Radiological results of modified Dega osteotomy in Tonnis grade 3 and 4 developmental dysplasia of the hip

Dega acetabuloplasty at the time of open reduction is effective in improving the acetabular coverage of the femoral head, hence improving the stability of reduction and preventing possible surgery in the future for residual acetabular dysplasia in older children with Tonnis grade 3 and 4 developmental dysplasia of the hip (DDH). The aim of this study was to assess the radiological results of open reduction combined with Dega osteotomy in DDH. Twenty-two children's 26 hips were operated on at a mean age of 38 +/- 20.4 SD months and followed up for an average of 42 (range 24-108) months. Thirteen hips (50%) were operated on with concomitant open reduction and capsulorrhaphy, and 13 hips (50%) were treated with concomitant open reduction, capsulorrhaphy and femoral shortening osteotomy. Radiological examination included acetabular index (AI) and centre edge angle measurements. The mean preoperative AI was 39.4 +/- 6.9 degrees SD, which improved to 18.3 +/- 4.5 degrees SD postoperatively, and AI was measured as 15 +/- 3.5 degrees SD at the latest follow-up. There was a significant difference in the mean AI values between the last follow-up and the preoperative measurements (P < 0.05). The mean centre edge angle was 31 +/- 5.6 degrees SD postoperatively, and it was 31 +/- 6.2 degrees SD at follow-up. There was no significant difference between the two values. Two hips were noted to have lateralization of the femoral head due to coxa valga anteverta. One of them was operated with a femoral varus osteotomy. The Dega osteotomy combined with anterior open reduction and femoral osteotomies is a safe and effective acetabular osteotomy for surgical treatment of severe DDH such as Tonnis grade 3 and 4 dislocations. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Relationship of Postoperative Achilles Tendon Elongation With Plantarflexion Strength Following Surgical Repair.

Background: Little data exist regarding the adverse effects of Achilles tendon (AT) elongation after rupture repair on plantarflexion strength. This study aimed to investigate the effect of AT elongation measured using AT resting angle (ATRA) on the plantarflexion strength in patients with surgically treated acute AT rupture. Methods: A retrospective chart review was performed on 40 patients (15 female and 25 female) who underwent open operative repair due to an acute AT rupture. At the final follow-up, AT elongation was assessed using ATRA. Plantarflexion strength (peak torques and angle-specific torques) was measured using an isokinetic dynamometer. All variables were obtained from the operated and unoperated contralateral ankles of the patients. Results: The mean ATRA was greater in the operated ankles (mean, 57 degrees; range, 39-71 degrees) compared with the unoperated ones (mean, 52 degrees; range, 36-66 degrees; P = .009). Except the plantarflexion torque at 20 degrees of plantarflexion (P = .246), all the other angle-specific torques were lower in the operated ankles (P < .05). Peak flexion torque at 30 degrees/s was lower in the operated ankle (P = .002). A negative correlation was found between operated/unoperated (O/N) ATRA and O/N plantarflexion torque ratios at 0 degrees (r = -0.404; P = .01), 10 degrees (r = -0.399; P= .011), and 20 degrees (r = -0.387; P = .014). Conclusion: Postoperative AT elongation measured using ATRA may have a deleterious effect on the plantarflexion strength in patients with surgically treated acute AT rupture

Quality of Life Evaluation Following Limb Lengthening Surgery in Patients with Achondroplasia

Background The primary objective of this study was to evaluate the quality of life following limb lengthening surgery in patients with achondroplasia. The complications and different lengthening techniques have and effects on mid-term results were also investigated. Methods We performed a retrospective, multicenter study by evaluating the records of patients with achondroplasia operated in our clinic between 1999 and 2014 for limb lengthening with a minimum follow-up of 3 years. Forty nine patients were underwent bilateral lower limb lengthening surgery and 21 of 49 patients underwent bilateral humerus lengthening surgery. Patients were evaluated by the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales to assess the health-related quality of life (HRQOL) of children. Twenty patients with achondroplasia who had no lengthening surgery history were also evaluated with the PedsQL score as the control group. Results The average age at the time of first surgery was 6.17 years. The average follow-up period was 100.2 months. The average age at the time of study 14.70 +/- 2.44 (11-18) years. There were significant differences between the patients with humeral lengthening and patients who did not undergo humeral lengthening in all scores. Transient complications had minimal effects on scores. Although all scores in the operated group were higher than non-operated patients with achondroplasia, there were no significant differences. Conclusion Quality of life was significantly improved as a result of humerus lengthening surgery of patients with achondroplasia, despite minor complications compared with Lower limb lengthening surgery