The effects of modified hardinge approach on hip muscle strength in patients with primary hip arthroplasty: a patient evaluation with isokinetic strength test and gait analyses.

OBJECTIVE: Numerous factors affect abductor strength after Total hip arthroplasty (THA), including surgical technique, prosthesis type, postoperative rehabilitation program, and preoperative patient condition. We prospectively investigated the effects of the modified Hardinge approach on hip muscle strength, which was evaluated using the isokinetic test, functional results, and gait function of patients who underwent primary THA. METHODS: The hip muscles strength were measured using an isokinetic dynamometer. The primary outcomes of the present study were measurement of isokinetic strength of hip abductor muscle strengths using an isokinetic evaluator and gait analyses preoperatively and at 6 months postoperatively in 27 patients. RESULTS: Isokinetic muscle strength test, abductor and other hip circumference groups achieved the preoperative muscle strength at 3 months postoperatively, and the postoperative sixth month values showed a statistically significant improvement compared with the preoperative and third month values. In gait analyze, our temporospatial data showed a slight regression at postoperative 3 months but reached the same values at 6 months postoperatively. Kinematic data showed a significant regression, but the data were not compared with those in the preoperative period. CONCLUSIONS: Adequate muscle strength and physiological gait pattern, similar to the preoperative status, can be achieved at 6 months postoperatively. LEVEL OF EVIDENCE: Level III.

Alpha-linolenic acid alleviates the detrimental effects of lipopolysaccharide during in vitro ovine oocyte development.

During the transition period and early lactation of ruminants with higher production, the reproductive organs are exposed to various stressors, like inflammation stimulators such as lipopolysaccharides (LPS), as a consequence of high concentrate consumption. In this study, we aimed to determine the probable potential of α-linolenic acid (ALA) in alleviating LPS-induced effects in ovine oocytes in vitro as well as the underlying controlling mechanisms. Different concentrations of LPS (0, 0.01, 0.1, 1, and 10 µg/mL) were added to the oocyte maturation medium to evaluate its effect on oocyte developmental competence. Likewise, different concentrations of ALA (0, 10, 50, 100, and 200 µM/mL) were added to the maturation medium to define its effects on oocyte developmental competence. Accordingly, a combination of ALA and LPS in a dose-dependent manner was added to the maturation medium to elucidate their effect on oocyte developmental competence and uncover any possible potential of ALA to alleviate the detrimental effect induced by the presence of LPS. The expressions of candidate genes were measured in mature oocytes treated either with ALA, LPS, or ALA plus LPS. Adding LPS to the maturation medium decreased the cleavage rate of the treated oocytes, and those oocytes reached the blastocyst stage at a lower rate. Adding ALA to the maturation medium in the presence of LPS alleviated the detrimental effects of LPS in a dose-dependent manner, which ultimately led to higher cleavage and blastocyst formation. A higher expression of Trim26, GRHPR, NDUFA, PGC-1α, SOD, CS, SDH, p53, and CAT was observed in LPS-treated oocytes compared with the ALA and control groups. Additionally, CS and CAT transcripts were down-regulated in oocytes in LPS plus ALA-treated group compared to that of the LPS-treated group. These findings revealed that ALA has the potential to alleviate the detrimental effects induced by LPS on in ovine oocytes during maturation in vitro. Thus, LPS-detrimental effect and ALA-preventing mechanisms seem to be regulated through the expression of genes involved in mitochondrial biogenesis and function, oxidative stress, and antioxidant systems.

Oxidative stress and decreased Nrf2 level in pediatric patients with COVID-19.

The aim of this study was to investigate the change in nuclear factor erythroid 2-related factor (Nrf2), which plays a critical role in cytoprotection against oxidative stress, in pediatric patients with coronavirus disease 2019 (COVID-19) infection positivity, and to evaluate the relationship between Nrf2 and oxidative balance. The study included 40 children with confirmed COVID-19 infection and 35 healthy children. The groups were compared in respect of Nrf2, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI), in addition to clinical findings of fever, cough, shortness of breath, contact history, and demographic data of age and gender. The mean Nrf2 values and TAS levels were determined to be statistically significantly low (p < 0.001) and the TOS level and OSI were statistically significantly high in the children with COVID-19 compared to the control group. A significant positive correlation was determined between Nrf2 and TAS (p < 0.01); as the Nrf2 value increased, so the TAS value increased. A significant negative correlation was determined between Nrf2 and TOS and OSI (p < 0.01); as the Nrf2 value increased, there was determined to be a significant decrease in the TOS and OSI values. COVID-19 infection in pediatric patients causes a decrease in the Nrf2 level. By causing a decrease in the TAS level and an increase in the TOS and OSI levels, the decrease in Nrf2 may explain the tissue damage which can be caused by COVID-19.

Comparing the effect of tourniquet and tranexamic acid on the tibial cement mantle thickness in total knee arthroplasty.

BACKGROUND: This study aims to determine the efficacy of both tranexamic acid (TXA) and tourniquet on the tibial cement mantle thickness in total knee arthroplasty (TKA). METHODS: We retrospectively reviewed the recorded data of patients with primary end-stage knee osteoarthritis who underwent TKA procedure during 2014-2016 at a single institution to evaluate the tibial cement mantle. Patients were categorized in two groups based on the use of tourniquet (groups 1 and 2). In addition, these groups were categorized into two different subgroups based on the use of TXA in groups 1 and 2 (group 1-A, B and group 2-A, B). Four zones at the tibial baseplate on the anteroposterior view and two zones on the lateral view were measured at the 4-6-week postoperative visit. RESULTS: A total of 28 patients (30 knees) were operated using tourniquet and TXA (group 1-A), 29 (30 knees) using tourniquet without TXA (group 1-B), 24 (28 knees) using TXA without tourniquet (group 2-A), and 38 (42 knees) without using TXA and tourniquet (group 2-B). Although a significant difference was found in the cumulative cement mantle penetration on postoperative X-rays between groups 1 and 2, no significant differences were found between groups A and B in both groups. CONCLUSIONS: This study reports that tourniquet use in TKA increased cement mantle penetration of the tibial component in primary TKA. The main strength of this study was that the TXA use alone exhibited no significant effect on the cement thickness.

A prospective evaluation of strength and endurance of ankle dorsiflexors-plantar flexors after conservative management of lateral malleolar fractures.

OBJECTIVES: This study aims to evaluate patients with conservatively treated stable lateral malleolar fractures with isokinetic tests. PATIENTS AND METHODS: Between January 2016 and November 2017, a total of 24 patients (12 males, 12 females; mean age 40.8±15.0 years; range, 18 to 68 years) with an isolated stable lateral malleolar fracture treated conservatively with the circular cast were included in this prospective study. Calf circumferences, ankle range of motion (ROM), pain levels, and functional outcomes were recorded. The muscle strengths and endurance of the injured side were compared with the non-injured side. All patients were evaluated by isokinetic test after removal of the cast, and three and six months after the rehabilitation period. RESULTS: The ROM was found to be lower after removal of the plaster cast, compared to the contralateral ankle. During cast removal, we also found that both dorsiflexor and plantar flexor muscle strength decreased by 25.6% and 44.7%, respectively, and decreased to 10.3% and 3.6% at three months post-rehabilitation. At the end of six months, no statistically significant difference was found between the two sides. In the dorsiflexion-plantar flexion endurance values, 37.8% and 54.1% deficit were detected before the rehabilitation protocol, respectively (p<0.05). At three months, these values decreased to 6.1% and 13.6%, respectively and the endurances of the injured sides surpassed the non-injured sides (p<0.05) at six months. CONCLUSION: Conservative management of stable isolated lateral malleolar fractures with circular cast causes atrophy and decreases strength-endurance of the calf muscles due to immobilization. These changes are expected to diminish over time and functional outcomes are excellent with a good rehabilitation program.

Effect of malpractice claims on orthopedic and traumatology physicians in Turkey: A survey study.

OBJECTIVE: This study aimed to investigate the malpractice claims experienced by orthopedic and traumatology physicians and to determine their effects on burnout, job satisfaction, and clinical practice. METHODS: A questionnaire survey was conducted on orthopedic and traumatology specialists between May 2019 and February 2020. Data collection was carried out via e-survey at "turk-ortopedi" mail group, which is an electronic communication network of orthopedic and traumatology physicians. For data collection, sociodemographic data forms were used including the general characteristics, working conditions, and the malpractice claim events along with the Maslach Burnout Inventory scale to evaluate burnout and the Minnesota Satisfaction Questionnaire to investigate job satisfaction. RESULTS: In total, 353 orthopedic and traumatology physicians (348 men, 5 women), including 37 professors, 41 associate professors, and 275 surgeons, completed the questionnaire. In total, 65.4% of the participants (231 physicians and 471 relevant dossiers) stated that they were currently facing a malpractice claim. Emotional burnout and hesitant behavior in medical practices were significantly higher among the physicians who had undergone an investigation/trial with the claim of malpractice (p<0.05), whereas intrinsic job satisfaction was significantly lower (p<0.05). It was determined that orthopedic and traumatology physicians dealing with arthroplasty, vertebral surgery, hand surgery, and foot/ankle surgeries had undergone significantly more trials (p<0.05). In the evaluation of the burnout levels and job satisfaction scores of the physicians according to the age, academic title, seniority, and institution, it was determined that burnout level decreased with age, those between the ages of 25 and 34 years were exhausted the most, and job satisfaction increased with age. It was also found that burnout level decreased and job satisfaction increased as the academic title became higher, and attending physicians were the most exhausted. Moreover, burnout level decreased as seniority increased, the most senior ones were the ones most exhausted, and job satisfaction increased with seniority. CONCLUSION: Evidence from this study has revealed that malpractice claims cause emotional burnout, low intrinsic job satisfaction, and a hesitant behavior in medical practice for the orthopedic and traumatology physicians. The concept of malpractice alone may result in unnecessary analyses/examinations for patients. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Instant messaging application usage for clinical consultation among orthopedic surgery residents in Turkey: A survey study.

OBJECTIVE: This study aimed to determine the characteristics of instant messaging application (IMA) usage for clinical consultation among orthopedic residents in Turkey and to explore their experiences and opinions concerning potential legal problems. METHODS: A questionnaire titled "Instant messaging for consultation among orthopedic surgeons" consisting of 21 questions was applied to orthopedic surgery residents, and the results were analyzed. The questions were designed to obtain information on 4 categories: 1) demographics and professional experience, 2) attitudes on the use of cellular phones, 3) IMA usage for clinical consultation purposes, and 4) problems and comments on smartphone application usage for clinical consultation purposes. The participants who had no experience with a smartphone or IMA usage were excluded at the final analysis. RESULTS: A total of 860 orthopedic residents (849 males [98.7%]; mean age=28.6 years; age range=22-44 years) participated in the survey (participation rate: 97.3%). The distribution of residency years was as follows: 1st year, 27%; 2nd year, 21.4%; 3rd year, 18.4%; 4th year, 17.4%; and 5th year, 49.9%. The most frequently used IMAs were WhatsApp (99.3%), Facebook Messenger (14.8%), Viber (8%), and Tango (1.3%). The rate of IMA usage for consultation was 95.3%. The most common reasons to prefer IMAs for consultation were being "fast" and "easy," but only 26.3% of the residents reported that they prefer the use of IMAs because they find them "reliable." Moreover, 41.7% of the respondents reported that they had an experience of misdiagnosis owing to the use of IMAs; 81.2% of the participants used the personal information of the patients during the consultation; 57.6% of the respondents considered that legal problems may arise because of the use of IMAs during the consultation; and 51.4% believed that an electronic platform, solely for consultation purposes, is required. CONCLUSION: This survey has shown that it is necessary to make some legal regulations regarding the use of IMAs for consultation purposes and to develop applications only for medical consultation purposes. Most of the trainees make decisions using IMAs without a proper examination, putting the patients at the risk of misdiagnosis. Moreover, the confidentiality of the patient's personal information appears to be in danger when IMAs are used. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

The Effects of Tourniquet Application in Total Knee Arthroplasty on the Recovery of Thigh Muscle Strength and Clinical Outcomes.

The present randomized controlled study aims to evaluate whether tourniquet application during total knee arthroplasty (TKA) has an effect on (1) thigh muscle strength (quadriceps and hamstring muscle strength) and (2) clinical outcomes (postoperative knee range of motion [ROM], postoperative pain level, and Knee Society Score [KSS]). The effects of tourniquet application during TKA were investigated in 65 patients randomly allocated to one of two groups: TKA with a tourniquet and TKA without a tourniquet. Patients in both groups were comparable in terms of the demographic and clinical data (p > 0.05 for age, number of patients, sex, radiographic gonarthrosis grade, American Society of Anesthesiologists [ASA] classification, and body mass index [BMI]). All patients in both groups were operated by the same surgeon using one type of prosthesis. Isokinetic muscle strength (peak torque and total work) of knee extensors (quadriceps) and flexors (hamstrings) was measured in Newton meters (Nm) using a CYBEX 350 isokinetic dynamometer (HUMAC/CYBEX 2009, Stoughton, MA). The combined KSS (knee score + function score), visual analog scale (VAS), and knee ROM were measured preoperatively and at 1 and 3 months postoperatively to evaluate clinical outcomes. There were no significant differences between the two groups in preoperative and postoperative values of isokinetic muscle strength (peak torque and total work) and aforementioned clinical outcomes (p < 0.05). The present study has shown that quadriceps strength and clinical outcomes were not improved in the early postoperative period (3 months) when a tourniquet was not used during TKA.

The Survival of Well-Fixed Cementless Femoral Component After Isolated Acetabular Component Revision.

BACKGROUND: It remains controversial whether isolated acetabular component revision or both component revision surgeries should be performed in patients with stable femoral component. The present study aimed to evaluate the survival of patients with unrevised stable uncemented femoral stem who underwent isolated acetabular component revision. MATERIAL AND METHODS: A retrospective analysis was conducted in patients who underwent isolated acetabular component revision and had stable uncemented femoral component during revision hip arthroplasty between February 1998 and December 2009. Demographic data of the patients included age, previous surgery, complications, duration between primary and revision surgery, and duration between revision and latest follow-up. Functional results were analyzed using Harris Hip Score (HHS). RESULTS: Fifteen hips of thirteen patients were included in the study with a mean age of 62.08 ± 12.9 years. Average time from THA to the isolated acetabular revision was 9.2 ± 3.48 years. Average follow-up time from revision to the latest follow-up was 12.39 ± 2.68 years, and femoral components had been followed for an average of 21.6 ± 4.06 years since the time of implantation. Average HHS of the patients were 53 before revision surgery and 81.9 at the last follow-up (p < 0.001). The 10-year survival rate of patients who underwent revision in the femoral component was 100%, whereas their 15-year survival rate was 93.3%. None of the acetabular components required revision. CONCLUSION: Isolated revision of acetabular component may be considered if there is stable uncemented femoral component in revision THA. Acetabular reconstruction quality, acetabular and unrevised femoral component survival are not affected by retaining well-fixed femoral component. LEVEL OF EVIDENCE: 4, retrospective cohort study.

An Analysis of the Potential Relationship between Crowe Type and Lower Extremity Morphology in Patients with Developmental Dysplasia of the Hip.

PURPOSE: To test whether Crowe type is related to femoral alignment and leg length discrepancy by evaluating the preoperative lengths and coronal alignment of femurs, pelvic parameters and hip morphology of patients who underwent primary hip arthroplasty due to coxarthrosis secondary to developmental dysplasia of the hip (DDH). MATERIALS AND METHODS: Medical records of patients with coxarthrosis secondary to DDH who were treated with total hip arthroplasty at Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine between 2008 and 2017 were reviewed. The mechanical axis of lower limbs was analyzed; pelvic height and femoral and tibial lengths were measured. All femurs were classified according to the Dorr classification. RESULTS: A total of 97 patients were eligible for analysis and were diagnosed with unilateral DDH (n=51) or bilateral DDH (n=46). In those diagnosed with unilateral DDH, the affected pelvis, femur, and tibia were often shorter than the unaffected side. In those diagnosed with bilateral DDH, femoral and pelvic lengths were unpredictable. In the femoral coronal alignment test, data varied widely but were within normal limits. The difference in the Dorr types of femurs was significant between dysplastic and normal sides of patients with unilateral DDH (P=0.001) but not those with bilateral DDH. CONCLUSION: Especially in patients with unilateral DDH, pelvic heights and femoral and tibial lengths on the affected side may be shorter compared with unaffected side regardless of the Crowe type. Femoral coronal alignment is unpredictable for both groups. Careful preoperative analyses of femoral coronal alignment and pelvic length are advised.

Functional outcomes of total knee arthroplasty in patients with Parkinson's disease: A case control study.

BACKGROUND: Parkinson's disease is a neurodegenerative condition causing coordination loss in musculoskeletal system. Many studies suggest that total knee arthroplasty in patients with Parkinson's disease has unfavorable treatment results and high complication rates. Our hypothesis was that total knee arthroplasty might be an effective procedure in patients with Parkinson's disease. METHODS: Parkinson's disease patients who underwent total knee arthroplasty between 2006 and 2018 were retrospectively evaluated. Patients who had Parkinson's disease diagnosis before surgery and who had a minimum follow-up duration of 12 months were included. Secondary knee osteoarthritis patients were excluded. A matched control group was randomly formed. Outcome measures were evaluated by preoperative and postoperative Knee Society Score and joint range of motion values. Comparison was made by means of increase in Knee Society Score and range of motion values. Study group patients were reviewed according to Columbia Classification System to determine disease severity. Stages I-II were accepted as "low-grade" and III-IV-V as "high-grade" disease. Another comparison was made between "low-grade" and "high-grade" patients. Patient who showed disease progression after surgery were also compared to patients without progression. RESULTS: There were 13 patients in both groups. In study group, mean preoperative and postoperative Knee Society Score values were 45.4 (±16.8) and 85.6 (±7.60); range of motion values were 93.9° (±17.0°) and 99.5° (±9.37°) respectively with a mean follow-up of 64.5 (±44.7) months. In control group, mean preoperative and postoperative Knee Society Score values were 38.8 (±11.5) and 86.1 (±10.0); range of motion values were 100.4° (±14.6°) and 109.2° (±10.2°) respectively with a mean follow-up of 51.8 (±13.6) months. No significant difference was observed between 2 groups (p > 0.05). Mean preoperative KSS and ROM values were significantly lower in high-grade patients (30.0 (±17.0) and 78.8° (±11.8°) respectively) compared to low-grade patients (52.2 (±11.9) and 100.6° (±14.7°) respectively) (p < 0.05). However, mean increase in KSS and ROM values were significantly higher for high-grade patients (p < 0.05). Mean increase in Knee Society Score and range of motion was 32.4 (±10.9) and 1.00° (±9.46°) respectively in patients with progression, 45.4 (±16.8) and 8.63° (±8.00°) in patients without progression (p > 0.05). CONCLUSION: Total knee arthroplasty is a successful treatment of knee osteoarthritis in Parkionson's disease patients with similar outcomes compared to general population despite disease severity and progression.

The Treatment Method and Results of Percutaneous Pinning and Dynamic External Fixator Application for Unstable Distal Radius Fractures.

OBJECTIVE: The aim of the present study was to present the results of patients with unstable distal radius fracture treated with closed reduction and percutaneous fixation followed by application of the Pennig dynamic wrist fixator to allow early wrist motion. METHODS: Twenty-five patients diagnosed with distal radius fracture and treated with closed reduction and percutaneous fixation followed by application of a dynamic wrist fixator were included in the study. There were 15 (60%) male and 10 (40%) female patients. The mean age of the patients was 47.32 (20-76) years. The mean period between initial trauma and operation was 8.52 (1-23) days. All patients were allowed active shoulder, elbow, and finger exercises immediately after surgery. RESULTS: Radiological evaluation was performed according to the criteria described by Sarmiento and modified by Lidström. Results were excellent in 12 (46.15%), good in 11 (42.30%), and fair in 3 (11.55%) patients. No patient had poor result. Functional scores were assessed according to the Gartland-Werley classification and modified by Sarmiento. Results were excellent in 14 (56%), good in 8 (32%), and moderate in 3 (12%) patients. CONCLUSION: Use of the Pennig dynamic wrist fixator in the treatment of unstable distal radius fractures has advantages, such as ease of use, minimal surgical trauma, allowing early rehabilitation, and early return to daily activities as well as increased anatomical and functional results.

Oocyte maturation with royal jelly increases embryo development and reduces apoptosis in goats.

Royal jelly (RJ) was supplemented to goat oocyte in vitro maturation (IVM) medium at three different concentrations (2.5, 5, and 10 mg/ml). Maturation rate, embryo cleavage, and blastocyst rate were recorded. Gene expression of apoptosis-related transcripts was investigated in matured oocytes. Percentage of oocytes that reached MII-stage was increased in RJ-treated groups compared to the control group. Glutathione (GSH) content of mature oocytes was enhanced when RJ was added to IVM medium at any supplementation compared with control. Percentage of cleaved embryos and blastocysts was higher in the RJ-treated groups at a concentration of 5 than in the 2.5 mg/ml and control group. Total number of cells per blastocyst was not different in the control and RJ-treated group at 5 mg/ml. However, number of apoptotic cells per blastocyst was higher in the control group than in the RJ-treated group at 5 mg/ml. Expression profile of Bax, and p53 was down-regulated while Bcl-2 was up-regulated in oocytes treated with RJ at 5 and 10 mg/ml compared with the control group. Addition of RJ at concentrations of 5 mg/ml improved embryo production through increasing maturation rate. RJ seems to improve the IVM microenvironment by reducing expression of genes inducing apoptosis, enhancing GSH content, and reducing incidence of apoptosis in blastocysts.

Strategies for Proximal Femoral Nailing of Unstable Intertrochanteric Fractures: Lateral Decubitus Position or Traction Table.

BACKGROUND: The aim of this prospective randomized study was to compare the traction table and lateral decubitus position techniques in the management of unstable intertrochanteric fractures. METHODS: Eighty-two patients with unstable intertrochanteric fractures between 2011 and 2013 were included in this study. All patients were treated surgically with the Proximal Femoral Nail Antirotation implant (DePuy Synthes). Patients were randomized to undergo the procedure in the lateral decubitus position (42 patients) or with the use of a traction table (40 patients). Patients whose procedure was not performed entirely with a semi-invasive method or who required the use of additional fixation materials, such as cables, were excluded from the study. The groups were compared on the basis of the setup time, surgical time, fluoroscopic exposure time, tip-to-apex distance, collodiaphyseal angle, and modified Baumgaertner criteria for radiologic reduction. RESULTS: The setup time, surgical time, and fluoroscopic exposure time were lower and the differences were statistically significant in the lateral decubitus group compared with the traction table group. The collodiaphyseal angles were significantly different between the groups in favor of the lateral decubitus method. The tip-to-apex distance and the classification of reduction according to the modified Baumgaertner criteria did not demonstrate a statistically significant difference between the groups. CONCLUSIONS: The lateral decubitus position is used for most open procedures of the hip. We found that this position facilitates exposure for the surgical treatment of unstable intertrochanteric fractures and has advantages over the traction table in terms of set up time, surgical time and fluoroscopic exposure time.

Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results.

INTRODUCTION: The aim of this study was to evaluate the clinical and radiological outcomes of total hip arthroplasty (THA) in patients with Ankylosing Spondylitis (AS). PATIENTS AND METHODS: One hundred five hips of 61 AS patients (mean age: 41.3 ± 10.2 years) who underwent THA between 1997 and 2012 were included into the study. Dorr's classification of proximal femoral geometry, acetabular protrusio, bone ankylosis, acetabular protrusion, Brooker classification of heterotopic ossification (HO), Gruen and Charnley classifications of implant loosening were used in radiographic assessments. Patients were called back to return for an additional long-term follow-up for functional assessment. RESULTS: Cementless total hip arthroplasty was used in 83 hips (79%) and cemented TKA was used in 22 hips (21%). The overall rate of aseptic loosening was 7.6% at a mean follow-up of 5.4 years. Femoral loosening was statistically similar in cemented and cementless femoral components (14% vs. 8%, p = 0.089). Acetabular component loosening was statistically higher in patients with any degree of HO (p = 0.04). Regardless of the type of femoral implant (cemented or cementless), femoral component loosening was higher in Dorr's type C patients (p = 0.005). The average pre-operative HSS was 46.6 ± 16.3, and it improved to 80.7 ± 18.7 at last follow-up (p < 0.01). CONCLUSION: Revision incidence was similar in between ankylosed and non-ankylosed hips. While complication rates are high, significant functional improvement can be achieved after THA in patients with AS.

Bilateral intertrochanteric and femoral diaphyseal fractures with unilateral proximal tibial fracture: A case report and review of the literature.

INTRODUCTION: Bilateral intertrochanteric femur fractures are relatively rare injuries. This study aims to present a case of a patient with simultaneous bilateral intertrochanteric femur fractures and femoral diaphyseal fractures and proximal tibial fracture with his twelve years follow-up. PRESENTATION OF CASE: A 44-year-old man presented to emergency department after a motor vehicle accident. Bilateral intertrochanteric femur fractures (OTA classification - 31A.1.2) and bilateral femoral diaphyseal fractures (OTA classification - 32A.2) and nondisplaced right proximal tibial fracture (OTA classification - 41B.1) were determined in radiographs. Following closed reduction, fractures were fixed with intramedullary nails bilaterally. Proximal tibial fracture was fixed with cannulated screws following open reduction. At twelfth year follow-up he was able to do his daily activities with minimal limitation. DISCUSSION: High energy traumas, stress fractures, systemic disorders (osteomalacia, chronic renal failure), steroid treatments, seizures and electric injuries are possible causes for bilateral hip factures. However bilateral femoral diaphyseal fractures are mostly due to high energy traumas. Long-term biphosphonate use may also cause bilateral fractures. Single-stage surgery should be performed in order to avoid secondary damages of surgical interventions. All fractures of our patient were fixed in a single session. This prevented further deterioration of patient's status and made rehabilitation easy. CONCLUSION: Careful evaluation of all systems should be performed in multi-trauma patients to find out concomitant injuries. Single staged surgical treatment may decrease morbidities.

Osteotendinous repair of bilateral spontaneous quadriceps tendon ruptures with the Krackow technique in two patients with chronic renal failure.

Although unilateral traumatic quadriceps tendon rupture is a relatively frequent pathology, bilateral non-traumatic spontaneous ruptures are uncommon and are usually associated with chronic renal failure, hyperparathyroidism, gout, and systemic lupus erythematosus. This paper aimed to discuss two patients with chronic renal failure treated with the Krackow suture technique for spontaneous bilateral quadriceps tendon rupture.

Early mobilization with customized TLSO brace in thoracolumbar burst fractures.

OBJECTIVE: This study aimed to research the effectiveness of customized thoracolumbosacral orthosis treatment for stable burst type thoracolumbar vertebral fractures without neurological deficits. METHODS: The study included 26 patients (14 males, 12 females; mean age: 46.03 years; range: 18 to 64 years) conservatively treated for thoracolumbar (T11-L2) burst type vertebral fractures according to Denis classification between 2002 and 2009. Etiology were a fall from various heights in 12 patients (46.2%), motor vehicle accidents as an occupant in 7 (26.9%) and as a pedestrian in 4 (15.4%), and simple fall in 3 (11.5%). None of the patients had neurologic deficit and no damage was found in the posterior ligamentous complex in MRI evaluations. Denis pain and functional scales were used in the clinical evaluation. Local kyphosis angle, sagittal index and height loss percentage were measured in the radiologic evaluation. Post-fracture and follow-up values were compared. Mean follow-up period was 41.30 (range: 14 to 80) months. RESULTS: Mean pain and functional scores were 1.65 and 1.15 points, respectively, at the final follow-up. Twenty patients returned to their pre-trauma work and activities completely and six patients with small limitations. Mean period for returning to work was 3.64 (range: 2 to 6) months. Local kyphosis angle, sagittal index and height loss percentage values increased significantly at follow-up (p<0.05). CONCLUSION: The conservative treatment of stable thoracolumbar burst fractures is widely accepted. Early mobilization with customized TLSO brace appears to produce effective functional results despite loss of vertebral body height.

Intramedullary osteosynthesis of instable intertrochanteric femur fractures with Profin® nail in elderly patients.

OBJECTIVE: The aim of this study was to retrospectively analyze the radiologic and functional results of patients with instable intertrochanteric femur fractures treated with Profin® nails. METHODS: This study included 32 patients (24 female, 8 male; mean age: 70.7 years; range: 65 to 96 years) who were treated with Profin® nails for instable intertrochanteric fractures. Fractures were caused by a simple fall in 30 patients and pedestrian accident in two. Eleven patients had Type 31-A2 and 21 patients had Type 31-A3 fractures according to the AO/OTA classification. Results were evaluated clinically and radiologically. Mean follow-up period was 17.3 (range: 12 to 23) months. RESULTS: Good or acceptable reduction was achieved in 93.7% of our patients. Mean surgery duration was 28.2 (range: 22 to 75) minutes and mean blood loss was 215 (range: 150 to 320) cc. Complete union was achieved in all patients at a mean of 17.6 (range: 15 to 22) weeks. Postoperative mean collodiaphyseal angle was 125.5 (range: 122 to 130) degrees and there was no significant difference with follow-up values (p>0.05). Twenty-two patients were able to walk with support and 10 without support after surgery. Mean Oxford hip score was 23.70 (range: 14 to 39) points. One year mortality rate was 18.75%. CONCLUSION: Good functional and radiologic results can be achieved using Profin® nails for unstable intertrochanteric femur fractures in elderly patients.

Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon.

HYPOTHESIS: Using radiologic and clinical results, we studied the outcome of patients who underwent open reduction and plate osteosynthesis for comminuted olecranon fractures. MATERIALS AND METHODS: We retrospectively studied 18 patients (5 women [27.8%] and 13 men [72.2%]; mean age, 41 years [range, 19-67 years]) with comminuted fractures of the olecranon who underwent locking-plate osteosynthesis after open reduction between March 2005 and August 2009. According to the Mayo classification, 11 cases were classified as type IIB (61.11%) and 7 cases were classified as type IIIB (38.88%). In 7 cases, additional injuries were present in the olecranon area. We evaluated results with respect to clinical and radiologic findings. The mean follow-up duration was 22.6 months (range, 7-42 months). RESULTS: Complete union was achieved in all cases. Mean union time was 4.4 months (range, 4-6 months). According to the Morrey scale, 4 cases were considered very good; 8, good; 5, fair; and 1, poor. The mean QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score was 17 (range, 0-75). There were no statistically significant differences between the Mayo type IIB and type IIIB cases in terms of elbow range of motion, QuickDASH score, and Morrey score. On long-term follow-up, elbow stiffness developed in 1 patient, who underwent surgical release with simultaneous removal of the hardware. The cases with fair and poor scores were cases with open fractures and additional elbow injuries. CONCLUSIONS: Locking-plate osteosynthesis is an effective and safe treatment option for comminuted olecranon fractures, allowing early joint motion and yielding satisfactory radiologic and clinical results. In cases with concomitant injuries, the risk of limited elbow motion is high.