PURPOSE OF THE STUDY To investigate the pressure levels on the axillary nerve at different plate positions after plate fixation of a proximal humerus fracture. MATERIAL AND METHODS Eight fresh-frozen cadaveric specimens were used. The plates were applied on the lateral side of the humerus. A FlexiForce pressure sensor was placed between the nerve and the plate, and the pressure on the nerve was measured (Group 1). The plates were then placed in two different positions such that distal portion of the plates would have 30° anterior and 30° posterior angles to the anatomical axis of the humerus (Group 2 and 3). The anterior of the distal attachment of the deltoid muscle was then elevated and the plates were placed in the middle of the anatomical axis of the humerus (Group 4). The position of the plates were controlled by fluoroscopy and the pressure was measured for each configuration sequentially. RESULTS The mean age of the cadavers was 70.5 ± 6.8 years (range: 61-80 years). Mean pressure values of the groups were 2.65 ± 0.8, 2.52 ± 0.8, 5.65 ± 1.4, and 2.56 ± 0.9 N, respectively. Group 3 had statistically highest-pressure values than the other groups, while no difference was found among groups 1, 2, and 4. DISCUSSION Numbness and weakness of the shoulder muscles are other clinical findings. If numbness on the deltoid muscle is reported, then atrophy is noted in the deltoid muscle in later stages. Persistent pain may be seen even if fracture union occurs after PHF surgery. Axillary nerve entrapment may be considered after the removal of common complications such as avascular necrosis due to fracture, screw migration, infection, and biceps tendon and rotator cuff problems. The sensory branch of the axillary nerve provides the sensation of the anterior joint capsule and lateral part of the deltoid muscle. CONCLUSIONS Proximal humerus plates, which are angled posteriorly along, lead to an increased pressure on the axillary nerve. Anterior orientation of the plate or elevation of deltoid insertion may be used to prevent the possible complications related to axillary nerve. Level of evidence Level II. Key words: proximal humerus fracture, Philos, axillary nerve, nerve injury.
- MeSH
- fraktury proximálního humeru * MeSH
- humerus MeSH
- kostní destičky MeSH
- kostní šrouby MeSH
- lidé středního věku MeSH
- lidé MeSH
- mrtvola MeSH
- rameno * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury škodlivé účinky MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Unsatisfactory functional results following hemiarthroplasty (HA) are seen in the treatment of 3- and 4-part proximal humeral fractures due to tuberosity healing problems and rotator cuff tears. Reverse shoulder arthroplasty (RSA) has been popular for improving functional outcomes. This study compares the results of HA and RSA in the treatment of comminuted proximal humeral fractures in the elderly. MATERIAL AND METHODS Patients over 60 years of age with three- or four-part proximal humeral fractures were included in the study. Twenty-five patients were treated with HA and 33 patients with RSA. The patients were evaluated with/using the American Shoulder and Elbow Surgeons (ASES) and Constant scores, active and passive ranges of motions of the shoulders and muscle strength measurements of HA and RSA patients were compared. RESULTS The mean age of the patients was 66 (60-85) years in the HA group and 73 (60-83) years in the RSA group. The mean ASES and Constant scores were 44.6 and 70 (p=0.06), 24 and 49 (p=0.022), respectively. The mean active abduction was measured as 50° and 90° (p=0.001), flexions as 70° and 120° (p=0.02), and external rotation as 30° and 50° (p=0.210), respectively. CONCLUSIONS In the treatment of three- or four-part proximal humeral fractures of the elderly, RSA gives significantly better functional results compared to HA. Key words: proximal humeral fractures, hemiarthroplasty, reverse shoulder arthroplasty.
- MeSH
- artroplastika ramenního kloubu * MeSH
- fraktury proximálního humeru * chirurgie MeSH
- hemiartroplastika * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- ramenní kloub * chirurgie MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY In this study it is aimed to prospectively evaluate the safety and efficacy of 20 mg/2 ml Hyaluronic Acid (HA) injections for non-operative palliation treatment of osteoarthritis (OA) of the knee joint. MATERIAL AND METHODS After institutional review board approval was obtained for the study, 63 patients were enrolled and followed prospectively. All the patients have signed informed consent form. Patients who had diagnosis of gonarthrosis according to clinical and radiological evaluation, were given nonsteroid antiinflammatory drug (NSAID) treatment for four weeks. Patients between 55-80 years old in both sexes, whose pain did not relieve were included to the study and were followed up for 6 months. They were applied HA injections in total; three times with one week of interval. Patients were evaluated three times during the study. First one at third week (at the control visit of third injection), secondly at third month and lastly at sixth month. Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Short Form Health Survey (SF-36) scores were used to clinically evaluate the patients at follow ups. RESULTS 56 (88.9%) patients completed the study and 7 (11.1%) patients did not show up for follow-up examinations and they were excluded. The mean age of the patients was 63.6 ± 6.90 (range 47 and 76) years old. 22 (39.2%) of the patients were male and 34 (60.7%) were female. Any adverse events and adverse effects were not seen in the enrolled patients group. CONCLUSIONS Results of this study revealed that the use of 20 mg/2 ml HA injection was effective in improving the WOMAC index score in patients of knee OA. Additionally, patients' quality of life as measured by SF-36 questionnaire was also significantly improved at the end of the study. None of the patient reported any of the adverse events during the study. Overall, the 20 mg/2 ml HA injection can be considered as a good treatment option for the knee OA in patients who do not respond to non-pharmacological therapy, NSAIDs or analgesics. Key words: osteoarthritis, hyaluronic acid, injection, non-operative.
- MeSH
- artróza kolenních kloubů * farmakoterapie MeSH
- injekce intraartikulární MeSH
- kolenní kloub MeSH
- kvalita života MeSH
- kyselina hyaluronová * terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY We hypothesized that preoperative planning with 3D modeling of complex foot deformities would be useful for the education of orthopedics and traumatology residents. MATERIAL AND METHODS This study is prospectively designed study with a control group. Twenty eight residents (study group) who assisted the surgeons during the interventions and ten senior surgeons (control group) were included in the study. All participants assessed virtual 3D-CT images and videos of the cases before the surgery. Ten adult cases of foot bone deformities were evaluated. 3D-CT reconstruction was performed and a 3D model of each deformity was created using the hospital's picture archiving and communication system. The completed 3D models were sterilized in hydrogen peroxide and put on the surgical table in a sterile manner. After surgery, the residents (group I) and surgeons (group II) were questioned regarding their satisfaction with 3D modeling. Responses were structured by a five-point Likert scale (1, strongly disagree; 2, disagree; 3, neither agree nor disagree; 4, agree; and 5, strongly agree). RESULTS The surgeons (group II, n = 10) were satisfied with the sterilized 3D models, which they could touch and re-examine on the operating table. The residents (group I, n = 28) were significantly more satisfied than the senior surgeons (p=0.01). The 3D modeling met both the surgeons' and residents' expectations. DISCUSSION The survey results for the surgeons (group II) were satisfied with the sterilized 3D models, which they could touch and reexamine on the operating table (question 3). They gave the best scores (mean, 4.8/5) for clarity of the 3D model. On the other hand, they gave the lowest scores (mean 3.1/5) to 3D models due to its contribution in understanding deformity over virtual 3D-CT evaluations (question 2 and 5). The residents (group I) differed from those for the senior surgeons. Residents gave the highest scores for understanding of the deformity (question 2 and 5) and clarity (question 1). These outcomes may be interpreted to indicate i) that 3D modeling may be used for education, and ii) that younger surgeons are more interested in novel technological developments. Therefore, the outcomes did differ significantly between the senior surgeons and residents (Table 1). These outcomes may be explicated as; 3D modeling of the foot deformities may not be mandatory for the experienced surgeons for understanding the deformity. On the other hand 3D modeling would be useful tools for younger surgeons and for their education. CONCLUSIONS 3D modeling of foot deformities is more informative than virtual 3D videos. However, with consideration of costs and long processing times, 3D printing may be used optimally for rare deformities. When considering the role of touch sense in surgical learning, 3D modeling gives more detailed and more satisfactory planning than virtual 3D videos. 3D modeling is more useful for young surgeons, and it will be used mainly for education in the future. Key words: 3D printing, deformity, foot and ankle, simulation.
- MeSH
- 3D tisk MeSH
- chirurgové * MeSH
- deformity nohy (od hlezna dolů) * MeSH
- dospělí MeSH
- lidé MeSH
- ortopedie * MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The prevalence of complications in surgical units is available in the literature. The aim of this study was to compare the "rotational" (more than one surgeon) and "full-time single surgeon" use of the orthopedic theater. MATERIAL AND METHODS We retrospectively evaluated patients who underwent orthopedic surgery in 2016 in different theaters. A total of 604 of 1973 patients were excluded from the study, and 1369 patients were analyzed. The follow-up period was 1 year. While evaluating the cases, the duration and order of each case, the total operation time on the table, the number of surgeons, the total number of cases, the number of residents, and the experiences of the surgeons were investigated, and the effects of these parameters on the complication rates were analyzed. The Dindo-Clavien system was used to classify the complications. RESULTS When comparing the methods, the complication rate of the full-time single-surgeon method (12.9%) was less than that of the rotational method (21.7%) (p: 0.022). A higher rate of complications (8.5%) was observed in operations with a duration of 115 minutes or more compared to other operations (p <0.001). A higher complication rate (23.7%) was observed in cases lasting more than 345 minutes (p = 0.002). CONCLUSIONS According to our study, full-time use of the orthopedic theater by a single surgeon was found to be safer than rotational use. In addition, the duration of surgeries lasting longer than 115 minutes or longer than 345 minutes during the day increased the rate of surgical complications. Key words: patient safety, surgical planning, operation time, operation order, orthopedic complication.
