Remodeling in Patients with in Situ Fixation for a Slipped Capital Femoral Epiphysis

Objective: This study has investigated the amount of bone remodeling in patients with a slipped capital femoral epiphysis (SCFE) treated with in situ fixation until closure of the epiphysis and the factors affecting remodeling. Method: Patients who underwent surgery for SCFE between January 2010 and January 2015 were retrospectively screened: Twenty-four male and 7 female patients (mean age 12.6 +- 1.9 years) were included in the study. Gender, age, history, and laterality of trauma, duration of hip pain (acute, chronic, acute on chronic background), and hip radiographs were evaluated. The Southwick and alpha angles were measured, and the factors affecting remodeling were assessed. The statistical analyses were conducted using SPSS 25.0 (IBM Corp., Armonk, NY); 95% confidence levels were calculated and p < 0.05 was considered to indicate statistical significance. Results: The preoperative displacement angles measured on the anteroposterior and lateral radiographs were 15.03° +- 9.1° and 25.93° +- 14.1° and at the last follow-up they were 11.63° +- 8.7° and 21.6° +- 12.1°, respectively. The alpha angles measured on the lateral radiographs preoperatively and at the end of follow-up were 52.33° +- 11.6° and 47.87° +- 11.8°, respectively. Significant remodeling was reflected in the angles measured on the anteroposterior and lateral X-ray images. Greater preoperative displacement angle was associated with less remodeling. Conclusion: Preoperative displacement affects the degree of postoperative remodeling. In patients with severe epiphyseal displacement, open reduction is an option but in situ pinning should be considered in that it is less invasive and more physiological

Forensic age diagnostics by magnetic resonance imaging of the proximal humeral epiphysis

The most commonly used radiological method for age estimation of living individuals is X-ray. Computed tomography is not commonly used due to high radiation exposure, which raises ethical concerns. This problem can be solved with the use of magnetic resonance imaging (MRI), which avoids the use of ionizing radiation. The purpose of the present study was to evaluate the utility of MRI analysis of the proximal humeral epiphyses for forensic age estimations of living individuals. In this study, 395 left proximal humeral epiphyses (patient age 12-30years) were evaluated with fast-spin-echo proton density-weighted image (FSE PD) sequences in a coronal oblique orientation on shoulder MRI images. A five-stage scoring system was used following the method of Dedouit et al. The intra- and interobserver reliabilities assessed using Cohen's kappa statistic were =0.818 and =0.798, respectively. According to this study, stage five first appeared at 20 and 21years of age in males and females, respectively. These results are not directly comparable to any other published study due to the lack of MRI data on proximal humeral head development. These findings may provide valuable information for legally important age thresholds using shoulder MRI. The current study demonstrates that MRI of the proximal humerus can support forensic age estimation. Further research is needed to establish a standardized protocol that can be applied worldwide

Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head

This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12-30years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman's rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho=0.664, p<0.001; males: 0.631, p<0.001; females: rho=0.651, p<0.001). The intra- and inter-observer reliability assessed using Cohen's kappa statistic was =0.898 and =0.828, respectively. The earliest age of epiphysis closure was 17years for females and 18years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure

Humerus diafiz kırıklarının sarmiento ortezi ile konservatif tedavisinin sonuçları

Amaç: Kliniğimizdeki humerus kırıklarının sarmiento tipi ortez kullanarak kaynama yüzdelerini ve süresini belirlemek, kaynamanın hasta yaşı kırık tipi gibi değişkenlerle olan ilişkisini belirlemek, kaynama sonrası hastaların günlük işlevlerini yerine getirme becerisini incelemek çalışmamızın amaçlarıdır. Yöntem: Ege Üniversitesi Ortopedi ve Travmatoloji kliniğinde Ocak 2010-Nisan 2014 tarihleri arasında humerus diafiz kırığı tanısıyla, Sarmiento ortezi ile tedavi edilen hastalar retrospektif olarak incelendi. Çalışmaya dahil edilen 46 hasta hastanın demografik verileri, kırık radyolojik tipleri, ek yaralanmaları kayıt edildi. Hastaların direk grafileri ile kaynamaları (süresi, açılanma, kısalık) değerlendirilmiş, hastalara takip süresi sonunda Quick DASH formu doldurulmuş, böylece günlük aktiviteleri değerlendirilmeye çalışılmıştır. Veriler SPSS 22.0 kullanılarak değerlendirilmiştir. Verilerin değerlendirilmesinde; ortalama, medyan ve standart derivasyon ile ki kare testi, ortalamalar arasındaki farkın belirlenmesinde Kruskall Wallis ve Mann-Whitney U testleri uygulanmıştır. p<0.05 anlamlı olarak kabul edilmiştir. Değişkenlerin bir biriyle olan korelasyonlarını incelemek için ise Spearman's rho testleri kullanılmıştır Bulgular: Hastaların yaşı ortalama 45,5±21,5 olarak bulundu. Hastaların kırkları AO sınıflamasına göre de yapıldı. AO sınıflamasına göre hastaların 26 tanesinin A1 kırık (%57), 8 tanesinin A2 kırık(%17), 9 tanesinin A3 kırık (%20), 2 tanesi B1 kırık (%4), 1 tanesinin de B2 kırık (%2) olduğu görüldü. Kırık kaynama oranlarına bakıldığında ise 40 hastada kaynama olduğu görüldü. (%87) Kaynama süresinin 2,9±1,53 ay olduğu görüldü (1-8 ay). 6 hastada kaynama olmadığı bulundu (%13). Kaynama ilişkileri değerlendirildiğinde; nonunion görülen hastaların yaşları 59,3±20,04 olarak görüldü. Kaynama olanlarda ise yaşların 43,4±21,17 olduğu görüldü. Ancak yaş ile kaynama arasındaki ilişkinin istatistiksel olarak anlamlı olmadığı görüldü. (p=0,06) Hastalardaki kaynama durumu ile hasta yaşı, cinsiyeti, kırık tarafı, kırık seviyesi, kırık tipi, radial sinir tutulumu, acilde yapılan ilk müdahale arasındaki ilişkilere bakıldı. Ancak bunlardan hiç birisi ile kaynama durumu arasında istatistiksel olarak anlamlı bir ilişki olmadığı bulundu(p0,05). Hastalarda yaş ile Quick DASH arasındaki bağıntıya bakıldı. Hastaların yaşı ile Quick DASH skoru arasındaki bağıntının orta derecede pozitif korele olduğu bulundu (r=0,422). Bu bağıntının da istatistiksel olarak anlamlı olduğu bulundu (p=0,007). Hastalarda kaynama süresi ile Quick DASH arasındaki bağıntıya da bakıldı. Hastaların kaynama süresi ile Quick DASH skoru arasında yüksek derecede pozitif bağıntı olduğu gözlendi (r=0,575). Bu bağıntının istatistiksel olarak da anlamlı olduğu görüldü (p0,001) Çıkarım: İyi seçilmiş hastalarda konservatif tedavi başarılı bir yöntemdir. Hastaların yaşı arttıkça kaynama zorlaşacak ve kaynama süresi de uzayacaktır. Hastalarda kaynama süresini uzatan durumlar uzun süreli immobilizasyon nedeniyle hastadaki klinik sonuçları da olumsuz etkileyecektir

How Long Do Octogenarians Benefit From Knee Arthroplasty?

Introduction Elderly patients are more prone to surgical risk regardless of the procedure. The overall mortality rate is expected to be high in this population. The aim of this study was to evaluate the survival rates of octogenarians who underwent knee arthroplasty procedures. Methods Sixty-two knee arthroplasties were performed on 52 patients who were >80 years of age al the time of the operation between November 1996 and May 2014. The preoperative American Society of Anesthesiologists (ASA) classes were available for 45 procedures. The database of the Civil Registry Service was used to assess whether the patients were alive at the time of the study. If they were deceased, their dates of death were recorded. The five-, 10-, and 15-year survival rates of patients were determined. Results Thirty patients (57.69%) were alive and 22 (42.31%) were deceased at the time of analysis. Based on the 62 procedures, the mean age of the patients at the time of the operation was 82.56 +/- 2.18 years. The mean time span between the operation and death of patients who passed away was 6.4 +/- 4.66 years. The mean age of the patients who were alive at the time of the study was 86.63 +/- 3.60 years. The mean time that had passed since the operation was 4.41 +/- 2.9 years for living patients. Only one patient died during the first 90 days postoperatively. The one-year mortality rate was 4.84% (three patients). A Kaplan-Meier survival analysis revealed that the mean survival time of the patients was 6.4 years, and the median survival time was 5.6 years. The five-year survival rate was 59%, the 10-year rate was 19%, and the 15-year rate was 7%. Conclusion Octogenarians benelitted from knee replacement longer than expected. Early mortality risks can be avoided with proper patient selection

Treatment of pelvic Ewing’s sarcoma: Pros and cons of chemotherapy plus definitive radiotherapy versus surgery

Objective: the aim of this study was to compare the results of chemotherapy or combined chemotherapy-radiation therapy with surgical intervention following neodjuvant therapy in pelvic Ewing’s sarcoma patients. Methods: the study population consisted of 39 patients with pelvic Ewing’s sarcoma treated in our clinic between 1994 and 2014. of these patients, 28 patients (11 boys and 17 girls; mean age: 19.57±6.8 years) were treated with chemotherapy and radiation therapy and the remaining 11 patients (9 boys and 2 girls; mean age: 18.64±8.1 years) patients underwent surgical intervention after neoadjuvant chemotherapy or chemotherapy plus radiation therapy. Internal hemipelvectomy was performed in 10 patients, and external hemipelvectomy was performed in one patient. Survival rates were compared between the surgical and non-surgical treatment groups. Predictive factors, such as treatment protocol (surgery, neoadjuvant chemotherapy, definitive radiotherapy), mass localisation, mass size, presence of metastasis at the time of diagnosis, and presence of late metastases were compared between the groups. T he effects of each variable on survival were also examined. Results: the overall 3- and 5-year survival rates of the 28 non-surgical patients were 41.4% and 26.1%, respectively, while those of the surgical patients were 53% and 35.4%, respectively (p=0.777). Large mass size, presence of metastasis at the time of diagnosis, and presence of late metastases were significantly associated with lower survival rates. Conclusion: the survival rates of the patients who underwent surgery were higher than those of non-surgical patients, although the difference was not statistically significant. Definitive radiation and chemotherapy would be preferable in selected cases, such as patients with sacral localisation, without surgical intervention

Evaluation of Clinical and Radiological Results of Humeral Diaphyseal Fractures with Treated Sarmiento Brace

WOS: 000515092400005PubMed: 32226678Aim in our study, we aimed to evaluate the duration and rate of the union of adult humerus diaphysis fractures treated with a functional brace. Methods Forty-six adult patients admitted to our hospital with humeral diaphyseal fracture between January 2010 and April 2014 and treated with a functional brace were evaluated retrospectively. the demographic data, fracture type, level of fracture, and presence of bone union of the patients were evaluated from clinic records. the Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire score of the patients was registered for patients and analyzed, and its correlation with parameters such as patient age and fracture bone union time was evaluated. Results It was observed that of the patients with the mean age of 45.5 years, six (13.6%) had non-union and five had delayed bone union (10.86%). Three (6.5%) patients had radial nerve injury, and all recovered without sequelae. Out of the patients with the bone union, 12 (30%) had an angulation above give degrees, and 3 (7.5%) had radiological shortness. the mean Quick-DASH score was 6.7, and there was no statistically significant correlation with parameters such as fracture type, level, angulation, radiological shortness and radial nerve involvement (p>0.05). Conclusions A functional brace is a good treatment choice with low complication rates and has satisfactory bone union rates in humerus diaphyseal fractures

Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head

This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12-30years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman's rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho=0.664, p<0.001; males: 0.631, p<0.001; females: rho=0.651, p<0.001). The intra- and inter-observer reliability assessed using Cohen's kappa statistic was =0.898 and =0.828, respectively. The earliest age of epiphysis closure was 17years for females and 18years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure