Özler, Turhan | Uluçay, Çağatay | Önal, Ayberk | Altıntaş, Faik

Other | 2015 | Acta Orthopaedica et Traumatologica Turcica49 ( 3 ) , pp.255 - 259

Objective: Prevention of deep venous thrombosis (DVT) and associated pulmonary embolism following major orthopedic surgeries is challenging, and there is an increased interest in developing new treatment strategies. We compared 2 switch-therapy modalitiesenoxaparin to rivaroxaban and enoxaparin to dabigatranand enoxaparin monotherapy for preventing DVT after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods: This was a prospective, non-blinded, randomized controlled study. We selected 180 eligible patients out of 247 patients undergoing TKA or THA. During the preoperative checkup, patients were randomized to re . . .ceive either enoxaparin (enoxaparin group) or switch-therapy regimens, comprising enoxaparin during hospitalization and rivaroxaban (rivaroxaban group) or dabigatran (dabigatran group) during the outpatient period. All patients were evaluated for DVT using Doppler ultrasonography (USG) 6 weeks postoperatively. The primary efficacy outcome was the prevention of symptomatic or Doppler ultrasonography (USG)-proven DVT, whereas the primary safety outcome was the incidence of bleeding during the DVT-prophylaxis period. Results: Doppler USG at 6 weeks after surgery revealed no signs of DVT in any patient. During the hospitalization period, only 2 major bleeding events were reported (1 [1.6%] in the enoxaparin group and 1 [1.6%] in the dabigatran group). No major bleeding events were reported during the outpatient follow-up period in any group. Differences among the 3 groups regarding bleeding events were not statistically significant (p>0.05). Conclusion: When using switch-therapy modalities, clinicians can take advantage of the safety of enoxaparin during the hospitalization period and ease of use of new oral anticoagulant drugs during the outpatient period Daha fazlası Daha az

Özler, Turhan | Güven, Melih | Önal, Ayberk | Uluçay, Çağatay | Beyzadeoğlu, Tahsin | Altıntaş, Faik

Article | 2014 | Acta Orthopaedica et Traumatologica Turcica48 ( 3 ) , pp.249 - 252

Amaç:Bu çalışmada tanısı atlanmış izole posterior malleol kırıklı hastaların yaralanma mekanizması ve klinik ve radyolojik sonuçlar açısından değerlendirilmesi amaçlandı. Çalışma planı: Atlanmış izole posterior malleol kırığı olan 7 hasta (5 erkek, 2 kadın, ortalama yaş 32 (23-40)) çalışmaya alındı. Ayak bileği burkulması nedeniyle acil servise başvuran ve standart ayak bilek grafileri ile kırık saptanmayan bu 7 hastada şikayetlerin devam etmesi nedeniyle 3. haftada çekilen ayak bileği MR görüntülemesi ile izole posterior malleol kırığı tanısı koyuldu. Hastalar 3 hafta boyunca yük kısıtlaması ve ayak bilekliği ile tedavi edildiler. . . .Kırık kaynamasının ve olası dejeneratif değişikliklerin değerlendirilmesinde ayak bileğinin ön-arka, yan ve 50 dış rotasyonda çekilen grafileri kullanıldı. Bütün hastalar 1 yıl takip edildi. Bulgular: Altıncı hafta sonunda 7 hastanın 6’sında kırık kaynaması görüldü. Bir hastanın ise 6. ayda hala kırığı kaynamamıştı. Hastaların ortalama AOFAS ayak bileği ardayak skorları tedavi öncesi ve tedavi sonrası 3. ayda sırası ile 20 (11-31) ve 86 (43-96) idi. Birinci yıl takiplerinde hiçbir hastada dejeneratif değişiklik veya instabilite saptanmadı. Çıkarımlar: Ayak bileği arkasında ağrı yakınması olan ve plantar fleksiyon ve/veya aksiyel kompresyon mekanizması ile ayak bileği burkulması tarif eden hastalarda izole posterior malleol kırığı akla getirilmelidir. Tanıda 50 dış rotasyonda çekilen yan grafi kırığın saptanmasına yardımcı olabilir. Objective:The aim of this study was to evaluate the injury mechanism and clinical and radiological results of the patients with isolated posterior malleolar fracture. Methods: Seven patients (5 male, 2 female; mean age: 32 years; range: 23-40) with a missed isolated posterior malleolar fracture were included in the study. All patients had initially been examined for an ankle sprain in the emergency room, where the initial plain radiographs did not show any abnormality. Due to the long lasting symptoms all patients underwent an MRI scan by the 3rd week which revealed a posterior malleolar fracture. Patients were treated with an ankle brace for 3 weeks. All patients were followed up for 1 year. Bone healing and degenerative changes were evaluated with plain Radiographs, including a 50° external rotation lateral. Clinical outcome was evaluated with American Orthopedic Foot and Ankle Society ankle hindfoot scale. Results: Fracture healing was seen in 6 of the 7 patients by the 6th week. There was no radiographic healing by 6th month in the remaining patient. Mean AOFAS ankle hindfoot scores at the beginning of the treatment and at 3rd month were 20 (11-31) and 86 (43-96), respectively. There was no instability or degenerative changes at one-year follow-up. Conclusion: Isolated posterior malleolar fracture should be kept in mind in patients who present with pain at the posterior part of the ankle following a forced plantar flexion and/or axial compression injury. A 50° external rotation lateral radiograph can be useful in detecting the fracture Daha fazlası Daha az