Anterior glenohumeral instability: Classification of pathologies of anteroinferior labroligamentous structures using MR arthrography

We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients’ instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI

Efficacy of periarticular injection applied trough knee other than posterior capsule in simultaneous bilateral total knee arthroplasty

WOS: 000385436400008PubMed ID: 26566320Background: We aimed to evaluate periarticular multimodal drug injection (PMDI) in bilateral total knee arthroplasty. Methods: In 154 knees of 77 patients, PMDI was administered intraoperatively through the regions other than posterior capsule to one knee; other knee was control. Results: Drug-injected knees had lower visual analog scale scores and higher passive range of motion postoperatively (p < 0.05). The active straight leg raise was higher in drug-injected knees (47 [61%] vs 19 [24.7%], p < 0.001). Conclusions: PMDI is a safe and effective method of early postoperative pain management in total knee arthroplasty when applied through regions other than posterior capsule

A New Anatomical Plate for Extra-Articular Distal Humeral Fractures: Biomechanical Study

Introduction: We compared the mechanical properties of two fixation techniques for the treatment of extra-articular distal third humeral fractures. Materials and Methods: Two groups were created from twenty-four humeri. Group 1 was instrumented using a new, precontoured, 8-hole (3.5-mm-diameter) locking compression plate (LCP) placed anterolaterally. Group 2 was instrumented using an 8-hole (3.5-mm-diameter) precontoured posterolateral LCP plate placed on the distal humerus. Four-point bending tests and torsion tests were performed until the specimens broke. Results: The four-point bending stiffness test showed that the stiffness of anterolaterally fixed humeri was significantly higher than that of posterolaterally fixed humeri (p0.05). Conclusions: The anterolateral plate exhibited higher bending stiffness and torsional yield strength than the posterolateral plate. Anterolateral plate fixation can thus be used to manage extra-articular distal humeral fractures. Multiaxial locking screws ensure rigid fixation, allow early elbow motion without olecranon fossa impingement, and prevent iatrogenic injury of the triceps muscle. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment

Relationship between Coronal Alignment and Posterior Tibial Slope in the Lower Extremity

Abstract Purpose: To restore the normal axial alignment of the lower extremity is important in reconstructive knee surgery. The aim of this study was to evaluate lower-limb alignment and posterior tibial slope. Methods: Thirty-two male and 32 female outpatients aged 22 to 46 were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb was obtained for each subject. The axial alignment was measured based on the centers of the femoral head, knee, and ankle. The tibiofemoral (TF), tibial joint (TJ), and posterior tibial slope (TS) angles were determined. Results: The mean TF angle was more varus in women (177.8˚) than men (179.2˚), and the mean TJ angle was more medially inclined in women than men. Women had a greater TJ angle than men (93.3˚ vs. 91.6˚). The mean posterior TS was greater in men than women (16.0˚ vs. 12.5˚, p &lt; 0.05), while the mean TS angle was greater in women (14.8˚) than men (12.3˚). Conclusion: Knee alignment and geometry vary among populations. In our study, the TF angle was varus among all participants. The knee joint was more medially inclined in women than men. And also the posterior TS was greater in women than men

Age and sex-based distribution of lumbar multifidus muscle atrophy and coexistence of disc hernia: an MRI study of 2028 patients

PURPOSEWe aimed to investigate the prevalence of lumbar multifidus muscle (LMM) atrophy in patients having mechanical low back pain with and without disc hernia.METHODSIn total, 2028 lumbar magnetic resonance imaging scans of low back pain patients (age range, 18–88 years) were re-evaluated retrospectively. LMM atrophy was visually assessed in axial sections of L4-L5 and L5-S1 levels.RESULTSLMM atrophy prevalence at both levels was significantly higher in subjects ≥40 years compared with younger adults (P < 0.001). LMM atrophy was significantly more frequent in women than in men (P < 0.001). Among patients with low back pain without hernia, LMM atrophy was significantly more frequent than normal muscle (n=559 vs. n=392; P < 0.001). Frequency of LMM atrophy in low back pain patients without disc hernia was 13%. Hernia was more frequent in patients with LMM atrophy compared with patients without atrophy (P < 0.001).CONCLUSIONLMM atrophy is more common in women; its prevalence and severity are observed to increase with advancing age, and disc hernia is found more frequently in individuals with LMM atrophy

HOW USEFUL IS ELASTOGRAPHY IN THE FOLLOW-UP OF ACHILLES TENDON REPAIR?

Introduction: In addition to conservative modalities in the treatment of Achilles tendon injuries, open, percutaneous and minimally invasive semi-open techniques, as well as biological open surgical repair methods are used as surgical options. Compression elastography is one of the methods used for the follow-up of treatment in Achilles tendon injuries. Methods: 23 patients were included in our study between July 2013 and June 2014, as long as they had at least 4 years of follow-up. In the final control, the intact side and the operated side were both examined and compared. The variables were the American Orthopedic Foot and Ankle Score (AOFAS) which is measured as a functional score considering plantar flexion and dorsiflexion; calf circumference; Achilles tendon anteroposterior (AP) diameter; and elastographic examination. Results: The strain ratio value and AP diameter of the patients was significantly higher on the operated side than on the non-operated side (p 0.05). No correlation was observed between strain ratio and AOFAS (p: 0,995). Conclusion: Elastography is not a useful technique to evaluate functional results on long-term tendon healing. Level of Evidence III; Retrospective comparative study. © 2022. Acta Ortopedica Brasileira. All Rights Reserved.Thanks to Prof. Dr. Ebru Yeşildağ for consultation of study plannin

Tourniquet use during total knee arthroplasty does not offer significant benefit: A retrospective cohort study

WOS: 000357389300022PubMed ID: 25917205Introduction: Tourniquets are routinely employed during total knee arthroplasty; however, their use remains controversial. Methods: This study investigates the efficacy and safety of this practice. A retrospective analysis of 186 patients was performed to assess benefits and/or risks associated with tourniquet use during knee arthroplasty. Total knee arthroplasty was performed using the Biomet Vanguard (R) PCL Prosthesis (Biomet, Warsaw, IN, USA). In total, 126 patients who had undergone total knee arthroplasty were included in our final analysis. Results: Patients with tourniquets had significantly less intraoperative blood loss than patients without (P < .001); patients without tourniquets required more blood transfusions (P = .551), and had significantly longer surgical times (P = .011). However, patients with tourniquets had more postoperative blood loss (P < .001), longer hospital stays (P = .013), and more frequent complications (P = .571). Blood transfusion requirement was significantly associated with complications (P < .001). Conclusions: Tourniquet use provided no overall benefit

Tırnak batması cerrahi tedavisinde winograd yöntemi ile yapılan kısmi matriks eksizyonu sonuçlarının değerlendirilmesi

Objective: The most frequent nail pathology of the hallux is the ingrown toenail. In our study, we evaluated Winograd s partial matrix excision method as a treatment for unilateral ingrown hallux toenail. Methods: Winograd s partial toenail excision was performed on 239 patients (127 males, 112 females; mean age 37.4 years) with an ingrown toenail. Primary patient complaints included a painful hallux toenail, discharge, nail deformation, and difficulty walking. According to the Heifetz staging system, there were 62 patients evaluated as Stage l, 96 as Stage ll, and 81 as Stage lll. A total of 174 (74%) patients had discharge from infection. In infected cases, an antibiotic was administered until inflammatory signs and discharged ceased, at which time surgical treatment was performed. Patients duration to return to daily living and work, recurrence ratio, satisfaction, and cosmetic issues were evaluated. The mean follow-up time was 27 months (range: 14-45 months). Results: Patients returned to daily living in 10-15 days (mean 11.3) and to work in 8.7 days (range: 6-13 days). A total of 230 patients (96.3%) were satisfied with the procedure, and 231 patients (96.6%) were satisfied with the cosmetic results. Nine patients were dissatisfied with the surgical outcome, and eight patients who experienced recurrence were dissatisfied with the cosmetic results. None of the patients experienced deep tissue infections or neurovascular complications. Conclusion: Winograd s partial matrix excision method is a beneficial surgical procedure for ingrown toenail, resulting in low recurrence and high satisfaction rates.Amaç: Tırnak batması, toplumda sık görülen ve en sık tırnak hastalığıdır. Bu çalışmada, ayak baş parmağına tek taraflı tırnak batması nedeniyle Winograd yöntemiyle kısmi matriks eksizyonu yapılan hastalarda tedavi sonuçları değerlendirildi. Yöntemler: Tırnak batması nedeniyle 239 hastaya (127 erkek, 112 kadın; ort. yaş 37,4) Winograd prosedürüne uygun olarak kısmi matriks eksizyonu uygulandı. Hastaların temel şikayetleri ayak baş parmağına ağrı, akıntı, tırnakta şekil bozukluğu ve yürüme güçlüğü idi. Heifetz in tırnak batması evrelendirmesine göre 62 hasta evre I, 96 hasta evre II, 81 hasta evre III olarak değerlendirildi. Yüz yetmiş sekiz (%74) hastada enfeksiyon zemininde aktif akıntı vardı. Enfekte olgularda enflamasyon bulguları ve akıntı ortadan kalkıncaya kadar antibiyoterapi uygulandı ve sonrasında cerrahi tedavi yapıldı. Hastaların günlük hayat ve işe dönüş zamanları, nüks gelişme oranı, hasta memnuniyeti ve kozmetik sorunlar açısından değerlendirildi. Ortalama takip süresi 27 ay (dağılım 14-45 ay) idi. Bulgular: Dokuz hastada (%3,7) nüks görüldü. Ortalama nüks gelişim süresi 5,6 aydı (dağılım 2-9 ay). Hastalar ortalama 6,7 günde (dağılım 3-11 gün) günlük aktivitelerine geri döndü. İşe dönüş süresi ortalama 10,2 gün (dağılım 7-16 gün) bulundu. İkiyüzotuz (%96,3) hasta yapılan müdahaleden memnundu. İki yüz otuz bir (%96,6) hastada kozmetik olarak memnundu. Nüks gelişen hastaların dokuzu cerrahiden ve sekizi ise kozmetik açıdan memnun kalmadığını bildirdi. Hastaların hiçbirinde derin doku enfeksiyonu veya nörovasküler komplikasyon gelişmedi. Sonuç: Tırnak batması tedavisinde Winograd yöntemiyle yapılan kısmi matriks eksizyonu nüks oranı düşük ve hasta memnuniyet oranı yüksek bir tedavi yöntemidir

Plate selection for fixation of extra-articular distal humerus fractures: A biomechanical comparison of three different implants

WOS: 000361894200050PubMed ID: 25801063We have read the biomechanical study entitled ‘Plate selection for fixation of extra-articular distal humerus fractures: A biomechanical comparison of three different implants.’ By John A. Scolaro et al. with great interest in the issue of Injury 45(12), (2014), 2040–2044 [1]. We would like to congratulate the authors for their valuable biomechanical study. However, we would like to raise an important issue about the bone models used in the study. According to the official website of the company, bone models used in this biomechanical study (model number 1028, Pacific Research Laboratories, Inc., Vashon, WA) are made of foam cortical shell which include cancellous inner material. It is highlighted that they are ideal for large-scale surgical skills courses or different exercises [2]. The studies investigating the biomechanical properties of the implants or surgical methods of the humerus bone are usually performed with the fourth generation Sawbones [3,4]. These biomechanical models (model number 3404, Pacific Research Laboratories, Inc., Vashon, WA) are producted for the use of biomechanical testing according to the official website of the company [5]. We would like to share this technical detail with the authors and the readers. We believe that using biomechanical test materials that are used as an alternative testing medium to human cadaver bone would provide a more reliable and valuable experiment. Once again, we congratulate the authors

Magnetic resonance imaging-based diagnosis of occult osseous injuries in traumatic knees

Background: Occult osseous knee injuries, such as bone bruises, can produce persistent pain and functional loss. Although bone bruises cannot be identified through direct examination or traditional radiographs, magnetic resonance imaging (MRI) has emerged as an effective diagnostic method. Nevertheless, the natural history of these injuries remains to be fully defined. Therefore, we used MRI to detect and follow bone bruise injuries secondary to knee trauma. Methods: We retrospectively reviewed knee MRIs from patients with bone bruising caused by trauma. Occult injuries were initially identified by MRI and subsequently rescanned for follow-up at 3 and 9 months. All patients underwent physical examinations, direct radiological imaging, and MRI. Results: Although direct radiographs showed no abnormalities, we used MRI to identify a total of 22 patients (age range: 19–42 years; mean: 28 years) with bone bruising. After 3 months, injuries remained detectable in 68.2% of the subjects, whereas 18.2% displayed bone bruising after 9 months. The majority of Type I lesions resolved spontaneously, whereas 80% of Type II injuries remained following 3 months, and 30% persisted at 9 months. Ligament and meniscal lesions were observed in 63.6% of patients with bone bruising and appeared to hinder recovery. Conclusion: Bone bruises generally resolved within 3 to 9 months in subjects with no soft tissue lesions and minor trauma. However, ligament and meniscal lesions were observed in the majority of patients, and these individuals required longer treatment and recuperation. Overall, these findings can contribute to improving the management of occult osseous knee injuries