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Objectives: the aim of this study was to translate, cross-culturally adapt the patient-based Constant-Murley Score (p-CMS), assess its validity, reliability, and compare it with the clinician-based CMS (c-CMS). Patients and methods: this cross-sectional study included a total of 51 shoulders of 46 patients (22 males, 24 females; mean age: 49 +/- 10 years; range, 29 to 70 years) with shoulder pain between December 2015 and July 2016. After translation of p-CMS, each participant was asked to complete the final Turkish version of the p-CMS. The c-CMS was assessed by a physiatrist who was blinded to the p-CMS. Retest of the p-CMS was performed in patients (n=15) who did not receive any treatment between two visits (Days 3 to 5). Results: a total of 51 shoulders (n=5 bilateral shoulder pain) were tested. Strength, subjective, objective, and total scores were significantly different between the p-CMS and c-CMS (p, NA

Bu araştırma, kaynak sebepli olabilecek distorsiyonları tahmin etmek için sayısal bir simülasyon ile bunun deneysel doğrulamasını sunmaktadır. 3mm, 5mm ve 8mm kalınlığındaki S355J2G3 yapı çeliğinden üç deneysel numune test edilmiştir. Simülasyon, SYSWELD programında yer alan gaz metal ark kaynağı (GMAW) ile tasarlanmış olup, ısı kaynağı Goldak’ın çift elipsoidal dağılımı ile modellenmiş ve hesaplamalarda doğrusal olmayan ısı transferi analizi kullanılmıştır. Sonuçları doğrulamak içinse tek köşe kaynaklı T-bağlantılarında meydana gelen bozulmaları analiz etmek üzere bir deney düzeneği kurulmuştur. Bu çalışmada, artık gerilmeleri ve açısal bozulmaları değerlendirmek için sonlu elemanlar (FE) yöntemi kullandı. Kesitlerdeki penetrasyon derinliğini, kaynak sonrası oluşan açısal bozulmaları, sıcaklık dağılımını ve artık gerilmeleri değerlendirmek için bir dizi FE simülasyonu ve ilgili deneyler gerçekleştirilmiştir. Deney sonuçları, kaynak işlemi henüz yapılmadan simülasyonlar yoluyla prosesin kontrol edilmesinin hem bozulmaları en aza indirmeye hem de maliyetli tasarım hatalarını azaltarak kaynak performansının artırılabileceğini göstermiştir., This research presents a numerical simulation for predicting welding induced distortion with an experimental validation. Three experimental specimens of S355J2G3 structural steel with thicknesses of 3mm, 5mm and 8mm have been used as test cases. In order to validate the results an experiment was set up to gain detailed information about distortions occurring in single fillet welded T-joints. The non-linear heat transfer analysis is used and heat source is modeled with the Goldak’s double ellipsoidal distribution by using SYSWELD in the gas metal arc welding (GMAW) process. This study employs the finite element (FE) method to evaluate residual stresses and angular distortions. A series of FE simulations and corresponding experiments are performed to evaluate the depth of penetration in the cross sections, angular distortions that occur after welding, temperature distribution, and residual stresses. A coordinate measuring machine and a 3D non-contact scanning device are used to measure the angular distortions and displacement distributions, respectively. The results show that controlling welding process via simulations can significantly enhance the performance of process, and help to minimize distortions and decrease costly design errors.

Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary disorder which typically results in scapular winging due to wasting of the periscapular muscles affected by this condition. Scapulothoracic arthrodesis (STA) is the current surgical treatment for FSHD patients with severe winging and preserved deltoid muscle. There are several different techniques in the literature such as multifilament cables alone and cable or cerclage wires combined with single or multiple plates. We prefer cables without plates as it provides independent strong fixation points and strongly recommend utilization of autograft. The functional results of studies report that regardless of the technique used, shoulder elevation and thus quality of life is improved, as shown with outcome scores. There are several complications associated with STA. Pulmonary complications are common and usually resolve spontaneously. Meticulous surgical technique and effective postoperative analgesia may reduce the incidence. Scapular complications which are associated with the fixation may be encountered in the early or late period, which are related to the learning curve of the surgeon. In conclusion, STA is a reliable solution to a major problem in FSHD patients that helps them maintain their activities of daily living until a cure for the disease is found. A successful result is strongly dependent on patient selection, and a multidisciplinary team of neurologists, geneticists and orthopaedic surgeons is required to achieve good results.

Symptomatic spinoglenoid ganglion cyst is a rare cause of shoulder pain and disability. Surgical treatment, which may be considered after failed nonoperative treatment, includes open or arthroscopic cyst debridement. Arthroscopic treatment is less invasive and has the advantage of addressing intraarticular pathologies; however, exposure of the cyst may be deemed difficult. Furthermore, the suprascapular nerve is susceptible to iatrogenic injury owing to its close proximity to the posterior glenoid rim. The purpose of this article is to present our technique for arthroscopic spinoglenoid cyst decompression after preoperative ultrasound-guided methylene blue injection., NA

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Amaç: Bu çalışmanın amacı, intertrokanterik kırık tanısı ile proksimal femur antirotasyon çivisi (PFNA) kullanılarak başarılı radyolojik kaynama elde edilmiş hastaların, postoperatif dönemdeki klinik fonksiyonel durumlarının araştırılmasıdır.Gereç ve Yöntem: Tek bir merkezde, 2015 – 2017 yılları arasında, düşme sonucu başvurarak, intertrokanterik femur kırığı tanısı ile PFNA kullanılarak opere edilen 65 yaş üzeri hastalar çalışmaya dahil edildi. Hastaların günlük aktivite düzeyinin ve kalça kaynaklı fonksiyonel durumlarının araştırılması için Türkçe geçerlilik ve güvenilirlik çalışması yapılmış olan “Oxford kalça skoru (OKS)” ve “Kalça yetersizliği ve osteoartrit sonuç skoru – Fiziksel fonksiyon kısa form (HOOS-PS)” değerlendirmeleri, hastaların kendileri veya birinci derece yakınları ile iletişime geçilip yanıtları işlenerek kullanıldı. İstirahat halinde ve aktivite sırasındaki ağrıyı değerlendirmek üzere ortalama istirahat ve aktivite vizüel analog skala (VAS) skorları kullanıldı. Mobilizasyon düzeylerini araştırmak için “Palmer – Parker Mobility Score (PPM)” kullanıldı. Bulgular: Yirmi bir hastanın fonksiyonel skor değerlendirmeleri ameliyattan ortalama 18,1±9 ay sonra araştırıldı. Bu 21 hastanın; ortalama istirahat VAS skorları 2.3±1.4, aktivite VAS skorları 3,5±1,8; OKS 30,4±12,2; HOOS-PS 10,9±5,1 ve PPM 5,5±3,3 olarak kaydedildi. Sonuç: Geriatrik populasyonda sık görülen femur intertrokanterik kırıklarında, PFNA ile osteosentez uygulanarak başarılı radyolojik sonuçlar sağlanan hastalar; her ne kadar ağrı yönünden iyi sonuçlara sahip olsalarda, fonksiyonel ve mobilizasyon düzeyleri düşük olmaktadır., Purpose: The aim of this study is to investigate the post-operative functional condition of patients who had intertrochanteric fractures and had successful fracture healing with proximal femoral nail (PFNA).Materials and Methods: Patients over 65 years who were admitted to a single center with intertrochanteric femur fractures after fall injury between 2015-2017 and treated using PFNA were included to the study. To investigate daily activity levels and functional status related to hip joint, Turkish versions of “Oxford Hip Score (OHS)” and “Hip Disability and Osteoarthritis Outcome Score – Physical Function Shortform (HOOS-PS)” were used to question patients or their first-degree relatives. To inspect pain at rest or with activity, visual analogue scale (VAS) was used. To investigate mobility levels, “Palmer – Parker Mobility Score (PPM)” was used.Results: Functional levels were investigated in 21 patients 18,1±9 months after the operation. 21 patients who were questioned had mean VAS score at rest 2.3±1.4, mean VAS score with activity 3.5±1,.; OHS 30.4±12.2; HOOS-PS 10.9±5.1 and PPM 5.5±3.3. Conclusion: Although PFNA is a successful treatment method in intertrochanteric femur fractures, patients do not reach the anticipated mobilization and functional levels when compared with healthy individuals at same age, even though they have low pain levels.

The aim of this study was to report the long-term results, residual instability, and recurrence rate of arthroscopic Bankart repair surgery without a re-dislocation event in the first 5 years.We performed a retrospective analysis of Bankart repairs performed in a single center, by a single surgeon, with a minimum of 5 years' follow-up. Patients without a re-dislocation in the first 5 years of surgery were included. Patients who underwent open repair, those who underwent revision surgery, and those with critical glenoid bone loss were excluded. A total of 68 shoulders in 66 patients (51 male and 15 female patients) were included. Patients were analyzed in 2 domains: (1) failures defined as re-dislocation and (2) failures defined as apprehension and re-dislocation combined (residual instability). Clinical outcomes were assessed using shoulder range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Shoulder Instability Index (WOSI) score. Pain, residual apprehension, re-dislocations, and additional surgical procedures were recorded.The mean age of patients was 31.16 (range, 16-60 years), and the mean follow-up duration was 8.42 ± 2.1 years. The median number of dislocations was 3 (range, 1-20), and the median time from first dislocation to surgery was 16 months (interquartile range, 3-100.5 months). Five patients reported re-dislocations (7.4%) with a mean period of 6.54 ± 2.5 years (range, 5-10.8 years). Seven patients without re-dislocations and 2 patients with re-dislocations reported residual apprehension. Mean shoulder elevation and mean external rotation were 161.3° ± 12.4° and 39.2° ± 11°, respectively. The mean visual analog scale, American Shoulder and Elbow Surgeons, and WOSI scores were 0.5 ± 1.4, 91 ± 11.9, and 88 ± 12.1, respectively. Age was similar in patients with stable shoulders and those with shoulders with re-dislocation or residual instability. The WOSI score was lower in patients with re-dislocation and residual instability (P = .030 and P = .049, respectively).Arthroscopic Bankart repair is a successful surgical option for anterior shoulder instability. The 7.4% re-dislocation rate after 5 years indicates there may be a deterioration of capsulolabral repair in certain patients. The long-term failure pattern may be underestimated in short- to mid-term projections.

To evaluate the surgical outcomes of arthroscopic removal of intraosseous deposits in patients with intraosseous calcific tendinitis of the rotator cuff.This study involved a retrospective review of 96 patients operated on from 2004 to 2019. Patients were divided into two groups according to the location of calcific deposits. Group I had pure tendinous involvement (n = 71), and Group II had tendinous and intraosseous involvement (n = 25). The mean follow-up time was 6.4 ± 3.9 years. There were 71 patients (46 women, 25 men) in Group I, and the mean age was 49.3 ± 8.2 years (range 30-65 years). In group II, there were 25 patients (18 women, 7 men); the mean age was 47.3 ± 11.2 years (range 28-70 years).The mean preoperative VAS pain score was 8.8 ± 1.4 in Group I compared to 9.5 ± 0.5 in group II (p = 0.017). The median preoperative Constant and Oxford scores were 42 (20-65) and 22 (8-34) in Group I and 25.5 (22-46) and 10 (8-16) in group II, respectively (p 0.001). There was no difference in postoperative pain scores (Group I: 0.7 ± 1.6 and group II: 0.5 ± 0.6, p = 0.926), Constant scores [Group I: 100 (80-100) and group II: 100 (90-100), (n.s).] and Oxford scores [Group I: 48 (28-48) and group II: 46.5 (4-48), (n.s.)] between the two groups. The number of preoperative injections was higher in Group II (p = 0.05). There was no correlation between the size of the soft tissue calcific deposit and the preoperative pain, Constant, and Oxford scores (n.s.).Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement.III.

Purpose The objective of this study was to evaluate the long-term functional outcomes and structural integrity of medium to massive rotator cuff tears at 10-12 years of follow-up after arthroscopic transosseous-equivalent (TOE) repair. Methods This was a retrospective study of a consecutive series of patients who underwent primary arthroscopic TOE repair of medium- to massive-sized degenerative rotator cuff tears performed by a single surgeon between January 2007 and August 2009. Patients were examined at a minimum follow-up of 10 years, and magnetic resonance imaging (MRI) was performed to assess tendon integrity. The Constant score (CS), American Shoulder and Elbow Surgeons score, and pain level documented using a visual analog scale were compared between intact repairs and recurrent defects. Univariate analysis was performed to identify factors related to recurrent defects. Results A total of 102 patients met the inclusion criteria, and 79 shoulders in 76 patients (74.5% of eligible patients) with a mean age at surgery of 55 ± 8 years (range, 40-72 years) were available for clinical evaluation at a mean follow-up time of 10.9 years (range, 10-12 years). The mean anteroposterior tear size was 3.1 ± 1.1 cm, and there were 41 medium (52%), 26 large (33%), and 12 massive (15%) tears. MRI was performed in 72 shoulders in 69 patients (91% of available shoulders) and revealed that 13 shoulders had recurrent defects (Sugaya stages 4 and 5). During the follow-up period, 3 patients underwent revision surgery, and the overall recurrent defect rate was 21.3%. A clinically meaningful improvement was observed in all outcome measures at the final follow-up regardless of tendon integrity. Patients with intact repairs showed superior outcomes compared with those with recurrent defects; however, only the overall CS met the threshold for clinical relevance. A significant linear correlation was observed between the Sugaya classification and all outcome scores except the CS pain subscale; however, the strength of correlation was weak. The presence of diabetes (odds ratio [OR], 8.6; 95% confidence interval [CI], 2.25-33.2; P = .002), tear size (OR, 2.08; 95% CI, 1.16-3.46; P = .012), and tear retraction (OR, 4.07; 95% CI, 1.11-14.83; P = .033) were associated with recurrent defects in the univariate analysis. Conclusion Arthroscopic TOE repair of rotator cuff tears provided improved clinical outcomes with a recurrent defect rate of 21.3% at 10-12 years after surgery. Future research focusing on tendon healing is needed as repair integrity on MRI correlates with clinical outcomes.

Objective:To evaluate the effects of kinesio taping on shoulder disorders, as a single treatment modality or as conjunction to other treatments.Data sources:MEDLINE, PEDro (Physiotherapy Evidence Database), The Cochrane Library, Web of Science, Embase and OpenGrey databases were searched for trials published before 5 February 2020.Methods:This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Randomized controlled trials published in English or Turkish were included. The methodological quality of the studies was assessed with the Physiotherapy Evidence Database scale. For analysis of continuous data, mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used. The I2statistics was used to measure the heterogeneity.Results:Fourteen studies were included with 680 participants. Kinesio taping did not produce better results on pain compared to sham (MD by –0.77 (95% CI = –1.77, 0.22), P = 0.13), exercises (MD by –0.51 (95% CI = –1.41, 0.39), P = 0.27), or passive treatments (MD by –0.29 (95% CI = –0.77, 0.19), P = 0.24). Similarly, kinesio taping did not found superior to sham kinesio taping (SMD by –0.01 (95% CI = –0.31, 0.29), P = 0.94), exercises (SMD by 0.41 (95% CI = –0.25, 1.07), P = 0.22), or passive treatments on function (SMD by –0.02 (95% CI = –0.19, 0.15), P = 0.82). There was no significant SMD on range of motion (ROM) by –0.07 (95% CI = –0.47, 0.33, P = 0.74) compared to sham kinesio taping and –0.06 (95% CI = –0.20, 0.09, P = 0.46) compared to passive treatment. Overall, effect size was found small to moderate.Conclusion:Despite reported positive effects in some studies, there is no firm evidence of any benefit of kinesio taping on shoulder disorders.

Rationale: facioscapulohumeral muscular dystrophy (FSHD) is the third most common muscular dystrophy, which is associated with facial, shoulder girdle, and paraspinal muscle atrophy. Most of the patients develop hypokyphosis and hyperlordosis in the course of the disease, to preserve standing posture. Corrective fusion is contraindicated in these patients as the surgery results with loss of compensatory hyperlordosis and leads to loss of trunk balance while standing. Although spinal fusion in neuromuscular scoliosis is a known treatment option, there are no studies in the literature on the spinal fusion of this specific patient group. Patient concerns: in this case report we have presented a 66-year-old woman, who was admitted with back and abdominal pain, inability to sit straight, abdominal discomfort, and numbness in the lower extremities after prolonged sitting. Diagnoses: the patient developed severe hyperlordosis causing intra-abdominal disorders, radicular symptoms, and sitting discomfort due to FSHD. Interventions: the patient underwent T2-S1 fusion and successful fusion was achieved. Outcomes:Individualized Neuromuscular Quality of Life Questionnaire (INQoL) was used to assess preoperative and 3 years postoperative functional outcomes. All domains and total score improved at the end of the follow-up period and successful fusion was verified radiologically. Lessons: this case suggests that spinal fusion may provide functional improvement in carefully selected patient groups. Patient stratification considering spinal disability is required for further studies in this specific indication., NA

Supplemental material, Supplementary_Material for The clinical efficacy of kinesio taping in shoulder disorders: a systematic review and meta analysis by Derya Celik, Sezen Karaborklu Argut, Ozge Coban and Ilker Eren in Clinical Rehabilitation

Context: ideal rehabilitation method following arthroscopic capsulolabral repair surgery for anterior shoulder instability has not been proven yet. Although rapid or slow protocols were compared previously, home- or hospital-based protocols were not questioned before. Objective: the aim of this prospective unrandomized controlled clinical trial is to compare the clinical outcomes of home-based and hospital-based rehabilitation programs following arthroscopic Bankart repair. Design: non-randomized controlled trial. Setting: orthopedics and physical therapy units of a single institution. Patients: fifty-four patients (49 males and 5 females) with an average age of 30.5 (9.1) years, who underwent arthroscopic capsulolabral repair and met the inclusion criteria, with at least 1-year follow-up were allocated into 2 groups: home-based (n = 33) and hospital-based (n = 21) groups. Interventions: both groups received identical rehabilitation programs. Patients in the home-based group were called for follow-up every 3 weeks. Patients in the hospital-based group admitted for therapy every other day for a total of 6 to 8 weeks. Both groups were followed identically after the eighth week and the rehabilitation program continued for 6 months. Main Outcome Measures: Clinical outcomes were assessed using Disabilities of Arm Shoulder Hand, Constant, and Rowe scores. Mann-Whitney U test was used to compare the results in both groups. Wilcoxon test was used for determining the progress in each group. Results: groups were age and gender matched (P =.61, P =.69). Average number of treatment sessions was 13.8 (7.3) for patients in the hospital-based group. Preoperative Disabilities of Arm Shoulder Hand (27.46 [11.81] vs 32.53 [16.42], P =.22), Constant (58.23 [14.23] vs 54.17 [10.46], P =.13), and Rowe (51.72 [15.36] vs 43.81 [19.16], P =.12) scores were similar between groups. Postoperative scores at sixth month were significantly improved in each group (P =.001, P =.001, and P =.001). No significant difference was observed between 2 groups regarding clinical scores in any time point. Conclusions: we have, therefore, concluded that a controlled home-based exercise program is as effective as hospital-based rehabilitation following arthroscopic capsulolabral repair for anterior shoulder instability., NA

OBJECTIVES: This study aims to evaluate the effect of core stabilization exercises and to explore the immediate effect of core muscles-activated posture on shoulder maximal voluntary isometric contraction (MVIC) strength. PATIENTS AND METHODS: Between November 2016 and January 2015, a total of 75 healthy female volunteers (mean age 25.36 years; range, 18 to 30 years) were included. Of these, 42 consecutive volunteers were assigned as the study group, while the remaining 33 volunteers were assigned as the control group. The study group completed a six-week core stabilization home-based exercise program. Two measurements were performed with six-week interval. A set of three repetitions for each shoulder side was performed by an electronic dynamometer under two conditions: core muscles relaxed and activated. Measurements were monitored real-time with a connected computer and recorded in Newton. RESULTS: The activation of core muscles during the measurement significantly decreased the MVIC values in both groups (p

Magnetic resonance (MRI) is a valuable imaging method which can detect pre-operative rotator cuff tear characteristics accurately. However, tendon degeneration almost always necessitates a certain amount of debridement during arthroscopic repair, which alters tear size and shape. The aim of this study is to question the accuracy of the pre-operative tear size and classification in MRI and its relation to the tear size and type of the debrided tendon during arthroscopic repair. A retrospective survey was performed to identify shoulders that underwent arthroscopic rotator cuff repair. Rotator cuff tears with an adequate history, a standard pre-operative MRI, and available surgical video records with appropriate measurements were included. Traumatic tears, calcifying tendonitis, isolated subscapularis tears, and revisions were excluded. In total, 60 shoulders’ (30 males, 27 females; age 55.2 [35–73]) preoperative MRIs and intra-operative measurements were analyzed by orthopaedic surgeons and radiologists. Tear width and type were recorded. Interdisciplinary and intradisciplinary consistency of measurements and classifications were analyzed. Tear width measured on pre-operative MRI and after debridement were compared. Average measured tear width was 9 ± 5.3 mm on MRI. Surgeons (9.98 ± 4.6 mm) measured tears significantly wider than radiologists (7.71 ± 6.6 mm). Radiologists (ICC, 0.930; CI, 0.883–0.959) showed superior consistency on MRI than surgeons (CI, 0.502; CI, 0.105–0.726). Average tear width measured after debridement (29.3 ± 9.6 mm) was significantly higher than tear width measured on pre-operative MRI (p

Background and purpose Impaired shoulder function is the most disabling problem for daily life of Fascioscapulohumeral muscular dystrophy (FSHD) patients. Scapulothoracic arthrodesis can give a high impact to the functionality of patients. Here we report our experience with scapulothoracic arthrodesis and spinal stenosis surgery in FSHD patients. Methods 32 FSHD patients were collected between 2015-2016. Demographical and clinical features were documented. All the patients were neurologically examined. The Medical Research Council (MRC) and the FSHD evaluation scale was used to assess muscle involvement1. Scapulothoracic arthrodesis and spinal stenosis surgeries were performed in eligible patients. Results There were 16 male and 16 female (mean age 34.4 years; range 12-73) patients. 6 shoulders of 4 patients aged between 2132 years underwent scapulothoracic arthrodesis (two bilateral, one left and one right sided). Only one 63 years old female patient with severe hyperlordosis had spinal fusion surgery. All of the patients undergoing these corrective surgeries have better functionality in daily life, as well as superior shoulder elevation. Conclusion Until the emergence and clinical use of novel therapeutics, surgical interventions are indicated in carefully selected patients with FSHD to improve arm movements, the posture and the quality of life of patients in general. Scapulothorosic arthrodesis is a management with good clinical results and patient satisfaction. In selected cases other corrective orthopedic surgeries like spinal fusion may also be considered.

BACKGROUND Facioscapulohumeral dystrophy (FSHD) is an autosomal-dominant myopathy characterized by facial and shoulder girdle muscle weakness with scapular winging. Scapulothoracic arthrodesis is a successful treatment approach for patients with

Background Scapulothoracic arthrodesis (STA) is a well-established surgical technique to provide scapular stabilisation in patients with facioscapulohumeral dystrophy (FSHD). There is no staging or scoring systems available to guide surgical decision. The aim of this study was to develop a staging system to evaluate the shoulder disability in patients with FSHD to guide surgical decision-making and assess its reliability among surgeons. Methods Fifty-seven shoulders of 29 patients (15 male, 14 female) with an average age of 34.5 years (13–73) were included. Six stages of the disease were defined to create a system consisting of shoulder elevation, deltoid function and scapular winging. Patients were assessed by two independent orthopaedic surgeons who were blind to each other. Statistical analyses included mean and standard deviation for descriptive variables, Pearson's correlation and Cohen's Kappa for inter- and intraobserver agreement. Results Measurement of elevation showed excellent correlation in both inter- and intraobserver assessment. There was substantial agreement on deltoid function and moderate agreement on scapular winging. Decisions on stage showed excellent agreement on interobserver and substantial agreement on intraobserver assessment. Surgical decision using the stage showed excellent agreement on both inter- and intraobserver assessment. Conclusion This novel staging system has an excellent inter observer agreement on FSHD patients’ shoulder disability. This would provide surgeons a beneficial tool to define patient groups that would have negatively or positively affected from STA.

Objective: rotator interval lesion (RIL) is a distinct rotator cuff (RC) injury patern consisting of subscapularis and supraspinatus tear with biceps problem. This pathology is an underdiagnosed RC entitiy and not studied in-depth. Aim of this study is to report the functional and radiological results of RIL surgeries performed. Methods: surgeries performed in a single center, in a 7-year-period were retrospectively reviewed. Sixteen cases (n=16) who underwent ar throscopic RC repair including subscapularis with biceps tenodesis or tenotomy were called for an up-to-date assessment. Fourteen shoulders of 13 patients (3 females, 10 males) were included. Constant, disabilities of the arm shoulder and hand (DASH), standardized shoulder assessment form (ASES) scores, and RC thickness measurements with magnetic resonance imaging (MR1) were recorded. Preoperative and postoperative results were compared. Results: average age of the patients were 60.6 (47-74), and follow-up period was 3.2 +/- 1.9 years. Average preoperative Constant, DASH and AS ES scores were 44.43 +/- 15.4, 22.11 +/- 17.21 and 51.37 +/- 27.6, respectively. Postoperative values improved to 90.45 +/- 6.44, 6 +/- 13.68 and 95.82 +/- 7.82, respectively (p, NA

Delamination of rotator cuff tears presents a challenge for surgeons. Recognizing and repairing such a complex tear pattern often require innovative approaches to achieve an anatomic restoration of footprint. In this Technical Note, we described our preferred method that anatomically repairs both layers of delaminated rotator cuff tear separately in a knotless transosseous equivalent technique. Two sutures are placed to the articular layer in a cinch stitch configuration. Then, closed-loop end sutures are passed through both layers while keeping the closed-loop end at the working portal. The free ends of cinch stitches are loaded to anchors with a preloaded fiber tape loop, which is placed to the medial row while approximating the articular layer onto its footprint. Fiber tapes are then shuttled through both layers of tendon with the help of a previously placed closed-loop suture. Finally, the lateral row anchors are placed while fiber tapes are tensioned in a cross-bridge configuration. We believe that this technique may facilitate uneventful healing of delaminated rotator cuffs by providing the biomechanical properties of transosseous equivalent repair., NA

Background Scapulothoracic arthrodesis (STA) is a well-established surgical technique to provide scapular stabilization in patients with facioscapulohumeral dystrophy (FSHD). There is no staging or scoring systems available to guide surgical decision. The aim of this study was to develop a staging system to evaluate the shoulder disability in patients with FSHD to guide surgical decision making and assess its reliability among surgeons. Methods Fifty-seven shoulders of 29 patients (15 male, 14 female) with an average age of 34.5 years (13–73) were included. Six stages of the disease were defined to create a system consisting of shoulder elevation, deltoid function and scapular winging. Patients were assessed by two independent orthopaedic surgeons who were blind to each other. Statistical analyses included mean and standard deviation for descriptive variables, Pearson's correlation and Cohen's Kappa for inter and intra observer agreement. Results Measurement of elevation showed excellent correlation in both inter- and intraobserver assessment. There was substantial agreement on deltoid function and moderate agreement on scapular winging. Decision on stage showed excellent agreement on inter observer and substantial agreement on intra observer assessment. Surgical decision using the stage showed excellent agreement on both inter and intra observer assessment. Conclusion This novel staging system has an excellent inter observer agreement on FSHD patients’ shoulder disability. This would provide surgeons a beneficial tool to define patient groups that would have negatively or positively affected from STA.

Impaired shoulder function is the most disabling problem for daily life of Fascioscapulohumeral muscular dystrophy (FSHD) patients. Scapulothoracic arthrodesis can give a high impact to the functionality of patients. Here we report our experience with scapulothoracic arthrodesis and spinal stenosis surgery in FSHD patients.32 FSHD patients were collected between 2015-2016. Demographical and clinical features were documented. All the patients were neurologically examined. The Medical Research Council (MRC) and the FSHD evaluation scale was used to assess muscle involvement1. Scapulothoracic arthrodesis and spinal stenosis surgeries were performed in eligible patients.There were 16 male and 16 female (mean age 34.4 years; range 12-73) patients. 6 shoulders of 4 patients aged between 2132 years underwent scapulothoracic arthrodesis (two bilateral, one left and one right sided). Only one 63 years old female patient with severe hyperlordosis had spinal fusion surgery. All of the patients undergoing these corrective surgeries have better functionality in daily life, as well as superior shoulder elevation.Until the emergence and clinical use of novel therapeutics, surgical interventions are indicated in carefully selected patients with FSHD to improve arm movements, the posture and the quality of life of patients in general. Scapulothorosic arthrodesis is a management with good clinical results and patient satisfaction. In selected cases other corrective orthopedic surgeries like spinal fusion may also be considered.A facioscapulohumeralis muscularis dystrophiában (FSHD) szenvedő betegek körében a korlátozott vállfunkció akadályozza leginkább a mindennapi tevékenységeket. A scapulothoracalis arthrodesis nagymértékben javíthatja a vállízület funkcióját. A tanulmányban bemutatjuk az FSHD-ben szenvedő betegek körében végzett scapulothoracalis arthrodesis és spinalis stenosis műtétekkel kapcsolatos tapasztalatainkat.32 FSHD-beteg vett részt a vizsgálatban, 2015 és 2016 között. Dokumentáltuk a betegek demográfiai és klinikai sajátosságait. Valamennyi beteg neurológiai kivizsgálásban részesült. A Medical Research Council (MRC) és az FSHD értékelő skálát használtuk az izomérintettség megállapítására1. Az alkalmasnak értékelt betegek esetében scapulothoracalis arthrodesist vagy spinalis stenosist végeztünk.16 férfi és 16 nőbeteget vontunk be a vizsgálatba (átlagos életkor: 34,4 év; minimum 12, maximum 73 év). Négy (21 és 32 éves kor közötti) beteg hat vállát operáltuk scapulothoracalis arthrodesissel (két bilaterális, egy bal és egy jobb oldali műtét). Egy 63 éves, súlyos hyperlordosisban szenvedő nőbeteg esetén került sor gerinc­fúzióra. Valamennyi korrekciós műtéten átesett beteg esetében növekedett a vállízületi eleváció mértéke, és javult a mindennapi élet során szükséges funkcionalitás.Amíg nem jelennek meg új terápiás módszerek, gondosan szelektált FSHD-betegek körében a karok mozgástartományának és a testtartásnak, valamint a betegek általános életminőségének a javítása érdekében a sebészeti beavatkozások fontos kezelési opciót jelentenek. A scapulothoracalis arthrodesis jó klinikai eredményességű és növekvő betegelégedettséget produkáló módszer. Válogatott esetekben más korrekciós ortopédiai műtétek, például a gerincfúzió is eredményes lehet.

Background:Gout is a purine metabolism disease. Tophaceous gout may cause joint destruction and other systemic problems and sometimes may be complicated by infection. Infection and sinus with discharge associated with tophaceous gout are serious complications, and treatment is difficult. We present a patient with tophaceous gout complicated by infection and discharging sinus treated by bilateral amputation at the level of the first metatarsus.Methods:A 43-year-old man previously diagnosed as having gout, and noncompliant with treatment, presented with tophaceous gout associated with discharging sinus and infection on his left first metatarsophalangeal joint. Because of the discharging sinus associated with the tophaceous deposits, the soft-tissue and bony defects, and the noncompliance of the patient, amputation of the first ray was undertaken, and a local plantar fasciocutaneous flap was used to close the defect. After 8 months, the patient was admitted to the emergency department with similar symptoms in his right foot, and the same surgical procedure was performed.Results:One year after the second surgery, the patient had no symptoms, there was no local inflammatory reaction over the surgical areas, and laboratory test results were normal.Conclusions:Gout disease with small tophi often can be managed conservatively. However, in patients with extensive lesions, risk of superinfection justifies surgical treatment. Results of complicated cases are not without morbidity; therefore, early surgical treatment may prevent extremity loss and further complications. In severe cases, especially with compliance issues, amputation provides acceptable results.

Deformity can be simply described as deviation from normal anatomy. This can be in the form of angulation, translation, rotation or length. The purpose of analysis is to report the magnitude and direction of a deformity or combination of deformities in a patient. To achieve this goal, we should have the standard values of the normal anatomy and a standard radiologic survey to work on. This chapter covers the description and basic components of a deformity and principles to obtain appropriate radiologic imaging for analysis. Details of each deformity component and methods for their correction will be discussed in the following chapters.

Fixation methods for SLAP lesions are still controversial, and the strength of the fixation, suture and knot irritation, and placement and number of anchors are still being discussed. This uncertainty is directly related to the function and anatomy of the superior labrum and attached biceps. Knotless fixation methods close to the biceps anchorage at the 12-o'clock position are favored in recent literature. We describe a practical SLAP repair technique, with a mattress configuration through the biceps anchorage, using a single knotless anchor. Fixing the biceps attachment instead of the labrum alone, in proximity to the biceps, without sutures or knots left in contact with the other intra-articular structures is the superiority of the described technique.

Duchenne muscular dystrophy (DMD) is the most common of the neuromuscular disorders. DMD is usually a challenge for the anaesthesiologist, with poor cardiac function, a high risk of developing rhabdomyolysis, and the probable life-threatening complications of general anaesthesia. To avoid possible morbidity associated with general anaesthesia, we applied a supraclavicular blockade. In this report, we present a 17-year-old DMD patient with a massive rhabdomyosarcoma, for whom a left arm amputation was indicated. In the post-operative period, a malignant hyperthermia-like reaction occurred, which resolved in a short time. We suggest a regional blockade as a safer alternative to general anaesthesia for the management of high risk DMD patients during orthopedic procedures.

INTRODUCTIONThere are various complications reported with surgical treatment of DDH. Most studied complication is avascular necrosis of the femoral head and hip stiffness. The purpose of this report was to describe a case with severe stiffness of the hip due to hypertonicity in periarticular muscles after it was treated for developmental dysplasia of the hip (DDH).PRESENTATION OF CASEThree-year-old patient referred to our institution with bilateral DDH. Two hips were operated separately in one year with anterior open reduction, femoral shortening osteotomy. Third month after last surgery, limited right hip range of motion and limb length discrepency identified. Clinical examination revealed that patient had limited range of motion (ROM) in the right hip and compensated this with pelvis obliquity. Gluteus medius, sartorius and iliofemoral band release performed after examination under general anesthesia. Symptoms were persisted at 3rd week control and examination of the patient in general anesthesia revealed full ROM without increased tension. For the identified hypertonicity, ultrasound guided 100IU botulinum toxin A injection performed to abductor group and iliopsoas muscles. Fifth month later, no flexor or abductor tension observed, and there was no pelvic obliquity.DISCUSSIONStiffness as a complication is rare and is usually resolved without treatment or simple physical therapy. Usually it is related with immobilization or surgery associated joint contracture, and spontaneous recovery reported. Presented case is diagnosed as hip stiffness due to underlying local hypertonicity. That is resolved with anesthesia and it was treated after using botulinum toxin A injection.CONCLUSIONHypertonicity with hip stiffness after surgical treatment of DDH differ from spontaneous recovering hip range of motion limitation and treatment can only be achieved by reduction of the muscle hypertonicity by neuromuscular junction blockage.

Objective: The aim of this study was to clinically and radiologically evaluate patients treated with plate osteosynthesis with structural allografts for severely valgus-impacted fractures of the proximal humerus.Methods: The study included 10 patients (average age: 57 years; range: 34 to 77 years) with valgus-impacted Neer Type 4 proximal humerus fractures. Fractures were classified according to the Robinson classification. Patients were called for an up-to-date examination and evaluated radiologically and clinically with Constant and DASH scores.Results: Average follow-up period was 22.5±12.2 (range: 12 to 50) months. Average DASH score at the final follow-up was 7.6±4.5 (range: 2.5 to 16.7) and average Constant score was 87.7±4.4 (range: 83 to 94). None of the cases had early or late head collapse. There was no avascular necrosis. One early screw penetration was observed.Conclusion: Surgical treatment of valgus-impacted proximal humerus fractures achieved successful results. However, the cavity under the humeral head may lead to failure due to mechanical insufficiency. Plate osteosynthesis with structural allografts warrants initial mechanical support until union, thus avoiding complications related to head collapse., Amaç: Bu çalışmada yapısal allogreftlerle yapılan plak osteosentezi ile ileri derecede valgus impakte kırıkları üzerinde alınacak sonuçların klinik ve radyolojik açıdan değerlendirilmesi amaçlanmıştır.Çalışma planı: Valgus impakte Neer Tip 4 proksimal humerus kırığı tanısı alan ve ortalama yaşı 57 (dağılım: 34-77) olan 10 hasta çalışmaya dahil edilerek, kırıkları Robinson sınıflamasına göre sınıflandı. Hastalar güncel muayeneleri için çağrıldı; Constant ve DASH skorları ile klinik ve radyolojik olarak değerlendirildiler.Bulgular: Ortalama takip süresi 22.5±12.2 (dağılım: 12-50) ay olarak kaydedildi. Son kontrol sırasında ortalama DASH skoru 7.6±4.5 (dağılım: 2.5-16.7) ve Constant skoru 87.7±4.4 (dağılım: 83-94) olarak ölçüldü. Hastaların hiçbirinde erken ve geç baş çökmesi veya avasküler nekroz görülmedi. Bir hastada erken vida penetrasyonu saptandı.Çıkarımlar: Valgus impakte kırıkların cerrahi tedavisi ile başarılı sonuçlar elde edilmiştir. Bununla birlikte, humerus başının altında ortaya çıkan kavite, mekanik yetersizlik nedeniyle başarısızlığa yol açabilir. Yapısal allogreftler ile yapılan plak osteosentezi, başlangıç aşamasından kaynamaya dek yeterli mekanik desteği sağlayarak, baş çökmesi ile ilişkili komplikasyonlar oluşmasına engel olmaktadır.

In this study, the correction accuracy of Smart Correction spatial fixators and of Ilizarov-type external fixators are compared in terms of deformity complexity.Seventy-seven (40 male, 37 female) bone segments of 57 patients treated with a Smart Correction device were compared with 94 (51 male, 43 female) segments of 68 patients treated with an Ilizarov fixator. Mean age of the Smart Correction group was 20.69 ± 12.94 years, and or the Ilizarov group 22.45 ± 12.18 years. Patients were categorised according to limb lengthening and the number of deformity planes.A longer correction period was found with Ilizarov (66.53 ± 47.7 days) compared with Smart Correction (49.05 ± 35.6 days) devices. The bone healing index of the Ilizarov group was significantly better compared with the spatial group. Residual deformity after treatment was significantly lower with the Smart Correction device; however, this relationship could not be shown between subgroups. Although there was no significant difference between subgroups, mean residual deformity was higher with the increasing number of planes of the deformity.The Smart Correction fixator is an accurate device that allows ease of application and planning. It demonstrates higher accuracy for correcting deformities compared with an Ilizarov external fixator. With an increasing number of planes, the difference between the two devices becomes even more pronounced. The relationship between the complexity of the deformity and residual deformity may possibly be significantly greater in favour of the Smart Correction fixator in a study with a larger sample size.

Objective: The aim of this study was to evaluate the outcome of patients undergoing limb lengthening using motorized intramedullary nails.Methods: This study included eleven femora and 4 tibiae from 14 patients (9 male, 5 female; mean age: 26.9 years; range: 14 to 51 years) who underwent limb lengthening using motorized intramedullary femoral nails (Fitbone® TAA). Average preoperative limb shortening was 4.9 (range: 2.5 to 7.5) cm. Distraction was initiated on the seventh postoperative day. Serial radiographs and Paley’s bone and functional outcome scoring systems were used to evaluate the results.Results: Mean follow-up period was 33.5 (range: 7 to 88) months. Mean distraction index value was 1.2 (range: 0.7 to 2.1) days/mm and mean bone-healing index value was 43.7 (range: 13.8 to 144) days/cm. The average lengthening achieved was 51.7 (range: 25 to 75) mm. The distraction mechanism of the nail did not function properly in two patients, restricted transient knee motion was observed in four patients, and delayed consolidation was observed in four patients. Other complications included valgus deformities and superficial infections surrounding the antenna of theintramedullary nail, as well as femur fractures at the proximal end of the nail. Bone scores were excellent in 11 segments and were good in one segment. Functional scores were excellent for all 12 patients.Conclusion: While usual complications related to the external fixators, such as pin-track infections and mobilization difficulties were not encountered, the development of additional complications such as dysfunction of the distraction mechanism should be monitored with the use of motorized intramedullary nails in limb lengthening., Amaç: Çalışmamızda alt ekstremite kısalığı nedeniyle motorize intramedüller çivi ile uzatma ameliyatı yapılan hastaların tedavi sonuçlarının değerlendirilmesi amaçlandı.Çalışma planı: Alt ekstremite kısalığı olan 14 hastanın (9 erkek, 5 kadın; ortalama yaş: 26.9; dağılım: 14-51 yıl) 11 femur ve 4 tibiasına motorize intramedüller çivi (Fitbone® TAA) ile uzatma yapıldı. Hastaların ameliyat öncesi ortalama kısalığı 4.9 (dağılım: 2.5-7.5) cm idi. Ameliyat sonrası yedinci günde distraksiyona başlandı. Sonuçlar Paley’in kemik ve fonksiyonel skorlama sistemine göre değerlendirildi. Bulgular: Hastaların ortalama takip süresi 33.5 (dağılım: 7-88) ay idi. Ortalama distraksiyon indeksi 1.2 gün/mm (dağılım 0.7-2.1 gün/mm) ve ortalama kemik iyileşme indeksi 43.7 (dağılım: 13.8-144) gün/cm olarak tespit edildi. Ortalama uzatma miktarı ise 51.7 (dağılım 25-75) mm olarak ölçüldü. İki hastada motorize intramedüller çivinin distraksiyon mekanizmasının çalışmaması nedeniyle farklı bir yönteme geçilmesi gerekti. Operasyon sonrasında 4 hastada geçici diz hareket kısıtlılığı, 4 hastada konsolidasyonun olgunlaşmasında gecikme, bir hastada valgus deformitesi, bir hastada intramedüller çivi anteni çevresinde yüzeysel enfeksiyon ve bir hastada çivinin proksimal ucunda kırık komplikasyonları ile karşılaşıldı. Kemik skoru 12 segmentte çok iyi, bir segmentte iyi olarak ve fonksiyonel skor 12 hastada çok iyi olarak değerlendirildi. Çıkarımlar: Ekstremite uzatma operasyonlarında, eksternal fiksatör uygulamalarında görülebilen pin dibi enfeksiyon ve mobilizasyon güçlüğü gibi problemler gözlemlenmediği halde, motorize intramedüller çivi distraksiyon mekanizmasının çalışmaması gibi ekstra komplikasyonların da olabileceği unutulmamalıdır.