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Objective: To compare the functional results and complications of open reduction-internal fixation and hemiarthroplasty performed in Neer three-part and four-part proximal humerus fractures., Methods: The retrospective study was conducted at the Istanbul Training and Research Hospital, Turkey, and comprised data of patients who were diagnosed with three-part or four-part fracture of the proximal humerus and underwent surgical procedure between January 2008 and April 2013. Those who had undergone open reduction-internal fixation using anatomical locking plates were placed in group A, and those who had undergone hemiarthroplasty were in group B. Constant-Murley shoulder outcome, University of California at Los Angeles shoulder and visual analogue scale scores were compared between the two groups. The degrees of forward flexion and abduction of the glenohumeral joint were recorded. Complications in both the groups were recorded. Data was analysed using SPSS 15.\., Results: Of the 48 patients, 30(62.5%) were in group A; 16(53.3%) males and 14(46.7%) females, with an overall mean age of 60.0±9.4 years. The remaining 18(37.5%) were in group B; 7(39%) males and 11(61%) females, with an overall mean age of 67.3±10.1 years. The mean follow-up period was 18.7±16.4 months. The mean Constant-Murley and University of California at Los Angeles shoulder scores were not significantly different between the two groups (p>0.05). The mean visual analogue scale score was significantly higher in group A compared to group B (p=0.021). In group A, heterotropic ossification was observed in 1(3.4%) patient, avascular necrosis in 3(10%), screw penetration without avascular necrosis in 4(13.2%), and non-union in 1(3.4%), while in group B, shoulder subluxation was noted in 2(11.1%) patients and malunion of the greater tubercle in 6(33.3%)., Conclusion: Although statistically non-significant, higher functional scores, forward flexion and abduction degrees were observed in patients who had undergone open reduction-internal fixation, while significantly lower visual analogue scale scores were recorded in the hemiarthroplasty group.

Objective: In this study we aimed to investigate the long-term clinical and radiological results, revision rates and causes, and the rate of implant survival in total hip arthroplasty performed using CLS ® expansion cup and Spotorno ® cementless femoral stem., Methods: Clinical results of total hip arthroplasty performed on 131 hips of 114 patients in Istanbul Training and Research Hospital between 1993 and 2003 were retrospectively evaluated according to the Harris Hip Score. Revision rates were determined and implant survival rates were identified using the Kaplan-Meier estimator., Results: Of the patients, 39 were males and 75 were females. The average age of the patients at surgery was 48.7±11.3 years. Patients were followed up for a mean period of 13.9±2.4 years. The mean Harris Hip Score was 34.35±6.09 preoperatively and 88.20±7.11 at the final follow-up (p<0.001). The Kaplan-Meier survivorship estimate for the cup at 13.9 years, taking revision for any reason as the end point was 95.6% (95% CI), while the 15 th and 17 th year survival rates were 90% and 85%, respectively., Conclusion: In total hip arthroplasty using a cementless expansive acetabular cup, a 95.6% survival rate is achieved after an average of 14 years, whereas the rate decreases to 85% after 17 years. Even if the incidence of cup breakage is reduced with proper implantation, particle disease and periacetabular osteolysis remains a problem for the long-term survival., Competing Interests: Conflict of interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

Background: The aims of this study were: 1. To evaluate the use of the tibial tubercle-trochlear groove (TT-TG) distance as a measurement showing rotational instability after anterior cruciate ligament (ACL) injury. 2. To determine the effect of concomitant anterolateral ligament (ALL) injury on TT-TG distance., Methods: Knee magnetic resonance (MR) images of 251 patients were retrospectively evaluated to compare the study group (131 patients) who underwent ACL reconstruction due to acute complete ACL injury and the control group (120 patients) without any trauma and/or patellofemoral instability. The rate of secondary signs of ACL injury (Anterolateral ligament injury, Kissing lesion, Anterior tibial translocation, Buckling of the posterior cruciate ligament (PCL)) in the study group was noted. The relationship between the TT-TG distance and other secondary signs was examined., Results: TT-TG distance was measured as 10.83 ± 1.2 mm, 12.88 ± 1.1 mm, 14.17 ± 1.5 mm in control, isolated ACL and ACL + ALL groups, respectively (p < 0.05). TT-TG distance was significantly higher in the patients with ALL injury and kissing lesions than the patients without these lesions (p ˂ 0.05). TT-TG distance did not differ significantly between the patients with and without anterior tibial translocation or buckling of the PCL (p ˃ 0.05). TT-TG distance measurements showed significant interobserver 0.994 (0.992-0.996) and intraobserver 0.997 (0.996-0.998) correlation., Conclusions: TT-TG distance measurement can be used as a reliable quantitative measure of the increased rotational instability after ACL injury. TT-TG distance increases significantly if there is an ALL injury accompanying the ACL injury., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: The aim of this study was to evaluate the radiologic outcomes and complication analysis of posterior vertebral column resection (PVCR) performed on previously operated patients with severe kyphoscoliosis (SK)., Methods: Twelve patients (6 men and 6 women) with SK underwent PVCR. The mean age of the patients preoperatively was 16 years (range, 10-26 years). The mean follow-up period was 5.3 years (range, 2-7 years). Previous surgeries included posterior growth arrest in 3 patients, hemivertebrectomy in 4 patients, and posterior fusion in 5 patients. The sagittal plane parameters and coronal parameters were measured in the preoperative, in the early postoperative, and during the last follow-up stages. Complications were also noted., Results: The mean thoracic scoliosis Cobb angle was 76.8° (range, 35°-142°) preoperatively, 37.8° (range, 5°-80°) early postoperatively, and 41.5° (range, 11°-80°) during the last follow-up (P < 0.0001). The mean thoracic kyphosis angle was 84.7° (range, 23°-132°) preoperatively, 50.3° (range, 25°-78°) early postoperatively, and 48.5° (range, 25°-80°) during the last follow-up (P = 0.0032). Complications occurred in 5 patients (41.7%); a hemothorax in 1 patient, rod fracture in 3 patients, and permanent neurologic deficit in 1 patient. Temporary loss of neuromonitoring motor evoked potentials developed in 2 patients during deformity correction., Conclusions: PVCR provides effective correction in patients with SK. However, expected surgical correction of a deformity may not always be achieved because of intraoperative neuromonitoring changes. Furthermore, PVCR can lead to a large number of major complications in patients with SK who have undergone previous spinal surgery., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to investigate the effect of reduction loss of more than 3 mm on clinical and radiological results after at least 2 years of follow-up after arthroscopic fixation of acute acromioclavicular joint dislocations using a double-button device., Methods: Thirty-six patients who had acute (< 3 weeks old), type III or V acromioclavicular (AC) joint dislocations underwent arthroscopic fixation of the AC joint using a double-button device. Clinical and radiological evaluations were performed at preoperative, postoperative first day, 3 months and last follow-up. When the coracoclavicular (CC) distances of patients at the last follow-up were compared to the early postop CC distances, those with a difference of 3 mm or less were grouped as group A and those with a difference of more than 3 mm were grouped as group B., Results: There was no statistically significant difference between the groups in terms of age, gender, follow-up time, time from injury to surgery, return to work, and distribution of Rockwood classification. Pre-operative CC distance was reduced from 18.7 ± 3.5 to 8.5 ± 0.6 in the early postoperative period. Anatomic reduction was achieved in all patients compared with the unaffected side (CC distance 8.6 ± 0.7). However, the CC distance increased to 9.9 ± 1.5 at the third-month follow-up and increased to 11 ± 2.7 at the last follow-up. There were no significant Constant score differences between the groups in the preoperative and last follow-up periods (p > 0.05). At the last follow-up, the mean Acromioclavicular Joint Instability (ACJI) score of group A was 84.4 ± 8, whereas it was 68.3 ± 8.3 for group B, and the difference was statistically significant (p < 0.01). Furthermore, the subjective evaluation and aesthetic subjective satisfaction values of group B were lower than group A (p < 0.01)., Conclusions: Reduction loss of more than 3 mm was observed in 25% of patients after arthroscopic fixation of acute acromioclavicular dislocations using a double-button device. Although this loss did not create a statistically significant difference in Constant scores, AC joint-specific tests such as ACJI, subjective evaluation, and aesthetic subjective satisfaction values were significantly impaired.

Objective: To determine the factors that affect the functional outcome of Oxford Phase 3 unicompartmental knee arthroplasty (UKA)., Methods: We assessed a total of 52 UKA knees of 49 patients with a minimum follow-up of 2 years (24-72 months). We recorded the results for Range of motion (ROM) and body mass index (BMI) and the presence o patello-femoral arthrosis (PFA). In the radiological evaluation, we measured the posterior tibial slope (PTS), the tibial plateau angle (TPA) and the femorotibial angle, in addition to an assement using the Oxford radiological criteria. Patients were grouped by age, follow-up time, BMI, radiological criteria, PFA presence, occurance of complications and revision surgery. The clinical and functional results of these groups were compared statistically., Results: A total of 40 women and 9 men participated in the study, with an average age of 60 years, and a mean BMI of 34.6. No significant differences were found among the age and PFA groups. Postop VAS scores were high and knee evaluation scores were significantly lower in the morbidly obese group and in the groups with postop TPA <85º and >90º. The revision ratio was 11.5%., Conclusion: Postop TPA, PTS and morbid obesity are the most significant factors that can lead to revision surgery. Level of Evidence IV, Case series., Competing Interests: All authors declare no potential conflict of interest related to this article.

Purpose: The aim of this study is to determine the prevalence of pathologic findings in asymptomatic knees of Kangoo Jumpers by using a 3T MRI and to compare them with age and sex-matched controls who do not regularly participate in any impact sports., Methods: Both knees of 18 Kangoo Jumpers were examined by 3T MRIs in a total of 36 MRI scans. The control group was comprised of 20 volunteers from the same age group and with similar weights who did not participate in any competitive sports, in a total of 40 MRI scans. Two orthopedists and one radiologist independently assessed all images for the presence or absence of any abnormalities., Results: In 32 (88.9%) of the 36 Kangoo Jumpers' knees, one or more abnormalities were observed. The most prevalent abnormality was bone marrow edema, which was detected in 32 knees (88.9%). The other significant findings were quadriceps tendinopathy (80.6%), patellar tendinopathy (63.9%), gastrocnemius tendinopathy (63.9%), infrapatellar fat pad edema (75%), suprapatellar fat pad edema (63.9%), meniscal signal change (72.2%) and cartilage damage in the patellofemoral joint (72.2%). There were no statistically significant differences in terms of joint effusion (8.3%), ganglion cysts (8.3%) or tibiofemoral joint cartilage injury (0%)., Conclusion: This study reveals many types of knee MRI findings of asymptomatic Kangoo Jumpers compared to the control group. These MRI findings may be associated with acute knee injuries or chronic joint problems such as osteoarthritis, which may develop in long-term follow-up studies.

Knee arthroscopy may be called the most commonly and increasingly performed orthopaedic procedure. Posterior medial compartment visualization may be quite challenging. The aim of the present study is to detect objective measurement of medial joint space widening with percutaneous "pie crust" release of medial collateral ligament (MCL) during knee arthroscopy. We used this technique for all knees that require any intervention in the posteromedial compartment and for tight knees in which adequate visualization of the posteromedial compartment cannot be obtained. Eighteen patients (18 knees) were included in this study. Patients were evaluated clinically with the Lysholm and Tegner scores at the final office visit. Joint balance, valgus instability, pain or tenderness on MCL region, and numbness over the medial side of the joint were also noted. Measurements of medial joint space (mm) were obtained at three different times with perioperative C-arm images: normal, controlled valgus force, and after pie crusting. The median follow-up time was 9 (6-12) months. Final follow-up Lysholm ( p < 0.05) and Tegner scores ( p < 0.05) increased significantly compared with preoperative scores. At the final follow-up, there was no pain or tenderness over MCL and there were no signs of saphenous nerve or vein injury. Medial joint space values in after pie crusting increased significantly ( p < 0.05) compared with neutral position measurements and controlled valgus force application ( p  < 0.05). Controlled release of the MCL in knees provided ∼2.45 times wider visualization place. Furthermore, pie crusting of MCL is a safe and effective technique that provides enough space for visualization and instrumentation in knees. This is a Level IV study., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: This study aimed to compare the clinical results and complications as well as patient satisfaction in patients with carpal tunnel syndrome operated with open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) techniques., Methods: This study conducted in Istanbul Training and Research Hospital between August 2016 and January 2018. A total of 54 patients were operated with the ECTR technique and 50 patients were operated with the OCTR technique after failing nonsurgical treatment. Patients functional scores are assessed with the carpal tunnel syndrome-functional status score (CTS-FSS) and carpal tunnel syndrome-symptom severity score (CTS-SSS). Operation time, incision length and complications of the two techniques were noted and compared., Results: The age, sex distribution, distribution of sides, and complaint period were not significant (p > 0.05) between the groups. The preoperative or postoperative CTS-SSS and CTS-FSS values did not differ significantly (p > 0.05). Incision length, time to return to work and return to daily life in the OCTR group was significantly higher than the ECTR group (p < 0.05)., Conclusion: ECTR has similar results in terms of symptom relief, severity, functional status, pillar pain and complication rates compared to OCTR. However, it has the advantages of early return to daily life, early return to work and less incision length., (Copyright: © Pakistan Journal of Medical Sciences.)

The authors aimed to investigate whether standard acromioplasty can reduce critical shoulder angle (CSA) effectively and to investigate the effects of postoperative CSA on the clinical outcomes and retear rates. Patients are divided in to three groups: group 1 (24 patients): CSA under 35° before surgery, group 2 (25 patients): CSA over 35° before surgery and under 35° after surgery and group 3 (17 patients): CSA over 35° before and after surgery. Standard acromioplasty was performed if CSA is over 35 and no acromioplasty was performed if the CSA is already under 35. Preoperative and postoperative CSAs, UCLA, Constant-Murley clinical score and visual analog scale (VAS) pain score were measured. The size of the rotator cuff tear was classified by the Patte classification in preoperative MRI and the quality of the repair was evaluated as retear if discontinuity detected in the postoperative first year MRI. There were 31 female and 35 male patients with a mean age of 59.3 ± 4.5 years (range, 48-68) at the time of surgery. The mean CSA is reduced from 37.8° ± 1.4 to 34.9° ± 1.2 (p < 0.001) significantly for patients who underwent acromioplasty. In 25 (59.5%) of the 42 patients, the CSA was reduced to under 35°, whereas in the other 17 (40.5%) patients, it remained over 35°. The mean Constant and UCLA score was 46.4 ± 6.6; 18.5 ± 1.6 preoperatively and 82.4 ± 6.2; 31.1 ± 1.9 postoperatively respectively (p < 0,001). The mean VAS decreased from 4.94 ± 1.09 to 0.79 ± 0.71 (p < 0.001). No Clinical difference was seen between patients in which CSA could be reduced under 35° or not in terms of Constant-Murley score, UCLA and VAS score. Retear was observed in 2 (8.3%) patients in group 1, in 4 (16%) patients in group 2 and in 3 patients (17.6%) in group 3. There was not any significant difference between the patients who had retear or not in terms of neither the CSA values nor the change of CSA after the surgery. Standard acromioplasty, which consists of an anterolateral acromial resection, can reduce CSA by approximately 3°. This is not always sufficient to decrease the CSAs to the favorable range of 30°-35°. In addition, its effect on clinical outcomes does not seem to be noteworthy.

Background: The aim of this study was to evaluate and compare the functional outcomes and complication rates of patients in short-term and midterm follow-up period when medial unicompartmental knee arthroplasty (UKA)-applied patients were grouped according to BMI values., Methods: One hundred four patients (mean age 60.2 ± 7.4 (range, 49-80)) to whom medial UKA was applied between 2011 to 2016 with a minimum of 2 years follow-up were grouped as normal and overweight (less than 30 kg/m 2 ), obese (30-34.9 kg/m 2 ) and morbidly obese (BMI ≥ 35 kg/m 2 ) according to their BMI. The postoperative Knee Society Scores (KSS), functional Knee Society Scores (fKSS), Oxford Knee Scores (OKS), visual analogue scale (VAS) and range of motion (ROM) results and complication rate of these groups were compared statistically. The implant positioning of the patients requiring revision was analysed according to the Oxford radiological criteria., Results: The average BMI of 104 patients was 34.4 (range, 22-56.9). Twenty-six (25%) of these were normal or overweight, 40 (38.5%) were obese and 38 (36.5%) were morbidly obese. However, in these BMI groups, there was no significant difference between the preoperative VAS, postoperative VAS and VAS score changes among these three groups (p > 0.05). The postop KSS, f KSS and OKS were significantly poorer in the morbidly obese group by 75.2, 70.5 and 33.1, respectively. Furthermore, amount of ROM changes (4.2°) were significantly poorer in the morbidly obese group (p < 0.05). Complications including eminence fractures, insert dislocations, tibial component collapses and superficial infections developed in 10 patients (9.6%). Six of them (60%) were morbidly obese, and four of them (40%) were obese. Furthermore, 11 (10.6%) of the patients required revision. Eight (72.7%) of the patients were morbidly obese, and three (27.3%) of them were obese., Conclusions: We concluded that morbid obesity is an independent risk factor for functional outcomes and implant survival after UKA. However, it is possible to obtain excellent results for obese and overweight patients with good planning and correct surgical technique. Morbid obese patients should be preoperatively informed about poor functional outcome and high complication rate. Treatment of morbid obesity before UKA surgery may be a good option.

Medial talonavicular dislocation associated with cuboid fracture is rare. We report an 18-year-old man with this injury who exhibited excellent results after open reduction and stabilization of the joint with temporary Kirshner wires.

Background: The aim of this study is to determine the diagnostic accuracy of lever sign test in acute, chronic, and postreconstructive ACL injuries., Methods: In total, 78 patients (69 male, 9 female) were subjected to clinical instability tests including Lachman, anterior drawer, pivot shift, and lever sign when an injury of the ACL was suspected. All tests were performed bilaterally in all patients in acute, chronic period and patients who underwent surgery after the anaesthesia and after the reconstruction at the last follow-up by two senior orthopaedic surgeons. MRI was taken from all patients and MRI image was taken as the reference test when evaluating the accuracy of the tests., Results: The mean age of patients was 26.2±6.4 years (range, 17-44 years). Sensitivity and accuracy values of the Lachman, anterior drawer, pivot shift, and lever tests in the acute phase were calculated as 80.6%, 77.4%, 51.6%, 91.9% and 76.9%, 75.6%, 60.3%, 92.3%, respectively, and in the chronic (preanaesthesia) phase were calculated as 83.9%, 79.0%, 56.5%, 91.9% and 80.8%, 78.2%, 64.1%, 92.3%, respectively. Lachman, anterior drawer, pivot shift, and lever sign Acute's significant [AUC: 0.716, 0.731, 0.727, 0.928, respectively] activity were observed in the prediction of ACL rupture in MRI., Conclusion: An ideal test to diagnose the integrity of the ACL should be easy to perform and reproducible with high sensitivity and specificity. From this perspective, the lever test seems to be a good test for clinicians in acute, chronic and postreconstructive ACL injuries.

Background: The aim of the present study was to evaluate the clinical role of anterolateral ligament (ALL) rupture and its impact on rotational stability by comparing the clinical results and rotational stability between reconstructed anterior cruciate ligament (ACL) with intact ALL knees and reconstructed ACL with ALL injured knees., Methods: A total of 69 patients who had undergone surgery for ACL reconstruction and had received a minimum of two years of follow-up were included. Patients were divided into two groups with respect to the presence of ALL rupture on knee magnetic resonance imaging. Patients were assessed preoperatively and at final follow-up with physical examination findings and functional outcomes. Rotational stability was measured by a non-invasive rotameter-like device at the final follow-up at different torque values of 5 Nm (newton metres), 10 Nm and 15 Nm, and compared between the two groups., Results: The ALL was considered to be ruptured in 45 cases, named Group I (65.2%). The ALL was considered to be intact in 24 cases, named Group II (34.8%). No significant difference was found between the groups regarding the improvement of the clinical scores and physical examination findings (P > 0.05). Group I showed significantly higher internal rotation difference compared with Group II in all torque values (P < 0.05)., Conclusion: The difference found on rotational measurement is possibly under the value of minimal clinical important difference and does not have a clinical effect, therefore ALL reconstruction is not recommended as a standard treatment in all patients., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: This study investigates ultrasonography as an effective tool for localizing and measuring the depth and size of wooden foreign bodies to perform less invasive and easier surgery without the need for any additional radiological techniques., Methods: Fifteen patients were operated to remove foreign bodies in the extremities in 2016. The side of the affected extremity, the material, size, and location of the foreign body and time of admission after injury were noted, along with CRP, WBC, and erythrocyte sedimentation rate; length of incision, surgery duration, and complications were evaluated., Results: The mean patient age was 39.66 (range: 6 to 68). Of the total, 8 of the foreign bodies were in the plantar surfaces of the feet, 3 were in the cruris, 2 were in the palm of the hand, and 2 were in the fingers. All patients underwent ultrasound evaluation before surgery. The surgeries lasted less than 10 min in 13 (87%) of the cases and from 10 to 20 min in 2 cases. No complications were observed in any of the patients., Conclusion: Delayed extraction of foreign bodies can lead to local infections. Ultrasonography can be a reliable option for diagnosing and localizing radiolucent foreign bodies such as wooden objects. Level of Evidence IV; Case series. , Competing Interests: All authors declare no potential conflict of interest related to this article.