The fluoroquinolones may positively affect tendon healing after surgical repair.

OBJECTIVES: This study aimed to evaluate the biomechanical and histological effects of fluoroquinolones on surgically repaired tendon healing. MATERIALS AND METHODS: The Achilles tendons of 40 Wistar rats (mean weight: 213.5 g; range 201 to 242 g) were bilaterally surgically cut and repaired. The rats were randomly divided into four groups: the first and third groups were designated as control groups and did not receive drug therapy, whereas the second and fourth groups received 300 mg/kg ciprofloxacin for a week after the surgical procedure. The first and second groups had both tendons dissected at the end of the first week, while the third and fourth groups were dissected at the end of the third week. The left tendons were examined biomechanically, while the right tendons were examined histologically. RESULTS: Statistical analysis revealed that the mean maximum tensile forces of tendons in the first and second groups were 5.2±1.84 N (range, 2.9 to 8.5 N) and 11.1±2.65 N (range, 7.3 to 13.9 N), respectively, which was found to be statistically significant (p< 0.05). At the end of the third week, mean maximum tensile forces of the third and fourth groups were determined to be 20.7±5.0 N (range, 22.1 to 29.8 N) and 28.7±4.6 N (range, 22.1 to 36.8 N), respectively, which was also statistically significant (p< 0.05). Histologically, our results were compatible. CONCLUSION: This study demonstrated that ciprofloxacin did not exhibit the expected adverse effects on surgically repaired tendon healing in the early stages but likely contributed to healing in the short term by affecting the inflammatory phase.

Mechanically induced experimental knee osteoarthritis benefits from anti-inflammatory and immunomodulatory properties of simvastatin via inhibition of matrix metalloproteinase-3.

BACKGROUND: We investigated the anti-inflammatory and immunomodulatory effect of simvastatin on articular cartilage via the inhibition of matrix metalloproteinase-3 (MMP-3), a matrix-degrading enzyme, in a mechanically induced experimental osteoarthritis (OA) animal model. MATERIALS AND METHODS: Twenty-seven albino Wistar rats were divided in three groups of equal number. Unphysiologic loading of articular cartilage was simulated by transecting anterior cruciate ligaments of the right knees of 18 rats consisting of groups 1 and 2. Nine animals in group 2 received orally administered simvastatin 20 mg/kg per day by gavage for 8 weeks. Animals in group 3 were sham operated. All animals were sacrificed at postoperative 8 weeks. Effects of simvastatin on disease progression was evaluated by documenting OA changes in cartilage specimens using Osteoarthritis Research Society International (OARSI) OA cartilage histopathology assessment system scores combined with the percentage of MMP-3 expression in chondrocytes. RESULTS: Simvastatin treatment significantly down-regulated the percentage of MMP-3 expression in chondrocytes as assessed by immunohistochemistry methods. Suppression of this matrix-degrading enzyme by simvastatin also reduced OARSI scores, suggesting the potential for statins against OA progression. CONCLUSIONS: Following knee trauma, OA initiates at the molecular level in a short period of time. Irreversible structural changes in cartilage that require demanding treatment strategies led us to focus on effective measures to prevent OA. Statins have immunomodulatory and anti-inflammatory properties independent from their serum-cholesterol-lowering effects. One of these widely used drugs, simvastatin, showed beneficial effects on OA progression and extent by reducing cartilage degradation in our experimental setting. If these results are confirmed by human trials, simvastatin might be considered by orthopedic surgeons as a disease-modifying drug during the early inflammatory phase of posttraumatic OA.

Fate of bulk autografts in uncemented total hip arthroplasty. Evaluation by bone scintigraphy.

OBJECTIVE: To review short term results of uncemented cup implantation and the fate of bulk femoral head autografts in patients with acetabular bone deficiency due to dysplasia of the hip. We used bone scintigraphy to assess the viability of the grafts. METHODS: We treated 19 hip joints of 17 patients with osteoarthritis due to developmental dysplasia of the hip with uncemented total hip arthroplasty between 1997-2003 in the Department of Orthopedics and Traumatology, Gazi University, Ankara, Turkey. The average age was 49.1 (31-72 years), and the average follow up period was 36 months. We used femoral head autografts to reconstruct superolateral segmental deficiencies of the acetabuli. We evaluated the patients clinically and radiologically to assess acetabular loosening, and we used three-phase bone scintigraphy to evaluate the viability of the autograft. RESULTS: There was no acetabular component revision throughout the follow up period. There was no radiological evidence of graft resorption or graft displacement in any of the patients. In bone scintigraphy, we observed hyperemia in the blood pool phase, and the osteoblastic activity of the bone graft was at the level of the neighboring iliac bone. CONCLUSION: The application of a non-cemented acetabular component with femoral autograft in superolateral acetabulum deficiency increases the stability of the implant and increases the bone stock. It is not easy to evaluate the viability of the graft by the use of radiological methods. Bone scintigraphy gives sufficient information about the viability of the graft as a non-invasive method.

What leads to unfavourable Cybex test results for quadriceps power after modified tension band osteosynthesis of patellar fractures?

This study recruited 20 patients who had undergone modified tension band wiring for patellar fracture, with a mean follow up of 30 months. Subjects were grouped according to results of Cybex isokinetic testing at 60 degrees /s angular velocity. Subjects with <30% deficit as compared with the contralateral knee constituted group I, and those with >30% similar deficit formed group II. Plain radiography and HSS scoring were also performed. According to patient satisfaction, HSS scoring and Cybex testing, results were good in 80%, 90% and 55% of cases, respectively. Statistical analysis revealed that there were no significant differences between the two groups in terms of age, gender, duration of follow up, fracture type (two-part or comminuted), dominancy, time interval between trauma and surgery, or duration of immobilisation. The number of patients with >1 mm articular incongruity postoperatively was significantly higher in group II, which also had significantly higher incidences of >1 cm thigh atrophy and pain and thus increased deficits. We suggest that articular incongruity should be limited strictly to 1mm in surgery for patellar fractures.

Value of bone scintigraphy in patients with carpal trauma.

OBJECTIVE: We planned this study to evaluate the role of bone scintigraphy in patients with suspected carpal fracture and normal or suspicious radiographs following carpal injury. METHODS: Three-phase bone scintigraphy using Tc-99m-MDP was performed on 32 patients with negative radiographs but clinically suspected fracture at two weeks after the trauma. Focally increased radiopharmaceutical uptake was interpreted as a fracture. The final diagnosis was established with clinical follow-up. RESULTS: Twelve (38%) patients had a normal scan excluding fracture. Twelve patients had a single fracture. Multifocal fracture was present in 8 (25%) patients. Eight patients showed scaphoid fractures; of these three showed single scaphoid fracture, and the other five patients revealed accompanying fractures. Distal radius fractures and carpal bone fractures other than scaphoid were both observed in 12 patients. These were eleven fractures of distal radius; three fractures of pisiform; two fractures of hamate; and single fractures of lunate, trapezium and triquetrum. In one patient there was fracture of a first metacarpal bone. CONCLUSION: In patients with suspected carpal bone fracture and normal or suspicious radiographs, bone scintigraphy can be used as a reliable method to confirm or exclude the presence of a scaphoid fracture and to detect clinically unsuspected fractures of distal radius and other carpal bones.

[Evaluation of functional results following surgical treatment of supracondylar femoral fractures]. / Cerrahi olarak tedavi edilen suprakondiler femur kirikli hastalarda fonksiyonel sonuçlarin degerlendirilmesi.

OBJECTIVES: We evaluated functional results of patients who underwent surgical treatment for supracondylar femoral fractures. METHODS: Functional results of surgical treatment for supracondylar femoral fractures were evaluated in 23 patients (14 males, 9 females; mean age 34 years; range 14 to 64 years) with the use of the Neer and HSS (The Hospital for Special Surgery) scoring systems. The strength of the quadriceps muscle was measured using Cybex isokinetic testing. The mean follow-up was 52 months (range 13 to 160 months). RESULTS: The average HSS score was 93.8 (range 68 to 100) and the average Neer score was 90.1 (range 55 to 100). The average losses of extension strength at 60 degrees /s and 180 degrees /s were 27.30% and 22.13%, respectively. Statistically significant correlations were found between the losses of extension strength and the Neer and HSS scores (p<0.01). The results showed that the patient's age and sex, the length of time between trauma occurrence and surgery, immobilization period, and the presence of subjective pain complaints had no significant influence on the HSS and Neer scores and on Cybex isokinetic test results (p>0.05). CONCLUSION: Evaluation of the quadriceps muscle strength with the use of objective tests proved helpful in the determination of functional results of surgery following supracondylar femoral fractures.