Investigation of the effects of Enoxaparin, Fondaparinux, and Rivaroxaban used in thromboembolism prophylaxis on fracture healing in rats.

BACKGROUND: Today, there is a small number of studies on the effects of Enoxaparin and Fondaparinux used commonly in the prevention of venous thromboembolism on healing of fracture cases. AIM: The aim of this study was to investigate clinically, radiologically and histopathologically, the effects of Enoxaparin, Fondaparinux and Rivaroxaban used in thromboembolism prophylaxis on fracture healing in a rat model of femur fracture. MATERIALS AND METHODS: Thirty-two male Sprague Dawley rats were randomized into four groups (n=8): the control group (Group 1), the Enoxaparin group (Group 2), the Fondaparinux group (Group 3), and Rivaroxaban group (Group 4). Under general anesthesia, a standard closed fracture was created in the left femur of each rat using an osteotome. Group 1 was given saline solution (1 cc/day, sc), Group 2 Enoxaparin (100 anti Xa IU/kg/day, sc), Group 3 Fondaparinux (0.2 mg/kg/day, sc), and Group 4 Rivaroxaban (3 mg/kg/day, po) for 21 days. After all rats were sacrificed at the end of day 21, their left femurs were disarticulated at the level of the hip and knee. The bony union was radiologically, clinically, and histopathologically evaluated. RESULTS: No differences were found between the groups in terms of clinical, radiological, and histopathological findings in fracture healing (p = 0.849, p = 0.731, and p = 0.395, respectively). CONCLUSIONS: Enoxaparin, Fondaparinux and Rivaroxaban used in thromboembolism prophylaxis cause no significant changes in fracture healing with short term follow up. Thus, they can be safely used in cases of fractures.

Effect of hyperbaric oxygen therapy on healing in an experimental model of degloving injury in tails of nicotine-treated rats.

The aim of this study was to investigate the effect of hyperbaric oxygen (HBO) therapy on healing in an experimental model of a degloving injury of the tails of nicotine-treated rats. Thirty-two male Sprague-Dawley rats were randomized to four groups (n = 8): nicotine (group 1); HBO (group 2); nicotine + HBO (group 3); and control (group 4). The mean length of the necrotic parts of the tails at the degloving injury site was significantly higher in group 1 compared with groups 2, 3, and 4, and was significantly lower in group 2 compared with groups 1, 3, and 4. The mean histopathological stage of ulcers at the degloving injury site was statistically significantly higher (more severe) in group 1 compared with groups 2, 3, and 4, and was statistically significantly lower in group 2 compared with groups 1, 3, and 4. It appears that the negative effects of nicotine on wound healing in degloving injuries are negated by the positive effects of immediate HBO therapy.

Treatment approaches and outcomes in childhood supracondylar humerus fractures.

BACKGROUND: Being one of the most frequent elbow fractures during childhood, supracondylar humerus fractures require rapid diagnosis and treatment, as they may be associated with significant neurovascular and functional problems. QUESTIONS AND PURPOSES: To evaluate demographic and clinical features, and treatment outcomes of the patients with supracondylar humerus fractures who underwent open reduction+minimal osteosynthesis or closed reduction+percutaneous wiring. PATIENTS AND METHODS: Forty patients (30 boys + 10 girls) between 2 and 13 years of age who were operated on with the diagnosis of supracondylar humerus fracture, between August 2003 and December 2006, were included. Open reduction+minimal osteosynthesis (n=34) and closed reduction+percutaneous wiring (n=6) were performed. The fractures were classified according to the Gartland classification and outcomes were assessed according to Flynn's criteria. RESULTS: All patients (mean age, 7.35 years; range, 2-13 years) had closed fractures (28 left and 12 right). Seven (17.5%) and 33 (82.5%) patients had Gartland type II and III fractures respectively. Three patients had flexion-type and 37 patients had extension-type fractures. Based on Flynn's criteria, cosmetic results were excellent in 37 (92.5%) patients and good in 3 (7.5%) patients, and functional results were excellent in 36 (90%) patients, good in 3 (7.5%) patients, and poor in 1 (2.5%) patient. A surgical success rate of 97.5% was noted. No significant difference was found between wire configurations (p > 0.05). CONCLUSIONS: Treatment of supracondylar humerus fractures in children should be patient-specific based on factors such as patient's age, soft tissue conditions and deformity status.

Carpal tunnel decompression: two different mini-incision techniques.

AIM: To compare two different mini-incision surgical techniques for carpal tunnel surgery. MATERIALS AND METHODS: A total of 45 patients in Group 1 underwent carpal tunnel release through a 2-cm longitudinal incision made distal to the flexor crease, whereas the 45 patients in Group 2 underwent carpal tunnel release through a 2-cm longitudinal incision made proximal to the flexor crease. The self-administered Boston Questionnaire was used to assess the severity of patients' symptoms and their functional status, both before and after the surgical intervention and at their final follow-up. Patients were also asked, during the final follow-up, about the pain level of their scar tissue. RESULTS: There was a significant decrease in the Boston Carpal Tunnel Questionnaire scores for the symptom severity scale and the functional status scale of patients in both groups, pre-operatively, post-operatively at one month and at final follow-up (p < 0.001 for both). The mean operative time for Group 2 was significantly shorter than for Group 1 (p < 0.001). At final follow-up, 11 patients in Group 1 stated they had scar tissue pain, compared to three patients in Group 2. The pain in scar tissue among Group 2 was significantly less than for Group 1 (p = 0.02). CONCLUSIONS: Due to shorter operative times, mini-incisions proximal to the flexor crease can be performed. The absence of relapse and good clinical results make both surgical techniques suitable. For this reason, we consider that the selection of the mini-surgical technique used should depend on the experience and skill of the surgeon.