Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

OBJECTIVES: The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. RESULTS: Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. CONCLUSION: Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Is there a safe place for posterior malleolar screw fixation? An anatomic study on dry bones.

OBJECTIVES: This study aims to determine the secure location and angle of the most distal screw during posterior malleolar (PM) fracture fixation. MATERIALS AND METHODS: This prospective study was performed on September 15, 2019. Distal tibial concave articular depth and PM inclination angle were measured on 100 (50 male and 50 female) dry tibia bones using a digital caliper. A comparative analysis between male and female tibias was performed. RESULTS: Anteroposterior width of male tibia (38.3±3.1 mm) was wider than female tibia (35.3±3.2 mm) (p:<0.001). Mediolateral length of the male tibia (44.8±3.5 mm) was longer than female tibia (42.7±3.4 mm) (p:0.003). Male tibial joint (5.4±0.7 mm) was deeper than that of female (4.7±0.3 mm) (p:<0.001). The PM inclination angle was higher in male tibia (18.0±1.5°) than female tibia (15.4±1.3°) (p:<0.001). CONCLUSION: If a screw placement parallel to the joint surface is desired, the screw insertion should be located 6 mm and 5 mm superior to the distal edge of the PM rim in males and females, respectively. If a more distal screw is required, the screw should be inserted in at least 18° and 15° anterosuperior direction for males and females, respectively.

Is there any change in surgeon's attitude to the management of ankle fractures accompanying syndesmotic injury? A nationwide survey.

OBJECTIVES: This study aims to investigate the attitudes of orthopedic surgeons to the management of ankle fractures accompanied by syndesmotic injury with a nationwide survey. PATIENTS AND METHODS: In the first step of this descriptive study, an electronic survey was prepared in Google drive and a survey link was sent to the Turk-Ortopedi e-mail group between 09 and 19 January 2019. The orthopedic surgeons and residents were requested to complete the questionnaire. A total of 320 orthopedic surgeons (77%) and residents (23%) participated in the survey. The responses were analyzed statistically. To evaluate the changing attitudes, our results were compared with the surgeon survey studies key worded "syndesmotic injury" in PubMed. RESULTS: The majority of the participants stated that they used the hook test, external rotation stress test, and fluoroscopy together (47.2%) for the diagnosis of syndesmotic injury during the operation. Of the participants, the majority (93%) reported to use metallic syndesmotic screws, and 59% reported to remove the syndesmotic screw routinely. Young surgeons with 5 to 10 years of experience preferred intraoperative diagnosis methods compared to surgeons with more than 20 years of experience. Foot and ankle surgeons and sports surgeons reported to allow weight bearing before removal of the screw much more than other unspecified branches. CONCLUSION: The preferences of the surgeon vary in syndesmotic injuries and there is still no consensus regarding diagnosis and rehabilitation. Compared to the past decade, fewer surgeons prefer to remove the screws today.

Comparison of two approaches for carpal tunnel release: Extended versus mini-open technique.

OBJECTIVES: This study aims to describe a retrospective study using prospectively gathered data to compare mini-open and extended open release techniques for moderate to severe carpal tunnel syndrome (CTS). PATIENTS AND METHODS: The data of 198 consecutive patients (139 males, 59 females; mean age 57.0±4.5 years; range, 44 to 75 years) treated for CPS were used. For matching, age, gender and severity of the compression, the Greathouse Ernst Halle Schaffer neurophysiological classification system was used. After matching, 63 observations in each group (group 1: mini-open and group 2: extended open) were used for analysis. A Jamar hydraulic hand dynamometer was used to measure pre- and postoperative third month grip strengths. The key pinch test was performed also at third month. Patients completed the Boston Carpal Tunnel Questionnaire at the last follow-up. RESULTS: Symptom severity and functional status were improved up to half fold in both groups at final follow-up; however, there was no statistically significant clinical difference between the groups (p>0.05). There were totally six patients with paresthesia symptoms (three in each group; 4.7%), which improved in three months. Eight patients (6.3%, one in group 1 and seven in group 2, p=0.032) had dysesthesia and pillar pain. CONCLUSION: Mini-open and extended open carpal tunnel release have similar clinical outcomes without any major complications.

Rhythm and orthopedics: The effect of music therapy in cast room procedures, a prospective clinical trial.

INTRODUCTION: Cast room procedures generally cause anxiety in patients. Anxiety complicates the procedure as well as increases the risk of a complication. Listening to music was found to be the safest and most common non-drug treatment method. The aim of this study is to evaluate the effect of listening to music on adult patients in cast room procedures. This study points out the relation between anxiety and anxiety relevant cardiac arrhythmia. MATERIALS AND METHODS: The study was performed on 199 patients with stable general condition, aged above 18. The patients were divided into two groups. Randomization method used in the study was coin flip. The first group (Group 1) listened to music during cast room procedures whereby the second group (Group 2) did not listen to music. Length of the procedure, complication, blood pressure and heart rate evaluations before and after the procedure, Visual Analogue Scale (VAS scores for pain), State-Trait Anxiety Inventory (STAI) anxiety score, patient satisfaction, willingness of the patient to repeat the procedure, P wave dispersion (Pd) and corrected QT interval dispersion (QTcd) as electrocardiographic arrhythmia predictors were evaluated. The Clinical Research Ethics Committee approval was obtained for this study. RESULTS: Significant difference was shown between the two groups for the following criteria: VAS scores (p = 0.005), anxiety scores (p = 0.032), processing time (p = 0.027), and QTcd values (p = 0.031). Patient satisfaction (p < 0.001) and willingness to repeat the procedure (p < 0.001) were higher for the group who listened to music. No significant difference in Pd values, blood pressure and heart rate was reported within the groups. CONCLUSION: Music therapy is a non-invasive, safe, nonpharmacologic, anxiolytic, and analgesic treatment. Music therapy should become standard protocol in cast room procedures. One of the most important achievements of this study was the fact that music decreases anxiety and anxiety-related cardiac arrhythmia. Therefore, conducting further prospective studies including high cardiac risk patients especially with arrhythmia is crucial.

Partial calcanectomy and Ilizarov external fixation may reduce amputation need in severe diabetic calcaneal ulcers.

Objective: The treatment of diabetic hindfoot ulcers is a challenging problem. In addition to serial surgical debridements, hyperbaric oxygen therapy and local wound care play important roles in the surgeon's armamentarium, for both superficial infection and gangrene of the soft tissue, often complicated by osteomyelitis of the calcaneus. The purpose of this study was to evaluate the results of an aggressive approach from diagnosis to treatment of calcaneal osteomyelitis in foot-threatening diabetic calcaneal ulcers. Methods: The study included 23 patients with diabetic hindfoot ulcers who were treated with radical excision of the necrotic tissue and application of circular external fixation. The treatment protocol was a combination of magnetic resonance imaging (MRI)-guided debridement of the necrotic tissues and application of an Ilizarov external fixator in plantarflexion to decrease the soft-tissue defect. Primary outcome measures were total cure of infection and obvious healing of the osteomyelitis at 12 weeks determined by MRI, and clinical cure through objective assessment of the appearance of the wound. Results: The wounds healed in 18 of the 23 patients (78%), partial recovery occurred and subsequent flap operation was performed in three patients (13%), and below-the-knee amputation was performed in two patients (9%). Conclusions: This surgical protocol is effective in ameliorating diabetic hindfoot ulcers with concomitant calcaneal osteomyelitis, and satisfactorily reduces the need for amputation.

Reduced Postoperative Functional Length Ratio Influences Patient Satisfaction in First Metatarsophalangeal Joint Replacement.

Complications of first metatarsophalangeal joint metallic arthroplasty are well known. However, the resulting shortening of the metatarsals can lead to transverse metatarsalgia or medial column pain at the metatarsophalangeal joints by creating Morton's toe/foot, which increases pressure on the second metatarsal head. The effect of the functional length ratio of the first and second metatarsals on pain and patient satisfaction has not been rigorously evaluated. We evaluated the effect of the first/second metatarsal ratio on patient satisfaction with first metatarsophalangeal joint metallic arthroplasty. From October 2008 to February 2010, 34 patients (median age 66.2, range 55 to 70 years) with hallux rigidus were treated surgically using the Toefit-Plus(™) prosthesis. At a mean follow-up period of 27.5 (range 17 to 35) months, 30 patients (88.24%) underwent re-evaluation. The functional length of the first and second metatarsals and the lucency around the prosthesis were evaluated. Statistically significant (p ≤ .05) improvements were found for the mean modified American Orthopaedic Foot and Ankle Society score (from 44 to 80), pain (from 7 to 3 on a 10-cm visual analog scale), and mean total range of motion (from 42.2° to 59.4°). Also, 20 patients (58.82%) were fully satisfied with the procedure (scores of 8 to 10 on a 3-point Likert scale). Shortening the first metatarsal reduced the functional length ratio (r = 0.95; p < .001) and was associated with lower patient satisfaction (r = 0.66, p = .007). Preoperative consideration of the first/second metatarsal functional length ratio could be useful in preventing medial column pain due to a relatively short first metatarsal to a long second metatarsal axis in the transverse plane.

[Total hip arthroplasty in patients with osteoarthritis secondary to developmental dysplasia of the hip: results after a mean of eight-year follow-up]. / Gelisimsel kalça displazisi zemininde gelisen osteoartritli hastalarda total kalça artroplastisinin ortalama sekiz yillik sonuçlari.

OBJECTIVES: We evaluated eight-year results of total hip arthroplasty in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH). METHODS: Total hip arthroplasty was performed in 31 hips of 29 patients (25 females, 4 males; mean age 54 years; range 35 to 78 years) with osteoarthritis secondary to DDH. According to the classification by Hartofilakidis et al., there were 13 type 1 hips, 13 type 2 hips, and five type 3 hips. The acetabular component was placed in the true acetabulum in all the hips. Hybrid and uncemented prostheses were used in six hips and 25 hips, respectively. Eight patients with severe acetabular deficiency required augmentation with an autogenous bone graft. Soft-tissue releases were performed in seven hips. Femoral shortening osteotomy was performed for high hip dislocations. All the patients were evaluated using the Merle d'Aubigne and Harris hip scores. The mean follow-up period was eight years (range 1 to 10 years). RESULTS: According to the postoperative Merle d'Aubigne and Harris hip scores, the results were excellent in eight hips (25.8%), good in 17 hips (54.8%), fair in five hips (16.1%), and poor in one hip (3.2%). The mean length discrepancy between the two extremities was 1.7 cm (range 0.5 to 2.5 cm). Complications included nonunion of the acetabular graft in one patient and superficial wound infection in two patients. Neurologic complications did not occur. Three patients required revision for loosening of the acetabular (n=2) or femoral (n=1) components. CONCLUSION: Successful results can be obtained with good planning and proper surgical procedures in the treatment of osteoarthritis secondary to DDH.

An unusual complication of familial Mediterranean fever: protracted arthritis with bilateral coxarthrosis and intraosseous amyloidosis of femoral head.

Protracted arthritis is uncommon in familial Mediterranean fever (FMF) and rarely may result in degenerative joint damage, a well-known complication of FMF, usually affecting kidneys. We present an unusual case of FMF involving severe bilateral coxarthrosis leading to residual incapacity that was treated by total hip arthroplasty, and an unusual presentation of amyloidosis - intraosseous amyloidosis of the femoral head.