Scabies infestation might predispose surgical site infection: Case report.

INTRODUCTION AND CLINICAL IMPORTANCE: Human scabies is a contagious skin condition caused by the Sarcoptes scabiei mite, leading to skin damage and subsequent mechanical irritation from scratching. This impaired skin integrity predisposes individuals to skin infections. While the association between scabies and skin infections caused by Staphylococcus aureus and Streptococcus pyogenes is well-documented, there is limited literature on the risk of surgical site infections in such cases. CASE PRESENTATION: This case report aims to explore this risk by presenting a case of surgical site infection caused by Streptococcus pyogenes following surgery for a complex elbow injury in a patient with scabies infestation. DISCUSSION: Scabies infestation leads to direct spread of bacteria and contributes to bacterial infection. Furthermore, complement inhibition and dysbiosis induced by the scabies may facilitate the occurrence of these bacterial infections. CONCLUSION: Skin infections are frequently encountered in scabies infestations. Preferred incision should be evaluated meticulously before surgery. Further studies are needed to reach a definitive conclusion on this subject.

Self-inflicted tourniquet application resulted with two fasciotomies: Case report of an initially omitted Munchausen case.

INTRODUCTION: Compartment syndrome is an emergency which requires prompt intervention. While main challenge typically revolves around determining necessity for fasciotomy in suspected cases, etiology is often pronounced, leaving little room for differential diagnosis. CASE REPORT: We report a case with unconventional presentation and clinical course, ultimately diagnosed as Munchausen Syndrome. DISCUSSION: It has been reported that individuals with Munchausen syndrome are successful at manipulating healthcare professionals. They often study the symptoms of their sickness, examination findings, and findings that may alert doctors, mastering their techniques over time. CONCLUSION: It is of importance to consider Munchausen Syndrome as a potential cause, particularly in cases where clinical history and course of symptoms do not align with our experiences and cannot be reconciled with other possible diagnostic patterns.

Comparison of the forearm rotation restriction capacities of four upper-extremity immobilization methods: there is no difference between single and double sugar tong splinting.

BACKGROUND: The aim of this study was to compare the effects of four different immobilization methods [single sugar tong splint (SSTS), double sugar tong splint (DSTS), short arm cast (SAC), and long arm cast (LAC)] commonly used for restricting forearm rotation in the upper extremity. METHODS: Forty healthy volunteers were included in the study. Dominant extremities were used for measurements. Basal pronation and supination of the forearm were measured with a custom-made goniometer, and the total rotation arc was calculated without any immobilization. Next, the measurements were repeated with the SAC, LAC, SSTS and DSTS. Each measurement was compared to the baseline value, and the percentage of rotation restriction was calculated. RESULTS: The most superior restriction rates were observed for the LAC (p = 0.00). No statistically significant difference was detected between the SSTS and DSTS in terms of the restriction of supination, pronation or the rotation arc (p values, 1.00, 0.18, and 0.50, respectively). Statistically significant differences were not detected between the SAC and the SSTS in any of the three parameters (p values, 0.25; 1.00; 1.00, respectively). When the SAC and DSTS were compared, while there was no significant difference between the two methods in pronation (p = 0.50), a statistically significant difference was detected in supination (p = 0.01) and in the total rotation arc (p = 0.03). CONCLUSION: The LAC provides superior results in restricting forearm rotation. The SAC and SSTS had similar effects on forearm rotation. The DSTS, which contains, in addition to the SSTS, a sugar tong portion above the elbow, does not provide additional rotational stability.

Composite Reconstruction With Irradiated Autograft Plus Total Hip Replacement After Type II Pelvic Resections for Tumors Is Feasible but Fraught With Complications.

BACKGROUND: Malignancies involving the pelvic ring present numerous challenges, especially in the periacetabular area. Extensive resection of the pelvic region without reconstruction can lead to severe functional impairment. Numerous reconstructive options exist, but all have drawbacks. Extracorporeally irradiated autografts are one option for reconstruction after periacetabular resections; they offer the potential advantages of eliminating the risk of allogeneic reactions associated with allografts and preserving local anatomy. However, little is known about the durability and risks of this approach in pelvic reconstruction. QUESTIONS/PURPOSES: (1) What are the survival rates of the autograft used, and if there is graft loss, what is the extent of this loss? (2) What are the functional outcomes after the implementation of this method? (3) What is the rate and nature of complications associated with this approach? METHODS: This is a retrospective case series from one subspecialty tumor unit that evaluated patients treated between January 2005 to January 2022. During that time, three surgeons treated 48 patients with Type II resections (defined as resection of periacetabular area). Patients treated with isolated Type II resections were eligible, as were those treated either with Type I+II resections, Type II+III resections, Type I+II+III resections, and Type I+II+III+IV resections. Of those, 21% (10 of 48) were treated primarily with a cone prosthesis, 13% (6 of 48) were treated without femoral reconstruction, 10% (5 of 48) were treated with resection without reconstruction, and 6% (3 of 48) had a THA on the sacrum, leaving 50% (24 of 48) of patients who were treated with femoral and acetabular reconstruction using extracorporeally irradiated autograft and total hip replacement; those patients were potentially eligible for this study. During that time span, we used this approach in all Type II pelvic resection procedures, when a part of the hemipelvis could be preserved without resection (other than Type I+II+III+IV) and where we predicted that there would be sufficient bone stock after tumor removal. Of those, 21% (5 of 24) were lost to follow-up before 2 years, and 13% (3 of 24) died within 2 years with the reconstruction intact and without any reoperation or graft loss, leaving 67% (16 of 24) for analysis here. Demographic characteristics, type of tumor, tumor origin site, type of applied resection, and extent of applied surgical procedure were noted. Of 16 patients, 12 were male, with a mean age of 38 ± 21 years. Tumor types included chondrosarcoma in eight patients, malignant mesenchymal tumor in four patients, osteosarcoma in two patients, and Ewing sarcoma in two patients. Among these, 10 patients had tumors originating from the pelvis, whereas six patients had tumors originating from the proximal femur. We used a Kaplan-Meier estimator to calculate survivorship free from total or partial graft removal at 72 months. To measure functional results, the Musculoskeletal Tumor Society (MSTS) scoring system was utilized at most recent follow-up so as to be able to evaluate the impact of complications (if any) on the ultimate result. The MSTS score ranges from a minimum of 0 points to a maximum of 30 points, where a higher score reflects lower pain and higher functional and emotional capacity. Related complications, time of complications, secondary interventions, and mortality rates were also ascertained from chart review. RESULTS: Graft survival rate at 72 months after initial reconstruction, free from partial or total graft removal, was 50% (95% CI 26% to 75%). Kaplan-Meier analyses revealed estimated mean time of graft removal as 43 months (95% CI 28 to 58). The graft was protected in eight patients on their final follow-up radiographs. The median (range) MSTS score was 18 (6 to 25) of 30 points at most-recent follow-up (these scores include patients who have had their grafts removed). In all, 15 of 16 patients had 17 complications; 16 were major complications (defined as those substantial enough to result in further surgery or a life- or limb-threatening event). A total of 14 of those 15 patients underwent one or more secondary procedures (a total of 21 unplanned additional procedures were performed in those patients). Deep infection was the most common complication, occurring in eight patients. Prosthesis dislocation occurred in four patients. Three patients developed aseptic acetabular component loosening, two had graft fractures, and one patient developed heterotopic ossification. CONCLUSION: Composite reconstruction with extracorporeal irradiated autografts plus total hip replacement is a feasible reconstruction technique after Type II pelvic resections, although complications and reoperations were common. Although no reconstruction technique has been proven superior to other alternatives, the high risk of complications and reoperations associated with this technique should be considered when selecting from among possible alternative reconstruction methods. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Characteristics of femoral neck fractures in osteogenesis imperfecta: Series of four-teen consecutive hips in twelve patients.

INTRODUCTION: While long bone fractures are commonly seen in individuals with Osteogenesis Imperfecta (OI), femoral neck fractures (FNF) are exceedingly rare. There is a lack of comprehensive data regarding the etiology of FNFs, their characteristics, and the treatment protocols. Our aim was to determine the characteristics of femoral neck fractures in children with OI. MATERIALS AND METHODS: This study was conducted as retrospective series covering period of January 2011-December 2022. Total of 14 femoral neck fractures in 12 patients were included into final analysis. Age, gender, fracture location, ambulation level, injury mechanism, Sillence type, pre-fracture collo-diaphyseal angle, presence of previous implants and applied treatments were noted. RESULTS: The mean age was 9.3 (range: 3-16), 8 out of 12 patients were males. Sillence type 3 OI was most common (50 %) type. Among 12 patients, 2 (16.6 %) were restricted ambulatory while 5 (41.6 %) were non-ambulatory. Seven patients had prior femoral implants. Six fractures were managed non-operatively, while others underwent surgery, with cannulated screws (42.8 %) or plate osteosynthesis (7.1 %). All eight cases (100 %) with minor trauma or unknown origin were Sillence type 3-4, displaying varus deformity. FNFs that occured in mobile patients required higher-energy traumas. CONCLUSION: Femoral neck fractures in OI showed differing trauma mechanisms in ambulatory vs. non-ambulatory patients. Non-surgical treatment may be considered with in patients with high-risk anesthesia concerns, requiring higher level clinical studies.

Morphological analysis of patellofemoral joint in haemophilic arthropathy: A case-control study.

INTRODUCTION: Knees affected by haemophilic arthropathy exhibit distinct differences in both bone morphology and soft tissue behaviour. This study aims to analyse the morphological characteristics of the distal femur and patellofemoral joint in patients with haemophilia in comparison to normal healthy population. MATERIAL AND METHODS: Study was conducted as pair-matched case-control study with 43 individuals in both the haemophilia group and the control group. Patellar luxation, patellar tilt (PT), length of the patella in both axis (pAP, pML), depth and angle of trochlear sulcus (SD, SA), lateral trochlear inclination (LTI), medial and lateral femoral facet length (mFL, LFL), intercondylar depth (ID), transepicondylar axis (TEA) and lateral condyle length (LCL) were assessed on knee MRI. Correlation between Pettersson score and measured variables were also analysed. RESULTS: PT was medial sided in 10 (23.2%) cases in haemophilic group. Mean values of pAP, pML, PT were significantly lower in haemophilia group (p < .001, p: .007, p = .001 respectively). There were no significant changes in SA (p = .628), SD (p = .340), LTI (p = .685), LFL (p = .241) and MFC-LFC (p = .770) whilst mFL was significantly longer in haemophilia group (p = .009). ID (p < .001), TEA (p = .007) and LCL (p = .001) were all shorter in haemophilia group. Pettersson score was inversely correlated with pAP, pML, ID, TEA, LCL, pML/SA and ID/LCL. CONCLUSION: Morphological changes in haemophilic arthropathy involve a smaller and medially-tilted patella, narrowed lateral condyle and transepicondylar axis, combined with reduced intercondylar depth. These alterations must keep in mind especially in pre- and intraoperative assessments for arthroplasty procedures.

Management of complex pilon fractures: Is it necessary to fix all the columns in AO/OTA type 43-C fractures?

INTRODUCTION: Surgical treatment of AO/OTA 43-C pilon fractures has not yet taken a standard form. We aimed to evaluate whether patients that appeared to be labelled as unsupported columns according to the four-column theory would affect long-term clinical and radiological outcomes. MATERIALS AND METHODS: Patients with AO/OTA 43-C type who were treated surgically between January 2010 and December 2019 were included in the study. 53 fractures in 52 patients who received osteosynthesis were categorized based on the fixed columns. These groups were formed as fully supported columns (FSC- Group A), partly supported columns (PSC-Group B), Ankle range of motions (ROM), Burwell Charnley's reduction evaluation criteria, Kellgren-Lawrence ankle osteoarthritis staging system, and American Orthopedic Foot and Ankle Society (AOFAS) Scoring System, Olerud-Molander Ankle Score, Visual Analog Scale were used for evaluating radiological and functional outcomes. RESULTS: The mean follow-up period was 72.6 (12-131) months. Mean age was 42.6 (18-76). Two groups were homogenously distributed in terms of age (p = 0.785), sex (p = 0.376), laterality (p = 0.732), smoking status (p = 0.488) and reduction quality. There was no difference in AOFAS score (p = 0.452), Olerud-Molander score (p = 0.354) and VAS scores (p = 0.589). TAS, TLS and TT angle measurements suggested no difference between groups (p = 0.493, p = 0.834, p = 0.577). There was no difference between groups in terms of infection (p = 0.734), malunion (p = 0.688) and arthritis (p = 0.483) CONCLUSION: We presented findings that contradicted the hypothesis positing the existence of four distinct columns in pilon fractures, as well as the notion that each fractured column requires support from distinct implants. LEVEL OF EVIDENCE: Level III.

Factors affecting return to work time and functional outcome after low-velocity gunshot injuries related to foot in civilian population.

BACKGROUND: Purpose of this study was to identify factors affecting return to work time and functional outcomes after low-velocity gunshot injuries related to foot. Related complications are also analyzed. METHOD: This study conducted as retrospective cohort study in tertiary care university hospital. Data on 26 patients obtained through retrospective database search. Type of causing weapon, anatomic location of wound, wound type according to Gustilo Anderson classification, extend of damage regarding injured structures, extend of soft tissue damage, duration of hospital stay, need of reconstructive surgery, return-to-work time, follow-up period and functional scores at final follow-up were recorded. Factors affecting functional outcome and return-to-work time were analyzed. RESULTS: Total of 12 patients (46.2 %) experienced complications, with eight being deep soft tissue infections. The mean MFS score for the study group was 77.27 (±11.82). The mean MFS for the pistol group was 83.46 (±6.90), extent of soft tissue damage was an independent risk factor (OR 10.67, 95 % CI 1.70-66.72, p = 0.011) for poor outcomes. On average, patients took 10.12 months (±7.59) to return to work, the type of gun used was an independent variable associated with delayed return to work (OR 144, 95 % CI 8.04-2578.09, p = 0.011). CONCLUSION: Gunshot injuries related to foot can lead to a high rate of complications, loss of workdays, and permanent functional losses. Therefore, it is crucial to develop appropriate treatment plans and manage inevitable complications in these injuries. LEVEL OF EVIDENCE: Level IV, Case series.

Use of polyglycolic acid-hyaluronic acid/ß-tricalcium phosphate scaffold with or without mesenchymal stem cells found ineffective in treating osteochondral lesions in rabbit knees.

OBJECTIVE: In this experimental animal study, a novel bilayered scaffold used in the treatment of osteochondral defects in rabbit knees was evaluated. This novel scaffold's upper (cartilage) layer consists of polyglycolic acid and hyaluronic acid, and the lower (bone) layer consists of ß-tricalcium phosphate. The purpose of this study was to evaluate the efficacy of this novel scaffold, combined with or without mesenchymal stem cells (MSCs), in the treatment of osteochondral defects in rabbit knees. METHODS: Osteochondral defects were created in the left femoral trochlea of 30 rabbits. In group A, defects were treated with scaffold combined with MSCs; in group B, defects were treated with cell-free scaffolds; and group C was a control group with defects left untreated. In the 12th week, animals were sacrificed for macroscopic evaluation. RESULTS: The mean International Cartilage Repair Society (ICRS) macroscopic scores were 4.95 for group A, 6.16 for group B, and 8.25 for group C. The mean Oswestry Arthroscopic Scores (OAS) were 1.65 for group A, 3.39 for group B, and 6.05 for group C. The macroscopic scores were significantly higher in group C than group A for ICRS scores and group A and group B for OAS (P < .001, P < .000, P < .022). CONCLUSION: In essence, our findings indicate that the newly developed osteochondral scaffold, when tested in a rabbit model, is not as effective as expected in repairing full-thickness osteochondral defects, with or without the supplementation of MSCs. Further investigation is required to enhance the effectiveness of this novel combination.

Isolated popliteus tendon injury in a young patient: A case report.

Isolated popliteus injury is a rare clinical condition which can be treated either surgically or conservatively. Factors such as the patient's age, activity level, and cooperation with the medical team are determinants to choose the most optimal treatment option. A 29-year-old female patient presented with a knee injury caused by a low-speed motorcycle accident. Further examination suggested an isolated popliteus injury without any concomitant knee injury. We opted for surgical treatment, as it allowed us to act more confidently in the postoperative follow-up and the patient did not inspire confidence in the medical team in terms of close follow-up and compliance with the physical therapy protocols that would be required, if conservative treatment was chosen. In conclusion, isolated popliteus injury is a rare condition with no consensus on the treatment algorithm. Both surgical and conservative treatments can yield good to excellent results. Surgical treatment may be considered in selected cases where an optimal close follow-up regimen seems to be unlikely.

Synovectomy induced patellar tendon ossification in patient with rheumatoid arthritis: A case report and review of the literature.

INTRODUCTION: Patellar tendon ossification is a rare complication that primarily occurs following a knee injury. This article aims to describe, for the first time, a case of patellar tendon ossification following synovectomy. CASE PRESENTATION: A 48-year-old male with a diagnosis of rheumatoid arthritis presented with swelling in his left knee following a synovectomy procedure. After a thorough physical examination, radiographic assessment, and computed tomography, the patient was diagnosed with total patellar tendon ossification. Subsequently, the patient underwent excision of the ossified mass and tendon reconstruction using an Achilles allograft. DISCUSSION: The primary causes of patellar tendon ossification are iatrogenic and traumatic injuries. The presence of rheumatoid arthritis, which negatively affects tissue healing, may exacerbate this condition. Smaller lesions can be managed conservatively or through resection and repair. In cases of extensive ossification, resection and reconstruction are necessary. A comprehensive literature review is also provided. CONCLUSION: The occurrence of patellar tendon swelling following trauma or surgery should raise suspicion of patellar tendon ossification. Rheumatoid arthritis is a risk factor for the development of patellar tendon ossification. In cases of extensive ossification, successful treatment can be achieved through reconstruction using an Achilles allograft.

Conducting osteochondral injury model in rabbit knee: Pearls and pitfalls.

Osteochondral damage is a commonly encountered issue in the daily orthopedic practice and has been extensively researched across various areas, including tissue transplantations, tissue engineering products, stem cell applications, and cell culture studies. The absence of a universally accepted treatment as the gold standard for osteochondral damage indicates the necessity for further studies in this field in the future. Although the biomechanical characteristics of the rabbit knee do not perfectly mimic those of the human knee, experimental studies conducted on rabbit knees are considered the most practical experimental model for testing a well-constructed experimental hypothesis. Our article endeavors to impart our practical insights and experiences to researchers without experience whom seeking to design studies utilizing this model. We aim to offer valuable guidance for preoperative, operative, and postoperative considerations. •Rabbits used in osteochondral healing models should be at least 4 months old or older. Inducing damage in the trochlea is a well-established technique and relatively easy to apply.•Do not use pointy ended drills as it might create uneven damage. Do not place applied treatment agent in inappropriate level in relation to the surrounding cartilage surface.

Safe Use of Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers: A Multidisciplinary Approach to Minimize Adverse Effects.

Purpose: The purpose of this study is to evaluate the side effects associated with hyperbaric oxygen therapy and provide recommendations to prevent them in patients with diabetic foot ulcers. Introduction: The use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers remains a contentious issue, and minimizing side effects is critical. While the incidence of side effects related to hyperbaric oxygen (HBO2) therapy is low, it is essential to evaluate cases in a multifaceted and interdisciplinary manner to prevent adverse outcomes. Methods: A retrospective cohort study was conducted over the period of 2018-2020, involving a dataset of 100 patients. The primary objective of the study was to examine the frequency and types of side effects experienced by patients who underwent hyperbaric oxygen therapy (HBO) for diabetic foot ulcers (DFUs). In addition, we analyzed various wound characteristics, characteristics of hospitalizations, the surgical or medical interventions received by patients, and laboratory parameters including CRP levels, total blood count, culture results, HbA1c levels, duration of diabetes, treatment received for diabetes, and antibiotic therapy regimens. Results: The percentage of patients who experienced side effects was as low as 6%, and none of them were critical. The most common side effect was discomfort due to the confined space in the chamber. Conclusion: Appropriate patient selection, combined with a multidisciplinary approach to evaluate eligibility, is crucial to avoid adverse side effects. Patient education and early screening for side effects are also essential. Since various treatment protocols exist for HBO2 therapy, pooled data from different protocols may be misleading. Further studies focused on side effects with specific indications are necessary.

A comparison of two immobilization methods in the conservative treatment of pediatric distal forearm fractures: Long arm cast versus single sugar-tong splint.

OBJECTIVES: The aim of this study was to compare the results of single sugar-tong splint (SSTS) and long arm cast (LAC) as an immobilization method in pediatric distal forearm fractures. PATIENTS AND METHODS: Between January 2016 and December 2019, a total of 186 pediatric patients (143 males, 43 females; mean age: 10.3±3 years; range, 4 to 15 years) with distal forearm fractures were retrospectively analyzed. The patients were divided into two groups according to the immobilization method: SSTS group (n=74) and LAC group (n=112). All patients were evaluated at the time of admission, immediately after the reduction, and at one, two, and four weeks. Sagittal and coronal plane angulations and translation percentages of the radius at each visit were calculated. Alterations in coronal angle, sagittal angle, sagittal translation and coronal translation were calculated by subtracting the measurements after reduction from the measurements at four weeks. RESULTS: Both groups were comparable in terms of demographic characteristics, fracture localization, and side of injured extremity. There was a statistically significant difference only in the sagittal angulations in the first (LAC: 4.7; SSTS: 6.5; p=0.009) and second week (LAC: 5.3; SSTS: 6.8; p=0.024). The rest of radiological measurements were comparable. In the LAC group, seven patients had re-intervention (three manipulations, four surgeries) and in the SSTS group, three patients had re-intervention (two manipulations, one surgery) (p=0.657). CONCLUSION: Our study results suggest that SSTS and LAC are comparable in terms of radiological results and need for re-intervention as an immobilization method of pediatric distal forearm fractures.

Combination of a High Residual Varus and Joint-Line Lowering Strongly Increases the Risk of Early Implant Failure in Medial Unicompartmental Knee Arthroplasty.

BACKGROUND: Outliers in implant positioning, malalignment, and joint line height change are risk factors for unicompartmental knee arthroplasty (UKA) failure. However, their relationships and patterns in large datasets remain unexplored. This study assessed medial UKA survival in a large cohort and explored associated risk factors. METHODS: This was a retrospective cohort study on medial UKA patients (2011 to 2019). Radiological outcomes included tibial implant positioning in the coronal plane, posterior tibial slope, residual knee deformity, and joint line restitution. Survival rate at last follow-up was recorded. Multinomial logistic regression analyzed risk factors, incorporating demographic and univariate analysis data. RESULTS: Three hundred and sixty-six knees met inclusion criteria, with 10 lost to follow-up (2.7%). Mean follow-up was 61.3 months [24.1 to 135.1]. 5- and 10-year implant survival rates were 92% ± 1.6 and 88.4% ± 3.8, respectively. Multivariate analysis identified post-operative hip-knee-ankle angle (HKA) ≤ 175° (OR = 5.30 [1.64 to 17.13], P = .005) and joint line lowering ≥2 mm (OR = 8.86 [2.06 to 38.06]) as significant risk factors for tibial implant failure. Their combination carried a significantly high risk of failure (OR = 10.3 [3.1 to 34.3]). Post-operative HKA < 175° was common in knees with pre-operative HKA < 172°. CONCLUSION: This study reports encouraging 5- and 10-year survival outcomes for medial UKA. Tibial loosening was the main reason for revision. Patients with joint line lowering ≥ 2 mm and post-operative HKA ≤ 175° were at high risk of tibial implant failure. Surgeons should carefully restore the joint line in cases of pre-operative HKA < 172°.

Conducting spinal cord injury model with clip compression in rodents: Pearls and pitfalls.

Research on spinal cord injuries is an important and living topic that raises many critical questions that need to be addressed. While numerous articles have compiled and compared various models of spinal cord injuries, there is limited comprehensive guide with clear instructions available for researchers who are unfamiliar with clip compression model. This model creates acute compression damage in spinal cord, which aims to mimic the nature of traumatic spinal cord damage in humans. Purpose of this article is to share our experience on clip compression model, with experience gained from more than 150 animals, and to provide guidance for researchers with lack of experience who wish to design studies with this model. We have defined several key variables, as well as the difficulties that may arise when applying this model.-Proper preparation, good infrastructure and necessary tools and knowledge of anatomy related is essential to the success of this model.-Good exposure with non-bleeding surgical site is key factor for surgical step.-Postoperative care is particularly challenging, and researchers should consider extending their studies over a reasonable time period to ensure that appropriate care could be provided.

Efficacy of telemedicine applications in patients with diabetic foot ulcers: A focus on mortality and major amputation rates.

Amputations related to diabetic foot ulcers (DFU) are associated with high morbidity and mortality rates. Glycaemic control and close follow-up protocols are essential to prevent such ulcers. Coronavirus disease (COVID) related restrictions and regulations might have a negative impact on patients who are with DFU or candidates for DFU. We retrospectively analysed 126 cases that had DFU underwent amputation surgery. Comparative analyses were done between cases that were admitted before COVID restrictions (Group A) and cases admitted after COVID restrictions (Group B). Two groups were homogenic demographically. There was no significant difference between groups in terms of mortality (p = 0.239) and amputation rates (p = 0.461). The number of emergent cases in the pandemic period doubled the number in pre-pandemic period even though this finding was not statistically significant (p = 0.112). Fastly adapted consulting practice and follow-up protocols to compensate for the problems created by COVID-related regulations seem to be effective in terms of mortality and amputation rates.

Better accuracy and implant survival in medial imageless robotic-assisted unicompartmental knee arthroplasty compared to conventional unicompartmental knee arthroplasty: two- to eleven-year follow-up of three hundred fifty-six consecutive knees.

PURPOSE: Implant malpositioning, joint line (JL) lowering, and malalignment have been identified as risk factors for implant failure in unicompartmental knee arthroplasty (UKA). The aims of this study were to compare the accuracy of implant positioning in robotic-assisted UKA versus conventional UKA in a large cohort and examine the correlation with implant survival at mid-term follow-up. METHODS: This retrospective study included 356 medial UKAs from 2011 to 2019. The radiological measurements performed were coronal positioning of tibial implant according to Cartier angle (Δ Cartier), posterior tibial slope (PTS), residual hip-knee-ankle (HKA), and JL restoration. Outliers were defined as follows: post-operative HKA < 175° or > 180°, Δ Cartier > 3° or < - 3°, JL change ≥ 2 mm, and PTS < 2° or > 8°. The survival probability was reported at the last follow-up. RESULTS: Out of the 356 knees included, 159 underwent conventional UKA (44.5%) and 197 (55.5%) robotic-assisted UKA. The mean follow-up was 61.3 months ± 24.0. Robotic UKA was associated with better accuracy compared to conventional UKA in relation to HKA (67% vs 56%, p = 0.023), JL restoration (70% vs 44%, p < 0.0001), PTS (83% vs 55%, p < 0.0001), and tibial varus restoration (65% vs 55%, p = 0.049). Implant survival in the robotic group was found to be superior at the last follow-up (96.4% versus 87.3% at 9 years, p = 0.004). CONCLUSION: Robotic assistance in patients undergoing medial UKA was associated with better accuracy compared to conventional UKA with respect to tibial implant positioning, post-operative limb alignment, and JL restoration. This was translated in improved survival at mid-term follow-up favouring the robotic group.

A Reminder for Chronic Ankle Pain: Case Report of Talar Osteoid Osteoma with Late Diagnosis.

Background: Talus osteoid osteomas are often overlooked. This pathology, which can cause chronic ankle pain, should be kept in mind when evaluating differential diagnoses. Case Report: A 21-year-old female applied to our clinic with chronic ankle pain diagnosed as talus OCD. The patient's pain was refractory to non-operative treatments. The detection of talar osteoid osteoma is delayed due to atypical radiologic findings and coexistent osteochondral lesion of talus. The patient is treated with ankle arthroscopy with excellent results. Conclusion: Chronic ankle pain causes severe functional limitations. Dealing with such cases especially in the young population, one should consider that atypical radiologic signs could have further meaning. When radiology fails to describe the lesion, ankle arthroscopy could be a good option, both for diagnosis and treatment.

Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review.

BACKGROUND: Critical-sized bone defects of the tibia are complex injuries associated with significant problems that are difficult to treat, and they are associated with a significant burden of disease in clinical practice; however, the treatment of these cases has still been a challenge for orthopedic surgeons. The aim of this review was to evaluate the current available studies reporting on classical Ilizarov methods in the treatment of infected or noninfected critical-sized bone defects of the tibia, and to perform an analysis of treatment period and complications. METHODS: This is a narrative review based on a comprehensive literature search among the studies in Pubmed, Scopus and Web of Science articles. The studies included were written in the English language or translated to English and they were published between 2008 and 2018. They were appraised with narrative data synthesis. The primary outcome measures were the external fixation time (EFT), bone union rate, and bone and functional results. Secondary outcomes were complications including docking site problems and solutions. The heterogeneity of the data in the studies which were taken into consideration allowed a narrative analysis. RESULTS: Twenty-seven articles with 619 patients were included in this study. These included 6 prospective and 21 retrospective case series. Mean age was 36.1 (range 13-89) years. Of the cases, 88.8% were infected and the remaining 11.2% were noninfected. The external fixation time was 10.75 (range 2.5-23.2) months. The mean bone union rate was 90.2% (range 77-100)%. Radiographic outcome measures were reported in 20 studies. Functional outcome measures were reported in 18 studies. ASAMI (Association for the Study of the Method of Ilizarov) criteria are useful and give reproducible data on patient outcome measurements. Data collected from these studies showed excellent radiological outcomes in 303, good in 143, fair in 31, and poor in 25 patients. Functional outcomes were excellent in 200, good in 167, fair in 58, and poor in 19, where reported. The excellent and good rate in bone results and functional results were 88.8% and 82.6%, respectively. The poor rate in bone results and functional results were 5% and 4.5%. Mean complication rate per patient was 1.22 (range 3-60). The most common complication was pin tract infection (PTI). Its occurrence was 46.6%. Joint stiffness followed PTI with a 25% incidence. The rates of refracture, malunion, infectious recurrence, and amputation, were 4%, 8.4%, 4.58%, and 1%, respectively. CONCLUSIONS: This narrative review shows that the patients with infected or noninfected critical-sized tibial bone defects treated by Ilizarov methods had a low rate of poor bone and functional results. Therefore, Ilizarov methods may be a good choice for the treatment of infected or noninfected tibial bone defects. The small number of cases in some studies, the absence of homogenity between studies and the fact that most data available are derived from retrospective studies are some of the difficulties encountered in the evaluation of evidence. LEVEL OF EVIDENCE: V.