RESUMO
Paediatric talus fracture is an extremely rare type of fracture and occurs due to the structural properties of the elastic cartilage that is resistant to high forces. It has a much lower prevalence than in adults. The axial loading of the talus to the anterior tibia while the ankle is in dorsiflexion is the most common mechanism of talus fractures. Although talus neck fracture is the most common fracture, talus corpus fractures are the second most common. Here we present the case of an adolescent male patient who underwent a successful non-surgical treatment and followup of a neglected talus neck fracture.
Assuntos
Tálus , Humanos , Tálus/lesões , Masculino , Adolescente , Fraturas Ósseas/complicações , Resultado do Tratamento , Fraturas do Tornozelo/cirurgiaRESUMO
AIM: To examine the effect of cerebellar damage on the process of fracture healing. MATERIAL AND METHODS: A total of forty-two male rats were selected at random and subsequently allocated into three distinct groups. The experimentals were divided into two subgroups within each group, with the intention of sacrificing them during the third and sixth weeks. Group 1 had isolated femoral fracture, Group 2 had femoral fracture after craniotomy, and Group 3 had femoral fracture accompanying cerebellar injury after craniotomy. Left femoral fractures in rats in all groups were treated using an intramedullary Kirschner wire. Radiological, histological, and biochemical evaluations were conducted at 3 and 6 weeks to assess the processes of fracture healing. To determine the effects of fracture healing and cerebellar injury on oxidant-antioxidant systems, catalase (CAT), malondialdehyde, superoxide dismutase (SOD), and glutathione peroxidase (GPx) activities were measured. RESULTS: Between the time frame of 3 to 6 weeks, Group 3 had higher radiography scores, alkaline phosphatase levels, callus/ diaphyse ratio, callus improvement, and bone mineral density in comparison to the other groups. The activity of SOD was found to be statistically negligible in all groups, suggesting that SOD does not have a substantial impact on fracture healing in cerebellar injury. However, notable increases in the activity of GPx and CAT enzymes were observed, showing their considerable involvement in the process of fracture healing. CONCLUSION: Cerebellar injury reduces the oxidative stress in the fracture area and contributes positively to fracture healing by means of radiologically, biochemically and histopathologically.
Assuntos
Fraturas do Fêmur , Consolidação da Fratura , Ratos , Animais , Masculino , Calo Ósseo/metabolismo , Calo Ósseo/patologia , Fraturas do Fêmur/metabolismo , Fraturas do Fêmur/patologia , Fraturas do Fêmur/cirurgia , Estresse Oxidativo , Superóxido Dismutase/metabolismo , Antioxidantes/farmacologiaRESUMO
OBJECTIVES: The aim of this study was to investigate whether hydroxychloroquine sulfate (HCQS) induced oxidative stress and how it affected the union of bone fractures in an experimental rat model. MATERIALS AND METHODS: A total of 48 Wistar albino male rats were used. The rats were divided into six groups. To investigate the effects of oral administration of HCQS at varying doses between the third and sixth weeks, fracture healing processes were evaluated using radiography, histopathology, biochemistry, and dual-energy X-ray absorptiometry. The activities of antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) were measured to analyze the relationship between HCQS and oxidative stress. RESULTS: Radiographic scores, alkaline phosphatase levels, callus/diaphysis ratio, callus development, and bone mineral density were significantly lower in rats given HCQS at three and six weeks compared to the control group (p<0.005). When oxidative stress parameters were compared among the groups, all antioxidant parameters were statistically significant, indicating that antioxidant systems played a role in peripheral blood, when HCQS was used (p<0.005). CONCLUSION: Oral HCQS intake impairs the fracture healing process by causing oxidative stress in rats. However, further biomolecular researches are needed to understand the underlying mechanism of these effects.
Assuntos
Antioxidantes , Hidroxicloroquina , Ratos , Animais , Antioxidantes/metabolismo , Antioxidantes/farmacologia , Ratos Wistar , Hidroxicloroquina/farmacologia , Consolidação da Fratura , Estresse OxidativoRESUMO
OBJECTIVES: In this experimental study, we aimed to analyze the effects of levocarnitine (L-carnitine) on tendon healing after surgical repair of Achilles tendon rupture in a rat model. MATERIALS AND METHODS: The study included 40 Wistar Albino rats divided into four groups: Group 1, neither surgical intervention nor substance applications were performed for the Achilles tendons. In the other groups, the right Achilles tendons were cut using a scalpel and repaired with a modified Kessler-type technique with 3/0 monofilament polydioxanone suture. In Group 2, the rats did not receive any additional treatment, except for surgical repair. In Group 3, the same volume similar to Group 4 of saline solution was administered intraperitoneally for seven days. In Group 4, each rat received 300 mg/kg of L-carnitine intraperitoneally for seven days. At Week 6, all rats were sacrificed. All right Achilles tendons were used for biomechanical tests and histopathological evaluations. Biochemical analysis of the matrix metalloproteinase was also performed using the blood specimens. RESULTS: There were no significant differences among the groups in terms of the histopathological parameters. Although the mean matrix metalloproteinase level was low in the L-carnitine group, it did not reach statistical significance. A significant increase in maximum force, tensile strength, and strength to 2-mm gap was observed in the L-carnitine group. CONCLUSION: The significant effects of L-carnitine on biomechanical parameters may indicate favorable effects on Achilles tendon healing in rats by reducing matrix metalloproteinase 2 and 9. To improve Achilles tendon healing, further investigation for these markers is needed. Since the effects of L-carnitine on the Achilles tendon cannot be clearly distinguished histopathologically, further studies involving L-carnitine-induced effects are warranted.
Assuntos
Tendão do Calcâneo , Carnitina , Cicatrização , Animais , Ratos , Tendão do Calcâneo/efeitos dos fármacos , Tendão do Calcâneo/cirurgia , Metaloproteinase 2 da Matriz , Ratos Wistar , Ruptura , Cicatrização/efeitos dos fármacos , Carnitina/farmacologiaRESUMO
PURPOSE: Adolescent idiopathic scoliosis (AIS) is believed to be caused by genetic, neurological, osseous growth anomalies, histological variables including muscle fiber percentage and core structure changes, metabolic and hormonal dysfunction, vestibular dysfunction, and platelet microarchitecture. The objective of this study was to contribute to the determination of the cause of AIS by analyzing the changes in pineal gland volume in AIS cases. METHODS: Study (AIS) and control group were each comprised of 26 patients who met the inclusion requirements. Scoliosis radiograph and MRI of the pineal glands were used for radiological examinations. The distribution of age, gender, Risser grading for skeletal radiological development, and sexual maturation according to Tanner categorization were uniform and statistically insignificant between groups. RESULTS: When the pineal gland volumes of the cases were evaluated according to age, the AIS group was found to have significantly reduced pineal gland volumes in all age groups. The pineal gland volume was found to be 38.1% lower in the AIS group compared to the control group (pË0.001). In the AIS group, patients aged 13 years had the lowest pineal gland volume (77.2 ± 13.86 mm3), while patients aged 15 years had the highest volume (97.9 ± 16.47 mm3). CONCLUSION: Changes in pineal gland volume support the role of the pineal gland in the etiopathogenesis of AIS.
Assuntos
Cifose , Glândula Pineal , Escoliose , Adolescente , Humanos , Escoliose/patologia , Glândula Pineal/diagnóstico por imagem , Glândula Pineal/metabolismo , Glândula Pineal/patologia , Cifose/complicações , Imageamento por Ressonância Magnética/efeitos adversosRESUMO
BACKGROUND: The aim of this study was to share the clinical results of open calcaneus fractures, which are extremely rare and have become the fearful nightmare of orthopedic surgeons. METHODS: Between June of 2014 and June of 2020, of 196 patients with the diagnosis of calcaneus fracture, Gustilo-Anderson type IIIB, 17 patients (11 men and six women; mean age, 36.2 ± 4.6 years; range, 22-56 years) under prospective follow-up were retrospectively screened and included in the study. Patients were recorded in terms of classification of fracture, mechanism of injury, comorbidities, surgical progress, complications, and associated orthopedic and nonorthopedic injuries. Functional clinical results and quality of life of the patients were evaluated at the 6-month follow-up with the American Orthopedic Foot and Ankle Society score and the 36-Item Short Form Health Survey questionnaire. RESULTS: The most common etiologic factor was work-related injuries, with 29.4%. Although triple arthrodesis surgery was performed in three cases because of pseudoarthrosis, amputation was performed in one case because of deep infection. The most common soft-tissue defect was located at the medial aspect of the foot, which was commonly reconstructed with the used of reverse flow island sural flap. The average total American Orthopedic Foot and Ankle Society hindfoot score was 51.6 (range, 48-74) and similarly, physical component, pain, and social parameters on the 36-Item Short Form Health Survey were statistically significant compared to Turkish population normal scores. CONCLUSIONS: A long and laborious process is required for both the patient and the surgeon in the treatment of open calcaneal fractures. However, it is possible to obtain good results with soft-tissue reconstructions.
Assuntos
Traumatismos do Tornozelo , Calcâneo , Fraturas Expostas , Masculino , Humanos , Feminino , Adulto , Calcâneo/cirurgia , Sonhos , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Fraturas Expostas/complicações , Fraturas Expostas/cirurgiaRESUMO
The anterolateral thigh (ALT) flap, which can be applied as a free or pedicled flap, is supplied by musculocutaneous or septocutaneous perforators belonging to the descending branch of the lateral circumflex femoral artery. Because local or regional flap options that can be used for the reconstruction of large tissue losses in the distal third of the tibia and foot are limited, ALT and other free flaps are frequently used when needed. The aim of this report is to present our experience with and clinical results of free ALT flaps in a tertiary health-care institution. Between June of 2017 and April of 2020, lower extremity reconstruction with free ALT flaps was performed in seven patients. In the preoperative period, dominant perforators were determined in each patient by Doppler ultrasonography, and surgery was planned considering the size and localization of the defect. All the patients were men, with an average age of 41.7 years. Three patients were operated on for implant exposition on the distal-medial third of the tibia after fracture repair, one patient for posttraumatic calcaneal deformity with osteomyelitis, and two patients because of localized posttraumatic tissue loss in the anterior aspect of the tibia and one patient in the dorsum of the foot. Secondary recovery was achieved in two patients and localized linear necrosis was observed at the flap suture line. No infection was observed in the donor or recipient site. In all patients, the donor site was closed primarily and no wound healing problem was encountered. This is one of the primary reconstruction options for the free ALT flap, especially in cases of large tissue losses in which local and/or regional flap alternatives are insufficient.
Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Masculino , Humanos , Adulto , Feminino , Coxa da Perna/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/cirurgia , Extremidade Inferior/cirurgia , Pesquisa , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgiaRESUMO
BACKGROUND: Ideal suture technique and type in tendon repair are remain unclear. This biomechanical study aimed to assess the biomechanical characteristics of three techniques, modified Kessler (mKE), modified Krackow (mKR), and modified tension Bunnell (mtBU), in sheep Achilles' tendon tear repair using three suture types, polypropylene, polyester, and ultra-high molecular weight polyethylene (UHMWPE) sutures, which are also compared. METHODS: Sixty-three Achilles' tendons harvested from sheep were transversely hacked as a replacement for rupture in a standardized measure and repaired using mKE, mKR, and mtBU techniques with No. 2 polypropylene, polyester, and UHMWPE sutures. Biomechanical parameters, such as Young's modulus, ultimate strength, and strength to the 5-mm gap were recorded for statistical analysis. RESULTS: The mtBU technique with UHMWPE use resulted in increased ultimate strength, strenght to 5-mm gap, Young's modulus, and quantity of specimens with low clinical failure modes compared to other techniques with other suture materials. Furthermore, mtBU has the lowest thickness at the repair side of the tendons. This approach showed tendon failure during maximal traction testing, whereas the mKE and mKR had polyethylene and polyester suture failures. CONCLUSIONS: The UHMWPE suture was significantly superior to the other sutures in each suture techniques in terms of strength and durability. The mtBU technique using UHMWPE suture showed better biomechanical results, implying that this repair might be more appropriate to obtain early mobilization after tendon ruptures.
RESUMO
OBJECTIVES: The aim of this experimental rat study was to investigate the effectiveness of vitamin B12 (Vit-B12) against the teratogenic effects of nicotine use during pregnancy in the fetus. MATERIALS AND METHODS: Eighteen Wistar-Albino pregnant rats were divided into six groups (n=3, each) as Group 1 (control), Group 2 (Vit-B12), Group 3 (nicotine 3 mg/kg/day), Group 4 (nicotine 3 mg/kg/day + Vit-B12), Group 5 (nicotine 6 mg/kg/day) and Group 6 (nicotine 6 mg/kg/day + Vit-B12). Nicotine was administered subcutaneously and Vit-B12 was administered intraperitoneally for 20 days. The skeletal systems of the embryos were stained using the double-staining method. The total bone length (TBL), the length of the ossified part, and the ossification rate were calculated using the ImageJ program. In addition, the weight and crown-rump length (CRL) of the embryos were measured and recorded. RESULTS: Clinical shock effect was observed in all rats administered nicotine. A significant decrease in weight, CRL, and TBL was measured in Group 3 (p=0.0081) and, particularly in Group 5 (p=0.026), which were given only nicotine, compared to other groups. In the morphometric measurements of Group 4 and Group 6 to which Vit-B12 was added, values close to the control group were measured (p=0.173). The data of Group 6 were statistically significantly larger than Group 5 (p=0.007), while it was statistically smaller than Group 1 (p=0.0038). CONCLUSION: Nicotine use negatively affects the morphological development of the embryo. On the other hand, Vit-B12 provides benefits in reducing these negative effects.
Assuntos
Nicotina , Vitamina B 12 , Animais , Desenvolvimento Ósseo , Feminino , Feto , Nicotina/toxicidade , Gravidez , Ratos , Ratos Wistar , Vitamina B 12/farmacologiaRESUMO
Although coracoid fractures are rare fractures, their treatment is critical as they form the coracoacromial arch and superior shoulder suspensory complex (SSSC), which are important structures for shoulder biomechanics. In this case series, clinical, radiological, and demographic characteristics of three male patients who received treatment due to coracoid fracture presenting with traumatic injuries were discussed. The fractures were classified according to the Ogawa and Eyres classifications, and fracture fixation was achieved surgically with the cannulated screws. All patients had a right coracoid fracture. The Constant-Murley Score and the Disabilities of the Arm, Shoulder and Hand scores the patients in the final follow-up visit at 12 months were calculated. In conclusion, good clinical and functional outcomes can be achieved by anatomical reduction and fixation through surgery for displaced coracoid fractures presenting with multiple traumatic injuries located in multiple regions of the SSSC.
Assuntos
Articulação Acromioclavicular , Fraturas Ósseas , Traumatismo Múltiplo , Articulação Acromioclavicular/lesões , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , OmbroRESUMO
BACKGROUND: The aim of the present study was to contribute new and updated information to the literature by comparing the clinical and radiologic results of arthroscopic microfracture, platelet-rich plasma (PRP) after arthroscopic microfracture, and BST-Cargel scaffold application after arthroscopic microfracture in the treatment of talar osteochondral lesions. METHODS: Sixty-two talar osteochondral lesion patients (31 women and 31 men) who underwent ankle arthroscopy in two different centers were randomized into three groups. The first group consisted of patients who underwent only arthroscopic microfracture (MF) (n = 22); the second group consisted of patients who underwent the PRP procedure after arthroscopic MF (PRP; n = 19); and the third group consisted of patients who underwent the BST-Cargel procedure after arthroscopic MF was (BST-Cargel; n = 21). The talar osteochondral lesions in the three groups were classified according to magnetic resonance and arthroscopic images. American Orthopedic Foot and Ankle Society, Foot and Ankle Ability Measurement (overall pain, 15-minute walking, running function), and visual analog scale scores were evaluated preoperatively and postoperatively, and postoperative return time to sports activities was performed. RESULTS: Compared to the preoperative score, postoperative American Orthopedic Foot and Ankle Society score increased 48.80 ± 9.60 in the BST-Cargel group, whereas there was an increase of 46.68 ± 3.65 in the PRP group and 29.63 ± 3.69 in the MF group, which were statistically significant (P < .05).There was a statistically significant postoperative change in the visual analog scale scores of the patients in all three groups compared to the preoperative scores (P < .05). At the end of the follow-up, the Foot and Ankle Ability Measurement overall pain, 15-minute walking, and running function results of all three groups increased significantly postoperatively compared to the preoperative values (P < .005). CONCLUSIONS: BST-Cargel application with microfracture is a method that can be applied easily and safely with arthroscopy to lesions larger than 1.5 cm2 regardless of the size of the cartilage defect, and it has been found to be superior to the other two methods in terms of pain, functional score, radiologic recovery, and return to sports activities.
Assuntos
Cartilagem Articular , Fraturas de Estresse , Fraturas Intra-Articulares , Tálus , Artroscopia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Feminino , Humanos , Masculino , Estudos Prospectivos , Tálus/diagnóstico por imagem , Tálus/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVES: This study aims to evaluate the clinical results and experiences in a community hospital regarding procedures for the replantation and revascularization of fingers. PATIENTS AND METHODS: Between June 2015 and December 2019, a total of 58 patients (51 males, 7 females; mean age: 33.4±6.3 years; range, 23 to 46 years) who were followed after total and/or subtotal amputation and replantation were retrospectively analyzed. The patients were evaluated at nine months in terms of cold intolerance, static two-point discrimination, and functional results using the range of motion (ROM) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. RESULTS: The majority of the patients presented with work-related injuries (70%), most commonly by the mechanism of guillotine (64%), and to the dominant hand (76%) and the third finger (36%) most frequently. The overall success rate of digit salvage was 72.9% (n=51). Of 19 digits with unsuccessful surgical outcomes, seven were from total and 12 were from subtotal amputations. In the long-term, cold intolerance was observed in 14 patients (24.1%) according to the cold intolerance severity scale. The mean static two-point discrimination value was 6.0±0.7 mm and the mean QuickDASH score was 22.3±5.0. The mean ROM measured at nine months after surgery in the metacarpophalangeal and interphalangeal joints of the third and fourth digits was significantly lower than that in the others (p<0.05). CONCLUSION: The predictors of survival of a replanted digit indicated in this study can be used as a guide and decision-making aid for any attempts for replantation.
Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Hospitais Comunitários , Reimplante , Procedimentos Cirúrgicos Vasculares , Adulto , Temperatura Baixa/efeitos adversos , Feminino , Traumatismos dos Dedos/fisiopatologia , Articulações dos Dedos/fisiopatologia , Dedos/irrigação sanguínea , Dedos/fisiopatologia , Humanos , Masculino , Articulação Metacarpofalângica/fisiopatologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Inquéritos e Questionários , Tato , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: In the present study, we aimed to evaluate the effects of pulmonary rehabilitation on respiratory functions after the surgery on the basis of early radiological findings, pain degree, function, and satisfaction scores in operated patients with adolescent idiopathic scoliosis (AIS). METHODS: Thirty patients with AIS were included in the present study, who were divided into 2 groups. Scoliosis surgery and diaphragmatic breathing and pursed lip exercises were applied in Group 1 (nâ=â15), whereas merely scoliosis surgery was applied in Group 2 (nâ=â15). Pulmonary functions, arterial blood gas analysis, Cobb and kyphosis angles, apical vertebral rotation, and apical vertebral translation were measured before and 1st and 6th months after the surgery. Using the SRS-30 test, the psychosocial statuses of the patients and their satisfaction degrees with surgery applied were measured before and after the surgery. RESULTS: Six months after the surgery, the values of Cobb and kyphosis angles and apical vertebral rotations, and apical vertebral translation of the patients were determined to be significantly ameliorated, which is consistent with the literature. Forced vital capacity (l) and forced expiratory volume in the first second (l/s) were observed to be significantly improved in both groups after the surgery (respectively, Pâ=â.001, Pâ=â.014, Pâ=â.001, Pâ=â.005). In addition, the partial pressure of oxygen (pO2) value was found to be significantly increased 6 months after the surgery compared with that before the surgery in Group 2 (Pâ=â.022). SRS-30 showed that most of the scores in Group 1 were dramatically increased; a significant difference between the groups was not recorded. CONCLUSION: Patients with AIS have been found to be satisfied with the surgery. Conversely, pulmonary rehabilitation has been shown to slightly improve the respiratory functions in the patients with AIS, 1 and 6 months after the surgery.
Assuntos
Pulmão/fisiopatologia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Adolescente , Gasometria/métodos , Estudos de Casos e Controles , Criança , Diafragma , Feminino , Volume Expiratório Forçado , Humanos , Cifose/diagnóstico por imagem , Masculino , Radiografia/métodos , Respiração , Testes de Função Respiratória/estatística & dados numéricos , Escoliose/fisiopatologia , Fusão Vertebral/métodos , Resultado do Tratamento , Capacidade Vital , Adulto JovemRESUMO
OBJECTIVE: We purposed to investigate whether preoperative HbA1c level is associated with the severity of surgical treatment in diabetic hand infection cases. MATERIALS AND METHODS: Between December 2015 and October 2018, 102 patients were surgically treated due to diabetic hand infection. Of the patients, 75 who met the criteria for diabetic hand infection were included in the study. The patients were divided into two groups: Group 1, < 8.5% HbA1c level (poorly controlled); and Group 2, 8.5% or higher HbA1c level (uncontrolled). Preoperative, intraoperative, and postoperative data were recorded. Drainage, VAC, ray/open amputation, and microsurgical reconstruction were performed according to the examination and clinical findings. p<0.05 was considered statistically significant. RESULTS: The study groups consisted of 41 patients (5 female/36 male; median age 59 years, range 32-68) in Group 1 and 34 patients (6 female/28 male; median age 62 years, range 28-67) in Group 2. The mean follow-up period was 21.14±10.42 months in Group 1 and 16.70±10.19 months in Group 2, which were not significantly different (p>0.05). The most common microbiological pathogen was polymicrobial in both study groups (39% in Group 1 and 41.2% in Group 2). Drainage was the most common surgical procedure in both groups and there was no significant difference between the groups in terms of the surgical techniques that were used (p>0.05). CONCLUSION: Although HbA1c level is an important biomarker for monitoring glycemia in diabetic patients, it is not associated with the severity of surgical treatment in diabetic hand infections.
Assuntos
Complicações do Diabetes/sangue , Complicações do Diabetes/diagnóstico , Hemoglobinas Glicadas/metabolismo , Mãos , Infecções/sangue , Infecções/diagnóstico , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Amputação Cirúrgica , Complicações do Diabetes/cirurgia , Drenagem , Feminino , Seguimentos , Mãos/microbiologia , Mãos/cirurgia , Humanos , Infecções/cirurgia , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Período Pré-Operatório , PrognósticoRESUMO
In this case report, we present the case of a 20-year-old male patient who suffered from pain in walking clinically, and in whom an extremely rare type of brachymetatarsia was diagnosed. Although distorted body image is the main reason for consulting a specialist, the patient presented because he was unable to find a proper shoe. The patient had no familial history of brachydactyly, trauma, or a genetic disorder. In this extremely rare case, the decision was made to perform shortening of the normal foot ray with a double osteotomy to the metatarsal and proximal phalanx. At the end of the follow-up period, the patient was walking pain-free and had no limitation in shoe choice.
Assuntos
Deformidades Congênitas do Pé , Ossos do Metatarso , Adulto , Deformidades Congênitas do Pé/diagnóstico , Deformidades Congênitas do Pé/cirurgia , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Osteotomia , Dor , Caminhada , Adulto JovemRESUMO
OBJECTIVES: This study aims to compare the clinical and functional results of intertrochanteric femoral fractures treated with bipolar hemiarthroplasty (BHA) or proximal femoral nailing (PFN) in elderly patients. PATIENTS AND METHODS: This multicenter, prospectively followed-up, retrospectively compared cohort-type study included 308 patients (81 males, 227 females; mean age 78.4±7.2 years; range, 65 to 95 years) who were treated with BHA or PFN for intertrochanteric fractures by five orthopedic surgeons in four provinces and seven clinics between January 2014 and May 2018. Clinical follow-up was performed at third week, third and sixth months, and at the end of the first and second years. The American Society of Anesthesiologists for preoperative status, Singh index for bone quality, and Harris Hip Score (HHS) for functional outcomes were evaluated. RESULTS: While 156 patients (38 males, 118 females; mean age 77.7±5.9) were treated with BHA, 152 patients (43 males, 109 females; mean age 79±6.1) were treated with PFN. While there was no significant difference between the two groups in terms of total HHS, a significant difference was found in the sub-parameters (p<0.001). Good and excellent results were found in 78.2% of BHA and 86.2% of PFN patients. Mortality rates were similar at the end of two years (14% and 13.6%, respectively). CONCLUSION: In general, clinical and functional outcomes of BHA and PFN are similar. The rates of pulmonary embolism and deep vein thrombosis are significantly higher in BHA. However, BHA is advantageous in terms of operation time and early weight bearing compared to PFN.
Assuntos
Fixação Intramedular de Fraturas , Hemiartroplastia , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Hemiartroplastia/efeitos adversos , Humanos , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVES: This study aims to evaluate the surgical and clinical outcomes of reversed cross-finger subcutaneous flaps applied to patients with dorsal digital defects. PATIENTS AND METHODS: Between January 2015 and September 2018, 25 (22 males, 3 females; mean age 35.6±11.6 years; range, 19 to 65 years) out of 27 patients under prospective follow-up with finger dorsal digital defect were retrospectively screened and included in the study. The data, obtained by the same two surgeons at six months postoperatively in patients who had undergone reversed cross-finger subcutaneous flaps surgery, concerned cold intolerance, a static two-point separation test, and functional results using range of motion (ROM) and Quick Disabilities of the Arm, Shoulder and Hand (DASH) scoring. RESULTS: The majority of the patients presented with occupational injury (64%), most commonly to the dominant hand (76%) and the fourth finger (36%) most frequently. Seven patients with extensor tendon defects underwent reconstruction with a palmaris longus autograft. At the six-week postoperative follow-up, all flaps were live, the donor site had no morbidity, and no additional intervention was performed. There was no statistically significant difference in finger joint ROM (p>0.05). Cold intolerance was observed in 14 patients (56%). The mean dynamic two-point distinction was 6.0±0.7 mm and the QuickDASH score was 22.3±5.0. CONCLUSION: Due to reasons such as minimal donor site morbidity, satisfactory functional finger outcomes, and easy applicability, reversed cross-finger subcutaneous flap is a good option for reconstruction of defects in the dorsal aspect of the finger with or without extensor mechanism defects.
Assuntos
Traumatismos dos Dedos , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Traumatismos dos Dedos/fisiopatologia , Traumatismos dos Dedos/cirurgia , Mãos/cirurgia , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: This study aims to report the outcomes of dorsal V-Y advancement flap technique used for the reconstruction of surgical defects following total matricectomy performed for the onychogryphosis of hand nails. PATIENTS AND METHODS: A total of 18 consecutive patients (10 males, 8 females; mean age 38.4 years; range, 24 to 41 years) with 20 onychogryphotic hand nails who underwent total matricectomy and dorsal V-Y advancement flap technique were analyzed retrospectively between June 2015 and March 2018. The Mann- Whitney U test was used to compare the pre- and postoperative Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) questionnaire scores while postoperative satisfaction rate was also evaluated. RESULTS: The mean follow-up period of the patients was 15.3 months. The etiology was finger trauma in eight and surgical complication of recurrent paronychia drainage in four cases, while the remaining six were idiopathic. The mean time to return to work was 5.2 weeks, and the mean pre- and postoperative Quick DASH scores were 0.97 and 3.45, respectively, with a statistically significant difference. The postoperative satisfaction was rated as excellent in 16, good in one, and moderate in one case. CONCLUSION: The dorsal V-Y advancement flap technique can be performed reliably due to its good soft tissue coverage, satisfactory cosmetic and functional outcomes, and allowing a short time to return to work.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Reoperação , Transplante de Pele/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Masculino , Doenças da Unha/etiologia , Doenças da Unha/cirurgia , Unhas/cirurgia , Reoperação/efeitos adversos , Reoperação/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: This study aims to investigate whether the motor cortex (MC) or the somatosensory cortex (SC) is more active during the course of bone healing after traumatic brain injury (TBI). MATERIALS AND METHODS: Thirty-three male Wistar albino rats (age, 8 to 10 months; weighing, 250 to 300 g) were randomized into three groups as the control group, MC damage group and SC damage group. Two rats from each brain damage group were sacrificed to verify the locations of the cortical injuries. Callus formation, callus/diaphysis ratios, and serum alkaline phosphatase (ALP) levels were measured at one, three and six weeks. RESULTS: The increases in callus masses in the control, MC, and SC groups were statistically significantly different between one and three weeks (p<0.05). Although this increase in the MC and SC groups was significant compared to the control group at the end of one week, no statistically significant difference was found between the MC and SC groups (p>0.05). There was a statistically significant difference in callus/diaphysis ratio between control, MC and SC groups in favor of MC group only at one week (p<0.05). The increase in serum ALP levels at three weeks was statistically significantly different in the MC and SC groups compared to the control group and significantly higher in the MC group compared to the SC group (p<0.05). CONCLUSION: There is a possible relationship between enhanced fracture healing after TBI and damage in the MC. Motor cortex plays a more active role on fracture healing in TBI.
Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Fraturas do Fêmur/fisiopatologia , Animais , Calo Ósseo/fisiopatologia , Lesões Encefálicas Traumáticas/complicações , Diáfises/fisiopatologia , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Consolidação da Fratura , Masculino , Modelos Animais , Traumatismo Múltiplo/fisiopatologia , Osteogênese , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
OBJECTIVES: This study aims to evaluate the effects of locally applied icariin on bone fracture healing in femur fractured rat model. MATERIALS AND METHODS: The study included 64 male Sprague-Dawley rats (mean age 6 months; weighing, 280-490 g) in eight main study groups. Fracture healing process and level were evaluated with radiography, histopathology and dual energy X-ray absorptiometry to investigate the effects of local administration of icariin at varying doses, which is an exogenous osteo-inductive substance. Activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were measured in the peripheral blood in addition to glutathione (GSH) and myeloperoxidase (MPO) levels to investigate the effects of icariin on the oxidant-antioxidant systems. RESULTS: Radiological bone mineral density measurements and histopathological findings revealed that icariin improved all these parameters in the two healing periods tested. Superoxide dismutase activity decreased in association with local icariin application to the fractured side whereas GPx and GSH increased and MPO remained unchanged. Icariin increased the GPx and GSH levels which are responsible from scavenging hydroxyl radical and hydrogen peroxide. CONCLUSION: Locally administered icariin to the fracture accelerated bone healing by reducing the oxidative stress.