Ibrahim Halil Kafadar

Biomechanical properties of Achilles tendon in diabetic vs. non-diabetic patients.

BACKGROUND/OBJECTIVES Structural and functional impairments of the Achilles tendon in diabetic patients has the potential to contribute to ulcer formation through altered foot mechanics. This study aimed to examine the biomechanical and histopathological alterations in Achilles tendon specimens from diabetic vs. non-diabetic individuals. MATERIALS AND METHODS 42 Achilles tendon samples obtained from patients treated with below-knee or above-knee amputation for chronic diabetic foot ulcers (n=21) or for non-diabetic conditions (n=21) were included. A tensile test was performed for each tendon and a stress vs. strain graft was obtained to calculate following biomechanical parameters: elasticity (Young modulus), load, stiffness, toughness, energy, strain, elongation and tenacity. Groups were also compared with regard to histopathological findings (inflammatory cell infiltration, collagen organization, and degeneration). RESULTS Non-diabetic tendons exhibited a superior biomechanical profile over diabetic tendons with regard to the following biochemical parameters: elasticity, maximum load, stiffness, toughness, load, energy, strain and elongation at break point, tenacity, and strain at automatic load drop (p<0.05 for all comparisons). Diabetic tendons had mild impairment of collagen organization and focal collagen degeneration, whereas neither diabetic nor non-diabetic tendons had inflammatory cell infiltration. CONCLUSION The structural and functional alterations associated with diabetes adversely affect the biomechanical properties of the Achilles tendon, potentially acting together with neuropathy and ischemia in the development of diabetic foot ulcers.

Mid-term results of the elastic intramedullary nailing in paediatric long bone shaft fractures: a prospective study of 102 cases.

The aim of this study was to evaluate the mid-term results of a large series of paediatric patients with long bone shaft fractures who were treated with elastic intramedullary nailing. Between November 2009 and November 2010, 108 long bone shaft fractures in 102 patients were treated with elastic intramedullary nails. The number of nails used, admission time, nail diameter/medullary canal diameter ratio of the nontraumatized extremity, weeks until radiological consolidation, weeks until full weight bearing for the femur and tibia shaft fractures, weeks until the nails were removed, number of radiographs from the diagnosis time to the removal time of nail(s), clinical complications and radiological results were recorded; the union rate, time to union, nonunion, delayed union, malrotation, malalignment, follow-up time and functional outcomes (Flynn outcome scoring) were also recorded. The mean follow-up time was 22.2 (14–30) months. The mean age of the patients was 9.6 (6–15) years for all cases. The mean nail removal time for all cases was 19.2 (17–29) weeks. Eighteen patients developed complications: six had insufficient reductions; two had refractures; four developed a deep infection; one had delayed union that needed revision; two had lower extremity length discrepancies of more than 15 mm; and three had skin impingements. The mean admission time was 19 (6–32) h; the mean number of radiographs from the diagnosis time to the removal time of nail(s) was 14 (8–20) for each fracture. All patients showed excellent or satisfactory results according to Flynn’s criteria. The mean time to full weight bearing for the femur and tibia shaft fractures was 62.4 (52–88) days. A nail diameter/medullary canal diameter ratio of over 0.4 showed good results; short union time, less lower extremity length discrepancy and less malalignment were recorded. When patients were informed about possible complications as well as the advantages, almost all chose the operative approach. According to our experience and opinion, elastic intramedullary nailing is the best choice for diaphyseal fractures in children with skeletal immaturity compared with other surgical choices such as osteosynthesis with a plate.

Intrapelvic pin migration after Salter innominate osteotomy and laparoscopic removal: a case report.

Although there are many methods for the treatment of developmental dysplasia of the hip, Salter innominate osteotomy is a surgical technique presently used successfully worldwide. However, several complications can be found after Salter innominate osteotomy. Kirschner (K) wire migration into the pelvic cavity is not a common occurrence and is also rarely reported in the literature. Here, we report the case of a patient who was admitted to the emergency department of our hospital with acute abdominal pain because of K wire migration into the pelvis. We recommend bending the proximal end of the K wires or using threaded K wires to prevent this complication.

Comparison of simultaneous bilateral with unilateral total knee arthroplasty

OBJECTIVE The aim of this study was to compare simultaneous bilateral total knee arthroplasty (BTKA) and unilateral total knee arthroplasty (UTKA) in terms of morbidity, clinical and radiological findings and quality of life. METHODS The study included 48 simultaneous BTKAs (46 females, 2 males; mean age: 64.00 ± 8.31 years) and 53 UTKAs (46 females, 7 males; mean age: 64.40 ± 7.45 years) performed between November 2007 and June 2012. Groups were compared with respect to comorbidity, complications, blood transfusion, hospital stay, clinical and radiological (American Knee Society Score) findings and quality of life (SF-36). RESULTS Three patients in the BTKA group and 1 in the UTKA group required intensive care admission due to pulmonary embolism; 2 cases occurred within the first postoperative 30 days. One BTKA patient died in the early postoperative period and 1 patient from the BTKA and 1 from the UTKA group died within 1 year. Hospital stay, perioperative blood transfusion parameters and mortality rates were significantly different in favor of UTKA and revision operation rates in favor of BTKA (p<0.05). All patients had improved knee and function scores and SF-36 scores. However, there was no significant difference between the groups (p>0.05). CONCLUSION Simultaneous BTKA should be considered in selected patients under 70 years of age with good compliance and no comorbid disease.

The effects of locally applied simvastatin on an experimental mouse femur nonunion model

OBJECTIVE The aim of this study was to assess the effects of locally applied simvastatin on femur nonunions in a mouse model. METHODS The study included 32 male Wistar albino mice randomly allocated to one of four groups: two control groups (control-4 week [C4w] and control-8 week (C8w)] and two treatment groups (simvastatin-4 week [S4w] and simvastatin-8 week [S8w]). The control groups received dimethylsulfoxide locally injected at a dose of 10 mg/kg/day after surgical intervention for 1 week. Treatment groups received a liquefied form of simvastatin locally to the osteotomy field by injection at a dose of 10 mg/kg/day, starting from the first postoperative day for 1 week. The C4w and S4w groups were sacrificed 4 weeks and the C8w and S8w groups 8 weeks after the end of local treatment. Before sacrifice, intracardiac blood samples were retrieved for biochemical analysis and radiographies were taken. The right femurs of mice were then removed for histopathological evaluation. RESULTS There were significant differences between the control and treatment groups when evaluated radiologically. Significantly higher levels of bone-specific alkaline phosphatase and osteocalcin values were found in the treatment groups than in the controls (p<0.05). CONCLUSION According to biochemical, radiological and histopathological results, local application of simvastatin appears to produce beneficial effects on the mouse femur nonunion model.

Fondaparınux Versus Nadroparın for Preventıon of Venous Thromboembolısm After Electıve Hıp and Knee Arthroplasty

Objective To evaluate the efficacy and safety of fondaparinux compared with nadroparin for prevention of venous thromboembolism after arthroplasty. Patients and methods One hundred fifteen patients were randomized into 2 treatment groups. Patients were given fondaparinux in Group I and nadroparin in Group II. Measurements were performed on Days 1, 5, and 21. The wound area was assessed with a subjective visual analog scale. Results The blood counts, clinical biochemical tests, and coagulation tests (ie, thrombin time, partial thromboplastin time, activated partial thromboplastin time, fibrinogen, prothrombin time–International Normalized Ratio, and antithrombin III activity) did not show statistically significant differences between Group I and Group II. In both study groups, anti-factor Xa activities increased significantly on the fifth and 21st day. The scores of the subjective visual analog scale showed significance on Day 21. Conclusions Our results confirm the safety and efficacy of both fondaparinux and nadroparin for prophylaxis after major orthopedic surgery.

Effect of intraarticular propolis in an experimental septic arthritis model.

To evaluate the efficacy and safety of intraarticular propolis compared with systemic antibiotic treatment in an experimental septic arthritis model. Thirty-two rabbits were infected intraarticularly by Staphylococcus aureus. The rabbits were randomly divided into four groups, including a control group and three experimental groups. Drainage was the only procedure performed in group I (control group). The animals were treated with daily intramuscular cefazolin sodium (75 mg/kg) for 7 days in group II. In group III, intraarticular ethanolic extract of propolis (0.5 mg/ml) was injected to the infected knees under sterile conditions on days 7, 14, and 21 after drainage. In group IV, the rabbits received both intramuscular cefazolin sodium as in group II and intraarticular ethanolic extract of propolis as in group III. After 8 weeks, the animals were killed and joint histopathological and scanning electron microscopic parameters were assessed. The best clinical score was obtained in group IV. There were statistically significant differences among all the groups (P<0.05). The highest total score of the histological examination was found in group I and the best total score was obtained in group IV. There were statistically significant differences among the groups when we evaluated the scores of the parameters as loss of chondrocytes, loss of matrix, and pannus in-growth (P<0.05). But there was no significant difference among the groups for the scores of cloning of the chondrocytes (P>0.05). The highest scanning electron microscopy score was found in group I and the best score was obtained in group IV. Our results confirm the safety and efficacy of intraarticular propolis and synergistic effect of propolis when used with cefazolin in an experimental septic arthritis model.

The Effects of Human Amniotic Fluid and Different Bone Grafts on Vertebral Fusion in an Experimental Rat Model

Objective The high risk of nonunion represents a challenge in vertebral surgery, thus stimulating new strategies to improve fusion rates. We investigated the effect of 2 different bone grafts and amniotic fluid application on radiologically and histologically evaluated vertebral fusion in an experimental rat model. Materials and methods Forty-eight 24-week-old Sprague Dawley rats were included and assigned into 1 of 4 groups: allograft group, allograft plus human amniotic fluid group, demineralized bone matrix (DBM) group, or DBM plus human amniotic fluid group. After decortication and L4–L6 spinal fusion, study treatments were applied. Fusion in each rat was examined radiologically and histologically 8 weeks after the intervention. Results The group that received only allograft had better radiologic scores (median = 3.5; range = 3–4) when compared with the group that received only DBM (median = 2; range = 1–4) (P = 0.002); however, histologic scores did not differ. When amniotic fluid was added to the grafting, allograft-based treatments performed better than DBM-based treatments both on radiologic (median = 4; range = 3–4 vs median = 3; range = 3–4; P = 0.003) and histologic (median = 7; range = 6–7 vs median = 5; range = 3–6; P < 0.001) evaluation. Addition of amniotic fluid did not result in better outcomes in the rats that received DBM-based treatments but based on histologic evaluation, rats that received allograft-based treatments benefited from this application. Conclusions Amniotic fluid seems to have an enhancing effect on posterior spinal fusion, particularly when combined with allograft.

Surgical excision of peripheral nerve schwannomas: analysis of 11 patients

OBJECTIVE Benign schwannomas are the most common tumour of the peripheral nerves. Symptomatic schwannomas are treated by surgical excision, but new neurological deficits may develop. We performed a retrospective review of cases of schwannomas in the extremities and reviewed the relevant literature. METHODS We retrospectively reviewed the demographic characteristics of 11 patients with schwannomas treated at our institution. We also reviewed the clinical characteristics and postoperative results of these cases, determined the possible risk factors influencing the development of complications and compared the risk factors with those reported in the literature. RESULTS There were five males and six females with a mean age of 37.6 (range: 17-62) years. The mean postoperative follow-up was 54.6 (range: 26-88) months. Three tumours were located in the forearm and the rest were localized in the lower extremity. No recurrences were observed during the follow-up period. New motor and sensory deficits were observed in only one patient. CONCLUSION Schwannomas in the extremities can be excised with acceptable risk of neurological deficits. Meticulous dissection is required during surgery.

The Plica: Is a New Aetiological Factor in the Knee Osteoarthritis?

Osteoarthritis is one of the most important diseases in the field of orthopedics worldwide. The disease is characterized by progressive loss of articular cartilage and formation of osteophytes, which lead to chronic pain and functional restrictions in the affected joints. Different factors can be involved in the development of osteoarthritis including traumatic events, genetic predisposition, defective position of joints, and ageing and malnutrition. The plica is the generic name of the ruins or folds of the synovial membrane in the knee joint. The incidence of the plicas in the knee joint is between 18,5-87 %. These plicas are named and classified according to their settlements in the knee joint (1-6). The plicas sometimes come to a pathologic state, which gains clinical importance and causes the plica syndrome (7). When plica is symptomatic, the condition is called plica syndrome. The plicas are considered to be one of the potential causes of the complaints around the knee joint (8). It is known that medial plica causes to degeneration of cartilage around the medial femoral condyle of the knee joint and / or the medial pole of the patella (2,8-14). Owing to the anatomic location of the medial plica, a loss of normal elasticity can cause it to impinge on the femoral medial condyle or the medial facet of the patella during flexion–extension motion of the knee. This kind of repetitive contact may result in a chondral lesion of varying severity, sometimes referred to as an impingement lesion (2,7,8,14-18). It has also been suggested that normal-looking medial plica, not impinging on the articular surfaces, could be symptomatic as well . This is supported by recent findings which have demonstrated an increase in the amount of nerve endings in the plica after trauma or overuse, indicating increased pain sensitivity and sensation of pain (19,20). The anatomy of the plicas or synovial folds was first described by Mayeda in 1918. In 1939, Lino first described the appearance of arthroscopic synovial folds in the cadaveric knees. In 1950 and 1971, Pipkin reported that the plicas should be distinguished from adhesions in the knee joint and those might cause clinical symptoms (21,22).