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.

[Ilizarov augmentation in the treatment of humeral shaft nonunions developing after failed intramedullary nailing]. / Basarisiz intramedüller çivi uygulamasi sonrasi gelisen humerus cisim kaynamamalarinda Ilizarov güçlendirme tedavisi.

OBJECTIVES: In this study, we presented our experience with Ilizarov augmentation in the treatment of patients with humeral shaft nonunion following failed intramedullary nail fixation. PATIENTS AND METHODS: Seven patients (4 females, 3 males; mean age 47 years; range 32 to 62 years) with established humeral nonunions following antegrade intramedullary nailing were evaluated retrospectively. In all patients an Ilizarov fixator was applied over the nail as a closed procedure. The average period between the first injury and fixator application was 12.2 months (range 8 to 21). The patients were assessed radiologically with respect to bony union at follow-up. Constant scoring was used to assess shoulder function in the clinical evaluation. RESULTS: All nonunions healed without a major complication. Five patients had superficial pin tract infections which responded well to antibiotic treatment. The follow-up average Constant score was 78. CONCLUSION: Ilizarov external fixation is an alternative and effective method in the treatment of aseptic humeral shaft nonunion following failed intramedullary nailing.

Comparison of various surgical methods in the treatment of implant-related infection.

The treatment of implant-related infections is troublesome. This study was conducted to compare the effectiveness of three different surgical modalities in the treatment of implant-related infection. A total of 32 Wistar albino rats were randomised into four groups after the establishment of implant-related infection: no treatment, surgical débridement, antibiotic-loaded bone cement and antibiotic-loaded autogenous bone. Microbiological colony counts were made at the sixth week in order to evaluate the effectiveness of of the treatments. The antibiotic-loaded bone cement group revealed superior results compared with the other groups in terms of reduction of microbiological colonies. Three animals in the bone cement group revealed extensive infection. Although antibiotic-loaded bone cement showed superiority over other treatment modalities, it should be employed after an unsuccessful trial of débridement because of the risk of extensive infection.

Arthrodesis of neuropathic ankle joint by Ilizarov fixator in diabetic patients.

BACKGROUND: Fusion of the neuropathic ankle joint is extremely difficult and associated with many complications. The use of the Ilizarov fixator in ankle fusion for patients with neuropathic arthropathy is not clear. We aimed to evaluate the results of the Ilizarov method for ankle arthrodesis in diabetic patients with neuropathic arthropathy. METHODS: We report the results of neuropathic ankle joint arthrodesis performed with the Ilizarov apparatus in 11 patients. The mean age of the patients was 51 years (range, 35-67 years), all patients were diabetic, and they all had a history of ankle trauma unresponsive to conservative treatment. Deformity and instability of the ankle resulting in a nonplantigrade foot was the operative indication. RESULTS: Solid fusion was obtained in all patients except one, at an average of 16.1 weeks (range, 12-20 weeks). At final follow-up, excellent results were obtained in three patients, good in six, fair in one, and poor in one. No major complication occurred. CONCLUSIONS: The Ilizarov fixator may be an alternative and effective means for neuropathic ankle arthrodesis, especially when the usage of internal fixation methods have some limitations.

Bilateral stress fractures of the distal fibula in a woman with osteoporosis: a case report.

Bilateral stress fractures of the fibula are very rare. We present an unusual case report of a 54-year-old osteoporotic woman with bilateral stress fractures involving the distal fibula. After conservative treatment, she made a good recovery with full motion and was free of pain.

Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study.

When performing a medial opening wedge upper tibial osteotomy, a fracture into the lateral cortex can lead to loss of stability of the construct. The aim of this study was to assess different intra-operative techniques to overcome this problem, and test the stability under axial compression. Twenty eight calf tibias had a medial opening wedge osteotomy and lateral cortical fracture created and then were tested in four groups depending on how this fracture was fixed; none, a plate and screws, two staples, and a circular external fixator. Loss of medial height of the osteotomy line and lateral cortex micromotion was evaluated under maximal axial loading of 2,500 N. No fixation had significantly inferior results compared with the other three types. The plate and screws and staples showed better results than circular external fixation in terms of preserving the medial height, whereas the plate and screws and circular external fixator showed better results compared with staples in terms of lateral cortex stability. This study suggests that plate and screw fixation for lateral cortex disruption during the medial opening wedge upper tibial osteotomy has better stability under axial compression than staples or a circular external fixator.

Fracture dislocation of sacroiliac joint associated with triradiate cartilage injury in a child: a case report.

We report a very rare injury of a 8-year-old girl with sacroiliac fracture dislocation and triradiate cartilage separation. After the restoration of the sacroiliac joint by open means, reduction of the separated cartilage was seen. At 20 months follow-up, an osseous bridging at the triradiate cartilage and mild coxa valga deformity developed. We think that every child with serious sacroiliac joint injury should be evaluated for associated triradiate cartilage injury and followed to skeletal maturity for late complications such as acetabular dysplasia, hip subluxation and pelvic asymmetry.

[In vitro evaluation of gentamicin and teicoplanin release from cancellous human bone]. / Insan süngerimsi kemiginden gentamisin ve teikoplanin saliniminin in vitro degerlendirilmesi.

OBJECTIVES: This study was designed to determine the in vitro antibacterial activity of gentamicin- or teicoplanin-impregnated human cancellous bone as a local antibiotic carrier. METHODS: The study samples were obtained from human cancellous bone within the femur head in seven patients who underwent partial or total hip arthroplasty. Bone specimens were processed and incubated with gentamicin or teicoplanin for an hour. Control bone specimens were soaked in sterile saline solution for the same duration. Antibiotic release of bone specimens was assessed by the disc diffusion technique after 1, 3, 7, 10, 14. 18, and 21 days of antibiotic impregnation, with seven samples in each group. The test strains were E. coli ATCC 25922 for gentamicin, and S. aureus ATCC 25923 for teicoplanin. In vitro antibiotic efficacy was defined as an inhibition zone diameter of = or >15 mm for gentamicin, and = or >14 mm for teicoplanin. RESULTS: Evaluation of inhibition zone diameters showed that bone-teicoplanin complexes had a longer duration of antibiotic release than that of bone-gentamicin complexes (12 to 18 days vs 7 to 10 days). There was no inhibition in the control group. There were no significant differences in inhibition zone diameters of teicoplanin- and gentamicin-treated specimens on the first and third days; however, teicoplanin exhibited significantly greater zone diameters on the seventh (p=0.008) and tenth (p=0.003) days. CONCLUSION: Our data show that, under appropriate conditions, human cancellous bone incorporates a considerable amount of teicoplanin and exhibits effective antibiotic release for approximately two weeks.

The effects of suramin in prevention of peritendinous adhesions following flexor tendon injury in a chicken model.

Peritendinous adhesions are the most common complication of flexor tendon injuries. Overproduction of transforming growth factor Beta has been reported as a major cause of tissue fibrosis. This study investigated the effects of suramin, a known inhibitor of transforming growth factor Beta, on the formation of flexor tendon adhesions in a chicken model. Forty-two chicken flexor tendons that were divided partially were repaired using a modified Kessler technique. The chickens were divided into 3 groups. In group 1 (control), no suramin was administered to the tendon repair site; in group 2, 1 mg of suramin was injected around the tendon repair site; and in group 3, 2 mg of suramin was injected around the tendon repair site. At 6 weeks postoperatively, the animals were sacrificed, and functional, histologic, and biomechanical examinations were performed. There was no difference between the groups in terms of tendon excursion. Histologic evaluation showed adhesions were decreased in the groups treated with suramin. In the biomechanical evaluation, a statistically significant difference was present only between the group treated with 2 mg of suramin and the control group. Although suramin is effective in preventing peritendinous adhesions, it can reduce tendon strength as dose-dependent. Future studies should be performed with different doses to determine clinical application.

Effects of three- or four-cortex syndesmotic fixation in ankle fractures.

BACKGROUND: There is no study comparing how Weber type C ankle fractures treated with either three- or four-cortex syndesmotic fixation affects the structure of the syndesmosis. METHODS: In a retrospective study, 46 patients were separated into two groups: 22 patients with three-cortex fixation and 24 patients with four-cortex fixation. All of the patients were evaluated clinically and radiographically at least 1 year after removal of the syndesmosis screws. RESULTS: There were three types of joint space obliteration: type 1, synostosis on plain radiographs; type 2, an incomplete bony bridge on magnetic resonance imaging with normal plain radiographs; and type 3, fibrous obliteration of the joint space. Although obliteration of the joint space was significant (P < .005) after four-cortex fixation, radiologic results did not affect the clinical outcome. CONCLUSION: Four-cortex fixation for diastasis after an ankle fracture should not be a routine procedure. We advocate three-cortex fixation because the clinical results are no different and there is less syndesmotic space obliteration postoperatively.

[Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure]. / Kronik renal yetmezlikli bir hastada femur boyun kirigi ve iki tarafli kuadriseps tendon kopmasi.

Simultaneous bilateral quadriceps tendon rupture is a very rare injury mostly seen in patients with chronic renal failure or other systemic chronic diseases. Metabolic acidosis in chronic renal failure predisposes these patients to tendon degeneration. A 37-year-old woman who received hemodialysis for chronic renal failure for two years presented with complaints of severe pain in the left hip and inability to walk. She had a history of two consecutive falls in the past two months. On physical examination, there were joint spaces in both suprapatellar areas, active extension of both knees was inhibited, and movements of the left hip were quite painful. Knee ultrasonography and magnetic resonance imaging showed bilateral quadriceps tendon rupture from patellar attachment. At surgery, full-thickness quadriceps tendon tears were repaired with Tycron transpatellar suture anchors. Internal fixation was not considered for hip fracture due to the presence of chronic renal failure, so hemiarthroplasty with bipolar endoprosthesis was performed in the same session for femoral neck fracture. Six months after the operation, the patient was able to walk without support and almost regained her normal knee functions.

The biomechanical effects of talectomy on the foot.

The biomechanical effects of talectomy on the foot were investigated in seven fresh below-the-knee amputation specimens using pressure-sensitive films placed on the facets of the calcaneus, footprints, and loading-pattern diagrams in the intact foot and after talectomy with anterior and posterior displacement of the foot. Both talectomy techniques distorted the loads carried by the facets of the calcaneus. In the intact foot, 65.6% of the loads were carried by the posterior facet of the calcaneus and 34.4% by the anterior and middle facets. After talectomy with anterior displacement of the foot, although the loads carried by the anterior and middle facets decreased significantly (P = .018), the increase in the loads carried by the posterior facet was not significant compared with the intact foot (P = .176). Similarly, the loads carried by the posterior facet decreased significantly after talectomy with posterior displacement of the foot (P = .028), but the increases in the loads carried by the anterior and middle facets were not significant (P = .735). Comparing the two types of talectomy, the loads carried by each facet changed significantly (P = .018). Talectomy with posterior displacement of the foot also changed the loading patterns and resulted in significant pronation of the foot. These results suggest that talectomy should be performed only as a salvage procedure and that talectomy with anterior displacement of the foot may be preferred when talectomy is indicated.

[Factors associated with failure in the surgical treatment of shoulder instability]. / Omuz instabilitesinde cerrahi tedavilerin basarisizlik nedenleri.

Open and arthroscopic surgical techniques are used to treat shoulder instability. There may be various reasons of failure related to these techniques, the understanding of which may increase success rates. In this paper, we evaluated the factors associated with failure in open and arthroscopic surgical repairs of anterior, posterior, and multidirectional instability, together with possible solutions.

A case of myositis ossificans as a complication of tetanus treated by surgical excision.

Myositis ossificans is a heterotopic ossification of skeletal muscles which is commonly seen after trauma. However, it is rarely seen as a complication of tetanus. We report a case of myositis ossificans following tetanus in a female adult patient presenting with ankylosis of both elbows in extension.