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BACKGROUND: Symptomatic degenerative meniscus tears are common in middle and old age. Arthroscopic partial meniscectomy (APM), physical therapy (PT) and hyaluronic acid injection (HAI) are the most commonly used treatment options. OBJECTIVES: The aim of our study is to compare the effectiveness of APM and PT in degenerative meniscus tears and to investigate the effect of HAI with a prospective, randomized, single-blind study. METHODS: The study included 192 patients with symptomatic degenerative meniscus tears. The patients were randomly divided into the four groups. The first group consisted of patients who underwent APM, the second group received HAI with APM, the third group received PT, and the fourth group received HAI with PT. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS) scores, and range of motion (ROM) values were used for evaluation. RESULTS: There was no difference between four groups according to age, gender, BMI, affected side, grade of osteoarthritis. In the 4 groups, WOMAC and VAS results at the 2nd and 6th months were better than pre-treatment. There was no difference between the groups in terms of WOMAC and VAS. In terms of ROM, the results were found better in PT group (Group 3, Group 4) at the 2nd and 6th months. However, the results were found worse in APM group (Group 1, Group 2). In addition, it was found that HAI applied with APM and PT had no effect on VAS, WOMAC, and ROM. It was determined that the increase of knee osteoarthritis negatively affected both the results of APM treatment and PT. VAS, WOMAC, and ROM results were found worse in patients with stage 3 osteoarthritis than grade 1 and 2, but there was no difference between grade 1 and 2. CONCLUSIONS: APM and PT give good results in terms of pain and functional results. However, ROM limitation develops after APM. Conversely, there is an increase in ROM after PT. Administration of HAI with these treatments has no effect on the results. PT is an easily applicable noninvasive method. Adding HAI to the treatment has no effect on the results and increases the cost.

Background A small autograft diameter negatively affects functional outcomes, knee stability, and the risk of rerupture after anterior cruciate ligament (ACL) reconstruction, whereas the strength of allograft decreases over time. Therefore, it is not clear whether the use of smaller autografts or the use of larger allografts in ACL yields better results. The aim of this study was to compare the outcome of smaller autografts and larger allografts for ACL reconstruction. Methods Fifty-one patients who underwent ACL reconstruction with hamstring tendon autografts (size ≤ 8 mm) and 21 patients who underwent ACL reconstruction with allografts (size ≥ 10 mm) were included in our study. All patients underwent the same aggressive early postoperative rehabilitation program. There were no significant differences between the autograft and allograft groups regarding the preoperative patient age, sex, time from injury to surgery, and average follow-up time. Results The mean diameter of the 4-stranded hamstring tendon grafts used as autografts was 7.48 ± 0.33 mm and the mean diameter of the allografts was 10.76 ± 0.67 mm. According to specific tests for the ACL (anterior drawer, Lachman, and pivot shift) and clinical evaluation tests (Lysholm knee scoring scale and International Knee Documentation Committee questionnaire), the final follow-up results were significantly better than the preoperative status in both autograft and allograft ACL reconstruction groups. Therefore, there were no significant differences between the autograft and allograft groups preoperatively and at the final follow-up. Conclusions The large size of the graft in ACL reconstruction has been reported to affect results positively. However, in our study, we could not find any significant differences between the smaller size autografts and larger size allografts in terms of inadequacy, rerupture, and final follow-up functional results. Although allografts were significantly larger than autografts, we did not have the positive effect of larger size grafts. Smaller size autografts were as effective as the larger size allografts.

This descriptive study was carried out to determine the attitudes of students working with people with disabilities towards people with disabilities. 2nd grade students studying in Yozgat Bozok University and Bartın University Health Services Vocational School Elderly Care, Child Development and Home Patient Care Program constituted the population of the study. A total of 362 students voluntarily participated in the study and the participation rate was 86.2%. The data were collected using the introductory information form and the "Attitudes toward Disabled Persons Scale” (ATDP) aimed at determining the attitudes. The mean score of the students from ATDP was found to be 55.30±12.32 (55.580±12.271 for females and 54.154±12.532 for males). There was no difference in the mean score of ATDP of the students according to gender, income, presence of disabled individuals in the family and the program they studied. A statistically significant difference was found between the mean scores of the scale and maternal educational status and paternal educational status (F=3.36, p=0.036; F= 3.47, p=0.032, respectively). Attitudes were found to be more positive in parents with higher educational level. While 17.1% of the students stated that they had the feeling of fear-uneasiness with respect to providing caring for people with disabilities, 15.3% of them stated that they had the feeling of mercy. It was determined that the attitudes of the students were generally positive, and it was concluded that they needed closer guidance and support in the education process to be able to cope with the negative emotions they had while working with people with disabilities.

BACKGROUND: Early full weight-bearing mobilization is controversial in osteoporotic patients who have undergone uncemented hemiarthroplasty (UCH). OBJECTIVES: The aim of the study was to compare the results of early full weight-bearing mobilization in CH and uncemented hemiarthroplasty (UCH). The effect of subsidence on the results was also evaluated. METHODS: Fifty-nine patients who underwent CH and UCH were evaluated. The mean age was 79.8 years (10 females, 15 males) for CH and 75.5 years (10 females, 24 males) for UCH. All patients started immediate full weight-bearing mobilization and weight-bearing exercises. RESULTS: There was no difference between the groups according to the Harris Hip Score. Both groups were evaluated in subgroups according to whether there is varus in the femoral stem. There was no difference between subgroups according to the Harris Hip Score. The femoral subsidence was not determined in CH group. In the UCH group, the subsidence was 1.13 ± 1.03 mm in varus femoral stem subgroup and 0.81 ± 0.85 mm in without femoral stem varus subgroup. There was no difference in subsidence between femoral stem with varus and without varus. The subsidence did not affect the Harris Hip Score. CONCLUSION: Full weight-bearing mobilization could be safely preferred in UCH, as in CH. Femoral stem varus below 5 degrees does not affect the results and subsidence.

Aim: The aim of our study is to investigate the effect of rehabilitation support after intertrochanteric femur fractures on men and women. The results of the groups consisting of male and female patients who received and did not receive rehabilitation support were compared both between the same sexes and between different sexes. Material and Method: One hundred twenty four patients were evaluated under two groups according to whether they received rehabilitation support or not. First group (no rehabilitation support) consists of 42 females, and 29 males, and second group (rehabilitation support) consists of 30 females, and 23 males. While the patients in the first group performed the exercises themselves at home, the patients in the second group received rehabilitation support under the guidance of a physiotherapist. The patients in both groups were also evaluated under 2 subgroups as male and female. Results: There was no significant differences between both groups in terms of mean age, female male ratio, fracture type, mean follow-up time, Harris hip score, Barthel life index, Parker and Palmer Mobility Scale before fracture. There was also no significant difference between the subgroups of the both groups. Harris hip score, Barthel life index, and Parker and Palmer Mobility Score of males were better than females at the final follow-up in the first group. The results of females were worse than pre-fracture, but there was no difference in males at the final follow-up. Harris hip score, Barthel life index, and Parker and Palmer Mobility Score of males were better than females at the final follow-up in the second group as first group. While the results of females were not different compared to pre-fracture, the results were better in males at the final follow-up. When the female and male subgroups of both groups were compared with each other, it was determined that the results in male and female subgroups in the 2nd group were significantly better. Conclusion: The continuity of rehabilitation support after hospital discharge is very important. Although rehabilitation support positively affects the results in male and female, it is much more important for female than male.

BACKGROUND There is no clear information on the efficacy of corticosteroids, and splints in the treatment of patients with diabetes mellitus (DM). The aim of this study was to compare the outcomes of isolated corticosteroid injection therapy with splint treatment with corticosteroid injection in patients with and without DM. METHODS 84 diabetics, and 84 healthy patients with a diagnosis of de Quervain's tenosynovitis were included in our study. The patients were randomly distributed into four subgroups with and without DM. Groups 1 and group 2 consisted of diabetic patients, while group 3 and group 4 consisted of healthy patients. Corticosteroid injections were administered to groups 1 and 3, and corticosteroid injection and splint treatment were administered to groups 2 and 4. RESULTS There was no significant difference in terms of age, gender, dominant/non-dominant hand, pre-treatment Quick Disabilities of the Arm, Shoulder and Hand score and visual analog scale scores score between the four groups. Quick Disabilities of the Arm, Shoulder and Hand and visual analog scale scores in the four groups were found to be significantly better than pre-treatment at the 12th month. Finkelstein test results were positive in 37.5% of the patients in the first group, 35% of the patients in the second group, 20% of the patients in the third group and 9.5% of the patients in the fourth group. Groups 1 and 2 and, groups 3 and 4 were compared to evaluate the effect of the splint. While forearm-based thumb splint affected the results positively in healthy individuals, it was determined that it had no effect on the results in diabetic patients. CONCLUSION Although corticosteroid treatment is effective in the treatment of de Quervain's tenosynovitis in healthy and diabetic individuals, the results are worse in diabetic patients than in healthy patients. In addition, the use of splint with corticosteroid injection in healthy individuals positively affects the results, while it does not affect the results in diabetic patients.

Purpose: Aim of our study was to compare the effects of partial meniscectomy and meniscus repair on knee proprioception and function. Methods: The study included 46 patients with clinical and radiological diagnosis of meniscal tear and accompanying anterior cruciate ligament (ACL) rupture. The patients were evaluated under two groups: group 1: partial meniscectomy and ACL reconstruction, and group 2: meniscal repair and ACL reconstruction. Proprioceptive and functional evaluation of all patients was performed prior to surgery and on postoperative 12th month. Results: Group 1 consists of 18 male and 1 female patients with an average age of 28.78 ± 3.50. Group 2 consists of 23 male and 4 female patients with an average age of 27.14 ± 3.65. Preoperative evaluation revealed significant differences in knee joint position sense values on wide range of knee motion (15°, 30°, 45°, 60°, and 75°) in both groups. The statistically significant difference was observed in only the range of knee motion of 60° in patients underwent meniscal repair (group 2), whereas in the range of knee motion of 45°, 60°, and 75° in patients underwent partial meniscectomy (group 1) at 12th-month control. According to Lysholm knee scoring system, significantly better results were achieved with meniscal repair compared to the partial meniscectomy at 12th-month control. Conclusion: In case of ACL rupture accompanied by meniscal tear, the meniscal repair should be sutured, if possible, in order to obtain better results in terms of knee function and proprioception.

Aim: To investigate the relationship between adhesive capsulitis and serum vitamin D levels. Materials and Methods: Patients who were diagnosed with primary adhesive capsulitis between 2015 and 2019 and had regular follow-up data were retrospectively evaluated. Age, gender, body mass index, affected side, disease duration, serum 25-OH vitamin D levels, range of shoulder motion, the Visual Analog Scale (VAS) score, the Constant-Murley score, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score were evaluated. Patients with a diagnosis of diabetes, history of rheumatic diseases, presence of cervical pathologies, history of fracture and/or shoulder surgery, history of infection, and full-thickness rotator cuff tear were excluded from the study. The serum 25 (OH) D levels below 20 ng/ml were accepted as deficiency. The patients were divided into two groups according to the serum vitamin D level (Group 1 if 20 ng/mL and Group 2 if ≥20 ng/mL). The VAS score, functional scores, range of motion (flexion, abduction, external and internal rotation) of the patients in the two groups were compared.Results: Of the 74 patients included in the study, 59 (79.2%) were female and 15 (20.3%) were male, with a mean age of 50.6 ± 9.74 years. The mean duration of pain was 8.21 ± 2.3 months. The serum vitamin D level was below 20 ng/ml in 43 patients (58.1%) who were then allocated to Group 1, and Group 2 comprised 31 patients. The mean VAS score was 7.8 for Group 1 and 5.2 for Group 2. The mean Constant-Murley and DASH scores were 54.4 ± 15.9 and 21.6 ± 9.78, respectively in Group 1 and 52.04 ± 12.2 and 24.3 ± 6.4, respectively in Group 2. No significant difference was observed between the groups according to the range of joint motion, Constant scores, or DASH scores. Conclusion: Vitamin D deficiency may be associated with shoulder pain in patients with adhesive capsulitis. However, the serum vitamin D level had no effect on the functional results. Conclusion: In the present study, serum CRP, TNF-α and H.pylori IgA levels were significantly higher than normal pregnant women.

This study sought to demonstrate that successful outcomes can be achieved with the new technique presented here for chronic ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal (MCP) joint, as well as with K-wire pinning for acute UCL injury. We followed 19 patients who suffered an UCL rupture (mean follow-up: 14.26±4.65 months) and 32 patients who presented with UCL avulsion fracture (mean follow-up: 16.81±7.54 months). We used a free tendon graft for UCL reconstruction in the UCL rupture group. Both ends of the graft were stabilized with bioabsorbable suture anchors, which were used as biotenodesis interference screws. Closed reduction and K-wire fixation was used in UCL avulsion fracture group. There were no statistically significant differences between operated and contralateral healthy thumb MCP joint in both groups in the grip strength, tip pinch strength, flexion, extension, ulnar deviation, and radial deviation movements at final follow-up. Grip strength, tip pinch strength, ulnar deviation and radial deviation were significantly better in the avulsion group than the rupture group. All patients regained full stability at the MCP joint in avulsion group; 16 patients regained full stability and 3 patients presented with mild laxity (less than 10° laxity) in rupture group. Glickel grading scale used as a functional score was excellent for 30 patients and good for 2 patients in avulsion group; it was excellent for 17 patients and good for 2 patients in rupture group. Our study shows that closed reduction and percutaneous K-wire fixation of acute displaced large UCL avulsion fracture is a simple technique and achieves adequate stability of UCL. For UCL rupture, free tendon reconstruction with bioabsorbable suture anchors provides adequate stability and stable fixation within the tunnels.

Background: In subungual exostosis surgery, repair of the damaged nail bed and surgical excision of the mass without damaging the nail bed is important. The ideal method of surgery is still unclear. This study is done to qualify the effects of different surgical methods on outcome measures in different types of subungual exostosis. Materials and Methods: Fifteen patients, operated with a diagnosis of subungual exostosis between January 2008 and June 2012, were evaluated. Protruded masses were excised with a dorsal surgical approach after the removal of the nail bed and nonprotruded masses were excised through a"fish-mouth" type of incision. Results: The mean age of the patients in protruded subungual exostosis group was 17.3 years (range 13-22 years) and this group consisting of seven female and two male patients. The patients were followed up for a mean of 14.1 ± 4.8 months. The mean age of the patients in the nonprotruded subungual exostosis group was 14.6 years (range 13-16 years) and consisting of six female patients. The patients were followed up for a mean of 11.6 ± 2.9 months. The results were positively affected by changing the surgical approach depending on whether or not the exostosis is protruded from the nail bed. All patients had healthy toe nails in the postoperative period without any signs of recurrence. Conclusions: In patients with a protruded subungual exostosis, the mass should be removed by a dorsal approach with the removal of the nail and injury to the nail bed should be repaired. In patients with a nonprotruded subungual exostosis, the mass should be excised through a "fish-mouth" type incision at the toe tip without an iatrogenic damage.

Objectives To evaluate the radiological and functional results of osteosynthesis with mini-plate and screws in metacarpal fractures. Methods In our study 43 patients who were operated between 2009 and 2012 were included. The patients were followed-up for (19.76±5.61) months. The mean age of patients was (31.11±7.81) years (7 females, 36 males). The fracture types were oblique for 19 patients, spiral for 15 patients and transverse for 9 patients. The patients were operated after a mean of 3.4 d (range 3 h-6 d) after the fracture had occurred. Patients were immobilized for 2 weeks with a splint after surgery. Passive joint movements were started on the third days, and active joint movements were started in the second week. Rehabilitation of all patients was done in the same center with supervision of the same physiotherapist. The patients were assessed by total joint range of movement of the finger, grasping strength and Quick-DASH scores. Results No significant differences were detected between fingers of the operated hand with same finger of the healthy hand according to total joint range of movement. Total joint range of movement values were measured perfect for 38 patients, good for 4 patients and medium for 1 patient. There were no significant differences with the corresponding finger on the opposite healthy side according to grasping strength. Soiling in the wound dressing was observed in 1 patient but there was no active drainage. Soiling of the wound dressing disappeared after 3-5 d of treatment with antimicrobial agent. Bone union was observed in all patients in a mean of 6 weeks (range 5-7 weeks). The time to return to work was (31.6±8.9) d after the surgical treatment of the fracture. Conclusions Mini-plate and screws fixation of unstable metacarpal fractures produces anatomical reduction of fractures with stabilization that is rigid enough to allow early mobilization, thereby preventing stiffness and hence good functional results.

We aimed to compare results of treatment of oblique–spiral metacarpal and phalangeal fractures with screw only or mini plate plus screw, respectively. A total of 43 patients who were operated with a diagnosis of displaced, irreducible, unstable, rotational oblique–spiral metacarpal and proximal phalangeal fracture between 2007 and 2010 were included in this study. The mean age of patients with a phalangeal fracture was 33.8 years (range 20–50 years; 4 females, 18 males), and the mean age of patients with a metacarpal fracture was 29.6 years (range 18–45 years; 3 females, 18 males). Mini plate plus screw or screw only was used for internal fixation of these fractures. The patients were followed up for 19.2 ± 5.4 months in the phalangeal fracture group and 20.9 ± 7.3 months in metacarpal fracture group. Of the metacarpal fractures, 14 were oblique and 10 spiral, whereas 14 of the phalangeal fractures were oblique and 8 spiral. The patients were evaluated according to total range of motion of the finger, grasping strength and Q-DASH score. For patients treated with mini plate plus screw after metacarpal and phalangeal fractures, the time to return to work was significantly shorter in comparison to patients treated with screws only. There was no significant difference between patients with metacarpal fractures treated with mini plate plus screw and patients treated with screw only in terms of total range of motion and Q-DASH results at last on control examination, while results of patients with phalangeal fractures treated with screw only were significantly better. There was no significant difference between these two treatments in phalangeal fractures in terms of grasping strength of the finger in early (1st month) and late (last control examination), whereas patients with metacarpal fractures treated with mini plate plus screw reached higher grasping strength earlier. Treatment with mini plate plus screw should be avoided in spiral and oblique phalangeal fractures, and fixation should be done with screw only with a short surgical incision and dissection. On the other hand, treatment with mini plate plus screw should be preferred in patients with spiral and oblique metacarpal fractures, especially in those who work in occupations requiring higher physical strength.

Background: Volar and/or dorsal surgical approaches are used for surgical treatment of perilunate and lunate dislocations. There are no accepted approaches for treatment in the literature. We evaluated the functional results of isolated volar surgical approach for the treatment of perilunate and lunate dislocation injuries. Materials and Methods: 9 patients (6 male and 3 female patients average age 34.5 +/- 3.6 years) diagnosed with perilunate or lunate dislocations between January 2000 and January 2009 were involved in the study. The reduction was performed through isolated volar surgical approach and K-wire fixation, fracture stabilization with volar ligament repair was performed. Range of wrist joint motion, fracture healing, carpal stability, grip strength, return to work were evaluated and also direct radiographs were taken routinely at each control. The scapholunate interval and the scapholunate angle were evaluated radiographically. Evaluations of the clinical results were done using the DASH, VAS and Modified Mayo Wrist Scores. Results: The physical rehabilitation was started at 6th week, after the K-wires were removed. The average followup was 18.2 months (range 12-28 months). At the final followup, the average flexion extension arc was 105.0 +/- 9.6 degrees (74.6% of the other side), the average rotation arc was 138.8 +/- 7.8 degrees (81.5% of the other side) and the average radioulnar arc was 56.1 +/- 9.9 degrees (86.4% of the other side). The grip strength was 0.55 bar; 83.2% that the uninjured arm. According to the Mayo Modified Wrist score, the functional result was excellent in five patients and good in four and the average DASH score was 22.8. The scapholunate interval was 2.1 mm and scapholunate angle was 51 degrees. Conclusion: The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.

The aim of the study was to evaluate the results of epiperineural suture repaired primary (clean transaction injury, massive soft-tissue associated injury) and secondary (delayed partial injury) ulnar nerve injuries according to lesion level and type.Forty-two patients diagnosed with ulnar nerve injury between January 2008 and January 2012 were involved in the study. Ulnar nerve lesions were classified according to the level of injury into three types: type 1--lesion located above the flexor carpi ulnaris branch; type 2--lesion located between the flexor carpi ulnaris and the flexor digitorum profundus III and IV; type 3--lesion located below the flexor digitorum profundus III and IV and no more than 10 cm distal from the elbow crease. Additionally, ulnar nerve lesions were classified according to type into three groups: group 1 (n 17)--clean transaction injury; group 2 (n 14)--massive soft-tissue associated injury; group 3 (n 11)--delayed partial clean transaction injury. In follow-up evaluations, sensory and motor recovery was analysed with the most common Highet scale modified by Dellon et al. Functional results were evaluated according to the Disability of Arm, Shoulder, and Hand (DASH) score at final follow-up.There were no statistically significant differences between groups according to men/women ratio, mean age, mean follow-up period and ulnar-nerve injury level. The DASH score was significantly better in the clean transaction injury group than the other groups and significantly better for type 3 than types 1 and 2 injuries in all groups. Sensory recovery of type 1 and 3 injuries in the massive soft-tissue associated injury group was significantly worse than the other groups. The worst motor recovery was evaluated in type 1 injury and the best in type 3 injury according to injury level. According to group, motor recovery of the massive soft-tissue associated group was significantly worse than the other groups in all injury types. There were no statistically significant differences between clean transaction injury and delayed partial clean transaction injury groups in all injury types.Prognostic factors that influenced motor-sensory recovery and functional results were found in interval between trauma and reconstruction, injury level (worse results from proximal to distal) and mechanism of injury (worse results from massive soft-tissue injury to clear, sharp-tissue injury).

We analyzed the outcomes of the ligament reconstruction and tendon interposition arthroplasty of the trapeziometacarpal joint with use of the full thickness of the flexor carpi radialis. We reviewed 19 patients, with 23 thumbs at mean follow-up of 59 ± 15 months. According to Dell classification, 11 thumbs were grade 2, and 12 thumbs were grade 3.The preoperative VAS pain score was 7 ± 0.9 and thumb web space was 23 ± 2.4°. The preoperative grip strength was 13 ± 0.7 kg, tip pinch strength was 2.8 ± 0.5 kg and lateral pinch strength was 4 ± 0.9 kg. None of the thumbs could touch the palmar crease of the little finger. The final outcome was 0.9 ± 1.4 for VAS, 19 ± 1 kg for grip strength, 4.5 ± 0.3 kg for tip pinch strength, 5.6 ± 0.5 kg for lateral pinch strength and 38 ± 2.4° for thumb web space. Mobility of the thumbs was improved; 19 thumbs could touch the base of the fifth finger, and five thumbs could touch the crease of the proximal interphalangeal joint. We compared the operated side with the healthy one in 15 patients, the grip strengths were 82% of the contralateral side, tip pinch strengths 78%, and lateral pinch strengths as 75%. According to our series, this surgical technique relieves pain and provides stability and mobility of the thumb.