Short-term outcomes of robotically assisted patello-femoral arthroplasty.

PURPOSE: The purpose of this study was to determine the outcomes in patients treated with robotically assisted patello-femoral arthroplasty (PFA). METHODS: This technique offers a safe, reliable, and reproducible way of obtaining correct implant positioning in patello-femoral arthroplasty, and as a result, reduces revision surgery due to implant malalignment. We evaluated 30 knees in 29 patients who underwent robotically assisted patello-femoral arthroplasty between June 2009 and May 2011. Mean follow-up was 15.9 months. This was a retrospective study that involved chart reviews and radiographic analysis. Radiographic analysis included pre-operative and postoperative plain films for implant positioning. Functional outcomes were evaluated using the Oxford Knee Score (OKS), range of motion, University of California at Los Angeles (UCLA) patient activity-level ratings, visual analog pain scale (VAS), and the Knee Society Score (KSS). RESULTS: The patients had an average OKS of 21.7 pre-operatively and reached an average of 33.5 postoperatively (p = 0.0033). Pre-operative UCLA patient activity-level ratings was 3.1, compared with 4.8 postoperatively. Average VAS pre-operatively was 8 and postoperatively it decreased to 2.1 (p = 0.0033). The average KSS final score pre-operatively was 56 and postoperatively it increased to 68.3 while the functional score pre-operatively was 47.2 compared to 68.1 postoperatively (p = 0.011). As a result, patello-femoral arthroplasty is an emerging knee resurfacing technique that is an alternative to the total knee arthroplasty. CONCLUSIONS: The early retrospective data for robotically-assisted PFA show encouraging results. Advantages of this technique include a smaller incision, faster rehabilitation, preservation of bone stock, and implantation without malalignment.

Biomechanical effects of menopause in ovariectomized rats' femurs.

OBJECTIVE: To demonstrate the biomechanical changes in rat bones occurred by surgical menopause and to search for correlation between biomechanical test results and bone mineral density (BMD) measurements. METHODS: Thirty female Wistar-albino rats aged ∼6 months and weighed ∼250-300 g were randomized into ovariectomy, sham and control groups. After 6 months, rats were sacrificed and right femurs were extracted. BMD measurements and three point bending biomechanical tests were made in femurs. RESULTS: The difference among the mean BMD measurements of three groups were found to be statistically significant (Pr > F value <0.0001). Mean elastic module, maximum elongation and femoral diameters were also found to be statistically significantly different (Pr > F value <0.05). Ovariectomised and sham-operated groups were significantly different in terms of elastic modulus. Ultimate force did not differ among the groups significantly. The difference between ultimate strain and maximum elongation of the ovariectomy and sham operated group was statistically significant. CONCLUSIONS: Bone quality was deteriorated and fragility was increased in rats 6 months after surgical menopause. Sole BMD measurement might not be reliable in evaluation of osteoporosis and fracture risk. Biomechanical quality of bone is more important than its mineral content in determining fragility.

Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study.

PURPOSE: This is a descriptive analysis, of victims of Turkey's October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma. METHODS: We retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome. RESULTS: The patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively. CONCLUSIONS: The results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

Are consanguineous marriage and swaddling the risk factors of developmental dysplasia of the hip?

The purpose of this study was to investigate prospectively the effects of swaddling and consanguineous marriage on developmental dysplasia of the hip and associated risk factors. We screened by ultrasound 265 infants using the Graf method. The Pediatrics Department referred all newborn infants with suspected instability or a recognized risk factor to the orthopedic clinic. Risk factors of developmental dysplasia of the hip were searched and noted in these patients. Swaddling and consanguineous marriage were also determined and noted. We observed 164 of 265 infants (61.9 %) who had been swaddled and that 64 of 265 infants' parents were in a consanguineous marriage (24.2 %). In the statistical analysis that was conducted for swaddling and consanguineous marriage, highly significant differences were found. Our study showed that the rate of developmental dysplasia of the hip is very high, 11.7 %, in our region, eastern Turkey. Also, we commonly see improper swaddling and consanguineous marriage in our region, which affects many infants.

Restless legs syndrome in multiple myeloma patients.

BACKGROUND: Restless legs syndrome (RLS) is a common neurological condition characterized by uncomfortable and unpleasant sensations in the legs that are relieved by movement. It is frequently idiopathic, sometimes associated with specific disorders such as malignancies. Because there is no study relevant to RLS in Multiple Myeloma (MM), we aimed to evaluate the frequency of RLS in MM patients during chemotherapy and examined the relationship between presence of RLS and depression and anxiety in these patients. METHODS: We enrolled a population of 62 adult MM patients for RLS features. RLS was ascertained in MM patients by both the presence of the four essential International RLS Study Group diagnostic criteria and neurological examination. The International RLS Study Group rating scale was used to measure RLS severity. Hospital Anxiety and Depression Scale (HADS) was used to evaluate the levels of depression and anxiety and Short Form-36 (SF-36) to evaluate health related quality of life (HRQOL). RESULTS: A total of 62 MM patients were evaluated. Among them 11 were identified by the screening questionnaire to meet the criteria for RLS (17.74%). MM patients with RLS had higher levels of depression (P < 0.01) and anxiety (P < 0.01) and poorer HRQOL compared with those without RLS. CONCLUSIONS: The frequency of RLS in MM patients is higher than that of expected in the general population. MM patients afflicted by RLS have significantly higher levels of depression, anxiety and poorer HRQOL. Recognition and treatment of RLS in MM patients may be an important target in clinical management and may improve overall health outcomes in these patients.

A randomized controlled trial of electrostimulation effects on effussion, swelling and pain recovery after anterior cruciate ligament reconstruction: a pilot study.

OBJECTIVE: To evaluate rehabilitation results of electrostimulation especially on joint effusion, swelling and pain recovery after anterior cruciate ligament reconstruction. DESIGN: A randomized controlled trial; the assessor was not blinded to the group allocation. SETTING: Orthopaedics-traumatology and physical medicine-rehabilitation departments. SUBJECTS: Twenty-nine consecutive patients underwent anterior cruciate ligament reconstruction. INTERVENTIONS: Both groups began the voluntary exercise protocol one day post-surgery. The intervention group (n = 15) also received 30 sessions electrostimulation treatment protocol started four days after the operation. MAIN MEASURES: Numerical bulge-dancing patella signs for effusion assessment; differences in circumferences of the mid-centre of the patella between operated and non-operated knees for swelling assessment. A self-report of average daily resting pain assessed by visual analogue scale; Intenational Knee Documentation Committee scoring system and Tegner Activity Scale for subjective response assessment. RESULTS: Twenty-six subjects including 13 patients from the intervention group completed the study. Significantly less effusion and swelling were determined in the intervention group after seven days (1.8 ± 1.3 versus 2.4 ± 1.7 for effusion and 1.7 ± 1.2 versus 3.4 ± 1.5 for swelling) to 12 weeks (0.2 ± 0.7 versus 0.6 ± 0.8 for effusion and 0.2 ± 0.8 versus 0.8 ± 0.9 for swelling) postoperative (P < 0.05). Patients treated with electrostimulation had significantly lower pain scores from seven days up to 12 weeks after the operation (P < 0.05). CONCLUSION: Electrostimulation along with exercise therapy appears superior to exercise alone regarding knee effusion, swelling and pain recovery after anterior cruciate ligament reconstruction. Still, there is need for further clinical studies using a radiologic method to demonstrate this effect of electrostimulation.

The development of giant lipoma on the BCG vaccine caused scar.

Lipoma is the most common mesenchymal tumors that accounts for about 6% of all soft-tissue tumors in children. The lesion size is usually around 1-2 cm that rarely reaches the bigger diameter. A 14-month-old baby girl was brought to our clinic for a progressively growing lesion on the left shoulder. The lesion started 4 months ago, and then was rapidly growing that caused pain and movement restriction. On the same site, there was a scar of BCG vaccination. The clinical and histopathological findings of the lesion were consistent with lipoma. The lesion was totally resected with no recurrence within 12 months. There are several complications related to BCG vaccination. However, the occurrence of lipoma on BCG vaccine caused scar has not been reported in literature. We reported this case because of its rarity and to emphasize that lipoma can present as a giant lesion in child.

The evaluation of trauma patients in Turkish Red Crescent Field Hospital following the Pakistan earthquake in 2005.

To provide better emergency and outpatient services in well-equipped field hospitals, organisation and team and equipment selection are of utmost importance to meet the demands of the earthquake zone. In the planning stage, the evaluation of data collected after the earthquake is essential. On 14 October 2005, following the earthquake in the city of Muzafferabad of Kashmir, Pakistan on 8 October 2005, Turkish Red Crescent Field Hospital was established and equipped with health professionals. A total of 2892 patients were treated and followed up. All the patients were prospectively evaluated. The profiles of the patients transferred, operated, or followed up within this period were documented. Furthermore, the patients who applied with post-traumatic musculoskeletal trauma were also documented. Of 1075 patients, who applied to orthopaedics outpatient clinic, 543 were female and 632 were male. The patients were evaluated based on their fracture as follows: pelvis (n=45), femur (n=59), tibia (n=87), ankle and foot (n=45), vertebra (n=41), clavicle (n=10), humerus (n=38), forearm (n=20) and hand and wrist (n=45). Medical necessities in an earthquake zone are dynamic and change rapidly. Field hospitals must be prepared for requested changes to their mode of activity and for extreme conditions.