Does the magnetic-guided intramedullary nailing technique shorten operation time and radiation exposure?

AIM: The aim of this study is to show whether a new magnetic-guided locking technique is superior to a standard freehand technique in terms of operation time and radiation exposure. This treatment will be used for distal locking of the tibia during intramedullary nailing. METHODS: This randomized trial is done through 80 patients having tibial fractures with a mean age of 25 years (range 16-67 years). In the magnetic locking group, there were 20 fractures of the distal third, 16 of the shaft, and 4 of the proximal tibia; in the freehand group, these numbers were 15, 20, and 5, respectively. The parameters like operation time, distal locking time, radiation exposure duration, and dose were compared. RESULTS: We placed 100 distal locking screws in the magnetic locking group and 95 in the freehand group. Fluoroscopy was necessary only in the freehand group. All screws were correctly positioned the first time in both groups. The magnetic locking group had a shorter mean surgical time (52 ± 6.2 vs 70 ± 10.9 min; P < 0.01), a shorter mean distal locking time (5 ± 1.1 vs 16 ± 2.0 min; P < 0.01), and a shorter mean placement time for each screw (2 ± 0.5 vs 7 ± 1.2 min; P < 0.01). The magnetic locking group had lower mean radiation exposures (8 ± 4.5 vs 40 ± 7.6 s; P < 0.01) and mean radiation exposure (5.4 ± 2.5 vs 25 ± 6.8 mGy range; P < 0.01). CONCLUSIONS: For distal locking during tibial intramedullary nailing, the magnetic locking system is as accurate as the standard freehand technique, but it has lower operative times and radiation exposures compared to the standard freehand technique. Therefore, the magnetic locking system should be preferred to current standard freehand techniques.

SURGICAL TREATMENT OF ACROMIOCLAVICULAR DISLOCATION: HOOK PLATE VERSUS SUTURE BUTTON.

Objectives: We aimed to compare the functional and radiographical outcomes of reconstruction of acute unstable acromioclavicular joint (ACJ) dislocation using Hook Plate (HP) versus Suture Endobutton (SE) fixation techniques. Methods: Forty-six consecutive patients with grade III to V ACJ dislocation according to Rockwood classification who underwent either HP or SE fixation in the period between January 2017 and June 2020 were evaluated. The treatment modalities were divided into either HP or SE fixation. The radiological assessment included standard anterior-posterior (AP) views to evaluate coracoclavicular (CC) distances for vertical reduction. Results: CC distances were grouped as preoperative (CC1), early postoperative (CC2), and late postoperative (CC3). The distance variance between CC2 and CC3 was referred as ΔCC (CC3 - CC2). A statistically significant difference was found in ΔCC between the two groups (p=0.008). ΔCC was significantly higher in the SE group compared to the HP group (p<0.05). The Constant and UCLA Scores of patients in the SE group were found to be significantly higher than in the HP group patients. Conclusion: Clinical outcomes were more satisfactory in patients with acute unstable ACJ dislocation who underwent SE compared to HP procedures, at the end of the first year. Evidence Level IV; Case Series.

Objetivo: Nosso objetivo foi comparar os resultados funcionais e radiográficos da reconstrução da luxação instável aguda da articulação acromioclavicular (ACJ) utilizando técnicas de fixação com placa com gancho (HP) versus botão de sutura (SE). Métodos: 46 pacientes com luxação da ACJ de grau III a V, de acordo com a classificação de Rockwood, que foram submetidos à fixação com HP ou SE no período de janeiro de 2017 a junho de 2020, foram avaliados. As modalidades de tratamento foram divididas em fixação HP ou SE. Na avaliação radiológica, foi utilizada a incidência antero-posterior (AP) para avaliação da redução vertical, por meio da medida da distância córaco-clavicular (CC). Resultados: As distâncias CC foram agrupadas em pré-operatória (CC1), pós-operatória imediata (CC2) e pós-operatória tardia (CC3). A variação da distância entre (CC2) e (CC3) foi denominada ΔCC. Uma diferença estatisticamente significativa foi encontrada na ΔCC entre os dois grupos (p=0,008). O ΔCC foi significativamente maior no grupo SE em comparação com o grupo HP (p <0.05). As pontuações de Constant e UCLA dos pacientes do grupo SE foram significativamente mais elevadas do que as dos pacientes do grupo HP. Conclusão: Os resultados clínicos foram mais satisfatórios com a técnica SE em comparação com a HP ao final do primeiro ano. Nível de Evidência IV; Série de casos.

Prevalence of chondromalacia patella according to patella type and patellofemoral geometry: a retrospective study.

BACKGROUND: The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate. OBJECTIVE: To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements. DESIGN AND SETTING: Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019. METHODS: This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables. RESULTS: Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05). CONCLUSION: Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.

[Treatment of adult tibial diaphysis fractures with reamed and locked intramedullary nailing]. / Tibia diyafiz kiriklarinin oymali kilitli intramedüller çivi ile tedavisi.

OBJECTIVES: We evaluated the results of reamed and locked intramedullary nailing for tibial diaphysis fractures. METHODS: The study included 73 patients (68 males, 5 females; mean age 31 years; range 17 to 68 years) who were treated with reamed and locked intramedullary nailing for tibial diaphysis fractures. There were 28 AO/ASIF type A, 29 type B, and 16 type C fractures. The fractures involved the proximal 1/3 (n=12), middle 1/3 (n=50), and distal 1/3 (n=11) of the tibial diaphysis. Twenty-eight fractures (38.4%) were closed. According to the Gustilo-Anderson classification, 30 patients (41.1%) had grade I, 10 patients (13.7%) had grade II, and five patients (6.9%) had grade IIIA open fractures. Intramedullary nailing was performed following open reduction in 17 patients (23.3%), and closed reduction in 56 patients (76.7%). The mean time to surgery was 3.4 days (range 2 to 11 days) and the mean follow-up was 48 months (range 24 to 60 months). The patients were evaluated with respect to range of motion, time to union, and complications. Functional results were assessed using the Johner-Wrush criteria. RESULTS: Union was achieved in all the patients within a mean of 18.2 weeks (range 8 to 52 weeks). Four patients required dynamization because of delayed union and grafting was performed in one patient. Transient sensorial deficit occurred in one patient after dynamization. One patient underwent revision surgery because of migration of the distal locking screws. The only limitation of range of motion was seen in flexion of two patients (2.7%) who developed anterior knee pain. According to the Johner-Wrush criteria, functional results were very good in 45 patients (61.6%), and good in 28 patients (38.4%). CONCLUSION: Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing is an appropriate choice with a low complication rate. It can be safely used in moderately contaminated open fractures.

Surgical treatment of acromioclavicular dislocation: hook plate versus suture button / Tratamento cirúrgico da luxação acromioclavicular: laca de gancho versus botão de sutura

ABSTRACT Objectives: We aimed to compare the functional and radiographical outcomes of reconstruction of acute unstable acromioclavicular joint (ACJ) dislocation using Hook Plate (HP) versus Suture Endobutton (SE) fixation techniques. Methods: Forty-six consecutive patients with grade III to V ACJ dislocation according to Rockwood classification who underwent either HP or SE fixation in the period between January 2017 and June 2020 were evaluated. The treatment modalities were divided into either HP or SE fixation. The radiological assessment included standard anterior-posterior (AP) views to evaluate coracoclavicular (CC) distances for vertical reduction. Results: CC distances were grouped as preoperative (CC1), early postoperative (CC2), and late postoperative (CC3). The distance variance between CC2 and CC3 was referred as ΔCC (CC3 - CC2). A statistically significant difference was found in ΔCC between the two groups (p=0.008). ΔCC was significantly higher in the SE group compared to the HP group (p<0.05). The Constant and UCLA Scores of patients in the SE group were found to be significantly higher than in the HP group patients. Conclusion: Clinical outcomes were more satisfactory in patients with acute unstable ACJ dislocation who underwent SE compared to HP procedures, at the end of the first year. Evidence Level IV; Case Series.

RESUMO Objetivo: Nosso objetivo foi comparar os resultados funcionais e radiográficos da reconstrução da luxação instável aguda da articulação acromioclavicular (ACJ) utilizando técnicas de fixação com placa com gancho (HP) versus botão de sutura (SE). Métodos: 46 pacientes com luxação da ACJ de grau III a V, de acordo com a classificação de Rockwood, que foram submetidos à fixação com HP ou SE no período de janeiro de 2017 a junho de 2020, foram avaliados. As modalidades de tratamento foram divididas em fixação HP ou SE. Na avaliação radiológica, foi utilizada a incidência antero-posterior (AP) para avaliação da redução vertical, por meio da medida da distância córaco-clavicular (CC). Resultados: As distâncias CC foram agrupadas em pré-operatória (CC1), pós-operatória imediata (CC2) e pós-operatória tardia (CC3). A variação da distância entre (CC2) e (CC3) foi denominada ΔCC. Uma diferença estatisticamente significativa foi encontrada na ΔCC entre os dois grupos (p=0,008). O ΔCC foi significativamente maior no grupo SE em comparação com o grupo HP (p <0.05). As pontuações de Constant e UCLA dos pacientes do grupo SE foram significativamente mais elevadas do que as dos pacientes do grupo HP. Conclusão: Os resultados clínicos foram mais satisfatórios com a técnica SE em comparação com a HP ao final do primeiro ano. Nível de Evidência IV; Série de casos.

Prevalence of chondromalacia patella according to patella type and patellofemoral geometry: a retrospective study

Abstract BACKGROUND: The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate. OBJECTIVE: To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements. DESIGN AND SETTING: Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019. METHODS: This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables. RESULTS: Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05). CONCLUSION: Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.

[Evaluation of pediatric patients with traumatic hip dislocation]. / Travmatik kalça çikigi nedeniyle tedavi edilen çocuk hastalarin degerlendirilmesi.

OBJECTIVES: We evaluated pediatric patients who were treated for traumatic dislocation of the hip. METHODS: Traumatic dislocation of the hip was detected in five children (all boys; mean age 9 years; range 7 to 13 years) between 1991 and 2005. Dislocations occurred in the right hip in four cases, and in the left hip in one, all of which had posterior localization. Etiology was fall during play in two children, and fall from height or car crash in three. One patient had posterior wall avulsion fracture of the acetabulum. Early radiologic follow-ups included conventional radiographs and computed tomography. Functional results were assessed with the Harris hip scoring system. Four patients had a sufficient follow-up period with a mean of 44 months (range 19 to 64 months). RESULTS: All the patients were treated with closed reduction under general anesthesia after a mean of 6.4 hours (range 2 to 16 hours) following trauma. Functional results were excellent in all the patients, with a mean Harris hip score of 92 (range 84 to 96). Based on early postoperative radiologic control with computed tomography, no surgical intervention was considered for posterior wall avulsion fracture of the acetabulum in one patient. At 40-month follow-up, he had no complaints, had a full range of motion and a hip score of 92. While no complications were observed in patients undergoing early reduction, one patient whose dislocation was reduced 16 hours after trauma developed avascular necrosis of the femur head 18 months after treatment, at which time his hip score was 84. CONCLUSION: Early reduction is of particular importance for the follow-up course of traumatic hip dislocations in childhood.

A new index for the assessment of distal radius fractures involving the ulnar styloid.

OBJECTIVE: The aim of this retrospective study was to evaluate the relation between a new index we created for the assessment of distal radius fractures involving the ulnar styloid, and the clinical outcome. METHODS: We devised a radiographic separation index (RSI), to evaluate the displacement of the ulnar styloid. We used this index in 44 patients (28 men and 16 women; mean age: 43.2 years; range: 24-64 years) with distal radius fractures involving the the ulnar styloid. In all cases, the distal radius fracture was fixed using a volar locking plate. The styloid fracture was treated conservatively. The relation between the RSI value and clinical results was then investigated. RESULTS: In the 44 patients there were clinically 38 excellent, 4 good, and 2 moderate results. RSI ratios ranged from 2% to 11%. The patients with an excellent result had an RSI ratio of less than 5%. We found a significant correlation between the RSI ratio values and the clinical outcomes. CONCLUSION: Our results suggested that the RSI can be used as a predictor of the clinical outcome in patients with distal radius fractures involving the ulnar styloid.

[Results of limited open rotator cuff repair with partial acromioplasty for rotator cuff tears with subacromial impingement syndrome]. / Subakromiyal sikisma sendromu ile birlikte rotator manset yirtiginin, kismi akromiyoplasti ile sinirli açik rotator manset tamiri sonuçlari.

OBJECTIVES: Short term results of partial acromioplasty and rotator cuff repair with a limited open surgical technique were evaluated in patients with rotator cuff tears. PATIENTS AND METHODS: Forty-eight patients (16 males, 32 females; mean age 52 years; range 29 to 70 years) with rotator cuff rupture were recruited to the study between January 2001 and December 2006. A limited open rotator cuff repair along with partial acromioplasty (via rasper) was applied in all cases. The Constant-Murley shoulder score was used before and after surgery. RESULTS: Mean duration of follow-up was 38 months (range 14 to 70 months). Pre- and postoperative Constant-Murley scores averaged 44 (range 36 to 51) and 88 (range 75 to 96) respectively. Anchoring sutures were displaced in one subject (2%) and tendon insufficiency recurred, another two cases (4%) had impingement from secondary granulation tissue that developed due to sutures in the tendon repair site. CONCLUSION: We believe that minimal acromioplasty via a limited open surgical approach is an applicable technique with good results in the treatment of rotator cuff tears with subacromial impingement syndrome.

[Open reduction and K-wire fixation of mallet finger injuries: mid-term results]. / Cekiç parmakta açik redüksiyon ve K-teli ile internal tespit: Orta dönem takip sonuçlari.

OBJECTIVES: We evaluated mid-term results of surgical treatment of mallet finger injuries in patients in whom close reduction was not successful. METHODS: The study involved 34 patients (26 males, 8 females; mean age 27 years; range 21 to 37 years) with mallet finger deformity due to avulsion fracture of the proximal dorsal lip of the distal phalanx. According to the Doyle classification, all injuries were type IVb. Following unsuccessful attempts of closed reduction, the patients were treated with open reduction and K-wire fixation. Cast immobilization of the distal interphalangeal joint was employed for four weeks and rehabilitation was started after removing the K-wires in the sixth week. Radiographic and clinical assessments were made according to the Doyle and Crawford criteria, respectively, after a mean follow-up period of 18 months (range 11 to 34 months). RESULTS: Radiographic union was achieved in all the patients and an anatomic reduction was obtained in 31 patients (91.2%). According to the Crawford criteria, the results were excellent in 27 patients (79.4%), good in four patients (11.8%), and moderate in three patients (8.8%). Patients with a good result had a mean extension loss of 5 degrees , and those with a moderate result had a mean flexion loss of 10 degrees . The remaining patients had full range of motion of the distal interphalangeal joint. None of the patients developed joint subluxation, narrowing of the joint space, or degenerative changes. CONCLUSION: An anatomical reduction is essential in mallet finger deformities. Open reduction and internal K-wire fixation can be preferred due to its low complication rate and ease of application in patients whose mallet deformity cannot be treated by closed reduction.

Complete transiliac pelvic osteotomy for patients with developmental dysplasia of the hip without internal fixation.

Several problems are encountered with pelvic osteotomy in hip dysplasia including insufficient coverage, avascular necrosis, graft instability and fixation of secondary bone grafts. We evaluated results of pelvic osteotomy in 4-8 year olds in our institution. 44 cases of developmental dysplasia of the hip between 1994 and 1999 were reviewed. 14 hips in 12 patients were treated with a step-cut osteotomy and the results are discussed. The mean age was 5.6 (range: 4-8) years, and mean follow up was 87.7 months (60-120). The patients were followed up according to the Severin clinical assessment criteria, and their radiological findings were evaluated and classified in accordance with the Tonnis criteria. Radiologically, a marked correction was obtained in center-edge angle, which was increased to 22.30 from the preoperative value of -11.20. No graft shift or loss was observed in any cases. There was also no loss in coverage achieved by surgical intervention. Coxofemoral positioning was found to be normal in eighty percent of cases. 8% of cases had avascular necrosis. Full range of hip motion was achieved in 84% of cases, and 84% of cases exhibited negative Trendelenburg's sign. The modified osteotomy we describe eliminated the need for fixation and secondary surgery. Graft stability and bone conservation were achieved.

[Retrograde intramedullary interlocking nailing in fractures of the distal femur].

OBJECTIVES: We evaluated retrograde locked intramedullary nail applications in patients with distal femur fractures. METHODS: Distal femur fractures of 16 patients (11 males, 5 females; mean age 45 years; range 25 to 69 years) were treated with retrograde locked intramedullary nailing. One patient had bilateral fractures. According to the AO classification, the fractures were A1 (n=8), A2 (n=4), A3 (n=4), and C1 (n=1). There were 13 closed (76.5%), and four open (23.5%) fractures. The mean time to surgery was 10 days (range 2 to 20 days). Open technique was used for nine fractures, and percutaneous technique for eight fractures. Preoperatively, three patients with a floating knee were evaluated with magnetic resonance imaging and were found to have a ruptured cruciate ligament. All patients underwent intraoperative knee examination, which showed a ruptured cruciate ligament in five patients. Functional results were assessed using the modified HSS (Hospital for Special Surgery) knee rating scale at the end of a mean follow-up period of 32.6 months (range (12 to 68 months). RESULTS: The mean time to union was 25 weeks (range 14 to 42 weeks). One patient had delayed union (42 weeks). Joint range of motion was normal in three knees (17.7%), was 100 to 110 degrees in nine knees (52.9%), 80 degrees in four knees (23.5%), and below 80 degrees in one knee (5.9%). According to the modified HSS knee scale, the results were excellent in five femurs (29.4%), good in six femurs (35.3%), moderate in five femurs, and poor in one femur (5.9%). Postoperative radiographic examination showed varus angulation (10 degrees ) in four patients (23.5%), and posterior angulation (10-20 degrees ) in four patients. In one patient, healing occurred with extreme deformation (30 degrees posterior angulation). None of the patients experienced wound site problems or infections. One patient developed deep vein thrombosis in the early postoperative period. CONCLUSION: Treatment of distal femur fractures with retrograde locked intramedullary nailing yields satisfactory results in adults.