Vücut kitle indeksi ve yaralanma süresinin menisküs tamiri sonrası sonuçlara etkisi]

Aim: Our study was to assess the outcome of meniscal repair surgery with anterior cruciate ligament reconstruction, focusing in particular on meniscal healing. Material and Method: We analyzed whether the time elapsed between the injury and the surgery affected the activity scores as measured by the Tegner Activity Scale, Modified Lysholm Knee Scoring, and Barrett criteria. Similarly, we analyzed whether body mass index (BMI) affected the activity scores. Result: The average BMI of the patients was 23.99 +/- 3.64 kg/m2 (range: 19.9-34). BMI was graded as underweight (18.5 kg/m2 or less), normal weight (18.5 kg/m2 to 24.99 kg/m2), overweight (25 kg/m2 to 29.99 kg/m2), or obese (30 kg/m2 to 39.99 kg/m2). Patients were divided into two groups. Overweight and obese patients were included in one group, and patients of normal weight or underweight were included in the other group. Out of a total of 34 patients, 3 (8.8%) were underweight, 20 (58.8%) were normal weight, 9 (26.5%) were overweight, and 2 (5.9%) were obese. Based on the BMI there was no significant difference between the two groups for results of the Tegner Activity Scale, Modified Lysholm Knee Score, and Barrett criteria. BMI of the patients was not a risk factor for the post-operative score scale (P>0.05). There was no significant difference between the injury period (the time elapsed between the injury and the surgery) and activity scores (P>0.05). The injury period had no effect on the post-operative scores. Discussion: BMI of the patients and injury time of the meniscus tear had no negative effect on the functional results of the operation. Meniscal lesions with ACL tear should be repaired when diagnosed

Outcomes of diaphyseal femur fractures treated by long- and short-term traction methods in pre-school children

This study aimed to compare the effects of the traditional short- and long-term traction methods on the union and angulation of femoral fractures in pre-school children.Thirty-six patients aged 0–6 years, with diaphyseal femur fractures, who had undergone a conservative treatment, were included in the study. The patients were dividedinto two groups according to their traction times before the application of the hip spica cast: 0–10 days of traction (Group A) and 11–21 days of traction (Group B). Afterthe completion of the union and the removal of the casts, bone scans were performed and the angulations in the coronal and sagittal planes were comparatively evaluated,as well as the lengths of the lower extremities. The mean age of the patients was 4.2 ± 1.94 years. Hip spica casts were applied to 17 patients after short-term traction and19 patients after long-term traction. The mean length of hospital stays of the patients who were applied the hip spica casts after short-term and long-term tractions were 8.4and 19.3 days, respectively. A statistically significant difference was observed between groups A and B regarding hospital stay (p 0.05). Hip spica casting after short-term traction can be used as a safe alternative method in the treatment of diaphyseal femur fractures inpreschool children due to its adequate stability and shorter length of hospital stay

Mini External Fixator Assisted Metacarpal Lengthening With The Distraction Method

Phalangeal brachydactyly, which is caused by the abnormal development of the metacarpal, is characterized by shortness that can be seen in a single finger or in all fingers of the hands. Although brachydactyly is usually thought of as congenital, it can occur due to metabolic disorders or trauma. A twelve-year-old girl was admitted to our clinic with complaints of shortness in the fourth finger of the left hand. Osteotomy was applied with the drilling-osteotomy technique. The screws holding the upper and lower segments were adapted to the external fixator. Lengthening began one week after the osteotomy. The lengthening rate was organized as 0.25×2 mm/day. The amount of elongation was planned not to exceed 40% of the original bone length. Distraction was terminated after the planned elongation amount was reached, and the bone was allowed to heal. In patients under twenty years of age, the results from progressive distraction without bone grafting are close to perfect. Although the technique of successfully lengthening metacarpal fractures in children is simple, strict rules should not be ignored. Primarily, the external fixator and the distraction system should be sufficiently stable, lightweight, and should be appropriate for the size of a child’s hand

Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A Retrospective Cohort Study

WOS: 000375550000011PubMed: 26987514Introduction: Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT). Material method: Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 +/- 6, and 27.9 +/- 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60 degrees/sec, 240 degrees/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis. Result: There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p 0.05). Conclusion: Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved

Evaluation of the accuracy of Lachman and Anterior Drawer Tests with KT1000 in the follow-up of anterior cruciate ligament surgery

WOS: 000446917800017PubMed: 27656635Ligament laxity measurement is clinically valuable to diagnose the injury and also to compare the laxity before and after surgical procedure. The aim of the study was to compare the accuracy of the Lachman and Anterior Drawer Tests to evaluate the knee examination with the KT1000 arthrometer after the anterior cruciate ligament (ACL) surgery in early follow-up period. Fourty ACL reconstructed knees were examined with the Lachman and Anterior Drawer Tests, and KT1000 arthrometer with compariable intact knee of the same patients. Physical emanination findings were compared with the KT1000 arthrometer with each power. Spearman correlation and receiver operating characteristic (ROC) analysis were used for the evaluation of relations between parameters. Significance was evaluated in P<0.1 and P<0.05. The mean age was 28.18 +/- 6.21 yr, and the mean follow-up was 23.09 +/- 9.08 months. The mean KT1000 measurements of 40 operated knees state at 6.8, 9.1, 13.6 kg and maxium anterior displacement forces were 4.9, 6.7, 8.7, and 11.9 mm, respectively. The same values for the same acting forces of intact knees were 4.2, 5.9, 7.8, and 10.2, respectively. In Spearman's correlation and ROC analysis at 13.6-kg power on KT1000 arthrometer statistically matched with pyhsical examinations (P<0.1, P<0.01). In our study, correlation of physical examinations with KT1000 arthrometer is a worthy evaluation technique that can be added to examination of ACL reconstructed knee to control with inexperinced examiners' findings. We suggest that at 13.6-kg power with KT1000 arthrometer findings perfectly match the Lachman and Anterior Drawer Tests of the knee

Is anterior cruciate ligament surgery technique important in rehabilitation and activity scores?

WOS: 000446917300016PubMed: 27419120To compare the two different anterior cruciate ligament surgery techniques' effect in rehabilitation and activity performance. Fifty-five patients were evaluated. Twenty-seven patients with transtibial technique (TT), 28 with anatomic single-bundle technique (AT) included. Tegner Activity Scale (TAS) was performed at preoperation and follow-up. The returning time of the sport and work was evaluated at follow-up. Single-leg hop test was performed at follow-up. Outcomes were compared between the two groups. The determined length difference between the operated knee and the intact knee was compared between the two groups. Average age of TT and AT was 27.9 +/- 6.4 yr, 28.3 +/- 6 yr, respectively. There was a significant difference between the two groups in duration of returning to sport. 7 group had higher duration to return to sport (P 0.05). There was a significant difference between the two groups. 7 group had significantly higher values than AT group (P 0.05). The increase of TAS in patients who had AT was higher than the patients who had TT (P> 0.05). No difference in single-leg hop test at 55%-65%, 65%-75%, and 85%-95% level (P> 0.05). In this test at 75%-85% TT group had higher values than AT group (P< 0.05), AT group had higher values at 95%-105% level (P<0.05). Good short and long-term knee outcome scores depend on rehabilitation protocol after surgery. Surgery technique should provide the adequate stability in rehabilitation period. AT obtains better outcomes in rehabilitation

Isolated Carpal Dislocation Of The Trapezium

Trapezium fractures and dislocations of the trapezium are both extremely rare injuries whether they occured with or without fractures of the surrounding bones. Specific radiological images can be difficult to help for the diagnosis. CT scan may be necessary for the diagnosis and adequate treatment. We are presenting an unusual case of volar and radial isolated trapezium dislocation concomitant second metacarpal basis fracture in which is treated by using open reduction and Kirschner wire fixation. In our case, isolated dislocation of trapezium was a result of violent and direct trauma. Different techniques have been proposed to achieve a stable fixation and the treatment outcomes. In our case, open reduction, Kirschner wire fixation and intercarpal ligament repair through dorsal approach are recommended for satisfactory outcomes in similiar cases

Flexor tendon complications in comminuted distal radius fractures treated with anatomic volar rim locking plates

WOS: 000392918400014PubMed: 27836497Objective: Anatomic volar rim locking plates are designed with the aim of treating intraarticular distal radius fractures. When used to treat comminuted distal radius fractures, these plates can damage the flexor tendons. In this study, we sought to determine the radiological and functional results and rate of complications of these plates. Methods: We retrospectively reviewed the records of 36 patients (28 males, 8 females; mean age: 46.4 years) with AO/OTA Type C2-C3 distal radius fractures treated with anatomic volar rim distal radius plates between January 2011 and December 2014. Radial length, radial inclination and palmar tilt were compared with the intact wrist. Results were evaluated with the Mayo wrist and Lidstrom scores. Complications were documented throughout the follow-up period of 23.8 (range: 12 to 48) months. Results: Postoperative measurements of the radial length, inclination and palmar tilt did not differ significantly. Mayo wrist and Lidstrom scores were good and excellent in 27 and 32 patients, respectively. Flexor tenosynovitis was symptomatic in 15 patients and asymptomatic (localized swelling only) in 21. Plates were removed from 15 patients due to symptomatic tenosynovitis and from six patients due to partial rupture of the flexor pollicis longus tendon. The flexor digitorum profundus tendon of the second finger was also partially ruptured in three patients. Conclusion: Anatomic volar rim locking plates provide satisfying radiological and functional results in treating AO/OTA Type C2-C3 comminuted distal radius fractures. However, if these plates interfere with the union of the fracture, they should be removed to avoid potential tendon problems caused by their placement in the rim region. (C) 2016 Publishing services by Elsevier B.V. on behalf of Turkish Association of Orthopaedics and Traumatology

Ultrasonography or direct radiography? A comparison of two techniques to detect dorsal screw penetration after volar plate fixation

Abstract Background Complications related to extensor tendons have begun to increase with the use of volar plates in the treatment of distal radius fractures. In this study, we aimed to compare four-plane radiography and ultrasonography in the evaluation of dorsal cortex screw penetration following volar plate fixation. Methods We recruited 47 patients (33 males, 14 females, mean age 37.4 years; range 18–58 years). To evaluate dorsal screw penetration in all patients, we performed radiographs at 45° pronation, 45° supination and obtained dorsal tangential graphs at maximum palmar flexion, and a wrist lateral radiograph. Wrist ultrasonography was performed in all patients. Results Dorsal screw penetration was detected in 12 of the 47 patients undergoing VLP application. While there was > 2 mm screw penetration in seven patients, there was  2 mm was detected in seven patients and screw penetration < 2 mm was detected in two patients. On four-plane radiography, dorsal screw penetration was not detected in three out of five patients, who were shown to have < 2 mm screw penetration by ultrasonography. In addition to perioperative four-plane radiographs are also required to detect dorsal cortex penetration in patients undergoing VLP due to distal radius fracture. However, the detection of screw penetrations < 2 mm is more likely with ultrasonography compared to four-plane radiography. Conclusion We recommend that dorsal cortex screw penetration should be evaluated with perioperative ultrasonography. Trial registration Research Registry, researchregistry3344, Registered 10 January 201

Ultrasonic Evaluation of the Flexor Pollicis Longus Tendon Following Volar Plate Fixation for Distal Radius Fractures

WOS: 000372018800007PubMed: 26787412Purpose To evaluate with ultrasound the thickness of the flexor pollicis longus (FPL) tendon and its relationship to the volar locking plate after the fixation of distal radius fractures. Methods We evaluated 27 type C2 and C3 distal radius fractures with ultrasound to evaluate damage to the FPL tendon after volar plate fixation. The thickness of the FPL tendon and its distance to the volar plate in the involved wrists and to the volar rim in the contralateral uninjured wrist were measured on sonograms taken 12 months postoperatively. Measurements of the involved wrists were compared with those of the intact wrists. Results The mean plate-tendon distance in the involved wrist was considerably shorter than the mean volar rim-tendon distance in the intact wrist, and the FPL tendon was considerably thicker in the involved wrist than in the intact wrist. Conclusions In distal radial fractures treated with volar locking plates, increases in the thickness of the FPL tendon and a consequent decrease in the distance between the tendon and the plate can be determined with ultrasonography. This finding is a warning that asymptomatic tenosynovitis may eventually cause tendon ruptures. (Copyright (C) 2016 by the American Society for Surgery of the Hand. All rights reserved.