Search

Background Previous studies have determined the videos on YouTube® have misleading information in medicine, however the assessment of the information for hallux valgus surgery is lacking. Methods YouTube® was analyzed using two keywords as ‘hallux valgus surgery’ and ‘bunion surgery’. Once redundancies were eliminated, each video was evaluated for the characteristic as following: duration, number of views, likes and dislikes, days since upload, view and like ratios and video power index (VPI). The quality of the information was evaluated using DISCERN, JAMA and Hallux Valgus Score (HVS). Results A total of 49 videos included. Fair or poor results for DISCERN and HVS (90% and 69% of videos, respectively) were found. No difference was found between video source and quality scores. Number of likes and VPI negatively correlated with all scores (p Conclusions YouTube® had poor quality of information for hallux valgus surgery.

In this article, numerical and experimental analyzes were made by adding winglet and endless blade to the tip of the airfoil to improve the wind turbine blade performance. Similarly, the change in performance was investigated by making notches at different sizes and distances on the trailing edge of the wing structure, inspired by the creatures in nature. First of all, the designed wing structures were analyzed by numerical analysis as a fixed wing, and the lift and drag forces were examined and the aerodynamic performance parameters were examined. Then, the winglet, endless wing and trailing edge notch were mounted to the wing structure cast from a 3D printer, and the energy parameters produced by each design in the wind tunnel were examined. In curved wings, the stress values produced depending on the size of the endless wing structure added to the wing tip have changed and up to 15% aerodynamic performance improvement has been observed in the designed wing structure. In addition, the design was experimentally examined on conventional fixed blades, and up to 6% improvement was observed on fixed blades.

The new type of coronaviruses (COVID-19) crisis has had a devastating impact across the world. Public administration discipline addresses emergency crisis management in various ways and dimensions. This article seeks answers to the question “How AI can contribute to crisis management policies to fight against COVID-19 and its impacts?” To this, the techniques and methods of AI in fighting against the COVID-19 virus will be explained in various dimensions. AI can make significant contributions in the preparation, mitigation-prevention, response, and recovery policies in the COVID-19 pandemic crisis. If adopted, AI can be used to find better treatment routes and drug development. Equally, policymakers can benefit from AI as decision support to reach high-quality decisions through fast and accurate data. The paper concludes that governments should create and implement effective AI-based crisis management strategies to fight against the epidemic locally, regionally, nationally, and internationally with a multi-level governance perspective.

Bu çalışmada, insansız hava araçlarında iniş yüklerine dayanıklı ve maksimum hafifliğe sahip kompozit iniş takımı tasarlamak amaçlanmıştır. Bu kapsamda, iniş ve kalkış sırasında uçağın iniş takımlarının maruz kalacağı yüklerden yola çıkılarak iniş takımı tasarımı yapılmış ve üç boyutlu modelleme oluşturulmuştur. Tasarlanan katı model sonlu elemanlar yöntemi kullanılarak sayısal analizler yapılmıştır. Elde edilen verilerin belirtilen konfigürasyonda uçak iniş takımları üzerindeki yükleri herhangi bir kırılma olmaksızın karşılayabildiği gözlemlenmiştir. Çalışma sonunda elde edilen bulgular grafiklerle desteklenmiştir.

Morton’s neuroma is a mechanical neuropathy of plantar interdigital nerve. It is one of the most common causes of forefoot pain. One of the most undesirable complications of Morton’s neuroma surgery is recurrent neuroma. Excision level of Morton’s neuroma is important to prevent recurrence. In this study, we aimed to figure out preferred excision levels of orthopedic surgeons by evaluating pathological samples. Pathological specimens of 192 patients were prepared and examined by the same pathologist. One hundred thirty-nine patients were women (72.3%) and 53 were men (27.6%). The most common interspace affected was the third at 171 (89%) patients, followed by the second at 21 (11%). Mean age was 45.8 years (between 23 and 73). Twenty-two of them were left foot and the other 170 were right foot. Recurrent neuromas, pathological sample more than one piece from one surgical site, were excluded from the study. Pathological specimens were prepared and examined by the same pathologist. Gross pathological appearance and histopathological findings were recorded. Mean sample length was 2.05 cm (between 0.8 and 6 cm). One hundred forty-five samples were smaller (75.5%) than 3 cm, and only 47 samples (24.5%) were bigger than 3 cm. Our database results showed that majority of surgeons excise the nerve shorter than it should be. One of the reasons for high recurrence rates in Morton neurinoma may be inadequate excision of the nerve.

The aim: type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. We aimed to evaluate results of surgical treatment with an anatomical distal clavicle plate using CC ligament augmentation. Materials and methods: 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. The average patient age was 38 years (range 24–52 years). All patients were male; the right clavicle was injured in 10 patients whereas the left clavicle was injured in 5 cases. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range, 12–40 months). Results: bony union was achieved at a mean follow-up of 8 weeks (range 6-10 weeks). The mean Constant score was 97 (range, 92–100). There were no complications or no need to second operation. All patients achieved satisfactory full range of shoulder motion. Hardware removal was performed for prominence in one case after the union was completed. Conclusion: the augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options. We recommend augmentative CC ligament repair techniques over the distal locking anatomic plate for type 2 fractures, Цель: переломы ключицы типа 2В с разрывом коноидной связки считаются нестабильными. Хотя хирургическое лечение рекомендуется как стандартный способ лечения переломов типа 2B, единого мнения относительно типа оперативного лечения нет. Мы имели целью оценить результаты хирургического лечения анатомической дистальной пластины ключицы с использованием аугментации КК связки. Материалы и методы: 15 пациентов с диагнозом перелом дистальной части ключицы, которые прошли операцию из-за нестабильных переломов 2 типа. Хирургическое лечение во всех случаях проводилось с использованием анатомического блокировки пластины дистальной части ключицы (ZipTight™). Средний период наблюдения составил 24 месяца (диапазон - 12-40 месяцев). Результаты: сращивание костей было достигнуто при среднем наблюдении 8 недель (диапазон 6-10 недель). Средний показатель постоянной оценки составил 97 (диапазон 92-100). Осложнений или необходимости повторной операции не было. Выводы: техника аугментации, о которой сообщается здесь, обеспечивает более ранние движения, повышенную стабильность и ускоренное анатомическое заживления по сравнению с другими обычными вариантами., Мета: переломи ключиці типу 2В з розривом коноїдної зв’язки вважаються нестабільними. Хоча хірургічне лікування рекомендується як стандартний спосіб лікування переломів типу 2B, єдиної думки щодо типу оперативного лікування немає. Ми мали на меті оцінити результати хірургічного лікування анатомічної дистальної пластини ключиці з використанням аугментації КК зв’язок. Матеріали та методи: 15 пацієнтів з діагнозом перелом дистальної частини ключиці, які пройшли операцію з приводу нестабільних переломів 2 типу. Хірургічне лікування у всіх випадках проводилось з використанням анатомічного блокування пластини дистальної частини ключиці (ZipTight™). Середній період спостереження становив 24 місяці (діапазон - 12–40 місяців). Результати: зростання кісток було досягнуто при середньому спостереженні 8 тижнів (діапазон 6-10 тижнів). Середній показник постійної оцінки становив 97 (діапазон 92-100). Ускладнень або необхідності повторної операції не було. Висновки: техніка аугментації, про яку повідомляється тут, забезпечує більш ранні рухи, підвищену стабільність та прискорене анатомічне загоєння порівняно з іншими звичайними варіантами.

In this study, the design of the electric powered VTOL Flying car was made in the CAD program, and the longitudinal, vertical and lateral flight dynamics were examined and aerodynamic analysis was made. In the design, the power and propulsion systems of the flying car, avionic systems, security systems, magnetic sensors, navigation landing and take-off methods, requirement verification methods, flight performance values were determined. Our design work for flying cars, which will soon start real-time flights, will guide the people and institutions that will design and produce in this field.A practical flying car should be able to operate safely and environmentally both in public spaces and in the air. For widespread adoption, it must be able to fly without a qualified pilot as we know it as a controller, and must have appropriate purchase and operating costs. Being a qualified car driver and having a pilot license, which certification processes are extremely difficult, is an important obstacle to the adoption and widespread process of the flying car concept. The certification processes of many different countries have been examined for the flying car we will design. Examination of these processes has been guiding in the creation of detailed data on many issues, and in this context, care has been taken to meet the requested competencies on a common ground. In order to overcome these procedures, a VTOL platform with high autonomy has been designed thanks to its subsystems as well as a stable flight dynamics., Bu çalışmada, elektrikle çalışan VTOL Uçan arabanın tasarımı CAD programında yapılarak boylamsal, dikey ve yanal uçuş dinamikleri incelenerek aerodinamik analizleri yapılmıştır. Tasarımda uçan arabanın güç ve tahrik sistemleri, aviyonik sistemler, güvenlik sistemleri, manyetik sensörler, seyrüsefer iniş ve kalkış yöntemleri, gereksinim doğrulama yöntemleri, uçuş performans değerleri belirlendi. Yakında gerçek zamanlı uçuşlara başlayacak olan uçan arabalara yönelik tasarım çalışmalarımız, bu alanda tasarım ve üretim yapacak kişi ve kurumlara yol gösterecek.Pratik bir uçan araba, hem kamusal alanlarda hem de havada güvenli ve çevreci bir şekilde çalışabilmelidir. Yaygın olarak benimsenmesi için, kontrolör olarak bildiğimiz nitelikli bir pilot olmadan uçabilmesi ve uygun satın alma ve işletme maliyetlerine sahip olması gerekir. Sertifikasyon süreçleri son derece zor olan kalifiye araç sürücüsü ve pilot ehliyetine sahip olmak, uçan araba kavramının benimsenmesi ve yaygınlaşmasının önünde önemli bir engeldir. Tasarlayacağımız uçan araba için birçok farklı ülkenin sertifikasyon süreçleri incelendi. Bu süreçlerin incelenmesi birçok konuda detaylı verilerin oluşturulmasında yol gösterici olmuş ve bu kapsamda talep edilen yetkinliklerin ortak bir paydada karşılanmasına özen gösterilmiştir. Bu prosedürlerin üstesinden gelebilmek için alt sistemleri ve stabil uçuş dinamiği sayesinde yüksek otonomiye sahip bir VTOL platformu tasarlanmıştır.

Background:Morton’s neuroma (MN) is mechanical neuropathy of plantar interdigital nerve. It is one of the most common causes of forefoot pain. One of the most undesirable complications of MN surgery is recurrent neuroma. Excision level of MN is important to prevent recurrence. In this study, we aimed to find the relation resection lenght of MN to clinical results of MN surgery cases. Methods:76 samples sent with the diagnosis of Morton neuroma to the pathology department of our hospital between years 2010-2019. 66 patients whose clinical results were available were included in the study. Mean age was 41,5 (between 21 to 70). All of 66 patients were primary diagnosed 22 of them was left foot and the other 170 were right foot. 50 of them were female, and 16 were male. Recurrent neuromas, pathological sample more than one piece from one surgical site were excluded from the study. 72 of them were evaluated as a clinically and compare the sample lenght.Results:76 pathological specimens were prepared and examined by the same pathologist. Gross pathological appearance and histopathology findings were recorded. Mean sample length was 2,05 cm (between 0,7cm and 3,5 cm). 68 samples was smaller (89.5%) than 3 cm and only 8 sample (10.5%) was bigger than 3 cm. Average interdigital neuroma score improved from 20 to 62 points following the surgery (p

Introduction: Morton’s neuroma (MN) is mechanical neuropathy of plantar interdigital nerve. It is one of the most common causes of forefoot pain. One of the most undesirable complications of MN surgery is recurrent neuroma. Excision level of MN is important to prevent recurrence. In this study, we aimed to figure out preferred excision levels of orthopedic surgeons by evaluating pathological samples. Methods: 192 samples sent with the diagnosis of Morton neuroma to the pathology department of our hospital between years 2010-2017 were added to our study. Mean age was 45,8 (between 23 to 73). All of 192 patients were primary diagnosed 22 of them was left foot and the other 170 were right foot was. 139 of them were female, and 53 were male. Recurrent neuromas, pathological sample more than one piece from one surgical site were excluded from the study. Results: 192 pathological specimens were prepared and examined by the same pathologist. Gross pathological appearance and histopathology findings were recorded. Mean sample length was 2,05 cm (between 0,8cm and 6 cm).145 samples was smaller (75.5%) than 3cm and only 47 sample (24.5%) was bigger than 3 cm.Conclusion: In conclusion our database results showed that majority of surgeons didn't take into account plantarly directed nerve branches.

Purpose The purpose of this study is to increase maximum lift/drag ratio (Emax) of tactical unmanned aerial vehicles (TUAVs) via applying novel small aerodynamic modifications. Design methodology/approach A TUAV is manufactured in Erciyes University, Faculty of Aeronautics and Astronautics, Model Aircraft Laboratory. It has both passive and active morphing capabilities. Its nosecone and tailcone shapes are redesigned to improve Emax. Moreover, active flow control is also built on its wing for improving Emax. Findings Using these novel small aerodynamic modifications, considerable improvement on Emax is obtained. Research limitations/implications Permission of Directorate General of Civil Aviation in Turkey is required for testing TUAVs in real-time applications. Practical implications Small aerodynamic modifications such as nosecone-tailcone shape modifications and building active flow control on wing are very beneficial for improving Emax of TUAVs. Social implications Small aerodynamic modifications satisfy confidence, high performance and easy utility demands of TUAV users. Originality/value The study will enable the creation of novel approaches to improve Emax value and therefore aerodynamic performance of TUAVs.

Mallet fracture is an avulsion of the extensor tendon and fracture of the dorsal rim of the articular surface of distal phalanx at the same time. If a part of the mallet fracture is angled or rotated to such a degree that prevents full anatomic reduction, malunion and deformities may occur as a result. The objective of this study was to describe a new surgical technique to provide derotation of the mallet fracture. A 22G or 21G needle is used like a joystick to reduce the mallet fracture with small, gentle movements. The extension block pinning technique described by Ishiguro was applied after proper alignment had been achieved. Bony union was achieved for all patients 6 weeks later. Derotation of type 2 and 3 mallet pieces with closed reduction to prevent surgical failure is simple but effective.

Amaç:Morton’s nöroma ön ayağın ilerleyici ve ağrılı bir hastalığı olup, cerrahi dışıyöntemler başarısız olduğunda nöroma eksizyonu tedavi seçenekleri arasındadır.Bu çalışmada dorsal yaklaşım ile nöroma eksizyonu yapılan olgularda fonksiyonelsonuçlar, komplikasyonlar ve devam eden şikayetler araştırılmıştır.Yöntemler:Morton’s nöroma tanısı ile dorsal nöroma eksizyonu yapılan 27 hasta (21 kadın) çalışmaya dahil edildi.Ortalama yaş 49 yıl (Yaş aralığı 24-74 yıl) ortalama takip süresi 52 ay idi (Yaşaralığı 24-96 yıl). Klinik skorlar interdigital nöroma skorlama sistemine göredeğerlendirildi. Hastalar son takiplerinde ağrı şiddeti, ayakkabıdeğişiklikleri ve duyu problemleri açısından sorgulandı.Bulgular:Cerrahi öncesi 20 puan olan ortalama interdigital nöroma skorlaması, sontakipte ortalama 62 puan olarak saptandı (p, Aim: Morton’s neuromais a paroxysmal neuralgia of forefoot and when nonsurgical treatment isunsuccessful, neuroma excision is indicated. The purpose of the present studywas to evaluate the outcomes, complications and existing symptoms following anexcision of the neuroma using dorsal approach.Methods: The study evaluated 27 patients (21 women)with an average age of 49 years (range, 24-74) and an average follow-up of 52months (range, 24-96). The clinical diagnosis was confirmed by history andclinical evaluation. Clinical outcomes were assessed using the interdigitalneuroma score and the patients were asked in terms of the level of pain, shoemodification, and sensorial problems. Results: Averageinterdigital neuroma score improved from 20 to 62 points following the surgery(p

Introduction: YouTube has become a common health information source for patients. Recent studies have determined that videos on YouTube contain misleading and inappropriate information for different medical conditions. The aim of the present study was to assess the quality and reliability of videos pertaining to rotator cuff (RC) repair surgery. Hypothesis: YouTube users prefer watching videos with high educational quality which are provided by physicians. Material and methods: A search was performed using keywords ``rotator cuff surgery{''} and ``rotator cuff repair{''} on YouTube and the first 100 videos for each keyword were analyzed. Video source, time since upload, duration, and number of views, likes, and dislikes were recorded. Video popularity was reported using the video power index (VPI) and view ratio. Video educational quality was measured using the recognized DISCERN, the Journal of the American Medical Association (JAMA) score and a novel RC-specific score (RCSS). Results: Among the 200 videos identified, 67 were included. The mean duration was 7.7 minutes and the mean number of the views was 147,430. Videos uploaded by a physician had significantly higher DISCERN, JAMA, and RCSS (p < 0.001). While the main video source was physicians (48\%), the most popular videos were uploaded by patients and commercial websites, according to the VPI and view ratios. The number of likes, view ratios, and VPI were negatively correlated with each score. There were negative correlations between duration and VPI scores, and positive correlations with DISCERN, JAMA score, and RCSS. Animated videos showed significantly lower results for all quality scores (p

Background: Carpal tunnel syndrome(CTS) is the most frequent compressive neuropathy of upper extremity .Median nerve is compressed under flexor retinaculum because of primary or secondary reasons. Although primary CTS may have different causes, idiopathic CTS's ethiology is unclear We aimed to evaluate tenosynovial tissue change under flexor retinaculum as a cause of idiopathic CTS even more as a possible cause of recurrent CTS. Materials and Methods: We operated 175 patients with carpal tunnel syndrome who had median nerve compression. 110 patients were diagnosed as idiopathic CTS were included at our study. Open carpal tunnel release was performed by same surgeon and synovial samples were taken from synovial connective tissue under median nerve for pathological examination. Results: All patients were followed-up 22 months ( 12 to 35 months ) prospectively. Mean age was 45 years( 22 to 65). Preop VAS score was 6 post op VAS score was 1. Synovial hypertrophy was detected at 38 of 110 patients(34%). Other pathological results were; 13 reactive synovitis (11%), 8 ganglion(7.2%) , 51 fibrohyaline nodulation(46.3%). Conclusions: We recommend the evalution of tenosynovial tissue under flexor retinaculum after releasing the retinaculum. If there is an inflammation or a hypertrofi or a mass effect, surgeon must do partial tenosynovectomy to decrease the volume of the carpal tunnel and to prevent recurrence.

Purpose The aim of this paper is to redesign of morphing unmanned aerial vehicle (UAV) using neural network for simultaneous improvement of roll stability coefficient and maximum lift/drag ratio. Design/methodology/approach Redesign of a morphing our UAV manufactured in Faculty of Aeronautics and Astronautics, Erciyes University is performed with using artificial intelligence techniques. For this purpose, an objective function based on artificial neural network (ANN) is obtained to get optimum values of roll stability coefficient (Clβ) and maximum lift/drag ratio (Emax). The aim here is to save time and obtain satisfactory errors in the optimization process in which the ANN trained with the selected data is used as the objective function. First, dihedral angle (φ) and taper ratio (λ) are selected as input parameters, C*lβ and Emax are selected as output parameters for ANN. Then, ANN is trained with selected input and output data sets. Training of the ANN is possible by adjusting ANN weights. Here, ANN weights are adjusted with artificial bee colony (ABC) algorithm. After adjusting process, the objective function based on ANN is optimized with ABC algorithm to get better Clβ and Emax, i.e. the ABC algorithm is used for two different purposes. Findings By using artificial intelligence methods for redesigning of morphing UAV, the objective function consisting of C*lβ and Emax is maximized. Research limitations/implications It takes quite a long time for Emax data to be obtained realistically by using the computational fluid dynamics approach. Practical implications Neural network incorporation with the optimization method idea is beneficial for improving Clβ and Emax. By using this approach, low cost, time saving and practicality in applications are achieved. Social implications This method based on artificial intelligence methods can be useful for better aircraft design and production. Originality/value It is creating a novel method in order to redesign of morphing UAV and improving UAV performance.

Sciatic nerve palsy is a recognized complication of hip arthroplasty1,2. The prevalence is low, ranging from 0% to 3.7%1. Delayed-onset acute sciatic nerve palsy due to hematoma formation is rarely seen. Recently, with the increased use of strong anticoagulants for thromboprophylaxis, an increase in the prevalence of sciatic nerve palsy secondary to local hematoma formation has been reported3. We report the case of a patient who developed complete sciatic nerve palsy over the course of a few hours on the fifth day after hip arthroplasty as a result of local bleeding secondary to bridging chemoprophylaxis with use of low-molecular-weight heparin. The patient discussed in this report was informed that data concerning her case were to be submitted for publication, and she provided consent. A seventy-year-old woman presented to our emergency department with a right intertrochanteric hip fracture. The orthopaedic examination revealed external rotation posture of the lower extremity, painful and limited range of motion of the right hip, and weakness on the right side of the body. The patient had a height of 1.65 m (65 in) and a weight of 70 kg (154 lb). Medical conditions included atrial fibrillation, mild hypertension, and cerebrovascular embolism. The patient had been followed by a cardiologist for three years because of a history of thromboembolism and was taking Coumadin (warfarin), amlodipine besylate, and metoprolol succinate. She was not taking any other antithrombotic medications, such as aspirin or clopidogrel, for the treatment of vascular disease. The preoperative neurological examination revealed weakness of the right upper and lower extremities. The international normalized ratio was 2.23. The Coumadin was stopped, and low-molecular-weight heparin (enoxaparin sodium, 60 mg; two times per day) was started, as recommended by the consulting cardiologist. When the international normalized ratio was decreased to 1.55 …

Introduction YouTube® has become a common health information source for patients. Recent studies have determined that videos on YouTube® contain misleading and inappropriate information for different medical conditions. The aim of the present study was to assess the quality and reliability of videos pertaining to rotator cuff (RC) repair surgery. Hypothesis YouTube® users prefer watching videos with high educational quality which are provided by physicians. Material and methods A search was performed using keywords “rotator cuff surgery” and “rotator cuff repair” on YouTube® and the first 100 videos for each keyword were analyzed. Video source, time since upload, duration, and number of views, likes, and dislikes were recorded. Video popularity was reported using the video power index (VPI) and view ratio. Video educational quality was measured using the recognized DISCERN, the Journal of the American Medical Association (JAMA) score and a novel RC-specific score (RCSS). Results Among the 200 videos identified, 67 were included. The mean duration was 7.7 min and the mean number of the views was 14,7430. Videos uploaded by a physician had significantly higher DISCERN, JAMA, and RCSS (p Discussion Online information on RC repair surgery provided by YouTube® was low quality, despite being mostly uploaded by physicians and having relatively higher quality scores. YouTube® users prefer watching low quality videos which were provided by patients and commercial websites. Level of evidence IV, Case series.

Tumours and sport injuries can both affect active, young patients, and the symptoms of the two often overlap. Neglected avulsion injuries sometimes cause a mass to develop which can mimic a tumour. We discuss the diagnosis, treatment, and results following nine anterior inferior iliac spine (AISS) avulsion fractures.

Introduction: We describe a simple and quickly applied electrodiagnostic method for confirming the diagnosis of interdigital neuropathy caused by Morton neuroma (MN). Meth- ods: Interdigital nerves II-III and III-IV were stimulated with sur- face electrodes simultaneously touching the lateral side of 1 toe and the medial side of the other. Recording was also made with surface electrodes. The results of 20 normal controls and 14 patients with MN were evaluated. Results: The amplitude and peak latency values elicited in the patients as well as the inter- side differences revealed an acceptable abnormality rate between 57.1% and 71.4%. Conclusions: Although the most popular and effective method of MN diagnosis is clinical evalua- tion supported by imaging, electrophysiological studies can, in selected patients, provide valuable information.

We hypothesized that regional migratory osteoporosis (RMO) and transient osteoporosis of the hip (TOH) terms describe a common disease process. Therefore, based on our patient, we aimed to review the pathogenesis, diagnosis, and treatment of both diseases. The patient was a pregnant woman in her third trimester with sacral insufficiency fracture, which was shortly followed by migratory arthralgia of both hips and ankles in a proximal to distal direction. She was operated (core decompression) for both hips and ankles, and she was symptom free at 17th month. RMO and TOH have an unclear etiology, share the similar course, and bear a self-limiting nature. Both disorders may be the same clinical entity with a common pathogenesis. Probably, many of RMO patients were labeled as TOH, and therefore, RMO has been underrepresented. In conclusion, we think that both RMO and TOH describe a common disease process. Either the diagnosis is RMO or TOH, the management will be the same. Finally, the conservative treatment protocol is a better treatment modality and must be obeyed even in resistant cases.

Bu calismada govde surukleme katsayisinin en uygun degerini hesaplamak icin yapay zeki bir yontem olan Yapay Sinir Aglari (YSA), hizli bir yontem olan Eszamanli Dagilim Rassal Yaklasim (EDRY) algoritmasi icerisine yerlestirilerek yeni bir algoritma tasarlanmistir. EDRY en iyi cozume oldukca hizli bir sekilde yakinsayabilmektedir. Ancak tek basina EDRY cozumu bulabilmek icin problemin bir fonksiyonuna ihtiyac duymaktadir. YSA ise problemin bir fonksiyonu olmaksizin da cozumu bulabilmektedir. Ancak YSA’nin iyi egitilebilmesi icin belirli bir veri kumesine ihtiyac vardir. Ayrica problemin degisen her veri kumesi icin en iyi sonucu veren uygun ag yapisi ve parametreleri de degisebilmektedir. Bu nedenle YSA yalniz basina kullanilarak tek bir ag yapisi ile her farkli veri kumesi icin en iyi sonuca ulasmak mumkun degildir. Bu calismanin temel amaci YSA’nin ogrenme kabiliyetinden faydalanarak EDRY’yi bir amac fonksiyonu olmayan problemler icin de kullanilabilir hale getirmektir. Bu amacla, oncelikle daha once ruzgâr tunelinde yapilmis deneysel calismalar neticesinde elde edilen govde sekillerine gore govde surukleme katsayisinin degisimi verileri ile YSA egitilmistir. Boylece YSA sekil degerlerine gore govde surukleme katsayisini kendisi tahmin edebilecek yetenege gelmistir. YSA artik herhangi bir deneysel hesaplamaya ihtiyac duymadan giris degerlerine gore govde surukleme katsayisini tahmin edebilmektedir. Fakat burada YSA ile en uygun deger degil, her giris degeri icin bir cikis degeri bulunmaktadir. EDRY’nin her adimda hesaplamaya ihtiyac duydugu maliyet fonksiyonu bu sekilde YSA, EDRY’ye gomulerek giderilmistir. Yani burada tasarlanan yeni algoritma YSA’yi hangi durumlarda govde surukleme katsayisinin ne olacagini bulmak icin kullanirken EDRY’yi de en iyi katsayinin olusmasi icin en uygun durumlarin ne oldugunu bulmak icin kullanmaktadir. Bu sekilde egitilen YSA, EDRY’ye gomulerek, govde surukleme katsayisini bir bagintiya ihtiyac olmaksizin hizli ve dogru bir sekilde hesaplayan, basarili ve yeni bir algoritma gelistirilmistir.

Objective: We aimed to investigate the clinical outcomes of femoroacetabular impingement syn - drome (FAIS) cases who underwent reconstruction with safe hip dislocation. Material and Methods: Be - tween 2006 and 2009, 13 male cases diagnosed with FAIS, whose anterior impingement sign was positive without hip dysplasia were included in the study. Posterior impingement test was positive in five cases. Mean age was 39.3 years (range 32-47). Pre- and post-surgical radiological investigation included hip antero-pos - terior and false profile x-rays in all cases. In the preoperative period, all cases had femur type impingement except one case with acetabulum type impingement. Radiological investigation revealed cross-over sign and posterior acetabuler wall insufficiency in all cases. Harris hip scoring system was used for functional as - seessment. Surgical dislocation was performed as described by Ganz et al. Trochanteric osteotomy line was fixed with two cannulated screws. Results: In all cases femoral impingement cause was eliminated during the operation. Only one case had Pincer lesion, complete degeneration and dissociation that required Labrum re - section. There was no nonunion following trochanteric osteotomy. The preoperative mean Harris hip score in 13 cases changed from 63.24 (range 55-70) to 89.75 (range 72-98) two years after the operation. Statisti - cal analysed including the Wilcoxon Signed Ranks test revealed highly significant (p

WOS: 000378564500006, PubMed: 27155881, Objective This study compares reducing radiation and operation time between single and double C-arm fluoroscopy in the treatment of intertrochanteric femur fractures with intramedullary nails. Patients and methods Forty four patients participated in the study. Patients were divided into two groups as single (23 patients) and double fluoroscope (21 patients). The time of preparation, the duration of the surgery, the total amount of blood loss, and the total duration of radiation exposure were compared, retrospectively. The collo-diaphyseal angle was compared with that of the contralateral hip on postoperative radiographs. Furthermore, the tip-apex distance and the position of the screws in the femoral head were recorded. Results The mean preparation periods, collo-diaphyseal angles and blood loss did not differ between groups. In the double-fluoroscopy group, the duration of surgery was 15.9 min shorter (p < 0.001), and the radiation time was 25.7 s shorter (p < 0.001). Conclusion The double fluoroscopy technique can significantly reduce surgical and radiation exposure times during surgery.

WOS: 000397812400011 PubMed ID: 28467582 BACKGROUND: Tibial torsion is rotation of the proximal versus the distal articular axis in the transverse plane. This study used computed tomography (CT) to examine rotational malalignment in the crus following use of minimally invasive plate osteosynthesis (MIPO) technique in distal tibial fractures and evaluated effect of rotational difference on clinical outcomes and VAS scores. METHODS: Analysis of 24 patients who were operated on for closed distal tibial fracture with MIPO technique between 2010 and 2012 was conducted. Malrotation was defined as rotational difference > 10 degrees. Operated knees were evaluated with 0.5-mm, fine-cut, 3-dimensional CT scan performed in cooperation with radiology department. Side-to-side difference in tibial torsion angle > 10 degrees was considered significant degree of malrotation. All patients were assessed clinically (visual analogue scale [VAS] and American Orthopaedic Foot and Ankle Society [AOFAS] scores) and radiologically at final visit. RESULTS: Mean follow-up period was 20.00 +/- 9.46 months (range: 18-51 months). Mean VAS score was 2.58 +/- 0.83 (range: 1-4) and mean AOFAS score was 87.50 +/- 4.05 (range: 78-93). Mean tibial rotation angle was 31.54 +/- 6.00 degrees (range: 18-45 degrees) on healthy side and 32.00 +/- 6.24 degrees (range: 10-43 degrees) on the operated side. No statistically significant difference was determined (p > 0.05). CONCLUSION: Use of intraoperative fluoroscopy, cable technique, and uninjured extremity as reference, can reduce incidence of rotational malalignment of distal tibial fractures treated with MIPO.

WOS: 000392918400014, PubMed: 27836497, Objective: Anatomic volar rim locking plates are designed with the aim of treating intraarticular distal radius fractures. When used to treat comminuted distal radius fractures, these plates can damage the flexor tendons. In this study, we sought to determine the radiological and functional results and rate of complications of these plates. Methods: We retrospectively reviewed the records of 36 patients (28 males, 8 females; mean age: 46.4 years) with AO/OTA Type C2-C3 distal radius fractures treated with anatomic volar rim distal radius plates between January 2011 and December 2014. Radial length, radial inclination and palmar tilt were compared with the intact wrist. Results were evaluated with the Mayo wrist and Lidstrom scores. Complications were documented throughout the follow-up period of 23.8 (range: 12 to 48) months. Results: Postoperative measurements of the radial length, inclination and palmar tilt did not differ significantly. Mayo wrist and Lidstrom scores were good and excellent in 27 and 32 patients, respectively. Flexor tenosynovitis was symptomatic in 15 patients and asymptomatic (localized swelling only) in 21. Plates were removed from 15 patients due to symptomatic tenosynovitis and from six patients due to partial rupture of the flexor pollicis longus tendon. The flexor digitorum profundus tendon of the second finger was also partially ruptured in three patients. Conclusion: Anatomic volar rim locking plates provide satisfying radiological and functional results in treating AO/OTA Type C2-C3 comminuted distal radius fractures. However, if these plates interfere with the union of the fracture, they should be removed to avoid potential tendon problems caused by their placement in the rim region. (C) 2016 Publishing services by Elsevier B.V. on behalf of Turkish Association of Orthopaedics and Traumatology.

INTRODUCTIONOchronosis is a rare disorder which is defined as the deposition of metabolites of oxidation and polymerization of homogentisic acid, which have high affinity to collogen, in the connective tissues. It is a clinical condition characterized with ochronotic pigmentation of tissues, degenerative arthropathy of especially large joints and black discoloration of urine. In this paper we present a case of ochronosis diagnosed with biopsy and additional tests when a black discoloration of menisci and joint cartilage were detected during arthroscopic intervention for a degenerative meniscus tear.PRESENTATION OF CASEA forty two year-old male patient was operated for lateral meniscus tear of his right knee. The arthroscopic examination of right knee revealed black colored synovial hypertrophy and torn lateral meniscus. Partial meniscectomy was performed. The diagnosis of ochronosis was made after histopathologic examination.DISCUSSIONOchronotic pigment can accumulate in hyaline cartilage, tendon, skin, teeth, nail, sclera, tympanic membrane, heart valves, renal tubular cells, duramater, pancreas and walls of large arteries. In ochronosis the most frequently involved joints are knee and hip. In ochronotic arthropathy, articular cartilage become more sensitive to mechanical stresses. Our patient had meniscal tear, cartilage damage and black discoloration of synovial tissues and meniscus.CONCLUSIONArthroscopy may be helpful in diagnosis of ochronotic arthropathy.

A boxer's fracture (BF) is the most common type of metacarpal fracture and is usually an intentional injury. This study aims to investigate the severity of depressive and anxiety symptoms and evaluate the personality features of patients with BF in comparison with patients with fractures other than boxer's fractures [other fractures (OFs)] and a group of healthy controls (C). The study group was comprised of 14 patients who were diagnosed to have BF, 13 patients who were assessed due to OF and 11 C. Patients and controls were assessed with Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-2) was used to screen axis II, personality disorders' symptoms. The results showed that patients with BF had more anxiety as a trait and had higher mean scores for self-defeating, borderline and antisocial personality disorders than both the group of OF and C. Additionally, BF group had higher scores on the anger and cynicism subscales of MMPI-2. These results suggest that maladaptive personality traits and anxiety symptoms are common in patients with BF. Psychiatric assessment of patients who apply to orthopedy clinics with BF should be a part of their treatment plan.

The aim of this study is to evaluate perimenopausal and postmenopausal women with extensive bone pain, who were not undergoing any osteoporosis treatment, were nonsmokers and who had a body mass index (BMI) below 30, to determine which age groups and which areas should have bone mineral density (BMD) measurements taken by Dual Energy X-Ray Absorptiometry (DXA). The study comprised 243 perimenopausal and postmenopausal (age range 42–78 years) women who presented at our clinic with extensive bone pain. All cases had BMD measurements taken by the same DXA machine on the right femoral neck (RT), the left femoral neck (LT) and lumbar vertebrae 1–4 (L1-4T). The patients were assigned to one of three groups; Group 1, under 50 years of age (n=83); Group 2, 50-60 years of age (n=103); Group 3, over 60 years of age (n=57). The difference between the T scores obtained from the BMD measurements of the whole group was found to be significant with the Kruskar-Wallis test. To determine between which age groups the difference in the T-scores was statistically significant, the patients were allocated to 3 age-related groups. The T-scores of these three groups were compared and evaluated with the Mann-Whitney U-test. The T-score differences (RT, LT, L1-4T) between Group 1 and Group 2 were found to be statistically significant, between Group 1 and Group 3, statistically highly significant, and between Group 2 and Group 3 there was no statistical significance. The differences between the T-score measurements of left hip, right hip and lumbar 1–4 vertebrae of the 3 created groups were statistically evaluated with a 95% confidence interval. In each group RT, LT and L1-4T were evaluated with no statistical difference. Our results lead us to believe that postmenopausal women with extensive bone pain should undergo routine BMD measurement after the age of 60 and that these measurements will be sufficient from just one area.

A rare type of dislocation of hemiarthroplasty after intertrochanteric fracture Dislocation of hemiarthroplasty after hip fracture surgery is a rare complication and mostly occurs as a total luxation of head from acetabulum. In our case, dislocation occured between head of prosthesis and femoral stem after operation with Leinbach type hemiarthroplasty due to intertrochanteric femur fracture . Although head of prosthesis stayed in acetabulum, femoral stem luxated posterosuperiorly. This study aims to emphesize the risk of atypic dislocation in case of incongruency of head and femoral stem of hemiarthroplasty.

In this study, our aim was to demonstrate the need of use of ultrasonography in rib fractures in order not to face medicolegal problems. One hundred patients admitted to our emergency service with mild to moderate blunt thorax trauma were included in our study prospectively. The inclusion criteria were pain upon palpation of ribs, deep inspiration, coughing but no any other pathologies like a pneumothorax, hemothorax. All patients are evaluated with ultrasonography (USG) and direct X-rays. X-ray revealed rib fracture diagnosis in 45 of 100 patients. Rib fracture is determined with using USG in 47 of 55 patients who are agreed on lack of rib fracture with direct X-rays. USG evaluation performed by an experienced radiologist is necessary in rib fractures for early diagnosis, arranging the treatment, documentation and preventing medicolegal problems.

Objectives: To evaluate the results of ligament reconstruction tendon interposition arthroplasty in osteoarthritis of the carpometacarpal joint of the thumb. Methods: Ten thumbs of eight patients who underwent arthroplasty for osteoarthritis at the base of the thumb evaluated grip, key pinch strengths, ROM and radiologically which did not respond satisfactorily to conservative treatment modalities. Results: All patients had improved pain, increase in grip %45, key pinch strengths %56, mean ROM were 30 degrees. Radiographically, any of the thumb was detected migration, subluxation. Conclusion: In our applied technique, successfull results were achieved in the treatment with use the fcr tendon in CMC osteoarthritis. [Hand Microsurg 2012; 1(1.000): 22-24]

Aim. To evaluate whether aseptic hypertrophic nonunion in the long bones of the lower extremity can be treated successfully with LISS applied with closed methods without grafting. Materials and Methods. The study included 7 tibias and 9 femurs of 16 patients. All cases had hypertrophic nonunion. Initial surgical treatment was with intramedullary nailing in 14 cases, 6 of which had required an exchange of intramedullary nail. All the patients were treated with LISS plate with closed methods. Results. Union was obtained at mean 7 months in all patients. No implant loosening or breakage of the implant was observed and there was no requirement for secondary surgery. Conclusion. Cases of hypertrophic nonunion have excellent blood supply and biological potential. Therefore, there is no need for bone grafting and the addition of fracture stability is enough to achieve full union. Using a limited approach and percutaneous screw insertion, LISS provides fracture stabilization with soft tissue protection.

WOS: 000366662600012, PubMed: 26542987, Introduction: Perilunate injuries are rare entities which can be difficult to diagnose. Most common type is dorsal perilunate fracture dislocation (97%). The purpose of treatment is anatomic reduction and stable fixation. We aimed to present the radiologic and functional results of surgically treated dorsal perilunate fracture-dislocations and discuss the factors influencing the prognosis. Methods: Between 2007 and 2013, 17 patients were operated for perilunate fracture-dislocations. The mechanism of injuries, soft tissue traumas, etiologic factors and stages according to Herzberg classification were determined. The MAYO wrist score was used for functional evaluation. Scapholunate distance and scapholunate angle were measured and, degenerative changes were investigated by comparing with contralateral side on plain x-ray images in terms of radiologic evaluation. Results: Mean follow-up was 37,8 (range, 16-84) months. The average age at surgery was 35.1 (range, 18-51) years. Fifteen patients were male and two were female. Functional results were excellent in four (23.5%), good in two (11.8%), satisfactory in five (29.4%) and poor in six (35.3%) patients. Degenerative changes were determined in radiocarpal and mid-carpal joints of 14 wrists (82.4%). Scapholunate dissociation more than 2 mm was detected in three wrists. In four wrists osteochondral fragments were determined on the head of the capitate. Stage 2 lesions, delayed presentations, open fractures, scapholunate dissociations more than 2 mm had worse functional results. Conclusion: Despite anatomic reduction, ligamentous and chondral injuries that occured at the time of trauma may cause persistant wrist pain in patients who suffer perilunate fracture dislocation. Mechanism of injury, presence of soft tissue defects and the time between injury and treatment can affect clinical and radiologic results. (C) 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Amac: Osteoporotik kiriklarin onlenmesi icin osteoporozun tanisi ve tedavisi onemli bir yer tutmaktadir. Bu tani icin en sik kullanilan yontem BMD olmakla beraber, davranis, kas fonsiyonlari ve kalsiyum dengesi; dolayli olarak da kemik yapisinin dongusunu saglayan vitamin D’ nin osteoporotik kiriklarin olusmasinda etkilidir; ama bu etkinin kalca kiriginin tipinin olusmasindaki etkisini degerlendirmeye calistik. Gerec-Yontem: Dusuk enerjili travma sonrasi meydana gelen 20 intertrokanterik ve 20 kollum femoris kirik tanisi ile servise yatirilan tum hastalarin BMD ve 25-OH vitamin D3 degerleri olculdu. Bulgular: Intertrokanterik femur kirigi olan hastalarda 25-OH vitamin D degeri ortalama 10,42; kollum femoris kirigi olan hastalarda 24,84 olarak bulundu. Sonuc: Osteoporotik, yasli hastalarda vitamin D eksikliginin tani ve tedavisi yapildigi takdirde, intertrokanterik kalca kiriklarinin, kollum femoris kiriklarina gore daha az gorulebilecegi kanaatindeyiz.

Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outlet syndrome. However, we emphasize that new instruments should be designed and further studies are needed to evaluate in vivo results.

Objectives: We aimed to evaluate radiographic complications occurring after treatment of unstable intertrochanteric hip fractures with the Proximal Femoral Nail (PFN) and their effect on functional results.Methods: The study included 35 patients (23 women, 12 men; mean age 71 years; range 62 to 111 years) who were treated with the PFN for unstable intertrochanteric hip fractures. According to the AO classification, there were 12 type AII-1, 12 AII-2, 3 AII-3, 3 AIII-1, 5 AIII-3 fractures. The mean time to surgery was 13 days (range 5 to 32 days). Closed reduction was achieved in 31 patients. The patients were evaluated clinically (Harris hip score) and radiographically after a mean follow-up of 32.4 months (range 26 to 52 months) and complications were recorded.Results: Reduction was assessed as good or acceptable in all the patients. The mean tip-apex distance was measured as 24.2 mm (range 16 to 40 mm). Complete union was achieved in all but two patients. The mean Harris hip score was 82.1. The results were excellent in 11 patients (31.4%), good in 15 patients (42.9%), fair in seven patients (20%), and poor in two patients (5.7%). Radiographic complications mainly included secondary varus displacement in nine patients (25.7%), and calcification at the tip of the greater trochanter in two patients (5.7%). Secondary varus displacement was due to cut-out of the proximal screws (n=2), screw loosening due to collapse of the fracture site (n=2), and reverse Z-effect (n=5). Clinical results were good in two patients with calcification at the tip of the greater trochanter. Of nine patients with secondary varus displacement, the results were excellent or good in six patients, fair in two patients, and poor in one patient. Five patients (14.3%) required a subsequent operation.Conclusion: The correct position of the osteosynthesis material and use of an intramedullary nail providing a stronger fixation of the proximal part may reduce mechanical complications following the treatment of unstable intertrochanteric hip fractures., Amaç: Dengesiz (instabil) intertrokanterik kalça kırıklarının Proksimal Femoral Çivi (PFN) ile tedavisi sonrasında gelişen radyografik komplikasyonlar ve bu komplikasyonların fonksiyonel sonuçlara etkileri değerlendirildi.Çalışma planı: Dengesiz intertrokanterik kırık nedeniyle 35 hasta (23 kadın, 12 erkek; ort. yaş 71; dağılım 62-111) PFN ile tedavi edildi. AO sınıflamasına göre 12 kırık tip AII-1, 12 kırık AII-2, 3 kırık AII-3, 3 kırık AIII-1, 5 kırık AIII-3 idi. Hastalar travma tarihinden sonra ortalama 13. günde (dağılım 5-32 gün) ameliyat edildi. Otuz bir hastada kapalı redüksiyon uygulandı. Olgular ortalama 32.4 ay (dağılım 26-52 ay) takip sonunda klinik (Harris kalça skoru) ve radyografik olarak incelendi ve oluşan komplikasyonlar belirlendi.Sonuçlar: Tüm olgularda iyi ya da kabul edilebilir redüksiyonun sağlandığı görüldü. İmplant ucu-apeks mesafesi ortalama 24.2 mm (dağılım 16-40 mm) ölçüldü. İkisi hariç tüm olgularda tam kaynama elde edildi. Olguların Harris kalça skoru ortalaması 82.1 bulundu. On bir hastada (%31.4) çok iyi, 15 hastada (%42.9) iyi, yedi hastada (%20) orta, iki hastada (%5.7) kötü sonuç alındı. Radyografik komplikasyon olarak, dokuz olguda (%25.7) ikincil varus gelişimi, iki olguda (%5.7) trokanter majör ucunda kalsifikasyon oluşumu görüldü. İkincil varusun proksimal vida sıyrılması (n=2), kırık hattında çökmeye bağlı vidaların geri gelmesi (n=2) ve ters Z etkisine (n=5) bağlı meydana geldiği görüldü. Trokanter majörde kalsifikasyon görülen iki olguda klinik sonuçlar iyi bulundu. İkincil varusu olan dokuz olgunun altısında Harris kalça skoru çok iyi veya iyi, iki olguda orta, bir olguda ise kötü idi. Beş olguda (%14.3) ikinci ameliyat uygulandı.Çıkarımlar: Osteosentez materyalinin doğru pozisyonda yerleştirilmesi ve proksimal parçanın daha kuvvetli tespitini sağlayan intramedüller çivi kullanımı dengesiz intertrokanterik kalça kırıklarının tedavisinde mekanik komplikasyonları azaltacaktır.

Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level) managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function.Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI).Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean fibular shortening was 1.2 cm (range, 0.5–2 cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90.Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening.