Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Distal radius intraarticular fractures in the elderly population are likely to cause impaired clinical outcomes. Intraarticular fracture treatment in the literature is a debatable issue with mixed results. Here, we aimed to present a tertiary trauma center experience with plate fixation and K wire-assisted external fixator in elderlies over 60 years old. Patients who were diagnosed with an unstable intraarticular distal radius fracture and received surgical treatment with plate fixation or K wire-assisted external fixator between 2016 January and 2020 January were included in the study. Patients were evaluated retrospectively in terms of radiologic stability criteria and clinical outcomes. There were 27 patients; 14 in the volar plate group (group 1) and 13 (group 2) in the external fixator group. The mean age was 64.2 (60-72) in group 1 and 67.7 (60-76) in group 2. The mean follow-up time was 31.6 (12-63) in group 1 and 28.8 (12-59) in group 2. The mean quick disabilities of the arm, shoulder, and hand (Q-DASH) score was 25.7 (5-75) in group 1 and 24.4 (10-87) in group 2. The mean patient-reported wrist evaluation (PRWE) was 27.1 (6-87) in group 1 and 31.4 (10-87) in group 2. There was no statistical difference between groups in terms of clinical scores, hospital stay, follow-up, and complications. (p>0.05). Although open reduction and plate fixation and K wire-assisted external fixator are viable options for providing radiologic union, unsatisfactory clinical outcomes were maintained independently of the fixation method in elderly patients.

This study aimed to evaluate the early effects of N-acetylcysteine, which has antioxidant, inflame-modulatory, and cytoprotective properties, on tendon healing. Thirty-five male Wistar Hannover rats were divided into five groups: first-week treatment (Group 1T), first-week control (Group 1C), third-week treatment (Group 3T), third-week control (Group 3C), and native tendons (Group N). Bilateral Achilles tenotomy was performed on all rats except Group N. After tenotomy, 150 mg/kg N-acetylcysteine was administered daily intraperitoneally to treatment groups, while isotonic saline was given to the control groups. Tendons were evaluated histopathologically, immunohistochemically, and biomechanically after sacrifice in the first and third weeks. No significant differences were observed in the first week (p > 0.05). Movin and Bonar scores (lower scores reflect improved histologic healing) were significantly lower in Group 3T than in Group 3C (p = 0.002). Collagen type-I/type-III ratios were higher in Group 3T compared to Group 3C (p = 0.001). Fmax (N) values were similar across Group 3T, Group 3C, and Group N (p = 0.772). However, cross-sectional areas (mm²) were significantly smaller in Group 3T than in Group 3C (p = 0.001), with the smallest areas observed in native tendons. Thus, tensile strength (MPa, load per unit area) and toughness (J/10³ mm³, energy absorbed per unit volume) were significantly higher in Group 3T than in Group 3C (p = 0.001). N-acetylcysteine supplied some improved results on early markers of tendon healing. Although our findings support the potential of NAC as a therapeutic adjunct in tendon injuries, further studies are needed to evaluate the long-term effects and underlying mechanisms.

Objective: The aim of this study was to immunohistochemically identify and characterize the presence of sensory nerve endings (SNEs) in pulvinar, ligamentum teres (LT), and hip joint capsule (HJC) of children with developmental dysplasia of the hip (DDH). Methods: Pulvinar, LT, and HJC specimens were obtained from 38 hips of 36 children (31 girls, five boys; mean age=49 months; age range=18-132 months) during open reduction surgery for DDH. All specimens underwent subsequent routine tissue processing (formalin fixation and paraffin embedding). To determine tissue morphology, haematoxylin and eosin staining was used. SNEs were analyzed immunohistochemically using a mouse monoclonal antibody against S-100 Beta Protein based on the classification of Freeman and Wyke including four types of SNEs including mechanoreceptors: type I Ruffini corpuscles, type II Pacini corpuscles, type III Golgi organs, and type IVa unmyelinated free nerve endings (FNEs). Additionally, children were sorted into three groups based on their age at the time of surgery: Group 1 (age 5 years; 9 hips of 8 children). Results: Although no Type I, II, or III SNEs were identified in any specimen, type IVa mechanoreceptor (FNEs) was immunohistochemically characterized in 13 (34%) pulvinar, 19 (50%) LT, and 16 (42%) HJC specimens. The total density of FNEs was 3.31±5.70)/50 mm2 (range 0-21) in pulvinar specimens, 3.18 ± 5.92)/50 mm2 (range 0–24) in HJC specimens, and 4.51±6.61/50 mm2 (range 0-22) in LT specimens. Furthermore, the operated side, gender, and the number of FNEs in specimens did not differ significantly among the age groups (p>0.05 for all), and the number of FNEs was not significantly correlated with age, gender, or the operated side (p>0.05 for all). Conclusion: Evidence from this study revealed that pulvinar, LT, and HJC include only FNEs, which play a role in pain sensation, among mechanoreceptors. Surgical excision of these tissues may not cause a significant loss of sensory function in the hip joint of children with DDH. Level of Evidence: Level II, Therapeutic Study Cite this article as: Ertürk C, Koçarslan S, Büyükdoğan H, Altay MA. Investigation of sensory nerve endings in pulvinar, ligamentum teres, and hip joint capsule: A prospective immunohistochemical study of 36 cases with developmental hip dysplasia [published online ahead of print, 2020 August XX]. Acta Orthop Traumatol Turc 2021; 55(1): 33-7.

Background: Proximal femoral nailing (PFN) is a preferred treatment for intertrochanteric femoral fractures in elderly patients due to its minimally invasive nature and early mobilisation benefits. However, mechanical complications such as implant failure, cutout, and reduction collapse remain significant challenges. This study introduces the targeted surgical score (TSS), a novel scoring system designed to predict and mitigate mechanical complications by evaluating modifiable surgical factors. Methods: A retrospective analysis of 586 patients aged 65 and older treated with PFN between 2015 and 2022 was conducted. Data on demographic characteristics, fracture classifications, and surgical parameters were collected. Radiographic assessments included tip-apex distance (TAD) and lag screw positioning for implant placement quality, medial and anterior cortical support (MCS and ACS), and fracture alignment in both AP and lateral planes for reduction quality. Each parameter was scored, resulting in a cumulative TSS ranging from 0 to 8. Logistic regression and ROC curve analysis were performed to evaluate the predictive capacity of TSS. Results: The average TSS was 4.06 ± 2.22 in the complication group and 6.14 ± 1.56 in the non-complication group (p < 0.001). A one-point increase in TSS was associated with a 44.9% reduction in complication risk (OR 0.551; p < 0.001). Independent risk factors included lag screw placement (non-central superior quadrants), inadequate cortical support in AP and lateral planes (MCS and ACS), and TAD (≥ 25 mm). The TSS demonstrated relatively good discriminative ability with an AUC of 0.768. Conclusion: TSS may aid in predicting and mitigating mechanical complications while potentially guiding surgical applications in PFN, but further prospective multicentre validation is required. While certain parameters of TSS could be considered intraoperatively, its full implementation may be more practical for postoperative risk assessment.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.