Evaluation of cannulated screw fixation configurations in femoral neck fractures by biomechanical studies: A systematic review

Aim: To investigate the cannulated screw fixation methods used in the treatment of femoral neck fractures with a systematic review. Methods: PubMed Central, Web of Science, OVID Medline, Embase, and Google Scholar databases were searched to identify relevant studies published until December 2021 with English language restriction. Studies were selected on the basis of the following inclusion criteria: biomechanical study of femoral neck fractures and the use of multiple screw fixation of the fracture. Results: A total of 10 studies were included in the systematic review. Five studies were conducted using cadavers and five studies using sawbones. Multiple cannulated screw fixation, fully threaded cannulated screw fixation, cannulated screw fixation perpendicular to the calcar, and fixation performed in a wider area have various advantages. During the mechanical tests, axial loading measuring device values, axial failure displacement, load to failure values, and axial loading values were measured for each operation. Conclusions: There are various surgical techniques and biomedical materials for the detection of femoral neck fractures. In addition, each cannulated screw treatment configuration has advantages and disadvantages. For this reason, the most appropriate treatment configuration should be selected, taking into account the experience of the surgeon and the fracture types

The effect of early tranexamic acid administration on hemoglobin levels after unstable pelvic fracture: An experimental study in rats

Aim: To investigate the effect of early systemic tranexamic acid (TRA) administration on hemoglobin (Hb) levels in rats with pelvic fracture. Method: In our study, 30 Wistar Albino rats were randomly divided into 3 groups in equal numbers and their hemoglobin levels were measured by taking blood samples from each. No trauma was applied to the first group and it was taken as the main control group of the study. Closed bilateral unstable pelvic fractures were created in all rats in groups 2 and 3. Fracture creation time is considered as minute 0. 10 minutes after the fracture was formed, TRA was given to the 1st group, TRA to the 2nd group and saline solution to the 3rd group systemically. Hemoglobin levels were measured by taking blood samples from all rats at 30th minute and 24th hour. The initial Hb values ​​obtained were normalized to 100 and the percentages of 30th minute and 24th hour values ​​were calculated. The initial, 30th minute and 24th hour values ​​of all groups were compared statistically with each other. The 30th minute and 24th hour values ​​were compared statistically between the groups. Results: No death was observed within 24 hours in all three groups. When the first Hb values ​​of each group are normalized to 100, the mean Hb percentages were calculated in the first group as 99.54 and 99.84 at 30 minutes and 24 hour, respectively; 92.95 and 87.73 in the second group; and 87.95 and 73.16 in the third group. When these values ​​obtained were compared statistically within the groups (initial, 30th minute, 24th hour Hb percentages), there was no significant difference between the initial, 30th minute and 24th hour values ​​in group 1. However, a statistically significant difference was found between the initial, 30th minute and 24th hour values ​​in group 2 and 3 (p<0.01). In the comparison between the groups, a statistically significant difference was found between group 1-2, group 1-3 and group 2-3 between both 30th minute and 24th hour values (p<0.01). Conclusion: In rats with bilateral unstable pelvic fractures due to blunt pelvis trauma, early administration of TRA after trauma significantly reduced the first 24-hour decrease in Hb value. Our study supports the early and prehospital use of TRA in traumas that are predicted to progress with acute bleeding, such as unstable pelvic fractures

Is magnetic resonance imaging reliable for the evaluation of the ruptured or healed anterior cruciate ligament?

Magnetic resonance imaging (MRI) is the preferred imaging technique to evaluate the intact, ruptured or healed anterior cruciate ligament (ACL). However, its effectiveness in the diagnosis of chronic tears with synovialization has not been searched. During conservative treatment of torn ACL, there is a reparative process with proliferation of synovial scar tissue which may produce a bridge. This healing, so called synovialization, may cause ACL to be misdiagnosed as intact on MRI. This is true for old ruptures of ACL. Magnetic resonance imaging is reliable in the evaluation of acute ACL ruptures. However, MRI is not reliable to evaluate the stability of the healed ACL after conservative treatment, and the ruptures due to degenerated ACLs

Is the preoperative neutrophil-to-lymphocyte ratio a predictive value for postoperative mortality in orthogeriatric patients who underwent proximal femoral nail surgery for pertrochanteric fractures?

BACKGROUND: Hip fractures in the orthogeriatric population are a health problem that causes mortality and morbidity, with an increasing frequency. The present study aims to investigate whether the preoperative neutrophil-to-lymphocyte ratio (NLR) is a predictive value for the postoperative mortality risk in patients who underwent only proximal femoral nail (PFN) surgery due to pertrochanteric fractures (PTF). To our knowledge, there is not any study conducted with a similar population in the litertaure

Spontaneous and bilateral avascular necrosis of the navicula: Muller-Weiss disease

Although, trauma, foot deformity (pes planovalgus), systemic diseases such as diabetes mellitus and lupus, drugs (steroids, antineoplastic) and excessive alcohol consumption have all been accused in the etiology of avascular necrosis of the tarsal bones, spontaneous avascular necrosis of the navicular bone, especially in adults, is a rare entity. In this article, we report a 50-year-old female patient with bilateral, spontaneous avascular necrosis of the navicular bone and related severe talonavicular arthrosis. Clinical and radiological findings were concordant with Muller-Weiss disease, which is a rare disease with complex idiopathic foot condition of the adult tarsal navicular bone characterized by progressive navicular fragmentation and talonavicular joint destruction. The patient was successfully treated with two-staged bilateral talonavicular arthrodesis

The evaluation of two different surgical approaches in total hip arthroplasty according to the patient satisfaction, plantar pressure distribution and trendelenburg sign

The aim of this prospective study was to analyze the results of two different surgical aproaches for total hip arthroplasty as Trendelenburg sign, plantar pressure distribution with the help of dynamic pedobarography and clinical results by Harris Hip Score. A total of 28 patients who underwent unilateral total hip arthroplasty using two different types of lateral approach as conventional lateral Hardinge approach and intermuscular Hardinge approach described by Pai were included in this study. Plantar pressures have maesured by EMED-SF pedobarography device and analysed by the help of a commercial software; that seperates the foot to the four different parts which are called masks. Trendelenburgs sign has been estimated as grade 1 and grade 2 by the method which was described by Hardcastle and Nade. Clinical outcome was measured by comparing Harris Hip Scores pre-operatively and postoperatively at last clinic visit. In both groups after the two years from the surgery; total contact time has increased at the operation side when the results were compared before the surgery at the same side and at the other side after the surgery. Also when we looked at the first and second masks which show the significant part of the stance phase; contact areas have similarly increased and the changes at the peak pressures were similar as contact areas. In both groups Harris Hip score was increased significantly after the operation. This is the first study to compare two different lateral approaches by pedobarographic analysis, clinical evaluation and functional scoring. The fuctional and clinical early results are similar in both lateral hip approaches for total hip arthroplasty when superior gluteal nerve protection, conjuant tendon repair and postoperative rehabilitation have done well. [Med-Science 2019; 8(1.000): 1-6

One patient, one bone, and two different tumoral lesions

In this article, we report a 67-year-old female patient who has two different tumoral lesions located in left humerus with clinical and radiological findings. Previously, the patient was diagnosed as impingement syndrome in shoulder, but, tumoral lesions were detected on the radiograms incidentally during evaluation

The role of ADAMTS genes in the end stage of hip osteoarthritis.

The aim of this study is to investigate which ADAMTS genes play a major role in the development of primary hip osteoarthritis, by comparing the tissue and blood samples in patients with hip osteoarthritis and a control group

Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios

Objectives: This study aims to assess the mortality and morbidity rates of patients with intertrochanteric femoral fractures who were performed proximal femoral nail-antirotation (PFNA) or cemented, bipolar hemiarthroplasty with calcar replacement. Patients and methods: A total of 127 patients (42 males, 85 females; mean age 79.2 years; range 55 to 98 years) who were treated due to proximal femoral fracture between January 2008 and January 2011 were compared retrospectively in terms of intraoperative mortality, total mortality, and monthly distribution of mortality rates. Of these 127 patients, 92 (28 males, 64 females; mean age 80.24 years; range 55 to 94 years) who were alive, who achieved at least a 12-month follow-up, and could walk and fulfil daily activities in preoperative period were included in the study. Patients were divided into two groups as PFNA group (n=34) and cemented, bipolar hemiarthroplasty with calcar replacement group (hemiarthroplasty group; n= 58). Both groups were compared in terms of duration of operation, requirement for intraoperative blood transfusion, duration of hospital stay, functional outcomes, quality of life, complication and revision rates, and costs of operation. Results: Patients in both groups had the same type of fracture. Bone mineral densitometry results and the type and risk of anesthesia of both groups were similar. No significant difference was detected between two groups in terms of intraoperative mortality, total mortality, and monthly distribution of mortality rates (p>0.05). Mean durations of operation were 54.85 minutes (range 40-110 minutes) and 74.66 minutes (range 55-120 minutes) in the PFNA and hemiarthroplasty groups, respectively. Mean durations of hospital stay were 5.91 days (range 5-12 days) and 9.41 days (range 6-16 days) in the PFNA and hemiarthroplasty groups, respectively. In the PFNA group, durations of operation and hospital stay were shorter and functional results were superior (p<0.05). Requirement for blood transfusion was lower in the PFNA group. Conclusion: Both PFNA and cemented, bipolar hemiarthroplasty with calcar replacement are good techniques in treatment of intertrochanteric femoral fractures. Internal fixation may be more appropriate for elderly patients due to shorter duration of operation and lower risk of reoperation

Is intraarticular administration of tranexamic acid efficient and safe as systemic administration in total knee arthroplasty? Single center, randomized, controlled trial

Objectives: This study aims to compare the efficiency and safety of intraarticular and intravenous tranexamic acid administration in patients who were performed primary total knee arthroplasty. Patients and methods: This single center, randomized, controlled trial included 60 patients (8 males, 52 females; mean age 67.8 years; range 53 to 87 years) who were performed primary total knee arthroplasty by three surgeons due to a diagnosis of primary osteoarthritis between January 2015 and June 2015. Patients were separated into three groups. Patients in group 1 and group 2 were administered 2 g intravenous tranexamic acid and 2 g intraarticular tranexamic acid, respectively. Patients in group 3 were not administered tranexamic acid. Pre- and postoperative hemoglobin difference, volume of blood collected in drains, and transfusion rate were analyzed. Results: Compared with the control group, there was no significant difference between group 1 and group 2 in terms of total blood loss from the drain, pre- and postoperative hemoglobin difference, and the need for blood transfusion. Conclusion: Both intraarticular and intravenous administrations reduce blood loss and need for transfusion and there is no significant difference between the two techniques in terms of safety