The Japanese Orthopedic Association Back Pain Evaluation Questionnaire: A Turkish validation study.

BACKGROUND: The aim of this study was to apply cross-cultural adaptation and validity assessment to the Turkish translation of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire applied to patients conservatively monitored for lumbar disc hernia and narrowing of the lumbar canal. METHODS: The questionnaire was translated into Turkish based on guidelines. In respect of the comprehensibility of the obtained pre-final version of the questionnaire, a pilot test was applied to 20 healthy individuals. The patients were requested to complete the final version of the questionnaire after an orthopedic and physical therapy assistant doctor (resident) had completed the diagnosis and demographic information. To evaluate the retest reliability, the test was applied a second time, 14 days (±3 days) after the first application, again in the Orthopedics and Physical Therapy Outpatient Clinic. RESULTS: The study was completed with a total of 215 individuals, comprising 107 patients and 108 healthy volunteers. When Turkish version of the questionnaire scale was evaluated of the patients and healthy volunteers together, the internal consistency was determined at the levels of Cronbach's α excellent. The lowest correlations of all the questionnaire scale items with the scale sub-dimensions was at the level of r = 0.509, which demonstrated that there was a sufficient validity level of the Turkish translated questionnaire scale. A statistically significant direct correlation at a high level was seen between the pre and post points in all the scale sub-dimensions. CONCLUSIONS: The results of the current study showed that Turkish version of the questionnaire had sufficient reliability and validity in the evaluation of low back pain and resulting dysfunction and disability in patients with LDH and narrowing of the lumbar canal.

Posterior bone block of chronic locked posterior shoulder dislocations with glenoid augmentation: a retrospective evaluation of ten shoulders.

PURPOSE: The aim of this study, which is the most extensive series to date on this subject, was to present the results of ten shoulders of seven patients treated with the posterior bone block augmentation method with autograft taken from the iliac wing for a chronic locked posterior shoulder dislocation and to evaluate the results in the light of the relevant literature. METHODS: A retrospective examination was made of patients who underwent iliac autograft with glenoid augmentation for chronic posterior shoulder dislocation in our clinic between 2004 and 2011. All of the patients had been initially treated at another centre and referred to our hospital because of continuing or relapsing posterior shoulder dislocation. Assessment was made by physical examination X-ray, computed tomography (CT), and the Constant-Murley score. RESULTS: All the patients were male with a mean age at the time of surgery of 42.4 years (range, 23-53 years), with a mean follow-up period of 40.6 months (range, 24-55 months). On presentation, all the patients had locked posterior shoulder dislocation. Radiological union was evaluated from the CT images taken 24 months postoperatively. The graft was observed to have been incorporated in all cases. The mean postoperative Constant-Murley score was 81.25/100 ± 17.8. In seven of the shoulders, arthropathy findings increased by varying degrees. CONCLUSIONS: A functional and stable shoulder can be obtained with glenoid augmentation in patients with chronic locked posterior shoulder dislocation. When other treatment alternatives are considered for a young patient group, this is a safe and applicable treatment method.

Turkish Validity and Reliability Study of Scoliosis Research Society-30 Questionnaire in Adolescent Idiopathic Scoliosis Patients.

STUDY DESIGN: Methodological. OBJECTIVE: Turkish validity and reliability study of Scoliosis Research Society-30 (SRS-30) questionnaire. SUMMARY OF BACKGROUND DATA: SRS-30 is the most current questionnaire of SRS, which is widely used in the evaluation of the treatment of patients with idiopathic scoliosis. There is no validity and reliability study for the Turkish language. METHODS: All translation and cross-cultural adaptation stages of the SRS-30 English version to Turkish were implemented. SRS-30 Turkish and Short Form-36 questionnaires were administered to 96 patients with adolescent idiopathic scoliosis simultaneously. Two weeks later, the SRS-30-Turkish version was applied again. Internal validity was examined using the Rasch model, and external construct validity (convergent validity) was evaluated with the Spearman rho correlation test. Person Separation Index was used for reliability. The internal consistency was analyzed with Cronbach alpha. For test re-test reliability, intraclass correlation coefficient between the two measurements was calculated. RESULTS: As a result of the Rasch analysis, it was observed that the Turkish version of SRS-30 has a multidimensional structure and the disordered threshold problem was observed in some items. Overall fit is provided for each of the four sub-dimensions of SRS-30 Turkish. There was no difference in the functioning of the items in terms of gender and age groups. The lowest Person Separation Index value was obtained with 0.539 in the satisfaction of the treatment sub-dimension. Cronbach alpha values were over 0.70 for all domains. The intraclass correlation coefficient value was found in satisfaction with management dimension (0.463) and above 0.60 in other dimensions. CONCLUSION: It was concluded that the SRS-30 Turkish questionnaire was valid and reliable in evaluating the treatment of patients with adolescent idiopathic scoliosis. Considering the studies related to SRS scales in the literature, especially those applied Rasch analysis, it is seen that the reply categories of the items should be reviewed.Level of Evidence: 2.

Effects of Artcure Diffusional Patch application on pain and functional status in lumbar disc herniation patients: a prospective randomized controlled study.

BACKGROUND/AIM: The aim of this study was to assess the efficacy of the Artcure Diffusional Patch, which contains a mixture of 6 herbal oils (oleum thymi, oleum limonis, oleum nigra, oleum rosmarini, oleum chamomilla, oleum lauriexpressum) and has a hypoosmolar lipid structure, in the conservative treatment of lumbar disc herniation patients and to show the advantages and/or possibility of using this as an alternative method to surgery. MATERIALS AND METHODS: Of the 120 patients enrolled, 79 clinically diagnosed patients were included in the study. Clinical evaluations were performed on patients who had findings of protrusion or extrusion in their magnetic resonance results. The treatment group was treated with the Artcure Diffusional Patch while the control group received a placebo transdermal diffusional patch. The functional state of patients was measured using the Oswestry Disability Index and pain intensity was measured with a visual analog scale as primary outcomes. Secondary outcomes of the study were Lasegue's sign, the femoral stretching test, and paravertebral muscle spasm. RESULTS: The treatment group showed a dramatic recovery in the first month following the application in regards to Oswestry Disability Index scores and visual analog scale values. The patients treated with the Artcure Diffusional Patch showed a statistically significant difference in recovery as compared to the control group. CONCLUSION: These findings suggest that the Artcure Diffusional Patch may be an alternative for the conservative treatment of lumbar disc herniation with radiculopathy.

Effect of Topical and Intravenously Applied Tranexamic Acid Compared to Control Group on Bleeding in Primary Unilateral Total Knee Arthroplasty.

We aimed to answer the following three questions in this study: (1) Does tranexamic acid (TA) reduce the amount of bleeding in total knee arthroplasty (TKA)? (2) Does TA reduce requirement for blood transfusion? (3) Is there any difference on reliability and efficacy between topical and intravenous (IV) applications of TA? Patients were allocated into three groups randomly by a software program as topical, IV, and control group. TA was applied as 20 mg/kg to the IV group and as 3 g/100 mL saline to the topical group. The hemoglobin values were recorded preoperatively and postoperatively on the same day and on day 1 and day 2. Removal of the drain postoperatively and length of hospital stay, as well as any complications such as pulmonary embolism or deep venous thrombosis, were also noted. The study comprised 40 patients in the IV group, 42 in the topical group, and 41 in the control group. The drain output values were similar in the IV and topical groups (p = 0.161), while those of the control group were significantly higher than both the IV and topical groups (p < 0.001 and < 0.001). Transfusion was applied to 19.5% of cases in the control group, 4.8% in the topical group, and 5.1% of the IV group (χ2 = 6.522; p = 0.038). The results of the study showed that 20 mg/kg single-dose IV bolus or 3 g topical TA application reduced blood loss and transfusion requirement without increasing the rate of thromboembolic complications in unilateral primary TKA.

The effectiveness of a back school program in lowerlimb amputees: a randomized controlled study.

BACKGROUND/AIM: A few studies have been carried out in lower limb amputees (LLAs) and they examined the incidence of and reasons for low back pain. The aim of this study was to assess the effectiveness of a back school program in LLAs with mechanical low back pain (MLBP). MATERIALS AND METHODS: Forty male unilateral transfemoral amputees with MLBP were randomly allocated into two groups. A back school program was applied to Group 1 over 2 weeks. A booklet for home use was given to each participant in Group 2. Pain was assessed using a visual analogue scale. Spinal flexibility measurements were obtained. For the assessment of back pain-related disability, the Oswestry Disability Index was used. Patients were assessed at baseline, at month 1, and at month 3. RESULTS: At the month 1 assessment, a reduction in pain intensity and disability, and increase in spinal flexibility measurements were detected in Group 1 only (P < 0.05). At the month 3 assessment, there were improvements in all measured parameters in both groups(P < 0.05). Group 1 had better results in all parameters compared with Group 2. CONCLUSION: The back school program, combined with an exercise program, decreased pain and disability and improved the spinal flexibility significantly in LLAs with MLBP.

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.

Immunohistochemical analysis of mechanoreceptors in transverse acetabular ligament and labrum: a prospective analysis of 35 cases.

OBJECTIVE: The labrum and transverse acetabular ligament (TAL) are classically described as distinct anatomical structures with abundant mechanoreceptors and free nerve fibers. They deepen the joint and act as natural barriers against dislocation, thus providing additional stability. We hypothesized that severe coxarthrosis leads to elimination of labrum and TAL mechanoreceptors. This study evaluated the microscopic anatomy of the labrum and TAL and specifically investigated the neurological status of these structures. METHODS: Labral and TAL specimens from 35 consecutive patients with coxarthrosis undergoing total hip arthroplasty were dissected into a total of 4 specimens per hip. Formaldehyde-fixed specimens were evaluated for the presence of mechanoreceptors and free nerve endings by neurofilament protein and S-100 protein immunohistochemistry and microscopy. RESULTS: Mechanoreceptors were identified in the labral (2.3/high power field) but not TAL specimens, with a sharp delineation between the tissues. In contrast, both labrum and TAL showed good vascularity with abundant free nerve fibers within fibrous connective tissue (mean, 2.6 sensory fibers/ high power field vs 3.1/high power field, respectively). CONCLUSION: This study demonstrated that the TAL lacks mechanoreceptors. However, TAL and labrum free nerve fibers suggest potential roles as hip pain generators.

Comparison of early postoperative period electrophysiological and clinical findings following carpal tunnel syndrome: is EMG necessary?

BACKGROUND: In this study, we aimed to compare the clinical findings and ENMG results of the patients who underwent surgery due to CTS, in the preoperative and early postoperative period. METHODS: 33 wrists of 29 patients who underwent open carpal tunnel surgery in our clinic due to CTS, between 2009 and 2011, were evaluated. Electrophysiological progress was evaluated with ENMG and clinical state with Boston scale. RESULTS: A significant decrease was observed in the postoperative BS symptomatic (SSS) and functional (FSS) scores of patients as compared to preoperative period (P=0.00), In the electrophysiological findings, statistically significant improvement was observed in all groups but very severe CTS group (P<0.05). When preoperative and postoperative EMG findings were compared, changes in DSL and DSA values were statistically significant (P<0.05). However, no statistically significant difference was seen between DML (P=0.085) and DMA (P=246) values on the 3rd month. When an examination was conducted on the patients whose DML and DSL values could not be obtained in the preoperative EMG, DML values were obtained in the early postoperative period in 6 of 7 cases (85.71% P<0.001), and DSL values were obtained in 17 of 24 cases (70.8% P<0.000). CONCLUSIONS: Sensory nerve findings were more significant, showed faster recovery compared to motor nerve findings, and accompanied the clinical recovery. Performance of an EMG test, especially on sensory nerves, will be more effective in patients selected in the early period, with the exception of patients with very severe CTS.

Comparison of early postoperative period electrophysiological and clinical findings following carpal tunnel syndrome: is EMG necessary?

UNLABELLED: In this study, we aimed to compare the clinical findings and ENMG results of the patients who underwent surgery due to CTS, in the preoperative and early postoperative period. METHODS: 33 wrists of 29 patients who underwent open carpal tunnel surgery in our clinic due to CTS, between 2009 and 2011, were evaluated. Electrophysiological progress was evaluated with ENMG and clinical state with Boston scale. RESULTS: A significant decrease was observed in the postoperative BS symptomatic (SSS) and functional (FSS) scores of patients as compared to preoperative period (P=0.00). In the electrophysiological findings, statistically significant improvement was observed in all groups but very severe CTS group (P<0.05). When preoperative and postoperative EMG findings were compared, changes in DSL and DSA values were statistically significant (P<0.05). However, no statistically significant difference was seen between DML (P=0.085) and DMA (P=246) values on the 3rd month. When an examination was conducted on the patients whose DML and DSL values could not be obtained in the preoperative EMG, DML values were obtained in the early postoperative period in 6 of 7 cases (85.71%, P<0.001), and DSL values were obtained in 17 of 24 cases (70.8%, P<0.000). CONCLUSIONS: Sensory nerve findings were more significant, showed faster recovery compared to motor nerve findings, and accompanied the clinical recovery. Performance of an EMG test, especially on sensory nerves, will be more effective in patients selected in the early period, with the exception of patients with very severe CTS.

Femoral insufficiency fractures in the elderly - excessive medial femoral bowing complicates intramedullary nailing.

OBJECTIVE: The aim of this study was to evaluate the characteristics of low-energy femoral insufficiency fractures in elderly patients. METHODS: The study retrospectively evaluated the clinical course of 4 patients with low-energy femoral shaft and subtrochanteric fractures admitted to our department between 2009 and 2011. Three patients had prior long-term alendronate therapy and one had prior glucocorticoid therapy. RESULTS: There were 5 femoral shaft fractures, 2 incomplete shaft fractures, 2 subtrochanteric and 1 intertrochanteric fractures. All femoral shaft fractures had characteristic fracture patterns with thickened lateral cortices at the proximal fragment. Six femurs had excessive medial femoral bowing, which complicated intramedullary nailing. Additional fractures were seen on both femurs of one patient who had been primarily treated with short implants. A bifocal femoral fracture was seen in one femur. Union was achieved in all patients. Two patients were able to walk independently, one with a cane and one with double crutches. CONCLUSION: We suggest the addition of another radiographic pattern of 'excessive medial femoral bowing' in low-energy femoral shaft fractures in elderly patients. This bowing complicates intramedullary nailing. Moreover, these insufficiency fractures should be fixed with long cephalomedullary nails.

Minimally invasive Achilles tendon repair: a modification of the Achillon technique.

BACKGROUND: The purpose of the study was to present the results of a new minimally invasive operative method for Achilles tendon (AT) ruptures that could reduce nerve injuries and add no extra cost. METHODS: Thirteen patients with acute AT ruptures who were treated with minimally invasive surgery and followed for a minimum of 12 months were included. At the latest follow-up, American Orthopaedic Foot & Ankle Society (AOFAS) score, calf diameters, ability to walk on tiptoe, and ultrasound examination were evaluated. The average age was 42.8 years (range, 31-62 years). Average follow up was 24.5 months (range, 12-34 months). RESULTS: AOFAS score was 92.5 (range, 85-100). Average calf diameters on the operated and nonoperated extremities were 38.9 cm (range, 36-44 cm) and 38.9 cm (range, 36-41 cm), respectively. On ultrasound examination, the site of the rupture was found to be 46.2 mm proximal from the calcaneal insertion, and the operated side was found to be significantly thicker than the nonoperated side (P = .008). There was 1 deep vein thrombosis, which recovered without sequelae. There were no wound problems, reruptures, or nerve injuries. CONCLUSIONS: This new minimally invasive operative method was successful, showing good functional results and low complication rates. In our experience, the use of 3 continuous polyester sutures was less irritable with 3 knots. LEVEL OF EVIDENCE: Level IV, retrospective case series.

The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures.

OBJECTIVE: The aim of this study was to evaluate the time to union and complications in cases of tibial diaphysis and distal tibial fractures fixed with a minimally invasive percutaneous plate. METHODS: Thirty-five patients (23 males, 12 females) were operated on using minimally invasive percutaneous plate osteosynthesis (MIPPO) principles for tibial diaphysis and distal tibial fractures. Twenty-eight were closed and seven were open fractures. After direct or indirect fracture reduction, the plate was advanced through a submuscular extraperiosteal tunnel through the distal incision without opening the fracture line. The plate was fixed with screws through the proximal and distal incisions. Clinical and radiological evaluations were made at four to six week intervals after surgery. Full weight-bearing was allowed after an average of 14.43 (range: 12 to 20) weeks and 15.39 (range: 8 to 32) weeks in open and closed fractures, respectively. Duration of the union and complications were analyzed. RESULTS: The mean duration of the union was 20.7 (range: 16 to 28) weeks and 17.96 (range: 10 to 36) weeks in open and closed fractures, respectively. All cases showed union except one who had an implant failure. Necrosis at the wound developed in one case and infection in another. CONCLUSION: MIPPO is an effective alternative treatment for tibial diaphysis and distal tibia fractures with low complication and high union rates.