Traumatology Clinic Research Articles

Ortopedi Kliniğinde Cerrahi Operasyon Sonrası Yara Kültür Sonuçlarının Değerlendirilmesi: Üç Yıllık Analiz

Objective: Wound infections constitute the most prevalent postoperative complication encountered by orthopedists. Lack of timely and correct treatment may lead to chronic wound infections. Therefore, this study aims to guide empirical treatment, investigate the isolated bacteria and associated antibiotic resistance states in wound cultures obtained after orthopedic surgery.Methods: In the three-year period between January 2016 and end of December 2018, 3100 patients were operated in the Orthopedics and Traumatology Clinic of the Kirsehir Ahi Evran University Training and Research Hospital. Wound cultures obtained from patients operated due to wound infections were retrospectively evaluated. Antibiotic susceptibility tests were performed in accordance with EUCAST guidelines using disc diffusion methods and the VITEK 2 Compact® (Biomerieux, France) automated system.Results: A total of 284 wound culture specimens were evaluated, and 85 (22.9%) of these demonstrated significant bacterial growth. Monomicrobial growth was detected in 92% and polymicrobial growth was found in 8% of the cultures. The most commonly isolated microorganism was Escherichia coli (22.3%), followed by coagulase negative staphylococci (CoNS) (20%), Staphylococcus aureus (15.3%), Acinetobacter baumannii (9.4%), Pseudomonas aeruginosa (9.4%) and Streptococcus spp. (5.8%) respectively. Extended-spectrum beta-lactamase (ESBL) positivity was determined as 100% and 25% for E. coli and K. pneumoniae isolates, respectively. Carbapenems were found to be the most effective antibiotics to Enterobacteriales family. Gram positive bacteria were not resistant against vancomycin and teicoplanin, but 7.6% of S. aureus strains and 57.1% of CoNS were methicillin-resistant.Conclusion: Identification and monitoring of causative microorganisms in postoperative wound infections and antibiotic resistance rates at every hospital is quite important. Taking these findings into consideration will result in better prevention of infections, increased treatment success, and decreased antibiotic resistance rates.

Relationship between anesthesia method and recurrence rate after surgical treatment of ganglion cysts

Aim: Recurrence is frequently reported in patients operated on with the diagnosis of ganglion cyst. In this study, it was aimed to investigate the relationship between relapse and anesthesia method in patients who underwent total surgical excision.Material and Methods: 133 patients who were operated with a preliminary diagnosis of ganglion cyst in the orthopedics and traumatology Clinic between 2015-2019 were included in the study. The demographic features of the patients, the location of the cyst and the anesthesia method applied were evaluated retrospectively.Results: Of the 120 patients operated on, 76 (63.3%) were female and 44 (36.7%) were male. General anesthesia was performed in 44 (37%), sedation anesthesia in six (5%), regional anesthesia in 42 (35%), and local anesthesia in 28 (23%). During routine follow-up, 19 (15.8%) patients showed recurrence on average 6-12 months after the operation. When anesthesia method of patients who developed recurrence after surgery was examined, it was found that local anesthesia was performed in 13 (46.4%) of 19 patients.Conclusion: It has been determined that ganglion cysts are more likely to recur with local anesthesia during surgery than other anesthesia methods. The result obtained suggests that local anesthesia causes surgical failure due to the limited working field of the surgeon, the patients feel pain when deeper tissues are reached and the lack of adequate exposure.

Epidemiology, Diagnosis and Treatment of Acute Septic Arthritis in Haseki Orthopedics and Traumatology Clinic

Epidemiology, Diagnosis and Treatment of Acute Septic Arthritis in Haseki Orthopedics and Traumatology Clinic

Morphometric analysis and prevalence of plantar calcaneal spurs among the adult population of the Province of Vojvodina

Introduction. Plantar calcaneal spur is a bony outgrowth which is most often located on the inferior aspect of the calcaneus, penetrating the surrounding soft tissues. Symptomatic and asymptomatic cases of plantar calcaneal spurs have been described and their analysis suggested that they may be a variation in regular bone development, but the exact cause is still unknown. The goal of this study was to determine the size, shape and prevalence of plantar spurs in the population of the Province of Vojvodina. Material and Methods. This retrospective research included a total of 272 foot X-rays. The X-rays belonged to the Clinic of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. The images were analyzed using a publicly available software Xrayline Workstation for 32-bit. Results. There was no statistically significant difference in the size of calcaneal spurs between sexes, as well as between the right/left foot. In regard to their shape, irregular calcaneal spurs were more frequent (61.9%) and all of the spurs were positioned horizontally. Conclusion. The results of this research were in agreement with the available literature data, showing no significant difference in morphometric analysis of the plantar spurs between sexes. Future researches should include data regarding the age, body weight, and comorbidities among examinees.

Cementless rectangular stems yield satisfactory results in osteoporotic bones.

The present study aims to investigate the effects sof osteoporosis on prosthesis survival by comparing the femoral stem survival rates of patients with poor and relatively good bone quality. We retrospectively investigated 61 patients with collum femoris fractures who were treated with cementless rectangular stems between 2011 and 2015 in the Orthopaedics and Traumatology Clinic of Taksim Training and Research Hospital. The preoperative pelvic anterior-posterior radiographs of the patients were evaluated. The patients were evaluated according to the Dorr classification, and no case with a type A femur was found. The patients were divided into two groups as advanced osteoporotic type C and moderate osteoporotic type B. Thirty patients were type B according to the Dorr classification and 31 were osteoporotic type C. The femoral component survival was evaluated using the Engh and ARA criteria. The relationship of the ARA score with type B and type C groups was evaluated. The median ARA score was five (min 3-max 6) for both types. These two groups were also statistically compared concerning the ARA scores using the Mann-Whitney U test, which revealed no statistically significant difference (p=0.24 >0.05). The Engh values, another criterion for the survival of femoral components, were also compared. The median Engh values were 16.5 (min 9-max 24) for the Dorr type B group and 14 (min 9-max 24) for the type C group. According to the Mann-Whitney U test, there was no significant difference between the Engh values of the two groups (p=0.061 >0.05). Lastly, no statistically significant difference was found in the ARA or Engh loosening scores between the type C advanced osteoporotic group and the type B moderate osteoporotic group. Our study supports the conclusion that cementless hip arthroplasty can be applied even in advanced elderly and osteoporotic patients without additional intraoperative or postoperative risks.

UC-USP collaborative exercise on photobiomodulation therapy in neurological orofacial disturbances.

BackgroundNeurosensory peripheral disorders are one of the most common risks associated with iatrogenic and/or post-traumatic injuries. It is often related to disability. Photobiomodulation therapy (PBMT) is a nonsurgical and safe procedure which can accelerate and improve the regeneration of injured biological tissue. This study aims to analyze the impact of PBMT, in the quality of life and impairment of individuals with orofacial neurological peripheral disturbance. Material and MethodsA retrospective analysis in the database of the dental traumatology clinic of the Hospital Centre of the University of Coimbra/Faculty of Medicine of the University of Coimbra was performed.5 out of 50 individuals were selected, according to the selection criteria. The neurosensory activity was assessed by a pinprick nociceptive test and the EQ-5D-5L self-report questionnaire was used to analyse the quality of life. The study was performed in two phases:1) inactive laser or placebo phase, for one month and 2) active laser or treatment phase. A diode low-level laser device (SIROLaserBlue;Sirona,Germany) was used, according to our protocol. A collaborative protocol in the PBMT influence in individuals with neurosensory peripheral disturbances was studied. ResultsThere was no improvement in the neurosensory activity nor in the quality of life, in the placebo phase. After the treatment phase, the EQ-5D-5L final results reported no problems in all of the five dimensions, except for anxiety/depression in individuals with long-standing neurosensory peripheral disturbances. The EQ-VAS scores increased in all the individuals. ConclusionsOur results supported the improvement of quality of life and impairment reduction in the individuals submitted to PBMT. Key words:Low-level light therapy, peripheral nerve injuries, sensation disorders, quality of life, forensic medicine.

A pilot study in Serbia by European Clostridium difficile Infection Surveillance Network.

Clostridium (Clostridioides) difficile infections (CDIs) are among the most frequent healthcare-associated infections in Serbia. In 2013, Serbia participated in the European Clostridium difficile Infection Surveillance Network (ECDIS-Net) who launched a pilot study to enhance laboratory capacity and standardize surveillance for CDI. Two clinics of Clinical Center of Serbia [Clinic for Infectious and Tropical Diseases (CITD) and Clinic of Orthopedic Surgery and Traumatology (COT)] from Belgrade and one general hospital from another metropolitan area of Serbia, Užice, participated. During a period of 3 months in 2013, all patients with diagnosed CDI were included. The CDI incidence rates in CITD, COT, and General Hospital Užice were 19.0, 12.2, and 3.9 per 10,000 patient-days, respectively. In total, 49 patients were enrolled in the study with average age of 72 years. A complicated course of CDI was found in 14.3% of all patients. Six (12.2%) of 49 patients died, but not attributable to CDI. Of 39 C. difficile isolates, available for ribotyping, 78.9% belonged to ribotype 027; other PCR ribotypes were 001, 015, 002, 005, 010, 014, and 276. Antimicrobial susceptibility testing revealed low levels of MIC50 and MIC90 for metronidazole (0.5μg/ml both) and vancomycin (0.25 and 0.5μg/ml), while 28 strains of ribotype 027 were resistant to moxifloxacin with MIC ≥4μg/ml. National surveillance is important to obtain more insight in the epidemiology of CDI and to compare the results with other European countries. This study by ECDIS-Net gives bases for a national surveillance of CDI in Serbia.

Analysis of effectiveness and drug related problems of pain reliever for knee osteoarthritis: weighing clinical risk and benefit.

Background Osteoarthritis (OA) is a chronic degenerative joint disease, characterized by physiological disorders, such as cartilage degradation, bone remodeling, osteophyte formation, and joint inflammation, which results in pain. Several studies have reported problems with the use of pain medications in OA, such as the use of a combination of many drugs and their long-term use. Therefore, this study was designed to evaluate the use of pain medications in OA patients. The study focused on the analysis of effectiveness and drug related problems (DRPs) with the category of drug interactions and adverse drug events (ADEs) in knee OA patients in Orthopedic and Traumatology Clinic, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia. Methods The study used a retrospective approach through tracking and recording of the medical data from the period of 1st January to 30th June, 2018. The potential of drug interactions was determined by analyzing data based on literature. The actual side effects of the drug were identified based on the patient's medical record through clinical data, laboratory data, and therapeutic data received by the patient. The study involved 143 subjects who met the inclusion criteria of 871 visits to the hospital. Results The results showed that women as much as 80.42% with an age distribution of at most 46-65 years are the most affected by OA cases. The predominant history of illness and comorbidities in OA patients was hypertension in 58.74% of patients. The use of analgesic meloxicam had a percentage of 26.06%, sodium diclofenac 20.21%, mefenamic acid 4.36% and paracetamol 4.25%. The effectiveness of the use of pain reliever was characterized by a decrease in VAS in each patient at the beginning and at the end of the study, where a decrease in pain intensity occurred in 79.72% of patients who received pain medications. Based on drug interactions, we were able to identify pharmacodynamic interactions of 43 events (4.94%) and onine events of pharmacokinetic interactions (1.03%), with a minor severity of 7 events (0.80%),44 moderate events (5.05%), and one major event (0.11%). Mostly identified side effects of the drugs were those due to the use of non-steroid anti inflammatory drugs, which occurred in 42 events (4.82%). Conclusions It can be concluded that OA therapy with a number of pain relievers shows an adequate therapeutic response with some side effects and interactions both pharmacokinetically and pharmacodynamically.

Place of orthopedic surgery in gout.

To evaluate the indications, surgical results, and complications related to tophaceous gout surgery in the orthopedics and traumatology clinic of our hospital. A retrospective analysis of all patients who underwent surgery for topical gout in our orthopedics and traumatology clinic between January 2008 and December 2017 was carried out. Their history, physical examination, and radiological and laboratory tests were examined. Surgical indications, surgical results, and complications were analyzed. Total 18 lesions in 15 patients with gout tophi were operated (60% males). The most common lesion was in the elbow (6; 33%). All patients underwent total excision, and the mean mass size was 4.0 cm. Only one patient had a delayed wound healing. All other patients had no complications. The results of surgical procedures which were performed to confirm the diagnosis, to reduce mechanical problems due to tophaceous and to alleviate pain were excellent, and complication risk was acceptable. Comorbidities and sepsis were the predictors of surgical complications.

The marks of gunshot wounds to the face

IntroductionThis article deals with the occurrence of health problems due to gunshot wounds to the face among military police officers, in the metropolitan region of Rio de Janeiro, who were submitted to surgery at the Oral and Maxillofacial Surgery and Traumatology Clinic of Hospital Central da Polícia Militar. ObjectiveTo identify the profile of patients submitted to surgery as a result of gunshot wounds, the anatomical distribution of maxillofacial fractures, the identified sequelae and complications, the health specialties involved in the rehabilitation of these patients, and to discuss the social, emotional and work performance-related effects of work among these subjects. MethodsA retrospective epidemiological study was carried out based on secondary data from military police officers who were submitted to surgery at Hospital Central da Polícia Militar due to gunshot wounds from June 2003 to December 2017. ResultsDuring the study period, 778 surgeries were performed in the operating room by the Oral and Maxillofacial Surgery and Traumatology service at Hospital Central da Polícia Militar, 186 of which were due to gunshot wounds (23.9%). All patients were males and the mean age 34.7 years. Bone segment loss was the most common sequela. Facial esthetic impairment and reports of insomnia were the most often identified late consequences of impact on health and social life. Regarding the occupational impacts of the sustained injury, the mean time away from work due to medical leave for the treatment of maxillofacial injuries was 11.7 months. ConclusionThe treatment of gunshot wounds patients with facial injuries requires multiple surgical interventions and their rehabilitation requires the involvement of different health specialties. Further studies are needed to qualitatively analyze the impact of this type of facial trauma on the patients' lives and their social consequences.

Clinical and Radiological Evaluation of Patients Undergoing Distal Radio Osteosynthesis with Locking Plate-Retrospective Study.

Objective The objective of the present work was to perform a retrospective study based on the medical files and radiographs of the patients, as well as on the socioeconomic data of the patients submitted to distal radio osteosynthesis with locking plates, evaluating them clinically and radiographically. Methods The postoperative period was evaluated clinically and radiologically in the orthopedics and traumatology clinic service of our hospital between 2016 and 2017. Results In the radiographic evaluation, we found 22 (75.86%) excellent results, 6 (20.69%) good results, and 1 (3.45%) regular result. In the clinical evaluation, the ulnar deviation obtained a mean of 28.40, a standard deviation (SD) of 3.0 and a coefficient of variation of 10.56%. The radial deviations averaged 22.93, with a SD of 2.2 and a coefficient of variation of 9.59%. The range of motion in flexion obtained a mean of 59.43, a SD of 9.86 and a coefficient of variation of 16.59%. The extension obtained a mean of 53.83, a SD of 5.09 and a coefficient of variation of 9.46%. Conclusion We have concluded that there is statistical correlation between clinical and radiographic data, and that the locking plate is a treatment method with a high success rate in the surgical procedure of distal radius fractures.

Distribution and evaluation of bone and soft tissue tumors operated in a tertiary care center

ObjectiveThe aim of this study was to retrospectively evaluate the patients who were operated in our orthopedics and traumatology clinic with the suspection of bone and soft tissue tumors. MethodsA total of 3133 patients (1146 (46.5%) female and 1318 (53.5%) male) who presented to our tertiary clinic from different regions of Turkey between January 2002 and July 2013 with the presumed diagnosis of bone and soft tissue tumors were analyzed according to age, gender, bone/soft tissue localization, tumoral localization, histopathological diagnosis, tumor size and incidence. ResultsOf all operated patients, 2464 (78%) were diagnosed with tumor, while non-tumoral causes were found in 669 (22%) patients. Of the cases diagnosed with tumor, 1139 were bone localized, 1004 soft tissue localized, and 321 metastasis. The most common benign bone tumors were osteochondroma (130, 20%), enchondroma (96, 15%), and simple bone cysts (90, 14%), while the most common malignant bone tumors were osteosarcoma (241, 44%), ewing's sarcoma (89, 16%), and chondrosarcoma (77, 14%); respectively. The most common benign soft tissue tumors were lipoma (141, 22%), giant cell tumors (108, 16%) and ganglion (107, 16%), while the most common malignant soft tissue tumors were liposarcoma (55, 16%), synovial sarcoma (53, 16%) and malignant mesenchymal tumors (45, 13%); respectively. ConclusionMusculoskeletal tumors are rare, but descriptive data in any region are important in order to reduce mortality and improve treatment. No significant difference was found between the data of our hospital regarding epidemiology of the musculoskeletal system tumors and those from the other regions around the world. Level of evidenceLevel IV, Therapeutic study.

Investigation of the functional status of patients with unicondylar knee prosthesis

Purpose: Knee osteoarthritis (OA) is common and problems from OA increase with age. Knee and foot / ankle pathology is probably present in patients undergoing knee replacement surgery. However, the condition of the foot / ankle against the valgus or varus deformity is not clearly understood. Unicompartmental knee arthroplasty (UKA) is an effective treatment option for rapid functional recovery. Is UKA an effective method in the treatment of unicompartmental knee osteoarthritis, especially in the development of functional status and performance, and does foot/ankle affect the outcome of the surgery and the performance of the patients? The aim of this study was to invastigate the functional status of patients with uicondylar knee prosthesis. Methods: Patients who underwent unicondylar knee arthroplasty between 2012-2018 in the orthopedics and traumatology clinic were evaluated. Descriptive data of the patients and the presence of problems related to the foot / ankle were recorded with a prepared form. The pain level of the patients at rest, sleep, and walking before and after surgery was evaluated by using visual analog scale. The range of motion and Q angles of the affected knees of the patients were evaluated using universal goniometry; quadriceps and hamstring muscle strength were evaluated using the handheld dynamotre. Stance test was performed on one foot with eyes closed for balance assessment. Functional status of patients was determined by The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), short physical performance battery (SPPB) and disease-related quality of life. Results: Twenty-five women and 5 men with a mean age of 58.08 ± 8.66 years were included in the study. Thirteen patients (52%) were affected by dominant side and 12 (48%) patients had nondominant affected sides. The majority of the patients were housewives (68%). There were 7 (28%) patients with foot / ankle problems. There was a statistically significant decrease (p = 0.000) when the pain level of the patients were compared before and after surgery. Affected and unaffected sides were compared with NEHA, Q angle, quadriceps and hamstring muscle strength and eyes closed balance durations on one leg. There was a statistically significant difference (p = 0.005) in knee flexion ROM in favor of the unaffected side whereas there was no significant difference in all other parameters (p> 0.05). Patients' complaints of pain and stiffness were low and their physical functions (31.19 ± 22.37) and physical performances (X = 8.37 ± 2.48) were good, and health-related quality of life (physical status X = 38.89 ± 12.40, mental status X = 52.48 ± 17.51) was moderate level. When the patients with and without foot / ankle problems were compared, it was found that there was no difference in pain, ROM, muscle strength, physical function and performance status (p> 0.05) Conclusions: There was a significant decrease in activity and perceived pain level at rest after surgery. Affected side extension AEHA, Q angle, quadriceps and hamstring muscle strength, balance status did not differ with the unaffected side. Physical function and performance were found to be good and quality of life was moderate level. The functional status of patients with foot / ankle problems such as pain, swelling and stiffness is not affected. Since our study was a preliminary study, the patients' foot / ankle status and problems, physical functions and performances were not evaluated before the surgery. Comprehensive evaluations before surgery, foot / ankle status and problems are evaluated and studies with more participants are needed.

Effects of Vapocoolant Spray Prior to SC LMWH Injection: An Experimental Study.

The aim of this study was to evaluate the effects of vapocoolant spray administration prior to subcutaneous (SC) low molecular weight heparin injection on local ecchymosis, hematoma, and pain. This randomized controlled study was carried out on 64 patients (n = 128 injections) in an orthopedics and traumatology clinic. After randomization, vapocoolant spray and then heparin injection was applied on one arm. The second necessary dose of heparin was applied to his or her other arm as a placebo by a water spray. Then, the pain of the patients was assessed. After 2 days, ecchymosis and hematoma were evaluated. Significant lower pain scores were determined in applications in which the vapocoolant spray was used. There was no statically significant difference between the mean diameter values of ecchymosis in both arm groups. There was no hematoma on the injection site after injections. However, this method did not create any significant reductive effect on ecchymosis. Nurses are advised to take advantage of vapocoolant spray effects prior to SC heparin injection.

Frequency of Comorbid Musculoskeletal Problems in Patients with Parkinson’s Disease: What and When?

Background: Musculoskeletal problems, deteriorating posture and pain are common complaints/comorbidities in Parkinson’s disease (PD). The aim of this study was to investigate the frequency of comorbid musculoskeletal problems in PD, and their relationship with disease stage and severity. Methods: The study was approved by the local ethical committee of Duzce University numbered with 2018/52 on date 26.03.2018. Patients with PD (pwPD) underwent a detailed examination to investigate the possible comorbidity of musculoskeletal findings in the orthopedics and traumatology clinic. Socio-demographic features, disease characteristics, motor and non-motor scores were recorded. Results: Thirty-seven pwPD were enrolled in the study. Mean age was 68.75 ± 10.75 years. Comorbid musculoskeletal problems were rotator cuff syndrome (27%), knee osteoarthritis (24.3%), meniscus (13.5%), lumber disc herniation (10.8%), kyphosis (8.1%), myotendinous diseases (16.3%). Rotator-cuff disease and knee osteoarthritis were most common comorbidities, especially in the “mild” and “moderate” stages of pwPD. Conclusion: Since most of the pwPD, especially the ones that have musculoskeletal complaints prior to the diagnosis of PD, present to the orthopedics and traumatology clinics or physiotherapists, it is mandatory to enhance the awareness of the orthopedic surgeons, and physiotherapy specialist in order to keep PD in mind.

Effect of the rehabilitation received under private and state insurance after arthroscopic rotator cuff repair on the results

Aim: This study investigated the effect of the rehabilitation received in individual (private) and state institutions on the results with regard to the patients undergoing arthroscopic repair due to isolated supraspinatus tear.Material and Methods: Fifty-eight patients, who underwent arthroscopic repair in the Orthopaedics and Traumatology clinic of the University betw Selcuk University between 2013 and 2015 were examined retrospectively and the preoperative and postoperative constant scores were calculated. Results: 15 of the 37 patients included in the study were rehabilitated in individual institutions, while 20 patients in state institutions and two patients were monitored by a home exercise program. The mean postoperative constant score was found 73 in the group who received individual rehabilitation, and 65.6 in the patients who were rehabilitated in state institutions (p 0.05); in the former, a significantly higher score was obtained.Conclusion: We consider that receiving individual rehabilitation after arthroscopic repair will be more advantageous in terms of pain and functional recovery.Keywords: Supraspinatus; arthroscopy; rehabilitation.

Operative treatment of pressure ulcers using pedicled flaps

Purpose: To present the results of surgical treatment concerning pressure ulcers. Materials and methods: All patients underwent surgical treatment at the Orthopedics and Traumatology Clinic from 1997 to 2016. One operator performed the procedures. A total of 28 pressure ulcers were operated (25 patients). The clinical material consisted of 15 pressure ulcers located in the lower back area, six pressure ulcers located in the ischial area, three pressure ulcers located in the trochanteric area and four pressure ulcers located in the heel area. Results: One conducted the result evaluation based on the criteria of complications proposed by Seiler. In case of all surgically treated patients, pressure ulcers appeared after 2-5 weeks after the surgery. One patient experienced hematoma below the slide piece. One could observe seroma in case of 5 patients. In this situation, it was required to apply a local postoperative puncture. Four patients experienced marginal skin necrosis (2 of them required resection of dead skin edges in operating block conditions which were later re-stitched using “side to side” technique). During the 3-year follow-up, there was no recurrence of operated pressure ulcers. Conclusions: Deep septic pressure ulcers, according to the division introduced by Seiler, connected with bone infection require the application of muscular-skin pieces. This procedure is aimed at improving local tissue blood supply. Proper preoperative preparation of the patient, careful planning of the surgery and suitable postoperative treatment of the patient are as significant as the surgery itself.

The effects of progressive relaxation method on the patients applied total knee arthroplasty

Objective: The aim of this quasi-experimental study is to depict the effects of progressive relaxation method on the patients who were applied total knee prosthesis. Material and Methods: The findings of the study were obtained from the patients who applied to Adnan Menderes University Research and Practice Hospital, Clinic of Orthopedics and Traumatology with the diagnosis of gonarthros in October 2014–February 2015.Sample of the study was consisted of 80 patients; 40 in experimental group and 40 in control group. The study findings were collected via patient information forms which showed the patients’ introductive information, and via Visual Analogue Scale in which independent variables of stable-ongoing anxiety inventory were investigated. Results: According to the results, experimental group patients’ age mean was analyzed as X=62.27±7.98, and control group patients’ X=62.35±9.80. 70% of the experimental group patients were female, and 75% of the control group patients were female, 50% of the patients in the experimental group were found to have any chronicle ilness; 62.5% of them had operation experience in the past; 60% used adjuvant tools; 62.5% used their own techniques to overcome the pain when emerged; and body-mass index mean was X=27.62±3.75. 67.5% of the patients in the control group were found to have any chronicle illness; 60% of them had operation experience in the past;76.2% used adjuvant tools;72.5% used their own techniques to overcome the pain when emerged; and body-mass index mean was X=29.57±5.10. Conclusion: It is considered that progressive relaxation method which was applied to patients has a positive effect on decreasing the post-operative pain and anxiety.

DEVELOPMENT OF HEALTH TOURISM IN DIYARBAKIR, TURKEY

Health tourism has grown in all over the world but the number of patients coming for health tourism to Turkey is very limited yet. Health tourism is potentially one of the strongest areas of Turkish tourism supply. This study provides a profile of the health tourism sector in Diyarbakır, Turkey. Although tourism officials discuss from different viewpoints that health tourism is one of the strengths of Diyarbakır tourism for future investment, the promotion of city’s qualified health institutions and staff, historical and natural places, and hospitality of citizens is not adequate in creating demand for health tourism. The aim of the study is to investigate the current status of health tourism in Diyarbakır and to make recommendations for future investments and promotional activities in order to increase number of medical tourists. The study is based on data delivered from tourism and health institutions for the years 2015-2018. The current paper reports that in 2016 and 2017 there is a meaningful increase in total tourist and health tourist number visiting Diyarbakır. Most of the patients received health service from private hospitals and came from Iraq. Germany, Syria and Azerbeijan are the countries which other health tourists come from. Foreign patients received healthcare service mostly from cardiology, orthopedics and traumatology clinics. Internal medicine, urology and general surgery are the following most prefferred health services by health tourists.

The predictive value of the clinical sign of excessive hip abduction for developmental dysplasia of the hip (DDH)

Aim To assess the relationship between the clinical sign of excessive hip abduction (abduction of the hip 90 degrees or more) and developmental dysplasia of the hip (DDH). Methods The research was conducted on 450 newborns in the Neonatal Unit at the Clinic of Gynecology and Obstetrics and the Clinic of Orthopedics and Traumatology of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns hip were performed using the Graf method on their first day of life. Results Clinical sign of excessive hip abduction showed significant predictive value for DDH. There were 37 (8.2%) newborns with the clinical sign of excessive hip abduction, of which 13 of them had DDH while 24 of them did not have this clinical sign. There were 89 newborns, in the overall sample, with one of the forms of DDH, 13 (12.7%) of them had this clinical sign, while from 324 newborns witouth DDH, 24 (6.9%) had this clinical sign. Excessive hip abduction had a positive predictive value (PPV) of 35.1% and a negative predictive value (NPV) of 78.5% for DDH. Conclusion Excessive hip abduction is an useful and important clinical sign of DDH. Doctors who perform the first examination of the child after birth, would have to turn their attention to this clinical sign. The newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.