Comparison of early outcomes of primary total knee arthroplasties performed using subvastus and medial parapatellar approaches and evaluation of quadriceps muscle elastography.

BACKGROUND: In primary total knee arthroplasty (TKA) surgeries, the medial parapatellar (MP) and subvastus (SV) approaches are frequently employed. The SV approach involves preserving the vastus medialis muscle, leading to debates about the possibility of earlier healing of the extensor mechanism. Shear wave elastography (SWE) is known for monitoring tissue healing. In this study, our research question revolves around whether there exist differences in tissue healing following MP and SV approaches. Unlike previous studies, we aim to investigate this difference using solely SWE, which provides a quantitative measurement specifically targeting the vastus medialis muscle. METHODS: We divided 17 patients into two groups: SV (10 patients) and MP (7 patients). SWE measurements and clinical scores were recorded before surgery and at the 3rd-month follow-up. The first straight leg raising days were also recorded. RESULTS: Both the MP and SV groups showed significant improvement in clinical scores postoperatively. Straight leg raising time was comparatively earlier in the SV group, but no significant difference was found. SWE measurements revealed similar recovery values in the vastus medialis muscle between the two groups. CONCLUSION: Both MP and SV approaches demonstrate similar and favorable early outcomes in TKA surgery. The preservation of the vastus medialis in the SV approach does not lead to significant differences in clinical scores or muscle recovery compared to the MP approach. TRIAL REGISTRATION: The study was retrospectively registered on ClinicalTrials.gov on March 7, 2024 (NCT06297746). https://classic. CLINICALTRIALS: gov/ct2/show/NCT06297746?id=am7mi3VB&draw=2&rank=1 .

Depression as a Prognostic Factor in Lower Extremity Amputation for Diabetic Foot: Insights From a Prospective Study on Wound Healing, Infections, and Early Mortality.

This study addresses the challenges faced by diabetic patients undergoing lower extremity amputation due to diabetic foot, particularly focusing on the implications for wound healing and early mortality. The wounds at the amputation stump may necessitate multiple surgical interventions. The aim is to identify prognostic factors associated with these outcomes, shedding light on the complexities surrounding the postamputation phase. A prospective study was conducted on 39 diabetic patients who underwent lower extremity amputation due to diabetic foot between 2021 and 2022. Comprehensive preoperative data, encompassing parameters such as blood count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, hemoglobin A1c, albumin, protein, transferrin, ferritin levels, age, gender, body mass index, smoking habits, dialysis, revascularization, duration of surgery, and the use of tourniquet during the procedure were meticulously recorded. Additionally, cognitive performance and depression status were assessed preoperatively using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI), respectively. A follow-up period of 3 months postsurgery allowed for the comparison of patients who developed infections at the amputation stump with those who did not, as well as the distinction between patients who survived and those who succumbed to mortality. The study revealed that the use of a tourniquet during surgery significantly increased the risk of infection (p = .027), and higher BDI scores were associated with increased risks of both infection (AUC = 0.814) and mortality (AUC = 0.769), with cut-off scores of 24.0 and 23.5 predicting these outcomes with high sensitivity and specificity, respectively. Additionally, lower MMSE scores were associated with increased short-term postoperative mortality. There were no statistically significant differences between the groups in parameters such as complete blood count, ESR, CRP, procalcitonin, HbA1c, albumin, total protein, transferrin, ferritin levels, age, gender, BMI, smoking, dialysis, revascularization, and surgery duration. This investigation highlights the significance of considering tourniquet usage during amputation, preoperative depression status, and cognitive function in patients who undergo amputation due to diabetic foot. The use of a tourniquet during surgery is a significant risk factor for infection, and elevated BDI scores are strong predictors of both infection and mortality in patients undergoing amputations. The findings underscore the importance of a multidisciplinary neuropsychiatric evaluation preoperatively to enhance patient care and outcomes.

Mid- to long-term outcomes of proximal humerus fractures treated with open reduction, plate fixation, and iliac bone autograft augmentation.

BACKGROUND: Open reduction and internal fixation (ORIF) using locking plates is a widely adopted treatment for displaced proximal humerus fractures. Various augmentation techniques have been developed to enhance the stability of plate fixation. Among these, iliac bone autograft is notable for its advantages over allografts, such as ready availability and the elimination of costs and risks associated with disease transmission. Despite its potential benefits, data on the outcomes of iliac bone autograft augmentation (IBAA) are still limited. This study aims to present the mid- to long-term results of treating proximal humerus fractures with ORIF using locking plates and IBAA. METHODS: The study included 15 patients treated with ORIF and IBAA. We classified fracture patterns using the Neer classification and estimated local bone density via the deltoid tuberosity index. We measured the neck shaft angle (NSA) and humeral head height (HHH) on both immediate postoperative and most recent X-ray images to assess the maintenance of reduction. Clinical outcomes were evaluated using the DASH (Disabilities of the Arm, Shoulder, and Hand) and Constant scores. RESULTS: The average follow-up duration was 59.56 months, ranging from 24 to 93 months. A majority of fractures were classified as four-part (53%). The average immediate and late postoperative NSAs were 132.6±8.19 and 131.6±7.32 degrees, respectively. The average HHH on the immediate postoperative and latest follow-up images were 16.46±6.07 and 15.10±5.34, respectively. None of the patients exhibited any radiological signs of avascular necrosis or loss of reduction at the latest follow-up. The mean postoperative Constant and DASH scores at the latest follow-up were 79.6 and 11.5, respectively. CONCLUSION: Our findings suggest that ORIF with IBAA is an effective method for managing three- or four-part proximal humerus fractures, yielding excellent outcomes.

Are acromiohumeral distance measurements on conventional radiographs reliable? A prospective study of inter-method agreement with ultrasonography, and assessment of observer variability.

OBJECTIVES: This study aims to investigate the reliability of acromiohumeral distance (AHD) measurements using conventional radiographs and to compare non-standardized and standardized radiographs with intra-/interobserver reliability measurements. PATIENTS AND METHODS: Between February 2021 and January 2022, a total of 110 shoulders of 55 patients (25 males, 30 females; mean age: 49.7±12.6 years; range, 25 to 77 years) were included. Radiographs were taken in four different positions: primarily shoulder anteroposterior (AP), true AP, standardized true AP, and standardized outlet views. The AHD was measured by three orthopedists. A prospective ultrasonography (US) evaluation was performed by an experienced physiatrist, and the relationship between US and radiographic measurements was evaluated. The intra- and interobserver reliability of radiographic measurements was assessed. RESULTS: On the standardized true AP view measurements, all observers showed a moderate to good agreement with US measurements (intraclass correlation coefficients [ICC]: 0.68-0.75). There was no significant difference between the AHD measurements of the senior orthopedist on standardized true AP and outlet views, and the US measurements. The intraobserver agreement of US measurements was excellent (ICC: 0.98, 95% confidence interval [CI]: 0.98-0.99), and the intraobserver agreement level of measurements on radiographs were good to excellent with a wide range of ICC values (ICC: 0.79-0.97). Interobserver reliability was the highest on the standardized outlet view, with an ICC of 0.91 and 0.88 in two measurement times. Interobserver reliability of other measurements were good with ICC values ranging from 0.82 to 0.88. CONCLUSION: The AHD measurements on radiographs are compatible with US measurements within up to 2 mm difference if standardization is ensured. Also, measurements on standardized views have a superior consistency with lower standard error of measurement and minimal detectable change values. Therefore, we recommend using standardized true shoulder AP and standardized outlet radiographs in clinical practice and studies, as these are the most accurate in demonstrating true AHD.

Semimembranosus: A Rare Muscle Herniation and Review of the Literature.

Extremity muscle hernias are rare pathologies, most of which are managed conservatively. In symptomatic cases, surgical intervention may be required. This study represents a case of a rarer muscle hernia, semimembranosus, in a 43-year-old patient and describes the surgical technique of grafting with synthetic nonabsorbable polypropylene surgical mesh as well as the review of the literature about extremity muscle hernias.

The impact of COVID-19 pandemic in the first 100 days on orthopedic trauma surgery practice, the experience of a university hospital in Istanbul.

BACKGROUND: With the rapid and effective change created by the COVID-19 pandemic in all medical practice, we aimed to evaluate the impact of the first 100 days of the COVID-19 pandemic on the operations performed in a reference university hospital in the field of orthopedics and traumatology. Compare the results with the same period of the previous year and aim to evaluate importance of restrictions. METHODS: The operations performed in orthopedics and traumatology clinic between March 18, 2020 (the day we stopped the elective surgeries), and July 1, 2020 (when the normalization process began), were collected from the electronic archive to compare with the same period of 2019. RESULTS: Comparing the same periods of the year, it was seen that 102 surgeries were performed in the 2020 COVID-19 period compared to 380 operations performed in 2019. Although most of the operations performed during the COVID-19 period were traumas, the comparison revealed that trauma cases decreased by 25% from 73 to 58 (p<0.001). Among trauma patients operated in the restraint period, decrease in the pediatric group and the increase in patients over 65 years of age had seen statistically significant. Compared to the same period of the previous year, 50% increase seen in amputation cases related to diabetic foot (p<0.001). CONCLUSION: The postponement of elective cases due to the COVID-19 pandemic enabled us to manage trauma cases despite decreasing capacity utilization. In addition, it was observed that the transition of schools to online education and the implementation of curfews significantly reduced the number of trauma in the pediatric group. Separation of operating rooms and wards had a huge effect on protection of non-COVID patients. We hope that, in light of this study, we can guide health policies and help other colleagues to manage the possible new waves of the pandemic process or similar processes that may occur in the future.

The risk factors for mechanical complication in endoprosthetic reconstruction of knee osteosarcoma.

BACKGROUND: The increased limb survival rates and higher functional demands have also increased the mechanical complication rates of megaprostheses. This study aimed to analyse possible risk factors which can predispose patients to mechanical complications. METHODS: Patients with knee osteosarcoma referred to our clinic from 1992 to 2014 were investigated retrospectively. The patients who underwent surgical resection and endoprosthetic reconstruction with at least 5 years of follow up were analysed. The revision of the megaprosthesis due to a mechanical complication was accepted as an endpoint. The possible risk factors, including cement usage, implant material, joint mechanism, neoadjuvant radiotherapy, and anatomical localization of the lesion, were analysed for any association with mechanical complication rates. RESULTS: A total of 118 patients were included for final analysis. The average age was 24.5 years (standard deviation ±10.1, range: 15-64). Mechanical complication rate was 22% which included 19 aseptic loosenings and seven implant failures. The average time to mechanical complication was 32.5 months. Overall, 5-year implant survival was 78%. Multiple regression analysis revealed that cement usage is an independent risk factor for mechanical complication (P = 0.007). Although the 5-year implant survival was higher in rotating hinge and titanium implants compared with fixed hinge and cobalt chrome, the multiple regression model did not yield a correlation with mechanical complication rates. CONCLUSION: Cemented implants showed significantly higher mechanical complication rates compared with cementless ones in this series of knee osteosarcoma patients who underwent megaprosthetic reconstruction. Hinge mechanism and implant material did not have a significant effect on mechanical complication rates.