Background: The purpose of this study was to compare the usage of positive and negative pressure hemovac drain according to blood loss and blood transfusion requirements in patients who diagnosed primary osteoarthritis and scheduled to undergo Total Knee Arthroplasty (TKA).

Methods: Between January- May 2015 patients were reviewed retrospectively. Fifty patients who scheduled to undergo TKA were enrolled in the study. Patients were divided into two groups. In the first post operative day, hemovac drains were kept under positive pressure in the patients of Group I. In the second day, drains were removed by switching into a negative pressure after the passive range motion exercises. In Group II, it had been kept in negative pressure until the hemovac drain removed. Both groups underwent the same rehabilitation program after the surgeries. Age, gender and body mass index of patients were similar in both groups.

Results: Preoperative value of hemoglobin (g/dl), hematocrit (%) and the number of erythrocytes (mm3) were similar in both groups. These values were also similar in both groups in the first four days after the surgery. The average blood loss from hemovac drain, and the amount of erythrocytes us pension used postoperatively were found similar statistically in both groups (p>0.05). Furthermore, 9 of the 24 patients in Group I, and 13 of the 26 patients in Group II were performed the allogeneic erythrocyte suspension transfusion, and the need for allogeneic transfusion in both groups were found similar statistically (p>0.05).

Conclusion: Considering the consequences of the present study, early usage of the positive pressure hemovac drain does not reduce the amount of blood loss, the amount of transfused allogeneic erythrocyte suspension, and the need for allogeneic transfusion at the postoperative period.

Background: Preoperative arthroscopic examinations were carried out in patients with varus deformity among those with osteoarthritis of the ankle caused by malalignment, and to assess the severity of the disease on the basis of the arthroscopic findings, and the associations of these findings with X-ray findings and the indications for supramalleolar osteotomy were evaluated.

Methods: A total of 57 joints in 56 patients were investigated, and the mean follow-up period was 4 years. The proportion of the surface area of the ankle that had become hardened into an eburnation was classified according to a five-grade scale on the basis of preoperative arthroscopy: Grade 1 indicated fibrillation of the articular cartilage alone with no evident eburnation; Grade 2, eburnation was limited to the medial malleolar articular surface; Grade 3, eburnation extended across the medial shoulder of the talus, but covered <25% of the talocrural joint; Grade 4, eburnation covered ≥25% but <50% of the talocrural joint; and Grade 5, eburnation covered ≥50% of the talocrural joint. The surgical procedure used was lateral closing wedge osteotomy, and assessments were carried out using Takakura, et al.’s clinical score and Tanaka, et al.’s radiographic grading system.

Results: Initially, 3 joints were Grade 1, 19 were Grade 2, 15 were Grade 3, 16 were Grade 4, and 4 were Grade 5. Postoperatively, 30 joints were Grade 1, 14 were Grade 2, 7 were Grade 3, 4 were Grade 4, and 2 were Grade 5. Clinical scores showed an improvement from 63.9±11.2 points preoperatively to 81.9±13.2 points postoperatively.

Conclusion: Patients who were classed as Grade 3 or below by preoperative arthroscopy showed improved clinical outcomes and radiographic grades. To assess the proportion of cartilage, that may be affect postoperative outcomes, preoperative arthroscopy should be done prior to the supramalleolar osteotomy.

Background: Successful posterior lumbar Interbody fusion requires excessive removal of posterior spinal elements and distraction of neural structures. It also requires a large amount of bone graft.

The authors were developed this technique to assess results of treatment of degenerative Spondylolisthesis by posterior lumbar Interbody fusion with preservation of posterior spinal elements and also to examine the safety and efficacy of the recapping T-saw laminoplasty technique for management of degenerative lumbar Spondylolisthesis using posterior lumbar Interbody fusion by Interbody cages with preservation of posterior elements.

Methods: Twenty-five patients with degenerative Spondylolisthesis underwent recapping T saw laminoplasty in the lumbar spine for posterior lumbar Interbody fusion with Interbody cage. The T-saw was used for division of the posterior elements. After discectomy and insertion of cages, the excised lamina was replaced exactly in situ to their original anatomic position. Patients were followed neurologically and radiologically.

Results: Only one lamina was excised and replaced again. Primary bone healing was obtained in all patients by 4-6 months after surgery. No complications such as postoperative spinal canal stenosis, facet arthrosis, or kyphosis were observed.

Conclusion: This technique of posterior lumbar Interbody fusion through recapping laminoplasty provide wide space for easier insertion of cages and allow anatomic reconstruction of the vertebral arch preserving its important mechanical roles.

We report a clinical case of a 31 -year- old patient with bilateral rupture of the quadriceps tendon secondary to hyperparathyroidism following minimal trauma. The objective of this case report is to present this clinical and radiological variety of bilateral quadriceps tendon rupture in a patient with hyperparathyroidism, as well and to discuss its therapeutic treatment. We opted for surgical treatment. The results at our last follow up at six months were satisfactory.

Boutonniere Deformity (BD) is a debilitating deformity where the Proximal Interphalangeal (PIP) joint of the finger is flexed, and the Distal Interphalangeal (DIP) joint is hyperextended.

Osteosarcoma (OS) is the most common primary bone malignancy, predominantly afflicting children and adolescents

We present a case of a 36 year old female working in fisheries lab with Distal Radius Fracture (DRF) and cold urticaria referred for hand therapy after the cast removal. Cutaneous vascular responses were observed before and after 5 minutes of cold water immersion (at 12 ºC) in the injured hand. Hives were observed on volar aspect of her forearm and dorsal aspect of her hand around 5 minutes after the period of immersion and did not subside till 10 minutes after immersion.

Symptomatic OA is generally defined by the presence of pain, aching, or stiffness in a joint with radiographic OA. The age-standardized prevalence of symptomatic hand and knee OA is 6.8% and 4.9%, respectively, in Framingham subjects age ≥26 years. However, prevalence of symptomatic knee OA was 16.7% among subjects age ≥45 in the Johnston County Osteoarthritis Project, much higher than that reported in the Framingham Study. About 9% of subjects in the Johnston County study had symptomatic hip OA

The pseudo Galeazzi equivalent lesion in children under study is about a case which associates a diaphyseal radial fracture and an epiphyseal detachment of the distal extremity of the ulna rather than a distal radio-ulnar dislocation. It concerns a boy of 16-years-old patient who was injured in sport (fall). Radiographs showed a fracture of the radial shaft, which is having an anterior angulation, and a Salter-Harris type II epiphyseal detachment of the distal ulna. We were unable to perform a closed reduction under general anesthesia due to the interposition of the periosteum at the fracture site.

Thus surgical management was the only option. It consisted of removing the offending periosteum and performing: firstly, the osteosynthesis of the radial shaft fracture with a plate, and secondly, the epiphyseal detachment with pins. After 10 months, we didn’t notice any bone growth disturbance, or any reduced mobility of the wrist. Nevertheless, we will continue the follow-up so as to monitor the bone growth disturbance of the distal extremity of the ulna.

The desmoids tumors are characterized by the excessive uncontrolled proliferation of connective tissue. Although benign, it has an aggressive nature that invades and permeates surrounding tissues and organs, resulting in the destruction, loss of function and deformity of the adjacent structures. It is a rare tumor, only 0.03% of all cancers, and whose etiology is still unknown. In this report, we describe a patient who has developed a desmoid tumor in her hand and discuss the treatment established.

It is a woman of 42 years old, without any pathological history, which has a painful mass of left knee at popliteal fossa, beginning progressively without any inflammatory clinical or biological signs. T he patient doesn’t report of trauma or nerve pain (electric discharge).

Osteoarthritis, a chronically painful debilitating joint disease affecting many aging adults, is not always amenable to, or improved by current pharmacologic and surgical approaches. In light of the contribution of peri articular structures to the osteoarthritic pain cycle, this exploratory overview and opinion piece was designed to examine if there is sufficient evidence in favor of treating muscle both as the sole means of reducing osteoarthritic pain or as a supplementary strategy for minimizing joint pain and further joint damage. To this end, research that focused on the sources of osteoarthritis pain, especially those detailing some aspect of neuromuscular derived pain was assessed. As well, research examining the outcome of treating muscle as regards osteoarthritis pain was explored. The results show that muscle can be deemed to play a key role in the osteoarthritis pain cycle. Moreover, treatments directed towards improving muscle function in some way tend to yield pain relief, when used alone, or in combination with other approaches, regardless of joint or method examined. It is concluded more work to better understand the muscle pain linkages in osteoarthritis will produce both a better understanding of the pathology associated with this disease, as well as its amelioration.

Tarsal tunnel syndrome is an entrapment neuropathy of tibial nerve in the tarsal tunnel. The condition may be secondary to a mass compressing the nerve. This report presents an uncommon case with tarsal tunnel due to bony protrusion of tarsal coalition in an adult patient

T he Complex Regional Pain Syndrome type 1 (CRPS1) is a reflex sympathetic dystrophy syndrome, that occurs after an illness or injury that didn’t directly damage the nerves in your affected limb

Sarcomas are extremely heterogenous and exceedingly rare group of malignancies. Broadly, the term ‘sarcoma’ encompasses both Soft Tissue Sarcoma (STS) including GIST (Gastro Intestinal Stromal Tumors) and bone sarcomas, though there might be some overlap between the two entities. For the years together, the standard treatment for advanced/ metastatic STS was ifosfamide and / or doxorubicin based chemotherapy. Treatment for STS in yesteryears depended largely upon general sensitivity for chemotherapy and not for individual histological subtypes or translocation studies. However, in last few years, with the advent of new agents like imatinib, trabectidin, pazopanib and eribulin, a lot of things have changed. The success in bone sarcomas during this timeframe has not been as tangible as STS but newer therapies like denosumab and Rexin G have some potential activity in selected subsets. In this review, we will try to highlight the latest advances in both advanced/ metastatic STS and bone sarcomas.

Objective: This study aims to investigate the effect of ibandronate, which is a biphosphonate and acts by inhibiting osteoclasts in osteoporosis treatment, on fracture healing in rat tibia model.

Material and Method: 60 Wistar-Albino type male rats were divided into two groups as study (ibandronate) and control. Under general anesthesia standard closed fractures were created on right tibias of all rats using blunt ended needle holder by three point principle and then closed reduction and fixing with intramedullary nail (0.5 mm) were provided. The day of fractures were created, one oral dose of 250 μg ibandronate (Bonviva® tablet 150 mg, Roche, Istanbul, Turkey ) was given to each group A, B, C and D. 1 month after 250 μg oral dose administration to groups E and F the day the fractures were created, the second dose of 250 μg ibandronate was administered. The rats were killed at 2nd week in groups A and B, at 4th week in groups C and D, and at 6th week in groups E and F. Oral administrations were performed by the same person with 15 gauge plastic feeding through nasogastric gavage. Fracture healing was evaluated as biomechanically, radiologically and histologically.

Results: No positive or negative radiological, biochemical and histological effect of ibandronate was detected, starting from the first day and reaching to 6 weeks, in healing process of closed tibia fractures created and fixed with IM nails in rats.

In the year 1879 [1], Paul Segond mentioned about the Anterolateral Ligament (ALL) for the f irst time in orthopedic literature.

Lateral Epicondylitis, or more commonly called “tennis elbow,” is a musculoskeletal condition characterized by pain upon extension and contraction of the fingers, wrist, and elbow. Such elbow pain can oftentimes be debilitating, as patients find themselves unable to work, enjoy their hobbies, or perform simple household tasks

Objectives: As regards osteoarthritis (OA), conventional treatment has still not given total satisfaction to our patients. This may explain their use of Complementary and Alternative Medicine (CAM) which could easily interfere with the physician prescription. The aim of the present study was to determinate the prevalence of CAM use by knee OA patients and to assess its predictive factors.

Methods: A cross-sectional study was set at the university hospital. Patients with knee OA according to the American college of rheumatology were included. Information was collected about Knee OA patients, the different types of CAM used, the reasons for using CAM, and CAM’s effectiveness on pain and function. The doctor-patient relationship was also analyzed. We performed a statistical analysis with a logistic regression to determine predictive factors of CAM use.

Results: Of the 105 patients included in this study, 64.8 % used CAM at least once in their lives, 77.5% said they started CAM as soon as their OA had been diagnosed. Fifty eight percent of patients reported using CAM to relieve pain, while 18.4% were using it to cure their OA. Regarding the types of CAM, 72% of patients used massage with application of essential oils, 51.5% used balneotherapy, 22% used phytotherapy, 17.6% did cupping, 13.2% went to sand baths and 10.3% have used acupuncture. Olive and argon oil were the most used as topic agents. Eighty eight percent of patients admitted that their doctor was not aware about their use of CAM, because he had never asked about it in the majority of cases. After univariate analysis, there were no predictive factors for the use of CAM.

Conclusion: The use of CAM is frequent and various in our study. Health care providers should discuss these therapies with all OA patients, in order to assess their effectiveness, and to prevent their adverse effects.

The World Health Organization (WHO) defines osteoporosis as a disease characterized by low bone mass and deterioration of the micro architecture of bone tissue, which causes an increased brittleness of the same, with a consequent increase in fracture risk. Osteoporosis affects more than 200 million individuals in the world, potentially 5 million people in Italy, of which 80% post-menopausal women.

In the daily practice of Orthopedics and Traumatology departments is very frequent hospitalization for fracture of the femoral neck in elderly patients. In our study we observed 162 patients hospitalized with hip fracture diagnosis at two Italian hospitals. In most cases there were fragility fractures with previous diagnosis of osteoporosis, but patients had never received an anti osteoporotic therapy. The prescription of a medical therapy in patients with osteoporosis is an essential prevention of secondary fractures.

Introduction: Venous Thromboembolism (VTE) is a leading cause of mortality among hospitalized patients [1]. In the United States, Pulmonary Embolus (PE) causes almost 300,000 deaths per year [2]. 12% of annual deaths are due to VTE [3]. Major orthopaedic surgery (e.g., hip or knee replacement) is associated with a high risk for postoperative VTE [1,4,5]. In hip fracture surgery without thromboprophylaxis, the incidence of VTE reported is 35% with venography, and symptomatic VTE is about 3% [6].

Because the clinical diagnosis of VTE is unreliable and its first manifestation may be a life-threatening PE, it is recommended that patients undergoing hip or knee replacement receive routine thromboprophylaxis with anticoagulant therapy after surgery unless they have contraindications to anticoagulant therapy [1,4,7,8].

This study quantifies the efficacy and safety of enoxaparin (LMWH) versus dabigatran (Indirect Anti-X) in patients with hip fractures.

Material and Methods: This prospective randomized study compared daily doses of LMWH 40 mg subcutaneously with Indirect Anti-X 220 mg orally in consecutive patients with hip fractures. Patients were evaluated with Doppler scans for deep DVT on postoperative days 5 and 30 and with a clinical evaluation on postoperative days 30, 45, 90, and 120.

Results: 330 study patients. LMWH Group: 165 patients (males 38%). Average age 72.4 years (range 32 to 84 years). Day 5 postoperative Doppler scan detected 1 asymptomatic distal DVT. Another patient later (in the period between day 5 to 30 day control) presented with signs of a PE and had a Doppler scan positive for proximal DVT. The V/Q scan was positive and the patient was treated per standard guidelines. Day 30 Doppler scan detected 11 DVTs (3 proximal and 8 distal). 4 of these were symptomatic (1 proximal and 3 distal). All were evaluated in the emergency department. After diagnosis, 2 were readmitted for studies and treatment, and 2 were discharged home. All 4 of these patients were started on LMWH as suggested by local guidelines. The overall incidence of PE in this group was 0.6%. Doppler scan detected DVTs in 6.6% (symptomatic 2.4%) of the LMWH group. 2 patients returned for the evaluation of bleeding, 2 for superficial wound infections and 3 for thigh hematomas.

Anti-X Group: 165 patients (males 43.3%) enrolled. Average age 69.3 years (range 18 to 73 years). Day 5 postoperative Doppler scan detected no DVTs. The postoperative day 30 Doppler scan detected 5 DVTs (1 proximal and 4 distal). An additional patient was diagnosed with a PE (V/Q scan positive, Doppler scan negative). 2 symptomatic patients (one with distal DVT who developed symptoms during in-hospital rehabilitation and one with a proximal DVT) were readmitted and treated per standard guidelines. The incidence of PE in this group was 0.68%, with Doppler scan-detected DVTs 3% (1.2% symptomatic). 1 patient had an hematoma involving 2/3 of the thigh, 1 had a wound infection, and 2 had a rash.

There were no significant differences between the two thromboprophylactic treatments, and the Fishers exact test was not significant for any individual complication or total number of complications. No patient died during the study period.

Conclusion: Both LMWH and Anti-X appear to be equally effective prophylactic medications for the prevention of deep venous thrombosis after proximal femur fracture surgery. The cost benefits of using Anti-X may be considerable.