Intra-Observational and Inter-Observer Agreement of The Radiographic Humerus Union Measurement (RHUM) in Patients Treated with Dynamic Compression Plate for Humeral Shaft Nonunion

BACKGROUND

It is important for orthopedic surgeons to follow the union of the fracture after surgery. This becomes even more important after nonunion surgery. The radiological union scale is popular in the follow-up of unions. However, the intraobserver and interobserver agreement of this scale in humeral nonunion surgery is still not found in the literature.

OBJECTIVE

This study aimed to reveal the intra/interobserver agreement of the Radiographic Union scale (RHUM) for the humerus as well as the relationship between this agreement, plate placement characteristics, and the number of plates in cases where plates were used for surgical treatment of humeral diaphysis nonunion.

MATERIALS AND METHODS

Twenty patients who received surgical treatment for aseptic humeral nonunion at our hospital between 2010-2019 were studied retrospectively. According to RHUM, two observers scored the patients' anteroposterior and lateral radiographs in the postoperative 12th week. The data obtained were statistically analyzed.

RESULTS

The mean age was 52.05±15.88 years. While a single plate was used in 14 cases, a double plate was used in 6 cases. Interobserver agreement was fair-moderate. The interobserver agreement values of the single plate group were significantly higher than those of the double plate group (p<0.05). Interobserver agreement in cases with a lateral plate was significantly higher than in the group where the lateral + posterior plate was applied (p:0.01).

CONCLUSION

In humeral diaphyseal fracture nonunion cases, the number and location of the plate following surgery negatively impact the evaluation of RHUM scores. Given the importance of the union's follow-up and the decision to proceed with additional treatment in these cases, it may be necessary to develop a new method for determining and monitoring the union if a plate was used in the surgical treatment of humeral nonunion.

An uncommon injury: Motorcycle chain injury of the hand, its socioeconomic outcome, and prevention

INTRODUCTION

The aim of the study was to define the characteristics of motorcycle chain injuries leading to serious limb loss, evaluating its socioeconomic outcome.

HYPOTHESIS

The severity of injury with motorcycle chain is associated with hospitalization day and morbidity.

MATERIAL AND METHODS

Total of 3486 patients applied to the two Centers of the Hand Surgery Clinic and 42 of them with injuries originating from squeezed hands between the motorcycle chain and the rear sprocket were included. Injured extremities were evaluated with the MHISS. In the retrospective analyses, patients were divided into groups according to the severity of injury and compared and patients who underwent replantation, flap and primary repair treatment protocols were also compared.

RESULTS

The number of patients with dominant hand injuries was 33 patients (78.5%). Inquiry of education level revealed that 24 (57.1%) patients graduated from primary school. According to MHISS, 76.2% of patients had major and severe injuries (mean: 95.05). Mean hospitalization time was 2.83 (range: 1-8) days. Mean time to returning to work was 2.71 (range: 1-5) months. The hospitalization days and return to work were longer in patients have major injury according to MHISS (p=0.006). The necrosis was observed three of the 9 (33.3%) replanted fingers. Flap necrosis was observed in two of the 15 (13.3%) cases.

DISCUSSIONS

Most of these injuries are severe and major according to MHISS. As the severity of the injury increases, the duration of hospital stay and the return to work are prolonged.

LEVEL OF EVIDENCE

IV; Economic/Decision Analysis.

The Healing Effect Of Digoxin On Peripheral Nerve Damage and Its Relation to IL-17/IL-10

AIM

Peripheral nerve damage mainly develops after mechanical trauma, and microenvironment impairment after damage delays the healing process. Additionally, digoxin is a glycoside with proven anti-inflammatory activity. Thus, this study aimed to demonstrate the curative effect of digoxin on peripheral nerve damage with its anti-inflammatory role on interleukin (IL)-17.

MATERIAL AND METHODS

The study was conducted with 30 male Sprague Dawley albino mature rats, of which 10 formed the control group, 10 were surgically treated and administered saline (group S), and another 10 were surgically treated and administered digoxin (group D). Motor functions and immunohistochemical and biochemical variables of the rats were assessed after therapy.

RESULTS

The amplitude of the inclined plane test scores and the compound muscle action potential levels were greater in group D than in group S. Likewise, there were higher nerve growth factor percentages, higher axon counts, and lower fibrosis score percentages in group D than is group S. Lastly, lower tissue malondialdehyde and plasma IL-17 levels were determined in group D, while the IL-10 level was higher.

CONCLUSION

Digoxin contributes to nerve healing and neuroprotective effect by demonstrating its anti-inflammatory effect on IL-17. It can be considered an adjunctive therapy for peripheral nerve injury.

Ulnar Nerve Deficit Case Series in Pediatric Midshaft Forearm Fractures: Four Cases with Nerve Entrapment in Callus Tissue

Purpose: Ulnar nerve palsy is a rare condition in children with closed fractures of the forearm. In the present study, we aimed to analyze 4 pediatric cases who underwent closed reduction and casting due to forearm mid-shaft fracture and then underwent surgical treatment for neurological deficit due to ulnar nerve entrapment in callus tissue. Methods: The files of 4 pediatric cases (3 male-1 female) who were diagnosed with forearm double fracture and underwent surgery for ulnar nerve deficit between 2013 and 2020 were reviewed retrospectively. Results: Nerve auto-graft was required in one patient (Case 1) who underwent late exploration, and end-to-end anastomosis was required in one patient (case 2). There was sensory recovery at the 8th week post anastomosis. However the two point discrimination recovery was not full. Partial motor recovery occurred in the 16th week. Pinch and grip strengths and low motor amplitude were still partially defective at 36 weeks. Conclusion: Albeit rare, ulnar nerve injuries associated with mid-shaft forearm fractures of both the radius and ulna exist and can result in debilitating morbidity if not detected in a timely manner. For this reason, early diagnosis and early surgical exploration are important. Routine neurological examination and USG in case of doubt may be beneficial in early diagnosis.

Is Hydatid Cyst with Musculoskeletal Involvement a Problem that Causes Morbidity? Long-Term Follow-Up and Functional Results

BACKGROUND

The aim of study is to evaluate the involvement characteristics of hydatid cysts, which are rarely involved the musculoskeletal system, and the results of recurrence, morbidity, and functional and mental scoring.

METHODS

We retrospectively investigated 18 patients with skeletal hydatid disease. Patients were categorized as those with bone or skeletal muscle involvement. Pre- and post-operative physical component scores (PCS) and mental component scores (MCS) on the functional Short Form 12-item Survey were recorded in these patients.We compared the functional scores, number of recurrences, and lesion volumes between patients with hydatid cyst of bone (HCOB) and those with hydatid cyst of soft tissue (HCOST).

RESULTS

This study included 11 women and 7 men with bone hydatid cysts. Patients' mean age was 38 years (range 22-70 years). Patients were followed up for a mean of 118.16 months (range 49-230 months). The mean lesion volume was 447.39 cm³ (36-1260 cm³). The 12th and 48th month PCS, the PCS was lower in the HCOB group during both periods (p = 0.04 and p = 0.001, respectively). The 48th month MCS was lower in the HCOB group (p = 0.04). Postoperative residual cysts were detected in five patients who underwent surgical treatment for bone c; all residual lesions were located in the pelvis.

CONCLUSIONS

Bone hydatid cysts are associated with high recurrence rates, and treatment is challenging. In view of the low functional results and high infection and recurrence rates observed in patients over long-term follow-up, particularly in those with pelvic hydatid cysts, we conclude that this disease is associated with significant morbidity.

Dexpanthenol reduces fibrosis and aids repair following nerve laceration and neurorrhaphy

The aim of the present study was to investigate the effect of dexpanthenol on nerve healing following neurorrhaphy in lacerated peripheral nerves. A total of 30 mature Sprague Dawley rats were used. Surgical sciatic nerve dissection and repair was performed on an experimental group of 20 rats. The remaining 10 rats were designated as the control group. The experimental group was divided into 2 subgroups. The surgery + saline group (SSLE; n=10) was given 1 ml/kg 0.9% sodium chloride saline intraperitoneally. The surgery + dexpanthenol group (SDPL; n=10) rats were given 500 mg/kg/day dexpanthenol intraperitoneally. Histological evaluation of the sciatic nerve tissue revealed that the fibrosis score was significantly lower in the SDPL group than in the SSLE group (P<0.001). Electrophysiological evaluation of compound muscle action potential (CMAP) indicated that the CMAP level in the SDPL group was significantly higher than that of the SSLE group (P<0.001), and the CMAP latency period was lower in the SDPL group compared with the SSLE group (P<0.001). In addition, the SDPL group malondialdehyde level was significantly lower than that of the SSLE group (P<0.001). Functional evaluation with an inclined plane test revealed a significant difference between the SSLE (39.6±5.5^˚) and SDPL (79.1±6.93^˚) groups (P<0.001). Dexpanthenol was observed to have a positive effect on nerve tissue repaired with neurorrhaphy in a rat sciatic model of laceration-type injuries similar to those frequently encountered in the clinic.

Effects of trimetazidine on nerve regeneration in a rat sciatic nerve injury model

AIM

The aim of this study was to evaluate the efficacy of trimetazidine(TMZ) after end-to-end repair in a peripheral nerve injury model.

METHOD

We performed end-to-end primary repair of sciatic nerves in rats and showed TMZ's regenerative effect. For this objective 30 male Sprague Dawley albino rats were used. Surgery+water group, rats were assigned to a placebo group and were given water by oral gavage. Surgery+TMZ group, rats were given trimetazidine by oral gavage. All medications were given for 12 weeks. Motor function test was performed. Afterwards, electromyography (EMG) recording was done. Finally, blood samples were taken, the animals were euthanized andsciatic nerve was removed.

RESULTS

The amplitudes of compound muscle action potential (CMAP) increased significantly in the Surgery+TMZ group when compared with the group that have been given Surgery+Water. Nerve growth factor (NGF) immunoexpression in the Schwann cell was significantly increased in the Surgery+TMZ group compared with the Surgery+Water group. Moreover, fibrosis score was reduced in the Surgery+TMZ group compared to the Surgery+Water group.CONCLUSİONS: In conclusion, we demonstrated the superiority of TMZ on nerve healing in our experimental study which was evaluated with comparative groups (Tab. 3, Fig. 2, Ref. 31).

A survey of distribution of terrestrial radionuclides in surface soil samples in and around the Osmaniyeprovince, Turkey

The purpose of this survey was to determine the distribution of terrestrial radionuclides ((238)U, (232)Th and (40)K) in surface soil samples collected from different locations in and around Osmaniye and assess the radiological implications of outdoor external exposure. The activity concentrations of (238)U, (232)Th and (40)K in soil samples ranged from 2.6 to 38.1 Bq kg(-1) with a mean of 10.4±0.7 Bq kg(-1), 3.7-40.5 Bq kg(-1) with a mean of 12.2±0.7 Bq kg(-1) and 30.0-639.7 Bq kg(-1) with a mean of 243.4±12.8 Bq kg(-1), respectively. The concentrations of these radionuclides, presented in this article, were compared with those obtained from similar studies related to Turkey reported in the literature as well as earth's crust average values. The results of the activity concentrations were used to assess the external absorbed gamma dose rate (GDR) in outdoor air and the annual effective dose (AED). The outdoor absorbed GDRs fluctuate from 5.2 to 53.6 nGy h(-1) with a mean of 22.4±9.5. The corresponding mean AED is found to be 0.03 mSv.

Natural and anthropogenic radionuclides in the granitic region of Kapidag peninsula, Western Anatolia, Turkey

Naturally occurring radionuclides of terrestrial origin (also called primordial radionuclides) are present in various degrees in all media in the environment. This study represents the reports on the natural and anthropogenic radionuclides in the Kapidag granitic region. For this purpose, activities of radionuclides in soil, beach sands and rocks of the region have been investigated to assess the radiological hazard of the natural radioactivity. The radium equivalent activities, the absorbed dose rates and the external hazard indexes have been calculated, and also in situ gamma dose rates have been measured in the region. The mean activities of (238)U, (232)Th and (40)K with the ranges were determined as 31.1±15.7 (12.1-71.9), 42.5±15.9 (19.7-94.9), 590.3±192.2 (184.7-892.5), in the soil, as 16.5±9.5 (4.9-40.8), 67.1±106.9 (18.5-433.0), 569.2±212.6 (162.0-821.1) in the sand and as 25.4±12.8 (4.8-50.7), 37.8±21.5 (4.5-96.7), and 592.4±285.5 (62.4-1121.6) Bq kg(-1) in the rocks, respectively. It was also observed that the average activities of (137)Cs were ranged 0-27.8 Bq kg(-1) in the soil and 0.6-3.8 Bq kg(-1) in the beach sands. The mean Ra(eq) activities of the rocks, sands and soil were found to be 125.1±59.5, 156.3±157.2 and 137.3±48.8 Bq kg(-1), respectively, lower than the recommended maximum value of 370 Bq kg(-1) with some exceptions. The maximum contributors to the total absorbed gamma dose rates in air were determined as (238)U (45%) for the beach sands, (238)U (40%) for the soil and (40)K (41%) for rocks. The average outdoor gamma dose rates for the soil due to terrestrial and cosmic radiations were found to be 64.6±22.7 and 47.1±9.6 nGy h(-1), respectively, with the total of 111.7±29.5 nGy h(-1) outdoor gamma exposure rate and the annual average effective outdoor gamma dose was calculated as 137±36.2 µSv for the region. The results of the study were discussed with similar studies in close regions and the worldwide averages.

Outdoor radioactivity and health risks in Balikesir, northwestern Turkey

External irradiation from radionuclides naturally present in the environment or released from man-made practices or events is usually an important component of the exposure of human populations. These exposures derive primarily from gamma radiation arising from the decay of these radionuclides at locations outside the human body. The main objective of this study is to evaluate the radioactivity levels and health risks due to terrestrial radionuclides in the soil of Balikesir, one of the largest cities of the country, northwestern Turkey. For this purpose, activity concentrations of radionuclides in soil and outdoor gamma dose rates (terrestrial and cosmic) have been investigated in the city of Balikesir. In addition, maps for the radionuclide activity concentrations of soil and the outdoor gamma dose rate distributions have been plotted for the region. The average activities of radionuclides, (238)U, (232)Th, (40)K, (235)U and (137)Cs in the soil were determined to be 37.6 ± 10.8, 54.7 ± 15.1, 674.5 ± 203.2, 3.6 ± 1.6, 3.4 ± 2.2 Bq kg(-1), respectively, in the region. The average outdoor gamma dose rates due to terrestrial and cosmic radiations were found to be 78.5 ± 12.4 and 48.9 ± 5.8 nGy h(-1) with the total of 127.4 ± 18.9 nGy h(-1) in the region. Annual effective dose due to environmental outdoor gamma radiation exposures was determined to be 156.3 nSv. The mean estimated cancer risk values were found to be 0.063 × 10(-2) for the region using risk factors of ICRP 103. The results of the study were discussed with the studies done in other cities of Turkey and the worldwide averages.

Radionuclide concentrations in soil and lifetime cancer risk due to gamma radioactivity in Kirklareli, Turkey

The objective of this study is to evaluate and map soil radionuclides' activity concentrations and environmental outdoor gamma dose rates (terrestrial and cosmic) in Kirklareli, Turkey. The excess lifetime cancer risks are also calculated. Outdoor gamma dose rates were determined in 230 sampling stations and soil samples were taken from 177 locations. The coordinates of the readings were determined by the Global Positioning System (GPS). The outdoor gamma dose rates were determined by Eberline smart portable device (ESP-2) and measurements were taken in air for two minutes at 1m from the ground. The average outdoor gamma dose rate was 118+/-34nGyh(-1). Annual effective gamma dose of Kirklareli was 144microSv and the excess lifetime cancer risk of 5.0x10(-4). Soil samples were analyzed by gamma spectroscopy. The average 226Ra, 238U, 232Th, 137Cs, and 40K activities were 37+/-18Bqkg(-1), 28+/-13Bqkg(-1), 40+/-18Bqkg(-1), 8+/-5Bqkg(-1) and 667+/-281Bqkg(-1), respectively. The average soil radionuclides' concentrations of Kirklareli were within the worldwide range although some extreme values had been determined. Annual effective gamma doses and the excess lifetime risks of cancer were higher than the world's average.

Radioactivity concentrations and dose assessment for soil samples around Adana, Turkey

The concentrations of natural radionuclides in surface soils around Adana, Turkey were determined using gamma ray spectrometry with an HPGe detector. The natural gamma ray radioactivity of the terrestrial radionuclides in air was calculated throughout different areas of Adana. The average activity concentrations of (238)U, (232)Th and (40)K were found to be 17.6, 21.1 and 297.5 Bq kg(-1), respectively. Outdoor gamma dose measurements in air 1m above ground level were determined by using a portable gamma scintillation detector. The gamma dose measurements in air were taken from the same places where soil samples were taken. Average outdoor gamma dose rates in sample stations were determined as 67 nGy h(-1). The annual effective dose to the public was found to be 82 microSv.

Determination of radioactivity levels and hazards of soil and sediment samples in Fırtına Valley (Rize, Turkey)

The natural radioactivity levels in soil and sediment samples of Firtina Valley have been determined. To our knowledge, there seems to be no information about radioactivity level in the Firtina Valley soils and sediments so far. For this reason, soil and sediment samples were collected along the Firtina Valley and analysis on the collected samples were carried out to determine 238U, 232Th, 40K and 137Cs radioisotopes using high purity germanium detector. The activity concentrations obtained for 226Ra, 214Pb, 214Bi, 228Ac, 208Tl, 40K and 137Cs are given in the unit of Bq/kg. The results have been compared with other radioactivity measurements in different country's soils and sediments. The radium equivalent activity (Raeq), the absorbed dose rate (D), the external hazard index (Hex), the annual gonadal dose equivalent (AGDE) and the annual effective dose equivalent (AEDE) were also calculated and compared with the international recommended values.

Natural and anthropogenic radionuclides in rocks and beach sands from Ezine region (Çanakkale), Western Anatolia, Turkey

This paper represents the first reports on the natural and anthropogenic radionuclides in Kestanbol granitic pluton and surrounding rocks, and coastal region of the Ezine town. To assess the radiological hazard of the natural radioactivity, the radium equivalent activity, the absorbed dose rate and the external hazard index were calculated, and in situ gamma dose rates were measured. The high-activity concentrations were measured in the pluton and sands, which was originated mainly from the pluton, due to the presence of zircon, allanite, monazite, thorite, uranothorite and apatite. The average activity concentrations of (238)U, (232)Th and (40)K are 174.78, 204.69 and 1171.95 Bq kg(-1) for pluton, and 290.36, 532.04 and 1160.75 Bq kg(-1) for sands, respectively. (137)Cs in Ezine region ranged from 0-6.57 Bq kg(-1). The average absorbed dose rate for the granitic and sand samples were calculated to be 251.6 and 527.92 nGy h(-1), respectively. The maximum contribution to the total absorbed gamma dose rate in air was due to the (232)Th (52.3% for pluton and 67.1% for sands). The Raeq activities of the pluton and sands are higher than the recommended maximum value of 370 Bq kg(-1) criterion limit of Raeq activity for building materials.

Gross alpha and beta activities in tap waters in Eastern Black Sea region of Turkey

Gross alpha and gross beta activities were determined for 27 different tap water samples collected from Eastern Black Sea region of Turkey. The instrumentation used to count the gross alpha and gross beta activities was a alpha/beta counter of the low background multiple detector type with 10 sample detectors (Berthold LB770). The obtained results showed that natural activity concentrations of alpha- and beta-emitting radionuclides in tap water samples did not exceed WHO and ITS recommended levels. Concentrations ranging from 0.2 mBq/l to 15 mBq/l and from 25.2 mBq/l to 264.4 mBq/l were observed for the gross alpha and gross beta activities, respectively. For all samples the gross beta activities were higher than the corresponding gross alpha activities.

Natural radioactivity in tap waters of Eastern Black Sea region of Turkey

In this study, the activity concentrations of some radionuclides in tap water samples of the Eastern Black Sea region of Turkey were measured. The activity concentrations of radionuclides (214)Pb, (214)Bi, (40)K, (226)Ra and (137)Cs were determined using high resolution gamma ray spectrometry. Furthermore, (222)Rn activity concentrations in tap water samples were measured using Liquid Scintillation Counting. The mean specific activities of (214)Pb, (214)Bi, (226)Ra, (40)K, (137)Cs and (222)Rn in tap water samples were 6.73, 6, 19.16, 168.57, 5.45 mBq l(-1) and 10.82 Bq l(-1), respectively. These values are comparable with concentrations reported for other countries. The effective doses were determined due to intake of these radionuclides as a consequence of direct consumption of tap water samples. The estimated effective doses were 6.878 x 10(-4) microSv y(-1) for (214)Pb, 4.800 x 10(-4) microSv y(-1) for (214)Bi, 3.916 microSv y(-1) for (226)Ra, 0.763 microSv y(-1) for (40)K, 0.052 microSv y(-1) for (137)Cs and 5.848 microSv y(-1) for (222)Rn.

Natural radioactivity levels in granitic plutons and groundwaters in Southeast part of Eskisehir, Turkey

The present work investigated the radioactivity level of the granitoid plutons and its effect on the groundwaters in the southeast part of Eskisehir. Fourteen granitic samples from the Kaymaz and Sivrihisar plutons and 11 groundwater samples from the near vicinity of the pluton were analyzed. The activity concentrations measured for (238)U and (232)Th ranged from 43.59+/-2 to 651.80+/-24 Bq/kg, and 51.16+/-3 to 351.94+/-13 Bq/kg, respectively. The activity concentrations obtained for (40)K varied from 418.50+/-17 to 1618.03+/-66 Bq/kg. The absorbed dose rates in air outdoors ranged from 87.14 to 531.81 nGy/h. All the results obtained from the Kaymaz pluton are higher than those from the Sivrihisar. The U (ave. 16.6 ppm) and Th (ave. 49.9 ppm) values of the Kaymaz pluton are higher than the average concentrations of the magmatic rocks of granitic composition. These results are consistent with high dose rates of the pluton. The gross-alpha activities in the groundwater samples ranged from 0.009 to 1.64 Bq/l and the gross-beta activities from 0.006 to 0.89 Bq/l. The highest gross-alpha value was found in the sample taken from near the Kaymaz pluton. The concentrations of (222)Rn varied from 0.060 to 0.557 Bq/l.