Kağan Arslan

The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures

OBJECTIVE The aim of this study was to evaluate the time to union and complications in cases of tibial diaphysis and distal tibial fractures fixed with a minimally invasive percutaneous plate. METHODS Thirty-five patients (23 males, 12 females) were operated on using minimally invasive percutaneous plate osteosynthesis (MIPPO) principles for tibial diaphysis and distal tibial fractures. Twenty-eight were closed and seven were open fractures. After direct or indirect fracture reduction, the plate was advanced through a submuscular extraperiosteal tunnel through the distal incision without opening the fracture line. The plate was fixed with screws through the proximal and distal incisions. Clinical and radiological evaluations were made at four to six week intervals after surgery. Full weight-bearing was allowed after an average of 14.43 (range: 12 to 20) weeks and 15.39 (range: 8 to 32) weeks in open and closed fractures, respectively. Duration of the union and complications were analyzed. RESULTS The mean duration of the union was 20.7 (range: 16 to 28) weeks and 17.96 (range: 10 to 36) weeks in open and closed fractures, respectively. All cases showed union except one who had an implant failure. Necrosis at the wound developed in one case and infection in another. CONCLUSION MIPPO is an effective alternative treatment for tibial diaphysis and distal tibia fractures with low complication and high union rates.

Postfusion pullout strength comparison of a novel pedicle screw with classical pedicle screws on synthetic foams.

Pullout is a very common failure mode on the use of pedicle screws. Numerous studies were completed to increase the pullout strength of pedicle screws especially for osteoporotic bones. In this study, a previously designed pedicle screw type was tested before and after fusion condition. Synthetic polyurethane foams were used in all tests. Three different grades of foams were used in tests to simulate severely osteoporotic, osteoporotic, and healthy bones. Test blocks were produced and characterized in our clinical biomechanics laboratory. Foaming of polyurethane was accepted as fusion process (bone in growth). Pedicle screw including radial holes (new design) was tested both before and after the fusion. It also exhibited remarkably higher pullout strength after fusion than before fusion and most of other alternatives stated in the literature. In total, 70% higher pullout strength was achieved with new design after fusion. On the other hand, new design did not dominate other alternatives when comparison was carried out on severely osteoporotic and healthy bones. To the knowledge of the authors, this is the first study investigating the postfusion properties on synthetic foams.

A critical appraisal of the North American Spine Society guidelines with the Appraisal of Guidelines for Research and Evaluation II instrument.

BACKGROUND CONTEXT The North American Spine Society (NASS) publishes clinical guidelines that are taken into consideration worldwide by clinicians who have a special interest in spinal surgery. The Appraisal of Guidelines for Research and Evaluation (AGREE) II is the second version of the original AGREE instrument to assess the quality of guidelines in terms of development process. This appraisal aims to evaluate each individual NASS guideline using AGREE II tool to demonstrate its methodologic robust and weakness. PURPOSE To evaluate the quality of the clinical practice guidelines published by the NASS. STUDY DESIGN Four appraisers used the AGREE II guideline evaluation instrument to evaluate the NASS guidelines. METHODS All six guidelines available on the NASS web site as of July 1, 2014 were evaluated. Four reviewers independently assessed these guidelines using the AGREE II instrument. The instrument standardizes the quantitative assessment of quality for a guidelines development process across six domains that include: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Additionally, each reviewer rated the overall quality of the guidelines. RESULTS Overall results for the AGREE II domains across all six guidelines were: scope and purpose (median score, 94.4%), stakeholder involvement (median score, 56.9%), rigor of development (median score, 91.7%), clarity of presentation (median score, 94.4%), applicability (median score, 60.9%), and editorial independence (median score, 71.9%). CONCLUSIONS Our study showed that the quality of the NASS guidelines needs some improvement. There is a critical need for broader stakeholder involvement including patient representatives and health economists. Consideration of resource implications and monitoring process and standardization of how recommendations are implemented need to be improved. Studies analyzing facilitators and barriers would be helpful for future NASS guidelines.

Pullout performance comparison of pedicle screws based on cement application and design parameters

Pedicle screws are the main fixation devices for certain surgeries. Pedicle screw loosening is a common problem especially for osteoporotic incidents. Cannulated screws with cement augmentation are widely used for that kind of cases. Dual lead dual cored pedicle screw has already given promising pullout values without augmentation. This study concentrates on the usage of dual lead dual core with cement augmentation as an alternative to cannulated and standard pedicle screws with cement augmentation. Five groups (dual lead dual core, normal pedicle screw and cannulated pedicle screw with augmentation, normal pedicle screw, dual lead dual cored pedicle screw) were designed for this study. Healthy bovine vertebrae and synthetic polyurethane foams (grade 20) were used as embedding test medium. Test samples were prepared in accordance with surgical guidelines and ASTM F543 standard testing protocols. Pullout tests were conducted with Instron 3300 testing frame. Load versus displacement values were recorded and maximum pullout loads were stated. The dual lead dual cored pedicle screw with poly-methyl methacrylate augmentation exhibited the highest pullout values, while dual lead dual cored pedicle screw demonstrated similar pullout strength as cannulated pedicle screw and normal pedicle screw with poly-methyl methacrylate augmentation. The dual lead dual cored pedicle screw with poly-methyl methacrylate augmentation can be used for osteoporotic and/or severe osteoporotic patients according to its promising results on animal cadaver and synthetic foams.

Biomechanical properties of osteoporotic rat femurs after different hormonal treatments: genistein, estradiol, and estradiol/progesterone

Introduction: The purpose of the study is to compare the effects of genistein, estradiol, estradiol/progesterone combination on the bone mineral density and biomechanical properties of ovariectomized rats’ bone. Methods: 50 female adult Sprague-Dawley rats were divided into five groups. Bilaterally ovaeriectomy were performed in all groups except the sham-operated group. Groups were a sham-operated group and a control group (water was given), estradiol treated group (17-β estradiol 0.015 mg/kg per day), genistein treated group (genistein 10 mg/kg per day), and an estradiol/progesterone combination group (17-β estradiol 0.015 mg/kg plus drosperinone 0.028 mg/kg per day). The water or hormones were implemented in relevant groups for eight weeks by orogasthric catheter. The bone mineral density and biomechanical properties of the femur were analyzed. Results: Genistein, estradiol, and estradiol/progesterone groups increased bone mineral density significantly compared to the control group. In diaphysis and metaphysis bending test, all groups had higher peak load values than the control group. There were statistically significant differences between the estrogen/progesterone group and control group in diaphysis bending with regard to peak load. There were statistically significant differences between the estradiol and control groups in metaphysis bending with regard to peak load. In axial rotation test, all groups had higher peak torque values than the control groups. Conclusions: Genistein, estradiol and estrogen/progesterone combination improved the biomechanical properties of the ovariectomized rat bone. Genistein which has less side effects may be considered as an alternative in the treatment of postmenopausal osteoporosis.

Rhythm and orthopedics: The effect of music therapy in cast room procedures, a prospective clinical trial

INTRODUCTION Cast room procedures generally cause anxiety in patients. Anxiety complicates the procedure as well as increases the risk of a complication. Listening to music was found to be the safest and most common non-drug treatment method. The aim of this study is to evaluate the effect of listening to music on adult patients in cast room procedures. This study points out the relation between anxiety and anxiety relevant cardiac arrhythmia. MATERIALS AND METHODS The study was performed on 199 patients with stable general condition, aged above 18. The patients were divided into two groups. Randomization method used in the study was coin flip. The first group (Group 1) listened to music during cast room procedures whereby the second group (Group 2) did not listen to music. Length of the procedure, complication, blood pressure and heart rate evaluations before and after the procedure, Visual Analogue Scale (VAS scores for pain), State-Trait Anxiety Inventory (STAI) anxiety score, patient satisfaction, willingness of the patient to repeat the procedure, P wave dispersion (Pd) and corrected QT interval dispersion (QTcd) as electrocardiographic arrhythmia predictors were evaluated. The Clinical Research Ethics Committee approval was obtained for this study. RESULTS Significant difference was shown between the two groups for the following criteria: VAS scores (p = 0.005), anxiety scores (p = 0.032), processing time (p = 0.027), and QTcd values (p = 0.031). Patient satisfaction (p < 0.001) and willingness to repeat the procedure (p < 0.001) were higher for the group who listened to music. No significant difference in Pd values, blood pressure and heart rate was reported within the groups. CONCLUSION Music therapy is a non-invasive, safe, nonpharmacologic, anxiolytic, and analgesic treatment. Music therapy should become standard protocol in cast room procedures. One of the most important achievements of this study was the fact that music decreases anxiety and anxiety-related cardiac arrhythmia. Therefore, conducting further prospective studies including high cardiac risk patients especially with arrhythmia is crucial.

Akut Aşil tendon yırtıklarının Lynn yöntemi ile tamiri

Objectives: Efficiency assessment of Lynn method on open primary repair of acute Achilles tendon ruptures. Methods: Data were evaluated from 19 patients who treated with the Lynne method due to acute Achilles tendon rupture. Average follow-up length was 12.3 months (range 8-15 months). Dominant side was the right side by all patients and all patients were males. Plantaris tendon augmentation was applied after end-to-end repair by modified Kessler suture technique. Results: The mean postoperative AOFAS score (The American Orthopaedic Foot and Ankle Society hindfoot clinical outcome scores) was 93.5 (range 82-100). The average of Achilles tendon postoperative assessment score, as developed by Thermann and colleagues, was 93.3. Both assessment scores were between 90-100 and were evaluated as very good. None of the patients developed post-operative wound infection. The Thompson test was negative on all patients and bilateral motor strength was 5/5. Conclusion: Lynn method, especially in young and active patients with acute Achilles tendon rupture is a method that should be considered in treatment protocols.Amac: Akut Asil tendon yirtiklarinin acik primer tamirinde Lynn yonteminin etkinliginin degerlendirilmesi. Yontemler: Akut Asil tendon yirtigi nedeniyle Lynn yontemi ile tedavi edilen 19 hastanin verileri degerlendirildi. Hastalarin ortalama takip sureleri 12,3 ay (8 – 15 ay) idi. Tum hastalarin dominant taraflari sag taraf olup, calismaya katilan butun hastalar erkekti. Tum hastalara modifiye Kessler dikis teknigi kullanilarak uc-uca tamir yapildiktan sonra plantaris tendonu ile guclendirme uygulandi. Bulgular: Postoperatif AOFAS skoru (The American Orthopaedic Foot and Ankle Society hindfoot clinical outcome scores) ortalama 93,5 (dagilim 82-100) olarak hesaplandi. Thermann ve arkadaslarinin gelistirdigi Asil tendon cerrahi sonrasi degerlendirme skorunda ortalama puan 93,3 olarak saptandi. Her iki degerlendirme 90-100 puan arasinda cikmis olup sonuclar cok iyi olarak degerlendirildi. Operasyon sonrasinda hicbir hastada yara yeri enfeksiyonu gelismedi. Yapilan son kontrollerinde tum hastalarin Thompson testi negatif olup, bilateral motor kuvvet 5/5 olarak saptandi. Sonuc: Lynn yontemi, ozellikle aktif ve genc yastaki akut Asil tendon yirtigi olan hastalarin tedavi protokolleri arasinda goz onunde bulundurulmasi gereken bir yontemdir.