Combining Salter-Harris and Dias-Tachdjian could be better at determining the prognosis of distal tibial physeal fractures.

OBJECTIVES: The aim of this study is determining the factors that affect prognosis of distal tibial physeal fractures (DTPF) and analyzing whether Salter-Harris (SH) or Dias-Tachdjian (DT) classification is more predictive for outcomes. METHODS: Patients treated for DTPF were retrospectively analyzed. Fracture patterns were classified according to SH and DT. Treatment methods and fracture characteristics were noted. Distal tibial angles and joint irregularities were analyzed on patient's final ankle radiographs followed by American Orthopedic Foot and Ankle Score questionnaire. RESULTS: 75 patients followed-up between 6 and 96 months meeting the inclusion criteria were evaluated. Joint irregularity was observed in 41.3% and partial premature physeal closure (PPC) in 34.7% of the patients. Lateral distal tibial angle (LDTA) and talocrural angle related deformity were detected in 20% and 14.7% of the patients, respectively. Partial PPC and joint irregularities that have been developed in pronation-eversion-external rotation and supination-inversion injuries (SH type 3, 4) were 62% and 50%, and 42% and 75%, respectively. On follow-ups of supination-external rotation injuries (SH type 2) joint irregularity has never been observed. Following supination-external rotation and supination-plantar flexion injuries, a low rate of partial PPC have been developed; LDTA related deformity was revealed at a high rate of 39.1% after supination-inversion injuries. There weren't any differences observed between the initial displacement, residual displacement or surgical technique and PPC, joint irregularity and angular deformities. Patients treated by ORIF technique had lower AOFAS scores than patients treated by other surgical techniques. CONCLUSIONS: In this study it was revealed that SH classification system is not sufficient alone to determine the prognosis of DTPF, the injury mechanisms causing SH types might be also significant in prediction of the prognosis of DTPF.

Visualizing Anatomic Variants of the Sciatic Nerve Using Diagnostic Ultrasound During Piriformis Muscle Injection: An Example of 4 Cases.

Objective: The aim of this article is to present examples of patients in whom piriformis muscle (PM) and sciatic nerve (SN) variations were detected by a diagnostic ultrasound (US)-guided examination and were successfully diagnosed and treated for piriformis syndrome (PS) by US-guided injections. Clinical Features: This series includes 4 cases. In case 1, a 30-year-old woman with a 7 numeric rating scale (NRS) score for pain (on a 0-10 scale) was evaluated for complaints of left gluteal pain radiating to the thigh for 5 years and right gluteal pain for 2 years. Case 2 involves a 32-year-old man with a 7 NRS score presenting with left gluteal pain radiating to his leg for 1 year. The third case presents a 37-year-old man who had pain (6 NRS score), numbness, and discomfort radiating from the right hip to the leg that lasted for 7 years. Finally, in case 4, a 23-year-old male patient was examined with deep gluteal paresthesia and discomfort on the left side for 1 year. Intervention and Outcome: Diagnostic US evaluation of the gluteal region for each patient revealed anatomical variations of the SN. In 3 of the cases, corresponding contralateral US images demonstrated similar anatomic variations. Diagnosis of PS in each patient was made by US-guided injection. After the injection of 4 cm3 of lidocaine 2% into the PM, the patients' complaints resolved almost fully. Conclusion: The anatomical variations of the SN and PM might be a facilitating factor for myofascial pain syndrome in PS. These cases demonstrate that SN variations could be visualized with the help of diagnostic US.

The effects of spasticity on glucose metabolism and soft tissue body composition in patients with spinal cord injury.

Objectives: The aim of this study was to assess the effects of spasticity on glucose metabolism and percentage of fat-free mass (FFM%) in patients with spinal cord injury (SCI). Patients and methods: A total of 33 patients (22 males, 11 females; mean age: 38.6±12.5 years; range, 20 to 64 years) with SCI defined by the American Spinal Injury Association Impairment Scale Grades A to D were included between September 2014 and May 2018. We assessed spasticity with the Modified Ashworth Scale (MAS) and evaluated spasms with the Penn Spasm Frequency Scale (PSFS). We assessed the glucose metabolism by calculating the Matsuda and HOMA-IR index, and measured FFM% by dual-energy X-ray absorptiometry. Results: Fourteen patients had motor complete, and 19 had motor incomplete SCI. The neurological injury levels of the patients were C4-T12. There was a positive correlation between hip adductor muscle MAS and trunk, android, and gynoid FFM% and between hip extensor muscle MAS and android FFM% in patients with motor complete SCI. Hip extensor and knee flexor muscle MAS showed a negative correlation with the HOMA-IR. Hip adductor and extensor muscle MAS, as well as knee flexor and extensor muscle MAS, had a positive correlation with the Matsuda index in these patients. There was a positive correlation between knee extensor muscle MAS and gynoid FFM% and between PSFS and arms, trunk, gynoid, and total FFM% in patients with motor incomplete SCI. There was a negative correlation between hip adductor and extensor muscle MAS, PSFS, and level of fasting glucose in these patients. Conclusion: This study supports the notion that spasticity has positive effects on the FFM% and glucose metabolism in patients with motor complete and incomplete SCI.

Evaluation of the physical and emotional effects of the COVID-19 pandemic on patients with fibromyalgia and chronic low back pain: A multicenter cross-sectional controlled study.

Objectives: This study aimed to investigate the physical and emotional effects of the coronavirus disease 2019 pandemic in patients with fibromyalgia syndrome (FMS) and chronic low back pain (CLBP) patients. Patients and methods: The cross-sectional controlled study was performed with 1,360 participants (332 males, 1,028 females; mean age: 42.3±12.5 years; range, 18 to 65 years) between September 2020 and February 2021. The participants were evaluated in three groups: the FMS group (n=465), the CLBP group (n=455), and the healthy control group (n=440). Physical activity, pain levels, and general health status before and during the pandemic were evaluated in all participants. Stress levels were analyzed with the perceived stress scale (PSS) in all groups, and disease activity was analyzed with the fibromyalgia impact questionnaire (FIQ) in patients with FMS. Results: Patients with FMS had worsened general health status and pain levels during the pandemic compared to the other groups (p<0.01). The FMS group showed significantly higher PSS scores than those in other groups (p<0.01). There was a weak-positive correlation between FIQ and PSS parameters in patients with FMS (p<0.05, r=0.385). Conclusion: The general health status, pain, and stress levels of the patients with FMS and CLBP tended to worsen during the pandemic. This high-stress level appeared to affect disease activity in patients with FMS.

Pregabalin as a probable cause of central serous chorioretinopathy: Two case reports.

Pregabalin is commonly used for the treatment of neuropathic pain and is attributed to adverse effects of peripheral vasodilation and peripheral edema. Central serous chorioretinopathy (CSCR) is characterized by choroidal fluid leaks from choroidal vessels under the retina, causing focal retinal detachment with macular vision loss. Herein, we report two cases admitted to our clinic with vision loss while under pregabalin treatment. Upon eye examination, both patients were diagnosed with acute CSCR. Pregabalin treatment was discontinued upon the diagnosis of CSCR. We consider that the use of pregabalin in the presented two cases may be the causal effect of the CSCR diagnosis, as pathophysiology of CSCR is in parallel with the edema-related adverse effects of pregabalin.

The Effect of Alpha Lipoic Acid on the Recovery of Sciatic Nerve Injury in Rats: A Prospective Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to investigate the regenerative effects of alpha lipoic acid on the recovery of sciatic nerve crush injury (SNCI) in rats. DESIGN: This was a randomized, experimental, and sham-controlled study. The sciatic nerves of 28 rats in four groups were traumatized for 60 secs: G1, sham operated + saline; G2, SNCI + saline; G3, SNCI + alpha lipoic acid 50 mg/kg/day; and G4, SNCI + alpha lipoic acid 100 mg/kg/day. Sciatic functional index values were measured on day 0, 1, 7, 14, 21, and 28. Sciatic nerve stimulation threshold values were recorded on day 1, 14, and 28. End-point histopathologic evaluation was conducted. RESULTS: The mean sciatic functional index value of G2 but not G3/G4 on day 7 was significantly lower than on day 0 (P = 0.035, P = 0.447/P = 0.800). The mean sciatic functional index value of G2 but not G3/G4 increased significantly between day 7 and 14 (P = 0.035, P = 0.447/P = 0.438). The day 14 mean sciatic nerve stimulation threshold values of G3/G4 but not G2 were decreased significantly compared with those on day 1 (P = 0.022/P = 0.022, P = 0.933). The mean sciatic nerve stimulation threshold values of G3/G4 on day 14 were similar to those on day 0 (P = 0.106/P = 0.418). Regeneration in muscle and nerve connective tissues and nerve structures was observed in G3/G4. Inflammation in the muscle and nerve tissues of G4 was suppressed down to similar levels of G1. Myelinated nerve fibers were less degenerated in G3/G4. CONCLUSION: Alpha lipoic acid has the potential to accelerate the process of nerve healing in the context of SNCI in rats.