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Objective: Diagnosing subscapularis tendon rupture in preoperative MRI slices can be challenging. This study investigated whether subcoracoid effusion (SE) is more common in subscapularis tendon injuries and whether it can serve as a marker. Methods: Patients with subscapularis tendon rupture were categorized as Group 1, consisting of 26 patients, while patients with intact subscapularis tendon but other cuff pathologies were classified as Group 2, consisting of 116 patients. We evaluated the presence of effusion in the subcoracoid bursa, effusion in the subscapular bursa, acromiohumeral distance, and coracohumeral distance. We examined retrospectively 208 patients who underwent shoulder arthroscopy in the same clinic between January 2021 and August 2023. We included 142 patients in the study who underwent surgery due to rotator cuff rupture. cuff rupture. We reviewed preoperative MRI images and surgical notes of the patients. Patients with subscapularis rupture were categorized as Group 1, consisting of 26 patients, while patients with intact subscapularis but other cuff pathologies were classified as Group 2, consisting of 116 patients. Results: No statistically significant differences were observed between the groups regarding sex, age, and gender. Of 142 patients, 26 (18%) had arthroscopically confirmed Ssc tears. Among these, 22 were repaired, and 4 underwent debridement. There was no significant difference between the groups regarding acromiohumeral distance (p=0.253) and coracohumeral distance (p=0.12). No significant difference was found in subscapular bursa effusion between the groups (p=0.81). The difference in SE between the groups was statistically significant (p=0.0003). Conclusion: In our study, we showed the relationship between the sub finding and Ssc tears. We found no relationship between coracohumeral and acromiohumeral distance and subscapularis tears. [ABSTRACT FROM AUTHOR]

Lisfranc injuries are rare, often missed, and may cause permanent structural deterioration of tarsometatarsal joint, despite optimal management. Consequently, a Lisfranc injury may lead to disruption of the biomechanics of the normal foot during walking and may alter the plantar pressure distribution, which is essential for proper gait mechanics. Therefore, the main purpose of the study was to specify the dynamic plantar pressure, radiographic and clinical features, after surgically managed Lisfranc injuries. This study was carried out over a period of 10 years and included 62 patients who were surgically treated for Lisfranc injury, with mean 57-month follow-up. Radiological (intermetatarsal, Kite's, first metatarsophalangeal, Meary's, Hibbs' and calcaneal pitch angles, and medial cuneiform–fifth metatarsal distance), pedobarographical, and clinical results with the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score assessments for both feet were assessed. In the radiological assessment, the mean first intermetatarsal (p = 0.006) and Meary's angle (p = 0.000) were decreased on the injured feet compared to the uninjured feet on the anteroposterior and lateral radiographs. In the pedobarographic assessment, the injured feet midfoot contact time increased (p = 0.03), and maximum force (p = 0.001), total peak pressure (p = 0.008), and contact area (p = 0.017) decreased, compared to the uninjured feet. The mean AOFAS score was 75/100 at the final follow-up visit. There was seen to be reduced both contact surface area and time of the midfoot. Despite surgical management of Lisfranc injuries, the injured foot does not regain functional, radiological, or pedobarographical levels as compared to the uninjured foot for ≥ 57 months. [ABSTRACT FROM AUTHOR]

Objective: Most of the previous studies have shown good functional outcomes for most patients after in situ pinning or pinning with anatomical reduction of slipped capital femoral epiphyses (SCFE). We undertook a retrospective study to document comparative outcomes of both treated groups of 25 SCFE patients. Methods: Between 2005 and 2013, 21 patients (26 hips) with SCFE underwent in situ pinning or pinning with anatomical reduction at a tertiary referral center. Medical records and radiographs were reviewed for slip characteristics. Magnetic resonance imaging (MRI) was performed to all patients at final visits. Mean follow-up was 139 months (range, 64 to 179). Results: There was no significant difference between in situ group and reduction group regarding range of motion (ROM), Visual Analog Scale (VAS), and Harris Hip Score (HHS) of hip (p>0.05). Mean outcome scores were; HHS 80.4, and VAS 2.9 respectively. Conclusion: Especially in the anatomic reduction group, a decrease in hip ROM was observed (not statistically significant) compared to the in situ group. MRI revealed atrophy of the peri-hip musculature in the reduction group. This present study may suggest that patients with SCFE whether anatomically reduced or in situ pinned may not contribute to clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: Polio survivors have common sequelae of lower extremity paralysis characterized by flaccid muscle tone, limited ambulation, asymmetric involvement, retarded growth, and disuse osteoporosis. Such patients at risk of disuse osteoporosis are also at risk of sustaining osteoporotic fractures. This study aims to evaluate the effectiveness of extramedullary internal fixation devices in achieving better results in osteoporotic poliorelated femoral fractures. Methods: Retrospective evaluation was made of a total of 13 adult polio patients treated with extramedullary internal fixation devices for unilateral proximal and diaphyseal femoral fractures. The functional status of all patients was evaluated with the Vignos grade of disability. Results: All patients (mean age 62 years; range 47-88 years) were treated with extramedullary internal fixation devices (locked plate in eight diaphyseal fractures; dynamic condylar screw (DCS) and plate in three, and dynamic hip screw (DHS) and plate in two proximal femoral fractures). The mean follow-up period was 48.6 months (range 26-62 months). Bony union was confirmed at a mean of 3.7 months (range, 3-5 months) in all patients. Massive pulmonary embolism was seen in one patient. No cases of non-union, implant cutout or any other complications developed. Conclusion: Post-polio patients are at high risk of fractures. Extramedullary internal fixation devices provide effective stability for bony union and good functional results in poliorelated femoral fractures. [ABSTRACT FROM AUTHOR]

Aim: Basicervical fractures of the femur are a unique type of unstable hip fracture, usually treated with sliding hip screw (SHS) or cephalomedullary nail (CMN). The aim of this randomized, prospective study was to evaluate the outcomes and complications of the two different treatment methods, SHS and CMN, in the management of basicervical fractures of the femur in the elderly osteoporotic bones. Methods: Patients aged over 65 years, who presented to our clinic with basicervical fracture of the femur between January 2016 and January 2018, were included in the study. The permuted block randomization method was used to randomize the participants into groups. The patients were allocated to one of two groups treated via CMN (n=29) or SHS (n=27). Functional and radiological evaluations included mobility score, Harris Hip score, modified Barthel index, Singh index, tip-apex distance, and fracture settling. Results: Continuous improvement in the Barthel index was seen over the 12-month period in either group (p<0.05). The average mobility score was found to be decreased at the 6th week follow-up visits in either group (p<0.05). The fracture settling measurements in SHS group was higher than in CMN group (p<0.01). Conclusion: The clinical and radiological outcomes of both CMN and SHS groups showed no superiority of one technique over the other in the treatment of basicervical fractures of the femu [ABSTRACT FROM AUTHOR]

Aim: Bone marrow edema syndrome (BMES) describes nonspecific, ill-defined areas of hypo intense and hyper intense signal on T1 and T2 sequences, respectively. BMES has unknown etiology and resolves without sequel. In this study, we aimed to evaluate the initial clinical and radiological features and clinical course of patients with standing BMES. Method: We evaluated 19 feet of 17 patients who applied to our clinic between January 2014 and December 2016. X-Ray and MRI were taken in patients with clinical suspicion of BMES. Initial vitamin-D levels, hemogram, sedimentation, C-reactive protein (CRP), rheumatoid factor (RF) and Anti-CCP values of patients were evaluated. After the diagnosis, indomethacin and vitamin-D therapy and weight-bearing protection with double crutches was given for 6 weeks. Result: All patients mentioned that sudden onset of pain. The mean duration of symptoms was 7.12(2-20) months. Mean serum 25(OH)D level was 14 IU, sedimentation values were slightly higher in 7 patients, CRP, RF and Anti-CCP values were normal. BMES mostly detected in talus. The mean AOFAS score of the patients was 63 and the last control was 92. Conservative treatments should be considered as the first-line treatment option in BMES. Conclusion: The importance of laboratory tests in BMES should not be forgotten. Vitamin-D may play a role in the etiology of the disease. For that reason, patients need to be investigated in that way. [ABSTRACT FROM AUTHOR]

Introduction: In the present study, we identified factors affecting the outcomes of patients who underwent incomplete triple pelvic osteotomies due to acetabular dysplasia. Methods: Data on a total of 58 hips in 50 patients for whom adequate data were available and who had undergone appropriate follow-up were retrospectively evaluated. We used Ömeroğlu scores for radiological evaluation, Harris Hip Scores for clinical evaluation, Tönnis scores to evaluate osteoarthritis progression and a modified Clavien-Dindo classification to evaluate complications. Results: The average patient age was 23.26 (14-47) years, and the average follow-up duration 105.59 (18-191) months. The complication rate was 10.3%, and complications negatively influenced clinical outcomes. Patients with radiologically poorer outcomes had more advanced osteoarthritis. We found minimal improvements in lateral centre edge angle (LCEA), refined centre-edge angle (RCEA), and lateral acetabulum head index (LAHI) were associated with osteoarthritis progression and that good improvements in LCEA, RCEA, acetabular angle (AA), and LAHI were associated with radiological outcomes. Neither patient age at the time of operation nor development of a postoperative relative crossover sign affected osteoarthritis progression or clinical or radiological outcomes. Conclusions: The most important factors influencing clinical outcomes were complications. However, neither postoperative acetabular retroversion nor a positive supra-equatorial crossover sign (often viewed as prognostically negative) directly affected clinical outcomes. When treating patients with acetabular dysplasia, either inadequate correction or overcorrection may negatively affect outcomes. In such patients, an incomplete triple pelvic osteotomy (allowing controlled correction) is both safe and effective. [ABSTRACT FROM AUTHOR]

Although there are major contributing factors causing developmental hip dysplasia, it is a well known fact that septic arthritis may cause hip subluxation, and developmental hip dysplasia. In this case report, a 28-day-old female patient whose ultrasonographic findings were found to be normal during neonatal period after detection of septic arthritis of the hip secondary to Candida spp., and who later developed hip subluxation of the affected hip is presented. It is emphasized that hip dysplasia, which is one of the rare complications of the septic arthritis, should be taken into consideration especially in patients with complaints of limping and yet the importance of close follow-up of patients with a history of septic arthritis for the risk of hip dysplasia and subluxation. [ABSTRACT FROM AUTHOR]

Treatment of reverse oblique trochanteric femoral fractures is still challenging. We present the results of our proximal nailing surgery performed for reverse obliquity intertrochanteric fractures using two lag screws and evaluated the quality of the reduction, operative time, complications and functional status of the patients. Fifteen patients with AO/OTA 31 A-A3 fractures were treated by proximal femoral nailing in our trauma centre. The mean Harris hip score was 74.66 (range 65-96) and the mean Barthel activity score was 15.71 (range 12-20). The mean duration of surgery was 48 minutes and the average consolidation time was 8.6 weeks. No intraoperative complications or postoperative technical failures and no stress shielding as evidenced by the lack of cortical hypertrophy at the level of the tip of the implant were detected. Intramedullary nailing with proximal femoral nails may be a good option in the treatment of reverse obliquity intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Objective: The Lisfranc complex is an osseo-ligamentous structure consisting of multiple tarsal and metatarsal bones, joints, and ligaments. The transarticular screw method is the most commonly preferred fixation technique in patients with Lisfranc injury. However, screw breakage complications can be seen with a considerable frequency. Although there are studies in the literature that associate the risk of screw breakage with the diameter or structure of the screw used, there is still no consensus. The aim of this study is to predict the risk of screw breakage by examining many parameters. Methods: We retrospectively evaluated 61 patients with lisfranc injuries who underwent transarticular fixation with screws of different diameters and properties. We found screw breakage complications in 9 (14.7%) of the patients. Some demographic and radiological parameters were examined to predict screw breakage in these patients. Age, gender, weight, diameter and structure of the screw used, presence of accompanying cuneiform, cuboid or metatarsal base fracture, how many tarsometatarsal joints were involved and whether anatomical reduction was achieved. In addition, the development of post-traumatic arthrosis during the 2-year follow-up, and the American Orthopedic Foot and Ankle Association (AOFAS) -Middle Foot Score and Visual Analogue Scale (VAS) scores were also compared in clinical evaluations. Results: We could not find any radiological or demographic parameter that could predict the screw breakage complication in the results. We found only that post-traumatic arthritis was significantly more common in patients with screw breakages. We also found that there was no significant difference in AOFAS-midfoot and VAS scores in patients with or without screw breakage complications. Conclusion: In the transarticular screw fixation of Lisfranc injury; screw's diameter, cannulated or solid structure, the presence of accompanying tarsal or metatarsal injuries and the reduction quality of the injured anatomic structures do not pose any risk factors for the screw breakage complication. [ABSTRACT FROM AUTHOR]

Background: Tenosynovial giant cell tumor (TSGCT) originates from the synovial cells of the tendon sheath and is the most common soft tissue tumor of the foot and ankle. Due to the lack of clinical data about TSGCT in the foot and ankle, this study was performed with the aim of investigating the clinical characteristics, and surgical outcomes that might predict the likelihood of recurrence.Methods: Clinical data, obtained from the pathology records and the clinic files, along with the tumor subtype, local recurrence, and patient functional status among 26 cases of TSGCT were evaluated with the mean 73 months follow-up period.Results: There were 26 patients including 16 males and 10 females with a mean age of 40 years, who underwent surgery. There were 15 localised TSGCT and 11 diffuse TSGCT. The diffuse TSGCT was more likely to be in the hindfoot dorsum (54,5%, 6/11). The localised TSGCT was mostly located in the forefoot (80%, 12/15). The recurrence rate in the diffuse TSGCT was 27,3% (3/11). In the localised TSGCT, recurrence was seen in 6,6% of patients (1/15). The mean AOFAS score was 79.Conclusion: Diffuse TSGCT is more likely to occur in the hindfoot and localised TSGCT is more common in the forefoot. Excision with clear margins is an effective treatment for TSGCT, with good oncological and clinical outcomes. But the orthopaedic surgeons should consider the equilibrium between surgical margins and the functional status of the patient. [ABSTRACT FROM AUTHOR]

Background: Tenosynovial giant cell tumor (TSGCT) is the second most common benign tumor of the hand. Even though it is a benign lesion there is still a high incidence of local recurrence (range, 7%–44%) according to data in published papers. In this study, the clinical and epidemiological features of 173 patients who underwent excision of localized TSGCT, the recurrence rates and possible reasons for recurrence were examined in the light of current literature. Methods: Medical records of 173 patients with TSGCT were reviewed. Data on demographic characteristics as well as clinical and intraoperative findings were collected. Patients were asked about the recurrence of the TSGCT and the QuickDASH scoring was applied at the final clinical evaluation after mean follow-up of 81 months. Results: Females were predominantly involved (73%). Patients aged mean 44 years at the time of surgery. There were 93 tumors in flexor zones and 80 tumors in extensor zones of the hand. Of the tumors with flexor zone localization, zone II was most predominantly involved with 46 tumors, and 18 of these were on the index finger. The extensor zones III and IV were mostly involved with 9 tumors each on the middle and ring fingers. A total of 12 recurrences (6.9 %) were determined over the mean follow-up period of 81 months. Conclusions: The characteristics of our patients identified were similar to the previous studies. Surgical excision provides good outcomes in the treatment of TSGCT especially when clear margins are obtained. [ABSTRACT FROM AUTHOR]

Patients with Lisfranc fractures may regain functional status after anatomical fixation, but they may experience sequelae such as flatfoot deformity and pain associated with foot pressure distribution during weight-bearing. What is the impact of Lisfranc fracture sequelae on both the injured and uninjured sides, and how does the antipronation taping affect plantar pressure distribution parameters? Twenty-six patients who underwent anatomical fixation for Lisfranc fracture, displaying pronation on the injured side based on the Foot Posture Index-6 test, as well as 15 healthy subjects, participated in this study. Plantar pressure distribution measurements were conducted during barefoot walking for the healthy subjects. In the patient group, measurements were taken under two antipronation taping conditions (kinesio and rigid taping), as well as during barefoot walking. Participants who received anatomical fixation after Lisfranc fracture exhibited significant alterations in plantar pressure distribution parameters on both the injured and uninjured sides, as compared to the control group. After the application of Kinesio Taping to the injured side, there was no significant change observed in the plantar pressure distribution values (p > 0.05). The analysis of the rigid taping on the injured side revealed statistically worse values in peak pressure of the hindfoot (p = 0.027) and maximum force of the midfoot and toes (p = 0.005 and p = 0.013, respectively) compared to the injured barefoot condition. Lisfranc fracture sequelae affected plantar pressure distribution on both injured and uninjured sides. Anti-pronation taping (kinesio and rigit), commonly used for foot conditions, did not lead to foot pressure distribution becoming more similar to that of the control group. • Anti-pronation foot taping didn't align with control pedobarographic data. • Lisfranc fracture sequelae in one foot affect pressure distribution in both feet. • Need for new methods to tackle Lisfranc's structural concerns. [ABSTRACT FROM AUTHOR]

Glomus tumors are rare, slow-growing vascular tumors that are uncommon in the foot or ankle. This case series describes 2 glomus tumors located in the hallux, 1 in the foot, and 3 in the ankle. One case was misdiagnosed and initially mistreated at another facility, radiographs were not diagnostic in any of the cases, and magnetic resonance imaging was diagnostic in only 2 cases. Surgical treatment was ultimately successful in all cases. It is hoped that this series may help to raise awareness of glomus tumors among foot and ankle surgeons. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aims to identify the physical examination tests most indicative of bone injury in patients with clinically suspected occult scaphoid fractures. Methods: Ten physical examination manoeuvres were performed on 41 patients with a history of a fall on an outstretched hand and tenderness at the anatomical snuffbox and scaphoid tubercle without a radiographically visible fracture line. The results of wrist examination and subsequent magnetic resonance imaging (MRI) were recorded. The sensitivity, specificity, positive and negative predictive values, accuracy and likelihood ratio of the physical examinations were calculated for the patients who had bone injury confirmed by MRI. Results: The distribution of MRI-confirmed conditions was as follows: 13 cases—no bone involvement; 12 cases—scaphoid fractures; 9 cases—fissures at the distal end of the radius; 6 cases—bone-bruise and 1 case—triquetral fracture. The symptoms most indicative of bone injuries were ‘pain during pinching by the thumb and index fingers’ and ‘pain during pronation of the forearm’. Conclusion: The two above-mentioned manoeuvres were most indicative of bone injury in patients with clinically suspected occult scaphoid fracture. These examinations may reduce the number of unnecessary MRI examinations. [Copyright &y& Elsevier]

We investigated whether a proximal femoral nail (PFN) having two lag screws can be implanted without distal locking screws in AO/OTA 31-A1 and 31-A2 intertrochanteric femur fractures. Twenty-four patients with AO/OTA 31-A1 and 31-A2 fractures were treated with a PFN without distal interlocking by a single surgeon. The mean follow-up was 12 months (range: 7-23). Clinical and functional outcome was assessed according to the Harris hip score and Barthel's activity score. The fractures healed in all patients; the average consolidation time was 14 weeks (range: 9-28). Fourteen patients had excellent and good results, nine patients had fair results, and one patient had a poor result according to the Harris hip score; 17 patients had a high range of mobility according to the Barthel activity score. Our results suggested that the PFN can be successfully implanted without distal interlocking in 31-A1 and 31-A2 fractures. [ABSTRACT FROM AUTHOR]

Chronic old unreduced anterior dislocations are extremely rare. We report a case of 75-year-old lady who was seen in policlinic with the symptoms of severe pain and limited shoulder range of motion in which radiographies revealed anteroinferior missed shoulder dislocation. Open reduction with Bankart repair was done, and patient was able to return her daily activities 6 weeks after the operation. To us, if the shoulder was found to be instable after reduction, anteroinferior glenohumeral ligament tear should be looked for, and if it exists should be repaired. [ABSTRACT FROM AUTHOR]

The treatment of unstable trochanteric femoral fractures is still challenging, and the proximal femoral nails are becoming more commonly used. The proximal femoral nailing is usually performed on a fracture table under traction which is associated with some possible complications. In our study, we tried to present the results of proximal nailing surgery performed in the lateral decubitus position and manual traction on a radiolucent table without the fracture table traction. [ABSTRACT FROM AUTHOR]

Freiberg’s disease usually affects the second and, less commonly, the third metatarsal heads [Helal and Gibb in Foot Ankle 8(2):94–102, 1987]. It was mainly observed unilaterally in adolescent females (F/M: 3/1–4/1) (Hay and Smith in The Foot 2:176–178, 1992). Bilateral occurrence and adjacent metatarsal involvement has been previously reported separately [Maresca et al. in Arthroscopy 12(1):103–108, 1996; Rafee et al. in Foot Ankle Surg 12:153–155, 2006]. The cases presented here involve two female patients aged 42 and 72 with bilateral Freiberg’s disease in both the second and third metatarsal heads. To our knowledge, this is the first report of such involvement of both the second and third metatarsal heads. [ABSTRACT FROM AUTHOR]