Evaluation of treatment processes in childhood fifth metacarpal bone (Boxer) fractures with QuickDASH scoring system.

OBJECTIVE: Metacarpal fractures are one of the most common orthopedic injuries seen in emergency departments. Despite this, only a few data have been published about the epidemiology of metacarpal fractures. Simple radiographs are the standard imaging modality used to diagnose boxer fractures and determine the degree of angulation. Fractures and angulations should be identified by anteroposterior and lateral radiographs. The aim of this study was to follow the healing after closed reduction of fifth metacarpal neck fractures in a pediatric population using the QuickDASH score to determine whether it results in clinically significant improvement. SUBJECTS AND METHODS: Between 2020 and 2022, our clinical record database for all metacarpal fractures treated at our institution was searched retrospectively every month. Children aged 18 years and younger with fifth metacarpal neck fractures treated with closed reduction and immobilization in our tertiary care emergency clinic were retrospectively reviewed. RESULTS: 52 pediatric patients were included in the study. The mean age at the time of injury was 14.04 years (SD=2.10, range=10-18 years). 92.30% (n=48) of the patients were male, and 7.70% (n=4) were female. CONCLUSIONS: Accurate diagnosis and appropriate treatment are crucial in the management of childhood fifth metacarpal fractures to ensure proper healing, prevent long-term complications, and facilitate optimal functional recovery.

Comparison of Shetty ankle test and Ottawa ankle rules in ankle injuries.

OBJECTIVE: Foot and ankle injuries are the most common extremity trauma and have an important place among the admissions to the emergency service. Ankle injuries are the most frequent form of orthopedic emergencies. Currently, Ottawa ankle rules (ORL) is the most popular test used worldwide for the ankle injuries. Shetty test is an important test used to evaluate the clinical status of patients admitted for the ankle trauma. PATIENTS AND METHODS: This study was initiated in the emergency service between May 1, 2018, and May 1, 2019, after the approval of the Ethics Committee. The patients were classified according to gender, age, and admission, Ottawa test results, Shetty test results, and radiography status. RESULTS: Shetty test can be used to differentiate between the foot sprains and fractures as a simple and inexpensive method. Despite its effectiveness, Ottawa ankle rules is not widely used due to the detailed implementation of the Ottawa ankle rules and the components of the test. The ease of applicability of the Shetty test in primary care makes the test stand out. In our study, although the sensitivity of Shetty and Ottawa tests resulted in close percentages (82.86% - 85.71%), the specificity of Ottawa test was found to be higher. CONCLUSIONS: Detecting a fracture in emergency services is more valuable than excluding a fracture. Even though Shetty test is simple to use, we recommend Ottawa test for the foot and ankle sprains due to the legal problem that could be caused by Shetty test.

Magnetic resonance imaging (MRI) findings after knee, foot, and ankle traumas.

OBJECTIVE: The aim of this study is to investigate the demographic and clinical characteristics of knee and ankle traumas that could not be detected in the first post-traumatic evaluation and diagnosed within 15 days after the follow-up examination and to discuss the results we obtained with current data. PATIENTS AND METHODS: Patients admitted to the emergency department trauma department between January 1, 2017, and December 31, 2018, were retrospectively analyzed. Applications due to traffic accidents and all traumas except knee and ankle trauma were excluded from the study. Medical records were used to reveal the demographic characteristics of the cases, clinical findings, mechanisms of injury, additional injuries, and interventions in the emergency room. RESULTS: The mean age of 2,039 patients included in the study due to knee, foot, and ankle trauma was 35.69±12.01, and the median value was 36 (age range 11-71). The patients were divided into 2 groups knee trauma and ankle trauma and statistical evaluations were made. Of the patients evaluated for knee trauma (n=1,157), 463 (40%) were female and 694 (60%) were male. Of the patients evaluated for ankle trauma (n=882), 397 (45%) were female and 485 (55%) were male. CONCLUSIONS: It is evident that knee, foot, and ankle traumas after simple falls and sports injuries are frequently encountered by emergency physicians. It is known that post-traumatic ligament injury, bone contusion, intraarticular fluid/hematoma formation, and fractures that cannot be detected by radiographs can be overlooked in emergency departments where patient density is high.

Effects of thymoquinone on spinal cord injury in rats.

PURPOSE: Spinal cord injury (SCI) is a condition that causes disturbances in normal sensory, motor, and autonomic functions. During SCI, damages occur such as, contusion, compression, distraction. The aim of this study was to investigate effects of the antioxidative thymoquinone on neuron and glia cells in SCI biochemically, immunohistochemically and ultrastructurally. METHODS: Male Sprague-Dawley rats were divided into Control, SCI and SCI + Thymoquinone groups. After T10- T11 laminectomy was performed, a metal weight of 15 grams was left down the spinal tube for spinal damage. Immediately after the trauma, the muscles and skin incision were sutured. Thymoquinone was given to the rats by gavage as 30mg/kg/21days. Tissues fixed in 10% formaldehyde, embedded in paraffin wax and immunstained with Caspase-9 and phosphorylated signal transducer and activator of transcription 3 (pSTAT-3) antibodies. Remaining were stored at -80oC for biochemistry. Frozen spinal cord tissues were placed in a phosphate buffer solution and homogenized, centrifuged then used to measure malondialdehyde (MDA) levels, glutathione peroxidase (GSH) and Myeloperoxidase (MPO). RESULTS: In the SCI group, MDA, MPO, neuronal degeneration, vascular dilatation, inflammation, apoptotic appearance in the nucleus, loss of membrane and cristae in mitochondria, and dilatation in the endoplasmic reticulum were observed due to degeneration in the neuron structure. In the electron microscopic examination of the trauma + thymoquinone group, the membranes of the nuclei of the glial cells were thick and euchromatin, and mitochondria were shortened in length. In the SCI group, pyknosis and apoptotic changes were observed in neuronal structures and nuclei of glia cells in the substantia grisea and substantia alba region, along with positive Caspase-9 activity. An increase in Caspase-9 activity was observed in endothelial cells in blood vessels. In the SCI + thymoquinone group, Caspase-9 expression was positive in some of the cells in the ependymal canal while the cuboidal cells showed a negative Caspase-9 reaction in the majority. A few degenerated neurons in the substantia grisea region showed a positive reaction with Caspase-9. In SCI group, pSTAT-3 expression was positive in degenerated ependymal cells, neuronal structures, and glia cells. pSTAT-3 expression was positive in the endothelium and surrounding aggregated cells of the enlarged blood vessels. In the SCI+ thymoquinone group, pSTAT-3 expression was negative in most of the bipolar and multipolar neuron structures and glial cells in ependymal cells, enlarged blood vessel endothelial cells. CONCLUSIONS: It has been thought that thymoquinone application in spinal cord injuries may be an antioxidant that can be recommended as an alternative treatment in suppressing the apoptosis of neural cells by significantly reducing the inflammation process.