The assessment of the efficacy of radiography in diagnosing developmental dysplasia of the hip in infants younger than six months with reference to hips graded by Graf classification using ultrasonography.

OBJECTIVE: This study aims to evaluate the diagnostic effectiveness of radiography for developmental dysplasia of the hip (DDH) in infants being younger than six months by comparing the results with hips graded by Graf classification using ultrasonography (US). While US is standard for screening and diagnosing DDH in this age group, radiography may provide broader insights for screening programs and boost diagnostic precision. PATIENTS AND METHODS: This retrospective research involved 994 hips from 497 newborns and infants under six months old who underwent hip US and radiography for DDH screening from August 2020 to September 2021. Radiographs were reassessed by an experienced pediatric orthopedic surgeon to identify DDH indications. Hips were graded using the Graf classification, and the primary outcome was the diagnostic accuracy of pelvic/hip radiography for DDH, using the US Graf classification as a reference. RESULTS: Among the 994 hips assessed, 71 (14.3%) right and 51 (10.3%) left hips showed radiograph signs of DDH. Graf grades IIa to IV were found in the radiographs of 43 (8.7%) right and 47 (9.5%) left hips, which accurately diagnosed right- and left-sided DDH with a specificity of 87.0% and 92.4% respectively. Graf grades IIb to IV appeared in the radiographs of 7 (1.4%) right and 14 (2.8%) left hips, diagnosing right- and left-sided DDH with a specificity of 86.1% and 91.1%, respectively. CONCLUSIONS: Our study results imply that radiographs may be limited in their diagnostic capacity for DDH in newborns and infants during the first six months of life.

Are orthopedic surgeons able to detect 3 mm and 5 mm joint step off on fluoroscopy?

OBJECTIVE: The aim of this study was to examine whether joint step-off created experimentally at 3 mm and 5 mm in the tibial lateral plateau can be accurately evaluated by orthopedic surgeons on fluoroscopic images. PATIENTS AND METHODS: A lateral tibia plateau fracture was created experimentally on above-the-knee amputated material. Using a ruler, step-off at 3 mm and then at 5 mm was made on the joint surface, then joint and lateral fluoroscopy images were obtained. These images were evaluated by 316 orthopedic surgeons. The surgeons were asked whether the joint congruence in the plateau fracture required surgical correction. The same question was asked again after 3 months, and all the responses were recorded. RESULTS: In the first measurements for 3 mm joint step-off, 77 (24.4%) orthopedic surgeons stated that surgical correction was necessary, and for 5 mm, 118 (37.3%) surgeons stated that surgical correction was necessary. In the 3rd month, the need for surgical correction was stated by 144 (45.6%) surgeons for 3 mm, and by 176 (55.7%) surgeons for 5 mm (p=0.001) CONCLUSIONS: Fluoroscopy is not a reliable method to determine articular step-off. Methods such as arthroscopic or open joint surface evaluation should be applied in the operating room.

The role of ASA score and Charlson comorbidity index in predicting in-hospital mortality in geriatric hip fracture patients.

OBJECTIVE: We aimed to determine the role of American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index (CCI) in determining in-hospital mortality and other factors associated with mortality in patients over 65 years of age who underwent surgery for hip fracture during our study, including the COVID-19 process. PATIENTS AND METHODS: Between January 1st, 2020, and December 31st, 2021, 200 patients over 65 years of age who underwent hemiarthroplasty or internal fixation for hip fracture after low-energy trauma were retrospectively evaluated. RESULTS: Of the 200 patients included in the study, 130 were female and 70 were male. The median ASA score was 3 (IQR: 2-3), and the median CCI was 3 (IQR: 5-7). Forty-two of 137 (68.5%) patients with intertrochanteric fractures and 22 of 63 (31.5%) patients with femoral neck fractures (34.4%) died. The median time to surgery was 4 days (IQR: 3-6). Among chronic diseases, cardiac pathologies were the most common (57%, n=114). There were statistically significant differences in ASA scores (p=0.0001 [z=-5.472]), CCI scores (0.0001 [z=-6.156]), presence of cardiac disease [p=0.0001 (χ²=32.155)] and presence of neurological disease [p=0.045 (χ²=4.007)] compared to mortality. ASA and CCI scores were significantly higher in people with mortality. As a result of the multivariate model established with these factors, which were found to be significant in univariate analyses, only the presence of cardiac disease (p=0.0001) and the increase in CCI scores (p=0.0001) were found to have a statistically significant increasing effect on mortality. CONCLUSIONS: CCI and cardiac pathology were associated with mortality. The type of hip fracture, surgical method, and anesthesia method were not associated with mortality.

Mechanical Analyses of Quadriceps Tendon Graft with Five Different Fixation Techniques on the Femoral Side: an Experimental Study on Sheep Knees.

PURPOSE OF THE STUDY We aimed to evaluate the biomechanical properties of quadriceps tendon graft with a bone plug ending (QTBP) and a quadriceps graft with a tendinous ending(QTT) fixed on the femoral side with different fixation devices. MATERIAL AND METHODS Twenty-five paired 2-year-old calf QTs and 25 paired 2-year-old sheep femurs were used for this study. 90x8 mm central part of the quadriceps tendons with or without a bone plug was harvested. 8×25 mm tunnel was placed in lateral condyles. The QTT was fixed with four different fixation devices, including the adjustable suspensory system (QTT-ASS, group 1), biodegradable interference screws (QTT-BIS, group 2), titanium interference screws (QTT-TIS, group 3), and an adjustable suspensory system + biodegradable interference screws (QTT-(ASS+BIS), group 4); QTBP was fixed with titanium interference screws (QTBP-TIS, group 5). All groups were tested in a servohydraulic materials testing machine. Stiffness(N/mm), slippage of the tendon(mm), and the ultimate tensile load-bearing ability(N) of the groups were tested. The Kruskal-Wallis H test was used with the Monte Carlo simulation technique to compare the nonparametric variables of stiffness, slippage, and ultimate tensile load. Dunn's test was used for the post hoc analyses. RESULTS Group 3 had the stiffest fixation (median 45.09 N/mm). The amount of slippage was highest in group 1(median 6.41mm). Group 1 was the most resistant group against a tensile load during the load-to-failure test(464 N). Fixing the QTT with the ASS and BIS in group 4 increased both stiffness and ultimate tensile load strength. There was no significant difference between the QTBP and QTT fixed with titanium screws. Fixing QTT with titanium screws was significantly superior to fixation with BIS(p < 0.05). CONCLUSIONS This study demonstrates that QTBP fixation with TIS have no advantage over QTT fixation with TIS on the femoral side. Although the QTT group fixed with ASS was the most resistant group against tensile forces during load-to-failure test, amount of slippage was highest for this group as well. Thus, if an ASS is to be used, a strong tension force must be applied prior to tibial side fixation to prevent further slippage of the graft in the tunnel. Key words: anterior cruciate ligament, quadriceps tendon graft, femoral side, fixation, biomechanical properties.

Indirect inguinal hernia repair conducted with single conventional port intracorporeal conventional equipment-endoscopic surgery.

PURPOSE: Laparoscopic or laparoscopy-assisted inguinal hernia repair (IHR) can be performed using one port plus two stab wounds. We herein present our experience with laparoscopic IHR conducted using a single conventional port and a single working instrument. METHODS: The records patients who underwent single conventional port intracorporeal IHR during November 2013-December 2018 were evaluated. The main outcome measurements were patient's demographic characteristics, hernia side, presence of incarceration, operative time, and complications. RESULTS: A total of 132 inguinal hernias (52 right, 40 left, and 20 bilateral) were repaired in 112 patients (76 boys, 36 girls). The mean ages of the patients were 69.8 ± 53.4 months (3 months to 17 years). In six patients, contralateral processus vaginalis was found to be patent during operation. Incarcerated inguinal hernia was present in two patients. Mean operative time was 17.9 ± 3.8 min (9-30 min) in unilateral hernias and 28.9 ± 6.5 min (24-45 min) in bilateral hernias. No intraoperative and postoperative complications were encountered. The mean hospital stay of the patients was 8.8 ± 5.0 h (4-36 h). Postoperative follow-up was 16.5 ± 5.1 months (6-24 months). No recurrent inguinal hernias were detected during follow-up. CONCLUSION: Single conventional port intracorporeal IHR obviates additional stab wounds. Additionally, present technique eliminates the risk of skin puckering, subcutaneous granuloma, infection, nerve, and muscle damage development induced by the subcutaneously placed knot in laparoscopy-assisted IHR. Single conventional port intracorporeal IHR in children is a feasible and safe operative technique with low complication rates.

A comparison of full arthroscopic and arthroscopic-assisted mini-open repair methods in rotator cuff tears 1-3 cm in size.

INTRODUCTION: Retrospective evaluation of rotator cuff repair with arthroscopic or arthroscopic-assisted mini-open methods for a diagnosis of non-retracted rotator cuff tear. MATERIALS AND METHODS: A total of 45 patients underwent rotator cuff repair; Group 1 (n = 24) with arthroscopic-assisted mini-open method and Group 2 (n = 21) with full arthroscopic method. RESULTS: Within both Group 1 and Group 2, a statistically significant results is p = 0.001. The patients of Group 2 were seen to return to daily life earlier than those of Group 1 (p = 0.001). CONCLUSIONS: Patients where full arthroscopic repair was applied, there was evidence of an earlier return to daily life. LEVEL OF EVIDENCE: IV, retrospective comparative study.

The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly.

BACKGROUND: The purpose of this study was to assess the impact of uniform anti-rotational proximal femoral intramedullary nail (APFN) use on patient mobility status with the treatment of two different unstable intertrochanteric femur fracture groups of geriatric patients. METHODS: The study included patients aged > 65 years who underwent surgery with APFN. Group 1 comprised AO classification, AO/OTA 31-A22, and A23 patients, and group 2, A31 and A32 patients. The demographic data of the patients, postoperative complications, follow-up, mortality status, postoperative reduction, tip-apex distance (TAD), and the Parker-Palmer mobility (PPM) score were evaluated. RESULTS: There were no statistically significant differences between the groups in terms of gender, affected side, time from trauma to surgery, ASA score, anesthesia type, duration of hospitalization, duration of surgery, TAD values, reduction values, or mortality rate. The average age of patients in group 2 was significantly higher than that of patients in group 1 (p < 0.05). The mobility scores of group 1 patients were significantly higher than those of group 2 (p < 0.05). CONCLUSIONS: While no relationship was found between the TAD values and the reduction status of the cases, the PPM scores of the AO 31 A3 cases were determined to be significantly worse. Therefore, fractures with a preoperative classification of AO type 31 A3 can be expected to have worse results than A2 ITF fractures. The fracture type seems to have as great an effect as other factors on the postoperative mobility score.

In vivo cartilage tissue engineering.

BACKGROUND: Biologic treatment options for cartilage injuries require chondrocyte expansion using cell culture. Clinical application is accomplished in two surgical sessions and is expensive. If isolation of chondrocytes and stimulus for proliferation and extracellular matrix synthesis can be achieved in vivo, the treatment can be performed in one session and the cost can be reduced. METHODS: A 2.5-cm diameter full-thickness chondral defect was created in the knees of five groups of sheep. In one group, some of the chondral tissues obtained from the creation of the defect were diced into small pieces and were placed into the defect and were covered with a collagen membrane (MIV group). In the other group, the collagen membrane was soaked in collagenase prior to usage. In the next group, the collagen membrane was soaked in both collagenase and growth factors. Matrix-induced autologous chondrocyte implantation (MACI) was applied to another group in two sessions, and the last group was left untreated. After 15 weeks of follow-up, repair tissues were compared macroscopically, histomorphometrically, and biochemically for tissue concentrations of glycosaminoglycan and type II collagen. RESULTS: MACI and MIV groups demonstrated better healing than others and were similar. Addition of collagenase or growth factors did not improve the results. Addition of collagenase did not have detrimental effect on the surrounding cartilage. CONCLUSIONS: With the described method, it is possible to obtain comparable results with MACI. Further studies are also needed to see if it works similarly in humans.

Analysis of glenohumeral morphological factors for anterior shoulder instability and rotator cuff tear by magnetic resonance imaging.

OBJECTIVE: The aim of this study was to investigate whether there are glenohumeral morphological differences between normal population, glenohumeral instability, and rotator cuff pathology. METHOD: In this study, shoulder magnetic resonance (MR) images of 150 patients were evaluated. Patients included in the study were studied in three groups of 50 individuals: patients with anterior shoulder instability in group 1, patients with rotator cuff tear in group 2, and control subjects without shoulder pathology in group 3. RESULTS: There were statistically significant differences between groups in evaluations for glenoid version, glenoid coronal height, glenoid coronal diameter, humeral axial and coronal diameters, and coracohumeral interval distances. Significant differences were observed between groups 2 and 3 in glenoid axial diameter, glenoid coronal height, glenoid depth, humeral coronal diameter, and coracohumeral distances. CONCLUSION: The results obtained in this study suggest that glenoid version, glenoid coronal height and diameter, humeral diameter, and coracohumeral interval parameters in glenohumeral morphology-related parameters in patients with anterior instability are different from those of normal population and patients with rotator cuff pathology. In cases where there is a clinically difficult diagnosis, these radiological measurements will be helpful to clinicians in diagnosis and treatment planning, especially in cases of treatment-resistant cases.

Tubularized incised plate urethroplasty for the treatment of penile fistulas after hypospadias repair.

OBJECTIVE: Urethrocutaneous fistula is the most common complication of hypospadias repair. Tubularized incised plate urethroplasty (TIPU) has been used for the management of distal fistulas. This study reports the usage of TIPU in the treatment of large penile fistulas. MATERIALS AND METHODS: Between April 2002 and September 2012, 15 patients with large penile fistulas who were managed with TIPU were included in the study. The fistulas were sited along the penile shaft from proximal to distal penile localization. Glanular and coronal fistulas were excluded. The surgical technique was completed according to the standard TIPU technique. The surrounding scar tissue of the fistula was circumferentially excised, and the urethral plate at the level of the fistula was incised to provide performance of loose urethral tubularization. A urethral stent was kept for 5-7 days. RESULTS: The mean age of the patients was 7.3 ± 3.1 years. Primary operation of these patients was tubularized preputial island flap (n = 6), on-lay preputial island flap (n = 4), and TIPU (n = 5). The sites of the hypospadias fistulas were as follows; penoscrotal (three), mid-penile (eight) and subcoronal (four). Fistulas recurred in two patients after fistula repair. The postoperative follow up of the patients was 12.4 ± 7.7 months. CONCLUSION: TIPU may be used safely for the treatment of fistulas after hypospadias repair.

Periodontal status and post-transplantation complications following intensive periodontal treatment in patients underwent allogenic hematopoietic stem cell transplantation conditioned with myeloablative regimen.

OBJECTIVES: Evaluation of the periodontal status is necessary prior to management with high-dose chemotherapy before hematopoietic stem cell therapy (HSCT). During medical therapy, pre-existing periodontal conditions may exacerbate and cause local and systemic complications. When possible, maximal oral health should be achieved prior to engraftment. In this study, we aimed to determine the alterations occurred in the periodontal status of the patients after periodontal treatment and allogenic HSCT and evaluate the effect of intensive periodontal approach on the short-term complications of HSCT. METHODS: The alterations occurred in the periodontal tissues 3-4 weeks after periodontal treatment and after HSCT periods of 3 months for 29 patients treated with full-mouth periodontal treatment completed in 24 h in addition to eradication of dental foci, and oral hygiene status were evaluated using pocket depth measurements, presence of bleeding on probing and plaque and gingival indices. The incidence and severity of acute graft-versus-host disease (GVHD) and oral mucositis (OM) were recorded. Duration of engraftment period and the episode of febrile neutropenia were also evaluated. RESULTS: There were significant improvements in periodontal status after periodontal treatment (P<0.001). There were 14 (48.3%) patients without acute GVHD and 17 (58.6%) patients with no sign of OM. The majority of OM was at grade II level. There was a negative relation that exists between the percentage of BOP (+) sites and presence of OM (r=-0.518, P<0.05). CONCLUSIONS: Together with a significant reduction in gingival inflammation and maintenance of the improvement in periodontal health, remarkable decrease in the incidence and severity of OM were observed.