Is handgrip strength and key pinch measurement related with biochemical parameters of nutrition in peritoneal dialysis patients?

BACKGROUNDS & OBJECTIVE: End-stage renal disease (ESRD) frequently causes Protein Energy Wasting (PEW), which is an important morbidity and mortality factor. Although it is difficult to assess PEW with a reliable method, there are various methods such as Handgrip strength test (HST), serum albumin, cholesterol, etc. HST is a simple and reliable antropometric method which is used for nutritional status and body muscle strength. This study aims to assess the relationship between HST and biochemical markers in evolution of nutritional status of ESRD patients. METHODS: This cross-sectional study included 36 consecutive patients, who are on peritoneal dialysis and 36 healthy -control subjects. Jamar-hand dynamometer was used for handgrip strength test; a pinch gauge was used for key pinch. Other antropometric tests included skin fold thicknesses at biceps, triceps, umbilical, suprailiac and subscapular regions; circumferences at waist hip, neck and midarm. Biochemical tests were performed only in Peritoneal Dialysis (PD) group. SPSS for Windows ver. 15.0 was used for statistics. RESULTS: The mean age of patients was 49.3±14.4, and mean age of control group was 43.8±10.6 (p=0.075). In PD group dominant hand dynamometer test 1,2 and 3 results were 19.3±9.3 kg, 25.3±10.8 kg, 25.5± 10.6 kg and; 34.2±10.3 kg, 34.4±9.8 kg, 34.6±10.0 kg for control group (p< 0,001). Right key pinch results were 6.7±1.9 kg for patients; 13.5±4.5 kg for control group (p<0.001). Left key pinch results were 6.8±1.9 kg for patients; 13.2±4.4 kg for control group (p<0.001). There was not any significant relationship concerning handgrip or key pinch tests with biochemical parameters. CONCLUSION: Handgrip Strength Test and key pinch may be reliable, cheap and easily performed tests for the diagnosis of Protein Energy Wasting in patients on Peritoneal Dialysis.

Glucosamine-sulfate on fracture healing.

BACKGROUND: The aim of this study is to determine whether glucosamine-sulfate has any effects on bone-healing. METHODS: A unilateral fracture was created in the tibia of sixty-one female rats. Rats were given no drug or 230 mg/kg glucosamine-sulfate daily. Fractures were analyzed during the first, second and fourth weeks after creation of fracture. Quantitative measurement for new bone formation and osteoblast lining were determined histologically. Semiquantitative score for fracture healing was used for histomorphometric analyses. Bridging bone formation was assessed radiographically. RESULTS: New bone formation and osteoblast lining were significantly higher in glucosamine-treated group at week 1. Surrounding connective tissue was more cellular and vascular, and the newly formed bone trabecules were present in greater amounts in glucosamine-treated group, compared to control group at week 1 and 4. But radiologically, the control group had better scores than that of the glucosamine-treated group at week 4. CONCLUSION: These data demonstrate that daily glucosamine-sulfate administration accelerates early phase of fracture repair in the rat tibia, with increased new bone formation and osteoblast lining histologically, but radiologic bone union is not favored on radiographs.

Bullet in hip joint.

Recently, hip arthroscopy has become more popular in the diagnosis and extraction of intraarticular foreign bodies compared to open surgery. If a foreign object such as a bullet is not extracted from the hip joint, it may cause mechanical arthritis, infection and systemic lead toxicity. We present the arthroscopic excision of a bullet from the hip joint of a 33-year-old male patient who sustained a gunshot injury.

[Volar plate fixation of distal radius fractures]. / Radius alt uç kiriklarinda volar plak ile tedavi uygulamalari.

BACKGROUND: We aimed to evaluate the results of volar locking and unlocking plate fixation of adult distal radius fractures. METHODS: Thirty-four patients (14 female, 20 male, mean age: 48.5 +/- 17.9 years) who were treated for distal radius fractures were investigated retrospectively. The fractures were distributed as follows: 17.6% AO type B3, 11.8% AO type C2 and 70.6% AO type C3. The patients were evaluated clinically (Gartland and Werley score, visual analog scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score) and radiographically (Stewart score). RESULTS: The mean follow-up of patients was 24 +/- 16.3 months. According to the Gartland-Werley score, the results were excellent in 24.9%, good in 55.9%, moderate in 11.8% and poor in 2.9% of the patients. The mean VAS score was 0.5 +/- 1.1, and the mean DASH score was 26.1. According to the Stewart criteria, 44.1% of the patients were rated as excellent, 52.9% as good and 2.9% as moderate. Two patients had complex regional pain syndrome, one patient carpal tunnel syndrome and one patient tenosynovitis. CONCLUSION: Volar plate fixation is a good and effective treatment for distal radius fractures. The plate should be inserted properly and physiotherapy should not be ignored.

Is it possible to save one lumbar segment in the treatment of thoracolumbar fractures?

Surgical treatment of unstable thoracolumbar fractures is controversial. Most authors reported that short segment fixation led to a high incidence of implant failure and correction loss. On the other hand, long segment fixation has the disadvantage of fusing more segments. We aimed to compare the outcomes of long-segment fixation versus two or three levels above and one level below fixation for acute thoracolumbar fractures. Twenty six consecutive patients were assigned to two groups. Group 1 included 14 patients treated with long fixation, whereas group 2 included 12 patients treated with two or three levels above and one level below fixation. Fractures were classified according to the Mc Cormack, Magerl and Denis classifications. Clinical (Oswestry questionnaire, Visual analog score) and radiological (Sagittal index, percentage of anterior body height compression, local kyphosis and Cobb angle) outcomes were analysed. The average follow-up for the long and hybrid fixation groups were 28 and 20 months respectively. Clinical scores of both groups at the last follow-up were not significantly different. The preoperative, postoperative and follow-up sagittal index, anterior body height compression, local kyphosis angle and Cobb angle were not significantly different. Correction loss of 3.36 degrees was seen in the long segment fixation group, versus 2.75 degrees in the other group at the last follow-up. There was no significant difference between the results achieved in the patients who had transpedicular fixation two or three levels above and one level below the fractured vertebra and those who had long segment fixation for thoracolumbar burst fractures.

Glove perforation time and frequency in total hip arthroplasty procedures.

OBJECTIVE: The aim of the present study was to investigate glove perforation rate and time and evaluate the factors affecting glove perforation in total hip arthroplasty (THA). METHODS: Nine hundred seventy-nine gloves used in 57 THA procedures were assessed according to the perforation. Forty-four (77.2%) procedures were primary THA and 13 (22.8%) were revision THA. Gloves were changed when perforated, become dirty with blood or blood products, and before bone cementing. All gloves were filled with water at the end of the operation and controlled for perforation. Two hundred and one surgical gloves used during scrubbing and removed after draping the patient were examined as the control group. The location (which finger), number and time of the perforation, surgery type and duration, and distribution of the perforation location according to the surgical team were assessed. RESULTS: Patients' mean age was 62.9 ± 14.6 (range: 33 to 97) years and the mean surgery duration was 162.9 ± 32.0 minutes. Thirty-two glove perforations were noted in 19 of the operations. Of these perforations, 28 belonged to the surgeons and first assistants. There was no significant difference between the dominant or non-dominant hand according to the location of perforations. Perforations in the first and second fingers of the gloves accounted for 81.3% of all perforations. There was no significant difference in terms of number of gloves used, perforation numbers and operation duration between the primary and revision THA procedures. Two perforated gloves (0.99%) were found in the control group and the difference between the number of perforations in the control and study groups was significant (p=0.048). CONCLUSION: We recommend the use of two pairs of gloves to avoid the risk of contamination and protect the surgical team from infectious disease in major surgeries like THA. Surgical gloves should be changed when they are excessively contaminated with surgical fluids and the surgeon and first assistant should also change their outer gloves at an average of every 90 minutes.

History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions.

PURPOSE: The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making. METHODS: A total of 30 patients with a preoperative MRI underwent arthroscopy over a 5-month period. All patients had a clinical examination performed by an experienced knee surgeon, a specialist in general orthopedics, a senior resident, and a fourth-year resident. These examiners recorded and evaluated the results of seven tests: the medial and lateral joint line tenderness test, the McMurray test, the Apley test, the Stienmann I test, the Payr's test, Childress' sign, and the Ege's test. The injury was classified as a meniscal tear if there were two positive tests. Clinical history, physical examination, and MRI findings were compared with the arthroscopic findings. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these methods of evaluation were then calculated. RESULTS: Clinical examination performed by an experienced knee surgeon had better specificity (90% vs. 60%), positive predictive value (95% vs. 83%), negative predictive value (90% vs. 86%), and diagnostic accuracy (93% vs. 83%) than MRI for medial meniscal tears. These parameters showed only a marginal difference in lateral meniscal tears. The experienced knee surgeon had better sensitivity, specificity, predictive values, and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners. CONCLUSION: These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear. LEVEL OF EVIDENCE: II.

Anger scale and anger types of patients with fifth metacarpal neck fracture.

OBJECTIVE: The aim of this study was to investigate aggressive and angry behavior in patients with fifth metacarpal neck fracture and to analyze the anger management style of these patients and their response to psychological support. METHODS: This study included 30 patients (mean age: 24.8 years) who presented to the emergency room with fractures of the fifth metacarpal neck and 30 healthy control subjects (mean age: 28.7 years). All subjects were evaluated with the Spielberger state-trait anger scale and the 30 subjects with the fifth metacarpal neck fractures completed the Turkish version of Barratt impulsiveness scale and semi-structured data form to assess anger level before the trauma and willingness to receive psychological support. RESULTS: In the metacarpal fracture group, 60% of injuries were caused by hitting the hand against a wall and 40% by hitting the hand in a fight. The non-planning impulsiveness score of Barratt impulsiveness scale was higher in the injured group. There was no significant difference between the Spielberger state-trait anger scores of the injured and control groups. High scores in the subsection that measures impulsiveness that requires attention were found in 82% of patients. CONCLUSION: Impulsive anger behavior is a common cause for fractures of the fifth metacarpal neck. Patients with these types of injuries often have difficulty controlling and directing their anger and often refuse psychiatric support. We believe that the hand surgeon should focus on the psycho-social problems of patients, and if necessary patients should be treated by a psychiatrist to prevent late psychopathologies for health promotion.

Which is more important after total knee arthroplasty: Local inflammatory response or systemic inflammatory response?

We aimed to determine the relationship between functional recovery after knee arthroplasty and systemic and local inflammatory responses. A prospective, clinical study of thirty patients who had osteoarthritis was conducted. After the total knee arthroplasty (TKA), intraarticular IL-6 levels, serum IL-6 levels and serum CRP levels were measured. The primary outcome measures for functional recovery after TKA were the the Knee Society Score (KSS) and Western Ontario and McMaster Universities Index (WOMAC). All patients were examined preoperatively and at 4, 8 and 24 weeks postoperatively. The mean postoperative intraarticular IL-6 level was 218355.1pg/ml, the mean postoperative serum CRP level was 109.9mg/L and the mean postoperative serum IL-6 level was 219.0pg/ml. Preoperative and 4-, 8- and 24-week postoperative KSS and WOMAC scores were evaluated. Significant correlations were found between intraarticular IL-6 concentrations and KSS and WOMAC scores at the first month according to the Pearson correlation test, but no correlations were found between serum IL-6 and CRP levels and KSS and WOMAC scores. The local inflammatory response is more important than the systemic response for early postoperative functional recovery. After TKA, control of local inflammation is much more important than control of systemic inflammation.

Evaluation of the reliability of classification systems used for distal radius fractures.

The objective of this investigation was to evaluate the reliability of classification systems by determining inter- and intraobserver agreement in displaced distal radius fractures. Radiographs of 32 patients (21 men and 11 women with a mean age of 41.6 years) who presented with a displaced distal radius fracture were classified by 9 orthopedic surgeons (5-25 years experience) using 5 different classification systems (Fernandez, AO, Frykman, Melone, and Universal Classification systems) twice with 20-day intervals. The results were processed with kappa statistics and used in assessment of inter- and intraobserver agreement of the classification systems. When classification systems were compared, the highest kappa coefficient in intraobserver agreement was determined in Universal classification (0.621). Fernandez (0.474), AO (0.309), Frykman (0.305), and Melone classification systems (0.262) followed the Universal system respectively. Kappa statistical results were evaluated using the Landis Koch score system for the assessment of interobserver agreement. According to the Landis Koch score system, the results were insufficient in all classification systems. Fernandez classification system had the highest interobserver agreement (0.235) and Melone classification system had the lowest interobserver agreement (0.056). According to the results of our study, the systems used to classify the displaced distal radial fractures are insufficient. A new classification system that ensures the 3-dimensional assessment of the fracture is more user-friendly and a high inter- and intraobserver agreement is necessary.

Bilateral lunate intraosseous ganglia.

An intraosseous ganglion is a relatively uncommon, benign cystic lesion that occurs in young and middle-aged adults. Bilateral and symmetrical lesions of the wrist are rare. Intraosseous ganglia of the carpal bones are uncommon causes of chronic wrist pain. Isolated cases of intraosseous ganglion have been reported most commonly in the lunate and scaphoid. The lunate was most frequently affected, followed by the capitate, scaphoid, and triquetrum bones. Radiolucent lesions in the carpal bones are not uncommon and are often seen incidentally in asymptomatic patients. The differential diagnosis of a lytic lesion in a carpal bone includes unicameral bone cyst, degenerative cyst, fibrous developmental defect, osteomyelitis, and intraosseous ganglion cyst. This article describes a case of bilateral lunate intraosseous ganglia. A review of the literature revealed that bilateral and symmetrical intraosseous ganglia of the wrist are rare, with only 3 other reported cases of bilateral lunate lesions.

[Knee ochronotic arthropathy and arthroscopic findings]. / Diz okronotik artropatisi ve artroskopik bulgulari.

Ochronotic arthropathy is a rare condition found in patients with alkaptonuria which is a hereditary metabolic disease associated with deposition of homogentisic acid derivatives in the articular cartilage, menisci, ligaments, and connective tissues due to homogentisic acid oxidase deficiency. These pigmentary changes are termed ochronosis. We presented a 50-year-old woman in whom arthroscopic examination of the right knee revealed brown-black discoloration of the articular cartilage and menisci leading to the diagnosis of alkaptonuria by further laboratory examinations.

Morphometrical features of the human malleolar groove.

BACKGROUND: Our aim was to investigate the morphometric features of malleolar groove of the lateral malleolus in humans. METHODS: This study was performed on the malleolar grooves of 93 (80 dry and 13 cadaveric) fibulae. We measured the length of the fibula; length, width, and depth of the malleolar groove; the angle between malleolar groove and the fibular axis. Furthermore, we measured the distances between the distal tip of the fibula and the lateral and medial tubercles of lateral malleolus, and the width of posterior surface of the lateral malleolus. RESULTS: We found the shape of malleolar groove regularly concave in 63 out of 93 (68%) fibulae. The features of the triangular area at the posterior aspect of the lateral malleolus, where the peroneal tendons pass over, may serve as a bed for the peroneal tendons. There was a significant correlation between the depth of the malleolar groove and the distances between the distal tip of the fibula and the medial and lateral tubercles, as well (p<0.05). CONCLUSION: A strong correlation existed between either the shape of the groove or the values of the reference points. CLINICAL RELEVANCE: The shape of the groove may be important in reinforcing the superior peroneal retinaculum (SPR) and other structures restraining the tendons.

Bilateral aplasia of the tibialis anterior and unilateral aplasia of the extensor hallucis longus muscles.

A 35-year-old woman presented with bilateral leg pain on walking that had been present since childhood. Clinical examination showed bilateral absence of the tibialis anterior tendons and the left extensor hallucis longus tendon. Magnetic resonance imaging revealed that signal intensities in the location of the tibialis anterior muscles bilaterally and the left extensor hallucis longus muscle were uniformly high on T1-weighted images, consistent with fat tissue and aplastic muscles: findings not previously reported.

Ischemia-reperfusion injury in rat skeletal muscle is attenuated by zinc aspartate.

BACKGROUND: Oxygen-derived free radical-induced cell injury has been suggested to have a pivotal role in the etiology of ischemia-reperfusion injury. Thus, several lines of evidence indicate that antioxidant agents may be useful therapeutics in this condition. In this regard, the effect of zinc aspartate on ischemia-reperfusion injury was investigated in skeletal muscle. MATERIALS AND METHODS: Tourniquet ischemia-reperfusion injury method was applied to Sprague-Dawley rats. Experimental groups were as follows: 1) sham control, 2) rats received zinc aspartate, 3) rats received hind limb tourniquet operation (left side), and 4) rats received hind limb tourniquet operation and zinc aspartate. Viability of muscle was evaluated by triphenyltetrazolium chloride dye method by using a spectrophotometer. Malondialdehyde, superoxide dismutase, catalase, glutathione, and glutathione peroxidase were measured in muscle, heart, lung, and blood via a spectrophotometer. RESULTS: The viabilities of ischemic limbs, percentage of the contralateral control muscle, in group 1, 2, 3, and 4 were 114 +/- 12%, 87% +/- 5%, 20% +/- 2%, and 95 +/- 10%, respectively. In muscle, increased malondialdehyde and decreased superoxide dismutase, catalase, and glutathione levels in group 3 were normalized by zinc aspartate in both left and right limbs. While malondialdehyde levels in heart and blood increased in group 3, the levels of superoxide dismutase, catalase, glutathione, and glutathione peroxidase were lower in group 3 than those in group 1. All these alterations were prevented by zinc aspartate. Malondialdehyde level of lung in group 3 was significantly higher than group 1 and 2. However, this augmentation was halted by zinc aspartate. The decrease in superoxide dismutase levels in group 3 was statistically reversed by the administration of zinc aspartate. CONCLUSION: Zinc aspartate seems to be an effective treatment option against ischemia-reperfusion injury.

Heel pad thickness and athletic activity in healthy young adults: a sonographic study.

PURPOSE: The aim of this study was to investigate the sonographic changes of heel fat pad thickness and compressibility index in healthy young adults in relation to level of athletic activity. MATERIALS AND METHODS: One hundred ten young adults (55 women and 55 men) with a body mass index between 18.5 and 24.9 were divided into 3 groups according to their athletic activity level: group 1, sedentary (n = 50); group 2, athletic activity <7 hours/week (n = 30); and group 3, athletic activity >or=7 hours/week (n = 30). The loaded heel pad thickness (LHPT) and unloaded heel pad thickness (ULHPT) were measured via sonography, and the heel pad compressibility index (HPCI) was calculated. RESULTS: The mean values of ULHPT, LHPT, and HPCI in group 1 were similar to those of group 2 (p > 0.05) and group 3 (p > 0.05). The mean values of ULHPT, LHPT, and HPCI were similar in the left and right feet in the 3 groups (p > 0.05). There was no correlation between level of athletic activity and ULHPT, LHPT, or HPCI. CONCLUSIONS: The heel pad thickness and HPCI of individuals engaging in athletic activity up to an average of 11 hours/week were similar to those of sedentary individuals.

Comparison of ultrasonography and radiography in assessment of the heel pad compressibility index of patients with plantar heel pain syndrome. Measurement of the fat pad in plantar heel pain syndrome.

AIMS: The shock absorption of the heel fat pad is assessed by heel-pad compressibility index measuring the thickness of the heel pad on the lateral radiographs unloaded and loaded by body-weight. Ultrasonography is an easily applicable method without radiation and magnification inherent in radiographs. There are no reports comparing these measurements by diagnostic ultrasonography and direct radiography in healthy individuals and in different clinical entities. The efficacy of ultrasonography in assessment of heel-pad compressibility index in patients with plantar heel pain syndrome was investigated comparing it with direct radiography. METHODS: The loaded and unloaded heel-pad thicknesses by ultrasonography and direct radiography were measured in 69 feet of 42 patients with plantar heel pain syndrome and their results were compared. RESULTS: In direct radiographs, the mean unloaded heel-pad thickness was 20+/-2 mm and ranged from 14 to 26 mm. Heel-pad compressibility index was 0.62+/-0.09. There was a strong positive correlation between the measurements of the unloaded thickness (r=0.84, P<0.001) and also between the measurements of the loaded thickness (r=0.88, P<0.001) done using ultrasonography and direct radiography. The difference between the results of measurements in two modalities did not exceed +/-1 mm in 50% and +/-2 mm in 81% in unloaded position and +/-1 mm in 62% and +/-2 mm in 82% in loaded position. CONCLUSION: Measuring unloaded and loaded heel pad thickness by ultrasonography is reliable in the adult feet with heel pain. The preference of ultrasonography is reasonable in the studies involving the heel fat pad.

The influence of athletic activity on the plantar fascia in healthy young adults.

PURPOSE: Complaints deriving from the plantar fascia are relatively common in athletes. This study aimed to investigate the changes of thickness of plantar fascia via sonography in healthy young adults with different levels of activity. PATIENTS AND METHODS: One hundred ten adults with normal body mass index were separated into three groups according to activity level: sedentary (group 1, n = 50), athletic activity less than 7 hours per week (group 2, n = 30), and athletic activity 7 or more hours per week (group 3, n = 30). The thicknesses of the plantar fascia at origin and at a point 5 mm distal to origin were measured via sonography. RESULTS: The mean values of the thickness of the proximal plantar fascia (PFp) and the distal plantar fascia (PFd) in group 1 were similar to those of groups 2 and 3 (p > 0.05). The mean values of PFp and PFd were significantly higher in men than in women (p < 0.05). The mean values of PFp and PFd were similar in left and right feet (p > 0.05). There were moderate positive correlations between PFp and weight, height, and body mass index but no correlation between PFp and amount of athletic activity. CONCLUSIONS: The thickness of the plantar fascia at origin did not change with athletic activity at the amateur level.

[Knowledge and attitude of nursing and midwifery college students on developmental dysplasia of the hip]. / Hemsirelik ve ebelik bölümü ögrencilerinde gelisimsel kalça displazisi konusundaki bilgi ve tutumun degerlendirilmesi.

OBJECTIVES: It is of special importance to educate families and health care providers, in particular midwives and nurses who are in close and frequent contact with families, for the prevention and early diagnosis of developmental dysplasia of the hip (DDH). A knowledge and attitude study was conducted concerning DDH among students of Nursing and Midwifery College of Kahramanmaras Sütçü Imam University. METHODS: A structured form was prepared consisting of 28 statements about medical and practical knowledge and traditional attitudes with regard to DDH and was administered to 232 voluntary students before and after an educational session of 60 minutes by a specialist in orthopedics. Prior to the study, the students of grade I and II had not received any theoretical or practical lectures about DDH, which were included in the curriculum of grades III and IV. RESULTS: The knowledge of the students about risk factors and prevention strategies for DDH was of a moderate level. They were not sufficiently furnished with information about traditional attitudes and applications that predispose infants to DDH. The mean test scores before and after training were 51.52+/-13.90 and 87.86+/-5.90, respectively (p=0.000). Compared to grade III and IV students, grade I students performed significantly less in the former test (p=0.00); however, the scores of the latter test did not differ significantly between the grades (p>0.05). CONCLUSION: The curriculum during the license education of midwives and nurses should include essential information on traditional attitudes. With sufficient knowledge and application skills, midwives and nurses may play an important role in the primary and secondary prevention of DDH in our country.