Management of persistent coccydynia with transrectal manipulation: Results of a combined procedure

WOS: 000431533600030PubMed ID: 29234884We compared the results of manual therapy combined with steroid injection with single steroid injection in the treatment of persistent coccydynia. Combined therapy was performed in 21 patients (Group 1) and steroid injection in 23 patients (Group 2). We compared two groups and investigated the combined therapy group in details. Patients were classified according to the underlying cause, BMI, anatomic type of coccyx and duration of symptoms (<6 or 6 months). Mean age was 30.5 years at the time of procedures. Mean followup time was 27.8 months. VAS scores were decreased in both groups but combined therapy group had much more better results. Complete pain relief was achieved in 61.9% of patients in Group 1 whereas it was only 17.4% in Group 2. In 23.8% of Group 1, the VAS score was significantly decreased but the feeling of uncomfortability persisted. This was 73.9% in Group 2. We had no relapse in Group 1 but in Group 2 the relapse rate was 56.5%. Underlying cause, body mass index, anatomic type of coccyx and duration of symptoms had no effect on results. Manual therapy combined with steroid injection would be an alternative method in case of persistent coccydynia. It is a safe and easy option before surgical treatment

Serebral palsili çocuklarda kalça subluksasyonu ve dislokasyonunun cerrahi rekonstrüksiyonu

WOS: 000427282300003PubMed ID: 29526153Objectives: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. Patients and methods: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range, 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1 +/- 10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre-and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. Results: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2 degrees preoperatively and 20.4 degrees postoperatively. In preoperative period, MP and NSA were 72.7% and 160 degrees, respectively, which improved to 24.3% and 130 degrees, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p<0.001). We performed revision surgery due to implant failure in two patients and detected hip subluxation due to increased pelvic obliquity in one patient who had thoracolumbar scoliosis. Conclusion: In CP patients, reconstruction of hip subluxation and dislocation with femoral VDRO and Dega transiliac osteotomy establish femoroacetabular congruency. Without any cast immobilization, early physical therapy is encouraged for immediate recovery.Amaç: Bu çalışmada serebral palsi (SP) hastalarındakalça subluksasyonu ve dislokasyonunun tedavisinde femurvarus derotasyon osteotomisi (VDRO) ve Dega transiliyakosteotomisinin etkinliği incelendi.Hastalar ve yöntemler: Geriye dönük bu çalışmaya Temmuz2010 - Aralık 2015 tarihleri arasında kalça subluksasyonu vedislokasyonu nedeniyle ameliyat edilen 22 SP hastasının (9 erkek,13 kadın; ort. yaş 8.7 yıl; dağılım 4-18 yıl) 25 kalçası dahiledildi. Ortalama takip süresi 36.1±10.4 ay (dağılım 20-65.6 ay)idi. Tüm olgularda femur VDRO ve Dega transiliyak osteotomisiuygulandı. Ameliyat sonrasında hastaların hiçbirine alçı ileimmobilizasyon uygulanmadı. Hastalar ameliyat öncesinde vetakip süresinde kaba motor fonksiyon sınıflandırma sistemi ileklinik olarak değerlendirildi. Asetabular indeks (Aİ), migrasyonyüzdesi (MY) ve boyun-cisim açısı (BCA) ameliyat öncesinde,sonrasında ve takip süresinde çekilen pelvis grafileri ileölçülüp belgelendi. Ameliyat sırası ve sonrası komplikasyonlarkaydedildi.Bulgular: Kaba motor fonksiyon sınıflandırma sistemi skorları16 hastada iyileşti. Ameliyat öncesi ortalama AI 33.2°, ameliyatsonrası 20.4° idi. Ameliyat öncesi sırasıyla %72.7 ve 160° olanMY ve BCA, ameliyat sonrası sırasıyla %24.3 ve 130°’ye iyileşti.Aİ, BCA ve MY’deki ameliyat sonrası iyileşme istatistiksel olarakanlamlı idi (p<0.001). İki hastada implant yetmezliği nedeniylerevizyon cerrahisi uygulandı ve torakolomber skolyozu olanbir hastada artmış pelvik oblisiteye bağlı kalça subluksasyonusaptandı.Sonuç: Serebral palsi hastalarında kalça subluksasyonu vedislokasyonunun femur VDRO ve Dega transiliyak osteotomisiile rekonstrüksiyonu femoroasetabular uyum sağlar. Hızlı düzelmeiçin alçı ile immobilizasyon olmaksızın erken fizyoterapi teşvikedilir

Minimally invasive plate osteosynthesis for tibial derotation osteotomies in children with cerebral palsy

WOS: 000452634300005PubMed ID: 29759883Objective: Tibial derotation osteotomy can be used in the treatment of rotational deformities in case of ineffective conservative management. Our aim was to evaluate the results of the patients who underwent minimal invasive plate osteosynthesis for tibial derotation osteotomies. Methods: Total of 16 patients (17 procedures) were included in this study. Mean age was 11.5 (3-25) years. We clinically assessed the tibial torsion by measuring the thigh-foot angle (TFA). No immobilization was used postoperatively and range of motion exercises were begun immediately. The patient was allowed weight-bearing activity, as tolerated, when callus formation was seen on the radiographs, at approximately three to four weeks after surgery. Results: The mean follow-up time was 27.5 months. Mean preoperative and follow up TFA were 27 degrees of internal rotation and 3.74 degrees of external rotation, respectively. A mean of 22.3 degrees improvement was achieved postoperatively. There was only one wound detachment, which was accepted as a complication and healed with local wound care. Conclusions: The recurrence risk and correction loss can be decreased with plate-screw fixation. Minimal invasive surgery would also decrease the risk of wound complications

A combined procedure for irreducible dislocation of patella in children with ligamentous laxity: A preliminary report

Objective: Irreducible patellar dislocation accompanying ligamentous laxity is rarely seen in pediatric patients. The most common complaints due to this condition are inability to walk, delayed walking, and difficulties with orthotics. The purpose of this retrospective study is to describe a novel surgical technique to treat dislocated patella in patients with symptomatic ligamentous laxity.Methods: Fourteen knees of 9 patients operated on by a single surgeon between 2009-2012 were included in the study. The tensor fascia was divided into 2 strips, and these strips were passed via the joint and sutured to themselves. The combined procedure additionally includes lateral capsular release, vastus lateralis (VL) resection, medial capsular plication, and Z-plasty of the rectus femoris (RF) tendon.Results: Mean age at the time of surgery was 6.9&plusmn;3.3 years (range: 4-13 years). The mean follow-up was 37.6&plusmn;0.9 months (range: 26-49 months). Patellofemoral instability was restored for all patients by using combined surgical technique. Patellar lateralization developed in 2 patients, in whom stability was obtained via secondary medial plication.Conclusion: Our results show that this combined surgical procedure stabilizes the knee and treats patellar dislocation accompanying ligamentous laxity in pediatric patient

Risk factors of refracture and morbidity during removal of titanium pediatric proximal femoral locking plates in children with cerebral palsy

Background: Pediatric proximal femoral locking plates (PFLPs) are widely used when performing proximal femoral osteotomy in children with cerebral palsy (CP). The purpose of this study is to report the difficulties and risk factors of titanium PFLPs removal in CP. Methods: PFLP removal was performed in 58 hips of 33 patients (17 males, 16 females). The mean age at the time of surgery (plate removal) was 10.9 (range, 5.7 to 19.2) years. The patients were divided into 2 groups as group 1 and 2, if any difficulty was observed during surgery or not. Results: Difficulty was not detected in 42 (72.4%) hips (group 1). Difficulties were encountered in 16 (27.6%) hips (group 2). A total of 364 screws were used (259 in group 1, 105 in group 2). The mean plate screw density ratios were 0.88 in group 1 and 0.94 in group 2. The difference between group 1 and 2 was statistically significant. The mean duration between the insertion and removal of the PFLP was 14.9 months (11.9 mo in group 1, 22.7mo in group 2). The difference between group 1 and 2 was statistically significant. The screw heads were cut and the shafts were left in the bone in 4 hips (4 screws); 3 of these 4 screws were calcar screws. Therefore, calcar screw application can be accepted as a handicap for screw removal. Conclusions: As a conclusion, this study suggested that difficulty in titanium PFLP removal in CP is common and PFLP removal is not a harmless procedure. A longer time from internal fixation to removal, increased plate screw density ratio, and calcar screw application are risk factors for difficulties in titanium PFLP removal in CP

A rare localization of osteoid osteoma - Presentation of two cases

WOS: 000388302400017PubMed ID: 29653045Introduction Osteoid osteoma is a benign osteoid-forming tumor generally localized to the long bones, is rarely localized in the hand and the major symptom is intermittent pain. This study aims to present two patients who were operated on for metacarpal osteoid osteomas. Case Outline A 16-year-old female patient and an 18-year-old male patient were operated on for metacarpal osteoid osteomas. The major symptom was intermittent pain for both patients. After surgical excision of the niduses, the complaints resolved in both cases. Conclusion In the case of high suspicion for osteoid osteoma, computed tomography or magnetic resonance imaging should be performed due to the risk of negative radiographic findings. Surgical excision is curative and a safe method of treatment

Treatment of iatrogenic pes calcaneus deformity in patients with cerebral palsy, short term results

Amaç: Serebral palside ekin kontraktürü çoğunlukla aşil tendonu uzatma prosedürleri ile tedavi edilmektedir. Bu işlemlerin en önemli komplikasyonu ise tendonun aşırı uzatılmasına bağlı gelişen ve yürümeyi olumsuz etkileyen pes kalkaneus deformitesidir. Bu çalışma ile serebral palsi tanılı hastalarda gelişen iyatrojenik pes kalkaneus deformitesinin tibialis anterior ve peroneus brevis tendon transferleri ile tedavisinin etkinliğini belirlemek amaçlanmıştır. Gereç ve yöntem: Çalışmaya ortalama yaşları 11.5 olan 8 çocuk (14 ayak) dahil edilmiştir. Ameliyat öncesi ve sonrası kaba motor fonksiyon sınıflama sistemi (GMFCS) seviyeleri, ayak bileği eklem hareketleri ve kas gücü değerlendirmeleri yapılmıştır. Ameliyat sonrası ayrıca plantar fleksiyon tork gücü de bakılmıştır. Bulgular: Ortalama 43 aylık (25-90 ay) takip sonunda ameliyat öncesinde plantar fleksiyonu olmayan hastalarda ortalama 10.1 derece aktif plantar fleksiyon elde edilmiştir. Tork değerleri ise 90°/sn ve 120°/sn açısal hızlarda 14.6 ve 8.7 N/m olarak ölçülmüştür. Sonuç: Serebral palsi hastası çocuklarda gastroknemius-soleus kompleksinin aşırı uzatılmasına bağlı gelişen pes kalkaneus deformitesinin yeni bir teknik olarak tibialis anterior ve peroneus brevis tendonlarının aşil tendonuna transferleri ile plantar fleksiyon gücünde ve GMFCS seviyelerinde anlamlı iyileşme elde edilmiştir.Purpose:Heel cord/calcaneal tendon lengthening procedures are commonly performed to treat the equinus deformity in cerebral palsy. Although it is mostly successful, pes/talipes calcaneus deformity secondary to over lengthening can be considered to be the most significant complication. The purpose was to determine the effectiveness of tibialis anterior and peroneus brevis tendon transfers in the surgical reconstruction of iatrogenic pes calcaneus deformity in cerebral palsy patients. Materials and methods: Fourteen feet of eight patients were included. The average age was 11.5 years. Gross functional capacity, range of motion and muscle strength evaluations were compared pre- and postoperatively. Besides, power of plantar-flexion torque was checked. Results: The mean follow up was 43 (range: 25–90) months. None of the patients could perform measurable plantar flexion, preoperatively. The mean values for postoperative plantar flexion and dorsiflexion were 10.1° and 17.1°, respectively. Postoperatively, mean peak torques at 90°/sec and 120°/sec for plantar flexion were 14.6 and 8.7 N/m, respectively. Conclusion: Significant improvement was observed in the plantar flexion power and GMFCS levels after using this technique to treat pes calcaneus foot deformity due to over-lengthening of the gastro-soleus muscle complex in CP patients

Surgical correction of hallux valgus deformity in children with cerebral palsy

Objective: This study aimed to present a treatment algorithm for the correction of the hallux valgus defor-mity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results. Methods: 29 patients (45 feet) were included in the study. The mean age of the patients at the time of the surgery was 14 (range 6e22) years. The mean follow-up was 33 (range 22e59) months. A reconstructive procedure was performed on 19 patients (27 feet); a soft tissue surgery and exostectomy of the bunion in six patients (11 feet); and MTP joint arthrodesis in four patients (7 feet). The hallux valgus angle (HVA) and the anteroposterior intermetatarsal angle (IMA) were used for radiologic evaluation and the DuPont Bunion Rating Score was used for clinical evaluation. Results: The follow-up period was 36 (range 22e59) months in reconstructive group, 27 (range 24e29) months in soft tissue group, and 29 (range 23e41) months in MTP arthrodesis group. Significant im-provements were detected in hallux valgus angle in three groups postoperatively but in soft tissue group correction loss was observed during follow up. Best results were achieved in arthrodesis group and worse in soft tissue group in terms of clinical evaluation. Conclusion: According to our results isolated soft tissue procedures are ineffective in CP patients. Soft tissue procedure combined with metatarsal osteotomy has satisfactory results. Level of evidence: Level IV, therapeutic study

Results of supracondylar femoral extension osteotomy and patellar tendon advancement in patients with cerebral palsy

Amaç:Diz fleksiyon kontraktürü ve patella alta serebral palsi (SP) hastalarında yaygın görülen ve yürüme fonksiyonunu önemli ölçüde bozan patolojilerdir. Suprakondiler femur ekstansiyon osteotomisi (SFEO) ve patellar tendon ilerletme (PTİ) ameliyatları SP kaynaklı diz fleksiyon kontraktürünün ve patella altanın tedavisinde uygulanan yöntemler arasındadır. Bu çalışmanın amacı SP kaynaklı diz fleksiyon kontraktürünün ve patella altanın tedavisinde uygulanan SFEO ve PTİ ameliyatlarının etkinliğinin incelenmesidir. Gereç ve yöntem: Bu retrospektif çalışmaya 2013 ve 2015 yılları arasında SP tanısı olan ve diz fleksiyon kontraktürü için SFEO ve patella alta için PTİ ameliyatı yapılan on bir hasta (22 diz) dâhil edildi. Ameliyat edildiklerinde hastaların ortalama yaşı 13; ortalama takip süresi 31 aydı. Hastalar klinik olarak kaba motor fonksiyon sınıflama sistemi (KMFSS) ve diz fleksiyon kontraktürünün nüksü ile radyografik olarak ameliyat öncesi, ameliyat sonrası, takip anterior-posterior ve lateral diz grafileri ile değerlendirildi. Koshino-Sugimoto indeksi (KS), komplikasyonlar kaydedildi. Bulgular: KMFSS değerleri yedi hastada yükselmiştir. Takipler sırasında bir olguda diz fleksiyon deformitesinin nüksü saptandı ve SFEO ile tedavi edildi. Ameliyat öncesi KS indeksi ortalaması 1.37 iken ameliyat sonrasında 1.07 ve son takipte 1.24 ölçüldü (p=0.004). İki olguda takiplerde serklaj teli iritasyonu saptandı ve ilave cerrahi ile teller çıkarıldı. Sonuç:SP’ye bağlı diz fleksiyon kontraktürünün ve patella altanın SFEO ve PTİ ile başarılı radyolojik ve klinik sonuçlara ulaşılarak tedavi edildiği görülmüştür.Purpose: Knee flexion contracture and patella alta are common problems in cerebral palsy (CP) patients and disrupts gait function significantly. Supracondylar femur extension osteotomy (SFEO) and patellar tendon advancement (PTA) are among the leading treatment methods. We reviewed the efficacy of SFEO and PTA in the treatment of knee flexion contracture and patella alta of CP patients. Materials and methods: In this retrospective study 22 hips of 11 CP patients who were operated between 2013 and 2015 were reviewed. The mean age was 13 years when the patients were operated and the mean follow-up period was 31 months. SFEO and PTA were peroformed in all cases. Patients were evaluated clinically with gross motor function classification system (GMFCS) and recurrence of knee flexion contracture and radiologically with knee radiograph. The Koshino-Sugimoto index (KS) was recorded. Results: GMFCS scores were improved in seven patients. Recurrence of knee flexion contracture was detected in one case who was treated with revision SFEO. The mean preoperatively KS was 1.37; postoperatively KS was 1.07 and follow-up 1.24 (p=0.004). Cerclage wire irritation was detected in two cases and extracted with additionally surgical procedures