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Because of the low complication rate, dry needling is a safe method, and it might be an effective treatment option for LE.

Closed total talus dislocation from tibiotalar, subtalar, and talonavicular joints is a very rare injury. A 25-year-old young man, who had severe ankle distortion while walking down a flight of stairs, was brought to the emergency room complaining of a deformity and pain in his ankle joint. Roentgenographies revealed total talar body extrusion. The patient was treated urgently with open reduction in the authors' clinic. Tibialis posterior tendon might prevent closed reduction so open reduction with retraction of the tendon may be necessary.

Although shoulder dislocations have been seen very frequently, inferior dislocation of shoulder constitutes only 0.5% of all shoulder dislocations. We share our 4 patients with luxatio erecta and present their last clinical control. 2 male and 2 female Caucasian patients were diagnosed as luxatio erecta. Patients' ages were 78, 62, 65, and 76. All patients' reduction was done by traction-abduction and contour traction maneuver in the operating room. The patients had no symptoms and no limitation of range of motion of their shoulder at their last control. Luxatio erecta is seen rarely, and these patients may have neurovascular injury. These patients should be carefully examined and treated by the orthopaedic and traumatology surgeons.

Accurate reduction and maintenance of the stability with correct implant positioning is critical for surgical treatment of tibial plateau fractures. Our technique includes an arthroscopic reduction and fixation of Schatzker type III tibial plateau fractures with a bulls-eye screw placement without fluoroscopy control. With the arthroscopic guidance, an anterior cruciate ligament drill guide is placed and a K-wire sent to the midpoint of the depressed fragment through the guide at a 40 angle to the coronal axis of the tibia. A tunnel is created with the drill over the K-wire. The depressed fragment is further augmented with gentle impacts over the K-wire. After arthroscopic reduction control, an appropriatesized iliac graft is pushed until it is below the depressed fragment. The targeting device is adjusted at 130 so that it is parallel to the joint line and a K-wire sent through the device so that it would pass just below the graft. The graft is then supported with cannulated screws sent over the K-wire. This technique provides an arthroscopic reduction of the chondral surface and precise placement of the rafting screws without fluoroscopy.L ong-term clinical results of tibial plate fractures are dependent on the quality of the intra-articular reduction of the articular surface. 1 Excessive dissection of the injured soft tissue envelope and devitalization of bone fragments are the primary concerns of the open techniques. To eliminate the problems related to the open techniques, many authors recommended minimally invasive reduction and stabilization techniques such as isolated lateral plating with medial external fixation, hybrid external fixation, tensionedwire fixation, and percutaneous reduction. [2][3][4] In Schatzker type III tibia plateau fractures, exploration of the fracture site is challenging because the lateral plateau is not displaced. Arthroscopic reduction and internal fixation are recommended as a safe and reliable method for treatment of tibia plateau fractures. 4 With arthroscopic-assisted techniques, the reduction of the depressed fragment can be performed indirectly without excessive dissection.Inherent advantages of arthroscopic-assisted techniques include less soft tissue stripping and lesser wound site complications. To avoid these complications, arthroscopic-assisted techniques that involve restoration of the depressed joint surface and grafting under the

ObjectiveTo evaluate the midterm clinical and radiological outcomes of the medial approach using two intervals for developmental hip dysplasia (DDH).MethodsThe study involved 62 hips of 47 patients (41 girls, 6 boys) treated with medial approach for DDH from 1999 to 2010. The age of the patients at surgery was 18.7 ± 2.25 months. Follow up of the patients was 11.3 ± 3.07 years. The age of the patients at the last follow up was 12.6 ± 1.74 years. According to the Tönnis classification, 13 hips were grade II, 27 hips were grade III and 22 hips were grade IV. Patients were evaluated according to Omeroglu radiological criteria and modified McKay functional criteria. The presence of avascular necrosis (AVN) of the hip was questioned using the KalamchiMacEwen classification.ResultsRadiologically, forty eight (77%) hips were evaluated as “excellent”, 8 (13%) hips as “good” and 5 (8%) hips as “fair plus” and 1 (%2) hip as “fair minus”. Two (3%) patients had type 1 temporary AVN and one (1%) patient had type 4 AVN with coxa magna and overgrowth of the greater trochanter. According to McKay functional criteria, 56 (90%) hips had “excellent” and 6 (10%) had “good” results. Two (3.2%) hips of one patient had to be reoperated with Salter osteotomy and femoral shortening + derotation osteotomy.ConclusionMedial approach using two separate intervals for tenotomy and capsulotomy does not jeopardize the medial circumflex or the femoral vessels and yields satisfactory midterm results for children 18 months old with dysplasia of the hip.Level of evidenceLevel IV, therapeutic study.

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