How understandable are the patient education materials about flat foot on the Internet for parents?

Flat foot is a common reason for parents to visit orthopedic clinics. As the Internet has become an easy-search platform, parents often seek online educational materials before seeking out a professional. The aim of this study was to investigate the quality, readability, and understandability of such online materials for parents. An Internet search was performed for "flat foot" and "pes planus" using the Google search engine. The readability was evaluated using 6 different grading systems: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Fry Readability score, Gunning Fog Index tests, and Automated Readability Index. The Patient Education Materials Assessment Tool test was used to assess the understandability. For quality assessment, the Journal of American Medical Association benchmark criteria and Health on the Net code were applied. One hundred nine websites were included and evaluated for readability, understandability, and quality. The mean readability grade for all websites was 10.5 ±â€…2.0. The mean Gunning Fog Index tests and Flesch-Kincaid Grade Level scores for all websites were 12.4 ±â€…2.2 and 9.7 ±â€…2.1 sequentially. The mean Coleman-Liau index score was 10.0 ±â€…1.5, and the average Fry Readability score was 9.9 ±â€…2.0. The automated readability index for all websites was 10.3 ±â€…2.5. The average Flesch Reading Ease score for all educational materials was 59.3 ±â€…10.1. The average Patient Education Materials Assessment Tool score for all educational materials was 81% (range, 70-87%). The mean Journal of American Medical Association benchmark criterion for all websites was 1.0, with a range from 1.0 and 2.0. Eighteen (16.5%) websites had Health on the Net certificates. Readability, understandability, and quality of patient education materials about flat feet on the Internet vary and are often worse than professional recommendations.

Treatment of comminuted radial head fractures with personalized radial head prosthesis produced with 3-dimensional printing technology.

BACKGROUND: The radial head is the forearm's pivot point for supination-pronation. Although radial head resection can be performed in comminuted radial head fractures, radial head prosthesis has gained popularity in order to prevent possible complications such as progressive valgus instability in the elbow and secondary ulnocarpal impaction that may develop due to proximal displacement of the radius. As for radial head prostheses, standard prosthetic designs do not provide the same results in everyone, and the alignment of the radial head and radial neck angle cannot be fully achieved. We believe that the radial head must be reconstructed with a complete anatomical implant. We designed and applied personalized prostheses to our patients, and in this study, we wished to share the 2-year results of these patients. METHODS: In this study, 23 patients who had comminuted radial head fractures had personalized radial head prostheses inserted. Preoperative variables such as type of injury, age, side, additional ligament injury, operation time, number of radial head parts, neck angle of individual prosthesis, stem length, and stem diameter were noted. The mean operating time was 26 ± 9 minutes. One month postoperatively, after physical therapy, elbow range of motion, loss of strength compared to the opposite joint, Mayo elbow scores, QuickDASH scores, and patient satisfaction were evaluated. Patients were evaluated 2 years postoperatively. RESULTS: QuickDASH and Mayo elbow scores were satisfactorily good (mean QuickDASH score: 9.091, mean Mayo score: 91.08). According to the results of the patient satisfaction questionnaire, 16 of the 23 patients reported excellent satisfaction, 5 patients good satisfaction, and 2 patients moderate satisfaction. None of the patients reported poor results. DISCUSSION: Since personalized radial head prosthesis consists of a single monoblock, its surgical application consists of a single step and has a short operating time. As the applications in the literature increase and more studies are conducted, this subject will be better understood. Our study demonstrated that these patients, whose anatomies were individually replicated, achieved good range of motion and patient satisfaction. In fact, none of the patients reported negative results. In comminuted radial head fractures, surgical implantation of personalized radial head prosthesis is a treatment modality with easy application, short operating time, and good functional results.

Comment on Lee et al. Accuracy of New Deep Learning Model-Based Segmentation and Key-Point Multi-Detection Method for Ultrasonographic Developmental Dysplasia of the Hip (DDH) Screening. Diagnostics 2021, 11, 1174.

We have read the article titled "Accuracy of New Deep Learning Model-Based Segmentation and Key-Point Multi-Detection Method for Ultrasonographic Developmental Dysplasia of the Hip (DDH) Screening" by Lee et al. [...].

Evaluation of iliopsoas tendon using shear wave elastography after open reduction surgery for developmental dysplasia of hip.

OBJECTIVES: The aim of this study was to investigate the wholeness, thickness, and elastography measurements of the iliopsoas tendon using shear wave elastography who underwent open reduction surgery for unilateral developmental dysplasia of the hip. PATIENTS AND METHODS: Between January 2011 and December 2016, a total of 15 patients (2 males, 13 females; mean age: 24.6±26.3 months; range, 3 to 98 months) who underwent surgical treatment for unilateral DDH were retrospectively analyzed. In addition to demographic data, clinical findings such as muscle strength, range of motion, and the presence of limping were recorded. Ultrasound elastography was used to examine the thickness, shear wave velocity and elasticity of the iliopsoas tendons. RESULTS: The mean follow-up was 92.6±30.2 (range, 44 to 120) months. Full range of motion of the hips was observed in all patients. Hip flexor muscles' strength was 5/5 in bilateral. No hip dislocation or limping was not detected in any of the patients. Ultrasound examinations revealed that tenotomized iliopsoas tendons were intact in all patients. The mean muscle thickness was lower in operated sides, indicating no statistically significant difference. The mean velocity and elasticity were statistically significantly higher in the operated sides. CONCLUSION: This is the first study using shear wave ultrasonography for iliopsoas tenotomy of the patients underwent open reduction for developmental hip dysplasia. Re-adhesion of the iliopsoas tendons provided wholeness while healing as a more rigid and thinner structure compared to the intact sides.

Does clozapine really affect bone mineral density? An experimental study.

PURPOSE: The aim of this study was to investigate the effect of clozapine use on bone tissue by applying computerized tomography, dual-energy X-ray absorptiometry, and histological and biomechanical analyses in an experimental rat model. METHODS: Sixteen female Wistar Albino rats were included in this study. These animals were divided into two groups: the control group and the clozapine group. The animals in the clozapine group received 10 mg/kg clozapine, and the animals in the control group received tap water by oral gavage daily for 28 days. After sacrification, the femurs of the rats were used for radiologic, histologic, dual-energy X-ray absorptiometry, and biomechanical evaluations. RESULTS: Although the mean values of the clozapine group were higher in terms of histological, bone mineral density, and biomechanical evaluations, the statistical analyses were not significantly different. CONCLUSION: Clozapine use did not affect bone density in the rats. Clozapine can be the preferred treatment for patients with schizophrenia to avoid osteoporosis. It will be necessary to conduct further long-term follow-up and controlled studies in animals and humans to confirm these findings.

Arthroscopic treatment of tibial eminence fractures using double-loop endobutton device: Surgical technique and short-term treatment outcomes.

OBJECTIVES: This study aims to explain the arthroscopic surgical technique of double-loop endobutton device for tibial eminence fractures and share the outcomes of this treatment method. PATIENTS AND METHODS: Thirteen patients (10 males, 3 females; mean age 19.9±5.6 years; range, 14 to 34 years) with tibial eminence fractures type II, IIIa, and IIIb were analyzed retrospectively between March 2017 and March 2019. Knee laxity, Tegner Lysholm knee scores, the International Knee Documentation Committee (IKDC) scores, knee mobility, Lachman test, and bone union were analyzed after the arthroscopic fracture fixation with double-loop endobutton device at first and sixth months after surgery. RESULTS: First month mean IKDC scores were 38.0±7.0 and mean Tegner Lysholm scores were 50.3±5.8. Sixth month mean IKDC scores were 80.2±4.0 and mean Tegner Lysholm scores were 87.1±5.4. All patients showed negative Lachman test and negative pivot-shift test at final follow-up. Radiological bone union without reduction loss was also seen in all patients. CONCLUSION: Using double-loop endobutton device provides successful results to fix tibial eminence fractures.

Center-edge angle values in healthy children between 5 and 14 years old in Turkey.

OBJECTIVE: The aim of this study was to determine the center-edge angle (CEA) values according to age, gender and side in healthy children between 5 and 14 years old in Turkey and to find out the angular limit values for mild and severe dysplasia. METHODS: The data pool that was gathered to investigate the frequency of hip dislocation in children between 6 months and 14 years old in Turkey was used. The data pool consists of pelvis and lower abdomen radiographs obtained for reasons other than hip dysplasia. Lower abdomen/pelvis radiographies of children between 5 and 14 years old were extracted from the data pool and were evaluated. Distribution of CEA values according to age, gender and side was examined. Measurements were performed by a single investigator on computer by using a standard method. Reliability of the measurements was tested by three different investigators on randomly selected films by using the standard method. RESULTS: CEA values of 3192 hips of 1596 children, who had no hip pathology, were measured. Mean CEA value was found as 26.2°±5.5°. The mean CEA was 26.2°±5.3° in males (%54) and 26.2°±5.7° in females (%46) (p=0.224). Mean values for the right and left hips were 25.7°±5.4° and 26.6°±5.6°, respectively. CEA value of 449 (14%) hips of 333 (20.8%) children was at the limit of mild dysplasia and CEA value of 70 (2.2%) hips of 58 (3.6%) children was at the limit of severe dysplasia. CEA values had increased by age and mild and severe dysplasia limits were determined for every age group. CONCLUSION: The mild and severe dysplasia values that are defined according to ages in Turkish population will guide the investigators in the diagnosis, follow-up and treatment planning of developmental dysplasia. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Effect of curcumin on bone healing: An experimental study in a rat model of femur fracture.

OBJECTIVE: To determine the radiologic, histologic and biomechanical effects of curcumin on bone healing using a total rat femur fracture injury model. MATERIALS AND METHODS: Sixty four male Wistar-Albino rats weighing 170-210 g were used in this study. The animals were randomly divided into eight groups and 5 or 6 animals were placed in each cage. A transverse femur shaft fracture model used. The animals in study groups received oral curcumin at a dose of 200 mg/kg for 14 days or 28 days. Remaining animals received only saline solution by oral gavage for a period of 14 days and 28 days as control groups. After sacrification the left femurs used for radiological, histological and biomechanical evaluation. RESULTS: The groups treated with curcumin showed no significant difference in terms of radiological, histological and biomechanical evaluations in 14 days groups. Also there was no significant difference between curcumin and control groups for 28 days according to radiological, histological and biomechanical tests. CONCLUSIONS: According to our results, curcumin has no positive effect on fracture healing not only histologically but also radiologically and biomechanically. Curcumin's antioxidant effect may be more noticeable with long term follow up investigation as it may have a positive effect in remodelling phase. Long term follow up designed studies may be planned to investigate its effect on remodelling phase of fracture healing.

A comparison of the effects on postoperative bleeding of the intra-articular application of tranexamic acid and adrenalin in total knee arthroplasty.

OBJECTIVE: To compare the efficacies of intra-articular applications of tranexamic acid and adrenaline on postoperative bleeding after total knee arthroplasty. METHODS: The single-center, retrospective, controlled study was conducted at Selcuk University , department of orthopedic surgery and comprised data of patients who underwent primary, unilateral, cemented total knee arthroplasty between July 2012 and December 2014. Group 1 had received tranexamic acid 1g after closure of articular capsule. Group 2 had received adrenalin. Group 3, the control group, received no medication intraarticularly after total knee arthroplasty. The amount of blood collected in the drain and postoperative alterations in haemoglobin and haematocrit values were compared. RESULTS: Of the total 90 subjects, there were 30(33.33%) in each of the three groups. The decrease of haemoglobin and haematocrit values in Group 1 was statistically significant compared to both Group 2 and Group 3 (p<0.05). The amount of blood collected in the drains was remarkably lower in Groups I and 2 compared to Group III (p<0.05). No deep venous thrombosis or pulmonary emboli were encountered across the sample. CONCLUSIONS: Intra-articular administration of tranexamic acid was found to be beneficial and safe for the achievement of effective haemostasis after total knee arthroplasty.

Methyl methacrylate in external fixation of supracondylar humerus fractures: An experimental study.

Supracondylar humerus fractures are common fractures around the elbow. Open fractures, comminuted metaphyseal fractures and also fractures with bone loss may need to be treated with external fixators. The aim of this study is to compare two different external fixators, tubular external fixators and polymethyl methacrylate with K wires external fixators, with regard to stiffness and stability for metaphyseal-diaphyseal osteotomies of distal humerus close to the joint. Six matched pairs (24 specimens) of second-generation sawbone humerus were prepared in a standard fashion to create a metaphyseal fracture, 5 cm proximal to the distal joint line of humerus and were randomly divided into two groups of 12 specimens each. Each sawbone humerus was osteotomized transversely at the mid-olecranon fossa with a 2-mm oscillating saw to simulate a Gartland type III fracture. The osteotomy was then reduced and stabilized using two different external fixation methods: carbon tubular external fixator with Schanz screws and methyl methacrylate with multiple K wires. Three-point bending and torsion tests were performed on the specimens. Bending and torsional stiffness of specimens were obtained for the fixation methods. According to the results of the study, the methyl methacrylate group has provided higher stiffness than classical tubular fixator with Schanz screws in three-point bending test (7.79 ± 2.33 N/mm vs 3.78 ± 1.18 N/mm, p = 0.006). The methyl methacrylate group also showed better stiffness in torsion test (0.12 ± 0.042 N m/° vs 0.067 ± 0.013 N m/°, p = 0.02). We determined for the first time in literature that external fixation with methyl methacrylate was significantly superior to the classical tubular external fixator with Schanz screws with regard to stiffness and stability under three-point bending and torsional loads. Moreover, methyl methacrylate is inexpensive and easily applied.

Effect of curcumin on tendon healing: an experimental study in a rat model of Achilles tendon injury.

PURPOSE: This in vivo study aims to investigate the effects of curcumin which is recently developed for tendon healing using a rat Achilles tendon injury model. MATERIALS AND METHODS: Eighteen male Wistar albino rats weighing 300-400 g were used in this study. Under anesthesia, Achilles tendon injuries were created and repaired surgically. Nine rats of the study group received curcumin (suspended in saline at a dose of 200 mg/kg orally) and eight rats of the control group received only saline solution by oral gavage for a period of 28 days. Animals were euthanized on the 28th post-operative day, and all the Achilles tendons were removed and transferred immediately for biomechanic and histological analysis. RESULTS: Macroscopically, all the tendons were fully healed. Total mean Bonar score was higher in the control group. When the parameters of Bonar score were analysed separately, tenocyte morphology, collogen, and ground substance scores were statistically lower than the control group (p = 0.03, 0.041, 0.049, respectively). Vascularity parameter did not show any statistical difference (p > 0.05). Of the nine biomechanical parameters, five of them (failure load, cross-sectional area, length, ultimate stress, strain) showed better results which were also statistically significant (p = 0.046, 0.027, 0.011, 0.021, 0.002, respectively). When the remaining four parameters were examined, the study group also had better results, but this difference was not statistically significant. CONCLUSION: Curcumin had better results for total tendon healing not only histologically but also biomechanically. Curcumin could be an additional agent in the management of surgically repaired tendon injuries.

Other benefits of intra-articular injection of tranexamic acid in primary total knee arthroplasty apart from reducing blood transfusion rates.

OBJECTIVES: This study aims to evaluate the effect of intra-articular tranexamic acid (TA) administration on the amount of blood in the drains, the amount of blood transfusion, length of hospital stay, and the total cost in total knee arthroplasty (TKA) patients. PATIENTS AND METHODS: The study included a total of 118 patients (24 males, 94 females; mean age 67.0 years, range 52 to 81 years) who underwent primary unilateral TKA surgery. Patients were divided into two groups as 58 patients who were performed intra-articular injection of 2 g TA after closure of articular capsule (TA group; 10 males, 48 females, mean age 65.6 years; range 55 to 80 years) and 60 patients who were not performed any intra-articular injection (non-TA group; 14 males, 46 females; mean age 68.3 years; range 52 to 81 years). The maximum difference between pre- and postoperative hemoglobin levels, the amount of blood in the drains, the amount of blood transfusion, length of hospital stay, and cost of each patient were recorded. RESULTS: The mean difference between pre- and postoperative hemoglobin levels were higher in the non-TA group (1.7 g/dL vs 2.6 g/dL, p<0.05). The mean amounts of blood in drains (327.5 mL vs 800.0 mL, p<0.05), the amounts of blood transfusions (0 units vs 10 units, p<0.05), the mean lengths of hospital stay (4.03 days vs 4.53 days, p<0.05), and the hospital costs (1,935.26 United States dollars vs 1,959.64 United States dollars, p<0.05) were lower in TA group. CONCLUSION: Administration of intra-articular TA during primary TKA may reduce blood loss and the need for blood transfusion while significantly shortening the postoperative length of hospital stay and reducing the total hospital costs.

Should orthopedic surgeons consider the effects of gabapentin administration on bone healing while treating a long bone fracture: experimental study in a rat model.

OBJECTIVE: The main purpose of the present study was to assess the radiographic, histological, and mechanical effects of gabapentin on fracture healing in a rat model of femur fracture. MATERIALS AND METHODS: A standard transverse fracture of the mid-diaphysis was created. A total of 60 female Wistar-Albino rats with the mean age of 13.5 ± 1.2 weeks were used for this experimental trial. The rats were randomized into four groups with 15 animals included in each group. Group A and B were the control groups whereas C and D were the treatment groups. Drugs were delivered by oral gavage twice a day with the daily dosage calculated according to body surface area conversion to the human equivalent dosing regimen of 1200 mg/day. Radiographic, histological, and biomechanical evaluation was performed. RESULTS: We could not detect any statistically significant difference between the control and gabapentin treatment groups according to the comparative assessment of radiographic scores on the 15th and 30th days. Although no significant differences were found between the groups on the 15th day, histological scores were better in the control group on the 30th day. According to the results of biomechanical testing, the fractured femurs resected from the control group exhibited significantly more strength on the 30th day. CONCLUSIONS: According to the data we acquired during the present study, administration of gabapentin negatively affects the fracture healing process especially in the aspects of histological progression as well as the biomechanical strength of the callus in a rat model.

Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain.

PURPOSE: Anterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. METHODS: This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. RESULTS: Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30° of knee flexion than did the controls. CONCLUSION: Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. LEVEL OF EVIDENCE: Diagnostic study, Level III.

Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast.

Randomized controlled clinical trial.The main purpose of the present study was to comparatively analyze the effectiveness, advantages, and the complications of using semirigid synthetic softcast with respect to plaster of Paris (POP) during the treatment of clubfoot deformity.The study group consisted of 196 babies (249 feet). A total of 133 feet treated by an orthopedic referral center using semirigid synthetic softcast were included in group A whereas the other 116 feet treated by another orthopedic clinic using POP cast were included in group B. The Pirani scores, number of cast applications, time period until Achilles tenotomy, any skin problems due to the cast itself, and/or cast removal were recorded. A final parent satisfaction score was also obtained.The mean Pirani sores were significantly improved from the first administration to the time before Achilles tenotomy in both groups. There was no significant difference according to the number of casts applied until tenotomy. The slippage of the cast and skin lesions was significantly more common in group B. Higher parent satisfaction levels were detected in group A.Semirigid softcast has been found as superior to POP in the aspects of parent satisfaction and cast-related complication rates.

Effect of Ankaferd blood stopper® on tendon healing: an experimental study in a rat model of Achilles tendon injury.

OBJECTIVES: This in vivo study aims to investigate the effects of Ankaferd Blood Stopper® (ABS) which is a recently developed topical hemostatic agent on tendon healing using a rat Achilles tendon injury model. MATERIALS AND METHODS: Twelve male Wistar-Albino rats were used in the study. Right legs of the rats were assigned as the study group, and left legs were assigned as the control group. Under anesthesia, bilateral Achilles tendon injuries were created and repaired surgically. To the surgical sites, 1 mL of ABS for the right side and 1 mL of serum physiologic solution for the left side were applied. Animals were euthanized on the 21st postoperative day, and tendon samples were collected from the extremities. Histological analyses were performed according to the semiquantitative tendon scoring system (Bonar Scale). RESULTS: Total tendon healing scores were significantly poorer in the study group compared to the control group. Although there were no significant differences between the groups in terms of tenocyte morphology, degree of ground substance staining, and vascularity, the collagen morphology scores were significantly poorer in the study group. CONCLUSION: In our study, application of ABS had histologically negative effect on tendon healing in rats. However, further biomechanical and immune histochemical studies are required to support these results.

Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report.

OBJECTIVE: Complex regional pain syndrome (CRPS) is a painful and disabling syndrome in which the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Polio paralysis is caused by the damage or destruction of motor neurons in the spine, which lead to corresponding muscle paralysis. This report is a case report on the application of a pulsed radiofrequency (PRF) current to dorsal root ganglia (DRG) for the treatment of CRPS type 1 in an adolescent patient. DESIGN: Single case report. SETTING: Selcuk University Hospital. PATIENT: A 16-year-old girl who suffered from CRPS type 1 secondary to surgeries for the sequelae of poliomyelitis. INTERVENTIONS: PRF current application to the lumbar 4 and lumbar 5 DRG. OUTCOME MEASURES: Pain reduction. RESULTS: The patient had complete resolution of her symptoms, which was maintained at a 6-month follow-up. CONCLUSIONS: This case illustrates that PRF applied to lumbar 4 and lumbar 5 DRG may play a significant role in CRPS type 1 management after the surgical treatment of poliomyelitis sequelae in adolescent patients. Further randomized, controlled studies are needed to support this argument.