Functional and Radiological Outcomes of the Proximal Humeral Fractures Treated with Proximal Anatomic Locking Plate

Aim: We aimed to evaluate functional and radiographic outcomes of patients with proximal humeral fractures treated with proximal anatomic locking plate and were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification. Methods: In this study we included 29 patients (13 females, 16 males) aged 16-82 years who were treated with proximal anatomic locking plate between February 2010 and July 2014. The mean follow up time was 17.76±8.31 months. The right shoulder was operated in 20 patients and the left shoulder in nine patients. Functional outcomes were assessed using the Constant-Murley and University of California at Los Angeles (UCLA) shoulder score and radiologic outcomes were assessed using anteroposterior radyograph. Results: At the final follow up, the mean Constant-Murley score was 75.48±18.69. The result was poor in 31.0% (n=9), moderate in 24.1% (n=7), 13.8% (n=4) good and excellent in 31.0% (n=9) of patients. The mean UCLA score was 30.10±5.73. The outcome was poor in 17.2% (n=5), good in 31.0% (n=9) and excellent in 51.7% (n=15) of patients. In 21 patients there were no complications, but complications occurred in eight. When we compared the patients per age groups (65), there was no difference in collo-diaphyseal angle (p=0,097, p>0,05), but the Constant-Murley scores (p=0,001) and UCLA scores (p=0,01) were statistically higher in patients below 65 years of age than in those above 65 years. Conclusion: Treathment with proximal anatomic locking plate is preferred since it supports early motion and leads to good functional results in partial proximal humeral fractures

Hallux Valgus Patients, Why Are They Happy?

Category: Bunion Introduction/Purpose: AOFAS score and angular changes are used widely to assess hallux valgus surgery. But our previous study showed us that these parameters do not reflect patient subjective satisfaction after surgery, angular changes do not correlate with patient satisfaction, and a subjective satisfaction scale must be used. So can we find a measurable parameter that reflects patient satisfaction? The purpose of the study was to evaluate the effect of percental reduction of first web space length (FWSL) on patient satisfaction, and if it can be used as a measurable parameter for this. Methods: Fifty feet of thirty-seven patients were included to the study. All patients were operated between 2010 and 2014. Same surgical technique (Lindgren-Turan osteotomy)used for operations. Patients were evaluated by using hallux valgus angle (HVA),1-2 intermetatarsal angle (IMA), first web space length (FWSL), AOFAS scores. On the final follow-up they were asked to scale their postoperative satisfaction between 1-10;as for 1-2 very unsatisfied, 3-4 unsatisfied, 5-6 neither unsatisfied nor satisfied, 7-8 satisfied, 9-10 very satisfied. The percental changes of HVA, IMA, and FWSL were compared with AOFAS score, and satisfaction scales. Results: Average age was 45,50±12,23 (22-68) years. Mean follow-up was 41,68±14,46 (24-68) months. 29 of 50 feet were right side, 21 were left. Preoperative HVAs have been changed from 32,52±5,19 to 11,58±4,70 degrees (p=0,001; p<0,01). Preoperative IMAs have been changed from 15,00±3,56 to 5,75±2,45 degrees (p=0,001; p<0,01). Preoperative AOFAS scores have been changed from 75,04±5,54 to 93,14±6,25 points (p=0,001; p<0,01). Preoperative FWSL changed from 14,5 (10-22) mm to 7,5 (5-14) mm (p=0,001; p<0,01). Postoperative satisfaction scale was 8,60±0,67 (7-10) points. When HVA and IMA percental changes were compared with AOFAS percental changes, they have shown a negative statistical significance according to Spearman’s Correlation Analysis. When AOFAS percental changes have been compared with satisfaction scale, they have shown a positive statistical significance. When FWSL percental changes were compared with AOFAS percental changes and satisfaction scale it has shown a positive statistical significance for both parameters according to Spearman’s Correlation Analysis. Conclusion: According to our results; we believe that the changes of FWSL have an influence on patient satisfaction. It is correlated both with AOFAS, and subjective satisfaction scale. It can be used as a measurable parameter to search for patients satisfaction. Angular changes do not have an influence on patients satisfaction. May be FWSL should also be used for surgical indications

Hip Ultrasonography in the Diagnosis of Developmental Dysplasia of the Hip: Bakırköy Experience

Aim: The purpose of the study was to determine the prevalence, incidence, and etiology as well as the risk factors for developmental dysplasia of the hip in newborns in whom we performed ultrasonography for screening using Graff’s method in our clinic. Methods: We retrospectively evaluated 2632 hip ultrasonography records of 1316 babies performed between 2008 and 2013. We analyzed the questionnaires of the Turkish Pediatric Orthopaedic Society which were filled by the physician during examination. The babies were divided into two groups according to ultrasonographic hip angles as pathological and normal. Results: The study is made on 1316 babies [680 girls (51.6%), 636 boys (48.4%)]. The risk for developmental dysplasia of the hip was higher in girls, babies with a family history, babies with metatarsus adductus and those have been swaddled before. The mean gestational age and gestational weight was statistically significantly lower in the pathological group (p=0.0011). Conclusion: In our cross-sectional study, the incidence of developmental dysplasia of the hip was 0.5%. Female gender, positive family history of developmental dysplasia of the hip,metatarsus adductus and swaddling are still risk factors. Researching risk factors carefully, patient education and adding hip ultrasonograpy to newborn routine screening program are important measures in preventing developmental dysplasia of the hip

Outcomes of Four Different Surgical Techniques in the Treatment of Geriatric Intertrochanteric Femur Fractures

Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: One hundred eighty-two patients operated due to intertrochanteric femur fracture in our clinic were divided into four groups: hemiarthroplasty (HA), proximal femoral nail (PFN), sliding hip screw (SHC), and external fixator (EF) groups. Time to surgery, comorbidities, anesthesia techniques, postoperative ambulation time, mortality rates and daily activity levels were compared. The patients were evaluated via outpatient follow-up and telephone interview. The Barthel index of activities of daily living was used for evaluation. Results: Patient distribution was: HA: 17 patients, PFN: 26 patients, SHC: 71 patients, and EF: 68 patients. The gender distribution (F/M) and the mean age were: HA: 11/6, 83.4 years, PFN: 18/8, 81.2 years, SHC: 48/23, 82.1 years, and EF: 44/24, 84.5 years. There was no statistically significant difference between the groups in gender, comorbidities, anesthesia techniques, mean follow-up period, and Barthel index scores. In HA group, walking with double support duration was shorter (p=0.028). Conclusion: Elderly intertrochanteric femur fractures should be operated as soon as possible in order to prevent eventual complications preferably by regional anesthesia and internal fixation