Dorsal Metatarsal Closed Wedge Osteotomy in the Treatment of Freiberg's Disease: A Prospective Observational Study.

The aim of this study was to prospectively evaluate the clinical and radiological results of dorsal metatarsal closed wedge osteotomy and headless screw fixation in the surgical treatment of Freiberg's disease.Thirty-four patients who were treated with dorsal metatarsal closed wedge osteotomy (DMCWO) for Freiberg's disease between February 2018 and March 2022 were included in the study. Patients were staged according to the classification system described by Smillie. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society's (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the visual analog scale (VAS), the range of motion (ROM) of the metatarsophalangeal (MTP) joint, and a subjective patient satisfaction questionnaire. For radiological evaluation, the amount of preoperative shortening of the involved metatarsal, the amount of metatarsal shortening developed after osteotomy, and radiological recovery times were recorded.Thirty-two (94.1%) of the patients were female, and two (5.9%) were male. The average postoperative follow-up period for patients was 33.7 months (range: 24 months to 41 months). The mean AOFAS scores increased from 53.24 to 86.26 (p < 0.01). The mean VAS scores decreased from 8.59 to 1.79, and it was observed that the patients' pain improved significantly (p < 0.01). The mean ROM of the MTP joint increased from 48.76 degrees to 70.76 degrees (p < 0.01). An average of 2.5 mm (range 1 mm to 4.1 mm) of shortening of the metatarsal length developed postoperatively (p < 0.01). Arthrosis developed in 1 case (2.9%), and transfer metatarsalgia developed in 2 cases (5.8%).DMCWO is an effective treatment for both the early and advanced stages of symptomatic Freiberg's disease, leading to high patient satisfaction.

Can The Systemic Immune-Inflammation Index (SII) and Charlson Comorbidity Index (CCI) be used to predict mortality in patients with necrotizing fasciitis?

PURPOSE: This study aimed to determine the impact of mortality and morbidity indices on the diagnosis and prognosis of patients suffering from necrotizing fasciitis. METHODS: A retrospective analysis was performed on 41 patients (26 females, 15 males) with necrotizing fasciitis (NF). The SII (Systemic Immune-Inflammation Index) was computed using the formula SII = (P × N)/L, where P, N, and L measure the counts of peripheral platelets, neutrophils, and lymphocytes, respectively. This study evaluated the clinicopathological characteristics and follow-up information to assess the comparative effectiveness of SII, CCI (Charlson Comorbidity Index), and LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) scores as mortality and morbidity indices for patients with NF. RESULTS: The optimal cut-off for SII was determined to be 455. The SII value in the group with mortality was significantly higher compared to the group without mortality (p < 0.05). The CCI value in the group with mortality was significantly higher than the group without mortality (p < 0.05). The SII and CCI values were found to be effective in distinguishing between patients who suffered mortality and those who did not. CONCLUSION: SII is a powerful tool for predicting mortality in patients with necrotizing fasciitis (NF). The SII index provides a novel, easily accessible, and inexpensive indicator for monitoring the progress and predicting the survival of patients with NF.

Fluroscopy-assisted transiliac antegrade lag screw placement technique in both columns of acetabulum: A novel procedure.

The use of pelvic osseous fixation corridors and lag screw fixation in acetabular and pelvic surgery has gained popularity, especially with the recent development of intraoperative imaging and navigation techniques. However, advanced intraoperative imaging and navigation techniques require technical equipment and are costly. Therefore, traditional fluoroscopic techniques still maintain their importance. In this article, we describe a novel pelvic osseous fixation corridor that traverses both columns of the acetabulum, along with the detailed methodology of its fluoroscopic imaging and the techniques for fluoroscopy-assisted screw placement. The technique of placing screws in this current fixation corridor is only under fluoroscopy assistance, without using any specially produced guide or navigation device. LEVEL OF PROOF: IV.

Which external fixation method is better for the treatment of tibial shaft fractures due to gunshot injury?

INTRODUCTION: The present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury. HYPOTHESIS: Patients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF. MATERIAL AND METHODS: The study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months). RESULTS: No statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05). DISCUSSION: Although AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures. LEVEL OF EVIDENCE: IV; retrospective, case-control study.

Injury characteristics and management of orthopaedic trauma in refugee children.

PURPOSE: Several factors affect injury types in childhood. The aim of the study was to evaluate the musculoskeletal injury types, treatment modalities, and demographic characteristics of refugee children and to reveal the differences from native children. METHODS: A total of 1297 patients (897 females, 400 males) treated in our clinic between January 2014 and January 2019 were included in the study. The mean age of the patients was 8.9 ± 5.1 in refugees and 7.5 ± 4.6 in the native group (range, 0-18 years). The patients were evaluated in terms of age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, surgical technique, complications, and treatment modalities. RESULTS: The trauma mechanism differed significantly between the groups, high-energy traumas such as falling from a height, fight/assault injury, gunshot injury, and work injury were found more frequently in the refugee group (p = 0.001). The rates of CRIF, ORIF, graft/flap surgery, and hospitalization time were observed to be significantly higher in the refugee group (p = 0.013). No significant difference was observed between groups in terms of demographic distribution, injury location, and complications. CONCLUSION: This population-based, cross-sectional study emphasizes that the refugee children have different injury mechanisms. Improved living conditions may reduce musculoskeletal injury in this population.

The Influence of Lumbar Modifiers on Functional and Radiological Outcomes in the Brace Treatment of Lenke Type 1 Adolescent Idiopathic Scoliosis.

BACKGROUND: Brace treatment prevents the progression of scoliosis and reduces surgical treatment rates. However, the efficacy of brace treatment varies depending on the patient's age, gender, curve magnitude and type, structure of the curve, and patient compliance at the beginning of treatment. METHODS: Between January 2009 and April 2015, 106 Lenke type 1 AIS consecutive patients (69 females, 37 males) who were treated with a brace were examined in three groups according to Lenke classification lumbar modifiers. The patients were evaluated at pre-bracing and 1 and 2 years after bracing. The Scoliosis Research Society 22 (SRS-22) and Oswestry Disability Index (ODI) were used for functional evaluation. Radiological evaluation revealed the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, trunk shift, shoulder asymmetry, and body height difference. RESULTS: Functional and radiological evaluation showed a statistically significant improvement in Lenke 1A, 1B, and 1C at 1 and 2 years after bracing compared to the pre-bracing (p = 0.000, p = 0.000, and p = 0.000, respectively). Lenke 1C had the best ODI score and followed by decreasing values of 1B and 1A respectively (p = 0.009). Lenke 1B had the best SRS-22 score and the mean scores of 1A and 1C were equal (p = 0.017). There was no significant difference between the groups in the parameters other than the trunk shift in radiological evaluation (p = 0.043). CONCLUSIONS: Significant improvement was observed in all types of lumbar modifiers at the end of the 2nd year compared to pre-bracing. The best improvement in the ODI score was in the 1C modifier, whereas the best improvement in the SRS-22 score was in the 1B modifier. The type of lumbar modifier should be directly taken into consideration before starting brace treatment in Lenke type 1 AIS. LEVEL OF EVIDENCE: Level III, retrospective study.

Importance of lowest instrumented vertebra on clinical and radiological outcomes in patients with Lenke type 3C adolescent idiopathic scoliosis: a minimum 4-year follow-up.

The purpose of this retrospective study was to determine the most appropriate distal fusion level in terms of clinical results and radiological changes in Lenke 3C adolescent idiopathic scoliosis (AIS). Between June 2010 and May 2014, a total of 90 consecutive patients who underwent surgery for Lenke 3C AIS were divided into three groups as L2, L3, and L4 according to the fusion levels and compared in terms of functional and radiological outcomes. Patients were evaluated with Scoliosis Research Society 22 (SRS 22) and the Oswestry disability index (ODI) at the final follow-up. Preoperative standard posteroanterior and lateral whole-spine radiographs and lateral bending radiographs were used to evaluate the curves. All patients were also assessed with lumbar MRI at the final follow-up, and classified for each patient in terms of disc degeneration (DD) and facet joint degeneration (FJD). There was a statistically significant difference between the groups in terms of ODI category (P = 0.001). The rate of minimal disability in the L3 group, moderate disability in the L2 group, and severe disability in the L4 group were higher. Statistically significant differences were observed between the groups in terms of pain, body image, mental health, and total score distribution from the SRS-22 domains (P < 0.05). No significant difference was observed between the groups in terms of DD and FJD in MRI (P = 0.263). Although the preoperative functional scores could not be evaluated due to the retrospective nature of the study, it was observed that the only significant difference between the groups was the SRS-22 score. The best SRS-22 score was obtained in patients in whom fusion was stopped at L3.

Comparison of the two types of bioresorbable barriers to prevent intra-abdominal adhesions in rats.

PURPOSE: The aim of this study was to evaluate the efficacy of two absorbable film barriers, polylactic acid and sodium hyaluronate-carboxymethyl cellulose, in preventing postoperative intra-abdominal adhesions, inflammation, and fibrosis in an animal model. METHODS: Forty Wistar albino rats were grouped as polylactic acid, sodium hyaluronate-carboxymethyl cellulose, and control. All rats underwent laparotomy with subsequent cecal wall abrasion and abdominal wall injury. The two treatment groups received polylactic acid or sodium hyaluronate-carboxymethyl cellulose film barriers, while control group received nothing. On postoperative day 21, three observers graded the intra-abdominal adhesions and resected specimens. Fibrosis, inflammation, and adhesions were graded using quantitative scoring systems. RESULTS: When compared to control group, polylactic acid group showed significantly less inflammation and adhesion (p < 0.005), while there was no significant difference for fibrosis. Sodium hyaluronate-carboxymethyl cellulose group has showed significantly less adhesions (p < 0.005), but there were no significant differences among fibrosis and inflammation when compared to control group. There were no significant differences between polylactic acid and sodium hyaluronate-carboxymethyl cellulose groups on adhesion formation, inflammation, or fibrosis. CONCLUSIONS: Placement of polylactic acid or sodium hyaluronate-carboxymethyl cellulose film barriers between injured surfaces is associated with a significantly reduced rate of postoperative adhesions. No superiority was detected between two barriers.

Effect of polylactic acid film barrier on intra-abdominal adhesion formation.

PURPOSE: The aim of the present study was to evaluate the efficacy of an absorbable polylactic acid film barrier in preventing postoperative intra-abdominal adhesions, inflammation, and fibrosis in an animal model. METHODS: Thirty Wistar albino rats were divided into treatment and control groups. All rats underwent laparotomy with subsequent cecal wall abrasion and abdominal wall injury. The treatment group had a polylactic acid film barrier placed between the cecal and abdominal injured surfaces while control group received nothing. The animals were sacrificed on postoperative day 21. Three observers graded the intra-abdominal adhesions and resected specimens for histological examination of fibrosis and inflammation. Fibrosis, inflammation, and adhesions were graded using a quantitative scoring system. RESULTS: The treatment group showed significantly less adhesions and inflammation (P < 0.05), while there was no significant difference in the amount of fibrosis. Statistical correlations between adhesion-inflammation, adhesion-fibrosis, and inflammation-fibrosis were also significant (P < 0.05). CONCLUSIONS: Placement of polylactic acid film barriers between injured surfaces is associated with a significantly reduced rate of postoperative adhesions and inflammation. This may be a promising result for reducing the morbidity and costs related to postoperative adhesions.