Comparison of single event multilevel surgery and multiple surgical events in the lower extremities of children with spastic cerebral palsy.

OBJECTIVES: This study aims to compare patients treated with single event multilevel surgery (SEMS) and multiple surgical events (MSE) for disorders of the lower extremities due to cerebral palsy (CP). PATIENTS AND METHODS: The study included 130 patients (74 males, 56 females; mean age 7.7±4 years; range, 4 to 13 years) who were retrospectively staged preoperatively and at the final follow-up with the Gross Motor Function Classification System (GMFCS). The patients were divided into two groups as group 1 (MSE) and group 2 (SEMS). Gross Motor Function Measure-88 (GMFM-88) was used as evaluation criteria and visual analog scale was used to measure family satisfaction. RESULTS: In the final follow-up, group 2 had better GMFM-88 D and E scores (p=0.037 and p=0.045, respectively). Similarly, family satisfaction was better in group 2 (p=0.047). There was a difference between preoperative and final follow-up GMFCS stages (I, II, III) of all patients (21÷53÷56 and 53÷49÷28; respectively, p<0.001). A total of 3.8 (range, 2-7) operations were performed per child. CONCLUSION: In this study, SEMS contributed significantly to movement, posture and independence of children with CP compared to MSE. Single event multilevel surgery also increased family satisfaction.

Comparison of the clinical and radiological outcomes of open reduction via medial and anterior approach in devleopmental dysplasia of the hip.

OBJECTIVES: This study aims to investigate the effects of surgical approach on the clinical and radiological outcomes, the incidence of avascular necrosis (AVN), and the need for revision surgery in children undergoing open reduction via medial or anterior approach for developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: Forty-three hips of 36 patients (9 males, 27 females; mean age 13.8 month; range 6 to 18 months) treated for DDH, followed-up regularly for at least four years between January 1997 and December 2010, and who were aged five or above in the final control were included in this retrospective study. Patients were divided into two groups according to surgical approaches. Group 1 consisted of 21 hips of 19 patients who underwent open reduction through medial approach. Group 2 consisted of 22 hips of 17 patients who underwent open reduction through anterior approach. Groups were compared in terms of clinical and radiological outcomes as well as the incidence of AVN and the need for revision surgery. RESULTS: There was no statistically significant difference between the groups with respect to clinical and radiological outcomes (p=0.407 and p=0.661, respectively). Similarly, there was no statistically significant difference between the groups in terms of AVN incidence and need for revision surgery (p=0.993 and p=0.170, respectively). On the other hand, acetabular index improved significantly in both groups at follow-up. CONCLUSION: This study showed that open reduction via medial or anterior approach in DDH has similar clinical and radiological results, significant improvement was achieved in the acetabular index with both approaches, and no significant difference was present in the incidence of AVN and the need for revision surgery between the groups.

The Intramedullary Nailing of Adult Femoral Shaft Fracture by the Way of Open Reduction is a Disadvantage or Not?

The purpose of this study is that to evaluate superiority and results of open technique in the treatment of femoral shaft fracture with interlocking intramedullary nailing. The retrospective study is designed to evaluate results of our technique. In this study, the patients that were admitted to the Orthopedics and Traumatology Department of University Hospital that is third level of trauma center. We claim that open technique is not a disadvantage during union process over closed technique in treatment of femoral shaft fracture with interlocking nailing. In this study, 44 patients that were consulted for adult femoral shaft fracture between January 2008 to July 2010 were included. Patients with open fractures, gunshot wounds, neurovascular injuries, and patients that did not have isolated femoral diaphysis fractures were excluded from the study. Clinical and radiological results of the patients were checked periodically. The open interlocking intramedullary nailing was used in treatment. Complete union rate was 90.9 % in 40 patients who were treated with open interlocking intramedullary nailing for adult femoral shaft fracture, and nonunion rate was 9.1 % in four patients. Mean union time was 18.3 weeks (12-36 weeks). Evaluation of 44 patients according to Thoresen criteria was excellent in 22 patients, good in 6 patients, and bad in 4 patients. We think that open technique is an acceptable technique because all results of our study were similar to results of closed intramedullary nailing technique in literature and some advantages of open technique over closed technique.

Open reduction and pinning for the treatment of Gartland extension type III supracondylar humeral fractures in children.

In this study, we aim to evaluate the clinical and radiological results of children who were treated with four different surgical approaches. In our clinics between February 2004 and November 2012, the children who underwent surgical treatment for supracondylar humeral fractures and whose data were available with regular follow-up of at least 1 year were included in the study. Clinical outcomes were evaluated for 54 patients with Gartland type 3 extension supracondylar fractures. Functional and cosmetic results of the patients were determined according to the Flynn criteria. Mean age of the patients was 4.9 (between 2 and 14) among which 26 of them were girls and 28 were boys. Mean operation time was 45 (35-85) min. Average length of hospital stay (LHS) was 2.9 (1-7) days. Average duration of splints was 3.5 (2-6) weeks, while the average removal period of the wires was 4.6 (3-8) weeks. Mean consolidation time was 4.6 weeks (3-8). Mean follow-up was 14.36 months. In our study, we performed 54 patients functional and cosmetic results. While 48 of the patients had satisfying results (excellent, good, or fair), six of them had unsatisfactory (poor) results. The results of this study suggest that clinical results with surgical treatment of Gartland type 3 extension fractures were satisfactory. However, the delay in the surgical treatment may cause a number of complications.

Is scintigraphy a guideline method in determining amputation levels in diabetic foot?

BACKGROUND: In this study, we aimed to evaluate the potential use of a 3-phase bone scintigraphy method to determine the level of amputation on treatment cost, morbidity and mortality, reamputation rates, and the duration of hospitalization in diabetic foot. METHODS: Thirty patients who were admitted to our clinic between September 2008 and July 2009, with diabetic foot were included. All patients were evaluated according to age, gender, diabetes duration, 3-phase bone scintigraphy, Doppler ultrasound, amputation/reamputation levels, and hospitalization periods. Patients underwent 3-phase bone scintigraphy using technetium-99m methylene diphosphonate, and the most distal site of the region displaying perfusion during the perfusion and early blood flow phase was marked as the amputation level. Amputation level was determined by 3-phase bone scintigraphy, Doppler ultrasound, and inspection of the infection-free clear region during surgery. RESULTS: The amputation levels of the patients were as follows: finger in six (20%), ray amputation in five (16.6%), transmetatarsal in one (3.3%), Lisfranc in two (6.6%), Chopart in seven (23.3%), Syme in one (3.3%), below-the-knee in six (20%), above the knee in one (3.3%), knee disarticulation in one (3.3%), and two patients underwent amputation at other centers. After primary amputation, reamputation was performed on seven patients, and one patient was treated with debridement for wound site problems. No mortality was encountered during study. CONCLUSIONS: We conclude that 3-phase bone scintigraphy prior to surgery could be a useful method to determine the amputation level in a diabetic foot. We conclude that further, comparative, more comprehensive, long-term, and controlled studies are required.

[Anterior cruciate ligament injuries: does surgical treatment with autograft versus allograft option affect the clinical results?]. / On capraz bag yaralanmalari: otogreft ve allogreft seçenekleriyle cerrahi tedavi klinik sonuçlari etkiler mi?

BACKGROUND: We investigated the clinical outcome of anterior cruciate ligament (ACL) reconstructions with allograft or autograft. METHODS: We retrospectively evaluated 82 patients who underwent arthroscopic ACL reconstruction with anterior tibial tendon (ATT) allograft (n = 52) or quadrupled hamstring tendon (QHT) autograft (n = 30). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores and functional (one leg hop) and laxity (pivot-shift, Lachman, anterior drawer) tests. RESULTS: The two groups were similar with respect to age and sex distribution, operated side, preoperative period and associated injuries (p > 0.05). Results were satisfactory in both groups, but there was no statistically significant difference between the groups with respect to IKDC and Lysholm scores, functionality and ligament laxity (p > 0.05). However, effusions were more frequent in the QHT group compared to the ATT group. CONCLUSION: Our results suggest that differences in graft options for ACL reconstruction have no effect on the clinical outcome. Allografts with to-be-developed solutions to immune response may be a good alternative in ACL reconstruction.

Comparison of buccal and intramuscular dexmedetomidine premedication for arthroscopic knee surgery.

STUDY OBJECTIVE: To compare the sedative, anxiolytic, analgesic, hemodynamic, and respiratory effects of buccal dexmedetomidine with intramuscular (IM) dexmedetomidine for premedication in patients undergoing arthroscopic knee surgery during spinal anesthesia. DESIGN: Randomized, placebo-controlled trial. SETTING: University medical center. PATIENTS: 75 ASA physical status I and II patients undergoing arthroscopic knee surgery with spinal anesthesia. INTERVENTIONS: Patients were randomized to one of three groups for premedication: group B, buccal dexmedetomidine 2.5 microg kg(-1); group IM, IM dexmedetomidine 2.5 microg kg(-1); and group P, buccal 0.9% and NaCl 2 mL. MEASUREMENTS: Noninvasive blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded. Sedation and anxiety levels were consecutively assessed with Ramsay sedation scores and Visual Analog Scale (VAS) scores of anxiety before premedication, before spinal anesthesia, during surgery, and at the end of surgery. Two, 4, and 8 hours after surgery, sedation levels, postoperative VAS pain scores, and consumption of analgesics (diclofenac sodium) were recorded. MAIN RESULTS: Before spinal anesthesia, during surgery, and at the end of surgery, sedation and anxiety scores of the patients receiving buccal or IM dexmedetomidine were, respectively, higher and lower than in group P. Patients receiving buccal dexmedetomidine (group B) had lower requirement of diclofenac sodium than group P and lower pain scores than groups P and IM. Mild hypotension and bradycardia were observed in the buccal and IM dexmedetomidine patients. CONCLUSIONS: Buccal dexmedetomidine for premedication in arthroscopic knee surgery provided equal levels of sedation and anxiolysis, and more evident analgesia compared with IM dexmedetomidine.

A case of recurrent and migratory complex regional pain syndrome type I: Prevention by gabapentin.

Complex regional pain syndrome type I (CRPS I) or reflex sympathetic dystrophy (RSD) is a painful and disabling neuropathic pain syndrome. We report a case of a patient who has experienced CRPS I four times with an unidentified cause for all recurrences. The patient responded well to a combination of physiotherapy and intravenous regional sympathetic block in the first two attacks, but not in the fourth one. Gabapentin was effective in the last two attacks. Gabapentin was gradually discontinued 12 months after the last attack and no other recurrence was observed for a follow-up period of 9 months. This case suggests that gabapentin might be considered in the treatment and prevention of CRPS I.

Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome): a report of two cases and review of the literature.

We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE) associated with prostatic adenocarcinoma. One of the patients was positive for Helicobacter pylori and the other had secondary bone metastases. In the latter, the clinical picture of RS3PE developed after surgical intervention for the primary lesion. On physical examination, while the hands and feet were swollen in the first patient, pitting edema was present only at the feet of the other. All joints of the affected hands and feet were painful. Serological tests including rheumatoid factor, antinuclear antibody, and human leukocyte antigen B27 were all negative. Response to low-dose corticosteroid treatment was delayed in the first patient, but the symptoms were relieved better in the second one.

Neglected case of osteoarticular Brucella infection of the knee.

A 49-year-old farmer had a history of recurrent knee effusion for 20 years. He did not report undergoing any diagnostic or therapeutic procedures apart from repeated aspirations of the joint fluid. After the isolation of Brucella melitensis from the joint fluid, computed tomography-guided bone biopsy was performed and histopathologic examination of the biopsy sample confirmed the diagnosis of chronic Brucella osteomyelitis. Arthroscopic synovectomy combined with antimicrobial therapy with doxycyclin, rifampicin, and ciprofloxacin for six months resulted in clinical recovery. This case indicates that brucellosis should be suspected in patients with non-specific and chronic osteoarticular symptoms, especially in endemic regions.

[Total calcanectomy in a patient with a giant cell tumor]. / Kalkaneusta dev hücreli tümör gelisen bir hastada total kalkanektomi.

Total en-bloc calcanectomy was performed in a 36-year-old male patient with a giant cell tumor in his right calcaneus. A year after surgery, the patient had no complaints, and a good functional result was obtained. He was able to return to his work. No local or metastatic recurrences were encountered.