Background: The study aimed to compare the outcomes of combined calcaneocuboid arthrodesis and split anterior tibialis tendon transfer (SPLATT) procedure to isolated SPLATT surgery for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). Methods: Forty-one ambulatory CCP with 56 equinovarus feet, with positive flexor withdrawal reflex test results, were studied. The average age was 9.1 ± 3.2 years (range 3-22). Patients were assigned into 2 groups based on the surgical procedures. Patients in group 1 underwent isolated SPLATT surgery, whereas patients in group 2 underwent the SPLATT procedure combined with calcaneocuboid arthrodesis. All feet were followed for at least 12 months after surgery. Patients were evaluated preoperatively and at the most recent follow-up visit. The hindfoot positions were assessed using Chang’s criteria, the functional outcomes were assessed using Kling’s criteria, and the ambulatory levels were assessed using the Gross Motor Function Classification System (GMFCS). Results: Patients were followed for an average of 30.4 ± 14 (range 14-84) months. We found no difference between the groups in Chang’s scoring ( P = .550), better clinical outcomes ( P = .034) according to the Kling criteria in SPLATT with calcaneocuboid fusion group, and postoperative GMFCS levels better in the SPLATT with calcaneocuboid fusion group ( P = .025). Conclusion: In this retrospective comparative study to treat children with spastic equinovarus feet, patients who had the SPLATT procedure combined with calcaneocuboid arthrodesis generally resulted in better functional outcomes compared to isolated SPLATT surgery in spastic equinovarus foot. Level of Evidence: Level III, retrospective cohort study.
Aim The rapid spread of COVID-19 infection around the world has integrated some precautions and restrictions. In this new period, disruptions and re-prioritizations were experienced in medical practices. The aim of this study is to reveal the changes in the outpatient clinics and surgical services in the practice of Orthopedics and Traumatology in Turkey from the perspective of both residents and specialist physicians with a survey study. Materials and Methods In order to evaluate the changes, a survey was prepared which had consisted 42 and 45 questions for residents and specialist working in Turkey, respectively. The survey was published online between December 6, 2020 and January 31, 2021. Data analysis were performed by dividing into 4 subgroups: 1) Demographic information, 2) Changes in internal tasking and working conditions, 3) Variety of services provided and changes in patient applications, 4) Changes in the health care delivery process. Results From all over Turkey 62 residents and 230 specialists participated in the survey. 80.4% (185) of the specialists participating in the study and 96.8% (60) of the residents were working in the pandemic hospital. During the pandemic, it was determined that the working hours of physicians were reduced by almost half, and also there was a decrease in the variety and quantity of elective cases. Furthermore, it was observed that the number of applications to emergency services and outpatients clinics decreased during this period. In addition to increased neglected trauma cases, increment of treatment rejection rates are among the observed results. Conclusion During the pandemic period, it is observed that there are significant disruptions in orthopedics and traumatology health care delivery and training processes. In the light of experiences, it is crucial to prepare health service action plans for other possible pandemic situations or new waves of COVID-19 due to mutations.
Objectives This study aimed to evaluate the treatment outcomes of patients treated with induced membrane technique (IMT) for the reconstruction of bone defects and to identify factors associated with the success and failure of the modified technique. Patients and methods Between January 2016 and April 2021, a total of 23 adult patients (20 males, 3 females; median age: 39.9 years; range, 20 to 69 years) who underwent bone reconstruction using the IMT for established pseudoarthrosis and acute bone loss were retrospectively analyzed. Fracture type, the size and location of bone defect, the nature of the index injury, the type of fixation, the interval between stages of the operation, and any diagnosis of infection or other complications of the patients were assessed. Results The median bone union was achieved in 6.6 (range, 4 to 11) months. The median index of reconstruction was 19 (range, 10 to 30%). The main complications were recurrent infection in two cases and nonunion in one case. Massive graft resorption occurred in two cases. Conclusion Immediate internal fixation is a reliable and effective method in the treatment of complex bone defects. A large volume of autograft is required for the reconstruction of long defects, which presents as a limiting factor, particularly in patients undergoing previous surgical interventions.
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