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OBJECTIVE: Postoperative pain control is important in terms of early recovery and rehabilitation in arthroscopic meniscectomy. For this purpose, we aimed to compare the effects of intraarticular tramadol, magnesium, and ketamine with combinations of pericapsular bupivacaine on postoperative pain and recovery in arthroscopic meniscectomy. METHODS: Ninety patients who underwent arthroscopic meniscectomy were enrolled in the study. Group T was given tramadol, Group K was given ketamine, and Group M was given magnesium reconstituted intraarticularly, and all groups received periarticular bupivacaine. Comparisons were made in terms of the patients' postoperative Visual Analogue Scale scores with and without movement, need for additional analgesics, first analgesic time, mobilization times, adverse effects, and satisfaction with the analgesics. RESULTS: The Visual Analogue Scale scores were lowest in Group T at 0 minutes, and were higher in the 15th and 30th minutes and 1st, 2nd, and 6th hours. Visual Analogue Scale values with movement were found to be high in Group M at 0 and 15 minutes, but they were found to be higher in group T in the 30th minute, 1st, 2nd and 6th hour. The groups were similar in terms of postoperative additional analgesic use, number of analgesic use, and satisfaction with analgesics; however, the first analgesic time was earlier in Group M, and the first mobilization time was earlier in Group K. CONCLUSION: Intraarticular ketamine enables early mobilization and less need for additional analgesics, it also provides a better analgesic effect in comparison with intraarticular tramadol and magnesium.
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Analgésicos/administración & dosificación , Anestésicos Locales/administración & dosificación , Artroscopía , Bupivacaína/administración & dosificación , Ketamina/administración & dosificación , Magnesio/administración & dosificación , Meniscectomía/métodos , Dolor Postoperatorio/tratamiento farmacológico , Tramadol/administración & dosificación , Adulto , Anciano , Quimioterapia Combinada , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Hands, especially lunatum, are involved very rarely with osteoid osteoma. This report presents an osteoid osteoma of the lunatum, which was previously misdiagnosed as Kienböck's disease and had undergone surgery. Magnetic resonance imaging may lead the clinician to misdiagnose because of the excessive bone edema around the carpus. The operation should be planned according to radiography and computed tomography findings.
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SUMMARY: Tuberculosis infections are still one of the most important public health problems among developing countries. Musculoskeletal involvement represents 10-15% of all extrapulmonary cases. Tuberculosis tenosynovitis is usually misdiagnosed as nonspecific tenosynovitis. To avoid misdiagnosis and mistreatment, it is important to be alert for mycobacterial infections. This article presents 3 patients with wrist tenosynovitis, which was caused by Mycobacterium bovis infection. The article also includes review of the literature.
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Failure to block the terminal nerves of the brachial plexus, the circumferential type of incomplete axillary brachial plexus block, is the main problem of the single-injection technique. Two studies were carried out to observe the internal anatomy of the axillary sheath and the effect of different volumes of dye injected into the sheath in cadavers. In our first study, the internal arrangement of the axillary sheath and its septae were examined microscopically by slicing the sheath longitudinally and transversely. In the second study, boluses of 10, 20, and 40 cc of methylene-blue were injected into one of the compartments of the axillary sheath. The axillary sheath was dissected out and sliced transversely to observe the spread of the dye in the injected and in the adjacent compartments. The specimens of the axillary sheath were then opened longitudinally and the septae excised and examined at x10 magnification to see the effect of the various volumes of the injection bolus. This study shows that septae from the deep surface of the axillary sheath form compartments for each nerve. The septae function as barriers under physiologic conditions. By increasing the injected volume of solutions, bubble-like defects are produced in the septae in the compartments into which leakage was demonstrated.
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Anestésicos/administración & dosificación , Plexo Braquial/anatomía & histología , Inyecciones , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors report a technique of the anterior cubital approach that is an exposure for displaced pediatric supracondylar fractures. Reduction is very safe and easy with this approach. Anatomical structures that hinder reduction such as the brachialis muscle or joint capsule and neurovascular tissues can be identified easily. This technique has not been a popular form of treatment in many countries, particularly in the United States.
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Fijación Interna de Fracturas/métodos , Fracturas del Húmero/cirugía , Hilos Ortopédicos , Niño , Humanos , Fracturas del Húmero/diagnóstico por imagen , RadiografíaRESUMEN
OBJECTIVES: We evaluated the results of external rotation osteotomy of the humerus for the treatment of shoulder problems secondary to obstetric brachial plexus palsy. METHODS: Forty children (24 boys, 16 girls; mean age 7.5 years; range 23 months to 14.8 years) underwent external rotation osteotomy of the humerus. Involvement was at the C5-6 roots in 11 patients, C5-6-7 roots in 19 patients, and at all the roots in 10 patients. Twenty-six patients had humeral head deformity and eight patients had posterior subluxation. The shoulder was ankylosed in one patient. Zancolli and Putti signs were positive in six and eight patients, respectively. The mean active shoulder abduction was 80 degrees (range 0 to 170 degrees ) and the mean internal rotation contracture was 27 degrees (range 10 degrees to 50 degrees ). Fourteen patients, all of whom were beyond five years of age, had an abduction contracture. Preoperative and postoperative functional evaluations were made with the use of the Mallet scale. Preoperatively, 35 shoulders had a score of II, five had a score of III. Osteotomies were performed in the proximal humerus in patients older than five years and in the mid-humerus in those without a contracture or younger than five years. RESULTS: The mean postoperative shoulder abduction was 95.7 degrees (range 30 degrees to 170 degrees ). Internal rotation contractures improved in all the patients. Abduction contractures did not resolve in two patients in whom a mid-humeral osteotomy was performed. Postoperative Mallet scores ranged from II to V in five, six, 15, and 14 shoulders, respectively. Rotation provided by the osteotomy was lost in one patient because of a humerus fracture that occurred in a traffic accident. Passive total shoulder rotation remained unchanged following surgery. Patients having better preoperative range of motion and who were at younger ages benefited the most from surgical treatment. CONCLUSION: External rotation osteotomy of the humerus must be performed at early ages before the shoulder gets stiffer.
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Plexo Braquial/lesiones , Húmero/lesiones , Parálisis/cirugía , Adolescente , Placas Óseas , Plexo Braquial/diagnóstico por imagen , Plexo Braquial/patología , Plexo Braquial/cirugía , Niño , Preescolar , Distocia , Femenino , Humanos , Húmero/diagnóstico por imagen , Húmero/patología , Húmero/cirugía , Lactante , Masculino , Osteotomía/métodos , Parálisis/rehabilitación , Embarazo , Radiografía , Resultado del TratamientoRESUMEN
To understand the lesion of the terminal branches of posterior interosseous nerve (PIN), an anatomic study was carried out. Thirty adult cadaver arms were dissected and the anatomic pattern of the nerve was documented. The distance between the point at which the nerve divides into branches and the distal edge of the supinator were measured, as well as the length of each nerve branch to its muscle-entering sites. The number of branches innervating each muscle was recorded. It was found that the PIN was branching to multiple short branches and a single deep long branch after leaving the supinator muscle with great morphometric and schematic variances.
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Brazo/inervación , Músculo Esquelético/inervación , Nervio Radial/anatomía & histología , Adulto , Antropometría , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors performed a retrospective review of the anterior cubital approach, an alternative exposure for displaced pediatric supracondylar fractures. Anatomic structures that hinder reduction, such as the brachialis muscle or joint capsule, and neurovascular tissues can be identified easily with this approach. Sixty-one children with displaced supracondylar humeral fractures were treated surgically with Kirschner wires using the anterior cubital approach between January 1996 and August 2002. The cohort comprised 35 boys and 26 girls with a mean age of 8.7 years (range 3-13 years). Mean follow-up was 3.5 years (range 1-6 years). Preoperatively 13 children (21.3%) had a neurovascular insufficiency that required an exploration during the operation. All patients were reduced completely with full anatomic position. On follow-up, no patient had any scar formation or deformity or experienced any restricted motion. The authors conclude that the anterior cubital approach is very effective and is an option for the treatment of pediatric supracondylar humerus fractures without serious complications.
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Fracturas del Húmero/cirugía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Procedimientos Ortopédicos/métodos , Estudios RetrospectivosRESUMEN
PURPOSE: To introduce a surgical technique for the treatment of macrodactyly in older children and adults, to represent the degree of correction obtained by the procedure, and to give the functional results. METHODS: Two thumbs and 5 fingers of 5 patients aged 12 to 32 years (mean, 17.5 years) with macrodactyly had surgery. The amount of tissue sufficient to reconstruct a normal-sized digit was left attached with the neurovascular bundle on the concave side of the macrodactylic digit and complete excision of whatever remained was performed. This requires usually arthrodesis of the distal interphalangeal joint with bone shortening. The large skin fold created during bone shortening and remaining angulations at the proximal phalanx were corrected during a second procedure. The patients were evaluated for 3 to 9 years (mean, 5.4 years) after the surgery. The length and circumferences of the involved digits and their opposites were measured before surgery and during the last follow-up examination to calculate the differences between the involved and the healthy digits, which were documented. The degree of reduction was quantified and noted. Two-point discrimination tests and active range of motion of the joints were recorded as well. RESULTS: For the thumbs an average 37% of circumference and 15% of length were reduced and for the fingers an average 44% of circumference and 35% of length were reduced. Ranges of motion of the joints of the involved digits were the same or nearly the same as before surgery in all of the cases. Two-point discriminations at the pulp of the involved digits were found to be the same as presurgical values in all digits. CONCLUSIONS: The technique is precise and simplifies the planning of the surgery. Although the macrodactylic digits with angulation deformities required a subsequent surgery for corrections patients with marked macrodactyly of the digit without a very wide proximal phalanx and metacarpal gained most from this technique.
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Dedos/anomalías , Gigantismo/cirugía , Deformidades Congénitas de la Mano/cirugía , Pulgar/anomalías , Adolescente , Adulto , Artrodesis , Niño , Femenino , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/cirugía , Dedos/diagnóstico por imagen , Dedos/cirugía , Estudios de Seguimiento , Gigantismo/diagnóstico por imagen , Deformidades Congénitas de la Mano/diagnóstico por imagen , Humanos , Hipertrofia/diagnóstico por imagen , Hipertrofia/cirugía , Masculino , Articulación Metacarpofalángica/diagnóstico por imagen , Articulación Metacarpofalángica/cirugía , Microcirugia , Osteotomía , Radiografía , Rango del Movimiento Articular/fisiología , Reoperación , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/inervación , Pulgar/diagnóstico por imagen , Pulgar/cirugía , Resultado del TratamientoAsunto(s)
Síndrome del Túnel Carpiano/cirugía , Endoscopía/métodos , Procedimientos Ortopédicos/efectos adversos , Traumatismos del Sistema Nervioso/etiología , Nervio Cubital/lesiones , Adulto , Endoscopía/efectos adversos , Femenino , Humanos , Procedimientos Neuroquirúrgicos/métodos , Recuperación de la Función , Reoperación , Traumatismos del Sistema Nervioso/cirugía , Resultado del Tratamiento , Nervio Cubital/cirugíaRESUMEN
Most of the mallet finger deformity results from tendinous origin. Many surgical techniques defined for chronic mallet deformity are aggressive, which often result in disappointment. The Brooks and Graner procedure is a developed surgical technique and useful procedure for chronic mallet finger deformity with tendinous origin. The method is simple and very effective for treatment of chronic mallet deformity.
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The spinoglenoid ligament has been implicated in compression of the suprascapular nerve in cases with isolated atrophy of the infraspinatus muscle. We dissected 32 shoulders of 16 embalmed cadavers. We could detect a spinoglenoid ligament in only 5 shoulders, and it was thin, loose, and weak. Instead of the spinoglenoid ligament, we observed a septum formed by the thickening of the fascial cover of the distal third of the supraspinatus and infraspinatus muscles. It originated from the spinoglenoid notch and extended into the posterior capsule. We named this structure the spinoglenoid septum. The suprascapular nerve passed between the bony margin of the spinoglenoid notch and the medial concave margin of the spinoglenoid septum. This septum may be a cause of dynamic compression of the suprascapular nerve.
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Ligamentos Articulares/anatomía & histología , Músculo Esquelético/anatomía & histología , Articulación del Hombro/anatomía & histología , Fascia/anatomía & histología , Femenino , Humanos , Masculino , Síndromes de Compresión Nerviosa/patología , Nervios Periféricos/anatomía & histología , Articulación del Hombro/inervaciónRESUMEN
After second ray amputation, neuroma formation is a common cause of postoperative pain localized at the web space due to sectioning and leaving the digital nerve ends. Most of the time the complaints lead to two or more operations, using several described techniques, with some limited success. However, transposition of the digital nerve ends into interosseous muscles should be added to the second ray amputation as a part of procedure, neuroma problems can be solved. The technique is described by detail in this article which is advised for other ray amputations and during revisions.
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We report a case of a supracondylar process that was located beneath the neurovascular bundle and caused tenting of the bundle with elbow extension and supination.