COMPARATIVE ANALYSIS OF OPEN AND CLOSED FLOATING KNEE INJURIES.

Objective: To compare the functional outcomes between floating knee injuries with open femur and tibia fractures and closed floating knee injuries. Methods: Floating knee injuries (followed up and treated in our clinic) were retrospectively analyzed. Patients were divided into two groups: floating knee injuries with open femur and tibia fractures (Group 1) and floating knee injuries with closed femur and tibia fractures (Group 2). Patients were compared according to their demographic characteristics and clinical and functional outcomes. Results: Of 52 study patients, 28 had Group 1 injuries and 24, Group 2 injuries. We found a statistically significant difference in length of hospital stay between the two groups (p = 0.01) and a statistically significant difference in Karlström-Olerud functional scores between the groups (p = 0.02). We found osteomyelitis in five (17%) patients in Group 1 and in one (4%) patient in Group 2. Conclusion: Patients with floating knee injuries and open fractures showed poorer outcomes than those with closed fractures. Those with open floating knee injuries show complications more often and longer hospital stays. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

Objetivo: Comparar os resultados funcionais entre lesões do tipo joelho flutuante com fraturas expostas de fêmur e tíbia e lesões de joelho flutuante fechadas. Métodos: As lesões de joelho flutuante acompanhadas e tratadas em nossa clínica foram analisadas retrospectivamente. Os pacientes foram divididos em dois grupos: lesões de joelho flutuante com fraturas expostas de fêmur e tíbia (Grupo 1) e lesões de joelho flutuante com fraturas fechadas de fêmur e tíbia (Grupo 2). Os pacientes foram comparados de acordo com as características demográficas e os desfechos clínicos e funcionais. Resultados: Entre os 52 pacientes do estudo, 28 tiveram lesões do Grupo 1 e 24 do Grupo 2. A diferença no tempo de internação entre os dois grupos foi estatisticamente significativa (p = 0,01). Também houve diferença estatisticamente significativa nos escores funcionais de Karlström e Olerud entre os grupos (p = 0,02). Osteomielite foi identificada em 5 (17%) pacientes do Grupo 1 e em 1 (4%) paciente do Grupo 2. Conclusão: Comparados aos pacientes com lesões de joelho flutuante com fraturas fechadas, aqueles com fraturas expostas têm piores resultados, uma vez que as complicações são mais comuns e a permanência hospitalar é mais longa nestes casos. Nível de Evidência III, Estudos Terapêuticos - Investigação dos Resultados do Tratamento.

Comparative analysis of open and closed floating knee injuries / Análise comparativa de lesão de joelho flutuante aberta e fechada

ABSTRACT Objective: To compare the functional outcomes between floating knee injuries with open femur and tibia fractures and closed floating knee injuries. Methods: Floating knee injuries (followed up and treated in our clinic) were retrospectively analyzed. Patients were divided into two groups: floating knee injuries with open femur and tibia fractures (Group 1) and floating knee injuries with closed femur and tibia fractures (Group 2). Patients were compared according to their demographic characteristics and clinical and functional outcomes. Results: Of 52 study patients, 28 had Group 1 injuries and 24, Group 2 injuries. We found a statistically significant difference in length of hospital stay between the two groups (p = 0.01) and a statistically significant difference in Karlström-Olerud functional scores between the groups (p = 0.02). We found osteomyelitis in five (17%) patients in Group 1 and in one (4%) patient in Group 2. Conclusion: Patients with floating knee injuries and open fractures showed poorer outcomes than those with closed fractures. Those with open floating knee injuries show complications more often and longer hospital stays. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

RESUMO Objetivo: Comparar os resultados funcionais entre lesões do tipo joelho flutuante com fraturas expostas de fêmur e tíbia e lesões de joelho flutuante fechadas. Métodos: As lesões de joelho flutuante acompanhadas e tratadas em nossa clínica foram analisadas retrospectivamente. Os pacientes foram divididos em dois grupos: lesões de joelho flutuante com fraturas expostas de fêmur e tíbia (Grupo 1) e lesões de joelho flutuante com fraturas fechadas de fêmur e tíbia (Grupo 2). Os pacientes foram comparados de acordo com as características demográficas e os desfechos clínicos e funcionais. Resultados: Entre os 52 pacientes do estudo, 28 tiveram lesões do Grupo 1 e 24 do Grupo 2. A diferença no tempo de internação entre os dois grupos foi estatisticamente significativa (p = 0,01). Também houve diferença estatisticamente significativa nos escores funcionais de Karlström e Olerud entre os grupos (p = 0,02). Osteomielite foi identificada em 5 (17%) pacientes do Grupo 1 e em 1 (4%) paciente do Grupo 2. Conclusão: Comparados aos pacientes com lesões de joelho flutuante com fraturas fechadas, aqueles com fraturas expostas têm piores resultados, uma vez que as complicações são mais comuns e a permanência hospitalar é mais longa nestes casos. Nível de Evidência III, Estudos Terapêuticos - Investigação dos Resultados do Tratamento.

Evaluation of the effect of proximal femur geometry on results of geriatric intertrochanteric fracture surgery.

BACKGROUND: This study aimed to explore the relationship between the complications and clinical outcomes after intertrochanteric femoral fracture surgery, and the Singh index (SI), canal-calcar ratio (CCR), cortical thickness index (CTI), and canal flare index (CFI) - the radiological indices defining proximal femoral morphology in the literature - among patients over 60 years of age. METHODS: The data of 350 patients who were operated between 2015 and 2019 were evaluated retrospectively. The study included patients who underwent dual lag screw proximal femoral nailing and had good intraoperative reduction quality according to Fogagnolo's criteria. The relationships among radiological indices measured on radiographs acquired after trauma, and post-operative complications, Barthel activity index, and Harris hip score (HHS) were assessed statistically. RESULTS: Among 121 patients who met the study criteria, there were 63 (52.07%) female and 58 (47.93%) male patients. The mean length of follow-up was 37.09 (36-60) months. The patients had a mean age of 79.78 (60-97) years. At least one mechanical complication developed in 32 (26.4%) patients in the study group. No significant relationship could be established between radiological indices and post-operative complications (p>0.05). The relationship between SI and HHS was statistically significant (p<0.05). CCR, CTI, and CFI did not have a statistically significant relationship with and HHS (p>0.05). CONCLUSION: No statistically significant relationship could be established between radiological indices and post-operative complications. It should be considered that SI may be a parameter that affects clinical outcomes.

How do vertebroplasty and kyphoplasty affect the quality of life of patients with multiple myeloma spinal metastasis?

BACKGROUND: Metastatic spinal lesions are diseases that impair the quality of life and require early diagnosis and treatment. The count of spinal metastasis patients rises day by day. Increased life expectancy has increased the incidence of cancer, making metastases more observable. The aim of our study was to investigate how the quality of life is affected in the patient group with vertebral fracture due to spinal metastases of multiple myeloma and undergoing vertebroplasty and kyphoplasty. MATERIALS AND METHODS: Forty-two patients with fracture due to spinal metastasis and adequate follow-up between the years of 2011 and 2018 were included in the study. Patients were listed according to their primary malignancy and metastases. The effect of vertebroplasty and kyphoplasty was investigated by evaluating preoperative and postoperative VAS and Oswestry Disability Index scores. All patients' radiographic kyphosis angle, compression ratio and wedging index were calculated before operation and after operation. RESULTS: A total of 76 vertebrae were operated in 42 patients. Significant differences were found in the comparison of preoperative and postoperative quality of life according to VAS and Oswestry Disability Index scores in the patients undergoing vertebroplasty, kyphoplasty or both procedures after spinal metastases (VAS; p = 0.0001, ODI; p = 0.002/0.0001). There were statistically significant differences in preoperative local kyphosis angle, compression ratio and wedging index and post-op local kyphosis angle, compression ratio and wedging index (p = 0.001). CONCLUSION: Vertebroplasty and kyphoplasty, minimally invasive procedures performed after spinal metastases, improve the quality of life of the patients.

Analyzing the effects of platelet gel on knee osteoarthritis in the rat model.

Platelet gel (PG) includes concentrated dose of growth factors which plays role in physiological processes of healing. The goal of this study is to evaluate repairing effects of intra-articular injection of PG use in a rat model of knee osteoarthritis (OA). A total of 20 rats were randomly distributed into a PG group and a control group. Both the groups were induced OA in knee joints with intra-articular formaline injection. The rats in the PG group and the control group were injected in the knee joint with PG and 0.9% NaCl solution, respectively. Two weeks after last injections, all rats were sacrificed by ether asphyxiation. Tissue samples were obtained from the knee joints and were examined histopathologically. No statistically significant differences were found between the groups regarding cartilage healing (P > .05). We were unable to determine any beneficial or harmful effects of PG on joint cartilage healing in OA.

Retroperitoneoscopic drainage of complicated psoas abscesses in patients with tuberculous lumbar spondylitis.

PURPOSE: Nowadays, endoscopic techniques are widely used in surgical procedures. Retroperitoneoscopy has been an extremely valuable tool for a wide variety of urologic disorders, whereas, it has limited use in orthopedic procedures. METHODS: We performed retroperitoneoscopic drainage (in combination with medical treatment) of complicated psoas abscess on 12 patients with tuberculous spondylitis. All the procedures were done under general anesthesia and in the lateral decubitus position. Psoas abscess was evacuated during procedure, and postoperatively, drainage was continued through a large silastic tube. The definitive diagnosis and the treatment were made based on the results of culture-antibiogram and PCR testing. RESULTS: Complete clinical and radiologic remission was observed in all patients in 3-6 months. The complication was not observed in any case postoperatively. CONCLUSIONS: Retroperitoneoscopic drainage of psoas abscesses gains advantages in terms of rapid recovery, minimal invasiveness, absence of radiation, and shorter hospital stay. This procedure can be used not only for cold abscesses but also for other pathologies of lumbar vertebral area.

Biopsy of vertebral tumour metastasis for diagnosing unknown primaries.

PURPOSE: To examine patients with vertebral tumour metastasis using transpedicular biopsy for diagnosing unknown primary tumours. METHODS: 13 men and 8 women aged 41 to 80 (mean, 61) years with vertebral tumour metastasis of unknown primary origin underwent transpedicular biopsy of the affected vertebra. RESULTS: The origins of the primary tumours were lung cancer (n = 6), prostate cancer (n = 5), colorectal cancer (n = 5), kidney cancer (n = 4) and lymphoma (n = 1). All the specimens matched pathological characteristics of their corresponding primary tumours, except in one patient. This 42-year-old man had stage-4 colon cancer, in whom the pathologic findings could not enable differentiation between colon and prostate cancer. CONCLUSION: Transpedicular biopsy of the vertebra is a cost-effective diagnostic tool for evaluating unknown primary tumours.

A giant congenital fibrosarcoma of the leg.

Congenital fibrosarcoma is a rare, malignant, soft-tissue tumor in infants and the pediatric age group. The clinical behavior of congenital fibrosarcoma is more favorable, and metastatic spread is rare, but local recurrence is a common problem. The patient was a 1-year-old girl at the time of operation, and there was a giant mass in the posterior region of the right leg. A wide surgical excision was performed and histological findings showed the diagnosis of congenital fibrosarcoma. After one and a half years, femoral supracondylar amputation was performed because of the recurrence of the local tumor.

Intravenous regional analgesia in a patient with Glanzmann thrombastenia.

Glanzmann thrombastenia (GT) is a rare condition of an inherited autosomal recessive gene characterized with bleeding tendency. The condition is rarely met in the OR. and therefore it is essential that anesthesiologist be cognizant of the risk involved and be prepared with all necessary precautionary measures. We present a GT case in a 27-year-old male with a mass in the anticubital region of right wrist that was successfully excised using the non-invasive intravenous regional analgesia (IVRA). The use of platelet transfusion and the recombinant factor VIIa, are stressed.

Outcome in unilateral or bilateral DDH treated with one-stage combined procedure.

UNLABELLED: The surgical treatment of patients with neglected developmental dysplasia of the hip (DDH) has been the subject of controversy. We asked if age affected outcome in patients with neglected DDH with unilateral or bilateral dislocation who underwent one-stage combined procedures. We retrospectively reviewed the results of 40 patients (51 hips) treated with a one-stage combined procedure consisting of open reduction, pelvic osteotomy, and femoral shortening. The average age at the time of surgery was 5.4 years for Group I (bilateral dislocation, 22 hips) and 6.7 years for Group II (unilateral dislocation, 29 hips). Mean followup was 5.4 years for Group I and 6.7 years for Group II. According to the modified score system of Trevor et al, 13 hips rated excellent, three were good, and six were fair in Group I; the ratings were 14, nine, and six hips respectively in Group II. Four patients had a limb-length discrepancy of approximately 1.5 cm in Group I. Twelve hips in Group I and 18 hips in Group II had osteonecrosis of varying severity. Our data suggest the outcomes of the children who were 5.5 years or younger in Group I and 8 years or younger in Group II were better. LEVEL OF EVIDENCE: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

Tuberculous spondylitis: abscess drainage after failure of anti-tuberculous therapy.

Spinal tuberculous abscesses usually respond to anti-tuberculous drugs. The purpose of this study was to evaluate the results of surgical drainage after failure of first-line anti-tuberculous drugs. Patients with spinal instability or vertebral collapse were excluded from the study. The authors retrospectively reviewed 11 patients. The operation was successful in all patients. Anterior/posterior spinal fusion or curettage was not performed. Drains were removed after two to three days. None of the patients required a second operation. Complications, such as spinal instability, vertebral collapse, or death did not occur.

Tuberculous osteomyelitis of the lumbosacral region: a spinal epidural abscess with presacral extension.

INTRODUCTION: Tuberculous osteomyelitis in the lumbosacral region is an uncommon occurrence, and its treatment is not well-defined in the literature, particularly when it is associated with abscess formation. We present the outcome of a patient who had an epidural abscess with presacral extension. MATERIALS AND METHODS: A 30-year-old man had microbiologically confirmed tuberculous infection of the lumbosacral vertebrae complicated by extensive abscess formation. After a trial of chemotherapy, the infection proved refractory, and the treatment proceeded with abscess drainage through the anterior route. RESULTS: Approximately 1 year after surgery, the patient was symptom-free and did not show any significant radiologic changes. CONCLUSION: Antituberculous chemotherapy combined with anterior surgery seems to be beneficial in the setting of lumbosacral osteomyelitis complicated by epidural abscess formation with presacral extension.

Seprafilm interposition for preventing adhesion formation after tenolysis. An experimental study on the chicken flexor tendons.

BACKGROUND: Hyaluronic acid and its derivatives have become increasingly popular for preventing adhesions in primary tendon repair. Their use in tenolysis, however, has not been established yet. The purpose of the current study was to evaluate the efficacy of Seprafilm, a combination of carboxymethylcellulose membrane and hyaluronate, in prevention of adhesion formation after tenolysis. MATERIALS AND METHODS: Thirty chickens were initially operated on their right central toes in order to constitute an experimental setting of postoperative flexor tendon adhesion. They were then randomly assigned to 3 groups at 6 weeks. Group 1 received no further procedure, group 2 underwent simple tenolysis with physiologic saline injection, and group 3 had tenolysis with Seprafilm interposition. RESULTS: Group 3 scored a significantly higher average gliding excursion value than the other groups. Histologic examination corroborated the biomechanical data. CONCLUSION: Seprafilm was effective in preventing adhesions after tenolysis.

Multidisciplinary evaluation of occult spinal dysraphism in 47 children.

OBJECTIVE: To present the clinical (urologic, orthopedic and neurologic) and urodynamic findings of 47 children suffering from occult spinal dysraphism, together with the long-term follow-up results obtained with various treatment modalities. MATERIAL AND METHODS: Between 1997 and 2000 a total of 47 children (27 girls, 20 boys; male:female ratio 1.3) referred to the Urology and/or Pediatrics Departments with symptoms and signs of closed spina bifida were enrolled in the study program. All patients underwent routine assessment of the urinary tract, including detailed anamnesis, physical examination and radiologic evaluation (X-ray, renal bladder ultrasonography and sacral MRI). In addition to video-urodynamic evaluation of the lower urinary tract, all patients were also evaluated by the Orthopedic Department with respect to possible lower extremity deformities. RESULTS: The age range of the children was 2 months to 16 years (mean 6.9 years). At first referral, 23 children were found to have normal urinary and fecal continence after toilet training; among the other presenting symptoms and signs, 34% of patients demonstrated recurrent urinary tract infections and 38.2% had abnormal findings on urinary tract investigations. Evaluation of urodynamic parameters before and after conservative treatment demonstrated an increase in age-related bladder capacity in 34 patients and detrussor instability had been cured in 23/30 patients (p < 0.05). Overall, bladder capacity was found to be normal in 40 children following conservative management (p < 0.05). The conservative approach proved to be effective in 40 children (85.1%), and intravesical instillation therapy with oxybutynine hydrochloride was successful in one of the remaining seven children (14.2%). Bladder augmentation was performed in six children (12.7%) in whom conservative measures were ineffective. CONCLUSIONS: In the light of our findings and the literature data it is obvious that a multidisciplinary approach together with early urologic evaluation to determine the extent of neurologic involvement of the lower urinary tract is essential to ensure a successful treatment outcome and to prevent the occurrence of serious functional and structural complications. Clinical, radiologic and video-urodynamic assessments should be performed to define the neuro-urologic pathophysiology and to provide management guidelines and a baseline for future comparison.

Evaluation of the fibular incisura of the tibia with magnetic resonance imaging.

Knowledge of the distal tibiofibular syndesmosis should be helpful in determining the normal position of the fibula in the incisural notch. The purpose of this study was to determine the anatomic characteristics of the fibular incisura of the tibia on MR imaging. One hundred fifty lower limbs (43 male, 32 female volunteers) were examined with MRI. The length of the anterior facet was 10.4 mm in males and 8.9 mm in females, and the length of the posterior facet was 10.4 mm in males and 8.9 mm in females. The angle between anterior and posterior facets was 138.6 degrees in males and 139.9 degrees in females. The depth of the fibular incisura of the tibia was 3.6 mm in males and 2.9 mm in females. The vertical distance of tibiofibular overlapping was 7.9 mm in males and 7.0 mm in females. The distance between anterior margin of the tibia and anterior margin of the fibula was 14.3 mm in males and 12.5 mm in females. All of these parameters of men (except the angle between anterior and posterior facets) were significantly higher than the parameters of women (p<.001, p<.001, p<.05, p<.05, p<.01, respectively).