Aim

The purpose of this study was to analyze the patellofemoral kinematics in neglected adult developmental dysplasia of the hip patients with patellofemoral symptoms and tried to clarify the affect of the severity of dislocation, the amount of limb length discrepancy, the deviation of mechanical axis and the changes in femoral anteversion on patellofemoral alignment.

Aim: This study was designed to investigate the role of VEGF in the etiopathogenesis of osteoporosis and to investigate its relation with bone mineral density (BMD) and other parameters.

Patients and Method: Bone scanning with Dual Energy X-ray Absorptiometry (DEXA) was performed to a total of 276 patients older than 40 years in our hospital’s radiology department. A total of 88 patients in accordance with the study criteria were included. 44 patients were female and 44 were male. These patients formed 4 groups; the osteoporotic males (MO) (group 1, n: 22, BMD −2.5 < ), the normal males (MN) (group 2, n: 22, BMD −1> ), the osteoporotic females (FO) (group 3, n: 22, BMD −2.5 < ), and the normal females (FN) (group 4, n:22, BMD −1> ). BMD measurements were performed with DEXA. Serum VEGF level was determined by the endogenous Human VEGF ELISA kit.

Results: The difference between male and female patient group in terms of serum VEGF levels was not statistically significant (p= 0.12). The difference among 4 groups in terms of serum VEGF levels was not statistical significant (p=> 0.05). There was a negative correlation between BMI and BMD in male patients. In MN cases age was negatively correlated with serum VEGF levels, BMI was negatively correlated with BMD, and BMD was negatively correlated with VEGF levels. Again in males, BMD was negatively correlated with VEGF values.

Conclussion: We think that the reason why they could not reveal statistically significant differences between osteoporotic and normal groups was their small sample size. Additionally difference between groups would be significant with larger sample size. As shown in the present study, the statistically significant negative correlation between BMD values and VEGF levels established in the male normal (MN) group and in the evaluation within the male population, suggest that VEGF could play a role in male osteoporosis.

Aim: The aim of the study was to assess the correlation of CE angle to the ratios of medial hip joint space width and femoral head diameter to acetabular width.

Material and metod: Measurements were done on 196 AP pelvic radiographs of 10 years old and 20 years old males and females obtained with “siemens lconos r 200 axion^®”. The patients were placed in the supine position with their hips extended and internally rotated 15°. Medial hip joint space width (mJSW), CE angle, femoral head diameter (FD) and acetabular width (AW) were measured. The intraobserver reproducibility was assessed by a randomly chosen subset of 50 radiographs and these were read 1 month apart. The levels of agreement were qualified using the intraclass correlation coefficient. The ratios of mJSW to AW and FD to AW were calculated.

Results: Mean CE angles in 10 years old females and males were 33.87±3.64 ve 32.74±4.21 degrees respectively. CE angle was correlated to mJSW/AW in 10 years old females (r = − 0.446, p=0.043). CE angle was not correlated to mJSW/AW in 10 years old males (r = − 0.293, p=0.146). CE angle was not correlated to mJSW/AW in 20 years old females while CE angle was correlated to mJSW/AW in 20 years old males (r = 0. 694, p=0.001). CE angle was correlated to FD/AW only in 20 years old males (r=0.553, p= 0.002).

Discussion: Ratios of medial hip joint space width and femoral head diameter to acetabular width are not correlated to CE angle in both preadelocent and postade-locent terms depending on sex. The expected inverse correlation of these parameters to CE angle was not dedected, so these parameters can be used in radiologic assessement of subluxation of the hip and acetabular dysplasia together with CE angle.

Aim: The aim of this study was to compare the treatment results of distal tibia shaft fractures treated with intramedullary nails with two different distal lockings and medial locking plates.

Patients and Method: Sixty-four patients with distal tibia fractures (4 to 11 cm proximal to the plafond) were operated with either unreamed intramedullary nails with medio-lateral distal locking (group A) or unreamed intra-medullary nails with both medio-lateral and antero-posterior lockings (group B), or medial locking plates (group C). There were 22 patients in group A, 22 patients in group B and 20 patients in group C. Mean age was 48.53±17.07 years. Mean follow-up was 26.68±7.02 months. At latest follow-up groups were compared for union time, malunion (defined as more than 5 degrees of angulation in any planes and/or any rotation and/or more than 5 milimeters of shortening), and delayed (lack of healing within 3 months) or nonunion (lack of healing within 6 months). Uninon was defined as healing of at least three of four cortices on AP and lateral radiographs.

Results: Mean union time was 17.45±4.22 weeks in group A, 16.71±4.90 weeks in group B and 15.73±3.26 weeks in group C. There was no significant difference between groups regarding union time. (p> 0.05) Malunion as defined was dedected in 4 patients in group A, in 4 patients in group B and in 1 patient in group C. There was no significant difference between groups regarding malunion rates. (p> 0.05). Delayed or non union was dedected in 6 patients in group A, in 5 patients in group B and in 1 patient in group C. There was no significant difference between groups regarding delayed or non-union. (p> 0.05). Two nonunions in group A and one nonunion in group B had to be treated with exchance reamed nailing. One infected nonunion in group C had to be treated with circular external fixation.

Conclusions: The results of surgical treatment of distal tibia fractures are similar with these three diifferent methods. Although malunion and delayed or nonunion rates are lower with medial locking plates, this is not significant.

Aim: This study was designed to investigate the association between clinical assessment International Clubfoot Study Group (ICFSG) and quantitative gait data of the children

Methods: Nineteen patients with 30 surgically treated clubfoot were included in this study. Bilateral involvement was present in 11. Average age was 9 years (range 6–14 years) at the time of last follow-up. Patients were treated with different surgical techniques at early childhood period. At the final follow-up they were evaluated according to ICFSG clinical scale. This rating system is based on three main subgroups of evaluation as morphologic evaluation, functional evaluation and radiological evaluation. The maximum score is 12 in morphologic evaluation, 36 in functional evaluation and 12 in radiological evaluation. The total score is from 0 for a perfect result to 60 for the worst result. Further, a total score of 0–5 is rated as excellent, 6–15 as good, 16–30 as fair and over 30 as poor. Quantitative gait data was collected with the Vicon 370 (Oxford Metrics, Oxford, UK). Two force plates (Bertec, Colombus, Ohio, USA) were used for kinetic analysis. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee and ankle in sagittal, coronal and transverse planes) and kinetic (ground reaction forces, moments and powers of hip, knee and ankle) data were processed using Vicon Clinical Manager software package. Spearman correlation analysis was used to evaluate if there is a correlation between total clinical score and gait parameters.

Results: Average ICSG score was 8.63 (range 1–29). Outcome was excellent in 16, good in 8 and fair in 6 patients according to ICSG. There was a significant correlation between total ICSG score and walking velocity (rs=−0.195, p=0.004), step length (rs=−0.476, p=0.019), pelvic excursion in sagittal plane (rs=−0.429, p=0.026), hip excursion in sagittal plane (rs=−0.511, p=0.006), knee excursion in sagittal plane (rs=−0.486, p=0.019), Ankle excursion in sagital plane (rs=−0.413, p=0.040), peak ankle plantar flexion moment (rs=−0.600, p=0.039), peak ankle plantar flexion power (rs=−0.487, p=0.025). When we compare the gait parameters between groups only foot progression angle showed a significant difference (p=0.031).

Conclusion: ICFSG score is a successful method to follow outcome in patients with surgically treated clubfoot. ICFSG score is correlated with many kinematic and kinetic gait data however foot progression angle is the only parameter predicting outcome in children with surgically treated idiopathic clubfoot. Quantitative gait analysis may help to define the liable factors of the functional deficits, and to prescribe novel rehabilitation techniques to enable better outcome for children with clubfeet.

Aim: Surgical treatment for idiopathic clubfeet aims to realign the foot and allow plantigrade weight bearing with adequate joint motion. In spite of satisfying clinical and radiological results for both the physician and the parents shortly after the operation, deterioration may occur years after the surgery. The aim of this study was to evaluate gait characteristics of children with surgically treated unilateral clubfoot and had good clinical outcome.

Methods: Twelve children (mean age 5.9±2.3 years (4–9)) with surgically treated unilateral clubfoot before age one and twelve age matched healthy children were included in the study. Foot length, calf circumference, ankle range of motion and radiographic measurements were recorded. Quantitative gait data was collected with the Vicon 370 (Oxford Metrics, Oxford, UK). Two force plates (Bertec, Colombus, Ohio, USA) were used for kinetic analysis. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee and ankle in sagittal, coronal and transverse planes) and kinetic (ground reaction forces, moments and powers of hip, knee and ankle) data were processed using Vicon Clinical Manager software package.

Results: Foot length of the operated side was shorter than the unaffected side but the difference was not significant (p> 0.05). Calf circumference and ankle range of motion were significantly less than the unaffected side (p< 0.05). Quantitative gait data revealed that children with clubfoot had slower walking velocity (0.75±0.25 versus 1.02±0.18 m/sec, p=0.001), shorter stride length (0.72±0.23 versus 0.91±0.05 meters, p=0.001) and less ankle plantar flexor moment (0.73±0.22 versus 0.88±0.11 m/sec, p=0.007) than healthy children. Unaffected side showed increased pelvic excursions and medio-lateral ground reaction forces as well as decreased ankle and hip motion in sagittal plane.

Conclusion: We detect various deviations in gait parameters even in so called well treated patients according to radiological and clinical criteria. Alterations in the unaffected foot may be the result of the subclinical involvement of the unaffected foot by disease as well as the compensatory mechanisms. These gait deviations may lead long-term morbidity later in adulthood.

Aim: The aim of this study is to evaluate the results of conservative treatment of Neer type III and IV fractures of the proximal humerus in patients who refused surgery or could not undergo surgery because of medical conditions.

Methods: Eighteen patients were included in the study. There were 8 Neer type III and 10 Neer type IV fractures. None of the patients had head-splitting fractures. Treatment and follow-up protocols were standardized for all cases. All patients were assessed for Constant scores in postoperative first year and at latest follow-up. Patients were divided into two groups regarding their age. Patients of 65 years or under that were named as group A (7 patients), while patients over 65 years old were named as group B (11 patients). Patients were further divided into two groups regarding their Constant scores. Patients with less than 70 points were named as group I (12 patients), while patients with 70 points or higher were named as group II (6 patients). Statistical analysis was performed using student’s t test, chi-square test and Fischer exact test.

Results: Mean age was 68.2± 13.8(39–90) years. Mean follow-up was 34.5±12.4 (18–56) months. Mean Constant score was 56.1±14.7 (26–76) points in postoperative first year follow-up. Mean Constant score was 59.7±13.9 (36–84) points at latest follow-up. Osteonecrosis of the humeral head was dedected in 5 patients. There was no significant difference between group A and group B regarding Constant scores (p=0.233). There was no significant difference between group I and group II regarding age (p=0.178). There was no significant difference between Neer type III and Neer type IV fractures regarding age (p=0.176) and Constant scores (p=0.075). Mean postoperative first year Constant score of Group A patients with type III fractures was significantly higher when compared to group B patients with type IV fractures (p=0.046). Constant scores at latest follow-up (p=0.261) and fracture types (p=0.618) were similar between patients with osteonecrosis and without osteonecrosis.

Conclusions: Results of conservative treatment of these fractures are satisfactory even in elderly patients. Similar functional results as in younger patients can be achieved with proper and accurate treatment. While fracture type individually does not have an influence on functional results, functional results are better in young patients with type III fractures then in old patients with type IV fractures.

Aim: Complete tenotomy was performed on the most important flexor hip muscle; namely the iliopsoas during open reduction in patients with developmental dysplasia of the hip (DDH). The iliopsoas and other flexor-extensor muscles in operated and contralateral hips were evaluated comparatively by magnetic resonance imaging (MRI).

Methods: A total of 22 patients with unilateral DDH after the walking age and treated with one-stage combined surgery were analyzed. All patients were operated by the same surgeon with complete tenotomy of iliopsoas muscle hindering open reduction. All patients had functionally excellent results in accordance with the Barrett’s Modified McKay Criteria in their last follow-up visits and according to Severin’s classification all cases were type 1. The imaging was performed by 1,5 T GE Excite MRI device at the supine position, without contrast material and sedation. The sagittal sections for iliopsoas muscle and T2-W FSE axial images for flexor and extensor muscle groups were used. The operated and contralateral sides were compared. Student’s t test, paired t test, and Spearman’s Rank correlation analysis were used for statistical assessment.

Results: The mean age was 12,8±2,9 (9–18) years old. The mean postoperative follow-up period was 112,6 ± 32,0 (68–159) months. The reattachment of the iliopsoas to trochanter minor was observed in 7 patients, with no significance in terms of age, postoperative follow-up period, and the duration of postoperative period (p> 0,05). The atrophy in the operated side was significant in the length of iliopsoas muscle section area (p=0,0001); and the section areas of rectus femoris (p=0,002), tensor fascia lata (p=0,0001), and gluteus maximus (p=0,0001). No significance was detected in sartorius muscle section area (p=0,886). However, unlike other muscles; the ratio of operated versus contralateral side mean muscle section areas was above 1 (1,1± 0,3) for the sartorius muscle. Iliopsoas muscle reattachment was not significant for ratios of the other muscles’ operated versus contralateral side muscle section areas (p> 0,05). The atrophy was significant for the second (p=0,03) and the third (p=0,022) section’s diameter ratios in the non-reattachment versus reattachment group for the iliopsoas muscle.

Conclusion: The reattachment of the iliopsoas muscle to trochanter minor after complete tenotomy was observed in 32% of patients. Following complete iliopsoas tenotomy, the expected compensatory hypertrophy in other flexor hip muscles was not detected. At the operated side, all evaluated muscles were atrophic except for the sartorius muscle. The atrophy of iliopsoas muscle was significant for the operated hip with non-reattachment to insertion site versus reattachment group.

Aim: In patients without infections following primary total hip (PTHA) and knee (PTKA) arthroplasty, the natural course of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were evaluated. The effects of gender, anesthesia type, cementing, and tourniquet use on the natural course of CRP and ESR were determined. Understanding the natural course of plasma ESR and CRP is helpful in terms of the diagnosis and follow-up of infections, especially in the early postoperative period.

Methods: A total of 82 patients with normal preoperative CRP and ESR, both in accordance with gender and age; without any chronic condition, infection, or inflammatory disease; and with no intra–and post-operative complications were included. PTHA was performed on 38 (Groups I–II) and PTKA on 44 patients (Groups III-IV). CRP and ESR measurements were performed on the 1st preoperative day; 1st, 2nd, 3rd, 5th, 7th, 14th, and 21st postoperative days; and the 1st, 2nd, 3rd, 6th, 9th, and 12th months. CRP measurements were performed with the nephelometric (Dade Behring S.p.A., Italy) and quantitative Methods: Westergren method was used for ESR measurements. The PTHA group was further classified as femoral component fixed with (Group I; 28 patients) and with-out cement (Group II; 10 patients), while PTKA as with (Group III; 32 patients) and without tourniquet (Group IV; 12 patients). Furthermore, epidural (Group IIIa) and general anesthesia (Group IIIb), and gender differences (Group Ia; female and Group Ib; male) were compared. Wilcoxon test, paired-t test, Students’-t test, ANOVA, and chi-square tests were used for statistical analysis.

Results: After the operation, separate peak CRP and ESR levels of each patient and days of reaching peak and normalization were evaluated. When the mean of peak CRP levels were compared, groups III and IV had significantly higher levels with regard to groups I and II (p=0.037), However, the days of reaching peak levels were statistically similar between PTHA and PTKA groups (p=0.245). The same comparison was repeated for the mean of peak ESR levels, the results were similar (p=0.547). In cemented PTHA, CRP normalized earlier than cementless PTHA and PTKA (p=0.035) and ESR also normalized earlier, but this was not significant (p= 0.074). Among groups comparing gender and anesthesia type, mean values of CRP and ESR peaks, distribution of these two levels on the days controlled, and days of reaching peaks and normalization were statistically similar (p> 0.05).

Conclusions: In the PTKA group, the mean CRP peak was higher than PTHA. CRP levels normalized earlier in cemented PTHA cases. Anesthesia type, gender differences, and use of tourniquet in PTKA did not affect the course of CRP and ESR following arthroplasty.

Aim: Patients treated with one-stage combined operations after walking age for developmental dysplasia of the hip (DDH), and whose follow-up revealed both clinical and radiological complete healing underwent flexor and extensor isokinetic muscle strength (IMS) measurements of the hip and results were evaluated in comparison with the contralateral hips.

Methods: A total of 22 patients with unilateral DDH and treated with one-stage combined operations after walking age were included in the study. All patients were operated by the same surgeon. In their last follow-up visit, all patients were functionally excellent in accordance with the Barrett’s Modified McKay Criteria and according to the Severin’s Classification for radiological grading of the hip all cases were type I. IMS of hip flexors and extensors were tested by Biodex 3 Pro isokinetic test device at 120º/sc and 240º/sc. In all patients, peak torque (PT), peak torque angle (PTA), total work (TW), and average power (AP) values of operated and non-operated hips were measured at both angular velocities and recorded separately for flexors and extensors. For comparative evaluation, values of the operated and non-operated hips were used for determining the differences in IMS (DIMS), total work (DTW), and average power (DAP). In statistical assessment; Student’s t test, paired t test, and Spearman’s Rank correlation analysis were used.

Results: The mean age of patients were 12,8±2,9 (9–18) years old. At the last control visit, the mean value of follow-up periods were 112,6±32,0 (68–159) months. Parameters like age, age at the time of operation, and the length of postoperative follow-up period showed no statistical relation with IMS measurements (p> 0,05). For flexors, TW was lower at the operated hip when compared with the non-operated hip at 120º/sc and 240º/sc (p=0,001 and p=0,002, respectively). AP was lower at the operated hip at 120º/sc and 240º/sc (p=0,011 and p=0,003, respectively). PT was lower at the operated hip (22,5±11,3) when compared with the non-operated hip (27,1±12,1) only at 120º/sc (p=0,001). For extensor muscles, PT, TW, AP, and PTA showed no statistically significant difference (p> 0,05). For flexors, the DIMS between operated and non-operated hips at 120º/sc and 240º/sc were measured as −15,3±22,2% (median;-14,4) and −8,0±21,4% (median;−2,5), respectively.

Conclusions: In operated DDH patients with a mean follow-up period of around 10 years, IMS measurements revealed that the flexor muscle strength of the operated hip was still weaker than the non-operated hip. At 120º/sc, which represented evaluation against higher resistance, DIMS, DWF, and DAP were higher when compared with 240º/sc. This finding shows that hip flexors of these patients may remain weak in activities like sports, which require more resistance.

Objectives: Surgical treatment of comminuted subtrochanteric fractures may be associated with high incidences of nonunion and implant failure. Taking the advantages of biologic fixation may solve this problem by yielding rapid callus formation and thus butressing the medial cortex.

Patients and method: 21 patients with comminuted subtrochanteric femur fractures were operated. Mean age was 35.4 (13–60) years. There were 5 type IA, 9 type IB, 3 type IIA and 4 type IIB fractures according to Russel-Taylor classification. All patients were treated with indirect reduction and biologic internal fixation. Patients were clinically assessed for pain, muscle power, hip and knee range of motions, angular and rotational deformities and leg length discrepency at latest follow-up. Functional assements were done using the Traumatic Hip Rating Scale proposed by Sanders et al.

Results: Patients were followed for a mean of 26.3 (12–55) months. Union was achieved in all patients in a mean of 15.85 (13–22) weeks. Limb-length discrepecency was dedected in 7 patients. In these 7 patients the operated extremity was short by a mean of 1.28 (1–2) cms. There was no limping in any patients due to limb-length discrepecency. A rotational deformity of lesser than 10 degrees was present in 5 patients. A frontal plane (varus) malalingment lesser than 10 degrees was present in 3 patients. 10 degrees and 20 degrees of restriction in flexion was present in 2 patients. Functional results were excellent in 14 and good in 7 patients. No patient had poor functional result or failure. All patients were satisfied with their postoperative functional results. A superficial infection dedected in early postoperative period in one case and it was treated with local wound care and antibioteraphy. There were no signs of infection in this patient at latest follow-up. Deep infection did not develop in any patients. Delayed union or non-union was not present in any patients.

Conclusions: Indirect reduction and biological internal fixation yields satisfactory results in comminuted fractures. These results can be attributed to early weight bearing with rapid solid callus formation and early union. Rapid callus formation and early union with biologic fixation is particularly advantageous in comminuted subtrochanteric fractures as it avoids implant failure which is not uncommon in these fractures.

Because endothelins (ET) have effects on functions of both osteoblasts and osteoclasts, it is thought that these peptides may be one of the mediators of coupling phenomena that maintain the connection and regulation between bone formation and resorption process in osteogenesis. Along with their demonstrated effects on osteogenic cells they have dual activity on both mineralization and resorption process. So it is also thought that they may have a major role in bone turnover and remodeling processes. We aimed to investigate if ET had a role in the pathophysiology of osteoporosis. Therefore we looked for a difference in ET plasma levels between osteoporotic and normal people.

86 patients (16 men and 70 women) with a mean age of 62.6 (ranges: 51–90) years were included in this study. All patients were examined by dual energy X-ray absorbsiometry evaluation at first. Patients were divided into 3 groups regarding reported T scores. T-scores less than −2.5 on either total lumbar spine or total hip were accepted as osteoporosis, while scores between −1 and −2.5 were accepted as osteopenia and scores above −1 were accepted as normal according to the suggestions of World Health Organization. According to these criteria 19 patients were normal, 43 were osteopenic and 24 were osteoporotic. Then total plasma level of ET was measured in all patients with monoclonal antibody based sandwich immunoassay (EIA) method.

One-way analysis of variance test was used to compare endothelin values between normals, osteopenics and osteoporotics regardless of gender and for each gender. A value of p< 0.05 was considered as significant.

Endothelin total plasma level in patients with osteoporosis was a mean of 98.3663.96 pg/ml, a mean of 100.9247.2 pg/ml in osteopenic group and a mean of 99.5656.6 pg/ml in normal group. The difference between groups was not significant (p> 0.05). In men with osteoporosis endothelin level was a mean of 185.7017.2 pg/ml and this was significantly higher than osteopenic men (124.8059.6 pg/ml) (p< 0.05) and normal men (93.0050.1pg/ml) (p< 0.05). In women there was not any significant difference between groups (normal:102.0060.7pg/ml, osteopenics: 94.7042.7pg/ml, osteoporotics: 79.9053.8pg/ml) (p> 0.05).

We found out that plasma ET levels of osteoporotic men were significantly higher than normal men. But comparison regardless of gender among osteoporotics, osteopenics and normals and comparison of female osteoporotics, osteopenics and normals yielded no significant differences. We think that the reason for differences in our results regarding gender may be the higher estrogen level of the females even if they were in the postmenopausal period and thus estrogens’ possible effect of down regulation in ET-1. Considering these results we think that ET may have a role in the pathophysiology of the men osteoporosis and it can be used as a marker for diagnosis and treatment follow-up of osteoporosis.

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.

Aims: We aimed to evaluate diagnostic contribution of MRI-Arthrography in syndesmosis disruption at ankle fractures. Methods: 18 patient who had Denis Weber type B-C fractures and are suspected to have syndesmotic diastasis considering tibiofibular clear space and tibiofibular overlap measurments in conventional radiographs are assesed with MRI followed by MRI-Arthrography. Because joint fluid was already seen in tibiofibular space in 3 patients at MRI, MRI-Arthrography was performed for the remaining 15 patients. If there was a changes between the results obtained from MRI and the results obtained after MRI-arthrography was tested istatistically. Convantional radiographs, MRIs and MRI-Arthrographies were analysed by 2 independent observers and interobserver concordance was assesed. Following intraoperative observation and asssesment syndesmotic diastasis was treated considering radiographic and MRI-arthrographic results. Results: In 15 cases who were regarded to have syndesmotic diastasis according to conventional radiographies, 8 (53.3%) diastasis were confirmed with only MRI and 12 (80%) diastasis were confirmed with MRI arthrography. Following intraoperative assesment 13 (86.6%) cases were regarded to have diastasis and surgical intervention was performed for diastasis repair. In 2 (13.3%) cases surgical intervention for diastasis repair was not performed. If there was a change in decission after MRI and after MRI-arthrography is analysed with chi-square test between related groups. There were statistically significiant difference (p< 0.05) in these means. There is interobserver concordance in conventional radiographic, MRI-arthrographic assesments and in assesments for ATIF and PTIF seperately inMRI.(p< 0.001). Conclusion: These results suggest that conventional radiography and MRI is not sufficient in assesing syndesmosis and MRI-arthrography is important for diagnosis.

We aimed to determine if there are mechanoreceptors in hip joint capsule and ligamentum capitis femoris of the patients with developmental dysplasia of the hip. We took capsule and ligamentum capitis femoris biopsies from 20 hips of 20 patients who were operated because of developmental dysplasia of the hip. Meanage was 10.2 months (ranges 6-20 months) on the time of surgery. There were 12 girls and 8 boys. Teratologic and secondary hip dislocations were not included in this study. 0.5x 0.5 cm full thickness anterior capsule and liga-mentum capitis femoris portions were taken for biopsy specimen. Specimens were stained with hemotoxylin eosin and examined immunohistochemically using poly-clonal antibodyagainst S-100 Protein. In both analysis no mechanoreceptors was found in any samples of capsule and ligamentum capitis femoris.

Conclusion: We think that there is a possibility that developmental dysplasia of the hip can be caused from a defect in formation of mechanoreceptors on localized capsule and ligamentum capitis femoris and we emphasize the need for further studies on the subject.