Preoperative Albumin and Postoperative CRP/Albumin Ratio (CARS) are Independent Predictive Factors in Estimating 1-Year Mortality in Patients Operated for Proximal Femoral Metastasis with Endoprosthesis.

Background: Proximal femur resection and prosthetic reconstruction are preferred in patients with extensive bone destruction, pathological fractures, tumours resistant to radiation therapy, and patients with more proximal metastatic lesions. There is increasing evidence that the CRP/albumin ratio (CAR) is an independent marker of inflammation in various primary organ cancers and maybe a more accurate prognostic factor. We aimed to evaluate whether preoperative and postoperative CAR values could be a factor in predicting mortality in these patients. We hypothesized that CAR could predict these patients' postoperative 90-day and 1-year mortality. Methods: The patient's age and gender, primary tumour, number of bone metastases, and presence of visceral metastases were recorded using imaging techniques such as computed tomography and bone scan or positron emission tomography. The following laboratory data were analyzed before and after surgery. Results: The mean age of the patients was 62.67 ± 14.8; 56.9% were female (n:29), and 43.1% were male (n:22). When the results of the ROC analysis of the parameters in predicting 1-year mortality were examined, and the cut-off value for preoperative albumin was taken as ≤ 3.75, the AUC value was found to be statistically significant as 0.745 (p:0.003). When the cut-off value for postoperative CAR was taken as ≥ 87.32, the AUC value was found to be 0.7 statistically significant (p:0.015). Conclusion: Length of stay, preoperative albumin and postoperative CAR values can be used as independent predictive values in predicting 1-year mortality in patients undergoing endoprosthesis due to proximal femur metastasis.

Evaluation and Management of Idiopathic Unilateral Foot Drop.

BACKGROUND: In this study, our purpose is to evaluate patients who were followed by acute developing single-sided foot drop and improving with conservative management or spontaneously. METHODS: Between 2019 and 2020, 10 patients were evaluated for a unilateral weakness of the lower extremity in the form of absent dorsiflexion at the ankle joint and were given a diagnosis of foot drop without any etiological cause. Patients were followed for a period of 18 months. All patients were evaluated for acute foot drop of the affected extremity by utilizing the following diagnostic modalities, EMG, MRI lumbar spine, MRI knee, peripheral MRI neurography and non-contrast brain MRI. Each patient was evaluated for a history of Covid-19 infection over the past year. Patients with any identified cause were excluded. RESULTS: Initial evaluation of muscle strength in all patients revealed 0/5 by the MRC muscle testing grading scale. (1) In 2 patients, the muscle strength was 3/5 at the 6th month, and in the other 8 patients 4/5 at the 6th month. The muscle strength of all patients improved as 5/5 in 1 year. Six of the patients were dispensed an AFO device and nine patient's performed physical therapy. Evaluation of EMG results identified significant neuropathy at the level of the common peroneal at the fibular head in all patients. In comparison with peroneal nerve stimulation below and above the fibular head in the lateral popliteal fossa; 50% reduction in sensory amplitude, and motor conduction slowing of >10 m/s was present. Evaluation of knee MRI revealed, no masses, edema, or anatomical variations at the level of the fibular head. CONCLUSIONS: In patients diagnosed with unilateral acute foot drop without an etiological cause, one should keep in mind that spontaneous resolution of this condition can occur within one year period.

An evaluation of meniscus tears in lateral tibial plateau fractures and repair results.

BACKGROUND: Soft tissue injuries may co-occur with tibial plateau fractures. These injuries may include medial or lateral ligament ruptures, peroneal nerve lesions, anterior cruciate ligament ruptures, and meniscus tears. OBJECTIVE: The aim of this study was to investigate the frequency of meniscus tears in lateral tibial plateau fractures and to evaluate the clinical and radiological results of meniscus repairs. MATERIALS AND METHOD: The study included 19 patients who underwent surgery for a closed lateral tibial plateau fracture. Anteroposterior and lateral radiographs of the knee, followed by magnetic resonance imaging (MRI) examinations, were undertaken for all cases. The clinical and radiological evaluation of the surgical treatment results was performed according to the Rasmussen criteria. RESULTS: Meniscus lesions were found in 10 (52.6%) patients. Nine meniscus tears were found in patients with type 2 fractures, and one meniscus tear was found in a patient with a type 3 fracture. All of the menisci were separated from the peripheral capsule adhesion point. On the MRI examination during follow-up, all of the repaired lateral menisci were determined to be in their original anatomic location. CONCLUSION: For successful outcomes in lateral plateau fractures, it is essential to determine whether there is a meniscus tear. In cases with meniscus tears, meniscus repair can be easily performed and should be considered because it has a positive impact on the treatment outcome.

Effects of the lower extremity external fixators on the sexual life of males.

OBJECTIVE: In tibial fractures, the use of an external fixator (EF) may be associated with sexual dysfunction (SD) in sexually active male patients. We aimed to investigate the influence of EF applied for tibial fracture on the sexual life in male patients. METHODS: We retrospectively evaluated 137 male patients who presented with tibial fractures and underwent surgical intervention with unilateral or circular EF. The patients completed the Brief Sexual Function Inventory (BSFI) form during the interview. We evaluated the incidence of the development of SD and the severity of SD with the use of an EF, and the relation with the type of EF and SD was investigated. The responses were compared with the results of the completed BSFI forms of 119 male patients who were treated with internal fixation (IF) for tibial fractures. RESULTS: In total, 108 patients (mean age, 42.8 years) treated with EF accepted the invitation and filled the form. The score of those patients were worse compared with that of the patients who were treated with IF (p<0.001). Postoperative sexual functions were the same with the preoperative sexual function in 12 patients (11%). However, the postoperative scores were decreased in 96 (89%) patients, which meant that the sexual functioning was impaired. None of the patients reported persistent SD. CONCLUSION: EF in the cruris may impair sexual functions in males. The rate of SD was higher in male patients who were treated with EF. Thus, SD might be associated with physical, psychological, and social limitations caused by EF.

Measurement of the knee joint line in Turkish population.

OBJECTIVE: The aim of the present study was to determine the knee joint line level by its distance to the adductor tubercle and the apex of the fibular head in the Turkish population. METHODS: The study included 117 knees of 108 patients (63 males, 45 females; mean age: 31.3 years, range: 16 to 82 years). Femoral width and the distance from the apex of the fibular head to the joint line as well as the distance from the adductor tubercle to the joint line were measured on anteroposterior radiographs. RESULTS: Mean femoral width was 87.2 mm. The average distance from the adductor tubercle to the joint line was 47.9 mm and from the fibular head to the joint line was 20.5 mm. A linear correlation was found between the distance from the adductor tubercle to the joint line and femoral width, with a ratio of 0.55. There was no significant correlation between the distance from the fibular head to the joint line and femoral width. CONCLUSION: There was a linear correlation between the femoral width and the adductor tubercle-joint line distance irrespective of any factors such as age, gender and height. Therefore, the adductor tubercle can be used as a reliable landmark to determine the joint line level for easy evaluation and measurement during surgery.

Osteoid osteoma treated with radiofrequency ablation.

Purpose. Our aim is to evaluate the results of treatment with computed tomography (CT) guided percutaneous radiofrequency ablation for osteoid osteomas which were localized in a difficult area for operation. Materials and Methods. Glenoid, distal tibia, humerus shaft, proximal humerus, and in third finger of the hand proximal phalanx were involved in one patient. Proximal femur was involved in three patients, distal femur was involved in three patients, and proximal tibia was involved in two patients. 9 males and 4 females were aged 4 to 34 years (mean age: 18.5 years). All patients had pain and were evaluated with X-rays, CT, bone scintigraphy, and MRI. In all patients, RF ablation was performed with local anesthesia. The lesion heated to 90°C for 6 minutes. Results. All of the patients achieved complete pain relief after ablation and were fully weight bearing without any support. In all patients, there was soft tissue edema after the procedure. During follow-up, all patients were free from the pain and there was no sign about the tumor. There was no other complication after the process. Conclusion. CT guided RFA is a minimally invasive, safe, and cost-effective treatment for osteoid osteoma placed in difficult area for surgery.

The role of simple elbow dislocations in cubitus valgus development in children.

PURPOSE: We investigated the functional and radiological outcomes of conservatively treated simple traumatic elbow dislocations and subsequent incidence of cubitus valgus development in children. METHODS: Eleven patients (one female, ten male; mean age 9.8 years, range seven to 12 years) who presented to our hospital with simple elbow dislocations and were conservatively treated between July 2008 and September 2010 were included in the study. All were posterolateral closed dislocations. None of the patients had accompanying elbow fractures. All patients had pre- and postoperative radiographic examinations. The carrying angle of the involved elbow was measured and compared to the contralateral non-injured elbow during follow-up. The incidence and severity of cubitus valgus development was assessed. The functional and clinical outcomes were evaluated using the Mayo Elbow Performance Scale. The mean monitoring period was 24.3 months (range 19-30 months). RESULTS: All patients had satisfactory good and excellent results (85-100 points; mean 96.8 points) according to the Mayo Elbow Performance Scale. The final average elbow flexion was 137° (range, 130-145°) and average extension was 8.6° (range 0-20°) with full supination and pronation in traumatic elbow. Four patients (36.4%) had an average increase (cubitus valgus) of 14.5° (10-20°) in carrying angle compared to the other elbow. CONCLUSIONS: While isolated traumatic dislocation of the elbow is uncommon among children, it can be successfully treated by urgent closed reduction, proper fixation of the elbow and appropriate timely rehabilitation. However, it should be considered that some patients may develop cubitus valgus deformity in a later period. Therefore, each patient with a simple traumatic elbow dislocation should be followed, and the parents should be informed of the potential for any deformity development.