Naci Ezirmik

Comparisons of analgesic effects of different doses of morphine and morphine plus methylprednisolone after knee surgery

Background: In this double‐blind randomized study, the analgesic effects of morphine alone and with methylprednisolone were examined in 72 patients undergoing arthroscopic knee surgery. Methods: At the end of arthroscopy, patients were allocated randomly to one of four groups to receive intra‐articular administrations of saline, morphine 1 mg, morphine 5 mg or morphine 1 mg with methylprednisolone 40 mg. Preoperative and postoperative pain levels at rest and during movement (active flexion of the knee) were measured by a visual analogue scale (VAS). Postoperative analgesic requirements to alleviate pain were evaluated. Results: Pain scores were significantly lower for the patients who received 5 mg morphine and 1 mg morphine with 40 mg methylprednisolone than for those who received saline or 1 mg morphine. This was accompanied by a decrease in the postoperative consumption of analgesics and prolongation of the duration of pain relief. Conclusions: This study confirms that the analgesic effect of morphine given intra‐articularly is dose dependent and that combination of methylprednisolone with morphine has an additive effect on analgesia.

Sport injuries: relations to sex, sport, injured body region.

The present study evaluated the association among sex, sport, and injured body region of sport injuries. The subjects were 329 men and 127 women, ranging in age from 17 to 28 years, attending classes in the departments of Physical Training and Sport of Atatürk University (Erzurum, Erzincan, and Ağri in Turkey). There were no differences between men and women in percentages of injuries. The difference among various sports in the percentages of injured athletes was statistically significant. Running had the lowest percentage of injuries and basketball had the highest percentage. The most frequently injured body regions were the foot and the ankle in basketball, volleyball, soccer, and running, but in wrestling, the knee. These findings suggest that injury rates are associated with the sport rather than sex of player, and the most frequently injured body regions are the lower extremities. Therefore, the muscles of lower extremity should be strengthened to avoid injuries.

Primary Hydatidosis of the Gracilis Muscle in a Girl

Primary muscle hydatidosis is very rare. Rupture and spreading of the cyst contents by improper handling may later cause secondary cyst or allergic reactions. Pre-operative recognition of a hydatid cyst is therefore critical. It often presents as a soft-tissue mass, however, and pre-operative recognition of this rare entity is clearly difficult. Here, a case of primary hydatidosis affecting the gracilis muscle is presented, and the magnetic resonance imaging, clinical and pathological findings are described.

First report of important causal relationship between the Adamkiewicz artery vasospasm and dorsal root ganglion cell degeneration in spinal subarachnoid hemorrhage: An experimental study using a rabbit model

Background: The blood supply of the lower spinal cord is heavily dependent on the artery of Adamkiewicz. The goal of this study was to elucidate the effects of lumbar subarachnoid hemorrhage (SAH) on the lumbar 4 dorsal root ganglion (L4DRG) cells secondary to Adamkiewicz artery (AKA) vasospasm. Materials and Methods: This study was conducted on 20 rabbits, which were randomly divided into three groups: Spinal SAH (n = 8), serum saline (SS) (SS; n = 6) and control (n = 6) groups. Experimental spinal SAH was performed. After 20 days, volume values of AKA and neuron density of L4DRG were analyzed. Results: The mean alive neuron density of the L4DRG was 15420 ± 1240/mm3 and degenerated neuron density was 1045 ± 260/mm3 in the control group. Whereas, the density of living and degenerated neurons density were 12930 ± 1060/mm3 and 1365 ± 480/mm3 in serum saline (SS), 9845 ± 1028/mm3 and 4560 ± 1340/mm3 in the SAH group. The mean volume of imaginary AKAs was estimated as 1,250 ± 0,310 mm3 in the control group and 1,030 ± 0,240 mm3 in the SF group and 0,910 ± 0,170 mm3 in SAH group. Volume reduction of the AKAs and neuron density L4DRG were significantly different between the SAH and other two groups (P < 0.05). Conclusion: Decreased volume of the lumen of the artery of Adamkiewicz was observed in animals with SAH compared with controls. Increased degeneration the L4 dorsal root ganglion in animals with SAH was also noted. Our findings will aid in the planning of future experimental studies and determining the clinical relevance on such studies.

The results of Pemberton’s pericapsular osteotomy in patients with developmental hip dysplasia

OBJECTIVE The aim of this study was to investigate the radiological and clinical outcomes of Pembertons pericapsular osteotomy in toddlers and preschool children with developmental hip dysplasia. METHODS Ninety-one hips of 86 patients (81 girls, 5 boys) with developmental hip dysplasia who underwent Pembertons pericapsular osteotomy were included in this study. The mean age of the patients was 34 (range: 18 to 96) months. The mean duration of follow-up was 60 (range: 24 to 158) months. All patients underwent open reduction and Pembertons pericapsular osteotomy, including 12 hips in which proximal femur osteotomy had been performed earlier. Clinical results were evaluated according to McKays clinical evaluation criteria, radiological results according to Severs radiological evaluation criteria, and the presence of avascular necrosis according to Kalamchi-MacEwens classification criteria. RESULTS At the final examinations the mean acetabular index was 12.04° (range: 5° to 24°) and the mean Wibergs center-edge angle was 35.5° (range: 20° to 52°). Clinically, excellent results were obtained in 81 (89.0%) hips, good results were obtained in 2 (2.2%) hips, and fair results in 8 (8.8%) hips. Radiologically, excellent results were obtained in 79 (86.8%) hips, good results in 7 (7.7%) and fair results in 5 (5.5%) hips. Clinically and radiologically no poor results were noted. Type 1 avascular necrosis was detected in 9 (9.9%) hips, Type 2 in 7 (7.7%) hips, and Type 3 in one (1.1%) hip. There were no cases with Type 4 avascular necrosis. CONCLUSION Pembertons pericapsular osteotomy is a safe and effective procedure for the surgical treatment of developmental hip dysplasia in toddlers and preschool children.

Advantages of Single-Stage Surgical Treatment with Salter Innominate Osteotomy and Pemberton Pericapsular Osteotomy for Developmental Dysplasia of Both Hips

OBJECTIVE: This study retrospectively compared the clinical and radiological outcomes of patients with bilateral developmental dysplasia of the hip who underwent either a single-stage operation (using a Salter innominate osteotomy for one hip and a Pemberton pericapsular osteotomy for the other hip) or a two-stage procedure comprising consecutive operations. METHODS: Extensive pre- and postoperative clinical, surgical and radiological examinations were undertaken. RESULTS: A total of 63 patients received the single-stage operation (group A), and 55 patients received consecutive operations (group B). There were no significant between-group differences in acetabular index or centre-edge angle correction. Group A had significantly reduced anaesthetic exposure, duration of hospitalization, blood transfusion volume, antibiotic costs and hospitalization costs. Group A also had a lower rate of surgical complications and avascular necrosis than group B. CONCLUSIONS: The single-stage surgical procedure was more economical and allowed more rapid recovery than two consecutive operations. The surgical and anaesthesia team must be highly proficient in order to perform single-stage operations successfully.

Treatment of Ipsilateral Distal Humerus and Diaphyseal Ulna Fractures by Using an Olecranon Osteotomy and Intramedullary Nail.

Objective: To evaluate the results of treatment of an osteotomy of the olecranon and an ulnar diaphyseal fracture with a single nail, in cases with an ipsilateral ulnar diaphyseal fracture and a comminuted fracture of the distal humerus. Design: Retrospective clinical study. Setting: University-affiliated teaching hospital. Patients: Eight patients with comminuted fractures of the distal humerus and ipsilateral ulnar diaphyseal fractures were included. Intervention: Using a transolecranon approach, internal fixation of the distal humeral fracture with medial and lateral plates was performed. The ulnar diaphyseal fracture and additional osteotomy were fixed using a locked intramedullary nail. Subjective pain assessment was performed by using a visual analog scale (VAS). Results: There were 6 (75%) male and 2 (25%) female patients, with a mean age of 40.9 (range, 32–56) years. The mean follow-up period was 24.6 (range, 12–36) months. All patients achieved union of the ulnar diaphyseal fracture and olecranon osteotomy. Union of the distal humeral fracture was observed in 7 (87.5%) patients. The mean time to union was 16.3 (range, 12–22) weeks, mean visual analog scale score was 1.8 (range, 0–3), median elbow performance score was 85 (range, 70–95), and median disabilities of the arm, shoulder, and hand score was 17.9 (range, 5–45.8). Conclusions: Osteotomy of the olecranon and ulnar diaphyseal fracture using an intramedullary nail was a cosmetically advantageous and safe technique that enabled rehabilitation during the early postoperative period. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Effects of Salter Innominate Osteotomy on the Sacroiliac Joint in Patients with Developmental Hip Dysplasia

The pressure effects of Salter innominate osteotomy (SIO), a surgical treatment for developmental hip dysplasia (DHD), on the sacroiliac joint were investigated in a retrospective study. Pre- and post-operative direct anteroposterior pelvic radiographs of 60 cases with unilateral DHD treated by SIO were examined. The mean age at surgery was 27.7 months (range 18–48 months). The distance from the posterior inferior iliac spine to the midline (from the middle of the first sacral vertebra to the symphysis pubis) was measured. No difference was found between pre- and post-operative distances on the normal, non-operated side. On the operated side, no change was observed in 10 cases (16.7%), but the distance increased by 2 mm or 3 mm in 50 cases (83.3%) post-operatively. This increase was statistically significant, but not related to age at surgery. These findings indicate that SIO creates pressure on the inferior part of the sacroiliac joint, resulting in some displacement. Such irreversible changes may eventually lead to joint degeneration and pain.

NEURODEGENERATIVE EFFECT OF ELECTROCAUTERIZATION ON SPINAL NERVE ROOT: AN EXPERIMENTAL STUDY

We investigated the number of degenerated neurons in spinal roots of rabbits after spinal surgery to test if electrocauterization causes neuronal loss. The number of degenerated neurons was higher in study group than in control group, and the number of live neurons was higher in control group than in study group. These results suggest that electrocauterization applied during spinal surgery is hazardous to spinal neurons and should not be applied unless required

A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures

BACKGROUND We compared the union and functional results of intramedullary nailing and open reduction internal fixation treatment applied to adults with a forearm diaphysis fracture (fracture of the radius and/or ulna). METHODS We retrospectively examined 90 patients with completed skeletal maturation who were surgically treated for a forearm diaphyseal fracture. Patients with a Monteggia Galeazzi and ipsilateral upper extremity fracture and those with an open epiphyseal line, Type 3 open fracture, pathological fracture, or brain trauma were excluded from the study. Open reduction and internal fixation (ORIF) was applied to 42 patients (plate group), and intramedullary nailing was performed in 48 patients (intramedullary nailing group). Both treatment groups were compared with respect to time to union, joint range of motion, operating time, grip strength, Grace-Eversman criteria, and complications. RESULTS The mean operating time was 63.29 (range, 40-100) min in the plate group and 46.02 (range, 17-85) min in the intramedullary nailing group. The mean time to union was 13.19 (range, 10-20) and 10.85 (range, 8-20) weeks, respectively. While a statistically significant difference was determined between groups with respect to operating time and time to union, no difference was determined in the Grace-Eversman evaluation criteria, forearm supination, pronation degrees, and grip strength. CONCLUSION The results of this study showed a significant difference in the intramedullary nailing treatment with respect to time to union, operating time, and amount of bleeding compared with the ORIF treatment. However, no difference was determined in the functional evaluation criteria. Thus, both treatment methods are acceptable in the treatment of forearm diaphyseal fractures in adults with skeletal maturation.