Comparison of Surgical Results of Modified Stoppa and Ilioinguinal Approach in Patients with Acetabular Fractures Involving Quadrilateral Surface Fractures.

Objectives: The aim of this study was to evaluate the results of surgical treatment in patients with acetabular fractures with a fractured quadrilateral surface treated using two different approaches. Methods: The study included 106 patients who were operated on with ilioinguinal (group A) or modified Stoppa (group B) technique for acetabular fracture with a fractured quadrilateral surface between 2011 and 2020 in our clinic. The quality of reduction was evaluated according to Matta criteria and postoperative pelvic (anteroposterior, external oblique, iliac oblique) radiographs. Evaluation of hip function was recorded using the Merle d'aubigne and Postel Score and Harris Hip Score. Results: Among the patients included in the study, there were 45 patients in group A and 61 patients in group B. When the group data were compared, it was seen that the modified Stoppa approach was superior in terms of intraoperative reduction quality, radiological data, Harris hip score, Merle d'aubigne and PostelScore. (Respectively p=0.40, p=0.49, p=0.040, p=0.028). Conclusion: : Modified Stoppa approach has successful clinical and radiological outcomes and better reduction quality and hip scores than ilioinguinal approaches in acetabular fractures involving quadrilateral plates.

COMPARATIVE ANALYSIS OF OPEN AND CLOSED FLOATING KNEE INJURIES.

Objective: To compare the functional outcomes between floating knee injuries with open femur and tibia fractures and closed floating knee injuries. Methods: Floating knee injuries (followed up and treated in our clinic) were retrospectively analyzed. Patients were divided into two groups: floating knee injuries with open femur and tibia fractures (Group 1) and floating knee injuries with closed femur and tibia fractures (Group 2). Patients were compared according to their demographic characteristics and clinical and functional outcomes. Results: Of 52 study patients, 28 had Group 1 injuries and 24, Group 2 injuries. We found a statistically significant difference in length of hospital stay between the two groups (p = 0.01) and a statistically significant difference in Karlström-Olerud functional scores between the groups (p = 0.02). We found osteomyelitis in five (17%) patients in Group 1 and in one (4%) patient in Group 2. Conclusion: Patients with floating knee injuries and open fractures showed poorer outcomes than those with closed fractures. Those with open floating knee injuries show complications more often and longer hospital stays. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

Objetivo: Comparar os resultados funcionais entre lesões do tipo joelho flutuante com fraturas expostas de fêmur e tíbia e lesões de joelho flutuante fechadas. Métodos: As lesões de joelho flutuante acompanhadas e tratadas em nossa clínica foram analisadas retrospectivamente. Os pacientes foram divididos em dois grupos: lesões de joelho flutuante com fraturas expostas de fêmur e tíbia (Grupo 1) e lesões de joelho flutuante com fraturas fechadas de fêmur e tíbia (Grupo 2). Os pacientes foram comparados de acordo com as características demográficas e os desfechos clínicos e funcionais. Resultados: Entre os 52 pacientes do estudo, 28 tiveram lesões do Grupo 1 e 24 do Grupo 2. A diferença no tempo de internação entre os dois grupos foi estatisticamente significativa (p = 0,01). Também houve diferença estatisticamente significativa nos escores funcionais de Karlström e Olerud entre os grupos (p = 0,02). Osteomielite foi identificada em 5 (17%) pacientes do Grupo 1 e em 1 (4%) paciente do Grupo 2. Conclusão: Comparados aos pacientes com lesões de joelho flutuante com fraturas fechadas, aqueles com fraturas expostas têm piores resultados, uma vez que as complicações são mais comuns e a permanência hospitalar é mais longa nestes casos. Nível de Evidência III, Estudos Terapêuticos - Investigação dos Resultados do Tratamento.

Quality and Content Analysis of Hallux Valgus Videos on YouTube®.

Our aim in this study is to analyze the content and quality of the videos about hallux valgus on YouTube®. The first 50 videos published by typing "hallux valgus" in the search engine on the YouTube® site were analyzed. The number of views of all videos, likes, dislikes, who uploaded the video, video duration, content, watch rate, and how many days it was uploaded were analyzed and recorded. All videos were analyzed with Journal of the American Medical Association (JAMA), DISCERN, GQS, and VPI scores. Six of the videos (12%) were from academic sources, 14 (28%) from commercial product vendors, 13 (26%) by medical animation organizers, 8 (16%) by physicians, 4 (8%) by physiotherapists, 2 (4%) by physical training trainers, 1 (2%) by patients, and last 2 (4%) by trainers. The JAMA mean score of the videos was recorded as 2 (1-4), GQS 3.02 (2-5), DISCERN score 37.56 (26-68), and Video Power Index 41.35 (0-470). The quality of YouTube® videos about hallux valgus is low. The content and quality of health-related information obtained through the Internet are of increasing importance for both healthcare professionals and patients.

Comparative analysis of open and closed floating knee injuries / Análise comparativa de lesão de joelho flutuante aberta e fechada

ABSTRACT Objective: To compare the functional outcomes between floating knee injuries with open femur and tibia fractures and closed floating knee injuries. Methods: Floating knee injuries (followed up and treated in our clinic) were retrospectively analyzed. Patients were divided into two groups: floating knee injuries with open femur and tibia fractures (Group 1) and floating knee injuries with closed femur and tibia fractures (Group 2). Patients were compared according to their demographic characteristics and clinical and functional outcomes. Results: Of 52 study patients, 28 had Group 1 injuries and 24, Group 2 injuries. We found a statistically significant difference in length of hospital stay between the two groups (p = 0.01) and a statistically significant difference in Karlström-Olerud functional scores between the groups (p = 0.02). We found osteomyelitis in five (17%) patients in Group 1 and in one (4%) patient in Group 2. Conclusion: Patients with floating knee injuries and open fractures showed poorer outcomes than those with closed fractures. Those with open floating knee injuries show complications more often and longer hospital stays. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

RESUMO Objetivo: Comparar os resultados funcionais entre lesões do tipo joelho flutuante com fraturas expostas de fêmur e tíbia e lesões de joelho flutuante fechadas. Métodos: As lesões de joelho flutuante acompanhadas e tratadas em nossa clínica foram analisadas retrospectivamente. Os pacientes foram divididos em dois grupos: lesões de joelho flutuante com fraturas expostas de fêmur e tíbia (Grupo 1) e lesões de joelho flutuante com fraturas fechadas de fêmur e tíbia (Grupo 2). Os pacientes foram comparados de acordo com as características demográficas e os desfechos clínicos e funcionais. Resultados: Entre os 52 pacientes do estudo, 28 tiveram lesões do Grupo 1 e 24 do Grupo 2. A diferença no tempo de internação entre os dois grupos foi estatisticamente significativa (p = 0,01). Também houve diferença estatisticamente significativa nos escores funcionais de Karlström e Olerud entre os grupos (p = 0,02). Osteomielite foi identificada em 5 (17%) pacientes do Grupo 1 e em 1 (4%) paciente do Grupo 2. Conclusão: Comparados aos pacientes com lesões de joelho flutuante com fraturas fechadas, aqueles com fraturas expostas têm piores resultados, uma vez que as complicações são mais comuns e a permanência hospitalar é mais longa nestes casos. Nível de Evidência III, Estudos Terapêuticos - Investigação dos Resultados do Tratamento.

Evaluation of the effect of proximal femur geometry on results of geriatric intertrochanteric fracture surgery.

BACKGROUND: This study aimed to explore the relationship between the complications and clinical outcomes after intertrochanteric femoral fracture surgery, and the Singh index (SI), canal-calcar ratio (CCR), cortical thickness index (CTI), and canal flare index (CFI) - the radiological indices defining proximal femoral morphology in the literature - among patients over 60 years of age. METHODS: The data of 350 patients who were operated between 2015 and 2019 were evaluated retrospectively. The study included patients who underwent dual lag screw proximal femoral nailing and had good intraoperative reduction quality according to Fogagnolo's criteria. The relationships among radiological indices measured on radiographs acquired after trauma, and post-operative complications, Barthel activity index, and Harris hip score (HHS) were assessed statistically. RESULTS: Among 121 patients who met the study criteria, there were 63 (52.07%) female and 58 (47.93%) male patients. The mean length of follow-up was 37.09 (36-60) months. The patients had a mean age of 79.78 (60-97) years. At least one mechanical complication developed in 32 (26.4%) patients in the study group. No significant relationship could be established between radiological indices and post-operative complications (p>0.05). The relationship between SI and HHS was statistically significant (p<0.05). CCR, CTI, and CFI did not have a statistically significant relationship with and HHS (p>0.05). CONCLUSION: No statistically significant relationship could be established between radiological indices and post-operative complications. It should be considered that SI may be a parameter that affects clinical outcomes.

Relationship between admission neutrophil/lymphocyte, thrombocyte/lymphocyte, and monocyte/lymphocyte ratios and 1-year mortality in geriatric hip fractures: Triple comparison.

BACKGROUND: Elderly patients with hip fractures have a high post-operative 1-year mortality rate. The aim of this study was to investigate the relationship of the neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (TLR), and monocyte/lymphocyte ratio (MLR) with mortality. METHODS: The data of 350 patients who suffered femoral intertrochanteric fractures between January 2015 and January 2020 were examined, and the demographic data of 124 patients who met the study criteria were evaluated. During the 1-year follow-up, 92 patients (74%) who continued their lives and 32 patients (25%) who died were divided into two groups: Group 1 (survivors) and Group 2 (non-survivors). NLR, TLO, MLO, presence of comorbidities, age, sex, American Society of Anesthesiologists Physical Status Classification, length of hospital stay, fracture type, and fracture pattern values were statistically compared between the two groups. RESULTS: NLR, TLR, and MLR are the laboratory parameters assessed within the scope of the study. Preoperatively, the mean NLR was 6.59 (1.61-26.29), mean TLR was 197.94 (86-516), and mean MLR was 0.73 (0.19-15.68). In this study, a significant relationship was found between NLR, TLR, and MLR values and the occurrence of post-operative 1-year mortality (p=0.01). In addition, the result was significant in the correlation between these parameters. Cutoff values were found to be 7.53 for NLR, 192 for TLR, and 0.54 for MLR in receiver operator characteristic curve analysis (p<0.01). CONCLUSION: NLR, TLR, and PLR are significant predictors of 1-year mortality in patients aged over 60 years with hip fractures.

Which is superior in the treatment of AO Type 42A tibial shaft fracture? A comparison of talon intramedullary nailing and conventional locked intramedullary nailing.

BACKGROUND: This study aimed to compare the clinical and radiological outcomes of conventional locked intramedullary nailing (IMN) and talon IMN in AO Type 42A tibial fractures. METHODS: A total of 93 patients with AO Type 42A fracture were retrospectively analyzed. The patients were divided into two groups: Those treated with conventional IMN (Group 1), and those treated with talon distal locked nailing (Group 2). The patients were statistically compared in terms of age, sex, mechanism of injury, follow-up time, time to union, smoking status, presence of open fracture, presence of concomitant fibula fracture, development of malunion and nonunion, and the number of intraoperative fluoros-copy shots captured. All patients were evaluated with American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores for clinical outcomes. RESULTS: A total of 93 patients (68 men and 35 women) participated in the study. Group 1 consisted of 35 (71.4%) men and 14 (28.6%) women, a total of 49 patients, while Group 2 consisted of 33 (75%) men and 11 (25%) women, a total of 44 patients. There were no significant differences between the two groups in terms of age, sex, mechanism of injury, follow-up times, smoking status, concomitant fibula fracture, presence of malunion, and presence of open fracture (p>0.05). However, there were significant differences between both groups in terms of time to union, nonunion rate, and the number of fluoroscopy shots captured (p<0.05). American Orthopaedic Foot and Ankle Society and Tegner Lysholm score were analyzed and compared, no statistically differences were found (p=0.786 and p=0.764). CONCLUSION: Although talon IMN reduces radiation exposure, locked conventional IMN has lower nonunion rates and achieves union faster.

How does tranexamic acid affect blood transfusion and bleeding amount in pelvis-acetabulum fractures treated with open reduction and internal fixation?

BACKGROUND: This study aimed to investigate intravenous tranexamic acid's (TA) effect on blood loss and transfusion ratios in pelvis-acetabulum fractures treated with open reduction and internal fixation. METHODS: Patients who underwent open reduction and internal fixation due to pelvis-acetabulum fractures between January 2017 and January 2019 constituted this study's target population. After applying inclusion and exclusion criteria, patients were divided into two groups: Those who were perioperatively given 15 mg/kg TA (i.e., Group 1) and those who were not (i.e., Group 2). Data including age, gender, mechanism of injury, fracture type, presence or absence of additional injuries, the time interval between admission and surgery, incision site, pre-operative and post-operative hemoglobin levels, intraoperative estimated blood loss (EBL), number of blood units transfused, and complications were recorded. Two groups were compared regarding these parameters. RESULTS: The study cohort included 58 patients. There were 30 patients in Group 1 and 28 patients in Group 2. Our analysis revealed that the number of blood units transfused was significantly higher in Group 2 than Group 1 (p=0.016). However, there was no significant difference between the two groups regarding intraoperative EBL, pre-operative and post-operative hemoglobin levels, and the time interval between admission and surgery. CONCLUSION: Administration of intravenous TA reduces blood transfusion requirement in patients with pelvis-acetabulum fractures treated with open reduction and internal fixation. This approach can prevent potential blood transfusion-related complications.

Quality and Content Analysis of Carpal Tunnel Videos on YouTube.

INTRODUCTION: Carpal tunnel syndrome is a disease that reduces the quality of life, and it is characterized by numbness, tingling in the fingers, and weakness in the hand, which we frequently encounter in our daily clinical practice. In this study, we aimed to evaluate the videos in terms of quality and reliability by watching the first 50 YouTube videos most relevant to the carpal tunnel in the YouTube video channel, which is often the first reference point as a source of information. METHOD: Among the videos that appear after typing "carpal tunnel" in the search tab of the YouTube, we eliminated those with advertisements and those that are not in English and evaluated the top 50 most relevant videos about the carpal tunnel. A specific YouTube channel was not selected during the search; however, the most relevant videos on carpal tunnel syndrome were determined. The duration, the number of views, the number of likes, dislike numbers, upload times, and upload sources of the videos were recorded and evaluated. The content, quality, and reliability of the videos were evaluated according to the GQS, JAMA, and DISCERN scales. RESULTS: The average length of the 50 videos included in the study was 315.18, the average number of views was 150,977.4, and the average number of likes was 1410.86. The average number of days when the videos were uploaded to the internet was calculated as 1259.62 days. The GQS average of 50 videos included in the study was calculated as 2.7, the JAMA score average as 2.14 and the DISCERN score average as 33.62, and the video quality, content, and reliability were low. There was no statistically significant relationship between uploading sources of videos to the internet and video content, quality, and reliability (p > 0.05). The number of views, the number of days uploaded to the internet, the number of views, the number of likes and dislikes, like rates, and the video power index of the videos showed no statistically significant relationship with JAMA, DISCERN, and GQS. CONCLUSION: Social media is one of the easiest methods to access information today. The high number of contents, quality, and reliability of social media videos are crucial for patients to obtain accurate information, gain awareness about diseases, and receive guidance on treatment. This study found out that the quality, content, and reliability of the existing videos on the carpal tunnel were at a low level. We propose that the videos' content and quality should be improved and become more beneficial for patients.

Surgery or Conservative Treatment of Forearm in Patients Diagnosed with Pediatric Floating Elbow? Retrospective Analysis of 60 Consecutive Cases.

BACKGROUND: The coexistence of supracondylar humerus fracture and forearm fracture is a rare trauma (3-13%) and it is called floating elbow. The aim of this study is to clinically compare the treatment outcomes of the patients diagnosed with floating elbow who underwent surgical treatment and who were followed up forearm with immobilization with splint. MATERIALS AND METHODS: When scanned retrospectively, 60 patients who were treated with the diagnosis of floating elbow due to traumatic causes and followed up for at least 1 year were included in our study. Surgical treatment was performed on 42 patients for forearm fracture. Eighteen patients followed up with immobilization with a long arm splint. The results were evaluated according to the criteria modified by Templeton and Graham, in comparison with the patient's intact side. RESULTS: In the patients whose forearms were followed up conservatively, the mean age was 5.67 ± 2.25 years, and the mean follow-up period was 62.17 ± 45.91 months. In the patients who underwent surgery for the forearm, the mean age was 8.79 ± 2.01 years, and the mean follow-up was 47.14 ± 34.25 months. Eighteen patients whose forearms followed up conservatively, 12 had excellent and good clinical results and 6 had poor and moderate clinical results. Excellent and good clinical results in 27 patients who underwent surgical treatment for their forearms, moderate and poor clinical results obtained in 15 of them. There was no significant difference between the two groups (p = 0.357). CONCLUSIONS: In conclusion, satisfactory clinical and radiological outcomes can be obtained with immobilization of the forearm fracture with splint, if acceptable reduction can be provided for the forearm following fixation of the supracondylar humerus fracture with the K-wire for treatment of floating elbow injury.

The Top 100 Most-Cited Articles on Hallux Valgus.

BACKGROUND: To perform the citation and content analysis of 100 articles on Hallux valgus from the most cited to the least. MATERIALS AND METHODS: Articles published on Hallux valgus between 1980 and 2020 were analyzed by making use of the Web of Science database. Articles were ranked from most cited to the least. Content analysis of all articles was also carried out. Original research articles, reviews, and clinical trials were included in the study whereas case reports were excluded from the study. RESULTS: The total number of citations of the 100 most-cited articles was 7,697. The most-cited article was 'Prevalence of hallux valgus in the general population; systematic review and meta-analysis' published by Sheere Nix in Journal of Foot and Ankle Research in 2010. The country where the articles were mostly produced was USA (n = 46). The most interesting issue was the osteotomy techniques and changes in Hallux valgus surgery. CONCLUSION: The treatment of the Hallux valgus disease is still discussed today. Citation analyses have shown that surgical developments related to HV surgery still attract attention, and this information will be updated continuously in line with the increasing number of articles.