Comparison of Surgical Results of Modified Stoppa and Ilioinguinal Approach in Patients with Acetabular Fractures Involving Quadrilateral Surface Fractures.

Objectives: The aim of this study was to evaluate the results of surgical treatment in patients with acetabular fractures with a fractured quadrilateral surface treated using two different approaches. Methods: The study included 106 patients who were operated on with ilioinguinal (group A) or modified Stoppa (group B) technique for acetabular fracture with a fractured quadrilateral surface between 2011 and 2020 in our clinic. The quality of reduction was evaluated according to Matta criteria and postoperative pelvic (anteroposterior, external oblique, iliac oblique) radiographs. Evaluation of hip function was recorded using the Merle d'aubigne and Postel Score and Harris Hip Score. Results: Among the patients included in the study, there were 45 patients in group A and 61 patients in group B. When the group data were compared, it was seen that the modified Stoppa approach was superior in terms of intraoperative reduction quality, radiological data, Harris hip score, Merle d'aubigne and PostelScore. (Respectively p=0.40, p=0.49, p=0.040, p=0.028). Conclusion: : Modified Stoppa approach has successful clinical and radiological outcomes and better reduction quality and hip scores than ilioinguinal approaches in acetabular fractures involving quadrilateral plates.

The Impact of Bone Marrow Venting Augmentation on Knee Functions in the Repair of Vertical/Longitudinal Meniscus Tears: A Triple Comparison.

Objective: Preserving and restoring meniscus function is crucial for maintaining knee biomechanics and overall functionality. To enhance the healing process after meniscus repair, various biological techniques have been introduced. In this study, three treatment approaches examined were bone marrow venting with stem cells (BMVP), anterior cruciate ligament reconstruction (ACLR) with meniscus repair, and isolated meniscus repair. Materials and Methods: From 2015 to 2019, we retrospectively analyzed data from 83 patients who presented with complaints of knee pain or pain in addition to instability, were diagnosed with vertical/longitudinal meniscus tears, and underwent arthroscopic repair (30 with isolated repair, 28 with ACLR repair, and 25 with BMVP) at our University Hospital. Among the 28 patients with anterior cruciate ligament rupture, pain and instability were the predominant complaints, whereas 55 patients with meniscus tear primarily complained pain. Clinical and functional conditions were assessed using Lysholm, WOMAC, IKDC, and VAS scores before and 18 months after surgery. Surgical success was evaluated based on Barrett's criteria. Causes of failure were analyzed considering demographic data, smoking status, injury time, tear location, shape, zone, and suture type and number. Results: Of the participants, 58 were male, 25 were female, 61 had medial meniscus lesions, and 22 had lateral meniscus lesions. The tear types included 51 simple longitudinal tears, 18 bucket handle tears, and 14 complex tears. A significant improvement was observed in the postoperative 18 month Lysholm, WOMAC, and IKDC values in all three groups (p: 0.001). At the 18 month mark, clinical and functional outcomes were comparable between BMVP and ACLR repair groups (Lysholm p: 0.951, WOMAC p: 0.241, IKDC p: 0.984). Both of these procedures yielded better results compared to isolated meniscus repair (Lysholm p: 0.001, WOMAC p: 0.027, IKDC p: 0.001). Conclusion: The superior clinical and functional outcomes observed after meniscus repair with BMVP and ACLR, compared to isolated meniscus repair, indicate positive effects of bone marrow stem cells, blood components, and tissue healing factors on meniscus repair and knee function.

A Single-Center Comparative Study: Outcome Analysis of Fixation Techniques for Tibiotalocalcaneal Arthrodesis.

Introduction Tibiotalocalcaneal arthrodesis (TTCA) is a well-known and accepted surgical technique for end-stage ankle osteoarthritis. The aim of this study is to compare the postoperative clinical and radiological comparison of retrograde intramedullary nailing (RIMN) and plate/cannulated screw (P/cS) fixation methods in patients undergoing TTCA. Methods Patients with end-stage ankle osteoarthritis due to traumatic causes or rheumatic diseases between December 2012 and March 2019 were included in the retrospective study. Patients who underwent isolated tibiotalar or isolated subtalar arthrodesis were not included in the study. Functional scores of patients with bone fusion were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) and Short Form-36 (SF-36) quality of life score surveys, administered either in person or by phone. From the radiological point of view, it was evaluated whether the union was achieved with the two-view ankle radiograph. There were 48 patients who underwent ankle arthrodesis in the clinical archive. A total of 31 patients were excluded from the study due to failure to attend follow-up, inability to be reached, or non-compliance with study criteria. The mean age of the patients participating in the study was 44.12 ± 12.95 years, the follow-up time was 40.06 ± 27.31 months, the union time was 5.19 ± 3.17 months, and the AOFAS score was 53.12 ± 13.87. SF-36 scores were evaluated among their own subunits. Results A total of 17 patients were enrolled in the study, of whom 13 were male (76.47%) and 4 were female (23.53%). There was no significant effect of the fixation methods (RIMN or P/cS) selected for TTCA on union times (p>0.05). However, there were significant differences in some parameters of the SF-36 when compared by gender. According to this, the scores of men in physical function (PF), mental health (MH), and general health perception (GHP) were higher than those of women. When AOFAS and SF-36 scores were compared by fixation type, no statistically significant difference was found (p>0.05). Conclusion This study investigated the impact of the fixation method on clinical and radiological outcomes in TTCA. We found that both methods were clinically similar in terms of bone union time and surgical efficacy. However, men had better physical function, mental health, and general health perception after TTCA than women.

Evaluation of the effect of proximal femur geometry on results of geriatric intertrochanteric fracture surgery.

BACKGROUND: This study aimed to explore the relationship between the complications and clinical outcomes after intertrochanteric femoral fracture surgery, and the Singh index (SI), canal-calcar ratio (CCR), cortical thickness index (CTI), and canal flare index (CFI) - the radiological indices defining proximal femoral morphology in the literature - among patients over 60 years of age. METHODS: The data of 350 patients who were operated between 2015 and 2019 were evaluated retrospectively. The study included patients who underwent dual lag screw proximal femoral nailing and had good intraoperative reduction quality according to Fogagnolo's criteria. The relationships among radiological indices measured on radiographs acquired after trauma, and post-operative complications, Barthel activity index, and Harris hip score (HHS) were assessed statistically. RESULTS: Among 121 patients who met the study criteria, there were 63 (52.07%) female and 58 (47.93%) male patients. The mean length of follow-up was 37.09 (36-60) months. The patients had a mean age of 79.78 (60-97) years. At least one mechanical complication developed in 32 (26.4%) patients in the study group. No significant relationship could be established between radiological indices and post-operative complications (p>0.05). The relationship between SI and HHS was statistically significant (p<0.05). CCR, CTI, and CFI did not have a statistically significant relationship with and HHS (p>0.05). CONCLUSION: No statistically significant relationship could be established between radiological indices and post-operative complications. It should be considered that SI may be a parameter that affects clinical outcomes.

Fixation of open, unstable tuft fractures in toddlers and preschool-aged children using a 25-gauge hypodermic needle.

This study aimed to assess the treatment process of open, unstable tuft fractures occurring in toddlers and preschool-aged children treated using a 25-gauge hypodermic needle in the emergency department, and the cosmetic and functional results achieved by this treatment. This retrospective cohort study included a total of 72 patients. Children aged two to six years were included in the study. Van Beek classification was used for the evaluation of nail bed injuries. Cosmetic results were evaluated on the basis of Zook classification whereas functional results were evaluated according to the Buck-Gramko score simplified by Nietosvaara et al . The patient population consisted of 52 men and 20 women. The mean age was 4 ± 1.33 years. The operating time was 19.17 ± 3.66 minutes and the time to union was 46.68 ± 4.84 days. While excellent and good functional results were obtained in 65 (90.2%) of the patients, excellent and very good cosmetic results were obtained in 51 (70.8%) patients. Unless there is an accompanying extremity fracture, unstable pediatric tuft fractures can be successfully fixed with a hypodermic needle in the emergency department. Gentle and precise repair of the nail bed may provide cosmetically and functionally satisfactory results.

Radiological and functional outcomes of modified Metaizeau technique in displaced radial neck fractures.

The management of displaced radial neck fractures in children is still a controversial topic. The objective of this study is to examine the outcomes of modified Metaizeau technique in the children with displaced radius neck fractures. The retrospective study included 15 children with displaced radial neck fracture with an angulation of more than 30° who were managed with the use of leverage technique by mosquito clamps and internal fixation with elastic stable intramedullary nailing (ESIN). Radiological and functional assessments were performed during follow-up. Additionally, the patients were evaluated using Mayo Elbow Per- formance Score (MEPS). All the children could be managed with clamp-assisted closed reduction. The average duration of follow up was 25.5 ± 6.1 months (15-36 months). An excellent elbow function was achieved in all but one patient. Based on Metaizeau classification, excellent, good, fair, and poor outcomes were achieved in 11, 1, 2, and 1 patients, respectively. The average postoperative MEPS score was 98.7 ± 5.1 (80-100). Clamp-assisted closed reduction and fixation with ESIN is a good choice in the children with displaced radial neck fractures. This technique is associated with good functional and radiologic outcomes in the medium-term. Further studies are warranted with larger sample sizes.

Surgery or Conservative Treatment of Forearm in Patients Diagnosed with Pediatric Floating Elbow? Retrospective Analysis of 60 Consecutive Cases.

BACKGROUND: The coexistence of supracondylar humerus fracture and forearm fracture is a rare trauma (3-13%) and it is called floating elbow. The aim of this study is to clinically compare the treatment outcomes of the patients diagnosed with floating elbow who underwent surgical treatment and who were followed up forearm with immobilization with splint. MATERIALS AND METHODS: When scanned retrospectively, 60 patients who were treated with the diagnosis of floating elbow due to traumatic causes and followed up for at least 1 year were included in our study. Surgical treatment was performed on 42 patients for forearm fracture. Eighteen patients followed up with immobilization with a long arm splint. The results were evaluated according to the criteria modified by Templeton and Graham, in comparison with the patient's intact side. RESULTS: In the patients whose forearms were followed up conservatively, the mean age was 5.67 ± 2.25 years, and the mean follow-up period was 62.17 ± 45.91 months. In the patients who underwent surgery for the forearm, the mean age was 8.79 ± 2.01 years, and the mean follow-up was 47.14 ± 34.25 months. Eighteen patients whose forearms followed up conservatively, 12 had excellent and good clinical results and 6 had poor and moderate clinical results. Excellent and good clinical results in 27 patients who underwent surgical treatment for their forearms, moderate and poor clinical results obtained in 15 of them. There was no significant difference between the two groups (p = 0.357). CONCLUSIONS: In conclusion, satisfactory clinical and radiological outcomes can be obtained with immobilization of the forearm fracture with splint, if acceptable reduction can be provided for the forearm following fixation of the supracondylar humerus fracture with the K-wire for treatment of floating elbow injury.

The Floating Knee Injuries: Does it Need a New Classification System?

BACKGROUND: This study aims to determine the differences between the clinical and radiological results of patients based on Karlstrom-Olerud Scoring System who cannot be included in any classification for floating knee injuries and to seek an answer to the question of whether a new classification is needed. MATERIAL AND METHODS: Seventy patients with floating knee injuries treated in our clinic were retrospectively analyzed between 2008 and 2019 in the study. The results of fractures that classifiable and unclassifiable according to the Fraser, Blake and McBryde classifications were statistically compared based on the Karlstrom-Olerud criteria. RESULTS: Seventy patients, 64 males and 6 females, participated in the study. The mean age of our patients was 32.3 ± 12.55 (18-68) years. The mean follow-up period of the patients was 30.26 ± 18.19 months (11-60 months). The results of the fractures that could not be classified according to the Blake and McBryde classification were statistically poorer than the results of those that could be classified according to the criteria (p = 0.041).The results of the fractures that could not be classified according to the Fraser classification were statistically poorer than the results of those that could be classified according to the criteria defined by Karlstrom and Olerud (p = 0.010). CONCLUSION: We observed that floating knee injuries that we could and could not classify led to different clinical results. In conclusion, we think that there is a need for a new floating knee classification that includes segmental fractures, patellar fractures and open fractures.

Comparison of two different proximal femoral nails in instabil intertrochanteric fractures concerning radiological parameters.

BACKGROUND: The aim of this study was to compare two different nail types (i.e., Intertan (IT) and Talon Distal Fix Nail / Lag Screw (TDFN)) used in the treatment of unstable intertrochanteric fractures in mobile patients over 65 years of age in terms of radiological parameters. METHODS: Between June 2013 and August 2018, 106 patients over 65 years old who were operated with closed reduction and internal fixation for intertrochanteric fractures were included in this single-center study. Patients were divided into two groups based on the proximal femoral nail used: IT group and TDFN group. These two groups were compared in terms of age, sex, complication rates and radiological parameters (i.e., reduction quality, tip apex distance (TAD), Parker index, union time, cut-out rate, and varus collapse). RESULTS: There were no differences between the groups in terms of age, sex, fracture union time as well as reduction quality measured on the first postoperative radiograph, Parker index, and collodiaphysial angle. In the first postoperative radiographs, TAD was higher than 25 mm in 12 patients in the IT group and in 5 patients in the TDFN group. Although the number of patients with high TAD was more than that of the IT group, varus collapse and the cut-out complications were higher in TDFN nail. In the IT group, nail-dependent complications emerged in 4 patients (trochanter major fracture in 3 cases, femoral fracture in distal screw in 1 case) while there was no complication in the TDFN group. CONCLUSION: Intertan nail is superior to TDFN in preventing varus collapse and the cut-out complications as well as in maintaining of radiological parameters until fracture union. On the other hand, the higher complication rate is a disadvantage of this nail.

The Top 100 Most-Cited Articles on Ankle Arthroscopy: Bibliometric Analysis.

The aim of this study was to analyze the 100 most-cited articles on ankle arthroscopy. Using the keyword ankle arthroscopy, the 100 most-cited articles in the Web of Science database were analyzed. Original articles, reviews, clinical trials, and case reports were included in the study. The search period included studies conducted between the years 1990 and 2020. The number of citations of the 100 most-cited articles ranged from 56 to 225 (mean, 95.52). The total number of citations was 9552. Among the articles examined, most were produced in the United States of America. The American Journal of Sports Medicine was the journal in which the most-cited articles were more frequently published. The article topic that drew attention most was osteochondral defects. Ankle arthroscopy is a technique that is still open to development and is a current topic that should be studied. Analyzing the 100 most-cited articles, it can be seen that most studies are on osteochondral defects. More articles will increase scientific data and provide more realistic solutions to ankle problems.

How do vertebroplasty and kyphoplasty affect the quality of life of patients with multiple myeloma spinal metastasis?

BACKGROUND: Metastatic spinal lesions are diseases that impair the quality of life and require early diagnosis and treatment. The count of spinal metastasis patients rises day by day. Increased life expectancy has increased the incidence of cancer, making metastases more observable. The aim of our study was to investigate how the quality of life is affected in the patient group with vertebral fracture due to spinal metastases of multiple myeloma and undergoing vertebroplasty and kyphoplasty. MATERIALS AND METHODS: Forty-two patients with fracture due to spinal metastasis and adequate follow-up between the years of 2011 and 2018 were included in the study. Patients were listed according to their primary malignancy and metastases. The effect of vertebroplasty and kyphoplasty was investigated by evaluating preoperative and postoperative VAS and Oswestry Disability Index scores. All patients' radiographic kyphosis angle, compression ratio and wedging index were calculated before operation and after operation. RESULTS: A total of 76 vertebrae were operated in 42 patients. Significant differences were found in the comparison of preoperative and postoperative quality of life according to VAS and Oswestry Disability Index scores in the patients undergoing vertebroplasty, kyphoplasty or both procedures after spinal metastases (VAS; p = 0.0001, ODI; p = 0.002/0.0001). There were statistically significant differences in preoperative local kyphosis angle, compression ratio and wedging index and post-op local kyphosis angle, compression ratio and wedging index (p = 0.001). CONCLUSION: Vertebroplasty and kyphoplasty, minimally invasive procedures performed after spinal metastases, improve the quality of life of the patients.

Intramedullary nailing and angulation prevention in distal metaphyseal tibial fractures.

Intramedullary nailing, which is preferred in tibial diaphyseal fractures, is also frequently used in distal third tibial fractures. Various angular deformities, including varus/valgus deformity, may be observed during postintramedullary nailing. Orthopedic surgeons use several methods to prevent this problem.In this study, at least 2 static locking screws were placed proximal and distal to the nail during intramedullary nailing of distal third tibial fractures. No additional supportive methods were used. The efficacy of this technique in the prevention of postoperative angular deformities was retrospectively investigated. Thirty-four patients with distal third tibial fractures who were treated with intramedullary nailing were included in the study. Angulations were measured in the anteroposterior and lateral planes on plain radiographs obtained preoperatively, on postoperative day 1, and after fracture union. Angulations measured on postoperative day 1 were compared with those measured after fracture union, and an increase was observed. Based on statistical analyses, the increase in the angulations was not significant.In distal third tibial fractures, when fixation was performed by placing 2 static screws distal and proximal to the intramedullary nail following adequate reduction, the angulations that developed during the period until union were not significant in terms of causing deformity, although additional fixation methods are not used.

Extra-articular Tenosynovial Chondromatosis Mimicking a Neoplastic Disease in the First Web Space of the Hand.

Tenosynovial chondromatosis is a very rare disease. The most common symptom is a slowly enlarging soft tissue mass, which may be painful or cause limitation of joint motion. Plain radiograph may appear normal during early phases of the disease, but subsequent imaging may be necessary to exclude other pathologies. Nonoperative treatment may be elected for some patients, but a synovectomy and the removal of loose bodies are indicated for persistent symptoms. This report describe a case with a multinodular cartilaginous proliferation and rice body in the first web space of the hand, similar to synovial chondromatosis, but arising in the tenosynovial membranes.

Compartment syndrome on a patient's forearm related to carbon monoxide poisoning.

Carbon monoxide (CO) is a colorless, odorless, nonirritating, toxic gas produced by the incomplete oxidation of hydrocarbons. Common sources of CO include motor vehicles, house fires, furnaces/heaters, and wood-burning stoves. It is a serious health problem resulting in approximately 50,000 visits to the emergency department and is responsible for 3500 deaths annually in the United States. Besides accidental exposure, CO is also one of the leading causes of death by suicide. In the present study, we discuss compartment syndrome caused by CO poisoning in a 15-year-old boy. To our knowledge, this is the first CO poisoning case causing compartment syndrome.

Retroperitoneoscopic drainage of complicated psoas abscesses in patients with tuberculous lumbar spondylitis.

PURPOSE: Nowadays, endoscopic techniques are widely used in surgical procedures. Retroperitoneoscopy has been an extremely valuable tool for a wide variety of urologic disorders, whereas, it has limited use in orthopedic procedures. METHODS: We performed retroperitoneoscopic drainage (in combination with medical treatment) of complicated psoas abscess on 12 patients with tuberculous spondylitis. All the procedures were done under general anesthesia and in the lateral decubitus position. Psoas abscess was evacuated during procedure, and postoperatively, drainage was continued through a large silastic tube. The definitive diagnosis and the treatment were made based on the results of culture-antibiogram and PCR testing. RESULTS: Complete clinical and radiologic remission was observed in all patients in 3-6 months. The complication was not observed in any case postoperatively. CONCLUSIONS: Retroperitoneoscopic drainage of psoas abscesses gains advantages in terms of rapid recovery, minimal invasiveness, absence of radiation, and shorter hospital stay. This procedure can be used not only for cold abscesses but also for other pathologies of lumbar vertebral area.

Complete lumbar spine duplication in a neurologically intact man.

BACKGROUND: Duplication of spine is a rare abnormality. Additional vertebral deformities and severe neurovascular, genitourinary, and gastrointestinal system abnormalities coexist in the majority of the cases. DESIGN: Case report. FINDINGS: A 44-year-old asymptomatic man was found to have double vertebral and double dural abnormalities of the lumbar spine as an incidental radiographic finding. Unlike most people with split cord malformations, this patient had no neurologic symptomatology or any other systemic abnormality. CONCLUSION: In our search of the literature, we did not find another case in a person of this age without any concomitant abnormalities.