Partial load-bearing rabbit ulnar segmental defects are regenerated with biocompatible grafts with or without bone marrow-derived mesenchymal stem cells.

BACKGROUND: The autologous bone grafts still have been used as the gold standard to initiate and facilitate bone healing in cases with bone defects. Because of some disadvantages of autologous bone grafts, the new biocomposite grafts have been researched. The purpose of the present study was to investigate whether the bone marrow-derived mesenchymal stem cells (BM-MSCs) loaded into a biocomposite scaffold enhance bone regeneration. METHODS: In our study, a 10 mm osteoperiosteal segmental bone defect was created in the middle of the right and left ulnar bones of eight rabbits. The created defects were filled in the right ulnar bones of eight rabbits (Group I) with BM-MSCs loaded onto a bio-composite scaffold (Plexur PTM, Osteotech, Eatontown, NJ, USA) and in the other ulnar bones of the same rabbits (Group II) with only biocomposite graft. Radiographs of each forelimb were taken postoperatively at the end of the 6th week. Then, the rabbits were euthanized pharmacologically for histopathological evaluation. RESULTS: Were scored using a modified Lane and Sandhu scoring system. All defects healed in both groups. Radiological and histo-logical total scores were slightly better in Group I, but statistical tests did not reveal any significant differences between the two groups at the end of the 6th week radiologically and histologically (p>0.05). CONCLUSION: The results of our study demonstrated that in rabbit ulnar segmental bone defect model was obtained satisfactory regeneration with using biocomposite graft with or without BM-MSCs.

The role of intraoperative cell salvage system on blood management in major orthopedic surgeries: a cost-benefit analysis.

INTRODUCTION: The aim of this study was to compare the efficiency and cost of cell salvage systems with allogeneic blood transfusions in patients who had major elective orthopedic surgeries. MATERIALS AND METHODS: Consecutive 108 patients who had intraoperative cell saver (CS) performed routinely constitute the study group. In control group, consecutive 112 patients who were operated without intraoperative CS were investigated. Hemoglobin (Hb) level less than 8 mg/dL was regarded as the absolute transfusion indication. The patients were evaluated for age, gender, body mass index, operation period, mean intraoperative estimated blood loss (EBL), postoperative hemovac drainage volume; preoperative, postoperative first day and discharge Hb levels, allogeneic blood transfusion (ABT) volume, hospitalization and cost parameters. RESULTS: The mean intraoperative EBL was 507 mL in the study group and 576 mL in control group. The mean ABT was 300 mL in the study group and 715 mL in control group. In the study group, intraoperative EBL, ABT usage and hospitalization period were significantly lower compared with the control group (p = 0.009, p = 0.000 and p = 0.000; p < 0.05, respectively). The mean cost was 771 Turkish liras (TL) in the study group and 224 TL in control group. In the study group, the cost was significantly higher than the control group (p = 0.000). The postoperative first day Hb level was significantly higher in the study group (p = 0.010). CONCLUSION: Although CS usage was determined to increase the costs in this study, it significantly decreases intraoperative and postoperative ABT requirements. We believe that the increase in cost may be neglected when the complications and prolonged hospitalization due to ABT usage were regarded.

Platelet-rich plasma versus exchange intramedullary nailing in treatment of long bone oligotrophic nonunions.

INTRODUCTION: The aim of the study was to evaluate the effects of platelet-rich plasma on healing rates and healing time in the treatment of long bone nonunions treated by an intramedullary nail previously. MATERIALS AND METHODS: Between August 2008 and January 2012, 14 consecutive patients who were treated for long bone nonunions with percutaneous platelet-rich plasma application (PRP) were included in the study. The control group included 15 consecutive patients who were treated with exchange intramedullary nailing (EIN). In the postoperative period, all patients were controlled in every 2 weeks clinically and in every 4 weeks radiologically. Patients were evaluated with visual analog scale (VAS) in preoperative and postoperative periods. RESULTS: The mean healing time was shorter in PRP group as 16.71 ± 2.4 weeks compared with that of 19.07 ± 3.67 weeks in EIN group (p = 0.053). At the end of the follow-up, the union is achieved in 92.8% of the cases in PRP group. This ratio was 80% in control group. The mean VAS values in preoperative and postoperative periods were not statistically significant in both groups (p > 0.05). When PRP and control groups were evaluated individually, the postoperative VAS was lower than that of preoperative VAS in both groups (p = 0.0001 and p = 0.0001, respectively). CONCLUSION: Percutaneous PRP application significantly affected union rate, but no significant difference found when compared to EIN in the treatment of oligotrophic nonunions after intramedullary nailing of long bone fractures. PRP can be applied as a minimally invasive and safe method of saving resources in medical care instead of EIN.

Orthopedic trauma surgery and hospital cost analysis in refugees; the effect of the Syrian civil War.

PURPOSE: The aim of this study was to evaluate the musculoskeletal injury types, injury mechanisms, surgical techniques and treatment costs of Syrian refugees. METHODS: Totally 158 patients (67 female, 91 male) treated in our clinic in 34 months period between January 2012 and October 2014 were included in the study. The mean age of the patients was 39.3 years (range: 18-82 years). The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, injury severity score, surgical technique, complications, mortality/morbidity and treatment cost. RESULTS: The injuries were more frequently reported in lower extremities, upper extremities and axial skeleton, respectively. Blunt trauma was significantly higher in upper extremity injuries compared with the other types of injuries (p = 0.001). Fractures were most commonly reported in foot/ankle region and in males, hand/wrist fractures were significantly higher than that of the females. Plate fixation of upper extremity fractures and intramedullary nailing in lower extremity fractures were the most commonly preferred treatment modalities. The mean hospitalization period of patients was 5.6 days and the mean treatment cost was 3844 Turkish Liras (TL). CONCLUSIONS: In this study, it was shown that there was a statistically significant increase in the cost of health expenses in patients with fall from heights or gunshot wound, with fractures in axial skeleton or with the ISS score between 16 and 66. The cost rise was associated with worse prognosis, complications, intensive care treatments and prolonged hospitalization periods.

Medial mini-open versus percutaneous pin fixation for type III supracondylar fractures in children.

BACKGROUND: The present objective was to compare medial mini-open and percutaneous treatment of pediatric supracondylar fractures according to fluoroscopy time, duration of surgery, and iatrogenic ulnar nerve injury. METHODS: A total of 104 Gartland type III supracondylar humerus fractures were prospectively evaluated between 2011 and 2013. Patients were divided into 2 groups according to type of fixation. In Group A (41 patients), medial pin was inserted with mini-open incision with 2 lateral pins inserted percutaneously. In Group B (63 patients), all pins were inserted percutaneously. Mean follow-up time was 14.1±1.2 months in Group A, and 14.6±2.1 months in Group B. All patients were postoperatively evaluated for nerve injury with both motor and sensory function assessment. Length of surgery, total fluoroscopy time, fluoroscopy time for medial pin insertion, Baumann's angle, humeral capitellum angle, final carrying angle, and range of motion were recorded. RESULTS: Sensorial evaluation showed that Group A had 3 poor, and 1 fair results, and Group B had 2 poor, and 1 fair results. No statistically significant differences were observed, including no differences in either surgery or total fluoroscopy times between groups. However, fluoroscopy time during medial pin placement was significantly lower in the mini-open group. CONCLUSION: In conclusion, similar results of both techniques were observed, and both carry risk of iatrogenic ulnar nerve injury. Medial pin placement is easier and less demanding when used with mini-open technique.

The outcome and parents-based cosmetic satisfaction following fixation of paediatric supracondylar humerus fractures treated by closed method with or without small medial incision.

Supracondylar humerus fractures are common in children. Displaced fractures are usually treated with closed reduction and cross pin fixation. But, medial pinning may cause the ulnar nerve injury. The aim of this study was to compare the parents-based cosmetic satisfaction of the incision scars in children with displaced supracondylar humerus fractures treated by closed reduction and cross pin fixation with or without small medial incision. We retrospectively reviewed the medical records of 72 children with displaced supracondylar humerus fractures treated two different closed reduction and percutaneous pinning methods at our institution from January 2010 through December 2013. A group has 36 patients treated with small medial incision and crossed K-wires fixation after closed reduction. The other group has 36 patients treated with closed reduction and K-wires fixation. At the final follow-up, the patients were evaluated radiologically and clinically with Flynn's criteria. Furthermore, a visual analogue scale was used to determine of the parents-based cosmetic satisfaction score. All fractures healed without major complications at the final clinical and radiological assessment. Although, between the two groups did not differ in terms of Flynn cosmetic and functional outcomes, there were statistically significant differences between both groups according to the parents-based cosmetic satisfaction scores. The closed reduction and crossed pin fixation without small medial incision should be preferred first because of better the parents-based cosmetic satisfaction.

The measurement of tibial torsion by magnetic resonance imaging in children: the comparison of three different methods.

BACKGROUND: There is no consensus about the measurement techniques to determine the tibial torsion by using MRI. The primary research question of this study was to find out which MRI-based tibial torsion measurement method is more reliable and reproducible. Secondly, we compared tibial torsion values measured by three measurement methods in T1- and T2-weighted images. METHODS: We retrospectively analyzed voluntary children performed MRI for determination of the lower limb torsional alignment after the surgical treatment between January 2013 and December 2013. Thirty-four extremities of 17 patients were included in the present study. The mean age of patients was 7.3 years (range 3-12 years). The transmalleolar, posterior intermalleolar and anterior talus angles were used for the measurement of tibial torsion. All tibial torsion measurements were calculated by three blinded observers in T1- and T2-weighted images, and these measurements were repeated blindly after 2 months. RESULTS: All measured intra- and interobserver intra-class correlations were greater than 0.60. The best scores were achieved with the anterior talus angle. It was followed by the posterior malleolar angle and the intermalleolar angle, respectively. Furthermore, there were no statistically significant differences between tibial torsion values measured by each observer in T1- and T2-weighted images of each method. CONCLUSION: MRI-based tibial torsion measurements were reliable and reproducible for all three methods. But we think that the anterior talus angle and the posterior malleolar angle are easier and more successful in determination of the tibial torsion. Also, both T1- and T2-weighted images can be used successfully for this purpose.

A new joystick technique for unsuccessful closed reduction of supracondylar humeral fractures: minimum trauma.

BACKGROUND: The purpose of this study was to compare operation duration, radiological and functional results of the open reduction with either posterior or lateral approach and closed reduction with joystick method in unsuccessful closed reduction of displaced (Gartland type III) supracondylar humeral fractures. METHODS: Between February 2010 and August 2011, 37 patients who were not obtained satisfactory reduction with classic closed reduction attempts for three times in operating room were included in this study. Patients were treated with three different surgical methods. Group I have 13 patients who had joystick and lateral K-wire-assisted closed reduction, group II have 12 patients who had open reduction by lateral approach, and group III have 12 patients who had open reduction by posterior approach. In final follow-up, AP and lateral radiographs of both elbows were taken and bilateral Baumann angles, lateral humerocapitellar angles, carrying angles, and elbow range of motion were measured. These angles and operation times compared between the groups. The functional and cosmetic outcome of surgery was evaluated by criteria of Flynn et al. RESULTS: There was no statistical significance difference between Baumann angles, lateral humerocapitellar angles, and carrying angles of fractured and uninjured sides in between three groups (respectively, p = 0.761, p = 0.354, p = 0.750). In group I, operation duration is shorter than the other groups. Functional scoring showed that in group I and group II, all patients have satisfactory results; however, in group III, three patients (25%) had poor results. In the perspective of cosmetic results, all three groups have satisfactory results. CONCLUSIONS: When classical closed reduction fail, lateral joystick and K-wire-assisted reduction is a useful way to make and maintain the reduction. Functional and radiological results are as good as lateral and posterior open approaches. Short operation time is an advantage. This method reduces the risk of complications due to repeated closed reduction and open reduction in unsuccessful closed reduction in pediatric supracondylar humeral fractures. LEVEL OF EVIDENCE: Level III.

Treatment and results in pediatric traumatic hip dislocation: case series and review of the literature.

BACKGROUND: Six acute traumatic hip dislocations in pediatric patients were retrospectively analyzed. Types of dislocations, associated lesions, treatment methods, complications, and clinical and radiological outcomes were reviewed. METHODS: Six child patients treated due to traumatic hip dislocation between 2007 and 2011 in our clinic were included in the study. While five of the patients were male, one was female; the average age was 8 years and 8 months. The mean follow-up was 25.2±10 months. There were posterior dislocations in five cases and transepiphyseal fractured dislocation in one case. Four cases were treated by closed reduction while two cases were treated with open reduction method. RESULTS: In the last control of the patients, asymmetric widening in the hip joint was found due to osteochondral fracture in one patient and coxa magna occurred in one patient. Avascular necrosis developed in one case with transepiphyseal fractured dislocation. Harris hip score evaluation was found excellent in five cases and bad in the case with fractured dislocation. CONCLUSION: Traumatic hip dislocation is a rare condition. It should be treated with preferably closed method as soon as possible. Repetitive reduction trials should be avoided. Open reduction should be performed to recognize accompanying lesions after advanced radiologic examinations such as computerized tomography and magnetic resonance imaging.