Long-term results of chronic achilles tendon ruptures repaired with V-Y tendon plasty and fascia turndown

Background: This study aimed to evaluate the long-term follow-up results of V-Y tendon plasty with fascia turndown, for repairing chronic Achilles tendon ruptures. Methods: Seventeen patients (12 males, 5 females), who were diagnosed with chronic Achilles tendon rupture and met the inclusion criteria, were included in the study. These patients received treatment by means of V-Y tendon plasty with fascia turndown from January 1995 to December 2001. Clinical outcomes of the patients were assessed by using isokinetic strength testing, questioning the patient regarding residual discomfort, pain, or swelling and having the ability to perform heel rises and using American Orthopaedic Foot & Ankle Society’s (AOFAS’s) Ankle-Hind Foot Scale score. Mean followup duration was 16 years (13-18 years). Results: Mean time from the injury to operative treatment was 7 months. Mean operative defect of Achilles tendon in neutral position after debridement was 6 cm. During the follow-up, the mean calf atrophy was 3.4 cm. The mean 30 degrees/s plantarflex and 120 degrees/s plantarflex peak torques were 89 and 45 Nm, respectively. The mean 30 degrees/s plantarflex peak torque deficiency was 16%. The mean 120 degrees/s plantarflex peak torque deficiency was 17%. The average peak torque deficiency was 17%. The pre- and postoperative mean AOFAS Ankle-Hindfoot Scale scores were 64 and 95, respectively. No patient had a rerupture. Superficial wound infection was treated with oral antibiotic therapy in 2 patients (11%). Conclusions: The V-Y tendon plasty with fascia turndown for repairing chronic Achilles tendon ruptures yielded results comparable with the literature regarding clinical outcomes. This method did not require synthetic materials for augmentation and was an economic alternative compared to other repair methods. Level of Evidence: Level III, retrospective comparative study

Abnormal foot angles has an association with ingrown toenail

Background: Onychocryptosis, frequently termed ‘‘ingrown toenail’’ is a common foot problem in routine dermatology and orthopaedic clinical practice which leads to pain and disability. Although the aetiology of ingrown toenail is not well understood various associated risk factors have been identified with the pathogenesis. Material and methods: This study was a retrospective investigation of 170 patients with hallux valgus and lateral border ingrown toenail of all stages. The patients were compared with a control group. The radiologic assessment in both groups included right hallux valgus angle, left hallux valgus angle, right first and second intermetatarsal angle, and left first and second intermetatarsal angle. Results: There were 121 female and 49 male patients in the case group and 68 female and 32 male in the control group. The mean age of the case group was 41.1 years and 41.1 years in the control group. A statistically significant difference was found between the case and the control groups in terms of the right hallux valgus angle variable. Conclusion: The abnormal hallux valgus angle and the abnormal intermetatarsal angle plays an important role in ingrown toenail aetiology. The X-rays of the feet should be performed to determine the susceptibility of the patients who are admitted to the hospital for ingrown toenail in order to prevent other toes ingrown toenail and for planning the treatment of the patients with an ingrown toenail

EVALUATION OF CHRONIC NECK PAIN IN ORTHOPEDICS AND TRAUMATOLOGY CLINIC

Objective: Evaluating the management in patients with chronic and non-spesific neck pain.Materials and method: Questionnaire based retrospective clinical studyResults: In the previous year forty-six percent visited the general practice (GP) for neck pain. These patients , 28% did not receive a diagnostic modality, 36% did not receive therapy and 36% were not referred. The most diagnostic and therapeutic modalities were physical examination (54%) and pain medication (64%), respectively. The GPs most frequently referred to a physiotheraphy and rehabilitation (52%).Conclusion: Administration to hospital to chronic neck pain is % 46. This percentage is a minor group among chronic neck pain. Fifty-four percent of these patients can be diagnosed, if appropriate evaluations are made

ASSESMENT OF CORRELATION BETWEEN GLOBAL SAGITTAL AXIS AND CLINICAL SCORES IN SPINAL DEFORMITY PATIENTS

Objectives: Sagittal deformity requires higher energy to maintain an erect posture. Clinically, to be able to assess the severity of sagittal deformity and efficacy of compensatory mechanisms, new parameters are required. This study investigated the correlation between clinical relevance of global sagittal axis (GSA) and the severity of sagittal deformity.Methods: In this study, retrospective review of patients who underwent full- body radiographs and clinical scoring systems which are Oswestry Disability Index (ODI), Scoliosis Research Society–22 and the visual analog scale for back and leg pain are integrated. The GSA is the angle between a line from the center of C-7 to midpoint of the femoral condyles, and a line from the posterior superior corner of the S-1 sacral endplate to midpoint between the femoral condyles. Correlation between clinical scoring systems and GSA data were compared.Results: Eighty-four patients (mean age 46 years) were included. The GSA correlated significantly with all ODI, Scoliosis Research Society–22 and the visual analog scale for back and leg pain scores. Statistical analysis revealed that in sagittal deformity, the GSA increased with a concurrent increase in pelvic posterior translation (+0.186) and knee flexion (+0.284) and decrease in pelvic retroversion (-0.832)Conclusions: The GSA is a practical and reliable measure to assess the sagittal deformity.The GSA correlated highly with clinical scores

Can primary insert be used in revision knee prosthesis?

The aim of osteoarthritis treatment is to reduce pain and relieve functional limitations. Total knee replacement is now frequently used in the ultimate treatment of osteo- arthritis. High patient satisfaction after total knee prosthesis leads to an increase in primary cases and parallel to this, an increase in the revision rate. In our study, a total of 42 patients (43 knees) who underwent single-stage revision knee replacement surgery between October 2009 and January 2016 and followed-up until November 2020 (4 years minimum, 11 years maximum) were included in the study. 41 of these patients were female and 1 was male. Two revision operations were performed for one patient. The mean age of patients when revision knee prosthesis was performed was 70.3 ± 6.7 (minimum 51; maximum 87). 42 patients; 23 had complaints from the left knee and 20 from the right knee. The mean follow-up time after revision is 56.2 ± 1 months. The postoperative clinical evaluation of the patients was made according to the American knee association score, and the differences between the clinical results of 3 different implants used differently were revealed. The most striking result is that the clinical results of normal inserts used in semi-constrained revision surgery are more successful than semi-constrained inserts. Both the range of motion and satisfac - tion were found to be higher in the patients. Regarding the insert differences between the prostheses used, we have seen that those using normal inserts increase the knee association score better than those using constrained or hinged inserts, and at the same time, we think that these normal inserts used will last longer than restrictive inserts

Primer Total Diz Artroplastisi İçin Traneksamik Asid Kullanımında Gizli Kan Kaybı, Enfeksiyon ve Fiyat-Fayda Oranı

Objective: The purpose was to evaluate the effect of combined administration of TXA on total blood loss, hidden blood loss, drain output, costeffectiveness and periprosthetic infection rate in patients undergoing unilateral primary knee arthroplasty.Sakarya Med J, 2018, 8(2):423-431 )Materials andMethodsWe enrolled fi fty-eight patients with primary gonarthrosis undergoing unilateral primary knee arthroplasty between May 2014 andDecember 2014. We compared 29 cases performed without the application of TXA to 29 cases performed with the application of TXA.Our TXA protocol consisted of three stages.Results Postoperative hemoglobin and hematocrit levels were found to be signifi cantly lower in the non-TXA group. Estimated blood loss, hiddenblood loss, and drain output were found to be higher in the non-TXA group. Transfusion rate was lower in TXA group. The blood bankcosts were found to be higher in the non-TXA group. The total direct cost was also higher in the non-TXA group. This was average 29.9$savings per case in the TXA group. No complication such as infection or thromboemboli was detected among the study groups.Conclusion Combined topical and continuous up to 24 hours intravenous administration of TXA reduced the total blood loss and decreased drainagevolume, as well as reducing hidden blood loss.Level of evidence III.Amaç Tek tarafl ı primer total diz artroplastisi uygulanan hastalarda kombine traneksamik asid (TXA) kullanımının total kan kaybı, gizli kan kaybı, drenaj miktarı, kost efektivite ve periprostetik enfeksiyon oranı üzerine etkisini değerlendirmektir. ( Sakarya Tıp Dergisi, 2018, 8(2):423-431 ). Gereç ve Yöntem 2014 yılı Mayıs ve Aralık ayları arasında primer gonartroz tanısı ile tek tarafl ı primer total diz artroplastisi uygulanmış olan 58 hasta çalışmaya dahil edilmiştir. TXA uygulanmamış 29 hasta ile TXA uygulanmış olan 29 hasta karşılaştırılmıştır. Söz konusu TXA protokolü 3 aşamadan oluşmaktadır. Bulgular Ameliyat sonrası hemoglobin ve hematokrit seviyeleri non-TXA grubunda anlamlı olarak düşük bulundu. Gene tahmini kan kaybı, gizli kan kaybı ve drenden olan kayıp miktarı non-TXA grubunda daha yüksek bulundu. Transfüzyon oranı TXA grubunda daha düşüktü. Kan bankası masrafl arı non-TXA grubunda daha yüksek bulundu. Total masrafl ar da gene non-TXA grubunda daha yüksek idi. TXA grubunda vaka başına 29,9 USD daha az masraf söz konusu idi. Çalışma gruplarında enfeksiyon veya tromboemboli gibi komplikasyonlara rastlanmadı. Sonuç Topikal ve 24 saat sürekli intravenöz TXA’in kombine kullanımı total kan kaybı, drenaj hacminin yanı sıra gizli kan kaybı miktarını da azaltır. Kanıt düzeyi II