Metacarpal squeezing reduces grip strength.

Unduly tight plaster hand casts may narrow the metacarpal joint space, hindering rehabilitation. This study investigated how metacarpal narrowing affects grip strength. Forty-two adult volunteers with no other pathology were included. Dominant and non-dominant hand grip strength was measured with a digital hand dynamometer (Jamar plus, China). Metacarpal width was measured with a metal caliper, and the caliper was then fixed at 10% narrowing of the joint space, and a second measurement of grip strength was taken. The measurements were thus taken twice each in the dominant and non-dominant hand, and the average of the two was recorded. A total 336 measurements were taken in the dominant and non-dominant hands of 42 individuals at two time points. There was no significant difference in grip strength between dominant and non-dominant hands (p = 0.183). After 10% narrowing, both the dominant and the non-dominant hand showed a mean 33.4% reduction in grip strength: i.e., squeezing the metacarpus with a caliper significantly reduced grip strength in both dominant and non-dominant hands (p = 0.01). The study thus showed that grip strength will decrease significantly when the metacarpus is squeezed by a tight cast. Although the patient does not feel the 10% narrowing of the metacarpus, it is clear that hand muscle mass may be adversely affected in the long term.

Synostosis after fracture of both forearm bones treated by intramedullary nailing.

This study evaluated the risk of radioulnar synostosis after fracture of both forearm bones at the same level. We hypothesized that (i) the incidence of synostosis in both-bone forearm fractures at the same level is low with intramedullary nailing (IMN); (ii) the type of fracture (open/closed) and type of reduction (open/closed) affect time to union. Seventy-eight patients who had been treated with IMN for fracture of both forearm bones and had at least 1 year of follow-up were included in the study retrospectively. All the patients were treated by IMN following closed reduction or open surgery. Patients were followed clinically and radiologically. Age, open or closed fracture, time to union, and occurrence of synostosis were documented. The mean age of the patients was 33.4 years. Fifty-three (68%) patients were male. Forty-eight (61.5%) patients had high velocity injuries. The mean follow-up was 26.4 (12-46) months. According to the Grace and Eversmann scoring system, 95% had good or excellent outcomes. The mean DASH score was 10.5 (0-56). Union rate was 100%. Only one patient (1.2%) had a radioulnar synostosis at middle third level. IMN is a safe method that yields a high union rate and contributes to a low incidence of synostosis. Open fracture and open reduction during surgery have no effect on time to union.

The Role of 3D Modeling in Education of Orthopedic Trainees for the Treatment of Foot Deformities.

PURPOSE OF THE STUDY We hypothesized that preoperative planning with 3D modeling of complex foot deformities would be useful for the education of orthopedics and traumatology residents. MATERIAL AND METHODS This study is prospectively designed study with a control group. Twenty eight residents (study group) who assisted the surgeons during the interventions and ten senior surgeons (control group) were included in the study. All participants assessed virtual 3D-CT images and videos of the cases before the surgery. Ten adult cases of foot bone deformities were evaluated. 3D-CT reconstruction was performed and a 3D model of each deformity was created using the hospital's picture archiving and communication system. The completed 3D models were sterilized in hydrogen peroxide and put on the surgical table in a sterile manner. After surgery, the residents (group I) and surgeons (group II) were questioned regarding their satisfaction with 3D modeling. Responses were structured by a five-point Likert scale (1, strongly disagree; 2, disagree; 3, neither agree nor disagree; 4, agree; and 5, strongly agree). RESULTS The surgeons (group II, n = 10) were satisfied with the sterilized 3D models, which they could touch and re-examine on the operating table. The residents (group I, n = 28) were significantly more satisfied than the senior surgeons (p=0.01). The 3D modeling met both the surgeons' and residents' expectations. DISCUSSION The survey results for the surgeons (group II) were satisfied with the sterilized 3D models, which they could touch and reexamine on the operating table (question 3). They gave the best scores (mean, 4.8/5) for clarity of the 3D model. On the other hand, they gave the lowest scores (mean 3.1/5) to 3D models due to its contribution in understanding deformity over virtual 3D-CT evaluations (question 2 and 5). The residents (group I) differed from those for the senior surgeons. Residents gave the highest scores for understanding of the deformity (question 2 and 5) and clarity (question 1). These outcomes may be interpreted to indicate i) that 3D modeling may be used for education, and ii) that younger surgeons are more interested in novel technological developments. Therefore, the outcomes did differ significantly between the senior surgeons and residents (Table 1). These outcomes may be explicated as; 3D modeling of the foot deformities may not be mandatory for the experienced surgeons for understanding the deformity. On the other hand 3D modeling would be useful tools for younger surgeons and for their education. CONCLUSIONS 3D modeling of foot deformities is more informative than virtual 3D videos. However, with consideration of costs and long processing times, 3D printing may be used optimally for rare deformities. When considering the role of touch sense in surgical learning, 3D modeling gives more detailed and more satisfactory planning than virtual 3D videos. 3D modeling is more useful for young surgeons, and it will be used mainly for education in the future. Key words: 3D printing, deformity, foot and ankle, simulation.

Safety and Efficacy of Intra-Articular 20 mg/2 ml Hyaluronic Acid Injection for the Non-Operative Palliation Treatment of Osteoarthritis of the Knee Joint.

PURPOSE OF THE STUDY In this study it is aimed to prospectively evaluate the safety and efficacy of 20 mg/2 ml Hyaluronic Acid (HA) injections for non-operative palliation treatment of osteoarthritis (OA) of the knee joint. MATERIAL AND METHODS After institutional review board approval was obtained for the study, 63 patients were enrolled and followed prospectively. All the patients have signed informed consent form. Patients who had diagnosis of gonarthrosis according to clinical and radiological evaluation, were given nonsteroid antiinflammatory drug (NSAID) treatment for four weeks. Patients between 55-80 years old in both sexes, whose pain did not relieve were included to the study and were followed up for 6 months. They were applied HA injections in total; three times with one week of interval. Patients were evaluated three times during the study. First one at third week (at the control visit of third injection), secondly at third month and lastly at sixth month. Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Short Form Health Survey (SF-36) scores were used to clinically evaluate the patients at follow ups. RESULTS 56 (88.9%) patients completed the study and 7 (11.1%) patients did not show up for follow-up examinations and they were excluded. The mean age of the patients was 63.6 ± 6.90 (range 47 and 76) years old. 22 (39.2%) of the patients were male and 34 (60.7%) were female. Any adverse events and adverse effects were not seen in the enrolled patients group. CONCLUSIONS Results of this study revealed that the use of 20 mg/2 ml HA injection was effective in improving the WOMAC index score in patients of knee OA. Additionally, patients' quality of life as measured by SF-36 questionnaire was also significantly improved at the end of the study. None of the patient reported any of the adverse events during the study. Overall, the 20 mg/2 ml HA injection can be considered as a good treatment option for the knee OA in patients who do not respond to non-pharmacological therapy, NSAIDs or analgesics. Key words: osteoarthritis, hyaluronic acid, injection, non-operative.

Protective effects of fish omega-3 fatty acids on doxorubicin-induced testicular apoptosis and oxidative damage in rats.

The aim of this study was to examine the protective effects of fish omega-3 (n-3) fatty acids on acute doxorubicin (DOX)-induced testicular apoptosis and oxidative damage. 24 male rats were divided into three groups: control, DOX-treated and DOX+fish n-3 fatty acids. Fish n-3 fatty acids (400 mg kg(-1) ) were given for 30 days by intragastric gavage. The rats received a single intraperitoneal injection of DOX (30 mg kg(-1) ) and were sacrificed after 48 h. The DOX+fish n-3 fatty acids group showed a decrease in malondialdehyde levels and increased activities of superoxide dismutase and glutathione peroxidase in comparison with the DOX-treated group. Acute DOX treatment caused severe damage such as disorganisation and separation of germ cells. The fish n-3 fatty acids-pretreated rats showed an improved histological appearance in the DOX-treated group. Our data indicate a reduction in the activity of terminal deoxynucleotidyl transferase mediated dUTP nick end labelling; there was a rise in the expression of proliferating cell nuclear antigen in testis tissues of the DOX+fish n-3 fatty acids group compared with DOX-treated group. These data suggested that fish n-3 fatty acids pre-treatment may be beneficial for spermatogenesis following acute DOX-induced testicular damage by decreasing germ cell apoptosis and oxidative stress.

Effects of chronic stress on cognitive functions and anxiety related behaviors in rats.

The effects of 100 dB prenatal and chronic postnatal white noise stress (WNS) on some cognitive functions and behaviors in rats were investigated. For this purpose, 60 female Sprague-Dawley rats and their 90 male offspring were used. Pregnant rats were divided into Prenatal Stress (PS) and Prenatal Control (PC) groups. WNS was applied to PS group between the 14th and 21st days of their pregnancy, while PC rats were left undisturbed. After weaning, 40 male pups of PS dams were assigned to prenatal + chronic postnatal stress (PSCS) and prenatal stress + non-stress (PSN) groups. Pups of PC dams were divided into Control (CON) and Corticosterone (CORT) groups. During the postnatal 30th and 51st days, WNS was applied to PSCS and CORT rats everyday for 45 minutes, while PSN and CON groups were left undisturbed. The effects of stress on adult male offspring were investigated using Morris water maze and defensive withdrawal tests. Blood samples were collected after each test for serum corticosterone measurements. Blood samples of CORT rats were collected before the stress application and at the 1st, 7th, 14th, and 21st days of the stress period, immediately after cessation of the stress application. There were no significant differences among groups for learning and behavior tests. Corticosterone levels of CORT rats were significantly higher after the stress period than before stress application. These results indicate that although chronic 100 dB WNS induces a stress response by increasing corticosterone levels, it does not affect cognitive functions and anxiety related behaviors of adult male offspring.

Anterior third ventricle meningiomas. Report of two cases.

Third ventricle meningiomas are rare, representing approximately 0.15% of all meningiomas. The majority of third ventricular meningiomas are located posteriorly in the pineal region. Less commonly, they arise in the anterior part of the third ventricle. We report the cases of two patients with large and giant meningiomas originating in the anterior part of the third ventricle.