Objective: Our study aimed to determine the effect of neutrophil-to-lymphocyte ratio, thrombocyte-to-lymphocyte ratio, systemic immune inflammation index (SII), and systemic inflammation response index (SIRI) in determining risk factors in pediatric patients who had underdone more than one surgical treatment for septic arthritis. Material and Methods: The study included patients younger than 16 years of age who were surgically treated for septic arthritis between 2018 and 2022. Blood neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), platelet count x neutrophil count/lymphocyte count ratio (SII), and monocyte count x neutrophil count/lymphocyte count ratio (SIRI) were calculated at admission. Results: Mean age of the 25 patients (10 males, 40%; 15 females, 60%) included in the study was (6.24 +/- 4.51) years. The number of patients operated on the hip joint was 6 (24%), and the number of patients operated on the knee joint was 19 (76%). When the type of operation was analyzed, arthroscopic debridement was performed in seven patients (28%) and open debridement in 18 patients (72%) in the first surgical treatment. The number of patients who underwent a second operation was 3 (12%). Conclusion: When comparing mean values of NLR, PLR, SII, and SIRI be- tween patients who underwent multiple surgeries due to septic arthritis and those who had only one surgery, no statistically significant differ- ences were found. Mean C-reactive protein (CRP) levels in patients who had undergone a second surgery were lower than those who had not. However, no significant differences were detected when examining the impact of CRP levels on the necessity of a second surgery.

Objective To compare the effectiveness of sensory-motor training and resistance training in patients with knee osteoarthritis. Design Randomized controlled trial. Setting Istanbul University, Department of Physiotherapy and Rehabilitation. Subjects Forty-eight participants with knee osteoarthritis. Interventions Following baseline assessment, participants were randomly allocated to sensory-motor training (n = 24) and resistance training (n = 24). Both groups received training three times a week for 8 weeks. Main measures The primary outcome measure was the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The secondary outcome measures were pain level, muscle strength, proprioception, range of motion, quality of life, and patient satisfaction with treatment. Patients were assessed before and after four- and eight-week interventions. Results There was no significant difference between the groups' total WOMAC scores after four- and eight-week interventions (respectively, p = 0.415, p = 0.828). There was a significant improvement in pain level during movement and in the energy subscale SF-36 for resistance training after the four-week intervention (respectively, p = 0.012, p = 0.007). After the eight-week intervention, a significant difference was noted in favor of resistance training in the secondary outcome measure quality of life (QoL). No significant difference was found in other secondary outcomes. Conclusions At the end of the treatment, it was observed that sensory-motor training had a similar effect in the treatment of knee osteoarthritis symptoms to resistance training. These findings may suggest that sensory-motor training is an effective new method to treat patients with knee osteoarthritis.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Purpose To evaluate the effect of COVID-19 positivity on inflammatory parameters and 30-day mortality rates in patients over 65 years of age who were operated on for intertrochanteric femur fractures (IFF). Methods Eighty-seven patients (31 males, 56 females) who had a dynamic hip screw (DHS) or proximal femur nail (PFN) for the IFF between March 2020 and November 2020 were included in the study. The patients were divided into two groups as COVID-19 confirmed and probable positive (Group 1) and COVID-19 negative (Group 2). Time to surgery, operation duration, length of hospital stay, 30-day mortality, rates of the intensive care unit (ICU) referral, and inflammatory parameters such as haemoglobin, CRP, sedimentation, PCT, D-Dimer, and ferritin were evaluated. Results No significant difference was observed in terms of demographic data such as age, gender, comorbidity, and fracture type between the groups. Thirty-day mortality, ICU referral rate, blood transfusion rate, and hospitalization period were higher in Group 1 (p = 0.016, p = 0.012, p = 0.031, and p = 0.011, respectively). The inflammatory parameters were higher in Group 1 compared to Group 2 in the preoperative and postoperative periods (p < 0.05). Conclusion COVID-19 positivity increases inflammatory parameters (as expected) and increases the 30-day mortality and ICU requirement in patients with surgically treated IFF.

To determine whether patient-specific instrumentation (PSI), computer-assisted surgery (CAS) or robot-assisted surgery (RAS) enable more accurate rotational alignment of the tibial baseplate in primary total knee arthroplasty (TKA) compared to conventional instrumentation, in terms of deviation from the planned target and the proportion of outliers from the target zone. The authors independently conducted three structured electronic literature searches using the PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases from 2007 to 2020. Studies were included if they compared rotational alignment of the tibial baseplate during TKA using conventional instrumentation versus PSI, CAS, and/or RAS, and reported deviation from preoperatively planned rotational alignment of the tibial baseplate in terms of absolute angles and/or number of outliers. Methodological quality of eligible studies was assessed by two researchers according to the Downs and Black Quality Checklist for Health Care Intervention Studies. Fifteen studies, that reported on 2925 knees, were eligible for this systematic review, of which 6 studies used PSI, and 9 used CAS. No studies were found for RAS. Of the studies that reported on angular deviation from preoperatively planned rotational alignment, most found smaller deviations using PSI (0.5° to 1.4°) compared to conventional instrumentation (1.0° to 1.6°). All studies that reported on proportions of outliers from a target zone (± 3°), found lower rates of outliers using PSI (0 to 22%) compared to conventional instrumentation (5 to 96%). Most studies reported smaller angular deviation from preoperatively planned rotational alignment using CAS (0.1° to 6.9°) compared to conventional instrumentation (1.1° to 7.8°). Of the studies that reported on proportions of outliers from a target zone (± 3°), most found fewer outliers using CAS (10 to 61%) compared to conventional instrumentation (17 to 78%). This systematic review and meta-analysis revealed that both CAS and PSI can improve the accuracy of rotational alignment of the tibial baseplate by decreasing angular deviation from the preoperatively planned target and reducing the proportion of outliers from the target zone. The clinical relevance is that PSI and CAS can improve alignment, though the thresholds necessary to grant better outcomes and survival remain unclear. IV.

Introduction: In this study we aimed to estimate if there is a releation between some inflammatory or adipocyte-derived cytokines as IL-1 beta, IL-6, TNF-alfa, VEGF, 4-HNE, macrophages, mast cells and osteoarthirites. Especially 4-HNE which associated obesity is a new marker for estimating the chondral injuries and there is a poor evidence of it's effect on IFP and osteoarthritis. Methods: We obtained tissues after ethical approving and designed our studying groups as one osteoarthritis (n=15) and one osteoarthritis patients group (n= 12) and then applied histological procedure for estimating the IFP tissues. We stained using IL-Ibeta, IL-6, TNF-alfa, VEGF, 4-HNE, CD68 (for macrophage marker) antibodies by immunohistochemical technique and toluidine for the mast cells, examined slides microscopically and evaluated all of the tissues according to the staining intensity by using HSCORE. Results: As a result, we detected high expression levels of inflammatory mediators especially IL-6, IL-1beta, VEGF and 4-HNE the osteoarthritis group (OAG) than the non-osteoarthritis group (NOAG) and the numbers of macrophages and mast cells are in the OAG, too. Also, the macrophages have distinctly different morphologies in the OAG and they were bigger and had crown structures compare to the NOAG. Conclusions: In conclusion, these data indicate that IFP-derived inflamatory mediators could contribute to pathophysiological in the osteoarthritis of the knee joint and there is a necessity for future studies in this area.

Proximal tibiofibular dislocation (PTFD) is a rare injury. In this article, we report a case of a PTFD, complicated with an intraarticular injury, a bucket-handle tear of the lateral meniscus. A 37-year-old male patient presented to the emergency department with pain and swelling on the lateral side of his right knee due to lateral trauma to the fibula during external rotation of the leg while his foot was on the ground. Closed reduction was performed under sedation. The lateral meniscus was repaired, and the fibular head was fixed with a cannulated screw. The patient had no pain in the tibiofibular joint after eight weeks postoperatively. Results of magnetic resonance imaging for the diagnosis of PTFD should be kept in mind during the presentation of sports trauma patients that experience difficulty in bearing weight on the affected extremity.

Background/aim: Trans-scaphoid perilunate fracture-dislocation (TSPFD) is a rare injury. TSPFD is a fracture-dislocation that severely disrupts the anatomical structure of the carpal bones and may occur as a result of a high energy trauma of the wrist or a fall on an open hand. In this study, the aim is to provide midterm clinical and radiological evaluations of cases diagnosed and treated as TSPFD. Materials and methods: Eleven patients diagnosed with TSPFD as a result of wrist trauma were treated surgically and were analysed retrospectively. Clinical and radiological follow-up of the cases was evaluated. The mean age of the patients was 34 years. All patients were males with a dorsal dislocation according to Herzberg's perilunate fracture-dislocation classification. The mean follow-up time was 33 months. All of the cases were evaluated with preoperative and postoperative standard wrist anteroposterior and lateral radiographs. A dorsal approach was used in all cases. However, in 1 case a volar approach was also required. The Green and O'Brien evaluation scale modified by Cooney was used for the clinical assessment of pain, wrist range of motion, grip strength, and functional status as excellent, good, moderate, or poor. The wrist range of motion was evaluated goniometrically at the final check-up, and a mid-grade disability was observed compared with the uninjured side. A visual analogue scale was used to evaluate the pain. Results: Sufficient union was obtained in all cases with open reduction and internal fixation of the fractures. Grip strength was up to 77.5% of the other side. According to the modified Green and O'Brien clinical evaluation scale, 6 cases were evaluated as good, 3 cases were fair, and 2 cases were poor. No median nerve damage was determined preoperatively or postoperatively and there was no postoperative pin tract infection in any of the patients. Conclusion: This kind of injury represents complex biomechanical damage of the wrist anatomy. If it is diagnosed early and treated with open reduction and stable fixation, a functionally adequate and anatomically integrated wrist can be achieved.

To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee.

A broad spectrum of physical therapy exercise programs provides symptom relief and functional benefit for patients with knee OA. Manual physical therapy, including tailored exercise programs provide relatively higher level benefit that persists to one year. It is currently unknown if there are important differences in the effects of different manual physical therapy techniques for patients with knee OA and there are virtually no studies comparing manual physical therapy and electrotherapy modalities. The aim of the study was to compare long-term results between three treatment groups (mobilization with movements [MWMs], passive joint mobilization [PJM], and electrotherapy) to determine which treatment is most effective in patients with knee OA. A single-blind randomized clinical trial with parallel design was conducted in patients with knee OA. Seventy-two consecutive patients (mean age 56.11 +/- 6.80years) with bilateral knee OA were randomly assigned to one of three treatment groups: MWMs, PJM, and electrotherapy. All groups performed an exercise program and received 12 sessions. The primary outcome measures of the functional assessment were the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Aggregated Locomotor Function (ALF) test scores. The secondary outcome measures were pain level, measured using a pressure algometer and a visual analogue scale (VAS), range of motion (ROM), measured using a digital goniometer, and muscle strength, evaluated with a handheld dynamometer. Patients were assessed before treatment, after treatment and after 1year of follow-up. Patients receiving the manual physical therapy interventions consisting of either MWM or PJM demonstrated a greater decrease in VAS scores at rest, during functional activities, and during the night compared to those in the electrotherapy group from baseline to after the treatment (p<0.05). This improvement continued at the 1-year follow-up (p<0.05). The MWMs and PJM groups also showed significantly improved WOMAC and ALF scores, knee ROM and quadriceps muscle strength compared to those in the electrotherapy group from baseline to 1-year follow-up (p<0.05). In the treatment of patients with knee OA, manual physical therapy consisting of either MWM or PJM provided superior benefit over electrotherapy in terms of pain level, knee ROM, quadriceps muscle strength, and functional level.

Purpose: the aim of this study was to assess the relationship of patient weight, height and body mass index (BMI) with the size of the quadrupled hamstring tendon used in anterior cruciate ligament (ACL) reconstruction. Methods: from patient records, we retrospectively assessed the weight, height, BMI and graft sizes of 126 patients who underwent ACL reconstruction using a quadrupled hamstring tendon autograft between January 2010 and January 2013 at our institution. The data obtained from perioperative measurements were studied using correlation analysis. Results: statistically significant relationships were found between patient height and graft diameter (p = 0.033, r = 0.19) and between patient weight and graft diameter (p < 0.0001, r = 0.33). No statistically significant relationships were found between graft diameter and BMI or between graft length and patient height, weight and BMI (p > 0.05). Conclusions: patient height and weight were found to be related to quadrupled hamstring graft diameter in our patient population. BMI was not related to the quadrupled hamstring graft size. The exact size of the graft cannot be predicted preoperatively on the basis of these variables. Level of evidence: Level IV, retrospective case series.

Category: Bunion Introduction/Purpose: AOFAS score and angular changes are used widely to assess hallux valgus surgery. But our previous study showed us that these parameters do not reflect patient subjective satisfaction after surgery, angular changes do not correlate with patient satisfaction, and a subjective satisfaction scale must be used. So can we find a measurable parameter that reflects patient satisfaction? The purpose of the study was to evaluate the effect of percental reduction of first web space length (FWSL) on patient satisfaction, and if it can be used as a measurable parameter for this. Methods: Fifty feet of thirty-seven patients were included to the study. All patients were operated between 2010 and 2014. Same surgical technique (Lindgren-Turan osteotomy)used for operations. Patients were evaluated by using hallux valgus angle (HVA),1-2 intermetatarsal angle (IMA), first web space length (FWSL), AOFAS scores. On the final follow-up they were asked to scale their postoperative satisfaction between 1-10;as for 1-2 very unsatisfied, 3-4 unsatisfied, 5-6 neither unsatisfied nor satisfied, 7-8 satisfied, 9-10 very satisfied. The percental changes of HVA, IMA, and FWSL were compared with AOFAS score, and satisfaction scales. Results: Average age was 45,50±12,23 (22-68) years. Mean follow-up was 41,68±14,46 (24-68) months. 29 of 50 feet were right side, 21 were left. Preoperative HVAs have been changed from 32,52±5,19 to 11,58±4,70 degrees (p=0,001; p<0,01). Preoperative IMAs have been changed from 15,00±3,56 to 5,75±2,45 degrees (p=0,001; p<0,01). Preoperative AOFAS scores have been changed from 75,04±5,54 to 93,14±6,25 points (p=0,001; p<0,01). Preoperative FWSL changed from 14,5 (10-22) mm to 7,5 (5-14) mm (p=0,001; p<0,01). Postoperative satisfaction scale was 8,60±0,67 (7-10) points. When HVA and IMA percental changes were compared with AOFAS percental changes, they have shown a negative statistical significance according to Spearman’s Correlation Analysis. When AOFAS percental changes have been compared with satisfaction scale, they have shown a positive statistical significance. When FWSL percental changes were compared with AOFAS percental changes and satisfaction scale it has shown a positive statistical significance for both parameters according to Spearman’s Correlation Analysis. Conclusion: According to our results; we believe that the changes of FWSL have an influence on patient satisfaction. It is correlated both with AOFAS, and subjective satisfaction scale. It can be used as a measurable parameter to search for patients satisfaction. Angular changes do not have an influence on patients satisfaction. May be FWSL should also be used for surgical indications?

Non-invasive prenatal screening (NIPS) of trisomy 21 (T21) using digital PCR (dPCR) with several advantages will be very effective. Here, we developed a dPCR system for T21 screening which allows high sensitivity and real-time diagnosis and thus overcome sequence based analysis.Cut-off value was established using DNA extracted from all 157 T21 negative samples including 47 pregnant woman samples and 3 T21 positive pregnant woman samples extracted from 4 different sample types. To increase the portion of the cell-free fetal DNA (cffDNA) in maternal cell-free DNA (cfDNA), a size selection method was devised. We evaluated the clinical reliability of NIPS using dPCR through analysis of 877 pregnant woman samples.We could demonstrate the possibility of NIPS using dPCR performed by applying cut-off value and size selection method. The overall accuracy was derived at 99.66% using 877 pregnant woman plasma samples.Our results showed that dPCR can meet the requirements for NIPS for T21. It is relatively inexpensive, easy to use in a screening method and compatible with ethical concerns regarding access to nucleotide sequence information. This study may be a basic data for the development of population-wide screening for T21 in pregnant women.

Supracondylar humerus fractures are common in children. Displaced fractures are usually treated with closed reduction and cross pin fixation. But, medial pinning may cause the ulnar nerve injury. The aim of this study was to compare the parents-based cosmetic satisfaction of the incision scars in children with displaced supracondylar humerus fractures treated by closed reduction and cross pin fixation with or without small medial incision. We retrospectively reviewed the medical records of 72 children with displaced supracondylar humerus fractures treated two different closed reduction and percutaneous pinning methods at our institution from January 2010 through December 2013. A group has 36 patients treated with small medial incision and crossed K-wires fixation after closed reduction. The other group has 36 patients treated with closed reduction and K-wires fixation. At the final follow-up, the patients were evaluated radiologically and clinically with Flynn's criteria. Furthermore, a visual analogue scale was used to determine of the parents-based cosmetic satisfaction score. All fractures healed without major complications at the final clinical and radiological assessment. Although, between the two groups did not differ in terms of Flynn cosmetic and functional outcomes, there were statistically significant differences between both groups according to the parents-based cosmetic satisfaction scores. The closed reduction and crossed pin fixation without small medial incision should be preferred first because of better the parents-based cosmetic satisfaction.

Özet Amaç Çalışmamızın amacı kliniğimizde mobil unikondiler diz artroplastisi uyguladığımız hastaların ameliyat önceki dönemdeki patellofemoral ağrı durumlarını ameliyat sonrası dönemle kıyaslamak ve sonuçlarını değerlendirmektir. Gereç ve Yöntem Yirmiiki unikondiler diz artroplastisi uyguladığımız hastayı çalışmaya dahil ettik. Ameliyat öncesi tüm hastalar ayakta ön-arka, lateral grafileri ve bacak uzunluk grafileri ile değerlendirildi. Tüm hastalar aynı cerrahi yöntem kullanılarak ameliyat edildi. Tüm hastalara aynı tip protez kullanıldı (Mobil insertli, Corin, UK). Hastaların operasyon öncesinde ve 3 ve 6. ay kontrollerinde değerlendirilmelerinde Womac diz skoru, Kujala patellofemoral skoru ve Vas skoru kullanıldı. Preopertaif diz skorları postoperatif skorlar ile istatistiksel olarak karşılaştırıldı. Bulgular Hastaların ameliyat öncesi ortalama WOMAC, VAS ve Kuaja patellofemoral skorlarında ameliyat sonrası ile kıyaslandığında belirgin olarak azalma tespit edildi (p<0.05). Üç hastada takiplerde komplikasyon saptandı ( (%13.6). Kompliksayon nedenleri; mobil insert luksasyonu ve metalozis, artan patellofemoral ağrı ve diğer kompartmanlarda gelişen artroz, ve minör travma sonrası (basit düşme) gelişen diz iç yan bağ rüptürü idi. Sonuç UKDA da başarıyı etkileyen en önemli faktörler cerrahi teknik özellikle ameliyat sırasında kinematik değerlendirmenin iyi yapılması ve hasta seçimidir. Özellikle patellofemoral kompartman durumu hem grafiler hemde klinik bulgular eşliğinde değerlendirilmelidir. Patellofemoral ağrı tek başına UKDA için bir kontrendikasyon olarak değerlendirilmemeli ancak bu hastalar için ameliyat kararı verirken seçici davranılmalıdır. Pattellofemoral semptomlar ve ağrı postop erken dönemde agreve olabilir, kesin değerlendirmeler için en az 6 ay beklenmeli erken revizyon kararı verilmemelidir. UKDA yapılan hastaların iç yan bağ rüptürüne karşı hassas olduğu ve minör travmalarla bile iç yan bağ rüptürü gelişebileceğini akılda tıutmalıyız.

Abstract The goal of this study was to evaluate the results of a novel method, arthroscopic fixation of isolated Hoffa fractures.This is a prospective, case series and set at Level 1 trauma center. A total of eight patients with isolated Hoffa fractures who were operated by arthroscopic screw fixation method in the anterior posterior direction with 6.5 mm cannulated screws were followed up prospectively. Same surgical method used for all patients. All patients underwent the same rehabilitation program and active range of motion (ROM) exercises were started immediately. The International Knee Society (IKS) knee and functional scores, postoperative knee ROMs, and time of bone union were used as outcome measurements. Postoperative knee ROMs was compared with the contralateral healthy knee. The mean follow-up time was 29 months (26 − 41 months). At the final review, no significant difference (p = 0.159) was found between the ROM of healthy side and operated side of patients (153.1 ± 4.6 and 150 ± 3.8). The mean IKS knee and functional scores at 12 months were 87.2 ± 5.8 and 96.8 ± 3.7, respectively. Union was achieved in all patients at a mean duration of 3.8 months. Fracture side had no influence on the IKS knee scores, functional scores, and ROM (p = 0.846, p = 0.913, and p = 0.374, respectively). Concomitant intra-articular lesions identified in two patients (%25) during arthroscopy were one anterior cruciate ligament rupture and one medial meniscus tear. Patients undergoing arthroscopic Hoffa fracture fixation have excellent outcomes at average 29 months postoperatively with no apparent complications and no significant loss of ROM. Also 25% of patients had intra-articular injuries that were identified with arthroscopic technique that may have been missed with the open technique. The level of evidence was Level 4 (case series).

Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes.