Does rotational deformity cause poor outcomes after pediatric supracondylar humerus fractures?

BACKGROUND: We aimed to show the effect of rotational deformity on the development of cubitus varus deformity (CVD) com-plication after supracondylar humerus fracture surgery. METHODS: Patients with Gartland type II, and more severe fractures treated with Closed reduction and percutaneous pinning alone were included in the study. Rotational deformity was assessed with the formula described by Henderson et al. Patients with rotational deformity >10° were included in Group 1, and patients with deformity <10° in Group 2. In terms of CVD development, patients were evaluated with the Baumann angle measurements made on the carrying angle and final follow-up radiographs. Patients who developed CVD were divided into two groups: Group A included patients who developed CVD and Group B included patients who did not develop CVD. The cosmetic and functional results were evaluated using Flynn criteria. RESULTS: Eighty-eight patients who met the inclusion criteria were enrolled in the study, 32 were female and 56 were male. The mean age at the time of surgery was 6.0±2.8 years and the mean follow-up time was 5.1±2.5 years. Based on measurements, Group 1 had 13 patients and Group 2 had 75 patients. Only four of the 88 had developed CVD. Three of these patients had a rotational deformity of ≥20°. The mean age of patients in group A was 2.1 years and the mean carrying angle was 5.7°±1.5° varus (P<0.001). According to the Flynn cosmetic criteria, Group A and Group 1 had significantly worse outcomes (P<0.001). CONCLUSION: In conclusion, fixation of the distal fragment in rotation may be associated with CVD and intraoperative assessment is of great value to avoid long-term deformity and cosmetic degradation.

Arthroscopic Treatment of Femoral Condyle Chondral Lesions: Microfracture Versus Liquid Bioscaffold.

Purpose: This study aims to compare the microfracture (MF) technique with the bioscaffold solution application (BST-CarGel) in treating femoral chondral lesions. Methods: Thirty-eight patients ages 18-45 with isolated single femoral condyle full-thickness (ICRS grade 3-4) chondral lesions were included in the study. Patients were divided into two groups as MF applied (Group I = 21) and bioscaffold combined with MF (Group II = 17). The visual analog scale (VAS), Western-Ontario, and McMaster Osteoarthritis Index (WOMAC) were used in clinical evaluation. The location, size, and depth of lesions were evaluated with preoperative magnetic resonance imaging (MRI). Magnetic resonance observation of cartilage repair tissue (MOCART) score was used for postoperative evaluation. Results: The mean age was 32.5 (range 19-44) years. Mean follow-up was 14.9 months (range 12-24). Lesion size was 3 cm2 in group I and 2.9 cm2 in group II. There were no differences between groups regarding demographic characteristics but BMI (Body Mass Index) was lower in group II which was significant. The duration of surgery was longer in group II (p < 0.001). Postoperative statistical significant improvements were found in WOMAC and VAS scores in groups, but there was no statistical difference. Although there was no significant radiological difference in the group II according to the MOCART score, higher scores were obtained compared to group I. Conclusion: No difference was found, clinical and radiological, in terms of short-term outcomes. MF is a method to be applied as a primary treatment with its cost-effective, simple and short surgery technique, and effective clinical results up to 4 cm2. Level of Evidence: Level III: retrospective comparative study.

Reliability of Fossae Lumbales Laterales and Pelvic Incidence for Estimating Transsacral Corridors Assessed Using Reconstruction Computed Tomography.

Background: The present study aimed to evaluate the effect of fossae lumbales laterales and pelvic incidence (PI) on transsacral corridors. Methods: Patients who underwent pelvic computed tomography (CT) during routine therapy in a single center between 2015 and 2020 were retrospectively reviewed. The patients' age and sex were documented during CT examination. Measurements were performed for both the upper and second sacral segments. Height and weight of the patients were determined using appropriate tools and body mass index (BMI) was calculated. Transsacral corridors were identified in true coronal and true sagittal planes and their width was determined as the maximum gap measured so that no screws could come out of the transacral corridors. PI was measured. Results: Our study included 244 (57%) male and 184 (43%) female patients, who had a mean age of 49.3 ± 14.15 years (range, 18-89 years) and a mean BMI of 26.57 ± 2.38 kg/m2. No statistically significant correlation was found between the detection of the dimple sign in physical examination and the presence of an adequate corridor. The PI was statistically significantly higher in the patients with dimples (p < 0.001). PI of the female patients was higher than that of the male patients (p = 0.026). The correlation between PI and the existence of adequate corridors for S1 and S2 screws was not statistically significant (p = 0.858 and p = 0.129, respectively). On the relationship between the presence of adequate S1 and S2 corridors where transsacral screws could be sent, an inverse relationship was detected: if the S1 transsacral corridor was adequate, the S2 corridor was inadequate or vice versa. Conclusions: We could not obtain meaningful results on the use of the dimples of Venus or PI instead of CT to evaluate the adequacy of transverse corridors. Nevertheless, we confirmed that an increased PI was associated with the presence of dimples of Venus.

Can C-reactive protein-based biomarkers be used as predictive of 30-day mortality in elderly hip fractures?A retrospective study.

BACKGROUND: C-reactive protein-to-lymphocyte ratio (CLR), C-reactive protein/albumin (CRP/ALB), and CRP are prognostic factors for outcome and survival in oncology and digestive surgery. CLR has not been studied for the prediction of mortality in hip fracture. The aim of this study is to investigate whether there is an association between pre-operative CLR, CRP/ALB, and CRP levels in patients with hip fracture and patient survival. METHODS: The medical reports of the patients who underwent surgery with a diagnosis of hip fracture in our hospital between January 2016 and December 2019 were retrospectively reviewed. The patients were divided into two groups (Group E: Those who died within 1 month and Group S: Those who died after the 1st month or those who survived). A total of 19 parameters, namely, included ' blood parameters including hemoglobin, C-reactive protein, albumin, lymphocytes, neutrophils, monocytes, platelets, PLR, NLR, LMR, CLR CRP/ALB ratios, gender, American Society of Anesthesiologists, Charlson Comorbidity Index, delirium, infections, repeated surgeries, and type of anesthesia were evaluated preoperatively and on the post-operative 2nd and 5th days and 1 month. RESULTS: A total of 165 patients with the mean age of 83.09±8.52 years who met the inclusion criteria were studied. The pre-op-erative means of CRP, neutrophil count, CLR ratio, and CRP/ALB ratio were statistically significantly higher in Group E than in Group S (p=0.016, p=0.023, p=0.035, and p=0.044, respectively). The univariate regression analysis showed that age, pre-operative Hb level, CRP, and CRP/ALB ratio were significant predictors of the 1-month mortality (ß=-0.335, p=0.049; ß=0.411, p=0.028; ß=3.632, p=0.007; and ß=-3.280, p=0.008; respectively). When we performed the ROC curve analysis, the CRP/ALB ratio had the highest AUC, with the highest sensitivity and specificity. The cutoff value of CRP/ALB ratio was found to be 12.42. CONCLUSION: We found that the pre-operative CRP/ALB ratio is an important parameter for predicting the first 30-day mortality in elderly patients with intertrochanteric femur fractures. For this reason, we recommend that CRP and albumin be checked in prepa-ration for routine pre-operative anesthesia.

Long-term results of the subtubercle tibial osteotomy using the circular external fixator for medi̇al compartment osteoarthri̇ti̇s of knee.

BACKGROUND: We evaluated the long-term clinical and radiographic outcomes of patients who underwent subtubercular tibial osteotomy (STO) with Ilizarov external fixation used for high tibial osteotomy for medial knee osteoarthritis (MKOA). METHODS: Between October 2003 and December 2011, 42 knees of 40 patients who had undergone STO with Ilizarov external fixator with a diagnosis of MKOA were evaluated. Survival analysis was performed by examining the duration of total knee arthroplasty (TKA). Clinical and radiological variables were collected at the time of admission after removal of the fixator and at outpatient follow up. RESULTS: Mean age was 49.3 ± 5.68 (range 37-61) years, mean postoperative follow up time was 14.22 ± 2.93 (range 9-18) years, and mean fixator duration was 14.6 (range 13-20) weeks. Survival analysis showed 100% at 5 years, 95.2% at 10 years and 88.1% at 15 years. Clinical examination of the patients showed significant improvement in American Knee Society score (KSS), KSS functional score and Oxford Knee Score (OKS) score (P = 0.005). In the study, it was observed that the patients' knee osteoarthritis had progressed over time. On examination, radiographic measurements including mechanical axis deviation, medial proximal tibial angle, femorotibial angle, and joint line alignment angle improved significantly after deformity correction (P = 0.001). CONCLUSION: STO using the Ilizarov method offers long-term survival. It provides effective treatment in young patients with isolated MKOA. Achieving the desired amount of correction in the coronal and sagittal planes can be presented as a surgical technique for the treatment of MKOA as an effective method in clinical and radiological correction.

Novice Surgeon Portal Preference to Visualize the Femoral Anterior Cruciate Ligament Footprint: The Accessory Medial Portal Offers Improved Visualization.

PURPOSE: To evaluate participant opinions on the appropriateness of different viewing angles by asking 8 questions, using visual content techniques. METHODS: Survey information from participants was used in this study. We used images of a patient who was operated on for symptomatic knee instability. Participants were asked whether the visual angle could determine the femoral tunnel entry point or evaluate anterior cruciate ligament (ACL) integrity. RESULTS: Questionnaires were completed by 40 participants. When all responses were evaluated, participant opinions on the accessory medial portal (AMP) were more positive than opinions on images taken from the anterolateral portal (ALP). These observations were statistically significant (P < .005). Both ACL integrity assessments and femoral tunnel entry site questions were evaluated, we observed that participant opinions on the AMP for both types of evaluation were more positive than opinions on the ALP. This observation was statistically significant (P < .005). When evaluations with photos and video transcripts were compared, no significant differences in terms of participant opinions were observed (P < .005). CONCLUSIONS: AMP use may be a valuable tool for assistant and postgraduate education, as it offers a more suitable view angle for ACL reconstruction. LEVEL OF EVIDENCE: Level V, survey study.

The Safety and Efficacy of Using Drainage in Arthroscopic Rotator Cuff Repair.

PURPOSE: This study aimed to evaluate the effects of not using a drain or placing a drain in the glenohumeral (GH) or subacromial (SA) joint spaces on fluid retention and pain in the early postoperative period and late clinical outcomes. METHODS: Patients who underwent arthroscopic rotator cuff repair between 2018 and 2020 were included in the study. Before the operation, demographic data, range of motion (ROM), visual analog scale (VAS) scores, Constant-Murley scores has documented. Deltoid muscle diameter (DMD) were measured. The total amount of irrigation used during the surgery and the operation duration were recorded, and the active amount of fluid coming from the drain in patients with a drain was recorded. The first postoperative DMD measure was made in the operating room and accepted as day 0. DMD measurements repeated postoperative first and second day. VAS assessments were performed on the postoperative first and second days. At the outpatient clinic, these measurements were repeated on the first and second weeks after discharge. Functional evaluations were made with ROM and Constant-Murley scores at the final follow-up examination. RESULTS: There was no difference in the amount of drainage between the two groups in which a drain was used. When the three groups were compared among themselves regarding preoperative and postoperative VAS scores, Constant-Murley scores, and DMD, no significant difference was found. CONCLUSIONS: We do not recommend the routine use of drains after arthroscopic rotator cuff surgery in terms of cost-effectiveness. LEVEL OF EVIDENCE: Level II: Prospective Cohort Study.

A Practical Method for Obtaining True Lateral Elbow X-rays in a Paediatric Age Group: Lateral Elbow X-ray in the Standing Salute Position.

INTRODUCTION: Paediatric elbow fractures constitute 10% of all paediatric fractures. Radiological interpretation of the immature elbow is difficult due to its cartilaginous structure. We aimed to describe an X-ray technique in paediatric patients to obtain true lateral elbow X-rays and to prevent the repeat X-ray shots. MATERIALS AND METHODS: Radiographs of 39 children, with a mean age of 48.17 months (range; 7-84 months), with elbow trauma were included. All elbow lateral radiographs were taken in the 90º flexion position. In the first group, radiographs were taken using the standard technique(lateral radiographs in shoulder internal rotation). In the second group, lateral radiographs of the elbow were taken while the patient was standing and the forearm was elevated passively with 90° shoulder abduction and 90° elbow flexion (standing salute position). Three criteria were examined from the graphs to determine the true lateral elbow graphy. RESULTS: In group 1 (n = 20) and group 2 (n = 19), lateral elbow radiographs were evaluated. No statistically significant differences were found between the groups, in terms of mean age and distal humeral fractures. In group 2; the presence of humeroulnar joint space, partial coronoid superposition of the radius head and presence of the hourglass formation were significantly higher. DISCUSSION: It is clear that radiographs taken in appropriate positions decreases diagnostic errors. In our study, the ratio of correct lateral radiographs was significantly higher in the radiograph group in the standing salute position, suggesting this method was safe for accurate lateral radiographs, in accordance with our hypothesis.

Knotless anchors offer better prevention of meniscal excursion than knotted anchors: An experimental study of the bovine knee.

OBJECTIVE: Due to the biomechanical importance of the meniscal root ligament, several surgical techniques have been defined in order to treat meniscal root tear. Different application techniques have different levels of difficulty. We aimed to find a stronger and simpler repair technique. METHODS: Sixteen bovine knee joints were prepared. The posterior root of the medial meniscus was dissected and repaired with one of two different techniques. The knees in group 1 ("knotted group") were repaired with the knotted suture anchor technique, and the knees in group 2 ("knotless group") were repaired using the knotless suture anchor technique. The strength of the repairs was tested biomechanically. RESULTS: Cyclic loading tests were done. On the 0-20 N one-cycle test, the knotted anchor group's equivalent stiffness average was 5.28 N/mm, and the knotless anchor group's equivalent stiffness average was 5.48 N/mm. The 5-20 N two-cycle test results were 8.29 N/mm for the knotted group and 8.66 N/mm for the knotless group. On the 5-20 N 100-cycle test, the equivalent stiffness averages were 8.59 N/mm for the knotted group and 10.18 N/mm for the knotless group. Elongation was 5.83 mm for the knotted group and 4.86 mm for the knotless group. After performing load-to-failure tests, the failure forces were recorded as 237.83 N for the knotted group and 204.90 N for the knotless group. The failure test elongation values were 26.83 mm for the knotted group and 18.70 mm for the knotless group. The failure energies were 3.87 J for the knotted group and 1.83 J for the knotless group. Except for elongation until failure (p=0.009), there were no significant differences between the two groups tested (p>0.05). The average elongation was significantly less in group 2, showing that the knotless anchor had an advantage, with less meniscal excursion compared to the sutured anchor. CONCLUSION: Knotless anchors have a mechanical advantage over knotted anchors for preventing meniscal excursion. When thought together with technical simplicity during arthroscopic surgery, knotless anchors could be used safely for the fixation of the meniscal root ligament.

"Horizontal butterfly" technique in repair of radial meniscus tears: A biomechanical study.

INTRODUCTION: Radial meniscus tears are seen in young patients, especially with anterior cruciate ligament ruptures. Repair of complete radial meniscus tear is necessary for the meniscus functions. The most important factor for success of the meniscus repair is primary stability, but it is still unknown which technique is ideal repair technique. AIM: We developed a new suture technique named Horizontal Butterfly (HB). In this novel technique the contact between meniscal tissue and suture is more than Horizontal Loop (HL) that routinely used today. So, we think that this technique will provide better fixation than HL. We aimed to compare 2 repair techniques (HB vs. HL) using human lateral menisci biomechanically with cyclic loading and load to failure tests. MATERIAL-METHOD: We used 22 intact lateral meniscus obtained from patients that operated (total knee replacement) for varus gonarthrosis in our clinic. All menisci were cut radially. In the first group (n:11) menisci were repaired with standard horizontal loop technique, and in the second group (n:11) horizontal butterfly technique were used for repair. All specimens were tested with load to failure test after cyclic loading test (500 cycle X 5-30 N). RESULTS: Both groups have similar failure load (71,4 ± 17,52 N vs. 77,9 ± 28,49 N; p:0,559) and stiffness (24,46 ± 19,19 N vs. 24,48 ± 15,87 N; p:0,818). HB group has less peak displacement (6,26 ± 1,24 mm vs. 8,4 ± 1,92 mm; p:0,010). CONCLUSION: This novel repair technique decreases the amount of displacement according to standard technique while as strong as standard technique routinely used. In this way; we believe that it will increase the rate of healing in clinical use.