Ender Alagöz

Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2).

Objective The aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2). Methods Seventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group. Results Functional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000). Conclusion Simple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature; however, successful results have been obtained with IMN in this fracture pattern. Level of Evidence Level III, Therapeutic Study.

Effect of platelet-rich plasma for treatment of Achilles tendons in free-moving rats after surgical incision and treatment

OBJECTIVE The purpose of this study is to investigate, both histopathologically and biomechanically, the effect of platelet-rich plasma (PRP) on surgically repaired Achilles tendon rupture recovery in rats. METHODS The study included 25 17-month-old male Sprague-Dawley rats with an average weight of 500-550 g. Five rats were used as donors, while 20 rats were separated as PRP group (n=10) and control group (n=10). The Achilles tendons of the rats were cut transversely, and PRP was administered to the PRP group, while the control group received serum physiologically to create the same surgical effect. In previous studies, it was shown that this serum does not affect tendon recovery. Fifteen and 30 days post-treatment, the rats were sacrificed, and their Achilles tendons were extracted and examined histopathologically and biomechanically. RESULTS Based on the obtained findings, it was observed that the histopathologic Movin and Bonar scores of PRP group on the 15th and 30th day post-treatment were significantly lower than those of the control group (p=0.019, p=0.017, respectively), while no significant difference was found in maximum force (Fmax) values in biomechanical measures on the 15th and 30th day post-treatment. CONCLUSION It is thought that PRP use in Achilles tendon ruptures positively affects histopathological recovery in the early period, but that it does not produce the same biomechanical effect. We believe that PRP use for qualified tendon recovery is histopathologically beneficial.

Biomechanical, histological, and radiological effects of different phosphodiesterase inhibitors on femoral fracture healing in rats

Purpose: To investigate the biomechanical, histological, and radiological effects of sildenafil and pentoxifylline on femoral fracture healing in rats. Methods: Forty-eight Sprague-Dawley rats were divided into three groups equally according to the pharmacological agents to be investigated. Femoral shaft fractures were formed in the left side. Group 1 (control group), group 2, and group 3 were administered with saline, sildenafil, and pentoxifylline during the fracture healing process, respectively. Eight rats from each group were euthanized on days 15 and 30. X-ray images of the rats were taken after euthanasia for radiographical examination. Femur samples were subjected to histopathological and biomechanical (three-point bending) examinations. Results: Radiologically, no difference between the Goldberg scores of the groups was found for day 15 (p > 0.05), while higher Goldberg scores were obtained from group 2 than that of group 1 (p > 0.05) and group 3 (p < 0.05) for day 30. In the biomechanical analysis, higher mean breaking forces were found both for day 15 and day 30 from group 2 than those obtained from group 1 (for day 15 p > 0.05 and day 30 p > 0.05) and group 3 (for day 15 p < 0.05 and day 30 p < 0.01). Higher mean absorbed energy values were obtained from group 2 than those obtained from group 1 (for day 15 p > 0.05 and day 30 p < 0.05) and group 3 (for day 15 p < 0.01 and day 30 p < 0.01). A significant difference was not found between the histological scores of all groups (p > 0.05) for day 15, while the histological score of group 1 on day 30 was found to be significantly lower than that of sildenafil and pentoxifylline groups (p < 0.05). Conclusion: Sildenafil had a positive effect on fracture healing, while pentoxifylline did not provide consistent positive effect.

Histopathological, immunohistochemical, and biomechanical effects of splenectomy on Achilles tendon healing in rats

ABSTRACT Purpose: This study aimed to assess Achilles tendon repair in rats following splenectomy to simulate patients with musculoskeletal system injury who had splenectomy after spleen injury, a situation often seen in orthopedics and traumatology practice. Materials and Methods: The study included 32 male Sprague–Dawley rats (10 months old; average weight, 394.5 ± 28.3 g). The rats were fed with standard rodent food ad libitum at 22°C in a dark environment for 12 h. They were divided into two groups, namely the splenectomy (total splenectomy and Achilles tendon repair) and control groups (only Achilles tendon repair; n = 16). Four weeks after the surgery, the rats were euthanized, and their Achilles tendons were examined histopathologically, immunohistochemically, and biomechanically. Results: In the splenectomy group, proinflammatory cytokines, such as interleukin-1β, tumor necrosis factor-α, and interferon-γ, showed significantly lower values than those in the control group (p ˂0.01); moreover, the levels of anti-inflammatory cytokines like vascular endothelial growth factor, transforming growth factor-β1, interleukin-2, interleukin-10, and hepatocyte growth factor were significantly higher than in the control group (p ˂ 0.001). The average ultimate tensile strengths were 2.58 ± 0.5 in the splenectomy and 2.78 ± 0.3 in the control group (p = 0.043). The average values were 0.33 ± 0.5 in the splenectomy and 0.44 ± 0.1 in the control group (p = 0.021). Conclusion: Splenectomy may positively influence Achilles tendon healing through modification of the proinflammatory/anti-inflammatory ratio in favor of anti-inflammatory cytokines by causing a decrease in spleen-originated inflammatory cells.

Bone and Joint Infections

Infectious diseases have threatened human beings from ancient times. Bone and joint infections continue to be serious conditions for the orthopedic surgeons. The use of implants in modern orthopedic surgery and low blood supply to bone and joint tissues increase the risk for infection. Infection is an important cause of morbidity and mortality in orthopedic surgery. The pathogenesis of infection must be well understood by orthopedic surgeons for the eradication of infection. Recognizing unique characteristics of joint and bone infections mentioned earlier, the best way is prevention.

The Results of the Winograd Method in Surgical Treatment of Ingrown Toenail

Bulgular: Hastaların yaş ortalaması 34,3 (dağılım: 12-69 yaş) idi. Heifetz sınıflamasına göre 93 olgu (%45,5) evre 2,111 olgu evre 3 (%54,5) idi. Yüz dokuz hasta (%62) erkek, 65 hasta (%38) bayan idi. Olguların 61 tanesi (%35) sol ayak 1. parmak, 83 tanesi (%47) sağ ayak 1. parmak, 30 tanesi (%18) bilateral 1. parmak idi. Doksan beş olguda (%46,5) tırnak mediyal taraf tutulumu, 66 olguda (%32,5) lateral taraf tutulumu, 43 olguda (%21) hem mediyal hem de lateral taraf tutulumu mevcut idi. Doksan olguda (%44) preoperatif dönemde akıntılı enfeksiyon nedeni ile antibiyotik kullanımı mevcut idi. Altı hastada (%3,4) periferik vasküler hastalık mevcut idi. Hastalar ortalama 16 (dağılım: 12-28 ay) ay takip edildi. Hastalar ortalama 8 gün (dağılım: 3-14 gün) içerisinde işlerine döndüler. Dikişler ortalama 12. günde (dağılım: 10-14. gün) alındı. Oniki hastada (%6,8) yineleme görüldü. Yinelemeler ortalama postoperatif 3. ayda (dağılım: 2-7 ay) görüldü. Hiçbir hastada osteomyelit veya ciddi bir komplikasyon gelişmedi. Yüz elli üç hasta (%87,9) ameliyathanede, steril şartlarda uygulanan cerrahi işlemden memnun kaldıklarını belirtti.

The functional results of complex distal humeral fractures treated with parallel plate technique

In our study the functional results of parallel plate technique applied to medial and lateral columns of elbow, in patients with complex elbow fracture were evaluated. Open reduction and internal fixation was performed by using parallel plate technique in 23 patients with complex elbow fracture (14 men, 9 women). Mean age was 39,8 year. The fracture mechanisms were traffic accident in 9 patients, simple fall in 6 patients, fall from high in 8 patients. Mean time from trauma to surgery was 5 days. Functional results were evaluated by using disabilities of the Arm, Shoulder and Hand score (DASH) and Mayo elbow performance score. Range of motion and instability of the elbow joint was also evaluated. Mean follow up was 21 months. Mean flexion/extension arch was 101,8 degree, mean flexion was 125,4 degree, mean extension was 26,3 degree. Mean Mayo elbow performance score was 80,4. Mean DASH score was 11,1. One patient had a nonunion of olecranon osteotomy, one patient had a nonunion at the fracture. Heterotophic ossification was devoloped in 5 patients (21,7%). Surgery was complicated by an infection in 5 patients, and one of them needed debridement due to deep infection. In 3 patients screw and cerclage wires at the osteotomy site were removed due to symptomatic implants. As a result the functional outcomes of the complex elbow fractures that are treated with stabile osteosynthesis which permits early range of motion are satisfactory.