Mehmet Erdem

An alternative method for the treatment of nonunion of the tibia with bone loss

In this retrospective study we evaluated the method of acute shortening and distraction osteogenesis for the treatment of tibial nonunion with bone loss in 17 patients with a mean age of 36 years (10 to 58). The mean bone loss was 5.6 cm (3 to 10). In infected cases, we performed the treatment in two stages. The mean follow-up time was 43.5 months (24 to 96). The mean time in external fixation was 8.0 months (4 to 13) and the mean external fixator index was 1.4 months/cm (1.1 to 1.8). There was no recurrence of infection. The bone evaluation results were excellent in 16 patients and good in one, while functional results were excellent in 15 and good in two. The complication rate was 1.2 per patient. We conclude that acute shortening and distraction osteogenesis is a safe, reliable and successful method for the treatment of tibial nonunion with bone loss, with a shorter period of treatment and lower rate of complication.

Tibial slope and high tibial osteotomy using the circular external fixator

Alteration of tibial slope is one of the important anatomical changes of the proximal tibia after high tibial osteotomy. Increased or decreased tibial slope can effect further total knee prosthesis procedure. In this retrospective study, 18 knees of 17 patients (17 female, mean age 51 range 43–61, mean BMI is 33.6xa0±xa04.6xa0kg/m2) who were applied high tibial osteotomy using circular external fixator due to medial compartment arthrosis of the knee were evaluated in terms of tibial slope changes. While mean correction about 12.3° in mechanical femoro-tibial angle was obtained in frontal plan (Pxa0=xa00.0001), significant change in tibial slope was not determined in sagittal plan (Pxa0=xa00.127). The mean posterior proximal femoral angle values were measured as 79.5xa0±xa02.1° preoperatively and as 80.3xa0±xa02.7° postoperatively and found to fall into the normal range (80.4xa0±xa01.6°). As there is no significant alteration in tibial slope after high tibial osteotomy performed with the Ilizarov system, complications due to alteration in tibial slope will not be experienced in follow-up or in further total knee prosthesis procedure.

Biomechanical evaluation of arthroscopic all-inside meniscus repairs.

Viper is a new device for arthroscopically all-inside meniscal repairing. In previous studies about Viper device, procedures were not applied arthroscopically despite this device has been designed for arthroscopic application. In this study, we evaluated primary fixation strength of arthroscopically applied meniscal repair using Viper device to obtain better clinical relevance. Two centimeter in length meniscal tear 2–3xa0mm far from periferic edge of medial meniscus of 50 calves were created arthroscopically. The menisci were divided into five groups including 10 menisci in each. In group 1, tears were repaired by outside-in vertical loop suture technique with No: 0 PDS. Tears were fixed by all-inside vertical suture by using Viper device with No: 0 PDS in group 2. In meniscal implant groups, RapidLoc, H-Fix, and Clearfix were applied in groups 3,4, and 5, respectively. Primary fixation strength of repairing techniques were evaluated with bio-mechanical testing machine. Fixation strengths determined in groups 1 and 2 were detected as 145xa0±xa013 and 136xa0±xa033xa0N, respectively. There was no difference in pull-out strength between groups 1 and 2. Fixation strengths in these two groups were significantly higher compared to groups 3, 4, and 5. There was no significant difference between group 3 (33xa0±xa06xa0N) and 5 (28xa0±xa06xa0N) in terms of fixation strengths whereas fixation strengths of these two groups were significantly higher compared to group 4 (20xa0±xa03xa0N) (Pxa0=xa00.005, Pxa0=xa00.018, respectively). All-inside vertical suture technique using Viper device revealed comparable primary fixation strength with outside-in vertical suture technique for meniscal repair. We suggest that the Viper device is safe and reliable for meniscal repair.

LENGTHENING OF SHORT BONES BY DISTRACTION OSTEOGENESIS-RESULTS AND COMPLICATIONS

We performed bone lengthening surgery on 12 metacarpals and 14 metatarsals of 15 patients. The mean age for metacarpal and metatarsal lengthening was 14.5 (10–21) and 17.5 (10–25) years, respectively. We used a unilateral or a circular external fixator. The mean healing index of the metacarpals and metatarsals was 1.6 (1.1–2.3) and 1.6 (1.0–2.0) months/cm, respectively. The mean increase in metacarpal and metatarsal length was 17.6 (13–26) and 24.3 (20–30) mm, respectively. The functional scores of the metatarso-phalangial (MTP) joint of lengthened metatarsals for the lesser toe were excellent in 12 and good in two cases based on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. Complications were seen in six of the metatarsal lengthening cases including four angulations, one subluxation and one non-union. We conclude that the periosteum must be protected with percutaneous osteotomy and lengthening should be performed at a rate of 0.25xa0mm twice a day and should not exceed 40% of the original bone length (or >20xa0mm).RésuméNous avons réalisé une chirurgie d’allongement sur 12 métacarpiens et 14 métatarsiens chez 15 patients. L’âge moyen était respectivement de 14.5 ans pour les métacarpiens (10 à 21) et 17.5 ans pour les métatarsiens (10 à 25). Nous avons utilisé un fixateur unilatéral ou circulaire. L’index moyen de consolidation a été de 1.6 mois/cm d’allongement, de 1.1 à 2.3 pour les métacarpiens et de 1.0 à 2.0 pour les métatarsiens. L’allongement moyen a été de 17.6xa0mm (13 à 26) pour les métacarpiens et de 23xa0mm (20 à 30) pour les métatarsiens. Le score fonctionnel de l’articulation métatarso-phalangienne a été excellent chez 12 patients, et bon chez 2 patients (score de l’AOFAS). Les complications ont été constituées par 4 angulations, 1 subluxation et 1 pseudarthrose parmi 6 allongements métatarsiens. Nous pouvons conclure que le périoste doit être protégé lors de l’ostéotomie percutanée mais la vitesse d’allongement doit être de 0.25xa0mm deux fois par jour. L’allongement ne doit pas excéder 40% de la longueur originale de l’os (plus de 20xa0mm).

Arthroscopic excision of the osteoid osteoma at the distal femur

Osteoid osteoma is a benign, osteoblastic and painful tumoral lesion. Apart from en-bloc resection, intralesional resection and percutaneous excision or destruction of the nidus, arthroscopic removal of the lesion in intraarticular locations have been reported. We present a patient with osteoid osteoma at distal femur which is accessible through knee joint, treated by arthroscopic complete excision.

Effects of diclofenac and tenoxicam on distraction osteogenesis

IntroductionIn the management of bone defects, pseudoarthrosis, deformities, chronic osteomyelitis and in extremity lengthening procedures, the technique of distraction osteogenesis (DO) has been frequently used. In this experimental animal study, the effects of two non-steroidal anti-inflammatory drugs, i.e., diclofenac and tenoxicam, on the outcomes of distraction osteogenesis are investigated.Materials and methodsIn this study, 30 mature New Zealand-type male rabbits (2.5–4.5xa0kg) were used. The rabbits were randomized into three groups, each consisting of ten animals. Under optimal operating conditions, a pre-reconstructed circular external fixator was applied on the right tibias of rabbits, and osteotomy was performed with a Gigli saw just below the tibial tuberosity. After seven postoperative days, distraction was initiated at a rhythm of 2xa0×xa00.5xa0mm/day. During the 10xa0days of distraction, adjunctive therapy was not instituted for group I (control group). For 10xa0days, group II received i.m. diclofenac sodium (0.5xa0mg/kg per day) and group III was treated with tenoxicam (8xa0mg/kg per day i.m.). At the end of 3xa0weeks postoperatively, five rabbits from each group were killed for histologic examinations. The remaining rabbits were killed at the end of eight postoperative weeks for biomechanical and histological analysis. Besides, radiological examinations were performed at the end of 3, 6 and 8xa0weeks postoperatively for the radiologic evaluation of calluses. For statistical evaluations between groups, Kruskal–Wallis variance analysis, and for intergroup assessments, Mann–Whitney test were performed.ResultsFor radiological evaluations, the scoring system developed by Lane and Sandhu, and for histopathological assessments, the grading system of Huddlestone etxa0al. were used. Biomechanical tests were realized using torsional loading. During the first 3xa0weeks, the groups did not differ much in the radiological parameters. However, in the diclofenac group and in especially the tenoxicam group, the histological scores were lower than in the control group. Radiological images obtained at the end of 6xa0weeks demonstrated inadequate consolidation in the diclofenac and tenoxicam groups when compared with the control group. At the end of 8xa0weeks postoperatively, in consideration of biomechanical, radiological and histological tests, significantly worse regenerates were obtained in the diclofenac and tenoxicam groups.ConclusionsDuring the distraction osteogenesis period, diclofenac and tenoxicam affected the quality of regenerate unfavorably. This effect is sustained during all periods of bone healing. However, this finding should be supported by experimental and human studies.

Osteoid Osteoma of the Trapezium: Case Report

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.

The “butterfly” suture technique for meniscal repair

One of the important factors effecting meniscal healing is the strength of primary fixation obtained by repairing technique. From this perspective, it is important to choose the technique ensuring a higher primary fixation strength for meniscal repairs. We described a new technique for meniscal repair called “butterfly” technique using Viper device and hypothesized that high primary fixation strength can be obtained with this technique. The study was performed on calve knees. Full-thickness longitudinal tears 2xa0cm in length and 3xa0mm medial from the periphery were created in corpora of medial menisci of 14 calves. After creating tears, menisci were divided into two equal groups. In Group 1, two vertical loop sutures 1xa0cm apart were placed using a Viper device. Whereas in Group 2, tears were repaired using “butterfly” sutures. The mean load to failure was 156.3xa0±xa013.1 and 186xa0±xa015.8xa0N in Group 1 and 2, respectively (pxa0=xa00.002). The fixation strength in Group 2 was significantly higher than in Group 1. We suggest that, using Viper device and all-inside “butterfly” suturing techniques, meniscal ruptures with appropriate locations can be repaired with higher primary fixation strength.

Intraarticular Hyaluronic Acid Injection after Microfracture Technique for the Management of Full-Thickness Cartilage Defects Does Not Improve the Quality of Repair Tissue

Objective: Tissue repair that occurs after microfracture does not include hyaline-like cartilage. Therefore, other treatment modalities must be combined with microfracture to improve repair tissue quality. In this study, we combined exogenous hyaluronic acid with microfracture. Design: Thirty mature New Zealand rabbits were randomly divided into 3 groups as control, microfracture (MF), and microfracture and hyaluronic acid (MFHA). Four-millimetre full-thickness cartilage defects were created in the medial femoral condyle of each rabbit. Microfracture was performed on defects in the MF and MFHA groups. At 1 week following surgery, 1 mL of saline was injected into the knees of the control and MF groups, whereas 1 mL (15 mg/mL) hyaluronic acid was injected into the knees of the MFHA group 3 times weekly. At 6 months postsurgery, defects were evaluated according to the ICRS (International Cartilage Repair Society) and Wakitani scales. Results: According to the ICRS and Wakitani scales, the quality of repair tissue was improved in MF and MFHA groups as compared the control group (P = 0.001 and 0.001, respectively). No significant difference was observed between the MF and MFHA groups (P = 0.342). Conclusions: According to the model in this study, no beneficial effect was obtained when HA injection was combined with microfracture in the treatment of full-thickness cartilage defects.

Quality of life in patients with varus gonarthrosis treated with high tibial osteotomy using the circular external fixator

Generally, surgeon-driven musculoskeletal evaluation systems are used for evaluating outcomes of patients who are treated with high tibial osteotomy. In this study, we investigated the effects of high tibial osteotomy using circular external fixator on quality of life. Twenty-one high tibial osteotomy of 19 patients were evaluated. Quality of life assessment was made using Short Form -36 at preoperative, before fixator removal and 6xa0months after fixator removal. After applying fixator, the physical function and physical role scores of Short Form-36 decreased and emotional role score did not improve. In other categories, significant improvements were observed when fixator in place. At the sixth month after fixator removal, significant improvements were dedected in all categories of Short Form-36. Although there was a decrease in physical functions after fixator application in patients who were treated with high tibial osteotomy using circular external fixator, significant improvement occurred in quality of life after fixator removal.