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The aim of this study was to evaluate the mid-term clinical and radiological results of patients who underwent arthroscopic subscapularis (SSC) tendon repair and to address the possible effect of repair technique(single or double row), tear pattern, and concomitant procedures among supraspinatus tears and long head of biceps tendon (LHBT) pathologies on outcomes and failure parameters.45 patients (24 female; mean age = 55.9 years, age range = 37 - 78) who underwent arthroscopic repair of an SSC tear between January 2009 and December 2016 were retrospectively identified and included inthe study. Pre- and postoperative internal rotation strength and shoulder joint range of motion angles were measured. Clinical outcomes were assessed by Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant-Murley, Rotator cuff-quality of life (RC-QoL), and University of California Los Angles (UCLA) scores preoperatively and at the final follow-up.The mean follow-up was 45.2 (range = 36-104) months. 14 patients had isolated SSC tears. The mean preoperative VAS, ASES, Constant-Murley, RC-QoL, and UCLA scores for all patients were respectively 8.6, 21.2, 24, 28.9, and 12. Significant improvement was observed in each clinical outcome at the final follow-up: 0.96, 88.4, 86.4, 90.2, and 32.2, respectively. Improvement in outcome scores was more prominent in patients with Lafosse grade I and II SSC tendon tears repaired by singlerow technique and in patients with concomitant supraspinatus tendon repairs. The mean preoperativeinternal rotation strength according to theOxford scalewas 3.4 (±0.6) / 5 and raised to 4.7 (±0.4) / 5 at the final follow-up (P.001).Although concomitant biceps interventions significantly improved the outcome scores; this improvement was not clinically significant. Failure was only seen in 6 patients with high-grade (Lafosse III or IV) tears.Significant improvement in clinical outcomes and lower failure ratios were more prominent in patients with Lafosse grade I or II tears than grade III or IV. Concomitant biceps interventions made a positivecontribution to the clinical outcome. Early diagnosis and repair seem to be advantageous before low-grade SSC tendon tears turn into high-grade tears.Level IV, Therapeutic Study.

WOS:000565031500001 PubMed: 33569106 Introduction Paediatric elbow fractures constitute 10% of all paediatric fractures. Radiological interpretation of the immature elbow is difficult due to its cartilaginous structure. We aimed to describe an X-ray technique in paediatric patients to obtain true lateral elbow X-rays and to prevent the repeat X-ray shots. Materials and Methods Radiographs of 39 children, with a mean age of 48.17 months (range; 7-84 months), with elbow trauma were included. All elbow lateral radiographs were taken in the 90o flexion position. In the first group, radiographs were taken using the standard technique(lateral radiographs in shoulder internal rotation). In the second group, lateral radiographs of the elbow were taken while the patient was standing and the forearm was elevated passively with 90 degrees shoulder abduction and 90 degrees elbow flexion (standing salute position). Three criteria were examined from the graphs to determine the true lateral elbow graphy. Results In group 1 (n = 20) and group 2 (n = 19), lateral elbow radiographs were evaluated. No statistically significant differences were found between the groups, in terms of mean age and distal humeral fractures. In group 2; the presence of humeroulnar joint space, partial coronoid superposition of the radius head and presence of the hourglass formation were significantly higher. Discussion It is clear that radiographs taken in appropriate positions decreases diagnostic errors. In our study, the ratio of correct lateral radiographs was significantly higher in the radiograph group in the standing salute position, suggesting this method was safe for accurate lateral radiographs, in accordance with our hypothesis.

One of the factors affecting the healing of a meniscus repair is the primary stability of the tear. The purpose of this study is to compare single and double vertical loop (SVL vs. DVL) meniscal suture configurations by measuring elongation under cyclic loading and failure properties under ultimate load. We hypothesized that DVL configuration would have superior biomechanical properties than SVL. Twenty-two intact lateral menisci were harvested from patients who required total knee arthroplasty. A 20-mm longitudinal full-thickness cut was made 3 mm from the peripheral rim to simulate a longitudinal tear. Two groups were formed and group randomization was done according to patient age and gender (SVL group: mean age 68.3 years [range, 58–78 years], five males, six females; DVL group: mean age 67.4 years [range, 59–77 years], six males, five females). Cyclic loading was performed between 5 and 30 N at a frequency of 1 Hz for 500 cycles. Then, the meniscus repair construct was loaded until failure. Statistical analysis was performed using the t-test and the Mann–Whitney's U-test. During the early phases of cyclic loading, three specimens from each group failed because of suture pull out and are excluded from the study. At the end of 500 cycles, there was significantly less displacement in the DVL group than the SVL group (6.13 ± 1.04 vs. 9.3 ± 2.59 mm) (p 0.05). All specimens in SVL and five specimens in DVL groups failed in the form of suture pull out from the meniscus tissue. Longitudinal meniscal tears repaired with DVL configuration had less elongation value under cyclic loading compared with SVL configuration. Because of its superior biomechanical properties, it would be more secure to repair large and instable longitudinal meniscal tears by the DVL technique. This is a level II study.

Pain is a protective mechanism. Congenital insensitivity to pain syndrome is a very rare disease in which there is no ability to feel physical pain. It has been reported that it occurs with an incidence of 1 in 125 million newborn. Patients with congenital insensitivity to pain may have various orthopedic complications such as recurrent fractures, osteomyelitis and neuropathic joints. The most frequently affected body parts are lower extremities. Besides, curvature of spine can be seen. Injuries in epiphyseal points may cause incompatibility of extremity. Charcot joints may develop, which can lead to neuropathic arthropathy as a result of insensitivity to pain. Here, we present a patient with traumatic fracture-dislocation on left hip that neglected the treatment, had a bilateral femur fracture and then had septic arthritis of knee.

Amaç: Bu calışmada kliniğimizde kapalı reduksiyon pelvipedal alcı ile tedavi edilen hastaların reduksiyon sırasındaki yaşının kısa dönemde klinik ve radyolojik sonuclara etkisini tartışmayı amacladık. Yöntem: Nisan 2004-Aralık 2011 tarihleri arasında kapalı reduksiyon ve pelvipedal alçı uygulaması ile tedavi edilmiş GKD’li 81 hastanın 126 kalcası değerlendirildi. Tedaviye başlanıldığında 0-6 ay arasında olanlar grup 1.6-12 ay arasında olanlar grup 2, 12-18 ay arasında olanlar grup 3 ve 18 aydan büyük olanlar grup 4 olarak adlandırıldı. Gruplar kapalı reduksiyonun elde edilmesi, yeniden çıkık gelişimi, takiplerinde asetabuler displazi nedeni ile pelvik osteotomi uygulanması, son kontrollerindeki fizik muayene ve radyoloji bulguları dikkate alınarak Mc Kay sınıflandırma sistemi ve Tonnis’in tarifflediği asetabuler displazi acısından kendi aralarında karşılaştırıldı. Bulgular: Tedaviye başlanıldığında hastaların ortalama yaşları 11.5 ay ve ortalama takip suremiz 35.1 ay idi. Grup 1’de24 kalca (%19.1), grup 2’de43 kalca (%34.1), grup 3’de 28 kalca (%22.2) ve grup 4’de 31 kalca (%24.6) mevcuttu. Grup 1 ve 2’deki hastaların hepsinde kapalı reduksiyon elde edilirken, grup 3’de 2 kalcada (%5.6), grup 4’de ise 4 kalca-da (%12.9) kapalı reduksiyon elde edilemedi. Tum gruplarda birer hastada takiplerinde yeniden çıkık gelişti. Yeniden çıkık gelişme oranı gruplara göre sırası ile %4.1; %2.3; %3.5 ve %3.2 idi. Takiplerinde asetabuler displazinin devam etmesi nedeni ile grup 1’ de 1 (%4.1), grup 2’ de 4 (%9.3), grup 3’ de 2 (%7.1) ve grup 4’ de 6 kalçada (%19.3) pelvik osteotomi uygulandı. Mc Kay sınıflandırma sistemine göre grup 1’deki kalcaların 18’inde (%81.8) cok iyi, 4’unde (%18.2) iyi; grup 2’deki kalcaların 33’unde (%86.8) cok iyi, 5’inde (%13.2) iyi; grup 3’deki kalcaların 20’sinde (%87) cok iyi, 3’unde iyi (%13) ve grup 4’deki kalçaların 14’unde (%70) cok iyi, 3’unde (%15) iyi ve 3’unde (%15) orta sonuc mevcuttu. Tonnis’ in tarif ettiği asetabuler displazi derecelendirmesine göre 27 kalçada evre 4 displazi mevcuttu. Ciddi, evre 4 displazili kalça sayısı grup 1’de 2 (% 8.7); grup 2’de 5 (%11.9), grup 3’de 5 (%20) ve grup 4’de 15 (%57.7) idi. Tum hastalarda reduksiyon oncesine gore son kontroldeki grafilerde asetabular indeks acısından anlamlı fark mevcuttu (p < 0.001). Kapalı reduksiyon elde edilememe acısından grup 3 ve 4 diğer gruplardan anlamlı farklılık gösteriyordu (p=0.005). Klinik parametreler acısından yaşlar arasında istatiksel olarak anlamlı fark mevcuttu (p=0.039). Displazi acısından yaşlar arasında istatiksel olarak anlamlı fark mevcuttu (p=0.001). Çıkarımlar: Bir yaşından sonra tedaviye başlanılan kalcalarda calışmamızda kapalı reduksiyon elde edememe, asetabuler displazinin düzelmemesine bağlı pelvik osteotomi uygulanma oranı daha yüksek bulunmuştur. Daha iyi sonuclar elde edebilmek icin tedaviye erken dönemde başlanılmalı ve bir yaşın üzerinde tedaviye başlanılan hastalar asetabular displazinin varlığını sürdürmesi acısından yakından takip edilmelidir.

Introduction Total hip replacement in patients with developmental dysplasia of the hip (DDH) is a difficult technical procedure for surgeons to perform because of the potential for these patients to have severe anomalies in their bones and soft tissues. Materials and methods We performed acetabuloplasty in 54 hips from 44 patients by reaming the posterior wall of the native acetabulum and medialising the acetabular component to restore the anatomic centre of hip rotation using a small cup without bone grafting. Median time to post-surgery follow-up was 5 (range 2-14) years. Results Prosthetic survival rates in patients after 2 and 5 years post hip replacement were 93% (50/54) and 89% (48/54), respectively. 4 patients required early revision because of malposition and instability of the acetabular cup. 3 patients with Crowe type IV dislocations had transient sciatic nerve palsy and 3 had deep vein thrombosis. Conclusions Placement of the acetabular shell using posterior bone stock to provide normal hip rotation is a successful alternative technique for acetabuloplasty in patients with DDH.