Eklem Hastaliklari Ve Cerrahisi-Joint Diseases and Related Surgery最新文献

Objectives: This study aims to evaluate the clinical and radiological results of patients with multiple dorsal carpometacarpal (CMC) joint fracture dislocations treated with open reduction and internal fixation (ORIF).

Patients and methods: We evaluated 14 patients (12 males, 2 females; mean age 35.1 years; range, 22 to 64 years) between January 2013 and December 2017. Our main outcome measurements were the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, loss of grip strength, limitation of range of motion (ROM), and Kellgren-Lawrence osteoarthritis classification identified with radiographs and computed tomography images.

Results: The mean QuickDASH scores at seventh week and third month were 73.57 (range, 65-90) and 29.11 (range, 25-42.5), respectively. The mean QuickDASH score at seventh, ninth, and 12th month, and final follow-up was 4.64 (range, 0-30) and the QuickDASH score at these follow-up points was not 0 for only three patients. The mean loss of grip strength was 32.14% and two patients (14.29%) had limitation of ROM in third proximal interphalangeal joint at final follow-up. Four patients had grade I, nine patients had grade II, and one patient had grade III osteoarthritis according to Kellgren-Lawrence classification at final follow-up.

Conclusion: Although functional results demonstrated that multiple CMC joint fracture dislocations can be treated with ORIF, the high rate of osteoarthritis is a disadvantage.

Objectives: This study aims to investigate the potential use and histological effects of the local administration of platelet-derived growth factor (PDGF) in the repair of full-thickness osteochondral defects in articular cartilage in an animal model.

Materials and methods: Twenty-four adolescent 18-week-old New Zealand White rabbits with an average weight of 2500 g (range, 1600 g to 3200 g) were used in the study. The rabbits were randomly divided into three groups (n=8) as the control group (group A) and two experimental groups (groups B and C). Defects of cylindrical full-thickness (3.5 mm wide, 4 mm deep) were created in the weight-bearing area of the right knee medial femoral condyles. In group A, the defect was left empty. In group B, the defect was filled with a collagen sponge. In group C, the defect was filled with a collagen sponge impregnated with PDGF. All rabbits were followed-up for 12 weeks. Right knee medial femoral condyles were used for macroscopic and histological analyses.

Results: At macroscopic level, the repair tissue was similar to normal adjacent cartilage at 12 weeks in group C. The surface of the repair tissue in group C was smoother and more regular compared to groups A and B. The total histological score of defects in group C was statistically significantly superior compared to groups A and B (p<0.05). Matrix staining and immunostaining of collagen type 2 were stronger in group C compared to the other groups, indicating the presence of a tissue similar to a normal cartilage.

Conclusion: Platelet-derived growth factor can induce repair in full-thickness defects of articular cartilage in an animal model. Thus, this study demonstrates the potential use of PDGF for full-thickness osteochondral defects.

Objectives: This study aims to detect the levels of some biochemical markers in A1 pulley tissue of type 2 diabetic trigger finger patients to enlighten the mechanisms leading to cellular complications.

Patients and methods: The study included 35 trigger finger patients (5 males, 30 females; mean age 53.9±9.15 years; range, 37 to 71 years). We measured total thiol (total-SH) levels to determine the status of the non-enzymatic antioxidant defense system and advanced oxidation protein product (AOPP) levels to determine levels of oxidative protein modification in pulley tissues of trigger finger patients with or without diabetes. Extracellular matrix degradation was assessed by measuring levels of sialic acid (SA) in the pulley tissue.

Results: Total-SH values for the groups with and without diabetes were 22.7±1.6 vs. 38.9±5.2 nmol/mg protein, respectively, while AOPP values were 472.5±131.6 vs.175.6±9.9 mmol/g protein, respectively. The SA levels of diabetic and nondiabetic patients were 0.4±0.0 vs. 0.63±0.1 nmol/mg protein, respectively.

Conclusion: Our results revealed that tissue SA levels and tissue SH levels decreased and AOPP levels increased disproportionally in the A1 pulley tissue of diabetic patients, which may indicate the role of oxidative protein damage and extracellular matrix changes in diabetic trigger finger etiology.

Objectives: This study aims to review the results of surgically treated displaced intra-articular calcaneal fractures with a fast, less complicated, and modified percutaneous technique.

Patients and methods: This retrospective study included 114 patients (86 males, 28 females; mean age 39 years; range, 16 to 66 years) admitted to our clinic for calcaneal fractures between May 2012 and June 2016 and operated using closed reduction and percutaneous fixation with two crossed Schanz pins. Trauma type, additional injuries, medical comorbidities, pre- and postoperative period, duration of operation, time to bone healing, complications, postoperative functional and radiological results were evaluated.

Results: The increase in the postoperative Bohler's angle measurements was statistically significant compared to preoperative values (p=0.001; p<0.01). According to Sanders classification, seven feet (5.3%) were type II, 76 feet (57.57%) were type III, and 49 feet (37.12%) were type IV. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 80.4 (range, 47 to 92). According to Sanders classification, the mean AOFAS scores were 81.25 for type II, 81.88 for type III, and 80.19 for type IV. Mean duration of operation was 8±1.5 minutes.

Conclusion: Modified percutaneous fixation can give good results, even when open reduction is contraindicated. Maintaining the alignment and elevating the depressed intra-articular fragment may be sufficient for good mid-term results without anatomic reduction.

Objectives: This study aims to evaluate proximal, shaft, and distal tibial fractures treated with suprapatellar (SP) tibial intramedullary nailing (IMN) in terms of alignment, healing, and patellofemoral (PF) pain.

Patients and methods: The study included 58 patients (41 males, 17 females; mean age 42.9 years; range, 18 to 75 years) treated via the SP approach in semiextention. Suprapatellar IMN surgeries were performed by two surgeons. After a minimum of 12 months of follow-up, patients' genders, ages, limb sides, fracture types, and classifications were recorded. Fracture reduction accuracy, angulation, PF arthritis, healing time, complications, and nonunions were analyzed. Anterior knee pain, visual analog scale (VAS), and Lysholm knee scoring scale were used as clinical measurements.

Results: Seventeen fractures were in the proximal third, while 22 were in the middle third and 19 were in the distal third of the tibia. The mean healing time was 7.14 months (range, 4 to 13 months); differences in healing time between fracture locations were not statistically significant (p=0.83). The mean follow-up duration was 19.83 months (range, 12 to 30 months); there were no statistically significant differences in follow-up times in terms of fracture sites (p=0.51). The VAS score for the knee was 0 in 49 patients (84.5%) and <3 in nine patients (15.5%). The Lysholm score differences between the fracture location groups were not statistically significant (p=0.33).

Conclusion: Suprapatellar tibial IMN can be applicable to extra-articular tibial fractures in all locations. Providing easy anatomic reduction in semiextention, convenient fluoroscopic imaging, safety for the PF joint, acceptable anterior knee pain, and satisfactory functional outcomes render SP approach more feasible.

Objectives: This study aims to investigate the significance of selective arterial embolization (SAE) as neoadjuvant for the treatment of pseudotumor (PT) associated with hip arthroplasty and present our case series including all the known bearing techniques.

Patients and methods: This retrospective study included 16 patients (9 males, 7 females; mean age 75.5 years; range, 55 to 87 years) affected by hip PT. Seven patients were treated only surgically without any adjuvant treatment (group A), while nine patients were performed preoperative SAE (group B). Pseudotumors were grouped according to magnetic resonance imaging and computed tomography (CT) classifications. Durations of all operations and number of blood units given intra- and postoperatively were recorded.

Results: Although embolization did not change the amount of intraoperative bleeding (p=0.619), a common vascular network leading to PT was observed in all patients in angiography. Group A's mean duration of operation was shorter than group B (p=0.03); however, this condition was attributed to larger and more complex lesions of patients who underwent embolization. According to CT classification, blood loss was more and duration of operation was longer in severe stages (p=0.046 and p=0.035, respectively).

Conclusion: Successful demonstration of vascular network in patients with PT strengthens the idea that SAE technique may be used particularly in severe cases according to CT classification. Our findings suggest that PT may develop in all commonly used bearings.

In this article, we report a 67-year-old male patient who had a different wear pattern on the bottom of his tennis shoe after surgical repair of acute Achilles tendon rupture with 22-year follow-up. The wear pattern was well-matched with dynamic pedobarography. In left shoe with less total contact area and higher pressure values, there was more wear compared to right shoe.

Objectives: This study aims to evaluate the efficacy of ultrasound (US)-guided peripheral nerve blocks in postoperative analgesia after pediatric orthopedic tumor surgery.

Patients and methods: This retrospective study included 108 children (64 boys, 44 girls, mean age 10.23 years; range, 2 to 18 years) who were performed orthopedic tumor surgery under general anesthesia. The children were divided into two groups as those who were performed nerve block for postoperative pain control (group 1, n=54) and those who were performed intravenous analgesic (group 2, n=54). In group 1, nerve blocks were performed with bupivacaine 0.25%. In group 2, intraoperative acetaminophen 15 mg/kg was performed intravenously. Postoperative visual analog scale (VAS) scores, time to pain onset, nausea, vomiting, total analgesic consumption in 24 hours, and complications were recorded at first, second, sixth and 24th hours.

Results: Visual analog scale scores were higher in group 2 than group 1 at first, second, and sixth hours, but were not different at 24th hour. Mean time to pain onset was 10.2 hours in group 1 and 1.8 hours in group 2 (p<0.05). Mean time to pain onset and VAS values at first, second, sixth and 24th hours did not differ between nerve block types. Nausea and vomiting rates were not different between groups 1 and 2 (18.51% and 16.66%, respectively; p=0.4). Total analgesic consumption in 24 hours was higher in group 2 compared to group 1 (1.7 and 0.07 mg/kg, respectively; p<0.05).

Conclusion: Pain-free periods extending up to 10 hours provided by US-guided peripheral nerve blocks may help recovery while reducing postoperative analgesic use and their side effects.

Objectives: This study aims to evaluate the clinical characteristics and treatment outcomes of patients with primary malignant tumors located in the proximal fibula.

Patients and methods: This retrospective study included 23 patients (15 males, 8 females; mean age 22.1 years; range, 9 to 63 years) with primary malignant tumors located in the proximal fibula between May 2007 and May 2017. The anamnesis or medical history, physical examination, plain chest radiography, lung computed tomography, direct radiograph, and magnetic resonance imaging of the affected extremity and routine laboratory tests of all patients were evaluated.

Results: Of the patients, 11 were diagnosed with osteosarcoma (47.8%), nine with Ewing's sarcoma (39.1%), two with chondrosarcoma (8.7%), and one was diagnosed with synovial sarcoma (4.3%). Pain and palpable mass were the most common symptoms. Six patients had lung metastases at the time of diagnosis. Of the patients, eight were performed Malawer type 1 resection (34.8%), nine type 2 resection (39.1%), four above knee amputation (17.4%), and two proximal tibia tumor resection prosthesis (8.6%). Mean follow-up duration was 36 months (range, 12 to 119 months). Local recurrence developed in three patients. Mean Musculoskeletal Tumor Society (MSTS) score of all patients was 62.

Conclusion: Surgical treatment of primary malignant tumors of the proximal fibula is problematic. In appropriate indications, Malawer type 1 resection should be the treatment of choice due to lower local recurrence rates and higher MSTS scores.

Objectives: This study aims to describe our standardized method for evaluating the tension of reduction around the hip joint during open reduction in patients with developmental dysplasia of the hip (DDH).

Patients and methods: We retrospectively evaluated 67 pediatric patients (8 males, 59 females; mean age 21.9±11.1 months; range, 9 to 67 months) who were performed open reduction or open reduction with concomitant pelvic and/or femoral osteotomy for DDH at our clinic between January 2009 and March 2014. The amount of distraction between femoral head and acetabulum was measured to evaluate the tension of reduction during surgery. Factors associated with avascular necrosis (AVN) such as age at reduction, presence of concomitant pelvic and/or femoral shortening osteotomy, and severity of dislocation were determined.

Results: Statistically significant association was found between the presence of femoral osteotomy, severity of dislocation, and amount of distraction and AVN. The incidence of AVN was 38.8% (10 grade I, 12 grade II, 3 grade III, and one grade IV AVN). Cut-off value for the amount of distraction to prevent the development of AVN was calculated as 4 mm.

Conclusion: According to our study findings, we advise using our technique for the evaluation of the tension of reduction around the hip joint and performing tension free reduction in the treatment of DDH to minimize the risk of AVN development.