Kadir Ertem

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.

Evaluation of the gluteus medius muscle after a pelvic support osteotomy to treat congenital dislocation of the hip

BACKGROUND Many authors have reported that the pelvic support osteotomy prevents a Trendelenburg gait by restoring the biomechanics of the abductor muscle in patients with congenital dislocation of the hip. However, we are not aware of any studies in which the hip abductor muscles were examined following pelvic support osteotomy. The purpose of this study was, first, to use magnetic resonance imaging to measure alterations in the length and volume of the gluteus medius muscle after pelvic support osteotomy and, second, to determine which factors influence the results of the Trendelenburg test. METHODS Eleven patients with a history of congenital hip dislocation who had been treated with a pelvic support osteotomy were examined clinically with the Harris hip score and the Trendelenburg test, radiographically to measure limb-length discrepancy and valgus angulation of the proximal part of the femur, and with magnetic resonance imaging to measure changes in the gluteus medius length and volume. RESULTS The pelvic support osteotomy achieved a functional and painless hip in all eleven patients. Five of the eleven patients had a persistently positive Trendelenburg gait at the time of the last follow-up visit, at an average of three years after the osteotomy. The muscle volumes were restored to 43% to 89% of the muscle volumes on the normal contralateral side, and the postoperative muscle volume correlated significantly with the result of the Trendelenburg test (r = -0.63; p = 0.03). There was a positive association between age and the result of the Trendelenburg test (p = 0.01): four of the five patients who had a positive test were at least thirty-one years of age at the time of the operation. There was no correlation between the Trendelenburg test and the change in the length of the gluteus medius muscle, which averaged 19.2 mm in the patients with a positive test and 19.3 mm in those with a negative test. CONCLUSIONS Patient age at the time of the operation and the postoperative change in the volume of the gluteus medius muscle have a significant influence on the result of the Trendelenburg test after a pelvic support osteotomy. Moreover, our study demonstrated that restoration of the muscle volume after a pelvic support osteotomy is not sufficient to prevent a Trendelenburg gait in older patients with congenital dislocation of the hip. LEVEL OF EVIDENCE Therapeutic Level IV.

Successful treatment of high congenital dislocated hips in older children by open reduction, pelvic and femoral osteotomy with external fixator stabilization (average 8.2 years of age).

A new technique using a hinged external fixator to stabilize an open reduction with pelvic and femoral osteotomies has been developed for treating high-dislocated hips in older children with developmental dislocated hip (DDH). This technique was performed in 11 patients (12 hips) at a mean age of 8.2 years. At follow up, radiographic results showed no redislocation/subluxation and clinical results demonstrated 11 hips as excellent/good and only one hip as poor from persistent stiffness. In conclusion, this new technique produces acceptable results in the treatment of older children with high dislocation of the hip from DDH.

Isolated zone III vertical fracture of first sacral vertebra--a case report.

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An unusual complication of ulnar nerve entrapment in a pediatric olecranon fracture: a case report.

The rates of rare complications of acute or late ulnar nerve entrapment after supracondylar fractures, medial condyl fractures, elbow dislocations, forearm fractures, Galeazzi fracture dislocations, and epiphyseal separation of the distal ulna were reported earlier in the literature. Here, we report a late ulnar nerve entrapment after displaced olecranon fracture in a 10-year-old boy.

An isolated acute pisiform fracture: usefulness of magnetic resonance imaging

The incidence of pisiform fracture is very low, and generally it is associated with other carpal or distal radial injuries. We present the case of an acute isolated pisiform fracture suspected on plain films and diagnosed on magnetic resonance imaging (MRI). MRI revealed a fracture line within the pisiform bone and helped to exclude additional fractures and soft-tissue injuries. Immobilization in a short arm cast was applied for 4 weeks, and the patient had good clinical response.RésuméLa fréquence de la fracture de l’os pisiforme est très faible et est souvent associée à d’autres lesions du radius distal ou du carpe. Les auteurs présentent un cas de fracture isolée du pisiforme suspectée sur les radiographies standard et confirmée par IRM. L’IRM mit en évidence le trait de fracture dans l’os et permit d’exclure d’autres lésions traumatiques associées. Le traitement consista en une immobilisation plâtrée de quatre semaines avec un bon résultat clinique.

Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis.

OBJECTIVES This study aims to evaluate clinical and radiological findings of a series of patients with avascular necrosis of the femur head (ANFH) treated by core decompression and vascular pedicled iliac crest grafting. PATIENTS AND METHODS This retrospective study included 26 hips of 22 patients (14 males, 8 females; mean age 36 years; range 16 to 48 years) with ANFH using the vascularized iliac bone grafting between March 2003 and July 2010 in our clinic. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system. RESULTS The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement. CONCLUSION Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.

Impairment of Peripheral Nerve Healing After Nerve Repair in Rats Chronically Exposed To Alcohol

BACKGROUND AND AIMS The aim of this study was to determine the effect of chronic alcoholism on the healing of repaired peripheral nerve and muscle. METHODS Group 1 rats (n = 9) were fed with an alcohol-free modified liquid diet (MLD) throughout the experiment and received no nerve transection or repair. Group 2 rats (n = 9) were fed the same isocaloric MLD and underwent nerve transection and repair. Group 3 (n = 7) consisted of alcoholic rats without nerve transection and repair and Group 4 (n = 8) consisted of alcoholic rats with nerve transection and repair. To assess the effects of chronic alcoholism on nerve healing, surgical procedures were applied to rats in Groups 2 and 4. After 2 months, posterior tibial nerve and gastrocnemius muscle samples were taken for histological analysis. RESULTS Group 2 rats displayed a group of atrophic fibers, whereas Group 3 rats showed myophagocytosis and endomysial mononuclear infiltration and type 2 fiber atrophy. Group 4 rats displayed a large section of atrophic fibres. Axonal loss, prominent regenerative clusters and endoneural fibrosis occurred in Group 2 rats. Axonal and myelin degeneration, myelin remnants and thinly myelinated axons were exhibited in Group 3 rats, whereas severe axonal loss, myelin degeneration, regenerative clusters and endoneural fibrosis were discovered in Group 4. There was a significant difference in the number of myelinated axons among the various groups of rats. CONCLUSIONS Our findings show that chronic alcoholism has a negative influence on peripheral nerve regeneration associated with a significant decrease in axon number and increased axonal degeneration.

Aneurysmatic bone cyst of the second metacarpal: en-block resection and bicortical iliac crest graft replacement

Hand is an unusual location for aneurysmal bone cysts. A case in whom the second metacarpal of the left hand was presented. Because of its rapidly growing nature, a radical excision was performed. The resected segment was replaced by a bicortical iliac crest graft. The graft healed without complications, and result was functional. On the follow-up at the 36th month no sign of relapse was found.RésuméLa main est un site inhabituel pour les kystes anévrysmaux osseux. Un cas d’atteinte du 2ème métacarpien fait l’objet de notre présentation. En raison d’une croissance rapide, une résection radicale fut réalisée. La partie réséquée fut remplacée par un greffon provenant de la crête iliaque. La greffe guérit sans complications et le résultat fonctionnel fut bon. Après 36 mois aucune récidive n’a été constatée.

Functional outcomes of arthroscopic treatment of lateral epicondylitis.

OBJECTIVE The aim of this study is to evaluate the functional results of arthroscopic lateral epicondylitis (LE) treatment in patients in whom conservative treatment proved insufficient. METHODS Between 2011-2014, 29 patients with LE (15 women, 14 men; mean age: 46 years; range: 33-79) who received at least 6 months of conservative treatment methods and did not achieve full recovery and thus underwent arthroscopic surgery were included in this study. RESULTS One patient was excluded from the functional assessment. Mean follow-up was 20.5 months (range: 7-42). Mean preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores were 81.1±17.5 and 34.7±26.8 (p<0.0001), respectively, and Mayo Elbow Performance Scores (MEPS) were 48.5±11.5 and 101.2±22.9 (p<0.0001), respectively. Twenty-one patients (75%) were satisfied with the functional outcome. CONCLUSION As a result, LE treated with the arthroscopic method, with its low complication rate, successful degenerated tendon debridement, and decortication of the lateral epicondyle, is a useful method for intervention in pathologies such as annular plica, loose body, synovial hypertrophy, and radiocapitellar chondropathy.