Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis : do we sacrifice ankle to the knee?

Total knee arthroplasty is one of the most commonly preferred surgical methods in the treatment of patients with varus gonarthrosis. In this study, we aimed to evaluate the radiological changes observed in the ankles after total knee arthroplasty. Between May 2012 and June 2013, 80 knees of 78 patients with varus deformity over 10A degrees underwent total knee arthroplasty. For each patient, full-leg standing radiographs were obtained pre- and post-operatively. Mechanical and anatomical axes (HKA and AA), lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle (LDTA), ankle joint line orientation angle (AJOA), tibial plafond talus angle (PTA) and talar shift were measured for each patient both pre- and post-operatively. Pre-operatively, the mean HKA was 16.6A degrees and the mean AA was 10.41A degrees, both in favour of varus alignment. Post-operatively, the mean HKA decreased to 3.6A degrees and the mean AA to -2.1. The mean LDTA was 87.3A degrees. Before the operation, the mean AJOA was -7.6A degrees, opening to the medial aspect of the ankle, and it was 0.04A degrees after the operation and opening to the lateral aspect (p < 0.05). Our study reveals the changes occurring in the ankle after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle should be taken into consideration and the amount of correction should be calculated carefully in order not to damage the alignment of the ankle

Effect of fracture level on the residual fracture gap during tibial intramedullary nailing for tibial shaft fractures

Introduction: The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate. Material and method: A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated. Results: The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6 ± 1.7 and 6.0 ± 1.7 mm in proximal fractures and 0.3 ± 2.4 mm and 0.4 ± 2.3 mm in distal fractures, respectively (p < 0.001 and p < 0.001, respectively). The mean time to union was 21.9 ± 2.9 weeks in the proximal fracture group and 16.7 ± 2.4 weeks in the distal fracture group (p < 0.000). The residual fracture gap amount significantly correlated with the level of fracture (r = 0.811, p < 0.001). Discussion: Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates

Erratum to: Art in Science: Orthopaedics Through Philatelic Material (vol 471, pg 3755, 2013)

WOS: 00033058500006

Art in Science: Orthopaedics Through Philatelic Material

WOS: 000327083800007PubMed ID: 2407262

Reply to the Letter to the Editor Art in Science: Orthopaedics Through Philatelic Material

WOS: 000330976400046PubMed ID: 2444283

Pure elbow dislocation in the paediatric age group

WOS: 000371084600017PubMed: 26686496Purpose The main purpose of the present study was to evaluate the clinical results and prognosis of pure elbow dislocations in the paediatric age group following non-surgical treatment. Methods Acute traumatic pure elbow dislocations treated between January 2008 and January 2013 were evaluated. The median age was eight years. The mean follow-up time was 46 months. Active and passive range of motion (ROM), elbow stability, neurovascular status, functional status and any early or late complications were evaluated and recorded at the latest follow-up. Results The mean flexion-extension ROM was measured as 119.5 degrees. The mean pronation and supination were 67 and 79 degrees. Moderate instability was diagnosed in four cases. The mean Mayo Elbow Performance Score (MEPS) score was 91.6 points; the clinical outcome was excellent in nine patients, good in two and fair in one. Conclusions Acute traumatic pure elbow dislocation in childhood is a very rarely seen emergency that can be treated safely with closed reduction combined long-arm plaster splinting and physical rehabilitation

Giant cell tumor of the capitate: an unusual case with 10 years follow-up

Giant cell tumor of the small bones, particularly the carpal bones of the hand, is exceedingly rare. We present a case report of giant cell tumor of the capitate in a 24 year-old female with 10 years postoperative follow-up. Although carpal bones are extremely unusual location, orthopedic surgeons should always keep in mind that differential diagnosis must include giant cell tumor of bone whenever an expansile osteolytic lesion with well-defined but nonsclerotic margins is identified in a young adult with closed physes