Minimally invasive plate osteosynthesis for short oblique diaphyseal tibia fractures: Does fracture site affect the outcomes?

Objective To report the results of patients with short oblique diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO). The secondary aim was to understand the effect of fracture location (midshaft or distal 1/3) on outcomes. Methods Twenty-eight patients with short oblique (>30 degrees) tibial shaft fractures (AO/OTA 42A2) treated with plate and MIPO technique between 2015 and 2019 were retrospectively assessed. Age, gender, follow-up time, fracture type (open or closed), operation time, postoperative infection rate, union time, ankle joint range of motion, and complications were analyzed. Patients' radiographs at a minimum 1-year follow-up were evaluated for malunion, nonunion, and implant-related complications. Results Mean age and follow-up time were 47.0 +/- 15.7 years and 18.3 +/- 12.1 months, respectively. Mean bone union time was 3.66 +/- 1.04 months in middle 1/3 diaphysis and 4.23 +/- 1.48 months in distal 1/3 tibia fractures. Seven (25%) patients developed superficial infections. Mean union time, malunion rate, coronal and sagittal angulation, operation length, and infection rate were similar between the groups. Conclusion MIPO is an effective method for treatment of short oblique diaphyseal tibia fractures, and results in few complications. Both distal and midshaft fractures have similar union and malunion rates

Short-term results of the management of severe bone defects in primary TKA with cement and K-wires

Objective: The aim of this study was to evaluate the results of cement and kirschner wire augmentation in the management of bone defects in primary TKA. Methods: Twenty-four patients (10 male, 14 female; mean age: 66 years) with uncontained unilateral medial tibial articular bone defect who underwent TKA between 2010 and 2014 were included in this study. The average follow up time was 33.7 months. Patients were divided to two groups according to the size of the bone defect (Group 1: 20 mm). The tibial defect was reconstructed by using cement and K-wires. We used posterior stabilized prosthesis with no tibial stem extension. Results: The preoperative and postoperative lower extremity mechanical axis in Group I was in a mean varus of 15 and mean varus of 3, respectively (p < 0.001). The preoperative and postoperative lower extremity mechanical axis in Group 2 was in a mean varus of 20 and mean varus of 3 respectively in Group II (p < 0.001). None of the patients neither suffered from failure of K-wires nor loosening. Conclusion: The use of cement and K-wires augmentation appears to be a simple and cost-effective treatment option for the tibial bone defects in primary TKA. Level of evidence: Level IV, Therapeutic study

Comparing the clinical results of anterior cruciate ligament reconstruction with concurrent meniscus repair or concurrent subtotal meniscectomy

Ön çapraz bağ (ÖÇB) ve menisküs yaralanması olan hastalarda menisküs tedavisinin ÖÇB tedavisini nasıl etkilediği literatürde tartışılmaktadır. Çalışmamızda ÖÇB ile birlikte vertikal longitudinal (kova sapı) tipi medial menisküs yırtığı olanlara ÖÇB onarımı ile beraber menisküs onarımı veya tama yakın menisektomi uygulamasının klinik sonuçlarını karşılaştırmayı amaçladık. Ocak 2009 – Kasım 2015 arasında UÜTF Ortopedi ve Travmatoloji A.D.' da ÖÇB kopuğu ile birlikte vertikal longitudinal tipte medial menisküs yırtığına girişimsel artroskopi uygulanan 30 hasta retrospektif olarak değerlendirildi. Hastaların; 28' i erkek 2' si kadın, takip süresi 44 ay (6-79), yaşları 28 (15-49), yaralanma ile ameliyat arasında geçen süre 10 ay (1-120) bulundu. ÖÇB onarımı ve eş zamanlı menisküs onarımı veya eş zamanlı tama yakın menisektomi uygulanan olarak iki grubun, muayeneleri, Lysholm, IKDC (International Knee Documentation Committee), HSS (Hospital for Special Surgery), Tegner aktivite skorları, komplikasyonları değerlendirildi. Menisküs onarımı grubunda ve tama yakın menisektomi grubunda Lysholm skoru 95 (85 – 100) - 99 (89 – 100), IKDC skoru 93 (70 – 100) - 99 (86 – 100), HSS skoru 95 (80 – 100) - 98 (78 – 100), ameliyat öncesi sportif aktivite düzeyine ulaşan hasta sayısı 6 (%40) - 14 (%93,3) saptandı. Gruplar arasında IKDC ve sportif aktiviteye dönüşte istatistiksel olarak anlamlı fark saptandı. Çalışmamızda ÖÇB ve vertikal longitudinal (kova sapı) tipi medial menisküs yaralanması olan hastalarda ÖÇB onarımı ve tama yakın menisektomi souçlarının kötü olmadığı, menisküs onarımının klinik sonuçlarının menisektomiye göre daha iyi olduğu anlaşıldı. Bu sebeple, onarılabilecek menisküs yaralanması olan hastalarda, menisektomiye göre teknik olarak daha zor ve maliyetli menisküs onarımının hasta için daha yararlı olacağı kanısındayız.The effect of meniscal injury treatment on (ACL) treatment is still controversial at the patients who have anterior cruciate ligament (ACL) and meniscal injury in literature. We aimed to compare the clinic results of ACL reconstruction with concurrent meniscus repair or concurrent subtotal meniscectomy at patients diagnosed with ACL rupture and vertical longitudinal (bucket handle) type medial meniscal tear. 30 patients diagnosed with ACL rupture with vertical longitudinal (bucket handle) type medial meniscus tear and performed interventional arthroscopy in Uludag University Faculty of Medicine Orthopaedics and Traumatology Department between January 2009 – November 2015 were retrospectively examined. Follow-up time was 44 months (6-79), age was 28 (15-49), 28 male and 2 female. Time interval between trauma and surgery was 10 months (1-120). At two groups - ACL reconstruction and simultaneously meniscus repair or simultaneously subtotal meniscectomy - knee examination findings, Lysholm, IKDC (International Knee Documentation Committee), HSS (Hospital for Special Surgery), Tegner activity scores, complications were evaluated. Meniscectomy and meniscus repair groups' results were Lysholm 95 (85-100) - 99 (89-100), IKDC 93 (70-100) - 99 (86-100), HSS 95 (80-100) - 98 (78-100), reached preoperative sportive activity level 6 (%40) - 14 (%93.3). Statistically significant difference was identified on IKDC score and sportive activity level. In this study ACL reconstruction and subtotal meniscectomy results were not bad; however, ACL reconstruction and meniscus repair's clinic results were better than meniscectomy. Our opinion by these means is, technically harder and costly meniscal repair is better than meniscectomy for patients diagnosed with repairable meniscal tear

The Effect of Age on Clinical, Functional and Quality of Life Outcomes After Arthroscopic Rotator Cuff Repair in Female Patients

© 2022, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.In the literature, the effects of age and gender on rotator cuff repair (RCR) have been evaluated separately in many studies. In our study, we aimed to analyze the outcomes of f emale patients above and below the age of 60. A total of 55 female patients who received arthroscopic rotator cuff repair (ARCR) between 2018 and 2020 were examined retrospectively. The patients were classified according to their age as Group 1 (0.05). The pre operative SF-36 values were similar between the two groups (P> 0.05). Emotional problems, energy, social function, pain and overall health change domains of SF-36 were higher in Group 1 (P <0.05). Clinical and functional outcomes are not affected by age, whereas emotional problems, energy, social function, pain and overall health domains become worse in patients over 60 years of age

The effect of watching shoulder ROM changes on functional outcome and quality of life following arthroscopic rotator cuff repair

Purpose This study aimed to evaluate the effectiveness of watching video records of their shoulder motion changes on functional outcomes and quality of life after arthroscopic rotator cuff repair (ARCR). Methods The patients were divided into two groups. In Group 1, video records of pre- and postoperative shoulder motions were recorded and showed. In Group 2, no video was showed to the patients. In Group 1, the first postoperative evaluation was done before video watching, and the second evaluation was done just after watching video records. In Group 2, the first and second postoperative measurements were performed with 10-20 days interval. The Constant Murley score (CS), the American Shoulder and Elbow Surgeons score (ASES), the Short-Form 36 (SF-36) score, and active shoulder range of motion (ROM) values were used as an outcome tool. Results A total of 196 patients (Group 1; 76 patients and Group 2; 120 patients) with a mean age of 62.06 +/- 7.17 years were included. There was a significant improvement in postoperative scores of SF-36 subscales (except emotional well-being and energy/fatigue), ASES, CM scores, and joint ROM values when compared to preoperative values for both groups (p .05). In the second postoperative evaluation, emotional role functioning, energy/fatigue, emotional well-being, health change subscales of SF-36, and ASES scores were significantly higher in Group 1 compared with Group 2 (p < .05). Conclusion When patients watch the pre- and postoperative video records of their shoulder ROM after ARCR, patients' satisfaction and well-being perception increase in the short-term despite unchanged shoulder ROM

Fracture line and comminution zone characteristics, and rotator cuff footprint involvement in OTA/AO 11C3-type proximal humeral fractures: complex proximal humerus fracture map

PurposeTo identify fracture characteristics and zones of comminution as well as the relationship with anatomic landmarks and rotator cuff footprint involvement in OTA/AO 11C3-type proximal humerus fractures.MethodsComputed tomography images of 201 OTA/AO 11C3 fractures were included. Fracture lines were superimposed to a 3D proximal humerus template, created from a healthy right humerus, after fracture fragment reduction on 3D reconstruction images. Rotator cuff tendon footprints were marked on the template. Lateral, anterior, posterior, medial, and superior views were captured for the interpretation of fracture line and comminution zone distribution as well as to define the relationship with anatomic landmarks and rotator cuff tendon footprints.ResultsA total of 106 females and 95 males (mean age = 57.5 & PLUSMN; 17.7 [range 18-101] years) with 103 C3.1-, 45 C3.2-, and 53 C3.3-type fractures were included. On the lateral, medial, and superior humeral surfaces, fracture lines and comminution zones were distributed differently in 3 groups. Tuberculum minus and medial calcar region were significantly less severely affected in C3.1 and C3.2 fractures than C3.3 fractures. The supraspinatus footprint was the most severely affected rotator cuff footprint area.ConclusionsSpecifically defining the certain differences for repeatable fracture patterns and comminution zones in OTA/AO 11C3-type fractures and the relationship between the rotator cuff footprint and the joint capsule may contribute to the decision-making process of surgeons

Fracture lines and comminution zones of traumatic sacral fractures

BACKGROUND: Sacral fractures are uncommon and understanding three-dimensional morphology is needed to obtain proper treatment. The purpose of this study was to identify the repeatable fracture patterns and comminution zones for traumatic sacral fractures and create fracture maps.METHODS: Computerized tomography images of 72 patients with traumatic sacral fracture were included in the study. For each fracture, fracture lines were identified and digitally reduced. All fractures were superimposed over a template and fracture maps; com-minution zones and heatmaps were created for each zone. RESULTS: There were 40 males and 32 females with a mean age of 46.5 +/- 19.9. Fifty-three (73.6%) patients sustained major trauma, and 19 (26.4%) had minor trauma. There were 37 (51.4%) Zone 1, 22 (30.6%) Zone 2, and 13 (18.1%) Zone 3 fractures. Each Denis zone showed certain fracture patterns. In Zone 1 fractures, most of the fracture lines were vertical and oblique (up to 45 degrees) orientation on both sides. In Zone 2 fractures, fracture lines were concentrated on the S1 and S2 levels. Anterolateral and posterolateral parts of the sacrum were less affected in right-side fractures. In Zone 3 fractures, fractures were concentrated in S1, S2, and S3 levels around the sacral canal. The median sacral crest and midline remained mostly unaffected.CONCLUSION: Sacral fractures showed specific repeatable patterns for each zone. These findings may be helpful for pre-operative planning, placement of fixation material, design of new implants, and modification of current fracture-classification systems