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

Objectives: This study aims to present the early-period outcomes of patients with Dupuytren's contracture (DC) treated with percutaneous needle aponeurotomy technique.

Patients and methods: This retrospective study included 28 patients (20 males, 8 females; mean age 63 years; range, 44 to 88 years) (75 fingers) treated with percutaneous aponeurotomy due to DC between November 2011 and December 2015. Patients were evaluated according to their demographic characteristics, presence of additional disease, family history, history of drug use, complication rate, recurrence development, postoperative patient satisfaction, reoperational request, postoperative Disability of Arm Shoulder and Hand Questionnaire and visual analog scale scores.

Results: Mean follow-up duration was 29 months (range, 12 to 60 months). In the postoperative satisfaction questionnaire, 92.9% (n=26) of patients stated that they were satisfied. In the questionnaire of reoperation request, 82.1% (n=23) of patients accepted the reoperation. While the complication rate was 39.3%, recurrence rate was 35.7%.

Conclusion: Percutaneous needle aponeurotomy technique may be an effective, simple, and safe method for the treatment of DC.

In this article, we report a 41-year-old right-handed male patient with Ideberg-type Vb fracture who was treated with arthroscopic reduction and fixation. The patient was a laborer who suffered from a high-energy trauma (fall from height). X-ray revealed an intra-articular fracture of the left scapula. Computed tomography with three-dimension reconstruction confirmed the fracture type to be an Ideberg-type Vb glenoid fracture. The patient was operated, discharged on postoperative day two, and was able to continue his daily activities even at two months postoperatively. At six months, the University of California at Los Angeles shoulder score was 33 of 35 and the Disabilities of the Arm, Shoulder, and Hand questionnaire score was 2 of 100. Arthroscopic reduction and fixation of Ideberg-type Vb fracture appears to be safe with good radiological and clinical outcomes.

Objectives: This study aims to evaluate the accompanying intra-articular pathologies in patients who underwent arthroscopic distal clavicle resection (DCR) for symptomatic acromioclavicular (AC) joint degeneration based on age groups and to reveal which additional pathologies should be considered across different age groups during physical examination of patients suspected of AC joint degeneration.

Patients and methods: The study included 156 patients (55 males, 101 females; mean age 57.2±10.0 years; range, 35 to 80 years) who underwent arthroscopic DCR between January 2006 and December 2017 and had at least one clinical positive test for AC joint degeneration during the preoperative physical examination. The patients were divided into three groups as those aged <50 years (group 1), between 50-65 years (group 2), and >65 years (group 3). The concomitant intra-articular pathologies were evaluated across different age groups and compared between the groups.

Results: Concomitant intra-articular pathologies were detected in 117 (75%) of a total of 156 patients. Additional pathology rate increased with increasing age (p=0.002). More than one concomitant intra-articular pathologies were detected in 37 patients (23.7%). This rate increased with increasing age (p=0.002). The number of patients with superior labrum anterior posterior (SLAP) lesion as the only additional pathology was 33 (21.2%). This rate decreased with increasing age (p=0.015). In group 1, the rate of concomitant SLAP lesion was 44.1%.

Conclusion: The high incidence of intra-articular pathologies accompanying symptomatic AC joint degeneration raises the importance of careful physical examination, detailed imaging, and arthroscopic surgery to obtain good results in patients scheduled for DCR. The frequency of AC joint degeneration and concomitant SLAP lesions, particularly in younger patients, should be considered during clinical examinations.

Objectives: This study aims to investigate the changes in preferences of orthopedic surgeons for venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and the factors that affect such changes in Turkey.

Materials and methods: Turkish Orthopedics and Traumatology Association members (n=2,180) were invited to fill in the questionnaire. A total of 366 orthopedic surgeons responded and completed questionnaire. The questionnaire was comprised of 12 questions investigating the demographics of surgeons, their preferences for VTE prophylaxis, the changes in their preferences over the course of the past three years, and the causes of such changes.

Results: In the past three years, 31.1% of surgeons changed their VTE prophylaxis method and 32.7% used risk classifications. The use of low molecular weight heparin (LMWH) decreased from 89.4% to 42.5% and from 85.8% to 44.2% after TKA and THA, respectively. The use of aspirin increased from 10.6% to 43.4% and from 9.7% to 37.2% after TKA and THA, respectively. The use of oral anticoagulants increased from 11.5% to 41.6% and from 10.6% to 39.8% after TKA and THA, respectively. Still, orthopedic surgeons in Turkey preferred LMWH at rates of 75.7% and 74% after TKA and THA, respectively. Congressional presentations were the first (47.7%) among the causes of the changes in preferences for VTE prophylaxis. Preferences of up to 60% of surgeons working at universities were influenced by the American Academy of Orthopedic Surgeons guidelines.

Conclusion: In the past three years, approximately one third of orthopedic surgeons changed their preferences for VTE prophylaxis after total joint arthroplasty in Turkey. Changes in preferences were largely in favor of aspirin and oral anticoagulants in parallel to changes in guidelines for VTE prevention.

Objectives: This study aims to investigate the role of subchondral trabecular bone thickness in the mechanism of knee osteoarthritis and the correlation of osteoarthritis and osteoporosis pathogenesis.

Patients and methods: The study included 62 patients (9 males, 53 females; mean age 66.7 years; range, 50 to 84 years) with osteoarthritis. All radiographs were evaluated according to Kellgren and Lawrence classification. The bone mineral density of the patients was measured and bone samples were collected from all patients included in the study during the surgical procedure and investigated pathologically.

Results: Osteoarthritis grade and trabecular bone thickness were correlated with each other. Trabecular thickness rate was higher in patients with severe osteoarthritis, whereas trabecular thickness rate was statistically significantly lower than the mean in patients with mild osteoarthritis (p=0.045).

Conclusion: Trabecular thickness rate was significantly lower in the mild grade of osteoarthritis compared to the severe grade. As the level of osteoarthritis increased, the number of patients with osteoporosis decreased.

Objectives: This study aims to compare the levels of osteoprotegerin (OPG) and 25-hydroxy vitamin D (25(OH)D) in patients with diabetic foot and patients with newly diagnosed type 2 diabetes mellitus (DM) and to investigate the prevalence and severity of 25(OH)D insufficiency in patients with diabetic foot.

Patients and methods: This prospective study was conducted on 105 patients including 58 patients with diabetic foot (42 males, 16 females; mean age 63.6 years; range, 31 to 90 years), who applied to our hospital between June 2014 and May 2015, and 47 newly diagnosed type 2 DM patients (27 males, 20 females; mean age 51.4 years; range, 29 to 85 years) (control group). 25(OH)D and osteoprotegerin serum levels in both groups were measured and compared.

Results: Osteoprotegerin levels in diabetic foot group were significantly higher than the control group (p<0.05). The 25(OH)D levels in diabetic foot group were significantly lower than the control group (p<0.05). There were positive correlations between OPG levels and C-reactive protein (CRP) and creatinine levels in patients with diabetic foot.

Conclusion: Elevated levels of OPG in patients with diabetic foot may display the severity of the clinical status due to its positive correlation with CRP and creatinine. We detected severe 25(OH)D deficiency in the majority of diabetic foot patients. Vitamin D supplementation may be required in diabetic foot patients to prevent unfavorable immunologic alterations.

Triple pelvic osteotomy (TPO) is a widely known and accepted procedure carried out to treat acetabular dysplasia in adults. According to this technique, osteotomies are performed through the ischium, ilium and pubis in order to mobilize the whole acetabulum. In this article, we report a 30-year-old female patient who was admitted to our outpatient clinic with a complaint of intense pain after standing or walking. Patient had undergone Steel-like TPO for acetabular dysplasia approximately nine months before. After physical and radiological evaluation, patient was diagnosed with triple nonunion. Patient was successfully treated with debridement and grafting at iliac nonunion site followed by refixation with reconstruction plate and screws. A review of the literature did not detect any published studies or case reports regarding symptomatic triple nonunion after TPO using Steel-like method.

Objectives: This study aims to analyze the effect of radiosynovectomy (RSO) on the radiological progression of osteoarthritis of the knee joint.

Patients and methods: The study included 207 knee joints of 181 patients (72 males, 109 females; mean age 58 years; range, 19 to 65 years) that were performed RSO between 01 April 2003 and 31 December 2015 in the Department of Orthopedics and Traumatology at Uzsoki Hospital. A total of 111 right and 96 left knees were treated. The mean duration of follow-up was 8.7 years (range, 1 to 12 years). Of the 181 patients, both knee joints were treated in 26.

Results: Of the 207 treated knee joints, 163 had the same Kellgren-Lawrence grade at the time of follow-up compared to the grade at the time of RSO, while 44 had worse outcomes. This indicated that radiological progression was not present in 79% of the treated knee joints. The intraclass correlation coefficient (ICC) showed significantly strong agreement between the pre- and post-measurements (ICC=0.835, p<0.001).

Conclusion: Radiosynovectomy was able to impede radiological progression in 79% of the treated joints and only one-grade deterioration was observed in 39 cases during follow-up.