Yüksel Özkan

The effects of human amniotic membrane and periosteal autograft on tendon healing: experimental study in rabbits

In this study, the effects of periosteal autograft and human amniotic membrane on tendon healing were compared. Forty-two New Zealand rabbits were divided into three groups. Flexor digitorum fibularis tendons were cut and repaired with a modified Kessler technique and circumferential sutures in all groups. Tendon repair alone was carried out in group 1, tendon repair and application of human amniotic membrane was done in group 2 and tendon repair and application of periosteal autograft was done in group 3. Biomechanical and histopathological examinations were done 2 and 6 weeks postoperatively. Biomechanical examination showed that group 3 was the strongest at weeks 2 and 6. Adhesion, inflammation and new bone formation showed no difference between groups at week 2. However, adhesion formation was found to be less in groups 2 and 3 than group 1 at week 6. The application of periosteal autograft might be useful in repair of tendon injuries.

A randomized comparison of the proximal crescentic osteotomy and rotational scarf osteotomy in the treatment of hallux valgus

Objectives The aim of this study was to compare clinical and radiological results of proximal crescentic osteotomy (PCO) and rotational scarf osteotomy performed in the treatment of hallux valgus. Methods A total of 57 consecutive patients (60 feet) with symptomatic hallux valgus deformity were randomly assigned to one of two groups. The PCO group consisted of 22 women and 5 men (30 feet) and the mean age was 43(±14.5) years. The scarf group consisted of 23 women and 7 men (30 feet) and the mean age was 40.9(±12.6) years. Outcomes were assessed by using of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS). Weight bearing X-rays were used for radiological evaluation. Results The mean AOFAS scores improved from 42(±16.2) to 66.7(±13.4) points in PCO group and from 36.2(±16.1) to 73.2(±13.5) points in scarf group. The mean pain score improved from 6.3(±1.3) to 2.4(±2) in PCO group and from 6.5(±1.9) to 2.5(±1.3) in scarf group. The mean hallux valgus angle (HVA) decreased from 38.1°(±7.1) preoperatively to 23.8°(±8.5) at postoperative first year in PCO group, and from 36.1°(±7.5) preoperatively to 22.2°(±7.5) at postoperative first year in scarf group. The mean intermetatarsal angle (IMA) decreased from 17.3°(±3.8) preoperatively to 11.8°(±3.3) at postoperative first year in PCO group, and from 16.2°(±2.6) preoperatively to 9.3°(±2.4) at postoperative first year in scarf group. When all the patients were assessed together, the relations between preoperative DMAA values and postoperative first year HVA (r = 0,327) and IMA (r = 0,399) values were positive but had low significance. The HVA and IMA values were increased in both groups at the end of the first year when compared to the postoperative sixth week values (p < 0.01 for both groups for both values). Conclusion The PCO and the rotational scarf osteotomy in the treatment of hallux valgus deformity provides a satisfactory correction. The clinical and radiological results of both methods are similar. Especially in patients with high preoperative DMAA, an increase in the HVA and the IMA values may occur in the first postoperative year when compared to the postoperative sixth week values. Level of evidence Level II, therapeutic study.

Functional and radiological results of percutaneous K-wire aided Métaizeau technique in the treatment of displaced radial neck fractures in children

Objectives The aim of the present study was to determine the radiological and functional results and the efficiency of paediatric radial neck fracture fixation following reduction with the Métaizeau technique together with percutaneous K-wire applied under fluoroscopy to ensure minimum soft tissue damage. Methods The study included 20 patients with Judet Type 3, Type 4a and Type 4b fractures operated on with the Métaizeau technique aided by percutaneous K-wire between 2007 and 2014. The mean age of the patients was 9.75 years (range, 4–13 years). Mean preoperative angulation was measured as 52.4° (range, 35°–85°). The average postoperative follow-up time was 34.65 months (range, 13–84) months. Postoperative radiological evaluations were made according to the Ursei classification and functional assessment with the Tibone – Stoltz classification system. Results Radiologically, the difference between preoperative and postoperative radius head angulation was found statistically significant (p0.001). In the clinical assessment of injured and uninjured arms, there was no statistically significant difference between flexion-extension (p = 0.330) and supination-pronation range of motion (p = 0.330) and carrying angles (p = 0.094). According to the radiological Ursei evaluation, 17 (85%) patients were in perfect condition and 3 (15%) were good. In the classification of Tibone – Stoltz, 16 (80%) patients were evaluated as perfect, 3 (15%) as good and 1 (5%) as fair. Conclusion From the results of this study and related literature, the use of the Métaizeau technique in displaced radial neck fractures requiring surgical treatment in children can be recommended since it creates minimum damage to the soft tissue, is easy to apply and the results are satisfactory. Level of evidence Level IV, therapeutic study.

Scarf osteotomy or Mau osteotomy for correction of moderate to severe hallux valgus deformity: a prospective, randomized study

Objective. The aim of this study was to compare the clinical and radiological results of Mau osteotomy and Scarf osteotomy with a modified McBride procedure to patients with moderate to severe hallux valgus deformity. Methods. The study included 40 feet which patients were separated into 2 groups followed up for 5 months. Scarf osteotomy was applied to 20 patients including 16 females and 4 males (Scarf group)) and a Mau osteotomy to 20 patients including 17 females and 3 males (Mau group). Radiological measurements were taken preoperative, postoperative and at the final follow-up examination of the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), metatarsocuneiform angle (MCA), the 1 st metatarsophalangeal joint congruity, 1 st metatarsal length, fibular sesamoid subluxation rate. Clinical evaluation was made according to the American Orthopaedic Foot and Ankle Society (AOFAS) and the severity of pain was assessed with the visual analog scale (VAS). Results. There was n o difference between the groups in term of the mean HVA, IMA, MCA and DMAA values in preoperative and postoperative measurements. A significant improvement was determined in all the angle values in Scarf and Mau group ( p < 0.001). A significant increase in DMAA and shortening in the metatarsal length were determined in Mau group compared to Scarf group ( p < 0.001). An improvement in joint congruity was seen in the goups ( p < 0.001). There was a significant improvement in term of the AOFAS and VAS values in the groups ( p < 0.001). Conclusion. Scarf and Mau osteotomies can provide the desired level of improvement in the short-term follow-up results of moderate to severe hallux valgus deformity, taking into consideration the clinical importance that complications are not formed.