16 research outputs found
Biomechanical comparison of rotator cuff repair techniques in osteoporotic conditions: testing a novel technique
No full textObjective: This study aimed to compare the biomechanical characteristics of conventional transosseous equivalent (TOE) techniques
with those of the novel free independent double-row medial fixation method, using rigid polyurethane (PU) foam blocks to simulate
osteoporotic humerus bone.
Methods: In this biomechanical study, 4 groups were tested using rigid PU foam blocks with osteoporotic properties and bovine infraspinatus tendons to simulate the rotator cu!. Groups 1 and 2 employed conventional TOE techniques: medial row knotted repair and knotless repair, respectively. Groups 3 and 4 utilized the “free independent double-row medial fixation method,” di!ering in the order of suture tying. Several biomechanical characteristic and pressure parameters were measured.
Results: Groups 3 (0.16 ± 0.04 MPa) and 4 (0.17 ± 0.05 MPa) achieved significantly higher initial contact pressure compared to standard TOE techniques (P=.039). While contact area (Group 3: 102.4 ± 55.0 mm", Group 4: 110.4 ± 37.2 mm") and ultimate failure force (Group 3: 212.0 ± 26.5 N, Group 4: 214.7 ± 30.2 N) were relatively higher, the di!erences were not statistically significant (P=.135 and P=.3, respectively). The overall failure types included medial anchor pullout (40%) and suture/tendon stripping (32.5%), with no significant di!erences among groups (P=.260).
Conclusion: With superior contact pressure and comparable ultimate failure and contact area measurements, the novel independent double-row medial fixation technique may be a viable alternative to conventional TOE techniques for enhancing medial row stability in osteoporotic conditions.
Cite this article as: Eskara H, Keskin A, Tatar Y, Gercek N, Imren Y, Semih Dedeoglu S. Biomechanical comparison of rotator cu! repair techniques in osteoporoticconditions: testing a novel technique. Acta Orthop Traumatol Turc., 2025;59(2):79-85
Minimally invasive plate osteosynthesiswith the application of a superior anatomic locking plate; is it a suitable treatment approach for AO-OTA Type B clavicular midshaft fractures?
No full textThe minimally invasive osteosynthesis technique has gained attention in fracture treatment in recent years. The aim of this study was to evaluate the effects of the minimally invasive plate osteosynthesis (MIPO) technique, on clinical and radiological outcomes in the surgical treatment of AO-OTA Type B (wedge) clavicular midshaft fractures. This prospective study included twenty-three patients who were diagnosed with acute clavicular midshaft fracture where surgical intervention was indicatedand MIPO was performed between February 2014 and April 2016.Exclusion criteria were patients with non-displaced fractures, pathological fractures, open fractures, cases where theindex trauma was three weeks ago, or those with concomitant neurovascular injuries.The patients comprised of 16 males and 7 females with a mean age of 36.5 years (range, 18-65 years).The mean time from trauma to surgery was 6.1 days (range, 3-12 days).The mean follow-up period was 15.3 months (range: 12-18 months). The mean duration of surgery was 65.5 mins (range: 50-80 mins). Anatomic reduction was obtained in 11 (47%) patients, of whom 7 were Type B1, 4 were Type B2, and 1 was Type B3. The mean time to union was found to be 15.9 weeks (range: 10-24 weeks). After union was confirmed, the mean Constant Murley score was 83 (range: 68-92) and the mean UCLA score was 29.95 (range: 23-34). The mean proportional length difference in the clavicle was 0.32% (range:-0.55 to +1.63).There was no statistically significant difference for the Constant Murley score and UCLA score between patients with anatomic reduction achieved and not achieved (p=0.36, p=0.43 respectively). Osteosynthesis with a minimally invasive percutaneously applied plate (MIPO) could be a successful therapeutic option for the management of acute, displaced AO OTA Type B clavicular midshaft fractures. [Med-Science 2017; 6(4.000): 737-742
Feasibility of diagnosing osteoporosis using routine computed tomography scans for hip fractures: Correlation with histopathological diagnosis of head and neck regions
No full textObjective: The aim of this study was to demonstrate the feasibility of diagnosing osteoporosis through routine computed tomography (CT) by assessing the association between the histopathological assessment of femoral head specimens extracted from patients who underwent surgery for intertrochanteric fractures and the Hounsfield unit (HU) measurements derived from preoperative CT scans.
Methods: Forty-eight patients who presented to our clinic between November 2019 and May 2020 with hip fractures and underwent partial prosthesis fixation were included in this retrospective study. Hounsfield unit measurements were performed on the head and neck regions using dual-energy x-ray absorptiometry (DEXA) and CT scans, respectively. The trabecular ratio per unit area was calculated using the Nikon Imaging Software (NIS-Elements ) program in the pathology laboratory from digitally captured images of the removed head and neck specimens.
Results: The mean HU receiver operating characteristic analysis had a sensitivity of 77% and a specificity of 87%, with a cutoff value of 77.68. There was a moderate correlation between the mean trabecular density and the mean HU of the femoral head (P=0.013, r=0.340). Additionally, there was a significant correlation between the mean HU and the T-score of the head, although this correlation was not found with the maximum–minimum HU. Although there was a significant correlation between trabecular density and mean HU, the correlation coefficient indicated a moderate relationship. This relationship was also observed between the inferior sections of the head and the trabecular density and HU (P=.018). However, no significant correlation was found between the T-score and the trabecular structure of the head (P=.977).
Conclusion: The results of the present study suggest that conventional CT has the potential to serve as a diagnostic tool for osteoporosis and may offer a more precise and accurate method for evaluating the success of intraosseous implants when compared to T-scores without the need for additional tests or procedures.
Cite this article as: Imren Y, Karslioglu B, Dedeoglu SS, Keskin A, Berkay AF, Tekin AC. Feasibility of diagnosing osteoporosis using routine computed tomography scans for hip fractures: Correlation with histopathological diagnosis of head and neck regions. Acta Orthop Traumatol Turc., 2023;57(6):384-388
Idiopathic talipes equinovarus with preaxial polydactyly of the foot: a case report
No full textThe aim of this study is to report an unusual combination of congenital idiopathic talipes equinovarus with preaxial polydactyly of the foot. A newborn infant was brought to the polyclinic at the age of 1 week. In the right foot, preaxial polydactyly was seen in addition to the club foot deformity. The preaxial polydactyly of the patient was surgically excised. The sutures were then removed and a series of plaster casts were applied according to the Ponseti method Then a Dennis-Brown brace was applied with both feet. This case shows that combination of congenital idiopathic talipes equinovarus with preaxial polydactyly of the foot can be treated succesfully by apply the standard Ponseti method after the surgical excision of the polydactyly. [Med-Science 2017; 6(4.000): 767-770
Clinical and radiological results of radial shortening osteotomy, and proximal row carpectomy in Kienbocks Disease
No full textIn this prospective study, we aimed to evaluate the clinical and radiological results of our patients treated with radial shortening osteotomy (RSO) and proximal row carpectomy (PRC) together with a short review of the literature. The study included 35 patients with the diagnosis of Kienbock disease RSO was performed for 17 patients and 18 patients underwent PRC. 15 of the patients had Lichtman Stage 2, 14 patients had Stage 3A and 6 patients had Stage 3B disease. Q-DASH Score, Preoperative and postoperative carpal height ratio (CHR), revised CHR, stahl index, radial inclination values were noted. Preoperative and postoperative flexion-extension range of Motion (ROM) and ulnar deviation angles were also obtained. Nakamuras clinical evaluation system was performed to each patient. Results of clinical evaluation revealed significant progression at postoperative sixth month follow-up. Our results showed clinical improvement following surgeries of both RSO and PRC for Lichtman Stage 2, 3a and 3b disease. We consider that experience and technical familiarity of the surgeon is key factor to decide the type of the procedure to be performed. [Med-Science 2017; 6(3.000): 526-30
Association between vitamin D concentrations and knee pain in patients with osteoarthritis
No full text
Objectives
Osteoarthritis (OA) and vitamin D deficiency are common health conditions in older people. Whether vitamin D concentration is associated with knee OA is controversial. In this study, we aimed to determine the association between serum concentrations of vitamin D and osteoarthritic knee pain.
Subjects and Methods
Vitamin D concentrations were measured with the 25 hydroxyvitamin D test in patients presenting with clinical symptoms of primary knee osteoarthritis. Osteoarthritis was graded on the Kellgren-Lawrence grading scale from anteroposterior and lateral radiographs. Height, weight, and body mass index (BMI) were recorded. Patients completed a 10-cm visual analogue scale (VAS) for indicating pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Vitamin D concentration was defined as severely deficient (<10 ng/mL), insufficient (10 to 19 ng/mL), or normal (20 to 50 ng/mL).
Results
Of 149 patients (133 women), the mean age was 63.6 years. Mean vitamin D concentration was 11.53 ng/mL, and 90% patients were vitamin D deficient. Mean WOMAC score was 57.2, and VAS pain score was 7.5. Kellgren-Lawrence grade was 2 for 10 patients, grade 3 for 61, and grade 4 for 88. Mean BMI was 33.4. Mean values of VAS, WOMAC, and BMI did not differ by vitamin D status.
Conclusion
Serum vitamin D concentration is not associated with knee pain in patients with osteoarthritis.
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Аугментація клювовидно-ключичної звязки при лікуванні перелому дистальної третини ключиці
No full textThe aim: type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. We aimed to evaluate results of surgical treatment with an anatomical distal clavicle plate using CC ligament augmentation.
Materials and methods: 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. The average patient age was 38 years (range 24–52 years). All patients were male; the right clavicle was injured in 10 patients whereas the left clavicle was injured in 5 cases. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range, 12–40 months).
Results: bony union was achieved at a mean follow-up of 8 weeks (range 6-10 weeks). The mean Constant score was 97 (range, 92–100). There were no complications or no need to second operation. All patients achieved satisfactory full range of shoulder motion. Hardware removal was performed for prominence in one case after the union was completed.
Conclusion: the augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options. We recommend augmentative CC ligament repair techniques over the distal locking anatomic plate for type 2 fracturesЦель: переломы ключицы типа 2В с разрывом коноидной связки считаются нестабильными. Хотя хирургическое лечение рекомендуется как стандартный способ лечения переломов типа 2B, единого мнения относительно типа оперативного лечения нет. Мы имели целью оценить результаты хирургического лечения анатомической дистальной пластины ключицы с использованием аугментации КК связки.
Материалы и методы: 15 пациентов с диагнозом перелом дистальной части ключицы, которые прошли операцию из-за нестабильных переломов 2 типа. Хирургическое лечение во всех случаях проводилось с использованием анатомического блокировки пластины дистальной части ключицы (ZipTight™). Средний период наблюдения составил 24 месяца (диапазон - 12-40 месяцев).
Результаты: сращивание костей было достигнуто при среднем наблюдении 8 недель (диапазон 6-10 недель). Средний показатель постоянной оценки составил 97 (диапазон 92-100). Осложнений или необходимости повторной операции не было.
Выводы: техника аугментации, о которой сообщается здесь, обеспечивает более ранние движения, повышенную стабильность и ускоренное анатомическое заживления по сравнению с другими обычными вариантами.Мета: переломи ключиці типу 2В з розривом коноїдної зв’язки вважаються нестабільними. Хоча хірургічне лікування рекомендується як стандартний спосіб лікування переломів типу 2B, єдиної думки щодо типу оперативного лікування немає. Ми мали на меті оцінити результати хірургічного лікування анатомічної дистальної пластини ключиці з використанням аугментації КК зв’язок.
Матеріали та методи: 15 пацієнтів з діагнозом перелом дистальної частини ключиці, які пройшли операцію з приводу нестабільних переломів 2 типу. Хірургічне лікування у всіх випадках проводилось з використанням анатомічного блокування пластини дистальної частини ключиці (ZipTight™). Середній період спостереження становив 24 місяці (діапазон - 12–40 місяців).
Результати: зростання кісток було досягнуто при середньому спостереженні 8 тижнів (діапазон 6-10 тижнів). Середній показник постійної оцінки становив 97 (діапазон 92-100). Ускладнень або необхідності повторної операції не було.
Висновки: техніка аугментації, про яку повідомляється тут, забезпечує більш ранні рухи, підвищену стабільність та прискорене анатомічне загоєння порівняно з іншими звичайними варіантами
Surgeon factor in pediatric supracondylar humerus fractures
No full textThe surgeon and the surgical approach of the clinic where the surgeon was trained may have an impact on perioperative outcomes. In this study, among the surgeons with similar surgical experiences, we aimed to investigate the association of open-closed reduction rates, postoperative sagittal, coronal and axial plan deformities, and preference of open surgical approaches to surgeons and the clinics they were trained. We evaluated 90 cases retrospectively who underwent surgery upon diagnosis of Gartland type 3 pediatric supracondylar humerus fractures associated with extension deformity. Those whose surgery was performed after 24 hours, or patients with open fractures, flexion type supracondylar fractures, non-Gartland type 3 supracondylar fractures, fractures with neurovascular deficits, multiple comminuted fractures, pathologic fractures, or additional injury and fractures were not included to the study. All the surgeons who had >5 years of surgical experience as a specialist and >15 of pediatric elbow fracture surgery as an operator (n=12) were numbered between 1 and 12. The clinics of these surgeons were classified from A to F (n=6). Data on patients age, gender, duration of surgery, follow-up time, postoperative sagittal, coronal angulation, postoperative rotational deformity, operation time, rates of open-closed surgery, the surgical approach in those open surgery was performed, the number and characteristics of the pins used were collected to analyze in relation with their assigned surgeons and the clinics they were trained. Among the 90 cases, 54 (59.3%) were male patients. The mean age was 6.21 ± 3.03 years. There was no significant difference between the clinics in terms of sagittal and rotational deformities and open reduction rates (p>0.05). The clinics significantly differed in preference of the side of incisions (medial, lateral, posterior), (p [Med-Science 2020; 9(1.000): 103-8
Fluoroscopy improves femoral stem placement in cementless total hip arthroplasty
No full textFluoroscopy is routinely used in trauma cases to evaluate alignment and reduction quality. Because conventional templating has a high mismatch rate, we sought to explore whether we could use intraoperative fluoroscopy while implanting the femoral stem. Sixty patients with Croft 3-4 coxarthrosis were included in this study. No preoperative templating was performed in either of the two groups. The final conformations of the stem sizes and positions were achieved freehand intraoperatively using anatomic landmarks. In the second group, after surgeons intraoperatively agreed on the final stem size, C-arm fluoroscopy images are obtained with the last rasp size before the stem implantation. The alignment of femoral stem according to the femoral canal, the lower leg discrepancy (LLD) and the lateral offsets were evaluated with X ray. The stem/endosteal areas at 2 cm above the trochanter minor (T+2) and 2 cm below the trochanter minor (T-2) and the deviation of the stem tip from the center of the femoral canal were evaluated in CT images. The stems that were implanted under fluoroscopic control filled the medullary cavity better at both the T+2 and T-2 levels. On fluoroscopy, in the control group, the malpositioning of the femoral stems were less, the centralizations were better, and the restorations of the lateral offset and LLD were more accurate. The use of fluoroscopy while rasping the femoral canal leads to proper alignment and press fitting of the stem and provides the opportunity to intraoperatively correct malpositionings of the stem. [Med-Science 2017; 6(2.000): 264-9
Effects of simple section of transverse carpal ligament on intercarpal stability in carpal tunnel surgery
No full textThe aim was to evaluate effects of simple section of transverse carpal ligament on intercarpal stability by radiological parameters in patients with carpal tunnel syndrome those are refractory to conservative treatment. Patients with suspected diagnosis of carpal tunnel syndrome upon medical history and physical examination underwent neurodiagnostic tests (EMG). All 47 subjects, comprising 39 female and 8 male patients, were operated, followed, and assessed by the same surgical team between January 2014 and May 2015 after written informed consent was obtained. Wrist range of motion and general physical examination findings were recorded at both preoperatively and postoperative week 8. Besides, conventional MRI were obtained at the same time points. Trapeziohamate distance, scaphopisiform distance, scapholunate angle, and carpal angle were measured preoperatively and at 12thweek postoperatively. The mean age of the subjects was 49(range: 36-65).Mean preoperative trapeziohamate distance was measured as 25.2 mm (range:20-33), while postoperative trapeziohamate distance was 26.4 mm (range:22-34), (p=0.031). Mean preoperative scaphopisiform distance was 32 mm (range:23-34), as compared to postoperative scaphopisiform distance being 33.6 mm (range:24- 36) (p=0.001). While mean scapholunate angle was 44°(range: 36-60) preoperatively, it was measured as 45.1° (range: 33-60) in the postoperative period (p=0.001). Both preoperative and postoperative mean carpal angles was 127° (range 118-134 and 119-134, respectively). Simple section of transverse carpal ligament is associated with a significant increase in carpal arch distance. We consider that whether or not increases in intercarpal distances may lead to a degenerative process at the wrist in future warrants further research. [Med-Science 2017; 6(3.000): 410-4
