The effects of full weight-bearing mobilization on clinical outcomes and subsidence in cemented and uncemented hemiarthroplasty in osteoporotic patients: A retrospective single-center study.

BACKGROUND: Early full weight-bearing mobilization is controversial in osteoporotic patients who have undergone uncemented hemiarthroplasty (UCH). OBJECTIVES: The aim of the study was to compare the results of early full weight-bearing mobilization in CH and uncemented hemiarthroplasty (UCH). The effect of subsidence on the results was also evaluated. METHODS: Fifty-nine patients who underwent CH and UCH were evaluated. The mean age was 79.8 years (10 females, 15 males) for CH and 75.5 years (10 females, 24 males) for UCH. All patients started immediate full weight-bearing mobilization and weight-bearing exercises. RESULTS: There was no difference between the groups according to the Harris Hip Score. Both groups were evaluated in subgroups according to whether there is varus in the femoral stem. There was no difference between subgroups according to the Harris Hip Score. The femoral subsidence was not determined in CH group. In the UCH group, the subsidence was 1.13 ± 1.03 mm in varus femoral stem subgroup and 0.81 ± 0.85 mm in without femoral stem varus subgroup. There was no difference in subsidence between femoral stem with varus and without varus. The subsidence did not affect the Harris Hip Score. CONCLUSION: Full weight-bearing mobilization could be safely preferred in UCH, as in CH. Femoral stem varus below 5 degrees does not affect the results and subsidence.

The effectiveness of corticosteroid injection and splint in diabetic de Quervain's tenosynovitis patients: A single-blind, randomized clinical consort study.

BACKGROUND: There is no clear information on the efficacy of corticosteroids, and splints in the treatment of patients with diabetes mellitus (DM). The aim of this study was to compare the outcomes of isolated corticosteroid injection therapy with splint treatment with corticosteroid injection in patients with and without DM. METHODS: 84 diabetics, and 84 healthy patients with a diagnosis of de Quervain's tenosynovitis were included in our study. The patients were randomly distributed into four subgroups with and without DM. Groups 1 and group 2 consisted of diabetic patients, while group 3 and group 4 consisted of healthy patients. Corticosteroid injections were administered to groups 1 and 3, and corticosteroid injection and splint treatment were administered to groups 2 and 4. RESULTS: There was no significant difference in terms of age, gender, dominant/non-dominant hand, pre-treatment Quick Disabilities of the Arm, Shoulder and Hand score and visual analog scale scores score between the four groups. Quick Disabilities of the Arm, Shoulder and Hand and visual analog scale scores in the four groups were found to be significantly better than pre-treatment at the 12th month. Finkelstein test results were positive in 37.5% of the patients in the first group, 35% of the patients in the second group, 20% of the patients in the third group and 9.5% of the patients in the fourth group. Groups 1 and 2 and, groups 3 and 4 were compared to evaluate the effect of the splint. While forearm-based thumb splint affected the results positively in healthy individuals, it was determined that it had no effect on the results in diabetic patients. CONCLUSION: Although corticosteroid treatment is effective in the treatment of de Quervain's tenosynovitis in healthy and diabetic individuals, the results are worse in diabetic patients than in healthy patients. In addition, the use of splint with corticosteroid injection in healthy individuals positively affects the results, while it does not affect the results in diabetic patients.

Comparison of physical therapy and arthroscopic partial meniscectomy treatments in degenerative meniscus tears and the effect of combined hyaluronic acid injection with these treatments: A randomized clinical trial.

BACKGROUND: Symptomatic degenerative meniscus tears are common in middle and old age. Arthroscopic partial meniscectomy (APM), physical therapy (PT) and hyaluronic acid injection (HAI) are the most commonly used treatment options. OBJECTIVES: The aim of our study is to compare the effectiveness of APM and PT in degenerative meniscus tears and to investigate the effect of HAI with a prospective, randomized, single-blind study. METHODS: The study included 192 patients with symptomatic degenerative meniscus tears. The patients were randomly divided into the four groups. The first group consisted of patients who underwent APM, the second group received HAI with APM, the third group received PT, and the fourth group received HAI with PT. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS) scores, and range of motion (ROM) values were used for evaluation. RESULTS: There was no difference between four groups according to age, gender, BMI, affected side, grade of osteoarthritis. In the 4 groups, WOMAC and VAS results at the 2nd and 6th months were better than pre-treatment. There was no difference between the groups in terms of WOMAC and VAS. In terms of ROM, the results were found better in PT group (Group 3, Group 4) at the 2nd and 6th months. However, the results were found worse in APM group (Group 1, Group 2). In addition, it was found that HAI applied with APM and PT had no effect on VAS, WOMAC, and ROM. It was determined that the increase of knee osteoarthritis negatively affected both the results of APM treatment and PT. VAS, WOMAC, and ROM results were found worse in patients with stage 3 osteoarthritis than grade 1 and 2, but there was no difference between grade 1 and 2. CONCLUSIONS: APM and PT give good results in terms of pain and functional results. However, ROM limitation develops after APM. Conversely, there is an increase in ROM after PT. Administration of HAI with these treatments has no effect on the results. PT is an easily applicable noninvasive method. Adding HAI to the treatment has no effect on the results and increases the cost.

Small Size Autograft versus Large Size Allograft in Anterior Cruciate Ligament Reconstruction.

BACKGROUND: A small autograft diameter negatively affects functional outcomes, knee stability, and the risk of rerupture after anterior cruciate ligament (ACL) reconstruction, whereas the strength of allograft decreases over time. Therefore, it is not clear whether the use of smaller autografts or the use of larger allografts in ACL yields better results. The aim of this study was to compare the outcome of smaller autografts and larger allografts for ACL reconstruction. METHODS: Fifty-one patients who underwent ACL reconstruction with hamstring tendon autografts (size ≤ 8 mm) and 21 patients who underwent ACL reconstruction with allografts (size ≥ 10 mm) were included in our study. All patients underwent the same aggressive early postoperative rehabilitation program. There were no significant differences between the autograft and allograft groups regarding the preoperative patient age, sex, time from injury to surgery, and average follow-up time. RESULTS: The mean diameter of the 4-stranded hamstring tendon grafts used as autografts was 7.48 ± 0.33 mm and the mean diameter of the allografts was 10.76 ± 0.67 mm. According to specific tests for the ACL (anterior drawer, Lachman, and pivot shift) and clinical evaluation tests (Lysholm knee scoring scale and International Knee Documentation Committee questionnaire), the final follow-up results were significantly better than the preoperative status in both autograft and allograft ACL reconstruction groups. Therefore, there were no significant differences between the autograft and allograft groups preoperatively and at the final follow-up. CONCLUSIONS: The large size of the graft in ACL reconstruction has been reported to affect results positively. However, in our study, we could not find any significant differences between the smaller size autografts and larger size allografts in terms of inadequacy, rerupture, and final follow-up functional results. Although allografts were significantly larger than autografts, we did not have the positive effect of larger size grafts. Smaller size autografts were as effective as the larger size allografts.

The effects of partial meniscectomy and meniscal repair on the knee proprioception and function.

PURPOSE: Aim of our study was to compare the effects of partial meniscectomy and meniscus repair on knee proprioception and function. METHODS: The study included 46 patients with clinical and radiological diagnosis of meniscal tear and accompanying anterior cruciate ligament (ACL) rupture. The patients were evaluated under two groups: group 1: partial meniscectomy and ACL reconstruction, and group 2: meniscal repair and ACL reconstruction. Proprioceptive and functional evaluation of all patients was performed prior to surgery and on postoperative 12th month. RESULTS: Group 1 consists of 18 male and 1 female patients with an average age of 28.78 ± 3.50. Group 2 consists of 23 male and 4 female patients with an average age of 27.14 ± 3.65. Preoperative evaluation revealed significant differences in knee joint position sense values on wide range of knee motion (15°, 30°, 45°, 60°, and 75°) in both groups. The statistically significant difference was observed in only the range of knee motion of 60° in patients underwent meniscal repair (group 2), whereas in the range of knee motion of 45°, 60°, and 75° in patients underwent partial meniscectomy (group 1) at 12th-month control. According to Lysholm knee scoring system, significantly better results were achieved with meniscal repair compared to the partial meniscectomy at 12th-month control. CONCLUSION: In case of ACL rupture accompanied by meniscal tear, the meniscal repair should be sutured, if possible, in order to obtain better results in terms of knee function and proprioception.

Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with mini plate plus screw or screw only.

INTRODUCTION: We aimed to compare results of treatment of oblique-spiral metacarpal and phalangeal fractures with screw only or mini plate plus screw, respectively. METHODS: A total of 43 patients who were operated with a diagnosis of displaced, irreducible, unstable, rotational oblique-spiral metacarpal and proximal phalangeal fracture between 2007 and 2010 were included in this study. The mean age of patients with a phalangeal fracture was 33.8 years (range 20-50 years; 4 females, 18 males), and the mean age of patients with a metacarpal fracture was 29.6 years (range 18-45 years; 3 females, 18 males). Mini plate plus screw or screw only was used for internal fixation of these fractures. The patients were followed up for 19.2 ± 5.4 months in the phalangeal fracture group and 20.9 ± 7.3 months in metacarpal fracture group. Of the metacarpal fractures, 14 were oblique and 10 spiral, whereas 14 of the phalangeal fractures were oblique and 8 spiral. The patients were evaluated according to total range of motion of the finger, grasping strength and Q-DASH score. RESULTS: For patients treated with mini plate plus screw after metacarpal and phalangeal fractures, the time to return to work was significantly shorter in comparison to patients treated with screws only. There was no significant difference between patients with metacarpal fractures treated with mini plate plus screw and patients treated with screw only in terms of total range of motion and Q-DASH results at last on control examination, while results of patients with phalangeal fractures treated with screw only were significantly better. There was no significant difference between these two treatments in phalangeal fractures in terms of grasping strength of the finger in early (1st month) and late (last control examination), whereas patients with metacarpal fractures treated with mini plate plus screw reached higher grasping strength earlier. CONCLUSION: Treatment with mini plate plus screw should be avoided in spiral and oblique phalangeal fractures, and fixation should be done with screw only with a short surgical incision and dissection. On the other hand, treatment with mini plate plus screw should be preferred in patients with spiral and oblique metacarpal fractures, especially in those who work in occupations requiring higher physical strength.

Comparison of ulnar nerve repair according to injury level and type.

PURPOSE: The aim of the study was to evaluate the results of epiperineural suture repaired primary (clean transaction injury, massive soft-tissue associated injury) and secondary (delayed partial injury) ulnar nerve injuries according to lesion level and type. METHODS: Forty-two patients diagnosed with ulnar nerve injury between January 2008 and January 2012 were involved in the study. Ulnar nerve lesions were classified according to the level of injury into three types: type 1--lesion located above the flexor carpi ulnaris branch; type 2--lesion located between the flexor carpi ulnaris and the flexor digitorum profundus III and IV; type 3--lesion located below the flexor digitorum profundus III and IV and no more than 10 cm distal from the elbow crease. Additionally, ulnar nerve lesions were classified according to type into three groups: group 1 (n 17)--clean transaction injury; group 2 (n 14)--massive soft-tissue associated injury; group 3 (n 11)--delayed partial clean transaction injury. In follow-up evaluations, sensory and motor recovery was analysed with the most common Highet scale modified by Dellon et al. Functional results were evaluated according to the Disability of Arm, Shoulder, and Hand (DASH) score at final follow-up. RESULTS: There were no statistically significant differences between groups according to men/women ratio, mean age, mean follow-up period and ulnar-nerve injury level. The DASH score was significantly better in the clean transaction injury group than the other groups and significantly better for type 3 than types 1 and 2 injuries in all groups. Sensory recovery of type 1 and 3 injuries in the massive soft-tissue associated injury group was significantly worse than the other groups. The worst motor recovery was evaluated in type 1 injury and the best in type 3 injury according to injury level. According to group, motor recovery of the massive soft-tissue associated group was significantly worse than the other groups in all injury types. There were no statistically significant differences between clean transaction injury and delayed partial clean transaction injury groups in all injury types. CONCLUSIONS: Prognostic factors that influenced motor-sensory recovery and functional results were found in interval between trauma and reconstruction, injury level (worse results from proximal to distal) and mechanism of injury (worse results from massive soft-tissue injury to clear, sharp-tissue injury).

Isolated volar surgical approach for the treatment of perilunate and lunate dislocations.

BACKGROUND: Volar and/or dorsal surgical approaches are used for surgical treatment of perilunate and lunate dislocations. There are no accepted approaches for treatment in the literature. We evaluated the functional results of isolated volar surgical approach for the treatment of perilunate and lunate dislocation injuries. MATERIALS AND METHODS: 9 patients (6 male and 3 female patients average age 34.5 ± 3.6 years) diagnosed with perilunate or lunate dislocations between January 2000 and January 2009 were involved in the study. The reduction was performed through isolated volar surgical approach and K-wire fixation, fracture stabilization with volar ligament repair was performed. Range of wrist joint motion, fracture healing, carpal stability, grip strength, return to work were evaluated and also direct radiographs were taken routinely at each control. The scapholunate interval and the scapholunate angle were evaluated radiographically. Evaluations of the clinical results were done using the DASH, VAS and Modified Mayo Wrist Scores. RESULTS: The physical rehabilitation was started at 6(th) week, after the K-wires were removed. The average followup was 18.2 months (range 12-28 months). At the final followup, the average flexion extension arc was 105.0 ± 9.6° (74.6% of the other side), the average rotation arc was 138.8 ± 7.8° (81.5% of the other side) and the average radioulnar arc was 56.1 ± 9.9° (86.4% of the other side). The grip strength was 0.55 bar; 83.2% that the uninjured arm. According to the Mayo Modified Wrist score, the functional result was excellent in five patients and good in four and the average DASH score was 22.8. The scapholunate interval was 2.1 mm and scapholunate angle was 51°. CONCLUSION: The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.

Protruded and nonprotruded subungual exostosis: Differences in surgical approach.

BACKGROUND: In subungual exostosis surgery, repair of the damaged nail bed and surgical excision of the mass without damaging the nail bed is important. The ideal method of surgery is still unclear. This study is done to qualify the effects of different surgical methods on outcome measures in different types of subungual exostosis. MATERIALS AND METHODS: Fifteen patients, operated with a diagnosis of subungual exostosis between January 2008 and June 2012, were evaluated. Protruded masses were excised with a dorsal surgical approach after the removal of the nail bed and nonprotruded masses were excised through a"fish-mouth" type of incision. RESULTS: The mean age of the patients in protruded subungual exostosis group was 17.3 years (range 13-22 years) and this group consisting of seven female and two male patients. The patients were followed up for a mean of 14.1 ± 4.8 months. The mean age of the patients in the nonprotruded subungual exostosis group was 14.6 years (range 13-16 years) and consisting of six female patients. The patients were followed up for a mean of 11.6 ± 2.9 months. The results were positively affected by changing the surgical approach depending on whether or not the exostosis is protruded from the nail bed. All patients had healthy toe nails in the postoperative period without any signs of recurrence. CONCLUSIONS: In patients with a protruded subungual exostosis, the mass should be removed by a dorsal approach with the removal of the nail and injury to the nail bed should be repaired. In patients with a nonprotruded subungual exostosis, the mass should be excised through a "fish-mouth" type incision at the toe tip without an iatrogenic damage.