The value of doppler ultrasound in predicting arterial injuries of the penetrating forearm trauma.

OBJECTIVE: The aim of this study was to determine the diagnostic value of Doppler ultrasound (DU) in predicting arterial injuries following the penetrating trauma of the forearm, by comparing preoperative diagnosis made by DU and that made by physical examination (PE) with the intraoperative diagnosis. METHODS: In this retrospective study, 48 patients (44 men, 3 women; mean age = 30 ± 12.5 years) who underwent surgical treatment due to a suspected arterial injury following a penetrating trauma in the forearm from 2016 to 2018 were included. The DU examination was frequently done before an orthopedic examination. In the orthopedic PE, the knowledge as to whether an arterial injury occurred or (if present) which artery was injured was noted. Preoperative diagnoses by PE and DU were first compared with each other, and then with the intraoperative diagnoses. The specificity, sensitivity, negative and positive predictive values were calculated. RESULTS: While the DU findings from 24 patients (50%) matched their intraoperative results, the result from the remaining 24 patients (50%) did not. Nine (18.75%) were considered false-positive and 15 (31.25%) were false-negative. Whereas the PE findings from 30 patients (62.5%) matched their intraoperative results, the remaining 18 patients (37.5%) did not. Six (12.5%) were considered false-positive and 12 (25%) were false- negative. No significant difference was found between the diagnoses of DU and PE, and there was good agreement between the DU and PE findings (P = 0,065, κ = 0,504). While the DU findings were significantly different from the intraoperative findings (P = 0.004), the PE findings were not significantly different from the intraoperative findings (P = 0.302). Sensitivities of DU and PE were both 75% for the diagnosis of radial artery injury as well as 63.3% and 70% for the ulnar artery injury, respectively. Specificities of DU and PE were 83.3% and 91.66% for the diagnosis of radial artery injury as well as 77.77% and 72.22% for the ulnar artery injury, respectively. CONCLUSION: The PE seems more sensitive and useful than the DU in predicting arterial injuries following the penetrating trauma of the forearm. LEVEL OF EVIDENCE: Level IV.

The Effect of Phospholipids (Surfactant) on Adhesion and Biomechanical Properties of Tendon: A Rat Achilles Tendon Repair Model.

Adhesion of the tendon is a major challenge for the orthopedic surgeon during tendon repair. Manipulation of biological environment is one of the concepts to prevent adhesion. Lots of biochemicals have been studied for this purpose. We aimed to determine the effect of phospholipids on adhesion and biomechanical properties of tendon in an animal tendon repair model. Seventy-two Wistar rats were divided into 4 groups. Achilles tendons of rats were cut and repaired. Phospholipids were applied at two different dosages. Tendon adhesion was determined histopathologically and biomechanical test was performed. At macroscopic evaluation of adhesion, there are statistically significant differences between multiple-dose phospholipid injection group and Control group and also hyaluronic acid group and Control group (p < 0.008). At microscopic evaluation of adhesion, there was no statistically significant difference (p > 0.008). Ultimate strength was highest at hyaluronic acid injection group and lowest at multiple-dose phospholipid injection group. Single-dose phospholipids (surfactant) application may have a beneficial effect on the tendon adhesion. Although multiple applications of phospholipids seem the most effective regime to reduce the tendon adhesion among groups, it deteriorated the biomechanical properties of tendon.

Effect of joint motion on safety of portals in posterior ankle arthroscopy.

PURPOSE: The purpose of this study was to determine the anatomic relation of the neural structures posteriorly crossing the ankle by use of classical ankle arthroscopy posterior portals and hindfoot endoscopy portals. The effect of ankle and hindfoot motions on portal-nerve distance was also determined. METHODS: This study included 20 feet and ankles in 20 adult volunteers who had no complaints regarding their ankle joints. To obtain 6 fixed positions of the ankle and hindfoot (neutral-neutral, neutral-varus, neutral-valgus, dorsiflexion-neutral, dorsiflexion-varus, and dorsiflexion-valgus) during magnetic resonance imaging examination, feet were positioned in a polycaprolactone splint that was shaped before examination. Magnetic resonance imaging examinations were performed at all 6 positions, and the shortest distance between the sural and posterior tibial nerves to the portals was measured at 2 different levels. RESULTS: The mean distance between the posterior tibial nerve and the posteromedial portal was 16.5 +/- 5.6 mm and that between the sural nerve and the posterolateral portal was 13.1 +/- 3 mm at the hindfoot portal level. At the level of the posterior ankle arthroscopy portal, the mean distance from the posterior tibial nerve to the posteromedial portal line was 13.3 +/- 4.6 mm and that from the sural nerve to the posterolateral portal line was 9.7 +/- 2.9 mm. The differences in distances were statistically significant (P < .001) according to the paired t test. We determined that the sural nerve approached the posterolateral portal in the dorsiflexion-varus (P = .026), dorsiflexion-valgus (P = .014), dorsiflexion-neutral (P < .001), and neutral-varus (P = .035) positions, and all differences were statistically significant. CONCLUSIONS: We found that the posterior medial and lateral portals created at the level of the tip of the fibula as described by van Dijk et al. while the foot was in a neutral-neutral position provided the greatest margin of safety. We found no advantage of placing the ankle and hindfoot in different positions to avoid neurologic complications. CLINICAL RELEVANCE: These findings suggest that neurovascular structures draw away from the posterior portals of ankle arthroscopy distally; by lowering the level of portals toward the tip of the fibula and positioning the foot at neutral, arthroscopic surgeons will decrease the risk of iatrogenic lesions.

A different treatment modality for trochanteric fractures of the femur in surgical high-risk patients: a clinical study of 44 patients with 21-month follow-up.

INTRODUCTION: To assess the effectiveness of a modular axial fixator as an alternative method in surgically high-risk patients with trochanteric fractures of the femur. MATERIALS AND METHODS: In a prospective, uncontrolled clinical study, 44 high-risk patients (ASA grade 3 or 4) with trochanteric femoral fractures were treated by a modular axial fixator. They were prospectively followed up for 21 months (range 14-30 months) and evaluated using Foster's criteria. RESULTS: All of the fractures healed, and mean time to union was 10.9 weeks. Three types of complications were noticed. These were infections, varus alignment and shortening. Results were anatomically excellent in 35 patients, good in 9, and functionally excellent in 36, good in 8. CONCLUSION: The modular axial fixator is a reliable alternative for treating frail patients with trochanteric fractures of the femur.

[Treatment of intertrochanteric femoral fractures with the use of a modular axial fixator device]. / Intertrokanterik femur kiriklarinin modüler aksiyel fiksatör ile tedavisi.

OBJECTIVES: Intertrochanteric femoral fractures are usually encountered in the elderly, leading to morbidity and even mortality due to age-related systemic complications. In this study, we evaluated the use of a modular axial fixator device in the treatment of intertrochanteric femoral fractures. METHODS: Intertrochanteric femoral fractures of 25 patients (18 females, 7 males; mean age 70 years; range 18 to 91 years) were treated by the use of a modular axial fixator. The fractures were classified according to the Boyd-Griffin classification. Surgery was performed after a mean of 5.76 days following trauma. The patients were allowed to walk using crutches on the second postoperative day and a single crutch after sufficient callus formation was radiologically determined. Final evaluations were made by the Foster's classification. The mean follow-up was 12 months (range 6 to 24 months). RESULTS: The mean operation duration was 34 minutes. Union was achieved in all patients after a mean of 12.3 weeks (range 9 to 18 weeks). Three patients (12%) developed varus deformity of 3, 5, and 9 degrees, respectively. Shortening in a range of 1 cm to 1.5 cm was detected in three patients (12%). Postoperatively, 10 patients developed pin tract infections, none of which required revision or removal of the fixator. Final evaluations yielded excellent and good anatomical results in 72% and 28%, and functional results in 80% and 20%, respectively. CONCLUSION: Reducing both the operation time and the immobilization period is of vital importance particularly in elderly patients with intertrochanteric femoral fractures. Due to its short length, the modular axial fixator offers significant advantages including higher tolerability, rapid weight bearing allowance, and achievement of union without seriously complicating events.