Analysis of Doppler ultrasonography and computer tomography angiography for predicting amputation level and re-amputation rate.

OBJECTIVE: Peripheral arterial disease of the lower extremities is one of the most common causes of non-traumatic lower extremity amputation. Computed tomography (CT) angiography and Doppler ultrasonography are mainly used to evaluate distal vascular structures. Our objective was to evaluate the predictive efficacy of Doppler ultrasound and CT angiographic radiographic examinations in determining amputation levels and reamputation rates in patients undergoing lower extremity amputation. METHODS: Patients with major or minor amputation at various levels due to lower extremity lesions were included in the study. Standard demographic information, clinical accompanying diseases, reamputation datas, Doppler ultrasound, and CT angiography radiological evaluation reports were obtained retrospectively from the hospital system records of the patients. RESULTS: A total of 166 cases including 119 (71.7%) males and 47 (28.3%) females were included in the study. About 36.7% (n=61) cases had amputation at the level of surgery above the knee, 38.6% (n=64) below the knee and 24.7% (n=41) at the level of foot/finger. In patients who underwent amputation above the knee, occlusion was seen at the level of the iliac artery (88.9%), femoral artery (47.8%), and popliteal artery (37%). The rate of occlusion at the level of the popliteral artery in patients with below-knee amputation (59.3%) was found in patients with foot/finger amputation (51.5%) at the levels arteria dorsalis pedis and posterior tibial artery. According to the level of occlusion at all blood flow levels, it was observed that the rate of reamputation was most common in occlusions at the level of popliteal artery. CONCLUSION: It was found that radiological data are effective in planning amputation according to blood flow level and does not make any difference per se. It was found that the reamputation rates were related to the determination of the level of blood flow in the primary surgical phase.

Comparison of effective factors in loss of reduction after locking plate-screw treatment in humerus proximal fractures.

BACKGROUND: In proximal humerus fractures, loss of reduction can occur following surgical fixation. The factors that affect loss of reduction in cases treated with locking plates as well as their relationship with the degree of loss of reduction were investigated in this study. METHODS: The study included 48 patients who underwent surgical treatment with a locking plate for a displaced proximal humerus fracture and experienced loss of reduction during follow-up. According to the degree of reduction loss, patients were divided into two groups as low grade and severe loss of reduction. The following parameters were investigated: Head-neck angle, loss of head height, degree of medial support displacement, screw penetration, implant-to-screw ratio, graft use, calcar screw application for medial sup-port, delayed union/nonunion, arthrosis, and avascular necrosis findings. RESULTS: In the early period, in Group I (n=27) and Group II (n=21) patients, the mean head-neck angle was 133°±9.9° (118°-141°) and 131°±11.2° (114°-143°), the distance between the head-plate end points was 8.08±2.8 mm and 11.5±3.1 mm, and the displace-ment between the medial support fracture fragment was 1.19±0.9 mm and 1.69±1.8 mm, respectively. Furthermore, in the late period, the mean head-neck angle was 120°±11.8° (106°-136°) and 112°±13.1° (98°-120°), the distance between the head-plate end points was 5.6±3.2 mm and 6.3±3.3 mm, and the displacement between the medial support fracture fragment was 2.79±1.9 mm and was 6.79±1.9 mm in Group I and Group II patients, respectively. While there was a significant relationship between the amount of medial displacement and changes in neck-shaft angle (p=0.0313) and humeral head height (p=0.0272), there was no significant relationship between the groups in terms of screw ratios, fracture type, and age. CONCLUSION: Many factors influence loss of reduction in proximal humerus fractures after surgical treatment with a locking plate. Supporting the medial region is particularly critical for maintaining reduction in the post-operative period. Furthermore, a relationship was revealed between the amount of medial displacement and the values of head-neck angle and head height.

Reliability of 2 Smartphone Applications for Cobb Angle Measurement in Scoliosis.

BACKGROUND: As mobile technology has evolved, smartphone applications have been used for radiographic angle measurements in daily clinical practice. This study aimed to assess the reliability of 2 smartphone applications (iPinPoint and Cobbmeter) in measuring scoliosis Cobb angles compared with picture archiving and communication system (PACS) tools. METHODS: Anteroposterior whole spinal digital radiographs of 50 patients were retrospectively analyzed. Four observers measured Cobb angles of predetermined major structural curves using the tools in the PACS software and 2 smartphone applications. The inter- and intraobserver reliabilty were measured using intraclass correlation coefficients (ICC). RESULTS: Very good interobserver agreement was seen with PACS, iPinPoint, and Cobbmeter measurements (ICC, 0.991, 0.980, and 0.991, respectively). Intraobserver reliability of the 4 observers was also very good for all techniques (ICC > 0.9 for all observers). CONCLUSIONS: Both smartphone applications were reliable in measuring scoliosis Cobb angles, with reference to PACS tools. They may be useful when digital or manual mesurement tools are not available.

The incidence of impingement syndrome in cases of cervical radiculopathy: An analysis of 220 cases.

BACKGROUND: We hypothesized that cervical radiculopathy (CR) has a role in subacromial impingement syndrome (SAIS) etiology, which cannot be directly connected to anatomical causes. OBJECTIVE: We aimed to investigate the presence of cervical radiculopathy in patients with SAIS diagnosed clinically and radiologically. METHODS: Patients who had a clinical and radiological SAIS diagnosis between 2014 and 2016 were included in the study. Patients with secondary causes that led to SAIS were excluded. Cervical MRI of all patients with SAIS was examined for cervical radiculopathy. RESULTS: A significant (p< 0.05) relationship was found between SIAS and the presence of root compression on the same side. 35% of the patients with SIAS had root compression on the same side. CONCLUSIONS: Cervical radiculopathy and shoulder impingement syndrome can be easily confused due to the similarity of the symptoms and the anatomical proximity of the lesions. Although both diseases can occur with different mechanisms, we believe that there is a cause and effect relationship between them.

Effects of psychological factors on the clinical outcomes of fifth metacarpal neck fractures and their relation to injury etiology.

BACKGROUND: The fifth metacarpal neck fracture injuries are commonly found in patients who applied to emergency clinics. The mechanism of trauma in these types of injuries seems to be different and, in some cases, appears to be intentional. Psychological factors play an important role in the treatment and rehabilitation, as well as in the etiology of metacarpal neck fractures. However, to the best of our knowledge, no research has yet compared the clinical outcomes of patients with fifth metacarpal neck fractures caused intentionally with those of patients with such fractures caused by unintentional injuries. Our goal is to investigate the relationships between the mechanism of injury, socioeconomic status, and clinical outcomes of patients with fifth metacarpal neck fractures. METHODS: The study included 59 patients with fifth metacarpal neck fractures. The patients were separated into two groups. Group 1 consisted of patients with intentional injuries, and Group 2 consisted of patients with unintentional injuries. Both groups were evaluated in terms of the anger analysis, impulsivity, and the level of anxiety in relation to somatic findings Visual Analogue Scale (VAS) and The Disabilities of the Arm, Shoulder and Hand Score (QDASH). In addition, the relationship between anger, impulsivity, and anxiety scores with the socioeconomic status and educational level was assessed. RESULTS: It was observed that the anger and impulsivity values of Group 2 patients were lower than the Group 1, and the decrease in Group 2 was correlated with the VAS and Q-DASH values. Group 1 barrat impulsivity score 61.5 (42-78), anxiety score 64 (55-77), state anger score 20 (16-30), and Group 2 barrat impulsivity score 61 (55-69), anxiety score 66 (58-72), and anger score 19 (14-26) were found as mean values. The impulsivity score and anger score were found to be lower in Group 2 at the low educational level. The number of patients with a low income was found to be high in both groups, and the impulsivity score and the anger score were higher in Group 1, while the anxiety score was higher in Group 2. CONCLUSION: Sociodemographic factors and the etiology of intentional injuries could not be detected, but psychological factors play a role in the clinical sequelae of intentional fifth metacarpal fractures, their effects thereof on the hand function and the pain course after treatment.

Comparison of Intra- and Extramedullary Implants in Treatment of Unstable Intertrochanteric Fractures.

INTRODUCTION: Comparison was made of the clinical and radiological results of the surgical treatments of proximal femoral nail (PFN), dynamic hip screw (DHS) or proximal femoral locking compression plate (PF-LCP) in patients with AO 31A2.2/2.3 unstable intertrochanteric femoral fracture(ITF). METHODS: Evaluation was made of a total of 91 patients in respect of age, gender, time from fracture to surgery, operating time, amount of blood replacement, total hospitalisation, follow-up period, time to full weight-bearing, time to union, complications and Harris hip scores(HHS). RESULTS: A statistically significant difference was determined between the groups in respect of perioperative operating time, blood replacement and hospitalisation period with the values of the PFN group seen to be superior to those of the other two groups (p < 0.001). No significant difference was determined beween the DHS and PFN groups in respect of time to union and in the long-term HHS, both groups were seen to be superior to the PF-LCP group (p < 0.001). Full weight-bearing was statistically significantly earlier in the PFN group (p < 0.001). The numbers of implant failures was statistically significantly higher in the PF-LCP group (p < 0.001). CONCLUSION: The new generation intra-medullar nails are easy to apply and have more successful clinical results compared to extra-medullar implants in the treatment of A2 unstable ITF. Due to the high rates of implant failure, PF-LCP should not be preferred in these fractures.

How are clinical outcomes related to the deviation severity of the tibiofemoral mechanical axis on coronal plane following knee arthroplasty?

OBJECTIVE: To analyze the effect of tibiofemoral mechanical axis (TFMA) deviation severity on clinical outcomes after total knee arthroplasty (TKA). METHODS: We retrospectively reviewed the patients who underwent primary TKA between January 2002 and December 2010. After applying inclusion/exclusion criteria, we evaluated 70 knees of 51 patients. The mean ± SD follow-up period was 7.08 ± 1.34 years. The knees were divided into 3 groups based on TFMAs. The first group, identified as "well aligned," included the TFMAs that were neutral within 3° (0° ± 3°) of alignment. The second group, identified as "outliers 1," included the slightly deviated TFMAs (-3° to -6° valgus and +3° to +6° varus). The third group, identified as "outliers 2," included the severely deviated TFMAs of more than 6° from neutral alignment (<-6° valgus and > + 6° varus). The clinical outcomes of each group were compared by evaluating the Oxford Knee Score (OKS), visual analog scale (VAS), and Short Form-36 physical component summary (SF-36 PCS) and mental component summary (SF-36 MCS) scores. RESULTS: We found that OKS, SF-36 PCS, and SF-36 MCS were nearly the same in the well-aligned and outliers 1 groups but worse in the outliers 2 group. VAS scores were nearly the same in all groups. (p > 0.05). CONCLUSION: Function scores were impaired when the TFMA deviated more than 6° from neutral. However, the differences in clinical outcomes between well-aligned knees and those of outliers were not found to be statistically significant in the medium term.

Unexpected Diagnosis in Gluteal Region -A Primary Intramuscular Hydatid Cyst: A Case Report.

INTRODUCTION: Primary hydatid cyst is rarely seen in musculoskeletal system. This paper presents a case of an intramuscular hydatid cyst in gluteal region. CASE OF REPORT: We present the case of a 36-year-old woman affected by pain and a mass in her right gluteal region. Serological tests and radiographies were inconclusive. Ultrasonography showed a 52 mm × 47 mm diameter hypoechoic intramuscular cyst with septations. Computed tomography showed a cystic lesion located between muscle groups. The mass was excised under spinal anesthesia. It was a well-demarcated cystic lesion with 5 cm diameter. Albendazole chemotherapy was prescribed postoperatively. CONCLUSION: Hydatid cysts must be considered in differential diagnosis in patients with cystic masses in musculoskeletal system, especially in patients living in endemic areas.

Effectiveness of Four Different Treatment Modalities in the Treatment of Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial.

No consensus has been reached about the best treatment method of plantar fasciitis and the results of the treatment methods have been inconsistent. The objective of the present study was to compare the therapeutic effects of extracorporeal shock wave therapy, platelet-rich plasma injection, local corticosteroid injection, and prolotherapy for the treatment of chronic plantar fasciitis using a randomized, controlled, prospective study. We performed a randomized controlled prospective clinical study of 4 groups. The first group received extracorporeal shock wave therapy, the second group received prolotherapy, the third group received platelet-rich plasma injection, and the fourth group received a local corticosteroid injection. The study included 158 consecutive patients with a diagnosis of chronic plantar fasciitis with a symptomatic heel spur. The clinical outcomes were assessed using the visual analog scale and Revised Foot Function Index. At the end of the follow-up period, the mean visual analog scale scores for all 4 groups were similar to the mean visual analog scale scores before treatment. At the end of the follow-up period, no significant improvement was noted in the Revised Foot Function Index score in any of the groups. The corticosteroid injection was more effective in the first 3 months and extracorporeal shock wave therapy was an effective treatment method in the first 6 months in regard to pain. The corticosteroid injection lost its effectiveness during the follow-up period. The effect of prolotherapy and platelet-rich plasma was seen within 3 to 12 months; however, at the 36-month follow-up point, no differences were found among the 4 treatments.

Efficacy of subcutaneous lidocaine injection in venous insufficiency: a prospective, randomized, controlled study, and new treatment protocol.

[Purpose] The purpose of this study was to evaluate the efficacy of subcutaneous injection with lidocaine in patients with chronic venous insufficiency in the early stage. [Subjects and Methods] Patients (n=50) randomized to the treatment group received subcutaneous injections from a mixture of physiological saline sterile solution and lidocaine once a week to both legs below the knee for 5 sessions. Patients in the treatment group were also given ankle pumping exercises and compression stockings throughout the treatment. Patients randomized to the control group (n=50) received only ankle pumping exercises and compression stockings. Patients were evaluated using the visual analog scale (VAS) for pain and Chronic Venous Disease Quality of life Questionnaire (CIVIQ-20) for quality-of-life at months 1, 3, 6, at the end of month 12, and at the end of the injection treatment for 5 sessions. [Results] CIVIQ-20 and VAS results were significantly lower in the treatment group, than in the control group at months 1, 3 and 6. However, CIVIQ-20 and VAS results were not significantly different, compared with the pre-operative period at month 12. [Conclusion] We observed that 5-week subcutaneous lidocaine injection treatment was effective in patients who do not respond to oral medical treatment or in whom surgery is not considered.

Efficacy of Trigger Point Injections in Patients with Lumbar Disc Hernia without Indication for Surgery.

STUDY DESIGN: Prospective comparative study. PURPOSE: To investigate the efficacy of gluteal trigger point (TP) injections with prilocaine in patients with lumbosacral radiculopathy complaining of gluteal pain. OVERVIEW OF LITERATURE: TP injections can be performed using several anesthetic agents, primarily lidocaine and prilocaine. While several studies have used lidocaine, few have used prilocaine. METHODS: A total of 65 patients who presented at the polyclinic with complaints of lower back pain with lumbar disc herniation (based on physical examination and magnetic resonance imaging) and TPs in the gluteal region were included in this prospective comparative study. Group 1 comprised 30 patients who were given TP injections, a home exercise program, and oral medications, and group 2 comprised 35 patients who were only treated with a home exercise program and oral medications. The patients' demographic data, Oswestry Disability Index (ODI) scores, and Visual Analog Scale (VAS) scores were recorded, and these data were evaluated at 1- and 3-month follow-ups. RESULTS: The ODI and VAS scores of both groups significantly decreased initially and at the follow-up examinations, but the decreases were more marked in group 1. CONCLUSIONS: We obtained better results with TP injections than only a home exercise program and oral medications in patients with radiculopathy and TPs in the gluteal region.

Bilateral Neuropathic Osteoarthropathy of the Shoulder Due to Syringomyelia.

Neuropathic osteoarthropathy, which is known as Charcot osteoarthropathy, is a degenerative arthritis that develops as a result of proprioceptive and sensory innervation loss. A 47-year-old man was admitted to the emergency department of the hospital with left shoulder pain, which was ongoing and exacerbating for 5 days. Examination of the cervical region takes a crucial part in determining shoulder pathology. Palliative therapy is the prior treatment of choice as surgical therapy has potential risks in Charcot osteoarthropathy.

Giant Baker's Cyst Associated with Rheumatoid Arthritis.

We report a rare case of a "giant Baker's cyst-related rheumatoid arthritis (RA)" with 95 × 26 mm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass behind his left calf located between the posteriosuperior aspect of the popliteal fossa and the distal third of the calf. In MRI cystic lesion which was located in soft tissue at the posterior of gastrocnemius, extensive synovial pannus inside and degeneration of medial meniscus posterior horn were observed. Arthroscopic joint debridement and partial excision of the cyst via biomechanical valve excision were performed. The patient continued his follow-up visits at Rheumatology Department and there was no recurrence of cyst-related symptoms in 1-year follow-up. Similar cases were reported in the literature previously. However, as far as we know, a giant Baker's cyst-related RA, which was treated as described, has not yet been presented.

Comparison of daytime and after-hours surgical treatment of supracondylar humeral fractures in children.

Reports on different types of surgical procedures show that night-time surgeries are often associated with a high number of complications than daytime surgeries. However, there are no data, and hence evidence that relate the outcome of supracondylar humeral fractures in children to the time of the day when the respective surgical procedure is implemented. In this study, we analyze the clinical and radiological outcomes of pediatric supracondylar humeral fractures surgically treated during daytime and night-time hours. In total, 91 patients with Gartland type-3 fractures were included; 47 patients treated between 0800 and 1700 h were defined as the daytime group and 44 patients treated between 1701 and 0759 h were defined as the after-hours group. Age, sex, affected side, fracture type, and day and time of operation were recorded. Any preoperative neurovascular injuries, open fractures, or ipsilateral fractures were noted. The surgical method, use of a medial pin or pins, operation time, any postoperative neurovascular complications, extent of successful reduction, fixation rate, any resultant deformity, and functional loss rate were evaluated. The two groups did not differ significantly in terms of operation time, open reduction rate, rate of poor reduction, extent of poor functional outcomes, or induction of deformity (P>0.05). The poor fixation rate was significantly greater in the after-hours group than in the daytime group (P<0.05). No significant between-group differences were evident in age, sex, affected side, or length of postoperative follow-up (all P-values>0.05). After-hours treatment of displaced supracondylar humeral fractures in children is associated with a higher poor fixation rate compared with daytime procedures. LEVEL OF EVIDENCE: therapeutic study (retrospective comparative study), Level III.

[Childhood injuries, their etiologies, and preventive measures]. / Cocuk yaralanmalari, nedenleri ve önlemler.

OBJECTIVES: The purpose of this study was to evaluate social, economical, and cultural factors of childhood injuries and to assess preventive measures. METHODS: The study included 120 children (75 boys, 45 girls; mean age 8.3 years; range 0 to 14 years) who presented to the emergency department due to trauma from September to December 2007. Information was gathered from the patients or parents on the following: age, number of siblings; time, etiology, place, and type of trauma; type and time of transportation, educational and sociocultural level of the parents, and whether the patient had a similar injury before. RESULTS: About one-tenth (10.8%) of the patients were admitted and treated. Twenty patients (16.7%) had at least one similar injury previously. Most of the events were household injuries (n=42, 35%). The highest number of injuries occurred at the ages of 7, 8, and 10 years, and the number of injuries remained high from 12 to 14 years of age. The most frequent site of injury was the elbow during the first six years of age, the wrist and the hand at ages 7 to 11 years, and the wrist from 12 to 14 years of age. The great majority of the mothers were housewives (86.7%). Occupation and educational status of the mother, and the number of siblings were not related with recurrent childhood injuries (p>0.05). CONCLUSION: This study provided helpful information on the characteristics of childhood trauma. Programs targeting to increase the awareness on pertinent risk behaviors and to promote educational efforts concerning the risks and preventive measures will be of great help in preventing childhood injuries, in particular at the beginning of school life (age 7) and adolescence (age 12), at which time child injuries show culmination.