Can the Length of the Tibia Nail Be Predicted Correctly Before the Operation According to the Patient's Height and Shoe Size?

OBJECTIVE: Although various methods have been identified for the appropriate tibial nail length, there are disadvantages such as extra time, radiation exposure, and additional cost. We aimed to predict the ideal length of the nail according to the patient's height and shoe size in the preoperative period to eliminate these disadvantages. MATERIALS AND METHODS: Between January 2018 and August 2023, the height and shoe size data of 71 patients who were diagnosed with tibial shaft fracture and had tibia intramedullary nail fixation were determined. A linear regression model was applied to the normally distributed data. The correlation coefficient between the variables was evaluated according to the Pearson correlation coefficient. RESULTS: While 1 1-centimeter (cm) increase in patient height causes an increase of 3.2 millimeters (mm) in nail length, it was found that it alone contributed by 89% to predicting the ideal nail length (p<0.001). An increase of 1 unit in shoe size (EU) causes an increase of 9 mm in nail length; its contribution to predicting the ideal nail length alone is 84% (p<0.001). In the evaluation of the patient's height and shoe size together, it was observed that they jointly contributed 91% to the accurate estimation of the nail length (p<0.001). CONCLUSION: It may be risky to determine the tibial nail length only by shoe size or the patient's height. However, the correlation between them is strong. Therefore, by estimating nail lengths before the operation, the ideal nail length can be found by making fewer fluoroscopy checks during the operation.

The healing effects of L-carnitine and spongostan on cartilage defect in rat model.

PURPOSE: We aimed to determine the effect of L-carnitine and spongostan on cartilage healing in an experimental animal model with a full-thickness cartilage defect. METHODS: In the study 32 Sprague-Dawley rats were divided into four groups in equal numbers. A cartilage defect with a diameter of 1 mm and a depth of 3 mm was created in the femoral intercondylar region of rats in groups A, B, and C. Group A received no treatment in the defective area. Group B received treatment with spongostan. Group C received treatment with spongostan soaked in L-carnitine. Group D served as the healthy control group. The rats were euthanized 6 weeks after the treatment. Histological evaluation of the condyles was done with the modified Mankin scoring. RESULTS: In the histopathological imaging of the cartilage structure, it was observed that in group A, there was complete disorganization and cellular structure was completely absent up to the subchondral bone. In group B, moderate structural improvement, partially intact appearance in border integrity and mostly diffuse hypercellularity were observed. In group C, a near-normal healing, a completely intact appearance in boundary integrities and normal or hypercellularity in cellular structure were observed. The total score of the modified Mankin decreases numerically from A to D. There was no statistically significant difference observed between the A-B (p = 0.176), C-D (p = 0.145), and C-B (p = 0.580) groups, while significant differences were detected between the A-C (p = 0.004), B-D (p = 0.007), and A-D (p = 0.000) groups. CONCLUSION: It has been known that mitochondrial activity is reduced in the osteoarthritis, and as a result, decrease in cellular activity occurs with ATP synthesis. For this reason, we found that L-carnitine, which we expect to stimulate cell proliferation by stimulating ATP synthesis, makes a positive contribution to cartilage healing, as expected. It has been found that combining spongostan with L-carnitine for the treatment of cartilage healing, instead of applying spongostan alone, provides near-normal healing.

How does the side of lumbar disc herniation influence the psoas muscle size at the L4-5 level in patients operated for unilateral hip arthroplasty?

Study Design: Retrospective studyObjection: There can be a relationship between degenerative diseases in the spine and hipSummary of Background Data: Degenerative diseases in the spine and hip may occur concomitantly. This study was done to investigate the cross-sectional area of psoas muscle size and incidence of lumbar disc herniation after unilateral hip arthroplasty.Methods: The data files of patients who were operated on for unilateral hip arthroplasty between January 2014- and 15 May 2021 at the Recep Tayyip Erdogan University Hospital were retrospectively analyzed for the relationship between the psoas muscle volume and the incidence of lumbar disc herniation. The patients were divided according to their operated sides.Results: The data files of 48 patients were retrospectively analyzed. The patients were divided into two groups according to the operated side of their hip joints. Gender and age differences were not significant, and the mean ages were 68,68 years old in the right hip arthroplasty group, and 69,39 in the left hip arthroplasty group.Conclusions: A complex interaction between the development of lumbar disc herniations and increased contralateral cross-sectional area of the psoas muscle at the L4-5 level was observed in patients operated for unilateral hip arthroplasty. This interaction can be a compensatory mechanism to counteract the spinal imbalance.

Clinical and Histologic Evaluation of Partial Achilles Tendon Injury Repair with Amniotic Membrane in Rats.

BACKGROUND: Adhesions after tendinopathy in individuals who perform physical work and those physically active in middle age are a challenging problem for orthopedic surgeons. We evaluated the effects of human-derivated amniotic membrane on tendon healing, adhesions, angiogenesis, and the inflammatory process. METHODS: Thirty-five rats were divided evenly into five groups, and the left lower extremity was used in this study. No interventions were applied to the control group (group 5). In the other groups, Achilles tendons were partially cut to the midline. Then, primary repair (group 1), amniotic membrane treatment with no repair (group 2), primary repair and amniotic membrane treatment (group 3), or secondary healing with no repair (group 4) was performed. RESULTS: Use of amniotic membrane in tendon healing resulted in decreased adhesion formation and positive effects on collagen sequencing and anti-inflammatory effects. In addition, for the vascular endothelial growth factor evaluation there was no difference among the amniotic membrane repair groups, but there was an increase in vascular endothelial growth factor positivity compared with the control group. CONCLUSIONS: These data show that amniotic membrane treatment can alter biological behavior and induce surface-dependent angiogenesis and can have angiogenetic effects on ischemia and inflammation.

Comparison of linear versus macrocyclic gadolinium chelates in rat skeletal muscle.

OBJECTIVE: We investigated the effects on skeletal muscle of gadolinium based linear and macrocyclic radiocontrast agents applied at experimental intervals using histopathological methods. METHODS: Thirty-two male Sprague-Dawley rats were included in the study for histopathological analysis. No procedure was performed on the healthy control group. The sham group received 0.1 ml/kg intravenous (IV) saline solution through the tail vein 4 times weekly for 5 weeks. The gadodiamide group received total 2 mmol/kg IV gadodiamide through the tail vein 4 times weekly for 5 weeks. The gadoteric-acid group received 2 mmol/kg IV gadoteric acid through the tail vein 4 times weekly for 5 weeks. RESULTS: We determined no marked apoptotic myofibrils associated withcaspase-3 expression in these two groups. Furthermore, no calcineurin expression was observed in myofibrils in the two groups. However, quantitative analyses revealed a decrease in muscle-fiber area in the gadodiamide and gadoteric-acid groups compared to the control group (Respectively; p=0.001 and p=0.017). CONCLUSION: In our experimental study, linear and macrocyclic GBCAs applied at repeated doses played no role in myofibril damage induced by caspase-3 and calcineurin - nuclear factor of activated T-cells in skeletal muscle tissue.

Is There A Relationship Between Three-Dimensionally Measured Baker's Cyst Volume and Knee Pathologies?

OBJECTIVE: Baker's cyst (BC) is also known as popliteal cyst. To evaluate its effect on intra-articular pathology, it is important to have the exact volume of the cyst. As BC may change its shape due to mass effect of the surrounding anatomic structures, it is difficult to measure the exact volume of BC. This study examined the relationship between three-dimensionally measured BC volume and symptomatic intra-articular knee pathologies. MATERIALS AND METHODS: The magnetic resonance (MR) images of 45 patients with symptomatic knees were retrospectively examined.The BC volumes were measured via volumetric analysis. The joint effusion was examined in the sagittal plane in T2-proton density-weighted images. The medial plicae were assessed in accordance with the modified Sakakibara classification. Using the MR images, the meniscuses were classified in accordance with the meniscus rupture classification of Stoller et al. The cartilaginous lesions were analyzed using an MR grading system.In this study, correlations between the following measures were analyzed: BC volume and effusion level, medial plica presence, medial femoral condyle, medial tibial condyle, lateral femoral condyle and lateral tibial condyle cartilage degeneration, and medial meniscus anterior horn, medial meniscus posterior horn, lateral meniscus anterior and posterior horn ruptures. RESULTS: Cartilage degeneration, medial plicae, increase in intra-articular effusion, and increase in the BC volume were found to be statistically significant (p<0.01). CONCLUSION: Cartilage degeneration, medial plicae, and increase in intra-articular effusion may increase the BC volume. We believe that this study may contribute to clinicians in understanding the relationship between BC volume changes and pathologies causing intra-articular knee symptoms.

Central Sagittal Angle of the Sacrum as a New Risk Factor for Patients with Persistent Low Back Pain after Caesarean Section.

STUDY DESIGN: Retrospective. PURPOSE: This study investigated the possible association of persistent low back pain (LBP) with caesarean section (CS) under spinal anesthesia. OVERVIEW OF LITERATURE: Many women suffer from LBP after CS, which is commonly performed under spinal anesthesia. However, this type of LBP is poorly understood, and there is poor consensus regarding increased risk after spinal anesthesia. METHODS: We examined two groups of patients who underwent cesarean delivery under spinal anesthesia. Group I included patients who presented to a neurosurgical clinic complaining of LBP for at least 6 months. Group II was a control group with patients without LBP. We analyzed clinical and sagittal angle parameters, including age, body mass index, parity, central sagittal angle of the sacrum (CSAS), and sacral slope (SS). RESULTS: Fifty-three patients participated in this study: 23 (43.1%) in Group I and 30 (56.9%) in Group II. Non-parametric Mann-Whitney U-tests showed that age, parity, and CSAS significantly differed between the two groups at 6 months. CONCLUSIONS: Age, parity, and CSAS appear to be associated with increased risk for LBP after CS under spinal anesthesia. Future prospective studies on this subject may help validate our results.

Neglected knowledge: Asymmetric features of lumbar disc disease.

BACKGROUND: Lumbar disc herniations have been extensively studied in the literature. Asymmetric trunk muscle anatomy could affect the development of this entity which has never been quantitatively studied previously. The purpose of this manuscript was to analyze the operated sides of herniated lumbar disc. MATERIALS AND METHODS: Data files of patients with lumbar disc herniation operated in author's hospital between January 2007 and March 2009 were analyzed. RESULTS: In operated side analysis, discectomy side was 53% on the left side, 40% on the right side, the difference between two sides was statistically significant. CONCLUSION: The asymmetric distribution may be a significant factor in the development and surgical treatment of lumbar disc herniations.

Restoration of Anterior Vertebral Height by Short-Segment Pedicle Screw Fixation with Screwing of Fractured Vertebra for the Treatment of Unstable Thoracolumbar Fractures.

BACKGROUND: The treatment of unstable thoracolumbar fractures remains controversial. Long-segment pedicle screw constructs may be stiffer and impart greater forces on adjacent segments compared with short-segment constructs. Short-segment pedicle screw fixation alone may be associated with instrumentation failure. Reinforcement fractured vertebra by the placement of an additional 2 screws at fracture level may be useful in thoracolumbar fractures for restoration of anterior vertebral height. MATERIAL AND METHODS: We retrospectively analyzed 35 patients (21 males, 14 females) with unstable thoracolumbar fractures. The patients were divided into 2 groups. In group I, patients were operated with posterior approach via the use of pedicle screws fixed long (2 levels above and 1 or 2 levels below of the fractured vertebra). In group II patients, short-segment stabilization with additional screwing at fracture level was made. Immediate postoperative radiologic evaluations were done by measuring the correction and maintenance of kyphotic angle at the fracture level, Cobb angle, and height of fractured vertebra. RESULTS: Average local kyphosis angle, anterior kyphotic angle at the fracture level, and Cobb angle were not statistically significantly different in the postoperative period (P > 0.05); however, postoperative anterior height of fractured vertebra was statistically significantly different between the 2 groups (P < 0.05). CONCLUSIONS: We compared a standard long-segment construct with a short-segment construct using instrumentation of the fractured segment. Short-segment pedicle screw fixation with screwing of fractured vertebra in unstable thoracolumbar fracture levels is an effective method to restoring anterior vertebral height for the treatment of unstable thoracolumbar fractures. It also provides anterior column support.

Synovial Sarcoma Mimicking Myositis Ossificans.

A calcification mass was incidentally found in the soft tissue of a patient who had a history of trauma to the extremity during examination. The patient had no symptom. The pathological analysis of the mass revealed it was an early-phase synovial sarcoma (SS). The diagnosis was made before the onset of symptoms and proper surgical intervention was performed. Therefore, in case of a <1 cm lesion clinically suspicious of myositis ossificans, SS should be taken into consideration as a possible diagnosis.

Inequality in leg length is important for the understanding of the pathophysiology of lumbar disc herniation.

OBJECTIVE: Inequality in leg length may lead to to abnormal transmission of load across the endplates and degeneration lumbar spine and the disc space. There has been no study focusing on lumbar disc herniation (LDH) and leg length discrepancy. This subject was investigated in this study. MATERIALS AND METHODS: Consecutive adult patients with leg length discrepancy and low back pain (LBP) admitted to our department were respectivelly studied. RESULTS: A total number of 39 subjects (31 women and eight men) with leg length discrepancy and LBP and 43 (25 females and 18 males) patients with LBP as a control group were tested. Occurrence of disc herniation is statistically different between patients with hip dysplasia and control groups (P < 0.05). CONCLUSION: The results of this study showed a statistically significant association between leg length discrepancy and occurrence of LDH. The changes of spine anatomy with leg length discrepancy in hip dysplastic patients are of importance in understanding the nature of LDH.

The effect of prenatal exposure to 1800 MHz electromagnetic field on calcineurin and bone development in rats.

PURPOSE: To investigated the effects of exposure to an 1800 MHz electromagnetic field (EMF) on bone development during the prenatal period in rats. METHODS: Pregnant rats in the experimental group were exposed to radiation for six, 12, and 24 hours daily for 20 days. No radiation was given to the pregnant rats in the control group. We distributed the newborn rats into four groups according to prenatal EMF exposure as follows: Group 1 was not exposed to EMF; groups 2, 3, and 4 were exposed to EMF for six, 12, and 24 hours a day, respectively. The rats were evaluated at the end of the 60th day following birth. RESULTS: Increasing the duration of EMF exposure during the prenatal period resulted in a significant reduction of resting cartilage levels and a significant increase in the number of apoptotic chondrocytes and myocytes. There was also a reduction in calcineurin activities in both bone and muscle tissues. We observed that the development of the femur, tibia, and ulna were negatively affected, especially with a daily EMF exposure of 24 hours. CONCLUSION: Bone and muscle tissue development was negatively affected due to prenatal exposure to 1800 MHz radiofrequency electromagnetic field.

The effect of prenatal exposure to 1800 MHz electromagnetic field on calcineurin and bone development in rats

PURPOSE: To investigated the effects of exposure to an 1800 MHz electromagnetic field (EMF) on bone development during the prenatal period in rats. METHODS: Pregnant rats in the experimental group were exposed to radiation for six, 12, and 24 hours daily for 20 days. No radiation was given to the pregnant rats in the control group. We distributed the newborn rats into four groups according to prenatal EMF exposure as follows: Group 1 was not exposed to EMF; groups 2, 3, and 4 were exposed to EMF for six, 12, and 24 hours a day, respectively. The rats were evaluated at the end of the 60th day following birth. RESULTS: Increasing the duration of EMF exposure during the prenatal period resulted in a significant reduction of resting cartilage levels and a significant increase in the number of apoptotic chondrocytes and myocytes. There was also a reduction in calcineurin activities in both bone and muscle tissues. We observed that the development of the femur, tibia, and ulna were negatively affected, especially with a daily EMF exposure of 24 hours. CONCLUSION: Bone and muscle tissue development was negatively affected due to prenatal exposure to 1800 MHz radiofrequency electromagnetic field.

Quadriceps Tendon Rupture due to Postepileptic Convulsion.

We present a case of quadriceps tendon (QT) rupture. QT ruptures can occur in all ages. The cause is mostly traumatic in origin. Spontaneous ruptures that are thought to result from predisposing conditions are rare. Post-convulsion QT ruptures lacking traumas in their history can be overlooked in clinical examinations. This should be born in mind by the attending physician, as early diagnosis and treatment of the condition can lead to satisfactory outcomes.

Paradox in the cubital tunnel syndrome--frequent involvement of left elbow: first report.

OBJECTIVE: Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy in the arm, but the existence of a compressive cause has not been determined conclusively and the majority of the cases are idiopathic. In this paper, involvement sides of limbs of patients with cubital tunnel syndrome were studied. MATERIAL AND METHODS: Between October 2008 and December 2011, the clinical assessment of consecutive operated patients with cubital tunnel syndrome in Rize Education and Research Hospital were analysed. The diagnosis and severity of syndrome was based on electro-diagnostic study. RESULTS: This study included 57 consecutive patients with cubital tunnel syndrome (39 men, 18 women; mean age, 44,7 years; range, 23-79 years; mean age, 44,7 years; range, 23-79 years); 31 patients underwent surgical treatment. Involvement was on the right side in 18 and on the left in 39 patients. Severity scores and MCV were statistically significant between sides. CONCLUSION: Profound involvement with cubital tunnel was found in left elbow. According to the finding of non-dominant elbow involvement in our study, the exact etiology and ideal management of cubital tunnel syndrome continues to be heavily debated.

Giant Cell Tumour of the Tendon Sheath: Analysis of 35 Cases and their Ki-67 Proliferation Indexes.

INTRODUCTION: A giant cell Tumour of the tendon sheath (GCTTS) is a slow-growing benign Tumour originating from the synovial cells of the tendon sheath. It is the second most common Tumour of the hand. The aim of this study was to perform a retrospective clinicopathological evaluation of GCTTS cases and determine whether the proliferative activity of giant cell tumour of tendon sheath is related to its recurrence rate and local aggressiveness. MATERIALS AND METHODS: The age, gender, Tumour location and diameter, treatment mode, Ki-67 proliferation index, mitotic rate, and recurrence were retrospectively evaluated in 35 patients diagnosed with GCTTS in the Department of Pathology, School of Medicine, Recep Tayyip Erdogan University between 2009 and 2014. RESULTS: Of the 35 GCTTS cases, 23 were female, and 12 were male. The mean age was 45 y (range 10-70). Sixteen tumours were located in the right hand and 14 in the left hand, and five were in the feet. The mean Tumour diameter was 2.3 cm (0.6-6 cm). All patients underwent marginal excision. The mean postoperative follow-up period was 4 y (range 28 months-5 y). Only six patients showed recurrence. In these cases, the site of GCTTS recurrence was the phalanx of the hand. The mean Ki-67 index in the recurrence cases was 6.5%, whereas it was 2.3% in those without recurrence. CONCLUSION: The Ki-67 proliferation index and mitotic activity were increased in recurrent cases compared to nonrecurrent cases. Therefore, these parameters may be helpful in predicting recurrence of GCTTS. However, adequate surgical excision and complete removal of the Tumour are important steps to minimize the recurrence rate.