Objective: The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of displacement, functional outcomes, and need for additional surgery after reduction.
Methods: A cross-sectional study was conducted. We evaluated radiographs of patients treated for combined GT fractures and anterior shoulder dislocation. Three morphologies were proposed; type 1 (a small avulsion), type 2 (GT fractures without articular head involvement), and type 3 (GT associated with articular head fractures). Two orthopedic surgeons independently measured all radiographs and classified fractures into three types. Patients were interviewed by telephone to assess functional outcomes (the simple shoulder test (SST) and EQ-5D-5L), and additional shoulder surgery was also performed.
Results: There were 52 eligible patients; 32 were male (61.5%) and the mean age was 57.3 · 17.1 years. Most cases were low-energy injuries (61.5%). Of all the cases, 32.7% were type I, 59.6% type II, and 7.7% type III cases. There were differences in the degree of displacement in each group at pre, post-reduction (both horizontal and vertical planes) and at two weeks post-reduction for HD (p < 0.05). Type III had more displacement than type I at pre- and post-reduction with a P value of less than 0.05. Type III also had higher rates of displacement than type II at post-reduction and at two-week postreduction (vertical plane). The intra and inter-rater reliabilities of measurement (ICC > 0.8) were in good to excellent agreement with the kappa value (>0.9). Three out of 52 cases (5.8%) required an additional surgery after closed reduction. Patients had good functional outcomes (SST score of 8) with an excellent utility index of EQ-5D-5L (0.9).
Conclusion: This new classification exhibited good-to-excellent intra-and inter-rater reliabilities, with an ability to determine injury type. Type III seems to be linked to higher risk of fracture displacement and may require additional surgery.
{"title":"A new classification for combined greater tuberosity fracture and anterior shoulder dislocation: A study of fracture configurations and displacement after reduction.","authors":"Phob Ganokroj, Narin Pakawech, Bavornrat Vanadurongwan, Thos Harnroongroj, Thossart Harnroongroj, Ekavit Keyurapan","doi":"10.5152/j.aott.2022.21316","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21316","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of displacement, functional outcomes, and need for additional surgery after reduction.</p><p><strong>Methods: </strong>A cross-sectional study was conducted. We evaluated radiographs of patients treated for combined GT fractures and anterior shoulder dislocation. Three morphologies were proposed; type 1 (a small avulsion), type 2 (GT fractures without articular head involvement), and type 3 (GT associated with articular head fractures). Two orthopedic surgeons independently measured all radiographs and classified fractures into three types. Patients were interviewed by telephone to assess functional outcomes (the simple shoulder test (SST) and EQ-5D-5L), and additional shoulder surgery was also performed.</p><p><strong>Results: </strong>There were 52 eligible patients; 32 were male (61.5%) and the mean age was 57.3 · 17.1 years. Most cases were low-energy injuries (61.5%). Of all the cases, 32.7% were type I, 59.6% type II, and 7.7% type III cases. There were differences in the degree of displacement in each group at pre, post-reduction (both horizontal and vertical planes) and at two weeks post-reduction for HD (p < 0.05). Type III had more displacement than type I at pre- and post-reduction with a P value of less than 0.05. Type III also had higher rates of displacement than type II at post-reduction and at two-week postreduction (vertical plane). The intra and inter-rater reliabilities of measurement (ICC > 0.8) were in good to excellent agreement with the kappa value (>0.9). Three out of 52 cases (5.8%) required an additional surgery after closed reduction. Patients had good functional outcomes (SST score of 8) with an excellent utility index of EQ-5D-5L (0.9).</p><p><strong>Conclusion: </strong>This new classification exhibited good-to-excellent intra-and inter-rater reliabilities, with an ability to determine injury type. Type III seems to be linked to higher risk of fracture displacement and may require additional surgery.</p><p><strong>Level of evidence: </strong>Level IV, Diagnostic Study.</p>","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/02/aott-56-4-245.PMC9612667.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40681687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21322
E. Aktaş, H. Ömeroğlu
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.
{"title":"Treatment preferences of orthopedic surgeons for closed, isolated middle-third diaphyseal long bone fractures without neurovascular injury in children: A cross-sectional survey","authors":"E. Aktaş, H. Ömeroğlu","doi":"10.5152/j.aott.2022.21322","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21322","url":null,"abstract":"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.","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42162177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21384
L. Mert, M. Demirel, Alper Şükrü Kendirci, T. Akgül, Önder İsmet Kılıçoğlu
Objective: The aim of this study was to analyse the factors that led to resignations from Orthopaedics and Traumatology Residency programmes in Turkey, and to determine the overall rate of resignation among residents from Orthopaedics and Traumatology programmes. Methods: In this cross-sectional survey,120 residents who either resigned or transferred to other OT clinics between autumn of 2013 and spring of 2020 were included. They were asked to complete a questionnare which was sent via Whatssapp application or e-mail. The questionnare was comprised of 2 sections; Section A, which adressed resignation, consisted of 15 questions and Section B, which adressed transfer to another OT programme, consisted of 12 questions. Both sections had open ended and multiple choice questions. Results: Of 120 residents, 96 (6.6%) resigned and then transferred to another specialty, and 24 (1.6%) transferred to another orthopedics and traumatology clinic based on our review. The overall resignation rate as per the total quotas for orthopedics and traumatology residency from 2013 to 2020 was 8.2%. Of the 120 orthopedics and traumatology residents who were eligible for the survey, 83 (70%) completed the questionnaire. Sixty-one (60 males, 1 female; median age = 26 years; age range = 25-35) of 96 residents who resigned from the orthopedics and traumatology residency completed section A (the response rate was 63.5%); 22 (22 males; median age = 27.6 years; age range = 25-34) out of 24 residents who transferred to another orthopedics and traumatology clinic completed section B (the response rate was 91.6%). In section A, 40 out of 61 individuals (65.5%) preferred orthopedics and traumatology specialty as the first choice in TUS, and 34 residents (55.7%) reported not to have had enough information regarding the residency program before starting their clinics. In section B, out of the 22 residents, 13 (59%) stated that orthopedics and traumatology residency was not their first choice in TUS, and 18 (81.8%) reported not to have had sufficient knowledge about the preferred clinic. The most common reason for resignation or transfer to another specialty was heavy workload (n = 46, 74.19%), followed by excessive hours of work (n = 45, 72.58%). The most common reason for transfer to another orthopedics and traumatology clinic was drudgery (n = 10, 45.5%), followed by problems with the hierarchy in orthopedics and traumatology residency (n = 9, 40.9%). Conclusion: The results of this survey have shown us, with an overall resignation rate of 8.2% as per the total quotas for OT residency from 2013 to 2020, that resignation from OT residency represents an important problem in Turkey. Workload and excessive hours of work were the most common reasons for resignation from orthopaedic residency programmes. Furthermore, extra work that diverted residents from their actual job responsibilities, as well as academic and educational concerns, were the main factors leading to transfer to anoth
{"title":"Reasons for resident resignations from Orthopedic Residency Programs in Turkey: A cross-sectional survey from residents’ perspectives","authors":"L. Mert, M. Demirel, Alper Şükrü Kendirci, T. Akgül, Önder İsmet Kılıçoğlu","doi":"10.5152/j.aott.2022.21384","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21384","url":null,"abstract":"Objective: The aim of this study was to analyse the factors that led to resignations from Orthopaedics and Traumatology Residency programmes in Turkey, and to determine the overall rate of resignation among residents from Orthopaedics and Traumatology programmes. Methods: In this cross-sectional survey,120 residents who either resigned or transferred to other OT clinics between autumn of 2013 and spring of 2020 were included. They were asked to complete a questionnare which was sent via Whatssapp application or e-mail. The questionnare was comprised of 2 sections; Section A, which adressed resignation, consisted of 15 questions and Section B, which adressed transfer to another OT programme, consisted of 12 questions. Both sections had open ended and multiple choice questions. Results: Of 120 residents, 96 (6.6%) resigned and then transferred to another specialty, and 24 (1.6%) transferred to another orthopedics and traumatology clinic based on our review. The overall resignation rate as per the total quotas for orthopedics and traumatology residency from 2013 to 2020 was 8.2%. Of the 120 orthopedics and traumatology residents who were eligible for the survey, 83 (70%) completed the questionnaire. Sixty-one (60 males, 1 female; median age = 26 years; age range = 25-35) of 96 residents who resigned from the orthopedics and traumatology residency completed section A (the response rate was 63.5%); 22 (22 males; median age = 27.6 years; age range = 25-34) out of 24 residents who transferred to another orthopedics and traumatology clinic completed section B (the response rate was 91.6%). In section A, 40 out of 61 individuals (65.5%) preferred orthopedics and traumatology specialty as the first choice in TUS, and 34 residents (55.7%) reported not to have had enough information regarding the residency program before starting their clinics. In section B, out of the 22 residents, 13 (59%) stated that orthopedics and traumatology residency was not their first choice in TUS, and 18 (81.8%) reported not to have had sufficient knowledge about the preferred clinic. The most common reason for resignation or transfer to another specialty was heavy workload (n = 46, 74.19%), followed by excessive hours of work (n = 45, 72.58%). The most common reason for transfer to another orthopedics and traumatology clinic was drudgery (n = 10, 45.5%), followed by problems with the hierarchy in orthopedics and traumatology residency (n = 9, 40.9%). Conclusion: The results of this survey have shown us, with an overall resignation rate of 8.2% as per the total quotas for OT residency from 2013 to 2020, that resignation from OT residency represents an important problem in Turkey. Workload and excessive hours of work were the most common reasons for resignation from orthopaedic residency programmes. Furthermore, extra work that diverted residents from their actual job responsibilities, as well as academic and educational concerns, were the main factors leading to transfer to anoth","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49468328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21212
Ersin Taşatan, Onur Kocadal
Objective: This study aimed to assess the effects of different cortical impingement scenarios on the biomechanical features of retrograde femoral nails in managing distal femoral fractures. Methods: A mesh femur model was constructed using computed tomography (CT) images. Five different cortical impingement (CI) scenarios were designed: central model (CM), lateral CI (LCI), medial CI (MCI), anterior CI (ACI), and posterior CI (PCI). The fixation stability was evaluated by femoral head movement, stress, and elastic strain at the fracture site. The maximum stress on the femoral cortex and the implants were also measured. Results: The maximal femoral head movements were 3.11 mm in ACI and 2.91 mm in MCI. Among all CI models, the highest stress value at the fracture site was recorded in ACI (18.9 MPa), and the maximum stress on the femoral cortex was determined in ACI (114.3 MPa). The highest microstrain value at the fracture site was measured in MCI (599.1 μstrain). In all scenarios, maximum stress was located around the proximal hole of the nail. Conclusion: This study revealed that cortical impingement results in excessive loading on the retrograde femoral nail in managing distal femur fractures. MCI and ACI mainly cause this pathological loading. Problems related to supraphysiological loadings, such as implant failure and periprosthetic fracture, can be reduced by applying the nail in the central position.
{"title":"The effects of different cortical impingement scenarios on the biomechanical features of retrograde femoral nails in the management of distal femoral fractures: A finite element analysis","authors":"Ersin Taşatan, Onur Kocadal","doi":"10.5152/j.aott.2022.21212","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21212","url":null,"abstract":"Objective: This study aimed to assess the effects of different cortical impingement scenarios on the biomechanical features of retrograde femoral nails in managing distal femoral fractures. Methods: A mesh femur model was constructed using computed tomography (CT) images. Five different cortical impingement (CI) scenarios were designed: central model (CM), lateral CI (LCI), medial CI (MCI), anterior CI (ACI), and posterior CI (PCI). The fixation stability was evaluated by femoral head movement, stress, and elastic strain at the fracture site. The maximum stress on the femoral cortex and the implants were also measured. Results: The maximal femoral head movements were 3.11 mm in ACI and 2.91 mm in MCI. Among all CI models, the highest stress value at the fracture site was recorded in ACI (18.9 MPa), and the maximum stress on the femoral cortex was determined in ACI (114.3 MPa). The highest microstrain value at the fracture site was measured in MCI (599.1 μstrain). In all scenarios, maximum stress was located around the proximal hole of the nail. Conclusion: This study revealed that cortical impingement results in excessive loading on the retrograde femoral nail in managing distal femur fractures. MCI and ACI mainly cause this pathological loading. Problems related to supraphysiological loadings, such as implant failure and periprosthetic fracture, can be reduced by applying the nail in the central position.","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47931486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21354
Qian Fang, G. Wang
We read the article by Grezda et al1 about systematic inflammatory responses of surgeries in pertrochanteric fractures. It was reported that the application of the proximal femoral nail (PFN) resulted in a significantly smaller increase of interleukin-6 (IL-6) and creatine kinase (CK) from baseline to 24 hours postoperatively compared to dynamic hip screw (DHS), but not in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). We applaud their achievement. However, there was no statement on blood loss and perioperative blood management strategies in the article. Excessive blood loss might call for the implementation of blood management strategies, for example, tranexamic acid, which is widely used in orthopedic surgeries and might cause a change in postoperative inflammatory responses. Postoperative CRP, IL-6, and ESR were reported to be significantly lower with an additional dose of tranexamic acid in total knee arthroplasty (TKA)2, 3 and total hip arthroplasty (THA)4. An extra anti-inflammatory effect from tranexamic acid might have resulted from its inhibition of plasminogen which binds to various inflammatory cells including monocytes, macrophages, and neutrophils5. Author Contributions: Writing Q.F.; Critical Review G.W.
{"title":"Comment on “Comparison of systemic inflammatory responses of proximal femoral nail versus dynamic hip screw after treatment of patients with pertrochanteric fractures: A prospective comparative study”","authors":"Qian Fang, G. Wang","doi":"10.5152/j.aott.2022.21354","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21354","url":null,"abstract":"We read the article by Grezda et al1 about systematic inflammatory responses of surgeries in pertrochanteric fractures. It was reported that the application of the proximal femoral nail (PFN) resulted in a significantly smaller increase of interleukin-6 (IL-6) and creatine kinase (CK) from baseline to 24 hours postoperatively compared to dynamic hip screw (DHS), but not in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). We applaud their achievement. However, there was no statement on blood loss and perioperative blood management strategies in the article. Excessive blood loss might call for the implementation of blood management strategies, for example, tranexamic acid, which is widely used in orthopedic surgeries and might cause a change in postoperative inflammatory responses. Postoperative CRP, IL-6, and ESR were reported to be significantly lower with an additional dose of tranexamic acid in total knee arthroplasty (TKA)2, 3 and total hip arthroplasty (THA)4. An extra anti-inflammatory effect from tranexamic acid might have resulted from its inhibition of plasminogen which binds to various inflammatory cells including monocytes, macrophages, and neutrophils5. Author Contributions: Writing Q.F.; Critical Review G.W.","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48838418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21293
Mehmet Salih Söylemez, E. Eceviz, İ. Esenkaya, A. Eren
Objective: This study aimed to establish a feasible conservative treatment algorithm for Legg-Calvè-Perthes Disease (LCPD), clarify its limitations, and evaluate the correlations between radiographical and clinical results. Methods: Patients diagnosed with LCPD and treated conservatively were evaluated retrospectively; 39 hips from 35 patients were included. The treatment protocol consisted of intermittent manual traction, range of motion exercises, activity limitation, bed rest, NSAID (ibuprofen 100mg/5mL), and ASA (100mg/day) during attack periods. The treatment protocol was standardized, and an algorithm was established for all the patients. Results: The mean follow-up was 13.7 (range = 8-22) years. According to the Stulberg classification, 26 (67%) hips were good, 6 (15,3%) were fair, and 7 (17%) were poor. No activity-limiting pain was detected in any patient. The mean Harris score was 90.5 ± 5.3 for Stulberg type 1, 2, and 3 hips, but 84.2 ± 8.8 for Stulberg type 4 and 5 hips. When the patients were evaluated in terms of pain, activity, and function, it was seen that pain and activity were not different, especially in the Stulberg 1, 2, 3, and 4 patients during the mid-term follow-up. The function was the main factor correlating with the Stulberg classification. Twenty-nine (82.8%) families defined the applicability of the treatment protocol as “easy,” 4 (10.3%) defined it as “moderate,” and 2 (6.2%) defined it as “difficult.” Conclusion: The present study demonstrated that the treatment protocol was successful and easily applicable to LCPD. Although lateral pillar classification was efficient to predict radiographic results, the Stulberg classification was not correlated with the clinical results for every subgroup. Level of Evidence: Level IV, Therapeutic Study
{"title":"Radiographical and clinical results of a new conservative treatment algorithm in Legg-Calvè-Perthes disease: A retrospective study","authors":"Mehmet Salih Söylemez, E. Eceviz, İ. Esenkaya, A. Eren","doi":"10.5152/j.aott.2022.21293","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21293","url":null,"abstract":"Objective: This study aimed to establish a feasible conservative treatment algorithm for Legg-Calvè-Perthes Disease (LCPD), clarify its limitations, and evaluate the correlations between radiographical and clinical results. Methods: Patients diagnosed with LCPD and treated conservatively were evaluated retrospectively; 39 hips from 35 patients were included. The treatment protocol consisted of intermittent manual traction, range of motion exercises, activity limitation, bed rest, NSAID (ibuprofen 100mg/5mL), and ASA (100mg/day) during attack periods. The treatment protocol was standardized, and an algorithm was established for all the patients. Results: The mean follow-up was 13.7 (range = 8-22) years. According to the Stulberg classification, 26 (67%) hips were good, 6 (15,3%) were fair, and 7 (17%) were poor. No activity-limiting pain was detected in any patient. The mean Harris score was 90.5 ± 5.3 for Stulberg type 1, 2, and 3 hips, but 84.2 ± 8.8 for Stulberg type 4 and 5 hips. When the patients were evaluated in terms of pain, activity, and function, it was seen that pain and activity were not different, especially in the Stulberg 1, 2, 3, and 4 patients during the mid-term follow-up. The function was the main factor correlating with the Stulberg classification. Twenty-nine (82.8%) families defined the applicability of the treatment protocol as “easy,” 4 (10.3%) defined it as “moderate,” and 2 (6.2%) defined it as “difficult.” Conclusion: The present study demonstrated that the treatment protocol was successful and easily applicable to LCPD. Although lateral pillar classification was efficient to predict radiographic results, the Stulberg classification was not correlated with the clinical results for every subgroup. Level of Evidence: Level IV, Therapeutic Study","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42666581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21314
A. Voelker, Friederike Schroeter, H. Steinke, C. Heyde
Objective: The aim of the study was to assess the relationship between the expression of elastin, collagen type I, II,III and the degeneration of the facet joint capsule and the ligamentum flavum. Methods: 10 patients (4 male, 6 female) (mean age 61 ± 14,9) undergoing surgery for degenerative lumbar spine syndrome and 5 cadavers (3 male, 2 female) (age of death 87 ± 8,6 years) were included in this study. One set of tissue samples was taken from each patient in the patient group intraoperatively and two sets of samples were taken from each cadaver in the cadaver group posthumosly from the ligamentum flavum (medial and lateral) and from the facet joint capsules (superior and inferior articular process) at the L4/5 segment.Western blot analysis was performed for collagen types I, II, III and for elastin. Disc degeneration was scored according to the Pfirmann Classification, facet joint arthrosis was scored according to the Fujiwara Classification and their relationship with protein expression was investigated. Results: There was a strong expression of Collagen type I in the patient group (PG) compared to the body donor group (BDG) in the facet joint capsule (FJC) and in the lateral samples of the ligamentum flavum. Samples of the FJC showed lower expression of elastin in the PG compared with the BDG, but without statistical significance. An increased expression of collagen type I compared to elastin in the PG could be shown. In contrast, elastin predominated in the samples of the BDG group compared to collagen type I (collagen type I/ elastin PG: PAsup 2,78; PAinf 2,61; LFmed 2,23; 225 LFlat 1,83; BDG: PAsup 0,15; PAinf 0,2; LFmed 0,2; LFlat 0,27). Rank correlation coefficient according to Spearman showed low to moderate correlations for collagen type I, III and elastin for the degree of disc degeneration according to Pfirrmann and the degree of facet joint osteoarthritis according to Fujiwara, all of them without statistical significance. Conclusion: This study has shown us that in the context of degenerative changes of the lumbar spine, there is an increased expression of collagen type I and a dominance over elastin. Level of Evidence: Level III, Diagnostic Study
{"title":"Degeneration of the lumbar spine and its relation to the expression of collagen and elastin in facet joint capsules and ligament flavum","authors":"A. Voelker, Friederike Schroeter, H. Steinke, C. Heyde","doi":"10.5152/j.aott.2022.21314","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21314","url":null,"abstract":"Objective: The aim of the study was to assess the relationship between the expression of elastin, collagen type I, II,III and the degeneration of the facet joint capsule and the ligamentum flavum. Methods: 10 patients (4 male, 6 female) (mean age 61 ± 14,9) undergoing surgery for degenerative lumbar spine syndrome and 5 cadavers (3 male, 2 female) (age of death 87 ± 8,6 years) were included in this study. One set of tissue samples was taken from each patient in the patient group intraoperatively and two sets of samples were taken from each cadaver in the cadaver group posthumosly from the ligamentum flavum (medial and lateral) and from the facet joint capsules (superior and inferior articular process) at the L4/5 segment.Western blot analysis was performed for collagen types I, II, III and for elastin. Disc degeneration was scored according to the Pfirmann Classification, facet joint arthrosis was scored according to the Fujiwara Classification and their relationship with protein expression was investigated. Results: There was a strong expression of Collagen type I in the patient group (PG) compared to the body donor group (BDG) in the facet joint capsule (FJC) and in the lateral samples of the ligamentum flavum. Samples of the FJC showed lower expression of elastin in the PG compared with the BDG, but without statistical significance. An increased expression of collagen type I compared to elastin in the PG could be shown. In contrast, elastin predominated in the samples of the BDG group compared to collagen type I (collagen type I/ elastin PG: PAsup 2,78; PAinf 2,61; LFmed 2,23; 225 LFlat 1,83; BDG: PAsup 0,15; PAinf 0,2; LFmed 0,2; LFlat 0,27). Rank correlation coefficient according to Spearman showed low to moderate correlations for collagen type I, III and elastin for the degree of disc degeneration according to Pfirrmann and the degree of facet joint osteoarthritis according to Fujiwara, all of them without statistical significance. Conclusion: This study has shown us that in the context of degenerative changes of the lumbar spine, there is an increased expression of collagen type I and a dominance over elastin. Level of Evidence: Level III, Diagnostic Study","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44664598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21161
Hiroshi Ohno, Minoru Murata, T. Kamo, Hideo Sugimoto, Takanori Saito
Objective: The aim of this study was to assess the outcomes and complications, such as tibiofemoral instability and recurrence of valgus deformity, of total knee arthroplasty for valgus knees with a new technique preserving the deep layer of the medial collateral ligament. Methods: In this study 33 (4 male and 29 female) patients, and a total of 36 (26 knees with osteoarthritis and 10 with rheumatoid arthritis) knees with a standing femorotibial angle (FTA) of <170° were included. Posterior Stabilized (PS) implants were used in 34 knees, rotating hinged knee implants were used in 2 knees. The procedures were carried out by a single surgeon protecting the deep layer of the medial collateral ligament. The patients’ average age at the time of the operation was 67.6 ± 12 years, and the average follow-up period was 9.0 ± 3 years (range, 4-15 years). The Japanese Orthopaedic Association (JOA) knee score, range of motion (ROM) (extension/flexion; measured in degrees), FTA (measured in degrees) and complications were investigated. Results: The Japanese Orthopaedic Association knee score significantly improved from an average of 51 ± 12 points before the operation to 86 ± 9 points after the operation (P <0.001). The extension ROM and flexion ROM improved from, -13 ± 13° to a postoperative average of -2 ± 4°, and 115 ± 25° to a postoperative average of 125 ± 18° respectively (P <0.001). The standing FTA significantly improved from 158 ± 9° to an average of 173 ± 2° after the operation (P <0.001). Thirty-four knees with severe valgus deformity were operated on using posterior stabilised implants, while only two knees required constrained implants. During follow-up, no complications, such as tibiofemoral instability, recurrence of valgus deformity, patellar necrosis, deep infection, wound problems, or peroneal nerve paralysis were observed. Conclusion: This study has shown us that after performing TKA while preserving the d-MCL for valgus knee deformity good clinical results were obtained and no complications were observed. Level of Evidence: Level IV, Therapeutic Study
{"title":"A New Total Knee Arthroplasty Technique for Valgus Knees that preserves the deep layer of the medial collateral ligament","authors":"Hiroshi Ohno, Minoru Murata, T. Kamo, Hideo Sugimoto, Takanori Saito","doi":"10.5152/j.aott.2022.21161","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21161","url":null,"abstract":"Objective: The aim of this study was to assess the outcomes and complications, such as tibiofemoral instability and recurrence of valgus deformity, of total knee arthroplasty for valgus knees with a new technique preserving the deep layer of the medial collateral ligament. Methods: In this study 33 (4 male and 29 female) patients, and a total of 36 (26 knees with osteoarthritis and 10 with rheumatoid arthritis) knees with a standing femorotibial angle (FTA) of <170° were included. Posterior Stabilized (PS) implants were used in 34 knees, rotating hinged knee implants were used in 2 knees. The procedures were carried out by a single surgeon protecting the deep layer of the medial collateral ligament. The patients’ average age at the time of the operation was 67.6 ± 12 years, and the average follow-up period was 9.0 ± 3 years (range, 4-15 years). The Japanese Orthopaedic Association (JOA) knee score, range of motion (ROM) (extension/flexion; measured in degrees), FTA (measured in degrees) and complications were investigated. Results: The Japanese Orthopaedic Association knee score significantly improved from an average of 51 ± 12 points before the operation to 86 ± 9 points after the operation (P <0.001). The extension ROM and flexion ROM improved from, -13 ± 13° to a postoperative average of -2 ± 4°, and 115 ± 25° to a postoperative average of 125 ± 18° respectively (P <0.001). The standing FTA significantly improved from 158 ± 9° to an average of 173 ± 2° after the operation (P <0.001). Thirty-four knees with severe valgus deformity were operated on using posterior stabilised implants, while only two knees required constrained implants. During follow-up, no complications, such as tibiofemoral instability, recurrence of valgus deformity, patellar necrosis, deep infection, wound problems, or peroneal nerve paralysis were observed. Conclusion: This study has shown us that after performing TKA while preserving the d-MCL for valgus knee deformity good clinical results were obtained and no complications were observed. Level of Evidence: Level IV, Therapeutic Study","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41867455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21140
Jae-hoo Lee, G. Kim, M. Park
Objective: The aims of the study were (1) to compare outcomes in terms of malunited distal radius bone union in open-wedge corrective osteotomy using autogenous or allogenic bone and (2) to introduce a new parameter that quantifies the rate of the bone union. Methods: This retrospective study included 22 patients (14 males, 8 females) who underwent open-wedge corrective osteotomy with bone grafting for a malunited distal radius fracture between January 2006 and December 2018 were enrolled. The mean follow-up duration was 57.2 weeks (SD 46.1, range 12-206). All the patients were then divided into 1 of the 2 groups based on the graft material used: autogenous bone graft group (n = 10, 5 males and 5 females) and allogenic bone graft group (n = 12, 9 males and 3 females). We introduced the “duration of union/correction gap ratio” to represent the healing potential of each graft materials. Radiologic parameters including initial correction gap, radial inclination, radial length, palmar tilt, and ulnar variance were also measured pre- and postoperatively. Functional outcomes were assessed by grip strength, range of motion, and the disability of the Arm, Shoulder, and Hand score. Results: Of the 22 patients, 16 (72.7%) achieved complete union within 12 weeks, 3 (13.6%) in over 12 weeks, and the other 3 (13.6%) showed nonunion. Excluding the 3 nonunion cases, the mean union duration was 10.6 weeks, and the mean correction gap was 10 mm. The mean correction gap was wider in the autogenous bone graft group, and the mean union duration was longer in the allogenic bone graft group. Autogenous bone grafts had a significantly lower duration of bone union/correction gap ratio than allogenic bone grafts (0.76 vs. 1.61, P < 0.001). According to the correction method (simple open-wedge corrective osteotomy vs. open-wedge corrective osteotomy OWCO), only duration of bone union/correction gap ratio reflected the actual difference between values. Conclusion: Despite autogenous bone graft donor site morbidities, in our study, autogenous bone showed better bone healing potential than allogenic bone. In terms of bone union, autogenous bone has the benefit of better union in larger gaps than allogenic bone. Surgeons can take advantage of the newly introduced “duration of bone union/correction gap ratio” to compare the bone healing potential by graft materials or surgical options. Level of Evidence: Level IV, Therapeutic Study
{"title":"Clinical outcomes of open-wedge corrective osteotomy using autogenous or allogenic bone grafts for malunited distal radius: A novel parameter for measuring the rate of bone union","authors":"Jae-hoo Lee, G. Kim, M. Park","doi":"10.5152/j.aott.2022.21140","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21140","url":null,"abstract":"Objective: The aims of the study were (1) to compare outcomes in terms of malunited distal radius bone union in open-wedge corrective osteotomy using autogenous or allogenic bone and (2) to introduce a new parameter that quantifies the rate of the bone union. Methods: This retrospective study included 22 patients (14 males, 8 females) who underwent open-wedge corrective osteotomy with bone grafting for a malunited distal radius fracture between January 2006 and December 2018 were enrolled. The mean follow-up duration was 57.2 weeks (SD 46.1, range 12-206). All the patients were then divided into 1 of the 2 groups based on the graft material used: autogenous bone graft group (n = 10, 5 males and 5 females) and allogenic bone graft group (n = 12, 9 males and 3 females). We introduced the “duration of union/correction gap ratio” to represent the healing potential of each graft materials. Radiologic parameters including initial correction gap, radial inclination, radial length, palmar tilt, and ulnar variance were also measured pre- and postoperatively. Functional outcomes were assessed by grip strength, range of motion, and the disability of the Arm, Shoulder, and Hand score. Results: Of the 22 patients, 16 (72.7%) achieved complete union within 12 weeks, 3 (13.6%) in over 12 weeks, and the other 3 (13.6%) showed nonunion. Excluding the 3 nonunion cases, the mean union duration was 10.6 weeks, and the mean correction gap was 10 mm. The mean correction gap was wider in the autogenous bone graft group, and the mean union duration was longer in the allogenic bone graft group. Autogenous bone grafts had a significantly lower duration of bone union/correction gap ratio than allogenic bone grafts (0.76 vs. 1.61, P < 0.001). According to the correction method (simple open-wedge corrective osteotomy vs. open-wedge corrective osteotomy OWCO), only duration of bone union/correction gap ratio reflected the actual difference between values. Conclusion: Despite autogenous bone graft donor site morbidities, in our study, autogenous bone showed better bone healing potential than allogenic bone. In terms of bone union, autogenous bone has the benefit of better union in larger gaps than allogenic bone. Surgeons can take advantage of the newly introduced “duration of bone union/correction gap ratio” to compare the bone healing potential by graft materials or surgical options. Level of Evidence: Level IV, Therapeutic Study","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41788197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.5152/j.aott.2022.21287
Orkhan Aliyev, T. Erden, Kerim Sarıyılmaz, E. Bozdag, E. Sünbüloğlu, I. Tuncay, F. Yıldız
Objective: This study aimed to investigate biomechanically the effects of onlay fibula grafts on Vancouver Type B1 Periprosthetic Femoral Fractures (PPFs). Methods: Vancouver Type B1 PFF models were created in 25 fourth-generation synthetic femurs and fixed with locking plates using bicortical, unicortical screws, and cables. While no graft was used in group 1, onlay fibula grafts were placed anteriorly in group 2 and medially in group 3. In group 4, the cortical strut allograft was placed on the medial femoral cortex, and a locking compression plate (LCP) was applied to the lateral femoral cortex. In group 5, the strut allograft was placed over the anterior cortex of the femur and fixed with the same technique as in group 4. All models were then subjected to rotational and axial cyclical stiffness tests and load to failure to measure and compare the mechanical strengths of the constructs. Results: The mean stiffness values of group 4 with medial allograft, before and after cyclical loading, were higher than all other groups, under both rotational and axial forces. The mean stiffness values of fibula autografts (groups 2 and 3) were similar to that of anterior allografts (group 5) in each test except that the mean initial axial stiffness of group 5 was higher than group 2. Failure loads were also not different between the groups. Conclusion: Although the rigidity of Vancouver type B1 periprosthetic femur fractures is highest if allografts are placed medially, fibula autografts can also provide similar fixation strengths to allografts if locking plates with unicortical and bicortical screws and cables are used.
{"title":"The effect of onlay cortical fibula strut grafts on biomechanical features of Vancouver type B1 periprosthetic femoral fractures","authors":"Orkhan Aliyev, T. Erden, Kerim Sarıyılmaz, E. Bozdag, E. Sünbüloğlu, I. Tuncay, F. Yıldız","doi":"10.5152/j.aott.2022.21287","DOIUrl":"https://doi.org/10.5152/j.aott.2022.21287","url":null,"abstract":"Objective: This study aimed to investigate biomechanically the effects of onlay fibula grafts on Vancouver Type B1 Periprosthetic Femoral Fractures (PPFs). Methods: Vancouver Type B1 PFF models were created in 25 fourth-generation synthetic femurs and fixed with locking plates using bicortical, unicortical screws, and cables. While no graft was used in group 1, onlay fibula grafts were placed anteriorly in group 2 and medially in group 3. In group 4, the cortical strut allograft was placed on the medial femoral cortex, and a locking compression plate (LCP) was applied to the lateral femoral cortex. In group 5, the strut allograft was placed over the anterior cortex of the femur and fixed with the same technique as in group 4. All models were then subjected to rotational and axial cyclical stiffness tests and load to failure to measure and compare the mechanical strengths of the constructs. Results: The mean stiffness values of group 4 with medial allograft, before and after cyclical loading, were higher than all other groups, under both rotational and axial forces. The mean stiffness values of fibula autografts (groups 2 and 3) were similar to that of anterior allografts (group 5) in each test except that the mean initial axial stiffness of group 5 was higher than group 2. Failure loads were also not different between the groups. Conclusion: Although the rigidity of Vancouver type B1 periprosthetic femur fractures is highest if allografts are placed medially, fibula autografts can also provide similar fixation strengths to allografts if locking plates with unicortical and bicortical screws and cables are used.","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48689800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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