Effects of a novel biodegredable implant system on a rat tibia fracture model

Objective: This study aimed to determine the effects of a novel biodegradable implant releasing platelet-derived growth factor (PDGF) at the fracture site on fracture healing in a rat tibia fracture model. Methods: In this study, 35 male Sprague-Dawley rats weighing between 300 and 350g were used. The rats were divided into four groups: Group A (control group without any treatment, n=10), Group B (spacer without PDGF Group, n=10), Group C (spacer with PDGF group, n=10), and Group D (healthy rat Group, n=5). Standardized fractures were created in the right tibias of rats, and then biodegradable implants made of poly-?-hydroxybutyrate-co-3-hydroxy valerate were implanted at the fracture sites in Groups B and C. In Group C, implants were loaded with 600 ng of PDGF. Animals were sacrificed 30 days after the operation, and fracture healing in each group was assessed radiologically based on the Goldberg score. Furthermore, the anteroposterior (AP) and mediolateral (ML) callus diameters were measured macroscopically, and fracture sites were mechanically tested. Results: In the radiological assessment, Group C showed higher fracture healing rate than Groups A and B (p=0.001), whereas no significant difference was found between group C and Group D (p>0.05). In the macroscopic assessment, while Group C exhibited the thickest AP callus diameter (p=0.02), no significant differences in ML callus diameters existed among the groups (p>0.05). Mechanical testing revealed that Group C had higher torsional strength (p=0.001) and stiffness than Groups A and B (p=0.001) while there was no significant difference between Groups C and D (p>0.05)

Migration of broken K-wires into the achilles tendon from a ostheosynthesed medial malleolar fracture

Yalcinozan, Mehmet/0000-0002-2772-1137WOS: 000286774500011Kirschner (K-) wires are often used for osteosynthesis of many types of fractures. Dislocation and migration through the tissues, especially when used for shoulder girdle fractures, have been reported previously. K-wire migration after surgery of pelvis and knee was reported before. To the authors' knowledge, broken and migrated K-wires after ankle fractures were not reported before. Here, we report a case with broken and migrated K-wires after open reduction and internal fixation of a medial malleolar fracture

Rafting technique without bone grafting in reverse Hill-Sachs lesions

WOS: 000415126000011PubMed: 29125820In this article, we report a case of bilateral posterior shoulder instability, having reverse Hill-Sachs lesions of 25 to 50% of the articular surface on the right side, and of 50% on the left side. The defects were anatomically reconstructed after tuberculum minus osteotomy by elevation of the articular surface and buttressing with raft screws without graft usage. Early rehabilitation with pendulum shoulder exercises was started at third postoperative day. At postoperative sixth week, patient had full range of motion without instability and pain. At postoperative 18th month, the patient had normal physical examination and the constant shoulder score was 86, which was 92.4% of the age-and gender-matched population. Rafting technique without bone grafting may be a treatment alternative with satisfactory clinical results for medium to large sized reverse Hill-Sachs lesions of posterior shoulder instability

Distal medial epicondylectomy. A modification of partial medial epicondylectomy for cubital tunnel syndrome: preliminary results

The medial epicondyle behaves as a fulcrum and a pulley that tethers the ulnar nerve during flexion. Excision of the distal half of the medial epicondyle sets the point of contact of the bone with the nerve proximally and decreases the traction effect of the medial epicondyle on the ulnar nerve. In this study, we aim to investigate the surgical and clinical results of excision of the distal half of the medial epicondyle in cubital tunnel syndrome (CuTS). Cubital tunnel release with excision of the distal half of the medial epicondyle was performed in 19 patients. The patients were evaluated preoperatively and postoperatively with clinical examinations, McGowan and Wilson-Krout scores, Semmes-Weinstein monofilament and two-point discrimination tests, and grip and pinch strength measurements. A one-grade improvement in McGowan classification was observed in 79 % of patients and a two-grade improvement in 21 % of patients at the time of the first postoperative examination. At 24 months after surgery, 18 patients reported the Wilson-Krout scores as excellent (95 %). Statistically significant improvements in sensory and motor strength measurements were achieved at all postoperative examinations. The objective and subjective outcome measures achieved with distal medial epicondylectomy are comparable with other epicondylectomy techniques. The complication rates seem to be lower than those of total or partial medial epicondylectomy. This procedure is an acceptable and safe alternative for the surgical treatment of CuTS

Risk of osteonecrosis of the femoral condyle after arthroscopic chondroplasty using radiofrequency: a prospective clinical series

Cirpar, Meric/0000-0001-9669-6513WOS: 000262438700005PubMed: 18758748Radiofrequency (RF) energy can be used for treatment of intraarticular pathologies in knee joint. RF energy was found to be superior to mechanical techniques in smoothening the articular surface (chondroplasty), shortening the operation time and reducing the blood loss. As RF produces thermal energy it has been reported to be responsible for the postoperative osteonecrosis however, there is no clinical evidence in the literature supporting that RF causes osteonecrosis. The current study searches for an answer whether surgical arthroscopic modalities using RF energy causes osteonecrosis. We hypothesize in the presented study that chondroplasty with RF has no effect on increasing the incidence of osteonecrosis in knee joint. In a prospective clinical trial, arthroscopic chondroplasty was performed in 50 patients with degenerative changes of the articular cartilage, stage II and III according to Outerbridge. To be included in the study, the patients had to meet the following criteria: (1) Preoperative MRI and plain film radiographs showing no evidence of osteonecrosis. (2) Patients had to be symptomatic for at least 6 weeks before the preoperative MRI. (3) Arthroscopically confirmed stage II or III. Preoperative MRI was taken in all patients. For chondral lesions bipolar RF energy system (VAPR-DePuy Mitek, Norwood, USA) was used. The patients were examined at the end of the sixth month and we performed MRI. Fifty patients with an average of age 45.54 (between 18 and 64) (SD, 10.63). During arthroscopy, together with chondropathy 22 patients pure medial meniscus tears, 7 patients medial and lateral meniscus tears, 7 patients pure lateral meniscus tears, 2 patients medial plica, and 3 patients synovial hypertrophy were detected. Among all 50 patients, osteonecrosis were detected at only 2 (4%) in the postoperative period. Until now it was not clear that RF energy causes osteonecrosis; however, according to this study if proper method is used, bipolar RF energy used for arthroscopic chondroplasty does not causes subchondral osteonecrosis

Bilateral traumatic patella fracture: a case report

Yalcinozan, Mehmet/0000-0002-2772-1137WOS: 000293815300011PubMed: 21762068Patellar fractures are uncommon injuries and account for approximately 1% of all fractures. In this article, a 35-year-old male patient who sustained a collision deceleration accident with bilateral comminuted transverse patellar fractures is presented. For this patient, open reduction and internal fixation with tension band technique, using two Kirschner wires and cerclage wire was applied for both fractures. At the first postoperative day, isometric quadriceps and active range of motion exercises were begun and the patient was allowed to walk full weight bearing with two crutches while both extremities were immobilized in a hinged brace allowing maximum 30 degrees of flexion. At postoperative fourth week brace immobilization was terminated. However, the patient was advised to use crutches for two weeks more to prevent any complications that may arise during walking because of the bilaterally of the injury. At six weeks solid union was achieved. During the last visit at postoperative second year, the patient had no complaints and the range of motion was full. In this paper a case of bilateral patella fractures is presented as a consequence of a dashboard injury, and the pathomechanical and therapeutical aspects of such an injury is discussed

Dorsal cutaneous innervation of the hand with respect to anatomical landmarks: is there a safe zone?

Esmer, Ali Firat/0000-0003-2511-9879; Yalcinozan, Mehmet/0000-0002-2772-1137WOS: 000312464900009PubMed: 23145760Objectives: In this study, we aimed to define the borders of the triangular area between the radial and dorsal nerves on the dorsum of the hand and to determine its dimensions using measurements between anatomic landmarks. Materials and methods: We statistically analyzed the relation between the distance from Lister's tubercle to the blending point of the central branches of radial and ulnar nerves and the distance between styloids on 14 hands of seven adult human cadavers (5 males, 2 females). The distances of nerve branches to vertical lines drown distally from both styloid processes were also compared with interstyloid distances to help in presuming the course of these nerves. Results: No statistical constant correlation was determined between the measurements. Neither the height of the triangular area nor the courses of both nerves seemed to be quantitatively related to any measurements between the anatomical landmarks. Conclusion: Variability in these measurements in our study indicates that there is no surgical safe zone on the dorsum of the hand

Prospective evaluation of preoperative and postoperative sleep quality in carpal tunnel release

WOS: 000459286100008PubMed: 30394830Sleep disturbance is a frequent symptom of carpal tunnel syndrome. The aim of this study was to investigate the effect of median nerve decompression on sleep quality of patients with this condition. The study sample consisted of 41 patients with severe carpal tunnel syndrome who were admitted to our clinic and treated with open median nerve decompression. Sensation and functional recovery of the patients were followed using the Boston Function Questionnaire, the Semmes-Weinstein monofilament test and the two-point discrimination test. Symptomatic recovery of the patients was followed by the Boston Symptom Questionnaire. The tests were used before surgery and at three and six months afterwards. Sensory, functional and symptomatic recovery from the third month to the sixth month following surgery also affected sleep parameters and improved the sleep quality of patients with carpal tunnel syndrome

Dorsal cutaneous innervation of the hand with respect to anatomical landmarks: is there a safe zone?

Conclusion: Variability in these measurements in our study indicates that there is no surgical safe zone on the dorsum of the hand

Re: Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach Rresponse

WOS: 000467807900008PubMed: 30844957