Reduction of the dislocated hips with the Tübingen hip flexion splint in infants.

PURPOSE: Early detection and conservative treatment are essential for a successful outcome in developmental dysplasia of the hip (DDH). The aim of this study was to evaluate the efficacy of Tübingen hip flexion splint treatment on dislocated hips of type D, 3, and 4 according to the Graf classification. METHODS: A total of 104 dislocated hips in 92 patients were treated with Tübingen splints. Splint treatment was applied to patients with dislocated hips as diagnosed under ultrasonographic evaluation. After four to six weeks of treatment, the hips were re-evaluated according to the Graf classification under ultrasonography. The success of Tübingen splinting was determined as follows: hips initially diagnosed as Graf type 3 and 4 were upgraded to type 2c, 2b, or 1 after treatment, and hips initially diagnosed as Graf type D were upgraded to type 2b or 1 after treatment. RESULTS: The mean age at treatment initiation was 11.91 ± 5.16 (range, 4-32) weeks. There were no statistically significant relationships between success rates and sex, bilateral hip involvement, or initial physical examination findings (p > 0.05). The age at the start of treatment was found to be statistically significant in terms of the success of the splint (p = 0.03). CONCLUSIONS: For successful treatment with Tübingen splints, the cut-off point of starting initial treatment was defined as the 15th week, with sensitivity of 84.62% and specificity of 62.50%. The success rate was 75% with a successful outcome in 78 hips. In view of these results, Graf type D, 3, and 4 dislocated hips can be successfully treated with Tübingen splints.

Effects of cepae extract, allantoin, and heparin mixture on developing andalready formed epidural fibrosis in a rat laminectomy model.

BACKGROUND/AIM: The study was designed to investigate whether local administration of a mixture composed of cepae extract, allantoin, and heparin (CAH) decreased already formed epidural fibrosis (EF) at the laminectomy site. MATERIALS AND METHODS: Twenty-four adult male Sprague Dawley rats were equally divided into four groups. Laminectomy was performed at the L5 level in all rats. The group 2 and group 4 rats were treated with local drug administration. While the group 1 and 2 rats were sacrificed after 6 weeks, the remaining rats were reoperated and CAH mixture was applied in group 4. The vertebral columns of all rats were removed en bloc. Fibroblast numbers, EF, and arachnoidal involvement (AI) were evaluated. RESULTS: The results of the treatment groups were separately compared with the control groups. The numbers of fibroblasts in the treatment groups were significantly lower than those in the control groups (P < 0.001). The grade of EF in group 2 was significantly less than that in group 1 (P < 0.05). There was no statistically significant difference regarding EF and AI grade between group 3 and group 4, and local application of the drug on EF and AI yielded better results than in the control groups. CONCLUSION: The mixture composed of CAH might be a successful candidate for preventing EF in clinical practice.

An alternative treatment method for defective pseudoarthrosis; evaluation of eight patients treated with Artelon+Kryptonite.

Pseudoarthrosis with bone loss is one of the most challenging orthopaedic problems for surgeons. Bone loss usually leads to technical difficulties during surgery due to instability in the fracture area. Eight patients with pseudoarthrosis of different long bones were operated on by the same surgeon. The median age was 53 years (25-61), and the median time period after the index operation was 21 months (12-72 months). Radiographic union was achieved in all patients in 3.62 months (2-5 months). Efficient healing with new bone formation was observed in all of the patients. The result of the current case series is promising. This treatment method can be used for the treatment of pseudoarthrosis without increasing morbidity. Long-term follow-up and larger case series are needed for evidence of the adequacy and reliability of this method of treatment.

Maternal Height and Infant Body Mass Index Are Possible Risk Factors for Developmental Dysplasia of the Hip in Female Infants.

Developmental dysplasia of the hip (DDH) is a wide-spectrum disease with a multifactorial etiology and, despite its prevalence, no definitive etiology has yet been established. The aim of this study was to investigate new risk factors for DDH by evaluating newly defined potential risk factors. A total of 71 infants were separated into 2 groups:Group I, 28 female first-born infants diagnosed with DDH and their mothers;and Group II, 43 healthy female first-born infants and their mothers. The maternal height and weight before pregnancy, infant height and weight at birth, and body mass index (BMI) of both mother and infant were determined. Calculations were made of the ratios between these parameters. Of the examined risk factors, only maternal height and the ratio of maternal height to infant BMI (MH/I-BMI) were found to be significant for DDH in infants. In conclusion, the results of this study show that a short maternal height and a low MH/I-BMI increase the risk of DDH. Further studies with a larger series are necessary to confirm these results.

The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model

ABSTRACT PURPOSE: To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats. METHODS: Eighteen adult male Sprague-Dawley rats were equally and randomly divided into three groups. In the treatment groups, ankaferd blood stopper and microporous polysaccharide hemospheres topically administrated upon duramater surface after laminectomy. Fibroblast count, epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that the count of fibroblasts, the grading of epidural fibrosis and arachnoideal involvement in the rats treated with microporous polysaccharide hemospheres were significantly less than the control group. Although the arachnoideal involvement in ankaferd blood stopper group were significantly less than the control group, there were no statistical differences when comparing the grading of epidural fibrosis and the fibroblasts count between the treatment groups and the control group. CONCLUSION: The ankaferd blood stopper and microporous polysaccharide hemospheres reduced epidural fibrosis and arachnoideal involvement after laminectomy in rats.

Which modality is the best choice in distal radius fractures treated with two different Kirschner wire fixation and immobilization techniques?

BACKGROUND: The aim of the study was to investigate whether the number and position of Kirschner (K)-wires, and the manner and duration of immobilization influence radiologic and functional outcomes of distal radius fractures treated with percutaneous K-wire fixation. METHODS: Ninety-two patients were included into the study with a mean follow-up period of 19.84±5.22 months (range, 13-34 months). In Group I, forty-five patients were treated with 3 K-wires and supported with a volar semi-circular cast for the first 3 weeks followed by a removable splint for a further 3 weeks. In Group II, forty-seven patients were treated with 2 K-wires and supported with a below-elbow circular cast for 6 weeks postoperatively. RESULTS: No significant difference in grip strength and DASH scores was found between the two groups. In clinical examination, significantly better functional results were determined in patients supported with a removable volar splint. At 6 weeks postoperatively, volar tilt, radial inclination, and radial length were significantly better in Group I compared to Group II (all p values). CONCLUSION: Tripod technique with 3 K-wires is a safe and reliable procedure to achieve stability and good radiological results. The use of a removable splint also improves the functional outcomes in the treatment of both intra- and extra-articular distal radius fractures.

The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model.

PURPOSE: To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats. METHODS: Eighteen adult male Sprague-Dawley rats were equally and randomly divided into three groups. In the treatment groups, ankaferd blood stopper and microporous polysaccharide hemospheres topically administrated upon duramater surface after laminectomy. Fibroblast count, epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that the count of fibroblasts, the grading of epidural fibrosis and arachnoideal involvement in the rats treated with microporous polysaccharide hemospheres were significantly less than the control group. Although the arachnoideal involvement in ankaferd blood stopper group were significantly less than the control group, there were no statistical differences when comparing the grading of epidural fibrosis and the fibroblasts count between the treatment groups and the control group. CONCLUSION: The ankaferd blood stopper and microporous polysaccharide hemospheres reduced epidural fibrosis and arachnoideal involvement after laminectomy in rats.

Does the wedge wing in the neck screw prevent cut-out failure in Ota/AO 31-A2 trochanteric fractures in elderly patients?

The purpose of this retrospective study was to evaluate the effects of Dyna Locking Trochanteric (DLT) nail (U & I Corporation 529-1, Yonghyun-dong, Uijungbu Kyunggi-Do, Korea 480-050) in 31-A1 and 31-A2 intertrochanteric femur fractures. Eighty-seven patients (63 female and 24 male, mean age 77 years) were treated. The mean duration of followup was 16.6 +/- 3.1 months (range, 12-24 months). There were 36 cases of 31-A1 and 51 cases of 31-A2 fractures. The duration of surgery, fluoroscopy screening time, the blood loss, the hospital stay, the tip-apex distance were significantly less in the 31-A1 fracture group compared with the 31-A2 fracture group (p < 0.001). Cut-out was observed in 13 patients (14.9%) above 80 years old with 31-A2 fractures. Especially in elderly patients with unstable 31-A2 fractures, the wedge wing on the neck screw does not work properly. Therefore further biomechanical investigations and also prospective clinical studies with larger series are needed to improve the device.

The efficacy of semirigid hip orthosis in the delayed treatment of developmental dysplasia of the hip.

UNLABELLED: This study assessed the use of semirigid hip orthosis to stabilize the femoral head into the acetabulum in the delayed treatment of developmental dysplasia of the hip (DDH; Graf type IIb or more severe) under the age of 6 months. Ninety-eight hips from 75 patients (four boys, 71 girls) were evaluated retrospectively. The mean age at treatment initiation was 3.2±1.3 months (1-6 months). As the dysplastic hip matured into a type I hip, we applied the weaning regimen for 1 month. Seventy-two patients (96%) were treated successfully in 4.2±1.1 months (2-8 months). All of the failures were type IV hips. We did not detect any acetabular or femoral head pathology in the later follow-up. Semirigid hip orthosis is safe and effective as the first-line treatment method for delayed DDH except in type IV hips in patients under 6 months of age. LEVEL OF EVIDENCE: Level IV. Case series.

Stress fracture of the femoral neck as a complication of revision arthroplasty of the knee: a case report.

Stress fracture of the femoral neck is a rare complication of total knee arthroplasty. We report a case of femoral neck fracture following revision arthroplasty of the ipsilateral knee. Contributing factors may have been the patient's osteoporosis and a period of immobilisation before the revision arthroplasty. The patient was treated successfully with hemiarthroplasty of the hip. In patients who have undergone total knee arthroplasty, complaints of groin pain that radiates to the involved knee should alert to the possibility of a stress fracture of the femoral neck.

Radiographic artifact mimicking epiphysis of the femoral head in a seven-month-old girl.

Conventional x-ray is still the most important diagnostic and follow-up tool in developmental dysplasia of the hip joint, where hip joint ultrasonography cannot be performed. Artifacts that are seen because of technical errors can cause difficulties in diagnosis and and even can lead to wrong diagnoses and treatments. Herein, we report a diagnostic problem caused by an x-ray artifact in a child who is followed up with developmental dysplasia of the hip joint.

Bilateral transverse (Bowdler) fibular spurs with hypophosphatasia in an adolescent girl.

Hypophosphatasia is a clinically heterogeneous inheritable disorder characterized by defective bone mineralization and the deficiency of serum and tissue liver/bone/kidney alkaline phosphatase activities. Due to the mineralization defect of the bones, various skeletal findings can be radiologically observed in hypophosphatasia. Bowing and Bowdler spurs of long bones are the characteristic findings. The Bowdler spurs reported on in the previous pertinent literature were observed in the perinatal aged patients and these lesions have rarely involved adolescents. We herein report on a 14-year-old girl with fibular Bowdler spurs.