RESUMEN
BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to relieve pain and inflammation. These NSAIDs have also analgesic effects and can be administered via oral, injectable, and topical routes. During inflammation, a number of synovial mediators and cytokines are released which decrease the pH level of the synovial fluid. Administration of acidic NSAIDs further decreases the pH levels and hence contributes to the destruction of the cartilage. To our knowledge, no cellular-based study regarding the chondrotoxicity of phenyl alkanoic acid derivatives on NSAIDs was conducted before. Thus, the aim of this pioneering study was to examine the effect of frequently prescribed NSAIDs, a phenyl alkanoic acid derivative, flurbiprofen, on the proliferation and differentiation of human primer chondrocyte cultures in vitro. METHODS: Primer chondrocyte cultures were prepared from osteochondral tissue obtained during surgery for gonarthrosis. Samples not exposed to the pharmacological agent were used as the control group. The samples were treated with 1, 10, 100, 250, 500, or 1000 µM of the agent for 24, 48, and 72 h. The cell viability, toxicity, and proliferation were assessed with MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) analysis and prechondrocytic precursor stage-specific embryonic antigen-1 (SSEA-1) expression using a commercial ELISA kit spectrophotometrically. The surface morphology of the samples in each group was compared using an inverted light microscope and an environmental scanning electron microscope (ESEM). An analysis of variance was used to compare between-group differences. Tukey's honest significant difference (HSD) method (95 % confidence interval) was used to evaluate the differences and significance in averages. The alpha significance value was considered <0.01. RESULTS: Statistically significant cytotoxicity was observed in the treatment groups. NSAID had a significant negative effect on the proliferation and differentiation of chondrocytes as compared to the control group (p < 0.01). CONCLUSION: Before administering phenyl alkanoic acid derivatives in the clinical setting, their role in suppressing the proliferation and differentiation of chondrocytes should be taken into account. Thus, caution should be given when prescribing these drugs.
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Analgésicos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Diferenciación Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Condrocitos/efectos de los fármacos , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Diferenciación Celular/fisiología , Proliferación Celular/fisiología , Células Cultivadas , Condrocitos/fisiología , Humanos , Inflamación/tratamiento farmacológico , Inflamación/patología , Dolor/tratamiento farmacológico , Dolor/patología , Método Simple CiegoRESUMEN
BACKGROUND: We aimed to evaluate the results of volar locking and unlocking plate fixation of adult distal radius fractures. METHODS: Thirty-four patients (14 female, 20 male, mean age: 48.5 +/- 17.9 years) who were treated for distal radius fractures were investigated retrospectively. The fractures were distributed as follows: 17.6% AO type B3, 11.8% AO type C2 and 70.6% AO type C3. The patients were evaluated clinically (Gartland and Werley score, visual analog scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score) and radiographically (Stewart score). RESULTS: The mean follow-up of patients was 24 +/- 16.3 months. According to the Gartland-Werley score, the results were excellent in 24.9%, good in 55.9%, moderate in 11.8% and poor in 2.9% of the patients. The mean VAS score was 0.5 +/- 1.1, and the mean DASH score was 26.1. According to the Stewart criteria, 44.1% of the patients were rated as excellent, 52.9% as good and 2.9% as moderate. Two patients had complex regional pain syndrome, one patient carpal tunnel syndrome and one patient tenosynovitis. CONCLUSION: Volar plate fixation is a good and effective treatment for distal radius fractures. The plate should be inserted properly and physiotherapy should not be ignored.
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Placas Óseas , Fijación de Fractura/instrumentación , Fracturas del Radio/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Placas Óseas/clasificación , Placas Óseas/normas , Síndrome del Túnel Carpiano/etiología , Síndromes de Dolor Regional Complejo/etiología , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Fijación de Fractura/métodos , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Radiografía , Fracturas del Radio/complicaciones , Fracturas del Radio/diagnóstico por imagen , Estudios Retrospectivos , Tenosinovitis/etiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Surgical treatment of unstable thoracolumbar fractures is controversial. Most authors reported that short segment fixation led to a high incidence of implant failure and correction loss. On the other hand, long segment fixation has the disadvantage of fusing more segments. We aimed to compare the outcomes of long-segment fixation versus two or three levels above and one level below fixation for acute thoracolumbar fractures. Twenty six consecutive patients were assigned to two groups. Group 1 included 14 patients treated with long fixation, whereas group 2 included 12 patients treated with two or three levels above and one level below fixation. Fractures were classified according to the Mc Cormack, Magerl and Denis classifications. Clinical (Oswestry questionnaire, Visual analog score) and radiological (Sagittal index, percentage of anterior body height compression, local kyphosis and Cobb angle) outcomes were analysed. The average follow-up for the long and hybrid fixation groups were 28 and 20 months respectively. Clinical scores of both groups at the last follow-up were not significantly different. The preoperative, postoperative and follow-up sagittal index, anterior body height compression, local kyphosis angle and Cobb angle were not significantly different. Correction loss of 3.36 degrees was seen in the long segment fixation group, versus 2.75 degrees in the other group at the last follow-up. There was no significant difference between the results achieved in the patients who had transpedicular fixation two or three levels above and one level below the fractured vertebra and those who had long segment fixation for thoracolumbar burst fractures.
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Vértebras Cervicales/lesiones , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/lesiones , Tornillos Óseos , Vértebras Cervicales/diagnóstico por imagen , Humanos , Radiografía , Estudios Retrospectivos , Fusión Vertebral/instrumentación , Vértebras Torácicas/diagnóstico por imagenRESUMEN
PURPOSE: The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making. METHODS: A total of 30 patients with a preoperative MRI underwent arthroscopy over a 5-month period. All patients had a clinical examination performed by an experienced knee surgeon, a specialist in general orthopedics, a senior resident, and a fourth-year resident. These examiners recorded and evaluated the results of seven tests: the medial and lateral joint line tenderness test, the McMurray test, the Apley test, the Stienmann I test, the Payr's test, Childress' sign, and the Ege's test. The injury was classified as a meniscal tear if there were two positive tests. Clinical history, physical examination, and MRI findings were compared with the arthroscopic findings. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these methods of evaluation were then calculated. RESULTS: Clinical examination performed by an experienced knee surgeon had better specificity (90% vs. 60%), positive predictive value (95% vs. 83%), negative predictive value (90% vs. 86%), and diagnostic accuracy (93% vs. 83%) than MRI for medial meniscal tears. These parameters showed only a marginal difference in lateral meniscal tears. The experienced knee surgeon had better sensitivity, specificity, predictive values, and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners. CONCLUSION: These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear. LEVEL OF EVIDENCE: II.
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Artroscopía/métodos , Traumatismos de la Rodilla/diagnóstico , Imagen por Resonancia Magnética/métodos , Examen Físico/métodos , Lesiones de Menisco Tibial , Adulto , Competencia Clínica , Femenino , Humanos , Traumatismos de la Rodilla/patología , Masculino , Meniscos Tibiales/patología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
We aimed to determine the relationship between functional recovery after knee arthroplasty and systemic and local inflammatory responses. A prospective, clinical study of thirty patients who had osteoarthritis was conducted. After the total knee arthroplasty (TKA), intraarticular IL-6 levels, serum IL-6 levels and serum CRP levels were measured. The primary outcome measures for functional recovery after TKA were the the Knee Society Score (KSS) and Western Ontario and McMaster Universities Index (WOMAC). All patients were examined preoperatively and at 4, 8 and 24 weeks postoperatively. The mean postoperative intraarticular IL-6 level was 218355.1pg/ml, the mean postoperative serum CRP level was 109.9mg/L and the mean postoperative serum IL-6 level was 219.0pg/ml. Preoperative and 4-, 8- and 24-week postoperative KSS and WOMAC scores were evaluated. Significant correlations were found between intraarticular IL-6 concentrations and KSS and WOMAC scores at the first month according to the Pearson correlation test, but no correlations were found between serum IL-6 and CRP levels and KSS and WOMAC scores. The local inflammatory response is more important than the systemic response for early postoperative functional recovery. After TKA, control of local inflammation is much more important than control of systemic inflammation.
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Reacción de Fase Aguda/sangre , Artroplastia de Reemplazo de Rodilla/rehabilitación , Complicaciones Posoperatorias , Sinovitis/metabolismo , Actividades Cotidianas , Reacción de Fase Aguda/etiología , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Proteína C-Reactiva/análisis , Femenino , Indicadores de Salud , Humanos , Interleucina-6/metabolismo , Articulación de la Rodilla/metabolismo , Articulación de la Rodilla/patología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/sangre , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Estudios Prospectivos , Recuperación de la Función , Índice de Severidad de la Enfermedad , Sinovitis/etiologíaRESUMEN
OBJECTIVES: The aim of this study was to compare the early postoperative results of open and arthroscopic Bankart repair for isolated traumatic anterior instability of the shoulder. METHODS: The study included 64 male patients who underwent surgery for traumatic recurrent anterior shoulder instability. Of these, 30 patients (mean age 25.1 years) underwent open Bankart repair and 34 patients (mean age 25.8 years) underwent arthroscopic Bankart repair. All the patients had labral tears on preoperative magnetic resonance scans and had complaints of instability even during daily activities. Patients with at least six dislocations were included in the study; patients with multidirectional instability were excluded. The mean time from the first trauma to surgical intervention was 4.4 years (range 1 to 24 years) in the open surgery group, and 3.8 years (range 1 to 17 years) in the arthroscopy group. Decision for surgical treatment was made based on limitation of activities because of fear of having a dislocation and on positive results of instability tests. Repair was performed using metal anchors in both groups. The clinical results were evaluated using the Rowe scale. The severity of pain on the first postoperative day was assessed using a visual analog scale (VAS). The mean follow-up period was 26.1 months (range 12 to 52 months) in the open surgery group, and 26.6 months (range 12 to 51 months) in the arthroscopic repair group. RESULTS: The mean duration of operation was 2 hours for open surgery, and 2.5 hours for arthroscopic repair. The size of the incision was approximately 8 cm in the open surgery group, and 3 cm in the arthroscopic repair group. The mean Rowe scores were 90.2 and 91.6, being higher in the arthroscopic repair group. Clinical results of open surgery were excellent in 21 patients (70%), good in eight patients (26.7%), and poor in one patient (3.3%). In the arthroscopic repair group, the results were excellent in 27 patients (79.4%), good in five patients (14.7%), and poor in two patients (5.9%). All the patients with a poor result experienced redislocations due to traumatic falls 5 to 18 months after surgery. The mean VAS score was 5.0 ± 1.3 in the open surgery group, and 4.4 ± 1.3 in the arthroscopic repair group. Loss of external rotation was observed in 15 patients (20° in 8 patients, 10° in 4 patients, 5° in 3 patients) in the open surgery group, and in nine patients (20° in 3 patients, 10° in 6 patients) in the arthroscopic repair group. There were no significant differences between the two groups with respect to Rowe scores, VAS scores, range of motion, apprehension test results, and the incidence of recurrent instability. CONCLUSION: Although, in the past, the results of arthroscopic repair were less satisfactory compared to open surgery, this condition has changed remarkably. The results of arthroscopic repair in our study were similar to those of open repair. We believe that, with enhanced experience and advances in arthroscopic repair techniques, arthroscopic treatment may outweigh open surgery.
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Artroscopía/normas , Inestabilidad de la Articulación/cirugía , Procedimientos Ortopédicos/normas , Articulación del Hombro/cirugía , Adulto , Humanos , Masculino , Procedimientos Ortopédicos/métodos , Dimensión del Dolor , Radiografía , Rango del Movimiento Articular , Recurrencia , Articulación del Hombro/diagnóstico por imagen , Adulto JovenRESUMEN
Femoral bifurcation and tibial agenesis are rare anomalies and have been described in both the Gollop-Wolfgang complex and tibial agenesis-ectrodactyly syndrome. This article presents a case of Gollop-Wolfgang complex without hand ectrodactyly. Tibial agenesis-ectrodactyly syndrome and Gollop-Wolfgang complex are variants of tibial field defect, which includes distal femoral duplication, tibial aplasia, oligo-ectrodactylous toe defects, and preaxial polydactyly, occasionally associated with hand ectrodactyly.This article describes the case of a patient with bilateral tibial hemimelia and left femoral bifurcation. The proximal tibial anlage had not been identified in the patient's left leg. After failed fibular transfer procedure, the knee was disarticulated. The other leg was treated with tibiofibular synostosis and centralization of fibula to os calcis. At 7-year follow-up, the patient ambulates with an above-knee prosthesis and uses an orthopedic boot for ankle stability.In patients with a congenital absence of the tibia, accurate diagnosis is of the utmost importance in planning future treatment. In the absence of proximal tibial anlage, especially in patients with femoral bifurcation, the knee should be disarticulated. Tibiofibular synostosis is a good choice in the presence of a proximal tibial anlage and good quadriceps function.
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Anomalías Múltiples/cirugía , Fémur/anomalías , Fémur/cirugía , Procedimientos de Cirugía Plástica/métodos , Tibia/anomalías , Tibia/cirugía , Femenino , Fémur/diagnóstico por imagen , Humanos , Lactante , Radiografía , Tibia/diagnóstico por imagen , Resultado del TratamientoRESUMEN
The study was intended determine the prevalence of scoliosis and to assess the cost-effectiveness of a school screening program for scoliosis in Turkey. A total of 4259 children (2057 females and 2022 males aged 10-14 years old) were screened. Thirty-nine children had a positive forward bending test. The prevalence of scoliosis was 25 per 1000 in the screened population. The ratio of girls to boys with scoliosis was 2.5:1. A minor curve was detected in 72.7% of children with scoliosis (Cobb angle of 10-20 degrees), and a major curve was found in 27.3% (Cobb angle >20 degrees). The cost of screening was found to be 47 cents per child, but the cost per case of scoliosis was determined to be $236.81. School screening for scoliosis seems to be cost-effective in Turkey.
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Tamizaje Masivo/economía , Escoliosis/diagnóstico , Escoliosis/epidemiología , Adolescente , Niño , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Prevalencia , Instituciones Académicas , Turquía/epidemiologíaRESUMEN
Ochronotic arthropathy is a rare condition found in patients with alkaptonuria which is a hereditary metabolic disease associated with deposition of homogentisic acid derivatives in the articular cartilage, menisci, ligaments, and connective tissues due to homogentisic acid oxidase deficiency. These pigmentary changes are termed ochronosis. We presented a 50-year-old woman in whom arthroscopic examination of the right knee revealed brown-black discoloration of the articular cartilage and menisci leading to the diagnosis of alkaptonuria by further laboratory examinations.
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Alcaptonuria/diagnóstico , Artroscopía/métodos , Articulación de la Rodilla/patología , Ocronosis/etiología , Alcaptonuria/complicaciones , Alcaptonuria/patología , Femenino , Humanos , Persona de Mediana Edad , Ocronosis/patologíaRESUMEN
The Spaso technique consists of forward flexion, external rotation, and gentle traction for the reduction of anterior shoulder dislocations with the patient in the supine position. The aim of this prospective study was to assess clinical efficacy of the Spaso technique and to evaluate its complications. We prospectively evaluated 52 shoulder dislocations using the Spaso technique. All reductions were performed by residents in training. Rescue methods if initial reduction was unsuccessful were at the discretion of the treating physician. Fifty-two patients were enrolled and 39 (75%) dislocations were successfully reduced without anesthesia or assistance. The mean reduction time was 3.2 min, and 87% of successful reductions occurred in less than 5 min. If we exclude the first 20 cases as a learning period, the success rate increases up to 87.5%. There were no complications associated with using the Spaso technique in this series. Patients with concomitant greater tuberosity fractures and late presentation had a lower success rate, although this was not statistically significant. The Spaso method is effective in reducing anterior shoulder dislocations without anesthesia or assistance and may decrease reduction time and length of stay in the Emergency Department.
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Manipulación Ortopédica/métodos , Luxación del Hombro/terapia , Adolescente , Adulto , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Internado y Residencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Luxación del Hombro/clasificación , Resultado del TratamientoRESUMEN
Osseous hydatid disease is caused by the parasitic tapeworm Echinococcus. The species most responsible for hydatid disease is Echinococcus granulosus, endemic especially in sheep-rearing districts like Mediterranean countries and Australia. In Turkey, the exact incidence of human hydatid disease is not known, but < or =34% of asymptomatic farmers have positive serology. Bone hydatidosis is rare, making up 0.5% to 4% of all cases. Patients usually present with pain, swelling, or pathological fracture. There are no specific radiographic signs in affected bone. In the later stages, lytic lesions with a trabeculated pattern, with or without sclerosis, may be seen. Computed tomography (CT) is still the best method for diagnosis and posttherapy follow-up of osseous hydatidosis. On CT, skeletal cystic hydatidosis appears as one or several closely related, well-defined, osteolytic lesions. There may be bone expansion, cortical thinning, cortical destruction, sclerosis, honeycomb appearance, and extension into adjacent soft tissues.