Clinical results of acetabular fracture treatment with hybrid fixation by anterior and posterior approach : A minimally invasive technique.

BACKGROUND: Open reduction and internal fixation have been described as the gold standard for the treatment of acetabular fractures, but the high complications of these surgeries have led surgeons to seek less invasive procedures. In recent years, minimally invasive treatment, such as fixation through the skin have been proposed. The aim was to assess acetabular fracture outcomes of combination of posterior approach (Kocher-Langenbeck [KL]) with anterior percutaneous screw fixation (APSF) with minimally invasive surgery (MIS). METHODS: Between February 2017 and July 2019, 155 patients with acetabular fractures underwent fixation with the KL + APSF approach. For 1 year functional outcomes, radiographic findings, and postoperative complications were evaluated. RESULTS: Of 155 patients with a mean age of 40.16 ± 10.32 years, 82 patients were male and 73 were female. The most common pattern of fracture was both columns (32.9%). The average blood loss was approximately 527 ml. The average operation time was 85 min. The mean length of surgical incision was 113.3 mm. Harris' hip score was excellent in 75.5% of cases. The mean VAS score was approximately 4 and 91.6% of patients returned to pre-trauma activity. In 74.8% of cases, the reduction was anatomical. Complications after surgery were very insignificant and included the following: 2 patients had foot drop within 5 months both patients recovered, 2 patients had femoral nerve palsy and 3 cases of deep vein thrombosis and 1 case of pulmonary thromboembolism were treated. There were four patients with surgical site infections, all of whom recovered and two of the seven patients with osteoarthritis underwent total hip arthroplasty. CONCLUSION: Combining posterior approach with minimally invasive anterior method in fixation and treatment of acetabular fractures is a safe and reliable method and showed significant functional results with minimal complications.

The Effect of Lower Limb Position on Anterior Cruciate Ligament Reconstruction on Uncommon Complications after Surgery.

Background: To reduce the complications of orthopedic surgery, the desire for less invasive procedures, such as, knee arthroscopy to repair the anterior cruciate ligament, has increased. There are, currently, two common positions for limbs that are used during surgery depending on the surgeon's experience. Therefore, our aim was to investigate the effect of limb position on complications after anterior cruciate ligament reconstruction surgery. Materials and Methods: From April 2016 to July 2020 at our orthopedic-sports trauma center, 688 patients between the ages of 18 and 50 with anterior cruciate ligament rupture underwent reconstruction surgery with a hamstring graft. Patients were divided into two groups in terms of limb position at the time of surgery. For three months, patients were evaluated for surgical complications, basic demographic information, and information during surgery. Results: There was no statistically significant difference between the two groups in terms of demographic information, side of injury, preparation time, tourniquet time, operation time, and duration of hospitalization. At quarterly follow-up, there was no significant difference between the two groups in terms of postoperative complications (P = 0.976). Conclusions: There is no difference between compartment syndrome and deep vein thrombosis in different situations, therefore, the surgeon should operate in any position he is skilled in. Also, surgeons should always pay special attention to these complications and provide necessary training to patients in order to prevent them.

Effects of Teriparatide on Clinical and Radiologic Long-Term Outcomes after Fixation of Pertrochanteric Hip Fractures.

Background: Pertrochanteric hip fractures are common and among serious injuries of the old population with considerable mortality and morbidity. The aim of this study was to evaluate long-term effects of recombinant human parathyroid hormone on postoperative clinical and radiologic outcomes in elderly patients with pertrochanteric hip fractures. Materials and Methods: Between 2016 and 2019, we prospectively assessed 80 patients with pertrochanteric hip fractures who underwent reduction and internal fixation with a dynamic hip screw. Patients were divided randomly into two groups. About 40 patients in the control group who received supplementary calcium (1000 mg/day) and vitamin D (800 UI/day), and 40 others who were treated additionally with 20-28 mg daily teriparatide for three months post-operatively. The functional and radiologic assessment was done using visual analog scale (VAS), Harris hip score (HSS), and standard radiographs of the hip. Results: At the final follow-up, there was a significant difference between the two groups regarding average HSS (68.38 in the control group versus 74.12 in the treatment group, P-value <0.001). VAS score was also significantly lower in the treatment group (P-value <0.001). Regarding radiographic evidence of union, the results were not statistically different between the two groups. Conclusions: The current study illustrated that short-term daily administration of teriparatide improves long-term functional outcome after pertrochanteric hip fracture fixation and can reduce the pain but does not affect union and callus formation.

Synergistic effect of LCI with ESWT on treating patients with mild to moderate CTS: a randomized controlled trial.

BACKGROUND: Applying radial extracorporeal shock wave therapy (R-ESWT) with LCI(local corticosteroid injection) in carpal tunnel syndrome (CTS) management is gaining momentum. The objective is to actualize the topic of this study. METHODS: In this prospective randomized controlled trial, forty patients with mild to moderate CTS are divided into two sham- R-ESWT and R-ESWT groups subject to LCI(local corticosteroid injection). The first group received four sessions of sham-ESWT weekly, which involved sound but no energy; the second group received R-ESWT at equal intervals and were assessed for pain score (VAS score) and symptoms (GSS) baseline, 1st month, 3rd month, and 6th month. RESULTS: A considerable improvement is observed in both groups for pain at (P < 0.05) and symptoms at (P < 0.05) in the 3rd month. The second group revealed more significant symptom improvement at (P < 0.05) in the 6th month. CONCLUSION: The R-ESWT + LCI combined therapy course is the first line of treatment in patients with mild to moderate symptoms and leads to control and reduction of symptoms and the need for surgery, thus a primary concern in CTS treatment with an orthopedist.

Comparison of Periodic in-Person and Remote Visits via Smartphone Applications during COVID-19 Pandemic in Clinical Follow-up of Range of Motion in Patients with Distal Radius Fracture.

Background: Wrist function has a significant impact on quality of life, which is why restoring normal wrist movement after surgery is so important. Due to the COVID-19 pandemic, and the restrictions imposed on "face-to-face" visits, using smartphones has become more important in tracking patients. The main purpose of this study was to determine the accuracy of telemedicine in following up patients who had undergone distal radius fracture operation. Materials and Methods: From February to October 2020, 126 patients between 20 and 60 years old were randomly selected at our orthopedic trauma center. All patients were visited in person by an orthopedic surgeon in the morning (control group) and again all of them were visited online via smartphone in the evening by another orthopedic surgeon (case group). Both visits were done at regular intervals in the 2nd, 6th, and 12th weeks after surgery. Patients were evaluated for extremity function outcomes and joint range of motion. Results: The two groups were similar in terms of mean Patient-Rated Wrist Evaluation score and Disabilities of the Arm, Shoulder, and Hand score and did not show a statistically significant difference (P < 0.05). There was no significant difference in wrist range of motion measurements between the two groups (in-person visits and smartphone visits) during the follow-ups (P > 0.05). Conclusion: Changes in wrist range of motion after surgery can be assessed with high accuracy using smartphone applications and this method can be considered as a proper alternative to frequent in-person visits to evaluate postsurgical wrist condition.

Evaluation of the effect of preoperative hemoglobin level and proinflammatory factors on intertrochanteric fracture union.

BACKGROUND: Intertrochanteric fractures are associated with high mortality and morbidity, so these patients should undergo fracture fixation surgery immediately. Despite surgery, the possibility of fracture fusion may not occur due to the association with various causes. Therefore, our aim is to investigate these factors (TNF­a, IL­1, Hb) and their effect on fracture union after fixation. METHODS: From 2018 to 2020, at our orthopedic trauma center, 163 patients older than 50 years with intertrochanteric fractures underwent DHS fixation surgery. Patients were divided into anemic and non-anemic groups in terms of preoperative hemoglobin level (standard hemoglobin 11 mg/dl). For 3 months, patients were assessed for union and failure fixation criteria, levels of proinflammation (TNF­α, IL-1) and level of hemoglobin. RESULTS: The results show that out of 163 patients with fractures, at the time of initial admission, 74 patients had less than 11 hemoglobin g/dl. Patients with union fractures had higher hemoglobin levels than patients with non-union (11.71 ± 1.51 versus 11.24 ± 1.96), which was statistically significant between hemoglobin and union level (p = 0.030). At the end of the third visit (third month), 44 (59.5%) anemic patients received union completly, while among the patients with normal hemoglobin level, 32 (36%) received union bread, which was statistically significant (p = 0.003). There were no statistically significant differences between proinflammatory factors before surgery and 3 months after surgery (p > 0.05). CONCLUSION: Due to the effect of anemia and proinflammatory factors in the process of healing fractures and bone formation and creating musculoskeletal balance, low hemoglobin level before surgery has a significant effect on fracture union and failure of fixation. So it is recommended to correct this anemia in these patients before surgery and during follow-up.

The Effect of COVID-19 Pandemic on the Characteristics of Pediatric Supracondylar Fracture: A Retrospective Cohort Study.

Background: Environmental factors play a key role in the occurrence of pediatric supracondylar humerus (SH) fracture which has been widely affected by the COVID-19 pandemic and the measures taken to curb its spread. In this study, we aim to investigate the ultimate impact coronavirus pandemic has had on SH fractures in children. Materials and Methods: This retrospective cohort study compares SH fractures which occurred during the pandemic with their prepandemic counterpart in a pediatric trauma public hospital. Patient's data, submitted from February to July 2020 and 2019, were collected and divided into two groups based on fractures' time of occurrence, i.e., during or before the pandemic. Results: There was no significant difference in terms of gender, type of fracture, injury location, and time of admission during a day between the aforementioned groups. However, in the pandemic group, patients were transferred to the operating room significantly quicker (odds ratio; 2.13 vs. 0.607, P = 0.01) and the surgery duration was shorter (40.17 ± 12.28 min vs. 49.11 ± 15.48 min, P = 0.011). It was found that the location of injury (home, school, etc.) varied between the two groups (P = 0.01) and the proportion of domestic injuries during the pandemic grew significantly (53.6% vs. 19.8%). Conclusion: Although the incidence of pediatric SH fractures has decreased due to the closure of schools and sports clubs during the pandemic, domestic occurrence of the same fracture type has grown disproportionately. To prevent this trend, pediatric centers should educate parents on child safety measures and fracture risks during the lockdown.

Comparison of the Effectiveness of Two Management Strategies in the Pandemic COVID-19 Period in Patient Visits (Face-to-Face Visits vs. a Smartphone) in follow-up the Range of Motion of the Knee in Patients with Anterior Cruciate Ligament Reconstruction.

Background: As the prevalence of the coronavirus increases, there is now more emphasis on reducing "face-to-face" patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR). Materials and Methods: From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2nd, 6th, and 12th week after surgery. Patients were evaluated for function outcomes and joint ROM. Results: The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05). Conclusion: Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.