Objectives This study aims to identify the factors affecting the activities of daily living, balance, and prosthesis satisfaction in patients with non-traumatic lower limb amputation (LLA). Patients and methods This cross-sectional study included a total of 195 patients (120 males, 75 females; mean age 65.9±11.6 years; range, 40 to 90 years) who underwent LLA between January 2009 and April 2017. All patients were evaluated in terms of age, sex, amputation etiology, side, level, comorbidity, length of hospital stay, prosthesis adjustment, ambulation level, functional outcome, and complications. Prosthesis adjustment, physical balance ability, and daily living activities were assessed using the Turkish versions of the Trinity Amputation and Prosthesis Experience Scales (TAPES), Berg Balance Scale (BBS), and Nottingham Extended Activities of Daily Living Scale (NEADLS), respectively. Results There was no significant difference between male and female patients in terms of prosthesis and amputation adaptation, physical balance, and activities of daily living. The BBS, TAPES, and NEADLS scores were lower in the patients aged over 65 years (p<0.001, p<0.001, and p<0.001, respectively). Prosthesis and amputation adaptation, physical balance, and daily living activities were also worse in this age group. Transfemoral amputees had lower BBS, TAPES, and NEADLS scores than the transtibial amputees (p=0.009, p=0.020, and p=0.004, respectively). Prosthesis and amputation adaptation, physical balance, and daily living activities were worse in the transfemoral amputees. Conclusion Age and amputation level affect physical balance, prosthesis satisfaction, and daily living activities after non-traumatic LLA. Therefore, orthopedic surgeons and physical therapists should conduct a multidisciplinary evaluation, particularly in patients aged over 65 years and in transfemoral amputees to improve outcomes.
Gonarthrosis is a chronic non-inflammatory, degenerative disease that starts with joint pain, movement limitation, as a result of joint cartilage damage in the knee joint. In gonarthrosis, patient education, rest, preventive measures, pharmacological, physical therapy and surgical treatment methods can be used alone or together according to the stages of the disease. Intra-articular injections are used to reduce pain and increase functional movements in gonarthrosis. The aim of this study is to evaluate the effect of intra-articular knee steroid injection on the knee pain. Materials and Methods: A total of 151 knees from 108 patients who were admitted to the orthopedics clinic with long-lasting knee pain and who had radiological grade 3-4 gonarthrosis according to the Kellgreen-Lawrence classification were included in the study. Pain scores were compared according to the Visual Analogue scale (VAS) and Verbal Category scale (VCS) before the injection and at 6-week post injection. Combination of 9 ccs 2% prilocaine and 1 cc triamcinolone hexacetonide injection was applied intra-articular. Results: A total of 151 knees from 101 patients aged between 48 to 88 (67.49±8.99) (F=77, M=31) were included. Of the cases, 55.6% (n=84) right and 44.4% (n=67) left knee were injected; 29.8% (n=45) were stage 3 and 70.2% (n=70.2) were stage 4. Pre-injection VAS score was 8.34±0.75, the VCS was 4.29±0.48; post-injection VAS score was 3.68±1.59, and VCS was 2.22±0.8 (p<0.001). Conclusion: Different treatment options are applied according to the stage of knee osteoarthritis. Intra-articular injections, physiotherapy and non-steroid anti-inflammatory drugs are commonly used conservative treatment modalities. Steroids and hyaluronic acid derivatives can be administered separately or together at intra-articular knee injections. Intra-articular knee injections are preferred in combination treatment of early-stage gonarthrosis due to rapid pain relief and replicable. Intra-articular knee steroid injections suggested for patients who don't consider the surgery or want to save time.
Amaç: Bu çalışmada, kliniğimizde ortopedik travma nedeniyle yatan hastaların demografik özellikleri ve proksimal femoral kırık nedeniyle cerrahi tedavi uygulanan hastaların ameliyat öncesi (AÖ) ve ameliyat sonrası (AS) klinik bulgularının değerlendirilmesi amaçlandı. Hastalar ve Yöntem: Çalışmaya 01 Ocak-31 Aralık 2014 tarihleri arasında kliniğimizde yatan tüm hastalar dahil edildi. Retrospektif, kesitsel ve tanımlayıcı nitelikteki çalışmamızda; hastaların kayıtları kontrol edilerek, demografik ve klinik verileri değerlendirildi. Bulgular: Toplam 3793 hastaya cerrahi tedavi uygulanmıştır. Ameliyat olan hastalardan 283'ü femur proksimal bölge kırığı nedeniyle opere olmuştur. Hastaların ortalama yaşı 55,77±29,98 yıldır. Yaşları gruplayarak incelediğimizde, 40 yaş altında 94 (%33,2) hasta; 40-60 yaş arası 36 (%12,7) hasta ve 60 yaş üzeri 153 (%54,1) hasta vardır. Hastaların %49,8'i (141) erkek; %50,2'si (142) kadındır. Hastaların %36,7'sinde (104) çeşitli ek hastalıklar saptanmıştır. Kliniğe kırık ile gelen hastaların % 91,2'si (258) şifa ile taburcu edilirken, %1,8 (5) ölüm gözlenmiştir. Hastaların %7,1´(20)i yoğun bakıma devredilmiştir. İleri yaş grubunda ASA skorlarının yükseldiği, ek hastalıkların arttığı, hastaların postoperatif dönemde hastanede kalış sürelerinin uzadığı ve yoğun bakım ihtiyaçlarının arttığı görülmektedir. Sonuç: İleri yaş grubu hastalarda ek hastalıkların sıklıkla eşlik etmesi, bu hastaların AÖ hazırlıklarının uzun sürmesi ve AS dönemde yoğun bakım ihtiyaçlarının artması nedeniyle bu hastaların multidisipliner olarak takip edilmesi uygun olacaktır.
BACKGROUND: Distal tibial epiphyseal fractures damage to epiphyseal growth plate. Epiphyseal growth arrest (EGA), reflex sympathetic dystrophy and ankle joint stiffness may also occur after distal tibial epiphyseal injury. This study aims to evaluate the role of trauma mechanism, fracture pattern and fixation technique on clinical outcomes and EGA in the surgically treated distal tibial epiphyseal fractures. METHODS:Twenty seven patients who underwent surgery for distal tibial epiphyseal fracture between the 2011 and 2017 were evaluated retrospectively. The effects of trauma mechanism, fixation technique, preoperative duration, fracture patterns on the clinical results and EGA were examined. AOFAS (The American Orthopedic Foot and Ankle Score) and MOXFQ (The Manchester-Oxford Foot Questionaire) were used for clinical evaluation. RESULTS:Twenty seven patients (17 male and 10 female) were included in this study. The most important complication of epiphyseal injury was the growth pause in eight patients. No statistically significant difference was observed concerning clinical scores and complications according to trauma mechanism, fixation techniques and fracture patterns (p>0.05). CONCLUSION:Regardless of the trauma mechanism, fracture pattern and the fixation material, an anatomical reduction should be obtained in distal tibial epiphyseal fractures to reduce complications and prevent the EGA.
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