Biomechanical Comparison of Headless Compression Screws, Kirschner Wires and Bioabsorbable Pins in Distal Oblique Metatarsal Osteotomy for Correction of Hallux Valgus

BACKGROUND

Distal osteotomy of the first metatarsal is a widely used method for the correction of mild-to-moderate hallux valgus deformities. The objective of this study was to compare the stability of headless compression screws, kirschner wires and absorbable pins in terms of stiffness and maximum load in distal oblique metatarsal osteotomy.

METHODS

A total of 30 4th generation first metatarsal synthetic bone models were divided into three groups according to the fixation techniques. The stiffness of the first metatarsal was calculated as the slope of the linear curve that fit with the first linear part of the force displacement curve. The failure strength was recorded as the maximum load. The stiffness and maximum load values in the axillary and transverse configurations were compared between the three fixation groups.

RESULTS

The stiffness was statistically higher in Group K and Group C compared to Group B in both axial and transverse loading. Similarly, the maximum load was significantly higher in both Group K and Group C compared to Group B in both loading conditions. No significant difference was found between Group K and Group C in stability. The higher failure strength was obtained with headless compression screws (113.34±35.88 N) in the axial loading. The lowest failure strength was found in the absorbable pins technique (16.17±7.72 N) in the transverse loading.

CONCLUSION

No significant difference was found between the Kirschner wires and headless compression screws techniques, although the highest strength was obtained with headless compression screws that are increasingly used in orthopedic practice.

Local Anesthesia and Conscious Sedation Does Not Affect Patient's Mood and Anxiety Levels during Percutaneous Endoscopic Lumbar Diskectomy: A Prospective Study

BACKGROUND AND STUDY AIMS

 Undergoing a surgical procedure can be very stressful for patients and can lead to high anxiety levels during both the preoperative and the postoperative period. Levels of anxiety and fear may depend on multiple factors including the type of anesthesia to be used. The objective of this study is to evaluate whether patient's awareness of the surgical environment in the operating room under local anesthesia and conscious sedation (LACS) affects their mood and anxiety levels.

METHODS

 We performed a prospective study for a series of consecutive patients who underwent transforaminal percutaneous endoscopic lumbar diskectomy (PELD) for the treatment of lumbar disk herniation. The patients completed Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) forms in the preoperative period and in the early postoperative period. We divided the patients into two groups according to the type of anesthesia applied during surgery: LACS and general anesthesia (GA) groups. We compared the preoperative and postoperative POMS and STAI scores between groups and the change of these scores between the preoperative and postoperative periods in each group.

RESULTS

 In this study, we included 30 patients who underwent PELD between May and December 2019 and met the inclusion criteria. The GA group consisted of 16 patients and the LACS group consisted of 14 patients. In each group, POMS and STAI scores decreased in the early postoperative period compared with the preoperative period. We found no significant difference in percentage of POMS and STAI TX-1 score changes between the LACS and GA groups.

CONCLUSION

 The results of our study show that patients' awareness of the surgical environment in the operating room under LACS does not significantly affect their mood and anxiety levels and patients do not seem to endure increased emotional stress during the PELD operation, as compared with PELD operation under GA.

Collimation Reduces Radiation Exposure to the Surgeon in Endoscopic Spine Surgery: A Prospective Study

BACKGROUND AND STUDY AIMS

 There are no previous studies in the literature comparing the radiation dose to which surgeons are exposed while using a standard fluoroscopy versus collimation during transforaminal percutaneous endoscopic lumbar diskectomy (PELD). The aim of this study is to compare this and to evaluate the effectiveness of collimation in reducing radiation exposure.

METHODS

 In this study, the operating surgeon (single surgeon) placed a gamma radiation dosimeter on his chest outside of the lead apron during transforaminal PELD surgeries and measured the radiation exposure immediately after each surgery. As foraminoplasty using free-hand reamers is a longer procedure and requires more fluoroscopy shots, we divided the patients into two groups. The first group consisted of 24 patients (nonforaminoplasty group). The second group consisted of 13 patients (foraminoplasty group). We compared the radiation exposure to the operating surgeon using a standard fluoroscopy versus collimation for each group individually and overall. We randomized the patients within each group based on the order in which they had their respective procedures.

RESULTS

 We analyzed 39 patients who underwent transforaminal PELD between May and December 2019. In both groups, as well as overall, the recorded radiation exposure to the surgeon was significantly lower in surgeries in which collimation was used. In the first group, the radiation dose was 0.083 versus 0.039 mSv per surgery (p = 0.019), whereas in the second group, it was 0.153 versus 0.041 mSv per surgery (p = 0.001), and overall it was 0.108 versus 0.039 mSv per surgery (p < 0.001).

CONCLUSION

 The use of collimation during transforaminal PELD significantly reduces spine the surgeon's exposure to radiation. Therefore, spine surgeons should consider using collimation during transforaminal PELD.

A Low-Cost Mobile Training Model for Biportal Endoscopic Spinal Surgery

AIM

To design a practical, low-cost, and freely mobile training model for biportal endoscopic spine surgery to improve the surgeons? abilities in basic endoscopic skills, including triangulation, two-dimensional visualization, and one-handed control of the instruments.

MATERIAL AND METHODS

The training model involved three stages: triangulation, drilling, and punching. It was composed of sawbones covered by solid and impenetrable materials (a cardboard box was used), monitor (laptop or mobile phone), and hand tools, including an ear endoscope cameras for mobile phone and laptop, Dremel® style + rotary tool at 22000 rpm, Dremel® 2.0-mm diamond wheel point burr, Kerrison punch, No.11 blade, 18 G spinal needle, and mobile phone holder.

RESULTS

The model was set up with easily accessible materials and could be performed everywhere. It can also be used to perform laminotomy on sawbones using a high-speed diamond burr and Kerrison punch under a two-dimensional endoscopic view.

CONCLUSION

The training model can be useful in improving the endoscopic skills of all spine surgeons, particularly neurosurgeons and those who have little to no experience in endoscopic procedures. Additionally, it can provide familiarity on two-dimensional endoscopic views and triangulation.

The effects of systemic ozone application and hyperbaric oxygen therapy on knee osteoarthritis: an experimental study in rats

OBJECTIVE

To evaluate the effects of systemic medical ozone (O₃) application and hyperbaric oxygen (HBO) therapy on surgically induced knee osteoarthritis (OA) in a rat model.

MATERIALS AND METHODS

We performed anterior cruciate ligament transection (ACLT) in order to create experimental OA in the right knees of 27 male rats. The left knee joints of all rats were sham-operated without ACLT as the negative control group. The rats were randomly assigned into three groups: (1) control group, which received no treatment; (2) O₃ group, which received intraperitoneal 30 μg medical O₃; (3) HBO group, which received HBO therapy for 60 minutes twice a day. We sacrificed the rats on the tenth week after the operation. We evaluated the degree of OA using Mankin scores.

RESULTS

As a result of histopathological examination, the mean Mankin scores in the right knees with ACLT were 8.17 ± 2.12 in the control group, 6.22 ± 1.56 in the HBO group, and 4.72 ± 1.30 in the O₃ group. The differences between the O₃ group and the HBO group and the O₃ group and the control group were found to be statistically significant (p 0.001, p 0.039, respectively). There was no difference between the HBO group and the control group (p 0.086).

CONCLUSIONS

The results of the present study show that systemic medical O₃ application was more effective than HBO therapy and may reduce development of cartilage damage and prevent OA formation.

No Decrease in Infection Rate with the Use of Local Vancomycin Powder After Partial Hip Replacement in Elderly Patients with Comorbidities

Introduction

The goal of this study was to evaluate the effects of local intra-wound vancomycin powder (VP) administration to decrease surgical site infections (SSIs), particularly in elderly patients with comorbidities, after having undergone partial hip replacement in the treatment of intertrochanteric (ITF) or femoral neck fractures (FNF).

Methods

We retrospectively reviewed patients who underwent partial hip replacement in the treatment of ITF or FNF in one year. We divided the patients into two groups. The non vancomycin-treated group received standard systemic prophylaxis only (1 gr cefazolin IV), while the vancomycin-treated group received 1 gr of VP in the surgical wound just before surgical closure in addition to the systemic prophylaxis. We included patients of 64 years or older who also had one or more comorbidities. We compared the post-operative SSI rates between the non vancomycin-treated group and the vancomycin-treated group.

Results

A total of 93 patients were included in the study. We detected post-operative wound infection in six patients (6.4%). The rate of SSI was found to be 5.7% in the vancomycin-treated group and 6.9% in the non vancomycin-treated group respectively, which showed no statistically significant difference (p:0.498). The incidence of SSI was statistically higher in the patients who had a follow-up in the post-operative intensive care unit than the patients who had not any follow-up in the intensive care unit.

Conclusion

Local application of VP in the surgical wound was found to be ineffective in reducing the incidence of SSI after partial hip replacement in elderly patients with comorbidities.

Evaluation of the Quality and Reliability of YouTube Videos on Rotator Cuff Tears

Introduction

The objective of this study was to investigate quality and scientific accuracy of videos related to rotator cuff tear on YouTube.

Methods

Term of “rotator cuff tear” was entered to the searching bar of YouTube and the first 50 YouTube videos about rotator cuff tear with the highest view counts were recorded and evaluated by two orthopedists. Title of the videos that met the inclusion criteria were recorded. The videos were evaluated with DISCERN and JAMA scoring system, and Video Power Index.

Results

The mean DISCERN score was calculated as 35.7±8.9, and the mean JAMA score was found as 2.9±0.4. The mean DISCERN score was statistically significantly higher in the physician group compared to the non-physician group. There was a very strong and statistically significant correlation and an excellent compliance between both observers.

Conclusion

In general, quality of videos published on YouTube about rotator cuff tear was low.

A novel preoperative trajectory evaluation method for L5-S1 transforaminal percutaneous endoscopic lumbar discectomy

BACKGROUND CONTEXT

L5-S1 transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a demanding procedure because of structures such as iliac crest, L5 transverse process, hypertrophic L5-S1 facet joint, and sacral ala. There has been no definite preoperative evaluation method to evaluate the surgical validity of L5-S1 transforaminal PELD.

PURPOSE

The authors report a new preoperative trajectory evaluation method for L5-S1 transforaminal PELD using magnetic resonance imaging (MRI) or computed tomography (CT) examinations.

STUDY DESIGN/SETTING

This is a technical report study.

PATIENT SAMPLE

Patients who were diagnosed L5-S1 soft disc herniation were included in the present study.

OUTCOME MEASURES

Success rate of transforaminal PELD according to height of iliac crest was measured.

METHODS

Twelve patients who were diagnosed L5-S1 disc herniation were preoperatively evaluated with this new method. A skin marker is attached to patient's back as a tentative skin entry point, which was determined by usual preoperative MRI or CT. A new tilted axial and coronal MRI or CT scan is performed according to axis of L5-S1 transforaminal working channel. The images show good relationship between working channel and iliac crest.

RESULTS

Six patients underwent a transforaminal PELD, and the results were successful. The other six patients were considered to be "unsuitable" for transforaminal PELD because of the probable blockade by iliac crest.

CONCLUSIONS

The tilted MRI or CT provides precise evaluation for L5-S1 transforaminal PELD trajectory and may achieve good outcome.

Transforaminal Percutaneous Endoscopic Lumbar Diskectomy for Downmigrated Disk Herniations: Lever-Up, Rotate, and Tilt Technique

BACKGROUND AND STUDY AIMS

 Although transforaminal percutaneous endoscopic lumbar diskectomy (PELD) offers certain advantages in the treatment of disk herniations, it used to be limited to nonmigrated or low-migrated herniations. With improvements in endoscopic spinal surgery, the range of indications for PELD has expanded. Various techniques including transforaminal and interlaminar approaches for migrated disk herniations are described in the literature. This study describes a transforaminal PELD approach to address downmigrated intracanal soft disk herniations effectively using the lever-up, rotate, and tilt technique.

PATIENTS AND METHODS

 We performed a retrospective review of 18 patients who had been operated on with the described technique between October 2012 and December 2015. We assessed clinical outcomes using the visual analog scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) preoperatively at their respective clinical visits and postoperatively at the patients' final follow-up examinations.

RESULTS

 The mean preoperative VAS scores for back and leg pain were 3.75 + 1.34 (range: 2-6) and 8.3 + 0.6 (range: 8-10), respectively. The mean preoperative ODI was 67.3 + 15.3 (range: 48-90). The mean VAS scores for back and leg pain improved to 1.38 + 1.58 (range: 0-6) and 1.19 + 0.75 (range: 0-3), respectively, at the last follow-up. The mean ODI also improved to 14.1 + 6.2 (range: 8-30) at the last follow-up. All differences between the preoperative and last follow-up scores were statistically significant (p < 0.05), Two surgeries failed because of a remnant disk fragment.

CONCLUSIONS

 The lever-up, rotate, and tilt technique for transforaminal PELD is an effective maneuver to treat downmigrated disk herniations in selected patients by experienced surgeons.

Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger

We performed a retrospective review of 12 patients with dorsal oblique and transverse amputations of the distal thumb who were treated with a volar cross-finger flap from the index finger. The mean patient follow-up period was 28 months postoperatively (range: 19-43 months). There were no instances of flap loss, infection, or donor site complication in our series. The mean Semmes-Weinstein monofilament testing scores on the injured thumb and the donor site were 0.65 g (range: 0.16-2 g) and 0.51 g (range: 0.16-1 g), respectively. The mean 2-point discrimination testing scores on the injured thumb and the donor site were 4.5 mm (range: 3-8 mm) and 4.3 mm (range: 3-7 mm), respectively. This study suggests that the volar cross-finger flap using the index finger is a reliable technique in repairing dorsal oblique and transverse amputations of the distal thumb.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures

BACKGROUND

The goal of this study was to report the results of selective open reduction and internal fixation of fractures of the posterior malleolus with a posterolateral approach and to compare the results of the 2 techniques.

METHODS

We prospectively evaluated 40 patients who underwent posterior malleolar fracture fixation between 2008 and 2012. The patients were treated with a posterolateral approach. We assigned alternating patients to receive plate fixation and the next screw fixation, consecutively, based on the order in which they presented to our institution. Fixation of the posterior malleolus was made with lag screws in 20 patients and a buttress plate in 20 patients. We used American Orthopaedic Foot and Ankle Society (AOFAS) scores, range of motion (ROM) of the ankle, and radiographic evaluations as the main outcome measurements. The mean follow-up was 38.2 (range, 24-51) months.

RESULTS

Full union without any loss of reduction was obtained in 38 of the 40 patients. We detected a union with a step-off of 3 mm in 1 patient in the screw group and a step-off of 2 mm in 1 patient in the plate group. At the final follow-up, the mean AOFAS score of the patients regardless of fixation type was 94.1 (range, 85-100). The statistical results showed no significant difference between the patients regardless of the fixation type of the posterior malleolus in terms of AOFAS scores and ROM of the ankle (P > .05).

CONCLUSIONS

Good (AOFAS score of 94/100) and equivalent (within 3 points) results were obtained using the 2 techniques (screws or plate) for fixation after open reduction of posterior malleolar fragments.

LEVEL OF EVIDENCE

Level II, prospective case series.

Pins and rubber band traction for treatment of comminuted intra-articular fractures in the hand

PURPOSE

To determine the efficacy of pins and rubber band traction for treatment of comminuted intra-articular fractures in the hand.

METHODS

We performed a retrospective study from 1994 to 2013 to evaluate 33 patients in whom pins and rubber band traction was employed. We clinically evaluated the active range of motion of the affected fingers after surgery. Eleven of the 33 fractures were at the proximal interphalangeal joint, 10 at the distal interphalangeal joint, 5 at the thumb interphalangeal joint, and 2 at the metacarpophalangeal joint of the thumb. The remaining 5 patients had complex fracture-dislocation of the proximal interphalangeal joints.

RESULTS

The mean follow-up period was 24 months. The average active motion of the metacarpophalangeal joints of the fingers was 91° (range, extension 0°-10°/flexion 85°-90°), proximal interphalangeal joints was 92° (range, extension/flexion 0°-10°/85°-100°), and distal interphalangeal joints was 73° (range, extension/flexion 0°-10°/60°-80°). The overall average of all active motion of the injured fingers except thumbs was 255° (range, 240°-270°). The average active motion of the of the thumb metacarpophalangeal joint was 56° (range, extension 5°-10°/flexion 50°-55°), and interphalangeal joint was 74° (range, extension 0°-10°/flexion 75°-80°). The average of active motion of the injured thumb metacarpal and interphalangeal joints combined was 130° (range, 125°-135°).

CONCLUSIONS

Pins and rubber band traction is a treatment option for comminuted displaced intra-articular fractures of the digits that offers satisfactory clinical results.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Prospective study of percutaneous radiofrequency nerve ablation for chronic plantar fasciitis

BACKGROUND

Chronic plantar heel pain is one of the most painful foot conditions and is generally associated with plantar fasciitis. This study reports 2-year follow-up results of radiofrequency nerve ablation (RFNA) of the calcaneal branches of the inferior calcaneal nerve in patients with chronic heel pain associated with plantar fasciitis.

METHODS

After receiving approval from the institutional review board, we prospectively evaluated the results of the RFNA of the calcaneal branches of the inferior calcaneal nerve on 35 feet in 29 patients with plantar heel pain between 2008 and 2011. All of the patients who were treated had been complaining of heel pain for more than 6 months and had failed conservative treatment. All of the patients were evaluated (quantitatively) using the average 10-point Visual Analog Scale (VAS) before treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure. We also evaluated 26 feet in 20 patients with American Orthopaedic Foot and Ankle Society scale (AOFAS) scores before the treatment, as well as at their 1-month, 1-year, and 2-year follow-up after the procedure.

RESULTS

The average VAS score of the feet was 9.2 ± 1.9 before treatment, 0.5 ± 1.3 at 1 month after the procedure, 1.5 ± 2.1 at 1-year follow-up, and 1.3 ± 1.8 at 2-year follow-up (P < .001). The average AOFAS scores of the patients were 66.9 ± 8.1 (range, 44-80) before treatment, 95.2 ± 6.1 (range, 77-100) at 1 month after the procedure, 93 ± 7.5 (range, 71-100) at the 1-year follow-up, and 93.3 ± 7.9 (range, 69-100) at the 2-year follow-up. At the 1- and 2-year follow-up, 85.7% of the patients rated their treatment as very successful or successful.

CONCLUSION

These findings suggest that RFNA of the calcaneal branches of the inferior calcaneal nerve was an effective pain treatment option for chronic heel pain associated with plantar fasciitis that did not respond to other conservative treatment options.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Artery-only fingertip replantations using a controlled nailbed bleeding protocol

PURPOSE

We report our experience, treatment protocol, and 2-year follow-up results of 24 fingertip replantations treated using the artery-only technique without vein or nerve repair.

METHODS

We performed a retrospective review of 24 patients who had undergone fingertip replantation at the same center between 2005 and 2011. All patients in this study had complete fingertip amputation at or distal to the distal interphalangeal joint of the fingers or interphalangeal joint of the thumb. Patients with incomplete and complete amputations who had undergone vein and/or nerve repair along with artery repair were excluded. All patients received the same protocol including removal of the nail at the surgery and intravenous heparin 70 U/kg administered at the time of arterial anastomosis. After surgery, the nailbed was mechanically made to bleed with a sterile needle and mechanically scrubbed with a heparin-saline gauze. All patients received the same postoperative medical treatment protocol until physiological outflow was restored. Successful replantation was confirmed with clinical observation.

RESULTS

Twenty-one of the 24 fingertip replantations (88%) were successful. The mean length of hospital stay was 7 days (range, 4-9 d). Fifteen of 22 patients required blood transfusion. The average amount of blood transfusion was 1.2 U (range, 0-3 U).

CONCLUSIONS

This study shows that the described technique and protocol reconstructed circulation without vein anastomosis and with a high success rate. Furthermore, adequate sensory recovery without any nerve repair had occurred by the 2-year follow-up.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken

PURPOSE

Pentoxifylline (PTX) is a derivative of methylxanthine and is used in peripheral vascular and cerebrovascular diseases for its effect on the regulation of blood circulation. We investigated whether PTX could be beneficial for femoral head osteonecrosis associated with steroid through these effects.

METHODS

Sixty mature Leghorn type chickens were chosen and divided into three groups. The 25 chickens in group A were given a weekly dose of 3 mg/kg/week methylprednisolone acetate intramuscularly. Four chickens in group B died after the first drug injection and were excluded from the study. Therefore, the remaining 21 chickens in group B were additionally given 25 mg/kg/day pentoxifylline intramuscularly, along with the steroid medication as given in group A. The ten chickens in group C were not given any injections, as they were accepted as the control group. After the sacrifice of the animals at week 14, both femoral heads were taken from each animal. The animals which died along the course of the study also underwent pathological examination but were not a part of the statistical analysis.

RESULTS

In this study, steroid induced femoral head osteonecrosis has been experimentally observed in chickens after high doses of corticosteroid therapy. The chickens were given pentoxifylline in order to prevent the effects of steroid on bones and bone marrow. The results showed that chickens are suitable osteonecrosis models, and that steroid causes adipogenesis and necrosis in the bone marrow and the death of the subchondral bone.

CONCLUSIONS

The results of this study hint at the assumption that PTX may have a positive benefit on ONFH. PTX seems to minimise the effects of the steroid and reduce the incidence of ONFH.