Do Different Approaches Make a Difference in Isokinetic Performance in Elderly Patients With Femoral Neck Fracture Who Underwent Bipolar Endoprosthesis?

Background There are ongoing doubts about the effects of the commonly used anterolateral approach (ALA) and posterolateral approach (PLA) for bipolar hemiarthroplasty (BHA) on hip muscle strength after surgery. In this study, it was aimed to evaluate the isokinetic performance of the operated and non-operated hips in patients with femoral neck fractures who underwent BHA with PLA or ALA and to compare the isokinetic performance of the hips and functional results between the two approaches. Materials and methods Forty-one patients who underwent unilateral BHA with PLA or ALA for femoral neck fracture between February 2019 and December 2020 were enrolled. The isokinetic performance of the flexor, extensor, and abductor muscles of the operated and non-operated hips were evaluated by measuring peak torque, total work, and average power. Functional status was assessed using Harris Hip Score and Short Form 36. Results The patients were divided into two groups; those operated with PLA (n=22) and with ALA (n=19). The groups had similar demographic and clinical characteristics. All isokinetic parameters of the operated hips did not differ between the groups (all p>0.05). In both groups, all isokinetic parameters were significantly lower in the operated hips than in the non-operated hips. Conclusion Although there are debates about potential extensor muscle injury with PLA and potential abductor muscle injury with ALA, this study showed that functional results and the isokinetic performance of both approaches were not different.

Clinical outcomes of tumors and tumor-like lesions located in the clavicle.

OBJECTIVES: The aim of this study was to examine the characterization of tumors and tumor-like lesions located in the clavicle and to present their clinical results. PATIENTS AND METHODS: Between January 2006 and December 2018, a total of 44 patients (25 males, 19 females; mean age: 36.2±21.8 years; range, 2 to 87 years) who were operated in our clinic for a clavicular lesion were included. Among 4,856 extremity tumors operated in our clinic between these years, 44 cases (0.9%) located in the clavicle were eligible. Demographic data, tumor types, location, surgical method, metastasis, survival analyzes and clinical results of these patients were reviewed retrospectively. According to the clavicle location, the patients were divided into groups according to their involvement in proximal, middle, lateral and more than one region. RESULTS: The most frequently involved site was the lateral edge of the clavicle, and the most common tumor was aneurysmal bone cyst. The most common malignant tumor was Ewing sarcoma and plasmacytoma (13.6%) and the most common surgical method in the clavicle was wide resection with 34.1%. Of the 38 primary clavicle tumors remaining after the metastatic lesions were removed, 21 (55%) were benign, while 17 (45%) were malignant. Aneurysmal bone cyst was most common in the group under 30 years of age, osteochondroma was most common in the 30-50 age group, and plasmacytoma was most common in those over 50 years of age. The mean musculoskeletal tumor society (MSTS) score of 15 patients (34.1%) who underwent clavicle resection was 79.4±6. CONCLUSION: We believe that a wide spectrum should be considered in the differential diagnosis of tumors located in the clavicle. Age is an important predictive factor for malignancy. We believe that resection should be applied without fear considering its effects on function and recurrence.

The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain: a prospective randomized controlled study.

To evaluate clinical and ultrasonographic efficacy of high-intensity laser therapy (HILT) in patients with hemiplegic shoulder pain (HSP) accompanied by partial thickness rotator cuff tear (PTRCT). The study was designed as a prospective, randomized, controlled trial. Patients with HSP accompanied by PTRCT (n = 44) were randomly assigned to HILT and control groups. Both groups were treated with a multidisciplinary stroke rehabilitation and a therapeutic exercise program to the affected shoulder supervised by physiotherapists. In addition, HILT group received 3 sessions of the intervention per week for 3 weeks. Primary outcome measure was visual analogue scale (VAS) for pain. Secondary outcome measures were range of motion (ROM) of the shoulder joint, Shoulder Pain and Disability Index (SPADI), Brunnstrom Recovery Stage (BRS), Modified Ashworth Scale (MAS), Nottingham Health Profile (NHP), Functional Independence Measure (FIM), and ultrasonographic PTRCT size. Participants were assessed at pre- and post-treatment. A total of 41 patients completed the study. A statistically significant improvement was observed in VAS, ROM, FIM, SPADI, NHP, and PTRCT parameters in HILT group at post-treatment compared to pre-treatment (all P < 0.05). However, control group indicated significant improvement only in VAS, ROM, and SPADI parameters (all P < 0.05). When differences in clinical parameters at pre- and post-treatment assessment were compared between two groups, change in VAS, FIM, BRS, SPADI, NHP, and PTRCT in HILT group was significantly better than control group (all P < 0.05). HILT combined with therapeutic exercise seems to be clinically and ultrasonographically more effective in the treatment of patients with HSP accompanied by PTRCT than therapeutic exercise alone in the short term. Further studies are needed with long-term follow-up. CinicalTrials.gov Identifier: NCT04669405.

Admission neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio to predict 30-day and 1-year mortality in geriatric hip fractures.

INTRODUCTION: Elderly patients with hip fractures exhibit a high incidence of mortality and morbidity. The aim of this study was to evaluate the factors that may predict mortality in patients with geriatric hip fracture. METHODS: Included in this retrospective study were 241 patients who were admitted to the hospital with hip fractures between May 2017 and March 2019. The effect of the modified 5-item frailty index (mFI-5) on 30-day and 1-year mortality was evaluated. In addition, admission neutrophil-to-lymphocyte ratios (NLRs) and monocyte-to-lymphocyte ratios (MLRs) were also examined. RESULTS: The mFI-5 was not found to be a statistically significant predictive indicator for 30-day and 1-year mortality (P = 0.485 and P = 0.484, respectively). Chronic obstructive pulmonary disease or current pneumonia was found to increase mortality by 2.702 times (P = 0.002). The 30-day mortality rates of patients aged ≥80 years were significantly higher than those aged 65-79 years (P < 0.05). However, there was no statistical difference in the mortality rates between the age groups after 30 days postoperatively (P = 0.114). Admission NLRs and MLRs were significantly higher in the 30-day and 1-year mortality groups. The cut-off values of the admission NLRs and MLRs for 30-day mortality were calculated as 6.55 and 0.65, respectively, while the same cut-off values for 1-year mortality were calculated as 6.55 and 0.635, respectively. CONCLUSIONS: Admission NLRs and MLRs are useful hematological data for the prediction of 30-day and 1-year mortality in geriatric hip fracture patients.

Surgical management of primary malignant proximal fibular tumors: Functional and clinical outcomes of 23 patients.

OBJECTIVES: This study aims to evaluate the clinical characteristics and treatment outcomes of patients with primary malignant tumors located in the proximal fibula. PATIENTS AND METHODS: This retrospective study included 23 patients (15 males, 8 females; mean age 22.1 years; range, 9 to 63 years) with primary malignant tumors located in the proximal fibula between May 2007 and May 2017. The anamnesis or medical history, physical examination, plain chest radiography, lung computed tomography, direct radiograph, and magnetic resonance imaging of the affected extremity and routine laboratory tests of all patients were evaluated. RESULTS: Of the patients, 11 were diagnosed with osteosarcoma (47.8%), nine with Ewing's sarcoma (39.1%), two with chondrosarcoma (8.7%), and one was diagnosed with synovial sarcoma (4.3%). Pain and palpable mass were the most common symptoms. Six patients had lung metastases at the time of diagnosis. Of the patients, eight were performed Malawer type 1 resection (34.8%), nine type 2 resection (39.1%), four above knee amputation (17.4%), and two proximal tibia tumor resection prosthesis (8.6%). Mean follow-up duration was 36 months (range, 12 to 119 months). Local recurrence developed in three patients. Mean Musculoskeletal Tumor Society (MSTS) score of all patients was 62. CONCLUSION: Surgical treatment of primary malignant tumors of the proximal fibula is problematic. In appropriate indications, Malawer type 1 resection should be the treatment of choice due to lower local recurrence rates and higher MSTS scores.

Pilomatrixoma located on the cruris: an uncommon localization.

Pilomatrixoma is a benign tumor of hair follicle matrix cells. The majority of all pilomatrixomas were reported to affect the head-neck region and rarely the upper extremity. We present a case of left-leg pilomatrixoma, which is a extremely rare localization, in a 10-year-old boy.

The Relationships among Vitamin D Level, Balance, Muscle Strength, and Quality of Life in Postmenopausal Patients with Osteoporosis.

[Purpose] The aim of this study was to examine the relationships among vitamin D levels, balance, falls, muscular strength, and quality of life in patients with postmenopausal osteoporosis. [Subjects and Methods] Forty-six patients diagnosed with postmenopausal osteoporosis and forty-six healthy controls were included in the study. Bone mineral density was determined by DEXA, and functional balance was evaluated the Timed Up and Go (TUG) test, Chair Raising (CRT) test, Berg Balance Scale (BBS). The muscular strengths were evaluated manually. The lumbosacral region range of motion (ROM) was measured by goniometry. The QUALEFFO-41 questionnaire was used for evaluating the quality of life. [Results] No statistically significant differences in muscular strength, balance, and fall values were found between the two groups. Statistically significant differences were noted between the QUALEFFO C, E, F and G scores and the QUALEFFO total scores of the QUALEFFO-41. Dividing the patient group into two groups revealed that patients with 25(OH)D levels < 15 ng/ml had significantly higher TUG and CRT test scores compared with patients with levels ≥ 15 ng/ml. Also, binary logistic regression analysis revealed that QUALEFFO total scores were found to be the independent factors for osteoporosis. [Conclusion] In this study, we found that vitamin D is necessary to maintain back extensor muscle strength, lumbar ROM, and balance. Our results show that bone mineral density, vitamin D level, balance, lumbar ROM, and the specified muscular strengths are factors that affect the quality of life.