A novel patella fracture fixation technique: finite element analysis.

INTRODUCTION: Patella fractures account for approximately 1% of all bone fractures. The tension band wiring technique has been used in surgical treatment. However, there is no clear information about the location of the K-wires in sagittal plane. Thus, a transverse fracture line was created in the patella finite element model and fixed with Kirchner (k) wires and cerclage at different angles and compared with two different standard tension band models. MATERIALS AND METHODS: A total of 10 finite element models were created to study AO/OTA 34-C1 patella fractures. Two models used the classical tension band method with either circumferential or 8-shaped cerclage wire. The other 8 models used K-wires placed at 45° or 60°, either alone or combination with cerclage wire. A force of 200 N, 400 N, and 800 N were applied at 45° knee angle and the resulting data fracture line opening, surface pressure and stress in the implants were analyzed through finite element analysis. RESULTS: When all the results are considered, it was determined that the K-wires 60° crossing at the fracture line and with cerclage modeling was superior to the other models. The diagonal placement of the K-wires with cerclage (could be 45° or 60° medium) was superior to the reference models. CONCLUSIONS: This study has shown that the new fixation method we propose could come to the fore as an alternative method to be used successfully in transverse patella fractures and lower complications. In transverse patellar fractures, the use of K-wires crossed at 60° may be a good alternative to the standard method.

Oval Window Temperature Changes in an Endoscopic Stapedectomy.

OBJECTIVES: Following the initial use of endoscopes in otology, the pros and cons of these instruments have been questioned increasingly. These instruments cause an increase in temperature that needs to be investigated. In this study, the authors aimed to investigate the temperature increase caused by endoscopes and light sources in the perilymph by performing a stapedotomy in an animal model under anesthesia. STUDY DESIGN: The study was performed in a guinea pig model. METHODS: In the animal model, a simulated otologic stapes surgery was performed at room temperature. The body temperatures of the guinea pigs were monitored; the temperature increase caused by the 0-degree rigid endoscopes with diameters of 3 and 4  mm as well as the light sources, including halogen, light-emitting diode (LED), and xenon lamps, were monitored following the stapedotomy to measure and document the continuous temperature increase in the perilymph using sensors placed at the oval window. RESULTS: Rigid endoscopes cause a temperature increase in the tympanum regardless of their diameter when used with xenon and halogen light sources. The LED light caused a relatively small temperature increase. CONCLUSIONS: The endoscopic instruments used in the stapes operation caused a temperature increase in the oval window. The authors concluded that this heat could easily be transmitted to the cochlea by the perilymph, which has obstructed contact with the outer environment following stapedomy, resulting in neurosensorial damage.

Comparison of the Results of Patients Treated With Limb-Sparing Treatment Options in Malignant Bone Tumors: Sharing the Experience of Twelve Bicentric Patients.

OBJECTIVES: Extremity-sparing surgery should be the main objective if a functional extremity is to be obtained in cases of malignant bone tumors. After extensive resection, numerous techniques have been described to reconstruct bone defects. This study aimed to compare the outcomes of patients who underwent external radiation therapy and liquid nitrogen biological reconstruction at two different facilities. METHODS: The study included 12 patients who received biological reconstruction therapy for bone sarcoma and had at least two years of follow-up. Demographic data, pathological diagnosis, presence of systemic metastasis, and recurrence during follow-up were among the information logged. Patients who used liquid nitrogen were placed in group 1, and those who underwent external irradiation were placed in group 2. After being contacted for their final follow-up appointments, the outcomes were compared by recording the Musculoskeletal Tumor Society Score (MSTSS). RESULTS: For participants with a mean age of 10.75±3.6 (5-17), the follow-up period was 30.2±16.3 months in total. In contrast to the patients in group 1, who experienced union on average after 7.5±1.2 months, those in group 2 experienced union after 7.6±1.1 months. Patients in group 1 had an MSTSS of 75.5±11.8%, while those in group 2 had a score of 77±4.4. There was no discernible difference between the two groups' union times (p>0.05). There was no statistically significant difference between the two groups' MSTSS (p>0.05). CONCLUSION: After tumor resection, extracorporeal radiation therapy and the application of liquid nitrogen are still useful treatment options and neither of them is superior to the other.

A novel robot-assisted knee arthroplasty system (ROSA) and 1-year outcome: A single center experience.

BACKGROUND: Total knee arthroplasty is a successful procedure in the treatment of knee osteoarthritis. Searches in surgical technique have focused surgeons in particular on implant alignment. For this purpose, the use of robot-assisted total knee arthroplasty has become increasingly common in the last 10 years. METHODS: A total of 46 patients (66 knees) who were operated for knee osteoarthritis with Robotic Surgical Assistant (ROSA, Zimmer-Biomet, Warshaw, Indiana, USA) between 2021 and 2023 were included in the study. Preoperative planning and intraoperative incision time, total surgical time, range of motion and follow-up time recorded. Oxford knee scores and knee society scores (KSS) of the patients were compared before and after surgery. At the last follow-up Forgotten Joint Score and the sagittal and coronal plane alignments were evaluated. RESULTS: Preoperative mean Oxford score of the right knee of the patients was 18.5 ±â€…3.2, post-surgery mean Oxford score progressed to 43.5 ±â€…2.2. While the preoperative left knee Oxford score of the patients was 16.9 ±â€…2.3, the mean left knee Oxford score improved to 43.4 ±â€…2.2 postoperatively. The mean KSS score of the patients' right knee preoperatively was 49.7 ±â€…3.5, and progressed to 89.2 ±â€…4.7 postoperatively. While the preoperative mean left knee KSS score of the patients was 46.5 ±â€…4.3, the mean KSS score improved to 89.8 ±â€…3.2 postoperatively. The mean Forgotten Joint Score of the left knee at the last follow-up of the patients was 77.4 ±â€…3.8, while the mean Forgotten Joint Score of the right knee was 75.4 ±â€…5.9. CONCLUSION: The results of ROSA-supported knee arthroplasty found to be functionally successful.

An unusual cause of mass in the shoulder: A primary hydatid cyst.

A hydatid cyst is a zoonotic infection which may affect any organ and tissue, particularly the liver and the lung. Primary muscular hydatid cysts comprise less than 0.7-3% of the cases. The hydatid cysts must be kept in mind to avoid a diagnostic puncture in cystic lesions to avoid the spreading of the disease. In this case report, we present an exceptionally rare case with an unusual localization of a primary hydatid cyst in the left deltoid muscle.