Risk factors associated with breakage of tibio-fibular syndesmotic screws.

PURPOSE: This retrospective study aimed to investigate the factors associated with the breakage of tibio-fibular syndesmotic screws (SS). METHODS: 69 patients with unstable AO-Weber Type 44-B ankle fractures who underwent three cortex SS (3.5 mm ø) fixation were included. Patients were followed for at least one year (mean, 18.3 ± 7.6 months). At the final follow-up, patients with broken (Group I) and intact (Group II) SS were compared regarding age, gender, height, weight, body mass index, fracture type, SS length, location, and orientation. Multivariate logistic regression was used to identify the independent risk factors associated with SS breakage. The sensitivity, specificity, cut-off value, and area under the ROC curve were analyzed. RESULTS: A stepwise backward logistic regression analysis revealed that age was the only independent predictor for SS breakage (OR = 0.938, 95% CI = 0.904-0.973, R2 = 0.270). ROC curve analysis demonstrated that patients younger than 36 years were associated with seven times increased risk of SS breakage [Odds ratio (95% CI), 7.042 (2.251-22.031)]. CONCLUSION: Age under 36 years was the only significant risk factor for SS breakage. The higher incidence of breakage of the syndesmotic screw can be informed to patients younger than 36.

Comparison of single and double incision leg fasciotomy in disaster settings-Experience from 2023 Türkiye earthquakes.

INTRODUCTION: Although there are studies comparing methods for leg fasciotomy in compartment syndrome after fractures, choice of single or double fasciotomies in disasters was not investigated. The aim of this study was to compare the efficacy of single and double incision leg fasciotomy in the setting of disaster. METHODS: Patients that have undergone fasciotomy after 2023 Kahramanmaras earthquakes were retrospectively analyzed. The cases were separated into two groups as single incision and double incision according to the method of the first fasciotomy. The number of debridements after each fasciotomy, muscle group excisions, completion time of treatment, presence of amputation, the method of closure (primary closure or graft/flap) and positive results of wound cultures were analyzed and compared between two groups. RESULTS: 62 legs of 52 patients (22 females, 30 males, age 36.9 ± 11.2 years) with compartment syndrome that have undergone fasciotomy after 2023 Kahramanmaras earthquakes were included in the study. Single-incision group included 27 legs and double incision group included 35 legs. Amputation was needed in 15 patients (%24.2), six in single incision group and nine in double incision group. (p = 0.75). Compartment excision (eight patients in single incision, nine patients in double incision groups, p = 0.81), number of debridements (median 4 in both groups, p = 0.55), wound closure time (median 17 days in single incision, 22 days in double incision groups, p = 0.52), graft or flap requirement (11 patients in single incision, 16 patients in double incision groups, p = 0.53), positive culture results (15 patients in single incision, 16 patients in double incision groups, p = 0.44) were not different statistically between two groups. CONCLUSION: Single and double incision fasciotomy methods are equally effective and safe in treatment of compartment syndrome of the leg in disaster situations. To our knowledge, this is the first study comparing outcomes of single and double incision fasciotomy in disaster settings.

Do all short stem types restore biomechanical parameters of the hip? Comparison according to femoral neck osteotomy levels.

PURPOSE: There is no consensus on ideal short femoral stem design. A classification system proposed by Feyen and Shimmin divides short stems in two types according to femoral neck osteotomy levels: subcapital (IIIA) and standard (IIIB). The study aims to determine which design type is more successful in restoring native biomechanical parameters and whether stem type has an impact on clinical results. METHODS: In this retrospective comparative study, patients that have undergone short stem hip arthroplasty were evaluated according to stem types: type IIIA (n = 52, 66.7%) (Mathys Optimys) and IIIB (n = 26, 33.3%) (Implantcast Aida and Smith & Nephew SMF). Pelvis X-rays were assessed in terms of femoral neck length, horizontal and vertical hip centres of rotation, horizontal and vertical femoral offsets, abductor lever arm lengths, leg lengths, and stem-shaft angles. Improvement in Harris hip scores, differences between post-operative and pre-operative measurements, and stem-shaft angles were evaluated and compared between two groups. RESULTS: Mean femoral neck resection (8.27 ± 6.68 mm in IIIA and 15 ± 6.33 mm in IIIB) was significantly different between both groups (p < 0.001). Harris hip scores were increased at post-operative six months in both groups with no difference (84.4 ± 6.4 and 84.6 ± 5.5, p = 0.4). The absolute values of differences between pre-operative and post-operative horizontal centres of rotation (p = 0.63), vertical centers of rotation (p = 0.75), horizontal femoral offsets (p = 0.78), vertical femoral offsets (p = 0.83), abductor lever arm distances (p = 0.63), and leg length (p = 0.21) measurements were not different between both groups. Stem positions were both varus with no statistically significant difference between groups (p = 0.14). CONCLUSION: We found no difference regarding restoration of biomechanical parameters between short stem designs with different levels of neck osteotomy. Additionally, short stem can mostly result in varus component positioning regardless of the level of neck osteotomy.

Use of tranexamic acid may reduce the need for routine tourniquet use in total knee arthroplasty.

OBJECTIVES: The aim of this study was to evaluate the effects of tranexamic acid (TXA) administration on bleeding control and to compare its utilization with and without simultaneous use of conventional pneumatic tourniquets during total knee arthroplasty (TKA). PATIENTS AND METHODS: Between January 2017 and December 2017, a total of 204 patients (23 males, 181 females; mean age: 66±6.9 years; range, 45 to 86 years) who underwent TKA for Stage 4 gonarthrosis were retrospectively analyzed. The patients were divided into two groups as those with (n=110) and without (n=94) pneumatic tourniquet use. Tranexamic acid (1 g) was administered intravenously to all patients in both study groups. Intra- and postoperative blood loss were calculated, and postoperative pain was evaluated by a Visual Analog Scale. Demographic and clinical data were compared between the study groups. RESULTS: The amount of total blood loss and postoperative blood loss were significantly higher in the tourniquet group than that in the no-tourniquet group (589.4±69.5 mL vs. 490.8±55.2 mL and 326±56 mL vs. 164±35.5 mL, respectively; p<0.001 for both). Intraoperative blood loss was significantly higher in the no-tourniquet group (326.9±42.9 mL vs. 263.5±53.8 mL, respectively; p<0.001). The pain score at 24 h was significantly higher in the tourniquet group (p<0.001). CONCLUSION: Total blood loss and postoperative pain were significantly higher among patients in whom a tourniquet was used during TKA. Therefore, the routine use of tourniquets with TXA should be reconsidered.

Which knee replacement do the patients forget? Unicondylar or total knee arthroplasty.

OBJECTIVE: The aim of this study was to determine which type of knee arthroplasty is easier to forget by comparing levels of joint awareness evaluated with the Forgotten Joint Score (FJS-12) after unicondylar versus total knee arthroplasty. METHODS: Patients who underwent either unicondylar or total knee arthroplasty due to primary gonarthrosis were retrospectively identified and then divided into 2 groups: the TKA group (218 patients; mean age = 68.93 ± 7.14 years) and the UKA group (131 patients; mean age = 60.39 ± 7.03 years). The status of joint awareness after knee replacement surgery was assessed using the Turkish version of the FJS-12 at the final follow-up by telephone interview. Also, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and The EuroQol five-dimensional (EQ-5D) scores were obtained to assess the clinical status of the patients. RESULTS: The mean follow-up was 2.8 years (range = 24-49 months) in the TKA group and 3.2 years (range = 24-50 months) in the UKA group. The FJS-12 was significantly higher in the UKA group (73.60 ± 9.95) than in the TKA group (64.88 ± 9.47) (P = .001). The WOMAC score was significantly better in the UKA group (81.39 ± 9.84) than in the TKA group (74.92 ± 9.99) (P = .001). No significant difference in EQ-5D existed between the groups (0.76 ± 0.14 for the TKA group, 0.79 ± 0.17 for the UKA group; P = .441). In terms of gender, the FJS-12 showed no differences between the groups; however, more favorable scores were recorded in younger patients with UKA. CONCLUSION: The results of this study have demonstrated that UKA may be better than TKA in terms of the patient perception of pain, stiffness, and physical functioning. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Rear drop: a new radiographic landmark for estimation of pelvic tilt on pelvis AP radiographs.

Estimation of pelvic tilt on anteroposterior (AP) pelvis radiograph is often done by indirect methods based on the midline pelvic landmarks. The purpose of this cadaveric study is to describe a new radiographic landmark and reference measurements to estimate the coronal tilt of the pelvis, independent of the midline references. The new radiologic reference is called 'rear drop', and its anatomic location is described with the cadaveric pelvis AP radiographs in various pelvic inclination. The parameters derived from the new reference were used to assess the pelvic tilt, and the results were compared with the previously established method using 'sacrococcygeal joint to symphysis distance' (SCSD). The shape of the new figure is used to determine the position of the pelvis, and its relationship with the previously described acetabular retroversion indicators was statistically analyzed. The new reference figure corresponds to the posteroinferior edge of the horseshoe shape of the acetabular margin. The newly derived reference parameters, rear to tear distance and rear to tear angle, changes with pelvic tilt and are strongly correlated with SCSD. The shape of the rear drop changes with the changing pelvic tilt and correlates statistically with the previously described acetabular retroversion indicators. Rear drop and its derivative measurements can be used as a reliable and reproducible indicator to estimate the coronal pelvic tilt, free of midline reference points. This new reference will be a base for future clinical studies on pelvic tilt, rotation and their application in intraoperative hip fluoroscopy.

Self-reported metal hypersensitivity in patients undergoing unicondylar knee arthroplasty.

OBJECTIVES: There is ongoing discussion about arthroplasty surgery of patients with metal hypersensitivity. The aim of this study was to compare the functional outcomes and eosinophil counts of unicondylar knee arthroplasty (UKA) patients with and without a history of metal hypersensitivity. METHODS: A retrospective review was made of the medical records of 148 extremities of 140 consecutive patients who underwent primary UKA between January 2016 and December 2017. The patients who met the inclusion criteria were screened for history of metal hypersensitivity using a questionnaire. The functional outcomes of patients and eosinophil levels were evaluated immediately before and at 6 weeks after surgery. RESULTS: The mean follow-up period was 37 months (range, 18-48 months). Of the total 128 patients, 13 (10.2%) reported a history of metal hypersensitivity before the operation. There was no statistically significant difference between patients with or without a history of metal hypersensitivity in respect of the functional outcomes or eosinophil counts (p > 0.05). CONCLUSIONS: The results of this study showed that the functional outcomes of patients who underwent UKA using a standard alloy did not change between the groups who reported having or not having a history of metal hypersensitivity. Although the study also showed that the eosinophil counts decreased after surgery compared to the preoperative counts, there was no statistical relationship between the eosinophil count and functional outcomes or metal hypersensitivity history.

Effects of Preoperative Pregabalin On Postoperative Pain Control in Total Knee Arthroplasty Surgery.

OBJECTIVE: Pain management is a major component of postoperative patient care. Pain management following total knee arthroplasty (TKA) provides patient comfort and early mobilization and prevents serious complications. The present study aimed to evaluate the effects of preoperative administration of oral pregabalin on postoperative pain control in patients undergoing TKA. METHODS: One hundred and twenty-six patients undergoing TKA were retrospectively included, of whom 65 (51.6%) received 150 mg pregabalin 2 hours before the operation and 61 (48.4%) did not. All patients received the same postoperative pain management protocol. Resting pain was recorded using a visual analog scale (VAS) at the postoperative 4th, 12th, and 48th hours. Findings including headache, dizziness, nausea-vomiting, constipation, dry mouth, pruritus, urinary retention, and sleepiness were recorded. RESULTS: The mean age of 126 patients (84.1% female) was 65.5 ± 4.5 years (range, 55-72 years). No significant differences were found in age, sex, ASA score, and operation duration between the groups. VAS scores at the postoperative 4th, 12th, and 48th hours, frequency of pushing the button of PCA system, and the total tramadol dose were significantly lower in the pregabalin group. The percent decrease in the postoperative VAS scores from the 4th hour to the 48th hour was significant in the pregabalin group. Nausea was the most frequent side effect followed by urinary retention, constipation, and pruritus. CONCLUSION: Preoperative pregabalin administration provided a favorable contribution to the postoperative pain management in the patients undergoing TKA. Preoperative pregabalin administration could reduce opioid drug usage and opioid related side effects.

Cross-Cultural Adaptation and Validation of the Turkish Version of the International Hip Outcome Tool - 12.

OBJECTIVES: The present study aims to conduct a translation and transcultural adaptation of the International Hip Outcome Tool - 12 (IHOT-12) into Turkish and evaluate the psychometric characteristics of the Turkish version of IHOT-12 (IHOT-12-TR) for validity and reliability in Turkish patients with hip joint disorders. METHODS: Following the translation and transcultural adaptation procedures, 109 patients completed the IHOT-12-TR and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. The retest was completed by 40 patients approximately one week after the initial assessments. The psychometric properties of the questionnaire were tested. RESULTS: Cronbach's alpha of 0.927 revealed the internal consistency to be highly satisfactory. The overall Interclass coefficient (ICC) between test and retest was 0.927 (p<0.001). The correlation between IHOT-12-TR and WOMAC scores was strong and statistically significant (r=0.815, p<0.001). The explanatory factor analyses revealed that IHOT-12-TR had a single factor structure, explaining 61.9% of the total variance. There was no floor or ceiling effect on the items and overall scale scores. CONCLUSION: The results of the analyses in this study demonstrated that the Turkish version of the IHOT- 12 scale, the IHOT-12-TR, is a valid and reliable tool to evaluate the functionality of patients with hip pathologies.

Is there any change in surgeon's attitude to the management of ankle fractures accompanying syndesmotic injury? A nationwide survey.

OBJECTIVES: This study aims to investigate the attitudes of orthopedic surgeons to the management of ankle fractures accompanied by syndesmotic injury with a nationwide survey. PATIENTS AND METHODS: In the first step of this descriptive study, an electronic survey was prepared in Google drive and a survey link was sent to the Turk-Ortopedi e-mail group between 09 and 19 January 2019. The orthopedic surgeons and residents were requested to complete the questionnaire. A total of 320 orthopedic surgeons (77%) and residents (23%) participated in the survey. The responses were analyzed statistically. To evaluate the changing attitudes, our results were compared with the surgeon survey studies key worded "syndesmotic injury" in PubMed. RESULTS: The majority of the participants stated that they used the hook test, external rotation stress test, and fluoroscopy together (47.2%) for the diagnosis of syndesmotic injury during the operation. Of the participants, the majority (93%) reported to use metallic syndesmotic screws, and 59% reported to remove the syndesmotic screw routinely. Young surgeons with 5 to 10 years of experience preferred intraoperative diagnosis methods compared to surgeons with more than 20 years of experience. Foot and ankle surgeons and sports surgeons reported to allow weight bearing before removal of the screw much more than other unspecified branches. CONCLUSION: The preferences of the surgeon vary in syndesmotic injuries and there is still no consensus regarding diagnosis and rehabilitation. Compared to the past decade, fewer surgeons prefer to remove the screws today.

Musculoskeletal Injuries in Master Swimmers: A National Survey in Turkey.

Background This study aimed to determine the frequency of musculoskeletal injuries in master swimmers in Turkey. Methods A questionnaire was formed and distributed to all master swimmers registered with the Turkish Swimming Federation. The collected data included age, sex, the age to start swimming (SAS), weekly training time (WTT), weekly training distance (WTD), any painful episode that lasted more than 10 days in any of the body regions within last one year, any confirmed diagnosis of musculoskeletal disease by a physician, and history of musculoskeletal surgical operation. The descriptive data were presented, and multiple comparisons were made according to demographic characteristics. Results There were 88 male swimmers with a mean age of 47.1±13.2 years (range, 26-89 years). Of the 88 athletes, 27 (30.7%) had no pain in daily activities, and 61 (69.3%) reported pain in at least one region, with a total of 118 pain zones reported. The shoulder was the most common painful body region (n:37, 42.0%), followed by the lower back (n: 24, 27.3%), neck (n: 19, 21.6%), back (n:12, 13.6%), and knee (n:9, 10.2%). The mean age, SAS, WTT, WTD, and distribution of stroke preference were similar in subjects with or without reported pain and diagnosis (p>0.005). Any painful body region and diagnosis were equally distributed in all swimming styles (p>0.05). The most common surgeries were lumbar disc disease (16.7%) and meniscectomy (16.7%). Conclusion Compared to the findings in the current literature, master swimmers do not have as many musculoskeletal problems as their younger counterparts. The problems seen in master swimmers are lower but similar to those in competitive elite swimmers. From the musculoskeletal health perspective, swimming is safe for the master age group. Swimming can be safely offered to elderly patients who underwent even musculoskeletal surgery.

Total knee replacement-cementless tibial fixation with screws: 10-year results.

BACKGROUND: The aim of this study was to evaluate the long term clinical and radiological results of cementless total knee replacement. METHODS: A total of 51 knees of 49 patients (33 female and 16 male; mean age: 61.6 years (range, 29-66 years)) who underwent TKR surgery with a posterior stabilized hydroxyapatite coated knee implant were included in this study. All of the tibial components were fixed with screws. The HSS scores were examined preoperatively and at the final follow-up. Radiological assessment was performed with Knee Society evaluating and scoring system. Kaplan-Meier survival analysis was performed to rule out the survival of the tibial component. RESULTS: The mean HSS scores were 45.8 (range 38-60) and 88.1 (range 61-93), preoperatively and at the final follow-up respectively. Complete radiological assessment was performed for 48 knees. Lucent lines at the tibial component were observed in 4 patients; one of these patients underwent a revision surgery due to the loosening of the tibial component. The 10-year survival rate of a tibial component was 98%. CONCLUSION: Cementless total knee replacement has satisfactory long term clinical results. Primary fixation of the tibial component with screws provides adequate stability even in elderly patients with good bone quality. LEVEL OF EVIDENCE: Level IV, Therapeutic study.