CPAK classification detect the real knee joint apex position in less than half of the knees.

PURPOSE: Accurate assessment of the knee joint line is essential for surgeries involving the knee. The knee joint line obliquity (KJLO) is a radiological measurement that evaluates the position of the knee joint relative to the ground and is frequently used in preoperative planning and clinical follow-up. On the other hand, coronal plane alignment of the knee (CPAK) classifications assesses the joint line as the summation of the medial proximal tibial angle (MPTA) and mechanical lateral distal femoral angle (mLDFA). The purpose of this study is to determine the concordance of these two measurement techniques. METHODS: This cross-sectional study evaluated the long-leg standing radiographs (LSRs) of 164 healthy knees. The extremity KJLO and CPAK classification JLO were measured twice by two observers at 8-week intervals. The knee joint line apex positions (proximal, neutral and distal) of the two measurement techniques are compared (concordance or discordant). The intraobserver and interobserver reliability were examined using the intraclass correlation coefficient (ICC). Possible causes of the discordant were evaluated with univariate and multivariate logistic regression analysis. RESULTS: CPAK classification detected the KJLO apex position in 70 extremities (42.7%) only. Subgroups CPAK JLO detected 13.6% of the proximal apex, 20.4% of the neutral, and 90.7% of the distal apex (p < 0.01). Upon multivariate logistic regression analysis, the variable KJLO apex position (proximal, neutral vs. distal, odds ratio (OR) = 10.291, 95% confidence interval [CI] = 2.225-25.656, and (p < 0.01) was determined as a risk factor for discordant. CONCLUSION: The CPAK JLO measurement technique can be misleading in defining the KJLO apex position and the concordance between them is less than 50%. It has a high tendency to misleadingly predict proximal and neutral apex positions, which can potentially have negative implications for assessing the joint line. LEVEL OF EVIDENCE: Level I.

'One millimetre equals one degree' is a major source of inaccuracy in planning osteotomies around the knee for metaphyseal deformities compared to the digital planning.

PURPOSE: The objective of this study was to compare the accuracy of virtually performed osteotomies around the knee. The comparison was made between the Miniaci method (method 1), considered the gold standard planning, with the widely held dogma that one degree of correction required equates to one millimetre of opening/closing (method 2). METHODS: This retrospective cross-sectional study was conducted between December 2018 and September 2022 in patients aged at least 15 years with metaphyseal knee deformity. Osteotomy planning was performed in methods 1 and 2 utilising calibrated long-leg alignment X-rays in the frontal plane. In both methods, the desired correction was defined by the Fujisawa point. The error % in measurement (ratio method 1/method 2) and the difference in millimetres (method 1 - method 2) between the two methods were analysed. RESULTS: A total of 107 osteotomies with 27 (25.2%) distal femoral osteotomies, 54 (50.5%) proximal tibial osteotomies and 26 (24.3%) double-level osteotomies were performed virtually with a mean hip-knee-ankle angle of 176.4 ± 6.6. In distal femur osteotomy, the mean error % between methods 1 and 2 was 38.9 ± 16.7% and 22.4 ± 16.8% for the opening and closing groups, respectively. In proximal tibial osteotomies, the mean error % was 22.7 ± 15.6% and 9 ± 10.8% for the opening and closing groups, respectively. In double-level osteotomy, the mean error % of femur-based corrections was 34.9 ± 19% and 19.5 ± 21% for the opening and closing groups, respectively, and the mean error of the tibial-based corrections was 26.4 ± 12.1% for the opening group and 10.8 ± 10% for the closing group, respectively. CONCLUSION: Planning one millimeter per degree of desired correction for osteotomies around the knee in metaphyseal deformities is a major source of error when compared with digital planning using the Miniaci method. This was seen most frequently with osteotomies of the distal femur and all opening wedge osteotomies. LEVEL OF EVIDENCE: Level Ⅲ, retrospective cross-sectional study.

Information videos posted on Instagram by orthopaedics and sports traumatology surgeons mostly explain surgical technique, and the least mentioned topics are injury prevention and complications.

PURPOSE: Social media has become the new information acquisition platform for all content producers. In the current literature, there are no studies examining the content quality and the strengths and weaknesses of videos on Instagram that explain anterior cruciate ligament (ACL) injuries, which is the most discussed topic of sports surgery. The aim of this study was to evaluate the quality, strengths and weaknesses of information pertaining to ACL surgery that is disseminated on Instagram. METHOD: An Instagram search was conducted from 30 May 2023 to 30 January 2024. The search encompassed six languages (English, Spanish, German, French, Italian and Turkish) and was performed by six different observers. The investigation focused on eight subheadings derived from current literature on the ACL. These subheadings were addressed in Instagram videos, covering ACL biology or biomechanics, injury mechanism, injury prevention, injury evaluation, surgical technique, injury or surgery complications, injury rehabilitation process and return to sport or work. RESULT: The content was assessed of 127 videos from 127 Instagram accounts, spanning six different languages. Across the review of eight subheadings, the average number covered for the entire group was 3 (range, 0-8). Further analysis revealed that surgical technique was the most frequently mentioned subheading for the whole group (68.5%), followed by injury evaluation (54.3%). Prevention (10.2%) and complications (19.6%) were the least mentioned subheadings. The number of followers showed a correlation with video content quality. CONCLUSION: Although the video quality scores were found to be moderate, the content often focused on surgery and evaluation subheadings. The prevalence of incomplete information underscores the importance of developing strategies to ensure more comprehensive and accurate dissemination of medical knowledge. LEVEL OF EVIDENCE: Level V.

Midterm Donor Site Morbidity After Vascularized Free Fibula Flap Harvesting.

BACKGROUND: Vascularized fibula grafts (VFGs) have become one of the most preferred grafts for the reconstruction of bone defects. However, despite the many advantages over other graft options, recipient and donor site morbidities are also common. Donor site morbidity has been reported at rates ranging from 5% to 67%. The aim of this study was to present a single-center series examining the clinical, functional, and radiologic aspects of donor site morbidity following VFG harvesting. METHODS: The study included 69 patients who underwent biological reconstruction with VFG for bone tumors, avascular necrosis of the femoral head, or bone defects after trauma. Patients were evaluated functionally, clinically, and radiologically for donor site morbidity. RESULTS: Donor site morbidity was observed in 33 of 69 patients (48%). The most complications were sensation deficits around the feet and ankles (20 of 69; 29%). Knee laxity was more common in patients who underwent osteoarticular fibular resection (P = .006). CONCLUSION: We found VFG to be an effective method for the reconstruction of large bone defects, but associated with a relatively high rate of complications. Complications requiring surgical intervention were rare and the majority of patients did not have long-term functional limitations. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Patellar Lateralization, Absence of Joint Hypermobility, and the Mechanism of Injury Are Associated With Osteochondral Fracture After First-time Acute Lateral Patellar Dislocation in Adolescents: An MRI-based Evaluation.

BACKGROUND: Although the risk factors for patellofemoral dislocation are clearly defined, risk factors for osteochondral fracture (OCF) after patellar dislocation are not as well defined. The aim of this study was to investigate the risk factors for OCF by evaluating patients with and without OCF after first-time acute patellar dislocation. METHODS: This multicenter study was conducted as a retrospective examination of the radiologic measurements on the magnetic resonance imaging of 306 patients. The patients were divided into the OCF group and non-OCF group, and OCFs were grouped according to whether the fracture was in the patella or femur. Patellar height, patellar lateralization, trochlear morphology, patellofemoral matching, and patella types were evaluated on patient magnetic resonance imaging. The presence of joint hypermobility in the patients was determined according to the Beighton scale score. The injury mechanisms of the patients were grouped as sports-related injuries, injuries resulting from simple falls, and injuries during daily activities. RESULTS: A total of 120 OCFs were detected in 108 (35.2%) patients, of which 96 (80%) were in the patella and 24 (20%) in the femur. The rate of OCF after sports-related injuries was found to be significantly higher than in other injury mechanisms ( P =0.001). More joint hypermobility was detected in patients without OCF ( P =0.041). The measurements of tibial tubercle-trochlear groove, tibial tubercle-posterior cruciate ligament distance and lateral patellar displacement were statistically higher in cases with OCF ( P =0.001). In patients with normal joint mobility, the rate of OCF localization in the patella was significantly higher ( P =0.035). No correlation was found between any other parameters and OCF ( P >0.05). The absence of joint hypermobility and the measurements of tibial tubercle-trochlear groove distance, tibial tubercle-posterior cruciate ligament distance, and lateral patellar displacement were independent risk factors for the incidence of OCF according to the logistic regression analysis. CONCLUSIONS: The absence of joint hypermobility and patellar lateralization are independent risk factors for the occurrence of OCF after first-time patellar dislocation. Sports-related injury is a nonindependent risk factor for the presence of OCF. In patients with normal joint mobility, the incidence of OCF in the patella is higher than in the femur. These important factors should be considered when evaluating patients and starting their treatment. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

The John Hopkins classification system used in pediatric supracondylar humerus fractures requires more experience than the Gartland system.

The Gartland classification is used to decide on surgery. In contrast, the John Hopkins classification system predicts clinical outcomes for patients undergoing surgery and determines the risk of reduction loss. This study aims to investigate the usability of the Gartland and the John Hopkins classification systems by pediatric and general orthopedic surgeons. The preoperative images of 200 patients who presented at a tertiary-level trauma center with a supracondylar humerus fracture were examined by 4 observers, twice at an interval of 6 weeks. The observers comprised 2 pediatric orthopedic surgeons and 2 orthopedics and traumatology surgeons. Inter- and intra-observer reliability were excellent for the first and second measurements of the Gartland classification. The inter-observer agreement of the pediatric orthopedic surgeons and the general orthopedic surgeons was found to be similar (ICC >90). Inter-observer reliability was excellent (ICC: 0.808) and good (ICC: 0.732) for the measurements of the John Hopkins classification, respectively. The inter-observer agreement of the pediatric orthopedic surgeons and the general orthopedic surgeons was not similar. The inter-observer agreement between the two pediatric orthopedic surgeons was excellent for the measurements (ICC: 0.868; ICC: 0.756, respectively). The inter-observer agreement between the two general orthopedic surgeons was good for the measurements (ICC: 0.605; ICC: 0.663, respectively). The John Hopkins classification system has good intra- and inter-observer reliability, and a high experience level increases the agreement. The Gartland classification system was not affected by experience. This should be considered when taking measurements in studies and patient management.

Midterm results of intra-articular stromal vascular fraction injection for the treatment of knee osteoarthritis.

PURPOSE: This study aimed to evaluate the safety and efficacy of intra-knee stromal vascular fraction (SVF) injection in patients with symptomatic knee osteoarthritis at the midterm (3-year) follow-up. METHODS: SVF injection was applied to 25 knees of 20 patients. Eighteen patients (90%) were female, and the means ± standard deviations of age was 61.9 ± 7.8 (range, 50-76) years. Patients who received conservative treatment for at least 6 months and had radiographic Kellgren-Lawrence (K-L) grades 2 and 3 varus gonarthrosis were included in the study. SVF was obtained from the umbilical region by liposuction using local anaesthesia. Patients were followed-up for 36 months. Their visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lysholm scores were evaluated before and at 6, 12, 24 and 36 months post-SVF injection. RESULTS: A statistically significant improvement (p < 0.05) was observed in VAS, WOMAC and Lysholm scores at the first 2-year follow-up compared to baseline. However, no statistically significant difference (n.s.) was observed in VAS, WOMAC and Lysholm scores at the 3-year follow-up compared with baseline. CONCLUSION: Intra-articular SVF injection decreased pain and significantly improved the functional outcomes in the first 2 years in knees with grade 2-3 osteoarthritis; however, these positive effects of the injection disappeared in the 3rd year. Although short-term successful results of SVF have been reported in the literature, prospective studies are needed for medium- and long-term results.

Reliability of Gordon Lateral Rotation Percentage and Prabhakar Percentage of Metaphyseal Overhang for Pediatric Supracondylar Humerus Fracture; Is it Clinically Reliable for John Hopkins Classification Coronal Fracture Subtypes?

BACKGROUND: Rotational malalignment is a common problem in pediatric supracondylar humerus fractures (SCHF). Several techniques have been described to evaluate the true rotation value. Although the Prabhakar and Gordon techniques are used frequently, their superiority to each other in terms of measurement quality is unknown. QUESTIONS/PURPOSES: The aim of this study was to investigate the clinical compatibility of the 2 techniques and to evaluate whether they are suitable for all subtypes. METHODS: This cross-sectional study included 40 patients with SCHF (including subtypes; Typical, Medial Oblique, Lateral Oblique, and High fracture pattern). The Gordon lateral rotation percentage and Prabhakar percentage of metaphyseal overhang were measured twice by 4 experienced Orthopedics and Traumatology surgeons at 8-week intervals. The interobserver and intraobserver reliability were examined using the intraclass correlation coefficient. RESULTS: The interobserver reliability for Gordon and Prabhakar technique was 0.816 and 0.762 for the first measurement and 0.811 and 0.811 for the second measurement, respectively.The medial oblique fracture pattern was determined to have the best interobserver agreement among the subtypes. The result was excellent for the medial and lateral oblique subtypes, good for the typical fracture pattern, and fair for the high fracture pattern. The intraobserver reliability for Gordon and Prabhakar technique was excellent, 0.924 and 0.922, respectively. CONCLUSION: The main finding of this study was that the Gordon and Prabhakar techniques have similar interobserver and intraobserver reliability. Although the Gordon technique tends to have higher interobserver reliability, the difference was clinically insignificant. These measurements should not be relied upon in cases of SCHF with a high fracture pattern because of the different anatomic features of that region. LEVEL OF EVIDENCE: Level III.

Is radiological rotation measurement affected by the fracture pattern in pediatric supracondylar humeral fractures?

BACKGROUND: In supracondylar humerus fractures (SCHF), the most frequently used method to calculate rotation is the Gordon lateral rotation percentage (GLRP) defined by Gordon et al. However, this technique includes only typical fractures (49%-80% of all fractures) from the Johns Hopkins (J-H) fracture classification system. PURPOSE: The aim of the study was to investigate (1) is Gordon criteria useful for John Hopkins subgroups of supracondylar fractures and (2) is Gordon criteria affected by internal and external rotation. MATERIAL AND METHODS: This study was designed using four pediatric left humerus bones obtained from the Sawbone© company. For each bone, an osteotomy was made to mimic each of the J-H coronal fracture patterns. The cut bones were placed in a wooden rotation apparatus. The GLRP measurements were taken by five blinded observers. RESULTS: In the repeated measurements of the observers, <20° rotation typical and <30° medial oblique and lateral oblique fracture pattern were measured as within the limits of an acceptable amount of rotation according to the Gordon criteria. However, for high fracture pattern (HFP), ≤30° internal rotation and <60° external rotation were determined to be within the acceptable rotation criteria according to the Gordon criteria. CONCLUSIONS: All fracture patterns have different characteristics; however, based on the data of this study, the Gordon criteria can be used safely for typical, medial oblique, and lateral oblique fracture patterns but it is necessary to lower the acceptable rate of 50% for HFP.

Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques.

INTRODUCTION: In the surgical treatment of supracondylar humeral fractures (SHF), the surgeon has to stand right next to the fluoroscopy device, so it is very important to know how to use it in the most appropriate way to reduce radiation exposure. The aim of this study was to investigate the effect of using C-arm in uniplanar (inverted) and biplanar (standard-horizontal) configurations on (1) the radiation exposure to the surgeon, and (2) surgical time and fluoroscopy exposure time. MATERIAL AND METHODS: This prospective randomised study was conducted on 20 patients who underwent fluoroscopy during closed reduction and percutaneous pinning for a SHF. In the first configuration, the C-arm was inverted and the image intensifier was used as a surgical table. In the second configuration, the C-arm was used biplanar. The operations were performed by 5 surgeons, with each surgeon using each method only twice. During the operation, to find a value closed to direct radiation exposure measurement was made by attaching a dosimeter to the wrist and scatter radiation exposure was measured by attaching a dosimeter to the neck and waist of the surgeons. The operation time and fluoroscopy exposure time were determined. RESULTS: The duration of operations performed with the biplanar C-arm position and the fluoroscopy exposure time in operations performed with the uniplanar method were found to be statistically significantly longer (p = 0.001). The measurements on the dosimeter worn on the neck of surgeons were found to be statistically significantly higher while using the uniplanar C-arm configuration (p = 0.001). There was no statistically significant difference between the dosimeter measurements on the wrists and waists of the surgeons and the C-arm configurations (p = 0.820; p = 0.185). CONCLUSIONS: Although the use of biplanar C-arm has no effect on radiation exposure to the surgeon's wrist, the most important advantages are that the neck area is exposed to less radiation and it shortens the fluoroscopy time so the use of a biplanar C-arm can be recommended. LEVEL OF EVIDENCE: Level II.

Foot and Ankle Forklift Injuries; Diagnosis to Treatment Options, Return to Work and Functional Outcomes.

As our tertiary-level trauma center is close to an industrial zone and associated international port, industrial injuries are seen more often than is expected in routine practice. The aim of this study was to present the demographic data, treatment options, and changes in work-life of patients with foot and ankle injuries due to a forklift accident, and to determine the factors affecting the clinical outcome. The study was conducted in our university hospital and included patients who presented with a foot and ankle injury resulting from a forklift accident. Data were collected including age, sex, dominant extremity, history of trauma, presence of fracture, management (surgical or conservative), complications, time of return to work, workforce loss, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Short Form Health Survey (SF-36) scores at the final follow-up examination. Evaluation was made of 132 patients, comprising 113 (85.6%) males and 19 (14.4%) females with a mean age of 32 years (range 16-65 years). The most frequently recorded occupational group was shipyard workers (50%). The most common mechanism of injury was crushing under the forklift wheel (n = 63, 47.7%). The most frequently injured foot region was the forefoot (47%). A total of 90 (68.1%) patients continued to work in the same position on return to work. The lowest mean AOFAS score (73.4) and SF-36 (physical component) score (37.3) were determined in cases with mixed region injuries (p = .0001, p = .0001). The wearing of protective footwear had no effect on the rate of return to work (p = .195), workforce loss (p = .34) and AOFAS score (p = .166). This study is the largest series of patients with foot and ankle injuries related to forklift accidents. Forklift injuries can be treated conservatively or surgically according to the clinical condition of the patient. The main indicators of return to work and functional outcome are which foot region is injured and whether or not the injury causes a fracture.

An unusual injury pattern: arm wrestling injury, treatment modalities, clinical outcomes, and return to sport.

BACKGROUND: In the sport of arm wrestling, the great rotational force is applied to the upper extremity, which can result in muscle and tendon injuries in the shoulder, elbow, and wrist joints, and even bone fractures. The aim of this study was to present the treatment modalities, functional outcomes, and return to sport after arm wrestling injuries. METHODS: A retrospective evaluation was made of the trauma mechanisms, treatment modalities, clinical outcomes, and time of return to sports of patients admitted to our hospital with an arm wrestling injury between 2008 and 2020. At the final follow-up examination, the functional scores (DASH score and constant score) of the patients were evaluated. RESULTS: Evaluation was made of 22 patients comprising 18 (82%) males and 4 (18%) females with a mean age of 20±6.1 years (range, 12-33 years). Two (10%) patients were professional arm wrestlers. The DASH scores at the final follow-up (mean 4 years) examination were 0.57 (min: 0 and max: 1.7) for the patients with humerus shaft fracture. All the patients with isolated soft-tissue injuries returned to sports within 1 month. Patients with humeral shaft fractures returned to sports later and had a lower functional score (P<0.05). There was no disability in any patient during long-term follow-up. Patients with soft-tissue injuries continued arm wrestling more than patients with bone injuries (P<0.001). CONCLUSION: This study constitutes the largest patient series evaluating patients presenting at a health-care institution with any complaint after arm wrestling. Arm wrestling is not a sport that only results in bone pathologies. Therefore, providing the participants in this sport with information that they may be injured in arm wrestling but there will be a full recovery, may reassure and encourage them.

Anatomical features of the proximal femur in the Turkish population / Características anatómicas del fémur proximal en la población turca

SUMMARY: Different populations have different genetic traits, and this causes various anatomical features to emerge. Orthopedic implants used in Turkey are generally of Western origin, and these implants are designed based on the anatomical features of Western populations. This study aimed to evaluate the compatibility of existing implants for the Turkish population by revealing the anatomical features of the proximal femurs of individuals from the Turkish population while also constituting a helpful source of data on newly developed implants. A total of 1920 proximal femurs of 960 patients were evaluated via images obtained by Computer Tomography. Twenty patients (10 females and 10 males) for each age within the age range of 18-65 years were included. Femoral head diameter, femoral neck width, femoral neck length, medullary canal width, and collodiaphyseal angle were measured. The right and left femoral head diameter was 46.46±3.84 mm, 46.50 ±3.85 mm respectively. The right and left femoral neck width was 30.63±3.4 mm, 30.85±3.29 mm respectively. The neck length was 94.62±8.33 mm for the right proximal femur, it was 94.75±8.19 mm for the left. The width of the medullary canal was 15.46±2.25 mm for the right proximal femur and 15.53±2.20 mm for the left. The right and left hips, the collodiaphyseal angles were 133.06±2.39° and 133.13±2.36°. Anatomical features of the proximal femur vary according to age, sex, and race. This study may be used as an important resource for the evaluation of patients' compatibility with existing implants and for the design of new implants.

Diferentes poblaciones tienen diferentes rasgos genéticos, y esto hace que surjan varias características anatómicas. Los implantes ortopédicos utilizados en Turquía son generalmente de origen occidental y estos implantes están diseñados en función de las características anatómicas de estas poblaciones. Este estudio tuvo como objetivo evaluar la compatibilidad de los implantes existentes para la población turca al revelar las características anatómicas de las epífisis proximales de fémures de individuos de la población turca y, al mismo tiempo, constituir una fuente útil de datos sobre implantes recientemente desarrollados. Se evaluaron un total de 1920 fémures proximales de 960 pacientes mediante imágenes obtenidas por tomografía computarizada. Se incluyeron veinte pacientes (10 mujeres y 10 hombres) para cada edad dentro del rango de edad de 18 a 65 años. Se midió el diámetro de la cabeza femoral, el ancho del cuello femoral, la longitud del cuello femoral, el ancho del canal medular y el ángulo colodiafisario. El diámetro de la cabeza femoral derecha e izquierda fue de 46,46 ± 3,84 mm, 46,50 ± 3,85 mm, respectivamente. La anchura del cuello femoral derecho e izquierdo fue de 30,63±3,4 mm, 30,85±3,29 mm, respectivamente. La longitud del cuello fue de 94,62±8,33 mm para el fémur derecho, fue de 94,75±8,19 mm, para el izquierdo. El ancho del canal medular fue de 15,46±2,25 mm para el fémur derecho y de 15,53±2,20 mm para el izquierdo. Las caderas derecha e izquierda, los ángulos colodiafisarios fueron 133,06±2,39° y 133,13±2,36°. Las características anatómicas de la epífisis proximal del fémur varían según la edad, el sexo y la raza. Este estudio puede utilizarse como un recurso importante para la evaluación de la compatibilidad de los pacientes con los implantes existentes y para el diseño de nuevos implantes.

Supracondylar Humerus Fractures in Infants and Early Toddlers; Characteristics, Clinical and Radiological Outcomes Compared with Older Children.

BACKGROUND: Supracondylar humerus fractures (SCHF) are rarely seen in the youngest age groups (1-3 years). Although there is no difference in the context of treatment options, it has been shown that younger age groups have different characteristics. Few studies have examined toddlers, which have notably different characteristics. This study is the first to report the characteristics, diagnosis, treatment and functional results of SCHF in infants and early toddlers. METHODS: A retrospective analysis was made of the data of patients younger than 30 months old, who were operated on in our clinic for SCHF between 2012 and 2020 with at least 2 years of follow-up. Patient demographic and surgical data, and the functional and radiological results were documented. RESULTS: Evaluation was made of a total of 52 patients comprising 30 females (58%) and 22 males (42%), with a mean age of 20.75 ± 5.4 months (range, 6-30 months). The injury was in the right elbow in 24 (46%) patients. The mechanism of injury was a fall from an object at home (table, chair, bed, etc.) in 41 (79%) patients. Patients who fell from a height of more than 4 meters had additional injuries (liver laceration, vertebral fracture, etc.). Only 1 patient had anterior interosseous nerve (AIN) damage before the operation, but the final follow-up neurovascular examinations for all patients were normal. The median follow-up period was 4 years (range, 2-7 years). Flynn outcome scores were (88.5%) excellent and variant Hospital for Special Surgery scores were (82.7%) excellent. CONCLUSIONS: With appropriate treatment of SCHF, the clinical outcomes in infants and early toddlers are excellent. Using a medial pin to achieve and protect stability in this age group does not increase the risk of iatrogenic ulnar nerve damage. Patients younger than 20 months tend to have more varus malalignment but similar functional results.

Management of orthopedic oncology patients during coronavirus pandemic.

The new measures implemented in hospitals also altered the operation of orthopedics and traumatology departments. The main purpose of this article is to discuss how orthopedic oncology clinics should be organized during the pandemic and to present the process management scheme for patients requiring orthopedic surgery, including trauma surgery, from diagnosis to treatment, together with our experiences. Instead of thinking about the global emergence of the epidemic, it is time to act decisively. At first glance, the coronavirus disease 2019 (COVID-19) pandemic and orthopedics may seem to be unrelated disciplines, but the provision of healthcare services to patients who require them proves that these two fields are parts of the same whole. Our experiences in treating neutropenic, lymphocytopenic, and chemotherapy patients seem to have proven beneficial during this process. We operated on 10 biopsy patients, 15 primary bone sarcomas, 9 soft tissue sarcomas, and 82 trauma patients within this time frame. Only three patients were suspected to have COVID-19 before admission. The early identification, strict isolation, and effective treatment of these patients prevented any nosocomial infections and disease-related comorbidities. This success is the result of the multidisciplinary cooperation of the Ministry of Health, our hospital, and our clinic.