The finite element method-based pattern recognition approach for the classification of patient-specific gunshot injury.

Violence related injuries and deaths mostly caused by firearms are a major problem throughout the world. Understanding the factors that control the extent of hard-soft tissue wound patterns using computer imaging techniques, numerical methods, and machine learning algorithms may help physicians to diagnose and treat those injuries more properly. Here, we investigate the use of computational results coupled with the pattern recognition algorithms to develop an approach for forensic applications. Initially, computer tomography (CT) images of the patient whose leg was shot by a 9 × 19 parabellum bullet are used to construct the FE models of that patient's femoral bone and the surrounding soft tissues. Then, Hounsfield units-based material properties are assigned to elements of the bone. To simulate the full range of loading conditions encountered in ballistic events, a constitutive model that captures the strain-rate dependent response is implemented. The entrance pathway vector of the bullet is directed in accordance with the patient's wound and the simulations are deployed for the cases having various inlet velocities such as 150, 200, 250, 300, and 350 m/s. Once the FE results for each case are obtained, they are processed with supervised machine learning algorithms to classify the wound and inlet velocity correspondence. The results demonstrate that they can be diagnosed with a percent accuracy of 97.3, 97.5, and 98.3 for the decision tree (DT), k-nearest neighbors (kNN) and support vector machine (SVM) classifier, respectively. This approach may provide a useful framework in classifying the wound type, predicting the bullet impact velocity and its firing distance.

Evaluation of Risk Factors for Second Hip Fractures in Elderly Patients.

BACKGROUND: Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. A second hip fracture can occur in elderly patients who have already suffered an initial hip fracture. The aim of this study was to investigate possible risk factors for second hip fractures in elderly patients with hip fractures. METHODS: Between 2010 and 2014, 230 patients who underwent uncemented bipolar hemiarthroplasty for hip fractures were retrospectively analyzed. The patients were divided into two groups: those with a first hip fracture (group 1) and those with a second hip fracture (group 2). RESULTS: The mean time from the first hip fracture to second hip fracture was 22 months. There were no significant differences in the American Society of Anesthesiologist scores, comorbidities were observed in the two groups. The mean length of hospitalization was not significantly different between the two groups. The mean postoperative functional scores after second hip fractures were significantly lower in group 2 than in group 1. CONCLUSIONS: Although there are not certain risk factors for second hip fractures in elderly patients with hip fractures, to prevent second hip fractures, elderly patients should be provided with physical and medical therapy as well as orthotic support and their functional activity should be maintained.

Comparison of Simple Decompression and Anterior Subcutaneous Transposition of the Ulnar Nerve for the Treatment of Cubital Tunnel Syndrome.

BACKGROUND: In this study, we aim to evaluate clinical and functional results in patients with cubital tunnel syndrome who were treated with subcutaneous anterior transposition vs simple decompression of the ulnar nerve. MATERIAL AND METHODS: Fifty-five patients were separated into two groups according to surgical technique. Group 1 comprised 35 patients (23 males, 12 females; mean age, 42.1 years; range, 28-56 years) who underwent anterior subcutaneous transposition of the ulnar nerve, whereas Group 2 included 20 patients (11 males, 9 females; mean age, 47.4 years; range, 25-59 years) who underwent simple decompression of the ulnar nerve. RESULTS: The mean modified Bishop scores were 7.26 and 7.85 in Group 1 and Group 2, respectively (P< .05). The mean Q-DASH scores were 16.94 in Group 1 and 15.80 in Group 2 (P> .05). Postoperatively, paraesthesia regressed in 17 (85.7%) and 30 (85%) patients in Group 1 and Group 2, respectively (P> .05). Both groups demonstrated improvement in ulnar nerve function in comparison with the preoperative period, and ulnar nerve paralysis was not seen in any of our patients. A postsurgical incision scar developed in six (17.1%) and three patients (15%) in Group 1 and Group 2, respectively. CONCLUSION: Both simple decompression and anterior subcutaneous transposition of the ulnar nerve are effective and safe for the treatment of cubital tunnel syndrome, so we would favour simple decompression as it is a less extensive procedure.

Chronic Achilles Tendon Rupture Reconstruction Using the Lindholm Method and the Vulpius Method.

BACKGROUND: We investigated the clinical and functional outcomes of chronic Achilles tendon rupture reconstruction via the Lindholm technique and via the Vulpius' lengthening of the gastrocnemius. METHODS: We evaluated 15 patients with chronic Achilles tendon rupture (Lindholm technique in eight patients and primary repair with the Vulpius technique in seven patients). In the final follow-up, the Hooker scale was used to measure the ankle functional capacity in all patients. The patients were evaluated on the basis of their capability to stand on tiptoe on the affected limb and the time required to return to pre-injury daily activities. RESULTS: The mean follow-up time was 19.6 months (range, 12 - 38 months). The mean time to return to work and daily activity was 3.2 months. The mean calf atrophy at the end of follow-up was 1.2 cm (range, 0 - 2.5 cm). At the last follow-up visit, no patient had any limitation in the activities of daily living and the active and passive ankle range of motion was good. All patients were able to perform single-leg heel rises at the end of follow-up and the Hooker scores were excellent for 11 patients and satisfactory for four patients. CONCLUSION: The reconstruction of chronic Achilles tendon ruptures via the Lindholm technique or via the Vulpius technique is associated with good clinical and functional outcomes.

Micro-computed tomography and mechanical evaluation of trabecular bone structure in osteopenic and osteoporotic fractures.

PURPOSE: Osteopenia and osteoporosis are the two most common musculoskeletal disorders in the elderly population. We determined whether osteopenic and osteoporotic patients with fractures exhibit differences in trabecular morphology and biomechanical properties of bone. METHODS: Fourteen osteopenic patients and 28 osteoporotic patients with hip fractures who underwent hemiarthroplasty for proximal femoral fractures caused by low-energy injury were included. Bone mineral density (BMD) measurements were performed. Compression tests and high-resolution micro-computed tomography were used to assess cancellous bone samples obtained from the principal compressive region of the femoral head. RESULTS: The BMD values were lower in the osteoporotic patients than in the osteopenic patients ( p < 0.05). There was a significant difference in the yield stress values between the groups ( p < 0.05). However, no significant differences in the strain energy density, stiffness and Young's modulus were observed between the groups ( p > 0.05). The mean maximum stress was significantly higher in the osteoporotic patients than in the osteopenic patients ( p < 0.05). Although structural parameters, including bone volume (BV), BV fraction, trabecular thickness, trabecular connectivity density and trabecular number, were higher in the osteopenic patients, the differences were not significant ( p > 0.05). Trabecular separation values were significantly higher in the osteoporotic patients ( p < 0.05). CONCLUSION: Our results showed that the trabecular morphology and biomechanical properties of bone were not significantly different between osteopenic and osteoporotic patients in terms of some parameters.

Radiofrequency Thermal Lesioning and Extracorporeal Shockwave Therapy: A Comparison of Two Methods in the Treatment of Plantar Fasciitis.

We compared the results of radiofrequency thermal lesioning (RTL) and extracorporeal shockwave therapy (ESWT) in patients with chronic plantar fasciitis. This prospective study included 56 patients diagnosed with plantar fasciitis who had complaints for ≥6 months: 40 (group 1) underwent ESWT and 16 (group 2) underwent RTL. The presence of calcaneal spurs was investigated with imaging studies. All patients were followed up clinically at baseline and 1, 3, and 6 months after treatment. Clinical evaluations were performed by the visual analog scale (VAS) and the modified Roles-Maudsley (RM) scoring system. There was no significant difference in the age, sex, body mass index, and side of involvement between the groups (all P > .05). Radiographic evaluation showed calcaneal spurs in 22 patients (55%) in group 1 and 7 patients (43%) in group 2. There was no significant difference in the baseline and posttreatment values between the groups; however, group 2 had significantly different RM values at 1 month than group 1 ( P < .05). In both groups, the VAS scores significantly decreased at 1, 3, and 6 months after treatment ( P < .05). The RM scores at 1, 3, and 6 months after treatment significantly decreased in both groups, except for the RM values at 1 month after treatment in group 1 ( P < .05). Our study results suggest that RTL and ESWT are safe and effective treatments in patients with chronic plantar fasciitis. LEVELS OF EVIDENCE: Level II: Therapeutic study.

Total hip arthroplasty in the developmental dysplasia of the hip using transverse subtrochanteric osteotomy.

BACKGROUND: We assessed the results of the transverse subtrochanteric femoral shortening osteotomy technique and the cementless THA process applied to Crowe type III and IV patients with developmental dysplasia of the hips. METHODS: We retrospectively evaluated 25 patients (32 hips) between 2006 and 2014. RESULTS: The mean follow-up time was 5.1 years. The mean preoperative Harris hip score was 49.5, which increased to 87.1 postoperatively. The mean preoperative leg-length discrepancy was 3.6 cm; the mean postoperative discrepancy was 0.5 cm. CONCLUSION: THA with subtrochanteric femoral shortening osteotomy technique is an effective technique for treating developmental dysplasia of the hip.

Symptomatic flexible flatfoot in adults: subtalar arthroereisis.

Flexible flatfoot is a common deformity in pediatric and adult populations. In this study, we aimed to evaluate the functional and radiographic results of subtalar arthroereisis in adult patients with symptomatic flexible flatfoot. We included 26 feet in 16 patients who underwent subtalar arthroereisis for symptomatic flexible flatfoot. Radiographic examination included calcaneal inclination angle, lateral talocalcaneal angle, Meary's angle, anteroposterior talonavicular angle, and Kite's angle. The clinical assessment was based on the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and a visual analog scale (VAS). The mean follow-up was 15.1±4.7 months. The mean preoperative AOFAS score was 53±6.6, while the mean AOFAS score at the last follow-up visit was 75±11.2 (P<0.05). The mean visual analog scale score was 6.9±0.6 preoperatively and 4.1±1.4 at the last follow-up visit (P<0.05). The mean preoperative and postoperative values measured were 13.4°±3.3° and 14.6°±2.7° for calcaneal inclination angles (P<0.05); 35.7°±6.9° and 33.2°±5.3° for lateral talocalcaneal angles (P>0.05); 8°±5.3° and 3.3±3 for Meary's angles (P<0.05); 5.6°±3.5° and 2.6°±1.5° for anteroposterior talonavicular angles (P<0.05); and 23.7°±6.1° and 17.7°±5° for Kite's angles, respectively (P<0.05). Implants were removed in three feet (11.5%). Subtalar arthroereisis is a minimally invasive procedure that can be used in the surgical treatment of adults with symptomatic flexible flatfoot. This procedure provided radiological and functional recovery in our series of patients.

Mechanical failures after fixation with proximal femoral nail and risk factors.

BACKGROUND: This study aims at assessing the clinical results, radiographic findings, and associated complications after osteosynthesis of trochanteric hip fractures with proximal femoral nail (PFN). METHODS: A total of 152 patients with hip fractures who underwent osteosynthesis with PFN were included. The hip fracture types in the patients included in the study were classified according to the American Orthopedic/Orthopedic Trauma Association (AO/OTA). AO/OTA A1, A2, and A3 type fractures were found in 24 (15.8%), 107 (70.4%), and 21 (13.8%) patients, respectively. The Baumgaertner scale was used to assess the degree of postoperative reduction. The Salvati-Wilson hip function (SWS) scoring system was used to evaluate functional results. After a follow-up period, clinical and radiographic results were evaluated and complications were assessed. The relationship between the complications and SWS score, age, sex, fracture type, reduction quality, and time from the fracture to surgery was evaluated. RESULTS: Eighty-five (55.9%) female patients and 67 (44.1%) male patients were enrolled in the study. Seventy-nine (51.9%) patients had left hip fractures, and 73 (48.1%) had right hip fractures. The mean age was 76 (range 21-93) years, and the mean follow-up duration was 23.6 (range 7-49) months. Postoperatively, one patient (0.6%) had a poor reduction, 16 patients (10.5%) had an acceptable reduction, and 135 patients (88.9%) had a good reduction according to the above criteria. The SWS scores were excellent, good, moderate, and poor in 91 (59.8%), 45 (29.6%), 15 (9.8%), and one (0.6%) patients, respectively. Late postoperative complications were seen in 27 patients (17.7%). A total of 14 patients (9.2%) underwent a revision procedure for mechanical complications. CONCLUSION: The study results suggest that the quality of fracture reduction is an important factor that affects the revision rate and SWS score in patients with mechanical complications after osteosynthesis with PFN for trochanteric fractures.

Partial matricectomy with curettage and electrocautery: a comparison of two surgical methods in the treatment of ingrown toenails.

BACKGROUND: An ingrown toenail is a common, painful, and debilitating condition. OBJECTIVE: This study aims to compare 2 surgical methods (partial matricectomy with curettage and electrocautery) in the treatment of ingrown toenails. MATERIALS AND METHODS: A total of 92 ingrown nails of the big toe in 86 patients underwent partial matricectomy with curettage, whereas 57 ingrown nails of the big toe in 52 patients underwent partial matricectomy with electrocautery. RESULTS: Recurrence was observed in 2 toenails in the partial matricectomy with curettage group, whereas no recurrence was observed in the partial matricectomy with electrocautery group (p > .05). The mean period of postoperative pain was 2.3 and 3.1 days in the curettage group and the electrocautery group, respectively (p < .05). There was a significant difference in the duration of scar tissue inflammation (p < .05). CONCLUSION: Both surgical methods are safe treatment modalities with a high success rate. Partial matricectomy, which is achieved using curettage, seems to be superior to electrocautery in respect of reduced inflammation and duration of pain.

Greater trochanteric fixation using a cable system for partial hip arthroplasty: a clinical and finite element analysis.

The aim of the study was to investigate the efficacy of greater trochanteric fixation using a multifilament cable to ensure abductor lever arm continuity in patients with a proximal femoral fracture undergoing partial hip arthroplasty. Mean age of the patients (12 men, 20 women) was 84.12 years. Mean follow-up was 13.06 months. Fixation of the dislocated greater trochanter with or without a cable following load application was assessed by finite element analysis (FEA). Radiological evaluation was based on the distance between the fracture and the union site. Harris hip score was used to evaluate final results: outcomes were excellent in 7 patients (21.8%), good in 17 patients (53.1%), average in 5 patients (15.6%), and poor in 1 patient (9.3%). Mean abduction angle was 20.21°. Union was achieved in 14 patients (43.7%), fibrous union in 12 (37.5%), and no union in 6 (18.7%). FEA showed that the maximum total displacement of the greater trochanter decreased when the fractured bone was fixed with a cable. As the force applied to the cable increased, the displacement of the fractured trochanter decreased. This technique ensures continuity of the abductor lever arm in patients with a proximal femoral fracture who are undergoing partial hip arthroplasty surgery.

The Nocardia farcinica infection developing after total knee arthroplasty surgery.

Infection is an important complication in total knee prosthesis implementations and possesses a serious morbidity. We present a case of Nocardia farcinica infection which appeared after application of cemented total knee prosthesis. A 78-year-old male patient had referred to the outpatient clinic with the complaints of restricted movement, pain and swelling of the knee which started after a month following total knee arthroplasty surgery due to left gonarthrosis. As no improvement could be achieved after arthroscopic debridement, synovectomy and antibiotherapy, the components of the total knee prosthesis were removed from him. Although improvement could not be achieved in the knee of the patient at the end of 20-month therapy, the case has still being followed-up.

A rare complication after intertrochanteric fracture treated with proximal femoral nail: femoral neck insufficiency fracture.

We present a case, 82-year-old woman, sustaining intertrochanteric fracture treated with proximal femoral nail. Up to 14 months postoperatively, everything went on seamlessly. Then, there was a rapid onset of worsening of the functional capacity. She came to outpatient clinic by using wheelchair. Plain X-rays revealed a femoral neck fracture on the operative side with no history of trauma. Laboratory studies showed no significant abnormalities but vitamin D [25 (OH) D] level was 14.82 ng/ml. X-ray survey of skeletal system was not indicative of osteomalacia. We performed total hip replacement instead of internal fixation due to patient's age. Vitamin D replacement therapy was launched. Three months later, she was totally satisfactory with clinical result and 25 (OH) D level increased to 53.68 ng/ml. At the last visit, the patient was pain free and active in all her recreational activities.

Morganella morganii osteomyelitis complicated by secondary septic knee arthritis: a case report.

Morganella morganii is a gram-negative, facultative anaerobic bacillus whose natural habitat is the gastrointestinal system. While it rarely causes infection alone, it is generally encountered in people with suppressed immunity and in cases of hospital infection. It may also manifest itself as a superinfection. Morganella morganii often demonstrates a course characterized by slow-paced progression with occasional attacks and remissions. Osteoarticular pathologies are not commonly observed in Morganella morganii infections and it has a high mortality rate. We present a 56-year-old male patient with Morganella morganii osteomyelitis in the distal femur and proximal tibia, complicated by septic arthritis in the knee joint.