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A Randomized Comparison Between Interscalene and Combined Interscalene-Suprascapular Blocks for Arthroscopic Shoulder Surgery: A Prospective Clinical Study. J Pain Res 2024; 17:335-343. [PMID: 38292756 PMCID: PMC10824609 DOI: 10.2147/jpr.s435685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Background To compare the analgesic effect of ISB with a combination of ISB-SSNB and patients who were given opioids with PCA without block in adult patients undergoing shoulder surgery, as measured by opioid consumption and pain intensity in the first 24 hours postoperatively. Methods Ninety patients who underwent shoulder surgery were randomly divided into three groups. Group I in which ISB was performed and patient-controlled analgesia (PCA) was inserted, Group II with; ISB and SSNB combined, and PCA was inserted, and Group III where; only PCA was used. Visual analog scale (VAS) pain scores at the second, fourth, sixth, 12th, and 24th hours, morphine consumption, additional analgesic requirement, and patient satisfaction were evaluated. Results Compared with Group III, the VAS pain score was significantly lower in Group I and Group II at 2, 4, 6, 12, and 24 hours postoperatively. In Group I, the VAS score at rest at the 6th hour was found to be higher than in Group II. The 24-hour total morphine consumption was higher in the control group than in Group I and Group II. The satisfaction score of the control group was lower than Group I and Group II. Conclusion The combined application of ISB and SSNB block is beneficial in shoulder surgery to provide both intraoperative and postoperative analgesia and opioid consumption. Level of Evidence Level I; Randomized Controlled Trial; Treatment Study.
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Anatomic Factors Associated With the Development of an Anterior Cruciate Ligament Rerupture in Men: A Case-Control Study. Am J Sports Med 2022; 50:3228-3235. [PMID: 36074046 DOI: 10.1177/03635465221120378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although several factors are associated with anterior cruciate ligament (ACL) rerupture, the effect of anatomic factors associated with ACL rupture on ACL rerupture development has not been evaluated. PURPOSE To determine individual anatomic parameters independently associated with ACL rerupture and the diagnostic values of these parameters. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 91 male patients with ACL rerupture and 182 age-, sex-, body mass index-, and side dominance-matched patients without rerupture who underwent ACL reconstruction with a 5-year follow-up were included. In all, 35 parameters that were previously defined as risk factors for primary ACL rupture were compared between the 2 groups. Uni- and multivariate logistic regression models were created to evaluate independently associated factors. Receiver operating characteristic curve analysis was performed for independently associated parameters to predict sensitivity, specificity, and cutoff values. RESULTS The mean ± standard deviation age of patients at the time of index surgery was 26.5 ± 6.7 years. Notch shape index (P = .014), tibial proximal anteroposterior (AP) distance (TPAPD) (P < .001), lateral femoral condylar AP distance (LCAPD)/TPAPD ratio (P < .001), medial meniscal cartilage bone height (P < .001), and lateral meniscal bone angle (P = .004) were found to be significantly different between the 2 groups. Only the LCAPD/TPAPD ratio (odds ratio, 2.713; 95% CI, 1.998-5.480; P < .001) was found to be independently associated with ACL rerupture development. The LCAPD/TPAPD ratio revealed 78.9% sensitivity and 75.5% specificity (area under the curve, 0.815; 95% CI, 0.760-0.870) for values above 1.52. CONCLUSION The LCAPD/TPAPD ratio can be used to distinguish patients who are at risk of developing ACL rerupture from patients who are not. In the clinical practice, findings of this study may help to develop surgical and nonsurgical preventive strategies in ACL rerupture development.
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Assessment of clinical, biochemical, and radiological outcomes following intra-articular injection of Wharton jelly-derived mesenchymal stromal cells in patients with knee osteoarthritis: A prospective clinical study. Medicine (Baltimore) 2022; 101:e30628. [PMID: 36123928 PMCID: PMC9478323 DOI: 10.1097/md.0000000000030628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to perform clinical, biochemical, and radiological evaluation of the efficacy of mesenchymal stem cells derived from Wharton jelly (WJ) present within the human umbilical cord in the treatment of knee osteoarthritis. Between 2018 and 2019, 10 patients with knee osteoarthritis for whom the conservative treatment was not beneficial were included in the study. Patients were clinically, radiologically, and biochemically evaluated before treatment initiation. Thereafter, the patients were intra-articularly injected using a solution containing 1 × 108 WJ-derived MSCs. Evaluations were performed on day 21 (V1) and 42 (V2) and month 3 (V3), 6 (V4), and 12 (V5) after the procedure. At 1-year post-injection, visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Lequesne scores of patients were lower than those observed during the initial evaluation, whereas the mean 36-Item Short Form Health Survey score was higher. Cartilage thicknesses were found to be increased in all regions except in the medial femur, medial posterior femur, lateral posterior femur, and lateral posterior tibia regions in magnetic resonance imaging. A significant increase was observed in tumor necrosis factor-alpha, interleukin-1β, adiponectin, resistin, and interleukin-6 levels compared with pre-injection values. The leptin levels at 6-month and 1-year controls were lower than the pre-injection levels, and the decrease observed at 6 months was significant. In patients with knee osteoarthritis, intra-articular WJ-derived MSC injection causes significant pain reduction, satisfactory functional improvement, and increased patient satisfaction following a 1-year follow-up. These clinical improvements were supported by magnetic resonance images, along with changes in adiponectin and leptin levels in synovial fluid. Level of evidence: IV.
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The impact of the level of anxiety and temperament in asymptomatic or mildly symptomatic patients requesting implant removal surgery after tibia intramedullary nailing. J Orthop Sci 2022; 27:887-891. [PMID: 34144881 DOI: 10.1016/j.jos.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKROUND Implant removal (IR) surgery is one of the most frequent procedures in orthopedic practice. Many of the IR surgeries result from patient request rather than a medical necessity. The purpose of the study was to investigate the association between the level of anxiety, type of temperament and psychopathological status, and the willingness to receive IR surgery in asymptomatic or mildly symptomatic patients. We also aimed to compare pre- and postoperative pain scores and document the complication rates after IR surgery. METHODS The patients who received tibia intramedullary nailing after tibia diaphyseal fracture with a minimum of 18 months follow-up were included in the study. A total of 246 asymptomatic or mildly symptomatic patients were evaluated, and all patients received detailed oral and written information about the risks of IR surgery. The patients who wished to receive IR surgery were called Group 1 (N = 104), and the patients who did not wish to have surgery were called Group 2 (N = 146). All patients were referred to a psychologist to complete the Beck anxiety inventory (BAI), Symptom checklist-90-R (SCL-R-90), and the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A). RESULTS The mean age of the patients was 32.31 ± 9.56. One hundred thirteen (45.9%) of the patients were male, and 133 were female (54%). Mean BAI and SCL-90-R were higher in Group 1 than Group 2 (P = 0.001). Anxious and irritable temperament was higher in Group 1 (P = 0.045 and P = 0.035 respectively), and non-dominant and hyperthymic temperament was higher in Group 2 (P = 0.02 and P = 0.04 respectively). CONCLUSIONS The level of anxiety and type of temperament is associated with the willingness to receive implant removal surgery in asymptomatic or mildly symptomatic patients. Measures to reduce anxiety levels may reduce the rate of unnecessary implant removal surgeries, associated patient care costs, and potential complications.
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Individual and Combined Anatomic Risk Factors for the Development of an Anterior Cruciate Ligament Rupture in Men: A Multiple Factor Analysis Case-Control Study. Am J Sports Med 2022; 50:433-440. [PMID: 35019732 DOI: 10.1177/03635465211062594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No comparative studies have evaluated anatomic risk factors in a large cohort including both patients with anterior cruciate ligament (ACL) ruptures and healthy participants. PURPOSE To determine which anatomic parameters are independently associated with an ACL rupture and the diagnostic values of the individual and combined anatomic parameters. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 352 male patients who underwent arthroscopic ACL reconstruction because of a primary ACL rupture and 350 age-, sex-, body mass index-, and side dominance-matched healthy participants were included. Measurements of 32 previously determined parameters and 7 calculations were performed. Between-group differences were calculated. Univariate and multivariate logistic regression models and receiver operating characteristic curve analysis were conducted for the individual and combined independently associated factors. RESULTS The mean age and body mass index of all participants were 29.9 ± 7.7 years and 27.2 ± 3.1, respectively. There were significant differences between the groups regarding the notch width (NW), notch shape index, anterior tibial slope, notch width index, NW-eminence width (NW:EW) ratio, notch height, axial lateral wall angle, medial intercondylar ridge thickness, alpha angle, medial tibial depth (MTD), lateral tibial slope (LTS), coronal tibial plateau width, eminence width index, tibial proximal anteroposterior distance (TPAP), lateral condylar anteroposterior distance (LCAP)/TPAP, ACL cross-sectional area, ACL volume, medial and lateral meniscal cartilage height, medial and lateral meniscal cartilage angle (MCA), and medial and lateral meniscal cartilage bone height. The NW:EW ratio (odds ratio [OR], 4.419; P = .017), MTD (OR, 8.617; P = .001), LTS (OR, 2.254; P = .011), LCAP/TPAP (OR, 2.782; P = .037), and medial MCA (OR, 1.318; P = .010) were independently associated with the development of an ACL rupture. Combining the independently associated factors revealed a sensitivity of 93% and a specificity of 94% (area under the curve, 0.968). CONCLUSION Patients with ACL ruptures could be distinguished from uninjured controls with high sensitivity and specificity via the combined use of the NW:EW ratio, MTD, LTS, LCAP/TPAP, and medial MCA. In clinical practice, these findings may contribute to the development of preventive strategies for ACL ruptures.
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Factors Affecting Prolonged Postoperative Pain and Analgesic Use After Arthroscopic Full-Thickness Rotator Cuff Repair. Orthop J Sports Med 2021; 9:23259671211012406. [PMID: 34368377 PMCID: PMC8299889 DOI: 10.1177/23259671211012406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Postoperative pain and analgesic use after arthroscopic rotator cuff repair remain important issues that affect rehabilitation and overall outcomes. Purpose: To evaluate the pre- and intraoperative factors that may cause prolonged duration of postoperative pain and analgesic use. Study Design: Case-control study; Level of evidence, 3. Methods: We included 443 patients who underwent arthroscopic rotator cuff repair and subacromial decompression. Visual analog scale (VAS) scores for pain were obtained preoperatively and at 30 and 90 days postoperatively. Patients were divided into a group who had prolonged postoperative pain (duration ≥1 and <3 months; n = 86 patients) and a group with nonprolonged pain (duration <1 month; n = 357 patients). The following factors were compared between groups: age, sex, body mass index, repair technique, tear size, retraction amount, repair tension, tendon degeneration, preoperative pseudoparesis, symptom duration, application of microfracture to the rotator cuff footprint for marrow stimulation, smoking, degree of fatty degeneration, preoperative narcotic analgesic use, diabetes, acromioclavicular joint degeneration, and preoperative Douleur Neuropathique 4 (DN4) and American Shoulder and Elbow Society (ASES) scores. Results: Significant differences were seen between the prolonged and nonprolonged groups regarding the median duration of pain (54 vs 27 days, respectively; P < .001) and analgesic use (42 vs 28 days, respectively; P < .001). Significant differences were noted between the groups for symptom duration (P = .007), smoking status (P = .001), degree of fatty degeneration (P = .009), preoperative narcotic analgesic use (P < .001), preoperative DN4 and ASES scores, 30-day VAS score (P < .001), duration of opioid and nonopioid analgesic use (P < .001), tear size (P = .026), and retraction stage (P = .032). Tear size (P = .009), retraction amount (P = .005), preoperative narcotic analgesic use (P < .001), degree of fatty degeneration (P < .001), and preoperative DN4 score (P = .024) were factors independently associated with prolonged postoperative pain and analgesic use. Conclusion: Patients with larger size tears, retracted tendons, preoperative use of narcotic analgesics, higher tensioned tendon after repair, and Goutallier grade 3 or 4 fatty degeneration faced an increased risk of prolonged postoperative pain and analgesic use after arthroscopic rotator cuff repair. These factors might be mitigated by psychosocial support; gentle, controlled, and individualized postoperative rehabilitation approaches; detailed preoperative evaluation; and closer follow-up of patients who are treated operatively.
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The Spectrum of Underlying Diseases in Children with Torticollis. Turk Neurosurg 2021; 31:389-398. [PMID: 33759163 DOI: 10.5137/1019-5149.jtn.31359-20.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To investigate the underlying conditions in children with torticollis. MATERIAL AND METHODS Between May 2016 and December 2019, 24 patients (10 girls and 14 boys; mean age, 8 years) presenting with twisted neck, neck pain, weakness of extremities, imbalance, and gait disorder were evaluated retrospectively. RESULTS Five of the patients had cranial pathologies (cerebellar anaplastic ependymoma and medulloblastoma, brain stem glioma, atypical teratoid rhabdoid tumor, and acute disseminated encephalomyelitis), and five of the patients had spinal pathologies (idiopathic intervertebral disc calcification, vertebral hemangiomatosis, compression fracture, multiple hereditary exostoses, and Langerhans cell histiocytosis at C4). Six of the patients had ocular pathologies (strabismus, Duane syndrome, and Brown syndrome each in two patients). Four patients had otorhinolaryngological infections (Sandifer syndrome, esophageal atresia, reflux, and spasmus nutans, with one patient each). Detailed clinical physical examination and necessary laboratory investigation were performed for all patients. CONCLUSION Torticollis is a sign that is not always innocent and may herald an underlying severe disease. Misdiagnosis can lead to wrong and unnecessary surgical procedures and treatments, and sometimes, the results can be damaging due to underlying severe conditions if diagnosed late. In addition, we first report a case of vertebral hemangiomatosis and temporomandibular joint ankylosis that presented with torticollis in the English medical literature.
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Factors associated with the development of early- to mid-term cuff-tear arthropathy following arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2021; 30:1572-1580. [PMID: 33038498 DOI: 10.1016/j.jse.2020.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have specifically evaluated the development of cuff-tear arthropathy (CTA) after a rotator cuff repair in the postoperative early to mid-term. This study aimed to identify the factors associated with the development of CTA, to evaluate the effect of arthropathy on functional outcomes, and to evaluate the incidence of CTA 3-10 years after an arthroscopic rotator cuff repair. METHODS A total of 312 patients who underwent an arthroscopic repair of a large or massive full-thickness rotator cuff tear with a minimum follow-up of 3 years were retrospectively divided into 2 groups for analysis: those with postrepair CTA (arthritic glenohumeral changes due to rotator cuff insufficiency) and those without. CTA was assessed using the Seebauer and modified Hamada-Fukuda classification systems. Pre-, intra-, and postoperative patient characteristics; characteristics of the rotator cuff tear; clinical and radiological parameters; and pre- and postoperative functional scores were compared. RESULTS The rate of development of CTA was 11.5% (36 of 312 patients, 13 centric and 23 eccentric arthropathy). CTA was more frequently associated with the poor integrity of the supraspinatus tendon after repair (P < .001) and massive tears (P = .006). Postoperative pseudoparalysis (P < .001), symptomatic retear (P < .001), tear size (P = .026), critical shoulder angle (P = .001), preoperative acromiohumeral interval (P = .046), and the humeral head superior migration (P = .001) were found to be associated with the development of CTA. However, only postoperative pseudoparalysis was found to be an independent risk factor (P < .001, odds ratio: 2.965). Patients with postrepair CTA had significantly worse functional outcome scores. CONCLUSION The postoperative development of pseudoparalysis may be a marker of CTA in the future and that closer follow-up may be necessary.
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Effect of Leg Dominance on Medium- to Long-Term Functional Outcomes, Quality of Life, and Revision Rates After Isolated ACL Reconstruction. Orthop J Sports Med 2021; 9:2325967121995808. [PMID: 33954220 PMCID: PMC8044576 DOI: 10.1177/2325967121995808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The effect of leg dominance on short-term functional outcomes and return to sports after arthroscopic anterior cruciate ligament reconstruction (ACLR) has been evaluated. However, postoperative medium- to long-term recovery and revision rates are not well known. Purpose: To investigate whether leg dominance affects medium- to long-term clinical and functional scores and revision rates after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Included in this study were 235 patients (205 male and 30 female) who underwent isolated arthroscopic ACLR. Patients were divided according to the leg dominance status of their injured limb into 2 groups: dominant leg injured (120 patients) and nondominant leg injured (115 patients). Preoperative and postoperative functional outcomes and health-related quality of life (HRQoL) were evaluated using the visual analog scale for pain, Tegner activity scale, Lysholm knee score, International Knee Documentation Committee (IKDC) subjective knee evaluation form, 36-Item Short Form Health Survey (SF-36), and overall patient satisfaction. Moreover, the revision rates of the 2 groups were compared according to leg dominance, patient characteristics, and operative features. Results: The mean follow-up period was 8.0 ± 2.3 years (range, 5-13 years). A significant preoperative to postoperative improvement in range of motion and functional scores was noticed in both groups (P < .001 for all). However, the improvement was significantly higher in the dominant leg group for the Tegner (P = .001), Lysholm (P = .006), and IKDC (P < .001) scores as well as for the SF-36 domain scores for general health (P = .009), social role (P = .048), and emotional role (P = .032). Also, patient satisfaction was significantly higher in the dominant leg group (P = .007). The dominant leg group was associated with a lower revision rate compared with the nondominant leg group (5.8% vs 15.7%, respectively; P = .015). Conclusion: High recovery rates were seen after arthroscopic ACLR, regardless of leg dominance. However, leg dominance had a significant effect on postoperative medium- to long-term functional outcomes, HRQoL, and revision rates.
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Factors affecting recurrence following arthroscopic Bankart repair in recreational athletes. MEDICINE SCIENCE 2021. [DOI: 10.5455/medscience.2021.04.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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The effect of the tear pattern and the number of preoperative locking episodes on the functional outcome following arthroscopic bucket-handle meniscal tear repair. MEDICINE SCIENCE 2021. [DOI: 10.5455/medscience.2021.04.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Are clinical outcomes and failure rate following meniscal repair for vertical-longitudinal tears age-dependent. MEDICINE SCIENCE 2020. [DOI: 10.5455/medscience.2020.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Evaluation of Midterm Clinical and Radiographic Outcomes of Arthroscopically Repaired Vertical Longitudinal and Bucket-Handle Lateral Meniscal Tears. Orthop J Sports Med 2019; 7:2325967119843203. [PMID: 31157282 PMCID: PMC6512156 DOI: 10.1177/2325967119843203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Lateral meniscal tears in the stable knee are rare. There are few comparative
studies evaluating functional and radiological outcomes of vertical
longitudinal and bucket-handle lateral meniscal tears. Purpose: To evaluate the midterm clinical and radiological outcomes of
arthroscopically repaired traumatic vertical longitudinal and bucket-handle
lateral meniscal tears. Study Design: Case series; Level of evidence, 4. Methods: A total of 43 full-thickness lateral meniscal repairs, including 22 (51.2%)
for vertical longitudinal tears and 21 (48.8%) for bucket-handle tears, were
evaluated. A clinical assessment was performed according to the Barrett
criteria, and patient outcomes were measured with the Lysholm knee score,
Tegner activity scale, and overall satisfaction scale. Magnetic resonance
imaging was used as the radiological re-examination method preoperatively
and at final follow-up. A subgroup analysis examining isolated repair versus
repair with concurrent anterior cruciate ligament (ACL) reconstruction was
performed. Results: The mean follow-up period was 63.2 months (range, 24-86 months). Based on
clinical and radiological outcomes, 38 of the 43 repairs (88.3%) were
successful, and the remaining 5 (11.6%) cases were considered to be
failures. Overall, the combined results for both groups demonstrated an
improvement in the Lysholm score, Tegner score, and patient satisfaction.
There was no significant difference in the postoperative Lysholm score (91.4
vs 87.0, respectively; P = .223), Tegner score (5.4 vs 5.5,
respectively; P = .872), or patient satisfaction (7.2 vs
7.4, respectively; P = .624) between bucket-handle repair
and vertical longitudinal repair. The subgroup analysis demonstrated no
difference in outcome scores for isolated repair versus repair with
concurrent ACL reconstruction. Smoking was identified as a risk factor for
repair failure. Conclusion: Comparable clinical and radiological outcomes were obtained after vertical
longitudinal and bucket-handle lateral meniscal repairs using the all-inside
or hybrid suture technique with different suture configurations, regardless
of whether ACL reconstruction was performed. Smoking was identified as a
risk factor for failure.
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Arthroscopic medial meniscal repair with or without concurrent anterior cruciate ligament reconstruction: A subgroup analysis. Knee 2018; 25:109-117. [PMID: 29162378 DOI: 10.1016/j.knee.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 10/03/2017] [Accepted: 11/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND There are few large-scale, long-term studies comparing medial meniscal repairs with or without concurrent anterior cruciate ligament (ACL) reconstruction. METHODS A total of 140 patients who underwent arthroscopic medial meniscal repair were divided into two groups: Group A, meniscus repair only and Group B, meniscus repair with concurrent ACL reconstruction. Clinical assessments in- cluded physical examination findings, Lysholm score, and the International Knee Documentation Committee (IKDC) form. Barret criteria were used for the clinical assessment of healing status. Magnetic resonance imaging (MRI)was obtained to confirmhealing and failure. Subgroups of participants were compared in terms of suture technique, type of tear, and location of tear. KT-2000 arthrometer testing was used for objective evaluation of anterior-posterior knee movement. RESULTS Mean follow-up duration was 61 (34-85) months. Clinical outcomes in both groups were significantly improved compared to baseline (P=0.001 vs. P=0.001); however, there was no significant between-group difference in postoperative Lysholm and IKDC scores (P=0.830). The outcomes of three participants (seven percent) in Group A and 11 (11.3%) in Group B were considered as treatment failures (P=0.55). Red-red zone tears had higher scores. Mean postoperative KT2000 arthrometer values of failed participants in Groups A and B were 4.66mm (range, four to six) and 5.2mm (range, two to seven), respectively. CONCLUSION Concurrentmedialmeniscus repair and ACL reconstruction did not have clinical superiority over meniscus repair alone. Repairs in the red-red zone appeared to be associated with better outcomes.
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Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears. Orthop J Sports Med 2017; 5:2325967117712448. [PMID: 28680898 PMCID: PMC5484431 DOI: 10.1177/2325967117712448] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although numerous studies have assessed arthroscopic medial meniscal repairs, few studies have focused on factors affecting outcomes of vertical longitudinal and bucket-handle repairs. PURPOSE To evaluate the factors affecting clinical outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle medial meniscal tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 223 patients underwent arthroscopic repair for medial meniscal tears between 2007 and 2012; 140 patients had isolated tears or concurrent anterior cruciate ligament (ACL) reconstruction, and 80 patients (76 men, 4 women; mean age, 29.1 years; range, 18-49 years) had vertical longitudinal tears and were included in the study. Pre- and postoperative functional status was assessed using physical examinations with Lysholm and International Knee Documentation Committee (IKDC) scores. Barrett criteria were used for clinical assessment of meniscal healing, and magnetic resonance imaging (MRI) was used as the radiologic assessment method. The effects of tear location, length, chronicity, and type; suturing technique; concurrent ACL reconstruction; and patient age, sex, and smoking habits were also investigated. RESULTS The mean follow-up period was 51.2 ± 9.4 months (range, 34-85 months). The mean Lysholm and IKDC scores improved at final follow-up (both Ps <.001). According to clinical scores, Barrett criteria, and MRI, failure was noted in 12 patients (15%). There were no significant differences in age, tear length, tear type, concurrent ACL rupture, suturing technique, or location of the meniscal repair between the success and failure groups. Failure rates were higher for red-white zone tears than for red-red zone tears (10/30, 33.3% vs 2/50, 4%; P = .004). Tear chronicity significantly affected failure rates. Early repairs had higher healing rates than late repairs (100% vs 73.4%; P = .008). Failure rates were higher for smokers than for nonsmokers (9/24, 37.5% vs 3/56, 5.3%; P = .008). CONCLUSION Peripheral tears and early repairs have better outcomes and patient satisfaction. Smoking adversely affects meniscal healing.
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The effect of erythropoietin on biomechanical properties of the Achilles tendon during the healing process: an experimental study. J Orthop Surg Res 2016; 11:55. [PMID: 27125266 PMCID: PMC4850695 DOI: 10.1186/s13018-016-0390-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/19/2016] [Indexed: 11/27/2022] Open
Abstract
Background The aim of this study was to examine the potential biomechanical and histological benefits of systemic erythropoietin administration during the healing of Achilles tendon injury in a rat experimental model. Methods Eighty Sprague-Dawley female rats were included in this study. Animals were randomly assigned into two groups with 40 animals in each: erythropoietin group and control group. Then each group was further divided into four subgroups corresponding to four time points with 10 animals in each. A full-thickness cut was made on the Achilles tendon of each animal and then the tendon was sutured with modified Kessler method. Erythropoietin groups received intraperitoneal erythropoietin (500 IU/kg/day) every day at same time throughout the study period, and the control groups received saline in a similar manner. Animals were sacrificed at four time points, and tensile test was performed on each tendon sample to assess maximum load for each sample. In addition, histopathological examination and scoring was done. Results Both groups had improvement on tensile test (maximum load) over time. However, groups did not differ with regard to maximum load in any of the time points. Similarly, groups did not differ with regard to any of the histopathological scores over time. Conclusions The findings of this study do not support the benefit of systemic erythropoietin administration in Achilles tendon healing process. Further evidence from larger experimental studies is required to justify any such potential benefit. Electronic supplementary material The online version of this article (doi:10.1186/s13018-016-0390-1) contains supplementary material, which is available to authorized users.
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Incidence and economic burden of prosthetic joint infections in a university hospital: A report from a middle-income country. J Infect Public Health 2016; 9:494-8. [PMID: 26829894 DOI: 10.1016/j.jiph.2015.12.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/27/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022] Open
Abstract
In this study, we aimed to evaluate the incidence and economic burden of prosthetic joint infections (PJIs) in a university hospital in a middle-income country. Surveillance data between April 2011 and April 2013 in the Orthopedic Surgery Department was evaluated. Patients (>16 years old) who had primary arthroplasty in Erciyes University were included in the study, and patients with preoperative infection were excluded. Patients were followed up during their stay in the hospital and during readmission to the hospital for PJI by a trained Infection Control Nurse. During the study period, 670 patients were followed up. There were 420 patients (62.7%) with total hip arthroplasty (THA), 241 (36.0%) with total knee arthroplasty (TKA) and 9 (1.3%) with shoulder arthroplasty (SA). The median age was 64, and 70.6% were female. The incidence of PJI was 1.2% (5/420) in THA, 4.6% (11/241) in TKA and 0% (0/9) in SA. PJI was significantly more prevalent in TKA (p=0.029). All of the PJIs showed early infection, and the median time for the development of PJI was 23.5 days (range 7-120 days). The median total length of the hospital stay was seven times higher in PJI patients than patients without PJI (49 vs. 7 days, p=0.001, retrospectively). All hospital costs were 2- to 24-fold higher in patients with PJI than in those without PJI (p=0.001). In conclusion, the incidence and economic burden of PJI was high. Implementing a national surveillance system and infection control protocols in hospitals is essential for the prevention of PJI and a cost-effective solution for the healthcare system in low-middle-income countries.
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Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2015; 23:2384-2389. [PMID: 24292979 DOI: 10.1007/s00167-013-2784-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 11/17/2013] [Indexed: 01/24/2023]
Abstract
PURPOSE To compare the effect of arthroscopic microfracture surgery alone or in combination with platelet rich plasma (PRP) on functional outcomes in osteochondral lesions of the talus. METHODS A total of 35 patients were included in the study. Control subjects (n = 16) received treatment with microfracture surgery alone, while the remaining patients (PRP group, n = 19) were also given PRP. After an average follow-up of 16.2 months (range 12-24 months), patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, Foot and Ankle Ability Measure (FAAM), and the visual analogue scale (VAS) for pain. RESULTS At baseline, AOFAS and FAAM scores were similar in the two groups, whereas pain scores (VAS) were higher in those who were assigned to combined treatment. Despite the latter finding, the combined treatment with PRP resulted in better outcomes in terms of functional scores [AOFAS, 89.2 ± 3.9 vs. 71.0 ± 10.2, (p = 0.001); FAAM overall pain domain, 1.0 (1.0-2.0) vs. 2.5 (1.0-4.0), (p = 0.04); FAAM 15-min walking domain, 1.0 (1.0-2.0) vs. 2.0 (1.0-4.0) (p = 0.001)]; and pain-related scores [VAS, 2.2 ± 0.8 vs. 3.8 ± 1.2, (p = 0.001)] as compared to arthroscopic microfracture surgery alone. CONCLUSIONS PRP as an adjunct to arthroscopic microfracture surgery for the treatment of osteochondral lesions of the talus resulted in improved functional score status in the medium-term. Further studies to determine the long-term efficacy of this approach were warranted. LEVEL OF EVIDENCE II.
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Abstract
Synovial chondromatosis is a rare and benign proliferative disorder of the synovial membrane in joints and bursae. Herein, we present the case of a 34-year-old male with synovial chondromatosis that caused limitation in the elbow joint in terms of mechanical function.
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Abstract
BACKGROUND/OBJECTIVES Structural and functional impairments of the Achilles tendon in diabetic patients has the potential to contribute to ulcer formation through altered foot mechanics. This study aimed to examine the biomechanical and histopathological alterations in Achilles tendon specimens from diabetic vs. non-diabetic individuals. MATERIALS AND METHODS 42 Achilles tendon samples obtained from patients treated with below-knee or above-knee amputation for chronic diabetic foot ulcers (n=21) or for non-diabetic conditions (n=21) were included. A tensile test was performed for each tendon and a stress vs. strain graft was obtained to calculate following biomechanical parameters: elasticity (Young modulus), load, stiffness, toughness, energy, strain, elongation and tenacity. Groups were also compared with regard to histopathological findings (inflammatory cell infiltration, collagen organization, and degeneration). RESULTS Non-diabetic tendons exhibited a superior biomechanical profile over diabetic tendons with regard to the following biochemical parameters: elasticity, maximum load, stiffness, toughness, load, energy, strain and elongation at break point, tenacity, and strain at automatic load drop (p<0.05 for all comparisons). Diabetic tendons had mild impairment of collagen organization and focal collagen degeneration, whereas neither diabetic nor non-diabetic tendons had inflammatory cell infiltration. CONCLUSION The structural and functional alterations associated with diabetes adversely affect the biomechanical properties of the Achilles tendon, potentially acting together with neuropathy and ischemia in the development of diabetic foot ulcers.
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Is There an Association Between Synovial CD30+ T Lymphocyte Count and Chondral Lesion Depth? Curr Ther Res Clin Exp 2014; 75:44-7. [PMID: 24465042 PMCID: PMC3898187 DOI: 10.1016/j.curtheres.2013.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2013] [Indexed: 11/13/2022] Open
Abstract
Background Exact role of the inflammation in osteoarthritis is still unclear, but it is thought to originate from synovitis due to micro-crystals or breakdown products of the cartilage. Objective To determine the effect of CD30+ T lymphocytes on the development of osteoarthritis by comparing the lesion depth and synovial CD30+ count in patients with chondral lesions undergoing knee joint arthroscopy. Design A total of 79 patients with chondral lesions detected during arthroscopy were categorized in 4 different groups based on chondral lesion classification. CD30+ lymphocyte counts were calculated using flow cytometry on synovial fluid samples obtained at the time of initial entrance into the joint and compared between the groups. In addition, biopsy samples obtained from the suprapatellar bursa were stained for histologic examination to identify existence of CD30+ lymphocytes in the synovium. Results Although there were no significant differences between the first 3 groups in terms of synovial fluid CD30+ lymphocyte counts, patients in Group IV had significantly higher counts (6.2 8 [2.48] vs 2.51 [1.84], 2.97 [2.40], and 3.80 [2.07], respectively; P < 0.05). Except for a single patient with a Grade III chondral lesion, there were no cases of CD30 positivity in synovial tissue. Also there was a correlation between CD30 levels and chondral lesion depth when controlled for age. Conclusions Our results indicate higher CD30+ lymphocyte counts in patients with modified Outerbridge Grade IV chondral lesions than in other groups. The origin of the CD30+ lymphocytes may not be the synovial tissue per se. Thus, it was hypothesized that the injured chondral tissues and the associated subchondral structures might have been the source of CD30+ lymphocytes with a possible influence on the development of osteoarthritis.
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Comparison of arthroscopic, radioactive and combined synovectomy in the treatment of chronic non-specific knee synovitis. Med Princ Pract 2014; 23:551-5. [PMID: 25196268 PMCID: PMC5586937 DOI: 10.1159/000365635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare the outcomes of arthroscopic, radioactive and combined synovectomies in patients with chronic non-specific recurrent synovitis who did not respond to conservative therapy. SUBJECTS AND METHODS Twenty-nine patients enrolled between 2007 and 2011 were divided into 3 groups: group 1 was treated with arthroscopy, group 2 received a radioactive drug and group 3 received a combined (radioactive and arthroscopic) synovectomy. Treatment efficacy was evaluated by comparing pre- and post-operative Lysholm knee scores (LKS), night pain, resting pain, activity pain and effusions using visual analogue scales (VAS). Patient satisfaction was assessed using the visual analogue patient satisfaction scale (VAPSS). RESULTS The mean age of the study participants was 41.5 ± 5.2 years (range 14-76), and the mean follow-up period was 33.6 ± 3.2 months (range 17-78). Before treatment, the mean LKS was 41.4 ± 3.4 in group 1, 39.6 ± 3.3 in group 2 and 37.1 ± 4.6 in group 3. After treatment, the corresponding mean LKS were 77.7 ± 2.1, 81.6 ± 2.8 and 91.3 ± 2.7 in groups 1, 2 and 3, respectively; the increase was statistically significant (p < 0.05). The VAS scores before and after treatment decreased significantly (p < 0.05). The mean VAPSS score, a measure of patient satisfaction, was 5.1 ± 1.7, 5.8 ± 1.5 and 7.4 ± 1.8 in groups 1, 2 and 3, respectively, and the difference between groups 1 and 2 was not statistically significant, while that between group 3 and the other two groups was significant (p < 0.05). CONCLUSION This study showed that the three methods used in individuals with chronic non-specific recurrent synovitis were effective; however, arthroscopic synovectomy in combination with radioactive synovectomy was more effective than the other methods and superior in terms of patient satisfaction.
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The Effects of Arthroscopic Joint Debridement in Knee Osteoarthritis Patients Over the Age of Sixty. ERCIYES MEDICAL JOURNAL 2013. [DOI: 10.5152/etd.2013.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Vascular access. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Septic Loosening Due to Brucella Melitensis After Bilateral Knee Prosthesis and Two-Stage Total Knee Prosthesis Revision. ERCIYES MEDICAL JOURNAL 2012. [DOI: 10.5152/etd.2012.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Effects of propolis on fracture healing: an experimental study. Phytother Res 2011; 25:1648-52. [PMID: 21425375 DOI: 10.1002/ptr.3470] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 02/10/2011] [Accepted: 02/10/2011] [Indexed: 01/17/2023]
Abstract
Propolis is a substance of honeybee origin with known antioxidant effects. The purpose of this study was to examine the effects of propolis on fracture healing and the antioxidant system in an experimental setting. Thirty-two rats that underwent experimental femur fracture and then fixation were randomly allocated in one of four groups: two control groups (Control-3w and Control-6w) and two treatment groups (Propolis-3w and Propolis-6w). Treatment groups received propolis until killing (at 3 or 6 weeks). X-ray, histological, bone mineral density measurement findings and endogenous antioxidant levels were examined. The bone mineral density was higher, radiological and histological evaluation scores were better, and superoxide dismutase, total glutathione and myeloperoxidase levels were lower among the rats that received oral propolis treatment compared with the controls. In addition, bone mineral density and histological assessment scores showed time-dependent improvement in the treatment group. In conclusion, the findings of this study suggest that propolis has some time-dependent beneficial effects on fracture healing.
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Short- and mid-term results of plica excision in patients with mediopatellar plica and associated cartilage degeneration. Knee Surg Sports Traumatol Arthrosc 2010; 18:1526-31. [PMID: 20376622 DOI: 10.1007/s00167-010-1125-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 03/11/2010] [Indexed: 11/27/2022]
Abstract
This study aimed to evaluate the short- and mid-term results of plica excision in patients with mediopatellar plica and associated cartilage degeneration. Seventy-six surgically treated patients with mediopatellar plica and associated cartilage degeneration at medial femoral condyle (MFC) and/or medial pole of patella were included. Patients were evaluated at baseline, at 6 weeks and 6 months after the operation for their clinical outcomes and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. The frequency of all signs and symptoms, including all pain parameters, and WOMAC scores were significantly improved compared to baseline, at 6 weeks and 6 months after the operation (P < 0.017). Based on mean WOMAC scores, results of most patients were rated as excellent both at 6 weeks (88%) and at 6 months (94%). Surgical excision of mediopatellar plica associated with cartilage degeneration appears to result in substantial clinical improvement, thus it represents an effective treatment modality.
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Treatment of bullous pemphigoid with enteric-coated mycophenolate sodium. J Eur Acad Dermatol Venereol 2007; 21:542-4. [PMID: 17373988 DOI: 10.1111/j.1468-3083.2006.01942.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Unusual Combination of Femoral Head Dislocation Associated Acetabular Fracture With Ipsilateral Neck and Shaft Fractures: A Case Report. ACTA ACUST UNITED AC 2006; 61:1545-8. [PMID: 17159705 DOI: 10.1097/01.ta.0000224898.83708.e1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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O-263. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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P-378. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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P-811. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Assisted Reproductive Treatments in Patients With Ovarian Endometriomas: Comparison of Endometriomas With Simple Basal Cysts. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Management of Prestimulation Ovarian Cysts During Assisted Reproduction Treatment Cycles: Is Aspiration Required? Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cycle Management in Young Poor Responders: Does an Associated Male Factor Make the Picture Worse? Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
We investigated the effects of the antioxidant alphae-tocopherol on early- and late-phase fracture healing in a rat model. Sixty male Sprague-Dawley rats were randomized into two groups. The right tibia of each rat was fractured manually under anaesthesia, and fracture sites fixed with intramedullary Kirschner wires. The alpha-tocopherol group received 20 mg/kg alpha-tocopherol intraperitoneally; the control group received intraperitoneal saline injections. Ten rats from each group were sacrificed on day 15, day 45 and day 60. In the alpha-tocopherol group, malondialdehyde concentrations, a measure of lipid peroxidation associated with oxygen free radicals, were significantly decreased on day 15 and day 45 compared with the control group, but had regained the 15-day value on day 60. On histopathological and radiological assessment, fracture healing on day 60 was significantly more advanced in the alpha-tocopherol group. We conclude that alpha-tocopherol has a positive effect on both early and late-phase fracture healing, and may be beneficial in clinical fracture
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Abstract
BACKGROUND Inferior dislocation of the glenohumeral joint or luxatio erecta humeri is a rare form of injury, accounting for only 0.5% of all shoulder dislocations. Bilateral cases are even less frequent, with only eight cases reported in the literature. METHOD AND RESULT We report one case of bilateral inferior dislocation of the shoulder. The patient made a complete functional recovery within 2 years after treatment by closed reduction and rehabilitation. CONCLUSION Based on this case and the pertinent literature, the pathophysiology, diagnosis, and treatment of this rare injury are discussed.
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