J Demel, L Planka, R Stichhauer, A Vrtkova, G Bajor, M Havlicek, L Pleva
PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.
{"title":"5th Metatarsal Jones Fracture - To Treat Conservatively, or Surgically Using Headless Double-Threaded Herbert Screw?","authors":"J Demel, L Planka, R Stichhauer, A Vrtkova, G Bajor, M Havlicek, L Pleva","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9512936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion - the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. Key words: rhizarthrosis, osteoarthritis, endoprosthesis of the carpometacarpal joint, dual mobility, Touch®.
{"title":"[Short-term Outcomes of Touch® Prosthesis for Thumb Carpometacarpal Joint].","authors":"D Filuś, R Pavličný","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion - the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. Key words: rhizarthrosis, osteoarthritis, endoprosthesis of the carpometacarpal joint, dual mobility, Touch®.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S Barik, V Garg, S K Sinha, S Chaudhary, P Kandwal, V Singh
PURPOSE OF THE STUDY Although there are numerous studies on outcomes and comparison of open and closed reduction but there is no clarity on relationship between outcomes and complications with type of surgical intervention done for Type 3 Gartland supracondylar humerus fracture. The aim of this study is to compare the outcomes and complications of closed vs open reduction in Type 3 Gartland supracondylar humerus fractures. MATERIAL AND METHODS Electronic literature searches of Embase, MEDLINE and the Cochrane Library was conducted in February 2022 using the terms "supracondylar", "humerus", "fracture", "Gartland type 3" and synonymous. The data extracted included the study details, demographic data, procedure performed, final functional and cosmetic outcome according to Flynn criteria and complications of included studies. RESULTS Pooled data analysis revealed no significant difference in mean satisfactory outcome rate according to Flynn cosmetic criteria in open group (97%, 95% CI 95.5%-98.5%), as compared to closed group (97.5%, 95% CI 96.3%-98.7%), although a statistically significant difference in mean satisfactory rate according to Flynn functional criteria in open group (93.4%, 95% CI 90.8%- 96.1%) as compared to closed group (98.5%, 95% CI 97.5%-99.4%) was noted. On separate comparison of the two-arm studies, closed reduction favoured better functional outcomes (RR 0.92, 95% CI 0.86-0.99). CONCLUSIONS Closed reduction and percutaneous fixation have better functional outcome than open reduction with K-wire fixation. But there was no significant difference in cosmetic outcomes, overall complication rate and nerve injury with either open or closed reduction. The threshold of converting a closed reduction to an open reduction in supracondylar humerus fractures of children should be high. Key words: supracondylar humerus, open reduction, percutaneous pinning, Flynn criteria.
研究目的:虽然有很多关于开放性复位和闭合性复位的结果和比较的研究,但对于3型Gartland肱骨髁上骨折的手术干预类型,结果和并发症之间的关系尚不明确。本研究的目的是比较3型Gartland肱骨髁上骨折的闭合复位和开放复位的结果和并发症。材料与方法于2022年2月对Embase、MEDLINE和Cochrane图书馆进行电子文献检索,检索词为“髁上”、“肱骨”、“骨折”、“Gartland 3型”和同义词。提取的数据包括研究细节、人口统计数据、进行的手术、根据Flynn标准的最终功能和美容结果以及纳入研究的并发症。结果合并数据分析显示,开放组按照Flynn美容标准的平均满意率(97%,95% CI 95.5%-98.5%)与封闭组(97.5%,95% CI 96.3%-98.7%)相比无显著差异,但开放组按照Flynn功能标准的平均满意率(93.4%,95% CI 90.8%- 96.1%)与封闭组(98.5%,95% CI 97.5%-99.4%)有统计学差异。在两组研究的单独比较中,闭合复位有利于更好的功能预后(RR 0.92, 95% CI 0.86-0.99)。结论闭合复位经皮内固定比切开复位加克氏针内固定具有更好的功能效果。但两组在美容效果、总并发症发生率和神经损伤方面均无显著差异。儿童肱骨髁上骨折的闭合复位到开放复位的阈值应该很高。关键词:肱骨髁上,切开复位,经皮钉钉,Flynn标准。
{"title":"A Meta-Analysis on Comparison of Open vs Closed Reduction of Gartland Type 3 Supracondylar Humerus Fractures in Children.","authors":"S Barik, V Garg, S K Sinha, S Chaudhary, P Kandwal, V Singh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Although there are numerous studies on outcomes and comparison of open and closed reduction but there is no clarity on relationship between outcomes and complications with type of surgical intervention done for Type 3 Gartland supracondylar humerus fracture. The aim of this study is to compare the outcomes and complications of closed vs open reduction in Type 3 Gartland supracondylar humerus fractures. MATERIAL AND METHODS Electronic literature searches of Embase, MEDLINE and the Cochrane Library was conducted in February 2022 using the terms \"supracondylar\", \"humerus\", \"fracture\", \"Gartland type 3\" and synonymous. The data extracted included the study details, demographic data, procedure performed, final functional and cosmetic outcome according to Flynn criteria and complications of included studies. RESULTS Pooled data analysis revealed no significant difference in mean satisfactory outcome rate according to Flynn cosmetic criteria in open group (97%, 95% CI 95.5%-98.5%), as compared to closed group (97.5%, 95% CI 96.3%-98.7%), although a statistically significant difference in mean satisfactory rate according to Flynn functional criteria in open group (93.4%, 95% CI 90.8%- 96.1%) as compared to closed group (98.5%, 95% CI 97.5%-99.4%) was noted. On separate comparison of the two-arm studies, closed reduction favoured better functional outcomes (RR 0.92, 95% CI 0.86-0.99). CONCLUSIONS Closed reduction and percutaneous fixation have better functional outcome than open reduction with K-wire fixation. But there was no significant difference in cosmetic outcomes, overall complication rate and nerve injury with either open or closed reduction. The threshold of converting a closed reduction to an open reduction in supracondylar humerus fractures of children should be high. Key words: supracondylar humerus, open reduction, percutaneous pinning, Flynn criteria.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE OF THE STUDY Dislocation is one of the most common early complications of total hip arthroplasty (THA). In this manuscript, 20 years of experience with the management of this complication are presented, particularly in relation to the type of instability. MATERIAL AND METHODS In the period between January 1999 and December 2020, at least one dislocation occurred in 157 of 8 286 (1.9%) THA patients, of which 117 dislocations (1.6%) in primary and 40 (3.4%) in revision THAs. Almost all patients were operated on from the anterolateral approach during the follow-up period. The type of dislocation was evaluated using the modified Dorr classification. In the first dislocations, conservative approach was usually opted for, except for cases with a clear malposition, irreducible or unstable hips after the reduction. The minimum follow-up period was 18 months (18-240). The success rate of the chosen treatment approach was assessed by means of standard statistical methods. RESULTS The total dislocation rate in the follow-up period was 1.6% for primary THAs and 3.4% for revision THAs. The dislocation rate was slightly higher between 1999 and 2009 compared to the following decade (2.1% versus 1.3% for primary THAs; p=0.009). The most common type of dislocation was the positional dislocation (62%), followed by dislocations due to a combination of causes (17%) and component malposition (11%). Treatment of dislocation was successful in a total of 130 patients (130/157; 83%). Even though a stable hip was achieved in 21 patients (13%), the functional outcome was unsatisfactory, and in 6 patients (4%) we failed to achieve a stable hip. In the positional type of dislocation, the success rate of closed reduction following the first-time dislocation was 86.4% and a similar success rate was reported for reoperations in the first-time dislocations due to the malpositioned components (85.7%). In the second-time dislocation, the surgical therapy was significantly more reliable compared to closed reduction regardless of the type of dislocation (78.6% versus 46%). The treatment of dislocations following primary THAs showed comparable outcomes to those of the treatment of dislocations following revision THAs. Overall, the worst outcomes were achieved in patients with a combined type of dislocation. In total, the THA had to be removed in 11.5% of hips (18/157). The probability of final THA removal increased with the increasing order of dislocation. DISCUSSION In our group of patients, the dislocation rate in THA was comparable or lower than the published data. With the use of preventive measures, i.e. dual mobility cup or larger head diameters in high-risk patients, we managed to reduce the dislocation rate over time. The positional type of dislocation prevails in our group of patients just as in the previously published series, followed by instability from malposition of components. The modified Dorr classification is used to guide the treatment since it allows
{"title":"[How Does Affect the Type of Instability after Total Hip Arthroplasty the Outcomes? Our Experience between 1999 and 2020].","authors":"J Špička, J Gallo, K Langová","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Dislocation is one of the most common early complications of total hip arthroplasty (THA). In this manuscript, 20 years of experience with the management of this complication are presented, particularly in relation to the type of instability. MATERIAL AND METHODS In the period between January 1999 and December 2020, at least one dislocation occurred in 157 of 8 286 (1.9%) THA patients, of which 117 dislocations (1.6%) in primary and 40 (3.4%) in revision THAs. Almost all patients were operated on from the anterolateral approach during the follow-up period. The type of dislocation was evaluated using the modified Dorr classification. In the first dislocations, conservative approach was usually opted for, except for cases with a clear malposition, irreducible or unstable hips after the reduction. The minimum follow-up period was 18 months (18-240). The success rate of the chosen treatment approach was assessed by means of standard statistical methods. RESULTS The total dislocation rate in the follow-up period was 1.6% for primary THAs and 3.4% for revision THAs. The dislocation rate was slightly higher between 1999 and 2009 compared to the following decade (2.1% versus 1.3% for primary THAs; p=0.009). The most common type of dislocation was the positional dislocation (62%), followed by dislocations due to a combination of causes (17%) and component malposition (11%). Treatment of dislocation was successful in a total of 130 patients (130/157; 83%). Even though a stable hip was achieved in 21 patients (13%), the functional outcome was unsatisfactory, and in 6 patients (4%) we failed to achieve a stable hip. In the positional type of dislocation, the success rate of closed reduction following the first-time dislocation was 86.4% and a similar success rate was reported for reoperations in the first-time dislocations due to the malpositioned components (85.7%). In the second-time dislocation, the surgical therapy was significantly more reliable compared to closed reduction regardless of the type of dislocation (78.6% versus 46%). The treatment of dislocations following primary THAs showed comparable outcomes to those of the treatment of dislocations following revision THAs. Overall, the worst outcomes were achieved in patients with a combined type of dislocation. In total, the THA had to be removed in 11.5% of hips (18/157). The probability of final THA removal increased with the increasing order of dislocation. DISCUSSION In our group of patients, the dislocation rate in THA was comparable or lower than the published data. With the use of preventive measures, i.e. dual mobility cup or larger head diameters in high-risk patients, we managed to reduce the dislocation rate over time. The positional type of dislocation prevails in our group of patients just as in the previously published series, followed by instability from malposition of components. The modified Dorr classification is used to guide the treatment since it allows","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The aim of our study was to investigate facet tropism and its impact on the development of lumbar spinal canal stenosis (LSCS) in patients with LSCS. MATERIALS AND METHODS Bilateral facet joint angles at the L3-4, L4-5, and L5-S1 levels were measured on axial plane in the lumbar magnetic resonance imaging (MRI) scans of 82 patients aged between 32 and 75 with LSCS, and 82 healthy individuals aged between 30 and 66 without LSCS, who were considered as the normal group. RESULTS Both groups in our study consisted of both males and females. The mean age was 51.4 for patients with LSCS and 44.7 for the healthy group, with no signifi cant difference (p>0.05). A total of 984 facet joint angles were measured, with 164 patients at three intervertebral disc levels each. The presence of facet tropism was found to be a signifi cant risk factor in the LSCS group compared to the healthy group, with an increased risk of 2.125 times at L3-4, 3.389 times at L4-5, and 2.496 times at L5-S1 (p<0.05). CONCLUSIONS In our study, we determined that facet joint tropism is statistically signifi cant in patients with LSCS compared to the control group (p<0.05). We believe that facet tropism plays a predisposing role as a contributing factor in the etiology of LSCS.
Key words: lumbar spinal stenosis, facet tropism, magnetic resonance ımaging.
{"title":"Investigation of the Effect of Facet Joint Angle Characteristics on the Development of Lumbar Spinal Stenosis in Patients with Lumbar Canal Stenosis.","authors":"A Eroğlu, M Atar, M Sapanci, C Atabey","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of our study was to investigate facet tropism and its impact on the development of lumbar spinal canal stenosis (LSCS) in patients with LSCS. MATERIALS AND METHODS Bilateral facet joint angles at the L3-4, L4-5, and L5-S1 levels were measured on axial plane in the lumbar magnetic resonance imaging (MRI) scans of 82 patients aged between 32 and 75 with LSCS, and 82 healthy individuals aged between 30 and 66 without LSCS, who were considered as the normal group. RESULTS Both groups in our study consisted of both males and females. The mean age was 51.4 for patients with LSCS and 44.7 for the healthy group, with no signifi cant difference (p>0.05). A total of 984 facet joint angles were measured, with 164 patients at three intervertebral disc levels each. The presence of facet tropism was found to be a signifi cant risk factor in the LSCS group compared to the healthy group, with an increased risk of 2.125 times at L3-4, 3.389 times at L4-5, and 2.496 times at L5-S1 (p<0.05). CONCLUSIONS In our study, we determined that facet joint tropism is statistically signifi cant in patients with LSCS compared to the control group (p<0.05). We believe that facet tropism plays a predisposing role as a contributing factor in the etiology of LSCS.</p><p><strong>Key words: </strong>lumbar spinal stenosis, facet tropism, magnetic resonance ımaging.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139401401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE OF THE STUDY The study retrospectively reviews the outcomes of patella stabilisation surgeries performed at our department in the period 2010-2020. It aimed to provide a more thorough evaluation, to compare the respective types of MPFL reconstruction and to confirm the beneficial effect of tibial tubercle ventromedialization on patella height. MATERIAL AND METHODS In the period 2010-2020, a total of 72 stabilisation surgeries of patellofemoral joint in 60 patients with objective patellar instability (OPI) were performed at our department. The surgical treatment outcomes were evaluated retrospectively using a questionnaire, including the postoperative Kujala score. A comprehensive examination was carried out in 42 patients (70%) who had completed the questionnaire. In case of distal realignment, the TT-TG distance and a change in the InsallSalvati index which serve as an indication for surgery, were assessed. RESULTS Altogether 42 patients (70%) and 46 surgical interventions (64%) were evaluated. The follow-up period was 1-11 years, with the mean follow-up of 6.9 years. In the studied group of patients, only 1 case (2%) of new dislocation was seen, in 2 cases (4%) the patients reported a subluxation episode. The mean score using the school grades was 1.76. Thirty-eight patients (90%) were satisfied with the surgical outcome, 39 patients would undergo a surgery in case of identical problems with the other limb. The mean postoperative Kujala score was 76.8 points, range 28-100 points. The mean TT-TG distance in the studied group with the preoperative CT scan (33x) was 15.4 mm (12-30 mm). The mean TT-TG distance in the cases indicated for tibial tubercle transposition was 22.2 mm (15-30 mm). The mean Insall-Salvati index prior to the performance of tibial tubercle ventromedialization was 1.33 (1-1.74). Postoperatively, the index decreased by 0.11 on average (-0.00 to -0.26) to 1.22 (0.92-1.63). No infectious complications were presented in the studied group. DISCUSSION In patients with recurrent patellar dislocation, the instability is often times caused by pathomorphologic anomalies of the patellofemoral joint. In patients with clinically expressed patellar instability and physiological values of the TT-TG distance, an isolated proximal realignment is performed by medial patellofemoral ligament (MPFL) reconstruction. In the case of pathological values of the TT-TG distance, distal realignment is performed by tibial tubercle ventromedialization to achieve physiological values of the TT-TG distance. In the studied group, tibial tubercle ventromedialization helped decrease the Insall-Salvati index by 0.11 points on average. This has a positive side effect on the patella height, thus on increasing its stability in the femoral groove. In patients with both proximal and distal malalignment, a two-stage surgery is performed. In the isolated cases of severe instability or if symptoms of lateral patellar hyperpressure are present, musculus vast
本研究回顾性回顾了2010-2020年期间在我科进行的髌骨稳定手术的结果。目的是提供更全面的评估,比较不同类型的MPFL重建,并确认胫骨结节腹内化对髌骨高度的有益影响。材料与方法2010-2020年,我科共对60例客观髌骨不稳(OPI)患者进行了72例髌股关节稳定手术。采用回顾性调查问卷评估手术治疗结果,包括术后Kujala评分。对42例(70%)完成问卷调查的患者进行全面检查。在远端复位的情况下,评估TT-TG距离和InsallSalvati指数的变化,作为手术的指征。结果42例患者(70%),46例手术干预(64%)。随访期1 ~ 11年,平均6.9年。在研究组中,仅有1例(2%)患者出现新脱位,2例(4%)患者出现半脱位。使用学校成绩的平均分数为1.76。38例患者(90%)对手术结果满意,39例患者在另一侧肢体出现相同问题时将进行手术。术后平均Kujala评分76.8分,范围28 ~ 100分。研究组术前CT扫描(33x) TT-TG平均距离15.4 mm (12-30 mm)。胫骨结节转位的TT-TG平均距离为22.2 mm (15-30 mm)。胫骨结节腹内化前Insall-Salvati平均指数为1.33(1-1.74)。术后指数平均下降0.11(-0.00 ~ -0.26)~ 1.22(0.92 ~ 1.63)。研究组未出现感染并发症。在复发性髌骨脱位患者中,不稳定常常是由髌股关节的病理形态学异常引起的。对于临床表现为髌骨不稳定和TT-TG距离生理值的患者,通过内侧髌股韧带(MPFL)重建进行孤立的近端重新调整。在TT-TG距离的病理值的情况下,通过胫骨结节腹中化进行远端重新定位,以获得TT-TG距离的生理值。在研究组中,胫骨结节腹中化使Insall-Salvati指数平均降低0.11点。这对髌骨高度有积极的副作用,从而增加其在股沟中的稳定性。对于近端和远端排列不一致的患者,需要进行两期手术。在严重不稳定的孤立病例中,如果存在外侧髌骨高压症状,也可以进行股内侧肌转移或关节镜下外侧松解。结论:如果指示正确,近端、远端复位或两者联合复位可带来良好的功能效果,且脱位复发和术后并发症的风险较低。本研究中所调查的组中复发性脱位的发生率较低,即与本文中使用Elmslie-Trillat手术对患者进行髌骨稳定的研究相比,证实了MPFL重建的重要性。相反,在孤立性强腓骨韧带重建过程中,不治疗骨不正会增加其失败的风险。从所获得的结果来看,胫骨结节腹中化通过其远端化对髌骨高度也有积极的影响。如果稳定过程得到正确指示和执行,患者可以恢复正常活动,通常甚至是体育活动。关键词:客观髌骨不稳,髌骨稳定,强韧带外突,胫骨结节转位。
{"title":"[Management Strategy and Evaluation of Surgical Outcomes in Patients with Recurrent Patellar Instability between 2010-2020].","authors":"R Čapek, D Musil, L Nevšímal, P Sadovský, T Trnka","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY The study retrospectively reviews the outcomes of patella stabilisation surgeries performed at our department in the period 2010-2020. It aimed to provide a more thorough evaluation, to compare the respective types of MPFL reconstruction and to confirm the beneficial effect of tibial tubercle ventromedialization on patella height. MATERIAL AND METHODS In the period 2010-2020, a total of 72 stabilisation surgeries of patellofemoral joint in 60 patients with objective patellar instability (OPI) were performed at our department. The surgical treatment outcomes were evaluated retrospectively using a questionnaire, including the postoperative Kujala score. A comprehensive examination was carried out in 42 patients (70%) who had completed the questionnaire. In case of distal realignment, the TT-TG distance and a change in the InsallSalvati index which serve as an indication for surgery, were assessed. RESULTS Altogether 42 patients (70%) and 46 surgical interventions (64%) were evaluated. The follow-up period was 1-11 years, with the mean follow-up of 6.9 years. In the studied group of patients, only 1 case (2%) of new dislocation was seen, in 2 cases (4%) the patients reported a subluxation episode. The mean score using the school grades was 1.76. Thirty-eight patients (90%) were satisfied with the surgical outcome, 39 patients would undergo a surgery in case of identical problems with the other limb. The mean postoperative Kujala score was 76.8 points, range 28-100 points. The mean TT-TG distance in the studied group with the preoperative CT scan (33x) was 15.4 mm (12-30 mm). The mean TT-TG distance in the cases indicated for tibial tubercle transposition was 22.2 mm (15-30 mm). The mean Insall-Salvati index prior to the performance of tibial tubercle ventromedialization was 1.33 (1-1.74). Postoperatively, the index decreased by 0.11 on average (-0.00 to -0.26) to 1.22 (0.92-1.63). No infectious complications were presented in the studied group. DISCUSSION In patients with recurrent patellar dislocation, the instability is often times caused by pathomorphologic anomalies of the patellofemoral joint. In patients with clinically expressed patellar instability and physiological values of the TT-TG distance, an isolated proximal realignment is performed by medial patellofemoral ligament (MPFL) reconstruction. In the case of pathological values of the TT-TG distance, distal realignment is performed by tibial tubercle ventromedialization to achieve physiological values of the TT-TG distance. In the studied group, tibial tubercle ventromedialization helped decrease the Insall-Salvati index by 0.11 points on average. This has a positive side effect on the patella height, thus on increasing its stability in the femoral groove. In patients with both proximal and distal malalignment, a two-stage surgery is performed. In the isolated cases of severe instability or if symptoms of lateral patellar hyperpressure are present, musculus vast","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9102190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A Křiváček, Z Vodička, F Krejčí, L Papežová, D Musil
PURPOSE OF THE STUDY The aim of this study is to confirm that the involvement of arthroscopy in the surgical treatment of painful elbow syndrome, when proper and long enough conservative treatment failed, has better results than open radial epicondylitis surgery alone. MATERIAL AND METHODS A total of 144 patients included 65 men and 79 women, with the mean age of 45.3 years, namely 44.4 years (range 18-61 years) in men and 45.8 years (range 18-60 years) in women. Each patient was clinically examined, an anteroposterior and lateral X-ray of the elbow were performed, and proper therapy was chosen - either primary diagnostic and therapeutic arthroscopy followed by open epicondylitis surgery or primary open epicondylitis surgery alone. The treatment effect was evaluated by using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) scoring system at 6 months after surgery. RESULTS Out of the total group of 144 patients, 114 (79%) patients completed the questionnaire. All the results of the QuickDASH score in our group of patients are in the better half (0-5 very good, 6-15 good, 16-35 satisfactory, over 35 poor), with the mean value 5.63 (in men the mean value was 2.95-2.27 for the combination of arthroscopic and open procedure of LE, 4.55 for open procedure of LE, while in women the mean value was 7.50-6.82 for the combination of arthroscopic and open procedure of LE, 9.09 for open procedure of LE only). Altogether 96 patients (72%) experienced full pain relief. In patients treated with a combination of arthroscopic and open surgery, a higher percentage of patients reported full relief (53 patients, 85%) compared to the patients treated with the open method alone (21 patients, 62%). DISCUSSION By involving arthroscopy in the surgical treatment of patients with lateral elbow pain syndrome after unsuccessful conservative treatment, a successful and early solution to the problem was achieved in 72% of patients. The advantage of elbow arthroscopy over the conventional approach to the treatment of lateral epicondylitis consists mainly in the opportunity to observe intraarticular structures, thus provide a detailed view of the entire joint without the need for direct extensive joint opening, which makes it possible to exclude other causes of problems (e. g. chondromalacia of the radial head, loose body and other intraarticular abnormalities). At the same time, we can treat this source of problems with minimum burden placed on the patient. CONCLUSIONS Arthroscopic examination of the elbow joint makes it possible to diagnose all potential intraarticular sources of difficulties. Simultaneous elbow arthroscopy and open treatment of radial epicondylitis (release of ECRB or EDC, ECU, necrotic tissue excision, deperiostation and radial epicondyle microfractures) is a safe method with low morbidity, faster rehabilitation and return to the original activities based on subjective evaluation of patients and objective scoring. Key words: lateral epicondyli
{"title":"[Benefit of Arthroscopy in Differential Diagnostics and Therapy of Lateral Epicondylitis].","authors":"A Křiváček, Z Vodička, F Krejčí, L Papežová, D Musil","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY The aim of this study is to confirm that the involvement of arthroscopy in the surgical treatment of painful elbow syndrome, when proper and long enough conservative treatment failed, has better results than open radial epicondylitis surgery alone. MATERIAL AND METHODS A total of 144 patients included 65 men and 79 women, with the mean age of 45.3 years, namely 44.4 years (range 18-61 years) in men and 45.8 years (range 18-60 years) in women. Each patient was clinically examined, an anteroposterior and lateral X-ray of the elbow were performed, and proper therapy was chosen - either primary diagnostic and therapeutic arthroscopy followed by open epicondylitis surgery or primary open epicondylitis surgery alone. The treatment effect was evaluated by using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) scoring system at 6 months after surgery. RESULTS Out of the total group of 144 patients, 114 (79%) patients completed the questionnaire. All the results of the QuickDASH score in our group of patients are in the better half (0-5 very good, 6-15 good, 16-35 satisfactory, over 35 poor), with the mean value 5.63 (in men the mean value was 2.95-2.27 for the combination of arthroscopic and open procedure of LE, 4.55 for open procedure of LE, while in women the mean value was 7.50-6.82 for the combination of arthroscopic and open procedure of LE, 9.09 for open procedure of LE only). Altogether 96 patients (72%) experienced full pain relief. In patients treated with a combination of arthroscopic and open surgery, a higher percentage of patients reported full relief (53 patients, 85%) compared to the patients treated with the open method alone (21 patients, 62%). DISCUSSION By involving arthroscopy in the surgical treatment of patients with lateral elbow pain syndrome after unsuccessful conservative treatment, a successful and early solution to the problem was achieved in 72% of patients. The advantage of elbow arthroscopy over the conventional approach to the treatment of lateral epicondylitis consists mainly in the opportunity to observe intraarticular structures, thus provide a detailed view of the entire joint without the need for direct extensive joint opening, which makes it possible to exclude other causes of problems (e. g. chondromalacia of the radial head, loose body and other intraarticular abnormalities). At the same time, we can treat this source of problems with minimum burden placed on the patient. CONCLUSIONS Arthroscopic examination of the elbow joint makes it possible to diagnose all potential intraarticular sources of difficulties. Simultaneous elbow arthroscopy and open treatment of radial epicondylitis (release of ECRB or EDC, ECU, necrotic tissue excision, deperiostation and radial epicondyle microfractures) is a safe method with low morbidity, faster rehabilitation and return to the original activities based on subjective evaluation of patients and objective scoring. Key words: lateral epicondyli","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9102192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE OF THE STUDY Osteotomies around the knee are an established technique for treating knee osteoarthritis and other knee conditions by redistributing the body's weight and force within and around the knee joint. The aim of this study was to determine if the Tibia Plafond Horizontal Orientation Angle (TPHA) is a reliable measure for describing ankle alignment of the distal tibia in the coronal plane. MATERIALS AND METHODS This retrospective study included patients who underwent supracondylar rotational osteotomies for correction of femoral torsion. All patients had standing radiographs taken preoperatively and postoperatively with both knees pointed forward. Five variables, including Mechanical Lateral Distal Tibia Angle (mLDTA), Mechanical Malleolar Angle (mMA), Malleolar Horizontal Orientation Angle (MHA), Tibia Plafond Horizontal Orientation Angle (TPHA), and Tibio Talar Tilt Angle (TTTA), were collected. The preoperative and postoperative measurements were compared to each other using the Wilcoxon signed rank test. RESULTS A total of 146 patients were included in the study, with a mean age of 51.47 ± 11.87 years. There were 92 (63.0%) males and 54 (37.0%) females. MHA decreased from 14.0° ± 5.32° preoperatively to 10.59° ± 3.93° (p < 0.001) postoperatively, and TPHA decreased from 4.88° ± 4.07° preoperatively to 3.82 ± 3.10° (p = 0.013) postoperatively. The change in TPHA was significantly correlated with the change in MHA (r = 0.185, CI 0.023 - 0.337; p = 0.025). No differences were found between the measurements of mLDTA, mMA, and mMA pre- and postoperatively. DISCUSSION The orientation of the ankle should be taken into consideration during preoperative planning of osteotomies and should be measured in cases of postoperative ankle pain. CONCLUSIONS The TPHA is a reliable measure for describing ankle alignment of the distal tibia in the frontal plane. Key words: osteotomy, ankle, realignment, coronal alignment, preoperative planning.
{"title":"The Tibia Plafond Horizontal Orientation Angle for Frontal Alignment Evaluation of the Distal Lower Extremity.","authors":"M A Alshrouf, M D Ahrend, C Konrads","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY Osteotomies around the knee are an established technique for treating knee osteoarthritis and other knee conditions by redistributing the body's weight and force within and around the knee joint. The aim of this study was to determine if the Tibia Plafond Horizontal Orientation Angle (TPHA) is a reliable measure for describing ankle alignment of the distal tibia in the coronal plane. MATERIALS AND METHODS This retrospective study included patients who underwent supracondylar rotational osteotomies for correction of femoral torsion. All patients had standing radiographs taken preoperatively and postoperatively with both knees pointed forward. Five variables, including Mechanical Lateral Distal Tibia Angle (mLDTA), Mechanical Malleolar Angle (mMA), Malleolar Horizontal Orientation Angle (MHA), Tibia Plafond Horizontal Orientation Angle (TPHA), and Tibio Talar Tilt Angle (TTTA), were collected. The preoperative and postoperative measurements were compared to each other using the Wilcoxon signed rank test. RESULTS A total of 146 patients were included in the study, with a mean age of 51.47 ± 11.87 years. There were 92 (63.0%) males and 54 (37.0%) females. MHA decreased from 14.0° ± 5.32° preoperatively to 10.59° ± 3.93° (p < 0.001) postoperatively, and TPHA decreased from 4.88° ± 4.07° preoperatively to 3.82 ± 3.10° (p = 0.013) postoperatively. The change in TPHA was significantly correlated with the change in MHA (r = 0.185, CI 0.023 - 0.337; p = 0.025). No differences were found between the measurements of mLDTA, mMA, and mMA pre- and postoperatively. DISCUSSION The orientation of the ankle should be taken into consideration during preoperative planning of osteotomies and should be measured in cases of postoperative ankle pain. CONCLUSIONS The TPHA is a reliable measure for describing ankle alignment of the distal tibia in the frontal plane. Key words: osteotomy, ankle, realignment, coronal alignment, preoperative planning.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9438379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The spleen is one of the most commonly injured organ in blunt traumas to the chest and abdomen. Splenic injury can be a serious complication of fracture of the left 9th to 11th rib. The authors present a case report of a 65-year-old male patient with a blunt trauma to the left chest and abdomen, diagnosed with multiple left rib fractures, left hemothorax and splenic injury with a small subcapsular hematoma with no signs of active splenic bleeding. Due to hemodynamic instability and a large volume of blood loss via the chest drain, the patient was indicated for emergency left thoracotomy. A perforation in the lower lobe of the left lung caused by rib fractures was found, which was treated with sutures. Furthermore, the diaphragm was examined, two ruptures were identified from which blood was coming out, and thus a phrenotomy was performed. The bleeding central splenic rupture came as a big surprise. A spleen preserving surgery was impossible, therefore a splenectomy had to be performed, followed by chest wall stabilization with splints. Transthoracic approach to manage the splenic injury through phrenotomy should not be used as a standard. In a selected group of patients with concomitant chest and upper abdominal organ injuries, the use of this surgical approach appears to be highly beneficial. Key words: splenic injury, splenectomy, thoracotomy, rib fractures, diaphragmatic rupture.
{"title":"[Splenectomy via the Transdiaphragmatic Approach].","authors":"J Chudáček, D Klos, M Gregořík","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The spleen is one of the most commonly injured organ in blunt traumas to the chest and abdomen. Splenic injury can be a serious complication of fracture of the left 9th to 11th rib. The authors present a case report of a 65-year-old male patient with a blunt trauma to the left chest and abdomen, diagnosed with multiple left rib fractures, left hemothorax and splenic injury with a small subcapsular hematoma with no signs of active splenic bleeding. Due to hemodynamic instability and a large volume of blood loss via the chest drain, the patient was indicated for emergency left thoracotomy. A perforation in the lower lobe of the left lung caused by rib fractures was found, which was treated with sutures. Furthermore, the diaphragm was examined, two ruptures were identified from which blood was coming out, and thus a phrenotomy was performed. The bleeding central splenic rupture came as a big surprise. A spleen preserving surgery was impossible, therefore a splenectomy had to be performed, followed by chest wall stabilization with splints. Transthoracic approach to manage the splenic injury through phrenotomy should not be used as a standard. In a selected group of patients with concomitant chest and upper abdominal organ injuries, the use of this surgical approach appears to be highly beneficial. Key words: splenic injury, splenectomy, thoracotomy, rib fractures, diaphragmatic rupture.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M N Arikan, M Yildiz, Z Sen, O Erel, M S Tutar, Y Tire, R Kaplevatsky, B Kozanhan
PURPOSE OF THE STUDY The purpose of this study was to minimize tourniquet-induced ischemia-reperfusion injury (IRI) in total knee arthroplasty (TKA) surgery using the remote ischemic preconditioning (RIPC) model, as well as to assess antioxidant balance with thioldisulfi de homeostasis (TDH). The secondary goal is to evaluate the impact of RIPC on TKA clinical outcomes. MATERIAL AND METHODS Patients in the ASA I-III group who underwent elective TKA were enrolled in this prospective, randomized, double-blind clinical research. TDH parameters were measured individually in groups with (Group I) and without (Group K) RIPC at the following times: preoperative (T0), right before the pneumatic tourniquet was opened (T1), 1 (T2), 6 (T3), and 24 (T4) hours after it was opened. In addition, at 3-hour intervals, the postoperative pain level was assessed using a visual analog scale (VAS). RESULTS This study included 60 cases (Group K; n=30, Group I; n=30). Both groups had equal native thiol, total thiol, disulfi de levels, disulfi de/native thiol, disulfi de/total thiol, and native thiol/total thiol ratios (p>0.05 for each). The change in native thiol, total thiol, and disulfi de values at T0 and T4 periods, however, was not statistically signifi cant for Group K (p=0.049, p=0.047, p=0.037, and p=0.217, p=0.191, p=0.220, respectively). At the 15th hour, VAS values in group I were considerably lower than in Group K (p=0.002). DISCUSSION This prospective, randomized, controlled trial examined how RIPC affected tourniquet-induced IRI-induced oxidative stress in TKA surgery. Lower native, total, and disulfi de levels at each postoperative time point were signifi cant. RIPC may reduce tourniquet-induced IRI-induced oxidative stress and TDH in TKA surgery. RIPC also reduced postoperative discomfort. CONCLUSIONS Our fi ndings suggest that RIPC may protect against the oxidative stress caused by IRI during limb surgery with a tourniquet and improve postoperative clinical outcomes. Key words: remote ischemic preconditioning, ischemia-reperfusion injury, thiol-disulfi de balance, oxidative stress, total knee arthroplasty.
{"title":"Effect of Remote Ischemic Preconditioning in Total Knee Arthroplasty on Thiol-Disulfi de Balance: a Randomized Controlled Study.","authors":"M N Arikan, M Yildiz, Z Sen, O Erel, M S Tutar, Y Tire, R Kaplevatsky, B Kozanhan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PURPOSE OF THE STUDY The purpose of this study was to minimize tourniquet-induced ischemia-reperfusion injury (IRI) in total knee arthroplasty (TKA) surgery using the remote ischemic preconditioning (RIPC) model, as well as to assess antioxidant balance with thioldisulfi de homeostasis (TDH). The secondary goal is to evaluate the impact of RIPC on TKA clinical outcomes. MATERIAL AND METHODS Patients in the ASA I-III group who underwent elective TKA were enrolled in this prospective, randomized, double-blind clinical research. TDH parameters were measured individually in groups with (Group I) and without (Group K) RIPC at the following times: preoperative (T0), right before the pneumatic tourniquet was opened (T1), 1 (T2), 6 (T3), and 24 (T4) hours after it was opened. In addition, at 3-hour intervals, the postoperative pain level was assessed using a visual analog scale (VAS). RESULTS This study included 60 cases (Group K; n=30, Group I; n=30). Both groups had equal native thiol, total thiol, disulfi de levels, disulfi de/native thiol, disulfi de/total thiol, and native thiol/total thiol ratios (p>0.05 for each). The change in native thiol, total thiol, and disulfi de values at T0 and T4 periods, however, was not statistically signifi cant for Group K (p=0.049, p=0.047, p=0.037, and p=0.217, p=0.191, p=0.220, respectively). At the 15th hour, VAS values in group I were considerably lower than in Group K (p=0.002). DISCUSSION This prospective, randomized, controlled trial examined how RIPC affected tourniquet-induced IRI-induced oxidative stress in TKA surgery. Lower native, total, and disulfi de levels at each postoperative time point were signifi cant. RIPC may reduce tourniquet-induced IRI-induced oxidative stress and TDH in TKA surgery. RIPC also reduced postoperative discomfort. CONCLUSIONS Our fi ndings suggest that RIPC may protect against the oxidative stress caused by IRI during limb surgery with a tourniquet and improve postoperative clinical outcomes. Key words: remote ischemic preconditioning, ischemia-reperfusion injury, thiol-disulfi de balance, oxidative stress, total knee arthroplasty.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66783500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}