Joint diseases and related surgery最新文献

Objectives: This study aims to assess the correlation between vertebral compression fractures (VCFs) and frailty and to identify the possible link between the number of VCFs and frailty intensity in patients with osteoporosis (OP).

Patients and methods: Between January 2025 and February 2025, a total of 204 patients (143 males, 61 females; mean age: 71.8±5.5 years; range, 65 to 89 years) over 65 years who received treatment for OP in the inpatient setting were included. The patients were divided into two groups according to their Clinical Frailty Scale (CFS) scores as the frail group (n=141, CFS ≥4) and the non-frail group (n=63, CFS <4). Demographic and clinical characteristics, geriatric syndromes, and fracture prevalence were recorded.

Results: The handgrip strength was significantly reduced in the frail group (19 kg vs. 21 kg, p=0.004), with a probable sarcopenia rate of 42% (p=0.034). The rate of participants with no fractures, a single fracture, and multiple fractures was 42%, 26%, and 22% in the non-frail group, compared to 57%, 73%, and 77% in the frail group, respectively (p=0.018). This difference was particularly evident in patients with multiple fractures (odds ratio [OR]=2.34, 95% confidence interval [CI]: 1.13-4.87, p=0.023).

Conclusion: Frailty is strongly associated with a higher incidence of VCFs and multiple fractures in older individuals with OP.

Epidermal inclusion cysts are defined as dermal or subcutaneous epithelial cysts which are filled with keratin and lined with true epidermis. Although exceedingly rare, they can lead to pathological conditions, such as nerve compression syndrome. To the best of our knowledge, this is the first documented case of a 59-year-old woman with ulnar nerve compression at the wrist due to dog bite hand injury. An epidermal inclusion cyst was located adjacent to the ulnar nerve, resulting in significant compression. Notably, no direct connection was observed between the cyst and ulnar nerve. Surgical resection of the cyst led to complete resolution of tingling in the patient's middle and ring fingers. Although uncommon compared to the frequently reported causes of ulnar neuropathy, epidermal inclusion cysts should be considered as a differential diagnosis, particularly in patients with a history of repetitive wrist motion and trauma. A comprehensive diagnostic approach and tailored surgical interventions are needed to ensure good clinical outcomes in such cases.

Objectives: This study aims to identify the effects of total hip arthroplasty (THA) on sexual activity and performance in sexually active female patients with hip arthritis and their partners in the early period, focusing on mobility and pain.

Patients and methods: Between January 2014 and December 2020, a total of 60 female patients (mean age: 49.4±4.2 years; range, 30 to 60 years) who were sexually active and underwent THA in our clinic were retrospectively analyzed. The New Sexual Satisfaction Scale (NSSS) and Visual Analog Scale (VAS) for satisfaction were used in sexual functional evaluation. The NSSS and VAS scores at three, six, and 12 months postoperatively were compared. The relationship between sexual functions, demographic data, and duration was analyzed.

Results: The NSSS levels of the cases were 11.5% at three months, 46.2% at the sixth month, and 81.7% at 12 months after surgery. The increase in joint range of motion, which correlated with NSSS, was 21.4% at three months, 62.5% at six months, and 68.4% at 12 months. The NSSS results did not significantly differ among patients with varying demographics (p>0.05). While 21% of the patients had average NSSS during preoperative period, this increased to 61.5% after surgery. The VAS scores before and after THA were 4 and 6, respectively. Significant relations between both self-centered and spouse/partner-centered NSSS of the patients and patients' ease in sexual intercourse (p=0.011 and p=0.002, respectively) and sexual quality (p=0.000 for both) were found after one-year follow-up. Multivariate analysis revealed that patients' ease in sexual intercourse and sexual quality significantly affected self-centered (p=0.047 and p=0.000, respectively) and spouse/partner-centered (p=0.006 and p=0.000, respectively) NSSS of the patients.

Conclusion: After THA surgery, sexual activity of female patients gradually increases at three, six, and 12 months in the early period due to decreased pain and increased mobility. In addition, the sexual satisfaction quality of both patients and their sexual partners increases significantly.

Objectives: This study aims to assess the overall performance of ChatGPT version 4-omni (GPT-4o) on the Turkish Orthopedics and Traumatology Board Examination (TOTBE) using actual examinees as a reference point to evaluate and compare the performance of GPT-4o with that of human participants.

Materials and methods: In this study, GPT-4o was tested with multiple-choice questions that formed the first step of 14 TOTBEs conducted between 2010 and 2023. The assessment of image-based questions was conducted separately for all exams. The questions were classified based on the subspecialties for the five exams (2010-2014). The performance of GPT-4o was assessed and compared to those of actual examinees of the TOTBE.

Results: The mean total score of GPT-4o was 70.2±5.64 (range, 61 to 84), whereas that of actual examinees was 58±3.28 (range, 53.6 to 64.6). Considering accuracy rates, GPT-4o demonstrated 62% accuracy on image-based questions and 70% accuracy on text-based questions. It also demonstrated superior performance in the field of basic sciences, whereas actual examinees performed better in the specialty of reconstruction. Both GPT-4o and actual examinees exhibited the lowest scores in the subspecialty of lower extremity and foot.

Conclusion: Our study results showed that GPT-4o performed well on the TOTBE, particularly in basic sciences. While it demonstrated accuracy comparable to actual examinees in some areas, these findings highlight its potential as a helpful tool in medical education.

Objectives: This study aims to investigate whether large unstained cells (LUCs) is a marker of inflammation in gout patients and whether it is associated with different clinical conditions such as erosion, tophus, intercritical period, and gout flare.

Patients and methods: Between November 2022 and May 2023, a total of 100 consecutive adult gout patients (81 males, 19 females; mean age 53.8±12.8 years; range, 21 to 79 years) and 30 healthy controls (24 males, 6 females; mean age 57.2±10.6 years; range, 28 to 75) were included in this cross-sectional study. Data including demographics, clinical characteristics, laboratory results and direct radiography images of affected joints at the most recent visit were recorded.

Results: Leukocyte counts were found to be significantly higher in gout patients (p=0.048). The LUC counts and percentages and levels of acute phase reactants were similar between the patient and control groups (p=0.401, p=0.668, p=0.222, and p=0.505, respectively). In subgroup analyses of the gout patients, there were no significant differences in LUC counts and percentages between those with tophaceous disease (p=0.650 and p=0.388, respectively), erosions (p=0.154 and p=0.137, respectively) and elevated serum uric acid levels (p=0.918 and p=0.196, respectively). However, LUC percentages were statistically significantly higher in patients without elevated C-reactive protein (CRP) and in the intercritical gout (p=0.039 and p=0.05, respectively).

Conclusion: Our study results showed similar LUC counts and percentages between the gout patients and healthy controls. However, in the subgroup analysis of the gout patients, the LUC percentages were observed to be significantly higher in those without high CRP levels and in patients with intercritical gout. This finding may suggest that subclinical inflammation persists in intercritical gout.

Objectives: The aim of this study was to evaluate the amount of hidden blood loss (HBL) in patients treated with percutaneous vertebroplasty (PVP) for thoracolumbar osteoporotic vertebral compression fractures (OVCFs) and to compare the HBL between unilateral extrapedicular approach and unilateral transpedicular approach.

Patients and methods: Between February 2022 to February 2023, a total of 136 patients (49 males, 87 females; mean age: 76.4±9.5 years; range, 55 to 100 years) with thoracolumbar OVCFs treated with PVP were retrospectively analyzed. Patients who underwent unilateral transpedicular approach were divided into Group A (n=62) and patients who underwent unilateral extrapedicular approach were divided into Group B (n=74). Demographic results and clinical data were collected and compared between the two groups. The HBL was calculated according to the Sehat formula.

Results: The mean operation duration was 31.7±9.9 min in Group A and 29.1±11.1 in Group B, indicating no statistically significant difference between the groups (p=0.159). The mean volume of bone cement instilled was 4.4±0.4 mL in Group A and 4.7±0.6 mL in Group B. The volume of cement injected in Group A was less than that of Group B (p=0.001). The mean hemoglobin loss and the amount of HBL were significantly lower in Group A than Group B (p=0.001 and p=0.040, respectively).

Conclusion: Our study results suggest that perioperative HBL cannot be ignored in PVP for thoracolumbar OVCFs, regardless of the surgical approach chosen. We should be more concerned about anemia in patients with thoracolumbar OVCFs after unilateral extrapedicular approach compared to the unilateral transpedicular approach.

While limb amputations are a common and routine procedure for hand surgery, degloving injuries to the hand and fingers are less common and challenging for many surgeons. For degloving injuries which mostly result in limb loss, amputation has been recommended in previous studies and established classification systems, if there is a total avulsion injury. In this article, we present a replantation case in which all difficult microsurgical techniques were used in an injury where four fingers were degloved like a glove and accompanied by a second-degree burn that would prevent flap applications along the dorsum of the forearm. We also performed a detailed analysis of a rare clinical image. In conclusion, many treatment options have been described for degloving injuries, such as flaps and skin-grafting, the most optimal functional and cosmetic results can be achieved with replantation. Therefore, the first option should be replantation, if possible, but in case of failure, other surgical options should be evaluated without delay.

Peripheral entrapment neuropathy is a rare complication of rhabdomyolysis and lacks successful treatment. In this article, we report a case of sciatic neuropathy caused by piriformis rhabdomyolysis which was successfully treated with ultrasound-guided sciatic nerve hydrodissection. A 27-year-old male patient with left buttock pain and left lower limb weakness received ultrasound-guided nerve hydrodissection via injection of dexamethasone and 5% dextrose water into the area surrounding the left sciatic nerve. After injection, the patient's pain and left lower extremity weakness subsided. In conclusion, although peripheral entrapment neuropathy due to rhabdomyolysis is rare, early diagnosis and treatment using ultrasound-guided nerve hydrodissection may yield favorable clinical outcomes.

Intraosseous lipomas (IOLs) are rare benign bone tumors which can closely mimic malignancy on imaging, leading to diagnostic challenges. A 34-year-old male patient was admitted with persistent knee pain which was initially suspected to be metastatic bone disease. The patient reported activity-related pain relieved by rest. Physical examination revealed mild tenderness without swelling or restricted motion. Laboratory findings, including serum calcium and inflammatory markers, were normal. Magnetic resonance imaging (MRI) showed hyperintense lesions in the tibial and femoral metaphyses with surrounding bone marrow edema, raising suspicion of malignancy. Bone scintigraphy revealed increased radionuclide uptake in the tibial tuberosity, iliac crest, and the ninth rib, further mimicking metastatic disease. A biopsy of the tibial lesion confirmed mature adipocytes without necrosis or atypia, diagnosing IOLs. The patient was managed conservatively with non-steroidal anti-inflammatory drugs and physiotherapy. At three months, symptoms resolved completely, with no recurrence or new complaints. Follow-up MRI confirmed lesion stability. In conclusion, this case highlights the diagnostic complexity of IOLs and emphasizes the need for multimodal imaging and histopathological confirmation to differentiate benign lesions from malignancies. Including IOLs in the differential diagnosis of unexplained bone pain can prevent unnecessary invasive procedures and mistreatment.

Objectives: This study aims to explore the prevalence of neuropathic pain (NP) in patients with knee osteoarthritis (KOA) and to assess its correlation with functional status.

Patients and methods: Between December 2023 and May 2024, a total of 193 patients (48 males, 145 females; mean age: 58.7±12.8 years; range, 22 to 89 years) who were diagnosed with KOA and had persistent knee pain for more than three months were included. The painDETECT and Douleur Neuropathique en 4 Questions (DN4) questionnaires were utilized to evaluate NP. The Visual Analog Scale (VAS) was used to assess pain severity, while the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was utilized to assess functional status.

Results: The painDETECT indicated NP in 27.5% of patients, while the DN4 scale showed 30.6%. Patients with NP exhibited significantly elevated VAS and WOMAC scores to patients without NP, indicating a greater severity of pain and functional impairment in this subgroup (p<0.05). The agreement between the painDETECT and DN4 was moderate (κ=0.472). There were significant correlations between the painDETECT and DN4 scores with the WOMAC total score (r=0.371 and r=0.242, respectively, p<0.001).

Conclusion: Neuropathic pain is common in KOA patients and is associated with higher pain intensity and poorer functional outcomes. The moderate agreement between the painDETECT and DN4 scores may lead to a certain degree of diagnostic variation. Combining more than one method may increase the diagnostic accuracy.