Comparison of Lateral and Central Achilles Tendon-Splitting Approaches in the Treatment of Haglund Deformity.

BACKGROUND: This study aimed to compare the complications and outcomes of lateral and central Achilles tendon-splitting approaches for the treatment of Haglund syndrome. METHODS: Patients who underwent surgery for Haglund syndrome between June 2012 and June 2022 were included in the study. Patients undergoing lateral approach surgery were included in group 1, whereas patients undergoing central Achilles tendon-splitting approach surgery were included in group 2. Surgical outcomes of the patients were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale, visual analog pain scale (VAS), and Victorian Institute of Sport Assessment-Achilles (VISAA) scores. In addition, preoperative and final follow-up scores were compared. RESULTS: The study included 66 patients: 32 (14 females, 18 males) underwent surgery using the lateral approach in group 1, whereas in group 2, 34 patients (18 females, 16 males) underwent surgery using the central Achilles tendon-splitting approach. There was a significant statistical difference in the AOFAS, VISAA, and VAS scores between preoperative and final follow-up for both group 1 and group 2 (P < .001, P < .001, P < .001, P < .001, respectively). Group 1 had a small (0.76) relative increase in VAS score compared with group 2 (P = .033). There was no significant difference between the complication rates of group 1 and group 2. CONCLUSION: In our study, we found the lateral approach and central Achilles tendon-splitting approaches to be safe and effective in the surgical treatment of Haglund syndrome without clinically meaningful differences in outcomes or complication rates. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Effects of tendon elongation on plantar pressure and clinical outcomes: A comparative analysis between open repair and minimally invasive surgery.

PURPOSE: The aim of this study was to assess whether variances in Achilles tendon elongation are linked to dissimilarities in the plantar pressure distribution following two different surgical approaches for an Achilles tendon rupture (ATR). METHODS: All patients who were treated with open or minimally invasive surgical repair (MIS) and were over 2 years post their ATR were eligible for inclusion. A total of 65 patients with an average age of 43 ± 11 years were included in the study. Thirty-five patients were treated with open repair, and 30 patients were treated with MIS. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and ATR Score (ATRS). Achilles tendon elongation was measured using axial and sagittal magnetic resonance imaging scans. Plantar pressure measurements for the forefoot, midfoot and hindfoot during gait were divided into percentages based on total pressure, measured in g/cm2 for each area. RESULTS: The average AOFAS score was found 'excellent' (93 ± 2.8) in the MIS group, while it was found 'good' (87.4 ± 5.6) in the open repair group. In addition, the MIS group showed significantly superior ATRS scores (78.8 ± 7.4) compared to the open repair group (56.4 ± 15.4) (p < 0.001). The average tendon elongation in the MIS group was 11.3 ± 2 mm, while it was 17.3 ± 4.3 mm (p < 0.001) in the open repair group. While the open repair group showed significantly higher plantar pressure distribution in the initial contact and preswing phases compared to uninjured extremities, there was no significant difference between the uninjured extremities and the MIS group. CONCLUSION: In conclusion, the findings of this study demonstrated that minimally invasive surgery was associated with less tendon elongation, more proximity to the plantar pressure distributions of the uninjured extremity and superior clinical outcomes compared to open surgical repair. Therefore, minimally invasive surgery may be considered a more suitable option for acute Achilles tendon repair to achieve overall better outcomes. LEVEL OF EVIDENCE: Level III.

Fracture Patterns and Mortality in Osteopetrosis: A 7-year Retrospective Analysis from Türkiye's National Registry.

BACKGROUND: The aim of this study is to determine the demographic data, fracture treatment methods, and medical treatments of patients diagnosed with osteopetrosis in the national registry. METHODS: Patients with International Classification of Diseases (ICD)-10 code Q78.2 for osteopetrosis between January 1, 2016 and April 11, 2023 were retrospectively reviewed. Data on sex, age at time of diagnosis, fracture history, mortality, and use of medications were evaluated for all patients. In addition, open reduction and internal fixation, closed reduction and internal fixation, closed reduction and casting, and conservative treatment methods were noted. The number of patients requiring deformity surgery was determined. The incidence and prevalence of osteopetrosis were also calculated in this cross-sectional study. RESULTS: A total of 476 patients diagnosed with osteopetrosis were identified. The mean age at time of diagnosis of these patients was 5.79 ± 5.43 years. A total of 101 patients died. As the age at diagnosis decreased, the mortality rate of the patients increased with statistical significance ( P <0.001). A total of 192 fractures were seen in 121 osteopetrosis patients in this study. Femur fractures were most common among these patients with osteopetrosis. A history of fracture was statistically significantly less common in patients using a combination of vitamin D + calcium compared with patients not using such medication ( P <0.001). In this 7-year cross-sectional study, the incidence was found to be 1 in 416,000 and the prevalence was 0.00199% in the population under 18 years of age. CONCLUSION: Younger age at diagnosis is associated with higher mortality in patients with osteopetrosis. In addition, the combination of vitamin D and calcium were associated with lower fracture incidence. LEVEL OF EVIDENCE: Prognostic Level II.

Does the Surgical Approach Influence Bleeding in Hip Fracture Patients Taking Clopidogrel?

Background The aim of this study was to evaluate the effect of the choice of approach on bleeding in patients with femoral neck fractures who are on clopidogrel. Materials and methods The study included patients over the age of 60 who were taking clopidogrel and had hemiarthroplasty surgery for a femoral neck fracture. A total number of 61 patients were evaluated in the study. Patients who underwent surgery using the posterior approach were assigned to group 1, while those who underwent surgery using the anterolateral approach were assigned to group 2. Preoperative and postoperative hemoglobin levels, transfusion needs, red blood cell (RBC) loss, duration of surgery, and the length of hospitalization were evaluated. Results The mean age of the patients was 79.36 ± 7.72 years. Twenty-nine patients were included in group 1 and 32 patients were included in group 2. There was no significant difference between the two groups in terms of gender, age, and comorbidities (p=0.74, p=0.12, p=0.23, respectively). There were no significant differences between group 1 and group 2 in terms of duration of surgery and length of hospital stay (p=0.41, p=0.37, respectively). Also, there was no significant difference in RBC loss between group 1 and group 2 (p=0.37). Conclusion The use of anterolateral or posterior approaches has no effect on bleeding in clopidogrel-treated patients having hemiarthroplasty for femoral neck fracture. The authors recommend surgeons choose the approach according to their experience and patients' needs.

A new scoring system for predicting cut-out risk in patients with intertrochanteric femur fractures treated with proximal femoral nail anti-rotation.

OBJECTIVE: The objectives of this study were to: (1) determine all the potential risk factors defined in the literature for cut-out after proximal femoral nail anti-rotation in managing intertrochanteric fractures and (2) make a reliable prediction about the likelihood of cut-out by developing a quantitative scoring system. METHODS: Four hundred eighty patients who were operated on for an intertrochanteric femur fracture were included in the study. The patients were evaluated retrospectively. Radiological parameters known to affect cut-out, including tip apex distance (TAD), calcarreferenced TAD (CalTAD), and reduction quality, were also used to evaluate the patients. Additionally, the classification of the fracture according to the cortical thickness index for osteoporosis, the Charlson comorbidity index for additional comorbidities, and the Arbeitsgemeinschaft Für Osteosynthesefragen classification were evaluated. RESULTS: The cut-out rate among all patients was 7.2%. Cut-out risk could be predicted by gender, TAD, CalTAD, and reduction quality. Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality significantly increased the cut-out risk. Based on the chi-square analysis, it was determined that there was a significant relationship between the cut-out risk and the variables of TAD, CalTAD, reduction quality, gender, and fracture type (P=.000, P=.000, P=.000, P=.008, P=.016, respectively). Logistic regression analysis showed a strong correlation between the newly developed scoring system and the risk of cut-out. The risk of cut-out increased 8.1 times in individuals with a score of more than 2 (P < .001). CONCLUSION: Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality are the parameters found to be significant in determining the cut-out risk. With the newly developed scoring system, risks can be calculated for all situations that may occur according to the scores obtained by the patients. The cut-out risk increases significantly in patients with a score above 2 points. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Evaluation of free vascularized medial femoral condyle bone grafts in the treatment of avascular scaphoid waist nonunion.

OBJECTIVES: The aim of this study was to evaluate the medial femoral condyle (MFC) bone graft procedure for scaphoid waist nonunion with avascular necrosis on magnetic resonance imaging or prior surgery failure. PATIENTS AND METHODS: Between June 2015 and December 2018, a total of 17 patients (16 males, 1 female; mean age: 29±8.2 years; range, 16 to 40 years) with scaphoid waist nonunion who were treated with vascularized MFC bone grafting were retrospectively analyzed. Pre- and postoperative carpal indices, grip strengths for both hands, range of motion, Visual Analog Scale (VAS) pain score, Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score, and Mayo Wrist Score (MWS) were evaluated. RESULTS: After vascularized MFC bone graft surgery, 15 patients healed and returned to work without any limitations. Ten patients of left scaphoid nonunion and seven cases of right scaphoid nonunion were treated; for eight of these patients, the operation was on the dominant side. Eight of these patients were smokers. The mean follow-up was 22.4±5.8 months. The mean hand grip strength was increased from 74.5 to 84% on the contralateral side (p<0.05). The average revised carpal height ratio improved from 1.57 to 1.59 (p<0.05) and the scapholunate angle changed from 56.9° to 51.6° (p<0.05). CONCLUSION: The MFC bone grafting is one of the best surgical procedures for small defects such as scaphoid waist nonunion with high union rates, good functional outcomes, and minimal donor site morbidity.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

OBJECTIVES: The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. RESULTS: Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. CONCLUSION: Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Hyperbaric oxygen therapy does not change the amputation level in patients with fasciotomy after an earthquake: Our single-center experience after 2023 Kahramanmaras earthquake.

OBJECTIVES: This study aims to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the amputation level in patients undergoing fasciotomy with a Mangled Extremity Severity Score (MESS) score of ≥7 after 2023 Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and March 10th, 2023, a total of 23 patients (14 males, 9 females; mean age: 36.8±13.2 years; range, 17 to 64 years) who needed amputation with a MESS score of ≥7 and refused amputation were included in the study. All fasciotomies were performed in an external center, and five of them was incomplete. First, incomplete fasciotomies were completed with debridement due to deep muscle necrosis. Daily two HBOT sessions were performed for the first three days. In the following days, daily one HBOT session was performed. The HBOT was terminated for the patients who were decided by the council that they did not benefit from HBOT treatment. RESULTS: Six (26.08%) of the patients had a bone fracture (n=2 forearm, n=1 femur, n=2 tibia, and n=1 ankle fracture). The mean number of HBOT session was 13.24±5.4 (range, 7 to 30) and the mean duration of HBOT was 26.5±10.8 (range, 14 to 60) h. The mean MESS score was 9.96±1.36 (range, 7 to 12). All of the patients were trapped under the rubble with a mean time of 12.3±5.4 (range, 6 to 23) h. All fasciotomies were performed within the first 30 h. Twenty-two of the patients were amputated at the level previously determined by the experienced trauma surgeons. The amputation level changed in only one patient. After 38 h of HBOT, transradial amputation was performed to the patient in whom transhumeral amputation level was determined previously. None of the patients had any adverse event related to HBOT. CONCLUSION: Our study results suggest that the MESS is a useful scoring system for amputation decision after a high-energy trauma, such as an earthquake, with a high accuracy rate. The outcomes of HBOT are not satisfactory for high-energy traumas, such as earthquakes, in those requiring fasciotomy having more muscle necrosis and a MESS score of ≥7.

Preventing extremity amputations after earthquakes: a quantitative analysis of fasciotomy and extrication time.

PURPOSE: The purpose of this study is to evaluate the impact of prolonged extrication time and the time to fasciotomy applications on amputation requirement by giving quantitative and cutoff values. METHODS: In this single-center study, the clinical records of patients with musculoskeletal injuries due to the 6 February Kahramanmaras earthquake in Turkey were retrospectively reviewed. All patients who underwent fasciotomy or amputation regardless of age and gender were included in the study. 163 extremities of 140 patients who met the inclusion criteria were evaluated. Demographic data of the patients, such as age and gender, were recorded in this study. The primary outcome of this study was the correlation of the time between injury and fasciotomy applications with the amputation requirement. At the same time, the effect of prolonged extrication time of earthquake victims on amputation requirement. RESULTS: The mean age was 29.01 ± 15.55 of earthquake victims included in the current study and the gender distribution of the patients is almost equal. 87 amputations of 65 patients were performed and transtibial amputation was the most common type (41.3%). The mean fasciotomy time was 38.78 ± 23.64 h. Delayed fasciotomies performed after 45.5 h increase 28.48 times the amputation requirement. The mean extrication time in the current study was 36.49 h. The patients with extrication time longer than 23 h was associated with an 8.8 times higher risk of amputation. CONCLUSIONS: Authors believe that knowledge of the relationship between earthquake survivors' prognosis and time of extrication, as well as the impact of fasciotomy timing on extremity loss, is essential for a more successful treatment management in future disasters.

Impact of Posterior Malleolus Fixation on Clinical and Functional Results.

BACKGROUND: Clinical studies have shown that posterior malleolar fractures treated with a posterior buttress plate have improved outcomes compared to anterior-to-posterior screw fixation. The aim of this study was to evaluate the impact of posterior malleolus fixation on clinical and functional results. METHODS: The patients with posterior malleolar fractures who were treated between January of 2014 and April of 2018 at our hospital were investigated retrospectively. Fifty-five patients included in the study were divided into three groups according to the fixation preferences of fractures (group I, posterior buttress plate; group II, anterior-to-posterior screw; and group III, nonfixated). The groups consisted of 20, nine, and 26 patients, respectively. These patients were analyzed according to demographic data, fixation preferences of fractures, mechanism of injury, hospitalization length of stay, surgical time, syndesmosis screw use, follow-up time, complications, Haraguchi fracture classification, van Dijk classification, American Orthopaedic Foot and Ankle Society score, and plantar pressure analysis. RESULTS: There were no statistically significant differences between the groups in terms of gender, operation side, injury mechanism, length of stay, anesthesia types, and syndesmotic screw usage. However, when the age, follow-up time, operation time, complications, Haraguchi classification, van Dijk classification, and American Orthopaedic Foot and Ankle Society scores were evaluated, statistically significant differences were observed between the groups. Plantar pressure analysis data showed that group I yielded balanced pressure distribution between both feet compared to the other study groups. CONCLUSIONS: The posterior buttress plating of posterior malleolar fractures yielded better clinical and functional outcomes compared to the anterior-to-posterior screw fixation and nonfixated groups.

Do Different Approaches Make a Difference in Isokinetic Performance in Elderly Patients With Femoral Neck Fracture Who Underwent Bipolar Endoprosthesis?

Background There are ongoing doubts about the effects of the commonly used anterolateral approach (ALA) and posterolateral approach (PLA) for bipolar hemiarthroplasty (BHA) on hip muscle strength after surgery. In this study, it was aimed to evaluate the isokinetic performance of the operated and non-operated hips in patients with femoral neck fractures who underwent BHA with PLA or ALA and to compare the isokinetic performance of the hips and functional results between the two approaches. Materials and methods Forty-one patients who underwent unilateral BHA with PLA or ALA for femoral neck fracture between February 2019 and December 2020 were enrolled. The isokinetic performance of the flexor, extensor, and abductor muscles of the operated and non-operated hips were evaluated by measuring peak torque, total work, and average power. Functional status was assessed using Harris Hip Score and Short Form 36. Results The patients were divided into two groups; those operated with PLA (n=22) and with ALA (n=19). The groups had similar demographic and clinical characteristics. All isokinetic parameters of the operated hips did not differ between the groups (all p>0.05). In both groups, all isokinetic parameters were significantly lower in the operated hips than in the non-operated hips. Conclusion Although there are debates about potential extensor muscle injury with PLA and potential abductor muscle injury with ALA, this study showed that functional results and the isokinetic performance of both approaches were not different.

The effect of reduced acromiohumeral distance and increased acromial thickness on the risk of rotator cuff tear.

OBJECTIVE: This study aimed to determine the effect of reduced acromiohumeral distance (AHD) and increased acromial thickness (AT) on the risk of rotator cuff tear (RCT). METHODS: Patients aged 25-70 were included in this retrospective study. Patients who were operated on for RCT between January 2019 and December 2021 were included in group 1, and patients who applied to the outpatient clinic in the same period with a complaint of shoulder pain and no problem on magnetic resonance imaging (MRI) were included in group 2. Three researchers performed AHD and AT measurements on the same true anteroposterior (AP) shoulder radiographs. The second measurement was performed 1 month later when, the first measurements were completed. RESULTS: Radiographs of 284 patients in group 1 and 234 patients in group 2 were evaluated. In group 1, the mean AHD measurement was 8.25 ± 1.73 mm, and the AT measurement was 8.58 ± 1.06 mm. In group 2, the mean AHD measurement was 10.25 ± 1.4 mm, and the AT measurement was 8.35 ± 0.92 mm. A significant relationship was determined between the RCT and the AHD (P < .001). Also, RCT and AT have a significant relationship (P < .001). The authors determined that the risk of RCT increased 3.45 times when patients with AHD 6-10 mm were compared with patients with AHD >10 mm. In addition, all patients with AHD < 6mm had RCT, and the risk of RCT increased 1.42 times when patients with AT > 8 mm were compared with patients with AT < 8 mm. CONCLUSION: Acromiohumeral distance and AT measurements are practical, inexpensive, and valuable in evaluating RCT. Decreased AHD and increased AT increase the risk of RCT.

The self-assessment of newly graduated orthopedic surgeons on essential surgical procedures.

OBJECTIVE: The aim of this study was to assess the self-confidence of newly graduated orthopedic surgeons on performing essential surgi- cal procedures. METHODS: The study included 151 orthopedics and traumatology surgeons who had completed their (orthopedics and traumatology) training within the last year. They were asked to complete an online questionnaire which was available from February 2020 to May 2021. In the questionnaire, newly graduated orthopedic surgeons were asked whether they could do the 18 listed essential adult and 8 listed essential pediatric cases independently. They were asked about patient follow-up systems and who these were supervised by, the demo- graphic data of the city and about the institution they were trained in, and how many times they performed the listed surgeries during their training. RESULTS: 74 (49%) of the participants received their training in training and research hospitals, 69 (45.7%) in state university hospitals, and 8 (5.3%) in foundation university hospitals. More than 80% of the participants answered, "I can do it independently" for 13 (81.6%) out of 16 adult cases and 7 (87.5%) out of 8 paediatric cases. The average self-efficacy score of the participants was 32.22 out of 36 for adult cases and 15.3 out of 16 for paediatric cases. The total average self-efficacy score was 47.52 out of 52. CONCLUSION: This study has shown us that newly graduated orthopedic surgeons have the self-confidence to handle many of the essential types of cases independently.

Demographic analysis of knee dislocation: A rare mechanism of injury.

PURPOSE: The aim of this study was to present to the literature a rare injury mechanism that causes knee dislocation (KD) and describe its characteristics. METHODS: A retrospective review of patients with KD who were treated between January 2014 and December 2019 at our hospital was performed. Patients with KD due to rotavator machine injury were included in Group 1 and all patients with KD due to other etiological reasons were included in Group 2. Patients' age, gender, side, injury mechanism, time to surgery, length of stay (LOS), operation time, follow-up time, neurological injury status, vascular injury status, open injury status, and surgical interventions were evaluated. RESULTS: A total of 34 patients were evaluated in the study. There was no statistically significant difference between the groups in terms of age, gender, side, or follow-up time (p = .915, p = 1.000, p = .682, p = .374, respectively). However, LOS and time to surgery were statistically significantly longer in Group 1 (p = .037, p = .010, respectively). Moreover, neurovascular damage was statistically significantly more common in Group 1. CONCLUSION: As a rare injury mechanism for KD, rotavator machine injuries cause more neurovascular injuries in patients compared to other injury mechanisms and increase the time to surgery and LOS due to preoperative soft tissue damage.

Comparison of the first and second waves of the COVID-19 pandemic with a normal period in terms of orthopaedic trauma: Data from a level 1 trauma centre.

OBJECTIVE: The aim of this study was to compare the characteristics and distribution of trauma surgeries performed in the first phase of the COVID-19 pandemic, the second phase of the pandemic, and the normal period before the pandemic. METHODS: Three different time periods were determined.Group 1 represented the first wave of the pandemic, in which lockdowns andrestrictions were strictly applied and only emergency and trauma surgeries wereperformed, between 1 April and 31 May 2020. Group 2 represented the second waveof the pandemic, during which restrictions were not applied and only emergencyand trauma surgeries were performed, from 1 September to 31 October 2020. Group3 represented the normal period before the pandemic, including surgeriesperformed between 1 September and 31 October 2019. In addition, patients ineach group were divided into two groups as younger than 16 or older than 16 inorder to understand the difference between paediatric and adult orthopaedictraumas. The distribution of patients and their fractures were evaluated. RESULTS: In Group 1, the rates of intra-articular fractures, distal extremity fractures, and proximal humerus fractures decreased, while the rate of proximal femur fractures increased (P < 0.05 for all). The frequency of hand fractures treated in Groups 1 and 2 compared to Group 3 was reduced (P < 0.05 for both). There was no statistically significant difference between Groups 2 and 3 for fractures in different parts of the body except for hand fractures (P = 0.001 for hand fractures, P > 0.05 for the other fractures). CONCLUSION: We observed that the frequency of fractures decreased, and the distribution changed due to severe restrictions and lockdowns in the first wave of the pandemic. When the restrictions and lockdowns were removed in the second wave, the frequency of fractures decreased, but the distribution of fractures was similar to the normal period in 2019. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Medium-term clinical and radiological results of surgically treated stage 3A Kienböck's disease.

The purpose of this study was to compare the methods of distal radial shortening osteotomy (RSO), lateral closing distal radial wedge osteotomy (RWO), and scaphotrapeziotrapezoid (STT) fusion in the treatment of stage 3A Kienböck's disease (KD). The research was planned as a single-center and retrospective study for the period 2008-2018. Patients were allocated to three groups according to surgical method: group 1, patients with negative ulnar variance, undergoing RSO; group 2, patients with non-negative (neutral or positive) ulnar variance, undergoing RWO; and group 3, patients with non-negative ulnar variance, undergoing STT fusion. Radiological measurements were compared: pre- and postoperative Stahl index, radioscaphoid angle, and carpal height ratio. Clinical comparison used QuickDASH and modified Mayo wrist scores. Fifty-one patients, with a mean age of 34 ± 12 years (range; 16-69 years), were included. Mean follow-up was 4.47 ± 1.8 (range 2-9) years. No statistically significant difference was observed between the groups in terms of change in carpal height ratio or Stahl index (respectively; P = 0.08, P = 0.065). A significant difference was observed in change in radioscaphoid angle between patients undergoing STT fusion versus RWO (P < 0.05). There was no statistically significant difference in postoperative functional scores between groups, and similar postoperative functional scores were achieved with STT fusion and with RWO in the surgical treatment of stage 3A KD with positive or neutral ulnar variance. Good medium-term radiological and clinical results were obtained with RSO in patients with stage 3A KD with negative ulnar variance.

Aneurysmal Bone Cyst of the Medial Cuneiform: A Case Report.

The aneurysmal bone cysts, usually found in the tibia, femur, pelvis, or humerus, are expansile pseudotumor lesions of unknown etiology. An aneurysmal bone cyst is rarely seen in the medial cuneiform. In this case report, a 43-year-old man with an aneurysmal bone cyst in the left medial cuneiform is presented. The cyst was curetted, and the defect was filled with an en bloc iliac crest graft. A screw was placed to fix the graft in the proper position. In the 2-year follow-up of the patient, recurrence was not detected radiologically.

Anterior cruciate ligament reconstruction with ToggleLoc with ZipLoop system versus transfix system: A cost-effectiveness analysis.

BACKGROUND: To evaluate the cost-effectiveness of the reconstruction of the anterior cruciate ligament tears using either ToggleLoc with ZipLoop or Transfix systems. METHODS: This study is a cost-effectiveness analysis of patients with anterior cruciate ligament reconstruction, ToggleLoc with ZipLoop and Transfix systems in our clinic between 2011 and 2016. This study was a retrospective cross-sectional study of patient's demographic, clinical and financial data. The effectiveness of surgery on patients with anterior cruciate ligament reconstruction was determined by the Lysholm Knee Score Scale. We compared two systems with the cost-effectiveness ratio. RESULTS: In this study, 103 patients were included. According to the Lysholm Knee Score Scales in both groups, the findings showed that there was no difference in effectiveness between them. The ToggleLoc with ZipLoop technique was cost-effectiveness ratio 254,57 and the Transfix technique cost-effectiveness ratio was 378,33. CONCLUSION: According to our results, ToggleLoc with ZipLoop technique was a more cost-effective method than the Transfix technique in the anterior cruciate ligament reconstruction.

Comparison of local infiltration analgesia and interscalene block for postoperative pain management in shoulder arthroscopy: a prospective randomized controlled trial

Background/aim: The aim of this study was to compare the effects of local infiltration analgesia and interscalene brachial plexus block techniques on postoperative pain control and shoulder functional scores in patients undergoing arthroscopic rotator cuff repair. Materials and methods: Sixty patients who underwent arthroscopic rotator cuff repair were prospectively included in the study. Patients were randomly divided into two groups. Group 1 was comprised of patients who had interscalene brachial plexus block, while group 2 was comprised of patients who had local infiltration analgesia. In group 1, interscalene block was applied with 20 mL 0.5% bupivacaine. In group 2, the Ranawat cocktail was used for local infiltration analgesia. Sixty milliliters of Ranawat cocktail was applied to the subacromial space and glenohumeral joint in equal amounts. Postoperative pain was assessed by the VAS score. Functional scores of the shoulder were also evaluated by Constant­Murley and UCLA scores. The time of first analgesic requirement and total analgesic consumption in the postoperative period were assessed. Results: The first analgesic requirement was significantly late in the interscalene brachial plexus block group (p = 0.000). There was no statistically significant difference between the groups in terms of total analgesic consumption (p = 0.204). In the postoperative 6th h, the VAS score was 2.43 in the interscalene brachial plexus block group, whereas 2.86 in the local infiltration analgesia group (p = 0.323). There was no statistically significant difference between the groups in terms of Constant­Murley shoulder and UCLA scores in the 3rd postoperative month (respectively, p = 0.929, p = 0.671). Besides, postoperative VAS scores and functional scores were negatively correlated (p < 0.01). Conclusion: Local infiltration analgesia is an effective alternative to interscalene brachial plexus block for postoperative pain management and total analgesic consumption in arthroscopic rotator cuff repair. However, the interscalene brachial plexus block provides a longer postoperative painless period.