Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty.

OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.

Effect of patellar resurfacing surgery on bleeding in total knee arthroplasty

SUMMARY OBJECTIVE: Postoperative bleeding is one of the most important factors affecting clinical and functional results in total knee arthroplasty. Therefore, many studies have been conducted on bleeding in arthroplasty patients. However, there are very few reports investigating the effect of patellar surface replacement on bleeding in knee arthroplasty. We, therefore, aimed to investigate the effect of patellar surface replacement on postoperative bleeding. METHODS: In this retrospective study, 30 with patellar resurfacing were compared with 39 without patellar resurfacing among patients who had undergone total knee replacement due to primary osteoarthritis. Demographic data, amount of transfusion, preoperative and postoperative hemoglobin and hematocrit values, and total, visible, and hidden blood loss values were recorded. RESULTS: No statistical difference was found between the two groups in terms of demographic values. There was no significant difference between the groups in terms of the amount of blood in the drain, total blood loss, hidden blood loss, and blood transfusion in patients who had and had not undergone patellar resurfacing. A positive significant correlation was found between postoperative drainage volume and total blood loss. CONCLUSION: Patellar component application in patients who had undergone total knee arthroplasty does not change the blood loss of the patients.

Effect on mortality of treatment method and surgery time for hip fracture patients aged over 65 years.

BACKGROUND: This study aimed to evaluate the effects on mortality of implant selection used and time to surgery in patients aged over 65 years operated for hip fractures. METHODS: A total of 301 patients aged over 65 years were investigated in this study. Patients were divided into three groups as follows: Group 1 cemented hemiarthroplasty (CH), Group 2 cementless hemiarthroplasty (CLH), and Group 3 proximal femoral nail (PFN). Time of surgery, fracture and demographic information were retrospectively recorded. RESULTS: After removing 59 patients with missing information, this study included 242 patients. Mean age of patients was 80.5 years. When patient groups were examined according to treatment method, Group 1 (n=146) comprised 60.3%, Group 2 (n=54) comprised 22.3% and Group 3 (n=42) comprised 17.4% of the study group. There was no significant difference in survival between the patients operated in the first 48 hours and the patients operated later (p=0.834). There was an effect on the survival of treatment implant selection (p=0.016). Patients with CH were observed to survive longer than patients with CLH and PFN. CONCLUSION: Operation in the first 48 hours was not observed to affect mortality. Additionally, while sex and age were found to be effective on mortality, implant selection was also concluded to affect mortality.

Investigation of mechanical strength of teicoplanin and ciprofloxacin impregnated bone cement on Day 1 and Day 15.

OBJECTIVE: The aim of this study was to compare the mechanical effects of different concentrations of teicoplanin and ciprofloxacin addition in bone cement. METHODS: In an experimental design, 3 different doses of teicoplanin and ciprofloxacin (800, 1600 and 3200 mg) were added to bone cement. Mechanical tests using compression and four-point bending tests were performed on Day 1 and after antibiotic leaching in water at 37°C on Day 15. Specimens that contained no antibiotics served as controls. Mechanical strength for each antibiotic concentration on Day 1 and Day 15 were evaluated. RESULTS: Both teicoplanin and ciprofloxacin significantly decreased the mean strength values in compression and four-point bending tests at Days 1 and 15 (p<0.05). While teicoplanin significantly decreased the mean strength values at high doses in both tests at Days 1 and 15 (p<0.05), ciprofloxacin did not significantly change these values. When the effects of two drugs compared, there were significant differences at the 3200 mg dose at Day 1 and at 1600 and 3200 mg doses at Day 15 in the compression testing and at 3200 mg at Day 15 in the four-point bending test. CONCLUSION: Teicoplanin and ciprofloxacin addition may adversely affect the biomechanical strength of bone cement. Ciprofloxacin addition seems to have less of a negative effect on strength than teicoplanin.

Aspiration and methylprednisolone injection to the cavity with IV cannula needle in the treatment of volar wrist ganglia: New technique.

OBJECTIVE: There are several types of treatment modalities for wrist ganglions. The aim of the study was to assess the effectiveness of cyst aspiration and methyl prednisolone acetate injection with double IV cannula rather than sharp pointed needle, as a new technique in the treatment of volar ganglia. METHODOLOGY: The study involves total of 19 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Mean follow up time was 2.1±0.5 years. RESULTS: The study involved 19 patients that received aspiration treatment for volar ganglion cysts between January 2004 and December 2009. There were 12 (63.2%) female and 7 (36.8%) male subject with volar wrist ganglion cyst. The mean age of patients was 27.63±6.6 years. Fourteen (73.7%) patients of total had cysts close to the artery. We didn't observe any complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in three (15.8%) patients. CONCLUSION: This method has lower recurrence rate than other aspiration therapy with sharp pointed needle. We prefer to use IV cannula needle for cyst aspiration and steroid injection in treatment of volar ganglia before any surgical intervention.

Mini transverse versus longitudinal incision in carpal tunnel syndrome.

OBJECTIVE: To evaluate the effectiveness of mini-transverse compared with mini-longitudinal incision for carpal tunnel release (CTR) with reference to postoperative functional capacity, symptom severity and complication rate. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Cumhuriyet University Medical Faculty, Department of Orthopaedics, Tokat State Hospital, Department of Orthopaedics and Medical Park Tokat Hospital, Department of Neurosurgery, from January 2007 to January 2009. METHODOLOGY: This study included 93 hands of 79 patients with carpal tunnel syndrome (CTS), which were operated between 2007 and 2009. Patients were divided according to incision types into Group-1 (undergoing mini-longitudinal incision) and Group-2 (undergoing mini-transverse incision). Patients were evaluated initially and at 3 weeks after treatment according to symptom severity and functional status of Boston Questionnaire (BQ). Demographic and clinical data were analyzed and compared statistically between two groups. RESULTS: Statistically significant differences were observed in BQ symptom and functional scores between the pre- and postoperative period (p < 0.0001). BQ symptom and functional scores at postoperative period were better in Group-1 than Group-2 (p = 0.044 and p = 0.023 respectively). The scar hypersensitivity (p = 0.258) and tenderness (p = 1.00) associated with the incision sites were not statistically different. CONCLUSION: Longitudinal incision is more effective on symptom and functional conditions than transverse incision. However, there was less scar formation with transverse incision.

The importance of needle echogenity in ultrasound guided axillary brachial plexus block: a randomized controlled clinical study.

OBJECTIVE: In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery. METHODS: 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided axillary block using non-echogenic needle with nerve stimulator assistance. Duration of block procedure, mean arterial pressure, heart rate, pulse-oximetry, onset time of sensory and motor block, duration of sensory and motor block, time to first analgesic use, total need for analgesics, postoperative pain scores, patient and surgeon satisfaction scores were recorded. RESULTS: Duration of block procedure values were lower in group E and NS, sensory and motor block durations, were significantly lower in group N. Sensorial and motor block onset time values were found lower in group NS but higher in group N. Patient and surgeon satisfaction scores were found lower in group N. CONCLUSION: We conclude that ultrasound guided axillary block may be performed successfully using both echogenic needles and nerve stimulation assisted non-echogenic needles.

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip before the age of 18 months.

PURPOSE: The purpose of this study is to evaluate the results of arthroscopy assisted surgical treatment of developmental dislocation of the hip (DDH). METHODS: Arthroscopic assisted surgical treatment was performed on nine hips of nine female children with DDH using our method, published previously, between January 2001 and December 2005. Their ages ranged from 9 to 16 months. Percutaneous adductor tenotomies were performed in seven cases. A spica cast and abduction splint were used for 11-17 weeks postoperatively. Acetabular index and Shenton line were used for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively with respect to range of motion restriction, and the leg length discrepancy. RESULTS: The average follow-up was 47.7 months (range 22-79 months). Acetabular index measurements of cases in the preoperative/postoperative periods were as follows: preoperative mean angle 39.9° (range 34°-52°)/postoperative mean angle 26° (range 22°-34°). Hip joint restriction and leg length discrepancy were not observed postoperatively. However, two patients had acetabular dysplasia. Acetabular dysplasia was completely resolved in one patient in the third year of follow-up, whereas Salter innominate osteotomy, required in another patient, was in the second year of follow-up. The latter patient was the oldest case (16-month-old) in our series. CONCLUSIONS: Based on the results of this study, treatment of developmental hip dysplasia with arthroscopic-assisted surgical treatment technique may be safe and effective method. Further clinical studies will be required to confirm this study.

Biomechanical properties of ciprofloxacin loaded bone cement.

OBJECTIVE: The purpose of this study was to investigate the biomechanical properties of bone cement used in joint replacement surgery after the addition of ciprofloxacin. METHODS: The first group received bone cement only and served as a control for the 4 groups where 500 mg, 1000 mg, 1500 mg and 2000 mg of ciprofloxacin were added to yield 40 g of bone cement. Axial compression tests were conducted using a 50,000 Newton capacity tension-compression testing device. RESULTS: While axial compression strength at failure was 80.2±4.3 MPa in the control group, values in the ciprofloxacin-treated groups decreased with rising concentration of ciprofloxacin to 74.5±5.4 MPa, 70.6±4.8 MPa, 70.5±4.7 MPa, and 69.3±3.4 MPa. CONCLUSION: Bone cement with addition of 500 to 1500 mg ciprofloxacin maintained mechanical axial strength values above 70.0 MPa recommended by American Society for Testing and Materials and can be safely used in joint replacement surgery.

Does Kinesio taping in addition to exercise therapy improve the outcomes in subacromial impingement syndrome? A randomized, double-blind, controlled clinical trial.

OBJECTIVE: The aim of this study was to determine the effectiveness of Kinesio taping (KT) application added to the exercise treatment of subacromial impingement syndrome (SIS). METHODS: Thirty-eight (25 female, 13 male) patients with SIS were randomly divided into therapeutic KT (n=19) and sham KT (n=19) groups. All patients received the same exercise therapy in addition to therapeutic or sham KT at 3-day intervals for 12 days. The groups were compared according to pain, range of motion (ROM), muscle strength and DASH and Constant scores before treatment and at the 5th and 12th treatment days. RESULTS: Within group comparisons showed significant improvements in both groups at the 5th and 12th day evaluations (p<0.05). In comparisons between the groups, pain with movement and DASH scores in the therapeutic group were significantly lower at the 5th day (p<0.01). There were significant improvements in night pain, pain with movement, DASH score, shoulder external rotation muscle strength, and pain free shoulder abduction ROM in the therapeutic group at the 12th day (p<0.05). Passive shoulder flexion ROM increased more in the sham group at the 12th day (p<0.05). CONCLUSION: The addition of KT application to the exercise program appears to be more effective than the exercise program alone for the treatment of SIS.

[Radiation synovectomy therapy combined with surgical synovectomy in chronic nonspecific synovitis of the knee joint]. / Diz ekleminin kronik nonspesifik sinovitlerinde cerrahi sinovektomi ile kombine radyasyon sinovektomi tedavisi.

OBJECTIVES: This study aims to investigate the effectiveness of the radiation synovectomy (RS) procedure combined with the surgical synovectomy in the treatment of chronic nonspecific synovitis, which are resistant to medical treatment. PATIENTS AND METHODS: Between March 2004 and October 2009, 17 knees of the 17 patients (15 males, 2 females; mean age 42.5 years; range 27 to 70 years) who underwent synovectomy surgery, followed by RS procedure with the 90Y at six weeks were included. At the end of a mean 48.7 months (range; 15-126 months) follow-up period, the Lysholm Knee Scale scores were used for functional assessment before and after RS procedure. The nocturnal pain, resting pain, activity pain and effusion were evaluated with the visual analog scale. The patient satisfaction was recorded as excellent, very good, good and poor. RESULTS: At the end of the follow-up period, all patients had satisfaction scores of excellent and very good. There was a statistically significant difference between all assessment scores before and after treatment (p<0.05). It was found that none of the cases had radionuclide leakage from the joint in their control scintigraphy following RS procedure. No significant complication was seen except for deep vein thrombosis developed in one case. CONCLUSION: Our study results showed that RS procedure combined with the surgical synovectomy is an effective and safe treatment method for the treatment of cases of chronic nonspecific synovitis which recurs despite medical treatment.

Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis.

Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure.

The long-term effects of extracorporeal shock waves on the epiphysis of the adolescent rat.

BACKGROUND: Extracorporeal shock waves (ESW) have been successfully used to treat musculoskeletal injuries, tendinopathy, and plantar fasciitis. Different side effects of high-energy ESWT on bones, tendons, nerves, epiphysis, and cartilage have been discussed. Although the effects of ESW on the epiphysis in animal models have been described, no studies have investigated the long-term effect of ESW on the immature epiphysis in an animal model. The purpose of this study was to investigate the long-term effects of ESW on the immature epiphysis in rats. METHODS: Sixteen 4-week old Wistar albino rats, average weight 116.3 grams (109.6-120.2 g) were used for these experiments. The rats were randomly divided into two groups, the ESW 1500 pulses (ESW1500p) group (n = 8) and the ESW 3000 pulses (ESW3000p) group (n = 8). In the ESW1500p group, 1500 pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. In the ESW3000p group, 3000 pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. The right knees (n = 16) of the rats in the two groups were used as the controls. The animals were sacrificed after an 8-month follow-up period. Femoral epiphyses were assessed by use of histology. The femoral length (FL), tibial length (TL), and femoral supracondylar medio-lateral width (MLW) were measured. RESULTS: There was no statistically significant difference between FL, TL, and MLW for the three groups (P > 0.05). The average histological scores were 8.8 (7-10), 17.8 (15-22), and 2.7 (0-4) in the ESW1500p, the ESW3000p groups, and the controls, respectively. The average histological score for the ESW3000p group was significantly higher than those for the ESW1500p group and the controls (P < 0.001). The average histological score for the ESW1500p group was significantly higher than that for the controls (P < 0.001). CONCLUSIONS: The histological findings of this study indicate that ESW increased the cellularity and basophilia of the extracellular matrix (ECM) in the adolescent rat epiphysis and there were no negative effects on extremity measurements in the long term.

Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block.

BACKGROUND: Although several studies have described effects of dexmedetomidine on peripheral nerve blocks, to date there is limited knowledge available on the impact of dexmedetomidine adjunct to levobupivacaine in axillary brachial plexus block. OBJECTIVE: In this study, we aimed to investigate the effects of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. METHODS: A total of 64 patients of American Society of Anesthesiologists physical status I/II scheduled to undergo forearm and hand surgery, in which an axillary block was used, were enrolled. The patients were randomly divided into 2 groups: in group L patients (n = 32), an axillary block was performed with 39 mL levobupivacaine 5% plus 1 mL of isotonic sodium chloride. In group D patients (n = 32), an axillary block was performed with 39 mL levobupivacaine 5% and 1 mL dexmedetomidine 1 µg/kg(-1) plus isotonic sodium chloride. Demographic data, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Spo2), sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, intraoperative verbal analog scale, postoperative visual analog scale (VAS) data, and side effects were recorded for each patient. RESULTS: There were no significant differences in patient and surgery characteristics between the 2 groups. Sensory block onset time was shorter in group D (P < 0.05). Sensory and motor block duration and time to first analgesic use were significantly longer in group D (P < 0.05), and the total need for analgesics was lower in group D (P < 0.05). Intraoperative 5- and 10-minute verbal analog scale values and postoperative VAS value at 12 hours were significantly lower in group D (P < 0.05). Intraoperative MAP and HR values, except at 5 minutes and postoperatively at 10 and 30 minutes and 1 and 2 hours, were significantly lower in group D (P < 0.01). Bradycardia, hypotension, hypoxemia, nausea, vomiting, and any other side effects were not seen in any patients. CONCLUSIONS: It was concluded in our study that adding dexmedetomidine to axillary brachial plexus block shortens sensory block onset time, increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side effects. ClinicalTrials.gov identifier ISRCTN67622282.

Long segment instrumentation of thoracolumbar burst fracture: fusion versus nonfusion.

OBJECTIVE: The treatment of thoracolumbar burst fracture is a controversial issue. Although spinal fusion has been a touchstone of spinal fixation, nonfusion technique have become raising its popularity recently. Some studies suggested that nonfusion had several advantages over fusion. The aim of this prospective study was to compare long segment posterior instrumentation with fusion versus long-segment posterior instrumentation without fusion. METHODS: For this purpose, 42 consecutive patients were assigned to two groups. Group 1 included 21 patients treated by long segment instrumentation with fusion (WF), whereas Group 2 included 21 patients treated by long segment instrumentation without fusion (WOF). Long segment instrumentation was hook fixation (claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra) above and pedicle fixation (pedicle screws attached to first and second lower vertebrae) below the fractured vertebra. RESULTS: Measurements of local kyphosis, sagittal index and anterior vertebral height compression showed that both group had similar outcome at final follow-up. Moreover, there was no difference between the two groups according to low back outcome score. Also, implant failure rate (4.7%) was quite low in both groups. However, WF group had prolonged operative time, increased blood loss and donor site morbidity. CONCLUSIONS: Radiological and clinical parameters demonstrated that spinal fusion is not necessary in long segment posterior instrumentation for the management of thoracolumbar burst fractures.

[School screening for scoliosis in Sivas, Turkey]. / Sivas il merkezinde skolyoz için okul taramasi.

OBJECTIVES: We investigated the prevalence of scoliosis among primary school students in Sivas, Turkey. METHODS: To determine the prevalence of scoliosis among primary school students in the age bracket of 10 to 15 years, 11 primary schools were selected with systematic sampling. A total of 3,175 students (1,538 girls, 1,637 boys) of grades 6 to 8 were selected from 16,103 students using a stratified sampling method. Examination for scoliosis was made by the forward bend test and palpation of the spine. RESULTS: Fifteen children (0.47%) were found to have scoliosis, including 10 girls (66.7%) and five boys (33.3%). The prevalence of scoliosis was significantly higher in girls (0.65% vs. 0.31%; p<0.05). The mean lateral curvature of the spine was 6.9 degrees (range 5 degrees to 20 degrees ), being 7.9 + or - 4.6 degrees in girls, and 5.4 + or - 0.9 degrees in boys. The mean age was 13.5 + or - 1.2 years (range 12-15 years). The severity of the curvature showed no significant relationship with gender and age groups (p>0.05). The levels of involvement were lumbar vertebrae in 73.3% (n=11), thoracic vertebrae in 13.3% (n=2), and thoracolumbar vertebrae in 13.3% (n=2). Spinal curvature was to the right side in 12 cases (80%), and to the left in three cases (20%). Girls and boys did not differ significantly with respect to the severity and direction of the curvature (p>0.05). During a two-year follow-up of children with scoliosis, no progression of the curvature was observed, including one child who wore a Milwaukee brace. CONCLUSION: School screenings may be performed as part of prevalence studies; however, routine school screening for scoliosis is debatable.

Addition of dexmedetomidine or lornoxicam to prilocaine in intravenous regional anaesthesia for hand or forearm surgery: a randomized controlled study.

BACKGROUND AND OBJECTIVES: Intravenous regional anaesthesia (IVRA) is a simple and cost-effective technique that is ideally suited for surgery involving the distal arm. This study compared the effect of lornoxicam or dexmedetomidine in IVRA with prilocaine in patients who underwent hand or forearm surgery. M ethods: This randomized, double-blind study enrolled 75 patients scheduled for hand or forearm surgery. IVRA was achieved with 2% prilocaine 3 mg/kg in the control group (n=25), 2% prilocaine 3 mg/kg plus dexmedetomidine 0.5 microg/kg in the dexmedetomidine group (n=25), and 2% prilocaine 3 mg/kg plus lornoxicam 8 mg in the lornoxicam group (n=25). In all groups, 0.9% NaCl solution was added to make up a total volume of 40 mL. Sensory and motor block onset and recovery times, haemodynamic variables, visual analogue scale (VAS) pain and sedation scores, duration of analgesia, total analgesic consumption over 24 hours, adverse effects and quality of anaesthesia were recorded. RESULTS: Sensory block onset was shorter and sensory block recovery time longer in the dexmedetomidine group compared with the lornoxicam and control groups (p<0.05). Sensory and motor block recovery times and duration of analgesia for tourniquet were prolonged in the dexmedetomidine and lornoxicam groups compared with the control group (p<0.05). Median VAS scores for tourniquet pain in the dexmedetomidine and lornoxicam groups were lower than that of the control group at 15 and 30 minutes (p<0.05). Postoperatively, the duration of analgesia time was longer and median VAS scores were lower during the first 12 hours in the dexmedetomidine and lornoxicam groups compared with the control group (p<0.05). Total analgesic consumption over 24 hours was lower in the dexmedetomidine and lornoxicam groups compared with the control group (p<0.05). Anaesthesia quality as determined by the anaesthesiologist was better in the dexmedetomidine and lornoxicam group than in the control group (p<0.05). CONCLUSIONS: Addition of dexmedetomidine or lornoxicam to prilocaine in IVRA decreased VAS pain scores, improved anaesthesia quality and decreased analgesic requirement. We suggest that addition of dexmedetomidine or lornoxicam at the doses used in this study to IVRA with prilocaine in this setting can be useful without causing adverse effects. No hypotension, bradycardia or hypoxia requiring treatment was seen in any of the patients. Addition of dexmedetomidine had a more potent effect, shortening sensory block onset time and prolonging sensory block recovery time more than lornoxicam.

Novo Parafuso (Acutrak®) No tratamento cirúrgico de jogadores de futebol de elite com fraturas do quinto metatarso / New screw (Acutrak®) in the surgical treatment of elite football players with fifth metatarsal

OBJETIVO: Há uma variabilidade considerável na literatura no que tange ao tratamento ideal de fraturas do quinto metatarso. O objetivo deste estudo é apresentar os resultados da fixação cirúrgica de fraturas do quinto metatarso usando o parafuso Acutrak® em jogadores de futebol de elite. MATERIAL E MÉTODOS: Três casos de fratura do quinto metatarso em jogadores de futebol de elite são apresentados. A média de idade dos pacientes era de 24 anos (18-26 anos). Tratamos as três fraturas do quinto metatarso em jogadores de futebol de elite. Os casos em nosso estudo consistiam de uma fratura diafisiária do quinto metatarso e duas fraturas de Jones. As fraturas ocorreram durante a participação nos jogos. Aplicamos fixação interna utilizando um parafuso Acutrak® percutâneo sob anestesia local com o auxílio de um fluoroscópio. Os pacientes foram clinica e radiograficamente avaliados. RESULTADOS: O restabelecimento clínico foi obtido em 10 semanas após a cirurgia. A consolidação radiográfica ocorreu em 8 semanas de pós-operatório, sendo que os pacientes retornaram a seus níveis prévios de atividade em 11 semanas de pós-operatório. Não foi relatada nenhuma complicação pósoperatória. Não se observou nenhuma irritação de pele devido à ausência de cabeça do parafuso Acutrak®. CONCLUSÃO: Os resultados sugerem que Acutrak® pode ser usado em jogadores de futebol com fraturas do quinto metatarso. Apesar de fatores como facilidade de implante, o custo e a resistência a inclinação também devem ser considerados.

OBJECTIVE: There is considerable variability in the literature concerning the optimal treatment of fifth metatarsal fracture. The purpose of this study is to report the outcome of surgical fixation of fifth metatarsal fractures using Acutrak® screw in elite football players. MATERIAL AND METHOD: Three cases of fifth metatarsal fracture in elite football players. The mean age was 24 years old (18-26 years). We treated three fifth metatarsal fractures in elite football players. The cases in our study consisted of one diaphyseal fifth metatarsal fracture and two Jones fractures. The fractures had been occurred during sports participation. We applied internal fixation using a percutaneous Acutrak® screw under local anesthesia with the aid of fluoroscopy. The patients were clinically and radiographycally evaluated. RESULTS: Clinic healing was obtained at 10 weeks postoperatively. Radiographic consolidation occurred at 8 weeks postoperatively and the patients returned to pre-injury activity levels at 11 weeks postoperatively. No postoperative complication was seen. No skin irritation due to a headless screw of Acutrak® was observed. CONCLUSION: The result suggested that Acutrak® may be used in elite football players with fifth metatarsal fractures. In spite of factors such as ease of implementation, cost and resistance to bending also need to be considered.

Pigmented villonodular synovitis managed by Yttrium 90 after debulking surgery.

The goal of this study was to evaluate outcome of patients with pigmented villonodular synovitis (PVNS) managed by Yttrium90 (90Y) after debulking surgery. Seven patients (3 males and 4 females) with PVNS were studied retrospectively. Mean follow-up was 47.8 months (range 24-97 months). Mean age was 44.8 years (range 20-68 years. Debulking surgeries via arthroscopic synovectomy were performed in 4 cases and in 3 cases via mini arthrotomy. After 90Y injection was applied. Magnetic resonance imaging (MRI) included measurement of synovial thickness in preoperative and at last control. Main musculoskeletal tumor society score was 26 (range, 23-29), main MTS rating was 70.4% (range, 38.5-86.2%). Mean preoperative synovial thickness was 14.9mm range 20-12mm. Synovial thickness was completely disappeared at last MRI examination. There was diffuse joint effusion preoperatively, decreasing at last control. No cases of PVNS recurrence were found. Although we had a small number of cases, we believe that combination of debulking surgery with intra-articular injection of 90Y for PVNS of knee joint is an effective and safe treatment method.

Treatment of skin necrosis after radiation synovectomy with yttrium-90: a case report.

Chronic synovitis, unresponsive to systemic medical therapy including agents, anti-inflammatory drugs and remission-inducing agents, and intra-articular administration of corticosteroids can be treated with surgical, chemical and radiation synovectomy. We reported a case of a 23 years old male. Skin radiation necrosis (4 x 5 cm) developed after an injection of Yttrium-90 (Y-90). Full-thickness skin graft had been applied but we were not able to succeed. Skin radiation necrosis was treated with Limberg's flap. As a result we recommend flap surgery instead of skin graft in skin radiation necrosis.