Comparison of two surgical techniques for Lisfranc injuries; closed reduction and fixation versus primary partial arthrodesis.

BACKGROUND: This study reviewed the outcomes of Lisfranc injuries treated by primary partial arthrodesis (PPA) or closed re-duction and internal fixation (CRIF). METHODS: A retrospective review was made of patients who underwent PPA or CRIF for a Lisfranc injury after low-energy trauma, and follow-up was assessed according to radiographic, and clinical outcomes. A total of 45 patients with a median age of 38 years were followed up for an average of 47 months. RESULTS: The average American orthopaedic foot and ankle society (AOFAS) score was 83.6 points in the PPA group and 86.2 points in CRIF group (p>0.05). The mean pain score was 32.9 in the PPA group, 33.7 in the CRIF group (p>0.05). Secondary surgery for symptomatic hardware was required in 78% of the CRIF group and in 42% of the PPA group (p<0.05). CONCLUSION: Treatment of low-energy Lisfranc injuries with either PPA or closed reduction and fixation produced good clinical and radiological outcomes. The total AOFAS scores were comparable between two groups. However, the function and pain scores were seen to improve more with closed reduction and fixation while there was a greater requirement for secondary surgery in the CRIF group.

Traditional versus magnetically controlled growing rods in early onset scoliosis surgical treatment.

PURPOSE: Growing rod surgeries are common methods in the treatment of early onset scoliosis. Magnetic growing rod (MGR) surgery, in particular, has become more widespread in the last 10 years. The aim of this study was to compare the effects of traditional and magnetically controlled growing rod techniques on efficacy, safety, spinal growth, and lung development. METHODS: A retrospective analysis was made of 24 TGR and 17 MGR patients. Inclusion criteria were patients aged < 10 years, curvature > 40° or a progression of > 10° in the 4-6 month follow-up for curves between 25 and 40°. RESULTS: There were 9 males and 15 females in the TGR cohort and 7 males and 10 females in the MGR cohort. The mean age at first surgery was 6.1 years and 7.1 years, respectively. Major curve Cobb angles of TGR were preop. 51.5°, postop. 21.4° and 18.1° at the final follow-up. In the MGR cohort, these values were 60.4°, 41.8°, and 36.4°, respectively. The mean T1-S1 lengthening velocity was calculated as 1.12 cm/year (0.9318 mm/month) in the TGR group and 1.27 cm/year (1.0571 mm/month) in the MGR group. In the TGR cohort, a total of 99 procedures were performed as 24 initial surgeries and 75 additional procedures (5 lengthening during unplanned surgery due to complications; 4 revision, 1 debridement). In the MRG cohort, a total of 25 surgical procedures were performed as 17 initial surgeries and 7 additional procedures (3 debridements, 5 revisions). CONCLUSION: The results of this study showed that the TGR system provided better correction in the coronal plane and was superior in kyphosis restoration than the MGR system. Both methods were successful in lengthening, but complication rates were slightly higher in the MGR cohort. The most common complication was the pullout of the proximal anchors, and this was more common in the MGR. Both TGR and MGR were found to be effective treatments. Lengthening without surgery is a significant advantage of the MGR system, but it has a high revision rate, and Cobb angle correction was found to be less effective than with TGR.

The effect of Modic changes on the fusion rates of posterior interbody fusion surgery.

BACKGROUND: Modic changes have been correlated to low back pain, spinal instability. The objective of this study was to evaluate the effect of Modic changes on the fusion rates of instrumented posterior interbody fusion surgery (PLIF). METHODS: The study included patients who underwent PLIF surgery between 2015-2019.The patients were separated into four groups according to Modic changes detected in the preoperative MRI. Fusion, subsidence were evaluated with postoperative CT and X-ray. Body mass index (BMI) and bone mineral density (BMD) of the patients were also evaluated. RESULTS: The study included 137 operated discs of 86 patients. There was no statistical difference between groups regarding age, gender, follow-up period, BMI, and BMD. There were 70 levels with no Modic changes (M0), 26 levels with Modic type 1 (M1), 21 levels with Modic type 2 (M2), and 16 with Modic type 3 (MC3) change. The rate of successful fusion was 92.9% in M0, 92.3% in M1, 93% in M2, and 93.7% in M3. The rate of high-grade subsidence was 28.5% in M0, 26.8% in M1, 27.5% in M2, and 24.9% in M3. There was no statistically difference between the patients regarding subsidence grade or fusion rate. CONCLUSIONS: Modic changes were not observed to be directly correlated to the radiological outcomes of instrumented posterior interbody fusion. The fusion rate demonstrated homogenous distribution between the Modic groups and the subsidence rate was slightly higher in MC1 and MC2 than in MC3 and MC0.

Comparison of Two Surgical Techniques for Periprosthetic Supracondylar Femoral Fractures: Minimally Invasive Locking Plate Versus Retrograde Femoral Nails.

Objectives: This study aimed to compare minimal invasive locking plate and retrograde intramedullary nailing in the treatment of supracondylar femur fracture following total knee arthroplasty (TKA) in respect of fracture healing, complications, and functional results. Methods: A retrospective analysis was made of 32 supracondylar femur fractures comprising 20 cases treated with minimal invasive locking plate fixation and 12 with retrograde femoral nailing. The two techniques were compared in respect of range of motion (ROM), functional scores, intraoperative blood loss, surgery time, and radiological examination findings. Results: The mean functional scores did not differ between the nailing and plate fixation groups. In the minimal invasive locking plate group, 2 (10%) patients had delayed union, so revision surgery was applied. The mean post-operative ROM was comparable between two groups (86.2° vs. 86°). Reduction quality in the sagittal plane and maintenance of the initial reduction were better in the minimal invasive locking plate group. Greater shortening of the lower extremity was seen in the retrograde femoral nailing group than in the minimal invasive locking plate group (20.3 vs. 9.3 mm). Perioperative blood loss was greater (2 units vs. 1.2 units) and mean operating time was longer in the minimal invasive locking plate group (126.5 min vs. 102.2 min). Conclusion: In patients with good bone stock, supracondylar femur fracture following TKA can be treated successfully with retrograde nailing or minimal invasive locking plate. Retrograde femoral nailing has the advantage of less blood loss and a shorter operating time. Reduction quality may be improved with the minimal invasive locking plate fixation technique. Both surgery techniques can be successfully used by orthopedic surgeons taking a case-by-case approach.

NEW GENERATION NAIL VS. PLATE IN THE TREATMENT OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURE.

OBJECTIVE: To compare antirotator proximal femoral nail (A-PFN) with antirotator dynamic hip screw (A-DHS). METHODS: Fourteen proximal femur models with type 31/A2 fracture, according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, were separated into two groups. Group 1 bones (n = 7) were fixed with A-PFN and Group 2 (n = 7) with A-DHS. A 5 mm/min axial load was applied to femur heads using a testing device. RESULTS: Two of the seven models in the A-PFN group fractured at the proximal, and the other five at distal locking screw level. All models in the A-DHS group fractured at the tightened distal screw region. The median fracture load for the A-PFN group was 132.1 N (97.1-173.69 N range), and for the A-DHS group it was 81.7 N (75.15-89.12 N range). CONCLUSION: A-PFN-treated unstable intertrochanteric fractured models resisted to higher levels of axial load than the A-DHS-treated group, with statistically significant difference. However, clinical studies are required to support these results. Level of Evidence V, Biomechanical study.

OBJETIVO: O objetivo deste estudo foi comparar a haste do fêmur anti-rotador (A-PFN) com o parafuso dinâmico do quadril anti-rotador (A-DHS). MÉTODOS: Este estudo envolveu dois grupos de quatorze modelos de fêmur proximal, tipo fratura 31/A2, de acordo com a classificação The AO Foundation/Orthopaedic Trauma Association (AO/OTA). Os ossos do grupo 1 (n = 7) foram fixados com A-PFN, enquanto o grupo 2 (n = 7) foi fixado com A-DHS. Um dispositivo de teste foi utilizado para aplicar força axial de 5 mm/min nas cabeças do fêmur. RESULTADOS: Dos sete modelos do grupo A-PFN, dois foram rompidos na proximal e o restante no nível do parafuso de travamento distal. Todos os modelos no grupo A-DHS foram quebrados a partir da região do parafuso distal apertado. Os modelos ósseos no grupo A-PFN foram quebrados a uma força mediana de 132,1 N (variação de 97,1-173,69 N). No grupo A-DHS, a força de fratura dos modelos ósseos foi mediana de 81,7 N (variação de 75,15-89,12 N). CONCLUSÃO: Neste estudo, modelos ósseos fraturados intertrocantéricos instáveis tratados com A-PFN foram resistentes a um nível mais alto de forças de pressão axial, em contraste com o grupo tratado com A-DHS, e a diferença foi estatisticamente significativa. No entanto, há uma necessidade de estudos clínicos para apoiar esses resultados. Nível de Evidência V, Estudo biomecânico.

New generation nail vs. plate in the treatment of unstable intertrochanteric femoral fracture / Pregos de nova geração contra a placa no tratamento de fraturas de fêmur intertrocantéricas instáveis

ABSTRACT Objective: To compare antirotator proximal femoral nail (A-PFN) with antirotator dynamic hip screw (A-DHS). Methods: Fourteen proximal femur models with type 31/A2 fracture, according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, were separated into two groups. Group 1 bones (n = 7) were fixed with A-PFN and Group 2 (n = 7) with A-DHS. A 5 mm/min axial load was applied to femur heads using a testing device. Results: Two of the seven models in the A-PFN group fractured at the proximal, and the other five at distal locking screw level. All models in the A-DHS group fractured at the tightened distal screw region. The median fracture load for the A-PFN group was 132.1 N (97.1-173.69 N range), and for the A-DHS group it was 81.7 N (75.15-89.12 N range). Conclusion: A-PFN-treated unstable intertrochanteric fractured models resisted to higher levels of axial load than the A-DHS-treated group, with statistically significant difference. However, clinical studies are required to support these results. Level of Evidence V, Biomechanical study.

RESUMO Objetivo: O objetivo deste estudo foi comparar a haste do fêmur anti-rotador (A-PFN) com o parafuso dinâmico do quadril anti-rotador (A-DHS). Métodos: Este estudo envolveu dois grupos de quatorze modelos de fêmur proximal, tipo fratura 31/A2, de acordo com a classificação The AO Foundation/Orthopaedic Trauma Association (AO/OTA). Os ossos do grupo 1 (n = 7) foram fixados com A-PFN, enquanto o grupo 2 (n = 7) foi fixado com A-DHS. Um dispositivo de teste foi utilizado para aplicar força axial de 5 mm/min nas cabeças do fêmur. Resultados: Dos sete modelos do grupo A-PFN, dois foram rompidos na proximal e o restante no nível do parafuso de travamento distal. Todos os modelos no grupo A-DHS foram quebrados a partir da região do parafuso distal apertado. Os modelos ósseos no grupo A-PFN foram quebrados a uma força mediana de 132,1 N (variação de 97,1-173,69 N). No grupo A-DHS, a força de fratura dos modelos ósseos foi mediana de 81,7 N (variação de 75,15-89,12 N). Conclusão: Neste estudo, modelos ósseos fraturados intertrocantéricos instáveis tratados com A-PFN foram resistentes a um nível mais alto de forças de pressão axial, em contraste com o grupo tratado com A-DHS, e a diferença foi estatisticamente significativa. No entanto, há uma necessidade de estudos clínicos para apoiar esses resultados. Nível de Evidência V, Estudo biomecânico.

Association of abductor hip muscle atrophy with fall-related proximal femur fractures in the elderly.

OBJECTIVE: The purpose of this study was to evaluate an association between fall-related intertrochanteric or femoral neck fractures and gluteus medius and minimus atrophy, furthermore, to find a correlation of whether any difference between femoral neck or intertrochanteric fracture and degree of muscle atrophy MATERIALS AND METHODS: A retrospective review of 230 patients with intertrochanteric or femoral neck fracture, aged > 65 years, and 60 age- matched controls was performed. We assessed gluteus medius and minimus atrophy and calculated the cross-sectional area (CSA) and ratio of lean muscle to adipose infiltration (M/A ratio) for each muscle. RESULTS: The atrophy scores for the g.medius and g.minimus muscles on the fractured side were significantly higher than scores on the healthy side and scores in the control group. The atrophy scores for the g.medius on the healthy side were not significantly different from scores in the control group. The atrophy scores for g.medius were significantly different between the fractured side and the healthy side for all ages, the atrophy scores for g.minimus was significantly different in the patients aged over 75. There was no significant difference in the following parameters between the fractured side and healthy side of the patients aged 65 - 75 years; the atrophy score, CSA and M/A ratio. The patients have a lower CSA and M/A ratio on the fractured side than on the healthy side and lower CSA and M/A ratio than in the control group. However, there were no significant differences in the M/A ratio between the healthy side and the control group. CSA was not significantly different between the fractured side and healthy side in the male patients and in the patients with lower BMI (<30). There was no significant difference in the atrophy scores between subjects with intertrochanteric versus femoral neck fractures, the CSAs of the g.medius and g.minimus were significantly different between the intertrochanteric fracture and femoral neck fracture groups. CONCLUSIONS: The fractured sides showed greater g.medius and g.minimus muscle atrophy, which may be a predictor of fall-related hip fractures in the elderly. Gluteal muscle volume may be associated with proximal femur fracture subtype.

The characteristics of the patients in mass public shootings among coup attempt in Turkey: A single-center hospital response.

BACKGROUND: Turkey is an experienced country for both military and civilian mass casualties that arise from explosions and shootings by various terrorist groups. In this study, we aimed to investigate the characteristics of patient flow admitted to our hospital caused by primarily gunshot wounds during the coup attempts on the 15th of July. METHODS: This descriptive, retrospective study included a total of 50 patients who were injured during a coup attempt on the date of July 15, 2016, and admitted to our emergency department (ED). Demographic characteristics, anatomical injury sites, postoperative clinical outcomes, and hospitalization settings were recorded. The Glasgow Coma Scale (GCS), Trauma and Injury Severity Score (TRISS), Abbreviated Injury Scale (AIS), Revised Trauma Score (RTS) and Injury Severity Score (ISS) were used to measure the severity of injuries. RESULTS: A total of 63 medical personnel voluntarily reached the ED within two hours. Extremity injuries were the most common injuries. The mean RTS, GCS, and TRISS scores did not differ significantly between the patients discharged from the ED and the patients who were hospitalized (p>0.05). However, there was a statistically significant difference in the ISS scores (p<0.001, independent t-test). There was no statistically significant difference in the GCS and RTS scores between the discharged and hospitalized patients, although the ISS scores were higher in hospitalized patients (p>0.05 and p<0.001, respectively). A total of 33 patients (66%) were admitted to the hospital for follow-up and/or surgical intervention. Five (10%) of the patients were hospitalized for more than 14 days. CONCLUSION: The management of each disaster is unique. Armed conflicts result in gunshot wounds, and preparations must be focused on surge capacity and a prolonged hospital stay of the patients. In our study, the length of stay in the hospital decreased after the arrival of volunteer staff to the ED, but we should note that the ISS increased. Hospital disaster plans should be reorganized not only for ED but also for the whole hospital.

Ultrasonographic comparison of bilateral patellar tendon dimensions in patients treated via intramedullary tibial nailing using a transpatellar approach.

OBJECTIVE: One of the most common complications following intramedullary nailing of a tibial shaft fracture is anterior knee pain. The etiology of pain remains unclear. Patellar tendon entry point is the most suspected reason for anterior knee pain. This study, sonographically examined the patellar tendons of patients treated via intramedullary nailing. METHODS: Thirty-two patients with a tibial shaft fracture requiring intramedullary nailing via a transpatellar approach were included in the study. After all patients were grouped by reference to the presence of anterior knee pain, bilateral patellar tendon ultrasonography was performed. RESULTS: Thirty-two patients were included in the study. Patients were measured postop average in 38.3 months (10th months - 84th months). It was determined that 10 patients of total 32 (31.3%) had anterior knee pain. There were no statistically differences between study groups in the length of patellar tendon. In the painless group; patellar tendon was wider and thicker in the operated side than the non operated side. The mean differences in the thickness between operated side versus non - operated side of the painless group were 5.3 ± 1.8 in the operated side and 3.9 ± 1.4 in the non - operated side (p = 0.007 < 0.05). The corresponding values for width of the patellar tendon was 29.6 ± 3.3 in the operated side and 27.6 ± 3.8 in the non - operated side (p = 0.007 ˂ 0.05). As a result, there were no statistically significant differences between width and thickness of the patellar tendons in the painful group, on the contrary, in the painless group; patellar tendons were wider and thicker in the operated side than those in the non - operated side. Mean values for thickness of the operated and non-operated side were 5.9 ± 2.3 and 4.2 ± 2.0, respectively (p = 0.059 > 0.05). Mean values for width of the operated and non-operated side were 30.2 ± 4.5 and 28.5 ± 4.0, respectively (p = 0.103 > 0,05). CONCLUSION: Based on the ultrasonographic investigation of their patellar tendons after intramedullary nailing of a tibial shaft fracture, in the painless patients group; the patellar tendon was wider and thicker in the operated side than the non - operated side, however, in the painful patients there were no statistically significant differences between this parameters. Although the number of patients was not sufficient to conclude precise relation between patellar tendon entry point and anterior knee pain, we determined that thicker and wider tendon might be less related to anterior knee pain. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Dry needling in lateral epicondylitis: a prospective controlled study.

PURPOSE: Lateral epicondylitis (LE), a common disease, especially in middle age, causes decreased productivity and economic losses. The first-line treatment for LE is conservative and consists of topical and oral anti-inflammatory drugs, ice application, and brace use. If the first-line treatment fails, second-line treatment modalities, which are generally invasive, are offered. Second-line therapeutic regimens include saline, corticosteroid, or platelet-rich plasma injections. Dry needling is relatively new. We hypothesized that dry needling would be at least as effective as first-line treatment for LE. We compared the outcomes of first-line treatment and dry needling. METHODS: The study allocated 110 patients into groups using online randomization software. After completing the Patient-rated Tennis Elbow Evaluation (PRTEE), patients in group I received dry needling, whereas those in group II received first-line treatment, consisting of ibuprofen 100 mg twice a day and a proximal forearm brace. The patients were evaluated after three weeks and six months. RESULTS: The study ultimately analyzed 92 patients. Although both treatment methods were effective at three weeks, dry needling was significantly more effective than the first-line treatment at six months. CONCLUSION: Because of the low complication rate, dry needling is a safe method, and it might be an effective treatment option for LE.

Intermittent negative pressure wound therapy with instillation for the treatment of persistent periprosthetic hip infections: a report of two cases.

Intermittent negative pressure wound therapy with instillation (NPWTi) is starting to be used successfully to treat early periprosthetic infections of endoprostheses. However, few articles have reported the outcome of treatment with intermittent NPWTi for late persistent periprosthetic infections of the hip. In this study, we report two cases who underwent several rounds of radical wound debridement for the treatment of a late persistent periprosthetic infection of the hip. Intermittent NPWTi was used in both cases. Patients were treated successfully and there was no recurrence after 3 and 1 years of follow-up, respectively.

Irreducible fifth metatarsophalangeal joint after car crush injury.

Metatarsophalangeal joint dislocations are uncommon injuries. Herein, an irreducible dislocation of fifth metatarsophalangeal joint with fractures on the second, third, and fourth metatarsal head was reported. Joint reduction could not be achieved which necessitated open reduction. Six months after surgery the patient was walking and doing his daily activities without any complaints. He had returned to his pretrauma functional level.

Developmental dysplasia of the hip associated with aplasia of the pubic bone (hook-pelvis): report of a case and review of the literature.

Aplasia of the pubic bone associated with congenital hip dislocation is rare. Various dysmorphic conditions featuring absence or hypoplasia of the ischiopubic bone, associated with congenital hip dislocation, have been distinguished in the literature. We report the case of an 18-month-old boy with developmental dysplasia of the hip associated with isolated total aplasia of the pubic bone. Patient was successfully treated with modified Salter osteotomy and reverse U-shaped capsuloplasty.