Search

The computed tomography scans of patients who underwent posterior instrumentation for thoracolumbar vertebral fractures were retrospectively reviewed. The aim of this study is to present a single surgeon's experience in the placement of pedicular screws in the thoracic, lumbar, and sacral spine using the two-way fluoroscopy-assisted freehand technique. The directions of screw malposition were classified as anterior, medial, lateral, superior, and inferior; screws with malposition in more than one direction were recorded. Patients' neurological symptoms were recorded and their compatibility with the direction and amount of screw malposition was assessed. The effect of surgical experience on thoracic, lumbar, and sacral pedicle screw placement and the amount of screw experience required for correct pedicle screw placement were investigated. The study evaluated 1112 pedicle screws in 147 patients with thoracolumbar fractures. Screw malposition was found in 206 (18.52%) screws. Medial malposition was found to be statistically higher in the lumbar spine (p<0.001). A significant correlation was found between inferior malposition and neurological deficit (p=0.012). Thoracic and sacral pedicle screw malposition was statistically higher than lumbar (p<0.001). It was found that 386 pedicle screws were required for the learning curve in lumbar fractures (p=0.004). Surgical experience is an important factor in correct screw placement. It was found that 386 pedicle screws were required for the learning curve in the lumbar spine. [ABSTRACT FROM AUTHOR]

Background/aim: The aim of this study was to compare the effects of local infiltration analgesia and interscalene brachial plexus block techniques on postoperative pain control and shoulder functional scores in patients undergoing arthroscopic rotator cuff repair. Materials and methods: Sixty patients who underwent arthroscopic rotator cuff repair were prospectively included in the study. Patients were randomly divided into two groups. Group 1 was comprised of patients who had interscalene brachial plexus block, while group 2 was comprised of patients who had local infiltration analgesia. In group 1, interscalene block was applied with 20 mL 0.5% bupivacaine. In group 2, the Ranawat cocktail was used for local infiltration analgesia. Sixty milliliters of Ranawat cocktail was applied to the subacromial space and glenohumeral joint in equal amounts. Postoperative pain was assessed by the VAS score. Functional scores of the shoulder were also evaluated by Constant-Murley and UCLA scores. The time of first analgesic requirement and total analgesic consumption in the postoperative period were assessed. Results: The first analgesic requirement was significantly late in the interscalene brachial plexus block group (p = 0.000). There was no statistically significant difference between the groups in terms of total analgesic consumption (p = 0.204). In the postoperative 6th h, the VAS score was 2.43 in the interscalene brachial plexus block group, whereas 2.86 in the local infiltration analgesia group (p = 0.323). There was no statistically significant difference between the groups in terms of Constant-Murley shoulder and UCLA scores in the 3rd postoperative month (respectively, p = 0.929, p = 0.671). Besides, postoperative VAS scores and functional scores were negatively correlated (p < 0.01). Conclusion: Local infiltration analgesia is an effective alternative to interscalene brachial plexus block for postoperative pain management and total analgesic consumption in arthroscopic rotator cuff repair. However, the interscalene brachial plexus block provides a longer postoperative painless period. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to evaluate the differences in mortality between young and elderly polytrauma patients. Materials and Methods In the present study, all consecutive polytrauma patients treated at our hospital between January 2014 and December 2018 were reviewed retrospectively. Patients younger than 65 years old were classified as Group I (n = 60), and patients aged 65 years and older were classified as Group II (n = 60). Age, gender, mechanism of injury, time of injury, injury severity score (ISS), preclinical hemodynamics, hospitalization, operative treatment, intubation rate, intensive care unit (ICU) treatment, and 1-year mortality were analyzed. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI) were calculated. Results The mean age was 36.6 ± 13.0 (18-64) years in Group I and 73.5 ± 7.4 (56-91) years in Group II. There was no difference in mortality rates between groups. Elderly polytrauma patients tend to be female, and lower ISS and higher blood pressure, as well as low-energy injury types, typically in the summer. A statistically significant positive correlation was found between mortality and ISS scores in both Group I and Group II. There was no statistically significant difference was found between elderly and younger polytrauma patients in terms of NLR, MLR, and SIRI scores. Conclusion There are several differences between elderly polytrauma patients and their younger counterparts. It was found that mortality in the elderly patient group was affected by many system injuries. However, the current study presents no differences in mortality rates between young and elderly polytrauma patients. [ABSTRACT FROM AUTHOR]