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Purpose Treatment is easier and complications are less likely to occur if developmental dysplasia of the hip (DDH) is diagnosed early. In this study, we examined the early results of open reduction using a medial approach which we had modified for DDH and analyzed the success of this technique and the associated complication rates, with a focus on avascular necrosis (AVN). Methods This is an Institutional Review Board-approved retrospective review of all patients diagnosed with DDH and treated with a modified medial approach at a single institution from July 1999 to December 2010. The patients’ charts were analyzed for clinical and radiographic features. Results Fifty-five hips of 41 patients, all of whom were treated by open reduction using a modified medial approach due to DDH, were evaluated retrospectively. The mean age of the patients at surgery was 19 (range 11–28) months, and the average follow-up was 5.5 (range 3–9.5) years. AVN was the most important complication in terms of radiological outcomes as assessed according to the Kalamchi–McEwen classification. Radiologic results were excellent or good in 51 hips (92.7 %) and fair–plus in four (7.3 %). Type 1 temporary AVN was detected in only two hips (3.6 %), and the lesions had disappeared completely in the final control graphs of these two patients. A secondary intervention was needed for two hips (3.6 %) of the same patients who were operated on due to bilateral DDH. No other complications, such as infection, re-dislocation, or subluxation, were seen in the operated patients. Conclusions We believe that treatment for DDH using a modified medial approach during early childhood is an effective and reliable method with low AVN rates. As shown here, this method achieves great success in radiological and clinical outcomes after a minimum 3-year follow-up.

Background:There are limited cases of humerus medial condyle fracture in the literature treated by open reduction and percutaneous pinning. This study presents cases treated by open reduction and percutaneous pinning and discussed the problems reported in the literature.Methods: Nine cases were treated by open reduction and percutaneous pinning between 2006-2014. These cases were followed for nonunion, avascular necrosis, range of motion, nerve lesion and infection for 15.3 months (range 11 to 18 months).Results:No non-union, avascular necrosis, iatrogenic nerve lesion or infection developed in our cases. All patients gained full range of motion.Conclusions:This study presents that surgical technique and early timing of surgery prevents the complications.

Tibial pilon fractures usually result from high energy trauma and present as a challenge to the orthopedic surgeon. Accurate reduction of the joint with meticulous care for the surrounding soft tissues is mandatory. We present a case report in which an anterior cruciate ligament targeting device is used with a minimally invasive technique under arthroscopic and fluoroscopic guidance for Orthopaedic Trauma Association 43-B2.3 type pilon fracture treatment.

Objectives: The aim of this prospective study was to evaluate the results of anatomical frame plate osteosynthesis in patients with Ada and Miller Type 2 or 4 scapula fractures. Methods: Eleven Ada and Miller Type 2 or 4 scapula fractures in nine patients were treated with anatomical frame plate osteosynthesis. The mean follow-up time was 39.8 (12–77) months. The results were evaluated using the Herscovici score. Results: No complications, such as neurovascular injury, postoperative hematoma, infection, delayed wound healing, implant failure, delayed union, or nonunion occurred. Based on the Herscovici score, the results were excellent. Conclusion: Osteosynthesis with anatomical frame plates appears to be a safe method that allows early range of motion and that provides excellent results in Ada and Miller Type 2 or 4 scapula fractures.

SUMMARY Renal osteodystrophy (ROD) is the skeletal complication of chronic kidney disease. Secondary hyperparathyroidism and 125 dihydroxy vitamin D3 deficiency are the major causative factors in ROD. Musculoskeletal problems remain among the main limitations of the quality of life of renal failure patients. In this report, a 60-year-old male with four extremity fractures due to a minor trauma was presented. The patient had been receiving haemodialysis for seven years due to hypertensive nephropathy. Our case emphasises the importance of multispecialty approach to the investigation and treatment of patients with ROD.

Simultaneous quadruple extremity fractures are rare and can be termed as “floating body” injury. A review of the literature produced only one previous report of this rare combination which could not be operated. We presented a 40-year-old female patient with bilateral humerus and femur fractures associated concomitant injuries such as nondisplaced acetabular fracture, rib fractures and traumatic tendon ruptures. She was operated by arthroscopically assisted retrograde intramedullary nailing for femur fractures as well as by external fixators for humerus fractures. She was able to walk with full weight-bearing without any assistance at the end of the first postoperative year. Early fixation of the fractures in floating body injury using retrograde intramedullary nailing and external fixator is successful treatment method.

Cushing’s disease, or endogenous hypercortisolism, is an endocrine disorder caused by high levels of cortisol in the blood from a variety of causes; and it may be associated with nontraumatic osteonecrosis of the hip joint. There are several reports about this rare combination in the literature in which it was concluded that osteonecrosis may appear as a rare presenting manifestation of Cushing’s disease. However it may also be a late sequela of this endocrine disorder. There are various treatment options for hip osteonecrosis, including core decompression, vascularized or nonvascularized bone grafting, rotational osteotomy, limited resurfacing of the femoral head, and total hip arthroplasty. The choice of treatment option depends on the patient’s age, the cause of osteonecrosis, the extent of femoral head involvement, and the condition of the acetabular articular cartilage. The results of total hip replacement and hemiarthroplasty have generally been poor. Therefore, many authors prefer to delay or eliminate the need for hip replacement by treating osteonecrosis with bone-preserving procedures. Bone grafting of the femoral head through a so-called trapdoor in the articular cartilage and subchondral bone has been used to treat late-stage hip osteonecrosis secondary to various etiologies. However there is no information in these reports about the results of this procedure for the treatment of hip osteonecrosis secondary to endogenous hypercortisolism. We present a patient who was operated on with bone-preserving procedures for bilateral osteonecrosis of the femoral heads that had developed secondary to Cushing’s disease. Case report

Rhabdomyolysis following pneumotic tourniquet use is an extremely rare complication. In this case report, we aimed to present an unusual tourniquet complication following proximal tibial osteotomy. A 55-year-old female patient was operated on for genu varum in our clinic. Postoperatively, an anuria developed, and liver and kidney function test levels increased. The patient was diagnosed with acute rhabdomyolysis, and an aggressive treatment was begun., Bu çalışmada; proksimal tibia osteotomi cerrahisi sonrasında karşılaşılan olağan dışı bir turnike komplikasyonunu sunmayı amaçladık. Elli beş yaşındaki kadın hasta genu varum nedeniyle kliniğimizde ameliyat edildi. Ameliyat sonrası dönemde anüri gelişti. Böbrek ve karaciğer fonksiyon test değerlerinde yükselme gözlendi. Akut rabdomiyoliz tanısı konularak agresif tedavi başlandı

Hoffa fracture associated with ipsilateral femoral shaft fractures is a rare clinical entity. We present a previously unreported multi-trauma case with a unique fracture combination of ipsilateral Hoffa, tibial eminence, femoral shaft and Malgaigne fractures. The Malgaigne fracture was treated non-operatively while the other three fractures were operated with arthroscopic and assisted techniques. Despite the use of minimally invasive techniques, the patient experienced postoperative soft tissue problems. In follow-up, all fractures healed with a good functional outcome. The application of a minimally invasive technique in such a high-energy trauma is crucial for prevention of soft tissue complications., Hoffa kırıklarının femur şaft kırıkları ile birlikte izlenmesi nadir bir klinik tablodur. Bu sunumda, aynı tarafta Hoffa, tibial eminens, femoral şaft ve Malgaigne kırıklarının birlikte izlendiği, literatürde bildirilmemiş nadir bir çoklu travma olgusu sunulmaktadır. Konservatif olarak tedavi edilen Malgaigne kırığı dışında kalan üç farklı kırık artroskopi destekli teknikler kullanılarak tedavi edilmiştir. Minimal invaziv tekniklerin kullanılmasına karşın, olguda yumuşak doku problemleri ile karşılaşılmış, takiplerde tüm kırıklar iyi fonksiyonel sonuçlar ile iyileşmiştir. Yüksek enerjili benzer travma olgularında minimal invaziv tekniklerin uygulanması yumuşak doku komplikasyonlarının engellenmesi açısından büyük önem taşımaktadır.

Objective: The aim of this study was to determine whether or not there is an association between attention deficit and hyperactivity disorder (ADHD) and Perthes disease.Methods: The study included 3 groups of patients: Perthes patients, trauma patients, and orthopedic patients without Perthes disease or history of trauma. Each group was comprised of 56 males and 4 females. Patients were evaluated for present or past diseases, exposure to second-hand smoke, the age at which they had begun to walk, history of trauma prior to Perthes diagnosis in the Perthes group, weight, height and body mass index (BMI). Eighteen questions on the DSM-4 (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition) ADHD checklist was used in the psychiatric evaluation of patients. The rate of ADHD was compared between groups.Results: Attention deficit and hyperactivity disorder was diagnosed in 7 patients in the Perthes group, 3 in the trauma group, and 3 in the non-trauma group; and this difference was not significant (p=0.160).Conclusion: There were no significant differences in the rate of ADHD between trauma and non-trauma groups of Perthes patients, which suggests no association between ADHD and Perthes disease., Amaç: Bu çalışmanın amacı dikkat eksikliği ve hiperaktivite bozukluğu (DEHB) ile Perthes hastalığı ile arasında bir ilişki olup olmadığının belirlenmesi idi.Çalışma planı: Hastalar 3 gruba ayrıldı. Birinci grup Perthes hastalarından, ikinci grup travma hastalarından ve üçüncü grup travması veya Perthes hastalığı olmayan ortopedi hastalarından oluşmaktaydı. Her grupta 56 erkek ve 4 kız yer almaktaydı. Hastalar mevcut ya da geçmiş hastalıkları, pasif sigara içiciliği, yürümeye başladıkları yaş, Perthes hastaları grubunda Perthes tanısı öncesi travma öyküsü, ağırlık, boy ve vücut kitle indeksi (VKİ) gibi faktörler ele alınarak değerlendirildiler. Hastaların psikiyatrik durum değerlendirmesinde DEHB için DSM-4 (Diagnostic and Statistical Manual of Mental Disorders - Dördüncü Baskı) kriterlerinde yer alan 18 soruluk listeden yararlanıldı. Elde edilen DEHB oranları gruplar arasında karşılaştırıldı.Bulgular: Perthes hastalarının 7’si, travma geçiren hastaların 3’ü ve travma geçirmeyen hastalarının 3’ünde DEHB saptanırken, gruplar arasındaki fark anlamlı bulunmadı (p=0.160).Çıkarımlar: Çalışmamıza göre travma geçiren ve geçirmeyen Perthes hastalarında DEHB görülme insidansı arasında anlamlı bir fark olmaması, DEHB ile Perthes hastalığı arasında bir ilişki olmadığını göstermektedir.

Chronic old unreduced anterior dislocations are extremely rare. We report a case of 75-year-old lady who was seen in policlinic with the symptoms of severe pain and limited shoulder range of motion in which radiographies revealed anteroinferior missed shoulder dislocation. Open reduction with Bankart repair was done, and patient was able to return her daily activities 6 weeks after the operation. To us, if the shoulder was found to be instable after reduction, anteroinferior glenohumeral ligament tear should be looked for, and if it exists should be repaired.

Objective: To report a case of bilateral secondary coxarthrosis in a patient with a history of pelvic irradiation for sarcoma botryoides. Clinical Presentation and Intervention: The patient had surgery and radiation therapy for sarcoma botryoides when she was 18 months old. Left and right cementless total hip arthroplasties were performed at the age of 36 and 40 years, respectively. Harris hip scores improved from 28.4 to 93 on the left hip after 84 months of follow-up and from 29.5 to 91.3 on the right hip after 38 months of follow-up. Conclusion: Cementless total hip arthroplasty may be considered for irradiated hips, if radiation damage in bone has been stable for a long period of time.

Osteoid osteomas are well-known benign tumors, seen generally in long bones. When seen in phalanxes or toes, they can cause a diagnostic dilemma. A young male presented to us with complaints of enlargement of the great toe and severe pain. He had had an ingrown toe-nail operation before, and this situation caused a diagnostic dilemma. In this case report, we emphasize that osteoid osteomas can cause diagnostic dilemmas and it should be kept in mind as a differential diagnosis.

Aims: The aim of our study was to compare the effects of suprascapular nerve block in patients with frozen shoulder and diabetes mellitus unresponsive to intraarticular steroid injections. Settings and Design: Ten patients without improvement of sign and symptoms after intraarticular injections were made a suprascapular nerve block. Methods: Pain levels and active range of movement of patients were recorded at initial attendance and after 1, 4, and 12 weeks. All patients′ simple pain scores, total pain scores, and range of motion of their shoulders were improved significantly after suprascapular nerve block. Statistical Analysis: In this study, the statistical analyses were performed by using the SPSS 8.0 program (SPSS Software, SPSS Inc., USA). To compare pre- and post-injection results of simple pain score, total pain score, shoulder abduction and external rotation, Wilcoxon test was used. Results: Patient′s simple pain scores, total pain scores also abduction, external rotation and internal rotation angles were improved significantly after suprascapular nerve block. Conclusion: Effective results after suprascapular nerve blockage was obtained for the treatment of refractory frozen shoulder cases.

The aim of this study is to compare distal tibial fractures (4–10 cm proximal to the plafond) treated by intramedullary nailing with those treated by percutaneous locked plating and to assess the clinical and radiographic results, complication rates, and the need for secondary procedures. Thirty-six patients received percutaneous locked plate treatment and 25 patients received intramedullary nail treatment. The results obtained from these two treatment methods were assessed by comparing infection rates, starting time for wight-bearing, local implant irritation, union and malunion rates and along with secondary procedures. In the percutaneous locked plate group, two deep infections, four superficial infections, two nonunions, one malunion and 10 local implant irritations were observed. In the intramedullary nail group, one nonunion, four malunions and two local implant irritations were observed. The incidence of deep and superficial infections, local implant irritations and secondary procedures in the percutaneous locked plate group was greater than those in the intramedullary nail group. The time to full weight bearing was shorter in the intramedullary nail group. There was no significant statistical difference in malunion and nonunion rates between the two groups. The need for secondary procedures was more common in group receiving the percutaneous locked plate treatment and the time to full weight bearing was shorter in the intramedullary nail group.

Hyperlipidemia is a major risk factor for coronary heart disease. The most commonly used antihyperlipidemic drugs are 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins), of which atorvastatin is one of the most widely used. Little is known about the relationship between tendinopathy and HMG CoA reductase inhibitors (statins) or the effects of atorvastatin use on tendon healing following surgical repair of tendon rupture. We hypothesized that atorvastatin negatively affects this healing process. The Achilles tendons of 16 New Zealand rabbits were ruptured surgically and repaired with sutures. Eight of the rabbits were given oral atorvastatin. The other 8 served as a surgical control group. Six weeks postoperatively, all the rabbits were sacrificed, and the repaired tendons were removed. After standard histological preparation, fibroblastic activity, revascularization, collagenization, collagen construction, and inflammatory-cell infiltration were evaluated. On comparing the atorvastatin and surgical control groups, we observed no difference in fibroblastic activity. Although it did not reach statistical significance in our study, a difference was noted in revascularization, collagenization, and inflammatory cell infiltration; and a statistical difference was observed in collagen construction. Doubt remains about the adverse effect of atorvastatin use during tendon healing. Further investigations in animal and human models are needed on the effects of tendon healing when atorvastatin is administered for a longer time frame prior to the injury.

The patellar tendon length changes and patella infera occurs in medial open wedge osteotomies. We hypothesized that patellar tendon length in the sagittal plane would not change in a proximal medial tibial biplanar retrotubercle open wedge osteotomy. Proximal medial tibial biplanar retrotubercle open wedge osteotomies were conducted on 23 knees of 22 patients; the mean patient age was 59 ± 7 years (range, 53-69 years). The surgical procedure used had some technical distinctions from those used in literature. The mean follow-up was 37 ± 11 months (range, 19-58 months). Preoperative and postoperative Hospital for Special Surgery Scoring System (HSS) scores, radiological tibial slope, Insall-Salvati, Blackburne-Peel, and Caton indices, femoro-tibial anatomical axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axis were measured and compared statistically. Postoperative HSS scores were statistically higher than the preoperative HSS scores. The femoro-tibial axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axes decreased significantly. No statistical difference was observed between the preoperative and postoperative Insall-Salvati, Blackburne-Peel, or Caton indices. When we performed proximal medial tibial biplanar retrotubercle open wedge osteotomy, clinical and radiological recovery was observed but patellar height did not change.

A 17-year-old man fell from a height of 10 m onto his right forefoot and sustained ipsilateral calcaneal, comminuted cuboid, and second, third, and fourth metatarsal neck fractures and first metatarsophalangeal joint open dislocation. This report discusses this rare injury. The authors believe that initial debridement with immediate surgical fixation and reduction with appropriate antibiotic treatment saved the patient’s extremity.

Hip arthroscopy was first described in 1931 by Burman, and in recent years the applications have extended to labral surgery, osteochondroplasty, and a variety of other procedures. Hip arthroscopy may also be employed to extract loose or foreign bodies from the hip, and may be associated with more rapid recovery than an open procedure. We present a case of arthroscopic bullet removal from the hip in a 24-year-old man.

Background The aim of the study was to determine whether osteomyelitis of the femur or septic arthritis of the knee develops after retrograde intramedullary nailing of the femur performed within 7 days of supracondylar femur fracture, secondary to gunshot wounds, without skin defects. Methods Fifteen patients with a mean age of 27.8 years (range, 18-52 years), with supracondylar fractures of the femur due to gunshot wounds and without skin defects. Retrograde intramedullary nails were inserted through the intercondylar notch of the femur. We evaluated whether osteomyelitis of the femur or ipsilateral septic arthritis of the knee joint developed postoperatively. Results None of the patients who were followed up for a mean period of 11.7 months (range, 9-16 months) showed evidence of ipsilateral septic arthritis of the knee or osteomyelitis of the femur. Conclusion Retrograde intramedullary nailing of the femur can be performed in patients with supracondylar fractures of the femur due to gunshot wounds, and without skin defects, in the first 7 days after the trauma. Neither osteomyelitis of the femur nor septic arthritis of the knee develops in these patients.

In radius neck fractures, reduction manipulations applied on the radial head with percutaneous K-wires may lead to epiphysis or physis damage. In this study, 16 cases were evaluated without using any percutaneous manipulations upon the displaced radius head. Rather, an Ender-pin-like, curve-tipped K-wire was inserted intramedullarly (Metaizeau technique) after a certain amount of reduction by manual manipulation under fluoroscopic guidance. Complete reduction was obtained with wire rotations in 16 patients. A total of 16 patients with open growth plates with an average age of 8 years were enrolled within the scope of the study. Thirteen patients (81.25%) showed excellent clinical results, two patients (12.5%) showed good results, and one patient (6.25%) showed average results. None of the cases exhibited poor results. A single K-wire was used in nine cases, whereas two K-wires were used for fixation rigidity in seven cases with larger medullas. No sign of neurovascular deficit, synostosis, or infection was observed in any of the cases. In conclusion, the use of two wires in patients with larger medullas and emphasis on the importance of closed reduction, even without percutaneous K-wire manipulation, might lead to the development of a new treatment approach for pediatric patients with radial head fractures. © 2010 Wolters Kluwer Health | Lippincott.

WOS:000274542500004 PubMed: 20170854 Background: Tip-apex distance greater than 25 mm is accepted as a strong predictor of screw cut-out in patients with intertrochanteric femoral fracture treated by dynamic hip screw. The aim of this retrospective study was to evaluate the position of the screw in the femoral head and its effect on cut-out failure especially in patients with inconvenient tip-apex distance. Patients and methods: Sixty-five patients (42 males, 23 females; mean age of 57.6 years) operated by dynamic hip screw for intertrochanteric femoral fractures were divided in two groups taking into consideration the tip-apex distance less (Group A; 14 patients) or more (Group B; 51 patients) than 25 mm. Patient's age and gender, follow-up period, fracture type, degree of osteoporosis, reduction quality of the fracture, position of the screw in the femoral head, number of patients with cut-out failure and Harris hip score were compared. Results: The average follow-up time was 41.7 months. The mean tip-apex distance was 17.14 mm in Group A and 36.67 mm in Group B. One (7.1%) patient in Group A and three (5.8%) patients in Group B had screw cut-out. Except the screw position, no statistical differences were observed between two groups with regards to study data's. The screw was placed in femoral head more inferiorly (p = 0.045) on frontal and more posteriorly (p = 0.013) on sagital planes in Group B, while central placement of the screw was present in Group A. The common characteristic of three patients with screw cut-out in Group B was the position of the screw which was located in femoral head more superiorly and anteriorly after an acceptable fracture reduction. Conclusions: Peripheral placement of the screw in femoral head increases tip-apex distance. However, posterior and inferior locations may help to support posteromedial cortex and calcar femoral in unstable intertrochanteric fractures and reduce the risk of cut-out failure. Level of evidence: Level IV, retrospective series. (C) 2009 Elsevier Masson SAS. All rights reserved.

Osteoid osteoma of the scapula is a rare benign lesion. This is a case report of a subchondral osteoid osteoma that involved the anterior rim of glenoid. Surgical approach in this atypical area may seem difficult. The excision of the lesion and grafting was performed by a deltopectoral approach. One year after the surgery, the patient remains pain free and has full range of motion with no recurrence of the tumour.

Posterior dislocation of the shoulder is a rare clinical entity with incidence of 6 per 1,000,000. It is more common in middle-aged men [1] and more than half of all cases may initially be missed [2]. Posterior shoulder dislocation is related to internal rotation, flexion, and abduction forcing of the shoulder secondary to grand mal seizure, electric shock, or trauma [3]. One case of posterior dislocation secondary to a seizure caused by a brain tumor has been reported [4]. Bilateral anterior dislocation because of hypoglycemic coma is very rare [5], and, to our knowledge, no case reports of bilateral posterior shoulder dislocation owing to hypoglycemic coma have been published.

Introduction Congenital peripheral constriction ring originating from soft tissues of the leg that is characterized with compression in the soft tissue usually involving the deep fascia surrounding the leg at the time of birth is occasionally observed in lower extremity. At the region of the constriction, fractures of tibia and fibula and foot deformities like clubfoot can be observed. Case presentation In our report, 6-month and 8-month old infants with congenital constriction band and ipsilateral clubfoot were presented. They were treated with multiple Z plasties for their constricting bands and Ponseti method of serial casting for their clubfoot deformities. Conclusion Congenital-constricting bands can be effectively released with multiple Z plasties. Ponseti method of correcting club foots of various causes can be applied to club foot deformities accompanying constricting bands.

Introduction Clay-shoveler's fracture is a rare cervicodorsal spinous process fracture and there is little information regarding the prognosis of patients with this condition in conjunction with osteoporosis and corticosteroid use. Case presentation A 39-year-old man was admitted to our institution with a 6-month history of cervicodorsal pain prior to admission. The patient had previously undergone renal transplantation and was on corticosteroids, and had developed osteoporosis. We treated him with a cervical collar, non-steroidal anti-inflammatory agents and alendronate. The patient was advised against performing weight-bearing activities for 6 months. Conclusion Clay-shoveler's fracture with osteoporosis and corticosteroid use presented by fracture of the cervicodorsal aspect of the spinous processes may be successfully treated with a collar, alendronate and long-term rest.

Introduction Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Case presentation A patient with bilateral comminuted, displaced distal fractures of the radius and bilateral fractures of the scaphoid was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating. Conclusion Rigid internal fixation of distal radius and scaphoid fractures is mandatory to start early active rehabilitation of the wrist without the need for wrist immobilization with a plaster or external skeletal fixation.

Objectives: We evaluated the results of the Grice subtalar extra-articular arthrodesis for pes planovalgus deformity in patients with cerebral palsy and its effectiveness in providing hindfoot alignment. Methods: Grice subtalar extra-articular arthrodesis was performed for pes planovalgus deformity in 14 feet of nine patients (5 males, 4 females; mean age 10.3 years; range 6 to 12 years) with cerebral palsy. Six patients were diplegic, two patients were paraplegic, and one patient was hemiplegic. Four patients had unilateral, five patients had bilateral involvement. A fibular graft taken from the distal third of the fibula above the syndesmosis was used in all the patients without any fixation material. The patients were assessed with the AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot scoring system pre- and postoperatively. The mean follow-up was 30 months (range 6 to 81 months). Results: Compared with the preoperative values, the mean AOFAS hindfoot score increased from 53 (range 41 to 81) to 68.4 (range 51 to 96), the mean talocalcaneal angle decreased from 52.6° (38°-60°) to 30.4°, and from 55.8° to 35.9° in frontal and sagittal planes, respectively (p

The expectations of both the patient and surgeon have been greatly revised in the last 10 years with the introduction of pedicle screws (PS) in spinal surgery. In this study, we have retrospectively evaluated and compared the results of PS instrumentation and the Hybrid System (HS), the latter consists of pedicle screws, sublaminar wire and hooks. The mean follow-up period was 60.1 months (range: 49–94 months) for the patients of the HS group and 29.3 months (range: 24–35 months) for those of the PS group. In the HS group, pedicle screws were used at the thoracolumbar junction and lumbar vertebra, the bilateral pediculotransverse claw hook configuration was used at the cranial end of the instrumentation, sublaminar wire was used on the concave side of the apical region and the compressive hook was used on the convex side. In the PS group, PS were used on the concave sides at all levels and on the convex side of the cranial and caudal end of instrumentation, in the transition zone and at the apex. The two groups were comparable for variables such as mean age, preoperative Cobb angle, thoracic kyphosis angle, lordosis angle, coronal balance, flexibility of the curve, apical vertebra rotation (AVR), apical vertebra rotation (AVT) and the number of vertebrae included in the fusion (p > 0.05). The parameters of values of correction, ratio of correction loss, AV derotation, AVT correction ratio, amount of blood loss, operation time, postoperative global coronal and sagittal balance, thoracic kyphosis angle and lumbar lordosis angle were measured at the last follow-up and used for comparing the HS and PS groups. There was no statistically significant difference between the groups for correction ratio, postoperative coronal balance, postoperative thoracic kyphosis and lumbar lordosis angle, operation time, amount of blood loss and number of fixation points (p > 0.05) The difference for the ratio of correction loss, AV derotation angle and the AVT correction ratio at the last follow-up visit and for the total follow-up period between the groups was found to be statistically significant (p 0.05) between the groups in terms of correction rate, postoperative coronal and sagittal balance, operation time, blood loss and number of fixation points. This may indicate that anchor points are more important than the use – or not – of screws. Correction durability and AV de-rotation was better with PS instrumentation, while AVT was better corrected by HS instrumentation (p

Pseudoaneurysms of the profunda femoris artery have been reported following different types of trauma and from orthopedic procedures performed in the proximal femur. Two cases of profunda femoris artery pseudoaneurysm with two rare causes are presented. The first one is a core decompression of femoral head for osteonecrosis and the second one is a proximal femur fracture nailing. Awareness and careful follow-up are the key issues for the early diagnosis.

Introduction Pyomyositis is a disease in which an abscess is formed deep within large striated muscles. Case presentation We report the case of a 10-year-old boy who presented with fever and a painful hip and was subsequently diagnosed with pyomyositis of the tensor fascia lata. In children with clinical and laboratory findings of inflammation in the vicinity of the hip joint, the differential diagnosis includes transient synovitis, an early stage of Legg-Calvé-Perthes disease, infectious arthritis of the hip, rheumatologic diseases and extracapsular infection such as osteomyelitis. Conclusion To the best of the authors' knowledge, this is the first report of pyomyositis of the tensor fascia lata. Although pyomyositis is a rare disease and the differential diagnosis includes a variety of other commonly observed diseases, pyomyositis should be considered in cases where children present with fever, leukocytosis and localized pain.