Pain management following simultaneous bilateral total knee arthroplasty: genicular nerve blockade versus periarticular injection.

The aim of the present study was to investigate whether the analgesic solution prepared for periarticular injection (PAI) could be utilized as a genicular nerve blockade (GNB) agent in bilateral knee arthroplasty, and to assess the pain control efficacy of this approach in comparison with PAI. This was a retrospective cohort in which patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were evaluated. Thirty patients were enrolled. The standard PAI was used for one knee, while the PAI solution was applied in the form of GNB to the other. Visual Analog Scale (VAS) pain scores were measured and recorded separately for each knee, at rest (static) and during exercise (dynamic). Active range of joint motion (JRM) for both knee joints was measured preoperatively, at postoperatively. Compared to the PAI group, the GNB group had lower VAS scores at 2 and 8 hours (p = 0.030 and p < 0.001, respectively). The GNB group also had lower dynamic VAS scores at 2, 8, and 24 hours (p = 0.009, p <0.001 and p<0.001, respectively). Static and dynamic VAS measurements did not demonstrate any differences between groups (GNB vs. PAI) at 48 hours and 30 days (p>0.05). When the reduction in VAS scores was assessed, we found that the decrease in both scores was significantly greater in the PAI group compared to the GNB group (p<0.001, for both). There were no significant differences between the groups with regard to drainage volume, complications and JRM (p>0.05). GNB was found to be more effective for pain control throughout the first postoperative day in patients who underwent simultaneous bilateral TKA.

A comparative study of digital nerve and digital arterial repairs performed using running versus interrupted suture techniques in finger replantations.

BACKGROUND: The present study aimed to retrospectively analyze replantations and compared the success rates of different suturing techniques. METHODS: The data of 54 patients who underwent 82 finger replantations between January 2016 and April 2020 were retrospectively analyzed. Patients who underwent traumatic total finger amputations were included in the study. Arteries were repaired with two techniques, the simple running suture technique and the simple interrupted suture technique. Demographic patient data, comorbidities, operative data, post-operative care, the length of hospital stay, mechanism of injury, and site of injury were recorded. The groups were statistically analyzed. Functional outcomes were evaluated according to the Quick DASH score. RESULTS: A total 54 patients with a mean age of 32.5±18.4 (range 1-75) who underwent finger replantation were included in the study. The mean duration of follow-up was 30.9±16.1 months. The mechanism of injury was guillotine-style injury in 29 (35.4%) fingers, avulsion injury in 15 (18.3%) fingers, and crush injury in 38 (46.3%) fingers. Forty-six fingers were repaired using a simple running suture technique, and 36 fingers were repaired using a simple interrupted suture technique. There was no statistically significant difference in terms of failure between the suture techniques (p=0.569). Further, although there was no statistically significant difference in Quick DASH scores according to the type of trauma in the simple running suture technique group (p=0.109), a comparison could not be made within simple interrupted suture technique group because of the small sample size. There was no statistically significant difference in failure rates between cases with an ischemia duration of <6 h and those with ischemia duration of 6-12 h (p>0.05). No statistically significant difference was found between the groups according to age, body mass index, arterial hypertension, or diabetes mellitus (p>0.05). Statistically significant differences were found in univariate analysis according to surgery time per digit, smokers, or vein repair (p<0.05). In total, 65 (79.3%) out of 82 finger replantations were successful. A total of 17 out of 30 fingers that could not undergo venous repair survived because of treatment with medicinal leeches. CONCLUSION: Finger replantation is a difficult-to-perform surgical procedure requiring consideration of the surgical indications and the presence of an experienced surgical team. Regardless of the suture technique in finger amputations, performing venous anastomosis after arterial anastomosis is essential to restore circulation.

Comparison of two biological internal fixation techniques in the treatment of adult femur shaft fractures (plate-screws and locked intramedullary nail).

BACKGROUND: We aimed to compare two (plate-screws and locked intramedullary nail) biological internal fixation techniques in the treatment of adult femur shaft fractures. METHODS: Group I included 28 patients operated with biological internal fixation with plate and screws. Group II consisted of 31 patients operated with locked intramedullary nailing technique. During the follow-up period in Group I, 1 patient died and 3 patients dropped out of the study, so the results of 24 patients were evaluated. During the follow-up period in Group II, 2 patients died and 3 patients dropped out of the study, so the results of 26 patients were evaluated in this group. RESULTS: Age, sex, injury mechanism, fracture type, time to operation, duration of operation, amount of bleeding, fluoroscopy usage time, early and late complications, duration of hospitalization, fracture union time, and functional results of all patients were comparatively evaluated. CONCLUSION: According to our results, no superiority of either technique was demonstrated with respect to fracture union time, complication rate and functional results. Biological internal fixation with plate and screws is an alternative technique to locked intramedullary nailing in patients with multi-trauma or compromised pulmonary or cardiac function, or in complex comminuted or segmented diaphyseal or metaphyseal fractures.

The chondroprotective effects of intraarticular application of statin in osteoarthritis: An experimental study.

BACKGROUND: Osteoarthritis (OA) is the most frequent chronic joint disease causing pain and disability. Recent reports have shown that statin may have the potential to inhibit osteoarthritis. This study of early stage OA developed in an experimental rabbit model, aimed to evaluate the chondroprotective effects of intraarticularly applied atorvastatin on cartilage tissue macroscopically and histopathologically by examining intracellular and extracellular changes by light and electron microscope. MATERIALS AND METHODS: The experimental knee OA model was created by cutting the anterior cruciate ligament of the 20 mature New Zealand rabbits. The rabbits were randomly allocated into two groups of 10. STUDY GROUP: The group that received intraarticular statin therapy; CONTROL GROUP: The group that did not receive any intraarticular statin therapy. The control group received an intraarticular administration of saline and the study group atorvastatin from the 1(st) week postoperatively, once a week for 3 weeks. The knee joints were removed including the femoral and tibial joint surfaces for light and electron microscopic studies of articular cartilages. RESULTS: The mean total points obtained from the evaluation of the lesions that developed in the medial femoral condyle were 11.33 ± 0.667 for the control group and 1.5 ± 0.687 for the study group. The mean total points obtained from the evaluation of the lesions that developed in medial tibial plateau cartilage tissue were 11.56 ± 0.709 for the control group and 1.40 ± 0.618 for the study group. Electron microscopic evaluation revealed healthy cartilage tissue with appropriate chondrocyte and matrix structure in study group and impaired cartilage tissue in control group. CONCLUSION: Chondroprotective effect of statin on cartilage tissue was determined in this experimental OA model evaluated macroscopically and by light and electron microscope. There are some evidences to believe that the chondroprotective effect of the statin is that, by protecting the structure of the endoplasmic reticulum and the Golgi complex.

A case report of multiple fractures with arterial vasospasm associated with ergotamine use.

Vasospasm that develops in association with ergotamine use is a rarely seen but well-understood complication. A case is presented here of multiple fractures in which arteriospasm affecting all the arteries of the lower limb on the same side occurred 10 days post-trauma. In this case, the arteriospasm resulting from ergotamine addiction and high doses of ergotamine, which may be confused with post-traumatic angiospasm, was treated with a marcaine infusion by epidural catheter and heparin, iliomedin and nitronal infusion intravenously. This clinical condition should be borne in mind for all trauma cases determined to have arterial vasospasm, and the use of ergotamine must be queried when taking the anamnesis from the patient.

An assessment of the chondroprotective effects of intra-articular application of statin and tetracycline on early-stage experimental osteoarthritis.

Objectives. To compare the effects of intra-articular application of statin and tetracyclines on cartilage and synovial tissue on experimental osteoarthritis. Methods. Osteoarthritis was created in 30 rabbits of 3 groups. The control group received saline intra-articularly, statin group, atorvastatin and the tetracycline group, doxycycline once a week for 3 weeks. Chondral and synovial tissues were evaluated macroscopically and histopathologically. Results. Macroscopic evaluation determined mean values of control group 3.0, statin group 0.56, and tetracycline group 2.5. Histopathological evaluations determined mean values; femoral medial condyle cartilage tissue, control group, 14.60 ± 1.00, statin group 2.20 ± 1.30, tetracycline group 12.7 ± 5.39: tibia medial plateau, control group, 14.33 ± 8.68, statin group 2.89 ± 1.96, tetracycline group, 15.90 ± 7.03: synovial tissue, control group 12.22 ± 3.63, statin group 4.33 ± 2.69, tetracycline group 10.70 ± 2.62. Average values of synovial tissue cell layer thickness were control group 14.46 ± 2.35 µm, statin group 10.56 ± 1.01 µm, tetracycline group 12.80 ± 0.79 µm. All measurements showed statistically significant differences between statin and control groups (P < 0.05) but not between tetracycline and control groups (P > 0.05). Conclusions. Tetracycline has little effect due to chemical modification requirement, and the effect is dose dependent. Statins have chondroprotective effects, so may become a novel therapeutic agent in osteoarthritis management after chemical processing.