Objective: The aim of this study was to detect the relationship between the development of Schmorl’s nodes (SNs) and bone
mineral density (BMD) in young patients.
Methods: Computerized tomography (CT) images of the thoracolumbar vertebral column were retrospectively examined
by two experienced radiologists for SNs. The diagnostic criterion for SN was defined as a node size larger than one-third but
not more than two-thirds of the relevant vertebral endplate. Considering the eligibility criteria, a total of 74 individuals (60
males and 14 females; mean age: 24.3 years; age range: 18-40 years) with SN at the thoracolumbar vertebrae were included
in the patient group, and a total of 38 age- and gender-matched individuals (30 males and 8 females; mean age: 25 years)
with no evidence of SN were included in the control group. All these individuals were younger than 40 years. In the patient
group, SNs were assessed in terms of the distribution of the thoracolumbar vertebrae, the location of the upper and lower
endplates, and the total number of lesions. In all individuals included in the study, BMD was measured from the axial CT
sections by quantitative CT and then compared between the two groups.
Results: The distribution of age and gender was comparable between the two groups (p=0.438). A total of 208 SNs were
identified in the patient group. Of these, 92 (44%) were located at the thoracic vertebrae and 116 (56%) at the lumbar vertebrae.
The mean BMD was 131.6 g/cm3 in the patient group and 140.7 g/cm3 in the control group (p=0.03). There was no
significant relationship between the total number of SNs per patient and the mean BMD (p=0.156).
Conclusion: Evidence from this study revealed that low BMD may be a predisposing factor for the development of SNs in
patients younger than 40 years.
|
Objective: The aim of this study was to biomechanically assess the effect of humeral-fenestration size in the Outerbridge-
Kashiwagi arthroplasty on the ultimate failure load of the distal humerus in a synthetic bone model.
Methods: We biomechanically tested the influence of different humeral-fenestration sizes on the failure load of the distal
humerus in Outerbridge-Kashiwagi arthroplasty. A total of 50 synthetic humerus models were divided into 5 groups based
on the fenestration size: 10 mm, 12 mm, 15 mm, 18 mm, and 20 mm. All the samples were randomly assigned to receive
either axial or anteroposterior (AP) loading and then loaded to failure at a rate of 2 mm/min on a material testing machine.
The data regarding ultimate failure loads under the axial and AP loading were analyzed.
Results: Under the AP loading, the mean ultimate failure loads of the 18 mm and 20 mm groups were lower than those of
the other groups. Under the axial loading, the mean ultimate failure load of the 10 mm group was significantly greater than
that of the 15 mm, 18 mm, and 20 mm groups. Additionally, the ultimate failure load of the 20 mm group was significantly
lower than that of the 12 mm, 15 mm, and 18 mm groups.
Conclusion: The distal humeral fenestrations with a size greater than 18 mm may offer poor biomechanical properties in the
Outerbridge-Kashiwagi ulnohumeral arthroplasty.
|
Objective: Internal fixation with cannulated screws for nondisplaced femoral neck fractures in the elderly has substantial
reoperation and mortality rates. The selection of either internal fixation or arthroplasty for nondisplaced femoral neck
fracture is debatable.
Methods: We performed a systematic review of the literature regarding complications in the internal fixation of nondisplaced
femoral neck fractures in elderly (>60 years old) patients. We searched in multiple databases (PubMed, Web of
Science, Embase, and Cochrane Library) for articles in this area; there was no limitation over the publication year.
Results: A total of 1971 patients were identified from 16 published studies. All these patients were over 60 years old. The
minimum follow-up after the surgical procedure was 11 months (range: 11–183 months). A total of 329 fractures (16.7%)
with radiographic and clinical failures after fixation were identified with regard to stable femoral neck fractures. The single
most common complication after surgery was nonunion (129/329), with a pooled percentage of 39.2%. Osteonecrosis was
found to be the second most common cause of revision surgery (31.9%). The overall reoperation rate attributable to surgical
complications was 15.2% (300/1971 patients). Conversion to hip arthroplasty was performed in 244 patients (12.4%) after
primary fixation.
Conclusion: Our study elucidated further the complication rate of nondisplaced femoral neck fractures treated with internal
screw fixation. Since the failure rate of screw fixation for stable femoral neck fractures in elderly patients is not low, we
believe that hemiarthroplasty is a reasonable treatment option in select patients.
|
Forefoot injuries are commonly caused by sport-related activities and are often around the metatarsophalangeal joints. The
hallux interphalangeal (IP) joint is anatomically stable; therefore, injuries to this joint are considered to be rare compared with
those to the metatarsophalangeal joint. Instability of the hallux IP joint has rarely been reported in barefoot contact sports,
and its treatment has not been sufficiently explored.This study investigated chronic varus instability of the hallux IP joint.
We performed a surgical reconstruction owing to conservative treatment failure. A good surgical outcome was achieved by
reconstruction of the collateral ligament using the $4^{th}$ extensor tendon-a promising alternative treatment option for this type of
injury. This method indicated no morbidity outside the site of surgery and was more cost-effective than reconstruction using
an allograft.
|
Nontyphoidal salmonella (NTS) infection can lead to gastroenteritis, enteric fever, and bacteremia. However, osteoarticular infections caused by NTS are rarely encountered. We report the case of a 53-year-old male patient with bilateral hip infection caused
by NTS. We performed a two-stage reconstruction comprising debridement of both hip joints followed by prosthetic replacement
with antibiotic-loaded acrylic cement because the patient’s diagnosis was delayed for approximately three months and the hip
joints were already damaged. At two-year follow-up, the clinical, radiologic, and laboratory findings were within the normal limits,
and there was no sign of infection. This case is presented because reports of bilateral hip joint infection due to NTS are rare. Early
detection and proper treatment are essential for the eradication of the infection. The use of a prosthesis made of antibiotic-loaded
acrylic cement and prolonged antimicrobial therapy can be considered in the management of bilateral hip joint destruction due to
delayed diagnosis of NTS infection.
|
Objective: The aim of this study was to determine the role of new inflammatory markers, including the platelet-to-lymphocyte ratio
(PLR) and neutrophil-to-lymphocyte ratio (NLR), in the prediction of length and cost of hospital stay in patients with infected
diabetic foot ulcers (DFUs).
Methods: A total of 78 patients with DFUs who were admitted to our endocrinology clinic between January 2016 and July 2017
were included. Patients were then divided into three groups according to the Wagner DFU classification system: group 1: 18 patients with grade 2 DFU (11 men, 7 women; mean age = 57.5±7 years); group 2: 44 patients with grade 3 DFU (18 men, 26 women;
mean age = 59.7±8.7 years); and group 3: 16 patients with grade 4 DFU (10 men, 6 women; mean age = 59.9±11.6 years). Laboratory findings were retrospectively obtained from hospital records; the PLR and NLR were calculated in all groups. Length and cost
of hospital stay were recorded. Hospital costs were estimated in Turkish Lira (TL) based on the evaluation of glucose regulation,
wound care, and antibiotic treatment.
Results: The mean NLR was significantly lower in group 1 (2.8±0.9) than in group 2 (6.0±5.2; p=0.017) and group 3 (6.9±5.3;
p=0.011). The mean PLR was significantly lower in group 1 (140.8±42.6) than in group 3 (222.1±95.5; p=0.006). The mean length
of stay was 7.9±2.7 days in group 1, 15.0±8.9 days in group 2, and 12.5±8.9 days in group 3. The mean cost was 1,310.8±500 TL
in group 1, 2,966.9±2105 TL in group 2, and 3,488.1±3603.1 TL in group 3. Length and cost of stay were both significantly lower
in group 1 than in groups 2 and 3 (p=0.011 and p=0.002, respectively). Comparative results showed that the length and cost of
hospital stay increased with increasing severity of DFUs. Furthermore, correlation analyses demonstrated no correlation of length
of stay with PLR and NLR but an obvious correlation between cost of stay and PLR (r=0.412; p<0.001). Additionally, there was no
correlation between cost of stay and NLR (r=0.158, p>0.05).
Conclusion: The PLR is inflammatory marker that can be measured by an inexpensive and easily accessible test and can aid in the
prediction of length and cost of hospital stay in patients with DFUs.
|
Objective: The aim of this study was to analyze the relationship between mortality and possible risk factors in elderly patients surgically treated with hemiarthroplasty for hip fracture and to determine mortality rates and yearly survival outcome in a selected cohort.
Methods: A total of 92 patients (51 men (55.4%) and 41 women (44.6%); mean age: 76.47 years) who underwent hemiarthroplasty for hip
fracture were included into the study. The following data associated with risk factors were recorded for 92 patients: age, gender, pre-fracture
activities of daily living (ADL), type of fracture, American Society of Anesthesiologists (ASA) score, therapeutic procedure, type of anesthesia, length of time after fracture until operation, postoperative mobility, and duration of hospitalization. A multivariate logistic regression
test was used to evaluate the correlation between the risk factors and first- and second-year mortality rates. Third-year mortality rate after
surgery was analyzed and compared with the general mortality rate in a similar population of the same age group living in the same city.
Results: The mortality rate was 18.5% (17 patients) after the first-year follow-up and 25% (23 patients) after the second year. The mortality risk after hip fracture was found to be 11.7 times greater than the similar age group population in the third year. In addition, there was
a significant relationship between a low (dependent) preoperative ADL score, advanced age (>80 years), male gender, high ASA score
and poor ability to walk (unable to walk), and first- and second-year mortalities (p<0.05). However, no significant relationship was found
between fracture type, fracture side, anesthesia type, time from fracture to surgery, or duration of hospitalization and mortality (p>0.05).
Conclusion: Advanced age, male gender, a high ASA score, a dependent preoperative ADL score, and a postoperative inability to walk
were determined to be the most important risk factors affecting mortality in elderly patients with hip fracture. The mortality risk was
11.7 times greater than that of a population with similar characteristics.
|
Objective: This study aimed to assess the efficacy and safety of a newly developed transpedicular, anterior open-wedge
osteotomy procedure with lamina preservation to correct sagittal imbalance in regional kyphotic deformities following
compression fractures.
Methods: All seven patients [four females and three males; mean (range) age, 67 (56-78) years] included in this study underwent surgery between May 2005 and May 2016 for symptomatic, rigid kyphosis secondary to compression fractures. Transpedicular, anterior
open-wedge osteotomy with lamina preservation was performed in all patients using an osteotome to create a transverse fracture in
the vertebral body through bilateral pedicles and an anterior open-wedge space filled with compacted bone graft to correct kyphosis.
Pre- and post-operative kyphotic Cobb angles were evaluated, and the volume of intra-operative blood loss was measured.
Results: The pre- and post-operative kyphotic Cobb angle was 35.3° and 17.7°, respectively (p<0.01); mean angle correction
was 17.6° (p<0.05). No patient developed any complication with neurologic injury. Mean blood loss was 771 mL. Callus
formation viewed on plain film was evident in all patients and was accompanied by decreased thoracolumbar back pain.
Conclusion: Transpedicular, anterior open-wedge osteotomy with lamina preservation is an easy and safe spinal osteotomy
procedure for the correction of regional, fixed kyphotic deformities.
|
|
|
Objective: This study is an evaluation of the overall survival rate and factors affecting survival in patients with osteosarcoma,
chondrosarcoma, or Ewing’s sarcoma. This study aimed to determine the effect of factors related to the preoperative period,
patient, tumor, treatment, and postoperative period on survival.
Methods: A total of 114 patients (64 male and 50 female) with osteosarcoma, chondrosarcoma, or Ewing’s sarcoma treated between
2005 and 2013 were included in this study. All the patients received standard treatment and were followed up regularly. In all, 44
cases of (conventional and telangiectatic) osteosarcoma, 30 cases of Ewing’s sarcoma, and 40 cases of high-grade chondrosarcoma
were identified using the Bone and Soft Tissue Tumor Registry. Gender, age, tumor size and localization, pathological fractures,
histopathological type, grade, surgical treatment, adjuvant treatments, relapse of the disease, and postoperative complication data
were obtained from follow-up forms. The learning curve of institutional expertise was also evaluated. The patient survival rate was
calculated using the Kaplan-Meier method, and log-rank statistical methods were used to compare survival rates.
Results: The mean length of survival of the patients was 72 months. There was a 56% 5-year survival rate, and the event-free
survival rate was 53%. The survival of patients with Ewing’s sarcoma whose prodromal period was less than 12 weeks was
significantly higher than that of the other groups (p=0.031). The survival of patients with tumor size greater than 150 cc,
with local recurrence and distant metastases was low for all groups. Survival rates were significantly lower in osteosarcoma
and Ewing’s sarcoma patients with stage III tumor or metastasis at diagnosis. The survival of patients with osteosarcoma
diagnosed between 2010 and 2013 was significantly higher than that of the earlier group (p=0.02).
Conclusion: Decreasing the prodromal period (early diagnosis) can improve survival by preventing the local and systemic spread
of the tumor. Increase in the surgical experience is likely to have a positive effect on survival rates, especially for patients with
osteosarcoma. The relapse of the disease is a poor prognostic factor for survival despite aggressive surgery and adjuvant therapies.
|
