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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.

Comparison of dorsal and volar percutaneous screw fixation methods in acute Type B scaphoid fractures.

OBJECTIVE In this study, we aimed to compare the clinical and functional results of patients treated with dorsal or volar percutaneous screw fixation for acute scaphoid fractures. METHODS We retrospectively evaluated 27 wrists of 26 patients (24 males, 2 females; mean age: 33.1 years) who underwent dorsal or volar percutaneous screw fixation for acute scaphoid fractures between 2000 and 2009. The dorsal approach group contained 13 wrists and the volar approach group 14 wrists. Splint was removed and wrist exercises initiated on the 10th postoperative day. Pinch power, grip power and range of motion were evaluated using the contralateral wrist as controls. Functional evaluation was performed using the patient-rated wrist evaluation score (PRWE) and Mayo wrist scoring system. RESULTS According to the Herbert and Fishers classification system there were 9 B2, 3 B3 and 1 B1 fractures in the dorsal approach group, and 12 B2 and 2 B1 fractures in the volar approach group. Fracture union was achieved in all patients. There was no significant difference between the two groups according to functional and clinical results (p>0.05). All patients returned to their jobs in an average of 4.2 weeks and there was no significant difference between the groups (p=0.437). Wrist flexion was significantly better in the control wrists in both groups (p=0.009). In one patient, the screw was removed due to ongoing pain and asymptomatic screw head displacement in the scaphotrapezoid joint was detected in another. CONCLUSION The surgical approach does not affect the clinical and functional outcomes in percutaneous screw fixation of Type B scaphoid fractures. Percutaneous fixation is a valuable treatment method for Type B scaphoid fractures as it enables early wrist motion and high patient satisfaction.

Effect of adjuvant therapies on recurrence in aneurysmal bone cysts

OBJECTIVE The aim of this study was to define the effective factors such as surgical method, age and cavity filling materials on local recurrence in the treatment of aneurysmal bone cysts. METHODS The study included 85 patients (mean age: 17.9 years) that received surgical treatment for primary aneurysmal bone cyst. Nine were treated with cyst excision and 76 with intralesional curettage. The intralesional curettage group was divided into 3 subgroups according to adjuvant therapies applied; the first group received no additional adjuvant therapy, the second group received additional high-speed burr and the third group received additional high-speed burr and alcohol/phenol adjuvant treatments. Bone graft or bone cement was used to fill in the cavity. Mean follow-up period was 107.5 months. Groups were analyzed statistically in terms of local recurrence. Onset of cyst in ages under 10 and 20 years were considered a negative prognostic factor and analyzed statistically. RESULTS Local recurrence occurred in 10 (11.8%) patients. Mean duration between the initial operation and recurrence was 10 months. There was no significant difference in terms of local recurrence among the surgical treatment groups, adjuvant therapy groups, age groups and bone graft and bone cement groups. CONCLUSION Careful curettage of the entire cyst wall remains the most important step in the intralesional treatment of aneurysmal bone cyst.

Aggressive fibromatosis: evaluation of prognostic factors and outcomes of surgical treatment

OBJECTIVE The aim of this study was to evaluate the results of surgical treatment of aggressive fibromatosis and the effects of prognostic factors on recurrence. METHODS Forty patients (24 female, 16 male; average age: 31.2 years) diagnosed with aggressive fibromatosis were evaluated retrospectively. Nine patients with tumor-positive surgical margins macroscopically were excluded. Prognostic factors such as age, gender, localization, admission status, compartment status, surgical margin, tumor size and adjuvant radiotherapy were evaluated. RESULTS Recurrence rate was 29%. Average disease free survival was 46±4 months. There was no statistically significant relation between prognostic factors and recurrence. Clinical results of the patients receiving adjuvant radiotherapy were more satisfactory. CONCLUSION Adjuvant radiotherapy administration appears to be a rational treatment method instead of sacrificing function to achieve wide surgical margins.

Clinical applications of free arterialized venous flaps.

Venous flaps are flaps by which tissue perfusion is accessed through the venous network. Despite originally being questioned due to potential perfusion problems, as the dynamics of tissue perfusion have been more fully comprehended, venous flaps appear to have a far wider range of application than first thought. In our study, we analyzed the clinical results of the applications of free arterialized venous flaps along with the factors that can affect flap survival. Forty-one flaps were assessed retrospectively. Type of the trauma, traumatized area, the time duration between trauma and application of the flap, donor area, type and count of the anastomosis, encountered complications, and flap survival rates were analyzed. Regression and classification trees were used to study the relationship between flap surface area, anastomosis count, and flap survival. Circulatory abnormalities such as early congestion and edema were seen in 53.6% of the applied flaps. A total of four flaps (9.7%) developed necrosis which presented as full thickness in three flaps and partial thickness in one flap. It can be said that there was a weak but positive correlation between the size of the flap area and the number of anastomosis. Although the results of arterialized venous flaps are inconsistent in the literature, those flaps can be preferred as an alternative treatment option in single finger defects where tissue compatibility and cosmetic results are quite impressive. In the meantime, syndactylized venous flaps are the preferred method regarding multiple finger soft-tissue defects.

Evaluation of the risk factors for acute occupational hand injuries

OBJECTIVES To evaluate the effect of demographic and occupational factors on the severity of the acute occupational hand injuries. METHODS Patients with acute hand injuries presenting to the emergency department of the Ege university hospital between 01.08.2008 and 27.02.2009 were included. A questionnaire investigating demographic and occupational factors of the patients and their injuries was filled out for each patient. Modified Hand Injury Severity Score (MHISS) was used to assess the severity of the injury. RESULTS A total of 144 subjects were included. Forty-three patients had occupational hand injuries. Age at injury, occupation, and main earning status did not alter the MHISS score significantly. Also, the mechanism of injury, occupational experience, timing of the injury, glove use, safety training did not have a significant effect on the injury severity. The injury pattern was found to have a statistically significant effect on the MHISS score. CONCLUSION The potentially modifiable factors such as the working conditions, safety training and use of gloves are important in the etiology of occupational acute hand injury. Most probably, in this study the size of the sample was not large enough to be able to demonstrate any relation between these and the injury severity. However, attempts to modify these factors by various strategies may reduce the incidence of acute hand injury at work. Precautions and widespread educational programs can prevent occupational acute hand injury.

The effect of excisional arthroplasty with palmaris longus tendon on carpal height ratio in Stage 3 Kienböck’s disease

OBJECTIVE Treatment methods in Kienböcks disease remain controversial despite the long-term awareness of the disease by orthopedic surgeons. Currently, excisional arthroplasty with a palmaris longus tendon ball is one of the most frequently used treatment methods. The aim of this study was to evaluate the long-term results of thirty-eight patients who had been treated with excisional arthroplasty and palmaris longus tendon ball, as well as the effect of this method on carpal height. METHODS In this study, we retrospectively evaluated 38 patients (mean age: 30.4 years; range: 17-64 years) with Stage 3 Kienböcks disease who underwent excisional arthroplasty between 1978 and 2008. According to the Lichtman classification, 8 patients were classified as Stage 3a and 30 patients were classified as Stage 3b in Kienböcks disease. The mean duration of follow-up after surgery was 81.3 (range: 25 to 264) months. The outcomes were evaluated with joint range of motion, grip strength and functional assessment of Nakamura and radiographic changes in carpal height. RESULTS According to the Nakamuras scoring system the results were excellent in 22 (57.9%) patients, good in 13 (34.2%) and moderate in 3 (7.9%). Comparison of pre and postoperative range of motion of the wrist revealed an average increase in wrist extension of 10° (p<0.05), and an average decrease in ulnar deviation of 4° (p<0.05) after the operation. No significant difference was observed when comparing other joint range of motion parameters. Dynamometric grip strength measurements revealed significant differences between the healthy and operated sides (67.6 kgf vs. 45.9 kgf, respectively; p<0.05). The decrease in the revised carpal height ratio were significant. CONCLUSION According to patient satisfaction rate and clinical results, the outcome of excisional arthroplasty with palmaris longus tendon ball in Stage 3 Kienböcks disease is satisfactory. However, carpal height reduction and development of degenerative changes may be expected in long-term follow-up.

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.

Surgical reconstruction in Wassel type IV thumb duplication

OBJECTIVE The aim of this study was to review the results of patients with Wassel type IV thumb duplication, treated with a single reconstructive procedure. METHODS The mean follow-up period was 76.9 months. Objective assessments were carried out using Horii modification of Tada scoring system and ALURRA scoring system. Thumb length, thumb girth, range of motion of metacarpophalangeal (MCP) and interphalangeal (IP) joints and angular deformities at MCP and IP joints were evaluated. RESULTS The mean ALURRA score was 21 (range; 16-24) and Tada Score 5.25 (range; 2-7). The length of the operated thumb was approximately 95%, the girth 89% and nail width 80% of the non-operated side. The mean range of motion was 75.1% of the unaffected thumb in interphalangeal joint and 80.1% in metacarpophalangeal joint. Metacarpophalangeal joint malalignment had shown statistically significant negative correlation with the scores of Tada, ALURRA and VAS. CONCLUSION Surgical reconstruction may provide a functional and stable thumb in Wassel type IV thumb duplications. The satisfaction of patients is affected by angular deformity of thumbs and cosmetic outlook.