The Clinical Results of Percutaneous Drilling in the Treatment of Chronic Lateral Epicondylitis.

AIM: Lateral epicondylitis is one of the leading orthopedic problems encountered in daily practice. Treatments are more symptomatic than curative. Percutaneous drilling is a minimally invasive method that provides satisfactory results. The aim of this study was to evaluate patients who had undergone percutaneous drilling for chronic lateral epicondylitis. MATERIAL AND METHOD: The study included 31 patients who underwent surgical percutaneous drilling because of chronic lateral epicondylitis between 2018 and 2021. The patients were evaluated with respect to demographic characteristics, including age, gender, body mass index (BMI), occupation, education level, hobbies, dominant side, and smoking status. The VAS (Visual Analog Scale) pain scores, PRTEE score (Patient-Rated Tennis Elbow Evaluation - a lateral epicondylitis function scale), and Roles-Maudsly score were examined preoperatively and at one and 12 months postoperatively together with grip strength measured with a Jamar hand dynamometer. RESULTS: Statistically significant improvements were determined in the VAS score during activity from 8.9 preoperatively to 2.06 at 12 months postoperatively (p<0.01), and in the PRTEE score, from 64.12 preoperatively to 20.61 at 12 months postoperatively (p<0.01). The Roles-Maudsly score at 12 months postoperatively was determined to be excellent in 13 (41.9%) patients, and good in 14 (45.2%). Mean grip strength increased from 69.55 before treatment to 90.97 at the end of 12 months postoperatively. CONCLUSION: Autobiological treatments are at the forefront of current treatments for tendinopathies. Percutaneous drilling is a closed method and can be considered an ideal method in the treatment of tendinosis caused by inflammation and mesenchymal stem cells (MSCs) contained in hematoma. It is also an advantageous treatment method for patients with aesthetic concerns as it does not leave any scar tissue and has a low risk of complications.

Does posterior approach always lead to poor functional and cosmetic outcomes in displaced pediatric supracondylar humeral fractures?

BACKGROUND: Supracondylar humerus fractures (SCHFs) are the most common types of elbow fractures in children. Closed reduction percutaneous pinning (CRPP) is the primary surgical treatment of SCHFs. In cases that cannot be managed with closed reduction, treatment with open reduction and internal fixation (ORIF) is necessary. We aimed to compare CRPP and ORIF through a posterior approach regarding clinical and functional outcomes in pediatric SCHF cases. METHODS: Patients with Gartland type III SCHF who underwent CRPP or ORIF with posterior approach at our clinic between January 2013 and December 2016 were included in this retrospective study. A total of 60 patients who underwent surgical treatment and had available data on our hospital database and no additional injuries were included in the study. We analyzed their data concerning age, gender, fracture type, neurovascular damage, and surgical treatment. In addition, we inspected the patients' anteroposterior and lateral radiographs at 1-year follow-up visits for Baumann (humerocapitellar) angle (BA) and carrying angle (CA) and checked their go-niometer assessments of elbow range of motion (ROM). The cosmetic and functional outcomes were determined using Flynn's criteria. RESULTS: Demographic, preoperative, and post-operative data of 60 patients between the ages of 2-15 were analyzed. 46 of these patients had CRPP, and 14 had posterior ORIF. CA, Baumann angle, and lateral capitello-humeral angle were measured for fractured elbow and contralateral elbow and compared statistically. There was no statistically significant difference between the two surgical ap-proaches in terms of CA (p=0.288), Baumann's angle (p=0.951) and LHCA (p=0.578). At the end of 1-year follow-up, elbow ROM was measured, and there was no statistically significant difference between the two groups (p=0.190). Furthermore, there is no statistically significant difference between the two surgical approaches in terms of both cosmetic (p=0.814) and functional (p=0.319) outcomes. CONCLUSION: A comprehensive literature review of pediatric SCHF shows that surgeons do not frequently prefer posterior incisions in Gartland type III fracture that cannot be managed with closed reduction. However, posterior open reduction is a safe and effective method since it provides more control over the distal humerus, allows for a complete anatomical reduction involving both cortices, reduces the risk of ulnar nerve injury, thanks to the nerve exploration, and yields positive cosmetic and functional outcomes.

Epidermal growth factor (EGF) promotes bone healing in surgically induced osteonecrosis of the femoral head (ONFH).

Angiogenic effects of epidermal growth factor (EGF), a potent mitogen, have been demonstrated previously. Moreover, different in vitro studies showed that EGF affects processes associated with bone healing, such as osteoblast differentiation and bone resorption. The aim of this study was to investigate the effect of combined core decompression (CD) and recombinant human EGF (rhEGF) treatment on early-stage osteonecrosis of the femoral head (ONFH) surgically induced in rats. ONFH was induced by dissecting the cervical periosteum and placing a ligature tightly around the femoral neck. Thirty rats were assigned to one of the following groups (n = 10 each group): sham-operated control, CD, and CD+rhEGF group. rhEGF was injected intraosseously into infarcted areas 2 weeks after the surgery. Preservation of femoral head architecture was assessed at 8 weeks post treatment by radiographic and histomorphological analyses. Osteopontin (OPN) and cluster of differentiation 31 (CD31) were detected by immunochemistry, as indicators of bone remodeling and vascular density, respectively. Inter- and intra-group (non-operated left and operated right femur) differences in radiographic and histomorphological results were analyzed. The femoral head area and sphericity were more preserved in CD+rhEGF compared to CD and sham-control group. CD31 levels were significantly different between the three groups, and were higher in CD+rhEGF compared to CD group. OPN levels were increased in CD and CD+rhEGF groups compared to sham control, but with no significant difference between CD and CD+rhEGF groups. Overall, our results indicate that EGF promotes bone formation and microvascularization in ONFH and thus positively affects the preservation of femoral head during healing.

Is scintigraphy a guideline method in determining amputation levels in diabetic foot?

BACKGROUND: In this study, we aimed to evaluate the potential use of a 3-phase bone scintigraphy method to determine the level of amputation on treatment cost, morbidity and mortality, reamputation rates, and the duration of hospitalization in diabetic foot. METHODS: Thirty patients who were admitted to our clinic between September 2008 and July 2009, with diabetic foot were included. All patients were evaluated according to age, gender, diabetes duration, 3-phase bone scintigraphy, Doppler ultrasound, amputation/reamputation levels, and hospitalization periods. Patients underwent 3-phase bone scintigraphy using technetium-99m methylene diphosphonate, and the most distal site of the region displaying perfusion during the perfusion and early blood flow phase was marked as the amputation level. Amputation level was determined by 3-phase bone scintigraphy, Doppler ultrasound, and inspection of the infection-free clear region during surgery. RESULTS: The amputation levels of the patients were as follows: finger in six (20%), ray amputation in five (16.6%), transmetatarsal in one (3.3%), Lisfranc in two (6.6%), Chopart in seven (23.3%), Syme in one (3.3%), below-the-knee in six (20%), above the knee in one (3.3%), knee disarticulation in one (3.3%), and two patients underwent amputation at other centers. After primary amputation, reamputation was performed on seven patients, and one patient was treated with debridement for wound site problems. No mortality was encountered during study. CONCLUSIONS: We conclude that 3-phase bone scintigraphy prior to surgery could be a useful method to determine the amputation level in a diabetic foot. We conclude that further, comparative, more comprehensive, long-term, and controlled studies are required.

Surgical treatment of osteopetrosis-related femoral fractures: two case reports and literature review.

Osteopetrosis is a rare hereditary disease which is characterized by increased bone density. Bone resorption is insufficient or fails due to the osteoclast defect in osteopetrosis. Half of the patients are asymptomatic and diagnosed incidentally or based on the presence of fracture. Adult onset osteopetrosis usually presents with hip and proximal femoral fractures. Internal fixation can be performed; however, technical challenges may be experienced due to increased bone density. As in other fractures, nonunion or varus malunion of these fractures may occur. Although rare, osteopetrosis may complicate treatment of fractures in such patients. In this study, we aimed to present two new cases of ADO type II with an osteopetrotic femoral fracture along with the clinical and radiological findings in the light of a comprehensive literature review. Orthopaedics surgeons should be aware of intraoperative technical difficulties and possible postoperative complications during the follow-up period. Investigation would be beneficial for the diagnosis of osteopetrosis such the patient with fractures who has minor trauma history and increased bone density in radiography.

Results of vacuum assisted wound closure application.

In recent past, various methods have been used for wound treatment purpose. In this study, we aimed to compare our results established from the vacuum-assisted wound closure method, which has gained popularity day by day, with the literature. A total of 48 patients, who received vacuum-assisted wound closure treatment in our clinic between 2007and 2010, were included in this study. Etiological distribution of the patients was as follows: 32 traumatic, 6 pressure sore, 9 diabetic, and 1 iliac disarticulation. All cases were evaluated in terms of age, gender, etiology, period of treatment, and size of the wound. In the patients studied, 42 were men (87.5 %) and 6 were women (12.5 %). Mean age of the patients was 39.6 years (11-61 years). All of our traumatic patients suffered from open fracture. After the vacuum-assisted wound closure application, wound size reduced by 28.8 %, while the mean area of the surface of the wound was 94.7 cm(2) (13.7-216.3 cm(2)) on average. After the wounds became ready for surgery, 15 of them were treated with split-thickness grafting, 9 of them were treated with secondary suture, 18 of them were treated with full-thickness grafting, and 6 of them were treated with flap. Average period of the application of vacuum-assisted wound closure was 11.6 days (7-15 days). Results of vacuum-assisted wound closure can be regarded as satisfactory when cases are selected properly. This system has three different effect mechanisms. Firstly, it increases local blood flow on the wound bed. Secondly, cell proliferation is triggered following the mechanic stress. Thirdly, vacuum removes the proteases from the environment which obstructs healing. Therefore, it is intended to prepare alive wound bed which is required for subsequent soft tissue reconstructions.