What is the role of primary hip hemiarthroplasty over 70 years of age?

AMAÇ: Yetmiş yaş üzeri anstabil intertrokanterik femur kırıklarda (IFK) hemiartroplasti uyguladığımız olguları morbidite açısından değerlendirdik. Günümüzdeki hemiartroplastinin yerini tartışmayı amaçladık. GEREÇ veYÖNTEMLER: Kliniğimizde 1995-2006 yılları arasında hemiartroplasti yöntemi ile tedevi edilen intertrokanterik femur kırıklı hastaların 75'i çalışmaya dahil edildi. Ortalama takip süreleri 44 (20-82) ay idi. Hastaların 43'ü kadın,32'si erkekti. 45 hastanın sağ, 30 hastanın sol kalçası etkilenmişti. Olguların hepsi Harris kalça skorlamasına göre değerlendirildi. BULGULAR: Harris kalça skorlama sistemine göre dört hastada mükemmel sonuç, 54 hastada iyi sonuç, dokuz hastada orta, sekiz hastada kötü sonuç saptandı.Yetmiş yaş üzeri anstabil IFK'larında uygulanan hemiartroplasti olgularının %78'inde iyi-mükemmel sonuca ulaşılmış olduğu saptandı SONUÇ: Ameliyat süresinin çok kısa olması, skopi gibi teknik donanıma sahip olma şartının olmaması ve erken tam yük verebilme gibi avantajları olan hemiartroplasti yönteminin yaşlı IFK olgularında halen geçerliliğini ve etkinliğini koruyan bir yöntem olduğu sonucuna vardık.OBJECTIVE: We assessed importance of primary hip hemiarthroplasty in treatment algorithm. And we have evaluated patients treated with primary hip hemiarthroplasty for unstable intertrochanteric hip fractures according to morbidity rates. MATERIAL and METHODS: In our clinic between 1995 and 2006; we selected 75 patients treated with primary hip hemiarthroplasty for intertrochanteric femur fracture (IFF). Mean follow-up was 44 months (20-82). Genders of patients were female 43% and male 32%. Numbers of affected hips were 45 right and 30 left. Patients were evaluated with Harris Hip Score. RESULTS: Harris Hip Score of patients; Excellent 4, Good 54, Fair 9 and Poor 8 results were obtained. Seventyeight percent excellent to good results obtained primary hip hemiarthroplasty for unstable intertrochanteric femur fracture patients over 70 years of age. CONCLUSION: There are advantages of primary hip hemiarthroplasty over osteosynthesis for patient's population over 70 years of age such as; short surgery time, no radiation exposure and immediate weight bearing. Primary hip hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilization. It is also current and effective treatment option for most elderly

Acetabulum protrusion following ceramic liner fracture: A case report

Esenyel, Cem/0000-0003-4835-7079WOS: 000433199500009PubMed: 29725513Hip arthroplasty is an extremely satisfying treatment method for coxarthrosis which is in increasing use throughout the world. However, loosening of the prosthesis is a significant complication and to overcome this, ceramic liners are increasingly being selected. If the survival of ceramic surfaces is prolonged, there is a risk of fracture of the ceramic materials. New ceramic materials developed to overcome this problem are more resistant. The case presented here is of a patient in whom liner fracture developed following ceramic-ceramic hip arthroplasty. The ceramic femoral head was observed to have protruded into the defect created in the acetabular component. Acetabular revision was applied to the patient

The results of bankart repair without capsular plication in patients with recurrent traumatic anterior shoulder dislocation

PubMed: 28193141Purpose: The aim of this study was to evaluate the results of patients with recurrent anterior shoulder dislocation, who had been treated with repair of the Bankart lesion without capsuler plication. Material and method: The study included 22 shoulders of 22 patients (16 males and 6 females) with a mean age of 28 years, who underwent Bankart repair between 2011 and 2014. Patients with bilateral shoulder instability, multiple instability, >25% glenoid bone loss, and those with a history of shoulder surgery were not included in the study. The average follow-up time was 21.2 months. Evaluation was made of the preoperative number of dislocations, postoperative recurrence, functional status, and daily activity performance of the patients. Shoulder range of motion was measured. The results were evaluated using the Rowe shoulder score and the Oxford shoulder instability score. Results: Recurrence was observed in only one patient who had a shoulder dislocation after trauma, thus giving a recurrence rate of 4.5%. Shoulder range of motion was full in all except that one patient. The mean Rowe shoulder score was 95.5 (excellent) and Oxford shoulder stability score was 44.6 (excellent). Conclusion: No recurrent shoulder dislocation was observed in patients who underwent Bankart repair surgery. Plication was not performed with the Bankart repair. Close to full range of motion was obtained in all patients. In conclusion, Bankart repair alone can be considered to be sufficient for the treatment of traumatic recurrent anterior shoulder instability. © Journal of Orthopaedic Surgery 2017

Comparison of carpal tunnel injection techniques: A cadaver study

The purpose of the study was to evaluate the accuracy of injections into the carpal tunnel using three different portals in cadavers, and to define safe guidelines. In this study, 150 wrists of 75 cadavers (54 male, 21 female) were included. To compare three injection sites, 50 wrists of 25 cadavers were used for each technique; we used 23 gauge needles, and acrylic dye. The first injection technique: the needle was inserted 1cm proximal to the wrist crease and directed distally by roughly 45 in an ulnar direction through the flexor carpi radialis tendon. The second injection technique: the needle was inserted into the carpal tunnel from a point just ulnar to the palmaris longus tendon and 1cm proximal to the wrist crease. The third injection technique: the needle was inserted just distal to the distal skin crease of the wrist in line with the fourth ray. The first injection technique gave the highest accuracy rate, and this was also the safest injection site. Median nerve injuries caused by injection was seen mostly with the second technique. Although a steroid injection may provide symptomatic relief in patients with carpal tunnel syndrome, the median nerve and other structures in the carpal tunnel are at risk of injury. Because of that, the injection should be given using the correct technique by physicians skilled in carpal tunnel surgery

Effects of calcitonin on the biomechanics, histopathology, and radiography of callus formation in rats

Background. This study was designed to examine the effect of salmon calcitonin on fracture repair

Relationship between Meniscal Tears and Tibial Slope on the Tibial Plateau

Objective: The geometry of the tibial plateau has a direct influence on the translation and the screw home biomechanics of the tibiofemoral joint. Little information on the relationship between the tibial slope and meniscal lesions is available. The objective of this retrospective study was to examine the effect of the tibial slope on the medial and lateral meniscus lesions in patients with intact ACLs. Materials and Methods: The MRIs and lat roentgenograms of 212 patients with meniscus lesions were examined to determine the possible effect of the tibial slope on meniscal tears. First, the anatomic axis of the proximal tibia was established. Then, the angle between the line drawn to show the tibial slopes (medial and lateral) and the line drawn perpendicular to the proximal tibial anatomic axis was established on MRI. The patients with previously detected meniscus lesions were classified into three categories: patients with only medial meniscal tear (Group 1, 90 patients); patients with only lateral meniscal tear (Group 2, 15 patients); and patients with both medial and lateral meniscal tear (Group 3, 19 patients). Group 4 had no meniscal tear (88 patients). The MRIs of the patients who had applied to the Orthopedic Outpatient Clinic with patellofemoral pain and no meniscal tear were included as the control group. Results: The average tibial slope of the medial tibial plateau was 3.18° in group 1, 3.64° in group 2, 3° in group 3, and 3.27° in group 4. The average tibial slope of the lateral tibial plateau was 2.88° in group 1, 3.6° in group 2, 2.68 in group 3, and 2.91 in group 4. The tibial slope on the medial tibial plateau was significantly larger than the lateral tibial plateaus in group 1 and group 4 (p0.05). In addition, the tibial slope on the lateral side of group 2 was significantly larger than that of groups 1, 3, and 4 (p<0.05).Conclusion: An increase in the tibial slopes, especially on the lateral tibial plateau, seems to increase the risk of meniscal tear

Comparison of Anesthetic Administration According to Method of Hip Surgery

OBJECTIVE: The aim of this study is to compare total hip prosthesis (THP), partial hip prosthesis (PHP), and proximal femoral nail (PFN) patients in terms of the chosen anesthetic method. METHODS: A total of 850 patients who underwent hip surgery were divided into 3 groups according to the operation type: PHP (n=281), PFN (n=393), and THP (n=176). The type of anesthesia administered, interventions during anesthesia, and complications were retrospectively evaluated. The groups were compared in terms of patient age, American Society of Anesthesiologists (ASA) scores, chosen anesthetic method, operation duration, colloid use during operation, use of antihypertensive medication, use of vasoconstrictor medication, development of hypotension, blood transfusion administered, development of cardiac arrest, requirements for intensive care after operation, and use of a central catheter. RESULTS: In the THP group, the mean age of patients was significantly lower as compared to the PHP and PFN groups. The duration of operation was lower in the PFN group as compared to the other two groups. In the THP group, general anesthesia was significantly high, while in the PFN group, regional anesthetic administration was high. While colloid use was greater in the PFN group, the blood transfusion rate was higher in the THP group. The use of antihypertensive medication was higher in the THP group as compared to the other groups. CONCLUSION: Although all three anesthetic methods could be used in hip surgery, the type of anesthesia should be chosen according to the type of hip surgery considering the duration of operation, age of the patient, and blood lost during the operation