Emre Yurdakul

Traumatic floating clavicle

We report a case of traumatic floating clavicula in a man aged 21 years. He was admitted to our emergency department with polytrauma sustained in a motor car accident, successfully treated 21 days after the accident with bipolar open reduction and wire stabilization.

Reducing Intra-articular Hemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction by the Administration of Intravenous Tranexamic Acid A Prospective, Randomized Controlled Trial

Background: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Hemarthrosis and pain adversely affect the functional outcomes of ACL reconstruction in the early postoperative period. Purpose: To evaluate the effects of administering tranexamic acid (TXA) to minimize knee joint hemarthrosis and associated pain. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 105 patients who underwent arthroscopic ACL reconstruction were enrolled in this prospective, randomized, double-blind study. The patients who were randomized to the TXA group (n = 53) received intravenous TXA; the control group (n = 52) did not receive TXA. The anesthetist, surgeon, observer, and patients were blinded to the study groups (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet, and an intravenous infusion of 10 mg/kg/h was continued for 3 hours after completion of the operation. In the control group, an equal volume of placebo was administered at the same rate and by the same route. The volume of drained blood was measured 24 hours postoperatively. Pain was evaluated using a visual analog scale (VAS) at a consistent time in the evening of postoperative day 3 and postoperative weeks 2 and 3. The Lysholm knee scoring scale was used to record patient satisfaction and knee function during postoperative weeks 2 and 4. Results: Significant differences were observed between the volume of fluid drained (60 mL [TXA group] vs 150 mL [control group]; P < .001) (between-group difference [95% CI], −90 [−114.15 to −65.85]) and hemarthrosis grade in postoperative weeks 1 and 2. In addition, the pain outcome improved in the TXA group after day 3 (VAS score, 1.4) compared with that in the control group (VAS score, 2.9) (P < .001) (95% CI, −1.51 to −0.49). The VAS scores of the TXA group at the end of weeks 2 and 3 were also significantly lower than those in the control group (P < .001) (95% CI, −2.00 to −1.00). The median Lysholm score at the end of week 2 was 70 (range, 40-85) in the control group and 75 (range, 50-90) in the TXA group; at the end of week 4, the score was 75 (range, 50-85) in the control group and 80 (range, 70-85) in the TXA group. A significant difference in the Lysholm score was observed between the 2 groups (P < .001) (95% CIs, 0.08-9.92 and 4.00-10.00 for weeks 2 and 4, respectively). Although range of motion was similar between the groups at the end of week 4, the mean was 107.36° ± 8.36° in the TXA group and 103.65° ± 7.68° in the control group on postoperative day 2 (P = .020) (95% CI, 0.60-6.81). The mean hemarthrosis values at the end of weeks 1 and 2 were significantly lower in the TXA group than in the control group (P < .001), and the need for aspiration in the TXA group during the early postoperative period was significantly lower than in the control group (P < .001). There were no infections in either group, and no patient developed deep venous thrombosis by postoperative day 3. Conclusion: The results of this prospective, randomized study show that TXA reduced the amount of postoperative hemarthrosis and decreased the need for aspiration of the knee after arthroscopic ACL reconstruction. Consequently, TXA reduced pain and improved range of motion of the knee in the early postoperative period without side effects.

Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients

Objectives Controversy exists regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients. Methods This study included 133 patients over 65 years of age admitted to our clinics from 2006 to 2012 for the surgical treatment of a displaced femoral neck fracture. All patients were treated via hemiarthroplasty. The patients (66 males, 67 females; mean age: 78.16 years; range: 60–110 years) were followed-up regularly. All patients were divided into one of two groups: group A was treated with cement; and group B without. Both groups were compared in terms of preoperative features (demographics and associated diseases), pre- and postoperative complications, mortality rates, pain and activity levels, and hip scores. Hospitalization time, average surgical duration, and time from fracture to operation were also recorded. Mean follow-up duration was 30.9 (range: 5–51) months. Results We found no significant between-groups differences in terms of length of hospital stay, Harris Hip Score, complications, or follow-up mortality rates. Walking ability and pain scores were better in the cemented group in the early follow-up period. Duration of surgery and perioperative mortality rates were somewhat lower in the cementless group, but the difference was not statistically significant. Conclusion The use of cement during hip hemiarthroplasty in patients over 65 years of age had no negative impact on mortality or morbidity. Hemodynamic changes during cement application are important, but it is noteworthy that patients fitted with cemented endoprostheses had increased levels of activity and lower pain levels.

Bilateral spontaneous atraumatic rupture of the Achilles tendon in an athlete

We report a case of spontaneous, bilateral Achilles rupture in a 33-year-old man with no specific risk factors. The rupture occurred after a heavy impact during a sports activity, and although the rupture was painful, he was able to mobilize slowly. After a clinical examination confirmed the diagnosis, ultrasonography and magnetic resonance imaging evaluation of the Achilles tendons revealed bilateral ruptures. The patient underwent bilateral conservative treatment and subsequently embarked on a comprehensive rehabilitation program with a good functional outcome at follow-up. The patients return to premorbid work and social life was uneventful. A spontaneous rupture in a patient without any predisposing risk factors is uncommon, and for it to occur bilaterally is notably rare.

Mobile- versus fixed-bearing total knee arthroplasty: a prospective randomized controlled trial featuring 6-10-year follow-up.

OBJECTIVE The purpose of this study was to compare long-term clinical and radiographic outcomes of mobile- (MB) and fixed-bearing (FB) total knee arthroplasties (TKA). METHODS A randomized controlled study was conducted to compare the clinical and radiographic outcomes of MB and FB prostheses in 93 consecutive patients who underwent primary TKA for knee osteoarthritis. Mean follow-up of the patients was 100.9 months in the MB group (range: 78-121 months) and 93.7 months (range: 78-120 months) in the FB group. The clinical results were graded according to the Knee Society Knee Score (KSKS) and the Knee Society Functional Score (KSFS). Secondary outcomes included pain, patellofemoral joint function, quality of life (QOL), and radiologic outcomes (Knee Societys roentgenographic evaluation system). RESULTS Although there was significant improvement in both groups, there were no significant differences between the groups with respect to mean KSFS and radiologic outcomes. However, mean pain score of the MB group was significantly higher than that of the FB group (48.83±0.62 vs 47.39±0.86, respectively, p=0.011), and mean KSKS was significantly higher than that of the FB group (93.5±6.2 vs 89.7±6.9, respectively, p=0.007). CONCLUSION TKA clinical results were satisfactory in both the MB and FB groups. KSKS and pain scores were significantly better in the MB than in the FB group. However, no differences were found in other assessments. Thus, we conclude that the best design is the one with which the surgeon is most comfortable and most able to implant reproducibly.

The treatment of eosinophilic granuloma of the humerus with nonvascularized fibular graft and elastic nail.

Eosinophilic granuloma is most common in children. In this paper we describe two children with a history of local swelling and pain in the humeral area who showed pathological fracture of the humerus. Needle biopsies confirmed the diagnosis of eosinophilic granuloma. Surgical procedures were performed in both patients. Both patients showed total remission after wide resection combined with segmental nonvascularized fibular graft and elastic nail. Both patients are currently free of disease after 4-year follow-up. There are several treatment modalities in eosinophilic granulomas such as radiotherapy, chemotherapy, local or systemic steroids, curettage, bone grafting and internal fixation. Although good results have been reported with nonsurgical treatment, surgery is a more effective treatment option in selected cases. In this paper we describe two children with massive solitary eosinophilic granuloma of the humerus who were successfully treated with segment resection and fibular bloc graft.