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Purpose:This study compares the durability and stability of Kirschner wires used in two different configurations for the fixation of extra-articular fractures of the proximal hallux. Methods:Standardized and reproducible extra-articular osteotomy lines were fixed with Kirschner wires arranged in cross and parallel configurations using synthetic composite bone models. These fixed composite bones were assessed under two distinct experimental setups. Measurements recorded included the load causing 2 mm displacement at the osteotomy line, load-to-failure, displacement at failure, and stiffness values. Results:In both experimental setups, the load causing 2 mm displacement, load-to-failure, and failure stiffness values were significantly higher for the cross configuration compared to the parallel configuration. Conversely, the displacement at failure was significantly lower in the cross configuration relative to the parallel configuration. Additionally, the force required to induce a 2 mm displacement in the cross-configuration group exceeded the force exerted on the hallux during normal walking. Conclusion:The results indicate that Kirschner wires applied in a cross configuration offer superior stability and durability for the fixation of proximal hallux fractures compared to the parallel configuration in synthetic composite bone models. To validate these findings and assess clinical outcomes, further research through a prospective randomized controlled trial is recommended.

Current capacity of the Turkish health system is reviewed to evaluate and develop appropriate policies for cardiovascular diseases (CVD), diabetes mellitus (DM) and related risk factors. This paper qualitatively evaluates existing policies; interviews with key informants (KIs); and rapid appraisal fieldwork in clinical settings about CVD–DM through the framework of Walt and Gilson (Health Policy Plan 9:353–370, 1994). Document review shows that prevention and control of CVD–DM were strongly addressed in Turkey, yet no document mentioned country-wide early detection or screening programs. KIs indicated over-fragmented management of CVD–DM by the Ministry of Health (MoH). Coordination among the MoH, organizational structure at provincial level and civil society organizations are poor where mutual trust is a significant problem according to KIs. Clinical setting findings point to a complete lack of a referral structure and a lack of follow-up, compounding the absence of functioning health information systems for patient records. Primary care services for CVD–DM require urgent attention, focusing particularly on the training of staff in public facilities, the integration of patient data, referrals and follow-up across all levels of the health system.

Background:Distal chevron osteotomy (DCO) is commonly performed in hallux valgus surgery. The fixation of the osteotomy is provided by various implants. The usage of biodegradable implants such as magnesium is gradually increasing due to the advantages they provide. In this study, we aimed to compare the fixation of DCO with magnesium or titanium screw biomechanically. Methods:Twenty sawbones were used. The samples were divided into two equal groups, including ten sawbones for fixation with single headless titanium (group-1) or magnesium screw (group-2). DCO and screw fixations were performed on all samples using the same technique. Biomechanical testing was applied to five samples in each group in cantilever and the other five in a physiological configuration using a computer connected to the electromechanical test machine. The obtained data were evaluated using the Shapiro–Wilk test, Student’s t-test and Mann–Whitney U test on the IBM® SPSS (Statistical Package for the Social Sciences) V22.0 software. Significance was accepted at the p< 0.05 level. Results:There was no statistically significant difference between the magnesium screw and the titanium screw in terms of maximum force, maximum displacement and stiffness measurements in cantilever and physiological loadings (p> 0.05 for all). Conclusion:This study found no significant difference in biomechanical stability between the magnesium and titanium screws in DCO fixation on sawbones. Further studies with real bones are needed.