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Objective: To evaluate the effect of 3d printed models on surgical pre-operative planning of complex spinal deformities. Methods: In our study, five orthopedic surgeons made surgical planning of 5 patients with severe spinal deformity in three conditions: X-ray with computer tomography (X-ray-CT), 3D-computed tomography (3dCT), and 3d printed spine models. Operation plans were examined according to the level and number of instrumentations, osteotomy level, and time required for decision-making. Results: X-ray-CT, 3dCT, and 3d modeling methods were compared, and no statistically significant difference was observed in the number of screws and osteotomy score to be used in operation. The time required for decision ranking is 3d Model, 3d CT, and Xray-CT. Conclusions: 3d printed models do not influence the operative plan significantly; however, it reduces surgical planning time at pre-op duration, and those models gave some opportunities to practice with implants on a patient’s 3d spine model. Level of Evidence III; Diagnostic Studies - Investigating a Diagnostic Test . RESUMO Objetivo: Avaliar o efeito de modelos 3D impressos no planejamento pré-operatório cirúrgico de deformidades complexas da coluna vertebral. Métodos: Em nosso estudo, 5 cirurgiões ortopédicos fizeram o planejamento cirúrgico de 5 pacientes com deformidade espinhal grave em três condições: raio-X com tomografia computadorizada (raio X-CT), tomografia computadorizada com reconstrução 3D (3dCT) e modelo de coluna vertebral impressa (modelo 3d). Os planos de operação foram examinados de acordo com o nível e número de instrumentos, nível de osteotomia e tempo necessário para a tomada de decisão. Resultados: Foram comparados os métodos de modelagem de raio X-CT, 3dCT e modelo 3d e nenhuma diferença estatisticamente significativa foi observada no número de parafusos e escore de osteotomia a serem utilizados na operação. O ranking do tempo necessário para a tomada de decisão foi de modelo 3d, 3d CT e raio X-CT. Conclusões: Os modelos impressos em 3d não influenciam significativamente o plano operatório, porém reduzem o tempo de planejamento cirúrgico no pré-operatório e esses modelos deram algumas oportunidades de praticar com implantes no modelo de coluna 3d do paciente. Nível de evidência III; Estudos de Diagnóstico - Investigando um Teste de Diagnóstico .

Treatment of Kienböck disease is still a clinical challenge. The treatment used in each instance is decided according to stage of the disease at presentation. Good clinical and radiological results could be obtained with partial capitate shortening osteotomy. However, mid-term results of this technique and its effect on lunate revascularization are not well known.The aim of this study was to report our results of partial capitate shortening osteotomy in the treatment of stage II and IIIA Kienböck disease.Ten patients were enrolled in the study with a mean age of 37.7 years old (standard deviation [SD] = 9.6). Patients were evaluated clinically in terms of range of motion, DASH and VAS scores, satisfaction with the outcome, and grip/tip/palmar/key pinch strength compared to the contralateral side. Radiological evaluation consisted of Lichtman staging on plain radiographs and lunate revascularization on magnetic resonance imaging (MRI) at both preoperative and postoperative evaluations.The mean duration of follow-up was 55.2 (SD = 24) months. The mean DASH and VAS scores were 14.3 (SD = 6.7) and 1.5 (SD = 1.3), respectively. For patient satisfaction, the mean score was 3.6 (SD = 0.6). The Lichtman stage of 7 patients remained unchanged. Lunate revascularization was detected with MRI in 6 patients.Although the number of patients in the study prevents more strict conclusions, our results are promising, and the technique presented offers minimally but observable lunate revascularization and high success rates in preventing the progression of the disease.Le traitement de la maladie de Kienböck demeure un défi clinique. Dans chaque situation, le traitement dépend de la phase de la maladie à la consultation. On peut obtenir de bons résultats cliniques et radiologiques grâce à une ostéotomie partielle de raccourcissement du capitatum. On connaît toutefois mal les résultats à moyen terme de cette technique et ses effets sur la revascularisation de l’os semi-lunaire.La présente étude visait à rendre compte des résultats de l’ostéotomie partielle de raccourcissement du capitatum dans le traitement de la maladie de Kienböck de stade II et IIIA.Dix patients d’un âge moyen de 37,7 ans (ÉT 9,6) ont participé à l’étude. Les chercheurs ont évalué l’amplitude de mouvement de ces patients, leurs scores DASH et VAS, leur satisfaction envers les résultats et leur force de préhension des doigts, de la paume et de la pince sub-termino-latérale par rapport au côté controlatéral. Ils ont procédé à une évaluation radiologique préopératoire et postopératoire au moyen de la classification de Lichtman par radiographie classique et de la revascularisation de l’os semi-lunaire par imagerie par résonance magnétique (IRM).Le suivi avait une durée moyenne de 55,2 mois (ÉT 24). Les scores DASH et VAS moyens s’élevaient à 14,3 (ÉT 6,7) et à 1,5 (ÉT 1,3), respectivement. Le score moyen de satisfaction des patients était de 3,6 (ÉT 0,6). Le stade de Lichtman de sept patients est demeuré stable. Chez 6 patients, l’IRM a révélé une revascularisation de l’os semi-lunaire.Même si le peu de patients à l’étude empêche les auteurs de tirer des conclusions plus rigoureuses, les résultats sont prometteurs. La technique utilisée entraîne une revascularisation de l’os semi-lunaire minime, mais observable, et empêche l’évolution de la maladie dans une grande proportion des cas.

Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the contribution of such combination to results isn't known well.We performed a comparative study to evaluate the effects of PIN neurectomy for PRC and a systematic review of the literature was performed to identify whether such combination has an advantage.Patients with wrist diseases who underwent PRC were evaluated retrospectively. Patients without PIN neurectomy (group 1, n = 7) and with PIN neurectomy (group 2, n = 8) were compared in respect of mean age, follow-up, gender, Q-DASH, VAS, MAYO wrist scores, flexion-extension/radial-ulnar deviation range of motion at final follow-up. The MEDLINE database was searched for studies published between 2005 and 2015, as the second part of the study. The following keywords were used: "proximal," "row," "carpectomy." Studies, which met the inclusion criteria, were evaluated in terms of such combination.There were no significant difference between the groups in regard with age (According to our study (which, to our knowledge, was the first comparative study in the literature), we advocate not to combine PRC with PIN neurectomy for such an approach has no advantage.La résection interosseuse postérieure (IOP) combinée à la carpectomie proximale (CTP) est favorisée pour stimuler une convalescence rapide. Cependant, on en connaît mal l’apport sur les résultats.Les auteurs ont procédé à une étude comparative pour évaluer les effets de la neurectomie IOP pour la CTP et à une analyse bibliographique systématique pour déterminer si cette combinaison comportait des avantages.Les chercheurs ont soumis les patients ayant une maladie du poignet qui avaient subi une CTP à une évaluation rétrospective. Ils ont comparé les patients sans neurectomie IOP (groupe 1, n = 7) à ceux en ayant subi une (groupe 2, n = 8) pour ce qui est de l’âge moyen, du suivi, du sexe, des scores du poignet Q-DASH, VAS et MAYO, ainsi que de l’amplitude de flexion–extension et de déviation radio-ulnaire au suivi final. Dans la deuxième partie de l’étude, ils ont effectué des recherches dans la base de données MEDLINE pour en extraire les études publiées entre 2005 et 2015. Ils ont utilisé les mots-clés suivants:Les chercheurs n’ont constaté aucune différence significative entre les groupes pour ce qui est de l’âge (D’après la présente étude, qu’ils croient être la première étude comparative sur le sujet, les chercheurs préconisent de ne pas combiner la CTP à la neurectomie IOP, car elle ne comporte aucun avantage.

OBJECTIVE: The objectives of this study were “1” to analyze the compressive and tensile mechanical strength characteristics of tigecycline loaded bone cement and “2” to compare them with those of vancomycin and daptomycin loaded bone cements which are used in prosthetic joint infections complicated with resistant microorganisms. METHODS: In this study, three experimental groups, which consisted of vancomycin (subgroups containing 1 g, 2 g, and 3 g vancomycin), daptomycin (subgroups containing 0.5 g, 1 g, and 1.5 g daptomycin), and tigecycline (subgroups containing 50 mg, 100 mg, and 150 mg tigecycline) and one control group without antibiotics were used. Using a standardized protocol, all antibiotic loaded bone cements were prepared. For each antibiotic group, including the control group, 10 samples were tested. All samples were biomechanically tested in terms of compressive strength and tensile strength. RESULTS: Compression tests showed that all determined antibiotic concentrations resulted in a significant decrease when compared with the control group (p0.0011). In addition, all statistically significant results from between groups comparisons revealed higher tensile and compressive mechanical strength values for the tigecycline groups (p

Objective: The aim of this study was to determine the prevalence of predatory journals in Orthopedics and Traumatology and to investigate the relationship of these publications with the regulations of scientific fields made in recent years in Turkey. Methods: The journals and publishers between the years 2000–2018 were screened and websites visited one by one on the basis of the orthopedic journals and publishers list determined as predators or possible predators. Orthopedic publications originated from Turkey was detected in these predatory journals. Article admissions, article processing charges, editorial and referee average response times were reviewed from the websites of journals. In addition, the effect of changing associate professorship application requirements and academic incentive regulation on the preference of predatory journals was examined. Results: Between 2000 and 2018 years 1626 issues which can be reached in 282 journals were examined. 4795 articles were screened in 29 journals which have articles originated from Turkey. One hundred and six (2.21%) articles which originated from Turkey was reached in these publications. Average article processing charge was $865 ($ 0–1819). Fifty-nine of 106 (55%) articles originated from Turkey were found in only 4 journal. Journals which have articles originated from Turkey were not on the Web of Science list. The response time to the articles was between 2 and 6 weeks in these journals. After the change criteria in associate professorship in 2016, 3.32 fold increase in annual average number of publications originated from Turkey have been identified in predatory journals. After the change criteria in academic incentive regulation in 2015, 4.76 fold increase in annual average number of publications originated from Turkey have been identified in predatory journals. Conclusion: The number of articles in predatory journals is increasing all over the world. This situation also valid in the field of Orthopaedics and Traumatology in Turkey. Authors should pay attention regarding predatory journals not only article processing charges but also very short evaluation period. Keywords: Publishing, Predatory, Orthopedics, Traumatology, Journals

Background:There is a lack of data that could address the effects of off-the-shelf insoles on gait variables in healthy people.Methods:Thirty-three healthy volunteers ranging in age from 18 to 35 years were included to this study. Kinematic and kinetic data were obtained in barefoot, shoe-only, steel insole, silicone insole, and polyurethane insole conditions using an optoelectronic three-dimensional motion analysis system. A repeated measures analysis of variance test was used to identify statistically significant differences between insole conditions. The alpha level was set at P < .05Results:Maximum knee flexion was higher in the steel insole condition (P < .0001) compared with the silicone insole (P = .001) and shoe-only conditions (P = .032). Reduced maximum knee flexion was recorded in the polyurethane insole condition compared with the shoe-only condition (P = .031). Maximum knee flexion measured in the steel insole condition was higher compared to the barefoot condition (P = .020). Higher maximum ankle dorsiflexion was observed in the barefoot condition, and there were significant differences between the polyurethane insole (P < .0001), silicone insole (P = .001), steel insole (P = .002), and shoe conditions (P = .004). Least and highest maximum ankle plantarflexion were detected in the steel insole and silicone insole conditions, respectively. Maximum ankle plantarflexion in the barefoot and steel insole conditions (P = .014) and the barefoot and polyurethane insole conditions (P = .035) were significant. There was no significant difference between conditions for ground reaction force or joint moments.Conclusions:Insoles made by different materials affect maximum knee flexion, maximum ankle dorsiflexion, and maximum ankle plantarflexion. This may be helpful during the decision-making process when selecting the insole material for any pathological conditions that require insole prescription.

© 2018, Springer-Verlag France SAS, part of Springer Nature.Background: Maximum stresses show critical points on an object because failure may start from the area close to maximum stress points. However, there appears no study on maximum loading points of carpal bones. Purpose: To clarify the loading pattern of each carpal bone during wrist movements. Methods: A finite element wrist model was designed using a three-dimensional reconstruction of computed tomographic images from the distal end of radius and ulna to the proximal third of metacarpals. Loading was performed in neutral, 45° of flexion and extension, 5° of radial and 25° of ulnar deviation, and maximum loading points were plotted. Results: In each position except for extension, minimum loads were carried by triquetrum, while minimum loads were carried by capitatum in extension. Maximum loads were carried by trapezium in neutral and ulnar deviation and flexion but by scaphoideum in radial deviation and extension. Conclusion: Studies on maximum loading of each bone are a new approach and may help to improve the knowledge on wrist mechanics.

Purpose: The aim of our study was to investigate the relationship between self-reported and performance-based tests in the assessment of patients with total hip arthroplasty (THA). Methods: Ninety four patients (35 males, 59 females) were included in the study with mean age 57.1 ± 14.6 years. Patients performed four performance tests (Timed “Up & Go” Test, Sit to Stand Test, Self-paced Walk Test and Stair Test) and two self-reported measurements (Harris Hip Score [HHS] and SF-36 [36-Item Short Form Health Survey]) were preferred to assess patients. Results: There were varying correlations between performance tests and subscales of the SF-36 including physical function, energy/fatigue, pain, general health. Strong correlation was found between HHS and Timed “Up and Go”( r = −0.59, p < 0.001), self-paced walk test ( r = −0.58, p < 0.001). Moderate correlation was found between HHS and sit to stand test ( r = −0.406, p < 0.001), stair test ( r = 0.32, p < 0.001). Conclusions: There were especially moderate-to-strong correlations between self-reported measurements and performance-based tests in the evaluation of patients with THA. Therefore, outcomes assessment after THA may include self-reported measurements or performance-based tests.

Objective: The aim of this study was to report our results of lunate excision combined with capitohamate fusion in the treatment of Kienböck's stage IIIB/IIIC disease. Methods: A total of 7 patients with a mean age 35.2 (SD 11.5) years were enrolled in the study. Pain was the principal reason for surgery. All operations were carried out by the same senior surgeon. Patients were evaluated in terms of range of motion, DASH and VAS scores, satisfaction, and grip/tip/palmar/key pinch strength compared with contralateral sides. Preoperative carpal height indexes and findings of osteoarthritis were determined radiographically and compared with postoperative evaluations. Results: Mean duration of follow up was 15.2 months. Mean DASH and VAS scores were 13.8 2.7 and 2 1.1 respectively. The mean patient satisfaction score was 3.2 0.4 over 4 points. The mean grip strength in the operated hands was 66.4%, palmar pinch was 75.1%, tip pinch was 71.8% and key pinch was 70.4% when compared to the contralateral unaffected sides. The mean flexion range in the operated hands was 58.8%, extension range was 60.3%, radial deviation range was 65.2% and ulnar deviation range was 65.7% when compared to the contralateral sides. There was no significant difference between preoperative and postoperative carpal height ratios (p = 0.086). Conclusions: Our early term results indicate that lunate excision combined with capitohamate fusion may be an alternative treatment option in patients with stage IIIB and IIIC Kienböck's disease. Level of Evidence: Level IV, Therapeutic study. Keywords: Capitate bone, Excision, Fusion, Hamate, Kienböck's diseasse, Lunate bone

Background The success of revision total knee arthroplasty depends on adequate exposure that does not produce complications. The purpose of this study was to compare the results of revision total knee arthroplasty between V-Y quadricepsplasty (QP) and quadriceps snip (QS) approaches. Methods In the study, 92 knees with follow-up of 12-108 months which were operated by using QP (55) and QS (37) were evaluated retrospectively. Measurements were taken by using universal transparent goniometer, also varus valgus deformities, knee flexion angles, instability, Hospital for Special Surgery and Lower Extremity Functional Scale scores, functional condition of the knee and activity levels of the patients were evaluated cross-sectionally. Results Statistically significant difference was not found regarding extensor restriction, varus or valgus deformities, knee flexion angles, flexor and extensor muscular strength, Hospital for Special Surgery and Lower Extremity Functional Scale score ( P > .05). Conclusion QP is a preferable method which allows a wider arthrotomy for stiff knees and revision knee surgery, and provides larger access to the joint. Choosing this incision does not bring disadvantage in terms of extensor mechanism.

© 2014, Springer-Verlag France.Although limited carpal fusion is a choice of treatment in several wrist disorders, little is known about the biomechanics of these procedures, especially the loads carried by the ligaments. In a finite element study, four types of limited carpal fusions (scaphotrapeziotrapezoid, capitohamate, four corner fusion with and without scaphoid excision) were simulated and the loads carried by the ligaments were recorded. Measurements were repeated with and without implantation. The load transmission through the ligaments varied by the type of the fusion but, radioscaphoid and long radiolunate ligaments carried significantly more loads if not excised during the operation. Implantation did not affect the results in most cases. The model of the present study may be useful in preoperative planning.

Alkaptonuria is an autosomal recessive disorder caused by the deficiency of homogentisate 1.2 dioxygenase activity. The clinical presentation shows an ochronotic pigment which is deposited in all connective tissues, including in cartilage, particularly. The knee is the most common site of peripheral abnormality. There is currently no definitive cure for alkaptonuric ochronosis. In this article, we present a 69-year-old male case who underwent bilateral cemented total knee arthroplasty simultaneously. Our results during two-year follow-up were satisfactory. A critical review of the literature revealed no uniformity in reporting such cases.

The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA) which may facilitate more precise biomechanical reconstruction of the hip. The purpose of this study was to compare the biomechanical results of the TPP with a conventional THA. We compared anteroposterior radiographs from 60 patients who had undergone cementless THA, with 44 who had undergone a TPP. We measured the hip centre of rotation, femoral offset, limb length, and neck-shaft angle. The horizontal hip centre of rotation, vertical femoral offset, limb length and neck-shaft angle measurements showed a significant difference (p Therefore, we found no difference in restoring the biomechanics of the hip using the two methods, and only the horizontal hip centre of rotation restoration favoured the THA. Our findings indicate that the TPP does not produce more accurate restoration of leg length or offset. Reproduction of hip mechanics after TPP may not be as good as has been suggested.

The purpose was to investigate the test-retest reliability of the 50-Foot Timed Walk (50FWT), and 30-Second Chair Stand Test (30CST) in the patients with total hip arthroplasty (THA). The study was a test-retest study. Thirty-seven patients with THA performed two trials for both the 30CTS and 50FWT on the same day with one hour interval. To assess reliability, the intra-class correlation coefficient [ICC(2,1)], standard error of measurement (SEM), the smallest real difference at the 95% confidence level (SRD95) were calculated. The ICCs for the 50FWT and 30CTS were 0.98 and 0.94, respectively. The SEM and SRD95 for the 50FWT and 30CTS were 0.3 and 0.8 seconds and 0.4 and 1.2 repeats, respectively. The test-retest reliability of the tests was very high. The 50FWT and 30CST are very reliable to measure the functional performance in patients with THA in the clinical settings.

The occurence of digit like structures around vertebral column is a rare and only one case in the cervical region has been reported before. Here we report three more cases of cervical digits with computed tomography and magnetic resonance imaging correlations as the first cases of the literature. DOI: 10.3944/AOTT.2015.13.0004

Avascular necrosis (AVN) of the scaphoid predominantly occurs in the proximal pole. Review of the literature revealed only six cases and all are suspect due to the lack of either MRI investigation or investigation of bleeding preoperatively. We report four new cases and one of them appears to be a real distal pole AVN of the scaphoid in the literature.

The thrust plate prosthesis is an implant with a metaphyseal fixation at the proximal femur that transmits the load forces of the hip onto the femoral neck.In this prospective study, 15 patients (8 women, 7 men) with 19 cementless thrust plate prostheses because of femoral head necrosis were examined. A clinical and radiologic evaluation was performed preoperatively, at 3, 6, 12, 18, and 24 months postoperatively, and every year thereafter. The mean follow-up period was 44 (range, 24-72) months. The average age at the time of surgery was 49 (27-70) years. The pathogenesis of femoral head necrosis included alcoholism (6 joints of 3 cases), Gaucher disease (1 joint of 1 case), Sheehan syndrome (2 joints of 1 case), and idiopathic (10 joints of 10 cases).The Harris hip score increased from 53 (range, 15-71) to 97 (92-100) points on the final evaluation. Although mean preoperative hip flexion and abduction were 78 degrees (45 degrees -110 degrees ) and 24 degrees (10 degrees -45 degrees ), respectively, these increased to 114 degrees (75 degrees -125 degrees ) and 47 degrees (45 degrees -50 degrees ) 12 months after surgery and remained stable up to the latest follow-up. None of the patients displayed mechanical problems, and revision was not necessary in any case.The thrust plate prosthesis shows midterm results comparable to those of the cementless stemmed prosthesis and supplies advantages, especially for younger patients with femoral head necrosis, because of its metaphyseal bone-preserving fixation.

The goal of this study was to determine whether hyaluronic acid (HA) or progressive knee exercises (PE) can improve functional parameters in patients with osteoarthritis (OA) of the knee. In a prospective clinical trial 200 knees (105 patients) with radiographic Kellgren Lawrence grade III OA were randomized and received either three intra-articular injections of hyaluronic acid (Hylan G-F 20) at one-week intervals or PE for 6 weeks. Patients were evaluated by use of the Hospital for Special Surgery (HSS) Knee Score and followed-up for 18 months. Total HSS score for HA and PE patients improved from 62.6 +/- 13.8 to 88.8 +/- 11.1 and from 65.4 +/- 12.3 to 88.3 +/- 9.1, respectively, at the end of the trial (P < 0.01). There were no statistically significant differences between the groups. Twenty-one patients of the HA group were excluded from the study because they had received another form of therapy. All patients in the PE group completed the trial. The patients who dropped out had also significant improvement from 57.0 +/- 12.9 to 76.7 +/- 11.9 (P < 0.01). This prospective randomized trial confirmed that both HA injections and PE result in functional improvement. HA injections also increase the levels of satisfaction of the OA patients.

Objective: Droopy shoulder syndrome [DSS] is classified as a small subgroup of disputed neurogenic thoracic outlet syndrome and characterized by drooping of the shoulders which leads to traction on the brachial plexus. The effect of exercise seems controversial in DSS. The aim of this study is to evaluate the effect of exercise both on clinical and radiological outcome in DSS.Methods: Thirty-four patients referred to the physical medicine and rehabilitation outpatient clinic with DSS were included in this prospective follow-up study. Of these patients, five were lost to follow-up. All patients were given home exercises and followed up for 13.7 ± 5.0 months. The patients were divided into two groups with regard to their adherence to exercise programs as regular and irregular exercise groups. The clinical outcome was assessed on the basis of pain with visual analog scale, patient's response to treatment, and radiographic changes.Results: At the end of the treatment when the two groups were compared, the pat...

This cadaveric study used 200 scaphoid bones (100 left and 100 right) to assess 24 morphological and 11 morphometric parameters. At least one morphometric feature was absent in all scaphoids, though the tubercle and the dorsal sulcus were present in all instances. There were significant differences in the circumferences of the waist and the base of the tubercle, the width of the main sulcus and the secondary height of the tubercle between left and right scaphoids. Detailed knowledge of anatomy and correlations between the anatomical features may help better understanding of clinical problems.

A case of chronic physical abuse and acute sexual abuse via anal penetration complicated with disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and subsequent bilateral trans-metatarsal amputation is reported. A 13-year-old male presented with old cigarette burns on his chest and acute anal laceration. Four days after laceration repair, he developed DIC and ARDS. The child had to undergo bilateral trans-metatarsal amputation. Due to the systemic defects of the child protection system in Turkey, sexual and physical abuse were recognized by medical personnel 45 days after admission, child protective services never got involved, and prosecution failed to punish the perpetrator(s) of this extreme victimization. This is the only reported case of bilateral trans-metatarsal amputation due to sexual abuse complicated with DIC and ARDS. Social and medico-legal management of sexual abuse is suboptimal in Turkey. Within that context, professionals should be trained on how to recognize, assess, diagnose and manage victims of child abuse and neglect. © 2004 Elsevier Ltd and AFP. All rights reserved.

Objective: Weight bearing after total hip arthroplasty is postponed in order to prevent early loosening, but this negatively affects the rehabilitation programme. For the force transfer characteristics of thrust plate prosthesis (TPP), a new type of hip prosthesis used without cement is similar to the normal hip. We evaluated the possibilities of early weight bearing after TPP by comparing early partial with early full weight bearing.Design: Randomized controlled study.Setting: Department of orthopaedics and traumatology in a university hospital.Subjects: Sixty hips of 51 patients who underwent total hip arthroplasty with TPP were randomly assigned into two groups.Interventions: Both groups received accelerated rehabilitation programmes: group 1 with early partial weight bearing and group 2 with early full weight bearing.Main outcome measures: Patients were evaluated by a blind observer preoperatively, at three months after surgery by clinical (measurement of range of hip motion (universal goniometry), muscle strength (Manual Muscle Test), functional test (6-minute walk test), hip function (Harris Hip Scoring System)) and radiographical parameters and one year after surgery by clinical (Harris Hip Scoring System) and radiographical parameters.Results: Group 2 performed transfer activities earlier, had more walking distance at the time of discharge and shorter hospital stay than group 1. At three months, Harris Hip Score, muscle strength, 6-minute walk test, and duration of crutch use were significantly ( p < 0.05) in favour of group 2. None of the patients in either group showed signs of loosening one year after the operation.Conclusions: These results suggest that patients with TPP can tolerate an accelerated rehabilitation programme with early weight bearing and will gain the goals of rehabilitation earlier.

The relationship between onychocryptosis and foot type was investigated in a series of 512 patients. Of these patients, 124 had signs or a history of onychocryptosis. Among the nine foot types identified by digital and metatarsal formulas, the Greek index minus and squared index minus types showed the strongest association with onychocryptosis, which was present in more than one-third of such feet. When anteroposterior radiographs of each type of foot were taken after binding the first and second toes together to simulate a tight shoe, the enlargement of bony structures of the second toe at the distal interphalangeal level in the Greek and squared index minus feet moved toward the distal enlargement of the distal phalanx of the first toe where the ingrowing occurs. Ten cases of stage I and four cases of stage II onychocryptosis were treated by placing a toe spacer between the first and second toes; all healed in about 3 weeks, suggesting that counterpressure of the second toe in tight shoes is a factor in the development of onychocryptosis. (J Am Podiatr Med Assoc 93(1): 33-36, 2003)

In a prospective randomized study of lateral epicondylitis, 120 patients were treated with 2 mL lidocaine (Group A, n=60) or 1 mL lidocaine combined with 1 mL triamcinolone (Group B, n=60). All injections were done using the peppering technique: after inserting the needle the tender area was peppered with 40 to 50 injections by injecting, withdrawing, redirecting, and reinserting without emerging from the skin. All patients were followed up for 1 year. Fifty-six patients in Group A and 57 patients in Group B had excellent results. There was statistically no difference between the groups. Both groups had excellent results and because the injection of local anesthetics is known to have no long-term effect in the treatment of lateral epicondylitis, the peppering technique seems to be a reliable method of treatment.

Purpose Stair climbing is one of the important functional activities of daily living to maintain mobility and independence. Walking and stair climbing have been identified by clinicians and patients as critical functional activities before and after total hip arthroplasty (THA). Testing the ability to manage steps has been commonly used in clinical and research settings because it is an inexpensive and simple way to measure functional status after THA. The frequent use of this test supports studies seeking evidence to validate stair test (ST) as a measure of physical performance in subjects with THA. The aim of this study is to determine the test-retest reliability of the 9-step ST in patients with THA. Methods Patients performed twice trials for the ST on the same day with one hour interval. To assess test-retest reliability, the intra-class correlation coefficient – ICC (2,1), standard error of measurement (SEM), minimal detectable change at the 90% confidence level (MDC90) were calculated. Results A total of 37 patients with THA participated in this study. The ST showed very high reliability (ICC = 0.98 (95% CI, 0.96 to 0.99)). The SEM was 0.3 seconds and the MDC90 was 0.7 seconds. Conclusions Test-retest reliability of the ST was very high for the patients with THA, and the SEM and MDC90 were adequate for clinical use. The ST is less time consuming and has very high reliability to measure the functional level after THA in the clinical setting.

There is no evidence-based treatment protocol for Preiser's disease. This case report studies seven cases treated by pronator quadratus pedicled bone graft. Three years after the operation, all patients had good or excellent results. This technique is advocated for stage 2 Preiser's disease.

Endoscopy-assisted percutaneous repair of Achilles tendon ruptures were investigated in a cadaveric and clinical study. Sixteen above-knee fresh amputation specimens in which different types of Achilles tendon ruptures were created were repaired percutaneously with the visualization of the tendon ends by endoscopy. Neither malalignment nor damage to the neurovascular structures was observed. Eleven patients were treated in this way. No reruptures, wound problems, or neurovascular injury were observed. All patients returned to daily activities 10-11 weeks after the repair. This technique seems to overcome certain problems of conservative, surgical, or percutaneous repair of the Achilles tendon ruptures.

Acetabular, femoral and tibial torsion of 50 normal adult male subjects were measured by computerized tomography and the relationship between these angles and foot-progression angle was examined. The mean acetabular anteversion was 15.6 degrees on the right and 15.8 degrees on the left, (range 3 degrees-30 degrees). The mean femoral torsion was 6.5 degrees on the right and 5.8 degrees on the left (range 14 degrees-28 degrees). The mean tibiofibular torsion was 30.9 degrees on the right and 29.1 degrees on the left (range 16 degrees-50 degrees). Although the normal range of torsional measurements of the lower extremity was very broad, subjects usually had out-toeing, with a mean foot-progression angle of 13.7 degrees on the right and 13.0 degrees on the left (range 6 degrees-21 degrees). No correlation was detected on the rotation between different levels of the lower limb. No difference was detected in the lower extremity rotational profile between right and left sides.

This study reviews the preliminary results of transmidtarsal osteotomy performed on 11 patients (12 feet) who previously underwent surgery for resistant clubfoot and needed further surgery for severe residual deformities. Opening wedge medial cuneiform osteotomy, closing wedge cuboid osteotomy, and truncated wedge middle and lateral cuneiform osteotomy were performed. The procedure was performed initially on normal cadaver feet. The average improvement of anteroposterior talo-first metatarsal angle was 20 degrees and lateral calcaneo-first metatarsal angle was 16 degrees. The authors conclude that with this simple procedure, angular and rotational correction in three planes can be obtained simultaneously in severe residual clubfoot deformity without the need for extensive soft tissue release.

Ten patients who had been treated by limited open reduction and percutaneous stabilization for four-part posterior fracture-dislocation of the shoulder were followed-up for an average of 3.2 years postoperatively. According to the criteria of Neer, the result was excellent in nine patients, with an average Constant score of 95.7. There was one failure who showed complete avascular necrosis. All patients with excellent results had at least 1 mm of the neck portion of the head fragment intact.

(1999). Llizarov circular external fixator for open olecranon fractures-a report of 3 cases. Acta Orthopaedica Scandinavica: Vol. 70, No. 1, pp. 93-96.

Percutaneous reduction of displaced both-bone forearm fractures is safe, minimally invasive, and cosmetically superior.

We have compared the results of simple patellectomy (group A, n = 16) and patellectomy with advancement of the vastus medialis obliquus (group B, n = 12) in a prospective, randomised trial, with a minimum follow-up of three years. The results in group B were significantly better (p < 0.001) than those in group A. Although the patella should be preserved if possible, we advocate advancement of the vastus medialis obliquus when patellectomy is necessary.

Os vesalianum pedis is an accessory bone located proximal to the base of the fifth metatarsal. Its prevalence has been reported to be from 0.1% to 1.0%. This bone is found within the peroneus brevis tendon and is considered to be asymptomatic in the majority of people. We describe a patient with os vesalianum pedis with a distinct mediocuboidal articulation. The radiologic differential diagnosis of the ossicle is discussed. (J Am Podiatr Med Assoc 95(6): 583–585, 2005)

The purpose of the present study is to evaluate scaphoid delayed fractures or nonunions treated by percutaneous fixation with MRI correlations.We evaluated 33 consecutive scaphoid delayed unions or nonunions treated by dorsal percutaneous fixation at a mean 16 months (range, seven to 48 months) after the operation. There were 31 male and two female patients with an average age of 29 years (range, 25-33 years).Pre-operative MRI revealed no signs of avascular necrosis. At the latest follow-up, all patients had good or excellent results.We suggest dorsal percutaneous screw fixation for scaphoid delayed fractures or nonunions after eliminating the presence of AVN by pre-operative MRI examination.

OBJECTIVE: To compare the results of tibia plateau fractures treated by locked plate, conventional plate, double plate and ilizarov fixation with special reference to the energy and the fracture and corrrelate with degree of osteoarthritis and radiological parameters. METHODS: All patients with tibial plateau fractures between 2000-2007 were reviewed (23 men and 16 women; mean age 49.43 years; range between 18-84 years). The patients were evaluated according to Rasmussen functional knee score (RFK), Rasmussen radiological healing score (RRH), Kell Lawrance grading of the osteoarthritis (KL). Correlation analysis between parameters was made. RESULTS: Conventional unlocked plate had higher RFK, RRH scores than locked plate, double plate and ilizarov groups (p0.05).. At the correlation analysis, there were positive correlations between functional, radiological scores and negative correlation between degree of osteoarthritis and radiological scores. There was no correlation between the degree of osteoarthritis and the functional scores (p>0.05). CONCLUSION: Short to medium prognosis probably depends on the alignment, stability of the knee while osteoarthritis seems to be secondarily important which may change at longer term follow-up., AMAÇ: Bu yazıda amaç kilitli plak, konvansiyonel plak, çift plak ve ilizaroz fiksasyonuyla tedavi edilmiş tibia plato kırıklarının sonuçlarını, kırık tipini ve enerjisini göz önüne alarak karşılaştırmak ve de osteartrit derecesi, radiolojik parametrelerle korele etmekti. GEREÇ YÖNTEM: 2000-2007 tarihleri arasındaki bütün tibia plato kırıklı hastalar gözden geçirildi (23 erkek, 16 kadın; ortalama yaş 49; dağılım 18-84 yaş). Hastalar Rasmussen fonksiyonel diz skoru (RFK), Rasmussen radyolojik iyileşme skoru (RRH) ve de Kell Lawrance osteoartrit derecelendirmesine göre değerlendirildi. BULGULAR: Konvansiyonel kilitsiz plağın RFK, RRH skorları kilitli plak, çift plak ve de ilizarovdan yüksekti (p0.05). Korelasyon analizinde, fonksiyonel, radyolojik skorlar arasında pozitif, osteoartrit derecesi, radyolojik skorlar arasında negatif korelasyon bulundu. Osteoartrit derecesi ve fonksiyonel diz skoru arasında korelasyon saptanmadı (p>0.05). SONUÇ: Kısa-orta dönem prognoz muhtemelen diz stabilitesi, dizilimine bağlıyken osteoartrit ikincil derecede öneme sahip gözükmektedir ki bu durum uzun dönem takiplerde değişebilir.

Achievement of a functional, painless lower limb through elimination of a severe foot deformity. Improved dorsiflexion of the foot. Severe and untreated clubfoot. Severe fracture-dislocation of talus (Hawkins III). Circulatory insufficiencies. Osteoarthritis of ankle and subtalar joints. Supine, leg in external rotation and knee flexed. General or regional anaesthesia. Removal of the talus through a medial approach after osteotomy of the medial malleolus. Anterior displacement of the foot and lateral displacement of the medial malleolus creating a joint between calcaneus and tibia and medial wall of calcaneous and medial malleolus. In instances of osteoporosis the osteotomy of the medial malleolus will be modified. Below knee cast for 3 weeks. Followed by partial weight bearing in a cast. Full weight bearing without cast after 6 weeks. Incomplete removal of talus. Poor articular contact. Injury to nerves and vessels. 14 talectomies, mean follow-up 42 months. 8 patients had a standard procedure and were assessed according to the criteria of Morris: 6 excellent, 1 good and 1 poor result. 6 patients underwent a modified procedure (see Figure 6): 2 excellent and 4 good results.

Total scaphoid excision and radial advancement osteotomy has been investigated in a eadaverie and clinical study. In three below-elbow fresh amputation specimens, the technique was utilized and stability was checked by radiographs. Instability on ulnar deviation was prevented by extensor carpi radialis longus tenodesis.Four patients were treated in this way. The wrist was immobilized in a below-elbow splint for 45 days, then active motion was encouraged. After 10 months, three patients had excellent results and one patient had good result using the criteria of Cooney et al (1987).

Objective: The aim of this study was to compare quadriceps femoris muscle performance parameters of patients who underwent unilateral and bilateral total knee arthroplasty (TKA).Methods: The study included 80 patients. Thirty-five underwent unilateral primary TKA (35 females; mean age: 67.11±3.97 years) and 45 underwent bilateral primary TKA (2 males, 43 females; mean age: 67.12±7.32 years). Patients were evaluated in terms of performance parameters including stand-up time, rising index, standing postural sway velocity, and symmetries of body weight distribution on the extremities while standing up using a Balance Master® balance and performance instrument in the postoperative 6th and 12th month.Results: No significant difference was determined in body weight symmetry ratios between the operated and non-operated extremity in unilateral TKA patients in the 6th and 12th month sit-to-stand test (p>0.05) whereas there was a significant difference in bilateral TKA patients (p0.05). Bilateral TKA patients stood up in a shorter time than unilateral TKA patients (p, Amaç: Bu çalışma tek taraflı ve iki taraflı total diz artroplastisi (TDA) uygulanan hastaların ameliyat sonrası 6. ve 12. ayda ayağa kalkma sırasındaki kuadriseps femoris kas performans parametrelerinin karşılaştırılması amacıyla planlandı.Çalışma planı: Çalışmaya, 35’i tek taraflı (35 kadın; ortalama yaş: 67.11±3.97) ve 45’i iki taraflı (2 erkek, 43 kadın; ortalama yaş: 67.12±7.32) primer TDA olmak üzere toplam 80 hasta alındı. Tek taraflı ve iki taraflı TDA’lı hastalar, ameliyat sonrası 6. ve 12. ayda Balance Master® denge ve performans cihazında ayağa kalkma süresi, yükselme indeksi, ayakta postural salınım hızı ve ayağa kalkma sırasında ekstremiteler üzerine verilen vücut ağırlık dağılım simetrileri gibi fiziksel performans parametreleri açısından değerlendirildi.Bulgular: Ameliyat sonrası 6. ve 12. ay otur-kalk testi sırasında, tek taraflı TDA’lı hastaların ameliyatlı taraf ve diğer taraf ekstremitedeki vücut ağırlık simetri oranları arasında anlamlı bir fark olmadığı belirlenirken (p>0.05), iki taraflı TDA’lı hastaların ise ayağa kalkarken vücut ağırlıklarını anlamlı oranda daha fazla dominant ekstremite üzerine verdikleri saptandı (p0.05). Ameliyat sonrası 12. ayda iki taraflı TDA hastalarının, tek taraflı TDA hastalarına göre daha kısa sürede ayağa kalktıkları (p

Objective: The exact prevalence of scapholunate dissociation (SLD) associated with distal radius fracture (DRF) and the effect of persistent SLD on the function of the wrist are not known. So, we examined the association between SLD and DRF and the effects of treatment on clinical outcomes. Methods: Eight hundred and twenty-nine patients with 839 DRF were included in the study. The radiographs of the patients were examined with special reference to SLD both in pre- and post-reduction period. Persistent SLD cases were evaluated by the scoring system of Green and O'Brien at least 2 years after the fracture. Results: Of the 839 fractures, 215 had SLD after the injury. When post-reduction radiographs were examined, SLD persisted in 98, but in 14 SLD was detected in the post-reduction period while not apparent in initial radiographs. So, a total of 112 patients (13.4 %) had persistent SLD. Nineteen patients were lost to follow-up and remaining 93 wrists examined clinically. Seventy-nine had pain on the scapholunate joint and 14 had not. When these patients were evaluated by Green and O'Brien system, symptomatic patients had fair or poor results but asymptomatic had good. The association between DRF and SLD is 13.4 %. Conclusions: Severity of the distal radius fractures is not associated with SLD. Intra-articular fractures were associated with significant increase in the prevalence of SLD. In some cases, SLD may appear after reduction in distal radius. Most cases with SLD are symptomatic, and this may be the reason of poor cases following distal radius fracture. © 2012 Springer-Verlag France.

The management of nonunion following high tibial osteotomy by total knee replacement (TKR) has been reported previously. We have extended the treatment to embrace cases with an infected high tibial osteotomy by performing an initial debridement with a period of antibiotic treatment followed by TKR. We have reviewed the results of seven knees in six patients with a mean follow-up of 40.5 months (20 to 57) after the staged TKR. At the latest follow-up, all the pseudarthroses had healed and there had been no recurrence of infection. The mean Hospital for Special Surgery knee score improved from 51.2 (35 to 73) to a mean of 91.7 (84 to 98) at final review. Management of nonunion following high tibial osteotomy with a TKR can be extended to infected cases when treated in two stages with a debridement and antibiotic therapy prior to TKR.

Objectives: Patients with coxarthrosis and proximal femoral deformity experience problems with total hip arthroplasty. A custom-made prosthesis or a proximal osteotomy is required for such cases, and these also increase the rate of complications. The purpose of this study was to evaluate the results of the thrust plate prosthesis (TPP) in patients with deformity of the proximal femur. Methods: Fifteen patients (7 females, 8 males) with a mean age of 56.4 years (range 19-75 years) at the time of the surgery were included in the study. The etiology was traumatic coxarthrosis in 12, and nonunion of a femoral neck fracture with osteonecrosis of the femoral head in the remaining three. While the femoral component was a third-generation TPP in all patients, the acetabular component was a Protek expansion cup in 12, and a cementless standard cup in three patients. All operations were performed through a Hardinge approach. Patients were followed up for at least 3 years (range 36-116 months) and evaluated clinically with the Harris Hip Score. Results: The mean preoperative Harris Hip Score increased from 51.2 (range 15-79) to 92.7 (range 60-100) at the latest assessment. In two cases, loosening of the femoral component was observed in zone 3, both 12 months postoperatively. One was replaced by an intramedullary prosthesis, and the other was asymptomatic. Conclusion: TPP is a good alternative for patients with deformations of the proximal femur. The use of TPP avoids technical difficulties and a custom-made prosthesis.

The aim of this study is to determine the differences between hip fracture and hip arthrosis groups and to assess pain related fear of injury in patients who were operated using the TPP following hip fracture or hip arthrosis. Fifty-eight patients (mean age = 63.9 +/- 10.3 years) who were operated using the TPP, following hip fracture (hip fracture group; n = 25) or coxarthrosis (coxarthrosis group; n = 33) were recruited. All of the measurements were performed after a follow-up time of at least 2 years. Functional level by Harris Hip Scoring System (HHS), pain related fear by Tampa Scale for Kinesiophobia (TSK) and pain intensity by numerical rating scale (NRS) was evaluated. There were no significant differences between demographic and clinical characteristics of two groups. However, pain intensity was higher in coxarthrosis group than hip fracture group. There was no correlation between the TSK scores and either Harris scores or NRS scores (p > 0.05) in the hip fracture group. No correlation between NRS and TSK was found in coxarthrosis group but there was a significant correlation between TSK and HHS. TSK scores were high in both groups. High TSK scores proved us that the patients with TPP had fear of movement even they had enough physical performance. The coxarthrosis group had higher pain intensity. Rehabilitation clinicians should consider pain-related belief which is more important than pain intensity and functional level in coxarthrosis patients. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

We have studied the biomechanical stability in vitro of three different Kirschner (K) wire configurations in three types of simulated scaphoid waist fractures. The fractures were created with a saw in Sawbones models. There were three fracture patterns: perpendicular to the long axis of the scaphoid model; and 30 degrees and 20 degrees oblique to that. Two 1.2 mm. K-wires were used in each scaphoid. The three configurations were: parallel; 20 degrees oblique; and crossing. The oblique or crossing configurations of K-wires were the most stable depending on the fracture pattern.

Seventeen children who met the criteria for juvenile chronic arthritis (JCA) were reviewed. Throughout the study, the clinical examination, HLA phenotyping, and radiological assessment of the hips were performed by separate authors who were blinded to other data. At the end of the study, the results were also compared with 25 healthy, age- and sex-matched children. Six of the children with JCA also had radiological signs of slipped capital femoral epiphysis (SCFE; five with minimal slip pattern, one with moderate slip), and five of them had DR4 in their genotypes, in contrast to the remaining 11 patients who did not {p < 0.001). On the other hand, only 2 of 25 children in the control group had DR4 (p < 0.01). The difference was not significant when the patients without SCFE were compared with the control group (p = 1.0). The relative risk of cases with DR4 antigen for SCFE was 57.5, while it was below 1 for the other antigens. These results suggest that although DR4 is not specific for JCA, it is the common HLA antigen for those who have SCFE, and patients with JCA and HLA-DR4 antigen should be examined for evidence of SCFE, which was not reported before to exist with JCA.

The treatment of implant-related infections is troublesome. This study was conducted to compare the effectiveness of three different surgical modalities in the treatment of implant-related infection. A total of 32 Wistar albino rats were randomised into four groups after the establishment of implant-related infection: no treatment, surgical debridement, antibiotic-loaded bone cement and antibiotic-loaded autogenous bone. Microbiological colony counts were made at the sixth week in order to evaluate the effectiveness of of the treatments. The antibiotic-loaded bone cement group revealed superior results compared with the other groups in terms of reduction of microbiological colonies. Three animals in the bone cement group revealed extensive infection. Although antibiotic-loaded bone cement showed superiority over other treatment modalities, it should be employed after an unsuccessful trial of debridement because of the risk of extensive infection.