Two-stage treatment of extremity deformities associated with thrombocytopenia-absent radius syndrome.

OBJECTIVE: The aim of this study was to evaluate the results of 2-stage treatment of upper and lower extremity deformities in patients with thrombocytopenia absent radius syndrome. METHODS: Four patients (3 female, 1 male) with a mean age of 1.8 years (range 1-4) were included in the study. The patients were followed up for an average of 5.5 years. All 4 patients had bilateral radial longitudinal deficiency, whereas only 2 patients had bilateral fixed knee contractures. A 2-stage surgical procedure was implemented. The surgical procedure performed for radial longitudinal deficiency consisted of distraction with an Ilizarov frame in the first stage, followed by centralization performed in the second stage. Knee contractures were first treated using an Ilizarov frame, followed by a hamstring tendon transfer in the second procedure. Radiological evaluation of the radial longitudinal deficiency was done by measuring hand-forearm angle, hand-forearm position, and ulnar bowing preoperatively and at postoperative follow-ups. Knee contracture was evaluated by measuring the angle preoperatively and at postoperative follow-ups. RESULTS: The mean hand-forearm angle values of patients at preoperative assessment, early postoperative period, and at the last follow-ups were 82.60, 5,80, and 11.10, respectively (P < .001). The hand-forearm position values were -14.25 mm, +11, and +7.1 mm, respectively (P < .001). The ulnar bowing values were 7.3°, 4.5°, and 2.9°, respectively (P < .001). Recurrence of the radial longitudinal deficiency deformity requiring surgery occurred in 1 patient. In the other 3 patients, some deformity recurred but did not require surgical intervention. In addition, 1 patient with knee flexion contracture had a recurrence of the contracture that did not require surgical intervention. There was no circulatory disorder or skin necrosis in the lower or upper extremities of the patients. CONCLUSION: This study has shown us that two-stage treatment is a reliable method for lower and upper extremity deformities accompanying thrombocytopenia absent radius syndrome. However, recurrence is still a major problem. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

COMPARISON OF SINGLE- AND DOUBLE-PLATE FIXATION TECHNIQUES IN THE TREATMENT OF NONUNIONS OF THE HUMERAL SHAFT.

Introduction: Humerus shaft fractures may be treated conservatively or surgically. In 2.5% to 13% of cases, nonunion is observed, and it leads to severe pain and morbidity. Plate osteosynthesis has become popular in the treatment of nonunion of the humeral shaft. In this study, we compared the clinical outcomes of patients with humerus shaft nonunion whom we treated with single- or double-plate fixation. Materials and Methods: Fifty-three patients diagnosed with aseptic humeral shaft nonunion and treated with plate fixation were included in the study. Patients were evaluated according to the number of plates (single vs. double plates). The two groups were subjected to statistical evaluation according to their clinical and radiographical results. Results: The average age of the patients was 53 years (range: 1-86); 28 (52.8%) were female and 25 (47.2%) were male. The union rate was 90.32% for single plate and 90.91% for double plate fixation. There was no statistically significant difference between single and double plates in the clinical and radiographical results (union time, union rate, Q-DASH score) (p > 0.05). There was a significant correlation between age and union times / Q-DASH scores according to the Spearman correlation test (p < 0.05). Transient radial nerve neuropraxia developed in 2 patients and 1 patient suffered from an infection that was treated with debridement and antibiotic therapy. Conclusion: In our study, similar good results were obtained with single and double plates. In treatment of humeral shaft nonunions, a second plate is not needed if enough stability is provided with single plate fixation. Level of evidence III, Retrospective comparative study.

Introdução: As fraturas do corpo do úmero podem ser tratadas de modo conservador ou cirúrgico. Em 2,5% a 13% dos casos, observa-se pseudoartrose, que causa dor intensa e morbidade. A osteossíntese com placas tornou-se popular para tratamento da não união da diáfise do úmero. Neste estudo, comparamos os resultados clínicos de pacientes com pseudoartrose do corpo do úmero que tratamos com fixação de placa simples ou dupla. Materiais e Métodos: Cinquenta e três pacientes com diagnóstico de pseudoartrose asséptica do corpo do úmero tratados com placa de fixação foram incluídos no estudo. Os pacientes foram avaliados de acordo com o número de placas (placa simples vs. dupla). Os dois grupos foram submetidos à avaliação estatística de acordo com seus resultados clínicos e radiográficos. Resultados: A média de idade dos pacientes foi de 53 anos (variação: 1 a 86); 28 (52,8%) eram do sexo feminino e 25 (47,2%) do sexo masculino. A taxa de união foi de 90,32% para placa simples e 90,91% para placa dupla. Não houve diferença estatisticamente significante entre a osteossíntese com placas simples ou duplas nos resultados clínicos e radiográficos (tempo de união, taxa de consolidação e escores do Q-DASH) (p > 0,05). Houve correlação significativa entre idade e tempo de união/escores do Q-DASH, de acordo com o teste de correlação de Spearman (p < 0,05). A neuropraxia transitória do nervo radial desenvolveu-se em dois pacientes e um paciente teve infecção tratada com desbridamento e antibioticoterapia. Conclusões: Em nosso estudo, resultados igualmente bons foram obtidos tanto com placas simples quanto duplas. No tratamento de pseudoartroses do corpo do úmero, uma segunda placa não é necessária se houver estabilidade suficiente com a fixação com placa única. Nível de evidência III, Estudo comparativo retrospectivo.

Comparison of Open Reduction and Internal Fixation With Minimally Invasive Plating in the Treatment of Distal Tibial Fractures: A Retrospective Study.

Introduction Treatment of distal tibial fractures may be problematic due to their close proximity to the ankle joint and poor skin coverage, resulting in skin problems, deep infection, and malunion. To address these problems, minimally invasive plating methods have been described. In this study, we aimed to compare the clinical findings, radiological findings, and complication rates of patients treated with open reduction or minimally invasive plating. Methods A total of 44 patients with distal tibial fractures with a mean follow-up period of 20.73 (12-50) months were included in this study retrospectively. The patients were divided into two groups, those who underwent open reduction and internal fixation and those treated with minimally invasive plates. The two groups were statistically compared in terms of radiological and clinical scores and complication rates (p=0.05). Comparative analysis was also performed for three fracture types in both groups. Results Twenty patients were treated with a minimally invasive approach and 24 patients were treated with the open reduction method. Age, gender, fracture type, and follow-up times were similar between the two groups (p>0.05). There was no statistically significant difference between postop American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), anterior distal tibial angle (ADTA), or lateral distal tibial angle (LDTA) values between both groups. There was also no difference in union times or nonunion rates (p>0.05). There was no statistically significant difference in rates of superficial skin problems or deep infections between the two groups (p>0.05). In comparison regarding fracture types, patients with type C fractures seemed to have better outcomes with minimal invasive plating. Conclusion Minimally invasive plating is a good approach in the treatment of distal tibial fractures. The technique seems to be advisable, especially for patients with type C fractures. However, the rates of skin problems and deep infections are similar to those seen with the open reduction method.

Analysis of risk factors affecting mortality in elderly patients operated on for hip fractures: A retrospective comparative study.

OBJECTIVE: The aims of this study were (1) to investigate the effects of different demographic and perioperative modalities on mortality rates and (2) to compare mortality rates between different implants in elderly patients operated on for hip fractures. METHODS: In this retrospective study, a total of 314 patients who were operated on for hip fractures were included study. Patients were then divided into four groups based in their implant types: long-stem cementless bipolar hemiarthroplasty (n = 124; 102 female, 22 male; mean age = 84.2 ± 6.4 years), standard-stem cementless bipolar hemiarthroplasty (n = 74; 48 female, 26 male; mean age = 83.5 ± 6.9 years), antegrade intertrochanteric nail (n = 61; 35 female, 26 male; mean age = 78.5 ± 6.8 years), and total hip arthroplasty (n = 55; 34 female, 21 male; mean age = 72.5 ± 4.3 years). Data including gender, age, duration from injury to surgery, American Society of Anesthesiologists (ASA) score, comorbidities, use of antiplatelet agents, Barthel Index of Activities of Daily Living, type of anesthesia, operation time, preoperative hemoglobin values, blood transfusions given, duration of hospital stay, complications, and type of fracture were recorded. RESULTS: Overall, the mean follow-up was 36.5 (range = 0 - 107) months. The overall mortality rate was 53.2%. The median survival duration was 44.2 ± 5 months (range = 34.3 - 54). Survival rates were found significantly different among the groups (P = 0.001). In the first three years postoperatively, the mortality rate was higher in the standard-stem bipolar hemiarthroplasty group, but in the long-term follow-up, the long-stem bipolar hemiarthroplasty group exhibited the higher mortality rates. It was observed that some parameters had statistically significant effects on the mortality rates. Male gender, higher age, lower hemoglobin values, increased number of blood transfusions, ASA scores ≥3, the existence of ≥ 3 comorbidities were found as main predictors of increased mortality rates. CONCLUSION: The results of this study have shown that age, gender, preoperative hemoglobin levels, ASA scores, and comorbidities are significant factors affecting mortality in elderly patients operated on for hip fractures. Long-stem cementless bipolar hemiarthroplasty appears to show similar rates of mortality with standard-stem cementless bipolar hemiarthroplasty. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Comparison of Expandable and Locked Intramedullary Nailing for Humeral Shaft Fractures.

Introduction In this study, we clinically and radiologically investigated whether the application of expandable nails for surgical treatment of humeral shaft fractures has an advantage over locked intramedullary nails. Methods Patients treated with intramedullary fixation due to humeral shaft fractures in our clinic were investigated retrospectively. Patients with fractures of type 12A and 12B according to the AO classification in the middle 1/3 shaft region of the humerus were divided into two groups as those receiving fixation with expandable nails and with locked intramedullary nails. The union rate, union time, Q-DASH scores, duration of surgery, and complication rates were statistically compared between the two groups. Results The study included 38 patients with clinical follow-up from among 47 patients; 20 patients received fixation with locked intramedullary nails and 18 with expandable nails. The mean age of the patients was 56.92 (19-91) years and 53% (n=20) were men while 47% (n=18) were women. During statistical evaluation, a statistically significant difference was found between the groups for union (100% and 72.2%) and complication rates (6% and 13%). More union and lower complication rates were found in patients treated with locked intramedullary nails. In comparing the mean of surgical times (71.1 and 30.2 min), expandable nails had a shorter surgical time. However, there was no statistically significant difference between the union time and Q-DASH scores between the two groups. Conclusion Locked intramedullary nails are a better fixation method than expandable nails due to the low complication rate and high rate of union. However, due to shorter surgery time, expandable nailing is an alternative method in limited cases.

Depression, Anxiety, and Post-Traumatic Stress Disorder Following Orthopedic War Injuries.

Introduction There are ongoing wars worldwide, during which significant numbers of people are injured. Several studies have indicated that high rates of depression and anxiety are seen in war-injured patients. Methods Eighty-one male patients treated between November 2019 and January 2021 far from home in a Turkish hospital due to war injuries that happened in the Libyan Civil War were investigated. Demographic characteristics and injury data of the patients were evaluated regarding age, Injury Severity Score (ISS), location of injuries, type and mechanism of injuries, operations, and accompanying traumas. The psychological statuses of the patients were evaluated with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and post-traumatic stress disorder (PTSD) records filled out at the first admission to the hospital. Results The mean age of the patients was 29.8±7.7 (19-56) years. While 59 patients had fractures, 22 patients had only soft tissue injuries. Eighteen patients suffered from other accompanying injuries. While 85.2% of the patients showed symptoms of depression, 82.7% of the patients suffered from anxiety and PTSD symptoms were seen in 86.4% of the patients. Statistical analysis was performed to investigate the effects of injury severity, duration of hospitalization, number of operations, and age on depression, anxiety, and PTSD among these patients with war injuries. The results did not indicate any significant effect of injury severity, hospitalization duration, or operations. Conclusion Depression, anxiety, and PTSD are common in patients injured in wars. Injury severity does not seem to affect depression, anxiety, or PTSD in these patients.

Management of orthopaedic injuries in Libyan civil war: experiences of a distant hospital.

AIM OF THE STUDY: In this study, we aimed to evaluate the musculoskeletal injury types, infections, and treatments of the patients injured in Libyan civil war. METHODS: A total of 291 patients (288 male, 3 female) treated in our clinic, between November 2011 and April 2020, were included in our retrospective study. Patients' age, injury severity score (ISS), injury type, mechanism, location, accompanying traumas, infection, and operations in Libya and in our clinic were evaluated. RESULTS: Injuries were caused by gunshots in 172 patients, by explosives in 56, by missiles in eight, and by different mechanisms in the remaining 55 patients. Injuries were located mostly in lower extremities, followed by upper extremities and by both extremities. The most common fracture was tibial fractures, followed with femur and humerus. Plate-screw fixation was performed for 82 cases, intramedullary nailing for 42, external fixator for 41, K-wire fixation for 27, foreign body excisions for 26, arthrodesis for 15, amputation for , arthroplasty for 11, and soft tissue operations for 78. Infection was present among 50 (% 17.2) patients. Complications were seen in five patients. Three patients needed implant removal due to infection, one patient had a plate fracture, and one patient died because of sepsis. DISCUSSION: Difficulties in the treatment of war injuries begin in the battlefield. Patients' transfers and treatments may not be provided properly due to unsuitable conditions. Hospitals in neighbouring and distant countries can be helpful for supporting the treatment of increased numbers of injured patients. CONCLUSION: Wars cause excessive numbers of injuries. In this study, we want to show that hospitals far from war zones can be considered as alternatives for treatment of these injuries.

Treatment of femoral defective osteomyelitis with minimal invasive plates.

Although recent treatment modalities reduced chronic osteomyelitis, it is still a challenging problem for both orthopaedic surgeons and patients. Especially treatment of femoral osteomyelitis with defective nonunion is reasonably difficult. Most accepted treatment option is external fixation. But the duration needed for external fixation may be too long for patient compliance. To reduce external fixation duration several methods were described. In this study we described a method for reconstruction of infected femoral defective nonunions using minimal invasive plates.

Treatment of intracapsular femoral neck lesions: aggressive or conservative surgery?

Benign fibrous histiocytomas (BFHs) and non-ossifying fibromas (NOFs) are benign bone tumors that are clinically different, but histologically similar. Most benign lesions are treated with curettage and grafting; however, some misdiagnosed cases are treated with more aggressive procedures, including arthroplasty. Herein, we present a 21-year-old patient that presented with a 1-year history of right hip pain. Anteroposterior X-ray showed a centrally located lesion in the femoral neck that was intracapsular and localized subcortically. To the best of our knowledge, the literature does not include any reposts of BFH or NOF localized at the intracapsular hip. In addition, localization of and treatment options for intracapsular hip lesions are clarified.