Midterm Donor Site Morbidity After Vascularized Free Fibula Flap Harvesting.

BACKGROUND: Vascularized fibula grafts (VFGs) have become one of the most preferred grafts for the reconstruction of bone defects. However, despite the many advantages over other graft options, recipient and donor site morbidities are also common. Donor site morbidity has been reported at rates ranging from 5% to 67%. The aim of this study was to present a single-center series examining the clinical, functional, and radiologic aspects of donor site morbidity following VFG harvesting. METHODS: The study included 69 patients who underwent biological reconstruction with VFG for bone tumors, avascular necrosis of the femoral head, or bone defects after trauma. Patients were evaluated functionally, clinically, and radiologically for donor site morbidity. RESULTS: Donor site morbidity was observed in 33 of 69 patients (48%). The most complications were sensation deficits around the feet and ankles (20 of 69; 29%). Knee laxity was more common in patients who underwent osteoarticular fibular resection (P = .006). CONCLUSION: We found VFG to be an effective method for the reconstruction of large bone defects, but associated with a relatively high rate of complications. Complications requiring surgical intervention were rare and the majority of patients did not have long-term functional limitations. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Is radiological rotation measurement affected by the fracture pattern in pediatric supracondylar humeral fractures?

BACKGROUND: In supracondylar humerus fractures (SCHF), the most frequently used method to calculate rotation is the Gordon lateral rotation percentage (GLRP) defined by Gordon et al. However, this technique includes only typical fractures (49%-80% of all fractures) from the Johns Hopkins (J-H) fracture classification system. PURPOSE: The aim of the study was to investigate (1) is Gordon criteria useful for John Hopkins subgroups of supracondylar fractures and (2) is Gordon criteria affected by internal and external rotation. MATERIAL AND METHODS: This study was designed using four pediatric left humerus bones obtained from the Sawbone© company. For each bone, an osteotomy was made to mimic each of the J-H coronal fracture patterns. The cut bones were placed in a wooden rotation apparatus. The GLRP measurements were taken by five blinded observers. RESULTS: In the repeated measurements of the observers, <20° rotation typical and <30° medial oblique and lateral oblique fracture pattern were measured as within the limits of an acceptable amount of rotation according to the Gordon criteria. However, for high fracture pattern (HFP), ≤30° internal rotation and <60° external rotation were determined to be within the acceptable rotation criteria according to the Gordon criteria. CONCLUSIONS: All fracture patterns have different characteristics; however, based on the data of this study, the Gordon criteria can be used safely for typical, medial oblique, and lateral oblique fracture patterns but it is necessary to lower the acceptable rate of 50% for HFP.

Foot and Ankle Forklift Injuries; Diagnosis to Treatment Options, Return to Work and Functional Outcomes.

As our tertiary-level trauma center is close to an industrial zone and associated international port, industrial injuries are seen more often than is expected in routine practice. The aim of this study was to present the demographic data, treatment options, and changes in work-life of patients with foot and ankle injuries due to a forklift accident, and to determine the factors affecting the clinical outcome. The study was conducted in our university hospital and included patients who presented with a foot and ankle injury resulting from a forklift accident. Data were collected including age, sex, dominant extremity, history of trauma, presence of fracture, management (surgical or conservative), complications, time of return to work, workforce loss, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Short Form Health Survey (SF-36) scores at the final follow-up examination. Evaluation was made of 132 patients, comprising 113 (85.6%) males and 19 (14.4%) females with a mean age of 32 years (range 16-65 years). The most frequently recorded occupational group was shipyard workers (50%). The most common mechanism of injury was crushing under the forklift wheel (n = 63, 47.7%). The most frequently injured foot region was the forefoot (47%). A total of 90 (68.1%) patients continued to work in the same position on return to work. The lowest mean AOFAS score (73.4) and SF-36 (physical component) score (37.3) were determined in cases with mixed region injuries (p = .0001, p = .0001). The wearing of protective footwear had no effect on the rate of return to work (p = .195), workforce loss (p = .34) and AOFAS score (p = .166). This study is the largest series of patients with foot and ankle injuries related to forklift accidents. Forklift injuries can be treated conservatively or surgically according to the clinical condition of the patient. The main indicators of return to work and functional outcome are which foot region is injured and whether or not the injury causes a fracture.

An unusual injury pattern: arm wrestling injury, treatment modalities, clinical outcomes, and return to sport.

BACKGROUND: In the sport of arm wrestling, the great rotational force is applied to the upper extremity, which can result in muscle and tendon injuries in the shoulder, elbow, and wrist joints, and even bone fractures. The aim of this study was to present the treatment modalities, functional outcomes, and return to sport after arm wrestling injuries. METHODS: A retrospective evaluation was made of the trauma mechanisms, treatment modalities, clinical outcomes, and time of return to sports of patients admitted to our hospital with an arm wrestling injury between 2008 and 2020. At the final follow-up examination, the functional scores (DASH score and constant score) of the patients were evaluated. RESULTS: Evaluation was made of 22 patients comprising 18 (82%) males and 4 (18%) females with a mean age of 20±6.1 years (range, 12-33 years). Two (10%) patients were professional arm wrestlers. The DASH scores at the final follow-up (mean 4 years) examination were 0.57 (min: 0 and max: 1.7) for the patients with humerus shaft fracture. All the patients with isolated soft-tissue injuries returned to sports within 1 month. Patients with humeral shaft fractures returned to sports later and had a lower functional score (P<0.05). There was no disability in any patient during long-term follow-up. Patients with soft-tissue injuries continued arm wrestling more than patients with bone injuries (P<0.001). CONCLUSION: This study constitutes the largest patient series evaluating patients presenting at a health-care institution with any complaint after arm wrestling. Arm wrestling is not a sport that only results in bone pathologies. Therefore, providing the participants in this sport with information that they may be injured in arm wrestling but there will be a full recovery, may reassure and encourage them.

Staged Management of Infection with Adjustable Spacers After Megaprosthesis Implantation in Primary Sarcoma Patients.

Background: While periprosthetic joint infection has always been a significant concern for orthopaedic surgeons, the rate of infection is five to ten times higher after tumor prosthesis implantation. With the growing use of mega-implants, the number of these infections has also increased. We aimed to investigate the results of our patients with a primary malignant musculoskeletal tumor, who underwent two-stage revision surgery for an infected mega-prosthesis. We also presented the emerging complicatons and required soft tissue reconstruction procedures. Methods: The study included 32 primary bone and soft tissue sarcoma patients who underwent a two-stage revision procedure for infection. After a rigorous bone and soft tissue debridement procedure at the first stage, antibiotic-loaded bone cement was wrapped around a cloverleaf type intramedullary nail and inserted into the forming gap. After a minimum of 6 weeks of antibiotic therapy, depending on patients' clinical signs and serum infection markers, the reimplantation stage was undertaken. Results: The mean oncologic follow-up period was 28 months (range 5-96 months). During this period, 11 patients died because of non-infection related causes, 12 patients were alive with their disease, whereas 9 patients were totally free of their oncologic condition. The infection was eradicated in all survivors except one patient, where a high-level transfemoral amputation became necessary. Conclusion: Periprosthetic infection after tumor proshesis implantation in cancer patients can be managed with same principles as conventional arthroplaty procedures, taking care that they are immunocompromised and vulnerable patients and their bone stock loss is significant which makes surgical options more challenging.

Supracondylar Humerus Fractures in Infants and Early Toddlers; Characteristics, Clinical and Radiological Outcomes Compared with Older Children.

BACKGROUND: Supracondylar humerus fractures (SCHF) are rarely seen in the youngest age groups (1-3 years). Although there is no difference in the context of treatment options, it has been shown that younger age groups have different characteristics. Few studies have examined toddlers, which have notably different characteristics. This study is the first to report the characteristics, diagnosis, treatment and functional results of SCHF in infants and early toddlers. METHODS: A retrospective analysis was made of the data of patients younger than 30 months old, who were operated on in our clinic for SCHF between 2012 and 2020 with at least 2 years of follow-up. Patient demographic and surgical data, and the functional and radiological results were documented. RESULTS: Evaluation was made of a total of 52 patients comprising 30 females (58%) and 22 males (42%), with a mean age of 20.75 ± 5.4 months (range, 6-30 months). The injury was in the right elbow in 24 (46%) patients. The mechanism of injury was a fall from an object at home (table, chair, bed, etc.) in 41 (79%) patients. Patients who fell from a height of more than 4 meters had additional injuries (liver laceration, vertebral fracture, etc.). Only 1 patient had anterior interosseous nerve (AIN) damage before the operation, but the final follow-up neurovascular examinations for all patients were normal. The median follow-up period was 4 years (range, 2-7 years). Flynn outcome scores were (88.5%) excellent and variant Hospital for Special Surgery scores were (82.7%) excellent. CONCLUSIONS: With appropriate treatment of SCHF, the clinical outcomes in infants and early toddlers are excellent. Using a medial pin to achieve and protect stability in this age group does not increase the risk of iatrogenic ulnar nerve damage. Patients younger than 20 months tend to have more varus malalignment but similar functional results.

Floating phalanx; simultaneous double dislocation of the interphalangeal joint in a finger: A case report and literature review.

Isolated proximal and distal interphalangeal joint (DIPJ) dislocations are widely seen as a result of sporting injuries and major trauma. The combination of dorsal dislocation of the DIPJ in the same finger concomitant to traumatic dorsal dislocation of the proximal interphalangeal joint (PIPJ) is a rarely seen injury. The case is, here, presented of a 65-year-old female patient with proximal and DIPJ dislocation of the right-hand ring finger accompanied by volar and dorsal plate injuries in the proximal and distal joints. With this case, it was aimed to introduce a new term of 'floating phalanx' into medical literature. The treatment was applied to the patient of closed reduction under peripheral block and the application of an aluminium finger splint in semiflexion. In a 24-month follow-up period, the 4th finger of the patient was observed to be stable and has pain-free range of movement. This case is an uncommon case of volar and dorsal plate avulsion fractures with PIPJ and DIPJ dorsal dislocation treated successfully with closed reduction and conservative treat-ment with excellent functional results.

Does Unplanned Soft Tissue Sarcoma Surgery Have a Negative Effect on Prognosis?

BACKGROUND: We aimed to compare the oncological outcomes of patients who underwent re-excision following unplanned surgery and those who underwent planned surgery. METHODS: Patients who were referred to our hospital after a mass was inappropriately resected and reported to have a malignant pathology with a positive surgical margin, as well as patients diagnosed with malignant soft tissue tumors, and operated on following a multidisciplinary assessment and staging between 2012 and 2018. All patients were followed up at least 6 months. RESULTS: Our study included a total of 125 patients. Forty percent (n = 50) underwent unplanned excision and sixty percent (n = 75) underwent planned excision.There was no statistically significant difference in the survival curves between the two groups (p = 0.248). Tumor size was larger, and the rate of deep-localized tumors was higher in patients undergoing planned surgery than in the unplanned surgery group (p = 0.001). The rate of tumors localized in the upper extremities was significantly higher in the unplanned surgery group than in the planned surgery (p = 0.033). MRI examinations could detect residual tumors with an accuracy of 80%. Age (>48 years), tumor size (>8 cm), tumor grade (grade 3), and distant organ metastasis at follow-up, which were among risk factors found to have a significant effect on mortality. CONCLUSION: Patients undergoing re-excision after an inappropriate resection and undergoing planned resection had a similar prognosis. Superficial, upper extremity-localized, and relatively small-size tumors are more prone to inadequate surgical resection. MRI can be used to detect residual tumors at a high rate in patients who have undergone unplanned surgery. Distant organ metastasis is the most important factor affecting survival.

Prediction of soft tissue coverage following distal femur bone sarcoma resection: A preliminary report.

We aimed to examine the predictability of the need for soft tissue reconstruction during limb-sparing surgery through preoperative magnetic resonance (MR) imaging in patients diagnosed with a malignant bone tumor in the distal femur. The study included 42 patients who were operated for a bone sarcoma of the distal femur at our clinic between 2016 and 2018. The recorded parameters included the demographic characteristics of the patients, tumor diagnosis, tumor side, total tumor volume, tumor soft tissue component volume, tumor soft tissue component volume-to-total tumor volume ratio, tumor localization by MR imaging, the need for soft tissue reconstruction, the muscles used for soft tissue reconstruction, the biopsy site, and the biopsy type. Tumor volume was calculated on MR imaging of the distal femur region performed before surgery. Our study established cut-off values for soft tissue reconstruction need following resection as a total tumor volume of 96.4 cm3 , a tumor soft tissue component volume of 22 cm3 , a tumor soft tissue component volume-to-total tumor volume ratio of 48.9%, and tumor localization in two different regions on axial distal femoral MR images. Considering these cut-off values, by calculating tumor volume values preoperatively we can predict the need for rotational muscle flaps for soft tissue coverage following distal femur bone sarcoma resection and endoprosthesis reconstruction. Anticipating the need for soft tissue reconstruction may affect the duration and success of the operation.

Is bipolar hemiarthroplasty an appropriate type of hip articulation following proximal femoral or total femoral resections for musculoskeletal malignancies?

BACKGROUND: Different approaches are applied for reconstruction in patients with a musculoskeletal malignancy which require a proximal femoral or total femoral resection. We aimed to evaluate the treatment outcomes of patients who underwent a proximal femoral or total femoral resection due to bone and soft tissue tumors and had an endoprosthetic reconstruction by a bipolar hemiarthroplasty type of hip articulation. METHODS: We retrospectively identified 133 patients who underwent a proximal femoral or total femoral endoprosthetic replacement after resection of a bone or soft tissue malignancy. There were 74 male and 59 female patients, with a mean age of 55.02 ± 16.92 years (range 11-84 years) and a median follow-up of 24.47 ± 24.45 months (range 6-164 months). Patient demographics, surgical, and oncological data were recorded. Acetabular wear was measured using the classification proposed by Baker. Functional assessment was performed using the Musculoskeletal Tumor Society (MSTS) functional score. RESULTS: There was no statistically significant difference among primary diagnostic groups in terms of gender, prosthesis type, trochanter major resection, local recurrence, complication/revision rate, and MSTS Score (p > 0.05, for each parameter). On the other hand, a statistically significant difference was detected in terms of degree of acetabular erosion among diagnostic groups (p < 0.001); the acetabular erosion rate (AER) was found to be lower in patients with metastatic carcinoma than in patients with a diagnosis of primary bone or soft tissue sarcoma. The univariable analysis revealed that the effect of age, primary diagnosis, localization, follow-up time, and presence and number of distant organ metastasis variables on AER were found to be statistically significant (p = 0.018, p = 0.035, p = 0.002, p = 0.007, p = 0.031, p = 0.040, respectively). CONCLUSION: In patients who undergo a proximal femoral or a total femoral resection due to a musculoskeletal tumor, bipolar hemiarthroplasty is an adequate type of hip articulation method, since it does not affect the revision requirements and functional outcomes of patients with acetabular erosion.

Is physical examination as effective as magnetic resonance imaging in the diagnosis of suspected pediatric scaphoid fractures?

OBJECTIVE: The aim of this study was to evaluate whether careful physical examination is as effective in diagnosis as magnetic resonance imaging (MRI) in pediatric patients with suspected scaphoid fractures and whether radiography is sufficient in the follow-up of these patients. METHODS: This prospective study included patients with tenderness of the anatomic snuffbox on physical examination and no fracture on radiography between 2015 and 2019, and the data were evaluated retrospectively. A short-arm thumb spica casting was applied for an initial diagnosis of suspected scaphoid fracture. MRI was performed within 1 week after initial trauma. Physical examination and X-rays at 2-week intervals were applied during the follow-up period. The functional outcomes were evaluated using the Modified Mayo Wrist score. RESULTS: A total of 92 patients (28 girls and 64 boys; mean age: 12.32±2.22 years) were diagnosed with suspected scaphoid fracture on physical examination and MRI was performed. The MRI confirmed the suspected scaphoid fracture at the rate of 77.2% (n=71). The sensitivity obtained for the radiograph was 14.08%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 25.61%. The mean Modified Mayo Wrist score was 92.43±2.64 (range, 85-98). CONCLUSION: Detection of tenderness on the anatomic snuffbox without determination of fracture radiographically should be evaluated and treated in favor of a scaphoid fracture. These fractures are mostly treated successfully with conservative treatment.

Effect of hand dominance on functional outcomes in paediatric patients with flexor tendon injuries: A cross-sectional study.

INTRODUCTION: There are limited data in the literature about the short- to mid-term results of children with flexor tendon injuries. We aim to evaluate the short- to mid-term functional outcomes of children with flexor tendon injuries and to disclose whether the injured side affects the results. MATERIALS AND METHODS: Patients who had undergone primary flexor tendon repair were included in the study. The demographic and clinical characteristics of the patients were recorded. Modified Hand Injury Severity Score was calculated for each patient. Sensory, motor and functional assessments of the bilateral hand were performed. RESULTS: A total of 44 patients (female = 16, male = 28) with a median age of 13 (6-17) were evaluated. Significant differences between the affected and healthy hands of the patients in terms of grip and pinch strengths and monofilament sensory test results were demonstrated while the Jebson Taylor Hand Function Test (JTHFT) scores were similar. No factor other than the injury side was found to be related to the affected hand functions. In patients with dominant hand injuries, JTHFT results of the affected hands were similar to the results of healthy dominant hands (P = .935). However, JTHFT results were found to be worse in the affected non-dominant hands compared to healthy non-dominant hands (P = .01). CONCLUSION: This study demonstrated that paediatric population with flexor tendon injuries in their dominant hands has better short- to mid-term functional outcomes. These results may be attributed to use their injured dominant hand more actively in daily activities.

The impact of pathological fractures on surgery, morbidity, functional and oncological outcomes in patients with primary bone sarcomas.

Background Although rare, pathological fractures may occur in primary bone sarcomas. There have been studies reporting that such patients have a poorer prognosis than those without a pathological fracture. This study investigates the impact of pathological fractures on surgery, morbidity, functional and oncological outcomes in patients with primary bone sarcomas. Patients and methods A retrospective analysis of 568 patients with primary bone sarcomas, treated between 2005 and 2019, was performed. The study included 41 patients with a pathological fracture and 51 control patients who did not have a pathological fracture. A multivariate Cox regression analysis was used to investigate the impact of pathological fractures and further independent variables on amount of intraoperative bleeding, duration of surgery, number of muscles and major neurovascular structures included in resection, tumor volume, surgical volume, Musculoskeletal Tumor Society (MSTS) functional score, postoperative complication rate, and local recurrence, distant metastasis, and survival rates. Results There were 36 (39%) female and 56 (61%) male patients. No statistically significant difference was noted in tumor volume, tumor/surgical volume percentage, number of major neurovascular structures included in resection, postoperative complication rate, and local recurrence, distant metastasis, and survival rates between the two groups (p > 0.05). A significantly higher amount of intraoperative bleeding and number of transfused blood components, a longer duration of surgery, and a higher amount surgical volume and number of resected muscles were detected in Group 1 compared to Group 2 (p=0.001, p=0.002, p=0.007, p=0.007, p < 0.001, respectively). The MSTS functional scores were lower in patients with a pathological fracture than in those without a pathological fracture (p=0.001). Conclusion We conclude that a pathological fracture through a primary bone sarcoma has no adverse effect on prognostic factors such as local recurrence, distant metastasis, and survival. However, pathological fractures increase the amount of intraoperative bleeding and surgical volume and result in a longer surgery, in addition to decreased functional outcomes.

Indications of amputation after limb-salvage surgery of patients with extremity-located bone and soft-tissue sarcomas: A retrospective clinical study.

OBJECTIVE: This study aimed to investigate amputation-related factors after limb-salvage surgery (LSS) in patients with extremity-located bone and soft-tissue sarcomas and determine the relationship between these factors and patient survival. METHODS: In this retrospective study at our institution, patients in whom LSS was first performed because of an extremity-located musculoskeletal sarcoma, and subsequently amputation was carried out for various indications were included. Patient and tumor characteristics, details of surgical procedures, indications of amputation, number of operations, presence of metastasis before amputation, and post-amputation patient survival rates were analyzed. RESULTS: A total of 25 patients (10 men, 15 women; mean age=41.96±21.88 years), in whom amputation was performed after LSS as initial resection of an extremity sarcoma or re-resection(s) of a local recurrence, were included in the study. The leading oncological indication for amputation was local recurrence that occurred in 18 (72%) patients. Non-oncological indications included prosthetic infection in 5 (20%), mechanical failure in 1 (4%), and skin necrosis in 1 (4%) patient. The patients underwent a median of 2 (range, 1-4) limb-salvage procedures before amputation. Distant organ metastasis was detected in 22 (88%) patients during follow-up; in 13 (52%) of these patients, metastasis was present before amputation. A total of 11 (44%) patients were alive at the time of study with no evidence of the disease (n=3) or with disease (n=8), and 14 (56%) patients died of disease. The mean overall and post-amputation survival were 47±20.519 (range, 11-204) months and 22±4.303 (range, 2-78) months, respectively. The median follow-up was 27 (range, 6-125) months. CONCLUSION: The most common causes of amputation after LSS were local recurrence and prosthetic infection. Patients who underwent amputation after LSS developed a high rate of distant organ metastasis during follow-up and had reduced survival. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Pelvic Ring Reconstruction After Iliac or Iliosacral Resection of Pediatric Pelvic Ewing Sarcoma: Use of a Double-Barreled Free Vascularized Fibular Graft and Minimal Spinal Instrumentation.

BACKGROUND: In patients undergoing iliosacral resections, pelvic ring reconstruction can maintain stability of the pelvis and spinal column, which is expected to achieve good functional outcomes. However, no optimal reconstruction method has been established. We aimed to analyze the outcome of pelvic ring reconstruction using double-barreled free vascularized fibular graft (FVFG) and internal fixation after iliosacral resections in children. METHODS: We retrospectively reviewed 16 children with pelvic Ewing sarcoma who underwent pelvic ring reconstruction using double-barreled FVFG after iliosacral resection. The fibular graft was placed between the supraacetabular region distally and the remaining ilium or sacrum proximally. The stability of the remaining pelvis and spinal column was provided by minimal spinal instrumentation. RESULTS: Eleven Type-I and 5 Type-I+IV resections were performed for 10 boys and 6 girls, who had a mean age of 13.4 years (range, 10 to 18 years). The mean follow-up was 49.8 months (range, 28 to 96 months). At the time of the final follow-up, 14 patients were alive and 2 patients had died of disease. The mean time for bone union was 9 months (range, 6 to 12 months). Graft hypertrophy was evident in all patients at 12 months. The median Musculoskeletal Tumor Society (MSTS) score at the time of the final follow-up was 80% (range, 60% to 96.6%). Seven patients had complications. Three complications required reoperation: 1 deep infection, 1 hematoma, and 1 wound dehiscence. Three patients had disease relapse in terms of lung metastases. CONCLUSIONS: This reconstruction method can achieve a high rate of bone union and can provide good functional outcomes following resection of pediatric pelvic Ewing sarcomas with iliosacral involvement. Complications are usually manageable without a need for revision surgical procedures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Soft tissue sarcoma of the upper extremity: oncological and functional results after surgery.

This retrospective study evaluates outcomes after treatment of upper-extremity soft tissue sarcoma in 44 patients. We re-resected 19 tumours that had been resected elsewhere without adequate preoperative planning, and we made 25 well-planned primary resections. Four patients in the unplanned group and five in the planned group eventually received amputations. Thirty-three patients were alive at a median follow-up time of 33 months (IQR 18 to 57). Tumour size > 7 cm, tumour Grade 3 and the presence of distant organ metastases were the main factors affecting the oncological outcomes. We found no statistical differences between the planning groups. Functional outcomes and quality of life were significantly worse after amputation or major nerve resections. We conclude with this sized sample that the lack of planning in itself did not influence the final results, but there were differences in tumour size, grade and localization between the groups that may play a role.Level of evidence: IV.

Factors affecting postmusculoskeletal tumour surgery wound problem treatment with negative pressure wound therapy.

The aim of the study is to investigate the risk factors identified in literature that have been associated with prolonged Negative Pressure Wound Therapy (NPWT). Our study included patients who developed local wound problems after bone or soft tissue sarcoma surgery with negative margin at our clinic between 2012 and 2018 and treated with NPWT. All patients were followed up of at least 6 months. Sex, albumin level, skin infiltration, type of wound problem, postoperative intensive care unit (ICU) requirement, and intraoperative blood loss were found to be influential factors on NPWT > 10 sessions. We conclude that treatment may be prolonged and the necessary precautions need to be taken in patients with an impaired preoperative nutritional condition, with intraoperative high amount of blood loss, and with long postoperative stays in the ICU as well as if the underlying cause for wound problem is an infection.

Locked Traumatic Pisiform Dislocation: A Case Report.

CASE: A 32-year-old man presented to the emergency department with several carpal bone fractures and a locked distal pisiform dislocation after trauma. Treatment consisted of open surgical and reduction, osteosynthesis with a single Kirschner wire, and ligament repair. The patient's functional outcome was excellent, and his Mayo wrist score was 90 at 36 months after injury. CONCLUSIONS: Pisiform dislocations may be difficult to diagnose because anteroposterior and lateral radiographs may not be sufficient to visualize the injury. A 30° semisupinated wrist x-ray and computed tomography can be helpful. A satisfactory clinical result may be achieved if distal pisiform dislocations are detected early and managed surgically with open reduction and ligament repair.

Is saphenous nerve radio frequency an effective treatment for advanced gonarthrosis in elders with cardiac comorbidity?

BACKGROUND: Pulsed radiofrequency (PRF) used for knee pain originating from osteoarthritis is one of these methods. OBJECTIVES: The aim of the study was to evaluate the knee functional status and pain palliation following the application of pulse radiofrequency in patients with cardiac comorbid disease who were diagnosed with advanced stage osteoarthritis. METHODS: Thirty-eight patients with high surgical risk having cardiac comorbidities with grade 3-4 gonarthrosis according to the Kellgren-Lawrence classification were retrospectively analyzed. PRF was applied to the saphenous nerve of each patient. Visual Analog Scale for knee pain evaluation both at rest and on movement and the Lysholm Knee Scoring Scale for function evaluation were used. The patient status was evaluated before the procedure and at the first and sixth months after the procedure. RESULTS: The mean age was 68.8 years (range, 53-82 years). Both the rest and movement post-procedural Visual Analog Scale scores at first and sixth months were significantly lower than pre-procedural values (p< 0.001). A statistically significant improvement was also determined when pre- and one and six months post-procedural Lysholm scores were compared (p< 0.001). CONCLUSIONS: PRF is a safe and function sparing minimally invasive pain palliation method for knee osteoarthritis in elders with cardiac comorbidity.

Early prediction of outcomes in hip fractures: initial fracture displacement.

We retrospectively analyzed the surgical treatment of 28 pediatric hip fractures. The majority of cases were Delbet type 2 (57%) and type 3 (29%). The average age of the patients was 10.8 years (range: 2-16 years). The mean follow-up period was 91 months. Displaced fractures were found in 18 cases (64%). The major factor in the development of avascular necrosis was the degree of displacement at the time of initial presentation (P<0.05), irrespective of fracture type. Although the degree of initial displacement cannot be prevented, careful exposure of soft tissue during open reduction will reduce avascular necrosis.