Investigation into the effects of static and electric fields on bone healing process: An experimental tibial fracture model study in Wistar-Albino male rats.

OBJECTIVE: In this experimental study, we aimed to investigate whether 0 Hz-Static and 50 Hz-Electric fields have an effect on bone healing. METHODS: In this study, 45 male Wistar-Albino rats were equally and randomly separated into three groups as follows: a 0 Hz-Static electric field (SEF), a 50-Hz low-frequency electric field (LFEF) and a control group. A manual fracture was performed in the left tibia diaphysis of all rats, and fractures were fixed using circular plaster over the knee. The LFEF group was exposed to 50 Hz electric field for 30 minutes a day, five days a week, for a total of eight weeks. The SEF group was exposed to 0 Hz electric field within the same time interval. The control group was held in identical environmental conditions, without exposure to electric field. Periodic radiographs were taken from all the animals. At the end of this study, rats were sacrificed and mechanical/histopathologic examinations were performed. RESULTS: Radiologic, mechanical and histologic scores of the LFEF group were lower than those of the SEF and control groups; however, no significant difference was found in group comparisons in terms of average histologic and radiologic scores (p>0.05). CONCLUSION: Results extracted from the current study suggest that 0-hz static and 50-hz electric field exposures affect bone healing tissue of tibial fracture models in rats, although it is not significant.

Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study.

An ideal surgical treatment of acute Achilles tendon rupture includes restoring the original length of the tendon, minimizing possible adhesions with the surrounding tissues, minimizing the risk of repeat rupture, alleviating wound problems, and providing an acceptable cosmetic outcome. In the mini-open repair technique, unlike the percutaneous repair technique, the quality of the tenodesis can be visualized without disturbing the healing potential of the surrounding tissues, thus minimizing wound problems. The purpose of the present study was to assess the long-term results of the mini-open repair technique in patients with acute Achilles tendon rupture. A total of 20 consecutive patients with acute Achilles tendon rupture, admitted to our inpatient clinic from October 2003 to March 2008, were included in the present study. The patients underwent Achilles tenodesis with the mini-open repair technique, and each patient was followed up for 5 years. The study was completed in April 2013. The surgical procedure was performed with the assistance of a device designed in our orthosis laboratories, similarly to that defined by Assal et al. Of the 20 patients, 18 were male and 2 were female. Their mean age was 39.3 (range 21 to 55) years. The Achilles tendon rupture was located on the left side in 15 patients (75%) and on the right side in 5 patients (25%). The mean follow-up duration was 58.5 (range 18 to 60) months and no complications occurred during the follow-up period, including repeat rupture, wound site infection, and sural nerve injury. The mean American Orthopaedic Foot and Ankle Society scale score for the patients was 99.2 (range 94 to 100) points at the final follow-up visit. All our patients were able to return to work and sporting activities. According to the Trillat scores, the outcome was excellent in 19 patients and good in 1 patient at the 18th postoperative month. No complaint, such as pain or loss of function, that might have a negative effect on the patients' business or social life was detected in 18 patients who were assessed at 5 years after surgery; 2 patients could not be reached at 5 years. In conclusion, as a technique combining percutaneous and open surgical techniques, mini-open repair of Achilles tendon rupture allows a satisfactory end-to-end approximation of the tendon just in the open surgery and provides the wound healing advantages of percutaneous surgery.

The Intramedullary Nailing of Adult Femoral Shaft Fracture by the Way of Open Reduction is a Disadvantage or Not?

The purpose of this study is that to evaluate superiority and results of open technique in the treatment of femoral shaft fracture with interlocking intramedullary nailing. The retrospective study is designed to evaluate results of our technique. In this study, the patients that were admitted to the Orthopedics and Traumatology Department of University Hospital that is third level of trauma center. We claim that open technique is not a disadvantage during union process over closed technique in treatment of femoral shaft fracture with interlocking nailing. In this study, 44 patients that were consulted for adult femoral shaft fracture between January 2008 to July 2010 were included. Patients with open fractures, gunshot wounds, neurovascular injuries, and patients that did not have isolated femoral diaphysis fractures were excluded from the study. Clinical and radiological results of the patients were checked periodically. The open interlocking intramedullary nailing was used in treatment. Complete union rate was 90.9 % in 40 patients who were treated with open interlocking intramedullary nailing for adult femoral shaft fracture, and nonunion rate was 9.1 % in four patients. Mean union time was 18.3 weeks (12-36 weeks). Evaluation of 44 patients according to Thoresen criteria was excellent in 22 patients, good in 6 patients, and bad in 4 patients. We think that open technique is an acceptable technique because all results of our study were similar to results of closed intramedullary nailing technique in literature and some advantages of open technique over closed technique.

Surgical treatment of osteopetrosis-related femoral fractures: two case reports and literature review.

Osteopetrosis is a rare hereditary disease which is characterized by increased bone density. Bone resorption is insufficient or fails due to the osteoclast defect in osteopetrosis. Half of the patients are asymptomatic and diagnosed incidentally or based on the presence of fracture. Adult onset osteopetrosis usually presents with hip and proximal femoral fractures. Internal fixation can be performed; however, technical challenges may be experienced due to increased bone density. As in other fractures, nonunion or varus malunion of these fractures may occur. Although rare, osteopetrosis may complicate treatment of fractures in such patients. In this study, we aimed to present two new cases of ADO type II with an osteopetrotic femoral fracture along with the clinical and radiological findings in the light of a comprehensive literature review. Orthopaedics surgeons should be aware of intraoperative technical difficulties and possible postoperative complications during the follow-up period. Investigation would be beneficial for the diagnosis of osteopetrosis such the patient with fractures who has minor trauma history and increased bone density in radiography.

Influence of 1800 MHz GSM-like electromagnetic radiation exposure on fracture healing.

BACKGROUND AND AIMS: In this study, we aimed to investigate whether 1800 MHz frequency electromagnetic radiation (EMR) has an effect on bone healing. METHODS: A total of 30 Wistar albino rats were divided into two equal groups. Fractures were created in the right tibias of all rats; next, intramedullary fixations with K-wire were performed. A control group (Group I) was kept under the same experimental conditions except without EMR exposure. Rats in Group II were exposed to an 1800 MHz frequency EMR for 30 min a day for 5 days a week. Next, radiological, mechanical, and histological examinations were performed to evaluate tibial fracture healing. RESULTS: Radiological, histological and mechanical scores were not significantly different between groups (respectively, p = 0.114, p = 0.184 and p = 0.083), and all of these scores were lower than those of the controls. CONCLUSIONS: EMR at 1800 MHz frequency emitted from cellular phones has no effect on bone fracture healing.

Effect of 900MHz electromagnetic fields emitted from cellular phones on fracture healing: an experimental study on rats.

OBJECTIVE: The aim of this study was to investigate the effect of electromagnetic fields (EMFs) at 900 MHz frequencies on bone fracture healing. METHODS: The study included 30 adult male Wistar albino rats (average weight: 256 g) divided into two equal groups. Transverse fracture was created manually by pressing a finger on the right tibias of all rats and fractures were fixed intramedullary using a K-wire. Rats in Group 1 were exposed to EMF at 900 MHz frequency 30 minutes a day, 5 days a week for 8 weeks. Group 2, the control group, was kept under the same experimental conditions without EMF exposure. Radiological, mechanical and histological examination of tibial fracture healing was performed. RESULTS: There was a significant difference between radiological, histological and manual biomechanical scores of the study and control groups (p=0.020, p=0.006 and p=0.032, respectively). All scores were lower in the study group than the control group. CONCLUSION: Results of this study demonstrate that EMF at 900 MHz of frequency emitted from cellular phones has a significantly negative effect on bone fracture healing in a rat tibia model.

Results of vacuum assisted wound closure application.

In recent past, various methods have been used for wound treatment purpose. In this study, we aimed to compare our results established from the vacuum-assisted wound closure method, which has gained popularity day by day, with the literature. A total of 48 patients, who received vacuum-assisted wound closure treatment in our clinic between 2007and 2010, were included in this study. Etiological distribution of the patients was as follows: 32 traumatic, 6 pressure sore, 9 diabetic, and 1 iliac disarticulation. All cases were evaluated in terms of age, gender, etiology, period of treatment, and size of the wound. In the patients studied, 42 were men (87.5 %) and 6 were women (12.5 %). Mean age of the patients was 39.6 years (11-61 years). All of our traumatic patients suffered from open fracture. After the vacuum-assisted wound closure application, wound size reduced by 28.8 %, while the mean area of the surface of the wound was 94.7 cm(2) (13.7-216.3 cm(2)) on average. After the wounds became ready for surgery, 15 of them were treated with split-thickness grafting, 9 of them were treated with secondary suture, 18 of them were treated with full-thickness grafting, and 6 of them were treated with flap. Average period of the application of vacuum-assisted wound closure was 11.6 days (7-15 days). Results of vacuum-assisted wound closure can be regarded as satisfactory when cases are selected properly. This system has three different effect mechanisms. Firstly, it increases local blood flow on the wound bed. Secondly, cell proliferation is triggered following the mechanic stress. Thirdly, vacuum removes the proteases from the environment which obstructs healing. Therefore, it is intended to prepare alive wound bed which is required for subsequent soft tissue reconstructions.

[Effect of bone cement application on the incidence of deep vein thrombosis in major joint arthroplasties]. / Büyük eklem artroplastilerinde kemik çimentosu uygulamasinin derin ven trombozu sikligina etkisi.

OBJECTIVES: In this study, we have investigated whether the application of bone cement has an effect on the frequency of deep vein thrombosis (DVT) in major joint arthroplasties (MJA). PATIENTS AND METHODS: A total of 95 MJA cases meeting the inclusion criteria of this study between January 2004 and January 2005 were divided into cemented and cementless groups. For prophylaxis, all patients were given low molecular weight heparin (LMWH). The patients were scanned for DVT preoperatively and on the postoperative 12(th) day by color Doppler ultrasonography. RESULTS: In hip arthroplasties, in knee arthroplasties and in general, DVT was seen more frequently in cemented group, however, there was no statistically significant difference between groups in the frequency of DVT (p=0.549, p=0.749 and p=0.462, respectively). Also, there was no significant difference between the results of the different LMWH groups (p=0.616). CONCLUSION: The results of this study shows that bone cement application in MJAs such as hip or knee arthroplasties has no significant effect on the frequency of DVT.

[The efficacy of low- and high-molecular-weight hyaluronic acid applications after arthroscopic debridement in patients with osteoarthritis of the knee]. / Gonartrozlu hastalarda artroskopik debridman sonrasi düsük ve yüksek molekül agirlikli hiyalüronik asit uygulamalarinin etkinligi.

OBJECTIVES: We evaluated the efficacy of viscosupplementation with low- or high-molecular-weight hyaluronic acid (HA) preparations following arthroscopic debridement (AD) in patients with osteoarthritis of the knee. METHODS: The study included 45 patients (19 men, 26 women; mean age 53 years; range 41 to 66 years) with Kellgren-Lawrence grade 2-3 osteoarthritis of the knee. Following AD, the patients were randomized to three groups to receive three intra-articular injections of 2 ml hylan G-F 20 (Synvisc, n=16), five intra-articular injections of 2 ml sodium hyaluronate (Hyalgan, n=14), and no injections (controls, n=15). Injections were administered at one-week intervals. All the patients were evaluated with pain, stiffness, and functional capacity scores of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index before and 6 and 12 months after AD. RESULTS: Two patients and three patients complained of transient pain in Synvisc and Hyalgan groups, respectively. WOMAC scores showed significant decreases in all the groups at 6 and 12 months. There were no significant differences between the three groups with respect to improvement in WOMAC scores at 6 months. However, compared to the control group, differences between pre- and posttreatment scores at 12 months were significantly greater in the Synvisc (p=0.004) and Hyalgan (p=0.003) groups, with no significant difference between the two HA groups (p>0.05). CONCLUSION: Our findings show that AD is beneficial in osteoarthritis of the knee in patients with appropriate indications, viscosupplementation increases the efficacy of treatment, and that low- and high-molecular-weight HA preparations have similar efficacy.

Modified crescentic proximal metatarsal osteotomy and distal soft tissue procedures in hallux valgus.

The results of a modified crescentic proximal metatarsal osteotomy and distal soft tissue procedures for patients with symptomatic, incongruent, metatarsophalangeal joint, hallux valgus deformity were reviewed. Forty-nine feet of 41 patients were evaluated. All of the patients were male military personnel of different ranks, and their mean age was 23 years (range, 20-43 years). The mean follow-up period was 25 months (range, 10-60 months). The patients were evaluated according to the American Orthopedic Foot and Ankle Society forefoot scoring system. The mean preoperative score was 54.4, and the mean postoperative score was 95.4. The mean hallux valgus angle was 39.4 degrees before surgery and 12.8 degrees after surgery (26.6 degrees correction); the mean intermetatarsal angle was 15.9 degrees before surgery and 7.1 after surgery (8.8 degrees correction). A total of 93.8% of the patients were satisfied with the results of the procedure. Complications included delayed union in one case and superficial wound infections in two cases. We also emphasize small modifications performed while shifting the metatarsal shaft laterally and compare the results of our study with those of similar studies.

Comparison of hemodynamic and postoperative analgesic effects and recovery of unilateral and bilateral spinal anesthesia.

OBJECTIVE: To compare unilateral with bilateral spinal anesthesia according to hemodynamic, postoperative analgesic effects and recovery. METHODS: This study took place in Ankara Numune Hospital, Ankara, Turkey, between March and July 2004. We accepted 60 patients undergoing elective lower extremity orthopedic surgery for the study, and randomly allocated the patients into 2 groups, bilateral and unilateral. We performed crystalloid preload spinal puncture at the L4-5 intervertebral space with a 25-gauge Quincke needle. Both groups received local anesthetic while lying in the lateral position, dependent on the side to be operated. All the patients had 10 mg 0.5% hyperbaric bupivacaine injected over 40 seconds. Only the patients in the unilateral group remained in the lateral position for 15 minutes. We measured noninvasive mean arterial blood pressure and heart rate before spinal blockade and then after 5, 15, 30, and 45 minutes. We also recorded motor block regression time and first analgesic need. We analyzed the data using Mann-Whitney U, Wilcoxon, and Chi-square tests, considering p<0.05 as significant. RESULTS: We observed no significant differences regarding height, age, and weight. In both groups, heart rate and mean arterial pressure showed a decrease after spinal blockade. Recovery time and the first analgesic need in the unilateral group were higher than the bilateral group. CONCLUSION: Because of its long lasting analgesic effect without any hemodynamic change, we suggest unilateral spinal block for lower extremity orthopedic procedures.

Conservative treatment of scapular neck fracture: the effect of stability and glenopolar angle on clinical outcome.

The aim of this study was to determine the effect of stability and glenopolar angle on the clinical outcome of conservatively treated scapular neck fractures. Eighteen patients with scapular neck fractures were treated with conservative treatment. Twelve of the 18 patients had surgical neck fractures, whilst six of them had anatomical neck fractures. Anteroposterior radiographs and computerised tomography were performed for each patient. Glenopolar angle was measured through anteroposterior radiographs in the scapular plane. After 3-5 weeks of immobilisation, a rehabilitation programme was started, throughout which all the patients were treated in a 3-phase rehabilitation programme. The mean follow-up was 25 months, and the Constant score was 78.83+/-8.12 point (range: 68-94 points). Patient gender and the type of scapular neck fractures had no effect on functionality or clinical outcome (p>0.05), whilst associated injuries significantly affected the clinical outcome (p<0.05). There was a positive correlation between the Constant score and glenopolar angle (r=0.891, p<0.05) and between the age and glenopolar angle (r=0.472, p<0.05).

[Comparison between the distraction and grafting methods in the treatment of peripheral neural defects: an experimental study in rabbits]. / Periferik sinir defektlerinin tedavisinde distraksiyon ve greftleme yöntemlerinin karsilastirilmasi: Tavsanda deneysel çalisma.

OBJECTIVES: We compared the electrophysiologic and histopathologic results of grafting and distraction methods in the treatment of defective peripheral neural injuries. METHODS: Thirty male white rabbits (age 6 months) were divided into three groups and a circular external fixator (CEF) was applied to the right tibias. In group I (primary repair), the right deep peroneal nerve was cut without inducing any defect and a tibial osteotomy was performed. The remaining groups underwent bone and nerve excision of about 1 cm in the middle third of the tibia. In group II, the defect area was closed acutely with the CEF and the continuity of the nerve was restored. In group III, a nerve graft obtained from the left side was placed in the defect area and an epiperineural repair was made. Group II underwent distraction 21 days after surgery for 10 days with a rate of 0.25 mm four times a day. Electrophysiological studies were performed in the 12th and 24th weeks and nerve biopsies were obtained in the 32nd week for histopathologic examination. RESULTS: Electrophysiological studies in the 12th week did not show any significant differences in nerve conduction between the three groups; however, in the 24th week, amplitude and latency values of the graft group were 50% lower than those of the primary repair and distraction groups (p<0.05). On histological examination, the results were good in group I and II, but poor in group III with respect to nerve fiber density, thickness of the myelin sheath, degenerative changes in the myelin sheath, and average axon number. CONCLUSION: Our data demonstrate that treatment of neural defects by the distraction method results in much better results than the grafting method.

Dropping of an EndoButton into the knee joint 2 years after anterior cruciate ligament repair using proximal fixation methods.

One of the most discussed subjects regarding anterior cruciate ligament (ACL) repair methods is femoral fixation. One of the materials often used for fixation in recent years is the EndoButton (Acufex Microsurgical, Mansfield, MA), which provides rapid and secure fixation. Although many reports about femoral fixation with EndoButton have been published, insufficient information is available on possible complications. We have used 240 EndoButtons in our clinic for ACL repairs since 1997. The goal of this study was to report a case of ACL repair with an EndoButton, in which we experienced a complication. In this case, the EndoButton dropped into the knee joint after 2 years.