Objective: The aim of this study was to evaluate the efficacy and safety of tranexamic acid (TXA) in elderly patients with intertrochanteric fracture undergoing intramedullary fixation surgery. Methods: We searched MEDLINE, the Cochrane Library and EMBASE for published randomized clinical trials relevant to use of TXA in elderly patients with intertrochanteric fracture treated with intramedullary fixation surgery. Meta-analysis was performed according to the guidelines of the Cochrane Reviewer’s Hand book. Results: Five trials assessing 540 patients were included for meta-analysis. The pooled results showed that the mean total blood loss in TXA group was significant lower than that in the control group (mean difference - 172.83, 95% CI -241.43 to -104.23; p<0.00001, f ixed-effect model). The intra- and postoperative transfusion rate for the TXA group was 34.4% (91/264) and for the control group was 49.27% (136/276), and the relative risk was 0.71 (95% CI 0.52 to 0.97; p<0.03, random-effect model) with substantial heterogeneity (I2=63%, p=0.03). The overall incidence of thrombotic events was 6.43% (17/264) in the intravenous TXA group, 7.63% (21/275) in the control group, with no significant difference (relative risk 0.84, 95% CI 0.46 to 1.54; p=0.57, fixed-effect model). Conclusion: The present evidence shows that TXA can significantly reduce total and hidden blood loss, transfusion rate, and do not increase the risk of thrombotic events in elderly patients with intertrochanteric fracture undergoing intramedullary fixation surgery. However, the impact of TXA on thrombotic events needs to be researched in more high-quality, large-sample randomized clinical trials.
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Objective: The aim of this study was to investigate the immunohistochemical stain profiling of adipocytic tumors. Methods: From our archive files between the years of 2012-2018, excised, formalin-fixed and paraffin-embedded adipocytic tumors were retrospectively screened and 61 subjects were selected. The gender, age, tumor location and tumor diameter were evaluated. The cases were investigated in terms of p16, CD34, MDM2 expression and clinicopathological information. Results: Of the 61 patients included in the study, we found that 2 had hibernoma, 4 had lipoblastoma, 14 had spindle cell lipoma (SCL), 10 had lipoma, 20 had atypical lipomatous tumor/well differentiated liposarcoma (ALT/WDL), and 11 had dedifferentiated liposarcoma (DDL). In terms of diameter, ALT/WDL and DDL were significantly different from the others (p=0.001, p=0.001, respectively). There was a significant difference between the groups according to the location (p=0.001). 35% (7/20) of ALT/WDLs were in the lower extremities (thighs) and 35% (7/20) were located in the retroperitoneal region. 70% of DDLs (7/11) were located in the retroperitoneum. When CD34 expression was evaluated among the groups, a significant difference was observed (p=0.001). CD34 was positive in 92.9% of SCL cases. p16 immunoreactivity was significantly different between the groups (p=0.001). p16 expression was observed in 50.5% of ALT / WDL cases and 79% of DDL cases. Conclusion: p16 and CD34 expression are valuable in the differential diagnosis of lipomatous tumors when radiological and clinical considerations do not help to differential diagnosis of adipocytic tumors.
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Objective: This study aimed to evaluate whether a history of a pelvic osteotomy or proximal femoral osteotomy compromises the outcomes of total hip arthroplasty in patients with dysplastic coxarthrosis. Methods: The results of total hip arthroplasty in 240 hips of 172 patients without previous pelvic osteotomy or proximal femoral osteotomy were compared to 118 hips of 88 patients with a previous pelvic osteotomy or proximal femoral osteotomy (osteotomy group). Technical difficulties and rates of complications during surgery, operative time, estimated blood loss, rates of postoperative complications, and pre- and postoperative Harris Hip Scores and visual analog scale pain scores were compared between the two groups. Results: In the osteotomy, the rate of complications was higher and the operative time was longer. The estimated blood loss was also higher, and the latest follow-up Harris Hip Scores and visual analog scale pain scores were worse in this group. Total hip arthroplasty was more demanding and the revision rate was higher in the osteotomy group (six vs four revisions). Conclusion: Our data showed that a previous history of pelvic osteotomy or proximal femoral osteotomy compromised the clinical outcomes of subsequent total hip arthroplasty and is related to an increased rate of complications, prolonged operative time, and increased amount of blood loss.
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Objective: Due to the biomechanical importance of the meniscal root ligament, several surgical techniques have been defined in order to treat meniscal root tear. Different application techniques have different levels of difficulty. We aimed to find a stronger and simpler repair technique. Methods: Sixteen bovine knee joints were prepared. The posterior root of the medial meniscus was dissected and repaired with one of two different techniques. The knees in group 1 (“knotted group”) were repaired with the knotted suture anchor technique, and the knees in group 2 (“knotless group”) were repaired using the knotless suture anchor technique. The strength of the repairs was tested biomechanically. Results: Cyclic loading tests were done. On the 0–20 N one-cycle test, the knotted anchor group’s equivalent stiffness average was 5.28 N/mm, and the knotless anchor group’s equivalent stiffness average was 5.48 N/mm. The 5–20 N two-cycle test results were 8.29 N/ mm for the knotted group and 8.66 N/mm for the knotless group. On the 5–20 N 100-cycle test, the equivalent stiffness averages were 8.59 N/mm for the knotted group and 10.18 N/mm for the knotless group. Elongation was 5.83 mm for the knotted group and 4.86 mm for the knotless group. After performing load-to-failure tests, the failure forces were recorded as 237.83 N for the knotted group and 204.90 N for the knotless group. The failure test elongation values were 26.83 mm for the knotted group and 18.70 mm for the knotless group. The failure energies were 3.87 J for the knotted group and 1.83 J for the knotless group. Except for elongation until failure (p=0.009), there were no significant differences between the two groups tested (p>0.05). The average elongation was significantly less in group 2, showing that the knotless anchor had an advantage, with less meniscal excursion compared to the sutured anchor. Conclusion: Knotless anchors have a mechanical advantage over knotted anchors for preventing meniscal excursion. When thought together with technical simplicity during arthroscopic surgery, knotless anchors could be used safely for the fixation of the meniscal root ligament.
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Vascular tumors in neonates are mostly benign; however, locally aggressive voluminous forms may destabilize the hemodynamics of a neonate. Herein, we present an unusual case of a neonatal giant vascular tumor in the right upper extremity, causing a consumption coagulopathy and acute deterioration of vital signs. The patient required mechanical ventilation, inotropic support, and administration of blood products by the seventh day. Vascular embolization attempts failed to improve the general condition of the patient. Due to the deteriorating and life-threatening general condition of the patient, amputation around the upper arm level occurred under emergency conditions on the twelfth day. The patient’s hemodynamic parameters were regained immediately, with neither inotropic agents nor blood products required after the second postoperative day. Clinical and pathological diagnosis revealed kaposiform hemangioendothelioma. Patient monitoring proceeded until the age of 15 months, with no local recurrence around the stump or soft tissue coverage complications. Therefore, since other treatment options failed, the early amputation decision was life-saving.
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Extraskeletal osteosarcoma is a malignant tumor of soft tissue characterized by osteoid production and has a very low prevalence, comprising approximately 4% of all osteosarcomas and about 1% of all soft tissue sarcomas, and a total of about 350 cases have been reported until now. Heterotopic ossification is a pathological finding of bony tissue in soft tissue regions such as muscle, skin and subcutaneous tissue. We report a case of an 86-year-old woman with a history of total hip arthroplasty (THA), in which open reduction and internal fixation were done for periprosthetic femoral Fracture. The ossified lesion misdiagnosed as heterotopic ossification initially was diagnosed as extraskeletal osteosarcoma at 6 months after the surgery. Both extraskeletal osteosarcoma and heterotopic ossification have no definite symptoms, but show radiopaque shadows on simple radiograph. Therefore, careful attention and thorough evaluation with multiple imaging tests may be necessary for the differential diagnosis of these entities
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Objective: The purpose of this study was to evaluate the types and the frequency of fractures, both in the pediatric and adult
population during the COVID-19 pandemic and to find out the differences in comparison to the non-pandemic period.
Methods: Patients who were admitted to the hospital with a new fracture during pandemic period (March 16 to May 22, 2020) were
evaluated. Control group consisted of patients with new fractures admitted to the hospital in the same date range in 2018 and 2019.
The patients were divided into two groups as ≤16 years old (group 1) and >16 years old (group 2). The evaluation was based on the
age and gender of the patients and localization of the fractures. Hospitalized and surgically treated patients were evaluated as well.
Results: A total of 1794, 1747, and 670 fractures were observed in 2018, 2019, and 2020, respectively. Mean age of the patients
in group 1 was found to have decreased in the pandemic period (p<0.001). The most common fracture sites in the pediatric
population were the distal forearm and distal arm, whereas hand, distal forearm, and foot were most common fracture sites in
adults, in both pandemic and non-pandemic periods. The proportional increase in femoral and tibial shaft fractures in group
1, and toe, tibial shaft, and metacarpal fractures in group 2 was found to be statistically significantly (p<0.05). In group 1; 6.8%,
7.7%, and 14.6% of the fractures were treated surgically in 2018, 2019, and 2020, respectively (p<0.001). For group 2, these rates
were 20.1%, 18.6%, and 18.1%, respectively (p=0.67). There were 48, 29, and 26 open fractures in 2018, 2019 and 2020, respectively (p=0.066). In pandemic period, duration of the hospital stay was significantly shorter for distal humerus and proximal
femur fractures (p values= 0.001 and 0.017, respectively).
Conclusion: We observed that the frequency of fractures decreased by approximately one-third during the pandemic period
compared with that in the non-pandemic period. The mean age of the patients with a fracture in the pediatric group was found
to have decreased also. Finger fractures in pediatric patients and metatarsal fractures in adult patients were found to have significantly decreased during the pandemic.
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Objective: This study aimed to radiologically assess the relationship between the tilt angle of the bipolar radial head prostheses and radiocapitellar instability.
Methods: In this radiological study, 28 consecutive patients (13 females and 15 males: mean age=47 years and age
range=23-77 years) who underwent cemented bipolar radial head arthroplasty (Judet CRF II) because of comminuted radial
head fracture with elbow instability were retrospectively reviewed.
Results: There was excellent intra- and interobserver reliability for the measurements of the tilt angle and the radiocapitellar
distance. ICC for interobserver reliability of the tilt angle was 0.93, and ICC for intraobserver reliability for the 2 observers
was 0.96 and 0.97, respectively. ICC for interobserver reliability of the radiocapitellar distance was 0.87, and ICC for intraobserver reliability for the 2 observers was 0.91 and 0.93, respectively. The mean tilt angle was 17.6° (range=1°-35°), and
the mean radiocapitellar distance was 8 mm (range=1–17 mm). Pearson’s correlation revealed a strong significant positive
correlation between the tilt angle and the radiocapitellar distance (r=0.77 and p<0.001).
Conclusion: Evidence from this study has demonstrated a strong positive correlation between the tilt angle of bipolar radial
head prostheses and radiocapitellar instability. The tilt angle can be used as an indicator of radiocapitellar joint instability
following bipolar radial head prostheses.
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Objective: The aim of this study was to compare the clinical and radiological outcomes of the conventional versus individualized
three-dimensional (3D) printing model-assisted pre-contoured plate fixation in the treatment of patients with acetabular fractures.
Methods: The data from 18 consecutive patients who underwent surgery for the acetabular fractures were retrospectively
analyzed. The patients were divided into two groups (9 in each): conventional and 3D printed model-assisted. The groups
were then compared in terms of the duration of surgery, time of instrumentation, time of intraoperative fluoroscopy, and
volume of blood loss. The quality of the fracture reduction was also evaluated postoperatively by radiography and computed
tomography in both the groups. The quality of the fracture reduction was defined as good (<2 mm) or fair (>2 mm) based
on the amount of displacement in the acetabulum.
Results: The conventional group included 9 patients (9 males; mean age=41.7 years; age range=16-70) with a mean follow-up of 11.9 months (range=8-15); the 3D printed model-assisted group consisted of 9 patients (9 males; mean age=46.2
years; age range=30-66) with a mean follow-up of 10.33 months (range=7-17). The average duration of surgery, mean time
of instrumentation, time of intraoperative fluoroscopy, and mean volume of blood loss were 180.5±9 minutes, 36.2±3.6
minutes, 6±1 times, and 403.3±52.7 mL in the 3D printed model-assisted group, and 220±15.6 minutes, 57.4±10.65 minutes,
10.4±2.2 times, and 606.6±52.7 mL in the conventional group, respectively. Procedurally, the average duration of surgery,
mean time of instrumentation, and mean time of fluoroscopy were significantly shorter, and the mean volume of blood loss
was significantly lower in the 3D printed model-assisted group (p<0.05). The quality of the fracture reduction was good in 7
patients (78%) in the conventional group and 8 patients (89%) in the 3D printed model-assisted group.
Conclusion: As compared with the conventional surgery, the 3D printing model-assisted pre-contoured plate fixation technique can improve the clinical and radiological outcomes of the acetabular fractures, with shorter surgery, instrumentation,
intraoperative fluoroscopy times, and blood loss.
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Objective: The aim of this study was to translate the Self-Reported Foot and Ankle Score (SEFAS) into Turkish and to determine the validity and reliability of the translated version in patients with foot or ankle pain.
Methods: A total of 98 patients (65 females, 33 males, mean age=39 years, age range 18-65 years) who presented with foot
or ankle pain for at least one week were included in the study. SEFAS was translated into Turkish (SEFAS-T) and then
back-translated into English by two bilingual translators to ensure the accuracy of translation. To determine the validity of
the translated version, SEFAS-T, The Foot and Ankle Outcome Score (FAOS), and the Short Form 36 (SF-36) were administered at the first assessment on the same day. SEFAS-T was repeated five days later (Spearman’s rho). Intra-class correlation
coefficients (ICCs) were used for assessment of the test re-test reliability, while the Cronbach’s alpha coefficient was used to
assess the internal consistency of the questionnaire
Results: SEFAS-T showed good test-retest reliability (ICC: 0.887). Item 4 showed poor item–total correlation and inter-item
correlations. When item 4 was excluded, the Cronbach’s alpha value was found as 0.906. SEFAS-T total scores showed correlation with all the FAOS sub-scores (p<0.001) and all the SF-36 components (p≤0.001) except mental health (rho: 0.149,
p: 0.143). The highest correlation was found between SEFAS-T Total Score and the Sports and Recreations subscale of FAOS
(rho: 0.796, p<0.001).
Conclusion: SEFAS-T seems to be valid and reliable as a measure for foot or ankle pain in Turkish patients.
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