Erdal Cila

Footprint and radiographic analysis of the feet.

There is controversy concerning the definition and measurement of the medial longitudinal arch of the foot. Various techniques are reported to assess the medial arch height, including radiographic measurements and footprint analysis, which are the most commonly used methods. Some authors define footprint analysis as unreliable for measuring the arch height. The purpose of this study was to investigate the relationship between radiologically measured angles and the arch index obtained from footprint analyses in 38 children with flexible pes planus. A positive correlation of arch index was found between lateral talo–horizontal and lateral talo–first metatarsal angles (p < 0.05). These angles have been used by some authors to describe the height of the medial longitudinal arch of the foot. This study demonstrated that footprint analysis could be used effectively for screening studies and at individual office examinations.

Demineralized bone matrix and hydroxyapatite/tri-calcium phosphate mixture for bone healing in rats

Purpose: Hydroxyapatite/tri-calcium phosphate (HA/TCP) mixture is an osteoconductive material used as a bone graft substitute, and demineralised bone matrix (DBM) is an osteoinductive material. A combination of DBM and HA/TCP mixture would probably create a composite with both osteoconductive and osteoinductive properties. The purpose of this study was to determine the effect of the combination of DBM and HA/TCP mixture on healing of rat radius segmental defects. Methods: Twenty-four adult male Wistar rats were used. Bilateral radial defects were created in each animal. Radial defects were implanted with DBM, HA/TCP mixture and a combination of both substances. Control defects were left unfilled. Ten weeks after implantation, the animals were sacrificed, and the radii were evaluated by radiograhic and histopathological studies. Results: The use of DBM alone demonstrated improved healing on radiographic and histological studies compared to other groups and the control group. There were no differences between the other two groups and the control group. Conclusion: The DBM group showed the best healing response. Combined use of DBM and HA/TCP mixture did not improve bone healing, and the osteoinductive properties of DBM were inhibited by HA/TCP mixture.RésuméLe mélange hydroxyapatite/phosphate tri-calcique (HA/TCP) est un matériel d’ostéo conduction utilisé comme greffe ou substitut osseux comme les matrices osseuses déminéralisées (DBM) utilisées en tant que matériel d’ostéo induction. La combinaison de DBM et HA/TCP devrait probablement avoir les deux propriétés d’ostéo induction et d’ostéo conduction. Le propos de cette étude est d’évaluer les effets d’un mélange de DBM et d’HA/TCP sur la consolidation de défauts osseux du radius chez le rat. Vingt quatre rats adultes Wistar ont été utilisés. Chaque animal était préparé avec un defect radial bilatéral. Les radius droits des rats ont été implantés soit avec DBM, soit avec HA/TCP isolée, soit avec une combinaison des deux substances, le radius gauche servant de contrôle. Dix semaines après l’implantation, les animaux ont été sacrifiés et les os ont été évalués sur la plan radiographique et histopathologique. L’utilisation de DBM isolée montre une amélioration de la guérison sur le plan radiographique et histologique. On ne retrouve pas de différence avec les autres groupes. En conclusion, le groupe DBM montre une bonne réponse sur le plan de la consolidation. L’utilisation d’une mixture DBM et HA/TCP n’entraîne pas une amélioration et une guérison, les propriétés d’ostéo induction du DBM étant inhibées par le mélange HA/TCP.

Supracondylar process syndrome

Abstract Supracondylar process syndrome of the humerus has received little attention in the orthopaedic literature. This case report presents a patient with this condition.

Treatment of segmental bone defects in rats by the stimulation of bone marrow osteo-progenitor cells with prostaglandin E2

An alternative to bone grafting is engineered osteo-conductive material that carries osteo-progenitor cells with osteo-stimulant factors impregnated on a malleable osteo-conductive material. We used bone marrow stem cells as the source of osteo-progenitor cells and stimulated them with prostaglandin E2 using demineralised bone matrix as a carrier. We treated 35 skeletally mature male Wistar albino rats with segmentary radial bone defects using five different treatment groups. Group I received no treatment; the remaining four groups all received a mixture of bone marrow and demineralised bone matrix. In group III, a copolymer was added. In group IV, prostaglandin E2 and in group V prostaglandin E2 within a copolymer was added to the mixture. Eight weeks after the surgical procedure, the rats were sacrificed. Radiological and histological evaluation of the radial bone showed that while there was no significant healing in groups I, II and III, there was a significant healing response in groups IV and V.RésuméUne alternative à la greffe osseuse est un matériel ostéoconducteur portant des cellules précurseurs avec des facteurs ostéostimulant imprégnés dans un matériel malléable ostéoconducteur. Nous avons utilisé des cellules de la moelle osseuse comme source de cellules précurseurs et les avons stimulés avec une prostaglandine E2 qui utilise la matrice osseuse déminéralisée comme porteur. Nous avons traité 35 rats Wistar albinos viril à maturation osseuse, avec un défaut segmentaire du radius, en utilisant cinq groupes de traitements différents. Le groupe I n’a reçu aucun traitement. Les quatre autres groupes ont reçu un mélange de moelle osseuse et une matrice d’os déminéralisé. Dans le groupe III a été ajouté un copolymère. Dans le groupe IV, une prostaglandine E2 et dans le groupe V, une prostaglandine E2 et un copolymère ont été ajouté au mélange. Huit semaines après la procédure chirurgicale, les rats ont été tués. L’évaluation radiologique et histologique de l’os radial a montré qu’il n’y avait aucune guérison notable dans les groupes I, II et III, mais une réponse curative appréciable dans les groupes IV et V.

Relevance of mangled extremity severity score to compartment syndromes

This study investigated the relevance of a mangled extremity severity score (MESS) to the evaluation of intracompartmental pressure in injured patients. We measured intracompartmental pressures with a modification of the Whitesides method and compared these values with MESS in 27 patients after trauma. For 5 of them fasciotomy was necessary to relieve high intracompartmental pressures. In our series MESS seemed to correlate with intracompartmental pressure values (r = 0.733, P < 0.05). We conclude that the MESS system provides objective criteria in determining the risk of a compartment syndrome.

Prostaglandin E2 activity in the synovial-like membrane

The events leading to aseptic loosening of total hip prostheses occur within the synovial-like membrane that forms around the prosthetic components. Prostaglandin E2 (PGE2) activity in this membrane is believed to be one of the factors that cause aseptic loosening. In this study, the authors investigated the correlation between grades of loosening and levels of PGE2-like activity in the membranes surrounding the implants in 14 patients in which total hip arthroplasty revisions were performed. The membranes of patients with high degrees of loosening demonstrated high levels of PGE2-like activity (P < .01). Among the many factors contributing to loosening of total hip arthroplasties, PGE2 appears to have an important role with its bone-resorbing properties.

[The effect of low-molecular-weight heparin on rat tendon healing].

OBJECTIVES We investigated the effect of low-molecular-weight heparin (LMWH) on the healing of tendons. METHODS Forty-five adult Wistar rats weighing 300 g were randomized into three groups equal in number. All the rats underwent full-thickness surgical incision of the Achilles tendon followed by primary repair. After the operation, two groups received daily subcutaneous LMWH injections (nadroparin calcium) for four weeks at high or low doses (group I, 6 mg/kg, 170 IU AXa; group II, 3 mg/kg, 85 IU AXa). Group III remained untreated as the control group. Histologically, the specimens were examined under light and electron microscopy with regard to the amount of fibrillar collagen synthesis, mitochondrial degeneration, and the composition of the extracellular matrix collagen. Biomechanically, maximum load to failure and correspondent elongation of the tendons were measured. RESULTS Compared to the control group, histologically, both LMWH-treated groups exhibited increased number of fibroblasts, increased fibrillar collagen formation in the extracellular matrix, and higher counts of granular endoplasmic reticula in cytoplasmic contents of fibroblasts as well as decreased mitochondrial vacuolization and degeneration. Biomechanical assessments showed that tendons in group I had significantly higher maximum load to failure and elongation values than group II and III (31 N vs. 24.6 N and 23.1 N; 25 mm vs. 19.6 mm and 17.3 mm, respectively; p<0.05). Groups II and III did not differ significantly in this respect (p>0.05). CONCLUSION Daily administration of single dose LMWH improves tendon healing through increasing the number of fibroblasts and fibrillar collagen synthesis and decreasing mitochondrial degeneration.

Acquired pelvic anomaly preventing sexual intercouse in a female patient

Abstract. This report describes a patient with dyspareunia related to an acquired pelvic anomaly that was treated surgically.

Indium-111 octreotide scintigraphy in patients with bone tumours of the extremities

Radiolabelled somatostatin analogues are of potential value in the imaging of somatostatin receptor-positive tumours. Recently, somatostatin receptors have been demonstrated in the osteoblast precursor cells. In this preliminary study, we evaluated the uptake characteristics of indium-111 octreotide in two benign and two malignant bone tumours. Tracer accumulation was observed in all four cases, and overall lesion to background ratio (mean±SD) was 2.74±0.84 and 2.98±1.49 at 4 h and 24 h, respectively. There was no clear relationship between I111In-octreotide accumulation and the benign or malignant nature of the tumour. In one patient, tracer uptake was inhibited by unlabelled octreotide administration. These results suggest that111In-octreotide can be taken up by benign and malignant bone tumours. The inhibition of tumour uptake by treatment with cold octreotide supports the concept that specific uptake mechanisms are responsible for111In-octreotide deposition by bone tumours.

What Happens at the Adjacent Knee Joint After Total Hip Arthroplasty of Crowe Type III and IV Dysplastic Hips

We prospectively evaluated 30 hips of 22 patients who had normal knees with a mean age of 53.4 years (range, 38-72 years). In the early postoperative period, genu valgum deformity was observed in all knees. Of 22 patients, 17 complained of severe pain owing to strain in the medial collateral ligament and iliotibial tract. Postoperatively, the ipsilateral extremities of the patients were extended by a mean of 16.5 mm (8-25 mm). Q angles of the patients increased by a mean of 4.4° ± 2.5° (P < .001). Although the Harris hip scores were improved (40.7-87.8 points), postoperative Lysholm-Gillquist knee scores were significantly reduced (92-76 points, P < .001). Reduction of displaced hips into the anatomical hip center and lengthening the extremity despite shortening procedure may lead to strain at the knee joint iatrogenically, particularly with the mechanical effect of tensor fascia lata, which results with changes in the knee biomechanics.