Platelet-rich plasma decreases fibroblastic activity and woven bone formation with no significant immunohistochemical effect on long-bone healing: An experimental animal study with radiological outcomes.

PURPOSE: This study aimed to analyze the immunohistochemical effect of platelet-rich plasma (PRP) on healing of long-bone fractures in terms of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF), the Ki-67 proliferation index, and radiological and histological analyses. METHODS: Sixteen adult rabbits, whose right femoral diaphysis was fractured and fixed with Kirschner wires, were randomly divided into two groups, control and PRP (groups A and B, respectively). PRP was given to group B at 1 week postoperatively, and all animals were euthanized after 12 weeks. Radiographic evaluations were performed periodically. Cortical callus formation, chondroid and woven bone area percentages, osteoblastic and fibroblastic activities, and mature bone formation were examined. The depths of BMP-2 and VEGF staining were measured. The Ki-67 proliferation index was also calculated. RESULTS: The mean radiological union score of group B was significantly higher than that of group A. There were also statistically significant differences between groups A and B in terms of cortical callus formation, woven bone area percentage, fibroblast proliferation, and mature bone formation. Group B had significantly more cortical callus and mature bone formation with less woven bone and fibroblast proliferation. Immunohistochemical analysis revealed no statistically significant difference between the groups in terms of BMP-2 and VEGF staining and the Ki-67 index. CONCLUSIONS: PRP had no effect on BMP-2 or VEGF levels with no increase in the Ki-67 proliferation index, although its application had a positive effect on bone healing by increasing callus and mature bone formation with decreased woven bone and fibroblast proliferation.

Comparison of repair techniques in small and medium-sized rotator cuff tears in cadaveric sheep shoulders.

OBJECTIVE: The aim of this study was to compare new knotless single-row and double-row suture anchor techniques with traditional transosseous suture techniques for different sized rotator cuff tears in an animal model. METHODS: The study included 56 cadaveric sheep shoulders. Supraspinatus cuff tears of 1 cm repaired with new knotless single-row suture anchor technique and supraspinatus and infraspinatus rotator cuff tears of 3 cm repaired with double-row suture anchor technique were compared to traditional transosseous suture techniques and control groups. The repaired tendons were loaded with 5 mm/min static velocity with 2.5 kgN load cell in Instron 8874 machine until the repair failure. RESULTS: The 1 cm transosseous group was statistically superior to 1 cm control group (p=0.021, p<0.05) and the 3 cm SpeedBridge group was statistically superior to the 1 cm SpeedFix group (p=0.012, p<0.05). The differences between the other groups were not statistically significant. CONCLUSION: No significant difference was found between the new knotless suture anchor techniques and traditional transosseous suture techniques.

Internal fixation of bilateral sacroiliac dislocation with transiliac locked plate: a biomechanical study on pelvic models.

OBJECTIVE: The purpose of this study was to analyze and compare the mechanical characteristics of a new iliosacral fixation technique (bilateral S1 pedicle fixation through a transiliac locked plate) for bilateral sacroiliac dislocations with other previously described methods. METHODS: Bilateral sacroiliac dislocations were created in 21 pelvic models and divided into three different fixation method groups. Group 1 was fixed using posterior tension band plating with a 3.5 mm locked plate combined with fixed-angle locked 3.5 mm screw fixation of bilateral S1 vertebra pedicles through suitable holes of the plate. Group 2 underwent posterior tension band plating with a 3.5 mm locked plate combined with bilateral spongious iliosacral screw fixation and Group 3 bilateral iliosacral spongious screw fixation alone. The ultimate load to failure and load for 10 mm of displacement for all three groups were compared. RESULTS: The average loads to failure for Groups 1, 2 and 3 were 1775, 2084 and 2230 N, respectively, and average loads for 10 mm of displacement were 1033, 1884 and 2013 N, respectively. Group 2 and 3 had the strongest fixation constructs although there was no statistically significant difference between these two groups (p=0.452). Group 2 and 3 were superior to Group 1 in terms of loads for 10 mm of displacement. There was no significant difference between Group 2 and 3 in this regard (p=0.397). CONCLUSION: Iliosacral screws are superior to bilateral S1 pedicle fixation through posterior tension band plating. However, the combination of tension band plating with iliosacral screw fixation does not improve the stability of the posterior pelvic ring.

A lipoma causing separation of toes in the second web space of the foot.

Lipomas are common and benign soft tissue neoplasms which are composed of fat cells. These tumors often develop where adipose tissue is present; however, they can be rarely found in the foot. In this article, we present a 55-year-old male case with a lipoma leading to separating toes in the second web space of the foot and mechanical discomfort.

Primary extracranial meningioma of the lower limb.

This paper is about a primary extracranial meningioma case of a 40-year-old male patient who presented with a complaint of a rapidly growing painless stiff mass located in his left thigh. The magnetic resonance imaging examination revealed that the lesion was well-circumscribed and with isosignal intensity to muscle on T1-weighted images and with a relatively hiperintense on T2-weighted images. The histopathological analysis of the specimens both from the incisional biopsy and the excisional surgery were typical of meningioma showing spindle cell proliferation with a whirling pattern. Although extracranial meningiomas are very rare, it should be considered in the differential diagnosis of a spindle cell neoplasm.

A glomus tumor anterior to the patellar tendon: a case report.

Glomus tumors are benign neoplasms originating from the glomus body. They are most frequently found in the nail bed of the hands, and their occurrence in other parts of the body is rare. A 75-year-old man presented with left anterior knee pain of 30-year history, that became more intense with light touch or clothing and increased in severity despite medical treatment. Physical examination showed a painful, soft, mobile, red-purple colored mass, 2 x 2 cm in size, at the inferior border of the patella. Plain radiographs showed no pathology other than mild degenerative changes. Magnetic resonance imaging revealed a mass lesion, 1.5 x 1.1 x 2 cm in size, located at the anterior border of the patellar tendon, which showed hypointensity on T1A-weighted sequences and hyperintensity on T2-weighted sequences and T2-weighted sequences with fat saturation. The mass was excised and the histopathological diagnosis was reported as glomangioma. Postoperatively, the patient had no complaint of pain and no recurrence was observed during a two-year follow-up.

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears.

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up, 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest follow-up was 28.5 and mean Constant score was 80.3. Constant scores were found to be significantly low for the failed group. Age was found to be significantly related to failed repair. Fatty infiltration stage in the failed repair group was significantly high, and a strong positive correlation for both groups existed pre and postoperatively. When both groups were compared, the failed group was found to have significantly low measurements at extension and internal rotation. Despite high failure rates, functional results were satisfactory. Increased age and fatty infiltration stage decrease success.

Biomechanical and histological comparison of the influence of oestrogen deficient state on tendon healing potential in rats.

Thirty-six female Sprague-Dawley rats were divided into two groups: oophrectomised (oestrogen deficient) rats and sham operated (oestrogen maintained) rats. Rats were sacrificed at six, ten, and 14 weeks. The rats were randomly chosen to have biomechanical evaluation on one side and histological evaluation on the other. Biomechanical testing was performed on an Instron machine to measure peak load. Histological sections were evaluated for cell proliferation, collagen-fibre organisation, fibroblast density, angiogenesis, inflammatory cells, chondroid and osseous metaplasia. Compared with the sham operated group, the oophrectomised group showed a lesser average maximum stress (42.9 N/m(2) versus 33.7 N/m(2)) at six weeks, which was significant (p < .05). Succeeding weeks showed no significant biomechanical differences between the two groups. The sham operated group showed greater inflammatory response, which was statistically significant (p < 0.05), and also revealed greater cell proliferation and density. The results of this study revealed that endogenous oestrogen may improve healing of the Achilles tendon in rats.

Acute fracture of the acetabulum secondary to a convulsive seizure 3 years after total hip arthroplasty.

While aseptic loosening, osteolysis, and infection are the most common causes of failure after total hip arthroplasty (THA), late hip pain can also be the result of acetabular fracture related to trauma and resultant prosthetic failure. However, atraumatic fracture of the acetabulum around a well-fixed acetabular component is unusual. We present a patient with an acetabular fracture resulting from a generalized convulsive attack 3 years after an uncomplicated primary THA. A 33-year-old man presented with acute left hip pain. He had chronic renal insufficiency and had undergone bilateral THA due to avascular necrosis. The night prior to his admission, he suffered a generalized convulsive attack with severe extremity contractions. Afterwards, he had acute left groin pain and had difficulty walking. Physical examination revealed moderate left hip pain as well as a 1-cm shortening of the affected limb. Radiological examination demonstrated an acetabular fracture with medial wall comminution. The acetabular component had migrated medially and rotated horizontally. Revision of the acetabular component with a reinforcement ring and implantation of a cemented acetabular component was realized. Severe muscle spasms during generalized seizures are known to lead to various musculoskeletal injuries (fractures of the proximal humerus, femur, acetabulum, and dislocation of the shoulder). Seizures could also lead to acute periprosthetic fracture of the acetabulum in patients with osteopenia. Therefore careful reaming is required to avoid overmedialization of the acetabular component in those patients.

[Development of osteonecrosis after arthroscopic meniscal and chondral knee surgery: a report of five cases]. / Artroskopik menisküs ve kikirdak cerrahisinden sonra osteonekroz gelisimi: bes olgu sunumu.

The development of osteonecrosis after arthroscopic surgery has been associated with meniscectomy, chondral surgery, and the use of thermal energy. This paper presents five cases, four of which fulfilled the temporal criteria for postarthroscopy necrosis, i.e. presurgical magnetic resonance imaging was obtained at least four weeks after the onset of symptoms). Four cases were treated conservatively while one underwent arthroscopic debridement and microfracturing. The diagnosis of osteonecrosis should be kept in mind in osteoarthritic patients whose knee symptoms manifest a sudden increase without trauma, and in cases with worsening knee symptoms after arthroscopic surgery. The optimal treatment strategy in these patients is still debatable.

[Early results of kyphoplasty in osteoporotic vertebral compression fractures]. / Osteoporotik vertebra kompresyon kiriklarinda kifoplasti sonrasi erken dönem sonuçlar.

OBJECTIVES: We evaluated early results of kyphoplasty for osteoporotic vertebral compression fractures with regard to the level of pain, activity levels of patients, and radiographic restoration of the vertebra bodies. METHODS: Sixteen patients (4 males, 12 females; mean age 63 years; range 55 to 72 years) with osteoporotic vertebral compression fractures in the lumbar spine were treated with kyphoplasty. The procedure was performed at 21 levels, with a minimum of 3 ml (range 3 to 6 ml) of cement per level. The mean time from the onset of symptoms to the application was six days (range 2 to 16 days). The effectiveness of the procedure was evaluated by a visual analog scale (VAS: 0 no pain; 10 very severe pain) before kyphoplasty, and after the first day and one month of the procedure. In addition, restoration of the vertebra bodies was assessed on pre- and postoperative radiographs by measuring the anterior, middle, and posterior heights. The mean follow-up was 11 months (range 4 to 30 months). RESULTS: The mean VAS scores were 8.8 (range 7 to 10), 2.4 (range 1 to 5), and 1.6 (range 0 to 3) before kyphoplasty, and after the first day and one month of the procedure, respectively (p<0.0001). All the patients returned to preinjury levels of activity within the first month. No collapse or refracture occurred in the treated vertebrae. Changes in the anterior, middle, and posterior heights of the vertebra bodies after the procedure were not significant. The only complication was the development of an additional fracture in the nearby segment in two patients, for which kyphoplasty was performed. CONCLUSION: With proper patient selection, kyphoplasty is an effective and reliable option for osteoporotic vertebral compression fractures, yielding 80% to 95% success rates.

[Transforaminal epidural steroid injection under computed tomography guidance in relieving lumbosacral radicular pain]. / Lumbosakral radiküler agri tedavisinde bilgisayarli tomografi esliginde transforaminal epidural steroid enjeksiyonu.

OBJECTIVES: We analyzed the efficacy of transforaminal epidural steroid injections under computed tomography (CT) in relieving lumbosacral radicular pain due to spinal stenosis. METHODS: Forty-two patients (7 males, 35 females; mean age 67 years; range 34 to 90 years) with lumbosacral radicular pain due to spinal stenosis were prospectively monitored following transforaminal epidural steroid injections under computed tomography. Injections were repeated twice in two patients (4.8%) and three times in one patient (2.4%). The severity of pain was assessed with the use of a visual analog scale (VAS) before and after injections (1st day, 1st week, 3rd week, 6th month, and the last follow-up). The mean follow-up period was 12.1 months (range 6 to 25 months). RESULTS: The median VAS score before injections was 9 (range 6 to 10). During the first six months, the median VAS scores were always significantly lower than the preinjection score (p<0.005). The mean VAS score of 23 patients with a follow-up of at least a year was still significantly lower than that obtained at the end of six months (2.26 vs 2.52, p<0.005). No procedure-related complications occurred. CONCLUSION: Selective transforaminal epidural steroid and analgesic injection under CT guidance is a safe and reliable conservative method to relieve lumbosacral radicular pain due to spinal stenosis.

Bipositional MR imaging vs arthrography for the evaluation of femoral head sphericity and containment in Legg-Calvé-Perthes disease.

Eleven hips of 10 patients with Legg-Calvé-Perthes disease (LCPD) were examined by arthrography and magnetic resonance (MR) imaging. Arthrogram and MR images were obtained with the hips in neutral position and in 20 degrees flexion-abduction and internal rotation. Modified arthrographic index (AI) was used for the evaluation of sphericity and acetabulum head index (AHI) was used for the assessment of containment. According to AI, there is no significant difference between the arthrograms and coronal MR imaging, but the difference between the coronal and sagittal MR imaging was significant. There was no statistical difference between the arthrograms and MR measurements in terms of AHI. Anterior flattening of the femoral head and the effect of hip flexion in the containment at the sagittal plane could be demonstrated clearly in sagittal MR imaging. Even if there was significant flattening in coronal plane, the sphericity of the head was preserved in the sagittal plane. Bipositional MR imaging is comparable to arthrography for the demonstration of sphericity and containment of the femoral head in both coronal and sagittal planes in LCPD.