Flexible flatfoot is a common deformity in pediatric and adult populations. In this study, we aimed to evaluate the functional and radiographic results of subtalar arthroereisis in adult patients with symptomatic flexible flatfoot. We included 26 feet in 16 patients who underwent subtalar arthroereisis for symptomatic flexible flatfoot. Radiographic examination included calcaneal inclination angle, lateral talocalcaneal angle, Meary’s angle, anteroposterior talonavicular angle, and Kite’s angle. The clinical assessment was based on the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and a visual analog scale (VAS). The mean follow-up was 15.1±4.7 months. The mean preoperative AOFAS score was 53±6.6, while the mean AOFAS score at the last follow-up visit was 75±11.2 (P<0.05). The mean visual analog scale score was 6.9±0.6 preoperatively and 4.1±1.4 at the last follow-up visit (P<0.05). The mean preoperative and postoperative values measured were 13.4°±3.3° and 14.6°±2.7° for calcaneal inclination angles (P<0.05); 35.7°±6.9° and 33.2°±5.3° for lateral talocalcaneal angles (P>0.05); 8°±5.3° and 3.3±3 for Meary’s angles (P<0.05); 5.6°±3.5° and 2.6°±1.5° for anteroposterior talonavicular angles (P<0.05); and 23.7°±6.1° and 17.7°±5° for Kite’s angles, respectively (P<0.05). Implants were removed in three feet (11.5%). Subtalar arthroereisis is a minimally invasive procedure that can be used in the surgical treatment of adults with symptomatic flexible flatfoot. This procedure provided radiological and functional recovery in our series of patients.
Background To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.
ÖzetTibia kırıklarının cerrahi tedavisi kırığın yerine, yumuşak dokunun durumuna, kırığın yer değiştirme miktarına göre değişmektedir. İntramedüller çivi-leme tibia kırıkları için altın standart tedavi olarak kabul edilmektedir. Bu çalışmada, şişirilebilir intramedüller çivi kullanılarak tedavi edilen tibia cisim kırıklarının fonksiyonel ve radyografik sonuçları değerlendirildi. 2013-2015 yılları arasında kapalı tibia kırığı olan ve şişirilebilir intramedüller çivi ile tedavi edilen 17 hasta (10 erkek, 7 kadın; 8 sağ, 9 sol; ortalama yaş 40.7 yıl) çalışmaya alındı. Hastaların kırık oluşumundan ameliyata kadar geçen süre ortalaması 2 gün (dağılım, 0-6) idi. Ortalama hastanede kalış süresi 6 gün (dağılım, 2-19), ortalama takip süresi 15.4 ay (dağılım, 9-25), hastaların ameliyat sonrası günlük aktivitelerine dönüş süresi ortalaması 4.5 ay (dağılım, 4-6) idi. Ortalama ameliyat süresi 47.5 dakika (dağılım, 35-80) olarak tespit edildi. Hastaların hiçbirinde majör komplikasyon tespit edilmedi. Bir hastada kaynama gecikmesi, dört hastada ise erken ameliyat sonrası dönemde diz önü ağrısı ve ayak bileği ağrısı tespit edildi. Şişirilebilir intramedüller çiviler AO/OTA sınıflamasına göre A ve B tip tibia orta cisim kırıklarının cerrahi tedavisinde güvenli ve etkili olduğu görüşündeyiz. Anahtar KelimelerŞişirilebilir İntramedüller Çivi; Tibia Kırıkları; Genişletilebilir Çivi; Cerrahi AbstractThe treatment strategy for tibial fractures differs with fracture location, displacement, soft tissue condition and comminution. Intramedullary nailing is considered the gold standard treatment for tibial fractures. In this study, the functional and radiographic results of tibial shaft fractures repaired with the inflatable intramedullary nail method were evaluated. From 2013 to 2015, 17 patients (10 males, 7 females; 8 right, 9 left; mean age 40.7 years) with closed tibial fractures repaired with inflatable intramedullary nails were assessed. The time from injury to surgery was an average of 2 days (range, 0-6 days). The mean time of hospital stay was 6 days (range, 2-19 days).The mean follow-up time was 15.4 months (range, 9-25 months). The mean time for patients to return to normal daily activities was 4.5 months (range, 4-6 months). The mean operation time was 47.5 min (range, 35-80 min).
Background: To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods: Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results: The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions: Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.
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