The effect of 2 different surgical methods on intracompartmental pressure value in tibial shaft fracture: An experimental study in a rabbit model.

BACKGROUND: Intracompartmental pressure (ICP) monitoring is a widely used modality, particularly after intramedullary nailing of tibial shaft fractures. It was hypothesized that ICP value in fracture fixed with Ilizarov circular fixator (ICF) might be lower than in fracture fixed with intramedullary pin (IMP). The present study is a comparison of ICP value in tibial fractures in a rabbit model fixed with ICF and IMP. METHODS: Twenty male New Zealand White rabbits were randomly divided into 2 groups of equal size: ICF group (Group 1) and IMP group (Group 2). Under anesthesia, half of proximal part of the right tibia of all rabbits was fractured. Tibial fractures were fixed with ICF in Group 1 and IMP in Group 2. ICP values were monitored at 6-hour intervals for 48 hours. RESULTS: There was statistically significant difference in ICP value between groups (p<0.001). While there was statistically significant increase in ICP values 24 hours post surgery, there was statistically significant decrease during second 24 hours following surgery. Most importantly, ICP values of ICF group were significantly lower than those of IMP group at 30, 36, and 42 hours post surgery (p<0.05). CONCLUSION: At 24th hour after fixation, ICP values measured in ICF group were lower compared with those of IMP group. These results indicate that use of ICF in tibial fractures provides additional decompression in the anterior compartment. In light of these findings, ICF may be preferable for treatment of tibial fractures with high risk for compartment syndrome.

[Early-term hip development following Pemberton osteotomy: a radiological follow-up]. / Pemberton osteotomisi sonrasi erken dönem kalça gelisimi: Radyolojik takip.

OBJECTIVES: This study aims to evaluate the relationship of early-term radiological changes with development of the hip joint after Pemberton osteotomy. PATIENTS AND METHODS: This study, which was conducted between January 2010 and December 2014, included 101 hips (26 bilateral) of 75 patients (25 males, 50 females; mean age 31.5 months; range 15 to 71 months) which were performed Pemberton osteotomy due to developmental dysplasia of the hip. Radiologically, we assessed the parameters of center-edge angle, acetabular index (AI), and acetabular depth index (ADI). We measured the surface area of the femoral head ossific nucleus on anterior-posterior pelvic X-rays. We graded the degree of hip dislocation according to Tönnis classification while the femoral head avascular necrosis was graded according to Kalamchi-MacEwen classification. We separated the operated hips in all patients and in only unilaterally operated patients in three groups according to their follow-up durations as 12 months, 12 to 24 months, and more than 24 months. We analyzed the associations of radiological parameters in all follow-up durations. RESULTS: Mean follow-up duration was 22.5 months (range, 6 to 66 months). Preoperative mean AI was 42.25° (range, 29° to 60°) and last follow-up mean AI was 20.45° (range, 10° to 32°). Preoperative mean ADI was 16.48° (range, 9°-30°) and last follow-up mean ADI was 26.1° (range, 23°-47°). Sixty hips were Tönnis type 4, 26 hips were type 3, and 15 hips were type 2. According to follow-up duration classification; there were 32 hips (21 unilateral) with 12 month-follow-up, 43 hips (17 unilateral) with 12-24 month-follow-up, and 26 hips (11 unilateral) with more than 24-month follow-up. We applied shortening osteotomy to 18 femurs. According to Kalamchi-MacEwen classification; avascular necrosis type 1 was present in 16 hips, type 2 in two hips, type 3 in three hips, and type 4 in two hips. We performed revision operations for five hips because of recurrent subluxations. CONCLUSION: We observed progressive improvements in hip joints and consequently in radiological parameters in the early-term after Pemberton osteotomy.

Clinical and radiographic outcomes of medial open-wedge high tibial osteotomy with Anthony-K plate: prospective minimum five year follow-up data.

PURPOSE: The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes, and complication rates, after a minimum of five years of follow-up after medial open wedge high tibial osteotomy (MOWHTO) using an Anthony-K plate. METHODS: MOWHTO was performed on 35 knees of 34 consecutive patients. A visual analogue scale (VAS), and Western Ontario and McMaster University Osteoarthritis (WOMAC) and Lysholm scores, were used in clinical evaluation. Upon radiographic assessment, alignment was expressed as the femorotibial angle (FTA). The posterior tibial slope (PTS) and the Insall-Salvati Index (ISI) were also measured. RESULTS: VAS, WOMAC, and Lysholm scores improved significantly upon follow-up (p < 0.001 for all). The overall mean FTA was 4.68 ± 4.39° varus pre-operatively; at the last post-operative follow-up, the value was 8.43 ± 2.02° valgus. The mean correction angle was 13.1 ± 2.7°. A significant increase in PTS was evident (p < 0.01), as was a significant decrease in the ISI (p < 0.01). The overall complication rate was 8.6 %. CONCLUSIONS: The Anthony-K plate affords accurate correction, initially stabilises the osteotomy after surgery, and maintains such stability until the osteotomy gap is completely healed, without correction loss. The plate survival rate was 97.2 % after a minimum of five years of follow-up. The plate increased the PTS, as do other medial osteotomy fixation plates.

Effects of salmon calcitonin treatment on serum and synovial fluid bone formation and resorption markers in osteoporosis patients.

OBJECTIVE: This study aimed to evaluate the effects of salmon calcitonin, and calcium and vitamin D treatment on bone mineral density, serum and synovial fluid bone formation and resorption markers in patients with osteoporosis. METHODS: The study was completed with twenty-five osteoporosis patients divided into two groups: The 15 patients comprising Group I (1 male and 14 females; mean age: 67.0±12.0) were administered calcitonin treatment in addition to calcium and vitamin D. The 10 patients in Group II (3 males and 7 females; mean age 68.0±16.0) were administered calcium and vitamin D only. Serum and synovial fluid calcium phosphorus, alkaline phosphatase, calcitonin, C-telopeptide (CTx), N-telopeptide (NTx) and sialoprotein levels, and bone densitometries were determined at the beginning and at the end of one year of treatment. RESULTS: In the calcitonin and calcium and vitamin D treatment group (Group I), femoral neck density scores were decreased and vertebrae scores were increased after one-year treatment. Both scores were increased in the non-calcitonin group (Group II). In Group I, synovial fluid levels of calcitonin, sialoprotein and NTx were decreased, and synovial fluid CTx levels showed no change. The only decrease that was statistically significant was that in calcitonin levels. In Group II, synovial fluid calcitonin levels were decreased, synovial fluid CTx levels were increased and synovial fluid NTx and sialoprotein level were unchanged. These changes were not statistically significant. Serum changes in the parameters were not statistically significant in either group. CONCLUSION: In osteoporosis, salmon calcitonin treatment affects synovial fluid bone formation and absorption marker levels. Advanced studies are needed to evaluate the mechanisms by which this takes place, and to explain the relationship between osteoporosis and articular cartilage metabolism.

Peroneal nerve palsy secondary to prolonged squatting in seasonal farmworkers.

OBJECTIVE: The aim of this study was to evaluate the follow-up and treatment results of peroneal nerve palsy secondary to prolonged squatting for working and to determine an approach for its treatment and prevention. METHODS: The study retrospectively evaluated 16 patients (7 males, 9 females; mean age: 23.6 years) diagnosed with peroneal nerve palsy due to squatting for work. Clinical and neurological evaluations were performed and weight and height were measured. Lesion site was determined using electrophysiological testing. After diagnosis, medical and orthotic treatment was initiated and rest was advised. Patients were followed until motor symptoms were resolved. RESULTS: Clinical and neurophysiological evaluations were consistent with isolated peroneal nerve palsy. The left side was affected in seven patients, the right side in seven and both sides in two. Average onset of the symptoms was 3.3 (range: 1 to 6) weeks and average daily squatting period was 6.8 (range: 6 to 8) hours. Average healing time was 7.4 (range: 3 to 16) weeks. None of the patients was obese or overweight. All patients healed with conservative treatment and no surgical treatment was necessary. CONCLUSION: Working conditions and duties should be considered in the evaluation of peroneal nerve palsy. In peroneal nerve palsy secondary to squatting, healing should be expected with conservative treatment, resting and close follow-up.

Bioelectrical impedance analysis of basal metabolic rate and body composition of patients with femoral neck fractures versus controls.

OBJECTIVES: In this study, we aimed to compare basal metabolic rate and body composition in patients with femoral neck fractures and controls. PATIENTS AND METHODS: Sixty-eight consecutive patients with femoral neck fractures (36 males, 32 females; mean age 73.9 ± 7.1 years, range 65 to 93 years) and 71 controls (33 males 38 females; mean age 72.1 ± 5.9 years; range 65 to 90 years) were prospectively analyzed. The controls were matched with the patients in terms of sex, age, and body mass index. The findings were assessed by bioelectrical impedance analysis (BIA). RESULTS: The phase angle, body capacitance, resistance, reactance, body cell mass, lean body mass, basal metabolic rate, and intracellular water values of the patients were found to be significantly lower, compared to the controls. Extracellular mass, fat mass, extracellular mass/body cell mass and extracellular water levels were significantly higher in the patients, compared to the controls. There was no significant difference between the patient and control group in terms of the total body weight/lean body mass ratio. CONCLUSION: Although it is not clear whether these physiological changes are an exact cause of a predisposition for simple falls, the assessment of basal metabolic rate and body composition by BIA may be a useful adjunctive tool for the evaluation of physiological changes in the routine health screening of elderly people.

Femoral segment graft is a suitable alternative to stabilize pelvic osteotomies in developmental dysplasia of the hip: a comparative study.

The aim of this study was to compare bone healing in pelvic osteotomy patients with osteotomy gaps filled with a femoral segment resected (FSR) graft with bone healing in patients with an iliac tricortical autograft (ITA) in treatment of developmental dysplasia of the hip. Sixty-three hips were treated using FSR grafts. Sixty-one hips were treated using ITA. The mean operation time and blood loss were significantly reduced in the FSR graft group, but graft union time was extended in the FSR graft group compared with that in the ITA group. The FSR graft was found to be safe and effective in treatment of developmental dysplasia of the hip and serves as an advantageous alternative to ITA.

The effect of extracorporeal shockwaves on cartilage end-plates in rabbits: a preliminary MRI and histopathological study.

OBJECTIVE: The aim of this study was to examine the changes in the lumbar intervertebral area after extracorporeal shockwave therapy (ESWT) at different energy levels in a rabbit model using magnetic resonance imaging (MRI) and histopathological evaluation. METHODS: The study included 30 male New Zealand white rabbits divided randomly into five groups: Groups A and C received 1,000 shockwave impulses at an intensity of 14 kV, Groups B and D received 1,000 impulses at 21 kV, and Group E was a sham group. Side effects such as subcutaneous and paravertebral soft-tissue injuries were evaluated using MRI one day after ESWT administration. Neovascularization, edema and fibroblast activity in the intervertebral area were evaluated histopathologically. RESULTS: No change was observed in any group on MRI. Histopathologically, Groups A and C showed no change, whereas Groups B and D showed edema, fibroblast activity and significant neovascularization at the intervertebral end-plate (p<0.05). CONCLUSION: Our findings indicate that ESWT caused dose-dependent changes in the intervertebral end-plate. This study constitutes a preliminary evaluation of shockwave therapy to the intervertebral area in an animal model. High-dose ESWT may stimulate angiogenesis at cartilage end-plates in rabbits.

The use of Ender nail in intertrochanteric fractures supported with external fixation.

BACKGROUND: Intramedullary Ender nailing in intertrochanteric fractures was very popular in the past. However, this method has fallen in favor over time, due to complications. The purpose of this study was to evaluate results with this method and possible ways to prevent these complications, including the use of unilateral fixators to support the Ender nails. METHODS: This technique (Ender nailing and external fixator) was used in 39 patients (17 M/22 F, mean age: 71.4 years). The preoperative mean American Society of Anesthesiologists (ASA) score was 1.84 (range: 1-4) for all the patients. AO/OTA classification of fractures was used. In our surgery, we used an external fixator to support the intramedullary nails. All patients were evaluated with Parker-Palmer mobility score and with the Harris hip score. RESULTS: The follow-up period was 29.2 months (20-56). Two patients experienced nail migration in the knees, two patients had varus deformation with a reduction in length of 2 cm, and seven patients developed pin-track infection. The average Harris score and Parker-Palmer score of the 14 patients who presented for their last follow-up examination were 64 and 6.8, respectively. CONCLUSION: This method demonstrated several advantages, in that it allows the patient to put weight on the extremity after a shorter period of time and enables the fracture to heal rapidly without any serious complications.

Mini-open versus closed reduction in titanium elastic nailing of paediatric femoral shaft fractures: a comparative study.

The purpose of this study is to compare retrospectively intraoperative fluoroscopy time and clinical-radiological results in pediatric femoral shaft fractures treated with titanium elastic nailing (TEN), with a mini-open "blind-hand" technique versus closed reduction. The study included 87 children (18 girls and 69 boys) who underwent surgical treatment with TEN for femoral shaft fractures. Patients were divided into two groups. Group 1 included 42 patients (mean age : 83 +/- 2.7 years) treated with a mini-open "blind-ha nd" technique (a 2-3 cm lateral incision at the level of the fracture ; reduction achieved with one or two fingers, without visualization of the fracture). Group 2 consisted of 45 patients (mean age: 8.8 +/- 2.6 years) treated with a closed reduction technique. Duration of surgery and intraoperative fluoroscopy time were recorded in both groups. Clinical and radiologic results were assessed using the TEN scoring system after mean follow-up periods of 213 +/- 5.8 months and 193 +/- 5.6 months in group 1 and group 2, respectively. Mean duration of surgery was 31.7 +/- 7.6 and 52.1 +/- 14.4 minutes, and mean fluoroscopy time 32.9 +/- 22.1 and 75.1 +/- 31.5 seconds in group 1 and group 2, respectively. Both surgical and fluoroscopy time were significantly longer in group 2 (p < 0.001). There was no significant difference between the two groups in terms of clinical and radiological results. All fractures healed with solid union, and there was no complication that was expected to cause permanent disability. Although successful clinical and radiological results were obtained with both techniques, duration of surgery and intraoperative fluoroscopy time were significantly higher in the closed reduction group 2. We suggest the "blind-hand" technique as an alternative to closed reduction to prevent extensive intraoperative radiation exposure and to decrease the length of the surgical procedure.

Ultrasonographic examination of the radial and ulnar nerves after percutaneous cross-wiring of supracondylar humerus fractures in children: a prospective, randomized controlled study.

In this prospective study, we aimed to find out whether there is a change in the ultrasonographic features of the radial and ulnar nerves as well as clinical outcomes after traditional and lateral percutaneous cross-wiring of the supracondylar humerus fractures in children. Twenty-nine consecutive children with completely displaced Gartland type III supracondylar humerus fractures were treated with the traditional (group T) or lateral (group L) cross-wiring technique. Our findings showed that ultrasonographic features of the radial nerve were not changed in both groups but the ulnar nerve movement was reduced, and the diameter of major axis of the ulnar nerve during elbow flexion was larger (P=0.040) than in elbow extension in the traditional cross-wiring technique but not in the lateral cross-wiring technique. Lateral cross-wiring technique does not change the ultrasonographic features of the radial and ulnar nerves, and provides satisfactory results.

Serum prolidase activity and oxidative-antioxidative status in Legg-Calve-Perthes disease.

We aimed to find out that whether collagen turnover is altered in the context of Legg-Calve-Perthes disease (LCPD) by evaluating serum prolidase activity. We also investigated the correlation between collagen turnover and oxidative-antioxidative status in LCPD. Plasma prolidase activity, total oxidant status (TOS), total antioxidant capacity, and oxidative stress index (OSI) were determined for 39 patients with LCPD and 40 healthy controls. Serum prolidase activity, TOS, and OSI were higher, but TAC was lower in patients with LCPD compared with controls. Prolidase activity was positively correlated with TOS and OSI levels. Serum prolidase activity is significantly associated with LCPD.

Patelloplasty with patellar decompression to relieve anterior knee pain in total knee arthroplasty.

OBJECTIVE: Anterior knee pain continues to be an important problem following total knee arthroplasty (TKA). The aim of this study was to present the early results of patelloplasty with patellar decompression to relieve anterior knee pain in patients who undergo TKA. METHODS: We prospectively reviewed 49 knees from 46 patients (35 females, 11 males; mean age: 69.2 years; range: 54 to 82 years) who underwent TKA between January 2004 and December 2008. Decompression and patelloplasty were performed in patients in whom Grade 3 and 4 chondropathy was detected during operation according to the Outerbridge classification. All knees were rated according to the Knee Society Knee and Function Scores, before surgery and during the final follow-up. The patella score was evaluated according to a specific patellofemoral pain questionnaire used by Feller, and the mean knee range of motion was measured preoperatively and postoperatively. Additionally, a patient satisfaction questionnaire used by Levitsky was performed during the final follow-up exam. The mean follow-up period was 41.1 (range: 24 to 68) months. RESULTS: The mean preoperative and final follow-up knee scores were 48.6 ± 8.8 and 87.70 ± 9.3, and function scores were 48.4 ± 10.4 and 81.4 ± 12.6, respectively. The mean preoperative patellar score was 18.1 ± 3.5, and the final follow-up patellar score was 25.7 ± 2.8. The mean patellar scores were significantly greater in knees with Grade 3 chondropathy compared to Grade 4 chondropathy (26.47 ± 2.38 and 24.29 ± 3.19, respectively). Postoperative anterior knee pain was present in four knees (8.2%). The mean preoperative knee range of motion was 85.1 ± 12.7, and the final follow-up knee range of motion was 117.0 ± 9.8. Patients were "extremely" or "very" satisfied with 93.8% of their operative outcomes on their knees. CONCLUSION: Patellar decompression with patelloplasty in TKA is an option for the reduction of anterior knee pain, but there is a lack of significant evidence in the literature, demonstrating that this method is superior to patellar resurfacing and patellar retention.

[Bipolar hemiarthroplasty for the treatment of femoral neck fractures and the effect of surgical approach on functional results]. / Femur boyun kiriklarinin tedavisinde bipolar kismi protez kullanimi ve cerrahi yaklasimin fonksiyonel sonuçlar üzerine etkisi.

OBJECTIVES: This study aimed to evaluate the effect of an anterior versus posterior surgical approach for bipolar hemiarthroplasty on postoperative functional results of patients treated for femoral neck fractures. PATIENTS AND METHODS: Among the 196 patients over the age of 65 treated with cemented bipolar prosthesis for femoral neck fracture in our clinic between May 2000 and November 2008, 76 patients who followed up for at least one-year were retrospectively evaluated. The average follow-up period was 18.7 months (range 12 to 40 months). All fractures were Garden's type III or IV. The patients were divided into two groups according the surgical approach: posterior in 52 patients (Group 1; 25 males, 27 females; mean age 73.8 years; range 65 to 88 years) and anterior in 24 patients (Group 2; 14 males, 10 females; mean age 71.4 years; range 67 to 94 years). Cement was applied by hand in 62 cases and with a cement gun in 14 cases. RESULTS: Mean Harris scores were 84.7±10.3 in group 1 and 85.8±7.1 in group 2. According to the Harris scoring system, the results were very good in 26 cases; good in 40 cases; fair in six cases; and poor in four cases. While early dislocation was observed in 9.6% of patients with the posterior approach, it was not observed in any patients treated with the anterior approach. There was no significant difference with regard to functional scores or early dislocations between group 1 compared to group 2 (p>0.05). CONCLUSION: Based on our results, bipolar prothesis is an appropriate and effective treatment option for patients with femoral neck fracture to obtain early return to daily activity. The surgical approach does not affect the functional results. Although not statistically significant, it was concluded that the anterior approach is more reliable for early dislocation.