The effect of platelet-rich plasma on osteochondral defects treated with mosaicplasty.

PURPOSE: This study investigated the efficacy of platelet-rich plasma (PRP) on articular surfaces on which the mosaicplasty technique was performed. Our hypothesis was that PRP can accelerate the osseointegration process and enhance the quality of articular integrity after the mosaicplasty procedure. METHODS: Standard defects were created in the femoral groove of both patellofemoral joints of 12 New Zealand rabbits. PRP solution was placed inside the defect before fixation of the osteochondral autografts and injected inside the involved joint after capsular closure of the tested knees. The contralateral knees served as the control sides. The animals were euthanized three or six weeks after mosaicplasty, and both limbs were assessed according to Pineda's histological grading scale. Significance level was set at p ≤ 0.05 a priori, and the Mann-Whitney U test was used for statistical analysis. RESULTS: Histologic findings at the interface between the transferred autograft and the original cartilage revealed better integration of the adjacent surfaces in the mosaicplasty with PRP group three weeks after the procedure; the difference was significant (p < 0.05). However, no significant difference in the transition zone was observed between the groups six weeks after the experiment (p = 0.59). CONCLUSIONS: Our animal model showed that adjunctive use of PRP produced a better healing response and resulted in superior histological scores after three weeks compared with the mosaicplasty-only procedure. Interpretation of our results is important in terms of rapid return to previous activity levels. Thus, application of PRP can represent a valid therapeutic option for improving the efficacy of mosaicplasty by stimulating the local healing response.

Forearm compartment syndrome of a newborn associated with extravasation of contrast agent.

Extravasation of contrast agents is a possible complication of imaging studies. Although extravasations typically cause minimal swelling or erythema, they can lead to compartment syndrome when the volume of extravasation is high. In this article, we will present an exceptional case where an insignificant amount of contrast agent extravasation led to a forearm compartment syndrome in a newborn, who was treated with an extended fasciotomy. We would like to emphasize the preventive techniques and treatment options of this iatrogenic complication in newborns. Close followup of the patient by the nurses, awareness of the parents and the personnel in the radiology department are the most important preventive measures in this extremity-threatening complication. Forearm compartment syndrome due to contrast agent extravasation may progress more rapidly in newborns even with smaller amounts of extravasation and prompt recognition of the pathology and immediate intervention are unevitable.

Effect of pentoxifylline on fracture healing: an experimental study.

OBJECTIVES: This study aims to investigate the effect of pentoxifylline on fracture healing in an experimental animal model. MATERIALS AND METHODS: Sixty-one male, Wistar-Albino rats were divided randomly into two groups as the pentoxifylline and control groups. Standard, closed femoral shaft fractures were established in all rats using a three-point bending device under general anesthesia. The rats were administered either pentoxifylline or isotonic NaCl injections everyday, beginning after production of fracture until they were sacrificed. Ten rats (11 rats in the pentoxifylline group on the 14(th) day) in each group were sacrificed on the 7(th), 14(th) and the 21(st) days and clinical, radiological, and histological examinations were performed to evaluate bony union. RESULTS: Radiological evaluation of callus did not reveal any significant difference between the control and the pentoxifylline groups in the first, second and the third weeks. However histological callus formation was significantly superior in pentoxifylline group compared to the control group at the end of the first week and callus formation was better in the control group in the third week. CONCLUSION: Pentoxifylline can be used to accelerate fracture union in early phases. Because of its hematological effects pentoxifylline accelerates the hematoma stage of fracture healing. But it inhibits fracture union in the later stages, presumably due to its anti-inflammatory effect. This should be taken into consideration during the clinical use of this drug.

Correction of a major flexion deformity developed after knee arthrodesis in child age: a case report.

Septic arthritis in child age results in sequelae when treated late or inappropriately. Arthrodesis is a salvage option which is rarely performed in children because of its complications and resultant disabilities. We report the case of a 16-year-old boy who had been treated with arthrodesis of his right knee at the age of seven and subsequently developed a progressive osseous deformity, eventually resulting in a 130 degrees flexion deformity of the knee. The deformity and the resulting limb length discrepancy were corrected using the Ilizarov method. In a single stage operation, a wedge resection osteotomy at the distal femur was performed and a ring fixator was applied. The mechanical axis was corrected first by gradual closing of the wedge thus avoiding damage to the posterior neurovascular structures, followed by lengthening.

A modified technique of internal bone transport.

A modification of the technique of internal bone transport is presented. It decreases bone and soft tissue complications during bone transport, increases patient's comfort, the volume of the fixator is smaller and painful scarring is limited. Nine patients with a mean age of 23.9 years were treated with this technique. The aetiology was tumour, trauma or sequelae of infection. The mean bone loss was 7.2 cm in length. Transportation was achieved with a special pulley system. The mean follow-up time was 18.3 months. The external fixation time ranged from 5 to 13.2 months, the mean distraction index was 12.1 days/cm. The mean length of bone transport done was 6.3 cm. An excellent bone result was obtained in 4 cases, a good result in 4 cases and a fair result in one case. An excellent functional result was obtained in 2 lower extremity cases, a good result in 3 cases. Preoperative DASH scores of the upper extremity cases improved from a mean of 80.1 to a mean of 15.85. Complications were seen in 4 cases.