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

Management of persistent coccydynia with transrectal manipulation: Results of a combined procedure

WOS: 000431533600030PubMed ID: 29234884We compared the results of manual therapy combined with steroid injection with single steroid injection in the treatment of persistent coccydynia. Combined therapy was performed in 21 patients (Group 1) and steroid injection in 23 patients (Group 2). We compared two groups and investigated the combined therapy group in details. Patients were classified according to the underlying cause, BMI, anatomic type of coccyx and duration of symptoms (<6 or 6 months). Mean age was 30.5 years at the time of procedures. Mean followup time was 27.8 months. VAS scores were decreased in both groups but combined therapy group had much more better results. Complete pain relief was achieved in 61.9% of patients in Group 1 whereas it was only 17.4% in Group 2. In 23.8% of Group 1, the VAS score was significantly decreased but the feeling of uncomfortability persisted. This was 73.9% in Group 2. We had no relapse in Group 1 but in Group 2 the relapse rate was 56.5%. Underlying cause, body mass index, anatomic type of coccyx and duration of symptoms had no effect on results. Manual therapy combined with steroid injection would be an alternative method in case of persistent coccydynia. It is a safe and easy option before surgical treatment

Basit humerus kistleri için bir aylık aralıklarla üçlü metilprednizolon enjeksiyonu

Objective: The aim of this study was to retrospectively assess treatment of humerus simple cysts in the childhood period with 3 methylprednisolone injections at monthly intervals. Material and Method: A total of 38 patients with simple humerus bone cyst were included in the study. Twenty patients were girls and 18 were boys. The mean age was 7.8 (4-14) years. Under anesthesia patients had methylprednisolone administered three times at the thinnest point of the cortex under fluoroscopy control. Early movement was begun and they were discharged on the same day. Healing was assessed according to the Neer classification. Results: Patients were monitored for mean 32 months (12- 60). Thirty-one (81.5%) patients recovered. 21 were classified as Neer type 1, 10 were Neer type 2, and 6 were Neer type 3. A fracture developed in a patient classified as Neer type 4. Three patients developed color changes on the skin after the 3rd injection. Two patients (5%) were identified to have unequal upper extremity lengths. Conclusions: The low cost and complication rate and short hospital stay have added to the popularity of humerus simple cyst treatment with methylprednisolone injection. With different administration forms, 3 methylprednisolone treatments at one month intervals is a very effective method.Amaç: Bu çalışmanın amacı, çocukluk döneminde basit humerus kistlerinin aylık aralıklarla 3 metilprednizolon enjeksiyonu ile tedavisini geriye dönük olarak değerlendirmekti. Gereç ve Yöntem: Basit humerus kemik kisti olan toplam 38 hasta çalışmaya dahil edildi. Yirmi hasta kız, 18’i erkekti. Ortalama yaş 7,8 (4-14)’di. Anestezi altında tüm hastalara floroskopi kontrolü altında korteksin en ince noktasında üç kez metilprednizolon enjeksiyonu yapıldı. İlgili ekstremiteye erken hareket başlandı ve hastalar aynı gün taburcu edildi. İyileşme, Neer sınıflamasına göre değerlendirildi. Bulgular: Hastalar ortalama 32 ay (12-60) izlendi. Otuz bir (%81,5) hasta iyileşti. Olguların 21’i Neer tip 1, 10’u Neer tip 2 ve 6’sı Neer tip 3 idi. Neer tip 4 olarak sınıflandırılan bir hastada kırık gelişti. Üç hastada 3. enjeksiyondan sonra deride renk değişiklikleri görüldü. İki hastada (%5) üst ekstremite uzunluk eşitsizliği olduğu tespit edildi. Tartışma: Düşük maliyet ve komplikasyon oranı ve kısa hastanede kalış, metilprednizolon enjeksiyonu ile humerus basit kist tedavisinin popülaritesini arttırmıştır. Farklı uygulama şekilleri ile, bir ay aralıklarla 3 metilprednizon tedavisi çok etkili bir yöntemdir

Legal responsibility of the physician in medical intervention

Sağlık hizmeti sunan hekimler için var olan imkânları hastanın somut ihtiyacını gözeterek kullanırken, tıbbi, etik, hukuki çerçeveye azamı düzeyde ulusal ve uluslararası, hukuka uyma yükümlülüğünü araştırmak çalışmamızın temel amacıdır. Tıp bilimi kurallarına göre hareket etmek hekim açısından zorunlu olmakla birlikte, hasta hakkıdır. Sağlık hakkı yaşam hakkının bir parçasıdır ve kişiye sıkı sıkıya bağlı haklardandır. Hastaya yapılacak müdahalenin hukuki geçerliğinin olmaması durumunda, müdahalede bulunan kişinin sorumluluğuna gidileceği ve gerekli hukuki yaptırımda bulunulacağı belirtilmelidir. Sağlık hizmeti verilirken standart müdahalenin, tıbbi kurallara uygunluğunun yanında hukuken geçerli olması gerekir. Hekim ve sağlık hizmeti veren profesyonellerin sorumluluk ve yükümlülükleri, insan bedeni ve ruhu üzerinde hizmet veriyor olmalarından dolayı diğer meslek profesyonellerine göre daha fazladır.The main purpose of our study is to investigate the obligation to comply with the medical, ethical and legal framework, national and international,at the highest level, while using the available opportunities for the physicians who provide health services, taking into account the concrete needs of the patient. Allthough it is obligatory for the physician to act according to the rules of medical science, it is the right of the patient. The right to health is a part of the right to life and is one of the rights strictly attached to the individual. It should be stated that if the intervention to the patient is not legally valid, the person who intervenes will be held responsible and the necessary legal sanction will be taken. While providing health care, the standard intervention must be legally valid as well as complying with medical rules. The responsibilities and obligations of physicians and health care professionals are more than other professionals because they serve on the human body and spirit

Reverse shoulder arthroplasty-early results

Although reverse shoulder arthroplasty is used in massive rotator cuff tears, it is also used in proximal humerus fractures and shoulder arthroplasty revision. In this study, we aimed to examine the early radiological and clinical results of patients undergoing reverse shoulder arthroplasty with different diagnoses. Between 2010 and 2013, reverse shoulder arthroplasty was applied to 10 patients (4 men, 6 women) with the diagnosis of arthropathy due to rotator cuff tear (n: 7), multi-fragmentary proximal humerus fracture (n: 2) and hemiarthroplasty revision (n: 1). The median age of the patients was 74 (64-85) years and the median follow-up was 15.5 (3-35) months. Patients were assessed in terms of joint range of motion, Constant score and Visual Pain Scale (VAS) and radiological examinations before and after surgery. Preoperative active shoulder flexion, abduction, internal and external rotation degrees of the patients were 65, 30, 40 and 50 degrees, and 105, 95, 30, 57.5 degrees respectively in their final controls. Constant score was 20.5 (14-63) preoperatively, and 54.5 (38-64) in the final controls (p<0.05). While the preoperative VAS was 7 (3-9), it was found to be 1.5 (1-3) in the final controls (p<0.05). As a complication, scapular notching was observed in one patient. Internal external rotation values were better in the rotator cuff arthropathy group than the fracture group. Reverse shoulder arthroplasty, especially in the treatment of patients with rotator cuff arthropathy, has good early results and a low complication rate. We recommend paying attention to the glenoid component location to avoid scapular notching

Utěsnění femorálního kanálu autologním kostním štěpem snižuje krevní ztrátu

PURPOSE OF THE STUDY Total knee arthroplasty is commonly used procedure with advanced stage arthritis which causes extensive blood loss intraoperatively and postoperatively. Purpose of this study is to show the effectiveness of sealing of femoral tunnel with bone grafting in preventing blood loss. MATERIAL AND METHODS 288 patients with primary bicompartmental knee arthroplasty who were operated in between April 2012 and June 2015 are retrospectively studied. Two groups are formed according to sealing of femoral tunnel with autologous bone graft or not. Group 1 was the plugged group with 192 patients and group 2 was the unplugged group with 96 patients. Operation time, arthrotomy method, anticoagulant therapy, postoperative care were similar in between two groups.‘Independent sample t-test’ is used to compare two groups as statistical method. RESULTS Postoperative lowest hemoglobin levels are higher in plugged group (p < 0.001). Drain outputs are much less than unplugged group (p < 0.001). There is no statistically significant difference between amount of given erythrocyte suspensions. DISCUSSION In the literature there are many attempts to reduce blood loss and allogenic blood transfusion. Some systemic or local usage of medical therapies, mechanical interventions such as cold application or intraoperative fibrin sealers are some of them. There are a few studies favoring usage of plugs and a few do not. Our findings showed less blood loss with usage of autologous bone grafting but did not significantly affect the blood transfusion amount. CONCLUSION Autologous bone grafting is a free to use, non-time consuming and an effective method to reduce blood loss

Causes of open fractures: orthopaedic injuries related to home-made agricultural vehicles in the eastern Black Sea region of Turkey

Background/aim: Small vehicles known locally as pat-pats, which are used in agricultural work, are forbidden in traffic. The inherent instability of the vehicle may result in accidents, both on farmland and in traffic. The aim of this study was to evaluate orthopaedic injuries related to pat-pats. Materials and methods: Patients hospitalised for pat-pat accidents in two central hospitals in Samsun between December 2006 and October 2013 were scanned using ICD codes. A total of 46 patients with orthopaedic injuries (43 male, 3 female) with a mean age of 36 &plusmn; 13.3 years were evaluated. Results: The most injured age group was between 10 and 49 years (n = 40, 87%), and accidents occurred most in summer (n = 30, 65%). Open fractures were determined in 42 (91%) patients. Amputation was necessary in 4 (8%) patients. The hospitalisation period was a mean of 17.1 &plusmn; 14 days. A statistically significant relationship was determined between open fracture type and the hospitalisation period (P &lt; 0.001). Conclusion: As most of the orthopaedic injuries related to home-made agricultural machines are open fractures, it is important to guard against these types of injuries. The regulations that these machines are not used in traffic should be enforced and safer practices should be applied for use in agriculture

Do endocrinopathies cause changes in transverse carpal ligament thickness and carpal tunnel area in carpal tunnel syndrome?

Objective: The purpose of this study was to investigate the effect of transverse carpal ligament (TCL) thickness and the size of carpal tunnel area on clinical findings and electrophysiological changes through the wrist magnetic resonance imaging (MRI). Methods: In this prospective study, the thickness of the TCL and the carpal tunnel areas of preoperative cases diagnosed with carpal tunnel syndrome (CTS) were measured via wrist MRI results. The effect of TCL thickness and carpal tunnel area on endocrinopathies such as diabetes mellitus (DM) and hypothyroidism and the effect of these variables on clinical findings and electrophysiologic changes were evaluated in the light of the literature. Results: TCL thickness and carpal tunnel area were not statistically significant among DM, hypothyroidism and electrophysiological changes (p>0.05). Conclusion: This study include one of the limited researches comparing the carpal tunnel area and TKL thickness in cases with and without endocrinopathy CTS. However, there is a need for further researches that have a greater number of cases, including multi-centered, differentwinged people