Murat Erdoğan

Estrogen receptors in hip joint capsule and ligamentum capitis femoris of babies with developmental dysplasia of the hip.

OBJECTIVE The aim of this study was to detect the incidence of estrogen receptors in human hip joint capsule and ligamentum teres. METHODS The study included biopsies of the ligamentum capitis femoris (LCF) and hip joint capsule from 15 patients undergoing hip surgery for developmental dysplasia of the hip (DDH) and from the control hips of 15 cases of intrauterine fetal death. Mean age was 10.3 (range: 6 to 18) months at the time of surgery. Full-thickness 1x1 cm anterior capsule and LCF portions were taken as biopsy specimens. An immunohistochemical study using monoclonal antibody against estrogen receptors was performed to identify the rate of target estrogen cells in the hip joint capsule and LCF. RESULTS Estrogen receptor (ER) staining rates were 1.6±0.2% for the LCF and 1.3±0.2% for the hip joint capsule in the control groups, and 2.5±0.3% for the LCF and 2.0±0.3% for the hip joint capsule in the DDH groups. Estrogen receptor staining rates in the LCF and hip joint capsule control groups were significantly lower than that in the DDH groups (p<0.001). In both groups, ER rates were significantly lower in the hip joint capsule than in the LCF (p<0.01). CONCLUSION The high rate of ERs in the LCF and hip joint capsule appears to support the effect of estrogen in the etiology of the DDH.

An evaluation of the functional and radiological results of percutaneous vertebroplasty versus conservative treatment for acute symptomatic osteoporotic spinal fractures

PURPOSE This study aimed to compare the results of the two different treatment regimens (percutaneous vertebroplasty (PV) and conservative treatment (CT)) regarding to efficacy, quality of life, functional and radiological results in patients with acute osteoporotic vertebral compression fractures (OVF). METHODS The study comprised 83 patients who presented with complaints of OVF associated with osteoporosis and were treated with CT (37) or PV (46). All patients were evaluated according to preoperative and postoperative visual analogue scale (VAS), Oswestry disability index (ODI) and plain radiographs. RESULTS All patients in VP group reported a significant decrease in pain at 1st day postoperative. While Pain relief and functional outcomes were significantly better in PV group than CT at 1st and 3rd months according to VAS and ODI scores, there were no statistically significant differences between the groups at 6th months follow-up. The mean preoperative local sagittal Cobb angle (LSCA) and the mean vertebra corpus mid-level height (MVCH) were 42.3° and 14.6 mm in the PV group, while they were measured as 39.8° and 15.7 mm in CT group, respectively. 15.6° decreasing the LSCA and 10.2 mm increasing MVCH were noted in the PV group at the 6th month follow-up. While LSCA increased 19.1° and MVCH decreased 7.6mm in CT group at same time period (p<0.001). CONCLUSIONS Compared to the CT group, PV provides a rapid decrease of pain and an early return to daily life activities. Although improvement was observed on the radiological findings following treatment in the PV group, PV may not enhance the quality of life in patients with acute OVF at 6th months follow up.

[Who is responsible for the postoperative nerve injury? Anesthesia? Orthopedics? Trauma?].

In the pathogenesis of peripheral nerve injury, mechanical as well as vascular pressure, and chemical reasons play a role. In the applications of peripheral nerve block, there can be mechanical injury due to the type of needle and intrafascicular injections. In humerus fractures, nerve injury can be seen due to the surgical retractions and close proximity of the nerves with the bone. In addition, trauma may be the reason for posttraumatic nerve injury. In this presentation, we discussed the causes of postoperative nerve damage, which is seen after the operation of the distal humerus fracture.

Effects of patients' sex on postoperative analgesic use for shoulder surgery

Aim. Postoperative pain is a major problem in patients who have undergone surgery of the shoulder joint. We retrospectively evaluated 26 patients in whom a subacromial catheter had been placed for postoperative pain management following shoulder surgery. Method. Infusion of local anesthetics and/or opioids through a subacromial catheter, placed at the end of the procedure, was started after surgery. This catheter was kept in place for 24 hours. The patients’ pain was evaluated by using a visual analog scale (VAS). Patients with a VAS score greater than 7 were given meperidine, 0.5 mg/kg i.v., those with a score of 5-7 received tenoxicam, 20 mg i.v., and patients who continued to have a score of >5 at the end of 30 minutes were given paracetamol, 1 g i.v. as an additional analgesic injection. Results. None of the patients had a need for meperidine after 24 hours of surveillance. Seven patients with a VAS score of 5-7 were given tenoxicam, while seven patients, all female, who had continuing pain, received paracetamol. Conclusion. A subacromial catheter, which does not cause adverse effects or complications, is easy to apply and allows effective analgesia, can be used with confidence in the postoperative pain management of patients undergoing shoulder surgery. The need for supplementary analgesia in women only is significant, indicating the role of the patient’s sex in pain perception.