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Objective: The aim of this study was to assess the effects of coracoid bone block (modified Latarjet) procedure on clinical and functional results in cases with glenoid bone defect accompanied with anterior shoulder instability., Methods: The study included 35 patients (average age: 35 years; range: 20 to 58 years) with glenoid bone defect and recurrent dislocations treated with the modified Latarjet procedure. There were 12 sports injuries, 5 post-epileptic cases and 18 recurrent anterior shoulder dislocation following non-sports-related injuries. Recurrence was reported in 7 patients formerly treated with the Bankart procedure. Average number of preoperative dislocations was 10.8 ± 6.5 and average time range between the first dislocation and surgery was 14.9 ± 13.2 months. All patients underwent preoperative diagnostic arthroscopy. Postoperative isometric exercises in braces were assigned for the first 6 weeks, followed by active strengthening exercises. Pre- and postoperative functional results were evaluated using the ASES (American Shoulder and Elbow Surgeons) and Rowe scores and pain using the VAS (Visual Analog Scale)., Results: Osseous union of coracoid graft was achieved in all patients. Average follow-up was 24 ± 12.2 (range: 12 to 74) months. No degenerative arthritis or continuing instability was detected in any of the patients. Average forward flexion was 165° ± 20° and external rotation 59° ± 13°. Mean preoperative ASES and Rowe scores of 49.6 ± 10.6 and 47.9 ± 21.5 increased postoperatively to 91.3 ± 11 and 89.1 ± 9.2, respectively. Mean VAS scores decreased significantly from 6.2 ± 2.4 to 1.8 ± 0.6 postoperatively (p<0.05)., Conclusion: Shoulder functionality and former activity levels can be successfully achieved in terms of increased patient satisfaction through use of the modified Latarjet surgery in the treatment of glenoid bone defect and anterior shoulder instability.

Acute mechanical symptoms due to excess retained cement in the posterior compartment of the knee joint following unicondylar knee arthroplasty (UKA) are uncommon. Infection, aseptic loosening, polyethylene wear and progressive arthritis are well-documented complications of UKA procedure. We present a patient with acute pain and 'clicking' sensation in the knee joint due to cement extrusion in the posteromedial compartment after UKA. Full functional recovery was achieved after arthroscopic removal of the cement debris. Of retrospectively screened 43 UKA cases, asymptomatic cement extrusion was detected in 8 patients in the posteromedial compartment on direct X-rays. Careful inspection of components is essential to minimize the risk of cement extrusion into the posterior compartment and perioperative fluoroscopy may be helpful during UKA procedure.

Objective: The aim of this study was to evaluate the short-term outcomes of metatarsal head metal resurfacing hemiarthroplasty in patients with advanced stage hallux rigidus., Methods: The study included 14 feet (4 left, 10 right) of 12 patients (10 female, 2 male; mean age: 63 ± 5; range: 55 to 71 years) who underwent metatarsal head metal resurfacing hemiarthroplasty (HemiCAP(®)) between 2007 and 2010. Additionally, capsular release and periarticular osteophyte debridement were performed. Staging was made according to Coughlin and Shurnas' clinical and radiological grading system. Hallux valgus and intermetatarsal angles were measured using pre and postoperative standing AP and lateral foot views. Clinical assessment was made with first metatarsophalangeal joint range of motion, the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale and satisfaction level., Results: Mean follow up was 19.5 (range: 14 to 26) months. Two patients had bilateral involvement. According to Coughlin and Shurnas' clinical and radiological grading system, nine feet were Stage 3 and five feet were Stage 4. According to the AOFAS scale, results of eight feet (57.1%) were excellent, four feet (28.6%) were good and two feet (14.3%) were moderate. Mean total AOFAS score increased by 26.2 points postoperatively (p<0.05). Mean range of motion of the first metatarsophalangeal joint improved significantly from a preoperative 22.2 ± 5.6 (range: 10 to 28) degrees to a postoperative 56.3 ± 9.6 degrees (p<0.05). Mean hallux valgus angle decreased from a preoperative 14.3 (range: 9 to 17) degrees to a postoperative 11.1 (range: 4 to 13) degrees and the mean intermetatarsal angle increased from a preoperative 10.5 (range: 8 to 14) degrees to a postoperative 10.8 (range: 8 to 15) degrees. Patient satisfaction levels were very good in 10 feet (71.4%), good in 3 (21.4%), and moderate in one (7.2%). Complications included metatarsalgia aggravated by long walks in one patient and hypoesthesia of the great toe in three patients. Push-off power of the great toes was measured as 4/5 in three cases, and 5/5 in others., Conclusion: Metatarsal head metal resurfacing hemiarthroplasty provides high patient satisfaction level and good functional outcome in the short-term, in the surgical treatment of advanced stage hallux rigidus refractory to conservative treatment options.

Background: Patients with obstetrical brachial plexus palsy (OBPP) sequela exhibit adduction and internal rotation contractures. The muscular imbalance may result in secondary bony changes. Tendon transfers and muscular releases may improve shoulder function in these patients. The aim of this study is to evaluate the functional and radiological results of pectoralis major tendon Z-plasty with transfer of latissimus dorsi and teres major tendons to rotator cuff tendons without release of subscapularis muscle in patients with mild sequela of OBPP., Materials and Methods: Twenty-six consecutive patients, who were treated with tendon transfer and met the eligibility criteria, were included in the study. No additional humeral osteotomy or subscapularis tenotomy was performed. Functional evaluation is made according to range of motion and Mallet scoring system. Preoperative radiologic evaluation was made according to the grading system of Waters., Results: A significant increase in shoulder function was found in all patients. Postoperative radiographs revealed glenohumeral congruity was maintained in all patients. Improvement in shoulder abduction and external rotation was higher in patients who were operated before the age of 7., Discussion/conclusion: Pectoralis major tendon lengthening with transfer of latissimus dorsi and teres major tendons to rotator cuff is an effective and reproducible technique and can improve shoulder functions in patients with OBPP. Subscapularis release is not always required to overcome internal rotation contracture. Secondary glenohumeral changes might also be prevented with this approach., (Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Bilateral traumatic hip dislocation is rarely seen. A patient who presented with simultaneous dislocation of both hips in opposite directions is presented in this case report. A 42-year-old female patient who was injured in a motor vehicle accident as a passenger was brought to the emergency department and was diagnosed with posterior fracture dislocation of the right hip and anterior dislocation of the left hip. Both hips were reduced under general anaesthesia by closed manipulation, and reduction was confirmed with computerized tomography. No skeletal or skin traction was applied. Hip range of motion exercises were begun immediately. The patient was mobilized at the end of the sixth week and returned to daily activities without any complaint at the end of 16th week.

Objectives: In external fixation, the type and configuration of K-wires have a considerable effect on fixation stability. Indications for external fixation have recently increased in the treatment of various musculoskeletal pathologies in osteoporotic patients. This biomechanical study was designed to determine the effect of surgical washers used with olive wires on surface kinetics of the cortical bone., Methods: The study included 32 tibiae obtained from one-year-old sheep. Samples were prepared from the proximal parts of the tibiae which were then divided into four groups equal in number. A 1.8-mm olive K-wire was inserted into the proximal metaphyseal regions of the tibiae. Except for the control group, surgical washers were used with olive K-wires in the three study groups, with diameters of 5 mm, 7 mm, and 10 mm, respectively. The samples were then placed in a specially designed servo-hydraulic universal testing machine for static tensile test at 10 mm/min., Results: The mean failure load was 806.9 N in the control group, compared to 1285.9 N, 1317.9 N, and 1345.9 N in the three groups in which 5-mm, 7-mm, and 10-mm surgical washers were used, respectively. While there were significant differences between the control and study groups (p<0.0001), failure loads did not differ significantly between the three study groups (p=0.574)., Conclusion: The use of surgical washers in combination with olive K-wires offers a significant advantage to increase stability and to decrease surface pressure. We recommend utilization of washers for external fixation surgery in osteoporotic patients and osteoporotic bone segments.

Objectives: We evaluated pediatric patients who underwent surgery for Langerhans cell histiocytosis with mono- or polyostatic involvement and an extensive soft tissue component and/or a high risk for pathologic fractures., Methods: The study included 13 children (6 boys, 7 girls; mean age 6 years; range 2 to 11 years) who were treated surgically for bone and soft tissue involvement of Langerhans cell histiocytosis with a high risk for fractures of the long bones and the pelvis. Eleven patients had only skeletal involvement while three patients had multisystem involvement. There were 17 bone lesions in the following localizations: acetabulum (n=7), femur neck and subtrochanteric region-proximal femur (n=5), and proximal (n=2) and distal (n=2) humerus. One patient had multifocal bone involvement. The risk for pathologic fractures was assessed using the scoring system of Mirels. Treatment consisted of surgery followed by chemotherapy. The results of treatment were evaluated according to the criteria by the Study Group of Langerhans Cell Histiocytosis. The mean follow-up after orthopedic surgery was 67 months (range 34 to 172 months)., Results: Only one patient developed recurrence, in which case bone marrow involvement responded well to chemotherapy. Radiographically, graft consolidation was observed in all the patients in the third postoperative month. No bone sequelae such as shortness and deformity were detected throughout the follow-up period., Conclusion: Surgical treatment combined with chemotherapy is effective in the treatment of aggressive histiocytic bone lesions associated with extensive soft tissue involvement and high risk for fractures.