Should venous doppler ultrasonography be routinely applied before lower extremity major orthopedic surgery?

BACKGROUND: Hip-knee arthroplasty and knee arthroscopy (KA) is frequently applied in the orthopaedic surgery. The approach does not exist related with the preoperative asymptomatic deep venous thrombosis (DVT). In this study, the patients who would undergo surgery lower extremity were screened for asymptomatic DVT, using the venous Doppler ultrasonography (USG). PATIENTS AND METHODS: DVT was screened by venous Doppler USG in the patients who would undergo hip-knee arthroplasty and KA between the dates of November 2013 and September 2015. The patients were investigated regarding the age, gender, and the planned operation. The cases were separated to the following three groups: group I (<49 years), Group II (49-69 years), and Group III (≥70 years). RESULTS: The study included 222 patients; of these, 174 were female and 48 were male. Group I, Group II, and Group III included 45, 115, and 62 patients, respectively. Of the six patients determined to exist with DVT, 2 (1.73%) were in Group II, and 4 (6.45%) were in Group III. CONCLUSION: Although the differences were not found to be statistically significant, it may be useful to screen asymptomatic DVT by Doppler USG in the preoperative period in the 70-year-old male patients, and in those over 70.

Effects of bone cement loaded with teicoplanin, N-acetylcysteine or their combination on Staphylococcus aureus biofilm formation: an in vitro study.

OBJECTIVES: This study aims to demonstrate the antibiofilm effects of teicoplanin alone, N-acetyl cysteine (NAC) alone, or combination of both compounds when mixed with bone cement. MATERIALS AND METHODS: A total of four groups were formed by using six cement samples in each, prepared with bone cement having different contents in each group. Group 1 (control group): cement alone without any drugs added. Group 2: 40 g cement, 400 mg teicoplanin. Group 3: 40 g cement, 6 g NAC. Group 4: 40 g cement, 6 g NAC, 400 mg teicoplanin. All cement samples were infected with Staphylococcus aureus for 48 hours at 36.5 °C. Bacterial colonies were then counted by serial dilution method. Bacteria were counted using scanning electron microscopic (SEM) images. RESULTS: Counts of bacteria colonies were 5.83±1.60 [mean colony forming unit (cfu) x 105±standard deviation (SD)] in group 1, 0.12±0.56 in group 2, 0.11±0.65 in group 3, and 0.01±0.001 in group 4. Significant difference was found between group 1 and all other groups (p<0.05), and between group 4 and all other groups (p<0.05). According to SEM analysis, counts of bacteria (mean±SD) were 1.88±0.45, 0.75±0.26, 0.21±0.22, and 0.13±0.25 in groups 1, 2, 3, and 4, respectively. Significant difference was found between group 1 and all other groups (p<0.05), and between group 4 and all other groups (p<0.05). CONCLUSION: N-acetyl cysteine, teicoplanin, and their combination significantly reduced formation of biofilm compared to the control group. Also, combination of NAC and teicoplanin had the highest antibiofilm effect.

Advantages of Pressurized-Spray Cryosurgery in Giant Cell Tumors of the Bone.

BACKGROUND: Giant Cell Tumor is considered a benign, local and aggressive tumor. Although considered a benign bone tumor, it is still the subject of discussion and research because of the associated local bone destruction, as well as high rates of recurrence and distant metastases. Options are being developed for both surgical techniques and adjuvant therapies. AIMS: The present study evaluated the administration of cryotherapy via a pressurized-spray technique in giant cell tumors of the bone. STUDY DESIGN: Cross-sectional study. METHODS: The study included 40 patients who were treated with extensive curettage and cryotherapy at various locations during the period from February 2006 to December 2013. Informed consent forms were obtained from the participants and ethics committee approval was taken from the local ethics committee of Ondokuz Mayis University. The pressurized-spray technique was performed using liquid nitrogen. The patients were evaluated with respect to age, gender, radiological appearance, treatment modality, duration of follow-up, skin problems and recurrence. RESULTS: Twenty-one patients were female; 19 were male. The average age of the patients was 33 years (range: 16-72 years), and the average duration of follow-up was 43 months (range: 12-80 months). The average time from the onset of the complaints to the diagnosis was 6 months (range: 2-12 months). Based on the Campanacci classification: 9 patients were Grade I; 25 patients were Grade II; six patients were Grade III. The lesion was located in the femur in 14 patients, in the tibia in 11 patients, in the radius in 5 patients, in the pelvis in 4 patients, in the fibula in 3 patients, in the metatarsal in 2 patients and in the phalanges of the hand in one patient. One patient had postoperative early fracture. None of the patients had skin problems and infection. Three (7.5%) of the patients had recurrence. CONCLUSION: It was found that cryotherapy was highly effective in the lesions, especially those located in the femur and tibia and remained insufficient in the lesions expanded outside the cortex. Wound healing problems, infection and fracture risk are lower with this technique.

Effect of Electromagnetic Wave on Bone Healing in Fixed and Unfixed Conditions.

Mobile phones have come into daily life and are now one of the most frequently used devices for communication. The aim of this study was to evaluate possible effect of electromagnetic wave (EMW) with and without fixation material on bone healing.Forty male rats were exposed to fracture on tibia bone and were randomly divided into 4 groups as E(+)K(+), E(+)K(-), E(-)K(+), and E(-)K(-) where E(+) means EMW exposure and K(+) means Kirschner wire fixation. At the end of study tibia samples were taken from all the groups for the quantitative evaluation of regeneration.Significant difference was found between Group E(+)K(+) and E(-)K(+) in terms of both new bone and capillary volume.Electromagnetic wave may be harmful for bone healing with fixation whereas it has no same effect on bone regeneration without fixation.

Comparison of treatment of unstable intertrochanteric fracture with different arthroplasty methods.

BACKGROUND: Intertrochanteric femur fractures are elderly is very common and can be treated by different fixation methods such as internal fixation and arthroplasty. In our study, we investigated the correlation between the hemiarthroplasty treatment method and functional results. MATERIALS AND METHODS: The study consists of 121 patients with intertrochanteric fractures and these patients are divided into three groups. Eighty-five were male and 36 were female. Group I was uncemented bipolar hemiarthroplasty patients, Group II was cemented bipolar hemiarthroplasty and Group III was cemented calcar preserving bipolar hemiarthroplasty. Mean follow-up period was 16 months. Harris hip score was used to evaluate functional outcome of the patients. RESULTS: There were no significant differences between three groups when comparing the mortality rate in the 1(st) month and 1(st) year but all time mortality was proportionally lower in Group I comparing to the two other groups. There were no significant differences between three groups when comparing the functional results in 1(st) month and 1(st) year. CONCLUSION: In our study, uncemented bipolar hemiarthroplasty is a preferable treatment over the two other arthroplasty treatment model (cemented bipolar and calcar preserving) regarding to the mortality rate since there is no significant difference between. This conclusion needs further studies with greater number of patients.

Periprosthetic joint infection treated via bone cement and without the removal of hardware.

Periprosthetic joint infection (PJI) is a challenging complication with a frequency of 0.5-3%. The patient's age, recurrent surgeries, and comorbid systemic diseases increase the risk of infection. Although the current approach in the treatment of PJI is a two-stage revision; sometimes, removing all the implants can lead to more serious complications. PJI's complications are increase in the time of surgery, loss of blood volume, and increase in the amount of bone loss. Infected soft tissue and dead bone tissue debridement must be made in all cases. One of our cases had bone defects due to recurrent hip arthroplasty revisions. Our case that was given PJI treatment by covering the well-fixed components with bone cement and removing only the mobile parts was discussed in line with the literature.

N-acetylcysteine eradicates Pseudomonas aeruginosa biofilms in bone cement.

Biofilm is an example of bacterial group behavior. We investigated the effect of N-acetylcysteine (NAC) alone and in combination with ciprofloxacin on Pseudomonas aeruginosa biofilm formation. Four groups (each contains six molds) of standardized bone cement molds were infected. NAC, ciprofloxacin each alone, and NAC/ciprofloxacin combination were evaluated in point of inhibiting and eradicating biofilm capacity using microbiological and electron microscopical evaluation techniques. Microbial counts and electron microscopical observations showed that the effect of NAC and ciprofloxacin combination on biofilm formation in bone cement is valuable. NAC enhances the beneficial effect of ciprofloxacin when used in combination with it in bone cement. SCANNING 38:766-770, 2016. © 2016 Wiley Periodicals, Inc.

The effect of teicoplanin on fracture healing: an experimental study.

OBJECTIVES: This study aims to investigate the effect of teicoplanin on fracture healing stereologically and histopatologically. MATERIALS AND METHODS: Twenty male Wistar albino rats were separated into two as the study (teicoplanin) and control groups. After intramedullary fixation of the right tibia of all the rats with 0.5 mm Kirschner wire under general anesthesia, standard closed shaft fractures were created using fracture formation apparatus. Teicoplanin (10 mg/kg) and saline were administered intraperitoneally to the study and control groups, respectively. Control radiographs were taken at the end of the procedure and the rats were sacrificed after 28 days. New bone and connective tissue volumes were calculated on obtained tissue samples using unbiased stereological and histopathological techniques. RESULTS: It was observed that teicoplanin increased the formation of bone, vascularization, and connective tissue. There was a statistically significant difference between the two groups in respect of bone and vascular total volume (p<0.05). Although an increase was observed in connective tissue total volume, no statistically significant difference was detected between the two groups (p>0.05). CONCLUSION: In addition to its antibacterial effect, teicoplanin may increase new bone formation; thus, it may be used safely in the treatment of bone defects accompanied with infection.

Brucella melitensis es un agente de la artritis pediatrica: Serie de casos / Brucella melitensis is an agent in pediatric arthritis: Case series

La brucelosis es un importante problema de salud y, en algunas regiones, es endémica. En ella, es muy frecuente observar un compromiso osteoarticular (20%-60%). En regiones donde es endémica, al analizar la etiología de la artritis, hay que pensar en esta entidad. En este artículo, se informan los casos de 12 pacientes; 11 de ellos eran varones, y la media de edad fue de 12 años (intervalo: de 2 a 17 años). Se determinó el compromiso de la cadera en 9 pacientes; de la articulación sacroilíaca, en 2; y de la rodilla, en 1. Todos los pacientes tenían artralgia; 8 pacientes tuvieron fiebre; y 1 paciente, leucocitosis. A un paciente se lo sometió a un tratamiento quirúrgico debido a artritis séptica. La infección puede derivar en complicaciones graves, especialmente en el compromiso del aparato locomotor. Debe tenerse en cuenta que, mediante el diagnóstico y tratamiento tempranos, es posible prevenir las complicaciones.

Brucellosis is a significant health problem and is endemic in some regions. Osteoarticular involvement is seen most frequently in brucellosis (20-60%). In regions where brucellosis is endemic, it should be considered in the etiology of arthritis. We report the 12 cases, were 11 males with a mean age of 12 years (range, 2-17 years). Involvement was determined in the hip in 9 cases, the sacroiliac joint in 2 and the knee in 1. All the cases had arthralgia, fever was determined in 8 cases and leukocytosis in one case. Surgical treatment was applied to one case because of septic arthritis. Serious complications of the infection may be encountered and particularly in musculoskeletal system involvement, it should be kept in mind that complications can be prevented by early diagnosis and treatment

[Brucella melitensis is an agent in pediatric arthritis: Case series]. / Brucella melitensis es un agente de la artritis pediatrica: Serie de casos.

Brucellosis is a significant health problem and is endemic in some regions. Osteoarticular involvement is seen most frequently in brucellosis (20-60%). In regions where brucellosis is endemic, it should be considered in the etiology of arthritis. We report the 12 cases, were 11 males with a mean age of 12 years (range, 2-17 years). Involvement was determined in the hip in 9 cases, the sacroiliac joint in 2 and the knee in 1. All the cases had arthralgia, fever was determined in 8 cases and leukocytosis in one case. Surgical treatment was applied to one case because of septic arthritis. Serious complications of the infection may be encountered and particularly in musculoskeletal system involvement, it should be kept in mind that complications can be prevented by early diagnosis and treatment.

La brucelosis es un importante problema de salud y, en algunas regiones, es endémica. En ella, es muy frecuente observar un compromiso osteoarticular (20%-60%). En regiones donde es endémica, al analizar la etiología de la artritis, hay que pensar en esta entidad. En este artículo, se informan los casos de 12pacientes; 11 de ellos eran varones, y la media de edad fue de 12 años (intervalo: de 2 a 17 años). Se determinó el compromiso de la cadera en 9 pacientes; de la articulación sacroilíaca, en 2; y de la rodilla, en 1. Todos los pacientes tenían artralgia; 8 pacientes tuvieron fiebre; y 1 paciente, leucocitosis. A un paciente se lo sometió a un tratamiento quirúrgico debido a artritis séptica. La infección puede derivar en complicaciones graves, especialmente en el compromiso del aparato locomotor. Debe tenerse en cuenta que, mediante el diagnóstico y tratamiento tempranos, es posible prevenir las complicaciones

Distribution of pediatric bone and soft tissue tumors in the central Black Sea region.

This study aimed to evaluate pediatric cases treated surgically for an initial diagnosis of bone and soft tissue tumor between January 1987 and January 2012. This retrospective study evaluated 328 patients with pathologically confirmed tumor from a total of 374 patients hospitalized with an initial diagnosis of tumor. The cases were analyzed with respect to frequency, age, gender, and localization. One hundred and eighty (54.8%) males and 148 (45.2%) females, with a mean age of 13 years (range: 1-18 years), were included in the study. The tumors were determined as 258 (78.6%) bone tumors and 70 (21.4%) soft tissue tumors. The most common benign bone tumor was observed to be osteochondroma (n=61, 30.7%), and the most common malignant bone tumor was osteosarcoma (n=31, 52.6%). The most common benign soft tissue tumor was hemangioma, which is a vascular tumor (n=28, 43.8%), and the most common malignant soft tissue tumor was rhabdomyosarcoma (n=5, 83.3%). It is thought that similar studies will serve to form larger series and facilitate inter-regional comparisons by collecting data from centers that surgically treat bone and soft tissue tumors, thereby benefitting both pediatric and public health.

[Is non-vascularized autografting in the proximal scaphoid nonunions ineffective?]. / Proksimal skafoid kaynamamalarinda non-vaskülarize otogreftleme etkisiz midir?

OBJECTIVES: In this study, we aimed to evaluate the results of proximal scaphoid non-union treated with non-vascularized bone grafting and screw fixation. PATIENTS AND METHODS: Thirteen patients who were treated surgically for proximal scaphoid non-union with a minimum of one-year follow-up in our clinic were evaluated. Wrist movements were measured by standard goniometry and muscle strength by hand dynamometry. Non-union was classified radiologically according to the Schernberg classification, while functional assessment was performed based on the Herbert-Fisher Grading System and the Mayo Clinic Modified Wrist Scoring System. RESULTS: The mean follow-up period was 14 months (range, 12 to 40 months). Full union was observed in eight of 13 patients (61.5%). The mean time to union was 16 (range, 12 to 40) weeks. There was no loss of function of more than 10% compared to the healthy hand in the cases with full union. Postoperative mean grip strength was 37.3±3.0 kg. The rates of excellent and good results were 61.5%, moderate and poor results were 38.5% according to the Herbert-Fisher classification and the mean Mayo score was 80±13. CONCLUSION: We obtained no satisfactory results in patients treated with non-vascularized bone grafting and screw fixation for proximal scaphoid non-unions. We suggest that grafting should be carried out in selected cases due to the adverse effects of open techniques and bone grafting on vascularity of scaphoid bone.