The comparison of bedside point-of-care ultrasound and computed tomography in elbow injuries.

OBJECTIVE: The objective of the study was to compare the efficacy of point-of-care ultrasound (POCUS) and computed tomography (CT) in the diagnosis of the fracture of the bones that form the elbow joint and the determination of treatment method in elbow injuries. METHODS: Forty-nine patients aged 5 to 65 years, who were admitted with low-energy elbow injuries, had at least 1 fracture of the elbow joint bones, and underwent CT scanning, were included in this study. Before the initiation of the study, orthopedic surgeons and emergency physicians determined a common treatment based on the fracture characteristics. Patients were first evaluated with direct radiography, and then with POCUS by trained emergency physicians. Emergency physicians made treatment decisions based on the ultrasonography results. Then, CT scans were performed. The CT images were interpreted by radiologists. Orthopedic surgeons made treatment decisions based on the CT interpretations. RESULTS: Forty-nine patients with elbow injury were included in the study. Eighteen (37%) patients were women, and 31 (63%) were men. The mean age was 21 ± 15 years. Compared with CT, sensitivity, specificity, positive predictive value, and negative predictive value of POCUS in fracture detection were 97%, 88%, 94%, and 93%, respectively. Although the sensitivity and specificity of POCUS in the decision for reduction were 95% and 100%, respectively, it was 93% and 100% in the decision for surgery. CONCLUSION: In conclusion, POCUS was shown to be successfully applied in the diagnosis and management of elbow injuries, in which direct radiography was inefficient and CT scans were required.

Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures.

OBJECTIVE: The aim of the study was to compare the effectiveness of point-of-care ultrasound (POCUS) with direct radiography in diagnosis and management of the patients with distal radius fractures (DRFs). METHODS: In this study, patients between ages 5 and 55 years admitted to the emergency department with low energy upper extremity trauma with suspected DRF were evaluated with POCUS and direct radiography by emergency physicians (EPs) trained in either musculoskeletal (MSK) imaging or x-ray interpretation of DRF. The EP performing the POCUS examination was blinded to the x-ray results. RESULTS: A total of 83 patients with DRF were included in the study. There were 18 (22%) females, and 65 (78%) males enrolled in the study. Mean age was 13 ± 14 years for males, and 15 ± 13 years for females. Compared with direct radiography, POCUS yielded 98% sensitivity, 96% specificity, 98% positive predictive value, 96% negative predictive value, and 98% accuracy of the test in detecting fractures. POCUS yielded 96% sensitivity, 93% specificity value in detecting linear fractures; 78% sensitivity, 98% specificity in detecting torus-type fractures, and 100% specificity and sensitivity for detecting fissure fractures. Specificity of POCUS in the decision for reduction was 100% and sensitivity was 98%; specificity was 100% for splint application. CONCLUSION: In our study, it was shown that POCUS could be applied easily by EPs trained in MSK POCUS imaging with success in diagnosing DRF and determining the correct fracture type and required treatment methods.

Evaluation of sexual quality of life after bilateral total hip arthroplasty surgery.

BACKGROUND: Patients experience limitation of hip joint movement due to coxarthrosis, such limitation may affect the quality of sexual activity in patients. We aimed at investigating the postoperative quality of sexual life and evaluating the clinical satisfaction of patients who underwent bilateral total hip arthroplasty. HYPOTHESIS: Postoperative sexual life quality improvement in patients undergoing bilateral total hip arthroplasty increases clinical satisfaction. METHODS: The study included patients who underwent staged bilateral total hip arthroplasty surgery between June 2016 and January 2019. Each patient was evaluated using the sexual quality of life-female (SQOL-F) or Sexual quality of life-male (SQOL-M) questionnaire containing similar questions for both genders regarding sexual satisfaction. RESULTS: Among all the individuals, 32 were sexually active (13 females, 19 males), and seven were not sexually active (6 females, 1 male) before the surgery. Among the 29 individuals (18 females, 11 males) who thought that their sexual life was negatively affected even before the surgery, 10 (1 female, 9 males) were found not to be negatively affected. Moreover, the sexual life of 18 females was negatively affected 27.93±14.5 months (range, 12-43) before hip arthroplasty and 11 males was negatively affected 19.5±11.0 months (range, 8-31) before the surgery as well. Twenty (10 females, 10 males) individuals stated an improvement in their sexual life, 13 (6 females, 7 males) individuals stated no change. Unfortunately, 6 (3 females, 3 males) individuals stated a degradation of their sexual activity after hip arthroplasty. Patients gained more than 60 degrees of hip range of motion and experienced significant reduction in pain after hip joint movements after surgery. DISCUSSIONS: In our study, we evaluated sexual limitations before and after total hip arthroplasty surgery and postoperative sexual quality of life. Due to the increased range of motion of patients after surgery, the proportion of sexually active individuals increased and the sexual quality of life reached a satisfactory level. LEVEL OF EVIDENCE: III; retrospective cohort study.

Is the compressive nail method capable of accelerating bone union in patients with femoral distal diaphysis fracture?

OBJECTIVES: This study was conducted to evaluate clinically and radiologically the patients for whom compressive and non-compressive intramedullary nails were applied and to analyse the compression effectiveness in adult femur distal diaphysis fractures. HYPOTHESIS: The compressive locked nails shortened the union period in the distal diaphysis fractures, and it was found to be an effective method, as the pseudoarthrosis rate was lower. MATERIAL AND METHODS: A retrospective study was conducted among 59 patients for whom the compressive and non-compressive IMNs were applied to treat femur distal diaphysis fractures. Thirty-one for whom the non-compressive IMN was applied were categorised as group I, and 28 for whom the compressive nail was applied were categorised as group II. Finite element analysis was performed using 1.5mm compression, and a mean stress value of 34.67Mpa. RESULTS: The mean values of union period were calculated as 13.6±2.4 weeks (range: 11-20 months) and functional score was 79.2, respectively in group I, and they were evaluated as a good grade. In group II, the respective mean values of union period were 11.5±2.6 weeks (range: 10-17 months) and functional score was 86, and they were evaluated as excellent. CONCLUSION: Radiological and functional scores were determined to be better with interlocking compressive nails and shortened the fracture union period in the follow-up in adult femur distal diaphysis fractures. LEVEL OF EVIDENCE: III; retrospective cohort study.

Finite element analysis of the effect of intramedullary nail compression amount on fracture union in distal tibial diaphyseal fractures.

BACKGROUND: The objective of this study was to investigate the relationship between the stress values on the fracture surface and union periods seen in cases of different compression amounts used to manage distal tibial diaphyseal fractures treated with intramedullary nailing (IMN). METHODS: Ninety-five patients (mean age: 33.99+-10.65 years; male: n=78, female: n=17) with tibial shaft fracture were included in the study. The patients were divided into 3 groups: No compression was used in Group 1 (33 patients), and dynamic compressive fixation was performed with IMN in Group 2 (1 mm, 32 patients) and Group 3 (1.5 mm, 30 patients). A finite element study was performed for Group 2 and Group 3. RESULTS: The average time to achieve radiological union was 16.08+-2.02, 13.54+-1.52, and 12.56+-1.73 weeks in Groups 1, 2, and 3, respectively. Comparatively, the union period in the non-compression group was significantly longer (p<0.001). The functional results were evaluated as excellent in 28 (85%) patients and good-medium in 5 (15%) in Group 1, excellent in 27 (92%) and good-medium in 5 (8%) in Group 2, and excellent in 26 (92%) and good-medium in 4 (8%) in Group 3. CONCLUSION: IMN is a highly effective treatment method for tibial shaft fracture.

Does the Use of Antibiotic-Loaded Bone Cement Have an Effect on Deep Infection in Primary Total Knee Arthroplasty Practice?

BACKGROUND: Total knee arthroplasty (TKA) is performed to improve the quality of life by reducing knee arthralgia. One of the most destructive and expensive complications of TKA is deep infection. The primary purpose of this study was to evaluate the effect of using antibiotic-loaded bone cement (ALBC) on the incidence of deep infection after primary TKA. PATIENTS AND METHODS: A total of 506 patients who underwent primary knee arthroplasty at the Antalya Training and Research Hospital between February 2009 and January 2016 were investigated retrospectively. RESULTS: The ALBC was used for 85 patients (16.7%), who constituted group 1. Plain bone cement was used for 421 patients (83.2%), who constituted group 2. Deep infection was observed in one patient (1.1%) in group 1 and in six patients (1.4%) in group 2, a difference that is not statistically significant. On average, the deep infection occurred six months after the surgery at the earliest and 19 months at the latest. CONCLUSION: Use of ALBC did not decrease the incidence of deep infection in TKA. Therefore, we prefer bone cement without any antibiotic.

The comparison of point-of-care ultrasonography and radiography in the diagnosis of tibia and fibula fractures.

OBJECTIVE: We aimed to compare the efficacy of Point-of-care ultrasonography (POCUS) with radiography in the diagnosis of tibia fracture (TF) and fibula fracture (FF), and determation of fracture characteristics. METHODS: Patients aged 5-55 years who were admitted to ED due to low-energy, simple extremity trauma, who had a suspected TF and FF on physical examination were included in this prospective study. One physician performed POCUS examination. Other physician evaluated the radiography images. The obtained results were compared. RESULTS: A total of 62 patients were included in the study. TF was detected in 21 patients by radiography and in 24 patients by POCUS. FF was detected in 24 patients by radiography and in 25 patients by POCUS. Ten of the patients had both TF and FF. Compared with radiography, sensitivity, specificity, PPV and NPV of POCUS in the detection of TF were 100%, 93%, 88% and 100% (95% CI, 91-100%), respectively. Compared with direct X-ray imaging, sensitivity, specificity, PPV and NPV of POCUS in the detection of FF were 100%, 97%, 96% and 100% (95% CI, 96-100%), respectively. We determined that POCUS is also successful in detection of fracture features such as angulation, step-off, extension into the joint space that can determine the treatment decision. CONCLUSION: This study demonstrated that POCUS was found to be as successful as direct X-ray imaging in the diagnosis of TF and FF.

The comparison of radiography and point-of-care ultrasonography in the diagnosis and management of metatarsal fractures.

OBJECTIVE: It was aimed to compare the efficacy of point-of-care ultrasonography (POCUS) with radiography in the diagnosis and management of metatarsal fracture (MTF). METHODS: Patients aged 5-55 years admitted to emergency room due to low-energy, simple extremity trauma and had a suspected MTF, were included in this prospective study. Patients were evaluated by two different emergency physicians in the emergency room. The first physician performed POCUS examination. Second physician evaluated the radiography images. The obtained results were compared. RESULTS: Seventy-two patients were enrolled in the study. Fracture was detected in 39% by radiography and in 43% of patients by POCUS. Multiple MTFs were identified in 5% of patients. Compared with radiography, POCUS had a sensitivity of 93%, specificity of 89%, positive predictive value of 84% and a negative predictive value of 95% (95% CI, 83-98%) in the detection of fractures. While soft tissue edema was seen in 61% of patients by POCUS, soft tissue edema with hematoma was detected in 14%. Compared with radiography, the sensitivity and specificity of POCUS in the decision for surgery were 100% and 98% (95% CI, 97-100%), respectively, whereas its sensitivity and specificity were both 100% in the decision for reduction. CONCLUSION: In our study, we demonstrated that POCUS could be applied with success in the diagnosis and treatment of MTF in low-energy injuries. POCUS can be used as an alternative to radiography in the emergency rooms due to being easy to learn and practice and availability of soft tissue examination along with bone tissue examination.