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

Objectives: This study aims to investigate the effect of obesity on pneumatic tourniquet inflation pressures determined with a novel formula during total knee arthroplasty (TKA).

Patients and methods: Data of 208 patients (19 males, 199 females; mean age 69.8 years; range, 53 to 84 years) who were performed TKA between January 2013 and December 2016 were evaluated prospectively. Patients were divided into two groups as non-obese (body mass index [BMI] ≤30.0 kg/m2) and obese (BMI >30.0 kg/m2) according to BMI. Tourniquet inflation pressures were set using arterial occlusion pressure (AOP) estimation method and adding 20 mmHg of safety margin to AOP value. All patients were assessed intra- and postoperatively with outcome measures such as systolic blood pressure, AOP, tourniquet pressure and its effectiveness. The quality of the surgical field and complications were assessed by the surgical team in a blinded fashion.

Results: The study included 118 and 90 lower extremity operations in obese and non-obese groups, respectively. Compared to non-obese group; extremity circumference, initial and maximal systolic blood pressures, AOP values, initial and maximal tourniquet pressures were higher in obese group. The performance of the tourniquet was assessed as "excellent" and "good" at almost all stages of the surgical procedure in all patients in both groups. No complication occurred intra- or postoperatively.

Conclusion: Compared to non-obese patients, higher tourniquet inflation pressure is required in obese patients during TKA due to their wider extremity circumference and higher systolic blood pressure profile.

Objectives: This study aims to compare the histopathological and biomechanical effects of low molecular weight heparin (LMWH) and rivaroxaban, which are frequently used in orthopedic surgery for thromboembolic prophylaxis, on rat Achilles tendon healing.

Materials and methods: In the study, 36 adult, male Sprague Dawley rats weighing between 300 g and 400 g were used. Three groups were formed including 12 rats in each. Achilles tendons of all rats were cut and repaired. Nadroparin calcium was administered subcutaneously for 21 days at a dose of 170 IU AXa to the first group (LMWH group). Rivaroxaban was administered daily at a dose of 3 mg/kg for 21 days as gastric lavage to the second group (rivaroxaban group). The third group was identified as the control group and no medication was administered in this group. At the end of three weeks, tendons extracted from the groups were examined histopathologically and biomechanically.

Results: Bonar's and Movin's scores obtained as a result of histopathological examination were statistically significantly higher in the control group (p=0.003 and p=0.004, respectively) (high scores indicate that tendon healing is not sufficient). When type I and type III collagen ratios were examined, type I collagen ratio, which should be found at a higher ratio in mature tendon, was statistically significantly higher in rivaroxaban and LMWH groups compared with the control group (p=0.002). As a result of biomechanical examination, higher mean maximum force values were obtained from the rivaroxaban group compared with the LMWH group (p=0.31). Mean maximum force values obtained from the control group were higher than those obtained from the LMWH group (p=0.03) and the rivaroxaban group (p=0.18).

Conclusion: Histopathological examination revealed that both LMWH and rivaroxaban have positive effects on tendon healing. However, the same positive effects were not detected in biomechanical examination.

Objectives: This study aims to evaluate the diagnosis and treatment approaches of the rarely seen chondrosarcomas of the phalanges of the hand.

Patients and methods: Fifty-two patients (27 males, 25 females; mean age 41.2 years; range 12 to 70 years) with chondroid lesions localized in hand phalanges who were performed surgical treatment between December 2012 and September 2016 were retrospectively reviewed. The study included 62 phalangeal chondroid lesions. Patients' mean follow-up duration was 60.6 months (range 13 to 165 months). Incisional biopsy was performed for the diagnosis. One patient with bilateral and multiple involvement was performed tru-cut biopsy. Phalangeal chondrosarcoma was diagnosed in five patients (9.6%).

Results: Of the chondroid lesions, 37 were localized in proximal phalanges (59.6%), 16 in midphalanges (25.8%), and nine in distal phalanges (14.6%). Chondrosarcoma was detected in 15 phalanges of five patients. Of the two patients with Ollier disease, localization was detected in nine phalanges (four proximal, two mid, three distal phalanges) of one patient and in three phalanges (one proximal, two midphalanges) of the other patient. None of the patients had distant metastasis on diagnosis. Ray amputation was performed in two patients under general anesthesia and amputation was performed in one patient. One patient did not give consent for operation. The other patient with Ollier disease gave consent for amputation of only one finger. No local recurrence was seen.

Conclusion: The hand localization of chondrosarcomas is rare with scarce information in the literature. Their metastasis potential is low but local recurrence rates are high after insufficient surgery. Amputation or ray amputation is the applicable treatment.

The infrapatellar fat pad (IFP) is an intracapsular structure with critical importance both mechanically and endocrinologically. Its dysfunction must be considered while clinically investigating the symptoms arising from the knee joint. Infrapatellar fat pad may be subject to trauma, impingement, inflammation or tumoral formations. Although tumors arising within or adjacent to IFP are not extremely rare, the literature can only provide limited information about them. This article aims to briefly review the current literature on tumors and tumor-like lesions of the IFP and surrounding tissues; focusing on diagnosis and treatment management.

Objectives: This study aims to evaluate the effects of anchor positions on the suture holding strength of a double-row knotless fixation in rotator cuff repair.

Materials and methods: Four different double-row fixation techniques were assessed. In group 1, a 15-mm-wide mattress suture was fixed using a knotless lateral row anchor, horizontal to the shaft. In group 2, the medial sutures were fixed with a 5-mm more lateral anchor that was placed at 45° to the long axis of the humeral shaft. In group 3, different from group 2, medial sutures were fixed with a 30-mm mattress suture width. In group 4, the mattress sutures coming from the medial row anchors were fixed to the 10-mm more lateral row, vertical to the long axis of the humeral shaft. The specimens were cyclically loaded from 10 N to 30 N at 0.5 Hz for 50 cycles, and then loaded to failure.

Results: Group 4 had higher cyclic elongation values than group 1 (p=0.021) and group 3 (p=0.006). Group 1 had lower maximum load value than group 3 (p=0.011). Most of the specimens failed with suture ruptures. Unlike the other groups, none of the specimens in group 4 failed via a suture pull through the lateral anchor.

Conclusion: A horizontal lateral row anchor positioned closer to the medial anchor resulted in less cyclic elongation when compared to a more vertically positioned lateral row anchor. The vertical or oblique positioning of the lateral row anchor did not result in any increase in the failure load value; however, the vertical placement prevented a suture pull through the lateral row anchor.

This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods. Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment and in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. Most of the fractures in children can successfully be treated by non-surgical methods.

Objectives: This study aims to investigate the incidence, anatomic localization, relationship to trauma, treatment complications, relapse ratios after treatment, and factors affecting relapse of epidermoid cysts localized on the extremities.

Patients and methods: The study evaluated retrospectively 120 patients (76 males, 44 females; mean age 41.8 years; range 9 to 76 years) diagnosed with and operated due to epidermoid cyst localized on the extremities between January 2012 and June 2017. Patients' age, gender, cyst's localization, anatomic localization, complaint duration, and trauma history were investigated as well as whether a cutaneous islet was left on the cyst and whether any cyst rupture occurred intraoperatively; and relapse and association of relapse ratios with these parameters.

Results: There was no statistically significant difference between patients with or without relapse in terms of age, gender distribution, or cyst size or localization (p>0.05). Relapse ratios were significantly lower in patients in whom a cutaneous islet was left intraoperatively (p<0.05). Relapse ratios were significantly higher in patients who developed intraoperative cyst rupture (p<0.05). There was no significant relationship between relapse and trauma history (p>0.05). Intraoperative cyst rupture ratios were significantly lower in patients in whom a cutaneous islet was left intraoperatively (p<0.05).

Conclusion: Epidermoid cysts are most frequently localized on the hands. They may also be atypically localized with different dimensions and characteristics. Well definition of the cyst margins and characteristics and avoiding intraoperative rupture while excising the cyst together with the cutaneous islet are essential to reduce possible postoperative complications and relapse ratios.

In this article, we report a case of bilateral posterior shoulder instability, having reverse Hill-Sachs lesions of 25 to 50% of the articular surface on the right side, and of 50% on the left side. The defects were anatomically reconstructed after tuberculum minus osteotomy by elevation of the articular surface and buttressing with raft screws without graft usage. Early rehabilitation with pendulum shoulder exercises was started at third postoperative day. At postoperative sixth week, patient had full range of motion without instability and pain. At postoperative 18th month, the patient had normal physical examination and the constant shoulder score was 86, which was 92.4% of the age- and gender-matched population. Rafting technique without bone grafting may be a treatment alternative with satisfactory clinical results for medium to large sized reverse Hill-Sachs lesions of posterior shoulder instability.

A 22-year-old male patient admitted to our clinic with mild pain in left knee. Pain had started 10 years ago and there was no history of trauma. Pain was increased with kneeling. No abnormality was detected on physical examination. Imaging results revealed proximal tibiofibular synostosis in left knee.