Effects of electromagnetic radiation exposure on bone mineral density, thyroid, and oxidative stress index in electrical workers.

BACKGROUND: In the literature, some articles report that the incidence of numerous diseases increases among the individuals who live around high-voltage electric transmission lines (HVETL) or are exposed vocationally. However, it was not investigated whether HVETL affect bone metabolism, oxidative stress, and the prevalence of thyroid nodule. METHODS: Dual-energy X-ray absorptiometry (DEXA) bone density measurements, serum free triiodothyronine (FT3), free thyroxine (FT4), RANK, RANKL, osteoprotegerin (OPG), alkaline phosphatase (ALP), phosphor, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were analyzed to investigate this effect. RESULTS: Bone mineral density levels of L1-L4 vertebrae and femur were observed significantly lower in the electrical workers. ALP, phosphor, RANK, RANKL, TOS, OSI, and anteroposterior diameter of the left thyroid lobe levels were significantly higher, and OPG, TAS, and FT4 levels were detected significantly lower in the study group when compared with the control group. CONCLUSION: Consequently, it was observed that the balance between construction and destruction in the bone metabolism of the electrical workers who were employed in HVETL replaced toward destruction and led to a decrease in OPG levels and an increase in RANK and RANKL levels. In line with the previous studies, long-term exposure to an electromagnetic field causes disorders in many organs and systems. Thus, it is considered that long-term exposure to an electromagnetic field affects bone and thyroid metabolism and also increases OSI by increasing the TOS and decreasing the antioxidant status.

An extraordinary mechanism causing intraoperative migration of the Kirschner-wire.

Migration of Kirschner wires (K-wires) postoperatively and with use of cannulated implants intraoperatively is a well-known complication. In this article, we present an extraordinary mechanism causing intraoperative migration of a K-wire. A K-wire which was used for temporary fixation of fracture fragments migrated forwardly due to its contact with the drill bit while drilling a hole for a screw. The interaction between the K-wire and the drill bit simulated a gear wheel effect and thus the rotating K-wire advanced. Although no complications occurred in this case, we believe that the mentioned mechanism may be of importance particularly in osteoporotic patients and may cause damage to vital structures.

How safe is titanium elastic nail application in the surgical treatment of tibia fractures in children?

Tibia fractures in children are generally treated successfully by conservative means. The aim of this study was to evaluate the efficacy and safety of fixation using Titanium elastic nails (TEN) in pediatric tibia fractures in which conservative measures failed or were deemed inapplicable. In this study, 30 patients who had tibia fractures and were fixated with TEN between 2007 and 2011 were analyzed retrospectively. The procedure was performed after poly-trauma in six patients, open fracture in seven, reduction loss in twelve, and unsuccessful closed reduction in five patients. The number of girls and boys was 3 and 27, respectively, with a mean age of 9.8 years. The evaluation criteria of Flynn et al. were used in the analysis of the results. The mean follow-up period was 18 months. The mean period of union was 8 weeks and 14 weeks in closed and open fractures, respectively. Epiphyseal damage, rotational deformity, need for reintervention, deep infection, implant failure, or recurrent fracture was not observed in any case. According to the Flynn evaluation system, 23 cases were evaluated as excellent, and 7 as good. Fixation with TEN is an easy, effective, and safe method that can be used in tibia fractures that are open, irreducible, or with loss of reduction and in cases with accompanying trauma, such as floating knee.

Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies.

OBJECTIVES: The purpose of this study to compare clinical and isokinetic results of patients who underwent biceps tenotomy or tenodesis for chronic tenosynovitis. METHODS: Arthroscopic biceps tenotomy, arthroscopy assisted or arthroscopic biceps tenodesis were done in 20 patients who had diagnosis of chronic tenosynovitis and in whom conservative treatment was not helpful. Rotator cuff repair and acromioplasty was performed in 18 patients and acromioplasty alone in two patients in addition to biceps surgery. Arthroscopic biceps tenotomy was done in 10 patients (5 female, 5 male; mean age 63, range 53-75), 10 patients underwent tenodesis out of which arthroscopy assisted biceps tenodesis was done in 8 patients and all arthroscopic biceps tenodesis was done in 2 patients (4 female, 6 male; mean age 57, range 49-66). All patients were evaluated with Constant and UCLA scores preoperatively and postoperatively. The average follow-up of the patients 3,1 years (between 1-8 years). Isokinetically elbow flexion and forearm supination were compared using the Cybex (Biodex 3, Cybex Biomedical System, NY, USA) machine. Pre-operative results of each group were compared with the postoperative results, using Mann-Whitney U test. RESULTS: Preoperative average constant scores of tenotomy group were 64.40, whereas postoperative scores were 89.50 (p=0.002), and preoperative average constant scores of tenodesis group were 62.80, whereas postoperative scores were 86.70 (p=0.003). Preoperative average UCLA scores of tenotomy group were 23.20 whereas postoperative UCLA scores 22.60 (p=0.003), preoperative average UCLA scores of tenodesis group were 30.00 whereas postoperative UCLA scores was 29.20 (p=0.004). In both groups statistically significant improvement of UCLA and Constant scores was detected. Comparison between Constant, UCLA scores and isokinetic measurements of both groups showed no statistically significant difference (p>0.05). No complication was noted. CONCLUSION: In the treatment of chronic tenosynovitis, biceps tenodesis and tenotomy of long head of biceps showed similar clinical, functional, isokinetic and cosmetic results. No Popeye deformity was seen in the tenotomy group.

Bilateral staged total knee arthroplasty in obese patients.

INTRODUCTION: The purpose of this study was to compare the clinical and functional results and complications associated with staged bilateral total knee arthroplasty (TKA) performed 4-11 days apart during a single hospitalization in patients who were obese and patients who were not obese. METHODS: We retrospectively evaluated 48 (96 knees) patients who were obese and divided into two groups based on their body mass indices (BMI). Morbidly obese patients (group A1, BMI > or = 40 kg/m2) consisted of 21 patients (42 knees), and obese patients (group A2, BMI > or = 30 kg/m2) consisted of 27 patients (54 knees). The control group (group B, BMI < 30 kg/m2) consisted of 20 non-obese patients (40 knees), who were undergoing staged bilateral procedure within the same time frame. All patients had cemented TKAs with use of posterior cruciate sparing prosthesis without patellar resurfacing. If medically stable after the first arthroplasty the patients then underwent the second arthroplasty 4-11 days later. The data on major complications and minor complications were evaluated. RESULTS: Although, there was no statistically significant difference in overall complication rates in any of the groups, the non-obese group had fewer wound complications than the other groups (P > 0.05). No significant differences in preoperative or postoperative Knee Society score, and functional score could be demonstrated between the three groups (P > 0.05). Both obese and nonobese patients showed improvements in pain and function from pre-surgery to a minimum 2 years follow-up. CONCLUSION: Results of bilateral staged TKAs in obese patients have low complication and high success rates and increased BMI has no negative effect on the early outcome. Bilateral staged TKA might be a good treatment alternative for the improvement of the patient's quality of life and functional and clinical outcomes.