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.

INTRODUCTIONAlkaptonuria is an autosomal recessive disorder of metabolism. The pathogenesis of alkaptonuria includes chronic inflammation, degeneration, and eventually osteoarthritis. Ochronotic arthropathy is a rare condition found in patients with alkaptonuria.PRESENTATION OF CASEA 60-year-old female presented for evaluation after a 10-year history of low back pain, right hip pain, and bilateral knee pain. A cementless right total hip and a cemented left knee replacement were performed. Intraoperatively, the joint surfaces, neighboring ligaments, and tendons were black with pieces of black cartilage tissue. Histological sections of bone and soft tissue demonstrated classic findings of ochronosis, including multiple pigmented areas, reactive giant cells, and a thickened, inflamed synovium.DISCUSSIONThe management of ochronotic arthropathy in alkaptonuria patients is usually conservative, but replacement surgery is offered for severely affected hip and knee joints. A few reports of the surgical treatment of ochronotic arthropathy have been published. This report describes a case of ochronotic hip and knee arthritis treated with total hip and knee arthroplasties.CONCLUSIONJoint replacement has excellent outcomes in a patient with significant degenerative arthropathy due to ochronosis.

Introduction:The aim of this study is to clinically compare isolated calcaneal spur excision and plantar fascia release in addition to spur excision in patients with plantar heel pain accompanied by a calcaneal spur.Method: Patients who did not benefit from conservative treatment and underwent surgical excision of the calcaneal spur and/or plantar fasciotomy were retrospectively evaluated. The patients were divided into two groups according to the surgical procedure performed. The evaluation was done according to the pre-and postoperative foot function index (FFI) using pain and functional evaluation. Pain, disability, and activity restriction were evaluated with FFI. The radiological results and FFI scores of both groups were measured before and after surgery, and the difference between the groups was compared.Results: Of the 46 patients in our study group, 30 (65.2%) were female, and 16 (34.8%) were male. The average age was 41.2 years. There was a significant improvement in postoperative FFI scores in both groups. There was no significant difference in postoperative functional results when the groups were compared. Conclusion:In patients whose plantar heel pain associated with calcaneal spur does not improve despite conservative treatments, both isolated spur excision and plantar fascia release in addition to spur excision may be effective treatment modalities that improve foot functions.

Objectives The purpose of this study was to evaluate the clinical and radiologic outcomes of unstable distal clavicle fractures in patients who underwent indirect fracture fixation by performing augmentation with nonabsorbable sutures. Patients and methods In this descriptive observational study, 16 patients (11 males, 5 females; mean age: 34.8±12.1 years; range, 18 to 67 years) who underwent indirect fracture fixation using nonabsorbable sutures for Neer type IIB distal clavicle fractures at the Gaziosmanpaşa Training and Research Hospital, Department of Orthopedic Surgery between January 2014 and September 2019 were retrospectively reviewed. Clinical outcomes were evaluated using the Constant-Murley score and Visual Analog Scale. Results Complete union was achieved in all patients, and mean union time was 45.3± 8.4 (range, 30 to 68) days. There were no patients with loss of reduction, infection, or requirement for additional surgery. Conclusion The coracoclavicular fixation method, which was applied using nonabsorbent sutures in a limited number of Neer type IIB clavicle fractures, provides a suitable and stable fixation comparable to classical techniques.

Objectives: This study aims to investigate the correlation between posterior cruciate ligament (PCL) buckling phenomena and the presence or absence of the anterior meniscofemoral ligament (aMFL). Patients and methods: Between January 2012 and January 2019, magnetic resonance imaging of a total of knee joints of 199 patients (163 males, 16 females; mean age: 31.5±5.3 years; range, 18 to 40 years) were reviewed retrospectively. The patients were divided into four groups. The first group included 32 patients with a ruptured anterior cruciate ligament (ACL) and absent aMFL. The second group included 67 patients with a ruptured ACL and apparent aMFL. The third group included 23 patients with an intact ACL and absent aMFL, and the fourth group included 77 patients with an intact ACL and apparent aMFL. The PCL angle was used to measure the buckling degree of the ligament, as calculated as the angle between two lines drawn through the tibial and femoral central portions of the PCL insertions. We assessed the buckling phenomena of the PCL in ACL-ruptured and ACL-intact knees and examined a possible correlation between the PCL buckling angle and the presence or absence of the aMFL of Humphrey. Results: In the ruptured ACL groups (Groups 1 and 2), the mean PCL buckling angle values were 133.88±6.32 and 104.83±7.34 degrees, respectively. A significant difference was detected between both groups (p=0.026). In the intact ACL groups (Groups 3 and 4), the mean PCL buckling angle values were 143.47±5.96 and 116.77±8.38 degrees, respectively. A significant difference was detected between both groups (p=0.039). No statistically significant difference was observed between Groups 1 and 3 (p=0.13) and between Groups 2 and 4 (p=0.088). Conclusion: The PCL buckling sign is not specific for ACL ruptures, and can be seen frequently in normal knee joints which it is strongly associated with the presence of aMFL of Humphrey.