Treatment preferences of orthopedic surgeons for closed, isolated middle-third diaphyseal long bone fractures without neurovascular injury in children: A cross-sectional survey

Objective: This study aimed to assess the treatment trends and the factors influencing the treatment methods of Orthopaedic Surgeons in closed, isolated, middle-third diaphyseal long bone fractures without any neurovascular injury in children. Methods: This was a cross-sectional electronic survey of Turkish Orthopaedic Surgeons who were active members of the Turkish Society of Children's Orthopaedics (TSCO) and still managing the children's fractures in their daily clinical practice. An initial e-mail including the electronic survey followed by three reminder e-mails was sent to 110 members, and then reminder telephone calls were made. Results: The survey response rate was 66/110 (60%). In recent years, a definitive trend to surgical treatment was not seen 98%, 77%, 39%, and 88% of the responders in the closed humerus, forearm, femur, and tibia mid-shaft fractures, respectively. Neither the years of expertise nor the intensity of daily pediatric patients of the participants did not affect the treatment trend in any fracture scenarios. The patient's age was the most cited factor influencing the responders' decisions on whether conservative or surgical treatment would be performed in each fracture scenario. The most cited lowest age limits for surgical treatment inclosed mid-shaft fractures of the humerus, forearm, femur, and tibia, were the adolescent age group, 10-12 years, six years, and ten years, respectively. Conclusion: This is the first study assessing the daily clinical practice of members of TSCO in the management of closed, isolated, non-complicated middle-third diaphyseal long bone fractures in children just before the covid-19 pandemic started. A marked tendency toward surgical treatment is seen in femur mid-shaft fractures, followed by forearm mid-shaft fractures up to a certain level. The patient's age is the main determinant of the responders' decisions on the type of treatment in closed, isolated, non-complicated middle-third diaphyseal long bone fractures in children

Eklem Hastalıkları ve Cerrahisi

Objectives: This study aims to evaluate the clinical outcomes of children with spastic type cerebral palsy (CP) treated with botulinum toxin type A (BoNT-A) injection for lower limb contracture and the influence of age, gender, functional level and degree of initial contracture on treatment outcomes. Patients and methods: Clinical records at pre-BoNT-A injection and post-BoNT-A injections of 153 sessions of a total of 118 consecutive children (67 boys, 51 girls; mean age 5.9 +/- 2.6 years; range, 2.5-16 years) were retrospectively evaluated. Degrees of pre- and post-injection contracture were evaluated. Post-injection supplemental casting for 10 days was recorded in all cases. Less than 20 degrees of hip flexion contracture, more than 30 degrees of hip abduction, a negative prone Ely test, less than 50 degrees of popliteal angle and at least 5 degrees of ankle dorsiflexion values at post-injection were accepted as sufficient clinical improvement. Results: Sufficient post-injection range of motion (ROM) was observed in 80% of cases with hip flexion contracture, in 45% of cases with hip adduction contracture, in 84% of cases with knee flexion contracture and in 77% of cases with ankle equinus contracture. Prone Ely test that was positive in 60% of cases with knee extension contracture was negative at post-injection. Improvement in contractures were prominent in children with lesser degree initial contractures. Conclusion: Botulinum toxin type A injection increases ROM in hip, knee and ankle joint contractures in CP. Although age, gender and functional level may influence the clinical outcomes, pre-treatment level of contracture is the main determinant in improvement in ROM at post-injection

A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips

Purpose:The aim of this expert consensus study was to establish consensus on the treatment of different types of slipped capital femoral epiphysis and on the use of prophylactic screw fixation of the contralateral unaffected side. Methods:In this study, a four-round Delphi method was used. Questionnaires including all possible theoretical slip scenarios were sent online to 14 participants, experienced in the field of children's orthopedics and in the treatment of hip disorders in children. Results:In-situ fixation was considered to be the first treatment choice in all types of mild slip scenarios and in moderate, stable ones. Performing in-situ fixation was not favored in moderate, unstable, and in all severe slip scenarios. In moderate to severe, unstable slip scenarios, there was consensus on the use of gentle closed or open reduction and internal fixation. Any consensus was not established in the optimal treatment of severe, stable slips. There was also consensus on the use of prophylactic screw fixation of the contralateral side in case of co-existing endocrine disorder and younger age. Conclusions:The establishment of consensus on the treatment of all types of slipped capital femoral epiphysis even among the experienced surgeons does not seem to be possible. The severity of the slip and stability of the slip are the primary and secondary determinants of the surgeons' treatment choices, respectively. In-situ fixation is still the preferred treatment option in several slip types. Gentle capital realignment by closed or open means is recommended in displaced, unstable slips. Prophylactic screw fixation of the contralateral side is indicated under certain circumstances

Effects of open adductor tenotomy and adductor muscle botulinum toxin A injection on the hip instability in spastic type cerebral palsy

Purpose: We aimed to evaluate the clinical and radiographic outcomes of hip instability in children with spastic-type Cerebral Palsy (CP) who had undergone open Adductor Tenotomy (AT) or received Botulinum Toxin-A (BTX-A) injections to the hip adductor muscles . Materials and Methods: Maximum Hip Abduction Angles (MHAA) with the knees and hips in extension were measured preoperatively and the latest clinical findings of all patients in the AT and BTX-A groups were recorded. Reimers' Migration Percentage (RMP) was measured as the radiographic assessment in the AT group. Results: There were 30 patients (mean age: 8.3 years) in the AT Group and 25 (mean age: 5.9 years) in the BTX-A Group whose clinical and radiographic data were available. The mean follow-up period in the AT Group was 29.6 months. In the AT Group, the mean MHAA before surgery and at the last assessment were 21.20 and 37.10 respectively. In the BTX-A Group, the mean MHAA before the injection and at the latest assessment were 25.30 and 34.20 respectively. The change in the mean MHAA in the AT Group was 16.20 and 8.80 in the BTX-A Group. In the AT Group, the preoperative RMP was 28.2% and the latest RMP was 22.2%. Conclusion: AT and BTX-A injections significantly improved hip abduction angles. However, AT provided better clinical improvement and considerable radiographic correction in pediatric patients with spastic-type CP and hip instability

Evaluation of labral pathology and hip articular cartilage in patients with femoroacetabular impingement (FAI) : comparison of multidetector CT arthrography and MR arthrography

Background: To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods. Material/Methods: Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference. Results: While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (k=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (k=0.76 for MRa and k=0.86 for CTa) Conclusions: Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology

Modified myocardial performance index for evaluation of fetal heart function and perinatal outcomes in intrahepatic pregnancy cholestasis

This study aims to evaluate cardiac function in cases of intrahepatic cholestasis of pregnancy (ICP) and compare results with those from healthy controls using the fetal left ventricular modified myocardial performance index (LMPI) and E-wave/Awave peak velocities (E/A ratio). Moreover, the association between LMPI values, total bile acid (TBA) levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. A prospective cross-sectional study of 120 pregnant women was conducted, with 60 having ICP and the other 60 serving as controls. Doppler ultrasound and two-dimensional gray-scale fetal echocardiography were used to calculate the LMPI values and E/A ratios, respectively. The association between LMPI values and TBA levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. Fetal LMPI values were significantly higher in the ICP group than in the control group (0.54 +/- 0.54 vs. 0.44 +/- 0.03; p 0.01). LMPI values were not associated with adverse neonatal outcomes in ICP cases. Fetal cardiac function (LMPI) is associated with increased bile acid levels in ICP. However, because it was not associated with adverse neonatal outcomes in ICP cases, the clinical significance of this finding is unclear. Further studies are required to evaluate the implications of increased LMPI

Bacteriocin Producing Bacteria Isolated from Turkish Traditional Sausage Samples

In this study, traditional sausage samples from different provinces of Turkey (Gaziantep, Antalya, Erzurum and Kahramanmaras) were obtained and one hundred three isolates were collected. Using the (GTG)5 -PCR genomic fingerprint analysis method, seven of them were observed to be different and conventional tests of these isolates were performed. Molecular identification of two isolates carrying the bacteriocin gene and having antimicrobial activity by agar disc diffusion method was performed by 16S rRNA sequence analysis. As a result, the seven isolates were identified as Aerococcus urinaeequi (EK1), Streptococcus salivarius (EK2), Leuconostoc mesenteroides (EK3), Macrococcus caseolyticus (EK4), Lactococcus garvieae (EK5), Staphylococcus saprophyticus (EK6) and Lactobacillus sakei (EK7). Among these strains, it has been determined that Ln. mesenteroides and L. sakei carried the mecentericin and sacacin genes. When antimicrobial activity against different strains was examined, inhibition formations of Ln. mesenteroides and L. sakei on Enterococcus faecalis, Shigella dysenteriae and Escherichia coli O157: H7 were observed

Determination and Interpretation of the Norm Values of PreSchool Social Skills Rating Scale Teacher Form

This study aimed to determine and interpret norms of the Preschool Social Skills Rating Scale (PSSRS) teacher form. The sample included 224 independent preschools and 169 primary schools. The schools are distributed among 48 provinces and 3324 children were included. Data were obtained from the PSSRS teacher form. The validity and reliability evidence was re-obtained from the norm sample, and it was concluded that the sample preserved the structure comprising 4 factors and 49 items. The alpha coefficient obtained from the PSSRS for the whole norm sample was determined at 0.96. PSSRS norm values were obtained for four factors and the total scale at each age. Children's social development skills are interpreted in accordance with the percentile norms pie charts, which include the total scores from the full scale score and sub-scales. Findings obtained with regard to the validity and reliability of PSSRS scores indicated that the scale can be used as an auxiliary tool in determining children's social skill levels. Consequently, children's PSSRS scores should be recorded and compared to future results, and the degree of improvement should be assessed. Furthermore, each child should be evaluated individually. It is important to consider children's ages and other developmental characteristics when interpreting the results of the scale