Comparison of AO, Schatzker, and three-column classification systems in tibial plateau fractures: Impact on functional outcomes.

OBJECTIVES: This study aimed to compare the AO, Schatzker, and Three-Column classification systems for tibial plateau fractures, focusing on their prognostic and functional outcome prediction and influence on clinical decisions across different trauma types. PATIENTS AND METHODS: In this retrospective study, we examined 49 patients (36 males, 11 females; mean age: 40.6±11.8 years; range, 19 to 67 years) with tibial plateau fractures between January 2011 and January 2017. The fractures were classified using the AO, Schatzker, and three-column systems. The main outcome measurements included functional scores (Knee Injury and Osteoarthritis Outcome Score [KOOS], Hospital for Special Surgery [HSS]), range of motion (ROM), duration of hospitalization, thigh atrophy, operation time, and the development of osteoarthritis. The impact of smoking was also assessed. RESULTS: According to the AO classification, type B fractures obtained higher KOOS and HSS scores compared to type C fractures (p=0.013 and p=0.007, respectively). According to the Schatzker classification low-energy fractures achieved higher KOOS and HSS scores than high-energy fractures (p=0.013 and p=0.026, respectively). One-column fractures had higher KOOS and HSS scores compared to two-column and three-column fractures (p=0.007 and p=0.001, respectively). Two-column fractures had a lower ROM compared to other column fractures (p=0.022). Shorter hospital stays were recorded for Schatzker low-energy fractures (p=0.016), whereas higher thigh atrophy was found in Schatzker high-energy fractures (p=0.022) and AO type C fractures (p=0.018). Longer operation times were observed in AO type C fractures (p=0.037) and Schatzker high-energy fractures (p=0.017). According to the Kellgren-Lawrence classification, AO type C fractures and three-column fractures yielded worse outcomes (p=0.039 and p=0.001, respectively). Smoking had a negative impact on functional KOOS and HSS scores across all groups (p=0.022 and p=0.001, respectively). CONCLUSION: This study highlights the predictive value of the AO, Schatzker, and Three-Column classification systems in determining functional outcomes and clinical data in tibial plateau fractures. Each system provides unique insights into different outcomes, suggesting their concurrent application may yield a more comprehensive prognosis.

Comparison of the functional and radiological results of the conservatively and surgically treated displaced acetabulum fractured patients.

BACKGROUND: The purpose of the study was to compare the functional and radiological results of the conservatively and surgically treated displaced acetabular fractured patients. METHODS: The study included 61 patients with a displaced acetabulum fracture over the age of 18, who have been treated con-servatively or surgically for acetabular fractures, between 2000 and 2014. Patients were divided into two groups according to their treatment type. Group 1 consisted of conservatively treated 31 between 2000 and 2010 patients and Group 2 consisted of surgically treated 30 patients between 2010 and 2014. The fractures were classified according to Judet and Letournel classification. Clinical evaluation of the patients was conducted according to Modified Merle D'Aubigne Score, SF-36, and Harris Hip Score. Radiological evaluation was evaluated according to Matta's Radiological Evaluation Criteria. Kolmogorov-Smirnov, t-test, Mann-Whitney U-test, and two Wilcoxon paired sample tests were used for statistical analysis. The significance limit was chosen as p<0.05. RESULTS: The mean follow-up time was 10 years for the conservative group and 5.5 years for the surgery group. There was no statistically significant difference in functional scores between both groups (p>0.05), Matta's radiological staging score was significantly higher in the operated group (p=0.023). CONCLUSION: Radiological scores are not directly correlated with the functional capacity. We obtained good radiological and functional scores in the surgical group, operative treatment should be considered when absolute indications are there. The outcome of conservatively managed fractures is not bleak. We think that there is an alternative to surgical treatment in displaced acetabular fractures and that similar functional results can be obtained in selected cases.

The effects of intravenous and local tranexamic acid on bone healing: An experimental study in the rat tibia fracture model.

BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic agent. It has long been used to reduce the need for perioperative blood loss in various surgeries. Few studies have investigated the effects of local and intravenous administration of TXA on fracture healing. Thus, we aimed to evaluate if TXA influences hematoma volume and fracture healing in the rat tibia fracture model. MATERIALS AND METHODS: A tibia fracture with intramedullary Kirschner wire fixation was created in all animals. Rats were randomly divided into three groups as local TXA, intravenous TXA, and control. A dose of 50 mg/kg local and intravenous TXA was administered to the study groups. Hematoma volume was measured on the first and third days of the study. The animals were sacrificed on the 14th and 21st days for radiological and histopathological examinations. RESULTS: There was no significant difference between the groups in terms of hematoma volume measured on Day 1 and the mean decrease of hematoma volume from Day 1 to Day 3 (p = 0.158 and p = 0.239, respectively). The total radiological scores of Day 14 and Day 21 were similar in all groups (p > 0.05 for all). There was also no significant difference between the histological staging of the fracture repair on Day 14 and Day 21 for all groups (p > 0.05 for all). CONCLUSION: Our findings suggest that TXA's local and intravenous application makes no significant difference in fracture healing.

Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression.

PURPOSE: Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions. METHODS: Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients' Knee Society Score and Knee Society Functional Score records. RESULTS: A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2. CONCLUSION: Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression.

Does electromagnetic-manual guided distal locking influence rotational alignment in antegrade femoral nailing?

PURPOSE: The aim of this study was to determine whether distal locking using an electromagnetic-manual guided distal locking decreases the malrotation rate in femur fractures treated with intramedullary nailing. METHODS: A total of 113 adult patients having unilateral femoral shaft fractures treated using IM nails were evaluated regarding demographic features, injury mechanism, fracture type, interval between trauma and nailing, operation time and number of image intensifier shots during the operation at least one year after nailing. Patients were divided into two groups according to distal locking technique. All patients had also undergone clinical examination for lower extremity alignment and range of motion and filled out the SF-36 questionnaire and undergone ultrasound measurement of femoral anteversion angles to reveal any rotational femoral malalignment. RESULTS: Group 1 consisted of 47 patients (41.6 %) with electromagnetic-manual targeting guided distal locking and group 2 consisted of 66 patients (58.4 %) with free-hand distal locking. Both groups were statistically similar regarding demographic features, injury mechanism, fracture type, interval between trauma and nailing, clinical examination and SF-36 results. Operation time and number of image intensifier shots were significantly less in group 1. No statistically significant difference was found between the femoral anteversion angles of injured and uninjured sides of the patients in both groups. CONCLUSIONS: Although there is no significant effect on malrotation, previously known advantages lead us to state that electromagnetic-manual guided distal interlocking is an advantageous treatment option in femoral shaft fractures.

Pseudo-arthrosis of the spine of the scapula: a case report with a delayed diagnosis.

Scapular spine fractures are rare injuries. The aim of this study was to evaluate a late-diagnosed scapular spine pseudo-arthrotic patient. Because of the surrounding soft tissue mass and overlapping of the scapula with the thoracal bones on a roentgenogram, diagnosis may be missed or delayed for years. We present a case of scapular spine pseudo-arthrosis in a 50-year-old man, who sustained a traffic accident 2 years ago. He was treated as a soft tissue injury of the left shoulder and later as a rotator cuff tear. His scapular spine fracture was diagnosed as pseudo-arthrosis of the scapular spine with a diagnostic delay of 2 years. Isolated scapular spine fractures are rare, usually associated with other injuries and frequently treated non-operatively. Sagging of the acromion as a result of a scapular spine fracture may mimic supraspinatus outlet impingement. If a painful pseudo-arthrosis limits the function of a shoulder, fractured ends should be fixed until union occurs. Although scapular spine fractures are rarely seen, they must take place in the differential diagnosis of impingement syndromes of the shoulder.

Traumatic posterior hip dislocation and ipsilateral distal femoral fracture in a 22-month-old child: a case report.

Minor trauma may cause hip dislocation in young children because of physiologic hip joint laxity and the soft cartilaginous structure of the acetabulum. In this work, we report on a 22-month-old boy with right-sided traumatic posterior hip dislocation and ipsilateral distal femoral fracture because of an outdoor motor vehicle accident. The patient was treated with emergency closed reduction and one and a half hip spica under general anaesthesia. The femoral fracture and hip dislocation were healed smoothly without any complication. Traumatic hip dislocation is rare in children, which may occur after trivial trauma. Prognosis is better in younger patients with low-energy trauma and in cases treated early.

The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients.

INTRODUCTION: Treatment of tibia pilon fractures is challenging. Outcome after tibia pilon fractures depend on multiple factors. Aim of this study is to evaluate the potential variables that are known to affect the outcome after tibia pilon fractures. PATIENTS AND METHODS: Forty patients with 42 tibia pilon fractures with a one-year follow-up, who had undergone surgical treatment between January 2007 and June 2011, were evaluated, retrospectively. Patients were divided into 3 groups regarding the choice of surgical treatment (Group A-22 patients treated with open reduction-internal fixation; Group B-9 patients treated with mini-open reduction-internal fixation and external fixation; and Group C-11 patients treated with closed reduction-external fixation). Fractures were classified using Müller-AO and Rüedi/Allgöwer classifications. Quality of reduction was evaluated using Ovadia and Beals' criteria. All patients underwent functional assessment using AOFAS ankle-hindfoot scale and Teeny-Wiss scoring system at the last follow-up. RESULTS: Mean age of the patients was 49 (20-80). There were eight 43-B3, six 43-C1, twelve 43-C2 and sixteen 43-C3 fractures according to Müller-AO classification and ten type 1, ten type 2 and twenty two type 3 fractures according to Rüedi/Allgöwer classification. There were 15 (35.7%) open fractures. No statistically significant relation was found between quality of reduction and type of surgery. Also no significant relation was found between the type of surgery and functional scores. No significant correlation was found between functional scores and Müller-AO classification, but functional scores were found significantly worse in Rüedi/Allgöwer type 3 fractures. Functional scores were found significantly related to the quality of reduction. Early complications were seen in 22 and late complications were seen in 9 fractures. No statistically significant relation was found between complications, type of surgery and functional scores. CONCLUSION: The most important factor affecting outcome in surgically treated tibia pilon fractures was quality of reduction. Poor functional scores were found independent from the type of surgery and quality of reduction in Rüedi/Allgöwer type 3 fractures, which was characterized with articular surface comminution and metaphyseal impaction.

Carpal tunnel syndrome in manual tea harvesters.

OBJECTIVES: This study aims to present the physiopathological and surgical aspects of carpal tunnel syndrome (CTS) related to manual tea harvesting based on nerve conduction studies and clinical scoring systems. PATIENTS AND METHODS: Clinical and neurophysiological scores as well as clinical and occupational variables were statistically analyzed using Boston questionnaire, modified criteria of Italian CTS study group, and modified neurophysiologic grading system of Italian CTS study group in 56 agricultural laborers who underwent surgery due to severe CTS. RESULTS: A statistically significant correlation was found among the clinical stages of the patients and age, working duration and duration of symptoms. There was a statistically significant relationship among neurophysiologic grades of the CTS in patients and the duration of symptoms and functional outcomes before and after surgery. CONCLUSION: We concluded that manual tea harvesting might be an occupational risk factor for work-related CTS development. Surgical treatment of CTS among manual tea harvesters revealed satisfactory results.

Major extremity injuries associated with farmyard accidents.

BACKGROUND: The aim of the study is to analyze the major agricultural injuries related to the extremities. PATIENTS: We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period. RESULTS: Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60-360). Mean length of stay was 24 days (4-150), and mean number of operations during hospitalization was 2.4 (1-30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%). CONCLUSIONS: Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall.

Magnetic resonance imaging predictors of surgical outcome in degenerative lumbar spinal stenosis.

PURPOSE: To identify any MRI predictors for surgical outcomes of patients with degenerative lumbar spinal stenosis (DLSS) having instrumented posterior decompression (IPD) surgery. MATERIALS AND METHODS: Seventy patients with DLSS who underwent IPD were reviewed retrospectively. The clinical score of each patient was assessed using the JOAS (Japanese Orthopedics Association Scoring) system, which is mainly based on the subjective symptoms and physical signs of the patients before (JOAS-I) and after (JOAS-II) surgery. Healing rate (HR) was calculated as: [(JOAS-II) - (JOAS-I)] × 100/[15 - (JOAS-I)]. HR >50 % was considered clinical improvement. Radiological stenosis was assessed on MRI and was graded from 0 to 3 at the laminectomy level in terms of thecal sac-nerve root compression, foraminal stenosis, and facet degeneration. RESULTS: Mean HR of the improved patients (n = 39) was 81.94; HR of the unimproved patients (n = 31) was 34.75 (p < 0.05). There was no statistical difference in radiological stenosis parameters between the two groups (p > 0.05). HR was worse in patients with severe facet degeneration. CONCLUSIONS: Surgical outcomes of DLSS depend on multiple variables. It is not possible to predict the outcomes by assessing only one parameter. The possible outcomes should be analyzed by considering all the factors individually.

Late-diagnosed bilateral intertrochanteric femur fracture during an epileptic seizure.

Although spontaneous and simultaneous bilateral hip fractures without trauma are seen rarely, epileptic seizures may lead to these fractures. We present an 82-year-old female patient with poor bone quality and a 20-year history of epilepsy. She had been using anticonvulsant drugs for almost 20 years. Following a convulsive epileptic attack, bilateral intertrochanteric femur fractures occurred (causing bilateral hip pain), which was diagnosed on the 12th day. An earlier pelvic anteroposterior roentgenogram would be helpful for early diagnosis. It should not be forgotten that bone fractures may be observed without trauma in epilepsy patients.

Non-operative treatment in children and adolescents with atlantoaxial rotatory subluxation.

OBJECTIVE: Atlantoaxial rotatory subluxation (AARS) is an uncommon lesion seen mainly in children and adolescents. A retrospective analysis of 12 patients with AARS treated non-operatively is presented in this study. MATERIAL AND METHODS: Twelve patients with AARS who were treated non-operatively were evaluated retrospectively in terms of recent trauma and respiratory tract infection history, accompanying injuries, radiological findings, duration of symptoms, amount and duration of traction and clinical results of the treatment. RESULTS: Traumatic AARS was present in 8 patients. No evidence of trauma was found in 4 patients. Type I subluxations in 10 and type II subluxations in 2 patients were found according to the Fielding and Hawkins classification. All patients were treated using bed-side mentooccipital tractions. The mean duration of bed-side mentooccipital traction was 3,75 days and the mean amount of load was 1.8 kg. All patients were kept in Philadelphia collars for additional 3 weeks after the clinical recovery. No limitations and pain in head movements were present in any patient at the sixth month follow-up examinations. CONCLUSION: Paediatric patients with neck pain and torticollis should be investigated concerning trauma and recent respiratory tract infection history in order to avoid any delay in diagnosis of a possible AARS.

Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index.

BACKGROUND: Ultrasonography is accepted as a useful imaging modality in the early detection of developmental dysplasia of the hip (DDH). Early detection and early treatment of DDH prevents hip dislocation and related physical, social, economic, and psychological problems. The purpose of this study was to evaluate the reliability of ultrasonographic and roentgenographic measurements measured by seven different observers. MATERIALS AND METHODS: The alpha angles of 66 hips in 33 patients were measured using the Graf method by seven different observers. Acetabular index degrees on plane roentgenograms were measured in order to assess the correlation between the ultrasonographic alpha angle and the radiographic acetabular index, which both show the bony acetabular depth, retrospectively. RESULTS: The interclass correlation coefficient, measuring the interobserver reliability, was high and statistically significant for the ultrasonographic measurements. There was a negative correlation between the alpha angle and the acetabular index. CONCLUSIONS: Ultrasonography, when applied properly, is a reliable technique between different observers, in the diagnosis and follow up of DDH. When assessed concomitantly with the roentgenographic measurements, the results are reliable and statistically meaningful.

Comparison of autogenous bone graft donor site haemostatic agents used in spinal surgery.

OBJECTIVE: The aim of our study was to investigate the effects of haemostatic agents used at the autograft donor sites in spinal fusion. METHODS: The study included 66 patients (26 men, 40 women; mean age: 42.9 years) who underwent spinal fusion surgery between March 1999 and October 2002. Patients were randomly assigned to 4 different groups according to the haemostatic agents used during surgery. In Group 1, bone wax was used on the graft donor site. In Group 2, spongostan was used. In Group 3, spongostan was applied to the donor site and removed after 10 minutes. Group 4 was the control group and no haemostatic agent was applied. Age, sex, diagnosis and incision shape were not taken into consideration during the selection of patient groups. Closed suction drainage systems were used for the evaluation of drainage amount. The drainage system was removed after 48 hours in patients with a daily drainage of less than 30 cc. RESULTS: In Group 1, there was significantly less drainage than the other groups. Group 2 and Group 3 had less drainage than the control group. When a separate incision was used for graft harvesting, keeping the spongostan at the application site (Group 2) was more effective than its removal (Group 3). CONCLUSION: The application of bone wax and spongostan to bleeding cancellous bone surfaces at the donor site is a safe and effective method to reduce bleeding and hematoma. Bone wax is more effective than spongostan for haemostasis.

Postoperative evaluation of quality of life in lumbar spinal stenosis patients following instrumented posterior decompression.

OBJECTIVES: Spinal stenosis is a clinical condition in which bone and soft tissues compress the spinal canal, neuronal foramina and nerve roots. In this study, we aimed to evaluate the effectiveness of surgical treatment on patient satisfaction. Our sample included 64 patients with degenerative lumbar spinal stenosis on whom posterior decompression and instrumentation was applied. METHODS: In this retrospective study, files of 64 patients who underwent posterior decompression surgery with instrumentation for degenerative lumbar spinal stenosis between March 2004 and April 2008 were examined. Patients were evaluated with Japanese Orthopaedic Association (JOA) form, form of degenerative lumbar spinal stenosis and the most recent postoperative orthopedic inspection findings for a minimum of one year after surgery. RESULTS: Mean age of patients was 59.9 years and mean follow-up was 27.9 months. When evaluated using the Japanese Orthopaedic Association form, postoperative scores in 63.5% of the patients improved. Based on this postoperative improvement; Japanese Orthopaedic Association scores were found statistically significant (p<0.001). Gender (p=0.651), age (p=0.192), with the length of complaint (p=0.095), time passed after surgery (p=0.933), number of laminectomy level (p=0.997), deformity before operation (p=0.773) and systemic disease were not statistically correlated with improvement based upon Japanese Orthopaedic Association scores (p=0.052). But Japanese Orthopaedic Association scores were found to have improved (83%) in cases with no systemic diseases. CONCLUSION: Our findings show that posterior decompression surgery with instrumentation is a useful treatment modality for patients with severe degenerative lumbar spinal stenosis. There is no secondary factor affecting improvement and instability after surgery is not observed in patient groups.

Fractures of the femoral head: what are the reasons for poor outcome?

BACKGROUND: In this article, we aimed to discuss treatment strategies in fracture of the femoral head, which is a very rare injury. METHODS: We reviewed five patients (six fractures) who admitted to our emergency department due to femoral head fracture between March 2006 and December 2007. Functional outcomes of the patients who were treated operatively and nonoperatively were compared. RESULTS: Half of the fractures were treated nonoperatively and half of them surgically. We observed a rate of 50% excellent to good results. Avascular necrosis developed in a patient with bilateral injury. The functional results were poor for this patient. Early posttraumatic arthritis was observed in a patient who was treated surgically; this patient had moderate results. CONCLUSION: We should aim at anatomic reduction of the fragments with minimum soft tissue injury. The best approach should be chosen for excellent view of the fragments. We should not forget that half of these patients will have a poor outcome despite all treatment strategies.

Does an abnormal infrapatellar plica increase the risk of chondral damage in the knee.

PURPOSE: the aim of this study was to evaluate abnormal infrapatellar plicae that cause chondral lesions on the patellofemoral sulcus and superior aspect of intercondylar notch. METHODS: in this study, 133 abnormal infrapatellar plicae were evaluated. The abnormal infrapatellar plicae may lead to chondral lesions on the superior portion of intercondylar notch and on the inferior portion of the patellofemoral sulcus with striking, friction, and compression forces during knee motion. RESULTS: the chondral lesions that were caused by abnormal infrapatellar plicae were more severe than the chondral lesions that were caused by normal infrapatellar plicae. The width of the plica did not affect the severity of chondral lesions. CONCLUSION: abnormal infrapatellar plicae might be one of the causes of chondral lesions on the superior portion of intercondylar notch and on the patellofemoral sulcus. The width of the plica did not affect the severity of chondral lesions.

Acute stress disorder and post-traumatic stress disorder following traumatic amputation.

Traumatic amputations are important causes of acute stress disorder and post-traumatic stress disorder. In this study, we aimed to find out the occurrence rate of symptoms of acute and post-traumatic stress disorder after traumatic amputations and according to this, to assess the psychiatric status of the patients in the postoperative period. Twenty-two patients with traumatic limb amputation who were treated in our institution were retrospectively evaluated. During the early post-traumatic period, the patients were observed to determine whether they needed any psychiatric supportive treatment. During the follow-up period, after the sixth month from the trauma, the patients were referred to the psychiatry department and they were evaluated to determine whether they needed any psychiatric supportive treatment, by clinical psychiatric examination and use of the 'post-traumatic stress disorder scale' (Clinician Administered Post traumatic Scale, or CAPS). Twenty-one (95.5%) of 22 patients were male, one (4.5%) female. Mean age of the patients was 40.8 years (range: 15 to 69). During the early posttraumatic period, 8 (36.3%) of these patients consulted the psychiatry clinic following the orthopaedists' observations. Five (22.7%) of these patients needed psychiatric supportive treatment for acute stress disorder. After the 6th month (6 months to 5 years), 17 (77.2%) had chronic and delayed post-traumatic stress disorder and needed psychiatric supportive treatment. Patients who have sustained a traumatic amputation may need psychiatric supportive treatment in the late period after the trauma. As we orthopaedic surgeons treat these patients surgically, we should be aware of their psychiatric status.