Medial tibia plato kırıklarının tedavisinde, plak-vida tespiti ile vida tespitinin etkinliğinin biyomekanik olarak karşılaştırılması

Tez (Tıpta Uzmanlık) -- Kırıkkale Üniversitesi87208

Biomechanical comparison of the efficiency of plate-screw fixation and screw fixation at the treatment of medial tibial plateau fractures

YÖK Tez ID: 415099Bu çalısmanın amacı, medial tibia plato kırıklarında da lateral plato kırıklarında olduğu gibivida ile osteosentez uygulandığında yeterli stabilitenin olusup olusmadığını anlamak; buamaçla plak-vida osteosentezi ile vida osteosentezi yöntemlerini biyomekanik olarakkarsılastırmaktır. Schatzker tip IV tibia plato kırıklarında 3 adet 6,5' luk 16 mm yivlispongioz vidalar ile tespit yapılmıs kırıklar ile 6 delikli destek T plak-vida ile tespit yapılmıskırıklarda stabiliteyi değerlendirmektir. Bu amaçla, kemik modelinde medial tibia platoyaSchatzker tip IV kırık modeli olusturuldu. Kırık redüksiyonu yapıldıktan sonra 2 tedaviseklini karsılastırmak için 2 gruba ayrıldı. Birinci grupta 10 adet kemik modelinde kırığınanatomik redüksiyonunu takiben 3 adet 6,5 ` luk spongioz vida pullu olarak kullanıldı. ?kincigrupta 10 adet kemik modelinde kırığın anatomik redüksiyonunu takiben 1 adet 6 delikli Tplak ile kırık hattı proksimaline 3 adet spongioz vida ve kırık hattı distaline 4 adet kortikalvida ile fiksasyon yapıldı. Tespitten sonra kemik modelini yük verme cihaza adapte edilerekyüklenme uygulandı. Kemik modeline artan tarzda aksiyal kompresyon uygulandı. Cihazbilgisayar bağlantılı olup bilgisayarda olusan grafi üzerinden yüklenme takip edildi.Grup I'deki kemik modelinin yüke dayanma sınırı 1397,6 ± 194,4 iken, Grup II için dayanmasınırı 2153,2 ± 204,4 olarak belirlendi. Her iki grup arasındaki fark istatistiksel açıdan anlamlıbulundu (p<0.001). Buna göre plak-vida uygulanan kemik modelinin deneysel yükdayanıklılığı sadece vida uygulanan modele göre anlamlı derecede yüksek olduğu belirlendi.Bu bağlamda, diz eklemine binen yük normal günlük aktivite sırasında vücut ağırlığının 4-6katıdır. Diz eklemine gelen yükün %75' i medial tibia platoya iletildiğine göre plak-vida ileelde edilen yüklenme kuvveti günlük fizyolojik aktivite ile olusan kuvvete sadece vida ileosteosentez sonucu elde edilen yüklenmeden daha yakındır. Bu nedenle anatomikrepozisyonun korunabilmesi için medial tibia plato kırıklarında vidaya göre daha stabil olanosteosentez yöntemi olan plak vidanın tercih edilmesi gerekmektedir.The objective of this study is to see if the stability is sufficient or not on medial tibial plateaufractures, as it is on lateral plateau fractures, when making screw osteosynthesis. In thatregard, a comparison was made biomechanically between the methods of plate-screwosteosynthesis and screw osteosynthesis. This study compares the stability of fractures atSchatzker type IV tibial plateau fractures fixed with either 3 pieces of 6.5 mm cancellousbone screw with a 16 mm threaded segment or with 6-holed buttress T plate-screw system.For this purpose, a Schatzker type IV fracture on a medial tibial plateau was modeled on abone model. After reduction of fracture, 2 groups were formed to compare two differenttreatment methods. In the first group on 10 fracture models, following the anatomicalreduction, fractures were stabilized with 3 pieces of 6.5 mm cancellous bone screws withwashers. In the second group, on 10 fracture models, following the anatomical reduction,fractures were stabilized with one 6-holed T plate, by three cancellous bone screws to theproximal of fracture line and four cortical screws to the distal to the fracture line.After fixation, bone model was adapted to the load device and loaded. Ascending axialcompression was applied on bone models. The device was computerized, and loading wasfollowed through graphics on computer.The graphics showed that load bearing capacity is 1397,6 ± 194,4 for group I bone model and2153,2 ± 204,4 for group II bone model. The difference between two groups were statisticallymeaningful (p<0.001). According to this result, experimental load bearing of bone modelsindicate that plate-screw fixation system has a significantly higher stabilization capasity thanfixation with three screws alone.In this context, load on knee joint is 4 to 6 times more than body weight during normal dailyactivity. Considering that the 75% of knee joint load is transmitted to medial tibial plateau,load force emerged after plate-screw is closer to the force emerged after daily physiologicalactivity than the force emerged after osteosynthesis with screws. For this reason, in order tomaintain anatomical repositioning, plate-screw system which is a more stable osteosynthesismethod than the screw should be preferred at medial tibial plateau fractures

Subacromial tenoxicam injection in the treatment of impingement syndrome

Objectives: As subacromial bursa injection is widely used for pain relief and functional improvements in patients with periarticular shoulder disorder, we aimed to present our results of subacromial tenoxicam injection in the treatment of impingement syndrome

Reconstruction of traumatic composite tissue defect of medial longitudinal arch with free osteocutaneous fibular graft

WOS: 000370657600029PubMed ID: 25459091A 34-year-old male sustained a crush injury resulting in bone and soft tissue loss along the medial longitudinal arch of his left foot. Specifically, the injury resulted in loss of first metatarsal without injury to the medial cuneiform or proximal phalanx, fracture of the third metatarsal, and a 5-cm x 9-cm soft tissue defect overlying the dorsomedial aspect of the right foot. After debridement and daily wound care, the defect was subsequently reconstructed using a free osteocutaneous fibular graft. Approximately 6 months after reconstructive surgery, the patient returned to his job without pain, and his pedogram showed almost equal weightbearing distribution on both feet

Are rosenberg graphics necessery for the diagnosis of ghonarthrosis?

Amaç: Gonartrozu olan hastalarda eklem aralığını değerlendirmede Rosenberg grafilerinin etkinliğini belirlemek. Gereç ve Yöntemler: Gonartroz nedeniyle kliniğimiz polikliniğine başvuran 38 hastanın 76 dizinin ayakta basarak direkt grafi ve Rosenberg grafileri çekildi. Her iki görüntüleme yöntemine göre hastaların medial ve lateral eklem aralıkları ölçüldü. Elde edilen sonuçlar T-test ve Mann-Whitney Testleri kullanılarak istatistiksel olarak değerlendirildi Bulgular: Ayakta basarak çekilen direkt grafilerde ortalama medial eklem aralığı 7,76±1,67(4,25-10,88) mm Rosenberg grafilerinde ortalama medial eklem aralığı 7,3±1,41 (4,5-10,06) mm olarak ölçülmüştür. Ayakta basarak çekilen direkt grafilerde ortalama lateral eklem aralığı 10,47±7,05 (7,85-14,94) mm, Rosenberg grafilerinde ortalama lateral eklem aralığı 10,03±7,77 (6,18-16,82) mm olarak ölçülmüştür. Her iki görüntüleme yöntemi ile eklem aralıkları ölçümlerinin arasında istatistiksel anlamlı bir fark tespit edilmedi. Sonuç: Gonartroz ön tanısı ile eklem aralığı radyolojik değerlendirme yapılması planlanan hastalarda ayakta basarak çekilen direkt grafi görüntüleme yeterlidir.Objective: To determine the effectiveness of Rosenberg graphics in the evaluation of range of joints in patients with gonarthrosis. Material and Methods: Among 38 patients who admitted to our clinic because of ghonarhrosis, direct X-ray graphics in standing position and Rosenberg graphics were taken for 76 knees. Imaging of patients with both medial and lateral intervals of the knees were measured on X-ray graphics in standing position and Rosenberg graphics. Results were statistically evaluated with T-test and Mann-Whitney tests for both groups. Results: The mean medial joint space on plain radiographs in standing position and Rosenberg radiographs are measured average 7,76&plusmn;1,67(4,25-10,88) mm and 7,3&plusmn;1,41 (4,5-10,06) mm. The lateral joint space width is measured 10,47&plusmn;7,05 (7,85-14,94) average on plain radiographs in standing position, the average lateral joint space width is measured 10,03&plusmn;7,77 (6,18-16,82) mm in Rosenberg radiographs. There is no statistically significant difference between measurements of the joint ranges of both imaging methods. Conclusion: Plain radiographs in standing position is enough for radiological evaluation of the joint space for the diagnosis of gonarthrosis

Fracture Pattern Influences Radial Head Replacement Size Determination Among Experienced Elbow Surgeons

Background: Correct sizing is challenging in radial head replacement and no consensus exists on the implant’s optimal height and width to avoid elbow stiffness and instability. Studies exists, suggesting how to appropriately choose the implant size, but the manner by which the fracture pattern influences the surgeons’ operative choices was not investigated. Methods: The radial heads of four fresh-frozen cadaveric specimens were excised, measured, and fractured to simulate four patterns: three fragments (A); four fragments (B); comminuted (C); comminuted with bone loss (D). Nine examiners were asked to indicate first the maximum diameter of the radial heads with the help of dedicated sizing dishes and then the appropriate implant size with trial implants. Accuracy and precision were determined. A coefficient of variation was calculated and agreement was evaluated with the Bland–Altman method. Results: Accuracy and precision of radial head diameter estimation with dedicated sizing dish were 96.73% and 93.64%, (best pattern, D; worst, C). Accuracy and precision of radial head diameter estimation with trial implants were 99.71% and 90.66% (best pattern, A; worst, D). Frequent modifications occurred between the initial radial head size proposal based on the sizing dish and the radial head size chosen after use of the trial implants (47.2%). Conclusions: Diameter estimation of radial heads with dedicated sizing dishes may be underestimated in comminuted fractures; when bone loss is present, this may lead to an overestimation, especially when using trial implants. Care is essential to determine the optimal size of the implant and to avoid overlenghtening and oversizing, which can be responsible for implant failure. Level of Evidence: Basic Science Study. Clinical Relevance: Knowledge of the manner by which the fracture pattern influences radial head replacement size estimation can help preventing overlenghtening and oversizing during this procedure

Locating the ulnar nerve during elbow arthroscopy using palpation is only accurate proximal to the medial epicondyle

Purpose: Knowledge of ulnar nerve position is of utmost importance to avoid iatrogenic injury in elbow arthroscopy. The aim of this study was to determine how accurate surgeons are in locating the ulnar nerve after fluid extravasation has already occurred, and basing their localization solely on palpation of anatomical landmarks. Methods: Seven cadaveric elbows were used and seven experienced surgeons in elbow arthroscopy participated. An arthroscopic setting was simulated and fluids were pumped into the joint from the posterior compartment for 15 min. For each cadaveric elbow, one surgeon was asked to locate the ulnar nerve solely by palpation of the anatomical landmarks, and subsequently pin the ulnar nerve at two positions: within 5 cm proximal and another within 5 cm distal of a line connecting the medial epicondyle and the tip of the olecranon. Subsequently, the elbows were dissected using a standard medial elbow approach and the distances between the pins and ulnar nerve were measured. Results: The median distance between the ulnar nerve and the proximal pins was 0 mm (range 0–0 mm), and between the ulnar nerve and the distal pins was 2 mm (range 0–10 mm), showing a statistically significant difference (p = 0.009). All seven proximally placed pins (100%) transfixed the ulnar nerve versus two out of seven distally placed pins (29%) (p = 0.021). Conclusions: In a setting simulating an already initiated arthroscopic procedure, the sole palpation of the anatomical landmarks allows experienced elbow surgeons to accurately locate the ulnar nerve only in its course proximal to the medial epicondyle (7/7, 100%), whereas a significantly reduced accuracy is documented when the same surgeons attempt to locate the nerve distal to the medial epicondyle (2/7, 29%; p = 0.021). Current findings support the establishment of a proximal anteromedial portal over a distal anteromedial portal to access the anterior compartment after tissue extravasation has occurred with regard to ulnar nerve safety