Efficacy of periarticular injection applied trough knee other than posterior capsule in simultaneous bilateral total knee arthroplasty

WOS: 000385436400008PubMed ID: 26566320Background: We aimed to evaluate periarticular multimodal drug injection (PMDI) in bilateral total knee arthroplasty. Methods: In 154 knees of 77 patients, PMDI was administered intraoperatively through the regions other than posterior capsule to one knee; other knee was control. Results: Drug-injected knees had lower visual analog scale scores and higher passive range of motion postoperatively (p < 0.05). The active straight leg raise was higher in drug-injected knees (47 [61%] vs 19 [24.7%], p < 0.001). Conclusions: PMDI is a safe and effective method of early postoperative pain management in total knee arthroplasty when applied through regions other than posterior capsule

Lumbar spinal angiolipoma with expanding left neural foramen mimicking lumbar schwannoma; case report and review of the literature

Aim: To describe a patient with lumbar angiolipoma mimicking schwannoma in the posterolateral side of the spinal canal with expansion of the left lumbar foramen and to discuss the clinical, radiologic, and surgical features of these lesions with literature. Methods: Without language restriction in this paper, the electronic databases; The Cochrane Collaboration the Cochrane, The Cochrane Library (Issue 2 of 12, Feb. 2011), ProQuest, US National Library of Medicine, National Institutes of Health (NLM) and PubMed dating from 1966 September to January Week 2 2017, were searched for comparative experimental studies using the terms: “OR”, “AND”. On-line literature searches were conducted using the key words “lumbar angiolipoma”, “schwannoma “, “spinal angiolipoma”, “spinal cord”, and “spinal canal”. We compared this research with our patient. Results: Bilateral L2 total laminectomy, excision of the tumors and bilateral L2-L3 transpedicular stabilization were performed, and complaints improved prominently. Pathological examination was reported as angiolipoma. Conclusion: The research shows that a probable diagnosis in such tumor cases could be made by sufficient pre-op scanning before surgical operations and although angiolipoma has been rarely seen in lumbar posterolateral space, it can be seen in lumbar region and mimic schwannoma as producing symptoms and signs of spinal cord and nerve root compression. © 2017 Akyuva et al

Evaluating the features of interdigital neuroma using 3-Tesla magnetic resonance imaging

Interdigital neuroma is an entrapment neurop-athy of the interdigital nerve. Previously, studies on interdigital neuroma were done with 1 Tesla Magnetic Resonance Imaging and more often 1.5 Tesla Magnetic Resonance Imaging. We used 3 Tesla Magnetic Resonance Imaging in our study and we did not encounter as much as we know about the study with 3 Tesla Magnetic Resonance Imaging in the literature. Between 2013 and 2019, the 3 Tesla Magnetic Resonance Imaging results of 39 consecutive surgically-confirmed interdigi- tal neuromas and patients' files were retrospec- tively evaluated. The soft tissue surrounding the prominent interdigital nerve "target sign" were assessed. Spearman's rho, Pearson's correlation tests, and Mann-Whitney U-tests were used. Of the 39 cases (mean transverse dimension = 4.64 mm), 35 (89.7%) were hypointense on T1-weight - ed sequencing, 34 were intermediate (87.1%) on short tau inversion recovery sequencing, and 29 (74.3%) had slightly-moderately enhanced neuro-mas on post-contrast spectral presaturation with inversion recovery sequences. A statistically sig-nificant negative relationship was found between contrast enhancement and disease duration (p = 0.020). On short tau inversion recovery or spec-tral presaturation with inversion recovery series, the intralesional nerve view "target sign" was ob-served in 23 (58.98 %) of 39 neuromas. This is the first study in the literature with 3 Tesla Magnetic Resonance Imaging that shows the visual charac-teristics of interdigital neuroma and its possible contribution to the diagnosis of the disease

Evaluation of Antibiotic Alternatives Used in Orthopedic Departments of 2 Hospitals According to Rational Use of Antibiotics

Amaç: Birbirine yakın ve aynı bölgede yer alan iki farklı hastanenin ortopedi ve travmatoloji servislerinde yatan hastalarda, etkeni saptanan enfeksiyon olgularında antibiyotik kullanımının, akılcı ilaç tedavi rehberleri ve kültür antibiyogram sonuçlarına göre uygunluğunun araştırılması amaçlandı.Gereç ve Yöntem: Bu araştırma projesi T.C. Sağlık Bakanlığı Genel Sekreterlik İzni doğrultusunda 01 Ocak 2014 ile 31 Aralık 2014 tarihleri arasında, iki hastanenin ortopedi ve travmatoloji servislerinde enfeksiyon tanısına sahip olguların verileri üzerinden gerçekleştirildi. Malignitesi olan veya başka bir servise taburcu edilen olgular çalışmadan dışlandı. Standart bir form oluşturuldu. Bu form içerisine, olguların demografik verilerine ek olarak, kültür antibiyogram sonuçları, enfeksiyon patojen etkeni, kültür materyalinin nereden alındığı, kullanılan antibiyotiklerin pozolojisi, süresi ve uygunluğu ile olguların yatış süreleri raporlandı. Maliyetlerin hesaplanmasında, Sağlık Bakanlığı ve Maliye Bakanlığı 2014 yılı fiyat listeleri temel alındı. Birim fiyat üzerinden hasta başına kullanılan antibiyotik maliyetleri hesaplandı.Bulgular: Saptanan enfeksiyon etkeni için her zaman uygun antibiyotiğin seçilmediği belirlendi. Antibiyogram sonuçlarına göre etkili, daha düşük maliyetli antibiyotikler kullanılabilinmesine rağmen sıklıkla daha pahalı ve toplam maliyeti yükselten antibiyotikler seçilmiştir.Sonuç: Kanıta dayalı tıp ve akılcı antibiyotik kullanımı kapsamında enfeksiyon tedavisinde kültür antibiyogram sonuçlarına göre uygun antibiyotik seçilmesi gerekliliği tartışılmaz bir bilimsel gerçektir. Ortopedi ve travmatoloji servislerinde enfeksiyon tedavisinde enfeksiyon hastalıkları ve farmakoloji uzmanlarını da sürece katarak multi-disipliner yaklaşılarak kanıta dayalı rehberlerin kullanımının artışı sağlanmalıdırBackground: The present study is an analysis of appropriateness of antibiotics use for patients in whom infectious agent was detected. Data from patients in orthopedics and traumatology department of 2 hospitals in the same district were evaluated according to rational antibiotic drug use guidelines and culture antibiogram results.Methods: Data of patients diagnosed with infection between January 1, 2014 and December 31, 2015 in orthopedics and traumatology department of 2 different hospitals were analyzed. Patients diagnosed with malignancy or who were discharged from other departments were excluded. A standard form was used to collect demographic data, culture antibiogram results, details of infectious agent, source of culture material, posology of antibiotic used, duration and appropriateness of use, and length of hospital stay. Costs were estimated based on number of units used and price per unit according to 2014 Ministry of Health price list. Mean price of antibiotics used per patient was calculated and descriptive analyses were also completed.Results: It was determined that appropriate antibiotics for detected infectious agent were not always selected. Though there were effective, less expensive antibiotics that could have been used according to antibiogram results, more expensive antibiotics were often chosen, resulting in greater total cost.Conclusion: Multidisciplinary approach in patient care and use of evidence-based guidelines should be increased. Teams should be formed and led by infectious disease and pharmacology specialists. New strategies should be developed immediately in health economics and new pharmacoeconomic models should be initiated in orthopedics and traumatology department

Comparison of short term results of type IIB2 middle third clavicular fractures treated with figure of eight bandage and locked plate fixation

Objectives: Most acute displaced midshaft clavicular fractures conventionally have been treated nonoperatively with the expectation of a high probability of fracture union, good functional outcomes, and a high level of patient satisfaction. However, the outcome of nonoperative treatment is not as favorable as once thought and there has been a growing trend to treat these fractures surgically We aimed to evaluate and compare the short term results of conservative treatment and locked plate fixation in the treatment of type IIB2 clavicula fractures according to Robinson classification in this study. Methods: Thirty eight patients with type IIB2 clavicula fractures according to Robinson classification were retrospectively reviewed. 20 patients who were treated conservatively were enrolled as group A and 18 patients who were operated with locked plate and screws were enrolled as group B. All patients were evaluated with Constant and Oxford scores in their last follow up control. For the patients that were treated conservatively (Group A) figure of eight bandage were applied for six week. Patients (Group B) were operated under general anesthesia in the beach chair position. A straight incision was made over the fracture line. Butterfly or free fragments in comminuted fractures were fixed to the main fragment with a lag screw in 3 patients before fracture reduction and plate fixation. Fracture reduction was performed with taking care of minimal periosteal stripping. After reduction of the main fragments, titanium alloy, locked anatomic compression plate were applied on the superior surface of the clavicle. A minimum of six cortexes were fixed with 3.5 mm locked cortical screws on the medial and lateral sides of the fracture. We did not need any Auto- or allografts during the surgery. Statistical analysis was performed between the scores of two groups. Conservative and surgical treated groups Oxford scores and Constant scores had normal distribution. For this reason Student's t test, and Non-parametric version of Student’s t test Mann Whitney U test were performed. 95% confidence interval and p <0.05 was considered significant as statistically. Results: Mean follow up period is 18 months (12-24 months). At the last follow-up, mean Constant score is 79.5 (98-43) and mean Oxford score was 46.35(49-44) for group A. In group B mean Constant score is 89.3(100-77) and mean Oxford score is 46,6(48-44) at the last follow-up. There were no patients who require any revision surgery in group B. Bone healing was detected in all fractures radiologically in both groups. There was no statistically significant difference between Oxford scores of the two groups (p=0,570). There was statistically significant difference between Constant scores of the two groups whereas results of Group B were better than group A (p=0,013) Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes. Conclusion: Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes. © The Author(s) 2014

Biyopolimerler ile uygulanan lökositten fakir veya lökositten zengin trombositten zengin plazmanın kondrosit proliferasyonunda konvansiyonel trombositten zengin plazma uygulamalarına üstünlüğü var mıdır?

WOS: 000415126000002PubMed ID: 29125811Objectives: This study aims to investigate the possible effects of leukocyte concentration in the content of platelet-rich plasma (PRP) and the administration of PRP using a drug delivery system on chondrocyte proliferation in vitro conditions. Patients and methods: Blood from nine male patients (mean age 65 years; range 49 to 81 years) with advanced stage osteoarthritis who had not responded to medical or conservative treatments and underwent total knee arthroplasty was used to prepare two formulations: PRP with low concentration leukocytes (2000-4000 leukocytes/mu L) was designated as pure PRP (P-PRP), whereas PRP with high concentration leukocytes (9000-11000 leukocytes/mu L) as leukocyte-rich PRP (L-PRP). Samples were divided into five groups as control group (group 1), chondrocyte cultures with P-PRP applied directly (group 2), chondrocyte cultures with L-PRP applied directly (group 3), chondrocytes co-cultured with P-PRP applied hydrogel (group 4), and chondrocytes co-cultured with L-PRP applied hydrogel (group 5). In all groups; cell morphology, viability and proliferation were compared with the expression of stage-specific embryonic antigen-1 (SSEA-1), a precondrocyte marker. Results: Maximum cell proliferation and SSEA-1 expression occurred in group 4, with a statistically significant correlation between SSEA-1 expression and cell proliferation. Conclusion: Our study showed the importance of leukocyte concentration of PRP and efficiency of delivery systems such as hydrogel and that L-PRP administered with a delivery system is more efficient than conventional applications of PRP in the treatment of cartilage damage.Namik Kemal University Scientific Research Administration Division [NKUBAP.00.10.AR.15.08]This study was supported by grants (Project no: NKUBAP.00.10.AR.15.08) from Namik Kemal University Scientific Research Administration Division

Radiological and clinical effect of prosthesis design in varus knees?

WOS: 000385436400009PubMed ID: 26566321Purpose: The aim of the study is to investigate the efficacy of the prosthesis design used in total knee arthroplasty in patients with varus malalignment. Methods: After exclusion criteria we classified 90 patients underwent total knee arthroplasty according to prosthesis used into two groups: posterior cruciate ligament substituting and retaining. Mean follow up period was 25-98 months. We evaluated pre-operative and postoperative radiological and as well as clinical parameters such as pain, knee function, flexion deformity. Results: We found statistically significant difference in both groups in terms of deformity correction (p = 0.000). Conclusion: Prosthesis design affects radiological outcomes in varus knees

A retrospective analysis on the correlation between hip pain, physical examination findings, and alpha angle on MR images

WOS: 000391330200001PubMed ID: 27846909Background: We aimed to search whether alpha angle, a radiological clue used in the diagnosis of femoroacetabular impingement, is correlated with the presence of hip pain, internal rotation angle, and impingement test results on hip impingement patients (CAM type). Methods: Medical records of 334 patients (156 women, 178 men) with an average age of 33.8 +/- 8.4 (range 20-50) years were retrospectively studied for the alpha angle of the hip measured on magnetic resonance images (MRI). Hip pain and internal rotation angles as well as results of impingement tests were reviewed. Results: Hip pain was reported more frequently on the right side (n = 35, 10.5%) compared to the left side (n = 22, 6.6%) (p = 0.047). No difference was observed between the right and left sides regarding alpha angles (p = 0. 145), internal rotation angles (p = 0.637), or positivity of impingement test (p = 0.210). Internal rotation angles were significantly higher in cases without hip pain (p < 0.001) and in patients with negative impingement test result (p < 0.001). Internal rotation angle correlated positively with age and negatively with the alpha angle. Alpha angle was increased in cases that report pain, those with an internal rotation angle <20 degrees, or cases with positive impingement test. The pain was more common, internal rotation angle was higher, and positivity for impingement was more frequent if the alpha angle was <55 degrees. Patients with hip pain or positive impingement test or internal rotation angle <20 degrees had increased alpha angles (p < 0.001). Conclusions: The pain, impingement test results, and internal rotation angle seem to be associated with alpha angle of the hip measured on MRI in hip impingement patients

Investigating the relationship between internal tibial torsion and medial collateral ligament injury in patients undergoing knee arthroscopy due to tears in the posterior one third of the medial meniscus

WOS: 000381590600017PubMed ID: 26751979Purpose: To evaluate the relationship between medial collateral ligament (MCL) injury and degree of internal tibial torsion in patients who had undergone arthroscopic resection due to tears in the posterior one third of the medial meniscus. Methods: Seventy-one patients were allocated into two groups with respect to foot femur angle (FFA) and transmalleolar angle (TMA) (Group 1 31 patients with FFA = 8 degrees.) The groups were compared in terms of valgus instability, Lysholm score, magnetic resonance view, FFA, and TMA, both before and after the operation. Results: Lysholm scores were higher in Group 2 at both postoperative week 1 (p < 0.001) and month 1 (p = 0.045) relative to Group 1. Preoperative cartilage injury was encountered more frequently in Group 1 (p = 0.037) than in Group 2. MCL injury was detected more frequently in Group 1 compared to Group 2 postoperatively at week 1 (p = 0.001). Conclusion: We conclude that FFA and TFA, indicators of internal tibial torsion, may serve as markers for foreseeing clinical improvement and complications following arthroscopic surgery

Safety of bioabsorbable implants in vitro

Background: The aim of the present study was to investigate the safety of bioabsorbable plates and screws in humans. Methods: For this purpose, an implant system based on [poly(lactic-co-glycolic acids)(85:15)] was designed. The system was tested for pH, temperature, and swelling and then its surface morphology was analyzed for surface porosity using environmental electron microscopy. Then, the effects of this bioabsorbable system on the viability and profileration of osteocytes were examined on a molecular level via in vitro experiments. A [poly(lactic-co-glycolic acids)(90:10)] bioabsorbable implant, which is commercially available and used in orthopedic surgery, was used as control group. For the statistical evaluation of the data obtained in the present study, the groups were compared by Tukey HSD test following ANOVA. The significance level was set as p < 0.05. Results: It was observed that the osteocytes cultivated on the PLGA system designed in the present study included more live cells and allowed more proliferation compared to the control. Conclusion: One of the criteria in the selection of implants for orthopedic surgery is that a good implant should not need removal and thus a second surgery. In the present study, a bioabsorbable implant was designed considering this criterion. The present study is the first step to prove the safety of this new design by in vitro toxicity and viability experiments