Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aimed to examine systemic erythropoietin's effect on the Achilles tendon's healing in a rat model.

Methods: Twenty-five adult Wistar rats were randomly assigned to one of two groups. The Achilles tendon of each rat was transected 5 mm proximal to its insertion to the calcaneus. All Achilles tendons were then repaired using modified Kessler methods. A single dose (5000 U/kg) of intraperitoneal erythropoietin (EPO) was administered to group I. Group II was a control group and did not receive an EPO injection. Four rats from each group were sacrificed at 1, 3 and 6 weeks after injection. Histopathological assessments were performed by observers blinded to the treatment.

Results: Groups I and II showed a similar increase in fibroblast cytoplasmic content and fibrillar collagen in the extracellular matrix. Collagen deposition, cellular proliferation, number of lipid vacuoles and capillary increases were similar between the groups.

Conclusion: Evidence from this study has shown no direct effect of a single systemic high dose of EPO on the histological properties of the Achilles tendon in rats.

Ankle fractures are relatively common orthopaedic injuries; however, irreducible ankle fractures with or without dislocations are a rare, unstable type of injury that require surgical treatment. The structures impeding the accurate reduction of ankle fractures may be soft tissues, such as the deltoid ligament, extensor retinaculum, tendons, or bony fragments between the fracture sites. A 47-year-old male patient with irreducible medial malleolus and distal fibula fracture was referred for treatment. Intraoperatively, it was discovered that failed reduction was due to the interposition of the posterior tibial tendon in the syndesmosis. The posterior tibial tendon was pushed posteriorly through the tibiofibular interosseous interval and relocated to its anatomical position. Reduction and fixation were only achieved after relocation of the tendon. In conclusion, when anatomical reduction is not easily achieved, interposition of the posterior tibial tendon in the syndesmosis should be considered.

Objective: This study aimed to compare the clinical and radiographic results of three different pelvic fixation techniques, i.e., Galveston Rod, Iliac Screw, and Sacroiliac Screw, in managing neuromuscular scoliosis in nonambulatory children with spastic cerebral palsy (CP).

Methods: This retrospective study included nonambulatory children aged < 18 years with neuromuscular scoliosis secondary to CP, undergoing a spinal fusion and pelvic fixation by either Galveston rod, iliac screw, or sacroiliac screw techniques. The primary outcome variable was to determine the stability of the major curve angle and pelvic obliquity over timeline intervals for each pelvic fixation tech nique. The two radiographic parameters were measured at five timeline intervals and were compared to define stability among the groups.

Results: One hundred and one patients (54 females [53%]) with spastic nonambulatory CP met the inclusion criteria; the mean age at sur gery was 13.5±3.1 years. Mean follow-up intervals were first-year (12.9±1.5) and second-year (25.8±2.5). Forty-one patients had minimum five-year (81.5±23 months) postoperative follow-up. Groups were based on pelvic fixation techniques: 25 patients with the Galveston rod, 24 with the iliac screw, and 52 with the sacroiliac screw. Of the 41 patients with a minimum five-year follow-up, 10 had the Galveston rod, 11 had an iliac screw, and 20 had sacroiliac screw fixation. Gross Motor Function Classification System level, medical comorbidities, intra thecal baclofen pump, and vitamin D level were compared with each pelvic fixation technique (P > .05). Major curve angle parameters were measured at the five timelines as 70.5°±21.1°, 15.7°±13°, 15.7°±12°, 17.5°±12.7°, and 15.1°±9.6°, and pelvic obliquity as 14.8°±10.4°, 4.9°±4.2°, 5.7°±4.6°, 5°±4.4°, and 7.2°±4.4°, respectively. After the surgery, corrected major curve angle and pelvic obliquity showed no sta tistically significant difference between pelvic fixation techniques (P > .05) and remained stable over timeline intervals (P > .05). Fifteen patients had complications requiring additional surgery. The iliac screw group (nine patients) had the highest rate of complications.

Conclusion: All three pelvic fixation techniques can provide equivalent correction for major curve angle and pelvic obliquity in managing neuromuscular scoliosis in nonambulatory CP children. Pelvic obliquity after surgery may remain stable regardless of pelvic fixation type. A higher rate of postoperative complication can be encountered with the iliac screw.

Level of evidence: Level III, Retrospective Study.

Objective: This prospective, randomized study aimed to compare anterior suprascapular nerve block versus interscalene block in terms of diaphragm paralysis in arthroscopic shoulder surgery.

Methods: Fifty-two patients undergoing shoulder arthroscopy surgery were prospectively randomly assigned to interscalene block (n=25) or anterior suprascapular nerve block groups (n=27) (each group receiving 5 mL, 0.5% bupivacaine). The ipsilateral diaphrag matic excursion was assessed in all patients using ultrasound imaging before (baseline), 30 minutes, and 24 hours after block completion. Pain scores were recorded 1 hour preoperative, 30-60 minutes in the postoperative recovery unit, and at 6 and 24 hours postoperatively.

Results: No complete paralysis was observed in either treatment group. The incidence of a partial decrease in diaphragm movements was significantly lower in the anterior suprascapular nerve block than in the interscalene block group (1 vs. 21 patients) (P < .01). Twenty-six patients in the anterior suprascapular nerve block and 4 in the interscalene block group had less than a 25% decrease in hemidiaphrag matic movements, 30 minutes after the blockade. Pain scores were similar in the 2 groups. However, mean pain scores at 24 hours post operatively were significantly higher in the interscalene block than in the anterior suprascapular nerve block group (P < .05). Time to first pain post-block was significantly longer in the anterior suprascapular nerve block compared to the interscalene block group (677.04 ± 52.17 minutes vs. 479.2 ± 99.74 minutes, P < .05).

Conclusion: Anterior suprascapular nerve block and interscalene block both appear to be clinically effective in providing postoperative analgesia for patients undergoing arthroscopic shoulder surgery under general anesthesia. However, the time to first pain is significantly longer with anterior suprascapular nerve block. Pain scores at 24 hours postoperatively were significantly lower in the anterior supra scapular nerve block compared to the interscalene block group. Diaphragmatic movements after anterior suprascapular nerve block were also better preserved at both 30 minutes after the block and 24 hours after surgery.

Level of evidence: Level I, Therapeutic Study.

Objective: The aim of this study was to evaluate the prognostic factors affecting mortality after major lower extremity amputations in patients with diabetes mellitus and peripheral vascular disease.

Methods: For this retrospective study, 484 patients (345 male, 139 female) who were previously diagnosed with diabetes mellitus and peripheral vascular disease and underwent first-time nontraumatic major lower extremity amputations between January 2008 and January 2021 were included. The mean age of the patients was 64.2 ± 13.8 (20-114). In 32.4% of patients, peripheral vascular disease was the underlying cause, whereas diabetes mellitus was responsible for the etiology in 67.6% of patients. About 68.8% of patients had below-knee amputations, whereas 2.9% had bilateral below-knee amputations, 27.1% had above-knee amputations, and 1.2% had hip disarticulation performed. Gender, age, amputation level, amputation etiologies, Charlson comorbidity index, need for blood transfusion, and laboratory findings such as hemoglobin, platelet, albumin, erythrocyte sedimentation rate, C-reactive protein, sodium, potassium, and neutrophil to lymphocyte ratio levels were recorded preoperatively and at the time of discharge. Patients were grouped as died ≤1 month, ≤3 months, ≤6 months, and ≤12 months or alive.

Results: Advanced age, female gender, high Charlson comorbidity index, blood transfusion requirement, proximal amputation level, preoperative low platelet, preoperative low albumin, and parameters such as low hemoglobin, low erythrocyte sedimentation rate, high sodium, low platelet, low albumin, high C-reactive protein, and high neutrophil to lymphocyte ratio at time of discharge were seen to have a statistically significant effect on mortality at 1 month, 3 months, 6 months, and 12 months postoperatively. Preoperative high C-reactive protein had a statistically significant effect on mortality at 1 and 3 months postoperatively, whereas low C-reactive protein had a statisti cally significant effect on mortality at 6 months postoperatively. High potassium at the time of discharge was associated with mortality at 6 and 12 months postoperatively.

Conclusion: This study has shown us that mortality rates are affected by modifiable parameters at the time of discharge such as hemoglo bin, sodium, potassium, platelet, and albumin, and normalization of these parameters before discharge could reduce the rates of mortality in the postoperative period.

Level of evidence: Level IV, Prognostic Study.

Objective: This study aimed to identify the preoperative predictive factors for the development of Gartland type IV supracondylar humerus fracture based on the patient characteristic, fracture mechanism, and preoperative radiographic fracture characteristics.

Methods: This prospective study included the data of 120 patients with Gartland type III and IV supracondylar humerus fractures treated in a single center from 2020 to 2021. Patients' age, gender, height/weight percentile values, injury mechanisms, the proximity of fracture fragment to the skin (i.e., dimple sign), and time from trauma to surgical treatment were recorded. In the preoperative radiographs, the degree of extension or flexion deformity between fracture fragments in the sagittal plane, varus/valgus angulation between fracture fragments in the coronal plane, the amount of translation (medial or lateral) in the coronal plane, and the amount of osseous apposition between fracture fragments in the coronal plane were evaluated. With the authors' consensus, the patients were divided into 2 groups based on the presence of multidirectional instability during the intraoperative reduction: group 1 (Gartland type III; 99 patients) and group 2 (Gartland type IV; 21 patients). Fixation of the fractures was then completed.

Results: Significant differences were observed between groups in the valgus/varus angle and amount of osseous apposition (P < .001). Although no significant difference was found in terms of translation amount between the groups (P=.088), there was a significant correlation with medial translation in type IV fractures (P < .001). The correlation between the results and the groups was checked with Spearman's test. Medial translation (r=0.352), varus or valgus angulation (r=0.616), and osseous apposition (r=0.433) exhibited a positive correlation. The probability of type IV fracture was modeled for the preoperative parameters using binary logistic regression. The regression analysis showed that the diagnosis of type IV supracondylar fractures could be predicted, if varus or valgus angulation was more than 25.5° (81% sensitivity, 85% specificity, odds ratio=1.725; 95% CI=1.170-2.541, P=.001, r=0.616) and if the amount of osseous apposition was more than 9.5 mm (85% sensitivity, 81% specificity, odds ratio=1.471; 95% CI=0.714-3.029, P=.001, r=0.433) in the preoperative radiographs. There was also a significant correlation between medial translation (varus angulation) (P < .001, r=0.352), age (P=.019, r=0.255), and patients with more than 90 height/weight percentile values (P < .001, r=0.508) with the possibility to have Gartland type IV fractures.

Conclusion: This study has found some preoperative factors that may be relevant for type IV Gartland fractures. Height/weight values greater than the 90 percentile, varus or valgus angulation greater than 25.5°, bone apposition values greater than 9

Modular femoral stem-head systems are used increasingly due to their ease of application and offset adjustment. However, this modular ity has brought complications of trunnion wear and breakage. Although very rarely encountered, trunnion fracture is a catastrophic com plication that requires challenging revision surgery. This report presents a trunnion fracture of a cobalt-chrome alloy, fully porous-coated femoral stem. Following single-stage revision surgery, full weight-bearing was achieved in six weeks, and the patient was painlessly mobile with a single cane and had a Hip Score of 81 in the last follow-up. Despite all the advantages of the femoral stem and head modu larity, one should remember that a catastrophic complication such as trunnion wear and fracture that require revision surgery is possible.

Supracondylar fracture of the humerus is one of the most common fractures seen in children, and posteromedial displacement of the distal fragment in extension-type supracondylar humerus fractures can cause injury to the radial nerve. A 6-year old girl who presented with symptoms of radial nerve injury after a supracondylar fracture of the right humerus with complete posteromedial displacement of the distal fragment (Gartland type III) underwent surgery where closed reduction and percutaneous pinning was performed. The patient was routinely followed up and at 6 months postoperatively no neurological improvement was seen. Exploratory surgery revealed complete discontinuation of the radial nerve at the fracture site and entrapment of the nerve stumps in healed bone callus. A gap of 2 cm was observed between nerve stumps, and sural nerve cable grafting was performed with good results. If neurological symptoms do not improve over time, appropriate differential diagnosis and, if necessary, exploratory surgery should be considered. Despite limited reports and their conflicting outcomes, sural nerve cable grafting could be a useful option to bridge the gap of discontinued nerve injury. Level of Evidence: Level IV, Case Report.