Is YouTube a Reliable and Quality Source on Unilateral Biportal Endoscopic Spine Surgery? A Cross-Sectional Study.

OBJECTIVE: This study aimed to evaluate the quality and reliability of YouTube videos focusing on unilateral biportal endoscopic spine surgery, a novel technique for spinal decompression in degenerative spinal disease. METHODS: This cross-sectional study, conducted in February 2023, involved an online search on YouTube using the term "unilateral biportal endoscopic spine surgery". Video popularity was assessed using the Video Power Index. Video reliability and quality were measured using the Global Quality Scale, the Journal of the American Medical Association benchmark criteria, and the modified DISCERN instrument. RESULTS: Ninety-three videos were included for evaluation. Uploader profiles were categorized by continent, with 61.3% from Asia, 35.5% from the United States, 2.2% from Africa, and 1.1% from Australia. When comparing 3 groups as South Korea, United States, and other countries, no significant differences were observed in the technical characteristics of the videos. However, the educational quality and reliability of the videos were higher in those uploaded from South Korea (P < 0.001).When the videos were divided into 2 groups according to their educational quality, significant difference were noted in video duration, loading time, video quality, and reliability (P < 0.001). CONCLUSIONS: The YouTube videos on unilateral biportal endoscopic spine surgery showed high quality and reliability. However, videos from South Korea were found to have higher educational quality and reliability, while other specifications were similar for all videos. Furthermore, it was determined that videos uploaded more recently and with longer duration were of higher quality.

An overview of the orthopedic patient profile in the first five days following February 6th, 2023 Kahramanmaras earthquake: A single-center experience in the earthquake zone.

OBJECTIVES: This study aims to investigate the patient profile at a medium-volume hospital located in the earthquake zone among patients who received orthopedic treatment within the first five days after the natural disaster that was considered a major earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 10th, 2023, a total of 338 patients (156 males, 182 females; mean age: 42.2±9.7 years; range, 0 to 87 years) who received orthopedic treatment in our center were retrospectively analyzed. The patients were divided into four groups according to age as follows: infants (younger than one year of age), children (one to 13 years), adults (14 to 59 years), and elderly (60 years or older). RESULTS: Considering the age distribution, 291 (86%) patients were young adults. A total of 173 orthopedic surgeries were performed, including internal fixation in 63 patients, external fixation in 11 patients, upper/lower extremity fasciotomy in 47 patients, amputation in 39 patients, and soft tissue debridement in 13 patients. CONCLUSION: It is of utmost importance to recognize the principles of emergency fracture fixation and fasciotomy to successfully perform orthopedic surgeries after a natural disaster such as a major earthquake, particularly when the number of earthquake victims is considerably high.

Intra- and inter-observer reliability of Dias-Tachdjian classification in pediatric ankle fractures: do clinical experience and expertise matter?

The Dias-Tachdjian classification is the most commonly used system for the classification of pediatric ankle fractures, but its inter- and intra-observer reliability has not been studied in detail. Also, the impact of the clinician's experience and expertise on the reliability of this system is unknown. This study aimed: (1) to determine the intra- and inter-observer reliability of the Dias-Tachdjian classification and (2) to investigate the effect of the clinician's experience and expertise on the reliability of this system. Anteroposterior and lateral ankle radiographs of 56 children (34 male, 22 female) with ankle fractures, aged between 3 and 14 years, with open growth cartilages, were retrospectively identified and included in the study. Each patient radiograph was examined by 10 observers from two different specialties with different levels of clinical experience (two orthopedic surgeons with interest in pediatric orthopedics, three orthopedic surgeons with no interest in pediatric orthopedics, three orthopedic residents, and two radiology specialists) from two different specialties (orthopedics and radiology). All observers were then asked to classify pediatric ankle fractures at 6-week intervals per the Dias-Tachdjian classification system. Overall, intra-observer reliability as substantial to very good (κ = 0.77-0.95, P < 0.01), but inter-observer reliability as fair for both assessments (κ = 0.21, P < 0.01 and κ = 0.20, P < 0.01 for the first and second occasions, respectively). Inter-observer reliability among pediatric orthopedic surgeons as very good (κ = 0.90, 95% CI = 0.86-0.94, P < 0.01 and κ = 0.82, 95% CI = 0.71-0.93, P < 0.01 for the first and second occasions, respectively). Orthopedic surgeons with no special interest in pediatric orthopedics demonstrated substantial agreement in the first occasion (κ = 0.63, 95% CI = 0.53-0.72, P < 0.01) but moderate in the second one. Orthopedic residents exhibited moderate levels of agreement in each assessment period (κ = 0.58, 95% CI = 0.47-0.68, P < 0.01 and κ = 0.44, 95% CI = 0.37-0.51, P < 0.01 for the first and second occasion, respectively). Considering that the specialists dealing with pediatric orthopedics show very good consistency for Dias-Tachdjian classification, both within and between observers, consistency in the identification of the ankle fracture models increases as the interest in the field of pediatric orthopedics intensifies.

Anatomical bone structure differences in patients with hemophilic arthropathy of the knee.

Objectives: The anatomical differences of the bony structure of the knee joint in patients with hemophilia were evaluated, and the results were compared with the knees of patients with primary gonarthrosis and no arthrosis. Material and Methods: This study reviewed 41 knees in 21 patients (with an Arnold-Hilgartner classification of Stages 4 and 5 hemophilic arthropathy) who underwent total knee arthroplasty in single center. Two control groups including 21 asymptomatic patients (42 knees) and 21 primary knee osteoarthritis patients (42 knees) were formed to compare the measurements with hemophiliacs. Femoral mediolateral width, femoral anteroposterior width, femur and tibia diaphysis width, adductor tubercle-joint line distance, tibial plateau width, and medial and lateral tibia plateau width were measured separately. Results: Femoral mediolateral width was significantly narrow comparing with healthy individuals and primary knee osteoarthritis group. Tibial plateau was similar to asymptomatic group but significantly narrow compared with primary knee osteoarthritis group. With the correlation, the tibial plateau measurements and medial and lateral plateau were significantly narrow at hemophilic arthropathy group (P < 0.05). The slope was less in hemophilic patients as compared with asymptomatic individuals (P: 0.001). Hemophilic patients had larger femoral aspect ratios than asymptomatic group but there were no observable differences with the primary osteoarthritis group. For the tibial aspect ratios, hemophilic had a smaller ratio than the primary osteoarthritis group but there were no significant differences with the asymptomatic group. Conclusion: Hemophilic knee has a mismatch between femoral and tibial side while comparing with the other groups. Level of Evidence: Level IV, cross-sectional study.

Which inflammatory marker is more reliable in diagnosing acute septic arthritis in the pediatric population?

BACKGROUND: The present study aimed to investigate diagnostic values of C-reactive protein (CRP), white blood cell (WBC), erythrocyte sedimentation rate (ESR), neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio as possible indirect inflammatory markers in children with septic arthritis (SA) for diagnosis process. METHODS: The medical records of pediatric patients with SA who underwent debridement surgery between February 2005 and November 2018 were obtained from the hospital records. A total of 59 children with SA and 60 age- and gender-matched healthy controls were enrolled in the study. Hemograms parameters including WBC count, neutrophil count, lymphocyte count, hemoglobin, platelet count, CRP, ESR, NLR, and platelet to lymphocyte ratio. Biochemical parameters including alanine transaminase, aspartate aminotransferase, blood urea nitrogen, creatinine, glucose, and albumin were investigated and compared between both groups. RESULTS: Fifty-nine patients, 30% female (n: 18) and 70% male (n: 41), who had received operations for SA were included in the study. The mean age of the patients was 7.1 (range 6 days to 15 years) years and mean follow up 56.6 (12-140) months. No significant differences were observed in any biochemical parameters between the groups. However, a significant difference was found between the septic arthritis and the control group in all hemogram parameters. CONCLUSIONS: Although the sensitivity and specificity of the NLR are lower than CRP, ESR, and WBC which are most commonly used inflammatory parameters in diagnosis process of septic arthritis, NLR may be useful in confirming the diagnosis in the clinical practise, with an optimum diagnostic cut-off value of 4.05.

Prognostic factors affecting survival of patients with intertrochanteric femoral fractures over 90 years treated with proximal femoral nailing.

OBJECTIVE: This study aimed to analyze the prognostic factors affecting the survival of patients over 90 years with intertrochanteric fractures treated with proximal femoral nailing. MATERIALS: Records of 53 patients over 90 years old treated in our clinic between 2009 and 2018 for intertrochanteric fractures with proximal femoral nailing were retrospectively reviewed. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were analyzed for validity as prognostic factors. Kaplan-Meier test was used to estimate overall survival. A multivariate Cox algorithm was used to determine independent factors associated with survival. The minimum follow-up duration was one year. RESULTS: The average age at the time of surgery was 92.8 years. There were 39 women and 14 men. The right femur was involved in 29 (54.7%) patients and the left in 24 (45.3%) patients. At the time of this study, 32 (60.3%) patients were deceased. There were 21 (39.7%) surviving patients with a mean survival of 41.2 months (range 12-113). Survival rates at first month, 6 months and 1 year after surgery were 90.6%, 88.6% and 86.7%, respectively. The mean survival after surgery was 29.6 (2 days-95 months) months for deceased patients. Among all the parameters, ASA score and delay to surgery were independently associated with worse overall survival. CONCLUSION: An ASA score of 4 increased mortality by a factor of 26 and delay to surgery increased mortality by a factor of 1.3. Both were prognostic factors influencing overall survival.