COMPARISON OF ANALGESIC EFFECTS OF SINGLE DOSE AND DIVIDED DOSES INTRAARTICULAR BUPIVACAINE, FENTANYL AND PREDNISOLONE ADMINISTRATION IN ARTHROSCOPIC KNEE SURGERY

Objective: We aimed to compare the perioperative hemodynamic and postoperative analgesic effects of i.a. administration of single dose and in two separate doses of bupivacaine+fentanyl+prednisolone combination through a catheter for supplying an effective postoperative analgesia after arthroscopic knee surgery and to help early mobilization

Mid-term functional results of surgically treated acetabulum fractures

The aim of the study was to evaluate the type of trauma, additional injury, age, additional diseases, need for ICU and blood transfusion, postoperative complications, mid-term patient satisfaction and hip functions of the patients who underwent surgical treatment for acetabulum fracture in our clinic. A total of 17 patients (15 males, 2 females, mean age 40,7 years ) who admitted to the emergency department between 2013 and 2016, and treated surgically due to acetabulum fractures were included in the study. According to Judet Letournel classification, 7 anterior wall fractures, 4 anterior column fractures, 3 posterior column fractures and 3 both column fractures were determined. Mean hospital stay was 14.5 days (range 3-45 days) and mean follow-up was 26 months (14 to 57 months). ICU needed in 3 (17.6%) cases, mean stay was 10.3 days (range 1-29 days). 6 (35.2%) patients required blood transfusion, mean amount was 4.1 units (range 2-6 units). Harris hip scores were excellent - good in 12 cases (70.5%) and 5 cases (29.5%) had moderate - poor results at 12th month. There was no statistically significant relationship between severity of trauma, type of injury, age, additional diseases, intensive care and blood transfusion requirements, postoperative complications and patient satisfaction (p> 0.05). In selected acetabular fracture cases with proper planning according to fracture type, in early period, surgery may lead to satisfactory results in terms of patient satisfaction and hip functions. [Med-Science 2018; 7(3.000): 668-71

Is the proximal femoral nail a favourable option for trochanteric femur fractures in osteopenic elderly patients?

Primary aim of this study to evaluate the functional results and complications of the patients aged 70 and over whom are treated with proximal femoral nail (PFN) because of hip fracture. 128 patients out of 223 patients were included in the study, who were aged 70 and over, to whom treated with proximal femoral nail because of hip fracture in our clinic between 2006 and 2014. Since 26 of these 128 patients who were included in this study passed away before the follow up period of 1 year, they were excluded from the study. Fractures were evaluated by AO/OTA classification. Their Singh index and morphological cortical indexes were calculated from the pre-surgery radiographies. The functional situations of the patients were evaluated by Harris hip score. Average age of the evaluated 102 patients was 81.13 (70-98), 44 of them were male, 58 of them were female. According to AO/OTA fracture classification 48 of them were 31-A1, 25 of them were 31-A2, 29 of them were 31-A3. 54 fractures were on the left hip, 48 fractures were on the right hip. Average Singh index was 2.72 (1-5), average morphological cortical index was 2.94 (2.1-3.7), average Harris hip score was 74.3 (49-88). 4 patients have had complications after surgery and revised with other treatment modalities. Since the functional results are on a satisfactory level, in our opinion as well, proximal femoral nail should be considered among the surgical treatments in the elderly patients with hip fracture. [Med-Science 2023; 12(2.000): 378-82

Fluoroscopy improves femoral stem placement in cementless total hip arthroplasty

Fluoroscopy is routinely used in trauma cases to evaluate alignment and reduction quality. Because conventional templating has a high mismatch rate, we sought to explore whether we could use intraoperative fluoroscopy while implanting the femoral stem. Sixty patients with Croft 3-4 coxarthrosis were included in this study. No preoperative templating was performed in either of the two groups. The final conformations of the stem sizes and positions were achieved freehand intraoperatively using anatomic landmarks. In the second group, after surgeons intraoperatively agreed on the final stem size, C-arm fluoroscopy images are obtained with the last rasp size before the stem implantation. The alignment of femoral stem according to the femoral canal, the lower leg discrepancy (LLD) and the lateral offsets were evaluated with X ray. The stem/endosteal areas at 2 cm above the trochanter minor (T+2) and 2 cm below the trochanter minor (T-2) and the deviation of the stem tip from the center of the femoral canal were evaluated in CT images. The stems that were implanted under fluoroscopic control filled the medullary cavity better at both the T+2 and T-2 levels. On fluoroscopy, in the control group, the malpositioning of the femoral stems were less, the centralizations were better, and the restorations of the lateral offset and LLD were more accurate. The use of fluoroscopy while rasping the femoral canal leads to proper alignment and press fitting of the stem and provides the opportunity to intraoperatively correct malpositionings of the stem. [Med-Science 2017; 6(2.000): 264-9

Effects of simple section of transverse carpal ligament on intercarpal stability in carpal tunnel surgery

The aim was to evaluate effects of simple section of transverse carpal ligament on intercarpal stability by radiological parameters in patients with carpal tunnel syndrome those are refractory to conservative treatment. Patients with suspected diagnosis of carpal tunnel syndrome upon medical history and physical examination underwent neurodiagnostic tests (EMG). All 47 subjects, comprising 39 female and 8 male patients, were operated, followed, and assessed by the same surgical team between January 2014 and May 2015 after written informed consent was obtained. Wrist range of motion and general physical examination findings were recorded at both preoperatively and postoperative week 8. Besides, conventional MRI were obtained at the same time points. Trapeziohamate distance, scaphopisiform distance, scapholunate angle, and carpal angle were measured preoperatively and at 12thweek postoperatively. The mean age of the subjects was 49(range: 36-65).Mean preoperative trapeziohamate distance was measured as 25.2 mm (range:20-33), while postoperative trapeziohamate distance was 26.4 mm (range:22-34), (p=0.031). Mean preoperative scaphopisiform distance was 32 mm (range:23-34), as compared to postoperative scaphopisiform distance being 33.6 mm (range:24- 36) (p=0.001). While mean scapholunate angle was 44°(range: 36-60) preoperatively, it was measured as 45.1° (range: 33-60) in the postoperative period (p=0.001). Both preoperative and postoperative mean carpal angles was 127° (range 118-134 and 119-134, respectively). Simple section of transverse carpal ligament is associated with a significant increase in carpal arch distance. We consider that whether or not increases in intercarpal distances may lead to a degenerative process at the wrist in future warrants further research. [Med-Science 2017; 6(3.000): 410-4

Lower numbers of mechanoreceptors in the posterior cruciate ligament and anterior capsule of the osteoarthritic knees

WOS: 000411176000022PubMed ID: 27338958Impaired proprioception accuracy of the knee has been proposed as a local factor in the onset and progression of knee osteoarthritis. Patients with decreased numbers of mechanoreceptors could be more likely to develop arthrosis due to a loss in proprioception of the joint. We aimed to identify and quantify the mechanoreceptors of the posterior cruciate ligament (PCL), the anterior capsule (AC) and the medial meniscocapsular junction (MCJ) in knee arthrosis. PCLs, ACs and MCJs were harvested from 30 patients with Kellgren and Lawrence grades 3 and 4 osteoarthritis (OA), and ten knees taken from five cadavers without OA were used as a control group. PCL degeneration was evaluated with haematoxylin & eosin, and the types and numbers of mechanoreceptors were evaluated using S100 immunostaining. The patient ages in the OA and control groups (n.s.) did not differ. PCL degeneration was more severe in the gonarthrosis group than in the control group (p = 0.04). The numbers of Golgi corpuscles, Ruffini corpuscles, free nerve endings, total nerve endings and small vessels of the PCL were low in the OA group, as were the numbers of Golgi corpuscles, free nerve endings and total nerve endings of the AC. No significant correlation was found regarding the mechanoreceptors of the MCJ between the two groups. The numbers of mechanoreceptors in patients with OA were low in the PCLs and ACs. A loss in proprioception could be a local risk factor in OA. The proprioceptive impact of preserving PCL while performing total knee arthroplasty may not be exaggerated as its thought. Prognostic study, Level I

Risk factors for mortality in delayed intertrochanteric fractures

We aimed to figured out the risk factors of one year mortality in intertrochanteric hip fractures with delayed operation more than 72 hours. 96 out of 226 patients with proximal femoral fracture included in this study. Hemogram, blood urine nitrogen (BUN), creatinine, sodium, potassium and serum albumin levels are recorded from their blood test at administration of hospital. Time to theatre and postoperative needs for intensive care are recorded. Mobility functions before fracture and after 3 months of operation are assessed by mobility part of Barthel index. Multiple logistic regression analysis was performed to estimate the simultaneous effects of important covariates. In univariate model, age(p=0.0027), ASA(p=0.00), loss of mobility(p=0.00), bone union time(p=0.001), blood transfusion(p=0.026), albumin(p=0.004) and mobility after operation (p=0.001) were associated with mortality but in the final model for multivariate regression analysis loss of mobility level (p=0.001) and bone union time (p=0.02) were found to be independent risk factors of mortality. In postoperative period mobilization is the most important variable that we could changed in intertrochanteric fractures to decrease mortality. Whatever the timing of operation, gaining the mobility as soon as possible should be the goal of our treatment. [Med-Science 2017; 6(3.000): 521-5