Mini-plate fixation via sinus tarsi approach is superior to cannulated screw in intra-articular calcaneal fractures: A prospective randomized study

WOS: 000441599800001PubMed ID: 30101667Objective: Intra-articular displaced calcaneal fractures are common fractures and are often treated with surgical interventions. Sinus tarsi approach provides secure access to lateral wall and joint facets. The aim of the study is to compare cannulated screw (CS) fixation and mini-plate (MP) fixation via sinus tarsi approach with Sanders types 2 and 3 fracture of calcaneus. Methods: Sixty patients with Sanders types 2 and 3 calcaneal fracture underwent surgical intervention were randomly allocated into two groups as group MP fixation and group CS fixation regarding osteosynthesis method for 5-year period. Open reduction via sinus tarsi approach was performed in both groups. Demographic variables, time to surgery (TS), operation duration (OD), length of hospital stay (LOS), surgical complications, and reoperations were recorded. Pre- and postoperative Gissane and Bohler angles; calcaneal length, height, and width; ankle anterior-posterior (AP) and lateral X-rays; and computed tomography were also recorded for radiological evaluation and fracture characteristics. Maryland Foot Score (MFS) was used to evaluate functional outcomes. Results: Preoperative age, type of fracture, calcaneal length, height, and Gissane and Bohler angles, TS, LOS, and OD were not different between the groups. The postoperative calcaneal widening was significantly better restored in group MP compared with that of group CS. The incidence of reoperation and algoneurodystrophy was statistically higher in group CS than group MP. MFS in group MP was also higher than group CS at final visit. Conclusion: MP fixation via sinus tarsi approach is superior to CS fixation in Sanders types 2 and 3 calcaneal fractures

Je intraartikulární podávání antibiotik efektivní v léčbě infekce způsobené methicillin-rezistentním stafylokokem?

PURPOSE OF THE STUDY Septic arthritis is an infection of joints caused by a pathogenic microorganism. Septic arthritis has a mortality rate of 11-40% when it's not treated properly. The mortality rate with methicillin-sensitive Staphylococcus aureus (MSSA)is 5-7%, while the rate with methicillin-resistant Staphylococcus aureus (MRSA)is 13-20%. The aim of this study is to evaluate the effects of intraarticular vancomycin and teicoplanin on joint cartilage in in vivo settings and its utility in routine MRSA treatment. MATERIALS AND METHODS In our study, 35 male Sprague-Dawley rats aged 28 days were used. Rats were obtained from the Regenerative and Restorative Medicine Research Center (REMER) of Istanbul Medipol University. Rats were randomly divided into 5 groups each containing 7 rats. Joint injections were administered with isoflurane analgesia every day at 6 am. Three rats (15 rats) from each group were sacrified in seventh day and evaluated immunohistologically to evaluate acute healing in articular cartilage. All remaining rats were sacrificed on day 28 and their knees were evaluated by immunohistochemical examination. RESULTS In our study, there were no complications in any rat during injection and the study period. Hematoxylin eosin (H & E) histological staining for evaluating cartilage healing and healing levels did not show statistically significant differences between the groups at first week (p > 0.05). Matrix metalloproteinase-13 (MMP-13) staining did not show any statistically significant difference between the groups. (p > 0.05). DISCUSSION MRSAseptic arthritis, diagnosed for the first time in 1960, has recently been responsible for 6-22% of all septic arthritis and is increasing day by day. The use of systemic vancomycin or teicoplanin is the first-line treatment method in MRSA septic arthritis. Serum levels reach the desired level, especially with intravenous infusion dose. On the other hand, it has been shown that intraarticular concentration does not reach a sufficient level in studies conducted. The use of intraarticular antibiotics during treatment can lead to more effective and early disease control by turning this negative situation into favor of the patient. As a result, intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSAseptic arthritis. CONCLUSIONS Intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSA septic arthritis

Association between vitamin D concentrations and knee pain in patients with osteoarthritis

WOS: 000430889900005PubMed ID: 29707434Objectives. Osteoarthritis (OA) and vitamin D deficiency are common health conditions in older people. Whether vitamin D concentration is associated with knee OA is controversial. In this study, we aimed to determine the association between serum concentrations of vitamin D and osteoarthritic knee pain. Subjects and Methods. Vitamin D concentrations were measured with the 25 hydroxyvitamin D test in patients presenting with clinical symptoms of primary knee osteoarthritis. Osteoarthritis was graded on the Kellgren-Lawrence grading scale from anteroposterior and lateral radiographs. Height, weight, and body mass index (BMI) were recorded. Patients completed a 10-cm visual analogue scale (VAS) for indicating pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Vitamin D concentration was defined as severely deficient (<10 ng/mL), insufficient (10 to 19 ng/mL), or normal (20 to 50 ng/mL). Results. Of 149 patients (133 women), the mean age was 63.6 years. Mean vitamin D concentration was 11.53 ng/mL, and 90% patients were vitamin D deficient. Mean WOMAC score was 57.2, and VAS pain score was 7.5. Kellgren-Lawrence grade was 2 for 10 patients, grade 3 for 61, and grade 4 for 88. Mean BMI was 33.4. Mean values of VAS, WOMAC, and BMI did not differ by vitamin D status. Conclusion. Serum vitamin D concentration is not associated with knee pain in patients with osteoarthritis

Increased acromiohumeral distance in a double-row arthroscopic rotator cuff surgery compared to a single-row surgery after 12 months

Abstract Background Arthroscopic rotator cuff surgery is an effective treatment for rotator cuff tears with the considered use of double-row repair techniques becoming popular in the last decade. We aim to compare the effects of double- and single-row arthroscopic rotator cuff repairs (ARCR) on repair integrity (RI) and acromiohumeral distance (AHD). Methods In this observational study, we retrospectively identified 98 patients with degenerative rotator cuff tear treated with arthroscopic rotator cuff repair between 2016 and 2019. We excluded 22 patients with partial-thickness tears, 15 with associated subscapularis or SLAP tears, 13 with massive tears, and 5 patients lost to follow-up; we included 43 patients who had ARCR for full-thickness cuff tear and clinical, radiologic follow-up. Of these 43 patients, 23 are grouped as double-row repair group (DRG) and 20 as single-row repair group (SRG). A minimum of 12 months after the surgery, bilateral shoulder MRIs were obtained. Contralateral shoulders without asymptomatic rotator cuff tears served as a control group (CG). The operating surgeon and two other surgeons experienced in arthroscopy blindly measured the AHD and determined the RI at the control MRIs in all groups. Functional assessments relied on UCLA and qDASH Scores. Results The mean age was 57.89 (45–78) years, and the mean follow-up time was 28,65 (21–43) months. The mean AHD of the CG was 9.7 ± 0.96 mm, the preoperative AHD of DRG was 8.62 ± 1.45 mm, and SRG was 9.71 ± 0.95 mm. The postoperative mean AHD of DRG 9.61 ± 1.83 mm and SRG was 10.21 ± 1.97 mm. AHD differences between the preoperative and postoperative groups were significant (P=0.009). The increase of the AHD in the double-row group was significantly higher than the single-row group (P=0.004). There was a high correlation between the RI and DASH scores (P=0.005). RI did not correlate with the repair method (P=0.580). Conclusion Although double-row repairs can maintain greater AHD than single-row repairs in the clinical setting, this difference did not affect functional results. Regardless of the surgical intervention, functional results are favourable if RI is achieved. Level of evidence Level III, Retrospective Cohort Stud

Evaluation of smartphone-assisted infrared thermal imaging efficiency in carpal tunnel syndrome

Abstract Background Thermography is an industrial method for surface temperature measurements, and although it is medically safe and non-invasive, its place in daily practice has been limited. With the development of technology, thermal cameras have become more accessible and practical via adaptation to mobile phones. Among patients evaluated with bilateral nerve conduction studies (NCS) for suspected carpal tunnel syndrome (CTS), those with electrophysiological findings consistent with mild-to-moderate unilateral CTS were accepted for this prospective study. The hands with positive NCS findings were the study group, and the unaffected hands were the control group. The images were evaluated with the thermal analysis software (FLIR Tools ver. 6.4, Windows 10) and compared with NCS for statistical significance. In addition, thermal images were examined by three orthopaedic surgeons, and interobserver correlation was analyzed. Our study aims to evaluate the mobile phone-assisted thermal camera (FLIR One Pro, FLIR Systems, Wilsonville, OR, USA) as a suitable tool to diagnose CTS. Results 48 patients, 35 women and 13 men were included in the study. Bilaterally, a total of 96 hands were evaluated. 18 patients had mild, and 30 patients had moderate NCS stages unilaterally. The mean temperature difference at the region of interest in the palm, first and third fingers were statistically significant between the study and control groups (p < 0.05). NCS values and stages were correlated with the temperature difference in the third finger (p = 0.002). The inter-observer reliability was high (ICC = 0.858) while detecting temperature differences. Conclusions Since smartphone-assisted thermal cameras are easy and convenient to use, we think they are helpful in the daily practice of diagnosing mild-to-moderate carpal tunnel syndrome

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

WOS: 000392927500022PubMed: 28118807Aim: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. Material and methods: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. Results: Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. Conclusion: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes

High intermetatarsal angle hallux valgus: Does modified chevron osteotomy solve the problem?

WOS: 000463029200008An evaluation was made to introduce the efficacy of modified chevron osteotomy, in which extended plantar limb osteotomy was applied to hallux valgus cases with a high intermetatarsal angle and no hypermobility of the 1st metatarsocuneiform and hallux interphalangeus. A total of 21 patients and 34 feet were examined. The mean age of the patients was 47.3 +/- 13.4 years (range, 20-74 years). The surgery was performed on 19 (55%) right feet and 15 (45%) left feet. Extended plantar limb osteotomy and soft tissue procedures were performed on all patients from a single dorsomedial incision. Fifteen-degree angle anterior-posterior, full lateral radiographs and photographs were taken preoperatively and at 6 weeks, 6 months, 12 months and at a final postoperative follow-up examination. The hallux valgus, intermetatarsal and distal metatarsal articular angles were determined, and the HV-foot-AOFAS values showing clinical satisfaction were calculated. The mean follow-up period was 12 months, (range, 11-22 months). At the final follow-up examination, the hallux valgus angle had decreased from 37.9 degrees to 17.2 degrees on the right foot and from 32.2 degrees to 11.9 degrees on the left foot; the intermetatarsal angle had decreased from 16 degrees to 6.6 degrees on the right and from 15.1 degrees to 6.6 degrees on the left; and the distal metatarsal articular angle had decreased from 21.1 degrees to 11.4 degrees on the right and from 18.8 degrees to 6.4 degrees on the left. The mean AOFAS-HV score increased from 63 to 83.8 on the right and from 64.3 to 88.2 on the left. A statistically significant improvement was determined in all the angle values at the final follow-up examination. The AOFAS scales showing clinical satisfaction were determined as 'good'. It was concluded that the extended plantar limb modified chevron osteotomy is an effective surgical treatment option for adult cases of hallux valgus with a high intermetatarsal angle, with no 1st metatarsal hypermobility or hallux interphalangeus and no history of recent foot surgery