The 2D and 3D MR arthrographic description of aponeurotic expansion of supraspinatus tendon and biceps tendon anomaly in a large patient cohort.

OBJECTIVE: To describe the aponeurotic expansion of supraspinatus tendon (AEST) and biceps tendon abnormalities with magnetic resonance (MR) arthrographic examinations and determine their prevalence in patients, we performed a high-resolution 3D direct MR arthrography. MATERIALS AND METHODS: This was a retrospective study of 700 shoulder MR arthrograms performed between May 2010 and January 2022. Extension in the coronal plane of an AEST on 3D fat-suppressed T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography was identified. Based on its morphology, the AEST on MR arthrography was divided into four subtypes: absence of tendinous thickness in the bicipital synovial surface or intra-synovial tendon-like structure in the bicipital groove, thin and flat tendinous thickness ≥1 mm of bicipital synovium, oval tendinous structure less than half the size of the adjacent biceps tendon, oval tendinous structure more than half the size of the adjacent biceps tendon, and oval tendinous structure larger than the adjacent biceps tendon. Based on its origin and termination, aponeurotic expansions can be divided into three subtypes: proximal pulley zone, middle humeral neck zone, and distal myotendinous junction zone. Association with the biceps synovium of the AEST was categorized into three types: intra-synovial, extra-synovial, and trans-synovial. RESULTS: An AEST in the anterior shoulder joint in 3D VIBE MR arthrography images was identified in 63 (9%) of 700 arthrograms. The most common arthrographic type of AEST was type 1-this was detected in 39 of 63 patients. The most common course type of the AEST was anteriorly midline. The most common distal insertion type was at the tenosynovial sheath of the long head of the biceps tendon (LHBT) in the middle humeral neck zone-this was detected in 31 of 63 patients. There were only 10 MR arthrograms biceps tendon abnormality, including 4 biceps agenesis and 6 split ruptures. CONCLUSION: A 2D and high-resolution 3D MR arthrography can demonstrate the anatomical detail around the bicipital groove and facilitate the differentiation between a biceps tendon anomaly and an AEST. On high-resolution 3D MR arthrographic images, the AEST tends to be in the anterior midline and anteromedial portions of the biceps synovium with intra-synovial, extra-synovial, and trans-synovial courses and its three different insertion types.

Bilateral Simultaneous Primary Patellar Giant Cell Tumors.

Giant cell tumor is a relatively frequent benign bone tumor; that is usually exhibited in the epiphyseo-metaphyseal region of long bones. Computed tomography and magnetic resonance imaging may show cortical thinning and endosteal scalloping of the bone cortex in giant cell tumors. In radiologic imaging, the giant cell tumor of the bone is a heterogeneous mass because it contains many components, such as solitary mass, cystic areas, and bleeding. The occurrence of giant cell bone tumor in the patella is a rare condition and in this letter, we have reported the unusual coexistence of giant cell tumor on the bilateral patella at the same time. To the best of our knowledge, there is no reported case in the literature of bilateral patellar giant cell tumors.

Mortality-Related Risk Factors in Geriatric Patients with Hip Fracture.

BACKGROUND: Mortality rates after hip fractures increase by up to 30% with age. This study investigated the contribution of various parameters to prognosis and mortality. METHODS: Our study prospectively examined patients with hip fracture aged 65 years and over who applied to the Atatürk University Medical Faculty Hospital Orthopedics Service in 2020-2021. RESULTS: The 120 patients included in the study had a mean age of 79.71±7.27 years, and 51.7% were female. Twenty patients (16.7%) died within the first 30 days after a hip fracture. They had a significantly lower median Lawton-Brody instrumental activities of daily living (IADL) scale score (p=0.045) and a higher rate of malnutrition according to the Mini Nutritional Assessment (MNA) score (p=0.016). Additionally, these patients with 30-day mortality had a significantly lower rate of surgical treatment (p=0.027) and a longer time from injury to surgery (p=0.014). The time to surgery was a significant independent risk factor for 30-day mortality, with each 1-hour delay increasing the odds of mortality by 1.066 (odds ratio [OR]=1.066; 95% confidence interval [CI], 1.001-1.013; p=0.013). In addition, the presence of malnutrition was another independent risk factor that increased the odds of mortality by 4.166 times (OR=4.166; 95% CI, 1.285-13.427; p=0.017). CONCLUSION: We recommend placing more importance on supportive treatment in patients presenting with hip fractures, especially in those with malnutrition; performing surgical intervention as early as possible; and more closely following up with patients with the aforementioned risk factors.

Corticosteroid, Platelet-Rich Plasma, and Ozone Injections for Sinus Tarsi Syndrome.

BACKGROUND: Sinus tarsi syndrome is characterized by permanent pain on the anterolateral side of the ankle due to chronic inflammation characterized by fibrotic tissue remnants and synovitis accumulation after repeated traumatic injuries. Few studies have documented the outcome of injection treatments for sinus tarsi syndrome. We sought to determine the effects of corticosteroid and local anesthetic (CLA), platelet-rich plasma (PRP), and ozone injections on sinus tarsi syndrome. METHODS: Sixty patients with sinus tarsi syndrome were randomly divided into three treatment groups: CLA, PRP, and ozone injections. Outcome measures were visual analog scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), Foot Function Index, and Foot and Ankle Outcome Score before injection compared with 1, 3, and 6 months after injection. RESULTS: At the end of months 1, 3, and 6 after injection, significant improvements were observed in all three groups compared with baseline (P < .001 for all). At months 1 and 3, improvements in AOFAS scores were similar in the CLA and ozone groups; those in the PRP group were lower (P = .001 and P = .004, respectively). At month 1, improvements in Foot and Ankle Outcome Score were similar in the PRP and ozone groups and higher in the CLA group (P < .001). At 6-month follow-up, there were no significant differences in visual analog scale and Foot Function Index results among the groups (P > .05). CONCLUSIONS: Ozone, CLA, or PRP injections could provide clinically significant functional improvement for at least 6 months in patients with sinus tarsi syndrome.

Detection of the glenoid bare spot by non-arthrographic MR imaging, conventional MR arthrography, and 3D high-resolution T1-weighted VIBE MR arthrography: comparison with CT arthrography.

OBJECTIVES: To determine the diagnostic accuracy of non-arthrographic MR imaging, conventional MR arthrography, and 3D T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography sequences as compared with a CT arthrography in the diagnosis of glenoid bare spot. METHODS: A retrospective study of 216 patients who underwent non-arthrographic MR imaging, conventional MR arthrography, VIBE MRI arthrography, and CT arthrogram between January 2011 and March 2022 was conducted. The diagnostic accuracy of non-arthrographic MR imaging, direct MR arthrography, and VIBE MRI arthrography in the detection of glenoid bare spot was compared with that of CT arthrography. All studies were reviewed by 2 MSK radiologists. Interobserver agreement for MR imaging and MR arthrographic findings was calculated. RESULTS: Sixteen of 216 patients were excluded. Twenty-three of 200 shoulders had glenoid bare spot on CT arthrographic images. The glenoid bare spot was detected in 11 (47.8%) and 7 (30.4%) patients on conventional non-arthrographic MR images and in 18 (78.3%) and 16 (69.6%) patients on conventional MR arthrograms by observers 1 and 2, respectively. Both observers separately described the bare spot in 22 of 23 patients (95.7%) on 3D volumetric MR arthrograms. Interobserver variabilities were fair agreement for conventional non-arthrographic MR imaging (κ = 0.35, p < 0.05), moderate agreement for conventional MR arthrogram (κ = 0.50, p < 0.05), and near-perfect agreement for 3D volumetric MR arthrogram reading (κ = 0.87, p < 0.05). CONCLUSIONS: A 3D high-resolution T1-weighted VIBE MR arthrography sequence may yield diagnostic performance that is comparable with that of CT arthrography in the diagnosis of glenoid bare spot. KEY POINTS: •Glenoid bare spot should not be misdiagnosed as a transchondral defect of the glenoid surface by radiologists. •A 3D high-resolution T1-weighted VIBE MR arthrography sequence may be used as a high-sensitivity imaging technique in the diagnosis of glenoid bare spot.

Ultra-low-dose computed tomography and its utility in wrist trauma in the emergency department.

BACKGROUND: The use and frequency of computed tomography (CT) are increasing day by day in emergency departments (ED). This increases the amount of radiation exposed. PURPOSE: To evaluate the image quality obtained by ultra-low-dose CT (ULDCT) in patients with suspected wrist fractures in the ED and to investigate whether it is an alternative to standard-dose CT (SDCT). MATERIAL AND METHODS: This is a study prospectively examining 336 patients who consulted the ED for wrist trauma. After exclusion criteria were applied, the patients were divided into the study and control groups. Then, SDCT (120 kVp and 100 mAs) and ULDCT (80 kVp and 5 mAs) wrist protocols were applied simultaneously. The images obtained were evaluated for image quality and fracture independently by a radiologist and an emergency medical specialist using a 5-point scale. RESULTS: The effective radiation dose calculated for the control group scans was 41.1 ± 2.1 µSv, whereas the effective radiation dose calculated for the study group scans was 0.5 ± 0.0 µSv. The effective radiation dose of the study group was significantly lower than that of the control group (P < 0.01). The CT images in the study group showed no significant differences in the mean image quality score between observer 1 and observer 2 (3.4 and 4.3, respectively; P = 0.58). Both observers could detect all fractures using the ULDCT images. CONCLUSION: ULDCT provides high-quality images in wrist traumas while reducing the radiation dose by approximately 98% compared to SDCT without any changes in diagnostic accuracy.

Simultaneous versus staged surgeries for the treatment of bilateral developmental hip dysplasia in walking age: A comparison of complications and outcomes.

OBJECTIVES: This study aims to compare the radiological outcomes and rate of complication between single-stage and staged operation for the treatment of bilateral developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: A total of 100 patients (13 males, 87 females; mean age: 18.1±2.1 months; range, 12 to 36 months) with bilateral DDH who were older than 15 months of age and treated with open reduction (OR) or Pemberton pericapsular osteotomy (PPO) were retrospectively analyzed. Of the patients, 48 were operated with OR and 52 were operated with PPO. Improvements in acetabular indices, presence of avascular necrosis, radiological results, and other complications were noted. RESULTS: There was no statistically significant difference in the preoperative acetabular indices, range of International Hip Dysplasia Institute (IHDI) classification, follow-up period, and age at the time of operation between the groups (p>0.05). There was no statistically significant difference in the acetabular indices, rate of avascular necrosis, and radiological results at the end of 24 months of follow-up between the groups (p>0.05). CONCLUSION: Our study results show no significant difference in the radiological outcomes and complications between simultaneous and staged surgeries for the treatment of bilateral DDH in children in the walking age.

The effects of Tendoflex® (polytendon complex) and Hypericum perforatum (St. John's wort oil) on repaired Achilles tendon healing in rats.

OBJECTIVES: This experimental study aims to examine the effects of Tendoflex® and Hypericum perforatum on tendon healing in rat models undergoing iatrogenic Achilles tendon rupture and similar surgical treatments. MATERIALS AND METHODS: Eighty Wistar albino rats weighing 250 to 350 g were randomly divided into four groups. Group A: Tendoflex® was administered orally as 1 capsule/2.5 kg daily by gavage. Group B: Hypericum perforatum was administered orally as 300 mg/kg daily by gavage. Group C: Tendoflex® and Hypericum perforatum were co-administered orally by gavage at the prespecified doses. Group D: No medication was given to the control group. Five rats from each group were sacrificed weekly, and the tissue samples were examined histologically, followed by the biomechanical tests of the Achilles tendon. RESULTS: In the mechanical testing, pulling forces were superior in all intervention groups and in all weeks over the control group. In particular, in the early periods (Weeks 1, 2, and 3), the mixed group showed the most favorable results, followed by the Hypericum perforatum group (p=0.010, p=0.591, and p=0.130, respectively). The most favorable collagen type I and type III expression values were found in the mixed and Hypericum perforatum groups at Weeks 2 and 3, respectively (p=0.025 and p=0.018). In the immunohistochemical and Western Blot examinations, extreme collagen type I and type III expression were detected in the mixed and Hypericum perforatum groups at Weeks 2, 3, and 4. CONCLUSION: Tensile strength of the Achilles tendon increased by using Hypericum perforatum and Tendoflex® following rupture and repair of the Achilles tendon in rats. The combined use of these two agents yielded the most favorable mechanical and histological results, particularly in the early period. This result may be related to the higher level of collagen type I and type III immunity in all groups, compared to the control group.

New bone cements with Pluronic®F127 for prophylaxis and treatment of periprosthetic joint infections.

In line with the increase in orthopedic prosthetic surgeries, there has been a significant rise in periprosthetic joint infections (PJI) due to Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteria. In case of infection, antibiotic-added spacers are temporarily placed into the periprosthetic region. With the release of antibiotics usually failing to work in fighting off infection, recent studies have centered around developing more effective approaches. New polymethylmethacrylate (PMMA) cement mixtures were prepared for this study with Pluronic®F127, bicarbonate, and citric acid addition. Optimal solutions were searched by monitoring vancomycin release on consecutive days with HPLC in in-vitro. The strengths of the samples were measured via four-point bending tests. Compared to conventional PMMA, strength values were observed to have improved by about 20% with 1.0 g of Pluronic®F127. According to HPLC studies, the highest increase for the area under the curve value was obtained for Pluronic®F127 doped mixture with a value of about 20%. It is understood from SEM and BET studies that addition of Pluronic®F127 helps increase porosity. The present study concludes that the optimum concentration of Pluronic®F127 could improve the strength and drug-releasing capacity of the spacer by increasing its porosity.