Increased Involvement of Staphylococcus epidermidis in the Rise of Polymicrobial Periprosthetic Joint Infections.

BACKGROUND: In this study, we aimed to analyze the temporal distribution of polymicrobial periprosthetic joint infections (PJIs), while also evaluating the patient risk factors associated with these infections following total joint arthroplasty at our institution across 2 distinct periods. METHOD: This retrospective cross-sectional study evaluated 259 patients who had knee or hip PJI from 2001 to 2006 and 2018 to 2022. A PJI was diagnosed using the 2018 International Consensus Meeting criteria. We utilized the Polymicrobial Pathogens' Co-occurrence Network Analysis, a novel approach that leverages network theory to map and quantify the complex interplay of organisms in PJIs. RESULTS: Of the 259 patients who had polymicrobial PJI, 58.7% were men, with mean age 67 years (range, 24 to 90). Of the 579 identified pathogens, Staphylococcus epidermidis was the most common (22.1%), followed by Staphylococcus aureus (9.0%) and Cutibacterium acnes (7.8%). The co-occurrence analysis indicated that Staphylococcus epidermidis frequently coexisted with Cutibacterium acnes (26 cultures) and Staphylococcus capitis (22 cultures). A notable increase in body mass index from 27.7 ± 4.4 in 2001 to 2006 to 29.7 ± 6.2 in 2018 to 2022 was observed (P = .001). Moreover, infections from Staphylococcus epidermidis, Cutibacterium acnes, and Staphylococcus capitis saw a significant uptick (P < .001). CONCLUSIONS: The study shows that from 2001 to 2022, there was a significant change in the pathogens responsible for polymicrobial PJIs, particularly an increase in Staphylococcus epidermidis, Cutibacterium acnes, and Staphylococcus capitis. Alongside these microbial changes, there was a rise in body mass index and shifts in comorbid conditions, such as more renal disease and fewer cases of congestive heart failure. These changes highlight the dynamic interplay between host and microbial factors in the pathogenesis of polymicrobial PJIs, necessitating adaptive strategies in both surgical and postoperative care to mitigate the rising tide of these complex infections.

Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review.

The increasing frequency of total hip (THA) and knee arthroplasties (TKA) is marred by the rise in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with PJIs incurring costs over $1.62 billion as of 2020 and individual case management averaging $90,000. SSIs additionally burden the U.S. healthcare economy with billions in expenses annually. PJI prevalence in primary THA and TKA ranges from 0.5% to 2.4%, spiking to 20% in revisions and representing 25% of TKA revision causes. Projections estimate up to 270,000 annual PJI cases by 2030. Often caused by gram-positive bacteria, particularly methicillin-resistant staphylococci, these infections demand preventive measures. This review dissects PJI prevention across preoperative, intraoperative, and perioperative phases, aligning with evidence-based CDC and WHO guidelines. Preoperative measures include managing diabetes, obesity, tobacco use, Staphylococcus aureus screening and nasal decolonization, nutritional optimization, and management of inflammatory arthropathies. Intraoperatively, antibiotic prophylaxis, skin preparation, operative room environmental controls, surgical technique precision, and irrigation options are scrutinized. Perioperative concerns focus on anticoagulation, blood management, and infection risk mitigation. Integrating these strategies promotes a patient-centric care model, aiming to reduce PJI incidence, improve patient outcomes, and increase care cost-effectiveness in joint arthroplasty.

Comparison of two versus three-screw fixation for biplanar chevron medial malleolar osteotomy.

PURPOSE: This study was designed to compare the clinical outcomes and complications of using two versus three screws to fix the biplanar chevron medial malleolar osteotomy (MMO). PATIENTS AND METHODS: A retrospective review was conducted on 43 patients (46 ankles) who underwent biplanar chevron MMO to treat talus osteochondral lesions. Of these, MMO was fixed with two parallel screws placed perpendicular to the osteotomy plane in 16 ankles, while in the remaining 30 ankles, MMO was secured with two parallel screws plus an additional third screw inserted parallel to the tibial plafond. Patients were divided into two groups based on the fixation method and clinical outcomes, union and malunion rates, and complications were compared. RESULTS: Demographic and clinical characteristics such as age (p: 0.411), gender distribution (p: 0.119), affected side (p: 0.126), lesion grades (p: 0.056), and lesion sizes (p: 0.310), immobilization (p: 0.119) and weight-bearing periods (p: 0.252) were statistically similar across both groups. Initial malreduction were observed in five cases within the three-screw group and one case in the two-screw group (p: 0.307). However, neither group exhibited any progressive step-off or gap in the follow-up radiographs, and osteotomy union was achieved in all patients. Delayed union was observed in one patient from the three-screw group. Significant improvements in American Orthopedic Foot and Ankle Society scores were observed in both groups, with no functional discrepancies evident at the final follow-up (p: 0.488). CONCLUSIONS: The study found no significant differences in union rates, complications, or clinical outcomes between two and three-screw fixation methods for medial malleolar osteotomies (MMO). Both methods allowed for effective MMO fixation without loss or displacement post-surgery, suggesting their safety and efficacy. LEVEL OF EVIDENCE: Level III, retrospective comparison.

Intermittent pedicle screw application provides better kyphosis restoration in adolescent idiopathic scoliosis for Lenke type 1 and type 2 curves.

PURPOSE: There is still no consensus on the optimum pedicle screw density required for the desired thoracic kyphosis restoration in adolescent idiopathic surgery (AIS). The aim of this study to evaluate the effect of pedicle screw density on thoracic kyphosis restoration in AIS surgery. METHODS: The data of 106 patients from two centers that operated for Lenke type 1 and 2 AIS were retrospectively reviewed. Two groups were constituted according to the pedicle screw density: intermittent pedicle screw constructs (IPSC) (n = 52 patients) and consecutive pedicle screw construct (CPSC) (n = 54 patients) groups. The preoperative and at least 24-month follow-up radiographs and SRS-22 scores were evaluated. The Cobb angle of the main and concomitant curves in the coronal plane and the sagittal plane were measured and compared. RESULTS: The mean follow-up period for the IPSC and CPSC groups was 72.3 ± 37.2 and 62.9 ± 28.8 months, respectively. In the SRS-22 questionnaire, there was no significant difference between the two groups in terms of self-image/appearance domain scores (p = 0.466), but better results were obtained in the IPSC group in terms of treatment satisfaction domain scores (p = 0.010) and better thoracic kyphosis restoration was achieved in IPSC group radiologically for Lenke type 1 curves with - 81.4 ± 81.4% in the IPSC group and 6.8 ± 83.8% in the CPSC group (p < 0.001). CONCLUSION: It was considered that better thoracic kyphosis restoration could be achieved with the less lordotic effect of IPSC in Lenke type 1 curves. Although the current situation had a significant impact on radiological outcomes, its effect on SRS-22 scores was limited.

Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs?

BACKGROUND: : Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis. METHODS: From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores. RESULTS: The UCLA scores increased from the preoperative value of 19.1 ± 3.2 to 29.8 ± 4.8 at the last follow-up and increased by an average of 10.7 ± 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 ± 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001). DISCUSSION: To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.

Surgical outcomes of extraskeletal myxoid chondrosarcoma.

BACKGROUND: Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma. The aim of this study is to present the results of the patients we treated with the diagnosis of EMC as an oncology reference center. METHODS: Information on 13 patients diagnosed with EMC between 2006 and 2018 was retrospectively reviewed. Patients' demographic information, tumor sizes, surgical treatments, chemotherapy and radiotherapy statuses, follow-up times, recurrences, and metastases were recorded. RESULTS: Mean patient age was 53.6 ± 15 years (range: 28-73). In 8 patients, the tumor was located in the lower limbs, most commonly in the thigh (46.2%). Mean follow-up period was 52.8 ± 19.9 (24-96) months. All patients underwent wide resections and only one had a positive surgical margin. In follow-up, 5 (38.5%) patients experienced recurrence; 6 patients had lung metastasis (46.2%) and 7 patients (53.8%) died. Mean tumor size was 10.4 ± 3.2 (5-17) cm. Median survival time was 61 (50.5-71.4) months and 5-year survival rate was 51.8%. There was no significant difference between survival times according to age, gender, side, limb location, postoperative radiotherapy, recurrence, or presence of lung metastasis. The cut-off value for death obtained by ROC analysis of tumor size was 11 cm. DISCUSSION: EMC is a rare soft tissue sarcoma with high local recurrence and metastasis capacity. Tumor size and metastatic disease are poor prognostic criteria. If it is a localized disease, the first option should be wide resection.

The effect of bicipital groove morphology on the stability of the biceps long head tendon.

BACKGROUND: Long head of biceps tendon (LHBT) instability is an important source of pain and disability for the shoulder. Supraspinatus and subscapularis tendons contribute to the formation of the biceps pulley system, which maintains biceps stability during shoulder movements. The aim of this study is to evaluate the effect of morphology of bicipital groove on the stability of LHBT. Also, to evaluate the relationship between bicipital groove morphology and subscapularis rupture and supraspinatus rupture. MATERIAL AND METHODS: Surgical images and magnetic resonance images of 200 patients who underwent shoulder arthroscopy surgery in our clinic between January 2016 and December 2017 were retrospectively analyzed. The depth of groove, medial wall angle and opening angle values of 200 patients were measured on MRI. The stability of the biceps long head tendon, rotator cuff tear and SLAP lesions was recorded by monitoring the shoulder arthroscopy records in each groups. RESULTS: There were 200 patients, 131 male and 69 female, with an average age of 40.9 ± 14.2 (range: 17.0-79.0) years. In 69 (34.5%) patients, long head of the biceps tendon (LHBT) instability was detected. The patients were divided into two groups according to LHBT instability.The subscapularis rupture was significantly more frequent in the group with LHBT instability (52.2%) than the group without LHBT instability (4.6%) (p < 0.001). The supraspinatus tear was observed in 72.5% in the group with instability and 56.5% in the non-instability group, which shows a statistical difference between the two groups (p = 0.027). The presence of SLAP was observed in similar rates in both groups (p = 0.053). Mean depth of groove, medial wall angle, and opening angle measurements were similar in both groups (p = 0.568, p = 0.393 and p = 0.598, respectively). CONCLUSION: To conclude, the morphology of the bicipital groove is not related to the stability of LHBT, and the soft tissue factors above the bicipital groove rather than bone morphology are important in stability. In addition, subscapularis rupture is a pre-disposing factor for LHBT instability; therefore, we recommend a more careful examination of LHBT in patients with subscapularis rupture. LEVEL OF EVIDENCE: III.

Primary aneurysmal bone cyst of the scapula in adult patient: two case reports and a review of the literature.

Aneurysmal bone cyst (ABC) is a rare, benign but locally aggresive bone tumor of unknown origin tumor. It commonly affects children and usually occurs at the metaphysis of long bones. Scapula is a very rare location and ABCs of the scapula have been sparsely described in the literature. Differential diagnosis can be challenging as it shares common radiological and clinicopathological features with other benign and malignant bone tumors. The degree of diagnostic difficulty increases even more when an unusual tumor site has to be taken into account. Here, we describe rare and challenging cases of a primary ABC located at the scapula that was surgically treated. This is the first case report of ABC involving the scapula in adult patient.

Management of Giant Cell Tumors in Hand and Foot.

The aim of this study is to determine the treatment modalities and clinical characteristics of 12 patients diagnosed with giant cell tumor (GCT) of the hand and foot. The clinical findings, treatment modalities, and treatment failures of 12 patients with giant cell tumors of the hand and foot bones between 2007 and 2018 years were evaluated retrospectively. The average age at diagnosis was 29.2 ± 14.9 std. (between 16 and 62 years old), 8 males (66.6%) and 4 females (33.3%). Tumor was more frequently located in the talus, metacarpal, and metatarsal bones. The mean tumor size was 3.1 ± 1.1 cm (between 2.2 and 5.3 cm). The mean post-operative follow-up period was 76.3 ± 42.5 (between 12 and 139 months). The most of patients' (58.3%) common complaints were pain. The most commonly used surgical method was curettage + autografting (91.7%). Infection was seen in one patient after relapse surgery. Recurrence occurred in 33.3% of the patients in the first year. Only one patient was detected to have knee and lung metastases. Swelling and pain in the hand and foot should be examined for tumor lesions. When a bone lesion is detected, the giant cell tumor of the bone should be included in the differential diagnosis. Patients with giant cell tumors should be followed closely for recurrence and metastasis after treatment.

Effects of hexagonal boron nitride on mechanical properties of bone cement (Polymethylmethacrylate).

OBJECTIVES: The aim of this study was to investigate the effects of adding hexagonal boron nitride at four different concentrations to polymethylmethacrylate (PMMA) bone cement, which is commonly used in orthopedic surgeries, on the mechanical properties and microarchitecture of the bone cement. MATERIALS AND METHODS: The study included an unaltered control group and groups containing four different concentrations (40 g of bone cement with 0.5 g, 1 g, 1.5 g, 2 g) of hexagonal boron nitride. The samples used for mechanical tests were prepared at 20±2ºC in operating room conditions, using molds in accordance with the test standards. As a result of the tests, the pressure values at which the samples deformed were determined from the load-deformation graphs, and the megapascal (MPa) values at which the samples exhibited strength were calculated. RESULTS: The samples with 0.5 g boron added to the bone cement had significantly increased mechanical strength, particularly in the compression test. In the group where 2 g boron was added, it was noted that, compared to the other groups, the strength pressure decreased and the porosity increased. The porosity did not change particularly in the group where 0.5 g boron was added. CONCLUSION: Our study results demonstrate that adding hexagonal boron nitride (HBN) to bone cement at a low concentration (0.5 g / 40 g PPMA) significantly increases the mechanical strength in terms of MPa (compression forces) without adversely affecting porosity. However, the incorporation of HBN at higher concentrations increases porosity, thereby compromising the biomechanical properties of the bone cement, as evidenced by the negative impact on compression and four-point bending tests. Boron-based products have gained increased utilization in the medical field, and HBN is emerging as a promising chemical compound, steadily growing in significance.

Using Proximal Hooks as a Soft-Landing Strategy to Prevent Proximal Junctional Kyphosis in the Surgical Treatment of Scheuermann's Kyphosis.

AIM: To evaluate the occurrence of proximal junctional kyphosis (PJK) as well as both the clinical and radiologic outcomes of patients who underwent surgery for Scheuermann?s Kyphosis (SK) using either exclusively pedicle screws or a combination of proximal hooks and pedicle screws constructs. MATERIAL AND METHODS: Surgically treated 37 patients with the diagnosis of SK were evaluated retrospectively. The patients were divided into two groups based on the type of instrumentation employed. The first group contained 22 patients with only pedicle screws (PP) while the second group consisted of 15 patients with mixed constructs that were proximal hooks and pedicle screws (HP) at the rest of the levels. The clinical and radiological data were compared in patients who were followed up for a minimum of 2 years. RESULTS: The average duration of follow-up for the PP group was approximately 94.7 ± 53.1 months, whereas the HP group had an average follow-up period of around 103 ± 64.4 months. After conducting the analyses, no statistically significant findings were identified in the measurements taken for the SRS-22 scores in preoperative, postoperative, and the most recent follow-up radiographs (p > 0.05). It is worth noting that among patients who exclusively utilized pedicle screws, both the proximal (p=0.045) and distal (p=0.030) junctional kyphosis angles experienced more pronounced increases compared to hybrid structures. CONCLUSION: While no notable distinction was observed between the two groups, patients with pedicle screws fixation had a higher PJK angle. Conversely, the use of hooks at the upper end seems to be a preventive measure against the development of PJK.

The prognosis of iatrogenic saphenous nerve injuries during hamstring tendon harvesting in anterior cruciate ligament reconstruction.

PURPOSE: This study aims to evaluate the long-term outcomes of saphenous nerve (SN) injuries from hamstring tendon harvesting during ACL reconstruction, focusing on clinical results and patient satisfaction after at least two years. Additionally, it investigates the incidence, recovery patterns, and impact of these injuries on functional outcomes, daily activities, and ACL re-rupture rates immediately post-surgery and at final follow-up. MATERIALS AND METHODS: A retrospective review was conducted on patients who had undergone ACL reconstruction with hamstring tendon grafts at a single institution between January 2015 and January 2020. The incidence of SN injuries was assessed immediately after surgery and at final follow-up. Additionally, the recovery rate and time were evaluated, and the impact of these injuries on functional outcomes was measured using the Lysholm Knee Score (LKS) and patient-reported effects on daily activities. RESULTS: Of the 159 patients analyzed, iatrogenic SN injuries were initially observed in 87 (54.7%) patients post-ACLR. By the final follow-up, paresthesia had resolved in 36 (22.6%) patients within an average of 11.1 months. Persistent SN injuries were recorded in 51 (32.1%) patients, affecting various extents of the infrapatellar branch (IPBSN) and the sartorial branch (SBSN) of the saphenous nerve. Patients with persistent SN injuries experienced a significant impact on daily activities and had lower LKS scores compared to those without injuries or with recovered injuries. Furthermore, a higher re-rupture rate was associated with persistent SN injuries. CONCLUSIONS: The study finds that SN injuries during hamstring graft harvesting for ACL reconstruction are common, with a significant portion of patients experiencing persistent sensory deficits for at least two years postoperatively. These injuries are observed to adversely affect patient satisfaction and functional outcomes and to increase the re-rupture rate.

ChatGPT's potential to support home care for patients in the early period after orthopedic interventions and enhance public health.

OBJECTIVES: This study presents the first investigation into the potential of ChatGPT to provide medical consultation for patients undergoing orthopedic interventions, with the primary objective of evaluating ChatGPT's effectiveness in supporting patient self-management during the essential early recovery phase at home. MATERIALS AND METHODS: Seven scenarios, representative of common situations in orthopedics and traumatology, were presented to ChatGPT version 4.0 to obtain advice. These scenarios and ChatGPT̓s responses were then evaluated by 68 expert orthopedists (67 males, 1 female; mean age: 37.9±5.9 years; range, 30 to 59 years), 40 of whom had at least four years of orthopedic experience, while 28 were associate or full professors. Expert orthopedists used a rubric on a scale of 1 to 5 to evaluate ChatGPT's advice based on accuracy, applicability, comprehensiveness, and clarity. Those who gave ChatGPT a score of 4 or higher considered its performance as above average or excellent. RESULTS: In all scenarios, the median evaluation scores were at least 4 across accuracy, applicability, comprehensiveness, and communication. As for mean scores, accuracy was the highest-rated dimension at 4.2±0.8, while mean comprehensiveness was slightly lower at 3.9±0.8. Orthopedist characteristics, such as academic title and prior use of ChatGPT, did not influence their evaluation (all p>0.05). Across all scenarios, ChatGPT demonstrated an accuracy of 79.8%, with applicability at 75.2%, comprehensiveness at 70.6%, and a 75.6% rating for communication clarity. CONCLUSION: This study emphasizes ChatGPT̓s strengths in accuracy and applicability for home care after orthopedic intervention but underscores a need for improved comprehensiveness. This focused evaluation not only sheds light on ChatGPT̓s potential in specialized medical advice but also suggests its potential to play a broader role in the advancement of public health.

Decision tree-based data mining approach for the evaluation of survival in primary malignant bone tumors: A surveillance, epidemiology and end results database study.

PURPOSE: This study aimed to conduct a large-scale population-based study to understand the epidemiological characteristics of Primary Malignant Bone Tumors (PMBTs) and determine the prognostic factors by concurrently using the classical statistical method and data mining methods. METHODS: Patients included in this study were extracted from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database: "Incidence-SEER Research Data, 18 Registries, Nov 2020 Sub". Patients with unclassified and incomplete information were excluded. This search algorithm resulted in a dataset comprising 6234 cases. Survival analyses were performed with Kaplan-Meier curves and the Log-rank test. Multivariate Cox regression analysis determined the independent prognostic factors of PMBT. A decision tree-based data mining technique was used in this study to confirm the prognostic factors. RESULTS: 5-years survival rate was 63.6% and 10-years survival rate was 55.3% in the patients with PMBT. Sex, age, median household income, histology, primary site, grade, stage, metastasis, and the total number of malignant tumors were determined as independent risk factors associated with overall survival (OS) in the multivariate COX regression analysis. The prognostic factors resulting in five terminal nodes in the decision tree (DT) included stage, age, and grade. The stage was the most important determining factor for vital status. The terminal node with the shortest number of surviving patients included 801 (72.3%) deaths in 1102 patients with distant stage, and hazard ratio was calculated as 5.4 (95% CI: 4.9-5.9; p < .001). These patients had a median survival of only 17 months. CONCLUSIONS: Rules extracted from DTs provide information about risk factors in specific patient groups and can be used by clinicians making decisions on individual patients. We recommend using DTs in combination with COX regression analysis to determine risk factors and the effect of these factors on survival.

Bilateral Femur and Humerus Avascular Necrosis Associated With Corticosteroids: A Rare Case Presentation.

Avascular necrosis of the bone is a pathology characterized by compromised blood circulation, leading to necrosis due to insufficient vascular nourishment. Within the realm of orthopedics and traumatology, instances of avascular necrosis are steadily increasing. Notably, the escalating use of corticosteroids in managing inflammatory diseases and acute respiratory distress syndrome associated with the COVID-19 pandemic has resulted in a surge of outpatient referrals concerning cases of glucocorticoid-associated avascular necrosis. This study aims to elucidate the management of avascular necrosis following oral corticosteroid use in a young and otherwise healthy male patient, impacting both humeral and femoral heads bilaterally. A 26-year-old adult male, devoid of chronic health conditions, received a diagnosis of bilateral avascular necrosis in humeral and femoral heads within two years following a one-month course of oral corticosteroids. The patient underwent a comprehensive treatment regimen, encompassing hyperbaric oxygen therapy, oral antiplatelet therapy, a tailored physical therapy and rehabilitation program, and bilateral core decompression surgery for both hip joints. During the three-year follow-up, the patient exhibited a favorable response to treatment, demonstrating a complete and painless range of motion in both shoulder and hip joints. This case serves to underscore a crucial point: femoral head avascular necrosis may not invariably manifest as the initial bone affected, and a substantial time lapse may transpire between corticosteroid use and the onset of clinical symptoms. We emphasize the critical importance of not dismissing complaints pertaining to other bones in patients with a confirmed diagnosis and stress the significance of prompt detection in avascular necrosis. Furthermore, this study highlights the necessity for heightened vigilance in instances of orthopedic grievances among individuals with a history of corticosteroid use, particularly those related to the pandemic and inflammatory diseases, to facilitate early diagnosis and intervention for avascular necrosis.

The combined use of carbon nanotubes with synthetic ceramics enhances posterolateral fusion: an experimental study in a rat spinal fusion model.

PURPOSE: The aim of the present study was to evaluate the effectiveness of carbon nanotubes (CNTs)/ HA-tricalcium phosphate (TCP) composite in a posterolateral spinal fusion model. METHODS: At first, CNTs and CNTs/HA-TCP composites were prepared. Twenty adult male Sprague Dawley rats were randomized into four groups with five rats in each group. Decortication was carried out in standard manner in all animals. Group 1 (only decortication), group 2 (CNTs), group 3 (HA-TCP) and group 4 (CNTs/HA-TCP) were formed. Eight weeks later, all animals were killed and obtained fusion segments were evaluated by manual palpation, histomorphometry and micro-computed tomography (mCT). RESULTS: In all evaluations, highest fusion values were obtained in Group 4. In mCT investigations, bone volume/ tissue volume (BV/TV) ratio was found to be significantly higher in composite group (group 4) only compared to ceramic group (group 3) (p < 0.001). Although in Group 2, in which only CNTs were used, the ratio was found to be statistically significantly higher than group 1(p < 0.001), the difference was not considered as significant in terms of fusion and in addition in group 2, CNTs were completely surrounded by fibrous tissue, i.e., no bone formation was observed. CONCLUSIONS: The CNTs/HA-TCP composite is a promising synthetic bone graft substitute for spinal fusion. Although CNTs are inadequate in producing spinal fusion when they are used alone, due to their high biocompatibility due to their high biocompatibility, and multiple effect on bone regeneration, they seem to increase fusion rates significantly when they are used in combination with ceramic-based synthetic grafts.

Comparison of infraclavicular brachial plexus block versus wide-awake local anesthesia no-tourniquet technique in the management of radial shortening osteotomy.

OBJECTIVES: The aim of this study was to evaluate the feasibility of the wide-awake local anesthesia no-tourniquet (WALANT) technique in radial shortening osteotomy and to compare it with the infraclavicular brachial plexus block (IBPB). PATIENTS AND METHODS: Between January 2020 and January 2021, a total of 26 patients (16 males, 10 females, mean age: 40±4.9 years; range, 29 to 45 years) with Kienbock's disease who underwent radial shortening osteotomy were retrospectively analyzed. The patients were divided into two groups according to the type of anesthesia as WALANT (Group 1, n=11) and IBPB (Group 2, n=15) anesthesia. Visual Analog Scale (VAS) during surgery, time from anesthesia to surgical incision, surgical time, overall patient satisfaction regarding the anesthesia was assessed. The Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and handgrip strengths were compared at the final follow-up and short-term outcomes were analyzed. RESULTS: Age (p=0.896), sex (p=1.000), and dominant side involvement (p=1.000) were similar between the groups. Waiting time to start surgery in both groups was similar (27 vs. 25 min; p=0.053). Intraoperative VAS-pain scores and the satisfaction from the anesthesia type of both groups were also similar (p=0.546 and p=0.500). CONCLUSION: The WALANT may be another anesthesia technique for radial shortening osteotomy with favorable outcomes. This technique adequately allows the surgeon to perform osteotomy and obtain a stable reduction without undue risk of tourniquet pain and palsy.

What is the clinical and functional effect of performing suspension arthroplasty with abductor pollicis longus tendon slip to carpometacarpal joint osteoarthritis of the thumb?

OBJECTIVES: This study aims to investigate the clinical, radiological, and functional results of trapeziectomy, ligament reconstruction and suspensionplasty surgery with abductor pollicis longus (APL) tendon slip autograft to thumb carpometacarpal (CMC) osteoarthritis. PATIENTS AND METHODS: Between January 2011 and June 2017, a total of 25 hands of 25 patients (4 males, 21 females; mean age: 63.6±5.8 years; range, 54 to 76 years) were included. All patients underwent trapeziectomy and ligament reconstruction and suspensionplasty procedure due to the diagnosis of thumb CMC joint osteoarthritis. The patients were administered the Patient-Rated Wrist Evaluation Questionnaire (PRWE), Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH), and Visual Analog Scale (VAS). Scaphometacarpal distance (SMD), Kapandji opposition score, thumb range of motion (ROM), grip strength, tip pinch, lateral pinch, and palmer pinch values were measured for both hands. The values calculated for the operated and contralateral hands of the patients were compared. RESULTS: The ROM measurements, Kapandji opposition scores, and pinch values of the operated hands of the patients were found to be statistically significant lower compared to the contralateral hands (p<0.001, p<0.001, p=0.002; respectively). The grip strength values were similar for both hands (p=0.147). The median SMD in the operated hand was found to be 7.5 mm and 12.1 mm in the contralateral hand (p<0.001). CONCLUSION: The ROM, strength and functional results were reached a satisfactory level, particularly in the patients with a follow-up period of ≥36 months. In patients with thumb CMC joint osteoarthritis, ligament reconstruction and suspensionplasty using APL tendon slip are considered to be a useful and preferable surgical technique modification.

Which one of the benign tumors and tumor-like lesions located in long bones needs prophylactic fixation during surgery?

OBJECTIVES: This study aims to define the simultaneous prophylactic fixation indications of benign tumors and tumor-like lesions located in long bones that were treated by curettage and grafting/cementing. PATIENTS AND METHODS: Fifty-six patients (33 males, 23 females; mean age 30.9±15.9; range, 15 to 65 years) who were treated by curettage and grafting or cementation for their benign tumors or tumor-like lesions in long bones between January 2013 and June 2016 were retrospectively analyzed. Age, sex, anamnesis and physical examination findings, histopathologic diagnosis, lesion localization, pre- and postoperative imaging results and follow-up data were all analyzed. The patients were divided into two groups as those with and without postoperative fracture. RESULTS: The most common localization was femur (38%). The mean tumor diameter was 6.8±2.2 (range, 2.6 to 12.6) cm and volume was 58.3±45.0 (range, 6 to 177) cm³. Postoperative fracture occurred in 14 patients. The lesion diameter and volume of the patients in postoperative fracture group were significantly higher compared to group without postoperative fracture (p=0.034 and p=0.004, respectively). A volume value greater than 67 cm³ and ages over 35 years were found to be associated with a higher rate of fracture for all lesions. CONCLUSION: In the postoperative period, patients with benign tumors or tumor-like lesions of long bones had a higher fracture risk if the volume value was greater than 67 cm³ and the age was over 35 years. Prophylactic fixation may be suggested for these patients.

Prognostic significance of the preoperative neutrophil-to-lymphocyte ratio patients with giant cell tumor of bone.

OBJECTIVE: To evaluate the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in giant cell tumor of bone (GCT). METHODS: The patients with GCT were identified in the hospital records and pre-treatment complete blood count results were acquired retrospectively. Whether preoperative NLR lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) values had prognostic significance in predicting recurrence was evaluated by Receiver operating curve (ROC) analysis. Furthermore, the prognostic value of NLR was evaluated by Multivariable Cox Regression analysis. RESULTS: There were 96 patients with GCT. It was found that only NLR values had prognostic significance for predicting recurrence (AUC:0.647; 95% CI:0.533-0.762; P=0.021). The statistically significant cut-off value of NLR for predicting recurrence was ≥2.25. NLR was ≥2.25 in 51% (n = 49) of patients. Multivariable analysis showed that NLR ≥2.25 (HR=2.9, 95% CI:1.3-6.6; p=0.009) and lung metastasis (HR=7.9, 95% CI:2.2-28.2; p=0.001) were independent factors of recurrence. In patients with lung metastasis and patients with NLR ≥2.25, recurrence was observed in a sooner period (Log rank test; p=0.001; p=0.009, respectively). CONCLUSION: Our findings showed that NLR is a new and promising inflammation-based prognostic factor in GCT patients.