Do neutrophil/lymphocyte, monocyte/lymphocyte, platelet/lymphocyte ratios affect prognosis and stage in avascular necrosis of the femoral head?

INTRODUCTION: Avascular necrosis of the femoral head (AVNFH) is an osteonecrosis type caused by ischaemic osteocyte loss of femoral head, and its exact pathomechanism is still unknown. Neutrophil, lymphocyte, monocyte, platelet levels in complete blood count and ratios between these levels have been used by almost all medical disciplines as accesible and reliable biomarkers of immune response. Aim of this study is to identify the effects of neutrophil/lymphocyte (NL), monocyte/lymphocyte (ML), platelet/lymphocyte (PLT/L) ratios on prognosis and stage in patients with avascular necrosis of the femoral head (AVNFH). MATERIALS AND METHODS: A total of 106 (30 female; 76 male) patients aged 18 and over diagnosed with avascular necrosis of femoral head between 2012-2022 years were retrospectively evaluated. Study was planned after a total of 106 (30 female, 76 male) healthy patients with consent to participate who were demographically equal to the study group were included in the control group. Patients in the study group were divided into 3 groups as Stage I, II and III according to the Ficat-Arlet classification. RESULTS: In terms of neutrophil counts; neutrophil values of study and control groups were 4.94±1.89 and 4,21±1,17; respectively. There was statistically significant difference between counts (p<0.05). In terms of neutrophil/lymphocyte ratio, NL ratio was statistically significantly higher in study group (2.11±0.85) than control group (1.75±0.44). Cut-off value of NL ratio was 2.13 according to the ROC analysis (sensitivity 47.17% (95% CI (37.4-57.1)); specificity=84.91% 95% GA (76.6-91.1)). Sensitivity and specificity of cut-off value was statistically significant. There was no difference between groups created according to Ficat-Arlet in terms of hemogram parameters. DISCUSSION: NL may indicate AVNFH; however, other parameters are considered as inadequate for identifying an independent marker in AVNFH due to ineffective immune response. Future studies with larger samples which allow standard and multi-dimensional analysis are needed (Tab. 4, Fig. 5, Ref. 20).

Comparison of Surgical Results of Modified Stoppa and Ilioinguinal Approach in Patients with Acetabular Fractures Involving Quadrilateral Surface Fractures.

Objectives: The aim of this study was to evaluate the results of surgical treatment in patients with acetabular fractures with a fractured quadrilateral surface treated using two different approaches. Methods: The study included 106 patients who were operated on with ilioinguinal (group A) or modified Stoppa (group B) technique for acetabular fracture with a fractured quadrilateral surface between 2011 and 2020 in our clinic. The quality of reduction was evaluated according to Matta criteria and postoperative pelvic (anteroposterior, external oblique, iliac oblique) radiographs. Evaluation of hip function was recorded using the Merle d'aubigne and Postel Score and Harris Hip Score. Results: Among the patients included in the study, there were 45 patients in group A and 61 patients in group B. When the group data were compared, it was seen that the modified Stoppa approach was superior in terms of intraoperative reduction quality, radiological data, Harris hip score, Merle d'aubigne and PostelScore. (Respectively p=0.40, p=0.49, p=0.040, p=0.028). Conclusion: : Modified Stoppa approach has successful clinical and radiological outcomes and better reduction quality and hip scores than ilioinguinal approaches in acetabular fractures involving quadrilateral plates.

Quality and Content Analysis of Hallux Valgus Videos on YouTube®.

Our aim in this study is to analyze the content and quality of the videos about hallux valgus on YouTube®. The first 50 videos published by typing "hallux valgus" in the search engine on the YouTube® site were analyzed. The number of views of all videos, likes, dislikes, who uploaded the video, video duration, content, watch rate, and how many days it was uploaded were analyzed and recorded. All videos were analyzed with Journal of the American Medical Association (JAMA), DISCERN, GQS, and VPI scores. Six of the videos (12%) were from academic sources, 14 (28%) from commercial product vendors, 13 (26%) by medical animation organizers, 8 (16%) by physicians, 4 (8%) by physiotherapists, 2 (4%) by physical training trainers, 1 (2%) by patients, and last 2 (4%) by trainers. The JAMA mean score of the videos was recorded as 2 (1-4), GQS 3.02 (2-5), DISCERN score 37.56 (26-68), and Video Power Index 41.35 (0-470). The quality of YouTube® videos about hallux valgus is low. The content and quality of health-related information obtained through the Internet are of increasing importance for both healthcare professionals and patients.

Relationship between admission neutrophil/lymphocyte, thrombocyte/lymphocyte, and monocyte/lymphocyte ratios and 1-year mortality in geriatric hip fractures: Triple comparison.

BACKGROUND: Elderly patients with hip fractures have a high post-operative 1-year mortality rate. The aim of this study was to investigate the relationship of the neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (TLR), and monocyte/lymphocyte ratio (MLR) with mortality. METHODS: The data of 350 patients who suffered femoral intertrochanteric fractures between January 2015 and January 2020 were examined, and the demographic data of 124 patients who met the study criteria were evaluated. During the 1-year follow-up, 92 patients (74%) who continued their lives and 32 patients (25%) who died were divided into two groups: Group 1 (survivors) and Group 2 (non-survivors). NLR, TLO, MLO, presence of comorbidities, age, sex, American Society of Anesthesiologists Physical Status Classification, length of hospital stay, fracture type, and fracture pattern values were statistically compared between the two groups. RESULTS: NLR, TLR, and MLR are the laboratory parameters assessed within the scope of the study. Preoperatively, the mean NLR was 6.59 (1.61-26.29), mean TLR was 197.94 (86-516), and mean MLR was 0.73 (0.19-15.68). In this study, a significant relationship was found between NLR, TLR, and MLR values and the occurrence of post-operative 1-year mortality (p=0.01). In addition, the result was significant in the correlation between these parameters. Cutoff values were found to be 7.53 for NLR, 192 for TLR, and 0.54 for MLR in receiver operator characteristic curve analysis (p<0.01). CONCLUSION: NLR, TLR, and PLR are significant predictors of 1-year mortality in patients aged over 60 years with hip fractures.

Which is superior in the treatment of AO Type 42A tibial shaft fracture? A comparison of talon intramedullary nailing and conventional locked intramedullary nailing.

BACKGROUND: This study aimed to compare the clinical and radiological outcomes of conventional locked intramedullary nailing (IMN) and talon IMN in AO Type 42A tibial fractures. METHODS: A total of 93 patients with AO Type 42A fracture were retrospectively analyzed. The patients were divided into two groups: Those treated with conventional IMN (Group 1), and those treated with talon distal locked nailing (Group 2). The patients were statistically compared in terms of age, sex, mechanism of injury, follow-up time, time to union, smoking status, presence of open fracture, presence of concomitant fibula fracture, development of malunion and nonunion, and the number of intraoperative fluoros-copy shots captured. All patients were evaluated with American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores for clinical outcomes. RESULTS: A total of 93 patients (68 men and 35 women) participated in the study. Group 1 consisted of 35 (71.4%) men and 14 (28.6%) women, a total of 49 patients, while Group 2 consisted of 33 (75%) men and 11 (25%) women, a total of 44 patients. There were no significant differences between the two groups in terms of age, sex, mechanism of injury, follow-up times, smoking status, concomitant fibula fracture, presence of malunion, and presence of open fracture (p>0.05). However, there were significant differences between both groups in terms of time to union, nonunion rate, and the number of fluoroscopy shots captured (p<0.05). American Orthopaedic Foot and Ankle Society and Tegner Lysholm score were analyzed and compared, no statistically differences were found (p=0.786 and p=0.764). CONCLUSION: Although talon IMN reduces radiation exposure, locked conventional IMN has lower nonunion rates and achieves union faster.

How does tranexamic acid affect blood transfusion and bleeding amount in pelvis-acetabulum fractures treated with open reduction and internal fixation?

BACKGROUND: This study aimed to investigate intravenous tranexamic acid's (TA) effect on blood loss and transfusion ratios in pelvis-acetabulum fractures treated with open reduction and internal fixation. METHODS: Patients who underwent open reduction and internal fixation due to pelvis-acetabulum fractures between January 2017 and January 2019 constituted this study's target population. After applying inclusion and exclusion criteria, patients were divided into two groups: Those who were perioperatively given 15 mg/kg TA (i.e., Group 1) and those who were not (i.e., Group 2). Data including age, gender, mechanism of injury, fracture type, presence or absence of additional injuries, the time interval between admission and surgery, incision site, pre-operative and post-operative hemoglobin levels, intraoperative estimated blood loss (EBL), number of blood units transfused, and complications were recorded. Two groups were compared regarding these parameters. RESULTS: The study cohort included 58 patients. There were 30 patients in Group 1 and 28 patients in Group 2. Our analysis revealed that the number of blood units transfused was significantly higher in Group 2 than Group 1 (p=0.016). However, there was no significant difference between the two groups regarding intraoperative EBL, pre-operative and post-operative hemoglobin levels, and the time interval between admission and surgery. CONCLUSION: Administration of intravenous TA reduces blood transfusion requirement in patients with pelvis-acetabulum fractures treated with open reduction and internal fixation. This approach can prevent potential blood transfusion-related complications.

The Floating Knee Injuries: Does it Need a New Classification System?

BACKGROUND: This study aims to determine the differences between the clinical and radiological results of patients based on Karlstrom-Olerud Scoring System who cannot be included in any classification for floating knee injuries and to seek an answer to the question of whether a new classification is needed. MATERIAL AND METHODS: Seventy patients with floating knee injuries treated in our clinic were retrospectively analyzed between 2008 and 2019 in the study. The results of fractures that classifiable and unclassifiable according to the Fraser, Blake and McBryde classifications were statistically compared based on the Karlstrom-Olerud criteria. RESULTS: Seventy patients, 64 males and 6 females, participated in the study. The mean age of our patients was 32.3 ± 12.55 (18-68) years. The mean follow-up period of the patients was 30.26 ± 18.19 months (11-60 months). The results of the fractures that could not be classified according to the Blake and McBryde classification were statistically poorer than the results of those that could be classified according to the criteria (p = 0.041).The results of the fractures that could not be classified according to the Fraser classification were statistically poorer than the results of those that could be classified according to the criteria defined by Karlstrom and Olerud (p = 0.010). CONCLUSION: We observed that floating knee injuries that we could and could not classify led to different clinical results. In conclusion, we think that there is a need for a new floating knee classification that includes segmental fractures, patellar fractures and open fractures.

The Top 100 Most-Cited Articles on Hallux Valgus.

BACKGROUND: To perform the citation and content analysis of 100 articles on Hallux valgus from the most cited to the least. MATERIALS AND METHODS: Articles published on Hallux valgus between 1980 and 2020 were analyzed by making use of the Web of Science database. Articles were ranked from most cited to the least. Content analysis of all articles was also carried out. Original research articles, reviews, and clinical trials were included in the study whereas case reports were excluded from the study. RESULTS: The total number of citations of the 100 most-cited articles was 7,697. The most-cited article was 'Prevalence of hallux valgus in the general population; systematic review and meta-analysis' published by Sheere Nix in Journal of Foot and Ankle Research in 2010. The country where the articles were mostly produced was USA (n = 46). The most interesting issue was the osteotomy techniques and changes in Hallux valgus surgery. CONCLUSION: The treatment of the Hallux valgus disease is still discussed today. Citation analyses have shown that surgical developments related to HV surgery still attract attention, and this information will be updated continuously in line with the increasing number of articles.

The Top 100 Most-Cited Articles on Ankle Arthroscopy: Bibliometric Analysis.

The aim of this study was to analyze the 100 most-cited articles on ankle arthroscopy. Using the keyword ankle arthroscopy, the 100 most-cited articles in the Web of Science database were analyzed. Original articles, reviews, clinical trials, and case reports were included in the study. The search period included studies conducted between the years 1990 and 2020. The number of citations of the 100 most-cited articles ranged from 56 to 225 (mean, 95.52). The total number of citations was 9552. Among the articles examined, most were produced in the United States of America. The American Journal of Sports Medicine was the journal in which the most-cited articles were more frequently published. The article topic that drew attention most was osteochondral defects. Ankle arthroscopy is a technique that is still open to development and is a current topic that should be studied. Analyzing the 100 most-cited articles, it can be seen that most studies are on osteochondral defects. More articles will increase scientific data and provide more realistic solutions to ankle problems.

Evaluation of complications in patients with open fractures of the upper and lower extremity treated with internal fixation after the external fixation.

BACKGROUND: Open fractures constitute an important mortality and morbidity cause among all musculoskeletal system injuries and bring along many social and economic problems. The cost occurring due to both long treatment duration and the delay in returning to work made these conditions more complicated. The present study aims to evaluate of the complications which may occur in cases with an application of internal fixation following external fixator in upper and lower extremity open fractures retrospectively. METHODS: Forty-nine patients, who applied to the emergency service between 2007 and 2013, participated in this study. Thirty-two of these patients consisted of the patients to whom external fixator was first placed, and then internal fixation was performed by us, while 17 patients were treated in another center with the external fixator, and then their treatments were performed by us. All patients' injury mechanism, duration of follow-up with an external fixator, whether debridement was performed after external fixator, the period between external fixation and internal fixation, pin site infection, duration of the union, delayed union, nonunion, whether bone graft was used during internal fixation, internal fixation type, reoperation, development of osteomyelitis and follow-up parameters were recorded. RESULTS: Results were evaluated separately for radius, humerus, tibia and femur fractures. Of the 49 patients, 39 were male, and 10 were female. Mean follow-up time for tibia 28.6 months, for femur 34, for humerus 26.9, for Radius 27 months. Of the 49 patients who participated in this study, 15 applied with upper extremity (11 humeri, 4 Radius) injury and 34 applied with lower extremity (25 tibias, 9 femora) injury. Of the 49 patients, 32 had pin tract infection, 11 had nonunion, 11 had delayed union, two had osteomyelitis. CONCLUSION: Open fractures are always hard to treat. After external fixation to the internal fixation process have some complications, phsycians should be aware of all these problems and plan according to the situation.

How do vertebroplasty and kyphoplasty affect the quality of life of patients with multiple myeloma spinal metastasis?

BACKGROUND: Metastatic spinal lesions are diseases that impair the quality of life and require early diagnosis and treatment. The count of spinal metastasis patients rises day by day. Increased life expectancy has increased the incidence of cancer, making metastases more observable. The aim of our study was to investigate how the quality of life is affected in the patient group with vertebral fracture due to spinal metastases of multiple myeloma and undergoing vertebroplasty and kyphoplasty. MATERIALS AND METHODS: Forty-two patients with fracture due to spinal metastasis and adequate follow-up between the years of 2011 and 2018 were included in the study. Patients were listed according to their primary malignancy and metastases. The effect of vertebroplasty and kyphoplasty was investigated by evaluating preoperative and postoperative VAS and Oswestry Disability Index scores. All patients' radiographic kyphosis angle, compression ratio and wedging index were calculated before operation and after operation. RESULTS: A total of 76 vertebrae were operated in 42 patients. Significant differences were found in the comparison of preoperative and postoperative quality of life according to VAS and Oswestry Disability Index scores in the patients undergoing vertebroplasty, kyphoplasty or both procedures after spinal metastases (VAS; p = 0.0001, ODI; p = 0.002/0.0001). There were statistically significant differences in preoperative local kyphosis angle, compression ratio and wedging index and post-op local kyphosis angle, compression ratio and wedging index (p = 0.001). CONCLUSION: Vertebroplasty and kyphoplasty, minimally invasive procedures performed after spinal metastases, improve the quality of life of the patients.

Retendo (mucopolygen complex) effects on achille tendon healing.

INTRODUCTION: The injuries of achilles tendon which is among the most important tendons in the body include many problems. Limited tendon recovery is provided through the surgical procedures available. Re-rupture occurs during and after recovery and the long time it takes to return to work, impossibility of early movement of the affected ankle and not being able to provide a physiological recovery in tendon constitute a problem. Thus, our objective in this study was to demonstrate the recovery effects of Retendon (mucopolygen complex) on achilles tendon. MATERIAL-METHOD: After taking the consent of the ethics board we applied for animal experiments, the experiment animals in our study were separated into two groups as those which were given Retendo® (Mucopolygen Complex - Mucopolysaccharides, Hydrolyzed Collagen Type I, Vitamin C) and the control group. These two groups were separated into four groups. In a total of eight groups, 40 female Wistar-Albino rats with an average weight of 200-350 gr. were included in the study. RESULTS: The study had biomechanical and histological results. While there was no significant difference in vascularization, inflamation and fibroblastic level among the groups in histological terms, collagen formation was detected to be more regular in the experiment group than the control group. A significant efficiency couldn't be acquired in biomechanical terms. DISCUSSION: Although Retendo® (mucopolygen complex) is commonly used in muscle and tendon diseases, its effect mechanism is not definitely known. But in the light of the findings we acquired in our study, we detected that Retendo® (mucopolygen complex) applied after achilles tendon ruptures positively effected collagen sequencing during recovery in histological terms but didn't have a significant effect on the mean load achilles tendon can tolerate before rupturing.