Is the version angle of the glenoid different in bone and cartilage? An MRI study

Background/aim: To determine whether or not there is a difference between the version of the bone and cartilage surfaces of the glenoid. Axial magnetic resonance imaging (MRI) slices were examined in order to evaluate the measurements taken based on both the cartilage and bone joint surfaces. Materials and methods: A retrospective evaluation was made of the MRI scans of 182 patients. All of the reviewers independently measured the glenoid version angles of all of the patients from 1­182. The process was then repeated, with each reviewer taking second measurements of the angles from 1­182. Pearson correlation coefficient analysis was applied to evaluate the interaction and relationships between the measurements taken from the bone and cartilage. The intra- and interobserver interclass correlation coefficients (ICCs) were assessed. Analysis of variance was applied to determine any interobserver significant differences. Results: The mean glenoid version was determined as ­3.58 ± 4.08° in the bone-based measurements and ­5.81 ± 4.30° in the cartilage-based measurements. The cartilage- and bone-based measurements were found to have inter- and intraobserver reliability. A statistically significant difference was observed between the mean cartilage-based version and the mean bone-based version. Changes in the cartilage- and bone-based measurements were correlated; however, this change was not linear. Conclusion: The cartilage-based version showed a significant difference from the bone- based version. Therefore, in the preoperative planning and evaluation of glenoid-based pathologies, it would be more appropriate to evaluate both the bone and cartilage surface on MRI.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

OBJECTIVES: The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. RESULTS: Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. CONCLUSION: Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Anterior cruciate ligament reconstruction with ToggleLoc with ZipLoop system versus transfix system: A cost-effectiveness analysis.

BACKGROUND: To evaluate the cost-effectiveness of the reconstruction of the anterior cruciate ligament tears using either ToggleLoc with ZipLoop or Transfix systems. METHODS: This study is a cost-effectiveness analysis of patients with anterior cruciate ligament reconstruction, ToggleLoc with ZipLoop and Transfix systems in our clinic between 2011 and 2016. This study was a retrospective cross-sectional study of patient's demographic, clinical and financial data. The effectiveness of surgery on patients with anterior cruciate ligament reconstruction was determined by the Lysholm Knee Score Scale. We compared two systems with the cost-effectiveness ratio. RESULTS: In this study, 103 patients were included. According to the Lysholm Knee Score Scales in both groups, the findings showed that there was no difference in effectiveness between them. The ToggleLoc with ZipLoop technique was cost-effectiveness ratio 254,57 and the Transfix technique cost-effectiveness ratio was 378,33. CONCLUSION: According to our results, ToggleLoc with ZipLoop technique was a more cost-effective method than the Transfix technique in the anterior cruciate ligament reconstruction.

Is tranexamic acid effective on hidden blood loss in patients during total knee arthroplasty?

OBJECTIVES: This study aims to investigate if tranexamic acid (TXA) reduces both visible and hidden blood loss in patients undergoing total knee arthroplasty (TKA). PATIENTS AND METHODS: A total of 128 female patients (mean age 68.9±5.8 years; range, 55 to 80 years) who underwent TKA and were admitted between January 2010 and January 2020 were included in this retrospective study. Only patients who had primary unilateral knee arthroplasty with a cemented posterior cruciate ligament substituting implant were included. Patients were divided into two groups according to TXA administration in the perioperative period. Group 1 consisted of patients who did not receive TXA (n=69), while Group 2 consisted of patients who received TXA (n=59). The effect of TXA on visible and hidden blood loss, amount of erythrocyte suspension transfusions, postoperative early wound complications, and the relationship between the volume of hidden blood loss and drainage volume were detected. RESULTS: There was no statistically significant difference between the groups in terms of age, body mass index, operation side, preoperative hematocrit (HCT) values, and total blood volume. Postoperative HCT values were statistically higher in Group 2. Fifty-four units of erythrocyte suspension transfusion were required in Group 1, while six units were required in Group 2 (p<0.001). Early wound complication was determined in 10 patients in Group 1 and only in one patient in Group 2 (p=0.011). Intraoperative blood loss, postoperative drainage volume, hidden blood loss, and total blood loss values were significantly lower in Group 2 (p=0.001). In all patients, there was a significant positive correlation between the postoperative drainage volume and the hidden blood loss volume (r=0.532, p=0.001). CONCLUSION: The use of TXA in patients undergoing TKA reduces postoperative bleeding (visible and hidden blood loss), blood transfusion needs, and early wound complications. In addition, drainage volume in postoperative 24 hours can be used to estimate the amount of hidden blood loss in early postoperative period.

There is a correlation between histopathological findings of joint capsule and synovium, and postoperative clinical outcomes and treatment in patients with isolated type II superior labrum anterior posterior lesions.

OBJECTIVES: This study aims to histologically examine the joint capsule and synovium to determine the correlation between histopathological findings and postoperative clinical outcomes in patients with isolated type II superior labrum anterior posterior (SLAP) lesions. PATIENTS AND METHODS: Thirty-eight patients (24 males, 14 females; mean age 53.2±6.6 years; range, 45 to 67 years) who underwent arthroscopic treatment of type II SLAP lesions between June 2017 and September 2018 were evaluated prospectively. Visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores of all patients were recorded preoperatively, and at 6th and 12th months postoperatively. Biceps tenotomy was applied as arthroscopic surgical treatment in all patients. Biopsy materials obtained from rotator interval joint capsule and synovium during the arthroscopy were evaluated histopathologically. The density of the vessels in the specimens was defined as low, medium, and high by the pathologist. The patients with medium or low vessel density in specimens were group 1 (n=14) and those with high vessel density group 2 (n=24). RESULTS: In group 2, preoperative VAS score was significantly higher. There was no difference between the scores of the groups except for the sixth month SST score which was significantly higher in group 1. Histopathological evaluation revealed that the number of lymphocytes, fibroblasts, mast cells, myofibroblast, synovial lining cells, macrophages, and amount of collagen in connective tissue were significantly higher in group 2. In five patients of group 2, the rehabilitation program was interrupted due to pain and difficulty in gaining a range of motion during the first four weeks postoperatively. Four of these patients recovered with medication and long-duration physiotherapy. Shoulder stiffness developed in one patient who required arthroscopic release and further rehabilitation. CONCLUSION: There is a correlation between histopathological findings of joint capsule and synovium, and postoperative clinical outcomes and treatment in patients with isolated type II SLAP lesions. Almost 20% of patients who had pathologic histological findings in joint capsule and synovium needed pain control and long-duration rehabilitation program after arthroscopic surgery for better shoulder function recovery and prevention of shoulder stiffness.

Effect of ulnar styloid fracture on outcomes after conservative treatment of distal radius fracture.

OBJECTIVES: This study aims to investigate the effect of accompanying ulnar styloid fracture (USF) on clinical outcomes and hand-wrist muscle strength in conservatively treated active patients after displaced distal radius fracture (DRF). PATIENTS AND METHODS: The retrospective study, which was conducted November 2012 and September 2016, included 56 patients (34 males, 22 females; mean age 28.8 years; range 20 to 40 years) with displaced DRF treated with closed reduction and casting. Patients were divided into three groups according to ulnar styloid status as group A (intact ulnar styloid), group B (USF non-union), and group C (healed USF). Grip strength, quick-disabilities of the arm, shoulder and hand (DASH) score, and joint range of motions were evaluated; the results were combined with measurements of isokinetic muscle strengths of hand-wrist region. Magnetic resonance imaging was performed to evaluate the accompaniment of distal radioulnar joint injury and triangular fibrocartilage complex (TFCC) lesion. RESULTS: There were no significant differences between the groups regarding joint range of motion, grip strength, and quick-DASH scores. However, the peak torque and total work of supination was better in group A compared to group B (p=0.008 and p=0.006, respectively). According to the magnetic resonance imaging findings, of the 10 patients with detected TFCC lesion, four were in group C, five in group B, and one was in group A. CONCLUSION: Results of this study suggest that USF should not be the focus of attention during initial treatment of DRF and surgical intervention might be considered in case of an accompanying TFCC lesion.

Fibular lengthening procedure: treatment for lateral instability of the ankle caused by fibular insufficiency in Melnick-Needles syndrome.

The Melnick-Needles syndrome (MNS) is a rare bone dysplasia with characteristic clinical and radiologic diagnostic findings. The diagnosis of MNS was made for the patient reported in this paper clinically and radiologic confirmation was done afterwards. Her left fibula was shorter than the right one. She had lateral insufficiency in her left ankle and could not bear weight on her left foot. A fibular length discrepancy of 2 cm was assessed. Her ankle-hindfoot score was 49 according to the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating system for ankle and hindfoot. Simple fibular lengthening was performed with a unilateral external fixator. Two centimetres of fibular lengthening was obtained in 14 weeks. Her AOFAS ankle-hindfoot score was 82 after 27 months of follow-up. Ankle stability and plantigrade foot were achieved and the result was satisfactory.

An unusual cause of mass in the shoulder: A primary hydatid cyst.

A hydatid cyst is a zoonotic infection which may affect any organ and tissue, particularly the liver and the lung. Primary muscular hydatid cysts comprise less than 0.7-3% of the cases. The hydatid cysts must be kept in mind to avoid a diagnostic puncture in cystic lesions to avoid the spreading of the disease. In this case report, we present an exceptionally rare case with an unusual localization of a primary hydatid cyst in the left deltoid muscle.