Background and objectives: Cryotherapy is a method of treatment using cold application. This study aimed to evaluate postoperative clinical and hematological parameters and pain associated with total knee arthroplasty in patients and compared cryotherapy to the conventional method of cold ice pack compressions. Materials and Methods: Between January 2015 and January 2016, 90 patients who underwent total knee arthroplasty for grade 4 gonarthrosis were prospectively evaluated. The patients were divided into three groups (n = 30, each): Group 1, cryotherapy was applied in the pre- and postoperative periods; Group 2, cryotherapy was applied only in the postoperative period; and Group 3 (control group), only a cold pack (gel ice) was applied postoperatively. In all groups, pre- and postoperative evaluations at 6, 24, and 48 h, hemorrhage follow-up, knee circumference measurement, visual analog scale pain score, knee circumference, and temperature measured by thermal camera were recorded. Results: Of the 90 patients, 10% were men and 90% were women. The mean age was 64.3 ± 8.1 (range: 46–83) years. The patella upper end diameter values were significantly lower in the postoperative period in Groups 1 and 2 than in Group 3 (p = 0.003). Hemoglobin levels at 24 and 48 h postoperatively were significantly lower in Group 3 than in Group 1 (p < 0.001, each) and Group 2 (p = 0.038, p < 0.001). At 6, 24, and 48 h follow-ups, pain values were significantly lower in Group 2 than in Group 3 (p < 0.001). Preoperative 6, 24, and 48 h temperature values were significantly lower in Group 1 than in Group 3 (p < 0.001 for each). It was found that the difference between preoperative and postoperative knee flexion measurements was significantly different in both groups or the difference between the groups was changed in each period (p < 0.001). Conclusions: Postoperative cryotherapy is a potentially simple, noninvasive option and beneficial for the reduction of reducing pain, bleeding, length of stay, analgesic requirement and swelling after total knee arthroplasty. Moreover, there was no early or late prosthesis infection in cryotherapy groups, which may be considered as an additional measure to prevent prosthesis infection.

Background and objectives: Hallux valgus is a complex deformity of the first metatarsophalangeal joint characterized by varus deformity of the first metatarsal bone, valgus deformity of the big toe, and lateral deviation of the extensor tendons and sesamoid bones. Several surgical methods have been described for correction of the deformity. Different materials have been used for the fixation of osteotomy. We compared the functional, radiological, and pain results of intramedullary self-locked plates and Herbert screws for the treatment of a hallux valgus deformity. Materials and Methods: Distal metatarsals were treated with self-locking intramedullary plate–screw systems in 18 feet from 12 patients (Group 1) and with Herbert screws in 18 feet from 12 patients (Group 2). The hallux valgus angle (HVA) and intermetatarsal angle (IMA) in patients of Group 1 and 2 were examined radiologically during the pre- and postoperative periods. We also determined the American Orthopedic Foot and Ankle Society (AOFAS), EQ-5D General Life Quality Scale, and Visual Analogue Scale (VAS) scores during the pre- and postoperative periods and compared the scores between groups. Results: Post hoc test results of HVA and IMA angles measured after the operation were significantly higher in Group 2 than in Group 1. In each group, the AOFAS scores during the preoperation period were significantly lower than those during the postoperation period (p < 0.001). According to the post hoc test results, the VAS scores after the operation were significantly higher in Group 2 than in Group 1 (p < 0.001). Conclusions: For the surgical treatment of hallux valgus, operations using self-locked plates compared to a single screw are superior in terms of providing rigid stability and for functional, radiological, and pain scores.

Background and objectives: Supracondylar humerus fractures are common in children and can be surgically treated. However, the general surgical procedures involving reduction and fixation might lead to reduction loss, failure to direct the Kirschner (K)-wire toward the desired position, prolonged surgery, or chondral damage. This study aimed to show that temporary fixation of closed reduction with a fabric adhesive bandage in pediatric supracondylar humerus fractures could maintain reduction so that surgical treatment can be easily performed by a single physician. Materials and Methods: Forty-six patients with Gartland type 3 supracondylar humerus fractures who underwent surgical treatment between May 2017 and June 2018 were retrospectively evaluated. Fluoroscopy-guided reduction and fixation were performed from the distal third of the forearm to the proximal third of the humerus using a fabric adhesive bandage. Two crossed pins were applied on the fracture line by first inserting a lateral-entry K-wire and then inserting another K-wire close to the anterior aspect of the medial epicondyle and diverging from the ulnar nerve tunnel. A tourniquet was not applied in any patient and no patients required open reduction. Results: The study included 32 boys (69.6%) and 14 girls (30.4%) (mean age, 7.1; range, 2–16 years). The mean hospital stay and follow-up duration were 4.3 ± 3.9 days and 48.1 ± 14.3 weeks, respectively. Heterotopic ossification was detected in one patient, and ulnar nerve neuropraxia was detected in another patient. Functional (according to Flynn criteria) and cosmetic outcomes were excellent in 95.6%, moderate in 2.2%, and poor in 2.2% of patients. The mean duration of fixation of the closed reduction with a fabric adhesive bandage was 8.1 ± 3.9 min, and the mean duration of pinning was 7.9 ± 1.4 min. Conclusions: Temporary preoperative fixation of supracondylar humerus fractures that require surgical treatment with a fabric adhesive bandage may be significantly convenient in practice.

Objective: The main purpose of the surgical treatment of posterior acetabular fracture is to achieve anatomical reduction to attain a functional and stable hip joint without pain. Although Kocher-Langenbeck (K-L) approach is the most commonly used surgical exposure, various modified approaches have been described in the literature. The aim of this study to determine the early surgical results of the acetabulum posterior fractures surgery via Iselin's modified K-L approach. Methods: We reviewed the hospital records of patients who were operated for acetabulum posterior wall fractures via Iselin's modified approach between 2016 and 2018. All patients had detailed radiological, clinical evaluation and fractures were classified by AO/ASIF classification. All patients had radiological and clinical evaluation at the end of the postoperative 1st year. Results: There were 16 men and 4 women with an average age of 42.8±18.0 (range 18-77) years. The average follow-up was 14.8±6.1 (range 6-28) months. The right hip was involved in 12 (60%) patients and the left in 8 (40%) patients. The average operative time was 78.6±16.7 (range, 54–115) minutes. Average blood loss during the operation was 179.22±51.9 (range, 100–260) ml. The postoperative reduction was graded as anatomic (0–1 mm of displacement) for 17 hips and imperfect (2–3 mm of displacement) for 3 patients. No patient had a deep infection, implant loosening, recurrent dislocation, deep venous thrombosis (DVT), pulmonary embolism (PE) or revision fixation. Conclusion: The modified approach of Iselin is a successful approach with its ease in the surgery of displaced fractures that extending proximally and early radiological and functional results.

Aim: The aim of this study was to investigate the effects of transtibial (TT) and anteromedial portal (AMP) techniques used in anterior cruciate ligament repair on knee joint function after anterior cruciate ligament reconstruction.Material and Methods: Sixty patients who were surgically treated in our clinic for anterior cruciate ligament tear were included in the study. Thirty patients underwent TT technique and 30 patients underwent AMP. Functional evaluations were performed according to Lysholm, International Knee Documentation Committee (IKDC) and Tegner scoring preop and postop. The angle between the femoral tunnel and the distal joint face was measured in postoperative Anteroposterior and Lateral knee graphs and its effect on the knee joint functional outcome was examined.Results: Eighty percent of the patients included in the study were male (n=47) and 20% were female (n=13). The gender distribution according to the groups was homogeneous (p=0.476). The mean age of the subjects was 32.75±8.81 (16-53) years. The postoperative Lysholm score was significantly higher in the AMP group than in the TT group (p<0.001). The postoperative Tegner score was significantly higher in the AMP group than in the TT group (p<0.001). Mean femoral tunnel obliquity was 59.3° in the TT group and 41.4° in the AMP group.Conclusion: It is thought that oblique femoral tunnel placement is more beneficial for the rotational stability of anterior cruciate ligament. In our study, we think that AMP technique is more beneficial than femoral obliquity in terms of functional outcome.