Serhat Özsoy

Time-Dependent Changes in Failure Loads of 3 Biceps Tenodesis Techniques In Vivo Study in a Sheep Model

Background Failure load of the tendon–fixation material–bone unit has a crucial importance for the rehabilitation protocol after tenodesis procedures. Purpose To investigate and compare the time-dependent changes in fixation strengths of 3 proximal biceps tenodesis techniques. Study Design Controlled laboratory study. Methods Two intraosseous techniques (suture sling and tenodesis screw) and 1 extraosseous technique (2 suture anchors) were investigated. Biceps tenodesis was performed on 45 shoulders of 26 sheep, 15 shoulders for each technique. Twelve similar cadaveric sheep shoulders (4 for each technique) provided the day 0 results. Sheep were sacrificed at 3, 6, and 9 weeks, and specimens were tested for the failure load of the tenodeses. Results All 3 tenodesis techniques were found to have similar failure loads at all time intervals tested. All 3 curves remained below the failure load of the intact tendon (862 ± 96 N) and above their day 0 results for the study period; similarly, at each time interval, results tended to be better compared to the previous test. The tenodesis screw group exhibited significantly higher failure loads at week 3 (419 ± 53 N) compared to day 0 values (164 ± 45 N) (P=. 009). The same level of significance was observed at week 6 in the remaining 2 groups. Conclusion Tenodesis of the biceps tendon on the proximal humerus at an extra-articular site does not weaken after surgery. The tenodesis screw group had a significantly higher increase in the fixation strength within the first 3 weeks. Clinical Relevance No significant differences could be found between the failure loads of all 3 investigated tenodeses for the first 9 weeks.

Evaluation of soft tissue reactions to three nonabsorbable suture materials in a rabbit model

OBJECTIVES We evaluated the inflammatory reactions induced by three commonly used nonabsorbable suture materials in a rabbit model. METHODS Three suture materials were tested: braided polyester suture (Ethibond), braided blend of polyester and polyethylene suture (FiberWire), and monofilament polypropylene suture (Polypropylene). Thirty-six rabbits were randomly allocated to three suture groups, equal in number. Each suture type was placed bilaterally in the quadriceps muscle, patellar tendon, knee joint capsule, and Achilles tendon. Six animals in each group were sacrificed in the third and sixth weeks. The inflammation induced by each suture was assessed using light microscopy and the width of the inflammation zone (WIZ) was measured. RESULTS Ethibond was found to cause the most severe reaction in the muscle and tendon in the third week; in the sixth week, however, it showed the lowest inflammatory reaction in all tissue types. Reaction to Propylene was moderate in the third week, whereas it caused the largest WIZ in all tissue types in the sixth week, such that the eventual size of the WIZ induced by Propylene (6.6 + or - 2.1 mm) was significantly greater than that of Ethibond (1.6 + or - 0.9 mm) in muscle specimens (p<0.05). Except for the largest WIZ seen in joint capsule specimens in the third week, inflammatory reactions associated with FiberWire were low or moderate in all tissue specimens throughout the study. FiberWire was associated with some necrotic areas in two muscle and one tendon specimens. CONCLUSION The extent of inflammatory reaction to nonabsorbable suture materials depends on the type of suture material, tissue type, and the duration of postoperative time.

A Radiological Follow-Up Study of Plasma Sprayed Fluorapatite (FA) Coatings

In this paper a radiologic follow-up study of plasma sprayed titanium implants in rams was performed. It is already known that, because of their properties, surface-active ceramics like hydroxyapatite (HA) and bioglass have been used in orthopedic surgery. Be cause of their low toughness, their use on metal surfaces as coatings has proven more appl icable. HA was produced from human teeth. Dentine and enamel flourapatite (DFA and EFA) wer e separately plasma sprayed on 6.35mm diameter titanium implants. These produced implants sterilize d and implanted in the metaphysis region of the tibia within the unsprayed control group. After circa 2.5 months x-rays were taken and it was noted that no radiolucent areas around the implant s evidenced. The soft tissues above the tibias were healed. Thus no inflammation flow was observed. Osseointegration around the implants was verified.

Use of intramedullary fully-threaded pins in the fixation of feline and canine humeral, femoral and tibial fractures

Intramedullary fully-threaded pins were manufactured from an alloy of titanium, aluminium and vanadium in a fully-threaded style. Pins were produced in various diameters, ranging from 4 mm to 11 mm. Pin lengths varied from 5 cm to 22 cm. The proximal end of the pins was designed to fit into a hexagonal screwdriver, while the distal end was slightly tapered to allow for ease of entry into cancellous bone. Treatment using the fully-threaded intra- medullary pin was carried out in a total of 175 fractures of the humerus, femur, and tibia in 95 cats (bilateral femur in 1 case) and 77 dogs (bilateral femur in 2 cases). Radiographic follow-up for the cases was performed at monthly intervals. Non-union developed in one dog with a femoral fracture in which cerclage wire had also been used. Delayed healing and lameness were observed in two other dogs. Healing with excessive callus formation was observed in 16 dogs. However, there were not any problems noted in these dogs in regards to limb usage. Clinical and radiological results obtained for the remaining cases were found to be very good. Normal, complete fracture healing occurred between four to 14 weeks in dogs, and between four to 12 weeks in cats. Pins were removed upon observation of satisfactory functional and radiographic recovery. Pins could not be removed from 26 cats and 21 dogs as the owners had declined pin removal, or because the owners were lost to follow-up.

A Histological Study of Human Derived Tooth-Hydroxyapatite (THA)

Different types of bone-graft substitutes have been developed and are in the market worldwide to eliminate the drawbacks of autogenous grafting. They vary in composition, strength, osteoinductive and osteoconductive properties, mechanism and rates by which they are resorbed and remodelled. Tooth derived hydroxyapatite (THA) is a novel biomaterial. This study was performed to determine the histological properties of THA on animals. A commercial coralline HA (CHA, Proosteon 200, Interpore Cross, USA) was used as control material. 20 sheeps were used and divided into 2 groups. Human THA (Group A) and CHA (Group B) materials were implanted to the tibiae of 10 sheeps for each group. The histological examinations of surrounding bone response were done 12 weeks after implantation. There was no significant difference histologically between group A and B. All materials were found to be surrounded by new bone tissue. THA was found to be as efficient as the standard CHA on histological basis. In addition, economical production of THA should be taken into consideration. Therefore, THA may be a viable alternative on bone grafting provided that clinical trials will be completed.

A Practical Method for Clinical Veterinary Use: Use of Dentine Hydroxyapatite (DHA) as a Graft Material

This study demonstrates the use of human dentine derived hydroxyapatite (DHA) as an easily prepared graft material in 23 dogs and 5 cats with various orthopaedic problems. Results of these cases were evaluated clinically and radiographically. This study reveals that DHA can be used safely in animals and is an effective graft material.

An In Vitro Comparative Study of Bioglass and Biologically Derived Hydroxyapatite with Bone Scintigraphy (BS) Method

Four rabbits received human derived HA to their left tibias. After 16 weeks bioglass was implanted to their right tibias. After other 16 weeks bone scintigraphies were taken with 99mTc- MDP. Three phase bone scan images showed no evidence of inflammation and superior vascularization rates at implantation sites. In this study, bioglass demonstrated higher uptake of 99mTc-MDP comparing to HA, suggesting a higher vascularization rate and better osseointegration.

Bilateral pes valgus in an Anatolian Sheepdog.

A 15-month-old, male, Anatolian Sheepdog weighing 45 kg, was admitted with uneven stance in both hindlegs, a condition it had had since the age of six months. Radiographs of both hindlimbs revealed lateral deviation of 26 degrees in the distal metaphysis of the left tibia and 32 degrees in the distal metaphysis of the right tibia. Corrective osteotomy was used to treat the deformity. Both tibias were aligned with the closed wedge osteotomy and a suitably curved plate was placed on both bones. In the assessment prior to the removal of both plates, it was determined that a valgus deformation of 6 degrees was still present. However, this did not affect the gait, nor did it have an abnormal effect on the cosmetic appearance. It was concluded that if corrective osteotomy is performed before any degenerative changes have taken place, the outcome will be successful.

A Radiological Follow-Up Study of Plasma Sprayed Bovine Hydroxyapatite (BHA) Coatings

In this study a short follow-up study of plasma sprayed stainless st el femoral implants in dogs was performed. Because of its excellent biologic properties, hy droxyapatite (HA) has been required widely in orthopaedic surgery. In this study HA has been used on metal in a form of a thin coating. The HA material has been derived from calcined (850°C) bovine bone . The bovine HA (BHA) which was produced had nearly the same mechanical properties when compared with the a commercial type HA (CHA) that was investigated in a recent r search, that is available in literature There were not any vital complications observed postoperatively after 1.5 month of implantation. The long-term follow-up investigations of this study should be carried out in the future.

BİR MİDİLLİ KISRAĞINDA MONTEGGİA KIRIĞI VE OPERATİF SAĞALTIMI

Ozet Bu gozlemde, 10 yasindaki bir Midilli kisraginda karsilasilan distal olekranon kirigi ile komplike dirsek eklemi cikigi (Monteggia kirigi) ve parsiyel radius kmgmin, plaka osteosentezi ile operatif sagaltimi ve gec donem klinik sonuclan rapor edilmektedir. Operasyondan 20 gun sonra plakayi tutan vidalardan bir kismi kirilarak fiksasyonun stabilitesi bozulmustur. Bunun sonucunda eklemde osteoartrit ve ankiloz geliserek, karpal eklemde fleksiyon ve orta derecede bir topalliga neden olmustur. Bu durumun duzeltilmesi icin, sumbugu gagali ozel bir nal cakilarak hayvanin genis alanda hareket etmesine imkan verilmistir. Bu uygulamalardan 4 ay sonra yapilan klinik ve radyolojik muayenelerde belirgin bir duzelme gorulmedigi ve atin halen sumbugu ile basarak ve topallayarak yurudugu belirlenmistir. Anahtar kelimeler: Midilli, Monteggia kirigi, plaka osteosentezi. MONTEGGIA FRACTURE AND OPERATIVE TREATMENT IN A PONY MARE Summary In this case report, distal olecranon fracture complicated with elbow luxation (Monteggia fracture) and partial radial fracture, encounter in a 10 years old Pony mare, treatment with plate osteosynthesis and late stage clinical result is reported. Some of screws, which were holding plate, broken 20 days after surgery and fixation were failed. According to this, carpal flexion and mild lameness has formed. Because of osteoarthritis, ankylosis occurred. To eliminate this problem a toe lengthen shoe applied and animal left in a large open space. Four month after this application, in clinical and radiological check-ups, there were no significant recovery and the horse were still step on toe and lamed. Key words: Pony, Monteggia fracture, plate osteosynthesis