What Would be the Difference Between Operative Treatment of Patients with Tibia Fractures out of Working Hours; Intramedullary Nailing for Tibial Shaft Fractures.

Objectives: Performing orthopedic surgery in and out of working hours may affect the success of the surgery. Timing of surgery in tibial shaft fractures is controversial. In this study, the effect of the timing of surgery on the success and complications of intramedullary nailing of tibial fractures is examined. Methods: Archieves of patients with tibial shaft fractures treated with reamed intramedullary nails between 2010 and 2016 were retrospectively analyzed. Fifty-seven patients were included in the study. Patients were categorized by the time of the surgery. Day time (Group I) is between 7:00 am and 5:00 pm and after hour (Group II) is between 5:00 pm and 07:00 am. Group I (n: 40) and Group II (n: 17) were evaluated. Technical errors, surgery time, and length of hospital stay statistical analysis was performed between the two groups in terms of technical errors, complication rates, length of hospital stay, and duration of surgery. Results: The mean duration of operation (p=0.419), number of distal screws (p=0.847), time to union (p=0.454), experience of the surgeon (p=0.192), and technical error rate (p=0.654) did not differ significantly between two groups. Length of hospital stay and time to surgery from emergency were significantly higher in day time group. Conclusion: Technical errors and surgery time of intramedullary nailing of tibial shaft fractures are not higher at after hour before midnight than day time. Non-urgent tibial shaft fractures might be treated with intramedullary nailing at after hours before midnight for efficient use of hospitals.

WITHDRAWN: Long-term follow-up results of a dorsal approach to complex dorsal metacarpophalangeal dislocation.

PURPOSE: The present study aimed to examine the dorsal approach to complex MCP joint dislocation and to compare our clinical results with others reported in the literature.This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal

Ultrasonography view for acute ankle injury: comparison of ultrasonography and magnetic resonance imaging.

INTRODUCTION: We aim to asses the diagnostic performance of ankle ultrasonography in patients presenting with acute ankle sprain injury, with comparison to MRI (Manyetik Rezonans Imaging). MATERIALS AND METHODS: The study included patients who applied to the hospital within 48 h after an ankle sprain, and who presented with signs of pain, swelling, and tenderness in the ankle. Ankle ultrasonography examination was performed and an ankle MRI took place the same day. RESULTS: 30 patients were included in the study. 53.3% (n = 16) were female. The mean age was 30 ± 6.4 years. The ultrasonography examination determined 76.6% (n = 23) of the patients to have anterior talofibular ligament (ATFL) injury, 33.3% to have (n = 10) CFL injury, and 33.3% to have (n = 10) anterior inferior tibia-fibular ligament (AITFL) injury. The MRI of the patients determined 73.3% (n = 22) of the patients to have ATFL injury, 43.3% (n = 13) to have calcaneal fibular ligament (CFL) injury, and 33.3% to have (n = 10) AITFL injury. The ATFL, CFL, and AITFL injuries diagnosed on ultrasonography correlated with the MRI results (ICC = 0.875, ICC = 0.879, and ICC = 0.858). However, among the ATFL injuries observed on MRI, 26.6% (n = 8) were grade I, 26.6% (n = 8) were grade II, and 20% (n = 6) were grade III injuries. Of the ATFL injuries observed on ultrasonography, 46.6% (n = 14) were grade I, 8.6% (n = 2) were grade II, and 30.4% (n = 7) were grade III injuries. CONCLUSIONS: Findings on all types of ATFL, CFL and AITFL appear to have a higher degree of correlation. Ultrasonography could have an added role as a triaging tool, to fast-track MRI.

Comparison of the radiological parameters between dynamic-referencing tactile guidance robotic system and Microplasty® instrumentation in unicompartmental knee arthroplasty.

OBJECTIVES: This study aims to compare the radiological outcomes of unicompartmental knee arthroplasty (UKA) performed by a navigation-based robotic system versus Microplasty® instrumentation. PATIENTS AND METHODS: Between January 2018 and January 2019, a total of 90 knees of 75 patients (65 males, 10 females; mean age: 62.0±9.4 years; range, 50 to 73 years) were included. Among these, 54 knees underwent Oxford mobile-bearing UKA with an Microplasty® instrumentation set and 36 knees were operated with the aid of a Restoris® MCK with MAKO navigation-based robotic system. Postoperative anteroposterior and lateral X-rays of all patients were evaluated according to nine different parameters. On the femoral side, femoral varus-valgus angle, flexion-extension angle, femoral condyle posterior fit; on tibial side, tibial component varus/valgus, tibial posterior slope, medial, anterior, posterior and lateral fit of tibial component assessed. RESULTS: There was no significant difference between groups in terms of age, sex, and affected side. On the femoral side, no significant difference was observed in the component position between groups. On the tibial side, tibial component medial fit (p=0.032) and anterior fit (p=0.007) were better in navigation-based robotic system group. CONCLUSION: Microplasty® instrumentation may lead to comparable implant positioning compared to a tactile-based navigated robotic instrumentation.

YouTube provides insufficient information on patellofemoral instability.

OBJECTIVE: Videos uploaded to YouTube do not go through a review process, and therefore, videos related to patellofemoral instability may have little educational value. The purpose of this study was to assess the educational quality of YouTube videos regarding patellofemoral instability. METHODS: A standard search was performed on the YouTube database using the following terms: "unstable kneecap," "patellar instability," "patellofemoral instability," "kneecap dislocation," and "patellar dislocation," and the top 50 videos based on the "relevance" assignment of the YouTube algorithm were included for analysis. The properties, content, and source of each video were recorded. The educational quality of videos was analyzed according to scores obtained using DISCERN, the criteria of Journal of the American Medical Association, Global Quality Score, and Patellofemoral Instability Specific Score, and the quality of the videos was evaluated according to the groupings of these scoring systems. RESULTS: A total of 250 videos were identified, of which 89 were included in the study for analysis. The mean video duration was 11.72 ± 22.03 minutes. The median number of views was 4516.5 (range, 3-6 044 971). The content of the videos was disease-specific in 60%, 20% were related to surgical technique or approach, and 14.1% were exercise videos. Most of the videos were uploaded by physicians (33.7%). The Global Quality Score and DISCERN scores were significantly correlated with video duration. The Patellofemoral Instability Specific Score was significantly correlated with video duration, number of views, view rate, likes, and Video Power Index. According to the DISCERN classification, 69.9% of the videos were very insufficient or insufficient. According to the Patellofemoral Instability Specific Score, 65.2% of videos were evaluated as very low or low. According to the Global Quality Score, 60.7% of videos were rated as poor quality. CONCLUSION: The quality of YouTube videos about Patellofemoral instability is insufficient. It was found that viewers tend to watch short and low-quality videos.

Does the clamping method in local and systemic TXA applications in total knee arthroplasty change the game?: A retrospective comparative cohort study.

Many different methods and drain clamping periods have been described in systemic and local tranexamic acid (TXA) applications, and the superiority of the methods to each other has not been clearly demonstrated. The method of local infusion in combined TXA applications may not alter the Hb drop or total or hidden blood loss. We aim to compare two different combined TXA application methods. We retrospectively analyzed 182 patients who underwent total knee arthroplasty between 2018 and 2021. Patients over 40 years of age who underwent TKA for degenerative knee arthritis were included in the study. Unicondylar, revision, or bilateral arthroplasties and patients with the cardiovascular or cerebrovascular disease were excluded from the study. All patients in the study received 1 g TXA intravenously half an hour before the incision. For the first group, 1 g TXA was given intra-articularly at the drain site after closure, and the clamp was kept closed for 1 hour. In the second group, the drain was clamped for an additional 6 hours, and a 1 g intravenous dose was administered at the 5th hour postoperatively. No local applications were used in the control group. Total, hidden, and visible blood loss (total blood loss, hidden blood loss, visible blood loss), postoperative decreases in hemoglobin and hematocrit level (ΔHgb, ΔHtc), blood transfusion rates, and hospital stay durations were evaluated. There were 72 patients in the first group, 52 in the second, and 58 in control. A total of 37 patients received one or more blood transfusions postoperatively, and there was no statistical difference in the need for blood transfusions between the groups (P = .255). Although a statistically significant difference (P = .001) in total blood loss, hidden blood loss, visible blood loss and ΔHgb values was observed between the groups, the difference between the first and second groups was insignificant (P = .512). The duration of hospital stay was observed to be less in the first and second groups (P = .024). Local and systemic TXA applications were observed to be more effective than only systemic applications in reducing blood loss after total knee arthroplasty, regardless of the local method.

Treatment Of Ingrown Toenail with a Minimally Invasive Nail Fixator: Comparative Study with Winograd Technique.

BACKGROUND: Many surgical techniques have been reported for the treatment of ingrown toenails. Occurrences of infection after matricectomy procedures could cause clinicians to prefer using external braces to treat ingrown toenails. This study compares patients with ingrown toenails who underwent the nail fixation technique and the Winograd technique. METHODS: Patients who underwent ingrown toenail surgery were retrospectively reviewed. The patients' demographic characteristics (age, gender, body mass index [BMI] morphology according to Heifetz classification, surgical technique, visual analog scale (VAS) values, time to return to daily activities (days), complications, and satisfaction levels were all recorded. RESULTS: Seventy patients were included in the study. Of the patients, 33 underwent nail fixation and 37 underwent the Winograd technique. No significant statistical differences were found in terms of patients' age, gender, BMI, preoperative clinical features, long-term satisfaction, and ingrown toenail recurrence rates between the two groups, but time to return to daily activities and VAS values were statistically significantly lower in patients treated using nail fixation compared with the Winograd technique. CONCLUSION: Nail fixation can be an effective surgical treatment option for an ingrown toenail.

The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems.

OBJECTIVES: This study aims to evaluate the effect of surgical experience on reliability for Boyd-Griffin, Evans/Jensen, Evans, Orthopaedic Trauma Association (main and subgroups), and Tronzo classification systems. PATIENTS AND METHODS: Between January 2013 and December 2014, radiological images of a total of 60 patients (13 males, 47 females; mean age: 78.9±21.9 years; range, 61 to 96 years) with the diagnosis of intertrochanteric femur fracture were analyzed. Radiographs were evaluated and classified by five residents and five orthopedics and traumatology surgeons according to the Evans, Boyd-Griffin, Evans/Jensen, OTA, and Tronzo classification systems. Intra- and interobserver reliability were calculated using the kappa statistics. RESULTS: The worst intraobserver compatibility among the residents was the classification system with OTA subgroups (κ=0.516), while the classification system with the best intraobserver fit was found to be OTA main groups (κ=0.744). The worst agreement among surgeons was in the Evans classification system (κ=0.456). However, the best intraobserver agreement was in the OTA main groups (κ=0.741). The best interobserver agreement was observed regarding the OTA main groups (κ=0.699). CONCLUSION: The classification that has the best harmony both among residents and surgeons, and between residents and surgeons is the OTA main group classification.

Comparison of 25-OH vitamin D levels between children with upper and those with lower extremity fractures: A prospective case-control study.

OBJECTIVE: The aims of this study were (1) to compare 25-OH vitamin D levels between children with upper and those with lower extremity fractures and (2) to determine whether 25-OH D insufficiency prevalence is increased compared to healthy controls. METHODS: This is a prospective case-control study for 12 months. The study was conducted with children aged 5-18 years, including 60 children with non-displaced, impaction type upper extremity and lower extremity fractures resulted from low-energy trauma. In addition, 60 healthy children were included as controls. In all participants, risk factors for low bone mineral density were assessed and serum 25(OH)D levels were measured. Vitamin D levels were compared among groups. RESULTS: Vitamin D deficiency (25-OH D <20) was 14.8 times (OR= 95% CI= 5.61 - 39.8) and 2.9 times (OR= 95% CI= 1.46-5.75) higher in patients with upper and lower extremity fractures, respectively. In the upper extremity fracture group, serum 25-OH D level was considered deficient (25-OH D level=<20 ng/mL) in 91.6% (55/60). In comparison, it was considered as insufficient (serum 25-OH D level=20-30 ng/mL in 8.3% (5/60) of the patients. In the lower extremity fracture group, serum 25(OH)D level was considered as deficient in 75.0% (45/60), while it was considered as insufficient in 25.0% (15/60) of the patients. In the control group, serum 25-OH D level was considered deficient in 10.0% (6/60), while it was considered insufficient in 61.6% (37/60) of subjects. The 25-OH D deficiency and insufficiency were more common in the whole fracture group (upper plus lower extremity fracture groups) when compared to healthy controls. CONCLUSION: This study has shown that hypovitaminosis D is associated with an increased risk for fracture in the pediatric population, and the fracture risk is higher in upper extremity fractures than in lower extremity fractures. In children with fractures, routine vitamin D evaluation should be considered. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Newborn Clavicle Fractures: Does Clavicle Fracture Morphology Affect Brachial Plexus Injury?

BACKGROUND: Newborn clavicle fractures and brachial plexus injuries (BPIs) are rare but serious perinatal complications. METHODS: The aim of this study was to examine the clinical relationship between the fracture morphology (spiral, oblique, transfer) of clavicle fractures that develop during delivery in newborns and BPI. We retrospectively reviewed all perinatal clavicle fractures diagnosed at our institution over 6 years. RESULTS: The study included 55 newborn infants with perinatal clavicle fracture. Of these, 60% (n=33) were male. Right-side clavicle fractures were present in 56.4% (n=31) and shoulder dystocia was present in 58.2% (n=32) of the patients. Of the fracture localization of the patients, 85.5% (n=47) (Allman I) and 14.5% (n=8) (Allman II) were lateral. Allman type I fractures were not associated with increased BPI (P>0.05). It was observed that 40% (n=22) of the clavicle fractures were characterized by oblique morphology, 34.5% (n=19) of the fractures by spiral morphology, and 25.5% (n=14) of the fractures by transfer morphology. In all, 41.8% (n=23) of the sample also had BPI. Of the entire sample, 40% (n=22) most frequently showed oblique morphology fractures, whereas the patient group with BPI showed spiral morphology as the most common fracture, at a rate of 52.2% (n=10). After examining the relationship between fracture morphology and BPI, the study determined a statistically significant correlation between spiral and oblique morphology fractures and the development of BPI. CONCLUSIONS: To our knowledge, our study is the first to examine the relationship between newborn clavicle fracture morphology and BPI. We think that they should be evaluated for increased BPI risk in newborn patients that have clavicle fractures with spiral and oblique morphology.