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We investigated oxidative status in patients with rotator cuff tendinopathy (RCT) and evaluated their relationship with radiological and clinical parameters. In this cross-section study, 88 patients with RCT (59 males and 29 females) and 86 healthy controls (66 males, 20 females) were enrolled. The sample consisted of nontraumatic patients who are suffering from shoulder pain because of rotator cuff disease, which was established by clinical tests and MRI scanning. Oxidative stress in patients with RCT was analyzed via the dynamic thiol/disulfide homeostasis (TDH). Thiol/disulfide homeostasis was measured by a new colorimetric method. Furthermore, oxidative stress was indirectly measured by serum total oxidant status (TOS), oxidative stress index (OSI), and total antioxidant capacity (TAC). Serum disulfide levels and the other oxidative stress parameters of the RCT group were significantly greater than those of the control group (P < .001 for all), whereas the anti-oxidative stress parameters remained unchanged (P > .05 for all). The lowest and highest serum disulfide levels were detected in patients with grades 1 and 3, respectively (P < .001). Furthermore, in a multiple regression analysis, the disulfide/natural thiol ratio (ß=-4.886, P = .004) and the MRI grading (ß=0.314, P=.001) were independently associated with the Western Ontario Rotator Cuff Index WORC score. We found an association between the levels of various serum markers of oxidative injury, especially serum disulfide levels, and the increasing severity of RCT. Thiol/disulfide homeostasis seems to play a critical role in RCT, both in the beginning and during the progression of disease.

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OBJECTIVES: The aim of this study was to compare the radiological and clinical results of femoral diaphyseal fractures operated in the lateral decubitus position with those operated in the supine position on a traction table and to detail the perioperative surgical technique. PATIENTS AND METHODS: Between October 2018 and January 2022, in this prospective, randomized, and single-blind comparative study, 75 patients diagnosed with adult femoral diaphyseal fractures to whom intramedullary nails were applied were operated in the lateral decubitus position without a traction table (Group 1, 37 patients) and in the supine position with a traction table (Group 2, 38 patients). Preoperative age, gender, fracture mechanism, fracture type, and surgical waiting times were determined. Perioperative anesthesia type, surgery preparation time, surgical time, number of fluoroscopy doses, amount of bleeding, and type of reduction were evaluated, and detailed observational descriptions of the surgical techniques were made. In the postoperative period, radiological evaluations were made with x-ray radiography and orthoroentgenogram, while in the clinical evaluation, hip-knee joint range of motion and rotational evaluation were made with the Craigs test. Follow-up periods were determined and complications noted. RESULTS: The average age was 32 in Group 1 and 28 in Group 2, the female/male ratio was 1:36 in Group 1 and 5:33 in Group 2, and the follow-up period was 18.2 months Group 1 and 21.7 months in Group 2. No significant difference was detected between the groups in terms of age, gender, fracture mechanism, fracture type, anesthesia type, surgical waiting time, and follow-up period (p > 0.05). Compared to Group 2, the shorter preparation time, surgical time, and number of fluoroscopy doses in Group 1 were found to be statistically significant (p < 0.05). The differences in the amount of bleeding and need for open reduction were not statistically significant between the groups (p > 0.05), and no statistical difference was found in joint range of motion and rotational evaluation in clinical evaluation in both groups (p > 0.05). There was no significant difference in terms of complications between groups. CONCLUSIONS: We found the lateral decubitus method without a traction table to be a safe and effective alternative to the supine method with a traction table in terms of the radiological and clinical results and that it also has the advantages of shortening the surgical time, reducing radiation exposure. LEVEL OF EVIDENCE: Level 1 prospective, randomized, single-blind controlled study.

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INTRODUCTION: This study aimed to compare the radiological and clinical results of VP and EF applications in multi-fragmented radius distal intra-articular fractures (AO type C) in our clinic. METHODS: We retrospectively analysed 80 patients who underwent surgery for radius distal fracture (AO type C) between 2014 and 2020. Group 1 comprised patients who were treated with VP, and Group 2 comprised patients who were treated with EF. Radiological evaluation was performed by measuring radial inclination, radial length, volar tilt, intra-articular step-off and ulnar variance by two-way radiography. The clinical findings were evaluated using the Gartland and Werley scoring system, and complications were noted. RESULTS: There were no statistically significant differences between the two groups in terms of age, gender, side, fracture subtypes and follow-up time (p > 0.05). There were no statistically significant differences between the two groups in radiological parameters (based on cut-off values) (p > 0.05). The clinical evaluation did not reveal a statistically significant difference between the two groups (p = 0.613). CONCLUSION: EF is as successful as VP in providing radiological cut-off values. EF treatment can be used as an effective and safe alternative method for multi-fragmented radius distal intra-articular fractures.

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OBJECTIVES: This study aims to investigate dynamic thiol/disulfide homeostasis as a novel indicator of oxidative stress and to find out its association with standard inflammatory markers during the treatment of patients with septic arthritis (SA). PATIENTS AND METHODS: In this prospective study, a new colorimetric method for measuring thiol/disulfide homeostasis was assessed between May 2013 and October 2014 in 24 patients with SA (14 males, 10 females; mean age 14.5±19.1 years; range, 1 to 80 years) at baseline and the end of the third week of the treatment, and in 24 healthy controls (14 males, 10 females; mean age 12.5±18.7 years; range, 1 to 85 years). Also, standard inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate, and white blood cell count were evaluated. RESULTS: At baseline, serum disulfide was higher in SA group compared to the control group, whereas native thiol was lower (p<0.05 for all). At the end of the third week of the treatment, serum disulfide level was lower, whereas the native thiol was higher compared to baseline (p<0.05 for all). In addition, serum disulfide level was positively correlated with CRP (r=0.736, p<0.001) and disulfide/native thiol ratio (r=0.779, p<0.001). Furthermore, in multiple regression analyses, the disulfide level was independently associated with CRP (ß=0.226, p=0.005). CONCLUSION: Our results suggest that the elevated levels of serum disulfide and standard inflammatory markers at baseline in patients with SA and decreased levels of these parameters are related with oxidative stress. This homeostasis shifted towards disulfide formation due to thiol oxidation. Therefore, thiol/ disulfide homeostasis may be a helpful biomarker for the follow-up in patients with SA.

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Osteoarthritis is one of the most common chronic diseases and associated with increased cardiovascular comorbidity and deaths. Elastic properties of aorta are closely associated with cardiovascular mortality and morbidity. In our study, we aimed to evaluate aortic stiffness in primary osteoarthritis patients. A total of 160 patients including 80 patients with primary knee osteoarthritis and 80 controls without osteoarthritis were included in the study. Additionally, osteoarthritis patients were divided into four subgroups according to the severity of the disease. Aortic parameters were evaluated by using transthoracic echocardiography method. While measurements of aortic stiffness of osteoarthritis group were higher compared to the control group (p < 0.01), aortic strain and aortic distensibility measurements of osteoarthritis group are lower than the control group (p < 0.01). Additionally, it was determined that as the severity of osteoarthritis increased also aortic stiffness increased highly significantly (p = 0.001). Presence and severity of osteoarthritis are closely associated with elastic properties of aorta, which are correlated with cardiovascular mortality and morbidity.

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Osteoarthritis (OA) is one of the most common chronic diseases seen in the elderly, and it is associated with increased cardiovascular morbidity and mortality. The cause of this association is not fully known. We aimed to investigate the relationship between epicardial fat and the presence and the grade of primary knee OA for analyzing the relationship between visceral adiposity and primary OA, thereby revealing the increased subclinical atherosclerosis and cardiovascular risk in OA patients. In this cross-sectional study, subjects with primary knee osteoarthritis and a control group were compared with regard to epicardial fat thickness through transthoracic echocardiography. In addition, OA was divided into four stages and the relationship between the grade of OA and epicardial fat thickness was analyzed. Eighty subjects with primary knee OA and 50 controls were analyzed. There was no difference between groups with regard to age, gender and BMI. Epicardial fat thickness was greater in patients in the primary OA group compared to the control group (3.73±1.08 vs 3.30±0.61, respectively, P=0.005). In-group comparison of OA patients revealed that epicardial fat thickness was detected to increase as the grade of OA increased (P=0.001). A relationship was detected between the presence of OA and epicardial fat thickness and CRP levels in multivariate logistic analysis (P=0.017, P=0.047, respectively). There is a significant relationship between primary OA and epicardial fat thickness, which is a part of visceral adipose tissue. These results may indicate the relationship between OA and visceral fat tissue and, consequently, cardiovascular risk, so body weight alone may not be an identifying co-factor.

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BACKGROUND: The aim of this study was to determine the factors affecting postoperative mortality in patients older than 65 years of age undergoing surgery for hip fracture. METHODS: A total of 308 patients (219 males and 89 females) were included into the study. Spinal-epidural anaesthesia was administered in 203 patients and general anaesthesia in 105 patients. In the evaluation of the patients regarding ASA, two groups were determined ASA 1-2 and ASA 3-4. Systemic diseases present in the patients were determined preoperatively. RESULTS: Seventy-seven (25%) of the total 308 patients died. In addition, patients with preoperative cardiac disease, patients on whom general anaesthesia was administered, patients in the ASA 3-4 group, and age were found to be significantly higher in mortality. When logistic regression analysis was performed for these four efficient factors, age, general anaesthesia, presence of cardiac disease were effective in mortality. However, ASA score changed depending on the age and cardiac disease. CONCLUSION: In case of presence of multiple risk factors, it is necessary to determine which factor is, in fact, more effective. Age, ASA score, type of anaesthesia, and presence of cardiac disease are effective in mortality. However, ASA score affects mortality depending on the cardiac disease and age.

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BACKGROUND: The aim of this study was to evaluate the long-term functional and cosmetic results as well as the sagittal and coronal plane remodeling of displaced supracondylar humerus fractures treated with open reduction and internal fixation. METHODS: In total, 49 patients (11 boys and 38 girls) with Gartland type III supracondylar humerus fractures treated with open reduction and cross-pin fixation were retrospectively evaluated. The mean follow-up time was 22.4 years (range, 10.6-37.5 years). The Flynn criteria were used to assess the cosmetic and functional outcomes. Baumann's angle, the lateral rotational percentage, the humerus-elbow-wrist angle, and the humeral condylar angle were obtained from follow-up radiographs. The flexion and extension deficits compared with the uninjured side were measured at the last follow-up. RESULTS: According to the Flynn criteria, the cosmetic outcomes were satisfactory in 93.9% of the patients, and the functional outcomes were satisfactory in 83.7% of the patients. The average flexion deficit was 5° ± 8°, and the average extension deficit was 4° ± 5°. At the final follow-up, the mean difference in the humerus-elbow-wrist angle and the humeral condylar angle between the injured and uninjured sides was -4° ± 7° and 0° ± 3°. CONCLUSIONS: We identified the remodeling in the sagittal plane in supracondylar humerus fractures that had been united in flexion. Satisfactory functional and cosmetic results were obtained with the open reduction and internal fixation of displaced supracondylar fractures of the humerus, and no degenerative changes were observed at the long-term follow-up.

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BACKGROUND: Cell-based strategies that combine in vitro- expanded autologous chondrocytes with matrix scaffolds are currently preferred for full-thickness cartilage lesions of the knee ≥2 cm(2). Although this approach is reasonable, continuing advances in the field of cartilage repair will further expand the options available to improve outcomes. HYPOTHESIS/PURPOSE: In the present clinical study, we compared the outcomes of matrix-induced autologous mesenchymal stem cell implantation (m-AMI) with matrix-induced autologous chondrocyte implantation (m-ACI) for the treatment of isolated chondral defects of the knee. STUDY DESIGN: Prospective, single-site, randomized, single-blind pilot study. METHODS: Fourteen patients with isolated full-thickness chondral lesions of the knee >2 cm(2) were randomized into two treatment groups: m-AMI and m-ACI. Outcomes were assessed pre-operatively and 3, 6, 12 and 24 months post-operatively. RESULTS: Clinical evaluations revealed that improvement from pre-operation to 24 months post-operation occurred in both groups (p < 0.05). At all follow-up intervals, m-AMI demonstrated significantly better functional outcomes (motion deficit and straight leg raise strength) than did m-ACI (p < 0.05). At all follow-up intervals, m-AMI demonstrated significantly better subjective sub-scale scores for pain, symptoms, activities of daily living and sport and recreation of the knee injury and osteoarthritis outcome score (KOOS) than did m-ACI (p < 0.05). Additionally, m-AMI demonstrated significantly better (p < 0.05) scores than m-ACI for the quality of life sub-scale of the KOOS and visual analog scale (VAS) severity at the 6-month follow-up. The Tegner activity score and VAS frequency were not significantly different between the two groups. Graft failure was not observed on magnetic resonance imaging at the 24-month follow-up. m-AMI and m-ACI demonstrated very good-to-excellent and good-to-very good infill, respectively, with no adverse effects from the implant, regardless of the treatment. CONCLUSION: For the treatment of isolated full-thickness chondral lesion of the knee, m-AMI can be used effectively and may potentially accelerate recovery. A larger patient cohort and follow-up supported by histological analyses are necessary to determine long-term outcomes.

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