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The computed tomography scans of patients who underwent posterior instrumentation for thoracolumbar vertebral fractures were retrospectively reviewed. The aim of this study is to present a single surgeon's experience in the placement of pedicular screws in the thoracic, lumbar, and sacral spine using the two-way fluoroscopy-assisted freehand technique. The directions of screw malposition were classified as anterior, medial, lateral, superior, and inferior; screws with malposition in more than one direction were recorded. Patients' neurological symptoms were recorded and their compatibility with the direction and amount of screw malposition was assessed. The effect of surgical experience on thoracic, lumbar, and sacral pedicle screw placement and the amount of screw experience required for correct pedicle screw placement were investigated. The study evaluated 1112 pedicle screws in 147 patients with thoracolumbar fractures. Screw malposition was found in 206 (18.52%) screws. Medial malposition was found to be statistically higher in the lumbar spine (p<0.001). A significant correlation was found between inferior malposition and neurological deficit (p=0.012). Thoracic and sacral pedicle screw malposition was statistically higher than lumbar (p<0.001). It was found that 386 pedicle screws were required for the learning curve in lumbar fractures (p=0.004). Surgical experience is an important factor in correct screw placement. It was found that 386 pedicle screws were required for the learning curve in the lumbar spine. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the relationship between the humeral head version and the cartilage- or bone-based glenoid version measurements on magnetic resonance imaging and to evaluate the usability of the glenoid articular surface and metaversion to determine the humeral head version. Methods: Magnetic resonance imaging slices of 182 patients were evaluated in this retrospective study. Bone- and cartilage-based glenoid version angles, humeral head version angles, and metaversion angles were measured by 3 researchers. All measurements were made twice, with an interval of 2 months. Interrater and intrarater reliability were evaluated. Results: The mean glenoid version angle was calculated as -3.58 ± 4.09° when measured from bone tissue and -5.79 ± 4.3° when measured from cartilage tissue. A non-linear correlation was determined between the measurements taken from bone and cartilage tissue for the glenoid version angle (r = 0.423). No statistically significant difference was determined between the inter- and intraobserver measurements (P = .223). No statistically significant difference was determined in the inter- and intrarater reliability for the humeral head version angle and metaversion angle measurements. A statistically significant relationship was observed between the humeral head version and the mean glenoid version measured from bone (P = .019). A negative correlation was observed between the bone-based glenoid version and the humeral head version (P = .034). Conclusion: In cases in which the humeral metaphysis can be evaluated, metaversion is a good guide for the humeral head version. In cases in which the metaphysis cannot be evaluated, the glenoid version is a good option for determining the humeral head version. Further studies are needed to determine the humeral head version relative to the glenoid version. [ABSTRACT FROM AUTHOR]

Major earthquakes can cause crush injuries. Damage to buildings is a major cause of death and injury in earthquakes, especially when solid building materials such as concrete are used. The most common injuries following earthquakes are fractures, compartment syndromes, major soft tissue injuries, and crush injuries. This highlights the importance of planning at the national level before natural disasters occur. The aim of this study was to review what needs to be done in orthopedic and trauma services in the field, during transfer, and in advanced treatment centers after an earthquake disaster in our country, where high-intensity earthquakes occur. In conclusion, strategic planning in the field, during transfer, and in advanced treatment centers can reduce the pressure on the health system in similar mass disasters. [ABSTRACT FROM AUTHOR]

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Objective The purpose of this study was to evaluate the differences in mortality between young and elderly polytrauma patients. Materials and Methods In the present study, all consecutive polytrauma patients treated at our hospital between January 2014 and December 2018 were reviewed retrospectively. Patients younger than 65 years old were classified as Group I (n = 60), and patients aged 65 years and older were classified as Group II (n = 60). Age, gender, mechanism of injury, time of injury, injury severity score (ISS), preclinical hemodynamics, hospitalization, operative treatment, intubation rate, intensive care unit (ICU) treatment, and 1-year mortality were analyzed. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI) were calculated. Results The mean age was 36.6 ± 13.0 (18-64) years in Group I and 73.5 ± 7.4 (56-91) years in Group II. There was no difference in mortality rates between groups. Elderly polytrauma patients tend to be female, and lower ISS and higher blood pressure, as well as low-energy injury types, typically in the summer. A statistically significant positive correlation was found between mortality and ISS scores in both Group I and Group II. There was no statistically significant difference was found between elderly and younger polytrauma patients in terms of NLR, MLR, and SIRI scores. Conclusion There are several differences between elderly polytrauma patients and their younger counterparts. It was found that mortality in the elderly patient group was affected by many system injuries. However, the current study presents no differences in mortality rates between young and elderly polytrauma patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the effect of reduced acromiohumeral distance (AHD) and increased acromial thickness (AT) on the risk of rotator cuff tear (RCT)., Methods: Patients aged 25-70 were included in this retrospective study. Patients who were operated on for RCT between January 2019 and December 2021 were included in group 1, and patients who applied to the outpatient clinic in the same period with a complaint of shoulder pain and no problem on magnetic resonance imaging (MRI) were included in group 2. Three researchers performed AHD and AT measurements on the same true anteroposterior (AP) shoulder radiographs. The second measurement was performed 1 month later when, the first measurements were completed., Results: Radiographs of 284 patients in group 1 and 234 patients in group 2 were evaluated. In group 1, the mean AHD measurement was 8.25 ± 1.73 mm, and the AT measurement was 8.58 ± 1.06 mm. In group 2, the mean AHD measurement was 10.25 ± 1.4 mm, and the AT measurement was 8.35 ± 0.92 mm. A significant relationship was determined between the RCT and the AHD (P < .001). Also, RCT and AT have a significant relationship (P < .001). The authors determined that the risk of RCT increased 3.45 times when patients with AHD 6-10 mm were compared with patients with AHD >10 mm. In addition, all patients with AHD < 6mm had RCT, and the risk of RCT increased 1.42 times when patients with AT > 8 mm were compared with patients with AT < 8 mm., Conclusion: Acromiohumeral distance and AT measurements are practical, inexpensive, and valuable in evaluating RCT. Decreased AHD and increased AT increase the risk of RCT.

Objective: The aim of this study was to assess the self-confidence of newly graduated orthopedic surgeons on performing essential surgi- cal procedures., Methods: The study included 151 orthopedics and traumatology surgeons who had completed their (orthopedics and traumatology) training within the last year. They were asked to complete an online questionnaire which was available from February 2020 to May 2021. In the questionnaire, newly graduated orthopedic surgeons were asked whether they could do the 18 listed essential adult and 8 listed essential pediatric cases independently. They were asked about patient follow-up systems and who these were supervised by, the demo- graphic data of the city and about the institution they were trained in, and how many times they performed the listed surgeries during their training., Results: 74 (49%) of the participants received their training in training and research hospitals, 69 (45.7%) in state university hospitals, and 8 (5.3%) in foundation university hospitals. More than 80% of the participants answered, "I can do it independently" for 13 (81.6%) out of 16 adult cases and 7 (87.5%) out of 8 paediatric cases. The average self-efficacy score of the participants was 32.22 out of 36 for adult cases and 15.3 out of 16 for paediatric cases. The total average self-efficacy score was 47.52 out of 52., Conclusion: This study has shown us that newly graduated orthopedic surgeons have the self-confidence to handle many of the essential types of cases independently.

Objective: The aim of this study was to compare the characteristics and distribution of trauma surgeries performed in the first phase of the COVID-19 pandemic, the second phase of the pandemic, and the normal period before the pandemic., Methods: Three different time periods were determined.Group 1 represented the first wave of the pandemic, in which lockdowns andrestrictions were strictly applied and only emergency and trauma surgeries wereperformed, between 1 April and 31 May 2020. Group 2 represented the second waveof the pandemic, during which restrictions were not applied and only emergencyand trauma surgeries were performed, from 1 September to 31 October 2020. Group3 represented the normal period before the pandemic, including surgeriesperformed between 1 September and 31 October 2019. In addition, patients ineach group were divided into two groups as younger than 16 or older than 16 inorder to understand the difference between paediatric and adult orthopaedictraumas. The distribution of patients and their fractures were evaluated., Results: In Group 1, the rates of intra-articular fractures, distal extremity fractures, and proximal humerus fractures decreased, while the rate of proximal femur fractures increased (P < 0.05 for all). The frequency of hand fractures treated in Groups 1 and 2 compared to Group 3 was reduced (P < 0.05 for both). There was no statistically significant difference between Groups 2 and 3 for fractures in different parts of the body except for hand fractures (P = 0.001 for hand fractures, P > 0.05 for the other fractures)., Conclusion: We observed that the frequency of fractures decreased, and the distribution changed due to severe restrictions and lockdowns in the first wave of the pandemic. When the restrictions and lockdowns were removed in the second wave, the frequency of fractures decreased, but the distribution of fractures was similar to the normal period in 2019., Level of Evidence: Level III, Diagnostic Study.

Background: To evaluate the cost-effectiveness of the reconstruction of the anterior cruciate ligament tears using either ToggleLoc with ZipLoop or Transfix systems., Methods: This study is a cost-effectiveness analysis of patients with anterior cruciate ligament reconstruction, ToggleLoc with ZipLoop and Transfix systems in our clinic between 2011 and 2016. This study was a retrospective cross-sectional study of patient's demographic, clinical and financial data. The effectiveness of surgery on patients with anterior cruciate ligament reconstruction was determined by the Lysholm Knee Score Scale. We compared two systems with the cost-effectiveness ratio., Results: In this study, 103 patients were included. According to the Lysholm Knee Score Scales in both groups, the findings showed that there was no difference in effectiveness between them. The ToggleLoc with ZipLoop technique was cost-effectiveness ratio 254,57 and the Transfix technique cost-effectiveness ratio was 378,33., Conclusion: According to our results, ToggleLoc with ZipLoop technique was a more cost-effective method than the Transfix technique in the anterior cruciate ligament reconstruction.

Objectives: This study aims to histologically examine the joint capsule and synovium to determine the correlation between histopathological findings and postoperative clinical outcomes in patients with isolated type II superior labrum anterior posterior (SLAP) lesions., Patients and Methods: Thirty-eight patients (24 males, 14 females; mean age 53.2±6.6 years; range, 45 to 67 years) who underwent arthroscopic treatment of type II SLAP lesions between June 2017 and September 2018 were evaluated prospectively. Visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores of all patients were recorded preoperatively, and at 6th and 12th months postoperatively. Biceps tenotomy was applied as arthroscopic surgical treatment in all patients. Biopsy materials obtained from rotator interval joint capsule and synovium during the arthroscopy were evaluated histopathologically. The density of the vessels in the specimens was defined as low, medium, and high by the pathologist. The patients with medium or low vessel density in specimens were group 1 (n=14) and those with high vessel density group 2 (n=24)., Results: In group 2, preoperative VAS score was significantly higher. There was no difference between the scores of the groups except for the sixth month SST score which was significantly higher in group 1. Histopathological evaluation revealed that the number of lymphocytes, fibroblasts, mast cells, myofibroblast, synovial lining cells, macrophages, and amount of collagen in connective tissue were significantly higher in group 2. In five patients of group 2, the rehabilitation program was interrupted due to pain and difficulty in gaining a range of motion during the first four weeks postoperatively. Four of these patients recovered with medication and long-duration physiotherapy. Shoulder stiffness developed in one patient who required arthroscopic release and further rehabilitation., Conclusion: There is a correlation between histopathological findings of joint capsule and synovium, and postoperative clinical outcomes and treatment in patients with isolated type II SLAP lesions. Almost 20% of patients who had pathologic histological findings in joint capsule and synovium needed pain control and long-duration rehabilitation program after arthroscopic surgery for better shoulder function recovery and prevention of shoulder stiffness.

Objectives: This study aims to investigate if tranexamic acid (TXA) reduces both visible and hidden blood loss in patients undergoing total knee arthroplasty (TKA)., Patients and Methods: A total of 128 female patients (mean age 68.9±5.8 years; range, 55 to 80 years) who underwent TKA and were admitted between January 2010 and January 2020 were included in this retrospective study. Only patients who had primary unilateral knee arthroplasty with a cemented posterior cruciate ligament substituting implant were included. Patients were divided into two groups according to TXA administration in the perioperative period. Group 1 consisted of patients who did not receive TXA (n=69), while Group 2 consisted of patients who received TXA (n=59). The effect of TXA on visible and hidden blood loss, amount of erythrocyte suspension transfusions, postoperative early wound complications, and the relationship between the volume of hidden blood loss and drainage volume were detected., Results: There was no statistically significant difference between the groups in terms of age, body mass index, operation side, preoperative hematocrit (HCT) values, and total blood volume. Postoperative HCT values were statistically higher in Group 2. Fifty-four units of erythrocyte suspension transfusion were required in Group 1, while six units were required in Group 2 (p<0.001). Early wound complication was determined in 10 patients in Group 1 and only in one patient in Group 2 (p=0.011). Intraoperative blood loss, postoperative drainage volume, hidden blood loss, and total blood loss values were significantly lower in Group 2 (p=0.001). In all patients, there was a significant positive correlation between the postoperative drainage volume and the hidden blood loss volume (r=0.532, p=0.001)., Conclusion: The use of TXA in patients undergoing TKA reduces postoperative bleeding (visible and hidden blood loss), blood transfusion needs, and early wound complications. In addition, drainage volume in postoperative 24 hours can be used to estimate the amount of hidden blood loss in early postoperative period.