Olcay Guler

Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures

17 patients with ankle syndesmosic injury were treated with a 4.5mm single cortical screw fixation (passage of screw 4 cortices) and 15 patients were treated with single-level elastic fixation material. All patients were evaluated according to the AOFAS ankle and posterior foot scale at the third, sixth and twelfth months after the fixation. The ankle range of movement was recorded together with the healthy side. The Students t test was used for statistical comparisons. No statistical significant difference was observed between the AOFAS scores (p>0.05). The range of dorsiflexion and plantar flexion motion of the elastic fixation group at the 6th and 12th months were significantly better compared to the screw fixation group (p<0.01). Elastic fixation is as functional as screw fixation in the treatment of ankle syndesmosis injuries. The unnecessary need of a second surgical intervention for removal of the fixation material is another advantageous aspect of this method of fixation.

A practical way to prepare primer human chondrocyte culture

Biological cartilage repair is one of the most important targets for orthopedic surgeons currently. For this purpose, it is mandatory to know how to prepare a chondrocyte culture. In this study, our purpose was to introduce a method enabling orthopedic surgeons to practice their knowledge and skills on molecular experimental setup at cellular level, based on our experiences from previous pilot studies. Thus, we believe it will encourage orthopedic surgeons.

Comparison of four different reduction methods for anterior dislocation of the shoulder

BackgroundShoulder dislocations account for almost 50 % of all major joint dislocations and are mainly anterior.ObjectiveThe aim is a comparative retrospective study of different reduction maneuvers without anesthesia to reduce the dislocated shoulder.MethodsPatients were treated with different reduction maneuvers, including various forms of traction and external rotation, in the emergency departments of four training hospitals between 2009 and 2012. Each of the four hospitals had different treatment protocols for reduction and applying one of four maneuvers: Spaso, Chair, Kocher, and Matsen methods. Thirty-nine patients were treated by the Spaso method, 47 by the Chair reduction method, 40 by the Kocher method, and 27 patients by Matsen’s traction-countertraction method. All patients’ demographic data were recorded. Dislocation number, reduction time, time interval between dislocation and reduction, and associated complications, pre- and post-reduction period, were recorded prospectively. No anesthetic method was used for the reduction.ResultsAll of the methods used included traction and some external rotation. The Chair method had the shortest reduction time. All surgeons involved in the study agreed that the Kocher and Matsen methods needed more force for the reduction. Patients could contract their muscles because of the pain in these two methods. The Spaso method includes flexion of the shoulder and blocks muscle contraction somewhat. The Chair method was found to be the easiest because the patients could not contract their muscles while sitting on a chair with the affected arm at their side.ConclusionsWe suggest that the Chair method is an effective and fast reduction maneuver that may be an alternative for the treatment of anterior shoulder dislocations. Further prospective studies with larger sample size are needed to compare safety of different reduction techniques.

Tourniquet use during total knee arthroplasty does not offer significant benefit: A retrospective cohort study

INTRODUCTION Tourniquets are routinely employed during total knee arthroplasty; however, their use remains controversial. METHODS This study investigates the efficacy and safety of this practice. A retrospective analysis of 186 patients was performed to assess benefits and/or risks associated with tourniquet use during knee arthroplasty. Total knee arthroplasty was performed using the Biomet Vanguard(®) PCL Prosthesis (Biomet, Warsaw, IN, USA). In total, 126 patients who had undergone total knee arthroplasty were included in our final analysis. RESULTS Patients with tourniquets had significantly less intraoperative blood loss than patients without (P < .001); patients without tourniquets required more blood transfusions (P = .551), and had significantly longer surgical times (P = .011). However, patients with tourniquets had more postoperative blood loss (P < .001), longer hospital stays (P = .013), and more frequent complications (P = .571). Blood transfusion requirement was significantly associated with complications (P < .001). CONCLUSIONS Tourniquet use provided no overall benefit.

Comparison of extracorporeal shock wave therapy in acute and chronic lateral epicondylitis.

OBJECTIVE The aim of this study is to evaluate and compare the results of extracorporeal shock wave therapy (ESWT) in the treatment of acute (<3 months) lateral epicondylitis (LE) and chronic (>6 months) LE groups. METHODS Fifty-four patients who were diagnosed with LE and treated with BTL-5000 SWT Power (BTL Türkiye Medikal Cihazlar, Ankara, Turkey) ESWT were included in the study. Twenty-four patients who had symptoms for <3 months were defined as the acute LE group (Group A), and 30 patients who had symptoms for >6 months were defined as the chronic LE group (Group B). All cases were evaluated pretherapy and at Weeks 2, 12, and 24 posttherapy according to pain while resting, pain while stretching, pain when pressed, pain while lifting chair, pain while working, nighttime pain on LE zone. RESULTS Almost all values in both Group A and Group B were significantly improved at Weeks 2, 12, and 24 compared to the baseline values. CONCLUSION ESWT is equally effective in the treatment of acute LE and chronic LE. In addition, the current data suggest the progression of LE cases from acute phase to chronic phase may be prevented by treatment with ESWT.

Need for Bone Grafts in the Surgical Treatment of Displaced Intra-Articular Calcaneal Fractures

Abstract Controversy is ongoing regarding the use of bone grafts to fill cavities that occur with collapse of the posterior facet in the joint and for repair of the calcaneal height with plating. The present study included 40 patients with 43 displaced intra‐articular calcaneal fractures treated with open reduction and internal fixation from March 2009 to November 2013. In the present case‐control study, the patients were separated into 2 groups: group A received an allograft (20 patients, 22 calcaneal fractures) and group B did not (20 patients, 21 calcaneal fractures). The calcaneal height and Böhlers angle were compared between the 2 groups. The final outcomes for all patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale score and compared between the 2 groups. No significant differences were observed between the groups with regard to the basic demographic variables (p > .05). Using Sanders classification, 8 (18%) were type 2, 19 (44%) were type 3, and 16 (37%) were type 4 fractures. The comparisons between the 2 groups showed a loss of Böhlers angle and loss of calcaneal height that was significantly greater in group B (p < .001). No significant differences were observed between the 2 groups in the AOFAS ankle hindfoot scale scores (p > .05). In conclusion, although no differences were found in the clinical results between the 2 groups, more satisfactory radiologic results were obtained in group A, in which bone grafts were used. &NA; Level of Clinical Evidence: 3

Is there a treatment protocol in which platelet-rich plasma is effective?

AIM We aimed to reveal whether there are prospective suggestions for effective and standard platelet-rich plasma applications. METHODS We searched for clinical trials and traced all the references of incorporated documents. RESULTS In literature, there was no study indicating which disease is treated by which mechanism of action, how much dose and content are prepared and applied, when the treatment is applied and how many cures are applied. CONCLUSION Guides introducing which concentrations of PRP are used for which diseases are to be prepared immediately by a committee which is comprised of primarily orthopedists, clinical pharmacologists and toxicologists.

Nail Braces as an Alternative Treatment for Ingrown Toenails: Results From a Comparison With the Winograd Technique

Ingrown toenails are one of the most frequent nail disorders and can be treated with conservative or surgical approaches. Although discovered a long time ago, the available data are still very limited on the potential effectiveness of nail braces for ingrown toenail treatment. In the present retrospective study, we compared nail braces with surgical wedge excision using the Winograd technique with respect to the time to return to work, recurrence, interval to recurrence, and patient satisfaction. A total of 159 patients were divided into the nail brace (n = 74; mean age 29.51 ± 8.48 years) and Winograd technique (n = 85; mean age 26.95 ± 8.06 years) groups. In the nail brace group, the mean time to return to work (4.15 ± 1.07 days) was significantly shorter than that in the Winograd technique group (13.8 ± 2.26 days; p < .001). Patient satisfaction was significantly greater in the nail brace group (94.6%) compared with the Winograd technique group (82.4%; p = .018). Of the 159 patients, 6 (8.1%) in the nail brace group and 8 (9.4%) in the Winograd technique group developed recurrence; however, this difference was not statistically significant (p > .05). A statistically significant difference was observed in the mean interval to recurrence (12.46 ± 1.60 versus 13.24 ± 2.48 months, respectively; p = .031). The progression-free follow-up periods for the nail brace and Winograd technique groups were 15.45 ± 0.22 months (95% confidence interval 15.02 to 15.88) and 17.18 ± 0.29 months (95% confidence interval 16.61 to 17.84), respectively. We have concluded that the use of nail braces is an appropriate alternative treatment of ingrown toenails with high patient satisfaction, fast recovery times, and a low recurrence rate.

Safety of bioabsorbable implants in vitro

BackgroundThe aim of the present study was to investigate the safety of bioabsorbable plates and screws in humans.MethodsFor this purpose, an implant system based on [poly(lactic-co-glycolic acids)(85:15)] was designed. The system was tested for pH, temperature, and swelling and then its surface morphology was analyzed for surface porosity using environmental electron microscopy. Then, the effects of this bioabsorbable system on the viability and profileration of osteocytes were examined on a molecular level via in vitro experiments. A [poly(lactic-co-glycolic acids)(90:10)] bioabsorbable implant, which is commercially available and used in orthopedic surgery, was used as control group. For the statistical evaluation of the data obtained in the present study, the groups were compared by Tukey HSD test following ANOVA. The significance level was set as p < 0.05.ResultsIt was observed that the osteocytes cultivated on the PLGA system designed in the present study included more live cells and allowed more proliferation compared to the control.ConclusionOne of the criteria in the selection of implants for orthopedic surgery is that a good implant should not need removal and thus a second surgery. In the present study, a bioabsorbable implant was designed considering this criterion. The present study is the first step to prove the safety of this new design by in vitro toxicity and viability experiments.

The association between different molecular weights of hyaluronic acid and CHAD, HIF-1α, COL2A1 expression in chondrocyte cultures

The aim of the present study was to investigate the effects of three different formulations of hyaluronic acid (HA): Low molecular weight (MW) Sinovial One®, medium MW Viscoplus® and high MW Durolane®, on chondrocyte proliferation and collagen type II (COL2A1), hypoxia-inducible factor 1α (HIF-1α) and chondroadherin (CHAD) expression in primary chondrocyte cultures. Standard primary chondrocyte cultures were established from osteochondral tissues surgically obtained from 6 patients with gonarthrosis. Cell morphology was evaluated using an inverted light microscope; cell proliferation was determined with a MTT assay and confirmed with acridine orange/propidium iodide staining. Levels of CHAD, COL2A1 and HIF-1α expression were assessed using specific TaqMan gene expression assays. The results demonstrated the positive effect of HA treatment on cell proliferation, which was independent from the MW. COL2A1 expression increased in the medium and high MW HA treated groups. It was observed that HIF-1α expression increased in the high MW treated group alone. CHAD expression increased only in the medium MW HA treated group. Evaluation of gene expression revealed that levels of expression increased as the duration of HA application increased, in the medium and high MW HA treated groups. In terms of increased viability and proliferation, a longer duration of HA application was more effective. Taken together, it may be concluded that the administration of medium and high MW HA may be a successful way of treating diseases affecting chondrocytes in a clinical setting.