Acta Orthopaedica Et Traumatologica Turcica[JOURNAL]
Sun
200 papers
Comparison of artificial intelligence algorithm for the diagnosis of hip fracture on plain radiography with decision-making physicians: a validation study.
Beyaz S, Yayli SB, Kılıç E … +1 more , Kılıç K
Acta Orthop Traumatol Turc · 2024 Jan · PMID 38525504 · Full text
OBJECTIVE: This study aimed to compare an algorithm developed for diagnosing hip fractures on plain radiographs with the physicians involved in diagnosing hip fractures. METHODS: Radiographs labeled as fractured (n=182)...
OBJECTIVE: This study aimed to compare an algorithm developed for diagnosing hip fractures on plain radiographs with the physicians involved in diagnosing hip fractures. METHODS: Radiographs labeled as fractured (n=182) and non-fractured (n=542) by an expert on proximal femur fractures were included in the study. General practitioners in the emergency department (n=3), emergency medicine (n=3), radiologists (n=3), orthopedic residents (n=3), and orthopedic surgeons (n=3) were included in the study as the labelers, who labeled the presence of fractures on the right and left sides of the proximal femoral region on each anteroposterior (AP) plain pelvis radiograph as fractured or non-fractured. In addition, all the radiographs were evaluated using an artificial intelligence (AI) algorithm consisting of 3 AI models and a majority voting technique. Each AI model evaluated each graph separately, and majority voting determined the final decision as the majority of the outputs of the 3 AI models. The results of the AI algorithm and labelling physicians included in the study were compared with the reference evaluation. RESULTS: Based on F-1 scores, here are the average scores of the group: majority voting (0.942) > orthopedic surgeon (0.938) > AI models (0.917) > orthopedic resident (0.858) > emergency medicine (0.758) > general practitioner (0.689) > radiologist (0.677). CONCLUSION: The AI algorithm developed in our previous study may help recognize fractures in AP pelvis in plain radiography in the emergency department for non-orthopedist physicians. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.
Beware of Artificial Intelligence hallucinations or should we call confabulation?
Berk H
Acta Orthop Traumatol Turc · 2024 Jan · PMID 38525503 · Full text
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Feasibility of diagnosing osteoporosis using routine computed tomography scans for hip fractures: Correlation with histopathological diagnosis of head and neck regions.
Imren Y, Karslioğlu B, Semih Dedeoğlu S … +3 more , Keskin A, Firat Berkay A, Cagri Tekin A
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454217 · Full text
OBJECTIVE: 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 hea...
OBJECTIVE: 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.
A new femur intramedullary nail with tube and coil spring for maximum interfragmentary rotational and axial stability after fracture site resorption.
Adnan Karaarslan A, Yamak K
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454216 · Full text
OBJECTIVE: This study aimed to biomechanically compare the maximum rotational, axial movements, and compression forces between fracture fragments before and after 1-4 mm fracture site resorption among interlocking nails,...
OBJECTIVE: This study aimed to biomechanically compare the maximum rotational, axial movements, and compression forces between fracture fragments before and after 1-4 mm fracture site resorption among interlocking nails, compression nails, and newly designed compressive anti-resorption (CARES) nails compressed with tube and coil spring. METHODS: We determined the maximum axial/rotational movements and interfragmentary compression loads between fragments on 10 interlocking nails, 10 compression nails, and 10 CARES nails with 30 composite femurs. Using a compression-distraction testing device, 6 N·m external and internal torques were applied, and we evaluated the maximum rotational and axial displacement between fragments after 1-4 mm fracture site resorption. RESULTS: When 6 N·m of internal-external rotation torque was applied after 2 mm fracture site resorption, the maximum rotational displacement between fragments in the CARES nail was 3 ± 0.52 mm, 101% less than the 6.03 ± 0.83 value in the compression nail and 100% less than the 6 ± 1 mm value measured in the interlocking nail (P=.000). The compression between fragments was 298 ± 72 N in the CARES nail after 1 mm of resorption, while this value was measured as 0 in the other nails. There was a significant difference in rotational, axial stability, and interfragment compression among the different femoral nails after 1-4 mm fracture site resorption. CONCLUSION: The CARES nail having additional coil springs seems significantly biomechanically superior to compression nails and interlocking nails, providing maximum rotational, axial stability, and interfragment compression after fracture site resorption.
Distal radius fractures: What are the effects of ulnar styloid fracture and face-toface rehabilitation on the functional outcome?
Ozben H, Uludağ S, Ataker Y … +2 more , Comert Ece S, Gudemez E
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454215 · Full text
OBJECTIVE: This study aimed to investigate the effects of the accompanying ulnar styloid fracture and 2 different postoperative rehabilitation protocols on the final outcomes following surgical treatment of distal radius...
OBJECTIVE: This study aimed to investigate the effects of the accompanying ulnar styloid fracture and 2 different postoperative rehabilitation protocols on the final outcomes following surgical treatment of distal radius fractures. METHODS: In this retrospective study, 47 patients (11 male, 35 female; mean age=52.6 years, age range=24-85) who underwent plate fixation for distal radius fractures were divided into 4 groups based on the presence of an ulnar styloid fracture and type of rehabilitation. To evaluate clinical outcomes, wrist range of motion (ROM), grip strength, lateral pinch strength, disabilities of the arm, shoulder, and hand (DASH) questionnaire scores and visual analog scale (VAS) scores were obtained at the final follow-up. The rehabilitation exercises of the patients in groups 1 and 2 were carried out in the physical therapy room by the hand therapist during the postoperative 2 months. Patients in groups 3 and 4 were supplied with videos of the exercises of each phase and instructed to carry out those exercises at home routinely. RESULTS: Patients who received home rehabilitation programs demonstrated greater grip strength loss. Patients without accompanying ulnar styloid fractures had better DASH and VAS scores. Final wrist ROM and the duration for return to preinjury activity level did not differ among groups. CONCLUSION: This study has suggested that accompanying ulnar styloid fractures may worsen the functional outcomes after plate fixation of distal radius fractures. Home-based programs may provide patients with adequate overall wrist function with certain drawbacks compared to rehabilitation under direct supervision.
The effect of reduced acromiohumeral distance and increased acromial thickness on the risk of rotator cuff tear.
Kılıç E, Bingöl O, Özdemir G … +2 more , Halit Keskin Ö, Deveci A
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454214 · Full text
OBJECTIVE: This study aimed to determine the effect of reduced acromiohumeral distance (AHD) and increased acromial thickness (AT) on the risk of rotator cuff tear (RCT). METHODS: Patients aged 25-70 were included in thi...
OBJECTIVE: This study aimed to determine the effect of reduced acromiohumeral distance (AHD) and increased acromial thickness (AT) on the risk of rotator cuff tear (RCT). METHODS: Patients aged 25-70 were included in this retrospective study. Patients who were operated on for RCT between January 2019 and December 2021 were included in group 1, and patients who applied to the outpatient clinic in the same period with a complaint of shoulder pain and no problem on magnetic resonance imaging (MRI) were included in group 2. Three researchers performed AHD and AT measurements on the same true anteroposterior (AP) shoulder radiographs. The second measurement was performed 1 month later when, the first measurements were completed. RESULTS: Radiographs of 284 patients in group 1 and 234 patients in group 2 were evaluated. In group 1, the mean AHD measurement was 8.25 ± 1.73 mm, and the AT measurement was 8.58 ± 1.06 mm. In group 2, the mean AHD measurement was 10.25 ± 1.4 mm, and the AT measurement was 8.35 ± 0.92 mm. A significant relationship was determined between the RCT and the AHD (P < .001). Also, RCT and AT have a significant relationship (P < .001). The authors determined that the risk of RCT increased 3.45 times when patients with AHD 6-10 mm were compared with patients with AHD >10 mm. In addition, all patients with AHD < 6mm had RCT, and the risk of RCT increased 1.42 times when patients with AT > 8 mm were compared with patients with AT < 8 mm. CONCLUSION: Acromiohumeral distance and AT measurements are practical, inexpensive, and valuable in evaluating RCT. Decreased AHD and increased AT increase the risk of RCT.
Closed versus medial open reduction in the treatment of developmental dysplasia of the hip under age 1: A retrospective comparative study.
Bakircioğlu S, Cetik RM, Danisman M … +3 more , Askin M, Abdulkadir Bulut M, Yilmaz G
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454213 · Full text
OBJECTIVE: This study aimed to compare the mid-term results of closed reduction (CR) versus medial open reduction (MOR) in the treatment of children with developmental dysplasia of the hip (DDH) under age 1. METHODS: Thi...
OBJECTIVE: This study aimed to compare the mid-term results of closed reduction (CR) versus medial open reduction (MOR) in the treatment of children with developmental dysplasia of the hip (DDH) under age 1. METHODS: Thirty-four patients with DDH (41 hips) were included in this retrospective study with a mean follow-up of 4.2 years (range: 2-6.9 years). All hips were then divided into 2 groups based on the treatment type: the CR group (20 hips) and the MOR group (21 hips). All hips from both groups were assessed with post-spica magnetic resonance imaging (MRI) in the first 24 hours, and reinterventions were recorded. Medial dye pool width was also measured. RESULTS: Age at the time of reduction was similar between the CR and MOR groups (6.6 ± 1.3 months vs. 6.7 ± 1.6 months). There was no significant difference between groups regarding avascular necrosis rate and further corrective surgery (FCS) requirement (P=.454, .697). The appropriate reduction was seen at 38/41 hips. Three hips in the CR group had revealed dislocation in post-spica MRIs and required re-intervention, and none of the hips in the MOR group required re-intervention (P=.107). Medial dye pool width in 3 planes showed no significant difference between MOR and CR. CONCLUSION: There is no difference in the avascular necrosis rate and FCS requirements between CR and MOR under age 1. Post-spica MRI is a favorable tool for evaluating reduction after CR, but its efficacy after MOR is questionable.
The initial response of a local hospital in the earthquake zone during the February 6, 2023 Kahramanmaraş earthquakes: Injuries and challenges.
Köroğlu M, Karakaplan M, Ergen E … +9 more , Ertem K, Çoban İ, Köse H, Yücel N, Bıçakçıoğlu M, Belin Özer A, Olcay Özdeş O, Utku Özdeş H, Aslantürk O
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454212 · Full text
OBJECTIVE: This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center. MET...
OBJECTIVE: This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center. METHODS: Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded. RESULTS: The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department. CONCLUSION: This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned.
Destructive disasters, trauma, crush syndrome, and beyond.
Sever MS, Katı YA, Özkaya U
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454211 · Full text
Orthopedic injuries, especially fractures of long bones as well as multiple fractures and comminuted fractures, are very common after destructive disasters (e.g., earthquakes, wars, and hurricanes). Another frequent prob...
Orthopedic injuries, especially fractures of long bones as well as multiple fractures and comminuted fractures, are very common after destructive disasters (e.g., earthquakes, wars, and hurricanes). Another frequent problem is traumatic rhabdomyolysis, which may result in crush syndrome, the second most frequent cause of death after direct traumatic impact following earthquakes. To improve outcomes, interventions should be initiated even before extrication of the victims, which include maintenance of airway patency and spine stabilization, stopping traumatic bleeding by any means, and initiating fluid resuscitation. On-site amputations have been extensively debated to liberate the victims if the release of trapped limbs is impossible. Early after the rescue, a primary survey and triage are performed, a fluid resuscitation policy is planned, complications are treated, the wounds are decontaminated, and the victim is transported to specialized hospitals. A triage and primary survey are also performed at admission to the hospitals, which are followed by a secondary survey, physical, laboratory, and imaging examinations. Washing and cleaning of the soft-tissue injuries and debridement in open, necrotic wounds are vital. Applications of fasciotomies and amputations are controversial since they are associated with both benefits and serious complications; therefore, clear indications should be defined. Crush syndrome has been described as the presence of systemic manifestations following traumatic rhabdomyolysis, the most important component of which is acute kidney injury that may contribute to fatal hyperkalemia. The overall mortality rate is around 20% in crushed patients, which underlines the importance of prevention. Treatment includes maintaining of fluid electrolyte and acid-base balance, application of dialysis, and also prevention and treatment of complications. The principles and practices in disaster medicine may differ from those applied in routine practice; therefore, organizing repeated training courses may be helpful to provide the most effective healthcare and to save as many lives as possible after mass disasters.
Orthopedic surgery in disaster.
Altintas B, L Helfet D
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454210 · Full text
Orthopedic injuries are a common occurrence in disasters. In the aftermath of a disaster, there may be a large number of patients with orthopedic injuries, and the health-care system may be overwhelmed. This review hopes...
Orthopedic injuries are a common occurrence in disasters. In the aftermath of a disaster, there may be a large number of patients with orthopedic injuries, and the health-care system may be overwhelmed. This review hopes to provide a review of modern concepts in disaster orthopedics.
Medical care following earthquakes: Clinical, organizational, and logistic challenges.
Bar-On E
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454209 · Full text
The orthopedic load following earthquakes exceeds that caused by any other disaster. This is due to the large number of musculoskeletal injuries due to falling debris, coupled with the widespread damage to general and me...
The orthopedic load following earthquakes exceeds that caused by any other disaster. This is due to the large number of musculoskeletal injuries due to falling debris, coupled with the widespread damage to general and medical infrastructure, causing a huge imbalance between surgical needs and the ability to address these needs, necessitating a switch in mindset and operational mode. Clinically, the operational mode will be that of damage control surgery, considering "life before limb" with only lifesaving and limb-saving procedures being performed during the acute phase of the event. Open wounds are treated by thorough debridement, and fixation is performed using plaster casts or external fixation. Open reduction and internal fixation of closed fractures will be deferred until the surge subsides or the patient reaches a fully functional medical facility. Organizational and logistic needs will be addressed considering the "4 S's": space, staff, supplies and system. Geographical changes will be necessary in the hospital, shifting activities from damaged structures to safe ones or to open spaces. Field hospitals may be erected on the hospital grounds or on an independent site. Medical staff will be overloaded, especially traumatologists, orthopedic and plastic surgeons, anesthesiologists, and surgical nurses. This can be addressed by the recruitment of supplementary personnel, task shifting, and on-site training. Supplies will be augmented from nonfunctional hospitals and other external sources, and the hospital system will switch to surge mode with appropriate work shifts and emergency standard operation procedures. All this necessitates preplanning, preparing, and drilling in order to mitigate the effects of this disastrous event.
Editorial.
Berk H
Acta Orthop Traumatol Turc · 2023 Nov · PMID 38454208 · Full text
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Management preferences of orthopedic surgeons in developmental dysplasia of the hip under 1 year of age in Türkiye: Results of a nationwide cross-sectional survey.
Çetin BV, Bakırcıoğlu S, Çiftci S … +9 more , Söylemez MS, Erkuş S, Turhan Y, Çamurcu İY, Duman S, Yıldırım T, Memişoğlu K, Şenaran H, Ömeroğlu H
Acta Orthop Traumatol Turc · 2023 Dec · PMID 38131337 · Full text
OBJECTIVE: This study aimed to evaluate the diagnosis and treatment preferences of orthopedic surgeons in developmental dysplasia of the hip (DDH) cases under the age of 1 in Türkiye with a higher incidence of DDH, estim...
OBJECTIVE: This study aimed to evaluate the diagnosis and treatment preferences of orthopedic surgeons in developmental dysplasia of the hip (DDH) cases under the age of 1 in Türkiye with a higher incidence of DDH, estimated to be around 5-15 per 1000 live births. METHODS: This was a nationwide cross-sectional survey. A link for the online survey, including 16 multiple-choice questions, was sent to the email group of the National Orthopedic Society. RESULTS: Among 233 filled-out surveys, 211 met the inclusion criteria. Half of the participants had experience of <10 years as orthopedic surgeons, managed <25% of pediatric patients in daily practice, and treated <25 DDH cases per year before walking age. Ninety-seven percent used more than one method, hip ultrasound the most common, for exact diagnosis of DDH under 6 months. Pavlik harness was the most commonly preferred brace, but the use of Tübingen orthosis increased among experienced surgeons. The uppermost age limit for bracing was higher in surgeons dealing with more pediatric patients and treating more DDH cases. Dislocated hips and hips requiring closed/open reduction were more commonly referred to other surgeons by less experienced surgeons in terms of years, number of pediatric patients, and treated DDH cases per year. The lowest age limit for intervention under general anesthesia was lower in surgeons treating >25 DDH cases per year. Over one-third used both anterior and medial approach open reduction, but a trend to anterior open reduction alone was more evident in surgeons treating >50 DDH cases per year. More experienced surgeons were more prone to check the intraoperative reduction with postoperative computed tomography or magnetic resonance imaging. Diagnosis and treatment ages of DDH cases did not significantly change during the coronavirus disease 2019 pandemic. CONCLUSION: Management preferences of orthopedic surgeons in DDH before walking age primarily depend on the rate of pediatric patients in daily practice and the number of treated DDH cases per year.
Wedge osteotomy combined with internal fixation in the treatment of Mayo IIB olecranon fractures.
Xue Y, Wang S, Wang Z … +2 more , Song H, Shi K
Acta Orthop Traumatol Turc · 2023 Dec · PMID 38108316 · Full text
OBJECTIVE: This study aimed to present the clinical outcomes and establish a safe range for olecranon wedge osteotomy combined with internal fixation in treating Mayo IIB-type olecranon fractures. METHODS: Ten consecutiv...
OBJECTIVE: This study aimed to present the clinical outcomes and establish a safe range for olecranon wedge osteotomy combined with internal fixation in treating Mayo IIB-type olecranon fractures. METHODS: Ten consecutive patients (10 elbows) underwent treatment involving wedge osteotomy combined with internal fixation. Primary outcome measures included the evaluation of the Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), pain severity assessed via a visual analogue scale (VAS), elbow mobility, and the extent of osteotomy at the final follow-up. RESULTS: At the last follow-up, the median OES was 45 (range 38-48), and the median MEPS was 90 (range 75-100). Six out of 10 patients reported no pain based on the VAS. No significant differences were observed between the healthy and affected sides regarding flexion–extension and rotation activities. The mean horizontal lengths of the olecranon articular surface and base osteotomy were 6.2 mm (range 5.5-7.4 mm) and 14.4 mm (range 10.2-16.5 mm), respectively. The mean olecranon shortening was 4.2 mm (range 2.2-5.4 mm), resulting in a shortening rate of 7.3% to 18.9%. Fracture union was achieved in all patients, with a mean time to union of 11.2 weeks (range 8-16 weeks). Early mild (grade 1) degenerative changes were observed in 3 cases. CONCLUSION: Wedge osteotomy combined with internal fixation represents a reliable treatment option for Mayo IIB olecranon fractures, particularly in cases of severe comminuted fractures that are challenging to restore anatomically.
Rim plate fixation for a rare fracture pattern of the lateral femoral condyle: A case report.
Xu H, Xu D, Lu Y … +1 more , Lin J
Acta Orthop Traumatol Turc · 2023 Dec · PMID 38108315 · Full text
Osteochondral fractures of the lateral femoral condyle caused by lateral patella dislocation have been rarely reported. The AO/OTA Classification is not suitable for this uncommon injury. Comminution of the anterior cart...
Osteochondral fractures of the lateral femoral condyle caused by lateral patella dislocation have been rarely reported. The AO/OTA Classification is not suitable for this uncommon injury. Comminution of the anterior cartilage surface of the lateral condyle with bone impaction is challenging to reduce and repair accurately, leading to uncertainty in joint function recovery. The treatment for this rare fracture is not commonly reported. We, herein, report a unique case where the lateral condyle osteochondral fracture occurred alongside patellar dislocation and instability of the patellofemoral joint. Autogenous bone grafting, open reduction, and internal fixation with a rim plate resulted in a satisfactory outcome.
The effect of triple-dose-intravenous tranexamic acid on blood loss in patients undergoing total hip arthroplasty without affecting blood coagulopathy: A prospective thromboelastographic analysis.
Jin WY, Yan ZW, Zhang X … +4 more , Pan S, Huang CR, Guo KJ, Zheng X
Acta Orthop Traumatol Turc · 2023 Nov · PMID 37987599 · Full text
OBJECTIVE: This study aimed to assess the safety and efficacy of triple-dose intravenous tranexamic acid (TXA) in patients following total hip arthroplasty (THA) using thromboelastography (TEG). METHODS: One hundred thir...
OBJECTIVE: This study aimed to assess the safety and efficacy of triple-dose intravenous tranexamic acid (TXA) in patients following total hip arthroplasty (THA) using thromboelastography (TEG). METHODS: One hundred thirty patients undergoing THA were prospectively enrolled in the study. According to the intravenous infusion TXA dose, patients were divided into single-dose (n=65; mean age=60.8 ± 8.1 years) and triple-dose groups (n=65; mean age=61.8 ± 8.6 years). Complete blood count (CBC), conventional coagulation tests (CCT), and TEG were conducted 1 day before the operation, on postoperative day 1 (POD1), and postoperative day 7 (POD7). Color Doppler ultrasonography was performed 1 day before the operation and on POD7. Drainage blood loss, total blood loss (TBL), hidden blood loss (HBL), deep vein thrombosis (DVT) incidence, and blood transfusion rates were calculated and recorded. The CCT, CBC, and TEG parameters were compared between the 2 groups. RESULTS: Single- and triple-dose groups had significantly different hematocrit on POD7 (P < .05). No significant differences were found in CCT and hemoglobin at any corresponding time point between the 2 groups (P > .05). Despite the reaction time (R) on POD1 (P < .05), there were no significant differences in other TEG parameters at any other time point between the 2 groups (P > 0.05). For drainage blood loss and TBL, the triple-dose group had lesser blood loss than the single-dose group (P < .05). However, no significant differences were found for blood transfusion rate, HBL, or incidence of DVT (P > .05). CONCLUSION: Compared with single-dose, triple-dose TXA can be more effective in decreasing blood loss without increasing DVT incidence in patients undergoing THA. Although there is a notable disparity in the R time on POD1, the administration of triple-dose TXA does not substantially impact the coagulation status as assessed by TEG and CCT.
Effect of osteosarcopenia on the development of a second compression fracture and mortality in elderly patients after vertebroplasty.
Kara GK, Ozturk C
Acta Orthop Traumatol Turc · 2023 Sep · PMID 37909684 · Full text
OBJECTIVE: This study aimed to investigate the effect of osteosarcopenia on second fracture development and mortality in patients aged above 60 years undergoing vertebroplasty because of osteoporotic vertebral compressio...
OBJECTIVE: This study aimed to investigate the effect of osteosarcopenia on second fracture development and mortality in patients aged above 60 years undergoing vertebroplasty because of osteoporotic vertebral compression fracture (OVCF). METHODS: A retrospective evaluation was conducted on 104 patients treated by vertebroplasty because of OVF between 2016 and 2021. The L3 vertebra Hounsfield unit values and the psoas muscle index (PMI) values measured at the L3 vertebra level were obtained from the patients' medical data and computed tomography images. Using these measurements, the patients were divided into 3 groups: only osteoporosis (OO group), only sarcopenia (OS group), and osteosarcopenia (OSP group). Differences between the groups were evaluated regarding second OVCF development and mortality. RESULTS: The study included 104 patients, comprising 30 males and 74 females aged 60-92 years. The OS group included 10 patients, the OO group included 54 patients, and the OSP group consisted of 40 patients. A single vertebral fracture occurred in 72 patients, and 2 vertebral fractures occurred in 32 patients. The chi-square test, Mann-Whitney U-test, Kruskal-Wallis test, and Kaplan-Meier survival analysis results showed no statistically significant difference between the 3 groups for the risk of second vertebral fracture. Sarcopenia, either alone or in combination with osteoporosis, was seen to have a negative effect on the survival of patients who underwent vertebro- plasty following a vertebral fracture. CONCLUSION: This study has shown that osteosarcopenia did not increase the risk of developing a second vertebral fracture, but it increased mortality 2.8-fold for those who underwent vertebroplasty after vertebral fracture. LEVEL OF EVIDENCE: Level III, Prognostic study.
A new scoring system for predicting cut-out risk in patients with intertrochanteric femur fractures treated with proximal femoral nail anti-rotation.
Kulakoglu B, Ozdemir G, Bingol O … +3 more , Karlidag T, Keskin OH, Durgal A
Acta Orthop Traumatol Turc · 2023 Sep · PMID 37909683 · Full text
OBJECTIVE: The objectives of this study were to: (1) determine all the potential risk factors defined in the literature for cut-out after proximal femoral nail anti-rotation in managing intertrochanteric fractures and (2...
OBJECTIVE: The objectives of this study were to: (1) determine all the potential risk factors defined in the literature for cut-out after proximal femoral nail anti-rotation in managing intertrochanteric fractures and (2) make a reliable prediction about the likelihood of cut-out by developing a quantitative scoring system. METHODS: Four hundred eighty patients who were operated on for an intertrochanteric femur fracture were included in the study. The patients were evaluated retrospectively. Radiological parameters known to affect cut-out, including tip apex distance (TAD), calcarreferenced TAD (CalTAD), and reduction quality, were also used to evaluate the patients. Additionally, the classification of the fracture according to the cortical thickness index for osteoporosis, the Charlson comorbidity index for additional comorbidities, and the Arbeitsgemeinschaft Für Osteosynthesefragen classification were evaluated. RESULTS: The cut-out rate among all patients was 7.2%. Cut-out risk could be predicted by gender, TAD, CalTAD, and reduction quality. Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality significantly increased the cut-out risk. Based on the chi-square analysis, it was determined that there was a significant relationship between the cut-out risk and the variables of TAD, CalTAD, reduction quality, gender, and fracture type (P=.000, P=.000, P=.000, P=.008, P=.016, respectively). Logistic regression analysis showed a strong correlation between the newly developed scoring system and the risk of cut-out. The risk of cut-out increased 8.1 times in individuals with a score of more than 2 (P < .001). CONCLUSION: Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality are the parameters found to be significant in determining the cut-out risk. With the newly developed scoring system, risks can be calculated for all situations that may occur according to the scores obtained by the patients. The cut-out risk increases significantly in patients with a score above 2 points. LEVEL OF EVIDENCE: Level III, Diagnostic Study.
Investigation into the effect of epidermal growth factor and hyaluronic acid on fracture healing in a rat femoral fracture model.
Kuzuca BC, Doral MN, Mangiavini L … +3 more , Sapmaz E, Maffulli N, Koken M
Acta Orthop Traumatol Turc · 2023 Sep · PMID 37909682 · Full text
OBJECTIVE: This study aimed to investigate the role of an exogenous Epidermal Growth Factor and a hyaluronic acid-based scaffold on fracture healing in a rat femoral fracture model Methods: Forty-eight male Wistar-Albino...
OBJECTIVE: This study aimed to investigate the role of an exogenous Epidermal Growth Factor and a hyaluronic acid-based scaffold on fracture healing in a rat femoral fracture model Methods: Forty-eight male Wistar-Albino rats, each weighing a mean 392 grams (range= 350-450 grams) and aged 8.2 months (6-9 months), were used for this experimental study. All surgical procedures were performed on the left femur by a single surgeon. An open femoral fracture was created in all rats. The animals were randomly divided into one of the four groups: Control (12), EGF (12), HA (12) and Combined (12). In the 4th and sixth weeks, samples were processed and analyzed using biomechanical and histological methods. RESULTS: Fracture healing was significantly improved in the Combined group compared to the control one, EGF and HA groups in all parameters at both experimental time points. At the fourth and sixth weeks after surgery, fracture healing in the EGF and HA groups was significantly increased at histological evaluation compared to controls. In addition, compared with EGF, HA and Control groups, a significant difference in callus tissue was detected in the Combined group at 4 and 6-week time points in biomechanical features. CONCLUSION: This study has shown that combining local EGF and HA scaffold accelerates bone healing and strengthens the bony callus histologically and biomechanically. Using EGF-HA combined scaffolds may represent a possible future strategy in trauma surgery. LEVEL OF EVIDENCE: N/A.
Editorial.
Berk H
Acta Orthop Traumatol Turc · 2023 Sep · PMID 37909681 · Full text
Abstract loading — click title to view on PubMed.
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