Comparison of 2 different fixation techniques of comminuted acetabular quadrilateral surface fractures using square bracket-shaped tubular plate or interfragmentary screws in addition to supra/infrapectineal plate fixation: An observational study.

The management of comminuted quadrilateral fractures remains challenging, and treatment options are constantly evolving. The purpose of the present study was to examine the outcomes of 2 different fixation techniques in the management of comminuted quadrilateral fractures. Twenty-two patients with comminuted quadrilateral acetabular fractures were surgically treated with interfragmentary lag screw (group 1) and square bracket-shaped tubular (SBST) plate technique (group 2), in addition to suprapectineal and infrapectineal pelvic reconstruction plate fixation between January 2016 and July 2019 at our clinic. 2 years follow-up control data of each group were compared in terms of radiological and functional results, and complications. According to the functional score comparison, the mean Merle d'Aubigne Postel scoring system (MAP) score was 15.2/15.6 (P = .632), and the mean Harris hip scoring (HHS) system score was 74.65/77.3 (P = .664) in groups 1 and 2, respectively. Radiological comparison was performed according to matta radiological criteria (MRC), and 2 excellent, 6 good, 2 poor, 4 excellent, 4 good, and 4 poor radiological results were observed in groups 1 and 2, respectively. intraarticular screw penetration was detected in 3 patients in group 1, while there was no articular implant penetration in group 2 (P = .001). We believe that satisfactory results can be obtained with the SBST plate technique, offering functional and clinical outcomes that are similar to those of the interfragmentary screw technique. The SBST plate technique is superior in terms of avoiding intraarticular screw penetration and related revision surgery.

Effect of Telerehabilitation-Based Exercise and Education on Pain, Function, Strength, Proprioception, and Psychosocial Parameters in Patients With Knee Osteoarthritis: A Randomized Controlled Clinical Trial.

OBJECTIVE: In middle-aged individuals with early-stage knee osteoarthritis, follow-up with remote rehabilitation methods may provide effective clinical outcomes. The present study aimed to investigate the effect of telerehabilitation on pain, function, performance, strength, proprioception, and psychosocial parameters in patients with knee osteoarthritis. DESIGN: A randomized controlled study was conducted with 54 participants with knee osteoarthritis. All patients were randomized into two groups: the home-based telerehabilitation group ( n = 29) and the home-based paper group ( n = 28). The home exercise program and training were provided with an instruction manual to paper group. The same home exercise and education prescriptions were given to individuals in telerehabilitation group via an online platform. Pain, function, quality of life, physical performance, muscle strength, and proprioception were evaluated at baseline and after 8 wks of intervention. In addition, satisfaction and usability were evaluated at week 8. RESULTS: Telerehabilitation group demonstrated better improvement in terms of pain, function, quality of life index score, and left extremity proprioception ( P < 0.05). Telerehabilitation group was not superior to paper group in terms of muscle strength and performance tests (except the Five Times Sit to Stand Test) ( P > 0.05). CONCLUSIONS: The home-based telerehabilitation program was superior to the home-based paper group program for pain, function, quality of life, and proprioception in patients with knee osteoarthritis.

Treatment of Acetabulum Anterior Wall Fractures Using the Modified Stoppa Approach.

Introduction The objective of this study was to describe the modified Stoppa approach for anterior wall fracture fixation and to present our radiological and functional results of this approach. Materials and methods Between April 2013 and December 2019, 256 acetabular fractures operated with the modified Stoppa approach in our clinic were retrospectively reviewed, and 11 patients who were operated for anterior acetabular wall fractures with at least two years of follow-up were included in the study. Results The median amount of bleeding during surgery was found to be 450 ml (200-800), and the median operation time was 120 minutes (90-180). The modified Merle d'Aubigné and Postel Hip Score (MDS), modified Harris Hip Score (HHS), Matta's Reduction Criteria (MRC), and Kellgren-Lawrence Classification (KLC) outcomes are similar to the anterior surgical approach. Conclusion We suggest that the modified Stoppa approach can be safely used in the surgical treatment of isolated anterior acetabular fractures due to its short operative duration, low amount of bleeding, low complication rate, and favorable radiological and clinical results. The modified Stoppa procedure is a considerable alternative to the ilioinguinal approach in anterior acetabular fractures.

A device that facilitates screwing at an appropriate angle in quadrilateral surface fractures: 105-degree drill attachment.

BACKGROUND: Within this study, we aimed to investigate the radiological and functional outcomes of acetabular fractures involving quadrilateral surface using 105° drill attachment in the anterior intrapelvic approach. METHODS: The 35 patients who underwent surgical treatment from January 2016 and January 2020 for acetabular fractures involving quadrilateral surface with anterior intrapelvic approach using 105° drill attachment and a minimum of 12 months of postoperative follow-up were included. Perioperative complications, operation duration, and the quality of reduction were evaluated. Reduction quality was classified as poor, imperfect, and anatomic. Functional evaluation was performed according to the Harris Hip Score (HHS) and Merle d'Aubigne Score. RESULTS: Among 35 patients (median age 36 (21-80)), radiological results of the acetabular fixations were anatomic, imperfect, and poor in 28 (80%), 5 (14.3%), and 2 (5.7%) patients, respectively. Postoperative 1-year functional outcomes with Merle d'Aubigne scores and HHS were median 18 (10-18) and 90 (60-96), respectively. The clinical outcomes of the patients showed concordance with reduction quality. The median operation duration was 180 minutes (range 125-270). Iatrogenic neurovascular damage was not noted in any patients. DISCUSSION: Reduction and fixation of deep intrapelvic fractures are risky and difficult due to the narrow anatomy and adjacent crucial neurovascular structures. As the 105-degree drill application is safe and easy to intervene in, short surgery duration and satisfactory results with minimum complications can be obtained with a 105 angulated drill in the deep pelvic region.

Fixation of bilateral acetabular fractures using the modified Stoppa approach: Two-year clinical outcomes.

OBJECTIVES: This study aims to evaluate the two-year clinical results of bilateral acetabular fractures operated via a single incision with the modified Stoppa approach. PATIENTS AND METHODS: Between January 2013 and January 2020, a total of 22 acetabular fractures of 11 patients (7 males, 4 females; mean age: was 42.9±13.7 years; range, 19 to 62 years) who were operated via the modified Stoppa approach were retrospectively analyzed. The medical records were analyzed in terms of time to surgery, fracture patterns, Injury Severity Score (ISS), operation duration, blood loss, reduction quality, perioperative complications and concomitant injuries. Reduction quality was assessed according to Matta's criteria. The Harris Hip Score (HHS) and modified Merle d'Aubigne score (MDS) were utilized for functional assessment. RESULTS: The mean follow-up was 49±15 (range, 30 to 79) months. The mean ISS was 28.2±7.2. The mean modified MDS was 15.90±1.57. The mean HHS was 84.27±8.85. For both sides, reduction was anatomical-anatomical (63.6%) in seven patients, anatomical-imperfect in three (27.3%) patients, and imperfectpoor in one (9.1%) patient. According to the Kellgren-Lawrence radiological evaluation at 24 months of follow-up bilaterally, Grade 0-1 osteoarthritis was observed in six (54.5%) patients, Grade 1-1 in four (36.4%) patients, and Grade 1-2 osteoarthritis in one (9.1%) patient. CONCLUSION: The modified Stoppa approach in bilateral acetabular fractures seems to be more preferable than other approaches, as it can be performed with a single incision and provides less bleeding, shorter operation duration, and satisfactory results.

Subacromial impingement as a predictor of proximal biceps tendon disorders.

OBJECTIVES: This study aims to investigate the relationship between proximal biceps tendon disorders and the degree of subacromial impingement in patients who underwent arthroscopic subacromial debridement. PATIENTS AND METHODS: Between January 2015 and June 2021, a total of 110 patients (44 males, 66 females; mean age: 52.5±11.43 years; range, 15 to 78 years) who underwent arthroscopic subacromial decompression were retrospectively analyzed. The degree of the subacromial impingement observed during arthroscopy was classified into four stages according to the Neer classification. We classified proximal biceps tendon disorders as five grades according to the Nirschl classification. The proportional relationship between subacromial impingement and biceps tendinopathy severity was analyzed. RESULTS: While biceps tendon degeneration was found to be significantly lower in patients with mild or no subacromial impingement, high rates of severe biceps tendon degeneration were observed in patients with high degree of subacromial impingement. A total of 75% of the patients who had no subacromial impingement had no biceps tendon disorder. Approximately 50% of the patients with Stage 1 subacromial impingement did not have biceps disorder, 31.3% had inflammation, and 12.5% had minor degeneration. In Stage 2 subacromial impingement group, the ratio of inflammation (42.9%) and minor degeneration (42.9%) of biceps tendon greatly increased, and the highest rate of biceps tendon degeneration was observed in the most advanced stage (Stage 3) subacromial impingement group (39.3%) (p=0.001). CONCLUSION: The stage of subacromial impingement is correlated with the degree of biceps degeneration. Therefore, one should keep in mind that the presence of advanced subacromial impingement may indicate advanced biceps tendon pathologies.

An Evaluation of the Fear of Falling, Balance Levels, and Prognostic Blood Parameters Among the Geriatric Population With Hip Fractures.

Background In this study, we determined that among patients who had been operated upon for hip fractures at our hospital, prognostic factors for mortality and functional recovery in the preoperative period were indicated via laboratory parameters using the International Falls Efficacy Scale (FES-I) and Berg Balance Scale (BBS) scores. Methodology Between January 2020 and January 2021, the results of 64 patients who had been surgically treated for a hip fracture and 57 patients who had scheduled elective surgery were compared retrospectively. The groups' demographic data and blood parameters were compared. We used the FES-I and BBS scores to determine patients' physical functional status and fear of falling. Results The case group's statistically significant FES-I score was high, and its BBS score was low (p = 0.001/0.001). As expected, the case group's D-dimer measurement was higher than the control group's (p = 0.001). In addition, hemoglobin, platelet, lymphocyte, albumin, total protein, and calcium levels were lower in the case group (p = 0.001 for all levels). No significant difference was found for other parameters. Conclusions The scales are used by physical therapy, neurology, and orthopedics professionals to evaluate the geriatric population's physical functional status and fear of falling. We believe prevention and cost-effective treatments for hip fractures can be achieved by determining geriatric patients' hemoglobin, platelet, lymphocyte, albumin, total protein, and calcium levels upon hospital admission and by directing these patients to relevant clinics using the fear-of-falling and balance scales.

Comparison of the Radiological and Functional Results of Tight Rope and Clavicular Hook Plate Technique in the Treatment of Acute Acromioclavicular Joint Dislocation.

Purpose/Aim: Options for surgery for acromioclavicular (AC) joint dislocation vary considerably. This study aimed to examine the functional and radiological results of patients who were operated on using the tightrope (TR) or clavicular hook plate (CHP) technique in the treatment for AC joint dislocation. Materials and methods: The data gathered from 35 consecutive patients who were operated on for AC joint dislocation were analyzed retrospectively in terms of their radiological and functional outcomes. Results: Thirty-two (91.4%) of the 35 patients were male and 3 (8.6%) were female. Thirty (85.7%) patients were classified as Rockwood type 3 and 5 (14.3%) as type 5. Twenty-one patients operated on using the TR technique were categorized as group 1, and 14 patients treated with the CHP technique formed group 2. Functional results were evaluated using the Constant-Murley shoulder scoring system; no statistically significant difference was observed between type 3 and 5 AC separation (p = 0.337). The mean Constant scores of type 3 and 5 injuries were 82.96 and 88.6, respectively. A significant relationship was noted between reduction quality and functional scores (p = 0.006). Postoperative osteoarthritis was seen in 12 (57.14%) patients in group 1 and 7 (50.00%) patients in group 2. In terms of surgery duration, 50.57 minutes in group 1 and 35.71 minutes in group 2 were noted. A statistically significant difference was found between the two groups in terms of surgery duration (p < 0.05). Conclusions: TR and CHP techniques, which do not differ significantly in terms of their clinical results, can be used safely in the treatment of AC separation.

Comparison of tunnel ligament release instrument assisted minimally open surgery and conventional open surgery in the treatment of tarsal tunnel syndrome.

AIM: This study compared the results of tarsal tunnel syndrome release surgeries using mini-open incisions and standard incisions. PATIENTS AND METHODS: From January 2012 until April 2018, 31 feet of 29 patients diagnosed with tarsal tunnel syndrome were treated surgically. 15 feet of 15 patients underwent surgeries utilizing minimally open technique and 16 feet of 14 patients underwent surgeries utilizing standard incisions. The following preoperative and postoperative data was obtained: foot and ankle muscle testing results, posture analyses, anthropometric measurements, joint movement ranges, pain complaints, endurance evaluation results, and functional test results. The mean follow-up period was 38 months (13-88 months). RESULTS: The mean operation times were 26.8 min (23-30 min) using the standard incision and 13.3 min (9-17 min) using the mini-open incision (p < 0.05). In the preoperative and postoperative comparisons of the total muscle strength and total joint limit values of the healthy and affected feet, statistically significant improvements were observed in both the mini-open incision and standard incision groups (p < 0.05). Moreover, statistically significant improvements were seen in both groups in the postoperative repeated toe raises for 1 minute assessments of the affected foot (p < 0.05). In the foot function index and functional foot score values, statistically significant improvements were seen between the preoperative and postoperative values in both groups (p < 0.05). CONCLUSIONS: Based on the results of this study, using a tunnel ligament release instrument assisted minimally open surgery to loosen the laciniate ligament may present an alternative to the standard incision, with its significantly decreased morbidity rate and cosmetic success.

Effects of different anesthesia techniques on intraoperative blood loss in acetabular fractures undergoing the Modified Stoppa approach.

BACKGROUND: This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach. METHODS: We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions. RESULTS: No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300-1.600 ml) in the GA group and 473.81 ml (150-1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1-5 units) in 14 patients in the GA group and 1.27 units (1-4 units) in 15 patients in the CEGA group (p<0.001). CONCLUSION: Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.

Crescent Technique with Dual C-Shaped Reconstruction Plates for Posterior Acetabular Wall Fractures.

Background: Here we have defined a novel technique for repairing posterior acetabular wall fractures called the "crescent technique," in which dual C-shaped reconstruction plates overlap at the distal ends and, if necessary, at the proximal ends. We also analyzed the efficacy and reliability of this method. Patients and Methods: This was a retrospective analysis of 27 patients undergoing the crescent technique. All of the fractures were treated by the senior author for a mean of 7.9 days (0-15 days) after the trauma. The mean follow-up period was 19 months (13-29 months). The clinical results were evaluated using the modified clinical grading system developed by Merle d'Aubigne and Postel, and then modified by Matta. The radiographs were graded according to the criteria described by Matta. Results: In the clinical grading, 16 (59%) of the patients were excellent and very good, 5 (19%) were good, 3 (11%) were moderate, and 3 (11%) were poor. According to the Matta radiological evaluation criteria, 19 (70%) were excellent, 4 (15%) were good, 4 (15%) were fair, and none were poor. Statistically significant consistency was seen between the clinical and radiological results (p = 0.002). Conclusions: The crescent technique is a dual plate technique modification that can provide a stable fixation. It appears to be an effective and reliable method for treating posterior wall fractures of the acetabulum.

Preoperative Mild Pericardial Effusion Is Associated With Perioperative Complications In Elderly Patients Following Hip Fracture Surgery.

Background: The prevalence and prognostic value of mild pericardial effusion (MPE) has not been examined in patients undergoing non-cardiac surgery. Our study aimed to assess the frequency and prognostic value of MPE in elderly patients undergoing surgery for hip fracture. Methods: This is a single center, and retrospective study including elderly patients who underwent hip fracture surgery. The medical records of all patients, aged ≥65 years with femoral neck, intertrochanteric or subtrochanteric hip fracture undergoing surgery (intramedullary hip screw, sliding compression hip screw, hemiarthroplasty, or total hip arthroplasty) from June 2014 to June 2019 were analyzed. Patients with of multiple trauma and accidents were excluded. The MPE was defined as the presence of <10 mm pericardial effusion. The primary outcomes of the study were perioperative adverse medical events and length of stay in hospital. Results: A total of 462 patients (mean age 75.2 ± 11.7 years, and 53.5% female) were enrolled. MPE was detected in 72 patients (15.6%), and 62 patients (13.4%) experienced perioperative adverse medical events. Patients with MPE were older, had higher prevalence of diabetes, coronary artery disease, and heart failure, and had longer length of stay compared to patients without MPE. Univariate analysis showed a significant association between age, diabetes, coronary artery disease, American Society of Anesthesiologists status, MPE, and perioperative adverse events. After adjustment for age, demographics, and medical history, the presence of MPE remained as significant variable associated with perioperative complications (OR: 2.543, 95% CI: 1.173-3.469, p = 0.003). Conclusion: Our study is the first to demonstrate that the presence of MPE is associated with perioperative adverse events in elderly patients undergoing hip fracture surgery.

Surgical treatment of acetabulum posterior wall fractures: Comparison between undercountering and marginal impaction reconstruction method with odd methods.

BACKGROUND: Modern treatment principles for posterior wall fractures have become widespread in the last decade in many countries by means of international or local courses. The purpose of this study was to compare the clinical and radiologic outcomes of acetabulum posterior wall fractures using unconventional methods of fixation, including plates placed in unusual directions, or, in the case of reoperation, only interfragmentary screws. In addition, we examined acetabulum posterior wall fractures treated by open reduction and internal fixation with standard undercountered plates from ischion to iliac bone in latter cases. METHODS: Twenty-one patients who had open reduction and internal fixation of an unstable unilateral fracture of the posterior wall of the acetabulum between 2009 and 2013 were included. Group 1 was composed of 10 former patients who were treated with unconventional methods that included a compression technique with a direct plate or solely screw fixation. Group 2 was composed of latter 11 patients who were treated with standard surgery that included undercountered plates oriented from the ischial tuberosity to the iliac bone proximally and reconstruction of marginal impaction if necessary. The functional outcome was evaluated with the use of the clinical grading system adopted by Merle d'Aubigné and Postel. The Kellgren-Lawrence radiologic criteria were used for the radiologic assessments. The reduction of the fracture, posterior dislocation, marginal impaction, mean fracture particle amount, trochanteric osteotomy and avascular necrosis were compared between the two groups and examined with the Mann-Whitney U test. RESULTS: In Groups 1 and 2, the median score of the modified Merle d'Aubigné and Postel clinical scoring system was 16 (8-18) and 18 (14-18), respectively. The clinical scores between the two groups were statistically significant (p < 0.01). When two groups were compared using the Kellgren-Lawrence radiographic criteria for the development of osteoarthritis, the median value in Groups 1 and 2 was 3 (0-4) and 1 (0-3), respectively (p < 0.01). CONCLUSIONS: This study displays the evolution of the surgical treatment of acetabular fractures of the posterior wall in our clinic. The older methods failed in terms of exposure, diagnosis of fracture anatomy and fixation techniques. Patients treated after the surgeons took courses in this field showed evidence of superior clinical and radiological scores. We attribute these benefits to exposure, definition and treatment of marginal impaction and fixation principles.

The Role of Biplanar Distal Locking in Intramedullary Nailing of Tibial Shaft Fractures.

BACKGROUND: To compare the union times of the uncomplicated tibial shaft fractures, which were distally locked by two coronal and one sagittal screws and by only two coronal screws. METHODS: 45 patients with tibial shaft treated with intramedullary nailing included in this study. 23 of 45 fractures were treated with uniplanar two distal interlocking (Group 1) and 22 fractures were treated with biplanar three distal interlocking (Group 2). Patients with closed fractures treated by closed nailing and having a full set of radiographs on PACS system was included. Fracture unions were evaluated by two authors. RESULTS: Union time was significantly shorter in biplanar distal interlocking group (Group 2) compared to uniplanar distal interlocking group (Group 1) (P=0.02). Mean union time in groups 1 and 2 were 14.63±4.5 and 10.77±3.0 weeks, respectively .When only distal third tibial shaft fractures were evaluated, Group 2 [11.2±3.1 weeks (n:17)] had significantly lower union time compared to Group 1 [15.07±4.8 weeks (n:14)] (P=0.01). Inter-observer reliability for fracture union times was high with rho= 0.89 with SE of 0.51 (P<0.001). CONCLUSION: Biplanar distal interlocking procedure had a significantly shorter union time. Biplanar distal interlocking procedure allows a faster fracture union probably because of a more stable fixation construct.

Treatment results for acetabulum fractures using the modified Stoppa approach.

OBJECTIVES: The aim of this study was to evaluate the clinical and radiological results of the surgical treatment of acetabular fractures using modified Stoppa approach. METHODS: A total of 57 patients (mean age 37.8 years; range 15-84) who underwent surgical treatment for acetabular fracture with modified Stoppa approach from February 2013 to June 2016 were included into the study. The mean follow-up time was 28.1 months (range 24-35). The records were reviewed for fracture patterns, time to surgery, operative time, blood loss, reduction quality, and perioperative complications. Reduction quality was graded as anatomic, imperfect, or poor. The Harris Hip Score (HHS) and Merle d'Aubigné score were used for functional evaluation. RESULTS: Among the 63 acetabulum fractures of the 57 patients, 27 were associated with both columns, 12 were T-type fractures, 10 were transverse, 7 were anterior column/posterior hemitransverse, 5 were anterior column, and 2 were anterior wall fracture. A single surgeon performed all operations. Pfannenstiel incision was used in the first 19 cases while vertical midline incision in the remaining 38 cases. Average time to operation was 5.5 days, and supplemental lateral windows were used in 17 (29.8%) patients. Average blood loss and operation times were 660 mL and 152 min, respectively. Radiological outcomes were anatomic, imperfect, and poor in 52 (82.5%), 9 (14.2%), and 2 (3.2%) of the acetabulum fractures, respectively. Clinical outcomes at 2 years with HHS and Merle d'Aubigné scores were mean 86.6 (range 66-96) (Excellent in 27, good in 23, fair in 4, poor in 3 patient) and 16.7 (range 10-18) (Excellent in 25, very good in 18, good in 6, fair in 5, poor in 3 patient), respectively. There was a significant relation between the reduction quality and clinical outcome (p < 0.001), while there was no significant relation between the clinical outcome and the fracture type (p > 0.05). Iatrogenic external iliac vein damage was noted in 2 patients. Obturator nerve palsy was noted in 3 patients, who recovered spontaneously at mean time of 3.7 months (range 3-5). Rectus abdominus paralysis was noted in 2 of the 19 (10.5%) Pfannenstiel-incision patients but not in the vertical-incision patients. CONCLUSION: Our experience in 57 patients shows that satisfactory results can be obtained, even in bilateral fractures with vertical midline incision. LEVEL OF EVIDENCE: Level IV Therapeutic Study.