Is Carpal Tunnel Release Necessary in High-Energy Distal Fractures of the Radius?

Purpose This study aimed to compare the clinical outcomes of patients who underwent volar plate osteosynthesis for high-energy distal radius fracture (DRFx) and carpal tunnel release (CTR) for acute or subacute carpal tunnel syndrome (CTS) with patients who did not undergo CTR. Methods This study is a retrospective evaluation of all high-energy DRFx treated with volar plate osteosynthesis in a regional hospital between January 2021 and January 2023. All adult patients (≥18 years) who underwent open reduction and internal fixation were included in the study after obtaining approval from the internal review board of our institution. Only patients who underwent plate osteosynthesis of the volar aspect through a modified Henry incision and patients who underwent CTR through a classic separate incision were included in the study. Clinical results include hand dynamometry, visual analog scale (VAS) scores, and physical examination findings of patients who underwent volar plate osteosynthesis because of high-energy DRFx and CTR due to CTS in the acute and subacute periods were retrospectively examined. Results Among the patients who underwent volar plate osteosynthesis because of high-energy DRFx, no statistically significant difference was detected between the hand grip strength and VAS scores of patients who underwent CTR because of acute CTS and subacute CTS at the sixth postoperative week (p>0.05). Conclusion Prophylactic CTR may be performed in the same session in selected cases, such as DRFx caused by a high-energy injury, to establish a scale for DRFx at a high risk of CTS and avoid delays in treatment. CTR for transient CTS detected in the subacute period during outpatient follow-up does not improve clinical outcomes.

Examining Postoperative Posterior Cruciate Ligament Index: A Structural Paradigm in Anterior Cruciate Ligament (ACL) Reconstructions With Hamstring Tendon Autograft.

BACKGROUND: The current study aimed to compare the posterior cruciate ligament (PCL) index values of patients who underwent hamstring tendon (HT) autograft reconstruction due to an anterior cruciate ligament (ACL) tear. The comparison involved assessing these values in a similar cohort and evaluating the association between the alteration in the PCL index and functional results. METHODS: Patients who were clinically diagnosed with a complete, unilateral ACL tear and underwent ACL reconstruction (ACLR) using HT autograft between January 2018 and January 2021 constituted the operated group (Group 1) of the study. The control group (Group 2) consisted of patients selected from a convenience sample without ACL rupture, meniscal lesion, or cartilage damage who underwent an MRI during an outpatient orthopaedic consultation for knee pain. The operated group was submitted for an MRI of the knee one year after the operation for any reason such as pain, graft healing, the presence of tunnel widening, or suspicion of re-rupture. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form and the Lysholm Scoring System were applied to the patients in the operated group in the preoperative and postoperative periods to evaluate their complaints, function, and participation in sports and to assess functional ability and functional capacity. A radiologist with five years of experience measured the PCL index in the sagittal section of an MRI. In the operated group, changes in PCL index, IKDC, and Lysholm values during the postoperative period were assessed, along with their correlation. Additionally, a comparison was made between the values of the operated group and the non-operated group. RESULTS: No statistically significant correlation was found between the PCL index alteration and the functional score alteration (IKDC and Lysholm) in the operated group (p>0.05). In comparison to the non-operated group, the preoperative PCL index measures of the operated group were significantly lower (p: 0.000; p<0.05). The increase in the postoperative PCL index measurements of the operated group was similarly statistically significant (p: 0.000; p<0.05). CONCLUSION: Although the PCL index appears to be a strong anatomical structural parameter in ACLR patients performing HT autograft in the postoperative period, its correlation with functional results is weak.

Does Immobilization of Distal Radius Torus Fractures Affect Treatment Outcome?

OBJECTIVE: The aim of this study is to compare the clinical results of splint, short arm circular plaster, and soft bandage immobilization methods applied in the treatment of wrist torus fractures in a single center. METHODS: Patients treated for torus fractures at a tertiary trauma hospital between January 2018 and January 2022 were analyzed retrospectively. According to the physician's preference, a splint, short arm circular plaster, or soft bandage was applied to each patient. The treatment modalities, the number of hospital admissions during the treatment, the number of radiological imaging procedures used during the treatment, immobilization time, and the follow-up periods of the patients were checked and noted on the hospital data processing system. RESULTS: Six hundred ten patients were included in the study. It was determined that 351 patients were treated with a short arm splint, 155 with a short arm circular cast, and 104 with soft bandaging. The number of radiological imaging procedures, the number of hospital admissions during the treatment, the duration of the pain complaint, and the complication rate of the patients treated with splint were significantly lower than the groups treated with short arm circular plaster and soft bandage (P < 0.001). CONCLUSIONS: It was observed that patients who were immobilized with a short arm splint required less follow-up time and fewer imaging procedures and hospital admissions and experienced earlier pain relief and lower complication rates. We think that the use of short arm splints in the treatment of torus fractures is sufficient, safe, and advantageous.

Carpal tunnel decompression: a comparison of elderly and younger patients' sleep quality.

The current study was conducted to evaluate sleep disturbances by age group in patients who underwent carpal tunnel decompression (CTD). Individuals who applied to the orthopedic outpatient clinic and had CTD between 2018 and 2022 had their medical records reviewed. Pre-operative data included patient demographics and the Pittsburgh Sleep Quality Index (PSQI). All post-surgery patients who returned for suture removal were clinically evaluated. Patients were requested to return for re-scoring on the PSQI 6 months after CTD. The cases' average age was 56.44±9.37 years. The study divided its subjects into two age ranges: those between the ages of 45 and 60 (82.2%) (Group1) and those between the ages of 70 and 85 (17.8%) (Group 2). The PSQI values of Group 1 were found to be significantly lower than Group 2. Preoperative PSQI levels were compared to post-op values at 2 weeks and 6 months, and both measurements decreased significantly. Sleep quality improved in all patient groups, regardless of their age, following CTD. Elderly patients had delayed improvements in sleep quality following CTD. The PSQI was effective in determining improvement following CTD, particularly in younger patients, and the progress remained for 6 months.

Post-Operative Modified All-Inside ACL Reconstruction Technique's Clinical Outcomes and Isokinetic Strength Assessments.

BACKGROUND AND OBJECTIVE: Anterior cruciate ligament (ACL) injuries are very common among the athletic population. ACL reconstruction (ACLR) performed because of these injuries is one of the procedures performed by orthopedic surgeons using different grafting methods. This study aims to compare the data related to post-operative 6-month isokinetic strength values, strength-related asymmetry rates, time parameters, and joint angle in athletes who underwent ACLR with the Modified All-inside (4ST) technique, on both the healthy knee (HK) and the ACLR-applied sides. MATERIALS AND METHODS: A total of 20 athletes from various sports on whom the 4ST ACLR technique had been applied by the same surgeon were evaluated retrospectively. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores of the patients were obtained pre-operative and at 6 months post-operative. Isokinetic knee extension (Ex) and flexion (Flx) strengths on the HK and ACLR sides of the patients were evaluated with a series of four different angular velocities (60, 180, 240, and 300°/s). In addition to peak torque (PT) and hamstring/quadriceps ratio (H/Q) parameters, the findings were also evaluated with additional parameters such as joint angle at peak torque (JAPT), time to peak torque (TPT), reciprocal delay (RD), and endurance ratio (ER). RESULTS: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with pre-operative levels (p < 0.05). As for PT values, there were significant differences in favor of the HK in the 60, 180, and 300°/s Ex phases (p < 0.05). In terms of the H/Q and (hamstring/hamstring)/(quadriceps/quadriceps) (HH/QQ) ratios, there were significant differences at 300°/s (p < 0.05). In terms of JAPT, there were significant differences in the 300°/s Ex and 180°/s Flx phases (p < 0.05). In terms of TPT, there were significant differences in the 300°/s Ex phase (p < 0.05). In terms of RD and ER, no significant difference was observed between the HK and ACLR sides at any angular velocity. CONCLUSIONS: Although differences were observed in PT values, particularly in the Ex phase, this did not cause a significant change in H/Q ratios. Similar results were observed for additional parameters such as JAPT, TPT, RD, and ER. The results show that this ACLR technique can be used in athletes in view of strength gain and a return to sports.

Evaluation of Psoas Muscle Atrophy and the Degree of Fat Infiltration After Unilateral Hip Arthroplasty.

OBJECTIVE: Atrophy of the muscles around the hip and thigh has been reported in patients with hip osteoarthritis (OA). Total hip arthroplasty (THA) reduces pain and improves quality of life and activity levels. Muscle strength of the hip and thigh also improves after THA. This study aimed to determine whether there is significant psoas muscle atrophy and to evaluate the degree of fat infiltration after unilateral hip arthroplasty. SUBJECT AND METHODS: Patients who underwent unilateral total hip arthroplasty for primary hip osteoarthritis and who had lumbar vertebra magnetic resonance imaging (MRI) for any reason in the one-year preoperative and postoperative period were evaluated retrospectively. The degree of fat infiltration was also graded visually based on a modified Goutallier rating system. RESULTS: The study was conducted with a total of 58 patients aged between 38 and 75, including 15 males and 43 females. Compared to the preoperative psoas muscle area values on the operated sides of the patients participating in the study, the decrease in the postoperative psoas muscle area was found to be statistically significant (p:0.000; p<0.05). Furthermore, the decrease in psoas muscle area on the non-operated side of the patients was also statistically significant (p:0.000; p<0.05). There was also a positive correlation between preoperative and postoperative psoas muscle areas (p:0.000; p<0.05). CONCLUSION: Early identification of psoas muscle mass reduction may allow for a more proactive psoas strength improvement program to improve post-operative function and mobility.

Patellar Tendon Reconstruction Using Peroneus Longus Tendon Autograft Following Revision Knee Arthroplasty: A Case Report.

Patellar tendon rupture is a rare but serious complication resulting in loss of knee extension that may develop during and after total knee arthroplasty and negatively affects the patient's quality of life. There are a number of surgical options available, from primary repair to reconstruction. Peroneus longus tendon autograft has begun to be used for knee extensor mechanism repair in recent years. In this case report, we aimed to present the case of a patient with traumatic patellar tendon rupture after revision knee arthroplasty. In conclusion, patellar tendon reconstruction using peroneus longus tendon autograft can be considered a successful method in selected patients following knee arthroplasty. It allows early rehabilitation via stable graft fixation and provides good clinical and functional outcomes in the late period.

Seasonal variation in paediatric orthopaedic trauma Patients - A single centre experience from Turkey.

PURPOSE: It is known that the incidence of paediatric orthopaedic trauma peaks in the summer months as a result of increased and uncontrolled physical activity. The aim of this study was to review the experience of a single centre with paediatric orthopaedic traumas and determine the relationship between the severity and the variations in the incidence of traumas in relation to the seasons and temperatures during the study period. MATERIALS AND METHODS: A single institutional review of the historical data of all patients aged 0-16 years who presented for orthopaedic trauma between January 2018 and December 2020 in the emergency department of Level 1 tertiary orthopaedic trauma centre was conducted. 65,182 paediatric orthopaedic trauma cases had been retrieved from the hospital data base during the 3 -year study period. We classified the traumas according to the variants of the patients' and by holidays, seasons, school days and weekends, months and in which part of the body it occurred. RESULTS: After excluding the summer vacation, 77% of paediatric orthopaedic trauma patients attended to the hospital on weekdays and 23% on weekends. While it was observed that hot weather had a statistically positive effect on trauma attendance, rainy weather had an negative effect (p < 0.05). Trauma attendances were found to be statistically higher in summer months, except for injuries that may occur with indoor activities such as metacarpal fracture, phalanx fracture and pulled elbow (p < 0.05). CONCLUSION: Orthopaedic trauma at a Level 1 tertiary health care trauma center do vary significantly with the weather and are highest in the summer season. Therefore, it should focus more attention on preventive strategies for paediatric trauma in the summer season.

Kyphosis-Related Information On The Internet Is the Quality, Content and Readability Sufficient for the Patients?

STUDY DESIGN: A quality-control Internet-based study using recognized quality scoring systems. OBJECTIVE: The aim of the study is to evaluate the quality, content and readability of online information on kyphosis. METHODS: The 3 most frequently used search engines were identified and a search for "Kyphosis" was made in each. The 2 reviewers categorized their Web-sites by type, and the quality of each was assessed using well-known scoring systems, including the DISCERN score, JAMA benchmark, GQS, and the kyphosis specific content score. The Flesch-Kincaid grade level (FKGL) was used to assess the readability. The quality of the information was also evaluated according to the presence and absence of the HONcode. RESULTS: Sixty unique Web sites were identified and analyzed. The distribution of the categories was 33 (55%) medical, 22 (36.7%) academic, 2 (3.3%) non-physician, 2 (3.3%) commercial and 1 (1.7%) physician. There wasn't statistically significant difference between the sources in terms of DISCERN, JAMA, GQS and KSC scores (P > 0.05). However, a review of the FKGL scores revealed that the academic-based websites' FKGL score was significantly higher than the medical-based websites (P: 0.007). Also there wasn't statistically significant difference among the DISCERN, JAMA, GQS, KSC, FKRS and FKGL scores of the web-sites according to the HON code's presence (P > 0.05). CONCLUSION: Information about kyphosis on the Internet is of limited quality and low information value. The readability of the online information in our results showed a significantly higher reading level than the sixth grade level recommended by the AMA and NIH.

Acute kidney injury after hip fracture surgery in patients over 80 years of age.

BACKGROUND: The aim of the study is to determine the rate of acute kidney injury (AKI) after hip fracture surgery over the age of 80 and to investigate the factors associated with AKI. METHODS: From January 2015 to January 2020, 589 patients who underwent surgery of hip fractures at our institution were retrospectively reviewed. Serum creatinine (sCr) was analysed daily pre- and postoperatively during the hospital stay. Patients were divided into groups; AKI and non-AKI based on KDIGO (Kidney Disease Global Outcomes) criteria. The incidence, risk factors, and mortality of postoperative AKI were investigated. RESULTS: Out of 589 patients, 58 developed an AKI (9.8%). Smoking (p: 0.004), pre and postoperative low albumin level (p < 0.05), pre- and postoperative high potassium level (p < 0.05), pre- and postoperative high urea levels (p < 0.05), high amount of intra-operative bleeding (p: 0.003) and prolonged surgery time (p: 0.003) were found to be risk factors associated with AKI. Although the mortality rate was higher in the AKI group, it was not statistically significant (p > 0.05). CONCLUSION: AKI is a temporary but common complication following hip fracture surgery, which can also be predicted if risk factors are adequately observed. It typically increases the length of hospital stays, mortality and morbidity. LEVEL OF EVIDENCE: Level III evidence, Retrospective comparative study.

Foot Loading Analysis of Intra-articular Tibia Pilon Fracture.

BACKGROUND: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of their treatment and their adverse effects on gait function. The aim of this was study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis, and plantar pressure distribution in patients with tibia pilon fractures. METHODS: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January of 2015 and January of 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria; ankle functional scores were evaluated with the Teeny-Wiss score; and ankle arthrosis was evaluated with the Takakura classification. At the last patient follow-up, foot loading analysis was performed, and the results were evaluated for their relation with postoperative reduction quality, ankle function, and ankle arthrosis. RESULTS: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range, 19-78 years). The mean follow-up was 34.3 months (range, 24-58 months). The mean Ovadia-Beals score was 12.35 ± 4.6 on the postoperative plain radiographs of the patients; the mean Teeny-Wiss score at the last follow-up was 76.82 ± 17.69; and the mean Takakura score was 1.47 ± 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior portion and 52.42% on the posterior portion of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial portion of the ankle and 57.85% loaded on the lateral portion of the foot. CONCLUSIONS: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.

Is the magnesium screw as stable as the titanium screw in the fixation of first metatarsal distal chevron osteotomy? A comparative biomechanical study on sawbones models.

Background: Distal chevron osteotomy (DCO) is commonly performed in hallux valgus surgery. The fixation of the osteotomy is provided by various implants. The usage of biodegradable implants such as magnesium is gradually increasing due to the advantages they provide. In this study, we aimed to compare the fixation of DCO with magnesium or titanium screw biomechanically. Methods: Twenty sawbones were used. The samples were divided into two equal groups, including ten sawbones for fixation with single headless titanium (group-1) or magnesium screw (group-2). DCO and screw fixations were performed on all samples using the same technique. Biomechanical testing was applied to five samples in each group in cantilever and the other five in a physiological configuration using a computer connected to the electromechanical test machine. The obtained data were evaluated using the Shapiro-Wilk test, Student's t-test and Mann-Whitney U test on the IBM® SPSS (Statistical Package for the Social Sciences) V22.0 software. Significance was accepted at the p < 0.05 level. Results: There was no statistically significant difference between the magnesium screw and the titanium screw in terms of maximum force, maximum displacement and stiffness measurements in cantilever and physiological loadings (p > 0.05 for all). Conclusion: This study found no significant difference in biomechanical stability between the magnesium and titanium screws in DCO fixation on sawbones. Further studies with real bones are needed.

How did restrictions mandated by the COVID-19 pandemic affect the performance of orthopedic trauma surgery in a Level-1 tertiary trauma hospital?

BACKGROUND: This present study was designed to evaluate the effect of restrictions on fracture admission to a Level-1 tertiary trauma hospital between COVID-19 pandemic and pre-pandemic restriction time intervals that included groups of younger than <20-years-old, 20-65-years-old, and older than aged >65-years-old. METHODS: Patients who were hospitalized and treated for orthopedic treatment between 10 March and 1 June during the pandemic period were retrospectively analyzed. Control group consisted of patients admitted to the hospital in the same time interval in 2019. The patients were divided into three groups, under 20 years of age, between 20 and 65 years of age, and over 65 years of age. The patients' data included age, gender, trauma mechanism, fracture type, and any COVID-19 radiological or clinical symptoms. RESULTS: The number of patients >65-years-old admitted to the orthopedic trauma center was high at pandemic intervals compared to pre-pandemic time. When the groups were compared for patients of 20-65-years-old; there was a significant difference for the fracture type (p<0.05). Lower extremity fractures were high at pre-pandemic group, whereas multiple traumas were high at pandemic group. For sub-group 20-65 ages, low-energy traumas were higher at pre-pandemic group, whereas high-energy traumas were more frequent at the pandemic group. CONCLUSION: We observed a decrease in fracture admission to orthopedic trauma centers during COVID-19 pandemic for subgroups of <20-years-old and 20-65-years-old ages, whereas there was a significant increase for >65-years-old age, most of them related to the osteoporotic hip fractures. So that older age group should be encouraged to mobilize at home and have permission to walk and make physical activity to avoid osteoporosis for a limited time daily.

Is Obesity Associated with Higher Complication Rates in Total Hip Arthroplasty for High-Riding Dysplastic Hips?

OBJECTIVE: Developmental dysplasia of the hip (DDH) is a disabling pathology leading to hip problems, such as painful arthritic hip, unstable hip, etc. Total hip arthroplasty (THA) is an effective treatment modality for this condition. Obesity has been shown to be associated with increased rates of complications following orthopaedic surgeries (Journal of Arthroplasty 20:46-50). The hypothesis of this study was that patients with a body mass index (BMI) greater than 30 (obese), who undergo total hip arthroplasty for dysplastic hip, are associated with longer operative and anaesthetic times, longer hospital stays and higher re-admission rates within 30 days. METHODS: All the cases of total hip arthroplasty in patients with high-riding dysplastic hips were reviewed. Evaluation was made of a total of 68 patients comprising 64 females and 4 males, classified into two groups. Patients with BMI < 30 kg/m2 formed the non-obese group and patients with BMI ≥ 30 kg/m2 the obese group. RESULTS: The mean age was 44.67 ± 6.49 years. BMI was < 30 in 44 (64.7%) patients and > 30 in 24 (35.3%) patients. The data analysis showed that mean surgical time, anaesthesia duration and re-admission rate were significantly higher in the group with BMI ≥ 30(obese) as compared to the group with BMI < 30 (non-obese) (p < 0.01). The complication rate was determined to be higher in the obese group (p < 0.05). CONCLUSION: Obese patients performed with total hip arthroplasty for high-riding dysplastic hips had more complications and higher rates of re-admission to hospital compared with the non-obese patients.

Comparison of two different screw trajectories in the treatment of oblique scaphoid fractures: A mechanical study on composite bone models.

OBJECTIVES: In this mechanical study, we aimed to compare two different screw trajectories in terms of durability against axial loads on oblique scaphoid fractures using composite bone models. MATERIALS AND METHODS: Oblique osteotomies were made along the dorsal sulcus of 14 composite scaphoid bone models. Following this, all bone models were randomly classified. One group of bones were fixed with a screw placed perpendicular to the osteotomy line and the other group was fixed with a screw placed centrally down the long axis of the scaphoid bone. Each scaphoid bone model was positioned on a mechanical testing machine. Subsequently, axial loading tests were applied on each bone model to measure the amount of loading required to cause 2-mm displacement and failure on the osteotomy side and maximum displacement at the time of failure on scaphoid bone models. RESULTS: There was no statistically significant difference in load to 2-mm displacement and failure between the two groups (p>0.05). Also, there was no statistically significant difference between the two groups in terms of maximum displacement seen on failure (p>0.05). CONCLUSION: In our study, we found that the stability of the screws which laid perpendicular to the fracture line and parallel to the long axis of the scaphoid was the same in fixing oblique scaphoid fractures.

The Surgical Outcomes of Unstable Ankle Fractures in Patients Aged >65 Years.

AIM: To evaluate the surgical outcomes and complications of patients over 65 years of age, with unstable ankle fractures. MATERIAL AND METHOD: The study included 111 patients (73F/38 M) operated on between January 2015 and February 2019 and followed up for a mean of 21.2 months (range, 6-62 months).Demographic characteristics, comorbidities, fracture type, and mechanisms of injury were evaluated. Relationships between postoperative complications and comorbidities were examined. In the postoperative functional evaluations, the AOFAS score was used and pre and postoperative mobilization (eg, use of assistive devices) was assessed. RESULTS: The mean age of the patients was 70.5 ± 6.1 years (range, 65-90 years). The mechanism of trauma was low-energy trauma in 90.1% of the fractures and high-energy trauma in 9.9%. The fractures were formed with a SER injury (supination external rotation) in 83.7% of cases and bimalleolar fractures were seen most frequently (85/111, 76%).Complications developed in 16 (14.4%) patients and a second operation was performed in 11 (9.9%) patients with complications. Plate was removed and debridement was performed in 5 of 6 patients due to wound problems. Nonunion was developed in the medial malleolus in 4 patients. Revision surgery was performed because of implant irritation in 2 patients and early fixation loss in the medial malleolus fracture in one patient. Calcaneotibial arthrodesis was performed in 3 patients because of implant failure and ankle luxation associated with non-union. A correlation was determined between ASA score and DM and complications, but not with osteoporosis. The mean follow-up AOFAS score was 86.7 ± 12.5 (range, 36-100).A total of 94 (84.7%) patients could walk without assistance postoperatively and 92 (82.9%) were able to regain the preoperative level of mobilization. CONCLUSION: Although surgery can be considered an appropriate treatment option for ankle fractures in patients aged >65 years, care must be taken to prevent potential complications and the necessary precautions must be taken against correctable comorbidities.

Epidemiologic Study of Syrian Refugees Underwent Surgery Due to Fracture in a Tertiary Reference Hospital in Turkey.

Aim This study aims to analyze the spectrum, management, and outcome of Syrian refugees' fracture over four-year period, highlighting challenges in management and follow-up. Methods This was a retrospective review of Syrian refugee patients operated for fractures at our centre from January 2015 to January 2019. The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, surgical technique, complications, mortality and morbidity. The comparison of complications and postop outpatient clinic controls between Turkish citizens and Syrian refugees were also evaluated. Results The study included a total of 455 patients comprising 281 adults (202 males, 79 females) with a mean (SD) age of 41.1 (19.3) years and 174 children with a mean age of 8.8 (4.9) years. The trauma mechanism was most commonly fall in both adult and pediatric patients (86.6% / 73.5%). Whilst lower limb fractures were more common in adults (73.7%), upper limb fractures were more common in children (63.4%). The presence of accompanying trauma was determined in 21 (7.5%) adults and 10 (5.7%) children. Multiple fractures were determined in 12 (4.3%) adults and eight (4.6%) children. Plate fixation (PF) was most used in 137 (48.8%) adult patients and K-wire augmentation was used in 75 (43.1%) pediatric patients. Out of the 455 patients, 41 (14.6%) adults and 13 (7.3%) children developed complications. Whilst three adult patients were died during follow-up, no deaths were recorded in the pediatric patients. Complication rate was 54/455 in Syrian refugees and 32/455 in citizens. It was observed that the complication was significantly higher in immigrants (p: 0.017). Sixty-five (14.2%) Syrian immigrants did not come to the outpatient clinic control at all or once, while this rate was 29/455 (6.3%) for Turkish citizens (p = 0.012). Conclusion Inadequate living conditions and lack of communication faced by refugees reduce the rate of patient follow-up and negatively affect the results of orthopedic trauma.

Comparison of Cementless Calcar-Replacement Hemiarthroplasty With Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures at Older Age Group.

BACKGROUND: The aim of this study was to compare the outcomes of unstable intertrochanteric femur fractures treated with cementless calcar-replacement bipolar hemiarthroplasty (CRH) and proximal femoral nail (PFN) in elderly patients. METHODS: All consecutive unstable intertrochanteric fractures treated with cementless CRH or PFN at our institution between January 2015 and January 2019 were reviewed retrospectively. The primary outcome measures were postoperative complications, reoperation rate, and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, hospital stay, and two- year mortality. RESULTS: Ninety-four patients in the hemiarthroplasty group and 77 patients in the PFN group were included for analysis. There were no significant differences between the two groups regarding the complications, ASA score, and reoperation rate. Significant differences were found between hemiarthroplasty and PFN group in comparison of the average length of hospital stay (P < 0.05), time from hospitalization to operation (P < 0.05), intraoperative blood loss (P < 0.001), transfusion rate (P < 0.001), operation time (P < 0.001), Harris Hip Score (HHS; P < 0.001), and two-year mortality (P < 0.05). CONCLUSION: Both hemiarthroplasty and PFN produce satisfactory results in surgically treated unstable intertrochanteric femur fractures in the elderly. Both groups are associated with their own complications, but in the PFN group, better functional results, less surgery-related trauma, and lower mortality rates are the main advantages.

The Effect of Anatomical Reduction on Functional Outcomes in Femoral Neck Fracture: A Novel Modified Garden Index.

BACKGROUND: Femoral neck fracture is a common cause of morbidity in the younger population with potentially poor prognosis and functional results. The purpose of this study was to evaluate how the success of anatomic reduction affects hip functional outcomes by using a new numerical index modified from the Garden index. METHODS: Twenty-six patients who underwent closed reduction and internal fixation by means of three cannulated screws due to femoral neck fracture between 2010 and 2014 were scanned retrospectively and included in the study. Harris hip scores of the patients at nine to 12 months were evaluated using the new index modified from Garden which is the sum of the differences from the ideal Garden index calculated on early postoperative anteroposterior and lateral pelvis radiographs. RESULTS: The mean hip score was 73.1 (± 16.4), the minimum score was 32, the maximum score was 93. Postoperative anteroposterior radiographs revealed a mean Garden alignment index of 153.6°, the lowest value was 135° and the highest value was 168°. In the lateral radiographs, the mean Garden alignment index was 173.1°, the lowest value was 160° and the highest value was 178°. The mean value of the novel index was found as 14.2°, the lowest value was 2°, and the highest value was 40°. There was an inverse correlation between the novel index we defined and the Harris hip score (p<0.01). CONCLUSION: In femoral neck fractures, the success of anatomic reduction is an important factor affecting the patient's functional outcome. We believe the new reduction index we proposed will contribute to literature comparing the success of reduction in femoral neck fractures.

Ipsilateral simultaneous inferior shoulder dislocation and posterior elbow dislocation: A case report.

This case report presents a 21-year-old male construction worker with ipsilateral inferior shoulder and posterior elbow dislocations, accompanied with other injuries. Such a combination of injury undoubtedly occurs; however, to the best of our knowledge, this is the first reported case. The prompt closed reductions without waiting for anesthesia were accomplished without the help of an assistant using a novel technique. The patient returned to his job with considerable recovery of motion and strength despite his permanent paralysis of the deltoid muscle and he was still employed as a worker after four years. He was abducting his arm by using his accessory muscles, which contribute to abduction when arm is externally rotated. The maneuver described in the report can be used to reduce all inferior shoulder dislocations and it is worth to know that working at a job requiring high level of activity is still possible despite a permanent loss of axillary nerve function.