The medial cortical ratio as a risk factor for failure after surgical fixation of proximal humerus fractures in elderly patients.

OBJECTIVES: This study aims to investigate whether the medial cortical ratio (MCR) is associated with fixation failure in patients undergoing plate-screw fixation due to proximal humeral fracture. PATIENTS AND METHODS: Between May 2011 and October 2020, a total of 93 patients (25 males, 68 females; mean age: 74.2±5.3 years; range, 65 to 92 years) who were operated for a proximal humeral fracture were retrospectively analyzed. The patients were divided into two groups during follow-up: patients with fixation failure (n=18) and patients with intact fixation (n=75). After radiological analysis, the MCR and fracture type were recorded. The effects of MCR and fracture type on the development of failure were evaluated. RESULTS: The mean follow-up was 41.3±4.7 (range, 18 to 66) months. There was no significant correlation between fixation failure and MCR in either group (p=0.535). However, the risk of fixation failure increased by seven-fold in patients with MCR greater than 0.09 compared to the other patients. In addition, the fracture type was significantly more severe in the failed fixation group than the intact fixation group (p<0.001). CONCLUSION: Surgical treatment of proximal humeral fractures in elderly patients still remains a challenge for surgeons due to the high failure rate. In elderly patients scheduled for surgery to treat a proximal humerus fracture, a reverse shoulder arthroplasty may be a reasonable choice to avoid reoperation due to fixation failure in elderly with three-part or more fragmented fractures and high MCR.

Could radial extracorporeal shock wave therapy have an effect on wound healing in clinical practice by creating genotoxic damage? An in vitro study in mouse fibroblasts.

OBJECTIVES: This study aims to evaluate wound healing effects of in vitro radial extracorporeal shock wave (rESW) application on mouse fibroblasts and whether the cytotoxic effect of extracorporeal shock wave (ESW) was due to a possible genotoxic effect. PATIENTS AND METHODS: After creating an in vitro wound healing model in L929 mouse fibroblast culture, fibroblasts were stimulated with a frequency of 3 Hz, and 100, 250, 500, 1,000 and 1,500 pulses shock waves were applied. Energy flux densities ranging from 0.01 to 0.23 mJ/mm2 (14.3 MPa) at a constant pressure level of 0.5 and 1 bar were applied. Wound healing, cell viability, and genotoxicity were evaluated at 24 and 48 h. RESULTS: All shot numbers for both pressures significantly reduced cell viability (p<0.05). For both 0.5 and 1 bar pressures, in both intervals, the rate of wound healing decreased, regardless of the number of shots (p<0.05). In vitro genotoxic damage was detected at both 0.5 and 1 bar pressures, in both time intervals, regardless of the number of shots. The genotoxic damage increased from 24 to 48 h. CONCLUSION: The study results suggest that, when ESWT is applied in this in vitro experimental setup, cell viability decreases and wound healing is delayed under all conditions. Furthermore, genotoxic damage can be prevented by using shots below 1,000 pulses. Therefore, while investigating the therapeutic effect of ESW therapy in vitro, the upper limit for the number of shots should be 1,000 pulses.

Persistent infection of Mycobacterium tuberculosis in a patient with Behçet's disease after rotator cuff repair surgery: A case report.

Tuberculosis (TB) infection is a common health problem in low socioeconomic populations in developing countries. Osteoarticular TB is a disease that rarely occurs outside the vertebral column and is often diagnosed late or misdiagnosed, particularly in non-weight bearing joints. A 51-year-old female patient with Behçet's disease presented with shoulder TB following rotator cuff repair surgery, leading to joint resection as a result of recurrent infections with no reproduction in culture samples due to delayed diagnosis. Surgical excision was proposed for the treatment of draining a mass with a sinus tract opening into the joint on the anterior aspect of the right shoulder. A diagnosis was able to be reached after 13 operations, based on the presence of TB bacilli in the pathological examination of the samples. In conclusion, TB should be considered in the absence of reproduction in culture samples taken during persistent post-surgical infections.