Distal Tibiofibular Malreduction in Ankle Fractures Received Fibula Plate and Syndesmotic Screw Fixation.

BACKGROUND: The aim of the study was to examine the effect of the position of the plate and syndesmotic screw on postoperative tibiofibular joint malreductions in cases where the syndesmotic screw is inserted through the hole of the anatomically locked lateral distal fibula plate. METHODS: Thirty patients (13 female and 17 male patients) with postoperative computed tomographic scans were examined retrospectively. Patient information (eg, tibiofibular congruence measured from postoperative computed tomographic scans, the anterior and posterior tibiofibular distance at axial sections, the presence and orientation of fibular rotation, the presence of tibiofibular intraarticular piece, the angle between the syndesmotic screw and incisural line, the placement of the plate, and the localization of the screw on the fibula in axial images) was recorded. RESULTS: Those with fibular internal rotation had a lower syndesmotic screw-incisural line angle (SIA) (P = .001).There was a very strong negative significant correlation between the tibiofibular angle and SIA (rho, -0.780; P = .001). The median tibiofibular angle was found to be higher in cases with the fibula plate placed anteriorly (P = .009).The median SIA was found to be lower in cases with the fibula plate placed anteriorly (P = .004).The rate of placement of syndesmotic screw in the anterior third of the fibula was found to be high in cases with the fibula plate placed anteriorly (P = .049). CONCLUSIONS: In ankle fractures treated with insertion of a syndesmotic screw through the plate, the orientation of the syndesmotic screw in the axial plane and the position of the plate may be associated with the incidence of postoperative syndesmosis malreduction.

Ultrasonography view for acute ankle injury: comparison of ultrasonography and magnetic resonance imaging.

INTRODUCTION: We aim to asses the diagnostic performance of ankle ultrasonography in patients presenting with acute ankle sprain injury, with comparison to MRI (Manyetik Rezonans Imaging). MATERIALS AND METHODS: The study included patients who applied to the hospital within 48 h after an ankle sprain, and who presented with signs of pain, swelling, and tenderness in the ankle. Ankle ultrasonography examination was performed and an ankle MRI took place the same day. RESULTS: 30 patients were included in the study. 53.3% (n = 16) were female. The mean age was 30 ± 6.4 years. The ultrasonography examination determined 76.6% (n = 23) of the patients to have anterior talofibular ligament (ATFL) injury, 33.3% to have (n = 10) CFL injury, and 33.3% to have (n = 10) anterior inferior tibia-fibular ligament (AITFL) injury. The MRI of the patients determined 73.3% (n = 22) of the patients to have ATFL injury, 43.3% (n = 13) to have calcaneal fibular ligament (CFL) injury, and 33.3% to have (n = 10) AITFL injury. The ATFL, CFL, and AITFL injuries diagnosed on ultrasonography correlated with the MRI results (ICC = 0.875, ICC = 0.879, and ICC = 0.858). However, among the ATFL injuries observed on MRI, 26.6% (n = 8) were grade I, 26.6% (n = 8) were grade II, and 20% (n = 6) were grade III injuries. Of the ATFL injuries observed on ultrasonography, 46.6% (n = 14) were grade I, 8.6% (n = 2) were grade II, and 30.4% (n = 7) were grade III injuries. CONCLUSIONS: Findings on all types of ATFL, CFL and AITFL appear to have a higher degree of correlation. Ultrasonography could have an added role as a triaging tool, to fast-track MRI.

Comparison of the radiological parameters between dynamic-referencing tactile guidance robotic system and Microplasty® instrumentation in unicompartmental knee arthroplasty.

OBJECTIVES: This study aims to compare the radiological outcomes of unicompartmental knee arthroplasty (UKA) performed by a navigation-based robotic system versus Microplasty® instrumentation. PATIENTS AND METHODS: Between January 2018 and January 2019, a total of 90 knees of 75 patients (65 males, 10 females; mean age: 62.0±9.4 years; range, 50 to 73 years) were included. Among these, 54 knees underwent Oxford mobile-bearing UKA with an Microplasty® instrumentation set and 36 knees were operated with the aid of a Restoris® MCK with MAKO navigation-based robotic system. Postoperative anteroposterior and lateral X-rays of all patients were evaluated according to nine different parameters. On the femoral side, femoral varus-valgus angle, flexion-extension angle, femoral condyle posterior fit; on tibial side, tibial component varus/valgus, tibial posterior slope, medial, anterior, posterior and lateral fit of tibial component assessed. RESULTS: There was no significant difference between groups in terms of age, sex, and affected side. On the femoral side, no significant difference was observed in the component position between groups. On the tibial side, tibial component medial fit (p=0.032) and anterior fit (p=0.007) were better in navigation-based robotic system group. CONCLUSION: Microplasty® instrumentation may lead to comparable implant positioning compared to a tactile-based navigated robotic instrumentation.

Does the clamping method in local and systemic TXA applications in total knee arthroplasty change the game?: A retrospective comparative cohort study.

Many different methods and drain clamping periods have been described in systemic and local tranexamic acid (TXA) applications, and the superiority of the methods to each other has not been clearly demonstrated. The method of local infusion in combined TXA applications may not alter the Hb drop or total or hidden blood loss. We aim to compare two different combined TXA application methods. We retrospectively analyzed 182 patients who underwent total knee arthroplasty between 2018 and 2021. Patients over 40 years of age who underwent TKA for degenerative knee arthritis were included in the study. Unicondylar, revision, or bilateral arthroplasties and patients with the cardiovascular or cerebrovascular disease were excluded from the study. All patients in the study received 1 g TXA intravenously half an hour before the incision. For the first group, 1 g TXA was given intra-articularly at the drain site after closure, and the clamp was kept closed for 1 hour. In the second group, the drain was clamped for an additional 6 hours, and a 1 g intravenous dose was administered at the 5th hour postoperatively. No local applications were used in the control group. Total, hidden, and visible blood loss (total blood loss, hidden blood loss, visible blood loss), postoperative decreases in hemoglobin and hematocrit level (ΔHgb, ΔHtc), blood transfusion rates, and hospital stay durations were evaluated. There were 72 patients in the first group, 52 in the second, and 58 in control. A total of 37 patients received one or more blood transfusions postoperatively, and there was no statistical difference in the need for blood transfusions between the groups (P = .255). Although a statistically significant difference (P = .001) in total blood loss, hidden blood loss, visible blood loss and ΔHgb values was observed between the groups, the difference between the first and second groups was insignificant (P = .512). The duration of hospital stay was observed to be less in the first and second groups (P = .024). Local and systemic TXA applications were observed to be more effective than only systemic applications in reducing blood loss after total knee arthroplasty, regardless of the local method.

Treatment Of Ingrown Toenail with a Minimally Invasive Nail Fixator: Comparative Study with Winograd Technique.

BACKGROUND: Many surgical techniques have been reported for the treatment of ingrown toenails. Occurrences of infection after matricectomy procedures could cause clinicians to prefer using external braces to treat ingrown toenails. This study compares patients with ingrown toenails who underwent the nail fixation technique and the Winograd technique. METHODS: Patients who underwent ingrown toenail surgery were retrospectively reviewed. The patients' demographic characteristics (age, gender, body mass index [BMI] morphology according to Heifetz classification, surgical technique, visual analog scale (VAS) values, time to return to daily activities (days), complications, and satisfaction levels were all recorded. RESULTS: Seventy patients were included in the study. Of the patients, 33 underwent nail fixation and 37 underwent the Winograd technique. No significant statistical differences were found in terms of patients' age, gender, BMI, preoperative clinical features, long-term satisfaction, and ingrown toenail recurrence rates between the two groups, but time to return to daily activities and VAS values were statistically significantly lower in patients treated using nail fixation compared with the Winograd technique. CONCLUSION: Nail fixation can be an effective surgical treatment option for an ingrown toenail.

Comparison of Pain, Muscle Strength, and Functional Status Following Unicompartmental Knee Arthroplasty, Total Knee Arthroplasty, and Conservative Management of Gonarthrosis.

BACKGROUND: Treatment options and surgical decision for grade 3-4 gonarthrosis remains controversial. We aimed to compare the pain level, muscle strength, physical performance, lower extremity functions, and other physical activity levels between patients who underwent arthroplasty and those who received conservative management for grade 3-4 gonarthrosis. METHODS: This prospective analytical observational study was conducted in a tertiary referral hospital. A total of 30 unicompartmental knee arthroplasty (UKA) and 30 total knee arthroplasty (TKA) patients as two different study groups and 30 patients were treated conservatively as the control group were included. The rehabilitation and complication rates were recorded. The values of the range of motion, quadriceps diameter, were measured and also the isokinetic muscle strength, pick-up, repeated sit-to-stand, stair ascending and descending, straight-line walking, timed up and go, and 20-m walk tests, the knee injury and osteoarthritis-outcome-score (KOOS), the hospital for special-surgery-knee-score (HSS), and Oxford-Knee-Score (OKS) were performed. RESULTS: Postoperative rehabilitation and complication rates were significantly higher in the TKA group compared to the UKA group (p = 0.029 and p = 0.026, respectively). Six months after the treatment, the knee extension muscle strength value at 180°/s, knee flexion degree, total work flexion, stair ascending, VAS at night, all KOOS symptom, pain and daily function and total scores in the UKA group was significantly different than the TKA and the control groups (p < 0.001). Total work extension values, knee flexion degree, in the control group were found to be significantly higher than the TKA group (p = 0.033, p < 0.001, respectively). CONCLUSIONS: The UKA was significantly superior to TKA and conservative treatment concerning pain, muscle strength, and quality of life. LEVEL OF EVIDENCE: IIa.

The time from injury to surgery is an important factor affecting the mechanoreceptors at stump of torn anterior cruciate ligament.

INTRODUCTION: Restoration of proprioceptive function after anterior cruciate ligament (ACL) reconstruction is as important as mechanical stability. For this purpose, remnant of the torn ACL is the only source of nerve endings. Our aim in this study is to investigate the quantity of mechanoreceptors in the remnants ACL stumps in injured knees and to correlate that with the quantity in intact ACL in control cases. MATERIALS AND METHODS: 48 patients that underwent ACL reconstruction between January 2016 and December 2018 as study group and 20 knees of 10 fresh frozen cadavers that as control group included in the study. Remaining stumps from study group and native ACL from control group were collected and investigated with S100 immunostaining. The type and number of mechanoreceptors in standardized areas was determined. The correlation of number of mechanoreceptors and time to surgery after ACL rupture were evaluated. RESULTS: The free nerve endings (FNE) and total number of mechanoreceptors were significantly lower in the study group as compared to the control group (p < 0.001 and p = 0.004, respectively). The number of Golgi-Mazzoni corpuscle decreased significantly with time (p = 0.041 CC: - 0.438). CONCLUSION: The time from injury to surgery is an important factor affecting the mechanoreceptors at stump of torn ACL. The surgeon and patient should be aware of the fact that delay in surgery could lead to the loss of mechanoreceptors.

Greater presence of receptors for relaxin in the ligamentum teres of female infants who undergo open reduction for developmental dysplasia of the hip.

BACKGROUND: While many factors involved in the etiology of developmental dysplasia of the hip (DDH), one of which is the hormone relaxin. Relaxin concentrations in patients with DDH may lead to pathodynamic changes during hip development by altering the physiological nature of the ligament, as well as by long-term exposure to relaxin during pregnancy. Our objective in this study was to determine the number of relaxin receptors in the ligamentum teres and their role in causing DDH. METHODS: We identified 26 infants between birth and 3 years of age who had undergone open reduction for DDH between 2010 and 2012. 12 hips of 12 miss abortus fetus between 20 to 35 weeks of gestation were used as control group. Specimens obtained from two groups were stained with Relaxin-2 antibody, and the amount of staining for relaxin receptors was determined using an ordinal H score. RESULTS: The mean (SD) H scores of infants with DDH were significantly higher than those of controls: 215 (59) versus 52 (48); P = 0.00; 95% CI. Statistically significant difference between the two groups in terms of gender was not found. CONCLUSION: As a result, increased number of relaxin receptors in the ligamentum teres could be a risk factor for DDH. LEVEL OF EVIDENCE: Level 2, Prospective comparative study.

Late Presenting Pediatric Radial Neck Fracture: A Case Report and Review of the Literature.

INTRODUCTION: A pediatric radial neck fracture, when the diagnosis is delayed, is still a challenging problem for the treating orthopedic surgeon. We report a pediatric patient with late presenting radial neck fracture and results of open reduction and fixation with Kirschner wires. CASE REPORT: A 13-year-old right-handed girl fell on an out-stretched right arm after being tackled during playing basketball and had a radial neck fracture. However, the diagnosis of her fracture was delayed for 3 weeks. At the first radiologic examination, the anteroposterior and lateral radiographs were showing over 80 degrees of angulation at the radial neck and subluxation of the radiocapitellar joint. We tried to obtain a closed reduction, but we could not succeed. Then, we performed open reduction while preserving medial periosteal continuity and vascular supply of the radial head by meticulous surgical dissection. Sixth-month radiography control and clinical examination confirmed the complete healing of the fracture without any epiphyseal injury. Painless full range of motion without any restriction of pronation and supination was achieved. The patient and her parents were satisfied with the outcome. CONCLUSIONS: Even if the diagnosis of pediatric radial fractures is delayed if we can preserve medial periosteal continuity and vascularity of the radial head with open reduction, satisfactory results are obtainable.

Increased acromiohumeral distance in a double-row arthroscopic rotator cuff surgery compared to a single-row surgery after 12 months.

BACKGROUND: Arthroscopic rotator cuff surgery is an effective treatment for rotator cuff tears with the considered use of double-row repair techniques becoming popular in the last decade. We aim to compare the effects of double- and single-row arthroscopic rotator cuff repairs (ARCR) on repair integrity (RI) and acromiohumeral distance (AHD). METHODS: In this observational study, we retrospectively identified 98 patients with degenerative rotator cuff tear treated with arthroscopic rotator cuff repair between 2016 and 2019. We excluded 22 patients with partial-thickness tears, 15 with associated subscapularis or SLAP tears, 13 with massive tears, and 5 patients lost to follow-up; we included 43 patients who had ARCR for full-thickness cuff tear and clinical, radiologic follow-up. Of these 43 patients, 23 are grouped as double-row repair group (DRG) and 20 as single-row repair group (SRG). A minimum of 12 months after the surgery, bilateral shoulder MRIs were obtained. Contralateral shoulders without asymptomatic rotator cuff tears served as a control group (CG). The operating surgeon and two other surgeons experienced in arthroscopy blindly measured the AHD and determined the RI at the control MRIs in all groups. Functional assessments relied on UCLA and qDASH Scores. RESULTS: The mean age was 57.89 (45-78) years, and the mean follow-up time was 28,65 (21-43) months. The mean AHD of the CG was 9.7 ± 0.96 mm, the preoperative AHD of DRG was 8.62 ± 1.45 mm, and SRG was 9.71 ± 0.95 mm. The postoperative mean AHD of DRG 9.61 ± 1.83 mm and SRG was 10.21 ± 1.97 mm. AHD differences between the preoperative and postoperative groups were significant (P=0.009). The increase of the AHD in the double-row group was significantly higher than the single-row group (P=0.004). There was a high correlation between the RI and DASH scores (P=0.005). RI did not correlate with the repair method (P=0.580). CONCLUSION: Although double-row repairs can maintain greater AHD than single-row repairs in the clinical setting, this difference did not affect functional results. Regardless of the surgical intervention, functional results are favourable if RI is achieved. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study.

The effect of gluteus maximus tenotomy in primary total hip arthroplasty with posterior approach: Kinematic analysis of hip extensor strength.

BACKGROUND: The posterior approach (PA) is the most commonly used surgical approach for total hip arthroplasty (THA), but the proximity of the sciatic nerve may increase the likelihood of sciatic nerve injury (SNI). Gluteus maximus tenotomy can be performed to prevent SNI because tenotomy increases the distance between the femoral neck and sciatic nerve and prevents compression of the sciatic nerve by the gluteus maximus tendon (GMT) during hip movements. We aimed to kinematically compare the postoperative hip extensor forces of patients who have and have not undergone gluteus maximus tenotomy to determine whether there is a difference in hip extensor strength. METHODS: Seventy-two patients who underwent gluteus maximus tenotomy during THA were included in the group 1, and 86 patients who did not undergo tenotomy were included in group 2. The Harris hip score, body mass index and hip extensor forces were measured both preoperatively, and 6 months after surgery with an isokinetic dynamometer and compared. RESULTS: The mean age was 64.6 ± 2.3 years in group 1 and 63.8 ± 2.1 in group 2. Mean body mass index was 25.7 ± 1.1 in group 1, and 25.5 ± 1.3 in group 2. Baseline Harris hip score (HHS) was 42.36 ± 12 in group 1 and 44.07 ± 9.4 in group 2 (p = 0.31), whereas it was 89.1 ± 7.8 and 88.4 ± 8.1 at 6 months after surgery, respectively. Baseline hip extensor force (HEF) was 2 ± 0.4 Nm/kg in group 1, and 2.1 ± 0.7 Nm/kg in group 2 (p = 0.28), while it was 2.4 ± 0.6 Nm/kg, and 2.5 ± 0.5 Nm/kg, respectively at 6 month follow-up (p = 0.87). Both groups had significantly improved HHS and HEF when comparing baseline and postoperative measurements (p < 0.0001). No cases of sciatic nerve palsy were noted in group 1, whereas there were two (2.32%) cases in group 2, postoperatively. CONCLUSION: The release of the GMT during primary hip arthroplasty performed with the PA did not lead to significant decrease in hip extension forces. Hip extensor strength improves after THA regardless of tenotomy. Gluteus maximus tenotomy with repair does not reduce muscle strength and may offer better visualization.

Editorial Commentary: Knee Anterolateral Ligament Mechanoreceptors: The First Step From Peripheral to Central Nervous System.

The mechanoreceptors around the knee are of interest, including those mechanoreceptors related to the anterolateral ligament. Histopathologic evaluations of mechanoreceptors are the first steps in understanding the exact sensorimotor system of the extremities. Many studies have shown these mechanoreceptors, but more electrophysiologic studies are needed to make sense of the reported phenomena.

Mini-plate fixation via sinus tarsi approach is superior to cannulated screw in intra-articular calcaneal fractures: A prospective randomized study.

OBJECTIVE: Intra-articular displaced calcaneal fractures are common fractures and are often treated with surgical interventions. Sinüs tarsi approach provides secure access to lateral wall and joint facets. The aim of the study is to compare cannulated screw (CS) fixation and mini-plate (MP) fixation via sinus tarsi approach with Sanders types 2 and 3 fracture of calcaneus. METHODS: Sixty patients with Sanders types 2 and 3 calcaneal fracture underwent surgical intervention were randomly allocated into two groups as group MP fixation and group CS fixation regarding osteosynthesis method for 5-year period. Open reduction via sinüs tarsi approach was performed in both groups. Demographic variables, time to surgery (TS), operation duration (OD), length of hospital stay (LOS), surgical complications, and reoperations were recorded. Pre- and postoperative Gissane and Böhler angles; calcaneal length, height, and width; ankle anterior-posterior (AP) and lateral X-rays; and computed tomography were also recorded for radiological evaluation and fracture characteristics. Maryland Foot Score (MFS) was used to evaluate functional outcomes. RESULTS: Preoperative age, type of fracture, calcaneal length, height, and Gissane and Böhler angles, TS, LOS, and OD were not different between the groups. The postoperative calcaneal widening was significantly better restored in group MP compared with that of group CS. The incidence of reoperation and algoneurodystrophy was statistically higher in group CS than group MP. MFS in group MP was also higher than group CS at final visit. CONCLUSION: MP fixation via sinus tarsi approach is superior to CS fixation in Sanders types 2 and 3 calcaneal fractures.

Association between vitamin D concentrations and knee pain in patients with osteoarthritis.

OBJECTIVES: Osteoarthritis (OA) and vitamin D deficiency are common health conditions in older people. Whether vitamin D concentration is associated with knee OA is controversial. In this study, we aimed to determine the association between serum concentrations of vitamin D and osteoarthritic knee pain. SUBJECTS AND METHODS: Vitamin D concentrations were measured with the 25 hydroxyvitamin D test in patients presenting with clinical symptoms of primary knee osteoarthritis. Osteoarthritis was graded on the Kellgren-Lawrence grading scale from anteroposterior and lateral radiographs. Height, weight, and body mass index (BMI) were recorded. Patients completed a 10-cm visual analogue scale (VAS) for indicating pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Vitamin D concentration was defined as severely deficient (<10 ng/mL), insufficient (10 to 19 ng/mL), or normal (20 to 50 ng/mL). RESULTS: Of 149 patients (133 women), the mean age was 63.6 years. Mean vitamin D concentration was 11.53 ng/mL, and 90% patients were vitamin D deficient. Mean WOMAC score was 57.2, and VAS pain score was 7.5. Kellgren-Lawrence grade was 2 for 10 patients, grade 3 for 61, and grade 4 for 88. Mean BMI was 33.4. Mean values of VAS, WOMAC, and BMI did not differ by vitamin D status. CONCLUSION: Serum vitamin D concentration is not associated with knee pain in patients with osteoarthritis.

Compatibility of Lauge-Hansen Classification Between Plain Radiographs and Magnetic Resonance Imaging in Ankle Fractures.

We evaluated the accuracy of the predictive injury sequences of the Lauge-Hansen (L-H) classification using magnetic resonance imaging (MRI) in patients with ankle fractures and determined the possible causes of mismatch. Sixty-five patients with ankle fractures who had a complete series of anteroposterior, lateral, and oblique radiographs and ankle MRI studies available were included. The fracture pattern was assigned by 2 senior orthopedic surgeons according to the L-H classification system. The syndesmotic ligaments, lateral collateral ligaments, and medial deltoid complex ligaments were evaluated on the preoperative MRI scans. Comparisons were performed between the predicted ankle ligamentous injury based on the radiographic L-H classification and preoperative MRI analysis. Of the 65 feet in 65 patients, 50 feet (76.9%) were classified as having a supination-external rotation (SER) fracture, 6 feet (9.2%) as having a pronation-external rotation fracture, 4 feet (6.2%) as having a supination adduction fracture, and 2 feet (3.1%) as having a pronation abduction fracture. The overall compatibility of the radiologic classification with the MRI classification was 66.1%. In the evaluation of 50 feet with the MRI SER designation, maximum compatibility was found for stage 4 (77.3%). The main cause for the discrepancy in the SER designation was missing the presence of deltoid ligament disruption on the plain radiographs, especially in the stage 2 and 3 SER fracture pattern. In the evaluation of deltoid complex injuries, all injuries were localized to the anterior part of the medial deltoid complex. The validity of the L-H classification system was low. A new classification system is needed to address the medial malleolus fracture or deltoid complex injuries without posterior injury. Also, stress radiographs could be added to standard radiographs for the classification to address deltoid complex injuries.

High Varus Angle and Lower Posterior Tibial Slope Associated with PCL Injury in Cruciate Retaining Total Knee Arthroplasty: An MRI Study.

The posterior tibial slope (PTS) is important for performing a tibial cut that does not injure the posterior cruciate ligament (PCL). In this study, the amount of PCL fibers sacrificed under simulated tibial cuts with varying posterior inclinations was evaluated using magnetic resonance images (MRIs) of osteoarthritic varus knees. Knee X-rays, orthoroentgenograms, and MRIs of 113 Kellgren and Lawrence grades 3 to 4 osteoarthritic knees were included. Four different simulated tibial cuts were performed at 0, 3, 5 degrees and parallel to the tibia plateau 3 mm below of the most defective part of the cartilage in the medial plateau. Correlations between the PCL avulsion amount and the PTS and varus alignment of the lower extremity were analyzed for all four simulated tibial cut levels. The maximum amount of PCL was preserved with a 0-degree tibial cut in patients with a PTS of more than 8 degrees. With increased tibial cut angles, the posterior slope resulted in an increased amount of avulsed PCL. Although the amount of avulsed PCL was proportional with the varus alignment, it was inversely proportional with the sagittal slope. The number of injured PCLs also increased as the slope of the tibial cuts increased. Patients with mild varus alignments and high PTSs are more suitable for cruciate retaining total knee arthroplasty.

Arthroscopy-assisted versus standard intramedullary nail fixation in diaphyseal fractures of the humerus.

PURPOSE: The aim of this study was to assess applicability of arthroscopic technique in intramedullary nail fixation of humerus shaft fractures and to compare with conventional nailing in terms of its effects on perioperative and postoperative intra-articular complication rates as well as on clinical and functional outcomes. METHODS: This prospective randomized controlled clinical trial included 40 patients (12 females and 28 males) indicated for surgery between either undergo arthroscopy-assisted (Arthroscopy-assisted intramedullary nailing [AIMN]; n = 20) or conventional (Intramedullary nailing [IMN]; n = 20) anterograde intramedullary nailing. Two groups were compared in terms of mean number of fluoroscopic shootings until the guide wire was inserted, time for union, length of hospital stay, and complication rates. Shoulder functions were assessed by Constant and American Shoulder and Elbow Surgeons (ASES) score. RESULTS: Groups did not significantly differ in terms of age, gender, and mechanism of injury, length of hospital stay, union rate, and mean union time ( p > 0.05). Mean ASES and Constant scores were found to be statistically significantly higher in AIMN group than that in IMN group ( p = 0.000 and p = 0.002, respectively). Mean number of fluoroscopic shootings until the guide wire was inserted was 2.15 in AIMN group, which was significantly lower compared to 4.2 of IMN group ( p = 0.000). CONCLUSIONS: Arthroscopy-assisted technique may be an applicable and safe method owing to its cosmetic advantages and more satisfactory postoperative shoulder functions subsequent to less injury to deltoid, rotator cuff, and other soft tissue, as compared to conventional anterograde approach.

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures.

AIM: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. MATERIAL AND METHODS: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. RESULTS: Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. CONCLUSION: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

Lower numbers of mechanoreceptors in the posterior cruciate ligament and anterior capsule of the osteoarthritic knees.

PURPOSE: Impaired proprioception accuracy of the knee has been proposed as a local factor in the onset and progression of knee osteoarthritis. Patients with decreased numbers of mechanoreceptors could be more likely to develop arthrosis due to a loss in proprioception of the joint. We aimed to identify and quantify the mechanoreceptors of the posterior cruciate ligament (PCL), the anterior capsule (AC) and the medial meniscocapsular junction (MCJ) in knee arthrosis. METHODS: PCLs, ACs and MCJs were harvested from 30 patients with Kellgren and Lawrence grades 3 and 4 osteoarthritis (OA), and ten knees taken from five cadavers without OA were used as a control group. PCL degeneration was evaluated with haematoxylin & eosin, and the types and numbers of mechanoreceptors were evaluated using S100 immunostaining. RESULTS: The patient ages in the OA and control groups (n.s.) did not differ. PCL degeneration was more severe in the gonarthrosis group than in the control group (p = 0.04). The numbers of Golgi corpuscles, Ruffini corpuscles, free nerve endings, total nerve endings and small vessels of the PCL were low in the OA group, as were the numbers of Golgi corpuscles, free nerve endings and total nerve endings of the AC. No significant correlation was found regarding the mechanoreceptors of the MCJ between the two groups. CONCLUSION: The numbers of mechanoreceptors in patients with OA were low in the PCLs and ACs. A loss in proprioception could be a local risk factor in OA. The proprioceptive impact of preserving PCL while performing total knee arthroplasty may not be exaggerated as its thought. LEVEL OF EVIDENCE: Prognostic study, Level I.