Comparison of the radiological parameters between dynamic-referencing tactile guidance robotic system and Microplasty® instrumentation in unicompartmental knee arthroplasty.

OBJECTIVES: This study aims to compare the radiological outcomes of unicompartmental knee arthroplasty (UKA) performed by a navigation-based robotic system versus Microplasty® instrumentation. PATIENTS AND METHODS: Between January 2018 and January 2019, a total of 90 knees of 75 patients (65 males, 10 females; mean age: 62.0±9.4 years; range, 50 to 73 years) were included. Among these, 54 knees underwent Oxford mobile-bearing UKA with an Microplasty® instrumentation set and 36 knees were operated with the aid of a Restoris® MCK with MAKO navigation-based robotic system. Postoperative anteroposterior and lateral X-rays of all patients were evaluated according to nine different parameters. On the femoral side, femoral varus-valgus angle, flexion-extension angle, femoral condyle posterior fit; on tibial side, tibial component varus/valgus, tibial posterior slope, medial, anterior, posterior and lateral fit of tibial component assessed. RESULTS: There was no significant difference between groups in terms of age, sex, and affected side. On the femoral side, no significant difference was observed in the component position between groups. On the tibial side, tibial component medial fit (p=0.032) and anterior fit (p=0.007) were better in navigation-based robotic system group. CONCLUSION: Microplasty® instrumentation may lead to comparable implant positioning compared to a tactile-based navigated robotic instrumentation.

Does the clamping method in local and systemic TXA applications in total knee arthroplasty change the game?: A retrospective comparative cohort study.

Many different methods and drain clamping periods have been described in systemic and local tranexamic acid (TXA) applications, and the superiority of the methods to each other has not been clearly demonstrated. The method of local infusion in combined TXA applications may not alter the Hb drop or total or hidden blood loss. We aim to compare two different combined TXA application methods. We retrospectively analyzed 182 patients who underwent total knee arthroplasty between 2018 and 2021. Patients over 40 years of age who underwent TKA for degenerative knee arthritis were included in the study. Unicondylar, revision, or bilateral arthroplasties and patients with the cardiovascular or cerebrovascular disease were excluded from the study. All patients in the study received 1 g TXA intravenously half an hour before the incision. For the first group, 1 g TXA was given intra-articularly at the drain site after closure, and the clamp was kept closed for 1 hour. In the second group, the drain was clamped for an additional 6 hours, and a 1 g intravenous dose was administered at the 5th hour postoperatively. No local applications were used in the control group. Total, hidden, and visible blood loss (total blood loss, hidden blood loss, visible blood loss), postoperative decreases in hemoglobin and hematocrit level (ΔHgb, ΔHtc), blood transfusion rates, and hospital stay durations were evaluated. There were 72 patients in the first group, 52 in the second, and 58 in control. A total of 37 patients received one or more blood transfusions postoperatively, and there was no statistical difference in the need for blood transfusions between the groups (P = .255). Although a statistically significant difference (P = .001) in total blood loss, hidden blood loss, visible blood loss and ΔHgb values was observed between the groups, the difference between the first and second groups was insignificant (P = .512). The duration of hospital stay was observed to be less in the first and second groups (P = .024). Local and systemic TXA applications were observed to be more effective than only systemic applications in reducing blood loss after total knee arthroplasty, regardless of the local method.

TREATMENT OF MIDSHAFT CLAVICLE FRACTURE WITH SUPERIOR PLATE PLACEMENT.

OBJECTIVE: To evaluate the late clinical and radiological results of patients had locking plate anatomically compatible from superior surface and muscle cover on plate due to clavicle mid-region. MATERIALS AND METHODS: Forty patients were included retrospectively. Patients had a routine right shoulder anterior posterior graph after examination. The results were assessed by returning to the patient's daily activities, Constant score, the Disability of the Arm, and Shoulder and Hand scoring, followed by radiological and clinical examination. RESULTS: Fourteen (35%) patients were female and 26 (65%) were male. The mean age was 36.2 years. Twenty-six patients had right clavicle fracture and 14 patients had left. Twenty-three fractures were type 2B1 and 17 fractures were type 2B2. Mean follow-up time was 36.4 months. Radiologic union was at a mean of 9.1 ± 1.3 weeks. All patients had excellent results. The mean Constant score was 97.2 ± 1.8, the mean Disability of the Arm, and Shoulder and Hand score was 3.8 ± 2.4. CONCLUSION: It is possible to obtain complete union with high patient satisfaction by avoiding the complications and difficulties of the conservative treatment with the use of the anatomically compatible locking plates in superior fixation and our surgical dissection. Level of Evidence III, Retrospective Case controlled study.

OBJETIVO: Avaliar os resultados clínicos e radiológicos tardios dos pacientes com placa óssea de trava anatomicamente compatível com a superfície superior e a cobertura muscular na placa devido à região média da clavícula. MATERIAIS E MÉTODOS: Quarenta pacientes foram incluídos retrospectivamente. Os pacientes apresentaram um gráfico ântero-posterior de rotina do ombro direito após o exame. Os resultados foram avaliados retornando às atividades diárias do paciente, escore de Constant, incapacidade do braço e escores de ombro e mão, seguidos de exame clínico e radiológico. RESULTADOS: Quatorze (35%) pacientes eram do sexo feminino e 26 (65%) do sexo masculino. A idade média foi de 36,2 anos. Vinte e seis pacientes tiveram fratura da clavícula direita e 14 pacientes saíram. Vinte e três fraturas foram do tipo 2B1 e 17 fraturas do tipo 2B2. O tempo médio de acompanhamento foi de 36,4 meses. A união radiológica foi em média de 9,1 ± 1,3 semanas. Todos os pacientes tiveram excelentes resultados. A pontuação média constante foi de 97,2 ± 1,8, a média de incapacidade do braço e a pontuação do ombro e da mão foi de 3,8 ± 2,4. CONCLUSÃO: É possível obter união completa com alta satisfação do paciente, evitando as complicações e dificuldades do tratamento conservador com o uso das placas ósseas de trava anatomicamente compatíveis na fixação superior e na nossa dissecção cirúrgica. Nível de evidência III, Estudo retrospectivo controlado por caso.

Treatment of midshaft clavicle fracture with superior plate placement / Tratamento para fratura da diáfise da clavícula com inserção de placa óssea superior

ABSTRACT Objective: To evaluate the late clinical and radiological results of patients had locking plate anatomically compatible from superior surface and muscle cover on plate due to clavicle mid-region. Materials and Methods: Forty patients were included retrospectively. Patients had a routine right shoulder anterior posterior graph after examination. The results were assessed by returning to the patient's daily activities, Constant score, the Disability of the Arm, and Shoulder and Hand scoring, followed by radiological and clinical examination. Results: Fourteen (35%) patients were female and 26 (65%) were male. The mean age was 36.2 years. Twenty-six patients had right clavicle fracture and 14 patients had left. Twenty-three fractures were type 2B1 and 17 fractures were type 2B2. Mean follow-up time was 36.4 months. Radiologic union was at a mean of 9.1 ± 1.3 weeks. All patients had excellent results. The mean Constant score was 97.2 ± 1.8, the mean Disability of the Arm, and Shoulder and Hand score was 3.8 ± 2.4. Conclusion: It is possible to obtain complete union with high patient satisfaction by avoiding the complications and difficulties of the conservative treatment with the use of the anatomically compatible locking plates in superior fixation and our surgical dissection. Level of Evidence III, Retrospective Case controlled study.

RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos tardios dos pacientes com placa óssea de trava anatomicamente compatível com a superfície superior e a cobertura muscular na placa devido à região média da clavícula. Materiais e Métodos: Quarenta pacientes foram incluídos retrospectivamente. Os pacientes apresentaram um gráfico ântero-posterior de rotina do ombro direito após o exame. Os resultados foram avaliados retornando às atividades diárias do paciente, escore de Constant, incapacidade do braço e escores de ombro e mão, seguidos de exame clínico e radiológico. Resultados: Quatorze (35%) pacientes eram do sexo feminino e 26 (65%) do sexo masculino. A idade média foi de 36,2 anos. Vinte e seis pacientes tiveram fratura da clavícula direita e 14 pacientes saíram. Vinte e três fraturas foram do tipo 2B1 e 17 fraturas do tipo 2B2. O tempo médio de acompanhamento foi de 36,4 meses. A união radiológica foi em média de 9,1 ± 1,3 semanas. Todos os pacientes tiveram excelentes resultados. A pontuação média constante foi de 97,2 ± 1,8, a média de incapacidade do braço e a pontuação do ombro e da mão foi de 3,8 ± 2,4. Conclusão: É possível obter união completa com alta satisfação do paciente, evitando as complicações e dificuldades do tratamento conservador com o uso das placas ósseas de trava anatomicamente compatíveis na fixação superior e na nossa dissecção cirúrgica. Nível de evidência III, Estudo retrospectivo controlado por caso.

The effect of the cerclage wire in the treatment of subtrochanteric femur fracture with the long proximal femoral nail: A review of 52 cases.

INTRODUCTION: To present the effect of the cerclage fixation, which was performed for the purpose of preserving the alignment obtained by open reduction, on the long-term clinical and radiological results of subtrochanteric fractures. MATERIALS AND METHODS: The inclusion criterias were at least 2 years of follow-up, no severe cognitive impairment, and to be able to walk independently prior to fracture. Patients with transverse or short oblique subtrochanteric hip fractures (AO/OTA class 32-A3.1), patients underwent previous femoral or hip operation for the same side and those with segmental fractures, bilateral fractures and pathological fractures were not included in the study. The clinical and radiological results of the patients were evaluated. The clinical evaluations were performed with Palmer and Parker Mobility Score (PPM), Lower Extremity Functional Score (LEFS), visual analogue score (VAS) and return to pre-injury activity status. The elapsed time between the trauma and the surgery date, the duration of surgery the estimated amount of bleeding, and the length of hospital stay of patients were assessed. RESULTS: Thirty-two of the 52 patients were female and 20 were male. The mean age of females was 77.80 ±â€¯9.75 years and the mean age of the males was 79.18 ±â€¯6.50 years. The mean follow-up period of the patients was 62.25 ±â€¯34.68 months. The mean time until the patients' surgery was 6.18 ±â€¯3.32 days. The mean duration of surgery was 52.6 ±â€¯13.8 min. The mean amount of bleeding was 176 ±â€¯90 ml. The mean length of patients' hospital stay was 6.2 ±â€¯3.2 days. The postoperative mean duration of union was found to be 3.8 ±â€¯1.6 months. The mean value of varus/valgus angulation in coronal plane measurements was 0.52°. No complication was observed in any patient during the cerclage application. The mean number of wire was 1.3. LEFS difference was statistically significant. PPM decline was not statistically significant. CONCLUSION: Open reduction and the use of cerclage did not produce a negative effect in terms of fracture union. The generation of medial support by anatomical reduction of the fracture prevents the implant failure and provide a basis for union.

The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years.

AIM: To evaluate the radiologic and clinical results of patients who underwent deformity correction and stabilization for congenital spinal deformities using pedicle screws after hemivertebra resection. MATERIAL AND METHOD: Nine patients, mean age 9.2, who underwent posterior hemivertebrectomy and transpedicular fixation for congenital spinal deformity and had longer than five years of follow-up were evaluated retrospectively. The hemivertebrae were located in the thoracic region in 4 patients and thoracolumbar transition region in 5 patients. The patients were evaluated radiologically and clinically in the postoperative period. RESULTS: Mean length of follow-up was 64.2 months. The mean operating time was 292 minutes. The mean blood loss was 236 mL. The average hospitalization time was 7 days. The amount of correction on the coronal planes was measured as 31%. The mean segmental kyphosis angle was 45.7 degrees preoperatively and it was measured 2.7 degrees in the follow-up period. There were no statistically significant differences between the early postoperative period and final follow-up X-rays with respect to coronal and sagittal plane deformities. CONCLUSION: The ability to obtain a sufficient and balanced correction in the cases accompanied by long compensator curvatures that have a structural character in hemivertebra may require longer fusion levels.

Intramedullary osteosynthesis of instable intertrochanteric femur fractures with Profin® nail in elderly patients.

OBJECTIVE: The aim of this study was to retrospectively analyze the radiologic and functional results of patients with instable intertrochanteric femur fractures treated with Profin® nails. METHODS: This study included 32 patients (24 female, 8 male; mean age: 70.7 years; range: 65 to 96 years) who were treated with Profin® nails for instable intertrochanteric fractures. Fractures were caused by a simple fall in 30 patients and pedestrian accident in two. Eleven patients had Type 31-A2 and 21 patients had Type 31-A3 fractures according to the AO/OTA classification. Results were evaluated clinically and radiologically. Mean follow-up period was 17.3 (range: 12 to 23) months. RESULTS: Good or acceptable reduction was achieved in 93.7% of our patients. Mean surgery duration was 28.2 (range: 22 to 75) minutes and mean blood loss was 215 (range: 150 to 320) cc. Complete union was achieved in all patients at a mean of 17.6 (range: 15 to 22) weeks. Postoperative mean collodiaphyseal angle was 125.5 (range: 122 to 130) degrees and there was no significant difference with follow-up values (p>0.05). Twenty-two patients were able to walk with support and 10 without support after surgery. Mean Oxford hip score was 23.70 (range: 14 to 39) points. One year mortality rate was 18.75%. CONCLUSION: Good functional and radiologic results can be achieved using Profin® nails for unstable intertrochanteric femur fractures in elderly patients.

Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon.

HYPOTHESIS: Using radiologic and clinical results, we studied the outcome of patients who underwent open reduction and plate osteosynthesis for comminuted olecranon fractures. MATERIALS AND METHODS: We retrospectively studied 18 patients (5 women [27.8%] and 13 men [72.2%]; mean age, 41 years [range, 19-67 years]) with comminuted fractures of the olecranon who underwent locking-plate osteosynthesis after open reduction between March 2005 and August 2009. According to the Mayo classification, 11 cases were classified as type IIB (61.11%) and 7 cases were classified as type IIIB (38.88%). In 7 cases, additional injuries were present in the olecranon area. We evaluated results with respect to clinical and radiologic findings. The mean follow-up duration was 22.6 months (range, 7-42 months). RESULTS: Complete union was achieved in all cases. Mean union time was 4.4 months (range, 4-6 months). According to the Morrey scale, 4 cases were considered very good; 8, good; 5, fair; and 1, poor. The mean QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score was 17 (range, 0-75). There were no statistically significant differences between the Mayo type IIB and type IIIB cases in terms of elbow range of motion, QuickDASH score, and Morrey score. On long-term follow-up, elbow stiffness developed in 1 patient, who underwent surgical release with simultaneous removal of the hardware. The cases with fair and poor scores were cases with open fractures and additional elbow injuries. CONCLUSIONS: Locking-plate osteosynthesis is an effective and safe treatment option for comminuted olecranon fractures, allowing early joint motion and yielding satisfactory radiologic and clinical results. In cases with concomitant injuries, the risk of limited elbow motion is high.

The results of surgical treatment for posttraumatic heterotopic ossification and ankylosis of the elbow.

OBJECTIVES: Heterotopic ossification which may develop following elbow injuries or elbow surgery may result in complete loss of elbow functions. We evaluated the results of surgical treatment for ankylosis of the elbow due to posttraumatic heterotopic ossification. METHODS: The study included seven patients (6 males, 1 female; mean age 36 years; range 23 to 55 years) who developed heterotopic ossification and ankylosis of the elbow joint following surgical treatment of high-energy fractures in the circumference of the elbow. Two patients had comminuted olecranon fractures and elbow luxation, and five patients had comminuted intra-articular distal humeral fractures. Three patients had open fractures. Involvement was in the right elbow in two patients, and in the left elbow in five patients. One patient was monitored and treated in the intensive care unit for head trauma for 22 days. Initially, six patients were treated with plate osteosynthesis and one patient with tension band wiring. Foci of heterotopic ossification were detected on the radiographs taken after a mean of 24 days (range 20 to 32 days) following surgical treatment of fractures. The patients were followed-up with conventional radiography and scintigraphy for a mean of 11 months (range 7 to 15 months) before surgical treatment, during which functional loss in elbow joint movements deteriorated and ankylosis developed. All the patients had Hastings type IIIC ankylosis and poor Mayo elbow performance scores (mean score 50.7). A posterior incision was used in three patients, and a double-column incision was used in four patients. At surgery, the ulnar nerve and the lateral and medial collateral ligaments were preserved, and a posterolateral capsular release, removal of heterotopic ossification, purging of the olecranon fossa, and resection of the tip of the olecranon were performed. After completion of capsular release, cartilage pathologies were evaluated. Four patients were found to have no definite cartilage damage, whereas in three patients the joint cartilage was seriously damaged. At final controls, the patients were assessed with the Mayo elbow performance score. The mean follow-up period was 23.4 months (range 10 to 36 months). RESULTS: In all cases, the range of motion and stability of the elbow joint were controlled and were found to be complete and stable at the end of the operation. At final controls, the Mayo elbow performance scores were good in three patients, moderate in one patient, and poor in three patients. All the patients with a poor elbow score had severe joint cartilage damage intraoperatively. CONCLUSION: Patients who develop heterotopic ossification and ankylosis of the elbow following trauma or elbow surgery may benefit from removal of heterotopic ossification foci and elbow relaxation procedures provided that there is not severe damage to the articular cartilage.

[Osteoid osteoma of the coronoid process causing flexion contracture of the elbow]. / Koronoid çikintida gelisen ve fleksiyon kontraktürüne neden olan osteoid osteoma.

Osteoid osteoma is one of the benign osteoblastic lesions that causes chronic pain. Diagnosis may be delayed in juxta-articular lesions in which characteristic radiographic findings may not be present, resulting in limited joint motion. A 23-year-old patient presented with a complaint of pain in the right elbow of one-year history. He sought medical treatment at another center and was prescribed non-steroidal anti-inflammatory treatment that resulted in significant pain relief; however, limitations of elbow motion ensued. On physical examination, there was pain in the antecubital part of the right elbow on palpation and a flexion contracture of 30 degrees. Findings of computed tomography and magnetic resonance imaging were consistent with osteoid osteoma. The lesion was excised and postoperative controls showed no flexion contracture.