Preoperative Albumin and Postoperative CRP/Albumin Ratio (CARS) are Independent Predictive Factors in Estimating 1-Year Mortality in Patients Operated for Proximal Femoral Metastasis with Endoprosthesis.

Background: Proximal femur resection and prosthetic reconstruction are preferred in patients with extensive bone destruction, pathological fractures, tumours resistant to radiation therapy, and patients with more proximal metastatic lesions. There is increasing evidence that the CRP/albumin ratio (CAR) is an independent marker of inflammation in various primary organ cancers and maybe a more accurate prognostic factor. We aimed to evaluate whether preoperative and postoperative CAR values could be a factor in predicting mortality in these patients. We hypothesized that CAR could predict these patients' postoperative 90-day and 1-year mortality. Methods: The patient's age and gender, primary tumour, number of bone metastases, and presence of visceral metastases were recorded using imaging techniques such as computed tomography and bone scan or positron emission tomography. The following laboratory data were analyzed before and after surgery. Results: The mean age of the patients was 62.67 ± 14.8; 56.9% were female (n:29), and 43.1% were male (n:22). When the results of the ROC analysis of the parameters in predicting 1-year mortality were examined, and the cut-off value for preoperative albumin was taken as ≤ 3.75, the AUC value was found to be statistically significant as 0.745 (p:0.003). When the cut-off value for postoperative CAR was taken as ≥ 87.32, the AUC value was found to be 0.7 statistically significant (p:0.015). Conclusion: Length of stay, preoperative albumin and postoperative CAR values can be used as independent predictive values in predicting 1-year mortality in patients undergoing endoprosthesis due to proximal femur metastasis.

The Potential of ChatGPT for High-Quality Information in Patient Education for Sports Surgery.

BACKGROUND AND OBJECTIVE: Artificial intelligence (AI) advancements continue to have a profound impact on modern society, driving significant innovation and development across various fields. We sought to appraise the reliability of the information offered by Chat Generative Pre-Trained Transformer (ChatGPT) regarding diseases commonly associated with sports surgery. We hypothesized that ChatGPT could offer high-quality information on sports-related diseases and be used in patient education. METHODS: On September 11, 2023, specific sports surgery-related diseases were identified to ask ChatGPT-4 (personal communication, March 4, 2023). The informative texts provided by ChatGPT were recorded by a non-observer senior orthopedic surgeon for this study. Ten texts provided by ChatGPT related to sports surgery diseases were evaluated blindly by two observers. Observers assessed and scored these texts based on the sports surgery-specific scoring (SSSS) and DISCERN criteria. The precision of the disease-related information offered by ChatGPT was evaluated. RESULTS: The calculated average DISCERN score of the texts in the study was 44.75 points and the average SSSS score was 13.3 points. In the interclass correlation coefficient analysis of the measurements made by the observers, the agreement was found to be excellent (0.989; p < 0.001). CONCLUSION: ChatGPT has the potential to be used in patient education for sports surgery-related diseases. The potential to provide quality information in this regard seems to be an advantage.

The Lack of High-quality Educational Resources about Adhesive Capsulitis on YouTube.

Objective The advent of the Internet has provided new, easily accessible resources for patients seeking additional health information. Many doctors and healthcare organizations post informative videos on this platform, and nearly all patients are looking for videos online for a second opinion. Methods The phrases "frozen shoulder," "frozen shoulder treatment," "adhesive" capsulitis, and "adhesive capsulitis treatment" were entered into YouTube's search bar for a normal inquiry. The informativeness and overall quality of the adhesive capsulitis videos were rated using three separate scales. Results The mean and standard deviation values of the scoring systems were JAMA 1.25 ± 0.51, DISCERN 39.4 ± 13.4, GQS 2.83 ± 0.96 and ACSS 7.43 ± 4.86, respectively. Number of views, rate of views, and likes all had a positive correlation with Global Quality Score (GQS), as did DISCERN and ACSS. There was no statistically significant difference between the median JAMA, GQS score and Discern Criteria values according to the video source/uploader (p > 0.05). Conclusion YouTube videos on adhesive capsulitis, thus, need to be of higher quality, reliability, and instructive quality. There is a need for reliable videos about adhesive capsulitis, with instructional and high-quality cited.

Morphology of Fibular Incisura is a Deciding Factor Between Posterior Malleolus Avulsion Fracture or Syndesmotic Ligament Injury in Ankle Fractures.

The bone anatomy of tibiofibular syndesmosis has been a topic of interest. Fibular incisura morphology has been analyzed on cadaver specimens, plain radiographs, or CT images. The aim of this study is to examine the effects of fibula incisura features and fibula morphology in ankle injuries, especially involving posterior malleolus and posteroinferior tibiofibular ligament injuries. From 2017 through 2022, A total of 59 patients with isolated lateral malleolar fracture, Mason-Malloy type 1 posterior malleolar fracture, syndesmosis injury in those without posterior malleolar fracture, supination external rotation type 3 injuries according to Lauge-Hansen classification, and preoperative bilateral ankle computed tomography images were included in the study. Fibula morphologies and syndesmosis measurements were made from preoperative computed tomography images using axial CT images from 1 cm proximal to the tibial plafond. The diagnosis of posterior malleolar fractures was made using the CT classification system of Mason and Malloy, and the diagnosis of syndesmosis injury was made with a cotton test during surgery. Age, gender, fractured side, incisura type, incisor depth, width, anterior and posterior facet lengths, incisor version (antevert-retrovert), the angle between the anterior and posterior facets, and fibula type were recorded. There was a statistically significant difference between the groups in posterior facet length and incisura width. Morphological features of fibular incisura may be the determinant of PITFL injury or PMA injury in fibular fractures caused by an external rotation mechanism.

Pectoralis major pedicle bone grafting vs. tricortical iliac grafting for Neer 4-part proximal humerus fractures: a randomized controlled trial.

BACKGROUND: The risk of avascular necrosis, nonunion, or malunion is high in osteoporosis-related 4-part fractures. We evaluated the results of patients who underwent plate osteosynthesis with a vascularized pectoralis major graft compared with tricortical iliac grafting to treat 4-part proximal humerus fractures. MATERIAL AND METHODS: Thirty-four patients aged 50-75 years with Neer 4-part proximal humerus fractures were studied. Group A (n = 17) underwent osteotomy of a 2.5 ± 1 cm pectoralis major pedicle bone graft and plate application, whereas group B (n = 17) underwent plate osteosynthesis using iliac autogenous grafts. Final follow-up assessments included evaluation using Constant and American Shoulder and Elbow Surgeons scoring systems, humeral neck-shaft angle (HNSA), humeral head height, and humeral head avascular necrosis. RESULTS: Reduction loss was observed in 3 patients (17.6%) in group A, whereas it was observed in 10 patients (58.8%) in group B (P = .013). Humeral head avascular necrosis was found in 1 patient (5.8%) in group A, whereas it was found in 5 patients (29.4%) in the other group (P = .071). The HNSA was normal in 12 (70.5%) of group A patients, whereas it was normal in 6 (35.2%) of group B patients. The HNSA was weak or bad (<1200) in 29.4% of group A patients, whereas this rate was 64.7% in group B patients. Humeral head height was 2.64 ± 1.45 mm in group A and 3.66 ± 1.65 mm in group B. There were no statistically significant differences between the 2 groups in terms of Constant and American Shoulder and Elbow Surgeons scoring systems. CONCLUSION: Pectoralis major bone pedicle graft in Neer 4-part proximal humerus fractures reduces the risk of avascular necrosis and nonunion rates. Our technique yielded excellent clinical and radiological results. We achieved recovery without creating additional donor site morbidity.

Distal Tibiofibular Malreduction in Ankle Fractures Received Fibula Plate and Syndesmotic Screw Fixation.

BACKGROUND: The aim of the study was to examine the effect of the position of the plate and syndesmotic screw on postoperative tibiofibular joint malreductions in cases where the syndesmotic screw is inserted through the hole of the anatomically locked lateral distal fibula plate. METHODS: Thirty patients (13 female and 17 male patients) with postoperative computed tomographic scans were examined retrospectively. Patient information (eg, tibiofibular congruence measured from postoperative computed tomographic scans, the anterior and posterior tibiofibular distance at axial sections, the presence and orientation of fibular rotation, the presence of tibiofibular intraarticular piece, the angle between the syndesmotic screw and incisural line, the placement of the plate, and the localization of the screw on the fibula in axial images) was recorded. RESULTS: Those with fibular internal rotation had a lower syndesmotic screw-incisural line angle (SIA) (P = .001).There was a very strong negative significant correlation between the tibiofibular angle and SIA (rho, -0.780; P = .001). The median tibiofibular angle was found to be higher in cases with the fibula plate placed anteriorly (P = .009).The median SIA was found to be lower in cases with the fibula plate placed anteriorly (P = .004).The rate of placement of syndesmotic screw in the anterior third of the fibula was found to be high in cases with the fibula plate placed anteriorly (P = .049). CONCLUSIONS: In ankle fractures treated with insertion of a syndesmotic screw through the plate, the orientation of the syndesmotic screw in the axial plane and the position of the plate may be associated with the incidence of postoperative syndesmosis malreduction.

Comparison of Supination-Adduction Type 2 and Supination-External Rotation Type 4 in Bimalleolar Ankle Fractures: Does Partial Pylon Variant of Supination-Adduction Type Fracture Affect Functional Outcomes?

BACKGROUND: Supination-adduction (SAD) type injuries are pylon variant injuries and lie between partial intra-articular pylon fractures and rotational ankle fractures. We aimed to evaluate functional outcomes of SAD type 2 bimalleolar fractures in comparison to supination-external rotation (SER) type 4 fractures. METHODS: We retrospectively reviewed data of 42 cases with SER type 4 and 20 cases with SAD type 2 injuries. Patients with a history of rheumatic disease, open fractures, pathologic fractures, nonbimalleolar fractures, neuropathic disease, and talus osteochondral lesion, and those operated on after greater than 72 hours because of skin lesion or managed with a two-stage surgical protocol after external fixation, were not included in the study. We compared these two groups in terms of the mean age, follow-up time, visual analog scale pain and American Orthopedic Foot and Ankle Society scores, Kellgren-Lawrence arthrosis classification, union time, and complications. RESULTS: The groups did not differ in terms of mean age (P = .115) and sex (P = .573). There was no significant difference in terms of union time between the groups (P = .686). American Orthopedic Foot and Ankle Society score was significantly higher in the SER group (91.2 ± 9.9) than in the SAD group (86.1 ± 13.2; P = .034). Visual analog scale pain scores were similar in the SAD (0.3 ± 0.92) and the SER (0.26 ± 0.7) groups (P = .897). CONCLUSIONS: Supination-adduction bimalleolar fractures may have worse functional outcomes in the intermediate term than do SER bimalleolar fractures, implying pylon variant fractures as a mechanism of injury. Supination-adduction bimalleolar fractures might be associated with a high rate of intra-articular cartilage impaction, resulting in varus deformity after surgery.

Arthroscopic Biological Augmentation With Subacromial Bursa for Bursal-Sided Partial-Thickness Rotator Cuff Tears.

Background: Augmentation with subacromial bursa has not been fully established in bursal-sided partial-thickness rotator cuff tears (PT-RCTs). Purpose: To compare the results of acromioplasty + arthroscopic debridement versus acromioplasty + augmentation with subacromial bursa for Ellman type 2 PT-RCTs involving 25% to 50% of the tendon surface area. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 40 patients (mean age, 47.8 years) with Ellman type 2 PT-RCTs whose symptoms did not regress despite 3 months of nonoperative treatment. The patients underwent either acromioplasty + debridement (group A; n = 18) or acromioplasty + augmentation (group B; n = 22). Outcome scores (visual analog scale [VAS] pain score, Constant-Murley score [CMS], and American Shoulder and Elbow Surgeons [ASES] score) were obtained preoperatively and at 6, 12, and 18 months postoperatively. Magnetic resonance imaging (MRI) scans performed at 6 months postoperatively were used to determine the integrity and state of healing. Results: There were no significant differences between groups A and B in preoperative VAS, CMS, or ASES scores, and patients in both groups saw significant improvement at each follow-up time point on all 3 outcome scores (P = .001 for all). Scores on all 3 outcome measures were significantly better in group B than group A at each postoperative time point (P < .05 for all). Postoperative MRI scans revealed persistent partial tears in 5 of 18 patients in group A compared with 2 of 22 patients in group B (P < .05). Conversion to full-thickness tear (3/18 patients) was seen only in group A. Conclusion: Patients who underwent biological augmentation of their PT-RCTs had improved outcome scores compared with those treated with acromioplasty and debridement alone.

Normal values of scapholunate distance in Turkish children aged 5-14 years.

Wrist kinematic indices and scapholunate distance play an essential role in diagnosing and treating injury and disease of the carpus. It can be challenging to measure and diagnose scapholunate ligament injury in the immature skeleton. The aim of this study was to measure the normal ranges of the carpal indices on radiographs in the Turkish population aged 5-14 years. This retrospective study examined children aged 5-14 years between 2021 and 2022. Children aged 5-14 years with a wrist anteroposterior X-ray, children admitted to the hospital for nontraumatic reasons, and children who had not had a wrist fracture before were included in the study. The distance between the scaphoid and the lunate, the distance between the lunate and the triquetrum, the carpal height, the length of the third metacarpal, and the ratio of the carpal height to the length of the third metacarpal were measured. It was found that the scapholunate distance was significantly higher in boys aged 7-8 years and 9-10 years (P = 0.001, P = 0.004). When the averages of the lunotriquetral distances were analyzed according to age groups, it was found that it was significantly higher in boys of 7-8 years old, 11-12 years old, and 13-14 years old groups compared with girls (P = 0.003, P < 0.001, P = 0.004). In this study aiming to find the average values of scapholunate distance, lunotriquetral distance, and carpal indices in children, we concluded that we should examine the wrist X-ray in terms of carpal injuries by considering age and gender.

The Preoperative Neutrophil-Lymphocyte Ratio Is an Independent Predictive Factor in Predicting 1-Year Mortality in Amputated Diabetic Foot Patients.

In this study, we aimed to evaluate the efficacy of neutrophil/lymphocyte ratio values in preoperative blood tests of patients amputated due to diabetic foot in predicting 1-year mortality. We assumed that the neutrophil/lymphocyte ratio predicted 1-year mortality in these patients. The inclusion criteria were as follows: to be diagnosed with diabetic foot, being >18 years of age, having a confirmed type 1 or type 2 diabetes mellitus diagnosis, stage 3 to 5 Wagner ulcers, and having at least 1 year of follow-up. The patients with acute traumatic injuries observed in less than 1 week, traumatic amputations, and nondiabetic amputations, and those whose data could not be obtained were excluded from the study. After the exclusion, 192 patients were included in the study. Age (p < .001), low preoperative hemoglobin (p = .024), high preoperative neutrophil (p < .001), low preoperative lymphocyte (p = .023), low preoperative albumin (p < .001), high preoperative neutrophil-to-lymphocyte ratio (p < .001), major amputation (p = .002), and were related to 1-year mortality. According to these results: (1) it was observed that a preoperative neutrophil/lymphocyte ratio value over 5.75 increases the risk of death 1.1 times and (2) it was observed that a preoperative albumin value under 2.67 increases the risk of death 5.74 times. In conclusion, the age, preoperative neutrophil/lymphocyte ratio, and albumin values of patients planning to undergo amputation surgery can be independent predictive factors in predicting 1-year mortality.

Effect of psoas and gluteus medius muscles attenuation on hip fracture type.

INTRODUCTION: Sarcopenia is defined as a progressive loss of muscle mass and function with increased age. The measurement of muscle mass and attenuation on the axial computed tomography (CT) scan has been reported to be a good indicator for sarcopenia in previous literature. This study aimed to compare muscle mass between the intertrochanteric fracture and femoral neck fracture groups by accurately measuring muscle mass around the hip joint using a CT scan. METHODS: The cases were matched according to age and gender on a 1-to-1 basis. As a result, a total of 400 patients, 200 patients in each group with the same age and gender characteristics, were included in the study. At the disc of L4-L5 level, the cross-sectional area (CSA) of the psoas muscle was evaluated, and at the disc of L5-S1 level, the CSA of the psoas, iliacus and gluteus medius muscles were evaluated. In addition, attenuation was evaluated using the average Hounsfield Unit (HU) for the specific area. RESULTS: The mean age of 400 patients (262 females, 138 male) included in the study was 78.49 ± 7.67 years. It was observed that the mean HU values of the patients in the femoral neck fracture group were significantly higher than the intertrochanteric fracture group (p < 0.001, p = 0.008; respectively). At the same time, the mean HU values of the gluteus medius muscle were higher in the femoral neck fracture group (p < 0.001), but in contrast with the psoas muscle, the CSA values of gluteus medius muscle were significantly higher in the intertrochanteric fracture group (p = 0.017). CONCLUSIONS: Fatty degeneration of the psoas muscle among the muscles around the hip may affect the type of hip fracture. Elderly patients with strong psoas muscles may experience femoral neck fracture due to contraction and torsion during falling.

Syndesmosis Injuries in Lateral Malleolar Fractures Accompanied by a Posterior Malleolar Fracture: A Nonfixed Posterior Fracture Fragment May Not Affect Postoperative Tibiofibular Joint Malreduction Rates.

BACKGROUND: The fact that lateral malleolar fracture is accompanied by posterior malleolar fracture may adversely affect syndesmosis malreduction rates. We aimed to compare syndesmosis malreduction rates determined on postoperative radiographs between isolated lateral malleolar fractures and lateral malleolar fractures accompanied by posterior malleolar fractures. METHODS: We retrospectively examined 128 operative patients: 73 with isolated lateral malleolar fractures (group L) and 55 with lateral + posterior malleolar fractures (group LP). In group LP, no patients received posterior fragment fixation. In both groups, indirect syndesmosis fixation was performed with a single screw after open reduction and internal fixation of the lateral malleolus. Patient age, sex, fracture side, fracture type (Lauge-Hansen and Danis-Weber classifications), Kellgren-Lawrence osteoarthritis classification, syndesmotic incongruency on postoperative radiographs, syndesmotic malreduction of postoperative fibula fracture, fracture union time, complication rates, accompanying injuries, and preoperative and postoperative radiographic syndesmotic measurements (tibiofibular overlap, tibiofibular clear space, medial clear space) were recorded, and the groups were compared. RESULTS: Mean ± SD age was 44.32 ± 15.66 years in group L and 48.93 ± 14.03 years in group LP (P = .087). There were no significant differences in preoperative and postoperative tibiofibular distance, tibiofibular overlap, and medial clear space values between groups (P > .05). The prevalence of grade 2 fractures according to the Kellgren-Lawrence classification was significantly higher in group LP (P = .047). Postoperative syndesmosis malreduction was detected in 12 patients in group L and in nine in group LP (P = .991). CONCLUSIONS: In lateral malleolar fractures accompanied by small-fragment posterolateral or avulsion-type posterior malleolar fractures, closed syndesmotic screw fixation does not cause syndesmosis malreduction.

The Injury Mechanism of Knee Extensor Mechanism Rupture in Professional Athletes: A Video Analysis Study.

Background: In Professional Athletes, quadriceps and patellar tendon ruptures are devastating injuries, often resulting in the loss of a season or a decreased return to the pre-injury level of sport. This study aimed to perform a comprehensive Video Analysis on extensor mechanism rupture (EMR) to describe the body postures and related mechanism in Professional Athletes. Methods: Using publicly available data on quadriceps tendon and patellar tendon ruptures from between 2000 and 2020, 52 elite athletes were identified. Of these, twenty-eight injuries with adequate video data were analyzed for Injury Mechanism, body posture, as well as player and sports characteristics. Results: Of the 27 athletes included in the study, with an average age of 28.18 ± 4.96 years, there were injuries in 28 extremities (1 case bilateral). The patellar tendon was ruptured in 20 cases (71.4%), and the quadriceps tendon in 8 cases (28.6%). There was total tendon rupture in 13 cases, and partial rupture in 6 cases (data for 1 case was not available). In 20 cases (70.4%), there was no contact resulting in the injury. Four of the contact injuries occurred in American football (3 direct, one indirect), 3 in basketball (1 direct, two indirect), and 1 in baseball (direct). Conclusion: The results of this research indicate that EMR occurs most commonly when the knee is in flexion and the ankle is in plantar flexion. There is the tendency for the knee to be in valgus at the time of injury. This information can guide physical therapy techniques, including neuromuscular training, proprioception, and balance training in the prevention of EMR in elite athletes.

Does Sectioning and Then Repairing of the Calcaneofibular Ligament at Subtalar Approach Lead to Residual Lateral Ankle Instability?

Background: The calcaneofibular ligament is cut to increase vision in surgical field in minimally invasive surgery of displaced intraarticular calcaneus fractures with subtalar incision. We aimed to investigate whether this causes talar tilt instability in ankle stress radiographs due to the calcaneofibular ligament deficiency in postoperative period. Methods: The files of 38 patients who were operated with the diagnosis of displaced calcaneus fracture between 2013 and 2018 were examined retrospectively. All the cases underwent with subtalar approach and the calcaneofibular ligament was repaired after the operation. The age, sex, injury mechanism, follow-up length, type of fracture by the Sanders classification, preoperative and postoperative Bohler's and Gissane's angle measurements, talar tilt measurements of intact and fractured side, postoperative calcaneal length, calcaneal height and calcaneal width of the cases were recorded. The obtained data were evaluated statistically. Results: 31 (81.6%) of the cases were men, seven (18.4%) were women. The average age was 31.92±7.95 years. The average follow-up time was 15.82±3.33 months. The preoperative Bohler's angle was 14.16±3.67 degree, while the postoperative Bohler's angle was 31.53±4.60 degree (P<0.05). The average talar tilt was 0.96±0.87 degrees on the intact side and 1.19±1.12 degrees on the fractured side (P:0.001). Although the talar tilt values were statistically higher on the fractured side than the intact side, no radiological instability finding was found in any case. The average postoperative Gissane's angles were 126.45±6.69 degrees. The calcaneal length (P:0.665), calcaneal width (P:0.212) and calcaneal height (P:0.341) were statistically similar between the postoperative fractured foot and intact foot. Conclusion: Sectioning of the calcaneofibular ligament in the surgical treatment with subtalar approach does not cause lateral ankle instability in stress radiographs but may cause laxity. Possible postoperative lateral ankle injuries can be prevented by ankle proprioception exercises.

Retrospective analysis of 35 pediatric femoral neck fractures.

OBJECTIVE: Pediatric proximal femur fracture is extremely rare trauma comparing to other fractures. The proximal femur fracture is 1% of all pediatric fractures. The aim of current study is to compare the incidence of early complications and outcomes of pediatric proximal femur fractures regarding fracture types retrospectively. DESIGN: Our study includes 35 cases which are criticized by Delbet classification system, modalities of treatment, duration of waiting for surgery, duration of follow-up and also complications. Our inclusion criteria are age below 16 years old, proximal femur fractures with no evidence of tumoral, romathologic and methabolic conditions. Age, sex and surgery type (open-closed) were noted, and the data were statistically assessed. Assessment of the final outcome was made at the last follow-up visit using the Ratliff's method. RESULTS: The mean of age of patients in our study is 9.5 ± 5.06 years. The average follow-up was 25.6 ± 13.2 months. 15 patients (42.9%) are type 2 Delbet fracture, 5 patients (14.2%) are Delbet type 3 and 15 patients (42.9%) are Delbet type 4 fracture. Using the Ratliff's method, 25 patients (71.4%) had satisfactory outcomes. Ten patients (28.6%) had unsatisfactory outcomes. The complications as AVN, coxa vara and premature closure of physis, non-union and postoperative infections have been detected in this study. AVN was seen in four (11.4%) patients. In addition, coxa vara was seen in six (17.2%) patients. CONCLUSION: Pediatric femoral neck fractures are extremely rare fractures and can be treated with low complication rates in cases with early treatment and anatomic reduction.

Distal metatarsal osteotomy and dorsal neutralization plate in the treatment of hallux valgus.

PURPOSE: Hallux valgus is a disease that can be treated with many different surgical procedures. In our study, we aimed to compare patients with and without dorsal neutralization plate after distal metatarsal osteotomy and fixation with compression screws. METHODS: The files of 59 patients with 89 feet operated with the diagnosis of moderate degree hallux valgus have been examined retrospectively. Hallux valgus angles, AOFAS, VAS and satisfaction scores, time to return to work of both groups were compared. The cases in which only screw fixation was performed were mobilized with the hallux valgus apparatus for 6 weeks postoperatively, while the cases in which dorsal neutralization plate was performed were immediately mobilized full weightbearing without using an additional apparatus. Patients with a minimum follow-up of 2 years were included in the study. RESULT: There was no statistically significant difference between the two groups in terms of being bilateral (p = 0.457), mean age (p = 0.105) and gender data (p = 0.105). There was no significant difference in the preop and postop second year hallux valgus angles, AOFAS, VAS and satisfaction scores of the patients. There was a significant difference in the time to return to work (p < 0.001) and the 6th week AOFAS (p < 0.001), VAS (p < 0.001) and postop satisfaction (p < 0.001) scores between the two groups. CONCLUSION: The dorsal neutralization plate performed in addition to the compression screw after distal metatarsal osteotomy can cause painless early postoperative results that do not require the use of an additional apparatus, and early good functional results.

The Effect of Syndesmotic Screw Level on Postoperative Syndesmosis Malreduction.

Tibiofibular injury repair of ankle fractures may result in over-compression when performed via a partially threaded screw depending on its placed level. We aimed to examine the relationship between the screw level relative to the tibiotalar joint and syndesmosis malreduction in postoperative radiographs of ankle fractures treated with partially threaded screws. We retrospectively analyzed 129 patients who underwent surgery due to lateral malleolar fractures between 2011 and 2019. We measured the distance between the screw and the tibiotalar joint and stratified the patients per their screw level as either trans-syndesmotic or suprasyndesmotic. According to Lauge-Hansen, 83 cases were supination-external rotation type (64.3%), and the remaining were pronation-external rotation type (35.7%) injuries. We found postoperative syndesmosis malreduction in 20 cases (15.5%). Eight (6.2%) cases had medial clear space mismatch. As the distance of the screw to the joint increased, postoperative medial clear space values increased (rho: 0.190, p = .031). The relationship between postoperative syndesmosis mismatch and the level of the syndesmotic screw was statistically significant (p = .044). In syndesmosis repair with a partially threaded screw, as the distance of the screw from the joint increases, the over-compression caused by the screw may cause an increase in postoperative syndesmotic malreduction rates.

Does Localisation of Fracture Line, According to Epicondyles, Affect Ligamentotaxis Negatively in Displaced Pediatric Supracondylar Humerus Fractures?

OBJECTIVE: To investigate the effect of localisation of the fracture line according to the trans-epicondylar line on open reduction rates and postoperative reduction quality. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Orthopedic and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey, from January 2011 to December 2018. METHODOLOGY: Pediatric cases (37 females-54 males) which underwent surgery with Gartland type three supracondylar humerus fracture having extension deformity, were included and examined retrospectively. Localisation of fracture line according to trans-epicondylar line, presence of postoperative rotation, sagittal and coronal deformity, reduction type and surgery duration were noted. RESULTS: According to trans-epicondylar level, fracture line passed through upper level of the line in 68 cases, while it passed through lower level in 23 cases. Rotation rate of patients, whose fraction line localisation was lower according to trans-epicondylar level (60.87%), was higher than upper localization patients (8.82%, p<0.001). It has been observed that the relation between localisation of fracture line according to trans-epicondylar level and sagittal deformity, coronal deformity, reduction type and surgery durations were similar (p>0.05). CONCLUSION: Determination of localisation of fracture line according to trans-epicondylar level in preoperative roentgenograms may allow the surgeon to predict the possibility of postoperative rotation deformity. Key Words: Fracture line, Humerus, Supracondylar, Pediatric, Epicondyle.