Search

PURPOSE: The aim of this study was to assess the clinical and radiological outcomes of patients with recurrent or neglected pes equinovarus (PEV), who underwent talonavicular or calcaneocuboid arthrodesis with a hexapod spider frame. METHODS: The study included 18 patients; a total of 25 feet were treated with dual arthrodesis and a hexapod spider frame. The International Club Foot Study Group (ICFSG) scoring system and visual analog scale (VAS) were used to assess preoperative status and postoperative outcomes. All functional, morphological and radiologic evaluations during the follow-up were done as described by Kling et al. RESULTS: Patients were followed up for an average of 24.1 ± 11.8 months. The mean age of our cohort was 8.84 ± 2.83 years. The mean duration of correction was 3 weeks and the mean duration treatment length was 15.3 ± 1.9 weeks. Postoperative assessment revealed eight excellent, 13 good, and four poor outcomes, according to the ICFSG scoring system. There was a significant difference between preoperative and postoperative ICFSG scores, 12 feet showed an excellent outcome, 12 feet had good outcomes, and one foot was rated as a failure in the final assessment, based on the Kling criteria. There was also a significant difference between preoperative and postoperative VAS scores. CONCLUSION: Dual arthrodesis plus a hexapod spider frame is a valuable option for patients with recurrent or neglected PEV. It can be offered safely to avoid secondary recurrences and potential complications in cases of rigid feet as well as challenging cases that are resistant to soft tissue manipulation.

Objective: To assess the effects of written and visual briefing on parents' state and trait anxiety in newborns with newly diagnosed pes equinovarus (PEV) who were treated using the Ponseti method during the neonatal period. Materials and Methods: Eighty parents (mother and/or father) of neonatal PEV patients who were treated using Ponseti Method between September 2014 and July 2017were included in this study. Participants were assigned into two groups according to the written and visual briefing. Participants in both groups were asked to complete the State-Trait Anxiety Inventory (STAI) before the procedure. Then, written and visual briefing was given to the participants. All participants repeated the inventory after briefing to assess changes in state and trait anxiety. Results: After visual and written briefing, parents' response was evaluated. In both groups, a significant decline was observed in trait and state anxiety after both written and visual briefing (p

This study aimed to examine the correlation between DTI, clinical assessment, and electromyography results in patients who underwent primary median nerve repair.Ten patients who underwent primary repair of the complete median nerve transection were included. Study assessments were performed on both the traumatized and non-traumatized extremities and patients were followed up for a minimum duration of 11 months. Clinical assessments, (Tinnel test, static 2-point discrimination test, motor and quality of life assessments), electromyography and DTI were performed.None of the clinical or electromyographic parameters correlated significantly with any of the diffusion tensor imaging parameters, i.e. fractional anisotropy (FA) or apparent diffusion coefficient (ADC) (p0.05 for all). In addition, The Disabilities of the Arm, Shoulder and Hand (DASH) scores did not correlate with either FA (r=0.55, p=0.098) or ADC (r=0.40, p=0.260) values. However, Tinnel positive cases (n=3) had lower relative FA when compared to Tinnel negative cases (n=7) (-0.11±0.19 vs. 0.05±0.04, p=0.033).Our findings do not support the presence of relations between DTI parameters and electromyographic or most of the clinical parameters. Further MRI studies with larger numbers of patients with complete transection of the median nerve using the novel imaging parameters are warranted.Diffusion Tensor Imaging (DTI), Electromyography (EMG), Median nerve, Nerve injury, Nerve repair.L’esame clinico e gli studi di conduzione nervosa con EMG sono spesso utilizzati per monitorare la velocità di recupero dopo la riparazione chirurgica di lesione neurale. Le caratteristiche di diffusione differenziale di tessuti nervosi intatti, in guarigione o danneggiati hanno suggerito che la guarigione dei tessuti nervosi può essere monitorata usando anche il DTI (imaging con tensore di diffusione).Lo scopo di questo studio è esaminare la correlazione tra DTI, valutazione clinica e i risultati dell’elettromiografia in pazienti che hanno subito la riparazione primaria del nervo mediano.Studio di accuratezza diagnostica METODI: Sono stati inclusi 10 pazienti sottoposti a riparazione primaria di completa sezione del nervo mediano. Le valutazioni dello studio sono state eseguite sia sulle estremità traumatizzate che sulle non traumatizzate e i pazienti sono stati seguiti con un follow up di almeno 11 mesi. Sono state effettuate valutazioni cliniche (Tinnel test, test di discriminazione di 2 punti statici, valutazione motoria e della qualità di vita), elettromiografia e DTI.Nessuno dei parametri clinici o elettromiografici ha dimostrato una correlazione statisticamente significativa con alcuno dei parametri dell’imaging con tensore di diffusione, i.e. anisotropia frazionale (FA) o coefficiente di diffusione apparente (ADC) (p0.05 per tutti). In aggiunta, lo score DASH (Disabilities of the Arm, Shoulder and Hand) non ha dimostrato correlazioni con i valori di FA (r=0.55, p=0.098) o ADC (r=0.40, p=0.260). Tuttavia, i casi positivi al Tinnel test (n=3) hanno avuto una minor relativa FA rispetto ai casi negativi al Tinnel test (n=7) (-0.11±0.19 vs. 0.05±0.04, p=0.033).I nostri risultati non supportano la presenza di correlazioni tra i parametri di DTI e parametri elettromiografici o la maggior parte dei parametri clinici. Sono necessari ulteriori studi di RMN con un maggior numero di pazienti con completa sezione del nervo mediano utilizzando i nuovi parametri di imaging.

This study aimed to compare medium-term functional effects of three different treatment modalities in patients with osteochondral lesions of the talus (OLT). Fifty-four patients undergoing arthroscopic surgery for osteochondral lesion of the talus were included in this study. Patients were assigned to one of the three treatment groups: microfracture surgery (n = 19), microfracture surgery plus platelet-rich plasma (PRP) (n = 22), and mosaicplasty (n = 13). Function was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scoring system and VAS scores for pain, before and after surgery. In addition, the Foot and Ankle Ability Measure (FAAM) tests for pain and 15-min walking were done at follow-up visits. The median duration of follow-up was 42 months (range 12–84 months). All groups showed significant improvements in AOFAS and VAS pain scores at the last follow-up visit, when compared to baseline. The groups did not differ with regard to change in baseline AOFAS score; however, improvement in VAS pain scores was significantly better in the mosaicplasty group when compared to the microfracture group (change from baseline, −5.8 ± 1.0 vs. −3.2 ± 2.9, p = 0.018). All the three treatment modalities resulted in good medium-term functional results. However, mosaicplasty procedure seems to be a promising option and it might be preferred particularly in patients where pain control is important. II.

Background: Exact role of the inflammation in osteoarthritis is still unclear, but it is thought to originate from synovitis due to micro-crystals or breakdown products of the cartilage. Objective: To determine the effect of CD30þ T lymphocytes on the development of osteoarthritis by comparing the lesion depth and synovial CD30þ count in patients with chondral lesions undergoing knee joint arthroscopy. Design: A total of 79 patients with chondral lesions detected during arthroscopy were categorized in 4 different groups based on chondral lesion classification. CD30þ lymphocyte counts were calculated using flow cytometry on synovial fluid samples obtained at the time of initial entrance into the joint and compared between the groups. In addition, biopsy samples obtained from the suprapatellar bursa were stained for histologic examination to identify existence of CD30þ lymphocytes in the synovium. Results: Although there were no significant differences between the first 3 groups in terms of synovial fluid CD30þ lymphocyte counts, patients in Group IV had significantly higher counts (6.2 8 [2.48] vs 2.51 [1.84], 2.97 [2.40], and 3.80 [2.07], respectively; P o 0.05). Except for a single patient with a Grade III chondral lesion, there were no cases of CD30 positivity in synovial tissue. Also there was a correlation between CD30 levels and chondral lesion depth when controlled for age. Conclusions: Our results indicate higher CD30þ lymphocyte counts in patients with modified Outerbridge Grade IV chondral lesions than in other groups. The origin of the CD30þ lymphocytes may not be the synovial tissue per se. Thus, it was hypothesized that the injured chondral tissues and the associated subchondral structures might have been the source of CD30þ lymphocytes with a possible influence on the development of osteoarthritis.

To compare the effect of arthroscopic microfracture surgery alone or in combination with platelet rich plasma (PRP) on functional outcomes in osteochondral lesions of the talus. A total of 35 patients were included in the study. Control subjects (n = 16) received treatment with microfracture surgery alone, while the remaining patients (PRP group, n = 19) were also given PRP. After an average follow-up of 16.2 months (range 12–24 months), patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, Foot and Ankle Ability Measure (FAAM), and the visual analogue scale (VAS) for pain. At baseline, AOFAS and FAAM scores were similar in the two groups, whereas pain scores (VAS) were higher in those who were assigned to combined treatment. Despite the latter finding, the combined treatment with PRP resulted in better outcomes in terms of functional scores [AOFAS, 89.2 ± 3.9 vs. 71.0 ± 10.2, (p = 0.001); FAAM overall pain domain, 1.0 (1.0–2.0) vs. 2.5 (1.0–4.0), (p = 0.04); FAAM 15-min walking domain, 1.0 (1.0–2.0) vs. 2.0 (1.0–4.0) (p = 0.001)]; and pain-related scores [VAS, 2.2 ± 0.8 vs. 3.8 ± 1.2, (p = 0.001)] as compared to arthroscopic microfracture surgery alone. PRP as an adjunct to arthroscopic microfracture surgery for the treatment of osteochondral lesions of the talus resulted in improved functional score status in the medium-term. Further studies to determine the long-term efficacy of this approach were warranted. II.

In order to test the role of platelet activation in the talar osteochondral disease, the mean platelet volume (MPV) in patients undergoing treatment of talar osteochondral disease was evaluated. White blood cell count and highly sensitive C-reactive protein were evaluated in 50 patients with osteochondral defect of talus. Disease activity was assessed according to American Orthopedic Foot and Ankle Society scoring. Additionally, visual analog scale for the pain assessment was used for the study. Biochemical parameters, rehabilitation parameters, and MPV levels were compared with each other at the admission and 3 weeks after surgery. MPV was significantly lower in patients with osteochondral lesions of talus after treatment as compared to admission levels. MPV and C-reactive protein levels decreased together. American orthopedic foot ankle score of the patients were increased after surgery. Visual analog scale decreased suggestive levels. It was proposed that MPV provides a useful marker in activity of inflammatory osteochondral disease. The aim of this study is to define the effect of platelet activation in talar osteochondral disease. Key words: Talus, osteochondral lesion, platelet volume (MPV), biomarker.

Propolis is a substance of honeybee origin with known antioxidant effects. The purpose of this study was to examine the effects of propolis on fracture healing and the antioxidant system in an experimental setting. Thirty-two rats that underwent experimental femur fracture and then fixation were randomly allocated in one of four groups: two control groups (Control-3w and Control-6w) and two treatment groups (Propolis-3w and Propolis-6w). Treatment groups received propolis until killing (at 3 or 6 weeks). X-ray, histological, bone mineral density measurement findings and endogenous antioxidant levels were examined. The bone mineral density was higher, radiological and histological evaluation scores were better, and superoxide dismutase, total glutathione and myeloperoxidase levels were lower among the rats that received oral propolis treatment compared with the controls. In addition, bone mineral density and histological assessment scores showed time-dependent improvement in the treatment group. In conclusion, the findings of this study suggest that propolis has some time-dependent beneficial effects on fracture healing. Copyright © 2011 John Wiley & Sons, Ltd.

This study aimed to evaluate the short- and mid-term results of plica excision in patients with mediopatellar plica and associated cartilage degeneration. Seventy-six surgically treated patients with mediopatellar plica and associated cartilage degeneration at medial femoral condyle (MFC) and/or medial pole of patella were included. Patients were evaluated at baseline, at 6 weeks and 6 months after the operation for their clinical outcomes and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. The frequency of all signs and symptoms, including all pain parameters, and WOMAC scores were significantly improved compared to baseline, at 6 weeks and 6 months after the operation (P < 0.017). Based on mean WOMAC scores, results of most patients were rated as excellent both at 6 weeks (88%) and at 6 months (94%). Surgical excision of mediopatellar plica associated with cartilage degeneration appears to result in substantial clinical improvement, thus it represents an effective treatment modality.

Objective: Benign schwannomas are the most common tumour of the peripheral nerves. Symptomatic schwannomas are treated by surgical excision, but new neurological deficits may develop. We performeda retrospective review of cases of schwannomas in the extremities and reviewed the relevant literature.Methods: We retrospectively reviewed the demographic characteristics of 11 patients with schwannomas treated at our institution. We also reviewed the clinical characteristics and postoperative results of these cases, determined the possible risk factors influencing the development of complications and compared the risk factors with those reported in the literature.Results: There were five males and six females with a mean age of 37.6 (range: 17–62) years. The mean postoperative follow-up was 54.6 (range: 26–88) months. Three tumours were located in the forearm and the rest were localized in the lower extremity. No recurrences were observed during the follow-up period. New motor and sensory deficits were observed in only one patient.Conclusion: Schwannomas in the extremities can be excised with acceptable risk of neurological deficits. Meticulous dissection is required during surgery., Amaç: Benign shcwannom periferik sinirlerin en yaygın tümörüdür. Semptomatik schwannomun tedavisi cerrahi eksizyondur. Cerrahlar yeni nörolojik defisitlerin gelişme olasılığına hazırlıklı olmalıdır. Biz literatürle birlikte ekstremite schwannomlarını içeren olguların geriye dönük bir analizi yaptık. Çalışma planı: Hastanemizde tedavi edilen 11 schawannomlu hastanın verilerini geriye dönük olarak inceledik. Klinik özellikleri ve ameliyat sonrası sonuçları gözden geçirdik ve komplikasyonların gelişimini etkileyen olası risk faktörlerini belirledik ve bunları literatürle karşılaştırdık. Bulgular: Ortalama yaşın 37.6 (17–62) olduğu beş erkek ve altı kadın vardı. Ameliyat sonrası ortalama takip süresi 54.6 (26–88) aydı. Önkolda üç tümör tespit edildi ve diğer tümörler bacak alt kısmındaydı. Takip periyodunda nüks gözlenmedi. Bir hastada yeni motor ve duysal defisit gözlendi. Çıkarımlar: Ekstremite schwannomaları kabul edilebilir nörolojik defisit riski ile eksize edilebilir. Cerrahi sırasında titiz bir disseksiyon gereklidir.

Structural and functional impairments of the Achilles tendon in diabetic patients has the potential to contribute to ulcer formation through altered foot mechanics. This study aimed to examine the biomechanical and histopathological alterations in Achilles tendon specimens from diabetic vs. non-diabetic individuals.42 Achilles tendon samples obtained from patients treated with below-knee or above-knee amputation for chronic diabetic foot ulcers (n=21) or for non-diabetic conditions (n=21) were included. A tensile test was performed for each tendon and a stress vs. strain graft was obtained to calculate following biomechanical parameters: elasticity (Young modulus), load, stiffness, toughness, energy, strain, elongation and tenacity. Groups were also compared with regard to histopathological findings (inflammatory cell infiltration, collagen organization, and degeneration).Non-diabetic tendons exhibited a superior biomechanical profile over diabetic tendons with regard to the following biochemical parameters: elasticity, maximum load, stiffness, toughness, load, energy, strain and elongation at break point, tenacity, and strain at automatic load drop (p0.05 for all comparisons). Diabetic tendons had mild impairment of collagen organization and focal collagen degeneration, whereas neither diabetic nor non-diabetic tendons had inflammatory cell infiltration.The structural and functional alterations associated with diabetes adversely affect the biomechanical properties of the Achilles tendon, potentially acting together with neuropathy and ischemia in the development of diabetic foot ulcers.

To investigate blood flow velocity changes and resistivity index values of orbital vessels in Behçet disease with or without ocular involvement, in uveitis patients with different etiologies, and in healthy volunteers.Subjects were divided into four groups: those with ocular involvement in Behçet disease (group I), those without ocular involvement in Behçet disease (group II), uveitis patients with different etiologies (group III), and a control group (group IV). Twenty-seven eyes in group I, 14 eyes in group II, 25 eyes in group III, and 27 eyes in group IV were investigated. The blood flow in the central retinal artery (CRA), ophthalmic artery (OA), nasal posterior ciliary artery (NPCA), and the temporal posterior ciliary artery (TPCA) was measured using color Doppler ultrasonography (CDU) to determine the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI).The PSV and EDV value of CRA in groups I, II, and III were found to be significantly lower than those in the control group (p0.05 for each). The PSV and EDV values of TPCA and NPCA in groups I, II, and III were significantly lower than those in the control group (p0.05 for each). Resistivity indexes of all arteries were higher in groups I, II, and III than the control group. The PSV and EDV in CRA, TPCA, and NPCA in Behçet disease patients with ocular involvement were significantly lower than all other groups (p0.05).There are significant reductions in the blood flow values of the orbital arteries in patients with Behçet disease and uveitis patients with different etiologies when compared with healthy volunteers. The decrease in blood flow values in Behçet disease is more evident in patients with ocular involvement than the patients without ocular involvement. This might be the result of occlusive vasculitis, which is frequently seen in the retinal vessels of patients with Behçet disease.

The purpose of this study was to investigate the effects of exogenous local Insulin like growth factor-I (IGF-I) on the repair of full-thickness articular cartilage defects in immature rabbits.Thirty-six skeletally immature New Zealand rabbits between 6 and 8 weeks old were used. A single defect, 3.5-mm-wide by 4-mm-deep full-thickness articular cartilage defect in the medial femoral condyle, was created. The defect was either filled with a collagen sponge or with a collagen sponge impregnated with 5 mug of recombinant IGF-I. The animals were sacrificed at 4, 8 or 12 weeks, and the repair tissue was examined macroscopically and histologically. Repair tissue was also examined immunohistochemically for the presence of type-I collagen, type-II collagen and PCNA at all weeks.Newly formed tissue in all of the defects in the IGF-I group had the gross, histological and histochemical appearance of a smooth, intact hyaline articular cartilage. The average total scores on the histological grading scale were significantly better (p0.05) for the defects treated with recombinant IGF-I at all time points. Immunostaining with an antibody against type-II collagen showed the diffuse presence of the repair cartilage in the IGF-I treated defects. The control groups demonstrated minimum staining with type-II collagen antibody.These findings suggest that repair of full-thickness immature cartilage defects can be enhanced by recombinant IGF-I.

OZET Infection after total knee replacement is a serious complication associated with a high incidence of morbidity. A prosthetic infection due to Brucella melitensis is a very rare condition. In this study, we describe a case of brucellosis infection with septic loosening of both knee joints after bilaterally cemented total knee prosthesis application; this is rarely encountered in the literature. The patient diagnosis was established by clinical findings (fever, joint swelling, etc.) and supported by laboratory findings and analysis of joint fluid obtained from joint aspiration. Plain radiography and bone scintigraphy confirmed septic loosening. In this case, we performed total knee prosthesis revision bilaterally after antibiotic treatment. We preferred two-stage surgery for the revision. In the first stage, the infected prosthesis was removed and a Teicoplanin-loaded bone cement spacer was inserted in both knees. Twenty weeks later, the second stage was performed. During the 24-month follow-up period, no complications were seen.

Anevrizmal kemik kisti, iyi huylu, genisleme ozelligi olan, daha cok cocukluk ve adolesan caglarda gorulen kemik lezyonlaridir. Ozellikle femur, tibia, humerus gibi uzun kemikler ve vertebra posterior elemanlarina yerlesir.Yaklasik yilda 1.5 milyon insan bu hastaliga maruz kalmaktadir. Herhangi bir kemik segmentini tutabilmekle birlikte en sik tutulum alanlari uzun kemikler ve vertebralarin metadiyafizleridir. Etyolojide hala fikir birligi saglanamamistir. En guclu kabul edilen gorus kemige gelen mikrotravmalarin kemigin dolasimini bozdugu kabul edilmektedir. Tedavi secenegine hastanin sikayeti, lezyonun lokalizasyonu ve buyume hizina gore karar verilir. Klinigimizde teshis ve tedavisini yaptigimiz bu vakayi hastaligin sinsi ve yikici etkilere yol acabilecegini vurgulamak amaci ile meslektaslarimizla paylasmayi amacladik

Objectives: In the treatment of traumatic anterior shoulder instability there is still not formed a ideal consensus. Although the results of the open technique for repairing Bankart lesions detected in these patients, in recent years with the development of arthroscopic methods, arthroscopic Bankart repair with the successful results are obtained. We aimed to present our results of Bankart repair with the arthroscopic method. Methods: The study included 42 patients who underwent arthroscopic Bankart repair in our clinic between the years 2011-2014. Mean age was 26.3 (18-37). Preoperative and postoperative pain and functions of the patients were assessed using the Constant and Rowe scores. The mean follow-up period was 19 months (range 6 to 30 months). Patients with at least two dislocations were included in the study. The mean number of dislocations was 4.8 (2-10). The mean time from the first trauma to surgical intervention was 2.5 years (range 0.5 to 10 years). Patients with multidirectional instability were excluded. Repair was performed using double-stranded double with the standard anterior portal. Decision for surgical treatment was made based on limitation of activities because of fear of having a dislocation and on positive results of instability tests. Before surgery for all patients, a detailed clinical examination, conventional radiography and conventional MRI were evaluated. All the patients had labral tears on preoperative magnetic resonance scans and had complaints of instability even during daily activities. Results: The mean passive shoulder abduction was 155 (145-170) degrees and mean external rotation was measured 80 (60-90) degrees. The mean preoperative Rowe score was 42 points, while the postoperative score was 89.1 points at the last time follow up. The difference was statistically significant (p Conclusion: Although, in the past, the results of arthroscopic repair were less satisfactory compared to open and mini open surgery. This condition has changed remarkably. The results of arthroscopic repair in our study were good enough compared to open surgeries. Also in patients who underwent arthroscopic repair, length of hospital stay is shorter, less pain and less scar tissue occurs after the surgery. We believe that, with enhanced experience and advances in arthroscopic repair techniques, arthroscopic treatment may outweigh open surgery.

Objective: The aim of this study was to assess the effects of locally applied simvastatin on femur nonunions in a mouse model.Methods: The study included 32 male Wistar albino mice randomly allocated to one of four groups: two control groups (control-4 week [C4w] and control-8 week (C8w)] and two treatment groups (simvastatin-4 week [S4w] and simvastatin-8 week [S8w]). The control groups received dimethylsulfoxide locally injected at a dose of 10 mg/kg/day after surgical intervention for 1 week. Treatment groups received a liquefied form of simvastatin locally to the osteotomy field by injection at a dose of 10 mg/kg/day, starting from the first postoperative day for 1 week. The C4w and S4w groups were sacrificed 4 weeks and the C8w and S8w groups 8 weeks after the end of local treatment. Before sacrifice, intracardiac blood samples were retrieved for biochemical analysis and radiographies were taken. The right femurs of mice were then removed for histopathological evaluation.Results: There were significant differences between the control and treatment groups when evaluated radiologically. Significantly higher levels of bone-specific alkaline phosphatase and osteocalcin values were found in the treatment groups than in the controls (p, Amaç: Bu çalışmanın amacı deneysel fare femur kaynamama modelinde lokal uygulanan simvastatinin etkilerini değerlendirmekti.Çalışma planı: Bu çalışmada 32 Wistar albino fare kullanıldı. Fareler rastgele biçimde aşağıdaki 4 gruptan birine ayrıldı: iki kontrol grubu (kontrol-4 hafta [K4h] ve kontrol-8 hafta [K8h]) ve iki tedavi grubu (simvastatin-4 hafta [S4h] ve simvastatin-8 hafta [S8h]). Kontrol gruplarında cerrahi girişimden sonra 1 hafta süreyle dimetilsülfoksit (10 mg/kg/gün) lokal olarak enjekte edildi. Tedavi gruplarında ameliyat sonrası birinci günden itibaren 1 hafta boyunca simvastatinin sıvılaştırılmış formu (10 mg/kg/gün) lokal olarak osteotomi alanına enjekte edildi. K4h ve S4h gruplarındaki hayvanlar lokal tedavinin sonlanmasından 4 hafta, K8h ve S8h gruplarındaki hayvanlar ise 8 hafta sonra öldürüldü. Öldürülmeden önce biyokimyasal analiz için intrakardiyak kan örnekleri alındı ve radyografiler çekildi. Histopatolojik inceleme için farelerin sağ femurları çıkarıldı.Bulgular: Radyolojik olarak incelendiğinde kontrol ve tedavi grupları arasında anlamlı farklılıklar mevcuttu. Tedavi gruplarında kontrol gruplarına kıyasla anlamlı şekilde daha yüksek kemiğe spesifik alkalin fosfataz ve osteokalsin değerleri saptandı.Çıkarımlar: Biyokimyasal, radyolojik ve histopatolojik sonuçlara göre, fare femur kaynamama modelinde simvastatinin lokal uygulanması yararlı etkiler oluşturmaktadır.

Objective: The aim of this study was to compare simultaneous bilateral total knee arthroplasty (BTKA) and unilateral total knee arthroplasty (UTKA) in terms of morbidity, clinical and radiological findings and quality of life.Methods: The study included 48 simultaneous BTKAs (46 females, 2 males; mean age: 64.00±8.31 years) and 53 UTKAs (46 females, 7 males; mean age: 64.40±7.45 years) performed between November 2007 and June 2012. Groups were compared with respect to comorbidity, complications, blood transfusion, hospital stay, clinical and radiological (American Knee Society Score) findings and quality of life (SF-36).Results: Three patients in the BTKA group and 1 in the UTKA group required intensive care admission due to pulmonary embolism; 2 cases occurred within the first postoperative 30 days. One BTKA patient died in the early postoperative period and 1 patient from the BTKA and 1 from the UTKA group died within 1 year. Hospital stay, perioperative blood transfusion parameters and mortality rates were significantly different in favor of UTKA and revision operation rates in favor of BTKA (p0.05).Conclusion: Simultaneous BTKA should be considered in selected patients under 70 years of age with good compliance and no comorbid disease., Amaç: Bu çalışmada tek seansta iki taraflı total diz artroplastisi (İTDA) ve tek taraflı total diz artroplastisinin (TTDA) morbidite, klinik ve radyolojik bulgular ile hayat kalitesi yönünden karşılaştırılması amaçlandı.Çalışma planı: Kasım 2007 - Haziran 2012 tarihleri arasında tek seansta gerçekleştirilen 48 İTDA (46 kadın, 2 erkek; ortalama yaş: 64.00±8.31) ile 53 TTDA (45 kadın, 8 erkek; ortalama yaş: 64.40±7.45) hastası çalışmaya dahil edildi. Gruplar, komorbidite, komplikasyon, kan transfüzyonu, hastanede kalış süreleri, klinik ve radyolojik (AKSS) bulgular ve hayat kalitesi (SF-36) yönünden değerlendirildi.Bulgular: İkisi cerrahi sonrası ilk 30 gün içinde olmak üzere, İTDA grubundan 3 hastada, TTDA grubundan 1 hastada pulmoner emboli gelişmesi nedeniyle hastaların yoğun bakım servisinde takibi yapıldı. İTDA grubundan 1 hasta erken dönemde; yine İTDA grubundan 1 hasta ile TTDA grubundan 1 hasta da bir yıl içinde yaşamlarını yitirdi. Hastaların hastanede kaldığı süreler, cerrahi sırasındaki kan transfüzyon miktarları ve mortalite bulguları TTDA lehine, revizyon bulguları İTDA lehine istatistiksel olarak anlamlı bulundu (p0.05). Çıkarımlar: Yetmiş yaş altında, ek hastalığı olmayan, uyumlu hasta seçimi ile tek seansta İTDA’nın uygulanması bir seçenek olarak düşünülebilir.

Objective: To compare the outcomes of arthroscopic, radioactive and combined synovectomies in patients with chronic non-specific recurrent synovitis who did not respond to conservative therapy. Subjects and Methods: Twenty-nine patients enrolled between 2007 and 2011 were divided into 3 groups: group 1 was treated with arthroscopy, group 2 received a radioactive drug and group 3 received a combined (radioactive and arthroscopic) synovectomy. Treatment efficacy was evaluated by comparing pre- and post-operative Lysholm knee scores (LKS), night pain, resting pain, activity pain and effusions using visual analogue scales (VAS). Patient satisfaction was assessed using the visual analogue patient satisfaction scale (VAPSS). Results: The mean age of the study participants was 41.5 ± 5.2 years (range 14-76), and the mean follow-up period was 33.6 ± 3.2 months (range 17-78). Before treatment, the mean LKS was 41.4 ± 3.4 in group 1, 39.6 ± 3.3 in group 2 and 37.1 ± 4.6 in group 3. After treatment, the corresponding mean LKS were 77.7 ± 2.1, 81.6 ± 2.8 and 91.3 ± 2.7 in groups 1, 2 and 3, respectively; the increase was statistically significant (p < 0.05). The VAS scores before and after treatment decreased significantly (p < 0.05). The mean VAPSS score, a measure of patient satisfaction, was 5.1 ± 1.7, 5.8 ± 1.5 and 7.4 ± 1.8 in groups 1, 2 and 3, respectively, and the difference between groups 1 and 2 was not statistically significant, while that between group 3 and the other two groups was significant (p < 0.05). Conclusion: This study showed that the three methods used in individuals with chronic non-specific recurrent synovitis were effective; however, arthroscopic synovectomy in combination with radioactive synovectomy was more effective than the other methods and superior in terms of patient satisfaction.

Although there are many methods for the treatment of developmental dysplasia of the hip, Salter innominate osteotomy is a surgical technique presently used successfully worldwide. However, several complications can be found after Salter innominate osteotomy. Kirschner (K) wire migration into the pelvic cavity is not a common occurrence and is also rarely reported in the literature. Here, we report the case of a patient who was admitted to the emergency department of our hospital with acute abdominal pain because of K wire migration into the pelvis. We recommend bending the proximal end of the K wires or using threaded K wires to prevent this complication.

In this study, we present three-dimensional computed tomography (CT) scan image findings of a case with congenital total absence of the quadriceps muscle and patella and partial absence of the sartorius muscle, which caused fixed flexion contracture of the knee joint. Physical examination, radiography, three-dimensional CT scan, and chromosome analysis of the patient were done. On physical examination, the knee joint was at 85 degree fixed flexion contracture. Radiographic views demonstrated soft tissue defects around left femur. Chromosome analysis was normal. CT scan showed total absence of the quadriceps femoris muscle and patella. Congenital absence of the extensor mechanism and patella are very rare anomalies. This case differed from other patellar aplasia or dysplasia syndromes with the presence of fixed flexion knee contracture and aplasia of the extensor mechanism.

Eosinophilic granuloma is most common in children. In this paper we describe two children with a history of local swelling and pain in the humeral area who showed pathological fracture of the humerus. Needle biopsies confirmed the diagnosis of eosinophilic granuloma. Surgical procedures were performed in both patients. Both patients showed total remission after wide resection combined with segmental nonvascularized fibular graft and elastic nail. Both patients are currently free of disease after 4-year follow-up. There are several treatment modalities in eosinophilic granulomas such as radiotherapy, chemotherapy, local or systemic steroids, curettage, bone grafting and internal fixation. Although good results have been reported with nonsurgical treatment, surgery is a more effective treatment option in selected cases. In this paper we describe two children with massive solitary eosinophilic granuloma of the humerus who were successfully treated with segment resection and fibular bloc graft.

In this study, we aimed to investigate whether royal jelly and bee pollen reduce the bone loss due to osteoporosis in oophorectomized rat model.Thirty-two female Sprague-Dawley mature rats at six-month-old, weighing 180-260 g were used in the study. The rats were divided into four groups: Sham-operation group, only oophorectomy group, oophorectomy in combination with royal jelly group, and oophorectomy and bee pollen group. The rats were sacrified within 12 weeks following surgery. Bone mineral density (BMD) was measured and blood samples were collected for biochemical analysis before sacrification. Following sacrification, uterine weights were measured and tissue samples were taken to determine bone calcium and phosphate level with imaging through scanning electron microscope.The uterine weights of the rats were found higher in Sham-operation group than the other groups. The difference among the groups was statistically significant (p=0.001). Total body BMD results were similar in all groups and there was not statistically significant difference (p=0.19). The lumbar spine and proximal femur BMD results were statistically significantly higher in the royal jelly and bee pollen groups, compared to only oophorectomy group (p=0.001). Bone tissue calcium and phosphate levels were higher in royal jelly and bee pollen groups.Royal jelly and bee pollen decrease the bone loss due to osteoporosis in oophorectomized rat model. These results may contribute to the clinical practice.

Proteus syndrome is a complex disorder characterized by a wide variety of deformities including macrodactyly. In the present report, we present a case with complex macrosyndactyly in his hand. The patient was surgically treated. However, he admitted with lymphangiomas on his body during the follow-up period, leading to the diagnosis of Proteus syndrome. This article discusses the differential diagnosis of Proteus syndrome and the treatment methods used for macrodactyly along with the presentation of the case.

We aimed to evaluate the biomechanical properties of a new multilocking loop peripheral suture technique. For this aim, 40-deep digital flexor tendons of adult male sheep front limb were divided and then repaired using one of the following methods: simple peripheral suture plus 2- or 4-strand Kessler core suture or a new multilocking loop peripheral suture combined with either 2- or 4-strand Kessler core suture. Intact tendons were used as controls. The following biomechanical parameters were tested: ultimate tensile strength, energy to failure, 2-mm gap formation force, stiffness, and mechanism of failure. Regardless of the number of core suture strands, the new technique resulted in greater ultimate tensile strength, energy to failure, 2-mm gap formation force, and stiffness values, compared with simple running peripheral suture. In conclusion, the new multilocking loop peripheral suture technique represents a biomechanically strong and technically suitable method for flexor tendon repair.

To evaluate the efficacy and safety of intraarticular propolis compared with systemic antibiotic treatment in an experimental septic arthritis model. Thirty-two rabbits were infected intraarticularly by Staphylococcus aureus. The rabbits were randomly divided into four groups, including a control group and three experimental groups. Drainage was the only procedure performed in group I (control group). The animals were treated with daily intramuscular cefazolin sodium (75 mg/kg) for 7 days in group II. In group III, intraarticular ethanolic extract of propolis (0.5 mg/ml) was injected to the infected knees under sterile conditions on days 7, 14, and 21 after drainage. In group IV, the rabbits received both intramuscular cefazolin sodium as in group II and intraarticular ethanolic extract of propolis as in group III. After 8 weeks, the animals were killed and joint histopathological and scanning electron microscopic parameters were assessed. The best clinical score was obtained in group IV. There were statistically significant differences among all the groups (P < 0.05). The highest total score of the histological examination was found in group I and the best total score was obtained in group IV. There were statistically significant differences among the groups when we evaluated the scores of the parameters as loss of chondrocytes, loss of matrix, and pannus in-growth (P < 0.05). But there was no significant difference among the groups for the scores of cloning of the chondrocytes (P > 0.05). The highest scanning electron microscopy score was found in group I and the best score was obtained in group IV. Our results confirm the safety and efficacy of intraarticular propolis and synergistic effect of propolis when used with cefazolin in an experimental septic arthritis model. J Pediatr Orthop B 20:8-13 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

Propolis is a substance of honeybee origin with known antioxidant effects. The purpose of this study was to examine the effects of propolis on fracture healing and the antioxidant system in an experimental setting. Thirty-two rats that underwent experimental femur fracture and then fixation were randomly allocated in one of four groups: two control groups (Control-3w and Control-6w) and two treatment groups (Propolis-3w and Propolis-6w). Treatment groups received propolis until killing (at 3 or 6 weeks). X-ray, histological, bone mineral density measurement findings and endogenous antioxidant levels were examined. The bone mineral density was higher, radiological and histological evaluation scores were better, and superoxide dismutase, total glutathione and myeloperoxidase levels were lower among the rats that received oral propolis treatment compared with the controls. In addition, bone mineral density and histological assessment scores showed time-dependent improvement in the treatment group. In conclusion, the findings of this study suggest that propolis has some time-dependent beneficial effects on fracture healing.

We aimed at assessing the visual functions in elderly patients with femoral neck fracture and to compare the results with age-matched controls in this three-year prospective study.Seventy-one patients with a history of fall related hip fracture (39 females, 32 males; mean age 76.3+/-9.7 years; range 64 to 90 years) and who were diagnosed with femoral neck fracture after direct graphy were treated by means of bipolar partial prosthesis and they were contacted postoperatively or prior to discharge to participate in the study. Visual acuity, depth perception, the presence of cataract in the red reflex were evaluated. A dilated fundus and slit-lamp examination were performed if possible. On completion of the examination, the ophthalmologist documented the causes of any visual impairment found. Control group was comprised of age-matched 40 subjects (22 females, 18 males; mean age 73.2+/-7.6 years; range 62 to 90 years) who applied to ophtalmology clinic for routine examination.The visual acuity was significantly decreased in the patient group as was stereopsis (p0.05). We found no difference between the study group and the controls when we evaluate the distribution of self reported eye disease and eye disease found on ocular examination. The rate of cases who reported not usually wearing glasses was 35% while it was 5% in the control group. When we evaluate the time since last examination, 38% of cases had not had an eye examination for over four years, as compared with 22.5% of controls.This study shows that elderly people should have their eyes tested at least once every two years, refractive errors should be corrected and eye diseases should be treated to decrease the risk of fall-related femoral neck fractures.

In the present study we evaluated the radiological and cosmetical results of reverse V osteotomy of the distal humerus for the correction of childhood cubitus varus deformity.Nine children (8 boys, 1 girl; mean age 9.3 years; range 4 to 16 years) treated with reverse V osteotomy between June 2004 - February 2007 were included in this study. The indication for surgery in all cases was cosmetic deformity. After the resection of a triangular bone segment, the entire distal humerus and forearm was rotated laterally to correct the deformity. Fixation was achieved with two lateral and one medial Kirschner wires. Postoperatively a posterior splint was applied in 90 degrees of elbow flexion in all cases. The results were assessed according to the criteria of Oppenheim.According to Oppenheim criteria, seven children had excellent and two had good results. The mean preoperative and postoperative humeral-elbow-wrist angle was -19.3 degrees (-12 degrees /-30 degrees ) and -2.4 degrees (-8 degrees /+3 degrees ), respectively. There were no short and long term complications except a transient radial nerve palsy in one case that resolved in three weeks spontaneously.Reverse V distal humerus osteotomy is a simple procedure with low complication rates and excellent results in childhood cubitus varus deformity correction.

ObjectiveTo evaluate the efficacy and safety of fondaparinux compared with nadroparin for prevention of venous thromboembolism after arthroplasty.Patients and methodsOne hundred fifteen patients were randomized into 2 treatment groups. Patients were given fondaparinux in Group I and nadroparin in Group II. Measurements were performed on Days 1, 5, and 21. The wound area was assessed with a subjective visual analog scale.ResultsThe blood counts, clinical biochemical tests, and coagulation tests (ie, thrombin time, partial thromboplastin time, activated partial thromboplastin time, fibrinogen, prothrombin time–International Normalized Ratio, and antithrombin III activity) did not show statistically significant differences between Group I and Group II. In both study groups, anti-factor Xa activities increased significantly on the fifth and 21st day. The scores of the subjective visual analog scale showed significance on Day 21.ConclusionsOur results confirm the safety and efficacy of both fondaparinux and nadroparin for prophylaxis after major orthopedic surgery.