The load transfer effect of monopolar and bipolar radial head prosthesis designs on capitellar cartilage: A comparative biomechanical cadaver study.

OBJECTIVE: The aim of this study was to determine whether bipolar radial head arthroplasty may transfer less load to the capitellum than monopolar radial head arthroplasty and native radial heads. METHODS: Six human elbow joints were obtained from six fresh frozen cadavers (3 males, 3 females; mean age = 78 years, age range = 66-80). None of the elbow joints had a previous osseous injury, a chondral defect, osteoarthritis, or instability. In group 1, load transfer of the native radial head was measured in each specimen under 100 N of compression force using a custom-made load cell at 0°, 30°, 60°, 90°, and 120° flexion of the elbow in supination, neutral rotation, and pronation, respectively. After excision of the radial heads, the same testing protocol was first applied for monopolar radial head arthroplasty (Group 2) and then for bipolar radial head arthroplasty (Group 3). RESULTS: The mean load transfer on the capitellum was significantly higher in each forearm rotation and all angles of the elbow flexion in the arthroplasty groups than the native radial head group. Mean load transfer values of bipolar prostheses were between the values of native radial heads and monopolar prostheses in all positions. Bipolar prostheses showed similar load transfer characteristics compared to those of the native radial head in supination at 60° flexion; in neutral rotation at 0°, 30°, 60°, and 120° flexion; and in pronation at 90° and 120° flexion. CONCLUSION: The results of this study have revealed that bipolar radial head arthroplasty transfers similar loading as the native radial head on the capitellum in certain forearm positions and at elbow flexion angles. No significant differences could be found between load transfer values of bipolar head design and monopolar head design except in the pronation at full extension.

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.

Coupled nonparametric shape and moment-based intershape pose priors for multiple basal ganglia structure segmentation.

This paper presents a new active contour-based, statistical method for simultaneous volumetric segmentation of multiple subcortical structures in the brain. In biological tissues, such as the human brain, neighboring structures exhibit co-dependencies which can aid in segmentation, if properly analyzed and modeled. Motivated by this observation, we formulate the segmentation problem as a maximum a posteriori estimation problem, in which we incorporate statistical prior models on the shapes and intershape (relative) poses of the structures of interest. This provides a principled mechanism to bring high level information about the shapes and the relationships of anatomical structures into the segmentation problem. For learning the prior densities we use a nonparametric multivariate kernel density estimation framework. We combine these priors with data in a variational framework and develop an active contour-based iterative segmentation algorithm. We test our method on the problem of volumetric segmentation of basal ganglia structures in magnetic resonance images. We present a set of 2-D and 3-D experiments as well as a quantitative performance analysis. In addition, we perform a comparison to several existent segmentation methods and demonstrate the improvements provided by our approach in terms of segmentation accuracy.

MRI T2 Hypointensities in basal ganglia of premanifest Huntington's disease.

Increased iron levels have been demonstrated in the basal ganglia of manifest Huntington's disease (HD). An excess in iron accumulation correlates with MRI T2-weighted hypointensity. Determination of the amount of hypointensities in the basal ganglia in the premanifest phase of HD may give more insight in the role of iron in the pathogenesis of HD. Therefore, the present study assessed whether the degree of hypointensities on T2-w MRI in the basal ganglia of premanifest gene carriers differs from non-carriers. Seventeen HD gene carriers without clinical motor signs and 15 non-carriers underwent clinical evaluation and MRI scanning. The amount of T2-w hypointensities was determined using a computer-assisted quantitative method that classified each pixel in the basal ganglia as hypointense or not, resulting in a total of hypointense pixels for each individual. Carriers showed an increased amount of hypointensities in the basal ganglia compared to non-carriers. More hypointensities were furthermore associated with a higher UHDRS total motor score, a longer CAG repeat length and a greater probability of developing symptoms within 5 years. We concluded that the increased amount of hypointensities in the basal ganglia of premanifest carriers of the HD gene may reflect excessive iron deposition and a role for iron in the neuropathology of HD. Furthermore, this phenomenon is associated with clinical and biological disease characteristics. An increased amount of hypointensities on T2-w MRI in the basal ganglia may be considered a biomarker for HD.

Local structure-based region-of-interest retrieval in brain MR images.

The aging population and the growing amount of medical data have increased the need for automated tools in the neurology departments. Although the researchers have been developing computerized methods to help the medical expert, these efforts have primarily emphasized to improve the effectiveness in single patient data, such as computing a brain lesion size. However, patient-to-patient comparison that should help improve diagnosis and therapy has not received much attention. To this effect, this paper introduces a fast and robust region-of-interest retrieval method for brain MR images. We make the following various contributions to the domains of brain MR image analysis, and search and retrieval system: 1) we show the potential and robustness of local structure information in the search and retrieval of brain MR images; 2) we provide analysis of two complementary features, local binary patterns (LBPs) and Kanade-Lucas-Tomasi feature points, and their comparison with a baseline method; 3) we show that incorporating spatial context in the features substantially improves accuracy; and 4) we automatically extract dominant LBPs and demonstrate their effectiveness relative to the conventional LBP approach. Comprehensive experiments on real and simulated datasets revealed that dominant LBPs with spatial context is robust to geometric deformations and intensity variations, and have high accuracy and speed even in pathological cases. The proposed method can not only aid the medical expert in disease diagnosis, or be used in scout (localizer) scans for optimization of acquisition parameters, but also supports low-power handheld devices.

Robustness of local binary patterns in brain MR image analysis.

The aging population in developed countries has shifted considerable research attention to diseases related to age. Because age is one of the highest risk factors for neurodegenerative diseases, the need for automated brain image analysis has significantly increased. Magnetic Resonance Imaging (MRI) is a commonly used modality to image brain. MRI provides high tissue contrast; hence, the existing brain image analysis methods have often preferred the intensity information to others, such as texture. Recently, an easy-to-compute texture descriptor, Local Binary Pattern (LBP), has shown promise in various applications outside the medical field. In this paper, after extensive experiments, we show that rotation-invariant LBP is invariant to some common MRI artifacts that makes it possible to use it in various high-level brain MR image analysis applications.

Medial transposition of the radial nerve for anterolateral plate fixation of the humerus: cadaveric study.

In the operative treatment of humeral shaft fractures the radial nerve may be injured during the reduction of fracture fragments or the application of plate and screws. Also, secondary surgical explorations due to delayed or non-union carry a high risk of radial nerve injury because of the scarring of the neighboring tissue and proximity of the nerve to the implants. Consequently, the need for the transposition of the radial nerve to a safer position arises. A total of 22 (11 right, 11 left) cadaveric upper extremities were studied to evaluate the medial transposition of the radial nerve during the open reduction and anterolateral plate fixation of humeral fractures. The radial nerve was transposed medially in a distal plate fixated humeral fracture model. Distance measurements of the radial nerve and the division points of its branches were carried out in the transposed position and in the original course of the nerve. There was no statistically significant difference between the original course and medially transposed measurements. The distances from the reference point to the division points of other branches (posterior antebrachial cutaneous nerve, motor branch to brachioradialis, most distal motor branch to triceps) were not altered. The mean length of the radial nerve was 185.2 +/- 14.3 mm in its original course and 183.7 +/- 13.8 mm in the medially transposed course. In conclusion, the present study shows that medial transposition of the radial nerve through the fracture line does not increase the nerve's length and may be utilized in cases in which anterolateral plate fixation is indicated.

A new method for estimating arterial occlusion pressure in optimizing pneumatic tourniquet inflation pressure.

To reduce pressure-related injuries resulting from pneumatic tourniquet use, the lowest possible inflation pressure is recommended. Arterial occlusion pressure (AOP) is a measure of the cuff pressure required to maintain a bloodless surgical field. However, its determination method is time consuming, requires operator skill, and is therefore seldom used in current practice. An AOP estimation can be made by knowing the pressure transmitted to the underlying soft tissues. We measured upper and lower extremity tissue pressures under the tourniquet cuff at 100, 200, and 300 mm Hg of tourniquet inflation pressures in 30 anesthetized living adult patients. All patients received general anesthesia with neuromuscular relaxation. A Stryker intra-compartmental pressure monitor was used to measure tissue pressures under the tourniquet cuff. In all patients, the soft tissue pressures were consistently lower than the applied tourniquet inflation pressures. Our results revealed tissue padding coefficients for extremities 20 to 75 cm in circumferences. An estimation method of AOP was developed [AOP = (systolic blood pressure + 10)/Tissue padding coefficient]. The new AOP estimation method may be a simple, rapid, and clinically practical alternative to the AOP determination method.

[Anatomy, biomechanics, and pathophysiology of instability of the glenohumeral joint]. / Glenohumeral eklem instabilitesinin anatomik, biyomekanik ve patofizyolojik özellikleri.

The stability of the shoulder is dependent on both static and dynamic anatomic restraints. In most cases, there must be insufficiency of more than one restraint for the shoulder joint to become instable. Although the role of these restraints is largely known in maintaining shoulder stability, our information on their interactions is insufficient. This article reviews the anatomy and biomechanics of the shoulder and conditions causing instability of the glenohumeral joint.

[Shoulder instability: classification and methods of clinical examination]. / Omuz instabilitesinin siniflandirilmasi ve klinik muayene yöntemleri.

The shoulder is a complex joint whose stability relies on both dynamic and static factors. Dysfunction of one of these components gives rise to shoulder problems. Diagnosis of shoulder instability depends on a detailed history and appropriate physical examination. Despite the presence of many tests, none has proved to be purely diagnostic for shoulder instability. Therefore, these tests should be regarded as a part of the diagnostic procedure rather than a referral to diagnosis itself. Tests performed to assess laxity and instability are different in nature; thus, positive laxity tests do not necessarily show instability unless supported by further evidence. The reliability of the tests for superior labrum anterior-posterior lesions has not been adequately validated by clinical studies and few anatomical studies have examined the effect of these tests on the superior labral complex.

[Open surgical treatment of recurrent anterior instability of the shoulder]. / Tekrarlayan anterior omuz instabilitesinin açik cerrahi tedavisi.

Recurrent anterior gleonohumeral instability is the most frequent joint instability of the body. Because of the complex stability mechanisms and diverse instability patterns of the glenohumeral joint, most cases present with more than one anatomic cause. Thus, the treatment of recurrent anterior instability of the shoulder should be designed to treat these pathologies. Although arthroscopic repair has outweighed the use of open surgical methods especially for the first dislocations, recurrent dislocations still require open repair techniques to overcome capsular laxity accompanying a Bankart lesion.

[Multidirectional shoulder instability and open surgical procedures]. / Cokyönlü omuz instabilitesinde açik cerrahi girisim.

The principles and procedures for multidirectional instability do not substantially differ from those for anterior instability. Correct diagnosis is difficult, but it is important for a successful treatment. Conservative treatment should be attempted before surgery. Open surgical treatment using the inferior capsular shift procedure is the gold standard. It can be carried out either anteriorly or posteriorly. We prefer a laterally-based capsular shift because it facilitates capsular plication.

Controlled hypotension and minimal inflation pressure: a new approach for pneumatic tourniquet application in upper limb surgery.

UNLABELLED: Minimal inflation pressures are recommended for limb surgery to eliminate complications attributable to high inflation pressures with the pneumatic tourniquets. We applied controlled hypotension and a minimal inflation pressure (CHAMIP) technique to provide a bloodless surgical field. Thirty-six patients scheduled for upper extremity surgery were randomized equally to receive either normotensive anesthesia and conventional inflation pressures or controlled hypotension (systolic arterial blood pressure of 80-100 mm Hg and mean arterial blood pressure >60 mm Hg) and minimum inflation pressures. Anesthesia was induced with propofol IV bolus and remifentanil IV continuous infusion and maintained with propofol and remifentanil IV continuous infusion. To determine the minimal inflation pressure, the digital plethysmograph was applied to the second finger at the side of the operation and the tourniquet was inflated slowly until the arterial pulsations disappeared on the oscilloscope. A bloodless surgical field was obtained in almost all patients, even though systolic arterial blood pressures (100-138 mm Hg versus 80-100 mm Hg) and applied tourniquet inflation pressures (270 mm Hg versus 110-140 mm Hg) were significantly lower in the hypotensive group. No complications associated with controlled hypotension were encountered. In conclusion, CHAMIP may be a safe and reliable method for upper extremity surgery performed with pneumatic tourniquets. IMPLICATIONS: Pneumatic tourniquets are associated with adverse effects resulting from high inflation pressures. Therefore, minimal inflation pressures are recommended in extremity surgery. To reach real minimal inflation pressure the patient's blood pressure must be reduced. We used controlled hypotension with remifentanil and propofol to reach minimal inflation pressures.

[Massive rotator cuff tears: diagnosis and treatment techniques]. / Masif rotator manset yirtiklarinin tani ve tedavi yöntemleri.

The treatment of massive rotator cuff tears presents challenging difficulties. Re-rupture after treatment may be frequently seen, along with it muscular degeneration, leading to insufficient clinical results. There is still controversy as to whether conservative or surgical treatment methods will be more appropriate for massive and partial tears. This article aimed to provide an update on the diagnosis and treatment of massive rotator cuff tears.

Automatic soccer video analysis and summarization.

We propose a fully automatic and computationally efficient framework for analysis and summarization of soccer videos using cinematic and object-based features. The proposed framework includes some novel low-level processing algorithms, such as dominant color region detection, robust shot boundary detection, and shot classification, as well as some higher-level algorithms for goal detection, referee detection, and penalty-box detection. The system can output three types of summaries: i) all slow-motion segments in a game; ii) all goals in a game; iii) slow-motion segments classified according to object-based features. The first two types of summaries are based on cinematic features only for speedy processing, while the summaries of the last type contain higher-level semantics. The proposed framework is efficient, effective, and robust. It is efficient in the sense that there is no need to compute object-based features when cinematic features are sufficient for the detection of certain events, e.g., goals in soccer. It is effective in the sense that the framework can also employ object-based features when needed to increase accuracy (at the expense of more computation). The efficiency, effectiveness, and robustness of the proposed framework are demonstrated over a large data set, consisting of more than 13 hours of soccer video, captured in different countries and under different conditions.

Temporal segmentation of video objects for hierarchical object-based motion description.

This paper describes a hierarchical approach for object-based motion description of video in terms of object motions and object-to-object interactions. We present a temporal hierarchy for object motion description, which consists of low-level elementary motion units (EMU) and high-level action units (AU). Likewise, object-to-object interactions are decomposed into a hierarchy of low-level elementary reaction units (ERU) and high-level interaction units (IU). We then propose an algorithm for temporal segmentation of video objects into EMUs, whose dominant motion can be described by a single representative parametric model. The algorithm also computes a representative (dominant) affine model for each EMU. We also provide algorithms for identification of ERUs and for classification of the type of ERUs. Experimental results demonstrate that segmenting the life-span of video objects into EMUS and ERUs facilitates the generation of high-level visual summaries for fast browsing and navigation. At present, the formation of high-level action and interaction units is done interactively. We also provide a set of query-by-example results for low-level EMU retrieval from a database based on similarity of the representative dominant affine models.