Kahraman, Hamit Çaǧlayan; Şibar, Kemal; Alemdaroǧlu, Kadir Bahadir; Subaşi, İzzet Özay; Gökgöz, Mehmet Burak

Three-point index (TPI), which can be used in the follow-up of conservative treatment, is an important indicator and reveals objective results about the fracture redisplacement. The hypothesis of the current study was that an initial TPI value of 0.6-0.8 may also be dangerous as it has the potential to exceed over 0.8 before a sufficient consolidation occurs and a prompt revision of the cast may prevent an upcoming displacement. This prospective controlled study 84 patients between 4 and 16 years of age, with radius distal metaphyseal fractures with more than 30% displacement or more than 15° initial angulation, were included. All of the patients in the groups had no redisplacement at 5-7 days and had TPI between 0.6 and 0.8. The patients who had cast replacement and adjusted TPI below 0.6 were included Group 1. The patients who had no cast replacement were included in Group 2. Redisplacement was observed in 8 of 38 (21%) patients in the Group 1 and in 27 of 46 (58%) patients in the Group 2 (P value 0.001). Redisplacement with cast revision was 2.8 times less (P < 0.005). The first reduction quality, fracture obliquity, renewed TPI values were found to be statistically significant for the prediction of redisplacement (P < 0.005). We recommend that the follow-up of the TPI is an important predictive factor in the conservative treatment of pediatric metaphyseal radius fractures. TPI may be renewed for protection of the fracture reduction when calculated in the gray zone which is 0.6-0.08.

Subaşi, İzzet Özay; Alemdaroǧlu, Kadir Bahadir; Arican, Gökhun; Iltar, Serkan; Şibar, Kemal; Özmeriç, Ahmet

Three-point index (TPI) has been reported to be effective in predicting the displacement of forearm fractures. The aim of this prospective study was to investigate the clinical efficacy of recasting critical but acceptable casts according to three-point index (0.6 < TPI < 0.8) before a redisplacement occurs in childhood forearm fractures. A TPI of 0.6-0.8 was determined in 68 patients, and these were separated as group 1 (n = 34) applied with prophylactic recasting and group 2 (n = 34) where treatment was continued with same cast. The remaining 28 patients had TPI < 0.6 and were assigned as group 3. Groups were compared in respect of age, initial displacement, cast type, location of fracture, initial and late three-point index values and inter-and intraobserver reliabilities of TPI measurements. Significantly less displacement was seen in group 1 than in group 2 (P = 0.004). It was found that a 0.1 increase of index value in the initial and late TPIs increases the probability of redisplacement by 5.06 and 7.78 times, respectively. Late TPI, measured 1 week after casting, had better predictive value than the initial TPI with a sensitivity of 77.8%, specificity of 92.3%, positive predictive value of 70% and negative predictive value of 94.7%. Patients in the grey zone will be able to safely complete the cast treatment with prophylactic recasting without surgical intervention. TPI should be remeasured at the end of first week, as its predictive value becomes more accurate after swelling subsides.

Camurcu, Yalkin; Ucpunar, Hanifi; Karakose, Resit; Ozcan, Seckin; Sahin, Vedat

This study aimed to comparatively evaluate the quality of life scores of patients with pediatric flexible flatfoot (PFF) according to the use of foot orthoses. We also aimed to compare quality of life scores of children and their parents. Nonobese children aged between 5 and 10 years old who were diagnosed as PFF according to physical and radiological examinations were included in this cross-sectional comparative study. All children and their parents completed the Turkish translation of Oxford ankle foot questionnaire (OxAFQ) which contains four domains (physical, school and play, emotional, and footwear). Patients were grouped according to the use of foot orthoses (group I: no foot orthoses group and group II: foot orthoses group). Comparison of OxAFQ scores demonstrated no significant differences between the two groups. However, the mean emotional scores of parents were significantly lower in group II (P= 0.007). In group I, the mean emotional score of children was significantly lower compared to their parents’ scores (P= 0.001). In group II, the mean physical score of children was significantly lower compared to their parents’ scores (P= 0.003). According to our results, we observed no significant difference in terms of quality of life scores between children using foot orthoses and not using foot orthoses. However, we observed significantly lower emotional scores in parents whose children were using foot orthoses. We recommend that physicians should be aware of low physical scores in children with PFF and should inform parents about this situation rather than considering foot orthoses to relieve parents’ concern about foot deformity.

Issin, Ahmet; Öner, Ali; Koçkara, Nizamettin; Çamurcu, Yalkin

In the treatment of developmental dysplasia of the hip, concentric reduction of the femoral head into the acetabular cavity plays a key role in the natural development of the acetabulum. However, there is still debate on the need for additional acetabular osteotomies and their timing. In this study, we compared open reduction (OR) alone with OR plus Dega osteotomy for acetabular index (AI) development. Twenty patients, 10 in each group, who underwent either OR alone or OR plus Dega osteotomy were studied retrospectively. All patients were diagnosed with developmental dysplasia of the hip and none of them received treatment previously. Preoperative, early postoperative, and follow-up radiographs were gathered, radiological grading was performed according to Tönnis, and AI angles were measured. The OR group had a mean age of 24.5 months, whereas the Dega group had a mean age of 24.8 months. The mean follow-up period of the OR group and Dega group was 57.8 and 66.6 months, respectively. In the OR group, the initial mean AI was 37.5° whereas in the Dega group it was 46°. After the follow-up, despite the acetabular development in the OR group being twice as fast, the final mean AI was 25.5, whereas it was 15.9 in the Dega group. The difference was statistically significant (P<0.05). Using Tönnis' definition, the Dega group ended up with 70% normal hips, 20% mild dysplasia, and 10% severe dysplasia, whereas the OR group had 20% normal hips, 30% mild dysplasia, and 50% severe dysplasia at the final visit. There was no correlation between the initial radiological grading of dislocation and the final result. OR plus Dega osteotomy is a good option to regain acetabular coverage over the femoral head. It provides better radiographic results after a 5-year follow-up period in patients with a mean age of 25 months. OR alone should not be performed unless the child had mildly dysplastic acetabulum according to Tönnis' definition. Level of evidence: Level III, retrospective comparative study.