Traumatology Clinic Research Articles

Treatment of fractures of the tibial plateau by transosseous osteosynthesis according to Ilizarov

Between 1994 and 2001 eighty eight patients with intraarticular tibial plateau fractures were treated at the Traumatology clinic of the Russian Mewdical Academy of Postgraduation Education on the base of Municipal Clinical Hospital # 15. All patients were operated on by Ilizarovs transosseous osteosynthesis. Differentiated approach to the definition of the reposition type for the osteo-cartilagenous fragments and to the choice of the external fixation device assembly depending on fracture type, fragment displacement pattern, bone tissue state was realized. To fix a fracture the external fixation device with arch supports was assembled. In 9 patients knee arthroscopy was performed during operation to minimize the traumatization. To reduce the load on injured tibial plateau postoperatively 8 patients used brace-device worked out in the Clinic. Those schemes of treatment allowed to accelerate the patients rehabilitation and improve the outcomes. There were 87.5% excellent and good results, 9.1% satisfactory and 3.4% unsatisfactory ones.

Hemşirelere Algoritma Rehberliğinde Yerinde Simülasyon ile Verilen Eğitimin Basınç Yarasını Önlemeye Etkisi: Müdahale Çalışması

Objective: The aim of this study was to determine the effect of training given to nurses with algorithm-guided in-situ simulation on preventing pressure ulcers. Material and Methods: This was an intervention study. The study was conducted at a university hospital's orthopedia and traumatology clinic with 21 beds. The study sample consisted of 10 post-licensure nurses and 79 pre-simulation and 84 postsimulation patients over 18 years of age, who had stayed in the clinic for at least 24 h. In the collection of data, 3 forms (the demographic data form, the information assessment form, the skill assessment form) were administered to the post-licensure nurses and 3 forms (the demographic data, the Braden scale, the follow-up form) were administered to the patients. The study consisted of 3 stages. In the first stage (01.04.2018-30.06.2018), the nurses recorded the demographic characteristics, nursing interventions for pressure ulcer prevention, pressure ulcer risks, and pressure ulcer incidence data of the patients. In the second stage, nurses participated in a scenario-based standardized patient simulation at the clinic where they worked. In the third stage (01.07.2018-30.09.2018), the nurses recorded the demographic characteristics, nursing interventions for pressure ulcer prevention, pressure ulcer risks, and pressure ulcer incidence data of the patients. The nursing interventions during this period were guided by the algorithm. Incidences of pressure ulcers for 3 months before and 3 months after the simulation were compared at the end of the study. Results: Nurses' knowledge, performance, and care interventions significantly improved during the 3 months simulation (p<0.05). Incidences of Stage 1 pressure ulcers per 1,000 patient days were 8.51 and 4.73 during the 3 months before and the 3 months after simulation, respectively (p=0.136). Conclusion: In-situ simulation is a method to reduce the incidence of pressure ulcers.

The relationship between extremity fractures and visual impairment in childhood: A case-control study.

Fractures are common extremity injuries in pediatric orthopedic practice. The aim of this study is to determine the relationship between pediatric extremity fractures and visual impairments. Thirty pediatric patients who were admitted to the emergency and orthopedics and traumatology clinic due to an extremity fracture after a fall were included in the study. Following fracture treatment, the patients were evaluated in terms of ocu-lar findings before discharge from the hospital. Thirty age- and sex-matched healthy children who presented to the ophthalmology department for routine care were also recruited as the control group. All participants underwent a comprehensive ophthalmologic examination, including cycloplegic refraction, visual acuity levels, and near stereoacuity measurement. The number of male participants was higher in both groups. There was no significant difference between the groups in terms of age and gender distribution. The most common upper extremity fractures were observed to be distal radius (52%) and distal humerus fractures (28%). The number of patients who had a refractive error that required spectacles was significantly higher in the fracture group (p=0.039). When the visual acuity levels of the better eye were evaluated, the mean visual acuity was significantly lower in the fracture group (p=0.016). The mean stereoacuity was also significantly lower in the study group (<0.001). In the binary logistic regression analysis model, low stereopsis levels were associated with the risk of pediatric extremity fractures (95% CI: 1.056-1.385; p=0.006). Our study showed that low-energy pediatric extremity fractures are more common in children with visual im-pairments that require treatment, and low stereopsis is a risk factor for fractures. Consequently, regular eye examinations and early treatment of visual impairments in children may help to prevent fall-related injuries.

Comparison of orthopedic fractures operated during the COVID-19 pandemic with the pre-pandemic period

The duration of staying at home increased during the coronavirus pandemic due to the people’s instincts to protect themselves and lock down. The aim of this study is to compare the changes in orthopedic trauma patients operated in the same term of the coronavirus disease 2019 (Covid-19) pandemic and pre-pandemic periods.This retrospective study was conducted with data obtained from Malatya Training and Research Hospital and compared the Covid-19 pandemic and pre-pandemic period. Orthopedic trauma patients who were operated in the Orthopedics and Traumatology clinic between 24 March-1 July, 2020 and 24 March-1 July, 2019 were included in the study. The patients’ demographic characteristics (age and sex) and trauma-related information (type and site of the fracture, osteoporotic fracture, injury mechanism and treatment modality) were compared between two groups.There were statistically significant differences between the groups in terms of the rates of osteoporotic fractures. We are in the opinion that arrangements for individuals with a high risk of osteoporotic fracture should be made where they can practice physical activities such as walking and exercising at certain times, when there is a lock down during the pandemic. Additionally, detailed studies on traumas that may occur due to increasing stress during such pandemics should be conducted. A total of 439 patients were included in the study. The traffic accidents were significantly lower in the pandemic group than the pre-pandemic group, simple falls were significantly higher in the pandemic group than the pre-pandemic group (P&amp;#60;0.05). Additionally, fractures induced by hitting a hard surface and gunshot wounds significantly increased in the pandemic group compared to the pre-pandemic group (P&amp;#60;0.05).

L’utilisation d’autogreffe avec ostéosynthèse à foyer ouvert des fractures isolées de l’ulna distal améliore les résultats cliniques à court terme : une expérience sur 11 ans

BackgroundMost of the studies on ulna fractures assess the treatment of fractures accompanied by other tissue injuries; thus, the number of studies focused directly on isolated distal ulna fractures are very few. In this study, it was aimed to evaluate the short-term results of open reduction internal fixation (ORIF) and autograft+ORIF approaches in the treatment of isolated distal ulna fractures. HypothesisUsing autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes. Patients and methodsThe records of isolated distal ulna fractures (distal one-third) operated at the Maltepe University Hospital Orthopedics and Traumatology Clinic between January 2009 and December 2019 were retrospectively reviewed. The cases were divided into two groups according to surgical approach, ORIF (n=40) or autograft+ORIF (n=34). ResultsThe mean age was 41.55±12.42 years. Among the cases, 52.7% were female, 67.6% of the fractures were right-sided, and 37.8% of the traumas causing the fracture were high-energy trauma. There was no significant difference between the ORIF and autograft+ORIF groups in terms of age, gender, side and severity of trauma (p>0.05). It was found that pseudoarthrosis development was significantly more prevalent in the ORIF group (25%) compared to the autograft+ORIF group (5.9%) (p=0.026). The median (1st quartile-3rd quartile) time to union was 16 (14–17) weeks in the ORIF group, and 9.5 (8.5–12) weeks in the autograft+ORIF group. Compared to ORIF, the time to union was significantly shorter with the autograft+ORIF procedure (p<0.001). At both the 3rd and 12th month follow-up examinations, the autograft+ORIF group was found to have significantly higher MAYO score and grip strength, and lower DASH score, compared to the ORIF group. DiscussionWhen an autograft is used in addition to ORIF in the surgical treatment of isolated distal ulna fractures, the bone heals faster, pseudoarthrosis develops less frequently, and short-term (3rd and 12th months) functional results are better. Level of evidenceIII; Therapeutic Study.

Дисфункция подвздошно-крестцового сочленения в структуре болевого синдрома у больных с тазобедренно-поясничным синдромом

Проведен анализ историй болезни 138 больных с тазобедренно-поясничным синдромом (ТПС), которым было выполнено эндопротезирование тазобедренного сустава в клинике ортопедии и травматологии взрослых ГУ «Институт травматологии и ортопедии НАМН Украины». Определено, что больные с дисфункцией подвздошно-крестцовых сочленений имеют достаточно большой удельный вес среди больных с ТПС (14,5 %). Доминирующим фактором у пациентов с дисфункцией подвздошно-крестцовых сочленений являются: асимметрия длины конечностей и гиперлордотическая осанка (83,3 %), что позволяет предположить патогенетическую связь между вариантом вертикальной осанки (гиперлордоз) и развитием дисфункции подвздошно-крестцовых сочленений. Доказана высокая эффективность лечебных блокад у больных с дисфункцией подвздошно-крестцовых сочленений при ТПС. Достигнуто значительное уменьшение болевого эффекта у 60 % больных при первичном и у 100 % — при повторном проведении лечебных блокад. Полученные в результаты проведенного исследования признаки могут быть включены в алгоритмы диагностики и лечения больных с ТПС.

Automated knee ligament injuries classification method based on exemplar pyramid local binary pattern feature extraction and hybrid iterative feature selection

BackgroundKnee ligament injuries have been widely seen in orthopedics and traumatology clinics worldwide. A correct diagnosis is required for treating knee ligament injuries diseases as with other diseases. Magnetic resonance images (MRI) have been often used for the diagnosis of knee ligament injuries. Problem definitionAutomated disease detection methods must be used in clinics to save more time and help medical doctors with diagnosis. This research aims to present an intelligent assistant system to detect knee ligament injuries automatically. MethodThis research presents a new hand-crafted feature generation, and this feature generation model is the exemplar pyramid local binary pattern (LBP) technique. A hybrid feature selector is applied to the generated features for selecting the most valuable/informative features. This feature selector uses ReliefF and Iterative Neighborhood Component Analysis together. The prime objectives of this feature selector are both to select the optimal number of features and using effectiveness both ReliefF and NCA. Two shallow classifiers are used to denote strength both feature generator and used hybrid feature selector. The presented model is tested on three MRI datasets about knee ligament injuries. ResultsThe proposed exemplar pyramid LBP and RFINCA based automated classification method reached 99.32%, 99.56%, and 100.0% classification accuracies for the collected three datasets respectively using the KNN classifier. ConclusionsThese results demonstrated the general and high success of this method. The obtained results were also shown that an intelligent health assistant for knee injuries could be developed by using the proposed exemplar pyramid LBP method.

Yanıkların Yıkıcı Bir Nedeni: Sentetik Kannabinoid Suistimali

Synthetic cannabinoids are human-made chemicals that are agonists of cannabinoid receptors. Globally, they have been marketed illegally for their psychoactive effects since the 2000s. The first synthetic cannabinoid traffic in Turkey was detected in the early 2010s. Since then, their psychiatric and psychological complications have become a growing concern. Bonzai, a common form of synthetic cannabinoid in our country, has varying mind-altering effects, from depression to euphoria. This altered state of mind makes users prone to trauma. Herein, we present our experiences of Bonzai-related burn cases. A total of 12 patients were referred to the Plastic Surgery, Orthopedics, and Traumatology Clinics between January 2018 and December 2020; their ages ranged from 18 to 57 years (average age: 33.5 years). The total burn surface area ranged from 2% to 40%. Five patients had been operated on due to burn injuries; all of these patients had complications and secondary surgeries. Two patients were lost after admission to the hospital, and three patients were lost during follow-up. Only one patient was verified to be clean from drugs after discharge from the hospital. We aim to point out the alarming danger of this synthetic drug, which can affect all ages and walks of life.

A Radiographic Study on the Effect of Menopause on Proximal Femoral Angle Parameters

Aim: In this study we aimed to investigate the effects of menopause on the femoral inclination angle (FIA) and femoral Alsberg angle (FAA) parameters in pelvic anteroposterior radiography.Methods: The FIA and FAA data were retrospectively reviewed in a total of 133 female subjects with natural menopause (the menopause group) and regular menstrual cycles (the control group) who were admitted to our orthopedics and traumatology clinic and underwent anteroposterior pelvic X-ray examination between October 2019 and June 2020.Results: There was a statistically significant difference between the menopause and control groups in terms of age (p&amp;lt;0.001), right-side FAA values (p&amp;lt;0.001), and right- and left-side FIA values (p&amp;lt;0.001 and p=0.026, respectively). Only the left-side FAA values did not differ significantly between the groups (p=0.446). All parameter measurements were higher in the menopause group.Conclusion: The finding that the FIA and FAA values were higher in the menopause group could be attributed to the fact that menopause occurs in the later decades of life and brings along changes in lifestyle. We recommend that the presence of menopause as a factor that can affect bone structure and metabolism in various ways should also be considered in studies on bone morphometry.

Using autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes: 11 years of experience

BackgroundMost of the studies on ulna fractures assess the treatment of fractures accompanied by other tissue injuries; thus, the number of studies focused directly on isolated distal ulna fractures are very few. In this study, it was aimed to evaluate the short-term results of open reduction internal fixation (ORIF) and autograft+ORIF approaches in the treatment of isolated distal ulna fractures. HypothesisUsing autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes. Patients and methodsThe records of isolated distal ulna fractures (distal one-third) operated at the Maltepe University Hospital Orthopedics and Traumatology Clinic between January 2009 and December 2019 were retrospectively reviewed. The cases were divided into two groups according to surgical approach, ORIF (n=40) or autograft+ORIF (n=34). ResultsThe mean age was 41.55±12.42 years. 52.7% of the cases were female, 67.6% of the fractures were right-sided, and 37.8% of the traumas causing the fracture were high-energy trauma. There was no significant difference between the ORIF and autograft+ORIF groups in terms of age, gender, side and severity of trauma (p>0.05). It was found that pseudoarthrosis development was significantly more prevalent in the ORIF group (25%) compared to the autograft+ORIF group (5.9%) (p=0.026). The median (1st quartile–3rd quartile) time to union was 16 (14–17) weeks in the ORIF group, and 9.5 (8.5–12) weeks in the autograft+ORIF group. Compared to ORIF, the time to union was significantly shorter with the autograft+ORIF procedure (p<0.001). At both the 3rd and 12th month follow-up examinations, the autograft+ORIF group was found to have significantly higher MAYO score and grip strength, and lower DASH score, compared to the ORIF group. DiscussionWhen an autograft is used in addition to ORIF in the surgical treatment of isolated distal ulna fractures, the bone heals faster, pseudoarthrosis develops less frequently, and short-term (3rd and 12th months) functional results are better. Level of evidenceIII; therapeutic study.

Coronavirus disease 2019 pandemic, restriction, and orthopedic trauma: Retrospective observational study.

In 2019, the Coronavirus disease 2019 (Covid-19) was reported in Wuhan, China. Governments in various countries had taken many safeguards. This study investigated the incidence of orthopedic trauma in a rural region epidemiologically and guided source distribution and medical professionals to sustain healthcare systems.Between December 2019 and August 2020, 1651 patients admitted to orthopedics and traumatology clinics with trauma were evaluated in this study. Patients were grouped into 3 groups: pre-covid, restriction, and permitted groups. Age, sex, and fracture types of patients were recorded.The number of patients in the pre-covid period was 629 (38.1%), those were 334 (20.2%) in the restriction period, and 688 (41.7%) patients were admitted in the permitted period. A total of 1203 (72.9%) patients with upper extremity fractures, 383 (23.2%) patients with lower extremity fractures, and 65 (3.9%) patients with axial skeleton and pelvic ring fractures were included in the study. The lowest rates were found in the restriction period when all fractures were evaluated according to the admission periods. There were significant differences between admission dates and the fractures (P < .001).In this study, a decrease in orthopedic trauma rates was observed by half in the restriction period compared with the other 2 periods. Public health precautions had led to a reduction in the incidence of orthopedic trauma in all age groups.

Correlation between Magnetic Resonance Imaging and Arthroscopic Findings in Knee Lesions

Abstract Background: Magnetic resonance imaging (MRI) is a noninvasive diagnostic method with no known side effects and a high sensitivity for detecting meniscal lesions as well as lesions of the anterior and posterior cruciate ligaments. For a correct and complete diagnosis, MRI results must be interpreted in the context of clinical examination and anamnesis. MRI results can support the surgical indication for arthroscopy, which is a minimally invasive intervention that facilitates the visualization, investigation, diagnosis, and treatment of intra-articular lesions of the knee. The purpose of this study was to assess the correlation between MRI results and the intra-articular lesions detected arthroscopically. Material and methods: This retrospective study evaluated a total of 60 patients admitted and treated between January 1, 2013 and January 1, 2014 in the Clinic of Orthopedics and Traumatology of Mureș County Hospital, Târgu Mureș, Romania. Results: In the 43 patients with lesion of the anterior cruciate ligament, the lesions were seen on MRI in 40 patients (93%) and confirmed arthroscopically in 37 patients (86%). In 34 cases (79.1% of the total of 43), the MRI and arthroscopic results were similar, the Kappa coefficient showing a high degree of correlation (0.90). Conclusion: By assessing the Kappa coefficient to highlight the correlation between MRI results and arthroscopic diagnosis for knee injuries, a statistically relevant correlation between the two methods was found. This suggests that a correct diagnosis can be achieved by both methods.

Assessment of static and dynamic balance in patients after total hip arthroplasty based on the Tinetti Test

Introduction: A degenerative disease of a hip joint (osteoarthritis) is a chronic affliction which causes progressive degeneration of a hip joint and tissue located around it. It inflicts limitation of locomotor skills, deteriorates life quality to a significant extent, and prevents a patient from normal activities in daily life. In Poland, more than 3 million people suffer from osteoarthritis. The disease symptoms are pain, limitation of mobility scope in a joint, postural and gait disorders, and positioning of a lower limb in non-functional position. The aim of the study was to analyze the gait pattern and to assess the static and dynamic balance of people qualified for hip joint arthroplasty, as well as possibility of falling.Material and methods: The Tinetti Test has been used for the research in question. This test has been completed in patients awaiting for hip joint arthroplasty, and once more on a third day upon completion of arthroplasty, in the Department and Clinic of Orthopaedics, Traumatology and Oncology of Locomotor System of the Pomeranian Medical University in Szczecin. This test has included a group of 31 – 11 women and 20 men.Results: The mean age of the research group was 65.1 years. The intensity of pain in the hip joint, based on the VAS scale before and after the procedure, was 6.53 and 5.22 points, respectively. The average number of points obtained by the patient in the Tinetti Test before the surgery was 22.71 points. On the third day of hip surgery, the mean number of points decreased to 18.81 points.Conclusions: Patients treated with alloplastic surgery of a hip joint show lower static and dynamic balance. Upon completion of the surgery, the patients are more prone to fall. The patients with completed hip joint arthroplasty show symptoms of locomotor system disorders.

Traumatic injuries in primary dentition and their immediate and long-term consequences: a 10-year retrospective study from the State University of Rio de Janeiro, Brazil.

Dental trauma is a highly prevalent problem worldwide. The aim of this study was to describe characteristics of trauma to anterior primary teeth and its sequelae for primary and successor teeth over a 10-year period of assistance at the paediatric dental traumatology clinic in the State University of Rio de Janeiro, Brazil. The data were obtained from the dental records of children assisted from 2006 to 2016. Inclusion criteria were trauma to anterior primary teeth; aged <1 to 9 years at the time of trauma; and at least one follow-up appointment. The data concerning traumatized teeth, child's age, soft tissue injuries, types of traumatic dental injuries and sequelae in both dentitions were collected. Of the 1230 dental records, 483 (39.3%) were eligible, consisting of 815 teeth. The mean age at the time of trauma was 37.4 months (239 males and 244 females). The most important characteristics were: tooth 51 was most affected; falls, at home, on a ceramic floor, were the main cause; gingival laceration, enamel fracture and intrusive luxation were the most frequent types of trauma; premature tooth loss of primary teeth and enamel discoloration in their successor were the most frequent sequelae; and injuries in the periodontal tissue were demonstrated as the highest risk for sequelae in successors (OR, 3.798; p< 0.001). Most traumatic injuries occur in young children, in their home environment. Consequences for the primary teeth were more frequent compared to the permanent successor tooth. Traumatized primary teeth involving periodontal tissue have more chances to result in sequelae to their successor teeth.

THE ROLE OF DISCOGENOUS RADICULOPATHIES AND SPONDYLOLYSTHESIS IN THE STRUCTURE OF PAIN SYNDROME AFTER TOTAL HIP ARTHROPLASTY

Resume. In the structure of complications, pain syndrome, which is not associated with instability of the components of the endoprosthesis or infection, remains a serious problem due to difficulties in diagnosis and treatment. The cause of residual pain may be the presence in the patient of discogenic radiculopathy or spon-dylolisthesis of the lumbar spine. The aim of the study. To determine the role of discogenic radiculopathies and spondylolisthesis of the lumbar spine in the structure of pain after hip arthroplasty. Materials and methods. A sample and retrospective analysis of case histories of 138 patients with hip and lumbar syndrome, who under-went hip arthroplasty in the clinic of orthopedics and traumatology of adults SI "ITO NAMS of Ukraine". All patients were examined clinically and radiologically. Additionally, all patients were examined by a neurolo-gist to determine the neurological status of patients, diagnosis. Evaluation of the effectiveness of treatment of patients with residual effects of discogenic radiculopathy and spondylolisthesis after hip arthroplasty was performed on the functional scale of Oswestry. Results. The analysis of the patient database revealed a statisti-cally significant (p≤0.05) predominance of patients with the presence of disc herniation at the level of L3-L4 and hypolordosis. The survey revealed 9 cases of discogenic radiculopathy and 6 cases of spondylolisthesis in patients with PD, which amounted to 6.5% and 4.5% of the total number of examined patients. The high effi-ciency of the developed treatment-and-prophylactic measures in patients with discogenic radiculopathy or spondylolisthesis and lumbar-lumbar syndrome has been determined. Timely appointment of complex conserva-tive and operative methods allowed to achieve satisfactory results in 100% of cases. Conclusions. Studies to determine the role of discogenic radiculopathy and spondylolisthesis of the lumbar spine in the structure of pain after hip arthroplasty will contribute to the further development of clinical, diagnostic and treatment algorithms for patients with hip and lumbar syndrome.

FEATURES OF FORMATION OF CONTRACTURES OF A HIP JOINT AT PATIENTS WITH A HIP-LUMBAR SYNDROME

Resume. With significant destructive changes in the hip joints, endoprosthesis is the main method of surgical treatment of coxarthrosis. However, according to the Swedish and Canadian registries, 17-20% of patients have pain after arthroplasty. The cause of residual pain may be a concomitant lesion of the spine, and the study of issues related to the clinical features of the hip-lumbar syndrome are relevant from a scientific and practical point of view. The purpose of the study: to analyze the clinical and radiological picture of patients with coxarthrosis with concomitant pathology of the spine, to investigate the dependence of the severity of flexion contracture of the hip, variable parameters (pelvic angle RT and lumbar lordosis GLL) from constant angle and angle; to study the features of the clinical course of hip-lumbar syndrome. Materials and methods. An analysis of the results of examination of 150 patients with stage III-IV idiopathic coxarthrosis who under-went hip arthroplasty in the clinic of orthopedics and traumatology of adults of the State Institution "ITO NAMS of Ukraine" was performed. Hip pain and functional impairment were assessed according Harris and Womac scales also before hip arthroplasty and 3 months after surgery. Results. Analysis of the obtained data shows that with an increase in the angle of inclination of the pelvis and flexion contracture, the values of the parameters of the angle of pelvic deviation increase, which causes a statistically significant increase in the angle of lumbar lordosis. The correlation coefficients between the parameters PI-PT and PI-GLL were 0.65±0.15 and 0.74±0.11, respectively. Conclusions. Pain in patients with small contracture of the hip joint is associated with neuro-dystrophic syndrome in osteochondrosis of the lumbar spine, in patients with larger contracture - with spondyloarthritis. In the vertical position of the sacrum - GLL - the smallest, least pro-nounced and flexion contracture of the hip joint. On the contrary, in the horizontal position of the sacrum in patients with hyperlordosis and significant, more than 10 ° contracture in the hip joints.

Lack of association between MMP13 (rs3819089), ADAM12 (rs3740199-rs1871054) and ADAMTS14 (rs4747096) genotypes and advanced-stage knee osteoarthritis.

Objectives The aim of this study was to investigate the relationship between MMP13 rs3819089, ADAM12 rs3740199 and rs1871054, and ADAMTS14 rs4747096 genotypes in patients with radiologically diagnosed knee osteoarthritis (OA). Patients and methods A total of 300 patients (68 males, 232 females; mean age: 61.6 years; range, 25 to 89 years) who were admitted to the orthopedics and traumatology clinic and diagnosed with knee OA according to the 2000 American College of Rheumatology (ACR) criteria between October 2018 and March 2019 were prospectively analyzed. Patients with Grades III-IV OA according to the Kellgren- Lawrence (K-L) grading system were included in the patient group (n=150) and those without radiological features of knee OA (K-L Grades I-II) were included in the control group (n=150) voluntarily. The presence of single nucleotide polymorphisms (SNPs) in the targeted genes in both groups was assessed by real-time polymerase chain reaction in the peripheral blood sample.Results The most common nucleotides in both the control and patient groups were CG for rs3740199 and CT for rs1871054 in the ADAM12 gene, and the most common nucleotides in alleles were GG for MMP13 rs3819089 and AA for ADAMTS14 rs4747096. No statistically significant relationship was detected between the gene polymorphisms and advanced OA. Conclusion The study results suggest that ADAM12 rs3740199 and rs1871054, MMP13 rs3819089, and ADAMTS14 rs4747096 polymorphisms have no relationship with knee OA susceptibility in the Turkish population. However, as this is the first study to investigate the relationship between the SNPs of ADAM12, ADAMTS14, and MMP13 genes and the development of OA in the Turkish population, it would contribute to our understanding of the molecular bases of OA.

Are preoperative complete blood count parameters in peripheral nerve sheath tumors useful diagnostic tools?

Objectives This study aims to evaluate the diagnostic value of complete blood count (CBC) parameters in patients with peripheral nerve sheath tumors (PNSTs).Patients and methods A total of 181 patients (83 males, 98 females; median age: 44 years; range, 15 to 83 years) who underwent surgical treatment for PNSTs in our tertiary oncology center between January 2010 and December 2019 were retrospectively analyzed. Eighty-two patients were diagnosed with a neurofibroma, 79 with a schwannoma, and 20 with a malignant PNST (MPNST). The patient group was evaluated as malignant (n=20) and benign (n=161). Age- and sex-matched patients admitted to our outpatient clinic of orthopedic and traumatology with non-specific symptoms other than tumor, infection, fracture, and rheumatological or hematological diseases were included as the control group (n=165). Data including age, sex, definitive histopathological diagnosis, and pre-treatment CBC values were obtained from the hospital records. Pre-treatment CBC values such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated for both malignant and benign groups and control groups. Diagnostic values of NLR, PLR, and LMR between PNST groups were assessed using the receiver operating characteristic (ROC) curve analysis.Results Neurofibroma, schwannoma, and MNPST groups had significantly higher median NLR, compared to the control group (p<0.001), while the median LMR was significantly lower in these groups (p<0.05). However, the median PLR was higher only in the MPNST group, compared to the control group (p<0.001). Post-hoc analyses revealed that median NLR, PLR, and LMR ratios were similar in PNST groups, compared to the control group. In addition, the median NLR, PLR, and LMR ratios were similar between malignant and benign patient groups. The highest area under the curve (AUC) was found for NLR (AUC=0.756) and LMR (AUC=0.716) in the MPNST group.Conclusion Our study results suggest that NLR, PLR, and LMR may have an added value in the early diagnosis of PNSTs and are valuable for differentiating patients from healthy individuals, although their value in differential diagnosis is still unclear.

Orthopaedics and Traumatology in COVID-19 Pandemic

Objectives: We aimed to convey our pandemic observations and experience as orthopedics and traumatology clinic in the period from the formal declaration of the first case in Turkey to the descending trend of the number of active cases. Materials and Methods: The first Coronovirus disease-2019 (COVID-19) case in Turkey was seen on March 11 and all elective surgeries were postponed as of March 17th. The number of active cases entered a downward trend with the number of patients recovering daily exceeding the number of new cases daily on April 24. The numbers and categories of surgeries performed in our clinic between March 17 and April 24, 2020 were examined and analyzed by comparing to the same period of 2019.

The history of orthopedics and traumatology in Iasi

In Iasi, Orthopedics-Traumatology later appeared as a distinct specialty. In a first stage, orthopedics developed in surgical clinics - the period of surgical clinics (1879-1970). In each surgical clinic there were surgeons who dedicated themselves to orthopedic pathology: Radu Dimitrie, Theodor Căpățînă (Surgery I), Filimon Cicerone, Eusebiu Neagoe, Iulian Grădinaru (Surgery II), Paul Trosc (Surgery III). In 1967, at the Charity Hospital, two surgical services were carried out: The Surgery and Children's Orthopedic Clinic (Th. Economu) and the Osteoarticular Tuberculosis Clinic (A. Berneaga). Also, this year, 1970, in Iasi, the construction of a new medical unit will be completed - the Children's Hospital where the Clinic of Pediatric Surgery and Orthopedics will be moved. The Charity Hospital is disbanded and the Emergency Clinical Hospital will be established on the site of the former establishment. A second period begins - the transition period (1970-1983) - characterized by the search for optimal solutions, which involved changes and temporary until the establishment of orthopedic clinics. The newly established unit, the Emergency Clinical Hospital, was designed to include three departments: General Surgery IV (I. Jitaru), Medical Clinic (G. Popa) and an Orthopedics and Traumatology Clinic (conf. Gh. Floareș). This clinic treated all surgical pathology of orthopedics, traumatology and had didactic activity with fourth year students. The Orthopedics-Traumatology Department had 40 beds. There is also an Orthopedics-Traumatology department, with 40 beds, located in the Dr. C. I. Parhon Hospital run first by A. Berneaga and then by P. Trosc. Dimitrie Radu, Iulian Grădinaru and G. Herescu worked in this department. A new Recovery Hospital appears in Iasi. The new hospital also has an Orthopedics-Traumatology department (with 111 beds) where the orthopedics department will be transferred from Parhon Hospital. In 1983, Professor Gh. Floareș opted to move the clinic from the Emergency Hospital to the new Rehabilitation Hospital. At the Emergency Hospital there remains an Orthopedics-Traumatology Department staffed by a single doctor - Nicolae Georgescu who will develop a new team, which also have teaching activity: T. Cozma, L. Stratan, P. Sîrbu, Ovidiu Alexa, Paul Corlaci, Cezar Popescu. There are eight resident doctors (Elena Glod, Luminița Lăbușcă, Victor Pencu, G. Ghinoiu, C. Nanu, T. Bunescu, R. Malancea, L. Pacu). During this period (1992-1996) a basic A.O. course was organized in Iași. internationally, on which occasion many orthopedists are persuaded to routinely use modern means of osteosynthesis. Two more doctors come in this clinic: B. Puha, R. Asaftei, D. Cionca and A. Ciubara. After 1989, the ATOM was born: The Association of Traumatologists and Orthopedists of Moldova, congresses and postgraduate courses are organized. In 2012 the Orthopedic Clinic moved to the St. Spiridon Emergency Clinical Hospital (Prof. Ovidiu Alexa). The orthopedic clinic at the Recovery Hospital treats chronic osteoarticular pathology (prof Paul Sirbu).