BEDAH VETERINER LUKSASI SCAPULOHUMERAL LATERAL DAN MEDIAL

2020

Abstrak Latar Belakang Tingginya angka persalinan section caesarea dipengaruhi banyak hal. Salah satunya adalah trauma persalinan pada ibu dikarenakan waktu persalinan yang cukup lama. Hal tersebut dapat dikarenakan posisi persalinan yang tidak tepat. Sebagian kematian maternal dan perinatal banyak terjadi pada saat persalinan. Salah satu penyebabnya kala II lama (37%) dan asfiksia pada bayi (28%) (Depkes RI, 2009). Tujuan : untuk mengetahui perbedaan posisi persalinan setengah duduk dan miring ke kiri terhadap lamanya kala II di RSU. Rhidos Tahun 2020. Metode: Penelitian ini merupakan penelitian eksperimen statis group comparison, Sampel penelitian semua ibu bersalin primigravida dengan asuhan persalinan normal, dibagi dalam 2 kelompok yaitu kelompok dengan posisi persalinan setengah duduk sebanyak 20 responden dan kelompok posisi persalinan miring kiri sebanyak 20 responden. Analisis data menggunakan analisa univariat disajikan dengan distribusi frekuensi, dan analisis bivariat un...

Kafkas Universitesi Veteriner Fakultesi Dergisi, 2017

Dorsal luxation, avulsion or dislocation of the scapula is described as the dorsal displacement of the scapula, resulting from the rupture of the ventral serratus, rhomboideus and trapezius muscles. In this report, we aimed to suggest a different way for the surgical treatment of dorsal scapular luxation in cats. The study material comprised of 6 cats presented to our clinics. Intra-operatively, in all the patients it was determined that the ventral serratus and rhomboideus muscles were ruptured, however, the trapezius muscle was undamaged. In surgical intervention, cauterization of contact surfaces of two muscle to improve adhesion and suturing of serratus and rhombeideus muscles to infraspinatus and supraspinatus muscles was carried out respectively. In the clinical follow-up examination on post-operative day 15, dorsal luxation of the affected extremity during weight-bearing had completely disappeared in all of the patients. On the telephone consultation 2 months after operation, owners declared no complaints of lameness or recurrence of symptoms. In conclusion, the treatment model suggested in this study is quite simple and minimally invasive which could be applied in the treatment of the dorsal scapular luxation in cats.

Fraktur femur merupakan salah satu kejadian yang sering terjadi pada kucing dalam pembedahan ortopedi. Insiden diaphyseal fraktur femur adalah 20 – 25%, fraktur femur merupakan fraktur yang paling sering terjadi pada tubuh kucing. Fraktur femur biasanya tidak dapat sembuh secara konservatif melainkan harus melalui fiksasi internal.

Bu çal›flmada seyrek görülen ve tedavisi zor olup, bazen önemli komplikasyonlarla sonuçlanan eriflkinlerin distal humerus eklem içi k›r›klar›n›n cerrahi tedavisinin sonuçlar› tart›fl›ld›. Çal›flmada 27 eriflkin hastan›n (19 erkek, 8 kad›n; ort. yafl 31; da¤›l›m 15-79) distal humerus eklem içi k›r›¤› d e ¤ e r l e n d i r i l d i. K›r›k nedeni olarak olgular›n 11 ' i n d e (%41) düflme, 9'unda (%33) yüksekten düflme, 5'inde (%18) trafik kazas›, 1'er (%4) olguda ifl kazas› ve spor yaralan-mas› saptand›, alt› olguda (%26) ek lezyonlar da v a r d ›. AO s›n›flamas›na göre 2 (%8) tip B1, 1 (%4) tip B2, 4 (%15) tip B3, 5 (%18) t i p C1, 12 (%44) tip C2, 3 (%11) tip C3 k›r›k saptand›. Olgular›n 21'i (%78) kapal›, 6's› (%22) aç›k k›r›kt›. Tip C k›r›kl› olgularda aç›k k›r›k oran› %30 olarak belirlendi. Olgular ortalama 7'inci günde ameliyat edildi. Cerrahi yaklafl›m olarak olgular›n 13'ünde (%48) olekranon osteotomisi, 10'unda (%37) Campbell'in tarif etti¤i triseps kesisi, 4'ünde (%15) posterolateral kesi kullan›ld›. K›r›klar›n 9'una (%33) rijit osteosentez, 18'ine (%67) ise rijit olmayan osteosentez uyguland›. Ameliyat sonras› olabildi¤ince erken dönemde rehabilitasyona baflland›. Hastanede yat›fl süresi ortalama 12 gün, ortalama takip süresi 65 ay idi. Jupiter'in klinik de¤erlendirme skalas›na göre olgular›n 9'u (%32) mükemmel, 12'si (%44) iyi, 3'ü (%12) orta, 3'ü (%12) kötü sonuç olarak de¤erlendirildi. Orta ve kötü sonuçlar›n tümü C tipi k›r›klar› olan ve 5. günden sonra ameliyat edilen olgularda al›nd›. Ortalama fleksiyonekstansiyon hareket aç›kl›¤› tüm seride 105°, C tipi k›r›klarda 100°, B tipi k›r›klarda 121° bulundu. Ameliyat sonras› komplikasyon olarak olgular›n 4'ünde (%15) ulnar sinir nöropraksisi, 2'sinde (%8) miyozitis ossifikans, 6's › n d a (%22) enfeksiyon görüldü. Eriflkinlerin distal humerus eklem içi k›r›klar›nda erken cerrahi giriflim, uygun yaklafl›m, eklem hatt›n›n anatomik redüksiyonu, stabil fiksasyon ve erken rehabilitasyonla iyi sonuçlar al›nabilir. Anahtar Sözcükler: Artiküler; distal humerus k›r›¤›/cerrahi/komplikasyon; eriflkin; hareket aç›kl›¤›; k›r›k fiksasyonu, internal; olekranon osteotomisi; rehabilitasyon. Results of surgical treatment of intraarticular distal humeral fractures in adults, which are rarely seen, present difficulties in treatment and sometimes result in serious complications, are discussed in this study. Mean age of the 27 patients (8 F, 19 M) included in the study was 31 (range 15-79). Fractures resulted from fall in 11 (41%) patients, fall from height in 9 (33%), traffic accident in 5 (18%), industrial injury in 1 (4%) and sports injury in 1 (4%). Six (26%) patients had additional injuries. Two (8%) B1, 1 (4%) B2, 4 (15%) B3, 5 (18%) C1, 12 (44%) C2 and 3 (11%) C3 fractures were determined according to AO classification. Twenty-one (78%) of the fractures were closed fractures while 6 (22%) were open. In type C fractures, 30% were open fractures. Patients underwent surgery on the mean 7th day of the injury. Surgical approaches included olecranon osteotomy in 13 (48%), triceps splitting approach defined by Campbell in 10 (37%) and posterolateral approach in 4 (15%) patients. Rigid osteosynthesis was achieved in 9 (33%) fractures, while non-rigid osteosynthesis was performed in 18 (67%) cases. Fixation of the fractures was achieved by using only plates in 2 (7%), only screws in 9 (34%), separated screws and plate in 7 (26%), screws and Kirschner wires in 6 (22%) and only Kirschner wires in 3 (11%) patients. Rehabilitation was begun as early as possible postoperatively. Mean hospitalization time was 12 days and mean follow-up time was 65 months. According to Jupiter's evaluation criteria, 9 (32%) excellent, 12 (44%) good, 3 (12%) moderate and 3 (12%) poor results were obtained. All the moderate and poor results were in the patients with type C fractures and all were operated after the 5th day of the injury. Mean flexion-extension ranges of motion were 105°, 100° and 121° in the entire series, in C type fractures and in B type fractures, respectively. Ulnar neurapraxia developed in 4 (15%), myositis ossificans in 2 (8%) and infection in 6 (22%) patients as postoperative complications. In intraarticular distal humeral fractures in adults, satisfactory results can be obtained by means of early surgical treatment, anatomical reduction of the joint surface through appropriate surgical approach, stable fixation and immediate rehabilitation.

Bozok Tıp Dergisi, 2018

Humerus proksimal uç kırığı nedeni ile proksimal humerus kilitli plağı kullanılarak ameliyat edilen 38 hastanın kırık tipi ve yaşa göre, klinik ve radyolojik sonuçlarını değerlendirmeyi amaçladık. Yöntem: Humerus proksimal kilitli plak cerrahisi uygulanan, yaş ortalaması 45,9 (aralık 16-74) olan 38 hasta (26 erkek , 12 bayan) çalışmaya alındı. Çalışmada 11 hasta 60 yaş üstü (aralık 60-74), 27 hasta 60 yaş altı (aralık 16-57) hastadan oluşmakta idi. Hastaların hastanede kalış süresi ortalama 10.1 gün (aralık 2-46 gün) idi. Hastaların ortalama takip süresi 9,5 ay (aralık 4-36 ay) idi. Değerlendirmeler Constant-Murley(CM) skorlamasına göre yapıldı. Bulgular: Neer sınıflamasına göre 2 hasta tip1, 11 hasta tip2, 16 hasta tip 3 ve 9 hasta tip 4 kırık idi. Gruplara göre ortalama CM skoru sırasıyla 93,60/78,27/79,00/62,66 olarak bulundu. 60 yaş üstü hasta grubu CM skoru 65,72, 60 yaş altı CM skoru 79,74 idi. Tüm hastalarda 3 ay sonunda tam kaynama görüldü. Cerrahi işlemler sonrası bir hastada avasküler nekroz, bir hastada implant yetmezliği, iki hastada antibiyotik tedavisi ve yıkama debritman ile tedavi edilen yüzeysel yumuşak doku enfeksiyonu ve iki hastada subakromiyal sıkışma görüldü. Sonuç: Hastaların kırık tipi ve fonksiyonel sonucun karşılaştırılmasın da kırık tipi arttıkça fonksiyonel sonuçların azaldığı, 60 yaş altı hastaların, 60 yaş üstü hastalara göre daha iyi fonksiyonel sonuçların olduğu izlendi. Kilitli plak uygulamasının tekniğine uygun şekilde yapıldığında, güçlü stabilizasyon ve erken rehabilitasyona izin vermesi nedeniyle özellikle artan yaşlı nüfus populasyonun da iyi bir tercih olduğunu düşünmekteyiz.

B-Dent: Jurnal Kedokteran Gigi Universitas Baiturrahmah

Pendahuluan: Ulserasi mukosa mulut dapat disebabkan oleh faktor lokal maupun sistemik. Salah satu faktor lokal yang sering diungkapkan oleh pasien adalah akibat tergigit. Data penelitian mengenai ulserasi mukosa mulut belum banyak dipublikasi terutama Indonesia, sehingga tujuan penelitian ini adalah untuk menyajikan informasi mengenai etiologi, distribusi dan terapi ulser traumatik pada pasien di Rumah Sakit Gigi Mulut Universitas Padjadjaran (RSGM UNPAD). Metode: Sebuah penelitian deskriptif, dengan data dilakukan dengan tabulasi dan persentase. Hasil: Terdapat 44 pasien yang terdiri atas 15 orang laki-laki (34,05%) dan 29 orang perempuan (65,95%), dengan rentang usia 17-55 tahun. Jenis trauma yang menjadi penyebab tersering ulser adalah tidak sengaja tergigit, tempat paling sering di mukosa bukal, dan obat yang paling banyak digunakan adalah kombinasi vitamin dan anti inflamasi yang diberikan pada 10 penderita ulser traumatik (22.7%). Simpulan: Penyebab ulser mukosa mulut tersering adalah trauma, dan trauma yang paling sering terjadi pada orang dewasa adalah akibat tergigit.

DergiPark (Istanbul University), 2023

Kemiğe kan sağlayan a. nutricia'nın seyrettiği foramen nutricium (FN) önemli bir role sahiptir. Bu çalışmada, humerus, radius ve ulna kuru kemiklerinde FN sayısı, konumları ve vertical çapları araştırıldı. Gereç ve yöntem: Trakya Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı'nda bulunan ve eğitim amaçlı kullanılan 64 humerus, 37 radius ve 26 ulna kuru kemiği üzerinde ölçüm yapıldı. FN yeri, sayısı ve vertical çapları ölçüldü. Kemiğin proksimal ucu ile FN arasındaki mesafenin kemiğin toplam uzunluğuna bölünmesiyle hesaplanan foraminal indeks (FI), FN çapı 0,5 mm'den büyük olan her bir kemik için hesaplandı. Bulgular: Humerus kemiklerinin %81'inde FN'un tek sayıda olduğu görüldü. Humerus kemiklerinin %80'inde FN anteromedial yüzeyde yer almaktaydı. Humerus kemiklerinde FN'nin ortalama vertikal çapı 1,20±0,27 mm ölçüldü ve ortalama FI %55,47 olarak bulundu. Radius kemiklerinde FN'un diğer ölçüm yapılan kemiklere göre daha az olduğu ve anterior yüzeyde bulunduğu görüldü. Radius kemiklerinde FN'nin ortalama vertical çapı 0,98±0,24 mm ölçüldü ve ortalama FI değeri %34,60 olarak bulundu. Ulna kemiklerinin %92'sinde tek FN bulunduğu görüldü ve %89'unda FN kemiğin ön yüzünde yer almaktaydı. Ulna kemiklerinde ortalama vertical FN çapı 1,24±0,32 mm olarak ölçüldü ve ortalama FI değeri %37,16 olarak belirlendi. Sonuç: FN'nin konumu, sayısı ve morfometrik özelliklerinin bilinmesi, uzun kemik kırıklarının iyileşmesinde ve ekstremite üzerindeki tüm cerrahi veya ortopedik prosedürlerde kemiğin beslenmesi açısından kritik öneme sahiptir.

Acta Orthopaedica et Traumatologica Turcica, 2014

The aim of this study was to investigate the relationship between the axillary nerve and the percutaneously inserted proximal humeral locking plate and to evaluate the risk of axillary nerve injury during percutaneous plate insertion. Methods: The study included 50 shoulders of 25 fresh frozen cadavers. A 5 cm incision was made from the anterolateral border of the acromion to the arm and a 5-hole 3.5-mm proximal humeral plate was inserted. The axillary nerve was then dissected. Plate holes which crossed the axillary nerve were noted. The distance between the axillary nerve and the lateral edge of the acromion and the length of the arm were measured and their relations evaluated with a correlation test. Results: The average arm length was 319 mm. The average distance between the axillary nerve and the lateral edge of the acromion was 60 mm. There was a significant correlation between the arm length and acromion-axillary nerve distance (p<0.05). The plate was inserted under the deltoid fascia in all shoulders except one. There were no axillary nerve lesions. In 1 case, the distal end of the plate was inserted in the deltoid muscle. No constant relationship between the plate holes and the axillary nerve was detected. Conclusion: There is a risk of axillary nerve injury during percutaneous plate insertion. It must be ensured that the plate is inserted under the deltoid fascia during the surgery. The axillary nerve must be visible during application of the screws due to the impossibility of knowing which holes cross the axillary nerve.

Genel tıp dergisi, 2022

In this study, we aimed to compare the clinical and radiological results of the extensile lateral (EL) approach and sinus tarsi (ST) approach in calcaneal fracture surgery. Materyal-Metod: A total of 40 patients with Sanders II-III calcaneal fractures, including 22 patients in the EL group and 18 patients in the ST group, were included in this retrospective study. In the radiological evaluation, changes in the calcaneus Bohler and Gissane angle, length, width, and height were measured during the preoperative and postoperative period. Clinically, American Orthopedic Foot and Ankle Society (AOFAS) and the visual analog scale (VAS) were evaluated. In addition, postoperative complications were also evaluated. Results: In terms of demographic data, the results of both groups were similar. Both the length of hospital stay and the time to surgery were shorter in the ST group (p=0.019, p=0.02, respectively). There was no significant difference between the groups regarding radiological, clinical AOFAS and VAS scores. 13.6% superficial infection was seen in the EL group, and no wound problems were encountered in the ST group (p=0.102). The rate of sural nerve injury was 36.4% in the EL group and 5.6% in the ST group (p =0.003). Conclusion: Both approaches clinical and radiological outcomes were similar. However, the advantages of the ST approach were shorter hospital stays, lower rate wound infections, and sural nerve injury problems.

Journal of Postgraduate Medicine, Education and Research

Aim: We did this study as a pilot project to plan the future research work in the field, with the aim to study the incidence and epidemiology of scapular fractures. Results of the study would be helpful in identifying the mass impact of the injury to the trauma victim and laying down the training curriculum. Materials and methods: It was a cross-sectional study from July 1, 2018, to December 31, 2018; all patients presented to our level 1 trauma center with polytrauma and shoulder injuries were screened for fracture of the scapula. The demographic details, mode and mechanism of injury, associated injury, severity, and fracture pattern of all patients with scapula fracture were recorded. Patients were evaluated for concomitant injuries. Results: Out of total 1,730 patients presenting to the Advanced Trauma Center, PGIMER, Chandigarh, between July 2018 and December 2018, 44 (2.3%) patients were diagnosed with scapular fractures. Total 63.4% (28) of patients sustained various associated injuries. Clinical significance: Results of this study have raised the awareness that fractures of the scapula are on the rise compared to what was thought previously. Conclusion: Our study mandates the need of more dedicated screening methodology at the busy trauma center, which could reduce the chances of missed scapular fracture. Moreover, we could be able to identify more frequent fracture patterns and area of research specific to our setting.