Comparing extracorporeal shock wave and hyaluronic acid in a rabbit cartilage defect model: the effects of ESW on cartilage defect

Aim: To compare the efficiency of extracorporeal shock wave (ESW) treatment with hyaluronic acid (HA) viscosupplementation in an experimental rabbit cartilage defect model. Materials and methods: A total of 24 New Zealand rabbits were randomly divided into 4 groups: HA, ESW, ESW + HA, and control. Chondral defects were created in the left knees of the rabbits. HA viscosupplementation was performed on the HA and ESW + HA groups, and after 24 h, 0.16 mJ/mm2 ESW was performed on the ESW and ESW + HA groups. After an 8-week follow-up, the rabbits were sacrificed and histopathological examination of the defects was carried out. In addition, immunohistochemistry was performed by the avidin-biotin peroxidase method using vascular endothelial growth factor (VEGF), transforming growth factor beta 1 (TGF-beta 1), and type II collagen antibodies, and the results were evaluated semiquantitatively. Results: There was a significant difference between the control group and the ESW group in terms of Pineda score and type II collagen expression; between the control group and the HA group in terms of Pineda score, VEGF expression, type II collagen expression, and TGF-beta 1 expression; and between the control group and the ESW + HA group in terms of Pineda score, VEGF expression, type II collagen expression, and TGF-beta 1 expression. Conclusion: The results show that both treatment methods have positive therapeutic effects on the articular cartilage defect model in terms of the parameters studied.Cumhuriyet University Scientific Research Projects (CUBAP) Project [T-421]The present study was supported by Cumhuriyet University Scientific Research Projects (CUBAP) Project no T-421

Ortopedi ve travmatoloji kliniğinde vankomisın dırençli enterokok enfeksiyonu sikliği

Our study aimed to identify the incidence of patients with vancomycin-resistant enterococci (VRE) colonization in the orthopedics and traumatology clinic and to present an approach for these patients. The anal swab samples of 781 patients applying to and inpatient in the orthopedic and traumatology clinic from August 2013-December 2013, taken by the infection control committee under the auspices of the VRE infection surveillance program, were investigated. Of the 781 samples investigated, 14 patients (1.79%) were found to have VRE colonization. In 4 patients there was a history of diabetes mellitus, 5 patients had dirty wounds and 5 patients had repeated inpatient stay and surgery history. Cultures taken from the patients produced E. species and E. casseliflavus/gallinarum. In Turkey, the first vancomycin-resistant E. faecium strain was reported from Akdeniz University in 1998. Since this date, VRE is encountered more and more often in the hospital environment. Resistant bacteria easily propagate in the hospital environment and this increases the possibility of colonization and infection incidence. Early identification of resistant enterococci colonization in inpatients is important for control of enterococcal infections. As a result, we believe identifying patients in the risk group may reduce VRE infections. © 2015, Anatolian Journal of Clinical Investigation. All rights reserved

Erişkin femur intertrokanterik kırıklarında uygulanan cerrahi tedavi sonuçlarının değerlendirilmesi

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.Tıp Fakültesi, Ortopedi ve Travmatoloji Ana Bilim DalıÖZET Cumhuriyet Üniversitesi Tıp Fakültesi Uygulama ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Klini ğinde; Ocak 1984-Aralık 1989 döneminde inter trokanterik femur kırığı nedeni ile cerrahi tedavi gören 52 hastanın sonuçları değerlendirilmiş, tedavi yöntemleri ve bulgu lar literatürdeki verilerle karşılaştırılmış ve bu sonuçların büyük oranda literatürle uyumlu olduğu görül müştür

Humeral diaphiseal fractures and the healing time of concomitant radial palsy

Amaç: Hastanemizde cerrahi yoldan tedavi edilen humerus cisim kırıklı bir grup hastadaki eşlik eden radial sinir felçlerinin iyileşme oranlarını ve ortalama iyileşme zamanlarını bulmak. Bu tip radial felçli hastaların takibine ışık tutmak. Materyal ve Metod: Cerrahi yöntemlerle tedavi edilmiş 31 komplike humerus cisim kırıklı hastadaki 14 radial sinir felci retrospektif olarak değerlendirildi. Toplam radial felç oranı % 45.2 idi. Radial sinir felçlerinin 12’si preoperatif (% 38.7), kalan ikisi ise postoperatifti (% 6.5). Preoperatif dönemde felci olan hastaların tümüne cerrahi kırık tespitinin yanında sinir eksplorasyonu yapıldı. Ateşli silah yaralanması olan bir hasta dışındaki diğer 11 hastada sinir intakt idi. Ateşli silah yarası olana ilaveten birincil sinir tamiri yapıldı. Bulgular: Siniri intakt olan 11 olgu ile postoperatif radial felçlerden biri 1.5-13 ayda klinik ve elektromiyografik olarak düzeldi. Ortalama iyileşme zamanı 7,5 aydı. Eksplorasyon sonrası uygun medikal tedavi ve atel destekleri ile ortalama iyileşme oranı 12/14 (% 85.7) idi. Preoperatif ve postoperatif olgulardan birer tanesi iyileşmedi. Onlara tendon transferi yapılarak el fonksiyonları restore edildi.Goal: To determine healing rate of the radial nerve palsy associated with humeral shaft fracture treated surgically at a group of patients and to find the mean neurological healing time. To give off light the nerve healing process. Material and method: The radial palsies at 31 patients with humeral shaft fractures treated by some surgical fixations were evaluated retrospectively. The number of total radial nerve paralysis was 14 (% 45.2). Preoperative radial nerve paralyses were in 12 of the cases (% 38.7), while postoperative paralyses were two (% 6.5). All of the patients were performed surgical fixation and early radial nerve exploration. It was not required to repair the nerve for any patients with intact radial palsy. But for one transected radial nerve on the patient with gunshot injury was performed primary nerve repair. Results: 11 of the preoperative radial nerve paralyses and one postoperative case were healed spontaneously during 1.5-13 month (as clinical and electromiographical). The mean healing time was 7.5 months. After exploration, the nerve healing rate with additional suitable conservative treatment was 85.7 percent. One preoperative and one postoperative radial palsy were not healed. These patients were required to undergo some additional operations for tendon transfer. The final hand functions were enough

Treatment of Bifocal Cyst Hydatid Involvement in Right Femur with Teicoplanin Added Bone Cement and Albendazole

Although bone involvement associated with cyst hydatid is rarely seen, it can cause unintended results such as high recurrence rate, infection, sepsis, or amputation of relevant extremity. Because of this reason, its treatment is difficult and disputed. In the case of bifocal bone cyst hydatid in right femur, along with albendazole treatment, result of resecting cyst surgically and its treatment with teicoplanin with added bone cement is given. In conclusion, since the offered treatment method both supports bone in terms of mechanical aspect and also can prevent secondary infection, the method is thought to be a good and safe treatment approach

Treatment of skin necrosis after radiation synovectomy with yttrium-90: a case report

Chronic synovitis, unresponsive to systemic medical therapy including agents, anti-inflammatory drugs and remission-inducing agents, and intra-articular administration of corticosteroids can be treated with surgical, chemical and radiation synovectomy. We reported a case of a 23 years old male. Skin radiation necrosis (4 x 5 cm) developed after an injection of Yttrium-90 (Y-90). Full-thickness skin graft had been applied but we were not able to succeed. Skin radiation necrosis was treated with Limberg's flap. As a result we recommend flap surgery instead of skin graft in skin radiation necrosis

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip before the age of 18 months

The purpose of this study is to evaluate the results of arthroscopy assisted surgical treatment of developmental dislocation of the hip (DDH). Arthroscopic assisted surgical treatment was performed on nine hips of nine female children with DDH using our method, published previously, between January 2001 and December 2005. Their ages ranged from 9 to 16 months. Percutaneous adductor tenotomies were performed in seven cases. A spica cast and abduction splint were used for 11-17 weeks postoperatively. Acetabular index and Shenton line were used for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively with respect to range of motion restriction, and the leg length discrepancy. The average follow-up was 47.7 months (range 22-79 months). Acetabular index measurements of cases in the preoperative/postoperative periods were as follows: preoperative mean angle 39.9A degrees (range 34A degrees-52A degrees)/postoperative mean angle 26A degrees (range 22A degrees-34A degrees). Hip joint restriction and leg length discrepancy were not observed postoperatively. However, two patients had acetabular dysplasia. Acetabular dysplasia was completely resolved in one patient in the third year of follow-up, whereas Salter innominate osteotomy, required in another patient, was in the second year of follow-up. The latter patient was the oldest case (16-month-old) in our series. Based on the results of this study, treatment of developmental hip dysplasia with arthroscopic-assisted surgical treatment technique may be safe and effective method. Further clinical studies will be required to confirm this study

Multiple cancellous screw fixation in the femoral neck fractures of adult

Giriş: Çalışmamızda kalça eklem kapsülünü açarak yada açmadan perkütan olarak multipl AO kansellöz vida fiksasyonu uyguladığımız femur boyun kırıklı olguların sonuçlarını değerlendirdik. Hastalar ve Yöntem: Kliniğimizde 1992-2002 tarihleri arasında femur boyun kırığı nedeniyle 116 hasta tedavi edildi. Bu olgulardan 49’u (%42) multipl kansellöz vidalarla tedavi edildi. Çeşitli nedenlerden dolayı ancak 42 olgu çalışma kapsamına alınabildi. Çalışma 1996 yılı öncesi retrospektif, 1996 yılı sonrası ise prospektif olarak gerçekleştirildi. Bulgular: Olguların ortalama yaşları 31.3 (17-50) idi. Altı olguda Garden tip I, 14 olguda Garden tip II, 12 olguda Garden tip III, ve 10 olguda ise Garden tip IV kırık vardı. Tüm olgular ortalama 1.5 (0-21) gün de operasyona alındı. On dört olgu kapsül açılmadan, 28 olgu ise açılarak kırık redükte edildi. Takip süreleri 5 ile 121 ay arasında değişmekte olup ortalama 70.5 ay idi. Kırıklar ortalama 5.2 (3-7.5) ayda kaynadı. Geç dönemde 3 (% 7.1) olguda kaynamama ve 7 (%16.7) olguda avasküler nekroz saptandı. Kliniğimizde uyguladığımız değerlendirme kriterlerine göre 12 (%28.6) olguda çok iyi, 16 (%38.1) olguda iyi, 6 (%14.3) olguda orta ve 8 (%19) olguda kötü sonuç tespit edildi. Tart??ma: Multipl kansellöz vida ile tespit, özellikle ayrıklı olmayan kırıklarda halen kullanılabilir bir yöntem olduğu; hematomun boşaltılması ile birlikte, redüksiyonun mümkün olduğunca erken, öncelikle kapalı olarak tam yapılması; tespitin rijit olması gerektiği sonucuna ulaştık. Ayrıca komplikasyonlar üzerinde kırığın ilk halindeki deplasmanında önemli derecede etki ettiğini tespit ettik.Introduction: We evaluated the results of patients with femoral neck fractures underwent multiple cancellous screws fixation either by percutaneous route without opening capsule or by opening capsule. Patients and Method: One hundred and sixteen patients with femoral neck fractures were treated in our department between 1992 and 2002. Multiple cancellous screws were used in 49 (42%) patients. Forty-two of these patients were able to follow-up and recruited into this study. The patients treated until 1996 were evaluated retrospectively and then follow-up was made prospectively. Results: The mean age of patients was 31.3 (17-50) years old. There were Garden type 1 in 6 patients, Garden type 2 in 14 patients, Garden type 3 in 12 patients and Garden type 4 in 10 patients. The mean operation time interval after fracture was 1.5 (0-21) days. The reduction was made without opening capsule in 14 patients and via opening capsule in 28 patients. Follow-up period was 70.5 (5-121) months. The mean union time of fractures was 5.2 months (range 3 to 7.5 months). Non-union in 3 (7.1%) patients, avascular necrosis in 7 (16.7%) patients were encountered. According to the evaluation criteria of our clinic the outcome was excellent 12 (28.6%), good in 16 (38.1%), average in 6 (14.3%) and inadequate 8 (19%) patients. Discussion: We concluded that multiple cancellous screws fixation is still a useful procedure especially in non-displaced fractures. We also concluded that reduction should be made as soon as possible preferably without opening and fixation should be rigid. We also noted that the displacement of fracture at first position was significantly effective on outcome