The determination of acetabular parameters in a Turkish population sample: CT-based retrospective analysis of side and gender differences.

Determination of the acetabular morphology and orientation is important for the total hip arthroplasty applications. In general, preoperative planning for these patients is done on true hip X-rays in orthopedics clinics. But those evaluations may not represent the acetabular architecture in detail, because of 2 dimensional images. The aim of this study is to determine the acetabular morphology of a healthy Turkish adult population sample through examination of acetabular parameters on 3-dimensional computed tomography (CT)-based images according to side and gender. A retrospective evaluation was made of acetabulum CT scans taken for various reasons in a healthy Turkish population sample. The examination parameters were defined as measurements of the acetabular anteversion angle, acetabular abduction angle, lateral center edge angle, acetabular width, acetabular depth, sagittal acetabular angle, and medial wall thickness values. The CT scans including the bone structure were examined of a total of 252 hips of 126 patients. The acetabular index was calculated as depth/width × 100. Lateral center edge angle of < 20° with medial wall thickness > 5 mm was accepted as a criterion of dysplasia of the acetabulum. Evaluation was made of the acetabular CT scans of 73 females and 53 males with a mean age of 44.64 ± 12.31 (19-68) years. A statistically significant difference was determined between the sides in respect of acetabular anteversion angle (P = .007) and between the genders in respect of acetabular depth and acetabular width (P = .001, P = .001). The prevalence of dysplasia was determined to be 1.6% for the whole study group, as 1.9% in males and 1.4% in females. In the current study sample there were parametric differences between sides and genders in terms of acetabulum morphology and orientation. Further studies of larger series will be able to provide a better representation of the Turkish population.

The effects on joint functions of biplanar distal tubercle open-wedge high tibial osteotomy: A prospective study.

Distal tubercle biplanar open-wedge high tibial osteotomy (DT-BOWHTO) is a method frequently applied in the treatment of knee joint medial osteoarthritis. The aim of this study was to evaluate the radiological, clinical, and functional results of patients at 5 years after DT-BOWHTO surgery. The study included a total of 41 patients who underwent DT-BOWHTO, comprising 19 (46.3%) males and 22 (53.7%) females with a mean age of 55.54 ± 4.17 (45-63) years and mean follow-up of 66.76 ± 6.29 (60-81) months. Statistical comparisons were made of the preoperative and postoperative body mass index (BMI), modified Insall-Salvati index, Blackburn-Peel index, Kelgren-Lawrence classification (KLC), tibial slope angle, American Knee Society Functional Score (AKSFS), Clinical American Knee Society Score (CAKSS), visual analog scale (VAS) pain score, Tegner Functional Activity Score (TFAS), total corrected angular measurements (TCA), and the tibio-femoral varus angle. Compared to the preoperative values, no statistically significant difference was determined in the postoperative modified Insall-Salvati index, Blackburn-Peel index, and tibial slope angle values (P > .05), and a statistically significant difference was determined in the BMI, AKSFS, CAKSS, VAS, KLC, tibio-femoral varus angle, and TFAS values (P ≤ .001). When the preoperative and postoperative BMI values were compared in 3 groups of normal, overweight, and obese, there was found to be a statistically significant difference (P = .014). No significant correlation was determined between the BMI values and the VAS and KLC values (P > .05). No significant correlation was determined between the total corrected angular and the preoperative and postoperative pain, and clinical and functional knee scores (VAS, AKSFS, CAKSS, TFAS) (P > .05). DT-BOWHTO was seen to provide extremely good 5-year results in the knee clinical findings, pain severity, and functional results. As the patella height and tibial slope angle were not changed, this did not cause the development of osteoarthritis in the patellofemoral and tibiofemoral joints. Grafting and fixation of the tibial tubercle with additional screws in the application of DT-BOWHTO were not seen to make any additional contribution to the healing of the osteotomy line. There was no relationship between increased BMI, reduced pain, and increase in knee functions in patients who underwent DT-BOWHTO.

Biomechanical comparison of different suture materials with different techniques in tendon repair: An ex-vivo study.

OBJECTIVES: Sheep Achilles tendons are used as an effective preclinical model of flexor tendon repair in plastic surgery, due to their biomechanical properties, which are similar to humans. The aim of this study was to examine the efficacy and biomechanical outcomes of suture materials and tendon repair techniques in flexor tendon repair. MATERIAL AND METHODS: 72 sheep tendons were obtained for a total of 12 different scenarios. Tendons were repaired using 4 different suture types and 3 different suture techniques. After repair, the tendons were fixed at both ends and subjected to biomechanical tests. Ultimate Failure Load (UFL) and 2-mm Gap Load (GL) per scenario were compared statistically within and between groups. RESULTS: UFL and GL of all sutures were significantly different between the modified Kessler, Bunnell and Krackow techniques (P < 0.05), and between Monosorb, Ti-Cron and V-loc sutures (P < 0.05). UFL and GL according to repair technique were not significantly different for the Propilen suture (P > 0.05). CONCLUSION: When UFL and GL were considered together, our findings indicate that optimal strength scenarios were for the modified Kessler technique using Monosorb or V-loc sutures.

CT-based analysis of posterior tibial slope in a Turkish population sample: A retrospective observational study.

Posterior tibial slope (PTS) is important for the success of high tibial osteotomy and unicondylar knee arthroplasty applications, as it provides anterior cruciate ligament function. In the literature, different studies have been carried out with various imaging methods to measure PTS in populations of different ethnic origins. In this study, it was aimed to detect PTS in the medial (MPTS) and lateral (LPTS) tibial condyles with computed tomography in a Turkish population sample and to compare the results between age groups (<65, ≥ 65), genders, sides, and literature data. In our sample, 39 left and 33 right knee images of 37 men and 35 women with a mean age of 52.01 ±â€…21.27 were evaluated. The tibial proximal anatomical axis was determined by the midpoint method. The MPTS and LPTS was evaluated by two different observers according to this axis. Thereby the global PTS (GPTS) was calculated as an arithmetic mean of MPTS and LPTS values. Measurements were repeated 2 weeks after the first measurement and values were analyzed. A significant difference was found between the mean of MPTS, LPTS, and GPTS in the whole population (P = .002), in men (P = .02) and in women (P = .02). On the other hand, there was no significant difference compared according to age, gender, and side by mean of same parameters. In comparison of the results of our Turkish population sample with other studies in the literature, MPTS and LPTS were similar to Chinese (P = .22, P = .07) and Japanese (P = .96, P = .67) populations, while different to White Asian (P < .001, P < .001) and Korean (P < .001, P < .001) populations. The midpoint method is a safe measurement method in computed tomography-based studies for the evaluation of PTS. Implant designs produces for different populations may not be suitable for the Turkish population. More comprehensive and detailed studies are needed to represent the Turkish population.

Is tendinitis in volar plating related to the dorsally protruding screw length and its compartment?

OBJECTIVES: The aim of this study was to evaluate the relationship between the length of the protruded screws from the dorsal cortex and extensor tendon damage in all compartments. PATIENTS AND METHODS: Between May 2020 and April 2021, a total of 29 patients (13 males, 16 females; mean age: 52.3±13.0 years; range, 30 to 78 years) who were operated and followed in our clinic for AO A2 and A3 distal radius fractures were included in this prospective study. Surface ultrasound (US) imaging was made to the dorsal sides of both wrists of the operated patients at different timepoints postoperatively. The length of screws with radius dorsal cortex penetration and the presence of tendinitis were recorded. RESULTS: In 15 of 23 patients, the presence of 29 protruding screws was accompanied by tendinitis and, in eight patients, no tendinitis was observed, despite the partial protrusion of screws. A statistically significant correlation was found between the screw protrusion and presence of tendinitis (p<0.05). The number of protruding screws and tendinitis were seen mostly in the second compartment. There was a statistically significant correlation between the protruding screw length of >1.6 mm and the presence tendinitis (p<0.05). CONCLUSION: Dorsal cortex screw protrusions in the application of volar plate for distal radius fractures can cause tendinitis. Screw protrusions occur more frequently in the second compartment and the development of tendinitis in this compartment is associated with a screw length of >1.6 mm. Screw penetration can be easily identified with intraoperative US to prevent tendinitis and potential tendon ruptures.

Open Fractures from Gustilo and Anderson to the Present: A Bibliometric Analysis with Global Productivity and Research Trends.

Background/Objective: Despite the increase in global research on open fractures, which continue to be a significant cause of morbidity and mortality, seriously affecting the health and quality of life of patients, there has not been any bibliometric research on this subject. The aim of this study was to make a holistic analysis of scientific articles published on the subject of open fractures using bibliometric methods. Methods: Articles published on the subject of open fractures between 1980 and 2021 were downloaded from the Web of Science (WoS) database, and were analysed using various statistical methods. Network visualisation maps were used to determine international collaborations and trend topics, and citation analyses to determine the most effective studies. Spearman's correlation coefficient was used to determine correlations, and exponential smoothing predictors to estimate the number of articles to be published in the next 5 years. Results: A total of 1742 articles were analysed. The 3 countries making the greatest contribution to literature were the USA (591, 33.9%), UK (219, 12.5%) and Germany (132, 7.5%). The most active author was Bhandari M. (n = 22). The 3 most productive institutions were determined to be the University of California System (n = 57), University of Washington (31), and Harborview Medical Center (29). The most active journal was Injury (n = 143). Conclusion: According to the analysis applied to identify trend topics, the topics most studied in recent years were determined to be surgical site infection, orthoplastics, intramedullary nail, Masquelet technique, BOAST, bone healing, closed reduction, classification, outcomes, and lower limb.

Ewing sarcoma: what trends in recent works? A holistic analysis with global productivity: A cross-sectional study.

Advances in the biology of Ewing sarcoma, which continues to be an important cause of mortality, have caused an increase in information in the literature related to the underlying molecular base of the disease and discussions of new treatment approaches. In this study, we aimed to comprehensively analyze the published scientific articles on Ewing sarcoma. The Web of Science database was used to obtain and statistically analysis articles on Ewing sarcoma that were published between 1980 and 2021. Maps of network visualization were used to reveal trending topics, global collaborations, and the most effective studies. Correlation analysis was performed using Spearman's correlation coefficient. A total of 3236 articles were analyzed. The first 3 countries that contributed the most to the literature and cooperated most intensively were USA (1194, 36.8%), Germany (293, 9%), Italy (254, 7.8%). Pediatric Blood & Cancer (n = 122), Cancer (87), Journal of Pediatric Hematology Oncology (71) were among the top 3 journals with the most articles. The most active author was Piero Picci (n = 94). High-income countries have a great effect on the literature on this subject. The most studied trend topics in recent years were pediatric oncology, EWS RNA Binding Protein 1 (EWSR1), EWSR1-FL1, epigenetics, bioinformatics, microRNA, gene expression, metastasis, migration, biomarker, immunotherapy, survival, outcomes, surveillance epidemiology and end results (SEER), nomogram, temozolomide, irinotecan, and drug resistance. Genetic studies, metastasis, immunotherapy, life analyses/nomogram based on new data obtained from SEER, and chemotherapy with irinotecan and temozolomide combination, were seen to be the topics researched in recent years.

An Evaluation of the Effect of the Use of N95 Respirators by Surgical Teams on Early Surgical Site Infections in Orthopedic Cases.

Background Surgical site infections (SSIs) are seen in the postoperative period in orthopedic and traumatology clinics. Just as in all surgical clinics, SSIs lead to patient dissatisfaction with the results, prolong the length of stay in the hospital, and increase treatment costs. SSIs are known to occur as a result of wound contamination through inoculation of microorganisms found mainly in the air or in the surgical area. Because of the coronavirus disease 2019 pandemic, N95 masks have been widely used in the operating rooms of our hospital by nurses, residents, and surgeons since March 2020. This study aims to evaluate the effect of N95 respirator use by the surgical team on SSIs determined in patients operated on in our clinic compared to surgical mask use. Methodology In this retrospective study, the use of N95 respirators by the surgical team was compared with the use of surgical masks to evaluate the effect on SSIs in patients operated on in our clinic. Two groups were formed of patients operated on by the surgical team wearing surgical masks between February 2019 and February 2020 and those operated on with the surgical team using N95 respirators between March 2020 and March 2021. Each patient was diagnosed with postoperative SSIs by two different surgeons in the same clinic and by an infection clinic specialist based on clinical and laboratory findings. Results A total of 1,486 patients were examined; 729 patients in February 2019-February 2020 period (Group 1) and 757 in March 2020-March 2021 period (Group 2). In total, 124 and 104 patients were excluded from the first and second groups, respectively, for various reasons, including revision surgery, open fractures, diabetes, smoking, peripheral vascular disease, or other comorbidities that could affect infection rates. SSIs were determined in 35 patients in Group 1 and 13 patients in Group 2. The SSI rates in the second period in both types of procedures (arthroplasty and trauma surgeries) were determined to be significantly lower. Conclusions Because of the use of intraoperative N95 respiratory masks by surgical teams in orthopedics and traumatology procedures, the number of SSIs decreased significantly compared to the use of surgical masks.

Effects of cilostazol on fracture healing: an experimental study.

OBJECTIVE: The aim of this experimental study was to examine the clinical, radiological and histological effects of cilostazol on fracture healing. METHODS: A total of 60 Wistar albino male rats were divided into 2 groups: the study group (cilostazol) and the control group. Under general anesthesia, using a blunt-ended guillotine, standard closed shaft fractures were formed on the 3-point principle in the left femurs. Starting on the same day after the fracture was formed until sacrifice, the study group animals were administered with cilostazol (50 mg/kg/day, oral tablet). An equal number of rats from both control and study groups were sacrificed on the 7th, 14th, and 21st days after fracture formation, and the bone union tissue was examined clinically, radiologically and histologically. RESULTS: The use of cilostazol was not determined to have any significant effect clinically or radiologically on fracture healing (p>0.05). According to the histological findings, at the end of the first week, the amount of union in the cilostazol group was observed to be significantly greater (p<0.05). At the end of the third week, no significant difference was determined between the control and study groups (p>0.05). CONCLUSION: In the long term, cilostazol did not show any positive effect on fracture healing clinically, radiologically or histologically.

Platelet gel does not improve peripheral nerve regeneration: an electrophysiological, stereological, and electron microscopic study.

Although use of platelet gel (PG) for promoting tissue regeneration is a popular approach because of its capacity to accelerate tissue regeneration, to our knowledge, its effects on peripheral nerve have still not been elucidated. Therefore, the aim of this study was to investigate effects of PG on sciatic nerve regeneration using electrophysiology, stereology, and electron microscopy. The study was performed using five groups of rats: sham operated (Sham), collagen tube conduit (CT), collagen tube conduit plus platelet gel (CT + PG), autogenous nerve graft (ANG), and primary repair (PR) groups. Gap length for CT and CT + PG groups is 1 cm. Electrophysiology showed that nerve conduction velocity was not different among experimental groups; the amplitude of compound action potential of PR group was significantly higher than other groups. Examination of the nerves showed that Sham group not only had a larger axon diameter but also a thicker myelin sheath. A higher number of myelinated axon was found in both ANG and PR groups in comparison to Sham, CT, and CT+PG groups. There is no significant difference between morphological quantities of CT+PG and CT group. It was expected that regeneration degree of the nerve fibers of CT+PG group would be better than CT group, which was the control group permitting to disclose the presence of a positive effect of PG on nerve regeneration, but this was not the case. Therefore, our results suggest that PG does not improve axon regeneration after microsurgical reconstruction of a nerve gap by collagen tubes.

Osteoarthritis models after anterior cruciate ligament resection and medial meniscectomy in rats. A histological and immunohistochemical study.

OBJECTIVE: To compare the amount of degeneration based on the time spent, using 2 different methods of surgically induced osteoarthritis (OA) that frequently used in treating OA. METHODS: We undertook this research in Ondokuz Mayis University, Surgical Research Center between April 2006 and July 2006. In this study, 55 rats were used, 7 as the control group, and 12 in each of 4 groups. We compared the amount of OA formed by the medial meniscectomy (MMx) and anterior cruciate ligament transection (ACLT) at 8 and 16 weeks according to the Modified Mankin Score and histologically and immunohistochemically due to their response to Matrix metalloproteinase 13 expression (MMP13). RESULTS: We observed the highest degeneration in the MMx model at 8 weeks, and this situation continued until 16 weeks. However, the degeneration in the ACLT model was lower at 8 weeks compared with the MMx group, however, it reached the same amount as the MMX group at 16 weeks. CONCLUSION: The OA model formed by the ACLT method was better than the MMx model when degeneration and time were taken into consideration and should be used when researching drugs on an experimental basis in OA.

[Tendon repair with the strengthened modified Kessler, modified Kessler, and Savage suture techniques: a biomechanical comparison]. / Tendon tamirinde güçlendirilmis modifiye Kessler, modifiye Kessler ve Savage yöntemlerinin karsilastirilmasi: Biyomekanik çalisma.

OBJECTIVES: The aim of the study was to develop a suture technique that would be simple and easy to perform, but also strong enough to resist the strength formed during early active exercise protocols. METHODS: Thirty flexor digitorum profundus muscle tendons were obtained from lambs aged 12 to 16 months. The tendons were assigned to three in situ repair groups, including the modified Kessler technique, six-strand Savage technique, and a strengthened modified Kessler technique, all combined with an epitendinous suture. Each group was subjected to biomechanical tests and the maximum strength of the tendons to rupture and the power exerted to yield a 3-mm separation were recorded. RESULTS: The mean strengths of the tendons repaired with the modified Kessler technique for 3-mm separation and rupture were 29.9+/-2.9 N and 37.0+/-4.0 N, respectively. The corresponding forces were 39.1+/-6.7 N and 51.3+/-6.1 N with the six-strand Savage technique, and 59.9+/-8.3 N and 69.0+/-8.7 N with the strengthened modified Kessler technique, respectively. Forces to produce a 3-mm separation and rupture were significantly higher with the strengthened modified Kessler repair, whereas the lowest forces were seen with the modified Kessler technique (p<0.001). CONCLUSION: Tendon repair with the strengthened modified Kessler technique provides the highest resistance to both 3-mm separation and rupture. These biomechanical properties may allow safe and active motion without any gap formation in the repair area.