A new configuration of lateral-pin fixation for pediatric supracondylar humeral fracture: A biomechanical analysis.

OBJECTIVE: The aim of this study was to biomechanically compare a new lateral-pinning technique, in which pins engage the medial and lateral columns of the distal humerus in a divergent configuration in both the axial and sagittal planes instead of the coronal plane, with the cross-pin, and with 2 and 3 coronally divergent lateral-pin techniques in a synthetic humerus model of supracondylar humerus fractures. METHODS: Thirty-six identical synthetic models of the humerus simulating a standardized supracondylar humerus fracture were included in this study. They were divided into 4 groups based on the pin configuration of fixation: the new 3-lateral pin-fixation technique (group A), 2 crossed pins (group B), 3 divergent lateral pins (group C), and 2 divergent lateral pins (group D). Each model was subjected to combined axial and torsional loading, and then torsional stability and torsional stiffness (Nmm/°) were recorded. RESULTS: Group A had greater rotational stability than groups C and D but had no statistically significant additional rotational stability compared with group B (P=.042, P=.008, P=.648, respectively), whereas group B had greater rotational stability than only group D (P=.020). Furthermore, group A demonstrated higher internal rotational stiffness compared with groups C and D (P=.038, P=.006, respectively). Group B had better internal rotational stiffness than group D (P=.015). There was no significant difference in internal rotational stiffness between groups A and B (P=. 542), groups B and C (P=.804), and groups D and C (P=.352). Although no statistically significant differences existed between groups A and B, the modified pin configuration exhibited the highest torsional stability and stiffness. Group D showed the lowest values in all biomechanical properties. CONCLUSION: This study has shown us that this new lateral-pinning technique may provide torsional resistance to internal rotational displacement as strong as the standard technique of crossed-pin configuration of fixation. Furthermore, with this new pin configuration, greater torsional resistance can be obtained than with either the standard 2- or the standard 3-lateral divergent pin configuration. Cite this article as: Bilgili F, Demirel M, Birisik F, Balci HI, Sunbuloglu E, Bozdag E. A new configuration of lateral-pin fixation for pediatric supracondylar humeral fracture: A biomechanical analysis. Acta Orthop Traumatol Turc., 2023 10.5152/j.aott.2024.21091 [Epub Ahead of Print].

The effects of modified hardinge approach on hip muscle strength in patients with primary hip arthroplasty: a patient evaluation with isokinetic strength test and gait analyses.

OBJECTIVE: Numerous factors affect abductor strength after Total hip arthroplasty (THA), including surgical technique, prosthesis type, postoperative rehabilitation program, and preoperative patient condition. We prospectively investigated the effects of the modified Hardinge approach on hip muscle strength, which was evaluated using the isokinetic test, functional results, and gait function of patients who underwent primary THA. METHODS: The hip muscles strength were measured using an isokinetic dynamometer. The primary outcomes of the present study were measurement of isokinetic strength of hip abductor muscle strengths using an isokinetic evaluator and gait analyses preoperatively and at 6 months postoperatively in 27 patients. RESULTS: Isokinetic muscle strength test, abductor and other hip circumference groups achieved the preoperative muscle strength at 3 months postoperatively, and the postoperative sixth month values showed a statistically significant improvement compared with the preoperative and third month values. In gait analyze, our temporospatial data showed a slight regression at postoperative 3 months but reached the same values at 6 months postoperatively. Kinematic data showed a significant regression, but the data were not compared with those in the preoperative period. CONCLUSIONS: Adequate muscle strength and physiological gait pattern, similar to the preoperative status, can be achieved at 6 months postoperatively. LEVEL OF EVIDENCE: Level III.

Effects of repeated intravenous doses of tranexamic acid on closed tibial fracture healing: Experimental study based on the rat model.

OBJECTIVE: The aim of this study was to assess the effects of tranexamic acid on fracture healing in the rat tibia closed fracture model. METHODS: Sixty-four male Sprague-Dawley rats were included in this study, where closed fracture and intramedullary nailing were performed on their right tibial diaphyses. They were divided into 2 main groups, the experimental group, which was given weekly tranexamic acid injections, and the control group, which received no additional treatment. Eight rats from each group were sacrificed and evaluated for fracture healing at the first experimental group and control group, second experimental group and control group, third experimental group and control group, and fourth experimental group and control group weeks. Fracture healing was radiologically assessed according to the "Spencer Index" and "Lane and Sandhu Scoring System," and histologically evaluated according to the scoring system devised by Huo et al. Results: According to the Spencer Index, the mean union score was statistically significantly higher in the E3 group than in the third con- trol group (P = .014). Furthermore, the mean union score was statistically significantly higher in the fourth experimental group compared to the fourth control group (P=.047). According to the Lane and Sandhu Scoring System, only the mean union scores of the E3-4 groups were statistically significantly higher than the mean union scores of the C3-4 groups (P=.048). There was no histological difference between groups in terms of union, according to the criteria defined by Huo et al (P > .05). CONCLUSION: This study showed us that repeated intravenous administrations of tranexamic acid had no negative effect on fracture heal- ing in the rat tibia fracture model. Although tranexamic acid demonstrated better radiological healing in the late period, it had no effect on histological union.

Radiological measurement parameters of distal radius and wrist measured on X-rays in the Turkish population.

OBJECTIVE: The aim of our study was to analyze the radiologic morphometry of the distal radius and wrist to assess acceptable limits for restoring normal wrist function after fracture. METHODS: Radiological measurement parameters were measured retrospectively on anteroposterior and lateral (LAT) wrist radiographs (n=981). Radiological measurement parameters were volar tilt, radial inclination, radial height, ulnar variance, radiocarpal angle, and volar angulation angle. The patients' age, gender, and side of the radiograph were recorded as demographic data. RESULTS: The mean volar tilt angle was 15.4±4.3 degrees. The mean radial inclination angle in males was 26.8±3.6 degrees. The mean radial height was 13.6±2.1 mm. The mean ulnar variance was 0.8±1.9 mm. One hundred and eighty-nine patients had negative ulnar variances. The mean radiocarpal angle was 12.3±2.7. The mean volar angulation angle was 32.1±6.9 degrees. Radial height was found to be positively correlated with radial inclination (p<0.001; r: 601), but it was not significantly correlated with ulnar variance (p=0.14). CONCLUSION: Distal radius fractures are one of the most common types of fractures. Radiological measurement parameters were used in the determination and follow-up of the treatment. The values obtained in this study belong to the Turkish population. These values may be used as reference values in determining the quality of reduction after fracture and in the design of suitable implants for fracture treatment.

Isokinetic Evaluation of Knee Strength and Endurance in Hemodialysis Patients Treated with the Transpatellar Tunnel Technique for Bilateral Spontaneous Quadriceps Tendon Ruptures.

There are numerous surgical techniques described for treating acute quadriceps tendon rupture. We aim to evaluate the strength of the quadriceps tendon using isokinetic tests in hemodialysis patients treated with the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures. Additionally, functional and clinical results were investigated and compared with hemodialysis patients without a history of quadriceps tendon rupture. We retrospectively reviewed hemodialysis patients diagnosed with quadriceps tendon rupture who were operated between 2005 and 2015 at our institution. Eight patients with simultaneous bilateral quadriceps tendon rupture treated with the transpatellar tunnel technique (group 1; the operated group) and 10 patients with chronic renal failure without a history of quadriceps tendon rupture who underwent hemodialysis (group 2; the control group) were included in this study. The active range of motion (ROM), Lysholm and Tegner scores, knee flexor and extensor muscle strengths, and endurances were measured using an isokinetic dynamometer for each group and compared between the groups. The mean age was 44.6 and 40.2 years in groups 1 and 2, respectively. The mean follow-up was 58.6 (range, 24-140) months in group 1. The active ROM was 113.7 ± 9.7 degrees in group 1 and 130 ± 4.8 degrees in group 2 (p < 0.001). The mean Tegner score was not significantly different between the groups (1.87 ± 1.1 in group 1 vs. 2.6 ± 0.9 in group 2; p = 0.212). However, the Lysholm score was significantly higher in group 2 (93.2 ± 7.3 vs. 76.7 ± 13.8; p = 0.009). The mean extensor strength and endurance were significantly higher in group 2 than in group 1. The mean flexor strength and endurance were higher in group 1 than in group 2, but no significant difference was found. Although using the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures in hemodialysis patients can provide acceptable functional results, the ROM and strength particularly in extensor muscle might be significantly lower than control group. Level of evidence is Level III therapeutic case-control study.

A prospective evaluation of strength and endurance of ankle dorsiflexors-plantar flexors after conservative management of lateral malleolar fractures.

OBJECTIVES: This study aims to evaluate patients with conservatively treated stable lateral malleolar fractures with isokinetic tests. PATIENTS AND METHODS: Between January 2016 and November 2017, a total of 24 patients (12 males, 12 females; mean age 40.8±15.0 years; range, 18 to 68 years) with an isolated stable lateral malleolar fracture treated conservatively with the circular cast were included in this prospective study. Calf circumferences, ankle range of motion (ROM), pain levels, and functional outcomes were recorded. The muscle strengths and endurance of the injured side were compared with the non-injured side. All patients were evaluated by isokinetic test after removal of the cast, and three and six months after the rehabilitation period. RESULTS: The ROM was found to be lower after removal of the plaster cast, compared to the contralateral ankle. During cast removal, we also found that both dorsiflexor and plantar flexor muscle strength decreased by 25.6% and 44.7%, respectively, and decreased to 10.3% and 3.6% at three months post-rehabilitation. At the end of six months, no statistically significant difference was found between the two sides. In the dorsiflexion-plantar flexion endurance values, 37.8% and 54.1% deficit were detected before the rehabilitation protocol, respectively (p<0.05). At three months, these values decreased to 6.1% and 13.6%, respectively and the endurances of the injured sides surpassed the non-injured sides (p<0.05) at six months. CONCLUSION: Conservative management of stable isolated lateral malleolar fractures with circular cast causes atrophy and decreases strength-endurance of the calf muscles due to immobilization. These changes are expected to diminish over time and functional outcomes are excellent with a good rehabilitation program.

Radiological parameter associated with the survival of old patients with hip fracture.

AIM: We aimed to investigate the relationship between radiological parameters and survival of patients with hip fracture aged >65 years. METHODS: We performed a retrospective cohort study with reviewed recorded data of patients who were treated for hip fracture. Radiological parameters were included the psoas:lumbar vertebral index (PLVI) by evaluating computed tomography (to assess sarcopenia), the cortical thickness index (CTI), Dorr morphology, canal-to-calcar ratio (CCR) and presence of iliac and femoral arterial calcification on both lower extremities by evaluating hip and pelvis radiographs. A multivariate Cox algorithm was applied to recognize these radiological factors independently associated with survival. RESULTS: A total of 304 patients [200 (65.8%) female and 104 (34.2%) male] were included, and the average age was 79.3 ± 8.3 years. During the study period, 154 (50.6%) patients died, whereas 150 (50.4%) were alive with a mean survival of 35.7 months. The survival rates at 1 month, 6 months and 1 year after surgery were 92.8%, 79.7% and 73.4%, respectively. A total of 120 patients were diagnosed with femoral neck fracture, at a mean age of 75.1 years, and 204 patients were diagnosed with intertrochanteric fracture, at a mean age of 82.2 years. The multivariate analysis demonstrated that presence of femoral calcification on the fracture side were independently associated with a poor overall survival. CONCLUSION: Although sarcopaenia was significantly higher in the deceased group, sarcopaenia was not significantly correlated with survival. However, the presence of femoral calcification on the fracture side was the only independent radiological parameter associated with poor overall survival, as patients had 1.4 times higher mortality rate. We did not find a significant difference between the intertrochanteric and femoral neck fracture groups with regard to CCR, CTI and Dorr type. However, the rate of femoral calcification in both the fracture and unaffected sides was significantly higher in the intertrochanteric group. LEVEL OF EVIDENCE: Level III prognostic study.

Does Presence of Femoral Arterial Calcification Have an Effect on Postoperative Complication and Mortality in Patients With Hip Fracture?

Introduction In this study, we investigated the relationship between femoral arterial calcification on preoperative hip radiography and post-operative complications and all-time mortality rates in patients with hip fracture >65 years old. Methods This retrospective study was conducted by evaluating the records of patients who were operated for hip fractures. All patients were divided into two groups according to the presence of lower extremity arterial calcification (LEAC) at the femoral artery which was diagnosed using the hip radiograph. The patients with and without the presence of LEAC were assigned as groups 1 and 2, respectively. A multivariate Cox algorithm was applied to recognize whether this radiological factor is independently associated with survival. Results The study included 530 patients (540 hips; 191 males and 339 females) with an average age of 80.8 ± 7.6 years. In the study after 24.8±19.9 months (range:0-65 months) follow-up period, 336 (63.3%) patients had expired. Conversely, 194 (36.7%) patients are surviving. Survival rates at one month and one year after surgery were 89.5% and 65.7%, respectively. 234 of 540 hips (230 patients) have LEAC on the femoral artery. The survival rate at one month, one year, and overall survival were significantly higher in patients with LEAC. The postoperative infection rate was also two times higher in patients with LEAC than without LEAC (p = 0.021). Multivariate analysis demonstrated that age, treatment modality (hemiarthroplasty), and the presence of femoral arterial calcification were independently associated with poor overall survival. Conclusions In our study, we found that the presence of femoral arterial calcification on the affected side of the hip identified on hip radiograph was independently associated with poor one month, one year, and overall survival as the patients had 1.5 times higher mortality rate. Additionally, a significant correlation was found between age and survival of patients with hip fracture, especially patients >80 years old.

The Effects of Tourniquet Application in Total Knee Arthroplasty on the Recovery of Thigh Muscle Strength and Clinical Outcomes.

The present randomized controlled study aims to evaluate whether tourniquet application during total knee arthroplasty (TKA) has an effect on (1) thigh muscle strength (quadriceps and hamstring muscle strength) and (2) clinical outcomes (postoperative knee range of motion [ROM], postoperative pain level, and Knee Society Score [KSS]). The effects of tourniquet application during TKA were investigated in 65 patients randomly allocated to one of two groups: TKA with a tourniquet and TKA without a tourniquet. Patients in both groups were comparable in terms of the demographic and clinical data (p > 0.05 for age, number of patients, sex, radiographic gonarthrosis grade, American Society of Anesthesiologists [ASA] classification, and body mass index [BMI]). All patients in both groups were operated by the same surgeon using one type of prosthesis. Isokinetic muscle strength (peak torque and total work) of knee extensors (quadriceps) and flexors (hamstrings) was measured in Newton meters (Nm) using a CYBEX 350 isokinetic dynamometer (HUMAC/CYBEX 2009, Stoughton, MA). The combined KSS (knee score + function score), visual analog scale (VAS), and knee ROM were measured preoperatively and at 1 and 3 months postoperatively to evaluate clinical outcomes. There were no significant differences between the two groups in preoperative and postoperative values of isokinetic muscle strength (peak torque and total work) and aforementioned clinical outcomes (p < 0.05). The present study has shown that quadriceps strength and clinical outcomes were not improved in the early postoperative period (3 months) when a tourniquet was not used during TKA.

The natural course of pain in patients with symptomatic tarsal coalitions: A retrospective clinical study.

BACKGROUND: This study aims to examine changes in pain intensity in the long course of symptomatic tarsal coalition. METHODS: Thirty consecutive patients who were treated for symptomatic tarsal coalition was retrospectively reviewed. The patients were divided into two groups: the nonsurgical group (14 patients) and the surgical group (16 patients). To assess pain intensity, the visual analogous scale (VAS) was utilized. RESULTS: On admission, the mean VAS was 4,9 ± 1,9 in the nonsurgical group and 7,7 ± 1,3 in the surgical group (p < 0,05). After 6 months of nonoperative treatment, the mean VAS was decreased from 4,9 ± 1,9 to 2,8 ± 1,0 in the nonsurgical group (p < 0,05) and from 7,7 ± 1,3 to 7,1 ± 0,8 in the surgical group (p > 0,05). At the final follow-up, the mean VAS was 2,3 ± 2,4 in the nonsurgical group and 3,1 ± 2,7 in the surgical group (p > 0,05). The decrease in the VAS after surgery was significant in the surgical group (p < 0,01). CONCLUSION: For patients with symptomatic tarsal coalitions who present with an initial VAS score of 6 and above, early surgery may be more effective than nonoperative treatment in relieving pain intensity.

Prognostic factors affecting survival of patients with pathologic humerus shaft fractures treated with intramedullary nailing without tumor removal.

BACKGROUND: Intramedullary nailing is the procedure of choice for pathologic fractures in humeral shaft because it allows early pain relief and mobilization. The aim of this study was to analyze the prognostic factors affecting survival of patients with pathologic humeral shaft fractures treated with intramedullary nailing without tumor removal. METHODS: We performed a retrospective study by evaluating the records of patients treated in our clinic between 2003 and 2018 for pathologic humerus shaft fractures with a minimum follow-up of one year. Kaplan-Meier methods were applied to estimate overall survival. A multivariate Cox algorithm was applied to recognize factors independently associated with survival. RESULTS: 52 patients (56 humeral fractures) were operated. The average age at the time of surgery was 58.9 years. There were 28 women and 24 men. In our series, multiple myeloma accounted for 52% of the cases. At the time of this study, 34 (65.3%) patients had deceased. Survival rates at first month, 6 months and 1 year after surgery were 96.2%, 67.4% and 59.6%, respectively. The median survival after surgery was 7.5 (6 days-84 months) months for deceased patients and 18 (34.7%) surviving patients with a median survival of 68.6 months. Rapid growth tumor, presence of pathological fracture in other extremities and, Eastern Cooperative Oncology Group performance status (ECOG-PS) were independently associated with a worse overall survival. CONCLUSION: More than 50% of patients with pathological humerus shaft fractures were diagnosed with multiple myeloma. Rapid growth tumors such as lung cancer and renal cell cancer increased mortality by a factor of 1 while presence of operative metastases in other extremities increased mortality by a factor of 3.1 and ECOG-PS increased mortality by a factor 6.8. Rapid growth tumors, ECOG-PS and presence of pathological fracture in other extremities were important prognostic factors influencing overall survival.

Isokinetic Evaluation of Shoulder Strength and Endurance after Reverse Shoulder Arthroplasty: A Comparative Study.

OBJECTIVE: The present study aimed to compare the isometric strength and endurance of shoulder abduction and internal and external rotation between operated shoulders and nonoperated, contralateral shoulders of patients who underwent reverse shoulder replacement due to unilateral rotator cuff tear arthropathy. PATIENTS AND METHODS: With a diagnosis of cuff tear arthropathy, 41 consecutive patients (mean age of 70.8 years; age range, 57 to 84; 36 females, 5 males) who underwent unilateral reverse shoulder arthroplasty were reviewed based on functional and radiological data. In all cases, cuff tear arthropathy was unilateral and contralateral shoulder was asymptomatic, with normal shoulder function. The average length of follow-up was 34 months (range of 12-67). To assess patients' functional level, the Constant score and the Disabilities of the Arm, Shoulder, and Hand (the Quick-DASH) outcome measure were used preoperatively and at the final examination. The primary outcomes of the present study were measurement of isokinetic strength and endurance of shoulder abduction and internal and external rotation using an isokinetic evaluator. RESULTS: Patients exhibited marked improvement in functional level as reflected by a significant increase in the mean Constant score from 38 preoperatively to 65 at the final follow-up (p = 0.03). The functional improvement was supported by a decrease in the mean Quick-DASH from 64 preoperatively to 26 at the final follow-up (p = 0.018). In the comparison of the isokinetic strength and endurance of shoulder abduction, no statistical difference was observed between operated shoulders and contralateral shoulders (p > 0.05). However; the strength and endurance of internal and external rotation were lower in operated shoulders than in contralateral shoulders (p < 0.05). Similarly, there was no statistically significant difference in comparisons of the durability of abduction (p > 0.05); however, the durability of internal and external rotation were significantly lower in operated shoulders (p < 0.05). CONCLUSION: In terms of durability and strength of abduction, similar results with the unaffected shoulder may be accomplished; nonetheless, the surgeon should be aware that durability and strength of rotation would be weak. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Outcomes of salvage total hip arthroplasty after failed osteosynthesis for collum femoris fractures.

BACKGROUND: This study is an investigation of the outcomes of salvage total hip arthroplasty (THA) to treat collum femoris fractures that resulted in complications or failure after osteosynthesis. METHODS: Twenty patients (6 male, 14 female; mean age: 56.7 years) who underwent salvage total hip arthroplasty (THA) between 1988 and 2012 due to failure developing after closed reposition and osteosynthesis in the treatment of collum femoris fractures were included in the study. The type of osteosynthesis, and the length of time until failure and before THA application after collum femoris fracture were recorded. Cementless acetabular and femoral components were used in all of the patients. Complications were defined as those occurring during and after surgery. The clinical results were assessed with the Harris Hip Score (HHS) and the presence of loosening was assessed with radiological evaluation in follow-up. RESULTS: The mean length of the follow-up period was 59.4 months (range: 15-178 months). The collum femoris fractures of the 20 patients were classified as: 5 Garden type II, 13 type III, 2 type IV, and 3 Pauwels type I, 8 type II, and 9 type III. Cannulated screws were used in 13 patients (65%) and dynamic hip screw (DHS) fixation was used in 7 patients (35%). Complications observed after osteosynthesis were nonunion in 4 cases (20%), malunion in 2 (10%), avascular necrosis in 10 (50%), and implant failure in 4 (20%). A mean of 9.66 months (range: 3-54 months) elapsed before osteosynthesis failure and the mean length of time until THA was 31.6+-51.7 months. There was no statistically significant difference between cannulated screw and DHS fixation in the development of complications (p=0.084). Early dislocation (5%), periprosthetic fracture (5%) and acetabular protrusion (5%) were recorded as complications. A revision was made upon determination of loosening in the 10th year in the patient who developed early dislocation. While the mean HHS was 54.05+-8.22 before THA, it was evaluated to be 86.45+-8.73 at the last follow-up, which was a statistically significant difference (p<0.0001). CONCLUSION: The study findings demonstrated that THA applied with suitable surgical technique is a safe and successful method that may be used after failed osteosynthesis in cases of collum femoris fracture.

Treatment of Graf Type IIa Hip Dysplasia: A Cut-off Value for Decision Making

Background: The rate of spontaneous normalization in type IIa hips is reported to be high, whereas dysplsia persists or worsens in 5%-10% of cases. Aims: To evaluate the natural course of type IIa hips using Graf's own perspective of physiological immaturity and maturational deficit. Study Design: A single center, retrospective cohort study. Methods: This was an institutional review board-approved retrospective review of all patients diagnosed with type IIa hip dysplasia at a single institution from 2012 to 2014. All patients included in the study had hip ultrasonography at about 6 weeks and 3 months of age. To assess reliability in α and ß angles, ultrasonography measurements were carried out on the same image individually by all observers. The α and ß angles were used as the main outcome measurements to evaluate hip maturation at the last follow-up. A receiver operating characteristics curve was drawn at the 3 month ultrasonography to evaluate the cut-off values for α and ß angles for persistent dysplasia. Results: Sixty-four patients and 88 affected hips (63% unilateral and 37% bilateral) were included. The mean age at diagnosis was 6.4±2.7 weeks. Fifty-four hips were type IIa(+) (physiologically immature) and 34 hips were type IIa(-) (maturational deficit) at the initial ultrasonography evaluation. Improvement to type I was seen in 52 type IIa(+) and 17 type IIa(-) hips. Receiver operating characteristic analyses showed that patients do well if the α angle was >55° (area under the curve: 0.86; p<0.001 for the left hip and area under the curve: 0.72; p=0.008 for the right hip). Conclusion: The cut-off α angle value of 55° on initial ultrasonography should be considered to prevent future dysplasia. An α angle <55° on the initial ultrasonography was an independent predictor of worsening sonographic findings.

Simultaneous Bilateral Quadriceps Tendon Rupture in a Patient with Diffuse Idiopathic Skeletal Hyperostosis after Minimal Trauma: Eight-Year Follow-Up.

INTRODUCTION: The purpose of this report was to describe a very rare case of simultaneous bilateral quadriceps tendon rupture seen in a patient who was diagnosed as having diffuse idiopathic skeletal hyperostosis. CASE PRESENTATION: A man aged 64 years presented to the emergency department with bilateral quadriceps tendon rupture. Surgical repair was performed with suture anchors and a stainless steel cable. His legs were immobilized in casts for six weeks. After removal of the casts, physiotherapy was started. Four months after surgery, he was able to walk with 0°-120° range of motion and active extension. He was followed up for 8 years without rerupture or other complications. CONCLUSION: Bilateral rupture of the quadriceps tendon is a rare condition and generally related to metabolic disorders. Diffuse idiopathic skeletal hyperostosis is a metabolic disorder that causes bilateral quadriceps tendon rupture, and it accounted for the differential diagnosis of the underlying condition.

High Rates of Psychiatric Disorders and Below Normal Mental Capacity Associated With Spastic Peroneal Flatfoot: A New Relationship.

Spastic peroneal flatfoot (SPFF) is a rare hindfoot pathology usually seen in the adolescent age group that is characterized by painful spasms in the peroneal muscles. We have clinically observed that patients with SPFF also have some behavioral and emotional difficulties and problems in their academic achievements. Because of these observations, we investigated the prevalence and patterns of psychiatric disorders and intellectual disability among young subjects with SPFF. Our cohort consisted of 16 patients with SPFF. Their mean age at presentation was 21 (range 13 to 31) years. Only 6 patients had a tarsal coalition as an underlying condition. The psychometric evaluation was conducted using validated instruments (Wechsler Intelligence Scale for Children-revised form, Stanford Binet intelligence quotient [IQ] test, and Cattell IQ test). Psychiatric disorders were assessed using a semistructured diagnostic instrument (Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version). The testers and psychiatrists were unaware of the orthopedic condition and the preliminary psychiatric diagnoses. The ethical committee approved the study protocol. The mean follow-up period was 41 (range 12 to 97) months. The mean IQ score of the patients was 75.1 ± 17.9 (range 52 to 107). Compared with the general population, the rate of intellectual disability was significantly greater (p = .0001) and the rate of normal intelligence significantly lower (p = .0015) in our patient group. Furthermore, according to the community schooling ratio, our cohort also had lower junior high and secondary education rates compared with the general population. The rate of most psychiatric disorders diagnosed in the SPFF patients was greater than that in the normal population. The most commonly identified psychiatric disorders were social phobia and attention deficit and hyperactivity disorder (75%). Timely interventions of the psychosocial and academic problems of patients with SPFF might increase their compliance with orthopedic treatment and help with their psychological well-being and academic achievement. In addition, this relationship might be a clue for uncovering the etiology of this disease, which has not yet been clarified.

Latarjet procedure using subscapularis split approach offers better rotational endurance than partial tenotomy for anterior shoulder instability.

PURPOSE: Latarjet, which is a coracoid bone block procedure, is an effective treatment for anterior shoulder instability with glenoid bone loss. During this reconstructive procedure the subscapularis may be tenotomized or be split to expose the glenoid neck. The aim of this study was to assess the effect of subscapularis management on functional outcomes and internal and external rotation durability and strength. Hypothesis is that the subscapularis split approach will result in better functional results and superior internal rotation strength and endurance. METHODS: The study included 48 patients [median age 30 (range 16-69); 42 males, 6 females], who underwent a modified Latarjet procedure for anterior shoulder instability. There were 20 patients in the subscapularis tenotomy group and 28 patients in the subscapularis split group. The groups were compared isokinetically using a computerized dynamometer for internal and external rotation durability and strength. At the latest follow-up, the patients were evaluated with the American Shoulder and Elbow Surgeons (ASES) and ROWE scores for functional outcomes. RESULTS: At a median follow-up period of 25 (range 12-73) months after the Latarjet procedure, the internal rotation durability was significantly higher in the split group (p = 0.045). However, a statistically significant difference could not be found for internal and external rotational strengths (n.s.). There was also no significant difference between the final ASES and ROWE scores (n.s.). CONCLUSION: Although both approaches offer promising results, the subscapularis split approach appears to provide better internal rotation durability compared to subscapularis tenotomy. Therefore, the subscapularis split approach may be more preferable for the management of the subscapularis muscle during Latarjet procedure. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

The quality of life analysis of knee prosthesis with complete microprocessor control in trans-femoral amputees.

OBJECTIVE: The aim of this study was to analyze the patient demographics, etiology of limb loss as well as reporting SF-36 scores for microprocessor prosthesis users in Turkish population. METHODS: We reviewed 72 patients (61 male and 11 female; mean age: 37.7 ± 10.7) with uni-lateral, above knee amputation and a history of regular and microprocessor prosthesis use. All patients were called back for a last follow-up and they were asked to fill a self-administered general health status questionnaire (SF-36). RESULTS: According to the SF-36 results; physical component score (PCS) score was 46 ± 7.3 and mental components summary (MCS) score was 46.5 ± 9.1. These scores have statistical similarity with Turkish healthy controls, except SF (social functioning) sub-dimension. PCS score for women microprocessor users were significantly lower than men (43.3 vs. 48.7, p = 0.03), but MCS scores were similar in between genders (46 vs. 48.2, p = 0.13). Conventional prostheses usage time was positively correlated with physical function (PF) scores (r = 0.322, p = 0.010). Microprocessor prosthesis usage time was negatively correlated with role limitations due to emotional problem (RE) scores (r = -0,313, p = 0.009). CONCLUSION: The quality of life surveys were showed that the loss of an extremity have higher physical and psychological impact on women's physical scores. Overall, SF-36 results were similar in microprocessor using amputee's and Turkish normal controls. LEVEL OF EVIDENCE: Level IV, therapeutic study.

The effect of screw thread length on initial stability of Schatzker type 1 tibial plateau fracture fixation: a biomechanical study.

BACKGROUND: This study compares the cyclic loading properties and failure loads of two screw combinations on a synthetic Schatzker type 1 tibia fracture model. Our hypothesis was that after adequate compression with first a partially threaded screw, addition of a fully threaded screw would provide more stability than an addition of a second partially threaded screw. METHODS: The Schatzker type 1 tibial plateau fracture model was created. Fixation was obtained in group A (n = 10) with two partially threaded screws and in group B (n = 10) with one fully threaded screw and one partially threaded screw. Load-displacement evaluation was made at each 1000-cycle interval up to 10,000 cycles. Failure load was identified as the load creating a 2-mm displacement. Two-factor (groups and periods) repeated measurement analysis of variance and independent sample t tests were used. RESULTS: According to the two-factor repeated analysis, there was no significant difference for periods (p = 0.29) and time-period interaction (p = 0.59) (Wilk's Lambda F value, 1.507 and 0.871, respectively). In the test of between-subject effects, there was no significant difference between groups in terms of cyclic loadings (p = 0.06, F = 4.065). However, in the t test for each 1000-cycle interval, the value of mean displacement in group B was significantly lower than that in group A in the initial, 1000-, 2000-, and 3000-cycle intervals (p = 0.023, 0.031, 0.025, 0.043, respectively). The mean displacement and standard deviations increased with the number of cycles. The mean range of displacement initially was 0.66 mm for group A and 0.36 mm for group B. The mean range of displacement after 10,000 cycles was 0.79 mm for group A and 0.44 mm for group B. The mean failure load value was 682 ± 234 N for group A and 835 ± 245 N for group B. In independent sample t tests, there were no significant differences between the two groups in terms of failure load (p > 0.05). CONCLUSIONS: Obtaining fixation with one partially and one fully threaded screw can minimize displacement at the fracture site at early cyclic loadings.