Tourniquet Use Does Not Affect Pain and Function after Total Knee Arthroplasty: Patient Evaluation According to Pain Threshold.

We evaluated the effect of using a tourniquet on early-stage pain and 1-year postoperative functional outcomes when patients were divided into two groups according to the pain threshold (PT). Overall, 120 patients who were assessed preoperatively with an algometer were recruited for this prospective, double-blinded, randomized controlled trial. Patients were randomized to undergo total knee arthroplasty (TKA) with a tourniquet (group 1, 60 patients) and without tourniquet (group 2, 60 patients). Primary outcome measures were visual analog scale (VAS) pain scores at 24, 36, and 48 hours postoperatively and functional assessment with Knee Society Score (KSS) test at 1 year postoperatively. No significant differences were observed between groups in terms of gender (49 females and 8 males in group 1 vs. 53 females and 6 males in group 2; p = 0.201) and age (68.9 years in group 1 vs. 68.7 years in group 2; p = 0.811). There was no significant difference between groups in all the VAS and KSS 1 and KSS 2 scores. PT measurements ranged from 2.5 to 11.5 with a mean of 7.69 ± 1.70 and a median of 8. Total 54 patients with a median value of < 8 were defined as the low-PT group, and 62 patients with a median value of ≥ 8 were defined as the high-PT group. When the groups were evaluated according to using the tourniquet, 21 patients were operated on with a tourniquet and 33 patients without it in the low-PT group, while 36 patients were operated on with a tourniquet and 26 patients without it in the high-PT group. There was no significant difference in pain or functional scores between patients when comparing with-tourniquet and without-tourniquet or when comparing the low- and high-PT groups. This showed that the use of a tourniquet during TKA was not associated with either early-stage pain or 1-year postoperative functional outcomes according to algometer evaluation.Level of evidence: Level 1 prospective randomized study.

Comparison of Self-adhesive Taping and Short-Leg Casting to Treat Tuberosity Fractures of the Proximal Fifth Metatarsal: A Prospective Study.

BACKGROUND: The aim of this study is to compare clinical and radiologic outcomes of self-adhesive taping (SAT) or a short- leg cast (SLC) groups with base of fifth metatarsi. METHODS: Functional outcome was assessed by the Visual-Analogue-Scale Foot and Ankle (VAS-FA) at the Emergency and at 2, 4, 6, and 12 weeks. Labour loss, bone union and The American Orthopedic Foot and Ankle Score (AOFAS) at 12 weeks were also assessed. RESULTS: There was no difference between the SAT group and SLC group in VAS-FA scores at time of injury, 6 and 12 weeks. The SAT group had a significantly higher mean VAS-FA score at the second and fourth weeks of follow-up compared with the SLC group (P = .001 and P = .039, respectively). No correlation was observed between the fracture gap and functional scores for both groups. There was no difference in AOFAS between two groups at 12 weeks. Twenty one patients were unable to work for a mean of 38.2 days during the treatment. 10 patients with the SAT missed 37.5 days and eleven patients with the SLC g missed 40.2 (p: 0.41). The bone union was also achieved for all patients within 12 weeks. CONCLUSION: Treatment with SAT in these fractures had satisfactory functional results compared with traditional SLC. Although there were no significant differences in labor loss and use of assistive devices, The VAS-FA score was significantly higher in SAT group than the SLC group at the second and fourth weeks of treatment.

Predictive Factors and Amputation Level for Reamputation in Patients With Diabetic Foot: A Retrospective Case-Control Study.

The aim of this study was to assess the rate and level of reamputation in patients who had a previous amputation from diabetic foot. We retrospectively analyzed patients who underwent amputation and reamputation due to diabetic foot in our clinic between 2011 and 2019. Fifty-nine were evaluated as the healed group after the first amputation and 55 were evaluated as the reamputation group. Given 55 patients who needed reamputation: there were 13 finger or ray, 23 transmetatarsal or syme, 18 transtibial, and 1 transfemoral in the first operation. We found the reamputation rate was 65.4% in distal amputations. When serum parameters were examined before the first amputation in each group, there was no statistically significant difference in white blood cells, neutrophils, lymphocytes, platelets, sedimentation, C-reactive protein, total protein, hematocrit, urea, creatinine, and HgA1c values. There was, however, a significant difference between groups in albumin levels. When comorbidities were assessed for smoking, hypertension, duration of diabetes, and number of debridements after the first surgery, a significant difference between groups was found. When peripheral artery disease and chronic renal failure were examined, no significant difference was observed. In our study, it was observed that the rate of reamputation was higher in distal level amputations for diabetic foot patients. Accordingly, albumin values, smoking, hypertension, duration of diabetes, number of debridements after surgery, were seen as risk factors for reamputation patients.

Clinical outcomes comparison of distal radius fractures between two conservative treatment methods: Below-arm cast versus reverse sugar tong splint.

BACKGROUND: The purpose of this prospective randomized study was to compare a new reverse sugar tong splint technique with a below-arm cast, in terms of patient radiological and clinical outcomes. METHODS: One hundred and forty patients who presented to our clinic between April 2017 and March 2019 were randomly divided into two groups: 70 received reverse sugar tong (RST group) and 70 received below arm cast (BAC group). Clinical and radiological follow-up was performed 7-10 days, three weeks, 5 or 6 weeks, 12 weeks and one year after the treatment. Clinical outcomes including wrist range of motion, complication rates, Health Assessment Questionnaire (HAQ) score at end of treatment, Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire and Mayo Elbow Performance score (MEPS) score at 12 weeks and last follow-up. RESULTS: Finally, sixty-five patients were treated with BAC, and their average age was 58.2 years and sixty-two patients with an average age of 57.4 years were treated with RST were completed the radiological and clinical one-year follow-up. There were no significant differences in range of motion, radiological parameters, the Q-DASH and MEPS scores between the groups the 12th week and last visit; however, the HAQ score was significantly higher in the cast group during the 6th visit (p < 0.001). The BAC group had a higher complication rate (40%) than the RST group (19.3%) (p = 0.01). CONCLUSION: Patient treated with RST had a higher functional status at end of treatment and lower complications when comparing traditional below arm cast. LEVEL OF EVIDENCE: Level I prognostic randomized controlled trial.

Clinical and radiological results of kyphectomy and sliding growing rod surgery technique performed in children with myelomeningocele.

BACKGROUND: The aim of this study was to present clinical and radiological results of myelomeningocele (MMC) patients treated with the sliding growing rod (SGR) technique after kyphectomy. METHODS: Between 2016 and 2019, 30 patients (21 males and nine females) who underwent the SGR technique with kyphectomy and posterior instrumentation due to MMC were retrospectively reviewed. Patients' pre- and postoperative kyphosis, scoliosis, correction rates, bleeding during surgery, blood supply during and after surgery, operation time, instrumentation levels, number of vertebrae removed, MMC onset levels, hospital stay, annual lengthening amounts, and complications were evaluated. RESULTS: The mean patient age was 6.9 (4-10) years. Mean preoperative kyphosis was 115° (87-166°), mean early postoperative kyphosis was 3.9° (20-10°), and final follow-up postoperative kyphosis was 5.1° (22-8°). In nine patients presenting with scoliosis, scoliosis was evaluated as 60.2° (115-35°) preoperative, as 12.9° (32-0°) early postoperative, and 15.7° (34-0°) in the final measurement. The kyphotic deformity correction rate was 96.5%, and the scoliotic deformity correction rate was 74.9%. A statistically significant difference was seen between pre- and early postoperative values in kyphosis and scoliosis measurements (p < 0.05). The annual prolongation of the patients was calculated as averages of 0.72 and 0.77 cm/year between T1-T12 and T1-S1, respectively. CONCLUSION: Kyphectomy performed during the early MMC period patients appears to be an excellent method for facilitating rehabilitation and daily care of these patients. It appears that the SGR technique, which provides lung volume protection and lengthening with kyphectomy, is a safe and reliable method in patients. LEVEL OF EVIDENCE: Level 4.

Effect of lower extremity amputation on caregiving burden in caregivers of patients with diabetic foot: Prospective cohort study.

Lower extremity amputation as a treatment of diabetic foot ulcer is probably a major burden for the patient's family and friends, who typically act as caregivers and support the patient in coping with the physical disabilities and emotional distress. In the present prospective study, we investigated the effects of different lower extremity amputation levels for diabetic foot ulcer treatment on caregivers of patients with diabetes using the Zarit Burden Interview (ZBI-12) scale. Patients with diabetic foot ulcers who underwent unilateral major amputation (above-below knee) and minor amputation of foot (heel sparing) and their caregivers were requested to volunteer to participate in this study from June 2016 to December 2018. The ZBI-12 form was completed immediately preoperatively and 3 and 6 months after postoperatively. In the minor amputation group, the mean age of the 51 patients was 72.1 years. In the major amputation group, the mean age of the 88 patients was 73.7 years. Both groups of caregivers of patients with minor amputation and major amputations showed a significant improvement in ZBI-12 score when compared preoperatively and at 3- and 6-month follow-up visits. The mean ZBI-12 score was significantly higher in the major than in the minor amputation group in preoperative and all postoperative visits. The absence of the ankle joint in the below- or above-knee amputation renders it more difficult for the amputee to quickly learn the use of prosthesis, thereby increasing the burden of the patient and caregivers. We found that lower extremity amputation for the treatment of chronic diabetic foot ulcers has significantly favourable effect on the caregiver burden, and thereby heel sparing was considerably more effective for the caregiver burden.

Assessment of the Quality and Reliability of the Information on Rotator Cuff Repair on YouTube.

INTRODUCTION: YouTube® has become a common health information source for patients. Recent studies have determined that videos on YouTube® contain misleading and inappropriate information for different medical conditions. The aim of the present study was to assess the quality and reliability of videos pertaining to rotator cuff (RC) repair surgery. HYPOTHESIS: YouTube® users prefer watching videos with high educational quality which are provided by physicians. MATERIAL AND METHODS: A search was performed using keywords "rotator cuff surgery" and "rotator cuff repair" on YouTube® and the first 100 videos for each keyword were analyzed. Video source, time since upload, duration, and number of views, likes, and dislikes were recorded. Video popularity was reported using the video power index (VPI) and view ratio. Video educational quality was measured using the recognized DISCERN, the Journal of the American Medical Association (JAMA) score and a novel RC-specific score (RCSS). RESULTS: Among the 200 videos identified, 67 were included. The mean duration was 7.7minutes and the mean number of the views was 147,430. Videos uploaded by a physician had significantly higher DISCERN, JAMA, and RCSS (p<0.001). While the main video source was physicians (48%), the most popular videos were uploaded by patients and commercial websites, according to the VPI and view ratios. The number of likes, view ratios, and VPI were negatively correlated with each score. There were negative correlations between duration and VPI scores, and positive correlations with DISCERN, JAMA score, and RCSS. Animated videos showed significantly lower results for all quality scores (p<0.05), while their VPI was significantly higher (p<0.01). DISCUSSION: Online information on RC repair surgery provided by YouTube® was low quality, despite being mostly uploaded by physicians and having relatively higher quality scores. YouTube® users prefer watching low quality videos which were provided by patients and commercial websites. LEVEL OF EVIDENCE: IV, Case series.

The effectiveness of preoperative colon cleansing on post-operative surgical site infection after hip hemiarthroplasty.

AIM: This study aimed to evaluate the effectiveness of prophylactic mechanical bowel preparation in elderly patients undergoing hip hemiarthroplasty in a single training institution over a period of 2 years. PATIENTS AND METHODS: The study was conducted in a prospective-randomised manner. All patients, who underwent primary hip hemiarthroplasty for femoral neck fracture in our institution between 20 February 2015 and 29 December 2016, were included. B.T. Enema (sodium dihydrogen phosphate + disodium hydrogen phosphate) 135 ml (Yenisehir Laboratory, Ankara, Turkey) was used for colon cleansing. RESULTS: Ninety-five patients were followed up for at least 1 year after surgery (16.3 ± 4.2 months). Of these, 46 were in the enema group and 49 were in the control group. Demographic and clinical characteristics of patients were similar in both groups (p > 0.05). Infection rates between the two groups were not significantly different (p > 0.05). In addition, ASA, age, sex, presence of diabetes mellitus, duration of surgery, time to surgery, ambulation status and blood count did not have a significant effect on surgical site infections (p > 0.05). However, all infections in the enema group were monobacterial and were successfully treated, whereas two of the four infections in the control group were polymicrobial and could not be successfully treated. CONCLUSION: Although preoperative colon cleansing did not reduce the overall incidence of post-operative infections, our study suggested that it may reduce polymicrobial infections after hip hemiarthroplasty. Polymicrobial infections after hip hemiarthroplasty seem to have worse prognosis. Therefore, the effectiveness of preoperative colon cleansing in remediating such infections must be investigated in a larger number of patients.

The combined administration of systemic and topical tranexamic acid for total hip arthroplasty: Is it better than systemic?

OBECTIVE: The aim of this study was to evaluate the effect of combined intravenous and topical use of tranexamic acid (TXA) on total blood loss and transfusion rate in total hip arthroplasty. METHODS: This prospective randomized study included 57 patients who had undergone total hip arthroplasty between September 2016 and September 2017. The IV administration group (Group 1) consisted of 26 patients (mean age: 63.73 ± 10.29 years), while the IV and topical administiration group (Group 2) consisted of 22 patients (62.82 ± 8.31 years). Demographic data and outcomes were obtained through a review of individual medical records. Medical comorbidities, body mass index (BMI), ASA and CCI, preoperative and postoperative hemoglobin levels, postoperative transfusion records and 90-day joint-related (implant subsidence, dislocation, postoperative anemia, deep infection, hematoma and/or wound problem, postoperative periprosthetic fracture) readmission rate and complication rate were compared between the groups. RESULTS: No significant differences were observed between the 2 groups in terms of age, gender, height, weight, body mass index (BMI), the level of preoperative Hb values, and the American Society of Anesthesiologists (ASA) and Charleson Comorbidty Index (CCI) rating (p > 0.05). The mean postoperative Hgb in the group 2 was higher by a small amount compared to the group 1. No statistically significant difference was determined between the groups in respect of the Hgb values (p = 0.562). Hgb Delta in the group 2 was lower than that of the group 1. The difference between the groups in the Hgb Delta values was not statistically significant (p = 0.268). The mean total blood loss was lower in the group 2 than in the group 1 but the difference was not statistically significant (p = 0.788). There was no significant difference observed in terms of any adverse complications among the 2 groups (p > 0.05). CONCLUSION: The combined administration of IV and topical TXA compared with IV alone can decrease total blood loss and the number of blood transfusions required without increasing the risk of DVT or/and PE in total hip arthroplasty. But the statistical analysis and clinical relevance is not significant. LEVEL OF EVIDENCE: Level I Therapeutic Study.

Is tranexamic acid safe and reliable during tibial intramedullary nailing?

BACKGROUND: The aim of this study was to determine if the use of tranexamic acid (TXA) during intramedullary reaming treatment for tibial diaphyseal fractures was safe, reduced blood loss, or affected cost effectiveness. METHODS: A total of 70 patients with a tibia diaphysis fracture were randomized into 2 groups and prospectively followed for data on blood loss, thrombosis, and fracture healing. Preoperative TXA was administered intravenously to Group A, and Group B served as the control group. RESULTS: While there was no significant difference between the preoperative and postoperative 1-hour hemoglobin (Hb) and hematocrit (Hct) levels of the patients, there was a statistically significant difference in the comparison of the postoperative 24-hour and 48-hour Hb and Hct levels. There was no need for an allogenic blood transfusion to any patient in Group A; however, 2 patients in Group B each received 1 unit of erythrocyte suspension because their Hct values dropped below 27%. There was no deep vein thrombosis or embolism observed in any of the patients. CONCLUSION: The application of intravenous TXA during the preoperative period in the treatment of tibial fractures with intramedullary nailing reduced the bleeding seen in the postoperative period. It did not lead to intravascular thrombosis in the postoperative period, and had no adverse effect on bone healing.

COMPARED EFFICACY OF INTRA-ARTICULAR INJECTION OF METHYLPREDNISOLONE AND TRIAMCINOLONE.

OBJECTIVE: To compare the effect of two different corticosteroid types in bilateral and symmetrical knee osteoarthritis (OA). METHODS: One hundred and twenty-six patients received injections of methylprednisolone acetate (MP) in one knee and triamcinolone hexacetonide (TH) in the contralateral knee. Patients were evaluated before injection and 2, 4, 8, 12, and 24 weeks after. RESULTS: Mean patient age was 68.5±9 years. Mean BMI was 26.3±2.6 kg/m2. At first admission, mean VAS score was 7.7±1.3 for the right side and 7.5±1.5 for the left side, and mean WOMAC score was 67.6±14.4. After bilateral intra-articular injection, VAS scores for both knees and WOMAC scores decreased significantly when initial scores were compared with 2, 4, 8, 12, and 24 weeks after injection (p<0.05). A statistically significant change was seen over time when VAS and WOMAC scores for 2, 4, 8, 12, and 24 weeks post-injection were compared to each other (p<0.05). No significant difference was seen between knee sides (p>0.05). CONCLUSION: MP and TH have similar efficacy in relieving pain and improving function. The efficacy of intra-articular corticosteroid injection peaks 2 weeks after injection and the effect continues until the 24th week. Level of Evidence II, Comparative Prospective Study.

OBJETIVO: Comparar o efeito de dois tipos de corticosteroides em osteoartrite (OA) de joelho bilateral e simétrica. MÉTODOS: Cento e vinte e seis pacientes receberam injeções de acetato de metilprednisolona (MP) em um joelho e de triancinolona hexacetonida (TH) no joelho contralateral. Os pacientes foram avaliados antes da injeção e 2, 4, 8, 12 e 24 semanas depois. RESULTADOS: A média de idade dos pacientes foi 68,5 ± 9 anos. O IMC médio foi 26,3 ± 2,6 kg/m2. Na primeira internação, o escore médio da EVA foi 7,7 ± 1,3 para o lado direito e 7,5 ± 1,5 para o esquerdo e a média do escore WOMAC foi 67,6 ± 14,4. Depois da aplicação bilateral das injeções intra-articular, os escores da EVA e do WOMAC para ambos os joelhos diminuíram significantemente ao comparar os escores iniciais com os de 2, 4, 8, 12 e 24 semanas depois da injeção (p < 0,05). Constatou-se diferença estatisticamente significante no decorrer do tempo, quando os escores EVA e WOMAC às 2, 4, 8, 12 e 24 semanas depois da injeção foram comparados entre si (p < 0,05). Não houve diferença significante entre os lados direito e esquerdo (p > 0,05). CONCLUSÃO: MP e TH têm eficácia similar quanto ao alívio da dor e à melhora da função. A eficácia da injeção intra-articular de corticosteroides atinge o máximo duas semanas depois da aplicação e o efeito continua até a 24a semana. Nível de Evidência II, Estudo Prospectivo Comparativo.

Compared efficacy of intra-articular injection of methylprednisolone and triamcinolone / Comparação de eficácia de injeção intra-articular de metilprednisolona e triancinolona

ABSTRACT Objective: To compare the effect of two different corticosteroid types in bilateral and symmetrical knee osteoarthritis (OA). Methods: One hundred and twenty-six patients received injections of methylprednisolone acetate (MP) in one knee and triamcinolone hexacetonide (TH) in the contralateral knee. Patients were evaluated before injection and 2, 4, 8, 12, and 24 weeks after. Results: Mean patient age was 68.5±9 years. Mean BMI was 26.3±2.6 kg/m2. At first admission, mean VAS score was 7.7±1.3 for the right side and 7.5±1.5 for the left side, and mean WOMAC score was 67.6±14.4. After bilateral intra-articular injection, VAS scores for both knees and WOMAC scores decreased significantly when initial scores were compared with 2, 4, 8, 12, and 24 weeks after injection (p<0.05). A statistically significant change was seen over time when VAS and WOMAC scores for 2, 4, 8, 12, and 24 weeks post-injection were compared to each other (p<0.05). No significant difference was seen between knee sides (p>0.05). Conclusion: MP and TH have similar efficacy in relieving pain and improving function. The efficacy of intra-articular corticosteroid injection peaks 2 weeks after injection and the effect continues until the 24th week. Level of Evidence II, Comparative Prospective Study.

RESUMO Objetivo: Comparar o efeito de dois tipos de corticosteroides em osteoartrite (OA) de joelho bilateral e simétrica. Métodos: Cento e vinte e seis pacientes receberam injeções de acetato de metilprednisolona (MP) em um joelho e de triancinolona hexacetonida (TH) no joelho contralateral. Os pacientes foram avaliados antes da injeção e 2, 4, 8, 12 e 24 semanas depois. Resultados: A média de idade dos pacientes foi 68,5 ± 9 anos. O IMC médio foi 26,3 ± 2,6 kg/m2. Na primeira internação, o escore médio da EVA foi 7,7 ± 1,3 para o lado direito e 7,5 ± 1,5 para o esquerdo e a média do escore WOMAC foi 67,6 ± 14,4. Depois da aplicação bilateral das injeções intra-articular, os escores da EVA e do WOMAC para ambos os joelhos diminuíram significantemente ao comparar os escores iniciais com os de 2, 4, 8, 12 e 24 semanas depois da injeção (p < 0,05). Constatou-se diferença estatisticamente significante no decorrer do tempo, quando os escores EVA e WOMAC às 2, 4, 8, 12 e 24 semanas depois da injeção foram comparados entre si (p < 0,05). Não houve diferença significante entre os lados direito e esquerdo (p > 0,05). Conclusão: MP e TH têm eficácia similar quanto ao alívio da dor e à melhora da função. A eficácia da injeção intra-articular de corticosteroides atinge o máximo duas semanas depois da aplicação e o efeito continua até a 24a semana. Nível de Evidência II, Estudo Prospectivo Comparativo.

Strategies for Proximal Femoral Nailing of Unstable Intertrochanteric Fractures: Lateral Decubitus Position or Traction Table.

BACKGROUND: The aim of this prospective randomized study was to compare the traction table and lateral decubitus position techniques in the management of unstable intertrochanteric fractures. METHODS: Eighty-two patients with unstable intertrochanteric fractures between 2011 and 2013 were included in this study. All patients were treated surgically with the Proximal Femoral Nail Antirotation implant (DePuy Synthes). Patients were randomized to undergo the procedure in the lateral decubitus position (42 patients) or with the use of a traction table (40 patients). Patients whose procedure was not performed entirely with a semi-invasive method or who required the use of additional fixation materials, such as cables, were excluded from the study. The groups were compared on the basis of the setup time, surgical time, fluoroscopic exposure time, tip-to-apex distance, collodiaphyseal angle, and modified Baumgaertner criteria for radiologic reduction. RESULTS: The setup time, surgical time, and fluoroscopic exposure time were lower and the differences were statistically significant in the lateral decubitus group compared with the traction table group. The collodiaphyseal angles were significantly different between the groups in favor of the lateral decubitus method. The tip-to-apex distance and the classification of reduction according to the modified Baumgaertner criteria did not demonstrate a statistically significant difference between the groups. CONCLUSIONS: The lateral decubitus position is used for most open procedures of the hip. We found that this position facilitates exposure for the surgical treatment of unstable intertrochanteric fractures and has advantages over the traction table in terms of set up time, surgical time and fluoroscopic exposure time.

Evaluation of the accuracy of Lachman and Anterior Drawer Tests with KT1000 in the follow-up of anterior cruciate ligament surgery.

Ligament laxity measurement is clinically valuable to diagnose the injury and also to compare the laxity before and after surgical procedure. The aim of the study was to compare the accuracy of the Lachman and Anterior Drawer Tests to evaluate the knee examination with the KT1000 arthrometer after the anterior cruciate ligament (ACL) surgery in early follow-up period. Fourty ACL reconstructed knees were examined with the Lachman and Anterior Drawer Tests, and KT1000 arthrometer with compariable intact knee of the same patients. Physical emanination findings were compared with the KT1000 arthrometer with each power. Spearman correlation and receiver operating characteristic (ROC) analysis were used for the evaluation of relations between parameters. Significance was evaluated in P<0.1 and P<0.05. The mean age was 28.18±6.21 yr, and the mean follow-up was 23.09±9.08 months. The mean KT1000 measurements of 40 operated knees state at 6.8, 9.1, 13.6 kg and maxium anterior displacement forces were 4.9, 6.7, 8.7, and 11.9 mm, respectively. The same values for the same acting forces of intact knees were 4.2, 5.9, 7.8, and 10.2, respectively. In Spearman's correlation and ROC analysis at 13.6-kg power on KT1000 arthrometer statistically matched with pyhsical examinations (P<0.1, P<0.01). In our study, correlation of physical examinations with KT1000 arthrometer is a worthy evaluation technique that can be added to examination of ACL reconstructed knee to control with inexperinced examiners' findings. We suggest that at 13.6-kg power with KT1000 arthrometer findings perfectly match the Lachman and Anterior Drawer Tests of the knee.

Comparison of mortality rates and functional results after transtibial and transfemoral amputations due to diabetes in elderly patients-a retrospective study.

INTRODUCTION: This study aimed to compare mortality rates and functional results of transtibial and transfemoral amputations in elderly patients with diabetes. METHODS: 87 amputees [54 (62.1%) transtibial and 33 (37.9%) transfemoral] were included. Mean ages were 70.7 and 69.3 years in transfemoral and transtibial groups, respectively. Mean follow up time was 41.8 months. Amputee Mobility Predictor scores (with and without prosthesis) and Barthel Daily Living Index were used for functional evaluation of the survivors. RESULTS: First year mortality rates were 29.6% and 30.3% in transtibial and transfemoral groups, respectively. Overall mortality rate of both groups was 65.5% (66.7% in transtibial and 63.6% in transfemoral group). There was no difference between mortality rates of two groups. Duration between surgery and death was significantly shorter in transfemoral group. The mean Amputee Mobility Predictor scores (with prosthesis) of the transtibial and transfemoral groups were 32.3 and 26.9 points, respectively. The average Amputee Mobility Predictor scores (without prosthesis) of the transtibial and transfemoral groups were 29.5 and 22.7 points respectively. The differences between two groups' scores were significant. The mean Barthel Daily Living Index scores of the transtibial and transfemoral groups were 82.5 and 80.2 points respectively. The difference was not significant. CONCLUSIONS: High mortality rates and morbidities after major lower limb amputations emphasize the importance of preventive measures and foot care in patients with diabetes.

Is anterior cruciate ligament surgery technique important in rehabilitation and activity scores?

To compare the two different anterior cruciate ligament surgery techniques' effect in rehabilitation and activity performance. Fifty-five patients were evaluated. Twenty-seven patients with transtibial technique (TT), 28 with anatomic single-bundle technique (AT) included. Tegner Activity Scale (TAS) was performed at preoperation and follow-up. The returning time of the sport and work was evaluated at follow-up. Single-leg hop test was performed at follow-up. Outcomes were compared between the two groups. The determined length difference between the operated knee and the intact knee was compared between the two groups. Average age of TT and AT was 27.9±6.4 yr, 28.3±6 yr, respectively. There was a significant difference between the two groups in duration of returning to sport. TT group had higher duration to return to sport (P<0.01). No difference between the two groups in duration of returning to work (P>0.05). There was a significant difference between the two groups. TT group had significantly higher values than AT group (P<0.01). No difference in TAS between the two techniques at preoperation and at last follow-up (P>0.05). The increase of TAS in patients who had AT was higher than the patients who had TT (P>0.05). No difference in single-leg hop test at 55%-65%, 65%-75%, and 85%-95% level (P>0.05). In this test at 75%-85% TT group had higher values than AT group (P<0.05), AT group had higher values at 95%-105% level (P<0.05). Good short and long-term knee outcome scores depend on rehabilitation protocol after surgery. Surgery technique should provide the adequate stability in rehabilitation period. AT obtains better outcomes in rehabilitation.

Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A Retrospective Cohort Study.

INTRODUCTION: Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT). MATERIAL METHOD: Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 ± 6, and 27.9 ± 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60°/sec, 240°/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis. RESULT: There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p < 0.01). Lysholm Activity level of patients who had AT significantly higher than TT. There was no statistically significant difference between Modified Cincinnati activity level of the patients (p < 0.05). Modified Cincinnati activity level of patients who had AT were significantly higher than those had TT. There was no statistically significant difference between two groups with post treatment IKDC activity level (p < 0.01). Intense activity after treatment rate of patient who had AT was significantly higher than those had TT. There was statistically significant difference between Cybex extension-flexion 60 measurement and extension 240 measurement of the patients (p < 0.01). KT-1000 arthrometer test results with AT was better than the TT in antero-posterior translation of the knee kinematics at 20 and 30 pound of forces. Return to exercise time of patients who had TT was significantly higher than those had AT (p < 0.01). There was no statistically significant difference between return to work time of patients (p > 0.05). CONCLUSION: Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics.

Surgical treatment of dorsal perilunate fracture-dislocations and prognostic factors.

INTRODUCTION: Perilunate injuries are rare entities which can be difficult to diagnose. Most common type is dorsal perilunate fracture dislocation (97%). The purpose of treatment is anatomic reduction and stable fixation. We aimed to present the radiologic and functional results of surgically treated dorsal perilunate fracture-dislocations and discuss the factors influencing the prognosis. METHODS: Between 2007 and 2013, 17 patients were operated for perilunate fracture-dislocations. The mechanism of injuries, soft tissue traumas, etiologic factors and stages according to Herzberg classification were determined. The MAYO wrist score was used for functional evaluation. Scapholunate distance and scapholunate angle were measured and, degenerative changes were investigated by comparing with contralateral side on plain x-ray images in terms of radiologic evaluation. RESULTS: Mean follow-up was 37,8 (range, 16-84) months. The average age at surgery was 35.1 (range, 18-51) years. Fifteen patients were male and two were female. Functional results were excellent in four (23.5%), good in two (11.8%), satisfactory in five (29.4%) and poor in six (35.3%) patients. Degenerative changes were determined in radiocarpal and mid-carpal joints of 14 wrists (82.4%). Scapholunate dissociation more than 2 mm was detected in three wrists. In four wrists osteochondral fragments were determined on the head of the capitate. Stage 2 lesions, delayed presentations, open fractures, scapholunate dissociations more than 2 mm had worse functional results. CONCLUSION: Despite anatomic reduction, ligamentous and chondral injuries that occured at the time of trauma may cause persistant wrist pain in patients who suffer perilunate fracture dislocation. Mechanism of injury, presence of soft tissue defects and the time between injury and treatment can affect clinical and radiologic results.

Isokinetic dynamometer evaluation of the effects of early thigh diameter difference on thigh muscle strength in patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft.

After anterior cruciate ligament (ACL) reconstruction, which muscle groups are more affected from frequently developing thigh muscle atrophy is a matter of debate. We evaluate the effect of thigh circumference difference between patients' knees who were administered the ACL reconstruction with hamstring tendon autograft and intact knees, on torque between the hamstring and quadriceps muscles. Fifty-five patients at least 6 months follow-up period available were included in our study. Power measurements of quadriceps and hamstring muscle groups in patients' extremities were done by using isokinetic dynamometer. The maximum torque values at 60°/sec, 240°/sec in frequency, positions of flexion and extension were determined. In accordance with our findings it is still possible to encounter the thigh atrophy in average 28 months after ACL reconstruction surgery even under physical rehabilitation programs and appropriate follow-up. It is inevitable for the clinician to consider these changes in diagnosis and rehabilitation stages. It can't be ignored that muscle weakness mechanisms developing in the thigh circumference vary according to the thigh muscle group and knee flexors play an important role in thigh atrophy when determining an appropriate rehabilitation program after reconstruction application.