Evaluation of single and multiple hyaluronic acid injections at different concentrations with high molecular weight in the treatment of knee osteoarthritis.

BACKGROUND: Knee osteoarthritis is severe progressive and most commonly diagnosed articular disease and its incidence is increasing around the world depending on age. This pathologic condition which limits daily activity of patients can be characterized by degeneration of cartilage and inflammation. Although non-steroidal anti-inflammatory (NSAII) agents and other analgesics are routinely used treatment options, the potential effects of intraarticular injections including hyaluronic acid (HA) have also been demonstrated by various studies. However, few studies compare the efficacy of a single high molecular weight (HMW) high dose and a triple HMW low dose. This study aimed to compare the efficacy of single high molecular weight (HMW) high dose (2 mL / 60 mg) and triple HMW low dose (2 mL /30 mg) intra-articular injection of HA in knee osteoarthritis (OA) patients by evaluating function and pain parameters during 12 months. METHODS: This is a single-center, retrospective clinical study that included and involved 128 patients. Group I (n=64) patients received triple 30 mg HA injections (SEMICAL®) with one-week intervals, while Group II (n=64) patients received a single 60 mg HA injection (SEMICAL®). Lequesne Index, WOMAC and VAS scores were recorded to assess pain and function during a 12-month period. RESULTS: There was no significant difference in characteristics of patient demographics. Our finding indicate that WOMAC, VAS score, and Lequesne Index values during follow-up visits exhibited a decrease, signifying improvement in the clinical condition. Notably, scores were significantly more favorable with the 30 mg of HA injection compared to the 60 mg of HA injection. CONCLUSION: This study suggests that the triple low-dose injection of HMW HA is more effective in improving WOMAC, VAS scores and Lequesne Index values than a single high-dose injection.

Treatment of recalcitrant femur nonunion with pedicled corticoperiosteal medial femoral condyle flap.

Periosteal or osteoperiosteal medial femoral condyle (MFC) flaps may be good options for atrophic nonunion. The aim of this study was to evaluate the effectiveness and safety of pedicled MFC flap in the treatment of recalcitrant femur nonunion without bone defect. Thirteen patients (11 male and 2 female), who suffered recalcitrant femur nonunion and were treated with pedicled osteoperiosteal MFC flap between January 2014 and April 2018, were included in this study. Patient files were reviewed retrospectively. Atrophic or recalcitrant 2/3 distal femoral nonunion were the indications for this clinical procedure. Demographics and operative data, flap size, visual analog scale (VAS) score, time to union, and complications were evaluated. A total of 13 patients underwent femur nonunion treatment with MFC flap after an average of 3.4 previous surgical procedures. The median age was 34 (Q1: 32.5, Q3:43) years old. The mean flap size was 4.3 × 6.4 cm, all nonunions healed in a median 5 months (Q1: 4.5, Q3: 6). There were an intraoperative knee medial collateral ligament injury in a patient, hematoma in a patient, and seroma in two patients. The median length of the follow-up was 40 months (Q1: 30, Q3: 47). There wasn't any additional complication in long-term follow-up. Functional outcomes were satisfactory. The median preoperative VAS score was 7 (Q1: 6, Q3: 9.5), decreasing to 1 (Q1: 0, Q3: 1) at the 6-month follow-up, and further reducing to 0 (Q1: 0, Q3: 1) at the 24-month follow-up. The nonunion period ranged from 6 to 18 months. The pedicled MFC flap is a good option for recalcitrant femur nonunion where larger vascularized flaps are not warranted. It is easy to harvest, does not require microvascular anastomosis, is effective, and offers minimal donor site morbidity.

An overview of the orthopedic patient profile in the first five days following February 6th, 2023 Kahramanmaras earthquake: A single-center experience in the earthquake zone.

OBJECTIVES: This study aims to investigate the patient profile at a medium-volume hospital located in the earthquake zone among patients who received orthopedic treatment within the first five days after the natural disaster that was considered a major earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 10th, 2023, a total of 338 patients (156 males, 182 females; mean age: 42.2±9.7 years; range, 0 to 87 years) who received orthopedic treatment in our center were retrospectively analyzed. The patients were divided into four groups according to age as follows: infants (younger than one year of age), children (one to 13 years), adults (14 to 59 years), and elderly (60 years or older). RESULTS: Considering the age distribution, 291 (86%) patients were young adults. A total of 173 orthopedic surgeries were performed, including internal fixation in 63 patients, external fixation in 11 patients, upper/lower extremity fasciotomy in 47 patients, amputation in 39 patients, and soft tissue debridement in 13 patients. CONCLUSION: It is of utmost importance to recognize the principles of emergency fracture fixation and fasciotomy to successfully perform orthopedic surgeries after a natural disaster such as a major earthquake, particularly when the number of earthquake victims is considerably high.

The Possibilities of Personalized 3D Printed Implants-A Case Series Study.

Background and Objectives: Following the most recent software and 3D printing developments, the use of personalized 3D printed orthopedic implants for treatment of complicated surgical cases has gained more popularity. Today, orthopedic problems that cannot be solved with standard implants may be effectively addressed using personalized prostheses. The aim of this study is to present the designing, modeling and production stages of four different personalized 3D printed prostheses and their application in clinical cases of patients who underwent treatment in various anatomical locations with a precisely specified indication for implantation. Materials and Methods: Based on computed tomography scanning, personalized 3D printed prostheses were designed, produced and used in four patients within a period of three to five days after injury or admission. Results: Early term follow-ups demonstrated good to excellent results. Conclusions: Personalized 3D printed prostheses offer an opportunity for a treatment of choice and provide good anatomical and functional results, shortened surgical time, less complications, and high satisfaction in patients with appropriate indications. The method should be considered primarily for patients with large bone defects, or such indicated for resection. Personalized 3D printed prostheses have the potential to become more common and beneficial in the future.

How understandable are the patient education materials about flat foot on the Internet for parents?

Flat foot is a common reason for parents to visit orthopedic clinics. As the Internet has become an easy-search platform, parents often seek online educational materials before seeking out a professional. The aim of this study was to investigate the quality, readability, and understandability of such online materials for parents. An Internet search was performed for "flat foot" and "pes planus" using the Google search engine. The readability was evaluated using 6 different grading systems: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Fry Readability score, Gunning Fog Index tests, and Automated Readability Index. The Patient Education Materials Assessment Tool test was used to assess the understandability. For quality assessment, the Journal of American Medical Association benchmark criteria and Health on the Net code were applied. One hundred nine websites were included and evaluated for readability, understandability, and quality. The mean readability grade for all websites was 10.5 ±â€…2.0. The mean Gunning Fog Index tests and Flesch-Kincaid Grade Level scores for all websites were 12.4 ±â€…2.2 and 9.7 ±â€…2.1 sequentially. The mean Coleman-Liau index score was 10.0 ±â€…1.5, and the average Fry Readability score was 9.9 ±â€…2.0. The automated readability index for all websites was 10.3 ±â€…2.5. The average Flesch Reading Ease score for all educational materials was 59.3 ±â€…10.1. The average Patient Education Materials Assessment Tool score for all educational materials was 81% (range, 70-87%). The mean Journal of American Medical Association benchmark criterion for all websites was 1.0, with a range from 1.0 and 2.0. Eighteen (16.5%) websites had Health on the Net certificates. Readability, understandability, and quality of patient education materials about flat feet on the Internet vary and are often worse than professional recommendations.

Treatment of comminuted radial head fractures with personalized radial head prosthesis produced with 3-dimensional printing technology.

BACKGROUND: The radial head is the forearm's pivot point for supination-pronation. Although radial head resection can be performed in comminuted radial head fractures, radial head prosthesis has gained popularity in order to prevent possible complications such as progressive valgus instability in the elbow and secondary ulnocarpal impaction that may develop due to proximal displacement of the radius. As for radial head prostheses, standard prosthetic designs do not provide the same results in everyone, and the alignment of the radial head and radial neck angle cannot be fully achieved. We believe that the radial head must be reconstructed with a complete anatomical implant. We designed and applied personalized prostheses to our patients, and in this study, we wished to share the 2-year results of these patients. METHODS: In this study, 23 patients who had comminuted radial head fractures had personalized radial head prostheses inserted. Preoperative variables such as type of injury, age, side, additional ligament injury, operation time, number of radial head parts, neck angle of individual prosthesis, stem length, and stem diameter were noted. The mean operating time was 26 ± 9 minutes. One month postoperatively, after physical therapy, elbow range of motion, loss of strength compared to the opposite joint, Mayo elbow scores, QuickDASH scores, and patient satisfaction were evaluated. Patients were evaluated 2 years postoperatively. RESULTS: QuickDASH and Mayo elbow scores were satisfactorily good (mean QuickDASH score: 9.091, mean Mayo score: 91.08). According to the results of the patient satisfaction questionnaire, 16 of the 23 patients reported excellent satisfaction, 5 patients good satisfaction, and 2 patients moderate satisfaction. None of the patients reported poor results. DISCUSSION: Since personalized radial head prosthesis consists of a single monoblock, its surgical application consists of a single step and has a short operating time. As the applications in the literature increase and more studies are conducted, this subject will be better understood. Our study demonstrated that these patients, whose anatomies were individually replicated, achieved good range of motion and patient satisfaction. In fact, none of the patients reported negative results. In comminuted radial head fractures, surgical implantation of personalized radial head prosthesis is a treatment modality with easy application, short operating time, and good functional results.

Evaluation of iliopsoas tendon using shear wave elastography after open reduction surgery for developmental dysplasia of hip.

OBJECTIVES: The aim of this study was to investigate the wholeness, thickness, and elastography measurements of the iliopsoas tendon using shear wave elastography who underwent open reduction surgery for unilateral developmental dysplasia of the hip. PATIENTS AND METHODS: Between January 2011 and December 2016, a total of 15 patients (2 males, 13 females; mean age: 24.6±26.3 months; range, 3 to 98 months) who underwent surgical treatment for unilateral DDH were retrospectively analyzed. In addition to demographic data, clinical findings such as muscle strength, range of motion, and the presence of limping were recorded. Ultrasound elastography was used to examine the thickness, shear wave velocity and elasticity of the iliopsoas tendons. RESULTS: The mean follow-up was 92.6±30.2 (range, 44 to 120) months. Full range of motion of the hips was observed in all patients. Hip flexor muscles' strength was 5/5 in bilateral. No hip dislocation or limping was not detected in any of the patients. Ultrasound examinations revealed that tenotomized iliopsoas tendons were intact in all patients. The mean muscle thickness was lower in operated sides, indicating no statistically significant difference. The mean velocity and elasticity were statistically significantly higher in the operated sides. CONCLUSION: This is the first study using shear wave ultrasonography for iliopsoas tenotomy of the patients underwent open reduction for developmental hip dysplasia. Re-adhesion of the iliopsoas tendons provided wholeness while healing as a more rigid and thinner structure compared to the intact sides.

Does clozapine really affect bone mineral density? An experimental study.

PURPOSE: The aim of this study was to investigate the effect of clozapine use on bone tissue by applying computerized tomography, dual-energy X-ray absorptiometry, and histological and biomechanical analyses in an experimental rat model. METHODS: Sixteen female Wistar Albino rats were included in this study. These animals were divided into two groups: the control group and the clozapine group. The animals in the clozapine group received 10 mg/kg clozapine, and the animals in the control group received tap water by oral gavage daily for 28 days. After sacrification, the femurs of the rats were used for radiologic, histologic, dual-energy X-ray absorptiometry, and biomechanical evaluations. RESULTS: Although the mean values of the clozapine group were higher in terms of histological, bone mineral density, and biomechanical evaluations, the statistical analyses were not significantly different. CONCLUSION: Clozapine use did not affect bone density in the rats. Clozapine can be the preferred treatment for patients with schizophrenia to avoid osteoporosis. It will be necessary to conduct further long-term follow-up and controlled studies in animals and humans to confirm these findings.

Effect of curcumin on bone healing: An experimental study in a rat model of femur fracture.

OBJECTIVE: To determine the radiologic, histologic and biomechanical effects of curcumin on bone healing using a total rat femur fracture injury model. MATERIALS AND METHODS: Sixty four male Wistar-Albino rats weighing 170-210 g were used in this study. The animals were randomly divided into eight groups and 5 or 6 animals were placed in each cage. A transverse femur shaft fracture model used. The animals in study groups received oral curcumin at a dose of 200 mg/kg for 14 days or 28 days. Remaining animals received only saline solution by oral gavage for a period of 14 days and 28 days as control groups. After sacrification the left femurs used for radiological, histological and biomechanical evaluation. RESULTS: The groups treated with curcumin showed no significant difference in terms of radiological, histological and biomechanical evaluations in 14 days groups. Also there was no significant difference between curcumin and control groups for 28 days according to radiological, histological and biomechanical tests. CONCLUSIONS: According to our results, curcumin has no positive effect on fracture healing not only histologically but also radiologically and biomechanically. Curcumin's antioxidant effect may be more noticeable with long term follow up investigation as it may have a positive effect in remodelling phase. Long term follow up designed studies may be planned to investigate its effect on remodelling phase of fracture healing.

Effect of curcumin on tendon healing: an experimental study in a rat model of Achilles tendon injury.

PURPOSE: This in vivo study aims to investigate the effects of curcumin which is recently developed for tendon healing using a rat Achilles tendon injury model. MATERIALS AND METHODS: Eighteen male Wistar albino rats weighing 300-400 g were used in this study. Under anesthesia, Achilles tendon injuries were created and repaired surgically. Nine rats of the study group received curcumin (suspended in saline at a dose of 200 mg/kg orally) and eight rats of the control group received only saline solution by oral gavage for a period of 28 days. Animals were euthanized on the 28th post-operative day, and all the Achilles tendons were removed and transferred immediately for biomechanic and histological analysis. RESULTS: Macroscopically, all the tendons were fully healed. Total mean Bonar score was higher in the control group. When the parameters of Bonar score were analysed separately, tenocyte morphology, collogen, and ground substance scores were statistically lower than the control group (p = 0.03, 0.041, 0.049, respectively). Vascularity parameter did not show any statistical difference (p > 0.05). Of the nine biomechanical parameters, five of them (failure load, cross-sectional area, length, ultimate stress, strain) showed better results which were also statistically significant (p = 0.046, 0.027, 0.011, 0.021, 0.002, respectively). When the remaining four parameters were examined, the study group also had better results, but this difference was not statistically significant. CONCLUSION: Curcumin had better results for total tendon healing not only histologically but also biomechanically. Curcumin could be an additional agent in the management of surgically repaired tendon injuries.