Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery.

PURPOSE: This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. METHODS: This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. RESULTS: A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. CONCLUSION: The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.

Higher reliability of triple-phase bone scintigraphy in cementless total hip arthroplasty compared to cementless bipolar hemiarthroplasty.

PURPOSE: Periprosthetic infection is one of the main reasons for revision surgery after hip arthroplasty. The purpose of the present study is to compare the reliability of triple-phase bone scintigraphy (TPBS) in the diagnosis of periprosthetic infection between cementless total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA). METHODS: In this retrospective study, 52 patients were analyzed; 33 of them were performed with THA and 19 of them were performed with BHA. The exclusion criteria were cementation in previous surgery, romatological joint disorders, periprosthetic fracture and malignancy history. C reactive protein (CRP) and erythrocyte sedimentation (ESR) rate results were recorded preoperatively. Tissue samples from the different areas periprosthetic tissue were obtained for histopathological examination and sample tissue culture. RESULTS: In the present study, the sensitivity, specificity and accuracy were 90.9%, 77.3% and 81.8%, respectively, for THA and 77.8%, 60.0% and 68.4%, respectively, for BHA. Positive predictive values for THA and BHA were 66.7% and 63.6%, and negative predictive values were 94.4% and 75.0%, respectively. CONCLUSIONS: Due to the higher sensitivity, specificity and accuracy, TPBS has a more reliable diagnostic value for cementless THA in the diagnosis of periprosthetic infection compared to cementless BHA.

Periprosthetic Femur Fracture Occuring after Contralateral Neglected Femoral Neck Fracture.

INTRODUCTION: Periprosthetic fractures of the femur are uncommon, but at times may lead to complications especially in elderly patients. As treatment of these fractures is difficult, prevention by identifying the risk factors is the best way to overcome these complex problems. CASE REPORT: A periprosthetic right femur fracture associated with a neglected left femoral neck fracture in the contralateral femur in a 78-year-old elder woman patient is reported in the present article. We discuss the prevention of periprosthetic fractures after hip arthroplasty and address the risk factors associated with this complication. CONCLUSION: The present case emphasizes the importance of investigating and treating the cause of sudden onset of restriction on full weight-bearing in the contralateral limb, to prevent periprosthetic femoral fracture after hip arthroplasty in elderly patients.

Better life quality and sexual function in men and their female partners with short-segment posterior fixation in the treatment of thoracolumbar junction burst fractures.

PURPOSE: Thoracolumbar junction burst fractures remain a challenging problem due to controversy over the treatment choice of short- or long-segment posterior fixation. The aim of the present study was to compare life quality and sexual function of patients after short- and long-segment posterior fixations in the treatment of thoracolumbar junction burst fractures. METHODS: In this prospective, randomized study, 24 sexually active male patients diagnosed with thoracolumbar junction burst fractures were randomly assigned to either the short-segment posterior fixation (SSPF) group or the long-segment posterior fixation group (LLPF). The exclusion criteria were rheumatological disease and spinal surgery history. There were no significant differences in age, body mass index or smoking habits between the groups. The life quality score of EQ-5D and the International Index of erectile function (IIEF-5) score of male patients and the Female Sexual Function Index (FSFI) score of female partners were recorded preoperatively and 1 year after surgery. RESULTS: The mean age of patients in the SSPF and LSPF groups was 44.58 and 42.92 years, respectively. There were no statistically significant differences between the groups in the preoperative EQ-5D and IIEF-5 scores of male patients and the FSFI score of their partners. Postoperatively, the EQ-5D scores (p = 0.011) and IIEF-5 scores (p = 0.000) of male patients and the FSFI score of their partners (p = 0.001) were better in the short-segment group. CONCLUSIONS: Patients treated with SSPF have better sexual function and life quality with their partners compared to those treated with LSPF. The main clinical relevance of this study is that the impact of the choice of short or long-segment treatment on postoperative sexual function and life quality should be considered by surgeons when performing posterior fixation after thoracolumbar junction burst fractures.

Clinical and radiological outcomes of conservative treatment after stable post-traumatic thoracolumbar fractures in elderly: Is it really best option for all elderly patients?

OBJECTIVE: The purpose of this study was to research the effectiveness of conservative treatment of stable post-traumatic thoracolumbar vertebral fractures in elderly patients. METHODS: The study included 21 elderly patients (13 females, 8 males) with post-traumatic thoracolumbar compression fracture who were treated with a brace. Fractures without any trauma history, pathological fractures, patients younger than 60 years old and patients with no malignancy history were excluded from study. Neurological examination and posterior ligamentous complex (PLC) were intact in all patients. Radiological parameters and pain scores were recorded in regular follow-up. RESULTS: The mean age and follow-up were 71.3 years (range, 60-84 years) and 20.1 months (range, 12-26 months) respectively. During follow-up, 4 patients had significant height loss resulting in kyphotic deformity and intractable pain. There was a significant increase in the local kyphosis angle (p = 0.001) and height loss percentage (p = 0.017). At the final follow-up, the mean Denis Score of pain was 1.62 ± 0.74. CONCLUSION: Although there is wide acceptance of conservative treatment of post-traumatic stable thoracolumbar fracture with intact PCL according to the Thoracolumbar Injury Classification and Severity Score (TLICS), elderly female patients with a post-traumatic compression fracture in the junctional region are at great risk of conservative treatment failure. These patients should be well-informed about the possible complications and poor results of conservative treatment, and surgical treatment should be considered in selective cases with the informed consent of the patients.

Isokinetic performance of hip muscles after revision total hip arthroplasty via previous anterolateral approach.

We investigated the isokinetic performance of hip muscles and clinical outcomes after revision total hip arthroplasty (THA) via same anterolateral approach used in primary surgery. Thirty patients who had undergone previous THA via an anterolateral approach underwent both acetabular and femoral component revision after aseptic loosening. The Harris Hip Score (HHS) was evaluated during a minimum 2-year follow-up. The isokinetic muscle strength of the operated and nonoperated hips was assessed 1 year after surgery. The HHS improved from 49.0 to 77.4. Operated and nonoperated hips exhibited similar isokinetic performance during all measurements (flexion, extension, and abduction) (p>0.05). This prospective study showed that the anterolateral approach preserves abductor strength after revision THA in aseptic cases with acceptable functional and clinical results. The main clinical relevance of this study is that the same anterolateral approach used in previous primary THA is also safe and viable for revision THA.

Perioperative alendronate, risedronate, calcitonin and indomethacin treatment alters femoral stem fixation and periprosthetic bone mineral density in ovariectomized rats.

BACKGROUND: Many factors affect implant stability and periprosthetic bone mineral density (BMD) following total joint arthroplasty. We asked whether perioperative alendronate, risedronate, calcitonin and indomethacine administration altered (1) femoral stem shear strength and periprosthetic bone mineral density BMD in ovariectomized rats and (2) whether there were differences in the effect of these drugs. METHODS: Thirty overiectomized rats were divided into five groups and implanted with intramedullary mini-cortical screws in the femur. Four groups were treated with alendronate, risedronate, salmon calcitonin and indomethacin for 4 weeks preoperatively and 8 weeks postoperatively. RESULTS: Although alendronate and risedronate increased the periprosthetic BMD more than calcitonin, they did not alter implant fixation compared to calcitonin. Indomethacin significantly decreased the BMD around the stem and implant stability compared to all other groups. CONCLUSIONS: This study showed that perioperative treatment with bisphosphonates and calcitonin improved the BMD around the stems and implant stability. Although bisphosphonates increased the BMD more than calcitonin, there was no difference in implant stability. Indomethacin markedly decreased the periprosthetic BMD and implant stability. The main clinical significance of our study was the finding about the need to strictly avoid long-term use of high-dose nonsteroidal antiinflammatory drugs for patients who have major joint arthritis and a previous history of arthroplasty.

The relationship between serum adiponectin level and anthropometry, bone mass, osteoporotic fracture risk in postmenopausal women.

OBJECTIVES: The aim of the present study was to evaluate the possible correlation between bone mass and serum adiponectin levels, and the correlation between adiponectin levels and osteoporotic fracture risk in a prospective clinical trial. PATIENTS AND METHODS: Postmenopausal non-diabetic 105 women (mean age 63.4+/-8.1; range 52 to 64 years) with hip fracture were evaluated. Of these 105 patients, 46 had trochanteric fractures, 24 had subtrochanteric fractures and 35 had femoral neck fractures. Anthropometric measurements were performed. Serum adiponectin level was measured by means of ELISA. Total bone mineral density and bone mineral content of lumbar spine and proximal femur were measured by dual-energy X-ray absorptiometry (DEXA). RESULTS: Lumbar bone mineral density and proximal femoral bone mineral density were not correlated with serum adiponectin levels. Serum adiponectin level was not found to have any significant effect on bone mass. Serum adiponectin levels were not significantly different between the patients with osteoporotic fractures and those with non-osteoporotic fractures. CONCLUSION: Our study showed that serum adiponectin level is not associated with bone mass and osteoporotic fracture risk. Investigation of local adiponectin levels in bony tissue is needed to clarify the possible relation between adiponectin and bone mass, and risk of fractures associated with osteoporosis.

[The role of functional bracing in the treatment of humeral shaft fractures]. / Humerus cisim kiriklarinda fonksiyonel breys tedavisinin yeri.

OBJECTIVES: We evaluated clinical, radiographic, and functional results of patients treated with functional bracing for humeral shaft fractures. METHODS: Humeral shaft fractures of 30 patients (19 males, 11 females; mean age 34 years; range 18 to 64 years) were treated with functional bracing. Fractures were on the right in 18 patients, on the left in 12 patients. All were closed fractures, being spiral in 10, comminuted in nine, transverse in six, and oblique in five patients. Humeral fractures were in the upper third, middle third, and distal third in 16, 8, and 6 patients, respectively. Functional brace was applied after a mean of six days (range 0 to 16 days) and was worn throughout day and night until radiographic signs of sufficient union and healing was observed. Functional assessment was made according to the Hunter criteria. The mean follow-up was 20 months (range 10 to 58 months). RESULTS: Union was achieved in 24 patients (80%) after a mean of 14 weeks (range 11 to 21 weeks). Six fractures (20%) failed to unite and were subsequently treated with surgery. According to the Hunter criteria, 24 patients (80%) were evaluated as good (G3-4), and six patients (20%) as excellent (G5). The mean varus-valgus rotation was 6 degrees , the mean anterior-posterior translation was 8 degrees in patients who had union with functional bracing. Four patients developed skin macerations secondary to brace use. Limb shortening of 1.7 cm occurred in one patient whose fracture was united with bracing. CONCLUSION: Our clinical and radiographic results suggest that, based on proper indications, functional bracing applied after regression of edema may be the treatment of choice in humeral shaft fractures.

[Capsuloperiosteal flap application for the stabilization of chevron osteotomy]. / Chevron osteotomisinin stabilizasyonu amaciyla kapsüloperiosteal flep uygulamasi.

OBJECTIVES: We retrospectively analyzed the results of capsuloperiosteal flap application to stabilize modified distal chevron osteotomy in patients with mild to moderate intermetatarsal and hallux valgus angles. METHODS: Modified chevron osteotomy was performed in 27 feet of 25 patients (14 females, 11 males; mean age 30.4 years; range 19 to 43 years) with hallux valgus. The study group was comprised of patients unresponsive to conservative treatment for painful deformity, at ages 18 to 50 years, and having an intermetatarsal angle less than 17 degrees, hallux valgus angle less than 40 degrees, and no osteoarthritic changes in the metatarsophalangeal joint. The patients were evaluated clinically and radiographically preoperatively and in the early postoperative period, in the sixth week, and once in every six weeks. Clinical assessments were made using the subjective and objective evaluation systems of Bonney and Macnab. The mean follow-up was 22 months (range 8 to 67 months). RESULTS: The mean preoperative hallux valgus angle, which was 31.4 degrees (range 23 degrees to 40 degrees), decreased to 12.8 degrees (4 degrees-22 degrees) postoperatively, with a corresponding decrease in the intermetatarsal angle from 14.2 degrees (11 degrees-17 degrees) to 9.6 degrees (7 degrees-14 degrees). Conformity of the first metatarsophalangeal joint was complete in all the cases. According to the Bonney and Macnab subjective scores, the results were excellent in seven feet (25.9%), good in 17 feet (63%), and moderate in three feet (11.1%). On objective evaluations, the results were excellent in 14 feet (51.9%), good in 11 feet (40.7%), moderate in one foot (3.7%), and poor in one foot. CONCLUSION: Our results suggest that modified chevron procedure whose stability is improved by the use of a capsuloperiosteal flap without using any internal fixation material is an effective alternative for the treatment of patients with moderate degrees of hallux valgus without metatarsophalangeal joint degeneration.

Mechanoreceptor evaluation of hip joint capsule and ligamentum capitis femoris in developmental hip dysplasia: a preliminary study.

We aimed to determine if there are mechanoreceptors in the hip joint capsule and ligamentum capitis femoris (LCF) of patients with developmental dysplasia of the hip (DDH). We took capsule and LCF biopsies from 20 hips of 20 patients who were operated on because of DDH. The mean age was 10.2 months (range 6-20 months) at the time of surgery. There were 12 girls and eight boys. Teratologic and secondary hip dislocations were not included in this study. Full thickness, 0.5 x 0.5 cm anterior capsule and LCF portions were taken for biopsy specimen. Specimens were stained with hemotoxylin eosin and examined immunohistochemically using monoclonal antibody against S-100 protein. In both analyses no mechanoreceptor was found in any samples of capsule or LCF. In this preliminary study we could not find mechanoreceptors in the local anterior joint capsule and LCF of the hip in children with DDH. We think that additional studies are necessary in order to understand the mechanoreceptor characteristics of the hip joint in children not only with DDH but also in children with healthy hips.

[Simultaneous asymmetric bilateral traumatic hip dislocation: a case report]. / Asimetrik iki tarafli travmatik kalça çikigi: Olgu sunumu.

Asymmetric bilateral (one side anteriorly, the other posteriorly dislocated) traumatic hip dislocations are very rare. We present a 21-year-old male patient who had simultaneous anterior and posterior traumatic hip dislocations due to a car crash. He also suffered from a tarsometatarsal (Lisfranc's) fracture-dislocation. The patient underwent conservative treatment and was followed-up for 44 months. Final evaluations with Thompson and Epstein radiologic and clinical criteria showed an excellent result. To our knowledge, this is the first report of a case with asymmetric bilateral traumatic hip dislocations associated with Lisfranc's injury.

Arthritis and osteomyelitis due to Aspergillus fumigatus: a 17 years old boy with chronic granulomatous disease.

BACKGROUND: Invasive Aspergillus infections are frequently seen in immunocompromised patients but arthritis is a rare complication of Aspergillus infections in the absence of immune suppressive therapy, trauma or surgical intervention. CASE PRESENTATION: A 17 years old male patient with arthritis and patellar osteomyelitis of the left knee whose further investigations revealed chronic granulomatous disease as the underlying disease is followed. Aspergillus fumigatus was isolated from the synovial fluid and the tissue samples cultures. He was treated with Amphotericin B deoxicolate 0.7 mg/kg/day. Also surgical debridement was performed our patient. Amphotericin B nephrotoxicity developed and the therapy switched to itraconazole 400 mg/day. Itraconazole therapy were discontinued at the 6th month. He can perform all the activities of daily living including. CONCLUSION: We think that, chronic granulomatous disease should be investigated in patients who have aspergillar arthritis and osteomyelitis.