Distally-fixed non-modular monoblock fluted long-stem hemiarthroplasty versus proximal femoral nailing for elderly patients with an osteoporotic intertrochanteric fracture: a retrospective comparative study.

BACKGROUND: The treatment of Intertrochanteric fractures in the elderly osteoporotic patient is still controversial. The aim of this study was to compare the outcomes of proximal femoral nailing (PFN) and a distally-fixed non-modular monoblock fluted long-stem hemiarthroplasty (HA) in elderly patients with an osteoporotic intertrochanteric fracture. METHODS: This retrospective study included patients who had undergone surgery for an unstable intertrochanteric fracture. The patients were separated into PFN and HA groups. The demographic features of the 2 groups were compared. All patients were evaluated using the Singh index, ASA score, AO/OTA classification, Harris Hip Score (HHS), and Parker and Palmer mobility score. RESULTS: The most common complications were nonunion (12.0%) and cut-out of the screw (10.7%) in the PFN group, and dislocation of the prosthesis (6.7%) and wound infection (5.7%) in the HA group. Overall, the 2-year mortality rate was 29.3%. Mortality, particularly within the first 3 months, was 2.4 times higher in the PFN Group than in the HA group (40% vs. 19.75%). Although the HHS was significantly higher in the first year for the HA group, no significant difference was seen between the 2 groups at 24 months. CONCLUSIONS: Although PFN and HA have similar good outcomes at 2 years, HA allows earlier mobilisation and has fewer complications and a lower mortality rate.

Management of thoracolumbar injury classification and severity score of 4 (TLICS=4) thoracolumbar vertebra fractures: Surgery versus conservative treatment.

BACKGROUND: This study aims to compare clinical and radiographic outcomes of surgical treatment and conservative treatment with bracing in neurologically intact patients with score 4 of TLICS thoracolumbar vertebra fractures. METHODS: Patients with traumatic thoracolumbar junction fractures (T11-L2), the score of TLICS 4, and minimum 24-month follow-up were included in this study. Patients were divided into surgery and bracing groups. The groups were compared concerning clinical and demographical features, local kyphotic angles (LKA), vertebra height loss percentage (VHL), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and time to return to work. RESULTS: There were 74 patients (71 males, 3 females) in the surgery group and 76 patients (58 males, 18 females) in the bracing group. Although the surgery group showed better improvement in VAS scores within six months postoperatively, no significant difference was observed at the 24th-month evaluation (p<0.001 and p=0.270, respectively). ODI, LKA and VHL were significantly lower in the surgery group (p<0.001, p<0.001 and p<0.001, respectively). In addition, return to work was significantly earlier in the surgery group (p<0.001). CONCLUSION: The findings obtained in this study suggest that the surgical treatment for TLICS 4 patients with thoracolumbar fractures has better clinical and radiographic outcomes than the bracing. Moreover, returning time to the work of patients is shortened with surgical treatment. The surgical treatment seems to be the first and the appropriate choice in the management of TLICS 4 thoracolumbar vertebral fractures.

Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study.

BACKGROUND CONTEXT: Studies have shown that adolescent idiopathic scoliosis (AIS) prevalence varies between 0.35% and 5.2% and it is generally accepted as an average of 2%-3% in children under age 16. There are a few narrow-scope studies based on school screening performed on the epidemiology of AIS in Turkey. Prevalence rates reported by these studies are lower than reported in neighboring countries. Of note, they were conducted in single cities, generally based on small sample size, and are different from each other in terms of methodology and age groups. The present study was conducted based on a large population in 85 schools of 40 provinces in Turkey. PURPOSE: The aim of this study was to determine the prevalence of AIS in Turkey. Secondary outcomes were to determine age, gender, curve distribution, using standard tests, and radiological verification. STUDY DESIGN: A cross-sectional epidemiological study. PATIENT SAMPLE: The sample size was calculated to estimate the prevalence of AIS in children aged 10-15 years in Turkey. OUTCOME MEASURES: Adams' forward bending test, angle of trunk rotation measurement, and posture analysis were used to screen. Students who had an angle of trunk rotation greater than or equal to five (≧5°) with scoliometer measurement or who had a positive forward bending test were referred to the mobile X-ray unit located in the school-yard on screening day. Their diagnosis was confirmed using Cobb angles of greater than or equal to 10 (≧10°). METHODS: Medical personnel, mobile radiological tools, and logistical support needed during fieldwork were provided by the Directorate General for Health Research, Ministry of Health Republic of Turkey. Spine and posture were examined in upright standing position. Examiners looked for shoulder asymmetries, scapular prominence, unequal waist, and lower limb length discrepancy. Potential scoliosis diagnosis was verified with onsite radiographic examination. Cases with a Cobb angle of ≧10° detected in any region were accepted as scoliosis. The direction and location of scoliosis were determined according to the Scoliosis Research Society terminology criteria. RESULTS: A total of 16,045 students were reached whose informed consent forms were signed by their parents. The prevalence of AIS was found to be 2.3% (female, 3.1%; male, 1.5%). Radiological confirmation rate was 98.8%; 256 (69.3%) of 369 adolescents with scoliosis had a single curvature and 108 (29.3%) had a double curvature. The most common single curve type was a lumbar curve. In all, 90.5% of cases with AIS had a mild (range of 10°-19°) Cobb angle. CONCLUSIONS: The prevalence of AIS was 2.3% in Turkey. This prevalence rate was considerably higher than the values in previous regional studies conducted in Turkey; however, it was close to generally accepted averages in the literature. One of the strongest aspects of the study was that radiologic confirmation of each suspected case was made during the screening.