Search

Torus fracture of the distal radius is one of the most common pediatric fractures. Though inherently stable, the literature lacks data about the complications or refracture rates after these fractures. The aim of this study was to evaluate the epidemiology of torus fractures of the distal radius in Turkey and to compare rigid and non-rigid immobilization modalities. 598 patients were enrolled in this retrospective study. Medical data such as age, gender, mechanism of the injury, duration and type of treatment were collected as well as the complications during this period. "The Faces Pain Scale – Revised" (FPSR) was used for the assessment of pain before and after the treatment. The mean age was 7.1± 3.6 and the median follow-up was 12 (9-15) months. 181 patients were treated with plaster of paris, 149 with soft casts, 80 with hard casts and 188 with splints. The mean duration of the immobilization was 22.6±5.39 days. FPSR scores before and after the treatment were 2.837(95%CI, 2.686-2.989) and 0.255 (95%CI, 0.186-0.324), respectively (p=0.001). There was no statistically significant difference between the immobilization modalities in terms of FPSR decline before and after the treatment (p=0.403). The overall complication rate was 7.4% among all patients (95% CI, 5.3%-9.5%). Complication rates for each stabilization modality were 13.3% for the plaster of paris, 6.7% for the soft cast, 10% for hard cast and 1.1% for the splint group. The complication rate in the patients treated with splints was statistically significantly lower in the splint group (p=0.001; p=0.033; p=0.002, respectively). The pain was the most common complication (47.8% of all complications). There were 2 refractures during the follow-up period. In conclusion, torus fractures are stable and do not require rigid immobilization. The refracture rate is below 1% and any increase in this rate should be further questioned in order to rule out a misdiagnosis of "green-stick" fracture. [Med-Science 2022; 11(4.000): 1690-6]

Purpose This study aimed to evaluate whether the posterior cruciate ligament sacrifice during total knee arthroplasty (TKA) has any effect on postoperative standing balance or not. Methods The patients who underwent bilateral TKA with either CR or PS design were analyzed. 30 patients (10 PS, 20 CR) were included for the final analysis. TKA designs were compared in terms of Lysholm score, range of motion, and balance characteristics including somatosensorial, vestibular, and visual balance scales, adaptation, limits of stability, and weight-bearing/squat tests by computerized dynamic posturography. Results The mean follow-up time was 59 months for CR, 49 months for PS group. The average Lysholm score values were 94 for CR and 95 for PS group, indicating functionally similar patient groups. The average knee flexion was found significantly higher in PS group (114°) compared to CR group (102°) ( p = 0.009). In the CR group, motor adaptation tests (toes up/toes down) were found to be better ( p = 0.034). In the on-axis velocity parameter (linear goal orientation) of limits of stability test, PS group patients were found to be more successful ( p = 0.035). Conclusions The use of CR implants can be recommended in patients with a high risk of falling since they provide better motor adaptation providing rapid reactions to rapid surface changes. Better linear goal orientation in PS group, providing a faster movement in an intended direction, should be considered when planning the ideal implant for the patients with relevant activities.

Objective:The purpose of the study is to evaluate the treatment results of reverse oblique AO/OTA 31A1 fractures that have highly mechanical instability risk with two third generation intramedullary nails.Methods:Twenty-eight patients (8 men, 20 women) treated by third generation proximal femoral nails [proximal femoral anti-rotation (PFNA)® or Intertan®] followed minimum one year were included. Average age was 65.0 (31-93) years. Clinical and radiological results, screw migration at one year and complications were recorded.Results:Mean operation time was 72.2 and 72.5 minutes, flouroscopy time was 64.4 and 64.7 seconds, mobilisation time was 2.1 and 2.2 days, full weight bearing time was 8.6 and 8.5 weeks, tip-apex distance was 20.1 and 20.2 mm, fracture healing time was 10.5 and 10.2 weeks, Harris hip score at one year was 80.5 and 83.5, neck-shaft angle difference at one year was 1.6 and 1.1 mm, screw migration at one year was found in 10 and 3 patients and mean migration distance was 3.1 and 0.4 mm for PFNA and Intertan nails respectively. No complications recorded that needs secondary intervention. Fracture healing obtained in all patients.Conclusion:Reverse oblique intertrochanteric fractures can be effectively treated with third generation intramedullary nails. More screw migration was seen in PFNA than Intertan nails after the operation in this study.

Background: Prior studies revealed the presence of superior labrum anterior-to-posterior (SLAP) injury together with Bankart lesions in some patients. The purpose of the study is to compare the clinical results of isolated Bankart repairs with the clinical results of Bankart repairs when performed with concomitant SLAP repairs. Methods: The patients who underwent arthroscopic surgery for treatment of anterior glenohumeral instability were evaluated retrospectively. Group 1 consisted of 19 patients who had arthroscopic SLAP repair together with Bankart repair. The mean age of the patients was 23. Group 2 consisted of 38 patients who underwent isolated Bankart repair. The mean age was 24. Knotless anchors were used in both groups. Results: The mean follow-up was 34 months (range: 26–72). In group 1, the mean preoperative Constant score was 84 (range: 74–90, standard deviation (SD): 5.91) and Rowe score was 64.1 (range: 40–70, SD: 8.14). In group 2, the preoperative Constant score was 84.4 (range: 70–96, SD: 5.88) and Rowe score was 60 (range: 45–70, SD: 7.95). In group 1, the postoperative mean Constant score raised to 96.8 (range: 88–100, SD: 2.91) and the mean Rowe score raised to 92.3 (range: 85–100, SD: 5.17). In group 2, the postoperative mean Constant score was 94.9 (range: 88–100, SD: 3.70) and the mean Rowe score was 94.2 (range: 80–100, SD: 4.71). The difference between the scores of two groups was insignificant ( p > 0.05). When the numbers of redislocations and range of motion were compared, no significant difference was found ( p > 0.05). Conclusion: Accompanying SLAP repair in surgical treatment with Bankart repair for shoulder instability does not affect the results negatively. Properly repaired labral tears extending from anterior inferior to the posterior superior of the glenoid in instability treatment have the same outcome in overall results as repaired isolated Bankart lesions.

Abstract Background Postoperative fluid management in critically ill neonates and infants with capillary leak syndrome (CLS) and extensive volume overload after cardiac surgery on cardiopulmonary bypass is challenging. CLS is often resistant to conventional diuretic therapy, aggravating the course of weaning from invasive ventilation, increasing length of stay on ICU and morbidity and mortality. Methods Tolvaptan (TLV, vasopressin type 2 receptor antagonist) was used as an additive diuretic in neonates and infants with CLS after cardiac surgery. Retrospective analysis of 25 patients with CLS including preoperative and postoperative parameters was performed. Multivariate regression analysis was performed to identify predictors for TLV response. Results Multivariate analysis identified urinary output during 24 h after TLV administration and mean blood pressure (BP) on day 2 of TLV treatment as predictors for TLV response (AUC = 0.956). Responder showed greater weight reduction (p

Background: Protein-losing enteropathy (PLE) is a severe complication of the univentricular Fontan circulation and associated with disturbances in salt and water homeostasis. Fontan patients with PLE have a poor prognosis, with increased morbidity and mortality. Due to limited therapeutic strategies, patients are often treated only symptomatically. Methods: We report our first experience of Tolvaptan (TLV) treatment in a Fontan patient with PLE, severe volume retention and hyponatraemia, refractory to conventional diuretic therapy. In addition to clinical parameters, we monitored drug effects including tissue sodium and volume status via serial 23 Na-magnetic resonance imaging ( 23 Na-MRI) and bioimpedance spectroscopy compared with age-matched controls. Results: 23 Na-MRI identified elevated tissue sodium, which decreased under TLV treatment, as well as volume status, while serum sodium increased and the patient’s symptoms improved. During long-term treatment, we were able to differentiate between sodium and volume status in our patient, suggesting that TLV uncoupled body sodium from water. Conclusion: TLV in addition to loop diuretics improved clinical symptoms of PLE and lowered tissue sodium overload. Long-term effects should be further evaluated in Fontan patients.

BACKGROUND:Coarctation of the aorta (CoA) accounts for 5-8% of all congenital heart defects. CoA can be detected in up to 20% of patients with Ullrich-Turner syndrome (UTS), in which a part or all of one of the X chromosomes is absent. The etiology of non-syndromic CoA is poorly understood. In the present work, we test the hypothesis that rare copy number variation (CNV) especially on the gonosomes, contribute to the etiology of non-syndromic CoA. METHODS:We performed high-resolution genome-wide CNV analysis using the Affymetrix SNP 6.0 microarray platform for 70 individuals with sporadic CoA, 3 families with inherited CoA (n=13) and 605 controls. Our analysis comprised genome wide association, CNV burden and linkage. CNV was validated by multiplex ligation-dependent probe amplification. RESULTS:We identified a significant abundance of large (>100 kb) CNVs on the X chromosome in males with CoA (p=0.005). 11 out of 51 (~ 22%) male cases had these large CNVs. Association analysis in the sporadic cohort revealed 14 novel loci for CoA. The locus on 21q22.3 in the sporadic CoA cohort overlapped with a gene locus identified in all familial cases of CoA (candidate gene TRPM2). We identified one CNV locus within a locus with high multipoint LOD score from a linkage analysis of the familial cases (SEPT9); another locus overlapped with a region implicated in Kabuki syndrome. In the familial cases, we identified a total of 7 CNV loci that were exclusively present in cases but not in unaffected family members. CONCLUSION:Of all candidate loci identified, the TRPM2 locus was the most frequently implicated autosomal locus in sporadic and familial cases. However, the abundance of large CNVs on the X chromosome of affected males suggests that gonosomal aberrations are not only responsible for syndromic CoA but also involved in the development of sporadic and non-syndromic CoA and their male dominance.