Which is the most appropriate anterior glenohumeral dislocation reduction technique among three different techniques? A prospective, randomized clinical trial.

OBJECTIVES: This study aims to compare three glenohumeral dislocation (GHD) reduction techniques in terms of pain and reduction time and to offer clinicians an idea of the selection of the most appropriate technique. PATIENTS AND METHODS: This multi-center, prospective, randomized clinical study included a total of 90 patients (55 males, 35 females; median age: 29 years; range, 22 to 41 years) who had isolated anterior GHD without complication between December 2019 and December 2021. The patients were divided into three equal groups (traction-countertraction [TCT], external rotation [ExR], and Cunningham) using the block randomization method, and reductions were performed. Pre-reduction, intra-reduction, and post-reduction Visual Analog Scale (VAS) scores, reduction times, success rates, and complication rates were analyzed. RESULTS: There was no statistically significant difference among the groups in terms of age (p=0.414), sex (p=0.954), pre-reduction VAS (p=0.175), and post-reduction VAS (p=0.204). The median intra-reduction VAS values in the TCT, the external rotation, and the Cunningham groups were 8 (range, 7 to 9), 5 (range, 4 to 7), and 4 (range, 2.75 to 5), respectively (p<0.001). The median reduction time and IQR were 105 (range, 82.5 to 120) sec for TCT, 270 (range, 232.5 to 300) sec for ExR, and 630 (range, 540 to 780) sec for Cunningham (p=0.001). CONCLUSION: The fastest, but most painful technique is TCT, while the longest and the least painful technique is Cunningham. An inverse relationship is found between time and pain. Based on these findings, it seems to be reasonable to leave the choice of the ideal reduction technique to the clinician. The clinician should choose the technique to be used according to the conditions in the emergency department.

Explainability and Transparency of Classifiers for Air-Handling Unit Faults Using Explainable Artificial Intelligence (XAI).

In recent years, explainable artificial intelligence (XAI) techniques have been developed to improve the explainability, trust and transparency of machine learning models. This work presents a method that explains the outputs of an air-handling unit (AHU) faults classifier using a modified XAI technique, such that non-AI expert end-users who require justification for the diagnosis output can easily understand the reasoning behind the decision. The method operates as follows: First, an XGBoost algorithm is used to detect and classify potential faults in the heating and cooling coil valves, sensors, and the heat recovery of an air-handling unit. Second, an XAI-based SHAP technique is used to provide explanations, with a focus on the end-users, who are HVAC engineers. Then, relevant features are chosen based on user-selected feature sets and features with high attribution scores. Finally, a sliding window system is used to visualize the short history of these relevant features and provide explanations for the diagnosed faults in the observed time period. This study aimed to provide information not only about what occurs at the time of fault appearance, but also about how the fault occurred. Finally, the resulting explanations are evaluated by seven HVAC expert engineers. The proposed approach is validated using real data collected from a shopping mall.

Clinical and radiological results of three different techniques for fixation of the olecranon osteotomy in the surgical treatment of distal humerus fractures: A retrospective comparison of plate-screw, tension band and intramedullary nail.

OBJECTIVE: The aim of this study was to compare clinical and radiological results of three different techniques (plate-screw, tension band, and intramedullary nail) in the fixation of olecranon osteotomy in patients with intercondylar fracture of the distal humerus surgically treated by the olecranon osteotomy approach. METHODS: Between January 2010 and December 2018, the study was initiated with 52 patients who underwent an olecranon osteotomy approach for an AO Type C distal humerus fracture. Thirty-seven patients (19 male, 18 female) who had regular control data and a final control examination were included in the study. In osteotomy fixation, we used tension band (K wire cerclage + Screw cerclage) in 20 patients, plate-screw in eight patients, and intramedullary nail fixation in nine patients. The functional evaluation included a measurement of the range of joint motion (flexion, extension, supination, pronation); MAYO elbow performance score; disabilities of the arm, shoulder, and hand (DASH) score; and comparative grip strength measurement, and a subjective pain assessment was performed using the visual analogue scale. RESULTS: The mean duration of follow-up was 44 (12-84) months. The mean time to union was 14 (7-32) weeks in patients that achieved union. The mean DASH score was 22 (0-72.7), the meanMAYOelbow performance score was 84 (35-100), and the mean VAS score was 3 (1-7). The mean grip strength was 32 (8-64) kgw in the treated extremity and 37 (17-70) kgw in the intact extremity. No statistically significant difference was detected between olecranon osteotomy fixation methods (tension band, plate-screw osteosynthesis, and intramedullary nailing) in terms of union time, DASH score, MAYO scale score, VAS score, extension, supination, and pronation (P > 0.05). The average grip strength (kgw) was lower than that in the uninvolved extremity, and this ratio was statistically significant (P = 0.04). CONCLUSION: The results of this study have shown that successful and comparable radiological and functional outcomes can be obtained by all the three different olecranon osteotomy techniques in the surgical treatment of intercondylar fracture of the distal humerus. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Bosentan, a drug used in the treatment of pulmonary hypertension, can prevent development of osteoporosis.

OBJECTIVES: We examined the antiosteoporotic effect of bosentan (Bose) by radiographic, histopathological, and molecular methods. MATERIALS AND METHODS: Rats were divided into 4 groups of 8 rats each: one control (Sham), one osteoporosis only (OP), and two osteoporosis groups treated with Bose doses of 50 and 100 mg/kg (OP+Bose50, OP+Bose100). Six weeks later, Bose was administered for eight weeks to animals undergoing ovariectomy. The left femoral bone of the rats was evaluated in vitro after surgical removal. Bone mineral density (BMD) was analyzed by Dual-energy X-ray absorptiometry (DEXA). Endothelin 1 (ET-1), ET-A, and ET-B expressions were examined by real-time polymerase chain reaction (real time-PCR). In addition, bone tissue was evaluated histopathologically. RESULTS: Compared with the osteoporosis group, Bose significantly increased BMD values at both 50 and 100 mg/kg doses. ET-1 mRNA levels were significantly higher in the OP group than in the Sham group, while ET-1 mRNA levels were significantly lower in Bose treatment groups. ET-A mRNA levels were significantly lower in the OP group than in the Sham group, while ET-A mRNA levels were significantly higher in Bose treatment groups. Histopathological results supported the molecular results. CONCLUSION: Our study is the first to demonstrate the molecular, radiological, and histopathological effects of Bose in preventing osteoporosis in rats.

The supramolecularly complexes of calix[4]arene derivatives toward favipiravir antiviral drug (used to treatment of COVID-19): a DFT study on the geometry optimization, electronic structure and infrared spectroscopy of adsorption and sensing.

While the world is in search of a vaccine that can cure COVID-19 disease, favipiravir is the most commonly used antiviral drug in the treatment of patients during the pandemic process. In this study, we investigated the host-guest interaction between the popular supramolecule calix[4]arene derivatives and the favipiravir drug by using the DFT (Density Functional Theory) method. The B3LYP hybrid method and 6-31G (d,p) basis set were utilized to determine the optimized structures of the host and guest molecules and their complexes. The negative adsorption energy (∆E) and adsorption enthalpy (∆H) calculated for the complexes formed between calix[4]arene compounds and favipiravir drug molecule mentioned that adsorption of favipiravir molecule was an exothermic process on calix[4]arene structures. On the other hand, among the calixarene derivatives in the study, Gibbs free energy change (∆G) value for the adsorption was only negative on calix[4]arene4 molecule. The infrared spectroscopy (IR) calculations were performed by examining the C=O, O-H and NH2 vibrational frequencies to see the adsorption behavior in the favipiravir-calix[4]arene complex. After adsorption of the favipiravir molecule, HOMO-LUMO gap values decreased significantly for the structures and therefore electrical conductivity increased proportionally. In addition, sensor response factors, Fermi energy levels and workfunction changes of calix[4]arene derivatives were calculated and examined. Charge transfer between the four calix[4]arene compounds and the favipiravir molecule has occurred after adsorption. This attributes that calix[4]arene derivatives can be used as a well-suited favipiravir sensor (electronic and workfunction) and adsorbent at room temperature. Based on the calculations made to see the solvent effect on the adsorption of favipiravir it was determined that it did not affect the interaction between the drug molecule and the calix[4]arene compound too much and the adsorption energy turned into a slightly less negative value.

Surgical management of displaced adolescent Tillaux Fractures with the mini-open technique.

BACKGROUND: There is no consensus on the optimal treatment of Tillaux-Chaput fractures. The results of our cases treated with mini-open surgery (open reduction and internal fixation) concerning efficacy and complications, we aim to compare other procedures (open, percutaneous, and arthroscopy-assisted) with the literature data and to look for an answer to the question of whether the primary treatment can be mini-open surgery. METHODS: Between the years 2014 and 2017, 22 of 30 patients with Tillaux-Chaput fractures were treated using mini-open surgery, open reduction and internal fixation with one cannulated screw. These cases were retrospectively examined concerning age, sex, side, surgery duration, complications, and American Orthopedic Foot and Ankle Score (AOFAS). Functional results were statistically evaluated 12 months after the injury. Follow-up included a clinical examination, imaging and AOFAS. RESULTS: Of the patients, 14 were male (63.6%) and eight were female (36.4%). The mean age of the patients was 13.8 years. The mean surgery duration was 21 minutes. All fractures healed after an average of 14 weeks. No complications were observed in any of the cases. The mean follow-up time was 24.7 months. The mean preoperative AOFAS score was 53.3 and the mean postoperative AOFAS score was 93.6, which was a statistically significant difference. At the last follow-up, the AOFAS score was perfect for all cases. CONCLUSION: Contrary to what is stated in the literature, the mini-open surgical procedure has many advantages. The operation is very short and the risk of nerve injury is very low. This study showed that Tillaux-Chaput fractures could be safely and efficiently treated with mini-open surgery. We recommend mini-open surgery, complete anatomical reduction, and internal fixation for successful results.

Analysis of Clinical Outcomes in Pediatric Distal Tibia Triplanar Fractures Treated Surgically and Conservatively.

Purpose We aimed to analyze the clinical and functional outcomes of patients who underwent surgery or received conservative treatment to look into the impact of treatment methods on clinical outcomes. Methods A retrospective study was performed on 25 patients with a minimum one-year follow-up. Patients were divided into two groups based on joint and physis displacement measured on preop CT images. Patients with a displacement of > 2 mm underwent surgery, while those with a displacement of < 2 mm received conservative treatment. The clinical results were assessed using the Ankle-Hindfoot Scale developed by the American Orthopedic Foot and Ankle Society (AOFAS) and the Modified Weber Protocol (MWP). Results The sample consisted of 14 patients who underwent surgery and 11 patients who received conservative treatment. The surgical group had a mean follow-up of 36.79±14.43 months, while the conservative group had a mean follow-up of 31.82±13.55 months. The surgical and conservative groups had a postop 1st-year AOFAS score of 96.64±3.54 and 93.64 ± 4.69, respectively. The difference was statistically insignificant (p > 0.05), but the surgical group had higher scores numerically. The surgical and conservative groups had a postop 6th-month AOFAS score of 84.64±1.64 and 80.82±2.85, respectively. The difference was statistically significant (p < 0.05). Conclusion The results of both surgical treatment and conservative treatment are satisfactory. Especially, surgical treatment should not be avoided in patients requiring surgery with a displacement of more than 2 mm and surgeons may consider surgery for better clinical outcomes and earlier rehabilitation in the treatment of triplane fractures.

Do peripheral melatonin agonists improve bone fracture healing? The effects of agomelatine and ramelteon on experimental bone fracture.

Melatonin improves fracture healing, but the long-term use of melatonin seems impracticable in the treatment of fracture due to side effects caused by hormonal stress on chronological rhythm. Ramelteon (RAMEL) and agomelatine (AGO) are non-selective peripheral melatonin receptor (MT) agonists. This study investigated the effects on bone fracture healing of these MT agonists, which do not affect the central nervous system. The rats were divided into 6 groups, including Group 1 (SHAM): sham operated group; Group 2 (FRACTURE): femoral fracture control; Group 3 (FR + AGO30): femoral fracture + agomelatine 30 mg/kg; Group 4 (FR + AGO60): femoral fracture + agomelatine 60 mg/kg; Group 5 (FR + RAMEL3): femoral fracture + ramelteon 3 mg/kg; and Group 6 (FR + RAMEL6): femoral fracture + ramelteon 6 mg/kg. After 21 days, the rats were subjected to X-ray imaging. Bone healing was evaluated with hematoxylin-eosin (HE) staining. Messenger RNA (mRNA) expressions of bone formation markers, such as bone alkaline phosphatase (ALP), osteocalcin (OC), and osteopontin (OP), were evaluated by real-time polymerase chain reaction (RT-PCR) and with immunohistochemistry (IHC) staining. The radiographic fracture healing scores were statistically significantly higher in the FR + AGO60 group and the FR + RAMEL3 group than in the FRACTURE group. The histopathology and molecular results supported the radiographic results. It was shown that agomelatine and ramelteon increase bone fracture healing, leading to the conclusion that a preference for agomelatine, an antidepressant, and ramelteon, a sleep aid, will increase bone fracture healing in patients with fractures.

Is Ebselen A Therapeutic Target in Fracture Healing?

OBJECTIVE: We investigated the effect of ebselen on fracture healing in an experimental fracture model. MATERIALS AND METHODS: We divided rats into two groups, 6 rats in each: the experimental femur fracture control group and the ebselen treatment group with an experimental femur fracture. In the experimental femur fracture control group, we created only experimental femur fracture. In the ebselen treatment group, we administered ebselen treatment with creating an experimental femur fracture. We administered ebselen intraperitoneally at 5 mg/kg once daily for 1 month after the 1st day of experimental femur fracture in the ebselen treatment group. We evaluated the recovery status of fractured femurs at the end of 1st month with radiographic, histopathological, and immunohistochemical methods. RESULTS: According to the radiographic fracture healing scores, ebselen treatment increased the extent of new bone formation and fracture cartilage callus significantly compared to the control group. According to the histopathological recovery scores, ebselen treatment significantly improved healing scores compared to the control group. Ebselen treatment increased the expression scores of bone healing markers in the ebselen treatment group, such as vascular endothelial growth factor and osteocalcin, compared to the control group. CONCLUSION: We demonstrated that ebselen treatment increases the formation of new bone in the femur in an experimentally created femoral fracture model. Ebselen has been shown to improve the bone fracture healing in a radiological and histopathological manner, and more detailed studies are needed.

Surgical management of Rockwood type 3 acromioclavicular joint injuries: a retrospective comparison of outcomes of suture anchor fixation and double-button fixation techniques.

The treatment of type 3 acromioclavicular joint injuries has still controversial issues. In this retrospective study, we aimed to compare the radiological and functional outcomes of the suture anchor and double-button fixation methods for the treatment of type 3 acromioclavicular joint injuries.This study included 20 patients who underwent suture anchor (9 patients) and double-button fixations (11 patients) for isolated type 3 acromioclavicular dislocation. Injuries were classified according to the Rockwood Classification System. Coracoclavicular(CC) distances and anterior translation have been measured pre-operatively and at the 12th month follow-up. Functional evaluation was performed using the DASH, and Constant-Murley scores of the patients were recorded at the12th-month follow-up.The mean age of the patients was 37 (22-50) years in Group 1(double-button group) and 39 (24-56) years in Group 2(suture anchor group). All of the patients were male. There was no statistically significant difference between the DASH and Constant-Murley scores of the 2 groups (P > .05). The mean DASH score of the patients evaluated at the postoperative 12th month was 6.65 (0-38.3) in Group 1 and 2.48 (0-4.2) in Group 2. The mean Constant-Murley score of the patients evaluated at the postoperative 12th month was 89,6 (50-98) in Group 1 and 93,6 (90-98) in Group 2. Comparison of the pre- and post-operative CC distances and pre- and post-operative anterior translation distances of both groups revealed that there was no statistically significant difference between groups regarding postoperative CC distances and anterior translation distances (P > .05).Suture anchor and double-button techniques are reliable treatment methods that are not superior to one another and can yield excellent functional outcomes.

Comparison of the accuracy of the cannulated pedicle screw and the classical pedicle screw in the treatment of Scheuermann's kyphosis: A retrospective study.

OBJECTIVES: This study aims to investigate if use of cannulated pedicle screw (CPS) in the dysplastic pedicles in Scheuermann's kyphosis (SK) increases the accuracy rate of the screw and reduces screw-related complications. PATIENTS AND METHODS: This retrospective study included 21 patients (11 males, 10 females; mean age 19.1 years; range, 13 to 22 years) (550 screws) who received correction with pedicle screws due to SK deformity between May 2015 and January 2019. Between 2017 and 2018, classical pedicle screws were used in addition to CPSs in the upper thoracic region (T2, T3, T4) and thin pedicles (group 1). However, during the years 2015 to 2016, only classical pedicle screws were used for the patients who underwent posterior instrumentation for SK (group 2). Computed tomography scanning was used to investigate the accuracy of the screws. RESULTS: There were 12 patients (316 screws) in group 1 and nine patients (234 screws) in group 2. Seventy-four (13.4%) of all screws were inserted incorrectly. Incorrect screw rate in group 1 was significantly lower than group 2; 21 (6.6%) and 53 (22.6%), respectively (p<0.001). There were no complications related to the use of CPSs after a mean follow-up of two-and-a-half years. CONCLUSION: The use of CPS in the surgical treatment of SK does not increase the complication rate; instead it increases the accuracy of the screw. For this reason, we believe that CPS may be an effective and reliable option in the treatment of SK.

Surgical treatment of pediatric forearm fractures with intramedullary nails: is it a disadvantage to leave the tip exposed?

Elastic intramedullary nailing is the main treatment method in the surgical treatment of pediatric forearm fractures. In this study, we compared the clinical outcomes of intramedullary nailing of forearm fractures with leaving the tips exposed and with placing the tip of the nails under the skin. We aimed to present the clinical outcomes of intramedullary nailing and determine the advantages and disadvantages of leaving the tips of the nails exposed. One hundred and ninety-two children with both-bone forearm fracture who were treated with titanium elastic nailing (TEN) in the Department of Orthopedics at Erzurum Regional Training and Research Hospital between January 2009 and December 2016 were included in the study. All cases had been followed up for at least 1 year. The tips of the TENs were left exposed in 74 and buried subcutaneously in 118 children. Union was achieved in all cases. Delayed union was observed in just one case. Skin irritation was observed in 11 (5.7%) of the exposed TEN cases. Superficial infection developed in two (1%) cases with exposed TEN tips. Migration developed during the follow-up of 11 (5.7%) cases with buried tips. The mean time to removal of TEN was 7.9 weeks in cases with exposed and 26.2 weeks in cases with buried cases. Refracture was observed in six buried (3.1%) cases and four exposed TEN (2.1%) cases in the first year after the removal of the nails. Perfect outcomes were achieved in 146 (76%) cases and good outcomes in 36 (19%) cases in our study. On comparing the rate of complications and clinicaloutcomes, leaving the TEN exposed seems to be safe.

Outcomes of Surgical Management of Acetabular Fractures Treated with Anterior Approaches.

OBJECTIVE: In this study we aimed to evaluate the outcomes of anterior and combined approaches for treatment of acetabular fractures. MATERIALS AND METHODS: Thirty-seven acetabular fractures in 35 patients treated with an anterior approach were evaluated retrospectively. Fractures were classified according to Judet-Letournel. Early and final radiological evaluation was based on Matta's criteria. Modified Merle d'Aubigne and Postel criteria were used for functional assessment. RESULTS: Eleven (30%) fractures were simple type and 26 (70%) were mixed type. Two (18%) of the simple fractures were transverse and 9(82%) were anterior column fractures. Fourteen (54%) of the mixed type fractures were both column fractures, 5 (19%) were transverse+posterior wall, 5 (19%) were T shaped and 2 (8%) were anterior column+posterior hemitransverse fractures. Surgical approach was ilioinguinal in 15 (43%) patients, Stoppa in 9 (26%) and combined11 (31%). Our functional outcomes were perfect in 10 (27%) hips, good in 20 (54%), moderate in 4 (10%) and poor in 3 (8%). Our radiological results were perfect in 15 (40.5%) hips, good in 15 (40.5%), moderate in 4 (11%) and poor in 3 (8%). CONCLUSION: Anterior surgical approaches provide satisfactory outcomes in appropriate fracture types. Posterior approach can be combined in certain fracture types. We think that rate of the requirement for a concomitant posterior approach for certain fractures of the acetabulum will decrease as experience increases.

Addition of taxanes to combination chemotherapy in distal intestinal gastric cancer is more beneficial than proximal ones: A multicenter retrospective study of Turkish Oncology Group.

PURPOSE: Advanced gastric cancer has a dismal prognosis. Platin/5-fluorouracil (PF) combination chemotherapy is the main treatment modality for metastatic gastric cancer patients. Third drug addition to PF is a controversial issue. The aim of this study was to evaluate the predictive role of tumor localization and histopathology on choosing three- or two-drug combination regimens. METHODS: This study was designed as a hospital-based retrospective observational case-series study. A total of 516 patients with advanced gastric cancer has been treated at eight different oncology centers in Turkey between 2006 and 2016. Laboratory results and demographic data were collected and analyzed. RESULTS: The median patient age was 59 years (range 25-85). Proximal intestinal and distal intestinal cancers were found in 357 (69.2 %) and 159 (30.8 %) patients, respectively. 5-fluorouracil (5FU) and cisplatin (PF) and cisplatin+5FU+docetaxel (PFtax, also known as DCF) were administered to 240 (46.5%) and 276 (53.5%) patients, respectively. Median progression free survival (PFS) was 5.0 (95% CI 4.21-5.29) and 8 months (95% CI 7.22-8.77) for PF and PFtax groups, respectively (p=0.000). When tumor localization was used as stratum in PFS survival, PFtax produced significantly higher PFS rates only in distal intestinal type gastric cancer compared to PF (p=0.000). Median overall survival (OS) was 12 (95% CI 9.8-14.2) and 16 months (95% CI 13.6-18.4) for the PF and PFtax groups, respectively (p=0.01). When tumor localization was used as stratum in OS, PFtax showed significantly higher OS rates only in the distal intestinal type gastric cancer compared to PF (p=0.01) Conclusion: Pathology and tumor location in gastric cancer may affect the outcome. Addition of taxanes as a third drug may significantly increase PFS and OS rates only in distal intestinal type gastric cancer but not in patients with proximal type gastric cancer.

Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures.

BACKGROUND: We aimed to present the radiological and clinical results of Kirschner-wire (K-wire) fixation and low-profile plate-screw fixation applied to unstable proximal phalangeal fractures without extension to the joint. METHODS: Clinical and radiological data of 22 patients who underwent fixation with open reduction and low-profile 1.5-mm titanium mini plate and unlocked screws and 18 patients who underwent fixation with K-wire due to closed, unstable extra-articular proximal phalangeal fractures were retrospectively examined. All evaluation and statistical analyses were based on sixth postoperative month evaluation parameters. Active and passive metacarpophalangeal joint and interphalangeal joint range of motions, total joint range of motion, measurement of grip strength for fractured and healthy hands, visual analog scoring, disabilities of the arm, shoulder, and hand scores, measurement of distance between the pulpa and palmar curve in the operated finger, Belsky score, reoperation, and complications were evaluated. RESULTS: Radiological union was achieved in all patients in a mean duration of 4.2 (3-6) weeks. When the functional results of the patients were evaluated, the mean active metacarpophalangeal joint flexion was 87.3° (75°-90°), mean proximal interphalangeal joint flexion was 94.3° (65°-100°), mean distal interphalangeal joint flexion was 77.6° (75°-80°), and mean total range of motion was 259° (210°-270°). The grip strength of the fractured hand was 52.7 (40-58) kgW, whereas that of the healthy hand was 54.4 (42-60) kgW. The mean value of visual analog score was 0.8 (0-2), mean score for disabilities of the arm, shoulder, and hand was 7 (2-27), and mean distance between the finger pulpa and finger curve was 3 (0-8) mm. CONCLUSION: Plate-screw osteosynthesis in the extra-articular, unstable fractures of the proximal phalanx, which is "small" compared with the body but has a "major function" for the hand and upper extremity, allows for rigid fixation, short immobilization, and early motion in spiral/oblique-fragmented fractures. K-wire fixation, an alternative treatment modality, applied to selected fracture patterns with appropriate indications can achieve good-excellent results radiologically and functionally.

Elbow Posterolateral Dislocation Accompanying Flexor Group Origo Rupture without Fracture - A Case Report.

INTRODUCTION: We wished to present a case that had elbow posterolateral dislocation accompanying complete medial collateral ligament rupture(MCLR) and complete flexor group origo rupture (FGOR) without fracture. CASE REPORT: A30-year-old man came to emergency department after falling on the outstretched palm. After first physical examination and radiologic searches, elbow joint posterolateral dislocation was diagnosed. Together with sedoanalgesia, elbow dislocation was reduced, and instability evaluation by applying varus and valgus stress tests was performed. Positive valgus stress test and palpation sign which indicated soft tissue damage on the medial side of elbow were determined. Control roentgenograms showed no osseous pathology. By magnetic resonance imaging, elbow dislocation diagnosis accompanying MCLR and FGOR without fracture was confirmed. Using medial approach, ruptured MCL and elbow FGO repairing procedures were performed. CONCLUSION: The complications of elbow dislocation without fracture, which is barely seen, should be treated through appropriate treatment strategies after meticulous physical examination and radiologic evaluation. Hence, possible sequelae could be prevented or satisfactory results could be obtained.

Comparison of the Cost and Efficacy of Axillary Anesthesia and Wide-Awake Anesthesia in Finger Surgeries.

OBJECTIVES: Wide-awake anesthesia is a type of local anesthesia consisting of a combined application of lidocaine, epinephrine, and bicarbonate and has a wide potential in hand surgery as it offers the advantage of being applied without sedation and without using a tourniquet. In light of recent studies, its use has increased with the disappearance of the belief among surgeons that epinephrine can cause circulatory disturbance in fingers. METHODS: Patients with finger pathologies who were operated upon at the Baltalimani Bone Diseases Teaching and Research Hospital between January 2015 and February 2016 were divided into two groups according to anesthesia type: wide-awake anesthesia and axillary block anesthesia, with 52 patients in each group. Start time of surgery, length of hospital stay, anesthesia cost, and patient satisfaction were compared. For the evaluation of patient satisfaction, the patients were postoperatively asked whether they would accept the same anesthesia method if they had to have the same experience. Each group was further divided into two subgroups: bone interventions (phalangeal fracture, bone biopsy, implant removal, and interphalangeal joint arthrodesis) and soft tissue interventions (digital nerve repair, fingertip local skin flap, flap division, releasing stiff joint, ligament repair, and debridment). Each subgroup included 26 patients. RESULTS: Sufficient anesthesia to cover the whole duration of surgery was achieved in both the groups. Regarding the question "If you were experiencing the same experience, would you accept the same anesthesia again?" 26 and 33 patients responded positively, 16 and 7 patients repsonded negatively, and 10 and 12 patients remained neutral in the axillary block and wide-awake anesthesia groups, respectively. According to the Social Security Institution data, the average anesthesia cost was 316.1 TL in the axillary block anesthesia group and 25.3 TL in the wide-awake anesthesia group; the average length of hospital stay was 32.9 h in the former and 13.6 h in the latter. Start time of surgery was 34 minutes in axillary block anesthesia and 5.3 minutes in wide-awake anesthesia. CONCLUSION: We found that compared with axillary block anesthesia, the length of hospital stay was 19.3 h less and anesthesia cost was 290.8 TL less with wide-awake anesthesia; furthermore, the start time of surgery decreased by 29.7 min with the latter. Moreover, patient satisfaction rate was better in the wide-awake anesthesia group. No bleeding, patient incompatibility, and other complications that might interfere with the surgery were detected .

A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures.

BACKGROUND: We compared the union and functional results of intramedullary nailing and open reduction internal fixation treatment applied to adults with a forearm diaphysis fracture (fracture of the radius and/or ulna). METHODS: We retrospectively examined 90 patients with completed skeletal maturation who were surgically treated for a forearm diaphyseal fracture. Patients with a Monteggia Galeazzi and ipsilateral upper extremity fracture and those with an open epiphyseal line, Type 3 open fracture, pathological fracture, or brain trauma were excluded from the study. Open reduction and internal fixation (ORIF) was applied to 42 patients (plate group), and intramedullary nailing was performed in 48 patients (intramedullary nailing group). Both treatment groups were compared with respect to time to union, joint range of motion, operating time, grip strength, Grace-Eversman criteria, and complications. RESULTS: The mean operating time was 63.29 (range, 40-100) min in the plate group and 46.02 (range, 17-85) min in the intramedullary nailing group. The mean time to union was 13.19 (range, 10-20) and 10.85 (range, 8-20) weeks, respectively. While a statistically significant difference was determined between groups with respect to operating time and time to union, no difference was determined in the Grace-Eversman evaluation criteria, forearm supination, pronation degrees, and grip strength. CONCLUSION: The results of this study showed a significant difference in the intramedullary nailing treatment with respect to time to union, operating time, and amount of bleeding compared with the ORIF treatment. However, no difference was determined in the functional evaluation criteria. Thus, both treatment methods are acceptable in the treatment of forearm diaphyseal fractures in adults with skeletal maturation.

Os subtibiale: Mimicking medial malleolar fracture.

There are numerous sesamoids and accessory ossicles around the foot which can easily be misdiagnosed as fractures. Os subtibiale is a very rare normal variant of the medial malleolus which is usually diagnosed incidentally in routine ankle radiographs. In this report, we present a case series of 3 patients with os subtibiale who were admitted to the emergency department with ankle sprains and misdiagnosed as medial malleolar fractures. We would like to raise awareness to the very rare and usually asymptomatic os subtibiale as a diagnostic pitfall.