Evaluation of structural changes in tarsal bones following complete subtalar release for congenital clubfoot

Amaç: Tek taraflı doğuştan çarpık ayak (DÇA) nedeniyle tam subtalar gevşetme ameliyatıyla başarılı sonuç alınan olguların orta dönem izleminde tarsal kemik değişiklikleri bilgisayarlı tomografi (BT) ile değerlendirildi. Hastalar ve yöntemler: Çalışmaya 1990-1995 tarihleri arasında tek taraflı DÇA nedeniyle tam subtalar gevşetme uygulanan dokuz hasta (5 erkek, 4 kız; ort. yaş 12; dağılım 9-14) alındı. Tüm olgularda iyileşme Simons kriterlerine göre iyi derecedeydi. Ortalama 10.5 yıl (dağılım 8-13 yıl) olan izlemden sonra olguların normal ve ameliyatlı ayakları düz grafilerle ve standart ve üç boyutlu BT ile incelendi. Bu görüntülerde tarsal kemik değişiklikleri niceliksel ve niteliksel olarak değerlendirildi. Bulgular: Aksiyel BT kesitlerinde sekiz olguda naviküler kemikte dorsala subluksasyon, yedi olguda naviküler kemikte kamalaşma, dört olguda talus başında düzleşme, üç olguda naviküler kemiğin lateral kısmında yassılaşma, iki olguda talonaviküler eklem aralığında azalma, iki olguda talonaviküler temas alanında azalma görüldü. Sağlam tarafta talus hacmi ortalama 29.3 mm3 ve naviküler kemik hacmi 8.5 mm3 iken ameliyatlı ayaklarda bu değerler sırasıyla 24.0 mm3 (p=0.008) ve 7.0 mm3 (p=0.01) bulundu. Sonuç: Doğuştan çarpık ayak nedeniyle cerrahi tedavi uygulanan ve klinik ve fonksiyonel olarak normale yakın sonuçlar elde edilen ayaklarda bile tarsal kemiklerde yapısal değişiklikler ortaya çıkmaktadır. Bu değişimlerin daha uzun dönemde klinik bulguları nasıl etkileyeceğinin araştırılması gerekir.Objectives: We evaluated the mid-term radiologic changes in tarsal bones by computed tomography (CT) in patients in whom complete subtalar release for congenital unilateral clubfoot resulted in a successful outcome. Patients and methods: The study included nine patients (4 girls, 5 boys; mean age 12 years; range 9 to 14 years) who underwent complete subtalar release for congenital unilateral clubfoot between 1990 and 1995. According to the Simons criteria, a satisfactory outcome was obtained in all the patients. After a mean follow-up of 10.5 years (range 8 to 13 years), all the feet were studied by plain radiographs and standard and three-dimensional CT. Changes in tarsal bones were evaluated and compared with the normal side. Results: Axial CT scans showed dorsal navicular subluxation in eight feet, wedge-shape formation in the navicular bone in seven feet, flattening of the talar head in four feet, flattening of the lateral part of the navicular bone in three feet, narrowing of the talonavicular joint distance in two feet, and decrease in the talonavicular contact area in two feet. Significant differences were found between the operated and the contralateral feet with respect to the mean volumes of the talus (24.0 mm3 vs 29.3 mm3,p=0.008) and the navicular bone (7.0 mm3 vs 8.5 mm3, p=0.01). Conclusion: Structural changes in tarsal bones may occur following surgical treatment of congenital unilateral clubfoot despite achievement of satisfactory clinical and functional results. Further studies are required to understand how these changes will influence the clinical condition of the foot in the long-term

Reliability of two common classifications for Legg-Calve-Perthes disease if using MRI: Pediatric orthopedists vs. radiologists

In patients with Legg-Calve-Perthes (LCP), the Catterall and Herring classifications based on standard hip radiographs are frequently used. In this study, the compatibility of classification systems in hip radiographs and MR images of LCP patients was examined among specialist working in the departments of Orthopedics and Radiology, and the reliability was investigated. In this study, which included 37 Perthes patients, two separate presentations were prepared in which the radiological imaging of the patients was determined by drawing lots. Six experienced specialists were selected as observers, three of whom were radiologist and three of pediatric orthopedists. Each presentations were sent to the observers one month apart. They were asked to categorize visual data. Data were evaluated with percent agreement (PA) and Gwet's AC1 method. In the Catterall classification, agreement among pediatric orthopedists decreased in MRI examination, while an increase was observed among radiologists. In the Herring classification, while pediatric orthopedists remained at a similar level, radiologists' inter-observer reliability increased. When the intra-observer reliability was examined, it was observed that the radiologists in the Catterall classification and the orthopedists in the Herring classification were more stable in the evaluations made with MRI. The usability of both classification systems, which provide prognostic prediction, in MRI examinations is a crucial unknown. It is fruitful that both radiologists and pediatric orthopedists work together in novel classification systems to be created using MRI. [Med-Science 2022; 11(4.000): 1507-10

Intra- and inter-observer reliability of Laredo classification system in Legg–Calvé–Perthes Disease

PubMed ID: 30788596The purpose of the current study was to investigate intra- and inter-observer reliability of arthrographic Laredo classification system in Perthes disease. Forty-seven patients were included in this cross-sectional descriptive study. Patients’ age, gender, physical findings and hip arthrographs were collected from hospital medical records. Two different sets of power point slides were prepared in which the order of cases was randomized and blinded. Observers were divided into three groups according to their surgical experience (9 residents, 10 seniors, 10 pediatric orthopedists), and they assessed two times 1 month’s intervals. Statistical analysis was performed by using the SPSS v21. Inter- and intra-observer reliabilities were calculated using intra-class correlation coefficient, weighted kappa and percentage agreement. Percentage agreement of Laredo classification was about 50% for all groups (residents, seniors and pediatric orthopedists); intra-observer reliabilities were excellent, excellent and fair, respectively. Inter-observer reliability of Laredo classification for each set was found to be excellent for all groups. Length of experience did not correlated significantly with the level of intra-observer agreement. As a conclusion, our results showed that Laredo’s arthrographic classification system’s intra-observer reliability is at least at a fair level and inter-observer reliability is at an excellent level. We believe that this classification system is valuable for an orthopedic surgeon who deals with the treatment of Perthes disease. © 2019, Springer-Verlag France SAS, part of Springer Nature

Intraarticular Giant Size Angiolipoma of the Knee Causing Lateral Patellar Dislocation

Background: Angiolipomas are benign tumors usually seen in patients during their 2nd and 3rd decades. The subcutaneous region of the trunk, neck and extremities are the places where they generally settle. There is only one case report on angiolipoma in the knee joint that was resected by arthroscopic procedure in the English literature. Case Report: We present a case of a giant-size multilobular non-infiltrating angiolipoma, extending outside of the right knee joint and causing lateral patellar dislocation in a thirteen-year-old boy. A large encapsulated mass with fatty and soft-tissue components on magnetic resonance imaging was suggestive of a liposarcoma. However, the diagnosis after the tru-cut biopsy was angiolipoma. The Quadriceps angle was 25°. Complete resection of the tumoral mass and repair of the medial retinaculum were performed with open surgery. Patellofemoral alignment was provided by transferring the tibial tuberosity medially. One year after the surgery, there was no evidence of recurrence. Conclusion: Intra-articular angiolipomas are rarely seen masses in the knee joint. To our knowledge, this case report is the first to demonstrate that angiolipoma causes patellar dislocation