Servet Tunay

Immobilization of the shoulder in external rotation for prevention of recurrence in acute anterior dislocation

OBJECTIVES We aimed to compare the functional and stability outcomes of the patients with acute anterior shoulder dislocation, who were stabilized at external versus internal rotation. METHODS A total of 33 patients (31 males and 2 females) with the diagnosis of acute primary traumatic anterior shoulder dislocation were immobilized at internal (n=17) or external rotation (n=16). The mean follow-up period was 20.85 months (range 6-41 months). Patients received rehabilitation program immediately after splinting. We assessed functionality by Constant-Murlay score and stability by Rowe scoring system in 6th month. Control examinations were performed in 12th and 24th months. RESULTS There were no statistically significant differences between internal rotation and external rotation groups in terms of Constant-Murlay and Rowe scores. Recurrent dislocation rate was 6.3% (1/16) in external rotation group and 29.4% (5/17) in internal rotation group (p>0.05). In the subgroup of patients aged between 21-30 years, while no recurrent dislocation was seen in external rotation group, 5 patients developed recurrent dislocation in internal rotation group(p=0.035). CONCLUSION Immobilization of the shoulder in external rotation is an effective technique for prevention of recurrent dislocations in acute anterior shoulder dislocation and should be preferred to traditional splinting in internal rotation in clinical practice.

Treatment of tibial bone defects with the Ilizarov circular external fixator in high-velocity gunshot wounds

Summary. One of the applications for circular external fixators is the treatment of large-bone defects which may be difficult to manage with conventional methods. Successful results have been reported with the use of circular external fixators, particularly in the treatment of infected tibial pseudoarthroses and those with bone loss. In this study, a total of 43 cases with tibial bone defects (18 infected) as a result of high-velocity gun-shot injuries were treated with circular external fixators between January 1, 1988 and December 31, 1995. The mean follow-up period was 50 months (range: 28–98 months) after the removal of the Ilizarov device. Satisfactory union was obtained in 40 cases without any major complication or additional surgical intervention, in spite of the large and in some cases infected defects. We conclude that this is a safe method for the treatment of infected or noninfected tibial bone defects.Résumé. Une des applications des fixateurs externes circulaires (FEC) est le traitement des pertes de substance osseuse qu’on ne peut pas traiter facilement avec les méthodes classiques. Des auteurs rapportent les résultats de traitement dans des cas de pseudarthrose infectée du tibia. Ils rapportent les résultats de 48 perte de substance du tibia secondaire à des blessures par arme à feu. 18 d’entre-eux étaient infectés. Le délai d’observation moyen était de 50 mois (28–98 mois) après ablation de l’appareil d’Ilizarov. Dans 40 cas, il n’y as pas eu de complication majeure ni de nécessité d’intervention chirurgicale complémentaire. En conclusion, c’est une bonne méthode pour traiter les pertes de substance osseuse du tibia infecté ou non.

The relation between the arthroscopic findings and functional outcomes in patients with septic arthritis of the knee joint, treated with arthroscopic debridement and irrigation

OBJECTIVES The aim of this study was to evaluate the relation between arthroscopic findings and functional outcomes in patients with septic arthritis of the knee joint, treated with arthroscopic debridement and irrigation. METHODS Twenty patients (17 male, 3 female; mean age: 31 years [5-63 years]) with knee septic arthritis treated with arthroscopic debridement and irrigation in our clinic between 2004-2007 were included in the study. The decision for arthroscopic debridement was made based on the clinical findings, erythrocyte sedimentation rate, C-reactive protein level and the aspiration of the affected knee. During the arthroscopic debridement, the joint was staged according to Gachter criteria. Continuous irrigation system was set up for all cases following surgery. After the surgery, the Bussiere functional scale was used for clinical evaluation. The mean follow-up periodwas 29±11months (range 13-54 months). The McNemar test was used in comparing the results. The Spearman correlation coefficient was used in the correlation analysis. The level of significance was set at 0.05. RESULTS The culture was positive in 3 cases, and negative in 8 cases who exhibited gram (+) cocci in gram stains. In nine cases, cultures were negative and no microorganisms were detected in gram stains. According to the arthroscopic Gachter classification, 4 cases (20%) were Stage 1, 10 cases (50%) were Stage 2, 5 cases (25%) Stage 3 and 1 case (5%) was Stage 4. There was a statistically significant difference between the mean functional score of the knees with differing Gachter stages (McNemar test, p=0.003). There was a statistically significant and strong correlation between Gachter score and functional results (correlation coefficient: 0.780; p<0.001). CONCLUSION Advanced arthroscopic findings are associated with poor functional results in patients with septic arthritis of the knee joint. In addition, the time between the initial symptoms and the surgery directly affects the functional results.

Late Tourniquet Release and Drain Clamping Reduces Postoperative Blood Loss in Total Knee Arthroplasty

BackgroundMany studies have investigated the effect of tourniquet release time and closed suction drainage in total knee arthroplasty (TKA). However, controversy remains as to the advisability of preclosure tourniquet release and the advisability of closed suction drain use following total knee arthroplasty.Questions/PurposesThe aim of the study was to investigate if there is a benefit of performing tourniquet release after skin closure, along with drain clamping, for the first 6h following TKA.MethodsNinety-six patients underwent TKA between May 2009 and April 2010. Fourteen of these were excluded because of systemic diseases and simultaneous bilateral TKA. Twenty-nine of these were excluded due to use of a patellar component and posterior cruciate ligament (PCL)-sacrificing systems. Thus, 53 patients that underwent PCL-retaining cemented TKA were reviewed retrospectively. In the control group (group C), the tourniquet was released before skin closure, an attempt at hemostasis was made, and a compressive bandage was applied. The drain was not clamped in these patients. The test group of 23 patients (group T) had tourniquet release after skin closure and after the compressive bandage was applied. The drain was clamped for the first 6h after surgery. The two groups were compared as to the amount of drained blood, postoperative change in hemoglobin, postoperative complications, and knee function.ResultsWe found that drained blood and hemoglobin drop were significantly lower in group T compared with group C. There was no difference regarding postoperative complications and knee function.ConclusionWe conclude that tourniquet release after skin closure and compressive dressing followed by 6h of drain clamping reduces postoperative blood loss in TKR surgery.

Effect of Preconditioned Hyperbaric Oxygen and Ozone on Ischemia-Reperfusion Induced Tourniquet in Skeletal Bone of Rats

BACKGROUND The aim of the study was to investigate effect of I/R injury on bone tissue and protective role of hyperbaric oxygen precondition (HBO-PC) and ozone precondition (O(3)-PC) on I/R injury by using biochemical analysis. MATERIALS AND METHODS Thirty-two rats were included in study. The animals were divided into four equal groups: sham operation, I/R, I/R+HBO and I/R+O(3). One session of 60 min, 3 ATA, 3-4 L/min, 100% oxygenation was defined as one dose of HBO. First dose of HBO was administrated 72 h before ischemia. Subsequent, one-dose of HBO administrated per 12 hours until ischemia time (total seven doses); 0.7 mg/kg ozone/oxygen mixture intraperitoneally was defined as one dose of ozone. First dose of O(3) was administered 72 h before ischemia (total four doses). I/R model was induced in anesthetized rats by unilateral (right) femoral artery clipping for 2 h followed by 22 h of reperfusion. The right tibia and were harvested. Tissue was assayed for levels of malondialdehyde (MDA) and protein carbonyl (PCO), activities of superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). RESULTS MDA and PCO levels were increased in I/R group. SOD activity was increased; GSH-Px activity was decreased in I/R group. MDA and PCO levels were decreased, SOD and GSH-Px activities were increased in both HBO+I/R and O(3)+I/R groups. CONCLUSION It has been shown that levels of MDA and PCO in bone were increased followed by 2 h of ischemia and 22 h of reperfusion period. Ozone-PC and HBO-PC has protective effect against skeletal bone I/R injury by decreasing levels of MDA and PCO, increasing activities of SOD and GSH-Px in rats.

Total Knee Arthroplasty in A Patient With Neglected Congenital Patellar Dislocation

Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of 56-year-old woman with advanced osteoarthritis due to right neglected congenital patellar dislocation treated with total knee arthroplasty (TKA) with release of the lateral retinaculum and proximal extensor mechanism realignment. One year later, the patient had improvement of her Knee Society scores and painless function, stability, and better extensor strength. A literature search revealed a limited number of similar cases in which congenital patellar dislocation was treated with TKA. Total knee arthroplasty provides a valid treatment option for adults with congenital patellar dislocation who have absence of the femoral sulcus and associated osteoarthritis. Total knee arthroplasty has the ability to correct the pathologies seen with congenital patellar dislocation, eg, external tibial rotation, absence of femoral groove, and patellar hypoplasia. Realignment of extensor mechanism restores quadriceps strength, normal knee biomechanics, and may prevent complications such as dislocation.

Evaluation of quality of life of female patients after bilateral total knee arthroplasty

OBJECTIVES We evaluated the quality of life of female patients following total knee arthroplasty. METHODS The study included 50 women (mean age 67 years; range 52 to 84 years) who underwent bilateral total knee arthroplasty for primary osteoarthritis of the knee. All the patients were administered the Medical Outcomes Study Short Form-36 (SF-36) and the Knee Society Clinical Rating System (KSCRS) preoperatively and at six weeks, three and six months postoperatively. Particular attention was given to provide patients with sufficient information on surgery and postoperative rehabilitation program. RESULTS Compared to preoperative scores, all the subscales of both instruments showed significant improvement at six weeks and six months (p<0.05). After six weeks, however, only SF-36 physical function scores continued to improve significantly till the final assessment (p<0.05), whereas the other subscales reflected only maintenance of improvement. Conversely, a consistent significant improvement after six weeks was seen in the pain score of the KSCRS, while the function score representing only maintenance of improvement. CONCLUSION Significant improvement is achieved in the quality of life of female patients within six weeks after total knee arthroplasty. It appears that, beyond six weeks, this improvement continues to be significant only in the physical function score of the SF-36 and pain score of the KSCRS.

Removal of a bent inflatable femoral nail: a case report

Intramedullary nailing is the gold standard for the treatment of diaphyseal femoral fractures. Bending of the nail secondary to trauma is a rare complication encountered in unhealed and comminuted fractures. A 23-year-old man was admitted with refracture of the right femoral shaft and a 32-degree bending of an inflatable intramedullary nail due to a fall, two months after the initial surgical treatment. The nail was first straightened by exerting an external force, which decreased the angulation to 10 degrees. Then, the fracture site was opened, the lateral wall of the nail was drilled, and one of the four metal bars of the nail was cut. This allowed complete straightening of the nail by the same maneuver and its removal. A new inflatable intramedullary nail was placed and union was achieved after four months. Tools that may be necessary to cut the nail partially or totally should be made available for removal of bent nails.

Turkish Version of Kolcaba's Immobilization Comfort Questionnaire: A Validity and Reliability Study

PURPOSE The purpose of this study was to determine the validity and reliability of the Turkish version of the Immobilization Comfort Questionnaire (ICQ). METHODS The sample used in this methodological study consisted of 121 patients undergoing lower extremity arthroscopy in a training and research hospital. The validity study of the questionnaire assessed language validity, structural validity and criterion validity. Structural validity was evaluated via exploratory factor analysis. Criterion validity was evaluated by assessing the correlation between the visual analog scale (VAS) scores (i.e., the comfort and pain VAS scores) and the ICQ scores using Spearmans correlation test. The Kaiser-Meyer-Olkin coefficient and Bartletts test of sphericity were used to determine the suitability of the data for factor analysis. Internal consistency was evaluated to determine reliability. The data were analyzed with SPSS version 15.00 for Windows. Descriptive statistics were presented as frequencies, percentages, means and standard deviations. A p value ≤ .05 was considered statistically significant. RESULTS A moderate positive correlation was found between the ICQ scores and the VAS comfort scores; a moderate negative correlation was found between the ICQ and the VAS pain measures in the criterion validity analysis. Cronbach α values of .75 and .82 were found for the first and second measurements, respectively. CONCLUSIONS The findings of this study reveal that the ICQ is a valid and reliable tool for assessing the comfort of patients in Turkey who are immobilized because of lower extremity orthopedic problems.

Preoperative position splint versus skin traction in patients with hip fracture: An experimental study

AIM The aim of the study was to compare the effects of a preoperative position splint and skin traction on pain, comfort, complications, and satisfaction with the treatment and care for patients with hip fracture. METHOD This randomized trial was conducted with a total of 68 patients with hip fracture in a tertiary care hospital in Turkey. Preoperatively, a position splint was applied to the patients in the intervention group (n = 34) and skin traction was applied to patients (n = 34) in the control group. Outcomes studied were pain, comfort, satisfaction and complications. RESULTS Mann-Whitney U Test showed a significant difference between the position splint group and skin traction group regarding pain severity after the application (p < .05). A significant difference was demonstrated between the two groups concerning comfort levels after the application (p < .05). The position splint group was significantly more satisfied with the treatment and care than the control group in the later period after the application (p < .05). The number of preoperative complications in the position splint group was significantly fewer than that of the skin traction group in the preoperative period (p < .05). CONCLUSION Preoperative position splint application in patients with hip fracture relieved pain and complications and increased comfort and satisfaction with treatment and care.