Factors Affecting Operative Time Intervals for Lower Limb Arthroplasties - Correlation with Total Operative Time.

PURPOSE OF THE STUDY The aim of this study is to evaluate the operative time intervals for major orthopaedic surgeries and analyze the correlation of different operative factors on total operative time. MATERIAL AND METHODS Specific time intervals; anesthesia release time (ART), surgical preparation time (SPT), operative procedure time (OPT), and anesthesia end time (AET); were recorded by independent observers. Total operative procedure time (TOPT), was also calculated and statisctical correlation analysis was performed between TOPT and study parameters. RESULTS The difference for ART and SPT time intervals between age groups below 65 and 65 to 85 years were found statistically significant. As the patient's age increased, ART and SPT time intervals were also significantly increased. As the patients ASA status increased, the ART intervals were also increased. ART and AET time intervals were significantly longer for residents compared to specialists. DISCUSSION This is one of the first studies in the literature analyzing different time intervals and their correlation on total operative time for major orthopaedic surgeries. Current study also analyzed the effects of other factors including age and ASA score of the patients, type of anesthesia and experience of anesthegiogist on operative time intervals. This study was designed for the analysis of specific time intervals previously described in the literature for only some major orthopaedic surgeries. By this way, we aimed to achieve a homogenous study group and to obtain comparable results with the literature. CONCLUSIONS The strongest correlation was found between ART and TOPT. As the patient's age increased, ART and SPT time intervals were also significantly increased. Increased age and higher ASA scores with an unexperienced anesthegiologist significantly increased the ART intervals. Therefore, reducing ART is the most important factor in reducing TOPT. Key words:arthroplasty, anaesthesia, operation time.

Metatarsal transfer for the treatment of post-axial metatarsal-type foot synpolydactyly: a new technique that allows for comfortable shoe wearing.

We analysed the clinical and radiological outcomes of a new surgical technique for the treatment of heterozygote post-axial metatarsal-type foot synpolydactyly with HOX-D13 genetic mutations with a mean follow-up of 30.9 months (24 to 42). A total of 57 feet in 36 patients (mean age 6.8 years (2 to 16)) were treated with this new technique, which transfers the distal part of the duplicated fourth metatarsal to the proximal part of the fifth metatarsal. Clinical and radiological assessments were undertaken pre- and post-operatively and any complications were recorded. Final outcomes were evaluated according to the methods described by Phelps and Grogan. Forefoot width was reduced and the lengths of the all reconstructed toes were maintained after surgery. Union was achieved for all the metatarsal osteotomies without any angular deformities. Outcomes at the final assessment were excellent in 51 feet (89%) and good in six (11%). This newly described surgical technique provides for painless, comfortable shoe-wearing after a single, easy-to-perform operation with good clinical, radiological and functional outcomes.

Unusual presentation of an infected primary hydatid cyst of biceps femoris muscle.

Hydatid cysts of the musculoskeletal system are rare. Unusual magnetic resonance imaging (MRI) findings of an infected primary hydatid cyst of the biceps femoris muscle are presented in a 40-year-old man on hemodialysis for chronic renal failure. No daughter cysts were present within the mother cyst cavity, but there was a fatty nodule which has not previously been described in a muscular hydatid cyst. Although the cyst was infected secondarily, no surrounding soft tissue inflammatory reaction was noted. Hydatid cysts should be included in the differential diagnosis of unusual soft-tissue masses in regions where the disease is endemic.

Calcific myonecrosis.

Calcific myonecrosis is a rare and late sequela of compartment syndrome, which becomes symptomatic years after the initial trauma. We diagnosed this condition in a 64-year old man, 42 years after he sustained a shot-gun wound to the right lower leg. Total excision of a peripherally calcified, cystic mass, continuous with the anterior tibial muscle belly resulted in complete resolution of symptoms. Consideration of the diagnosis is warranted in patients with a history of major injury who develop a soft tissue mass in the traumatized compartment. The treatment of choice is marginal excision.

Spontaneous resolution of congenital anterolateral bowing of the tibia.

In a series of 43 patients diagnosed with congenital anterolateral bowing of the tibia or congenital pseudarthrosis of the tibia treated between 1980 and 1992, the deformities corrected themselves spontaneously in five patients who had no other congenital abnormalities or evidence of neurofibromatosis. At an average follow-up of 58 months (average age at follow-up 80 months), the only residual deformity seen was a limb-length discrepancy in patients with unilateral involvement. In patients with subperiosteal callus formation on the posteromedial concavity of this deformity and an uninvolved fibula, no treatment appears necessary, as this deformity will spontaneously resolve.

Salter's innominate osteotomy in the treatment of congenital hip dislocation: a long-term review.

We reviewed 39 patients with 52 congenitally dislocated hips, all managed by open reduction and Salter's innominate osteotomy. Mean follow-up period was 13 years (range, 8 to 25 years); 78.9% of the hips had a good or excellent clinical result, and 71.1% were good or excellent radiologically. The patients who underwent Salter's innominate osteotomy before the age of 4 had better clinical and radiological results (88.4 and 81.4%, respectively). The radiographs of the unilateral normal hips were compared to the surgically treated hips according to their acetabular index angles, center-edge angles of Wiberg, and femoral neck-shaft angles. No statistical differences were found between these two groups. The Bucholz-Ogden classification was used for the diagnosis and classification of avascular necrosis. The late radiographic signs of types 2, 3, and 4 avascular necrosis were seen in 34.6% of this series. The results show that Salter's innominate osteotomy provides good lateral coverage of the femoral head. The results are better if the operation is performed between the ages 18 months and 4 years.