What should be the preferred choice of hemiarthroplasty technique in American Society of Anesthesiologists (ASA) class III patients with femoral neck fractures? Cemented or cementless.

The hypothetical basis of this trial specifies that hemiarthroplasty applications without cement will prove to be superior to applications with cement in terms of survival, complications, clinical and radiological improvements in the early stages of femoral neck fracture cases, which belongs to the Society of Anesthesiologists (ASA) class III group. Society of Anesthesiologists (ASA) class III elderly patients (minimum 70 years of age), who had undergone surgical interventions for femoral neck fractures were classified into two groups as those undergoing the intervention without cement (Group A) and those undergoing the procedure with cement (Group B), and these were retrospectively evaluated. The patients were followed up for a mean duration of 47.4 and 44.8 months, respectively. Survival in the early stage, duration of stay in the intensive care, intraoperative cardiac indexes, complications, clinical and radiological parameters were the main factors used in the evaluation and comparisons. The mean duration of operation in Group B cases was determined to be statistically significantly longer than that of Group A (p<0.001). The postoperative stay at the intensive care unit in both groups and the rate of mortality for 6 months in Group B were determined to be statistically significantly high (p<0.05). In group B, significant depressive findings were determined in the comparison of the intra-operative pre-and post-cement cardiac indexes. In the clinical assessment, no statistically significant results were obtained, although higher final Harris scores were determined in Group A cases (p=0.581). In the treatment of femoral neck fractures, bipolar hemiarthroplasty applications without cement provide favourable early and short-term results, which are at least as effective as the applications with cement.

Which treatment option for paediatric femoral fractures in school-aged children: elastic nail or spica casting?

OBJECTIVE: Titanium elastic nails and immediate spica casts are treatment options for femoral fractures in school-aged children (6-12 years). This study aimed to compare the results of elastic nail and immediate spica cast methods for treating femoral fractures in school-aged children. MATERIALS AND METHODS: A retrospective evaluation was made of patients who underwent immediate spica cast (20 patients) or titanium elastic nail (22 patients) for femoral fracture. Groups were compared in terms of clinical and radiographic union, duration of hospitalisation, range of knee motion, walking independently and complications. The mean age was 9.8 ± 1.3 years for the elastic nail group and 6.4 ± 1 for the cast group. The mean follow-up period was 12.6 ± 5.2 months for the elastic nail group and 14.3 ± 6 months for the cast group. RESULTS: All fractures in both group were healed. Duration of hospitalisation was shorter (2.2/7.1) and range of knee motion was better (132°/129°) in the cast group. The duration for independent walking was shorter (49.2/79.8) in the nail group. These differences were significant (p < 0.001). Two superficial infections and two malalignment were detected in the nail group. Three superficial infections and four malalignment were detected in the cast group. CONCLUSION: We detected that both treatment options were similar with regard to complications and results. Although the complications are similar in two treatment methods, complications of elastic nail are more challenging and may require new surgical procedure. If the elastic nail is selected, surgical complications should not be underestimated.

Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis.

OBJECTIVE: The aim of this study was to compare the effects of platelet-rich plasma (PRP) and steroid injections in patients diagnosed with plantar fasciitis. METHODS: A total of 50 patients with chronic plantar fasciitis were included in the study and divided into 2 groups. In the PRP group (n=25), PRP taken from the patients' blood was activated using calcium chloride and injected in a single dose. In the steroid group (n=25), a single dose methylprednisolone with local anesthetic injection was given. Clinical evaluation was made using the American Foot and Ankle Score (AFAS) and the visual analog scale (VAS). RESULTS: No complications were seen in any patients. Mean AFAS was 85.5 ± 4.2 at 6 weeks and 90.6 ± 2.6 at 6 months in the PRP group and 75.3 ± 4.8 and 80.3 ± 4.7, respectively, in the steroid group (p<0.001). The difference in the mean VAS between the PRP group (2.4 ± 0.8 and 1 ± 0.8) and the steroid group (4 ± 1.1 and 2.6 ± 0.9) at the 6th week and 6th month was statistically significant (p<0.001). Changes in AFAS and VAS scores were significantly higher in the PRP group (p<0.001). CONCLUSION: The application of PRP appears to be more effective than steroid injection in terms of pain and functional results in the treatment of chronic plantar fasciitis.