Orthopedic surgeons' knowledge regarding risk of radiation exposition: a survey analysis

Introduction: The purpose of this study is to evaluate the knowledge levels of orthopedic surgeons working in Turkey about the uses and possible risks of fluoroscopy and assess methods for preventing radiation damage.

Methods: A questionnaire with a total of 12 questions was sent to 1121 orthopedic surgeons working in Turkey. The questionnaire evaluated participants’ knowledge about the uses and risks of fluoroscopy and methods for preventing damage. One thousand and twenty-four orthopedic surgeons were found to be suitable for inclusion in the study. The effects of fluoroscopy on patients were not assessed in our study.

Results: The data obtained were statistically evaluated. Of the surveyed surgeons, 313 (30%) had used fluoroscopy in over 50% of their operations. The average number of fluoroscopy shots per case was 54.5. A lead apron was the most commonly used (88%) protection from the harmful effects of radiation. Fluoroscopy shots were performed with the help of operating room personnel (86%). A dosimeter was used 5% of the time.

Conclusion: According to the survey results, the need for fluoroscopy was very high in orthopedic surgery. However, orthopedic surgeons have inadequate knowledge about the uses and risks of fluoroscopy and methods for preventing damage. Therefore, we believe that training on this topic should be provided to all orthopedic surgeons.

Functional Comparison of Immediate and Late Weight Bearing after Ankle Bimalleolar Fracture Surgery

AIM

The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures.

METHODS

Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment.

RESULTS

According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2.

CONCLUSION

As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately.

Morphometry of the medial tibial plateau in Turkish knees: correlation to the current tibial components of unicompartmental knee arthroplasty

OBJECTIVE

The objective of this study was to measure the resected surfaces of the tibia in knees of Turkish patients and to compare these measurements with the dimensions of tibial implants in current use.

METHODS

We made measurements of seven different dimensions of the medial tibial plateau at the virtual resection level for unicompartmental knee arthroplasty (UKA) on MRIs of 260 patients and the most commonly used four UKA implants in Turkey. Statistical analysis was performed by using Student's t-test, analysis of variance (ANOVA), chi-square test and Pearson's correlation coefficient by using SPSS software.

RESULTS

The anteroposterior and widest mediolateral dimensions of the tibial plateau of Turkish knees were found relatively more approximate to the dimensions of Oxford and Zuk prostheses compared to that of Accuris and Mitus (p<0.001). The distance between the central mediolateral dimension and the widest mediolateral dimension was 2.4 (range: 0-6.3) mm in males and 2.6 (range: 0-6.2) mm in females. The maximum mediolateral dimension was found posterior to the central mediolateral dimension in the majority (202 out of 260) of cases. These findings point towards the asymmetry in the AP halves of the resected medial tibial condyle.

CONCLUSION

Tibial components designed according to anthropometric measurements based on both Western and Asian populations do not perfectly meet the requirements of Turkish population. Designing different UKA prostheses for different populations are required for best fit.

Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus

The purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus.