The adult congenital hip dislocations and dysplasias have been previously classified by Eftekhar, Crowe et al., Hartofilakidis et al., Kerboul et al. and Mendes et al. The most conventient and widely used one is the Hartofilakidis and Crowe classification. Three different types of congenital hip disease in adults have been distinguished by Hartofilakidis and et al. based upon the position of the femoral head relative to the acetabulum: dysplasia; low dislocation; and high dislocation. All these classification systems are only radiological and does not highlight the operative technique in detail and the complications that we can observe perioperatively. Our classification system is also a radiological classification system but more useful for predicting the difficulty of the operative procedure and selecting the right operative method. In our classification system; at type I; dysplasia and less than 25% subluxations, we divided type I in to three subgroups, at type Ia, only dysplastic acetabulums, at type Ib, with elephant’s trunk type osteophyte formation and at type Ic, curtain type osteophytic formations, we included dysplasia and less than 25% subluxations in the same group because of operative technique similarities. At type 2; subluxations between 25% and 75%, we divided type II in two subgroups according to the angle between the inner margin of the teardrop and superior border of the acetabulum, at type IIa, the angle is less than 60°, at type IIb, the angle is greater than 60°, it’s important to show femoral allogreft usage requirement, at type 3; subluxations greater than 75%, at this type there will be no need of femoral allogreft usage but extra-small reamer usage for forming a suitable acetabular bed. At type 4; luxations greater than 100%, we also divided type IV in to two subgroups accordind to the distance between superior margin of true acetabulum and trochanter major line, at type IVa, < 2.5 cm, at type IVb, > 2.5 cm. It’s also important to make the decission of shortening. To form this classification three observers with different levels of training independently classified 412 dysplastic hips (operated between1995 and 2005) on 380 standard anteriorposterior pelvis radiographs, retrospectively according to the criteria defined by us. To assess intraobserver reliability, the measurement was repeated 3 months later. Statistical analysis was performed by calculating the weighted kappa correlation coefficient. System showed good inter- and intraob-server reliability for use in daily practice. Eventually, we determined a significant correlation between the aplied surgical procedures and classification. As a conclusion, we believe that our classification system of osteoarthritis secondary to developmental dysplasia of the hip in adult patients guides the surgical procedure more effectively than the other classification systems.

Current treatment modalities for chronic non-healing leg ulcers are time consuming, expensive, and only moderately successful. The use of sub-atmospheric pressure dressings, available commercially as the vacuum-assisted closure (VAC) device, has been shown to be an effective way to accelerate healing of various wounds. There is patented computer-controlled system technology available that is established V.A.C.(KCI Concepts, San Antonio, Texas) treatment. Reducing costs associated with wound treatments is therefore becoming an increasingly important issue in health care. This study included 45 patients with open wounds of the lower extremity with exposed tendon, bone, hardware or with osteomyelitis. Fifteen wounds were the result of trauma. Thirty wounds were non-traumatic (twenty dehisced or infected orthopedic surgical wounds, five pressure sores and five miscellaneous wounds). We use the vacuum therapy as a tool to bridge the period between debridement and definite surgical closure in full-thickness wounds. Treatment efficacy was assessed by semi-quantitative scoring of the wound conditions (signs of rubor, calor, exudate and fibrinous slough) and by wound surface area measurements. In our technique, the system consist of a sterilized simple foam sponge, a vacuum drain, two blood infusion kit and a negative pressure aquarium air pump, one liter salin bottle, an steril drape. It’s mean applying time ten minutes and mean cost at the first time 36 dollars consecutive seances 11 dollars (the aquarium air pump 15 dollars – an electrical engineer change it positive to negative air pressure mode). Forty-five patients who needed open wound management before surgical closure were included in this study. Healing was characterized by development of a clean granulating wound bed (“ready for surgical therapy”) and reduction of wound surface area. To quantify bacterial load, cultures were collected. The total quantitative bacterial load was generally stable. However, nonfermentative gram negative bacilli showed a significant decrease in vacuum-assisted closure-treated wounds, whereas Staphylococcus aureus showed a significant increase in vacuum-assisted closure-treated wounds. Succesfull wound closure was obtained 43 of 45 patients. 41 wounds were closed with split-thicknees skin graft. The median time to complete healing was 31 days (27.5 to 34.5) and wound bed preparation was 7 days (5.8 to 8.2) in the non-computerized V.A.C. therapy, similar with the computerized therapy 29 (25.5 to 32.5–7 days 5.7 to 8.3) This study shows a positive effect of vacuum-assisted closure therapy on wound healing, expressed as a significant reduction of wound surface. The costs of computerized wound care were higher than our techique of V.A.C. and similar clinical results at the end.