Comparison of epoprostenol and viscum album efficiencies in the treatment of avascular necrosis of the femoral head: An experimental animal study.

BACKGROUND: The aim of our study is to compare the efficacy of epoprostenol and viscum album in the treatment of femoral head avascular necrosis with an experimental study. Our hypothesis is that viscum album, which has similar properties to epoprostenol on the vascular system, is as effective as epoprostenol in the treatment of avascular necrosis. METHODS: Avascular necrosis was created on the femoral heads of 45 New Zealand type rabbits by surgical vascular deprivation method. The rabbits were divided into 3 groups. Group 1 was designed as a control group, in group 2 Ilomedin (epoprostenol analogue) was administrated to subjects and in group 3, Helixor (viscum album extract) was administrated. At the end of the study, there were nine subjects in each group. Osteocyte necrosis, bone marrow necrosis, new bone formation and cartilage degeneration were evaluated microscopically. The extent of bone necrosis and repair and involvement of epiphysis, the bone marrow cellularity ratio and trabecular bone volume were investigated. RESULTS: Subchondral necrosis was seen in more animals in the control group (p=0.03). Osteoblastic and osteoclastic activity were more prominent in the Ilomedin group (p=0.25 and 0.07, respectively). It was seen that the cartilages of the subjects in the Helixor and Ilomedin groups were less damaged. In the Ilomedin group, more animals were seen in the chronic phase of the repair process than in the other groups (p=0.07). Bone marrow cellularity was higher in treatment groups (22% and 20,6% for Ilomedin and Helixor, respectively, p=0,04). Trabecular volume was found to be increased in damaged femoral heads in the treatment groups, the highest increased observed in the Helixor group (p=0.01). CONCLUSION: Viscum album seems to be effective in decreasing the extention of necrosis and protecting the articular cartilage, and epoprostenol in increasing repair and regeneration.

Analysis of the Intra- and Inter-observer Reliabilities of Delbet Classification: Is Simplification Required.

Objective: This study aims to investigate the intra- and inter-reliabilities of Delbet classification and whether simplifying the classification improves reliability. Method: The Radiographs of 58 patients under 16 years old diagnosed with pediatric hip fractures between January 2012 and January 2020 were evaluated. Two separate Microsoft® PowerPoint (PPT) presentations consisting of 58 slides for Delbet's classification and its simplified form were prepared in which the order of cases was randomized and blinded. Then five orthopedic surgeons with different years of experience (more than 15 years of surgical experience were accepted experienced group) in pediatric trauma surgery evaluated the presentations two times one month apart. Results: In the inter-observer reliability analysis, a moderate agreement for the classical Delbet classification and a substantial agreement for the simplified Delbet classification was found in both evaluations. As a result of the intra-observer reliability analysis, there was substantial agreement in four observers, moderate agreement in one observer for the classical Delbet classification and substantial agreement in two observers, very good agreement in three observers for the simplified Delbet classification. The experience was not effective on agreement levels in the intra-observer reliability analysis of the classical Delbet classification system. The inter-reliability values of the less experienced group in the simplified classification were much higher than the classical Delbet classification. Conclusion: The simplification of the Delbet classification provides a significant increase in inter-observer reliability levels, especially in less experienced orthopedics and traumatology specialists, and a significant increase in intra-observer reliability levels. Level of Evidence: Level III, diagnostic study.

Can a coracoclavicular screw added to the clavicular hook plate reduce subacromial stress? A finite element analysis.

OBJECTIVES: The aim of this study was to investigate the stresses on the plate and the clavicle in the standard clavicular hook plate model and the clavicular hook plate models with a coracoclavicular (CC) screw by finite element analysis (FEA). MATERIALS AND METHODS: The FEA models were created with the combination of acromion, clavicle, coracoid process, 8-hole clavicular hook plate and screw components. Model 1 was created as a standard clavicular hook plate model and plates were implanted to the clavicle and the acromion by six locking screws. Model 2 was created by a cortical screw placed in the coracoid process through the third hole of the plate (CC screw) and fixation of hook plate by five locking screws. The upward-pull force was applied to clavicle at the insertion of sternocleidomastoid muscle with three axes. The stress exerted by acromion on the hook of the plate, stresses on the plate, clavicle, and CC screw were analyzed. RESULTS: When the screw holes were compared, in Model 1, the highest stress was found in the last hole of the plate. In Model 2, the highest stress was detected on the CC screw. The stress on the clavicle was found to be 0.14 Mpa in Model 1 and 0.21 Mpa in Model 2. In Model 1 and Model 2, the stress exerted by acromion on the subacromial part of the plate was found to be 2.05 KPa and 1.66x10-6 KPa, respectively. CONCLUSION: The results of this study show that addition of CC screw to the standard clavicular hook plate shares the loading and reduces the stress on the hook of the plate.

Analysis of risk factors for re-displacement of pediatric tibia fractures: A retrospective study of 196 cases.

OBJECTIVE: The aims of this study were (1) to analyze the factors that may cause loss of reduction (LOR) in pediatric tibia diaphysis and distal third fractures treated with closed reduction and casting (CRC) and (2) to determine the effectiveness of cast index (CI), gap index (GI), and three-point index (TPI) in prediction of LOR. METHODS: The patients aged 0-16 years who were admitted to the emergency department between January 2014 and January 2018, with tibia diaphysis or distal third fractures and treated with CRC were included the study. A total of 196 pediatric patients (41 females, 155 males) were retrospectively evaluated. The radiographs on admission were analyzed in terms of fracture type, location of the fracture, presence/location of the fibula fracture as well as initial angulation in both planes, translation, and the time of definitive cast. On radiographs taken after closed reduction and final casting, angulation in the coronal and sagittal planes, amount of translation (%), CI, GI, and TPI were measured. Logistic regression analysis was used to evaluate the risk factors of re-displacement. RESULTS: Of 196 patients, 46 developed re-displacement (23%). Age (P : 0.029), initial translation (P : 0.006), post-reduction translation (P : 0.001), and post-reduction AP angulation (P : 0.002) were found statistically significant. Mean CI and GI were higher in re-displacement group (P : 0.033, 0.036, respectively). According to multivariate logistic regression analysis postreduction AP angulation, post-reduction translation, and cast index were found independent risk factors. CONCLUSION: One should carefully evaluate patients who underwent CRC due to tibia fracture with CI > 1.02, post-reduction AP angulation > 3.4°, and post-reduction translation > 24.3° in terms of occurrence of re-displacement. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Does the size of Thurston-Holland fragment have an effect on premature physeal closure occurrence in type 2 distal tibia epiphyseal fractures?

The purpose of this study was to investigate the possible effect of Thurston-Holland fragment (THF) size on the development of premature physeal closure (PPC) in distal tibia type 2 epiphyseal injuries. Fifty-eight fractures in 57 patients with a minimum follow-up period of 12 months were included. For statistical analysis, sex and age of the patient, number of reduction attempts, percentage of THF base relative to physis length on anteroposterior or lateral radiograph, maximal initial and postreduction displacement amount, presence of accompanying fibula fracture and trauma mechanism were evaluated. PPC was observed in 12 fractures (20.7%). An increased amount of initial displacement, increased number of reduction attempts and passing the physis with three Kirschner wires were determined as statistically significant factors for PPC occurrence (P = 0.011, 0.011 and 0.005, respectively). The THF percentage was not found to be an important factor for the occurrence of PPC. In males, THF size was less than 50% more frequently than that in females (P = 0.013). THF size had no significant effect on PPC occurrence after distal tibial epiphyseal fractures.

Analysis of the factors that are important in re-displacement in pediatric diaphyseal femur fractures treated with a spica cast.

BACKGROUND: There is no detailed data on the factors affecting the re-displacement in pediatric femoral fractures treated with closed reduction and early spica casting. This study aimed to investigate the factors effective in re-displacement in pediatric diaphyseal femur fractures (PDFF) treated with spica casting. METHODS: In all, 151 displaced PDFF were evaluated retrospectively. Demographic data of the patients were evaluated. Type of fractures, anteroposterior and lateral angulations, amount of shortening, translation ratio, cast index (CI), gap index (GI), and three-point index (TPI) measurements were evaluated radiologically. Thigh flexion angle (TFA) and knee flexion angle (KFA) were measured. After casting, angulation of more than 10° in any plane and a shortening of more than 10 mm was accepted as re-displacement. Binary logistic regression analysis was used to evaluate the risk factors of re-displacement. Receiver operating characteristic analysis was performed for TFA and KFA. RESULTS: Re-displacement was detected in 40 patients (26.5%). Transverse type fracture (p = 0.001), TFA ˂71.4° (p <0.001), and KFA ˂52.6° (p = 0.002) were found to be statistically significant factors on re-displacement. It was determined that the combination of transverse femoral fracture and TFA ˂71.4° increased the probability of re-displacement by approximately 14 times. It has been observed that indices such as CI, GI, and TPI were not effective in predicting the risk of re-displacement. CONCLUSION: When treating a PDFF with spica casting, one should be aware of re-displacement if the fracture type is transverse, TFA is ˂71.4°, and KFA is ˂52.6°. LEVEL OF EVIDENCE: Level III, prognostic.

Analysis of Factors Affecting Return to Work After Surgical Treatment in Patients with AO Type C Distal Humerus Fractures.

BACKGROUND: The purpose of this study is to evaluate the functional results of distal humerus fractures which were treated by open reduction and fixation with pre-contoured angular stable plates in young patients, and investigate whether the patients could return to their pre-injury work and patients' financial conditions while they were not working. MATERIALS AND METHODS: The data of 48 patients, ages between 18 and 55 years, working in a job and having AO/OTA type C distal humerus fracture were retrospectively evaluated. Mayo Elbow Performance Score (MEPS) was used to determine functional results. Postoperative radiographs were evaluated to determine the rate of union, degenerative changes, malunion and heterotopic ossification. Financial outcome form was constituted by the authors and the patients asked whether she/he could return to their pre-injury works after treatment finished and the financial status of the patients during the treatment and after the treatment. RESULTS: The mean flexion-extension arc was 114° ± 12°(range 85°-135°) and the mean MEPS score was 85 ± 11(range 65-100). The average time to return to work was 6.5 ± 2.4 months (3-12 months). AO type C2 and C3 fractures and heterotopic ossification negatively affected the functional results and also adversely affected the patients' return to their pre-injury works. 38 (79%) patients returned to pre-injury work and 29 (76%) of them started to work at the same position before the fracture occured. Nine of 38 patients (24%) had to change their positions. Among the 48 patients, 10 patients (21%) could not return to the same work, 7 of them found light duty and 3 of them had not been to work. CONCLUSION: Although the functional results of surgical treatment of intra-articular distal humerus fractures are good, at the end of the treatment, especially heavy workers may have difficulties in returning to their former works.

Evaluation of the quadrants of femoral neck-head in the cephalomedullary fixation of intertrochanteric fractures with a helical blade: Is inferior posterior quadrant also safe? A clinical study.

OBJECTIVES: This study aims to investigate the positioning of the helical blade to prevent mechanical complications in surgically fixed intertrochanteric fractures (ITFs). PATIENTS AND METHODS: In this retrospective study, 392 patients (158 males, 234 females; mean age: 75.5±13.4; range, 20 to 101) years) with ITFs treated in lateral decubitus position with proximal femoral nail anti-rotation in a single center between January 2009 and January 2017 were evaluated. The fractures were classified according to the Orthopedic Trauma Association classification preoperatively and grouped as stable or unstable. Postoperatively, tip-apex distance (TAD), Baumgaertner reduction criteria, and obtained quadrants were evaluated. Patients with an unstable fracture, proper TAD, and acceptable or good reduction were included in the final evaluation for statistical analysis to investigate the safest quadrant to prevent cut-out complication. RESULTS: Cut-out complications were observed in 19 (4.8%) patients. The scenario; unstable fracture, TAD <25 mm, acceptable or good reduction consisted of 111 patients in total and cut-out complication occurred in four of them (3.6%) (one in center-posterior, one in center-center, one in superior-anterior, and one in superior-center quadrants). There was no statistically significant difference between center-center, inferior-center, and inferior-posterior quadrants (p=0.49). CONCLUSION: Inferior-posterior placement is as safe as central-central or inferior-central placement for blade fixation in the surgical treatment of ITF.

A New Reference to Evaluate Syndesmosis in Sagittal Plane Radiographs of the Ankle: The Lateral Posterior Ankle Ratio.

BACKGROUND: Confirmation of anatomical reduction of ankle syndesmosis is mandatory because improper reduction leads to poor functional results. Coronal plane evaluation of syndesmosis is well described in the literature, but there is little information about sagittal plane evaluation. We sought to evaluate the relationship of fibula and tibia in the sagittal plane and create a new reference that can be applied easily and reliably. METHODS: Lateral ankle radiographs of 337 individuals with no history of ankle fracture were evaluated. A line was drawn between the anterior and posterior cortices of the distal lateral tibia, and the length of this line was measured (line 1). The distance between the anterior and posterior cortices of the fibula on this line was measured, and the center of this second distance was identified and marked. The posterior half of the fibular width was divided by line 1 and was named the lateral posterior ankle ratio (LPAR). Statistical analysis was performed by side and sex. RESULTS: Mean patient age was 38.6 years; mean LPAR was 0.48. There was a significant difference between men and women by age (P < .001) and LPAR (P = .01). There was no significant difference between right and left ankles by age (P = .63) and LPAR (P = .64). The LPAR was less than 0.40 in 6.8% of the radiographs, 0.40 to 0.50 in 57.9%, and greater than 0.50 to 0.60 in 32.9%. CONCLUSIONS: The LPAR should approximate 50% in normal lateral ankle images and, by extrapolation, after syndesmotic reduction.

Comparison of Second and Third-Generation Nails in the Treatment of Intertrochanteric Fracture: Screws versus Helical Blades.

OBJECTIVE: The aim of this study was to compare the radiological and functional outcomes of anti-rotation trochanteric nails (ATNs) with proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric femur fractures in elderly patients. MATERIALS AND METHODS: In total, 165 intertrochanteric fractures were treated between January 2007 and January 2010. One hundred forty patients were included. The operation time, amount of blood loss, fluoroscopy screening time, and length of hospitalization were recorded. The radiological position of the implant, quality of fracture reduction, and tip-apex distance were evaluated, and the postoperative complications as well as functional condition of the patients were assessed. RESULTS: There were no significant differences between the ATN and PFNA groups for the presence of general complications, length of hospitalization, and functional capacity. The mean operation time, blood loss amount, and fluoroscopy screening time were more in the ATN group than in the PFNA group. Reoperation was needed for nine and two patients in the ATN and PFNA groups, respectively, because of implant-related complications. CONCLUSION: Both ATNs and PFNA were suitable for the fixation of intertrochanteric fractures, but the risk of complication occurrence and need for reoperation were found to be higher in patients who were treated with ATNs.

Evaluation of symphysis pubis and sacroiliac joint distances in skeletally immature patients: A computerized tomography study of 1020 individuals.

OBJECTIVE: The aim of this study was to create a reference about normal pubic symphysis and sacroiliac joint widths of children and adolescents. METHODS: A total of 1020 computerized tomography axial scans of patients without pelvic injury between 2 and 18 year-old were studied. The narrowest width of pubic symphysis and bilateral sacroiliac joints were measured. RESULTS: The average pubic symphyseal width at 2 years old boys was 6.35 ± 1.06 mm (4.88-9.13 mm). The average of right and left sacroiliac joints' widths at 2 years old boys was 4.56 ± 0.65 mm (3.59-6.07 mm) and 4.58 ± 0.66 mm (3.44-5.74 mm), respectively. The average pubic symphyseal width of 2 years old girls was 5.85 ± 1.14 mm (4.06-8.20 mm). The average of right and left sacroiliac joints' widths at 2 years old girls was found 4.36 ± 0.56 mm (3.50-5.37 mm) and 4.42 ± 0.59 mm (3.58-5.73 mm), respectively. The average pubic symphyseal width at 18 years old boys was found 3.68 ± 1.30 mm (1.90-5.79 mm). The average of right and left sacroiliac joints' widths at 18 years old boys was found 1.97 ± 0.21 mm (1.73-2.41 mm) and 2.04 ± 0.30 mm (1.70-2.65 mm), respectively. The average pubic symphyseal width at 18 years old girls was 3.92 ± 0.52 mm (2.97-4.76 mm). The average of right and left sacroiliac joints' widths at 18 years old girls was found 2.34 ± 0.40 mm (1.58-3.34 mm) and 2.33 ± 0.37 mm (1.58-3.10 mm), respectively. CONCLUSION: Our results suggest that one should be suspicious about pelvic injury if the width of pubic symphysis is over 10 mm and width of sacroiliac joint is over 8 mm especially in patients younger than 10 years-old. LEVEL OF EVIDENCE: Level III Diagnostic study.

Do Patients With Acute Isolated Pubic Ramus Fractures Have To Be Hospitalized?

A total of 129 patients were included in the study. Haemoglobin levels on admission and at 24 hours were evaluated. Radiographs and computed tomography of the pelvis were also evaluated. The patients were divided into subgroups, according to the accompanying occult posterior pelvic injuries, whether they received anticoagulant-antiaggregant treatment, the number of pubic ramus fractures (single or multiple), the level of energy (low or high) and the zone(s) of the fracture(s). The mean haemoglobin decrease was 1.21 g/dL. Forty-six of the patients were under anticoagulant or antiaggregant treatment. Fifty-one of the fractures occurred due to low energy trauma. Posterior ring injuries were observed in 75 of the patients. Haemoglobin level decreases were statistically significant in injuries with high energy trauma aetiology, in patients using antiaggregant or anticoagulant and in fractures of the lateral half of the superior pubic ramus. It is important to follow all pubic ramus fractures closely because, even in low energy trauma, haemoglobin levels could decrease significantly. We recommend hospitalization to monitor this group of patients.

Is surgeons' experience important on intra- and inter-observer reliability of classifications used for adult femoral neck fracture?

PURPOSE: To evaluate whether surgeons' experience affect inter- and intra-observer reliability among mostly used classification systems for femoral neck fractures. MATERIAL AND METHODS: A power point presentation was prepared with 107 slides which were antero-posterior radiographs of each femoral neck fracture. Five residents, 5 orthopaedic surgeons and 5 senior orthopaedic surgeons reviewed this presentation and classified the fractures according to Garden, Pauwels and AO classifications. The order of the slides was changed and reviews were repeated after 3 months. Fleiss kappa and intraclass correlation coefficient values were calculated to evaluate inter and intra-observer reliability. RESULTS: Garden and AO classifications' inter-observer reliabilities were similar and higher than Pauwels classification. Among three experience groups, the inter-observer reliability for Garden classification was highest in senior surgeon group, the interobserver reliability for AO classification was highest in surgeon group, and interobserver reliability of Pauwels classification was highest in low experienced groups (residents and surgeons). Intra-observer reliability was highest for Garden and lowest for Pauwels classifications. Surgical experience was found to be not effective for intraobserver reliability. CONCLUSION: Both Garden and AO classifications were more reliable than Pauwels classification. Surgical experience was not significantly important on these three classification systems' evaluation. LEVEL OF EVIDENCE: Level IV, Diagnostic study.

Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients.

INTRODUCTION: Mechanical complications, such as cut-out of the head-neck fixation device, are the most common causes of morbidity after trochanteric femur fracture treatment. The causes of cut-out complications are well defined in patients who are treated with sliding hip screws and biaxial cephalomedullary nails but there are few reports about the patients who are treated with proximal femoral nail antirotation. AIM: The purpose of this study was to evaluate the most important factor about occurance of cutout complication and also to evaluate the risks of the combination of each possible factors. PATIENTS AND METHODS: Overally 298 patients were enrolled in the study. Medical records were reviewed for patients' age, fracture type, gender, anesthesia type and occurance of cut-out complication. Postoperatively taken radiographs were reviewed for tip-apex distance, obtained collo-diaphyseal angle, the quadrant of the helical blade and Ikuta reduction subgroup. The most important factor (s) and also predicted probability of cut-out complication was calculated for each combination of factors. RESULTS: Cut-out complication was observed in 14 patients (4.7 %). The most important factor about occurrence of the cut-out complication was found as varus reduction (p: 0.01), the second important factor was found as implantation of the helical blade in the improper quadrant (p: 0.02). Tip-apex distance was found as third important factor (p: 0.10). The predicted probability of cut-out complication was calculated as 45.6 % when whole of the four surgeon dependent factors were improperly obtained. CONCLUSION: Althought obtaining proper tip-apex distance is important to prevent cutout complication in these fractures, if the fracture is not reduced in varus position and helical blade is inserted in the proper quadrant, possibility of cut-out complication is very low even in the patients with high tip-apex distance.

Posterior fixation of thoracolumbar burst fractures: is it possible to protect one segment in the lumbar region?

BACKGROUND: The treatment for thoracolumbar burst fractures is controversial. The aim of this retrospective study was to compare intermediate-segment (IS) and long-segment (LS) instrumentation in the treatment for these fractures. METHODS: IS instrumentation was considered as pedicle fixation two levels above and one level below the fractured vertebra (infra-laminar hooks attached to lower vertebra with pedicle screws). LS instrumentation was done two levels above and two levels below the fractured vertebra. Among a total of 25 consecutive patients, Group 1 included ten patients treated by IS pedicle fixation, whereas Group 2 included fifteen patients treated by LS instrumentation. RESULTS: The measurements of local kyphosis (p = 0.955), sagittal index (p = 0.128), anterior vertebral height compression (p = 0.230) and canal diameter expansion (p = 0.839) demonstrated similar improvement at the final follow-up between the two groups. However, there was a significant difference (p < 0.05) between Group 1 and Group 2 regarding clinical outcome [Hannover scoring system, Oswestry disability questionnaire and the range of motion of the lumbar region compared to neutral (0°)]. CONCLUSIONS: The radiographic parameters were the same between the two groups. However, the clinical parameters demonstrated that IS instrumentation is a more effective management of thoracolumbar burst fractures.

Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures.

The aim of this study is to compare the radiological and functional outcomes of open reduction and volar locking plates versus external fixation (EF) in the treatment of unstable intra-articular distal radius fractures. In this retrospective comparative study, 69 of 80 patients who underwent an operation for AO/ASIF C1, C2 and C3 distal radius fractures were assessed. Functional evaluation was performed using the Gartland-Werley scoring system and the PRWE scale, and wrist range of motion and grip strength was also measured. For the radiological assessment, radial inclination, volar tilt, radial length, ulnar variance, and articular step-off were compared. The range of movement was better for all parameters in the volar plate group, but only wrist flexion and pronation range differed significantly between the groups (p = 0.037 and p = 0.014, respectively). With the exception of better subjective functional results in the volar plate group, the differences were not significant. With respect to radiological evaluation, all parameters were better in the volar plate group, but only radial inclination and articular step-off were significantly better (p = 0.018 and p = 0.029, respectively). In the volar plate group, two patients had carpal tunnel syndrome and one patient had regional pain syndrome. In the external fixator group, six patients had superficial pin tract infection, two patients had sensory branch injury, and four patients had regional pain syndrome. Volar locking plate fixation appeared as a dependable method for the treatment of intra-articular distal radius, with lower complication rates. On the other hand, EF remains a suitable surgical alternative for these fractures, with easy application and acceptable results.

Reliability and reproducibility of classifications for distal radius fractures.

OBJECTIVE: The aim of this study was to evaluate the interobserver reliability and intraobserver reproducibility of the Universal, AO, Fernandez and Frykman classifications for distal radius fractures. METHODS: Fifty standard sets of posteroanterior and lateral roentgenograms of displaced distal radius fractures were classified two times by two groups of evaluators at 2-month intervals. The first group consisted of 10 orthopedic surgeons with a minimum of 5 years of experience. The second group consisted of 10 orthopedic residents in their first two years of practice. Interobserver reliability and intraobserver reproducibility were assessed using Cohen's kappa test. RESULTS: None of the classifications achieved good- very good reliability levels. The Fernandez classification had a moderate and the others had a fair interobserver agreement kappa coefficient. All classifications had fair kappa intraobserver agreement although the Frykman and Fernandez classifications had better results. CONCLUSION: None of the classification systems were superior in terms of reliability and reproducibility. The reliability and reproducibility rates of all four classifications were insufficient.

IGF-1 Increases with Hyperbaric Oxygen Therapy and Promotes Wound Healing in Diabetic Foot Ulcers.

Objectives. To investigate insulin-like growth factor I (IGF-1) levels in response to hyperbaric oxygen therapy (HBOT) for diabetic foot ulcers and to determine whether IGF-1 is a predictive indicator of wound healing in patients with diabetic foot ulcers. Design and Methods. We treated 48 consecutive patients with diabetic foot ulcers with HBOT. Alterations of IGF-1 levels in patients whose wound healed with HBOT were compared with those in patients who did not benefit from HBOT. Results. There was no significant difference in initial IGF-1 levels between the two groups (P = 0.399). The mean IGF-1 level increased with HBOT (P < 0.05). In the healed group, the mean IGF-1 increase and the final values were significantly higher (P < 0.05). In the nonhealed group, the mean IGF-1 increase was minus and the final values were not significantly different (P < 0.05). The increase in IGF-1 level with HBOT was significantly higher in the healed group (P < 0.001). Conclusions. IGF-1 increased significantly in the healed group. We believe that HBOT is effective in the treatment of diabetic foot ulcers, with an elevation of IGF-1. This alteration seems to be a predictive factor for wound healing in diabetic foot ulcers treated with HBOT.