases]. / Femur basi osteonekrozu sagaltiminda darbeli elektromanyetik alanin iki olguda tek basina kullanimi.

Long-term radiologic and clinical results of pulsed electromagnetic fields (PEMF) are presented with illustration of two patients having Ficat-Arlet grade 2 osteonecrosis of the femoral head. One patient (female, age 33 years) had bilateral involvement due to systemic steroid use, the other (male, age 39 years) had right-sided involvement of unknown etiology. Surgical treatment was ruled out because of aplastic anemia associated with significant thrombocyte deficiency in the first patient, while the other refused surgery. Pulsed electromagnetic fields were applied as the sole treatment modality in three hips for six months with a duration of 10 hours daily (at nights). At the end of 12-year- and five-year-follow-ups, respectively, clinical improvement was observed in all hips, with no radiologic deterioration. It is concluded that application of PEMF stimulation alone may be an alternative treatment modality in patients in whom surgical treatment cannot be performed for femoral head osteonecrosis, in particular Ficat-Arlet grade 1 and 2 disease.

[Normal values of several acetabular angles on hip radiographs obtained from individuals living in the Eskisehir region]. / Eskisehir yöresinde çekilen kalça radyografilerinde yas gruplarina göre asetabulum açilarinin normal degerleri.

OBJECTIVES: To determine the normal values of several radiographic acetabular angles in individuals of Eskisehir region. METHODS: The acetabular index (AI) angle, acetabular angle (AA) of Sharp and the ACM angle were measured in 1162 normal hips (n=581, 251 males, 330 females; mean age 33 years; range 5 to 75 years). For AI angle, Hilgenreiner's line and the line connecting the lower end points of the sclerotic lines of the acetabular roofs were used for reference in subjects between five to 11 years with an open Y cartilage and in those with closed Y cartilage, respectively. AA and ACM angles were measured by the same method in all subjects. RESULTS: The mean AI angle between 5-11 years was 12.9+/-4.5 degrees; the upper normal limit for the Hilgenreiner's AI angle was derived as 22 degrees. The mean AI angle above age 11 was 3.3+/-4.7 degrees and the upper normal limit for the AI angle defined by Tönnis after age 11 was found as 13 degrees. Significant linear correlations were found between the AI angle and age for 5-11 years (p=0.002) and above 11 years (p=0.001), respectively. The mean AA angle was 39.2+/-4.6 degrees. There was a significant linear correlation between the AA angle and age (p=0.001). The upper limits for the AA angle in normal juvenile, adolescent, and adult hips were found as 52 degrees, 49 degrees, and 45 degrees, respectively. The mean ACM angle was 41.9+/-3.3 degrees. A significant linear correlation was observed between the ACM angle and age (p=0.001). The upper limit for the ACM angle in normal hips was assessed as 49 degrees in all age groups. CONCLUSION: The authors of this study propose that the normal limits of acetabular angles obtained from our own population be used as reference values in interpreting standard radiographs of the hip.