Ulunay Kanatli

Footprint and radiographic analysis of the feet.

There is controversy concerning the definition and measurement of the medial longitudinal arch of the foot. Various techniques are reported to assess the medial arch height, including radiographic measurements and footprint analysis, which are the most commonly used methods. Some authors define footprint analysis as unreliable for measuring the arch height. The purpose of this study was to investigate the relationship between radiologically measured angles and the arch index obtained from footprint analyses in 38 children with flexible pes planus. A positive correlation of arch index was found between lateral talo–horizontal and lateral talo–first metatarsal angles (p < 0.05). These angles have been used by some authors to describe the height of the medial longitudinal arch of the foot. This study demonstrated that footprint analysis could be used effectively for screening studies and at individual office examinations.

Evaluation of the medial longitudinal arch: a comparison between the dynamic plantar pressure measurement system and radiographic analysis

OBJECTIVES The measurement of the medial longitudinal arch (MLA) of the foot is a controversial issue in orthopedics. Several methods have been developed to define and determine the MLA, but none of them are universally accepted. The purpose of this study was to compare some statically obtained radiographic angles with the dynamic plantar pressure distribution measurement system for the evaluation of the MLA in healthy individuals. METHODS A total of 95 subjects (72 females, 23 males; mean age 37.8 years; range 11 to 85 years) were retrospectively evaluated. All the subjects were referred to the pedobarography laboratory for varying causes, had foot radiographies, and were evaluated as having normal feet. On standard lateral weight-bearing radiographs of the foot, the lateral talocalcaneal angle, talo-first metatarsal angle, talohorizontal angle, and calcaneal pitch angle were measured. The plantar pressure distribution was measured by the EMED-SF system. To evaluate the MLA, the arch index method was used. The arch index was calculated by the ratio of the pressure area of the midfoot to the sum of the forefoot, midfoot, and the hindfoot areas. Correlations between the radiographic angles and the arch index were analyzed by the Pearson correlation test. RESULTS The mean values of the lateral talocalcaneal angle, talo-first metatarsal angle, talohorizontal angle, and calcaneal pitch angle were 43.2, 7.2, 29.5, and 41 degrees, respectively. The mean value of the arch index was 0.12 (range 0.04 to 0.17). There was no significant correlation between the arch index and gender (r=-0.10, p>0.05). The talo-first metatarsal (r=0.38) and talohorizontal (r=0.19) angles were found to be in significant correlation with the arch index (p<0.05), whereas the talocalcaneal (r=-0.16) and calcaneal pitch (r=-0.10) angles did not show correlation with the arch index (p>0.05). CONCLUSION The arch index method is a simple and reproducible pedobarographic measurement for the evaluation of the MLA. However, the angles measured on statically obtained radiographs and showing correlations with the arch index may give similar results concerning the MLA. Both static and dynamic methods can be utilized in the evaluation of the MLA.

Screening for developmental dysplasia of the hip: Results of a 7‐year follow‐up study

Abstract Background : Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years.

Anatomical variations of the anterosuperior labrum: Prevalence and association with type II superior labrum anterior-posterior (SLAP) lesions

BACKGROUND Anterosuperior labrum variations have been generally described as innocent anatomical variations without clinical significance. This study was intended to determine their prevalence and reveal their possible relationship with type II SLAP lesions. MATERIALS AND METHODS A total of 713 consecutive shoulder arthroscopies were evaluated retrospectively for anterosuperior labrum variations and co-existing labral pathologies. Twenty two of these were excluded from the study due to the interobserver variability in the categorization process. The relationship of both these anatomic variants and shoulders with a normal appearing anterosuperior labrum to intra-articular pathology was analyzed statistically and compared with each other. RESULTS Found in 98 patients (14.18%), the anatomic variations in the anterosuperior labrum were classified into 3 groups as the sublabral recess (2.46%), the sublabral foramen (7.67%), and absent anterosuperior labrum with a cord-like middle glenohumeral ligament (4.05%). The latter 2 of these groups displayed a statistically significant relationship with type II SLAP lesions (21 of 53 and 23 of 28 patients; P = .0028 and P < .0001, respectively). DISCUSSION Although mostly considered as simple morphological variations, the anatomic variants of the anterosuperior labrum may predispose the shoulder to labrum pathologies by altering the intra-articular biomechanics. CONCLUSION As previously suggested in the literature, certain anatomic variants of the anterosuperior labrum are associated with the development of SLAP lesions.

Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: A retrospective study in 42 patients

AIM Our study reports long-term results and factors related to patient satisfaction in the case of primary hemiarthroplasty for humeral proximal end fractures. PATIENTS AND METHODS We retrospectively evaluated 42 patients with humeral proximal end fractures who underwent primary hemiarthroplasty in our clinic from February 1994 to March 2004. Of the 42 patients, 14 (33%) were male and 28 (67%) female. The mean age was 68.9+/-5.57 years (age range: 59-81 years). The mean follow-up period was 78.8+/-26.6 months (range: 48-118 months). We evaluated the following parameters: fracture type according to the Neer classification, the time interval between the fracture and the operation, postoperative radiological examination, the Neer outcome assessment criteria for patient satisfaction and functions, according to the Constant and Murley Scoring (CMS) system. RESULTS We found good-to-excellent outcomes in 36 (85.7%) and poor outcome in six (14.3%) patients according to the Neer criteria. The average values for CMS score, anterior elevation and external rotation were 73.59+/-17.95 (25-94), 121.30+/-42.99 degrees (range: 30-170 degrees ) and 30 degrees (range: 0-80 degrees ), respectively. The patients who had been operated in the early period (within 2 weeks) had better functional outcomes (p<0.001) and had significant pain relief. There was a strong positive correlation between the humeral offset (distance between the head and the tuberosities) and the degree of elevation (r=0.872, p<0.001). There was a strong negative correlation between the height of the humeral head and the degree of elevation (r=-0.853, p<0.001). CONCLUSION In humeral proximal end fractures, primary hemiarthroplasty in the early period with the anatomic reconstruction of bone and soft tissues of the shoulder joint and long-term regular rehabilitation programme are important factors contributing to increased patient satisfaction.

The relationship between the hindfoot angle and the medial longitudinal arch of the foot

Introduction: The relationship of hindfoot valgus and the medial longitudinal arch (MLA) is a well-known parameter for the evaluation of the foot deformities. In this study, we evaluated the relationship between the hindfoot angle and the MLA and the effect of these parameters on the development and general joint laxity of the subjects. Methods: Two-hundred-sixty-one volunteers who had no foot pain or major foot deformity were examined. The age range of the volunteers was 4 to 20 years. For each subject, the right foot was evaluated for the clinical hindfoot angle and footprint analysis. General ligamentous laxity also was recorded. Arch index and valgus index were used for the evaluation of the footprint analysis, and the valgus angle was measured clinically. Results: The average heel valgus angle for all subjects was 5.2 (SD 3.3) degrees. The means of valgus index and arch index were 3.34 (SD, 5.6) and 0.7 (SD, 0.2), respectively. Although there was a positive correlation between the valgus angle and valgus index (p = 0.027), the arch index was not found to be correlated with these values. Positive correlation between joint laxity and arch height also was demonstrated (p < 0.05). Conclusions: We concluded that the hindfoot angle and MLA height must be considered separately in clinical practice, particularly in the management of childhood pes planus.

Treatment of segmental bone defects in rats by the stimulation of bone marrow osteo-progenitor cells with prostaglandin E2

An alternative to bone grafting is engineered osteo-conductive material that carries osteo-progenitor cells with osteo-stimulant factors impregnated on a malleable osteo-conductive material. We used bone marrow stem cells as the source of osteo-progenitor cells and stimulated them with prostaglandin E2 using demineralised bone matrix as a carrier. We treated 35 skeletally mature male Wistar albino rats with segmentary radial bone defects using five different treatment groups. Group I received no treatment; the remaining four groups all received a mixture of bone marrow and demineralised bone matrix. In group III, a copolymer was added. In group IV, prostaglandin E2 and in group V prostaglandin E2 within a copolymer was added to the mixture. Eight weeks after the surgical procedure, the rats were sacrificed. Radiological and histological evaluation of the radial bone showed that while there was no significant healing in groups I, II and III, there was a significant healing response in groups IV and V.RésuméUne alternative à la greffe osseuse est un matériel ostéoconducteur portant des cellules précurseurs avec des facteurs ostéostimulant imprégnés dans un matériel malléable ostéoconducteur. Nous avons utilisé des cellules de la moelle osseuse comme source de cellules précurseurs et les avons stimulés avec une prostaglandine E2 qui utilise la matrice osseuse déminéralisée comme porteur. Nous avons traité 35 rats Wistar albinos viril à maturation osseuse, avec un défaut segmentaire du radius, en utilisant cinq groupes de traitements différents. Le groupe I n’a reçu aucun traitement. Les quatre autres groupes ont reçu un mélange de moelle osseuse et une matrice d’os déminéralisé. Dans le groupe III a été ajouté un copolymère. Dans le groupe IV, une prostaglandine E2 et dans le groupe V, une prostaglandine E2 et un copolymère ont été ajouté au mélange. Huit semaines après la procédure chirurgicale, les rats ont été tués. L’évaluation radiologique et histologique de l’os radial a montré qu’il n’y avait aucune guérison notable dans les groupes I, II et III, mais une réponse curative appréciable dans les groupes IV et V.

Proximal humeral fractures with minimal displacement treated conservatively

We reviewed 27 patients with a minimally displaced proximal humeral fracture treated conservatively after a mean follow-up of 25 (12–34) months. All fractures had united. Patients were evaluated using the Constant-Murley scoring system, and isokinetic muscle strength was tested using a Cybex dynamometer. Finally, all shoulders were examined ultrasonographically. The mean Constant score for all patients were 81 (54–100). Twenty-three patients had no or only mild pain, while three had moderate and one severe pain necessitating regular use of oral analgesics. Twenty patients were able to perform all activities of daily living, but seven had mild trouble in overhead activities and weight carrying. Only in one patient, the abduction peak torque equalled the one of the opposite shoulder. In all other patients, the peak torque was lower than, and in 14 patients below, 50%. In nine patients, rotator cuff tears were seen at ultrasonography.RésuméNous avons examiné 27 malades avec une fracture humérale proximale peu déplacée traitée d’une manière conservatrice après un suivi moyen de 25 (12–34) mois. Toutes les fractures avaient consolidé. Les malades ont été évalués avec le score de Murley Constant et la force musculaire isokinetique a été testée par un dynamomètre Cybex. Toutes les épaules ont été examinées par échographie. Le score de Constant moyen pour tous les malades était de 81 (54–100). Vingt-trois malades n’avaient aucune douleur ou des douleurs très discrètes, trois avaient des douleurs modérées et une patiente avait des douleurs sévères nécessitant l’usage régulier d’analgésiques oraux. Vingt malades étaient capables d’exécuter toutes les activités de la vie quotidienne mais sept avaient des difficultés pour les activités en hauteur et pour le port de charges. Chez seulement un patient la force d’abduction maximum était égale à celle de l’épaule opposée, pour tous les autres malades elle était inférieure et chez 14 d’entre eux elle était même à moins de la moitié. Chez neuf patients une déchirure de la coiffe des rotateurs était visible à l’échographie.

A novel biodegradable PCL film for tendon reconstruction: Achilles tendon defect model in rats.

This study aims to investigate applicability of poly(epsilon-caprolactone) (PCL) biodegradable films for repair of gaps in Achilles tendons in a rat model, also comparing surgical repair versus no repair approaches. PCL was synthesized with tailor-made properties, then, PCL films were prepared by solvent casting. Seventy-five outbred Sprague-Dawley rats were randomly allocated into five groups: (i) sham operated (skin incision only); (ii) no repair (complete division of the Achilles tendon and plantaris tendon without repair); (iii) Achilles repair (with a modified Kessler type suture); and (iv) plasty of Achilles tendon defects with the biodegradable PCL films, and (v) animals subjected to 1 cm mid-substance defect with no repair. Functional performance was determined from the measurements of hindpaw prints utilizing the Achilles functional index. The animals were killed 8 weeks after surgery and histological and biomechanical evaluations were made. All groups subjected to Achilles tendon division had a significant functional impairment that gradually improved so that by day 28 there were no functional impairments in any group whereas animals with a defect remained impaired. The magnitude of the biomechanical and morphological changes at postoperative 8 weeks were similar for no repair group (conservative), Achilles repair group and tendonplasty group (biodegradable PCL film group). The initial rate of functional recovery was significantly different for primary suture, Achilles repair group and PCL film group (p>0.01). But, at the 28th day, functional recovery was quite similar to the other groups. In summary, our results suggest that the PCL film can be an alternative biomaterial for tendon replacement.

The Relationship of the Heel Pad Compressibility and Plantar Pressure Distribution

Loss of heel pad elasticity has been suggested as one of the possible explanations of heel pain. This study aimed to determine the effect of heel pad thickness and its compressibility to heel pressure distribution, in 47 (94 feet) normal subjects and 59 (94 feet) patients with heel pain, using radiological measurements and EMED-SF (Novel, Munich) plantar pressure distribution measurement system. Both heels of the patients and control group were radiographed with and without weight bearing. The ratio of the heel pad thickness in loading to unloading position was defined as “the heel pad compressibility index.” The plantar peak pressure of the heel was measured at heel strike phase of the gait cycle. The compressibility index for control and patient groups were found to be 0.60 and 0.69, respectively. The peak pressure under the heel pad was recorded to be 28.4 N/cm2 for patients and 31.7 N/cm2 for control group. No significant difference was found for heel pad compressibility index and heel pad pressures between patient and control groups (p>0.05). This study revealed that there is no relationship between heel pad compressibility and pressure distribution of the heel pad both in control and patient group. We feel the flexibility of the heel pad does not have any influence on heel pain syndromes.