Mehmet Armangil

Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference?

Purpose. The use of uncemented unicompartmental knee prostheses has recently increased. However, few studies on the outcomes of uncemented unicompartmental knee prostheses have been performed. The purpose of this study was to compare the outcomes of cemented and uncemented Oxford unicompartmental knee arthroplasty. Materials and Methods. This retrospective observational study evaluated the clinical and radiological outcomes of 263 medial Oxford unicompartmental prostheses (141 cemented, 122 uncemented) implanted in 235 patients. The mean follow-up was 42 months in the cemented group and 30 months in the uncemented group. Results. At the last follow-up, there were no significant differences in the clinical results or survival rates between the two groups. However, the operation time in the uncemented unicompartmental knee arthroplasty group was shorter than that in the cemented unicompartmental knee arthroplasty group. In addition, the cost of uncemented arthroplasty was greater. Conclusion. Despite the successful midterm results in the uncemented unicompartmental knee arthroplasty group, a longer follow-up period is required to determine the best fixation mode.

Arthroscopic stabilization of anterior shoulder instability using a single anterior portal

OBJECTIVE The aim of this study was to compare the effects of the use of a single anterior portal in the arthroscopic surgery treatment of traumatic anterior shoulder instability with those in the literature. METHODS The study included 72 patients (60 males, 12 females; mean age: 23.9 years) who underwent surgery using a single arthroscopic anterior portal for the treatment of traumatic anterior shoulder instability between 2002 and 2011. Clinical outcomes were assessed using the Rowe and Oxford scales, forward flexion range and external rotation limitation. Redislocation was considered failure. RESULTS Mean follow-up was 49.3 months. Bankart lesion was determined in 38 patients and Bankart and SLAP lesions in 34. An average of 3.7 (range: 2 to 5) anchors were used. Redislocation was observed in 4 (5.6%) patients in the postoperative period. Postoperative Rowe and Oxford scores were 93.4 and 42.6, respectively. CONCLUSION Instability surgery performed using a single arthroscopic anterior portal provided findings comparable with the literature regarding clinical outcomes, postoperative shoulder movements and low recurrence rates, emphasizing the importance of appropriate patient selection rather than the number of the portals. The use of a single portal is less invasive and reduces the surgical period.

Correction of nascent malunion of distal radius fractures

OBJECTIVE Early correction of malunion of distal radius fractures may be necessary in young, active patients. The aim of this study was to report the advantages and disadvantages of early correction of distal radius malunion. METHODS Eleven patients (10 male, 1 female; average age 36 years, range: 20 to 54 years) with nascent malunion of distal radius fractures were included in this study. The malunions occurred after initial conservative treatment of unstable distal radius fractures. Mean interval between injury and corrective surgery was 12 (range: 8 to 15) weeks. Two patients had intra- and extra-articular malunion and 9 had an extra-articular malunion. Volar correction was made in seven patients and dorsal correction in four. Results were evaluated radiologically and functionally using the Mayo wrist score. RESULTS Bony healing was established after correctional osteotomies at an average of 8 (range: 5 to 16) weeks. The average preoperative dorsal deformity was 28° and was corrected to 4° of volar tilt postoperatively. Patients had a positive ulnar variance with an average of 5 mm initially and less than 1 mm postoperatively. Radial inclination was corrected from an average of 9° preoperatively to an average of 20° and the average postoperative Mayo wrist score was 82.5. Tenotomy of brachioradialis was useful for the correction of radial inclination, especially in old cases. Structural (corticocancellous) grafting was used in one patient. All patients returned to their previous functional level. CONCLUSION Advantages of early corrective osteotomy include anatomic restoration at the original fracture line, a shortened healing period and a decreased need for structural bone grafting. Disadvantages are that the recreation of the original fracture line is technically demanding and patients must be cooperative to achieve a successful outcome.

Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication

Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications.

Post operative pain management in shoulder surgery: Suprascapular and axillary nerve block by arthroscope assisted catheter placement.

Background: Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia. Materials and Methods: 24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2. Results: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P < 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively. Conclusion: These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients’ satisfaction could be improved.

First Dorsal Compartment Musculotendinous Avulsion Accompanied by Close Radial Styloid Fracture: Case Report

Highlights • Our study is the third case report about radial styloid fracture accompanying with first extensor compartment muscles rupture.• Our study will be the first study in this issue because of some privileges.• Other case report did not have long term follow-up time, mean that just 8 month follow-up time.• Our study also has preoperative MRI views and intraoperative photographs.• First case report; which was about this issue, muscle strength test was not applied by authors.

Immediate emergency free anterolateral thigh flap after car-tyre friction injury: A case report with eight years follow-up

The car-tyre friction injury has differences from other injuries. The components of injury which are burn, crushing, shearing, and degloving occur. Many treatment options can be performed for coverage of wound which are Vacuum Assisted Closure system (V.A.C), skin grafting, free flaps, local flaps and cross leg flap.

reconstruction of Proximal Humeral Defects with Shoulder Arthrodesis Using Free Vascularized Fibular Graft : surgical Technique

Introduction We describe upper-extremity reconstruction after proximal humeral bone loss by means of glenohumeral arthrodesis using a vascularized fibular graft and double plate fixation. Step 1 Preoperative Evaluation and Planning Use preoperative imaging to estimate the length of the humeral defect, the absence or presence of a glenoid defect, and the available length of fibular graft. Step 2 Position the Patient Place the patient in the beach-chair position, securing him/her with side supports. Step 3 Expose and Prepare the Shoulder The approach is a typical anterior approach to the shoulder following an anterolateral approach to the humeral shaft. Step 4 Harvest the Fibular Graft Harvest the full length of the fibula, after leaving 6 cm proximally and distally for ankle and knee stability. Step 5 Prepare the Humerus and Recipient Vessels in the Upper Arm Ream the humeral medullary canal by hand to avoid fracture and prepare the profunda brachii or brachial artery as recipient vessels. Step 6 Insert the Fibula Into the Proximal Part of the Humerus and Complete the Vascular Anastomosis Insert the bare osseous fibula into the humeral canal, pass the graft pedicle through the loose tunnel, and anastomose the vessels. Step 7 Double Plate Fixation It is very important to bend the lateral plate to match the contour of the osseous surfaces. Step 8 Follow-up and Rehabilitation Immobilize the shoulder until union is achieved and then start scapula-thoracic exercises. Results We recently reported on a retrospective series of nine shoulder arthrodeses performed with use of a free vascularized fibular graft. What to Watch For IndicationsContraindicationsPitfalls & Challenges.

Does Injury Rate Affect a Football Team’s Level of Play? Injury Report from Turkey

The primary aim of this study is to make an overall assessment of injuries in the Turkish professional football league and to establish a baseline database for comparative purposes and for use in future studies. The seasons between 2004 and 2006 in Premiere and Secondary Turkish League are evaluated. A total number of 1,264 players from 42 teams were included in the study. Twenty-six teams included in the study were from Premier League and the rest from Second Turkish League. A total of 779 injuries were reported, accounting for 19.8 injuries/1,000 h, including both matches and training. When categorized separately by match or training, the number of injuries per 1,000 h were 17.3 and 21.2, respectively. Noncontact injuries accounted for 69% of all injuries. Different from the literature, the incidence of injury in training was determined higher than that in matches, which clearly indicates the need for more properly designed training programs and warrants a review of the entire training approach.