Kubilay Beng

Salter innominate osteotomy in the treatment of late presentation Perthes disease

Purpose The aim of this study was to evaluate the clinical and radiological results of patients presenting older than eight years and treated with Salter osteotomy for Perthes disease. Method Seventeen patients (18 hips) with late presentation of Perthes disease treated with Salter osteotomy. Sixteen males were identified. The average age of patients was 8.8 years (range 8-12). Preoperation radiographs were analysed for lateral pillar staging, centre-periphery (CP) angle, Sharp acetabular index, acetabular depth index, acetabular covering percentage and Cross-over sign. Final follow-up radiograph were classified using modified Stulberg grade. Results The average follow-up of the patients was 78 months (range 40-104). During the surgery, seven hips were found to be lateral pillar grade B, three hips grade B/C and 8 hips grade C. In the final examination, 10 hips were evaluated as good (Stulberg 1 or 2), seven as medium (Stulberg 3) and one as bad (Stulberg 4). There was shortening in four patients who were all either Stulberg stage 3 or 4. A meaningful difference was detected between the pre-operation and post-operation radiographic values, regardless of the surgical staging. However, no statistical difference was found between the patients in Stulberg stage 3 or 4 and stage 1 or 2 for radiographic variables. Conclusion Salter osteotomy can be used to treat older patients with lateral pillar stage B, B/C and C at presentation.

Bosworth and modified Phemister techniques revisited. A comparison of intraarticular vs extraarticular fixation methods in the treatment of acute Rockwood type III acromioclavicular dislocations

Objective The aim of this study was to compare the long-term clinical and radiological results of Acromioclavicular (AC) fixation with K-wires (the modified Phemister procedure) and Coracoclavicular (CC) fixation with the Bosworth screw in the surgical treatment of Type 3 AC joint dislocations. Methods Thirty-two patients with complete set of medical records and who received surgical treatment between September 2005 and January 2009 due to acute Rockwood Type 3 AC joint dislocation and properly attended their follow-ups were retrospectively evaluated. Sixteen patients (13 males, 3 females; mean age: 38, range: 24–52 years) were treated with CC fixation with Bosworth screw (Group 1), and the other 16 (12 males, 4 females; mean age: 53.3, range: 38–64 years) with AC fixation using K-wires (Group 2). Results The mean follow-up time was 96 months for Group 1 and 93 months for Group 2 patients (p > 0.05). The mean Constant–Murley score at the final follow-up was 84.7 in Group 1 and 87.3 in Group 2 (p = 0.069). Radiological evaluation of the patients revealed AC arthrosis in 2 and 3 patients in Group 1 and 2, respectively. In Group 2, one patient had a recurrent dislocation, three patients had AC arthrosis and two patients had ossification in the CC ligament (Fig. 2). There was no superficial or deep wound infection in Group 1, while two patients from Group 2 had a superficial wound infection. Conclusions Our results suggest that both techniques are reliable and provide adequate reduction and similar outcomes in terms of functionality and pain levels, following the reduction of Type 3 AC joint dislocations. With lower rates of wound site infection in the early and AC arthrosis in the late postoperative period, CC fixation method with the Bosworth screw may be a better surgical option than AC fixation method with K-wires. Level of Evidence Level III, Therapeutic study.

Tibia kırığının intramedüller çivi ile tedavisinde, intakt fibula dezavantaj mıdır?

BACKGROUND The aim of this study was to compare solitary tibial diaphysis fractures and tibial diaphysis fractures associated with fibula fracture treated with the intramedullary nailing method. METHODS Records of 254 patients diagnosed with tibial diaphysis fracture and treated with intramedullary nailing between 2010 and 2013 were examined and 30 patients were included in the study. Group 1 comprised patients with solitary tibial diaphysis fracture, and Group 2 was made up of patients with tibial diaphysis fractures associated with fibula fracture. Patients in both groups were compared in terms of time to surgery, duration of surgical tourniquet, time to union, and varus, valgus, recurvatum, and antecurvatum deformities of the tibia at final follow-up. RESULTS No statistically significant difference was found between the 2 groups in time to surgery, duration of surgical tourniquet, time to union, or varus, valgus, recurvatum, and antecurvatum deformities. CONCLUSION Results indicated that intact fibula in tibial diaphysis fracture treated with intramedullary nailing was not a disadvantage; it did not affect rate of union or lead to loss of reduction, non-union, or malunion.

Comparison of Salter osteotomy and Tonnis lateral acetabuloplasty with simultaneous open reduction for the treatment of developmental dysplasia of the hip: midterm results.

The aim of this study was to compare the midterm clinical and radiological outcomes of the Salter osteotomy (SO) and Tonnis lateral acetabuloplasty (TLA) with concomitant open reduction for the treatment of developmental dysplasia of the hip. Twenty-five hips of 20 patients who underwent SO with open reduction and 26 hips of 23 patients who underwent TLA with open reduction were evaluated retrospectively. The average age of the patients at the time of the operation was 35.6 months in the SO and 36.6 months in the TLA group, without a statistically significant difference (P=0.836). The average follow-up times in the SO and TLA groups were 59.9 and 54.8 months, respectively (P=0.397). Preoperative (40.6° in the SO vs. 42.2° in the TLA, P=0.451) and last follow-up acetabular index (12° in the SO vs. 14° in the TLA, P=0.227) and center-edge angle measurements (30° in the SO vs. 26° in the TLA, P=0.069) did not show a statistically significant difference between the SO and TLA groups; however, early postoperative acetabular index improvement was better in the TLA group than in the SO group (21.2° in the SO vs. 17.2° in the TLA, P=0.014). According to the Severin grading system, both groups showed a similar number of good outcomes without a statistically significant difference (P=0.936). Clinical assessment on the basis of McKay’s criteria showed similar good and excellent outcomes (P=0.936). Both osteotomy techniques showed similar satisfactory outcomes for the treatment of DDH in patients older than 18 months of age.

Recurrent anterior hip dislocation in a patient with myasthenia gravis: a case report

Traumatic anterior hip dislocation is a rare condition compared to posterior dislocation and recurrent anterior hip dislocation is encountered even less. Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by various degrees of muscle weakness. Closed reduction is the first choice of treatment for traumatic, non-recurring hip dislocation. We report a 59-year-old female with myasthenia gravis who underwent surgical intervention for recurrent anterior hip dislocation after failure of closed reduction. To our knowledge, this is the first case with recurrent anterior hip dislocation and myasthenia gravis in the literature.