Turgut Akgül

The efficacy of cell saver method in the surgical treatment of adolescent idiopathic scoliosis.

OBJECTIVE The aim of the study was to evaluate the efficacy of the intraoperative blood salvage cell saver method for allogeneic blood transfusion in the surgical treatment of adolescent idiopathic scoliosis with pedicle screw and rod combination. METHODS The study included 33 patients (5 males and 28 females) who underwent surgery due to adolescent idiopathic scoliosis. Patients were divided into 2 groups; 16 patients (mean age: 17.1±3.9 years) in Group A were operated using the cell saver (Medtronic Autolog; autologous cell saver machine) method and the 17 patients (mean age 18.7±6.8 years) in Group B (control group) were treated without cell saver. The Cobb angle, levels of pedicle fixation, operation time, postoperative bleeding, hemoglobin change, allogeneic blood replacement and the amount of autologous erythrocytes were recorded. RESULTS Mean level of pedicle fixation was 12.9±1.54 vertebra using a mean of 21.1±3.21 screws in Group A and 12.8±1.47 vertebra using 18.7±3.59 screws in Group B (p>005). The mean operation time was 224 (Group A: 228±58; Group B: 221±60) minutes. There were no statistically significant differences in the demographic characteristics of both groups (p>0.05). The preoperative mean hemoglobin levels were 12.2±1.47 mg/dl in Group A and 13.1±1.56 mg/dl in Group B. Postoperative mean hemoglobin level was 11.3±1.62 mg/dl in Group A and 9.86±0.93 mg/dl in Group B (p=0.004). The mean amount of autologous erythrocyte replacement was 284±139 ml. The mean postoperative bleeding was 834±253 ml in Group A and 759±380 ml in Group B (p>0.05). The mean allogeneic blood replacement was 1.88±0.88 units in Group A and 1.94±1.34 in Group B (p>0.05). CONCLUSION Autologous erythrocyte replacement was possible using the cell saver method. However, there was no decrement in allogeneic blood replacement using cell saver in the surgical treatment of adolescent idiopathic scoliosis.

Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study

Objective The aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total knee arthroplasty (TKA). Material and method 70 patients (65.5 ± 8.1 years old) that have undergone TKA were divided in two groups. The 20 mg/kg IV TXA was given before the skin incision to one group (study group). On the control group, TKA was performed without TXA. The demographic data, body mass index, amount of bleeding and erythrocyte infusion during the operation, hemoglobin and hematocrit values (preoperative and 48th hour), the amount of drainage after the operation were compared between the groups. Results The total amount of bleeding in the study group was 634.03 ± 182.88 ml and 1166.42 ± 295.92 ml in the control group (p < 0.001). Perioperative bleeding was 252.01 ± 144.13 ml in the study group and 431.33 ± 209.10 ml in the control group (p = 0.018). The drainage after the operation was 311.11 ± 141.64 ml at the 24th hour in the study group, 640.74 ± 279.43 ml at the 24th hour in the control group (p < 0.001). The drainage after 24th hour was 97.96 ± 115.86 ml in the study group and 112.96 ± 64.43 ml in the control group (p = 0.584). Conclusion A high, single dose of TXA intravenously given to the patient prior to the TKA significantly reduces the bleeding during the operation and within the postoperative 24 h. There is no significant change in the bleeding amount after the 24th hour following the operation.

Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery

Superior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this paper, we describe a patient who developed superior mesenteric artery syndrome after scoliosis surgery and was treated with duodenojejunostomy due to failure and complications of conservative treatment.

Red cell distribution width and mortality in patients with hip fracture treated with partial prosthesis

OBJECTIVE This study aimed to determine the relationship between red cell distribution width (RDW) and mortality in patients that received a partial hip prosthesis. METHODS The study included 316 patients (183 female and 133 male) that underwent surgery due to hip fracture and were followed up for ≥1 year. Mean age of the male and female patients was 77.50 years (range; 65-95) and 78.23 years (range; 65-100), respectively. The relationship between the RDW level at the time of presentation and mortality was evaluated. RESULTS There was a significant relationship between mortality, and age (median age for man 77.50 and for woman 78.23) trochanteric fracture, and a high RDW level (>14.5%). In patients with these 3 characteristics the mortality rate was 2.8-fold higher than in the other patients. CONCLUSION RDW is a parameter measured via routine blood testing. We think that RDW measurement should be used in the planning of the treatment of hip fractures and in scoring systems used to estimate post-operative mortality.

Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails.

OBJECTIVE The aim of the study was to present the results of osteosynthesis with elastic expandable intramedullary nail for clavicle fractures. METHODS The study included 17 patients (11 males, 6 females; mean age 36.4 years, range: 21 to 54 years) who underwent surgery for a displaced clavicle fracture and had a shortening of more than 2 cm. The Constant Score and DASH (Disabilities of The Arm, Shoulder and Hand) scoring were used to determine the functional status of the patients. RESULTS Mean operation time was 30.4 (range: 25 to 42) minutes and mean follow-up period was 10.3 (range: 8 to 19) months. Mean union time was 15.8 (range: 9 to 20) weeks. A superficial infection was treated with wound debridement and antibiotherapy in one patient. No patient suffered from neurovascular compromise, deep infection or implant irritation. Implant fracture developed at 2 months after surgery in one patient treated for Type B1 clavicle fracture and healed without any other intervention. There was no statistically significant shortening (p>0.05). In the final follow-up, the mean Constant Score was 94.3 (range: 86 to 97), and mean DASH score was 11.8 (range: 7.3 to 17.4). CONCLUSION Expandable elastic locking intramedullary nail appears to provide minimal complication and high success rate for the surgical treatment of non-comminuted displaced clavicle shaft fractures. Additional studies with large series are necessary for further investigation.

Results of closing wedge osteotomy in the treatment of sagittal imbalance due to ankylosing spondylitis

OBJECTIVE Ankylosing spondylitis is a systemic disease which affects the axial skeleton and may cause rigid spinal deformities in advanced cases. Clinical and radiological results of patients with ankylosing spondylitis who underwent pedicle subtraction osteotomy (PSO) were evaluated. METHODS Twelve (3 female, 9 male) patients who were treated for rigid spinal deformities due to ankylosing spondylitis were evaluated. All patients were treated with the same surgical technique, which included PSO and pedicle screw-rod combination. For radiological results, thoracic kyphosis, lumbar lordosis, pelvic parameters (pelvic incidence, sacral inclination, pelvic tilt), and the distance between the central sagittal line (CSVL) and the sacrum were measured from pre- and postoperative radiograms. For functional results, SF-36 and Oswestry Disability Index (ODI) were used. RESULTS Mean age of the patients was 39.8±8.4 years, and mean follow-up was 85.6±39.1 months. Mean angle of lordosis was improved from 6.6°±13.7° preoperatively to 43.8°±8.4° postoperatively (p<0.0001). Mean CSVL was improved from 19.7±9.7 cm preoperatively to 7.45±3.8 cm postoperatively (p=0.0005). Mean local angular change around the osteotomy site was 30.2°±6.2°. The pelvic parameters were not significantly changed after the surgeries. Mean ODI, SF-36 mental, and SF-36 physical scores were 30.16±9.7, 41.2±9.9 and 35.3±7.1, respectively. CONCLUSION In patients with rigid sagittal spinal deformities due to ankylosing spondylitis, lumbar lordosis and sagittal balance can be obtained using PSO.

Pediatric open elbow dislocation without fracture: A case report.

INTRODUCTION Elbow dislocations in children are rare injuries. These injuries are often in the form of complex injuries that is accompanied by the median nerve damage and medial epicondyle fracture in the pediatric age group. Open elbow dislocation without fracture in the pediatric age group has been reported very rarely in the literature. PRESENTATION OF CASE The purpose of this study is to present an 8-year-old patient who has open elbow dislocation without fracture accompanying with brachial artery injury. In the clinical examination of the patient, there was an open wound in the transverse antecubital region. After repair of brachial artery injury, open reduction was performed under general anesthesia. In the postoperative clinical examination at 6 months, left elbow flexion was 140°, extension was full and there were no deficit in the supination and pronation of the forearm. DISCUSSION Elbow dislocation without fracture in pediatric patients is a very rare injury. Usually the trauma mechanism of elbow dislocation is falling on outstretched hand with elbow in approximately 30° of flexion. However our patient had fallen on outstretched hand with elbow in full extension. Although this type of trauma mechanism is typical for supracondylar humerus fractures in pediatric age group, in our patient an open posterior elbow dislocation without fracture had occurred. CONCLUSION Pediatric elbow dislocations are rare injuries and the management of these injuries can be technically demanding due to concurrent neurovascular injuries. An open dislocation without fracture is very rare and it should be treated with immediate intervention, an effective teamwork and good rehabilitation.

Biological reconstruction of the femur using double free vascularized fibular autografts in a vertical array because of a large defect following wide resection of an osteosarcoma: a case report with 7 years of follow-up.

Free vascularized fibular autograft transfer to the defect area after wide resection of bone sarcoma is one of many biological reconstruction methods. We report on an 8-year-old girl with 7 years of follow-up treated for right femur osteosarcoma. A 26 cm long tumor was resected with clear margins. Because the length of one fibular autograft was shorter than the defect length, bilateral free vascularized fibular autografts were used in a vertical array on top of one another, and placed inside a fresh-frozen femoral allograft. The original length of the femur was maintained by this technique.

Applications of external fixation for management of complications associated with musculoskeletal tumors and related surgery

OBJECTIVES We evaluated the results of, and the course of treatment with, external fixation (EF) in treating complications associated with bone tumors and related surgery. METHODS Eighteen patients (9 males, 9 females; mean age 19 years; range 6 to 35 years) who were treated with EF were evaluated in three groups. Histologic diagnoses were osteosarcoma (n=3), Ewings sarcoma (n=3), hereditary multiple exostosis (n=3), chondrosarcoma (n=2), synovial sarcoma (n=2), Olliers disease, giant cell tumor of bone, desmoid fibroma, chondromyxoid fibroma, and enchondroma. Complications secondary to bone tumors (n=4) and occurring following limb salvage surgery (n=14) were treated with Ilizarov circular EF in nine patients, unilateral EF in six patients, and both in three patients. RESULTS The first group included eight patients who were treated with EF for infection and nonunion or deformity following surgery. The mean shortening was 10.6 cm, the mean lengthening was 9.7 cm, and the mean external fixator index was 48.8 days/cm. One patient developed fracture of the free vascularized fibula graft after EF removal, and amputation was required in two patients. The second group consisted of six patients who had shortening secondary to tumor surgery. The mean shortening was 7.5 cm, the mean lengthening was 6.5 cm, and the mean external fixator index was 28 days/cm. In this group, the major complications were implant failure and knee stiffness. The third group included four patients with deformity and shortening secondary to multiple exostosis (n=3) and Olliers disease. The mean shortening was 7.5 cm, the mean lengthening was 6.5 cm, and the mean external fixator index was 57.2 days/cm. One patient developed ulnar shortening of 2 cm after growth. CONCLUSION The use of EF in the management of complications associated with bone tumors and related surgery yields successful results especially in young patients.

The results of monoblock stem with step-cut femoral shortening osteotomy for developmentally dislocated hips

Introduction The main objective of this study was to evaluate the midterm results of cementless THA with the use of monoblock stems combined with step-cut femoral shortening derotational osteotomy for DDH. Materials and methods A total of 66 hips of 49 patients with Crowe type IV developmental hip dislocation, with a mean follow-up of 90 (range 26-207) months, were reviewed retrospectively. Subtrochanteric step-cut shortening osteotomy and monoblock femoral stems were used. The cup was placed in the true acetabulum in all cases. 21 hips had previous femoral valgisation osteotomies. Anteroposterior and lateral radiographs of both hips were obtained preoperatively and at the last follow-up examination. The Harris Hip Score (HHS) was used for pre- and postoperative clinical evaluation. Results The mean HHS increased from 49 to 86 points. A total of 13 hips of 10 patients (the isolated acetabular component in 7 hips of 6 patients, the femoral component in 3 hips of 3 patients, and both components in 2 patients) were revised during the follow-up period. Dislocation occurred in 3 hips, deep periprosthetic infection in 2, superficial wound infection in 2, and femoral vein injury and sciatic nerve palsy in 1. Nonunion was observed in 3 osteotomy sites. 10-year survival probabilities of 91% for femoral components for all cases and 78% for acetabular components were found. Conclusions THA with subtrochanteric femoral shortening osteotomy was proven to be an effective technique for avoiding neurological complications for Crowe IV DDH. Cementless THA with the use of monoblock stems showed overall survival rates of 95% at 5 years and 85% at 10 years.