Open wedge high tibial osteotomy with sliding cancellous bone in distal fragment into the osteotomy gap; 2-year follow-up results

Open wedge high tibial osteotomy (OWHTO) has been performed by orthopedic surgeons without filling the osteotomy gap. However, the osteotomy space dimension and fixation methods suitable for this method are still controversial. We use the metaphyseal cancellous bone of tibia distal fragment; using a special technique to slide the cancellous bone into the osteotomy gap to provide better bone healing. This study was conducted to investigate the benefits of this method in terms of bone union. This was designed as a prospective randomized controlled study. There are 17 patients in each group. Patients with an osteotomy gap of only 12 mm were included in the study in preoperative planning. The Lysholm Knee Scoring Scale was used to assess the functional status of the patients. Hip Knee ankle (HKA) angle and tibial posterior slope angle were measured during preoperative and control visits. Bone healing was assessed by trabecular and cortical continuity on anteroposterior and lateral radiographs. Reduced pain and recovery of functions confirmed the union. The mean union time was 14.3 ± 4.7 (12-22) weeks in the control group and 13.1 ± 3.9 (11-18) weeks in the graft sliding group (P = 0.04). In the control group, the HKA angle was 10.8 ± 2.5 ° Varus preoperatively and 2.1 ± 1.4 ° valgus at second-year control visit. In the graft sliding group, preoperative HKA angel was found 11.3 ± 1.9 ° Varus and 2.7 ± 2.1 ° valgus at second-year control visit (p> 0.05). There was no statistically significant difference between the groups in terms of Lysholm Knee Scale scores at preoperative and postoperative second-year control visits. The sliding cancellous bone of the tibial distal fragment into the osteotomy gap provided earlier bone union than the control group. There was no difference in functional results between the groups in the two-year follow-up results of the patients. [Med-Science 2020; 9(3.000): 683-7

Clinical results of endoprosthetic reconstructions in metastatic and primary bone tumors

In this study, we aimed to compare the functional outcomes and survival of 38 patients with primary bone and metastatic bone tumors who were reconstructed with endoprosthesis. Thirty-eight patients who underwent endoprosthesis for malign bone tumors 2012- 2015 were included in the study. We retrospectively reviewed 38 patients, eight of whom underwent limb salvage with tumor resection prosthesis of tibia, 21 femur, and 9 humerus. When comparing functional outcomes, the revised Musculoskeletal Tumor Society (MSTS) scoring system was used for all surviving patients. The patients were evaluated in two groups as primary bone tumor and metastatic bone tumor. The mean follow-up period of 32 healthy and alive patients was 38 (12 to 98) months. While 12 patients were primary malign bone tumors, the other 26 patients had bone metastasis. All six patients who died during follow-up had a diagnosis of metastatic bone tumor. Periprosthetic infection was observed in two patients, recurrence tumor in one and prosthetic dislocation in one. It was found that the MSTS score in patients with primary bone tumors (22, 6) was statistically significantly higher than in patients with metastases (17, 6) (p [Med-Science 2022; 11(1.000): 199-203

Mid-term outcome of wide resection in musculoskeletal fibrosarcoma patients

The aim in this study, musculoskeletal system fibrosarcomas which are rare malignant soft tissue tumors that originate from fibroblasts, was to evaluate the mid-term outcome of patients that were diagnosed, treated and followed-up at our clinics. Methods: Included in the study were 12 patients treated for fibrosaecoma at our clinics between 2014 and 2017. The patients were evaluated in terms of age, location of tumor and time of resection, and were followed-up for mid-term recurrence. A wide resection was performed on all patients. Results: No recurrence was found in all but one patient during follow-up. Conclusions: Musculoskeletal system fibrosarcomas are rare but represent high mortality and morbidity risks since the diagnosis is commonly delayed. The most frequently seen symptom is a painless mass reaching large dimensions. Early diagnosis plays a major role in prognosis, as is the case with other malignant tumors. In conclusion, we suggest that malignancy should be considered in the presence of giant, fixed and painful tumors, and a wide resection should be applied. [Med-Science 2020; 9(1.000): 6-8

Percutaneous surgery using Admix NoKorTM Non-Coring 16 G needle in cases with trigger finger

In this study mid- and long-term outcomes of the cases with trigger finger we treated using Admix NoKorTM have been presented. Percutaneous release procedures were applied for 24 fingers of 22 (19 female, 3 male patients; mean age, 57; range, 39-72) patients between May 2009 and May 2011. Preoperatively US was performed so as to confirm the presence of trigger finger. Diameters of the tendons of the affected and intact hands measured using US, were compared so as to be able to demonstrate thickening of the tendon of the trigger finger. The patients were monitored for an average period of 25.2 (range, 14-36) months. During surgery, clinically loss of the catching sensation was observed. In two patients percutaneous trigger finger release failed, so we have to proceed with open surgery. During open surgery, we observed longitudinal wounds on the tendon. One patient developed unilateral radial digital nerve damage. Percutaneous release of the trigger finger using Admix NoKorTM 16-G gauge needle can be preferred in the treatment of trigger finger. Trigger finger of the first digit requires more attentive approach and one should be aware of the complications. If required open surgery can be preferred. [Med-Science 2017; 6(3.000): 551-6

Three-dimensional Spinal Deformity: Scoliosis [Uc Boyutlu Omurga Deformitesi: Skolyoz]

In human body, average of 33 separate vertebrae of the spinal column is sorted and connected to each other in a row. The primary task of this column is to support the head, chest and abdominal organs and form a stable and strong sheath to the spinal canal where the medulla spinal passes through. Spinal column of a new born baby is straight, but after the baby starts to hold his head, cervical lordosis is formed. After the baby starts to sit and stands up, thoracic kyphosis, lumbar lordosis and sacral kyphosis develops. Although, normal physiological curves of spine is normal, deviations from the front or rear view is considered pathological. Scoliosis is characterized as lateral deviation, the reduction in sagittal slope and axial rotation. Scoliosis can also be defined as the deviation of the normal vertical line, deviating more than 10 degrees, as seen in X-ray. All treatment methods used in the treatment of scoliosis aims to perform physically normal, balanced, painless and a stable backbone. Although, the treatment of Scolyosis is performed in several different ways, further studies are still being conducted. [Med-Science 2015; 4(1.000): 1796-808

An investigation of infection rate and seasonal effect level in total joint replacement cases

This study aims at evaluating gender, age range and seasonal differences in patients who developed articular infection after undergoing joint prosthesis in our clinic. This study is a retrospective screening of advanced articular arthrosis patients who had undergone total joint arthroplasty of the upper and lower extremities between 2009 and 2016. Of 504 patients who had been treated with total joint replacement, our study includes 468 patients we could follow up or contact by phone and who had been applied 559 primary or revision total knee arthroplasty. The mean age of these patients was 58.9 (ranging from 41 to 74). We detected infection in 22 (3.9%) total joint arthroplasty patients. Of these 14 (63.63%) were females and 8 (36.36) were males. There was no statistically significant difference between infection rates in terms of seasonal distribution nor gender or age range. In the light of our findings, we concluded that gender, age range and seasonal differences have no effect on infection rates in total joint replacement cases. [Med-Science 2018; 7(1.000): 210-213

The clinical and histopathological effects of perineural dexmedetomidine in combination with bupivacaine in sciatic nerve block in rabbits undergoing sevoflurane anesthesia

Many drugs or additives have been tried as adjuvants in the blocking of nerve blocks with local anesthetics, and it is aimed to increase the duration of action and analgesia quality of local anesthetics in this way. In this study, we aimed to see the adjuvant efficacy of Dexmedetomidine [Dex] added to bupivacaine and its effect on analgesia and histopathological effects in rabbits by administering sevoflurane anesthesia. Twenty-four rabbits were randomly allocated to 3 groups; Group S: sham [0.5 ml saline], Group B: perineural bupivacaine [0.5 mg/kg] [0.5 ml] and Group BD: perineural bupivacaine [0.5 mg/kg] combined with Dex [20 µr/kg] [0.5 ml]. Analgesia measurement was evaluated by hotplate test, the paw withdrawal response was performed for sensorial and motor blockades also were recorded at baseline, 30, 60, 90, and 120 min after drug administration. Dissected nerve tissue was also examined for histopathologic evaluation. In the hot-plate test applied for the measurement of acute thermal pain; when compared to Group S, significant prolongation was found in Group B and Group BD at 0, 30, 60, 90, and 120 minutes [p [Med-Science 2022; 11(2.000): 547-53

The effect of tramadole HCL and paracetamol on fracture healing in rat tibia model

In our research, we aim to study the effects of combined usage of tramadole HCl + paracetamol on rat tibia fracture model. In our study, 60 Wistar-Albino type male rats, weighted at 300-350 g., were divided as control and test ( tramadole HCl + paracetamol) groups Under general anesthesia, standard closed fractures were created on right tibias of all rats using blunt ended needle holder with three point principle and then closed reduction and fixing with intramedullary nail (0.7 mm) were provided. After fracture treatment of 30 rats in the test group, starting at the same day, 40mg/kg/day tramadole HCL was introduced as daily intermuscular dosage until they were sacrificed. Rats were sacrificed after the fractures as groups of 10 individuals at 2nd, 4th and 6th weeks. Healing fractured tibias were examined mechanically, radiologically, histopathologically. Results: No positive or negative radiological, biochemical and histological effect was detected after the long duration of tramadole HCL + paracetamol usage, starting from the first day and reaching to 6 weeks, in healing process of closed tibia fractures created and fixed with IM nails in rats. Considering the negative effects of NSAIDs on fracture healing, we think that tramadole HCl + paracetamol combination is a safe option in postoperative pain treatment after fracture. [Med-Science 2017; 6(1.000): 81-5

Clinical features and follow-up results of the patients with methicillin-resistant Staphylococcus aureus (MRSA) in orthopedic practice

Treatment of the infections caused by methicillin-resistant Staphylococcus aureus (MRSA) strains in orthopedic patients is a difficult and laborious process for both the patient and physician. Staphylococcus aureus(S. aureus) is one of the leading causes of community-acquired and nosocomial infections. In this study, we aimed to investigate the susceptibilityof the MRSA strainsisolated in orthopedic patients cultured for different reasons in our clinic to various antibiotics, and to evaluate clinical characteristics of the patients and factors affecting the prognosis. A total of 40 patients with MRSAisolated in our orthopedics clinic between December 2012 and November 2016 were retrospectively analyzed. Data including age, sex, comorbidities, previous surgeries, and previous antibiotic treatments were obtained from patients files and electronic information system. Of 40 patients, 60% were male, and 56% were over 60 years old. While 80% of the patients underwent an orthopedic surgery, 20% of them received no surgical intervention before the diagnosis. A total of 90% were in-patients, and the mean length of hospital stay was 22 days. The mean time from the date of hospitalization to the isolation of MRSA was 12 days. According to the consultation findings, in the clinical recovery process of the patients and in the treatment algorithm given to those patients, vancomycin and teicoplanin were found to be among the most important treatment options, in addition to significant debridement to be done, for MRSA strains. Our study results suggestthat, in addition to the surgical debridement, timely antibiotherapy is of utmost importance to reduce mortality and morbidity in MRSA-positive orthopedic patients. [Med-Science 2018; 7(1.000): 162-165

Airway management in patients with cleft lip and palate: Evaluation of intubation conditions with videolaryngoscopy

Cleft lip and palate are one of the most common congenital head and neck anomalies and are seen at a frequency of 11-15%. In this study we aimed to observe airway management and intubation conditions with videolaryngoscopy in patients with cleft lip and palate. 40 patients with cleft lip and palate (Group Y) and 40 normal patients (Group N) aged between 4 months and 10 years undergoing elective surgery were included in this prospective randomized study. Mallampati Classification (MMC), Cormack-Lehane Classification (CL-S), thyromental distance (TMM) and mouth opening were evaluated to predict difficult airway. Intubation times, number of intubation attempts, heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) and end-tidal CO2 (Et-C02) values were also recorded. Intubation times was significantly higher in Group Y than Group N. HR and MAP values measured in Group Y were found to be significantly higher than Group N at the 5th and 10th minutes (p [Med-Science 2021; 10(2.000): 520-3