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Objective: This study was carried out to evaluate the clinical outcomes such as pain, kinesiophobia and quality of life of additional manual lymph drainage (MLD) technique in the after total knee arthroplasty (TKA) surgery.Methods: Twenty-one TKA patients were randomly allocated to a control group (n:10) and MLD group (n:11). Both groups received routine postoperative rehabilitation. MLD group also received MLD in the first three days after surgery. Clinical assessment was undertaken on postoperative 3rd day and at 6th week. This included knee pain using Visual Analog Scale (VAS), kinesiophobia using Tampa Kinesiophobia Scale (TKS) and quality of life using Nottingham Health Profile (NHP).Results: VAS and TKS values of the MLD group on the 3rd day and at the 6th week were found to be significantly lower than the control group (p, Amaç: Bu çalışma total diz artroplasti (TDA) cerrahisi sonrası uygulanan manuel lenf drenajı (MLD) tekniğinin ağrı, kinezyofobi ve yaşam kalitesi üzerine olan klinik sonuçlarını değerlendirmek amacıyla yapılmıştır.Metod: TDA cerrahisi geçiren hastalar randomize olacak şekilde kontrol grubu (n:10) ve MLD grubuna (n:11) ayrıldı. Her iki gruba standart postoperatif rehabilitasyon protokolü uygulandı. MLD grubunun rehabilitasyon protokolüne ek olarak cerrahiden sonra üç gün boyunca MLD uygulaması eklendi. Klinik değerlendirme postoperatif 3. gün ve 6. haftada yapıldı. Dizdeki ağrıyı değerlendirmesi için Vizüel Analog Skala (VAS), hareket korkusunu değerlendirmesi için Tampa Kinezyofobi Skalası (TKS) ve yaşam kalitesi değerlendirmesi için Nottingham Sağlık Profili (NSP) anketleri kullanıldı.Bulgular: MLD grubunun 3. gün ve 6. haftadaki VAS ve TKS puanları kontrol grubuna göre anlamlı olarak düşük bulundu (p

Amaç: Araştırmanın amacı elastik titanyum çivi ile intramedüller tespit uygulanan stabil olmayan femur kırıklarının fonksiyonel ve radyolojik sonuçlarını değerlendirmek ve sonuçlara etki eden faktörleri belirlemektir. Yöntemler: 2001 ile 2014 yılları arasında, 4-17 yaş arası femur diafiz kırığı nedeniyle intramedüller elastik çivi ile tedavi edilen 32 hasta incelendi. On iki hastada sol femur diafiz kırığı, 18 hastada sağ ve 2 hastada bilateral femur diafiz kırığı mevcuttu. On bir hastada parçalı, 11 hastada kısa oblik, 8 hastada transvers ve 4 hastada spiral kırık paterni tespit edildi. Tüm hastalarda aynı cerrahi teknik ve ameliyat sonrası bakım uygulandı. Cerrahi sonrasında ve kontrollerde ön-arka ve yan direk grafiler ile sagital ve koronal açı ölçümleri yapıldı. Hastalar ortalama 54 (aralık, 12-156 ay) ay takip edildi. Ağrısız tam yük verme ve direk grafilerde en az üç kortekste kallus köprü olumu kaynama kriterleri olarak kabul edildi. Bulgular: Takiplerde bir hasta hariç tüm hastalarda kaynama elde edildi. Hastalar eski aktivitelerine geri döndü. Diz ve kalça eklem hareket açıklıkları geri kazanıldı. Ortalama kaynama süresi radyolojik olarak 9 (aralık, 6-16 hafta) hafta tespit edildi. Beş (14%) hastada kısalık tespit edildi. Kırık paterni ile kısalık arasında istatistiksel anlamlı ilişki saptanmadı. On dereceden fazla varus ya da valgus açılanması görülmedi. Sonuç: Elastik titanyum çivi uygulaması hastanın erken yük vermesine izin veren konforlu, ekonomik ve güvenli bir yöntemdir., Objective: The aim of this study was to evaluate the func­tional and radiological results of the application of intra­medullary fixation with elastic titanium nails in unstable femoral fractures and to determine the factors affecting these results. Methods: A total of 32 patients aged 4-17 years treated with intramedullary elastic nails for a femoral diaphysis fracture between 2001 and 2014 were included. The frac­ture was left side in 12 cases, right side in 18 and bilateral in 2. The fracture pattern was determined as fragmented in 11 cases, short oblique in 11, transverse in 8 and spi­ral in 4. The same surgical technique and postoperative care was applied to all the patients. Sagittal and coronal angle measurements were made from postoperative and follow-up anterior-posterior and lateral radiographs. The mean follow-up period was 54 months (12-156 months). Positive union criteria were accepted as pain-free weight-bearing and callus bridging in at least 3 cortices seen on direct radiographs. Results: Union was achieved in all except one patient. They were able to return to previous activities with full knee and hip joint range of movement. Radiologically, the mean time to union was determined as 9 weeks (range, 6-16 weeks). Limb shortness was determined in 5 (14%) patients. No significant association was detected be­tween shortness and fracture pattern. No varus or valgus angulation of >10˚ was determined in any patient. Conclusion: Application of titanium elastic nails in pe­diatric femoral diaphysis fractures is a comfortable, eco­nomic, and reliable method which is allows early weight-bearing.

Amaç: Araştırmanın amacı elastik titanyum çivi ile intramedüller tespit uygulanan stabil olmayan femur kırıklarının fonksiyonel ve radyolojik sonuçlarını değerlendirmek ve sonuçlara etki eden faktörleri belirlemektir. Yöntemler: 2001 ile 2014 yılları arasında, 4-17 yaş arası femur diafiz kırığı nedeniyle intramedüller elastik çivi ile tedavi edilen 32 hasta incelendi. On iki hastada sol femur diafiz kırığı, 18 hastada sağ ve 2 hastada bilateral femur diafiz kırığı mevcuttu. On bir hastada parçalı, 11 hastada kısa oblik, 8 hastada transvers ve 4 hastada spiral kırık paterni tespit edildi. Tüm hastalarda aynı cerrahi teknik ve ameliyat sonrası bakım uygulandı. Cerrahi sonrasında ve kontrollerde ön-arka ve yan direk grafiler ile sagital ve koronal açı ölçümleri yapıldı. Hastalar ortalama 54 (aralık, 12-156 ay) ay takip edildi. Ağrısız tam yük verme ve direk grafilerde en az üç kortekste kallus köprü olumu kaynama kriterleri olarak kabul edildi. Bulgular: Takiplerde bir hasta hariç tüm hastalarda kaynama elde edildi. Hastalar eski aktivitelerine geri döndü. Diz ve kalça eklem hareket açıklıkları geri kazanıldı. Ortalama kaynama süresi radyolojik olarak 9 (aralık, 6-16 hafta) hafta tespit edildi. Beş (14%) hastada kısalık tespit edildi. Kırık paterni ile kısalık arasında istatistiksel anlamlı ilişki saptanmadı. On dereceden fazla varus ya da valgus açılanması görülmedi. Sonuç: Elastik titanyum çivi uygulaması hastanın erken yük vermesine izin veren konforlu, ekonomik ve güvenli bir yöntemdir., Objective: The aim of this study was to evaluate the functional and radiological results of the application of intramedullary fixation with elastic titanium nails in unstable femoral fractures and to determine the factors affecting these results. Methods: A total of 32 patients aged 4-17 years treated with intramedullary elastic nails for a femoral diaphysis fracture between 2001 and 2014 were included. The fracture was left side in 12 cases, right side in 18 and bilateral in 2. The fracture pattern was determined as fragmented in 11 cases, short oblique in 11, transverse in 8 and spiral in 4. The same surgical technique and postoperative care was applied to all the patients. Sagittal and coronal angle measurements were made from postoperative and follow-up anterior-posterior and lateral radiographs. The mean follow-up period was 54 months (12-156 months). Positive union criteria were accepted as pain-free weightbearing and callus bridging in at least 3 cortices seen on direct radiographs. Results: Union was achieved in all except one patient. They were able to return to previous activities with full knee and hip joint range of movement. Radiologically, the mean time to union was determined as 9 weeks (range, 6-16 weeks). Limb shortness was determined in 5 (14%) patients. No significant association was detected between shortness and fracture pattern. No varus or valgus angulation of

Objectives: Reverse Segond fracture, which was described as the association of an avulsion of deep capsular portion of medial collateral ligament and tears of both posterior cruciate ligament (PCL) and medial meniscus, is an extremely rare injury, unlike Segond fracture. The aim is to report successful surgical treatment of a case with “Reverse Segond Fracture” with intact PCL. Methods: The patient was a 16 years old male, who admitted to emergency department of our Level I trauma center after a pedestrian traffic accident. The main complaint was pain on left knee and shoulder. Physical examination revealed mainly limitation in range of motion (ROM) of relevant joints. Radiology revealed Reverse Segond fracture in the left knee and associated left clavicula mid-shaft fracture. Imaging with MRI and CT revealed neither PCL injury or additional ligamentous pathologies of knee. MRI only revealed medial meniscus tear. Results: In surgery, avulsed bony portion of Reverse Segond fracture was fixed to tibia with a suture anchor and a cannulated screw securely under medial meniscus. Peripheral longitudinal medial meniscus tear was fixed with a 2-0 absorbable suture. Clavicle was internally fixed meanwhile. Knee range of motion (ROM) was started early on postoperative first day, then augmented progressively. The patient was mobilized partially-weight bearing after 1.5 months and returned to his active daily life after 2.5 months. He was without any residual complaints after a final follow-up period of 26 months. Conclusion: This case report would be evaluated as a Reverse Segond Fracture variant, as no injury to PCL was noted, in contrast to its original definition in the relevant literature, which is also scarse. To the best of knowledge, this is the first report of successful surgical treatment of a case with Reverse Segond Fracture variant without PCL tear in the relevant literature.

The number of obese patients has increased dramatically worldwide. Morbid obesity is associated with an increased incidence of medical comorbidities and restricts the application choices in anesthesiology. We report a successfully performed combined ultrasound-guided blockade of the femoral, tibial, and common peroneal nerve in a superobese patient. We present a case report of a 31-year-old, ASA-PS II, super obese man (190 kg, 180 cm, BMI: 58 kg/m2) admitted to the emergency department with a type II segmental tibia shaft fracture and ankle dislocation after a vehicle accident. After two failed spinal anesthesia attempts, we decided to apply a femoral block combined with a sciatic block. Femoral blocks were successfully performed with US guided in-plane technique. Separate blocks of the tibial and common peroneal nerves were planned after the sciatic nerve could not be located due to the thick subcutaneous tissue. We performed a tibial nerve block at 2 cm above the popliteal crease and common peroneal nerve at the level of the fibular head with US guided in-plane technique. The blocks were successful and no block-related complications were noted. Ultrasound guidance allows new approaches for multiple peripheral nerve blocks with low local anesthetic doses in obese patients.

Introduction: Mallet finger is a common injury and is frequently the result of direct trauma to the tip of an extended finger (forced flexion) or secondary to a laceration over the dorsal distal interphalangeal (DIP) joint of a digit, resulting in a DIP extensor lag. The injury may result from either tendon disruption or a fracture of the distal phalanx and can be treated by splinting or surgery. Method: Between January 2006 and January 2011, 53 mallet finger were treated in our clinic. We treat 41 patients (without open injury) conservative methods (plastic stack splinting and aluminum stack splinting). In 16 of these; we had succesfull results. Of those 25 patients who failed with conservative treatment and 12 patients who had open wounds were treated by surgical methods. We used Y or H type incisions on DIP joint. Results: The study involved 37 patients (25 males, 12 females; mean age years; range 2 to 64 years) with 38 mallet finger deformity. 25 patients (male (%67.6), 12 patients female ( %34.4) (one of them bilateral) who had poor results were and also 12 patiens who had open injury treat with surgical treatment. Conclusion: Although mallet finger might appear as a minor injury, over a quarter of the patients with a mallet injury have been reported to be off work during a 6-week period. In addition, activities, such as sports, are often avoided during the first weeks after the trauma (3). An anatomical reduction is essential in mallet fractures. Open reduction and internal K-wire fixation can be preferred due to its low complication rate and ease of application in patients whose mallet deformity cannot be treated by closed reduction., Amaç: Çekiç parmak deformitesi yaygın bir yaralanmadır ve ekstansiyon eksikliğiyle sonuçlanan, genellikle ekstansiyonda parmak ucunun doğrudan darbe alması sonrası fleksiyona zorlanması ya da parmakta distal interfalangeal (DİF) eklemin laserasyonu sonucu oluşur. Yaralanma tendonun kesilmesi , distal falanks kırığı sonucu olabilir ve splintleme veya cerrahi olarak tedavi edilebilir. Metod: Ocak 2006- Ocak 2011 yılları arasında 53 çekiç parmak deformitesi kliniğimizde tedavi edildi. 41 hasta (açık yaralanması olmayan) konservatif metodlarla (plastik ve aluminyum stack splintleme) tedavi edildi. 16’sında başarılı sonuç elde edildi. Konservatif tedaviden fayda görmeyen 25 hasta ve açık yaralanması olan 12 hasta cerrahi olarak tedavi edildi. Y ve H tipi insizyonlar kullanıldı. Sonuçlar: Çalışmaya 38 çekiç parmak deformitesi olan 37 hasta(25 erkek, 12 kadın, 30.8 yaş ortalaması ve 2-64 yaş aralığı) dahil edildi. Crawford kriterlerine göre 30 hasta (%81.1) mükemmel, 4 hasta (%10.8) iyi, 2 hasta (%5.4) orta ve 1 hasta (%2.7) kötü sonuç olarak değerlendirildi. 1 hastada yüzeyel enfeksiyon, 1 hastada cilt nekrozu ve 1 hastada rekürren deformite oluştu. Tartışma: Çekiç parmak deformitesi minör yaralanma gibi görünmesine rağmen hastaların dörtte birinde yaralanmanın 6 haftalık dönemde işgücü kaybına neden olduğu bildirilmiştir. Ayrıca travmadan itibaren spor gibi aktivitelerden kaçınılmalıdır. Biz bu çalışmada açık yaralanması olan ve kapalı yöntemlerden fayda görmeyen çekiç parmak deformitesi olan hastaları cerrahi olarak tedavi ettik. Açık redüksiyon ve K teli tespiti etkili ve kolay metoddur.