Treatment of Periarticular Fractures of the Knee Using the Less Invasive Stabilization System: A Retrospective Clinical Trial.

Introduction Periarticular fractures of the knee in adults are generally treated with internal fixation. The Less Invasive Stabilization System (LISS) plate, developed by Arbeitsgemeinschaft Osteosynthesefragen (AO)/Association for the Study of Internal Fixation (ASIF) in the late 1990s, allows reduction and biological fixation through smaller incisions without violating periosteal blood supply. It offers several advantages for the treatment of complex periarticular fractures of the knee. In this study, we have aimed to report the results of a single series of these fractures. Materials and methods Forty-eight patients with AO type 33 and AO type 41 periarticular knee fractures who were operated between 2009 and 2014 at a single institution were included in this retrospective study. Patient demographics, fracture epidemiology, intraarticular extension, concomitant injuries, American Society of Anesthesiologists (ASA) score, time to union, the average time from admission to surgery, and the mean time from operation to patient discharge were noted. The effect of patient and fracture-related factors on length of hospital stay were evaluated. Results The mean follow-up time was 23.7 (12-48) months. The average time from admission till surgery and from surgery till discharge was 10.2 (1-39) and 9.7 (2-35) days, respectively. The average time for union was 6.8 months. Femur fractures healed in mean 6.6 months whereas tibia fractures took 7.1 months to heal. Time from admission to surgery and postoperative hospital stay was longer in patients with higher ASA scores (p<0.01) and open fractures (p<0.001). Patients' body mass index (BMI) and intraarticular extension of the fracture did not cause an increase in either preoperative or postoperative hospital stay (p>0.05). The presence of concomitant major injuries caused a delay in operation (p<0.05), whereas postoperative hospital stay was not different (p>0.05). Conclusion LISS plating provides good stability through a small incision, permits biological fracture healing, may be used in multifragmentary fractures and has low complication rates. It is a good alternative for the treatment of periarticular fractures of the knee.

COMPARISON OF RADIOFREQUENCY ABLATION AND CURETTAGE IN OSTEOID OSTEOMA IN CHILDREN.

OBJECTIVE: Osteoid osteoma, which is observed in the adolescent and young adult population as benign bone tumors, appears as a single nidus with a diameter < 2 cm and is treated with open surgery. However, technological advances in medicine have made it possible to apply less invasive procedures in surgery. METHODS: Between 2006-2014, 24 patients < 18 years of age were treated for osteoid osteoma. Patient demographic data, surgical data, complications, and recurrences were noted. RESULTS: Twenty-four patients (mean age, 11 [2-18] years) were treated and followed up for a mean 3.58 (range, 1-9) years. Mean patient age in the curettage group was 12.1 (range, 3-18) years. Mean operation length was 69.5 (range, 60-120) minutes. Mean hospital stay was 1.3 (range, 0-2) days. Mean patient age in the radiofrequency ablation (RFA) group was 10.7 (range, 2-17) years. Five patients were female and 8 were male. Mean operation length was 49.6 (range, 20-90) minutes. Mean hospital stay was 0.3 (range, 0-1) days. Mean follow-up time was 1.76 (range, 1-4) years. Mean operation length, hospital stay, and follow-up were significantly shorter in the RFA group. CONCLUSIONS: Considering reduced costs due to shorter hospitalization periods and the ability to reach anatomically difficult locations, percutaneous procedures are likely to replace the conventional open approach. Level of evidence: II, retrospective study.

OBJETIVO: O osteoma osteoide, tumor ósseo benigno, acomete predominantemente adolescentes e adultos jovens. É descrito como um nicho único menor que 2 centímetros e o tratamento, nas últimas décadas, era realizado por cirurgia aberta. Com os avanços tecnológicos na medicina, os procedimentos menos invasivos tornaram-se o tratamento de escolha. MÉTODOS: Entre 2006 e 2014, 24 pacientes com menos de 18 anos foram submetidos ao tratamento de osteoma osteoide. Foram coletados os dados demográficos da população estudada e as informações sobre a cirurgia, complicações e recorrência. RESULTADOS: Os vinte e quatro pacientes com média de idade de 11 anos (2-18) foram tratados e o acompanhamento teve média de 3,58 anos (1-9). A média de idade dos pacientes no Grupo curetagem foi de 12,1 anos (3-18). O tempo médio da cirurgia foi de 69,5 minutos (60-120). A média de permanência hospitalar foi de 1,3 dias (0-2). A média de idade dos pacientes no Grupo ARF foi de 10,7 anos (2-17) anos, sendo cinco do sexo feminino e oito do sexo masculino. O tempo médio de cirurgia foi de 49,6 minutos (20-90). A permanência hospitalar média foi de 0,3 dias (0-1). O tempo médio de acompanhamento foi de 1,76 anos (1-4). As médias de tempo cirúrgico, tempo de internação e acompanhamento foram significativamente menores no Grupo ARF. CONCLUSÕES: Quando a redução de custos promovida pelo menor tempo de hospitalização e a capacidade de atingir locais anatomicamente difíceis também forem considerados, os procedimentos percutâneos provavelmente substituirão a cirurgia aberta convencional. Nível de evidência II; Estudo retrospectivo.

Comparison of radiofrequency ablation and curettage in osteoid osteoma in children / Comparação entre ablação por radiofrequência e curetagem de osteoma osteoide em crianças

ABSTRACT Objective: Osteoid osteoma, which is observed in the adolescent and young adult population as benign bone tumors, appears as a single nidus with a diameter < 2 cm and is treated with open surgery. However, technological advances in medicine have made it possible to apply less invasive procedures in surgery. Methods: Between 2006-2014, 24 patients < 18 years of age were treated for osteoid osteoma. Patient demographic data, surgical data, complications, and recurrences were noted. Results: Twenty-four patients (mean age, 11 [2-18] years) were treated and followed up for a mean 3.58 (range, 1-9) years. Mean patient age in the curettage group was 12.1 (range, 3-18) years. Mean operation length was 69.5 (range, 60-120) minutes. Mean hospital stay was 1.3 (range, 0-2) days. Mean patient age in the radiofrequency ablation (RFA) group was 10.7 (range, 2-17) years. Five patients were female and 8 were male. Mean operation length was 49.6 (range, 20-90) minutes. Mean hospital stay was 0.3 (range, 0-1) days. Mean follow-up time was 1.76 (range, 1-4) years. Mean operation length, hospital stay, and follow-up were significantly shorter in the RFA group. Conclusions: Considering reduced costs due to shorter hospitalization periods and the ability to reach anatomically difficult locations, percutaneous procedures are likely to replace the conventional open approach. Level of evidence: II, retrospective study.

RESUMO Objetivo: O osteoma osteoide, tumor ósseo benigno, acomete predominantemente adolescentes e adultos jovens. É descrito como um nicho único menor que 2 centímetros e o tratamento, nas últimas décadas, era realizado por cirurgia aberta. Com os avanços tecnológicos na medicina, os procedimentos menos invasivos tornaram-se o tratamento de escolha. Métodos: Entre 2006 e 2014, 24 pacientes com menos de 18 anos foram submetidos ao tratamento de osteoma osteoide. Foram coletados os dados demográficos da população estudada e as informações sobre a cirurgia, complicações e recorrência. Resultados: Os vinte e quatro pacientes com média de idade de 11 anos (2-18) foram tratados e o acompanhamento teve média de 3,58 anos (1-9). A média de idade dos pacientes no Grupo curetagem foi de 12,1 anos (3-18). O tempo médio da cirurgia foi de 69,5 minutos (60-120). A média de permanência hospitalar foi de 1,3 dias (0-2). A média de idade dos pacientes no Grupo ARF foi de 10,7 anos (2-17) anos, sendo cinco do sexo feminino e oito do sexo masculino. O tempo médio de cirurgia foi de 49,6 minutos (20-90). A permanência hospitalar média foi de 0,3 dias (0-1). O tempo médio de acompanhamento foi de 1,76 anos (1-4). As médias de tempo cirúrgico, tempo de internação e acompanhamento foram significativamente menores no Grupo ARF. Conclusões: Quando a redução de custos promovida pelo menor tempo de hospitalização e a capacidade de atingir locais anatomicamente difíceis também forem considerados, os procedimentos percutâneos provavelmente substituirão a cirurgia aberta convencional. Nível de evidência II; Estudo retrospectivo.

The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor.

PURPOSE: To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. METHODS: Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness from 3 locations and meniscus injury were assessed by two specialist radiologists. RESULTS: Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P = 0.033). CONCLUSIONS: An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process.

Neutrophil to lymphocyte ratio may be a predictive marker of poor prognosis in Legg-Calvé-Perthes disease.

BACKGROUND: Legg-Calvé-Perthes disease (LCPD) is the idiopathic avascular necrosis of the femoral head in childhood. The pathologic changes seen in the femoral head are likely a result of vascular factors. Blood neutrophil to lymphocyte (N/L) ratio is a simple marker of subclinical inflammation. This study aims to to analyse the predictive ability of N/L ratio for the prognosis in LCPD patients. METHODS: Patients who had been diagnosed as LCPD from 2008 to 2014 were investigated retrospectively and 40 LCPD patients (33 male and 7 female) and 25 healthy age and sex-matched children (controls) were included in the study. LCPD patients were divided into 2 groups according to expected prognosis (good prognosis expected Herring A and B patients as Group I and poor prognosis expected Herring B-C and C patients as Group II) and healthy children (control) were included in Group III. All the patients' hematological markers were analysed. RESULTS: Mean age was 7.1 ± 2.0 years in group I (4.9-12 years), 8.3 ± 2.2 years (4-12.5 years) in group II and 7.8 ± 1.3 years (6-12 years) in group III. Mean values for Groups I, II and III for neutrophil to lymphocyte (N/L) ratio were 1.13 ± 0.65, 1.75 ± 0.95, 1.08 ± 0.37, respectively. The mean neutrophil to lymphocyte (N/L) ratio of Group II was higher than the other 2 groups (p = 0.003). CONCLUSIONS: N/L ratio may give us information about the natural course of LCPD and may be used as independent predictor of prognosis in patients with LCPD.

The Efficacy of Boric Acid Used to Treat Experimental Osteomyelitis Caused by Methicillin-Resistant Staphylococcus aureus: an In Vivo Study.

We explored the ability of local and systemic applications of boric acid (BA) to reduce the numbers of methicillin-resistant Staphylococcus aureus (MRSA) in a rat model of tibial osteomyelitis (OM), and compared boric acid with vancomycin (V). Implant-associated osteomyelitis was established in 35 rats. After 4 weeks, at which time OM was evident both radiologically and serologically in all animals, the rats were divided into five groups of equal number: group 1, control group (no local application of BA or other medication); group 2, V group; group 3, local BA + V group; group 4, local BA group; and group 5, local + systemic BA group. Serum total antioxidant status, and the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6, were measured. Pathological changes attributable to bone OM were evaluated using a grading system. Bacterial colony-forming units (CFUs) per gram of bone were counted. The lowest bacterial numbers were evident in group 3, and the bacterial numbers were significantly lower than that of the control group in all four test groups (p < 0.001). Group 3 also had the least severe bone infection (OM score 1.7 ± 1.1, p < 0.05). Upon histological and microbiological evaluation, no significant difference was evident between groups 2 and 3. Total antioxidant levels were significantly different in all treatment groups compared to the control group. Microbiological and histopathological evaluation showed that systemic or local application of BA was effective to treat OM, although supplementary V increased the effectiveness of BA.

Effects of boric acid on the healing of Achilles tendons of rats.

PURPOSE: Tendinous lesions are among the most frequent pathologies encountered in sportsmen. The objectives of new treatments are to improve the healing process and reduce the recovery time. Boron plays an important role in the wound repair process by increasing components of extracellular matrix and angiogenesis. This animal study aimed to investigate the effect of boric acid on healing of the Achilles tendon. METHODS: The right Achilles tendons of 40 rats were completely sectioned, and the rats were randomly divided into five groups. Each group consisted of eight rats. Groups 1 and 2 were oral boric acid groups with the doses of 4 and 8 mg/kg/day boric acid, respectively. Group 3 was the local boric acid group (8 mg/kg boric acid intratendinous injection). Group 4 was administered both oral and local boric acid (8 mg/kg/day orally and 8 mg/kg boric acid intratendinous injection), and group 5 was the control group with no boric acid application. At the end of the fourth week, all the rats were killed and histopathological examination of the Achilles tendon repair site was made. RESULTS: Histopathological examination of the tissue sections revealed more properly oriented collagen fibres, more normal cellular distribution of tenocytes and more properly organized vascular bundles in group 1 and group 2, which were the groups administered oral boric acid. Pathological sum scores of groups 1 and 2 were less than those of the other groups, and the differences between the oral boric acid groups (group 1 and group 2) and the other three groups (groups 3, 4 and 5) were statistically significant (p = 0.001). CONCLUSION: As boric acid is safe and toxicity even after very high doses is unusual, oral boric acid may be used as an agent to improve the healing process of tendon injuries. However, biomechanical tests should also be performed to show the effect of boric acid on strength and endurance of the tendon before it can be used in clinical practice.

Safety and feasibility of lumbar spine for intralaminar screw fixation: a computed tomography-based morphometric study.

OBJECTIVE: The use of intralaminar screws (ILS) in spinal surgery has experienced a recent increase in popularity. The aim of this study is to define the morphological parameters of the lumbar laminas so that guidance may be defined for ILS placement. METHODS: The study involved the evaluation of lumbar computed tomography (CT) images of patients. Two hundred thirty-five patients (127 male, 108 female) were included in the study. The mean patient age was 44.2 years (19-78 years). The measured parameters of the lamina were the transverse inner diameter, transverse outer diameter (lamina width), lamina length, subdural space (safe zone), and spinolaminar angle for each lumbar level (L1-L5). RESULTS: The mean transverse outer diameter (L1-L5) ranged from 7.2-7.8 mm, and mean transverse inner diameter ranged from 2.5-3.0 mm. The lamina of L3 had the largest width and the lamina of L1 and L5 the smallest. The mean lamina length was 26.6 mm, ranging from 21.0-34.0 mm, and the mean spinolaminar angle was 124.7°, ranging from 111-135°. The L1 level had the shortest mean lamina length and L4 the lowest spinolaminar angle. Mean subdural space (safe zone), which was narrowest at the L5 level, was 2.4 mm, ranging from 1.3-3.6 mm. CONCLUSION: ILS of the appropriate size (3.5-4.5 mm) and length (20 and 25 mm) can be used safely in the lumbar spine. However, further biomechanical studies should be performed to measure strength of the fixation.

Non-union of the great toe in a 4-year-old child.

Phalangeal fractures of the foot are very rare in children. They are treated with closed reduction and splinting. Cases reported of non-union in children are rare. We report on treatment of a 4-year-old child with non-union of the proximal phalanx of the great toe foot following an open fracture caused by a motor vehicle accident 4 months prior. No graft was used. We present this case with good clinical outcome at 1 year follow-up.

Treatment of juvenile hallux valgus interphalangeus with a double compression headless bone screw.

A 14-year-old girl presented with idiopathic valgus deformity of her left great toe at the interphalangeal joint (IPJ). The deformity, which had been present but asymptomatic for the past 4 years, began to enlarge and cause discomfort. The measured IPJ angle on anteroposterior standing X-ray was 26°. We treated the toe by medial closing wedge osteotomy and fixation with a double compression headless bone screw (DCHBS). Postoperative hallux valgus interphalangeus (HVI) angle was 14°.

Atypical Localization of Enchondroma in the Calcaneus.

A 53-year-old man presented to the orthopedic outpatient clinic with pain and swelling in the right heel without any trauma. On physical examination and radiologic assessment, a lesion with calcification and peripheral sclerosis was detected in the medullary cavity of the calcaneus, and computed tomographic images revealed cortical thinning adjacent to the lesion. Magnetic resonance images showed a 23 × 19-mm lesion. Tru-Cut biopsy, performed to clarify the diagnosis, revealed an enchondroma. As a definitive treatment, curettage of the lesion and grafting of the cavity was performed. Although enchondromas are common pathologic abnormalities of the skeleton and are usually asymptomatic, atypical localization, such as the calcaneus, and atypical clinical manifestations, such as heel pain, should also be kept in mind.

The Effect of Coumaric Acid on Ischemia-Reperfusion Injury of Sciatic Nerve in Rats.

The aim of the study was to determine the effect of coumaric acid on sciatic nerve ischemia/reperfusion (SNI) injury in rats. The rats were randomly divided into four groups: control group (no medication or surgical procedure), SNI group, SNI + coumaric acid (CA) group, and SNI + methylprednisolone (MP) group. Ischemia was achieved by abdominal aorta clamping, and all animals were sacrificed 24 h after ischemia. Harvested sciatic nerve segments were investigated histopathologically and for tissue biochemistry. A significant decrease in MDA, an increase in NRF1 levels, and increase in SOD activity were observed in the groups which received coumaric acid and methylprednisolone when compared to the corresponding untreated group (p < 0.05). Ischemic fiber degeneration significantly reduced in the SNI + CA and SNI + MP groups, especially in the SNI + MP group, compared to the SNI group (p < 0.05). Beta amyloid protein expressions were significantly decreased in the SNI + CA group compared to the SNI group (p < 0.05). Our study revealed that coumaric acid treatment after ischemia/reperfusion in rat sciatic nerves reduced oxidative stress and axonal degeneration. Therefore, coumaric acid may play a role in the treatment of peripheral nerve injuries due to ischemia/reperfusion.

Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging.

[Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3±7.0 years, while it was 16.7±12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.

Effects of Boric Acid on Fracture Healing: An Experimental Study.

Boric acid (BA) has positive effects on bone tissue. In this study, the effects of BA on fracture healing were evaluated in an animal model. Standard closed femoral shaft fractures were created in 40 male Sprague-Dawley rats under general anesthesia. The rats were allocated into five groups (n = 8 each): group 1, control with no BA; groups 2 and 3, oral BA at doses of 4 and 8 mg/kg/day, respectively; group 4, local BA (8 mg/kg); and group 5, both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally). After closed fracture creation, the fracture line was opened with a mini-incision, and BA was locally administered to the fracture area in groups 4 and 5. In groups 2, 3, and 5, BA was administered by gastric gavage daily until sacrifice. The rats were evaluated by clinical, radiological, and histological examinations. The control group (group 1) significantly differed from the local BA-exposed groups (groups 4 and 5) in the clinical evaluation. Front-rear and lateral radiographs revealed significant differences between the local BA-exposed groups and the control and other groups (p < 0.05). Clinical and radiological evaluations demonstrated adequate agreement between observers. The average histological scores significantly differed across groups (p = 0.007) and were significantly higher in groups 4 and 5 which were the local BA (8 mg/kg) and both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally), respectively, compared to the controls. This study suggests that BA may be useful in fracture healing. Further research is required to demonstrate the most effective local dosage and possible use of BA-coated implants.

Atypical Localization of Enchondroma in the Calcaneus.

A 53-year-old man presented to the orthopedic outpatient clinic with pain and swelling in the right heel without any trauma. On physical examination and radiologic assessment, a lesion with calcification and peripheral sclerosis was detected in the medullary cavity of the calcaneus, and computed tomographic images revealed cortical thinning adjacent to the lesion. Magnetic resonance images showed a 23 × 19-mm lesion. Tru-Cut biopsy, performed to clarify the diagnosis, revealed an enchondroma. As a definitive treatment, curettage of the lesion and grafting of the cavity was performed. Although enchondromas are common pathologic abnormalities of the skeleton and are usually asymptomatic, atypical localization, such as the calcaneus, and atypical clinical manifestations, such as heel pain, should also be kept in mind.

Effects of Local Administration of Boric Acid on Posterolateral Spinal Fusion with Autogenous Bone Grafting in a Rodent Model.

Spinal fusion is among the most frequently applied spinal surgical procedures. The goal of the present study was to evaluate whether the local administration of boric acid (BA) improves spinal fusion in an experimental spinal fusion model in rats. Currently, there is no published data that evaluates the possible positive effects if the local administration of BA on posterolateral spinal fusion. Thirty-two rats were randomly divided into four independent groups: no material was added at the fusion area for group 1; an autogenous morselized corticocancellous bone graft was used for group 2; an autogenous morselized corticocancellous bone graft with boric acid (8.7 mg/kg) for group 3; and only boric acid was placed into the fusion area for group 4. The L4-L6 spinal segments were collected at week 6, and the assessments included radiography, manual palpation, and histomorphometry. A statistically significant difference was determined between the groups with regard to the mean histopathological scores (p = 0.002), and a paired comparison was made with the Mann-Whitney U test to detect the group/groups from which the difference originated. It was determined that only the graft + BA practice increased the histopathological score significantly with regard to the control group (p = 0.002). Whereas, there was no statistically significant difference between the groups in terms of the manual assessment of fusion and radiographic analysis (respectively p = 0.328 and p = 0.196). This preliminary study suggests that BA may clearly be useful as a therapeutic agent in spinal fusion. However, further research is required to show the most effective dosage of BA on spinal fusion, and should indicate whether BA effects spinal fusion in the human body.

The effect of intraoperative sounds of saw and hammer on psychological condition in patients with total knee arthroplasty: prospective randomized study.

PURPOSE: Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures. METHODS: A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. RESULTS: The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. CONCLUSION: It would seem that sounds of hammer and saw have no evident negative effect on patient's mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed.

Consultation of traditional bone setters instead of doctors: is it a sociocultural and educational or social insurance problem?

BACKGROUND: Patients consulting bone setters is common in the eastern and south-eastern regions of Turkey. The reasons for consulting bone setters instead of qualified doctors remains unclear. We investigated the characteristics of such patients who consult traditional bone setters after trauma prior to admission to hospital. METHODS: In the study, 3,422 of 14,080 patients were investigated admitted to hospital between January 2012 and February 2013 with trauma or sequelae of such who were previously treated by bone setters. The characteristics of these patients and the main reasons for consultation of bone setters instead of doctors were recorded. RESULTS: Most of the patients consulting bone setters were found to be young adults or children. Generally speaking, the poorly educated prefer bone setters despite having social insurance. The most common reason (29.3%) was a general preference and secondarily (27.1%) the fear of being disabled after medical treatment. However, the most common cause of patients' consultation at hospital subsequently was due to complications of treatment (46.8%); indeed the complication rate after bone setters' intervention was found to be 54.8%. CONCLUSION: Although improvements have occurred in the access to and utilisation of healthcare services, consultation by patients of bone setters seems to be a sociocultural and educational issue rather than a problem of lack of medical insurance.