Fizyoterapi Bölümü Koleksiyonu


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    Bilateral locked posterior shoulder dislocation overlooked for 15 months treated with the modified McLaughlin procedure: A case report
    (Bayçınar Tıbbi Yayıncılık, 2023) Saylık, Murat; Gökkuş, Kemal
    Neglected bilateral posterior shoulder dislocation is a rare injury caused primarily by an epileptic seizure. The injury is usually associated with a reverse Hill-Sachs lesion in the anteromedial aspect of the humeral head. The modified McLaughlin technique may avoid instability and osteoarthritis when 20 to 40% of the articular surface is affected by reverse Hill-Sachs. In this article, we present the clinical results of a case overlooked in the literature for the longest time, i.e., for 15 months. A 46-year-old male patient was receiving treatment for epilepsy for five years. There was no fall or trauma in the four seizures he had during this time. The last seizure was 15 months ago. When the patient presented to our clinic, both shoulders were symmetrically deformed, the anterior shoulder contour disappeared (empty socket sign), and there was a loss of upper contour. The computed tomography (CT) scan revealed a posteriorly locked dislocation with a reverse Hill-Sachs lesion in 32% of the left shoulder and 36% of the right shoulder. We applied the modified McLaughlin procedure to the dominant right shoulder and, two months later, we used it to the left shoulder (with a graft taken from the anterior superior iliac spine). At one-year of follow-up, both shoulders were moderately functional: forward elevation left 70° and right 50°, abduction left 40° and right 60°, and internal rotation: the back of the hand could touch the fifth lumbar vertebra. Meanwhile, the patient did not suffer from recurrent dislocation. The pre- and postoperative Constant-Murley Scores for the right and left shoulder were 30/52 and 11/48, respectively. Although the operational outcomes using the modified McLaughlin technique were not ideal, with no recurrence, the patient seemed to be satisfied with this outcome. In conclusion, in neglected locked shoulder fracture-dislocations, the modified McLaughlin technique is a method that can respond to the pathophysiology by eliminating reverse Hill–Sachs lesion.
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    Open and arthroscopic excision of the distal clavicle for osteoarthritis of the acromioclavicular joint--results over 5 years
    (TMMOB Makina Mühendisleri Odası, 2022) Saylık, Murat
    Objective: Initially performed as open surgery, arthroscopic applications of distal clavicle excision (DCE) have gained prevalence in recent years. Literature reviews about the long-term results give no clear indication that one method is superior to the other. This study aims to compare the follow-up results of patients treated with arthroscopic and open DCE for more than five years and to detect the superiority of each method. Material and Method: The study involved 328 patients treated with DCE between February 2008 and April 2017. One hundred and fourteen patients (66 male and 48 female; 81 arthroscopic and 33 open surgery), who had their records available and under went no other surgery than DCE, were included in the study. The Disability of the Arm, Shoulder, and Hand (DASH) score and Visual Analogue Scale (VAS) were used to assess post-DCE shoulder functions and pain, respectively. Within the study's scope, surgery duration, excision extent, complications (frozen shoulder, hematoma, surgical site infection, and instability), and revisions were compared. Results: In the >5-year follow-up process, no statistically significant difference was observed between pre-DCE DASH and VAS values or between post-DCE DASH and VAS values of the two groups, one involving 32 patients who underwent open surgery and the other involving 82 patients treated with arthroscopic surgery. However, there was a statistically significant difference between the pre- and post-DCE DASH and VAS scores of both groups, and it was observed that both surgical methods were effective. No statistically significant difference was observed between the two groups regarding the surgery duration. Arthroscopic DCE was measured to be 4.70 mm on average, while the average measure for open surgery was 5.53 mm, which indicated a statistically significant difference between the two groups. However, no significant association was observed between the excision extent and the DASH and VAS scores. Furthermore, no significant difference was observed between complication and revision rates. Conclusion: In the >5-year follow-up of patients who underwent arthroscopic or open DCE due to their acromioclavicular joint osteoarthritis, which could not be treated with conservative treatment, no statistically significant difference was observed in the two groups' post-DCE DASH scores, VAS scores, complication rates, and revision rates. There was, however, a statistically significant difference between both groups' pre- and post-DCE VAS and DASH scores, and both methods were effective.