Volumetric evaluation of the subacromial space in shoulder impingement syndrome.

INTRODUCTION: Shoulder impingement syndrome is evaluated radiologically with two-dimensional measurement parameters. None of these measurement parameters accurately reflect the three-dimensional geometry. The purpose of this study was to evaluate the volumetric status of the subacromial space in patients with shoulder impingement syndrome and to investigate its relationship with two-dimensional parameters. HYPOTHESIS: The primary hypothesis of this study is that subacromial volume is reduced in patients with impingement syndrome. The second hypothesis is that the sagittal plane morphology of the acromion reflects the subacromial volume better than the coronal plane morphology. PATIENTS AND METHODS: This retrospective study consisted of a total of 52 participants: 26 patients with impingement syndrome and 26 controls. Volumetric measurements were performed with using magnetic resonance imaging. The relationship between humerus and acromion was evaluated by acromiohumeral distance. The sagittal plane morphology of the acromion was evaluated with an objective acromial angle, while the coronal plane morphology was evaluated with a lateral acromial angle. The radiological parameters between groups were compared. RESULTS: The mean subacromial volume was significantly smaller in the impingement group compared to the control group (p=0.01). The subacromial volume had a negative correlation with the objective acromial angle (R=-0.46; p=0.01) The mean tendon volume was significantly higher in the impingement group (p<0.001). The mean acromiohumeral distance in the impingement group (6.8mm±1.0mm), was calculated to be significantly lower than the control group (10.1mm±1.5mm) (p<0.001). There was a positive moderate correlation between subacromial volume and acromiohumeral distance (R=0.61; p=0.01). DISCUSSION: This is the first study to demonstrate a reduction in subacromial volume in patients with impingement syndrome. The sagittal plane morphology of the acromion, rather than the coronal plane, appears to be more closely related to the subacromial volume. LEVEL OF EVIDENCE: III; case-control study.

Anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior lesions: A cadaveric study and preliminary report.

OBJECTIVE: This study aims to investigate the anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior (SLAP) lesions in a human cadaveric model. METHODS: In this anatomic study, bilateral shoulder girdles of 12 adult formalin embalmed cadavers were used. All cadavers were male, and the mean age was 63.4±7.3 years. The portal entry point was determined as midway between the anterior and posterior borders of the acromion, approximately 1 cm lateral from the edge of the acromion. After a guidewire was placed in the glenoid cavity at the 12 o'clock position where the SLAP lesion typically occurs, a switching stick was inserted there. Each glenoid was then drilled with a 2.4 mm drill through an arthroscopic cannula. Subsequently, anatomical dissection was executed to assess the relationship of the transmuscular portal with the suprascapular nerve, axillary nerve, supraspinatus tendon, acromion, and biceps tendon. Lastly, the shortest distance between the aforementioned structures with the drill was measured by a sensitive caliper to determine whether there was a penetration of the structures. Differences between the right and left sides were analyzed. RESULTS: The mean distance between the portal and the axillary nerve was 55.5 mm±6.0 mm, and the mean length of the suprascapular nerve was 61.2 mm±7.0 mm. The mean distance between the portal and the supraspinatus tendon was 2.8 mm±1.5 mm. No penetration of the axillary nerve, suprascapular nerve, and supraspinatus tendon was observed in any cadaver. No differences were detected for measured anatomical parameters between the right and left sides (p>0.05). CONCLUSION: Findings from this cadaveric study revealed that the transmuscular portal may allow for a reliable anchor placement without any nerve or tendon penetration during arthroscopic SLAP repair. LEVEL OF EVIDENCE: Level V.

Non-traumatic Ceramic Head Fracture in Total Hip Arthroplasty with Ceramic-on-Ceramic Articulation at Postoperative 16th Years.

Ceramic articulation has gained popularity in total hip arthroplasty (THA); however, one of the most important concerns about the use of ceramic materials is the potential for breakage. Importantly, almost all ceramic fractures occur within the first six years after surgery. Here, we present a case report of a 52-year-old female patient who experienced an atraumatic ceramic head fracture at the 16th year after surgery. Key parameters that may be associated with ceramic head fracture are considered to be the use of a 28-mm head and high body mass index (BMI); the patient described here had a BMI of 34.3 kg/m2. Surgical treatment of the case included removal of the broken ceramic head and replacement with an alumina matrix composite ceramic head. At the 12th month follow-up visit, the patient was mobilized independently and could perform her daily activities. Ceramic head fracture after THA may occur even in late periods after surgery. For the treatment of fractures of ceramic material, the fractured component must be removed together with extensive soft tissue excision to ensure that no residual fragments are left behind.

The Role of Surgical Closure Position in Total Knee Arthroplasty: Flexion versus Extension-A Randomized Prospective Study.

We aimed to investigate the effect of the knee position during the surgical closure on isokinetic muscle strength, clinical score, and range of motion in total knee arthroplasty. Seventy-five eligible patients were enrolled in the study and randomly divided into two groups; wound closure was performed with the knee flexed at 90° in group 1 and knee extended in group 2. All the surgeries were performed by the same surgeon and by the same prosthesis type. All the patients received the same rehabilitation program postoperatively. The primary outcomes were the knee flexion degrees and the American Knee Society Score values at preoperative and postoperative 6 weeks, 3, and 6 months. The secondary outcome was the isokinetic muscle strength measurements of both knees before the surgery and after 6 months. There were no significant differences in the American Knee Society Scores and knee flexion degrees between the flexion and extension groups. However, a significant decrease was found in the extensor muscle strength in the extension group after 6 months of the surgery. The findings of our study are that the closing of the knee in flexion or extension does not affect the postoperative knee flexion degrees and scores in total knee arthroplasty. However, quadriceps strength recovers early if the knee closure is performed in flexion position.

The Evaluation of Exogenous Melatonin Administration in Supraspinatus Overuse Tendinopathy in an Experimental Rat Model.

BACKGROUND: Increased oxidative stress and inflammation play a critical role in the etiopathogenesis of chronic tendinopathy. Melatonin is an endogenous molecule that exhibits antioxidant and anti-inflammatory activity. The aim of this study was to evaluate the biochemical and histopathological effects of exogenous melatonin administrations in supraspinatus overuse tendinopathy. METHODS: Fifty rats were divided into the following four groups: cage activity, melatonin treatment, corticosteriod therapy, and control. Melatonin (10 mg/kg, intraperitoneal; twice a day) and triamcinolone (0.3 mg/kg, subacromial; weekly) were administered to the treatment groups after the overuse period. Biochemical and histopathological evaluations were performed on serum samples and biopsies obtained from rats. Plasma inducible nitric oxide synthase (iNOS), vascular endothelial growth factor (VEGF), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were evaluated biochemically. RESULTS: The TAS, TOS, OSI, iNOS, and VEGF values were significantly lower than the pre-treatment levels in rats receiving exogenous melatonin treatment (3 or 6 weeks) (p<0.05). TOS, iNOS, VEGF, and OSI values after 3 weeks of triamcinolone administration, and TOS, VEGF, and OSI levels after 6 weeks of triamcinolone application, were significantly lower than the pre-treatment levels (p<0.05). CONCLUSIONS: Exogenous melatonin application in overuse tendinopathy reduces oxidative stress and inflammation. Melatonin might be an alternative potential molecule to corticosteroids in the treatment of chronic tendinopathy.

Subacromial space volume in patients with rotator cuff tear: The effect of surgical repair.

OBJECTIVE: The aim of this study was to evaluate the effect of the rotator cuff tear repair on subacromial space volume. METHODS: We retrospectively identified 21 eligible patients (5 males and 16 females; mean age: 56.4 (range; 46-71) years) who had shoulder arthroscopy for unilateral full-thickness small to medium rotator cuff tear and normal controlateral shoulder joint. The mean follow-up time was 16.1 (range; 12-25) months. Preoperative and postoperative 1 year bilateral shoulder MRIs and Constant scores were reviewed. Subacromial volume was calculated by using Osirix software. Pre-, postoperative and healthy side (contralateral control group) subacromial volumes were recorded. Paired sample and t-tests were used to compare the pre- and postoperative groups. Independent sample t-tests were used to compare the healthy and pre- and postoperative groups. The correlation between the changes in the subacromial volume and the shoulder Constant score were analyzed using Pearson correlation analyses. RESULTS: The mean subacromial volume of the preoperative group was 2.95 cm3 (range; 1.53-4.23) and the postoperative group was 3.59 cm3 (range; 2.12-4.84). The volume increase was statistically significant (p < 0.05). The mean subacromial volume of the control group was 3.93 cm3 (range; 2.77-5.03), and the difference between the preoperative group and the control group was statistically significant. There was no significant difference found between the postoperative group and the control group (p = 0.156). There was no significant correlation found between the volume and the constant score changes (r = 0.170, p = 0.515). CONCLUSION: The subacromial space volume significantly decreases in full-thickness rotator cuff tears smaller than 3 cm and the surgical repair increases the subacromial volume significantly. LEVEL OF EVIDENCE: Level IV; Diagnostic Study.

Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis.

PURPOSE: The two-tunnel coracoclavicular ligament reconstruction (CLR) technique is one of the treatment approaches commonly used in the surgical treatment of acromioclavicular (AC) injuries. Clavicular tunnel malposition is one of the major causes of failure in coracoclavicular ligament reconstruction. The main purpose of this study was to investigate the effects of clavicular tunnel placement on tendon loading in the CLR technique with finite element analysis. METHODS: Models of clavicle and scapula were constructed using computerized tomography images. Two clavicular bone tunnel reconstruction models were created with the tendon passing through the conoid and trapezoid tunnels. Four models based on the tunnel ratio (TR) method and defined as primary, anatomic, medialized, and lateralized were constructed to evaluate the effect of tunnel placement on loading conditions during tendon graft. All models were loaded by insertion from the trapezius and sternocleidomastoid muscles. The loading on the tendon were evaluated with the finite element analysis. RESULTS: The highest load value measured on the tendon was in the anatomic model (0.789 kPa), and the lowest load value (0.598 kPa) was measured in the lateralized tunnel model. The load value of the primary model was (0.657 kPa), and the medialized model's value was (0.752 kPa). CONCLUSIONS: In two-tunnel CLR technique, tendon loadings are related to tunnel placement. Medialized tunnel placement increases tendon loading. The TR method may be an appropriate option for determining tunnel placement.

Acetabular components with or without screws in total hip arthroplasty.

AIM: To compare the operation time, blood loss, and early outcomes of acetabular components with and without the screw. METHODS: Thirty patients who underwent cementless acetabular component with or without screw and whose follow-up exceeded one year period in total hip arthroplasty were evaluated. A posterior approach was used in all surgical procedures by one experienced surgeon. Demographic data, operation time, intra- and postoperative blood loss volume, follow-up clinical score, cup migration, and osteolysis were recorded. The Kolmogorov-Smirnov test was performed for testing the normality of study data. Mann-Whitney U test was used to analyze the inter-group differences. A P-value of ≤ 0.05 was considered statistically significant. RESULTS: Acetabular components were used in 16 (53.3%) patients with screw and 14 (46.7%) without screw. After one year of follow-up, an osteolytic lesion of 3 mm was found in only one patient in the screw group. No cup migration was encountered. Intra-group mean Harris hip score significantly increased, but there was no significant inter-group difference. While the mean operation time of the screw group was 121.8 min (range; 95-140), it was 102.7 min (range; 80-120) in the no-screw group, and this difference was statistically significant (P = 0.002). The mean intraoperative/postoperative, and total blood loss were 556.6 mL (range: 350-800)/423.3 mL (range: 250-600), and 983.3 mL (range: 600-1350), respectively in the screw group; and 527 mL (range: 400-700)/456 mL (range: 230-600), and 983 mL (range: 630-1250), respectively in the no-screw group. The blood loss difference between the two groups was not significant. In the screw group, the operation time was 19.1 min longer than the no-screw group, and this difference was statistically significant. CONCLUSION: Acetabular components with or without screw have similar results, but the use of screw increases the operation time significantly, while not changing the blood loss volume.

Lateral Ligament Reconstruction for Ball-and-Socket Ankle Accompanying Lateral Ankle Instability: A Case Report and Literature Review.

The ball-and-socket ankle joint is a rare deformity characterized by the loss of concavity in the trochlear surface of the talus with rounding of the articular surfaces of the distal fibula and tibia. Frequently, tarsal coalitions, fibular hypoplasia, and shortening of the limb accompany this deformity. To date, no data have been reported on surgical treatment of lateral ankle joint instability and peroneal tendon dislocation concomitant with a ball-and-socket ankle joint. In the present study, we report the case of a 43-year-old male patient with right lateral ankle joint instability and peroneal tendon dislocation in a ball-and-socket ankle joint, with accompanying tarsal coalition. This was surgically treated by lateral ankle joint ligament reconstruction and tenodesis.

A Radiographic Dye Method for Intraoperative Evaluation of Syndesmotic Injuries.

BACKGROUND: The Chertsey test has been recently defined as an intraoperative test for the detection of the syndesmotic injuries by the application of intra-articular contrast. However, no study has investigated the reliability and comparative analysis of the Chertsey test. The purpose of this study was to explore the diagnostic accuracy of the Chertsey test in predicting syndesmosis instability of the injured ankle, with correlation to preoperative computed tomography (CT) findings. METHODS: A total of 39 patients who were operated on due to the unilateral ankle fracture and had no complaint on the contralateral ankle joint were included in the study. An intraoperative Chertsey test was performed on all ankle fractures and bilateral ankle CT was obtained preoperatively. Ankles were classified as Chertsey +, Chertsey -, and contralateral control group. The morphology categorization, width, and volume of the syndesmotic region were measured on axial images of the CT. Mann-Whitney U test was used to compare the data. Intraobserver and interobserver agreements were accessed by calculating the intraclass correlation coefficient (ICC) for radiologic parameters and the Chertsey test. RESULTS: The Chertsey test was positive in 13 (33.3%) of 39 ankle fractures. Patients with a positive Chertsey test showed a significant increase in syndesmotic width and volume compared with Chertsey - and control group. However, there was no significant difference between Chertsey - and the control group. All the ICC values were excellent for both radiologic measurements and test. CONCLUSION: The Chertsey test is a reliable and useful test that can be used intraoperatively in the diagnosis of syndesmotic injuries. LEVEL OF EVIDENCE: III, comparative series.

Arthroscopic-assisted retrograde mosaicplasty for an osteochondral defect of the femoral head without performing surgical hip dislocation.

Osteochondral autograft transplantation (mosaicplasty) for the osteochondral defects of the femoral head is generally performed with safe dislocation of the hip joint. Here, we present a 27-year-old male patient who had a symptomatic osteochondral defect of the femoral head and underwent mosaicplasty applied by hip arthroscopy without surgical hip dislocation. The preoperative radiological evaluation showed a focal osteochondral defect on the weight-bearing surface of the femoral head. With the assistance of hip arthroscopy, the defect area was reconstructed with osteochondral plug, which was taken from the ipsilateral knee, inserted in a retrograde fashion, and positioned with the spherical surface of the femoral head cartilage under fluoroscopic and arthroscopic control. At the final follow-up (26 months postoperatively), he had full range of motion (ROM) without pain and radiographic evaluation showed near complete incorporation of the graft with preservation of the native joint space. Mosaicplasty can be applied in a retrograde fashion with the assistance of hip arthroscopy without using surgical hip dislocation and may be an alternative treatment option for the osteochondral defects of the femoral head in young patients.

Pedobarographic Analysis in Total Knee Arthroplasty.

Pedobarographic gait analysis is a useful tool for the determination of loading distributions and alterations on the lower extremity and their reflection on the foot sole after many orthopaedic surgical applications. To date, there have been no studies evaluating the relationship between component alignment and changes of pedobarographic gait analysis in total knee arthroplasty (TKA). We aimed to investigate the effects of TKA and prosthetic alignment on the distribution of pedobarographic parameters. Quantitative gait patterns of 47 patients were prospectively evaluated by using pedobarography 1 week before surgery and at the seventh month, on average, postoperatively. Component positions were assessed, and all applications were divided into three groups according to tibial component position as varus, neutral, and valgus. Pedobarographic results were compared between pre- and postoperative values for all applications and compared among the groups. Mean postoperative tibiofemoral angle was 5.4 degrees in valgus, and preoperative knee scores were markedly improved postoperatively. The range of tibial component alignment changed between 1 and 4 degrees in the varus and valgus groups. Plantar loading parameters (force and pressure) were significantly decreased in all operated knees, especially in forefoot and midfoot. In varus tibial components, plantar loading values decreased in midfoot and hindfoot. However, in the neutral and valgus groups, similar alterations of plantar loadings were obtained, which included decreasing in forefoot and midfoot with significant increase in hindfoot. Plantar loading distribution changed statistically significantly after TKA despite good clinical and radiographic results. Tibial component alignment was also responsible for plantar loading distribution. Tibial components in varus position create different foot loading characteristics compared with neutral and valgus aligned components. Pedobarographic evaluation in TKA allows clinicians to obtain a proper understanding of abnormal gait caused by component malposition.

Use of the smartphone for end vertebra selection in scoliosis.

OBJECTIVES: The aim of our study was to develop a smartphone-aided end vertebra selection method and to investigate its effectiveness in Cobb angle measurement. METHODS: Twenty-nine adolescent idiopathic scoliosis patients' pre-operative posteroanterior scoliosis radiographs were used for end vertebra selection and Cobb angle measurement by standard method and smartphone-aided method. Measurements were performed by 7 examiners. The intraclass correlation coefficient was used to analyze selection and measurement reliability. Summary statistics of variance calculations were used to provide 95% prediction limits for the error in Cobb angle measurements. A paired 2-tailed t test was used to analyze end vertebra selection differences. RESULTS: Mean absolute Cobb angle difference was 3.6° for the manual method and 1.9° for the smartphone-aided method. Both intraobserver and interobserver reliability were found excellent in manual and smartphone set for Cobb angle measurement. Both intraobserver and interobserver reliability were found excellent in manual and smartphone set for end vertebra selection. But reliability values of manual set were lower than smartphone. Two observers selected significantly different end vertebra in their repeated selections for manual method. CONCLUSION: Smartphone-aided method for end vertebra selection and Cobb angle measurement showed excellent reliability. We can expect a reduction in measurement error rates with the widespread use of this method in clinical practice. LEVEL OF EVIDENCE: Level III, Diagnostic study.

Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella.

PURPOSE: The aims of this study were to evaluate sagittal plane alignment in patients with chondromalacia patella via magnetic resonance imaging (MRI), analyse the relationships between the location of the patellar cartilaginous lesions and sagittal alignment and finally investigate the relationships between the sagittal plane malalignment and patellofemoral loadings using by finite element analysis. METHODS: Fifty-one patients who were diagnosed with isolated modified Outerbridge grade 3-4 patellar chondromalacia based on MRI evaluation and 51 control subjects were evaluated. Chondromalacia patella patients were divided into three subgroups according to the chondral lesion location as superior, middle and inferior. The patella-patellar tendon angle (P-PT) was used for evaluation of sagittal alignment of patellofemoral joint. Each subgroup was compared with control group by using P-PT angle. To investigate the biomechanical effects of sagittal plane malpositioning on patellofemoral joint, bone models were created at 30°, 60° and 90° knee flexion by using mean P-PT angles, which obtained from patients with chondromalacia patellae and control subjects. The total loading and contact area values of the patellofemoral joints were investigated by finite element analysis. RESULTS: The mean age of all participants was 52.9 ± 8.2 years. The mean P-PT angle was significantly lower in chondromalacia group (142.1° ± 3.6°) compared to control group (144.5° ± 5.3°) (p = 0.008). Chondral lesions were located in superior, middle and inferior zones in 16, 20 and 15 patients, respectively. The mean P-PT angles in patients with superior (141.8 ± 2.7) and inferior subgroups (139.2 ± 2.3) were significantly lower than the values in the control group (p < 0.05). The contact area values were detected higher in models with chondromalacia than in the control models at the same flexion degrees. There were increased loadings at 30° and 90° flexions in the sagittal patellar tilt models. CONCLUSION: This study revealed that sagittal plain malpositioning of the patellofemoral joint might be related to chondromalacia, especially in the presence of lesions in the upper and lower part of the patella. This condition leads to supraphysiological loadings on the patellofemoral joint. Sagittal patellar tilt should be considered in the evaluation and management of patellar cartilage defects. Taking sagittal plane malalignment into consideration in patellofemoral joint evaluation will enable us to design new physical and surgical modalities. LEVEL OF EVIDENCE: IV.

Is There Any Difference Between The Biomechanical Strengths Of The Current Fixation Techniques For Comminuted Distal Patellar Fractures? (Comparison Of Distal Patella Fracture Fixation Techniques).

In this biomechanical study, the strength of five different fixation techniques -anterior tension band wiring with K-wires, separate vertical wiring, headless compression screws with anterior tension band wiring, cannulated screws with tension band wiring and memory shape patellar fixator- for distal patellar fractures were compared. Forty calf knees were used for the biomechanical testing. Each specimen was pre-loaded with 10 N at 1 N/s. The distraction forces were applied consistently with the velocity of 5 mm/s. The ultimate load (N) and displacement (mm) values were recorded. The headless compression screw with anterior tension band wiring (656.9±167.9 N) and the cannulated screws with anterior tension band wiring (642.6±166.0 N) obtained significantly higher ultimate loading values compared to the other fixation methods (p<0.05). Fixation via cannulated screws with anterior tension band wiring techniques are more stabile than the patellar shape memory fixator and anterior K wire fixation.

Association between trochlear morphology and chondromalacia patella: an MRI study.

This study aimed to compare trochlear morphology seen in magnetic resonance imaging between patients with chondromalacia patella and age-matched control patients without cartilage lesion. Trochlear morphology was evaluated using the lateral trochlear inclination, medial trochlear inclination, sulcus angle and trochlear angle on the axial magnetic resonance images. Consequently, an association between abnormal trochlear morphology and chondromalacia patella was identified in women. In particular, women with flattened lateral trochlea are at an increased risk of patellar cartilage structural damage.

Gartland Type 3 Supracondylar Humeral Fractures in Children: Which Open Reduction Approach Should Be Used After Failed Closed Reduction?

OBJECTIVES: For displaced supracondylar humeral fractures in children, in the event of closed reduction failure, anatomic reduction is achieved via open reduction techniques; however, there are no confirmative reports among the published open reduction approaches that deliver the best functional and cosmetic results. Here, we compared long-term functional and cosmetic results of different surgical approaches. DESIGN: Retrospective cohort study. SETTING: Ankara Education and Research Hospital/Turkey. Secondary care hospital and trauma center. PATIENTS/PARTICIPANTS: We evaluated 70 surgically treated Gartland type 3 supracondylar humeral fractures. Patients, with detailed history record, were divided into 5 groups with respect to surgery methods. INTERVENTION: All patients were treated surgically using closed reduction and percutaneous pinning or 4 different open reduction approaches and percutaneous pinning. MAIN OUTCOME MEASURES: Flynn cosmetic and functional score results were compared between surgical groups. RESULTS: Posterior open reduction and triceps transection groups showed worst results, whereas medial and lateral open reduction groups showed good to excellent results similar to closed reduction group. CONCLUSION: Medial and lateral approaches demonstrated better functional results than posterior and triceps transection approaches. Posterior approaches lead to restrictions in extension and poor functional results. In the posterior approach, transecting triceps from olecranon does not benefit from fracture reduction but results in loss of triceps strength and should be avoided. In failed closed reduction, medial and lateral open reduction approaches lead to similar cosmetic outcomes and functional results that are only slightly worse compared with those in closed reduction. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries.

BACKGROUND: Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. METHODS: Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. RESULTS: There was a statistically significant decrease in the degree of fibular rotation (P = .03) and an increase in the upper syndesmotic area (P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area (P = .02) and distal tibiofibular volumes (P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. CONCLUSION: Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Proximal femoral nail shows better concordance of gait analysis between operated and uninjured limbs compared to hemiarthroplasty in intertrochanteric femoral fractures.

PURPOSE: The purpose of this study was to compare the results of pedobarographic gait analysis between the patients treated by proximal femoral nail or bipolar partial hemiarthroplasty due to intertrochanteric fractures. METHODS: Thirty-seven patients with a minimum 1-year follow-up who had been operated for intertrochanteric fractures were evaluated clinically, radiologically and with pedobarographic gait analysis. Proximal femoral nail had been performed to 21 patients (group A), whilst 16 patients had been operated by partial bipolar hemiarthroplasty (group B). Pedobarographic analysis was performed by measuring plantar pressure, force and contact area values in both static and dynamic manner. Pedobarographic results of operated limb were compared among groups. Same data's also were compared between operated and uninjured limbs in each group to determine any asymmetry on weight-bearing. RESULTS: Average follow-up period in group A and group B was 36 (12-56) and 30 (12-48) months, respectively. There were no statistically significant differences among groups in terms of age, gender, body mass index, type and side of fracture, follow-up period, leg length discrepancy and postoperative hip scores. When the pedobarographic results of operated limb were compared, group B showed much more plantar force and pressure values than group A, on both static and dynamic evaluations. If the evaluation was taken into consideration to comparison of pedobarographic results between operated and uninjured limbs in each group, we found asymmetry in static load bearing, caused by higher load on uninjured limb in both groups. However, there was no statistically significant asymmetry between operated and uninjured limbs in respect to dynamic pedobarographic parameters for patients in group A. On the contrary, operated limbs in group B exposed much more plantar force and pressure values than uninjured limbs, which indicated asymmetric weight-bearing on dynamic evaluation. CONCLUSIONS: Assessment of pedobarographic parameters can be another way of measuring the results of treatment in intertrochanteric fractures. Uninjured limbs of patients expose much more loading than operated limbs in postoperative static evaluation for both treatment options. However in dynamic evaluation, there is a better concordance of gait analysis between both limbs in patients operated by proximal femoral nail.