The Relation between the Radial Collapse and the Number of Metaphyseal Screws for Distal Radius Fractures

Introduction

The purpose of this study is the evaluation of radial collapse, based on the number of screws used in the metaphyseal region and by distal dorsal distance (DDD) and lunate facet distance (LFD) measurement.

Materials and methods

Between 2015 and 2019, 60 patients who were being treated with volar locking plates due to isolated distal radius fracture were evaluated. Control radiographs were taken on the first day and at 3rd-, 6th- and 12th-month follow-ups. Distal dorsal cortex distance and lunate facet distance were measured in the lateral radiographs. The number of screws used in the metaphyseal region was also evaluated. According to the number of screws, the amount of collapse was analysed based on both the LFD and the DDD.

Results

The mean age of patients was 43.5±12.7 years. Thirty-three of the patients included in the study were male and 27 were female, and the minimum follow-up period was one year. According to the mean number of screws, groups were defined as up to 6 screws or 7 screws and above. There was a statistically significant difference between the groups in terms of DDD collapse at the 6th-month and 12th-month follow-ups (p<0.005). It was observed that the radial collapse and decrease in DDD and LFD were lower in plates with seven screws and above.

Conclusion

Decreases in either DDD or LFD, or radial collapse were observed less in patients who had seven or more metaphyseal screws inserted. These findings might be useful for surgeons treating distal radius fractures to reduce radial collapse.

Is Compressive Intramedullary Nailing an Effective Method in Aseptic Humerus Nonunions without Bone Defects?

PURPOSE OF THE STUDY Treatment of nonunion of humerus continues to be a matter of debate. For this purpose, many treatment methods have been reported. The aim of this retrospective cohort study is to evaluate the results of patients who underwent revision surgery with compressive intramedullary nailing implemented a single type of surgical technique in aseptic humeral nonunions without bone defects. MATERIAL AND METHODS Data of 15 patients with humerus nonunion, all were treated with compressive intramedullary nailing between 2000 and 2019 were retrospectively evaluated. Three patients were hypertrophic and 12 were atrophic types. The mean ages of patients at the surgery was 47.3±18 years. In all cases, maximal bone contact was created between the proximal and distal bone fragments after reaming and debridement, and fixation was performed with compressive intramedullary nailing. Radiological assessment of union was performed based on the RUSHU criteria, and functional outcomes were assessed according to Constant-Murley scoring criteria. RESULTS The ten out of 15 patients were male. The radiological union was achieved at a mean duration of 16.6±2.3 weeks in 14 patients. The average time of follow-up after nonunion treatment was 25.2±8.8 months. Twelve out of 15 patients implemented bone grafting taken form iliac bone with spongiosa obtained via reaming. The functional results were made according to the Constant-Murley score and excellent functional results were obtained in nine patients, good in four patients and poor functional results in one patient. Implant failure was not observed. One patient has had post-operative transient ulnar nerve palsy and another patient developed transient radial nerve palsy. CONCLUSIONS Compressive intramedullary nailing is a useful method that provides excellent union in the surgical treatment of aseptic non-union of the humerus, without bone defects. Key words: intramedullary compressive humeral nail, nonunion, failed intramedullary nailing humerus fracture, fracture fixation, autologous bone grafting.

Alteration of Thiol-Disulfide Homeostasis in Fibromyalgia Syndrome

BACKGROUND

Fibromyalgia syndrome (FMS) is an extra-articular rheumatological disease, characterized by widespread pain and somatic symptoms. The etiology has not yet been clarified. Oxidative stress may play an important role in FMS etiology. Thiol group is a very strong antioxidant. We aimed to investigate whether thiol/disulfide homeostasis in FMS is altered or not.

MATERIAL AND METHODS

A total of 80 female FMS patients and 64 healthy female control individuals were included in this study. Thiol and disulfide values were measured by Erel's novel methods.

RESULTS

Native thiol (330.6 ± 46.1 vs. 356.8 ± 55.5 μmol/L, p = 0.005) and native thiol/total thiol (89.4 ± 3.2 vs. 93.3 ± 4.0, p < 0.001) levels of FMS patients were significantly lower when compared to the values of control group. However, disulfide (19.4 ± 6.3 vs. 12.2 ± 6.3 μmol/L, p < 0.001) levels of FMS patients were significantly higher than healthy individuals. A negative correlation was found between the native thiol/total thiol and fibromyalgia impact questionnaire (FIQ) score among the FMS patients. A positive correlation was found between disulfide values and FIQ score among the patients.

CONCLUSIONS

In FMS patients, there was a significant correlation between the decrease in the thiol levels and an increase in the disulfide levels with the FIQ scores. We determined that thiol-disulfide rate was deteriorated in FMS patients and it increases in favor of disulfide amounts.

Alteration of Thiol-Disulfide Homeostasis in Fibromyalgia Syndrome

BACKGROUND

Fibromyalgia syndrome (FMS) is an extra-articular rheumatological disease, characterized by widespread pain and somatic symptoms. The etiology has not yet been clarified. Oxidative stress may play an important role in FMS etiology. Thiol group is a very strong antioxidant. We aimed to investigate whether thiol/disulfide homeostasis in FMS is altered or not.

MATERIAL AND METHODS

A total of 80 female FMS patients and 64 healthy female control individuals were included in this study. Thiol and disulfide values were measured by Erel's novel methods.

RESULTS

Native thiol (330.6 ± 46.1 vs. 356.8 ± 55.5 μmol/L, p = 0.005) and native thiol/total thiol (89.4 ± 3.2 vs. 93.3 ± 4.0, p < 0.001) levels of FMS patients were significantly lower when compared to the values of control group. However, disulfide (19.4 ± 6.3 vs. 12.2 ± 6.3 μmol/L, p < 0.001) levels of FMS patients were significantly higher than healthy individuals. A negative correlation was found between the native thiol/total thiol and fibromyalgia impact questionnaire (FIQ) score among the FMS patients. A positive correlation was found between disulfide values and FIQ score among the patients.

CONCLUSIONS

In FMS patients, there was a significant correlation between the decrease in the thiol levels and an increase in the disulfide levels with the FIQ scores. We determined that thiol-disulfide rate was deteriorated in FMS patients and it increases in favor of disulfide amounts.

Outcome of Locked Compressive Nailing in Aseptic Tibial Diaphyseal Nonunions without Bone Defect

BACKGROUND

Treatment of tibial diaphyseal nonunions are rather difficult. Plate-screw, intramedullary nailing and external fixation are the methods used for treatment. The aim of this study is to evaluate the treatment results of aseptic diaphyseal nonunions following tibia fractures by intramedullary compressive tibia nailing (IMCN) with or without bone graft.

MATERIALS AND METHODS

Twenty eight patients who had aseptic tibial nonunion without bone defects operated between 2005 and 2015 were included in the study. The mean age of our patients was 36.4 years (range 20-56 years). There were 22 males and 6 females. Fifteen of the patients exhibited hypertrophic nonunion and thirteen exhibited atrophic nonunion. The average time between fracture occurrence and presentation to our department was 1.6 years (range 1-20 years). All patients underwent fibular osteotomy by removal of a 2 cm bone block from the middle one-third of the fibulas. In all cases, IMCN was applied following the reaming procedure, then maximum bone contacts were achieved manually between proximal and distal bone fragments afterward, and dynamic compressive fixation with 1 mm of compression was performed by a single rotation of the compression screw at the top of the nail. Direct X-ray images were assessed according to the Rust criteria, and functional outcomes were assessed according to the Johner-Wrush criteria. Finite-element analysis was performed for 1 mm of compression. For statistical analysis, Fisher's exact test, Pearson's Chi-square test, and Mann-Whitney U-test were used.

RESULTS

Union was achieved in all patients. Radiological union was obtained at an average of 15.5 ± 1.86 weeks. Functional results were found to be good or excellent in 25 (89.2%) patients and average or poor in 3 (10.8%) patients. One patient developed skin necrosis at the wound site, which was treated with rotational flap and skin graft. None of the patients developed implant failure, thromboembolism, deep-vein thrombosis, or infection.

CONCLUSIONS

The use of compressive intramedullary nailing with or without bone graft is an effective method for the treatment of tibial nonunion.

A detailed analysis of messages posted on the 'Turk-Orthopod' mailing list over a 13-year period

OBJECTIVE

The objective of this study was to analyze the content of the 'Turk-Orthopod' mailing list between 2000 and 2013.

METHODS

All messages posted to the 'Turk-Orthopod' mailing list were documented and categorized by 4 orthopedic surgeons who were active members of the mailing list into 11 categories based on the content of the messages.

RESULTS

A total of 15,699 messages were evaluated and included in the analysis. The mean number of daily messages in 2000 was 0.98 messages/day and increased to 7.23 messages/day in 2013. The most common type of message was announcements (37.5%) about national or international congresses, conferences, symposia, meetings, and panels. The second most common type of message was condolence messages (11.7%). Case discussions and academic discussions comprised 6.3% and 4.5% of the messages, respectively.

CONCLUSION

The 'Turk-Orthopod' mailing list serves primarily as an information board and a powerful social media platform for communication among Turkish orthopedic surgeons. However, scientific case discussions and other professional issues comprise a minority of the messages.

The effects of laparoscopic sleeve gastrectomy on head, neck, shoulder, low back and knee pain of female patients

As the rise on the prevalence of obesity, it is related with physical impairment of joints, especially in the lumbar spine and knee joints. Losing body weight can reduce or eliminate pain of head, neck, shoulder, lumbar spine and knees. By performing a laparoscopic bariatric surgery we demonstrated a significant improvement on the pain by body weight reduction. In this study we aimed to explore the efficacy and safety of Laparoscopic Sleeve Gastrectomy (LSG) on the relief of pain on head and neck, shoulder, low back and knee among the severely morbid obese female patients. A total of 39 morbidly obese female patients who underwent LSG for morbid obesity were included in this study. Body weight, height, body mass index (BMI), head and neck, shoulder, low back and knee pain intensity were measured with Visual Analog Scale (VAS) before and after LSG at the 6(th) month. 39 morbidly obese female patients were enrolled to this study. The mean age of the patients was 37.69 ± 11.33 years. Preoperative and postoperative body weights were 127.3 kg and 91.21 kg, respectively. Mean height was 165.23 ± 5.78 cm. Preoperative and postoperative BMIs were 46.49 kg/m(2) and 32.33 kg/m(2), respectively. A significant correlation between preoperative and postoperative parameters was found according to BMI. Our data showed that LSG is an efficient and safe procedure on severely obese patients and showed a predictive remission of head and neck, shoulder, low back and knee pain intensity of female patients by analyzing with VAS during the first 6 months.

Ipsilateral supracondylar humerus fracture and Monteggia lesion with a 5-year follow-up: a rare injury in a young girl

Although elbow injuries and fractures of the forearm are common in children, the combination of these injuries is rare. We present a case of a 5-year-old patient with a concomitant ipsilateral supracondylar humerus fracture and Monteggia lesion. After physical and radiographic examination of the injured extremity in the emergency department, closed reduction and percutaneous pinning were performed under image intensifier under general anaesthesia. A long-arm cast was applied for postoperative immobilisation. Excellent radiological and functional outcomes were obtained at the end of 1-year follow-up and no deformity was observed at 5-year follow-up.

Simultaneous shoulder and elbow dislocation

Ipsilateral shoulder and elbow dislocation is very rare and only six articles are present in the literature mentioning this kind of a complex injury. With this presentation we aim to emphasise the importance of assessing the adjacent joints in patients with trauma in order not to miss any accompanying pathologies. We report a case of a 43-year-old female patient with ipsilateral right shoulder and elbow dislocation treated conservatively. The patient reported elbow pain when first admitted to emergency service but she was diagnosed with simultaneous ipsilateral shoulder and elbow injury and treated conservatively. As a more painful pathology may mask the additional ones, one should hasten to help before performing a complete evaluation. Any harm caused to the patient due to this reason would not be a complication but a malpractice.

Traction apophysitis of the fifth metatarsal base in a child: Iselin's disease

Although Iselin's disease, apophysitis of the fifth metatarsal base, is not infrequent in clinical practice, it is accepted as a rare cause of lateral foot pain in young adolescents. Usually a simple clinical examination and radiographs are sufficient for diagnosis. We present a patient with Iselin's disease and discuss its clinical and radiographic characteristics, differential diagnosis, aetiopathogenesis and treatment.

Iloprost inhibits fracture repair in rats

BACKGROUND

Previous studies have shown that prostaglandins (PGs) dramatically stimulate healing processes in bone. However, the effect of prostaglandin I2 (PGI2) on fracture healing remains unclear. To investigate the effect of PGI2, a study on fracture healing process in closed tibia fractures was designed.

METHODS

Thirty-six Sprague-Dawley male rats were randomized into two groups. On the first day, their right tibias were fractured by three-point bending technique. The study group (n = 18) received a single injection of 10 µg/kg iloprost for 5 days, while the control group (n = 18) received saline solution in the same way. On the 7th, 14th and 28th days following the fracture, six rats were sacrificed and their right legs were harvested in each group. The progression of fracture healing was assessed for each specimen by the scores of radiography (by Lane-Sandhu) and histology (by Huo et al).

RESULTS

On the 7th day, the radiographic and histologic scores were equal. On the 14th day radiographic total score was 6 and histologic total score was 23 in the iloprost group, whereas radiographic total score was 11 and histologic total score was 33 in the control group. On the 14th day radiographic and histologic scores were significantly decreased in the iloprost group compared to the control group (P < 0.05). On the 28th day radiographic total score was 12 and histologic total score was 37 in the iloprost group, whereas radiographic total score was 15 and histologic total score was 40 in the control group. On the 28th day although there was a decrease in radiographic and histologic scores of the iloprost group acording to control group, it was not statistically significant (P > 0.05).

CONCLUSION

Iloprost delays fracture healing in early stage in rats.

Dislocated ankle fracture complicated by near total distal ischaemia

Total arterial ischaemia is rarely seen following a dislocated ankle fracture but if it does and intervention is not made, it can lead to serious morbidity. We present a 39-year-old woman with almost total occlusion in the arteria tibialis and arteria dorsalis pedis following a dislocated ankle fracture as a result of a bicycle fall.

Fixation of femoral neck fractures with three screws: results and complications

OBJECTIVES

To evaluate the results and complications of femoral neck fractures treated with internal fixation with three screws with an average follow-up of three years.

METHODS

Thirty seven patients operated upon between June 2000 and May 2005 for fractures of the femoral neck with three screws were identified as the study population. The final results of 26 patients (11 male, 15 female, with an average age of 39.8, range 16-69) that had a minimum of two year follow-up (average 37 months, range 24-64 months) were evaluated. Those patients that had additional fractures were not included in the evaluation. Preoperatively based on Garden classification four patients (15%) were Type I, eight patients (31%) were type 2, six patients (23%) were type three and eight patients (31%) were type 4. Functional results were evaluated according to the UCLA hip score.

RESULTS

The average time to union was 5.5 months (range 3-12 months). One patient did not achieve union and a total hip replacement was done in the 15th postoperative month. Four patients had avascular necrosis (AVN) of the femoral head. The incidence of AVN in patients who had an operation within 24 hours of fracture was 9.5% while 40% in patients operated later than that. In patients with AVN one required a total hip replacement, another required treatment with bipolar hemiarthroplasty, the other two patients did not require further operations. One patient underwent bipolar hemiarthroplasty after screw pullout occurred on the 35th postoperative day. Fifteen patients (58%) had excellent results, five (19%) had good, 5 (19%) had moderate results and one (4%) had a poor result.

CONCLUSION

Operative treatment with internal fixation using three screws in femoral neck fractures in the first 24 hours after a fracture gives favourable results in young patients that are too young to be considered for arthroplasty.

[Assessment of surgical and conservative treatment of forearm fractures: results in juveniles]

BACKGROUND

We aimed to assess treatment outcomes of forearm fractures in patients aged between 10-18 years, for whom strict guidelines for surgical and conservative treatment are not yet clear.

METHODS

From a total of 41 patients between the ages of 10-18 years, 34 patients with a minimum of one-year follow-up in our clinic with the diagnosis of forearm fracture were evaluated retrospectively. All the patients had open epiphyses. Twenty-three of these patients were treated conservatively and 11 surgically. Patients were evaluated according to time of union, function and cosmesis. Average follow-up was two years (12-36 months).

RESULTS

Conservative treatment gave excellent and good results in 21 (91%), while surgical treatment gave excellent and good results in 9 (82%) of the patients when evaluated according to Anderson's criteria. A bad result was seen in one patient who did not accept an operation, and had an angulation of over 15 degrees. We also had one bad result in the operatively treated group because of implant failure and a need for a second operation.

CONCLUSION

According to our results, conservative treatment should be the mainstay in the treatment of childhood fractures of the forearm. However, we should not hesitate in considering surgical treatment when the patients have a malalignment of more than 15 degrees.

[Early results of balloon kyphoplasty for osteoporotic spinal fractures]

OBJECTIVES

We evaluated early results of osteoporotic spinal fractures treated with balloon kyphoplasty.

METHODS

The study included 16 patients (11 females, 5 males; mean age 66 years, range 55 to 75 years) who were treated with balloon kyphoplasty for osteoporotic spinal fractures. One patient had vertebral fractures at two levels. The mean duration from trauma to kyphoplasty was two months (range 0 to 4 months). The mean amount of cement used during the procedures was 4 ml (range 3 to 6 ml). Kyphoplasty was performed with a bipedicular approach in all the patients. Functional results were assessed with the Oswestry Disability Scale (ODS) and a visual analog scale (VAS). The mean follow-up period was 18 months (range 13 to 27 months).

RESULTS

Compared to the preprocedure measurements, the mean local kyphosis angle decreased from 16 degrees to 11.8 degrees , and anterior compression angle decreased from 16.7 degrees to 9.6 degrees , the improvements being 26.3% and 42.5%, respectively. The mean vertebral body and anterior wall heights increased by 44.4% and 37.9%, respectively. At final evaluations, the ODS score decreased by 52.2% (from 13.8 to 6.6) and the VAS score decreased by 59.5% (from 4.2 to 1.7). No complications were encountered other than cement extrusion at two aspects of the vertebral body (2 anterior, 2 posterior leaks).

CONCLUSION

Being a minor surgical procedure, balloon kyphoplasty is an appropriate treatment in osteoporotic vertebral fractures with high patient satisfaction and low complication rate.