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Strain ratio measurements of tendons vary because of the reference tissue selection. The main purpose of this study is to highlight, in detail, the numeric variability attributable to the use of various reference materials on strain ratio measurements of patellar and Achilles tendons. Measurements were performed at the proximal, middle and distal thirds of the patellar and Achilles tendons on the dominant site of healthy volunteers. A total of 3 references were used: the Hoffa's fat pad for the patellar tendon, the Kager's fat pad for the Achilles tendon, subcutaneous tissue and Aquaflex gel pads (Parker Laboratories, Fairfield, NJ, USA) for both tendons. Although the same methods were used by the same physician for each tendon site on repeated measurements, strain ratio values had numeric variability with various reference materials in each measurement. Therefore, comparison of numeric strain ratio results of various studies with various reference materials could confuse the clinical interpretations of these numeric data, and, using a reference material with standard stiffness like Aquaflex ultrasound gel pads, should be considered by verifying these results with further studies. © 2019 World Federation for Ultrasound in Medicine & Biology

The aim of this study was to investigate whether overactive bladder (OAB) influences hip fractures in climacteric women by comparing the frequency of OAB and nocturia symptoms in patients with hip fractures and their age-matched controls in pre-fracture period. A total of 30 climacteric patients with a history of hip fracture were compared to a control group of 51 women in terms of OAB, nocturia and nocturia-QoL. A questionnaire composed of structured questions and Turkish validated versions of the specific questionnaires for OAB, OAB-Quality of Life (OAB-q) and nocturia-QoL was directed to the two groups. We did not detect statistically relevant differences between the groups for the presence or severity of OAB and OAB-q (p >.05). However, Nocturia-QoL was worse in the group with hip fracture (p =.022). Overactive bladder has no contribution to the overall risk of hip fracture, whereas, the severity of nocturia seems to play a role as a risk factor in the formation of hip fracture.Impact statementWhat is already known on this subject: Hip fracture is associated with high morbidity, mortality and the cost. Prevention of hip fracture is a high priority for the patients, physicians and the public health. Several studies and consensus opinions have investigated the risk factors for the hip fractures. What the results of this study add: Although urinary symptoms were not evaluated in previous studies as a risk factor, desire of urination makes people stand up and move to their toilet, and may put them in a hurry if it is sudden and uncontrollable one. Therefore, we hypothesised that overactive bladder (OAB) and nocturia may be a risk factor in the formation of hip fractures. Our study showed that Nocturia Quality of Life is worse in patients with the hip fracture. Therefore, overactive bladder may not have a role on the overall risk of hip fracture, but the severity of nocturia seems as a risk factor in the fracture process. What the implications are of these findings for clinical practice and/or further research: The getting up from the bed would probably be harder than getting up from a chair in elderly, and life style modifications such as illumination bedroom and organisation of living place may be helpful to minimise the risks. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

Giriş:Tibia cisim kırıkları, ortopedi ve travmatoloji pratiğinde en sık görülen kırıktiplerinden biridir. Bu çalışmada tibia cisim kırıkları tedavisinde kilitliintramedüller çivi uygulanan hastaların klinik sonuçlarının ve fonksiyoneldurumlarının değerlendirilmesi ve yük verme ile kaynama zamanınınkarşılaştırılması amaçlanmıştır.Yöntem:Çalışmaya 18-73 yaş arası, tibia cisim kırığı nedeni ile intramedüllerfiksasyon uygulanmış olan 44 hasta dahil edildi. Çalışmamızda sonuçlar, Johnerve Wruhs Kriterlerine göre ve Karlstum-Olerud kriterlerine göre kaydedildi.Radyolojik olarak iyileşme, radyografilerde hastanın desteksiz olarak yükverebileceği düzeyde kallus formasyonu ve/veya kırık hattının kaybolması olarakdeğerlendirildi. Klinik iyileşme ise hastanın ağrısız tam yük verebilmesi vegünlük aktivitelerine dönebilmesi olarak değerlendirildi.Bulgular:Hastaların yaş ortalaması 38,7±14,9 (17-73) yıl idi. 44 hastadan Hastaların 16’sında ( %36,4) tibia 1/3 orta cisim kırığı, 25’ inde (%56,8) tibia 1/3 distalkırık, 3’ ünde ise ( %6,8) ise tibia 1/3 proksimal kırığı görüldü. Hastalarınortalama kaynama süresi 11,36±3,8 (6-20) hafta olarak gözlendi.Karlstrom-Olerud'un fiziksel fonksiyonel değerlendirme skalasına göre ; 21hasta (%47,7) mükemmel, 14 hasta (%31,8)iyi, 1 hasta (%2,3) tatmin edici, 8hasta ( %18,2 ) ise orta olarak kaydedildi ve hiç kötü sonuç yoktu. Johner-Wrushkriterlerine göre 32 hastada (%72,7) mükemmel, 12 hastada ise %27,3 iyi olarak değerlendirildi. Takipsürecinde bütün kırıkların kaynadığı gözlendi.Sonuç:Hastalar Johner-Wrush Kriterlerine göre mükemmel ve iyi skora sahiptiler. Karlstrom-Olerud'un fiziksel fonksiyoneldeğerlendirme skalasına göre ise hiçbir hasta kötü skora sahip değildi. Genç,erken ağırlık aktaran ve çivi korteks mesafesi 2mm’den az olan hastalardakaynama süresi kısalmaktadır., Introduction: Tibialdiaphyseal fractures are one of the most common types of fractures in practiseof the orthopedics and traumatology. In this study, clinical results of thepatients with diaphyseal fractures of the tibia which have been treated withlocking intramedullary nailing tecnique and the weight bearing time and uniontime has been evaluated. Method: Patients who appliedto our hospital with tibial diaphyseal fractures were evaluatedretrospectively. 43 patients wereincluded in the study. Karlstrom-Olerud, Johner and Wruhs score were used toevaluate clinical results. Radiologic improvement was assessed as loss ofcallus formation and / or fracture line at the level that the patient couldload without support on radiographs. Clinical improvement was assessed as thepatient was able to give full pain relief and return to daily activities.Results: Mean duration ofunion was 11.36 ± 3.8 (6-20) weeks. According to Karlstrom-Olerud 21 patients(47,7%) has received a full grade of 36, 14 patients (31,8%) have beenevaluated as good with a grade between 33 and 35, 1 patient (2,3%) wassatisfactory with a grade in the range 30-32 and 8 patients were in the range27-29 and they are evaluated as fair. Non of the patients were evaluated aspoor.Conclusion: Patients have anexcellent and good score according to the Johner-Wrush criteria. According toKarlstrom-Olerud's physical functional assessment scale, no patient had a badscar. Younger, early-weight-bearing patients with a nail cortex distance ofless than 2mm, the duration of union is shortening.

Introduction: Patellar tendon donor site has been previously evaluated in patients with auto-graft bone–tendon–bone (BTB) anterior cruciate ligament (ACL) reconstruction using either magnetic resonance imaging or B mode ultrasound. However, donor site patellar tendon strain ratio—reflecting structural features—has not been studied with US elastography. Here, we ascertain real-time elastography properties of patellar tendon donor site and clinical relevance of these properties in patients with auto-graft BTB ACL reconstruction in the postoperative period. Methods: Patients who underwent ACL reconstruction using BTB autograft were evaluated. Demographic, operative and clinical data (severity of pain, Lysholm Knee score, sit to stand test, packages/year for smoking amount) were noted. Patellar tendons of the operated knees were evaluated by ultrasound (length and thickness) and sonoelastography (strain ratio). The healthy knees of the patients constituted the control group. Results: Eighteen patients (17 M, 1 F; mean age 30.9 ± 7 years) were evaluated. Mean postoperative follow-up period was 22.1 ± 2.6 (range 18–26) months. Patellar tendons were shorter and thicker on the operated side when compared with the contralateral side (both p = 0.001). Patellar tendon strain ratios of the operated side were lower than the contralateral side (harder tendon on operated side). While there was no correlation between strain ratios and clinical variables (age, BMI, postoperative time, severity of pain, Lysholm score, all p values > 0.05), significant negative correlations were detected between strain ratios of proximal, middle and distal thirds of operated side and amount of smoking (p = 0.008, r = −0.607, p = 0.009, r = −0.598, p = 0.023, r = −0.533, respectively). Conclusion: Patellar tendons on the operated sides seemed to thicken and shorten with decreased strain ratios at the donor side compared to the healthy side at an average of 2-year follow-up in patients with ACL reconstruction using BTB autograft, and amount of smoking had negative relationship with strain ratio of donor patellar tendon. © 2016, Springer-Verlag Berlin Heidelberg.

BACKGROUND: Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). OBJECTIVE: To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. METHODS: Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N = 18) or un-weighted (free of weight, N = 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. RESULTS: Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p < 0.05). There was no significant difference for pre and post-treatment AHD measurements at 0°, 30°, and 60° shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°'30°, and 0°'60°) between groups (p > 0.05). CONCLUSION: While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups. © 2017 IOS Press and the authors. All rights reserved.

Aims: We ascertained effects of hand dominance in both right and left-handed volunteers on the thickness and cross sectional area (CSA) of pronator quadratus (PQ) muscle as measured by the axial and sagittal views of ultrasound imaging. Secondly, we also aimed to document the extent of the relationship between the PQ measurements and handgrip. Materials and methods: Healthy adults from the volunteer medical staff were included in the study. Handedness was assessed via The Flinders Handedness survey. The sonographic appearance of the PQ was evaluated on sagittal and axial images for both hands. CSA of PQ muscle was digitally drawn and calculated on the axial plane. Handgrip was measured by using adjustable-handle dynamometer. Results: Eighty-nine healthy volunteers were included (54 right and 35 left-handed). Significant difference was detected between dominant and non-dominant hands in CSA and muscle thickness in both right and left-handed volunteers (p

Objectives: This study aims to evaluate sonoelastographic properties of the distal femoral cartilage in patients with anterior cruciate ligament (ACL) reconstruction. Patients and methods: Demographic characteristics and operative data of 28 patients (27 males, 1 female; mean age 31.7 +/- 7.1 years; range 22 to 48 years) with unilateral ACL reconstruction were evaluated. Reconstruction was performed with patellar tendon graft in 22 patients (78.6%) and hamstring tendon graft in six patients (21.4%). Lysholm knee score was used for functional evaluation and chair stand test was used for lower extremity strength. Medial, intercondylar, and lateral distal femoral cartilage thicknesses of operated knees and healthy knees were measured with B-mode ultrasound, while strain ratios were measured with real time sonoelastography. Results: Postoperative mean follow-up duration was 20.4 +/- 9.8 months. Mean Lysholm knee and patient satisfaction scores were 88.0 +/- 8.5 and 8.2 +/- 1.8, respectively. Cartilage thicknesses were similar between operated and healthy knees (all p>0.05). Sonoelastographic strain ratio of medial distal femoral cartilage in operated knees was significantly higher (softer cartilage) (p=0.026). There was a negative correlation between strain ratio difference of medial cartilage of operated knees and lower extremity muscle strength (p=0.009, r=-0.487). Conclusion: While there was no difference for cartilage thickness between operated and healthy knees in B-mode ultrasound evaluation, detection of sonoelastographic strain ratio changes in medial distal femoral cartilage on the operated sides may indicate early structural changes following ACL reconstruction. Further studies are required to highlight the clinical effects of this relationship between the changes in cartilage structure and sonoelastography features.

Although adverse effects of smoking on bone health are all well known, data on how smoking interacts with cartilage structure in otherwise healthy individuals remains conflicting. Here, we ascertain the effects of cigarette smoking on sonoelastographic properties of distal femoral cartilage in asymptomatic adults. Demographic characteristics and smoking habits (packets/year) of healthy volunteers were recorded. Medial, intercondylar, and lateral distal femoral cartilage thicknesses and strain ratios on the dominant extremity were measured with ultrasonography (US) and real time US elastography. A total of 88 subjects (71 M, 17 F; aged 18–56 years, N = 43 smokers and N = 45 nonsmokers) were evaluated. Mean amount of cigarette smoking was 10.3 ± 8.9 (1–45) packets/year. Medial, intercondylar and lateral cartilage were thicker in smokers than nonsmokers (p = 0.002, p = 0.017, and p = 0.004, respectively). Medial distal femoral cartilage strain ratio was lower in smokers (p = 0.003). The amount of smoking was positively correlated with cartilage thicknesses and negatively correlated with medial cartilage strain ratios (p < 0.05). Femoral cartilage is thicker in smokers but has less strain ratio representing harder cartilage on the medial side. Future studies are needed to understand how these structural changes in the knee cartilage should be interpreted with regard to the development of knee osteoarthritis in smokers. © 2016 by the authors; licensee MDPI, Basel, Switzerland.

BACKGROUND: Impaired postural balance due to somatosensory data loss with mechanical instability has been shown in patients with ACL deficiency. OBJECTIVE: To assess postural balance in patients with ACL insufficiency prior to surgery and following reconstruction with serial evaluations. METHODS: Thirty patients (mean age of 27.7 ± 6.7 years) who underwent arthroscopic reconstruction of ACL with bonepatellar tendon-bone autograft were examined for clinical and functional variables at preoperative day and postoperative 12th week. Posturographic analysis were performed by using Tetrax Interactive Balance System (Sunlight Medical Ltd, Israel) at preoperative day, at 4th, 8th, and 12th weeks following reconstruction. Data computed by posturographic software by the considerations of the oscillation velocities of body sways is fall risk as a numeric value (0-100, lower values indicate better condition). RESULTS: All of the patients (mean age of 27.7 ± 6.7 years) had significant improvements for clinical, functional evaluations and fall risk (p < 0.05). Mean fall risk was within high-risk category (59.9 ± 22.8) preoperatively. The highest fall risk was detected at postoperative 4th week. Patients had high fall risk at 8th week similar to preoperative value. Mean fall risk decreased to low level risk at 12th week. Preoperative symptom duration had relationships with preoperative fall risk and postoperative improvement of fall risk (p = 0.001, r = -0.632, p = 0.001, r = -0.870, respectively). The improvement of fall risk was higher in patients with symptoms shorter than 6 months (p = 0.001). CONCLUSIONS: According to these results, mean fall risk of patients with ACL insufficiency was within high risk category preoperatively, and fall risk improves after surgical reconstruction, but as the duration of complaints lengthens especially longer than 6 months, the improvement of fall risk decreases following reconstruction. © 2016 - IOS Press and the authors. All rights reserved.

Objectives - The aim of this study was to explore the sonographic and elastographic properties of patellar and Achilles tendons in smoking and nonsmoking otherwise healthy adults. Methods - We conducted a level 3 case-control analytical study. Smoking and nonsmoking volunteers (>18 years) without musculoskeletal system disorders were included in the study. Demographic characteristics and smoking habits (pack-years) were recorded. Proximal, middle, and distal third thicknesses of the patellar and Achilles tendons were measured by B-mode sonography. Strain ratio measurements of the same regions were measured by real-time ultrasound elastography. Results - A total of 69 participants (57 male and 12 female; mean age ± SD, 35.5 ± 7.8 years) were evaluated in the study. Smoking (n = 35) and nonsmoking (n = 34) groups had no significant differences in terms of age, body mass index, sex, and activity level (all P > .05). Proximal, middle, and distal thirds of the patellar and Achilles tendons were significantly thinner in the smoking group (all P < .05). Furthermore, strain ratio measurements in the same regions were significantly lower in the smoking group (all P < .05). Patellar tendon thicknesses and strain ratios had negative correlations with the smoking amount (all P < .05). Conclusions - Thickness and strain ratio measurements of patellar and Achilles tendons were reduced (thinner and harder tendons) in smokers. Clinical implications of these morphologic and elastographic changes should be investigated in future studies. © 2016 by the American Institute of Ultrasound in Medicine.