Fatih Küçükdurmaz

Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty.

Background: Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO). Objective: The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome. Methods: A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO. Results: Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles. Conclusion: Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.

Biomechanical comparison of antirotator compression hip screw and cannulated screw fixations in the femoral neck fractures.

OBJECTIVE The aim of this study was to compare the biomechanical properties of minimal invasive sliding antirotator compressive hip screw (MIS-A-CHS), and multiple cannulated screws (CS) on a Pauwels type 3 femoral neck fracture model. METHODS A Pauwels type 3 vertical femoral neck fractures was created on 12 third-generation proximal femur models which were divided into two equal groups. The fracture was fixed with three CS in the first group, and MIS-A-CHS in the second group. The axial and rotational stiffness and maximum compression effect were compared between the groups. RESULTS The axial and rotational stiffness and maximum compression were significantly higher in MIS-A-CHS group (912.5 N, 540 N and 10.2 N/m, respectively) than the CS group (627.5 N, 380 N, and 3.9 N/m, respectively). CONCLUSION MIS-A-CHS appears to be a more secure fixation method in Pauwels type 3 femoral neck fractures than the CS.

The Prevention of Periprosthetic Joint Infections

Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

Current Concepts in Orthopedic Management of Multiple Trauma.

Multiple trauma patients frequently present challenging clinical scenarios with musculoskeletal injuries being the most common indications for surgical procedures in these patients. Despite our substantial knowledge, a universally approved objective definition for “multiple trauma” is yet to be delineated. Several controversial aspects of economics, pathophysiology, animal models, diagnosis, management and outcome of patients with multiple trauma have recently been explored and although some progress has been made, it seems that the available evidence is still inconclusive in some occasions. This manuscript revisits several current concepts of multiple trauma that have been the focus of recent investigation. We aim to provide the reader with an updated perspective based on the most recently published literature in the field of multiple trauma.

Congenital Insensitivity to Pain with Anhidrosis (CIPA) Manifested with Chronic Osteomyelitis; A Case Report

DOI: 10.4328/JCAM.912 Received: 02.02.2012 Accepted: 20.02.2012 Printed: 01.03.2015 J Clin Anal Med 2015;6(2): 230-2 Corresponding Author: Yunus Imren, Bezmialem Vakif University, Faculty of Medicine, Orthopaedics & Traumatology Department, Vatan Cad. Fatih, 34093, Istanbul, Turkey. E-Mail: yunusimren@yahoo.com Ozet Kronik osteomyelit cocuklarda cok nadir gorulen bir durumdur. Herediter duyusal ve otonomik noropati tiplerinden biri olan anhidrozla birliktelik gosteren dogumsal agri duyarsizligi da sinir sisteminin otozomal resesif gecisli cok nadir bir hastaligidir. Agri duyarsizligi, anhidroza bagli ates, tekrarlayan kiriklar, kronik osteomyelit, mental retardasyon, kendine zarar verme egilimi, yara ulserleri gorulebilir. Bu sunumda agri duyarsizligi, sag uyluk alt ucunda kronik osteomyelit, bilateral korneal opasite ve mental geriligi olan 10 yasinda bir erkek cocugunu takdim etmekteyiz.

Morphometry of the medial tibial plateau in Turkish knees: correlation to the current tibial components of unicompartmental knee arthroplasty

OBJECTIVE The objective of this study was to measure the resected surfaces of the tibia in knees of Turkish patients and to compare these measurements with the dimensions of tibial implants in current use. METHODS We made measurements of seven different dimensions of the medial tibial plateau at the virtual resection level for unicompartmental knee arthroplasty (UKA) on MRIs of 260 patients and the most commonly used four UKA implants in Turkey. Statistical analysis was performed by using Students t-test, analysis of variance (ANOVA), chi-square test and Pearsons correlation coefficient by using SPSS software. RESULTS The anteroposterior and widest mediolateral dimensions of the tibial plateau of Turkish knees were found relatively more approximate to the dimensions of Oxford and Zuk prostheses compared to that of Accuris and Mitus (p<0.001). The distance between the central mediolateral dimension and the widest mediolateral dimension was 2.4 (range: 0-6.3) mm in males and 2.6 (range: 0-6.2) mm in females. The maximum mediolateral dimension was found posterior to the central mediolateral dimension in the majority (202 out of 260) of cases. These findings point towards the asymmetry in the AP halves of the resected medial tibial condyle. CONCLUSION Tibial components designed according to anthropometric measurements based on both Western and Asian populations do not perfectly meet the requirements of Turkish population. Designing different UKA prostheses for different populations are required for best fit.

Functional Comparison of Immediate and Late Weight Bearing after Ankle Bimalleolar Fracture Surgery

Aim : The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures. Methods : Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment. Results : According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2. Conclusion : As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately.

Olecranon anatomy: Use of a novel proximal interlocking screw for intramedullary nailing, a cadaver study

AIM To define the optimum safe angle of use for an eccentrically aligned proximal interlocking screw (PIS) for intramedullary nailing (IMN). METHODS Thirty-six dry cadaver ulnas were split into two equal pieces sagitally. The following points were identified for each ulna: the deepest point of the incisura olecrani (A), the point where perpendicular lines from A and the ideal IMN entry point (D) are intersected (C) and a point at 3.5 mm (2 mm safety distance from articular surface + 1.5 mm radius of PIS) posterior from point A (B). We calculated the angle of screws inserted from point D through to point B in relation to D-C and B-C. In addition, an eccentrically aligned screw was inserted at a standard 20° through the anterior cortex of the ulna in each bone and the articular surface was observed macroscopically for any damage. RESULTS The mean A-C distance was 9.6 mm (mean ± SD, 9.600 ± 0.763 mm), A-B distance was 3.5 mm, C-D distance was 12.500 mm (12.500 ± 1.371 mm) and the mean angle was 25.9° (25.9° ± 2.0°). Lack of articular damage was confirmed macroscopically in all bones after the 20.0° eccentrically aligned screws were inserted. Intramedullary nail fixation systems have well known biological and biomechanical advantages for osteosynthesis. However, as well as these well-known advantages, IMN fixation of the ulna has some limitations. Some important limitations are related to the proximal interlocking of the ulna nail. The location of the PIS itself limits the indications for which intramedullary systems can be selected as an implant for the ulna. The new PIS design, where the PIS is aligned 20°eccentrically to the nail body, allows fixing of fractures even at the level of the olecranon without disturbing the joint. It also allows the eccentrically aligned screw to be inserted in any direction except through the proximal radio-ulnar joint. Taking into consideration our results, we now use a 20° eccentrically aligned PIS for all ulnas. In our results, the angle required to insert the PIS was less than 20° for only one bone. However, 0.7° difference corresponds to placement of the screw only 0.2 mm closer to the articular surface. As we assume 2.0 mm to be a safe distance, a placement of the screw 0.2 mm closer to the articular surface may not produce any clinical symptoms. CONCLUSION The new PIS may give us the opportunity to interlock IMN without articular damage and confirmation by fluoroscopy if the nail is manufactured with a PIS aligned at a 20.0° fixed angle in relation to the IMN.

Domestic electric drills in the service of orthopaedic surgery: a potential and preventable source of surgical site infections

OBJECTIVE We aimed to assess the contamination potential of the exhaust air from venting ports of running domestic electric drills which are commonly used in orthopaedic surgeries by means of both microbiological sampling and particle counting. METHODS In an empty operating room, the exhaust air from five running sterile domestic electric drills measured using a particle counter and microbiological sampling was made via aspirating isolator with colony formations noted for a 2-week period. International Organization for Standardization (ISO) 14644 criteria were implemented with respect to the sterility standards. RESULTS All of the drills produced statistically significantly higher levels of particles than the ambient air (p<0.01). There was no statistically significant difference in the number of collected particles among drills (p>0.05). No bacterial growth was detected in microbiological sampling via blood agar medium in the ambient air. Conversely, Staphylococcus epidermidis, Micrococcus luteus, and Staphylococcus capitis were isolated from the exhaust air of all running drills. There was no correlation between the number of particles produced by drills and the microbiological sampling. CONCLUSION Domestic electric drills are not safe and may be a direct source of surgical site infection, as the use or re-use of these drills during orthopaedic surgery increases the risk of infection with contaminated aerosols that are produced by these devices.

Tips and tricks for using the internet for professional purposes

Online resources provide access to large amounts of information which is expanding every day. Using search engines for reaching the relevant, updated and complete literature that is indexed in various bibliographical databases has already become part of the medical professionals’ everyday life. However, most researchers often fail to conduct a efficient literature search on the internet. The right techniques in literature search save time and improve the quality of the retrieved data. Efficient literature search is not a talent but a learnable skill, which should be a formal part of medical education. This review briefly outlines the commonly used bibliographic databases, namely Pubmed, Cochrane Library, Web of Science, Scopus, EMBASE, CINAHL and Google Scholar. Also the definition of grey literature and its features are summarised. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160066. Originally published online at www.efortopenreviews.org