The Effect of Intraoperative Patient Positioning on the Success of Intertrochanteric Fracture Surgery in Older Patients.

Background and Objectives: The incidence of hip fractures in people of advanced ages is increasing due to our aging society. Patient positioning for the intertrochanteric fractures of the femur can be performed in various ways. The aim of this study is to clinically and radiologically compare the use of the supine hemilithotomy position, the lateral decubitus position, and the traction table when performing proximal femoral nail (PFN) surgery for femoral intertrochanteric fractures in the geriatric age group. Materials and Methods: A total of 170 elderly patients with femoral intertrochanteric fractures were included in this cross-sectional study. The patients were divided into three groups (the supine hemilithotomy group, the lateral decubitus group, and the fracture table group). For the postoperative period, complications, length of stay in the intensive care unit, and length of stay in hospital were examined, while in postoperative radiographs, tip-apex distances (TADs), collodiaphyseal angles (CDAs), and Cleveland-Bosworth quadrants were examined to evaluate the placement of the lag screw in the femoral head. The quality of fracture reduction was evaluated according to the modified Baumgaertner criteria. Results: The mean age of the patients was 77.8 ± 8.8; 57.6% of patients were female. According to the modified Baumgaertner criteria, it was determined that patients with 'poor' reduction quality had an approximately ten times higher risk of cut-out than those with 'good' reduction quality (OR = 10.111, p = 0.002, 95% confidence interval; 2.313-44.207). The operative time for patients in the fracture table group was longer than that of the other groups Additionally, the CDA in the supine hemilithotomy position group was longer. Conclusions: Although PFN surgery using the traction table is longer in terms of surgical time compared to surgery performed in the lateral decubitus position and the supine hemilitotomy position, it is advantageous in terms of better TAD and CDA values and lower complication rates.

During Arthroscopic Repair of Medial Meniscal Tears: Do Not Be Afraid to Perform "Pie Crust" Technique.

In the absence of effective long-term repair of meniscal injuries, damage to the knee may lead to the development of osteoarthritis. Recent reports have recommended meniscal repair to be undertaken in all cases of meniscal tears. However, the most common complication encountered during repair of the medial meniscus is iatrogenic cartilage and meniscal injury due to its unclear visualization. The aim of this study is to evaluate the long-term clinical and radiological results of the pie-crust (PC) technique performed during the repair of medial meniscal tears. This retrospective study included 86 patients who underwent arthroscopic medial meniscus repair. PC technique was performed if the medial joint width was less than 5 mm. The patient population was divided into two groups as who underwent meniscus repair with PC technique (PC + repair group) or not (repair group). All patients were evaluated clinically (Kujala score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity score) and radiologically (medial joint width and valgus laxity angle). When the medial joint width measurements before the PC technique and at the postoperative first and sixth months were compared, it was found to be statistically significant (p < 0.05). However, there was no significant difference between the preoperative and 12-month postoperative joint width measurements (p > 0.05). At the 12-month follow-up, no statistically significant difference was determined for the valgus laxity angle in the PC group compared with preoperative values (p > 0.05). The follow-up Kujala score, IKDC subjective score, Lysholm score, and Tegner activity score were similar between the groups. The clinical scores in both groups were determined to have statistically significant increase at 12-month postoperatively compared with the preoperative values (p < 0.05). The results of this study showed that performing the PC technique prior to medial meniscal tear repair increase the medial joint visualization safely and effectively without permanent valgus laxity.