Huseyin Gunay

Effects of platelet-rich plasma on nerve regeneration in a rat model

OBJECTIVE The aim of this study was to determine whether platelet-rich plasma has a regenerative effect on a sciatic nerve injury model in rats. METHODS A sciatic nerve cut model was created in 24 nerves of 12 rats. All nerves were repaired with epineural sutures by the same surgeon. Rats were randomly divided into two groups; platelet-rich plasma was applied to the injury site in the platelet-rich plasma group and saline only to the same area in the control group. Motor and electromyographic assessments were performed at the end of 12th postoperative week and all rats were euthanized for histological specimens. RESULTS Motor recovery was significantly better in the platelet-rich plasma group than the control group. The differences in electromyographic and histomorphometric findings between the groups were significant (p<0.05). CONCLUSION Our experimental study demonstrated positive effects of platelet-rich plasma on nerve regeneration.

Reliability and reproducibility of classifications for distal radius fractures

OBJECTIVE The aim of this study was to evaluate the interobserver reliability and intraobserver reproducibility of the Universal, AO, Fernandez and Frykman classifications for distal radius fractures. METHODS Fifty standard sets of posteroanterior and lateral roentgenograms of displaced distal radius fractures were classified two times by two groups of evaluators at 2-month intervals. The first group consisted of 10 orthopedic surgeons with a minimum of 5 years of experience. The second group consisted of 10 orthopedic residents in their first two years of practice. Interobserver reliability and intraobserver reproducibility were assessed using Cohens kappa test. RESULTS None of the classifications achieved good- very good reliability levels. The Fernandez classification had a moderate and the others had a fair interobserver agreement kappa coefficient. All classifications had fair kappa intraobserver agreement although the Frykman and Fernandez classifications had better results. CONCLUSION None of the classification systems were superior in terms of reliability and reproducibility. The reliability and reproducibility rates of all four classifications were insufficient.

Monofocal bone transport technique for bone defects greater than 5 cm in tibia: our experience in a case series of 24 patients

BACKGROUND As the tibial bone defect increases in size, the problems in treatment also increase. The treatment may be problematic but different treatment approaches can be used. Among these approaches, distraction osteogenesis is a method an orthopedic surgeon with limited conditions can use although it has a longer treatment period. In our case series, we evaluated current treatment approaches. METHOD Retrospective study based on patient records and radiographs. We evaluated our cases with tibial bone defects Type B and greater than 5 cm. Twenty four cases were operated between 1995 and 2013. Clinical follow-up consisted of physical examination, review of radiographs, and Association for the Study of the Method of Ilizarov (ASAMI) scoring system of bone and functional results. RESULTS The defects had an average lenght of 7.01 cm (SD:2.88) (range, 5-18). The mean follow-up time from removal of the apparatus to the time of the last clinic visit averaged 74.08 ±24.17 months (range: 39-122). The Ilizarov frame was placed for transport and until bone was solid, average of 275.5 ± 70.6 days (range: 190-437 days). The mean external fixator time (EFT) was 350.91 ± 89.22 days (range: 261-627 days). The mean external fixator index (EFI) was 52 days/cm (range: 34.8-62.8 days/cm). Bone union was obtained in 23/24 (95.8%) patients. Seven patients suffered from stiffness (2 knee, 5 ankle) from which 3 patients developed equinus deformity and required tenoplasty (Achilles tendon lengthening at the time of frame removal. After reaching docking site, 5 patients needed intramedullary nailing to speed up union. Twelve (50%) cases had excellent radiological results, 8 (33%) cases had good, 2 (8%) cases fair and 2 (8%) cases had poor results. Regarding the functional ASAMI scoring system 14 (58%) cases had excellent, 9 (38%) cases had good and one case (4%) had fair result. CONCLUSION According to our experience, the Ilizarov bone transport technique remains a reliable method to repair bone defects. However, the treatment time is lengthy with a considerable risk of complications. We found closed intramedullary nailing as an effective and easy solution for cases without pin tract infections to manage the nonunion problem of the docking site and this option should be considered where the surgeon envisages difficulties of healing or the patient has lost patience with the frame. Careful selection of case and patient profile can optimize the outcomes.

Comparison of ultrasound and dorsal horizon radiographic view for the detection of dorsal screw penetration

Objective The aim of this study was to compare the efficiency of dorsal tangential fluoroscopy and ultrasonography in detecting dorsal screw penetration in distal radius volar locking plate applications. Methods Ten cadaveric forearms were operated. The distal four screws were protruded 0, 1 and 2 mm into each of the second, third and fourth dorsal compartments of distal radius. Dorsal horizon views were taken using fluoroscopy. Each radiographic image was evaluated by two orthopedic surgeons who are blinded to procedure. Sonographic evaluations were performed by an orthopedic surgeon blinded to the procedure. Both dorsal horizon view and ultrasonography assessments were noted by the evaluators whether the tip of the screw penetrated or not the dorsal cortex for each compartment. Results No significant difference was observed on correct detection of 0 mm, 1 mm and 2 mm screw penetrations at second and third compartments. In the fourth compartment, there was no difference with 0 mm and 2 mm penetrations but correct detection accuracy of 1 mm screw penetration was 87% in ultrasonography group and 71% in dorsal horizon view group. Conclusions The accuracy of ultrasonography on 1 mm penetration at the fourth compartment is better than dorsal horizon view. However, dorsal horizon view and ultrasonography accuracy is similar for the other compartments and penetration levels. Ultrasonography is a reliable and effective procedure for detection of dorsal screw penetrations. Level of evidence Level III, Diagnostic study.

Anesthetic approach to a patient with multiple pterygium (Escobar) syndrome.

SIR—We read with interest the article by Lee et al. (1) on optimum time for intravenous cannulation after induction with sevoflurane. We feel that their recommendation of 3.5 mins of sevoflurane induction after loss of eyelash reflex for problem-free intravenous cannulation may not be appropriate in all patients. This is because all patients may not be ready for cannulation at 3.5 mins as it may occasionally be prolonged depending on variables such as depth of spontaneous breathing and occasional periods of breath holding. We have been placing supraglottic device and performing intravenous cannulation in pediatric patients depending on the eye signs. We begin with gradually increasing concentrations of sevoflurane induction. While this is in progress, we watch for the eyeball movement. During initial period of induction, the eyeballs are roving from the midline and are often pulled up/down or are divergent. As anesthesia deepens, eye balls become gradually central. This generally takes 4–5 mins. It is at this stage of eye sign, which is most suited for intravenous cannulation or placement of supraglottic device without any unwanted reaction from the patient. This technique is independent of patient breathing variables and provides a clear end point for safe intervention which is tailored to the specific patient.

A prospective study of angle grinder injuries in the hands and forearms during a one-year period

Angle grinders are powerful tools used for cutting, shaving and polishing metal, stone, concrete and many hard surfaces in the work and hobby context. The aim of this study was to evaluate the acute hand injuries caused by angle grinders and to identify risk factors. Out of 742 acute hand and forearm injuries presenting in our emergency department between March 2016 and March 2017, 82 cases of injury due to angle grinder were included in the study. The age, gender, occupation, experience and education level of the injured patients were recorded. In addition, the location, mechanism, time of day, cigarette or alcohol use and occupational cases were determined. The Modified Hand Injury Severity Score (MHISS) was used to determine the injury severity. The vast majority of injuries (except 8) were not occupational injuries. They often occurred when individuals were using this tool outside of a work context (home, etc.); 44% of the patients were retired. There were more injuries between the hours of 3 pm and 6 pm. The mean overall MHISS score of was 74 (2-330). These angle grinder injuries, many of which are severe, are difficult to treat and the resulting disability is high. Many factors, such as smoking, age and time of day contribute to these injuries. Precautions should be taken and safety training should be provided for this powerful tool which is widely used and easy to obtain.

Long term results of primary repair of combined cuts of median and ulnar nerves on forearm

BACKGROUND The objective of this clinical study was to evaluate sensory and motor functions in the later period following primary repair of combined injuries of the ulnar and median nerves in the forearm at proximal, middle, and distal levels. METHODS Later period sensory evaluation of ulnar and median combined cuts was performed using two-point discrimination and monofilament tests. On the other hand, motor evaluation was performed by determining dorsal palmar interosseus strength for the ulnar nerve and abductor pollicis brevis muscle strength for the median nerve. Cold intolerance, object recognition, and weight discrimination were also reviewed. RESULTS In total, 26 patients with ulnar-median combined cut and aged between 5 and 59 years were included in this study. Although no deficiency was observed in the sensory functions of any of the patients, a decrease in tactile sensation was detected in the median sensory region in 12 (46%) patients and in the ulnar sensory region in 7 (26%) patients. The most significant loss in terms of motor functions was detected in the opposition pinch strength. Two patients developed claw hand and two showed joint contracture. CONCLUSION Ideal treatment for peripheral nerve injuries should be primary repair. Restoration of the motor function in the median nerve is relatively easier than that in the ulnar nerve. No significant difference was observed in terms of sensory function. An alternative is needed for primary repair because of lack of motor function in proximal ulnar incisions. There is no standardization of tests performed for peripheral nerve repair.

The value of short segment conduction studies in localizing ulnar neuropathy of the elbow

Objectives: The aim of this study was to examine the localizing value of short segment conduction studies (SSCSs) by comparing pre-surgical SSCS findings with intraoperative findings in patients with ulnar neuropathy of the elbow. Patients and Methods: Pre-surgical SSCSs were performed in 20 patients and compared with the intraoperative findings. Functional and electrophysiological recoveries were assessed at postoperative month 3. Overall, compressed nerve segments identified by SSCSs were compatible with the intraoperative findings in 90% of patients. Results: The success rate of surgery was higher in the patients with SSCS-determined single-level compression as compared to multi-level compression. SSCS abnormalities persistent in six patients with poor functional recovery. Conclusion: SSCSs are valuable for localizing compressed segments, thus they can be used as a guide for minimalist surgical techniques. These studies also appear valuable for predicting surgical outcome in patients with ulnar neuropathy of the elbow.

Comparison of single event vs multiple event soft tissue surgeries in the lower extremities with cerebral palsy

UNLABELLED In children with spasticity of multiple muscle groups, the need for repeat surgical interventions increases with advancing age. AIM The present study aimed to investigate retrospectively whether there are any clinical and functional differences between single-event multilevel surgeries and multiple surgical events at a single level. METHOD The medical records of 109 patients with cerebral palsy (CP) were used. The patients, who met the inclusion and exclusion criteria, were assigned into following 4 groups based on the surgical procedures. The Gross Motor Function measure-88 (GMFCS) and Functional Independence Measure for Children (WeeFIM) were used for assessments. RESULTS When compared to groups, there was no significant difference. This study showed that both surgical techniques resulted in improvements in GMFCS and WeeFIM levels.