The effect of anterior cruciate ligament reconstruction and RAMP lesion repair on psychological status.

BACKGROUND: There are few studies examining anterior cruciate ligament reconstruction (ACLR) and RAMP lesion repair. However, no studies have investigated the level of functional performance and psychological state after ACLR and all-inside RAMP lesion repair. HYPOTHESIS/PURPOSE: The aim of this study is to determine the effect of ACLR and RAMP lesion repair on psychological status. ACLR and meniscal RAMP lesion repair were hypothesized to be associated with better psychological outcomes. STUDY DESIGN: This is a cohort study. METHODS: Patients who underwent ACLR with semitendinosus and gracilis autografts by a single surgeon were determined retrospectively. Fifteen patients who underwent ACLR and all-inside meniscus RAMP lesion repair (ACLR-RR) and 15 patients who underwent isolated ACLR were compared. Patients were evaluated by a physiotherapist at least 9 months after surgery. The primary outcome measure was anterior cruciate ligament-return to sports after injury (ACL-RSI), and the psychological status of the patients was examined. Secondary outcomes were visual analog scale (VAS), Tegner activity score, Lysholm knee score, single hop tests, and limb symmetry index (LSI). While pain intensity at rest and during movement was evaluated with VAS, functional performance level was evaluated with the Tegner activity score, the Lysholm knee score, single hop tests, and limb symmetry index (LSI). RESULTS: A significant difference was found in the ACL-RSI values in the ACLR-RR group compared to the isolated ACLR group (p = 0.02). The results of the groups in VAS scores at rest and during movement, Tegner activity levels, and Lysholm knee scores, in the intact and operated leg single hop tests (single leg hop, cross hop, triple hop, and six-meter hop test), and the LSI values in the single leg hop tests showed no significant difference. CONCLUSIONS: This study revealed different psychological outcomes and similar functional levels for ACLR and all-inside meniscus RAMP repair compared with isolated ACLR. It was observed that the psychological status of patients with RAMP lesions should also be evaluated.

Is shoulder joint position sense affected in partial and full-thickness supraspinatus tears?

PURPOSE: Neuromuscular control is important for joint stabilization. Supraspinatus muscle plays an essential role in the perception of proprioceptive sense. The aim of this study is to investigate active joint position sense (AJPS) both in patients with partial and full-thickness supraspinatus tears and in healthy participants. METHODS: Twenty patients with partial supraspinatus tears, 20 patients with full-thickness supraspinatus tears, and 20 healthy participants, aged 40-65 years, were included in the study. Proprioceptive sense was assessed with AJPS measurement. Absolute error was calculated to evaluate joint position sense. RESULTS: Active joint position sense was decreased in partial and full-thickness tears on both in affected and contralateral shoulders compared to control group (p < 0.05). There was no difference between groups with partial and full-thickness tears on the affected and contralateral shoulders at 40° and 100° elevation (p > 0.05). CONCLUSION: AJPS was affected after supraspinatus injury. It was seen as proprioceptive deficit in patients with partial and full-thickness tears in both affected and contralateral shoulders.

Is there a relation between plantar fasciitis and total cholesterol levels?

BACKGROUND: The main objective of this study is to investigate the relationship between hypercholesterolemia and Plantar Fasciitis (PF). METHODS: The study includes patients who presented to the orthopedics outpatient clinic with heel pain and were diagnosed with PF. The control group was composed of patients who came to the orthopedics outpatient clinic, with complaints other than heel pain. The two groups were compared in terms of epidemiological data, total cholesterol (TC) levels, and hypercholesterolemia prevalence. We also performed an in-group analysis of PF patients in terms of age, sex, body mass index, and duration of symptoms. RESULTS: There were 238 patients (mean age, 46.7) in the PF group and 240 patients (mean age, 47.9) in the control group. There was a significant difference between the PF group and the control group in TC levels (207.6 ± 47.5 versus 195.1 ± 30.1, p = 0.001). Hypercholesterolemia (TC level > 240 mg/dL) was found in 22.7% (n = 54) of the patients in the PF group whereas in the control group this rate was 10.8% (n = 26) (p < 0.001). It was seen that the TC levels were significantly higher in patients over the age of 45 in the PF group (p = 0.038). We also found that TC levels were higher in PF patients with symptoms for longer than a year (p = 0.026). CONCLUSION: Significantly higher TC levels were found in PF patients in comparison with other orthopedic outpatients. Besides, being over the age of 45 and having a duration of symptoms longer than a year is associated with higher cholesterol levels for PF patients. LEVEL OF CLINICAL EVIDENCE: 4.

Is plantar foot sensation affected in patients with gonarthrosis.

OBJECTIVE: The aim of this study was to compare pain, plantar foot sensation, postural control, fear of movement, and functional level between women patients with early-stage gonarthrosis and those with late-stage gonarthrosis. METHODS: A total of 62 women with gonarthrosis were included in the study. Patients were then divided into two groups: earlystage gonarthrosis group (31 women) and late-stage gonarthrosis group (31 women) according to Kellgren Lawrence criteria. Light touch-pressure sensation (Semmes Weinstein Monofilaments), two-point discrimination sensation (esthesiometer), and vibration sensation (128 Hz diapason) were used to evaluate plantar foot sensation. Pain intensity was assessed by the numeric rating scale, postural control by Berg balance scale, fear of movement by the Tampa kinesiophobia scale, functional mobility by the Timed Up and Go test and knee injury and osteoarthritis outcome score. RESULTS: Early-stage patients were found to have higher light-touch pressure sensation on 1st metatarsal head of dominant side, 5th metatarsal head of non-dominant side, heel of non-dominant side than late stage patients. Early-stage patients had a higher sensation of vibration than late stage patients. The patients in the early stage were found to have higher two-point discrimination sensation on middle of dominant side, heel of dominant side, trans-metatarsal of non-dominant side, middle of non-dominant side, heel of non-dominant side than late stage. Postural control of early-stage patients were found to be higher than late-stage patients. Early-stage patients had lower kinesophobia and higher functional levels than late-stage patients. CONCLUSION: The light touch sensation, vibration sensation, and two-point discrimination deteriorated by the progression of the disease should be important criteria in patients with gonarthrosis. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Surgical Treatment of Meniscal RAMP Lesion.

RAMP lesion, defined as peripheral detachment lesion of posterior horn of medial meniscus, has been shown to accompany anterior cruciate ligament (ACL) ruptures and is thought to play an important role in the knee joint stability. In this study, we aimed to present results of postoperative knee function scores and patient satisfaction after surgical repair of RAMP lesion. We included 15 patients who had undergone knee arthroscopy due to RAMP lesion in 2017. We recorded demographic data, diagnosis, pre- and postoperative International Knee Documentation Committee and Tegner-Lysholm scores of all patients. In this study, we included 15 patients: the number of male and female patients was eight and seven, respectively. The mean age of patients was 26.8 (18-35). Associated injuries included ACL rupture in 12 patients, additional medial meniscus lesion in 3 patients, lateral meniscus lesion in 3 patients, and superomedial patellar plicae syndrome in 2 patients. All patients had the same postoperative rehabilitation protocol. Mean preoperative Tegner-Lysholm knee score was 64.4 (53-75), while it was 82.5 (75-89) postoperatively, and mean preoperative and postoperative Visual Analogue Scale score at last postoperative follow-up were 5.26 (2-8) and 1.06 (0-2), respectively. All differences were found to be statistically significant. Meniscal RAMP lesions are commonly associated with ACL ruptures. RAMP repair significantly increases postoperative knee function scores and patient satisfaction following ACL reconstruction.

Correction to: Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.

This article [2] was published twice [1] due to a production error. The original article [1] should be considered the version of record and used for citation purposes. The publisher apologizes to the authors and readers for the error and any inconvenience caused.

An Alternative Femoral Fixation in All-Inside Anterior Cruciate Ligament Reconstruction: A Solution for Preventing Possible Graft Loosening.

The aim of this surgical Technical Note is to search for a way to prevent possible graft loosening in all-inside anterior cruciate ligament (ACL) reconstruction. We used a fixed-loop cortical suspensory device on the femoral end and a suspensory cortical fixation technique and sutures on the tibial end. Then we flexed the knee for 150 cycles, reexamined the tightness of the ACL graft, and compared it with the initial tightness. Loosening of the ACL graft, which is suggested to be related to suspensory cortical fixation, could be prevented using the button system on the femoral end and tightening the suspensory cortical fixation on the tibial end.

Otologic Findings Based on no Complaints in a Pediatric Examination

Abstract Introduction the otological evaluation is highly significant in those branches of medicine in which the general evaluation of the patient is conducted by general practitioners and pediatricians. Objectives To investigate the otologic findings and their incidences in the sample, which consisted of patients who presented to the pediatric outpatient clinic with nonotologic complaints. Methods Patients, aged between 2 and 16 years, who had neither otorhinolaryngological complaints nor history of surgery by the otolaryngology (ear, nose and throat, ENT) department were included in the present study. The findings detected in the external auditory system and in the tympanic membranes as well as the otorhinolaryngologists' otologic examination findings of the referred patients were recorded from the files of each patient along with the applied medical and surgical treatments, and diagnostic investigations. Results Of a total of 973 patients evaluated, 129 (13.2%) were referred to the ENT outpatient clinic due to any otologic pathology. In the otorhinolaryngological examinations, false positivity was detected in 12 (1.2%) patients, and pathological findings were detected in 117 (12%) patients who received the following diagnoses: 68 (6.9%) had otitis media with effusion(OME); 37 (3.8%) had cerumen impactions; 8 (0.8%) had acute otitismedia (AOM); 2 (0.2%) had ticks in the external auditory canal; 2 (0.2%) had a retraction pocket in tympanic membrane; 1 (0.1%) had unilateral central dry perforation of the tympanic membrane; and 1(0.1%) had congenital cholesteatoma. Conclusion Any complications and sequelae that may develop due to any pathologies and predominantly infections can be prevented by an early diagnosis, which can be made by means of a simple examination, performed merely with an otoscope. Pediatricians and general practitioners should be in close contact with otorhinolaryngologists regarding the pathologies they identify. (AU)

Otologic Findings Based on no Complaints in a Pediatric Examination.

Introduction the otological evaluation is highly significant in those branches of medicine in which the general evaluation of the patient is conducted by general practitioners and pediatricians. Objectives To investigate the otologic findings and their incidences in the sample, which consisted of patients who presented to the pediatric outpatient clinic with non-otologic complaints. Methods Patients, aged between 2 and 16 years, who had neither otorhinolaryngological complaints nor history of surgery by the otolaryngology (ear, nose and throat, ENT) department were included in the present study. The findings detected in the external auditory system and in the tympanic membranes as well as the otorhinolaryngologists' otologic examination findings of the referred patients were recorded from the files of each patient along with the applied medical and surgical treatments, and diagnostic investigations. Results Of a total of 973 patients evaluated, 129 (13.2%) were referred to the ENT outpatient clinic due to any otologic pathology. In the otorhinolaryngological examinations, false positivity was detected in 12 (1.2%) patients, and pathological findings were detected in 117 (12%) patients who received the following diagnoses: 68 (6.9%) had otitis media with effusion(OME); 37 (3.8%) had cerumen impactions; 8 (0.8%) had acute otitis media (AOM); 2 (0.2%) had ticks in the external auditory canal; 2 (0.2%) had a retraction pocket in tympanic membrane; 1 (0.1%) had unilateral central dry perforation of the tympanic membrane; and 1(0.1%) had congenital cholesteatoma. Conclusion Any complications and sequelae that may develop due to any pathologies and predominantly infections can be prevented by an early diagnosis, which can be made by means of a simple examination, performed merely with an otoscope. Pediatricians and general practitioners should be in close contact with otorhinolaryngologists regarding the pathologies they identify.

Can double fluoroscopy in the oblique position reduce surgical time and radiation exposure during intertrochanteric femur fracture nailing?

BACKGROUND: The purpose of this study was to determine the comparative effectiveness of the use of single fluoroscopy versus double fluoroscopy during intramedullary nailing in the oblique position for intertrochanteric femur fractures in terms of surgery and radiation time. METHODS: Fifty-two patients (20 men, 32 women; average age: 78.2 years; range: 69-88 years) were included in the study. While double fluoroscopy was used for 25 patients, single fluoroscopy was used for the remaining 27 patients. Data of the preparation time between anesthesia and surgery, surgery time, radiation time, bleeding volume, postoperative collodiaphyseal angle between the fractures and intact parts, and the tip-apex distance (TAD) were compared. RESULTS: The surgery time in the double and single fluoroscopy groups averaged 34.48±8.92 minutes and 50.37±16.63 minutes, respectively (p<0.01). The radiation time was 42.72±16.00 seconds for the double-fluoroscopy group and 68.22±21.53 seconds for the single-fluoroscopy group (p<0.01). The surgical preparation time, bleeding volume, collodiaphyseal angle and TAD distance did not vary significantly between groups (p>0.05). CONCLUSION: The use of double fluoroscopy in the oblique position in the surgical treatment of intertrochanteric femur fractures reduced the surgical time and the anesthesia time for patients, as well as the exposure to radiation, thereby also reducing the risk of complications.

Application of hybrid external fixation by the "joystick method" in bicondylar tibial plateau fractures: Technical note.

BACKGROUND: This study aimed to present clinical outcomes in patients with tibial plateau fractures who were treated with hybrid external fixators and describe the details of our technique. Schanz screws were synchronously applied and used as a joystick for fracture reduction. METHODS: The study population included 72 patients with bicondylar tibial plateau fractures classified as type 41-C2 according to the AO classification. Joint reduction was maintained using Schanz screws transmitted through tibial condyles as a joystick under fluoroscopy. The patients then underwent surgery with these Schanz screws and a hybrid external fixation system. RESULTS: The median age of the patients was 39 (21-67) years, and the median follow-up time was 21 (12-35) months. The mean knee flexion and extension were 105° (80°-125°) and 0° (-5°-7°), respectively. The mean varus laxity and valgus laxity were 4.30° (2°-7°) and 3.10° (2°-5°), respectively. Four patients had leg shortness of 0.4-1.1 cm. The external fixators were removed between 8 and 16 weeks (mean = 11 weeks) postoperatively. The KSS scores at the end of 1 year were "excellent" for 48 patients, "good" for 19 patients, and "inadequate" for 5 patients. CONCLUSION: With the synchronous application of the two Schanz screws of 6.5-mm thickness and the two-drill technique under fluoroscopic guidance, we obtained stable reductions over a short period. No patient experienced major complications, and this enabled early weight bearing and a return to daily living activities.

Which unicondylar prosthesis is better in the mid- term in obese patients: fixed or mobile?

As it is mentioned in the literature, rates of complications and revision are higher in the obese compared to non-obese patients, although obesity does not a contraindication for unicompartmental knee arthroplasty and successful outcomes are achieved. However, there is not any study in the literature comparing the outcomes of fixed and mobile unicompartmental prostheses which are applied in the obese patients. Objective of this study was to compare outcomes of our obese patients who we applied fixed or mobile unicompartmental arthroplasty and followed up for 8 years and over. Of 293 patients in whom we performed unicompartmental knee prosthesis due to medial gonarthrosis between 2003 and 2014, 239 patients who were regularly followed-up at least for 18 months were included in this study. Total 248 knees with 193 (77.8%) fixed including bilateral prosthesis in 9 patients and 55 (22.2%) mobile prostheses were retrospectively assessed. The study included 57 patients having BMI >30 kg/ m2 who were regularly followed-up. In the final controls; mean flexion was found as 107° (100-128°)(p < 0.05), mean extension as 3° (0-5°) and mean tibio femoral angle as 4° (1-5°) (p < 0.05) valgus. Postoperative mean WOMAC value was found as 91.23 ± 3.02 (92-96) (p < 0.05) and mean KSS score as 88.3 ± 3.94 (85-100) (p < 0.05). In the final controls, respective knee flexions were seen to be 105° (100-125°) and 108°(105-128°) in the fixed and mobile insert subgroups (p > 0.05). Unicompartmental knee prosthesis is a good treatment option which can be applied also in obese patients and has high survival rates. No significant difference was found between the prostheses with fixed and mobile insert in terms of function and knee scores. However, fixed unicompartmental prosthesis should primarily be preferred in obese patients because of the challenging surgical technique, difficult learning curve and insert dislocation that we encounter with mobile prostheses.

Assessment of the kinesiotherapy's efficacy in male athletes with calcaneal apophysitis.

BACKGROUND: The aim of the present study was to assess the efficacy of kinesiotherapy used for treating various disorders in athletes on pain and pedal functions in patients with calcaneal apophysitis. METHODS: This prospective randomized controlled study included 22 patients with calcaneal apophysitis aged 8 to 16 years presenting with heel pain among junior athletes of a professional football club. The patients were randomly grouped into two groups, with one group receiving sham tape only and the other kinesio tape. American Orthopedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores were recorded before and after the treatment. RESULTS: The preoperative VAS score of the kinesio tape was 7, and AOFAS score was 62.4; the corresponding figures of the sham group were 6.81 and 70.5, respectively. The kinesio-tape group had a better AOFAS scores at 1st and 3rd month (p < 0.05). Posttreatment AOFAS score was 99.7 ± 0.9 for the kinesio-tape group and 97.4 ± 3.9 for the sham-tape group. Posttreatment VAS score was 0.1 ± 0.3 for the kinesio-tape group and 0.4 ± 0.5 for the sham-tape group (p > 0.05). DISCUSSION: Conservative treatment modalities are preferentially used for its treatment. Kinesiotherapy is one of the treatment methods for the apophysitis. In the literature, our study is the first prospective randomized trial on the efficacy of kinesio taping in calcaneal apophysitis. CONCLUSIONS: Although kinesio taping can be effectively used for the restoration of ankle functions of athletes with calcaneal apophysitis, its role in pain is limited. Since it lacks serious side effects, it can be used in combination with or as an alternative to pharmacological treatment in this patient group.

Difference between biomarkers of tibial bone marrow and adipose tissue.

BACKGROUND: Stem cells, with their regeneration capacity, long-term viability, and differentiation characteristics, have indispensable biological properties. As described by Hauner and Grigoradis et al., mesenchymal stem cell originating from adipose or bone marrow can be differentiated into many tissues such as adipocyte, chondrocyte, myeloblast, and osteoblast. The aim of our study is to compare the use of adipose and tibial bone marrow derived stem cells for therapeutic purposes in orthopedic surgery, which has not been clearly evaluated in the literature to our knowledge and to also evaluate their use. MATERIAL AND METHOD: Our study was performed between May 2014 and December 2016 in our clinic (Istanbul Medipol University, Department of Orthopedics and Traumatology) in 40 patients. Twelve patients were excluded. The ages of the 28 included patients ranged from 19 to 61 years, with a mean of 41.18 ± 13.39 years. The stem cell samples of these patients were analyzed by flow cytometry. RESULTS: Tibial bone marrow stem cells were used in 15 cases and the mean age was 49.33 ± 9.15. Adipose-derived stem cells were used in 13 patients and the mean age was 31.77 ± 11.25. None of the patients had any minor/major complication in the areas where stem cells were collected. DISCUSSION: Tibial-derived bone marrow has better results with regard to the complications, economic burden, and surgery time. Tibial-derived bone marrow harvesting and stem cell preparation time are one-fourth of the stem cell treatment prepared from adipose tissue and the surgical duration is shortened by 45 min. CONCLUSION: If stem cell use is the preference of the surgeon, we have found that the tibial-derived stem cell system is more advantageous for ease of acquisition, cost analysis, and surgical time.

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.

BACKGROUND: Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early-grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment. METHODS: This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter. RESULTS: The patients had mean preoperative VPS (visual pain scale) and AOFAS (American Orthopedic Foot and Ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70, respectively. Both VPS and AOFAS-Hallux scores changed significantly. DISCUSSION: In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment. CONCLUSIONS: An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.

Evidence for reliability, validity and responsiveness of Turkish version of Hip Outcome Score.

BACKGROUND: Hip Outcome Score (HOS), originally developed in English, assesses the severity of hip pathology. To date, no Turkish version of the questionnaire exists. PURPOSE: The aim of our study was to translate the HOS into Turkish and verify its psychometric properties. METHODS: The translation and cultural adaptation were performed according to international recommendations in five stages: The HOS was translated into Turkish, consistent with published methodological guidelines. The process included 2 forward translations, followed by the synthesis of these translations, and 2 backward translations, followed by an analysis of the translations and creation of the final version. The measurement properties of the Turkish HOS (internal consistency, construct validity, floor and ceiling effects and responsiveness) were tested in 130 patients. RESULTS: A committee consisting of the four translators agreed with the final version of the HOS (HOS-Tr). The internal consistency and the test-retest reliability of the HOS-Tr-ADL and HOS-Tr-S subscales were excellent. Correlations between the HOS-Tr and convergent validity of the with HHS and NAHS were fair to good. The responsiveness of the HOS-Tr-ADL and HOS-Tr-S subscales were 3.4 to 1.4 for patients treated with surgically and 0.9 to 1.1 for patients treated with non-surgically. CONCLUSION: The HOS-Tr is understandable, reliably, valid, and responsive for Turkish-speaking patients with hip pathology. LEVEL OF EVIDENCE: Level 3 Diagnostic Study.

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.

BACKGROUND: Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment. METHODS: This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter. RESULTS: The patients had mean preoperative VPS (visual pain score) and AOFAS (American Orthopedic Foot and ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70. Both VPS and AOFAS-Hallux scores changed significantly. DISCUSSION: In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment. CONCLUSIONS: An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.

Patient compliance with touchdown weight bearing after microfracture treatment of talar osteochondral lesions.

BACKGROUND: The aim of this study was to prospectively evaluate the compliance of our patients with a touchdown weight bearing (without supporting any weight on the affected side by only touching the plantar aspect of the foot to the ground to maintain balance to protect the affected side from mechanical loading) postoperative rehabilitation protocol after treatment of talar osteochondral lesion (TOL). METHODS: Fourteen patients, who had been treated with arthroscopic debridement and microfracture, were followed prospectively. The patients were evaluated for weight bearing compliance with using a stationary gait analysis and feedback system at the postoperative first day, first week, third week, and sixth week. RESULTS: The mean visual analog scale (VAS) scores of the patients at the preoperative, postoperative first day, first week, third week, and sixth weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. The decrease in VAS scores were statistically significant (p < 0.0001). First postoperative day revealed a mean value of transmitted weight of 4.08% ±0.8 (one non-compliant patient). The mean value was 4.34% ±0.8 at the first postoperative week (two non-compliant patients), 6.95% ±2.3 at the third postoperative week (eight non-compliant patients), and 10.8% ±4.8 at the sixth postoperative week (11 non-compliant patients). In the analysis of data, we found a negative correlation between VAS scores and transmitted weight (Kendall's tau b = -0.445 and p = 0.0228). CONCLUSIONS: Although patients were able to learn and adjust to the touchdown weight bearing gait protocol during the early postoperative period, most patients became non-compliant when their pain was relieved. To prevent this situation of non-compliance, patients should be warned to obey the weight bearing restrictions, and patients should be called for a follow-up at the third postoperative week.

Mid-Term Results of Minimally Invasive Plate Osteosynthesis and Circular External Fixation in the Treatment of Complex Distal Tibia Fractures.

BACKGROUND: The treatment of pilon tibia fractures is challenging. Anatomical reduction of the joint surface is essential. Excessive soft-tissue dissection may interfere with the blood supply and can result in nonunion. We sought to compare the outcomes of distal tibia fractures treated with medial locking plates versus circular external fixators. METHODS: We retrospectively evaluated 41 consecutive patients with closed pilon tibia fractures treated with either minimally invasive locking plate osteosynthesis (n = 21) or external fixation (EF) (n = 20). According to the Ruedi and Allgower classification, 23 fractures were type B and 18 were type C. Soft-tissue injury was evaluated according to the Oestern and Tscherne classification. Time to fracture union, complications, and functional outcomes were assessed annually for 3 years with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score. RESULTS: Mean ± SD values in the plate group were as follows: age, 42.4 ± 14 years; union time, 19.4 ± 2.89 weeks (range, 12-26 weeks); and AOFAS ankle scores, 86.4 ± 2.06, 79.5 ± 1.03, and 77.9 ± 0.80 at 1, 2, and 3 years, respectively. Four patients in the plate group needed secondary bone grafting during follow-up. In the EF group (mean ± SD age, 40.7 ± 12.3 years), all of the patients achieved union without secondary bone grafting at a mean ± SD of 22.1 ± 1.7 weeks (range, 18-24 weeks). In the EF group, mean ± SD AOFAS ankle scores were 86.6 ± 1.69, 82.1 ± 0.77, and 79.7 ± 1.06 at 1, 2, and 3 years, respectively. There were no major complications. However, there were soft-tissue infections over the medial malleolus in five patients in the plate group and grade 1-2 pin-tract infections in 13 patients and grade 3 pin-tract infections in one patient in the EF group. Post-traumatic arthritis was detected in eight plate group patients and seven EF group patients. CONCLUSIONS: Minimally invasive plating and circular EF methods have favorable union rates with fewer complications.

The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty.

The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.