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Although there are many studies evaluating optimal inlet and outlet angles required for the correct placement of S1 iliosacral screws, there is no study evaluating reliability and feasibility of these angles for all individuals on three‐dimensional (3D) anatomical models. A total of 100 women and 100 men were selected randomly. A vertical line was created according to long axis of the tomography device on which patient was lying in supine position. The automatized best‐fit planes were created on superior and inferior endplates, anterior cortex including notch region and posterior cortex of first sacral vertebrae using 3D imaging software to measure mean inlet and outlet angles. We observed no statistically significant difference between gender groups in terms of inlet and outlet angles. Mean inlet view is obtained for anterior cortex of S1 in 22.5 ± 9.5° and for posterior cortex in 46.5 ± 9.3°. Mean fluoroscopic view angle of S1 for superior outlet is 40.3 ± 7.6 and for inferior outlet is 46.9 ± 8.8. Mean anterior and posterior S1 inlet view angles do not accurately visualize anterior cortex of 74 (37%) and posterior cortex of 66 (33%) individuals. Mean superior and inferior S1 outlet view angles do not accurately visualize superior endplate of 74 (37%) and inferior endplate of 56 (28%) individuals. Due to individual alterations of spatial position of sacrum, mean inlet and outlet view angles of S1 are not sufficient to visualize the iliosacral screws under fluoroscopy in many individuals. [ABSTRACT FROM AUTHOR]

Objective: Carpal tunnel syndrome is a condition caused by the compression of the median nerve within the carpal tunnel, resulting in clinical symptoms in the area innervated by the nerve. The role of electromyography in surgical planning for carpal tunnel syndrome is controversial. The current study aimed to compare the clinical results of patients who underwent carpal tunnel release surgery based on their preoperative electromyography grading. Methods: We examined 102 patients who underwent carpal tunnel release surgery between 2015 and 2018. All patients were evaluated by electromyography preoperatively and 2-year postoperatively and completed the Boston Questionnaire. Based on the Bland classification for electromyography grades, the patients were divided into 2 groups: group 1 (grades 1-3) and group 2 (grades 4-6). Changes in scores were analyzed after carpal tunnel release surgery for each group. Results: When considering the results for all patients irrespective of group, both scores showed significant improvement after surgery. Group 2 exhibited greater improvement in the functional status scale score and electromyography grade compared to group 1, while similar changes were observed in the symptom severity scale scores. Conclusion: Both the symptom severity scale and functional status scale scores improved significantly after surgery for all patients. However, group 1 consistently had lower scores than group 2 across all evaluation periods. The evaluation of the improvement in the electromyography grade (ΔEMG) indicated that group 2 had better improvement than group 1. [ABSTRACT FROM AUTHOR]

Objective: Staphylococcus aureus is a critical infectious agent in orthopedics and traumatology clinics. Treatment of S. aureus infection is a problem, mainly due to the increased incidence of methicillin-resistant strains. This study aims to determine the antibiotic resistance of S. aureus strains isolated from wound samples of patients admitted to a tertiary care hospital's orthopedics and traumatology clinic. Methods: Patients admitted to our hospital's orthopedics and traumatology clinic between January 2012 and November 2018 were included in this study and studied retrospectively. Participants in the study were required to have S. aureus strains present within their wounds. In addition to more traditional approaches, an automated microbiologic agent detection system known as VITEK® 2 Compact (bioMérieux, Marcy l'Etoile, France) was utilized in this study to identify S. aureus and determine its level of antibiotic resistance. Results: S. aureus was identified in 64 out of 298 wound samples, with a detection rate of 21.5%. Fifty-one S. aureus strains (79.7% of the total) were taken from the inpatient clinic, and the remaining 13 (20.3%) were obtained from the outpatient clinic. S. aureus strains were categorized as either methicillin-resistant S. aureus positive (19 patients, 29.7%) or methi cilli n-sus cepti ble S. aureus positive (45 patients, 70.3%), with the majority being methi cilli n-sus cepti ble S. aureus positive. Conclusion: We found out that among methicillin-resistant S. aureus positive patients, vancomycin, teicoplanin, linezolid, tigecycline, and daptomycin were effective antibiotic agents for the treatment. Also, methicillin-resistant S. aureus positive patients were resistant to penicillin, rifampicin, tetracycline, and erythromycin. This study detected methicillin resistance as a significant issue, and S. aureus strains antibiotic resistance in our study population was comparable to previous research. [ABSTRACT FROM AUTHOR]

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Objectives: This study aims to find the shortest needed time interval between two consecutive anteroposterior (AP) knee X-rays of the same patient to determine the progression of knee osteoarthritis (KOA) by a trained eye. Patients and methods: In this retrospective study, 2,145 AP knee X-rays of 848 primary KOA patients (331 males, 517 females; mean age 65±9 years; range, 50 to 92 years) followed-up between January 2014 and December 2017 were used. Randomly generated 1,280 pairs of knee X-rays were shown to 14 orthopedic surgeons working in the Department of Orthopedics and Traumatology, and then the physicians were asked to select the second X-ray of the same arthritis knee. The physicians completed the test twice. The patient's age, gender, time interval between two radiographs and the responses of the physicians were recorded. Results: Our results showed that if the time interval between the two radiographs was six months or more, the correct estimation rates increased gradually. When the time interval was 36 months and more, the ratio reached 92%. The sensitivity and specificity rate of the method was 81%, while the positive predictive value was 86%. However, interestingly, age or gender did not have any effect on this result. Conclusion: In our study, X-rays taken in less than six months apart could not give additional information about the radiographic progression of KOA. To discern between the progression of KOA, we recommend that there be a 12 to 18-month interval between consecutive X-rays. The data of our study can be used for a routine algorithm to be developed for the evaluation of KOA patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare and evaluate the efficacy of intraarticular methylprednisolone acetate and an intra-articular polyacrylamide hydrogel in patients with different stages of knee osteoarthritis. Materials and Methods: Patients with symptomatic knee osteoarthritis and history of failed pharmacotherapy or physiotherapy interventions were included in this study. The first 64 consecutive patients got intra-articular polyacrylamide hydrogel, the latter 79 consecutive patients got intra-articular methylprednisolone acetate. Patients were evaluated by WOMAC score and self-assessment questions. Results: There was no statistically significance difference between groups when WOMAC scores and answers of self-assessment questions were compared. Conclusion: Intra-articular use of polyacrylamide hydrogel was not superior to methylprednisolone acetate, for patients with knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to compare the results of talon tibial intramedullary (IM) nailing with the results of conventional distal locked tibial IM nailing., Patients and Methods: The study included 60 patients (37 males, 23 females; mean age 42.2 years; range 18 to 92 years) who underwent tibial IM nailing with the diagnosis of unilateral, closed or open (Gustilo-Anderson type 1) tibial diaphyseal fracture (Orthopaedic Trauma Association 42) between January 2013 and January 2016. Patients were separated into two groups as talon tibial IM nailing group (group 1, n=30) and distal locked tibial IM nailing group (group 2, n=30). All patients' operative and total radiation exposure times were recorded. At last control, American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores were evaluated for clinical outcomes. All complications were recorded., Results: Mean operative time was 43.8 minutes in group 1 and 50.2 minutes in group 2. Mean radiation exposure time in group 1 was 5.4 minutes, which was three times shorter than the time of group 2, which was 17.5 minutes. Mean time until union was 16.9 weeks in group 1 and 12.2 weeks in group 2. Statistically significant differences were present between two groups in operative, radiation exposure time and time until union (p=0.019, p=0.001, p=0.001, respectively). When American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores were compared, there were no statistically significant differences (p=0.951 and p=0.896)., Conclusion: Talon tibial IM nailing is an easier and safer alternative to conventional distal locked tibial IM nailing with shorter operative and radiation exposure times. However, it should be kept in mind that the time until radiographic union may be longer compared to conventional tibial IM nailing.

Objectives: This study aims to investigate the effects of the use of citric acid and sodium bicarbonate mixture as an effervescent in polymethylmethacrylate bone cement in terms of better drug elution., Patients and Methods: Multiple cylinder cement blocks each containing 10 g of glucose and different amounts of effervescent (E), with different numbers of pieces (P), surface areas, volumes, and porosities were prepared. Physical properties of all blocks were calculated. Blocks were placed in jars containing saline solutions and the released glucose concentrations were measured at predefined intervals. Correlations between elution rate and physical properties were defined., Results: Elution rates were significantly higher in samples with effervescent. At the end of 45th day, E0P1 released mean 21% of its glucose content. This value was 38%, 61%, 82% and 88% for E0P2, E0P4, E2P1 and E4P1, respectively. Strong correlations were detected between water absorption ratio, surface areas, porosity and glucose elution rates (r=0.942, p<0.01; r=0.894, p<0.05; r=0.918, p<0.05)., Conclusion: Using sodium bicarbonate and citric acid as effervescent in bone cement provides satisfactory porosity development for better antibiotic elution. This method may be useful when a monolithic spacer and better local antibiotic elution are required.

Objectives: This study aims to assess the radiographic, histological, and biomechanical effects of pregabalin on fracture healing in a rat model of femur fracture., Materials and Methods: A total of 32 female Wistar-Albino rats (mean age 12±1 weeks; mean body weight 236±12 grams) were randomized into four groups with eight rats in each group. Groups A and B were the control groups whereas C and D were the treatment groups. Drugs were delivered by oral gavage. Radiographic, histological and biomechanical evaluations were performed after sacrificing the rats in groups A and C on 15th postoperative day and the rats in groups B and D on 30th postoperative day., Results: Although radiographic results were better in groups A and B than groups C and D at the end of 15th day, no significant difference was detected at the end of 30th day. No statistically significant differences were observed between the groups on 15th and 30th days in terms of histological or biomechanical evaluation., Conclusion: Administration of pregabalin did not affect fracture healing process adversely in rats.

In the treatment of developmental dysplasia of the hip, concentric reduction of the femoral head into the acetabular cavity plays a key role in the natural development of the acetabulum. However, there is still debate on the need for additional acetabular osteotomies and their timing. In this study, we compared open reduction (OR) alone with OR plus Dega osteotomy for acetabular index (AI) development. Twenty patients, 10 in each group, who underwent either OR alone or OR plus Dega osteotomy were studied retrospectively. All patients were diagnosed with developmental dysplasia of the hip and none of them received treatment previously. Preoperative, early postoperative, and follow-up radiographs were gathered, radiological grading was performed according to Tönnis, and AI angles were measured. The OR group had a mean age of 24.5 months, whereas the Dega group had a mean age of 24.8 months. The mean follow-up period of the OR group and Dega group was 57.8 and 66.6 months, respectively. In the OR group, the initial mean AI was 37.5° whereas in the Dega group it was 46°. After the follow-up, despite the acetabular development in the OR group being twice as fast, the final mean AI was 25.5, whereas it was 15.9 in the Dega group. The difference was statistically significant (P<0.05). Using Tönnis' definition, the Dega group ended up with 70% normal hips, 20% mild dysplasia, and 10% severe dysplasia, whereas the OR group had 20% normal hips, 30% mild dysplasia, and 50% severe dysplasia at the final visit. There was no correlation between the initial radiological grading of dislocation and the final result. OR plus Dega osteotomy is a good option to regain acetabular coverage over the femoral head. It provides better radiographic results after a 5-year follow-up period in patients with a mean age of 25 months. OR alone should not be performed unless the child had mildly dysplastic acetabulum according to Tönnis' definition.

The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends on the procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.

Objectives: In this study, we aimed to evaluate the components of knee varus in the adjacent joints and to investigate the possible correlations between them., Patients and Methods: Between January 2005 and December 2010, 315 lower limbs of 164 patients who underwent high tibial osteotomy (HTO) due to varus gonarthrosis were analyzed. Alignment and orientation angles of these limbs using preoperative orthoroentgenography were measured. The results were compared with normal values and evaluated statistically for possible correlations., Results: Statistical analysis of the data showed that the mean value of mechanical lateral distal femoral angle (mLDFA) increases in varus knees and thus distal femoral joint orientation showed less valgus. The effect of mLDFA on mechanical tibiofemoral angle (mTFA) was almost the same as medial proximal tibial angle (MPTA). Both together; they explain 52.2% of variance in mTFA. mLDFA has a negative and MPTA has a positive and significant influence on mTFA (b= -0.765, p<0.001) and (b= 0.798, p<0.001) respectively. A moderate correlation was found between the mTFA and lateral distal tibial angle (LDTA) in the lower limbs grounding at the same angle (r=0.634, R=0.40, p<0.001). A slight, but significant correlation between mTFA and medial neck shaft angle (MNSA) was found (r=0.15, R=0.02, p<0.01)., Conclusion: Distal femoral joint showing less valgus significantly contributes to the deformity in varus gonarthrosis, also a very important contributor to the deformity. Abnormal forces applied to ankle may cause collapse in distal lateral tibial metaphysis and decrease LDTA in varus knees. Medial neck shaft angle may decrease due to possible abnormal loading angles to the femoral neck in some individuals with varus gonarthrosis.

Objectives: In this study, we aimed to evaluate the efficacy of open surgical treatment including safe femoral head dislocation, femoral neck osteochondroplasty and labral repair in early-term following surgery., Patients and Methods: Between April 2006 and January 2010, 22 hips of 22 patients (13 males, 9 females; mean age 33.3 years; range 17 to 52 years) who underwent open surgical treatment due to femoroacetabular impingement syndrome (FAIS) were retrospectively analyzed. Thirteen of the patients had bilateral and nine patients had unilateral FAIS. The mean follow-up was 27.5 months (range, 6-51 months). The functional evaluation of the patients was performed using Harris hip score both pre- and postoperatively after union was achieved in the trochanteric osteotomy site., Results: The mean preoperative Harris score was 54.3, increasing to 70.6 postoperatively. The mean internal rotation of hip, which was 10.5 degrees preoperatively, increased to 15.2 degrees postoperatively. With regard to the patient satisfaction, 18 of 22 patients reported that they were satisfied with the surgical treatment., Conclusion: Our study results showed that we concluded that safe hip dislocation and open osteochondroplasty of femoral head is an effective method in the treatment of FAIS, originating from different etiological factors.