Early detection and conservative treatment are essential for a successful outcome in developmental dysplasia of the hip (DDH). The aim of this study was to evaluate the efficacy of Tübingen hip flexion splint treatment on dislocated hips of type D, 3, and 4 according to the Graf classification.

Pseudoarthrosis with bone loss is one of the most challenging orthopaedic problems for surgeons. Bone loss usually leads to technical difficulties during surgery due to instability in the fracture area. Eight patients with pseudoarthrosis of different long bones were operated on by the same surgeon. The median age was 53 years (25-61), and the median time period after the index operation was 21 months (1272 months).Radiographic union was achieved in all patients in 3.62 months (2-5 months). Efficient healing with new bone formation was observed in all of the patients. The result of the current case series is promising. This treatment method can be used for the treatment of pseudoarthrosis without increasing morbidity. Long-term follow-up and larger case series are needed for evidence of the adequacy and reliability of this method of treatment.

PURPOSEAnkaferd Blood Stopper (ABS), which is a standardized mixture of herbal extracts obtained from five plants, has been proven as an efficient hemostatic agent and is still used in emergency situations. It is not known exactly if decreased bleeding has positive or negative effects on muscle healing and fibrosis, so the purpose of this study was to test the effect of ABS on muscle healing and morphology.METHODSA total of 66 outbred Wistar rats were divided into three control and three experimental subgroups. In the experimental groups, ABS was sprayed on the cut surface of the soleus. In the control groups, a saline solution was sprayed on the cut surface of the soleus. Subgroups were euthanized after 2 weeks, 3 weeks and 4 weeks, respectively. In each subgroup, eight rats were used for the biomechanical study to determine muscle healing and three rats were used for the histopathological investigation.RESULTSAlthough muscle strength in the control groups was lower than that of the experimental groups in early weeks, no differences were found between the control and the experimental groups at 4 weeks.CONCLUSIONSABS has no negative effect on muscle healing. We also observed that ABS accelerated muscle healing compared to the control group. ABS could be used in hemostasis of open fractures and elective orthopedic surgeries.

Developmental dysplasia of the hip (DDH) is a wide-spectrum disease with a multifactorial etiology and, despite its prevalence, no definitive etiology has yet been established. The aim of this study was to investigate new risk factors for DDH by evaluating newly defined potential risk factors. A total of 71 infants were separated into 2 groups:Group I, 28 female first-born infants diagnosed with DDH and their mothers;and Group II, 43 healthy female first-born infants and their mothers. The maternal height and weight before pregnancy, infant height and weight at birth, and body mass index (BMI) of both mother and infant were determined. Calculations were made of the ratios between these parameters. Of the examined risk factors, only maternal height and the ratio of maternal height to infant BMI (MH/I-BMI) were found to be significant for DDH in infants. In conclusion, the results of this study show that a short maternal height and a low MH/I-BMI increase the risk of DDH. Further studies with a larger series are necessary to confirm these results.

Radial longitudinal deficiencies are characterized by radial deviation of the wrist, a short and bowed forearm and a non-functional or absent thumb. The deformity is caused by varying degrees of underdevelopment and malformation including hypoplasia of the bones, joints, muscles, tendons, ligaments, nerves and vessels. This study describes our results from centralization in 8 limbs with Bayne type III-IV radial longitudinal deficiencies. We reviewed 8 limbs from 6 patients with a centralization performed between 2002 and 2010. The median patient age at the time of the operation was 2.75 years (range 2-14 years). The sex ratio was 4 male and 2 female. All patients underwent centralization. One patient had an additional 6.5 cm elongation of the ulna bone by means of a circular external fixator (CEF). The median follow-up time from centralization was 4,5 years (range 2-10 years). The result was considered to be excellent in 4 cases, good in 3 cases and fair in 1 case. Radial deviations regenerated in all cases. During follow-up, a radial deviation of 15 degrees developed in one patient; this deviation did not require surgical correction. Hand and wrist movements were within acceptable levels. Movement and function of the wrist and forearm can be obtained through centralization of the wrist and ulnar elongation when necessary. A cosmetically pleasant appearance can be ensured.

Radial longitudinal deficiency (radial club hand) is a congenital deformity in the upper extremity that can present with a range of thumb deficiencies. A variety of surgical procedures to correct for absence of a thumb have been described, such as pollicization, osteoplastic reconstruction, toe to hand transfer, and extension with distraction. We have reviewed 8 index finger pollicizations in 6 patients after correction of the radial club hand deformity through wrist centralization. Four hands used were the dominant hand. Buck-Gramcko's technique was used with a mean age of 4.6 (range from 2 to 14) years. The mean follow-up time was 6 (range from 2 to 10) years. The mean active range of motion at the pollicized digit was 121.4 (range from 83 to 150) degrees. The result was considered excellent in 5 cases (62.5%), good in 2 cases (25%), and fair in 1 case (12.5%) in accordance with Percival's scoring system; none of the outcomes were poor. The younger patients adapted easier. Index finger pollicization is a method that provides dramatic improvement to hand function in thumb aplasia or severe hypoplasia, which may be preferred in treatment. The operations improved hand cosmetic appearance and functional ability.

This study assessed the use of semirigid hip orthosis to stabilize the femoral head into the acetabulum in the delayed treatment of developmental dysplasia of the hip (DDH; Graf type IIb or more severe) under the age of 6 months. Ninety-eight hips from 75 patients (four boys, 71 girls) were evaluated retrospectively. The mean age at treatment initiation was 3.2±1.3 months (1–6 months). As the dysplastic hip matured into a type I hip, we applied the weaning regimen for 1 month. Seventy-two patients (96%) were treated successfully in 4.2±1.1 months (2–8 months). All of the failures were type IV hips. We did not detect any acetabular or femoral head pathology in the later follow-up. Semirigid hip orthosis is safe and effective as the first-line treatment method for delayed DDH except in type IV hips in patients under 6 months of age. Level of Evidence: Level IV. Case series.

BACKGROUND:Universal ultrasound screening has led to overtreatment and higher follow-up rates than are found with clinical examination alone because of high incidence of physiologically immature hips (type IIa) in the first weeks of life. The ability to predict future acetabular development in physiologically immature hips (type IIa) would therefore help to reduce overtreatment and unnecessary follow-up. METHODS:We described the γ-angle to assess the femoral head coverage by the acetabular roof, which is measured between the baseline defined by Graf and the cartilaginous edge line connecting the inferior point of the iliac bone (lower limb) to the medial corner of the acetabular labrum. We retrospectively analyzed ultrasonographic findings of infants with developmental dysplasia of the hip diagnosed in our hospital and infants with normal hips screened in our hospital. Group 1 (35 hips) consists of type IIa hips at initial examination and went on to develop into dysplastic hips at follow-up. Group 2 (279 hips) consists of type IIa hips at initial examination and went on to develop into normal hips (type I) at follow-up. RESULTS:The γ-angles of type IIa hips that developed into type I hip at follow-up ranged between 77 and 82. The γ-angles of type IIa hips that developed into hip dysplasia ranged between 72 and 78. All type IIa hips that had γ-angles >78 degrees developed into normal hips. We also observed that all type IIa hips that had γ-angles <77 degrees developed into dysplasia. CONCLUSIONS:The amount of cartilage mass covering the femoral head, which is a part of the acetabular roof, can therefore provide information about future acetabular development. This paper describes a new method of measurement (the γ-angle) that assesses the extent of the cartilage coverage of the femoral head, which can predict acetabular development. Its use would decrease the rates of unnecessary follow-up and treatment. LEVEL OF EVIDENCE:Level II (development of diagnostic criteria on the basis of consecutive patients).

Although acute elbow dislocations are common orthopedic injuries, concomitant neurovascular injury is rare. Brachial artery transection can result from open elbow dislocation and responds well to vascular repair. Rapid evaluation and a high level of suspicion are essential to facilitate immediate treatment. Delay to identify vascular injury after elbow dislocation or reduction can potentially lead to limb ischemia, and potential loss of limb. We present a case of relatively rare transection of the brachial artery, with an accompanying traumatic open elbow dislocation in a 12-year-old boy.

Ozet: Amac: Calismanin amaci, ilkokul cocuklarinda canta tasima sekli, bilgisayar kullanim sikligi, postur bozukluklari ve buna bagli agri siddetini ve yerini belirlemektir. Yontem: Yaslari 7-11 arasinda degisen 347 (199 kiz, 148 erkek) cocuga omuz elevasyonu, pelvis elevasyonu, skapular prominens, torakal prominens, lumbar prominens, azalmis kol-govde araligi, artmis kifoz ve lordozu iceren Adam’s Forward Bend Test, uc fizyoterapist tarafindan uygulandi. Cocuklarin canta tasima sekli, bilgisayar kullanim sikligi ve agri anketle sorgulandi. Sonuc: Cocuklarin %77,4’u cantasini askilari bilateral ve sirtla temasta olacak sekilde takmaktaydilar. %44,6’si cantasinin agir oldugunu ifade etti. %43,8’si vucudunun herhangi bir bolumunde agri hissettigini ve bunlarin da %14,1’i agrinin sirtta oldugunu belirtti. %80,5’i gun icinde bilgisayar kullandigini ve %70’i gunde en az 1-2 saat bilgisayar karsisinda kaldigini ifade etti. Degerlendirme sonunda %63,7’sinde omuz elevasyonu (%28,2’inde sag, %35,4’unde sol), %7,5’inde pel-vis elevasyonu, %79,3’unde skapular prominens (%38,9’undasol, %36,6’sinda bilateral), %66,9’unda kol-govde araliginin azalmasi (%47’sinde sol) %21,9’unda torakal prominens, %21,3’unde kifoz, %63,4’unde lordoz kaydedildi. Tartisma: Calismanin sonuclarina gore, cocuklarin canta kullanma aliskanliklari dogru olmasina ragmen, ozellikle sirtta agri hissetmelerinin nedeninin posturde gorulen asimetriden ve canta agirligindan kaynaklandigi dusunulmektedir. Ilkokul cocuklarinda postural asimetrinin bir kismi normal olarak ve buyume doneminde duzelecek olarak kabul edilse bile, bir kisim bozukluklarin erken donemde fark edilmesi ve eriskin donemde cocugun gunluk yasantisini etkilememesi acisindan okul taramasinin yapilmasi ve ailenin bilgilendirilmesi gerekmektedir.

Compressive and entrapment neuropathy of the peroneal nerve is the most common entrapment syndrome in the lower limbs, often caused by mechanical or dynamic compression of a segment of nerve at the level of the fibula head. Because of its special anatomic situation, external compression while under trauma or traction is quite easy. A case of entrapment neuropathy syndrome in a 33-year-old man treated by pulse radiofrequency to the lateral cutaneous branch of the common peroneal nerve is presented.

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Scapular mobility plays a central role in normal shoulder function, and alterations in scapular mobility have been suggested as a factor in impingement syndrome. We therefore measured the effect of restricted scapular mobility during arm abduction on acromiohumeral and coracohumeral distances. For the control measurements, healthy volunteers (n = 10, all male, age range 25-35 years) underwent multislice computed tomography in a supine position, with the humerus actively maintained in the scapular plane at 45 degrees internal rotation and 60, 90 or 120 degrees abduction. To restrict scapular mobility a custom-made brace was then placed on each volunteer and fastened firmly with bandages, and the measurements were repeated. From the three-dimensional images the acromiohumeral and coracohumeral distances were measured. With the humerus in 90 degrees abduction, the acromiohumeral distance was significantly reduced (Student's t test). This result suggests that impingement syndrome may have a functional component.

Developmental hip dysplasia is a condition that may be successfully treated with early diagnosis. There is a need for a new method of screening and early diagnosis, due to the insufficiency of clinical examination alone, varying interpretations by the examiners, and the inability of standard radiographs to fully evaluate the hip joint, especially within the first three months. Hip ultrasonography, given its effectiveness, non-invasive nature and the fact that it does not involve radiation, is becoming more widely used for this purpose. In our country, studies using hip ultrasonography reported the frequency of this condition 0.86%-17%. Varying results in some of these studies, appear to be due to the participants being few in number or being selected cases. In our hospital's screening program for developmental hip dysplasia, 3541 infants were examined clinically and were followed up with hip ultrasonography. The frequency of developmental hip dysplasia according to ultrasonography was 4.71%. In this article, the studies investigating this topic in our country were reviewed and developmental hip dysplasia frequency and screening methods were discussed.

Objectives: We evaluated surgical treatment of patients with chondromyxoid fibroma. M e t h o d s : The study included 11 patients (6 females, 5 males; mean age 31 years; range 8 to 53 years) who underwent surgical treatment for chondromyxoid fibroma. The most common site of involvement was the tibia in three patients. Diagnosis was made preoperatively by tru-cut biopsies in seven patients and all the diagnoses were confirmed postoperatively by histopathologic examination. In addition to plain radiographs, computed tomography was used in 10 patients, and magnetic resonance was used in six patients. Surgery included wide resection, marg i n a l excision or intralesional curettage followed by autologous bone graft or bone cement. The mean follow-up was 62.8 months (range 2 to 162 months). R e s u l t s : The main presenting symptom was pain in all the patients. Two patients with thoracic wall and tibia involvement, respectively, complained of a mass. Radiologic imaging showed soft tissue involvement in two patients. Recurrence occurred in three patients (27.3%), in whom initial surgical procedures were curettage alone (n=2) or with iliac graft (n=1). One patient with involvement in the phalanx of the thumb presented with pain 46 months after the second operation. A tru-cut biopsy yielded a diagnosis of secondary chondrosarcoma for which ray amputation was performed. No wound site infections or functional loss developed after surgical treatment. Conclusions: Chondromyxoid fibroma may develop in various bones of the body and occur at a wide age range. Curettage with autologous bone graft is an effective surgical method.

A 14-year-old was admitted with right groin pain which has started after kicking ball in a football game one week before. He had limited active and passive hip extension. A plain AP radiograph of the pelvis revealed a bone fragment displaced inferiorly about 1 cm from the right anterior inferior iliac spine. The patient was treated conservatively with analgesics and limited weight bearing. Four weeks later, range of motion was normal without pain and at eighth week the hip flexors regained full strength.