Murat Celal Sözbilen

Aims: An increase in temperature in an area suspected of septic arthritis is a clinically important finding. The aim of this study is to evaluate temperature changes in septic arthritis with a high-resolution thermal camera. Methods: A total of 49 patients, who were evaluated with a prediagnosis of arthritis (septic or non-septic), were included in this study. A temperature increase in the knee with suspected septic arthritis was evaluated by using thermal imaging and compared with the opposite-side joint. Then, in order to confirm the diagnosis, a culture was taken using routine intra-articular aspiration. Results: The thermal measurements were compared in 15 patients with septic arthritis and 34 patients with non-septic arthritis. The mean temperature was 37.93 °C in the septic group, while it was 36.79 °C in the non-septic group (p < 0.000 *). The mean temperature difference in both joints was 3.40 °C in the septic group, while it was 0.94 °C in the non-septic group (p < 0.000 *). While the mean temperature was 37.10 °C in the group with septic arthritis, it was measured to be 35.89 °C in the group non-septic arthritis (p < 0.020). A very strong positive correlation was found between the difference in the mean temperatures of both groups and the values of the hottest and coldest points (r = 0.960, r = 0.902). Conclusions: In the diagnosis of septic arthritis, thermal imagers can be used as a non-invasive diagnostic tool. A quantitative value can be obtained to indicate to a local temperature increase. In future studies, specially designed thermal devices can be developed for septic arthritis.

Aim: Perioperative hypothermia is more common in pediatric patients than in adult patients due to increased body surface area/weight ratio and limited subcutaneous fat deposits. Therefore, active and passive warming techniques are used more frequently in the surgeries applied to pediatric patients. This study presents the prevalence of perioperative hypothermia and the predisposing conditions for perioperative hypothermia in pediatric orthopedic surgeries in which active and passive warming techniques are applied.Methods: This cross-sectional, descriptive, and observational study included 102 children admitted to the pediatric orthopedic clinic of a children’s hospital. Temperature measurements were made with a calibrated infrared tympanic thermometer in all cases while they were waiting in the service room, when they entered the operation theater, when they left the operation theater and when they left the postoperative care unit. Their demographic data, hemogram and thyroid hormone parameters, preoperative fasting times related to the procedure and temperature were recorded. Also, the humidity and temperature values of the operating theater, the operation type performed, the duration of the operation, the time spent in the operating theater and the recovery time from anesthesia, were all recorded in their follow-up forms. Data analysis was done using the SPSS V21.0 and was conducted at a 95% confidence interval.Results: Hypothermia was observed in 20.58% of 102 patients included in the study. Predisposing factors for perioperative hypothermia included the fact that the patient had a diagnosis of concomitant cerebral palsy, the patient's body temperature was low in the service area, low temperature and humidity values in the operating theatre and staying in the operating theatre for a prolonged period of time.Conclusion: Although active and passive warming techniques are applied during the operation, perioperative hypothermia was observed in 20.58% of pediatric patients who underwent the orthopedic operation. Consideration of predisposing factors together with active and passive warming techniques may reduce the incidence of perioperative hypothermia.

The primary aim of this study was to assess the epidemiological evaluation of acute pediatric hand injuries frequently encountered in emergency department units. Its secondary aim was to identify the risk factors associated with such injuries. Out of the 1547 acute hand and forearm injury cases admitted to emergency trauma department between March 2017 and March 2018, the 129 injuries pertaining to children were included in the study. Mechanism, time, etiology, injured structures, anatomical regions, cut structures, and occupational accident status were determined in addition to demographic information. The injuries were evaluated according to circadian rhythm in order to ascertain the hours of intensification. The Modified Hand Injury Severity Score (MHISS) was used to assess injury severity. The mean age of 129 patients was 10.1 years. The most injuries were observed in the groups of patients over 12 years of age (57, 44%), and 0–6 years of age (42, 32%), respectively. Nineteen students participating in vocational internships were injured (14%). Twenty-six cases (20%) in the 12-year-old group involved punching glass, and 34 (26%) cases in the 0–6 age groups involved fingertip crush injuries. Temporal injury intensity was seen to have increased between 12.00 and 19.00 hours. The mean MHISS was 41 (8–120). Injury prevention measures need to be increased, particularly for fingertip injuries. A specific injury severity assessment system is also required for pediatric hand injuries, which are often simpler and easier to treat than adult hand injuries. Additionally, training and increasing awareness are believed to be important steps in preventing pediatric hand injuries.

Tr en Amaç: Bu çalışmanın amacı total diz protezi uygulanmış olgularda subvastus ve medial parapatellar yaklaşımın komponentlerin yerleşimine etkisini araştırmak; özellikle yüksek deformiteli dizlerde potansiyel olarak daha kısıtlayıcı yaklaşımların varsa olası olumsuz etkilerini ortaya koymaktır. Gereç ve Yöntem: Total diz protezi uygulanmış 84 hastanın 88 dizi çalışmaya alındı. Hastalardan 46’sına medial parapatellar (grup 1), 42’sine subvastus yaklaşımla total diz protezi (grup 2) yapılmıştır. Preoperatif radyografilerinde mekanik eksen ve posterior tibial eğim açıları; postoperatif radyografilerinde femoral ve tibial komponentlerin frontal ve sagittal planlarda anatomik eksenlere göre konumlanışı ölçüldü. Bulgular: Postoperatif femoral komponentin frontal planda konumlanışını gösteren alfa açısının ortalama değeri grup 1’de 96.79°±2.86°, grup 2’de ise 96.81°±3.22° olarak bulundu. Tibial komponentin frontal planda konumlanışını gösteren beta açısının ortalama değeri ise grup 1’de 89.07°±3.45°, grup 2’de 89.97°± 3.00° idi. Sagittal planda konumlanış açısından ortalama sagittal femoral açı grup 1 ve 2’de sırasıyla 4.85°±3.84° ve 3.31°±3.58°, sagittal tibial açı ise yine sırasıyla 5.10°±3.88° ve 4.08°±3.18° olarak bulundu. Hastaların posterior tibial eğimi ve postoperatif sagittal tibial komponent eğimi karşılaştırıldığında, her iki grupta azalmış bulundu. Sonuç: Total diz protezinde cerrahi yaklaşımın yüksek dereceli deforme dizlerde bile protezin konumlanışı üzerine etkisi gösterilememiştir. Her iki yaklaşımla da komponentler uygun şekilde yerleştirilebilmektedir ve tibianın proksimal posterior eğiminde azalmaya neden olmaktadır. Purpose: The aim of this study was to evaluate the influence of subvastus and medial parapatellar total knee arthroplasty approaches on component positioning and to explore the possible negative effects of potentially more restrictive approaches especially in highly deformed knees. Materials and Methods: 88 knees of 84 patients (46 knees operated with medial parapatellar approach (group 1), and 46 knees operated with subvastus approach (group 2)) who had undergone total knee arthroplasty. The patients were also regrouped according to their preoperative mechanical axis deviations. Postoperative femoral and tibial component positioning on frontal and sagittal planes were evaluated. Results: Frontal femoral (α) and tibial (β) component angles as well as sagittal femoral and tibial component angles were not significantly different between two groups (mean values of α of groups 1&2: 96.79±2.86° and 96.81±3.22°, respectively, of β 89.07°± 3.45° and 89.97°± 3.00° respectively, of sagittal femoral angle 4.85° ± 3.84° and 3.31° ± 3.58°, respectively, of sagittal tibial angle 5.10° ± 3.88° and 4.08 °± 3.18°, respectively). Postoperatively, posterior tibial slope was significantly decreased in both groups. Conclusion: None of the total knee arthroplasty approaches tested in this study found to exert a significant effect on component positioning even in highly deformed knees. The components can be placed properly utilizing both approaches.