Don't Let Our Operating Theatre to Be Desert.

PURPOSE OF THE STUDY The purpose of this study is to reveal the waste of water by medical staff hand scrubbing preoperatively in the operation theatre, draw attention to the water consumption with small precautions. The study compares motion-sensitive sensor tap with an uncensored classic tap, to assess the difference of water consumption during hand scrubbing. MATERIAL AND METHODS The presented study compared two groups; hand scrubbing with sensory tap was enrolled as group A and classic tap with running water was enrolled as group B. Three participants were included in each group. Operation faucets with a motion-sensitive sensor and timekeeper were used in group A. Running water from a tap in 10 seconds was measured with the help of a measuring cup. The water amount after 3 minutes of washing was also measured. The difference between the two obtained data was compared. The obtained data were also multiplied to the global surgical data. RESULTS Measurements were performed with a measuring cup and it was measured that 1,250 ml of water is running from faucets in 10 seconds. In group A, faucets were open for 23 seconds whereas in group B faucets were open for 180 seconds. In group A, water utilization was 2,875 ml per person (8,625 ml for three), in group B was the water utilization of 22,500 ml per person (67,500 ml for three). Regarding this data for a single operation, the consumption difference between the two groups was measured as 58,875 ml. The total count of major surgery worldwide per year is reported to 321,500,000. When this number is multiplied with the obtained data, it is calculated that the total amount of water to be saved between the two groups is 18,928,313 m3. That is equal to one year of water consumption of a city with 125,000 inhabitants. CONCLUSIONS In conclusion, as healthcare professionals, it is possible to save enough water as a medium-sized city by changing our handwashing habits in the operation rooms. As a result, water-conserving systems and hand scrubbing education can be very effective in using the natural resources economically and protecting these resources. Key words: water, operation theatre, washing.

The Evaluation of Results of Repair using All-Soft Suture Anchor in the Treatment of Chronic Tendinous Mallet Finger Surgery.

PURPOSE OF THE STUDY The purpose of this study is to evaluate the results of chronic tendinous mallet finger repair with all soft suture anchors. MATERIAL AND METHODS In this retrospective study we evaluated 14 patients. Data included age, side of surgery, the degree of extensor lag, the ratio of the damaged articular surface, postoperative recovery period and time to return to work. We recorded extensor lag and Crawford scores of all patients at the last follow-up. RESULTS Mean follow-up period was 22.07 months. The preoperative and postoperative extensor lags were 27.2 (15-35) and 3 (0-19), respectively. Crawford scores of patients were moderate in 1 patient, fair in 2 patients and excellent in 10 patients. We observed only one skin complication in the postoperative period. CONCLUSIONS All-soft suture anchors have high patient satisfaction rates and functional results. Thus, they could be used in the treatment of patients with chronic tendinous mallet finger. The low complication rate is a major advantage. Key words: tendinous mallet finger, hand surgery, all-soft anchor. Level of evidence: Level-4, Retrospective case-control study.

Is Kinesiotherapy Effective in Relieving Pain and Reducing Swelling after Shoulder Arthroscopy?

PURPOSE OF THE STUDY The purpose of this study is to investigate the acute and long term effectiveness of kinesio taping applied following shoulder arthroscopy in relieving pain and reducing swelling. MATERIAL AND METHODS This study included 50 patients undergone shoulder arthroscopy between June 2016 and December 2017 in our clinic. Patients were randomly assigned into two groups. Group I consisted of patients who had kinesiotherapy; while Group II consisted of control patients whom we applied sham taping with no effect. Pre and postoperative pain and swelling status of patients were recorded and groups were compared. RESULTS Comparing two groups, we found that kinesio taping significantly reduced pain levels in the early post-operative period. However, we didn't detect any significant difference in reduction of shoulder swelling between two groups. CONCLUSIONS Kinesio taping could be an alternative treatment in relieving pain after shoulder arthroscopy. However, we didn't find a significant reduction in swelling in shoulder. Key words:kinesio taping, arthroscopy, shoulder.

An Effective Technique in Treatment of Femoral Neck Fractures - Ostheosynthesis under Double Fluoroscopic Guidance.

PURPOSE OF THE STUDY The most commonly used technique for fixation of the femoral neck fractures is percutaneous osteosynthesis with cannulated screw under fluoroscopy guidance. Osteosynthesis performed under single-fluoroscopic guidance requires continuous repositioning the fluoroscope to obtain biplane imaging. This study aimed to evaluate whether there is a statistically significant difference between the osteosynthesis procedures performed under guidance of single-fluoroscopy and double fluoroscopy with respect to radiation emission safety and treatment parameters for fixation of femoral neck fractures. MATERIAL AND METHODS This retrospective study included 35 patients operated for femoral neck fracture between December 2013 and October 2017. Osteosynthesis was performed in 21 of these patients using cannulated screw under guidance of single-fluoroscopy whereas other 14 patients underwent same type of osteosynthesis assisted by double-fluoroscopy. The parameters of these two groups such as duration of surgery preparation, duration of the surgery, duration of radiation exposure, collo-diaphyseal angle and Harris hip score values were recorded. RESULTS No significant difference was found between the groups regarding time for surgery preparation (p > 0.05). On the other hand, duration of surgery and overall duration of radiation exposure were found 14 (p < 0.05) and 15 (p < 0.05) minutes shorter in the double-fluoroscopy group, respectively. No significant difference was found between the groups in terms of collo-diaphyseal angle and Harris hip score values (p > 0.05). CONCLUSIONS Use of double-fluoroscopy significantly reduces time of surgical duration and also level of radiation exposure in surgery of femoral neck fractures. Key words:double fluoroscopy, femoral neck fractures, radiation, osteosynthesis, cannulated screw.

Orthopedics and Traumatology Residency - Working Conditions, Training, and Psychological Stress.

PURPOSE OF THE STUDY The specialty of orthopedics and traumatology that is completed in the 5 years period in our country is a challenging educational process and our purpose in this study is to demonstrate through a survey training conditions of the orthopedic assistants in our country and the effects of this process on assistants. MATERIAL AND METHODS 524 (70.05%) of 748 assistants who receive specialization training in Turkey were reached. There were 20 multiple choice questions ( 1 mark each) and 3 questions (more than 1 mark each) in the survey consisting of twenty-three questions. Our study group was formed by doctors who have still worked as assistant in our country and have accepted to participate in the study. The doctors who finished assistantship with any reason and did assistantship for time less than 6 months and did not exactly fill the questionnaire form were excluded from the study. RESULTS 524 (71.97%) of 728 assistant who are in 40 (100%) of 40 provinces where assistant training given in Turkey were reached. 474 (90.45%) participants were satisfied to do orthopedic specialization. When considering working hours, it was observed that 337 (64.31%) participants had over 90 hours weekly including night shift and 521 (99.42%) participants had to work after night shift. The majority of participants (361 persons 68.89%) were receiving salaries between TL 4000-6000. When looking at the entire working group, the rate of participants who said that scientific training is weak or there is no scientific training was 427 (81.48%). CONCLUSIONS Our survey study is one of the first statistical study which investigating professional and social problems of orthopedic assistants. Some of important problems as training satisfaction, abuse by patients and/or manager, the average monthly income and psychological status assessment is emphasized. Orthopedics and Traumatology assistantship is a challenging process to cause physical and psychological problems with the hard working conditions in our Turkey. Key words:residency training, orthopedic surgery, life quality, salary.

Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Repair with Mini Soft Suture Anchor (JuggerKnot™).

PURPOSE OF THE STUDY We aimed to investigate the functional outcomes and complications of a new approach, the primary UCL repair using JuggerKnot™ Soft Anchor-1.0 mm Mini (Zimmer-Biomet). MATERIAL AND METHODS This study included a total of 12 patients with acute UCL injury who were operated with primary repair with JuggerKnot™ Soft Anchor-1.0 mm Mini between January 2012 and September 2016. All patients were operated on using the same surgical technique. The thumb pinch and grip strengths, articular range of motion, and Glickel functional score were recorded for all patients. The pinch grip strength and articular range of motion were compared with the intact side. Early and late postoperative complications were recorded. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). The grip strength and the pinch strength were 94.3% and 92.27%, respectively, of the contralateral side. Articular range of motion attained the same level as the contralatereal side in all patients at the final visit, and no patient suffered from any complication. The patients returned to work at a mean of 5.45 weeks, and the Glickel score was good in 1 patient and excellent in the remainder 11 patients. CONCLUSIONS Surgical repair using the JuggerKnot™ Soft Anchor-1.0 mm is an effective alternative treatment method for acute total ulnar collateral ligament (UCL) rupture. Key words:ulnar collateral ligament, acute total injury, thumb, soft suture anchor, JuggerKnot™.

Arthroscopic Excision of Tendinous Giant Cell Tumors Causing Locking in the Knee Joint.

PURPOSE OF THE STUDY Non-osseous giant cell tumors are locally aggressive tumors arising around joints. They are commonly located around synovial joints such as wrist and knee and occasionally cause mechanical symptoms. MATERIAL AND METHODS This retrospective case series includes 7 patients operated due to intraarticular lesion. The mean age of the patients was 28.7 (range 22-37) years. Mean follow-up period was 12 months. RESULTS All patients underwent arthroscopic debridement. They were followed monthly with clinical examination and magnetic resonance imaging (MRI) was obtained at third month for all patients. Patients were contacted through phone call and evaluated with the WOMAC score retrospectively. No recurrence was detected in any patient. CONCLUSIONS Arthroscopic debridement is a safe surgical technique that may replace open surgery in the treatment of intraarticular tendinous giant cell tumors. Key words:tendinous giant cell tumor, arthroscopy, knee locking.

Kinesiotaping Reduces Knee Diameter but Has No Effect on Differences Pain and Edema Following Knee Artroscopy.

PURPOSE OF THE STUDY Investigating the efficacy of kinesiotaping for the reduction of postoperative pain and swelling after invasive knee arthroscopy, which tend to develop in almost every patient undergoing this procedure. MATERIALS AND METHODS Kinesiotaping or sham taping was performed in a total of 42 patients who underwent invasive knee arthroscopy. Pain intensities; mid-thigh, knee, mid-calf, and ankle diameters; and VAS (Visual Analogue Scale) were recorded preoperatively and postoperatively. RESULTS However knee diameter was significantly greater in the control group compared to the group there is no significant differences were observed between the two groups' pain scores at the postoperative period. There were also no significant statistical differences between the two groups with respect to mid-thigh, calf, and ankle diameters. CONCLUSIONS Kinesiotherapy could be used as an effective treatment method to relieve knee effusion after knee arthroscopy. However, both groups did not have significant differences with respect to pain and edema levels. Key words:knee arthroscopy, kinesiotaping, pain control, edema.

The Effect of Incorrect Foot Placement on the Accuracy of Radiographic Measurements of the Hallux Valgus and Inter-Metatarsal Angles for Treating Hallux Valgus.

PURPOSE OF THE STUDY Accurate radiographic measurements are crucial in treating hallux valgus (HV). This three-dimensional deformity should not be evaluated from one joint on one plane. However, in practice, surgeons measure the deformity only on transverse dorsoplantar radiographs. We determined the amount of error associated with positioning the foot incorrectly on radiographs. MATERIAL AND METHODS To simulate incorrect positions of the foot in radiographic evaluation, we designed an angled device that can move in transverse and frontal plane. In four patients with symptomatic HV, we took weight-bearing radiographs of the involved foot in seven different positions. These 28 radiographs were given identifying but meaningless labels. On each radiograph, six surgeons blinded to the position of the radiograph measured the HV angle (HVA) and the inter-metatarsal angle (IMA) and state the treatment plan according to five treatment options were given to participants. RESULTS Inter-observer agreement was high for measurements of HVA and IMA in all positions (interclass correlation coefficients, 0.96 and 0.88, respectively). However, intra-observer agreement was poor for HVA (intra-observer agreement, 0.17) but good for IMA (intra-observer agreement, 0.64). According to the measurements in different positions, intra-observer treatment choices revealed moderate results (ICC: 0.524). Clinical Relevance Radiographic measurements are very important on the treatment decisions of hallux valgus. The foot position can influence the measurement accuracy and can cause incorrect decisions. In this study, we evaluated the impact of foot positions on measurements of hallux valgus angle and inter-metatarsal angle. Additionally, we evaluated the incorrect foot positioning on treatment decisions. Moreover, we analyzed intra-observer and inter-observer agreements of these angles in various positions. CONCLUSIONS We recommend that measurements of IMA are more reliable than those of HVA for managing hallux valgus in terms of false weight bearing radiographs taken in different positions. Positional changes during foot radiographs could lead clinicians to perform incorrect HVA and IMA measurements. This could change the treatment option. HVA measurements were more affected with foot positioning. It is important to take full weight bearing foot radiographs in correct technique. Key words: hallux valgus, radiology, data accuracy.