RESUMEN
BACKGROUND: High-energy casualties such as firearm injuries may result in extensive loss of soft tissue and bone in the lower extremities. Although the primary aim in these types of injuries is the preservation of the extremity, repeated surgical procedures for extremity salvage and subsequent restoration of function could have detrimental effects on the patient both physically and psychologically. The main aim of this study is to evaluate the physical and psychological outcomes of patients who underwent lower extremity amputation in the early period after a firearm injury compared with the results of patients who underwent amputation in the late period. We also evaluated the factors affecting the prognosis in patients undergoing late below-knee amputation (BKA). METHODS: This retrospective study included patients who underwent BKA following a lower extremity injury caused by firearms between March 2016 and March 2022. Patients who underwent emergency BKA at the first center they were taken to immediately after the injury constituted the early amputation (EA) group. Patients who were transferred to our tertiary-level referral center for continuation of treatment after the first intervention at another center and later underwent BKA constituted the late amputation (LA) group. The patients were evaluated regarding age, gender, amputation side, presence of phantom limb pain (PLP), and post-traumatic stress disorder (PTSD). RESULTS: Information was available from hospital records for a total of 35 patients; 16 in the EA group and 19 in the LA group. All patients were male. The mean age at the time of injury was 25.5±5.3 years (range, 20-45 years), and the mean follow-up period was 37±17 months (range, 25-84 months). In the comparison of PLP experienced, the difference between the groups was statistically significant, with PLP experienced by 1 (10%) patient in the EA group and by 9 (90%) in the LA group (p=0.010). PTSD was diagnosed in 3 (23%) patients in the EA group and 10 (77%) patients in the LA group (p=0.039). CONCLUSION: Patients who underwent late BKA were found to be affected by PLP and PTSD at a higher rate. When deciding on extremity-preserving surgery for patients with severe open injuries to the lower extremity, it is crucial to consider the poor outcomes associated with late BKA. Patients should be thoroughly informed about these negative outcomes.
Asunto(s)
Amputación Quirúrgica , Heridas por Arma de Fuego , Humanos , Heridas por Arma de Fuego/cirugía , Heridas por Arma de Fuego/complicaciones , Masculino , Estudios Retrospectivos , Adulto , Femenino , Estudios de Seguimiento , Persona de Mediana Edad , Traumatismos de la Pierna/cirugía , Extremidad Inferior/lesiones , Extremidad Inferior/cirugía , Factores de Tiempo , Adulto Joven , Resultado del TratamientoRESUMEN
BACKGROUND: The question of how to specify the posterior tilt of the tibia during arthroplasty operations remains unclear. The most current opinion is that a design whereby incisions are made in parallel with the individual pre-arthritic posterior tilt will yield better post-operational results. However, the wide range of inter-individual variations of posterior tilt of the tibia and the difficult task of identifying the shaft axis of the tibia through standard lateral radiographs are the main obstacles to this particular method. Therefore, there is a need for another reference line that can be measured with plain radiography and yields less inter-individual variation. The hypothesis of this study was that the angle formed between the anterior metaphyseal line of the proximal tibia and the tibial plateau would prove to be less variable across individuals. METHODS: Long-shot radiographs of non-rotating lateral tibias of 85 patients aged between 18 and 38 years were analysed. The angle forming between the anterior metaphyseal line of the proximal tibia and the slope of the tibial plateau, and the posterior slope angle was measured by 2 separate observers using the classical method. RESULTS: From the measurements of the posterior slope angle taken with the classical method, 38% (33/85) of the patients were within the ±2-degree range of the mean, and the anterior metaphyseal angle was within ±2 degrees of the mean in 75% (64/85) of the total patients. 44.23% variation (CoV) in posterior slop degrees, 2.73% (CoV) variation in the anterior metaphyseal angle measured by the same researchers. The difference between the percentages of variation was also found to be statistically significant. (z = 15.36, p = 0.000). CONCLUSION: The anterior metaphyseal angle can be utilized to predict the individual posterior slope. Nevertheless, further large-scale, multicentre studies are needed to establish a mean value for the population.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Articulación de la Rodilla , Humanos , Adolescente , Adulto Joven , Adulto , Articulación de la Rodilla/cirugía , Tibia/diagnóstico por imagen , Tibia/cirugía , Artroplastia de Reemplazo de Rodilla/métodos , RadiografíaRESUMEN
BACKGROUND: There are ongoing debates on the effects of surgical approach on outcome after total hip arthroplasty (THA). It was hypothesised that with the anterolateral approach, trauma to the abductor arm can occur and related detrimental effects can diminish the postoperative outcomes. In this first randomised controlled trial in the literature on this subject, isokinetic performance and patient-reported functional outcomes were evaluated in patients undergoing THA with a posterior approach (PA) and an anterolateral approach (ALA). METHODS: A total of 48 patients scheduled to undergo THA were randomised to ALA or PA groups. The patients were evaluated preoperatively and at 6 and 12 months postoperatively, with flexion, extension and abduction strength measurements and the Harris Hip Score (HHS). The physiatrist performing isokinetic tests and the patients were blinded to the study groups. RESULTS: Both groups were similar in respect of age, body mass index (BMI), gender and preoperative isokinetic performance and HHS. Both groups demonstrated similar isokinetic performance (p < 0.05) and there was no difference in HHS (p < 0.05) at the 6- and 12-months follow-up evaluations. CONCLUSION: Although there is concern about potential abductor muscle damaging during ALA, the results of this randomised controlled study demonstrated that ALA can produce similar isokinetic performance and functional outcome to PA at 6 and 12 months, despite the close proximity to the abductor arm. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04640740 (retrospectively registered).
Asunto(s)
Artroplastia de Reemplazo de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Fuerza Muscular/fisiología , Músculo Esquelético , Rango del Movimiento Articular , Periodo Posoperatorio , Resultado del TratamientoRESUMEN
BACKGROUND: For decades there have been concerns about patellar resurfacing (PR) in total knee arthroplasty (TKA) and the individual preference of the surgeon is still the main determinant of whether or not resurfacing is applied. According to preference, surgeons can be categorized in 3 main groups of those who usually, selectively, or rarely resurface. The aim of this prospective, randomized, controlled study was to compare the isokinetic performance and clinical outcome of TKAs with PR and without PR. METHODS: A total of 50 patients scheduled to undergo TKA for primary osteoarthritis of the knee were randomly assigned to either the PR or non-PR groups. There were no significant differences between the groups in respect of age, BMI, gender and preoperative Knee Society Score (KSS) and isokinetic performance. Patients were evaluated at postoperative 3, 6, and 12 months with KSS and at 6 months and 1 year with isokinetic measurements. RESULTS: The PR group had a higher mean score, especially in the functional component of KSS, but the difference was not statistically significant. Knee extension peak torque was significantly higher in the PR group at 6 months (p = 0.029) and 1 year (p = 0.004) postoperatively. There were no significant differences between the groups in respect of knee flexion peak torque values following TKA. CONCLUSIONS: The results of this study demonstrated that PR during TKA is associated with better isokinetic performance and higher knee scores. These results support routine/usually resurfacing of the patella. For surgeons who selectively resurface the patella, the advantage of better isokinetic performance may be taking into consideration in favor of resurfacing the patella where they are undecided. LEVEL OF EVIDENCE: Level I, therapeutic study.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Rótula/cirugía , Estudios Prospectivos , Osteoartritis de la Rodilla/cirugía , Articulación de la Rodilla/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Humanos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios Retrospectivos , Hemorragia , Drenaje , Periodo PosoperatorioRESUMEN
SUMMARY OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.
RESUMEN
BACKGROUND: The aim of this study was to compare the clinical and isokinetic evaluation of distal radius fractures treated by volar locking plate (VLP) and external fixator. METHODS: The study included fifty patients with distal radius fracture type C1/C2/C3. Twenty-seven patients (12 men, 15 women; mean age 49.5±4.42) underwent open reduction and VLP fixation, and 23 patients (10 men, 13 women; 52.1±4.6) underwent closed reduction and external fixation. The follow-up period was at least 12 months and the mean following time was 13.5±1.02 (12-15) months. The functional parameters measured were range of motion (ROM) and grip strength. Radiographic parameters (radial incli-nation, palmar tilt, and radial height) and isokinetic evaluation were measured at the 6 months and at the final follow-up after surgery. The isokinetic test was done at the speed of 60º/s. The non-fractured arm was tested first and all results were also expressed as a percentage of that on the normal side. Wrist scores according to the disability of the arm, shoulder, and hand (DASH) questionnaire were used. RESULTS: The DASH scores, grip strength, and palmar flexion were better in VLP group at the 6 months (p<0.05). However, there were no differences between two groups at the one year (p=0.79). Isokinetic evaluation of the VLP showed that peak pronation torque and total pronation work were better than external fixation at the 6 month (p<0.05). At the final of follow-up was seen no significant differences between two groups (p=0.11). CONCLUSION: We looked at external fixation and locked volar plates in a prospective study and we found an improved range of movement and isokinetic evaluation outcome at 6 months after locked plating, but there were no differences between two groups at the final of follow-up. Our study showed no evidence for the superiority of one treatment over the other at the final follow-up.
Asunto(s)
Fracturas del Radio , Placas Óseas , Fijadores Externos , Femenino , Fijación Interna de Fracturas/métodos , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of this study was to compare radiation exposure of the patient during the closed reduction and proximal femoral nailing (PFN) of the trochanteric region fractures of the proximal femur using a traction table (TT) or a radiolucent table (RT) in the supine position. PATIENTS AND METHODS: Between June 2019 and December 2020, the study included 42 patients (19 males, 23 females; mean age: 81.2±9.5 years; range, 60 to 97 years) with trochanteric region fractures applied with closed reduction and PFN with the same implant type, 21 who underwent surgery on a TT (TT group), and 21 on a RT (RT group). The cumulative radiation dose was the primary outcome and was measured as the dose area product (DAP) in Gray cm2 (Gycm2 ). Intraoperative fluoroscopy times and amount of radiation exposure were compared between the two groups. RESULTS: There was no significant difference between the two groups in terms of sex, age, body mass index, fracture side, and the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification (p>0.05). No statistically significant difference was found between the TT and RT groups in terms of the mean intraoperative fluoroscopy time (48.29±22.31 and 55.95±21.54 sec, respectively; p=0.264) and amount of radiation exposure (2.26±1.86 and 2.84±1.96 Gycm2 , respectively; p=0.332). CONCLUSION: Both TT and RT with the patient positioned supine provide similar results for closed reduction and PFN of trochanteric region fractures, in terms of DAP as the most reliable measurement method. The main clinical relevance of this study is that radiation exposure of the patient need not be considered while selecting the operating table.
Asunto(s)
Fijación Intramedular de Fracturas , Fracturas de Cadera , Exposición a la Radiación , Anciano , Anciano de 80 o más Años , Clavos Ortopédicos , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Fijación Intramedular de Fracturas/métodos , Fracturas de Cadera/cirugía , Humanos , Masculino , Exposición a la Radiación/efectos adversos , Tracción/métodosRESUMEN
OBJECTIVES: In this study, we aimed to examine the effect of tranexamic acid (TXA) on hidden blood loss in total hip arthroplasty (THA) patients. PATIENTS AND METHODS: Between June 2015 and June 2021, a total of 120 patients (45 males, 75 females; mean age 57.2±4.9 years; range, 45 to 67 years) with primary osteoarthritis who underwent THA without the use of TXA and 53 patients who received TXA were retrospectively analyzed. Demographic data, amount of transfusion, early complications, preoperative and postoperative hemoglobin and hematocrit values, total blood loss, visible blood loss, and hidden blood loss values were compared. RESULTS: There was a significant difference between the groups with and without the use of TXA in terms of intraoperative bleeding, amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion (p<0.05). A significant positive correlation was found between intraoperative blood loss and hidden blood loss (r=0.325 p<0.01), while no significant correlation was found between postoperative drainage volume and hidden blood loss (r=-0.006 p=0.946). CONCLUSION: The use of TXA in patients undergoing THA reduces blood loss, including hidden blood loss, thereby reducing the need for blood transfusion after hip arthroplasty. However, there seems to be no linear relationship between postoperative blood loss and hidden blood loss. Considering these results, the routine use of TXA can be recommended in THA, unless there is a contraindication.
Asunto(s)
Antifibrinolíticos , Artroplastia de Reemplazo de Cadera , Ácido Tranexámico , Antifibrinolíticos/uso terapéutico , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Pérdida de Sangre Quirúrgica/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Ácido Tranexámico/uso terapéuticoRESUMEN
There are concerns that total infrapatellar fat pad (IPFP) excision in total knee arthroplasty (TKA) results in patellar tendon shortening due to ischemic contracture, but individual preference of the surgeon is still the main determinant between total or partial excision. The aim of this randomized controlled study was to compare isokinetic performance and clinical outcome of TKAs with total and partial excision of the IPFP. Seventy-two patients scheduled to undergo TKA for primary knee osteoarthritis by a single surgeon were randomly assigned to either total or partial excision group. Patients were evaluated preoperatively and at postoperative 1 year, with Knee Society Score (KSS) and isokinetic measurements. The physiatrist performing isokinetic tests and patients were blinded to the study. There were no significant differences between the groups in respect of age, body mass index, gender, and preoperative KSS and isokinetic performance. Postoperatively, both groups had improved KSS knee and KSS function scores, with no difference determined. Knee extension peak torque was significantly higher postoperatively in the partial excision group at postoperative 1 year (p = 0.036). However, there were no significant differences in knee flexion peak torque following TKA (p = 0.649). The results of this study demonstrated that total excision of the IPFP during TKA is associated with worse isokinetic performance, which is most likely due to changes in the knee biomechanics with the development of patella baja. Partial excision of the IPFP appears to be a valid alternative to overcome this potential detrimental effect without impeding exposure to the lateral compartment. This is a Level I, therapeutic study.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Ligamento Rotuliano , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Rótula/cirugía , Articulación de la Rodilla/cirugía , Ligamento Rotuliano/cirugía , Osteoartritis de la Rodilla/cirugía , Tejido Adiposo/cirugía , Rango del Movimiento Articular , Resultado del TratamientoAsunto(s)
Cementos para Huesos , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Cuello Femoral , Hemiartroplastia , Humanos , Lactante , Masculino , Medicare , Estudios Retrospectivos , Estados UnidosRESUMEN
OBJECTIVES: The aim of this study was to compare the smartphone- based gait analysis data of patients who underwent total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). PATIENTS AND METHODS: Between January 2016 and April 2019, a total of 51 patients (3 males, 48 females; mean age: 60.92 years; range, 51 to 70 years) who were operated with UKA or TKA in our clinic were retrospectively analyzed. The patients were divided into two groups according to the type of procedure as the UKA group (n=17) and unilateral TKA group (n=34). Gait analysis was made via a smartphone application (Gait Analyzer software version 0.9.95.0) with data acquired from the accelerometer of the smartphone. This analysis was performed using data collected from the Acceleration Sensor LSM6DSO into the Samsung Galaxy Note 10 Plus phone. Gait velocity, step time, step length, cadence, step time symmetry, step length symmetry, and vertical COM (vert-COM) parameters were measured. RESULTS: There were no statistically significant differences between the groups in respect of age, sex, body mass index, operated side, and follow-up duration. Compared to the TKA group, the UKA patients showed a better gait pattern in gait velocity (p=0.03), step time symmetry (p=0.005), and step length symmetry (p=0.024). No significant difference was detected in step time (p=0.807), step length (p=0.302), cadence (p=0.727) and vert-COM parameters (p=0.608). CONCLUSION: The gait of UKA patients is closer to the physiological pattern with a better gait velocity, step time symmetry, and step length symmetry than TKA patients. The surgical treatment option of UKA for knee medial compartment osteoarthritis leads to a better gait pattern than TKA.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Análisis de la Marcha , Complicaciones Posoperatorias , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/métodos , Investigación sobre la Eficacia Comparativa , Femenino , Marcha/fisiología , Análisis de la Marcha/instrumentación , Análisis de la Marcha/métodos , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Teléfono InteligenteRESUMEN
PURPOSE: Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCL-sacrificing TKA. METHODS: Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no significant differences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. RESULTS: There were no significant differences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no significant differences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and flexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). CONCLUSION: The use of UC or PS inserts in TKA did not affect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential differences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacrificing the PCL in TKA. LEVEL OF EVIDENCE: I.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Ligamento Cruzado Posterior , Humanos , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Ligamento Cruzado Posterior/cirugía , Estudios Prospectivos , Diseño de Prótesis , Rango del Movimiento ArticularRESUMEN
OBJECTIVE: Epidural fibrosis is one of the main reasons for requiring repeated surgical intervention. Our objective was to compare the effect of Platelet Rich Plasma (PRP) on the development of epidural fibrosis with collagen dural matrix and free autogenous fat graft. METHODS: Male rats were separated into 3 groups. Laminectomy was implemented on the rats and epidural fat pad was placed in the first group (n = 7); equal size of collagen dural matrix was applied in the second group (n = 7); a single dose of PRP was applied in the third group (n = 7). RESULTS: Epidural fibrosis was more common in the group that collagen dural matrix was applied when compared the ones that PRP was applied. PRP group presented better values in preventing epidural fibrosis when compared to the fat pad group, however this difference was not statistically significant. CONCLUSION: PRP is a material that can be easily obtained from the very blood of patients and at an extremely low cost; the main clinical relevance of our study is that the PRP might be an efficient material for better clinical results after laminectomy surgery due to its tissue healing and epidural fibroris preventing potentials. Level of Evidence V, Animal research.
OBJETIVO: A fibrose epidural é uma das principais razões que motiva intervenções cirúrgicas repetidas. O objetivo deste estudo foi comparar o efeito do plasma rico em plaquetas (PRP) no desenvolvimento de fibrose epidural com matriz de colágeno e enxerto de gordura autógena. MÉTODOS: Ratos machos foram separados em 3 grupos. A laminectomia foi aplicada nos ratos e gordura epidural foi colocada no primeiro grupo (n = 7); matriz de colágeno de tamanho igual foi aplicada no segundo grupo (n = 7); uma dose única de PRP foi aplicada no terceiro grupo (n = 7). RESULTADOS: A fibrose epidural foi mais comum no grupo em que a matriz de colágeno foi aplicada, quando comparada aos animais do grupo PRP. O grupo PRP apresentou os melhores valores na prevenção da fibrose epidural quando comparado ao grupo enxerto de gordura, porém a diferença não foi estatisticamente significante. CONCLUSÃO: PRP é um material de fácil obtenção do sangue dos pacientes e a baixo custo; a principal relevância clínica de nosso estudo é que o PRP pode ser um material eficiente para obter melhores resultados clínicos após a laminectomia devido à sua cicatrização tecidual e potencial de prevenção de fibrose epidural. Nível de evidência V, Pesquisa com animais.
RESUMEN
ABSTRACT Objective: Epidural fibrosis is one of the main reasons for requiring repeated surgical intervention. Our objective was to compare the effect of Platelet Rich Plasma (PRP) on the development of epidural fibrosis with collagen dural matrix and free autogenous fat graft. Methods: Male rats were separated into 3 groups. Laminectomy was implemented on the rats and epidural fat pad was placed in the first group (n = 7); equal size of collagen dural matrix was applied in the second group (n = 7); a single dose of PRP was applied in the third group (n = 7). Results: Epidural fibrosis was more common in the group that collagen dural matrix was applied when compared the ones that PRP was applied. PRP group presented better values in preventing epidural fibrosis when compared to the fat pad group, however this difference was not statistically significant. Conclusion: PRP is a material that can be easily obtained from the very blood of patients and at an extremely low cost; the main clinical relevance of our study is that the PRP might be an efficient material for better clinical results after laminectomy surgery due to its tissue healing and epidural fibroris preventing potentials. Level of Evidence V, Animal research.
RESUMO Objetivo: A fibrose epidural é uma das principais razões que motiva intervenções cirúrgicas repetidas. O objetivo deste estudo foi comparar o efeito do plasma rico em plaquetas (PRP) no desenvolvimento de fibrose epidural com matriz de colágeno e enxerto de gordura autógena. Métodos: Ratos machos foram separados em 3 grupos. A laminectomia foi aplicada nos ratos e gordura epidural foi colocada no primeiro grupo (n = 7); matriz de colágeno de tamanho igual foi aplicada no segundo grupo (n = 7); uma dose única de PRP foi aplicada no terceiro grupo (n = 7). Resultados: A fibrose epidural foi mais comum no grupo em que a matriz de colágeno foi aplicada, quando comparada aos animais do grupo PRP. O grupo PRP apresentou os melhores valores na prevenção da fibrose epidural quando comparado ao grupo enxerto de gordura, porém a diferença não foi estatisticamente significante. Conclusão: PRP é um material de fácil obtenção do sangue dos pacientes e a baixo custo; a principal relevância clínica de nosso estudo é que o PRP pode ser um material eficiente para obter melhores resultados clínicos após a laminectomia devido à sua cicatrização tecidual e potencial de prevenção de fibrose epidural. Nível de evidência V, Pesquisa com animais.
RESUMEN
PURPOSE: This study was aimed to investigate the effects of trochanteric femur fracture treatment methods on erectile functions of the patients and on sexual functions with their female partners. MATERIALS AND METHODS: A total of 43 patients with trochanteric femur fracture who underwent proximal femoral nail (PFN) or proximal femur locking compression plate (PF-LCP) surgery were included in the study. The PFN implant was applied to group 1 ( n = 23) and the PF-LCP implant to group 2 ( n = 20). All the patients and their female partners completed the 5-item version of the International Index of Erectile Function (IIEF-5) and the Female Sexual Function Index (FSFI) preoperatively and at 1 year postoperatively after the rehabilitation period. RESULTS: The mean preoperative IIEF-5 and FSFI score was 21.910.9 and 21.911.1, 72.319.7 and 70.516.2 for the PFN and PF-LCP treatment groups, respectively, and at postoperative 1 year after rehabilitation, change in IIEF-5 score and FSFI score of each group was -6.512.1 versus -3.811.6, ( p < 0.001) and -16110.7 versus -6.314, ( p = 0.001), respectively. CONCLUSION: These data show that trochanteric femur fractures treated with PFN or PF-LCP had a negative impact on sexual function. PF-LCP had a greater negative effect than PFN on sexual function.
Asunto(s)
Disfunción Eréctil/epidemiología , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/psicología , Fracturas de Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Sexualidad , Clavos Ortopédicos , Placas Óseas , Disfunción Eréctil/psicología , Femenino , Fijación Interna de Fracturas/métodos , Fracturas de Cadera/psicología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/psicologíaRESUMEN
AIMS: The combined (IV (intravenous) + topical) use of tranexamic acid (TXA) has been shown to be a safe method and more effective than single (IV or topical) application. The optimal administration method of TXA is still being investigated and safety, efficiency and cost are the three main crucial parameters in achieving the best administration method. We aimed to determine whether combined (oral + topical) use of TXA reduced blood loss and transfusion rates more than single (topical) administration in TKA and whether oral + topical use is as safe and efficient as the IV + topical use, in addition to the main advantage of relatively low cost. METHODS: In this prospective, randomized study, 100 patients were randomly assigned to either the topical TXA group or the combined (oral + topical) TXA group. There were no significant differences between the groups in age, body mass index or gender. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on post-operative days 0, 1, 2 and 3. The post-operative suction drainage and blood transfusion volumes were also recorded. RESULTS: There were statistically significant differences between the groups in haemoglobin and haematocrit levels on post-operative days 0, 1, 2 and 3 ( p < 0.05) in favour of the combined group. The post-operative drainage amounts ( p = 0.0001), measured blood loss volume ( p = 0.003) and transfusion rates ( p = 0.03) were lower in the combined (oral + topical) group compared to the topical group. CONCLUSIONS: Of the different methods of TXA administration, the combined use of oral and topical TXA is a safe, efficient and low-cost method in reducing blood loss and transfusion rates after TKA.
Asunto(s)
Antifibrinolíticos/administración & dosificación , Artroplastia de Reemplazo de Rodilla/efectos adversos , Pérdida de Sangre Quirúrgica/prevención & control , Osteoartritis de la Rodilla/cirugía , Hemorragia Posoperatoria/prevención & control , Ácido Tranexámico/administración & dosificación , Administración Oral , Administración Tópica , Anciano , Artroplastia de Reemplazo de Rodilla/métodos , Transfusión Sanguínea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Estudios ProspectivosRESUMEN
PURPOSES: When the evaluation of patellar instability is examined from the aspect of the conical-cylindrical anatomy of the tibia, metric measurement parameters such as the tuberositas tibia (TT)-trochlear groove (TG) and patellar tendon (PT) insertion-trochlear groove (TG) distances are not sufficient. We asked whether defined angular parameters reveal the rotational movement of the tuberositas tibia on the tibia shaft, additional to the metric parameters and there is a correlation between the metric and angular parameters. METHODS: 19 patients with patellar instability and 22 patients without patellar instability were evaluated. For all patients, two angle and three length parameters were evaluated on the slices taken. Evaluations were made of the TT-TG, the midpoint of the PT insertion-TG distances, the anatomic midpoint of the dome of the TT-TG, the TG-PT angle, and the TG-dome angle (DA). The Pearson correlation test was used for the statistical analysis of correlations between groups. RESULTS: A statistically significant increase was determined in the patellar instability group in the TG-DA and TG-PT angle values compared to the group without patellar instability ( p < 0.05). In both groups, a positive and strong correlation was determined between the TT-TG and the TG-PT and dome of the TT-TG distances, but no statistically significant correlation was determined between the tuberositas TT-TG and TG-PT angle and TG-DA. CONCLUSION: Metric parameters may not be sufficient alone in the evaluation of patellar instability. Metric parameters should be supported by additional angular parameters which reveal the rotational movement of the TT on the tibia shaft.
Asunto(s)
Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/patología , Articulación Patelofemoral/diagnóstico por imagen , Articulación Patelofemoral/patología , Adulto , Pesos y Medidas Corporales , Estudios de Casos y Controles , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Rótula/diagnóstico por imagen , Ligamento Rotuliano/diagnóstico por imagen , Tibia/diagnóstico por imagen , Adulto JovenRESUMEN
PURPOSE: This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. METHODS: This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. RESULTS: A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. CONCLUSION: The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.
Asunto(s)
Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Bloqueo Nervioso/métodos , Dolor Postoperatorio/tratamiento farmacológico , Lesiones del Hombro/cirugía , Adulto , Anciano , Analgesia Controlada por el Paciente , Método Doble Ciego , Femenino , Humanos , Infusiones Parenterales , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/etiología , Estudios Prospectivos , Rango del Movimiento ArticularRESUMEN
BACKGROUND/AIM: Despite the importance of hip fractures, very few studies have assessed their epidemiological characteristics in Turkey. The aim of this study was to evaluate the frequency and demography of hip fractures from the recent data of a central training and research hospital. MATERIALS AND METHODS: In this descriptive study, we identified hip fracture cases between 2009 and 2013. The age, sex, region, injury pattern, and calendar year for all patients were evaluated. RESULTS: Among the 687 patients (488 women, 199 men) described in our clinic's records, 122, 131, 144, 138, and 154 patients applied with hip fractures from the years 2009 to 2013, respectively. The mean ages of the women and men were 74.8 and 68.5 years, respectively. There were 220 patients who had femoral neck fracture (32%), 419 who had intertrochanteric fracture (61%), and 48 who had subtrochanteric fracture (7%). CONCLUSION: The female geriatric population may have an increasing and distinct hip fracture risk, mainly in the trochanteric region. Furthermore, recent studies that show variations in the frequency and demography of hip fractures highlight the importance of meticulous recording of patients' information. A nationwide survey of different categories of hospitals and various geographic regions of Turkey is also needed to inform effective prevention strategies.