Ilker Abdullah Sarikaya

Atelosteogenesis type III: orthopedic management.

Atelosteogenesis type III is a rare autosomal dominant skeletal dysplasia caused by mutations in the synthesis of the protein filamin B (FLNB). The mutation in the gene coding for FLNB causes the osteochondrodysplastic features of this disorder. Clinically, osteochondrodysplasia causes unbalanced skeletal maturation and absent or mostly hypoplastic bones, such as the pelvis, vertebrae, ribs, or long bones. In the literature, an orthopedic management for this disorder has not been well described. We report the case and orthopedic management of a 6-year-old female patient with atelosteogenesis type III after 3 years of follow-up.

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, 22.7 mo 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. Level of Evidence: Level III.

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±3.3 years (range: 4-13 years). The mean follow-up was 37.6±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 patients.

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

Objective 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° of internal rotation and 3.74° of external rotation, respectively. A mean of 22.3° 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. Level of evidence Level IV, Therapeutic study.

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 deformity 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 6–22) years. The mean follow-up was 33 (range 22–59) 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 22–59) months in reconstructive group, 27 (range 24–29) months in soft tissue group, and 29 (range 23–41) months in MTP arthrodesis group. Significant improvements 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.

Management of knee rheumatoid arthritis and tibia nonunion with one-stage total knee arthroplasty and intramedullary nailing: A report of two cases

Total knee arthroplasty (TKA) is a surgical procedure which is widely used in the treatment of gonarthrosis secondary to rheumatoid arthritis (RA). The incidence of stress fractures in tibia in the patients with RA is higher compared to normal patients. In this study, we report two cases of TKA and intramedullary nailing in RA patients with severe knee arthritis and tibial nonunion. Both patients had a satisfactory clinical outcome with radiological healing of the tibial fracture.

Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy

OBJECTIVE The aim of this study was to determine the efficacy of semitendinosus and gastrocnemius tenotomies on popliteal angle presenting knee flexion spasticity in children with cerebral palsy (CP). METHODS The study included 44 patients (25 males, 19 females; mean age: 8.1 years, range: 4 to 14 years) with spastic CP who underwent surgery for knee flexion spasticity. A total of 78 semitendinosus tenotomies and 28 associated gastrocnemius tenotomies were performed. Popliteal angle was measured under general anesthesia before and after surgery. Patients were divided into groups according to age (younger and older than 7 years), severity of deformity and type of CP. RESULTS Mean popliteal angles decreased by 14.3º (30.1%) following semitendinosus tenotomy and by 6.1º (12%) following gastrocnemius tenotomy (p=0.0001). The change in popliteal angle was not statistically significant according to age, severity of flexion spasticity, and type of CP palsy. There was a significant difference following gastrocnemius tenotomy between groups with a popliteal angle of greater or lesser than 50º (p=0.0001). CONCLUSION Semitendinosus and gastrocnemius tenotomies improved popliteal angle by 30.1% and 12%, respectively. Age, preoperative popliteal angle or anatomical disease classification did not a significantly affect popliteal angle.