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BACKGROUND: It has not yet been fully established that there is coronavirus disease 2019 (COVID-19) involvement in the synovial fluid and it remains a topic of debate. OBJECTIVE: The aim of this study was to evaluate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in knee joint synovial fluid of patients with COVID-19. METHODS: This retrospective study was conducted with an initial screening of patients who were admitted to a tertiary pandemic hospital due to COVID-19 symptoms, and underwent treatment for COVID-19 between March and June 2020. RESULTS: A total of 2476 patients were hospitalized or received treatment for a possible diagnosis of COVID-19. While the RT-PCR test was positive in 318 patients (12.8%), 2158 (87.2%) were computed tomography positive but reverse transcription-polymerase chain reaction (RT-PCR) negative. Twelve patients were consulted due to acute joint effusion. Of five patients with knee joint effusion and a positive RT-PCR test, the synovial tissue RT-PCR test was positive in only one patient. CONCLUSION: This paper is the first to show the presence of SARS-CoV-2 in synovial fluid. This can be considered of importance for the determination and elimination of the route of transmission, thereby preventing further development and spread of the disease. [ABSTRACT FROM AUTHOR]

Objective: Vertebroplasty (VP) is a commonly used technique for the treatment of osteoporotic vertebral fractures (OVF). The aim of the study is to compare general anesthesia (GA) and local anesthesia (LA) applications for VP. Materials and Methods: Patients who underwent VP for a single-level OVF were included in to the study. Visual analog scale (VAS), demographic characteristics, operative time, mean arterial pressure (MAP), heart rate, length of stay in intensive care and hospital, complications, side effects, kyphotic angle (KA) and anterior vertebral height (AVH) of the vertebral body were compared between groups. Results: Eighty patients (52 female, 28 male) were included and divided into two groups: As GA, group 1, and as LA, group 2. There was statistical significant differences between preoperative VAS scores, KA, AVH compared to postoperative period in both groups (p<0.05). There was no difference between the groups in terms of recovery rates of these variables, complications and side effects (p>0.05). Heart rate and MAP was lower in group 1 (p<0.05). Conclusion: VP is a minimally invasive method that provides pain relief and restoration of the fractured vertebrae. Our study showed there is no difference in the success, complication and side effect rates of VP surgeries performed with both anesthesia methods. LA may be an alternative method to GA as the primary anesthetic option for VP operations. VP can be performed under local anesthesia to avoid complications of GA and shorten the length of stay in the hospital especially in high-risk patients. [ABSTRACT FROM AUTHOR]

Background: The treatment of Intertrochanteric fractures in the elderly osteoporotic patient is still controversial. The aim of this study was to compare the outcomes of proximal femoral nailing (PFN) and a distally-fixed non-modular monoblock fluted long-stem hemiarthroplasty (HA) in elderly patients with an osteoporotic intertrochanteric fracture. Methods: This retrospective study included patients who had undergone surgery for an unstable intertrochanteric fracture. The patients were separated into PFN and HA groups. The demographic features of the 2 groups were compared. All patients were evaluated using the Singh index, ASA score, AO/OTA classification, Harris Hip Score (HHS), and Parker and Palmer mobility score. Results: The most common complications were nonunion (12.0%) and cut-out of the screw (10.7%) in the PFN group, and dislocation of the prosthesis (6.7%) and wound infection (5.7%) in the HA group. Overall, the 2-year mortality rate was 29.3%. Mortality, particularly within the first 3 months, was 2.4 times higher in the PFN Group than in the HA group (40% vs. 19.75%). Although the HHS was significantly higher in the first year for the HA group, no significant difference was seen between the 2 groups at 24 months. Conclusions: Although PFN and HA have similar good outcomes at 2 years, HA allows earlier mobilisation and has fewer complications and a lower mortality rate. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the number of deep vein thrombosis (DVT) cases during the quarantine period for COVID-19 to that of the last year. Methods: This study was conducted as a single-center and retrospective study. All hospital admissions during April 2020 and May 2020 were screened from the hospital records, and DVT cases were recorded. Likewise, all hospital admissions during April 2019 and May 2019 were screened, and DVT cases were noted. DVT cases of both years were compared. Results: Among 480931 patients admitted to our hospital in April 2019 and May 2019, DVT was detected in 82 patients (0.017%) (47 males, 35 females) with a mean age of 56.99 ± 9.1 years (ranges 39 to 79 years). Besides, among 145101 patients admitted to our hospital in April 2020 and May 2020, DVT was detected in 123 patients (0.084%) (51 males, 72 females) with a mean age of 58.64 ± 8.9 years (ranges 40 to 83 years). Despite the decrease in the total number of patients admitted to the hospital, there was a significant increase in the number of DVT patients. Interestingly, there were only two symptomatic pulmonary-embolism cases in the 2019 period, whereas there were seven symptomatic pulmonary embolisms secondary to DVT in the 2020 period. Unfortunately, one patient died due to pulmonary embolism secondary to DVT in 2020. The previous history of DVT was remarkable in patients admitted during the COVID-19 confinement. Conclusion: In conclusion, COVID-19 confinement seems to be associated with increased rates of DVT. Strict preventive measures such as exercise training or prophylactic drug use should be considered to prevent immobility-related DVT during the COVID-19 quarantine. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

objective: The efficiency and cost of cell saver system is compared with in patients who underwent to complex spine surgery with and without the system. Material and methods: We restrospectively evaluated the patients who underwent to posterior instrumentation and fusion in our clinic between Jan 2009-Mar 2013 for treatment of complex spine disease. There were 44 patients in group I which cell saver system was used during operation, and 20 patient in group II which system was not used. We aimed to determine the efficiency and cost of the usage of cell saver system against to allogenic blood transfusion in peroperative and postoperative periods. IBM SPSS Statistic Version 20.0 program was used for statistical analyses. Results: The number of erytrosyte suspension used in the peroperative and the postoperative periods was 1±1 in group I, and 2.6±1.8 in group 2 and the difference was statistically significant (p=0.004). When compared by the cost, group I was 752.7±148.7 TL and group II was 241.8±169.1 TL with statistically significant difference (p<0.00l). Conclusion: in complex spine surgery, hemoglobin, hematocrit and red blood cell values are higher at the first postoperative day in patients whom cell saver system is used during operation against whom did not used and the usage of this system decreases allogenic blood transfusion at the peroperative and the postoperative periods. [ABSTRACT FROM AUTHOR]

Objective: In this study, the efficiency of three different rigid screw types on preserving reduction in Lindgren-Turan osteotomy is investigated. Material and Methods: Between 2007-2012, 86 feet of 60 patients who underwent Lindgren-Turan osteotomy procedure due to hallux valgus deformity in our clinic were retrospectively evaluated. Fixation was done by Herbert screws, cannulated headless screws and 2.7 mm cortical screws. Hallux valgus angles, intermetatarsal angles and distal metatarsal articular angles were evaluated in preoperative, early postoperative and late postoperatively. Different rigid internal screws which are used in fixation after Lingdren-Turan osteotomy were evaluated by these angles. Results: While there was no statistically significant difference between averages of hallux valgus angles at early and late postoperative controls in cannulated headless group, the difference was significant in Herbert screw and 2.7 mm cortical screw groups. While there was no statistically significant difference between averages of intermetatarsal angles at early and late postoperative controls in cannulated headless and Herbert screw groups, the difference was significant in 2,7 mm cortical screw group. There was no statistically significant difference between averages of distal metatarsal articular angles at early and late postoperative controls in all screw groups. Conclusion: In fixation of osteotomy site by 2.7 mm cortical screws after Lindgren-Turan osteotomy, there was significant correction decrement at late postoperative intermetatarsal and hallux valgus angles. There was less reduction loss with cannulated headless screws in our study. [ABSTRACT FROM AUTHOR]

Objective: In this study, we purposed to evaluate the early and mid term results and life quality of the patients who underwent to arthroscopic cartilage debridement and joint lavage because of symptomatic gonarthrosis which didn't response to medical treament at least three months, restricted the patient's daily activity and wasn't at the late stage radiologically. Material and Methods: We made our study between 2004-2010 with 96 patients over forty years who applied to our clinic and came to their controls periodically because of knee pain which did not remit by conservative treatment at least three months, had gonarthrosis diagnosis according to modified ACR criteria, under 4. Stage according to Kellgren-Lawrence criteria radiologically and underwent to arthroscopic cartilage debridement and articular lavage because of symptomatic gonarthrosis. We evaluated the life quality, pain and functional scores of the patients pre and post-operatively by SF-36 and WOMAC point index. (Number Cruncher Statistical System) 2007 & PASS 2008 Statistical Software (Utah, USA) program was used for statistical analyze. The results are evaluated with Student t test ve Mann Whitney U test. p<0.05 was statistically significiant Results: In our study we found that the postoperatively physical and social functions, mental health and total SF-36 scores are increased, WOMAC scores are decreased statistically significantly (p<0.0l). We found that the difference between preoperative and postoperative WOMAC and SF-36 scores were not different statistically between two groups whose BMI<30 and BMI≥30 (p>0.05). Physical and social functions, mental health and total SF-36 scores of the patients who underwent to operation in the last 18 months were statistically significantly increased against the patients whose operation time was earlier (P<0.01). Physical and social functions, mental health and total SF-36 scores of the patients who are under 50 were statistically significiantly greater than patients over 50 (p<0.01). Conclusion: The arthroscopic joint debridement and lavage can be used, cheap, low morbid method to improve life quality, functions and to recruit the pain when applied on well chosen patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of our study was to evaluate aortic stiffness and distensibility changes and the presence of aortic and mitral valve calcifications in patients with primary knee osteoarthritis (OA), using 2-dimensional and Doppler transthoracic echocardiography., Methods: This case-control study included 115 participants with OA and a control group between May 2019 and November 2019. The Kellgren-Lawrence classification was used for the diagnosis and classification of knee OA, based on radiological images. We compared the demographic data, 2-dimensional and Doppler transthoracic echocardiography results, and laboratory findings between the OA patient group and the control group., Results: There was a significant difference between aortic strain, aortic distensibility, aortic stiffness, and C-reactive protein values between the OA patient group and the control group (p < 0.001 for all). Post hoc analyses revealed that aortic strain and aortic distensibility values were significantly lower, and aortic stiffness values were significantly higher in the grade 4 OA group than those of other groups (p < 0.05 for all). In addition, the C-reactive protein values of the grades 3 and 4 patients were significantly higher than those of other groups (p < 0.05 for all). No significant difference was observed between the groups in terms of aortic and mitral valve calcifications (p > 0.05 for all)., Conclusion: Aortic strain and distensibility values were lower in the advanced grades of primary knee OA, whereas aortic stiffness values and the frequency of valve calcifications were higher., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The aim of this study was to conduct a sonographic assessment of sciatic nerve thickness and stiffness following total hip arthroplasty (THA) and to determine the relationship between sonographic characteristics of the sciatic nerve and clinical outcomes., Methods: This prospective study included patients undergoing primary cementless THA due to hip osteoarthritis between January 2018 and January 2019 in a tertiary-level hospital. The thickness, strain elastography, strain ratio (SR), and shear wave elastography (SWE) of the sciatic nerve were measured. The clinical outcome measures included leg lengthening (LL), leg length discrepancy (LLD), Oxford Hip Score (OHS), Visual Analog Scale (VAS) at rest, VAS during activity, and the Leeds Neuropathic Symptoms and Signs Evaluation (LANSS) scale. The data of the patient group were assessed preoperatively and at 3, 6, and 12 months postoperatively., Results: The sciatic thickness and SR values of the operated side were significantly lower than those of the non-operated side (P < 0.05 for all). The sciatic SWE was significantly greater on the operated side compared with the non-operated side (P < 0.001 for all). Sciatic nerve thickness and SR were negatively correlated, and sciatic nerve SWE was positively correlated with OHS, VAS at rest, VAS during activity, and LANSS values. Sciatic nerve thickness and SR values were significantly lower, and SWE was significantly higher in the group with a change in LL > 20 mm. Clinical scores decreased during the following period in mild and moderate lengthening group (< 20 mm). In the severe lengthening group (≥ 20 mm), the clinical score increased over time. The VAS activity score was higher in the mild and moderate LL group (< 20 mm) than the VAS rest score (P < 0.001). However, the VAS rest score was significantly higher in the severe LL group (≥ 20 mm) than the VAS activity score (P < 0.001)., Conclusion: The results of this study have shown a significant relationship between thickness and stiffness of the sciatic nerve and LL after THA. The ultrasound parameters were significantly associated with functional outcomes., Level of Evidence: Level IV, Therapeutic Study.

Background: Various surgical techniques have been defined for hip hemiarthroplasty (HA), including metaphyseal vs. diaphyseal and short stem vs. long stem. The present study aims to compare outcomes of metaphyseal fixed short-stem vs. diaphyseal fixed long-stem HA in treating unstable intertrochanteric fractures in elderly patients., Methods: This study was conducted retrospectively and included 129 patients ≥65 years of age, having unstable intertrochanteric fractures and undergoing HA. Outcome measures were the 2-year Harris hip score and the mobility score of Parker and Palmer; comorbidities as well as mortality rates of the groups were compared., Results: Mean operation time and median full weight-bearing time were significantly shorter in group B (p<0.05 for both). As for the Harris hip scores, group B showed better outcomes for the third-month evaluation (p=0.006). However, 2-year assessments were similar (p=0.067). In addition, higher Parker and Palmer mobility scores were obtained in group B at the 2-year assessment (p<0.001). The frequencies of prosthetic dislocation, cortical porosis and subsidence were higher in group A (p<0.05 for all)., Conclusion: The findings obtained in this study suggest that diaphyseal fixed long-stem HA seems to be superior to the metaphyseal fixed short-stem HA because the former is related to better functional scores, earlier mobilization, and lower complication rates.

The purpose of this retrospective study was to determine the most appropriate distal fusion level in terms of clinical results and radiological changes in Lenke 3C adolescent idiopathic scoliosis (AIS). Between June 2010 and May 2014, a total of 90 consecutive patients who underwent surgery for Lenke 3C AIS were divided into three groups as L2, L3, and L4 according to the fusion levels and compared in terms of functional and radiological outcomes. Patients were evaluated with Scoliosis Research Society 22 (SRS 22) and the Oswestry disability index (ODI) at the final follow-up. Preoperative standard posteroanterior and lateral whole-spine radiographs and lateral bending radiographs were used to evaluate the curves. All patients were also assessed with lumbar MRI at the final follow-up, and classified for each patient in terms of disc degeneration (DD) and facet joint degeneration (FJD). There was a statistically significant difference between the groups in terms of ODI category (P = 0.001). The rate of minimal disability in the L3 group, moderate disability in the L2 group, and severe disability in the L4 group were higher. Statistically significant differences were observed between the groups in terms of pain, body image, mental health, and total score distribution from the SRS-22 domains (P < 0.05). No significant difference was observed between the groups in terms of DD and FJD in MRI (P = 0.263). Although the preoperative functional scores could not be evaluated due to the retrospective nature of the study, it was observed that the only significant difference between the groups was the SRS-22 score. The best SRS-22 score was obtained in patients in whom fusion was stopped at L3.

Background: This study aims to compare clinical and radiographic outcomes of surgical treatment and conservative treatment with bracing in neurologically intact patients with score 4 of TLICS thoracolumbar vertebra fractures., Methods: Patients with traumatic thoracolumbar junction fractures (T11-L2), the score of TLICS 4, and minimum 24-month follow-up were included in this study. Patients were divided into surgery and bracing groups. The groups were compared concerning clinical and demographical features, local kyphotic angles (LKA), vertebra height loss percentage (VHL), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and time to return to work., Results: There were 74 patients (71 males, 3 females) in the surgery group and 76 patients (58 males, 18 females) in the bracing group. Although the surgery group showed better improvement in VAS scores within six months postoperatively, no significant difference was observed at the 24th-month evaluation (p<0.001 and p=0.270, respectively). ODI, LKA and VHL were significantly lower in the surgery group (p<0.001, p<0.001 and p<0.001, respectively). In addition, return to work was significantly earlier in the surgery group (p<0.001)., Conclusion: The findings obtained in this study suggest that the surgical treatment for TLICS 4 patients with thoracolumbar fractures has better clinical and radiographic outcomes than the bracing. Moreover, returning time to the work of patients is shortened with surgical treatment. The surgical treatment seems to be the first and the appropriate choice in the management of TLICS 4 thoracolumbar vertebral fractures.

Background: The aim of this study was to compare the functional and radiological outcomes of K-wire-supported bridging external fixation (KW-EF) and volar locking plate (VLP) in the treatment of comminuted intra-articular distal radius fractures., Methods: Patients treated for complex intra-articular distal radius fractures between February 2010 and April 2013 were retrospectively investigated. A total of 114 patients (42 females and 72 males) with a mean age of 44.9±15.4 (range: 18-86) years were evaluated. Wrist ranges of motion were measured using a universal goniometer, and hand grip strength was determined using hand dynamometers. The results were evaluated with Gartland-Werley score. QuickDASH questionnaire was administered in subjective functional assessment. Radiological evaluations were performed, with wrist radiographs obtained on the 3rd month and 2nd year., Results: Wrist flexion, extension, pronation, and supination were all significantly better in the VLP group than in the KW-EF group at last control (p=0.001). Gartland-Werley, QuickDASH, and Visual Analog Scale were significantly better in the VLP than group than in the KW-EF group (p=0.003, p=0.003, and p=0.001, respectively). At the last follow-up, loss of grip strength compared with that on the uninjured side was 4% in the VLP group and 7% in the KW-EF group., Conclusion: VLP is a safe method with low complication rates. It is superior to KW-EF as it facilitates early return to daily activities and shows better functional and radiological outcomes in the 2nd year of treatment.