The relation between ankle morphology and osteochondritis dissecans of talus.

The purpose of this study is to describe, if there is, any relation between ankle morphology and development of talus osteochondritis dissecans (OCD) using certain morphological parameters derived from high resolution magnetic resonance imaging (MRI). Study included a total of 93 patients: 26 patients with traumatic medial talus OCD, 30 patients with idiopathic medial talus OCD and 37 patients with normal ankle as the control group. Five MRI morphological parameters (Maximal Tibial Thickness (MTiTh), Malleolar Width (MalW), Length of Trochlea Tali Arc (TaL), Height of Trochlea Tali Arc (TaH) and Angle of Trochlea Tali Inclination (TaIA)) that are expected to be relevant to talus OCD formation are measured and compared for the three groups. Significant difference was found between the idiopathic and the traumatic group in terms of age and gender. Two of five morphologic parameters (MalW and TaL) also showed significant difference for the traumatic and idiopathic group compared to healthy volunteers. Two morphologic parameters that were found to be significantly different from healthy controls may suggest that ankle morphology be a possible factor for talus OCD. Age and gender difference between the traumatic and idiopathic group also may point out different underlying mechanisms for OCD formation.

Reconstruction of intercalary bone defects following bone tumor resection with segmental bone transport using an Ilizarov circular external fixator.

AIM: The purpose of this retrospective study was to report the long-term follow-up results of the reconstruction of bony defects with Ilizarov distraction osteogenesis using the bone transport method following en bloc resection of bone tumors. MATERIALS AND METHODS: En bloc resection was performed in 13 patients with bone tumors between October 1991 and December 2010 in our clinic. The mean age of the patients was 19.46 years (range 7-42 years) at the time of surgery. Histological diagnosis was osteosarcoma in seven cases, Ewing's sarcoma in three cases, giant cell tumor in one case, osteoblastoma in one case and fibrous dysplasia in one case. In all cases either the femur or tibia was involved. RESULTS: The average follow-up period was 157.23 months (range 32-288 months), and the bone defect after resection was 14.61 cm ± (9-24 cm). The mean Musculoskeletal Tumor Society score of the patients was 89.46 (83-96) at the final follow-up. The mean Knee Society Scale scores of patients in whom reconstruction was performed around the knee joint were 74.3 (51-84). The mean foot and ankle disability index of patients with a tumor around the ankle joint was 81 (73-95). Quality of life of the patients according to the SF-36 and BQUILI indexes was scored as 104 (88-150) and 4 (0-13), respectively. CONCLUSION: From the long-term follow-up results, reconstruction with distraction osteogenesis seems to be an efficient method in patients with long life expectancies. However, a long external fixation time is a disadvantage of this technique. Problems in patient compliance and possible complications such as nonunion should be managed promptly.

Amputation versus functional reconstruction in the management of complex hind foot injuries caused by land-mine explosions: a long-term retrospective comparison.

The purpose of this study is to compare the long-term clinical outcomes of patients who were treated with either hind foot reconstruction or amputation in complex hind foot injuries accompanied with bone and soft tissue loss due to land-mine explosions. Between 1994 and 2004, all patients with hind foot complex injuries due to land-mine explosion, who were operated in our clinic, were enrolled to the study. All patients were evaluated with Short-Form 36 (SF-36), Foot and Ankle Disability Index (FADI) and Body Image Quality of Life Inventory (BIQLI) after a mean of 15.1 ± 2.2 (range 9-19) years of follow-up. Demographic characteristics, number of operations, necessity of psychiatric treatment and all complications were compared between groups. There were a total of 42 patients [21 in reconstruction group (Gr I) and 21 in amputation group (Gr II)]. The mean age at the time of final follow-up was 38.4 ± 3.04 years in Gr I and 38.2 ± 4.24 years in Gr II (p = 0.732). The mean follow-up duration was 15.7 ± 2.07 years in Gr I and 14.57 ± 2.29 years in Gr II (p = 0.081). The number of operations was significantly higher in Gr I (8.66 ± 10.2 times vs. 4.42 ± 7.7 times, respectively, p = 0.001). The mean FADI score at the final follow-up was 64.3 ± 18.1 in Gr I. In amputation group, more patients needed psychotherapy due to major depression (12 patients vs. 4 patients, p = 0.012). Major complications in Gr I were musculocutaneous flap atrophy in calcaneal region (n = 8 patients), limited ankle motion (n = 11) and painful osteophytes on plantar region (n = 6). In Gr II, stump problems were dominating (pain and tenderness n = 10, ulcer n = 2, allergic skin lesions n = 7, painful neuroma n = 10, bony spur n = 5, paresthesia n = 1, excessive sweating n = 12). At the final visit, although SF-36 scores were similar between groups (p = 0.182), extremity reconstruction group had significantly higher BIQLI scores than the amputation group (p = 0.016). If the dorsalis pedis is intact and midfoot and forefoot is relatively protected, hind foot reconstruction should be attempted. Long-term outcomes of hind foot reconstruction are satisfactory with minor complications and better BIQLI.

Lower limb salvage surgery using Ilizarov circular external frame for a landmine injury about the knee.

Limb salvage for severe trauma has been replaced amputation as the primary treatment in many trauma centers. However, the long-term outcomes after limb reconstruction or amputation have not been fully evaluated. In this report, we present the treatment results of limb salvage surgery using Ilizarov external circular frame in a male case who had a-22-cm bone loss on the left distal femur and left proximal tibia and large soft tissue defect around the knee due to stepping on a landmine with his knee. The decision to amputate a severely injured limb, being irreversible, is challenging and significantly affects the body image and the patient. Extremity salvage surgery should be considered initially when evaluating patients with high-energy injured limbs at high risk for amputation.

[A comparison of the efficacy of bupivacaine and levobupivacaine in patient-controlled epidural analgesia for postoperative pain in patients undergoing knee arthroplasty]. / Diz artroplastisi yapilan hastalarda ameliyat sonrasi agri için hasta kontrollü epidural analjezide bupivakain ve levobupivakainin etkinliginin karsilastirilmasi.

OBJECTIVES: In this study, we aimed to compare the efficacy of bupivacaine and levobupivacaine in the patient-controlled epidural analgesia (PCEA) in patients who underwent total knee arthroplasty (TKA), particularly with cardiac diseases. PATIENTS AND METHODS: Forty-four patients (16 males, 28 females; mean age 70.2±6.3 years; range 18 to 80 years) who were scheduled for TKA surgery under combined spinal and epidural anesthesia were included. Patients were randomly divided into two groups. Bupivacaine 15 mg 0.5% for group 1 (n=23) and levobupivacaine 15 mg 0.5% for group (n=23) were administered via spinal route. The amount of local anesthetics, PCEA starting times and bolus/demand ratio of local anesthetics were recorded. The level of pain, need for additional analgesic, total amount of analgesic, degree of motor block, complications were asked for patient satisfaction at postoperative 6, 12, 24 and 48 hours. RESULTS: No statistical differences were determined between group 1 and group 2 in terms of the operation times, PCEA starting times, bolus number/demand ratios, visual analog scale (VAS) scores and numerical rating scores (NRS) at the postoperative 6, 12, 24 and 48 hours, need for additional analgesic, total amount of analgesic, degree of motor block and patient satisfaction. Although the incidence of side effects was lower in the group 1 compared to group 2, it was not statistically significant. CONCLUSION: We concluded that it would be proper using levobupivacaine rather than bupivakaine for patients with cardiac diseases, as the cardiotoxic and neurotoxic effects of levobupivacaine is lower then bupivacaine with a similar analgesic efficacy.

The importance and efficacy of posterior only instrumentation and fusion for severe idiopathic scoliosis.

AIM: In mild and moderate idiopathic scoliosis (IS), posterior only instrumentation and fusion can provide satisfactory reduction. However in severe and rigid curvatures, combined anterior and posterior fusion is generally required. In this study we have aimed to evaluate the efficacy of posterior only instrumentation in severe thoracolumbar scoliosis clinically and radiologically and compare these results with the literature. MATERIAL AND METHODS: In this retrospective study, 29 consecutive patients with severe idiopathic scoliosis who underwent posterior only instrumentation and fusion between March 2003 and February 2011 were included the study. Radiological evaluation was performed with preoperative, postoperative and folllow up standing AP and lateral x-rays. Clinical evaluation was made with shoulder balance and trunk shift. REAULTS: Major curve magnitude decreased to 24,1° and compensatory curve magnitude decreased to 12.20° at postoperative period. There was no significant difference in sagittal plane angles. Major curve correction rate was %68,65 in screw only instrumentation and % 65 in hybrid instrumentation. CONCLUSION: Transpedicular screw instrumentation in severe IS is a safe and effective method in proper hands when flexibility of the curve evaluated accurately in preoperative period.

Adjunctive hyperbaric oxygen therapy in the treatment of atrophic tibial nonunion with Ilizarov external fixator: a radiographic and scintigraphic study in rabbits.

OBJECTIVE: The aim of this experimental study was to determine the effects of adjunctive hyperbaric oxygen therapy (HBO) on atrophic tibial nonunion treatment using Ilizarov external fixator. METHODS: Twenty New Zealand white rabbits were randomly divided into two equal groups. A circular external fixator was applied to the right tibia of all the rabbits. A 5-mm bone block was resected and a tibial pseudarthrosis was obtained after a 6-month waiting period. The experimental group rabbits (n=10) underwent daily 2.5 ATA HBO therapy for 2 hours for 20 days and the control group rabbits (n=10) did not receive any corresponding treatment. Osteoblastic activity was evaluated with bone scintigraphy on days 30 and 90. Fracture healing was evaluated by plain radiographs on days 30 and 90. RESULTS: On Day 30, radiological scores were statistically similar in both groups (p=0.167). However, on Day 90, the experimental group displayed significantly higher radiological scores (p<0.001). Osteoblastic activity was also higher in the experimental group on both scintigraphic assessments (p=0.005 and p=0.001). CONCLUSION: The results of this study suggest that HBO can be used as a supplementary therapy in the management of atrophic tibial nonunion.

Ilizarov external fixation without removal of plate or screws: effect on hypertrophic and oligotrophic nonunion of the femoral shaft with plate failure.

Patients with hypertrophic and oligotrophic nonunion of the femoral diaphysis associated with plate failure can be treated by Ilizarov external fixation without plate removal. Advantages of this technique include a lack of damage to the blood supply and simultaneous deformity correction.

Evaluation and comparison of the effects of hyperbaric oxygen and ozonized oxygen as adjuvant treatments in an experimental osteomyelitis model.

BACKGROUND: We evaluated and compared the efficacy of ozone (O(3)) and hyperbaric oxygen (HBO) therapies in an experimental rat model of osteomyelitis. MATERIALS AND METHODS: Forty-eight male Sprague-Dawley rats were divided into sham, osteomyelitis (control), vancomycin (V), vancomycin + HBO (VHB), vancomycin + O(3) (VO), and vancomycin + HBO + O(3) (VOHB) groups. Osteomyelitis was induced by a bone injection of 10(8) CFU/mL methicillin-resistant Staphylococcus aureus. HBO was administered daily at 2.8-atm pressure for 90 min; O(3) therapy was provided as intraperitoneal injections of 0.7 mg/kg O(3)/O(2) gas mixture once daily. Treatments were continued from d 7 to 21 after induction of osteomyelitis. Bone tissues and blood samples were harvested for biochemical, histopathologic, and microbiologic analyses. RESULTS: Rats in the sham, VO, and VOHB groups gained weight but those in the control, V, and VHB groups did not. Levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase were lower in the VHB, VO, and VOHB groups than in V and control groups. Levels of interleukin-10 and -1ß and tumor necrosis factor-α were decreased in the VHB, VO, and VOHB groups; transforming growth factor-ß was increased in these groups compared with V and control groups (P ≤ 0.001). Bacteria counts in VOHB were significantly lower than those in group of V (P = 0.012). Histopathologic scores in group VO were significantly lower than those in group V (P = 0.046). CONCLUSIONS: O(3) was as effective as HBO in decreasing oxidative parameters and inflammatory cytokines. Rats in the VO and VOHB groups gained more weight than did the other groups. Bacteria counts were significantly decreased in group VOHB compared with the other groups. Histopathologic scores in group VO were significantly decreased compared with the other groups.

[Outcomes of multilevel orthopedic surgery in children with cerebral palsy]. / Serebral palsili çocuklarda çok seviyeli ortopedik cerrahi tedavinin sonuçlari.

OBJECTIVES: Outcomes of single-event bilateral multilevel orthopedic surgery in children with cerebral palsy were retrospectively investigated by physical findings, and gross motor function measurement (GMFM) score in all patients and additionally by joint kinematics, and time-distance parameters in ambulatory patients. PATIENTS AND METHODS: A total of 24 patients (17 ambulatory; 7 non ambulatory; mean age 12 years; range 5 to 19 years) treated with multilevel orthopedic surgery between December 2003 and December 2005 were included in the study. Patients were evaluated with physical examination and GMFM score. In addition, computed gait analysis was used to evaluate joint kinematics and time-distance parameters in ambulatory children. The following surgeries were performed on the children in the study cohort: adductor tenotomy (n=24); psoas lengthening (n=14); hamstring lengthening (n=46); distal rectus femoris transfer (n=18); bilateral Achilles tendon lengthening (n=22); distal femoral derotation osteotomy (n=1); open reduction and Dega osteotomy (n=1), and proximal femur resection (n=2). Patients were evaluated with the same parameters after an average of eight months postoperatively. The pre- and postoperative results were statistically compared. RESULTS: Improvements were achieved in the lying-rolling (7%), sitting (9%), crawling-kneeling (7%), standing (5%), and walking-running-jumping (5%) activities of GMFM score. An increase in hip abduction angle and external rotation and a decrease in the Thomas test results were observed. A decrease in popliteal angle and an increase in active and passive knee extension were provided. Active and passive ankle dorsiflexion increased. In the kinematic parameters, the minimum hip and knee flexions in the stance phase were significantly decreased, while no significant decrease was seen in the maximum hip and knee flexion in the swing phase. Both the ankle dorsiflexion in the stance and swing phase and the time-distance parameters consist of walking velocity, stride length and the cadence were significantly improved. CONCLUSION: Single-event bilateral multilevel orthopedic surgery performed in the right indication was shown to be effective with improvements in physical examination findings GMFM scores, joint kinematics and time-distance parameters in children with cerebral palsy.

Effect of alpha-tocopherol on bone formation during distraction osteogenesis: a rabbit model.

PURPOSE: The purpose of this study was to evaluate the effects of alpha-tocopherol on distraction osteogenesis. MATERIALS AND METHODS: Right tibias of 30 New Zealand white rabbits were distracted at a rate of 0.5 mm/day for 20 days with a circular external fixator. Experimental group rabbits (n = 15) were administered i.m. 20 mg/kg/day alpha-tocopherol for 30 days. Radiographic examinations were performed at the 20th, 30th and 40th days. Bone scintigraphy was performed at the 5th and 20th days. Serum total antioxidant capacity (TAC) was measured at the 5th and 30th days. All animals were sacrificed and the right tibias of all animals were harvested for histopathologic examination at the 40th day. RESULTS: Radiologic scores were statistically similar at the 20th day. However, the experimental group demonstrated higher radiologic scores at the 30th and 40th days. A scintigraphic baseline study at the 5th day of the study showed statistically similar osteoblastic activities in both groups. However, at the 20th day, osteoblastic activity was significantly higher in the experimental group. Serum TAC values were also significantly higher in the experimental group at the 30th day. At necropsy, histopathologic examination revealed statistically significantly higher scores in the experimental group. CONCLUSION: The results of this study show that alpha-tocopherol has beneficial effects on new bone formation during distraction osteogenesis.

The role of preconditioning and N-acetylcysteine on oxidative stress resulting from tourniquet-induced ischemia-reperfusion in arthroscopic knee surgery.

BACKGROUND: The aim of this study was to investigate the effects of ischemic preconditioning (IPC) and N-acetylcysteine (NAC) on oxidative stress resulting from tourniquet-induced ischemia-reperfusion (IR) period in arthroscopic knee surgery. METHODS: Forty-five patients who had arthroscopic knee surgery for meniscal and chondral lesions and for pathologic medial plica were included in this study. They were assigned to the following treatment groups: control (group C; n=15), IPC (group P; n=15), and NAC (group N; n=15). Subjects in the control group underwent routine surgical procedures. Subjects in the preconditioning group were subjected to temporary ischemia, with tourniquet performed by three compression cycles of 5 minutes followed by 5 minutes of reperfusion just before the application of tourniquet inflation. Subjects in the NAC group received 10 mg/kg NAC dissolved in 100 mL 0.9% normal saline intravenously 30 minutes before tourniquet inflation. An hour before the tourniquet was applied (preischemia) and 2 hours after tourniquet was removed (reperfusion), blood samples (to test for metabolites) were obtained. Levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidant capacity (TAC), and total oxidant status (TOS) were measured in all serum samples. Results were compared between preischemia and reperfusion in three groups. RESULTS: MDA in the control group was found to be increased significantly compared with preischemia, whereas MDA in IPC and NAC groups did not change insignificantly. SOD and GSH activities in the control group were found to be increased significantly, whereas SOD and GSH activities in IPC and NAC groups did not change significantly after reperfusion. TAC in the control group was found to be decreased and TOS was found to be increased significantly, but TAC and TOS in IPC and NAC groups were not significantly different after reperfusion. Mean serum MDA, TOS, SOD, and GSH-Px levels were lower in group P than group C at reperfusion period (p<0.05). Mean serum SOD levels were lower in group P than group N at reperfusion period (p<0.05). CONCLUSIONS: Tourniquet-induced IR period in routine arthroscopic knee surgery resulted in oxidative stress by increasing MDA, SOD, GSH-Px, TOS and decreasing TAC. NAC and IPC had protective effect on occurrence of oxidative stress resulting from IR period by preventing MDA, SOD, GSH-Px, TAC, and TOS changes in routine arthroscopic knee surgery.

Effect of preconditioned hyperbaric oxygen and ozone on ischemia-reperfusion induced tourniquet in skeletal bone of rats.

BACKGROUND: The aim of the study was to investigate effect of I/R injury on bone tissue and protective role of hyperbaric oxygen precondition (HBO-PC) and ozone precondition (O(3)-PC) on I/R injury by using biochemical analysis. MATERIALS AND METHODS: Thirty-two rats were included in study. The animals were divided into four equal groups: sham operation, I/R, I/R+HBO and I/R+O(3). One session of 60 min, 3 ATA, 3-4 L/min, 100% oxygenation was defined as one dose of HBO. First dose of HBO was administrated 72 h before ischemia. Subsequent, one-dose of HBO administrated per 12 hours until ischemia time (total seven doses); 0.7 mg/kg ozone/oxygen mixture intraperitoneally was defined as one dose of ozone. First dose of O(3) was administered 72 h before ischemia (total four doses). I/R model was induced in anesthetized rats by unilateral (right) femoral artery clipping for 2 h followed by 22 h of reperfusion. The right tibia and were harvested. Tissue was assayed for levels of malondialdehyde (MDA) and protein carbonyl (PCO), activities of superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). RESULTS: MDA and PCO levels were increased in I/R group. SOD activity was increased; GSH-Px activity was decreased in I/R group. MDA and PCO levels were decreased, SOD and GSH-Px activities were increased in both HBO+I/R and O(3)+I/R groups. CONCLUSION: It has been shown that levels of MDA and PCO in bone were increased followed by 2 h of ischemia and 22 h of reperfusion period. Ozone-PC and HBO-PC has protective effect against skeletal bone I/R injury by decreasing levels of MDA and PCO, increasing activities of SOD and GSH-Px in rats.

AO tension band technique application in proximal humerus fractures.

OBJECTIVES: The aim of this study was to report our functional results after an intramedullary Kirschner wires (K-wires) and tension band wiring combination for the treatment of a large group of humeral head fractures was performed. PATIENTS AND METHODS: Seventy-four patients (54 females, 20 males; mean age 42 years; range 24 to 73 years) who had proximal humerus fractures were treated with an intramedullary K-wire and tension band technique and were retrospectively analyzed. Fracture patterns were according to Neer classification type II in 43 patients, type III in 23 patients and type IV in five patients. The Constant-Murley shoulder score test was used to evaluate the function of both shoulders. The outcome was graded according to Neer's criteria. The pain score was determined with a 10-point visual analog scale. RESULTS: All fractures were healed (radiologically and clinically) within 3.6 months (range 2.5 to 4.7 months) after the surgery. In one patient, the cerclage wire was broken and in eight patients, K-wires produced impingement like symptoms that required a second procedure (wire removal) after healing. The results of the patients with regard to Constant-Murley score and Neer criteria were indifferent when the 6th and the 12th month data were compared (p<0.05). Visual analog scale scores of the patients between the two control visits were significant different (p>0.05). CONCLUSION: The type of fixation depends on the bone quality and the degree of comminution. But the recent trend is towards osteosynthesis -the limited, less invasive technique- which is performed with minimal soft tissue dissection and minimal osteosynthesis. It allows less stripping of bone and therefore preservation of the blood supply to the humeral head. This procedure is simple to perform and provides good postoperative results.

Bilateral absence of patella.

A 20-year-old man with bilateral absence of patella, thinness of the left femoral neck, femoral and tibial shaft was reported. This clinical presentation has not been reported in the English language literature. We propose that the unusual association observed in our patient may represent a distinguishing clinical presentation from previously reported aplastic patella syndromes.

Immobilization of the shoulder in external rotation for prevention of recurrence in acute anterior dislocation.

OBJECTIVES: We aimed to compare the functional and stability outcomes of the patients with acute anterior shoulder dislocation, who were stabilized at external versus internal rotation. METHODS: A total of 33 patients (31 males and 2 females) with the diagnosis of acute primary traumatic anterior shoulder dislocation were immobilized at internal (n=17) or external rotation (n=16). The mean follow-up period was 20.85 months (range 6-41 months). Patients received rehabilitation program immediately after splinting. We assessed functionality by Constant-Murlay score and stability by Rowe scoring system in 6th month. Control examinations were performed in 12th and 24th months. RESULTS: There were no statistically significant differences between internal rotation and external rotation groups in terms of Constant-Murlay and Rowe scores. Recurrent dislocation rate was 6.3% (1/16) in external rotation group and 29.4% (5/17) in internal rotation group (p>0.05). In the subgroup of patients aged between 21-30 years, while no recurrent dislocation was seen in external rotation group, 5 patients developed recurrent dislocation in internal rotation group(p=0.035). CONCLUSION: Immobilization of the shoulder in external rotation is an effective technique for prevention of recurrent dislocations in acute anterior shoulder dislocation and should be preferred to traditional splinting in internal rotation in clinical practice.

Effect of hyperbaric oxygen and ozone preconditioning on oxidative/nitrosative stress induced by tourniquet ischemia/reperfusion in rat skeletal muscle.

OBJECTIVES: The aim of the study was to investigate the effect of hyperbaric oxygen-preconditioning (HBO-PC) and ozone-preconditioning (O3-PC) on oxidative/nitrosative stress induced by tourniquet ischemia/reperfusion (I/R) in rat skeletal muscle. METHODS: Thirty-two Wistar-Albino-type male rats included in the study were divided into four groups of equal number: 1) sham operation, 2) I/R, 3) I/R+HBO-PC, or 4) I/R+O3-PC. One session of 3-4 L/min 100% oxygenation for 60 min at 3 absolute atmosphere (ATA) was defined as one dose of HBO; in total, 7 doses of HBO-PC were administered before ischemia. One dose of O3 comprised 0.7 mg/kg ozone/oxygen mixture, administered intraperitoneally; a total of 4 doses of O3-PC were administered before ischemia. The I/R model was performed in anesthetized rats by clipping right femoral artery to induce 2 h ischemia followed by 22 h of reperfusion. The right gastrocnemius muscle and venous blood samples were harvested. Tissue was assayed for levels of malondialdehyde (MDA), inducible nitric oxide synthase (iNOS), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). Serum was assayed to measure the level of nitrite-nitrate (NOx). RESULTS: Tissue MDA level, SOD activity, and serum NOx level were increased, whereas GSHPx was decreased in the I/R group. MDA and NOx levels were decreased, whereas GSH-Px activity was increased in both the I/R+HBO-PC and I/R+O3-PC groups. SOD activity was increased in the I/R+O3-PC group, but did not change significantly in the I/R+HBO-PC group. iNOS staining score and intensity were lower in the I/R+HBO-PC and I/R+O3-PC groups than I/R group. CONCLUSION: Both O3-PC and HBO-PC reduced tissue lipid peroxidation, NOx levels, and iNOS staining scores in the experimental I/R model. Our data suggest that HBO-PC and O3-PC protect against oxidative/nitrosative stress induced by I/R in rat skeletal muscle.

Coccygectomy with or without periosteal resection.

The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent coccygectomy. Resection of all mobile coccygeal segments including the periosteum was performed in 11 patients (group 1) and resection was performed subperiostally sparing the periosteum in the remaining 14 patients (group 2). A visual analogue scale was used for pain assessment before and after the surgery both in sitting and standing positions. A questionnaire to evaluate subjective patient satisfaction was also used. The two groups were statistically similar in terms of age, sex, aetiology, duration of symptoms before surgery and follow-up time. Both surgical techniques resulted in a statistically similar clinical outcome. Overall, 84% of patients who underwent coccygectomy benefited from surgery. We observed four wound infections (two superficial and two deep) that caused delayed wound healing in group 1. The rate of infection in group 1 was statistically higher than in group 2. The results of this study suggest that periosteal preservation and closure are related to low risk of infection.

Outcomes of combined hamstring release and rectus transfer in children with crouch gait.

BACKGROUND: Our aim was to evaluate the outcomes of combined hamstring release and rectus transfer in children with crouch gait using physical examination and gait analysis. MATERIALS AND METHODS: A total of 19 patients (38 knee joints) with crouch were evaluated by static examination and computerized analysis with dynamic EMG. The Ely test was positive together with prolonged and increased activity in the rectus muscle bilaterally in all patients. These patients underwent hamstring release and rectus transfer. Intensive rehabilitation was provided following the surgery and the patients were evaluated again by static examination and gait analysis after an average of 6.3 (4-7.5) months after surgery. The preoperative and postoperative static examination findings, knee and ankle joint kinematics and time-distance parameters were compared in 19 children. RESULTS: There was a significant improvement in static examination findings, knee and ankle kinematics and time-distance parameters. However, there was no significant difference between the preoperative and postoperative swing phase peak knee flexion. CONCLUSIONS: This study demonstrated that static parameters, time-distance parameters, knee and ankle kinematics were improved following combined hamstring release and rectus transfer in children with cerebral palsy without any cases of stiff knees.