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Background: It is known that neuroanatomical and neurofunctional changes observed in the brain, brainstem and cerebellum play a role in the etiology of adolescent idiopathic scoliosis (AIS). This study aimed to investigate whether volumetric measurements of brain regions can be used as predictive indicators for AIS through machine learning techniques. Methods: Patients with a severe degree of curvature in AIS (n = 32) and healthy individuals (n = 31) were enrolled in the study. Volumetric data from 169 brain regions, acquired from magnetic resonance imaging (MRI) of these individuals, were utilized as predictive factors. A comprehensive analysis was conducted using the twelve most prevalent machine learning algorithms, encompassing thorough parameter adjustments and cross-validation processes. Furthermore, the findings related to variable significance are presented. Results: Among all the algorithms evaluated, the random forest algorithm produced the most favorable results in terms of various classification metrics, including accuracy (0.9083), AUC (0.993), f1-score (0.970), and Brier score (0.1256). Additionally, the most critical variables were identified as the volumetric measurements of the right corticospinal tract, right corpus callosum body, right corpus callosum splenium, right cerebellum, and right pons, respectively. Conclusion: The outcomes of this study indicate that volumetric measurements of specific brain regions can serve as reliable indicators of AIS. In conclusion, the developed model and the significant variables discovered hold promise for predicting scoliosis development, particularly in high-risk individuals.
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BACKGROUND: Flatfoot (pes planus) is a decrease or loss of longitudinal medial arch height. The cause of symptomatic flatfoot occurring in adolescents is still unclear. In this study, the relationship between adolescent pes planus and foot bone shape was investigated. For this purpose, the volume and superficial area data of the foot bones of adolescent individuals with flatfoot deformity and individuals without any foot deformity were compared. METHODS: Between September 2022 and June 2023, 30 individuals with adolescent pes planus with a medial arch angle greater than 145 degrees and 30 individuals without any foot deformity were included in the study. Computed tomography (CT) images of the participants' feet were obtained with a General Electric brand IQ model 32 detector CT device with a section thickness of 0.625 mm in accordance with the bone protocol. Using the 3D Slicer program on CT images, foot bones were segmented and the volume and surface area ratios of each foot bone were determined. RESULTS: Cuneiforme mediale and cuneiforme intermediale volume ratios in individuals with flatfoot deformity decreased by 14% and 24%, respectively, compared with the control group (P<0.05). Cuneiforme mediale and cuneiforme intermediale superficial area ratios were found to be 10% and 30% lower in the flatfoot group compared with the control group, respectively (P<0.05). There was no difference in the volume and superficial area ratios of other foot bones between the groups (P>0.05). CONCLUSIONS: The study results suggest that symptomatic adolescent flatfoot deformity may be associated with developmental anomalies of the os cuneiforme mediale and os cuneiforme intermedium.
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STUDY DESIGN: Cross-sectional study. OBJECTIVE: Pain in individuals with opered scoliosis is usually evaluated with a postural analysis or questionnaire. In this study, we evaluated pain in individuals with scoliosis who underwent spinal correction surgery by tractography and compared it with individuals with non-opered scoliosis and healthy individuals. DESIGN: Fifteen healthy individuals, 15 non-operated scoliosis patients and 15 operated scoliosis patients were included in the study. METHODS: All female participants in this prospectively planned study used their right hand as the dominant hand. Bilateral tractography analysis of the pain pathways was performed with DSI Studio software using brain magnetic resonance images (MRI) of the participants. Statistical analysis of the study was performed with IBM SPSS 23.0 and p<0.05 values were considered significant. RESULTS: It was observed that the tractography values of the operated scoliosis group were similar to the control group (pË0.05). In the non-operated scoliosis group, tractography findings related to nerve conduction velocity such as fiber count, fiber ratio and axial diffusivity (AD) were found to be higher than the other two groups (p<0.05). Fractional anisotropy (FA) values of the unoperated scoliosis group were significantly different between the pain pathways projected from the right/left side of the body (p<0.05). CONCLUSION: The fact that the pain path tractography values of patients with scoliosis who underwent surgery were similar to those of healthy individuals may be evidence of decreased pain sensation reaching the brain. Surgery may be a good choice in the treatment of pain in patients with scoliosis.
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Imagem de Tensor de Difusão , Escoliose , Humanos , Escoliose/cirurgia , Escoliose/diagnóstico por imagem , Feminino , Imagem de Tensor de Difusão/métodos , Estudos Transversais , Adulto , Adolescente , Dor/diagnóstico por imagem , Dor/etiologia , Dor/cirurgia , Adulto Jovem , Estudos ProspectivosRESUMO
It has always been wondered how the muscle volumes of the lumbar region are affected on the convex and concave sides of the curvature in idiopathic scoliosis (IS) and their possible differences compared to healthy individuals. Muscular changes in individuals with IS have generally been tried to be determined by measurements such as muscle cross-sectional area. However, since the changes in the locomotor system in scoliosis affect the anatomical structures of the muscles such as origin and insertion, the reliability of muscle cross-sectional area measurement decreases. Our aim in this study was to compare the psoas major (PM) and quadratus lumborum (QL) muscle volumes, which undergo the most changes on the concave and convex side of the curvature in scoliosis, within themselves and with healthy individuals. 34 women with scoliosis and 29 healthy women were included in this descriptive retrospective study. PM and QL muscle volumes were measured bilaterally on computed tomography (CT) images of individuals in both groups and recorded as mm3. Statistical analysis was performed with IBM SPSS 23.0, P < .05 was considered significant. In the IS group, both PM and QL muscle volumes were greater on the convex side of the curve (P < .001). When the IS group was compared with the control group, both muscle volumes were significantly lower in the IS group bilaterally than in the control group (P < .001). It was observed that individuals with IS developed atrophy in the lumbar muscles of both sides of the curve, mostly on the concave side of the curve, compared to healthy individuals. We think that these results will be important in planning appropriate physical therapy for individuals with IS.
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Escoliose , Humanos , Feminino , Escoliose/diagnóstico por imagem , Estudos Retrospectivos , Região Lombossacral/diagnóstico por imagem , Reprodutibilidade dos Testes , Músculos Psoas/diagnóstico por imagemRESUMO
PURPOSE: It has been suggested that the cause of the balance disorder seen in adolescent idiopathic scoliosis (AIS) originates from the central nervous system. However, the extent of the balance problem and the dysfunction of which part of the central nervous system has not been investigated in detail. This study aimed to correlate the values obtained by balance analysis and cerebellum volume measurement in female individuals with AIS with healthy individuals. METHODS: Cerebellum volume was calculated via the cloud-based software " https://volbrain.upv.es " using brain magnetic resonance images of 27 healthy and 26 individuals with AIS. The duration of stay in the test positions, the movement strategy used during this time and the amount of postural sway were analyzed by using a computer-assisted force platform and compared statistically. RESULTS: Significant differences were found between the AIS and control groups in cerebellum total volume, vermis cerebelli volume (cm3), and trunk oscillation velocity (mm/s) parameters (p < 0.05). Cerebellum and vermis cerebelli volumes were found to be lower and trunk oscillation velocity was found to be greater in patients with AIS. CONCLUSION: Balance problems in patients with AIS are correlated with decreased cerebellum volume and increased trunk oscillation velocity.
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Cifose , Escoliose , Humanos , Adolescente , Feminino , Cerebelo/diagnóstico por imagem , Movimento , Cifose/complicações , Imageamento por Ressonância Magnética/efeitos adversos , Equilíbrio Postural/fisiologiaRESUMO
PURPOSE: The reason behind the balance control disorder seen in adolescent idiopathic scoliosis (AIS) has been suggested as a central nervous system dysfunction, yet it has not been investigated in detail whether this problem originates from sensory, motor, or from both systems. This study aimed to reveal the differences in the pathways that provide proprioceptive sense, motor control, and coordination between these 2 systems in female individuals with AIS. METHODS: Brain Diffusion Tensor Imaging was applied to 30 healthy individuals and 30 Lenke type 1 AIS patients. All of the individuals included in the study were predominantly right-handed and aged between 10 and 18. Diffusion tensor imaging of both groups were performed bilateral tractography on the corticospinal tract (CS tr), medial lemniscus (ML), superior longitudinal fasciculus (SLF), and inferior longitudinal fasciculus (ILF) tracts using DSI Studio software. RESULTS: Significant differences in the parameters of CS tr, ML, SLF, ILF pathways were found between the AIS and the control groups. In the AIS group, significant differences were found in the fiber count and fiber ratio of the ML that carries the proprioceptive sense and CS tr, which is responsible for the somatomotor system. There were also significant differences between the left and right CS tr, ML, SLF, and ILF pathways of the AIS group ( P <0.05). CONCLUSIONS: Differences in the CS tr, ML, SLF, and ILF pathways may trigger muscular asymmetry and cause postural instability and thus spinal deformity in AIS.
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Cifose , Escoliose , Substância Branca , Humanos , Feminino , Adolescente , Criança , Imagem de Tensor de Difusão/métodos , Escoliose/diagnóstico por imagem , EncéfaloRESUMO
PURPOSE: Adolescent idiopathic scoliosis (AIS) is believed to be caused by genetic, neurological, osseous growth anomalies, histological variables including muscle fiber percentage and core structure changes, metabolic and hormonal dysfunction, vestibular dysfunction, and platelet microarchitecture. The objective of this study was to contribute to the determination of the cause of AIS by analyzing the changes in pineal gland volume in AIS cases. METHODS: Study (AIS) and control group were each comprised of 26 patients who met the inclusion requirements. Scoliosis radiograph and MRI of the pineal glands were used for radiological examinations. The distribution of age, gender, Risser grading for skeletal radiological development, and sexual maturation according to Tanner categorization were uniform and statistically insignificant between groups. RESULTS: When the pineal gland volumes of the cases were evaluated according to age, the AIS group was found to have significantly reduced pineal gland volumes in all age groups. The pineal gland volume was found to be 38.1% lower in the AIS group compared to the control group (pË0.001). In the AIS group, patients aged 13 years had the lowest pineal gland volume (77.2 ± 13.86 mm3), while patients aged 15 years had the highest volume (97.9 ± 16.47 mm3). CONCLUSION: Changes in pineal gland volume support the role of the pineal gland in the etiopathogenesis of AIS.
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Cifose , Glândula Pineal , Escoliose , Adolescente , Humanos , Escoliose/patologia , Glândula Pineal/diagnóstico por imagem , Glândula Pineal/metabolismo , Glândula Pineal/patologia , Cifose/complicações , Imageamento por Ressonância Magnética/efeitos adversosRESUMO
BACKGROUND: The aim of this study was to share the clinical results of open calcaneus fractures, which are extremely rare and have become the fearful nightmare of orthopedic surgeons. METHODS: Between June of 2014 and June of 2020, of 196 patients with the diagnosis of calcaneus fracture, Gustilo-Anderson type IIIB, 17 patients (11 men and six women; mean age, 36.2 ± 4.6 years; range, 22-56 years) under prospective follow-up were retrospectively screened and included in the study. Patients were recorded in terms of classification of fracture, mechanism of injury, comorbidities, surgical progress, complications, and associated orthopedic and nonorthopedic injuries. Functional clinical results and quality of life of the patients were evaluated at the 6-month follow-up with the American Orthopedic Foot and Ankle Society score and the 36-Item Short Form Health Survey questionnaire. RESULTS: The most common etiologic factor was work-related injuries, with 29.4%. Although triple arthrodesis surgery was performed in three cases because of pseudoarthrosis, amputation was performed in one case because of deep infection. The most common soft-tissue defect was located at the medial aspect of the foot, which was commonly reconstructed with the used of reverse flow island sural flap. The average total American Orthopedic Foot and Ankle Society hindfoot score was 51.6 (range, 48-74) and similarly, physical component, pain, and social parameters on the 36-Item Short Form Health Survey were statistically significant compared to Turkish population normal scores. CONCLUSIONS: A long and laborious process is required for both the patient and the surgeon in the treatment of open calcaneal fractures. However, it is possible to obtain good results with soft-tissue reconstructions.
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Traumatismos do Tornozelo , Calcâneo , Fraturas Expostas , Masculino , Humanos , Feminino , Adulto , Calcâneo/cirurgia , Sonhos , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Fraturas Expostas/complicações , Fraturas Expostas/cirurgiaRESUMO
BACKGROUND: Ideal suture technique and type in tendon repair are remain unclear. This biomechanical study aimed to assess the biomechanical characteristics of three techniques, modified Kessler (mKE), modified Krackow (mKR), and modified tension Bunnell (mtBU), in sheep Achilles' tendon tear repair using three suture types, polypropylene, polyester, and ultra-high molecular weight polyethylene (UHMWPE) sutures, which are also compared. METHODS: Sixty-three Achilles' tendons harvested from sheep were transversely hacked as a replacement for rupture in a standardized measure and repaired using mKE, mKR, and mtBU techniques with No. 2 polypropylene, polyester, and UHMWPE sutures. Biomechanical parameters, such as Young's modulus, ultimate strength, and strength to the 5-mm gap were recorded for statistical analysis. RESULTS: The mtBU technique with UHMWPE use resulted in increased ultimate strength, strenght to 5-mm gap, Young's modulus, and quantity of specimens with low clinical failure modes compared to other techniques with other suture materials. Furthermore, mtBU has the lowest thickness at the repair side of the tendons. This approach showed tendon failure during maximal traction testing, whereas the mKE and mKR had polyethylene and polyester suture failures. CONCLUSIONS: The UHMWPE suture was significantly superior to the other sutures in each suture techniques in terms of strength and durability. The mtBU technique using UHMWPE suture showed better biomechanical results, implying that this repair might be more appropriate to obtain early mobilization after tendon ruptures.
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OBJECTIVES: The aim of this experimental rat study was to investigate the effectiveness of vitamin B12 (Vit-B12) against the teratogenic effects of nicotine use during pregnancy in the fetus. MATERIALS AND METHODS: Eighteen Wistar-Albino pregnant rats were divided into six groups (n=3, each) as Group 1 (control), Group 2 (Vit-B12), Group 3 (nicotine 3 mg/kg/day), Group 4 (nicotine 3 mg/kg/day + Vit-B12), Group 5 (nicotine 6 mg/kg/day) and Group 6 (nicotine 6 mg/kg/day + Vit-B12). Nicotine was administered subcutaneously and Vit-B12 was administered intraperitoneally for 20 days. The skeletal systems of the embryos were stained using the double-staining method. The total bone length (TBL), the length of the ossified part, and the ossification rate were calculated using the ImageJ program. In addition, the weight and crown-rump length (CRL) of the embryos were measured and recorded. RESULTS: Clinical shock effect was observed in all rats administered nicotine. A significant decrease in weight, CRL, and TBL was measured in Group 3 (p=0.0081) and, particularly in Group 5 (p=0.026), which were given only nicotine, compared to other groups. In the morphometric measurements of Group 4 and Group 6 to which Vit-B12 was added, values close to the control group were measured (p=0.173). The data of Group 6 were statistically significantly larger than Group 5 (p=0.007), while it was statistically smaller than Group 1 (p=0.0038). CONCLUSION: Nicotine use negatively affects the morphological development of the embryo. On the other hand, Vit-B12 provides benefits in reducing these negative effects.
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Nicotina , Vitamina B 12 , Animais , Desenvolvimento Ósseo , Feminino , Feto , Nicotina/toxicidade , Gravidez , Ratos , Ratos Wistar , Vitamina B 12/farmacologiaRESUMO
OBJECTIVE: Patients with adolescent idiopathic scoliosis (AIS) may face motor control problems and health disability barriers during mandibular movements and chewing. However, studies investigating the extent of these disadvantages, and possible associated factors are quite limited in patients with AIS. This study was conducted to gain a deeper perspective on the effect of AIS on temporomandibular disorders (TMD) and to contribute to the small amount of data on this subject. METHODS: Twenty-nine patients with AIS and 29 age- and sex-matched asymptomatic controls participated in this cross-sectional study. Cobb's method was used to measure scoliosis curves. In both groups, the volume of the masseter muscle was determined on magnetic resonance imaging, and Helkimo and Fonseca anamnestic indexes were used to evaluate temporomandibular joint (TMJ). RESULTS: It was observed that the TMD symptoms were higher in the AIS group (22.6- Helkimo and 1.2 - Fonseca) than the asymptomatic group (13.6 - Helkimo and 0.7 - Fonseca). There was no significant asymmetry in masseter volume in patients with AIS, however the volume of the masseter muscles was smaller in the AIS group (R = 14.6/L = 13.6) compared to the control group (R = 16.1/L = 16.2). CONCLUSIONS: The study results indicate that spinal curvatures affect the anatomical, biomechanical, and kinesiological features of the masticatory system, and individuals with AIS may experience more chewing problems than asymptomatic individuals. Examining musculoskeletal properties of masticatory system can provide information about the limitation of the TMJ in patients with AIS.
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Escoliose , Transtornos da Articulação Temporomandibular , Adolescente , Estudos Transversais , Humanos , Músculo Masseter , Mastigação/fisiologiaRESUMO
In this case report, we present the case of a 20-year-old male patient who suffered from pain in walking clinically, and in whom an extremely rare type of brachymetatarsia was diagnosed. Although distorted body image is the main reason for consulting a specialist, the patient presented because he was unable to find a proper shoe. The patient had no familial history of brachydactyly, trauma, or a genetic disorder. In this extremely rare case, the decision was made to perform shortening of the normal foot ray with a double osteotomy to the metatarsal and proximal phalanx. At the end of the follow-up period, the patient was walking pain-free and had no limitation in shoe choice.
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Deformidades Congênitas do Pé , Ossos do Metatarso , Adulto , Deformidades Congênitas do Pé/diagnóstico , Deformidades Congênitas do Pé/cirurgia , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Osteotomia , Dor , Caminhada , Adulto JovemRESUMO
BACKGROUND: While parachute jumping, soldiers may suffer minor or life-threatening injuries in various parts of the body. Several trauma scoring systems assess the severity of such injuries. The primary goal of this study was to assess clinical characteristics and the severity of orthopaedic, musculoskeletal, and other injuries from military training-related parachute jumping using two trauma scoring systems (AIS and ISS). Our secondary goal was to assess whether there was an increase in injury rates with age. METHODS: In total, 185 military personnel between 19 and 51 years old who were injured as a result of daytime static parachute jumping during 44 months between January 2016 and August 2019 were included in the study. Demographic data; vital signs; the level of consciousness; the Glasgow Coma Scale; ISS trauma region classifications; anatomical injury sites; AIS and ISS scores; diagnoses; treatment methods; hospitalization status; and duration of hospital stay were examined descriptively. RESULTS: There were 184 male and one female participant. The most commonly injured body site was the foot (33.5%), and the most common diagnosis was soft tissue trauma (64.3%). The most commonly injured body site was the foot (33.5%), and the most common diagnosis was soft tissue trauma (64.3%). Regarding treatment methods, 51.4% received analgesic pills and cold pack application, 42.7% received a plaster splint, and 5.9% had orthopaedic surgery. The mean ISS score was 5.16 ± 3.92. The hospitalization rate was significantly higher for patients with a critical AIS score than those with a severe AIS score (p < 0.001). CONCLUSIONS: The use of trauma scoring systems to assess injury severity among patients admitted to an ED due to a parachute jumping injury may facilitate treatment selection. We found that AIS and ISS were useful in determining injury severity. Therefore, we recommend the use of trauma scoring systems for assessing the injury severity and the therapeutic approach, and we advocate for the use of the 17 anatomical regions we used in this study. We also found that with increasing age, the severity of injury could increase.
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Aviação , Militares , Sistema Musculoesquelético/lesões , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo , Índices de Gravidade do TraumaRESUMO
OBJECTIVES: This study aims to compare the clinical and functional results of intertrochanteric femoral fractures treated with bipolar hemiarthroplasty (BHA) or proximal femoral nailing (PFN) in elderly patients. PATIENTS AND METHODS: This multicenter, prospectively followed-up, retrospectively compared cohort-type study included 308 patients (81 males, 227 females; mean age 78.4±7.2 years; range, 65 to 95 years) who were treated with BHA or PFN for intertrochanteric fractures by five orthopedic surgeons in four provinces and seven clinics between January 2014 and May 2018. Clinical follow-up was performed at third week, third and sixth months, and at the end of the first and second years. The American Society of Anesthesiologists for preoperative status, Singh index for bone quality, and Harris Hip Score (HHS) for functional outcomes were evaluated. RESULTS: While 156 patients (38 males, 118 females; mean age 77.7±5.9) were treated with BHA, 152 patients (43 males, 109 females; mean age 79±6.1) were treated with PFN. While there was no significant difference between the two groups in terms of total HHS, a significant difference was found in the sub-parameters (p<0.001). Good and excellent results were found in 78.2% of BHA and 86.2% of PFN patients. Mortality rates were similar at the end of two years (14% and 13.6%, respectively). CONCLUSION: In general, clinical and functional outcomes of BHA and PFN are similar. The rates of pulmonary embolism and deep vein thrombosis are significantly higher in BHA. However, BHA is advantageous in terms of operation time and early weight bearing compared to PFN.
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Fixação Intramedular de Fraturas , Hemiartroplastia , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Hemiartroplastia/efeitos adversos , Humanos , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: We aimed to evaluate the choroidal thickness (CT) in patients with adolescent idiopathic scoliosis (AIS) using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: In this cross-sectional, observational comparative study, 56 eyes of 56 patients with AIS and 56 eyes of 56 age- and sex-matched healthy subjects were included. All participants underwent complete ophthalmologic examination and CT measurements at the fovea and at 750 µm intervals from the fovea to 1,500 µm in the nasal and temporal site obtained by spectral domain EDI-OCT. RESULTS: The mean subfoveal CT was lower in the AIS patients (285.2 ± 24.4 µm) than that of the controls (313.2 ± 28.8 µm; p < 0.001). The difference was also significant at all extrafoveal measurement points (p < 0.001 for all). There were negative correlations of CTs at subfoveal and extrafoveal locations with the Cobb's angle in the AIS patients (for subfoveal location: r = -0.71 and p < 0.001; and for extrafoveal locations: r = -0.66 and p < 0.001 at 750 µm in the nasal side; r = -0.64 and p < 0.001 at 1,500 µm in the nasal side; r = -0.71 and p < 0.001 at 750 µm in the temporal side; and r = -0.69 and p < 0.001 at 1,500 µm in the temporal side). CONCLUSION: This preliminary study showed that AIS patients have thinner CT compared to that of healthy subjects. The lower CT was correlated with the increased angle of scoliosis.
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Corioide/diagnóstico por imagem , Doenças Retinianas/diagnóstico , Escoliose/complicações , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adolescente , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Doenças Retinianas/etiologia , Estudos Retrospectivos , Escoliose/diagnósticoRESUMO
OBJECTIVES: This study aims to investigate whether the motor cortex (MC) or the somatosensory cortex (SC) is more active during the course of bone healing after traumatic brain injury (TBI). MATERIALS AND METHODS: Thirty-three male Wistar albino rats (age, 8 to 10 months; weighing, 250 to 300 g) were randomized into three groups as the control group, MC damage group and SC damage group. Two rats from each brain damage group were sacrificed to verify the locations of the cortical injuries. Callus formation, callus/diaphysis ratios, and serum alkaline phosphatase (ALP) levels were measured at one, three and six weeks. RESULTS: The increases in callus masses in the control, MC, and SC groups were statistically significantly different between one and three weeks (p<0.05). Although this increase in the MC and SC groups was significant compared to the control group at the end of one week, no statistically significant difference was found between the MC and SC groups (p>0.05). There was a statistically significant difference in callus/diaphysis ratio between control, MC and SC groups in favor of MC group only at one week (p<0.05). The increase in serum ALP levels at three weeks was statistically significantly different in the MC and SC groups compared to the control group and significantly higher in the MC group compared to the SC group (p<0.05). CONCLUSION: There is a possible relationship between enhanced fracture healing after TBI and damage in the MC. Motor cortex plays a more active role on fracture healing in TBI.
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Lesões Encefálicas Traumáticas/fisiopatologia , Fraturas do Fêmur/fisiopatologia , Animais , Calo Ósseo/fisiopatologia , Lesões Encefálicas Traumáticas/complicações , Diáfises/fisiopatologia , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Consolidação da Fratura , Masculino , Modelos Animais , Traumatismo Múltiplo/fisiopatologia , Osteogênese , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
BACKGROUND: Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. A second hip fracture can occur in elderly patients who have already suffered an initial hip fracture. The aim of this study was to investigate possible risk factors for second hip fractures in elderly patients with hip fractures. METHODS: Between 2010 and 2014, 230 patients who underwent uncemented bipolar hemiarthroplasty for hip fractures were retrospectively analyzed. The patients were divided into two groups: those with a first hip fracture (group 1) and those with a second hip fracture (group 2). RESULTS: The mean time from the first hip fracture to second hip fracture was 22 months. There were no significant differences in the American Society of Anesthesiologist scores, comorbidities were observed in the two groups. The mean length of hospitalization was not significantly different between the two groups. The mean postoperative functional scores after second hip fractures were significantly lower in group 2 than in group 1. CONCLUSIONS: Although there are not certain risk factors for second hip fractures in elderly patients with hip fractures, to prevent second hip fractures, elderly patients should be provided with physical and medical therapy as well as orthotic support and their functional activity should be maintained.
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Kirschner wire (K-wire) is one of the commonly used implants in orthopaedics practice. Migration of the wire is one of the most frequently reported complications after fixation by the K-wire. In particular, it has been reported that a greater range of motion in the shoulder, negative intrathoracic pressure associated with respiration, gravitational force, and muscular activities may cause migration from the upper extremities. In general, thin and long foreign bodies with smooth surfaces that are localized within the tendon sheath and at an upper extremity can migrate more readily and can reach longer distances. Here, we present a patient with long-term migration of a broken K-wire who underwent fixation for acromioclavicular joint dislocation 5 years ago.