To evaluate the radiological and clinical outcomes in two patient groups: first, varus aligned medial meniscus posterior root tear (MMPRT) patients who underwent posteromedial open wedge high tibial osteotomy (PMOWHTO) and simultaneous root repair; second, patients with varus medial knee osteoarthritis without MMPRT who underwent PMOWHTO. Patients had MMPRT repair concomitant with PMOWHTO and varus medial knee osteoarthritis without concomitant root tear patients who underwent PMOWHTO and were reviewed. Radiographic parameters, medial meniscus extrusion (MME) and Knee Society Scores [KSSs, including the following subscores: knee score (KS) and knee function score (KFS)] were evaluated. Continious variables are expressed as the median and interquartile range (IQR) [IQR: (Q1;Q3); Q1: median of lower half, Q3: median of upper half]. The minimum follow-up period was 24 months [29 (28;35) months]. A total of 36 knees of 34 patients underwent PMOWHTO were included. Patients were divided into two groups according to the presence or absence of a MMPRT. Nineteen of the 36 knees had MMPRTs, and all of them had concomitant root repair (Group 1). Seventeen of the 36 patients did not have MMPRTs (Group 2). The posterior tibial slope (PTS) decreased postoperatively in a total of 36 knees (p < 0.001). There were no significant changes in MME postoperatively in any intragroup comparison. The preoperative and follow-up MMEs of Group 1 were greater than those of Group 2 (p < 0.001). The KSs and KFSs in both Group 1 and Group 2 increased during follow-up [KS; Group 1: 43 (36;53) vs. 86 (84;95), p < 0.001. Group 2: 49 (45;57) vs. 89 (80;93), p < 0.001. KFS; Group 1: 60 (50;60) vs. 90 (80;100), p < 0.001. Group 2: 60 (50;60) vs. 80 (80;90), p < 0.001]. All knees achieved minimal clinically important difference (MCID) in terms of KSs. Eighteen (95

A 63 -year old male was brought to the geriatric outpatient unit by his wife with a complaint of progressive loss of movement skill and intellectual capacity over the last 3 years. He was a farmer and began to have difficulties in multilevel tasks. Sleeping problems started to occur. Also, he was agitated most of the time and even used violence against his wife. At presentation to the geriatric outpatient unit, he was in a wheelchair and dependent on his wife during all daily living activities. He was bedridden and incontinent. He had muscle stiffness. He had 14 points on the Glasgow Coma scale. His eyes were open spontaneously but did not obey commands. Cranial nerve reflexes were intact. His neurological examination did not reveal any specific findings for a previous stroke or meningitis. A cranial magnetic resonance imaging scan revealed an atrophic cortex of the cerebrum with ischemic gliosis fields in the periventricular white matter. In the light of all findings, major neurocognitive disorder with Lewy body diagnosis was made according to the diagnostic and statistical manual of mental disorders -5 diagnostic criteria. Dementia related to Parkinson's disease (PD) and supranuclear palsy were other relevant diseases for differential diagnosis. In this case, the movement disorder developed after psychotic symptoms and memory impairment. This is contrary to dementia related to PD. At presentation, cranial nerve examination was normal, unlike supranuclear palsy in this case. Rivastigmine 10 cm 2 transdermal patch once a day and levadopa-benserazid 50-12.5 mg three times a day prescribed.

Inroduction: In the treatment of medial gonarthrosis, the high tibial osteotomy (HTO) is recognized as an effective joint-sparing surgical procedure. Severe valgus deformity is not a common complication after HTO. There are no cases in the literature reporting valgus deformity of 10° or more after HTO. Case Report: An open-wedge HTO was performed on a 57-year-old female patient due to left knee pain and varus deformity. In this case, a progressive and severe valgus deformity occurred during follow-up. The severe valgus deformity was then corrected using an inverted V-shaped (hemi-closing, hemi-opening) HTO. Conclusion: Valgus deformity after HTO is not common. There are various factors that can lead to post-HTO valgus deformity; although no cases of valgus deformity exceeding 10° have been described. Intra-operative releasing of the superficial medial collateral ligament and associated lateral hinge fracture was a risk factor for overcorrection. This case aims to uncover the factors contributing to the development of severe valgus deformity subsequent to HTO and to present solutions for its management. Keywords: Case report, high tibial osteotomy, valgus deformity, biplanar osteotomy.

Purpose We aimed to evaluate frequency and risk factors of re-hospitalization which are not stated in comorbidity indexes in geriatric wards. Methods A total of 585 patients who were admitted to tertiary care geriatric inpatient clinics at least once between 1 September 2017 and 1 September 2018 and who survived to discharge during initial hospitalization were included in this cross-sectional retrospective multicenter study. Results Overall, 507(86.7%) patients were hospitalized once for treatment during the study period, while re-hospitalization occurred in 78(13.3%) patients. Rates of previous surgery (10.3 vs. 3.0%, p = .006), urinary incontinence (UI) (50.0 vs. 36.3%, p = .021), controlled hypertension (64.1 vs. 46.4%, p = .024), malnutrition (55.1 vs. 29.6%, p = .014) were significantly higher in re-hospitalized patients. Re-hospitalized patients were younger (mean +/- SD 76.4 +/- 8.3 vs. 79.6 +/- 7.9 years, p = .002) than once-hospitalized patients. Multivariate logistic regression analysis revealed the younger patient age (OR, 0.942, 95% CI 0.910 to 0.976, p = .001), higher Modified Charlson Comorbidity Index (MCCI) score (OR, 1.368, 95% CI 1.170 to 1.600, p < .001) to significantly predict the increased risk of re-hospitalization. Conclusions Our findings showed that previous history of surgery and geriatric syndromes such as UI, malnutrition were determined to significantly predict the increased risk of re-hospitalization. We suggest that these risk factors be added to prognostic tools designed for elderly patients.

Introduction: Polypharmacy can lead to drug-drug interactions. The aim of this study was to determine the possible factors affecting the prevalence and clinical importance, and interrater reliability of clinical significance of drug interactions in geriatric outpatients. Materials and Method: Potential drug-drug interactions in 228 patients treated in an outpatient geriatric clinic were evaluated in this cross-sectional, retrospective study. The potential significance of the interactions was reviewed separately by a geriatrician and a clinical pharmacist. Results: A total of 1342 drugs were prescribed (median 6 [2-14], per patient). Mean age of the patients was 78±0.5 (65-96). Polypharmacy was present in 64.0% of the patients. A weak positive correlation was found between patient age and the number of drugs used (Rs =.205; p=.002). No drug interaction was detected in 18.0% of the patients. In the prescriptions of the remaining 187 patients 760 category C, 70 category D, and 18 category X interactions (Lexicomp®) were detected. A strong positive correlation was found between the number of drugs per patient and the number of drug interactions (Rs =.734; p<.001). There was a strong correlation between the number of interactions and the presence of polypharmacy (rpb=.702, p<.001). The measure of agreement between the clinicians was more pronounced for category D and X interactions (Cohen’s k=.714 and 1, p<.001). Conclusion: Advanced age, a higher frequency of concomitant use of drugs, and polypharmacy are factors that require clinicians to be aware of drug-drug interactions. Clinical pharmacists can work with geriatricians in outpatient clinics to prevent drug interactions. Keywords: Drug Interactions; Polypharmacy; Health Services for the Aged; Pharmacist.

INTRODUCTION:Patellar tendon ossification is a rare complication that primarily occurs following a knee injury. This article aims to describe, for the first time, a case of patellar tendon ossification following synovectomy.CASE PRESENTATION:A 48-year-old male with a diagnosis of rheumatoid arthritis presented with swelling in his left knee following a synovectomy procedure. After a thorough physical examination, radiographic assessment, and computed tomography, the patient was diagnosed with total patellar tendon ossification. Subsequently, the patient underwent excision of the ossified mass and tendon reconstruction using an Achilles allograft.DISCUSSION:The primary causes of patellar tendon ossification are iatrogenic and traumatic injuries. The presence of rheumatoid arthritis, which negatively affects tissue healing, may exacerbate this condition. Smaller lesions can be managed conservatively or through resection and repair. In cases of extensive ossification, resection and reconstruction are necessary. A comprehensive literature review is also provided.CONCLUSION:The occurrence of patellar tendon swelling following trauma or surgery should raise suspicion of patellar tendon ossification. Rheumatoid arthritis is a risk factor for the development of patellar tendon ossification. In cases of extensive ossification, successful treatment can be achieved through reconstruction using an Achilles allograft.

Denosumab is a relatively new medicine that has become the second option in the treatment of biphosphonate-resistant or intolerant osteoporosis. Subcutaneous injection with 6-month intervals, approval of its usage in stage 3-4 CKD and not having gastrointestinal side effects are advantages of denosumab. However, it has some disadvantages like requiring monitoring serum levels of calcium and vitamin D before each injection.

Background:Talus osteoid osteomas are often overlooked. This pathology, which can cause chronic ankle pain, should be kept in mind when evaluating differential diagnoses.Case Report:A 21-year-old female applied to our clinic with chronic ankle pain diagnosed as talus OCD. The patient's pain was refractory to non-operative treatments. The detection of talar osteoid osteoma is delayed due to atypical radiologic findings and coexistent osteochondral lesion of talus. The patient is treated with ankle arthroscopy with excellent results.Conclusion:Chronic ankle pain causes severe functional limitations. Dealing with such cases especially in the young population, one should consider that atypical radiologic signs could have further meaning. When radiology fails to describe the lesion, ankle arthroscopy could be a good option, both for diagnosis and treatment.

Background The use of potentially inappropriate medications (PIM) has become more common among nursing home residents (NHR). This study focused on drugs initially prescribed as pro re nata (PRN) medications and pill burden in association with PIM among NHR. Methods This observational cross-sectional study was conducted between March and April 2019 on 225 adult NHR aged ≥60 years. Results The prevalence of PIM was 47.6% among NHR according to the Screening Tool of Older Persons' Prescriptions (STOPP) criteria version 2. The most frequent PIM was the use of any drug prescribed without evidence-based clinical indication; most medication errors were associated with PRN medications. The prevalence rates of PRN in non-PIM and PIM users were 12% and 62.4%, respectively. PRN medications that most commonly caused PIM were non-steroidal anti-inflammatory drugs and proton pump inhibitors. The cut-off value for both medications and pills to correctly identify participants with PIM was 5.5. Pill burden had a similar sensitivity to polypharmacy in identifying individuals with PIM. Conclusion Medication errors associated with PRN medications were overlooked as factors that increased the risk of PIMs. The most common error related to PRN medications was the continued daily use despite symptom resolution.

Objective: Our aim is to determine the prevalence of polypharmacy and the relationship between polypharmacy and geriatric syndromes as well as comorbidity in older nursing home residents (NHR). Materials and Methods: This observational and cross-sectional study was conducted with 217 adults >= 60 years of age who had Katz index of Independence in activities of daily living score over 4 points and were institutionalized at nursing care home from March to April 2019. Polypharmacy was defined as the daily use of 5 or more medications. Geriatric syndromes include dementia, depression, urinary incontinence (UI), malnutrition, falls, mobility problems, hearing loss, vision impairment.Results: The prevalence of polypharmacy among NHR was 61.8%. By univariate analysis, polypharmacy was associated with chronic diseases such as heart disease, chronic obstructive pulmonary disease (COPD) and diabetes mellitus, and with geriatric syndromes such as dementia, depression, UI, and mobility problems (p<0.05). In the multivariate analyses, depression [odds ratio (OR) =9.57; 95% confidence interval (CI), 2.73-33.60] and mobility problems (OR= 4.88; 95% CI, 1.80-13.25) increased polypharmacy by 9.6 and 4.9-fold respectively.Conclusion: Comorbidity and geriatric syndromes play an important role in the development of polypharmacy. Monitoring polypharmacy is often necessary as well as giving complex medication regimens for NHR.

Abstract The adult joint cartilage has limited regeneration capacity. The balance between synthesis and degradation can be determined by the measurement of matrix proteins in the synovial fluids. In this study, the detrimental effects of different knee pathologies were investigated by measuring the proteoglycans degradation products in synovial fluids. Eighty six patients with unilateral knee pathologies were included in the study and classified as follow; meniscal lesion (Group I, n=36), chronic ACL and meniscal lesion (Goup II, n=15), isolated subacute chronic ACL lesion (group III, n=8), patellar pain (Group IV, n=14), gonarthrosis (Group V, n=13), normal control (NC, n=9). The level of proteoglycan degradation products in pathological knees was significantly higher than those in the normal knees. Group II had statistically significantly higher values than group I (p<0.05). These data show that the cartilage matrix turnover is strongly effected by the internal derangement of the knee joint. Long-term monitorization is needed to clarify whether the imbalance of cartilage matrix turnover can eventually cause the osteoarthritis. Özet Erişkin eklem kıkırdağı sınırlı onarılma yeteneğine sahiptir. Yapım ve yıkımdaki denge matriks proteinlerinin eklem sıvısından ölçümleriyle ortaya konabilmektedir. Bu çalışmada oldukça sık karşılaşılan değişik diz eklemi patolojilerinin eklem kıkırdağı üzerine olan yıkıcı etkileri eklem sıvısından proteoglikan yıkılım ürünleri ölçülerek araştırıldı. Menisküs lezyonlu 36 olgu (Grup l), kronik ön çapraz bağ-menisküs lezyonu gösteren 15 olgu (Grup II), izole subakut-kronik ön çapraz bağ lezyonlu 8 olgu (Grup III), patellar ağrılı 14 olgu (Grup IV), gonartrozlu 13 olgunun (Grup V) 86 patolojik dizi çalışma kapsamına alındı. Aynı olguların 9 kontralateral normal dizi Kontrol (NK) olarak kullanıldı. Tüm patolojik olgu gruplarında yıkılım ürunlerinin düzeyi NK den anlamlı olarak yüksek bulundu. Ön çapraz bağ-menisküs grubunun değerleri izole menisküs grubundan anlamlı olarak yüksekti. Bu erken bulgular eklem için patolojilerden eklem kıkırdak turnoverinin önemli ölçüde etkilendiğini ortaya koymaktadır. Kıkırdak yapım ve yıkılımındaki bu dengesizliğin osteortroza neden olup olmayacağını ortaya koymak için uzun süreli monitorizasyona gereksinim vardır.

Abstract Although the etiology of synovial chondromatosis has not been completely clarified, it is assumed that the entity occurs as a result of metaplastic transformation of subsynovial and synovial tissue to the cartilage. The involvement of the ankle among the other joints is very rare, but the differential diagnosis of the disease chalIenges the orthopaedic surgeons, especially in the cases of Yong sportmen. In this article, the diagnosis and arthroscopic management of a case of synovial chondromatosis of ankle is presented and the diagnostic vaIue of MRI in early stage of the disease is emphasized. Özet Sinovyal kondromatozisin etiyolojisi tamamen açıklanamamakla birlikte sinovyal ve subsinovyal dokuların kıkırdak oluşumuna kadar varan metaplastik dönüşümü sonucu ortaya çıktığı düşünülmektedir. Bütün eklemIer gözönüne alındığında ayakbileği tutuluşu oldukça nadirdir. Fakat özellikle genç sporcularda hastalığın ayırıcı tanısı ortopedistler için güçlük göstermektedir. Bu yazıda bir ayak bileği sinovyal kondromatozis olgusunun tanısı ve artroskopik tedavisi anlatılırken hastalığın erken evrelerinde MRI ın tanısal değeri vurgulanmaya çalışılmaktadır.

Abstract The chronic or permanent dislocation of patella is a different entity from a congenital dislocation. Because of secondary pathological changes, both proximal and distal realignment should be carefuffy applied in reconstruction procedure. The recent clinical and Iaboratory studies have supported a functional reconstruction of medial retinaculum rather than a simple Iongitudinal plication. The purpose of this paper is to introduce a new surgical technique which we developed to reconstruct the structures of medial retinaculum more anatomically and more functionally in a case of bilateral chronic dislocation of the patella. Özet Patellanın kronik veya kalıcı çıkığı doğumsal çıkıktan ayrı bir durumdur. Sekonder patolojik değişiklikler nedeniyle proksimal ve distal realignment dikkatli bir şekilde uygulanmalıdır. Yakın zamanda yapılan klinik ve Iaboratuar çalışmaları medial retinakulumun basit Iongitudinal plikasyonundan çok fonksiyonel rekonstrüksiyonunu desteklemektedir. Bu yazının amacı bilateral kronik patella çıkığı olgusunda tarafımızdan geliştirilen ve medial retinakuler yapılan daha fonksiyonel ve anatomik olarak rekonstrükte etmeyi amaçlayan yeni cerrahi tekniği tanıtmaktır.

Freddie was definitely a legend, but he has never been inaccessible. Apart from thousands of people he treated or restored to a higher degree of sportive performance, he built countless number of personal relationships with friends, fellows, students, and people from every possible area of the community. He never ceased to connect himself to the society and made everyone feel endeared to him, as a reason why many is mourning today and not only the orthopaedic community.

Abstract Osteoarthritis, is a slowly progressive disease that is caused by an imbalance between synthesis and breakdown of cartilage matrix. Diagnosis is commonly performed clinically and radiologically during the Iate stages of disease. In both primary and secondary arthritis, the degradation products of cartilage matrix released into the synovial fluid is found elevated and can be detected using sensitive biochemical methods before the radiological findings manifest. In this paper, the matrix molecules and fragments used as the markers of cartilage turnover in the early diagnosis and monitorization of osteoarthritis will be discussed. Özet Osteoartrit, kıkırdak matrikste yapım ve yıkım olayları arasındaki dengenin bozulmasına bağlı olarak ortaya çıkan ilerleyici blr hastalık olup, günümüzde tanısı klinik ve radyolojik bulgularla ancak geç evrelerde konulabilmektedir, Primer veya sekonder osteoartritte, kıkırdak yaralanmalarına bağlı olarak eklem aralığına salınan kıkırdak yıkılım ürünleri artmakta ve bu ürünlerin biyokimyasal analizi kıkırdak hasarı hakkında bilgi vermektedir. Bu yazıda kıkırdak matriksinin turnoverini gösteren biyokimyasal markerlerin osteoartritin erken tanısında ve tedavinin izleminde kullanılabilirliği tartışılacaktır.

Aim: The annual incidence of chronic subdural hematoma is 2-4/100000 in geriatric population. We aimed to investigate relationship between potentially inappropriate medication usage according to Beers 2019 criteria, fall and Charlson comorbidity index in geriatric patients diagnosed with chronic subdural hematoma. Materials and Methods: We retrospectively collected medical records of 69 geriatric patients diagnosed with chronic subdural hematoma and hospitalized for the last 5 years in neurosurgery department of Izmir Katip Çelebi University Hospital with the permission of local ethical committee of medical faculty. Data was recorded and analyzed with appropriate method by using SPSS v18. Results: Mean age was 78.43 ± 7.51 years, mean Charlson comorbidity index was 5.87 ± 2.97. Falling events were responsible for 59 (85.5%) out of 69 chronic subdural hematoma cases. Potentially inappropriate medication usage according to Beers 2019 criteria was found in 20 (29%) patients. Inappropriate medications belonged to cardiovascular system (14.5%) class and antiplatelet/anticoagulant (14.5%) class mostly. When group was divided into two groups as patients who used potentially inappropriate medication or not, Charlson comorbidity index was found to be higher in the first group. (p 0.05). Charlson comorbidity index and number of medications showed significant correlation (p = 0.001). Conclusion: We could not reach a significant correlation between fall, Charlson comorbidity index and potentially inappropriate medication usage in our retrospective study. Small study population size, unreliable medical records and relatively healthy characteristics of population may contribute to crossing results.

BACKGROUND:The present study aimed to evaluate stress radiography and magnetic resonance imaging (MRI) findings in medial meniscus posterior root tears (MMPRTs).METHODS:The study included 27 patients (26 females, mean age, 53.52 years) who underwent high tibial osteotomy and in whom medial menisci were concurrently examined arthroscopically. Preoperative stress radiographs and MRI series in 14 cases with root tears (MMPRT group, detected arthroscopically) and in 13 cases without tears (control group) were evaluated. Joint spaces measured on the stress radiographs were compared between the operated and opposite knees in each group.RESULTS:On the varus stress radiographs, the mean lateral joint space of the operated knees was significantly wider than that of the opposite knees in the MMPRT group (P = 0.007). Upon MRI studies, meniscal extrusion was significantly more common in the MMPRT group than in the control group. Moreover, the amount of meniscal extrusion was correlated with the tear size.CONCLUSIONS:Widening of the lateral joint space on the varus stress radiography was higher in the cases with root tears. Therefore, we propose that stress radiographs can be helpful in the diagnosis of MMPRT.

To evaluate the impact of (1) different adjustments of body size, (2) regional grip strength thresholds, and (3) EWGSOP1 and EWGSOP2 algorithm on sarcopenia prevalence using regional muscle mass thresholds in a geriatric outpatient clinic specific to endocrinological problems. There was no sarcopenic patient with the height square adjusted regional muscle mass thresholds for EWGSOP1 and EWGSOP2. Sarcopenia prevalence was 11.7% with EWGSOP2, and 41.1% by the use of regional grip strength thresholds for EWGSOP2 with body mass index adjustments. The prevalence of sarcopenia varied significantly regarding the adjustment method for muscle mass in this specific patient group including normal to overweight and obese individuals, and also the regional grip strength thresholds whereas the comparison of the two criteria was not possible due to lack of sarcopenic individuals with height square adjusted regional muscle mass thresholds. The aim of this study was to determine the prevalence of sarcopenia according to different methods in older outpatients using regional threshold values of muscle mass and muscle strength. We used data from our university hospital’s geriatric outpatient clinic specific to endocrinological problems, retrospectively. Sarcopenia was defined according to European Working Group on Sarcopenia in Older People (EWGSOP)1 and EWGSOP2 criteria using regional threshold values of skeletal muscle mass (SMM) with the use of different adjustments, and also according to EWGSOP2 with regional threshold values of grip strength. Among 248 study participants, 53.6% were obese. There was no sarcopenic patient with the height square adjusted regional SMM thresholds for EWGSOP1 and EWGSOP2. Sarcopenia prevalence was 11.7% with EWGSOP2, and 41.1% by the use of regional grip strength thresholds for EWGSOP2 with body mass index adjustments for SMM. The comparison of EWGSOP1 versus EWGSOP2 was not possible due to lack of sarcopenic patients with height adjustment. The prevalence of sarcopenia varied significantly with the application of different adjustment methods for SMM, and the use of regional grip strength thresholds in the specific patient group with normal to overweight and obese individuals. The use of regional thresholds of grip strength increased the prevalence of EWGSOP2-defined sarcopenia. The impact of the adjustment methods, the characteristics of the study population, and the regional thresholds should be taken into consideration while evaluating the results of sarcopenia studies.