Revisiting the surgical indication of mid-shaft clavicle fractures: Clavicle asymmetry.

OBJECTIVES: The aim of the study was to investigate whether clavicular symmetry was a valid assumption and to assess the factors that could predict clavicular asymmetry. PATIENTS AND METHODS: Between January 2021 and April 2021, a total of 100 consecutive patients (61 males, 39 females; mean age: 63.6±15.5 years; range, 27 to 94 years) whose both clavicles were adequately seen on chest computed tomography (CT) were retrospectively analyzed. Clavicular lengths were measured on three-dimensional (3D) reconstruction of chest CTs by two independent orthopedic surgeons on two separate occasions. The longest distance passing the straight line between the most lateral part of the clavicle at the acromioclavicular joint and the most medial point of the clavicle on the sternoclavicular joint was given as the clavicle length after adjusting tilt of convertible 3D CTs. Clavicular length difference was calculated by subtracting the short clavicle's length from the long clavicle's length. Patients' age and sex were noted. The calculated clavicular length differences were assigned into three groups: ≤5 mm, >5 mm and ≤10 mm, and >10 mm. RESULTS: The mean right and left clavicle lengths were 13.9±1.3 cm and 14.1±1.2 cm, respectively (p<0.001). A total of 29 patients (29%) had >5 mm clavicle asymmetry and six patients (6%) had more than 10 mm clavicular length difference. Age, sex, and clavicular length were not associated with the clavicular length difference. CONCLUSION: Our study results showed that 29% of the patients had >5 mm clavicular length asymmetry. The clavicular symmetry may not be a valid assumption in the decision making for the surgical treatment of mid-shaft clavicle fractures; thus, this assumption may lead to maltreatment. More factors that can predict clavicle asymmetry should be investigated in future studies.

What is the importance of distal nail diameter in the treatment of intertrochanteric femur fractures?

OBJECTIVES: The aim of this study was to investigate the effect of distal nail diameter in the treatment of geriatric intertrochanteric femur fractures (ITFFs). PATIENTS AND METHODS: Between January 2017 and January 2021, a total of 91 patients (34 males, 57 females; mean age: 80.6±7.8 years; range, 65 to 96 years) who had osteosynthesis due to an ITFF with a short cephalomedullary nail (CMN) were retrospectively analyzed. The patients were divided into two groups: Group 1 (n=18) included patients with a distal nail diameter of ≤10 mm and Group 2 (n=73) included patients with a distal nail diameter of >10 mm. Patients' age, sex, fracture type according to AO classification, intramedullary femoral canal diameter, canal fit ratio, operation duration, reduction quality, the distal diameter of the CMN, and complications were evaluated. RESULTS: There was no statistically significant difference between Group 1 and Group 2 in terms of the mean age, sex, fracture type, mean intramedullary canal diameter, reduction quality, and implant failure (p>0.05). The mean operation duration was significantly shorter in Group 2 (112.9±39.9 min) compared to Group 1 (128.8±36.4 min) (p=0.048). A total of three intraoperative peri-implant fractures occurred which included one 9 mm nail, one 12 mm nail, and one 14 mm nail. CONCLUSION: Our study results suggest that there is no advantage of using a >10-mm CMN in the treatment of geriatric ITFFs in terms of reducing the implant failure rate. However, the utility of a >10-mm CMN can reduce the operation duration.

Indirect impact of the COVID-19 pandemic on diabetes-related lower extremity amputations: A regional study.

OBJECTIVES: This study aims to evaluate the indirect impact of the novel coronavirus disease 2019 (COVID-19) pandemic on diabetes-related lower extremity amputations. PATIENTS AND METHODS: Patients who underwent lower limb amputation due to complications of diabetes between August 2019 and February 2020 (control group) and August 2020 and February 2021 (pandemic group) were retrospectively reviewed. None of the patients had a previous COVID-19 infection. Patients' amputation level and latest diabetes follow-up date until amputation were recorded. RESULTS: A total of 19 feet of 19 patients (14 males, 5 females; mean age: 70.0±10.5 years; range, 53 to 91 years) in the control group and 18 feet of 18 patients (12 males, 6 females; mean age: 70.4±11.3 years; range, 54 to 91 years) were included. There was no statistically significant difference in amputation levels between the two groups (p=0.959). The mean time elapsed from the last diabetes control in the control and the pandemic group was 5.9±12.8 months and 8.2±9.8 months, respectively (p=0.038). A total of eight (42.1%) patients in the control group and seven (38.9%) patients in the pandemic group did not have a follow-up for diabetes in the last year prior to amputation (p=0.842). CONCLUSION: Although the COVID-19 pandemic seems to cause a delay in the routine medical care of patients with diabetes, it appears not to have an indirect effect on the lower extremity amputation level and incidence. Patients' adherence may be the major determinant in amputation surgery.

Turkish Validity and Reliability Study of Scoliosis Research Society-30 Questionnaire in Adolescent Idiopathic Scoliosis Patients.

STUDY DESIGN: Methodological. OBJECTIVE: Turkish validity and reliability study of Scoliosis Research Society-30 (SRS-30) questionnaire. SUMMARY OF BACKGROUND DATA: SRS-30 is the most current questionnaire of SRS, which is widely used in the evaluation of the treatment of patients with idiopathic scoliosis. There is no validity and reliability study for the Turkish language. METHODS: All translation and cross-cultural adaptation stages of the SRS-30 English version to Turkish were implemented. SRS-30 Turkish and Short Form-36 questionnaires were administered to 96 patients with adolescent idiopathic scoliosis simultaneously. Two weeks later, the SRS-30-Turkish version was applied again. Internal validity was examined using the Rasch model, and external construct validity (convergent validity) was evaluated with the Spearman rho correlation test. Person Separation Index was used for reliability. The internal consistency was analyzed with Cronbach alpha. For test re-test reliability, intraclass correlation coefficient between the two measurements was calculated. RESULTS: As a result of the Rasch analysis, it was observed that the Turkish version of SRS-30 has a multidimensional structure and the disordered threshold problem was observed in some items. Overall fit is provided for each of the four sub-dimensions of SRS-30 Turkish. There was no difference in the functioning of the items in terms of gender and age groups. The lowest Person Separation Index value was obtained with 0.539 in the satisfaction of the treatment sub-dimension. Cronbach alpha values were over 0.70 for all domains. The intraclass correlation coefficient value was found in satisfaction with management dimension (0.463) and above 0.60 in other dimensions. CONCLUSION: It was concluded that the SRS-30 Turkish questionnaire was valid and reliable in evaluating the treatment of patients with adolescent idiopathic scoliosis. Considering the studies related to SRS scales in the literature, especially those applied Rasch analysis, it is seen that the reply categories of the items should be reviewed.Level of Evidence: 2.

All-suture anchors versus metal suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A comparison of mid-term outcomes.

OBJECTIVES: This study aims to compare metal suture anchors and all-suture anchors clinically and radiologically in arthroscopic Bankart repair. PATIENTS AND METHODS: In this retrospective study, 67 patients (61 males, 6 females; mean age 26.0±5.8; range, 18 to 43 years) who underwent arthroscopic Bankart repair between April 2009 and October 2016 were divided into two groups depending on the type of the suture anchor used in different periods. Group A comprised 32 patients with arthroscopic Bankart repair performed with metal suture anchors, and Group B comprised 35 patients with arthroscopic Bankart repair performed with all-suture anchors. The patients were clinically evaluated using Rowe scores, Constant scores, redislocation rates, and positive apprehension test rates. Radiographic evaluation was performed using the Samilson-Prieto classification to observe the development of glenohumeral osteoarthritis. RESULTS: The mean follow-up period was 41.1±10.4 (range, 30 to 60) months in Group A, and 39.6±9.4 (range, 28 to 60) months in Group B, with no significant difference between the two groups (p=0.559). No significant difference was observed between Group A and Group B in terms of mean Rowe score (89.2±13.8 [range, 40 to 100] vs. 88.7±16.9 [range, 25 to 100]; p=0.895) or Constant score (87.2±8.9 [range, 48 to 96] vs. 86.9±9.0 [range, 46 to 96]; p=0.878), which were the clinical outcomes at the final follow-up examination. Postoperative redislocation rates (3.1% vs. 2.9%, p=1.0) and positive apprehension test rates (6.3% vs. 8.6%, p=1.0) were found to be similar in both groups. According to the Samilson-Prieto classification, there was no evidence of glenohumeral osteoarthritis in any of the patients in either group. CONCLUSION: Satisfactory outcomes were obtained with the use of all-suture anchors in arthroscopic Bankart repair for traumatic anterior shoulder instability. All-suture anchors and metal suture anchors, have similar outcomes in the mid-term and all-suture anchors are a reliable and effective option for arthroscopic Bankart repair.

The Japanese Orthopedic Association Back Pain Evaluation Questionnaire: A Turkish validation study.

BACKGROUND: The aim of this study was to apply cross-cultural adaptation and validity assessment to the Turkish translation of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire applied to patients conservatively monitored for lumbar disc hernia and narrowing of the lumbar canal. METHODS: The questionnaire was translated into Turkish based on guidelines. In respect of the comprehensibility of the obtained pre-final version of the questionnaire, a pilot test was applied to 20 healthy individuals. The patients were requested to complete the final version of the questionnaire after an orthopedic and physical therapy assistant doctor (resident) had completed the diagnosis and demographic information. To evaluate the retest reliability, the test was applied a second time, 14 days (±3 days) after the first application, again in the Orthopedics and Physical Therapy Outpatient Clinic. RESULTS: The study was completed with a total of 215 individuals, comprising 107 patients and 108 healthy volunteers. When Turkish version of the questionnaire scale was evaluated of the patients and healthy volunteers together, the internal consistency was determined at the levels of Cronbach's α excellent. The lowest correlations of all the questionnaire scale items with the scale sub-dimensions was at the level of r = 0.509, which demonstrated that there was a sufficient validity level of the Turkish translated questionnaire scale. A statistically significant direct correlation at a high level was seen between the pre and post points in all the scale sub-dimensions. CONCLUSIONS: The results of the current study showed that Turkish version of the questionnaire had sufficient reliability and validity in the evaluation of low back pain and resulting dysfunction and disability in patients with LDH and narrowing of the lumbar canal.