FIXATION METHODS IN LATARJET: BIOMECHANICAL COMPARISON OF SCREW TYPES AND PLATE FIXATION.

Objective: Latarjet procedure is often preferred in recurrent shoulder dislocations accompanied by glenoid bone loss. It is observed that the superiority of bone graft fixation methods is still controversial. The aim of this study is to biomechanically compare the bone graft fixation methods in the Latarjet procedure. Methods: 15 third-generation scapula bone models were divided into 3 groups. Graft was fixated in the first group with fully-threaded cortical screws of 3.5mm diameter, in the second group two 16 mm partially-threaded cannulated screws of 4.5mm diameter, and in the third group via a mini plate and screw. The hemispherical humeral head was placed on the tip of the cyclic charge device, and thus, the charge applied to the coracoid graft was homogeneous. Results: No statistically significant difference was found between paired comparisons (p>0.05). The forces in 5 mm displacement in total vary between 502-857N. Total stiffness measurements ranged between 105 and 625; the mean value was 258.13±53.54 with no statistically significant difference by groups (p = 0.958). Conclusion: This biomechanical study showed that there is no difference between three coracoid fixation options in terms of fixation strength. Unlike previous assumptions, plate fixation is not biomechanically superior to screw fixation. Surgeons should consider their personal preferences and experience in choosing fixation methods.

Objetivo: O procedimento Latarjet é normalmente preferencial em deslocamentos recorrentes do ombro acompanhados por perda óssea da glenóide. Observa-se que a superioridade dos métodos de fixação dos enxertos ósseos ainda é controversa. O objetivo deste estudo é comparar biomecanicamente os métodos de fixação de enxerto ósseo no procedimento Latarjet. Métodos: 15 modelos de escápulas de terceira geração foram divididos em 3 grupos. O enxerto foi fixado no primeiro grupo com parafusos corticais totalmente rosqueados com 3,5 mm de diâmetro, no segundo grupo com dois parafusos canulados parcialmente rosqueados de 16 mm de diâmetro de 4,5 mm e no terceiro grupo através de miniplaca e parafuso. A cabeça hemisférica umeral foi colocada na ponta do dispositivo de carga cíclica e, desta forma, a carga aplicada ao enxerto coracoide foi homogênea. Resultados: Nenhuma diferença estatisticamente significativa foi encontrada entre as comparações pareadas (p>0,05). As forças em 5 mm de deslocamento no total variam entre 502-857N. As medidas de rigidez total variaram entre 105 e 625 e o valor médio foi 258,13±53,54, sem diferença estatisticamente significativa por grupos (p = 0,958). Conclusão: Este estudo biomecânico mostrou que não há diferença entre três opções de fixação de coracoides em termos de resistência à fixação. Ao contrário de suposições anteriores, a fixação de placas não é biomecanicamente superior à fixação de parafusos. Os cirurgiões devem considerar suas preferências pessoais e sua experiência na escolha de métodos de fixação.

Anatomical bone structure differences in patients with hemophilic arthropathy of the knee.

Objectives: The anatomical differences of the bony structure of the knee joint in patients with hemophilia were evaluated, and the results were compared with the knees of patients with primary gonarthrosis and no arthrosis. Material and Methods: This study reviewed 41 knees in 21 patients (with an Arnold-Hilgartner classification of Stages 4 and 5 hemophilic arthropathy) who underwent total knee arthroplasty in single center. Two control groups including 21 asymptomatic patients (42 knees) and 21 primary knee osteoarthritis patients (42 knees) were formed to compare the measurements with hemophiliacs. Femoral mediolateral width, femoral anteroposterior width, femur and tibia diaphysis width, adductor tubercle-joint line distance, tibial plateau width, and medial and lateral tibia plateau width were measured separately. Results: Femoral mediolateral width was significantly narrow comparing with healthy individuals and primary knee osteoarthritis group. Tibial plateau was similar to asymptomatic group but significantly narrow compared with primary knee osteoarthritis group. With the correlation, the tibial plateau measurements and medial and lateral plateau were significantly narrow at hemophilic arthropathy group (P < 0.05). The slope was less in hemophilic patients as compared with asymptomatic individuals (P: 0.001). Hemophilic patients had larger femoral aspect ratios than asymptomatic group but there were no observable differences with the primary osteoarthritis group. For the tibial aspect ratios, hemophilic had a smaller ratio than the primary osteoarthritis group but there were no significant differences with the asymptomatic group. Conclusion: Hemophilic knee has a mismatch between femoral and tibial side while comparing with the other groups. Level of Evidence: Level IV, cross-sectional study.

Effects of Collagen- and Arginine-Fortified Osteokine Supplementation on Fracture Healing.

Introduction Delayed union or nonunion is an important clinical challenge for orthopedic surgeons. In addition to the main treatment algorithms, the use of nutritional supplements is increasingly common. In this study, we investigated the effects of nutritional supplements fortified with arginine and collagen on fracture healing. Materials and methods Twenty-four rats with femur fractures were divided into experimental and control groups. Intramedullary fixation was performed in both groups. 20 ml/kg nutritional supplement was given to the experimental group. Radiological examination was performed at third and sixth weeks, and histopathological examination was performed at the sixth week. Results No statistically significant difference was found between the radiological scores of the groups at the third and sixth weeks. Nutritional supplement affected the histological properties of callus. Histological evidence of bone healing was observed by the sixth week in both groups but the score was higher in nutritional supplement group. A statistically significant difference was found between the histopathological scores of the groups at the sixth week. Conclusion Arginine- and type two collagen-augmented traditional nutritional supplements may help to achieve more successful results in fracture healing.

Repair Integrity and Functional Outcomes Between Knot-Tying and Knotless Suture-Bridge Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial.

BACKGROUND: Knot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates. PURPOSE: To compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial). RESULTS: Overall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03). CONCLUSION: Both techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique. REGISTRATION: NCT03982108 (ClinicalTrials.gov identifier).

Prevalence of femoroacetabular impingement and effect of training frequency on aetiology in paediatric football players.

PURPOSE:: The aim of this study was to determine the prevalence of asymptomatic radiographic findings of femoroacetabular impingement (FAI) in paediatric football players in different age groups and to investigate aetiological factors. METHODS:: Paediatric male athletes between 10 and 17 years of age from 8 soccer teams were recruited. In addition to an annual control check-up, anteroposterior pelvis and frog-leg radiographs as well as the curriculum vitae of the athletes, their injuries, and real-time complaints were recorded. The alpha angle, lateral centre-edge angle, Tönnis angle, and collodiaphyseal angle were measured and morphological abnormalities were noted. RESULTS:: There were 214 male football players with a mean age of 13.4 ± 3.2 years included in the study. In the morphological analysis of hips, there was FAI in 30% of the athletes. In the analysis of FAI prevalence in 3 subgroups based on age (Group 1: 10-12 years [ n = 25], Group 2: 13-15 years [ n = 104], Group 3: 16-17 years [ n = 85]), there was 0% FAI in Group 1, 19.1% in Group 2 and 60% in Group 3. In the analysis of aetiological factors, there was no significant difference between the right and left hips of players regarding alpha angles and FAI prevalence. However, the prevalence of FAI was higher in players who had been playing football for 3 years or more and who had been training for 12.5 hours/week or more. CONCLUSION:: Training for 12.5 hours or more per week in paediatric football players doubled the risk development of FAI morphology.

Simultaneous Metacarpophalangeal Dislocation and Carpometacarpal Fracture-Dislocation of the Ring Finger: A Case Report.

INTRODUCTION: Fracture-dislocations of the carpometacarpal (CMC) joints are pretty uncommon injuries with an incidence of 1%. A 17-year-old male was referred due to multiple traumas following a car accident with Glasgow Coma Score of 9. CASE REPORT: Simultaneous metacarpophalangeal dislocation and CMC fracture-dislocation of the ring finger were present in the 4th finger (ring finger) of the right hand. Closed reduction and short arm splint in the intrinsic plus position was applied, and full range of motion was accomplished after 1 year postoperatively. CONCLUSION: High clinical suspicion with adequate plain radiographs are required to diagnose precisely CMC fracture-dislocation injuries. To the best of our knowledge, any case report similar to the nature of the present injury has yet to be reported to date, addressing CMC fracture-dislocation of the ring finger and concomitant volar MCP joint dislocation in the same finger. Therefore, we can make the argument that our case report is unique.

Prevalence of asymptomatic femoroacetabular impingement in Turkey; cross sectional study.

OBJECTIVES: Femoroacetabular impingement (FAI) is one of the causes of hip pain in young-adult patients. The purpose of our study is to determine the prevalence of radiological FAI findings in asymptomatic population in Turkey. METHODS: Trauma patients aged 18-65 years who applied to the emergency service between September 2015 and September 2016 were retrospectively evaluated for this study. After a preliminary study and power analysis, 2152 hips of the 1076 previously asymptomatic patients were evaluated radiologically with pelvis antero-posterior and frog-leg radiographs. On radiographs of these patients; alpha angle, lateral central edge angle (LCEA), Tönnis angle (TA) and collodiaphyseal angle were measured. Alpha angle values higher than 55° were noted as cam type FAI. TA values lower than 0° or LCEA values higher than 39° were noted as pincer type FAI. LCEA values lower than 25° or TA values higher than 10° were noted as acetabular dysplasia. RESULTS: Mean age of 1076 patients (602 female, 474 male) was 42.1 ±â€¯15.6 years. The assessment showed that 15.9% of the patients had cam type, 10.6% had pincer type, 3.1% had combined type FAI and 9.3% had findings of acetabular dysplasia. The prevalence of asymptomatic FAI is significantly more in males (46%) in comparison to females (17%) in Turkey. CONCLUSION: Even though FAI is considered to be a pathology associated with hip osteoarthritis; it is very common in asymptomatic population. In this respect, our study showed that prevalence of radiological FAI findings in asymptomatic adult population was 29.6% in Turkey.

Fixation methods in latarjet: biomechanical comparison of screw types and plate fixation / Métodos de fixação em latarjet: comparação de tipos de parafusos e fixação de placas

ABSTRACT Objective Latarjet procedure is often preferred in recurrent shoulder dislocations accompanied by glenoid bone loss. It is observed that the superiority of bone graft fixation methods is still controversial. The aim of this study is to biomechanically compare the bone graft fixation methods in the Latarjet procedure. Methods 15 third-generation scapula bone models were divided into 3 groups. Graft was fixated in the first group with fully-threaded cortical screws of 3.5mm diameter, in the second group two 16 mm partially-threaded cannulated screws of 4.5mm diameter, and in the third group via a mini plate and screw. The hemispherical humeral head was placed on the tip of the cyclic charge device, and thus, the charge applied to the coracoid graft was homogeneous. Results No statistically significant difference was found between paired comparisons (p>0.05). The forces in 5 mm displacement in total vary between 502-857N. Total stiffness measurements ranged between 105 and 625; the mean value was 258.13±53.54 with no statistically significant difference by groups (p = 0.958). Conclusion This biomechanical study showed that there is no difference between three coracoid fixation options in terms of fixation strength. Unlike previous assumptions, plate fixation is not biomechanically superior to screw fixation. Surgeons should consider their personal preferences and experience in choosing fixation methods.

RESUMO Objetivo O procedimento Latarjet é normalmente preferencial em deslocamentos recorrentes do ombro acompanhados por perda óssea da glenóide. Observa-se que a superioridade dos métodos de fixação dos enxertos ósseos ainda é controversa. O objetivo deste estudo é comparar biomecanicamente os métodos de fixação de enxerto ósseo no procedimento Latarjet. Métodos 15 modelos de escápulas de terceira geração foram divididos em 3 grupos. O enxerto foi fixado no primeiro grupo com parafusos corticais totalmente rosqueados com 3,5 mm de diâmetro, no segundo grupo com dois parafusos canulados parcialmente rosqueados de 16 mm de diâmetro de 4,5 mm e no terceiro grupo através de miniplaca e parafuso. A cabeça hemisférica umeral foi colocada na ponta do dispositivo de carga cíclica e, desta forma, a carga aplicada ao enxerto coracoide foi homogênea. Resultados Nenhuma diferença estatisticamente significativa foi encontrada entre as comparações pareadas (p>0,05). As forças em 5 mm de deslocamento no total variam entre 502-857N. As medidas de rigidez total variaram entre 105 e 625 e o valor médio foi 258,13±53,54, sem diferença estatisticamente significativa por grupos (p = 0,958). Conclusão Este estudo biomecânico mostrou que não há diferença entre três opções de fixação de coracoides em termos de resistência à fixação. Ao contrário de suposições anteriores, a fixação de placas não é biomecanicamente superior à fixação de parafusos. Os cirurgiões devem considerar suas preferências pessoais e sua experiência na escolha de métodos de fixação.

A rare pathogen for subacute osteomyelitis in adolescent: Serratia marcescens.

INTRODUCTION: There are various pathogens reported for osteomyelitis. Osteomyelitis is bone infection which produces pain and fever, also threatens bone instability. It can lead to nonunion. The purpose of this report was to describe a case with union delay of the tibia due to serratia marcescens osteomyelitis. Serratia marcescens is an unexpected pathogen for subacute osteomyelitis in adolescence. Because of difficulty of diagnosis, treatment can be delayed or the situation can cause complications like nonunion or loss of function. PRESENTATION OF CASE: Serratia marcescens is an unexpected pathogen for subacute osteomyelitis in adolescence. Because of difficulty of diagnosis, treatment can be delayed or cause complications like nonunion or loss of function. We present a meningomyelocele female adolescent operated with distal tibia varus osteotomy for correcting ankle valgus deformity. Insufficient healing was determined at osteotomy side on radiographs. The patient's erythrocyte sedimentation rate and CRP level was slightly higher with minimal clinical inflammation. MRI examination showed abscess formation at T2 imaging. Debridement, grafting and circular external fixation was performed. Sulperazon was started for drug therapy. Union was achieved after compression and distraction osteogenesis by circular external fixator. Orthopedic surgeons should be aware of opportunistic infections like serratia and keep in mind as a probable cause of disease. DISCUSSION: Osteomyelitis is one of our main problems in orthopedics. Serratia does not come to mind as a causative factor when we learn the patient has osteomyelitis. We give treatment for the most expected pathogens like staphylococcus species firstly. This shows us the importance of bone biopsies and wound culture tests. Presented case is diagnosed as serratia osteomyelitis after culture results and given treatment with antibiotics and debridement. CONCLUSION: Orthopedic surgeons should be aware of opportunistic infections like serratia and keep in mind when diagnosing the unexpected problem.