Several factors such as nutritional deficiencies, use of antiepileptic drugs can lead alterations in the hematologic status of children with cerebral palsy (CP). This issue may increase the risk of peroperative hematologic complications in these children. We aimed to evaluate the preoperative routine hematologic tests of CP patients to clarify such peroperative risks.

Hemoglobin (HGB), hemotocrit (HTC), red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCHB), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), white blood cell count (WBC), platelet count (PLT), phrothrombine time (PT), activated partial thromboplastin time (APTT) and plasma fibrinogen concentration (FIB) of 62 consecutive CP patients (28 girls, 34 boys) whose mean age was 8.8 years (2–16) were retrospectively compared with the ones of 130 consecutive patients (64 girls, 66 boys) whose mean age was 9.2 (2–16) years and who did not have any skeletal, cranial, thoracic, abdominal or major soft tissue injury, plus any other infectious, metabolic, hematologic or malign tumoral disorder. None of the patients had any other surgical intervention within the last 12 months and all patients underwent an orthopaedic intervention under general anesthesia.

CP and control groups were similar concerning age (P=0.512) and gender (P=0.598). We observed similar mean values between CP and control groups, regarding HGB (P=0.147), HTC (P=0.189), RBC (P=0.598), MCV (P=0.541), MCHB (P=0.389), MCHC (P=0.450), RDW (P=0.072), WBC (P=0.262), PLT (P=0.634), PT (P=0.060), APTT (P=0.254) and FIB (P=0.722). In the CP group, we found no difference between GMFCS I and II level and GMFCS III and IV level patients regarding HGB (P=0.061), HTC (P=0.050), RBC (P=0.598), MCV (P=0.541), MCHB (P=0.389), MCHC (P=0.450), RDW (P=0.072), WBC (P=0.568), PLT (P=0.453), PT (P=0.414), APTT (P=0.203) and FIB (P=0.722).

We can conclude that, CP patients, treated in the Orthopaedics clinics, have similar preoperative routine hematologic tests, with the ones of other orthopaedic patients. Therefore, CP patients, undergoing orthopaedic interventions, carry similar peroperative hematologic risks like other orthopaedic patients. Besides, walking ability of CP patients does not infiuence the preoperative routine hematologic tests.

We aimed to report our initial experience with the use of cementless, rectangular, dual-taper, straight femoral stem (SL-PLUS) with bipolar head prosthesis in femur neck fractures.

We operated 50 consecutive patients (28 women, 22 men; age ranged from 41 to 99 years; mean age 74) due to femur neck fractures and inserted the above-mentioned prosthesis. We used cemented femoral stem in severely osteoporotic patients. According to the Garden’s classification, there were 12 type II, 34 type III and 4 type IV fractures. We used direct lateral or posterolateral approach to insert the prosthesis. The entire operating time did not exceed 90 minutes and severe bleeding was not seen, in any patient. All patients were allowed to full weight bearing by a walker within the first postoperative 48 hours. We could evaluate the functional outcome of 25 patients who survived and had at least 6 months complete follow-up. We used Harris’ hip score for evaluation of the patients’ functional outcomes. Eight patients were lost to follow-up within the first postoperative 3 months, 15 patients died within the first postoperative 8 months and two patients could not walk due to an initial cerebrovascular disorder. The data of 15 patients, who passed away, showed that, mean age was 82 (70–99) years, 13 of 15 them were older than 75 years, 9 were man and 6 were woman, there were 2 type 2, 11 type 3 and 2 type 4 fractures.

Mean age of the included patients was 70 (41–88) years. There were 18 women and 7 men. There were eight type II, 15 type III and 2 type IV fractures. After a mean follow-up period of 17 (6–27) months, the mean hip score of 25 patients was 77 (51–96) points. There were two excellent (90–100 pts), 7 good (80–89 pts), 12 fair (70–79 pts) and 4 poor (< 70 pts) functional outcomes. Similar mean hip scores were observed between ≤70 (77.9 pts) and > 70 years (75.8 pts) age groups (P=0.849), between man (78.0 pts) and woman (76.1 pts) patients (P=0.297) and between Garden type II (70.9 pts) and Garden types III–IV (79.3 pts) fractures (P=0.075).

The rate of obtaining a satisfactory or fair functional outcome in the surviving elderly patients who were initially treated using a cementless, rectangular, dual-taper, straight femoral stem with bipolar head prosthesis due to femur neck fractures was 84% at the early postoperative period. Age, gender and type of the fracture do not influence the functional outcome. The risk of early postoperative mortality seems to increase in patients older than 75 years and with displaced fractures.

This kind of prosthesis can be preferred to lessen the operation time, intraoperative bleeding, to avoid the peroperative complications due to bone cement application and to allow early postoperative rehabilitation in femur neck fractures of the geriatric population.

The aim of this retrospective study was to assess the effects of several preoperative and intraoperative factors on the final clinical and radiological outcomes in pediatric hip fractures.

Forty-four pediatric patients with a hip fracture were treated at our department between January 1998 and September 2007. Thirty-nine patients with a minimum follow-up period of 1 year were included the study. Three patients had inadequate follow-up and two died at the early postoperative period. Mean age of 39 patients were 11.1 (4–16) years. There were 22 boys and 17 girls. The two main etiologic factors were traffic accident and fall from height. Associated injury was present in 15 patients and the pelvis and distal radius fractures were the two most common. The type of the hip fracture according to the Delbet classification was type II in 21, type III in 14 and type IV in 4 patients. Two patients were treated by a hip spica under general anesthesia and 37 were surgically treated by internal fixation using mostly 3 cancellous screws. Ratliff’s clinical and radiological assessment system was used to assess the final outcome and Ratliff’s classification was used for grading the avascular necrosis of the femoral head (AVN). The effects of patient age, gender, fracture type, fracture displacement, laterality, intervention time and capsulotomy on the final outcome were evaluated and a P value less than 0.05 was considered significant.

Mean follow-up was 3.1 (1–9.5) years and the final outcome was satisfactory (good) in 28 (72%) and unsatisfactory (fair or poor) in 11 (28%) patients. AVN was observed in 11 (28%) patients. No significant correlation was found between the final outcome and age (< =10 yrs vs. > 10 yrs; P=0.288), laterality (P=0.477), gender (P=0.158), intervention time (< =24 hours vs. > 24 hours; P=1.0), capsulotomy (P=0.609) or amount of displacement (displaced vs. non-displaced; P=0.078). However, there was a significant correlation between the final outcome and fracture type (worst in type II; P=0.014).

The risk of AVN is nearly 30% in pediatric hip fractures and it is the main determinant of the final outcome. The final radiological and clinical outcomes are correlated significantly with fracture type. Besides, fracture displacement may influence the final outcome. As, cervical femoral neck fractures (mainly displaced) have a higher risk of unsatisfactory outcome in children, the patients and parents should initially be warned about this subject.

Purpose: The aim of this retrospective study was to assess the correlation between the occurance of iatrogenic ulnar nerve injury and frontal and saggital angular insertion of the medial pin in pediatric type 3 supracondylar humerus fractures treated with closed reduction and percutaneous fixation using a crossed-pin configuration.

Method: Among 164 patients with type 3 supracondylar humerus fractures, treated with closed reduction and percutaneous fixation using a crossed-pin configuration while the elbow was in hyperflexion, between 1999 and 2003, ninety patients (54 male and 36 female, mean age 6.1 years) with complete clinical and radiological records and follow-up period of at least 6 months were included the study. Frontal humerus-pin angle (FHPA) was the angle between the long axis of humerus and the axis of the medial pin measured on an anteroposterior radiograph. Saggital humerus-pin angle (SHPA) was the angle between the long axis of humerus and the axis of the medial pin measured on a lateral radiograph and expressed as a positive value if the medial pin direction was anteroposterior and as a negative value if the direction was posteroanterior. All the mesurements were made by the same observer blinded to the clinical records of the patients.

Results: Postoperative ulnar nerve injury was observed in 18 patients. The ulnar nerve injury group and control group were similar with respect to age and gender. Mean FHPA was 36.6 and 33.8 degrees in ulnar nerve injury and control groups respectively (p=0.270). Mean SHPA was 12.1 and 1.6 degrees in ulnar nerve injury and control groups respectively, and the difference was significant (p=0.001). All the patients with ulnar nerve injury had complete recovery within 3 months following surgery.

Conclusion: There are several methods to avoid iatrogenic ulnar nerve injury in supracondylar fractures such as insertion of two or three lateral pins, insertion of the medial pin while the elbow is less than 90 degrees of flexion. The findings of this retrospective study revealed that there was a considerable correlation between the occurence of iatrogenic ulnar nerve injury and sagittal angular insertion of the medial pin. We suggest that if a crossed-pin figuration is desired, it is better to insert the medial pin neutral or posteroanterior direction in the sagittal plane if the elbow is in hyperflexion.

Purpose: The aim of this prospective controlled study was to assess the natural history of acetabular development in D.D.H. treated under 18 months of age.

Method: For this purpose, patients who were treated using a posteromedial approach soft tissue surgical procedure due to unilateral D.D.H., had intraoperative radiographic anatomic reductions, had neither any type of avascular necrosis of the femoral head nor breakage of the Shenton’s line during the follow-up period, had complete follow-up till at least 10 years of age and had normal center-edge angles at the latest follow-up were selected from a prospective series that started in December 1993. Unaffected contrlateral hips were used as controls. Fourteen hips of 14 patients (13 females and 1 male) met the above mentioned strict criteriae and included the study. Acetabular angle of Sharp (AA) was measured to assess the acetabular slope in the frontal plane preoperatively and during follow-up. A paired t-test was used for the statistical analysis of the data and a P value less than 0.05 was considered significant.

Conclusion: In anatomically reduced and uncomplicated dysplastic hips which have been treated under 18 months of age, acetabular slope in the frontal plane tends to improve continuosly till at least 10 years of age and reaches to similar angular values as in the unaffected hips at nearly 7 years of age. In such hips, it may not be appropriate to make a final decision on whether the acetabular development is sufficient or not before 7 years of age.

Purpose: The purpose of this study was to evaluate a possible correlation between DDH and lumbosacral spina bifida occulta (LSSBO).

Patients and Methods: This multicentric study included the assessment of anteroposterior pelvic radiographs of 415 adolescents and adults without any bilateral clinical and radiological hip joint abnormality and of latest radiographs of 291 adolescent and adult patients who had treated or untreated DDH which had occured unilaterally or bilaterally. Control group included 332 females and 83 males and mean age was 38±17 (12-70) years. DDH group included 246 females and 45 males and mean age was 30±17 (12-80) years.

Results: Female/male ratio of both groups was statistically similar (p=0.124). Rate of LSSBO was 12% and 23% in the control and DDH groups, respectively (p< 0.001). S1 and L5 vertebrae were the two most common involved sites in both groups. There wasn’t any significant correlation between the rate of LSSBO and the involved hip side in the DDH group (p=0.336). In females, rate of LSSBO was 9% and 23% in the control and DDH groups, respectively (p< 0.001). In males, rate of LSSBO was 22% and 24% in the control and DDH groups, respectively (p=0.893).

Conclusion: In females, DDH is significantly accompanied by LSSBO and LSSBO may be considered as a risk factor for DDH. Further intrauterine studies are needed for better understanding of this fact. It may be better to perfom ultrasonographic hip screening for the newborns who has an evident posterior vertebral arch defect without any intraspinal anomaly which has been seen during fetal ultrasonography.