Polytrauma in the Geriatric Population: Analysis of Outcomes for Surgically Treated Multiple Fractures with a Minimum 2 Years of Follow-Up.

INTRODUCTION: This study analyzed the clinical and radiological outcomes of geriatric polytrauma patients who had multiple fractures surgically treated and a minimum of 2 years of follow-up. METHODS: Eighty-six geriatric patients with polytrauma and multiple fractures which were surgically treated in orthopedics and who had a minimum of 2 years of follow-up were retrospectively analyzed. Patients' demographic characteristics, comorbidities, and follow-up time were recorded. The mechanism of injury, fracture type and location, Injury Severity Score (ISS), American Society of Anesthesiologists (ASA) score, duration of hospital stay, complications, and 1-year mortality were also recorded. Fracture union, implant failure, and refractures/misalignment were analyzed from radiographs. RESULTS: There were 34 (39.5%) male and 52 (60.5%) female patients. Mean age was 73.5 years with an average follow-up time of 32.9 months. Patients had more low-energy traumas and more lower extremity, comminuted fractures. On the contrary, high-energy traumas and femur/pelvic fracture surgeries had higher associated mortality. The mean ISS score was 26.3. The most common ASA score was ASA 3 (75.8%). The most common clinical and radiological complications were prolonged wound drainage and implant failure. The total 1-year mortality rate was 22.1%. Patients with high ASA scores and patients with lower extremity fractures (femoral/pelvic fractures) also had significantly increased mortality rates. No significant relation was detected between mortality and ISS, fracture type, number of fractures, and duration of hospital stay. CONCLUSION: Orthopedic surgeons must be alert about the possible complications of femoral fractures and comminuted fractures including pelvic girdle. Surgically treated, multifractured patients with high-energy trauma, advanced age, and high ASA scores are also at risk for mortality regardless of the ISS, comorbidities, and duration of hospital stay. Pulmonary thromboemboli must be kept in mind as a significant complication for mortality.

Is simple decompression enough for the treatment of idiopathic cubital tunnel syndrome: A prospective comparative study analyzing the outcomes of simple decompression versus partial medial epicondylectomy.

OBJECTIVES: This study aims to compare the clinical and functional outcomes of simple in-situ decompression and partial medial epicondylectomy for the treatment of idiopathic cubital tunnel syndrome (CuTS). PATIENTS AND METHODS: Between March 2014 and December 2016, 71 patients (31 males, 40 females; mean age 46.7 years; range, 38 to 62 years) with CuTS scheduled to undergo simple in-situ decompression (group 1) or partial medial epicondylectomy (group 2) were prospectively reviewed. All patients were analyzed with clinical examination (Tinel sign, Froment's and Wartenberg's signs, elbow flexion test, subluxation), and McGowan scores before and after surgery. Final outcomes were reviewed with Wilson and Krout grading system. RESULTS: There was no significant difference between the study groups in regard to Wilson and Krout grading and McGowan scores postoperatively. Group 1 had significantly better grip and key pinch strength values compared to group 2 at the final follow-up control. CONCLUSION: In-situ decompression and partial medial epicondylectomy represent efficient and safe methods for the treatment of idiopathic CuTS. When their efficiency is compared, in-situ decompression had better grip and key pinch strength values and more excellent outcomes compared to partial medial epicondylectomy.

Treatment of Full-Thickness Cartilage Defects with Pedunculated and Free Synovial Grafts: A Comparative Study in an Animal Model.

AIMS AND OBJECTIVES: The purpose of this study was to compare the potential effects of pedunculated and free synovial grafts in the repair of full-thickness articular cartilage defects on an animal model with histological and immunohistochemical analysis. MATERIALS AND METHODS: A comparative study in an animal model was performed with 24 rabbits, divided into two groups. Full-thickness cartilage defects were created bilaterally on the knees of all rabbits. Pedunculated and free synovial grafts were applied to the right knees of Group 1 and Group 2, respectively. Left knees were left as the control group. Six rabbits from each group were randomly selected for euthanasia 4 and 8 weeks postoperatively. All samples were examined histologically with a cartilage scoring system. For immunohistochemical analysis, the degree of collagen 2 staining was determined using a staging system. All data were statistically compared between the study groups with Student's t-test or Mann-Whitney U-test. The correlations between categorical variables were analyzed with Fisher's exact test and Chi-square test. RESULTS: In Group 1, the mean defect size had significantly decreased at 8 weeks postsurgery. It was also significantly smaller than that of Group 2. Both pedunculated and free synovial grafts had significantly better histological and immunohistochemical outcomes compared with the controls. Contrastingly, the results of comparison between the study groups (Group 1 vs. 2) at the 4th and 8th week were not statistically significant with regard to histological scores and immunohistochemical staining. CONCLUSION: Synovial tissue, whether pedunculated or free, provided much better cartilage recovery compared with the control. It can be used as a mesenchymal stem cell (MSC) source, and synovium-derived MSCs have the chondrogenic potential for the in vivo treatment of full-thickness cartilage defects.

Outcomes for core decompression with multiple drilling of the osteonecrosis of the femoral head in patients with solid organ transplantation.

OBJECTIVES: This study aims to investigate the clinical and radiological outcomes of core decompression surgery performed with multiple drilling in solid organ transplantation patients with osteonecrosis of femoral head (ONFH) and evaluate the effectiveness of this procedure in regard to duration of corticosteroid use and stage of osteonecrosis. PATIENTS AND METHODS: A total of 22 solid organ transplantation (kidney, liver or heart) patients (14 males, 8 females; mean age 43.3 years; range, 23 to 67 years) who were scheduled to undergo core decompression surgery with multiple drilling for ONFH were evaluated. Patients' Harris hip scores (HHSs) and radiographic data including Association Research Circulation Osseous (ARCO) staging and Kerboul grading were retrospectively reviewed at pre- and postoperative controls. RESULTS: Patients were followed-up for mean 34.3 months (range, 12 to 76 months). Two patients (9.09%) were performed total hip arthroplasty. These two patients' Kerboul grade was 3. There was no statistically significant relationship between preoperation and postoperative final control in terms of ARCO staging. There was no statistically significant difference between pre- and postoperative HHSs. CONCLUSION: Although multiple drilling is a safe and minimally invasive surgery, its effect is limited, particularly in solid organ transplantation patients with ONFH due to long-term corticosteroid use. Therefore, solid organ transplantation patients should be closely monitored in terms of ONFH development.

Platelet-rich plasma decreases fibroblastic activity and woven bone formation with no significant immunohistochemical effect on long-bone healing: An experimental animal study with radiological outcomes.

PURPOSE: This study aimed to analyze the immunohistochemical effect of platelet-rich plasma (PRP) on healing of long-bone fractures in terms of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF), the Ki-67 proliferation index, and radiological and histological analyses. METHODS: Sixteen adult rabbits, whose right femoral diaphysis was fractured and fixed with Kirschner wires, were randomly divided into two groups, control and PRP (groups A and B, respectively). PRP was given to group B at 1 week postoperatively, and all animals were euthanized after 12 weeks. Radiographic evaluations were performed periodically. Cortical callus formation, chondroid and woven bone area percentages, osteoblastic and fibroblastic activities, and mature bone formation were examined. The depths of BMP-2 and VEGF staining were measured. The Ki-67 proliferation index was also calculated. RESULTS: The mean radiological union score of group B was significantly higher than that of group A. There were also statistically significant differences between groups A and B in terms of cortical callus formation, woven bone area percentage, fibroblast proliferation, and mature bone formation. Group B had significantly more cortical callus and mature bone formation with less woven bone and fibroblast proliferation. Immunohistochemical analysis revealed no statistically significant difference between the groups in terms of BMP-2 and VEGF staining and the Ki-67 index. CONCLUSIONS: PRP had no effect on BMP-2 or VEGF levels with no increase in the Ki-67 proliferation index, although its application had a positive effect on bone healing by increasing callus and mature bone formation with decreased woven bone and fibroblast proliferation.

The biochemical and histological analysis of subcutaneous calcitonin and intramedullary methylprednisolone on bone repair after bone marrow ablation: an experimental comparative study in rats.

BACKGROUND: Although, glucocorticoid (GC) and calcitonin-induced changes in bone repair have been studied previously, the exact effects of these on fracture healing remain controversial. Hence, the purpose of this experimental study is to determine biochemical and histological effects of locally administrated GC and systemically administrated calcitonin on the kinetics of healing response after bone marrow ablation in rats. METHODS: After having undergone marrow ablation, a steroid-treated group of rats (n = 24) received a single dose of intramedullary methylprednisolone (2 mg/kg), a calcitonin-treated group (n = 24) received intermittently administrated subcutaneous salmon calcitonin (16 IU/kg), and a control group (n = 24) received intramedullary saline (25 µl). RESULTS: Blood samples taken on days 1, 3, 7, 9, and 15 after ablation showed an increase in serum calcium, alkaline phosphatase (ALP), and phosphate levels in the Calcitonin and Control groups. Levels of calcium and ALP peaked on day 7 after ablation. However, an increase in phosphate levels indicated a biphasic reaction that peaked on the third and ninth day after ablation. Hypercalcemia was not observed in Steroid group because of the inhibition of osteoclastic bone resorption. In that group, the serum levels of ALP and phosphate were lower than baseline levels. The levels of urinary calcium excretion peaked 3 to 7 days after marrow ablation in the control group and 7 to 9 days after that procedure in the steroid group. Histologic evaluation showed that the rats in the control group demonstrated the expected healing period according to the histological grades and that a delay in healing occurred in the calcitonin group after day 9 because of the inhibition of osteoclastic bone resorption. All rats in the steroid group exhibited a decrease and delayed healing response. CONCLUSION: Total serum calcium, phosphate, and ALP levels increased after bilateral tibial bone marrow ablation and urine calcium and hydroxyproline excretion also increased as a factor of bone resorption. Subcutaneously administrated salmon calcitonin did not affect biochemical changes after marrow ablation. Single-dose intramedullary methylprednisolone inhibited extra-tibial bone resorption induced by cytokines after bone marrow ablation.

A novel computer-based method for measuring the acetabular angle on hip radiographs.

OBJECTIVE: The aim of this study was to propose a new computer based method for measuring acetabular angles on hip radiographs and to assess its practicality, sensitivity and reliability for acetabular angle measurement. METHODS: A total of 314 acetabulum were assessed on 157 pelvic X-ray images. Acetabular angles were measured with both the conventional method (Method 1) and our proposed method (Method 2). All the Acetabular Index (AI) angle, Acetabular Angle (AA) and Acetabular Center (ACM) angle were measured with both methods. RESULTS: The mean AI angle for Method 1 is 11.02° ± 2.7° and the mean AI angle for Method 2 is 10.08° ± 1.88°, the mean AA angle for Method 1 is 39.5° ± 5.3° and the mean AA angle for Method 2 is 39.36° ± 4.68°, the mean ACM angle for Method 1 is 50.5° ± 6.01° and the mean ACM angle for Method 2 is 55.42° ± 12.43°. CONCLUSION: Our novel automated method appear to be reliable and practical for acetabular angle measurement on hip radiographs. LEVEL OF EVIDENCE: Level III, Diagnostic study.

Consanguineous marriage and increased risk of idiopathic congenital talipes equinovarus: a case-control study in a rural area.

BACKGROUND: The purpose of this study is to evaluate if there is any relationship between consanguineous marriages and idiopathic congenital talipes equinovarus (CTEV). METHODS: A case-control study on CTEV screening was conducted in a rural eastern city of Turkey between 2009 and 2011 and a total of 28 cases (infants with idiopathic CTEV) and 575 controls (healthy infants) were recruited. Sociodemographic status of the infants, including gestational age and birth weights, maternal characteristics and, if any, the degree of consanguinity, were recorded. As an inclusion criterion, only singleton, full-term, live births were accepted. A backward stepwise logistic regression model was used to evaluate the relationship between idiopathic CTEV and parental consanguinity. Unadjusted and adjusted odds ratios (OR) with 95% confidence interval (CI) were calculated. RESULTS: Among maternal and infant characteristics, significant risk factors for idiopathic CTEV in the regression analysis were work status (employed), consanguineous marriage, sex (male), and gestational age (>42 wk). Babies born to first-cousin parents had >4 times the risk of idiopathic CTEV [OR, 4.138, (95% CI, 1.484, 11.538)] and the risk for those born to distant relatives was 2.9 times higher [OR, 2.941, (95% CI, 1.070, 8.087)] than for children of unrelated parents. CONCLUSIONS: Consanguineous marriage was significantly associated with an increased risk of idiopathic CTEV. This association remained significant even after adjusting for potential confounding variables. To obtain more accurate results, a population-based screening study with an increased number of cases and controls should be performed in future studies. LEVEL OF EVIDENCE: Case-control study investigating the effect of a patient characteristic on the outcome of disease (level-III).

Internal fixation of bilateral sacroiliac dislocation with transiliac locked plate: a biomechanical study on pelvic models.

OBJECTIVE: The purpose of this study was to analyze and compare the mechanical characteristics of a new iliosacral fixation technique (bilateral S1 pedicle fixation through a transiliac locked plate) for bilateral sacroiliac dislocations with other previously described methods. METHODS: Bilateral sacroiliac dislocations were created in 21 pelvic models and divided into three different fixation method groups. Group 1 was fixed using posterior tension band plating with a 3.5 mm locked plate combined with fixed-angle locked 3.5 mm screw fixation of bilateral S1 vertebra pedicles through suitable holes of the plate. Group 2 underwent posterior tension band plating with a 3.5 mm locked plate combined with bilateral spongious iliosacral screw fixation and Group 3 bilateral iliosacral spongious screw fixation alone. The ultimate load to failure and load for 10 mm of displacement for all three groups were compared. RESULTS: The average loads to failure for Groups 1, 2 and 3 were 1775, 2084 and 2230 N, respectively, and average loads for 10 mm of displacement were 1033, 1884 and 2013 N, respectively. Group 2 and 3 had the strongest fixation constructs although there was no statistically significant difference between these two groups (p=0.452). Group 2 and 3 were superior to Group 1 in terms of loads for 10 mm of displacement. There was no significant difference between Group 2 and 3 in this regard (p=0.397). CONCLUSION: Iliosacral screws are superior to bilateral S1 pedicle fixation through posterior tension band plating. However, the combination of tension band plating with iliosacral screw fixation does not improve the stability of the posterior pelvic ring.

Treatment of chronic lateral instability of the ankle with the Colville technique: a prospective analysis with minimum five years of follow-up.

OBJECTIVES: This study aims to prospectively analyze of the long-term results of the Colville's technique for the treatment of chronic lateral ankle instabilities. PATIENTS AND METHODS: Twenty-eight ankles of 28 male patients (mean age 24.6 years; range 20 to 35 years) which were treated using Colville's technique were evaluated with a mean follow-up of 76.1 months (range 60 to 106 months). Ankle instability, ankle functions and outcomes in the last visit were assessed and statistically compared. Stress radiographs with the TELOS device were repeated at six-months and five-years after surgery and compared with the stability of the uninjured ankle. RESULTS: Twenty-three of the results were excellent and five were good according to the criteria of Chrisman and Snook. All patients returned to normal daily activity levels at an average of eight months following surgery. Radiographic analysis revealed the significant preservation of stability at least five years after surgery with no sign of arthritis. The difference between preoperative and sixth-months postoperative values of both the talar tilt and the anterior draw tests were found statistically significant, indicating significant correction of the laxity. On contrary, difference between sixth months and five year values were not statistically significant, indicating the preservation of the correction. CONCLUSION: Anatomical augmented reconstruction procedure of Colville's is a long-lasting and good alternative compared to other more complex techniques of reconstruction with minimum long-term complications.

Giant solitary osteochondroma arising from the fifth metatarsal bone: a case report.

Accounting for 20% to 50% of all benign forms, solitary osteochondroma is the most common bone tumor. The long bones of the lower extremity are most frequently affected, whereas the small bones of the hands, feet, pelvis, scapula, and spine are less common locations. Osteochondromas are benign osseous neoplasms with a distinct hyaline cartilage cap originating from the physis, and they cease to grow with skeletal maturity. Treatment of osteochondroma is usually conservative, unless symptoms, usually pain, are progressive or the lesion demonstrates rapid or new growth, or if enlargement after skeletal maturation is noted or malignant transformation is suspected. In this report, we describe the case of an adult with a giant, symptomatic osteochondroma localized to the fifth metatarsal. The lesion was treated with excision, and after more than 2 years of follow-up, no evidence of recurrence was noted. This case demonstrated that, despite the benign nature of the lesion, a large osteochondroma could localize to a metatarsal.

Non-tuberculous thoracic and lumbar spondylodiscitis: single-stage anterior debridement and reconstruction, combined with posterior instrumentation and grafting.

Debridement is warranted for the treatment of nontuberculous spondylodiscitis in case of neurological compromise, deformity, instability, abscess formation, extensive destruction, intractable pain or failure of medical management. The additional use of instrumentation is still controversial, but might fight infection and yield stability. The purpose of this retrospective study was to evaluate the outcome of 16 cases of non-tuberculous thoracic or lumbar spondylodiscitis treated with anterior debridement and reconstruction (tricortical graft or titanium mesh cage), combined with single-stage posterior instrumentation and grafting. The pathogens identified were: Brucella (5), coagulase-negative Staphylococcus aureus (4), Staphylococcus aureus (3), unidentified (4). All 16 infections resolved without recurrence. Bony union was obtained in all cases. Fourteen out of 16 patients (87.5%) were completely relieved of pain and fully active, an excellent result according to Macnab's criteria; the other two patients obtained a good result. All 7 patients who had a neurological deficit improved. There were two superficial infections, which healed with debridement and antibiotics. A single iliac vein injury was primarily repaired. In conclusion, the proposed technique is an effective and safe treatment for pyogenic spondylodiscitis, if surgery is mandatory.

[The effects of two different continuous passive motion protocols on knee range of motion after total knee arthroplasty: a prospective analysis]. / Iki farkli sürekli pasif hareket protokolünün total diz protezi sonrasi diz hareket açikligina etkileri: Ileriye dönük bir çalisma.

OBJECTIVES: We prospectively evaluated the effects of continuous passive motion (CPM) started after two different time intervals following total knee arthroplasty (TKA) on short- and long-term results, in comparison with standard physical therapy. METHODS: Eighty-six patients were randomized to three groups following TKA for primary osteoarthritis. The control group (n=28) received only conventional physical therapy. Group I and II, each consisting of 29 patients, were treated with conventional physical therapy combined with CPM that was started on the first and third postoperative days, respectively, and continued until discharge with three one-hour sessions daily. Preoperative and postoperative measurements of the knee range of motion were recorded. Clinical and functional results were assessed using the Knee Society rating system. The patients were followed-up for at least two years (range 26 to 52 months). RESULTS: The duration of CPM was 22 hours in group I, and 19 hours in group II (p>0.05). Knee flexion values measured in the CPM groups on day 3 and at discharge showed significant differences with those of the control group, but no significant differences were found between the groups after the first postoperative month in this respect (p>0.05). The mean duration to reach 100 degrees of passive knee flexion (p=0.03) and the mean length of hospital stay (p=0.04) in the CPM groups were shorter by three and two days compared to the control group, respectively. Clinical and functional knee scores showed significant improvements in all the groups postoperatively (p<0.001), but there were no significant differences between the groups with respect to pre-and postoperative knee scores (p>0.05). CONCLUSION: Even though CPM protocols applied following TKA may shorten the length of hospital stay, CPM applications do not offer additional short- and long-term benefits over standard physical therapy with respect to knee flexion and clinical and functional results.

Remodeling potentials of biphasic calcium phosphate granules in open wedge high tibial osteotomy.

INTRODUCTION: Biphasic calcium phosphate (BCP) has proved to be an effective bone substitute, but it's effectiveness and remodeling potential in open wedge high tibial osteotomy (OWHTO) has not been analyzed yet. This study sought to evaluate the bone healing and remodeling potentials of BCP granules using a radiographic rating system in biplanar OWHTO. MATERIALS AND METHODS: Fifteen patients (15 knees) underwent biplanar OWHTO. Bone gaps were filled with BCP granules. For radiographic evaluation, remodeling was divided into four phases. Phase 1 was accepted as rounded osteotomy sites, with clear distinction between BCP and bone, phase 2 was accepted as whitened osteotomy sites, with distinction between BCP and bone still visible, phase 3 was accepted as distinction between BCP and bone not visible and cloudy bone formation and phase 4 was accepted as full reformation of BCP granules (4A-BCP visible, 4B-disappearence of BCP) with no sign of osteotomy. Bone union was confirmed with clinical (full weight bearing without pain) and radiographic evaluation (cortical bridging callus on radiographs and phase 3 or greater remodeling). The time to full remodeling and the starting point of the consolidation on anteroposterior radiographs were noted. Complications were also noted at each clinical follow-up. RESULTS: Mean follow-up was 27.2 months. The mean age was 55.8 years. At clinical follow-up, there were no wound healing problems, no loss of corrections, no infections, and no complications. All osteotomies successfully healed. According to the radiologic classification system, at the 6th week, 73.3% (11/15) of patients were in phase 1 and the remaining 26.7% (4/15) were in phase 2. At 12-month follow-up, 46.7 (7/15) of the patients were still in phase 3. After 2 years, all radiographs showed to be in phase 4A. Radiographic union was noted to progress from lateral to medial and finally central. CONCLUSIONS: BCP can be successfully used as a bone substitute. The radiographic remodeling and consolidation process of BCP was found to be different from that of beta-tricalcium phosphate. In our patients with more than 2 years of follow-up, BCP granules did not completely remodel. As a result, this clinical study demonstrated that calcium phosphate granules containing hydroxyapatite had a long period of "creeping substitution" that lasts longer than 2 years.

Analysis of modified oblique Keller procedure for severe hallux rigidus.

BACKGROUND: Several procedures have been described for treating hallux rigidus, but all have limitations. The purpose of this study is to evaluate the clinical and radiologic results of a modified oblique Keller procedure for treating hallux rigidus. MATERIALS AND METHODS: Eleven patients (13 feet) with Grade III or IV hallux rigidus were treated by modified oblique Keller procedure. Average age was 64.7 years and followup was 27.2 months. Outcomes including range of motion (ROM) of first metatarsophalengeal joint, complications, American Orthopaedic Foot and Ankle Society (AOFAS) scores, satisfaction, osteophyte recurrence, osteonecrosis, and shortening were analyzed. Preoperative and postoperative values were statistically compared. RESULTS: Mean preoperative and postoperative ROMs were 6.5 degrees and 51.9 degrees, respectively (p < 0.005). Two feet had numbness on the dorsum of the first toe. Transfer metatarsalgia occurred in one patient. Mean preoperative and postoperative AOFAS scores were 29.1 points and 93.6 points, respectively (p < 0.005). All patients had good or excellent results. There was no recurrence of the dorsal osteophyte. One patient had radiographic mottling of the first metatarsal head. Average preoperative and postoperative first toe length was 124.3 mm and 123.1 mm, respectively. CONCLUSION: This technique was a good treatment alternative for patients with end-stage hallux rigidus. It was a safe and reliable procedure that preserved range of motion and has good outcomes.

Bilateral staged total knee arthroplasty in obese patients.

INTRODUCTION: The purpose of this study was to compare the clinical and functional results and complications associated with staged bilateral total knee arthroplasty (TKA) performed 4-11 days apart during a single hospitalization in patients who were obese and patients who were not obese. METHODS: We retrospectively evaluated 48 (96 knees) patients who were obese and divided into two groups based on their body mass indices (BMI). Morbidly obese patients (group A1, BMI > or = 40 kg/m2) consisted of 21 patients (42 knees), and obese patients (group A2, BMI > or = 30 kg/m2) consisted of 27 patients (54 knees). The control group (group B, BMI < 30 kg/m2) consisted of 20 non-obese patients (40 knees), who were undergoing staged bilateral procedure within the same time frame. All patients had cemented TKAs with use of posterior cruciate sparing prosthesis without patellar resurfacing. If medically stable after the first arthroplasty the patients then underwent the second arthroplasty 4-11 days later. The data on major complications and minor complications were evaluated. RESULTS: Although, there was no statistically significant difference in overall complication rates in any of the groups, the non-obese group had fewer wound complications than the other groups (P > 0.05). No significant differences in preoperative or postoperative Knee Society score, and functional score could be demonstrated between the three groups (P > 0.05). Both obese and nonobese patients showed improvements in pain and function from pre-surgery to a minimum 2 years follow-up. CONCLUSION: Results of bilateral staged TKAs in obese patients have low complication and high success rates and increased BMI has no negative effect on the early outcome. Bilateral staged TKA might be a good treatment alternative for the improvement of the patient's quality of life and functional and clinical outcomes.

Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis.

BACKGROUND: Hip fractures in patients with end-stage renal disease are associated with frequent complications. This study analyzed clinical outcomes for patients on chronic hemodialysis who sustained hip fractures and were treated with a variety of fracture repair methods. METHODS: Twenty-nine patients with thirty-two hip fractures were analyzed in three groups. Group 1 consisted of eleven hips in eleven patients with an intertrochanteric fracture that was treated with internal fixation; Group 2, thirteen hips in ten patients with a femoral neck fracture that was treated with screw fixation; and Group 3, eight hips in eight patients with a femoral neck fracture that was treated with hemiarthroplasty. The outcomes and early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were compared. RESULTS: In Group 1, eight complications occurred in six hips and nonunion developed in five hips. In Group 2, sixteen complications developed in eleven hips. Union was achieved in two of the thirteen hips, nine hips had nonunion, and two hips had osteonecrosis develop. In Group 3, only one hip had early complications, there were no late complications, and three patients died. The mean duration of follow-up was twenty-three months, and the overall mortality rate was 45%. There were no significant differences among the groups with respect to the cumulative survival proportions. Regression analysis of age, sex, and total hemodialysis duration in relation to mortality risk revealed that only age had a significant influence on mortality (p = 0.019). CONCLUSIONS: Surgical treatment of hip fractures in patients with end-stage renal disease who are on chronic hemodialysis is associated with frequent complications and a high mortality rate. Osteosynthesis is an acceptable option for treating intertrochanteric fractures and nondisplaced femoral neck fractures, but displaced femoral neck fractures should be treated with hemiarthroplasty.

Glove punctures in major and minor orthopaedic surgery with double gloving.

We assessed the frequency of glove perforation during major and minor orthopaedic surgeries, in order to determine the efficacy of double gloving. A total number of 1528 gloves (622 inner and 906 outer) used in 200 procedures (100 major-100 minor), and 100 pairs of unused gloves were examined. Glove perforation rate, incidence among surgical team, location of perforation and duration of surgery were compared. The overall perforation rate was 15.8% (242/1528). Perforation rates for major versus minor surgical procedures were 21.6% and 3.6%, respectively. The perforation rate for the unused control group was 1% (2/200). Inner-outer gloves perforation rates were 3.7% (23/622) and 22.7% (206/906), respectively. Surgeons had a higher perforation rate compared with the other staff. The right thumb and left index finger had more punctures than other fingers. Routine use of double gloving during orthopaedic procedures is recommended, because this significantly reduces the perforation of inner gloves.

[Symptomatic lumbar intraspinal synovial cyst: a case report]. / Semptomatik lomber intraspinal sinovyal kist: Olgu sunumu.

Synovial and ganglion cysts, also known as juxta-facet cysts, are intraspinal lesions that may mimic disc herniations and cause radicular symptoms. A 75-year-old male patient presented with a 6-month history of left leg pain and numbness in the foot that increased in severity within the past week. Physical examination showed motor deficit of the left extensor hallucis longus muscle (4/5) and hypoesthesia on the left L4-5 dermatomes. Magnetic resonance imaging revealed an intraspinal cyst originating from the L4-5 facet joint. Medial facetectomy and cyst excision were performed, which provided immediate relief of pain. He had no loss of strength of the extensor hallucis longus muscle and his neurologic examination was normal during the first postoperative year.