Morphometric indices and carpal tunnel syndrome: a radiological study in female patients.

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy syndrome of the upper extremities. The carpal tunnel is an osteofibrous canal that is medially bordered by hamulus ossis hamati and pisiform bone, and laterally by scaphoid and trapezoid bones. In this retrospective case-control study, we investigated the relationship between radiologically measured morphometric indices and CTS in female patients. METHODS: Clinical, radiological, and demographic data were collected for 55 hands of 40 female patients diagnosed with CTS and 58 hands of control subjects. Radiological measurements included various morphometric parameters derived from wrist and hand X-rays. Statistical analysis was conducted to assess associations between morphometric indices and CTS. RESULTS: Significant associations were observed between CTS and several morphometric indices, including carpal height, capitate length, palm length, and others. Notably, these values were lower in CTS patients, suggesting a potential link between reduced carpal tunnel volume and increased pressure due to synovial hypertrophy. Additionally, a newly introduced index, Scaphoid Pisiform Width Index (SPWI), showed promise in assessing the proximal part of the carpal tunnel. CONCLUSION: It was found that the values for Capitate length, Carpal height, Palm length, SPWI, and Palmar ratio were lower in the patient group. These results suggested that decreasing volume of the carpal tunnel allows for an easier increase in carpal tunnel pressure due to increased synovial hypertrophy and the carpal bone configuration affects the proximal part of the carpal tunnel, and influences the compression of the median nerve, in female patients.

Foot radiologic morphology as a predictor of pseudo-jones fractures: A retrospective case-control study.

BACKGROUND: Fifth metatarsal basis fractures are common injuries. Zone 1 fractures are also known as pseudo-jones fractures. This study aimed to elucidate the impact of foot radiologic morphology on pseudo-Jones fractures. METHODS: Patients with pseudo-Jones fractures formed the case group and individuals with ankle sprains but no fractures formed control group. Weight-bearing anteroposterior and lateral radiographs were evaluated for pre-determined measurements: metatarsus adductus angle (MAA), intermetatarsal angles (1-2, 4-5), calcaneal inclination (CI) angle, and fifth metatarsal base angle. All measurements were performed by a single investigator using digital PACS tools. Statistical analysis compared these radiographic parameters between the groups. RESULTS: The fracture group demonstrated a significantly lower 4-5 intermetatarsal and calcaneal inclination angles than the control group (p < 0.05). Notably, no statistically significant difference was found in the metatarsus adductus angle. CONCLUSION: This study demonstrates a potential association between foot radiographic morphology and pseudo-Jones fractures. Patients with a lower 4-5 IMA and calcaneal inclination angle may be at a higher risk for developing pseudo-Jones fractures. However, these requires future prospective studies. LEVEL OF EVIDENCE: Level III case control study.

Fluoroscopy guided without contrast injection for ganglion impar blockade in traumatic coccydynia: Description a modified approach and 1-year results.

BACKGROUND: This study presents a new fluoroscopy-controlled approach in patients with chronic traumatic coccydynia by applying ganglion impar block using the needle-inside-needle technique from the intercoccygeal region without the administration of contrast material. With this approach, the cost and possible side effects of using contrast material can be prevented. In addition, we examined the long-term effect of this method. METHODS: The study was designed retrospectively. The marked area was entered with a 21-gauge needle syringe, and 3 cc of 2% lidocaine was administered subcutaneously by local infiltration. A 25-gauge 90 mm spinal needle was inserted into the guide 21-gauge 50 mm needle tip. The location of the needle tip was controlled under fluoroscopy, and 2 mL of 0.5% bupivacaine and 1 mL of be-tamethasone acetate were mixed and administered. RESULTS: A total of 26 patients with chronic traumatic coccydinia participated in the study between 2018 and 2020. The average procedure time was approximately 3.19 min. The mean time of pain relief of more than 50% was 1.25±1.22 (1st min-72 h) min. The mean Numerical pain rating scale scores were 2.38±2.26 at 1 h, 2.50±2.30 at 6 h, 2.50±2.21 at 24 h, 3.73±2.20 at 1 month, 4.46±2.14 at 6 months 1 and 5.23±2.52 at 1 year. CONCLUSION: Our study shows that as an alternative in patients with chronic traumatic coccydynia, the long-term results of the needle-inside-needle method from the intercoccygeal region without contrast material are safe and feasible.

Polypharmacy is Associated with Diabetic Foot Ulcers in Type 2 Diabetes mellitus.

Objectives: This observational study aimed to investigate the relationship between polypharmacy and the existence of diabetic foot ulcers in patients with type 2 diabetes. Methods: Patients with T2DM with and without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were involved in the study. Overall, five hundred and twelve patients with T2DM (293 patients with diabetic foot ulcer and 219 patients without diabetic foot ulcer) were included. The exclusion criteria were pregnancy, lactation, type 1 diabetes, patients under 18 years and over 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. Results: The comparison of the two groups revealed that patients with diabetic foot ulcers had significantly higher rates of diabetic retinopathy (p = 0.017). The patients with diabetic foot ulcers who had polypharmacy had significantly higher rates of hypertension, ischaemic heart disease, diabetic retinopathy, and complaints of diabetic neuropathy (P < 0.001, P < 0,001, p = 0.021 and P = 0.004, respectively). In the binary logistic regression analyses, polypharmacy was independently associated with diabetic foot ulcers in all models. Conclusion: Polypharmacy should be seriously concerned in type 2 diabetes mellitus in patients with diabetic foot ulcers and polypharmacy was related to diabetic foot ulcers.

Low handgrip strength is associated with diabetic foot disease in geriatric patients with type 2 diabetes.

BACKGROUND: This study aims to reveal the prevalence of low handgrip strength in older patients with type 2 diabetes who have diabetic foot disease and to assess the association of handgrip strength with diabetic foot disease in older patients with type 2 diabetes. METHODS: Eighty-nine geriatric patients with diabetic foot ulcers and 69 patients without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were included in the study. The exclusion criteria were the usage of steroids, stroke-induced quadriplegia, myopathy, disability, hemodialysis treatment, type 1 diabetes, patients under 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. A handgrip strength test was performed with a handheld digital dynamometer. For females <16 kg (kilograms), for males <27 kg was accepted as low handgrip strength. RESULTS: Forty-nine patients (55.1%) with diabetic foot ulcers and 25 (36.2%) patients without diabetic foot ulcers had low handgrip strength. There was a significant difference between two groups (p = 0.019). The patients with diabetic foot ulcers who had lower handgrip strength had higher rates of peripheral artery disease than patients with diabetic foot ulcers who had normal handgrip strength (p = 0.02 and p = 0.009, respectively). The patients with diabetic foot ulcers who had lower handgrip strength, had significantly higher rates of Wagner scores 4 and 5 and lower rates of Wagner scores 1 and 3 (p = 0.039). DISCUSSION: Older patients with type 2 diabetes and diabetic foot disease had a higher rate of low handgrip strength. Low handgrip strength was significantly associated with the occurrence of diabetic foot ulcers and directly correlated with Wagner score in geriatric patients with type 2 diabetes.

Effects of pregabalin on spinal fusion.

PURPOSE: Gamma-aminobutyric acid analogues are commonly used to treat neuropathic and chronic pain before and after spinal surgery in recent years. Aim of this study is to investigate the influence of pregabalin on spinal fusion and to determine the proper pregabalin dose for postoperative utilization in a validated rat intertransverse spinal fusion. METHODS: Lumbar intertransverse fusion surgeries performed in four groups of rats according to a previously established rat model for posterolateral spinal fusion. All rats were followed up for 6 weeks at the postoperative period by administering oral pregabalin doses of 10 (D10), 30 (D30) and 100 mg/kg/day (D100) except the control group. All rats were killed after 6 weeks and evaluated in terms of manual palpation, radiographic investigation and histological analysis to investigate posterolateral fusion. RESULTS: Assessment of fusion with manual palpation revealed lower fusion rates in D100 group. In histological analysis, scores were significantly lower in D30 and D100 groups compared to the control group; this finding was interpreted as inhibition of spinal fusion. Radiographic evaluation did not reveal any significant statistical difference between groups. CONCLUSIONS: Histological analysis and manual palpation results showed inhibition of spinal fusion formation with high doses of pregabalin. According to these results, administration of high-dose pregabalin should be avoided at the postoperative period until successful fusion is obtained in patients who undergo spinal fusion surgery. These slides can be retrieved under electronic supplementary material.