The Effect of Clavicular Tunnel Position on Reduction Loss in Patients with Acute Acromioclavicular Joint Dislocations Operated with a Single-Bundle Suspensory Loop Device.

OBJECTIVE: The treatment of acromioclavicular joint (ACJ) dislocations offers numerous options, and ongoing debates persist regarding their comparative effectiveness. Among these options, the suspensory loop device (SLD) is one of the most favored treatment modalities. Despite the observed high reduction loss rate associated with SLD, the treatment yields favorable clinical outcomes. This study aimed to investigate the clinical outcomes of patients with acute type 3 and 5 ACJ dislocations who underwent open and arthroscopic procedures using a single-bundle SLD, and to evaluate the effect of clavicular tunnel position on reduction loss. METHODS: Thirty-seven eligible patients diagnosed with acute type 3 and type 5 ACJ dislocation who underwent open and arthroscopic surgery with a single-bundle SLD between January 2015 and March 2022 were evaluated retrospectively. Demographic data and radiological measurements including coracoclavicular (CC) interval, clavicle length (CL), and implant distance (ID) were recorded. The ID/CL ratio was calculated and a value between 0.17 and 0.24 was considered as "acceptable implant position". Reduction loss and other complications were noted. Patients were divided into two groups: open (Group 1) and arthroscopic (Group 2). Constant Murray Score (CMS) and Visual Analog Scale (VAS) were used for clinical and functional outcomes. Non-parametric tests were used for statistical analysis of variables. RESULTS: The study included six females (16.2%) and 31 males (83.8%) with a mean age of 40.2 ± 14.7 years (range: 20-75). The mean follow-up period was 22.3 ± 16.7 months (range: 6-72). The average time from trauma to surgery was 6.3 ± 5.3 days (range: 1-18). At the last follow-up, the CMS was 89.3 ± 8.8 and the VAS score was 2.1 ± 0.9. The mean ID/CL ratio was 0.19 ± 0.1 and 19 patients (51.4%) were between 0.17 and 0.24. Reduction loss was observed in nine patients (24.3%). There were no significant differences between Group 1 and Group 2 regarding operation time (p = 0.998), ID/CL ratio (p = 0.442), reduction loss (p = 0.458), CMS (p = 0.325), and VAS score (p = 0.699). Of the 28 patients without reduction loss, 16 had an ID/CL ratio between 0.17 and 0.24 (p = 0.43). Furthermore, within the 0.17-0.24 interval, CMS was higher with an average of 91.8 ± 5.1 compared to the other intervals (p = 0.559). CONCLUSION: The clinical and functional outcomes of acute type 3 and type 5 ACJ dislocation operated open and arthroscopically with single-bundle SLD are similar and satisfactory. A clavicular tunnel position in the range of 0.17-0.24 (ID/CL ratio) is recommended to maintain postoperative reduction.

Which is more dangerous, earthquake, or the panic?Evaluation of the 24 January 2020 Elazig/Türkiye earthquake related musculoskeletal injuries.

BACKGROUND: The aim of this study is to evaluate the musculoskeletal injuries related with 24 January 2020 Elazig/Türkiye earthquake and their treatment protocols. METHODS: Data of patients applied to Inönü University Medical Faculty Hospital, Elazig Training and Research Hospital and Malatya Training and Research Hospital emergency departments within 48 h after the earthquake, were evaluated retrospectively. Age, gender, soft tissue injuries and sites, fracture sites and types, fracture etiology, and treatment methods were evaluated. RESULTS: 247 patients were evaluated. 118 were women and 139 were men. There were 24 (9.7%) pediatric patients. Mean age was 37.3 (1-92) years. Waist majority of injuries were simple soft-tissue injuries. There were 103 fractures in 86 patients. Thirty-eight patients' fractures were treated surgically. CONCLUSION: Every major disaster warrants retrospective studies so we can learn how to improve all levels of Emergency Medical Services. Great proportion of Elazig earthquake victims had only simple soft tissue injuries such as sprain, laceration, or contusion. Many patients were injured due to reasons indirectly related to the destruction brought by the earthquake. Panic caused by the earth-quake caused more injury than the destruction it brought.

Effectiveness of the Thermal Genicular Nerve Radiofrequency Ablation Therapy Under Fluoroscopy in Patients with Non-operative Advanced Stage Knee Osteoarthritis: 1-Year Follow-Up Results.

Background: In this study, our aim was to present the 1-year results of the effect of thermal genicular nerve radiofrequency ablation (GNRFA) therapy on pain and functional outcomes in patients with advanced knee osteoarthritis. Materials and Methods: After retrospectively examining the hospital records, 49 knees of 35 patients who had undergone thermal RFA of the superior medial, superior lateral, and inferior medial branches of the genicular nerve under fluoroscopic guidance between July 2019 and December 2020 were included in the study. The visual analog scale (VAS) scores of the patients were recorded before RFA, on the day of RFA, and at the first, sixth, and 12th months postoperatively, as well as their Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores before RFA and at the 12th month postoperatively. Complications developed after the procedure and during the follow-up period were screened. Results: Twenty-five of the patients were females and 10 males, with a mean age of 77.3 ± 7.9 years (range 61-92 years). The mean VAS score was 8.4 ± 0.9 before RFA, and as 1.7 ± 1.0 right after the procedure, 2.4 ± 1.7 at the first month, 3.4 ± 1.8 at the sixth month, and 4.4 ± 1.9 at the 12th month (p < 0.01). In terms of the WOMAC score, the average value was 69.7 ± 6.4 before the treatment and 36.1 ± 11.8 at the final follow-up at the 12th month (p < 0.01). No complications were observed in any patient during the treatment or the follow-up period. Conclusion: Non-surgical thermal GNRFA therapy of knee osteoarthritis provides significant outcomes in terms of pain and functionality, with no significant systemic or local side effects. Therefore, the technique can be considered as an alternative to other methods when treating advanced osteoarthritis.

Management of developmental dysplasia of the hip in less than 24 months old children.

BACKGROUND: There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age. MATERIALS AND METHODS: Sixty hips of 50 patients (4 male, 46 female) with mean age of 14.62 ± 5.88 (range 5-24 months) months with a mean followup of 40.00 ± 6.22 (range 24-58 months) months were included. Twenty five right and 35 left hips (10 bilaterally involved) were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tönnis type II-III and IV hip dysplasias) and for those aged 20-24 months with Tönnis type II and III hip dysplasias (n = 47). However for 13 patients aged 20-24 months with Tönnis type IV hip dysplasias, anterior bikini incision was used. RESULTS: Mean acetabular index was 41.03 ± 3.78° (range 34°-50°) in the preoperative period and 22.98 ± 3.01° (range 15°-32°) at the final visits. Mean center-edge angle at the final visits was 22.85 ± 3.35° (18°-32°). Based on Severin radiological classification, 29 (48.3%) were type I (very good), 25 (41.7%) were type II (good) and 6 (10%) were type III (fair) hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent (n = 42; 70%), good (n = 14; 23.3%) and fair (n = 4; 6.7%). Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3%) hips for continued acetabular dysplasia and recurrent subluxation. (Salter [n = 12]/Pemberton [n = 2] osteotomy was performed). Avascular necrosis (AVN) developed in 7 (11.7%) hips. CONCLUSION: In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking age group with high acetabular index.