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BACKGROUND Treatment of extra-articular distal tibial fractures is problematic owing to limited soft tissue cover, poor vascularity of the location, and adjacency to the ankle, and thus continues to be controversial. This study aimed to compare clinical and radiological outcomes in 69 patients with extra-articular distal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO) and an interlocking intramedullary nail (IMN). MATERIAL AND METHODS Sixty-nine patients, with mean of age 39.8±18.3 years, were retrospectively evaluated. Thirty-five patients were treated with IMN, and 34 patients were treated with MIPO. Clinical and radiological outcomes were evaluated. RESULTS The average follow-up was 13.3±6 months and union time was 16.2±5.4 weeks. Nonunion was observed in only 4.3% of patients treated with MIPO (P=0.114). Non-acceptable malalignment of extremity was observed in 4.3% of patients with IMN and 7.2% of patients with MIPO. There were no significant differences in union time, nonunion, surgical timing, operating time, malalignment, and complications between groups (P>0.05). The mean American Orthopaedic Foot and Ankle Society (AOFAS) surgery score was 95.8±5 in IMN and 91.9±14.3 in MIPO. AOFAS, Tenny-Wiss radiological, and Ovadia-Beals clinical scores were better in IMN than MIPO (P=0.019, P=0.03, P=0.02, respectively). Mean time of full weight-bearing and of return to daily life with IMN was significantly shorter than with MIPO (P.
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Fijación Intramedular de Fracturas , Fracturas de la Tibia , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Fijación Intramedular de Fracturas/métodos , Tibia/diagnóstico por imagen , Tibia/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Curación de Fractura , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Placas Óseas , Extremidad Inferior , Articulación del TobilloRESUMEN
PURPOSE: To study blood cobalt (Co) and chromium (Cr) levels in patients who have undergone total knee arthroplasty and their effect on the retinal nerve fiber layer and macular ganglion cell complex. METHODS: One hundred patients who had undergone total knee arthroplasty and 50 healthy individuals who had no implants were included in the study. The patients were separated into two groups based on how long ago the prosthesis had been implanted (Group 1: 1 to 5 years; Group 2: 5 to 10 years). After a complete ophthalmological examination, retinal nerve fiber layer and macular ganglion cell complex of the patients were evaluated with optical coherence tomography, performed on dilated pupils. To assess the metal ion levels of the patients, venous blood samples were drawn from each patient. RESULTS: The mean age of the patients was 64.72 ± 6.26 years in Group 1, 67.80 ± 8.07 years in Group 2, and 63.42 ± 7.90 years in the control group. In the comparison of age and sex, there were no statistically significant differences between the groups and the control group. Co and Cr levels were statistically higher in Group 1 and Group 2 compared with the control group (P < 0.001). Mean retinal nerve fiber layer thicknesses and mean macular ganglion cell complex thicknesses in Group 1 and Group 2 were statistically lower than in the control group. CONCLUSION: Levels of Co and Cr are higher in patients who undergone total knee arthroplasty than healthy subjects, and these higher levels were associated with changes in the retinal nerve fiber layer and macular ganglion cell complex.
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Artroplastia de Reemplazo de Rodilla , Cromo/sangre , Fibras Nerviosas/patología , Células Ganglionares de la Retina/patología , Tomografía de Coherencia Óptica/métodos , Anciano , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To compare five different repair techniques for extensor tendon zone III modified Kessler (MK), double-modified Kessler (DMK), modified Kessler epitendinous (MKE), double-modified Kessler epitendinous (DMKE), and running-interlocking horizontal mattress (RIHM) in terms of shortening, stiffness, gap formation, and ultimate load to failure. METHODS: A total of 35 human cadaver fingers were randomly assigned to five suture techniques with 7 fingers each and were tested under dynamic and static loading conditions. RESULTS: DMK was found to be superior over MK in terms of ultimate load to failure (36 N vs. 24 N, respectively), shortening (1.75 vs. 2.20 mm, respectively) and gap formation. However, these two methods had similar characteristics in terms of stiffness. The addition of epitendinous sutures to the repair methods resulted in approximately 40% increase in ultimate load to failure, whereas epitendinous sutures had no effect on shortening. DMKE was found to be superior over MKE in terms of shortening (1.77 vs. 2.22 mm, respectively). However, these two methods had similar characteristics in terms of mean ultimate load to failure and stiffness. RIHM was found to be superior over the other four methods in terms of ultimate load to failure (89 N), stiffness, and shortening (0.75 mm). CONCLUSION: RIHM was found to be stronger and more durable for extensor tendon zone III than the other techniques in terms of ultimate load to failure and stiffness.
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Traumatismos de los Dedos/cirugía , Dedos/cirugía , Técnicas de Sutura , Traumatismos de los Tendones/cirugía , Tendones/cirugía , Fenómenos Biomecánicos , HumanosRESUMEN
BACKGROUND & AIM: The aim of this study was to compare hypothermia patients with and without an Osborn wave (OW) in terms of physical examination findings, laboratory results, and clinical survival. METHODS: The study was carried out retrospectively on hypothermic patients. The hypothermic patients were divided into two groups. Group 1 comprised patients with OW on electrocardiogram (ECG), and Group 2 comprised patients without OW on ECG. The Mann-Whitney U test was used to compare the two groups, and the relationships between the variables and the presence of OW and mortality were analyzed with ANOVA. A value of pâ¯<â¯0.05 was considered statistically significant. RESULTS: OW was detected on ECG of 41.9% of the patients (Group 1). The mean body temperature was 30.8⯱â¯4.1 °C in Group 1 and 33.3⯱â¯1.6 °C in Group 2 (pâ¯=â¯0.106). The mean creatinine level was 1.01⯱â¯0.6â¯mg/dl in Group 1 and 0.73⯱â¯0.5â¯mg/dl in Group 2 (pâ¯=â¯0.046). The mean bicarbonate level was 15.9⯱â¯3.8â¯mmol/l in Group 1 and 18.6⯱â¯3.5â¯mmol/l in Group 2 (pâ¯=â¯0.038). A relationship was determined between the presence of OW and pH, bicarbonate, and creatinine levels (pâ¯=â¯0.026; 0.013; 0.042, respectively). The mortality rate was 69.2% in Group 1 and 77.8% in Group 2 (pâ¯=â¯0.689). CONCLUSION: Although there is a relationship between the decrease in bicarbonate levels, changes in kidney functions that cause acidosis, and the presence of OW, it has no effect on mortality. The presence of OW in hypothermic patients is insufficient to make a decision regarding mortality.
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Arritmias Cardíacas/diagnóstico , Electrocardiografía/clasificación , Hipotermia/fisiopatología , Mortalidad/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/fisiopatología , Electrocardiografía/métodos , Electrocardiografía/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND Whether or not there is a relationship between the newly-discovered irisin hormone and bone healing is not yet known. The aim of this study was to investigate what effect irisin hormone has on the bone healing process. MATERIAL AND METHODS The study included 21 adult patients with a diagnosed fracture of the lower extremity (femur or tibia). Informed consent was obtained from all the patients. A total of four venous blood samples were taken from the patients: before fracture stabilization, then postoperatively on days 1, 10, and 60. In patients with femoral neck fracture who had hip prosthesis applied, bone tissue samples were taken from the removed femur head and irisin was determined immunohistochemically in muscle biopsies taken from the same patients. RESULTS In analysis, it was revealed that the mean value of irisin 60 days after operation is significantly higher than the values of irisin before operation, 1 day after operation, and 15 day after operation (p<0.001, p<0.001, p<0.001, respectively). Intense staining was observed in compact bone tissue, muscle tissue, and in hypertrophic vascular endothelium within the Havers canal. CONCLUSIONS The level of irisin hormone increased in the bone union process and affects fracture healing due to irisin receptors in human bone tissue.
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Fibronectinas/análisis , Fibronectinas/fisiología , Adulto , Huesos/metabolismo , Huesos/fisiología , Callo Óseo/metabolismo , Femenino , Fracturas del Cuello Femoral/cirugía , Fémur/cirugía , Cabeza Femoral/cirugía , Fibronectinas/metabolismo , Curación de Fractura/fisiología , Humanos , Masculino , Tibia/cirugíaRESUMEN
BACKGROUND Surgical treatment of acetabular fracture and the anatomic reconstruction of the hip joint are difficult to achieve due to the complex pelvic anatomy, and surgical training requires a prolonged and steep learning curve. The aim of this study was to evaluate the effects of an applied training course, including cadaveric dissection, for the surgical treatment of acetabular fractures. MATERIAL AND METHODS This retrospective study included 35 patients who underwent surgical treatment for acetabulum fractures between 2012-2016. Patients were divided into three groups during two training courses, for the first two years and second two years. The surgical treatment was performed through single or combined standard approaches, according to the fracture pattern. The radiological outcome was evaluated using Matta's criteria to grade postoperative reduction and final radiological outcome and the restoration of the hip joint center (HJC). The clinical outcome was evaluated using the modified the Merle d'Aubigné-Postel (DAP) hip score. RESULTS Both post-course groups had statistically better functional and radiological outcomes compared with the pre-course group. Depending on the learning curve, the mean duration of surgery decreased from 153 minutes to 82.3 minutes. Although there was no statistical difference between groups in the vertical shift of the HJC, there was a statistically significant in the amount of horizontal shift of the HJC in the second two years of training, compared with the other groups. CONCLUSIONS Functional and radiological outcome of surgical treatment of acetabular fracture may be improved with increased training, depending on the learning curve.
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Acetábulo/lesiones , Acetábulo/cirugía , Fracturas Óseas/cirugía , Curva de Aprendizaje , Acetábulo/diagnóstico por imagen , Adulto , Demografía , Femenino , Fracturas Óseas/diagnóstico por imagen , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair. METHODS: Thirty-one patients who underwent rotator cuff repair prospectively completed the Pittsburgh Sleep Quality Index, the Western Ontario Rotator Cuff Index, and the Constant and Murley shoulder scores before surgery and at 6 months after surgery. Preoperative demographic, clinical, and radiologic parameters were also evaluated. RESULTS: The study analysed 31 patients with a median age of 61 years. There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions (p < 0.001). A statistically significant improvement was determined by the Western Ontario Rotator Cuff Scale and the Constant and Murley shoulder scores (p Ë 0.001). CONCLUSION: Sleep disorders are commonly seen in patients with rotator cuff tear, and after repair, there is an increase in the quality of sleep with a parallel improvement in shoulder functions. However, no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality. It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life. LEVEL OF EVIDENCE: IV.
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Dolor Postoperatorio/etiología , Calidad de Vida , Lesiones del Manguito de los Rotadores/psicología , Trastornos del Sueño-Vigilia/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Lesiones del Manguito de los Rotadores/cirugía , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Hyaluronic acid and glycosaminoglycans have shown positive effects in improving lateral epicondylitis and other tendinosis conditions. Therefore, we designed a prospective, randomized study to compare the effects of a combined sodium hyaluronate and chondroitin sulfate (HA + CS) injection versus a triamcinolone injection in the treatment of lateral epicondylitis. METHODS: In total, 57 consecutive patients with clinically diagnosed lateral epicondylitis were divided randomly into two groups. In the HA + CS group, 25 patients received a single injection of a solution containing an HA + CS combination and prilocaine HCl, while the 32 patients in the triamcinolone group received a single injection of a solution of triamcinolone and prilocaine HCl. We evaluated the pain and function outcome measures using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at the beginning of the study, and 3 and 6 months after the injection. Additionally, the Minimum Clinically Important Difference values and percentage changes in the PRTEE subscale scores between the assessments were calculated. RESULTS: No serious adverse events were reported throughout the study. The mean pain and function scores for the HA + CS and triamcinolone groups had significantly improved at 3 months, but the mean function scores in the HA + CS group were statistically significantly better when compared to the triamcinolone group. At 6 months, both groups had significantly improved mean pain and function scores, compared to the baseline scores; however, the mean pain and function scores in the 6-month HA + CS treatment group were better than in the 6-month triamcinolone group. The relative change for the mean total score in the HA + CS group was much better when compared with the triamcinolone group, and the HA + CS treatment group showed clinically significant improvement when compared with triamcinolone group at 3 and 6 months. CONCLUSIONS: This study supports the idea that for a single injection treatment of patients with lateral epicondylitis, a combination injection of HA + CS may offer better pain benefits for 6 months after injection, when compared to triamcinolone. TYPE OF STUDY/LEVEL OF EVIDENCE: Level II, Randomized Clinical Trial, Prospective Comparative Study.
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Sulfatos de Condroitina/administración & dosificación , Ácido Hialurónico/administración & dosificación , Codo de Tenista/cirugía , Triamcinolona/administración & dosificación , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Quimioterapia Combinada , Estudios de Seguimiento , Glucocorticoides/administración & dosificación , Humanos , Inyecciones , Persona de Mediana Edad , Estudios Prospectivos , Codo de Tenista/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: This study aimed to retrospectively evaluate the effectiveness of hydroxyapatite-coated (HA-coated) implants and other caput-collum implants in preventing cut-out observed in treatment with proximal femoral nail (PFN) of intertrochanteric femur fractures in elderly patients. METHODS: A total of 98 consecutive patients (56 males and 42 females; mean age: 79.42 (61-115) years) treated with three differ-ent PFNs for intertrochanteric femoral fractures were retrospectively examined. The mean of the follow-up period was 7.87 (4-48) months. It was used a threaded lag screw in 40 patients, an HA-coated helical blade in 28 patients and a non-coated helical blade in 30 patients for PFN. The reduction quality, fracture type, and radiological outcomes among all groups were evaluated. RESULTS: Unstable type was seen in 50 (52.1%) patients according to AO Foundation/Orthopedic Trauma Association fracture classi-fication. An acceptable-good reduction quality was seen in 87 (88.8%) of all patients. The average of tip-apex distance (TAD) value was 27.61 mm, calcar-referenced TAD (CalTAD) value was 28.72 mm, caput-collum diaphyseal angle was 128,° Parker's anteroposterior ratio was 46.36%, and Parker's lateral ratio was 46.82%. The best suitable implant position was observed in 49 (50%) patients. Cut-out was observed in 7 (7.14%) patients, and secondary varus displacement of more than 10° was observed in 12 (12.24%) patients. Correlation analysis and multivariate logistic regression analysis showed a significant difference between HA-coated and other implants in cut-out. Furthermore, implant type was the strongest predictive factor for cut-out complications in the multivariate logistic regression analysis. CONCLUSION: HA-coated implants may reduce the long-term cut-out risk due to increased osteointegration and bone ingrowth in elderly patients with intertrochanteric femoral fractures with poor bone quality. However, this alone is not enough; a suitable screw position, optimal TAD values, and excellent reduction quality are other important factors.
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Fracturas de Cadera , Extremidad Inferior , Anciano , Femenino , Masculino , Humanos , Estudios Retrospectivos , Fémur/diagnóstico por imagen , Fémur/cirugía , Fracturas de Cadera/cirugía , HidroxiapatitasRESUMEN
OBJECTIVE: To compare the clinical and radiographic outcomes between patients treated with single plate osteosynthesis, double plate osteosynthesis, and antegrade locked intramedullary nailing (IMN) in treatment of humerus diaphyseal fractures. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Orthopaedics and Traumatology, Adiyaman University Training and Research Hospital, Adiyaman, Turkey, between 2014 and 2020. METHODOLOGY: A total of 99 patients with humerus diaphyseal fractures were retrospectively evaluated. Forty-six had been treated with single plating, 24 were treated with double plating, and 29 with IMN. The outcomes were evaluated in terms of the union time, union rate, complications, and Disabilities of the Arm, Shoulder, and Hand (DASH) functional scores. RESULTS: The average union time was 17 weeks and nonunion rate was 6% of patients. There was no significant difference between the groups in terms of DASH functional score and nonunion (p >0.05). The surgical time and bleeding amount were significantly shorter in the IMN group compared to the other groups (p <0.05). A statistically significantly short union time was observed in both plating groups compared to IMN (p <0.05), but it was not different between single and dual plating (p >0.05). CONCLUSION: Regardless of the implant used, good reduction and stable fixation, respect for the soft tissue and use of the implant in accordance with the surgical technique are sufficient to achieve union in the surgical treatment of humeral shaft fractures. KEY WORDS: Humeral shaft fracture, Surgical treatment options, Comparison, Outcomes.
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Fijación Intramedular de Fracturas , Fracturas del Húmero , Humanos , Fijación Intramedular de Fracturas/efectos adversos , Fracturas del Húmero/diagnóstico por imagen , Fracturas del Húmero/cirugía , Estudios Retrospectivos , Fijación Interna de Fracturas/métodos , Placas Óseas/efectos adversos , Húmero , Resultado del Tratamiento , Clavos Ortopédicos/efectos adversosRESUMEN
Introduction: Due to the continual increase in the number of children engaging in sports today, physicians encounter finger injuries at an increasing frequency. This study sought to investigate the effectiveness of the method of Kinesio taping versus classic finger splint technique on pediatric patients with PIP (proximal interphalangeal) joint sprains of the fingers. Method: This is a retrospective cohort study. Forty-nine pediatric patients with PIP joint sprains were included in the study. The patients were divided into two groups, Group 1 being those treated with Kinesio taping and Group 2, those treated with splints. The area around the PIP joint was measured before and after treatment. Visual analog scale (VAS) evaluation: nighttime pain, numbness, pain at rest, and pain during activity were each separately evaluated before and after treatment. Also, flexion was measured at rest and in active motion before and after treatment. Results: The patients' periarticular measurements of the affected joint were statistically significant in both groups after treatment (p < 0.001). In the comparison between the groups, it was found that the group treated with Kinesio taping displayed a better outcome (p < 0.021). According to the VAS for PIP joint pain, it was observed that in both groups, pain at rest, pain during activity, nighttime pain, and numbness were statistically significant after treatment (p < 0.001). In the comparison of the groups, it was seen that the difference was statistically significant only in terms of nighttime pain (p < 0.013). Conclusions: The study conducted supported the literature that Kinesio taping method does not restrict the function of the extremity to which it is applied and also does not produce the complications reported in other treatment techniques. Kinesio taping was found to have a higher patient compliance and the outcomes were better in terms of edema and joint range of motion as well as night time pain when compared to the group treated with splint.
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Cinta Atlética , Traumatismos de los Dedos/terapia , Manejo del Dolor/instrumentación , Férulas (Fijadores) , Esguinces y Distensiones/terapia , Adolescente , Niño , Femenino , Traumatismos de los Dedos/complicaciones , Traumatismos de los Dedos/fisiopatología , Articulaciones de los Dedos/fisiología , Humanos , Masculino , Dolor/diagnóstico , Dolor/etiología , Manejo del Dolor/métodos , Dimensión del Dolor , Cooperación del Paciente , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Esguinces y Distensiones/complicaciones , Esguinces y Distensiones/fisiopatología , Resultado del TratamientoRESUMEN
Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients' life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients' social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.
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Background: Here we have defined a novel technique for repairing posterior acetabular wall fractures called the "crescent technique," in which dual C-shaped reconstruction plates overlap at the distal ends and, if necessary, at the proximal ends. We also analyzed the efficacy and reliability of this method. Patients and Methods: This was a retrospective analysis of 27 patients undergoing the crescent technique. All of the fractures were treated by the senior author for a mean of 7.9 days (0-15 days) after the trauma. The mean follow-up period was 19 months (13-29 months). The clinical results were evaluated using the modified clinical grading system developed by Merle d'Aubigne and Postel, and then modified by Matta. The radiographs were graded according to the criteria described by Matta. Results: In the clinical grading, 16 (59%) of the patients were excellent and very good, 5 (19%) were good, 3 (11%) were moderate, and 3 (11%) were poor. According to the Matta radiological evaluation criteria, 19 (70%) were excellent, 4 (15%) were good, 4 (15%) were fair, and none were poor. Statistically significant consistency was seen between the clinical and radiological results (p = 0.002). Conclusions: The crescent technique is a dual plate technique modification that can provide a stable fixation. It appears to be an effective and reliable method for treating posterior wall fractures of the acetabulum.
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Acetábulo/lesiones , Placas Óseas , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the effects of intramedullar nailing of the tibia using a suprapatellar (SP) approach with respect to pain and function of the knee. DESIGN: Prospective clinical investigation. SETTING: Academic level I trauma center. PATIENTS/PARTICIPANTS: Twenty-one patients with tibial shaft fractures (Orthopaedic Trauma Association 42A-B-C) with a minimum of 12-month follow-up. INTERVENTION: Locked intramedullary nailing using a SP approach. MAIN OUTCOME MEASUREMENTS: Radiographic evaluation for nail position proximally, tibial shaft alignment and union, anterior knee pain using the visual analog scale, and knee function evaluation using the Lysholm and SF-36 scores. Examination of intra-articular damage was performed using intraoperative patellofemoral arthroscopy before and after nail insertion. RESULTS: The mean age of the patients was 35.4 ± 12.4 years (range, 18-63 years), and the mean follow-up period was 15.62 ± 3.2 months (range, 12-21 months). The visual analog scale score for anterior knee pain was a mean of 1.0 ± 1.3 (range, 0-4). The SF-36 physical score was mean 45.1 ± 9, and the SF-36 mental score was a mean of 51.7 ± 9.9. The knee joint range of movement was measured as 133.1 ± 87 degrees on the affected extremity side and 134.05 ± 8.4 degrees on the unaffected side. The mean Lysholm knee score was 95.76 ± 4. No intra-articular pathology was seen on arthroscopy after nail insertion. CONCLUSIONS: The SP approach for intramedullar nailing for tibial shaft fractures was not associated with either anterior knee pain or functional limitations of the knee in our series. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Artralgia/epidemiología , Fijación Intramedular de Fracturas/métodos , Articulación de la Rodilla , Dolor Postoperatorio/epidemiología , Rótula/cirugía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Rango del Movimiento Articular , Recuperación de la Función , Centros Traumatológicos , Resultado del Tratamiento , Adulto JovenRESUMEN
Sleep disturbance is a frequent symptom of carpal tunnel syndrome. The aim of this study was to investigate the effect of median nerve decompression on sleep quality of patients with this condition. The study sample consisted of 41 patients with severe carpal tunnel syndrome who were admitted to our clinic and treated with open median nerve decompression. Sensation and functional recovery of the patients were followed using the Boston Function Questionnaire, the Semmes-Weinstein monofilament test and the two-point discrimination test. Symptomatic recovery of the patients was followed by the Boston Symptom Questionnaire. The tests were used before surgery and at three and six months afterwards. Sensory, functional and symptomatic recovery from the third month to the sixth month following surgery also affected sleep parameters and improved the sleep quality of patients with carpal tunnel syndrome. Level of evidence: IV.
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Síndrome del Túnel Carpiano/cirugía , Descompresión Quirúrgica , Recuperación de la Función/fisiología , Sueño/fisiología , Adulto , Anciano , Síndrome del Túnel Carpiano/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Nervio Mediano/cirugía , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
PURPOSE: The purpose of this study was to investigate the clinical results of arthroscopic rotator cuff repair in patients with anterior greater tubercle cyst in magnetic resonance imaging (MRI). METHODS: The cyst-present group comprised 38 patients with anterior greater tubercle cyst in MRI, and age- and sex-matched 30 patients without cyst in humeral head were included in the control group. The cystic group was divided into two groups, smaller than 5 mm (21 patients) and larger than 5 mm (17 patients), according to the cyst size. A total of three groups were created. In the evaluation of clinical outcomes, modified University of California at Los Angeles (UCLA) and the Western Ontario Rotator Cuff Index (WORC) were used. The visual analog scale (VAS) was used to assess pain. One-way analysis of variance was used to compare VAS, UCLA, and WORC scores among the groups. RESULTS: There was a statistically significant difference in the clinical results of VAS, UCLA, and WORC among the cystic and noncystic groups in the anterior greater tubercle ( p < 0.05). There was also a statistically significant difference in the clinical results of UCLA, WORC, and VAS scores according to the cyst sizes in the anterior greater tubercle cyst group ( p < 0.05). CONCLUSION: Anterior greater tubercle cysts have negative effects on rotator cuff repair results. If the anterior greater tubercle cyst size is greater than 5 mm, the negative effects of rotator cuff repair results are more pronounced. An understanding of anterior greater tubercle cysts has a critical importance for rotator cuff surgery planning.
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Artroscopía , Quistes/complicaciones , Cabeza Humeral , Lesiones del Manguito de los Rotadores/complicaciones , Lesiones del Manguito de los Rotadores/cirugía , Adulto , Anciano , Artroplastia , Quistes/diagnóstico por imagen , Quistes/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Resultado del TratamientoRESUMEN
INTRODUCTION: Femur neck fracture comprises a significant part of intracapsular femur fracture in the intracapsular area of proximal femur and it is mostly seen in elder people. However, these kinds of fractures may be seen in young adults. The present study aims to search factors that affect femoral neck fractures in young adults after surgery carried out by internal determination method. METHODS: Files of patients who were applied internal determination through closed reduction and cannulated screw because of intracapsular femur neck fractures between 2010 and 2015 were analyzed retrospectively. Fractures were evaluated by means of Garden classification, which is based on radiological appearance. The cases were examined in terms of timing of surgery in two groups. Cases operated in the first 24 hours after trauma consisted of group 1 and after 24 hours group 2. Radiological staging in femoral head avascular necrosis was evaluated by Ficat-Arlet classification system whereas acetabular fractures and hip functionality was evaluated by Letournel and Judet system, which is based on direct graph of fracture line. RESULTS: Mean age at the time of surgery for 31 cases included in the study was 40.04 ± 9.63 year. The average duration from injury to surgery was 6.6 (1-20) days. Thirty nine percent of fractures was nondisplaced whereas 61% was displaced. The average follow-up period was 4.9 ± 1.35 years. The rate of nonunion was found 16% and femoral head avascular necrosis 6.4%. According to Judet System, 67.7% of cases showed excellent/good and 32.3% moderate/bad functional results. Six cases had a secondary surgery. Cases who had displaced fractures statistically showed worse functional results and underwent more secondary surgery than patients with nondisplaced fractures (P>0.05). As a result of logistic regression analysis, presence of displacement was a factor negatively affecting the judet score but did not affect the rate of complication. There were no significant differences between the two groups according to the surgical timing in terms of functional outcomes and complications. CONCLUSION: Because of surgical treatment of femoral neck fractures in the first 24 hours does not affect functional outcomes and complication rate, surgery is recommended in optimal conditions. In the case of displacement, care must be taken in terms of poor functional results.
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Fracturas del Cuello Femoral/cirugía , Necrosis de la Cabeza Femoral/epidemiología , Fijación Interna de Fracturas/métodos , Curación de Fractura , Adolescente , Adulto , Tornillos Óseos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Meniscocapsular separation (MCS) is a lesion of the area which is attached from the peripheral section of the meniscus to the capsule and is seen less often than other meniscus injuries. The aim of this study was to investigate which of the different side applications of all-inside MCS repair of the meniscus was better in respect of clinical and functional results. METHODS: In this retrospective study, 53 patients with MCS pattern in their knee joints were treated with arthroscopic meniscus repair made with the all-inside method. The patients were separated into three groups according to the surface from which the fixation was applied: group 1, from the femoral joint surface of the meniscus (n = 17), group 2, from the tibial joint surface of the meniscus (n = 21) and group 3, from the femoral and tibial joint surfaces of the meniscus (n = 15). The participants were assessed using the subjective International Knee Documentation Committee Scoring (IKDC), Lysholm Knee Scale, Tegner Activity Level Scale, Barrett criteria and Kellgren-Lawrence classification after a 45 ± 12.1 months (range, 24-70 months) follow-up. RESULTS: Postoperatively, all the groups exhibited significantly increased subjective IKDC score, Lysholm score and Tegner activity score compared with their preoperative results (p < 0.001). At 6 months postoperatively, a statistically significant difference was determined between the groups in respect of the subjective IKDC score, Tegner activity score and Lysholm score with group 2 showing better results than the other groups (p < 0.001). At the final follow-up examination, no statistically significant difference was determined between the groups in respect of the subjective IKDC score, Tegner activity score or Lysholm score. A statistically significantly lower level of pulling and stress sensation was determined in group 2 (p < 0.001). CONCLUSIONS: MCS repair made with the all-inside method is successful clinically and functionally and in respect of MRI findings. In addition, it was seen that the fixation method applied from the tibial surface of the meniscus does not disturb the anatomic position of the meniscus in MCS repair. The tibial joint surface is the most appropriate area for suturation in all-inside repair of MCS. LEVEL OF EVIDENCE: Level IV.
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Traumatismos de la Rodilla/cirugía , Procedimientos Ortopédicos/métodos , Lesiones de Menisco Tibial/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Suturas , Adulto JovenRESUMEN
BACKGROUND: In total knee arthroplasty, it is better to use more than one reference point for correct alignment of the components. By measuring the distances of Achilles tendon (AT) and other conventional landmarks from the mechanical axis in magnetic resonance imaging (MRI) of the ankle, we aimed to demonstrate that, as a novel landmark which can help for correct alignment in the coronal plane, AT is a better option than other landmarks. MATERIALS AND METHODS: This retrospective study was done on 53 ankle MRIs that met the criteria for inclusion to the study among 158 ankle MRIs. After identification of the mechanical axis, the distances of distal landmarks, which were extensor hallucis longus tendon (EHLT), tibialis anterior tendon (TAT), dorsalis pedis artery (DPA), AT, extensor digitorum longus tendon (EDLT), and malleoli, were measured from the mechanical axis and were statistically evaluated. RESULTS: In proximal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 2.64±1.62 mm lateral; EHLT, 3.89±2.45 mm medial; DPA, 4.69±2.39 mm medial; TAT, 8.24±3.60 mm medial; and EDLT, 14.2±4.14 mm lateral (P<0.001). In distal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 1.99±1.24 mm medial; EHLT, 4.27±2.49 mm medial; DPA, 4.79±2.10 mm medial; TAT, 12.9±4.07 mm medial; and EDLT, 12.18±4.17 mm lateral (P<0.001). CONCLUSION: In this study, the mechanical axis line, which is the center of talus, passes through the AT. Our MRI investigations showed that the AT, EHLT, DPA, and malleolar center (3-5 mm medial) may help in correct alignment.
RESUMEN
OBJECTIVE: In focal cartilage lesions, multipotent mesenchymal stem cells in bone marrow are aimed to be moved into the defect area using subchondral drilling or microfracture method. However, repaired tissue insufficiently fills the defect area or cannot meet natural hyaline tissue functions, due to fibrous structure. We investigated the effect of a combined solution of sodium hyaluronate + chondroitin sulfate (HA+CS) administered intra-articularly after subchondral drilling on newly formed cartilage in rabbits with focal osteochondral defects. MATERIALS AND METHODS: A total of 32 New Zealand White mature rabbits, whose weights ranged from 2.5 to 3 kg, were randomly divided into four groups. Full-thickness osteochondral defect was formed in the left-knee medial femur condyles of all rabbits. Subchondral drilling was then performed. The following treatment protocol was administered intra-articularly on knee joints on days 7, 14, and 21 after surgery: group 1, 0.3 mL combined solution of HA+CS (20 mg CS combined with 16 mg HA/mL); group 2, 0.3 mL HA (16 mg/mL); group 3, 0.3 mL CS (20 mg/mL); and group 4 (control group), 0.3 mL saline solution. In the sixth week, all animals were killed and then evaluated histopathologically and biochemically. RESULTS: There was significant articular cartilage formation in the HA+CS group compared to the HA, CS, and control groups. Hyaline cartilage formation was observed only in the HA+CS group. Cartilage-surface continuity and smoothness were significantly higher in the HA+CS and HA groups compared to the other groups. Normal cartilage mineralization was found to be significantly higher in the HA+CS group compared to the other groups. Increased levels of VEGFA and IL-1ß in synovial fluid were observed in the HA+CS group. CONCLUSION: After subchondral drilling, intra-articular HA-CS combination therapy is a good choice to promote better quality new cartilage-tissue formation in the treatment of focal osteochondral defects.