Feyza Unlu Ozkan

The effect of transforming growth factor β1 (TGF-β1) on the regenerate bone in distraction osteogenesis

Distraction osteogenesis is a well established clinical treatment for limb length dicrepancy and skeletal deformities. Transforming growth factor beta 1 (TGF-β1) is a multifunctional peptide which controls proliferation and expression of cells specific to bone like chondrocytes, osteoblasts, osteoclasts including mesenchymal precursor cells. To decrease the external fixation time with increasing the strength of regenerate (newly formed bone after distraction) we tested the effect of locally applied transforming growth factor beta 1 on distraction osteogenesis. A total of 28 mature female white New zealand rabbits weighing 3,5 kg–4,5 kg were studied. 10 animals were belonging to biomechanical testing group (5 for the study and 5 for the control subgroups), and the others were to histology group. In biomechanical group after tibial ostetomy TGF-β1 was applied subperiosteally for 5 days just proximal to osteotomy site. Control group received only the solvent. Seven days after tibial osteotomy distraction was started at a rate of 0.25mm/12 hours for 3 weeks with a unilateral fixator. Rabbits were sacrified at the end of a consodilation period 8 week after tibial osteotomy. We assessed density of the elongation zone of rabbit tibial bones with the computed tomography. Then biomechanical parametres were assessed using the torsional testing using the material testing machine. In histology group rabbits were classified as control and study (rabbits that were given TGF-β1). Rabbits were sacrified at the end of first week, second week and fourth week also at the end of consolidation period 8 week after tibial osteotomy. Immunohistochemical and histologic parameters were examined. Biomechanical testing was applied as tortional testing. These values are used in determination of maximal loading, stiffness and energy absorbed during testing (brittlenes). The histomorphometric examination looked for the differences between the study and control groups in terms of bone formation pattern, bone quality and quantity. The immunohistochemical studies investigated the mechanism of TGF- β1, and its presence in different cell types. The results of this study suggest that locally applied TGF-β1 improves the mineral density of distraction gap and load to failure(energy absorbed during testing). Though there is no significant histomorphometric difference between the study and control groups, there is an increased bone mineral density and an according maximum energy absorbance in the study group. This effect can be explained by the following mechanism: TGF-β1 exerts its effect on two different receptor types (Type 1 and 2). Type 1 receptors are localized to bone matrix and type 2 receptors are localized to the intracellular space. The specific stains utilized in the current experiment are specific to type 2 receptors. They have been shown to be down-regulated by exogenous TGF-β1 injections. Most probably, type 1 receptors are up-regulated by this exogenous administration, but unfortunately, there is currently no specific stain on tha market to display type 1 receptors and to prove this explanation.

Effects of hyperbaric oxygen therapy on distraction osteogenesis

Investigators in the present study explored the effects of hyperbaric oxygen (HBO) therapy on distraction osteogenesis in a rabbit limb-lengthening model. HBO treatment was provided to participants in a small animal pressure chamber once a day during the latent period of distraction osteogenesis at 2.5 absolute atmospheres of pressure. Bone mineral density measurements were obtained through torsional testing. The control group received no HBO treatment. Animals were killed 8 wk postoperatively for biomechanical testing. There was a statistically significant increase in bone mineral density in the HBO group compared with that in the non-HBO group, but no statistically significant differences were observed between biomechanical parameters of the 2 groups. The investigators suggest that these results must be further studied through histologic examination to determine the stepwise effects of HBO during and after collagen synthesis.

Osteoid Osteoma of the Great Toe Mimicking Osteomyelitis: A Case Report and Review of the Literature

Osteoid osteomas are well-known benign tumors, seen generally in long bones. When seen in phalanxes or toes, they can cause a diagnostic dilemma. A young male presented to us with complaints of enlargement of the great toe and severe pain. He had had an ingrown toe-nail operation before, and this situation caused a diagnostic dilemma. In this case report, we emphasize that osteoid osteomas can cause diagnostic dilemmas and it should be kept in mind as a differential diagnosis.

Sciatica due to Schwannoma at the Sciatic Notch

Schwannomas are rarely seen on the sciatic nerve and can cause sciatica. In this case report we aimed to present an unusual location of schwannoma along sciatic nerve that causes sciatica. A 60-years-old-man was admitted to us with complaints of pain on his thigh and paresthesia on his foot. Radiography of the patient revealed a solitary lesion on the sciatic nerve. The lesion was excised and the symptoms resolved after surgery.

Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes

OBJECTIVE To assess the reliability of the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS). DESIGN Observational reliability study of the SCATS. SETTING Inpatient rehabilitation unit at an education and research hospital. PARTICIPANTS Subjects (N=47) between the ages of 18 and 88 years with spinal cord injury (SCI) and with American Spinal Injury Association Impairment Scale grades from A to D with spasticity, who were at least 6 months postinjury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Interrater and test-retest reliability of the SCATS. RESULTS The SCATS had substantial to almost perfect interrater agreement (κ=.669-1.000) between the 2 physiatrists. Test-retest agreement of the SCATS was also substantial to almost perfect (κ=.614-1.000) as well. There was a significant correlation between the SCATS clonus scores and the Modified Ashworth scores of the hip, knee, and ankle. No correlation was found between SCATS extensor spasm scores and Modified Ashworth scores. The SCATS flexor spasm scores were only correlated significantly with the ankle plantar flexor Modified Ashworth scores (P<.05). CONCLUSIONS The SCATS is a reliable tool for assessing spasm activity and spastic hypertonia in patients with SCI.

Kinesiotaping as an alternative treatment method for carpal tunnel syndrome

BACKGROUND/AIM Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Conservative treatment choices are not always satisfactory. The aim of this study was to investigate the effect of kinesiotaping (KT) on pain level, grip strength, and functional status compared with that of placebo KT and orthotic device (OD) in patients with CTS. MATERIALS AND METHODS In this randomized, placebo-controlled study, participants were allocated into one of three groups: an experimental KT group (Group 1), a placebo KT group (Group 2), and an OD group (Group 3). Visual analogue scale (VAS) and Douleur Neuropathique 4 (DN4) scores, dynamometric grip strength measures, and the Boston CTS questionnaire (BQ) were the outcome measures. RESULTS All groups significantly improved in terms of VAS scores (P < 0.05), DN4 scores (P < 0.05), and BQ scores (P < 0.05). Grip strength improved in Group 3 (P = 0.001). There was a significant difference among the groups with respect to BQ scores (P < 0.05). CONCLUSION KT application for the treatment of CTS should be an alternative treatment choice.

Bilateral Freiberg’s disease in adjacent metatarsals

Freiberg’s disease usually affects the second and, less commonly, the third metatarsal heads [Helal and Gibb in Foot Ankle 8(2):94–102, 1987]. It was mainly observed unilaterally in adolescent females (F/M: 3/1–4/1) (Hay and Smith in The Foot 2:176–178, 1992). Bilateral occurrence and adjacent metatarsal involvement has been previously reported separately [Maresca et al. in Arthroscopy 12(1):103–108, 1996; Rafee et al. in Foot Ankle Surg 12:153–155, 2006]. The cases presented here involve two female patients aged 42 and 72 with bilateral Freiberg’s disease in both the second and third metatarsal heads. To our knowledge, this is the first report of such involvement of both the second and third metatarsal heads.

Pigmented villonodular synovitis of hip diagnosed with hip arthroscopy

Pigmented villonodular synovitis is a synovial proliferative disorder that rarely involves the hip joint. It is an inflammatory response to an unknown agent. Pigmented villonodular synovitis of the hip usually presents with extensive joint destruction because of the limited joint space. Various methods of treatment modalities including synovectomy, total hip arthroplasty, radiation therapy and arthrodesis were used for treating this disease in hip joint. Diagnosis and treatment with hip arthroscopy is a new and less invasive modality comparing to open procedures.RésuméLa synovite villo-nodulaire pigmentée est une lésion proliférative qui affecte rarement la hanche. Il s’agit d’une réponse inflammatoire à un agent inconnu. A la hanche elle se présente avec d’importantes lésions destructives en raison du confinement de l’espace articulaire. Plusieures méthodes thérapeutiques ont été proposées comprenant la syovectomie, l’arthroplastie totale de hanche, la radiothérapie et l’arthrodèse. Le diagnostic et le traitement arthroscopiques constituent des méthodes innovantes et peu invasives par comparaison avec les autres traitements.

Deep peroneal nerve palsy due to osteochondroma arising from fibular head and proximal lateral tibia

Highlights • Osteochondroma are the most common benign tumors.• Disease affecting knee joint in 94% of all cases.• Clinicians should be aware of the possible tumoral lesions in drop foot etiology.

Salmonella enteridis Septic Arthritis: A Report of Two Cases

Introduction. Nontyphoidal salmonellosis causes significant morbidity, is transmitted via fecal-oral route, and is a worldwide cause of gastroenteritis, bacteremia, and local infections. Salmonella is a less common etiologic factor for septic arthritis compared with other gram-negative bacteria. Cases. We present two septic arthritis cases with Salmonella enteridis as a confirmed pathogen and also discuss the predisposing factors and treatment. Discussion. Septic arthritis is an orthopedic emergency. The gold standard treatment of septic arthritis is joint debridement, antibiotic therapy according to the culture results, and physiotherapy, which should start in the early postoperative period to prevent limitation of motion. Salmonella is an atypical agent for septic arthritis. It must be particularly kept in mind as an etiologic factor for the acute arthritis of a patient with sickle cell anemia and systemic lupus erythematosus. Clinicians should be cautious that the white blood cell count in synovial fluid can be under 50.000/mm3 in immune compromised individuals with septic arthritis. The inflammatory response can be deficient, or the microorganism may be atypical. Conclusion. Atypical bacteria such as Salmonella species in immune compromised patients can cause joint infections. Therefore, Salmonella species must always be kept in mind for the differential diagnosis of septic arthritis in a clinically relevant setting.