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Background: The aim of this study was to present characteristics and publication patterns of studies arise from orthopedic theses obtained from National Thesis Center; database in terms of publication years, study types, topics, level of evidence between 1974 and 2014. Methods: Firstly, National Thesis Center database was searched for orthopedics and Traumatology theses. The theses, which their summary or full text were available were included in the study. The topics, study types and quality of study designs were reviewed. Then theses were searched in the PubMed database. Journals of published theses were classified according to category, scope and impact factors of the year 2014. Results: 1508 theses were included into the study. Clinical studies comprised 71,7% of the theses, while 25,6% of the theses were non-clinical experimental and 2,7% of the theses were observational studies. Clinical studies were Level I in 8,6% (n = 93) and Level II in 5,8% of the theses (n = 63). A total of 224 theses (14,9%) were published in the journals indexed in PubMed database from 1974 to 2012. Fifty-two (23,2%) were published in SCI; 136 theses (60,7%) were published in SCI-E journals and 36 theses (16%) were published in other Journals indexed in PubMed. Conclusion: The quantity and quality of published theses need to be improved and effective measures should be taken to promote quality of theses. Theses from universities and Training hospitals which did not allow open access, and; incomplete records of the National Thesis Center database were major limitations of this study. Keywords: Orthopaedics, Publication patterns, Theses, Level of evidence

Tourniquet has long been used in TKA (Total Knee Arthroplasty) as the other orthopedic procedures for decreasing operation time and blood loss, providing better visualization of anatomic structures. While having much more advantages, these devices have a potential of serious complications, so they must be used with adequate knowledge and attention. Paralysis, compression neuropathy, compartment syndrome, prolonged period of rehabilitation, edema, pain, skin problems, nerve damage and systemic problems are the some complications seen. Selections of appropriate blood pressure, cuff selection, tourniquet timing are the essential points of tourniquet use. Through these increasing complication rates and improvements in the surgical and anesthesia methods contrary to old beliefs, surgery has been preferred without tourniquet in the patients who have no cardiovascular problems and morbidity. In the patients who have any contraindicated situations as stated above, TKA must be performed with tourniquet, with proper control of the amount of pressure and the duration of application, the risk of complications decrease, in the other situations TKA can be performed without tourniquet with the aims for fast-recovery, postsurgical pain relief and better muscle activity. The objective of this paper is to describe current perspectives of tourniquet use in total knee arthroplasty.

Objective: The aim of this study was to investigate the effect of hypothermia (H) on skeletal ischemia-reperfusion (IR) injury in rats by measuring malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), nitric oxide (NO), and interleukin-1 beta (IL-1β) in muscle, and measureing immunohistochemical- inducible nitric oxide synthase (iNOS) staining of skeletal muscle. Materials and Methods: Eighteen Wistar Albino rats were divided randomly into three groups (sham, IR, hypothermia) (n=6). The sham group had all procedures without the IR period. The lower right extremity of rats in the IR and hypothermia groups was subjected to 2 hours of ischemia and 22 hours of reperfusion by applying a clamp on the common iliac artery and a rubber-band at the level of the lesser trochanter under general anesthesia. Rats in the hypothermia group underwent 4 hours of hypothermia during the first four hours of reperfusion in addition to a 2-hour ischemia and 22-hour reperfusion period. All rats were sacrificed at end of the IR period using a high dose of anesthesia. The tibialis anterior muscles were preserved. Immunohistochemical iNOS staining was performed, and MDA, SOD, GSH-Px, NO, and IL-1β were measured in the muscle. Results: The level of MDA, NO, and IL-1β in muscle was increased in the IR group compared with that in the sham group, but these parameters were decreased in the hypothermia group compared with the IR group. The activities of SOD and GSH-Px in muscle were decreased in the IR group; however, these parameters were increased in the hypothermia group. The score and intensity of iNOS staining of skeletal muscle was dens in IR group, mild in hypothermia group, and weak in sham group. Conclusion: The present study has shown that hypothermia reduced IR injury in the skeletal muscle by decreasing the levels of MDA, NO, and IL-1β, and increasing the activities of SOD and GSH-Px. In addition, hypothermia attenuated the score and intensity of iNOS staining.

Macrodactyly of the foot is a rare congenital anomaly characterized by an enlargement of the soft tissue and osseous elements. It is difficult to treat this disorder when both the functional and cosmetic problems are addressed simultaneously. In the presented case, we describe an adult male patient with macrodactyly of the great toe, who underwent surgical correction consisting of amputation with debulking of soft tissues. To our knowledge, only a few cases regarding adults with macrodactyly of the foot have been reported in the literature. We advocate early surgical treatment of macrodactyly of the foot to enhance the quality of social life. [Arch Clin Exp Surg 2014; 3(2.000): 123-128]

Rheumatoid arthritis (RA) is an inflammatory multisystem disease of unknown etiology characterized by chronic destructive synovitis. It and #8217;s prevalence is about 1% all over the world. Serologic markers are also important beside some clinical situations upon RA diagnosis. Today, the most commonly used laboratory test is rheumatoid factor (RF) in patients with suspected RA. RF is sensitive but not a specific biomarker for diagnosing RA. Early diagnosis of RA is essential to prevent of progressive joint damage. In recent years, anticyclic citrullinated peptide/protein antibody (anti-CCP) attracts the attention as a remarkable biomarker for early diagnosis. Anti-CCP which is a family of anti-citrullinated protein antibodies (ACPA) family, showed quite satisfactory specificity in the diagnosis of RA. Due to the prescence of ACPA was included to 2010 RA diagnostic criteria, in a manner of speaking, importance of anti-CCP was registered. [TAF Prev Med Bull 2014; 13(1.000): 83-88]

DOI: 10.4328/JCAM.1406 Received: 16.11.2012 Accepted: 04.12.2012 Publihed Online: 04.12.2012 Corresponding Author: Omer Ersen, Maresal Cakmak Military Hospital Palandoken, Erzurum, Turkey. T.: +905335275181 E-Mail: merschenn@yahoo.com Ozet Trapezium kiriklari nadir kiriklardir ve tum karpal kemik kiriklarinin %3-5’ini olustururlar. Bunlarin yaklasik %20’si vertikal sagittal split kiriklardir ve izole olarak cok nadir gorulurler. Literaturde bildirilen trapezium kiriklari cok azdir. Normal basparmak fonksiyonunun kazanilabilmesi icin acik trapezium kiriklarinda yaralanmis yapilarin tam restorasyonu saglanmalidir. Aksi takdirde hareket kisitliligi, agri ve kuvvetsizlige bagli fonksiyon kayiplari gorulebilir. Bu vaka takdiminde distal radiustan elde edilen lokal kemik grefti ile defektif trapezium kiriginin tedavisi sonucu normal basparmak fonksiyonu elde edilmesi sunulmustur.

Context Prolotherapy is a popular injection-based complementary treatment, which has shown promising results in the treatment of sprained and degenerated ligaments, and damaged dense connective tissues structures. More research was conducted in this area and many authors declared successful results for different indications. Evidence Acquisition The purpose of this study was to present a literature review regarding the current concepts of prolotherapy injections and improvements in the orthopedic clinical care practice. The Medline and PubMed databases were searched for the articles related to prolotherapy injections in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation. Results Numerous studies have been conducted on prolotherapy injections for different indications for orthopedics clinical care practice. Prolotherapy injections have successfully used for major orthopedic procedures in terms of rotator cuff lesions, knee ligamentous lesions, osteoarthritis-cartilage defects, and ligament-tendon injuries. Most of the studies showed that prolotherapy provided faster and better healing of tissues. Conclusions There is a great interest to prolotherapy in orthopedic clinics, especially to manage musculoskeletal lesions. More research conducted in this area and many authors declared successful results in their studies. In spite of this increasing trend for prolotherapy injections, there were only one or two clinical studies investigated prolotherapy injections for different indications and most of them have limited participants, short-term follow-up or poor quality studies. There is still need for further high-quality studies investigated optimal strategy of the injections of prolotherapy.

Context Musculoskeletal injuries may be painful, troublesome, life limiting and also one of the global health problems. There has been considerable amount of interest during the past two decades to stem cells and tissue engineering techniques in orthopedic surgery, especially to manage special and compulsive injuries within the musculoskeletal system. Evidence Acquisition The aim of this study was to present a literature review regarding the most recent progress in stem cell procedures and current indications in orthopedics clinical care practice. The Medline and PubMed library databases were searched for the articles related with stem cell procedures in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation. Results Various sources of stem cells have been studied for orthopedics clinical care practice. Stem cell therapy has successfully used for major orthopedic procedures in terms of bone-joint injuries (fractures-bone defects, nonunion, and spinal injuries), osteoarthritis-cartilage defects, ligament-tendon injuries, femoral head osteonecrosis and osteogenesis imperfecta. Stem cells have also used in bone tissue engineering in combining with the scaffolds and provided faster and better healing of tissues. Conclusions Large amounts of preclinical studies have been made of stem cells and there is an increasing interest to perform these studies within the human population but preclinical studies are insufficient; therefore, much more and efficient studies should be conducted to evaluate the efficacy and safety of stem cells.

In this paper, we report a case of a 23-year-old male patient with bilateral absence of the flexor pollicis brevis and abductor pollicis brevis muscles with an intact functioning opponens pollicis and flexor pollicis longus muscles with bilateral thenar atrophy due to its rarity. All physical, neurological, ultrasonographic, direct radiographic, electromyographic and MRI studies were used to confirm and document this congenital anomaly.

Background/aim: Urticaria is a vascular skin reaction characterized with papules and plaques. Neopterin is accepted as an immunologic marker and an indicator of activation of the immune system. Homocysteine and asymmetric dimethylarginine (ADMA) are the markers of increased vascular resistance. Alteration in vascular resistance has a role in the pathogenesis of urticaria. We aimed to investigate whether there is a relationship between urticaria and neopterin, homocysteine, or ADMA. Materials and methods: The study is designed as a prospective descriptive study and patients with a diagnosis of urticaria in the emergency department were included in the study. Demographic data and characteristics of the disease were recorded. Neopterin, homocysteine, and ADMA levels were measured both during and after urticaria attacks. All data were statistically analyzed. Results: The differences between neopterin levels measured during and after urticaria attacks were statistically significant (P < 0.001). The differences between homocysteine and ADMA levels measured during and after urticaria attacks were not statistically significant (P > 0.05). Conclusion: Our results indicate that neopterin levels in patients with urticaria attacks are increased and the level of neopterin is also a useful parameter in acute urticaria. Further studies should clarify whether homocysteine levels contribute to diagnosis of acute urticaria. However, no relation was found between ADMA and urticaria.

[Arch Clin Exp Surg 2014; 3(1.000): 66-68]

We have read with a great interest the published article by Aoki and colleagues entitled ‘Increase of nerve growth factor levels in the human herniated intervertebral disc: can annular rupture trigger discogenic back pain?’ [1]. The authors suggest that nerve growth factor (NGF) increases in herniated discs, and may play an important role in the generation of discogenic pain. However, we think some points should be discussed. NGF is a polypeptide that plays an important role for cells belonging to the nervous, endocrine, and immune systems [2]. We think the study group in which the authors evaluated tissue NGF levels is not well defined. Namely, they should state whether the patients have one of following diseases, which could probably affect NGF levels: neuropsychiatric diseases such as epilepsy, depression, schizophrenia, migraine and primary headache; and eating disorders or cardiometabolic diseases such as atherosclerosis, metabolic syndrome and type 2 diabetes mellitus [3]. In addition to these diseases, obesity is also shown to affect NGF levels [4]. In this regard, the above diseases should be taken into account while designing a study group, and the body mass index of participants has to be thought of as another confounding variable and included in multiple regression analysis like age and sex are. Besides the above confounders, supplements such as vitamin D analogs, zinc, vitamin B12, vitamin A, omega 3 fatty acid or herbal medicines and some drugs such as estrogen, glucocorticoids, acetyl-l-carnitine and antipsychotics also have to be denoted regarding whether the participants use these medications or not because they are affecting factors for NGF [5]. In conclusion, explanation of these concerns will certainly provide clearer information for the readers.

Dear Editor, We have read with great interest the published article by Hussain T. entitled “Grade-III Paraplegia in Spinal Tuberculosis: Follow up of A Case Report and Review of Literature” [1]. In this good paper the author presents his experience on a case with spinal tuberculosis which could not be diagnosed in the early stages and supported an approach of nonoperative treatment over surgery, where the patient had progressive paralysis [1]. However, we think that some more points should be discussed on decision making and therapy planning. Spinal tuberculosis is the most common and the worst form of tuberculosis lesions in the skeleton [2–4]. If the lesion is limited in the vertebrae and if there are no other complications, triple-drug anti-tuberculous chemotherapy can play a main role to treat tuberculosis [5]. However, with proper indications, surgical procedures are superior in the prevention of neurological deterioration, maintenance of stability and early recovery [3–6]. Oguz et al., [4] reported total 76 cases with spinal tuberculosis who had an excellent recovery without developent of any neurological deterioration. Further, they developed an effective classification system named GATA. In the mentioned case report, authors mentioned that the patient’s treatment period persisted about 18 mounts. According to us this period is so long and dangerous. We believe that the best treatment method for this patient was apply surgical treatment at the same time anti tuberculous therapy at first diagnosis time. This new classification system (GATA) can be considered as a practical guide for spinal tuberculosis treatment planning in all countries.

Total knee arthroplasty (TKA) is known to be most successful procedure for advanced knee rheumatoid arthritis. If it is performed with meticulous pre-operative assessment and preparation, appropriate surgical technique, and efficient post-operative rehabilitation it has the potential to improve functionality and overall quality of life. Because of the early degeneration of knee joints, RA patients are younger at TKA and the potential revision rate may be increased in this patient population. In addition, bone and soft tissue are poorer and also deformity patterns are different from other patients. Therefore this population requires special attention in the orthopedic management. The aim of the present article was to describe current perspectives of total knee arthroplasty in the patients with RA.

Objectives: The aim of this cross-sectional epidemiologic study was to investigate the prevalence and distribution of musculoskeletal disorders causing unfitness to Turkish Military Service. Methods: This study has been carried out by examining the medical reports of 1.777.500 people who applied to the Turkish Armed Forces for military service between 2009-2011. Age and geographic region of individuals were compiled and organized in groups. Musculoskeletal disorders were classified mainly as fracture sequel, spine disorders, absence of phalanges, extremity amputation, aggressive or multiple benign tumors of bones and pes planus. Results: Unfitness to military service caused by musculoskeletal disorders was found to be 6.53‰ in 2009, 7.10‰ in 2010 and 7.28‰ in 2011. The prevalence of musculoskeletal diseases has increased by years. The prevalence of fracture squeal by years was found to be 2.83‰ in 2009, 3.10‰ in 2010 and 3.03‰ in 2011. In this study, the most common musculoskeletal disorders were: limitation of joint mobility (0.89‰), degeneration of joint surface (0.69‰), lower and upper limb discrepancies (0.60‰), posterior fusion surgery (0.59‰) and the absence of the phalanges in hand (0.51‰). We found an increase in both the prevalence of posterior fusion surgery and the absence of the phalanges in study group. Conclusion: These results has given information about severe musculoskeletal disorders among young adult male in Turkey. New studies including young adult female will add important information to our knowledge about musculuskelatal problems in our community.

Piriformis syndrome is a clinical picture of non-discogenic sciatica caused by compression of the sciatic nerve by the piriformis muscle. It has variable etiologies and the patho-physiology is not fully understood. The major etiology was known to be the spasm, edema and inflammation of the piriformis muscle and sciatic nerve compression of the muscle later on. Patients can be diagnosed immediately with a comprehensive clinical examination and early diagnosis makes the treatment much easier. Diagnosis of the piriformis syndrome, a very rare cause of low back pain, first requires that this syndrome is remembered, and then a differential diagnosis should be performed. A case of piriformis syndrome diagnosed in a patient who presented with low back pain is reported in this study.

Dear Editor, We would like to discuss on the publication entitled "Lumbar morphometry: a study of lumbar vertebrae from a Pakistani population using computed tomography scans [1]". In the study, the authors described the characteristics of lumbar vertebrae of Pakistani patients and compared them with studies from other populations. Honestly the objective of the study is noteworthy and we have a question for the authors: lumbosacral transitional vertebrae (LSTV) are common in the general population, with a reported prevalence of 4%-21% [2,3]. We have studied 500 lumbar plain films and observed 17.6% transitional lumbosacral junctions [4,5]. Have the authors observed and noted transitional vertebrae in their study or have any other studies/reports on this issue shown correlation with their population? We would appreciate the authors' comments on this concern.

Dear Editor, We have read the published article by Rathinavelu at al. [1] entitled "The Extended Posterior Circumferential Decompression Technique in the Management of Tubercular Spondylitis with and without Paraplegia" with great interest. The study we well written and the authors described a new posterior procedure termed the "Extended Posterior Circumferential Decompression (EPCD)", a technique that manages tubercular spondylitis, in the presence or nonpresence of paraplegia. The objective of the study is noteworthy and we have some questions for authors: (1) In the study it was written, "During this period, all cases of dorsal, dorso-lumbar and lumbar tuberculous spondylitis cases operated for any indication were performed using this technique." and "Major indication for the procedure was paraplegia in 24 patients (59%), and contiguous vertebral body destruction with deformity in 17 patients (41%)." What are the authors' operation indications? In 2008, Oguz et al. [2] developed a classification system for spinal tuberculosis based on seven clinical and radiological criteria. In this system, the researchers divided spinal tuberculosis into three categories by using these criteria, andrecommended specific therapeutic techniques for each type. Are the authors using a classification system to provide guidance in selecting the proper treatment approach for patients with spinal tuberculosis? (2) Which method did the authors use for differencial diagnosis from malignancy or methastasis before operations? Is the needle biopsy diagnostic significant? (3) What is the best option for multilevel tuberculosis spondylitis for patients having both thoracal and lumbar complications,with severe kyphosis or collapse? (4) Some authors advised using intraoperative cell salvage system in vertebral operations [3]. What is the author's opinion about this issue? We appreciate the author's comments on this concern.

Dear Editor, We would like to discuss the publication entitled "Evidence-based of nonoperative treatment in adolescent idiopathic scoliosis [1]" which we read with great interest. In his study, the author reviewed articles concerning adolescent idiopathic scoliosis (AIS). Honestly the objective of the study is noteworthy and we have some questions for author: (1) Scoliosis of less than 20° should be followed up in periodic outpatient visits at 4 to 6 month intervals, and new X-rays should be taken if progression is suspected [2]. Bracing is generally recommended for scoliosis between 30° and 45° before the termination of bone growth. Bracing has been shown to successfully prevent curve progression in 75% in this patient population [3]. The recommendations for the bracing study inclusion were based on patients aged 10 years and above, a Risser sign of 0 to 2, initial curve magnitude of 25° to 40° [4]. What is the authors' opinion on a correlation between scoliosis angle and the Risser sign at therapy planning with AIS patients? (2) What is the authors' opinion on Charleston and Providence braces? Have part-time or nighttime bracing any advantages with patient compliance? (3) Classification of idiopathic scoliosis is of utmost importance in defining curvature by physicians, physiotherapists and orthotic technicians and designing the treatment plan [5,6]. Which classification system (King, Peking Union Medical College-PUMC, Lenke) did the author use for providing guidance for patients with AIS? We appreciate the authors' comments on these concerns.

Dear Editor We read with great interest the published article by Park et al. [1] entitled "Paralysis Developing as a Paradoxical Response During the Treatment for Tuberculous Spondylitis: A Case Report". The authors report the case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. We think several more points should be discussed concerning therapy. Spinal tuberculosis is the most common and the worst form of tuberculosis lesions in the skeleton [2,3,4]. If the lesion is limited to the vertebrae and there are no complications, triple-drug anti-tuberculous chemotherapy can be the main therapy to treat tuberculosis [5]. However, with proper indications, surgical procedures are superior in the prevention of neurological deterioration, maintenance of stability and early recovery [3,4,5,6]. Oguz et al. [4] reported on 76 cases with spinal tuberculosis between 1989 to 2002 without any neurological deterioration that all featured eventual excellent recovery. As a result, these authors developed a effective classification system abbreviated GATA (Gulhane Askeri Tip Akademisi). This new classification system has been using as a practical guide in the treatment of Pott disease. In the case that was presented in the article, despite the initiation of medical treatment, deterioration in the clinical status of the patient was observed. However, when we examined the MRI in Fig. 1, we noted vertebral collapse and abcess formation, which is type II in the GATA classification system. Type II treatment is anterior debridement and fusion. As a result, we believe that if surgical intervention is made at the time of diagnosis (early stage), the patient will heal more quickly without any neurological deterioration.

Dear editor, We recently read the interesting article entitled "Coccygectomy as a surgical option in the treatment of chronic traumatic coccygodynia: a single-center experience and literature review" by Antoniadis et al. [1] which touches on an underrated topic in neurosurgical practice. Periosteal preservation and closure during the coccygectomy procedure have been found to be related to a low risk of infection [2]. Although Antoniadis et al. did not mention this in their case series, the information should be presented in a literature review. Additionally, some other treatment options, such as caudal epidural pulsed radiofrequency treatment, have been found to be efficient after unsuccessful non-surgical and surgical treatment modalities in the treatment of coccygodynia and should also be mentioned in the article. Atim et al. [3] achieved excellent and good results in 81% of cases treated with caudal epidural pulsed radiofrequency. We expect that these small additions will increase the value of Antoniadis' article.

Foot and ankles are the most frequent injury region of the body, either sportmens or general population. There are many bones, joints and tendons exist in this narrow area. This situation get harder to diagnosis by using imaging methods. Because of this well anamnesis, knowledge about anatomy of this region and frequent diseases are important to correct evaluation. The approach to this frequent health problem was held on in this paper. [TAF Prev Med Bull 2011; 10(3.000): 339-342]

Ugras, Ali Akin/0000-0001-6534-9201 WOS: 000355166800001 PubMed: 26016671 Background: Shoulder dislocations account for almost 50 % of all major joint dislocations and are mainly anterior. Objective: The aim is a comparative retrospective study of different reduction maneuvers without anesthesia to reduce the dislocated shoulder. Methods: Patients were treated with different reduction maneuvers, including various forms of traction and external rotation, in the emergency departments of four training hospitals between 2009 and 2012. Each of the four hospitals had different treatment protocols for reduction and applying one of four maneuvers: Spaso, Chair, Kocher, and Matsen methods. Thirty-nine patients were treated by the Spaso method, 47 by the Chair reduction method, 40 by the Kocher method, and 27 patients by Matsen's traction-countertraction method. All patients' demographic data were recorded. Dislocation number, reduction time, time interval between dislocation and reduction, and associated complications, pre- and post-reduction period, were recorded prospectively. No anesthetic method was used for the reduction. Results: All of the methods used included traction and some external rotation. The Chair method had the shortest reduction time. All surgeons involved in the study agreed that the Kocher and Matsen methods needed more force for the reduction. Patients could contract their muscles because of the pain in these two methods. The Spaso method includes flexion of the shoulder and blocks muscle contraction somewhat. The Chair method was found to be the easiest because the patients could not contract their muscles while sitting on a chair with the affected arm at their side. Conclusions: We suggest that the Chair method is an effective and fast reduction maneuver that may be an alternative for the treatment of anterior shoulder dislocations. Further prospective studies with larger sample size are needed to compare safety of different reduction techniques.