Physiotherapist-supervised exercises versus physiotherapist-prescribed home exercises for treating partial thickness rotator cuff tears: a randomized controlled trial.

BACKGROUND: Partial thickness rotator cuff tears significantly affect physical and psychosocial well-being. This study aimed to compare the efficacy of physiotherapist-supervised exercise and physiotherapist-prescribed home exercise programs on physical and psychosocial health measures in partial thickness rotator cuff tears. METHODS: Seventy patients with partial thickness rotator cuff tears (44 female; mean age, 50.1 ± 5.2 years) were divided into 2 groups. Both the physiotherapist-supervised exercise group (group 1, n = 35) and physiotherapist-prescribed home exercise group (group 2, n = 35) received a program consisting of glenohumeral joint range of motion, stretching, and strengthening exercises (twice a week for eight weeks). The primary outcome measures were the modified Constant-Murley Score (mCMS) and the Hospital Depression and Anxiety Scale. Secondary outcome measures were the visual analog scale, active range of motion (AROM), Pain Catastrophizing Scale, Pittsburg Sleep Quality Index, Short Form-12, and Global Rating of Change Scale. Patients were assessed at baseline and the end of the treatment. The significance level was adjusted to 0.025 after the Bonferroni correction. RESULTS: Both groups showed significant improvements in all measures after treatment. There were no statistically significant group-by-time interactions for the mCMS (F = 12.47, P = .03) and the Hospital Depression and Anxiety Scale (F = 0.89, P = .14 for depression; F = 0.73, P = .44 for anxiety). However, the improvement in the mCMS was clinically meaningful in both groups. The overall group-by-time interaction was significant for the visual analog scale activity (P = .004), shoulder flexion (P = .01) and abduction (P = .02) AROM, and Pain Catastrophizing Scale (P = .005) in favor of group 1. CONCLUSION: Exercise effectively improves physical and psychosocial health measures in partial thickness rotator cuff tears when delivered in the clinic or at home. However, exercise is more effective for activity pain, AROM, and pain catastrophizing when delivered in the clinic, highlighting the effectiveness of the physiotherapist-supervised exercise program.

Biomechanical comparison of reverse offset-L osteotomy and chevron osteotomy in cadaveric hallux valgus surgery.

OBJECTIVE: Chevron osteotomy offers near-excellent clinical results and adequate stability at lower shift percentages, among the techniques used to correct hallux valgus deformity. This cadaveric study aimed to compare the Chevron osteotomy with the reverse offset-L osteotomy, which may provide a greater surface area and a more stable geometry to withstand higher cantilever forces at higher shift percentages. METHODS: Metatarsal bones obtained from 20 human cadavers with similar bone quality were divided into two groups: Chevron osteotomy was applied to the 1st group and reverse offset-L osteotomy was applied to the 2nd group. The load-to-failure, displacement in the y-axis, and total displacement values of both groups were compared statistically. Furthermore, bone densities were compared between the groups with computed tomography imaging. RESULTS: When outliers in both groups were excluded, a statistically significant difference was found in favor of reverse offset-L (143 ± 42 vs. 204 ± 51.2 N, p = 0.02) in terms of failure load. The groups were similar in terms of displacement on the y-axis and total displacement values. Bone densities were similar. CONCLUSION: The reverse offset-L osteotomy has been shown to withstand greater loads before failure compared to the standard Chevron osteotomy. This significant difference in load-to-failure may enable reverse offset-L to provide reliable stability in osteotomies performed in advanced HV cases requiring higher shifts.

Modified and alternative bone cements can improve the induced membrane: Critical size bone defect model in rat femur.

BACKGROUND: As a two-stage surgical procedure, Masquelet's technique has been used to care for critical-size bone defects (CSD). We aimed to determine the effects of modified and altered bone cement with biological or chemical enriching agents on the progression of Masquelet's induced membrane (IM) applied to a rat femur CSD model, and to compare the histopathological, biochemical, and immunohistochemical findings of these cements to enhance IM capacity. METHODS: Thirty-five male rats were included in five groups: plain polymethyl methacrylate (PMMA), estrogen-impregnated PMMA (E+PMMA), bone chip added PMMA (BC+PMMA), hydroxyapatite-coated PMMA (HA) and calcium phosphate cement (CPC). The levels of bone alkaline phosphatase (BALP), osteocalcin (OC), and tumor necrosis factor-alpha (TNF-α) were analyzed in intracardiac blood samples collected at the end of 4 weeks of the right femur CSD intervention. All IMs collected were fixed and prepared for histopathological scoring. The tissue levels of rat-specific Transforming Growth Factor-Beta (TGF-ß), Runt-related Transcription Factor 2 (Runx2), and Vascular Endothelial Growth Factor (VEGF) were analyzed immunohistochemically. RESULTS: Serum levels of BALP and OC were significantly higher in E+PMMA and BC+PMMA groups than those of other groups (P = 0.0061 and 0.0019, respectively). In contrast, TNF-α levels of all groups with alternative bone cement significantly decreased compared to bare PMMA (P = 0.0116). Histopathological scores of E+PMMA, BC+PMMA, and CPC groups were 6.86 ± 1.57, 4.71 ± 0.76, and 6.57 ± 1.51, respectively, which were considerably higher than those of PMMA and HA groups (3.14 ± 0.70 and 1.86 ± 0.69, respectively) (P < 0.0001). Significant increases in TGF-ß and VEGF expressions were observed in E+PMMA and CPC groups (P = 0.0001 and <0.0001, respectively) whereas Runx2 expression significantly increased only in the HA group compared to other groups (P < 0.0001). CONCLUSIONS: The modified PMMA with E and BC, and CPC as an alternative spacer resulted in a well-differentiated IM and increased IM progression by elevating BALP and OC levels in serum and by mediating expressions of TGF-ß and VEGF at the tissue level. Estrogen-supplemented cement spacer has yielded promising findings between modified and alternative bone cement.

The Shanghai Elbow Dysfunction Score: Psychometric Properties, Reliability and Validity Study of the Turkish Version.

The Shanghai Elbow Dysfunction Score (SHEDS) is a self-reported assessment of post-traumatic elbow stiffness that measures elbow-related symptoms and elbow motion capacities. This study aimed to (1) translate and cross-culturally adapt the SHEDS into Turkish and (2) investigate the psychometric properties of the Turkish version in patients with post-traumatic elbow stiffness. The psychometric properties of the Turkish version of the SHEDS (SHEDS-T) were tested in 108 patients (72 male; mean age, 43.2 ± 11.2 years) with post-traumatic elbow stiffness. Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficients were used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Disabilities Arm, Shoulder and Hand (DASH), the Mayo Elbow Performance Score (MEPS), and the Short Form-12 (PCS-12 and MCS-12). The SHEDS-T showed sufficient internal consistency (Cronbach's α coefficient = 0.83) and test-retest reliability (ICC = .96). The correlation coefficients between the SHEDS-T, the DASH, and the MEPS were .75 and .54, respectively (p < .001). There was a moderate correlation between the SHEDS-T and PCS-12 (r = .65, p = .01) and a weak positive correlation between the SHEDS and the MCS-12 (r = .40, p = .03). The SHEDS-T has sufficient reliability and validity to measure elbow-related symptoms and elbow motion capacities for Turkish-speaking individuals with post-traumatic elbow stiffness.

Reliability and Validity of the Turkish Version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale.

BACKGROUND: The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale is one of the most widely used outcome measures to evaluate hallux pathologies. This study aimed to translate the AOFAS Hallux MTP-IP scale into Turkish and investigate its psychometric properties. METHODS: The psychometric properties of the Turkish version of the AOFAS Hallux MTP-IP (AOFAS Hallux MTP-IP-T) scale were tested in 66 patients with hallux pathologies (52 women; mean age, 47.64 ± 12.75 years). Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analogue Scale (VAS), and 12-item Short-Form Health Survey(SF-12). RESULTS: The AOFAS Hallux MTP-IP-T scale had adequate internal consistency (α = 0.71) and test-retest reliability (ICC2,1 = 0.93 for pain, ICC2,1 = 0.97 for function, and ICC2,1 = 0.97 for total score). The AOFAS Hallux MTP-IP-T total score has a moderate to strong correlation with VAS-activity and MOXFQ (ρ = -0.77, P = .001; ρ = -0.69, P = .001, respectively). The weakest correlation was found between the AOFAS Hallux MTP-IP-T and the SF-12 mental component scale (ρ = 0.31, P = .01). CONCLUSION: AOFAS Hallux MTP-IP-T has sufficient reliability and validity to evaluate Turkish-speaking individuals with a variety of forefoot pathologies including the hallux. LEVELS OF EVIDENCE: Level II.

Interdisiplinary and intraobserver reliability of the Greulich-Pyle method among Turkish children.

OBJECTIVES: Greulich-Pyle (GP) is one of the most used method for bone age determination (BAD) in various orthopedic, pediatric, radiological, and forensic situations. We aimed to investigate the inter- and intra-observer reliability of the GP method between the most relevant disciplines and its applicability to the Turkish population. METHODS: One-hundred and eighty (90 boys, 90 girls) patients with a chronological age younger than 18 (mean 9.33) were included. X-rays mixed by the blinded investigator were evaluated by two orthopedists, two radiologists, and two pediatric endocrinologists to determine skeletal age according to the GP atlas. A month later the process was repeated. As a statistical method, Paired t-test was used for comparison, an Intraclass Correlation Coefficients test was used for reliability and a 95 % confidence interval was determined. Results were classified according to Landis-Koch. RESULTS: All results were consistent with chronological age (p<0.001), according to the investigators' evaluations compared with chronological age. At the initial evaluation, the interobserver reliability of the method was 0.999 (excellent); at the second evaluation, the interobserver reliability was 0.997 (excellent). The intra-observer reliability of the method was 'excellent' in all observers. When results were separately evaluated by gender, excellent intraobserver correlation and excellent correlation with chronological age were found among all researchers (>0.9). When X-rays were divided into three groups based on age ranges and evaluated, 'moderate' and 'good' correlations with chronological age were obtained during the peripubertal period. CONCLUSIONS: The GP method used in skeletal age determination has excellent inter- and intra-observer reliability. During the peripubertal period, potential discrepancies in bone age assessments should be kept in mind. This method can be used safely and reproducibly by the relevant specialists.

Three-Dimensional Finite Element Analysis of a Notched Insert Design for Reverse Total Shoulder Arthroplasty to Prevent Scapular Notching.

Purpose: Reverse total shoulder arthroplasty (RSA) is an effective treatment option for rotator cuff arthropathy. Scapular notching following RSA remains a major complication and has a high incidence. This finite element analysis (FEA) study provides a future reference for the optimal design of the insert component of RSA. This study aims to clarify the effect of a new design RSA with a notched insert on the range of adduction, scapular notching, and stress variation of its insert component using three-dimensional (3D) FEA. Methods: 3D nominal Grammont-type monobloc RSA implant components are modeled on the sawbones glenohumeral joint. The polyethylene insert is redesigned with notching of the inferior part. The comparison of standard and notched designs was performed by FEA for stress pressure of scapular notching and the degree of adduction. 3D mesh models are created for stress analysis to compare the results between standard and notched inserts for the adduction. Results: The redesigned notched inserts had an additional ~ 11.2° on adduction and prevented scapular notching. The stress analysis results for the notched insert design were lower than the standard ones (4.7 vs 22.4 Kpa). Conclusions: Notched insert design of Grammont-type RSA could provide additional adduction with lower stress on the glenoid, leading to less scapular notching. Further experimental and clinical studies on different RSA types are needed to verify this effect. Study Design: Basic Science Study; Biomechanics and Computer Modeling.

Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance.

Background: The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. Purpose/Hypothesis: The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Study Design: Case series; Level of evidence, 4. Methods: This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. Results: All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. Conclusion: ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.

The antibiotics supplemented bone cement improved the masquelet's induced membrane in a rat femur critical size defect model.

BACKGROUND: Masquelet technique is a two-stage surgical procedure used in the treatment of critical-size bone defects (CSD). Adding antibiotics to polymethylmethacrylate (PMMA) is still questionable to create higher quality induced membrane (IM). The aim of the study was to evaluate the effects of three antibiotic-supplemented cement, fusidic acid, teicoplanin, and gentamicin, on osteogenesis and IM progression applied to rat femur CSD model by comparing histopathological, biochemical, and immunohistochemical findings. METHODS: Twenty-eight male rats were divided into four groups control, gentamicin (G), teicoplanin (T), and fusidic acid (FA). A 10 mm CSD was created in rat femurs. In the postoperative 4th week, intracardiac blood samples were collected for biochemical analysis of bone alkaline phosphatase (BALP), osteocalcin (OC), and tumor necrosis factor-alpha (TNF-α) levels. IMs obtained in secondary operation were fixed and prepared for histopathological scoring of membrane progression and immunohistochemical evaluation of rat-specific Transforming Growth Factor-Beta (TGF-ß), Runt-related Transcription Factor 2 (Runx2), and Vascular Endothelial Growth Factor (VEGF) expressions. RESULTS: Levels of BALP and OC in serum didn't change among groups significantly while serum TNF-α levels significantly decreased in all antibiotic groups compared to the control group (P = 0.017). Histological scores of groups FA and T were significantly higher than those of groups Control and G (P = 0.0007). IMs of groups T and FA showed good progression while those of groups Control and G were also moderately progressed. A significant increase in TGF-ß expression was observed in group G and FA (P = 0.001) while a significant increase in the expression of VEGF was observed in groups G and T compared to the control group (P = 0.036). CONCLUSIONS: The bone cement impregnated with thermostable and safe antibiotics, gentamicin, fusidic acid, and teicoplanin can increase osteogenesis and support IM progression by increasing the expressions of TGF-ß and VEGF. Anabolic effects of induced membranes used in the treatment of critical-size bone defects can be enhanced by antibiotic-supplemented PMMAs applied by altering the original technique.

The Effectiveness of Neuromuscular Electrical Stimulation in Patients With Subacromial Impingement Syndrome: A Randomized Controlled Study.

OBJECTIVE: The aim of the study is to compare the effects of exercise training plus neuromuscular electrical stimulation with exercise training alone on shoulder function, pain, range of motion, and muscle strength in patients with subacromial impingement syndrome. DESIGN: Patients were randomly divided into groups of exercise training ( n = 24) and exercise training + neuromuscular electrical stimulation ( n = 24). Shoulder function was evaluated with the Disabilities of the Arm, Shoulder and Hand Questionnaire, pain level was assessed with a visual analog scale, range of motion was measured with a goniometer, and muscle strength was assessed with a handheld dynamometer baseline and at the end of treatment (week 8). RESULTS: In both groups, shoulder function, range of motion, and muscle strength (except flexion muscle strength in the exercise training group) increased, while pain decreased ( P < 0.05). Compared with the exercise training group, visual analog scale-activity and visual analog scale-night decreased more, and external-rotation range of motion and whole muscle strength increased more in the exercise training + neuromuscular electrical stimulation group ( P < 0.05). On the other hand, the effect sizes were medium to large for both groups. CONCLUSIONS: The addition of neuromuscular electrical stimulation treatment to exercise training did not improve shoulder function, which is the primary outcome, more than exercise training alone, but increased muscle strength and range of motion (external-rotation only) and decreased pain (activity-night), which are the secondary outcomes.

Comparison of the early-term clinical results of capitate forage procedure and radial shortening osteotomy in Stage 3A Kienböck's disease.

OBJECTIVES: This study aims to evaluate the efficacy of an alternative method by comparing an old established method with a new less invasive method in the surgical treatment of Stage 3A Kienböck's disease. PATIENTS AND METHODS: Between January 2014 and July 2018, a total of 35 patients (28 males, 7 females; mean age: 22.8±3.3 years; range, 17 to 29 years) who underwent surgery due to Kienböck's disease were retrospectively analyzed. The patients were divided into two groups according to the procedure applied as the capitate forage procedure (CFP) group (Group 1, n=16) and the radial shortening osteotomy (RSO) group (Group 2, n=19). Patients with a minimum follow-up period of 18 months were examined according to the MAYO wrist scores pre- and postoperatively. RESULTS: The postoperative MAYO scores were statistically significantly higher in both groups (CFP, p=0.001; RSO, p=0.000). However, the osteotomy group showed statistically significantly higher results than the forage group in terms of not only postoperative scores, but also pre- and postoperative score difference (p=0.004). CONCLUSION: Our study results confirm that both CFP and RSO are effective in the treatment of Stage 3A Kienböck's disease. However, RSO should be the first choice in Stage 3A patients with high success rates. Supported by long-term follow-up results, CFP may be considered a minimally invasive alternative only in selected patients who avoid major surgery or expect a rapid return to work.

Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures?

BACKGROUND: The aim of the study is to evaluate the relationship between plate-screw density (PSD), functional results, and complication rates in the treatment of proximal humerus fractures (PHFs) with proximal humerus locking anatomical plate (PHLAP). METHODS: Consecutive 43 patients (22 females and 21 males) who underwent PHLAP for the treatment of PHF between 2010 and 2016 were evaluated. AO classifications were used for the classification of fractures. Based on the biomechanical stability the-ory of Erhardt et al., the patients were divided into two groups as <60% and >60% according to the number of screws fixed to the humeral head for the determination of PSD. The patients were divided into two groups as PSD <60% (n=21) and PSD>60% (n=22) according to the number of screws fixed to the humeral head for the determination of PSD. Functional results were evaluated using the Constant-Murley shoulder score (CMS). Radiological evaluation was performed with collodiaphyseal angle (CDA), varus-valgus angulation, avascular necrosis (AVN), and arthrosis. The groups were compared in terms of demographic characteristics, functional results, radiological scores, and complications. RESULTS: The mean age was 54.47±17.43 years and the mean follow-up time was 19.51±5.27 months. Although the CMS scores of patients with a PSD of over 60% were higher than those below 60%, the CMS score did not differ statistically. In groups, the mean CDA of the operated shoulder was significantly lower than that of the non-injured side (p=0.002). Eight patients had varus angulation, whereas two patients had humerus head AVN. No significant relationship was observed between PDS and functional scores, radiolog-ical results, and complications. CONCLUSION: Functional results of PSD >60% are higher than PSD <60% group but there is no statistical difference between groups according to functional, radiological results, and complications.

Fibular fixation improves ankle functional outcomes and alignment in the intramedullary nailing of distal third tibiofibular diaphyseal fractures.

PURPOSE: The study aims to determine the effect of fibular fixation on alignment and fracture healing of tibia, and ankle functional outcomes in the treatment of distal third tibiofibular diaphyseal fractures. METHODS: Consecutive 111 patients (33 females and 78 males) with distal third tibiofibular diaphyseal fracture who met the inclusion criteria were included in the study. Patients were divided into two groups as those who underwent fibular fixation with tibia intramedullary nailing (study group) and those who did not (control group). Groups were compared in terms of demographic features, trauma and fracture characteristics, functional and radiological outcomes. RESULTS: No significant difference was observed between the groups in terms of demographic features, trauma characteristics, complications, and follow-up time (p > 0.05). Surgery time was significantly lower in the control group (p = 0.001). Ankle joint range of motion, AOFAS score, OMAS score, and full weight-bearing time were significantly better in the fibular fixation group (p = 0.023, p = 0.001, p = 0.001 and p = 0.039, respectively). Significantly better coronal alignment and sagittal alignment were found in the fibular fixation group (p = 0.001 and p = 0.001, respectively). Patients who underwent fibular fixation had significantly better radiological outcomes in terms of fibular rotation angle and ankle arthrosis (p = 0.000 and p = 0.022, respectively). CONCLUSION: Fibular fixation not only contributes to fracture union, early full weight-bearing, and alignment but also improves ankle functional outcomes in the distal third tibiofibular fractures treated with intramedullary nailing for tibia. LEVEL OF EVIDENCE: Level III, retrospective study.

Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) after Hip Arthroplasty.

Ogilvie's syndrome is a clinical entity that occurs with signs of excessive dilatation of the colon and obstruction, despite the absence of a mechanical obstruction. Although its etiology remains uncertain, anticholinergic drugs, metabolic disorders, diabetes mellitus, hyperparathyroidism, Parkinson's disease, major orthopedic interventions, or blunt abdominal trauma are considered to be possible causes. Imbalance in sympathetic innervation plays a role in the pathogenesis. The characteristic feature of the syndrome is the presence of a major trauma or surgical history. Although this is an uncommon complication, especially after hip and knee arthroplasty, it is an important cause of mortality and morbidity. Conservative or surgical colonic decompression and anticholinergic agents play a role in the treatment of Ogilvie's syndrome, which is defined as acute colonic pseudo-obstruction (ACPO). In this case report, we present the postoperative process of an elderly patient with comorbid diseases who underwent hemiarthroplasty due to a hip fracture as a result of a domestic fall. We will discuss the diagnosis of ACPO and the approach to multidisciplinary management of the treatment in a case that is frequently encountered in daily practice and starts as a normal report. We aim to remind surgeons that they may encounter ACPO in the postoperative period and to emphasize that mortality and morbidity can be reduced with early diagnosis and a multidisciplinary approach. We would like to emphasize that Ogilvie's syndrome should be included in the differential diagnosis portfolio of all orthopedic surgeons.

Comparison of Functional and Radiological Outcomes of Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion Techniques in the Treatment of Lumbar Spinal Stenosis.

BACKGROUND: This study aimed to compare posterolateral fusion with transforaminal lumbar interbody fusion (PLF + TLIF) and PLF only in terms of revision surgery rates and complications, as well as functional and radiological outcomes in lumbar spinal stenosis (LSS) patients. METHODS: Seventy-one patients (37 patients in the PLF + TLIF group and 34 patients in the PLF only group) who underwent surgery due to LSS between January 2013 and December 2016 were retrospectively investigated. Functional evaluation was performed by using the McGill-Melzack Pain Questionnaire (MPQ), Roland Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI) scales pre-and postoperatively. Radiological evaluation was made by examining adjacent vertebrae, posterior ligamentous complex (PLC) morphology, and sagittal balance on magnetic resonance imaging (MRI). RESULTS: Postoperative MPQ, RMDQ, and ODI scores were significantly better in the PLF + TLIF group (p < 0.001, p < 0.001, and p = 0.001, respectively). The complication rate was significantly higher in the PLF only group (p = 0.026). In the PLF + TLIF group, postoperative functional scores showed significant improvement in terms of the instrumented segment and level of interbody fusion. Postoperative functional scores showed significant improvement in PLF + TLIF patients with no complications, no revision surgery, no postoperative MRI findings, and neutral sagittal balance compared to the preoperative functional scores (p < 0.001). CONCLUSION: PLF + TLIF is significantly superior in terms of functional scores and complications, despite the statistical similarity in terms of postoperative MRI findings and sagittal balance between the groups. Surgeons should prefer PLF + TLIF for the surgical treatment of LSS for better results.

Injury characteristics and management of orthopaedic trauma in refugee children.

PURPOSE: Several factors affect injury types in childhood. The aim of the study was to evaluate the musculoskeletal injury types, treatment modalities, and demographic characteristics of refugee children and to reveal the differences from native children. METHODS: A total of 1297 patients (897 females, 400 males) treated in our clinic between January 2014 and January 2019 were included in the study. The mean age of the patients was 8.9 ± 5.1 in refugees and 7.5 ± 4.6 in the native group (range, 0-18 years). The patients were evaluated in terms of age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, surgical technique, complications, and treatment modalities. RESULTS: The trauma mechanism differed significantly between the groups, high-energy traumas such as falling from a height, fight/assault injury, gunshot injury, and work injury were found more frequently in the refugee group (p = 0.001). The rates of CRIF, ORIF, graft/flap surgery, and hospitalization time were observed to be significantly higher in the refugee group (p = 0.013). No significant difference was observed between groups in terms of demographic distribution, injury location, and complications. CONCLUSION: This population-based, cross-sectional study emphasizes that the refugee children have different injury mechanisms. Improved living conditions may reduce musculoskeletal injury in this population.

Strut graft vs. traditional plating in the management of periprosthetic humeral fractures: a multicentric cohort study.

Aim The gradual increase in shoulder implants in active elderly patients has appeared in a parallel increase in periprosthetic humeral fractures. The aim of this study was to investigate the advantages of using strut grafting with plate fixation during periprosthetic humerus fractures. Methods Thirty patients diagnosed with periprosthetic humeral fracture were divided into two groups. The first group of 15 patients (PS) underwent plate, ring, screws and strut allografts. The second group with resting 15 patients (PWS) was treated with only plate and screws. The criteria to evaluate the groups during followup were the Constant Shoulder Score (CSS) and Oxford Shoulder Score (OSS); the bone healing was measured by X-rays, controls measured by radiographic union score (RUS), and complications. The follow up was terminated at 12nd month in both groups. Results The difference between the two groups in all parameters was not significant. However, all patients gained adequate shoulder motor skills for normal daily living activities. All fractures were healed. Only two complications were registered, and blood loss was minimal. Conclusion We believe a revision to reverse shoulder prosthesis with a long-stem implant with or without cortical strut allograft augmentation to be safe and appropriate in the management of these complex injuries, though technically challenging, and having good results for normal activities daily life.

Results of acromioclavicular joint reconstruction using a novel minimally invasive technique.

BACKGROUND: AC joint injury is a common disorder with a reported incidence of three to four cases per 100.000. A multitude of surgical techniques has been described for the treatment of the AC joint injuries with no clear consensus regarding the optimal treatment. We hypothesized that we would obtain favorable clinical outcomes using a novel minimally-invasive polymer cerclage wire system compared to other reported techniques in the literature. METHODS: All adult patients treated with subacute AC separations in our department between the dates of 2014-2017 were retrospectively reviewed clinically and radiographically. Clinical outcomes scores that were obtained preoperatively and postoperatively included ASES score, constant score and the UCLA shoulder rating scale. RESULTS: Five patients with Type 5 AC separations were included in this study who underwent surgical treatment by the same orthopedic surgeon (G.H.) using the same minimally-invasive technique. The mean follow-up period was 22.4 months (range 18 to 29). Mean preoperative coracoclavicular (CC) distance was 19.7 mm (range 16.4 to 24.5 mm) on the surgical side and 9.48 mm on the contralateral side. Mean early postoperative CC distance was 7.1 mm (range 4.5 to 11.2 mm). At the latest follow-up, the mean CC distance was 13.8 mm (range 7.3 to 21.2 mm). Mean preoperative Constant score was 48, the UCLA shoulder rating score was 14.8, and the ASES shoulder score was 49.26. Mean follow up Constant score was 91.6, UCLA shoulder rating score was 33.8 and ASES shoulder score was 93.75. No neurovascular complication was observed after procedure. There were no cases of clinical or radiographic failure or loss of fixation. No AC joint arthritis was observed at the latest follow-up. CONCLUSION: We present a novel minimally-invasive polymer cerclage wire technique which provides comparable results as other reported arthroscopic and open techniques for Type 5 AC joint separations.

Importance of lowest instrumented vertebra on clinical and radiological outcomes in patients with Lenke type 3C adolescent idiopathic scoliosis: a minimum 4-year follow-up.

The purpose of this retrospective study was to determine the most appropriate distal fusion level in terms of clinical results and radiological changes in Lenke 3C adolescent idiopathic scoliosis (AIS). Between June 2010 and May 2014, a total of 90 consecutive patients who underwent surgery for Lenke 3C AIS were divided into three groups as L2, L3, and L4 according to the fusion levels and compared in terms of functional and radiological outcomes. Patients were evaluated with Scoliosis Research Society 22 (SRS 22) and the Oswestry disability index (ODI) at the final follow-up. Preoperative standard posteroanterior and lateral whole-spine radiographs and lateral bending radiographs were used to evaluate the curves. All patients were also assessed with lumbar MRI at the final follow-up, and classified for each patient in terms of disc degeneration (DD) and facet joint degeneration (FJD). There was a statistically significant difference between the groups in terms of ODI category (P = 0.001). The rate of minimal disability in the L3 group, moderate disability in the L2 group, and severe disability in the L4 group were higher. Statistically significant differences were observed between the groups in terms of pain, body image, mental health, and total score distribution from the SRS-22 domains (P < 0.05). No significant difference was observed between the groups in terms of DD and FJD in MRI (P = 0.263). Although the preoperative functional scores could not be evaluated due to the retrospective nature of the study, it was observed that the only significant difference between the groups was the SRS-22 score. The best SRS-22 score was obtained in patients in whom fusion was stopped at L3.

Alkaptonuria: Spontaneous Achilles tendon rupture: Case report.

Alkaptonuria is an autosomal recessive disease caused by the accumulation of homogentisic acid (HGA) products in the ligament, cartilage, skin and various organs due to the lack of HGA oxidase enzyme. In this article, we present a 61-year-old male patient operated on due to a diagnosis of spontaneous Achilles tendon rupture and diagnosed as alkaptonuria due to the intraoperative color of the tissues and the subsequent examinations. We also reviewed alkaptonuria and its accompanying pathologies in light of the literature.