Factors affecting the closed reduction of diaphyseal fractures of the femur.

INTRODUCTION: This level II prospective study investigates patient and fracture-related factors likely to affect closed reduction time in the surgical treatment of femur fractures, and the effect these factors have on closed reduction time. PATIENTS AND METHODS: Seventy-nine diaphyseal femur fractures of 75 patients were included in the present study. All fractures were treated with indirect closed reduction by manual traction using antegrade nailing and static, locked, reamed intramedullary nails. The three variables considered to influence the duration of closed reduction, that is, the type of fracture, BMI, and the preoperative period (time from injury to surgery), were evaluated either separately or in a combination of two or three of the variables. Their influence on the closed reduction time was analyzed and evaluated. RESULTS: In this study according to the outcomes, a preoperative period ≤24 h had a significant effect in shortening the reduction time. The reduction time was not significantly affected by the type of fracture. The reduction time was prolonged in overweight patients, but the difference was not significant. When the three variables BMI, preoperative period, and fracture types were evaluated together, the common effect of these three variables was not significant. CONCLUSION: In conclusion, based on these results, we think that closed reduction should certainly be aimed for in femur fractures in which intramedullary nailing is planned. Also, early surgical intervention appears to have a beneficial effect on the success of closed reduction.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

OBJECTIVES: The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. RESULTS: Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. CONCLUSION: Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Anterior humeral approach with nerve stimulator.

INTRODUCTION: The prevalence of radial nerve injury during surgery is as high as the prevalence of radial nerve injury due to trauma. The aim of this study is to minimize the risk of iatrogenic injury of radial nerve. MATERIALS AND METHODS: Fifty patients with middle or distal diaphysis fractures of humerus and 18 patients with pseudoarthrosis at the same localizations were treated with surgery. Plate-screw fixation was performed with anterior approach in 43 patients. Eleven patients had minimally invasive plate osteosynthesis, and 14 patients had intramedullary nailing. The localization of the radial nerve was determined with nerve stimulator at the area of dissection. RESULTS: Iatrogenic radial nerve injury did not occur in patients treated with open reduction or minimally invasive approach. DISCUSSION: Nerve stimulator may be a method that decreases radial nerve injury, an iatrogenic complication. This method may be used in anterior approach and minimally invasive procedures.

Rate of conversion of reports presented at the Turkish Society of Sports Traumatology, Arthroscopy and Knee Surgery Congress into publication.

OBJECTIVE: The aim of this study was to evaluate the conversion rate of oral and poster presentations into publications presented at four consecutive congresses held by the Turkish Society of Sports Injuries and Arthroscopy between 2008 and 2014 and to determine the publication pattern. METHODS: The manuscripts published in peer-reviewed journals were identified using the Web of Knowledge, PubMed, Google Scholar databases, ULAKBIM, and Endnote citation management software (X7.7.1). The identified manuscripts were classified according to the level of evidence, number of citations, subject, publication journals, time period until publication, and citation index of the journal. RESULTS: Between 2008 and 2014, a total of 561 presentations were made, comprising 278 posters and 283 oral presentations. Of these presentations, 164 (29.2%) were published as a manuscript. Of the published articles, 114 were originated from oral presentations (40.2% of total) and 50 from poster presentations (18% of total). A significantly higher number of oral presentations compared to poster presentations were converted into publications (p < 0.05). However, no significant difference was determined between the conversion rates of oral and poster presentations in 2014. The mean time from presentation at the congress to publication was 15.4 months (range: -144 months to +62 months). The mean impact factor of the journals at the time of publication increased for each congress. Evidence level of presented articles was significantly higher in the 2014 congress when compared to previous congresses. CONCLUSION: The rate of conversion into publication was higher for oral presentations, which can be attributed to the fact that studies with a higher level of evidence are more likely to have been presented as oral presentations. Based on these study results, authors of oral presentations at congresses should be encouraged to increase the rate of conversion into publication.

Assessment of quality of life in children after successful treatment of hip dysplasia as compared with normal controls.

OBJECTIVE: To document the quality of life of children who have been treated for developmental dysplasia of the hip (DDH) within the first 3 years of life successfully after a minimum follow-up period of 2 years, and compare their results with healthy age-matched children. METHODS: Thirty patients with DDH treated between 1998 and 2002 in Ankara Numune Education and Research Hospital, Ankara, Turkey and 19 age-matched healthy controls were included in this study with the approval of the ethical committee. The mean follow up period was 56.1 months. Each child's parents answered the Child Health Questionnaire-Parent Form 50 (CHQ-PF50) after giving informed consent. The answers were evaluated, and scores were calculated and results were analyzed. RESULTS: There were no significant differences in 14 health-related quality of life concepts, according to the CHQ instrument's outcomes, between the healthy controls and the patients with DDH who were successfully treated within the first 3 years of life. Only the physical functioning concept was found to be lower for the DDH patients (Mann Whitney U test, p=0.036). CONCLUSION: Although children who were successfully treated for DDH may have impairment in physical functioning after a certain period of follow-up, there was no significant impairment in physical and psychosocial summary scores, in comparison with their age-matched controls.

An Overlooked Deformity in Patients with Hallux Valgus Tailor's Bunion.

BACKGROUND: Tailor's bunion is a deformity of the fifth toe, and its concomitance with hallux valgus (HV) is defined as splayfoot deformity. Treatment is focused on the HV deformity in splayfoot, and the tailor's bunion deformity can be overlooked. The frequency of HV concomitant with tailor's bunion in splayfoot has not been reported in the literature. METHODS: A retrospective evaluation was performed to detect the existence of tailor's bunion deformity in 203 patients (376 feet) treated for HV. Standing anteroposterior and lateral radiographs were used in the radiologic evaluation. Fallat's classification was used to grade tailor's bunion. Surgery for HV was applied to 86 patients (136 feet), and conservative treatment was applied to 117 patients (240 feet). Mean follow-up was 28.3 months (range, 18-42 months). Clinical evaluation was by American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: Of the 376 feet with HV, 28 (7.4%) had tailor's bunion, of which 17 (60.7%) were overlooked according to the surgery criteria for tailor's bunion. In the HV surgery group, there were no differences in preoperative mean AOFAS scores according to concurrence with tailor's bunion, but postoperative AOFAS scores were low in patients with accompanying tailor's bunion (P < .001). In the conservative group, no differences were determined in mean AOFAS scores according to tailor's bunion. CONCLUSIONS: Tailor's bunion deformity sometimes goes undiagnosed in patients with treated HV. This deformity must be kept in mind for patients with HV to improve clinical results.

An unusual cause of mass in the shoulder: A primary hydatid cyst.

A hydatid cyst is a zoonotic infection which may affect any organ and tissue, particularly the liver and the lung. Primary muscular hydatid cysts comprise less than 0.7-3% of the cases. The hydatid cysts must be kept in mind to avoid a diagnostic puncture in cystic lesions to avoid the spreading of the disease. In this case report, we present an exceptionally rare case with an unusual localization of a primary hydatid cyst in the left deltoid muscle.

Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus.

OBJECTIVE: Our aim was to assess the results of posterior retraction technique to prevent iatrogenic radial nerve injury during humeral fracture surgery. METHODS: Seventy-two patients who underwent surgery for a distal humerus fracture between 1996 and 2002 were reviewed. These 72 patients comprised Group 1. Following a cadaveric study on the vascularization of the radial nerve, a modified surgical approach was undertaken starting in 2002. Sixty-one patients who underwent this new surgical approach were included in Group 2. The rates of radial nerve deficit of the groups were compared using the Pearson chi-square test. RESULTS: In Group 1, 19 iatrogenic nerve deficits occurred. After defining the blood circulation of the nerve, the lateral approach was modified. The anterolateral side of the nerve was released and the nerve was left attached to the triceps muscle. In Group 2, one patient developed postoperative transient nerve deficit. CONCLUSION: The radial nerve is supplied by the branches of the deep brachial artery in close relation with the triceps muscle. Anterior dissection and posterior retraction of the radial nerve during lateral approach may preserve its blood supply and reduces the risk of iatrogenic injury.

Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study.

We evaluated the gait characteristics of patients who had short or long-segment fusion after thoracolumbar burst fractures. The study included 12 patients (5 male, 7 female) who had vertebral fusion after traumatic thoracolumbar region (T12-L2) burst fractures. Patients were divided into two groups based on fixation type (short or long segment). Twelve healthy age and sex-matched subjects (seven male, five female) served as controls. Quantitative gait data, including all time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle), and kinetic data (moments of hip in sagittal and coronal plane) were collected. Three patients had a T12, six patients an L1, and three patients had an L2 lesion. Patients in the two groups were similar in terms of age, sex, and time since operation. No significant differences were found in the time-distance, kinematic, and kinetic gait characteristics between the two groups. This preliminary study reveals that the gait characteristics of patients with short and long-segment fusion after thoracolumbar burst fractures were similar to those of healthy subjects and did not differ from each other. However, the present results should be interpreted with caution due to the small sample size. Future studies with larger groups are needed to provide additional data to validate these findings.

Performance of modified anatomic plates is comparable to proximal femoral nail, dynamic hip screw and anatomic plates: finite element and biomechanical testing.

AIM: To establish whether the modified anatomic plate (MAP) performs as well as the anatomic plate (AP), dynamic hip screw (DHS) and proximal femoral nail (PFN) from a biomechanical perspective. MATERIALS AND METHODS: The, AP, MAP, DHS and PFN were assessed using finite element (FE) methods and biomechanical tests. A solid model was created based on the fracture lines and results were assessed using analyses of variance. MAIN OUTCOME MEASUREMENTS: Independent variables were the implants (n=4) and axial loads: 0-1000 Newton (N) in 100 N increments. Dependent variables were loads at the intertrochanteric fracture line as measured by load cells. RESULTS: Axial loads ≤400 N generated significantly (p<0.05) greater stress at the fracture line in both the FE model and biomechanical settings: the PFN generated the highest forces at the fracture line followed by the AP, MAP and DHS. For axial loads ≥400 N, the AP and DHS generated nonsignificant (p>0.5) lower forces (almost 50% less) compared with the MAP and PFN. At 1000 N, the DHS generated the highest (p<0.05) load at the fracture line. CONCLUSION: The biomechanical features of the MAP were similar to those of the PFN. The MAP generated optimal loads at both the fracture site and the proximal femur. FE methods and biomechanical tests revealed that the MAP is associated with both intra- and extra-medullary fixation features, even though the load was applied as an extramedullary stimulus.

Gait symmetry in patients with unilateral partial hip arthroplasty.

OBJECTIVES: In this study gait deviations symmetry and asymmetry in patients with unilateral partial hip arthroplasty was determined. PATIENTS AND METHODS: Gait characteristics and time since operation (11.9+/-6.1; range 7 to 29 months) of 16 patients (9 females, 7 males; mean age 61.5+/-16.5 years; range 27 to 86 years) with unilateral partial hip arthroplasty were evaluated. Ten healthy volunteers (3 females, 7 males; mean age 54.1+/-11.9 years; range 35 to 65 years) were included in the study as control group. Quantitative gait data was collected with the Vicon 370 System (Oxford Metrics, Oxford, UK). Spatio-temporal (walking velocity, cadence, step time, step length, double support time) and kinematic (joint rotation angles of pelvis and hip in sagittal plane) data were processed by using Vicon Clinical Manager software package. Spatio-temporal and kinematic gait symmetry indices of both groups were calculated. RESULTS: Spatio-temporal and kinematic gait characteristics, but not the symmetry indices, of patients with unilateral partial hip arthroplasty were different from the control group (p>0.05). CONCLUSION: Findings of this study reveal that patients with unilateral partial hip arthroplasty had various gait deviations compared to healthy subjects, but that symmetry was preserved.

Timing of surgical treatment for type III supracondylar humerus fractures in pediatric patients.

BACKGROUND: Type III supracondylar humeral fracture is a common cause of emergency hospitalization among children requiring surgical treatment. The configuration of the internal fixation material, surgical technique, and optimal timing of surgery (TS) have always been popular topics of debate. The TS in uncomplicated cases is usually determined by surgeons. METHODS: In this study, we prospectively followed children with type III supracondylar fractures. We aimed to clarify the effects of injury side, gender, and post-injury delay on switching to open surgery and the ease of the reduction. RESULTS: Based on our results, the probability of switching to open surgery increased by a factor of 4 every 5 h beginning 15 h after injury. Open surgery was necessary after 32 h. CONCLUSION: Reduction became technically more difficult as TS increased.

The effect of prophylactic dose of a low molecular weight heparin on skin wound healing of rats.

PURPOSE: To investigate the effect of prophylactic dose of a low molecular weight heparin, enoxaparin, on skin wound healing of rats. METHODS: Forty rats were used for the study. Rats were randomly assigned to two equal groups. Experimental group received prophylactic dose of enoxaparin. Physiologic saline was administered to the control group. Parameters of wound healing of experimental and control groups were compared. For comparison of the groups in terms of fibrosis, vascularization, inflammation, epithelization, and tensile strength test (Newton). Mann-Whitney-U test was used because variables were categorical data (fibrosis, vascularization, inflammation and epithelization). Differences between groups were analyzed with independent samples t-test (tensile strength). Significance was set at p<0.05. RESULTS: Skin wound of the experimental group presented tensile strength significantly decreased (p<0.001), histopathologic examination revealed a significant (p<0.001) delayed epithelization and decreased in fibrosis, vascularization, inflammation (p<0.001) in the experimental group. CONCLUSION: Enoxaparin delay wound healing by decreased inflammatory cells, fibroblast contents and their products (growth factors), and by promoted hemorrhage.

Blood loss evaluation in children under the age of 11 with femoral shaft fractures patients with isolated versus multiple injuries.

BACKGROUND: Blood loss from non-cavitary hemorrhages is a significant source of hypovolemic shock in trauma patients. It has been reported that pediatric femoral fractures do not cause excess blood loss if there is no additional injury or trauma. The purpose of this study was to define the magnitude of blood loss resulting from pediatric femoral fractures and the factors influencing the loss. METHODS: Twenty children under the age of 11 with femoral shaft fractures were included in this study. The patients' data were collected prospectively for 2 years. Hemoglobin concentrations, hematocrit levels, emergency room records, and clinical findings were evaluated and additional injuries were considered. RESULTS AND CONCLUSION: The patients with additional trauma showed significant decreases in both hemoglobin concentrations and hematocrit levels, comparison with the patients who had only isolated femoral fractures. If there is an obvious decrease in hematocrit and/or hemoglobin concentration in a child with a femoral fracture, the possibility of additional injuries should be investigated.

The effect of prophylactic dose of a low molecular weight heparin on skin wound healing of rats / Efeito da dose profilática de heparina de baixo peso molecular na cicatrização de feridas na pele de ratos

PURPOSE: To investigate the effect of prophylactic dose of a low molecular weight heparin, enoxaparin, on skin wound healing of rats. METHODS: Forty rats were used for the study. Rats were randomly assigned to two equal groups. Experimental group received prophylactic dose of enoxaparin. Physiologic saline was administered to the control group. Parameters of wound healing of experimental and control groups were compared. For comparison of the groups in terms of fibrosis, vascularization, inflammation, epithelization, and tensile strength test (Newton). Mann-Whitney-U test was used because variables were categorical data (fibrosis, vascularization, inflammation and epithelization). Differences between groups were analyzed with independent samples t-test (tensile strength). Significance was set at p<0.05. RESULTS: Skin wound of the experimental group presented tensile strength significantly decreased (p<0.001), histopathologic examination revealed a significant (p<0.001) delayed epithelization and decreased in fibrosis, vascularization, inflammation (p<0.001) in the experimental group. CONCLUSION: Enoxaparin delay wound healing by decreased inflammatory cells, fibroblast contents and their products (growth factors), and by promoted hemorrhage.

OBJETIVO: Investigar o efeito de dose profilática da heparina de baixo peso molecular, enoxaparina, na cicatrização de feridas na pele de ratos. MÉTODOS: Quarenta ratos foram utilizados para o estudo. Ratos foram distribuídos aleatoriamente a dois grupos iguais. O grupo experimental recebeu profilática de enoxaparina. Solução salina fisiologica foi administrada ao grupo controle. Foram comparados parâmetros de cicatrização dos grupos experimental e controle.Os grupos foram comparados em termos de fibrose, vascularização, inflamação, epitelização e força tensil (teste de Newton). Foi realizado o teste de Mann-Whitney-U para variáveis com dados categóricos (fibrose, cicatrização, inflamação e epitelização). Diferenças entre os grupos foram analisadas como amostras independentes pelo t-teste (força tensil). Significância foi fixada para p < 0,05. RESULTADOS: A ferida do grupo experimental apresentou força tensil diminuída significativamente (p < 0,001), o exame histopatológico revelou um significativo (p < 0,001) retardo na epitelização e diminuição na fibrose, cicatrização, inflamação (p < 0,001) no grupo experimental. CONCLUSÃO: A enoxaparina retarda a cicatrização da ferida pela diminuição das células inflamatórias, pelo menor conteúdo de fibroblasto e seus produtos (fatores de crescimento) e por promover hemorragia. O grupo experimental foi incluído pela perda significativa da força tênsil no presente estudo.