Conservative Treatment of an Isolated Greater Tuberosity Fracture With Dislocation: Management of Post-Traumatic Subacromial Impingement Syndrome and a Mini-Review of the Literature.

This case report evaluates the effectiveness of conservative treatment for an isolated greater tuberosity fracture-dislocation, detailing the treatment process and addressing post-traumatic subacromial impingement syndrome with a mini-review of the literature. A 26-year-old male fell from a height, resulting in a self-reduced dislocated shoulder. Examination revealed extensive ecchymosis, pain, and limited motion in the right shoulder. Radiological assessments showed an isolated greater tuberosity fracture, partial tears of the supraspinatus and subscapularis muscles, a suspected ALPSA lesion, and periarticular effusion. Initial treatment included a shoulder sling, passive elbow and wrist exercises, and pendulum exercises starting in the second week. At six weeks, persistent pain prompted TENS therapy and advanced rehabilitation exercises. At three months, the patient continued to experience pain and restricted shoulder movement. An MRI ruled out labral pathology, and a shoulder ultrasound revealed post-traumatic subacromial bursitis, leading to a diagnosis of subacromial impingement. A diagnostic ultrasound-guided injection of prilocaine into the subacromial bursa significantly improved the range of motion and alleviated pain within one hour. Treatment recommendations included avoiding overhead activities, NSAIDs, and continued rehabilitation. By six months, the patient had achieved a pain-free range of motion of 180 degrees. This case demonstrates that conservative treatment and appropriate rehabilitation can effectively manage isolated greater tuberosity fractures and associated glenohumeral joint dislocations. Early diagnosis and suitable rehabilitation strategies for post-traumatic subacromial impingement syndrome positively influenced the patient's recovery. Given the patient's youth and swimming background, steroid injections were avoided due to potential complications, with successful recovery achieved through NSAIDs, overhead activity restriction, and rehabilitation.

Effect of bone grafting on bone union in exchange nailing for the treatment of femoral shaft nonunions.

OBJECTIVE: This study aims to investigate the effect of bone grafting on the bone union in exchange nailing (EN) for the treatment of femoral shaft nonunions. METHODS: A total of 26 patients (16 male) were included in this study. The mean age of the patients was 36.1±9.3. Bone grafts were used in 8 patients (bone graft group), and EN was performed without bone grafting (no bone graft group) in 18 patients. Etiology, fracture type, location, and classification of the fractures at the time of initial injury were evaluated. The reduction type (open or closed) and locking status of the nails were also noted. Nonunion types were recorded. In the bone grafting group, iliac bone autografts were used in seven patients and a synthetic bone graft was used in one patient. Following EN, the presence and duration of bone union, and the increase in the nails' diameter were analyzed for each group and compared. RESULTS: Union rates were 100% and 94.4% in bone grafting and no bone grafting groups, respectively. The mean union period was not significant between the groups (22.5 and 16.5 months, respectively). The mean increase in the nail diameter was 1.88 mm in the bone graft group and 2.00 mm in the no bone graft group (p>0.05). CONCLUSION: This study demonstrated that high union rates can be achieved with EN by means of using larger diameter nails with or without bone grafting in the management of femoral shaft nonunions, and bone grafting had no significant effect on union rates and periods.

Mid- to long-term outcomes of proximal humerus fractures treated with open reduction, plate fixation, and iliac bone autograft augmentation.

BACKGROUND: Open reduction and internal fixation (ORIF) using locking plates is a widely adopted treatment for displaced proximal humerus fractures. Various augmentation techniques have been developed to enhance the stability of plate fixation. Among these, iliac bone autograft is notable for its advantages over allografts, such as ready availability and the elimination of costs and risks associated with disease transmission. Despite its potential benefits, data on the outcomes of iliac bone autograft augmentation (IBAA) are still limited. This study aims to present the mid- to long-term results of treating proximal humerus fractures with ORIF using locking plates and IBAA. METHODS: The study included 15 patients treated with ORIF and IBAA. We classified fracture patterns using the Neer classification and estimated local bone density via the deltoid tuberosity index. We measured the neck shaft angle (NSA) and humeral head height (HHH) on both immediate postoperative and most recent X-ray images to assess the maintenance of reduction. Clinical outcomes were evaluated using the DASH (Disabilities of the Arm, Shoulder, and Hand) and Constant scores. RESULTS: The average follow-up duration was 59.56 months, ranging from 24 to 93 months. A majority of fractures were classified as four-part (53%). The average immediate and late postoperative NSAs were 132.6±8.19 and 131.6±7.32 degrees, respectively. The average HHH on the immediate postoperative and latest follow-up images were 16.46±6.07 and 15.10±5.34, respectively. None of the patients exhibited any radiological signs of avascular necrosis or loss of reduction at the latest follow-up. The mean postoperative Constant and DASH scores at the latest follow-up were 79.6 and 11.5, respectively. CONCLUSION: Our findings suggest that ORIF with IBAA is an effective method for managing three- or four-part proximal humerus fractures, yielding excellent outcomes.

Depression as a Prognostic Factor in Lower Extremity Amputation for Diabetic Foot: Insights From a Prospective Study on Wound Healing, Infections, and Early Mortality.

This study addresses the challenges faced by diabetic patients undergoing lower extremity amputation due to diabetic foot, particularly focusing on the implications for wound healing and early mortality. The wounds at the amputation stump may necessitate multiple surgical interventions. The aim is to identify prognostic factors associated with these outcomes, shedding light on the complexities surrounding the postamputation phase. A prospective study was conducted on 39 diabetic patients who underwent lower extremity amputation due to diabetic foot between 2021 and 2022. Comprehensive preoperative data, encompassing parameters such as blood count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, hemoglobin A1c, albumin, protein, transferrin, ferritin levels, age, gender, body mass index, smoking habits, dialysis, revascularization, duration of surgery, and the use of tourniquet during the procedure were meticulously recorded. Additionally, cognitive performance and depression status were assessed preoperatively using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI), respectively. A follow-up period of 3 months postsurgery allowed for the comparison of patients who developed infections at the amputation stump with those who did not, as well as the distinction between patients who survived and those who succumbed to mortality. The study revealed that the use of a tourniquet during surgery significantly increased the risk of infection (p = .027), and higher BDI scores were associated with increased risks of both infection (AUC = 0.814) and mortality (AUC = 0.769), with cut-off scores of 24.0 and 23.5 predicting these outcomes with high sensitivity and specificity, respectively. Additionally, lower MMSE scores were associated with increased short-term postoperative mortality. There were no statistically significant differences between the groups in parameters such as complete blood count, ESR, CRP, procalcitonin, HbA1c, albumin, total protein, transferrin, ferritin levels, age, gender, BMI, smoking, dialysis, revascularization, and surgery duration. This investigation highlights the significance of considering tourniquet usage during amputation, preoperative depression status, and cognitive function in patients who undergo amputation due to diabetic foot. The use of a tourniquet during surgery is a significant risk factor for infection, and elevated BDI scores are strong predictors of both infection and mortality in patients undergoing amputations. The findings underscore the importance of a multidisciplinary neuropsychiatric evaluation preoperatively to enhance patient care and outcomes.

A Rare Case of Periprosthetic Joint Infection with Streptococcus dysgalactiae subspecies dysgalactiae.

Periprosthetic joint infection (PJI) is a rare but most vital complication after joint arthroplasty and requires a revision surgery. Synovial fluid analysis is essential in diagnosis of the PJI, and conventional and molecular microbiologic investigations may help in determining the cause of the infection. With this unusual case, we aimed to present the second instance in the literature of PJI of the knee caused by Streptococcus dysgalactiae subspecies dysgalactiae (SDSD). S. dysgalactiae PJI in the literature are commonly Streptococcus dysgalactiae subspecies equisimilis (SDSE), and SDSD mostly infects animals. A farmer with comorbid illnesses who works with cattle and sheep experienced periprosthetic knee joint infection caused by SDSD. Surgical excisional debridement with open washing, decompression, and liner exchange were performed. The identification of the bacteria was done with VITEK MS as SDSD. After 1-year follow-up, the patient has fully recovered without recurrence.

Are acromiohumeral distance measurements on conventional radiographs reliable? A prospective study of inter-method agreement with ultrasonography, and assessment of observer variability.

OBJECTIVES: This study aims to investigate the reliability of acromiohumeral distance (AHD) measurements using conventional radiographs and to compare non-standardized and standardized radiographs with intra-/interobserver reliability measurements. PATIENTS AND METHODS: Between February 2021 and January 2022, a total of 110 shoulders of 55 patients (25 males, 30 females; mean age: 49.7±12.6 years; range, 25 to 77 years) were included. Radiographs were taken in four different positions: primarily shoulder anteroposterior (AP), true AP, standardized true AP, and standardized outlet views. The AHD was measured by three orthopedists. A prospective ultrasonography (US) evaluation was performed by an experienced physiatrist, and the relationship between US and radiographic measurements was evaluated. The intra- and interobserver reliability of radiographic measurements was assessed. RESULTS: On the standardized true AP view measurements, all observers showed a moderate to good agreement with US measurements (intraclass correlation coefficients [ICC]: 0.68-0.75). There was no significant difference between the AHD measurements of the senior orthopedist on standardized true AP and outlet views, and the US measurements. The intraobserver agreement of US measurements was excellent (ICC: 0.98, 95% confidence interval [CI]: 0.98-0.99), and the intraobserver agreement level of measurements on radiographs were good to excellent with a wide range of ICC values (ICC: 0.79-0.97). Interobserver reliability was the highest on the standardized outlet view, with an ICC of 0.91 and 0.88 in two measurement times. Interobserver reliability of other measurements were good with ICC values ranging from 0.82 to 0.88. CONCLUSION: The AHD measurements on radiographs are compatible with US measurements within up to 2 mm difference if standardization is ensured. Also, measurements on standardized views have a superior consistency with lower standard error of measurement and minimal detectable change values. Therefore, we recommend using standardized true shoulder AP and standardized outlet radiographs in clinical practice and studies, as these are the most accurate in demonstrating true AHD.

Intralesional curettage and cementation of low-grade chondrosarcomas of the appendicular skeleton: Long-term results from a single center.

OBJECTIVE: The purpose of this study was to investigate the results and complications in patients who had low-grade chondrosarcomas in the appendicular skeleton and were treated by intralesional curettage and cementation within the scope of 25 years of experience in a single center. METHODS: Ninety-one patients (72 female and 19 male) were retrospectively analyzed. The median at the time of surgery was 43 (17-78) years, and the median follow-up was 102 (26-288) months. All patients were treated by intralesional curettage followed by cementation with high-viscosity bone cement (polymethylmethacrylate). Complications and local recurrence rates, as well as clinical outcome scores were recorded. RESULTS: Five patients (5.49%) developed local recurrence at an average of 6.6 (6-9) months postoperatively. Four were treated with local wide excision and reconstruction with tumor prosthesis. One patient received recurettage and cementation. Two recurred patients were dedifferentiated into grade II chondrosarcomas in the last intervention. No major postoperative complication was identified in the series. Patients achieved an average Musculoskeletal Tumor Society scoring system of 92.4% (standard deviation 5.2; range 80-100) in the sixth postoperative month. Musculoskeletal Tumor Society scores in the recurrent patients decreased from an average of 90% to 75.3% after the final intervention. CONCLUSION: Intralesional curettage and cementation seem safe and reliable techniques with low recurrence and complication rates in treating low-grade chondrosarcomas of the appendicular skeleton. Clinical, radiological, and pathological evaluations are mandatory before surgical intervention, and a multidisciplinary approach is crucial. A strict follow-up regimen in the early postoperative period is needed and strongly recommended to detect local recurrence. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

The Effect of Preoperative Albendazole Treatment on Intramuscular Cyst Structure in a Patient with Simultaneous Cystic Echinococcusis of Liver and Vastus Lateralis Muscle.

We report a 44-years-old woman with cystic echinococcosis (CE) who presented with simultaneous involvement of liver and vastus lateralis muscle to Istanbul University-Cerrahpasa, Istanbul, Turkey in 2020. Although she underwent surgery for the liver, the intramuscular mass was ignored. While the patient was under post-operative albendazole treatment, she was investigated for the mass on her right thigh which was excised later. The comparison of magnetic resonance imaging before and after albendazole treatment showed that albendazole eliminated the intramuscular vesicle structures by accelerating the degeneration process of the cyst. The comparison of pathology samples sent from both liver and intramuscular CE also revealed that the albendazole has left the laminar membrane intact, degenerate the germinative membrane, thereby reducing the intra-vesicle pressure and also caused the scolex structures to disappear. To the best of our knowledge, this is the first paper to report the effect of preoperative albendazole treatment on the structure of intramuscular CE.

Closed reduction percutaneous pinning versus open reduction internal fixation in the treatment of intraarticular distal radius fractures: Mean four-year results.

BACKGROUND: This study was performed to compare the results of closed reduction percutaneous pinning (CRPP) versus open reduction internal fixation with a volar locking plate (ORIF) in the treatment of intraarticular distal radius fractures (IDRF) average four-year follow-up. METHODS: In this study, 43 patients had unilateral intraarticular distal radius fractures (type B and C) treated with CRPP (n=19; 11 males and eight females) and ORIF (n=24; 14 males and 10 females) were retrospectively evaluated. The mean follow-up was 50.3 months (12-74) at the CRPP group and 45.2 months (40-65) at the ORIF group. The mean age was 50.8 years (29-73) in the CRPP group and 51.5 (19-75) in the ORIF group. The patients were evaluated functionally and radiologically at the last follow-up. RESULTS: There was no statistically significant difference between the groups concerning follow-up, age, and gender. However, there was no statistical difference concerning grip power and the range of motion. The Disabilities of the Arm, Shoulder and Hand Score (Q-DASH) was better in the ORIF group. Voler tilt and radial height measurements were statistically significantly better in the ORIF group. Degenerative arthritis was 63% in the CRPP group and 41% in the ORIF group, and there was no statistically significant difference. CONCLUSION: ORIF with a volar locking plate has better functional and radiological results than CRPP in IDRF patients' average four-year follow-up.

Predatory journal preference in the field of Orthopaedics and Traumatology in Turkey.

OBJECTIVE: The aim of this study was to determine the prevalence of predatory journals in Orthopedics and Traumatology and to investigate the relationship of these publications with the regulations of scientific fields made in recent years in Turkey. METHODS: The journals and publishers between the years 2000-2018 were screened and websites visited one by one on the basis of the orthopedic journals and publishers list determined as predators or possible predators. Orthopedic publications originated from Turkey was detected in these predatory journals. Article admissions, article processing charges, editorial and referee average response times were reviewed from the websites of journals. In addition, the effect of changing associate professorship application requirements and academic incentive regulation on the preference of predatory journals was examined. RESULTS: Between 2000 and 2018 years 1626 issues which can be reached in 282 journals were examined. 4795 articles were screened in 29 journals which have articles originated from Turkey. One hundred and six (2.21%) articles which originated from Turkey was reached in these publications. Average article processing charge was $865 ($ 0-1819). Fifty-nine of 106 (55%) articles originated from Turkey were found in only 4 journal. Journals which have articles originated from Turkey were not on the Web of Science list. The response time to the articles was between 2 and 6 weeks in these journals. After the change criteria in associate professorship in 2016, 3.32 fold increase in annual average number of publications originated from Turkey have been identified in predatory journals. After the change criteria in academic incentive regulation in 2015, 4.76 fold increase in annual average number of publications originated from Turkey have been identified in predatory journals. CONCLUSION: The number of articles in predatory journals is increasing all over the world. This situation also valid in the field of Orthopaedics and Traumatology in Turkey. Authors should pay attention regarding predatory journals not only article processing charges but also very short evaluation period.