Gökay Görmeli

Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial

PurposeTo compare the effectiveness of intraarticular (IA) multiple and single platelet-rich plasma (PRP) injections as well as hyaluronic acid (HA) injections in different stages of osteoarthritis (OA) of the knee.MethodsA total of 162 patients with different stages of knee OA were randomly divided into four groups receiving 3 IA doses of PRP, one dose of PRP, one dose of HA or a saline injection (control). Then, each group was subdivided into two groups: early OA (Kellgren–Lawrence grade 0 with cartilage degeneration or grade I–III) and advanced OA (Kellgren–Lawrence grade IV). The patients were evaluated before the injection and at the 6-month follow-ups using the EuroQol visual analogue scale (EQ-VAS) and International Knee Documentation Committee (IKDC) subjective scores. Adverse events and patient satisfaction were recorded.ResultsThere was a statistically significant improvement in the IKDC and EQ-VAS scores in all the treatment groups compared with the control group. The knee scores of patients treated with three PRP injections were significantly better than those patients of the other groups. There was no significant difference in the scores of patients injected with one dose of PRP or HA. In the early OA subgroups, significantly better clinical results were achieved in the patients treated with three PRP injections, but there was no significant difference in the clinical results of patients with advanced OA among the treatment groups.ConclusionThe clinical results of this study suggest IA PRP and HA treatment for all stages of knee OA. For patients with early OA, multiple (3) PRP injections are useful in achieving better clinical results. For patients with advanced OA, multiple injections do not significantly improve the results of patients in any group.Level of evidenceI.

Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery A Prospective Randomized Clinical Trial

Background: Osteochondral ankle injuries commonly affect the dome of the talus, and these injuries are a common cause of athletic disability. Various treatment options are available for these injuries including intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) injections. The purpose of this study was to compare the effects of HA and PRP as adjunct therapies after arthroscopic microfracture in osteochondral lesions (OCLs) of the talus. Methods: In this prospective, randomized blinded study, 40 patients with talar OCLs in their ankle joints were treated with arthroscopic debridement and a microfracture technique. Thirteen randomly selected patients received PRP, 14 patients received HA, and the remaining 13 patients received saline as a control group. The participants were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog pain scale (VAS) scores after a 15.3-month (range, 11-25 months) follow-up. Results: Postoperatively, all the groups exhibited significantly increased AOFAS scores and decreased VAS scores compared with their preoperative results (P < .005). The AOFAS scores were significantly increased in the PRP group versus the HA and control groups (P < .005), although the increased AOFAS scores in the HA group versus the control group were also significant (P < .005). Similar to the AOFAS scores, the decrease in the VAS scores was significantly lower in the PRP group versus the HA and control groups (P < .005). In addition, the HA group had significantly lower VAS scores than the control group (P < .005). Conclusion: Both PRP and HA injections improved the clinical outcomes of patients who underwent operation for talar OCLs in the midterm period and can be used as adjunct therapies for these patients. Because a single dose of PRP provided better results, we recommend PRP as the primary adjunct treatment option in the talar OCL postoperative period. Level of Evidence: Level I, prospective randomized study.

Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study

PurposeThis is a descriptive analysis, of victims of Turkey’s October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma.MethodsWe retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome.ResultsThe patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively.ConclusionsThe results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

[Eight-year follow-up of uncemented hydroxyapatite coated hip prosthesis for hip osteoarthritis secondary to developmental hip dysplasia].

OBJECTIVES This study aims to investigate the mid-term clinical and radiological results of cementless hydroxyapatite coated total hip arthroplasty (THA) for hip osteoarthritis due to developmental dysplasia of the hip (DDH). PATIENTS AND METHODS Between January 2004 and December 2010, 34 hips (12 Crowe type I, 12 Crowe type II, 4 Crowe type III, 6 Crowe type IV) of 30 patients (22 females, 8 males; mean age 53.4 years; range 30 to 75 years) with degenerative arthritis due to DDH were analyzed in terms of cementless hydroxyapatite coated acetabular component (EPF Plus(®)) over Zweymüller femoral component (Zweymüller SL-PLUS(®)) and porous coating. Clinical assessment was performed using Harris hip scores (HHS) preoperatively and at the last clinic visit, while radiological assessment was done according to the Callaghan and Enghs criteria. RESULTS The mean follow-up was 48 months (range, 25-91 months). The mean HHS was 44.97 (28-55) preoperatively and 92.25 (69-100) at the last visit. All femoral components were graded as stable according to Callaghan and Enghs criteria. Radiolucency was mostly observed in Gruen zones 1 and zone 7 of the femur [zone 1; 20 hips zone 7; 19 hips zone 2; one hip, zone 3; one hip and zone 6 one hip]. Around acetabular component, radiolucency was detected in zone 2 in 12 hips, zone 3 in 10 hips and zone 1 in six hips. Heterotopic ossification developed in two hips, while neuropraxy was detected in two hips postoperatively. Femoral fissure in one hip, nonunion in the femoral osteotomy line in one hip, and femoral head autograft nonunion in one hip developed. CONCLUSION Mid-term results of uncemented Zweymüller femoral stem and hydroxyapatite coated press-fit using acetabular components for THA femoral stem are excellent.

Analysis of burn cases observed after the 2011 Van earthquake

BACKGROUND The purpose of this study was to determine the epidemiological features of cases that were registered for burns and treated at a hospital after the Van earthquake to compare burn cases from the previous year and to determine the factors that influenced mortality. METHODS Patients who were admitted to the Van Region Training and Research Hospital within the 3-month period after the earthquake were categorized as group 1; patients who were admitted within the same time interval in the previous year were categorized as group 2. RESULTS There were 121 patients in Group 1 and 89 patients in Group 2. It was determined that there were 36% more burn cases in Group 1. Flame burns were observed 4.8 times more often in Group 1 compared to Group 1 (p=0.002). Exitus was observed in 25.4% of cases in Group 1 and in 7% of cases in Group 2 (p=0.0069). CONCLUSION It was determined that the number of burn cases registered after the earthquake, the number of flame burns, the percentage of burns and the rate of mortality were higher than the data before the earthquake.

Biepicondylar fracture presenting with elbow dislocation: a case report

IntroductionBiepicondylar fracture of the elbow is very rare, and to date there have only been three reports of this injury and its treatment in the English scientific literature. This case report evaluates the surgical internal fixation of a biepicondylar fracture of the elbow with an associated dislocation.Case presentationWe report the case of a 15-year-old Turkish girl with a biepicondylar fracture dislocation of the left elbow. Open reduction and an internal fixation operation were applied. There were no complications.ConclusionIn these injuries, open reduction and internal fixation appear to be a good method to restore elbow stability and function.

The Effect of The Intercondyler Notch Width Index on Anterior Cruciate Ligament Injuries A Study on Groups with Unilateral and Bilateral ACL Injury

Objectives: To evaluate the relationship of the intercondylar notch width with unilateral and bilateral ACL injury by using MR images. Methods: The intercondylar notch width index was measured on the MR images of 18 patients with a bilateral ACL injury, 38 patients with a unilateral ACL injury and 53 healthy subjects with a normal ACL and the results of all groups were compared with each other. Results: The mean NWI values were 0.227 (±0.008) in bilateral injured; 0.245 (±0.009) in unilateral injured and 0.272 (±0.01) in control groups and 0.251(±0.01) in unaffected side of the unilateral group. There were statistically significant differences in intercondylar notch width index (NWI) values between all groups and there was a significant difference between the affected and the unaffected sides in group with unilateral ACL injury. A cutoff value of 0.25 for NWI gave an odds ratio of 26.5 for bilateral and 3.23 for unilateral ACL injuries. Conclusion: The finding that NWI is significantly narrowed in patients with bilateral and unilateral ACL tears compared with the healthy controls suggest a relationship between a narrow NWI and an increased risk of ACL injury. The patients with a narrow NWI should also be screened contralaterally for assessment of ACL injury risk on the other knee. So, specialized training programmes for the people with narrow NWI can be prepared for preventing ACL injuries.

Comparison of the results of ultrasonographic evaluation and arthroscopy in patients scheduled for surgery of the supraspinatus tendon rupture.

BACKGROUND AND OBJECTIVES This study aims to compare the findings of the shoulder ultrasonography (US) of patients with a supraspinatus (SS) tendon rupture with those of the shoulder arthroscopy, to determine the reliability and diagnostic performance of the shoulder US in the algorithm of the SS tendon pathologic lesions and their secondary ultrasonographic findings. DESIGN AND SETTINGS A prospective study conducted with patients scheduled for arthroscopy of the shoulder due to an SS tendon rupture in Yildirım Beyazit Education and Research Center and Gazi University, Ankara, Turkey. MATERIALS AND METHODS Fifty patients scheduled for an arthroscopy of the shoulder due to an SS tendon rupture were evaluated by shoulder US 1 week before the surgery. SS tendon pathologic lesions (tendinosis, partial tears, and full-thickness tears) and humeral degeneration were recorded, and the results of shoulder US were compared with those of arthroscopy. RESULTS With reference to the arthroscopic data, the sensitivity of the ultrasonographic evaluation for the diagnosis of a full-thickness SS tendon rupture was 91%, with a specificity of 88%; the sensitivity for the diagnosis of a partial-thickness rupture was 86%, with a specificity of 82%; and the sensitivity for the diagnosis of a tendinosis was 98%, with a specificity of 71%. With reference to the arthroscopic data, the sensitivity of US for the diagnosis of humeral degeneration was 93%, with a specificity of 91%. CONCLUSION The high sensitivity and specificity rates of US in detecting SS tendon rupture and its secondary imaging findings make it an efficient and reliable diagnostic modality, which should be preferred to other more expensive and more invasive methods in the algorithm.

An investigation of infection rate and seasonal effect level in total joint replacement cases

This study aims at evaluating gender, age range and seasonal differences in patients who developed articular infection after undergoing joint prosthesis in our clinic. This study is a retrospective screening of advanced articular arthrosis patients who had undergone total joint arthroplasty of the upper and lower extremities between 2009 and 2016. Of 504 patients who had been treated with total joint replacement, our study includes 468 patients we could follow up or contact by phone and who had been applied 559 primary or revision total knee arthroplasty. The mean age of these patients was 58.9 (ranging from 41 to 74). We detected infection in 22 (3.9%) total joint arthroplasty patients. Of these 14 (63.63%) were females and 8 (36.36) were males. There was no statistically significant difference between infection rates in terms of seasonal distribution nor gender or age range. In the light of our findings, we concluded that gender, age range and seasonal differences have no effect on infection rates in total joint replacement cases.

Clinical results of anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: a prospective study

Aim: In this study, we aimed to present prospective follow-up results of patients who were reconstructed with bone-patellar tendon-bone autograft for ACL rupture. Material and Methods: Twenty-seven patients were operated for ACL rupture with bone-patellar tendon-bone(B-PT-B) autograft ACL reconstruction. Patients were followed for at least 2 years. Patients were evaluated preoperatively and postoperatively with Lysholm knee function score, IKDC objective score and Tegner activity level scale. Results: All of operated patients were male. The mean age of the patients was 25.4 (range 19-35 years). The mean follow-up time was 27.9 (range 24-30 months). There was a statistically significant increase in postoperative knee scores. Hematoma, requiring surgical drainage, developed in two patients. Six patients had anterior knee pain while kneeling. Conclusion: Patients with ACL rupture showed increase in knee stability and functional scores after reconstruction. Anterior cruciate ligament reconstruction with B-PT-B autograft incorporates and heals faster with low rerupture and complication rate.