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1.
Ulus Travma Acil Cerrahi Derg ; 29(12): 1368-1375, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38073453

RESUMEN

BACKGROUND: This study aimed to compare the analgesic efficacy of the femoral nerve block (FNB) with that of the pericapsular nerve group (PENG) block in the lateral decubitus position for spinal anesthesia in geriatric hip fracture surgery. METHODS: Patients aged ≥65 years scheduled to undergo hip fracture surgery for proximal femur fractures with an American Society of Anesthesiologists physical status of class I-IV and body mass index of 18-40 kg/m2 were included in the study. The PENG block or FNB was performed 20 min before positioning for spinal anesthesia. Lateral position, hip flexion, and lumbar spine flexion pain were evaluated during spinal anesthesia. RESULTS: Sixty patients completed the study. The median pain scores for lateral positioning were 2 (0-4) and 2.5 in the PENG and FNB groups, respectively (P=0.001). The median pain scores during hip flexion were 1 (0-4) and 2.5 in the PENG and FNB groups, respectively (P<0.001). The median pain score during lumbar flexion was 1 (0-4) and 2.0 in the PENG and FNB groups, respectively (P=0.001). The two groups did not show a significant difference in the quality of the spinal anesthesia position (P>0.05). CONCLUSION: Pre-operative PENG block is more effective in reducing the pain associated with spinal anesthesia position than FNB in geriatric hip fractures. Both blocks had a similar effect on posture quality and the number of spinal interventions.


Asunto(s)
Analgesia , Anestesia Raquidea , Fracturas de Cadera , Fracturas Femorales Proximales , Anciano , Humanos , Nervio Femoral , Fracturas de Cadera/cirugía , Dolor , Dolor Postoperatorio
2.
J Orthop Sci ; 28(1): 195-199, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34991940

RESUMEN

BACKGROUND: For decades there have been concerns about patellar resurfacing (PR) in total knee arthroplasty (TKA) and the individual preference of the surgeon is still the main determinant of whether or not resurfacing is applied. According to preference, surgeons can be categorized in 3 main groups of those who usually, selectively, or rarely resurface. The aim of this prospective, randomized, controlled study was to compare the isokinetic performance and clinical outcome of TKAs with PR and without PR. METHODS: A total of 50 patients scheduled to undergo TKA for primary osteoarthritis of the knee were randomly assigned to either the PR or non-PR groups. There were no significant differences between the groups in respect of age, BMI, gender and preoperative Knee Society Score (KSS) and isokinetic performance. Patients were evaluated at postoperative 3, 6, and 12 months with KSS and at 6 months and 1 year with isokinetic measurements. RESULTS: The PR group had a higher mean score, especially in the functional component of KSS, but the difference was not statistically significant. Knee extension peak torque was significantly higher in the PR group at 6 months (p = 0.029) and 1 year (p = 0.004) postoperatively. There were no significant differences between the groups in respect of knee flexion peak torque values following TKA. CONCLUSIONS: The results of this study demonstrated that PR during TKA is associated with better isokinetic performance and higher knee scores. These results support routine/usually resurfacing of the patella. For surgeons who selectively resurface the patella, the advantage of better isokinetic performance may be taking into consideration in favor of resurfacing the patella where they are undecided. LEVEL OF EVIDENCE: Level I, therapeutic study.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Rótula/cirugía , Estudios Prospectivos , Osteoartritis de la Rodilla/cirugía , Articulación de la Rodilla/cirugía , Resultado del Tratamiento
3.
Jt Dis Relat Surg ; 33(2): 338-344, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35852192

RESUMEN

OBJECTIVES: The aim of this study was to compare radiation exposure of the patient during the closed reduction and proximal femoral nailing (PFN) of the trochanteric region fractures of the proximal femur using a traction table (TT) or a radiolucent table (RT) in the supine position. PATIENTS AND METHODS: Between June 2019 and December 2020, the study included 42 patients (19 males, 23 females; mean age: 81.2±9.5 years; range, 60 to 97 years) with trochanteric region fractures applied with closed reduction and PFN with the same implant type, 21 who underwent surgery on a TT (TT group), and 21 on a RT (RT group). The cumulative radiation dose was the primary outcome and was measured as the dose area product (DAP) in Gray cm2 (Gycm2 ). Intraoperative fluoroscopy times and amount of radiation exposure were compared between the two groups. RESULTS: There was no significant difference between the two groups in terms of sex, age, body mass index, fracture side, and the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification (p>0.05). No statistically significant difference was found between the TT and RT groups in terms of the mean intraoperative fluoroscopy time (48.29±22.31 and 55.95±21.54 sec, respectively; p=0.264) and amount of radiation exposure (2.26±1.86 and 2.84±1.96 Gycm2 , respectively; p=0.332). CONCLUSION: Both TT and RT with the patient positioned supine provide similar results for closed reduction and PFN of trochanteric region fractures, in terms of DAP as the most reliable measurement method. The main clinical relevance of this study is that radiation exposure of the patient need not be considered while selecting the operating table.


Asunto(s)
Fijación Intramedular de Fracturas , Fracturas de Cadera , Exposición a la Radiación , Anciano , Anciano de 80 o más Años , Clavos Ortopédicos , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Fijación Intramedular de Fracturas/métodos , Fracturas de Cadera/cirugía , Humanos , Masculino , Exposición a la Radiación/efectos adversos , Tracción/métodos
4.
Ulus Travma Acil Cerrahi Derg ; 28(7): 1020-1026, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35775677

RESUMEN

Gluteal compartment syndrome (CS) secondary to the superior gluteal artery (SGA) injury and pseudoaneurysm formation is a very rare condition. When it does occur, it usually manifests with acute and life-threatening hemorrhage resulting in early hypov-olemic changes. Delayed presentation of the gluteal CS (GCS) after trauma has been described in the literature seldom and these cases were demonstrated with sciatic nerve palsy, hemodynamic instability, decreased hemoglobin levels, increasing buttock pain, and a large gluteal hematoma. In this report, we present a case of GCS presenting with the palsy of the peroneal division of the sciatic nerve secondary to SGA pseudoaneurysm following ballistic injury, with a delay of nearly 20 days in diagnosis and treatment with normal hemodynamic findings. The patient required emergent angiographic embolization and then fasciotomy which were approx-imately 13 days after the onset of the symptoms. The patient made a positive recovery with no further neurologic deterioration and none local wound or systemic complications. This case emphasizes the importance of early diagnosis and treatment of this rare condition.


Asunto(s)
Aneurisma Falso , Síndromes Compartimentales , Neuropatías Peroneas , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Nalgas , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Humanos , Arteria Ilíaca , Neuropatías Peroneas/complicaciones
5.
Jt Dis Relat Surg ; 33(1): 102-108, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35361084

RESUMEN

OBJECTIVES: In this study, we aimed to examine the effect of tranexamic acid (TXA) on hidden blood loss in total hip arthroplasty (THA) patients. PATIENTS AND METHODS: Between June 2015 and June 2021, a total of 120 patients (45 males, 75 females; mean age 57.2±4.9 years; range, 45 to 67 years) with primary osteoarthritis who underwent THA without the use of TXA and 53 patients who received TXA were retrospectively analyzed. Demographic data, amount of transfusion, early complications, preoperative and postoperative hemoglobin and hematocrit values, total blood loss, visible blood loss, and hidden blood loss values were compared. RESULTS: There was a significant difference between the groups with and without the use of TXA in terms of intraoperative bleeding, amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion (p<0.05). A significant positive correlation was found between intraoperative blood loss and hidden blood loss (r=0.325 p<0.01), while no significant correlation was found between postoperative drainage volume and hidden blood loss (r=-0.006 p=0.946). CONCLUSION: The use of TXA in patients undergoing THA reduces blood loss, including hidden blood loss, thereby reducing the need for blood transfusion after hip arthroplasty. However, there seems to be no linear relationship between postoperative blood loss and hidden blood loss. Considering these results, the routine use of TXA can be recommended in THA, unless there is a contraindication.


Asunto(s)
Antifibrinolíticos , Artroplastia de Reemplazo de Cadera , Ácido Tranexámico , Antifibrinolíticos/uso terapéutico , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Pérdida de Sangre Quirúrgica/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Ácido Tranexámico/uso terapéutico
6.
Eur J Trauma Emerg Surg ; 48(3): 1879-1884, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33864094

RESUMEN

PURPOSE: Intertrochanteric femur fractures (IFF) is one of the biggest health problems in elderly population and mostly treated by proximal femoral nails. Although it is done in less invasive technique this method can cause higher blood loss than expected and subsequent allogenic blood transfusions. In this study, we aimed to investigate the factors that were related to the blood loss in proximal femoral nail fixation of IFF including patients' ongoing anticoagulant treatments. METHODS: 231 consecutive patients with IFF who treated with proximal femoral nail anti-rotation between January 2017 and December 2019 were included the study. The factors that can affect the blood loss determined as patients demographics, time from injury to operation, duration of operation, the American Society of Anesthesiologists (ASA) scores, preoperative anticoagulant medications. Hematocrit and hemoglobin were obtained on admission day, postoperative day one and postoperative day 3. Total blood loss and allogenic blood transfusions assessed. RESULTS: Higher BMI is found related to higher blood loss. The patients who were operated in the first two days after admission had lower blood loss levels independent from anticoagulant use (p = 0.027). Preoperative Hct was higher in patients who did not need RBCs in the perioperative period (p = 0.039). According to the AO classification, A2.1 fractures had lower blood loss levels. CONCLUSION: This study demonstrated that ongoing anticoagulant treatments of intertrochanteric fracture patients did not increase the perioperative blood loss. The factors affecting blood loss in the proximal femoral nail fixation were BMI, the time to surgery, and fracture type in the elderly.


Asunto(s)
Fracturas del Fémur , Fijación Intramedular de Fracturas , Fracturas de Cadera , Anciano , Anticoagulantes/uso terapéutico , Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fémur , Fijación Intramedular de Fracturas/métodos , Hemorragia , Fracturas de Cadera/cirugía , Humanos , Estudios Retrospectivos , Resultado del Tratamiento
7.
J Coll Physicians Surg Pak ; 31(11): 1320-1324, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34689490

RESUMEN

OBJECTIVE: To compare the long-term functional results of the first and second knees in simultaneous bilateral total knee arthroplasty. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Gulhane Education and Research Hospital, Ankara, Turkey from January 2003 to December 2010. METHODOLOGY: A total of 47 patients with at least 10 years of follow-up after simultaneous bilateral total knee arthroplasty were included in the study. The range of motion, forgotten joint score (FJS), Oxford knee score (OKS), and Western Ontario McMaster university osteoarthritis index (WOMAC) were compared between the first and the second knees. The Dependent t-test and the Wilcoxon Sign test were used to determine the significance. Whether there was a statistically significant correlation, so Spearman's correlation test and Bonferroni correction were used. RESULTS: WOMAC total scores both knees were 13 (p=0.755). The average OKS of the first operated knees was 40.53 ± 4.44, while it was 40.28 ± 4.59 in the second knees (p=0.239). The FJS of the first and second operated knees were 69.36 ± 21.97 and 69.02 ± 21.89, respectively (p=0.321). As the age increased, the ROM was decreased. As the patient age increased, WOMAC pain scores were found to decrease. CONCLUSION: The functional scores of the first and the second operated knees in SBTKA were similar in the long term. Although no correlation was found between age and the functional scores, these results complied with the previous information about the effect of age on TKA results. Key Words: Simultaneous total knee arthroplasty, Bilateral, Clinical outcome, Osteoarthritis.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento
8.
Med Sci Monit ; 26: e919993, 2020 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-31961830

RESUMEN

BACKGROUND In the present study, we aimed to evaluate early clinical and biochemical outcomes of direct anterior approach (DAA) versus posterolateral approach (PLA) for hemiarthroplasty in the treatment of displaced femoral neck fractures in geriatric patients. MATERIAL AND METHODS Between September 2012 and September 2017, a total of 110 patients who underwent hemiarthroplasty for displaced femoral neck fractures were retrospectively analyzed. The patients were divided into 2 groups according to the surgical technique PLA (Group 1, n=54) and DAA (Group 2, n=56). Clinical and biochemical results were compared. RESULTS There was no significant difference in the demographic characteristics of the patients, fixation type, and follow-up (P>0.05). However, there was a significant difference in the duration of surgery, amount of blood transfusion, change from baseline in postoperative hemoglobin levels, amount of intraoperative gauze dressing, amount of drainage fluid from the surgical wound, postoperative VAS scores, incision length, length of hospital stay, and Barthel Index scores in favor of DAA group (P<0.05). There was no significant difference in the degree of mobilization (P>0.05). None of the patients had postoperative complications in Group 1, while 3 patients in Group 2 developed a lateral femoral cutaneous nerve lesion and one patient had a missed iatrogenic fracture of the greater trochanter. CONCLUSIONS Our study results suggest that early clinical and biochemical outcomes are better in DAA than PLA with early return to daily living activities in patients undergoing hemiarthroplasty for displaced femoral neck fractures.


Asunto(s)
Fracturas del Cuello Femoral/cirugía , Fracturas del Cuello Femoral/terapia , Hemiartroplastia/métodos , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Fémur/cirugía , Humanos , Tiempo de Internación , Masculino , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento
9.
Eklem Hastalik Cerrahisi ; 30(3): 329-32, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31650934

RESUMEN

Brachial plexus injury due to prolonged immobilization of the arms in a hyper-abducted position during intensive care unit (ICU) follow-up is uncommon. In this article, we present an unusual case of a 20-year-old male drug addict who sustained unattended brachial plexus injury in left upper extremity after being bound over the axilla tightly during ICU follow-up. He had progressive numbness and near-total immobility of the left upper extremity. Atrophy, loss of muscle strength, and absence of deep tendon reflexes were observed in left upper extremity. Electrodiagnostic studies showed lower trunk partial axonal involvement. After aggressive physical therapy, patient's muscle function improved, showing full strength in all muscles innervated by median, ulnar, musculocutaneous, axillary and radial nerves. During follow-up of unconscious patients in ICU, clinicians and other staff should be more careful about restraining such patients by considering complications such as nerve injuries.


Asunto(s)
Plexo Braquial/lesiones , Pacientes Internos , Trastornos Relacionados con Sustancias , Humanos , Enfermedad Iatrogénica , Unidades de Cuidados Intensivos , Masculino , Adulto Joven
10.
Turk Neurosurg ; 29(3): 400-403, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30649816

RESUMEN

AIM: To evaluate the pelvic incidence (PI) of coccydynia patients treated by different methods and to determine whether it is a risk factor or a prognostic factor. MATERIAL AND METHODS: Patients who were treated for coccydynia were evaluated retrospectively, and 110 patients were enrolled. Spinopelvic parameters were measured by using Surgimap software, and the position of the coccyx was evaluated according to the Postacchini classification. The results were compared to spinopelvic parameters of healthy population. RESULTS: The mean PI of the coccydynia patients did not differ from the healthy population, and there were no differences between treatment subgroups. The Postacchini classification showed that patients with type-3 and type-4 configurations had higher PI. When treatment groups were evaluated according to Postacchini classification, 80% of the surgery group had type-3 and type-4 configurations (50%, 30% respectively). CONCLUSION: This is the first study to evaluate the PI of coccydynia patients. Patients with higher PI were prone to having type-3 of type-4 coccyx configurations and undergoing surgical treatment.


Asunto(s)
Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/terapia , Cóccix/diagnóstico por imagen , Tratamiento Conservador/métodos , Procedimientos Neuroquirúrgicos/métodos , Huesos Pélvicos/diagnóstico por imagen , Corticoesteroides/administración & dosificación , Adulto , Anciano , Antiinflamatorios no Esteroideos/administración & dosificación , Dolor de Espalda/epidemiología , Cóccix/cirugía , Tratamiento Conservador/tendencias , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/tendencias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
11.
J Orthop Surg (Hong Kong) ; 26(1): 2309499017754093, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29382296

RESUMEN

INTRODUCTION: The purpose of this present study is to investigate the efficacy of vancomycin-loaded VK100 silicone cement drug delivery system in the treatment of implant-related methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis in rats. MATERIALS AND METHODS: Thirty-six adult (18-20 weeks old) female Sprague-Dawley rats were included in the study. All rats underwent experimental osteomyelitis surgery via injecting 100 µL bacterial suspension of MRSA into the medullary canal. After a 2-week duration for the formation of osteomyelitis model, rats were assigned randomly into four groups: control (C), systemic vancomycin (V), local vancomycin-loaded VK100 silicone cement (vVK100), and systemic vancomycin and local vancomycin-loaded VK100 silicone cement (V+vVK100). The following treatment protocols were administered to each group for 4 weeks. For group C, 0.9% saline solution equivalent to the volume of vancomycin dose (approximately 1 ml/kg) was administered intraperitoneally twice daily (12-h intervals). For group V, 15 mg/kg of vancomycin was administered intraperitoneally twice daily (12-h intervals). For group vVK100, vVK100 polymer was included so that the intramedullary canal of the rats are affected. For group V+vVK100, vVK100 polymer was included so that the intramedullary canal of the rats are affected and 15 mg/kg of vancomycin was administered intraperitoneally twice daily (12-h intervals). After 4 weeks of treatment, clinical, radiologic, microbiologic, and histopathologic evaluations were performed for all groups. RESULTS: Results of this study revealed that all scores of the evaluation criteria for the treatment groups (groups V, vVK100, and V+vVK100) decreased due to the treatment protocols when compared to group C. These results show the effectiveness of all treatment protocols for the implant-related chronic MRSA osteomyelitis. However, there were no statistical difference between these three protocols. CONCLUSIONS: vVK100 polymer, as a local antibiotic delivery system, seems to be an effective method for the treatment of implant-related chronic MRSA osteomyelitis.


Asunto(s)
Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Osteomielitis/tratamiento farmacológico , Prótesis e Implantes/microbiología , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Siliconas , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/farmacología , Animales , Antibacterianos/farmacología , Modelos Animales de Enfermedad , Femenino , Osteomielitis/etiología , Osteomielitis/microbiología , Prótesis e Implantes/efectos adversos , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/microbiología , Ratas , Ratas Sprague-Dawley , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/microbiología
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