Analysis of predictive factors for post-traumatic osteoarthritis and poor outcomes in acetabular fractures treated surgically

OBJECTIVE

The aims of this study were (i) to assess the radiological and functional outcomes of surgically treated displaced acetabular fractures and (ii) to analyze the predictive factors of poor outcomes following surgery.

METHODS

A total of 119 patients (24 female, 95 male) who were operated between 2009 and 2019 were included in the study. The mean age was 47.5 years (range=18-61). The mean follow-up was 92.3 months (range=24-120). Failure to preserve the biological hip joint, as treated with total hip replacement or the Girdlestone procedure, was defined as a poor outcome. Patients' demographic information, comorbidities, fracture types, surgical approach, concomitant injuries, reduction quality, and complications were analyzed. Computed tomography was utilized to evaluate the fracture type and quality of reduction. Factors affecting poor outcomes were analyzed by logistic regression analysis. The modified Harris Hip Score was also used to evaluate the functional status.

RESULTS

The poor outcome rate was 10.1%. Multivariate logistic regression analysis revealed that dislocation (odds ratio: 44.87, confi- dence interval: 3.18-633.22, P=.005), wound site problems (odds ratio: 9.09, confidence interval: 1.01-81.12, P=.04), reduction quality (odds ratio: 77.88, confidence interval: 5.95-1019.07, P = .001), and diabetes (odds ratio: 7.29, confidence interval: 1.01-52.07, P = .04) were associated with poor outcomes. Eight of the 12 patients with poor outcomes had a fair Harris Hip Score, and 4 had a poor Harris Hip Score. The relationship between poor outcomes and Harris Hip Score was found to be significant (P < .001).

CONCLUSION

For a favorable functional outcome in acetabular fractures, preservation of the biological hip joint should be a top priority. The accompanying dislocation and the patient's diabetes appear to be uncontrollable factors for the poor prognosis. Good reduction qual- ity and wound infection protection are modifiable factors.

LEVEL OF EVIDENCE

Level IV, Therapeutic Study.

Prevalence of elastofibroma dorsi on CT: Is it really an uncommon entity?

Objective

The aim of this study was to determine the prevalence, demographic data of elastofibroma dorsi (ED) in adult population who had undergone chest CT examination and to discuss clinical, and radiological presentations, and treatment options of ED.

Methods

We retrospectively reviewed 4074 chest CT examinations for ED from July 2014 to April 2015. Lesion size, side, and patient demographics were analyzed for positive cases of ED. The initial radiology reports of patients with ED were also reviewed.

Results

Of the 4074 patients, 111 patients (2.73%) (77 women and 34 men; mean age: 68.2 years; range: 35–91 years) had a total of 168 ED. The females had a 1.96 -fold higher prevalence of ED than the males (OR, 1.96; 95% CI, 1.481–2.59). The mean lesion thickness was found to be significantly greater in the female patients compared with the male patients (p = 0.001). The prevalence of the disease was estimated to be 4.98 times higher in patients aged 65 years or older (CI 95%, 3.25–7.36). In 111 ED patients, the lesions were only noted in 9 patients' initial radiology report.

Conclusion

Here, we present a prevalence study with the largest population in the literature concerning ED. Our study shows that ED is not as uncommon as previously thought and should be especially suspected in females and older age groups.

Level of Evidence

Level IV, Diagnostic Study.

Evaluation of surface characteristics of rotary nickel-titanium instruments produced by different manufacturing methods

BACKGROUND

Instrument fracture is a serious concern in endodontic practice.

OBJECTIVE

The aim of this study was to investigate the surface quality of new and used rotary nickel-titanium (NiTi) instruments manufactured by the traditional grinding process and twisting methods.

MATERIALS AND METHODS

Total 16 instruments of two rotary NiTi systems were used in this study. Eight Twisted Files (TF) (SybronEndo, Orange, CA, USA) and 8 Mtwo (VDW, Munich, Germany) instruments were evaluated. New and used of 4 experimental groups were evaluated using an atomic force microscopy (AFM). New and used instruments were analyzed on 3 points along a 3 mm. section at the tip of the instrument. Quantitative measurements according to the topographical deviations were recorded. The data were statistically analyzed with paired samples t-test and independent samples t-test.

RESULTS

Mean root mean square (RMS) values for new and used TF 25.06 files were 10.70 ± 2.80 nm and 21.58 ± 6.42 nm, respectively, and the difference between them was statistically significant (P < 0.05). Mean RMS values for new and used Mtwo 25.06 files were 24.16 ± 9.30 nm and 39.15 ± 16.20 nm respectively, the difference between them also was statistically significant (P < 0.05).

CONCLUSION

According to the AFM analysis, instruments produced by twisting method (TF 25.06) had better surface quality than the instruments produced by traditional grinding process (Mtwo 25.06 files).

Evaluation of Labral Pathology and Hip Articular Cartilage in Patients with Femoroacetabular Impingement (FAI): Comparison of Multidetector CT Arthrography and MR Arthrography

Background

To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods.

Material/Methods

Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference.

Results

While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p<0.05). The same values for acetabular cartilage assessment were 89/56, 40/60, 71/71 (p>0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (κ=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (κ=0.76 for MRa and κ=0.86 for CTa)

Conclusions

Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology.

Inherited thrombophilia may be a causative factor for osteonecrosis of femoral head in male patients with developmental dysplasia of the hip: a case series

PURPOSE

The aim of this case series was to assess the effect of two common causes of inherited thrombophilia, factor V Leiden (FVL) and prothrombin mutation (PTM) on the development of osteonecrosis of the femoral head (ONFH) following the treatment of developmental dysplasia of the hip (DDH).

METHODS

FVL and PTM analysis of 58 patients (45 females and 13 males; mean age 12.2 years) with ONFH due to DDH treatment was done.

RESULTS

Rate of inherited thrombophilia (FVL plus PTM) was 15.5 %. Inherited thrombophilia was nearly four times higher in male patients than in female patients and this difference was mainly due to FVL (P < 0.05). This finding was against the common belief that, coagulation abnormalities were equally distributed across the sexes in normal population. Rates of overall inherited thrombophilia, FVL and PTM were not correlated with the type of ONFH (P > 0.05).

CONCLUSION

Hereditary thrombophilia, especially FVL, may be one of the causative factors for the development of ONFH following DDH treatment in male patients. Further prospective, controlled studies are needed to undoubtedly enlighten this issue.

Incomplete left-hand and complete right-hand pisiform and hamate coalition: multidetector computed tomography findings

Pisiform-hamate coalition is a rare form of carpal coalition. Only 14 cases of pisiform-hamate coalition have been reported in the English-language literature. We present a case of asymptomatic bilateral pisiform-hamate coalition in a 16-year-old boy. We also review the embryology, pathogenesis, and clinical features of pisiform and hamate coalition, along with the associated multidetector computed tomography findings.

Preoperative hematological assessment of pediatric patients with cerebral palsy

OBJECTIVES

Nutritional deficiencies and use of antiepileptic drugs can lead to alterations in the hematological status of children with cerebral palsy (CP), which may increase the risk of intraoperative or postoperative hematological complications. In this retrospective study, we evaluated the preoperative routine blood tests of CP patients with different levels of walking ability, who were scheduled to undergo orthopedic procedures.

METHODS

Hemoglobin level, hematocrit, red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width, white blood cell count, platelet count, prothrombin time, activated partial thromboplastin time, and plasma fibrinogen concentration were compared between 62 consecutive CP patients [28 girls, 34 boys; mean age 8.8 years (range 2-16 years)] and 130 consecutive orthopedic patients as control [64 girls, 66 boys; mean age 9.2 years (range 2-16 years)] who did not have any skeletal, cranial, thoracic, abdominal or major soft tissue injuries, or any other infectious, metabolic, hematological or malignant tumor disorders.

RESULTS

CP and control groups were similar with regard to the above-mentioned hematological parameters. In the CP group, no difference was found between Gross Motor Function Classification System for Cerebral Palsy (GMFCS) level I/II patients and GMFCS level III/IV patients in terms of these hematological parameters.

CONCLUSION

Preoperative blood tests results of pediatric CP patients, walking with or without any supportive devices and undergoing orthopedic interventions, are similar to those of other orthopedic patients. Advanced preoperative hematological tests can only be recommended for CP patients with abnormal blood test results.

Early clinical results of cementless, bipolar hemiarthroplasty in intracapsular femur neck fractures

OBJECTIVES

In this study we report our initial experience with the use of cementless, bipolar hemiarthroplasty in elderly patients with intracapsular femur neck fractures.

PATIENTS AND METHODS

We operated 67 consecutive patients (39 females, 28 males; mean age 74.4±11.0 years; range 41 to 99 years) who admitted to our clinic June 2007 and November 2009, due to intracapsular femur neck fracture and implanted cementless, rectangular, dual-taper, straight femoral stem (Zweymüller stem) with bipolar head prosthesis. All patients were allowed to full weight bearing with a walker within the first postoperative 48 hours.

RESULTS

According to the Garden's classification, there were nine type II, 53 type III and five type IV fractures. Twelve patients were lost to follow-up and 21 deceased during the postoperative follow-up period. Among 34 patients with complete follow-up, 30 were evaluated for the clinical outcome. The mean follow-up time and Harris hip score of the evaluated patients were 19.4 months and 79.4 points, respectively. It was seen that, the patient age significantly correlated with the clinical outcome and a better mean hip score was obtained in the '70 years and younger age group' (83.6 points) as compared to the 'older than 70 years age group' (75.6 points) (p=0.014). Mortality rate was found to be higher in patients older than 70 years (47% vs. 18%; p=0.036) and with displaced fractures (45% vs. 0%; p=0.018).

CONCLUSION

Zweymüller cementless bipolar hemiarthroplasty may be an alternative treatment method for intracapsular femur neck fractures especially in the patients under the age of 70 years.

Observations of Earth space by self-powered stations in Antarctica

Coupling of the solar wind to the Earth magnetosphere/ionosphere is primarily through the high latitude regions, and there are distinct advantages in making remote sensing observations of these regions with a network of ground-based observatories over other techniques. The Antarctic continent is ideally situated for such a network, especially for optical studies, because the larger offset between geographic and geomagnetic poles in the south enables optical observations at a larger range of magnetic latitudes during the winter darkness. The greatest challenge for such ground-based observations is the generation of power and heat for a sizable ground station that can accommodate an optical imaging instrument. Under the sponsorship of the National Science Foundation, we have developed suitable automatic observing platforms, the Automatic Geophysical Observatories (AGOs) for a network of six autonomous stations on the Antarctic plateau. Each station housed a suite of science instruments including a dual wavelength intensified all-sky camera that records the auroral activity, an imaging riometer, fluxgate and search-coil magnetometers, and ELF/VLF and LM/MF/HF receivers. Originally these stations were powered by propane fuelled thermoelectric generators with the fuel delivered to the site each Antarctic summer. A by-product of this power generation was a large amount of useful heat, which was applied to maintain the operating temperature of the electronics in the stations. Although a reasonable degree of reliability was achieved with these stations, the high cost of the fuel air lift and some remaining technical issues necessitated the development of a different type of power unit. In the second phase of the project we have developed a power generation system using renewable energy that can operate automatically in the Antarctic winter. The most reliable power system consists of a type of wind turbine using a simple permanent magnet rotor and a new type of power control system with variable resistor shunts to regulate the power and dissipate the excess energy and at the same time provide heat for a temperature controlled environment for the instrument electronics and data system. We deployed such systems and demonstrated a high degree of reliability in several years of operation in spite of the relative unpredictability of the Antarctic environment. Sample data are shown to demonstrate that the AGOs provide key measurements, which would be impossible without the special technology developed for this type of observing platform.

Mazabraud's syndrome coexisting with a uterine tumor resembling an ovarian sex cord tumor (UTROSCT): a case report

The association of intramuscular myxoma and fibrous dysplasia is a rare disease known as Mazabraud's syndrome. We present a case of Mazabraud's syndrome coexisting with a uterine tumor and resembling an ovarian sex cord tumor (UTROSCT). This uterine tumor showed a high mitotic index and cytological atypia. To the best of our knowledge, the coexistence of the two different entities has not been reported in the literature.

Effects of intraarticular contrast media on synovial membrane and cartilage. An electron microscopic evaluation in rabbit knees

OBJECTIVE

To evaluate the histological and ultrastructural alterations in rabbit knee joint cartilage and synovia induced by intraarticular injections of 2 water soluble contrast agents.

METHODS

The study was conducted at the Department of Orthopedics and Traumatology, Medical Faculty, Osmangazi University, Eskisehir, Turkey in January 2002. To examine the effect of contrast agents on articular cartilage and synovial membrane, rabbit model was used. Specimens from 62 knee joints were examined by light microscopy and transmission electron microscopy one hour, one day, one week and 2 weeks after intraarticular administration of gadolinium-diethylenetriamine pentaacetic acid, iopromide or saline.

RESULTS

In the knees injected with saline, light microscopic changes of the synovium consisted of edema only. Edema and hyperemia were seen in contrast agent injected knees. Ultrastructurally, numerous and large pinocytotic vesicles in A cells of the synovial membrane were seen in contrast agent injected groups. In the knees injected with saline the cartilage were ultrastructurally normal but contrast agent injected knees showed increased activation of chondrocytes with increase of dense glycogen accumulation, large lipid vacuoles and matrix material. There were very rare pycnotic cells in these samples. The rating scale has been used and the means of the total scores were determined for the groups.

CONCLUSION

The effects of contrast agents reduced gradually on the cartilage and synovium in general but did not become completely normal in the observation period.

Magnetic resonance imaging of bilateral lateral congenital dislocations of unossified patellae

We describe our experience using magnetic resonance imaging (MRI) to evaluate the unossified dislocated cartilaginous patella in a 6-year-old male patient with restricted extension and flexion deformity of both knees. MRI is used widely in the visualization of cartilage since it can show cartilage directly. In addition, FS FLASH 3D sequence has recently been accepted as a suitable sequence in the evaluation of hyaline cartilage. MRI makes it possible to evaluate ligamentous, tendinous, muscular, and cartilaginous structures as well as the abnormalities related to them. We applied this technique in our case and found it very effective in locating the unossified dislocated cartilaginous patella. We also observed structural changes such as bilateral lateral displacement of short quadriceps tendon inserting into diminutive patella, insertion of bilateral patellar tendons into anterolateral tibia, and a stretching of the medial collateral ligament associated with valgus stress.

Assessment of the correlation between commonly used radiographic parameters in normal, subluxated and dislocated hips

The correlations between the commonly used radiographic parameters, center-edge angle (CEA), acetabular-head index (AHI), acetabular index angle (AIA), acetabular angle (AA) and ACM angle, in normal, subluxated and dislocated hips were investigated in the radiographs of 364 normal, 23 subluxated and 19 dislocated hips of patients between 5 and 18 years of age. A significant correlation was observed between all the parameters in normal hips. A significant correlation between AIA and the other four parameters, and between CEA-AHI and AA-ACM, was noted in subluxated hips. AIA-AA and AIA-ACM had significant correlations in dislocated hips. It was concluded that measurement of more than one radiographic parameter might be better to exactly evaluate the radiographic hip anatomy in developmental dysplasia of the hip.

[Our three-year experience with an ultrasonographic hip screening program conducted in infants at 3 to 4 weeks of age]

OBJECTIVES

The aim of this study was to evaluate the results of a newborn ultrasonographic hip screening program conducted at 3-4 weeks of life, and to assess its utility and feasibility in Turkey.

METHODS

During a three-year period, parents of 1440 newborns were interviewed within 48 hours following birth to be informed in detail about developmental dysplasia of the hip (DDH) and its risk factors. They were asked to bring their infants for clinical and ultrasonographic examinations of the hips 3 to 4 weeks after birth.

RESULTS

A total of 975 infants (67.7%; 488 girls, 487 boys; mean age 26 days; range 17 to 34 days) were available on the day of screening. According to the Graf's classification, 1664 hips (85.3%) were considered type I. Immediate treatment was initiated for 22 hips (1.2%) which were considered type IIc, D, or IIIa. All but one hip were found to be type I after eight weeks of treatment. Among type IIa hips with a complete follow-up, 12% required treatment. In total, 45 hips (2.3%) of 35 infants (3.6%) were treated preferably with a Pavlik harness. Of these, 10 infants (28.6%) had at least one risk factor for DDH, the most common being a positive family history (n=7, 20%). Of 45 treated hips, 12 hips (26.7%) exhibited positive clinical findings, the most common being asymmetry of the thigh/inguinal folds.

CONCLUSION

Ultrasonographic hip screening program conducted at the age of 3 to 4 weeks is effective for early diagnosis and successful treatment of DDH. However, nearly one-thirds of the infants were not available at the appointed date, despite transmission of detailed information to the parents just after birth.

Canal preparation with Hero 642 rotary Ni-Ti instruments compared with stainless steel hand K-file assessed using computed tomography

AIM

To compare ex vivo root canal preparation with conventional stainless steel K-files and Hero 642 rotary Ni-Ti instruments.

METHODOLOGY

Mesiobuccal canals of 20 maxillary first molars (with angles of curvature between 25 degrees and 35 degrees ) were used. After preparation with Hero 642 rotary instruments and stainless steel K-files, the amount of transportation that occurred was assessed using computed tomography. The teeth were scanned by computed tomography before instrumentation. One millimetre thick slices were prepared from the apical end point to the pulp chamber. The first two sections were 3 mm from the apical end of the root (apical level) and 3 mm below the orifice (coronal level). A further section (mid-root level) was recorded, dividing the distance between the sections of apical and coronal levels into two equal lengths. Ten teeth were instrumented using Hero 642 rotary instruments and another 10 teeth were instrumented using stainless steel K-files. Following the completion of the instrumentation, the teeth were again scanned and compared with the cross-sectional images taken prior to canal preparation. Amount of transportation and centreing ability was assessed. Student's t-test was used for statistical analysis.

RESULTS

Less transportation occurred with Hero 642 rotary instruments than stainless steel K-files at the mid-root and coronal levels (mid-root: P < 0.05 and coronal: P < 0.001). Hero 642 rotary instruments had better centreing ability than K-files at all three levels (apical: P < 0.05, mid-root: P < 0.05 and coronal: P < 0.001).

CONCLUSIONS

Hero 642 rotary instruments transported canals less, especially at the middle and coronal thirds of the root canals than stainless steel K-files. Hero 642 instruments had better centreing ability.

Assessment of the use of hip ultrasonography by Graf's method between 1 and 6 years of age

Ultrasonographic examinations of both hips of 133 children whose age ranged from 13 to 72 months were performed using the Graf's method. A standard plane which was mandatory prior to the hip typing could be obtained in 93, 91, 84, 79 and 66% of the sonograms for 13-24, 25-36, 37-48, 49-60 and 61-72 months age groups, respectively. The 61-72 months age group had the lowest percentage of valid sonograms and this difference was considered significant (P=0.001). It was concluded that plain radiography was still the gold standard imaging technique in developmental dysplasia of the hip, but hip ultrasonography by the Graf's method might be an alternative imaging technique in experienced hands for the evaluation of developmental dysplasia of the hip in children between 1 and 5 years of age.

[Normal values of several acetabular angles on hip radiographs obtained from individuals living in the Eskişehir region]

OBJECTIVES

To determine the normal values of several radiographic acetabular angles in individuals of Eskişehir region.

METHODS

The acetabular index (AI) angle, acetabular angle (AA) of Sharp and the ACM angle were measured in 1162 normal hips (n=581, 251 males, 330 females; mean age 33 years; range 5 to 75 years). For AI angle, Hilgenreiner's line and the line connecting the lower end points of the sclerotic lines of the acetabular roofs were used for reference in subjects between five to 11 years with an open Y cartilage and in those with closed Y cartilage, respectively. AA and ACM angles were measured by the same method in all subjects.

RESULTS

The mean AI angle between 5-11 years was 12.9+/-4.5 degrees; the upper normal limit for the Hilgenreiner's AI angle was derived as 22 degrees. The mean AI angle above age 11 was 3.3+/-4.7 degrees and the upper normal limit for the AI angle defined by Tönnis after age 11 was found as 13 degrees. Significant linear correlations were found between the AI angle and age for 5-11 years (p=0.002) and above 11 years (p=0.001), respectively. The mean AA angle was 39.2+/-4.6 degrees. There was a significant linear correlation between the AA angle and age (p=0.001). The upper limits for the AA angle in normal juvenile, adolescent, and adult hips were found as 52 degrees, 49 degrees, and 45 degrees, respectively. The mean ACM angle was 41.9+/-3.3 degrees. A significant linear correlation was observed between the ACM angle and age (p=0.001). The upper limit for the ACM angle in normal hips was assessed as 49 degrees in all age groups.

CONCLUSION

The authors of this study propose that the normal limits of acetabular angles obtained from our own population be used as reference values in interpreting standard radiographs of the hip.

The effect of propolis extract in experimental chemical corneal injury

PURPOSE

To investigate the effect of propolis, a natural resin produced by honeybees, in the treatment of alkali-injured rabbit eyes.

METHOD

A corneal alkali burn was induced by applying filter paper immersed in 1 N NaOH on the central axis of the right corneas of 24 rabbits for 30 s. The animals were divided into three treatment groups: group 1 (control) was given 0.3% tobramycin and phosphate-buffered solution; group 2 was treated with antibiotic coverage and topical 1% ethanolic extract of propolis; group 3 received antibiotic coverage and topical 1% dexamethasone. The dexamethasone-treated group was maintained as the positive control. Drugs were instilled 4 times a day for 7 days. The corneal inflammation was evaluated by calculating the average inflammatory index obtained from clinical observation of the ciliary hyperemia, central and peripheral corneal edema at 24 h, 48 h, on day 5 and day 7, before sacrificing the animals. Then, the corneas underwent routine histological examination.

RESULTS

The effects of dexamethasone and propolis on healing of injured corneas were similar (p>0.05) and significantly better than controls at 24 h (p<0.01, p< 0.05, respectively), and on day 7 (p<0.05) with respect to the inflammatory index. On histological observation, inflammatory cell infiltration was lower as compared to control in both the dexamethasone and propolis groups (p<0.001) and similar with each other (p>0.05).

CONCLUSIONS

Our study shows that propolis has an anti-inflammatory effect comparable to dexamethasone in chemical corneal injury.