Analysis of increased motorcycle accidents during the COVID-19 pandemic: a single-center study from Türkiye.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has led to a unique set of circumstances, straining health-care systems and affecting the way of life in societies around the world. Measures such as social isolation, travel restrictions, and workplace closures have led to an increase in motorcycle use. Consequently, motorcycle accidents have become a significant problem during this period. This study presents detailed research conducted to examine motorcycle accidents during the COVID-19 pandemic and to understand the causes and consequences of the increase in these accidents. METHODS: This research evaluated records from a single health examination and used various models to analyze motorcycle acci-dents within a specified time period. Additionally, retrospective analyses were conducted to examine associations between motorcycle use and crashes in our country before and after the pandemic. The records of 386 patients who were injured in motorcycle accidents and followed up, received treatment, and were recorded at Biruni University Hospital between November 2015 and April 2023 were retrospectively examined. Noted details included the victims' age, gender, injury mechanism, injury site, injury severity, helmet use, presence and location of fractures, time distribution of the accident, and the severity of other important tissue injuries. The relationship between the injury site, fractures, and accident details, and the "Injury Severity Score" (ISS) was also investigated. RESULTS: Among the 386 injured victims in motorcycle accidents, 333 were male and 53 were female. Of these, 168 (43.5%) were motorcycle drivers, 137 (35.5%) were motorcycle couriers, and 81 (21%) were pedestrians. A total of 186 (48%) injuries occurred before the pandemic (November 2015-March 2020), while 200 (52%) were sustained during the pandemic. The study indicates a noticeable increase in motorcycle injuries, particularly among motor couriers, especially during the pandemic quarantine periods. Post hoc analysis revealed that motor couriers had significantly lower ISS compared to other professions (p=0.009 and p=0.045, respectively). Motorcyclists who wore helmets were found to have significantly lower ISS than those who did not wear helmets (p<0.05). Furthermore, it was found that the ISS was positively correlated with the number of bone fractures, total soft tissue injury, and significant clinical characteristics (r=0.758, r=0.756, and p<0.001, respectively). CONCLUSION: This clinical study's findings demonstrate that the measures implemented during the pandemic to limit society's mobility have led to an increase in motorcycle accidents. Notably, there has been a significant rise in the number of accidents, particularly involving individual motorcycle use and motorcycle courier services.

Segmentation of measurable images from standard plane of Graf hip ultrasonograms based on Mask Region-Based Convolutional Neural Network.

OBJECTIVES: This study proposed a Mask Region-Based Convolutional Neural Network (R-CNN)-based automatic segmentation to accurately detect the measurable standard plane of Graf hip ultrasonography images via segmentation of the labrum, lower limb of ilium, and the iliac wing. PATIENTS AND METHODS: The study examined the hip ultrasonograms of 675 infants (205 males, 470 females; mean age: 7±2.8 weeks; range, 3 to 20 weeks) recorded between January 2011 and January 2018. The standard plane newborn hip ultrasound images were classified according to Graf's method by an experienced ultrasonographer. The hips were grouped as type 1, type 2a, type 2b, and type 2c-D. Two hundred seventy-five ultrasonograms were utilized as training data, 30 were validation data, and 370 were test data. The three anatomical regions were simultaneously segmented by Mask-R CNN in the test data and defective ultrasonograms. Automatic instance-based segmentation results were compared with the manual segmentation results of an experienced orthopedic expert. Success rates were calculated using Dice and mean average precision (mAP) metrics. RESULTS: Of these, 447 Graf type 1, 175 type 2a or 2b, 53 type 2c and D ultrasonograms were utilized. Average success rates with respect to hip types in the whole data were 96.95 and 96.96% according to Dice and mAP methods, respectively. Average success rates with respect to anatomical regions were 97.20 and 97.35% according to Dice and mAP methods, respectively. The highest average success rates were for type 1 hips, with 98.46 and 98.73%, and the iliac wing, with 98.25 and 98.86%, according to Dice and mAP methods, respectively. CONCLUSION: Mask R-CNN is a robust instance-based method in the segmentation of Graf hip ultrasonograms to delineate the standard plane. The proposed method revealed high success in each type of hip for each anatomic region.

Relationship of Altmetric Attention Score, Twitter Performance, and Dimensions Badge Value With Traditional Metrics in Top-Cited Anterior Cruciate Ligament Research Studies.

Background: Alternative citation metrics-such as the Altmetric Attention Score (AAS), number of tweets (TN), and dimensions badge value (DBV)-are emerging as new options for assessing the value of scientific works. Purpose: To analyze the AAS of highly cited articles on the anterior cruciate ligament (ACL) and to assess the relationship between alternative and traditional metrics such as journal rankings and article citation performance. Study Design: Cross-sectional study. Methods: A search was conducted using the Web of Science Core Collection of databases with "anterior cruciate ligament" as the search term. Full-text articles published between 2011 and 2021 were reviewed, and the top 100 cited articles were determined. The articles were analyzed by publication year, study design, research topic, journal impact factor, journal h-index, number of total citations (TC), recent citations (RC) (ie, citations in the latest 2 years), and average citation per year (ACY), as well as AAS, TN, and DBV. Results: For articles in the top 100 list, the median TC was 160 (interquartile range [IQR], 117-561) and the median AAS was 24.50 (IQR, 1-730). A higher AAS score was achieved by articles on return to sports and anterolateral ligament (P < .05). The AAS and TN were significantly and positively correlated with the RC (r = 0.459 and P = .001; r = 0.438 and P = .001, respectively) and ACY (r = 0.363 and P = .001; r = 0.393 and P = .001, respectively). Conclusion: Alternative metrics were linked to traditional metrics but were not a direct representation of bibliometrics. The AAS was not correlated with TC numbers in the ACL research. Higher AAS and Twitter popularity of an article were related to receiving high-volume RC performance. The DBV represented a stronger correlation with traditional metrics than the AAS.

Baropodometric comparison of orthopedic footwear to assess the effectiveness of pairs of orthopedic shoes for reducing the forefoot pressure.

OBJECTIVES: This study aimed to evaluate the distribution of foot pressure with the most frequently used orthopedic shoes and demonstrate the effect of offloading philosophy on the pressure distributions of rocker bottom or heel support shoes applied unilaterally or bilaterally. MATERIALS AND METHODS: Three bilateral and four unilateral, a total of seven shoe designs with sensors included in the insole were tested by the same subject in a standard acquisition protocol. Two of the unilateral and one of the bilateral shoes had heel support, while others had a rocker bottom design. A descriptive analysis was performed for each shoe and compared to a reference value obtained from a standard shoe. RESULTS: Shoes with an offloading heel resulted in a greater reduction in pressure on the forefoot than other models. All other shoes increased pressure on the first metatarsophalangeal joint. Heel offloading models performed the best in forefoot offloading, and bilateral heel offloading shoes performed the best in first metatarsal offloading, with the highest scores of 83% and 82%, respectively. CONCLUSION: This study showed that orthopedic shoes sold in pairs could reduce pressure on the forefoot at a comparable level to unilateral shoes. It supports their use to limit the disadvantages of single orthopedic shoes, such as limb length discrepancies.

Arthroscopic revision of osteochondral autograft in distal tibia: A case report demonstrating precision of intraoperative 3D fluoroscopy.

Graft failures of the tibial plafond are very rare. This article presents the technique of precise antegrade osteochondral auto-grafting under three-dimensional (3D) fluoroscopy. A 20-year-old athletic patient with a recurrent osteochondral lesion of the tibial plafond on a first osteochondral autograft after two years of follow-up was admitted. The revision osteochondral autograft was performed under real-time perioperative arthroscopic and 3D fluoroscopic control for greater precision. Surgery was followed by six weeks of non-weight-bearing in a walking boot. At one-year follow-up, the patient was effusion and pain free and returned to his previous activity level completely. Revision osteochondral autografting under arthroscopic and 3D fluoroscopic control seems to be an effective therapeutic option.

Early postoperative practices following anterior cruciate ligament reconstruction in France.

INTRODUCTION: The early postoperative period after anterior cruciate ligament reconstruction (ACL) is critical for optimal functional recovery. Despite an abundance of literature, there is no consensus regarding good practices. This period is often under-considered by orthopedic surgeons. The aim of this study was to identify early postoperative practices after ACL reconstruction in France. HYPOTHESIS: The hypothesis was that there was a discrepancy between validated data in the literature and the current practices of orthopedic surgeons in France. MATERIAL AND METHODS: In 2019, a questionnaire was sent to all the members of the French Arthroscopy Society to investigate their postoperative practices after ACL reconstruction. Two hundred sixty-nine members responded. Surgeons were divided into two groups of experienced (n=137) and less experienced (n=132) surgeons, according to the number of ACL reconstructions performed per year (

Treatment of Acute Bony Avulsion of Ischial Tuberosity With Cortical Screw Fixation.

Displaced bony avulsion of the hamstring origin is a rare condition that necessitates surgical treatment. This article describes the surgical treatment of acute apophyseal separation of the ischial tuberosity via open reduction and internal fixation with cortical screws.

The "sleeper's sign" is valid and suggestive of a medial sub-meniscal flap tear.

PURPOSE: To describe, evaluate and validate the diagnostic performance of a new clinical sign, the sleeper's sign, for the diagnosis of a medial submeniscal flap tear (MSMFT). METHODS: This retrospective single-center series included patients aged 18-55 years old who underwent arthroscopic treatment in 2013-2015 for a medial meniscal tear. This study was performed according to STARD (standards for reporting of diagnostic accuracy) guidelines, and the reference test was a peroperative diagnosis of a MSMFT. The preoperative consultation reports were all analyzed to search for the sleeper's sign, defined as night time medial tibiofemoral pain when the patient is in the fetal position with both knees in contact and no pain during daytime activities. RESULTS: Three-hundred and ten patients responded to the study criteria, mean age 41.7 ± 9.7 years old. The sleeper's sign was identified in 39 (12.6%) patients and a MSMFT was confirmed during arthroscopy in 47 (15.2%) cases, with significant agreement between this sign, arthroscopy (kappa = 0.78, p = 10-4) and MR-imaging (kappa = 0.72, p < 0.0001). The performance parameters of the sleeper's sign were: sensitivity 74.5 ± 12.5%, specificity 98.5 ± 1.6%, Youden index 0.73 and accuracy 96.9%. MR imaging was found to be more sensitive (91.5 ± 8%). Multivariate analysis identified the sleeper's sign as a risk factor of MSMFT during arthroscopy: OR 131.9 CI 95% [26.9-646.2], p < 0.0001 and a bone edema next to the flap tear on MR-imaging: OR 13, CI 95% [1.9-7.1], p = 0.008. CONCLUSION: The "sleeper's sign" is a new, valid, highly specific clinical sign for the diagnosis of a medial submeniscal flap tear. MRI was found to be more sensitive than the sleeper's sign. LEVEL OF EVIDENCE: II.

Correction to: Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function.

The article Vancomycin­soaked autografts during ACL reconstruction reduce the risk of post­operative infection without affecting return to sport or knee function, written by Yoann Bohu.

Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function.

PURPOSE: To compare return to sport and knee function 1 year after anterior cruciate ligament (ACL) reconstruction using autografts with and without vancomycin presoaking. METHODS: A case-control study based on a retrospective analysis of prospective data included athletes over the age of 16 operated from 2012 to 2018 for ACL reconstruction. There were two groups of patients due to a change in treatment protocols: Group 1 « without vancomycin ¼ before November 2016 and Group 2 « with vancomycin¼ after this date. In Group 2, the graft was soaked in a vancomycin solution for 10 min and then fixed into the bone tunnels. The primary evaluation criterion was the return to sport 1 year after surgery. The secondary criteria were various knee scores. The number of patients needed to perform a non-inferiority study was calculated. RESULTS: 1674 patients fulfilled the selection criteria, 1184 in Group 1 and 490 in Group 2. The series included 1112 men and 562 women, mean age 30 ± 9.7 years, 68 professional athletes, 674 competitive athletes and 932 recreational athletes. While seven patients presented with post-operative septic arthritis in Group 1, this complication was not found in Group 2. No significant difference was identified in the return to running between the two groups 1 year after surgery (75.9% vs. 76.1%, n.s.). Significantly more of the patients in Group 2 returned to their preinjury sport (p = 0.04). Knee function was comparable between the groups. CONCLUSION: Vancomycin-soaked grafts during ACL reconstruction reduce the risk of post-operative infection of the knee without affecting the return to sport or knee function. LEVEL OF EVIDENCE: III. TRIAL REGISTRATION: https://clinicaltrials.gov/ , ClinicalTrials.gov Identifier: NCT02511158.

Deep Convolutional Neural Network-Based Automatic Classification of Neonatal Hip Ultrasound Images: A Novel Data Augmentation Approach with Speckle Noise Reduction.

Neonatal hip ultrasound imaging has been widely used for a few decades in the diagnosis of developmental dysplasia of the hip (DDH). Graf's method of hip ultrasonography is still the most reproducible because of its classification system; yet, the reproducibility is questionable as a result of the high dependency on the skills of the sonographer and the evaluator. A computer-aided diagnosis system may help evaluators increase their precision in the diagnosis of DDH using Graf's method. This study describes a fully automatic computer-aided diagnosis system for the classification of hip ultrasound images captured in Graf's standard plane based on convolutional neural networks (CNNs). Automatically segmented image patches containing all of the necessary anatomical structures were given to the proposed CNN system to extract discriminative features and classify the recorded hips. For ease of evaluation, the data set was divided into three groups: normal, mild dysplasia and severe dysplasia. This study proposes a different approach to data augmentation using speckle noise reduction with an optimized Bayesian non-local mean filter. Data augmentation with this filter increased the accuracy of the proposed CNN system from 92.29% to 97.70%. This new approach for automatic classification of DDH, classifies dysplastic neonatal hips with a high accuracy rate and might help evaluators to increase their evaluation success.

Hermes patellofemoral arthroplasty: Annual revision rate and clinical results after two to 20 years of follow-up.

BACKGROUND: Patellofemoral arthroplasty (PFA) is an alternative to a total knee arthroplasty (TKA) in patients with severe isolated patellofemoral osteoarthritis. The main goal of this study was to determine the revision rate of the Hermes™ (Ceraver) anatomical unconstrained PFA. METHODS: A retrospective single surgeon study was performed including all patients operated for PFA between 1997 and 2015. A standardized procedure was used to perform PFA with one type of prosthesis. All patients in the study were contacted at the final follow-up. The main judgment criterion was the annual rate of revision. Secondary criteria were the severity of anterior knee pain on a numerical scale (0-10) and functional scores (IKS and AKP scores). RESULTS: During this period, PFA was performed in 64 patients (74 PFA), 52 women/12 men, mean age at surgery 59.6 ±â€¯11.8 (31.3-82.1) years old. Four patients (5.4% of PFA) were lost to follow-up. Mean follow-up for the remaining 70 PFA was 7.5 ±â€¯7.1 (2-20) years. TKA was required in 10 (14.3%) patients after a mean 5.4 ±â€¯3.4 (1-9.3) years. The annual rate of revision was two-percent CI95% [1.1-3.7%] if TKA was considered to be the defining event and 3.1% CI95% [1.9-5.1%] for all types of revision (partial/total PFA replacement or TKA). Patients who underwent revision were significantly younger. After a mean eight (2-20) years of follow-up, mean anterior pain, the IKS and AKP scores improved significantly. CONCLUSION: In this series, 78.6% of patients with a Hermes™ PFA did not require any revision after a follow-up of between two and 20 years. LEVEL OF EVIDENCE: Level IV - retrospective study.

Epithelioid Angiosarcoma in Femur: A Case Presentation.

Primary malignant vascular tumors which constitute less than 1% of the primary bone tumors are very rarely encountered. Epithelioid angiosarcoma is a very uncommon subtype of angiosarcomas presenting with an epithelioid phenotype and mimicking carcinomas clinically. These tumors select mostly extra-skeletal locations but rarely bones as their medium. A 31-year-old male patient applied to our clinic with a nonspecific left hip pain. X-ray evaluation revealed a cystic expansile mass in the trochanteric region of the femur extending to the femoral neck. Computed tomography examination proved that the mass was cystic and 7 cm in its greatest width and contained septum. Moreover, magnetic resonance imaging examination was reported as a mass resembling aneurysmal bone cyst. The final diagnosis of epithelioid angiosarcoma was made by histological examination and biopsy of the mass. The excised specimen was examined further to verify the preoperative diagnosis.

Utilization of arterial grafts in foot replantation.

Our subject is a 36-year-old man who presented to the emergency department with bilateral lower extremity amputation at the level of the distal third of the tibia after a car accident. Surgery was planned for below-knee amputation of the right lower extremity and replantation of the left foot. The arteries dissected from the iatrogenically amputated segment were used as grafts to repair vascular gaps during the replantation. The patient's follow-up had been problem free. We concluded that whenever possible, amputated parts unsuitable for replantation should be examined thoroughly and neurovascular structures that might be used as grafts should be preserved.

Nontraumatic Myositis Ossificans of Hip: A Case Presentation.

In most of the cases trauma is the leading etiology and the nontraumatic myositis ossificans (MO) is a very rare condition. We present an MO case without any trauma occurring. A 36-year-old female patient with a history of pain and restriction of range of motion of the left hip was admitted. Hip motions were restricted with 10-60° of flexion, 10° of internal rotation, 20° of external rotation, 10° of abduction, and 10° of adduction. There was no history of trauma and familial involvement. The biopsy of the lesion revealed mature bone tissue confirming our diagnosis of MO. The mass was removed surgically and postoperatively the patient was treated with a single dose radiotherapy with 800 gyc. MO is a benign and well differentiated bone formation or in other words heterotopic ossification of the muscle tissue. It has a prevalence of less than 1/1 million. Trauma is the most frequent etiological factor seen in almost 60-75% of the cases. Nontraumatic MO is very rare in the literature. Our patient had no history of trauma or familial involvement. Combination of the surgical excision with radiotherapy in the treatment of the MO of the hip may give satisfactory results.

Reconstruction of neglected achilles tendon ruptures with gastrocnemius flaps: excellent results in long-term follow-up.

OBJECTIVE: Repair of the neglected achilles tendon ruptures can be challenging due to retraction of tendon stumps. Different repair and augmentation techniques were described. This study aims to investigate long-term results of neglected achilles tendon rupture repair with gastrocnemius flaps. PATIENTS AND METHODS: Between 1995 and 2005, 21 neglected achilles tendon rupture reconstructions were performed with using gastrocnemius fascial flaps. Mean age was 32.1 years. Mean period between rupture and operation was 8.4 weeks. Ankle range of motion, calf circumference, heel raise test, Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) hindfoot and Foot and Ankle Disability Index (FADI) scores were checked. RESULTS: The average gap length was 6.4 cm. Mean follow-up was 145.3 months. Median dorsiflexion/plantar flexion values for operated and uneffected sides were 18°/30° and 19°/30°, respectively. The mean values for AOFAS and FADI scores were 98.5 points and 98.9 %, respectively. VAS score was 0 point for all patients. With the numbers available, no significant difference could be detected in terms of ankle range of motion, calf circumference measures and dynamometric analysis. Mean time for return to daily activities was 11.1 (8-16) weeks after surgery. Prerupture activity level was achieved 14.1 months postoperatively. All patients were able to perform heel raise test. CONCLUSION: Repair of neglected achilles tendon ruptures with gastrocnemius flaps has satisfactory long-term results.

Segmentation of Bone with Region Based Active Contour Model in PD Weighted MR Images of Shoulder.

Proton density (PD) weighted MR images present inhomogeneity problem, low signal to noise ratio (SNR) and cannot define bone borders clearly. Segmentation of PD weighted images is hampered with these properties of PD weighted images which even limit the visual inspection. The purpose of this study is to determine the effectiveness of segmentation of humeral head from axial PD MR images with active contour without edge (ACWE) model. We included 219 images from our original data set. We extended the use of speckle reducing anisotropic diffusion (SRAD) in PD MR images by estimation of standard deviation of noise (SDN) from ROI. To overcome the problem of initialization of the initial contour of these region based methods, the location of the initial contour was automatically determined with use of circular Hough transform. For comparison, signed pressure force (SPF), fuzzy C-means, and Gaussian mixture models were applied and segmentation results of all four methods were also compared with the manual segmentation results of an expert. Experimental results on our own database show promising results. This is the first study in the literature to segment normal and pathological humeral heads from PD weighted MR images.

Ochronosis diagnosed after knee arthroscopy.

INTRODUCTION: Ochronosis is a rare disorder which is defined as the deposition of metabolites of oxidation and polymerization of homogentisic acid, which have high affinity to collogen, in the connective tissues. It is a clinical condition characterized with ochronotic pigmentation of tissues, degenerative arthropathy of especially large joints and black discoloration of urine. In this paper we present a case of ochronosis diagnosed with biopsy and additional tests when a black discoloration of menisci and joint cartilage were detected during arthroscopic intervention for a degenerative meniscus tear. PRESENTATION OF CASE: A forty two year-old male patient was operated for lateral meniscus tear of his right knee. The arthroscopic examination of right knee revealed black colored synovial hypertrophy and torn lateral meniscus. Partial meniscectomy was performed. The diagnosis of ochronosis was made after histopathologic examination. DISCUSSION: Ochronotic pigment can accumulate in hyaline cartilage, tendon, skin, teeth, nail, sclera, tympanic membrane, heart valves, renal tubular cells, duramater, pancreas and walls of large arteries. In ochronosis the most frequently involved joints are knee and hip. In ochronotic arthropathy, articular cartilage become more sensitive to mechanical stresses. Our patient had meniscal tear, cartilage damage and black discoloration of synovial tissues and meniscus. CONCLUSION: Arthroscopy may be helpful in diagnosis of ochronotic arthropathy.

Bilateral bucket handle medial meniscal tears of the knee: A case report.

INTRODUCTION: Meniscal tears may cause knee pain and functional impairment. Bilateral bucket-handle meniscal tears is an uncommon condition. PRESENTATION OF CASE: This report presents the case of a 35-year-old male patient with bilateral bucket handle medial meniscal tears that occurred nonsimultaneously. The lesions were treated arthroscopically with partial resection in one knee and meniscal suture in the other. DISCUSSION: Bucket handle meniscal tear of meniscus without underlying meniscal, ligamentous pathology or lower limb deformity is a rare condition. CONCLUSION: To our knowledge, bilateral bucket handle medial meniscal tears without underlying meniscal anomalies have been reported in only two cases before, and our case is the third one.