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Objective: This study aims to evaluate the impact of the pathogen's sensitivity to the loaded antibiotics on infection resolution, the number of revisions, and the associated costs in patients undergoing revision total knee arthroplasty (rTKA) due to PJI., Material and Methods: We reviewed the treatment and follow-up processes of 61 patients who underwent rTKA for late-stage PJI following primary total knee arthroplasty in our clinic. The study included 11 patients in the resistant group and 50 in the sensitive group in line with the power analysis results. Patients' demographic characteristics and comorbidities were recorded. All patients received dual antibiotic-loaded cement. Microbiological examinations of patients were analyzed, and the number of revision surgeries each patient underwent was determined. We analyzed all surgeries related to infection treatment, including open irrigation, debridement, polyethylene exchange, implant extractions, antibiotic-loaded cement spacer placements, spacer changes, and debridements, and the implantation of revision prostheses, including tumor prostheses. The total number of surgeries each patient underwent was recorded. We also reviewed hospital system records of total protocol costs during patient admissions., Results: Of 61 patients undergoing revision total knee arthroplasty (rTKA) for periprosthetic joint infection, 11 had antibiotic-resistant infections and 50 had antibiotic-sensitive infections. The groups had similar demographics. Polymicrobial infections were more frequent in the resistant group (p = 0.017), with all resistant cases showing gentamicin resistance and two showing teicoplanin resistance. The resistant group required more surgeries (average 3.91 ± 2.7 vs. 2.34 ± 1.3, p = 0.043) compared to the sensitive group, with teicoplanin resistance doubling revision surgeries (p = 0.005). Costs were similar between groups, averaging $6536.96. Gram-negative infections led to more revisions (p = 0.013). Polymicrobial infections did not significantly affect the number of surgeries or costs compared to single strain infections., Conclusions: Our study demonstrates that in rTKA surgeries using dual antibiotic-loaded bone cement, infections caused by antibiotic-resistant microorganisms are more challenging and time-consuming to treat. This underscores the necessity of exploring new methods to enhance local efficacy by loading cement with antibiotics based on specific pathogen culture and sensitivity results, while also providing clinical evidence of the effectiveness of current treatment methods against sensitive microorganisms., Level of Evidence: Level 3 (a retrospective cohort study)., Competing Interests: Declarations. Conflict of interests: All the authors declare no conflict of interest. Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. Ethical approval: Application Date: 26.03.2024. Approval Number: E-83045809–604.01–1001730. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical committee approved the study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Shoulder septic arthritis is a severe infection of the shoulder joint, commonly caused by bacteria such as Staphylococcus aureus . It leads to inflammation, severe pain, swelling, and reduced mobility in the affected shoulder. The condition is typically diagnosed through clinical evaluation, blood tests, imaging studies, and joint aspiration. Prompt treatment, usually involving antibiotics and sometimes surgical intervention, is crucial to prevent joint destruction and other serious complications. Necrotizing fasciitis of the upper extremity is a rapidly progressing, life-threatening bacterial infection that affects the fascia - the connective tissue surrounding muscles, nerves, and blood vessels. This condition is characterized by severe pain, swelling, erythema, and tissue necrosis. Commonly caused by bacteria such as Streptococcus pyogenes , it requires immediate medical attention. Diagnosis is often based on clinical evaluation, imaging, and laboratory tests. We discuss the surgical treatment of a patient referred to our clinic with a preliminary diagnosis of septic arthritis and a history of chronic lymphocytic leukemia that had been untreated and not followed up. During the examination, we also considered the possibility of gas gangrene in the arm and forearm., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ozturk et al.)

Background: In primary total knee arthroplasty (TKA) surgeries, the medial parapatellar (MP) and subvastus (SV) approaches are frequently employed. The SV approach involves preserving the vastus medialis muscle, leading to debates about the possibility of earlier healing of the extensor mechanism. Shear wave elastography (SWE) is known for monitoring tissue healing. In this study, our research question revolves around whether there exist differences in tissue healing following MP and SV approaches. Unlike previous studies, we aim to investigate this difference using solely SWE, which provides a quantitative measurement specifically targeting the vastus medialis muscle., Methods: We divided 17 patients into two groups: SV (10 patients) and MP (7 patients). SWE measurements and clinical scores were recorded before surgery and at the 3rd-month follow-up. The first straight leg raising days were also recorded., Results: Both the MP and SV groups showed significant improvement in clinical scores postoperatively. Straight leg raising time was comparatively earlier in the SV group, but no significant difference was found. SWE measurements revealed similar recovery values in the vastus medialis muscle between the two groups., Conclusion: Both MP and SV approaches demonstrate similar and favorable early outcomes in TKA surgery. The preservation of the vastus medialis in the SV approach does not lead to significant differences in clinical scores or muscle recovery compared to the MP approach., Trial Registration: The study was retrospectively registered on ClinicalTrials.gov on March 7, 2024 (NCT06297746). https://classic., Clinicaltrials: gov/ct2/show/NCT06297746?id=am7mi3VB&draw=2&rank=1 ., Competing Interests: Declarations. Ethical approval: This study was performed following the principles of the Declaration of Helsinki. The study protocol was approved by the Istanbul University - Cerrahpaşa, Clinical Research Ethics Committee (Application code: am7mi3VB). Informed consent: Informed consent was obtained from all individual participants included in the study. Permission to publish was obtained from all participants. Conflict of interest: All authors declare that they have no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Periprosthetic joint infection (PJI) is a rare but most vital complication after joint arthroplasty and requires a revision surgery. Synovial fluid analysis is essential in diagnosis of the PJI, and conventional and molecular microbiologic investigations may help in determining the cause of the infection. With this unusual case, we aimed to present the second instance in the literature of PJI of the knee caused by Streptococcus dysgalactiae subspecies dysgalactiae (SDSD). S. dysgalactiae PJI in the literature are commonly Streptococcus dysgalactiae subspecies equisimilis (SDSE), and SDSD mostly infects animals. A farmer with comorbid illnesses who works with cattle and sheep experienced periprosthetic knee joint infection caused by SDSD. Surgical excisional debridement with open washing, decompression, and liner exchange were performed. The identification of the bacteria was done with VITEK MS as SDSD. After 1-year follow-up, the patient has fully recovered without recurrence., Competing Interests: Conflict of interestsAll the authors declare no conflict of interest., (© Indian Orthopaedics Association 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Aspergillus fumigatus is a saprophytic fungus encountered as a pathogen in airborne lung infections. Although it commonly causes pulmonary infectious diseases, when disseminated, it may cause a systemic infection termed invasive aspergillosis, which is associated with high mortality and morbidity. Virtually, all organ systems may be involved. However, the musculoskeletal system is relatively uncommon. Here, we present a case of invasive aspergillosis in an immunocompromised patient involving the wrist joint, an exceedingly rare site. Our treatment choice is serial open debridement, irrigation, and intravenous antibiotics. This case study exemplifies the potential challenges in the identification and treatment of such an uncommon clinical condition. A thorough clinical and microbiological evaluation is essential for accurate diagnosis of fungal septic arthritis of the wrist. Aggressive early surgical treatment combined with appropriate early intravenous antibiotics is crucial for eradicating joint infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Taskin et al.)

Purpose: This study aimed to assess the impact of fixation on functional and radiological outcomes of ankle fractures involving the posterior malleolus. We hypothesized that fixation of the posterior malleolus would be associated with improved radiological and functional outcome., Methods: A prospective randomized controlled study was planned and 40 consecutive ankle fractures involving middle-sized (10-25%) posterior fragment were included. Posterior fragments in Group 1 were not fixated while Group 2 underwent posterior malleolus fixation. The patients were evaluated both functionally and radiologically at minimum 2-years., Results: Demographics and fracture type distributions were similar between the groups. Despite the slightly better functional outcome in Group 2, no significant functional or radiological outcome difference could be detected. Articular step-off> 1 mm was more common in Group 1 (p = 0.04) and the patients with articular step-off showed significantly worse functional outcome in all functional parameters (p < 0.05). Radiological and functional outcome parameters were positively correlated when all patients were evaluated together. Lateral radiographs caused an overestimation in the size of posterior fragment compared to CT (p < 0.001)., Conclusion: Although there was a slightly better clinical outcome in patients with fixed posterior fragments, it was not significant at short to mid-term follow-up. However, posterior fragment fixation contributed to functional outcomes by decreasing the incidence of articular step-off> 1 mm, which was found to be a negative prognostic factor., Level of Evidence: Level I; prospective randomized controlled study., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

In this study, a biological conduit, consisting of an adipocyte-derived mesenchymal stem cell (AdMSCs) sheet and amniotic membrane (AM), was designed for the reconstruction of peripheral nerve defects. To evaluate the effect of the produced conduit on neural regeneration, a 10-mm sciatic nerve defect was created in rats, and experiments were carried out on six groups, i.e., sham control group (SC), negative control group (NC), nerve autograft group (NG), the biological conduit (AdMSCs + AM) group, the commercial PGA tube conduit (PGA) group, and the conduit only consisting of AM (AM) group. The effects of different nerve repair methods on the peripheral nerve and gastrocnemius muscle were evaluated by functional, histological, and immunohistochemical tests. When the number of myelinated axons was compared between the groups of AdMSCs + AM and PGA, it was higher in the AdMSCs + AM group (p < 0.05). The percentage of gastrocnemius collagen bundle area of AdMSCs + AM group was found to be statistically lower than the PGA group (p < 0.05). The muscle fiber diameter of AdMSCs + AM group was lower than that of the NG group, but significantly higher than that of the PGA group and the AM group (p < 0.001). Muscle weight index was significantly higher in the AdMSCs + AM group compared to the PGA group (p < 0.05). It was observed that nerve regeneration was faster in the AdMSCs + AM group, and there was an earlier improvement in pin-prick score and sciatic functional index compared to the PGA group and the AM group. In conclusion, the biological conduit prepared from the AdMSCs sheet and AM is regarded as a new biological conduit that can be used as an alternative treatment method to nerve autograft in clinical applications., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This study focused on the anatomical characteristics and variations of intercostobrachial (ICBN) nerve and median nerve to investigate the possible use of ICBN in restoration of sensory damage of hand after traumatic median nerve injury and to evaluate the feasibility of ICBN neurotization to median nerve., Methods: Variations of ICBN were noted in 16 axillary region dissections of eight cadavers. Measurements for ICBN's suitability in terms of neurotization to brachial plexus were done with millimetric devices. The distance of ICBN to the distal end of the lateral (LCMN) and medial (MCMN) contributions of the median nerve and the diameters of ICBN, LCMN, and MCMN were measured., Results: Fifteen axillary dissections exhibited ICBN, whereas it was absent on the left side of one of the cadavers. The mean diameter of ICBN at its origin was 2.0±0.7 mm and the mean diameter of ICBN at its coaptation point was 3.1±0.9 mm. The mean diameter of the LCMN was 3.9±2.0 mm, the mean diameter of MCMN was 3.5±0.9 mm. The length of ICBN was found to be adequate at both 45 and 90° of shoulder abduction to be extended to both LCMN and MCMN. The diameters of LCMN and MCMN were not significantly correlated with the diameter of ICBN both at origin and at coaptation point (LCMN: p=0.55-0.63 and MCMN: p=0.89-0.85). There is no significant difference between the diameter of LCMN and the diameter of ICBN at its coaptation point (p=0.168) and also between the diameter of MCMN and the diameter of ICBN at its coaptation point (p=0.232)., Conclusion: All ICBNs dissected showed adequate length to reach the lateral and medial contribution of the median nerve directly. The ICBN could be a feasible candidate since its diameter was close to LCMN and MCMN according to the descriptive and inferential statistics.

Congenital hypertrophy of intrinsic foot muscles is a rare condition. We report an unusual case of a 24-year-old male with a painless swelling at the plantar and medial aspect of the right foot, which was present since birth. The significant size of deformity and discomfort in wearing shoes were major concerns. MRI revealed expansion of multiple intrinsic foot muscles, which are abductor hallucis, flexor digitorum brevis, and quadratus plantae. We used shear wave elastography (SWE) as an imaging technique besides MRI and ultrasonography, which has not been used or published previously. Muscle shear wave velocity values were measured in abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, and quadratus plantaris muscles. The mean stiffness values of muscles on the affected side were significantly higher compared to the healthy side. The median SWE value was 6.67 kPa (range: 4.7-8.6 kPa) on the healthy side, while it ranged between 9.2 and 13.4 kPa on the affected side. Total excision of abductor hallucis and subtotal resection of flexor digitorum brevis and quadratus plantae muscles were performed, and motor and sensory functions were preserved by protecting the neurovascular bundle. Excess skin was also removed. Surgery and postoperative course were uneventful. The patient was allowed to bear weight as tolerated. There was no recurrence, and the patient was satisfied with the shape and size of his foot at the six-month follow-up. Congenital hypertrophy of foot muscle is uncommon especially when multiple intrinsic foot muscles are involved. The main aim is to relieve patients' concerns, correct deformities, and provide comfortable shoe wear., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Tuncer et al.)

PURPOSE OF THE STUDY Cementless stems in highly dysplastic hips are considered to increase the risk of femoral fracture and associated morbidity. Several authors speculated to use prophylactic cabling in this patient group to prevent intraoperative fractures. This study aims to reveal objective results regarding the perioperative complications in a large and consecutive patient group with respect to use of prophylactic cabling. MATERIAL AND METHODS A retrospective comparative study was planned. A total of 122 consecutive patients with dysplastic hips of Crowe type 3 or 4, operated on with total hip arthroplasty (THA) and shortening osteotomy using a rectangular femoral stem were included. Patients were stratified according to use of a diaphyseal prophylactic cerclage cable. Perioperative complications were recorded. Clinical outcome was measured in terms of Harris Hip Score and Visual Analog Scale (VAS) for pain. All results were compared between the groups. RESULTS The mean follow-up time was 27 months. Two (2%) versus five (14%) patients had a fracture at the diaphyseal level in cabled versus non-cabled groups. Difference between groups was statistically significant (p=0.01). Relative risk of fracture in case of a non-cabling was 5.8 (p=0.03). Eleven (9%) patients had a non-displaced fracture at the metaphyseal level. No significant differences were detected with respect to preoperative clinical outcome scores or change in these scores between groups. CONCLUSIONS Femoral diaphyseal fracture rates are low when cementless, rectangular stems are used in dysplastic high riding hips. Prophylactic cerclage cabling further decreases the fracture risk and eases treatment in case of a fracture without causing additional complications and therefore is recommended. Key words: intraoperative fracture, periprosthetic fracture, total hip arthroplasty, cerclage cabling, developmental hip dysplasia, transverse shortening osteotomy.

Background: There is limited information about the effect of hip center location on gait parameters of knee and ankle. This study aimed to compare anatomical vs. high hip center arthroplasty according to gait parameters of knee and ankle and investigate whether the high hip center has any adverse effect on these joints or not., Methods: 20 patients who underwent unilateral total hip arthroplasty (Group 1; 10 patients with anatomical reconstruction, Group 2; 10 patients with high hip center) due to Crowe type III-IV developmental dysplasia of the hip and completed 2 years of follow-up were included. The patients were examined by 3-D gait analysis., Findings: The maximum extension of the knee on the operated side was lower in Group 2 (p = 0.044). Longitudinal knee joint force was higher in Group 2 on both operated (p = 0.041) and non-operated sides (p = 0.031). Lateral knee joint force was also higher in Group 2 (p = 0.023). No significant difference was detected in ankle parameters., Interpretation: Unilateral high hip center has been shown to restrict the dynamic knee range of motion on the operated side and increase the knee load on both sides, thus putting the knees at risk for osteoarthritis., Level of Evidence: Level III, Retrospective comparative study., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: This study aims to compare clinical and radiological follow-up results of a rectangular (SL-Plus®) or a round (Synergy®) femoral component in patients with Crowe type 2 or 3 hip dysplasia operated with total hip arthroplasty (THA) without a shortening osteotomy., Patients and Methods: Between January 2012 and December 2017, a total of 34 hips of 30 female patients (mean age: 42.9±11.6 years; range, 24 to 66 years) were retrospectively analyzed. All patients were evaluated using the Harris Hip Score (HHS) and Visual Analog Scale (VAS) for pain pre- and postoperatively. Intra- and postoperative complications were noted. Evaluation criteria included leg length discrepancy, stem subsidence, bone atrophy or hypertrophy around the stem according to Gruen zones, operative time, and intraoperative blood loss. Correlation analysis of radiological, clinical findings, and stem size was performed., Results: The mean follow-up was 61.3±27.2 months. The mean postoperative HHS was 89.3±6.2 vs. 93.1±9.1, and the mean VAS score 1±0.6 vs. 1±0.8 in round and rectangular stem groups at the final follow-up. No significant differences were detected between the groups in any of the evaluated parameters, except for a more severe degree of stress shielding observed in the round stem group. Round stem size was positively correlated with a more severe stress shielding (r=0.55, p=0.020). No patient had to be revised during the follow-up period. The overall complication rate was 9%., Conclusion: Successful and comparable results can be obtained with cementless THA in patients with high riding dysplastic hips implanting either of the femoral components, a rectangular or a round stem. Although the round stem was associated with more common proximal stress shielding, this was not associated with worse clinical outcomes.

D-dimer is a fibrin degradation product formed by the destruction of the cross-linked fibrin clot by activation of the coagulation system. Many studies have shown that systemic and local infections cause fibrinolytic activities. The purpose of this study was to determine the role of serum D-dimer in the diagnosis of periprosthetic joint infection (PJI) and the timing of reimplantation. The patients who underwent primary and revision knee or hip arthroplasty between July 2018 and May 2019 were prospectively evaluated. All surgeries were performed by the same surgeon. 60 of 71 patients who met our criteria were included in the study, comprising of 27 primary arthroplasties (PA), 21 two-stage septic revision (SR) and 12 aseptic revision (AR). We analyzed D-dimer, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. The values of the septic group were evaluated as two groups; Group 1 (before the first stage) and Group 2 (before the second stage) to investigate the role of D-dimer in determining the timing of reimplantation. D-dimer level was significantly higher in the SR group compared to PA and AR groups (p<0.001 and p=0.045). CRP and ESR levels were significantly higher in the SR group compared to PA and AR groups. There was no statistically significant difference between preoperative D-dimer levels of Group 1 and Group 2 (p=0.2). Serum D-dimer level can be used as an easy and inexpensive test to support the diagnosis of PJI. But the D-dimer level is not useful to determine the timing of reimplantation.

Introduction: Numerous tests are being evaluated in order to aid the diagnosis of periprosthetic infections since it is a complicated and sometimes inconclusive process. The purpose of this study was to assess the diagnostic performance of platelet count to mean platelet volume ratio as a tool to aid the diagnosis of periprosthetic joint infections. The investigated questions were: "Is platelet count/mean platelet volume ratio more sensitive or specific than C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) in the diagnosis of periprosthetic joint infections?" and "Does platelet count/mean platelet volume ratio increase the accuracy of periprosthetic joint infection diagnosis?"., Hypothesis: Platelet count/mean platelet volume ratio increases the accuracy of periprosthetic joint infection diagnosis., Materials and Methods: This study was performed retrospectively on patients who underwent revision hip or knee arthroplasty between 2016 and 2019. 62 patients with 33 aseptic (AR) and 29 septic revision (SR) who met our inclusion criteria were included. The sensitivity, specificity and diagnostic performance of CRP, ESR and platelet count/mean platelet volume values were analyzed and compared., Results: The demographic characteristics were similar between groups. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly encountered microorganisms, while seven patients had negative cultures in SR group. ESR, CRP and platelet count/mean platelet volume values were significantly higher in SR group compared to AR group (p<0.01). ROC analysis for platelet count/mean platelet volume ratio revealed a cut-off value at 35.3 which provided 75.9% sensitivity and 78.8% specificity for periprosthetic joint infections. Platelet count/mean platelet volume ratio yielded lower sensitivity and similar specificity compared to ESR and CRP values. Platelet count/mean platelet volume had a lower area under curve value, indicating a poorer diagnostic performance compared to ESR and CRP., Discussion: The diagnostic performance of platelet count/mean platelet volume ratio is low and current findings do not support its usage to increase the accuracy of periprosthetic joint infections diagnosis., Level of Evidence: III; diagnostic case-control study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction and Objective: Total hip arthroplasty with rectangular femoral component and transverse osteotomy for patients with Crowe type 3 or 4 dysplasia yields successful results with varying radiological findings. This study aims to investigate the surgery and patient related factors associated with successful clinical and radiological results., Patients and Methods: Fifty hips of 41 patients were retrospectively examined. Length and percentage of the stem passing the osteotomy level and canal fill ratio were measured. Radiological findings such as radiolucent lines (RL) around the stem, hypertrophic callus or an identifiable osteotomy line on X-ray images were assessed. All clinical and radiological results were analyzed for any significant association., Results: Mean stem length and percentage passing the osteotomy level were 6.4 cm (± 0.7) and 51% (± 6). Presence of an identifiable osteotomy line was positively associated with the increasing length of the stem passing the osteotomy level and with a lower HHS (p < 0.05). RL around the stem were associated with a lesser reduction in VAS score (p < 0.05)., Conclusion: Rectangular femoral stem conveniently accommodate the proximal femur in severely dysplastic hips. An upper limit for the femoral stem exists to obtain better bony union and higher HHS. RL around the stem are clinically relevant and is associated with a worse VAS score at the latest follow-up.

Background: Total hip arthroplasty (THA) involving shortening osteotomy for patients with Crowe type 3 or 4 dysplasia is a challenging surgical procedure. This study aims to demonstrate that rectangular femoral component use in anatomical reconstructions with THA and transverse shortening osteotomy yields successful results without the use of bone graft or any fixation material at the osteotomy site., Methods: Fifty hips from 41 patients were identified retrospectively as per study objectives. All patients were evaluated using the Harris Hip Score and Visual Analog Scale for pain. Complications were reported. Radiological evaluation criteria were then evaluated, including leg length discrepancy, degree of trochanter caudalization and stem subsidence, radiolucent and radiodense lines for both components and bone atrophy or hypertrophy around the stem according to Gruen zones, and the canal fill ratio of the stem., Results: Postoperative Harris Hip Score was excellent for 68% of patients. No patient had poor results. Complication rate was 32%. One patient had nonunion (2%). The mean postoperative leg length discrepancy was 0.8(±0.6) cm. No patient had a subsidence of more than 5 mm. Radiolucent and radiodense lines were present in up to 34% of patients, and bone atrophy was present in the proximal femur in up to 96% of patients. No patient had osteolysis or loosening in neither component., Conclusion: Successful clinical and radiological results can be obtained from Crowe type 3 and 4 dysplastic hips operated on with THA using a rectangular femoral component and transverse shortening osteotomy technique. The use of graft or any fixation material at the osteotomy site is not mandatory., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Aim: This study aimed to culturally adapt and validate the Turkish version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-TR) which primarily assesses the functional status of patients., Methods: The translation and cross-cultural adaptation of SMFA to Turkish was made by the standardized procedure and tested for clinimetric quality. The following analyses were made to evaluate clinimetric quality of the SMFA-TR: reliability with factor analysis and Chronbach's α (construct validity), correlations between SMFA-TR and Short Form (SF)-36 (concurrent validity), test-retest reliability (intraclass correlation analyses), floor and ceiling effects. The questionnaire was applied to 166 patients with musculoskeletal problems. All patients filled in the SMFA-TR and the validated Turkish SF-36 questionnaire. Forty-two patients returned to complete the same questionnaires at 10 days., Results: Factor analysis revealed a 4-factor structure of the SMFA-TR. Cronbach's α values were over 0.88 for both original subscales (dysfunction and bother) of the SMFA. Internal consistency (0.88-0.94) and test-retest reliability coefficients (0.90-0.98) were high for both subscales. Turkish SF-36 questionnaire conventional subscales showed significant correlations with SMFA-TR subscales. No floor or ceiling effects were found., Conclusion: The Turkish version of the SMFA was found to be reliable and valid for Turkish-speaking patients with musculoskeletal injuries or disorders., (© 2020 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: Challenges must be handled in an integrated manner when addressing food security and climate change. More efficient designs for food production systems, as well as their logistics, are needed in order to increase food production and to reduce emissions intensity. Specifically, any enhancements done on this purpose would contribute to mitigating climate change. Five important dimensions are being considered in smart agriculture: food security, availability, accessibility, utilization, and stability., Scope and Approach: Food supply-demand chain can seriously be effected by uncontrolled population growth. Thus, any perspective to solve these uncontrolled conditions can have a positive impact. Especially giving emphasis on reduction of food losses via expoloring various ways of production, or increasing productivity, or ensuring food security are effective ways for solutions. For example, the use of solar drying for agricultural, marine or meat products is very important for preservation, thus minimizing food losses. However, traditional sun drying is a relatively slow process. Also, the product quality worsens due to several factors: microorganism growth, enzymatic reactions, insect infestations. It is known that utilizing solar energy involves several factors that need attention. Thus, a lot of effort is directed toward improving solar energy technology for drying processes., Key Findings and Conclusion: This study presents a smart agriculture design for drying using low cost and highly-efficient solar selective absorber. The system is based on an air heating flat plate solar absorber. Levelized cost of heat (LCOH) for the prototype using solar renewable energy is calculated and compared with the fossil fuel energy sources; natural gas, electricity, and liquified petroleum gas (LPG). In addition; a comparison of the costs for air collectors using various selective absorbers; unglazed or glazed, is presented. It is shown that solar energy, in the long run, will be more advantageous compared to fossil fuels., (© 2020 Published by Elsevier Ltd.)

Background: Total hip arthroplasty in severe dysplasia is challenging due to diminished periacetabular bone stock and the highly placed femoral head. Although anatomical reconstruction of the hip, with required interventions such as subtrochanteric osteotomy and graft usage, is the main aim of the procedure, good long-term clinical outcomes of the high hip center technique have also been reported. Information regarding the effect of hip center placement on gait characteristics is limited; therefore, the aim of this study is to analyze the differences in gait parameters between the high hip center technique and anatomical reconstruction of the hip., Methods: Twenty patients (40 hips) with bilateral Crowe type III-IV developmental dysplasia of the hip who underwent bilateral total hip arthroplasty and completed at least 2 years of follow-up were included. Group 1 comprised 10 patients (20 hips) who underwent anatomical hip center reconstruction, while group 2 comprised 10 patients (20 hips) who underwent high hip center reconstruction. The gait characteristics of patients were examined through markers placed in certain anatomical regions, the cameras placed around, and the force plates embedded in the walking platform., Results: There was no significant difference in the gait characteristics according to the location of the hip rotation center. The mean temporospatial, kinematic, and kinetic values were similar between the groups. The most prominent difference was in the peak dynamic hip extension, which was lower in group 2 (-9.71° ± 7.46°) compared to group 1 (-6.80° ± 11.44°), although it was not statistically significant (P = .09)., Conclusion: The bilateral high hip center technique can provide similar gait characteristics as anatomical reconstruction and may be preferred in particularly difficult cases based on the surgeon's decision., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Recently, cell sheet engineering has emerged as one of the most accentuated approaches of tissue engineering and cardiac tissue is the pioneering application area of cell sheets with clinical use. In this study, we cultured rat cardiomyoblasts (H9C2 cell line) to obtain cell sheets by using three different approaches; using (1) thermo-responsive tissue culture plates, (2) high cell seeding density/high serum content and (3) ascorbic acid treatment. To compare the outcomes of three methods, morphologic examination, immunofluorescent stainings and live/dead cell assay were performed and the effects of serum concentration and ascorbic acid treatment on cardiac gene expressions were examined. The results showed that cardiomyoblast sheets were successfully obtained in all approaches without losing their integrity and viability. Also, the results of RT-PCR analysis showed that the types of tissue culture surface, cell seeding density, serum concentration and ascorbic acid treatment affect cardiac gene expressions of cells in cell sheets. Although three methods were succeeded, ascorbic acid treatment was found as the most rapid and effective method to obtain cell sheets with cardiac characteristics.

Background: Long-term favorable clinical outcomes of anatomical or high hip center techniques in total hip arthroplasty (THA) are reported in patients with developmental dysplasia of the hip (DDH). However, there is little information about the effect of the hip center location on gait characteristics. The purpose of this study was to compare these surgical techniques with gait analysis, analyze the effect of the hip rotation center location on gait parameters, and discuss the possible problems that may arise., Methods: A total of 40 patients who underwent THA due to unilateral coxarthrosis secondary to Crowe type III-IV DDH and completed 5 years of follow-up were included in the study. Group 1 included 20 patients who underwent anatomical hip center reconstruction, while group 2 included 20 patients who underwent high hip center reconstruction. Gait analysis was performed, and the groups were compared according to the gait characteristics., Results: The mean temporospatial values were similar between the groups. The extension of the operated side was significantly lower in group 2 (-9.11 ± 8.92) than in group 1 (-1.87 ± 11.51) (P = .04). The mean longitudinal hip joint force was found to be significantly higher in group 2 (8.92 N/kg ± 0.54) than in group 1 (8.16 N/kg ± 0.66) (P = .04). The high hip center technique has been shown to increase the load on the hip and restrict the dynamic range of motion., Conclusion: The high hip center technique can decrease the survival of the implant and increase the fall risk as it increases the load on the hip and reduces the dynamic range of motion. The hip center should be reconstructed anatomically when possible in DDH patients who undergo unilateral THA., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Fifth metacarpal fractures are the most common fractures of the hand. These fractures are generally treated with conservative methods. The aim of this study was to compare the radiological and clinical outcomes of two conservative treatment methods, functional metacarpal splint(FMS) and ulnar gutter splint(UGS), for the treatment of fifth metacarpal neck fractures., Methods: A prospective comparative study was designed to assess the conservative treatment of isolated and closed stable fractures of the fifth metacarpal neck. In total, 58 patients were included in the study and were treated with FMS or UGS after fracture reduction in a consecutive order. Angulation, shortening and functional outcome (QuickDASH scores and grip strengths) were evaluated at the 2nd and 6th months., Results: Forty patients returned for follow-up. Twenty-two patients were treated with FMS, and 18 patients were treated with UGS. The average age was 28 years (SD ± 12, range;18-43) in the FMS group and 30 years (SD ± 14, range;18-58) in the UGS group. After reduction, significant correction was achieved in both groups, but the average angulation was lower in the FMS group(16 ± 7) compared with the UGS group (21 ± 8)(p = 0.043). However, this better initial reduction in FMS group(16 ± 7) could not be maintained in the 1st month follow-up (21 ± 5) (p = 0.009). In the FMS group, the improvement in QuickDASH scores between the 2nd and 6th month follow-up was significant (p = 0.003) but not in the UGS group(p = 0.075). When the expected grip strengths were calculated, the FMS group reached the expected strength values at the 2nd month follow-up, whereas the UGS group still exhibited significantly lower grip strength at the 2nd month follow-up(p = 0.008). However, at the end of the 6th month follow-up, both groups exhibited similar reduction, QuickDASH and grip strength values., Conclusions: In stable 5th metacarpal neck fractures, FMS is adequate to prevent loss of reduction and yields faster improvement in clinical scores with earlier gain of normal grip strength compared with UGS. However, in the long term, both FMS and UGS methods yield similar radiological and clinical outcomes. Patient comfort and compliance may be better with FMS due to less joint restriction, and these findings should be considered when deciding the treatment method., Trial Registration: ISRCTN79534571 The date of registration: 01/04/2019 Type of study/level of evidence: Therapeutic, II.

Objectives: This study aims to assess the effect of shear-wave elastography (SWE) on vastus medialis obliquus (VMO) and vastus lateralis (VL) muscle performances and functional outcomes of patients with patellofemoral pain syndrome (PFPS) undergoing non-selective open kinetic chain exercises (NSOKCE) and selective open kinetic chain exercises (SOKCE)., Patients and Methods: This randomized-controlled clinical trial included a total of 40 patients with PFPS (20 males, 20 females; mean age 46.5±9.8 years, range, 27 to 65 years) and 40 healthy controls (20 males, 20 females; mean age 36.3±11.2 years, range, 23 to 71) between February 2013 and August 2014. The participants in each group were randomized into subgroups according to NSOKCE or SOKCE for six weeks. The VMO and VL muscles were assessed with the SWE, thigh circumferences were measured, and the Visual Analog Scale (VAS) and Lysholm Knee Scale (LKS) scores were obtained., Results: The OKCE alleviated pain, improved LKS scores, and increased the thigh circumference in PFPS patients. While the healthy controls were able to increase the resting muscle tone of their VMO, the patients with PFPS failed in their both knees. Similarly, resting as well as contracted VMO and VL muscles' functions were improved significantly by both NSOKCE and SOKCE in the healthy controls. The NSOKCE improved the VAS scores in the PFPS group. The increase in the muscle mass of the affected sides of PFPS patients were more evident with NSOKCE., Conclusion: Our study results show that NSOKCE planning can be preferred over SOKCE, thanks to its contribution to pain improvement and increase in the thigh circumference in the conservative treatment of PFPS., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Background: The radial head is essential for the rotational stability of the forearm and resistance to valgus stress. Radial head fractures are the most common elbow fracture in adults. Various treatment options are available, depending on the fracture severity. However, the treatment of Type-III fractures is controversial. The aim of this study was to evaluate functional results in patients with irreparable Mason Type-III radial head fractures treated with radial head resection or prosthesis., Methods: Fourteen irreparable Mason Type-III radial head fracture patients treated with radial head resection (n=7) or radial head prosthesis (n=7) were evaluated in this multicenter, retrospective study. Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow and Wrist scores were used to determine clinical outcomes. A hydraulic hand dynamometer was used to measure grip strength on the operated and unoperated sides to avoid potential bias. Measurements were made three times for each extremity, and the mean value was recorded. Grip strength was calculated as a percentage of the strength of the unoperated side., Results: Functional outcomes for resection and prosthesis patients were the following: mean DASH scores, 25.8 and 17.2; mean Mayo Elbow scores, 74 and 84.1; mean Mayo Wrist scores, 84 and 92.5; and maximum grip strengths, 48.8% and 77.8%, respectively. The range of motion of the respective resection and prosthesis groups were as follows: flexion, 112.14° and 104.29°; extension, -10.00° and -25.00°; pronation, 70.00° and 47.86°; and supination, 70.00° and 52.14°., Conclusion: Although range of motion was restricted in the radial head resection group, functional results and grip strength were superior in patients treated with a radial head prosthesis. These results support the radial head prosthesis as a superior treatment modality for patients with irreparable Mason Type-III radial head fractures with respect to patient satisfaction and functional outcomes.

Background: Stable fracture fixation is important in the treatment of intertrochanteric femur (ITF) fractures in the elderly population to prevent the loss of reduction, achieve early mobility, and restore independence. The aim of this study was to present the results of surgical treatment of stable and unstable ITF fractures using a trochanteric antegrade intramedullary nail with two cephalocervical screws in an integrated mechanism (Intertan®; Smith & Nephew, Memphis, TN) and evaluate the relationship between the loss of reduction and screw position in the femoral neck in two planes., Methods: The authors investigated all varus misalignments and losses of reduction in 57 patients (22 males, 35 females) treated for ITF fractures with the Intertan® between 2010 and 2011. Two indices (screw alignment index in the frontal projection [SAIcoronal] and screw alignment index in the lateral projection [SAIsagittal]) were defined to evaluate the loss of reduction. Patients were also evaluated according to the Harris hip score and Barthel independence index., Results: The mean patient age was 77.1 years. The mean follow-up period was 21.7 months. All patients achieved complete union. We did not detect any varus collapse or loss of reduction. At the end of the follow-up period, the mean Barthel independence index was 90.7, and the mean Harris hip score was 83.7., Conclusion: The use of a trochanteric antegrade intramedullary nail with two cephalocervical screws allows for linear intraoperative compression and rotational stability of the head/neck fragment, prevents reduction loss, and has a wide application area in the femoral head. Its inherent continuous stability permits early weight-bearing and mobilization. It is a safe and an efficient option for the treatment of ITF fractures.

Background: Achilles tendon injuries are one of the most common tendon injuries. Surgical treatment is preferred in young and active patients. Although there are studies which evaluate the repair area with magnetic resonance imaging and ultrasonography after surgical treatment, there are very few studies which analyzes the elasticity of the tendon by quantitative methods. ARFI (acoustic radiation force impulse) elastography is a simple and non-invasive method that can quantitatively measure the elasticity of the soft tissues. Our study aims to evaluate the elasticity in the repair area of the surgically treated Achilles tendons, compare them to the non-injured side, and evaluate the effect of the suture method to the elasticity of the repaired tendons by using ARFI elastography., Methods: In our retrospectively designed study, 19 patients who underwent surgical treatment with Krackow and modified Kessler suture methods after the Achilles tendon rupture between 2006 and 2014 were included. Shear wave velocity (SWV) of the repaired and non-injured Achilles tendons were measured by ARFI elastography in four different positions of the ankle., Results: It was determined that SWV in the surgically repaired tendons were significantly higher in each four different position of the ankle, compared to the non-injured side (p < 0.01), indicating less elasticity in the repaired tendons. There was no statistically significant difference between the SWV of Krackow and modified Kessler suture method groups at four different positions of the ankle (p > 0.05). AOFAS Ankle-Hindfoot, VISA-A, VAS, and FAOS scores were not also statistically different between these two suture methods (p > 0.05)., Conclusions: In the repaired Achilles tendon, there is a decrease in the elasticity compared to the non-injured side. The functional and elastographic results of Krackow and modified Kessler suture methods are similar in long-term follow-ups of the patients.

Nowadays, human dental pulp stem cells (hDPSCs) became more attractive for therapeutic purposes because of their high proliferation and differentiation potential. Thus, coupling the desired cellular characteristics of hDPSCs with good biomaterial properties of the chitosan scaffolds provide an interesting approach for tissue engineering applications. On the other hand, scaffold surface modification is also needed to promote stem cell adhesion since chitosan lacks adhesion motifs to support direct cell anchorage. In this study, hDPSCs were isolated from third molars of healthy female individuals (aged 16-25) with enzymatic digestion. For cell culture studies, the chitosan scaffolds which have approximately 9 mm diameter and 2 mm thickness with interconnected structure were prepared by freeze-drying. To support cellular attachment the scaffolds were covalently immobilized with either RGD (arginine-glycine-aspartic acid) or fibronectin (Fn) molecules. Cells were seeded on chitosan scaffolds with or without immobilized RGD and fibronectin. Cell attachment, spreading, adhesion behaviors and proliferation capacity were examined by scanning electron microscopy, immunofluorescence staining and PrestoBlue ® assays, respectively. In addition, differentiation potential of hDPSCs on Fn immobilized chitosan scaffolds was determined with real time reverse transcriptase polymerase chain reaction analysis. The results showed that chitosan scaffolds were not able to support stem cell attachment. hDPSCs on chitosan scaffolds formed spheroids more quickly and the size of spheroids were smaller than on chitosan-RGD while Fn-immobilized chitosan scaffolds strongly supported cellular attachment but not odontogenic differentiation. The results suggest that the Fn-immobilized chitosan scaffolds may serve as good three-dimensional substrates for dental pulp stem cell attachment and proliferation. In the case of dental regeneration, they must be supported by appropriate biosignals to induce odontogenic differentiation.

Objective We aimed to evaluate the efficiency of O-(beta-Hydroxyethyl)-rutosides (Oxerutin) in reducing the incidence of venous system disease among patients with calf muscle pump dysfunction secondary to immobilization due to lower-limb fractures. Methods A total of 60 patients with lower-limb fractures and immobilized in plaster casts were included in this study randomized into control (n = 30; mean: 30.37 ± 6.03 years; 73.3% males; no treatment) and experiment (n = 30; mean: 31.67 ± 4.76 years; 66.6% males; Oxerutin, 500 mg po q12hr) treatment groups. Doppler ultrasound was performed to evaluate the effect of oxerutin on the alterations in the venous circulation. Results Patients in the control group were determined to be more commonly affected from the below-knee immobilization in terms of venous dysfunction in the great saphenous vein in the below-knee region when compared with the patients in the oxerutin treatment group (46.7 vs. 13.3%, respectively; p = 0.011). Incidence of reflux in the small saphenous vein was more common in the control group during the healing period when compared with the experiment group (40.0 vs. 10.0%, respectively; p = 0.017). None of the patients developed venous thrombosis. Conclusions In conclusion, the impairment of the lower extremity muscle pump should be considered as an important risk factor for venous disease, and should be evaluated. O-(beta-Hydroxyethyl)-rutosides during 6-8 week cast immobilization for a lower limb fracture may be an effective prophylactic regimen in reducing the incidence of reflux in the below-knee superficial veins.

Simulated body fluid (SBF) can form calcium phosphates on osteoinductive materials, so it is widely used for coating of bone scaffolds to mimic natural extracellular matrix (ECM). However, difficulties of bulk coating in 3D scaffolds and the necessity of long process times are the common problems for coating with SBF. In the present study, a microwave-assisted process was developed for rapid and internal coating of chitosan scaffolds. The scaffolds were fabricated as superporous hydrogel (SPH) by combining microwave irradiation and gas foaming methods. Then, they were immersed into 10x  SBF-like solution and homogenous bone-like hydroxyapatite (HA) coating was achieved by microwave treatment at 600W without the need of any nucleating agent. Cell culture studies with MC3T3-E1 preosteoblasts showed that microwave-assisted biomimetic HA coating process could be evaluated as an efficient and rapid method to obtain composite scaffolds for bone tissue engineering., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: Idiopathic flexible pes planus (IFPP) is a common foot problem in adolescents and young adults. Hypothesis for the present study was that combination of procedures for IFPP can achieve results in adolescents and young adults that are as good as those seen in adult-acquired pes planovalgus (AAPP) treatment in adults., Methods: A total of 21 feet of 18 patients (10 boys, 8 girls) with mean age of 15.6 years underwent surgical reconstruction for flatfoot deformity. Symptomatic patients who had been unresponsive to conservative treatment were included in study group. Mean follow-up time was 39.2 months. American Orthopedic Foot and Ankle Society (AOFAS) scores were calculated for all patients, and based on final results, all families were asked whether or not they would elect to have the surgery again in same circumstances., Results: All procedures were performed by the same surgeon: lateral column calcaneal lengthening osteotomy on 21 feet; percutaneous lengthening or gastrocnemius recession for Achilles tendon on 21 feet; medializing calcaneal osteotomy on 15 feet; flexor digitorum longus tendon transfer on 15 feet; medial cuneiform opening wedge osteotomy on 5 feet, spring ligament plication on 3 feet, and accessory navicular bone excision on 2 feet. Preoperative mean AOFAS score increased significantly from 56.76 to 95.29. All parents stated that they were satisfied with surgery results and would choose to have the same surgery performed again., Conclusion: Soft tissue and bony procedures used for reconstruction of AAPP can be used safely for IFPP in adolescents and young adults., Level of Clinical Evidence: Level IV, Therapeutic study., (Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Spring waters used as spas and their region may contain significant amounts of natural radionuclides. The main sources of exposure are the inhalation of radon and its decay products released from the water and soil and terrestrial gamma-radiation. In order to evaluate the potential risk of thermal regions in Bursa, located in the impact area of the NAF (North Anatolian Fault), radon and thoron concentrations in soil gas, radon concentrations in thermal waters and outdoor gamma radiation levels were measured in thermal regions that have different geological formations. The radon and thoron concentrations in soil-gas were found to vary from 2272  ±  121 to 245196  ±  3455 Bq m -3 and from 999  ±  218 to 178 848  ±  17 742 Bq m -3 , respectively. The radon concentrations in thermal waters ranged from 0.99  ±  0.21 to 226.74  ±  2.51 Bq l -1 in the rainy season and from 0.26  ±  0.10 to 178.03  ±  12.86 Bq l -1 in the dry season. The measured outdoor gamma radiation levels varied from 38 to 180 nGy h -1 . The gamma dose rates were found to be strong positively correlating with the radon and thoron concentrations in soil-gas. The radon and outdoor gamma radiation levels were observed to be a function of the geological formations of the area.

Purpose: To compare the length, thickness, and elasticity of the patellar tendon between operated and non-operated knees following closed wedge high tibial osteotomy (CWHTO)., Methods: Three men and 17 women aged 52 to 75 (mean, 64.8) years who underwent unilateral CWHTO by a single surgeon and were followed up for a mean of 11 (range, 5-22) years were included, as were 3 male and 17 female healthy controls aged 35 to 61 (mean, 47.9) years. The length, thickness, and elasticity of the bilateral patellar tendons in the patients and healthy controls were measured using shear wave elastography., Results: In the CWHTO patients, the patellar tendon on the operated side was thicker (4.4 vs. 3.3 mm, p=0.001) and stiffer (74.1 vs. 47.7 kPa, p<0.001) than on the non-operated side., Conclusion: Patellar tendon contracture (thickening and stiffening) is associated with CWHTO.

Background: Osteoid osteoma is an uncommon benign bone-forming tumor of the musculoskeletal system but it is the most common primary bone tumor of the carpal region. However, only seven cases of its pisiform involvement have been described., Case: We present a 19 year-old male patient with osteoid osteoma of the pisiform which initially could not be detected in any diagnostic study for long standing wrist pain. The patient was treated with excision and curettage. In 1 year of follow-up, the patient was asymptomatic without recurrence., Conclusion: In cases with long standing ulnar wrist pain, one should consider osteoid osteoma of the pisiform in differential diagnosis. If an OO is suspected, thin slice CT scan in initial evaluation would be valuable in preventing the patient from misdiagnosis or delay in diagnosis., (Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Salinomycin has been introduced as a novel alternative to traditional anti-cancer drugs. The aim of this study was to test a strategy designed to deliver salinomycin to glioblastoma cells in vitro. Salinomycin-encapsulated polysorbate 80-coated poly(lactic-co-glycolic acid) nanoparticles (P80-SAL-PLGA) were prepared and characterized with respect to particle size, morphology, thermal properties, drug encapsulation efficiency and controlled salinomycin-release behaviour. The in vitro cellular uptake of P80-SAL-PLGA (5 and 10 µM) or uncoated nanoparticles was assessed in T98G human glioblastoma cells, and the cell viability was investigated with respect to anti-growth activities. SAL, which was successfully transported to T98G glioblastoma cells via P80 coated nanoparticles (∼14% within 60 min), greatly decreased (p < 0.01) the cellular viability of T98G cells. Substantial morphological changes were observed in the T98G cells with damaged actin cytoskeleton. Thus, P80-SAL-PLGA nanoparticles induced cell death, suggesting a potential therapeutic role for this salinomycin delivery system in the treatment of human glioblastoma., (© 2015 Wiley Periodicals, Inc.)

Background: The treatment of proximal humerus tumors with reverse shoulder arthroplasty with allograft augmentation is still controversial. A tumor prosthesis represents a proven solution for such osseous defects. We investigated the functional results of patients who underwent reverse shoulder tumor prosthesis (RSTP) without the use of allograft after resection of a proximal humerus tumor., Methods: We retrospectively evaluated 10 patients with malignant proximal humerus tumors who had undergone RSTP, with a mean follow-up period of 18.2 months (range, 6-27 months). The average age of the patients was 49.4 years. The mean resection length was 10.2 cm (range, 6-16 cm). The tumor prosthesis was preferred for the humeral component. Released rotator cuff muscles were reattached to the prosthesis with nonabsorbable sutures., Results: The mean active forward flexion was 96° (range, 30°-160°), the mean active abduction was 88° (range, 30°-160°), and the mean active external rotation was 13° (range, 0°-20°). The mean Constant-Murley score was 53.7%. The mean Disabilities of the Arm, Shoulder, and Hand score was 26.2. The mean visual analog scale score was 1.3. The mean Musculoskeletal Tumor Society score was 78.1%. None of our patients have shown local recurrence or infection signs in the follow-up period., Conclusions: Functionally satisfying results and a stable shoulder can be achieved by reverse shoulder arthroplasty without the need for an allograft. An intact abductor mechanism with a shorter resection humerus length produced good results. The treatment of malignant proximal humerus tumors with RSTP is an alternative that minimizes surgery time and complexity., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to evaluate the long-term functional and cosmetic results as well as the sagittal and coronal plane remodeling of displaced supracondylar humerus fractures treated with open reduction and internal fixation., Methods: In total, 49 patients (11 boys and 38 girls) with Gartland type III supracondylar humerus fractures treated with open reduction and cross-pin fixation were retrospectively evaluated. The mean follow-up time was 22.4 years (range, 10.6-37.5 years). The Flynn criteria were used to assess the cosmetic and functional outcomes. Baumann's angle, the lateral rotational percentage, the humerus-elbow-wrist angle, and the humeral condylar angle were obtained from follow-up radiographs. The flexion and extension deficits compared with the uninjured side were measured at the last follow-up., Results: According to the Flynn criteria, the cosmetic outcomes were satisfactory in 93.9% of the patients, and the functional outcomes were satisfactory in 83.7% of the patients. The average flexion deficit was 5° ± 8°, and the average extension deficit was 4° ± 5°. At the final follow-up, the mean difference in the humerus-elbow-wrist angle and the humeral condylar angle between the injured and uninjured sides was -4° ± 7° and 0° ± 3°., Conclusions: We identified the remodeling in the sagittal plane in supracondylar humerus fractures that had been united in flexion. Satisfactory functional and cosmetic results were obtained with the open reduction and internal fixation of displaced supracondylar fractures of the humerus, and no degenerative changes were observed at the long-term follow-up., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Microwave-assisted methods have been frequently used in many processes owing to their numerous advantages such as performing fast, efficient and homogenous processes and reducing side reactions. In view of these benefits, in this study it was purposed to produce bone-like hydroxyapatite (HA) by inducing biomimetic process with microwave-irradiation. This is why, concentrated body fluid (SBF) i.e. 10×SBF-like solution was used and it was precipitated in different microwave powers i.e. 90W, 360W, 600W, and 1200W and in different exposure times. For comparison, precipitation process was also carried out at room temperature for 6h and at 80°C for 1h. The obtained HA structures were characterized by appropriate instrumental techniques. As a result, microwave-induced precipitation at 600W for 9 times 30s was determined as the optimum condition for the production of HA which has similar properties to the cortical bone. At this condition, B-type HA with 9.22% (wt.) carbonate content, 1.61 Ca/P molar ratio and amorphous structure was obtained easily, rapidly and efficiently. So, this is the first time microwave technology has been used to precipitate HA from SBF solution., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The aim of this study was to develop boron (B)-releasing polymeric scaffold to promote regeneration of bone tissue. Boric acid-doped chitosan nanoparticles with a diameter of approx. 175 nm were produced by tripolyphosphate (TPP)-initiated ionic gelation process. The nanoparticles strongly attached via electrostatic interactions into chitosan scaffolds produced by freeze-drying with approx. 100 μm pore diameter. According to the ICP-OES results, following first 5h initial burst release, fast release of B from scaffolds was observed for 24h incubation period in conditioned medium. Then, slow release of B was performed over 120 h. The results of the cell culture studies proved that the encapsulated boron within the scaffolds can be used as an osteoinductive agent by showing its positive effects on the proliferation and differentiation of MC3T3-E1 preosteoblastic cells., (Copyright © 2015 Elsevier GmbH. All rights reserved.)

Objective: The aim of this anatomical study was to compare the effects of the prone and lateral decubitus positions in endoscopic disc surgery on the Kambin's triangle (KT) and neural foramina zones in the lumbosacral region., Methods: The study included 32 healthy volunteers (16 females and 16 males). Bilateral KT areas (KTA) and neural foraminal areas (FA) of the L4-L5 and L5-S1 levels in the prone and lateral decubitus positions were calculated depending on the freehand region of interest measurements on magnetic resonance images. KTA and FA values for each side and level in the prone and lateral decubitus positions were compared., Results: Mean left KTA value in the prone and right lateral decubitus positions was 0.58 cm(2) and 0.69 cm(2), respectively, for L4-L5; and 0.69 cm(2) and 0.78 cm(2), respectively, for L5-S1 levels. Mean right KTA values in the prone and left lateral decubitus positions were 0.54 cm(2) and 0.65 cm(2) for L4-L5; and 0.69 cm(2) and 0.81 cm(2) for L5-S1, respectively. The differences in the KTA between prone and lateral decubitus positions for both levels and both sides were statistically significant (p=0.05). Only the difference in the FA between the prone and lateral decubitus positions at L5-S1 level on the right side was statistically significant (p=0.05)., Conclusion: The KTA is wider in the lateral decubitus position than in the prone position at the levels of L4-L5 and L5-S1.

The radon concentrations in soil-gas and water samples (in the form of springs, catchment, tap, thermal) used as drinking water or thermal were measured using a professional radon monitor AlphaGUARD PQ 2000PRO. The measured radon concentrations in water samples ranged from 0.32 to 88.22 Bq l(-1). Most of radon levels in potable water samples are below the maximum contaminant level of 11 Bq l(-1) recommended by the US Environmental Protection Agency. The calculated annual effective doses due to radon intake through water consumption varied from 0.07 to 18.53 µSv y(-1). The radon concentrations in soil gas varied from 295.67 to 70 852.92 Bq m(-3). The radon level in soil gas was found to be higher in the area close to the formation boundary thrust and faults. No correlation was observed between radon concentrations in groundwater and soil gas. Also, no significant correlation was observed between soil-gas radon and temperature, pressure and humidity. The emanation of radon from groundwater and soil gas is controlled by the geological formation and by the tectonic structure of the area., (© The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Introduction: The most common variant muscle of the ankle, peroneus quartus muscle, is located in the lateral leg compartment. In literature there is ambiguous nomenclature of this muscle because of its different origin and insertion sides. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures., Material and Method: We dissected 115 cadaver legs and investigated prevalence of peroneus quartus. We also present 2 year result of a patient who had torn superior peroneal retinaculum reconstructed with peroneus quartus tendon., Results: The peroneus quartus muscle, with a number of different attachments, was present in 5.2 % (6/115) of the legs. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. There is no any association between the prevalence of peroneus quartus and the height of retrotrochlear eminence or presence of peroneal tubercule (p > 0.05). But there is strong relationship between peroneus brevis degeneration and peroneus quartus existence (p: 0.03). We also defined a new type of peroneus quartus with a bifurcated insertion around the peroneus brevis. In literature our case report is unique because we present a patient who has torn superior peroneal retinaculum which is reconstructed with peroneus quartus tendon with 2 year follow up., Conclusion: Peroneus quartus may lead to some pathologic conditions (pain, snapping, tear, synovitis, etc.) in the lateral ankle compartment but it may be used to reconstruct some pathologic conditions. Orthopaedics, anatomists and radiologists should be aware of this accessory tendon structure because of its clinical importance.

Squamous cell carcinoma of the lung usually presents as a local rather than a metastatic disease. We present a 55-year-old male who was referred to the orthopedics and traumatology clinic for evaluation of pain and discomfort around the left ankle 2 months after diagnosis of locally advanced non-small cell (squamous cell) lung cancer. Physical examination revealed nonspecific pain and tenderness around the ankle. T2-weighted MR images showed lesions like a bone marrow edema around the talar head and neck. Whole body dynamic bone scan revealed a metastatic lesion only in the foot. The patient died 4 months after diagnosis of the metastasis. Early diagnosis of foot metastasis may be challenging and delays in diagnosis of up to 24 months have been reported. Foot metastases are usually associated with advanced metastatic disease and survival rates are poor. Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot in the elderly lung cancer patients. Palliative treatments such as pain relief medications should be chosen for patients with an expectancy of short survival whereas aggressive approaches may be applied for those with longer survival expectations.

Charcot arthropathy of the foot is a rare but devastating complication of diabetes that remains to be a challenging issue for the foot and ankle surgeons. Charcot foot fails to be an obvious diagnostic option that comes to mind, even in a pathognomonic clinical appearance. The rarity of the disorder, more common pathologies that mimic the condition, and the self-limiting prognosis deviate the clinician from the right diagnosis. The clinical challenges in the diagnosis of Charcot foot require in-depth investigations of its enigmatic nature to establish useful guidelines. Yet, this goal seems to be beyond reach, without a holistic view of the immense literature concerning the pathophysiology of the disorder. The primary objective of this article is to put together and review the recent advancements about the etiology and intrinsic mechanisms of diabetic Charcot foot.

Charcot neuroarthropathy (CN) is a severe joint disease in the foot and ankle that can result in fracture, permanent deformity, and limb loss. It is a serious and potentially limb-threatening lower-extremity late complication of diabetes mellitus. The aim of this manuscript was to evaluate modern concepts of chronic CN through a review of the available literature and to integrate a perspective of management from the authors' extensive experience.

Objective: The aim of our study was to define and compare the mechanical properties of the vastus lateralis (VL) and vastus medialis obliquus muscles (VMO) by the way of quantitative shear-wave elastography in male and female healthy control (HC) subjects, and in female patients with patellofemoral pain syndrome (PFPS)., Materials and Methods: Twenty-two healthy volunteers (11 male and 11 female) and 11 female patients with anterior knee pain were included in the study. The SWE examinations for VL and VMO were performed while the subjects were performing open kinetic chain exercises in neutral and 30° hip abduction. The contraction capacity (CC) and contraction ratio (CR) values were determined in resting and contraction phases in both hip positions., Results: The mean elasticity values in the CC for VL and VMO muscles were significantly higher in male HC subjects when compared to female HC subjects (p < 0.05). The CR of the VL muscle in female patients with PFPS was not significantly different than the female HC group. The CR for the VMO muscle was significantly lower in female patients with PFPS when compared to female HC subjects (p < 0.05)., Conclusions: We found a significant VMO weakness, and this method may provide quantitative data that might influence the diagnosis of muscle weakness, in female patients with PFPS.

Objective: The aim of this study was to evaluate the results of the endoscopic calcaneoplasty technique for the treatment of retrocalcaneal bursitis and Haglund's disease., Methods: This study included 30 feet of 28 patients who underwent endoscopic surgery for Haglund's disease between 2003 and 2011. The inflamed bursa and posterosuperior surface of the calcaneus were removed with a shaver and bone resection performed until there was no friction on the Achilles tendon with the ankle in dorsiflexion. All patients were discharged on the same day and allowed full weight-bearing at the second postoperative week. American Orthopedic Foot and Ankle Society (AOFAS) scores and patient satisfaction were recorded., Results: Average follow-up was 58.4 months. AOFAS scores significantly improved from a postoperative average of 52.6 points to 98.6 points at the final evaluation (p<0.005). All patients were satisfied with the result of the operation., Conclusion: Endoscopic calcaneoplasty with the patient in the prone or supine position appears to be a safe and effective surgical procedure for the treatment of retrocalcaneal bursitis and Haglund's disease.

The distributions of (226)Ra, (232)Th, (40)K and (137)Cs activity concentrations were determined using a high-purity germanium detector in uncultivated surface soil samples collected from Bursa. The range of (226)Ra, (232)Th, (40)K and (137)Cs activity concentrations varied from 10±1 to 61±3 Bq kg(-1) (mean value 25±3 Bq kg(-1)), from 12±1 to 50±2 Bq kg(-1) (mean value 26±3 Bq kg(-1)), from 257±5 to 1010±11 Bq kg(-1) (mean value 435±44 Bq kg(-1)) and from 1.01±0.07 to 48.97±0.54 Bq kg(-1) (mean value 8.52±2.59 Bq kg(-1)), respectively. In addition, the mean outdoor absorbed dose rates in air, annual effective dose equivalent, radium equivalent activity and external hazard index were found to be 45 nGy h(-1), 56 μSv y(-1), 96 Bq kg(-1) and 0.26, respectively. The gross beta activity concentrations were determined using a Tennelec LB 1000-PW detector. The range of gross beta activity concentrations varied from 46±9 to 1199±113 Bq kg(-1) with a mean value of 541±19 Bq kg(-1).