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    Accurate calculation of limb length discrepancy using scoliosis radiography
    (2019) Yenigul, Ali Erkan; Batibay, Sefa Giray
    Aim: When we want to determine the difference in leg height by using only scoliosis radiographs in patients with scoliosis; we have looked for answer to the question of where should be the accurate measurement point for values that are closest to reality.Material and Methods: In this study 129 patients of our hospital between December 2016and 2018 with scoliosis radiography and leg height graphies were detected. The actual leg height difference was calculated on leg height graphies. Afterwards, the right and left femoral head top points were determined on scoliosis graphy. A parallel line was drawn from the top of the right femoral head. By measuring the distance of this line to the top point of left femur; difference between right and left legs was calculated. The same procedure was repeated after determining the right and left acetabulum top points and right and left iliac wing top points Results: A total of 129 patients, including 45 male and 84 female patients, were evaluated. Significant results were obtained from the correlation analysis between the leg length difference of the total patients and the distance between the acetabulum (p0,0001).Statistically significant correlation was found between iliac wing distance and femur length difference measurements (p0,0001).A significant correlation was detected between Femur head top spot difference measurements and length differences that were measured with orthoroentgenogram (p0,0001). Conclusion: The difference between the top point of the femoral head, the acetabulum or the iliac wing can be used on scoliosis graphy which was taken during the follow-up of leg length discrepancy in scoliosis patients.Keywords: Scoliosis; limb length discrepancy; radiography; osteogenesis.
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    Effects of bilateral knee arthroplasty on sagittal spinopelvic balance in patients with primer degenerative osteoarthritis
    (2020) Akgul, Turgut; Batibay, Sefa Giray; Camur, Savas; Koca, Huseyin; Kaya, Ozcan; Saglam, Necdet; Bayram, Serkan
    Aim: We aimed to evaluate the change in sagittal spinopelvic parameters in knee osteoarthritis patients without prior degenerative spinal disease following bilateral knee arthroplasty. Knee osteoarthritis often causes knee flexion contracture and the flexion contracture may affect posture and lumbar lordosis.Material and Methods: We performed a retrospective study by evaluating the records of patients who have undergone bilateral knee arthroplasty in our clinic between 2012 and 2016 in patients due to degenerative bilateral knee osteoarthritis and minimum 12 months follow up. Patients with prior hip surgery, prior spine surgery, rheumatic disease and postoperative flexion contracture were excluded. Lumber lordosis, sacral slope, pelvic tilt and pelvic incidence were measured on lateral lumbosacral view in supine position pre-postoperatively and compared with paired T test. Extension deficit was also measured preoperatively.Results: This study includes 83 patients (77 females and 6 males) who underwent bilateral knee arthroplasty and matched the inclusion and exclusion criteria. The average age at the time of first total knee arthroplasty was 64.4 years. Mean follow up was 37.3(12-66) months. The mean lumber lordosis was 43.9° preoperatively and 49.6° postoperatively. The increase in lumbar lordosis angle was statistically significant (p: 0,001). These changes were only related to the degree of extension deficit but not to age and postoperative follow-up time. Sacral slope, pelvic incidence and pelvic tilt did not change significantly. Conclusion: Bilateral knee arthroplasty increased lumbar lordosis patients with primer degenerative osteoarthritis especially who had high extension deficit. Sacral slope and pelvic tilt were decreased postoperatively but not significantly changed.
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    What is the reason for out-toeing gait on the injured side after surgical treatment of distal tibia physeal fractures?
    (2020) Batibay, Sefa Giray; Turkmen, Ismail; Yenigul, Ali Erkan; Saglam, Yavuz
    Aim: The aim of this study was to analyze the cause of out-toeing gait pattern in children who underwent anatomic reduction and internal fixation for distal tibial physeal injury. Material and Methods: This IRB-approved, Level IV review study included traumatic distal tibia epiphyseal injury treated surgically at a single institution between 2010 and 2015. Patients were called back to return for additional follow-up. All clinical (foot progression angle-FPA, hip rotations, thigh foot angle-TFA) and radiological (distal tibial measurements) evaluations were done by 2 independent observers to assess inter- and intra-observer reliability using intraclass correlation coefficients (ICC). Results: There were 38 patients with an average age of 11.4±3.8. There was a non-significant trend noted towards externally in FPA on the injured side. TFA was similar in both extremities (p: 0.56). Hip external rotation was significantly high in injured side, whereas hip internal rotation was similar. Hip external rotation was significantly high.Conclusion: Anatomic joint reduction is mandatory to prevent growth arrest and to maintain lower extremity alignment. Considering that there is no pathology of the hip and no radiologic signs of mal-alignment of the ankle, we think that hip external rotators may shortened due to post-operative resting position, which was ended up with out-toeing gait pattern on the injured side.