Tibiofibular Relationships of the Normal Syndesmosis on Axial Computed Tomography in the Turkish Population.

OBJECTIVE: Computed tomography (CT) is superior to plain radiography for evaluating ankle syndesmosis, but anatomical variations can affect the measurements. This study aimed to assess the radiologic parameters of the incisura fibularis and the factors that could affect these parameters. MATERIALS AND METHODS: Lower-extremity CT angiography images were used to evaluate the morphology of the incisura fibularis, anterior and posterior tibiofibular distance, longitudinal and transverse length of the distal fibula, length and depth of the incisura fibularis notch, tibiofibular clear space, tibiofibular overlap, and fibular rotation. Each measured parameter was compared based on sex and body side. Also, the effect of age, height, weight, and body mass index (BMI) on parameters was evaluated. RESULTS: A total of 123 patients (83 men and 40 women) were included, and 246 ankles were measured. The CT measurements demonstrated excellent intraobserver and interobserver reliability. No statistically significant sex or side differences were found in tibiofibular overlap (TFO) and tibiofibular clear space, the most-used parameters in radiographs. Age, weight, and BMI were found to be correlated with TFO. CONCLUSIONS: The present study provides CT measurements of the normal tibiofibular syndesmosis in the Turkish population. Also, the correlations of the parameters with age, height, weight, and BMI are presented. Therefore, TFO and tibiofibular clear space of the uninjured side can be used to plan the treatment of ankle injuries.

Health-Related Quality of Life of Patients with Postural Kyphosis Compared to Spinal Deformities in Adolescence: A Cross-Sectional Study.

AIM: To evaluate the quality of life of patients with postural kyphosis (PK) compared with those adolescent idiopathic scoliosis (AIS) and Scheuermann Kyphosis (SK). MATERIAL AND METHODS: Health-related quality of life (HRQoL) of adolescents with PK who were admitted to our clinic between January 2020 and June 2022 was compared with that of patients with AIS and SK who were admitted during the same period by using the Scoliosis Research Society-22 (SRS-22) questionnaire. All patients were asked to complete the SRS-22 questionnaire before the radiological evaluation. In the radiological evaluation, the sagittal and coronal deformities of the patients were measured. RESULTS: In total, 126 patients with PK were compared with age and sex-matched AIS patients and 42 SK patients. The mean SRS-22 function score of the PK group was 4.72 ± 0.3 while it was 4.38 ± 0.6 (p=0.015) in SK patients and it was 4.34 ± 0.6 (p < 0.001) in AIS patients. The mean SRS-22 pain scores of PK patients was 4.18 ± 0.7. The mean pain score was 3.68 ± 0.8 (p=0.033) in the SK group and 3.6 ± 0.8 (p=0.010) in the AIS group. Adolescents with PK perceived less pain than those with AIS or SK. The scores for the other domains of SRS-22 revealed no differences. CONCLUSION: HRQoL of patients with PK is reduced, similar to that of patients with common structural spine deformities. Recognizing the effects of PK on the HRQoL in adolescents can help physicians to treat these patients.

Effect of clinical and radiological parameters on the quality of life in adult patients with untreated adolescent idiopathic scoliosis: a cross-sectional study.

PURPOSE: The aim of this study is to evaluate the factors that affect health-related quality of life (HRQoL) in untreated adolescent idiopathic scoliosis (AIS) patients in adulthood. We investigate the effect of clinical and radiological parameters on the SRS-22 results. METHODS: A total of 286 untreated adolescent idiopathic scoliosis patients at adult age between April 2021 and April 2022 who were admitted to our clinic were included in the study. Rotational deformities were evaluated with a scoliometer. Cobb angles, coronal balance, clavicle angle, coronal pelvic tilt, trunk shift, and apical vertebral translation were measured in standing anteroposterior X-rays. The effect of each clinical and radiological parameter on SRS-22 results was evaluated. RESULTS: No correlation was found between gender, age, curve type, presence of gibbosity or diagnosis time, and SRS-22 scores. A negative correlation was found between the BMI of the patients and the self-image scores (r = - 0.246, p < 0.01) and function scores (r = - 0.193, p < 0.05). Main thoracic (MT) gibbosity negatively correlates with self-image and total SRS-22 scores. Also, negative correlations were found between lumbar/thoracolumbar (LTL) gibbosity, function, and pain scores. MT Cobb angle magnitude was negatively correlated with self-image, mental health, and total SRS-22 scores. There were negative correlations between clavicle angle and mental health score, coronal pelvic tilt and self-image score, and apical vertebral translation and pain score. CONCLUSION: BMI, MT gibbosity, LTL gibbosity, MT Cobb angle, clavicle angle, coronal pelvic tilt, and apical vertebral translation were negatively correlated with SRS-22 domains in untreated AIS patients in adulthood.

Which design tolerates rotational mismatch better in unicompartmental knee arthroplasty: fixed or mobile bearing?

Unicompartmental knee arthroplasty is an effective method for the treatment of medial compartment osteoarthritis. However, appropriate surgical tech- nique and optimum implant positioning are crucial for a satisfactory outcome. This study aimed to demonstrate the relation between the clinical scores and the alignment of the components in UKA. A total of 182 patients with medial compartment osteoarthritis and treated by UKA between January 2012 and January 2017 were enrolled in this study. Computed tomography (CT) was used to measure the rotation of components. Patients were divided into two groups according to the insert design. These groups were divided into three subgroups according to the angle of the tibia relative to the femur (TFRA) (A): TFRA 0° to 5° either internal or external rotation; (B): TFRA >5° internal rotation, and (C): TFRA >5° external rotation. There was no significant difference between the groups in terms of age, body mass index (BMI) and follow-up period. KSS scores increased as the tibial component rotation (TCR) external rotation increased, but there was no correlation for WOMAC score. (P: 0,039 r: 0,207; P:0,347 r:0,095, respectively) Post-operative KSS and WOMAC scores decreased as TFRA external rotation was increased. (p: 0,001; p:0,001, respectively) No correlation has been observed between femoral component rotation (FCR) internal rotation and post-operative KSS and WOMAC scores. (p: 0,261; p: 0,502, respectively) Any mismatch between the components is better tolerated by mobile-bearing designs compared to fixed-bearing designs. Orthopedic surgeons should take care of rotational mismatch of components, not only the axial alignment of the components.

The factors that affect blood loss in intertrochanteric fractures treated with proximal femoral nail in the elderly.

PURPOSE: Intertrochanteric femur fractures (IFF) is one of the biggest health problems in elderly population and mostly treated by proximal femoral nails. Although it is done in less invasive technique this method can cause higher blood loss than expected and subsequent allogenic blood transfusions. In this study, we aimed to investigate the factors that were related to the blood loss in proximal femoral nail fixation of IFF including patients' ongoing anticoagulant treatments. METHODS: 231 consecutive patients with IFF who treated with proximal femoral nail anti-rotation between January 2017 and December 2019 were included the study. The factors that can affect the blood loss determined as patients demographics, time from injury to operation, duration of operation, the American Society of Anesthesiologists (ASA) scores, preoperative anticoagulant medications. Hematocrit and hemoglobin were obtained on admission day, postoperative day one and postoperative day 3. Total blood loss and allogenic blood transfusions assessed. RESULTS: Higher BMI is found related to higher blood loss. The patients who were operated in the first two days after admission had lower blood loss levels independent from anticoagulant use (p = 0.027). Preoperative Hct was higher in patients who did not need RBCs in the perioperative period (p = 0.039). According to the AO classification, A2.1 fractures had lower blood loss levels. CONCLUSION: This study demonstrated that ongoing anticoagulant treatments of intertrochanteric fracture patients did not increase the perioperative blood loss. The factors affecting blood loss in the proximal femoral nail fixation were BMI, the time to surgery, and fracture type in the elderly.

Functional outcomes of internal fixation of scapula fractures due to high-velocity gunshot injuries.

BACKGROUND: Open fractures of the scapula are relatively rare and only a few studies are interested in this subject. This study aims to demonstrate the results of internal fixation of open scapula fractures due to gunshot injuries. MATERIALS AND METHODS: Eight patients who had open scapula fractures and were treated by internal fixation through the conventional Judet approach included in this study. Patients were followed up monthly in the first 6 months and every 2 months in the rest of the follow-up. Shoulder range of motion, Constant Shoulder Score, and Disabilities of the Arm, Shoulder, and Hand score were used for functional evaluation. RESULTS: The average follow-up period was 34.6 ± 11.9 months. The average time between injuries and the surgery was 10.5 ± 5.1 days. The average shoulder abduction of the patients was 135.6 ± 18.8°, the average forward flexion of the shoulder was 160 ± 19.2°. The average internal and external rotations of the shoulders were 80 ± 14.1° and 63.1 ± 17.3°, respectively. CSS was calculated as 79.8 ± 14.4, and DASH was calculated as 14.1 ± 14.9. CONCLUSIONS: In the treatment of open scapula fractures due to gunshot injuries, an internal fixation is a reliable option and the results were comparable with previous studies.

Long-term Functional Difference between the First and Second Knees in Simultaneous Bilateral Total Knee Arthroplasty.

OBJECTIVE: To compare the long-term functional results of the first and second knees in simultaneous bilateral total knee arthroplasty. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Gulhane Education and Research Hospital, Ankara, Turkey from January 2003 to December 2010. METHODOLOGY: A total of 47 patients with at least 10 years of follow-up after simultaneous bilateral total knee arthroplasty were included in the study. The range of motion, forgotten joint score (FJS), Oxford knee score (OKS), and Western Ontario McMaster university osteoarthritis index (WOMAC) were compared between the first and the second knees. The Dependent t-test and the Wilcoxon Sign test were used to determine the significance. Whether there was a statistically significant correlation, so Spearman's correlation test and Bonferroni correction were used. RESULTS: WOMAC total scores both knees were 13 (p=0.755). The average OKS of the first operated knees was 40.53 ± 4.44, while it was 40.28 ± 4.59 in the second knees (p=0.239). The FJS of the first and second operated knees were 69.36 ± 21.97 and 69.02 ± 21.89, respectively (p=0.321). As the age increased, the ROM was decreased. As the patient age increased, WOMAC pain scores were found to decrease. CONCLUSION: The functional scores of the first and the second operated knees in SBTKA were similar in the long term. Although no correlation was found between age and the functional scores, these results complied with the previous information about the effect of age on TKA results. Key Words: Simultaneous total knee arthroplasty, Bilateral, Clinical outcome, Osteoarthritis.

Results of quadratus femoris muscle pedicle bone grafting (Meyers' procedure) in the management of ununited femoral neck fractures.

PURPOSE: Femoral neck fractures in young patients are associated with increase complication risk. The objective of this study was to evaluate the results of quadratus femoris muscle pedicle grafting in the treatment of ununited femoral neck fractures. METHODS: This study includes 16 patients with ununited femoral neck fractures treated with quadratus femoris muscle pedicle graft. 7 patients had neglected femoral neck fractures while 9 had ununited femoral neck fractures after fixation. Quadratus femoris muscle with 2 × 1 × 1 cm (length-width-height) bone in its insertion was elevated and placed in the posterior cortex of the femoral neck with additional cancellous graft from the posterior iliac bone. The graft was fixed with 3.5-mm cortical screws. RESULTS: The average follow-up period was 96 weeks and the radiological union occurred at an average of 7 months. The femoral inclination of all patients was 128.5° ± 3.9° with an average 7 (range 0-35) mm thigh atrophy in the last follow-up visit. Only 1 patient (6%) had avascular necrosis of the femoral head and was treated with hip arthroplasty. CONCLUSIONS: Quadratus femoris muscle pedicle grafting provides better stability and blood supply in ununited femoral neck fractures. Achieving fracture union provides better clinical and functional results in the treatment of femoral neck fractures.

Pelvic Incidence as a Prognostic Factor in Coccydynia.

AIM: To evaluate the pelvic incidence (PI) of coccydynia patients treated by different methods and to determine whether it is a risk factor or a prognostic factor. MATERIAL AND METHODS: Patients who were treated for coccydynia were evaluated retrospectively, and 110 patients were enrolled. Spinopelvic parameters were measured by using Surgimap software, and the position of the coccyx was evaluated according to the Postacchini classification. The results were compared to spinopelvic parameters of healthy population. RESULTS: The mean PI of the coccydynia patients did not differ from the healthy population, and there were no differences between treatment subgroups. The Postacchini classification showed that patients with type-3 and type-4 configurations had higher PI. When treatment groups were evaluated according to Postacchini classification, 80% of the surgery group had type-3 and type-4 configurations (50%, 30% respectively). CONCLUSION: This is the first study to evaluate the PI of coccydynia patients. Patients with higher PI were prone to having type-3 of type-4 coccyx configurations and undergoing surgical treatment.

Is staged management with immediate conversion of external fixation to retrograde intramedullary nailing for combat-related Gustilo Type III supracondylar femur fractures safe and reliable method?

INTRODUCTION: Femur fractures due to bomb explosions and gunshots in battlefield require osseous stabilization as quickly as possible to expedite emergent conditions. Immediate external fixation is the initial procedure as usual with planned early conversion to definitive treatment. The purpose of the current study is to determine the results of the early retrograde intramedullary nailing in combat-related injuries. MATERIAL AND METHODS: Eighteen patients with comminuted supracondylar femur fractures, initially treated with external fixation followed by planned conversion to retrograde intramedullary nailing in a one-stage procedure, were evaluated in a retrospective review to gather demographic, injury, management, and fracture-healing data for analysis. RESULTS: According to the system of Gustilo Anderson and Orthopedic Trauma Association, all fractures were open type III and 33-A3, respectively. The mean follow-up, operation time and union time were 1.8 years (range, 6 months to 2,6 years), 75 min (range, 60-100), and 3 months (range, 1.5-4), respectively. There was one complication of acute osteomyelitis which was successfully treated with antibiotic-load beams and aggressive bone debridement. No septic arthritis was observed. CONCLUSIONS: We concluded that immediate retrograde intramedullary nailing in combat-related supracondylar femur fractures regardless of contamination even in Gustilo type III is a safe and reliable treatment method.

A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis.

OBJECTIVES: This study aims to evaluate the efficacy of prolotherapy injections for the treatment of plantar fasciitis. MATERIAL AND METHODS: Between October 2014 and October 2015, 60 patients with symptomatic chronic plantar fasciitis were randomly divided into two groups, as control (n=31) and prolotherapy (n=29) groups. In the prolotherapy group, ultrasound-guided prolotherapy injections into the plantar fascia up to five different points were performed three times every 21 days. In the control group, the patients received instructions for plantar fascia and Achilles tendon stretching exercises three times a week for three months. Additionally, all patients were given heel lifts and instructed to refrain from heavy loading activity. The patients were evaluated via the Visual Analog Scale (VAS), Food and Ankle Outcome Score (FAOS), and Foot Function Index (FFI) at baseline and at 21, 42, 90, and 360 days during follow-up. RESULTS: A total of 50 patients completed follow-up (26 patients in the prolotherapy group and 24 patients in the control group). The VAS, FAOS, and FFI scores were significantly improved in both groups (p<0.001). There were no statistically significant differences in the pain and functional scores at 21 days of treatment between the groups. The VAS and FAOS scores were higher in the prolotherapy group than the control group at 42, 90, and 360 days of treatment. The FFI scores were also higher in the prolotherapy group than the controls at 42 and 90 days of treatment; however, both groups had similar scores at 360 days. CONCLUSION: Our study results suggest that prolotherapy is an effective auxiliary method for treating chronic plantar fasciitis.

Intramedullary elastic nailing of the displaced radial neck fractures in children.

OBJECTIVE: The aim of this study was to report the clinical and radiological results of 11 patients with Judet type 3 severely displaced radial neck fractures, who were treated with intramedullary elastic nail fixation with the help of percutaneous K-wire reduction maneuver (Métaizeau technique). METHODS: A total of 11 children (4 boys and 7 girls with a mean age of 7.7 (6-10) years) with Judet type 3 radial neck fractures were treated in our clinic between February 2013 and August 2015. The fractures were evaluated according to Judet classification system modified by Métaizeau. Reduction and fixation was performed within the first 24 h after injury in all patients. All fractures were treated by closed reduction using distal elastic intramedullary nail. Clinical evaluation was performed by measuring elbow range of motion (ROM) with goniometer, radiological evaluation by assessing fracture healing and functional evaluation by using Mayo Elbow Performance Score (MEPS). RESULTS: The mean MEPS score increased from 15 points preoperatively to 88 points postoperatively (range, 12-95 points). Radiological evaluation revealed that all fractures healed with excellent or good alignment. The mean flexion was 150° (range, 145-154°), extension 1° (range, 0-2°), supination 82° (range, 80-86°), and pronation 83° (range, 80-85°). CONCLUSION: Reduction and osteosynthesis of radial neck fractures by intramedullary nailing with the help of percutaneous K-wire manipulation appears to be a simple, safe and effective treatment method in children. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

An analysis of orthopaedic theses in Turkey: Evidence levels and publication rates.

BACKGROUND: The aim of this study was to present characteristics and publication patterns of studies arise from orthopedic theses obtained from National Thesis Center; database in terms of publication years, study types, topics, level of evidence between 1974 and 2014. METHODS: Firstly, National Thesis Center database was searched for orthopedics and Traumatology theses. The theses, which their summary or full text were available were included in the study. The topics, study types and quality of study designs were reviewed. Then theses were searched in the PubMed database. Journals of published theses were classified according to category, scope and impact factors of the year 2014. RESULTS: 1508 theses were included into the study. Clinical studies comprised 71,7% of the theses, while 25,6% of the theses were non-clinical experimental and 2,7% of the theses were observational studies. Clinical studies were Level I in 8,6% (n = 93) and Level II in 5,8% of the theses (n = 63). A total of 224 theses (14,9%) were published in the journals indexed in PubMed database from 1974 to 2012. Fifty-two (23,2%) were published in SCI; 136 theses (60,7%) were published in SCI-E journals and 36 theses (16%) were published in other Journals indexed in PubMed. CONCLUSION: The quantity and quality of published theses need to be improved and effective measures should be taken to promote quality of theses. Theses from universities and Training hospitals which did not allow open access, and; incomplete records of the National Thesis Center database were major limitations of this study.

Hyperbaric oxygen therapy in the treatment of osteonecrosis of the femoral head: a review of the current literature.

OBJECTIVE: To review the current literature on the use of hyperbaric oxygen (HBO2) therapy in the treatment of osteonecrosis of the femoral head (ONFH). SEARCH STRATEGY: We searched PubMed, Directory of Open Access Journals (DOAJ), EMBASE, Web of Science, Academic Search Complete, CINAHL and MEDLINE through April 2015. We hand-searched relevant textbooks, conference proceedings and the reference lists of review articles and clinical studies STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCT) and observational studies (cohort study, case-control study, case series) that reported the outcome of patients who received HBO2therapy for ONFH were included. Only English-language articles were included. Study quality was not used as an exclusion criterion. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently assessed trials for inclusion, extracted data and presented to other authors. Disagreements were resolved by consensus. RESULTS: We identified eight clinical studies; two randomized controlled trials (RCTs); one historically controlled study; and five case series. The majority of the studies were small-scale, heterogeneous and methodologically weak. In four of the studies HBO2therapy was combined with other treatment modalities, making it impossible to draw firm conclusions on the specific effects of HBO2therapy. Hip survivorship in studies wherein HBO2therapy was used alone was 95.5% in Steinberg Stage I lesions, 89% in Steinberg Stage II lesions and 100% in Ficat Stage II lesions. CONCLUSIONS: There is a room for HBO2therapy in the management ONFH. Further RCTs, however, are required to better elucidate the role of HBO2therapy in the treatment of ONFH.