High tibial osteotomy for medial compartment osteoarthritis: a comparison of clinical and radiological results from closed wedge and focal dome osteotomies.

This study aimed to evaluate the clinical and radiological results of closed wedge osteotomy (11 knees) and focal dome osteotomy (14 knees) in cases of high tibial osteotomy undertaken for varus knee with medial compartment osteoarthritis. Clinical evaluation was performed using the Knee Society Score and no significant difference was seen between the two groups at final follow-up. Radiological evaluation was made on the basis of the pre- and postoperative mechanical axis, postoperative movement of the tibial axis, loss of correction at final follow-up and patellar height measured using the Insall-Salvati index. Statistically significant differences were seen with focal dome osteotomy compared with closed wedge osteotomy in the InsallSalvati index at final follow-up, the amount of correction loss and the change in tibial axis location. It is concluded that, in the treatment of medial compartment osteoarthritis by high tibial osteotomy, focal dome osteotomy is more beneficial than closed wedge osteotomy in not creating any additional deformity.

The effects of vitamins E and C on fracture healing in rats.

Forty-eight rats were divided into four groups of 12. For 3 days, each group received the following vitamins in once-daily doses: group 1, vitamin E only; group 2, vitamin C only; group 3, vitamins E and C; and group 4, no treatment (control). The right tibia of each rat was fractured on day 4; the rats then received the same regimen three times a week (once-daily doses) until day 21. Fracture healing was evaluated radiologically by measuring the callus indices, and histologically by a 5-point grading scale. On days 14 and 21, the callus index values in group 2 were statistically higher than those in the other groups. Histological evaluation scores in group 2 were the highest overall, and group 3 scores were higher than those in groups 1 and 4. These findings indicate that vitamin C accelerates fracture healing, vitamin E does not exert a marked effect on this process, and vitamins E and C in combination do not have a synergistic impact on fracture healing.

C-reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty.

We studied the changes in serum C-reactive protein levels (CRP) and erythrocyte sedimentation rates (ESR) in patients with primary osteoarthritis, who underwent uncomplicated arthroplasty. Of the 28 patients studied, 12 had cementless total hip replacement (THR), and 16 underwent cemented total knee replacement (TKR) with a tourniquet. In both groups serum CRP levels increased rapidly after surgery, peaking on day 2 (THR 23.17 mg/dl, TKR 26.02 mg/dl), and dropping gradually to pre-operative values on day 21 in THR patients and at the end of the second month in TKR patients. ESR peaked on day 5 after operation (THR 100.5 mm/h, TKR 101.3 mm/h), dropping close to pre-operative values at the end of the third month in THR patients and at the end of the ninth month in TKR patients, although, even after a year, ESRs were slightly above their pre-operative values. Serum CRP levels changed more rapidly than ESRs and returned to normal more rapidly. CRP and ESR values tended to be higher in TKR than in THR patients.

Results of conversion total hip prosthesis performed following painful hemiarthroplasty.

Fifteen of 18 cases who underwent conversion total hip prosthesis due to painful hemiarthroplasty, between 1992 and 1997, were investigated retrospectively. The 13 (86.6%) women and two (13.4%) men (mean age, 59 years) were followed up for an average of 32 months. Pre-operative and post-operative Harris hip scores were 36.4 (28 - 42) and 85.9 (69 - 98), respectively. In all cases the femoral component had more than 2 mm radiolucency in Gruen zones I, IV and VII, and five cases had acetabular protrusion; other cases had cartilage erosion. In the last follow-up of conversion total hip prosthesis, there was no radiolucency in either femoral or acetabular components. Comparing our results of conversion total hip prosthesis with primary total hip prosthesis results for femoral neck fractures in the literature we conclude that, in elderly patients with femoral neck fractures, primary total hip prosthesis has better results.

Antioxidant effect of alpha-tocopherol on fracture haematoma in rabbits.

In this study, the effect of free oxygen radicals on lipid peroxidation and the antioxidant role of alpha-tocopherol (vitamin E) in these reactions were investigated in haematoma fluid and venous blood samples in rabbits with femoral fracture. There were 21 male rabbits, divided into 3 groups. Conjugated dienes values (as optical density) were compared in venous blood of the rabbits in Group I taken preanaesthesia and after the onset of anaesthesia and the difference between these values proved to be insignificant (P > 0.05). A control group (Group 2) was given saline before fracture occurrence and the other group (Group 3) was injected with alpha-tocopherol 20 mg/kg intramuscularly. Venous blood samples and fracture haematoma fluids in both Group 2 and Group 3 were assayed biochemically. It was established that conjugated dienes values in fracture haematoma fluid in rabbits in the control group were higher than the values in the venous blood of the rabbits in the same group (P < 0.05). However, conjugated dienes values in the alpha-tocopherol injected group both in the haematoma fluid and in venous blood were reduced compared with those in the control group (P < 0.5). In view of the fact that ischaemia and reperfusion develop in fractured regions and that general body ischaemia develops following serious fractures of the extremities, we consider that prophylactic administration of antioxidants such as alpha-tocopherol may be beneficial in suppressing the destructive effects of free oxygen radicals in cells.

Distal fibula resection in osteochondroma.

We evaluated the effects of distal fibula resection on the ankle function in a patient with osteochondroma. Osteochondroma is a benign tumour which localizes in the metaphysis of the long bones, in the knees and in the shoulders. Although it does not usually cause any symptoms in children under 10 years, we had a 4-year-old patient with a painful swollen ankle with limited motion. Resection of the lateral malleolus did not affect ankle function and he remained pain-free in daily activities during a 2.5 year follow-up period.

Medial dislocation of the long head of the biceps tendon. Magnetic resonance imaging evaluation.

Medial dislocation of the long head of the biceps branchii tendon is a rare occurrence and is often associated with degenerative or traumatic tears of the rotator cuff, specifically tears of the subscapularis tendon. Following a dislocation, the biceps tendon will assume either an intra- or extra-articular position depending on whether or not the subscapularis tendon detaches from its humoral insertion. Magnetic resonance imaging (MRI) has been found to provide valuable information concerning the location of the biceps tendon and the integrity of the rotator cuff. In this report, three patients with suspected dislocations of the biceps tendon are evaluated using MRI.