ObjectiveThe aim of this study was to evaluate the behaviour and knowledge skill levels of Turkish orthopedic surgeons about fluoroscopy usage and radiation safety.MethodsThe questionnaire, consisting of nineteen questions, was sent to orthopaedic surgeons and requested by a total of 323 surgeons online. The questions were about personal information, training and behaviours related to radiation and fluoroscopy usage, and the use of protective equipment.ResultsA total of 277 individuals completed the questionnaire. The answers of 180 surgeons whose working duration was more than 1 year and also who participated in at least one fluoroscopy requiring operation per week, were analysed. 22 (12%) participants answered that they were trained on fluoroscopy usage. Sixty people (33.3%) reported that they did not use any protective equipment regularly. The most commonly used protection methods were lead aprons 123 (68.3%). Thyroid protectors were used by 92 participants (52.1%). There was no significant difference between the groups when comparing the use of protective equipment according to the academic title. Only 19 (10.6%) of the surgeons noted that they used dosimeter regularly, and 15 (83.3%) of them reported that they controlled their dosimeters.ConclusionIn this study, Orthopedic surgeons were found not to be adequately trained about use and risks of fluoroscopy and also not to be equipped about methods for preventing radiation damage.
Background We aimed to evaluate radiologic and clinical outcomes of ankle fractures involving posterior fragments that were fixed with a posterior plate by the posterolateral approach. Methods Sixty-five patients who were followed for at least 12 months and were older than 18 years were included. The posterior malleolus fractures were classified according to the Haraguchi classification system with computed tomography (CT). The posterior malleolus fragments were fixed with a plate through a posterolateral approach. Intra-articular step-off, reduction of the posterior malleolar fragment, and fibular position in the incisura were evaluated by early postoperative CT. American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale pain score were used for clinical assessment. Results The posterior malleolus fractures were classified as Haraguchi type 1 in 45 patients (69.2%), Haraguchi type 2 in 12 patients (18.5%), and Haraguchi type 3 in eight patients (12.3%). No patients showed signs of instability or loss of reduction on direct radiographs during follow-up. Postoperative CT showed no loss of reduction in the posterior malleolus and tibiofibular alignment. On evaluation, there was no intra-articular step-off (<1) in any of the patients. The mean AOFAS score was calculated to be 91.6. The mean visual analog scale score was 1.2. Conclusions We conclude that direct posterior fixation with the posterolateral approach can be a good option for ankle fractures involving posterior malleolar fragments.
PURPOSE OF THE STUDYIn this study we aimed to investigate the clinical and radiographic results of AO/OTA 31 A3 fractures operated on with either a proximal femoral lateral locking plate or short cephalomedullary nails. MATERIAL AND METHODS/RESULTSMedical data of patients treated with either implant were evaluated retrospectively. Patients > 55 years old sustaining an AO 31 A3 type fracture with a minimum follow-up of one year from two institutions were included in the study. RESULTSIn all, 22 patients in the plate group and 30 patients in the nail group were included. All patients achieved union excluding the patients with failure. No significant differences in the mean duration of surgery, pre-and postoperative hemoglobin levels, duration of union time, or need for an open reduction or revision surgery were observed between the two groups. Reduction quality was better in the nail group. Failure of fixation was detected in three patients in the plate group and in four patients in the nail group. The duration of hospital stay was longer in the plate group than the nail group (p = 0.007). Time to independent mobilization was significantly shorter in the nail group than the plate group (p = 0.027). The Harris hip score results were similar between the groups after one year (p = 0.479). CONCLUSIONSBoth implants had similar radiographic and clinical outcomes treat 31 A3 intertrochanteric fractures if the lateral wall of the proximal fragment was intact and anatomical medial-posteromedial restoration of the fracture is performed. Although complication rates were similar between the two groups, nails enabled early mobilization of patients.
BACKGROUND:The present study aims to investigate the effects sof osteoporosis on prosthesis survival by comparing the femoral stem survival rates of patients with poor and relatively good bone quality. METHODS:We retrospectively investigated 61 patients with collum femoris fractures who were treated with cementless rectangular stems between 2011 and 2015 in the Orthopaedics and Traumatology Clinic of Taksim Training and Research Hospital. The preoperative pelvic anterior-posterior radiographs of the patients were evaluated. The patients were evaluated according to the Dorr classification, and no case with a type A femur was found. The patients were divided into two groups as advanced osteoporotic type C and moderate osteoporotic type B. Thirty patients were type B according to the Dorr classification and 31 were osteoporotic type C. RESULTS:The femoral component survival was evaluated using the Engh and ARA criteria. The relationship of the ARA score with type B and type C groups was evaluated. The median ARA score was five (min 3-max 6) for both types. These two groups were also statistically compared concerning the ARA scores using the Mann-Whitney U test, which revealed no statistically significant difference (p=0.24 >0.05). The Engh values, another criterion for the survival of femoral components, were also compared. The median Engh values were 16.5 (min 9-max 24) for the Dorr type B group and 14 (min 9-max 24) for the type C group. According to the Mann-Whitney U test, there was no significant difference between the Engh values of the two groups (p=0.061 >0.05). Lastly, no statistically significant difference was found in the ARA or Engh loosening scores between the type C advanced osteoporotic group and the type B moderate osteoporotic group. CONCLUSION:Our study supports the conclusion that cementless hip arthroplasty can be applied even in advanced elderly and osteoporotic patients without additional intraoperative or postoperative risks.
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