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"Living with a fragmented body": a new qualitative study on views about body modifications following a vertebrae harm.
OBJECTIVES This study aims to analyze the nationwide trends in carpal tunnel surgery by surgeons practicing in Turkey according to experience in years, training received (plastic surgery or orthopedics), and working location (Turkey or abroad) by slightly modifying Munns' survey. MATERIALS AND METHODS A printed and online survey consisting of 11 questions was sent to Turkish and international surgeons. The surgeon's province of practice, years in practice, type of education received as a resident, preferred operation room, preferred surgical approach, type of anesthesia used, use of postoperative orthosis and therapy were assessed in the survey. RESULTS The survey was completed by 198 surgeons (a 25% response rate). The majority of surgeons practicing in Turkey (87%) and 67% of surgeons practicing abroad demanded electromyography (EMG) and nerve conduction studies. Sixty- one percent of respondents from Turkey and 76% of respondents practicing abroad did not administer antibiotics preoperatively. While the most common anesthetic technique used by international surgeons was subcutaneous local anesthesia (42%), Turkish surgeons preferred wrist block (18%). Surgeons practicing in Turkey with fewer than five years of experience were more likely to administer antibiotics preoperatively, use EMG/nerve conduction studies, utilize a mini-open approach and apply an orthosis postoperatively (p less then 0.05). CONCLUSION There are comparable differences between Turkish and international surgeons regarding pre- and postoperative management of carpal tunnel surgery. Province of practice, years in practice, and type of education received as a resident have influence over the management of carpal tunnel syndrome.OBJECTIVES This study aims to describe a retrospective study using prospectively gathered data to compare mini-open and extended open release techniques for moderate to severe carpal tunnel syndrome (CTS). PATIENTS AND METHODS The data of 198 consecutive patients (139 males, 59 females; mean age 57.0±4.5 years; range, 44 to 75 years) treated for CPS were used. For matching, age, gender and severity of the compression, the Greathouse Ernst Halle Schaffer neurophysiological classification system was used. After matching, 63 observations in each group (group 1 mini-open and group 2 extended open) were used for analysis. A Jamar hydraulic hand dynamometer was used to measure pre- and postoperative third month grip strengths. The key pinch test was performed also at third month. Patients completed the Boston Carpal Tunnel Questionnaire at the last follow-up. RESULTS Symptom severity and functional status were improved up to half fold in both groups at final follow-up; however, there was no statistically significant clinical difference between the groups (p>0.05). There were totally six patients with paresthesia symptoms (three in each group; 4.7%), which improved in three months. Eight patients (6.3%, one in group 1 and seven in group 2, p=0.032) had dysesthesia and pillar pain. CONCLUSION Mini-open and extended open carpal tunnel release have similar clinical outcomes without any major complications.OBJECTIVES This study aims to evaluate the cosmetic and functional results of suture treatment on pincer nail deformity (PND). PATIENTS AND METHODS This study was conducted between June 2018 and November 2018. Sixteen nails of 13 patients (6 males; 7 females; mean age 46.9 years; range, 24 to 74 years) with PND were treated with silk sutures. The pathologic stage (including tissue status and level of pain), visual analog scale (VAS), nail height (H) and width (W) were evaluated pre- and postoperatively. Nail H and W were measured pre- and postoperatively from digital photographs of each nail and H/W ratio was calculated. RESULTS The postoperative VAS, severity of pain scores, and nail H showed a significant decrease compared to the preoperative values (p less then 0.05). Curvature of the nail and pain scores decreased in all patients. Nail W showed a significant increase, therefore H/W ratio decreased significantly (p less then 0.05). Although recurrence of cosmetic deformity was seen at six months, the VAS and tissue scores remained lower than preoperative values. Patients reported favorable outcomes compared to their preoperative complaints. CONCLUSION The described suture treatment method is an inexpensive, simple technique, not requiring any special material. These results support that this technique is useful for pain relief and tissue healing even if cosmetic recurrence occurs.OBJECTIVES This study aims to report the outcomes of dorsal V-Y advancement flap technique used for the reconstruction of surgical defects following total matricectomy performed for the onychogryphosis of hand nails. PATIENTS AND METHODS A total of 18 consecutive patients (10 males, 8 females; mean age 38.4 years; range, 24 to 41 years) with 20 onychogryphotic hand nails who underwent total matricectomy and dorsal V-Y advancement flap technique were analyzed retrospectively between June 2015 and March 2018. The Mann- Whitney U test was used to compare the pre- and postoperative Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) questionnaire scores while postoperative satisfaction rate was also evaluated. RESULTS The mean follow-up period of the patients was 15.3 months. The etiology was finger trauma in eight and surgical complication of recurrent paronychia drainage in four cases, while the remaining six were idiopathic. The mean time to return to work was 5.2 weeks, and the mean pre- and postoperative Quick DASH scores were 0.97 and 3.45, respectively, with a statistically significant difference. The postoperative satisfaction was rated as excellent in 16, good in one, and moderate in one case. CONCLUSION The dorsal V-Y advancement flap technique can be performed reliably due to its good soft tissue coverage, satisfactory cosmetic and functional outcomes, and allowing a short time to return to work.OBJECTIVES This study aims to investigate the reliability of the Lichtman classification among residents, orthopedic surgeons, and hand surgeons. MATERIALS AND METHODS This study was carried out with 30 male observers (mean age 37.8 years; range, 26 to 62 years) who agreed to participate in the study. All observers were orthopedic surgeons. The observers were separated into three groups that consist of 10 residents, 10 orthopedic surgeons, and 10 hand surgeons. The anteroposterior and lateral wrist radiographs of 20 patients (12 males, 8 females; mean age 49 years; range, 38 to 74 years) diagnosed as Kienböck's disease were sent to observers via e-mail as a survey. All 40 radiographs were asked to be kept classified. RESULTS The classification of Kienböck's disease was analyzed by 30 observers on 40 digital radiographs. The overall agreement with the Lichtman classification was fair within all of the observers (kappa=0.203). When groups were evaluated within themselves, the agreement level was found poor in group 1 (kappa=0.162) and fair in group 2 (kappa=0.210) and group 3 (kappa=0.252). CONCLUSION A useful classification system in orthopedics and traumatology should classify the type of musculoskeletal disorder reliably, facilitate communication in clinical practice, guide preoperative planning, and enable comparison of results between studies. The Lichtman classification alone is insufficient and should be supported by other imaging and measurement techniques.OBJECTIVES This study aims to investigate the usability and reliability of our new axis in a three-dimensional modelling work and demonstrate if it is a reproducible method for anteversion measurement that sufficiently correlates with other computed tomography (CT)-derived gold standards including trans- epicondylar axis (TEA) and posterior condylar axis (PCA). PATIENTS AND METHODS Three-dimensional solid models were derived from left femoral CT data of 100 participants (50 males, 50 females; mean age 57 years; range, 21 to 86). The newly proposed popliteal surface axis (PSA) was compared with TEA and PCA in terms of anteversion measurement on these solid models. RESULTS Popliteal surface axis was found as a reproducible reference axis in our study as it could be measured in 99% of our sample. The mean value of PSA based anteversion was (-) 1.8° which was 10.7° and 4.4° for PCA and TEA, respectively. Popliteal surface axis was perfectly correlated with PCA and TEA for anteversion measurements (p less then 0.001, r=0.92 for both). Selleck Epalrestat CONCLUSION Our findings suggest that the newly defined PSA may be used as an alternative method for determination of anteversion.OBJECTIVES This study aims to evaluate the effects of local adipose stem cell injection on non-union and diabetic non-union of rat femurs. MATERIALS AND METHODS Forty-eight female Wistar albino rats (weighing mean 200 g and aged 8 weeks) were used in this study. The rats were divided into six groups. Group 1 was chosen as a reference for receptor activator of nuclear factor-kappa (κ) B (RANK), receptor activator of nuclear factor-κ B ligand (RANKL) and osteoprotegerin (OPG) genes and no femur osteotomy was performed in this group. Group 2 underwent femur osteotomy, the osteotomy was fixed with a 1.5 mm K-wire as retrograde from the knee joint, and no gap was left in the osteotomy line. In order to induce non-union, femurs underwent osteotomy fixed with K-wires in groups 3, 4, 5 and 6. In addition, the osteotomy line was measured as 1.8 mm gap with electronic calipers and the gap was fixed with U staple. Before osteotomy, streptozocin was injected intraperitoneally at a dose of 60 mg/kg in 0.1 mol/L citrate butudy, local adipose stem cell injection has positive radiological and histopathological effects in diabetic and non-diabetic femoral non-unions, independently of RANK, RANKL, or OPG gene expression pathways.OBJECTIVES This study aims to investigate if geometrical modelling in addition to three-dimensional (3D) modelling will standardize models and allow performing mathematical calculations easily for the compatibility of femoral implant curvature. PATIENTS AND METHODS The study included 50 subjects (27 males, 23 females; mean age 55 years; range, 21 to 84 years). The femoral shaft intramedullary cavity was resembled into a chord of the ring cyclide, where the rotational radius was centered at its smallest radius. A 3D evaluation of the left femoral computed tomography data of the subjects was used to investigate the population parameters. The fitting was defined as being between the anterior and posterior border radii in the sagittal plane. RESULTS The best fitting radius of implants was in between 90 to 99 cm in 72% of subjects in our sample. These radii values were lower than the mean intramedullary and cortical centerline radii which had only 62% and 50% fittings, respectively, among our population sample. The bowing radii and the smallest intramedullary width increased with the femoral length. These values were not affected by gender. CONCLUSION This modelling may have value for understanding femoral shaft intramedullary cavity geometry and may be a good tool to assess implant fitting.OBJECTIVES This study aims to analyze the effect of intravenous administration of tranexamic acid (TA) on reducing the risk of revision for acute and delayed periprosthetic joint infection (PJI) after primary total knee replacement (TKR). PATIENTS AND METHODS This prospective observational cohort study included 1,529 TKRs (396 males, 1,133 females; mean age 67.8 years; range, 44 to 85.1 years) performed between January 2003 and October 2017. We analyzed the revision rate for acute and delayed PJI in a group of 787 TKRs with preoperatively intravenously administered TA (TA group) in comparison with a group of 742 TKRs without administration of TA (non-TA group). Multiple logistic regression analysis was used to evaluate significant predictors of TKR revision for acute and delayed PJI. RESULTS Revision surgery due to PJI was recorded in one patient in the TA group and eight patients in the non-TA group. Cumulative revision rate of TKR was significantly lower in the TA group (0.13% vs. 1.08%, hazard ratio 0.113; 95% confidence interval [CI] 0.
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