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Objective: This study was performed on fresh frozen cadavers to investigate the role of angular artery damage., Methods: Lateral osteotomies ('high-low-high' method) were carried out bilaterally, with a 4 mm guarded lateral osteotome, after the creation of a subperiosteal tunnel. Following completion of the lateral osteotomy, a skin incision was made in the midline dorsum. The dermis and subcutaneous tissues were carefully dissected, taking care not to damage the angular artery. Overlying tissues were cut and retracted to show the course of the angular artery., Results: The angular artery was not damaged in any of the cadavers. The angular artery was always lateral to the lateral osteotomy line., Conclusion: The high-low-high lateral osteotomy does not damage or traumatise the angular artery. The ecchymosis and oedema are related to other factors.

Objective: To evaluate the midterm clinical and radiological outcomes of the medial approach using two intervals for developmental hip dysplasia (DDH)., Methods: The study involved 62 hips of 47 patients (41 girls, 6 boys) treated with medial approach for DDH from 1999 to 2010. The age of the patients at surgery was 18.7 ± 2.25 months. Follow up of the patients was 11.3 ± 3.07 years. The age of the patients at the last follow up was 12.6 ± 1.74 years. According to the Tönnis classification, 13 hips were grade II, 27 hips were grade III and 22 hips were grade IV. Patients were evaluated according to Omeroglu radiological criteria and modified McKay functional criteria. The presence of avascular necrosis (AVN) of the hip was questioned using the KalamchiMacEwen classification., Results: Radiologically, forty eight (77%) hips were evaluated as "excellent", 8 (13%) hips as "good" and 5 (8%) hips as "fair plus" and 1 (%2) hip as "fair minus". Two (3%) patients had type 1 temporary AVN and one (1%) patient had type 4 AVN with coxa magna and overgrowth of the greater trochanter. According to McKay functional criteria, 56 (90%) hips had "excellent" and 6 (10%) had "good" results. Two (3.2%) hips of one patient had to be reoperated with Salter osteotomy and femoral shortening + derotation osteotomy., Conclusion: Medial approach using two separate intervals for tenotomy and capsulotomy does not jeopardize the medial circumflex or the femoral vessels and yields satisfactory midterm results for children 18 months old with dysplasia of the hip., Level of Evidence: Level IV, therapeutic study., (Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Objective: Ankylosing spondylitis is a systemic disease which affects the axial skeleton and may cause rigid spinal deformities in advanced cases. Clinical and radiological results of patients with ankylosing spondylitis who underwent pedicle subtraction osteotomy (PSO) were evaluated., Methods: Twelve (3 female, 9 male) patients who were treated for rigid spinal deformities due to ankylosing spondylitis were evaluated. All patients were treated with the same surgical technique, which included PSO and pedicle screw-rod combination. For radiological results, thoracic kyphosis, lumbar lordosis, pelvic parameters (pelvic incidence, sacral inclination, pelvic tilt), and the distance between the central sagittal line (CSVL) and the sacrum were measured from pre- and postoperative radiograms. For functional results, SF-36 and Oswestry Disability Index (ODI) were used., Results: Mean age of the patients was 39.8±8.4 years, and mean follow-up was 85.6±39.1 months. Mean angle of lordosis was improved from 6.6°±13.7° preoperatively to 43.8°±8.4° postoperatively (p<0.0001). Mean CSVL was improved from 19.7±9.7 cm preoperatively to 7.45±3.8 cm postoperatively (p=0.0005). Mean local angular change around the osteotomy site was 30.2°±6.2°. The pelvic parameters were not significantly changed after the surgeries. Mean ODI, SF-36 mental, and SF-36 physical scores were 30.16±9.7, 41.2±9.9 and 35.3±7.1, respectively., Conclusion: In patients with rigid sagittal spinal deformities due to ankylosing spondylitis, lumbar lordosis and sagittal balance can be obtained using PSO.

Objectives: Open reduction through a medial approach for the treatment of developmental dysplasia of the hip has been advocated in children younger than 18 months of age. In this study, we evaluated the results of this technique in children above 18 months of age., Methods: A retrospective evaluation of 34 hips (22 patients; 16 girls, 6 boys) was made, whose treatment was performed using open reduction through a medial approach between 1987 and 1997. Only typical dislocations were included. The ages of the patients at the time of surgery were either 18 months or above (mean age 23.7 months; range 18 to 54 months). Clinical and radiographic evaluations were made according to the modified McKay and Severin's criteria, respectively. The hips in which avascular necrosis developed were evaluated according to the Bucholz-Ogden classification. The mean follow-up was 10 years (range 5 to 14 years)., Results: Secondary interventions were required in 24 hips (70.6%). Avascular necrosis developed in nine hips (26.5%). Final clinical results, together with secondary procedures, were excellent in 18 hips (52.9%), good in 10 hips (29.4%), moderate in four hips (11.8%), and poor in two hips (5.9%). Radiographically, there were six hips in Severin class I (17.7%), 11 hips (32.4%) in class II, 10 hips (29.4%) in class III, six hips (17.7%) in class IV, and one hip (2.9%) in class V., Conclusion: These data show that, because of high rates of secondary interventions and ensuing avascular necrosis, open reduction through a medial approach cannot be considered to be successful for the treatment of developmental dysplasia of the hip in children above 18 months of age.