An evaluation of the characteristics of orthopedic pediatric traumas during the COVID-19 pandemic lockdown period.

BACKGROUND: The purpose of this study is to investigate the effects of implemented social isolation measures on the characteristics of orthopedic pediatric traumas during this COVID-19 pandemic lockdown period. METHODS: Patients who were admitted at our center between two time periods: April 3, 2019-May 31, 2019 (no lockdown period) and April 3, 2020-May 31, 2020 (lockdown period) were included to the study. Group 1 comprised 743 patients who were treated during no lockdown period, whereas Group 2 comprised 615 patients who were treated during lockdown period. Patients' medical records and radiographs were reviewed through our hospital's computer database. In addition, we recorded each patients' age and gender, their definite diagnosis, the anatomic location of the trauma, the type of trauma (fracture, dislocation, tendon injury, ligament injury, fracture dislocation, open fracture, etc.), the type of pediatric fracture (displaced fracture, torus fracture, epiphyseal fracture, pathological fracture, etc.), and the treatment method (non-operative/operative). RESULTS: The mean age of the patients was significantly lower in Group 2 (p<0.001). There were significant differences between the groups in terms of anatomic locations of the traumas (p<0.001). The types of the traumas, pediatric traumas, and treatment were significantly different between the groups (p<0.001, p<0.001, and p<0.001, respectively). The frequency of operative treatment was significantly higher in Group 2 (p<0.001). CONCLUSION: Our results demonstrated significant differences in patients' demographics as well as trauma characteristics during COVID-19 pandemic.

Intramedullary nailing versus minimally invasive plating in the treatment of distal tibial extra-articular fractures: Comparison of cost analysis in Turkey.

BACKGROUND: Minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are the two most commonly used methods for distal tibial extra-articular fractures; however, the ideal treatment is still on debate. The aim of this study was to compare MIPO and IMN in the treatment of distal tibial extra-articular fractures in terms of cost analysis according to health insurance records in Turkey. METHODS: The data of patients who underwent either MIPO or IMN for the treatment of distal tibial extra-articular fractures between 2013 and 2018 were analyzed in this retrospective study. Patients' clinical data, as well as the overall expenses from the first admission until return to work including hospitalization, and all outpatient controls had been reviewed from the hospital's billing department. The total amount of money paid per month by Turkish National Social Security Institution to the patient until the patient's returns to work were also recorded. RESULTS: 118 consecutive patients (35 female-83 male) with the mean age of 37.2±13.4 were participated to the study. IMN group consisted of 57 patients with a mean age of 36.7±12.8 years, and MIPO group consisted of 61 patients with a mean age of 37.8±13.6 years. No significant differences were observed between study groups in terms patients' age, gender, fracture classification (AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association), soft-tissue injury (Tscherne classification), presence of type 1 open fracture, and presence of accompanying fibula fracture. There was no statistical difference between two groups in terms of pre-operative hospital stay (p=0.713). However, the mean length of hospital stay was significantly higher in the MIPO group (p=<0.001). The means of number of total outpatient controls, time to union, and return to work were also significantly higher in the MIPO group (p=0.005, p<0.001 and p<0.001, respectively). The mean hospital cost until discharge and the mean total cost until return to work were significantly higher in the MIPO group (p=0.001 and 0.001, respectively). The mean total costs of hospital stay and outpatient controls were also significantly higher in the MIPO group (p=0.001 and 0.004, respectively). The mean implant costs did not significantly differ between groups (p=0.179). CONCLUSION: According to the results acquired from the present study, IMN is a better option compared to MIPO for the treatment of extra-articular distal tibial fractures in terms of costs paid by the national health insurance in Turkey.

Leaving the stable ramp lesion unrepaired does not negatively affect clinical and functional outcomes as well as return to sports rates after ACL reconstruction.

PURPOSE: To evaluate the effects of untreated stable ramp lesions on clinical and functional outcomes, return to sports rates, and complications of patients who underwent anterior cruciate ligament reconstruction. METHODS: A total of 879 patients with anterior cruciate ligament rupture were evaluated. Of these, 66 patients [33 patients with anterior cruciate ligament rupture and stable medial meniscal ramp lesion (ramp + group) and 33 patients with isolated anterior cruciate ligament rupture (ramp - group)] with a minimum 3-year of follow-up were included. Stable ramp lesions were not repaired in the ramp + group. Preoperative and postoperative Lachman and pivot-shift grades, Lysholm knee scores, International Knee Documentation Committee score and 12-Item Short Form Health Survey score were compared between groups. The return to sports rates, level of return to sports, time to return to sports and complications were compared. RESULTS: The mean patient age was 27.8 ± 7.2 years. The mean follow-up period was 47.3 ± 9.4 months. There were no significant differences between groups regarding preoperative and postoperative Lachman and pivot-shift grades, 12-Item Short Form Health Survey mental and physical component summary scores, Lysholm and International Knee Documentation Committee scores, and complication rates (n.s.). Although the return to sports rates (84.8% vs 90.1%) and the level of the return to sports (return to preinjury level: 75% vs 78%) were similar between groups (n.s.), the time to return to sports was significantly longer for patients with ramp lesions (11.1 ± 4.0 vs. 8.7 ± 2.5 months, p = 0.007). CONCLUSION: Leaving the stable ramp lesion unrepaired does not negatively affect clinical and functional outcomes as well as return to sports rates after ACL reconstruction. However, the time to return to sports is prolonged in patients with ramp lesions In clinical practice, surgeons should be aware that repairing stable ramp lesions is not an absolute necessity and will not affect return to sport rates. LEVEL OF EVIDENCE: Level III.

New Proposal for Size and Size-Distribution Evaluation of Nanoparticles Synthesized via Ultrasonic Spray Pyrolysis Using Search Algorithm Based on Image-Processing Technique.

Nanoparticle properties are correlated to their size, size distribution, and shape; it is essential to accurately measure these features in the field of nanoscience. In this study, silver nanoparticles (AgNPs) were synthesized with the ultrasonic-spray-pyrolysis (USP) method from a water solution of silver nitrate. The synthesized AgNPs were characterized by Dynamic Light Scattering (DLS) analysis and Scanning Electron Microscopy (SEM) to reveal their size and size distribution. A search algorithm based on an image-processing technique to obtain particle size and particle-size distribution from SEM micrographs is proposed. In order to obtain more quantitative information and data with respect to the morphology of particles synthesized under different process parameters, SEM micrographs with a nonhomogeneous background contrast were examined via image-processing techniques in MATLAB. Due to the inhomogeneous contrast of SEM micrographs, defining an overall threshold value was insufficient in the detection of whole nanoparticles. Thus, subimages were directly created according to the maximum and minimum particle size specified by the user to determine local threshold values. The obtained results were automatically combined to represent both particle dimension and location in the SEM micrographs. We confirmed that the results of our DLS analysis, theoretical calculation, and image-processing technique were correlated with our expected results.