Hasan Göçer

N‐acetylcysteine eradicates Pseudomonas aeruginosa biofilms in bone cement

Biofilm is an example of bacterial group behavior. We investigated the effect of N-acetylcysteine (NAC) alone and in combination with ciprofloxacin on Pseudomonas aeruginosa biofilm formation. Four groups (each contains six molds) of standardized bone cement molds were infected. NAC, ciprofloxacin each alone, and NAC/ciprofloxacin combination were evaluated in point of inhibiting and eradicating biofilm capacity using microbiological and electron microscopical evaluation techniques. Microbial counts and electron microscopical observations showed that the effect of NAC and ciprofloxacin combination on biofilm formation in bone cement is valuable. NAC enhances the beneficial effect of ciprofloxacin when used in combination with it in bone cement. SCANNING 38:766-770, 2016.

Should venous doppler ultrasonography be routinely applied before lower extremity major orthopedic surgery

Background: Hip-knee arthroplasty and knee arthroscopy (KA) is frequently applied in the orthopaedic surgery. The approach does not exist related with the preoperative asymptomatic deep venous thrombosis (DVT). In this study, the patients who would undergo surgery lower extremity were screened for asymptomatic DVT, using the venous Doppler ultrasonography (USG). Patients and Methods: DVT was screened by venous Doppler USG in the patients who would undergo hip-knee arthroplasty and KA between the dates of November 2013 and September 2015. The patients were investigated regarding the age, gender, and the planned operation. The cases were separated to the following three groups: group I (<49 years), Group II (49–69 years), and Group III (≥70 years). Results: The study included 222 patients; of these, 174 were female and 48 were male. Group I, Group II, and Group III included 45, 115, and 62 patients, respectively. Of the six patients determined to exist with DVT, 2 (1.73%) were in Group II, and 4 (6.45%) were in Group III. Conclusion: Although the differences were not found to be statistically significant, it may be useful to screen asymptomatic DVT by Doppler USG in the preoperative period in the 70-year-old male patients, and in those over 70.

Reconstruction of lower extremity primary malignant and metastatic bone tumours with modular endoprosthesis

Introduction: This study is aimed to assess the functional results of cases with lower extremity malignant and metastatic bone tumours that were treated with modular tumour resection prostheses. Materials and Methods: 49 patients were retrospectively examined. 27 (55.1%) patients had a primary bone tumour, and 22 (44.9%) had a metastatic bone tumour. Although most tumours located in the proximal femur were metastatic, tumours located around the knee were mostly primary malignant bone tumours. The functional assessments of our patients were made according to the Musculoskeletal Tumour Society (MSTS) scoring system. The Students t-test and the Chi-square test were used for statistical analyses. Results: 30 (61.2%) of the patients were men, and 19 (38.8%) were women. The average age was 46.2 ± 1.9 years. Tumours were located in the proximal femur in 27 (55.1%) patients, distal femur in 16 (32.7%) patients and proximal tibia in 6 (12.2%) patients. 14 (28.6%) patients had a pathological fracture on admission. The average follow-up period of our patients was 27.4 ± 3.4 months, and the average MSTS score was 74.3 ± 13%. Complications developed at any time in 34.7% of the patients, and the most common symptoms were aseptic loosening (8.2%) and prosthesis infection (8.2%). Local relapse was found in one (2%) patient. The 5-year survival rate was 68.3% in patients with a primary tumour and 30% in patients with a metastatic tumour. Conclusion: Although endoprosthesis reconstruction had advantages of giving very good functional results in the early phases, it was found to cause mechanical complications, especially in patients with primary bone tumours during the mid and late phases.

Periprosthetic joint infection treated via bone cement and without the removal of hardware.

Periprosthetic joint infection (PJI) is a challenging complication with a frequency of 0.5–3%. The patients age, recurrent surgeries, and comorbid systemic diseases increase the risk of infection. Although the current approach in the treatment of PJI is a two-stage revision; sometimes, removing all the implants can lead to more serious complications. PJIs complications are increase in the time of surgery, loss of blood volume, and increase in the amount of bone loss. Infected soft tissue and dead bone tissue debridement must be made in all cases. One of our cases had bone defects due to recurrent hip arthroplasty revisions. Our case that was given PJI treatment by covering the well-fixed components with bone cement and removing only the mobile parts was discussed in line with the literature.

Comparison of treatment of unstable intertrochanteric fracture with different arthroplasty methods.

Background: Intertrochanteric femur fractures are elderly is very common and can be treated by different fixation methods such as internal fixation and arthroplasty. In our study, we investigated the correlation between the hemiarthroplasty treatment method and functional results. Materials and Methods: The study consists of 121 patients with intertrochanteric fractures and these patients are divided into three groups. Eighty-five were male and 36 were female. Group I was uncemented bipolar hemiarthroplasty patients, Group II was cemented bipolar hemiarthroplasty and Group III was cemented calcar preserving bipolar hemiarthroplasty. Mean follow-up period was 16 months. Harris hip score was used to evaluate functional outcome of the patients. Results: There were no significant differences between three groups when comparing the mortality rate in the 1st month and 1st year but all time mortality was proportionally lower in Group I comparing to the two other groups. There were no significant differences between three groups when comparing the functional results in 1st month and 1st year. Conclusion: In our study, uncemented bipolar hemiarthroplasty is a preferable treatment over the two other arthroplasty treatment model (cemented bipolar and calcar preserving) regarding to the mortality rate since there is no significant difference between. This conclusion needs further studies with greater number of patients.

Effect of Electromagnetic Wave on Bone Healing in Fixed and Unfixed Conditions.

AbstractMobile phones have come into daily life and are now one of the most frequently used devices for communication. The aim of this study was to evaluate possible effect of electromagnetic wave (EMW) with and without fixation material on bone healing.Forty male rats were exposed to fracture on tibia bone and were randomly divided into 4 groups as E(+)K(+), E(+)K(−), E(−)K(+), and E(−)K(−) where E(+) means EMW exposure and K(+) means Kirschner wire fixation. At the end of study tibia samples were taken from all the groups for the quantitative evaluation of regeneration.Significant difference was found between Group E(+)K(+) and E(−)K(+) in terms of both new bone and capillary volume.Electromagnetic wave may be harmful for bone healing with fixation whereas it has no same effect on bone regeneration without fixation.

Tibia diafiz transvers kırığının plak-vida ile tespitinin sonlu elemanlar yöntemi ile analizi

Amac: Sonlu Elemanlar Yontemi ile hasta icin en uygun implantin secilebilmesi ve secilen implant uzerinde ani isi degisikliklerinin etkisinin saptanmasi amaclanmistir. Gerec ve Yontem: Diafiz bolgesi 1 cm duzenli araliklarla transvers olarak parcalara ayrildiktan sonra ortaya cikan kesitler, kemigin onden ve yandan gorunumleriyle bilgisayar ortaminda birlestirilerek uc korteksi olan tubuler kemik modeli olusturuldu. Model uzerinde 8 delikli plak ve 8 adet vida tibianin lateral korteksi uzerine oturacak sekilde yerlestirildi. Plagin tam ortasindan transvers bir kirik olusturulduktan sonra kemik-plak-vida ile olusan tum model, matematik model (orgu) haline getirildi. Analiz sonuclari sonlu elemanlar yontemi kullanilarak degerlendirildi. Bulgular: Kirik hattina proksimaldeki ve distaldeki en yakin 2. delikte ve vida uzerinde gerilme degerinin en fazla oldugu bulundu. Isi farklarini degerlendirdigimizde de soguk ortamdaki plak-vida gerilme degerlerinin normal, ancak sicak ortamdaki gerilme degerlerine gore yuksek oldugu goruldu. Sonuc: Bu yontem ile cerrahi oncesi plak-vida-kemik uzerindeki gerilme degerleri bulunarak hastaya kullanilabilecek en uygun plak-vida belirlenebilir. Ayrica sicak ortamdan soguk ortama gectiginde plak-vida uzerindeki gerilme kuvvetinde artis oldugundan kirilmalarin soguk ortamda daha fazla oldugu soylenebilir.

İhmal Edilmiş Patella Dislokasyonunda Uygulanan Total Diz Protezi

Travma sonrası ihmal edilmiş patella dislokasyonu oldukça nadir görülmektedir. Bu hastalarda hayatın ilerleyen dönemlerinde dizde osteoartritik değişiklikler gelişmekte ve buna bağlı olarak da ciddi derecede şikayetlere sebep olmaktadır. Literatürde çok az sayıda olgu bildirilmekle birlikte bu hastalar total diz artroplastisi ile tedavi edilmektedirler. Her cerrahın tedavi planında değişiklikler olmakla birlikte kabul edilmiş standart bir cerrahi teknik bulunmamaktadır. Bu olgulardaki amaç patellanın femoral olukta olması ve ekstansiyon mekanizmasının tam çalıştığı fonksiyonel bir diz eklemi elde etmektir. Yazımızda travma sonrası tedavi edilmemiş patella çıkığı nedeniyle diz osteoartriti gelişen ve total diz artroplastisi uygulanan olgu literatür eşliğinde değerlendirilmiştir. (Ha se ki T›p Bül te ni 2014; 52: 140-3) Anahtar Sözcükler: Patella, dislocation, trauma, total knee arthroplasty Abs tract