Appropriate image selection with virtual reality in vestibular rehabilitation: Cross-sectional study

Background: While vestibular rehabilitation with virtual reality (VR) is becoming more popular every day, the disadvantages of this method are not yet clear. Objective: The aim of this study is to examine the effect of the image to be used in vestibular rehabilitation with VR on the systems that provide body posture. Methods: The study was carried out with 36 participants (18 women and 18 men) aged 18 to 30 years. To assess balance control components separately, a sensory organization test was administered to the participants in the presence of stressful and relaxing environment images with VR technology. The State-Trait Anxiety Inventory survey was also used to measure the stress values in the created environments. Results: The State-Trait Anxiety Inventory survey revealed that while stressful videos significantly increased stress, relaxing videos reduced stress. Among measurements obtained in the presence of VR, significant decreases were observed mostly in the visual system data. A significant increase in vestibular system data (P=.01) was observed with a decrease in visual system data (P<.001) when the relaxing image was presented. Additionally, there was a significant difference in the somatosensory (P=.001), composite (P=.002), and visual system (P[removed

The Value of Immature Granulocyte and Immature Granulocyte/Total Granulocyte Ratio in Predicting the Need for Surgical Treatment in Patients Diagnosed with Intestinal Ileus in the Emergency Department

Background/Aims: Although many biomarkers that can predict the need for surgical treatment of patients with intestinal ileus have been investigated, effective, inexpensive, and fast-resulting biomarkers have not been determined. In our study, showing the value of immature granulocyte (IG) and immature granulocyte/total granulocyte (IG/TG) ratio in predicting the need for surgical treatment in patients diagnosed with intestinal ileus in the emergency department was aimed. Methods: Our study was carried out as a prospective cohort between 23.11.2021 and 07.04.2022. Patients aged 18 years and older who applied to the emergency department and were diagnosed with intestinal ileus after clinical, laboratory and radiological evaluation were included in the study. Demographic characteristics, comorbidities, treatments, laboratory tests and IG, IG/TG results of the patients were recorded. The patients were divided into two groups as those who underwent surgical treatment and those who did not, and comparisons were made. p value &lt;0.05 was considered statistically significant. Results: A total of 78 patients were included in the study. 46.2% (n=36) of the patients were female and the median age was 65 years. While surgery was performed in 41% (n=32) of the patients, 59% (n=46) were followed up with medical treatment. IG number and IG/TG ratio were found to be higher in patients who underwent surgical intervention than in those who underwent medical treatment, and these differences were statistically significant (p&lt;0.05). In receiver-operating characteristic (ROC) analysis AUC: 0.658 was found for IG number. With the best cut-off value of 0.03, the sensitivity was found to be 56.3% specificity: 71.7%; and the AUC value for IG/TG: 0.627 (95% CI; 0.500-0.753), and when the best cut-off value was taken as 0.2, the sensitivity for this value was 59.4%, and the specificity was 63%. Conclusion: In this study, in which we examined the IG numbers and IG/TG ratios in patients with intestinal ileus, although we showed that these parameters were higher in patients who needed surgical treatment, upon the analysis done, we believe that it is not a clinically significant marker

Cerrahi yolla tedavi edilen el ve el bileği kitlelerinin değerlendirmesi

Amaç: El ve el bileği kökenli tümörler, Ortopedi ve Travmatoloji uzmanlarının sıkça karşılaştıkları durumlardır. Bu tümörler sıklıkla benign karakter taşımalarına karşın nadiren malign özellikte tümörlerle de karşılaşılabilir. Bu çalışmamızda; cerrahi tedavi için hastanemize yatan el ve el bileği tümörlü hastalar incelenmiştir. Gereç ve yöntem: 1985-2011 yılları arasında patolojik tanıları doğrulamış 379 hastanın 381 el ve el bileği kitlesi çalışmaya dahil edilmiştir. Hastaların; 213’ü kadın, 166’sı erkek ve yaş ortalamaları 30,8 olarak bulunmuştur. Sonuçlar: Tümörlerin 14 % 3,7 tanesi malign; 367 % 96,3 ’si ise benigndi. Malign tümörlerin görüldüğü ortalama yaş 42,3 ; benign tümörlerinki ise 30,6 olarak hesaplandı. Histopatolojik tetkik sonuçlarına göre en sık olarak görülen tümör, 117 olgu ile enkondrom olurken; ikinci sırayı 104 olgu ile ganglion, üçüncü sırayı 49 olgu ile osteokondrom almıştır. En sık görülen malign tümör 8 olgu ile kondrosarkom olmuştur. Yorum: El ve el bileği tümörlerinin sıklığı ve çeşitliliğine dair epidemiyolojik veriler oldukça kısıtlıdır. El ve el bileği yerleşimli kitleler, her Ortopedi ve Travmatoloji uzmanının karşılaşma ihtimali yüksek olan olgulardır. Bu tümörlerin çok büyük bir kısmı benign nitelikte olsa da; malign tümörlerin de görülebileceği unutulmamalıdır. Bu çalışmamızın; el ve el bileğinde görülen kitlesel lezyonların, tanı ve tedavisi açısından Ortopedi ve Travmatoloji ile uğraşan meslektaşlarımıza faydalı olacağına inanmaktayı

Patients with Black Hip and Black Knee Due to Ochronotic Arthropathy: Case Report and Review of Literature

Ochronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis

Patients with Black Hip and Black Knee Due to Ochronotic Arthropathy: Case Report and Review of Literature

Abstract Ochronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Konjenital İdyopatik Talipes Ekinovarus Artmış Gelişimsel Kalça Displazisi Sıklığı İçin Risk Faktörü müdür?

Amaç: Gelişimsel kalça displazisi GKD ve idyopatik talipes ekinovarus PEV en sık görülen çocukluk çağı ortopedik deformitelerindendir. Bu çalışmanın temel amacı ülkemizde PEV deformitesi nedeniyle tedavi edilen pediatrik hasta grubunda GKD sıklığını ve PEV deformitesinin GKD sıklığı açısından bir risk faktörü olup olmadığını araştırmaktır.Gereç ve Yöntem: Konjenital idiopatik pes ekinovarus tanısı ile Ponseti metodu uygulanarak tedavi edilmiş 113 çocuk Grup 1 ve ulusal rutin GKD tarama programı kapsamında kalça ultrasonografisi uygulanmış fakat PEV deformitesi olmayan 129 sağlıklı çocuk Grup 2 çalışmaya dahil edildi. Çocukların ultrasonografi esnasında ortalama yaşı Grup 1’de 3.8 hafta ve Grup 2’de 4.6 hafta olarak saptandı. Grup 1’de 65 kız ve 48 erkek, Grup 2’de 69 kız ve 60 erkek vardı. Her iki grupta Graf sınıflamasına göre GKD sıklığı mukayeseli olarak değerlendirildi.Bulgular: Ultrasonografi uygulanan toplam 484 kalçanın 20 tanesinde %4.1 GKD görüldü. Grup 1’de 10 çocuk %8.8 ve Grup 2’de 6 çocuğa %4.6 GKD tanısı kondu. Grup 1’deki 13 kalçanın 4 tanesi Tip 2A, 1 tanesi Tip 2B, 4 tanesi Tip 3 ve 4 tanesi Tip 4 olarak sınıflandırıldı. Grup 2’de ise 6 kalçada Tip 2A ve 1 kalçada Tip 3 displazi saptandı. Graf sınıflamasına göre GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekti.Sonuç: Gruplar arasında displazik kalça sıklığı bakımından anlamlı farklılık gözlemlenmemiş olmasına rağmen, GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekt

The Effect of C-Arm Mobility and Field of Vision on Radiation Exposure in the Treatment of Proximal Femoral Fractures: A Randomized Clinical Trial

Objectives. To examine the effect of fluoroscopy devices with different sizes of image intensifier and C-arm maneuverability on operating time, fluoroscopy time, radiation dose and reduction, and fixation quality at intertrochanteric femoral fractures. Design. Single-center, randomized, prospective study. Setting. Academic Level I trauma hospital. Patients and Intervention. 34 patients treated with cephalomedullary nailing for a stable, intertrochanteric proximal femur fracture (OTA A1). Main Outcome Measurement. The total working time of the fluoroscopy device, the dose-area product (DAP), operating time, reduction quality (cortical continuity, symmetrical collodiaphyseal angle, and shortness), and fixation quality (Bosworth quadrants, the tip-apex distance, TAD). Results. There were no cases of poor reduction; also the placement of the blade was optimal for 14 patients and suboptimal in 3 patients in each group. Superior-posterior placement of the blade or TAD > 25 mm was not seen in any patient. Total operating time was significantly shorter when using device A compared to the use of device B (20.1±3.4 mins versus 25.3±5.4 mins, p<0.001). Total radiation time was significantly shorter with device A compared to the use of device B (58.1±19.4 secs versus 98.9  ±  55.4 secs, p=0.008). The measured radiation dose was lower with the use of device A compared to device B (3.5  ±  1.2 Gy·cm2 versus 7.3  ±  4.5 Gy·cm2, p=0.002). Conclusion. Physical properties of fluoroscopy devices used during the fixation of intertrochanteric fractures could yield significant differences in operating times and the radiation dose while having comparable clinical results

Does fondaparinux have really positive effect on fracture healing? An experimental study in rats

OBJECTIVE: Antiembolic agents are routinely used in orthopaedics and traumatology clinics especially in arthroplasty, tumor and trauma surgery to decrease the embolism prob-lems. The effect of fondaparinux on fracture healing is unclear. The aim of this study is to find out the effect of fondaparinux on frac-ture healing and to compare with the effect of enoxaparin using a rat model. MATERIALS AND METHODS: 64 Wistar-Albino rats were randomi-zed into eight groups. Standard closed left femur fractures crea-ted under general anaesthesia. The control groups (A, B), heparin groups (C, D), enoxaparin groups (E, F), and fondaparinux groups (G, H), which administered isotonic NaCl solution (1cc/day), hepa-rin (1000 anti Xa IU/kg/day), enoxaparin (100 anti Xa IU/kg/day) and fondaparinux (0.2mg/ kg/day) respectively for 14 days. The rats in groups A, C, E, G were sacrificed at the end of day14 and the rats in groups B, D, F, H were scarified at the end of day 28 postopera-tively. All the femurs were radiologically evaluated with standard AP and lateral X-rays of the sacrificed femurs were rated according to the Goldberg classification system. Histological classification of healing was done according to Huo’s histological healing sca-le. Statistical analysis in this study was performed with GraphPad Prisma V.3 package software. Significance in the results were eva-luated at the level of p<0.05. RESULTS: Radiological evaluation did not reveal any significant difference between the groups in the second and the fourth weeks. Histological callus formation was found to be significantly poorer in the heparine group compared to other groups at the end of the fourth week. No significant differences were found between the groups histologically except the heparin group. Besides that, there was no significant difference on fracture healing radiologically and histologically between the enoxaparine and fondaparinux groups. CONCLUSION: We did not detect any extra positive effect of fondaparinux on fracture healing compared to enoxaparin. But fondaparinux can be used to prevent embolism problems in traumatic cases as the application of fondaparinux has no negative effect bone healing.AMAÇ: Antiembolik ajanlar ortopedi ve travmatoloji kliniklerinde özellikle artroplasti, tümör ve travma cerrahilerinde embolizm problemlerini azaltmak için rutin olarak kullanılmaktadır. Fondaparinuks’un kırık iyileşmesi üzerine etkisi belirsizdir. Bu çalışmanın amacı sıçan modeli kullanarak fondaparinuksun kırık iyileşmesi üzerine etkisinin incelenmesi ve enoksaparinin etkisi ile karşılaştırılmasıdır. GEREÇ VE YÖNTEM: 64 adet Wistar-Albino sekiz gruba randomize olarak ayrıldı. Genel anestezi altında sol femur kapalı standart kırıkları oluşturuldu. Kontrol grupları (A, B), heparin grupları (C, D), enoksaparin grupları (E, F), ve fondaparinuks grupları (G, H), sırasıyla izotonik NaCl (1cc/gün), heparin (1000 anti Xa IU/kg/gün), enoksaparin (100 anti Xa IU/kg/gün) ve fondaparinuks (0.2mg/kg/ gün) olacak şekilde 14 gün süre ile uygulandı. A, C, E, G gruplarındaki sıçanlar postoperatif 14. günün, B, D, F, H gruplarındakiler ise 28. günün sonunda sakrifiye edildiler. Tüm femurların radyolojik incelemesi standart ön-arka ve yan grafiler kullanılarak Goldberg sınıflamasına göre yapıldı. Histolojik inceleme ise Huo histolojik iyileşme sınıflamasına göre yapıldı. Bu çalışmanın istatiksel analizleri GraphPad Prisma V.3 paket programı kullanılarak yapıldı. Sonuçlarda anlamlılık p<0.05 düzeyi olarak belirlendi. BULGULAR: Radyolojik incelemede, ikinci ve dördüncü hafta sonundaki sonuçlar incelendiğinde, gruplar arasında istatiksel olarak anlamlı fark saptanmadı. Histolojik incelemede ise heparin almış olan H grubundaki iyileşme sonuçları diğer gruplarla karşılaştırıldığında istatiksel olarak anlamlı şekilde kötü olarak saptandı. Diğer gruplar arasında histolojik açıdan, heparin grubu hariç, istatiksel olarak anlamlı bir fark saptanmadı. Ayrıca histolojik ve radyolojik olarak fondaparinuks ve enoksaparin grupları arasında kırık iyileşmesi üzerine etkileri arasında istatiksel olarak anlamlı fark saptanmadı (p>0.05). SONUÇ: Çalışmamızda fondaparinuksun enoksaparin ile karşılaştırıldığında kırık iyileşmesi üzerine herhangi ekstra olumlu etkisini saptamadık. Fondaparinuks uygulamasının kırık iyileşmesi üzerine negatif bir etkisi saptanmamış olması nedeniyle travma vakalarında embolizm problemlerini önlemede kullanılabileceği kanaatindeyiz