Comparision of lateral, medial, and posterior approaches in the surgical treatment of pediatric supracondylar humerus fractures.

OBJECTIVE: The aim of this study was to compare the functional and radiological results of lateral, medial, and posterior surgical approaches in pediatric patients undergoing open reduction and internal fixation for supracondylar humerus fractures. METHODS: A total of 86 patients were included in the study. The clinical and radiographic results of the treatment in patients who underwent open reduction and internal fixation with lateral, medial, and posterior approaches were evaluated. Flynn's criteria were used in the evaluation of cosmetic and clinical results. Comparisons were made between the groups in terms of Baumann angle, lateral capitellohumeral angle, and post-operative complications. RESULTS: There was no statistically significant difference between the three groups in terms of complications. No statistically significant relationship was observed between Flynn's criteria and surgical approaches. When the relationship among post-operative range of motion (ROM) and surgical approach was evaluated, no extension defect was found in any of the patients, but a significant relationship was found between post-operative flexion ROM and surgical approach (p=0.011). CONCLUSION: Closed reduction and percutaneous pinning are preferred in cases of pediatric supracondylar humerus fractures. However, when this method cannot be applied, lateral, medial, and posterior approaches are the possible open reduction methods, that can be safely preferred.

The effect of pre-fracture proximal femur geometry on hip fracture type in elderly patients.

This study aimed to analyze the relationship between fracture type by determining data on the geometry of the proximal femur in the pre-fracture period in patients over 65 years of age who had hip fractures as a result of low-energy trauma. A total of 127 patients who were admitted to the hospital for reasons other than hip pathology within 1 year before the occurrence of hip fracture and who had an anterior-posterior pelvic X-ray were included in the study. Measurements were made to evaluate the proximal femur geometry, neck shaft angle, central edge angle, femoral head diameter, femoral neck diameter, femoral neck length, femoral offset length, femoral neck axial length, hip axis length, and femoral shaft diameter. As a result of these measurements, analyses were performed to determine the relationship between the control group and fracture types. The mean Neck shaft angle scores were significantly higher in both fracture types than in the control group (P = .034, P = .002). The mean Femoral offset length values of both fracture types were lower than those of the control group (P = .002, P = .011, respectively). Multiple logistic regression analysis revealed that the risk of collum femoris fracture increased as the Femoral head diameter value increased. (OD = 0.21, P = .002). The geometric parameters of the proximal femur play an important role in the formation of hip fracture types. Therefore, differences in proximal femur geometry in hip fracture types should be considered, and patient-focused choices should be made regarding the surgical procedures and implants to be used during fracture fixation.

Analysis of Doppler ultrasonography and computer tomography angiography for predicting amputation level and re-amputation rate.

OBJECTIVE: Peripheral arterial disease of the lower extremities is one of the most common causes of non-traumatic lower extremity amputation. Computed tomography (CT) angiography and Doppler ultrasonography are mainly used to evaluate distal vascular structures. Our objective was to evaluate the predictive efficacy of Doppler ultrasound and CT angiographic radiographic examinations in determining amputation levels and reamputation rates in patients undergoing lower extremity amputation. METHODS: Patients with major or minor amputation at various levels due to lower extremity lesions were included in the study. Standard demographic information, clinical accompanying diseases, reamputation datas, Doppler ultrasound, and CT angiography radiological evaluation reports were obtained retrospectively from the hospital system records of the patients. RESULTS: A total of 166 cases including 119 (71.7%) males and 47 (28.3%) females were included in the study. About 36.7% (n=61) cases had amputation at the level of surgery above the knee, 38.6% (n=64) below the knee and 24.7% (n=41) at the level of foot/finger. In patients who underwent amputation above the knee, occlusion was seen at the level of the iliac artery (88.9%), femoral artery (47.8%), and popliteal artery (37%). The rate of occlusion at the level of the popliteral artery in patients with below-knee amputation (59.3%) was found in patients with foot/finger amputation (51.5%) at the levels arteria dorsalis pedis and posterior tibial artery. According to the level of occlusion at all blood flow levels, it was observed that the rate of reamputation was most common in occlusions at the level of popliteal artery. CONCLUSION: It was found that radiological data are effective in planning amputation according to blood flow level and does not make any difference per se. It was found that the reamputation rates were related to the determination of the level of blood flow in the primary surgical phase.

Comparison of three different surgical treatment methods in humeral shaft fractures.

Introduction: in this study, we aimed to compare the clinical and radiological results of single 4.5 mm locking compression plate (LCP), dual 3.5 mm LCP and intramedullary nailing (IMN) methods applied to the surgical treatment of humeral shaft fractures. Methods: the study included 77 patients (41 males, 36 females; mean age 46.38 years; range 18-74 years) with humeral shaft fractures treated with a single 4.5 mm LCP, dual 3.5 mm LCP and IMN between January 2016 and December 2020. Single 4.5 mm LCP (Group A) was applied to 31 (40.3%) patients, dual 3.5 mm LCP (Group B) to 20 (26%) patients and IMN (Group C) to 26 (33.8%) patients. The preoperative and postoperative data of the patients were analyzed from the hospital registry system. A short version of the disabilities of the arm, shoulder and hand (QuickDASH) questionnaire was used to evaluate functional outcomes. Results: as a result of the comparison of the rates of nonunion between the groups, a significantly lower rate of nonunion was observed in group B patients (p=0.027). While the rate of nonunion was 14% in the cases included in the study, no cases of nonunion were encountered in group B. There was no difference between the three groups in terms of demographic data and other postoperative complications. Conclusion: dual 3.5 mm LCP method is a suitable alternative to other surgical methods in the treatment of humeral shaft fractures, due to similar functional results and lesser nonunion.

Evaluation of the Accuracy and Quality of Information in Videos About Lateral Epicondylitis Shared on Internet Video Sharing Services.

Purpose In this study, it was aimed to determine the quality and accuracy of the videos on YouTube about lateral epicondylitis. Methods The first 100 videos were included in the study by typing the keyword "lateral epicondylitis" in the YouTube search tab without using any filters. The video power index (VPI) was used to evaluate the popularity of the videos, and the global quality score (GQS), Journal of the American Medical Association (JAMA), and DISCERN scoring systems were used to evaluate the quality. The obtained data were statistically analyzed according to these scoring systems. Results The mean DISCERN, JAMA, and GQS of the analyzed videos were 46.66, 3.13, and 3.85, respectively. According to these results, it was determined that the videos were of medium quality. A statistically insignificant and weak correlation was found between the VPI and DISCERN, GQS, and JAMA scores (p>0.05, intraclass correlation coefficient, ICC: -0.05, 0.09, and -0.05, respectively). While there was no significant relationship between the video source and the DISCERN, JAMA, and GQS scores (p>0.05), it was determined that the DISCERN, JAMA, and GQS scores in the exercise videos were significantly higher than in the other content types in terms of the video content (p=0.041). Conclusions According to the results obtained, it was determined that YouTube videos about lateral epicondylitis were not of sufficient quality. In order to ensure standardization for quality videos, internationally acceptable guidelines should be determined and studies should be carried out to provide an adequate infrastructure for the preparation of quality medical videos that can meet the increasing needs of patients by health institutions.