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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.
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Objective: The aim of this study was to evaluate clinical and functional outcomes in diabetic patients undergoing tibiocalcaneal
arthrodesis using a retrograde nail.
Methods: A total of 12 diabetic patients [8 men and 4 women; mean age at intervention: 56.8 years (range: 27-76 years)]
who underwent tibiocalcaneal arthrodesis by a retrograde nail were enrolled in this study. The indication for surgery was
massive talar osteonecrosis in four patients, Charcot arthropathy in another four patients, and various severe ankle/hindfoot
derangements in four patients. All surgeries were performed by the same surgeon. All patients were evaluated by their
American Orthopedic Foot and Ankle Score (AOFAS) score, and radiographic follow-up was performed.
Results: The mean follow-up time was 59.5 months (range: 27-121 months). Ten patients (83.3%) healed and were able to
walk with full weight bearing without crutches. Among them, nine patients (75%) achieved union with solid bone healing.
The mean overall improvement in the AOFAS score was 72.5% (preoperatively: 40 points vs postoperatively: 69 points;
p<0.001). We observe a complication in 50% of our patients. Minor complications included two cases of dehiscence of the
surgical wound, one case of soft tissue irritation owing to hardware protrusion, and one cause of lymphedema. Two patients
had deep infection and underwent surgical removal of hardware, debridement, and antibiotic treatment: one healed after
the treatment but never recovered full weight bearing and the other one died from other complications. These two deep
infections occurred after 23 months of follow-up.
Conclusion: Tibiocalcaneal arthrodesis using retrograde nails is a salvage technique extremely effective in ankle and hindfoot
disorders in a diabetic patient. This procedure allows good functional outcomes and pain relief. When correctly indicated,
it is a safe procedure with good clinical outcomes and low risk of below-knee amputation.
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Objective: The aim of this study was to evaluate the results of the innervated digital artery perforator (IDAP) flap and to
analyze the relationship between patient satisfaction and outcome measures.
Methods: A total of 17 fingertips of 15 patients (14 men and one woman; mean age: 47.2 (26-62) years) were included in
this retrospective study. Patients’ injured finger and defect type were recorded. At the last follow-up, the static two-point
discrimination (s2PD) test, Semmes Weinstein monofilament (SWM) test, and range of motion of the affected finger were
analyzed. We interviewed patients to determine hand dominance, cold intolerance, and their satisfaction with the result. We
performed correlation and logistic regression analyses between patient satisfaction and outcome measures.
Results: The mean follow-up period was 13.8 (7-18) months. The mean range of motion was 77.3±3.5 (70-80) degrees for
the distal interphalangeal joints of affected fingers. The mean s2PD was 6.4 (3-10) mm, and the SWM records ranged from
2.83 to 4.93 monofilament markings. Cold intolerance was noted in seven fingers (41%). Patient satisfaction was negatively
correlated with cold intolerance, and cold intolerance decreased as the follow-up period extended.
Conclusion: IDAP flap satisfies both patient and surgeon, with the only significant problem being cold intolerance, regarding
which patients must be informed. Although cold intolerance is hard to treat, fortunately, it generally improves with time.
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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.
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Objective: This study aimed to develop the Turkish version of Identification of Functional Ankle Instability (TV_IdFAI)
scale and evaluate its validity and reliability.
Methods: A total of 100 participants (54 men and 46 women; 50 volleyball players and 50 sedentary individuals) between 18
and 38 years of age were included this study. The construct validity, reference validity, sensitivity, specificity, and test–retest
reliability of TV_IdFAI were evaluated. For the test–retest reliability, the scale was applied to all participants again in 10–14
days. A correlation between the scale scores and test–retest results was examined with intraclass correlation coefficient. To
evaluate the construct validity, a factor analysis method was used. For reference validity, a sports physician evaluated all
participants and the clinical diagnoses were compared with total score of the scale. Sensitivity and specificity were calculated
to evaluate the classification success of the scale with specified cutoff.
Results: TV_IdFAI scale was grouped under two separate factors. It was determined that the variance for factor 1, factor
2 and for scale was 46.68%, 15.70%, and 62.38%, respectively. There was a statistically significant relationship 0.74 (95%
CI 0.64–0.84; p<0.001) between the physician’s diagnosis and TV_IdFAI in terms of reference validity. The sensitivity and
specificity of TV_IdFAI was 0.61 and 0.80, respectively. The reliability of TV_IdFAI was 0.94 (95% CI 0.92–0.96; p<0.001).
Conclusion: This study shows that TV_IdFAI is a simple, easy to apply, reliable, and valid scale to define functional ankle
instability in Turkish population.
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Objective: This study aimed to evaluate the functional outcomes of the surgical treatment performed with a buttress plate
for the trochlear and distal capitellum fractures with posterior extension in the humerus.
Methods: The data belonging to 6 female and 4 male patients with a mean age of 43.8±11.1 (34–72) years were retrospectively
evaluated. The mean follow-up period was 59.6±38.79 (22–127) months. The trochlear extension and posterior comminution
of the fractures were assessed through the initial X-rays and computerized tomography images. Ten patients were classified
as Dubberley type B. All fractures were treated surgically, with open reduction and internal fixation using a lateral buttress
plate, headless cannulated screws, and Kirschner (K)-wires. The passive flexion and extension exercises were initiated at the
first postoperative day. The patients were evaluated clinically and radiographically at the final follow-up. The outcomes were
quantified using the Mayo Elbow Performance Index (MEPI), visual analog scale (VAS) pain score, and the patient’s opinion.
Results: At the final follow-up, the mean elbow flexion was 137.5°±3° (132°–140°), extension was −17.9°±9.2° (10°–35°),
pronation was 72.2°±2.6° (68°–75°), and supination was 78.9°±4.09 (72°–85°). The mean MEPI score was calculated as
95.5±5.98 (85–100). According to the MEPI score, 8 patients were evaluated as excellent and 2 as good. The mean VAS pain
score was 0.8±1.03 (0–2). The subjective patient evaluation was recorded as excellent in 5 patients, good in 3 patients, and
moderate in 2 patients. One patient developed avascular necrosis and 2 patients had elbow joint arthrosis. K-wire migration
was observed in one patient. Loss of reduction, nonunion, malunion, reflex sympathetic dystrophy, or heterotopic ossification were not encountered.
Conclusion: The management of distal humeral fractures is challenging, and favorable outcomes are closely associated with early joint motion. A solid fixation grants early mobilization. An internal fixation using lateral buttress plate, headless cannulated
screws, and interfragmentary K-wires provides a solid and secure construction that allows early postoperative joint motion.
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Objective: This study aimed to assess the effects of kinesio taping (KT) on pain, paresthesia, functional status, and overall
health status in patients with symptomatic thoracic outlet syndrome (sTOS).
Methods: A single-blind placebo-controlled design was employed in this study. The study duration was defined as 12
months. Analyses were performed on 60 patients with sTOS randomly assigned to KT (4 men and 26 women; mean
age=33.5 years, range=20–46 years) and control groups (5 men and 25 women; mean age=26 years, range=20–43 years).
KT was applied to the KT group three times. The control group received placebo taping. Pain and paresthesia were evaluated using the visual analogue scale (VAS) pain (10 cm) and VAS paresthesia (10 cm). The upper limb function was
assessed using the disabilities of the arm, shoulder, and hand (DASH) questionnaire. The overall health status was evaluated based on the Nottingham Health Profile (NHP). Each assessment was carried out at baseline (t0), posttreatment
(t1), and 8 weeks after baseline (t2).
Results: In the KT group, except the social isolation domain of the NHP, all outcome measures showed improvement
from t0 to t1. At the second follow-up visit (t2), improvements remained visible compared with baseline. However, none
of the variables improved from t1 to t2. Otherwise, all measures deteriorated slightly, and the deteriorations in VAS for
pain, NHP pain, NHP sleep, and NHP physical abilities were statistically significant (p=0.041, p=0.048, p=0.013, and
p=0.016, respectively). In the control group, only VAS for paresthesia and NHP emotional reaction showed improvement
over time (p=0.002 and p=0.044, respectively). When changes in outcome measures between the two groups were compared, except NHP emotional reaction and NHP social isolation, median changes (from t0 to t1) were higher in the KT
group than in the control group (p<0.05 for all variables). Regarding VAS pain, VAS paresthesia, DASH, and three NHP
domains (energy level, pain, and physical abilities), changes from t0 to t2 were also higher in the KT group (p<0.05 for
all variables).
Conclusion: KT can provide benefits in terms of relieving pain and paresthesia, as well as improving the upper limb function
and quality of life in patients with sTOS.
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Objective: The aim of this study was to translate and cross-culturally adapt the Nonarthritic Hip Score (NAHS) into Turkish
and determine the validity and reliability of the translated version in physically active patients with hip pain.
Methods: Sixty young to middle-aged and physically active patients (34 women and 26 men; mean age=35 years; age range:
18-40 years) with hip pain were included in the study. The original version of the NAHS was first translated into Turkish
and back-translated into English by two bilingual translators each. The back-translated version was compared with the
initial English version by a committee of the four translators. The Turkish version was then tested with 15 patients with hip
pain and 15 healthy individuals. The participants were asked whether they had difficulties in understanding the questions.
Subsequently, the questionnaire was accepted for use in the study population. Test–retest reliability and internal consistency
were assessed using Intraclass Correlation Coefficient (ICC) and Cronbach’s alpha, respectively. The construct validity was
determined via the Pearson correlation coefficient between the NAHS and Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and Short Form-12 (SF-12). Floor and ceiling effects
were analyzed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to test construct
validity.
Results: An ICC of 0.994 and Cronbach’s alpha value of 0.908 were obtained; thus, the Turkish version of the NAHS was
reliable. Neither floor nor ceiling effects (15%) were found in the sub-parameters (8.3-1.7%) and the total score (1.7%) of
the NAHS. The EFA test showed that this questionnaire had four factors. Model fit indices in CFA were χ2/df=2.23, Tucker–
Lewis index=0.90, comparative fit index=0.91, goodness of fit index=0.63, root mean square error of approximation=0.14
(90% CI: 0.12-0.16). The NAHS total score showed an excellent correlation with WOMAC (r=-0.909), mHHS (r=0.850),
and SF-12 (r=0.811) scores.
Conclusion: The Turkish version of the NAHS is a valid and reliable questionnaire for young and physically active patients
with hip pain
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