Intraarticular TXA Administration with Appropriate Timing of Clamping and Appropriate Dose is More Effective Than IV Administration.

PURPOSE OF THE STUDY: Our aim was to compare the effects of intraarticular and intravenous (IV) tranexemic acid (TXA) application on bleeding and complication rates in patients who underwent total knee arthroplasty (TKA). MATERIAL AND METHODS: Between 2017 and 2021, 406 patients who underwent TKA with 2 g of IV TXA and retrograde 1.5 g of TXA applied through the drain were included in the study. Of the patients, 206 were in the IV TXA group. Preoperative and postoperative hemoglobin levels, drain output, BMI, ASA score, blood loss, and the number of transfused patients were recorded. Complications such as symptomatic venous thromboembolism were also recorded. RESULTS: There was no significant difference between the two groups in terms of age, sex, American Society of Anesthesiologists (ASA) score, or BMI (p = 0.68, 0.54, 0.28, 0.45). Total drain output and blood loss were significantly higher in the IV TXA group than in the intraarticular TXA group (p < 0.0001, p < 0.0001). Eighteen patients in the IV TXA group and 1 patient in the intraarticular TXA group received a blood transfusion (p < 0.0001). There was no difference between the two groups in terms of preoperative hemoglobin or platelet count (p = 0.24). However, postoperative hemoglobin level was higher in the patients who received intraarticular TXA (p=0.0005). More thromboembolism events were seen in the IV TXA group (p < 0.0001). CONCLUSIONS: Intraarticular TXA application reduces blood loss more than IV application, reduces the blood transfusion rate, and causes fewer complications. KEY WORDS: tranexemic acid, total knee arthroplasty, intraarticular injection, blood loss, blood transfusion.

Mean platelet volume and neutrophil/lymphocyte ratio in adolescent idiopathic scoliosis: can they be predictive value in diagnosis?

In our study, we evaluated whether mean platelet volume (MPV) and neutrophil lymphocyte ratio (NLR) are predictive values in the diagnosis of Adolescent Idiopathic Scoliosis in patients diagnosed with scoliosis in our clinic. Approximately 15000 patients who applied to our spine outpatient clinic with the suspicion of scoliosis between 2011 and 2018 were reviewed retrospectively. 292 patients were included in the study. The patients were divided into 3 groups. Group 1; control group group 2; group with the possibility of developing scoliosis under follow-upand group 3; the patient group diagnosed with scoliosis. Spinal curvature degrees of the patients were measured using the Cobb method. The MPV and NLR values of the patients were compared with the degree of curvature measured by the cobb method. NLR was 2.17 ± 2.10 K/ul in Group 1, 2.42 ± 1.76 K/ul in Group 2, and 2.72 ± 3.91 K/ul in Group 3. Although the NLR of the 3rd group was higher than the other 2 groups, it was not statistically significant. (p > 0.05). MPV was 7.90 ± 1.07 fL in Group 1, 7.95 ±1.39 fL in Group 2, 8.33 ± 1.37 fL in Group 3.MPV was higher in Group 3 and was found to be statistically significant (p=0.024). After adjusting for the effects of gender and age variables on the groups, the difference in MPV between groups became more significant (p=0.017) . While there was no statistically significant difference between the groups in terms of NLR, it was observed that MPV was statistically significantly higher in patients with AIS.Could this relationship be a promising inflammatory marker for AIS? We think that this question should be answered by studies involving larger patient and control groups.

The gluteal sling: an anatomical study.

INTRODUCTION: Sciatic nerve palsy is a devastating complication which may be seen after acetabular exposure in total hip resurfacing via a posterior approach. An anatomical structure termed as the "gluteal sling" was suggested to play a role in sciatic nerve palsies during this operation. "Gluteal sling" is formed by the attachment of the deep fibers of the inferior part of the gluteus maximus on the gluteal tuberosity of the femur and the lateral intermuscular septum. It is suggested to be released to avoid such compressive injuries. The purpose of this study is to demonstrate how much of the gluteal sling should be released to decrease the tension on sciatic nerve during posterior hip arthroplasties. We also aimed to study the anatomical structures at risk during releasing procedure. MATERIALS AND METHODS: The gluteal sling was examined in 17 sides of 9 adult cadavers. Its relation with the sciatic nerve, first perforating artery, the tip of greater trochanter and the ischial tuberosity were evaluated. RESULTS: The closest distance between the gluteal sling and the sciatic nerve was measured as 1.9 ± 0.6 cm. This point was corresponding to the distal 2/3 part of the gluteal sling. The distance of the proximal edge of the gluteal sling to the first perforating artery was 3.7 ± 0.9 cm, while its ascending branch was closer, being 1.8 ± 0.8 cm. CONCLUSIONS: Theoretically, it is enough to release the proximal 2/3 of the gluteal sling to avoid its compression on the sciatic nerve. However, further clinical studies would need to be undertaken to properly determine the effects of this procedure.

Evaluation of the olfactory memory after spinal anesthesia: a pilot study.

BACKGROUND: The aim of this study was to investigate the effect of spinal anesthesia (SA) on olfactory memory using Brief-Smell Identification TestTM (B-SIT). PATIENTS AND METHODS: This, prospective, clinical study was performed on 40 ASA physical status I-III patients, between 18-65 years of age undergoing a planned elective minor surgery under SA. All participants were preoperatively informed about B-SIT and the mode of application of the test according to the information in the book. B-SIT was applied to each patient preoperatively and the scores were recorded. B-SIT was reapplied to all patients on the 1st and 2nd postoperative days and the scores were recorded. Moreover, development of postdural puncture headache (PDPH) and/or neurological symptoms (such as hearing loss, diplopia) were checked. RESULTS: Postoperative headache was observed in 7 of the participants and 3 of them was diagnosed to have PDPH. No statistically significant difference was observed in the olfactory memory evaluation of the patients suffering from headache and the 3 patients diagnosed with PDPH. No statistically significant difference was observed in the correct odor answer ratio between the preoperative and postoperative 1st and 2nd days (p > 0.05). CONCLUSIONS: We confirm that SA does not affect olfactory memory. Further studies are necessary to confirm the results of our pilot study in a larger sample.

Microfracture technique versus carbon fibre rod implantation for treatment of knee articular cartilage lesions.

PURPOSE: To compare the microfracture technique with carbon fibre rod implantation for treatment of knee articular cartilage lesions. METHODS: 10 men and 30 women aged 22 to 56 (mean, 37.4) years underwent microfracture (n=20) or carbon fibre rod implantation (n=20) for International Cartilage Repair Society grade 3 to 4 knee articular cartilage lesions after a mean of 12.2 months of viscosupplementation and physiotherapy. Clinical outcome at 6 and 12 months was assessed using the Tegner-Lysholm score and modified Cincinnati score. Magnetic resonance imaging (MRI) outcome at 12 months was assessed by a radiologist. The modified magnetic resonance observation of cartilage repair tissue (MOCART) score was evaluated. RESULTS: The 2 groups were comparable in terms of age, body mass index, lesion location, lesion size, duration of symptoms, and coexisting pathology. The microfracture group had a higher preoperative Tegner-Lysholm score (39.4±7.3 vs. 34.4±4.9, p=0.015) and modified Cincinnati score (36.4±7.2 vs. 30.4±4.0, p=0.002) than the carbon fibre rod group. At 12 months, change in both scores was significant within each group (p<0.001) and was higher in the microfracture than carbon fibre rod group (p<0.001). MRI showed minimal regenerative tissue. Lobulation, oedema, and hypertrophy were more commonly found in the regeneration tissue after carbon fibre rod implantation than microfracture. At 12 months, the MOCART score was higher in the microfracture than carbon fibre rod group (59 vs. 47, p<0.001). CONCLUSION: Microfracture is superior to carbon fibre rod implantation in terms of clinical and radiological outcome.

Magnetic resonance imaging in the evaluation of eyes treated with silicone oil.

BACKGROUND AND OBJECTIVE: To evaluate the sensitivity of magnetic resonance imaging (MRI) in detecting retinal detachment (RD) in eyes filled with silicone oil, and to determine the MRI characteristics of silicone oil in vivo. PATIENTS AND METHODS: Seven eyes of seven patients with RD and eight eyes of eight patients without RD after silicone oil surgery were included in the study. All of the patients had clear media. MRI was performed in these patients. The results of ophthalmic examinations were compared with MRI findings. RESULTS: MRI detected six of the seven detached retinas. The multiplanar imaging capability of MRI helped in showing the RDs in various locations. The chemical shift artifact exaggerated the retinal thickness and made the detached retina visible. Fat suppressed images showed the silicone oil-corneal contact clearly. CONCLUSION: MRI is an effective technique for demonstrating RD in eyes filled with silicone oil and can be used successfully in eyes with opaque media.

Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine.

The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling. We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6° (12° to 28°) which was corrected to -1.8° (-5° to 3°) post-operatively and 2.4° (0° to 8°) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation. Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.

Flexor tendons repair: effect of core sutures caliber with increased number of suture strands and peripheral sutures. A sheep model.

BACKGROUND: Surgeons have aimed to achieve strong repair so as to begin early active rehabilitation programs for flexor tendon injury. Multi-strand suture techniques were developed to gain improved gap resistance and ultimate force compared with the respective two-strand techniques. In vivo studies indicate that multiple strands may cause ischemia during the intrinsic healing process by decreasing the total cross-sectional area of the injured site, unless the total cross-sectional area of the sutures is not decreased. HYPOTHESIS: The hypothesis was to design an in vitro study to understand the biomechanical relationship between suture calibers of core sutures with increased number of suture strands and peripheral suture on final repair strength. MATERIALS AND METHODS: Sixty fresh sheep forelimb flexor digitorum profundus tendons were randomly placed into three groups (A, B, and C), each containing 20 specimens, for tendon repair. Two-, four-, and eight-strand suture techniques were respectively used in Groups A, B, and C. A simple running peripheral suture technique was used in Subgroups A2, B2, and C2. For each repaired tendon, the 2-mm gap-formation force, 2-mm gap-formation strength, maximum breaking force and maximum breaking strength were determined. RESULTS: Differences in 2-mm gap-formation force and 2-mm gap-formation strength were found between Subgroups A1 and A2, B1 and B2, and C1 and C2. Between Groups A and B, A and C, and B and C, there was no difference as well. CONCLUSION: Both the number of strands and the ratio between the total suture volume and tendon volume at the repair site are important for ideal repair. If the total cross-sectional area of the sutures is equal in 2-strand, 4-strand, and 8-strand procedure, there is no difference in the strength of the repair. A decrease in caliber size suture requires more passes to achieve the same strength. Instead, it is much better to use peripheral suture techniques to improve the strength of the repair with larger diameter 2-strand core sutures.