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.

Objective: The aim of this study was to evaluate the long-term results of shoulder and elbow functions in humeral shaft fractures treated with functional brace, plate and screw osteosynthesis or intramedullary nailing.\r\nMethods: The study included 128 patients treated for humeral shaft fracture. The patients were divided into three groups according to treatment method: Group 1 (n=62) received functional brace, Group 2 (n=36) plate and screw osteosynthesis and Group 3 (n=30) intramedullary nailing. Coronal and sagittal humeral angulations were measured radiologically during the final follow-up. Shoulder and elbow functions were evaluated using the Constant shoulder score, the Mayo Elbow Performance Scoring and range of movement measurements.\r\nResults: The mean follow-up time was 74 (range: 20 to 132) months. Mean Constant shoulder scores were 92.4 in Group 1, 85.6 in Group 2 and 74 in Group 3. A statistically significant difference was detected between the Constant shoulder scores of Groups 2 and 3 (p0.05). In the statistical evaluation of the Constant shoulder scores, a statistically significant difference was detected between the Constant scores of patients with a varus angulation greater than 20° and those with neutral alignment.\r\nConclusion: Functional results of humeral shaft fractures treated with functional brace appear to be satisfactory. Varus and antecurvatum may affect shoulder and elbow function. In the presence of surgical indications, plate and screw fixation technique is the most effective method in terms of shoulder and elbow functions. Özet Amaç: Çalışmamızın amacı fonksiyonel breys, plak-vida ile osteosentez ve intramedüller çivileme yöntemi ile tedavi edilmiş humerus cisim kırıklarının fonksiyonel sonuçlarını değerlendirmekti.\r\nÇalışma planı: Çalışmaya humerus cisim kırığı tanısıyla tedavi edilmiş 128 hasta katıldı. Bu hastalar tedavi yöntemlerine göre 3 gruba ayrıldı. Grup 1 fonksiyonel breys ile tedavi edilen (n=62), Grup 2 plak-vida ile osteosentez uygulanan (n=36), Grup 3 intramedüller çivi uygulanan (n=30) hastalardan oluştu. Hastaların son kontrollerinde radyolojik olarak koronal ve sagital humeral açılanmaları ölçüldü. Omuz fonksiyonları için Constant skorlaması ve omuz eklem hareket açıklığı, dirsek için Mayo dirsek performans skorlaması ve dirsek eklem hareket açıklığı değerlendirildi.\r\nBulgular: Hastaların ortalama takip süresi 74 (dağılım: 20-132) ay idi. Ortalama Constant omuz skoru Grup 1’de 92.4, Grup 2’de 85.6, Grup 3’te 74 idi. İstatistiksel değerlendirmede Constant skoru açısından Grup 2 ve 3 arasında anlamlı fark tespit edildi (p0.05). Varus açılanması 20 dereceden fazla olan hastalarda, koronal düzlemde nötral olan hasta grubuyla karşılaştırıldığında istatistiksel olarak anlamlı şekilde daha kötü Constant skorlarının olduğu tespit edildi (p<0.05).\r\nÇıkarımlar: Sonuç olarak, fonksiyonel breys tedavisinde omuz ve dirsek fonksiyonu sonuçları tatmin edicidir. Varus ve antekurvatum gibi humeral açılanmalar omuz ve dirsek fonksiyonlarını etkileyebilmektedir. Cerrahi endikasyonu olan kırıklarda omuz ve dirsek fonksiyonları açısından plak-vida osteosentezi tercih edilecek tedavi yöntemi olmalıdır.

Many scoring systems for predicting mortality, rebleeding and transfusion needs among patients with upper gastrointestinal bleeding (UGIB) have been developed. However, no scoring system can predict all these outcomes. To show whether the perfusion index (PI), compared with the Rockall score (RS), helps predict transfusion needs and prognoses among patients presenting with UGIB in emergency departments. In this way, critical patients with transfusion needs can be identified at an early stage. Prospective cohort study in an emergency department in Turkey, conducted between June 2018 and June 2019. Patients’ demographic parameters, PI, RS, transfusion needs and prognosis were recorded. A total of 219 patients were included. Blood transfusion was performed in 174 patients (79.4%). The PI cutoff value for prediction of the need for blood transfusion was 1.17, and the RS cutoff value was 5. The area under the curve (AUC) value for PI (AUC: 0.772; 95% confidence interval, CI: 0.705-0.838; P < 0.001) was higher than for RS (AUC: 0.648; 95% CI: 0.554-0.741; P = 0.002). 185 patients (84.5%) were discharged, and 34 patients (15.5%) died. The PI cutoff value for predicting mortality was 1.1, and the RS cutoff value was 7. The AUC value for PI (AUC: 0.743; 95% CI: 0.649-0.837; P < 0.001) was higher than for RS (AUC: 0.725; 95% CI: 0.639-0.811; P < 0.001). PI values for patients admitted to emergency departments with UGIB on admission can help predict their need for transfusion and mortality risk.

Intramedullary nailing can be performed with a fracture table or manual traction. Manual traction can be applied with the patient in either the supine or lateral decubitus (LD) position. However, in either of these positions, the reduction can be difficult because the fractured extremity is not positioned parallel to the floor and the contralateral leg on the operating room table overlaps the fractured limb while the fractured extremity is in full adduction. Therefore fluoroscopy time may be increased. Accordingly, we developed a technique with the patient supine and the contralateral leg elevated (SCLE). We performed anterograde femoral intramedullary nailing with the patient in the supine position with the contralateral leg elevated to allow easy nail entry, reduction, and locking. In this position, the uninjured leg was placed on the leg holder in a semilithotomy position to allow full hip adduction. We retrospectively reviewed 63 patients treated with intramedullary nailing: 30 with the SCLE position (mean age, 38 years; 30% female) and 33 with the LD position (mean age, 37 years; 36% female). From the medical records we extracted demographic information, fracture pattern, intramedullary nail diameter, duration of fluoroscopy and operation, and complications. At the last visit, extremity lengths, rotation, and alignment were determined. Minimum followup was 46 months (mean, 46 months; range, 20-72 months). The mean durations of surgery and fluoroscopy were shorter for the SCLE group than the LD group: 98 versus 108 minutes and 3.4 versus 3.8 minutes, respectively. The open reduction rate was less in the SCLE group when compared with the LD group: 10% versus 36%. We believe the SCLE technique is a reasonable treatment choice for femoral intramedullary nailing as it facilitates obtaining orthogonal views of the femur while possibly shortening surgery and fluoroscopy times. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.