Can The Systemic Immune-Inflammation Index (SII) and Charlson Comorbidity Index (CCI) be used to predict mortality in patients with necrotizing fasciitis?

PURPOSE: This study aimed to determine the impact of mortality and morbidity indices on the diagnosis and prognosis of patients suffering from necrotizing fasciitis. METHODS: A retrospective analysis was performed on 41 patients (26 females, 15 males) with necrotizing fasciitis (NF). The SII (Systemic Immune-Inflammation Index) was computed using the formula SII = (P × N)/L, where P, N, and L measure the counts of peripheral platelets, neutrophils, and lymphocytes, respectively. This study evaluated the clinicopathological characteristics and follow-up information to assess the comparative effectiveness of SII, CCI (Charlson Comorbidity Index), and LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) scores as mortality and morbidity indices for patients with NF. RESULTS: The optimal cut-off for SII was determined to be 455. The SII value in the group with mortality was significantly higher compared to the group without mortality (p < 0.05). The CCI value in the group with mortality was significantly higher than the group without mortality (p < 0.05). The SII and CCI values were found to be effective in distinguishing between patients who suffered mortality and those who did not. CONCLUSION: SII is a powerful tool for predicting mortality in patients with necrotizing fasciitis (NF). The SII index provides a novel, easily accessible, and inexpensive indicator for monitoring the progress and predicting the survival of patients with NF.

Mortality analyses of elderly patients with proximal femoral fracture during the pandemic: vaccination affects or not.

PURPOSE: To evaluate the mortality rate, intensive care unit (ICU) referral, and Charlson comorbidity index (CCI) between different types of vaccinated and non-vaccinated patients operated on due to intertrochanteric femoral fracture (IFF) during the pandemic. METHODS: Ninety-six patients (43 males, 53 females) who had proximal femur nails (PFN) for the IFF during the pandemic were included in the study. The patients were divided into four subgroups; non-vaccinated, and different types of vaccinated. Mortality rates, ICU referrals, and CCI relations were evaluated. RESULTS: No significant difference was observed in terms of demographic data such as age, gender, side, CCI, and ICU referrals between the subgroups (p = 0.164, p = 0.546, p = 0.703, p = 0.771, p = 0.627 respectively). The mortality rate was significantly lower in the Sinovac + BioNTech subgroup (p = 0.044). CONCLUSION: No relationship was found between mortality rate, ICU referral, and CCI in different types of vaccinated and non-vaccinated patient subgroups.

Erectile Dysfunction after Conservative Treatment of Sacral Fractures in Males without Injury to the Urinary System.

BACKGROUND: This study aimed to determine the incidence of erectile dysfunction (ED) reported by patients, and to define the prognostic relationship between ED and conservatively treated sacral fracture without urethral injury. METHODS: Patients aged between 20 - 50 years who were sexually active and had no known sexual dysfunction prior to the trauma were included in the study. Seventy-seven patients (47 married, 30 single) treated conservatively for sacral fracture between April 2012 and February 2017 were retrospectively screened. Patients were compared in terms of age, marital status, body mass index (BMI), trauma mechanism, additional system injury, functional outcomes, and complications. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the Majeed pelvic fracture functional assessment scale (MPS). RESULTS: No statistically significant difference was observed between fracture types with respect to age, BMI, follow-up, marital status, trauma mechanism, and accompanying injury. The incidence of ED was 27.3% for those that received conservative treatment after sacrum fracture. The mean score of IIEF-5 was 18.6 ± 6.6 and MPS was 77.2 ± 13.2. There was no significant relationship between the injury type of the patients and the IIEF-5 and MPS scores (p = 0.593 and p = 0.907, respectively). The lowest IIEF-5 score was found in Denis type 2 fractures (p = 0.020). CONCLUSION: The frequency of ED was higher in Denis type 2 sacrum fractures. Sexual function should be questioned in the follow-up, especially in those fracture types.

Partial load-bearing rabbit ulnar segmental defects are regenerated with biocompatible grafts with or without bone marrow-derived mesenchymal stem cells.

BACKGROUND: The autologous bone grafts still have been used as the gold standard to initiate and facilitate bone healing in cases with bone defects. Because of some disadvantages of autologous bone grafts, the new biocomposite grafts have been researched. The purpose of the present study was to investigate whether the bone marrow-derived mesenchymal stem cells (BM-MSCs) loaded into a biocomposite scaffold enhance bone regeneration. METHODS: In our study, a 10 mm osteoperiosteal segmental bone defect was created in the middle of the right and left ulnar bones of eight rabbits. The created defects were filled in the right ulnar bones of eight rabbits (Group I) with BM-MSCs loaded onto a bio-composite scaffold (Plexur PTM, Osteotech, Eatontown, NJ, USA) and in the other ulnar bones of the same rabbits (Group II) with only biocomposite graft. Radiographs of each forelimb were taken postoperatively at the end of the 6th week. Then, the rabbits were euthanized pharmacologically for histopathological evaluation. RESULTS: Were scored using a modified Lane and Sandhu scoring system. All defects healed in both groups. Radiological and histo-logical total scores were slightly better in Group I, but statistical tests did not reveal any significant differences between the two groups at the end of the 6th week radiologically and histologically (p>0.05). CONCLUSION: The results of our study demonstrated that in rabbit ulnar segmental bone defect model was obtained satisfactory regeneration with using biocomposite graft with or without BM-MSCs.

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.

Which external fixation method is better for the treatment of tibial shaft fractures due to gunshot injury?

INTRODUCTION: The present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury. HYPOTHESIS: Patients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF. MATERIAL AND METHODS: The study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months). RESULTS: No statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05). DISCUSSION: Although AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures. LEVEL OF EVIDENCE: IV; retrospective, case-control study.

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.

The effect of COVID-19 positivity on inflammatory parameters and thirty day mortality rates in patients over sixty five years of age with surgically treated intertrochanteric fractures.

PURPOSE: To evaluate the effect of COVID-19 positivity on inflammatory parameters and 30-day mortality rates in patients over 65 years of age who were operated on for intertrochanteric femur fractures (IFF). METHODS: Eighty-seven patients (31 males, 56 females) who had a dynamic hip screw (DHS) or proximal femur nail (PFN) for the IFF between March 2020 and November 2020 were included in the study. The patients were divided into two groups as COVID-19 confirmed and probable positive (Group 1) and COVID-19 negative (Group 2). Time to surgery, operation duration, length of hospital stay, 30-day mortality, rates of the intensive care unit (ICU) referral, and inflammatory parameters such as haemoglobin, CRP, sedimentation, PCT, D-Dimer, and ferritin were evaluated. RESULTS: No significant difference was observed in terms of demographic data such as age, gender, comorbidity, and fracture type between the groups. Thirty-day mortality, ICU referral rate, blood transfusion rate, and hospitalization period were higher in Group 1 (p = 0.016, p = 0.012, p = 0.031, and p = 0.011, respectively). The inflammatory parameters were higher in Group 1 compared to Group 2 in the preoperative and postoperative periods (p < 0.05). CONCLUSION: COVID-19 positivity increases inflammatory parameters (as expected) and increases the 30-day mortality and ICU requirement in patients with surgically treated IFF.

Comparison of two types of fixation for proximal tibial epiphysiodesis: An experimental study in a rabbit model.

OBJECTIVES: In this study, we describe a novel hemiepiphysiodesis technique to prevent implant-related perichondrial ring injury in a rabbit model. MATERIALS AND METHODS: Proximal tibial epiphyseal plates of a total of 16 white New Zealand rabbits were used for this animal model. The subjects were divided into three equal groups as follows: Group 1 (Kirschner wire [K-wire]/cerclage), Group 2 (8-plate) right-hind legs, Group 3 (Control) left hind legs. Using anteroposterior radiography, the medial slope angle (MSA), articular line-diaphyseal angle (ALDA), and the angle between screws of 8-plate in lateral X-ray tibial slope angle (TSA) were measured. The radiographs were taken early postoperative (Day 1) and on sacrification day (Week 8). The histological evaluation of the perichondrial ring was made on a 7-mm axial section that stained with Safranin O/fast green at X10 magnification. RESULTS: In both K-wire and 8-plate groups, the early postoperative ALDA and TSA were greater than the sacrification ALDA and TSA (p=0.028 and p<0.001, respectively). The early postoperative MSA was lower than the sacrification MSA in groups, (p<0.001). The MSA in the control group was lower than the K-wire and 8-plate groups (p<0.001 and p=0.009; respectively). The perichondrial ring thickness of the K-wire group was greater than the 8-plate group in histological evaluation (p<0.001). CONCLUSION: Both of the K-wire and 8-plate groups showed similar angulation effects in the proximal tibia, although histologically less damage to the perichondrial ring was observed in the K-wire group, compared to the 8-plate group.

Could percutaneous fixation with crossed Schanz pins be an alternative to open reduction in the treatment of intra-articular calcaneal fractures?

PURPOSE: Despite modern operative techniques and a considerable number of studies in the literature, the best treatment for calcaneal fractures remains an enigma for orthopaedic surgeons. The purpose of the study was to compare clinical and radiographic outcomes between anatomic calcaneal plate (ACP) fixation and crossed Schanz pin (CSP) fixation in the treatment of Sanders type II and III displaced intra-articular calcaneus fractures (DICFs). METHODS: Consecutive 65 patients (49 males, 16 females) who underwent surgery for DCIFs between January 2009 and February 2013 were retrospectively evaluated. The patients were divided into two groups as ACP and CSP according to the operative technique. The groups were compared in terms of demographic features, injury mechanism, operation time, fluoroscopy exposure, complications, full weight-bearing time, functional, and radiological outcomes. RESULTS: VAS-rest score did not differ significantly between the groups while the VAS-activity score was significantly higher in the CSP group (p = 0.001 and p = 0.645, respectively). Foot Function Index (FFI) was significantly lower, Maryland Foot Score (MFS) and the American Orthopaedic Foot and Ankle Society-hindfoot score (AOFAS) were significantly higher in the ACP group (p = 0.047, p = 0.016, and p < 0.001, respectively). While no difference was observed between the preoperative and the early post-operative (1st day) Böhler angle and Gissane angle, both were significantly higher in the ACP group at the post-operative last control (p < 0.001 and p < 0.001, respectively). CONCLUSION: Although crossed Schanz pin fixation shortens the operation time in displaced intra-articular calcaneus fractures compared to anatomic calcaneal plate, increased fluoroscopy exposure rates and low functional and radiological outcomes are disadvantageous of crossed Schanz pin. Anatomic calcaneal plate is still a better technique for preserving the alignment and elevating the displaced intra-articular segment for good to excellent mid-term 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.

The effect of fibrin clot and C vitamin on the surgical treatment of Achilles tendon injury in the rat model✰.

BACKGROUND: This study aimed to determine the histological, biochemical, and biomechanical efficacy of fibrin clot and vitamin C in the healing of Achilles tendon ruptures (ATR) in a rat model. METHODS: 52 adult Wistar-Albino rats (300-450 g) were used in the study. 12 rats were divided into four groups as Monitor (Group I), Control (Group II), Fibrin Clot (Group III), Fibrin Clot with vitamin C (Group IV). Four rats were used for fibrin clot preparation. Fibroblast Growth Factor (FGF) and Vascular Endothelial Growth Factor (VEGF) were measured on the 3rd, 7th, 14th, and 21st days. Four rats were sacrificed on the 21st day from each group for histological evaluation. The rest of the rats were sacrificed at 42nd day, half for biomechanical and a half for histological evaluation. RESULTS: The 42nd-day HSS score of group IV was significantly lower than those of group I, group II and group III (p = 0.036, p = 0.019, and p = 0.036, respectively). Group IV showed a significantly higher Maximum force N value than those of group I, group II and group III (p = 0.034, p = 0.034 and, p = 0.025, respectively). The blood FGF and VEGF levels of group III and group IV on the 3rd, 7th, 14th, and 21st days were higher than those of group I and group II (p < 0.05). CONCLUSION: Fibrin clot and vitamin C produced a stronger tendon structure in terms of biomechanics while providing histological and biochemically better quality tendon healing in the surgical treatment of ATR. This model can be used to accelerate high-quality tendon healing after ATR. LEVEL OF EVIDENCE: Level II, experimental study.

The Influence of Lumbar Modifiers on Functional and Radiological Outcomes in the Brace Treatment of Lenke Type 1 Adolescent Idiopathic Scoliosis.

BACKGROUND: Brace treatment prevents the progression of scoliosis and reduces surgical treatment rates. However, the efficacy of brace treatment varies depending on the patient's age, gender, curve magnitude and type, structure of the curve, and patient compliance at the beginning of treatment. METHODS: Between January 2009 and April 2015, 106 Lenke type 1 AIS consecutive patients (69 females, 37 males) who were treated with a brace were examined in three groups according to Lenke classification lumbar modifiers. The patients were evaluated at pre-bracing and 1 and 2 years after bracing. The Scoliosis Research Society 22 (SRS-22) and Oswestry Disability Index (ODI) were used for functional evaluation. Radiological evaluation revealed the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, trunk shift, shoulder asymmetry, and body height difference. RESULTS: Functional and radiological evaluation showed a statistically significant improvement in Lenke 1A, 1B, and 1C at 1 and 2 years after bracing compared to the pre-bracing (p = 0.000, p = 0.000, and p = 0.000, respectively). Lenke 1C had the best ODI score and followed by decreasing values of 1B and 1A respectively (p = 0.009). Lenke 1B had the best SRS-22 score and the mean scores of 1A and 1C were equal (p = 0.017). There was no significant difference between the groups in the parameters other than the trunk shift in radiological evaluation (p = 0.043). CONCLUSIONS: Significant improvement was observed in all types of lumbar modifiers at the end of the 2nd year compared to pre-bracing. The best improvement in the ODI score was in the 1C modifier, whereas the best improvement in the SRS-22 score was in the 1B modifier. The type of lumbar modifier should be directly taken into consideration before starting brace treatment in Lenke type 1 AIS. LEVEL OF EVIDENCE: Level III, retrospective study.

Acute correction and intramedullary nailing of aseptic oligotrophic and atrophic tibial nonunions with deformity.

OBJECTIVES: This study aims to describe the important points for treatment of aseptic tibial oligotrophic and atrophic nonunions by intramedullary nailing (IMN). PATIENTS AND METHODS: The retrospective study included 17 biologically nonactive nonunion patients (12 males, 5 females; mean age 36.4 years; range, 19 to 49 years) operated between February 2010 and November 2017 by deformity correction, static IMN and autografting. The mean follow-up time was 4.2 (range, 3 to 7) years. The initial fracture management was external fixator for all patients. Fourteen patients had open fractures initially. Six patients had valgus, four patients had varus, three patients had oblique plane, and four patients had external rotational deformity. Nonunion diagnosis was established on the basis of the patient history and physical examination based on plain radiographs, computed tomography or both. All patients were evaluated by the same protocol to exclude any infection. RESULTS: The median time from injury to nailing was mean 10.3 (range, 6.1 to 36.5) months. Radiologic and clinical union was achieved in all patients. The mean union time was 3.64 (range, 3 to 6) months. Three patients had positive intraoperative bacteriological culture. In four patients, dynamization was necessary for consolidation. Late deep infection developed in three patients after union, and all infected cases were operated by implant removal, debridement, and appropriate antibiotics. CONCLUSION: Intramedullary nailing and autografting after external fixator provide good results for the treatment of aseptic biologically nonactive nonunions with deformity. Reamed IMN ensures sufficient deformity correction, biological environment, and mechanical stability. The infection risk should always be kept in mind and patients should be followed-up closely to prevent complications.

The role of trauma mechanism, fracture pattern and fixation technique on clinical outcomes and epiphyseal growth arrest in the surgical treatment of distal tibial epiphysiolysis.

BACKGROUND: Distal tibial epiphyseal fractures damage to epiphyseal growth plate. Epiphyseal growth arrest (EGA), reflex sympathetic dystrophy and ankle joint stiffness may also occur after distal tibial epiphyseal injury. This study aims to evaluate the role of trauma mechanism, fracture pattern and fixation technique on clinical outcomes and EGA in the surgically treated distal tibial epiphyseal fractures. METHODS: Twenty seven patients who underwent surgery for distal tibial epiphyseal fracture between the 2011 and 2017 were evaluated retrospectively. The effects of trauma mechanism, fixation technique, preoperative duration, fracture patterns on the clinical results and EGA were examined. AOFAS (The American Orthopedic Foot and Ankle Score) and MOXFQ (The Manchester-Oxford Foot Questionaire) were used for clinical evaluation. RESULTS: Twenty seven patients (17 male and 10 female) were included in this study. The most important complication of epiphyseal injury was the growth pause in eight patients. No statistically significant difference was observed concerning clinical scores and complications according to trauma mechanism, fixation techniques and fracture patterns (p>0.05). CONCLUSION: Regardless of the trauma mechanism, fracture pattern and the fixation material, an anatomical reduction should be obtained in distal tibial epiphyseal fractures to reduce complications and prevent the EGA.

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.

Efficacy and cost-effectiveness of the cell saver system in instrumented posterior fusion with thoracic and lumbar vertebral fractures.

BACKGROUND: The aim of our study was to determine the efficacy and cost-effectiveness of intraoperative autotransfusion that uses the cell saver system (CSS) in patients undergoing posterior instrumentation and fusion of thoracic and lumbar vertebral fractures. METHODS: We divided 121 patients who were to undergo posterior instrumentation and fusion due to thoracic and lumbar vertebral fractures into two groups: 59 patients (23 males and 36 females) were in the cell saver group, and 62 patients (22 males and 40 females) were in the control group. Hemoglobin, hematocrit, and red blood cell (RBC) values were recorded for all patients preoperatively, on the postoperative first, second, and third days, and on the hospital discharge day. Transfusion rates and numbers of allogeneic erythrocyte transfusions, as well as the costs of transfused total auto- and allogeneic transfusions were compared. RESULTS: The numbers of erythrocyte suspensions transfused perioperatively were 0.2±0.6 units in the cell saver group and 0.7±1.4 units in the control group (p=0.01). Statistically significant differences were noted between the two groups on the postoperative first, second, and third days in terms of hemoglobin, hematocrit, and RBC values. These differences had disappeared by the hospital discharge day. The average cost of perioperative blood transfusions was $431±27.4 in the cell saver group and $34.5±66.25 in the control group (p<0.001). CONCLUSION: The use of the CSS was not cost-effective, but it was particularly successful at reducing the rate and the number of units of postoperative allogenic blood transfusions.

Comparison of the functional results of radial head resection and prosthesis for irreparable mason type-III fracture.

BACKGROUND: The radial head is essential for the rotational stability of the forearm and resistance to valgus stress. Radial head fractures are the most common elbow fracture in adults. Various treatment options are available, depending on the fracture severity. However, the treatment of Type-III fractures is controversial. The aim of this study was to evaluate functional results in patients with irreparable Mason Type-III radial head fractures treated with radial head resection or prosthesis. METHODS: Fourteen irreparable Mason Type-III radial head fracture patients treated with radial head resection (n=7) or radial head prosthesis (n=7) were evaluated in this multicenter, retrospective study. Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow and Wrist scores were used to determine clinical outcomes. A hydraulic hand dynamometer was used to measure grip strength on the operated and unoperated sides to avoid potential bias. Measurements were made three times for each extremity, and the mean value was recorded. Grip strength was calculated as a percentage of the strength of the unoperated side. RESULTS: Functional outcomes for resection and prosthesis patients were the following: mean DASH scores, 25.8 and 17.2; mean Mayo Elbow scores, 74 and 84.1; mean Mayo Wrist scores, 84 and 92.5; and maximum grip strengths, 48.8% and 77.8%, respectively. The range of motion of the respective resection and prosthesis groups were as follows: flexion, 112.14° and 104.29°; extension, -10.00° and -25.00°; pronation, 70.00° and 47.86°; and supination, 70.00° and 52.14°. CONCLUSION: Although range of motion was restricted in the radial head resection group, functional results and grip strength were superior in patients treated with a radial head prosthesis. These results support the radial head prosthesis as a superior treatment modality for patients with irreparable Mason Type-III radial head fractures with respect to patient satisfaction and functional outcomes.

Platelet-rich plasma versus exchange intramedullary nailing in treatment of long bone oligotrophic nonunions.

INTRODUCTION: The aim of the study was to evaluate the effects of platelet-rich plasma on healing rates and healing time in the treatment of long bone nonunions treated by an intramedullary nail previously. MATERIALS AND METHODS: Between August 2008 and January 2012, 14 consecutive patients who were treated for long bone nonunions with percutaneous platelet-rich plasma application (PRP) were included in the study. The control group included 15 consecutive patients who were treated with exchange intramedullary nailing (EIN). In the postoperative period, all patients were controlled in every 2 weeks clinically and in every 4 weeks radiologically. Patients were evaluated with visual analog scale (VAS) in preoperative and postoperative periods. RESULTS: The mean healing time was shorter in PRP group as 16.71 ± 2.4 weeks compared with that of 19.07 ± 3.67 weeks in EIN group (p = 0.053). At the end of the follow-up, the union is achieved in 92.8% of the cases in PRP group. This ratio was 80% in control group. The mean VAS values in preoperative and postoperative periods were not statistically significant in both groups (p > 0.05). When PRP and control groups were evaluated individually, the postoperative VAS was lower than that of preoperative VAS in both groups (p = 0.0001 and p = 0.0001, respectively). CONCLUSION: Percutaneous PRP application significantly affected union rate, but no significant difference found when compared to EIN in the treatment of oligotrophic nonunions after intramedullary nailing of long bone fractures. PRP can be applied as a minimally invasive and safe method of saving resources in medical care instead of EIN.