Computational Mechanical Analysis of AO 44A1, 44B1, and 44C1 Fractures with Finite Element Modeling: Evaluation of Screw, Plate, and Kirschner Wire Fixation.

BACKGROUND: The aim of this study was to create AO 44A1, 44B1, and 44C1 fractures using finite element analysis to determine the stability of Kirschner wire, intramedullary screw, and plate-screw fixation methods in fracture. METHODS: Using finite element analysis, the postreduction behavior of AO 44A1, 44B1, and 44C1 fractures with Kirschner wire, intramedullary screw, and plate-screw fixation methods was analyzed and compared in terms of displacement and stress. RESULTS: The lowest amount of displacement was provided with the intramedullary screw method in AO 44A1 and 44B1 fractures and with the 4-mm Kirschner wire method in AO 44C1 fractures. The total displacement of the intramedullary screw system used for fixation in AO 44A1, 44B1, and 44C1 fractures was lower. CONCLUSIONS: According to finite element analysis results, the lowest amount of displacement was obtained with intramedullary screw fixation in AO 44A1 and 44B1 fractures, and 4-mm Kirschner wire fixation was achieved in AO 44C1 fractures.

Biomechanical effect of ankle ligament injury in AO 44B2.1 lateral malleolus fractures after lateral plate fixation: A finite element analysis.

BACKGROUND: Distal fibula fractures at the ankle level are common and are usually accompanied by ligament injuries. This study aims to evaluate the effects of ankle ligament ruptures on ankle joints, fracture instability, and plate stress after distal fibula fracture fixed with plate created by finite element analysis (FEA) modeling and loading applied to ligament rupture models that may accompany this fracture. METHODS: A finite element model consisting of 3-D (3D) fibula, tibia, foot bones, and ankle ligaments was designed to investigate the effects of ligament injuries accompanying plate-detected Arbeitsgemeinschaft für Osteosynthesefragen (AO 44B2.1)-type fractures on fracture detection, fixation material, and ankle joints. Then, the results were evaluated by modeling ligament rupture in 6 different ways. RESULTS: In the modeling where the deltoid and the talofibular ligament are broken together, instability is the highest in the ankle (2.31 mm) and fracture line (0.15 mm). In our study, the rupture of the tibiofibular anterior and posterior ligaments associated with syndesmosis caused less instability in the fracture and ankle than the single rupture models of both the deltoid and the talofibular ligament. CONCLUSIONS: In the finite element modeling of AO 44B2.1-type fractures detected with plate, the importance and potential effects of often overlooked ankle ligaments are pointed out shown. It is important to keep in mind that when treating ankle injuries, the ankle should be treated as a whole, with both bone and soft tissue. In some cases, the fracture may represent the visible tip of the iceberg.

Evaluation Of YouTube Information Quality About Pes Planus.

BACKGROUND: The aim of this study is to measure the quality of information about 'flatfoot' and 'pes planus' presented online on the social media site YouTube and to determine the trends of viewers to medical information on YouTube. METHODS: 'flatfoot and pes planus' was typed into the YouTube search module. From the search results, videos with 50000 views or more, longer than 45 seconds, containing information about flatfoot and pes planus disease were selected. DISCERN, JAMA scoring, daily average views, number of likes, number of comments were collected from 53 videos that met the criteria. The profession of the sharer was evaluated in terms of the information quality of the sharing and the orientation of the audience. RESULTS: The mean number of views per day of the examined videos was 2047. Mean video presentation time was 8 minutes 50 seconds. The mean JAMA score was 2/4 and the mean DISCERN score was 38.16/75. According to the DISCERN score according to the professions, the video quality was moderate in doctors (41.44±12.99), moderate in physiotherapists (41.91±9.04), poor in coaches (32.78±7.87), poor in patients (34.50±5.32) and weak in others (34.89±14.00). According to the Spearman correlation between DISCERN score and mean daily viewing significant relationships were found in the doctors group p:0.0102 and the others group p:0.0033, however, no significant relationships were observed in the physiotherapists group p:0.1073, the flatfoot patients group p:0.5363 and the coaches group p:0.9111. There were significant relationships between like and comment counts in all groups (doctors p:0.0088, coaches p:0.0069, physiotherapists p:0.0007, others p:0.0018, patients p:0.0066). CONCLUSIONS: Looking at previous studies, it was observed that the quality of online health information was historically inadequate. Likewise, in our study on YouTube, we found that the quality of flatfoot and pes planus information was poor to moderate.

Two-Point Discrimination in Feet with Ankle Sprains.

BACKGROUND: This study aimed to compare two-point discrimination in feet with ankle sprains and feet without ankle problems, and to determine whether there was a change in the two-point discrimination values in ankle sprains. METHODS: A total of 108 people were included in the study. These subjects were aged between 18 and 40 years and visited the Medical Faculty of Yozgat Bozok University for various reasons in July and September of 2022. These people were divided into two groups: subjects with an ankle sprain and subjects with no ankle problems. Two-point discrimination values measured in mm were recorded for both groups using a caliper (esthesiometer) used in six regions of 216 feet. The two-point discrimination threshold values of the feet were compared statistically according to feet with ankle sprains and feet without ankle problems, as well as in right and left feet. RESULTS: The study determined that the two-point discrimination threshold values measured at the 1st toe tip, heel, 3rd plantar metatarsal head, medial malleolus, and lateral malleolus in subjects with an ankle sprain was higher than in subjects with no ankle problems. When comparing both feet of the subjects with an ankle sprain, the two-point discrimination threshold value in the heel of the foot with an ankle sprain was higher than in the heel of the foot without ankle problems. CONCLUSIONS: The two-point discrimination threshold value was higher in subjects with an ankle sprain than in subjects with no ankle problems. The data suggest that the two-point discrimination threshold may be higher in people with an ankle sprain. Further studies are needed to better understand the two-point discrimination threshold in ankle sprains.

Is the preoperative neutrophil-to-lymphocyte ratio a predictive value for postoperative mortality in orthogeriatric patients who underwent proximal femoral nail surgery for pertrochanteric fractures?

BACKGROUND: Hip fractures in the orthogeriatric population are a health problem that causes mortality and morbidity, with an increasing frequency. The present study aims to investigate whether the preoperative neutrophil-to-lymphocyte ratio (NLR) is a predictive value for the postoperative mortality risk in patients who underwent only proximal femoral nail (PFN) surgery due to pertrochanteric fractures (PTF). To our knowledge, there is not any study conducted with a similar population in the litertaure. METHODS: Fifty-five patients who were operated on by two National Board-certified surgeons with the PFN method were included in our retrospective study. The patients were divided into two groups. Group A included the patients who lost their lives within the postoperative first year (n=13), while Group B included the survivors (n=42). Preoperative NLR data, demographic information, duration of hospitalization, postoperative intensive care requirements (ICU) and comorbid diseases of all patients were recorded. RESULTS: In our study with a maximum follow-up period of 27 months, no statistically significant difference was found between the groups concerning age, gender, body mass index, preoperative American Society of Anesthesiologists scores (ASA), types of fractures, ICU requirements, duration of hospitalization (p>0.05). However, the NLR was significantly higher in Group A (p<0.01), with a cut-off value of 5.25, sensitivity of 84.6% and specificity of 78.6%. CONCLUSION: We believe that the preoperative NLR is a predictive variable for orthopedic surgeons in assessing the postoperative mortality risk in orthogeriatric patients who presented to the emergency room due to PTF and were planned to undergo PFN surgery.

No Sedation, No Traction, and No Need for Assistance: Analysis of New Prakash's Method of Shoulder Reduction.

MATERIALS AND METHODS: A total of 19 patients who were admitted to the emergency department with the diagnosis of anterior shoulder dislocation participated in this study. The diagnosis of shoulder dislocation was established in the emergency department with physical examination and anteroposterior shoulder radiography. The method was applied only once to the patients in the sitting position by the same physician without using any help, traction, anesthesia, analgesia, and myorelaxant. RESULTS: The mean age of the patients was 37.3 ± 13.1 years. Among them, 36.8% (n=7) were female and 63.2% (n=12) were male. Recurrent dislocations were observed in 21.1% (n=4) of the patients. The success rate of the method was 94.7% (n=18). No complication was noted in the patients. The mean procedure time was 243 ± 38 seconds. CONCLUSION: Prakash's method is a safe method for anterior shoulder dislocations that can be quickly performed with no need for sedation, assistance, and traction and has a high success rate.

Relationship between the AB0 Blood System and Proximal Femoral Fracture Patterns in the Turkish Population.

OBJECTIVE: AB0 blood groups have shown to be associated with increased risk of several orthopedic disorders such as Achilles tendon rupture and hip osteoarthritis. The objective of this study was to investigate relationships between the AB0 blood system and hip fracture patterns, duration of hospitalization, and amount of blood transfusion. METHODS: Data of 308 patients treated due to hip fractures in our hospital between 2017 and 2019 were evaluated. Epicrisis reports and X-rays of the patients included in this study were retrospectively screened, and hip fractures were classified as intracapsular and extracapsular fractures. Patients were divided into A, B, 0, and AB groups according to blood groups. RESULTS: The mean age of the patients was 75.54 ± 13.5 years. Of all patients, 103 had an intracapsular fracture and 205 had an extracapsular fracture. No statistically significant correlation was found between blood groups and fracture patterns. No statistically significant difference was found between the amounts of transfusion according to the blood groups, and no significant difference between the durations of hospitalizations according to the blood groups. CONCLUSION: In our study population, we could not find a significant relationship between the AB0 blood system and fracture patterns. We think that these potential relationships could be explained with further comprehensive studies with larger populations.

Can injection of adipose stem cells to non-union zone increase bone union? Experimental rat study.

OBJECTIVES: This study aims to evaluate the effects of local adipose stem cell injection on non-union and diabetic non-union of rat femurs. MATERIALS AND METHODS: Forty-eight female Wistar albino rats (weighing mean 200 g and aged 8 weeks) were used in this study. The rats were divided into six groups. Group 1 was chosen as a reference for receptor activator of nuclear factor-kappa (κ) B (RANK), receptor activator of nuclear factor-κ B ligand (RANKL) and osteoprotegerin (OPG) genes and no femur osteotomy was performed in this group. Group 2 underwent femur osteotomy, the osteotomy was fixed with a 1.5 mm K-wire as retrograde from the knee joint, and no gap was left in the osteotomy line. In order to induce non-union, femurs underwent osteotomy fixed with K-wires in groups 3, 4, 5 and 6. In addition, the osteotomy line was measured as 1.8 mm gap with electronic calipers and the gap was fixed with U staple. Before osteotomy, streptozocin was injected intraperitoneally at a dose of 60 mg/kg in 0.1 mol/L citrate buffer solution (Ph 4.4) in groups 4 and 6, in order to induce diabetes mellitus. Left femur anteroposterior and lateral X-rays were taken 10 weeks after the operation and the union in group 2 and non-union in groups 3, 4, 5, and 6 were confirmed. To see if injection of adipose stem cells into the non-union site increases bone union, 2 mL 0.9% sodium chloride (NaCl) in groups 3 and 4 and 2×106 adipose stem cell in groups 5 and 6 were locally injected into the non-union area with fluoroscopy. Femur X-rays were taken eight weeks after the injection and all rats were sacrificed. Femurs of rats were removed for histopathological and gene expression evaluation. RESULTS: There were significant differences between the groups injected 0.9% NaCI and adipose stem cells in terms of bone healing according to radiological and histopathological evaluations (p<0.05). No statistically significant difference was observed between the groups in terms of gene expression levels. CONCLUSION: According to the results of our study, local adipose stem cell injection has positive radiological and histopathological effects in diabetic and non-diabetic femoral non-unions, independently of RANK, RANKL, or OPG gene expression pathways.

Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: a retrospective analysis.

Background/aim: Hip fractures in older adults are associated with high morbidity, mortality, and subsequent hospital costs and decreased quality of life. The objective of this study was to evaluate geriatric patients who underwent partial prosthesis surgery following hip fracture and effects of early mobilization and weight bearing on postoperative walking ability and pain. Materials and methods: A total of 52 geriatric patients with intertrochanteric and femoral neck fractures were included in the study. Patients' service files, system records, pre- and postoperative X-rays were retrospectively reviewed. Results: There were 52 patients in the study group with 36 (69.2%) being female. The mean age of the patients was found as 82.9 ± 6.5 years. The mean length of stay in hospital was found as 6.2 ± 2.6 days. The mean length of stay in hospital was found as 5.3 ± 1.7 days in male and 6.6 ± 2.8 days in female patients, and the difference was statistically significant (P = 0.035). The mean length of stay in hospital was found as 5.4 ± 1.8 days in early mobilization group and 6.9 ± 2.9 days in late mobilization group, and the difference was statistically significant (P = 0.026). There was a significant difference between Harris and pain scores in terms of the time of first weight bearing at the postoperative 1st month follow-up. Harris score was found as 84.0 ± 5.8 (median: 84.0, min­max: 73­94), and the main pain score as 36.8 ± 6.8 in the group with the first weight bearing within the first 24 h, while Harris score was found as 71.10 ± 2.8, and the main pain score as 24.4 ± 6.4 in the group with the first weight bearing after the postoperative 24th hour. Conclusion: The results of our study indicated that early mobilization and full weight bearing in geriatric patients after hip fracture surgery shortened length of stay in hospital, reduced postoperative pain, and increased walking ability.