Venous thromboembolism in orthopedic surgery: Global guidelines.

Venous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, cardiology, hematology, vascular, and internal medicine, conducted a comprehensive review of the literature using a strict Delphi process to generate practical recommendations for VTE prophylaxis across all types of orthopedic procedures. This review article summarizes some of the recommendations of the ICM.

Outcomes of antegrade homodigital neurovascular island flap in fingertip amputations.

BACKGROUND: Antegrade homodigital neurovascular island flap (AHIF) is one of the methods used in fingertip amputations to cover the defect area, preserve finger length and obtain a painless and sensitive fingertip. The aim of this study was to evaluate the functional and sensory outcomes in patients who underwent AHIF for fingertip amputation and to analyze the relationship between patient satisfaction and outcome measures. METHODS: Twenty patients with a mean age of 37 (18-63) years were analyzed retrospectively. The patients were evaluated in terms of hook nail development, active interphalangeal joint movements, cold intolerance, and sensory function of the flap covered area. Static two-point discrimination test and Semmes Weinstein monofilament test were performed for sensory evaluation. RESULTS: All flaps survived completely at the end of follow-up (mean, 36 months; range 11-64 months). Five patients had cold intolerance and two had hook nails. In total, proximal interphalangeal or distal interphalangeal joint flexion contracture developed in 25 % of the patients. The mean static two-point discrimination score was 4.6 ± 1.6 (2-8) and Semmes-Weinstein monofilament test score was 3.48 ± 0.6 (2.44-4.17). Subjective satisfaction levels of the patients were found to be high and did not show a statistical relationship with the measured clinical outcome parameters (p > 0.05). CONCLUSIONS: Since AHIF contains a solid and continuous neurovascular pedicle, the probability of necrosis and loss of sensation is low in AHIF. In addition, the graft need of the donor area is not high. Its disadvantage is the rate of restriction of joint movements. LEVEL OF EVIDENCE: IV.

Isolated A1 pulley release surgery for trigger finger leads to significant increase in tip-to-tip pinch strength.

BACKGROUND: Even in the first application of patients with early complaints of trigger finger, pinch strength of the hand may be affected. Therefore, it is difficult to assess the change of strength as a result of treatment in this problem. In this study, we aimed to evaluate the change of strength taking into account both measured and expected pinch strengths before and after A1 pulley release surgery. METHODS: Thirty fingers (9 thumbs, 12 middle, 8 ring and 1 index fingers) of 26 patients (17 women, 9 men) who underwent A1 pulley release were included into this study. The mean age of the patients was 53 (16-71). Tip-to-tip finger pinch strengths were measured pre-operatively and at 3 months postoperatively. The expected strengths were calculated using the values obtained from the healthy side and taking into account the dominance effect. In the analysis, pre-operative and postoperative measured strength/expected strength ratios were compared. RESULTS: The mean of measured pinch strength/expected pinch strength ratio was 0.91 ± 0.3 pre-operatively and 1.14 ± 0.3 postoperatively (p < 0.05). CONCLUSION: With the calculation method used in this study, it was found that there was a significant increase in the tip-to-tip pinch strength after surgical A1 pulley release for the trigger finger. LEVEL OF EVIDENCE: III (Retrospective cohort study).

Effect of Osteoporosis on Proximal Humerus Fractures.

INTRODUCTION: Proximal humerus fractures (PHF) constitute the majority of the most common osteoporotic fractures. Bone density measurements can affect treatment methods and outcomes. This study was aimed to investigate the effect of osteoporosis values, measured from direct radiographs, on fracture type, surgical outcomes. METHODS: 248 patients over 50 years of age who presented to Mersin City Hospital between 2017 and 2020 with proximal humeral fractures were retrospectively evaluated. The age and gender of the patients and the fracture types were evaluated according to the AO classification system from the direct radiographs obtained at the time of admission were recorded. The Tingart cortical thickness and deltoid tuberosity index (DTI) measurements were used to assess osteoporosis status in all patients. Postoperative and follow-up radiographs of 45 patients, treated with fixed-angle proximal humeral locking plate, were evaluated for radiographic results and their correlations with osteoporosis measurements were examined. RESULTS: According to the demographic characteristics of the patients, 171 patients were female and 77 patients were male (F/M: 3/1), and mean age was 69.2 ± 11.66 (50-95). Considering the bone quality parameters in all patients, the mean Tingart value was 5.8 ± 1.6 mm and the mean DTI was 1.43 ± 0.17, where there was a correlation between the Tingart value and DTI (r = 0.810 and p < 0.001). Although there was a statistically significant relationship between the osteoporosis parameters and age and gender (p < 0.001 and p = 0.023, respectively), main AO fracture types were not related to osteoporosis (p < 0.05). In the operated group (n = 48, 19%), 19 patients (42%) showed poor outcomes, which were not associated with age and osteoporosis parameters. CONCLUSION: This study was concluded that osteoporosis parameters differ between genders and age groups in patients with PHF, however osteoporosis is not the main factor affecting the fracture type and surgical outcomes.

An evaluation of treating non-union of femoral neck fractures with valgus angulation osteotomy using sliding hip screws.

This study presents the outcomes of patients treated with non-union of femoral neck fractures healed with valgus osteotomy, fixed with a Dynamic Hip Screw (DHS). The study retrospectively evaluated 16 patients who, between 2007 and 2014, developed pseudarthrosis following treatment for a femoral neck fracture and who were treated with DHS-osteosynthesis, after a valgus subtrochanteric osteotomy. Postoperative clinical evaluation of the patients was done? using the Harris Hip Scoring (HHS) system. Union of both the fracture and the osteotomy site was achieved in 17.2 weeks (range: 14-24 weeks) in all patients. The average Pauwels angle decreased from 72o (range 62-80) preoperatively to 26o (range 20-50) postoperatively. All fractures were Pauwels type III preoperatively and 4 type II and 12 type I postoperatively. The average HHS increased from 26 (range 18-34) preoperatively to 85 (range 68-94) postoperatively. Of the patients who were followed up for a mean duration of 3.1 years (range: 1-5 years), four had 1-cm shortening. No patient developed postoperative AVN of the femoral head. For patients with non-union after femoral neck fracture, DHS-osteosynthesis after valgus osteotomy is a method with a shorter learning curve, which can be successfully performed.

Functional outcomes and quality of life in adult ipsilateral femur and tibia fractures.

OBJECTIVE: The aim of our study is to evaluate the functional outcomes and quality of life in adult ipsilateral femur and tibia fractures. METHODS: 26 patients (21 male, 5 female; mean age 30 years, range: 18 to 66) treated for adult ipsilateral femur and tibia fractures were evaluated retrospectively. For femur fractures, intramedullary nails were used in 15 patients (12 antegrade, 3 retrograde), plate in 11 patients (10 locked-plate, and 1 blade-plate with a 95 degree angle). For tibia fractures, locked-plate were used in 13 patients, intramedullary nails in 9 patients, external fixator in 3 patients and multiple screws in 1 patient. According to Blake and McBryde classification, 17 fractures were type I, 9 fractures were type II (7 type 2A and 2 type 2B). The functional outcomes were evaluated by Karlström and Olerud criteria, and quality of life was evaluated by Short Form-36. The mean follow-up duration was 4.4 years (range: 1.1 to 7.3 years). RESULTS: The functional outcomes were excellent in 6 patients, good in 8 patients, acceptable in 6 patients and poor in 6 patients. The mean values of quality of life scales were; physical function: 64.8, physical role limitation: 60.5, pain: 68.2, general health: 63.3, vitality: 58.4, social function: 68.2, emotional role limitation: 62.7, and mental health: 65.8. CONCLUSION: Adult ipsilateral femur and tibia fractures are severe injuries and adversely affect the quality of life and functional outcomes. The quality of life scales should be used along with functional outcome scores in evaluating these injuries. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Adult ipsilateral femur and tibia fractures cause severe morbidity. Functional outcomes and quality of life scales should be used together to evaluate these fractures. Karlström and Olerud criteria for functional outcomes and Short Form-36 scales for quality of life are suitable methods to evalute these fractures.

A Newly Designed Intramedullary Nail for the Treatment of Diaphyseal Forearm Fractures in Adults.

BACKGROUND: The treatment of diaphyseal forearm fractures using open reduction and plate fixation is generally accepted as the best choice in many studies. However, periosteal stripping, haematoma evacuation may result in delayed union, nonunion and infection. Refracture after plate removal is another concern. To overcome these problems intramedullary nails (IM) with different designs have been used with various outcomes. However previous IM nails have some shortcomings such is rotational instability and interlocking difficulties. We evaluated the results of newly designed IM nail in the treatment of diaphyseal forearm fractures in adults. MATERIALS AND METHODS: 32 patients who had been treated with the interlocking IM nail for forearm fractures between 2011 and 2014 were included in this study. There were 23 males and 9 females with mean age of 36 years (range 18-68 years). 22 patients (68.8%) had both bone fractures. Nine patients (28.1%) had open fractures. The remaining ten patients (31.2%) had radius or ulna fractures. Grace and Eversmann rating system was used to assess functional evaluation. Patient reported outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. RESULTS: Union was achieved in all patients. The mean followup was 17 months (range 13 - 28 months). According to the Grace-Eversmann criteria, 27 patients (87.5%) had excellent or good results. The mean DASH score was 14 (range 5-36). Overall complication rate was 12.5%. Superficial infection was encountered in two patients. One patient had delayed union, however fracture healed without any additional surgical procedure. One patient who had open grade 3A, comminuted proximal third radius fracture developed radioulnar synostosis. CONCLUSIONS: The new design IM interlocking forearm nail provides satisfactory functional and radiological outcomes in the treatment of adult diaphyseal forearm fractures.