Antibiotic release and antibacterial efficacy in cement spacers and cement beads impregnated with different techniques: In vitro study.

OBJECTIVES: This study aims to compare the antibiotic release and biological effectiveness of bead type and articulating spacers of different cement types with antibiotics added at alternative phases of cement preparation. MATERIALS AND METHODS: Four gram vancomycin was added into two types of antibiotic-free cement (Simplex®, Biomet®) with similar viscosity and also gentamycin-containing cement (Refobacin®). Prepared specimens were used to create cement beads and articulating hip spacers, making a total of six different groups. Two alternative groups were formed by adding the Vancomycin while the cement was in dough phase. Antibiotic release and biological activity were evaluated with immunoassay techniques and agar-disk diffusion methods. RESULTS: All groups showed initial antibiotics surge in the first week, which was 2 to 4 times more evident in the beads group. Antibiotic release and change in release rate were significantly different between Simplex-alternative and Simplex, Biomet, Refobacin-beads, and between Biomet-spacer and Refobacin-beads groups (p<0.05). Elution of antibiotics was not different between mobile spacers prepared with conventional or alternative methods (p>0.05). Biomet cement showed larger diffusion inhibition zone in agar. There was no difference between biological activity of the bead and mobile designs of the Biomet brand (p>0.05). Inhibition zone analyses of agar and disk diffusion tests revealed significant differences between several groups (p<0.05). CONCLUSION: Cement beads provide superior antibiotic release regardless of cement type or preparation method. Simplex P® cement has lower anti-bacterial efficiency than Biomet®. Different methods for cement and antibiotics mixing and addition of extra vancomycin into the commercially drug loaded cement do not have any effect on the results.

A randomized comparison of the proximal crescentic osteotomy and rotational scarf osteotomy in the treatment of hallux valgus.

OBJECTIVES: The aim of this study was to compare clinical and radiological results of proximal crescentic osteotomy (PCO) and rotational scarf osteotomy performed in the treatment of hallux valgus. METHODS: A total of 57 consecutive patients (60 feet) with symptomatic hallux valgus deformity were randomly assigned to one of two groups. The PCO group consisted of 22 women and 5 men (30 feet) and the mean age was 43(±14.5) years. The scarf group consisted of 23 women and 7 men (30 feet) and the mean age was 40.9(±12.6) years. Outcomes were assessed by using of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS). Weight bearing X-rays were used for radiological evaluation. RESULTS: The mean AOFAS scores improved from 42(±16.2) to 66.7(±13.4) points in PCO group and from 36.2(±16.1) to 73.2(±13.5) points in scarf group. The mean pain score improved from 6.3(±1.3) to 2.4(±2) in PCO group and from 6.5(±1.9) to 2.5(±1.3) in scarf group. The mean hallux valgus angle (HVA) decreased from 38.1°(±7.1) preoperatively to 23.8°(±8.5) at postoperative first year in PCO group, and from 36.1°(±7.5) preoperatively to 22.2°(±7.5) at postoperative first year in scarf group. The mean intermetatarsal angle (IMA) decreased from 17.3°(±3.8) preoperatively to 11.8°(±3.3) at postoperative first year in PCO group, and from 16.2°(±2.6) preoperatively to 9.3°(±2.4) at postoperative first year in scarf group. When all the patients were assessed together, the relations between preoperative DMAA values and postoperative first year HVA (r = 0,327) and IMA (r = 0,399) values were positive but had low significance. The HVA and IMA values were increased in both groups at the end of the first year when compared to the postoperative sixth week values (p < 0.01 for both groups for both values). CONCLUSION: The PCO and the rotational scarf osteotomy in the treatment of hallux valgus deformity provides a satisfactory correction. The clinical and radiological results of both methods are similar. Especially in patients with high preoperative DMAA, an increase in the HVA and the IMA values may occur in the first postoperative year when compared to the postoperative sixth week values. LEVEL OF EVIDENCE: Level II, therapeutic study.

Tibial Tuberosity-Trochlear Groove Distance Shows no Change in Patients with or Without Knee Osteoarthritis.

OBJECTIVE: The primary aim of this study is to compare tibial tuberosity-trochlear groove (TTTG) distance in patients with or without knee osteoarthritis. Additionally, the variability of tibial tubercle according to trochlear groove was evaluated. MATERIALS AND METHODS: In this retrospective cohort study, TTTG distance was measured with two different methods on magnetic resonance (MR) images. TTTG distance was measured by the familiar method on 173 MR images, and by the novel method on 157 MR images of 175 patients totally. The patients were divided into two groups as group 1 (Kellgren Lawrence osteoarthritis grade <2) and group 2 (Kellgren Lawrence osteoarthritis grade ≥2). TTTG values measured by both methods were compared between groups. The coefficient of variation for all patients in TTTG values were calculated. A p-value <0.05 was considered as significant. RESULTS: The mean age, sex distributions, and side ratios were different between groups. There was no statistical difference in TTTG values between group 1 and 2. There was no statistically significant difference between the two measurement methods. The coefficient of variation for all patients in TTTG values were high (43.95% for familiar method and 44.64% for novel method). There was excellent interrater reliability for two measurement methods in both groups. CONCLUSION: The TTTG distance is similar in patients with/without knee osteoarthritis. The position of the tibial tubercle according to the trochlear groove is variable, so the tibial tubercle may not be a good reference point for rotational position of the tibial component in total knee arthroplasty.

ESIN and K-wire fixation have similar results in pediatric both-bone diaphyseal forearm fractures.

BACKGROUND: The purpose of this study was to compare short-term radiographic and clinical results of pediatric both-bone diaphyseal forearm fractures treated with intramedullary nail fixation using titanium nails or K-wires. METHODS: This was a prospective comparative trial. In total, 43 patients with both-bone open or closed forearm fractures who underwent surgical treatment with intramedullary fixation were randomly classified into two groups. Three patients did not return for the follow-up and were excluded from the study. Twenty of the 40 patients were assigned to the elastic stable intramedullary nail group and 20 were assigned to the K-wire group. Demographic data suggested no difference between the two groups except for the side of injury. Perioperative data and radiological and clinical outcomes were evaluated. RESULTS: The cohort comprised 5 girls and 35 boys whose mean age was 11.60 ± 2.69 years. Except the proportion of patients who were conservatively followed up preoperatively, all perioperative data were similar between the groups. Radiographic and functional results were similar. There were two delayed unions; one pin track infection and one re-fracture. CONCLUSION: Intramedullary fixation of forearm fractures in children with titanium nail or K-wire does not affect radiological and clinical results. Both elastic stable intramedullary nail and K-wire fixation were effective in stabilizing pediatric diaphyseal forearm fractures.

Is axial shape of distal femur different in normal and osteoarthritic female patients?

OBJECTIVES: This study aims to investigate whether the axial shape of the distal femur is different between normal and osteoarthritic female knees using statistical shape analysis. PATIENTS AND METHODS: A total of 126 knee magnetic resonance images of 126 female patients were examined in this study conducted between May 2013 and May 2014. Patients were divided into two groups as study and control groups. The study group consisted of 41 patients (median age 65 years; min. 36 - max. 88 years) who were determined to have knee osteoarthritis, while the control group consisted of 85 patients (median age 43 years; min. 20 - max. 81 years) without knee osteoarthritis. Anatomic and constructive landmarks were selected and marked on each two-dimensional digital image in the axial section of the distal femur. The mean axial shapes of the distal femur were compared between the groups by statistical shape analysis. Shape deformations were investigated by thin plate spline analysis. RESULTS: There were significant differences between the groups regarding the axial shape of the distal femur. Maximal deformation was observed in the femoral notch area. CONCLUSION: This study showed that there are deformations in the axial shape of the distal femur in female patients with knee osteoarthritis. Further studies are required to determine whether these differences are important for implant design and surgical technique of total knee replacement.

Calibration and efficiency curve of SANAEM ionization chamber for activity measurements.

A commercially available Fidelis ionization chamber was calibrated and assessed in PTB with activity standard solutions. The long-term stability and linearity of the system was checked. Energy-dependent efficiency curves for photons and beta particles were determined, using an iterative method in Excel™, to enable calibration factors to be calculated for radionuclides which were not used in the calibration. Relative deviations between experimental and calculated radionuclide efficiencies are of the order of 1% for most photon emitters and below 5% for pure beta emitters. The system will enable TAEK-SANAEM to provide traceable activity measurements.

The effect of local and systemic application of tranexamic acid on the amount of blood loss and allogeneic blood transfusion after total knee replacement.

The effect of local and systemic Tranexamic Acid on blood loss and need for transfusion after total knee replacement was compared prospectively. Between 2012-2013, 90 patients with unilateral TKR were included. They were randomly divided into 3 and 15 mg/kg TXA was infused before and 10 mg/kg 1 hour after surgery in Group 1, 2 gr TXA was used topically in 2 and no TXA was applied in 3. Total blood loss and transfusion rate were used as outcome. Mean amounts of blood loss were 898.03 ±â€ˆ298.21, 823.64 ±â€ˆ224.33 and 1263.77 ±â€ˆ298.79 ml in Groups 1, 2 and 3 respectively. There was a decrease in blood loss in TXA groups (p < 0.001). No difference was found between local and systemic groups (p = 0.385). Transfusion was not required in TXA groups but it was 8 in control group. No thromboembolic problem was seen in any patient. Since TXA decreased blood loss and lessen the need for transfusion significantly without increasing thromboembolic events in TKR, we suggest its usage in TKR either systemically or topically whenever possible. Level of evidence: Prospective Randomized Controlled Trial, Level II).

Half-life measurements of lutetium-176 using underground HPGe-detectors.

The half-life of (176)Lu was determined by measuring the (176)Lu activity in metallic lutetium foils. Three different HPGe-detectors located 225 m underground were employed for the study. Measurements using the sum-peak method were performed and resulted in an average massic activity of (52.61±0.36) Bq g(-1). The foils were of natural isotopic abundance so using the massic activity and the value of the natural isotopic abundance of (2.59±0.01)%, a half-life of (3.722±0.029)×10(10)a could be calculated.

A new versatile underground gamma-ray spectrometry system.

The newest development in IRMM's underground analytical facility is a large lead shield lined with copper that is versatile and can host several detectors of different types. The characteristics and the background performance of the shield are described for four different detector configurations involving HPGe-detectors and NaI-detectors. The shield has been designed to swap detectors, while still maintaining a low background. This enables testing of detectors for other experiments and optimisation of detection limits for specific radionuclides in different projects.

Centre of the posterior cruciate ligament and the sulcus between tubercle spines are reliable landmarks for tibial component placement.

PURPOSE: The purpose of the present study was to determine whether the axes aligned with the sulcus between the tibial spines and the middle of the posterior cruciate ligament at the knee and with the tibialis anterior tendon at the ankle provide a neutral rotational and coronal alignment of the tibial component in total knee arthroplasty (TKA). METHODS: In a cohort of 45 TKA patients, CT scans were taken to quantify coronal and rotational positioning of the components. All patients received a posterior stabilised total knee replacement with a fixed insert (PFC Sigma; DePuy Orthopaedics, Inc; Warsaw, IN, USA). The tibial guide was aligned with the sulcus between the tibial spines and the middle of the posterior cruciate ligament at the knee and with the tibialis anterior tendon at the ankle. RESULTS: The average post-operative coronal mechanical alignment was 1° varus (range 4.5° varus-1.5° valgus; SD ±1.51). The average post-operative rotational deviation from the transepicondylar axes (TEA) was 0.78° of internal rotation (1.50° of internal rotation - 3.5° of external rotation) for the tibial component. The whole-extremity mechanical axis deviation was outside the tolerance range of 3° in 4 patients (8.9 %). Deviation of the tibial component rotational position relative to the TEA was 3° or less in 94.5 % of the patients. CONCLUSIONS: When the tibial component is aligned using the axis drawn from the centre of the PCL to the sulcus between the tibial spines on the proximal tibia and to the tibialis anterior tendon at the ankle, good alignment will be achieved in both the coronal and axial planes. LEVEL OF EVIDENCE: IV.

Accuracy of anatomical references used for rotational alignment of tibial component in total knee arthroplasty.

PURPOSE: This study aimed to research which was the most reliable of the four techniques based on local anatomic markers used to determine tibial component rotation in total knee arthroplasty, and whether the markers varied in knees with varus deformity. METHODS: The study included 33 knees with a normal anatomic axis and 32 knees with a varus deformity and osteoarthritis. On the MR images, the femoral transepicondylar axis (TEA) was determined and transposed to the standard tibial resection level. At this level, four axes were drawn on the axial sections: tibial posterior condylar line (PC), tibial plateau anterior line (AC), a vertical line (AA) drawn to Akagi's line, and the maximal mediolateral distance (MMLD). The relationships of these lines and the transposed TEA were compared between two groups. RESULTS: In all the knees, the mean values of the PC, AA, and MMLD axes compared to TEA reference were 5.5° ± 5.7 (mean ± SD), 7° ± 3.2, and 6.7° ± 8.1 internal rotation, respectively, and the AC axis was 8.9° ± 6.7 external rotation. In the AC, AA, and MMLD axes, the change occured because of varus deformity was statistically meaningful. For all the observers, the axis with the least SD and the most accuracy was the AA axis. CONCLUSIONS: Of the four axes used to determine tibial component rotation, only the PC axis is not affected by varus deformity, and the least affected axis according to the observers was the AA axis, and thus the AA and PC axes can be used for guidance in determining the rotation of the tibial component. LEVEL OF EVIDENCE: Prognostic studies-investigating natural history and evaluating the effect of a patient characteristic: High-quality prospective cohort study with >80% follow-up, and all patients enrolled at same time point in disease, Level I.

[The relationship between chronic hip pain and femoroacetabular impingement: an evaluation with clinical signs and radiography]. / Kronik kalça agrisi ile femoroasetabuler sikisma arasindaki iliski: Klinik bulgular ve radyografi ile degerlendirme.

OBJECTIVES: In this study, we investigated the rate of the clinical and radiographic findings of femoroacetabular impingement (FAI) in patients with chronic hip pain and compared the findings with those of a control group. PATIENTS AND METHODS: The clinical and radiographic findings of FAI in 38 patients (group 1) having hip pain for more than three months were analyzed and compared with 42 controls (group 2). Internal rotation degrees were measured while the hips were at 90° flexion and impingement test was performed by rotating the hips internally at 90° flexion and adduction. The FAI findings were investigated on anteroposterior pelvis radiographs and cross-table lateral radiographs of the hip joint in both groups. The collum-diaphyseal angle, alpha angle and anterior offset ratio on the femoral side and the center-edge angle, acetabular index, extrusion index and crossover sign on the acetabular side were evaluated. RESULTS: The internal rotation degree of the painful hips were less than 20 degree in 18 (47.4%) patients in group 1 and in one (2.4%) patient in group 2 (p<0.001). The impingement sign was positive in 15 (39.5%) patients in group 1 and in one (2.4%) patient in group 2 (p<0.001). While the rate of radiographic findings that can cause pincer type FAI were same in both groups, the rate of patients with radiographic findings that can cause cam type FAI was 76.3% (n=29) in group 1 and 42.9% (n=18) in group 2 (p=0.002). CONCLUSION: Femoroacetabular impingement is one of the causes of chronic hip pain and if evaluated with suitable clinical and radiographic parameters, the rates of diagnosis may increase.

A comparison of the scapular manipulation and Kocher's technique for acute anterior dislocation of the shoulder.

OBJECTIVES: The aim of the present study was to compare the scapular manipulation technique and the Kocher's method in terms of efficacy, safety, and the intensity of pain felt by the patient in the reduction of acute anterior shoulder dislocation. PATIENTS AND METHODS: Between July 2009 and January 2010, a total of 64 patients with acute traumatic anterior dislocation of the shoulder were evaluated. Of the 64 patients assessed, three patients were excluded because of cardiopulmonary problems. The remaining 61 patients (41 males, 20 females; mean age 42±18.5 years; range 17 to 87 years) were enrolled in this prospective randomized study and divided into two groups. Thirty-one patients were treated with scapular manipulation (group 1) and 30 patients were treated by the Kocher's method (group 2). A procedural sedation/analgesia was applied before the reduction to meet the target sedation score of 1 or 2 according to the Ramsay sedation scale. A visual analog scale was used to determine the intensity of the pain felt by the patients during reduction. RESULTS: Reduction was successfully achieved with the scapular manipulation method in 96.7% of the patients, and with the Kocher's method in 93.3% (p>0.05). The degree of pain experienced by group 1 was lower than group 2 (p<0.01). CONCLUSION: Both scapular manipulation and Kocher's techniques are successful and reliable methods when procedural sedation/analgesia is used routinely. Scapular manipulation is a less painful method of reduction of an anterior shoulder dislocation in comparison with the Kocher's technique.

[Treatment of intertrochanteric femur fractures in high-risk geriatric patients (≥65 years) with external fixation]. / Ileri yasli (≥65 yas) yüksek riskli olgularda gelisen intertrokanterik femur kiriklarinin eksternal fiksatörle tedavisi.

BACKGROUND: We evaluated the results of intertrochanteric hip fractures treated with closed reduction and external fixation (minimally invasive and biological osteosynthesis) in patients with high surgical risk. METHODS: Twenty-three patients (14 females, 9 males; mean age 74 [65-88]) with intertrochanteric hip fracture classified as group III and IV according to American Society of Anesthesiologists (ASA) criteria were treated with closed reduction and unilateral external fixation under short-term anesthesia. Fourteen fractures were stable (60.8%) and nine were unstable (39.2%). The mean follow-up was 23.8 months (4-58). We evaluated the operation time, hospitalization time, union time, mobilization capacity, complications, and mortality rates. RESULTS: The mean duration of operation was 25 minutes (15-40), mean duration of hospital stay 4 days (2-9) and average union time 13 weeks. Five patients (21.7%) died due to additional health problems in the first six months after surgery. Superficial pin tract infection occurred in 11 cases (47.8%). There was no implant failure. In the last follow up, an average 5° varus (range: 0-8°) and 1 cm shortening (range: 0-3) in stable fractures and an average 15° varus (range: 8-20°) and 3 cm shortening (range: 2-5) in unstable fractures were determined. CONCLUSION: The treatment of intertrochanteric hip fractures with closed reduction and external fixation is an easy, effective and safe biological fixation method with minimal damage to surrounding tissues, especially in patients with high surgical risk.

Foot mobility and plantar fascia elasticity in patients with plantar fasciitis.

OBJECTIVES: In this study, we investigated the radiologic changes of feet in sagittal plane under weightbearing either with or without plantar fasciitis. METHODS: The study includes 64 feet of the 42 subjects with heel pain (Group 1: 32 women, 10 men, mean age 48 years, range 33-57 years) and 80 feet of the 40 patients (Group 2: 30 women, 10 men, mean age 47.2 years, range 35-56 years) without heel pain. Calcaneal inclination angle (CIA), calcaneal-first metatarsal angle (CMA), and plantar fascia length (PFL) were measured in the lateral radiographs of the weightbearing and non-weightbearing foot. The values of Group 1 and Group 2 were compared. RESULTS: The mean CIA was 26° (range 18-35°), CMA was 121° (range 115-133°), and PFL was 131 mm (range 110-158 mm) in non-weightbearing position for Group 1. The mean CIA was 27° (range 17-38°), CMA was 122° (range 110-135°), and PFL was 136 mm (range 120-155 mm) in non-weightbearing position for Group 2. The mean CIA was 13.6° (range 5-25°), CMA was 138° (range 130-153°), and PFU was 143.8 mm (range 118-158 mm) in weightbearing position for Group 1. The mean CIA was 9.9° (range 4-25°), CMA was 145° (range 130-155°), and PFU was 151.4 mm (range 137-167 mm) in weightbearing position for Group 2. The difference between CIA, CMA, and PFL values were -13°, 17°, and 12 mm under condition of weightbearing and nonweightbearing position values for Group 1; and -17°, 23°, and 15 mm for Group 2. The differences were significant between weightbearing and non-weightbearing position values (p<0.05). CONCLUSION: The reduced CIA, CMA, and PFL changes during weight bearing might show reduced foot mobility and plantar fascia elasticity, which may lead to posterior heel pain syndrome.

What do patients recall from informed consent given before orthopedic surgery?

OBJECTIVES: We aimed to evaluate the effectiveness of the consent process and the retention of relevant information in patients with orthopedic trauma and those undergoing elective surgery. METHODS: The study enrolled 142 consecutive patients (79 women, 63 men; mean age 52.02±20.05 years) undergoing either elective or trauma-related surgery. The patients were introduced to the consent process, which involves a verbal and written explanation of the orthopedic condition, surgical procedure, and intraoperative and postoperative risks. At postoperative 1-3 days, patients were asked to recall the orthopedic condition, procedure they underwent, and risks of the surgery. RESULTS: The rate of recall by patients was 131/142 patients (92.3%) for diagnosis, 86/142 patients (60.6%) for surgical procedure, and 32/142 patients (22.5%) for potential complications. Fifty-nine patients (41.5%) could not recall any potential complications. Gender did not influence the ability to describe the operation or potential complications (p>0.05). Advanced age negatively affected recall of information about the surgery and complications (p<0.01), and educational level was correlated with the recall rate (p<0.05). Forty-two patients (29.6%) claimed to have read the consent form before signing it. A greater percentage of patients undergoing elective surgery had read the consent form (p<0.05). Rate of not recalling any potential complications was higher in the trauma group compared with the elective surgery group (p<0.01). CONCLUSION: Patients had poor retention of information presented during the consent procedure. Further attention should be focused on enhancing patients' understanding of several components of the informed consent process for surgery.

Turf toe in a taekwandoo player: case report.

Metatarsophalengeal joint injuries of great toe termed as ''turf toe" can occur in many sportive activities. However, it has not been reported before in taekwondoo players. These injuries may result in significant morbidity. Turf toe injuries, which are mainly treated with conservative methods, occasionally require surgery. In this case report, we present a surgically treated turf toe in a taekwondoo player. Key PointsMTP joint injury may occur when the joint is forced into hyperextension repeatedly if the exercise is being performed bare foot on hard and artificial surfaces.Surgery should be taken into consideration as a choice of treatment of Turf Toe.