Publications by authors named "Mehmet Ali Talmac"

15 Publications

  • Page 1 of 1

Serum Levels of Vitamin D in Children with or without Isolated Distal Radius Fractures: A Prospective Clinical Study.

Rev Bras Ortop (Sao Paulo) 2021 Jun 31;56(3):351-355. Epub 2021 Mar 31.

Departamento de Cirurgia Ortopédica e Traumatologia, Sisli Hamidiye Etfal Training and Research Hospital, Istambul, Turquia.

 To compare the serum levels of vitamin D and minerals in children with or without isolated distal radius fractures.  The present prospective clinical study included 50 children (aged between 5 and 15 years) with isolated distal radius fractures who were admitted to our emergency unit between February and May 2018 as the study group (group A), and 50 healthy children with no history of fracture as the control group (group B). Peripheral venous blood samples were obtained and analyzed for measurements of 25-hydroxyvitamin D (25(OH)D), calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) in both groups. Patient characteristics and peripheral venous blood samples were compared between the groups.  The mean age, height, weight, body mass index (BMI) and gender distribution were similar in both groups. There were no statistical differences in the blood analyses, including Ca, Mg, P, ALP, and PTH. However, the serum levels of 25(OH)D were statistically lower in group A when compared to group B (  < 0.001), and the number of patients with 25(OH)D insufficiency was statistically higher in group A than in group B (p = 0.012).  Children with isolated distal radius fracture should be informed about vitamin D deficiency, and, in children with low levels of vitamin D, supplementation may be considered.
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http://dx.doi.org/10.1055/s-0040-1721362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249071PMC
June 2021

Characteristics of femoroacetabular impingement morphology and relation with skeletal maturity among asymptomatic adolescents.

Acta Orthop Belg 2021 Mar;87(1):47-54

The aim of this study was to analyze presence of the morphological characteristics and prevalence of FAI in asymptomatic adolescents and assess the relation of skeletal maturation with development of FAI morphology. Abdominopelvic computed tomography (CT) of 265 adolescents (9-19 years old) who were admitted to the emergency department between 2011 and 2016 were evaluated retrospectively. Radial reformatted CT images from the femoral neck were created using the multiplanar reconstruction (MPR) method. The femoral neck was divided into 12 segments and alpha angle (AA), femoral head-neck ratio (FHNR) and center-edge angle (CEA) were measured from each segment. Additionally, images were evaluated for the physiological status (open or closed) of the triradiate- cartilage and proximal femoral epiphyses. 204 hips from 102 patients (32 females, 70 males) were retrospectively reviewed. There were 27 (26.5%) patients with cam-type morphology and 18 (17.6%) patients with pincer-type morphologies. No statistically significant difference was detected between the prevalences of cam and pincer morphologies between the two genders. Cam deformity was most frequently seen in anterosuperior segment. All of the patients (100%) with pincer-type morphology and 88% of the patients with cam-type morphology had closed triradiate cartilage, 89% of the patients with cam morphology and 83% with pincer morphology had open proximal femoral physis. Our results showed that prevalence of cam and pincer-type morphology in asymptomatic adolescents is similar to asymptomatic adults. Our findings also indicate that cam- and pincer-type FAI morphologies likely develop during late adolescence after closure of triradiate cartilage and before closure of proximal femoral physis. Level of Evidence - 3.
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March 2021

CT-guided Percutaneous Radiofrequency Ablation of Osteoid Osteoma with Double Nidi in One Session.

J Coll Physicians Surg Pak 2020 Dec;30(12):1348-1351

Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Osteoid osteoma with multiple nidi is a rare condition. The aim of this report is to share a case of an osteoid osteoma with two separate nidi, which underwent radio-frequency ablation (RFA) treatment under CT-guidance for each of the nidi in the same session. A 15-year girl with osteoid osteoma in left tibia was referred to our clinic for percutaneous RFA. She had pain that worsened at nights. The patient was diagnosed as osteoidosteoma, according to radiologic findings and the clinical symptoms. After CT-guided percutaneous RFA of each nidi in the same procedure, pain was relieved in 24 hours. Each of the RFA-treatments was successful in pain control without any complications and no recurrence occurred during eight months of follow-up period. To our knowledge, this case is one of the very few cases with double nidi, which was treated with RFA in one session. RFA is safe in treatment of osteoid osteomas; even two close and separate nidi can safely be treated in the same session. Key Words: Osteoid osteoma, Nidi, Treatment, Radiofrequency ablation.
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http://dx.doi.org/10.29271/jcpsp.2020.12.1348DOI Listing
December 2020

Postoperative Outcomes for Plate-Screw Fixation in Adolescent Patients with Ankle Fracture.

J Am Podiatr Med Assoc 2020 Nov;110(6)

Backround: We compared postoperative outcomes in adolescent patients who did and did not undergo plate-screw fixation of at least one of the lateral, medial, or posterior malleoli in ankle fractures. It was hypothesized that using plate-screw fixation would not negatively affect postoperative outcomes.

Methods: All of the preoperative data and postoperative outcomes for 56 patients with ankle fractures aged 12 to 15 years who underwent surgical treatment between January 1, 2007, and December 31, 2017, were reviewed retrospectively. Patients were grouped into plate-screw fixation (n = 15) and non-plate-screw fixation (n = 41) groups and as high- and low-energy trauma patients.

Results: There were no significant differences in postoperative outcomes between the plate-screw fixation and non-plate-screw fixation groups. The mean American Orthopaedic Foot & Ankle Society score of high-energy trauma patients was significantly lower than that of low-energy trauma patients (P < .001), and the rate of degenerative change in high-energy trauma patients was significantly higher than that in low-energy trauma patients (P = .008). There were no significant differences between high- and low-energy trauma patients with respect to other postoperative outcomes.

Conclusions: If anatomical reduction is performed without damaging the growth plate, postoperative clinical outcomes may be near perfect regardless of screw-plate fixation use. Postoperative outcomes of adolescent ankle fracture after high-energy trauma, independent of Salter-Harris classification and surgical treatment methods, were negative.
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http://dx.doi.org/10.7547/19-080DOI Listing
November 2020

Atraumatic hip dislocation in a 3-year old child with leukemia: A case report and review of the literature.

J Orthop Sci 2020 Sep 14. Epub 2020 Sep 14.

Department of Orthopaedics and Traumatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.jos.2020.08.001DOI Listing
September 2020

Our Ultrasound Guided Brachial Plexus Block Experiences for Upper Extremity Surgeries in Pediatric Patients.

Sisli Etfal Hastan Tip Bul 2020 1;54(2):231-235. Epub 2020 Jun 1.

Department of Anesthesiology and Reanimation, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objectives: Brachial plexus block is the most effective analgesia and anesthesia procedure for the upper extremity surgeries in pediatric patients. In recent years, ultrasound guidance for this procedure has reduced the fail and complications like pneumothorax, intravascular injection and nerve damage. However, the number of studies about brachial plexus block is not enough, particularly in pediatric patients, which remained under-researched. In our study, we aimed to discuss the efficacy and safety of the ultrasound-guided brachial plexus block in pediatric patients by retrospectively examining their data.

Methods: We retrospectively reviewed the data of pediatric patients who underwent ultrasound-guided brachial block in our clinic between January 2015-January 2017. Demographic data, diagnosis, procedure and operation times, medications, motor and sensorial block times were recorded.

Results: Between January 2015 and January 2017, the number of pediatric patients who underwent ultrasound-guided peripheral nerve block in our clinic was 24. In 15 of these patients, the supraclavicular block was applied in 15, and the infraclavicular block was applied in nine patients. The mean age of the patients was 9.6±3.12, with a male/female ratio 14/10. The mean duration of the procedure was 9.54±2.14 minutes in patients for the supraclavicular block and 12.9 ± 2.8 minutes for the infraclavicular block. The mean surgery time was 64±13.6 minutes. As a local anesthetic, bupivacaine was used in three patients; bupivacaine+lidocaine combination was used in 21 patients and adjuvants were added in eight patients. The block procedure was performed under general anesthesia in 12 patients and under sedation in 12 patients. The mean motor block time was 7.5±2 hours in patients who received supraclavicular block, and 7.4±1.5 hours in patients who received infraclavicular block. The mean sensorial block time was 10.5±1.7 hours in the supraclavicular block, and 10.45±1.15 hours in the infraclavicular block. The mean motor block period with added adjuvants was 7.7±0.5 hours, and the sensorial block period was 11.12±1.1 hours. No complications were seen during the procedure, intraoperative and postoperative follow-up.

Conclusion: Ultrasound-guided brachial plexus block in pediatric patients is effective and safe, with longer analgesia duration and lower complication rates. Prospective studies with a larger number of patients are needed in this regard.
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http://dx.doi.org/10.14744/SEMB.2018.98958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326672PMC
June 2020

The Effect of Single High-Dose Preoperative Intravenous Tranexamic Acid Administration to Reduce Blood Loss in Patients with Primary Total Knee Replacement.

Sisli Etfal Hastan Tip Bul 2019 21;53(2):137-142. Epub 2019 Jun 21.

Department of Orthopaedics, Health Sciences University Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Objectives: This study aimed to analyze the efficacy of single-dose tranexamic acid (TA) 20 mg/kg preoperatively to reduce blood loss in patients undergoing total knee replacement (TKR).

Methods: A total of 387 patients (82 males, 305 females) undergoing TKR between January 2014 and December 2018 were included in the study. The T + group was administrated intravenous (iv) TA 20 mg/kg 20 min before the skin incision. We determined perioperative blood loss, the amount of drainage postoperative 24 h, the amount of drainage after postoperative 24-48 h, total volume of drains, total volume of blood loss, postoperative hemoglobin and hematocrit levels, and amount of total blood transfusion.

Results: In terms of demographic data, no statistically significant difference was observed between the groups. Perioperative blood loss and total volume of blood loss was found statistically higher in T - group compared to T + group. Postoperatively, the mean hemoglobin and hematocrit levels of T - group were statistically significantly lower than T + group.

Conclusion: A single 20 mg/kg iv TA administration before TKR reduces bleeding during surgery and within 24 h postoperatively.
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http://dx.doi.org/10.14744/SEMB.2018.73604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199840PMC
June 2019

Survey on the surgical skills of orthopedics and traumatology residents from accredited and nonaccredited institutions in İstanbul.

Acta Orthop Traumatol Turc 2020 Mar;54(2):168-177

Department of Orthopedics and Traumatology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Objective: To investigate whether orthopedic and traumatology residents who are undergoing training achieve competence in surgical techniques after completion of their specialization and to determine whether there are significant differences between the responses of residents from accredited and nonaccredited institutions.

Methods: A total of 131 orthopedics and traumatology residents from nine institutions in the İstanbul province answered the questionnaire during the morning training meeting. In addition to basic demographic data, level of seniority, equipment competence, and theoretical and practical training, the residents were asked about their opinion on what type of surgeries they could perform after their specialization, considering the surgery and follow-up of the case as well as the complications occurring during this period. The residents responded to questions on 46 surgeries under the main headings of trauma, arthroscopy, arthroplasty, spine, pediatric orthopedics, hand surgery, deformity, and bone and soft tissue tumors. In addition to descriptive statistical methods, one-way analysis of variance, Tukey's multiple comparison test, and chi square test were used to evaluate the data. The significance level for the results was set at p<0.05.

Results: In total, 131 orthopedics and traumatology residents answered the questionnaire. Furthermore, 53 (40.5%) specialization students were employed at accredited institutions and 78 (59.5%) at nonaccredited institutions. According to the responses, case presentations, article-writing sessions, and in-province meetings held regularly at accredited institutions showed a significant difference compared to non-accredited institutions (p<0.05), and the residents at the accredited institutions benefited significantly more from the availability of books and electronic media in gaining theoretical knowledge (p<0.05). When the responses of the residents from accredited and nonaccredited institutions regarding 46 different surgeries were compared, a significant difference was found in 17 of them (p<0.05). There was a significant difference between the averages of residents' responses on the surgical fields they have interest for (p<0.05). It was determined that the residents believed that they could mostly perform surgeries in the fields of trauma, followed by arthroplasty, deformity, arthroscopy, pediatric orthopedics, hand surgery, and spine and tumor surgery. According to their level of seniority, a significant difference was found between the averages of residents' opinions regarding their surgical skill levels (p=0.02).

Conclusion: We believe that it would be beneficial for the trainers to take necessary precautions to increase the skill levels of the residents of orthopedic surgery. Accreditation significantly contributes to the standardization of education as well as quality improvement. Further action should be taken to increase the number of accredited clinics.
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http://dx.doi.org/10.5152/j.aott.2020.02.158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286170PMC
March 2020

Comparison of three surgical methods in the treatment of intraarticular comminuted distal radius fractures: Volar locking plate, non-bridging external fixator, and bridging external fixator.

Eklem Hastalik Cerrahisi 2019 Dec;30(3):224-32

Department of Orthopedics and Traumatology, Şişli Hamidiye Etfal Training and Research Hospital, 34381 Şişli, Istanbul, Turkey.

Objectives: The aim of this study was to evaluate both clinical and radiological results of intraarticular comminuted distal radius fractures treated with volar locking plate (VLP), non-bridging external fixator (NbEF), and bridging external fixator (BEF).

Patients And Methods: 95 patients (44 males, 51 females; median age 49 years; interquartile range (IQR), 37 to 60 years) who were treated with VLP, NbEF, or BEF due to intraarticular comminuted distal radius fractures between January 2010 and April 2014 were evaluated retrospectively. 34 of these patients were treated with a VLP (VLP group), 30 with a NbEF (NbEF group) and 31 with a BEF (BEF group). In the final follow-up, all patients were evaluated according to clinical and radiological parameters.

Results: The median follow-up was 5 (IQR, 4 to 6) years. The VLP and NbEF groups had better results than the BEF group in terms of wrist range of motion, loss of grip strength, Green O'Brien, Mayo Modified Wrist, The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and VAS scores. The VLP group had the most significant radiological improvement.

Conclusion: Although clinical and radiological results for intraarticular comminuted distal radius fractures are more significantly improved in patients treated with VLP, favorable results close to VLP can be also obtained with NbEF. The BEF seems to be the least effective treatment option among the three surgical methods.
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http://dx.doi.org/10.5606/ehc.2019.66955DOI Listing
December 2019

Examining implant superiority in the treatment of simple pertrochanteric fractures of the proximal femur in elderly patients.

Ulus Travma Acil Cerrahi Derg 2019 Jul;25(4):410-416

Department of Orthopedics and Traumatology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Background: The aim of this study was to compare the clinical and radiological results of the proximal femoral nail antirotation (PFNA) with those of the dynamic hip screw (DHS) and percutaneous compression plate (PCCP) in the treatment of simple pertrochanteric fractures.

Methods: A total of 203 patients were included in the study. PFNA fixations were performed in 73 patients (PFNA group), DHS in 68 patients (DHS group), and PCCP in 62 patients (PCCP group). The main outcome measurements were perioperative properties, the Harris hip score, changes in the neck-shaft angle, and loss of the abductor muscle strength. Data were compared between the groups.

Results: The mean estimated total blood loss and the number of patients receiving the blood transfusion rate in the PFNA group were statistically significantly lower. The mean operation and fluoroscopy times in the PCCP group were statistically significantly higher. The mean loss of the abductor muscle strength and changes in the neck-shaft angle in the PFNA group were statistically significantly higher. The mean Harris hip scores were similar.

Conclusion: Our findings demonstrated that although PFNA was superior with regard to the perioperative data, DHS and PCCP were superior in maintaining the reduction and the abductor muscle strenght. All three implants were similar and had satisfactory functional outcomes.
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http://dx.doi.org/10.14744/tjtes.2019.21270DOI Listing
July 2019

Functional and radiological outcomes of multiple dorsal carpometacarpal fracture dislocations treated with open reduction and internal fixation.

Eklem Hastalik Cerrahisi 2019 Aug;30(2):130-6

Department of Orthopedics and Traumatology, Şişli Hamidiye Etfal Training and Research Hospital, 34381 Şişli, Istanbul, Turkey.

Objectives: This study aims to evaluate the clinical and radiological results of patients with multiple dorsal carpometacarpal (CMC) joint fracture dislocations treated with open reduction and internal fixation (ORIF).

Patients And Methods: We evaluated 14 patients (12 males, 2 females; mean age 35.1 years; range, 22 to 64 years) between January 2013 and December 2017. Our main outcome measurements were the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, loss of grip strength, limitation of range of motion (ROM), and Kellgren-Lawrence osteoarthritis classification identified with radiographs and computed tomography images.

Results: The mean QuickDASH scores at seventh week and third month were 73.57 (range, 65-90) and 29.11 (range, 25-42.5), respectively. The mean QuickDASH score at seventh, ninth, and 12th month, and final follow-up was 4.64 (range, 0-30) and the QuickDASH score at these follow-up points was not 0 for only three patients. The mean loss of grip strength was 32.14% and two patients (14.29%) had limitation of ROM in third proximal interphalangeal joint at final follow-up. Four patients had grade I, nine patients had grade II, and one patient had grade III osteoarthritis according to Kellgren-Lawrence classification at final follow-up.

Conclusion: Although functional results demonstrated that multiple CMC joint fracture dislocations can be treated with ORIF, the high rate of osteoarthritis is a disadvantage.
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http://dx.doi.org/10.5606/ehc.2019.64279DOI Listing
August 2019

The Results of Core Decompression Treatment in Avascular Necrosis of the Femoral Head.

Sisli Etfal Hastan Tip Bul 2018 28;52(4):249-253. Epub 2018 Dec 28.

Department Orthopedics and Traumatology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Objective: Avascular necrosis of the femoral head (AVNFH) is a progressive disease seen in young, active patients, leaving significant disability in the joint when untreated. We retrospectively examined the results of patients with early stage AVNFH who had been operated in our clinic.

Methods: In our study, 65 hips of 46 patients were evaluated retrospectively. These patients were evaluated clinically by the Merle d'Aubigné-Postel Score and Harris Hip Score. The patients were radiologically staged according to the criteria by Ficat and Arlet with hip anterior-posterior and lateral graphs and magnetic resonance imaging.

Results: The mean follow-up period of the patient group was 73 months, and the mean age of the patients was 35 years. Of these patients, 59% were female and 41% were male; 41% had bilateral and 40% had right hip involvement. One of the patients developed AVNFH while she was pregnant, 7 were idiopathic, and 38 (81%) developed AVNFH due to steroid use. According to the Ficat and Arlet classification, 18 hips were found to be stage 1, 37 hips stage 2, and 9 hips stage 3 during admission. From the etiological point of view, 81% of the patients developed AVNFH while using steroid and 19% had idiopathic AVNFH. As for clinical improvement of the patients, the Harris Hip Score increased from 58 to 90 in idiopathic patients and 55 to 83 among steroid users. The Merle d'Aubigné-Postel classification scores increased from 6 to 15 in the idiopathic group and from 6 to 13 among steroid users. Radiologically, according to the Ficat and Arlet stage, progression was seen in all stages. Of the patients, 38.8% in stage 1, 70.2% in stage 2, and 88.8% in stage 3 showed progression, whereas 20% demonstrated rapid progression and needed total hip prosthesis. All patients who demonstrated progression were on chronic steroid therapy. The mean time to conversion to total hip replacement was 27 months.

Conclusion: Osteonecrosis is a disease associated with high morbidity. Early diagnosis can reduce morbidity and improve a patient's quality of life. Core decompression has the effect of stopping the progression of AVNFH in the early (stage 1) stages, although it has a significant and long-term palliative effect in all stages. Most of the young and active patients with AVNFH still do not have any ideal method for treatment today, but core decompression in the early stages has been seen to reduce morbidity. It is a time-saving attempt before the final treatment, which is hip arthroplasty, is performed.
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http://dx.doi.org/10.14744/SEMB.2018.47135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406557PMC
December 2018

Minimally invasive plate osteosynthesis for tibial derotation osteotomies in children with cerebral palsy.

Acta Orthop Traumatol Turc 2018 Sep 14;52(5):352-356. Epub 2018 Aug 14.

Ortopediatri Istanbul, Istanbul, Turkey.

Objective: Tibial derotation osteotomy can be used in the treatment of rotational deformities in case of ineffective conservative management. Our aim was to evaluate the results of the patients who underwent minimal invasive plate osteosynthesis for tibial derotation osteotomies.

Methods: Total of 16 patients (17 procedures) were included in this study. Mean age was 11.5 (3-25) years. We clinically assessed the tibial torsion by measuring the thigh-foot angle (TFA). No immobilization was used postoperatively and range of motion exercises were begun immediately. The patient was allowed weight-bearing activity, as tolerated, when callus formation was seen on the radiographs, at approximately three to four weeks after surgery.

Results: The mean follow-up time was 27.5 months. Mean preoperative and follow up TFA were 27° of internal rotation and 3.74° of external rotation, respectively. A mean of 22.3° improvement was achieved postoperatively. There was only one wound detachment, which was accepted as a complication and healed with local wound care.

Conclusions: The recurrence risk and correction loss can be decreased with plate-screw fixation. Minimal invasive surgery would also decrease the risk of wound complications.

Level Of Evidence: Level IV, Therapeutic study.
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http://dx.doi.org/10.1016/j.aott.2018.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205033PMC
September 2018

Surgical correction of hallux valgus deformity in children with cerebral palsy.

Acta Orthop Traumatol Turc 2018 May 22;52(3):174-178. Epub 2018 Feb 22.

Ortopediatri Istanbul, Istanbul, Turkey.

Objective: This study aimed to present a treatment algorithm for the correction of the hallux valgus deformity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results.

Methods: 29 patients (45 feet) were included in the study. The mean age of the patients at the time of the surgery was 14 (range 6-22) years. The mean follow-up was 33 (range 22-59) months. A reconstructive procedure was performed on 19 patients (27 feet); a soft tissue surgery and exostectomy of the bunion in six patients (11 feet); and MTP joint arthrodesis in four patients (7 feet). The hallux valgus angle (HVA) and the anteroposterior intermetatarsal angle (IMA) were used for radiologic evaluation and the DuPont Bunion Rating Score was used for clinical evaluation.

Results: The follow-up period was 36 (range 22-59) months in reconstructive group, 27 (range 24-29) months in soft tissue group, and 29 (range 23-41) months in MTP arthrodesis group. Significant improvements were detected in hallux valgus angle in three groups postoperatively but in soft tissue group correction loss was observed during follow up. Best results were achieved in arthrodesis group and worse in soft tissue group in terms of clinical evaluation.

Conclusion: According to our results isolated soft tissue procedures are ineffective in CP patients. Soft tissue procedure combined with metatarsal osteotomy has satisfactory results.

Level Of Evidence: Level IV, therapeutic study.
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http://dx.doi.org/10.1016/j.aott.2018.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136310PMC
May 2018

Legg-Calvé-Perthes disease in children with Down syndrome.

Acta Orthop Traumatol Turc 2013 ;47(5):334-8

Department of Orthopedics and Traumatology, Cerrahpaşa Medical Faculty, İstanbul University, İstanbul, Turkey.

Objective: The aim of this study was to describe the features of Perthes disease in patients with Down syndrome.

Methods: The data of this retrospective case series were collected between 2000 and 2011. Patients were assessed according to demographic, clinical and radiographic classifications.

Results: The study included 7 hips of 6 patients (5 males, 1 female). Mean age at first visit was 6.1 (range: 3.5 to 12.7) years and mean follow-up period was 52.3 (range: 30.2 to 90.8) months. Initial complaints were pain and limping with limited range of motion at the first visit. Range of motion tended toward early improvement despite continuous radiographic changes. One patient had late onset Perthes disease and developed rapid femoral head collapse managed with total hip arthroplasty.

Conclusion: Perthes disease in children with Down syndrome must be followed despite clinical improvement. Radiographic characteristics of Perthes disease in patients with Down syndrome do not differ from those without it.
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http://dx.doi.org/10.3944/aott.2013.3128DOI Listing
July 2014
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