Yalim Ates

Comparison of prilocaine and bupivacaine for post-arthroscopy analgesia: A placebo-controlled double-blind trial

Arthroscopic surgery requires early postoperative analgesia for early discharge and early rehabilitation of patients. To accomplish the effectiveness of intraarticular application of local anesthetics, a placebo-controlled double-blind trial was performed. Results were evaluated using the visual analog scale on a blind basis. The mean pain scores were generally lower in the bupivacaine group than in the control or prilocaine group. There were no statistically significant differences between the oral intake of analgesics and the level of analgesia obtained in all three groups. We consider the local application of analgesics to be ineffective for post-arthroscopy analgesia.

Fixation of femoral neck fractures with three screws: results and complications

OBJECTIVES To evaluate the results and complications of femoral neck fractures treated with internal fixation with three screws with an average follow-up of three years. METHODS Thirty seven patients operated upon between June 2000 and May 2005 for fractures of the femoral neck with three screws were identified as the study population. The final results of 26 patients (11 male, 15 female, with an average age of 39.8, range 16-69) that had a minimum of two year follow-up (average 37 months, range 24-64 months) were evaluated. Those patients that had additional fractures were not included in the evaluation. Preoperatively based on Garden classification four patients (15%) were Type I, eight patients (31%) were type 2, six patients (23%) were type three and eight patients (31%) were type 4. Functional results were evaluated according to the UCLA hip score. RESULTS The average time to union was 5.5 months (range 3-12 months). One patient did not achieve union and a total hip replacement was done in the 15th postoperative month. Four patients had avascular necrosis (AVN) of the femoral head. The incidence of AVN in patients who had an operation within 24 hours of fracture was 9.5% while 40% in patients operated later than that. In patients with AVN one required a total hip replacement, another required treatment with bipolar hemiarthroplasty, the other two patients did not require further operations. One patient underwent bipolar hemiarthroplasty after screw pullout occurred on the 35th postoperative day. Fifteen patients (58%) had excellent results, five (19%) had good, 5 (19%) had moderate results and one (4%) had a poor result. CONCLUSION Operative treatment with internal fixation using three screws in femoral neck fractures in the first 24 hours after a fracture gives favourable results in young patients that are too young to be considered for arthroplasty.

Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method.

In this prospective case series we evaluated the effectiveness and safety of using an anterior approach to paediatric supracondylar humerus fractures. We gathered data on 46 children that had a displaced supracondylar fracture of the humerus. All the patients had sustained a Gartland type III extension fracture that could not be reduced by closed means. Open reduction through an anterior approach was performed and two Kirschner wires were used to fix the fracture to the medial and lateral sides. Patients were recalled for follow-up and were evaluated using Flynn’s radiological and clinical criteria. Loss of extension and flexion was noted by clinical assessment and carrying angle measured on radiograms. A follow-up examination performed in the 24th postoperative week showed that all fractures had healed; the patients’ outcomes were rated as excellent or good according to Flynn’s criteria. As a result the anterior approach for open reduction of paediatric supracondylar humeral fractures is a safe and reliable method with very good results.RésuméCette étude prospective a pour but d’évaluer l’efficacité et la sécurité apportées par l’abord antérieur lors des fractures supra condyliennes chez l’enfant. Nous avons réuni les données de 46 enfants ayant présenté une fracture déplacée supra condylienne de l’humérus. Tous les patients présentaient une fracture de type III de Gartland en extension qui ne pouvait être réduite orthopédiquement. La réduction sanglante par abord antérieur a été réalisée à l’aide de deux broches de Kirschner de façon à fixer cette fracture au niveau du pilier interne et du pilier externe. Les patients ont été revus sur le plan clinique et radiologique en utilisant la technique de Flynnac. Les défauts d’extension et de flexion ont été notés et rapportés aux angles radiographiques. Le suivi réalisé à la 24ème semaines post-opératoire montrait que toutes les fractures avaient consolidées, tous les patients pouvant être côtés comme excellents, ou bons selon les critères de Flynnac. Nous pensons que le traitement sanglant de ces fractures par voie antérieure est un traitement fiable et qui permet d’avoir de bons résultats.

Early results of HemiCAP® resurfacing implant

OBJECTIVE Metallic implants in the first metatarsophalangeal (MTP) joint have been used for many years in the treatment of hallux rigidus (HR). The HemiCAP(®) prosthesis is the first implant used for resurfacing the metatarsal head in HR treatment. The aim of our study was to evaluate the early results of the HemiCAP(®) prosthesis for the treatment of HR. METHODS A total of 27 toes of 25 patients with MTP arthritis of the great toe were treated with an Arthrosurface(®)HemiCAP(®) resurfacing implant. The average follow-up time was 37.6 (range: 30 to 43) months. All patients were evaluated clinically and radiographically. Postoperative satisfaction and function were scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Pain was assessed with the use of a visual analogue scale (VAS) ranging from 0 to 10, with 0 indicating the absence of pain and 10 describing the worst pain imaginable. RESULTS Mean preoperative AOFAS score improved from 40.94 (range: 25 to 63) to 85.1 (range: 54 to 98) at the final follow-up (p<0.0001). Preoperative average VAS pain scores improved from 8.30 preoperatively to 2.05 at the final follow-up (p<0.0001). The average MTP joint range of motion (ROM) the improved from 14.36 degrees preoperatively to 54.38 degrees at the final follow-up. No radiologic loosening or osteolysis was observed in patients with HemiCAP(®) implant. CONCLUSION The early results of the HemiCAP(®) implant on the metatarsal head are promising. However, studies over a longer period involving more patients would be beneficial in terms of defining and reviewing the stability of the implant and any innovations in the treatment strategy for HR.

Comparison of anterior and lateral approaches in the treatment of extension-type supracondylar humerus fractures in children.

Eighty-four patients who underwent open reduction and Kirschner wire (K-wire) fixation for supracondylar humerus fractures through anterior or lateral approach with or without additional medial incisions were compared with regard to complications and end results. A total of 46 patients were operated through the anterior and 38 through the lateral approach. In lateral approach cases, medial incision was added only in those patients in whom the medial condyle and therefore the ulnar nerve were not easily distinguished due to excessive oedema. All the fractures were Gartland type III extension fractures. The patient series was consecutive, and lateral approach had a longer follow-up of 89 months (70–134 months); the incision protocol was changed approximately mid-series to the anterior approach, and therefore a shorter follow-up time of only 50 months (24–84 months) was possible. All patients were treated according to the same postoperative protocol. A follow-up examination was performed and all the patients were evaluated according to Flynns criteria; loss of flexion or extension clinically, any deviation of the carrying angle radiologically, and the appearance of the incision scar were evaluated. According to the above parameters, results were excellent in 19, good in 18, and fair in one in the lateral incision group, whereas in the anterior incision group, excellent results were obtained in 31 patients and good results in 15 of them. Cosmetically, two patients in the lateral incision group had hypertrophic scar tissue, whereas the anterior incisions were barely noticeable as they were included into the flexion crease. In conclusion, we can say that anterior incision when open reduction is needed in pediatric supracondylar fractures offer the advantage of a smaller scar and easy access to structures that might be injured between the fractured fragments.

THE RELATIONSHIP BETWEEN THE TREATMENT OF CONGENITAL DISLOCATION OF THE HIP AND AVASCULAR NECROSIS

The most important complication following the treatment of congenital dislocation of the hip is avascular necrosis. The potential sequelae that may arise after the onset of avascular necrosis are worse than if the hip remained dislocated. We evaluated 38 hips in which avascular necrosis developed after reduction. The average patient age at the time of reduction was 4.3 years, with a follow up of 6 to 15 years. Twelve hips had closed reduction and 26 had open reduction. Following reduction, 8 hips had Type I, 6 had Type II, 9 had Type III, and 15 had Type IV avascular necrosis. In this article, we evaluate our cases and review current literature on the subject. Close follow up and timely interventions can reduce potential sequelae to a minimum.