Mini-plate fixation via sinus tarsi approach is superior to cannulated screw in intra-articular calcaneal fractures: A prospective randomized study

WOS: 000441599800001PubMed ID: 30101667Objective: Intra-articular displaced calcaneal fractures are common fractures and are often treated with surgical interventions. Sinus tarsi approach provides secure access to lateral wall and joint facets. The aim of the study is to compare cannulated screw (CS) fixation and mini-plate (MP) fixation via sinus tarsi approach with Sanders types 2 and 3 fracture of calcaneus. Methods: Sixty patients with Sanders types 2 and 3 calcaneal fracture underwent surgical intervention were randomly allocated into two groups as group MP fixation and group CS fixation regarding osteosynthesis method for 5-year period. Open reduction via sinus tarsi approach was performed in both groups. Demographic variables, time to surgery (TS), operation duration (OD), length of hospital stay (LOS), surgical complications, and reoperations were recorded. Pre- and postoperative Gissane and Bohler angles; calcaneal length, height, and width; ankle anterior-posterior (AP) and lateral X-rays; and computed tomography were also recorded for radiological evaluation and fracture characteristics. Maryland Foot Score (MFS) was used to evaluate functional outcomes. Results: Preoperative age, type of fracture, calcaneal length, height, and Gissane and Bohler angles, TS, LOS, and OD were not different between the groups. The postoperative calcaneal widening was significantly better restored in group MP compared with that of group CS. The incidence of reoperation and algoneurodystrophy was statistically higher in group CS than group MP. MFS in group MP was also higher than group CS at final visit. Conclusion: MP fixation via sinus tarsi approach is superior to CS fixation in Sanders types 2 and 3 calcaneal fractures

Adolescent in conservative treatment of avulsion fracture of ınferior anterior ıliac spine (two cases report)

Spina Iliaka Anterior Inferior (SIAI) avülsiyon kırıkları pelvik kemiklerin çok sık görülmeyen yaralanmalarındandır. Genelde futbolcularda sut çekme esnasında tanımlanmıstır. Olgularımızın ikisi de amatör futbol onayan sporculardı. Her iki olguda futbol maçı esnasında sut çektikten sonra baslayan kalça agrısı nedeniyle poliklinigimize basvurdular. Her iki olgudada SIAI avülsiyon kırıgı saptandı. Yük vermeden yürüme ve steroid olmayan antiinflamatuar ilaçlar ile dört hafta istirahat ettirildiler. Dört haftanın sonucunda yapılan fizik muayenelerinde pasif kalça hareket açıklıkları tam ve agrısız olarak degerlendirildi. Altıncı haftanın sonunda yapılan fizik muayenelerinde aktif ve agrısız olarak tam eklem hareket açıklıgına ulasılmıstı. Çalısmamızda futbolcularda daha çok rastlanabilecek SIAI avülsiyon kırıklarının koservatif tedavi sonuçlarının yeterli oldugu sonucuna vardık.Avulsion fractures of spina iliaca anterior inferior (SIAI) are among the infrequent injuries of pelvic bones, which are usually described during shooting in football players. Both of our cases were amateur football players, presented to our clinic with pelvic pain which began just after shooting during a football game. Both cases were detected to have SIAI avulsion fractures. They were offered rest for 4 weeks with non-weight bearing plus nonsteroidal anti-inflammatory drugs. At the end of four weeks, physical examination revealed complete and painless passive range of motion of hip. Upon further physical examination at the end of sixth weeks, active, painless and complete range of motion were achieved. In our study, we concluded that results of conservative treatment were satisfactory in avulsion fractures of SIAI that may commonly be encountered in football players

What is the role of primary hip hemiarthroplasty over 70 years of age?

AMAÇ: Yetmiş yaş üzeri anstabil intertrokanterik femur kırıklarda (IFK) hemiartroplasti uyguladığımız olguları morbidite açısından değerlendirdik. Günümüzdeki hemiartroplastinin yerini tartışmayı amaçladık. GEREÇ veYÖNTEMLER: Kliniğimizde 1995-2006 yılları arasında hemiartroplasti yöntemi ile tedevi edilen intertrokanterik femur kırıklı hastaların 75'i çalışmaya dahil edildi. Ortalama takip süreleri 44 (20-82) ay idi. Hastaların 43'ü kadın,32'si erkekti. 45 hastanın sağ, 30 hastanın sol kalçası etkilenmişti. Olguların hepsi Harris kalça skorlamasına göre değerlendirildi. BULGULAR: Harris kalça skorlama sistemine göre dört hastada mükemmel sonuç, 54 hastada iyi sonuç, dokuz hastada orta, sekiz hastada kötü sonuç saptandı.Yetmiş yaş üzeri anstabil IFK'larında uygulanan hemiartroplasti olgularının %78'inde iyi-mükemmel sonuca ulaşılmış olduğu saptandı SONUÇ: Ameliyat süresinin çok kısa olması, skopi gibi teknik donanıma sahip olma şartının olmaması ve erken tam yük verebilme gibi avantajları olan hemiartroplasti yönteminin yaşlı IFK olgularında halen geçerliliğini ve etkinliğini koruyan bir yöntem olduğu sonucuna vardık.OBJECTIVE: We assessed importance of primary hip hemiarthroplasty in treatment algorithm. And we have evaluated patients treated with primary hip hemiarthroplasty for unstable intertrochanteric hip fractures according to morbidity rates. MATERIAL and METHODS: In our clinic between 1995 and 2006; we selected 75 patients treated with primary hip hemiarthroplasty for intertrochanteric femur fracture (IFF). Mean follow-up was 44 months (20-82). Genders of patients were female 43% and male 32%. Numbers of affected hips were 45 right and 30 left. Patients were evaluated with Harris Hip Score. RESULTS: Harris Hip Score of patients; Excellent 4, Good 54, Fair 9 and Poor 8 results were obtained. Seventyeight percent excellent to good results obtained primary hip hemiarthroplasty for unstable intertrochanteric femur fracture patients over 70 years of age. CONCLUSION: There are advantages of primary hip hemiarthroplasty over osteosynthesis for patient's population over 70 years of age such as; short surgery time, no radiation exposure and immediate weight bearing. Primary hip hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilization. It is also current and effective treatment option for most elderly

Association between vitamin D concentrations and knee pain in patients with osteoarthritis

WOS: 000430889900005PubMed ID: 29707434Objectives. Osteoarthritis (OA) and vitamin D deficiency are common health conditions in older people. Whether vitamin D concentration is associated with knee OA is controversial. In this study, we aimed to determine the association between serum concentrations of vitamin D and osteoarthritic knee pain. Subjects and Methods. Vitamin D concentrations were measured with the 25 hydroxyvitamin D test in patients presenting with clinical symptoms of primary knee osteoarthritis. Osteoarthritis was graded on the Kellgren-Lawrence grading scale from anteroposterior and lateral radiographs. Height, weight, and body mass index (BMI) were recorded. Patients completed a 10-cm visual analogue scale (VAS) for indicating pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Vitamin D concentration was defined as severely deficient (<10 ng/mL), insufficient (10 to 19 ng/mL), or normal (20 to 50 ng/mL). Results. Of 149 patients (133 women), the mean age was 63.6 years. Mean vitamin D concentration was 11.53 ng/mL, and 90% patients were vitamin D deficient. Mean WOMAC score was 57.2, and VAS pain score was 7.5. Kellgren-Lawrence grade was 2 for 10 patients, grade 3 for 61, and grade 4 for 88. Mean BMI was 33.4. Mean values of VAS, WOMAC, and BMI did not differ by vitamin D status. Conclusion. Serum vitamin D concentration is not associated with knee pain in patients with osteoarthritis

Strednedobe vysledky unikompartmentalni nahrady kolenniho kloubu

PURPOSE OF THE STUDY The purpose of this study was to evaluate clinical and functional results for a series of patients undergoing unicompartmental knee arthroplasty (UKA) at mid-term follow-up. MATERIAL AND METHODS This study included 32 patients with isolated medial compartment arthritis who underwent unilateral UKA. Outcomes were assessed using pre- and postoperative Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores and Knee Society Score (KSS) metrics. RESULTS On physical examination at afollow-up of at least 5 years, mean knee flexion was 121°, mean knee extension was 2°, and mean varus angulation was 2°. At post-operative evaluation, the mean WOMAC score was 96.12 and the mean KSS score was 93. Pre- and postoperative WOMAC and KSS scores were evaluated by paired Student's t-tests; p < 0.001 determined ahighly significant difference. DISCUSSION Early UKA designs had poor outcomes. Newer implant designs and specific patient selection criteria have been reported to be associated with improved outcomes. This study examined mid-term outcomes (mean duration of follow-up, 5 years). CONCLUSION The clinical and functional results of UKA at 5-year follow-up were shown to be satisfactory. Longer follow-up is needed to determine whether UKA provides satisfactory long-term outcomes

High intermetatarsal angle hallux valgus: Does modified chevron osteotomy solve the problem?

WOS: 000463029200008An evaluation was made to introduce the efficacy of modified chevron osteotomy, in which extended plantar limb osteotomy was applied to hallux valgus cases with a high intermetatarsal angle and no hypermobility of the 1st metatarsocuneiform and hallux interphalangeus. A total of 21 patients and 34 feet were examined. The mean age of the patients was 47.3 +/- 13.4 years (range, 20-74 years). The surgery was performed on 19 (55%) right feet and 15 (45%) left feet. Extended plantar limb osteotomy and soft tissue procedures were performed on all patients from a single dorsomedial incision. Fifteen-degree angle anterior-posterior, full lateral radiographs and photographs were taken preoperatively and at 6 weeks, 6 months, 12 months and at a final postoperative follow-up examination. The hallux valgus, intermetatarsal and distal metatarsal articular angles were determined, and the HV-foot-AOFAS values showing clinical satisfaction were calculated. The mean follow-up period was 12 months, (range, 11-22 months). At the final follow-up examination, the hallux valgus angle had decreased from 37.9 degrees to 17.2 degrees on the right foot and from 32.2 degrees to 11.9 degrees on the left foot; the intermetatarsal angle had decreased from 16 degrees to 6.6 degrees on the right and from 15.1 degrees to 6.6 degrees on the left; and the distal metatarsal articular angle had decreased from 21.1 degrees to 11.4 degrees on the right and from 18.8 degrees to 6.4 degrees on the left. The mean AOFAS-HV score increased from 63 to 83.8 on the right and from 64.3 to 88.2 on the left. A statistically significant improvement was determined in all the angle values at the final follow-up examination. The AOFAS scales showing clinical satisfaction were determined as 'good'. It was concluded that the extended plantar limb modified chevron osteotomy is an effective surgical treatment option for adult cases of hallux valgus with a high intermetatarsal angle, with no 1st metatarsal hypermobility or hallux interphalangeus and no history of recent foot surgery