Surgical vs ultrasound-guided lumbar erector spinae plane block for pain management following lumbar spinal fusion surgery.

PURPOSE: Spinal surgery is associated with severe diffuse pain in the postoperative period. Effective pain management plays an essential role in reducing morbidity and mortality. This study is designed to compare the ultrasound-guided erector spinae plane (ESP) block and surgical infiltrative ESP block for postoperative analgesia management after lumbar spinal fusion surgery. METHODS: The patients who underwent two or three levels of posterior lumbar spinal fusion surgery were randomly allocated into one of three groups with 30 patients each (Group SE = Surgical ESP block; Group UE = ultrasound-guided ESP block; Group C = Controls). The primary aim was to compare postoperative opioid consumption, and the secondary aim was to evaluate postoperative dynamic and static pain scores and the incidence of opioid-related adverse effects. RESULTS: There was a significant difference in terms of opioid consumption, rescue analgesia on demand, and both static and dynamic pain scores between groups at all time periods (p < 0.05). Group SE and Group UE had lower pain scores and consumed fewer opioids than the controls (p < 0.05). However, the Group UE had lower pain scores and opioid consumption than the Group SE. The sedation level of patients was significantly higher in the control group than in the other two groups. Also, nausea was more common in controls than in the other groups. CONCLUSION: While both surgical and ultrasound-guided ESP blocks reduced opioid consumption compared to the controls, the patients who received ultrasound-guided ESP blocks experienced better postsurgical pain relief than those in the other groups (surgical ESP and controls).

Effects of topically administered 0.6% hyaluronic acid on the healing of labial frenectomy in conventional and 940-nm indium gallium arsenide phosphide (InGaAsP) diode laser techniques in pediatric patients: a randomized, placebo-controlled clinical study.

This study aimed to investigate the effects of 0.6% hyaluronic acid (HA) gel on the healing process and postoperative pain levels after diode laser-assisted labial frenectomy in pediatric patients. Ninety-six pediatric patients (females, 50 and males, 46) aged 8-14 years were randomly divided into four groups as follows: (1) conventional frenectomy with 0.6% topically administered HA (CFH, n = 24); (2) conventional frenectomy with placebo gel (CFP, n = 24); (3) frenectomy performed by diode laser with 0.6% topically administered HA (DLH, n = 24); and (4) frenectomy performed by diode laser with placebo gel (DLP, n = 24). HA application was continued for 1 week thrice daily after the frenectomy. Visual analog scale forms were collected from patients 1 week after the operation. In addition, the plaque index, gingival index, periodontal probing depth, and keratinized tissue width and thickness were recorded. This process was repeated 1 and 3 months after the first visit. The DLH group revealed significant differences in the probing depth, bleeding on probing, keratinized gingiva width, and attached gingiva width according to dual comparisons of the initial, first, and third-month values (p = 0.010, p = 0.007, p<0.001, and p = 0.001, respectively). Significant differences were observed between the CFP and CFH groups according to the initial and initial third-month values with regard to the bleeding on probing (p=0.019 and p = 0.019, respectively). The attached gingival thickness revealed significant differences between the CFP and CFH groups for the initial and initial-third-month comparisons (p = 0.005 and p = 0.007, respectively). The mean values of the initial and initial-third-month differences were significantly higher in the CFH group than those in the CFP group. HA- and laser-assisted labial frenectomies revealed better outcomes in terms of the probing depth, attached gingiva width, keratinized gingiva width, healing process, and postoperative comfort.

Comfort and wearability properties of custom-made and boil-and-bite mouthguards among basketball players: A randomized parallel arm clinical trial.

BACKGROUND/AIM: Thermoplastic mouthguards have been a reliable means of protection against impacts and shocks for a century. Although orofacial injuries are prevalent among basketball players, many athletes still avoid using mouthguards due to concerns regarding impaired breathing, speech interference, and nausea. This study aims to compare basketball players' subjective assessments of two different thicknesses of custom-made mouthguards (MGs) with boil-and-bite MGs (B&B MG). MATERIAL AND METHODS: A total of 60 systematically healthy male professional basketball players, without active orthodontic treatment, were enrolled and randomly assigned to three groups: Group 1 (received B&B MGs; n = 20), Group 2 (received custom-made MGs with a 3 mm thickness [ethyl vinyl asetat]; n = 20), and Group 3 (received custom-made MGs with a 5 mm thickness; n = 20). To evaluate MG comfort and usability, 12 key factors, including comfort, fit, stability, tiredness, thirsting, oral dryness, nausea, speaking, breathing, drinking, ease of wear and removal, and inclination to chew, were assessed. The athletes were made to rate these factors using a 10 cm-long Visual Analog Scale, measured at three-time intervals, and the values for both inter-group and intra-group were compared. RESULTS: Data from 48 basketball players were retrieved, and data analysis revealed that B&B MGs had the least favorable parameter values. Among the B&B MG group, stability was reported to be poorer during the initial measurement (p < .05). In the second measurement, B&B MGs showed significantly lower values for comfort, stability, tiredness, speaking, and inclination to chew (p < .05). During the third measurement, the B&B MG group exhibited significantly reduced values for comfort, breathing, drinking, and speaking (p < .05). In contrast, no statistically significant difference was observed between 3 and 5 mm thickness MGs in these measurements. CONCLUSIONS: Custom-made MGs with different thicknesses consistently outperformed B&B MGs in all measurements, indicating the potential to tailor MG thickness based on sport, age, professional level of athlete, and presence of other protective equipment. While custom-made mouthguards are considered the gold standard, dentists who provide B&B MGs can lead to cost savings while maintaining protection and encouraging athletes to use higher-quality custom-made mouthguards.

Internet and social media preferences of orthopaedic patients vary according to factors such as age and education levels.

BACKGROUND: Patients can often access the internet and social media for health information but it is not clear how much they trust and use the information retrieved. OBJECTIVE: To investigate the social media and internet use rates and preferences of orthopaedic patients, to reveal to what extent they self-treat, and to probe the affecting factors. METHODS: Two thousand fifty-eight patients admitted to an orthopaedic polyclinic were asked to fill out a survey (voluntarily) consisting of 15 items, to collect demographic data, preference for platforms and sources used, trusted sources, and the extent to which information obtained was used for self-care. RESULTS: The most preferred and most trusted sources of information were Google and other search engines, and physicians' personal websites (p < 0.001). DISCUSSION: Variables such as age, gender, educational level and occupation affect the research preferences. Reliance on social media decreases with increasing educational levels (p < 0.001). CONCLUSION: Health information and knowledge services should work with health professionals to improve aspects of health literacy among orthopaedic patients.

Arm design of band and loop space maintainer affects its longevity: a patient-specific finite element study.

Fixed space maintainers (FSMs) are commonly utilized in pediatric dentistry to prevent space loss following premature tooth extraction. Although previous studies have examined the survival rates and causes of FSM failure, the impact of arm design on failure has not been investigated. This study aimed to investigate the tensile and compressive stresses related to FSMs with different arm designs and evaluate the effect of arm designs on FSM failure. Cone beam computed tomography images of a child who experienced premature loss of a primary mandibular left second molar tooth were retrieved from our database, then processed and simulated using the Rhinoceros software. Finite element analysis was performed to evaluate the stresses on four distinct FSM arm designs under simulated chewing forces. The results showed that the straight-arm FSM design exhibited the highest von Mises principal stress, while FSMs with curved arms and surrounding primary mandibular left first molar in the mesial area demonstrated the lowest von Mises stress accumulation. Intense stress accumulation on the distal surface of tooth 74 was observed in the test models due to the transmitted forces by the FSM. The maximum principal stresses accumulated at the base of the alveolar socket of the mesial root of tooth 36, while the minimum principal stresses were identified at the mesio-marginal area of the alveolar crest. The arm design played a crucial role in enabling the appliance to effectively withstand the stresses accumulating on the Space maintainer (SM) and orthodontic band. Bending the SM arms to match the surrounding profile with curvature increased the stress absorption capacity by increasing the arm length.

Redislocation After Posteromedial Open Reduction in Developmental Dysplasia of the Hip: Analyzing the Risk Factors and Determining the Optimal Treatment Method.

BACKGROUND: Redislocation, which is one of the most serious problems in developmental dysplasia of the hip (DDH), might occur because of several reasons. Regardless of the treatment, redislocations are reported to be associated with high complication rates in the literature. Our objective was to identify the risk factors for redislocation in the patients treated for DDH and to determine the optimal treatment method for redislocations. METHODS: Patients with DDH who were treated with the limited posteromedial approach in our clinic between 1993 and 2021 and followed up prospectively were examined in this single-centered study. The participants were assigned into 2 groups: a study group consisting of 25 hips of 17 patients with redislocation and a control group consisting of 502 hips of 390 patients without redislocation. To determine the risk factors for redislocation, demographic data, known risk factors for DDH, preoperative Tönnis stage, and whether the capsule was opened or not were evaluated. To determine the optimal treatment method, a subgroup analysis based on applied treatment (closed reduction and cast replacement vs. repeating open reduction) was conducted, and recurrent redislocation, complication, and secondary surgery rates were evaluated. RESULTS: Bilaterality and high-grade hip dislocations were found to be associated with higher odds ratio (OR) for redislocation [ P =0.007, OR=3.64, 95% confidence interval (CI), 1.3 to 8.8; and P =0.006, OR=4.52, 95% CI, 1.37 to 14.91, respectively]. Recurrent redislocation and complication rates were found to be significantly higher in redislocations treated with closed reduction and cast replacement ( P =0.007 and P =0.015, respectively). CONCLUSIONS: Bilaterality and higher preoperative Tönnis stage are critical risk factors for redislocation after open reduction in DDH. It should be kept in mind that closed reduction and cast replacement is associated with higher rates of recurrent redislocation and complications, and redislocation cases should be treated by repeating open reduction. LEVEL OF EVIDENCE: Level II-therapeutic study.

An analysis of anesthetists' awareness, knowledge, and attitudes toward peri-anesthetic dental trauma.

BACKGROUND/AIM: Peri-anesthetic dental trauma is a common anesthesia-related complication. It is the reason for a significant number of malpractice lawsuits against anesthetists through insurance companies. The frequency, outcomes, and risk factors related to peri-anesthetic dental trauma have been well documented. The aim of this study was to evaluate anesthetists' awareness, knowledge, and attitudes toward peri-anesthetic dental trauma. MATERIAL AND METHODS: This nationwide, cross-sectional, descriptive study comprising 220 anesthetists was conducted in Turkey between June 2019 and May 2020. A specific questionnaire was created using Google Forms and delivered to 591 participants via WhatsApp. Pearson's Chi-squared test and the Fisher-Freeman-Halton tests were used to analyze the results. RESULTS: The overall response rate was 37.2% (220 out of 591 participants). Of the 80.5% of the participants who encountered peri-anesthetic dental trauma during their practice, 32.8% had encountered avulsion and 32.8% reported that they had caused soft tissue injuries. More than one-third of the participants (38.9%) stated that the patient group that was the most at-risk for peri-anesthetic dental trauma was older people with missing teeth. Half of the participants (50.9%) stated that avulsed teeth could be replanted; among them, 21.8% and 11.8% specified that the ideal replantation time was <30 min and that the ideal storage medium for the avulsed tooth was fresh milk, respectively. Furthermore, 88.1% of the participants noted that peri-anesthetic dental trauma occurred more frequently during emergency intubations and only 20.9% were aware of custom-made mouthguards. CONCLUSIONS: Anesthetists lack knowledge around peri-anesthetic dental trauma and its interventions.

Ultrasonography and erythrocyte distribution width in patients with plantar fasciitis.

BACKGROUND: The measurement of plantar fascia thickness with ultrasonography can be used for both for diagnosis and as a response-to-treatment parameter in plantar fasciitis. Furthermore, with the recent studies, red cell distribution width may be used as an inflammatory marker. Aim of this study is to investigate the association of red cell distribution width and ultrasonography on diagnosis and monitoring of treatment in patients with plantar fasciitis. METHODS: Clinically diagnosed 102 patients with plantar fasciitis between the dates January 2016 to July 2018 were analysed. Hemogram, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and plantar fascial ultrasonography were obtained on initial evaluation and in 1 month, 2 months and 3 months of the standard nonoperative treatment; American Orthopaedic Foot & Ankle Hindfoot Score (AOFAS) and Visual Analog Scale (VAS) scores were recorded. Posthoc and multivariate logistic regression analysis were used for statistical analysis on SPSS 21.0. RESULTS: Red cell distribution width was correlated with plantar fascia thickness by the end of the 1 month (r=0.26, P=.013). Female sex, BMI over 30kg/m2, higher red cell distribution width and higher plantar fascia thickness were associated with plantar fasciitis on initial evaluation. Higher red cell distribution width together with higher plantar fascia thickness were also found to be a risk factor for both on initial evaluation and 1 month after treatment in plantar fasciitis. CONCLUSION: This study shows that association of red cell distribution width and plantar fascia thickness can be not only a diagnostic predictor but also an indicator of treatment response in plantar fasciitis. LEVEL OF CLINICAL EVIDENCE: Level IV.

Primary total knee replacement leads to an increase in physical activity but no changes in overall time of sedentary behaviour: a retrospective cohort study using an accelerometer.

INTRODUCTION: There is no consensus between patient-reported subjective scores and objectively measured physical activity (PA) behaviour after total knee arthroplasty (TKA). The aim of this study was to understand the volume and pattern of physical activity and daily energy consumption after total knee arthroplasty for osteoarthritis. METHOD: Physical activity patterns of 36 patients (31 female, 5 male) with an average age of 67.3 ± 6.7 (50-81) years and end-stage gonarthrosis were investigated using an accelerometer (ActiCal) for seven consecutive days prior to and six months after total knee arthroplasty. Knee Society scores, Oxford knee scores, range of motion, and muscle strength around knee were also recorded. RESULTS: Sedentary behaviour did not change after total knee arthroplasty (p = 0.975). Increases in light physical activity time (p = 0.005) and moderate-vigorous physical activity time (p = 0.006) were found significant. In the post-operative period, light PA awake time increased 25% and moderate-vigorous PA awake time increased four times compared with the pre-operative value. In addition, a significant increase was observed in the amount of daily energy expenditure after TKA (p = 0.001). The subjective functional scores were increased in the post-operative period compared with baseline values (p < 0.001). While a significant increase in knee flexion angle was found after TKA (p = 0.01), there was no increase in muscle strength around the knee (p = 0.096). CONCLUSION: Accumulation patterns of activity evaluated by using an accelerometer objectively can give a new insight to realize the behavioral changes after total knee arthroplasty. Daily life style changes can be encouraged by means of objective evaluations.

Pentoxifylline Alleviates Early Brain Injury in a Rat Model of Subarachnoid Hemorrhage.

BACKGROUND: Subarachnoid hemorrhage (SAH) is a severe cerebrovascular disease frequently caused by ruptured aneurysms. Early brain injury (EBI) is the primary cause of morbidity and mortality in patients diagnosed with SAH and is associated with increased intracranial pressure, decreased cerebral blood flow and cerebral ischemia. Pentoxifylline (PTX) is a methylxanthine derivative clinically proven to improve perfusion in the peripheral microcirculation and has been shown to have neuroprotective effects in brain trauma and global cerebral ischemia in experimental animal models. This study aimed to determine the effect of PTX in experimental SAH, which has not been investigated yet. METHODS: An experimental SAH model was induced in male Wistar rats by autologous blood injection into the prechiasmatic cistern, and PTX was injected intraperitoneally immediately after SAH. The effects of PTX were evaluated 24 h after SAH via assessing the cerebral ultrastructure via transmission electron microscopy (TEM). Brain edema, blood-brain barrier (BBB) permeability, red blood cell deformability, tumor necrosis factor-alpha (TNF-alpha), nitrite-nitrate levels and apoptotic neuron death were also determined 24 h after SAH. The BBB permeability was measured by Evans blue (EB) extravasation, erythrocyte deformability was determined by filtration technique, and TNF-alpha and reactive nitrogen metobolites were analyzed in brain tissue by ELISA and spectral analysis, respectively. Apoptotic neurons were determined in brain sections by cleaved caspase-3 immunohistochemical analysis, and expression intensity was quantified using image J software. RESULTS: Cerebral ultrastructure in SAH group animals revealed intense perivascular edema and distortion in the astrocyte foot processes. PTX treatment attenuated structural deterioration due to SAH. Brain water content, BBB permeability, TNF-alpha, nitrite-nitrate levels and apoptotic neuronal death were significantly increased 24 h after SAH and were significantly alleviated by PTX treatment. There was no significant change in red cell deformability after SAH. CONCLUSIONS: Our results show that PTX reduces brain edema, BBB permeability, TNF-alpha expression, reactive nitrogen metobolites and apopotosis in experimental SAH. Based on our findings we suggest that PTX exerts neuroprotection against SAH-induced EBI, which might be associated with the inhibition of inflammation and apoptotic neuronal cell death.

Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing.

PURPOSE: The aim of the study was to analyse the patellofemoral alignment in the sagittal plane following tibial fracture surgery with intramedullary nailing and its relationship to parapatellar muscle status. METHODS: The patellofemoral MRI results of 27 patients (15 males and 12 females) treated with locked intramedullary nailing following tibia shaft fracture were reviewed. The mean age of the patients was 41.8 (±15) years. The patella-patellar tendon angle (P-PT) and the distance between the inferior patellar pole and the tibial tubercle (DP-TT) were evaluated for both the operated extremity and the contralateral normal side. MRI assessment of the infrapatellar fat pad, quadriceps, sartorius, gracilis, semi-membranosus muscles and biceps muscles was also carried out. The correlation between the changes in skeletal muscle mass, the volume of the infrapatellar fat pad and the alterations in the DP-TT distances and P-PT angles were analysed. RESULTS: The quadriceps muscle cross-sectional diameter had a mean of 157.2 mm(2) (115.6/319.5) in the operated extremity, and it was 193 mm(2) (77.6/282.2) in the non-operated normal side (p = 0.001). For the Gracilis muscle, the mean was 84.4 mm(2) (19.7/171) at the operated extremity and 75.7 mm(2) (26.9/238.2) on the normal side (p = 0.05). The cross-sectional areas of the semi-membranosus, sartorius and biceps muscles in the operated and non-operated extremity were not noticeably different (n.s). The P-PT angle was 153° (129.7/156.4) in the operated extremity and 145.7° (137.6/163.4) in the non-operated normal extremity (p < 0.05). While DP-TT distance was 11.4 mm (9.4/20.4) in the operated extremity, it was 14.1 mm (7.3/17.1) in the non-operated extremity (p = 0.001). The correlation analyses revealed that the quadriceps hypotrophy negatively correlated (r = -0.4, p = 0.02) with the P-PT angle but positively correlated with the increase in gracilis muscle volume (r = 0.4, p = 0.03). CONCLUSION: This study revealed that patellofemoral joint kinematics in the operated extremity was diminished in the sagittal plane correlating with the quadriceps muscle volume loss and gracilis muscle hypertrophy. The modalities focused on both preventing and treating the hypotrophy of the quadriceps muscle following the surgical treatment of tibial fracture, which may help to overcome this quite common pathology.

Use of theoretical waste inventories in planning and monitoring of hazardous waste management systems.

Hazardous waste (HW) generation information is an absolute necessity for ensuring the proper planning, implementation, and monitoring of any waste management system. Unfortunately, environmental agencies in developing countries face difficulties in gathering data directly from the creators of such wastes. It is possible, however, to construct theoretical HW inventories using the waste generation factors (WGFs). The objective of this study was to develop a complete nationwide HW inventory of Turkey that relies on nation-specific WGFs to support management activities of the Turkish Ministry of Environment and Urbanization (MoEU). Inventory studies relied on WGFs from: (a) the literature and (b) field studies and analysis of waste declarations reflecting country-specific industrial practices. Moreover, new tools were introduced to the monitoring infrastructure of MoEU to obtain a comprehensive waste generation data set. Through field studies and a consideration of country specific conditions, it was possible to more thoroughly elucidate HW generation trends in Turkey, a method that was deemed superior to other alternatives. Declaration and literature based WGFs also proved most helpful in supplementing field observations that could not always be conducted. It was determined that these theoretical inventories could become valuable assets in supporting regulating agencies in developing countries for a more thorough implementation of HW management systems.

The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture.

OBJECTIVE: The purpose of this study was to investigate the effect of rotational deformities on patellofemoral alignment using the dynamic magnetic resonance imaging method on patients whose femur fractures were treated with intramedullary locking nails. METHODS: The dynamic patellofemoral magnetic resonance imaging results of 33 patients (5 females and 28 males) were reviewed. The mean age of the patients was 36.3 (range 19-61) years. The mean follow-up was 30.2 months (range 24-38). All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Those with less than 10° of rotational deformity in either direction were classified as Group A, those with more than a 10° of internal rotation deformity as Group B and more than a 10° of external rotation deformity as Group C. The three groups were then compared regarding to clinical scores. Patellofemoral parameters of operated and contralateral side were also compared in each group. RESULTS: There were 14 (42.4 %) patients in Group A, 12 (36.4 %) patients in Group B and 7 (21.2 %) patients in Group C. The mean patella score in Group C (74 ± 7.02) was significantly lower when compared with Group B (87.6 ± 9.9) and group A (90.6 ± 6.1) (p < 0.05). In Group C patients, medial patellar tilt was detected when compared with the intact side. There were no significant changes in patellofemoral position in either Group A or Group B. CONCLUSION: The results of this study revealed that more than 10° of external rotation deformity could cause a detoriation in the patellofemoral scores. Anatomic reduction of the fracture site should be performed as soon as possible and external rotational deformities should especially be avoided in order to prevent patellofemoral malalignment.

Bilateral Involvement in Developmental Dislocation of the Hip: Analysis of 561 Patients Operated on Using the Limited Posteromedial Approach.

Our objective was to scrutinize the risk factors related to bilateral involvement in the developmental dysplasia of the hip (DDH) and to inspect the impact of bilaterality on the enduring results of the DDH. All patients, aged between 6 and 18 months, who underwent surgery using the limited posteromedial approach (734 hips from 561 patients), were included in this study. The number of births, birth type, history of consanguineous marriage, family history, and swaddling were analyzed. Physical examination and complaints of the patients were evaluated, and direct radiographs were examined in terms of the redislocation, avascular necrosis, and residual acetabular dysplasia. Among the 561 patients, bilateral DDH was observed in 173 patients (30.8%). The use of swaddling was found to be statistically significant between groups (p = 0.012). The use of swaddling for more than one month was associated with a higher odds ratio for bilaterality (p = 0.001, OR = 1.56, 95% CI: 1.2-2.0). Furthermore, bilaterality was associated with a higher risk for redislocation in DDH (p = 0.001, OR = 4.25, 95% CI: 1.6-11.2). The study concludes that swaddling for over a month is strongly linked with the bilateral involvement in DDH. It is important to note that bilaterality plays a crucial role in the development of redislocation after open reduction in DDH.

Patellar height changes after treatment of tibia plateau fractures: A radiological analysis.

OBJECTIVES: To determine the impact of tibial plateau fractures on patellar height and the factors affecting this impact. METHODS: A total of 40 patients treated for plateau fractures between 2017-2021 were evaluated in this retrospective prognostic study. The patient group consisted of lateral radiographs of the operated knees, whereas the control group consisted of lateral radiographs of the healthy sides of the same patients. Insall-Salvati, Caton-Deschamps, Blackburne-Peel, and modified Insall-Salvati indices were measured for both groups. In addition, Schaztker and Luo classifications, as well as the demographic profiles of the patients, were analyzed. RESULTS: There was no significant difference between the groups in terms of patellar height indices (p>0.05). A significant relationship was found between the Insall-Salvati (p=0.046) and Blackburne-Pell (p=0.011) indices and Luo classification. Post hoc analyses revealed a significant relationship between the Insall-Salvati index and "One Column" fractures and between the Blackburne-Peel index and "Two Column" fractures. CONCLUSION: Long-term functions of tibial plateau fractures should be evaluated not only with a painless range of motion but also with patellar height. It should be noted that the Luo classification, which evaluates the plateau 3-dimensionally, may be associated with changes in postoperative patellar height values.

Extra Lateral Pin or Less Radiation? A Comparison of Two Different Pin Configurations in the Treatment of Supracondylar Humerus Fracture.

BACKGROUND: Closed reduction and percutaneous fixation are the most commonly used methods in the surgical treatment of supracondylar humerus fractures. The pin configuration changes stability and is still controversial. The aim of this study was to investigate the relationship between surgical duration and radiation dose/duration for different pinning fixations. METHODS: A total of 48 patients with Gartland type 2, 3, and 4 supracondylar fractures of the humerus were randomized into two groups-2 lateral and 1 medial (2L1M) pin fixation (n = 26) and 1 lateral 1 medial (1L1M) pin fixation (n = 22). A primary assessment was performed regarding surgical duration, radiation duration, and radiation dose. A secondary assessment included clinical outcome, passive range of motion, radiographic measurements, Flynn's criteria, and complications. RESULTS: There were 26 patients in the first group (2L1M) and 22 patients in the second group (1L1M). There was no statistical difference between the groups regarding age, sex, type of fracture, or Flynn's criteria. The overall mean surgical duration with 1L1M fixation (30.59 ± 8.72) was statistically lower (p = 0.001) when compared to the 2L1M Kirschner wire K-wire fixation (40.61 ± 8.25). The mean radiation duration was 0.76 ± 0.33 s in the 1L1M K-wire fixation and 1.68 ± 0.55 s in the 2L1M K-wire fixation. The mean radiation dose of the 2L1M K-wire fixation (2.45 ± 1.15 mGy) was higher than that of the 1L1M K-wire fixation (0.55 ± 0.43 mGy) (p = 0.000). CONCLUSIONS: The current study shows that although there is no difference between the clinical and radiological outcomes, radiation dose exposure is significantly lower for the 1L1M fixation method.

Can Anterior Knee Pain Be Explained by Patella Position After Infrapatellar Tibia Intramedullary Nailing?

OBJECTIVE: The objective of this study is to investigate the postoperative position of the patella and its relationship with anterior knee pain in patients operated with infrapatellar reamed tibia intramedullary nailing (IMN). MATERIALS AND METHODS:  Patients who underwent tibia IMN between 2019 and 2022 and who had anterior knee pain in their postoperative follow-up at least two outpatient clinic controls with an interval of at least one month were examined. Patellar height indices (Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Insall-Salvati) and sagittal angulation (patella-patellar tendon angles) were measured on the lateral direct radiographs of the patients in semi-flexion. As a control group, measurements were made on the contralateral intact extremity radiographs of the same patients. RESULTS:  There was no significant difference in patellar height indices between the fractured and intact sides in any of the patients (p = 0.588; p = 0.747; p = 0.446; p = 0.573, respectively). When the sagittal angulations were analyzed, a significant difference was found between the fractured and intact sides of the patients (p = 0.048), resulting in an approximate three-degree change. CONCLUSION:  Patellar sagittal balance has been identified as one of the contributing factors to the development of anterior knee pain following reamed tibial IMN. Further biomechanical and comprehensive clinical studies are needed on this subject.

Protective potential of different mouthguard thicknesses against perianaesthetic dental trauma: a patient specific-finite element study.

Perianaesthetic dental trauma is a common anaesthesia-related complication. Theprevious studies have shown a lack of knowledge regarding mouthguard usage and controversial results related to perianaesthetic dental trauma prevention. This study aimed to conduct a finite element analysis of the compressive and tensile stresses on the tooth-periodontal ligament-bone complex using custom-made mouthguards of different thicknesses and glass fibre splints to prevent perianaesthetic dental trauma. Custom-fitted ethylene-vinyl acetate mouthguards of two different thicknesses (2 and 3 mm) and glass fibre splint were modelled. A linear static finite element analysis was performed by applying a rigid Macintosh laryngoscope to the palatal surface of the maxillary central incisors at 150 N. The model without a mouthguard and glass fibre splint showed the highest stress values at the palatinal root surfaces during the impact. Increasing the mouthguard thickness significantly decreased the stress-strain values regardless of the presence of the glass fibre splint. Maximum stresses in the group using the 3 mm mouthguard were the lowest compared with the other groups.

Middle School Graduates' Understandings of Scientific Inquiry and Its Relation to Academic Achievement.

There are conflicting reports not only on the effect of scientific inquiry on academic achievement but also insufficient evidence on the relationship between understanding the nature of scientific inquiry and academic achievement; more generalizable studies are needed. The purpose of this large sampled study was to investigate the middle school graduates' understandings of scientific inquiry (SI) and the relationship between students' understandings of SI and academic achievement. The sample of the study (X = 3067) was selected by purposeful and layered-sampling techniques among ninth grade students studying at high schools with different orientations in Istanbul. Descriptive and inferential statistical approaches were used in the data analysis procedure. The students' academic achievement was operationally defined as the scores they received in the High School Entrance Exam (HEE). Views about scientific inquiry scale was applied to determine the participants' understandings about scientific inquiry. The data were collected in the first 2 weeks of the first semester of high school in accordance with the purpose of the study. The results of the study revealed that middle school graduates generally do not have adequate understandings of SI. Furthermore, according to the findings except for the "conclusion data conformity" aspect, there are statistically significant correlations between students' academic achievement and understandings in all aspects of SI.