Comparison of clinical outcomes of autologous bone graft versus pronator quadratus pedicled vascularized bone graft in the treatment of scaphoid nonunion.

We aimed to compare the union rate and clinical outcome of autologous bone graft versus pronator quadratus vascularized pedicled muscle flap in treatment of scaphoid nonunion. Forty patients with a diagnosis of scaphoid nonunion who underwent unilateral pseudarthrosis surgery were included in this study. Notably, the scaphoid nonunion was unilateral, and the contralateral wrist was asymptomatic with normal function, per the physical and radiological examinations. Pronator quadratus vascularized pedicled muscle flap was used in 16 patients (group 1), and autologous bone graft was used in 24 patients (group 2). Patients were compared used Scapholunate angles, Natrass carpal height ratio and Mayo wrist score pre and postoperatively. Fifteen of the 16 (93.3%) patients in group 1 and 19 of the 24 (79.2%) patients in group 2 achieved bone union. Four of twelve patients in group 2 with avascular necrosis (AVN) and one of eight in group 1 with AVN were not able to achieve union. The group 2 (34%) had higher nonunion rate than group 1 (12%) in AVN patients. The scapholunat angle was significantly decreased and the Natress ratio was significantly increased postoperatively compared to the preoperative measurement in both group. There was no statistically significant difference in the postoperative measurement. The postoperative Mayo wrist score showed no statistically significant differences between both groups. The pronator quadratus vascularized pedicled muscle flap was superior to non-vascularized bone grafting in the treatment of scaphoid nonunion with AVN. However, management of the patients without avascular necrosis is not requiring the vascularized pedicled muscle flap technique.

Effects of Focal Cerebellar Injury on Fracture Healing and Oxidative Stress in Rat Model: An Experimental Animal Study.

AIM: To examine the effect of cerebellar damage on the process of fracture healing. MATERIAL AND METHODS: A total of forty-two male rats were selected at random and subsequently allocated into three distinct groups. The experimentals were divided into two subgroups within each group, with the intention of sacrificing them during the third and sixth weeks. Group 1 had isolated femoral fracture, Group 2 had femoral fracture after craniotomy, and Group 3 had femoral fracture accompanying cerebellar injury after craniotomy. Left femoral fractures in rats in all groups were treated using an intramedullary Kirschner wire. Radiological, histological, and biochemical evaluations were conducted at 3 and 6 weeks to assess the processes of fracture healing. To determine the effects of fracture healing and cerebellar injury on oxidant-antioxidant systems, catalase (CAT), malondialdehyde, superoxide dismutase (SOD), and glutathione peroxidase (GPx) activities were measured. RESULTS: Between the time frame of 3 to 6 weeks, Group 3 had higher radiography scores, alkaline phosphatase levels, callus/ diaphyse ratio, callus improvement, and bone mineral density in comparison to the other groups. The activity of SOD was found to be statistically negligible in all groups, suggesting that SOD does not have a substantial impact on fracture healing in cerebellar injury. However, notable increases in the activity of GPx and CAT enzymes were observed, showing their considerable involvement in the process of fracture healing. CONCLUSION: Cerebellar injury reduces the oxidative stress in the fracture area and contributes positively to fracture healing by means of radiologically, biochemically and histopathologically.

Contribution of Multilevel Transformainal Lumbar Interbody Fusion Surgery to Restoration of Lumbar Lordosis in Patients with Degenerative Spine: Comparison of Long and Short Level Fusion.

AIM: To investigate the effect of multilevel transforaminal lumbar interbody fusion (TLIF) procedures in lumbar degenerative spine conditions on the restoration of lumbar lordosis (LL) in patients with short- and long-level fusion, and to examine the associated radiological results. MATERIAL AND METHODS: This retrospective study reviewed patients with degenerative spinal diseases who underwent lumbar fusion using a multilevel TLIF procedure. Patients with three or fewer segments involved in fusion were assigned to the shortlevel fusion group and those with more than three segments involved in fusion were assigned to the long-level fusion group. The anteroposterior and lateral spine radiographs of the patients were used to measure LL, distal lumbar lordosis and radiological parameters. RESULTS: The study included 47 patients who met the inclusion criteria, with a mean age of 60.4 ± 12.2 years. The mean follow-up time of our patients was 18.3 ± 11 months. Thirty-five (74.5%) patients were women and 12 (25.5%) were men. Overall, 12 patients underwent 3-level and 35 patients underwent 2-level TLIF. Long-level fusion was performed in 24 patients and short-level fusion was performed in 23 patients. CONCLUSION: Multilevel TLIF can be used to correct spinopelvic alignment when applied with the appropriate indications and techniques in patients with degenerative spinal disorders. Multilevel TLIF is associated with substantial improvements in LL, distal lumbar lordosis, and SVA (sagittal vertical axis). It also helps to correct the correlation between PI and LL.

Smith c/b ratio and teardrop figure measurements; Can it be used in the follow-up of patients who underwent salter innominate osteotomy?

BACKGROUND: This study aimed to investigate the effectiveness of radiological parameters used in the follow-up of patients who underwent salter innominate osteotomy (SIO) for the treatment of developmental dysplasia of the hip. METHODS: Acetabular index, c/b ratio, teardrop width, femoral head teardrop distance (TDD), and acetabular teardrop angle were measured on anteroposterior pelvic radiographs of patients who underwent SIO between 2017 and 2020. The patients were divided into 2 groups according to their preoperative Tönnis stage. Twenty-five (51%) hips of 23 patients with Tönnis stage 2 were classified into group 1, and 24 (49%) of 17 patients with Tönnis stages 3 and 4 were classified into group 2. Changes in radiologic parameters over time and between the groups were statistically evaluated. RESULTS: The study included 49 hips of 40 patients (37 female and 3 male). The age at surgery was 26.53 (18-53) months. After a mean follow-up period of 33.7 ± 12.8 months, there was no statistically significant difference between Groups 1 and 2 in terms of clinical, radiological and femoral head avascular necrosis results (P = .591, P = 956, P = .492). The changes in radiological parameters over time and between groups were statistically significant. (P < .001). Only the TDD and c/b ratio were significantly different between groups 1 and 2 (P = .002 and P < .001, respectively). CONCLUSION: In our study, along with acetabular index, the c/b ratio, teardrop width, TDD, and acetabular teardrop angle significantly changed after SIO and could be used as a guide for patient follow-up.

Investigation of Possible Reasons of Failed Treatment of Conservative Thoracolumbar Osteoporotic Vertebral Fractures.

AIM: To investigate the possible reasons of failed conservative treatment of osteoporotic thoracolumbar vertebral compression fractures (VCFs). Sagittal balance impairment may weaken union by increasing the load on the fracture line. Most osteoporotic vertebral fractures occur in the thoracolumbar and mid-thoracic regions. MATERIAL AND METHODS: We investigated the records of patients aged > 60 years who underwent treatment for osteoporotic thoracolumbar VCFs between 2012 and 2020. The patients were divided into two groups: those who required surgical treatment due to the failure of conservative treatment and those who were successfully treated with conservative treatment. All the patients underwent lateral radiography and computer tomography of the whole spine at their initial and final visit. The radiographic parameters of spine and presence of sarcopenia, age, and gender were compared between the groups. RESULTS: Of the study subjects, the mean age of 13 females and 7 males in whom conservative treatment was successful was 67.4 years and the mean follow-up period was 23.5 months, while in 18 females and 5 males who underwent surgical treatment due to the failure of conservative treatment, the mean age was 68.7 years and the mean follow-up period was 22.1 months. No significant differences between the groups regarding age and gender were observed. However, significant differences were observed between the groups regarding the presence of sarcopenia and thoracic kyphosis, thoracolumbar kyphosis and distance from the center of the fractured vertebra to the plumb line (DSVA). CONCLUSION: Sarcopenia and DSVA were significantly higher in the surgical treatment group. Receiver operating characteristic analysis demonstrated that the sensitivity and specificity of DSVA for identifying high-risk patients for failed conservative treatment of osteoporotic thoracolumbar VCFs were 100% and 95%, respectively, with an optimum diagnostic cutoff value of 6.5 mm.

D-dimer may aid in the diagnosis of pediatric musculoskeletal infections: a prospective study.

Musculoskeletal infections, including septic arthritis, osteomyelitis, and soft tissue infections, are critical morbidity factors for children and adolescents. This study investigated the role of D-dimer levels for diagnosing childhood musculoskeletal infections. This single-center prospective study was initiated in April 2020 following approval from the local ethics committee. The study included 54 children, divided into the infection group ( n = 21), comprising patients who underwent surgical treatment for childhood musculoskeletal infections and had macroscopically visible purulent discharge during surgery, and the control group ( n = 33), comprising healthy children. In the infection group, the mean values of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), plasma D-dimer, and white blood cell (WBC) were 39.42 ± 27.00 mm/h, 101.50 ± 76.90 mg/l, 2.34 ± 2.59 mg/l, and 15.55 ± 6.86 × 10 9 /l, respectively. On comparison, the infection group showed higher levels of WBC, CRP, ESR, D-dimer, and neutrophil-to-lymphocyte ratio than the control group. When the D-dimer cutoff value of 0.43 mg/l was taken, it was observed that it had 95.2% sensitivity and 81.8% specificity. The area under curve (AUC) of the above-mentioned parameters calculated via receiver operating characteristic curves showed CRP levels as the optimum predictor of childhood musculoskeletal infections, followed by the ESR, plasma D-dimer, and WBC levels in descending order (AUC: 0.999, 0.997, 0.986, and 0.935, respectively). D-dimer is another test, which in combination with other conventional established tests (CRP and ESR) can be helpful in diagnosis of pediatric infection. We recommend the addition of D-Dimer to ESR, CRP, and WBC as a first-line investigation in cases with suspected pediatric musculoskeletal infections.

A Prospective Randomized Trial: Does Full Weight Bearing Improve Functional Outcomes in Elderly Patients With Proximal Intramedullary Nailing After an Intertrochanteric Femur Fracture?

Introduction This study aimed to compare the functional outcomes and degree of independence in activities of daily living in patients aged >65 years who were treated with a proximal femoral nail (PFN) after an intertrochanteric femur fracture (ITFF) and underwent full and partial load-bearing in the early stage. Methods Overall, 133 patients who were hospitalized for ITFF and treated with PFN between August 2018 and March 2021 were randomly assigned to two groups. During the follow-up period, 45 patients who underwent partial load bearing (Group 1) and 40 patients who underwent full load bearing (Group 2) were prospectively evaluated. The Harris hip score was used for functional evaluation, and the Barthel index was used to evaluate the degree of independence in activities of daily living. Results The mean age of the patients included in the study was 76.67 ± 8.62 years. Regarding the comparison among groups in terms of age, sex, direction of fracture, reduction quality, fracture type, tip-apex distance, and surgical risk, there was no statistically significant difference between the two groups (p ≥ 0.05). Moreover, regarding the comparison in terms of calcium, phosphate, alkaline phosphatase, vitamin D, and keratin levels, which affect bone metabolism, no statistical difference was observed (p ≥ 0.05). We found that the mean Harris hip score was significantly higher in Group 1 than in Group 2 (Group 1: 76.82 ± 12.48; Group 2: 67.80 ± 15.34; p = 0.004). Moreover, 73.3% (n=33) and 42.5% (n=17) of patients in Groups 1 and 2 were fully independent or mildly dependent, respectively. We also found that the independence status was significantly better in Group 1 (p = 0.004). Conclusion Mobilization of older patients treated with PFN after ITFF using partial load-bearing protocols in the early postoperative period positively impacts hip function and the ability to perform activities of daily living independently.

Evaluation of depression, anxiety, and stress status in parents of patient with congenital clubfoot treated with Ponseti method: A prospective study.

Congenital diseases have been reported to increase the incidence of depression, anxiety, and stress among parents. In this study, we aimed to investigate the depression, anxiety, and stress status in parents of patients with congenital clubfoot before and after treatment with the Ponseti method. A total of 20 patients diagnosed with congenital clubfoot at our clinic and treated with the Ponseti method were included in this study. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate the depression, anxiety, and stress status of the parents before and after treatment. We considered the following parameters to investigate the effects of these on the parents: the educational level of the parents; economic status of the family; gender; birth order of the child in the family; time of diagnosis (prenatal or postnatal). The mean DASS and subdomain scores after treatment were significantly lower than those before treatment (P < .05). Moreover, there was a significant difference in the pre- and posttreatment mean DASS and depression scores of the participants in terms of the education level (P < .05). The pre- and posttreatment DASS and depression scores of the participants with an education level of primary school and below were lower than those of the participants with an education level of secondary and high school. Parents may be less concerned during this process if they are fully informed by the orthopedic surgeons about the treatment protocol and the near-perfect results of the Ponseti method as well as are counseled by healthcare professionals.

Comparison of Suture Types and Techniques in Achilles Tendon Repair: An Ex Vivo Biomechanical Animal Experiment.

BACKGROUND: Ideal suture technique and type in tendon repair are remain unclear. This biomechanical study aimed to assess the biomechanical characteristics of three techniques, modified Kessler (mKE), modified Krackow (mKR), and modified tension Bunnell (mtBU), in sheep Achilles' tendon tear repair using three suture types, polypropylene, polyester, and ultra-high molecular weight polyethylene (UHMWPE) sutures, which are also compared. METHODS: Sixty-three Achilles' tendons harvested from sheep were transversely hacked as a replacement for rupture in a standardized measure and repaired using mKE, mKR, and mtBU techniques with No. 2 polypropylene, polyester, and UHMWPE sutures. Biomechanical parameters, such as Young's modulus, ultimate strength, and strength to the 5-mm gap were recorded for statistical analysis. RESULTS: The mtBU technique with UHMWPE use resulted in increased ultimate strength, strenght to 5-mm gap, Young's modulus, and quantity of specimens with low clinical failure modes compared to other techniques with other suture materials. Furthermore, mtBU has the lowest thickness at the repair side of the tendons. This approach showed tendon failure during maximal traction testing, whereas the mKE and mKR had polyethylene and polyester suture failures. CONCLUSIONS: The UHMWPE suture was significantly superior to the other sutures in each suture techniques in terms of strength and durability. The mtBU technique using UHMWPE suture showed better biomechanical results, implying that this repair might be more appropriate to obtain early mobilization after tendon ruptures.

Rare coracoid fractures presenting with superior shoulder suspensory complex injury: A case series.

Although coracoid fractures are rare fractures, their treatment is critical as they form the coracoacromial arch and superior shoulder suspensory complex (SSSC), which are important structures for shoulder biomechanics. In this case series, clinical, radiological, and demographic characteristics of three male patients who received treatment due to coracoid fracture presenting with traumatic injuries were discussed. The fractures were classified according to the Ogawa and Eyres classifications, and fracture fixation was achieved surgically with the cannulated screws. All patients had a right coracoid fracture. The Constant-Murley Score and the Disabilities of the Arm, Shoulder and Hand scores the patients in the final follow-up visit at 12 months were calculated. In conclusion, good clinical and functional outcomes can be achieved by anatomical reduction and fixation through surgery for displaced coracoid fractures presenting with multiple traumatic injuries located in multiple regions of the SSSC.

Biomechanical Comparison of Pull-out Strength of Different Cementation and Pedicle Screw Placement Techniques in a Calf Spine Model.

BACKGROUND: We hypothesized that an entire pedicle screw tract cement augmentation has greater strength than traditional techniques. METHOD: Twenty-four fresh frozen calf lumbar spines were randomized into three study groups, each having eight vertebrae: (1) screw cemented after vertebroplasty; (2) fenestrated cemented screw; and (3) cementation of the entire pedicle screw tract. For the right side screws, two pedicle screws were inserted in each vertebra with the standard position in the sagittal plane, whereas the left side screws were placed at a 30° angle craniocaudal plane. From the recorded force-displacement curves, the maximum peak load (failure load) of each screw was determined. The mode of failure was screw stripping at all levels tested. RESULTS: The pull-out strength for standard screw replacement at the sagittal plane was 1843.3 N, 1707.45 N, and 5365.1 N consecutively. The failure load value in the standard position in the sagittal plane in the cementation of the entire pedicle screw tract group was significantly higher than that in the fenestrated cemented screw group and screw cemented after vertebroplasty (p < 0.001 and p < 0.001, respectively). The standard pedicle screw position in the sagittal plane showed a significant pull-out strength than the others (p < 0.001). CONCLUSION: The pull-out strength of the cementation of the entire pedicle screw tract was 2.5 times higher than the others. The pull-out strength of the pedicle screws in malposition obtained the same strength to the standard positions after the augmentation procedure in our study.

Palliative Posterior Instrumentation versus Corpectomy with Cage Reconstruction Treatment for Thoracolumbar Pathological Fracture.

STUDY DESIGN: Single-center, retrospective cohort study. PURPOSE: We aimed to evaluate and compare the clinical outcomes in patients who underwent palliative posterior instrumentation (PPI) versus those who underwent corpectomy with cage reconstruction (CCR) for thoracolumbar pathological fracture. OVERVIEW OF LITERATURE: The requirement for anterior support after corpectomy has been emphasized in the treatment of pathological fractures of the vertebrae. However, for patients with a relatively short life expectancy, anterior reconstruction may not be required and posterior instrumentation alone may provide adequate stabilization. METHODS: A total of 43 patients with metastases of the thoracolumbar spine underwent surgery in the department of orthopaedic and traumatology of Istanbul University Faculty of Medicine from 2003 to 2016. Surgical outcomes were assessed on the basis of survival status, pre- and postoperative pain, complication rate, and operation time. RESULTS: PPI was performed for 22 patients and CCR was performed for 21 patients. In the PPI group, the follow-up period of the five surviving patients was 32 months. The remaining 17 patients died with a mean survival duration of 12.3 months postoperatively. In the CCR group, the five surviving patients were followed up for an average of 14.1 months. The remaining 16 patients died with a mean survival duration of 18.7 months postoperatively. No statistically significant difference (p=0.812) was noted in the survival duration. The Visual Analog Scale scores of the patients were significantly reduced after both procedures, with no significant difference noted on the basis of the type of surgical intervention (p>0.05). The complication rate in the CCR group (33.3%) was higher compared with that in the PPI group (22.7%); however, this difference was not noted to be statistically significant (p=0.379). The average operation time in the PPI group (149 minutes) was significantly shorter (p=0.04) than that in the CCR group (192 minutes). CONCLUSIONS: The PPI technique can decompress the tumor for functional improvement and can stabilize the spinal structure to provide pain relief.