Avascular necrosis (AVN) of the femoral head is one of the most important complications after closed reduction and spica cast application in developmental dysplasia of the hip (DDH) treatment. This study aims to put forth the impact of closed reduction age and other factors which can cause AVN. Inclusion criteria of the study were: closed reduction and spica cast application before walking age (12 months) and minimum 2 years duration of follow-up. The presence of femoral head ossific nucleus, International Hip Dysplasia Institute (IHDI) score, acetabular indices and AVN were evaluated from radiographies. Hip abduction angles were evaluated on CT images. The absence of the ossific nucleus at the closed reduction time and preoperative IHDI grade were not significant risk factors for AVN (respectively OR = 2.83; 95% CI, 0.99–8.07; P = 0.052; OR = 2.5; 95% CI, 0.85–7.32; P = 0.094). For the patients older than 10 months, (1) the absence of the ossific nucleus was a significant risk factor for grade 2 or higher AVN according to the Bucholz Ogden criteria (P = 0.020) and (2) the higher preoperative IHDI grade (IHDI 3–4) was a significant risk factor for AVN (P = 0.032). AVN of the femoral head was a significant risk factor for fair or poor clinical outcome (P = 0.001). It is not reasonable to wait for radiological visibility of the ossific nucleus to prevent femoral head AVN before applying closed reduction and spica cast, irrespective of the age interval.

The glenohumeral joint is the most mobile joint in the human body. Shoulder stability is provided by static and dynamic stabilizers and load resistance is ensured by these stabilizers. [1] Damage to these structures leads to dislocation and recurrent instability. Traumatic anterior instability or dislocation of the shoulder joint usually results in avulsion of the anterior inferior labrum. Bankart defined this lesion as the "essential lesion" of shoulder instability. [2] In addition to Bankart lesions, lesions in different areas of the labrum can occur, such as superior labrum anterior to posterior (SLAP) lesions. Superior labral tears were first defined by Andrews et al. in 1985. [2] Then in 1990, Snyder [3] coined the term SLAP lesions. With SLAP lesions, the superior labrum detaches along with the biceps tendon and the labral tear extends anteriorly from the posterior superior labrum. Snyder further classified SLAP lesions into four categories and over time different types of SLAP lesions were added to Snyder's classification. [3-5] The etiology of SLAP lesions remains uncertain. There Objectives: This study aims to compare the clinical results of patients with traumatic isolated Bankart lesions and type V superior labrum anterior to posterior (SLAP) lesions after arthroscopic repair. Patients and methods: Patients who underwent arthroscopic repair for traumatic anterior glenohumeral instability were evaluated retrospectively between December 2014 and January 2019. Fifty-one patients (49 males, 2 females; mean age 25 years; range, 18 to 36 years) without bone defects affecting >20% of the glenoid fossa, off-track engaging Hills-Sachs lesions, multidirectional instability, or ligamentous laxity were included in the study. Group 1 had 31 patients with isolated Bankart lesions and group 2 had 20 patients with type V SLAP lesions. There were only two female patients in group 1 and all patients were male in group 2. The mean age was 25 years (range, 18 to 36 years) in group 1 and 25 years (range, 19 to 35 years) in group 2. Rowe, Constant, and Western Ontario Shoulder Instability (WOSI) scoring systems were used to evaluate the clinical outcomes of the patients preoperatively and at the last follow-up. Results: The mean follow-up time was 32 months (range, 12 to 48 months) in group 1 and 28.5 months (range, 12 to 42 months) in group 2. There were no statistically significant differences between the two groups in terms of the number of shoulder dislocations before the surgery, mean age at the time of surgery, and the mean time from the first dislocation to surgical treatment. When the Rowe, Constant, and WOSI scores were evaluated preoperatively and at the last follow-up, there were statistically significant changes within, but not between, the two groups. Conclusion: In type V SLAP lesions, the affected and repaired labrum surface area is larger than isolated Bankart lesions. However, as a result of appropriate surgical treatment, the affected surface area does not have a negative effect on clinical outcomes, and s...

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Congenital talipes equinovarus (clubfoot) is a disease that is treated frequently in orthopedics clinics. Its incidence is 1-2 per 1,000 live births. [1] Cavus, adductus, varus, and equinus deformities are observed in clubfoot patients; [2] each of these contributes to various bone, muscle, vascular, and neurological problems. [3] Vascular deficiencies have been suggested as one of the underlying etiologies of clubfoot. Various studies using arteriography, [3] continuous wave Doppler ultrasonography (DU), [4] color Doppler ultrasonography (CDU), [2,4-6] and magnetic resonance image angiography [3,7] were performed to show arterial patterns in clubfoot patients. Deficiency of the anterior tibial artery and dorsalis pedis (dp) artery were demonstrated in 6.7-86% of patients. [4] Many researchers have reported that CDU is a reliable technique and can be used as a suitable alternative for arteriography. [1,8] Several CDU studies have been undertaken to investigate the arterial structures in clubfoot patients. In these studies, Objectives: This study aims to investigate whether resistive index (RI) and peak systolic velocity (PSV) are suitable parameters to determine if a clubfoot differs from feet of the normal population. Patients and methods: Fifty-four feet of 27 clubfoot patients (22 males, 5 females; mean age 30.4±16.3 months; range, 5 to 72 months) were included in this retrospective study conducted between December 2017 and January 2019. Twentyseven feet were conservatively treated, 19 had surgical treatment, and eight feet were healthy in patients with unilateral clubfoot. In addition, 22 feet of 11 normal controls (6 males, 5 females; mean age 33.4±15.3 months; range, 15 to 60 months) were studied. Color Doppler ultrasonography examinations were performed to evaluate the three major arteries of the leg and foot: dorsalis pedis (dp), tibialis posterior (tp), and popliteal (pop). Color filling, flow direction, spectral analysis, velocity, and RI were examined. Results: With the exception of the dp artery RI, the PSV and RI values for all arteries differed significantly from those of the control group. There were no significant differences among the conservative, surgical, and healthy groups, while there were significant differences between each of the treated groups and the control group. Tibialis posterior artery PSV and pop artery RI were the best parameters to identify clubfoot and the cutoff points were 54 cm/second and 0.77, respectively. Conclusion: Peak systolic velocity and RI may be accepted as important parameters for identification of clubfoot deformity. Tibialis posteriorartery PSV and pop artery RI are the bestdetailed parameters for this examination.