Dilemma of Supra- or Infrapatellar Tibial Nailing: Anterior Knee Pain vs. Intra-Articular Damage.

Aim: Intramedullary nailing (IMN) is widely accepted as the treatment of choice for tibial fractures, and a suprapatellar method has been described to prevent common problems associated with the typical infrapatellar IMN technique, such as anterior knee pain. However, in the suprapatellar technique, injury to intra-articular structures is a concern. The aim of this study was to compare the clinical and radiological results of suprapatellar and infrapatellar IMN in terms of union, complications, and function. Methods: A retrospective evaluation of 61 patients who had undergone suprapatellar (n = 29, Group A) or infrapatellar (n = 31, Group B) tibial IMN was conducted. For the suprapatellar group, magnetic resonance imaging scans were acquired on the sixth month follow-up. Complications, radiological findings, functional outcomes, surgery duration, and differences in a range of motion (ROM) were compared. Results: Surgery duration was significantly shorter in Group A (81 mins vs. 107 mins, p < 0.001), and visual analog scale (VAS) values were significantly higher in Group B (0.17 vs. 1.62, p < 0.001). In Group A, the patients' Lysholm scores were significantly higher (95.6 vs. 92, p=0.006). In terms of anterior knee pain, none was experienced in Group A (0%), while 11 patients (26.1%) reported about it in Group B. There were no statistically significant differences between the two groups in SF-36 score (p=0.925), the radiographic union scale in tibial (RUST) fractures score (p=0.454), union time (p=0.110), or ROM (p=0.691). In Group A, two cases of patellofemoral cartilage degeneration were observed. Conclusion: If performed with sufficient expertise, the suprapatellar IMN technique is a safe, reliable technique with a low frequency of anterior knee pain for treating tibial fractures. There is no clear evidence that it causes damage to intra-articular structures. The possibility of patellofemoral cartilage degeneration due to this technique should be further evaluated by prospective studies including pre- and postoperative radiologic assessments.

Association Between Increased Elbow Carrying Angle and Lateral Epicondylitis.

Introduction The goal of this study was to ascertain the effect of increased elbow carrying angle (ECA) in lateral epicondylitis (LE) development. Materials and methods This retrospective study involved a total of 62 participants between January and December 2021, of whom 29 were diagnosed with LE. Physical examinations and elbow radiographs of the patients were reviewed retrospectively. ECAs were measured with the elbow fully extended and the forearm fully supinated on anteroposterior elbow radiographs. Two experienced orthopedic surgeons separately evaluated the values on the radiograph. Results This study involved 62 individuals, of which 55.4% are female and 44.6% are male. The mean age of the patients was 45.45 ± 4.77 years (range, 40-69 years), and the mean body mass index (BMI) was 28.1 ± 3.8 kg/m2 (range, 19-34 kg/m2). There were significant differences in elbow carrying angle between the LE group and the control group (p < 0.05). Also, there was a significant correlation between the LE side and the dominant side (p < 0.05). Conclusion Increased ECA is associated with increased incidence of LE and may contribute to its etiology by elevating extensor carpi radialis brevis (ECRB) tendon tension and rerouting it, resulting in increased abrasive and pressurizing forces.

Prosthetic vascular graft management in above-knee amputations.

OBJECTIVE: Critical limb ischaemia (CLI) is the most severe state of peripheral arterial disease and is one of the major causes of lower-limb amputations. One of the treatment choices is prosthetic vascular grafts. Despite treatment, CLI may lead to amputation owing to infection or progressive ischaemia. The aim of this study was to show that multidisciplinary planning and surgery for CLI patients with prosthetic grafts decreased the duration of hospital stay, costs, risk of infection and ascending conversion of the amputation level. METHODS: Forty-two above-knee amputation patients with grafts were retrospectively evaluated. Group A patients (n = 24) had partial excision and group B patients ( n = 18) total excision with or without saphenous patch-plasty, according to the patency of the deep femoral artery. Growth in wound culture, antibiotic therapy duration, conversion to hip disarticulation and hospitalisation periods were compared. RESULTS: Differences in growth of wound culture (p = 0.007), antibiotic duration (p = 0.003), hip disarticulation (p = 0.029) and duration of hospital stay (p = 0.0001) between the two groups were found to be statistically significant (p < 0.05). CONCLUSIONS: Management of CLI patients is a complex process, and a multidisciplinary approach is key to avoiding undesirable outcomes. Meticulous planning, including excision of the total graft, while ensuring the vascular supply, is essential.

Intravenous Leiomyosarcoma of the Lower Extremity: As Peripheral as It Gets.

Leiomyosarcomas of the vascular system (vLMSs) are rare tumors that commonly originate from large proximal and central veins. Pancreatic metastasis is rare for sarcomas, and surgical excision with large margins is the treatment of choice. We present a case of a 32-year-old female with primary vLMS originating from the distal crural veins and local invasion of the fibula. A prior open biopsy site was suboptimal. The patient was treated with neoadjuvant chemotherapy and radiotherapy, followed by surgery. The follow-up radiological imaging showed pancreatic head metastasis, which is also an extremely rare site for vLMS.

Quality Analysis of Hallux Valgus Videos on YouTube.

BACKGROUND: The aim of this study was to evaluate the information quality of YouTube videos on hallux valgus. METHODS: A YouTube search was performed using the phrase "hallux valgus" to determine the first 300 videos related to hallux valgus. A total of 54 videos met our inclusion criteria and were evaluated for information quality by using DISCERN, Journal of the American Medical Association (JAMA), and hallux valgus information assessment (HAVIA) scores. Number of views, time since the upload date, view rate, number of comments, number of likes, number of dislikes, and video power index values were calculated to determine video popularity. Information regarding video length (in seconds), video source, and video content was also noted. The relation between information quality and these factors were statistically evaluated. RESULTS: The mean DISCERN score was 30.35 ± 11.56 (poor quality) (range, 14-64), the mean JAMA score was 2.28 ± 0.96 (range, 1-4), and the mean HAVIA score was 3.63 ± 2.42 (moderate quality) (range, 0.5-8.5). Although videos uploaded by physicians had higher mean DISCERN, JAMA, and HAVIA scores than videos uploaded by nonphysicians, the difference was not statistically significant. In addition, view rates and video power index values were higher for videos uploaded by health channels, but the difference did not reach statistical significance. A statistically significant positive correlation was found between video length and DISCERN (r = 0.294; P = .028), and HAVIA scores (r = 0.326; P = .015). CONCLUSIONS: This study demonstrated that the quality of information available on YouTube videos about hallux valgus was low and insufficient. Videos containing accurate information from reliable sources are needed to educate patients on hallux valgus, especially with regard to less frequently mentioned topics such as postoperative complications and healing period.

Monostotic Paget's disease of the second metacarpal.

Paget's disease of the bone is a focal chronic disorder proceeding with elevated osteoblastic and osteoclastic activity in the affected area. The most common sites are pelvis, femur, lower lumbar vertebrae and skull. Monostotic disease is reported in 15-30% of all cases. We report a case of monostotic Paget's disease of the second metacarpal, which is a rare location even for polyostotic disease.