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

Objectives: This study aims to evaluate the distance between the median nerve and the hook of the hamate pre- and postoperatively in patients with carpal tunnel syndrome and to investigate the efficiency of magnetic resonance imaging in diagnosis and postoperative follow-up.

Patients and methods: Median nerve decompression was performed by releasing the carpal tunnel in 15 patients (4 males, 11 females; mean age 51 years; range, 41 to 66 years) with carpal tunnel syndrome. The shortest distance between the median nerve and the hook of the hamate was measured with magnetic resonance imaging preoperatively and at three months after the operation and radial and ulnar translations were assessed. Findings were compared to those of a control group of 15 subjects (5 males, 10 females; mean age 52.2 years; range, 40 to 65 years).

Results: Median nerve shifted ulnarwards in patients with carpal tunnel syndrome. An intragroup evaluation of five patients with thenar atrophy revealed that as disease severity increased, the degree of the nerve's medial translation increased. Compared to preoperation, the median nerve significantly shifted to the radial side after decompression.

Conclusion: In carpal tunnel syndrome patients, we observed significant ulnar translation of the median nerve and lateral translation after releasing the carpal tunnel. Magnetic resonance imaging may be used to establish a diagnosis and to assess operation success in advanced carpal tunnel syndrome patients who may recover slowly postoperatively.

Objectives: This study aims to compare the efficacy of existing training models for acquisition of arthroscopic skills and to investigate the most effective training method or combination of methods for residents.

Materials and methods: A total of 100 fifth-year students from medical school (40 males, 60 females; mean age 23.7 years; range, 22 to 33 years) volunteered to participate in the study and were randomly divided into five education groups (E1-5): group E1 (trained on bench-top simulator), group E2 (read surgical technique), group E3 (read surgical technique and watched surgical video), group E4 (watched surgical video only), and group E5 (control group). After completion of the pre-training, each student was individually asked to perform an arthroscopy practice. A checklist containing the tasks to be performed was given to students and students were asked to complete the tasks on the checklist in five minutes.

Results: In group E1, the mean rate of successful achievement of tasks was significantly higher than other groups in both knee and shoulder arthroscopy models. Rate of each task was statistically similar for groups E2, E3, E4 and E5. In group E1, mean durations for completion of tasks in both arthroscopy models were significantly shorter than other groups. There was no statistically significant difference in terms of gender between those who successfully completed the tasks in both arthroscopy models.

Conclusion: A basic arthroscopic bench-top simulator may be a low-cost and effective training method to increase arthroscopic skill levels in resident training compared to traditional methods.

Osteoma is a benign tumor. Extracranial cases are very rare. Twelve cases have been reported by 10 different authors in the literature. To our knowledge, osteoma was never reported in the patella. In this article, we report a 61-year-old male patient who presented with a painless mass in the patella of his right knee, which appeared almost four years before and showed a progressive enlargement in the past six months. Range of motion (ROM) of the joint was limited. Marginal excision was performed under regional anesthesia and the histopathological evaluation of the lesion confirmed the diagnosis of osteoma. There were no postoperative complications and the ROM of the joint returned to normal. Patient was followed-up for 24 months without any recurrence. This case of peripheral osteoma identified in the patella is an example of an atypical presentation. Patella tumors may affect the extensor mechanism. Therefore, detailed examination should be performed and differential diagnosis should be established carefully.

Objectives: This study aims to evaluate the effect of diabetes mellitus (DM) on intramuscular fatty degeneration after a full-thickness supraspinatus (SS) tendon tear in rats.

Materials and methods: The study included 24 adult male Wistar Albino rats (age, 18 to 24 weeks; weighing, 320-380 g) randomized into a sham group (n=6), control group (n=6) and experimental group (n=12). Rats with fasting blood glucose levels ≥250 mg/dL at each measurement after an injection of streptozotocin were accepted to have DM. On the seventh day of the study, the SS muscles of the rats in the experimental and control groups were cut from the insertion. All animals were performed euthanasia four weeks after the surgical procedure and SS muscles were excised completely. Fatty degeneration in the SS muscle was assessed histologically and immunohistochemically with oil red O and peroxisome proliferator-activated receptor gamma (PPAR-γ) staining using histological score (H-score) and quantitative methods.

Results: More intense oil red O and PPAR-γ staining was observed in all regions of the SS muscles of the experimental group compared to control and sham groups (p<0.05).

Conclusion: The results of this study showed that DM accelerates intramuscular fatty degeneration after SS tendon tears. Fatty degeneration should be monitored closely in diabetic patients with rotator cuff tear who were selected for conservative treatment and early surgical treatment should be considered as an option.

Objectives: This study aims to investigate the clinical and radiological outcomes of core decompression surgery performed with multiple drilling in solid organ transplantation patients with osteonecrosis of femoral head (ONFH) and evaluate the effectiveness of this procedure in regard to duration of corticosteroid use and stage of osteonecrosis.

Patients and methods: A total of 22 solid organ transplantation (kidney, liver or heart) patients (14 males, 8 females; mean age 43.3 years; range, 23 to 67 years) who were scheduled to undergo core decompression surgery with multiple drilling for ONFH were evaluated. Patients' Harris hip scores (HHSs) and radiographic data including Association Research Circulation Osseous (ARCO) staging and Kerboul grading were retrospectively reviewed at pre- and postoperative controls.

Results: Patients were followed-up for mean 34.3 months (range, 12 to 76 months). Two patients (9.09%) were performed total hip arthroplasty. These two patients' Kerboul grade was 3. There was no statistically significant relationship between preoperation and postoperative final control in terms of ARCO staging. There was no statistically significant difference between pre- and postoperative HHSs.

Conclusion: Although multiple drilling is a safe and minimally invasive surgery, its effect is limited, particularly in solid organ transplantation patients with ONFH due to long-term corticosteroid use. Therefore, solid organ transplantation patients should be closely monitored in terms of ONFH development.

Objectives: This study aims to compare the antibiotic release and biological effectiveness of bead type and articulating spacers of different cement types with antibiotics added at alternative phases of cement preparation.

Materials and methods: Four gram vancomycin was added into two types of antibiotic-free cement (Simplex®, Biomet®) with similar viscosity and also gentamycin-containing cement (Refobacin®). Prepared specimens were used to create cement beads and articulating hip spacers, making a total of six different groups. Two alternative groups were formed by adding the Vancomycin while the cement was in dough phase. Antibiotic release and biological activity were evaluated with immunoassay techniques and agar-disk diffusion methods.

Results: All groups showed initial antibiotics surge in the first week, which was 2 to 4 times more evident in the beads group. Antibiotic release and change in release rate were significantly different between Simplex-alternative and Simplex, Biomet, Refobacin-beads, and between Biomet-spacer and Refobacin-beads groups (p<0.05). Elution of antibiotics was not different between mobile spacers prepared with conventional or alternative methods (p>0.05). Biomet cement showed larger diffusion inhibition zone in agar. There was no difference between biological activity of the bead and mobile designs of the Biomet brand (p>0.05). Inhibition zone analyses of agar and disk diffusion tests revealed significant differences between several groups (p<0.05).

Conclusion: Cement beads provide superior antibiotic release regardless of cement type or preparation method. Simplex P® cement has lower anti-bacterial efficiency than Biomet®. Different methods for cement and antibiotics mixing and addition of extra vancomycin into the commercially drug loaded cement do not have any effect on the results.

Objectives: This study aims to investigate the effects of different amounts of compression used in intramedullary nailing on the stress values of the fracture surface and time of the union process in tibia diaphysis fractures treated with intramedullary nails.

Patients and methods: Seventy patients (50 males, 20 females; mean age 34.0±10.7 years; range, 20 to 56 years) who had suffered from tibial shaft fractures between January 2007 and December 2015 were included in the study. Patients who had A2, A3, and B2 type fractures according to AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification and those with closed fractures were included. The patients were divided into three groups. No compression was applied to Group A, dynamic compressive fixation intramedullary nailing was applied to Groups B and C. Amount of applied compression was 1 mm for Group B and 1.5 mm for Group C. Postoperative and follow-up radiographs of patients were evaluated according to Rust criteria, and functional results were evaluated according to Johner-Wrush criteria. Additionally, finite element analyses were performed separately for 1 mm and 1.5 mm compressions that were applied in Group B and C, respectively. The data were analyzed using a statistical software package.

Results: Clinical and radiological union was achieved in all patients. The average time of radiological union was 15.05±2.06 weeks in Group A, 12.48±1.42 weeks in Group B, and 11.64±1.63 weeks in Group C. The time of union for the group in which no compression was applied (Group A) was significantly longer than the other groups in which compression was applied (Group B and C) (p<0.001). Functional outcomes were 17 patients (85%) with excellent and three patients (15%) with good-moderate results in Group A, 23 (92%) excellent and two (8%) good-moderate in Group B, and 23 (92%) excellent and two patients (8%) with good-moderate results in Group C. In total, seven patients had knee pain. No infection was seen in any patient.

Conclusion: Interlocking compression intramedullary nailing is a very effective treatment method for tibial shaft fractures. As the compression applied by the nail increases, the time of union shortens significantly.

Objectives: This study aims to investigate whether or not low-energy distal radius or vertebra fractures are harbingers of hip fracture.

Patients and methods: A total of 142 patients had surgical treatment due to hip fracture in our clinic between February 2013 and January 2017. The patients had low-energy fractures before hip fracture, and they received either medical treatment for osteoporosis or not before hip fracture developed.

Results: Of 142 patients, 32 had distal radius, humeral neck, ankle, vertebra fractures and 15 had a second hip fracture. The patients were determined to have most frequently a distal radius and vertebra fracture before hip fracture. The treatment of osteoporosis was determined to be neglected in 58% of 47 patients in total who had a fracture previously.

Conclusion: Distal radius and vertebra fractures are the harbingers of a potential hip fracture. Physicians, especially orthopedists, who face with these fractures should be careful in terms of osteoporosis.

Objectives: In this study, the T2 mapping magnetic resonance imaging technique was used to evaluate early cartilage changes associated with patellofemoral alignment and morphology.

Patients and methods: Fifty four patients (Study group: 38 females, 16 males) with anterior knee pain and a randomly selected and age-matched 50 controls (Control group; 37 females, 13 males) were compared by two blinded authors in terms of T2 values of the patella medial, lateral facet, and trochlea, Insall-Salvatti index, lateral trochlear inclination angle, patellar tilt angle, sulcus angle, and patella medial and lateral facet lengths. The inter- and intra-observer reliability tests were assessed.

Results: The T2 medial patellar facet value, T2 lateral patellar facet value, T2 trochlea value, Visual Analog Scale, tibial tubercle - greater trochanter distance, and patellar tilt angle measure were statistically significantly higher in the study group.

Conclusion: Based on our study findings, the T2 mapping magnetic resonance imaging (MRI) technique was found to be reliable test that can be used to diagnose early cartilage damage in patients with anterior knee pain. In patients with anterior knee pain, especially with decreased Insall Salvatti index, low lateral trochlear inclination angle, and higher patellar tilt angle, adding a T2 mapping sequence to the standard knee MRI protocol is recommended to help detect early cartilage damage.

Objectives: In this study, we introduce the SanatSwing cementless total knee prosthesis coated with a combination of titanium plasma spray and hydroxyapatite porous coating and compared its early results to the SanatSwing cemented knee prosthesis.

Patients and methods: We compared 278 patients, who underwent total knee replacement between September 2012 and February 2017. A total of 142 patients (Group A; 78 male, 64 female, mean age 69±14) were implanted a cemented SanatSwing and 136 patients (Group B; 83 male, 53 female, mean age 59±10), a cementless SanatSwing knee prosthesis was implanted. Implant position and periprosthetic bone conditions were investigated over time on radiographs after a mean follow-up period of two years. Range of motion, pain level, distance of painless walk, and the ability to climb stairs were evaluated.

Results: Significant improvement was observed in both the cemented and uncemented groups when the preoperative scores were compared to the scores of their final visit, but we did not find any difference in measured scores between the cemented and uncemented group. Complication rates were low and almost similar in both groups without any significant difference.

Conclusion: We used the combination of titanium plasma spray and the hydroxyapatite porous coating technique in cementless prostheses. Our results showed us that the novel SanatSwing cementless total knee prosthesis could be a great alternative to cemented total knee arthroplasty.