Internet and social media preferences of orthopaedic patients vary according to factors such as age and education levels.

BACKGROUND: Patients can often access the internet and social media for health information but it is not clear how much they trust and use the information retrieved. OBJECTIVE: To investigate the social media and internet use rates and preferences of orthopaedic patients, to reveal to what extent they self-treat, and to probe the affecting factors. METHODS: Two thousand fifty-eight patients admitted to an orthopaedic polyclinic were asked to fill out a survey (voluntarily) consisting of 15 items, to collect demographic data, preference for platforms and sources used, trusted sources, and the extent to which information obtained was used for self-care. RESULTS: The most preferred and most trusted sources of information were Google and other search engines, and physicians' personal websites (p < 0.001). DISCUSSION: Variables such as age, gender, educational level and occupation affect the research preferences. Reliance on social media decreases with increasing educational levels (p < 0.001). CONCLUSION: Health information and knowledge services should work with health professionals to improve aspects of health literacy among orthopaedic patients.

Can Anterior Knee Pain Be Explained by Patella Position After Infrapatellar Tibia Intramedullary Nailing?

OBJECTIVE: The objective of this study is to investigate the postoperative position of the patella and its relationship with anterior knee pain in patients operated with infrapatellar reamed tibia intramedullary nailing (IMN). MATERIALS AND METHODS:  Patients who underwent tibia IMN between 2019 and 2022 and who had anterior knee pain in their postoperative follow-up at least two outpatient clinic controls with an interval of at least one month were examined. Patellar height indices (Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Insall-Salvati) and sagittal angulation (patella-patellar tendon angles) were measured on the lateral direct radiographs of the patients in semi-flexion. As a control group, measurements were made on the contralateral intact extremity radiographs of the same patients. RESULTS:  There was no significant difference in patellar height indices between the fractured and intact sides in any of the patients (p = 0.588; p = 0.747; p = 0.446; p = 0.573, respectively). When the sagittal angulations were analyzed, a significant difference was found between the fractured and intact sides of the patients (p = 0.048), resulting in an approximate three-degree change. CONCLUSION:  Patellar sagittal balance has been identified as one of the contributing factors to the development of anterior knee pain following reamed tibial IMN. Further biomechanical and comprehensive clinical studies are needed on this subject.

The effects of remnant-preserving anterior cruciate ligament reconstruction on proprioception: A prospective comparative study.

OBJECTIVE: The aim of this study was to investigate the effects of anterior cruciate ligament reconstruction performed by preserving remnant tissue on proprioception and to assess the effects it has on isokinetic quadriceps and hamstring muscle strength, as well as on range of motion and functional scores. METHODS: A prospective study was conducted with 44 patients who underwent either anterior cruciate ligament reconstruction with remnant preservation (study group, n=22) or with remnant excision (control group, n=22) with the use of a 4-strand hamstring allograft. The mean follow-up time was 20.2 ± 1.4 months after surgery. Using an isokinetic dynamometer, proprioception was evaluated with passive joint position perception at 150, 450, and 600, and quadriceps femoris, and hamstring muscle strength were evaluated at speeds of 900, 1800, and 2400 per second. Range of motion was measured using a goniometer. Functional outcomes were assessed using International Knee Documentation Committee subjective knee evaluation score and Lysholm knee scoring questionnaires. RESULTS: It was only at 15° of knee flexion that there was a statistically significant difference in proprioception; the median of the difference in the amount of deviation from the target angle between the healthy knee and the operated side was 1.7 (range, 0.7-20.7) in those with remnant preserved, and 2.7 (range, 1-26) in those with remnant excised (P=.016). At 2400/s speed, the mean quadriceps femoris strength was 77.2 ± 24.3 Nm in those with remnant preserved and 67.6 ± 24.2 Nm in those with remnant excised. (P=.048) There was no difference between the 2 groups in terms of range of motion, International Knee Documentation Committee, and Lysholm knee scoring. (P > .05) Conclusion: The present study has demonstrated that better proprioception and higher quadriceps femoris muscle strength can be obtained by remnant-preserving anatomical single-bundle anterior cruciate ligament reconstruction using a hamstring autograft. LEVEL OF EVIDENCE: Level II, Therapeutic study.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

OBJECTIVES: The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. RESULTS: Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. CONCLUSION: Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Extra Lateral Pin or Less Radiation? A Comparison of Two Different Pin Configurations in the Treatment of Supracondylar Humerus Fracture.

BACKGROUND: Closed reduction and percutaneous fixation are the most commonly used methods in the surgical treatment of supracondylar humerus fractures. The pin configuration changes stability and is still controversial. The aim of this study was to investigate the relationship between surgical duration and radiation dose/duration for different pinning fixations. METHODS: A total of 48 patients with Gartland type 2, 3, and 4 supracondylar fractures of the humerus were randomized into two groups-2 lateral and 1 medial (2L1M) pin fixation (n = 26) and 1 lateral 1 medial (1L1M) pin fixation (n = 22). A primary assessment was performed regarding surgical duration, radiation duration, and radiation dose. A secondary assessment included clinical outcome, passive range of motion, radiographic measurements, Flynn's criteria, and complications. RESULTS: There were 26 patients in the first group (2L1M) and 22 patients in the second group (1L1M). There was no statistical difference between the groups regarding age, sex, type of fracture, or Flynn's criteria. The overall mean surgical duration with 1L1M fixation (30.59 ± 8.72) was statistically lower (p = 0.001) when compared to the 2L1M Kirschner wire K-wire fixation (40.61 ± 8.25). The mean radiation duration was 0.76 ± 0.33 s in the 1L1M K-wire fixation and 1.68 ± 0.55 s in the 2L1M K-wire fixation. The mean radiation dose of the 2L1M K-wire fixation (2.45 ± 1.15 mGy) was higher than that of the 1L1M K-wire fixation (0.55 ± 0.43 mGy) (p = 0.000). CONCLUSIONS: The current study shows that although there is no difference between the clinical and radiological outcomes, radiation dose exposure is significantly lower for the 1L1M fixation method.

Bilateral Involvement in Developmental Dislocation of the Hip: Analysis of 561 Patients Operated on Using the Limited Posteromedial Approach.

Our objective was to scrutinize the risk factors related to bilateral involvement in the developmental dysplasia of the hip (DDH) and to inspect the impact of bilaterality on the enduring results of the DDH. All patients, aged between 6 and 18 months, who underwent surgery using the limited posteromedial approach (734 hips from 561 patients), were included in this study. The number of births, birth type, history of consanguineous marriage, family history, and swaddling were analyzed. Physical examination and complaints of the patients were evaluated, and direct radiographs were examined in terms of the redislocation, avascular necrosis, and residual acetabular dysplasia. Among the 561 patients, bilateral DDH was observed in 173 patients (30.8%). The use of swaddling was found to be statistically significant between groups (p = 0.012). The use of swaddling for more than one month was associated with a higher odds ratio for bilaterality (p = 0.001, OR = 1.56, 95% CI: 1.2-2.0). Furthermore, bilaterality was associated with a higher risk for redislocation in DDH (p = 0.001, OR = 4.25, 95% CI: 1.6-11.2). The study concludes that swaddling for over a month is strongly linked with the bilateral involvement in DDH. It is important to note that bilaterality plays a crucial role in the development of redislocation after open reduction in DDH.

Redislocation After Posteromedial Open Reduction in Developmental Dysplasia of the Hip: Analyzing the Risk Factors and Determining the Optimal Treatment Method.

BACKGROUND: Redislocation, which is one of the most serious problems in developmental dysplasia of the hip (DDH), might occur because of several reasons. Regardless of the treatment, redislocations are reported to be associated with high complication rates in the literature. Our objective was to identify the risk factors for redislocation in the patients treated for DDH and to determine the optimal treatment method for redislocations. METHODS: Patients with DDH who were treated with the limited posteromedial approach in our clinic between 1993 and 2021 and followed up prospectively were examined in this single-centered study. The participants were assigned into 2 groups: a study group consisting of 25 hips of 17 patients with redislocation and a control group consisting of 502 hips of 390 patients without redislocation. To determine the risk factors for redislocation, demographic data, known risk factors for DDH, preoperative Tönnis stage, and whether the capsule was opened or not were evaluated. To determine the optimal treatment method, a subgroup analysis based on applied treatment (closed reduction and cast replacement vs. repeating open reduction) was conducted, and recurrent redislocation, complication, and secondary surgery rates were evaluated. RESULTS: Bilaterality and high-grade hip dislocations were found to be associated with higher odds ratio (OR) for redislocation [ P =0.007, OR=3.64, 95% confidence interval (CI), 1.3 to 8.8; and P =0.006, OR=4.52, 95% CI, 1.37 to 14.91, respectively]. Recurrent redislocation and complication rates were found to be significantly higher in redislocations treated with closed reduction and cast replacement ( P =0.007 and P =0.015, respectively). CONCLUSIONS: Bilaterality and higher preoperative Tönnis stage are critical risk factors for redislocation after open reduction in DDH. It should be kept in mind that closed reduction and cast replacement is associated with higher rates of recurrent redislocation and complications, and redislocation cases should be treated by repeating open reduction. LEVEL OF EVIDENCE: Level II-therapeutic study.

Searching for a New Parameter in the Healing of Tibia Pilon Fractures: Fracture Area Measurement.

BACKGROUND: Tibia pilon fractures are associated with high complication rates, decreased quality of life, and low patient satisfaction. Although many factors such as reduction quality and soft-tissue coverage have been identified, researchers continue to investigate the factors that affect healing in tibia pilon fractures. Our objective was to investigate the effect of initial fracture crack width and displacement degree on clinical functional results in tibia pilon fractures. METHODS: In this retrospective cohort study, 40 patients with Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association type 43B and 43C tibia pilon fractures and operated on through the extensile anteromedial approach were analyzed. The demographic data of the patients, injury mechanisms, fracture type, reduction quality, clinical results, and postoperative complications were recorded. To evaluate the objective quantity of initial fracture crack width and displacement, a new parameter was defined: "fracture area." All measurements were conducted using a feature from the picture archiving and communication system on anteroposterior and lateral radiographs taken separately in standard fashion. RESULTS: With an average follow-up period of 29.2 months (range, 24-40 months), 34 patients (85%) had excellent or good results, whereas only two patients (5%) had poor clinical results. Age, injury mechanism, and reduction quality have a significant relationship with Maryland Foot Score (P < .001, P < .037, and P < .001, respectively). Preoperative fracture area, measured on both the anteroposterior and the lateral views, are significantly related to both Ovadia-Beals Score and Maryland Foot Score (P < .001 for each). CONCLUSIONS: Preoperative fracture area measurement has a major effect on healing of tibia pilon fractures. Increased initial fracture area is correlated with poor clinical functional results. High-energy injuries, older age, and poor reduction quality are also related to worse clinical outcomes.

Single versus double plating for bicondylar tibia plateau fractures: Comparison of range of motion, muscle strength, clinical outcomes and accelerometer-measured physical activity levels.

BACKGROUND: Optimal treatment of bicondylar plateau fractures is still a matter of debate. Accelerometer-measured physical activity levels may help us to obtain objective information regarding the quality of life of patients. The aim of this study was to compare the physical activity levels, objective and subjective functional results and stabilities of fixations of patients with treated bicondylar plateau fractures. METHODS: In this cross-sectional study of 23 patients, accelerometer-measured physical activity levels, daily energy consumption and measurements of knee joint range of motion (ROM) and muscle strength were measured. While Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as a patient-reported outcome measurement, Rasmussen Radiological Score was used for radiological evaluation. RESULTS: There was no significant difference between the groups in terms of physical activity levels and daily energy consumption (P = 0.667). While Total KOOS, Symptom and Stiffness and Sports Activities scores were higher in patients with a single plate (P = 0.034, P = 0.003 and P = 0.014, respectively), knee flexion and extension ROM and flexor and extensor muscle strength were similar between groups (P = 0.405, P = 0.095, P = 0.982 and P = 0.988, respectively). CONCLUSIONS: While patient-reported outcome measurements were better with single plating, there was no difference between the groups in terms of physical activity levels, ROM, muscle strength and radiological results. Although it should be kept in mind that the choice of the primary surgeon, the condition of the soft tissue and the fracture geometry are also effective in the decision-making process, single plating seems to be a valid surgical option in the treatment of bicondylar plateau fractures.

Comparison of the first and second waves of the COVID-19 pandemic with a normal period in terms of orthopaedic trauma: Data from a level 1 trauma centre.

OBJECTIVE: The aim of this study was to compare the characteristics and distribution of trauma surgeries performed in the first phase of the COVID-19 pandemic, the second phase of the pandemic, and the normal period before the pandemic. METHODS: Three different time periods were determined.Group 1 represented the first wave of the pandemic, in which lockdowns andrestrictions were strictly applied and only emergency and trauma surgeries wereperformed, between 1 April and 31 May 2020. Group 2 represented the second waveof the pandemic, during which restrictions were not applied and only emergencyand trauma surgeries were performed, from 1 September to 31 October 2020. Group3 represented the normal period before the pandemic, including surgeriesperformed between 1 September and 31 October 2019. In addition, patients ineach group were divided into two groups as younger than 16 or older than 16 inorder to understand the difference between paediatric and adult orthopaedictraumas. The distribution of patients and their fractures were evaluated. RESULTS: In Group 1, the rates of intra-articular fractures, distal extremity fractures, and proximal humerus fractures decreased, while the rate of proximal femur fractures increased (P < 0.05 for all). The frequency of hand fractures treated in Groups 1 and 2 compared to Group 3 was reduced (P < 0.05 for both). There was no statistically significant difference between Groups 2 and 3 for fractures in different parts of the body except for hand fractures (P = 0.001 for hand fractures, P > 0.05 for the other fractures). CONCLUSION: We observed that the frequency of fractures decreased, and the distribution changed due to severe restrictions and lockdowns in the first wave of the pandemic. When the restrictions and lockdowns were removed in the second wave, the frequency of fractures decreased, but the distribution of fractures was similar to the normal period in 2019. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty.

Although there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50-89 years) and mean follow-up time was 19 ± 7.8 months (range, 6-39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2-23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27-48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

Is male gender a prognostic factor for developmental dysplasia of the hip? Mid-long-term results of posteromedial limited surgery.

OBJECTIVE: The aim of this study was to determine if male sex is a poor prognostic factor for developmental dysplasia of the hip (DDH) and to determine the mid-long-term radiological and clinical results of male patients in comparison with female patients following an open reduction with posteromedial limited approach. METHODS: We examined 54 hips of 41 male patients (12.38 ± 4.82 months) and 96 hips of 82 female patients (11.11 ± 4.93 months) with DDH. All the patients underwent open reduction with posteromedial limited approach. The average follow-up time was 108 months for the male patients and 110 months for the female patients. The Tönnis grade, acetabular index, Kalamchi and MacEwen classification, and Severin classifications were determined for all patients. The Mc Kay classification system was used to evaluate the functional results. RESULTS: From the total, 25 (60%) male and 70 (85%) female patients had satisfactory radiographic outcomes (Severin Ia, Ib, or II) according to the Severin classification. There was a significant difference between the two groups in terms of the Severin classification (P = 0.04). Residual acetabular dysplasia (RAD) was observed in 12 (15%) female and 17 (41%) male patients (P = 0.001). Grade 2 or higher osteonecrosis was observed in 7 (9%) patients in female and 6 (15%) patients in male group. The clinical outcomes in terms of the Mc Kay classification showed satisfactory outcomes in 72 (87%) female and 34 (82%) male patients. Further, 8 (9.7%) female patients and 6 (14.6%) male patients underwent a second operation. However, there was no difference between the two groups in terms of postoperative osteonecrosis presence (P = 0.982), functional outcomes (P = 0.571), and secondary operation rates (P = 0.298). Male sex was associated with poor outcomes in terms of the Severin classification (P = 0.04) and RAD (P = 0.001). CONCLUSION: Although our results indicated that male sex is a poor prognostic factor for radiological results and RAD, there was no difference between male and female patients in terms of osteonecrosis, redislocations, and functional outcomes. Secondary surgical interventions should not be delayed in the absence of the spontaneous development of acetabulum. LEVEL OF EVIDENCE: Level III, prognostic study.