Comparison of radiological and functional results in osteoporotic distal femur fractures operated with single plating, lateral incision, and double plating, anterior paramedial incision: A retrospective study.

Treatment of osteoporotic distal femur fractures is often complicated by a high rate of nonunion and varus collapse. For such fractures, lateral plating with lateral incision and double plating with anterior paramedial incision have shown promising results in the recent literature. The hypothesis of this study was that bilateral plating of comminuted distal femur fractures in osteoporotic patients would result in higher union rates and lower revision rates compared to an isolated lateral locking plate. The study included 56 patients (23 males, 33 females) with supracondylar femur fracture. According to the OA/OTA classification, 9 were type A3, 8 were A2, 13 were C1, 16 were C2, and 10 were C3. The mean follow-up period was 12 months, with 29 patients treated using lateral mini-incision, lateral locking plate, and 27 patients treated with anterior paramedial incision, dual plating. The clinical and radiological results were evaluated. The mean duration of radiological union in the studied population was 15 ±â€…2.1 months (range, 11-21 months) in the single plate group (Group A), and 13.5 ±â€…2.6 months (range, 9-19 months) in the double plate group (Group B). Mean ROM was 112.3° and flexion contracture 4° in Group A, and ROM 108.3° and flexion contracture 6.7° in Group B. (P = .15). The average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was 85.6 points in Group A and 83.5 points in Group B (P = .2278). The postoperative anteversion measurement in the operated extremity ranged from -15 to 19 in Group A, and from 5 to 18 in Group B. When the anteversion degrees were compared between the injured and uninjured extremities in the postoperative period, a significant difference was observed within Group A (P = .0018), but no significant difference was observed in Group B (P = .2492). Dual plate fixation using the anterior paramedial approach is an effective operative method for osteoporotic distal femur fractures. This has many advantages such as precise exposure, easy manipulation, anatomic reduction, and stable fixation. However, for surgical indications and medial bone defects > 1 cm, grafting should be performed.

The effects on joint functions of biplanar distal tubercle open-wedge high tibial osteotomy: A prospective study.

Distal tubercle biplanar open-wedge high tibial osteotomy (DT-BOWHTO) is a method frequently applied in the treatment of knee joint medial osteoarthritis. The aim of this study was to evaluate the radiological, clinical, and functional results of patients at 5 years after DT-BOWHTO surgery. The study included a total of 41 patients who underwent DT-BOWHTO, comprising 19 (46.3%) males and 22 (53.7%) females with a mean age of 55.54 ± 4.17 (45-63) years and mean follow-up of 66.76 ± 6.29 (60-81) months. Statistical comparisons were made of the preoperative and postoperative body mass index (BMI), modified Insall-Salvati index, Blackburn-Peel index, Kelgren-Lawrence classification (KLC), tibial slope angle, American Knee Society Functional Score (AKSFS), Clinical American Knee Society Score (CAKSS), visual analog scale (VAS) pain score, Tegner Functional Activity Score (TFAS), total corrected angular measurements (TCA), and the tibio-femoral varus angle. Compared to the preoperative values, no statistically significant difference was determined in the postoperative modified Insall-Salvati index, Blackburn-Peel index, and tibial slope angle values (P > .05), and a statistically significant difference was determined in the BMI, AKSFS, CAKSS, VAS, KLC, tibio-femoral varus angle, and TFAS values (P ≤ .001). When the preoperative and postoperative BMI values were compared in 3 groups of normal, overweight, and obese, there was found to be a statistically significant difference (P = .014). No significant correlation was determined between the BMI values and the VAS and KLC values (P > .05). No significant correlation was determined between the total corrected angular and the preoperative and postoperative pain, and clinical and functional knee scores (VAS, AKSFS, CAKSS, TFAS) (P > .05). DT-BOWHTO was seen to provide extremely good 5-year results in the knee clinical findings, pain severity, and functional results. As the patella height and tibial slope angle were not changed, this did not cause the development of osteoarthritis in the patellofemoral and tibiofemoral joints. Grafting and fixation of the tibial tubercle with additional screws in the application of DT-BOWHTO were not seen to make any additional contribution to the healing of the osteotomy line. There was no relationship between increased BMI, reduced pain, and increase in knee functions in patients who underwent DT-BOWHTO.

Teratomas from past to the present: A scientometric analysis with global productivity and research trends between 1980 and 2022.

There is currently no bibliometric study on teratomas in the literature. This study aims to analyze the published articles on teratomas to provide an overview of the subject, determine global productivity, and identify current research trends. Additionally, data on different components of scientific output (countries, journals, institutions, authors) were analyzed. A total of 4209 articles published on teratomas between 1980 and 2022 were analyzed using various bibliometric and statistical methods. Bibliometric network visualization maps were used to determine trending topics, citation analyses, and international collaborations. Spearman correlation coefficient was used for correlation analysis. The top 3 countries that made the most contributions to the literature were the USA (1041, 24.7%), Japan (501, 11.9%), and India (310, 7.3%). The top 3 active institutions were the University of California System (n = 78), University of London (64), and Harvard University (62). The top 3 productive journals were the Journal of Pediatric Surgery (n = 141), Pediatric Surgery International (n = 70), and Journal of Pediatric Surgery Case Reports (69). The most productive author was Ulbright TM. (n = 18). The most studied topics from past to present were ovarian cancer/ovarian teratoma/ovarian torsion, mature cystic teratoma/dermoid cyst, sacrococcygeal teratoma, germ cell tumors, immature teratoma, malignant transformation, mediastinal teratoma/mediastinum, neonate/newborn/infant, prenatal diagnosis, testis/testicular cancer/teratoma, ultrasonography/ultrasound, magnetic resonance imaging, chemotherapy, growing teratoma syndrome, surgery, retroperitoneal teratoma/retroperitoneum, laparoscopic surgery/laparoscopy, children/child, and fetal surgery/fetus. We identified trend research topics in the field of teratomas in recent years, including mature cystic teratoma, ovarian teratoma/neoplasm, ovarian cancer, ovarian torsion, growing teratoma syndrome, recurrence, pediatric, testicular cancer, anti-n-methyl-d-aspartate receptor encephalitis, immature teratoma, retroperitoneal, struma ovarii, and carcinoid. The research leadership in the development of teratoma literature was determined by countries with major economies such as the USA, Japan, India, the UK, China, Turkey, South Korea, and other European countries (France, Germany, Italy).

Is tendinitis in volar plating related to the dorsally protruding screw length and its compartment?

OBJECTIVES: The aim of this study was to evaluate the relationship between the length of the protruded screws from the dorsal cortex and extensor tendon damage in all compartments. PATIENTS AND METHODS: Between May 2020 and April 2021, a total of 29 patients (13 males, 16 females; mean age: 52.3±13.0 years; range, 30 to 78 years) who were operated and followed in our clinic for AO A2 and A3 distal radius fractures were included in this prospective study. Surface ultrasound (US) imaging was made to the dorsal sides of both wrists of the operated patients at different timepoints postoperatively. The length of screws with radius dorsal cortex penetration and the presence of tendinitis were recorded. RESULTS: In 15 of 23 patients, the presence of 29 protruding screws was accompanied by tendinitis and, in eight patients, no tendinitis was observed, despite the partial protrusion of screws. A statistically significant correlation was found between the screw protrusion and presence of tendinitis (p<0.05). The number of protruding screws and tendinitis were seen mostly in the second compartment. There was a statistically significant correlation between the protruding screw length of >1.6 mm and the presence tendinitis (p<0.05). CONCLUSION: Dorsal cortex screw protrusions in the application of volar plate for distal radius fractures can cause tendinitis. Screw protrusions occur more frequently in the second compartment and the development of tendinitis in this compartment is associated with a screw length of >1.6 mm. Screw penetration can be easily identified with intraoperative US to prevent tendinitis and potential tendon ruptures.

Comparison of Unilateral Knee Arthroplasty with High Tibial Osteotomy in Surgical Treatment of Medial Knee Osteoarthritis.

BACKGROUND: High tibial osteotomy (HTO) and unicondylar knee arthroplasty (UKA) are two procedures of choice in moderate medial-sided knee osteoarthritis. In this study, we aimed to compare the outcomes of patients undergoing either unilateral knee arthroplasty or open-wedge HTO both clinically and radiologically. METHODS: Clinical records of 105 patients treated surgically with either medial unilateral knee arthroplasty or high tibial osteotomies were reviewed. Fifty-one cases of HTO (group 1) and 54 cases of unicompartmental knee arthroplasty (group 2) were reviewed. Radiographic follow-up data included Kellgren Lawrence index and mechanical alignment measurements using the PACS system. Clinical and functional follow-up data included range of motion degrees and functional assessment scores (Tegner, Lysholm, Knee Society Score and VAS). RESULTS: Mean time of follow-up was 66.10±8.14 months and 65.27±6.95 months for groups 1 and 2, respectively. The HTO group had better radiographic improvement and greater range of motion than the unicompartmental knee arthroplasty group. Despite a significant difference in Lysholm Knee Score and a slight difference in VAS score in favor of HTO, both groups were similar with regard to functional outcomes. CONCLUSION: Both techniques are satisfactory in terms of functional outcomes about five years after the operation and may be considered in cases of middle-aged medial-sided gonarthrosis (<65 years of age) who do not have additional ligament or compartmental pathology.

Intratendinous Injection of Autologous Conditioned Serum for Treatment of Lateral Epicondylitis of the Elbow: A Pilot Study.

BACKGROUND: Autologous conditioned serum (ACS) has been effectively used in treatment of osteoarthritis. However, less is known about its efficacy in tendon disorders. In this pilot study, we aimed to evaluate the short- and long-term effects of intratendinous injection of ACS in lateral epicondylitis (LE) of the elbow. METHODS: This prospective cohort included 42 patients with LE of the elbow who received 4 intratendinous injections of Orthokine® (Orthogen Lab Services GmbH, Düsseldorf, Germany) under local anesthesia over 2 weeks in an outpatient setting. The clinical and functional outcomes of injections were evaluated at 3 months and 1 year after the procedure. Pain was assessed using a visual analog scale (VAS) and functional assessment was made using the Mayo Elbow Performance Score (MEPS) and Oxford Elbow Score (OES). RESULTS: The pre-injection VAS score (7.07±1.19) improved significantly after the procedure at both 3 months (3.55±0.56, P<0.001) and 1 year (1.73±0.82, P<0.001). Similarly, the mean MEPSs were significantly different between baseline and 3 months (56.42±7.51 vs. 79.76±3.81, P<0.001) and between baseline and 1 year (56.42±7.51 vs. 94.28±4.06, P<0.001). The baseline OESs (84.17±6.07) also improved with intratendinous injection of ACS at 3 months (41.96±9.23, P<0.001) and 1 year (7.43±4.31, P<0.001). Only six patients (14.2%) had mild ecchymosis and swelling around the injection site which resolved spontaneously. CONCLUSION: ACS is a promising option for treatment of LE of the elbow, given its early onset of pain-relieving action and longlasting functional effects. These findings await confirmation by large-scale and prospective trials.

Is Lever Test Superior to Lachman, Pivot Shift, Drawer Tests in Diagnosing Anterior Cruciate Ligament Injuries?

INTRODUCTION: The physical examination in anterior cruciate ligament (ACL) injuries is extremely important, and the Lever test is commonly utilized on ACL evaluation. However, the number and scope of studies on the Lever test is limited. In this prospective cross-sectional study, we aimed to evaluate the effectiveness of the diagnostic values of Lachman, Pivot Shift, Lever, and Anterior Drawer tests in terms of quadriceps atrophy and case phase in ACL injuries. METHODS: In this prospective study, diagnostic values of Lachman, Pivot Shift, Lever, and Anterior Drawer tests were examined on 189 patients with positive MRI results as the gold standard. RESULTS: Lever test positivity was significantly more frequent in the group with quadriceps atrophy preoperative and after sedation (p<0.05). Anterior Drawer test positivity was significantly more frequent in the group with positive quadriceps atrophy preoperatively, after sedation and after spinal anesthesia (p<0.05). Lever and Anterior Drawer tests were positively correlated with quadriceps atrophy preop and after sedation (p<0.05). Lever test before surgery, after sedation and after spinal anesthesia in the chronic patient group was more positive than in the acute and subacute groups (p<0.05). Lever test was positively correlated with phase preoperatively, after sedation and after spinal anesthesia (p<0.01). CONCLUSION: The presence or absence of quadriceps atrophy in patients with acute, sub-acute, or chronic ACL injury has a significant effect on the predictive value of the Lever test. We think that univariate analyzes may give incorrect results when demonstrating predictive value, and it would be more correct to perform multivariate analyzes.

Treatment of Basicervical Femoral Fracture With Retractable Talon Hip Compression Screw.

Background Basicervical femoral fractures (BFFs) are rare and biomechanically unstable. The goal of this study was to evaluate the effectiveness of the Talon™ DistalFix™ (Orthopedic Designs North America, Inc., Tampa, FL, USA) nail for the treatment of BFFs with a novel design. Methodology In this retrospective study, 25 patients with BFFs were analyzed between January 2016 and March 2020 at our institute. All patients were treated with the Talon™ DistalFix™ nail. Patients over the age of 60 years with basicervical fractures caused by low-energy trauma were included in this study. For inclusion into the study, the minimum follow-up time had to be longer than six months. The postoperative radiographic bone union, operative time, tip-apex distance (TAD), sliding distance of the lag screw, quality of fracture reduction, and major complications such as cut-out, non-union of the fracture, femoral head collapse, and cut-through were recorded. The Harris Hip Score was used to evaluate hip function at the end of the follow-up period. Results The mean follow-up period was 22 months (range, 16-28 months), and the mean age was 77.8 years (range, 61-91 years). The average sliding distance of the lag screw was 5.7 mm (range, 0.2-13.1 mm). The mean TAD of immediate postoperative view was 20.8 mm (range, 18.7-23.7 mm), and the TAD was <25 mm in all cases. Radiographic union was confirmed in most cases, and the average time for radiographic union was 18.8 weeks (range, 12-25 weeks). Most fractures (90.5%) had healed with no postoperative mechanical complications (cut-out, cut-thorough, or lateral wall fracture) at the final follow-up, except for two patients. One of the two patients had no evidence of union at six months, and mild varus reduction was observed in the other patient who had shortening of >10 mm. Conclusions According to the clinical and radiological findings of this study, treatment with the Talon™ DistalFix™ nail showed satisfactory results. Hence, it can be a suitable option in the treatment of BFFs.

Can developmental dysplasia of the hip be identified in the prenatal period? A pilot study: Ultrasonographic evaluation and postnatal follow-up results of fetal hips in the third trimester.

OBJECTIVE: This study aimed to determine the predictability of developmental dysplasia of the hip (DDH) in the prenatal period by means of evaluating fetal hips using the Graf method on obstetric ultrasonography (US) after the 34th week of gestation. METHODS: A total of 84 pregnant women (mean age = 27.04; age range = 19-46 years), who were referred to our radiology clinic for an obstetric US examination in the third trimester, and their fetuses were included in this study. In the obstetric US, alpha angles of both hips of the fetuses were measured based on Graf's method, and each case was assessed ultrasonographically by a second physician at 6-10 postnatal weeks. Prenatal and postnatal hips were then classified according to alpha angles as ≥ 60° or < 60°. The kappa coefficients between the diagnoses based on prenatal and postnatal alpha angles were calculated. RESULTS: According to the postnatal alpha angle, 77 fetuses were diagnosed to have type 1 right hip and 7 fetuses had type 2A right hip. The prenatal alpha angle provided the same results (77 type 1 and 7 type 2A right hips). Similarly, the postnatal alpha angle revealed type 1 left hip in 82 fetuses and type 2A left hip in 2 fetuses, which was the same as the diagnoses based on the prenatal alpha angles. There was a complete agreement between prenatal and postnatal alpha measurements for both the left and right hips (kappa = 1.00, P < 0.001). CONCLUSION: Evidence from this study has revealed that DDH can be identified by obstetric ultrasonographic examinations in the prenatal period.

Weber C ankle fractures with tibiofibular diastasis: syndesmosis-only fixation.

OBJECTIVES: To evaluate syndesmosis-only fixation in Weber C ankle fractures with tibiofibular diastasis and to assess the need for additional fibular fixation. METHODS: Twenty-one patients with Weber C ankle fractures and tibiofibular diastasis were followed for at least 24 months after treatment. In treatment of the Weber C fractures, only a syndesmosis screw was used through a mini open lateral incision if the syndesmosis could be anatomically reduced and fibular length and rotation could be restored. At follow-up, anteroposterior tibiofibular distance, lateral fibular distance, medial mortise distance and fracture healing were compared and patients were clinically evaluated using the Olerud and Molander ankle scale scoring system. RESULTS: The average duration of follow-up was 49 months and the decreases in anteroposterior tibiofibular distance and lateral fibular distance were statistically significant. At the last follow-up the average clinical score was 86. Ankle mortise was reduced at follow-up in all cases except one, which resulted in a late diastasis. CONCLUSIONS: Syndesmosis-only fixation can be an effective method of treating Weber type-C lateral malleolar fractures with syndesmosis disruption in cases where intraoperative fibular length can be restored and anatomical syndesmosis reduction can be achieved. Level of Evidence IV, Case Series.

OBJETIVOS: Avaliar a fixação apenas da sindesmose em fraturas do tornozelo de Weber tipo C com diástase tibiofibular e a necessidade de fixação adicional. MÉTODOS: Vinte e um pacientes com fraturas de tornozelo Weber C e diástase tibiofibular foram seguidos por pelo menos 24 meses após o tratamento. No tratamento dessas fraturas, apenas um parafuso para sindesmose foi colocado através de mini-incisão lateral e se a sindesmose pudesse ser anatomicamente reduzida e o comprimento e a rotação da fíbula pudessem ser restaurados. No seguimento, a distância tibiofibular anteroposterior, a distância fibular lateral e a distância medial do encaixe do tornozelo e a consolidação das fraturas foram comparados e os pacientes foram avaliados clinicamente pelo sistema de pontuação da escala de tornozelo de Olerud e Molander. RESULTADOS: A duração média do seguimento foi de 49 meses e as diminuições da distância tibiofibular anteroposterior e fibular lateral foram estatisticamente significantes. No último seguimento, a pontuação clínica média foi de 86. O encaixe do tornozelo foi reduzido em todos os casos, exceto um, que resultou em uma diástase tardia. CONCLUSÕES: A fixação apenas da sindesmose pode ser um método eficaz de tratamento de fraturas laterais Weber tipo C com lesão na sindesmose, nos casos em que o comprimento fibular intraoperatório pode ser restaurado e a redução anatômica da sindesmose possa ser obtida. Nível de Evidência IV, Série de Casos.

Weber C ankle fractures with tibiofibular diastasis: syndesmosis-only fixation / Fraturas no tornozelo Weber C com diástase tibiofibular: fixação apenas da sindesmose

ABSTRACT OBJECTIVES: To evaluate syndesmosis-only fixation in Weber C ankle fractures with tibiofibular diastasis and to assess the need for additional fibular fixation. METHODS: Twenty-one patients with Weber C ankle fractures and tibiofibular diastasis were followed for at least 24 months after treatment. In treatment of the Weber C fractures, only a syndesmosis screw was used through a mini open lateral incision if the syndesmosis could be anatomically reduced and fibular length and rotation could be restored. At follow-up, anteroposterior tibiofibular distance, lateral fibular distance, medial mortise distance and fracture healing were compared and patients were clinically evaluated using the Olerud and Molander ankle scale scoring system. RESULTS: The average duration of follow-up was 49 months and the decreases in anteroposterior tibiofibular distance and lateral fibular distance were statistically significant. At the last follow-up the average clinical score was 86. Ankle mortise was reduced at follow-up in all cases except one, which resulted in a late diastasis. CONCLUSIONS: Syndesmosis-only fixation can be an effective method of treating Weber type-C lateral malleolar fractures with syndesmosis disruption in cases where intraoperative fibular length can be restored and anatomical syndesmosis reduction can be achieved. Level of Evidence IV, Case Series.

RESUMO OBJETIVOS: Avaliar a fixação apenas da sindesmose em fraturas do tornozelo de Weber tipo C com diástase tibiofibular e a necessidade de fixação adicional. MÉTODOS: Vinte e um pacientes com fraturas de tornozelo Weber C e diástase tibiofibular foram seguidos por pelo menos 24 meses após o tratamento. No tratamento dessas fraturas, apenas um parafuso para sindesmose foi colocado através de mini-incisão lateral e se a sindesmose pudesse ser anatomicamente reduzida e o comprimento e a rotação da fíbula pudessem ser restaurados. No seguimento, a distância tibiofibular anteroposterior, a distância fibular lateral e a distância medial do encaixe do tornozelo e a consolidação das fraturas foram comparados e os pacientes foram avaliados clinicamente pelo sistema de pontuação da escala de tornozelo de Olerud e Molander. RESULTADOS: A duração média do seguimento foi de 49 meses e as diminuições da distância tibiofibular anteroposterior e fibular lateral foram estatisticamente significantes. No último seguimento, a pontuação clínica média foi de 86. O encaixe do tornozelo foi reduzido em todos os casos, exceto um, que resultou em uma diástase tardia. CONCLUSÕES: A fixação apenas da sindesmose pode ser um método eficaz de tratamento de fraturas laterais Weber tipo C com lesão na sindesmose, nos casos em que o comprimento fibular intraoperatório pode ser restaurado e a redução anatômica da sindesmose possa ser obtida. Nível de Evidência IV, Série de Casos.

Social media and Internet usage of orthopaedic surgeons.

INTRODUCTION: The main objective of this study was to identify the prevalence of social media and Internet usage of orthopaedists and to determine its effects on patient-physician communication. METHODS: Data were collected by e-mail from 321 orthopaedists who filled out the questionnaire. The questionnaire consists of a total 25 items pertaining to personal information, which social media tool they use, their overall views of and expectations from social media, the effects of social media on patient-physician relationship and communication. RESULTS: The rates of keeping in contact with patients and "often" helping patients to manage their treatments over social media increased with age (p < 0.05). It was found that the rate of helping patients to manage their treatments over social media was significantly higher in academicians compared to that in specialist physicians (p = 0.040). The rates of having a personal website and being a member of online physician platform and social-networking sites were higher in participants working in the private sector than participants working in the public sector (p = 0.001). It was found that the rate of finding it useful to be in contact with patients over social media was higher in physicians working in the private sector compared to that in those working in the public sector (p < 0.01). CONCLUSION: Social media tools and Internet are commonly used by orthopaedists to communicate with their patients. Even though there are beneficial effects in patient-physician relationship, effective standards and regulations should be developed to enable a safe communication and to resolve ethical and legal uncertainties.

Internet and social media usage of orthopaedic patients: A questionnaire-based survey.

AIM: To evaluate social media usage of orthopaedic patients to search for solutions to their health problems. METHODS: The study data were collected using face-to-face questionnaire with randomly selected 1890 patients aged over 18 years who had been admitted to the orthopaedic clinics in different cities and provinces across Turkey. The questionnaire consists of a total of 16 questions pertaining to internet and social media usage and demographics of patients, patients' choice of institution for treatment, patient complaints on admission, online hospital and physician ratings, communication between the patient and the physician and its effects. RESULTS: It was found that 34.2% (n = 647) of the participants consulted with an orthopaedist using the internet and 48.7% (n = 315) of them preferred websites that allow users to ask questions to a physician. Of all question-askers, 48.5% (n = 314) reported having found the answers helpful. Based on the educational level of the participants, there was a highly significant difference between the rates of asking questions to an orthopaedist using the internet (P = 0.001). The rate of question-asking was significantly lower in patients with an elementary education than that in those with secondary, high school and undergraduate education (P = 0.001) The rate of reporting that the answers given was helpful was significantly higher in participants with an undergraduate degree compared to those who were illiterate, those with primary, elementary or high school education (P = 0.001). It was also found that the usage of the internet for health problems was higher among managers-qualified participants than unemployed-housewives, officers, workers-intermediate staff (P < 0.05). CONCLUSION: We concluded that patients have been increasingly using the internet and social media to select a specific physician or to seek solution to their health problems in an effective way. Even though the internet and social media offer beneficial effects for physicians or patients, there is still much obscurity regarding their harms and further studies are warranted for necessary arrangements to be made.

Injury of the infrapatellar branch of the saphenous nerve due to hamstring graft harvest.

PURPOSE: Sensory disturbance around the surgical incision due to injury of the infrapatellar branch of the saphenous nerve can be seen in the anterior cruciate ligament reconstruction. In this research, we aimed to compare the incidence, extent of sensory loss, its clinical effect, and natural course caused by two different skin incisions used for hamstring graft harvest. METHODS: Vertical incision for 36 patients and oblique incision for 42 patients used for graft harvest were included in this study. Sensory loss areas were documented at 6th week, 3rd month and 6th month. Pin prick examination is used to detect the change in sensation. Digital photographs of hypaesthesia were taken and analysed by computer for area detection. The length of incision and subjective complain of sensory loss were also noted. RESULTS: At 6th month, 77% (28/36) of the vertical incisions were associated with persistent sensory loss when compared to the oblique incision (45%, 19/42). The measured area of hypaesthesia was significantly higher in vertical incision (42.4 ± 22.3 cm2) than that in oblique incision (9.3 ± 15.3 cm2) at 6th month. The area of hypaesthesia gradually shrunk in size from distal to proximal in direction. Also, subjective cutaneous anaesthesia was higher in vertical incision (15/36, 41%) than oblique incision (6/41, 14%) at 6th month. CONCLUSION: Oblique incision with less risk of nerve damage is better for graft harvesting. Area of hypaesthesia gradually reduces with time and even recover totally. As a possible complication, nerve injury and its benign prognosis should be explained to the patient before surgery.

Gluteal compartment syndrome secondary to superior gluteal artery injury following pelvis fracture: A case report and review of literature.

Acute gluteal artery syndrome secondary to superior gluteal artery injury following pelvic fracture is a rare entity with potential for significant morbidity and mortality. In this report we present such a case resulting with a favorable outcome with prompt diagnosis and appropriate treatment.

Comparison between locked intramedullary nailing and anatomical locking plating in the treatment of displaced clavicular midshaft fractures.

OBJECTIVE: The aim of this study was to compare the results of expandable flexible locked intramedullary nailing and anatomical locking plating in clavicular midshaft fractures. METHODS: Thirty-three patients (21 male, 12 female) who had displaced fractures and at least 2-cm shortening fixed with expandable flexible locked intramedullary nailing and 38 patients (24 male, 14 female) who underwent anatomical locking plating were recruited. Duration of surgery, incision size, duration of hospital stay, union time, and early and late complications were compared between the groups. Functional results were compared with Constant scoring system. RESULTS: Mean duration of surgery was 32.4±9.1 minutes (range: 20-42 minutes) in the nailing group and 54.1±11.9 minutes (range: 42-70 minutes) in the plating group. The incision was 4.1±0.9 cm (range: 3-5 cm) in the nailing group and 9.5±1.7 cm (range: 7-12 cm) in the plating group. Mean union time was 14.8 weeks (range: 10-24 weeks) in the nailing group and 21.3 weeks (range: 12-33 weeks) in the plating group. Mean duration of hospital stay was 3.6±1.1 days (range: 2-4 days) in the plating group, whereas it was 2.3±0.8 days (range: 1-3 days) in the nailing group. In the plating group, an average of 2.7-mm (range: 0-7 mm) shortening was determined in the clavicles that underwent surgery as compared to the intact clavicles, whereas shortening was 2.3 mm (range: 0-6 mm) in the nailing group. CONCLUSION: Expandable flexible locked intramedullary nailing can provide more successful outcomes than plating in displaced clavicular midshaft fractures, due to advantages such as shorter union time, lower complication rate, and better cosmetic outcomes.

Traction table versus manual traction in the intramedullary nailing of unstable intertrochanteric fractures: A prospective randomized trial.

INTRODUCTION: The purpose of this prospective randomized study was to compare traction table with manual traction for the reduction and nailing of unstable intertrochanteric femur fractures. DESIGN: Prospective, randomized, two-center trial. MATERIALS AND METHODS: 72 elderly patients with AO/OTA 31A2 and 31A3 proximal femur fractures were randomized to undergo surgery with either manual traction (MT) or traction table (TT) facilitated intramedullary nailing. The demographics and fracture characteristics, duration of preparation and surgery, total anaesthesia time, fluoroscopy time, blood loss, number of assistants, early post-operative radiological evaluations and 6th month functional and radiological outcomes were evaluated. Data of 64 patients attending 6th month follow-up examination were evaluated statistically. RESULTS: No significant differences were observed between groups regarding demographics and fracture characteristics. In the manual traction group, there was a significant time gain in respect of the positioning and preparation period (18.0±1.6min in MT group, 29.0±2.4min in TT group) (p<0.05). In terms of total anaesthesia time (Preparation+surgery) approximately 6min of difference was observed in favor of MT group (72.8±14.0min for MT and 78.6±6.5min for TT, [p<0.05]). Median number of assistants needed was significantly lower in TT group (2 assistants [1-3]) in MT group and (1 assistant [1,2]) in TT group [p<0.05]). There was no significant difference between two groups regarding other surgical and outcome parameters. CONCLUSIONS: Manual traction reduced the preparation time and total anaesthesia duration, despite an increase in number of surgical assistant. LEVEL OF EVIDENCE: Level II.

Role of anti-adhesive barriers following rotator cuff repair surgery: an experimental study.

OBJECTIVE: This experimental study investigates the effectiveness of expanded polytetrafluoroethylene (Dualmesh®, Gore Medical, Flagstaff, AZ, USA), sodium hyaluronate-carboxymethyl cellulose (Seprafilm®, Genzyme, Cambridge, MA, USA), and polysiloxane (silicone) as anti-adhesive barriers for inhibition of fibrosis in the subacromial area following rotator cuff repair. METHODS: Rabbit rotator cuff tenotomy and repair was conducted on 24 rabbits in 4 groups: control (Group A), Dualmesh® (Group B), Seprafilm® (Group C), and silicone (Group D). Anti-adhesive barrier materials were sutured over the repaired rotator cuff. Macroscopic and histological evaluations were made at the end of the sixth postoperative week. RESULTS: Macroscopic evaluation revealed that minimal adhesion occurred in the control and silicone groups, while the Seprafilm® and Dualmesh® groups showed evidence of fibrosis. Microscopic evaluation revealed diffuse fibrosis and collagen accumulation in the Dualmesh® and Seprafilm® groups, whereas minimal collagen deposition and inflammatory cell reaction was found among the silicone and control groups. Significant differences were found between the silicone and Dualmesh® (p=0.001) and silicone and Seprafilm® groups (p=0.002), as well as between the control and Dualmesh® (p=0.002) and control and Seprafilm® groups (p=0.002). CONCLUSION: Expanded polytetrafluoroethylene (ePTFE/Dualmesh®) and sodium hyaluronate carboxymethyl cellulose (SH-CMC/Seprafilm®) did not prevent or attenuate postoperative subacromial fibrosis following cuff tear repair. Nor did silicone prevent or attenuate fibrosis. More detailed research is needed for development of an effective anti-adhesive barrier for use after rotator cuff tear surgery.

[Preferences of surgeons in total knee and hip arthroplasty, and operating room facilities in Turkey: a survey]. / Türkiye'de total diz ve kalça artroplastisinde cerrahlarin tercihleri ve ameliyathane olanaklari: Bir anket.

OBJECTIVES: This study aims to determine the pre- and postoperative approaches of orthopedic surgeons and operative room environment facilities in total knee arthroplasty (TKA) and total hip arthroplasty (THA) in Turkey. MATERIALS AND METHODS: Data for this study were collected through a questionnaire completed by 234 physicians randomly identified from the database of Turkish Society of Orthopedics and Traumatology. The questionnaire comprised 19 questions investigating the operative room environment, demographic characteristics of surgeons, laboratory and radiologic analyses required by surgeons in pre- and postoperative patient evaluation, and management of postoperative complications. RESULTS: In Turkey, 48% of the operating rooms where TKA and THA are performed lack laminar airflow, while 35% lack HEPA filters. Only 20.5% of surgeons continue antibiotic prophylaxis for postoperative 24 hours. Low molecular weight heparins are the most preferred anticoagulant (86%) for thromboembolism prophylaxis. While all surgeons perform primary TKA or THA, only 63.7% perform revision TKA or THA. Of the surgeons, 84.6% do not recommended antibiotic prophylaxis before dental or urologic procedures in patients who were performed TKA or THA. CONCLUSION: In Turkey, although consensus has been built on many issues regarding TKA and THA, different approaches are adopted based on academic position, duration of specialty, and employer institution.