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This study aimed to investigate the clinical, pathological, and prognostic characteristics of acral metastases in patients with malignant disease and to determine the impact of different types of acral metastasis treatment on patient survival.

In this retrospective study, 64 acral metastatic lesions in 46 patients (17 women, 29 men; mean age, 61.5 years; age range, 35-82 years) who were evaluated by the Bone and Soft Tissue Tumors Council of our institute from 2015 to 2019 were included. The patients' primary tumor site, tumor type, localization of acral metastases, main symptom, duration from the diagnosis of the primary tumor to the diagnosis of acral metastasis, duration from the diagnosis of acral metastasis to death, and survival data were analyzed. The diagnosis of acral metastasis was confirmed by histopathological evaluation in 38 patients and clinical and radiological assessment of the lesions in 8 patients. The treatment type for each acral metastasis was individualized by the institutional Boneatment in 10 (21.7%) patients, and only non-surgical treatment modalities in 21 (45.7%) patients. No significant correlation existed between the treatment types and patient survival (p=0.058). At the final follow-up, 30 (65.2%) patients were dead owing to the disease. MSU-42011 chemical structure The mean overall survival of the entire study group was 24.9 (range, 3-55) months. The mean duration between the diagnosis of acral metastasis and death was 7.6 (range, 3-24) months in patients who were dead owing to the disease (p=0.012).

When the diagnosis of acral metastasis is established, it should be borne in mind that the most common primary tumor site and type are most likely the lungs and adenocarcinoma, respectively. The treatment type for acral metastasis may have no significant impact on patient survival, but the extensiveness of the disease may be a critical factor for survival.

Level IV, Prognostic study.

Level IV, Prognostic study.

This study aimed to compare 2 methods of ulnar variance (UV) measurement (the perpendicular method and the circular method) and to determine whether UV changed based on the demographic characteristics (sex and age).

UV was measured on bilateral wrist radiographs of 124 patients (62 men, 62 women; mean age=48.5 years; range=18-79 years) who had no history of trauma, congenital wrist anomaly, previous wrist surgery, and wrist osteoarthritis by a single radiologist with 4 years of experience. All measurements were made on standardized radiographic images using 2 methods the perpendicular method and the circular method. All the patients were then divided into groups based on sex and age, and the study population was determined by selecting a similar number of patients for each sex and age group.

The mean UV of the right and left wrists was measured as 0.33 (range=-4.3 to 5.7) mm by the perpendicular method and as 0.034 (range=-5 to 5.7) mm by the circular method. A significant difference was determined between the 2 measurement methods (p<0.001). There was a statistically significant difference between sex and UV values in the left wrist measurements by both methods (p<0.05). A significant correlation was found between the UV and age in both right and left side measurements, indicating a statistically significant difference between the methods (p<0.001).

The results of our study demonstrated significant differences in the UV measurement between the 2 methods. Furthermore, UV measurement may change based on age and sex. These differences should be considered in the treatment planning of patients with wrist disorders.

Level IV, Therapeutic Study.

Level IV, Therapeutic Study.

This study aimed to present the mid-term clinical and radiographic outcomes of patients with perilunate injuries treated with open reduction and internal fixation (ORIF).

Patients who underwent ORIF due to perilunate injuries from 2004 to 2015 were retrospectively reviewed. Surgery was mostly performed using a standard dorsal approach. Each injury was graded as per Mayfield staging. At the final follow-up, pain intensity was evaluated using a 10-cm visual analog scale (VAS). Wrist and elbow range of motion, handgrip and pinch strength, Modified Mayo Wrist Scores, and the disabilities of the arm, shoulder, and hand (DASH) scores were measured. On plain radiographic examination, the scapholunate (SL) angle, SL interval, carpal height, and continuity of Gilula arcs were evaluated. The presence of arthritis was also assessed using the Herzberg classification.

In total, 26 male patients (27 wrists) who met the inclusion criteria were included in the study. The mean age was 40 years (range 20-58); the mean foity, and 3 wrists with fractures of the Gilula arcs. The mean carpal height was within the normal range.

In the treatment of perilunate injuries, satisfactory clinical and radiographic outcomes can be expected from ORIF at mid-term follow-up.

Level IV, Therapeutic Study.

Level IV, Therapeutic Study.

The aims of this study were (1) to investigate the changes in the serum concentration of prophylactically administrated vancomycin in the perioperative period of revision hip arthroplasty in penicillin/cephalosporin-allergic patients, (2) to assess whether the postoperative re-administration of vancomycin is needed, and (3) to determine the relationships of vancomycin serum concentration with blood loss, body weight, and fluid replacement in such patients.

This study consisted of 29 patients (20 females, 9 males; mean age=63.3 years; age range=45-79 years) with a history of penicillin/cephalosporin allergy undergoing revision hip arthroplasty secondary to aseptic loosening or periprosthetic fractures. Serum vancomycin levels were measured (1) before administration of vancomycin, (2) at the time of skin incision, (3) every 1,5 hours thereafter until the end of the operation, (4) during the skin closure, and (5) after three and 12 hours from the initial dosage. Data regarding body weight, amounts of intraopum effective serum level at 12th hour postoperatively (AUC=0.793±0.16, p=0.009, AUC=0.753) 26±0.12, p=0.025, respectively).

Evidence from this study has indicated vancomycin concentration at 12th hour is below the effective level in most patients. Thus, earlier repetitive infusion of vancomycin seems to be necessary in penicillin/cephalosporin-allergic patients undergoing revision hip arthroplasty, especially in those with high blood loss.

Level III, Therapeutic Study.

Level III, Therapeutic Study.