Every new technique either conservative or surgical is good?

Radial collateral ligament (RCL) injuries account for 10-40% of collateral ligament injuries of the thumb metacarpophalangeal (MP) joint. [1] In acute tears, immobilization with plaster or splint is recommended. Complete tears are classified as grade 3 and denote a complete ligament tear with an absence of a solid end point on stress testing. In chronic grade 3 RCL injuries, a dorsoradial prominence occurs in the MP joint, resulting in weakness and pain during activity; the recent literature supports surgical treatment for this type of injury. [2] There are many surgical treatment options for chronic tears, including RCL soft tissue advancement, reconstruction with the abductor pollicis brevis (APB), and free tendon grafts. [3-5] In this study, we aimed to review our reconstruction method to treat chronic grade 3 thumb MP joint RCL tears using free tendon grafts. [6] PATIENTS AND METHODS This study was conducted at Haydarpaşa Numune Training and Research Hospital between May 2016 and July 2018. Adult patients who received a free tendon graft to treat chronic grade 3 thumb MP joint RCL injury were evaluated prospectively. Patients with incomplete bone maturation (n=1), those who had additional injuries in the same extremity (n=1), and Objectives: This study aims to review our reconstruction method to treat chronic grade 3 thumb metacarpophalangeal (MP) joint radial collateral ligament (RCL) tears using free tendon grafts. Patients and methods: Thirteen male patients (mean age 41 years; range, 20 to 67 years) who received a free tendon graft to treat chronic grade 3 thumb MP joint RCL injury between May 2016 and July 2018 were evaluated prospectively. Patients with incomplete bone maturation (n=1), those who had additional injuries in the same extremity (n=1), and those who had previously undergone surgery on the same extremity (n=1) were excluded. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used for functional evaluation and the visual analog scale (VAS) was also used for pain evaluation. Results: The decrease in DASH (p=0.008) and VAS (p=0.03) scores and the increase in grip (p=0.031) and pinch strength (p=0.006) between the preoperative and final follow-up values were statistically significant. No ulnar deviation was observed in X-rays at the final examination, nor was MP joint radial instability observed under ulnar stress during clinical examinations. In two patients, 1 and 1.5 mm palmar subluxation was observed at final examination. The other 11 patients had no palmar subluxation at final examination. Conclusion: Although ours is a more complicated method compared to other reconstruction approaches, we think that it is a suitable alternative for achieving joint stability and good functional results.

Section: Discussionsupporting

confidence: 52%

Reconstruction of chronic thumb metacarpophalangeal radial collateral ligament injuries with free tendon grafts

Kibar

Malkoç

2020

“…Our results showed that both septic arthritis and deep SSI were higher in the non-drained group 1. [15] In two patients (0.49%) in whom no drainage was placed at the graft harvesting region, the same microorganism (S. aureus) was grown in both the surgical graft area and the intra-articular puncture fluid, indicating that the infection might be carried from the surgical site into the joint. While deep SSI occurred in six patients (1.4%, four in the surgical area and two in both the surgical area and the joint) in the non-drained group 1, no SSI was observed in group 2.…”

Section: Discussionmentioning

confidence: 96%

Can infection after anterior cruciate ligament surgery be prevented by inserting a Hemovac drain into graft donor site?

Sever

2020

Anterior cruciate ligament (ACL) reconstruction surgery is a highly successful orthopedic surgery providing both functional stability of the knee and more active participation of a person in daily life. [1,2] Postoperative infection following ACL reconstruction in normal population is reported to be highly rare with the incidence rate of only 0.14 to 1.4%. [2-8] On the other hand, the incidence rate among professional athletes was reported as high as 5.7%. [9] Although the occurrence of postoperative infection is very rare, once occurring, it causes devastating complications that can lead to significant problems such as cartilage destruction, arthrofibrosis, loss of range of motion and decreased activity level. [4,5,7,10,11] Although there are no pre-defined treatment guidelines for the postoperative infection, the treatment of the infection after ACL reconstruction is open or arthroscopic debridement supported by usage of antibiotic. [12,13] Preventing from infection becomes more critical because of both the difficulty of postoperative infection treatment and the high likelihood of adverse outcomes despite the extended treatment. Though previous studies have not revealed any exact cause, the frequency of infection in the use of hamstring autograft in ACL reconstruction surgery is higher than in bone patellar Objectives: This study aims to investigate the effect of Hemovac drainage placed in graft harvesting area on preventing deep surgical site infection (SSI) and/or septic arthritis through draining the hematoma formed in the graft area in arthroscopic primary anterior cruciate ligament (ACL) reconstruction surgery using hamstring autograft. Patients and methods: This retrospective study was conducted between January 2008 and March 2019. A total of 819 patients (769 males, 50 females; mean age 33.7 years; range, 25 to 41 years) who underwent arthroscopic primary ACL reconstruction surgery using hamstring autograft were divided into two groups based on whether a Hemovac drain was also placed at the hamstring graft harvested area. Both groups were compared in terms of the presence of deep SSI and/or development of septic arthritis. Results: In the non-drained group (group 1, n=401), 16 patients (3.9%) had septic arthritis, four (0.9%) had deep SSI, and two (0.49%) had both wound and joint infections. Septic arthritis was identified in only one patient (0.2%) in the drained group (group 2, n=418). In group 2, the mean amount of blood coming from the drain at the graft harvesting region was 36.85 mL (range, 20-50 mL). Conclusion: In arthroscopic primary ACL reconstruction surgery using hamstring tendon autograft, we concluded that the use of a Hemovac drain could be effective in preventing deep SSI through reducing the hematoma occurring in this region. However, future studies are needed to validate the effect of Hemovac drain on preventing the septic arthritis.

“…In this study, we aimed to introduce a new low-cost universal LAD that can be used in existing C-arm fluoroscopy devices, independent of brand and model, and to determine whether this new universal LAD improves technician accuracy in locating the desired region at the midpoint of the fluoroscopic image. [7]…”

mentioning

confidence: 99%

The effect of a new universal laser aiming device in C-arm fluoroscopy on the technician’s accuracy

Beyaz

Kurtuldu

2020

This study aims to introduce a new low-cost universal laser aiming device (LAD) that can be used in existing C-arm fluoroscopy devices, independent of brand and model, and to determine whether this new universal LAD improves technician accuracy in locating the desired region at the midpoint of the fluoroscopic image. Materials and methods: A low-priced universal LAD that is compatible with existing 12-inch C-arm fluoroscopy devices was designed. Eight radiology technicians with varied levels of experience in C-arm fluoroscopy participated in the study. A 12 mm cortical screw with a diameter of 3.5 mm was placed on proximal, diaphyseal, and distal points of femur, tibia, and humerus bones in the anteroposterior plane on L3 vertebrae and the left pubis arm in the pelvis bone model. Technicians were asked to align each screw in the image center 10 times from a distance of 30 cm in the anterolateral plane, first without the LAD and then with the LAD. The distance of the screw head to the center point was measured from the 3,520 images with the help of medical viewer software based on the X-and Y-axis. Results: Each fluoroscopic image was divided into 48 equal parts and the length of a part was taken as one unit for distance measurements. The compliance between technicians without the LAD was 0.347 (95% confidence interval [CI]: 0.208-0.47, p=0.001) and with the LAD was 0.687 (95% CI: 0.621-0.741, p=0.001). The distance between the screw head and the center of the image without the LAD was 19.0±9.8 for technicians with more than 10 years of experience and 28.0±12.9 for those with less than 10 years of experience. This difference was statistically significant (p=0.001). When the LAD was used, the difference between the less experienced (3.1±1.5) and more experienced (3.3±2.0) technicians was statistically reduced, along with the distance (p=0.033). Conclusion: The use of the LAD with C-arm fluoroscopy appears to be successful in helping technicians capture the desired point in the center of the fluoroscopic image. The use of the LAD reduces the experience gap between technicians.