Nadir Ozkayin

Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: A prospective randomised clinical study

INTRODUCTION The purpose of this prospective randomised study is to compare in the elderly the functional results of intertrochanteric femur fractures treated either with closed reduction and internal fixation with proximal femoral nailing or cemented hemiarthroplasty. MATERIALS AND METHODS The study included patients above the age of 75 who were diagnosed with intertrochanteric femur fracture and admitted to the Department of Orthopaedics and Traumatology, Ege University Hospital between October 2006 and December 2012. After informed consent was obtained from the patients, they were randomised via sealed opaque envelops into two groups. Patients in Group 1 were internally fixated utilizing proximal femoral nail, whilst the patients in Group 2 were treated with a cemented hemiarthroplasty. Complications were recorded and functional results were evaluated using the Harris Hip score. The mean time of follow up was 31.72 months (min. 18-max. 47, std. dev. ±10.68). RESULTS A total of 54 patients were included in the study. 21 of them (38.9%) received a proximal femoral nail whilst 33 (61.1%) were treated with hemiarthroplasty. Average age of the patients was 82.24 (min. 75-max. 97). Average age in Group 1 was 79.57 (min. 75-max. 91), whilst it was 83.94 in Group 2 (min. 75-max. 97). Harris Hip score analysis revealed that the difference between the patients treated with hemiarthroplasty and proximal femoral nailing was statistically significant in favour of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point, and even reversed as of the 12th month postoperatively. DISCUSSION AND CONCLUSIONS Although cases with hemiarthroplasty achieved a better level of activity in the beginning, cases with proximal femoral nailing reached a comparable level of activity within a short period of time, faster than those treated with hemiarthroplasty, displaying a better level of activity in the end.

Should full threaded compression screws be used in adult femoral neck fractures

INTRODUCTION Operative treatment consisting of fracture reduction and fixation, or arthroplasty to permit early patient mobilization, continues to be the treatment of choice for most femoral neck fractures. Options for internal fixation have included a variety of implants; however most recent reports and textbooks cite parallel multiple cancellous screws as the surgical technique of choice. METHODS The study was prospective, randomized and IRB approved. Inclusion criteria included skeletal maturity, closed femoral neck fracture without concomitant fractures or injuries with complete charts and adequate radiographs obtained from the initial injury till the last follow-up. Forty-four patients were enrolled in this study during one-year period at two university centers. 22 were randomized to be treated with full threaded, cannulated compression screws (Acutrak 6/7, ACUMED) (Group 1) and the other 22 with 16mm partial threaded, 6.5mm or 7.3mm cannulated screws (SYNTHES) (Group 2). Three or four screws were used in both groups according to fracture type and surgeons preference. Data evaluated included surgical time, fluoroscopy time, fracture type, radiological outcome, complications and functional status using the Harris Hip Score. RESULTS Both groups were comparable in terms of age and gender. There was not a significant difference in terms of surgical time, follow-up period, fracture type, or fluoroscopy time. There were eight complications in Group 1 and two in Group 2 (P=0.049) Time to union was significantly longer in Group 1 (P=0.001). However, Hip Scores were not significantly different in both groups (P=0.20). CONCLUSION When compared with full threaded compression screws, partial-threaded cannulated screws provides a shorter union time and less complication rate while providing equivalent functional results in adult femoral neck fractures.

Single dose of intra-muscular platelet rich plasma reverses the increase in plasma iron levels in exercise-induced muscle damage: A pilot study

Background Platelet rich plasma (PRP) therapy is widely used in enhancing the recovery of skeletal muscle from injury. However, the impact of intramuscular delivery of PRP on hematologic and biochemical responses has not been fully elucidated in exercise-induced muscle damage. The purpose of this investigation the effects of intramuscular delivery of PRP on hematologic and biochemical responses and recovery strategy muscle damage induced by high intensity muscle exercise (exercise-induced muscle damage, EIMD). Methods Moderately active male volunteers participated in this study and were assigned to a control group (control, n = 6) and PRP administration group (PRP, n = 6). The subjects performed exercise with a load of 80% one repetition maximum (1RM) maximal voluntary contraction of the elbow flexors until point of exhaustion of the non-dominant arm was reached. The arms were treated with saline or autologous PRP post-24 h EIMD. Venous blood samples were obtained in the morning to establish a baseline value and 1–4 days post-exercise and were analyzed for serum ferritin, iron, iron binding capacity (IBC), creatinine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Results The baseline levels of plasma iron, ferritin, IBC, CK, LDH, AST, and ALT were similar in both the control and PRP groups. However, 24-h following exercise a significant increase in these parameters was observed in both groups between 1 and 4 days during the recovery period. Interestingly, PRP administration decreased plasma iron levels compared to the control on the second day post-exercise. Plasma IBC increased in PRP group from Days 2 to 4 post-exercise compared to the control group whilst PRP administration had no effect on plasma ferritin, CK, AST, ALT, or LDH. Conclusion Acute exhaustive exercise increased muscle damage markers, including plasma iron, IBC, and ferritin levels, indicating muscle damage induced by exercise. PRP administration improves inflammation by reversing the increase in the iron levels post-exercise without displaying any myotoxicity and may have a role to play in the recovery of exercise-induced muscle damage.

The state and importance of motorcycle injuries in progression with trauma etiologies

Objective: Motorcycle injuries have shown a progression in last years in trauma patients admitted to our clinic. The aim of this study is to evaluate statistically whether the motorcycle accidents’ incidence is really has a progression or not. Method: The study involved 180 patients (87 women, 93 men) operated for the fractures after a motorcycle crash between the first six months of 2002 and 2007. The injury patterns are investigated if there is a significant increase or not. The mean age was 45.2 years. In Group I; 50 patients (22 women, 28 men ) were included which operated in the first 6 months of 2002. The mean age was 44.8 years. In Group II; 130 patients (65 women, 65 men ) were included which operated in the first 6 months of 2007. The mean age was 45.7. Results: We compared two groups and found a significant 3.425 increase in motorcycle injuries contrary to 0.075 decrease in falls, 0.023 decrease in traffic accidents within the vehicle, 0.013 decrease in traffic accidents out of the vehicle, 0.616 decrease in sports injuries, 0.25 decrease in gunshot injuries. This increase in motorcycle injuries is statistically significant. Conclusion: We have found significant increase in motorcycle injuries statistically. The importance of this, it affects younger population, and they bring out high morbidity. Since; we think that motorcycle injuries must be stated especially in literatures. We must warn our colleagues to state this injuries, and must take precautions against this problem.

Single Dose of Intra-Muscular Platlet Rich Plasma Reverses the Increase in Plasma Iron Levels in Exercise Induced Muscle Damage A Pilot Study

Objectives: Autologous Platelet Rich Plasma (PRP) therapy, is considered to be a promising solution in accelerating the healing process of injured skeletal muscle tissue. In addition to the release of growth factors, PRP also promotes concentrated anti-inflammatory signals, including interleukins. However, the impact of the intramuscular administration of the PRP on hematologic and biochemical responses has not been fully elucidated in exercise induced muscle damage. Methods: Twelve healthy moderately active male volunteers, without previous experience with eccentric/concentric elbow flexors exercise, participated in this study. They were divided into two groups: control group (CONTROL, n=6) and platelet rich plasma administration group (PRP, n=6) group. To induce muscle damage, subjects in both groups performed concentric/eccentric contractions with load of (80 % 1RM) maximal voluntary contraction of the elbow flexors until point of exhaustion of the non-dominant arm. The non-dominant arms of the PRP group were treated with autologous PRP (Regen ACR-C, Regen Lab, Switzerland) post-24h exercise induced damage (DOMS). Subsequently, 4 ml PRP samples was injected using a 20-gauge needle into the region of the biceps brachii of the non-dominant arm under sterile aseptic conditions. Venous blood samples were collected pre-, and 4 days post-exercise, and analyzed for complete blood counts, serum ferritin, iron, iron binding capacity (IBC), creatinine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT) as markers of muscle damage and inflammation. Results: We found that the baseline levels of iron, ferritin, IBC, CK, LDH, AST and ALT were similar in control and PRP groups. However, 24 h following exercise induced muscle damage a significant increase in these parameters was observed in both groups. Interestingly, PRP administration decreased plasma iron levels compared to the control group but this was only achieved on the second day of post-exercise induced muscle damage. In addition, the plasma IBC levels increased in PRP group from day 2 to 4 post exercise compared to control group. PRP administration had no effect on plasma ferritin, CK, LDH, AST, and LDH levels. Conclusion: Acute exhaustive exercise increased muscle damage markers, including plasma iron, IBC and ferritin levels, indicating metabolic stress due to exercise induced muscle damage. PRP administration decreased the iron levels post-exercise and may have a role to play in the recovery of exercise induced muscle damage.