Finger distal tip amputation due to upper extremity injuries is frequently encountered in the emergency setting. Methods such as wound care, replantation, flap or composite graft applications and stump closure are frequently used in treatment. The method to be chosen depends on the type of injury, the level of amputation, factors related to the patient, the surgeon, and the center where treatment is applied. [1] The main goal of treatment should be to restore the length, appearance, sensation and function of the finger. Although protecting the nail bed and providing length can provide a good aesthetic appearance, it is also of utmost importance to provide the patient with a painless and functional finger. [2,3] Replantation is an important treatment option which can meet all these expectations. [3][4][5][6][7][8][9][10] Unfortunately, replantation cannot be applied to every patient for many reasons. [1,3] Objectives: The aim of this study was to evaluate the effectiveness of using cross finger and thenar flaps in treatment of distal fingers amputations with reposition-flap method.Patients and methods: Between September 2017 and January 2020, a total of 20 fingers of 19 patients (15 males, 4 females; mean age: 31.6±10.4 years; range, 19 to 52 years) who were treated with repositioning using a cross finger or thenar flap were retrospectively analyzed. Finger length, flap status, pain, cold intolerance, two-point discrimination, bone healing and appearance of the nail were recorded. Functional evaluation was performed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score and range of motion. Results:The mean follow-up was 19.5±5.2 months. A poor result was seen in one patient with the development of necrosis in the flap. With the exception of one finger with necrosis in the flap, no major complications were observed. Union was achieved in all other bones. The mean shortness was 3.7±1.9 mm. The mean Quick-DASH score was 4.5±5.0 and the mean two-point discrimination test was measured as 6.8±0.9. Conclusion:In fingertip amputations repositioning with a cross finger or thenar flap can achieve a near-normal fingertip appearance with the advantages for the surgeon of a short learning curve and no requirement for microsurgery experience. If replantation cannot be applied in fingertip amputations, this method should be considered among the treatment options, particularly for patients with high aesthetic expectations.
Objectives The standard surgical method for primary gonarthrosis in advanced stages is total knee arthroplasty (TKA), despite the risk of bleeding that requires transfusion. Blood transfusions are potentially dangerous. The aim of this study was to determine whether there is a statistical difference in the amount of bleeding and the need for transfusion between patients who received and did not receive perioperative local tranexamic acid in TKA. Methods The hospital data system was used to access the data of patients who underwent TKA in our clinic between January 2015 and January 2022 with a diagnosis of gonarthrosis. Patients who underwent TKA and had gonarthrosis as the primary diagnosis were included in the study. They were separated into two groups: A control group (Group C) and a group that received perioperative local tranexamic acid (Group LTXA). The amount of bleeding was compared by taking into account patients’ hemogram follow-ups, the amount of blood from their drains, and their transfusion needs during the postoperative period. Results The findings demonstrated that TKA patients who received local tranexamic acid administration experienced a significant decrease in perioperative blood loss and needed lesser transfusions. Conclusion The findings of our investigation are consistent with other studies and are in favor of the usage of TXA in TKA. To validate our findings and establish the ideal TXA dosage and administration method in TKA, additional research is required.
PURPOSE OF THE STUDYThe purpose of this study was to evaluate if the fixation method of a posterior fragment in trimalleolar ankle fractures affects the surgical outcomes. MATERIAL AND METHODSA retrospective evaluation was made of all the cases of trimalleolar fractures over a 9-year period in a trauma center. Patients aged 18 -70 years were enrolled in the study. Patients were separated into 2 groups according to the fixation method (A -P percutaneous screw, and posterior open reduction -internal fixation). The fractures were classified according to the AO classification system and the Haraguchi posterior malleolar fracture classification system. The FAOS and SF-36 scores, postoperative reduction quality, arthritis scores and minor -major complications were evaluated. RESULTS86 patients were found to eligible for the study. The PMF was fixed using anteroposterior percutaneous screw in 50 (58.1 %) patients and with posterior open reduction-internal fixation in 36 (41.9 %) patients. AO 44 B type fracture was determined in 89.5 % of the patients, AO 44 C type was seen in 10.5 %. There were 27 patients (31.4 %) with Haraguchi type 1 fracture and 59 patients (68.6 %) with type 2 fracture. The mean step-off of the articular surface was statistically greater in Group 1 than in Group 2. No statistically significant difference was determined between the two groups in respect of syndesmosis malreduction. The mean arthritis score was higher in Group 1 than in Group 2. Mean scores of the SF-36 and FAOS questionnaire was statistically significantly improved in the patients with open reduction and internal fixation. DISCUSSIONAlthough there is no consensus on the treatment of posterior malleolar fractures, the indication for surgery is mainly based on posterior fragment size in the literature. The anatomic articular reduction has been emphasized recently. In this study, it was determined that the anatomic articular reduction was correlated with better surgical outcomes. CONCLUSIONSThe study results demonstrated that better functional and radiological outcomes was observed with direct open reduction and fixation of the posterior fragment than indirect reduction and percutaneous fixation in the patients with trimalleolar fracture. The arthritis risk and patient satisfaction were seen to be correlated with the anatomic reduction of the articular surface.
Introduction: This study aimed to evaluate the effectiveness of a computer-assisted circular external fixator used to achieve arthrodesis in elderly patients with failed infected total knee arthroplasty. Materials and Methods: Retrospectively 11 patients who treated with arthrodesis between 2015 and 2020 were included in the study. The average age was 73.5 ±4.73 years (65–81). All patients had recurrent infections after total knee arthroplasty. Radiologic evaluations, the time for fusion, shortening of extremities, visual analog scale scores, Oxford knee scoring system, lower extremity functional scale of all patients were compared pre-and post-operatively. complications of the technique were noted. Results: The mean follow-up was 33.7 ±12.85 (12–52) months. Fusion was achieved in all patients. The average limb length discrepancy after removal of the fixator was 46±0.78 (36–61) mm. The mean visual analog scale score measured pre-op was 6.91±0.94 (5–8), and after fixator removal they were measured as 2.36±0.92 (1–4). The mean Oxford knee score was 10.27±2.68 (4–14) pre-operatively and 28.64±2.69 (23–32) postoperatively. The mean, lower extremity functional scale was 17.06±9.38 (7.5–33.8) pre-operatively and 38.54±12.22 (21.3–56.3) postoperatively. No joint infection recurrence was seen post-operatively. Conclusion: Arthrodesis is a suitable option for elderly patients with limited mobilization who are tired of repeated revision surgeries. Due to its high fusion and low complication rate, computer-assisted circular external fixator is an effective method in the treatment of difficult knee arthrodesis required after infected total knee arthroplasty. Key Words: Arthroplasty, Replacement, Knee; Reoperation; Infection; Arthrodesis; External Fixators.
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