45 research outputs found
Medial femoral condyle fracture after cementless unicompartmental knee replacement: A rare complication
This case report describes a rare complication of unicompartmental knee arthroplasty. Femoral fracture after
TKR is a serious and relatively common problem, but to the best of our knowledge, only one case of femoral
condylar fracture after UKA has been reported thus far
Lyophilised medial meniscus transplantations in ACL-deficient knees: a 19-year follow-up
The treatment of meniscal tears has changed since the early 1980s. Meniscus transplantation emerged as a treatment option during that period. This study aims to present the long-term results of the first lyophilised meniscus allograft transplants in Turkey. Between 1990 and 1992, four transplants of the medial meniscus combined with anterior cruciate ligament (ACL) reconstruction were performed on patients with a history of medial meniscectomy and anterior knee instability at our institution. For all patients who underwent meniscus lyophilised allograft transplantation and revision ACL reconstruction, clinical outcomes were evaluated over a mean period of 19 years of postoperative follow-up by clinical assessment, Tegner score, Lysholm score, Knee Society Score, radiography and magnetic resonance imaging (MRI). The median value of Tegner score was 3 before index surgery and 2.5 at year 19 postoperatively. The median value of Lysholm score was 60.5 before index surgery and 62.5 at year 19. All of the patients had Outerbridge grade IV osteoarthritis by X-ray examination at year 19. Successful meniscus transplantation depends on many factors. This study examines the effect of allografts on these factors and describes experiences with lyophilised allografts in four male patients. IV
Arthroscopic stabilization of anterior shoulder instability using a single anterior portal
Objective: The aim of this study was to compare the effects of the use of a single anterior portal in the
arthroscopic surgery treatment of traumatic anterior shoulder instability with those in the literature.
Methods: The study included 72 patients (60 males, 12 females; mean age: 23.9 years) who underwent
surgery using a single arthroscopic anterior portal for the treatment of traumatic anterior shoulder instability
between 2002 and 2011. Clinical outcomes were assessed using the Rowe and Oxford scales,
forward flexion range and external rotation limitation. Redislocation was considered failure.
Results: Mean follow-up was 49.3 months. Bankart lesion was determined in 38 patients and Bankart
and SLAP lesions in 34. An average of 3.7 (range: 2 to 5) anchors were used. Redislocation was observed
in 4 (5.6%) patients in the postoperative period. Postoperative Rowe and Oxford scores were
93.4 and 42.6, respectively.
Conclusion: Instability surgery performed using a single arthroscopic anterior portal provided findings
comparable with the literature regarding clinical outcomes, postoperative shoulder movements
and low recurrence rates, emphasizing the importance of appropriate patient selection rather than the
number of the portals. The use of a single portal is less invasive and reduces the surgical period
Two cases with HSSDRESS syndrome developing after prosthetic joint surgery: does vancomycin-laden bone cement play a role in this syndrome?
We report two cases of hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (HSS/DRESS) syndrome following systemic and local (via antibiotic laden bone cement (ALBC)) exposures to vancomycin. Both cases developed symptoms 2-4 weeks after the initiation of treatment. They responded to systemic corticosteroid treatment and were cured completely. Various drug groups may cause HSS/DRESS syndrome, and vancomycin-related cases do not exceed 2-5% of the reported cases. Almost all of these cases developed the syndrome following systemic exposure to vancomycin. ALBC seems to be the safer antibiotic administration method, as systemic antibiotic levels did not reach a toxic threshold level. However, local administration may not always be sufficient for bone-related/joint-related infections; these infections may require systemic antibiotics as well. As HSS/DRESS syndrome can mimic infectious diseases, it must be considered during differential diagnosis before suspecting failure of treatment and initiation of a different antibiotic course. Copyright 2015 BMJ Publishing Group. All rights reserved
The effect of adding dexmedetomidine to levobupivacaine for ınterscalene block for postopertive pain management after arthroscopic shoulder surgery
Outcomes for revision total knee replacement after unicompartmental knee replacement
Objective: The aim of this retrospective, observational study was to describe the outcomes of total knee
replacement (TKR) after failed Oxford phase 3 medial unicompartmental knee replacement (UKR).
Methods: The study included 24 revision TKRs (20 females, 4 males; mean age: 61 years) performed
following failed aseptic UKR. Outcomes were assessed using the Knee Society Score (KSS).
Results: The most common causes for revision were mobile bearing dislocation and unexplained pain.
Mean preoperative KSS was 50.3 (range: 37 to 66) and 82.2 (range: 58 to 97) after TKR. There were
17 excellent, 4 good, 2 fair and 1 poor results.
Conclusion: The type of UKR performed (cemented versus uncemented) had no effect on TKR success.
Revision for failed UKR with TKR appears to be a technically straightforward procedure with
satisfactory early clinical results
Clinical evaluation of an antero-medial approach for plate fixation of the proximal humeral shaft
Objective Surgical approach of fractures of the proximal
humeral shaft should protect the muscular insertions and
the vascularisation of fragments, improving bone union and
functional recovery. The aim of this study is to review
cases operated with an original anteromedial approach, in
cases of specific fractures of the proximal humeral shaft.
Materials and methods Prior to clinical application, a
cadaveric study was accomplished. Based on the results,
six clinical cases had surgery using an approach medial to
the biceps and brachialis. The osteosynthesis was performed
with locked plates and 4.5 screws. The approach
was indicated in fractures presenting with a large lateral
wedge including the deltoid muscle insertion. Stable osteosynthesis
achieved with this approach allowed early
postoperative mobilization of the arm in all cases.
Results The case-series consisted of three women and
three men with a mean age of 52.1 years (range 38–68).
The minimal follow-up was 1 year. Bone union was
observed at an average time of 11.2 weeks. There were no
intra- or postoperative complications.
Discussion Open reduction and internal fixation with
compression plating is a standardized and successful
procedure in the treatment of humeral fractures. Internal
fixation with lateral plating is difficult in the proximal third
of the humeral shaft, where the positioning of the implant
may hurt the long biceps tendon and the deltoid insertion.
This approach was successful and safe in the presented
cases.
Conclusion The antero-medial approach with metaphyseal
locking plate protects the muscular insertions and the
vascularisation of the wedge fragment, leading to good
results in all the cases in this series
Arthroscopic release of the subscapularis for shoulder contracture of obstetric palsy
Objective Retrospective study of one surgeon’s experience
with arthroscopic release in obstetrical brachial plexus
palsy.
Methods Over a four-year period, 6 patients who presented
with a shoulder contracture secondary to obstetric
palsy before the age of 8 years were treated arthroscopically.
Small arthroscopy instruments, small shaver blades,
including a 2.7-mm, 30° angled scope, and 90° radiofrequency
probe, were used for this surgery. Patient selection
for this approach was based on the lack of bone deformity
and targeted soft tissue release. Postoperative brace immobilization
for 6 weeks was used in all patients. Functional
status of the patients was evaluated pre- and postoperatively
with the assessment of external rotation.
Results The case series consisted of 2 girls and 4 boys
with a mean age of 5.1 years (range, 3–8 years). No patient
was lost to follow-up, and all patients completed a minimum
1 year of clinical and radiographic follow-up.
Increases in external rotation were observed in all patients.
There was no intra- or postoperative complications.
Conclusion Arthroscopic treatment of the shoulder contracture
in obstetric palsy was found to be a safe and eVective
procedure in patients who are likely to undergo future
tendon transfer or bone surgery
The effect of magnesium added to levobupivacaine for femoral nerve block on postoperative analgesia in patients undergoing ACL reconstruction
Purpose The aim of this prospective randomised doubleblind
study is to investigate the effect of magnesium added
to local anaesthetics on postoperative VAS scores, total
opioid consumption, time to first mobilisation, patient
satisfaction and rescue analgesic requirements in arthroscopic
ACL reconstruction surgery.
Methods A total of 107 American Society of Anaesthesiologists
physical status grade I and II patients between 18
and 65 years of age who were scheduled to undergo elective
anterior crucial ligament (ACL) reconstruction with
hamstring autografts were enrolled in the study. The
patients were randomly allocated to Groups L (n = 51) and
LM (n = 56) using the closed-envelope method. Group
LM was administered 19 ml of 0.25 % levobupivacaine
and 1 ml of 15 % magnesium sulphate, while Group L was
administered 20 ml of 0.25 % levobupivacaine for femoral
blockade. General anaesthesia was administered using
laryngeal airway masks following neural blockade in both
groups. The patients were evaluated for heart rate and
mean arterial pressure, oxygen saturation, visual analogue
score (VAS), verbal rating scale (VRS), rescue analgesic
requirements, total opioid consumption, side effects and
time to first mobilisation at the 1st, 2nd, 4th, 6th, 12th and
24th hours postoperatively.
Results There was no statistically significant difference in
terms of demographic data, mean arterial pressure, heart
rate or oxygen saturation between groups. The area under
the curve VAS and VRS scores were lower at 4, 6, 12 and
24 h in Group LM (p = 0.001, p = 0.016, respectively).
The rescue analgesic requirement and the total opioid
consumption were significantly lower in Group LM
(p = 0.015, p = 0.019, respectively). The time to first
mobilisation and the Likert score (completely comfortable;
quite comfortable; slight discomfort; painful; very painful)
were higher, and the block onset time was lower in Group
LM (p = 0.014 and p = 0.012, respectively). There was
no difference in terms of side effects.
Conclusions The addition of magnesium to levobupivacaine
prolongs the sensory and motor block duration
without increasing side effects, enhances the quality of
postoperative analgesia and increases patient satisfaction;
however, the addition of magnesium delays the time to first
mobilisation and decreases rescue analgesic requirements
Effect of Potassium Aluminum Sulfate Application on the Viability of Fibroblasts on a CAD-CAM Feldspathic Ceramic before and after Thermocycling.
Potassium aluminum sulfate (alum) is a known adjuvant, which has been used as a mordant in textile industry for color fixation. This material has potential to be incorporated into dentistry for color stability, yet its toxicity first needs to be evaluated. The present study aimed to evaluate the cytotoxic potential of potassium aluminum sulfate (alum) on fibroblasts when applied onto feldspathic ceramic before and after thermocycling. Forty-eight feldspathic ceramic specimens were divided into four groups (FC: no alum application or thermocycling; FCT: thermocycling without alum application; FA: alum application without thermocycling; FAT: alum application and thermocycling) (n = 12). Cell viability was assessed by using a tetrazolium salt 3-[4,5-dimethylthiazol-2-yl]-2,5-diphnyltetrazolium bromide assay at 24 and 72 h, and cell cultures without any ceramic specimens served as control (C). One sample from each material group was further analyzed with energy dispersive X-ray spectroscopy (EDX). Cell viability at different time intervals within each group was analyzed with Friedman tests, while Kruskal-Wallis tests were used to compare the test groups within each time interval. Pairwise comparisons were further resolved by using Wilcoxon tests (a = 0.05). C had lower (p = 0.01) and FA had higher (p = 0.019) cell viability after 72 h. After 24 h, the highest cell viability was observed in C (p ≤ 0.036). After 72 h, the differences between C and FA, C and FAT, FC and FA, and FCT and FAT were nonsignificant (p > 0.05). Cell viability was not affected by alum application or thermocycling at any time interval (p ≥ 0.631). EDX analysis showed an increase in potassium concentration in FA and FAT when compared with FC and FCT. Regardless of the time interval, alum application onto feldspathic ceramic and thermocycling did not influence the cell viability