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It has not yet been fully established that there is coronavirus disease 2019 (COVID-19) involvement in the synovial fluid and it remains a topic of debate. The aim of this study was to evaluate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in knee joint synovial fluid of patients with COVID-19. This retrospective study was conducted with an initial screening of patients who were admitted to a tertiary pandemic hospital due to COVID-19 symptoms, and underwent treatment for COVID-19 between March and June 2020. A total of 2476 patients were hospitalized or received treatment for a possible diagnosis of COVID-19. While the RT-PCR test was positive in 318 patients (12.8%), 2158 (87.2%) were computed tomography positive but reverse transcription-polymerase chain reaction (RT-PCR) negative. Twelve patients were consulted due to acute joint effusion. Of five patients with knee joint effusion and a positive RT-PCR test, the synovial tissue RT-PCR test was positive in only one patient. This paper is the first to show the presence of SARS-CoV-2 in synovial fluid. This can be considered of importance for the determination and elimination of the route of transmission, thereby preventing further development and spread of the disease. [ABSTRACT FROM AUTHOR]

Background: The treatment of Intertrochanteric fractures in the elderly osteoporotic patient is still controversial. The aim of this study was to compare the outcomes of proximal femoral nailing (PFN) and a distally-fixed non-modular monoblock fluted long-stem hemiarthroplasty (HA) in elderly patients with an osteoporotic intertrochanteric fracture. Methods: This retrospective study included patients who had undergone surgery for an unstable intertrochanteric fracture. The patients were separated into PFN and HA groups. The demographic features of the 2 groups were compared. All patients were evaluated using the Singh index, ASA score, AO/OTA classification, Harris Hip Score (HHS), and Parker and Palmer mobility score. Results: The most common complications were nonunion (12.0%) and cut-out of the screw (10.7%) in the PFN group, and dislocation of the prosthesis (6.7%) and wound infection (5.7%) in the HA group. Overall, the 2-year mortality rate was 29.3%. Mortality, particularly within the first 3 months, was 2.4 times higher in the PFN Group than in the HA group (40% vs. 19.75%). Although the HHS was significantly higher in the first year for the HA group, no significant difference was seen between the 2 groups at 24 months. Conclusions: Although PFN and HA have similar good outcomes at 2 years, HA allows earlier mobilisation and has fewer complications and a lower mortality rate. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the number of deep vein thrombosis (DVT) cases during the quarantine period for COVID-19 to that of the last year. Methods: This study was conducted as a single-center and retrospective study. All hospital admissions during April 2020 and May 2020 were screened from the hospital records, and DVT cases were recorded. Likewise, all hospital admissions during April 2019 and May 2019 were screened, and DVT cases were noted. DVT cases of both years were compared. Results: Among 480931 patients admitted to our hospital in April 2019 and May 2019, DVT was detected in 82 patients (0.017%) (47 males, 35 females) with a mean age of 56.99 ± 9.1 years (ranges 39 to 79 years). Besides, among 145101 patients admitted to our hospital in April 2020 and May 2020, DVT was detected in 123 patients (0.084%) (51 males, 72 females) with a mean age of 58.64 ± 8.9 years (ranges 40 to 83 years). Despite the decrease in the total number of patients admitted to the hospital, there was a significant increase in the number of DVT patients. Interestingly, there were only two symptomatic pulmonary-embolism cases in the 2019 period, whereas there were seven symptomatic pulmonary embolisms secondary to DVT in the 2020 period. Unfortunately, one patient died due to pulmonary embolism secondary to DVT in 2020. The previous history of DVT was remarkable in patients admitted during the COVID-19 confinement. Conclusion: In conclusion, COVID-19 confinement seems to be associated with increased rates of DVT. Strict preventive measures such as exercise training or prophylactic drug use should be considered to prevent immobility-related DVT during the COVID-19 quarantine. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate the thickness and stiffness of the diaphragm, using ultrasound (US) and strain elastography (SE) in patients with hyperkyphosis due to osteoporotic vertebral fracture. Material and methods: This prospective and case-control study was conducted between October 2019 and December 2019. Diaphragm thickness, SE, and strain ratio values of patients with hyperkyphosis due to osteoporotic vertebral fracture were compared with those of the control group. Results: There were 42 patients (14 males, 28 females) with a mean age of 81.10 ± 6.3 years in the kyphosis group and 36 subjects (11 males, 25 females) with a mean age of 81.00 ± 5.5 years in the control group. End-inspirium thickness, change level, and thickening ratio of the diaphragm were significantly higher in the control group (p < 0.001 for all). Strain ratio values were significantly higher in the kyphosis group, and the rate of hardest colour code was significantly higher in the control group. The diaphragm thickness at end-inspirium and thickening ratio values correlated positively with the forced expiratory volume in the first second (FEV1, %) and forced vital capacity (FVC, %) values. The strain ratio values correlated inversely with the FEV1 (%) and FVC (%) values. The diaphragm thickness at end-inspirium and thickening ratio values correlated inversely with the Cobb values and number of vertebra fractures. A positive correlation was determined between the strain ratio values and the Cobb values and number of vertebra fractures. Conclusions: Ultrasonography is a promising imaging tool to evaluate and quantify the diaphragm function and stiffness in relevant patients. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate the thickness and stiffness of the diaphragm, using ultrasound (US) and strain elastography (SE) in patients with hyperkyphosis due to osteoporotic vertebral fracture. Material and methods: This prospective and case-control study was conducted between October 2019 and December 2019. Diaphragm thickness, SE, and strain ratio values of patients with hyperkyphosis due to osteoporotic vertebral fracture were compared with those of the control group. Results: There were 42 patients (14males, 28 females) with a mean age of 81.10 ± 6.3 years in the kyphosis group and 36 subjects (11 males, 25 females) with a mean age of 81.00 ± 5.5 years in the control group. End-inspirium thickness, change level, and thickening ratio of the diaphragm were significantly higher in the control group (p < 0.001 for all). Strain ratio values were significantly higher in the kyphosis group, and the rate of hardest colour code was significantly higher in the control group. The diaphragm thickness at end-inspirium and thickening ratio values correlated positively with the forced expiratory volume in the first second (FEV1, %) and forced vital capacity (FVC, %) values. The strain ratio values correlated inversely with the FEV1 (%) and FVC (%) values. The diaphragm thickness at end-inspirium and thickening ratio values correlated inversely with the Cobb values and number of vertebra fractures. A positive correlation was determined between the strain ratio values and the Cobb values and number of vertebra fractures. Conclusions: Ultrasonography is a promising imaging tool to evaluate and quantify the diaphragm function and stiffness in relevant patients. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the effect of previous arthroscopic surgery on total knee arthroplasty outcomes and complication rates. Material and Methods: This retrospective study included patients who underwent total knee arthroplasty due to grade 4 osteoarthritis, according to the Kellgren-Lawrance classification system in a tertiary hospital, between January 2012 and December 2016. The patients were divided into two groups according to whether or not they had undergone previous knee arthroscopy. The arthroscopic procedure included degenerative meniscus tear subtotal excision and synovectomy. The data of the two groups were compared. Outcome measures were the visual analog scale, McMaster Universities Osteoarthritis Index, Knee Society scoring system and knee range of motion. Results: The previous arthroscopy-free group comprised 94 patients (35 males, 59 females), and the previous undergoing arthroscopy group included 73 patients (23 males, 50 females). The mean age of previous arthroscopy-free group was 63.12 ± 2.8 years (range, 57 to 68), and the mean age of previous undergoing arthroscopy group was 62.42 ± 3.9 years (range, 55 to 73). The groups were similar in terms of age, gender, body mass index, follow-up periods, sides, and complications (p > 0.05 for all). In assessments at the end of 4 years, the groups were similar in respect of visual analog scale, McMaster Universities Osteoarthritis Index, Knee Society scoring system and knee range of motion. Conclusions: The results of this study showed that clinical outcomes and complications were similar in patients with primary total knee arthroplasty and no previous procedure and those who had previously undergone knee arthroscopy. In the light of these preliminary results, previous knee arthroscopy has no negative effect on the outcomes of total knee arthroplasty and complication rates. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the clinical and demographic data of patients requiring revision surgery after lumbar spinal stenosis (LSS) surgery and to provide a guide us in choosing primary surgical options. Material and Methods: This study was conducted as a single-center, descriptive, and retrospective study. LSS patients, who were operated upon using the same implant technique between 2012 and 2017, and subsequently underwent revision surgery due to implant failure and operated by the same surgeon were included. Medical records, preoperative and postoperative two-plan radiographs, and computed tomography (CT) scans of the primary and revision surgeries of the patients were evaluated. Results: A total of 19 patients (5 males, 14 females) with a mean age of 64.16 ± 7.9 years (range: 47 to 77 years) were included in the study. Most of the patients who underwent revision surgery were over 65 years of age and had a normal body mass index (BMI). In addition, 16 patients (84.2%) who underwent revision surgery were operated without transforaminal lumbar inter-body fusion (non-TLIF). L5-S1 was the most commonly seen level for spinal stenosis revision. The mean revision time was 245.26 ± 65.1 days (range: 135 to 342). Conclusion: Debates are ongoing between transforaminal lumbar inter-body fusion (TLIF) and non-TLIF surgery. In light of the data obtained through this study, we think that TLIF cage surgery should be included in the primary surgical procedure, especially at the lumbosacral junction, where it is difficult to obtain fusion to avoid revision in patients undergoing LSS surgery. [ABSTRACT FROM AUTHOR]

objective: The efficiency and cost of cell saver system is compared with in patients who underwent to complex spine surgery with and without the system. Material and methods: We restrospectively evaluated the patients who underwent to posterior instrumentation and fusion in our clinic between Jan 2009-Mar 2013 for treatment of complex spine disease. There were 44 patients in group I which cell saver system was used during operation, and 20 patient in group II which system was not used. We aimed to determine the efficiency and cost of the usage of cell saver system against to allogenic blood transfusion in peroperative and postoperative periods. IBM SPSS Statistic Version 20.0 program was used for statistical analyses. Results: The number of erytrosyte suspension used in the peroperative and the postoperative periods was 1±1 in group I, and 2.6±1.8 in group 2 and the difference was statistically significant (p=0.004). When compared by the cost, group I was 752.7±148.7 TL and group II was 241.8±169.1 TL with statistically significant difference (p<0.00l). Conclusion: in complex spine surgery, hemoglobin, hematocrit and red blood cell values are higher at the first postoperative day in patients whom cell saver system is used during operation against whom did not used and the usage of this system decreases allogenic blood transfusion at the peroperative and the postoperative periods. [ABSTRACT FROM AUTHOR]

Objective: In this study, the efficiency of three different rigid screw types on preserving reduction in Lindgren-Turan osteotomy is investigated. Material and Methods: Between 2007-2012, 86 feet of 60 patients who underwent Lindgren-Turan osteotomy procedure due to hallux valgus deformity in our clinic were retrospectively evaluated. Fixation was done by Herbert screws, cannulated headless screws and 2.7 mm cortical screws. Hallux valgus angles, intermetatarsal angles and distal metatarsal articular angles were evaluated in preoperative, early postoperative and late postoperatively. Different rigid internal screws which are used in fixation after Lingdren-Turan osteotomy were evaluated by these angles. Results: While there was no statistically significant difference between averages of hallux valgus angles at early and late postoperative controls in cannulated headless group, the difference was significant in Herbert screw and 2.7 mm cortical screw groups. While there was no statistically significant difference between averages of intermetatarsal angles at early and late postoperative controls in cannulated headless and Herbert screw groups, the difference was significant in 2,7 mm cortical screw group. There was no statistically significant difference between averages of distal metatarsal articular angles at early and late postoperative controls in all screw groups. Conclusion: In fixation of osteotomy site by 2.7 mm cortical screws after Lindgren-Turan osteotomy, there was significant correction decrement at late postoperative intermetatarsal and hallux valgus angles. There was less reduction loss with cannulated headless screws in our study. [ABSTRACT FROM AUTHOR]

Objective: In this study, we purposed to evaluate the early and mid term results and life quality of the patients who underwent to arthroscopic cartilage debridement and joint lavage because of symptomatic gonarthrosis which didn't response to medical treament at least three months, restricted the patient's daily activity and wasn't at the late stage radiologically. Material and Methods: We made our study between 2004-2010 with 96 patients over forty years who applied to our clinic and came to their controls periodically because of knee pain which did not remit by conservative treatment at least three months, had gonarthrosis diagnosis according to modified ACR criteria, under 4. Stage according to Kellgren-Lawrence criteria radiologically and underwent to arthroscopic cartilage debridement and articular lavage because of symptomatic gonarthrosis. We evaluated the life quality, pain and functional scores of the patients pre and post-operatively by SF-36 and WOMAC point index. (Number Cruncher Statistical System) 2007 & PASS 2008 Statistical Software (Utah, USA) program was used for statistical analyze. The results are evaluated with Student t test ve Mann Whitney U test. p<0.05 was statistically significiant Results: In our study we found that the postoperatively physical and social functions, mental health and total SF-36 scores are increased, WOMAC scores are decreased statistically significantly (p<0.0l). We found that the difference between preoperative and postoperative WOMAC and SF-36 scores were not different statistically between two groups whose BMI<30 and BMI≥30 (p>0.05). Physical and social functions, mental health and total SF-36 scores of the patients who underwent to operation in the last 18 months were statistically significantly increased against the patients whose operation time was earlier (P<0.01). Physical and social functions, mental health and total SF-36 scores of the patients who are under 50 were statistically significiantly greater than patients over 50 (p<0.01). Conclusion: The arthroscopic joint debridement and lavage can be used, cheap, low morbid method to improve life quality, functions and to recruit the pain when applied on well chosen patients. [ABSTRACT FROM AUTHOR]