11 research outputs found
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
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
The Relationship Between Arthroplasty Surgeons' Experience Level and Optimal Cable Tensioning in the Fixation of Extended Trochanteric Osteotomy
Introduction: In this study, our aim was to examine the relationship between the arthroplasty surgeons' experience level and their aptitude to adjust the cable tension to the value recommended by the manufacturer when asked to provide fixation with cables in artificial bones that underwent extended trochanteric osteotomy (ETO). Materials and Methods: A custom-made cable tensioning device with a microvoltmeter was used to measure the tension values in Newtons (N). An ETO was performed on 4 artificial femur bones. Surgeons at various levels of experience attending the IXth National Arthroplasty Congress were asked to fix the osteotomized fragment using 1.7-mm cables and the tensioning device. The participants' demographic and experience data were investigated and recorded. The surgeons with different level of experience repeated the tensioning test 3 times and the average of these measurements were recorded. Results: In 19 (35.2%) of the 54 participants, the force applied to the cable was found to be greater than the 490.33 N (50 kg) value recommended by the manufacturer. No statistically significant difference was determined between the surgeon's years of experience, the number of cases, and the number of cables used and the tension applied over the recommended maximum value (P = .475, P = .312, and P = .691, respectively). Conclusions: No significant relationship was found between the arthroplasty surgeon's level of experience and the adjustment of the cable with the correct tension level. For this reason, we believe that the use of tensioning devices with calibrated tension gauges by orthopedic surgeons would help in reducing the number of complications that may occur due to the cable
Scheduling surgery after transarterial embolization: does timing make any difference to intraoperative blood loss for renal cell carcinoma bone metastases?
PURPOSEOur purpose is to clarify the optimal timing of surgery after transarterial embolization (TAE) for renal cell carcinoma (RCC) bone metastases.METHODSThis retrospective study included 41 patients with RCC bone metastases embolized between 2013 and 2019. Different-sized particulate and/or liquid embolic agents were used for TAE. Embolizations were categorized into groups 1–3 according to the interval between TAE and surgery (group 1: 3 days). Degree of embolization after TAE was graded visually based on angiographic images (90%). The relationship between the TAE–surgery interval and intraoperative blood loss (IBL) and the correlation between IBL and embolization grade were examined. Lesion sizes and the relationships among lesion localizations and contrast media usage, intervention time, and IBL were also analyzed.RESULTSForty-six pre-operative TAEs (single lesion at each session) were performed in this study (26 in group 1, 13 in group 2, 7 in group 3). Lesion sizes and distributions were similar between groups (p = 0.897); >75% devascularization was achieved in 40 (TAEs 86.96%), but the IBL showed no correlation with the embolization rate (r=0.032, p = 0.831). The TAE–surgery interval was 1–7 days. The median IBL in group 1 (750 mL; range, 150–3000 mL) was significantly lower than those in the other groups (p = 0.002). Contrast media usage (p = 0.482) and intervention times (p = 0.261) were similar for metastases at different localizations. IBL values after TAE were lower for extremity metastases (p = 0.003).CONCLUSIONBone metastases of RCC are well-vascularized, and to achieve lowest IBL values, surgery should preferably be performed <1 day after TAE
Trokanterik Osteotomi Sonrası Kablo Gerginliği Ne Kadar Sıkıyoruz Tork Kısıtlayıcı Gerekli mi
The natural course of serum D-Dimer, C-Reactive protein, and erythrocyte sedimentation rate levels after uneventful primary total joint arthroplasty
Background: This study aimed to assess the baseline levels of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and monitor the natural course of these serum markers after uneventful primary total joint arthroplasty.
Methods: This prospective study enrolled 81 patients undergoing primary total knee arthroplasty or total hip arthroplasty. The level of serum D-dimer, CRP, and ESR was measured preoperatively and on postoperative days 1, 3, 5, 15, and 45. Mean peak values, peak times, and distribution were compared between D-Dimer, CRP, and ESR.
Results: The mean preoperative serum D-dimer, CRP, and ESR level was 412 +/- 260 (range 200-980) ng/mL, 2.93 +/- 2.1 (range 1-18) mg/L, and 22.88 +/- 17.5 (range 3-102) mm/h, respectively. The highest mean peak for D-dimer, CRP, and ESR was at postoperative day 1, 3, and 5, respectively.
Conclusion: D-dimer levels reached peak levels on postoperative day 1 and then declined rapidly to a plateau level by postoperative day 3. A second, albeit small, peak in the level of D-dimer occurred on postoperative day 15. The level of CRP and ESR remained elevated for much longer with CRP returning to baseline on postoperative day 45 and the level of ESR had not returned back to normal on postoperative day 45