Upper extremity acute compartment syndrome during tissue plasminogen activator therapy for pulmonary embolism in a morbidly obese patient

AbstractIntroductionDeep vein thrombosis (DVT) and pulmonary embolism (PE) are more frequently observed in morbidly obese patients. Tissue plasminogen activator (tPA) is a thrombolytic agent which dissolves the thrombus more rapidly than conventional heparin therapy and reduces the mortality and morbidity rates associated with PE. Compartment syndrome is a well-known and documented complication of thrombolytic treatment. In awake, oriented and cooperative patients, the diagnosis of compartment syndrome is made based on clinical findings including swelling, tautness, irrational and continuous pain, altered sensation, and severe pain due to passive stretching. These clinical findings may not be able to be adequately assessed in unconscious patients.Presentation of caseIn this case report, we present compartment syndrome observed, for which fasciotomy was performed on the upper right extremity of a 46-year old morbidly obese, conscious female patient who was receiving tPA due to a massive pulmonary embolism.DiscussionCompartment syndrome had occurred due to the damage caused by the repeated unsuccessful catheterisation attempts to the brachial artery and the accompanying tPA treatment. Thus, the bleeding that occurred in the volar compartment of the forearm and the anterior compartment of the arm led to acute compartment syndrome (ACS). After relaxation was brought about in the volar compartment of the forearm and the anterior compartment of the arm, the circulation in the limb was restored.ConclusionAs soon as the diagnosis of compartment syndrome is made, an emergency fasciotomy should be performed. Close follow-up is required to avoid wound healing problems after the fasciotomy

Anterior glenohumeral instability: Classification of pathologies of anteroinferior labroligamentous structures using MR arthrography

We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients’ instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI

Concomitantly intra-articular fracture of proximal condylar second and third proximal phalanges: A rare case report

AbstractIntroductionA rare case of proximal phalange fractures has been presented in this study.Presentation of caseA 29-year-old male patient from Turkey was admitted to the orthopedics and traumatology clinic with a complaint of left hand pain, which had persisted for 10days. He described a rotational trauma that had occurred right after hitting his hand on the wheel of a car as a result of an in-car traffic accident 10days ago. Radiological work-ups were requested. In the anteroposterior (AP) graph of the case in which the fracture line could not be observed in the oblique graph, unicondylar fractures in the proximal section of the second and third proximal phalanges have been observed. Surgical treatment was not planned because 10days had passed since the trauma. In the control graphs taken after 3 weeks, healing at the fracture site was observed, and he was referred to physiotherapy after the removal of the splint. A good result was observed after physiotherapy.DiscussionBecause of the extension of tendons is important over the bone, the goal of the treatment is not only to heal the fracture, but also to preserve the sliding mechanism of these tendons. Regarding to lack of soft tissue trauma, favored joint movements after the healing of the fracture can be achieved more easily with conservative treatment; however, the fracture must be closely followed up.ConclusionCondylar fractures of proximal phalanges those nondisplaced can be conservatively treated with closed methods

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

A New Anatomical Plate for Extra-Articular Distal Humeral Fractures: Biomechanical Study

Introduction: We compared the mechanical properties of two fixation techniques for the treatment of extra-articular distal third humeral fractures. Materials and Methods: Two groups were created from twenty-four humeri. Group 1 was instrumented using a new, precontoured, 8-hole (3.5-mm-diameter) locking compression plate (LCP) placed anterolaterally. Group 2 was instrumented using an 8-hole (3.5-mm-diameter) precontoured posterolateral LCP plate placed on the distal humerus. Four-point bending tests and torsion tests were performed until the specimens broke. Results: The four-point bending stiffness test showed that the stiffness of anterolaterally fixed humeri was significantly higher than that of posterolaterally fixed humeri (p0.05). Conclusions: The anterolateral plate exhibited higher bending stiffness and torsional yield strength than the posterolateral plate. Anterolateral plate fixation can thus be used to manage extra-articular distal humeral fractures. Multiaxial locking screws ensure rigid fixation, allow early elbow motion without olecranon fossa impingement, and prevent iatrogenic injury of the triceps muscle. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment

Relationship between Coronal Alignment and Posterior Tibial Slope in the Lower Extremity

Abstract Purpose: To restore the normal axial alignment of the lower extremity is important in reconstructive knee surgery. The aim of this study was to evaluate lower-limb alignment and posterior tibial slope. Methods: Thirty-two male and 32 female outpatients aged 22 to 46 were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb was obtained for each subject. The axial alignment was measured based on the centers of the femoral head, knee, and ankle. The tibiofemoral (TF), tibial joint (TJ), and posterior tibial slope (TS) angles were determined. Results: The mean TF angle was more varus in women (177.8˚) than men (179.2˚), and the mean TJ angle was more medially inclined in women than men. Women had a greater TJ angle than men (93.3˚ vs. 91.6˚). The mean posterior TS was greater in men than women (16.0˚ vs. 12.5˚, p &lt; 0.05), while the mean TS angle was greater in women (14.8˚) than men (12.3˚). Conclusion: Knee alignment and geometry vary among populations. In our study, the TF angle was varus among all participants. The knee joint was more medially inclined in women than men. And also the posterior TS was greater in women than men

Fungal diversity and ex vitro symbiotic germination of Serapias vomeracea (Orchidaceae)

Conservation of orchids can be possible with effective seed germination and seedling growth methods. In this context, ex vitro symbiotic seed germination and seedling growth of orchid seeds may be convenient and advantageous. In this study, both the diversity of the root endophytic fungi in Serapias vomeracea (Burm.f.) Briq. and the ex vitro effects of these fungi on seed germination, seedling development and tuber formation were revealed. The fungi were isolated monthly for two years from S. vomeracea roots and the isolates were identified based on morphological characters and internal transcribed spacer (ITS) region of nuclear ribosomal DNA (rDNA) sequences. All of the Rhizoctonia-like isolates that joined the mycorrhizal association were closely related to Tulasnella calospora (thirty isolates). Non-Rhizoctonia isolates are closely related to Fusarium tricinctum (two isolates), Aspergillus spelaeus (one isolate) and Talaromyces pinophilus (Pezizales) (one isolate). The viability rate of the seeds was 90.32%. The seed packs were placed in soils containing fungus and the germination process was followed. All isolates associated with Tulasnella calospora promoted germination and seedling development. Isolate Svl 21 (Tulasnella sp.) was found to have the highest germination rate (98%) but isolate Svl 4 developed seedlings with advanced leaves (stage 4 (S4): seedlings with advanced leaves and/or rooted, 13.67%). All seedlings at S4 were transferred to the natural environment; the first tubers were observed seven months after. In this study, for the first time, a tuberous European orchid, S. vomeracea developed from seed to adult plant in a natural environment

Graft position in arthroscopic anterior cruciate ligament reconstruction: Anteromedial versus transtibial technique

Introduction: When treating anterior cruciate ligament (ACL) injuries, the position of the ACL graft plays a key role in regaining postoperative knee function and physiologic kinematics. In this study, we aimed to compare graft angle, graft position in tibial tunnel, and tibial and femoral tunnel positions in patients operated with anteromedial (AM) and transtibial (TT) methods to those of contralateral healthy knees. Materials and methods: Forty-eight patients who underwent arthroscopic ACL reconstruction with ipsilateral hamstring tendon autograft were included. Of these, 23 and 25 were treated by AM and TT techniques, respectively. MRI was performed at 18.4 and 19.7 months postoperatively in AM and TT groups. Graft angles, graft positions in the tibial tunnel and alignment of tibial and femoral tunnels were noted and compared in these two groups. The sagittal graft insertion tibia midpoint distance (SGON) has been used for evaluation of graft position in tunnel. Results: Sagittal ACL graft angles in operated and healthy knees of AM patients were 57.78° and 46.80° (p  0.05). Conclusions: Precise reconstruction on sagittal plane cannot be obtained with either AM or TT technique. However, AM technique is superior to TT technique in terms of anatomical graft positioning. Posterior-placed grafts in tibial tunnel prevent ACL reconstruction, although tibial tunnel is drilled on sagittal plane