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Askerlik Başvurusu Yapan Olgularda Ayak Deformiteleri ve Omurga Anomalileri Prevalansı ve İlişkisi: Kesitsel Çalışma Amaç: Askerlik çağındaki erkeklerde pes kavus, planus ve spinal anomalilerin prevalansını ve ilişkisini araştırmak.Amaç: Askerlik çağındaki erkeklerde pes kavus, planus ve spinal anomalilerin prevalansını ve ilişkisini araştırmak. Gereç ve Yöntem: Ocak 2019-Kasım 2019 tarihleri arasında askeri okul sağlık tarama programı için hastaneye başvuran 3524 hasta incelendi. Hastaların tamamı 22-30 yaş arasındaydı. Dışlama kriterleri; ayak ve/veya omurgalara ilişkin travma ve ameliyat öyküsü, sistemik musküler veya nörolojik hastalıklar, inflamatuar hastalıklar. Hastalar, radyolojik olarak; Pes planus, pes kavus deformiteleri, skolyoz, lomberizasyon, sakralizasyon ve spinia bifida deformiteleri açısından değerlendirildi. Ayak ve omurga anomalilerinin ilişkisi incelendi. Olgular Vücut Kitle İndeksine (VKİ) göre gruplara ayırıldı. Ayak ve omurga anomalileri ile VKİ ilişkisi değerlendirildi. Bulgular: Çalışmaya 450 oldu dahil edildi. Ortalama yaş 22,9 ±3,01 olarak bulundu. Ortalama VKİ ise 23,04 ±2,3 olarak bulundu. Hastaların 343’ünün (%80) normal VKİ değerine sahipken 82’sinin (%18,9) fazla kilolu, 3’ünün (%1) ise obez olduğu görüldü. 22 hastada (% 4,9) ayak deformitesi olduğu görüldü (21 hastada pes planus 1 hastada pes kavuş). Omurga deformitesi görülen hasta sayısı ise 82’ydi (%18,2). En sık görülen omurga deformitesi, 32 (%7,1) olgu ile posterior füzyon defektiydi. Hastalarda ayak deformitesi görülme sıklığı, omurga deformitesi görülme sıklığı ilişkisi incelendiğinde gruplar arasında anlamlı fark bulunamadı. (p =0,779) Hastalar VKİ açısından gruplandırıldığında, gruplar arasında anlamlı fark bulunmadı. Sonuç: Hastalarda pes planus görülme sıklığı pes kavus sıklığından daha fazla olduğu görülmüştür. En sık görülen omurga anomalisi posterior füzyon defekti olmuştur. Pes planus veya pes kavus sıklığının omurga anomalileri ile ilişkisi bulunmamıştır Prevalence and Relationship of Foot Deformities and Spinal Anomalies in Army Recruits: Cross-sectional study Aim: To investigate the prevalence and relationship of pes cavus, planus and spinal anomalies in military age males. Material and Methods: 3524 patients which applied to hospital for military school health screening program were recorded between January 2019 and November 2019. All of the patients were between 22 and 30 years old. Exclusion criteria were; trauma and surgery history regarding foot and / or vertebrae, systemic muscular or neurological diseases, inflamatuar diseases. Patients were radiologically evaluated for pes planus, pes cavus deformities and scoliosis, lumbarization, sacralization and spina bifida anomalies. The relationship between foot deformities and spine anomalies was examined. Cases were divided into groups according to Body Mass Index (BMI). The relationship between foot and spine anomalies and BMI was also evaluated. Results: 450 patients were included in the study. The mean age was 22.9 ±3.01 years. The mean BMI was 23.04 ±2.3. While 343 (80%) of the patients had normal BMI, 82 (18.9%) were overweight and 3 (1%) were obese. Foot deformity was observed in 22 (4.9%) patients (21 patients with pes planus and 1 patient with pes cavus). The number of patients with spinal deformity was 82 (18.2%). The most common spinal anomaly was posterior fusion defect with 32 (7.1%) cases. When the relationship between the prevalance foot deformities and spinal anomalies was examined, no significant difference was found between the groups. (p = 0.779) When the patients were grouped in terms of BMI, no significant difference was found between the groups. Conclusion: The prevalance of pes planus was higher than the prevalance of pes cavus in the patients. The most common spinal anomaly was posterior fusion defect. The frequency of pes planus or pes cavus was not found to be associated with spinal anomalies.

Amaç: Tırnak batması ileri evrelerde cerrahi tedavi gerektiren önemli bir ayak problemidir. Te-davi için birçok cerrahi yöntem bildirilmiştir. Bu çalışmanın amacı, ileri evre ayak tırnakları batık hastalarda matriksektomi yapılmadan batık ayak tırnağı ameliyatının sonuçlarını değerlendirmek-tir.Materyal ve Metod: Çalışmaya 22 hasta dahil edildi. Tüm hastalara cerrahi öncesi ve sonrasında ayakkabı giyebildiklerinde görsel analog skala (ağrı / memnuniyet) uygulandı ve hastaların ra-hatsızlık duymadan ayakkabı giyme zamanlaması sorgulandı.Bulgular: Preoperatif VAS (ağrı) skoru ayakkabı giyebildikten sonra 8.2 ± 1.1'den 2.4 ± 1.2'ye anlamlı olarak düzeldi (p

OBJECTIVES This study aims to compare two single-step arthroscopic techniques, microfracture and cell-free scaffold implantation, in the treatment of talar osteochondral lesions (OCLs) clinically and radiologically. PATIENTS AND METHODS This retrospective study included 62 patients (35 males, 27 females; mean age 41±13 years; range, 15 to 65 years) diagnosed with talar OCLs between March 2007 and January 2015. Patients who were followed-up with a minimum of 24 months with lesions larger than 1 cm2 were included. Pre- and postoperative clinical evaluations were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and radiological evaluations according to the magnetic resonance observation of cartilage repair tissue (MOCART) scale. RESULTS Patients were divided into microfracture (n=22) and scaffold (n=40) groups. The mean follow-up duration was 36.1±14.9 months. The mean preoperative AOFAS score increased from 60.6±13.9 to 82.1±11.8 in the microfracture group (p

Background: Accompanying injuries are frequently seen in middle aged patients with recurrent instability. The aim of this study was to elucidate the associated injuries, report patient outcomes of the following arthroscopic instability surgery regarding 40-60 years old patients with recurrent shoulder instability. Methods: Patients that underwent arthroscopic instability surgery due to recurrent shoulder instability between February 2008 and November 2015, and which were 40-60 years old were included and evaluated retrospectively. Minimum follow-up duration was 24 months. Anterior-inferior labral injuries and accompanying pathologies such as rotator cuff tears and SLAP lesions were documented. Postoperative patient-reported outcome evaluation was made using Oxford Shoulder Instability Score. Results: Among 355 patients that underwent arthroscopic instability surgery, 88 patients which had pathology of recurrent instability were in the range of 40-60 years old. Patients who had previous shoulder surgery or fracture (n = 8) epileptic seizure history (n = 3), neurologic deficit (n = 2) were excluded from the study. 75 patients were included with a mean follow-up 69 +/- 23 months (32-125). The percentage of middle-aged and elderly (40-60 years old) was 24.8% among recurrent shoulder instability patients. 44% had isolated Bankart lesion whereas 56% revealed multiple pathologies. Bankart + SLAP lesions were found in 32%, whereas Bankart + Rotator Cuff tears in 26.7% (13 isolated supraspinatus, 4 supraspinatus + subscapularis, 1 isolated subscapularis full-thickness and 2 partial thickness supraspinatus tears). The mean Oxford Shoulder Instability Score was 38.4 +/- 5.2 (26-48). The scores of patients which were treated with labrum and rotator cuff repair (median 42, range 30-48) were significantly better than the patients who were treated with isolated labrum repair (median 39, range 20-46) (p = 0.015). There was no difference regarding patients with or without SLAP repair (median 39 vs 39 and range 30-48 vs 20-48, respectively) (p = 0.702). Conclusions: Arthroscopic repair of capsulolabral lesions is a safe and successful technique in 40-60 years old patients. Furthermore, the presence of repaired rotator cuff tears led to even superior results. Accompanying SLAP lesions did not affect the results. Study design: Retrospective Case Series. Level of evidence: 4, Retrospective Case Series. (c) 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Purpose To evaluate the clinical results of arthroscopic repair and open Ahlgren-Larsson method in patients with chronic lateral ankle instability. Methods We retrospectively evaluated 60 patients who were operated in our clinic between 2010 and 2018 with the diagnosis of chronic lateral ankle instability. Preoperative and postoperative clinical evaluations were performed with AOFAS ankle-hindfoot score, FAOS, and VAS scores. Results Sixty patients with chronic lateral ankle instability were evaluated. 28 patients were treated with Ahlgren-Larsson method, and 32 patients were treated with arthroscopic repair. Follow-up duration was 35 +/- 12 months for the open surgery group and 19 +/- 2 months for the arthroscopic surgery group. The mean age of the arthroscopy group was 44 +/- 9; the mean age of the open surgery group was 46 +/- 11. There was no significant difference between the groups in terms of demographic features (age, sex, BMI). Postoperative clinical improvement was observed in both groups. There was no statistically significant difference between the groups in terms of functionality. However, there was a statistically significant difference in VAS in terms of pain and patient satisfaction in favor of arthroscopy group. Conclusions Ahlgren-Larsson method and arthroscopic repair technique are safe and effective for chronic lateral ankle instability. Arthroscopic technique may be preferred for pain and patient satisfaction as it is less invasive and less morbid.

Arthroscopic techniques have recently gained popularity for the treatment of osteochondral defects of the talus. The microfracture procedure is the most commonly applied arthroscopic technique. However, it is not effective for the treatment of larger lesions. Tissue-engineered scaffolds have been used for cartilage regeneration arthroscopically, and promising results have been reported. We treated larger osteochondral lesions of the talus with polyglycolic acid-hyaluronan scaffold biomaterial (Chondrotissue, BioTissue AG, Zurich, Switzerland) in a single-step arthroscopic surgery. Traction methods and fibrin glue were avoided.

Objective Patients who underwent arthroscopic repair for partial rotator cuff tears were evaluated retrospectively. This study purposed to assess the postoperative clinical results of arthroscopic treatment of intratendinous rotator cuff tears and to investigate the effect of the tear type on the postoperative clinical outcomes. Methods Overall, 60 patients [36 women and 24 men; mean age: 48.6±12.2 years (range 33-67 years)] who underwent arthroscopic repair of Ellman stage 3 partial rotator cuff tear were evaluated retrospectively. These patients were grouped into the following three groups: articular-sided tears, bursal-sided tears, and intratendinous tears, with 20 patients included in each group. Subacromial decompression, acromioplasty, and tear repair without transforming to full-thickness tear were applied to the bursal-sided tears. The same technique was performed for intratendinous ruptures, with the only technical difference was that the capsular tissue was preserved during debridement of intratendinous tears. The articular-sided tears were transformed to complete tears and repaired arthroscopically. The preoperative and postoperative ASES scores and range of motion improvements were evaluated in all patients. The mean follow-up time was 44±6.5 months (range: 36-62 months). Results No significant intergroup differences were observed concerning the age and the mean follow-up duration (p=0.524, p=0.665). A similar increase in ASES scores was observed for all three types of tears (bursal-sided tears: 31.09-82.65; articular-sided tears: 35.50--84.00; intratendinous tears: 34.01-83.49). Statistically, no significant intergroup difference was observed concerning ASES score improvement (p=0.585). An increase in mean forward flexion, abduction, and external rotation were observed, especially, a statistically significant increase in flexion (p=0.001) and abduction (p=0.001) in all three types of tears. No patient experienced any intraoperative or postoperative complications. Conclusion The results of arthroscopic treatment of intratendinous tears were similar to the other types of partial tears, and the results of arthroscopic treatment of grade 3 partial rotator cuff tears revealed satisfactory outcomes, regardless of the type of the tear. Level of evidence Level III, Therapeutic study.

Objective: The aim of this study was to investigate the effect of long term oral warfarin sodium treatment on bone mineral density (BMD) and spinal sagittal alignment. Materials and Methods: Sixty four participants were enrolled for this retrospective study. Participants were divided into two groups-participants who had taken warfarin sodium for at least two years (n=33) and participants who had never taken warfarin sodium (n=31). All of the individuals were evaluated at the same center. Dual X-ray absorptiometry (DXA) was used for measuring BMD. Whole spine x-rays were obtained for sagittal assessment and the following parameters were measured: Cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope and sagittal vertical axis (SVA). Results: The mean BMD value was significantly higher in participants who had not taken warfarin sodium compared to participants who had taken warfarin sodium. The differences between the average values were 0.1552 g/cm2 in BMD; 2.1 in T scores; 1.4 in Z scores. On the radiological evaluation of the spine, cervical lordosis was 7.1 degrees lower, lumbar lordosis was 4.7 degrees lower and thoracic kyphosis was 5.3 degrees higher in the patients using drug. C7 plumb line was interchanged forward in the patients using drug. Conclusions: This study shows that warfarin sodium use worsens bone quality in the lumbar region and does not affect bone quality in the femoral region. Furthermore, warfarin sodium use also reduces physiological lordosis and enhances thoracic kyphosis. Consequences of these changes are the likely cause of sagittal spinal anterior imbalance. Long-term oral warfarin sodium use affect bone mineral density and spinal alignment. Our conclusion about giving clear message and show exactly mechanism we need prospective randomized multicentre studies in future. We strongly believe this study will be pioneer for future researches.

A 68-year-old female patient admitted to our clinic with right anterior thigh pain ongoing for six months and which increased in last two months. The patient had no trauma history. The patient had been followed-up for 15 years because of osteoporosis and administrated alendronate and ibandronate treatment for 10 years. Patient had three shots of zoledronate once a year during the last three years. Her pain was increasing when she was walking. Physical examination revealed pain in her right thigh. Radiogram showed thickened lateral cortex of the subtrochanteric area. Magnetic resonance imaging also showed thickening and edema of the same area. These images were correlated with atypical fracture in right femoral subthrochanteric zone. Dual energy X-ray absorptiometry revealed that T score was -3.3 in lumbar region and -2.5 in femoral neck. Zoledronate treatment was ended. Prophylactic surgical fixation was performed with titanium elastic nails.

Congenital dislocation of the patella is a rare and difficult pathology to treat. We present a case of bilateral congenital dislocation of the patella with synostosis of proximal tibiofibular and proximal radioulnar joints without genu valgum deformity of both knees in a 30-year-old man. To our knowledge, congenital dislocation of the patella associated with synostosis of proximal tibiofibular and proximal radioulnar joints has not been reported in the literature yet.

Purpose To report the clinical and radiological results of patients with talar osteochondral lesions who were treated by microfracture and cell-free scaffold implantation in a single-step arthroscopic surgery. Methods Forty patients, treated with a single-step arthroscopic surgery, were evaluated in this single-center-based retrospective study. Patients with degenerative arthritis (n = 1), history of ankle fracture (n = 1), kissing lesions (n = 1), lower extremity deformity (n = 1), and lesions 2 (n = 4) were excluded. Oversized (>10 mm depth) bone cysts were additionally treated with bone graft. Patients were evaluated clinically, using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. Radiological assessment was performed with magnetic resonance imaging, using the magnetic resonance observation of cartilage repair tissue (MOCART) score. Results Thirty-two patients with a mean age of 38 ± 12 years were evaluated. The mean defect size was 2.5 ± 0.8 cm 2 and the mean defect volume was 2.4 ± 1.9 cm 3 . The mean preoperative AOFAS score was 52.8 ± 13.9 and increased to 87.1 ± 11.1 postoperatively at the mean follow-up of 33.8 ± 14.0 months ( P = .0001). A total of 84.4% of patients had good to excellent clinical scores. Clinical scores had no significant relation with age, lesion size, depth, or body mass index. The mean MOCART score was 64.2 ± 12.0. There was no significant correlation between the total MOCART and AOFAS scores ( P = .123). A significant relation was found between the defect filling (the subgroup of the MOCART score) and the clinical outcomes ( P = .0001, rho = 0.731). Conclusions The arthroscopic scaffold implantation technique is a single-step, safe, and effective method for the treatment of talar osteochondral lesions with satisfactory clinical and radiological outcomes. Level of Evidence Level IV, therapeutic case series.

A 90-year-old female patient was admitted to our clinic complaining of pain in her left hip which occurred due to fall from a chair. Her medical history included memory loss and mental changes associated with Alzheimer's disease and depression. Patient's cooperation and orientation were weak. Range of motion of the left hip was restricted and painful. Radiographs of the left hip demonstrated subtrochanteric comminuted fracture of femur. Laboratory tests revealed anemia and liver insufficiency. Departments of internal medicine and anesthesiology reported high risk for surgery. Surgery was performed under spinal anesthesia on radiolucent table and in supine position. Using fluoroscopy, subtrochanteric comminuted fracture of femur was reduced. Proximally, two Schanz screws were placed through femoral neck and head in axial plane, and distally, three Schanz screws were placed through femoral shaft in coronal plane. Finally, fixation of the screws was achieved with an external fixator which was made of carbon fiber rods. Patient was allowed to sit in the bed and move around with a wheelchair as of the day of surgery. No infection or loosening of fixator occurred.