Arthroscopy-assisted procedure provides less residual horizontal instability and optimal coracoid tunnel creation with less radiation exposure compared to percutaneous procedure after endo-button fixation of type III AC joint dislocations.

PURPOSE: The aim of this study was to evaluate the postoperative radiological and functional results of patients treated with arthroscopy-assisted (AA) and percutaneous (P) procedures using endo-button for type III acromioclavicular joint dislocations with a minimum 1-year follow-up. The study hypothesis was that the AA technique would provide more favourable coracoid tunnels. METHODS: This retrospective study included patients who underwent surgery between 2017 and 2022. Computed tomography images taken immediately postoperatively of all the patients were analysed to group coracoid tunnels as optimal or suboptimal based on orientation and placement within the coracoid base. Residual horizontal instability was assessed using the bilateral Alexander view at the final follow-up. Shoulder functions were evaluated at the final follow-up examination. RESULTS: Of the 63 patients, 39 underwent surgery using the percutaneous procedure and 24 with the AA procedure. Surgical duration was significantly longer in the AA group (AA: 61.1 ± 5.9 min; P: 34.7 ± 5.6 min) (p = 0.001; 95% confidence interval [CI]: 23.3-29.3), whereas fluoroscopy time was longer in the percutaneous group (AA: 2.0 ± 0.8 s; P: 15.7 ± 3.9 s) (p = 0.001; 95% CI: -14.9 to 12.3). Optimal coracoid tunnels were more frequently observed in the AA group (p = 0.001; 95% CI: 7.4-137.8). There was no significant difference in functional scores between the groups (n.s.). Postoperative horizontal instability was more common in the percutaneous procedure (p = 0.013; 95% CI: 8.3-39.2). CONCLUSIONS: Although no difference was detected between the methods in terms of complications and functional results, the higher frequency of residual horizontal instability, the high risk of suboptimal tunnel creation and greater radiation exposure were seen to be the most important disadvantages of the percutaneous technique. During surgery, such technical problems related to the percutaneous method should be kept in mind and care should be taken about the orientation of the coracoid tunnel. LEVEL OF EVIDENCE: Level III.

Sexual Dysfunction in Women After Tibial Fracture: A Retrospective Comparative Study.

BACKGROUND Tibial fractures, common in adults, are often treated with external or internal fixation methods. While effective, external fixation (EF) can lead to sexual dysfunction (SD), especially in young patients. This study aimed to assess SD in women undergoing EF versus internal fixation for tibial fractures. MATERIAL AND METHODS Sexual function and frequency of monthly sexual intercourse (SI) were evaluated using the Female Sexual Function Index (FSFI) before surgery, with the fixator, after at least 6 months following fixator removal in EF group, and after achieving bone union for at least 3 months in the IF group. RESULTS The EF group consisted of 107 (mean age 28.5 years; 19-40 years) and IF group consisted of 106 patients (mean age 32.1 years; 18-40 years). The duration of EF was an average of 4.7 months (range, 2.5-13 months). FSFI scores were significantly lower in the EF group compared to the IF group (9.33 versus 27.3, P<0.001). Also, there was no significant difference between the FSFI scores before EF and after EF was removed (34.22 versus 33.8, P=0.413). FSFI sub-group scores such as desire, arousal, lubrication, and orgasm were significantly lower in the EF group (P<0.001). The monthly average frequency of SI before surgery and after the removal of EF was 10.2 and 9.1, respectively, while this frequency was 2.56 when EF was present (P<0.001). CONCLUSIONS The quality and frequency of SI in women significantly deteriorate and decrease during the period of extremity fixation following tibial diaphyseal fractures treated with EF, but return to normal after removal.

The quality of YouTube videos related to patellofemoral pain syndrome is insufficient.

BACKGROUND: Videos uploaded to YouTube do not go through a review process. The educational aspect of these videos may be insufficient for patellofemoral pain syndrome (PFP). OBJECTIVE: To examine the reliability and educational quality of PFP videos on YouTube. METHODS: A standard search was performed in the YouTube database using the following terms: patellofemoral pain syndrome/anterior knee pain syndrome/anterior knee pain/patellofemoral pain. For each search term, the top 50 videos based on "relevance" assignment of YouTube's algorithm were included in the examination. The remaining 96 videos after exclusion were included in the study. The educational quality and reliability of videos was analyzed using DISCERN, JAMA (The criteria of Journal of the American Medical Association), GQS (Global Quality Score) and PFPSS (Patellofemoral Pain Specific Score). RESULTS: According to PFPSS, 81.2% of the videos were evaluated as low and very low quality. According to the DISCERN classification, 74.9% of the videos were evaluated as poor and very poor. According to GQS, 59.4% of the videos had scores of 2 or less, which were considered poor quality. According to JAMA, 41.7% of the videos scored 2 and below. CONCLUSIONS: The information content of YouTube videos is inadequate. Video design should be created to be understandable by patients and to attract their attention while making these videos.

YouTube provides insufficient information on patellofemoral instability.

OBJECTIVE: Videos uploaded to YouTube do not go through a review process, and therefore, videos related to patellofemoral instability may have little educational value. The purpose of this study was to assess the educational quality of YouTube videos regarding patellofemoral instability. METHODS: A standard search was performed on the YouTube database using the following terms: "unstable kneecap," "patellar instability," "patellofemoral instability," "kneecap dislocation," and "patellar dislocation," and the top 50 videos based on the "relevance" assignment of the YouTube algorithm were included for analysis. The properties, content, and source of each video were recorded. The educational quality of videos was analyzed according to scores obtained using DISCERN, the criteria of Journal of the American Medical Association, Global Quality Score, and Patellofemoral Instability Specific Score, and the quality of the videos was evaluated according to the groupings of these scoring systems. RESULTS: A total of 250 videos were identified, of which 89 were included in the study for analysis. The mean video duration was 11.72 ± 22.03 minutes. The median number of views was 4516.5 (range, 3-6 044 971). The content of the videos was disease-specific in 60%, 20% were related to surgical technique or approach, and 14.1% were exercise videos. Most of the videos were uploaded by physicians (33.7%). The Global Quality Score and DISCERN scores were significantly correlated with video duration. The Patellofemoral Instability Specific Score was significantly correlated with video duration, number of views, view rate, likes, and Video Power Index. According to the DISCERN classification, 69.9% of the videos were very insufficient or insufficient. According to the Patellofemoral Instability Specific Score, 65.2% of videos were evaluated as very low or low. According to the Global Quality Score, 60.7% of videos were rated as poor quality. CONCLUSION: The quality of YouTube videos about Patellofemoral instability is insufficient. It was found that viewers tend to watch short and low-quality videos.

Approach to Displaced Intra-Articular Calcaneus Fractures After Attempted Suicide Among Patients With Psychiatric Disorders: Nonsurgical or Surgical?

Displaced intra-articular calcaneus fracture is one of the injurious events in psychiatric patients after high-jump suicide attempts. These patients are reported to have poorer compliance and worse postoperative outcomes compared to those with no psychiatric condition.  We aimed to compare nonsurgical and surgical treatment with respect to functional and radiological outcomes and complications in this patient. We evaluated medical records of 42 psychiatric patients who had displaced intra-articular calcaneal fractures after high-jump suicide attempt. 20 (54%) of these were treated nonsurgically and further 17 patients (46%) received surgical intervention. We compared to nonsurgical and surgical approaches statistically. The mean follow-up period were 30.4 ± 8.02 months and 31.8 ± 7.5 months in the nonsurgical and surgical groups, respectively. Böhler's angle was significantly higher in the surgical group (30.4 ± 6.4) than that in the nonsurgical group (16.1 ± 3.7) (p = .001). AOFAS scores and supination levels were significantly higher in the surgical group than that in the nonsurgical group (p ≤ .05). During the follow-up period, one patient from the surgical group re-attempted high-jump suicide and died, and another one caused the subtalar joint to re-collapse after full weightbearing on the first postoperative day. Surgical treatment of displaced intra-articular calcaneal fractures following a high-jump suicide attempt in psychiatric patients may not cause increased complication rates. However, behavioral manifestations of the psychiatric disorder might be associated with several complications. Should any surgical intervention be decided, minimal invasive approach would be the appropriate choice.