The effects of modified hardinge approach on hip muscle strength in patients with primary hip arthroplasty: a patient evaluation with isokinetic strength test and gait analyses.

OBJECTIVE: Numerous factors affect abductor strength after Total hip arthroplasty (THA), including surgical technique, prosthesis type, postoperative rehabilitation program, and preoperative patient condition. We prospectively investigated the effects of the modified Hardinge approach on hip muscle strength, which was evaluated using the isokinetic test, functional results, and gait function of patients who underwent primary THA. METHODS: The hip muscles strength were measured using an isokinetic dynamometer. The primary outcomes of the present study were measurement of isokinetic strength of hip abductor muscle strengths using an isokinetic evaluator and gait analyses preoperatively and at 6 months postoperatively in 27 patients. RESULTS: Isokinetic muscle strength test, abductor and other hip circumference groups achieved the preoperative muscle strength at 3 months postoperatively, and the postoperative sixth month values showed a statistically significant improvement compared with the preoperative and third month values. In gait analyze, our temporospatial data showed a slight regression at postoperative 3 months but reached the same values at 6 months postoperatively. Kinematic data showed a significant regression, but the data were not compared with those in the preoperative period. CONCLUSIONS: Adequate muscle strength and physiological gait pattern, similar to the preoperative status, can be achieved at 6 months postoperatively. LEVEL OF EVIDENCE: Level III.

Is central sarcopenia a predictor of prognosis for patients with pathological fracture?

INTRODUCTION: We aimed to investigate the relationship between central sarcopenia and survival in patients with pathological fracture. METHODS: We reviewed records of patients who were treated for pathological fracture of axial and appendicular skeleton in our clinic between 2011 and 2020. We used the psoas: lumbar vertebral index (PLVI) on axial computer tomographic evaluation to assess for central sarcopenia. A multivariate Cox algorithm was applied to recognize these factors independently associated with one month, six months, one year, and overall survival. RESULTS: A total of 147 patients [61 (41.4%) male and 86 (58.6%) female] were included, with an average age of 62.4 years. During the study, 108 (73.4%) patients died, and 39 (26.6%) were alive. The survival rates at 1 month, 6 months, and 1 year after surgery were 94.6%, 68.7%, and 53.1%, respectively. PLVI values ranged from 0.21 to 1.20 with a mean of 0.536 and a median of 0.520. According to the median value of PLVI, 68 patients with sarcopenia had low PLVI and 79 patients without sarcopenia had high PLVI. For the first month, only the preoperative albumin level was identified as a prognostic factor. Eastern Cooperative Oncology Group Performance Status (ECOG), American Society of Anesthesia (ASA) scores and primary malignancy (rapid grade) were strong predictor of poor survival. The PLVI was independent significant predictor of first month (HR, 0.083 [95% CI, 0.011-0.649], p = 0.018) and overall survival (HR, 0.129 [95% CI, 0.034-0.492], p = 0.003). CONCLUSION: The PLVI was a strong predictor of first year, and overall survival in patients with pathological fracture.

Sleep-related breathing disorders in diaphragmatic pathologies.

OBJECTIVE: The diaphragm is the most significant muscle involved in breathing. There are very few studies and cases evaluating sleep-related breathing disorders in diaphragmatic pathologies. This study compares preoperative and postoperative polysomnography (PSG) and pulmonary function test (PFT) results in diaphragmatic pathologies. MATERIAL AND METHODS: The study included 28 patients who underwent video-assisted mini-thoracotomy (VATS) due to diaphragm eventration and paralysis between January 2014 and October 2019. Pulmonary function tests (PFT) and polysomnography (PSG) were performed preoperatively in all patients, and PSG and PFT were repeated 2 months after the surgery. RESULTS: Twenty-five of the 28 patients were found to have apnea-hypopnea index (AHI) ≥ 5 (89%). A significant decrease in the preoperative TST, stage 3, and REM periods was observed. Nineteen of these patients (76%) were supine isolated or supine dominant. There was a marked improvement in AHI and PFT values after the surgery. Only five patients required a PAP device. CONCLUSION: Doctors should perform PSG in patients with diaphragm pathologies, and these patients should be operated on after considering the comorbidities when OSA is detected.

Comparison of the Isolated Plantar Fascia Release Versus Plantar Fascia Release Combined With Calcaneal Decompression in Management of the Patients With Resistant Heel Pain.

We aimed to compare isolated percutaneous plantar fascia release by using a needle versus percutaneous plantar fascia release combined with calcaneal decompression in treatment of the patients with resistant heel pain. We reviewed the prospectively recorded data of patients who treated and follow-up for resistant heel pain (treated more than 6 months with other treatment modalities) with a minimum 1-year follow-up. Twenty patients were treated with plantar fascia release using a needle (group 1) and 21 patients were treated with a similar percutaneous release combined with calcaneal decompression (group 2). Functional outcomes were evaluated using visual analog scale (VAS) and Foot Function Index (FFI) pre- and postoperatively. No significant differences were observed between both groups in terms of age (44.3 years in group 1 vs 46.8 years in group 2), gender (18 females and 2 males in group 1 vs 19 females and 3 males in group 2), body mass index (25.1 in group 1 vs 26.3 in group 2), and follow-up (14.6 months in group 1 vs 15.7 months in group 2). The decrease in postoperative FFI and VAS scores compared with preoperative VAS scores was statistically significant in both groups. However, improvement of FFI and VAS score was significantly higher in group 2 than group 1. Although both methods are very effective in the treatment of persistent heel pain, the group 2 has a better improvement in functional scores than group 1 with a mean 15 months following the procedure.

Comparison of clinical outcomes of autologous bone graft versus pronator quadratus pedicled vascularized bone graft in the treatment of scaphoid nonunion.

We aimed to compare the union rate and clinical outcome of autologous bone graft versus pronator quadratus vascularized pedicled muscle flap in treatment of scaphoid nonunion. Forty patients with a diagnosis of scaphoid nonunion who underwent unilateral pseudarthrosis surgery were included in this study. Notably, the scaphoid nonunion was unilateral, and the contralateral wrist was asymptomatic with normal function, per the physical and radiological examinations. Pronator quadratus vascularized pedicled muscle flap was used in 16 patients (group 1), and autologous bone graft was used in 24 patients (group 2). Patients were compared used Scapholunate angles, Natrass carpal height ratio and Mayo wrist score pre and postoperatively. Fifteen of the 16 (93.3%) patients in group 1 and 19 of the 24 (79.2%) patients in group 2 achieved bone union. Four of twelve patients in group 2 with avascular necrosis (AVN) and one of eight in group 1 with AVN were not able to achieve union. The group 2 (34%) had higher nonunion rate than group 1 (12%) in AVN patients. The scapholunat angle was significantly decreased and the Natress ratio was significantly increased postoperatively compared to the preoperative measurement in both group. There was no statistically significant difference in the postoperative measurement. The postoperative Mayo wrist score showed no statistically significant differences between both groups. The pronator quadratus vascularized pedicled muscle flap was superior to non-vascularized bone grafting in the treatment of scaphoid nonunion with AVN. However, management of the patients without avascular necrosis is not requiring the vascularized pedicled muscle flap technique.

Cemented radial head arthroplasty: Does radiographic loosening have an effect on clinical and functional outcomes? Average 10 years' results.

PURPOSE: The aim of this study was to evaluate the possible effect of radiographic loosening on clinical and functional outcomes, while presenting the mid-term radiographic and functional outcomes of cemented, monopolar RHA applied to patients with comminuted radial head fractures. METHODS: We performed a retrospective study by evaluating the records of patients who were diagnosed in a single center with radial head fractures between 2001 and 2013. Twenty-six patients with comminuted radial head fractures with a mean age of 48.9 and a mean follow-up time of 132.2 months were included. The radiographic evaluation was performed by assessing peri-prosthetic radiolucent lines around the stem to evaluate loosening, while the clinical evaluation was performed by utilizing elbow range of motion (ROM), Mayo elbow performance score (MEPS), Oxford elbow score (OES) and quick-DASH scores. RESULTS: 13 patients (Group 1) with peri-prosthetic stem lucency were defined as radiographic loosening (50%), while the remaining 13 patients (Group 2) were not detected to have stem lucency. One patient in group 1 also had concomitant pain and underwent removal of the prosthesis, while 12 patients (92.3%) remained pain-free. On the latest follow-up visit, there was no significant difference between the groups regarding ROM, MEPS, OES and quick-DASH scores. CONCLUSIONS: Within ten years following surgery, half of the patients with radial head prostheses were noted to show radiographic signs of loosening which did not have any major negative effect in terms of clinical-functional outcomes and quality of life, except requiring the removal of the implant in one patient. LEVEL OF EVIDENCE: Level III.

Comparing the effect of tourniquet and tranexamic acid on the tibial cement mantle thickness in total knee arthroplasty.

BACKGROUND: This study aims to determine the efficacy of both tranexamic acid (TXA) and tourniquet on the tibial cement mantle thickness in total knee arthroplasty (TKA). METHODS: We retrospectively reviewed the recorded data of patients with primary end-stage knee osteoarthritis who underwent TKA procedure during 2014-2016 at a single institution to evaluate the tibial cement mantle. Patients were categorized in two groups based on the use of tourniquet (groups 1 and 2). In addition, these groups were categorized into two different subgroups based on the use of TXA in groups 1 and 2 (group 1-A, B and group 2-A, B). Four zones at the tibial baseplate on the anteroposterior view and two zones on the lateral view were measured at the 4-6-week postoperative visit. RESULTS: A total of 28 patients (30 knees) were operated using tourniquet and TXA (group 1-A), 29 (30 knees) using tourniquet without TXA (group 1-B), 24 (28 knees) using TXA without tourniquet (group 2-A), and 38 (42 knees) without using TXA and tourniquet (group 2-B). Although a significant difference was found in the cumulative cement mantle penetration on postoperative X-rays between groups 1 and 2, no significant differences were found between groups A and B in both groups. CONCLUSIONS: This study reports that tourniquet use in TKA increased cement mantle penetration of the tibial component in primary TKA. The main strength of this study was that the TXA use alone exhibited no significant effect on the cement thickness.

The effect of oral magnesium supplementation on acute non-specific low back pain: Prospective randomized clinical trial.

OBJECTIVE: We aimed to investigate the effect of oral magnesium supplementation for acute low back pain. METHODS: This is a three-arm, prospective randomized open label clinical trial, which included two hundred and forty patients. We based our sample size calculation assumptions on a recently published clinical trial, thus we enrolled 80 patients for each group. NSAID alone group included (400 mg etodolac twice a day), NSAID + mg group included NSAID - magnesium combination treatment (400 mg etodolac twice a day with 365 mg oral magnesium supplementation) and NSAID + paracetamol group included NSAID - paracetamol combination treatment (400 mg etodolac twice a day with 500 mg paracetamol twice a day). Follow-up visits after initiation of relevant treatment were performed at 4th and 10th days and outcome measures included pain (Visual analogue scale - VAS), mobility of lumbar spine and functional outcome (RMDQ). RESULTS: Thirty-one patients were considered lost to follow-up or excluded due to use of other medications and final analysis was performed with 209 participants in three groups (71 patients in NSAID alone group, 68 patients in NSAID + mg group and 70 patients in NSAID + paracetamol group). NSAID + mg showed a significantly higher improvement in RMDQ and VAS scores at acute stage (at 4th day visit) compared to two other study groups However, there was no significant difference between three groups in terms of mean improvement of RMDQ, VAS scores and lumbar mobility between initial visit and 10-day. CONCLUSION: Results of this study suggest that addition of magnesium to acute low-back pain treatment does not significantly improve final clinical outcomes. LEVEL OF EVIDENCE: Level I, prospective randomized controlled study.

Which inflammatory marker is more reliable in diagnosing acute septic arthritis in the pediatric population?

BACKGROUND: The present study aimed to investigate diagnostic values of C-reactive protein (CRP), white blood cell (WBC), erythrocyte sedimentation rate (ESR), neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio as possible indirect inflammatory markers in children with septic arthritis (SA) for diagnosis process. METHODS: The medical records of pediatric patients with SA who underwent debridement surgery between February 2005 and November 2018 were obtained from the hospital records. A total of 59 children with SA and 60 age- and gender-matched healthy controls were enrolled in the study. Hemograms parameters including WBC count, neutrophil count, lymphocyte count, hemoglobin, platelet count, CRP, ESR, NLR, and platelet to lymphocyte ratio. Biochemical parameters including alanine transaminase, aspartate aminotransferase, blood urea nitrogen, creatinine, glucose, and albumin were investigated and compared between both groups. RESULTS: Fifty-nine patients, 30% female (n: 18) and 70% male (n: 41), who had received operations for SA were included in the study. The mean age of the patients was 7.1 (range 6 days to 15 years) years and mean follow up 56.6 (12-140) months. No significant differences were observed in any biochemical parameters between the groups. However, a significant difference was found between the septic arthritis and the control group in all hemogram parameters. CONCLUSIONS: Although the sensitivity and specificity of the NLR are lower than CRP, ESR, and WBC which are most commonly used inflammatory parameters in diagnosis process of septic arthritis, NLR may be useful in confirming the diagnosis in the clinical practise, with an optimum diagnostic cut-off value of 4.05.

Clinical outcomes comparison of distal radius fractures between two conservative treatment methods: Below-arm cast versus reverse sugar tong splint.

BACKGROUND: The purpose of this prospective randomized study was to compare a new reverse sugar tong splint technique with a below-arm cast, in terms of patient radiological and clinical outcomes. METHODS: One hundred and forty patients who presented to our clinic between April 2017 and March 2019 were randomly divided into two groups: 70 received reverse sugar tong (RST group) and 70 received below arm cast (BAC group). Clinical and radiological follow-up was performed 7-10 days, three weeks, 5 or 6 weeks, 12 weeks and one year after the treatment. Clinical outcomes including wrist range of motion, complication rates, Health Assessment Questionnaire (HAQ) score at end of treatment, Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire and Mayo Elbow Performance score (MEPS) score at 12 weeks and last follow-up. RESULTS: Finally, sixty-five patients were treated with BAC, and their average age was 58.2 years and sixty-two patients with an average age of 57.4 years were treated with RST were completed the radiological and clinical one-year follow-up. There were no significant differences in range of motion, radiological parameters, the Q-DASH and MEPS scores between the groups the 12th week and last visit; however, the HAQ score was significantly higher in the cast group during the 6th visit (p < 0.001). The BAC group had a higher complication rate (40%) than the RST group (19.3%) (p = 0.01). CONCLUSION: Patient treated with RST had a higher functional status at end of treatment and lower complications when comparing traditional below arm cast. LEVEL OF EVIDENCE: Level I prognostic randomized controlled trial.

Effect of lengthening speed on the quality of callus and complications in patients with congenital pseudarthrosis of tibia.

PURPOSE: This study aims to evaluate the effect of lengthening speed on the quality of callus and complications during distraction osteogenesis and describe an optimal lengthening speed in patients with congenital pseudarthrosis of tibia (CPT). METHODS: Twenty-seven patients with CPT with a minimum follow-up of 36 months who underwent limb lengthening surgery between 1997 and 2016 with external fixator only were included in this study. All patients underwent lengthening procedures after achieving complete bone union in this study. Regenerate quality is evaluated according to the Li classification on the X-ray taken one month after the end of the distraction period. Complications were noted in post-operative follow-up period. Receiver operator characteristics (ROC) curve analysis was performed to obtain optimal lengthening speed for these patients. RESULT: The mean age at the time of surgery was 5.74 years. The mean lengthening speed was 0.596 mm/day. Follow-up period of 136.14 months with a mean lengthening period of 92.4 days. Mean amount of lengthening was 5.44 cm for patients with CPT. Total rate of callus with good morphological quality was calculated as 66%. According to ROC analysis, optimal cut-off values of lengthening speed for the obtaining good morphological quality callus was 0.564 mm/day for tibial lengthening in CPT. There was a significantly positive correlation between complication rate and lengthening speed for each group. CONCLUSION: We recommend a mean lengthening rate of 0.56mm/day for the lengthening procedures with external fixator in patients with CPT who had complete bone union at the area of pseudarthrosis.

Effect of lower extremity amputation on caregiving burden in caregivers of patients with diabetic foot: Prospective cohort study.

Lower extremity amputation as a treatment of diabetic foot ulcer is probably a major burden for the patient's family and friends, who typically act as caregivers and support the patient in coping with the physical disabilities and emotional distress. In the present prospective study, we investigated the effects of different lower extremity amputation levels for diabetic foot ulcer treatment on caregivers of patients with diabetes using the Zarit Burden Interview (ZBI-12) scale. Patients with diabetic foot ulcers who underwent unilateral major amputation (above-below knee) and minor amputation of foot (heel sparing) and their caregivers were requested to volunteer to participate in this study from June 2016 to December 2018. The ZBI-12 form was completed immediately preoperatively and 3 and 6 months after postoperatively. In the minor amputation group, the mean age of the 51 patients was 72.1 years. In the major amputation group, the mean age of the 88 patients was 73.7 years. Both groups of caregivers of patients with minor amputation and major amputations showed a significant improvement in ZBI-12 score when compared preoperatively and at 3- and 6-month follow-up visits. The mean ZBI-12 score was significantly higher in the major than in the minor amputation group in preoperative and all postoperative visits. The absence of the ankle joint in the below- or above-knee amputation renders it more difficult for the amputee to quickly learn the use of prosthesis, thereby increasing the burden of the patient and caregivers. We found that lower extremity amputation for the treatment of chronic diabetic foot ulcers has significantly favourable effect on the caregiver burden, and thereby heel sparing was considerably more effective for the caregiver burden.

Arthroscopic versus open release of internal rotation contracture in the obstetrical brachial plexus paralysis (OBPP) sequela.

BACKGROUND: Latissimus dorsi (LD) and teres major (TM) tendon transfers are effective surgical procedures to improve shoulder abduction and external rotation for children with obstetrical brachial plexus palsy (OBPP). Open pectoralis major (PM) tendon Z-plasty and arthroscopic subscapularis (SS) release are 2 options for the release of internal rotation contractures to enhance muscle transfers. This study compared the functional results of LD and TM tendon transfers with open PM tendon Z-plasty or arthroscopic SS release. METHODS: The study included 24 patients who underwent LD and TM tendon transfers for OBPP (9 arthroscopic SS release, 15 open PM tendon Z-plasty) with a mean follow-up of 41.33 months (range, 36-60 months) and 47.2 months (range, 36-60 months), respectively. Functional evaluation was made according to range of motion and Mallet scoring system. RESULTS: Shoulder abduction-external rotation degrees and scores in all sections of the Mallet scoring system significantly increased in both groups (P < .001). Postoperatively, the arthroscopic SS release group had significantly better abduction degrees (P = .003), total Mallet scores (P < .001), and superior abduction (P = .043), active external rotation (P = .043), hand-to-head (P = .043), and hand-to-mouth (P < .001) scores for the Mallet scoring system. DISCUSSION: Transfer of LD together with TM tendons combined with one of the internal rotation contracture release procedures yielded good clinical and functional results in patients younger than age 7, regardless of the type of release method. However, arthroscopic SS release, although requiring an experienced surgeon, revealed better clinical and functional outcomes and is considered to be a less invasive and superior method.

Prognostic factors affecting survival of patients with pathologic humerus shaft fractures treated with intramedullary nailing without tumor removal.

BACKGROUND: Intramedullary nailing is the procedure of choice for pathologic fractures in humeral shaft because it allows early pain relief and mobilization. The aim of this study was to analyze the prognostic factors affecting survival of patients with pathologic humeral shaft fractures treated with intramedullary nailing without tumor removal. METHODS: We performed a retrospective study by evaluating the records of patients treated in our clinic between 2003 and 2018 for pathologic humerus shaft fractures with a minimum follow-up of one year. Kaplan-Meier methods were applied to estimate overall survival. A multivariate Cox algorithm was applied to recognize factors independently associated with survival. RESULTS: 52 patients (56 humeral fractures) were operated. The average age at the time of surgery was 58.9 years. There were 28 women and 24 men. In our series, multiple myeloma accounted for 52% of the cases. At the time of this study, 34 (65.3%) patients had deceased. Survival rates at first month, 6 months and 1 year after surgery were 96.2%, 67.4% and 59.6%, respectively. The median survival after surgery was 7.5 (6 days-84 months) months for deceased patients and 18 (34.7%) surviving patients with a median survival of 68.6 months. Rapid growth tumor, presence of pathological fracture in other extremities and, Eastern Cooperative Oncology Group performance status (ECOG-PS) were independently associated with a worse overall survival. CONCLUSION: More than 50% of patients with pathological humerus shaft fractures were diagnosed with multiple myeloma. Rapid growth tumors such as lung cancer and renal cell cancer increased mortality by a factor of 1 while presence of operative metastases in other extremities increased mortality by a factor of 3.1 and ECOG-PS increased mortality by a factor 6.8. Rapid growth tumors, ECOG-PS and presence of pathological fracture in other extremities were important prognostic factors influencing overall survival.

Evaluation of risk factors for stiffness after distal humerus plating.

PURPOSE: In distal humerus fractures, the goal is to achieve a functional range of motion of 30°-130° which is not always possible. The aims of the study were to evaluate the functional results after distal humerus fracture operation and to investigate the risk factors for stiffness. METHODS: Between 2005 and 2014, 75 patients with the mean age of 37.8 years (17-80) underwent open reduction and plate fixation for distal humerus fractures. Range of motion (ROM), Mayo elbow performance scores, and quick DASH scores were used for functional evaluation. Patients were divided into two groups according their ROM. Group 1 had > 100° of extension-flexion ROM and group 2 had < 100°. Older age (> 60), AO type C2-3 fracture, open fracture, longer injury-surgery interval, type of plating, and presence of olecranon osteotomy were investigated as risk factors for poor outcome. RESULTS: At a mean follow-up of 25 months (6-80), 40 patients were in group 1 and 35 patients were in group 2. Group 1 had significantly better functional scores than group 2. AO type C2 and C3 fracture (odds ratio (OR) 16.6, p < 0.0001) and injury-surgery interval longer than 7 days (OR 2.59, p 0.047) were found as significant risk factors for stiffness. CONCLUSIONS: Patients who had distal humerus fracture should be informed about the risk of elbow stiffness especially in AO type C2-C3 fractures and surgical treatment should be planned without any delay.

Conservative management equally effective to new suture anchor technique for acute mallet finger deformity: A prospective randomized clinical trial.

STUDY DESIGN: Prospective randomized controlled trial. PURPOSE OF THE STUDY: This study was designed to compare our new suture anchor technique with conservative management in acute Wehbe-Schneider type I A-B and II A-B mallet fingers. METHODS: Twenty nine patients who presented to our clinic between 2013 and 2015 were randomized for surgical or conservative treatment. Wehbe-Schneider subtype C fractures were excluded. Fourteen were treated with surgery, and 15 were treated with conservative treatment. Primary outcomes were visual analog scale score, active distal interphalangeal (DIP) joint flexion, return to work, extension deficit and DIP joint degeneration. Follow-up time was 12 months. RESULTS: The mean visual analog scale was 2.0, and return to work was on average in 63.2 days in the surgical group and 1.47 and 53.7 days in the conservative group. Extension deficit was 8.1° in the surgical group and 6.1° in the conservative group. The mean DIP flexion at final follow-up was 54.5° (40-65) in the surgery group and 58.3° (45-70) in the conservative group. DIP joint degeneration was observed with X-rays in 4 patients in surgical group, and none of the patients in the conservative group had DIP degeneration at 1 year after treatment. CONCLUSIONS: The therapeutic effectiveness of suture anchor technique was not statistically different from conservative treatment. Subluxation seen after fixation treatment with suture anchors may be due to inadequate anchor fixation. DIP joint degeneration was seen significantly more in the surgical group. Our study suggests that the new suture anchor technique is not superior to conservative treatment. LEVEL OF EVIDENCE: Ib.

Calcaneal Ewing's Sarcoma With Skip Metastases to Tarsals and Lymph Node Involvement: A Case Report.

Ewing's sarcoma (ES) represents the second most common primary malignant tumor of bone of children and occurs rarely in the bones of the foot. Dissemination to regional lymph nodes and skip metastases to adjacent bones are thought to be uncommon. We report a case of a 19-year-old female with the diagnosis of ES of the right calcaneus. Six months earlier, she had presented to the hospital with a history of ankle sprain and was treated with analgesics and ice application. Despite the treatment, the pain over the ankle persisted, her foot swelled progressively, and a mass evolved on the lateral side of the foot. She was referred to our clinic for further treatment options. Radiography and magnetic resonance imaging revealed an expansile mass originating from the calcaneus with talar and cuboidal skip metastases, with concomitant popliteal and inguinal lymph node involvement. The diagnosis was confirmed by histopathologic evaluation after Tru-Cut biopsy. Below-the-knee amputation with popliteal and inguinal lymph node dissection was performed after neoadjuvant chemotherapy. The postoperative first-year follow-up data for the patient showed no evidence of metastasis. The calcaneus is a rare location for the development of ES. A few patients with ES will present with skip metastases to adjacent juxtaarticular bones or regional lymph node involvement. Therefore, the present study has presented a unique case of ES with a rare anatomic location and an unusual metastatic pattern.

Rare radiological manifestation of enchondromatosis in children: Columnar pattern: A retrospective cohort study.

The columnar cartilage pattern is characterized by parallel aligned cartilage tissue columns related to the physis without matrix calcification separated by the surrounding osseous tissue. Usually, it is seen in patients with multiple enchondromas. The objective of this study was to elucidate the clinical and radiological features of this rare radiological pattern in the physis, which remains unfamiliar to most physician. We retrospectively evaluated the clinical features and imaging findings of 15 patients (9 men and 6 women) who have a columnar pattern with varied spectrum of enchondromatosis. On X-ray and computed tomography (CT) examination, all these lesions were seen as vertical or oblique oriented tubular zones, which have relatively low radiologic density compared with normal bone. The lesions have similar signal characteristics relative to epiphyseal cartilage plates, on T1W and T2W magnetic resonance images. Columnar pattern was observed in different appearances from one single column in one physis to multiple columns in multiple physis. The mean follow-up was 62 months (range: 36-96 months). The mean age was 9.7 (range: 4-14) years at the initial admission. Eight patients had 3 or less affected physis. Five patients had only one affected physis. We defined these patients' group who had up to 3 affected physis as "limited enchondromatosis with columnar pattern (LE-CP)." We observed that most of the columnar cartilage was turning into the normal bone via endochondral ossification. Based on our observations, the columnar pattern is a rare manifestation of the enchondromas. Columnar pattern, along with the related physis, acts as a normal endochondral ossification process, and surgery is not necessary unless there is a risk of fracture or severe deformity. Further awareness of this unique subset of patients may improve our understanding of the disease and lead to better patient outcomes. We have modified non-hereditarily enchondromatosis into 2 categories: limited enchondromatosis with the columnar pattern and multiple enchondromatosis. We believe that LE-CM reflects a developmental anomaly of the physis rather than a true neoplasia, and it acts as a normal endochondral ossification process. Level IV (case series).

Which factor is more associated with survival of patients with hip fracture over 90 years: Type of fracture or treatment modality?

OBJECTIVE: We aimed to analyze prognostic factors affecting the mortality and to evaluate whether the fracture type (collum femoris or intertrochanteric fracture) or treatment method (proximal femoral nail or hemiarthroplasty) affects the mortality in patients with hip fractures and older than 90 years old. METHODS: In our study, we retrospectively reviewed the patients aged >90 years and operatively treated hip fractures. Patients were categorized according to fracture type and treatment method. Finally, three groups were created. Demographic values, laboratory values were analyzed for prognostic factors and determining independent factors associated with survival for each group. RESULTS: A total of 193 patients were included with an average age of 92.5±2.4 (range, 90-104) years. There were 144 women and 49 men. There were 126 (65.2%) patients with intertrochanteric fracture and 67 (34.8%) patients with collum femoris fracture. At the time of this study, 142 (73.5%) patients had deceased. Staying in intensive care unit for collum femoris group, general anesthesia for intertrochanteric fracture treated with hemiarthroplasty group and delay to surgery and preoperative albumin level for intertrochanteric fracture treated with proximal femoral nail group were associated with poor survival. CONCLUSION: Staying intensive care unit, general anesthesia, delay to surgery and preoperative albumin levels should be carefully evaluated for patients aged over 90 years with hip fractures. Our study showed that both fracture type and treatment modality were not associated with poor overall survival of the patients aged >90 years following hip fracture surgery.

A Novel Operation Technique for Forearm Deformities in Patients with Brachial Plexus Birth Injury: Retrospective Analysis of 14 Patients.

Background: We aimed to evaluate the effectiveness of our novel operation technique that included radial shaft shortening plus supination producing osteotomy and transfer of the biceps brachii tendon to the brachialis tendon in patients with chronic radial head dislocation secondary to brachial plexus birth injury (BPBI). Methods: Fourteen patients with chronic radial head dislocation resulting from BPBI were included in this study, with a minimum 1-year postoperative follow-up period. All patients underwent the same surgical procedure. The range of motion of affected elbow was measured with a standard goniometer. The Mayo Elbow Performance Score (MEPS) was used to measure for evaluation of functional result of these patients. The affected elbow radiograph also obtained in the last visit for evaluation of compatibility of the radiocapitellar joint. Results: Fourteen patients (10 males and 4 females) were included in the study. The average age at the time of surgery was 7.2 (5-8) years and average follow-up was 73.2 ± 19 (36-131) months. Although the forearm active-passive pronation decreased, active-passive supination significantly improved postoperatively (p < 0.001). Ten patients had excellent MEPS results (90 and above), two patients with good results (75 and 80), one patient with fair (65) and one patient with poor result (55). Radiocapitellar reduction was achieved in 78.5% (11/14) of the patients. Conclusions: The novel surgical techniques that included radial shaft shortening plus supination producing osteotomy and transfer of the biceps brachii tendon to the brachialis tendon improved the functional outcomes of patients with chronic radial head dislocation secondary to BPBI. Level of Evidence: Level IV (Therapeutic).