Ercan Şahin

Effect of Topical and Intravenously Applied Tranexamic Acid Compared to Control Group on Bleeding in Primary Unilateral Total Knee Arthroplasty

&NA; We aimed to answer the following three questions in this study: (1) Does tranexamic acid (TA) reduce the amount of bleeding in total knee arthroplasty (TKA)? (2) Does TA reduce requirement for blood transfusion? (3) Is there any difference on reliability and efficacy between topical and intravenous (IV) applications of TA? Patients were allocated into three groups randomly by a software program as topical, IV, and control group. TA was applied as 20 mg/kg to the IV group and as 3 g/100 mL saline to the topical group. The hemoglobin values were recorded preoperatively and postoperatively on the same day and on day 1 and day 2. Removal of the drain postoperatively and length of hospital stay, as well as any complications such as pulmonary embolism or deep venous thrombosis, were also noted. The study comprised 40 patients in the IV group, 42 in the topical group, and 41 in the control group. The drain output values were similar in the IV and topical groups (p = 0.161), while those of the control group were significantly higher than both the IV and topical groups (p < 0.001 and < 0.001). Transfusion was applied to 19.5% of cases in the control group, 4.8% in the topical group, and 5.1% of the IV group (χ2 = 6.522; p = 0.038). The results of the study showed that 20 mg/kg single‐dose IV bolus or 3 g topical TA application reduced blood loss and transfusion requirement without increasing the rate of thromboembolic complications in unilateral primary TKA.

Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures

BACKGROUND The aim of this study was toreport our experience regarding the use of three different methods for intramedullary nailing in the treatment of intertrochanteric fractures. METHODS Patients with A2 and A3 type fractures operated on for unstable trochanteric fractures were included into this retrospective cohort study. Patients were divided into three groups based on the technique used; Talon distal fix nail/lag screw (n=78; mean age, 78.5±6.6), PFNA nail (n=96; mean age, 77.2±6.8) or InterTan nails (n=102; mean age, 76.8±6.7). Harris hip scores were recorded at the last outpatient visit and survival information was obtained by phone interview and civil registry database. RESULTS Baseline characteristics were similar among groups. Operation time, fluoroscopy time and blood loss were significantly higher in InterTan group. Screw cut-out occurred in eight patients in PFNA group. In-hospital mortality occurred in nine (3.2%) patients. Length of hospital stay and postoperative tip-apex distance was not different among groups. At follow-up, healing time and Harris hip scores were also similar among groups. One-year survival rate was 83.1±4.5% in Talon distal fix nail/lag screw, 84.0±3.8% in PFNA group and 84.4±3.7% in InterTan group (p=0.33). CONCLUSION New Talon distal fix nail/lag screw was associated with lower cut-out rates than PFNA and shorter operative times than InterTan. Further study is warranted to clearly establish the potential advantages of Talon distal fix over any other technique described herein.

Traction table versus manual traction in the intramedullary nailing of unstable intertrochanteric fractures: A prospective randomized trial.

INTRODUCTION The purpose of this prospective randomized study was to compare traction table with manual traction for the reduction and nailing of unstable intertrochanteric femur fractures. DESIGN Prospective, randomized, two-center trial. MATERIALS AND METHODS 72 elderly patients with AO/OTA 31A2 and 31A3 proximal femur fractures were randomized to undergo surgery with either manual traction (MT) or traction table (TT) facilitated intramedullary nailing. The demographics and fracture characteristics, duration of preparation and surgery, total anaesthesia time, fluoroscopy time, blood loss, number of assistants, early post-operative radiological evaluations and 6th month functional and radiological outcomes were evaluated. Data of 64 patients attending 6th month follow-up examination were evaluated statistically. RESULTS No significant differences were observed between groups regarding demographics and fracture characteristics. In the manual traction group, there was a significant time gain in respect of the positioning and preparation period (18.0±1.6min in MT group, 29.0±2.4min in TT group) (p<0.05). In terms of total anaesthesia time (Preparation+surgery) approximately 6min of difference was observed in favor of MT group (72.8±14.0min for MT and 78.6±6.5min for TT, [p<0.05]). Median number of assistants needed was significantly lower in TT group (2 assistants [1-3]) in MT group and (1 assistant [1,2]) in TT group [p<0.05]). There was no significant difference between two groups regarding other surgical and outcome parameters. CONCLUSIONS Manual traction reduced the preparation time and total anaesthesia duration, despite an increase in number of surgical assistant. LEVEL OF EVIDENCE Level II.

Parosteal lipoma as a rare cause of peripheral neuropathy and local irritation: A report of 12 cases

Objective The aim of this study was to evaluate the clinical features and functional results of patients with parosteal lipomas. Methods A total of 12 patients (8 females and 4 males; mean age: 45 (10–62) years) with parosteal lipomas who were treated between April 1986 and April 2014, were included into the study. The medical records of the patients were reviewed to analyze the clinical features and functional results of the patients. Results Of the 12 lipomas, 5 were localized in the proximal arm, 4 in the forearm, 1 in the distal arm, 1 in the distal thigh and 1 in the distal tibia. All patients presented with a progressive, slow-growing mass that was associated with thumb extension weakness in 1 case, and brachialgia-like symptoms in 1 case. Plain radiographs showed a juxtacortical mass in all cases and irregular ossification in 3 cases. In all cases, marginal excision was performed and no clinical recurrence was observed after a mean follow-up of 16 months. Conclusion Parosteal lipomas are uncommon tumors that can be diagnosed with their characteristic radiological features. Parosteal lipomas occurring in the proximal radius may easily cause paralysis of the posterior interosseous nerve or muscle weakness. Level of Evidence Level IV, Therapeutic study

Gluteal compartment syndrome secondary to superior gluteal artery injury following pelvis fracture: A case report and review of literature

Acute gluteal artery syndrome secondary to superior gluteal artery injury following pelvic fracture is a rare entity with potential for significant morbidity and mortality. In this report we present such a case resulting with a favorable outcome with prompt diagnosis and appropriate treatment.

Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries

OBJECTIVE The aim of this study is to report our institutions experience regarding the use of open tibial inlay technique in patients undergoing single-stage combined posterior cruciate ligament (PCL) reconstruction. METHODS Records of 17 patients who underwent PCL reconstruction with tibial inlay technique were retrospectively reviewed. Patients with ipsilateral femoral or tibial osteochondral avulsion fractures or ipsilateral concomitant tibia and femur shaft fractures were excluded. Out of these 17 patients, six cases underwent anterior cruciate ligament (ACL) + PCL reconstruction, nine cases underwent ACL+ PCL + posterolateral corner reconstruction, one case underwent ACL + PCL + MCL reconstruction and one case underwent ACL+ PCL + posterolateral corner + MCL reconstruction. Mean follow-up was 14.27±6.77 (range: 6-30) months. RESULTS In preoperative assessments, all patients had 3+ posterior laxity in posterior drawer test; at final follow-up, 6 patients had 0 laxity, 7 patients had 1+ laxity, and 4 patients had 2+ laxity (p<0.001). International Knee Documentation Committee (IKDC) objective evaluation showed severe disability in all patients preoperatively, whereas 5 knees were grade A, 8 knees were grade B, 3 knees were grade C, and 1 knee was grade D at final follow-up. Mean IKDC subjective score was 75.22±7.53 at final follow-up. Postoperatively, mean side-to-side difference in KT-1000 arthrometer measurement was 2.45±1.80 mm. At final follow-up, mean range of motion (ROM) was 0º on extension and 123.56±6.31º on flexion. CONCLUSION Open tibial inlay approach is beneficial during PCL reconstruction. Further study is warranted to establish its effectiveness on functional outcomes and prevention of complications.

Effect of intramuscular botulinum toxin-A in a rat rotator cuff repair model: an experimental study.

OBJECTIVE Rotator cuff repair is associated with multiple complications, significant morbidity, and reintervention, which could be mitigated by postoperative chemodeneveration with botulinum toxin-A (BTX-A). This study evaluated the antinociceptive and paralytic effects of BTX-A on an experimental supraspinatus repair rat model and its effect on functional outcomes (running performance). METHODS Thirty rats were grouped into the surgical repair group (group A), repair + intramuscular BTX-A group (group B), or control group (group C). At the end of the 3-month follow-up, running performance of the rats on a motorized treadmill was evaluated in four time periods (0-30 min, 30-60 min, 60-90 min, and 90-110 min), and penalty points (i.e., number of shock stimuli per lane) were recorded. Afterwards, the supraspinatus muscles were removed and evaluated histologically. RESULTS Regarding running performance, group B received significantly fewer penalty points than did group A (p<0.05). The penalty points received were not significantly different between groups B and C in the first three time periods, but were significantly higher in group B at the 90-110-min interval than in group C. On necropsy, all repaired tendons were intact, with no sign of failure at the repair site. Histological evaluation revealed marked degeneration and necrosis of muscles in both repair groups, which was much less evident in group B. Groups A and B had less fatty infiltration than group C. CONCLUSION BTX-A injections resulted in a better function based on running performance, probably due to decreased tissue tension at the repair site and less pain. Further studies on humans are needed to demonstrate this effect clinically.

Results of anterior and posterior capsular approaches in bipolar hemiarthroplasty patients with femoral neck fractures

BACKGROUND We evaluated the functional status and postoperative complications of bipolar hemiarthroplasty patients with femoral neck fractures, which we operated using anterior and posterior approaches. MEHTOHDS Between November 2007 and February 2011, 224 patients were evaluated according to their surgical exposure type in two groups. The first group, which was approached anteriorly to the joint capsule, included 92 patients, and the second group, approached posteriorly, included 132 patients. The mean follow-up period for group 1 was 16.4 months and for group 2 was 18.9 months. RESULTS Harris hip score of group 1 was 81.7 and of group 2 was 79.2. In group 1, 19 patients had very good, 52 patients good, 15 patients moderate, and 6 patients insufficient results. In group 2, 29 patients had very good, 74 patients good, 21 patients moderate, and 8 patients insufficient results. Although we had higher hip dislocation and infection rates in group 2, there were no statistical differences between the two groups. DISCUSSION Surgical exposure type does not affect functional outcome in bipolar hip arthroplasty patients. Although statistically insignificant, we had higher hip dislocation and infection rates using the posterior approach in the selected femoral neck fracture patients. An anterior approach to the joint capsule appears to be more reliable.

Satoyoshi Sendromu’na sekonder edinilmiş patellar instabilite ve distal femoral epfizyoliz

Satoyoshi sendromu, postnatal baslangicli nadir gorulen multisitemik tutulumu olan bir noromuskuler hastaliktir. Agrili kas spazmlari ile karakterize bu sendromda, kas spazmlarina sekonder ortopedik bozukluklar gozlenebilmektedir. Bu olgu sunumunda, Satoyoshi sendromu tanisi olan 12 yasinda kiz olguda gozlenen distal femur buyume plaginda meydana gelen degisiklikler ve buna sekonder gelisen patellar instabilite durumu ozetlenmektedir.

Comparison of two closed surgical techniques at isolated pediatric radial neck fractures

INTRODUCTION This paper aims to compare the clinical and radiological results of children operated using elastic stable intramedullary nailing as described by Métaizeau to those with the closed reduction and percutaneous pinning (CRPP). METHODS Results of 21 pediatric patients with radial neck fracture who were treated by two pediatric surgeons between January 2011 and December 2013 were reviewed retrospectively. 10 were treated with the Métaizeau method versus 11 with the CRPP. Operation time, fluoroscopic exposure time, Mayo elbow performance score (MEPS) and radiological assessment at final follow-up 1 year or greater and complications were main outcome measures. RESULTS The MEPS were excellent in all the patients of both groups. Reduction quality was excellent in 8 patients and good in 2 of the Métaizeau, and excellent in 9 and good in 2 of the CRPP. The fluoroscopy and operating times were statistically significantly greater, 3-fold and 2-fold respectively, in the Métaizeau method compared to the CRPP with comparable functional and radiological results. CONCLUSION Surgeon should adhere to a closed surgical method of his/her experience for excellent result. LEVEL OF EVIDENCE Therapeutic Level III.