RELATION OF FEMUR FRACTURES LOCATION WITH CLINICAL OUTCOMES IN ELDERLY PATIENTS.

Objectives: This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods: 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results: Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion: Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

Objetivos: Este estudo foi desenhado para investigar a possível relação entre a localização anatômica da PFP (fraturas de cabeça e pescoço) e as características demográficas, comorbidades e fatores de risco de pacientes idosos. Métodos: Foram incluídos 233 pacientes com idade igual ou superior a 65 anos, admitidos no pronto-socorro com diagnóstico de fratura do fêmur proximal. Resultados: A maioria dos pacientes (59,6%) apresentou fratura trocantérica. A incidência de fraturas trocanterianas apresentou correlação positiva estatisticamente significativa com a idade. Verificou-se que as quedas no nível do solo estão altamente associadas às fraturas trocantéricas (92,8%). Pelo menos uma complicação foi observada em 57 (41%) casos e 31 (22,3%) morreram em um ano, dos pacientes com fraturas trocantéricas. A comoborbidade não foi realizada estatisticamente com a localização da fratura. Queda do nível do solo (p = 0,013), taxa de complicações (73,7%; p < 0,001), índice de comorbidade charlesen (p = 0,019) foram estatisticamente significativamente associados à morte. Na análise de regressão logística das variáveis, determinou-se que apenas a quantidade de comorbidades pode estar relacionada às fraturas do colo do fêmur (p = 0,047). Conclusão: Pacientes do sexo feminino com fraturas trocantéricas foram consideradas mais velhas do que pacientes do sexo masculino. Queda no nível do solo, mortalidade e complicações foram observadas com mais frequência em pacientes com fraturas trocantéricas. Nível de evidência II, Estudo retrospectivo .

Relation of femur fractures location with clinical outcomes in elderly patients / Relação da localização das fraturas de fêmur com desfechos clínicos em pacientes idosos

ABSTRACT Objectives: This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods: 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results: Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion: Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

RESUMO Objetivos: Este estudo foi desenhado para investigar a possível relação entre a localização anatômica da PFP (fraturas de cabeça e pescoço) e as características demográficas, comorbidades e fatores de risco de pacientes idosos. Métodos: Foram incluídos 233 pacientes com idade igual ou superior a 65 anos, admitidos no pronto-socorro com diagnóstico de fratura do fêmur proximal. Resultados: A maioria dos pacientes (59,6%) apresentou fratura trocantérica. A incidência de fraturas trocanterianas apresentou correlação positiva estatisticamente significativa com a idade. Verificou-se que as quedas no nível do solo estão altamente associadas às fraturas trocantéricas (92,8%). Pelo menos uma complicação foi observada em 57 (41%) casos e 31 (22,3%) morreram em um ano, dos pacientes com fraturas trocantéricas. A comoborbidade não foi realizada estatisticamente com a localização da fratura. Queda do nível do solo (p = 0,013), taxa de complicações (73,7%; p < 0,001), índice de comorbidade charlesen (p = 0,019) foram estatisticamente significativamente associados à morte. Na análise de regressão logística das variáveis, determinou-se que apenas a quantidade de comorbidades pode estar relacionada às fraturas do colo do fêmur (p = 0,047). Conclusão: Pacientes do sexo feminino com fraturas trocantéricas foram consideradas mais velhas do que pacientes do sexo masculino. Queda no nível do solo, mortalidade e complicações foram observadas com mais frequência em pacientes com fraturas trocantéricas. Nível de evidência II, Estudo retrospectivo.

Tibia stress fracture secondary to obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder characterized by obsessions and compulsions. Early-onset OCD is one of the most common mental illnesses of children and adolescents, with a prevalence of 1% to 3%. It is related to worse lifespan symptoms and prognosis. Therefore, the treatment of OCD in children and adolescent has gained importance. If it is not treated successfully, the compulsive behaviors may cause extreme stress for children and their parents. Although minor complications of OCD are commonly observed, major complications are considerably rare due to the nature of compulsive behaviors. Apparently, loss of vision, autocastration, rectal prolapse are examples of major complications secondary to OCD. As far as we know, it is the first case of tibia stress fracture secondary to OCD. In the present case report, we will discuss tibia stress fracture developing secondary to compulsive behavior due to OCD.

[The effect of human placental suspension on rat sciatic nerve healing]. / Siçan siyatik sinir iyilesmesinde insan plasenta süspansiyonunun etkisi.

OBJECTIVES: We investigated the effect of human placental suspension (HPS) on rat sciatic nerve regeneration. METHODS: Eight adult female Sprague-Dawley rats weighing between 250 and 300 g were randomly divided into control and study groups equal in number. Both sciatic nerves were explored under anesthesia, transsected and then immediately repaired. At the end of the operation, and on the second and fifth days, HPS and saline were administered to the operation zone in the test and control groups, respectively. For functional examination, electromyographic activity was measured in posterior extremities of all rats preoperatively and at the end of eight weeks. The rats were then sacrificed to obtain transections from the repaired area and its distal region for histologic examination and the number of myelin-sheathed axons was estimated in both regions. RESULTS: Electromyographic study showed delayed latency and decreased amplitude following operation in both groups, being less severe in the study group without reaching a significant difference from the control group (p>0.05). The most notable histopathologic finding was increased endoneural collagen in the control group and regenerative axonal growth in the HPS group. The number of axons was greater in the distal region in both groups. In both regions, the number of myelin-sheathed axons was greater in the HPS group, but this difference was significant only for the number of axons in the repair zone (p=0.001). CONCLUSION: Our data suggest that HPS may exert a favorable effect on peripheral nerve regeneration.

Histoacryl glue in meniscal repairs (a biomechanical study).

The purpose of this study was to investigate the biomechanical efficacy of Histoacryl (cyanoacrylate, N-asetil 2 butyl sistein) in meniscal tear repair. In our study, the primary stability of three different repair techniques in delaying the formation of a gap of 2 mm was investigated. A meniscal tear was repaired with two vertical sutures and Histoacryl in the first group; it was repaired only with Histoacryl in the second group, and with only two vertical sutures in the third group. Menisci were then placed in a tensile loading machine, and the primary stability of the repair zones was measured until a displacement of 2 mm occurred. Biomechanical force was significantly (P<0.05) high (112.0+/-17.20 N) in all groups when vertical suture and Histoacryl glue were used together during displacements of 0.5, 1.0, 1.5 and 2.0 mm. We believe that Histoacryl is superior to vertical sutures regarding gap delaying. It potentiates the effect of vertical suture strength, permits early motion and thus merits an in vivo study.

Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms.

AIM: To investigate the risk factors for infection of the diabetic foot with multidrug resistant microorganisms. METHODS: Amongst 102 diabetic patients with evidence of soft tissue infection of the foot who presented to our health center over a three year period, we investigated risk factors that might be predictive of multi-antibiotic resistance of the infecting organism. RESULTS: Of 102 patients with a diabetic foot wound, bacteria were cultured from 73, yielding a total of 104 isolates. The number of multidrug resistant isolates was 42 from 36 cases and the number of isolates other than multidrug resistant ones was 62 from 37 cases. Previous antibiotic therapy (p=0.002) and its duration (p=0.0001), frequency of hospitalization for the same wound (p=0.000), duration of hospital stay (p=0.000) and osteomyelitis (p=0.001) were significant risk factors for infections with multidrug resistant microorganisms. CONCLUSION: In conclusion, an appropriate antibiotic should be initiated promptly, wound perfusion should be effective, duration of hospital stay should be as short as possible and optimum hygiene should be provided during wound care to prevent infections of diabetic foot wound with multidrug resistant microorganisms.

Evaluation of cyanoacrylate augmentation of transpedicular screw pullout strength.

PURPOSE: Pedicle screw fixation of osteoporotic bone in the elderly is a challenge. Various augmentation methods have been studied by many authors. Although polymethylmethacrylate (PMMA) augmentation is believed to be a standard method, its usage is fraught with complications. Butyl-2-cyanoacrylate is an alternative to PMMA as it is bioresorbable, biocompatible, inexpensive, and noninfective. The objective of the current study was to determine the pullout strength of the pedicle screws when butyl-2-cyanoacrylate is used for augmentation. METHODS: Fresh calf lumbar vertebrae were obtained from male calves weighing 100-120 kg and implanted with pedicle screws. The screws were placed in native, unaugmented bone (group 1), butyl-2-cyanoacrylate-augmented bone (group 2), and PMMA-augmented bone (group 3). Axial pullout tests were done by an Instron 4411 universal testing machine. Statistical analysis was performed using the SPSS 9.0 for Windows program. Paired samples t test was used, and P < 0.05 was considered significant. RESULTS: The mean bone mineral density of the vertebrae was 1.6 +/- 0.1 g/cm2. The mean pullout strengths were 1.55 +/- 0.23 kN for group 1, 1.62 +/- 0.42 kN for group 2, and 2.55 +/- 0.22 kN for group 3. There was no statistically significant difference between groups 1 and 2. PMMA augmentation increased the pullout strength significantly when compared with butyl-2-cyanoacrylate augmentation and native bone (P = 0.002 and P = 0.001, respectively). CONCLUSIONS: The results of this study show that butyl-2-cyanoacrylate has no contribution to the augmentation of pedicle screw fixation in a calf model when compared with native bone or PMMA augmentation. Further studies are required to evaluate the effectiveness of butyl-2-cyanoacrylate in osteoporotic specimens and under cyclic loading in calf vertebra and animal and cadaver models before dispensing with its utility as an augmentation method in the clinical setting.

[The use of N-butyl-2-cyanoacrylate (Histoacryl) in primary tendon repair: a biomechanical study with sheep flexor tendons]. / Tendon onariminda N-butil-2-siyanoakrilat (Histoakril) kullanimi: Koyun fleksör tendonuyla biyomekanik çalisma.

OBJECTIVES: In this study, the biomechanical properties of peripheral tendon repair with the use of epitendinous suture technique and N-butyl-2-cyanoacrylate (Histoacryl) (NBSA), a biodegradable glue, were compared. METHODS: Twenty-four flexor tendons were harvested from sheep hind limbs. Following transection of the tendons, 12 tendons (group 1) were repaired with modified Kessler core sutures using no 2 prolene and epitendinous running sutures with 3/0 prolene. In the other 12 tendons (group 2), NBSA was applied between the cut surfaces before placing modified Kessler core sutures. Placed on an hydrolic test machine, half of the tendons from each group were subjected to load to failure with a tensile force of 20 mm/min and the other half to cyclic loading with a tensile loading between 1-15 N at a rate of 20 cycles/min. Observation of a gap of 1 mm between the tendon ends in each test was regarded as repair failure. RESULTS: The mean load to failure was 27.3 N (range 25 to 32 N) for group 1 and 50.4 N (range 32 to 63 N) for group 2 (p=0.022). The mean number of cycles at failure was 140 (range 45 to 250) in group 1 and 350 (range 150 to 600) in group 2 (p=0.032). CONCLUSION: Our results showed that peripheral tendon repair with the use of NBSA has biomechanical advantages over repair with the epitendinous running suture technique.

[A case of lumbar ganglion cyst causing radiculopathy]. / Radikülopatiye yol açan lomber gangliyon kisti: Olgu sunumu.

Ganglion cysts represent a rare pathology mostly encountered in the lumbar region of the spinal column. Magnetic resonance imaging revealed a ganglion cyst at the L4-5 level in a 46-year-old woman who had a complaint of long-standing pain in her right leg. The cyst was completely excised following total laminectomy at L4. After surgery, her symptoms and neurological signs completely disappeared.

Clarithromycin destroys biofilms and enhances bactericidal agents in the treatment of Pseudomonas aeruginosa osteomyelitis.

In this study, the effect of clarithromycin on the destruction of bacterial biofilm in Pseudomonas aeruginosa osteomyelitis was investigated. Foreign body-related osteomyelitis caused by ceftazidime-sensitive Pseudomonas aeruginosa was produced in the tibias of 26 rats. After osteomyelitis was verified on Day 14, 10 rats had ceftazidime (1500 mg/kg/day) given subcutaneously, and 10 rats had ceftazidime given subcutaneously and clarithromycin (100 mg/kg/day, two 50-mg/kg doses every 12 hours) given orally; three rats formed the control group. After a treatment period of 20 days, the tibias and the foreign bodies were removed, cultured, and examined by electron microscopy. The number of microorganisms growing on the bone tissue in the group receiving combined treatment was significantly lower than in the other groups. The number of microorganisms growing on the foreign body in the group receiving only ceftazidime was significantly higher than that of the group receiving combined treatment. Electron microscope examination revealed that the biofilm layer was eradicated in the group that had combined therapy; however, biofilm formation was evident on the foreign body in the group receiving only ceftazidime. Clarithromycin enhanced the activity of concomitantly used bactericidal agents by destroying biofilm on the surface of the materials.

The anterior center edge angle: a study of 102 volunteers.

OBJECTIVES: To measure the anterior center edge (VCE) angle that reflects anterior coverage of the femoral head. PATIENTS AND METHODS: False profile views of both hips of 102 volunteers, 23 male and 79 female, were taken between October 2000 and October 2001. Radiographs with evidence of degenerative hip disease and those with poor image quality were excluded from the study. This left 181 radiographs. RESULTS: An orthopedic surgeon and a radiologist used a standard protractor to examine each of the 181 radiographs twice, at an interval of 24 h. The mean VCE angle was 49.27 +/- 7.77 degrees (range, 24.75-68.75), a value different from those found in previous studies. No significant intraobserver or interobserver differences were found. CONCLUSIONS: Our findings may contribute to the determination of a new parameter for evaluating anterior femoral head covering. In patients with acetabular dysplasia and deficient anterior coverage, this parameter may prove useful for selecting patients for surgery, planning the procedure, and evaluating postoperative results.

The effect of alprostadil on ischemia-reperfusion injury of peripheral nerve in rats.

OBJECTIVE: To determine the effect of alprostadil on the ischemia-reperfusion (I/R) injury of the sciatic nerve in rats. MATERIALS AND METHODS: Pre-reperfusion administration of alprostadil (0.05 microg kg(-1)) was assessed in the I/R injury model of the rat sciatic nerve. In this model, blood samples were investigated for the I/R injury markers namely malondialdehyde (MDA), an indicator of lipid peroxidation, and nitrite/nitrate levels, products of nitric oxide (NO) metabolism. RESULTS: A significant decrease in MDA, and increase in NO levels were observed in the groups which received alprostadil before reperfusion, when compared to their corresponding untreated controls (I/R only) at all time intervals (P=0.0001). There was a statistically significant difference in both MDA, and NO levels between certain time intervals. There was no statistical linear correlation between MDA and NO levels. CONCLUSION: Alprostadil may be suggested as a protective anti-inflammatory and a vasodilator pharmacological agent for I/R injury in peripheral nerves. Also, measurements of NO and MDA may be complementary to the generally accepted evaluation parameters of I/R injury including electromyography and nerve histopathology.

[The role of electrophysiologic tests in the early diagnosis of posterior interosseous neuropathy in patients thought to have lateral epicondylitis]. / Lateral epikondilit öntanisi konan olgularda posterior interosseöz sinir nöropatisinin elektrofizyolojik testlerle arastirilmasi.

OBJECTIVES: We investigated the role of electrophysiologic tests in determining posterior interosseous neuropathy (PIN) in patients with a preliminary diagnosis of lateral epicondylitis. METHODS: Thirty-three patients (24 females, 9 males; mean age 49 years) with a preliminary diagnosis of lateral epicondylitis and 15 healthy controls (10 females, 5 males; mean age 48 years) underwent radial, median, and ulnar nerve conduction studies, electromyography (EMG) of some selected muscles, and measurements for grip strength. The duration of symptoms was less than a month in all the patients and no therapy was instituted. RESULTS: A diagnosis of PIN was made in 22 patients (66.7%). The mean ages of the patients with and without PIN were 45 and 51 years, respectively. The mean grip strengths did not differ significantly between the patients and controls, and between the right and left hands. All the patients responded well to conservative treatment. CONCLUSION: Electrophysiologic tests may be necessary and beneficial in the differential diagnosis of PIN in patients unresponsive to treatment for lateral epicondylitis of early stage.

Involvement of the proximal tibiofibular joint in osteoarthritis of the knee.

This study was performed to evaluate the possible involvement of the proximal tibiofibular joint in primary osteoarthritis of the knee. A total of 40 patients with primary osteoarthritis of the knee who had magnetic resonance imaging scans were reexamined for proximal tibiofibular joint involvement. The patient was questioned if pain was present in the proximal tibiofibular joint while at rest, when walking and climbing stairs. Symptoms were evaluated by applying moderate compression over the proximal tibiofibular joint during active ankle and knee motions. Magnetic resonance imaging scans were reexamined by two radiologists. Three of the 40 patients had minimal or moderate pain in the proximal tibiofibular joint during stair-climbing and on clinical examination. Magnetic resonance imaging scans of these three patients revealed osteophyte or subchondral cyst formation, or both. Degenerative changes in the proximal tibiofibular joint may be evident in association with osteoarthritis of the knee and may result in lateral-sided pain at the knee.

[The reliability of somatosensory evoked potentials in the diagnosis of thoracic outlet syndrome]. / Somatosensoriyel uyarilmis potansiyellerin torasik çikis sendromu tanisinda güvenilirligi.

OBJECTIVES: We assessed the role of somatosensory evoked potentials (SEP) in the diagnosis of thoracic outlet syndrome. METHODS: Somatosensory evoked potentials were recorded in provocative and decompressing positions in 30 patients (28 females, 2 males; mean age 32 years; range 20 to 52 years) with a diagnosis of thoracic outlet syndrome and in 30 healthy subjects showing a similar age and sex distribution. RESULTS: All recordings yielded normal ranges in both groups. No statistically significant differences were found between the positions in which SEPs were recorded and between the patient and control groups. CONCLUSION: Our data suggest that SEPs do not give diagnostic information in the identification of thoracic outlet syndrome.

The effects of carnitine on distally-burned dorsal skin flap: an experimental study in rats.

OBJECTIVE: In ischemia and burn injuries, there are major alterations threatening tissue survival. Increased energy flow requirements are among the major problems in these disorders. Carnitine is an endogenous cofactor, which has a regulatory action on the energy flow from different oxidative sources. The purpose of this study was to determine the effects of carnitine in an experimental flap model. Biochemically, nitric oxide (NO), malondialdehyde (MDA), and acetylcholinesterase levels, and histopathologically tissue examination under light microscope were studied. METHODS: In the rat dorsal skin, a 10 cm x 3 cm flap was marked. The most distal 3 cm x 3 cm of the flap was burned to full-thickness. The dorsal flap was elevated, and sutured back to its original site. Sixteen rats were divided into two groups (a control (1) and a study group (2)), consisting of eight rats in each. While the animals in the control group were just followed, the animals in the study group were administrated carnitine with a dose of 100 mg/kg per day for 7 days. RESULTS: At the end of the experiment: the mean surviving areas of the flaps were 15.22 cm(2) (50.73%) in group 1, 20.53 cm(2) (68.43%) in group 2, and the difference was statistically significant (P=0.008). In the analysis of blood samples; the mean levels of NO were 22.63 and 40.78 micromol/l; of MDA were 6.74 and 3.79 ng/ml; and of acetylcholinesterase were 136.14 and 222.85 U/l in groups 1 and 2, respectively. The differences in the levels of NO (P=0.001), MDA (0.027) and acetylcholinesterase (P=0.006) were statistically significant. Histopathological examination revealed a full-thickness muscle necrosis in addition to skin tissue in the control group, while healing tissue was present with marked cellularity including mixed inflammatory cells and fibroblast proliferation with an increased vascularity in the form of capillary budding in the study group. CONCLUSION: Carnitine has a positive effect in such a model, particularly in preventing the progressive effect of burn, and limiting the necrosis in the full-thickness burned part.

Bone mineral density and grip strength in postmenopausal Turkish women with osteoporosis: site specific or systemic?

OBJECTIVE: To assess the relationship of grip strength to site-specific bone mineral density of the metacarpal bone and also axial bone mineral density. The bone mineral density of the lumbar spine, femoral neck and the nondominant hand were measured by DEXA. SUBJECTS: A total of 187 postmenopausal women were included in the study. Of the patients, 102 were osteoporotic, and 85 were not osteoporotic and served as control subjects. METHODS: Grip strength of the nondominant hand was measured by hand-held dynamometer. Skinfold thickness of the nondominant hand was measured by a caliper (Holstain). Biochemical markers of bone turnover and other osteoporosis-related variables were also measured. RESULTS: There was a statistically significant difference between groups regarding bone mineral density of the lumbar, femoral (neck) and hand regions and the grip strength (P < .05). Hand bone mineral density (BMD) was found to be correlated with bone mineral density of the lumbar and femoral (neck) regions in osteoporotic patients. Grip strength was correlated positively with the BMD of the nondominant hand. Grip strength was correlated negatively with age and years since menopause. Grip strength was also correlated positively with femoral neck BMD. CONCLUSION: The study provides support for a site-specific and also systemic relationship between muscle and bone. Grip strength is also a predictor of hand bone mineral density.

Study of axial bone mineral density in postmenopausal women with diffuse idiopathic skeletal hyperostosis related to type 2 diabetes mellitus.

OBJECTIVE: The association of bone mineral density (BMD) with diffuse idiopathic skeletal hyperostosis (DISH) related to diabetes mellitus was studied. METHODS: We measured BMD and elevated known determinants of BMD (bone markers) in 35 patients with DISH-related type 2 diabetes mellitus, 47 type 2 female diabetics, and 52 female controls with no systemic disease and no drug administration. All subjects were matched for age and body mass index (BMI). All subjects were in the postmenopausal period. RESULTS: Among subjects, BMD values were significantly higher in DISH patients than in diabetics and controls (p < 0.05). In addition, the duration of diabetes mellitus was longer in DISH patients and significantly correlated with total hip BMD in DISH patients (p < 0.05). CONCLUSIONS: Patients with DISH have higher BMD, and increased BMD probably results from hyperostosis of the axial skeleton, which may cause decreased fracture risk.