Isokinetic performance and function are similar after total hip arthroplasty applied with a posterior or anterolateral approach: a randomised controlled trial.

BACKGROUND: There are ongoing debates on the effects of surgical approach on outcome after total hip arthroplasty (THA). It was hypothesised that with the anterolateral approach, trauma to the abductor arm can occur and related detrimental effects can diminish the postoperative outcomes. In this first randomised controlled trial in the literature on this subject, isokinetic performance and patient-reported functional outcomes were evaluated in patients undergoing THA with a posterior approach (PA) and an anterolateral approach (ALA). METHODS: A total of 48 patients scheduled to undergo THA were randomised to ALA or PA groups. The patients were evaluated preoperatively and at 6 and 12 months postoperatively, with flexion, extension and abduction strength measurements and the Harris Hip Score (HHS). The physiatrist performing isokinetic tests and the patients were blinded to the study groups. RESULTS: Both groups were similar in respect of age, body mass index (BMI), gender and preoperative isokinetic performance and HHS. Both groups demonstrated similar isokinetic performance (p < 0.05) and there was no difference in HHS (p < 0.05) at the 6- and 12-months follow-up evaluations. CONCLUSION: Although there is concern about potential abductor muscle damaging during ALA, the results of this randomised controlled study demonstrated that ALA can produce similar isokinetic performance and functional outcome to PA at 6 and 12 months, despite the close proximity to the abductor arm. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04640740 (retrospectively registered).

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures.

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

[Effects of short- and long-segment posterior instrumentation on spinal canal remodeling in thoracolumbar vertebra burst fractures]. / Torakolomber vertebra patlama kiriklarinda kisa ve uzun segment posterior enstrümantasyonun kanal içi düzelme üzerine etkileri.

BACKGROUND: Spinal canal remodeling results according to Magerl classification and fracture localization after short- and long-segment posterior instrumentation treatment were evaluated in patients with thoracolumbar junction burst fracture. METHODS: Eighty patients were divided into two groups: Group 1: short-segment posterior instrumentation was applied in 36 patients [9F, 27M; Median age: 42.1 (range: 19-65)] and Group 2: long-segment posterior instrumentation was applied in 44 patients [18F, 26M; Median age: 46.3 (range: 18-78)]. Twenty patients had T12, 41 patients had L1 and 19 patients had L2 fracture. According to Magerl classification, 44 patients were A3.1, 19 were A3.2 and 17 were A3.3. In both groups, spinal canal remodeling effectiveness was evaluated postoperatively with respect to all parameters. RESULTS: Median follow-up time was 35.7 months for Group 1 (12-58) and 33.1 months for Group 2 (12-58). In both groups, spinal canal remodeling was statistically significant, but a higher recovery ratio was obtained in Group 2 in comparison to Group 1. According to Magerl classification, in type A3.3 fractures, a more significant remodeling was obtained in Group 2 patients (p=0.005). A significant difference was determined in Group 2 at the T12 level according to fracture localization (p=0.018). CONCLUSION: An adequate spinal canal remodeling is obtained by posterior instrumentation, but in comminuted fractures like Magerl type A3.3, a better remodeling can be obtained by long-segment posterior instrumentation.