Investigation of the pressure value while performing biceps tenodesis for superior capsuler reconstruction.

BACKGROUND: To compare the histopathological results of biceps tenodesis (BT) performed with normal, low, and high pressures for superior capsule reconstruction (SCR) in rabbits with massive rotator cuff tears. MATERIALS AND METHODS: Thirty rabbits were divided into three groups. Rabbits 1-10 underwent SCR with BT at the same pressure (Group 1), value measured in the groove; 50% lower (Group 2); 50% higher (Group 3). After the 4-week follow-up, shoulder were en-bloc excised and histopathological evaluation was performed with modified Bonar's scale. Results were compared between the groups, statistically. RESULTS: Extracellular matrix were significantly lower in group 2 compared to the other groups (p < 0.05). Cellularity levels were significantly lower in group 2 compared to the other groups (p < 0.05). Group 2 had no difference between the sides (p > 0.05). Group 2 had lower vascularity levels compared to the other groups (p = 0.01). DICSUSSION: When the biceps tendon was in the bicipital groove and in a more mobile state with lower pressure exposure. BT performed with a tension that creates less pressure than the biceps in the groove is more successful in SCR.

Knowledge and awareness of anterior cruciate ligament injury among Turkish professional athletes: an online survey.

The purpose of this study was to assess the awareness and knowledge of professional team sport athletes about ACL injuries, injury prevention programs, and the return to sports after ACL injuries. A total of 419 athletes representing soccer, basketball, volleyball and handball sports were included in the study. We utilized a 15-item self-report survey to assess the awareness of athletes about ACL injury, ACL injury prevention program, and return to sport after ACL injuries. Male and soccer players participated in prevention programs more than female athletes (p = 0.001). Participation in prevention programs was significantly higher in the ≥ 18 years old group than in the < 18 years old group (p = 0.040). Participants who were informed about ACL injuries were 8.4 times more likely to participate in the ACL injuries prevention program than others (OR: 8.38, 95% CI: 3.823-18.376, p < 0.001). The majority of participants believed that return to sport after ACL injury takes 6 months and 81.4% of them thought that it is not possible to do sport without an ACL. This study revealed that the awareness and performance of ACL prevention training programs among professional team sport athletes were insufficient. The athletes' knowledge regarding return to sports after ACL injuries was also inadequate. Improving athletes' knowledge of ACL injuries may lead to increased participation in ACL injury prevention programs. Thus, the provision of tailored educational interventions to athletes could potentially enhance their awareness and understanding of ACL injuries, consequently contributing towards the prevention of such injuries.

Investigation of the effects of subacromial bursal tissue preservation and microfracture procedure on healing after rotator cuff repair in a rat model.

INTRODUCTION: The aim of this study is to compare the preservation of bursal tissue and microfracture techniques and to examine the effectiveness of the combination of the two methods in rotator cuff tear healing in the rat shoulder. HYPOTHESIS: Bursal tissue preservation combined with microfracture is more effective in the rotator cuff repair. MATERIALS AND METHODS: Twenty-three male Sprague-Dawley rats were randomly divided into two groups. The bursal tissue was preserved in group 1 (n=11) and excised in group 2 (n=12). Groups were categorized into subgroups as L (left) and R (right) based on the shoulder side receiving microfracture (L received microfracture, R did not). Histopathological examination was performed using modified Bonar Score System. RESULTS: Cell morphology grades of group 1 were lower than group 2 (p<0.05). In terms of collagen measurements, the grade of group 1L (bursa preservation+microfracture) was lower than groups 1R, 2L, and 2R, and the grade of group 1R was lower than groups 2L and 2R. Cellularity grades of group 2 were higher than group 1 (p<0.05). Extracellular matrix grades of group 1 were lower than group 2 (p<0.05). The overall grades were lower in group 1 than in group 2 (p<0.05). DISCUSSION: Combined treatment of bursal tissue preservation and microfracture was the most efficient method as determined by healing findings in histopathological specimens. Preservation of bursal tissue was a more effective option in tendon healing than performing only microfracture. LEVEL OF PROOF: II, animal research.

Efficacy and Reliability of Percutaneous Gigli Saw Osteotomy in Midfoot Surgery: A Cadaver Study.

BACKGROUND: Midfoot osteotomy is often used in the surgical treatment of foot deformities. The percutaneous Gigli saw osteotomy (PGSO) technique has many advantages compared with known osteotomy techniques. We aimed to show the efficacy and reliability of the PGSO technique in the midfoot of fresh frozen cadavers without using an image intensifier. METHODS: Four mini-incisions were performed on the dorsomedial, dorsolateral, plantar medial, and plantar lateral regions of the midfoot. Subperiosteal tunnels were then opened with a thin bone elevator, and the four incisions were combined with each other. The Gigli saw was tied to suture material and passed through the tunnels. The PGSO was performed in the midfoot of 12 feet of the cadaver specimens without using an image intensifier. Cadaver specimens were dissected, and injured structures were noted. RESULTS: The mean ± SD (range) cadaver age was 81.16 ± 10.38 years (65-93 years) and weight was 60.86 ± 12.39 kg (49.8-81.6 kg). All of the osteotomies were adequate as planned in the cuboid-cuneiform level and all of them were complete osteotomy .Incomplete osteotomy was not observed in any cadaver specimens. In one specimen, a complete injury of the peroneal tendons (peroneus longus and brevis) was detected. In another specimen, an incomplete tibialis anterior tendon injury was detected. There was no iatrogenic neurovascular injury in the specimens. CONCLUSIONS: The PGSO technique is recommended for use even by inexperienced surgeons owing to its minimal risk of soft-tissue injury, provision of a complete osteotomy line, and easy application with limited incisions.

An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures.

OBJECTIVE: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. METHODS: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden's view. Preoperative and postoperative values were evaluated. RESULTS: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. CONCLUSION: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

Serum Levels of Vitamin D in Children with or without Isolated Distal Radius Fractures: A Prospective Clinical Study.

Objective To compare the serum levels of vitamin D and minerals in children with or without isolated distal radius fractures. Methods The present prospective clinical study included 50 children (aged between 5 and 15 years) with isolated distal radius fractures who were admitted to our emergency unit between February and May 2018 as the study group (group A), and 50 healthy children with no history of fracture as the control group (group B). Peripheral venous blood samples were obtained and analyzed for measurements of 25-hydroxyvitamin D (25(OH)D), calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) in both groups. Patient characteristics and peripheral venous blood samples were compared between the groups. Results The mean age, height, weight, body mass index (BMI) and gender distribution were similar in both groups. There were no statistical differences in the blood analyses, including Ca, Mg, P, ALP, and PTH. However, the serum levels of 25(OH)D were statistically lower in group A when compared to group B ( p < 0.001), and the number of patients with 25(OH)D insufficiency was statistically higher in group A than in group B (p = 0.012). Conclusion Children with isolated distal radius fracture should be informed about vitamin D deficiency, and, in children with low levels of vitamin D, supplementation may be considered.

Serum Levels of Vitamin D in Children with or without Isolated Distal Radius Fractures: A Prospective Clinical Study / Níveis séricos de vitamina D de crianças com ou sem fraturas isoladas da extremidade distal do rádio: Um estudo clínico prospectivo

Abstract Objective To compare the serum levels of vitamin D and minerals in children with or without isolated distal radius fractures. Methods The present prospective clinical study included 50 children (aged between 5 and 15 years) with isolated distal radius fractures who were admitted to our emergency unit between February and May 2018 as the study group (group A), and 50 healthy children with no history of fracture as the control group (group B). Peripheral venous blood samples were obtained and analyzed for measurements of 25-hydroxyvitamin D (25(OH)D), calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) in both groups. Patient characteristics and peripheral venous blood samples were compared between the groups. Results The mean age, height, weight, body mass index (BMI) and gender distribution were similar in both groups. There were no statistical differences in the blood analyses, including Ca, Mg, P, ALP, and PTH. However, the serum levels of 25(OH)D were statistically lower in group A when compared to group B (p < 0.001), and the number of patients with 25(OH)D insufficiency was statistically higher in group A than in group B (p = 0.012). Conclusion Children with isolated distal radius fracture should be informed about vitamin D deficiency, and, in children with low levels of vitamin D, supplementation may be considered.

Resumo Objetivo Comparar os níveis séricos de vitamina D e minerais de crianças com ou sem fraturas isoladas da extremidade distal do rádio. Métodos Este estudo clínico prospectivo incluiu 50 crianças (com idade entre 5 e 15 anos) com fratura isolada distal do rádio que deram entrada em nossa unidade de emergência entre fevereiro e maio de 2018 como grupo de estudo (grupo A), e 50 crianças saudáveis sem histórico de fratura como grupo controle (grupo B). Foram obtidas e analisadas amostras de sangue venoso periférico para medições de 25-hidroxivitamina D (25(OH)D), Cálcio (Ca), Magnésio (Mg), Fósforo (P), fosfatase alcalina (FA) e hormônio da paratireoide (HPT) em ambos os grupos. As características dos pacientes e as amostras de sangue venoso periférico foram comparadas entre os grupos. Resultados A média de idade, altura, peso, índice de massa corporal (IMC) e distribuição de gênero foram semelhantes em ambos os grupos. Não houve diferenças estatísticas nas análises sanguíneas, incluindo Ca, Mg, P, FA e HPT. No entanto, os níveis séricos de 25(OH)D foram estatisticamente menores no grupo A do que no grupo B (p < 0,001), e o número de pacientes com insuficiência de 25(OH)D foi estatisticamente maior no grupo A do que no grupo B (p = 0,012). Conclusão Crianças com fratura isolada distal do rádio devem ser informadas sobre deficiência de vitamina D, e, em crianças com baixos níveis de vitamina D, a suplementação pode ser considerada.

Is It Necessary to Evaluate the Craniocervical Junction with Computed Tomoghraphy in Adolescent Spinal Deformities?

AIM: To assess the craniocervical junction (CCJ) by using radiological measurements in patients with adolescent idiopathic scoliosis (AIS) and Scheuermann?s kyphosis (SK), and to compare those reults with healthy adolescent population. MATERIAL AND METHODS: Patients were assigned to three groups. Group 1 consisted of AIS patients, Group 2 consisted of patients with SK, and Group 3 was the control group who did not have any spinal disorder. The groups were matched based on age and gender. Major Cobb angle and kyphosis angle were measured on X-Ray. asion-axial interval (BAI), basion-dens interval (BDI), posterior atlantodental interval (PADI), anterior atlantodental interval (ADI), atlanto-occipital interval (AOI), and Power?s ratio were measured by computerized tomography. The results were compared in each group statistically. RESULTS: A total of 120 participants, comprised of 78 (65%) female and 42 (35%) male were included in the study. There was no statistically difference between 3 groups based on age and gender (p > 0.05). According to the measurements, Group 3 had significantly higher PADI measurements than Group 1 (p=0.01). The ADI measurements of Group 2 were significantly higher than those of Group 1 and Group 3 (p=0.01). Group 3 had significantly higher BDI measurements than Group 1 and Group 2. (p=0.01). The Power ratios of Group 1 and Group 3 were statistically higher than that of Group 2 (p=0.01). There were no statistically significant differences between the groups in terms of AOI and BAI measurements (p=0.84, p=0.18, respectively). CONCLUSION: The presence of AIS and SK may affect the measurement of CCJ, and it may be considered to evaluate instability of the region.

A Safe Method for Early Rehabilitation of Articular Fracture at the Base of Thumb Metacarpal Bone.

BACKGROUND: To evaluate the clinical and radiological results of closed reduction, distraction using an external fixator, and percutaneous fixation in patients with Bennet and Rolando fractures. METHODS: Patients over 18 years of age, who had isolated fracture at the base of the first metacarpal bone, had no previous functional limitations and pain complaints, were regularly followed up, and had fixation using K-wire combined with an external fixator, were included. Arthrosis was evaluated according to Eaton and Littler classification. Pain intensity was evaluated using the visual analogue scale (VAS) on a 0-10 scale. Furthermore, patients were questioned regarding limitations in their daily activities and hobbies. Pinch and grasp strengths were evaluated. RESULTS: Thirteen of the patients were male and five were female, with a mean age of 31.5 ± 12.5 years. The surgical procedure was performed on the right extremity in 12 patients and left extremity in six patients. Twelve patients were found to have Bennet fractures, whereas six patients had Rolando fractures. The mean follow-up period of the patients was found to be 29.6 ± 5.4 months. The VAS score was rated as 2 in one patient and 1 in one patient. Other patients had a pain VAS score of 0. The mean Quick-DASH score was calculated to be 1.20. No statistical difference was found in pinch strength between the two extremities (p > 0.05). No difference was observed in terms of the range of motion (p > 0.05). CONCLUSION: Fixation using K-wire combined with an external fixator has more benefits than its disadvantages and is superior to other methods in the intra-articular fractures of the first metacarpal bone.

A Novel Mathematical Model to Calculate the Osteotomy in Ankylosing Spondylitis.

MINI: The authors developed a mathematical model to the sagittal vertical axis (SVA) change in ankylosing spondylitis whom PSO is planned. The mathematical model was developed using trigonometric equations. No significant difference exists between postop SVA change amount and SVA calculated. The mathematical model is reliable in restoring the global sagittal balance.

Retrospective study. This study aims to develop a mathematical model to help precalculate the sagittal vertical axis (SVA) change in patients with ankylosing spondylitis (AS) with rigid kyphotic deformity for whom pedicle subtraction osteotomy (PSO) is planned. SVA is an important metric parameter used to evaluate the global sagittal balance. Previous studies have investigated angular changes in pelvic parameters using PSO; however, no mathematical model is available to calculate SVA change as a metric in these studies. Twenty-one patients who met the inclusion criteria were included in the study. The mathematical model was developed using basic trigonometric equations. Measurements for SVA, lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and the mathematical model were performed in the preop and early postop period. The amount of SVA change in the poststop period was calculated in the mathematical model. The mean age was 33.81 ±â€Š6.01 years. No statistical difference was observed between MATLAB and the angles used in the mathematical modeling ( P  > 0.05). No significant difference exists between postop SVA change amount and SVA calculated via mathematical modeling ( P  > 0.05). A statistically significant difference was observed between preop and postop measurements of LL, SVA, PT, and SS variables ( P  < 0.001). No statistically significant difference existed between PI ( P  > 0.05). This novel mathematical model is reliable in restoring the global sagittal balance of the patients with AS scheduled for PSO and prevent the osteotomy complications. Level of Evidence: 3.

Is the Measurement of Pedicle Axial Axes on Computed Tomography in Adolescent Idiopathic Scoliosis Also a Guide for Safer Screwing?

OBJECTIVE: To evaluate the effect of pedicle angle measurement in preoperative axial computed tomography in patients with adolescent idiopathic scoliosis (AIS) on correct thoracic screw placement in free-hand technique on 3-dimensional printing AIS models. METHODS: In this study, 14 3-dimensional spine models with a scale of 1:1, including the entire spine of a patient with Lenke type 1 curve, were used. Group 1 included screwing applications with unknown pedicle axial angles, and group 2 included screwing applications with known pedicle axial angles. The number and direction of screws in malposition were recorded. In addition, medial encroachment distances of the screws were classified as 0-4 mm and greater than 4 mm, and lateral encroachment distances were classified as 0-6 mm and greater than 6 mm. Evaluation parameters were compared statistically between the groups. RESULTS: The number of screws in the correct position in group 1 was lower than that in group 2 (P < 0.05). The medial and lateral malposition rate in group 1 was greater than that in group 2 (P < 0.05). The medial encroachment rate of 4 mm and greater and lateral encroachment rate of 6 mm and greater in group 1 was greater than that in group 2 (P < 0.05). The medial encroachment rate of 0-4 mm and lateral encroachment rate of 0-6 mm were similar between groups 1 and 2 (P > 0.05). CONCLUSIONS: Measurement of pedicle axial axes of preoperative thoracic vertebrae on computed tomography in patients with AIS offers more reliable screwing in free-hand technique.

Treatment strategy for elderly patients with the isolated greater trochanteric fracture.

BACKGROUND: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment. METHODS: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination. RESULTS: This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404). CONCLUSION: Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery.

TREATMENT OF MIDSHAFT CLAVICLE FRACTURE WITH SUPERIOR PLATE PLACEMENT.

OBJECTIVE: To evaluate the late clinical and radiological results of patients had locking plate anatomically compatible from superior surface and muscle cover on plate due to clavicle mid-region. MATERIALS AND METHODS: Forty patients were included retrospectively. Patients had a routine right shoulder anterior posterior graph after examination. The results were assessed by returning to the patient's daily activities, Constant score, the Disability of the Arm, and Shoulder and Hand scoring, followed by radiological and clinical examination. RESULTS: Fourteen (35%) patients were female and 26 (65%) were male. The mean age was 36.2 years. Twenty-six patients had right clavicle fracture and 14 patients had left. Twenty-three fractures were type 2B1 and 17 fractures were type 2B2. Mean follow-up time was 36.4 months. Radiologic union was at a mean of 9.1 ± 1.3 weeks. All patients had excellent results. The mean Constant score was 97.2 ± 1.8, the mean Disability of the Arm, and Shoulder and Hand score was 3.8 ± 2.4. CONCLUSION: It is possible to obtain complete union with high patient satisfaction by avoiding the complications and difficulties of the conservative treatment with the use of the anatomically compatible locking plates in superior fixation and our surgical dissection. Level of Evidence III, Retrospective Case controlled study.

OBJETIVO: Avaliar os resultados clínicos e radiológicos tardios dos pacientes com placa óssea de trava anatomicamente compatível com a superfície superior e a cobertura muscular na placa devido à região média da clavícula. MATERIAIS E MÉTODOS: Quarenta pacientes foram incluídos retrospectivamente. Os pacientes apresentaram um gráfico ântero-posterior de rotina do ombro direito após o exame. Os resultados foram avaliados retornando às atividades diárias do paciente, escore de Constant, incapacidade do braço e escores de ombro e mão, seguidos de exame clínico e radiológico. RESULTADOS: Quatorze (35%) pacientes eram do sexo feminino e 26 (65%) do sexo masculino. A idade média foi de 36,2 anos. Vinte e seis pacientes tiveram fratura da clavícula direita e 14 pacientes saíram. Vinte e três fraturas foram do tipo 2B1 e 17 fraturas do tipo 2B2. O tempo médio de acompanhamento foi de 36,4 meses. A união radiológica foi em média de 9,1 ± 1,3 semanas. Todos os pacientes tiveram excelentes resultados. A pontuação média constante foi de 97,2 ± 1,8, a média de incapacidade do braço e a pontuação do ombro e da mão foi de 3,8 ± 2,4. CONCLUSÃO: É possível obter união completa com alta satisfação do paciente, evitando as complicações e dificuldades do tratamento conservador com o uso das placas ósseas de trava anatomicamente compatíveis na fixação superior e na nossa dissecção cirúrgica. Nível de evidência III, Estudo retrospectivo controlado por caso.

Treatment of midshaft clavicle fracture with superior plate placement / Tratamento para fratura da diáfise da clavícula com inserção de placa óssea superior

ABSTRACT Objective: To evaluate the late clinical and radiological results of patients had locking plate anatomically compatible from superior surface and muscle cover on plate due to clavicle mid-region. Materials and Methods: Forty patients were included retrospectively. Patients had a routine right shoulder anterior posterior graph after examination. The results were assessed by returning to the patient's daily activities, Constant score, the Disability of the Arm, and Shoulder and Hand scoring, followed by radiological and clinical examination. Results: Fourteen (35%) patients were female and 26 (65%) were male. The mean age was 36.2 years. Twenty-six patients had right clavicle fracture and 14 patients had left. Twenty-three fractures were type 2B1 and 17 fractures were type 2B2. Mean follow-up time was 36.4 months. Radiologic union was at a mean of 9.1 ± 1.3 weeks. All patients had excellent results. The mean Constant score was 97.2 ± 1.8, the mean Disability of the Arm, and Shoulder and Hand score was 3.8 ± 2.4. Conclusion: It is possible to obtain complete union with high patient satisfaction by avoiding the complications and difficulties of the conservative treatment with the use of the anatomically compatible locking plates in superior fixation and our surgical dissection. Level of Evidence III, Retrospective Case controlled study.

RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos tardios dos pacientes com placa óssea de trava anatomicamente compatível com a superfície superior e a cobertura muscular na placa devido à região média da clavícula. Materiais e Métodos: Quarenta pacientes foram incluídos retrospectivamente. Os pacientes apresentaram um gráfico ântero-posterior de rotina do ombro direito após o exame. Os resultados foram avaliados retornando às atividades diárias do paciente, escore de Constant, incapacidade do braço e escores de ombro e mão, seguidos de exame clínico e radiológico. Resultados: Quatorze (35%) pacientes eram do sexo feminino e 26 (65%) do sexo masculino. A idade média foi de 36,2 anos. Vinte e seis pacientes tiveram fratura da clavícula direita e 14 pacientes saíram. Vinte e três fraturas foram do tipo 2B1 e 17 fraturas do tipo 2B2. O tempo médio de acompanhamento foi de 36,4 meses. A união radiológica foi em média de 9,1 ± 1,3 semanas. Todos os pacientes tiveram excelentes resultados. A pontuação média constante foi de 97,2 ± 1,8, a média de incapacidade do braço e a pontuação do ombro e da mão foi de 3,8 ± 2,4. Conclusão: É possível obter união completa com alta satisfação do paciente, evitando as complicações e dificuldades do tratamento conservador com o uso das placas ósseas de trava anatomicamente compatíveis na fixação superior e na nossa dissecção cirúrgica. Nível de evidência III, Estudo retrospectivo controlado por caso.

Analysis of Subcutaneous Anterior Transposition versus in-situ Decompression of Ulnar Nerve with Force Transducer in Cadaver Specimen.

AIM: To evaluate the changes in the pressure values of the ulnar nerve after in-situ decompression and anterior subcutaneous transposition of the ulnar nerve. MATERIAL AND METHODS: The ulnar nerve was released in the postcondylar groove. An ultrathin (100 lm) force transducer was embedded between the posterior of the ulnar nerve and the anterior of the medial epicondyle. The elbow joint was flexed from full extension position to maximum flexion and was measured to obtain the maximum stress at 0°, 45°, 90°, and 135° of flexion. Then, the ulnar nerve was transposed anterior subcutaneously. The same measurement was applied to the two procedures. Data were compared between the two surgical techniques. RESULTS: Our study was performed on the right upper extremities of eight (seven men and one woman) fresh frozen cadavers. The mean age of the cadavers was 67.25 ± 12.2 years. Mean values of 0°, 45°, 90°, and 135° of flexion after the ulnar nerve insitu decompression were 0.41, 0.9, 1.7, and 4.3 N, respectively. Mean values of 0°, 45°, 90°, and 135° of flexion after anterior transposition of the ulnar nerve were 0.3, 0.73, 1.63, and 2.15 N, respectively. No significant difference was noted between the two groups in terms of 0°, 45°, and 90° of flexion values. However, there was a significant difference between the two groups in the 135° of flexion measurement values. CONCLUSION: Anterior transposition is a more appropriate technique than in-situ decompression in the treatment of cubital tunnel syndrome that does not respond to conservative treatment regardless of the severity of the symptom.

Assessment of the Quality and Reliability of the Information on Rotator Cuff Repair on YouTube.

INTRODUCTION: YouTube® has become a common health information source for patients. Recent studies have determined that videos on YouTube® contain misleading and inappropriate information for different medical conditions. The aim of the present study was to assess the quality and reliability of videos pertaining to rotator cuff (RC) repair surgery. HYPOTHESIS: YouTube® users prefer watching videos with high educational quality which are provided by physicians. MATERIAL AND METHODS: A search was performed using keywords "rotator cuff surgery" and "rotator cuff repair" on YouTube® and the first 100 videos for each keyword were analyzed. Video source, time since upload, duration, and number of views, likes, and dislikes were recorded. Video popularity was reported using the video power index (VPI) and view ratio. Video educational quality was measured using the recognized DISCERN, the Journal of the American Medical Association (JAMA) score and a novel RC-specific score (RCSS). RESULTS: Among the 200 videos identified, 67 were included. The mean duration was 7.7minutes and the mean number of the views was 147,430. Videos uploaded by a physician had significantly higher DISCERN, JAMA, and RCSS (p<0.001). While the main video source was physicians (48%), the most popular videos were uploaded by patients and commercial websites, according to the VPI and view ratios. The number of likes, view ratios, and VPI were negatively correlated with each score. There were negative correlations between duration and VPI scores, and positive correlations with DISCERN, JAMA score, and RCSS. Animated videos showed significantly lower results for all quality scores (p<0.05), while their VPI was significantly higher (p<0.01). DISCUSSION: Online information on RC repair surgery provided by YouTube® was low quality, despite being mostly uploaded by physicians and having relatively higher quality scores. YouTube® users prefer watching low quality videos which were provided by patients and commercial websites. LEVEL OF EVIDENCE: IV, Case series.

Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH.

OBJECTIVE: Although the Pavlik Harness (PH) is the most utilized treatment for developmental dysplasia of the hip (DDH), the ideal treatment protocol (frequency of clinic visits in the first month and daily wear duration) for Barlow â€‹+ â€‹hips (reduced but dislocatable) has yet to be defined. METHODS: This study compared DDH patients with Barlow hips who were treated with 23 vs 24 h per day PH wear and weekly vs every other week visits. Clinical success was defined as a stable hip that did not require closed or open reduction, or the use of an abduction orthosis prior to achieving clinical stability. Radiographic success was based on the acetabular index at 2-year follow up. RESULTS: Sixty-five patients (75 hips/58 females) with Barlow hips had a mean age of presentation of 15 ±â€¯12 days (range 4-70) and mean follow-up of 33 ±â€¯17 months (range 6-90). There was no difference in clinical or radiographic success rate between 23 h vs 24 h wear groups (p > 0.99 both) or the Frequently vs Infrequent visit groups (p = 0.49 both). Overall clinical success rate was 97% (73/75 hips) and radiographic success rate at 2 years was 97% (58/60 hips). CONCLUSION: A strict, weekly clinic visit and 24-h PH regimen may not be necessary to obtain good clinical and radiographic outcomes in infants presenting <6 months of age with Barlow positive hips. LEVEL OF EVIDENCE: Therapeutic, Level III.

Complications of Computer Tomography Assisted Radiofrequency Ablation in the Treatment of Osteoid Osteoma.

BACKGROUND: Osteoid osteoma (OO) is one of the most commonly occurring benign bone tumors. It constitutes 10-12% of benign bone tumors and 2-3% of primary bone tumors. In radiofrequency ablation (RFA) treatment, the cells of the tumor are thermally inactivated by the help of electrodes shaped like needles. In our study, we aimed to show the major and minor complications in patients undergoing RFA and to show what should be done to prevent these complications. METHODS: The study was carried out as a prospective study on the follow-up of 87 osteoid osteoma patients treated between 2015 and 2017. The youngest of the patients was 1 year old and the oldest was 42 years old. The RFA procedure lasted 10 min on average, excluding anesthesia and preparation. All lesions were ablated at 90 degrees for 7 minutes with the heat increased gradually. All patients were followed up for 1 day in the orthopedics clinic. RESULTS: Complications were observed in 7 patients. The lesions with the most complications were observed to be in the tibia, second-degree burns were seen in 2 patients, and superficial skin infection was observed in 2 patients. In 1 patient, the probe tip was broken and remained within the bone. Intramuscular hematoma was detected in 1 lesion located in the proximal femur. A complaint of numbness in the fingers developed in a lesion located in the metacarpus. CONCLUSION: Preventive measures should be taken before the procedure in order to prevent minor complications, and, for major complications, close follow-up should be done after the procedure and patients should be kept away from heavy physical activities for the first 3 months.

Does anterolateral ligament rupture affect functional outcomes in patients who underwent an anterior cruciate ligament reconstruction?

BACKGROUND: Studies have shown that the anterolateral ligament contributes to knee stability. This study aims to compare the results of postoperative physical examinations, knee joint stability tests, and functional assessment tests of patients with intact anterolateral (AL) ligaments and patients with ruptured anterolateral (AL) ligaments. MATERIAL AND METHOD: This study consisted of 101 patients, with at least a 12-month follow-up period, who underwent an anterior cruciate ligament reconstruction between 2010 and 2016, and whose AL ligaments were evaluated by the radiologist with the preoperative and postoperative magnetic resonance images (MRI). Of these patients, 41 had intact AL ligament (Group 1) in MRI and other 60 had ruptured AL ligament (Group 2). Groups were compared according to postoperative physical examinations, knee joint stability tests, and functional assessment tests. RESULTS: The average Lysholm score of Group 1 was 94.9 (range: 81-100), and the score of Group 2 was 87.2 (range: 74-100). The modified Cincinnati score of Group 1 was 28.7 (24-30), while the score of Group 2 was 25.6 (21-30). The average IKDC subjective knee evaluation score of Group 1 was 91.9 (range: 83-100), and the score of Group 2 was 86.6 (range: 75-100). The average thigh atrophy value was 1.5 centimeters (cm) in Group 1 and 2.4 cm in Group 2. Thirty-three patients in Group 1 were able to jump over 85% of the distance in single-legged hop test compared to the intact side, while 16 patients in Group 2 were able to jump over this distance successfully. As a result of the analysis, it was determined that the Lysholm activity scoring results, the Modified Cincinnati scoring results, IKDC subjective knee evaluation results, two-cycle IKDC activity scale results, comparison of thigh diameters and the single-legged hop tests of two groups showed a statistically significant difference, and the results of the patients with intact AL ligaments who underwent an ACL reconstruction were found to be better (p < 0.05). No significant difference was found in other examinations and tests. CONCLUSION: Since the rupture of the AL ligament has negative effects on functional outcomes, we think that the reconstruction of the AL ligament in the same session with the ACL reconstruction or later will have a positive effect on functional outcomes.

COMPARISON OF IMPLANT DENSITY IN THE MANAGEMENT OF LENKE 1B AND 1C ADOLESCENT IDIOPATHIC SCOLIOSIS.

OBJECTIVE: To compare radiographic and surgical outcomes of Lenke 1B and 1C patterns. METHODS: One hundred twenty patients with Lenke 1B and 1C scoliosis were grouped according to implant density as follows: low density (LD) of ≤1.4 and high density (HD) of >1.4. Matched subgroups (30 patients each) based on age, curve magnitude, and body mass index (BMI) were analyzed. Radiographic parameters were evaluated before operation, immediately after operation (ipo), and at 2 years' follow-up. SRS-30 was administered before operation and at 2 years' follow-up. RESULTS: The major curves of the LD (n = 82) and HD groups (n=38) were respectively 59.1° and 65.6° before operation (p <.001), 26.3° and 22.9° ipo (p =.05), and 29.9° and 19.8° at 2 years' follow-up (p <.001). No significant differences in postoperative trunk shift and coronal balance were found (p =.69 and p =.74, respectively). The HD group had higher blood loss (p =.02), number of implants (p <.001), levels fused (p =.002), and surgical time (p <.001). The HD group had a higher prevalence of hypokyphosis from before operation to follow-up (p <.001). No significant differences were observed in the SRS-30 scores before operation and at 2 years' follow-up. The matched groups had similar preoperative major curves (p =.56), ages (p =.75), and BMIs (p =.61). Significantly longer surgical time (p =.009), higher density (p <.001), and better correction (p =.0001) were found in the HD group at 2 years' follow-up. No significant differences were found in the SRS-30 scores before operation and at 2 years' follow-up. CONCLUSION: LD constructs included fewer segments fused, lower intraoperative estimated surgical blood loss, and shorter operation time, and potentially decreasing complication risks due to fewer implants. Level of evidence III, Retrospective Cohort Study.

OBJETIVO: Comparar os desfechos radiográficos e cirúrgicos da escoliose Lenke 1B e 1C. MÉTODOS: Cento e vinte pacientes com escoliose Lenke 1B e 1C foram agrupados de acordo com a densidade do implante, como segue: baixa densidade (BD) de ≤ 1,4 e alta densidade (AD) de > 1,4. Foram analisados os grupos pareados (30 pacientes cada) com base na idade, magnitude da curva e índice de massa corporal (IMC). Os parâmetros radiográficos foram avaliados antes da cirurgia, no pós-operatório imediato (POI) e no acompanhamento de dois anos. O questionário SRS-30 foi administrado antes da cirurgia e no acompanhamento de dois anos. RESULTADOS: As principais curvas dos grupos BD (n = 82) e AD (n = 38) foram respectivamente 59,1° e 65,6° antes da operação (p < 0,001), 26,3° e 22,9° no POI (p = 0,05) e 29,9° e 19,8° aos 2 anos de acompanhamento (p < 0,001). Não foram encontradas diferenças significantes no desvio do tronco e no balanço coronal no pós-operatório (p = 0,69 e p = 0,74, respectivamente). O grupo AD teve mais perda sanguínea (p = 0,02), número de implantes (p < 0,001), níveis de fusão (p = 0,002) e tempo de cirurgia (p < 0,001). O grupo AD teve maior prevalência de hipocifose do período anterior à cirurgia até o acompanhamento (p < 0,001). Não houve diferenças significantes nas pontuações do SRS-30 antes da operação e aos 2 anos de acompanhamento. No pré-operatório, os grupos pareados tinham curvas principais (p = 0,56), idade (p = 0,75) e IMC (p = 0,61) semelhantes. Constatou-se tempo cirúrgico expressivamente maior (p = 0,009), maior densidade (p < 0,001) e melhor correção (p = 0,0001) no grupo AD aos 2 anos de acompanhamento. Não foram encontradas diferenças significantes nas pontuações do SRS-30 antes da cirurgia e no acompanhamento de 2 anos. CONCLUSÃO: As estruturas de BD incluíram menos segmentos fundidos, menor perda de sangue intraoperatória estimada, menor tempo de cirurgia e menos risco de complicações, com possibilidade de redução, por causa do menor número de implantes. Nível de evidência III, Estudo retrospectivo de coorte.