Osman Tecimel

Nondrainage Decreases Blood Transfusion Need and Infection Rate in Bilateral Total Knee Arthroplasty

This retrospective study enrolled 526 patients undergoing bilateral total knee arthroplasties at our institution. In nondrainage group (Group 1) of 255 patients (510 knees), a disposable elastic sterile exsanguination tourniquet (HemaClear), wound closure in layers and Jones Bandage, without pre-tourniquet removal hemostasis or Hemovac drain were used. In drainage group (Group 2) of 227 patients (454 knees), pneumatic tourniquet, post-deflation hemostasis, a Hemovac drain and Jones bandage were used. The maximal drop in hemoglobin was significantly greater in Group 2 than Group 1 (P < 0.001). Also infection rate was significantly lower in Group 1 (P = 0.017). The use of sterile tourniquet removed after wound closure without Hemovac drain decreases blood transfusion need, infection rate, tourniquet related pain and postoperative complications.

Blood mean platelet volume and platelet lymphocyte ratio as new predictors of hip osteoarthritis severity.

Abstract Osteoarthritis (OA) is a low grade systemic inflammatory disease in which many inflammatory mediators are known to be elevated in the peripheric blood. Blood platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) are accepted as novel markers in many of the systemic inflammatory disorders, but have not been investigated in synovitis-free radiographic OA yet. The aim of this study was to evaluate the levels of blood PLR and MPV in radiographic hip OA. A total of 880 patients were evaluated retrospectively and after certain exclusion criteria, 237 of them who have primary hip OA were included. Age, sex, height, weight, body mass index, neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR), PLR, and MPV levels were recorded, Kellgren–Lawrence (KL) grading of the hip joints were performed. Patients were then divided into 2 groups as KL grades 1 to 2 (mild–moderate) and KL grades 3 to 4 (severe) hip OA. Mean age, mean neutrophil, lymphocyte and platelet counts, mean MPV, mean PLR, and mean ESR were statistically significantly different between mild/moderate hip OA group and severe hip OA group. In univariate analysis, older age and higher MPV, PLR, and ESR were severely associated with severe hip OA. In multiple logistic regression analysis, MPV, PLR, and ESR emerged as independent predictors of severe hip OA. The results of the present study, for the first time in the literature, suggest blood PLR and MPV as novel inflammatory markers predicting the radiographic severity of hip OA in the daily practice.

The comparison of plate-screw and tension band techniques in the osteosynthesis of Danis-Weber Type A and B lateral malleolar fractures.

OBJECTIVE The aim of this study was to compare the clinical and radiological results of plate-screw and tension band fixation in isolated Danis-Weber Type A and B lateral malleolar fractures. METHODS A total of 135 cases of lateral malleolar fractures (82 Danis-Weber Type B and 53 Type A) operated on in 4 different centers and 6 orthopaedic clinics between November 2005 and December 2010 were reviewed retrospectively. Eigthy-one patients (55 Type B and 26 Type A) had lateral 1/3 tubular plate and screw fixation (Group 1), while the remaining 54 patients (27 Type B and 27 Type A) were operated on with tension band technique (Group 2). The clinical and radiological results of the groups were compared. Student t test was used in statistical analysis. RESULTS The mean length of surgical incision scar was 4.9 cm (4.5-5.4 cm) for Type A fractures and 6.8 cm (5.6-7.5 cm) for Type B in Group 1 and 4.0 cm (3.5-5.2 cm) for Type A and 5.3 cm (5.0-5.9 cm) for Type B fractures in Group 2. Radiological union was obtained at mean of 10 weeks (7-13 weeks) in Group 1 and 9 weeks (7-12) in Group 2. The implant had to be removed in 12 patients in Group 1 and in one patient in Group 2. The mean AOFAS Score was 90 (72-100) and 92 (70-100) in Groups 1 and 2, respectively. CONCLUSION Both plate-screw and tension band techniques revealed excellent results in isolated Danis-Weber Type A and B fractures. The tension band technique may be an alternative fixation method in the treatment of these fractures.

Surgical Technique: Supine Patient Position With the Contralateral Leg Elevated for Femoral Intramedullary Nailing

BackgroundIntramedullary nailing can be performed with a fracture table or manual traction. Manual traction can be applied with the patient in either the supine or lateral decubitus (LD) position. However, in either of these positions, the reduction can be difficult because the fractured extremity is not positioned parallel to the floor and the contralateral leg on the operating room table overlaps the fractured limb while the fractured extremity is in full adduction. Therefore fluoroscopy time may be increased. Accordingly, we developed a technique with the patient supine and the contralateral leg elevated (SCLE).Description of TechniqueWe performed anterograde femoral intramedullary nailing with the patient in the supine position with the contralateral leg elevated to allow easy nail entry, reduction, and locking. In this position, the uninjured leg was placed on the leg holder in a semilithotomy position to allow full hip adduction.MethodsWe retrospectively reviewed 63 patients treated with intramedullary nailing: 30 with the SCLE position (mean age, 38 years; 30% female) and 33 with the LD position (mean age, 37 years; 36% female). From the medical records we extracted demographic information, fracture pattern, intramedullary nail diameter, duration of fluoroscopy and operation, and complications. At the last visit, extremity lengths, rotation, and alignment were determined. Minimum followup was 46 months (mean, 46 months; range, 20–72 months).ResultsThe mean durations of surgery and fluoroscopy were shorter for the SCLE group than the LD group: 98 versus 108 minutes and 3.4 versus 3.8 minutes, respectively. The open reduction rate was less in the SCLE group when compared with the LD group: 10% versus 36%.ConclusionsWe believe the SCLE technique is a reasonable treatment choice for femoral intramedullary nailing as it facilitates obtaining orthogonal views of the femur while possibly shortening surgery and fluoroscopy times.Level of EvidenceLevel III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

A case of ancient schwannoma of the great toe

Ancient schwannoma (degenerated neurilemmoma) is a rare form of schwannoma characterized by calcification and cystic degeneration. A 42-year-old male patient presented with a mass in the base of the left great toe, which had existed for eight years and undergone significant enlargement for the past six months. On physical examination, there was a mass, 3x2x2 cm in size, in the lateral aspect and base of the left great toe. Radiographic appearance of the feet was normal. The mass was removed by blunt dissection. No postoperative problems were seen. The histopathological diagnosis of the specimen was made as ancient schwannoma.

Effects of custom-made insole on gait pattern of patients with unilateral displaced intra-articular calcaneal fracture: evaluation with computerized gait analysis

OBJECTIVE The aim of this study was to investigate whether use of custom-fabricated insoles improves the gait pattern in patients with displaced intra-articular calcaneal fractures. METHODS Fourteen patients (7 female, 7 male; mean age: 39 ± 12 years) and 11 healthy individuals (mean age: 42 ± 13 years) were included in the study. Treatment protocol included conservative treatment involving immobilization, with or without closed reduction, active exercises, wear of a custom-fabricated insole and prospective follow-up. All patients were evaluated by physical examination, axial and lateral radiographs, computerized tomography, and computerized gait analysis. RESULTS The use of custom-made insoles significantly improved step and stride lengths and the peak values of fore-aft component in the involved foot and tended to increase plantar flexor moment and total ankle power. The majority of patients (71%) continued to have substantial mechanical abnormalities by computerized gait analysis. Plantar flexion moment, total ankle power, vertical component of ground reaction forces (GRFs), and total sagittal plane excursion were significantly decreased in the involved foot when compared to the uninvolved foot. Plantar flexion moment, total ankle power, vertical, fore-aft and mediolateral components of GRFs were significantly decreased in the involved foot when compared to the healthy control group. CONCLUSION Use of a custom-made insole improves advancement of limb and weight-bearing in patients with a displaced intra-articular calcaneal fracture. Nevertheless, mechanical abnormalities persist in the affected limb, which does not appear to recover a gait pattern similar to that of normal walking.

Use of contact pressure-sensitive surfaces as an indicator of graft tension in medial patellofemoral ligament reconstruction

BackgroundNo previous description has been made about an objective method to test the graft resistance in MPFL reconstruction intraoperatively. In our study, we aimed to obtain intraoperative objective data about the graft resistance using contact pressure-sensitive surfaces and measuring pressure formed under the graft.Materials and methodsIn 2012, double-layered contact pressure-sensitive Fuji Prescale Film bands were placed under MPFL in 15 fresh-frozen high above-knee amputates (Group 1) and under graft in 10 patients who underwent MPFL reconstruction (Group 2). Measured values at different flexion angles were compared between and in groups.ResultsStatistical analysis was performed by Student’s t test. It has been found that the pressure under the graft was higher in patients having reconstruction as compared to the pressure under natural MPFL. Decreasing pressure values were observed with increasing flexion angles in both groups.ConclusionContact pressure-sensitive surfaces provided objective data when placed under the graft in natural MPFL and during surgery. Therefore, they may be used as an objective marker providing information about graft resistance.

Treatment of rotator cuff tears with arthroscopic transosseous technique: results of the first twenty cases

Purpose: The aim of this study was to evaluate the results of our first 20 cases of rotator cuff tear treated with arthroscopic transosseous technique Methods: Patients with supraspinatus and infraspinatus extended supraspinatus tears were included. Local etchical board acceptance was obtained. Surgical technique was trained with model and cadaver. Surgical technique was done using transosseous implant Sharc-FT (NCS Lab, Carpi, Italy) with arthroscopy. Acromyoplasty in all patients, subscapularis repair in 2 patients, biceps tenotomy in 4 patients, biceps tenodesis in 6 patients and acromyoclavicular coplanning in 6 patients were performed. During postoperative period, the standart rehabilitation protocol was performed. Prospectively collective datas were evaluated retrospectively. Outcomes were measured with surgery time, VAS score and Constant score at the preoperative period and the last follow-up. Rerupture was evaluated with magnetic resonance at the last follow-up. Results: The mean age was 52,2 (39-64) and follow-up was 16,4 month (14-20). Fifthteen of patients were female. The mean surgery time was 72 min (38-124). VAS score was 6.6±0.4 preoperatively and 1.6±0.5 at the last follow up. Constant score was 58.4±3.2 preoperatively and 84.4±3.8 at the last follow up. Statistically significant differences were determined. Two reruptures (%10) were determined. One patient with superficial infection was treated using antibioteraphy. Conclusions: The implant that we used in this study allows transosseous repair of rotator cuff with cortical fixation. Pull out problem that is seen with anchors is elaminated with this technique. We determined our results were satisfactory at the early period. But we think that bone-tendon healing need to be evaluated with long follow-up studies. A patient’s shoulder X-ray who treated with transoseous implant

Average Thickness of the Four Folded Hamstring Tendons Which we Use in ACL Reconstruction

Objectives: The purpose of this study is to determine the average thickness of 4 folded hamstring tendons (autograft) which we used on our patients who had tendon reconstruction because of ACB rapture diagnostic. Methods: Between the dates of January 2009 and December 2013, patients who had tendon reconstruction with hamstring autograft because of ACB rapture diagnostic were evaluated retrospectively in Yıldırım Beyazıt University Ankara Atatürk Training And Research Hospital – Orthopaedics and Trauma Clinic. 258 patients who had 4 folded hamstring tendon which was prefered usually, were included into the study but 26 patients were not included into the study who had different autograft applications and direct allografts usages. Results: 242 of the 258 patiens who were included into the study were males and remaining 16 were females. Average age was 28.7 (14-52). The average thickness of the 4 folded hamstring tendons (semitendinosus and gracilis tendons) of the patients was observed as 7.9mm (6-10mm). The tendon thickness of 47 patients were measured below 7mm. For those patients, the tendon thickness was increased by combining allografts with autografts. Conclusion: The average thickness of the 4 folded hamstring tendons what we have used was 7.9mm. By considering the average graft thickness, it may be beneficial to make the planing by thinking about different configurations or keeping allografts ready for the cases which may require thicker grafts.

Hava Yastığının Kendiliğinden Açılması İle İlişkili İzole Medial Malleol Kırığı: Vaka Sunumu ve Literatür Taraması

Airbags are automatic passive restrictive type of car safety tools. In the literature, a small number of injuries that is related to spontaneous airbag deployment have been reported. In our article, we reported isolated medial malleolus fracture that is rare and related to spontaneous airbag deployment without any collision. We detected the injury of a twenty nine-year-old woman due to direct trauma as a result of the spontaneous airbag deployment. According to the Pankovich and Shivaram classification system, there was a type B, close, isolated medial malleolus fracture. We have performed open reduction and internal fixation. As a result of a one-year follow up, we detected that the ankle joint is painless, stabile and has a full range of movement. According to our research on literature, our patient is the first medial malleolus fracture case that is related to spontaneous airbag deployment in literature.