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Kas iskelet sistemi dışındaki pek çok dokuda D vitamini reseptörleri ve 1α-hidroksikaz enzim aktivitesinin gösterilmesi, araştırmacıların ilgisini bu hormonun kalsiyum metabolizması dışındaki etkilerine yönlendirmiştir. Ciddi D vitamini eksikliğinin ileri yaştaki bir hastada yıkım lehine bir kemik döngüsü, osteoporoz ve giderek kalça kırığı ile sonuçlanması kaçınılmazdır (61). Kalça kırıklı hastalarda D vitamini desteğinin daha önceki yayınlarda ispat edilmiş geç dönem olumlu etkileri yanı sıra, ameliyat sonrası erken dönem komplikasyonlardan koruyucu etkisi olabileceği bu tezin yola çıkış noktasıdır.Hastalar ve Yöntem2013-2014 yılları arasında Cerrahpaşa Tıp Fakültesi Acil Ortopedi ve Travmatoloji birimi'nde travmatik kalça kırığı tanısı alan ve delirium, hareket kısıtlılığı öyküsü veya oral d vitamini desteği için herhangi bir engeli olmayan 60 yaş ve üzerindeki hastalar çalışmamıza katıldı. Hastalar pertrokanterik ve kollum kırığı olmak üzere iki gruba ayrıldı ve her bir grup içinde, hastaneye başvuru sırasına göre randomize edilerek d vitamini desteği uygulanan ve uygulanmayan olmak üzere iki alt grup oluşturuldu. Hastalar ameliyatları sıradında ve sonrasında delirium, hipertansiyon ve peroperatif kanama gibi komplikasyonlar açısından izlendi ve erken dönem kas gücü ve denge açısından değerlendirildi. Hastaların delirium izlemi delirium değerlendirme skalası, kas gücü ve denge değerlendirmesi ise 2,5 metre yürüme testi kullanılarak yapıldı.Bulgular27'si erkek 58'i kadın toplam 85 hasta çalışmamıza katıldı. Hastalar kalça kırığı tipleri ve buna bağlı olarak aldıkları endikasyon çerçevesinde bölündüğü biplar grubunda 34 hasta ve osteosentez grubunda 51 hasta yer aldı. d vitamini desteği verilme durumuna göre oluşturulan alt gruplar arasında delirium sıklığı, ameliyat süresi, peroperatif kanama miktarı, peroperatif ortalama kan basıncı, parametreleri arasında istatistiksel olarak anlamlı fark saptanmadı. Buna karşın bipolar grubunda d vitamini desteği alan hastalardan elde edilen 2,5 metre yürüme testi sonuçlarının d vitamini verilmeyen gruba göre anlamlı ölçüde daha iyi olduğu; bunun yanında osteosentez grubunda hastanede toplam yatış süresinin vitamini desteği verilen grupta anlamlı ölçüde daha kısa olduğu kaydedildi. Delirium gelişen hastalar ayrı bir grup olarak incelendiğinde iler yaş ve polifarmasinin delirium için anlamlı risk faktörleri olduğu ve delirium gelişen hastaların yatışlarının bu komplikasyon gelişmeyen hastalara göre anlamlı ölçüde uzun olduğu kaydedildi.SonuçD vitamini eksikliği ve osteoporoz zemininde gelişen kalça kırığı nedeni ile cerrahi tedavi edilen hastalarda ameliyat öncesi yüksek doz d vitamini desteğinin hastanede toplam yatış süresini kısalttığı ve hastaların erken dönem fiziksel performanslarını olumlu etkilediği saptanmıştır. IntroductionFollowing the recent revelation of the widespread distribution of vitamin D receptor in almost all the tissues of the body, Vitamin D is no longer considered as just a fat soluble vitamin that plays an important role in calcium and bone metabolism. Emerging pulications on the pleiotrophic effects of vitamin D, attracted more and more authors to understand the true identity of the sunshine vitamin. Severe hypovitaminosis D ends up imperatively to a negative bone turnover, osteoporosis and to the most unfortunate, a hip fracture. The objective of this study is to demonstrate the favorable effects on the short term postoperative complications of a hip fracture patient, along with its long term benefits reported previously on the literature. Patients and Methods85 consecutive patients over 60 years old who applied to the emergency department of Orthopaedics and Traumatology of Cerrahpaşa Medical Faculty, from 2013 to 2014 with a hip fracture, and who had neither a history of delirium nor a mobility impairment, or a counterindication to vitamin D treatment were included in the study. The patients were enrolled into two groups according to the anatomic localisation of their fractures and further into two subgroups according to a subsequent order of their hospitalization. First subgroup had vitamin D supplementation and second group did not. The patients were operated with an adequate indication related to their fracture type and followed postoperatively for complications such as delirium, bleeding and hypertention. Short term postoperative assesment for muscle power and balance were also investigated. Delirium observation scale was used for assessing delirium and 8 foot up and go test for evaluating muscle power. Results27 men and 58 women were included in the study. The bipolar group included 34 patients who had femoral neck fracture and trated with a bipolar hemiartroplasty, the osteosynthesis group included 51 patients who had pertrochanteric fractures that were treated with osteosynthesis using a proximal femoral nail. No statistical difference was detected between groups for the incidence of delirium, the lengt of operation, bleeding or mean peroperative blood pressure. However, the vitamin D supplementation subgroup with bipolar patiens showed better results for 8 foot up and go test, and shorter hospital stay in the osteosynthesis group. When we regouped the delirium patients without considering the fracture type we demonstrated that the age of the patient and the polypharmacy were two independents risk factors of delirium. The mean lenght of hospitalization oof the patients who developped delirium were significantly longer than the patients who did not. Conclusion A large dose of vitamin D supplementation was demonstrated to shorten the hospitalization in the patients with a vitamin D insufficiency and who treated surgically for an osteoporotic proximal femur fracture. The patients with a vitamin D supplementation obtained also better short term results in tests evaluating their physical performance. 115

Objectives: the aim of this study was to translate, cross-culturally adapt the patient-based Constant-Murley Score (p-CMS), assess its validity, reliability, and compare it with the clinician-based CMS (c-CMS). Patients and methods: this cross-sectional study included a total of 51 shoulders of 46 patients (22 males, 24 females; mean age: 49 +/- 10 years; range, 29 to 70 years) with shoulder pain between December 2015 and July 2016. After translation of p-CMS, each participant was asked to complete the final Turkish version of the p-CMS. The c-CMS was assessed by a physiatrist who was blinded to the p-CMS. Retest of the p-CMS was performed in patients (n=15) who did not receive any treatment between two visits (Days 3 to 5). Results: a total of 51 shoulders (n=5 bilateral shoulder pain) were tested. Strength, subjective, objective, and total scores were significantly different between the p-CMS and c-CMS (p, NA

Symptomatic spinoglenoid ganglion cyst is a rare cause of shoulder pain and disability. Surgical treatment, which may be considered after failed nonoperative treatment, includes open or arthroscopic cyst debridement. Arthroscopic treatment is less invasive and has the advantage of addressing intraarticular pathologies; however, exposure of the cyst may be deemed difficult. Furthermore, the suprascapular nerve is susceptible to iatrogenic injury owing to its close proximity to the posterior glenoid rim. The purpose of this article is to present our technique for arthroscopic spinoglenoid cyst decompression after preoperative ultrasound-guided methylene blue injection., NA

Objective: this study aimed to evaluate the functional outcomes of the surgical treatment performed with a buttress plate for the trochlear and distal capitellum fractures with posterior extension in the humerus. Methods: the data belonging to 6 female and 4 male patients with a mean age of 43.8±11.1 (34–72) years were retrospectively evaluated. The mean follow-up period was 59.6±38.79 (22–127) months. The trochlear extension and posterior comminution of the fractures were assessed through the initial X-rays and computerized tomography images. Ten patients were classified as Dubberley type B. All fractures were treated surgically, with open reduction and internal fixation using a lateral buttress plate, headless cannulated screws, and Kirschner (K)-wires. The passive flexion and extension exercises were initiated at the first postoperative day. The patients were evaluated clinically and radiographically at the final follow-up. The outcomes were quantified using the Mayo Elbow Performance Index (MEPI), visual analog scale (VAS) pain score, and the patient’s opinion. Results: at the final follow-up, the mean elbow flexion was 137.5°±3° (132°–140°), extension was −17.9°±9.2° (10°–35°), pronation was 72.2°±2.6° (68°–75°), and supination was 78.9°±4.09 (72°–85°). The mean MEPI score was calculated as 95.5±5.98 (85–100). According to the MEPI score, 8 patients were evaluated as excellent and 2 as good. The mean VAS pain score was 0.8±1.03 (0–2). The subjective patient evaluation was recorded as excellent in 5 patients, good in 3 patients, and moderate in 2 patients. One patient developed avascular necrosis and 2 patients had elbow joint arthrosis. K-wire migration was observed in one patient. Loss of reduction, nonunion, malunion, reflex sympathetic dystrophy, or heterotopic ossification were not encountered. Conclusion: the management of distal humeral fractures is challenging, and favorable outcomes are closely associated with early joint motion. A solid fixation grants early mobilization. An internal fixation using lateral buttress plate, headless cannulated screws, and interfragmentary K-wires provides a solid and secure construction that allows early postoperative joint motion., NA

Background: the Covid-19 pandemic drastically affected the health care delivery worldwide. Elective surgical interventions were cancelled or postponed to avoid disease transmission and excessive consumption of critical hospital resources. The main objective for composing this survey was to document the preventive attitude and its variations against the Covid-19 pandemic in a specific group: shoulder and elbow surgeons. The secondary objective was to evaluate their perception of emergency and to envisage the “new normal” with the altered order of priority in the upcoming post-coronavirus era. Methods: an anonymous survey composed of 25 questions was sent to all the members of the Turkish Society of Shoulder and Elbow Surgery in April 22-29, 2020, while governmental preventive measures were maximal. A secure web-based application (SurveyMonkey Inc., San Mateo, CA, USA) was used for the composition of the survey and the analysis of the responses. Results: eighty-eight responses were collected from 129 members of the Turkish Society of Shoulder and Elbow Surgery (68%), with a mean 13.9 years of practice in shoulder and elbow surgery. A more than 75% decrease in surgical and outpatient clinical activity was documented. Half of respondents used telemedicine, and the rate of obtaining informed consent remained low. The preventive attitude showed significant variation. Discussion: the perception of emergency and the protective measures showed a wide discrepancy among our respondents. Almost 80% of our respondents indicated the necessity of task forces for composing protocols to maintain subspecialty practice under adequate protective measures, and the subspecialty societies as the most eligible institutions to compose these criteria., NA

Delamination of rotator cuff tears presents a challenge for surgeons. Recognizing and repairing such a complex tear pattern often require innovative approaches to achieve an anatomic restoration of footprint. In this Technical Note, we described our preferred method that anatomically repairs both layers of delaminated rotator cuff tear separately in a knotless transosseous equivalent technique. Two sutures are placed to the articular layer in a cinch stitch configuration. Then, closed-loop end sutures are passed through both layers while keeping the closed-loop end at the working portal. The free ends of cinch stitches are loaded to anchors with a preloaded fiber tape loop, which is placed to the medial row while approximating the articular layer onto its footprint. Fiber tapes are then shuttled through both layers of tendon with the help of a previously placed closed-loop suture. Finally, the lateral row anchors are placed while fiber tapes are tensioned in a cross-bridge configuration. We believe that this technique may facilitate uneventful healing of delaminated rotator cuffs by providing the biomechanical properties of transosseous equivalent repair., NA

Objectives: this study aims to assess the effect of shear-wave elastography (SWE) on vastus medialis obliquus (VMO) and vastus lateralis (VL) muscle performances and functional outcomes of patients with patellofemoral pain syndrome (PFPS) undergoing non-selective open kinetic chain exercises (NSOKCE) and selective open kinetic chain exercises (SOKCE). Patients and methods: this randomized-controlled clinical trial included a total of 40 patients with PFPS (20 males, 20 females; mean age 46.5 +/- 9.8 years, range, 27 to 65 years) and 40 healthy controls (20 males, 20 females; mean age 36.3 +/- 11.2 years, range, 23 to 71) between February 2013 and August 2014. The participants in each group were randomized into subgroups according to NSOKCE or SOKCE for six weeks. The VMO and VL muscles were assessed with the SWE, thigh circumferences were measured, and the Visual Analog Scale (VAS) and Lysholm Knee Scale (LKS) scores were obtained. Results: the OKCE alleviated pain, improved LKS scores, and increased the thigh circumference in PFPS patients. While the healthy controls were able to increase the resting muscle tone of their VMO, the patients with PFPS failed in their both knees. Similarly, resting as well as contracted VMO and VL muscles' functions were improved significantly by both NSOKCE and SOKCE in the healthy controls. The NSOKCE improved the VAS scores in the PFPS group. The increase in the muscle mass of the affected sides of PFPS patients were more evident with NSOKCE. Conclusion: Our study results show that NSOKCE planning can be preferred over SOKCE, thanks to its contribution to pain improvement and increase in the thigh circumference in the conservative treatment of PFPS., NA

Objective: The aim of this study was to compare the long-term clinical and radiological results of Acromioclavicular (AC) fixation with K-wires (the modified Phemister procedure) and Coracoclavicular (CC) fixation with the Bosworth screw in the surgical treatment of Type 3 AC joint dislocations. Methods: Thirty-two patients with complete set of medical records and who received surgical treatment between September 2005 and January 2009 due to acute Rockwood Type 3 AC joint dislocation and properly attended their follow-ups were retrospectively evaluated. Sixteen patients (13 males, 3 females; mean age: 38, range: 24–52 years) were treated with CC fixation with Bosworth screw (Group 1), and the other 16 (12 males, 4 females; mean age: 53.3, range: 38–64 years) with AC fixation using K-wires (Group 2). Results: The mean follow-up time was 96 months for Group 1 and 93 months for Group 2 patients (p > 0.05). The mean Constant–Murley score at the final follow-up was 84.7 in Group 1 and 87.3 in Group 2 (p = 0.069). Radiological evaluation of the patients revealed AC arthrosis in 2 and 3 patients in Group 1 and 2, respectively. In Group 2, one patient had a recurrent dislocation, three patients had AC arthrosis and two patients had ossification in the CC ligament (Fig. 2).There was no superficial or deep wound infection in Group 1, while two patients from Group 2 had a superficial wound infection. Conclusions: Our results suggest that both techniques are reliable and provide adequate reduction and similar outcomes in terms of functionality and pain levels, following the reduction of Type 3 AC joint dislocations. With lower rates of wound site infection in the early and AC arthrosis in the late postoperative period, CC fixation method with the Bosworth screw may be a better surgical option than AC fixation method with K-wires. Level of Evidence: Level III, Therapeutic study. Keywords: Acromioclavicular separation, Type 3 separation, Bosworth screw, Phemister procedure