What if an articular bone fragment drops on the floor in the course of osteosynthesis? An experimental study.

OBJECTIVES: This study aimed to evaluate the effectiveness of a 1-min 10% povidone-iodine immersion in the decontamination of dropped osteochondral fragments. MATERIALS AND METHODS: Forty-eight sets of sterile osteochondral bone fragments, each consisting of three samples, were prepared from removed femoral heads that would otherwise be discarded during different hip replacement surgeries. Immediately afterward, each set was dropped on the floor right behind the surgeon in another operating room in which fracture fixation operations were being performed. Samples were picked up with sterile gloves. A swab culture of the floor was taken. One of the three pieces was kept as the control group. The second one (saline group) was washed with saline and subsequently soaked in saline for 1 min. The last one (treatment group) was first immersed in a 10% povidone-iodine solution for 1 min, then rinsed with saline and soaked in saline for 1 min. The samples were cultured in nutrient media, and microorganisms were identified at the microbiology laboratory. The groups were compared in terms of positive culture rates. RESULTS: The positive culture (contamination) rates were 100%, 58.3%, 39.6%, and 10.4% for the swab samples, control group, saline group, and treatment group respectively. The decontamination ratio in the treatment group was significantly more than both the control group (p<0.001) and the saline group (p=0.001). Handling only with saline did not significantly decontaminate compared to the control group (p=0.066). CONCLUSION: Immersing the dropped osteochondral fragments in 10% povidone-iodine solution for 1 min and then rinsing with saline may provide statistically significant decontamination but cannot be accepted to be safe enough for clinical practice. Further studies are needed to find the optimal time needed for safe decontamination without compromising the viability of cartilage tissue.

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.

The Effect of Anatomical Reduction on Functional Outcomes in Femoral Neck Fracture: A Novel Modified Garden Index.

BACKGROUND: Femoral neck fracture is a common cause of morbidity in the younger population with potentially poor prognosis and functional results. The purpose of this study was to evaluate how the success of anatomic reduction affects hip functional outcomes by using a new numerical index modified from the Garden index. METHODS: Twenty-six patients who underwent closed reduction and internal fixation by means of three cannulated screws due to femoral neck fracture between 2010 and 2014 were scanned retrospectively and included in the study. Harris hip scores of the patients at nine to 12 months were evaluated using the new index modified from Garden which is the sum of the differences from the ideal Garden index calculated on early postoperative anteroposterior and lateral pelvis radiographs. RESULTS: The mean hip score was 73.1 (± 16.4), the minimum score was 32, the maximum score was 93. Postoperative anteroposterior radiographs revealed a mean Garden alignment index of 153.6°, the lowest value was 135° and the highest value was 168°. In the lateral radiographs, the mean Garden alignment index was 173.1°, the lowest value was 160° and the highest value was 178°. The mean value of the novel index was found as 14.2°, the lowest value was 2°, and the highest value was 40°. There was an inverse correlation between the novel index we defined and the Harris hip score (p<0.01). CONCLUSION: In femoral neck fractures, the success of anatomic reduction is an important factor affecting the patient's functional outcome. We believe the new reduction index we proposed will contribute to literature comparing the success of reduction in femoral neck fractures.

Ipsilateral simultaneous inferior shoulder dislocation and posterior elbow dislocation: A case report.

This case report presents a 21-year-old male construction worker with ipsilateral inferior shoulder and posterior elbow dislocations, accompanied with other injuries. Such a combination of injury undoubtedly occurs; however, to the best of our knowledge, this is the first reported case. The prompt closed reductions without waiting for anesthesia were accomplished without the help of an assistant using a novel technique. The patient returned to his job with considerable recovery of motion and strength despite his permanent paralysis of the deltoid muscle and he was still employed as a worker after four years. He was abducting his arm by using his accessory muscles, which contribute to abduction when arm is externally rotated. The maneuver described in the report can be used to reduce all inferior shoulder dislocations and it is worth to know that working at a job requiring high level of activity is still possible despite a permanent loss of axillary nerve function.

Responsiveness of the Turkish KOOS-PS and HOOS-PS in knee and hip joint arthroplasty patients.

BACKGROUND: Adaptation to Turkish language and validation studies of Knee Injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS) and Hip Disability and Osteoarthritis Outcome Score - Physical Function Short Form (HOOS-PS) were done previously but responsiveness to changes of these questionnaires could not be tested in these studies. OBJECTIVE: The aim of this study was to assess the responsiveness of the Turkish versions of the KOOS-PS and HOOS-PS in a patient group who underwent knee or hip joint arthroplasty operation. METHODS: Sixty-three patients who underwent total knee arthroplasties and sixteen patients who underwent total hip arthroplasties for primary osteoarthritis were included in this study. The preoperative and 3-month postoperative KOOS-PS, HOOS-PS, and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index hip and knee scores were collected from the hospital records, and the effect sizes (ESs) and standardized response means (SRMs) were calculated. RESULTS: The ESs and SRMs, respectively, were as follows: -1.954 and -2.156 for the KOOS-PS, -1.833 and -2.464 for the HOOS-PS, -4.848 and -4.210 for the WOMAC-knee, and -3.835 and -4.625 for the WOMAC-hip. CONCLUSIONS: The Turkish versions of the KOOS-PS and HOOS-PS exhibited strong responsiveness to change in the arthroplasty patients.

Fit assessment of two different anatomically contoured distal femur plate sets on cadaveric bones.

OBJECTIVES: This study aims to investigate the fitness of two anatomic distal femoral plates with cadaveric femurs and to show whether current plates optimally match each femur. MATERIALS AND METHODS: Two different sets of plates with five, seven and nine shaft holes were applicated on 62 cadaveric femurs. Ball clay was molded onto the entire inner surfaces of the plates and then the plates were fixed to the bones using two self-locking nylon cable zip ties. The volume of ball clay sandwiched in between the plate and bone was calculated and used as a quantitative fit parameter. Data of each plate were analyzed separately. RESULTS: Using Double Medical Technology IncorporatedTM plates, the mean plate to bone volumes were calculated as 8.4 mL (range, 5-14 mL), 10.0 mL (range, 6-17 mL), and 13.1 mL (range, 7-25 mL) in five, seven and nine-hole plates, respectively. Using Zimmer Biomet IncorporatedTM plates, the mean volumes were 10.5 mL (range, 6-21 mL), 12.7 mL (range, 7-22 mL) and 16.3 mL (range, 8-30 mL) in five, seven and nine-hole plates, respectively. Within each group, the measurements were significantly correlated positively with femoral length. CONCLUSION: Optimal fit may not be achieved in each femur using current distal femoral plate implant sets. Thus additional sizes of plates should be supplied in the implant sets.

Early improvement in physical activity and function after total hip arthroplasty: Predictors of outcomes.

OBJECTIVES: This study aims to assess early changes in physical activity and function after total hip arthroplasty (THA) using both subjective and objective methods, and to identify predictors of outcomes of THA. PATIENTS AND METHODS: Between October 2014 and October 2015, a total of 50 patients (14 males, 36 females; mean age 57.1±13.0 years; range, 31 to 75 years) with end-stage primary hip osteoarthritis who were scheduled for THA and 50 age- and sex-matched controls (10 males, 40 females; mean age 52.9±9.3 years; range, 36 to 75 years) were included in the study. Pain was evaluated using the Numeric Rating Scale (NRS), physical function using the Lequesne Index, physical capacity using the Six-Minute Walking Test (6MWT), and physical activity using both International Physical Activity Impact Questionnaire Short Form (IPAQ-SF) and step count monitor. Data at baseline and six weeks and six months were recorded. RESULTS: Pain severity was significantly lower after THA at six weeks and six months (NRS scores: 2.83 and 0.82, respectively; p<0.001), compared to baseline. Physical function, capacity, and activity significantly improved after THA at six weeks and six months with a mean Lequesne Index score of 2.62 and 1.02, respectively. The mean 6MWT distance was 272.62 at six weeks and 326.16 at six months. The mean IPAQ and 6MWT results were similar between the patient and control groups at six weeks and six months. Age, presence of comorbidities, and baseline Lequesne Index score were found to be effective on functional outcomes of THA. Age and baseline 6MWT scores were correlated with physical capacity after THA. CONCLUSION: Our study showed a significant early improvement in pain severity and physical activity and function at six weeks and six months after THA, compared to baseline values. Baseline values and age were the positive predictors of improved postoperative function and physical capacity.

Are unilateral or staged bilateral total knee arthroplasty really safer than simultaneously bilateral TKA, or is it a myth?

The purpose is to evaluate feasibility of simultaneous TKA in comparison with staged and unilateral procedures. Number of patients included: 72 simultaneous bilateral, 61 staged bilateral and 222 unilateral TKAs were included. The mean age in the simultaneous group was lower than the other groups. Heart failure as comorbidity was observed less in the simultaneous TKA group than the other two groups. There was no significant difference between simultaneous and staged groups with respect to postoperative WOMAC and SF36 scores. Rates of thrombotic complications and mortality were not different. There was no significant difference in terms of wound healing, periprosthetic infection and TKA revision rates. Younger age and heart failure as a comorbidity were found to be decisive in the selection of simultaneous procedure. Thus, in the case of advanced bilateral knee osteoarthritis, simultaneous bilateral TKA should be performed after a proper preoperative risk assessment when there is a medical rationale, or the patient's personal preference. In the light of aforementioned conditions, hesitancy about simultaneous TKA seems unnecessary.

Is it Possible to Recover Cardiac Functions After Total Knee Arthroplasty?

BACKGROUND: Patients suffering from knee osteoarthritis lead a less active life than their healthy peers. It is well known that insufficient physical activity is the most common cause of chronic diseases. However, there is not enough research to enlighten the effect of increased functional capacity on cardiac functions after Total Knee Arthroplasty (TKA). This study aimed to investigate whether the orthopedic surgeons can predict that the patients will be healthier after TKA in terms of cardiac functions or not? METHODS: 109 patients who underwent TKA were prospectively followed for one year. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short form 36 (SF-36) surveys, BMI measures, average step count per day, the six-minute walking test (6MWT), the Five-Times-Sit-to-Stand Test (FTSST) and Doppler echocardiography were performed both in the preoperative and postoperative period. RESULTS: After TKA, there was a substantial improvement in terms of WOMAC and SF36 survey scores. The average step count increased from 2199.6±690.8 steps/day to 4124.3±1638.8 steps/day. 6MWT and FTSST improved significantly as well. The average brisk walking time was 174.23±95.11 minutes/week. The means of early and late mitral inflow velocity ratios (E/A and Em/Am ratios) increased from 0.71±0.12 to 0.77±0.13 and from 0.66±0.13 to 0.76± 0.15 at the first year follow-up visit, respectively (p<0.001). CONCLUSION: In the first year, objective physical capacity measures increased together with the expected improvements in disease-specific and generic measures. After TKA, left ventricular diastolic functions may be considered to have recovered in the light of the healing signs via echocardiography.

External Fixation Versus Hemiartroplasty In Unstable Intertrochanteric Hip Fractures Of The Elderly.

To compare two alternative methods : external fixation (EF) and hemiarthroplasty (HA) in elderly patients with unstable intertrochanteric hip fractures. Forty-two patients with Orthopaedic Trauma Association type 31A2-2 or 31A2-3 fractures treated between January 2007 and December 2010 were included. Twenty-two patients underwent hemiarthroplasty and twenty patients underwent external fixation. The mean length of stay in the operation room was 45 minutes and 108 minutes in the EF and HA groups, respectively (p<0.05). The mean postoperative length of hospital stay was 2.7 days in the EF group and 4.9 days in the HA group (p<0.05). The total length of hospital stay, functional scores and mortality rates were not different. Findings of the current study comparing EF and HA in a limited number of non-randomized elderly patients with unstable intertrochanteric fracture indicated that the EF method, when performed in a sufficiently stable manner, might be a valuable alternative to HA since it is less aggressive and cheaper.

Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures.

BACKGROUND: External fixation is a well-known procedure for the management of intertrochanteric fractures in very elderly high-risk patients. A new compression pin that can be adapted to all fixators was designed to provide inter fragmentary compression. In the present study, its effects on the fracture stability and healing were evaluated. MATERIALS AND METHODS: Thirty-one patients treated using compression pin and thirty-six patients treated using standard pins were evaluated retrospectively between January 2009 and July 2014. Patients were evaluated according to age, gender, duration of preoperative period, duration of operation time, American Society of Anesthesiologists (ASA) scores, and immediate postoperative and final femoral neck angle measurements. The stability of the fixation was evaluated by calculating the secondary varus angulation after weight bearing. RESULTS: Thirty one patients (82.1 ± 6.1 years old) comprised the compression pin group, and 36 patients (83.33 ± 6.24 years old) comprised the standard pin group. From the time of weight bearing to healing time, 1.0 ± 1.25° (0-4) and 2.5 ± 1.8° (0-9) of secondary varus angulation in the compression pin and standard pin groups were measured, respectively (P = 0.000). With weight bearing, 2 of 31 (6%) and 9 of 36 (25%) patients in the compression and standard pin groups, respectively, had >4° of secondary varus angulation. In the compression pin group, 13 fractures were unstable, but only 2 (15%) of them had >4° of secondary varus angulation. In the standard pin group, 19 fractures were unstable, and 7 (37%) of them had >4° of secondary varus angulation. CONCLUSIONS: Treatment of very elderly, high risk patients' with intertrochanteric fractures with external fixation is effective. Compression pin maintained stability better than standard pins after weight bearing, especially for unstable intertrochanteric fractures.

Treatment of Chronic Plantar Heel Pain With Radiofrequency Neural Ablation of the First Branch of the Lateral Plantar Nerve and Medial Calcaneal Nerve Branches.

From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. Pain was evaluated using the visual analog scale, and patients were followed for at least one year. A total of 41 feet from 37 patients (30 [81.1%] females, 7 [18.9%] males; mean age, 50.7 ± 1.6 years; mean body mass index, 30.6 ± 0.7 kg/m(2)) were included. The mean visual analog scale scores improved significantly from 1 to 6 to 12 months after the procedure relative to before the procedure, with 88% of all patients rating the treatment as either very successful or successful at 12 months postoperatively. RFNA applied to both the first branch of the lateral plantar nerve and the medial calcaneal nerve sensory branches (16 [39%] feet) and only the first branch of the lateral plantar nerve sensory branches (25 [61%] feet) showed similarly high levels of success. Of the 41 feet, 28 [68.3%] had received extracorporeal shockwave therapy, 35 [85.4%] had received steroid injections, and 22 [53.7%] had received both extracorporeal shockwave therapy and steroid injections before RFNA as an index procedure. All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA.

Congenital absence of the medial meniscus associated with lipoma arborescens.

Congenital abnormalities of the medial meniscus are extremely rare and have been reported commonly with other deformities. We report an isolated aplasia of the medial meniscus. A 37-year-old man presented with a slow-growing painless swelling, accompanied by intermittent effusion of his left knee. Magnetic resonance imaging demonstrated frond-like proliferations of fatty synovium. He was initially diagnosed with synovial chondromatosis, but later found to have lipoma arborescens. While an arthroscopic synovectomy was being performed, congenital absence of the medial meniscus was discovered as an incidental finding.

[Miliary tuberculosis presented as a sacroiliitis: a case report]. / Sakroileit bulgulariyla seyreden miliyer tüberküloz: Olgu sunumu.

Miliary tuberculosis is a clinical picture due to hematogenous dissemination of a very large amount of bacilli. We present a case with miliary tuberculosis in which the diagnosis and treatment was delayed due to focusing on complaints about the sacroiliac joint. The 28-year-old male patient was admitted with a five-month history of pain in his left sacroiliac joint which was not traumatic. As a definitive diagnosis could not be reached by means of laboratory tests performed, an open biopsy was planned. In the chest X-ray obtained for routine preoperative evaluation, diffuse, bilateral opacities with a 1-2 mm radius were detected and the case was diagnosed with miliary tuberculosis. Miliary tuberculosis is a disease involving multiple organs and systems and treatment can be started empirically as microbiologic verification is difficult. Sacroiliac joint infections are rare and diagnosis is often delayed. The diagnosis of bone and joint tuberculosis is hard because of relative rarity of the disorder, the wide variety in clinical presentation, low suspicion of the examining physician, and rare diagnostic findings on radiographs. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.

[Seroprevalences of hepatitis B, hepatitis C, and HIV in patients admitted to orthopedic and traumatology department]. / Ortopedi ve travmatoloji hastalarinda hepatit B, hepatit C ve HIV seroprevalansi.

OBJECTIVES: Orthopedic surgeons are at a higher occupational risk for blood-borne infections because of frequent handling of sharp instruments and bone fragments. We investigated the seroprevalences of hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) among patients treated at orthopedic and traumatology department. METHODS: Data on age, sex, diagnoses, and the seroprevalences of HBsAg, anti-HCV and anti-HIV were reviewed in 1,040 patients hospitalized between September 2003 and December 2004. The patients were divided into two groups as orthopedics (n=646; mean age 37.8 years) or trauma (n=394; mean age 38.3 years) according to the initial cause of presentation. The results were compared with those of 28,642 blood donations during the same period. RESULTS: HBsAg positivity was similar in the patients (2.3%) and the controls (2.1%). HBsAg was detected in 16 patients (2.5%) in the orthopedics group and eight patients (2%) in the trauma group (p>0.05), three of whom were younger than one year. Similarly, the prevalences of anti-HCV antibodies were similar in the patient (0.6%) and control (0.3%) groups. Four patients (0.6%) in the orthopedics group and two patients (0.5%) in the trauma group were positive for anti-HCV (p>0.05), and all had a past history of operations. Anti-HIV positivity was not detected in the patient group, whereas it was 0.2% in the control group. CONCLUSION: The similarities between patients admitted to orthopedic and traumatology department and blood donors in the prevalences of HBsAg, and anti-HCV and anti-HIV antibodies suggest that data obtained from blood banks can be used for risk calculations.

Carpal tunnel release: using a short vertical incision above the flexor crease of the wrist.

BACKGROUND: Numerous surgical incision techniques have been used to treat carpal tunnel syndrome. The advantages and disadvantages of each are a matter of debate. However, the technique should be cost effective and also decrease the amount of time needed before the patient can return to work. A minimally invasive surgical procedure for the treatment of carpal tunnel syndrome is described in this report. METHODS: Ninety-six patients with carpal tunnel syndrome (106 wrists) were operated on through a 2 cm vertical incision, above the flexor crease of the wrist, under local infiltration anesthesia, without tourniquet control. The mean time length of the operation was nine minutes. RESULTS: Numbness and night pain disappeared in all cases postoperatively. The mean time period to return to work and full activity was 18 (12-26) days. CONCLUSION: Decreasing the time needed before the patient can return to work, minimizing the rate of complications and reducing hospital costs are advantages of this technique.

Distraction of skeletal muscle: evolution of a rat model.

To better study the effects of limb lengthening on skeletal muscle, the authors developed a rat model that uses a miniature external skeletal fixator applied to the tibia of an adult Sprague-Dawley rat. The mounting and lengthening protocols follow the principles developed by Ilizarov. With the initial version of the fixator, the rats had progressive equinus contractures develop because the calf muscles resisted elongation. By incorporating a footplate in the distraction apparatus, tibial lengthening can be achieved without concomitant equinus.

Effects of distraction on muscle length: mechanisms involved in sarcomerogenesis.

Although a great deal of interest has been given to understanding the mechanisms involved in regulating the radial growth that occurs because of resistance training, much less has been given to studying the longitudinal growth of skeletal muscle that occurs because of passive stretch. The current authors provide a brief overview of key issues relevant to the longitudinal growth of skeletal muscle that occurs during distraction osteogenesis. Specifically, five key issues are addressed: (1) the pattern of sarcomerogenesis during distraction; (2) sarcomerogenesis and altered expression of sarcomeric and nonsarcomeric genes; (3) the satellite cell hypothesis; (4) mitogenic factors; and (5) new approaches for studying the longitudinal growth of skeletal muscle. A discussion is provided that revolves around the concept of a negative feedback loop. One of the most interesting issues to be resolved in muscle biology is the role of satellite cells in regulating the growth of skeletal muscle. Currently, it is not known whether satellite cell activation is a prerequisite for the longitudinal growth of skeletal muscle. Gene chip analyses provide a paradoxical view, showing that distraction osteogenesis results in the upregulation of a gene, GADD45, involved with growth arrest and deoxyribonucleic acid destruction.