An overview of the orthopedic patient profile in the first five days following February 6th, 2023 Kahramanmaras earthquake: A single-center experience in the earthquake zone.

OBJECTIVES: This study aims to investigate the patient profile at a medium-volume hospital located in the earthquake zone among patients who received orthopedic treatment within the first five days after the natural disaster that was considered a major earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 10th, 2023, a total of 338 patients (156 males, 182 females; mean age: 42.2±9.7 years; range, 0 to 87 years) who received orthopedic treatment in our center were retrospectively analyzed. The patients were divided into four groups according to age as follows: infants (younger than one year of age), children (one to 13 years), adults (14 to 59 years), and elderly (60 years or older). RESULTS: Considering the age distribution, 291 (86%) patients were young adults. A total of 173 orthopedic surgeries were performed, including internal fixation in 63 patients, external fixation in 11 patients, upper/lower extremity fasciotomy in 47 patients, amputation in 39 patients, and soft tissue debridement in 13 patients. CONCLUSION: It is of utmost importance to recognize the principles of emergency fracture fixation and fasciotomy to successfully perform orthopedic surgeries after a natural disaster such as a major earthquake, particularly when the number of earthquake victims is considerably high.

Radiographs are not sufficient for evaluation of component fit in subtle knee pain after total knee arthroplasty.

PURPOSE: To determine the component fit by radiography or computed tomography after total knee arthroplasty and the relation of imaging with clinical examination of residual knee pain. METHODS: The study was conducted in 172 patients with residual knee pain after total knee arthroplasty. The patients were examined to determine whether they experienced pain upon palpation at nine regions surrounding the tibial and femoral components, and the results were noted. The Knee Society Clinical Rating System and The Western Ontario and McMaster Universities Arthritis Index pain scale score forms were completed for all patients. Radiologic evaluation was performed using computed tomography and anteroposterior, lateral, and oblique radiographs to determine component overhang/underhang status at these nine regions. Overhang, underhang, and cortical fit groups were created based on the position of the component at the bone margin. A statistical relationship was sought between the clinical scores and the values measured to determine which imaging method showed the best correlation with clinical scores. Consistency of CT and Rx measurements was compared using the McNemar-Bowker test. Comparisons between groups were made using Student's t test for normally distributed data, and the Mann-Whitney U test. RESULTS: Computed tomography and radiographic measurements were similar in the medial, anterior, and lateral tibial regions. However, no similarities were observed in the anteromedial, anterolateral, posteromedial, and posterolateral tibial regions, and in the distal-medial and distal-lateral aspects of the femur. Statistical relationships among decreased clinical scores, pain with palpation, and the presence of overhang/underhang were only observed in the medial tibial region for imaging using radiography. A statistically significant relationship was observed in the medial, posteromedial, and posterolateral tibial regions, and in the distal-medial region of the femur for imaging based on computed tomography. CONCLUSIONS: Radiography could only aid in assessing the component fit in the anteromedial, medial, and lateral regions of the tibia in patients with residual knee pain following knee arthroplasty, but it was not sufficient in comparison with computed tomography in six other regions. LEVEL OF EVIDENCE: Prospective study, level of evidence II.

Diagnosis of developmental dislocation of the hip by sonospectrography.

UNLABELLED: Because not all infants can be screened for DDH by experts, early diagnosis of developmental dysplasia of the hip (DDH) by primary health care professionals is important. We developed a broadband electroacoustic sound transmission-detection (sonospectrography) system and explored its utility in 22 patients (average age, 5.9 years; range, 0.3-14 years) with unilateral DDH in this preliminary study. Distinct from ultrasonography, the sonospectrography system functions by sound transmission and recording through tissues to differentiate between normal and abnormal hips. All hips were examined at four different hip and knee positions. The normal hip served as the control. The sonospectrography system was able to detect unilateral DDH. Dysplastic hips had lower sound transmission values when compared to normal hips in all patients and all four positions; however, the highest (X = 88.8 +/- 30.2 Hz) and lowest (X = 8.3 +/- 5.4 Hz) sound transmission mean values were obtained at different positions in the normal hips and those with DDH. Sound transmission values of dysplastic hips were always lower than that of normal hips when the hip and knee was flexed during measurements. Sound transmission values decreased with age. The sonospectrography system may offer a new noninvasive method in the diagnosis of unilateral DDH but requires further study of sensitivity and specificity of detecting dysplastic hips without subluxation in newborn infants. LEVEL OF EVIDENCE: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

[Comparison of K-wire fixation methods in terms of stability in Salter iliac osteotomies]. / Salter iliyak osteotomisinde K-teli ile yapilan tespit yöntemlerinin stabilite açisindan karsilastirilmasi.

OBJECTIVES: We compared the stability of K-wire fixation methods used in Salter iliac osteotomies in developmental dysplasia of the hip (DDH) to determine the most appropriate method for stabilization of the acetabular fragment. METHODS: The study included 425 hips of 331 patients (63 boys, 268 girls; mean age 23.3 months; range 17 to 35 months) who underwent iliac osteotomies for DDH with appropriate indications described by Salter. Fixation of the graft was made with the use of one or two K-wires. All the patients were assessed postoperatively with anteroposterior pelvic radiographs obtained before a hip spica cast was applied and after it was removed. The patients were divided into four groups based on the fixation methods used, namely, one or two K-wires directed either to the triradiate cartilage or to the roof of the acetabulum. On postoperative pelvic radiographs, we assessed the relation between the proximal and distal iliac fragments, position of the graft in the osteotomy area, medialization of the distal iliac bone corner at the sciatic notch, and coverage of the femoral head. RESULTS: Fixation with two K-wires resulted in no graft displacement. Of 381 hips in which a single K-wire was used, 15 hips (3.9%) exhibited graft displacement due to fixation instability. Orientation of the K-wire fixation was toward the triradiate cartilage in eight hips (2.9%), and toward the roof of the acetabulum in seven hips (6.4%). No significant differences were found between the four groups in terms of fixation instability. CONCLUSIONS: The absence of fixation failure with the use of two K-wires suggests that this method provides a more stable fixation of iliac osteotomy and bone graft.

Value of limited hip abduction in developmental dysplasia of the hip.

BACKGROUND: Developmental dysplasia of the hip (DDH) continues to be missed by routine physical examination in up to 50% of cases. Ultrasound (US) supplementation is the best method of screening for DDH, but the resources required should not be underestimated. Limited abduction of the hip (LHA) in an infant triggers suspicion, and often an urge to treat, in most orthopaedic surgeons and pediatricians alike. This study aimed to document the value of unilateral LHA in the diagnosis and decision making of DDH, and the correlation between LHA and US. METHODS: In total, 464 infants referred from the pediatrics clinic with LHA, aged between 30 and 120 days, were included in the study. RESULTS: Physical examination revealed LHA in 186 (41%) infants, 26 of which were unilateral and 160 were bilateral. US examination showed that 13 (8.1%) patients in the bilateral LHA group and 18 (69.2) patients in the unilateral LHA group, had DDH (total number 31, 7%). CONCLUSION: Unilateral limitation of hip abduction was found to be a sensitive sign for developmental hip dysplasia, but US could be defined once again as the best golden standard before initiating treatment.