Publications (22)37.76 Total impact
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Article: Effects of hyperbaric oxygen therapy on distraction osteogenesis
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ABSTRACT: Investigators in the present study explored the effects of hyperbaric oxygen (HBO) therapy on distraction osteogenesis in a rabbit limb-lengthening model. HBO treatment was provided to participants in a small animal pressure chamber once a day during the latent period of distraction osteogenesis at 2.5 absolute atmospheres of pressure. Bone mineral density measurements were obtained through torsional testing. The control group received no HBO treatment. Animals were killed 8 wk postoperatively for biomechanical testing. There was a statistically significant increase in bone mineral density in the HBO group compared with that in the non-HBO group, but no statistically significant differences were observed between biomechanical parameters of the 2 groups. The investigators suggest that these results must be further studied through histologic examination to determine the stepwise effects of HBO during and after collagen synthesis.Advances in Therapy 04/2012; 24(2):326-332. · 2.11 Impact Factor -
Article: Comparison of fixator-assisted nailing versus circular external fixator for bone realignment of lower extremity angular deformities in rickets disease.
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ABSTRACT: In rickets patients, limb deformities are usually multiapical and complex even with medical treatment; residual deformities remain necessitating surgical correction. In our study we aim to compare the results of correction of lower limb deformities, in rickets patients, treated with circular external fixator versus fixator-assisted intra-medullary nail. Seventeen rickets patients, with 39 deformed lower extremity segments (femur and or tibia), underwent deformity correction procedures in our institution. Ten patients with 26 segments were treated using fixator-assisted nailing. Nine patients with 17 segments were treated using Ilizarov technique with circular frame. All patients were evaluated by long-standing true anteroposterior and lateral orthoroentgenograms of lower extremities preoperatively. Joint alignment, joint orientation, and apices of deformities were calculated and noted. The postoperative results of MAD, MPTA, LDFA, PPPTA and functional criteria were compared with preoperative values and assessments made in SPSS 13.0 for Windows by using McNemar, Pearson Chisquare, and Fisher exact statistical tests. Mean age for the fixator-assisted nailing (FAN) group patients at the time of surgery was 23.8 years (14-37 years). There were 16 femur and 10 tibiae operated on 6 female and 4 male patients. The mean follow up time is 42.6 months (6-71 months). In the Ilizarov group patients the mean age at the time of surgery was 16.7 years (13-22 years). There were 14 tibiae and 3 femur operated on 6 female and 3 male patients. The mean follow-up time was 19 months (6-48 months). Results were evaluated according to the Paley et al. classification of bone and functional results. According to those criteria we had 1 fair, 1 good, and 7 excellent bone results and 1 fair, 1 good, and 7 excellent functional results in the circular ring fixator group. In the FAN group we found 3 good and 7 excellent bone results; 1 fair, 2 good, and 7 excellent functional results. Nearly all patients complained of pain, limping, instability, and walking problems at their first preoperative visit. In both groups there was no union problem; in the FAN group, in one patient correction loss occurred and in another one screw loosening was encountered; in the Ilizarov group, 66% of patients had pin tract infections and one premature fibula consolidation occurred. Statistical analysis revealed no significant difference between two groups in correction ratios.(pearson chi square p = 0.332 for MAD; pearson chi square p = 0.477 for LDFA; Paley functional criteria fisher exact p = 0.684). The results indicated that fixator-assisted nailing carries deformity correction accuracy comparable with Ilizarov-type external fixators. FAN provides great patient comfort and the total treatment time is less. In patients with rickets, the retained IM nail can further provide protection against recurrence even if the metabolic pathology reoccurs.Archives of Orthopaedic and Trauma Surgery 05/2011; 131(5):581-9. · 1.37 Impact Factor -
Article: Fixator-Assisted Nailing for Correction of Long Bone Deformities
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ABSTRACT: Many surgical options exist for the correction of long bone deformities. The fixator-assisted nailing (FAN) technique developed by Paley et al combines the accuracy, lack of invasive-ness, and adjustability of external fixation with the stability and comfort of internal fixation. A temporary external fixator is applied for acute deformity correction. Once the desired alignment is achieved, an intramedullary nail is placed and locked statically, interference screws are inserted for additional stability, and the fixator is removed during the surgery. This combinatory technique may further be combined with lengthening or arthrodesis procedures. Oper Tech Orthop 21:163-173 L ong bone deformities cause significant disability as well as psychological consequences to patients, both in child-hood and adulthood. It has been shown that deformities around the knee result in arthritic development at the knee joint. 1 Many surgical options exist for the correction of long bone deformities that either acutely or gradually correct the deformity and provide fixation until bone healing is estab-lished at the osteotomy site. 2-4 However, the fixator-assisted nailing (FAN) technique described by Paley et al in 1997 has become the gold standard for the correction of long bone deformities. 5,6 This technique combines the accuracy, mini-mal invasiveness, and safety of external fixation with the pa-tient convenience of internal fixation. The intramedullary nail prevents the recurrence of the deformity, which is espe-cially important in patients with metabolic bone diseases who are prone to recurrence of the deformity as the metabolic problem continues. 7 Preoperative PlanningOperative Techniques in Orthopaedics 01/2011; 21:163-173. -
Article: A review of problems, obstacles and sequelae encountered during femoral lengthening : uniplanar versus circular external fixator.
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ABSTRACT: There is currently a consensus regarding the superiority of circular type external fixators over uniplanar fixators for lengthening of the tibia, but femoral lengthening is still subject to the surgeon's preference. This study compares the occurrence rates of significant problems, obstacles and sequelae between these two techniques. Fifty patients (29 male, 21 female), with a mean age of 20 years were assigned to a circular type fixator group (54 lengthening segments), whereas 60 patients (29 male, 31 female), with a mean age of 20 years were assigned to a uniplanar fixator group (67 lengthening segments). The incidence of knee stiffness was significantly higher in the circular external fixator group (031 per segment) compared to the uniplanar external fixator group (0.13 per segment) (p < 0.05). The incidence of pain during lengthening was higher in the circular external fixator group, and patient satisfaction was higher in the uniplanar external fixator group. We recommend the uniplanar external fixator as a preferable device for femoral lengthening.Acta orthopaedica Belgica 10/2010; 76(5):628-35. · 0.40 Impact Factor -
Article: Correction of forearm deformities in children with multiple osteochondroma, by corrective radial osteotomy and ulnar lengthening by distraction osteogenesis.
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ABSTRACT: We retrospectively evaluated the results after ulnar lengthening and radial deformity correction using an external fixator for forearm deformities caused by osteochondromas. Eight forearms were treated surgically in seven patients with multiple hereditary osteochondroma. The mean follow-up time was 40 months (range, 20 to 60 months). The average radial articular angle improved from 43 degrees to 35.5 degrees (range, 28 to 56 degrees) and the carpal slip improved from 69.5% to 55% (range, 40 to 60%) postoperatively. The average shortening of the ulna was reduced from 2.06 cm to 0.44 cm (range 0 to 1 cm) after the treatment. There were no serious complications associated with the surgery; two minor pin track infections were successfully treated by local wound care and antibiotics. Although technically demanding, ulnar osteotomy and gradual lengthening by an external fixator provided promising results in the treatment of forearm deformities in children with multiple osteochondroma.Acta orthopaedica Belgica 12/2009; 75(6):743-7. · 0.40 Impact Factor -
Article: The effect of transforming growth factor β1 (TGF-β1) on the regenerate bone in distraction osteogenesisA biomechanical, histologic and immunohistochemical study on rabbits
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ABSTRACT: Distraction osteogenesis is a well established clinical treatment for limb length dicrepancy and skeletal deformities. Transforming growth factor beta 1 (TGF-β1) is a multifunctional peptide which controls proliferation and expression of cells specific to bone like chondrocytes, osteoblasts, osteoclasts including mesenchymal precursor cells. To decrease the external fixation time with increasing the strength of regenerate (newly formed bone after distraction) we tested the effect of locally applied transforming growth factor beta 1 on distraction osteogenesis. A total of 28 mature female white New zealand rabbits weighing 3,5 kg–4,5 kg were studied. 10 animals were belonging to biomechanical testing group (5 for the study and 5 for the control subgroups), and the others were to histology group. In biomechanical group after tibial ostetomy TGF-β1 was applied subperiosteally for 5 days just proximal to osteotomy site. Control group received only the solvent. Seven days after tibial osteotomy distraction was started at a rate of 0.25mm/12 hours for 3 weeks with a unilateral fixator. Rabbits were sacrified at the end of a consodilation period 8 week after tibial osteotomy. We assessed density of the elongation zone of rabbit tibial bones with the computed tomography. Then biomechanical parametres were assessed using the torsional testing using the material testing machine. In histology group rabbits were classified as control and study (rabbits that were given TGF-β1). Rabbits were sacrified at the end of first week, second week and fourth week also at the end of consolidation period 8 week after tibial osteotomy. Immunohistochemical and histologic parameters were examined. Biomechanical testing was applied as tortional testing. These values are used in determination of maximal loading, stiffness and energy absorbed during testing (brittlenes). The histomorphometric examination looked for the differences between the study and control groups in terms of bone formation pattern, bone quality and quantity. The immunohistochemical studies investigated the mechanism of TGF- β1, and it's presence in different cell types. The results of this study suggest that locally applied TGF-β1 improves the mineral density of distraction gap and load to failure(energy absorbed during testing). Though there is no significant histomorphometric difference between the study and control groups, there is an increased bone mineral density and an according maximum energy absorbance in the study group. This effect can be explained by the following mechanism: TGF-β1 exerts it's effect on two different receptor types (Type 1 and 2). Type 1 receptors are localized to bone matrix and type 2 receptors are localized to the intracellular space. The specific stains utilized in the current experiment are specific to type 2 receptors. They have been shown to be down-regulated by exogenous TGF-β1 injections. Most probably, type 1 receptors are up-regulated by this exogenous administration, but unfortunately, there is currently no specific stain on tha market to display type 1 receptors and to prove this explanation.07/2009; 25(2):101-107. -
Article: The Ilizarov hip reconstruction osteotomy for hip dislocation
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ABSTRACT: Treatment of neglected high dislocation of the hip is difficult in adults. We performed hip reconstruction osteotomy, consisting of a proximal abduction and extension osteotomy, and a distal varisation and lengthening osteotomy, utilizing the Ilizarov external fixator in 14 (12 women) patients having a mean age of 20 (12-33) years. The most frequent preoperative complaints were pain, leg-length discrepancy, limping, reduced activity and limited abduction of the hip. After an average follow-up of 68 (55-81) months, the outcome was satisfactory; pain subsided in all patients, the Trendelenburg sign became negative in all but 3 patients, no patient had limb-length discrepancy, and alignment of the extremity was reestablished. However, 3 patients still complained of lurch.07/2009; 73(4):432-438. -
Article: Fixator-assisted acute femoral deformity correction and consecutive lengthening over an intramedullary nail.
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ABSTRACT: External fixators are being used frequently in standard limb-lengthening and deformity-correction procedures. Lengthening over an intramedullary nail has been a successful technique, and fixator-assisted intramedullary nailing has provided satisfactory results for the correction of selected deformities. We report a combined technique for the treatment of femoral deformities associated with shortening. Between 1997 and 2005, twenty-eight femora in twenty-five patients with a median age of twenty-seven years underwent reconstruction with an intramedullary nail and a unilateral fixator. The mean amount of shortening was 6.33 cm, and the mean preoperative mechanical axis deviation was 33.86 mm. Deformity correction was performed acutely and secured by the intramedullary nail, which was locked distally, and the same external fixator that was used for the deformity correction was utilized for lengthening. At the end of the distraction period, proximal locking screws were placed in the intramedullary nail and the external fixator was removed. At the time of follow-up, deformity correction and bone healing were assessed clinically and radiographically, complications were noted, and the functional results were assessed. The mean duration of follow-up was forty months. The mean duration of the external fixation was 83.29 days, and the mean external fixation index was 14.98 days/cm. The mean amount of lengthening was 6.02 cm. The mean amount of mechanical axis deviation at the end of the treatment was 11.29 mm. The mean bone healing index was 36.66 days/cm. A knee flexion contracture developed in one patient and resolved after intensive rehabilitation. One patient underwent two revisions because of Schanz screw displacement secondary to cortical fracture, and four patients with minor pin-track infections were treated successfully with local wound care and oral antibiotics. While femoral lengthening and deformity correction can be obtained with classic methods for application of an external fixator, the long period of external fixation, patient discomfort, and plastic deformation of the regenerated bone after removal of the fixator are major disadvantages. Two techniques, fixator-assisted nailing and lengthening over an intramedullary nail, were combined in this series. The duration of the external fixation was reduced compared with that required for classic treatment with an external fixator and patient comfort was increased. In addition, the intramedullary nail prevented fracture and deformation of the regenerated bone.The Journal of Bone and Joint Surgery 02/2009; 91(1):152-9. · 3.27 Impact Factor -
Article: Periosteal grafting for congenital pseudarthrosis of the tibia: a preliminary report.
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ABSTRACT: The results of treatment of congenital pseudarthrosis of the tibia (CPT) are frequently unsatisfactory because of the need for multiple operations for recalcitrant nonunion, residual deformities, and limb-length discrepancies (LLD). Although the etiology of CPT is basically unknown, recent reports suggest the periosteum is the primary site for the pathologic processes in CPT. We hypothesized complete excision of the diseased periosteum and the application of a combined approach including free periosteal grafting, bone grafting, and intramedullary (IM) nailing of both the tibia and fibula combined with Ilizarov fixation would improve union rates and reduce refracture rates. We retrospectively reviewed 20 patients at two centers. The minimum followup was 2 years (mean, 4.3 years; range, 2-10.7 years). Union was achieved after the primary operation in all patients. Ten refractures occurred in eight of the 20 patients (two each in two patients, one each in six patients). Seven patients underwent seven secondary surgical procedures to simultaneously treat refracture and angular deformities. We used bisphosphonate as adjuvant therapy in three patients with refracture without subsequent refracture. We performed no amputations in these 20 patients. All patients were braced through skeletal maturity. Combining periosteal and bone grafting, IM nailing, and Ilizarov fixation is an effective treatment. IM nailing decreases the severity of subsequent fracture. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 11/2008; 466(12):2981-94. · 2.53 Impact Factor -
Article: Distal tibial reconstruction with use of a circular external fixator and an intramedullary nail. Surgical technique.
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ABSTRACT: Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been introduced to overcome these problems. The present study investigates this combined technique. Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular external fixator and an intramedullary nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months. The mean size of the bone defect in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean external fixation time was 3.5 months, and the mean external fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment). The combined technique is an improvement over the classic external fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of external fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation.The Journal of Bone and Joint Surgery 11/2008; 90 Suppl 2 Pt 2:181-94. · 3.27 Impact Factor -
Article: Comparison of three different treatment modalities in the management of humeral shaft nonunions (plates, unilateral, and circular external fixators).
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ABSTRACT: To compare 3 different fixation methods for the treatment of humeral shaft nonunions in terms of union time, functional outcome, and complications. Retrospective case series. University hospital. Between 1996 and 2004, 80 patients (mean age, 49; range, 15 to 86; 30 women and 50 men) with nonunions of the humeral shaft were treated surgically in our institution. Circular external fixators (CEF) were used in 35 patients, unilateral limb reconstruction system (LRS) fixators in 24 patients and fixation with plates in 21 patients. Surgical procedure included hardware removal in previously operated patients, autogenous grafting in all patients in the plate group and in those patients with atrophic nonunions in the external fixator groups, compression of the nonunion site in all patients. Radiological union time, complications, shortening, and disabilities of the arm, shoulder, and hand (DASH) score. Mean follow-up period was 48.1 months (range, 12 to 121). Mean radiological union time was 5.5 months (range, 1.5 to 12) in the CEF group, 5.2 months (range, 3 to 10) in the LRS group, and 5.7 months (range, 3 to 12) in the plate group. Mean DASH score was 23.7 in the CEF group, 18.6 in the LRS group, and 26 in the plate group. There were no statistical differences in terms of union time and the DASH score among the 3 groups. Successful union was achieved in 77 (96.3%) patients. Both external fixation and plate fixation produce excellent results in humeral shaft nonunions if applied properly. The procedure can be tailored to the surgeon's experience, keeping in mind that plate fixation demonstrates a longer healing time in those cases that had previous surgeries.Journal of Orthopaedic Trauma 05/2008; 22(4):248-57. · 2.13 Impact Factor -
Article: Distal tibial reconstruction with use of a circular external fixator and an intramedullary nail. The combined technique.
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ABSTRACT: Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been introduced to overcome these problems. The present study investigates this combined technique. Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular external fixator and an intramedullary nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months. The mean size of the bone defects in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean external fixation time was 3.5 months, and the mean external fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment). The combined technique is an improvement over the classic external fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of external fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation.The Journal of Bone and Joint Surgery 11/2007; 89(10):2218-24. · 3.27 Impact Factor -
Article: Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. Surgical technique.
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ABSTRACT: Callus distraction over an intramedullary nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical débridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an intramedullary nail for the treatment of bone defects and limb-shortening resulting from radical débridement of chronic osteomyelitis. Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical débridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an intramedullary nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days/cm, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation.The Journal of Bone and Joint Surgery 10/2007; 89 Suppl 2 Pt.2:183-95. · 3.27 Impact Factor -
Article: The effect of transforming growth factor beta1 (TGF-beta1) on the regenerate bone in distraction osteogenesis.
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ABSTRACT: Distraction osteogenesis is a well established clinical treatment for limb length discrepancy and skeletal deformities. Transforming growth factor beta 1 (TGF-beta1) is a multifunctional peptide which controls proliferation and expression of cells specific to bone like chondrocytes, osteoblasts, osteoclasts including mesenchymal precursor cells. To decrease the external fixation time with increasing the strength of regenerate (newly formed bone after distraction) we tested the effect of locally applied transforming growth factor beta 1 on distraction osteogenesis. A total of 28 mature female white New zealand rabbits weighing 3,5 kg-4,5 kg were studied. 10 animals were belonging to biomechanical testing group (5 for the study and 5 for the control subgroups), and the others were to histology group. In biomechanical group after tibial osteotomy TGF-beta1 was applied subperiosteally for 5 days just proximal to osteotomy site. Control group received only the solvent. Seven days after tibial osteotomy distraction was started at a rate of 0.25 mm/12 hours for 3 weeks with a unilateral fixator. Rabbits were sacrificed at the end of a consolidation period 8 week after tibial osteotomy. We assessed density of the elongation zone of rabbit tibial bones with the computed tomography. Then biomechanical parametres were assessed using the torsional testing using the material testing machine. In histology group rabbits were classified as control and study (rabbits that were given TGF-beta1). Rabbits were sacrificed at the end of first week, second week and fourth week also at the end of consolidation period 8 week after tibial osteotomy. Immunohistochemical and histologic parameters were examined. Biomechanical testing was applied as torsional testing. These values are used in determination of maximal loading, stiffness and energy absorbed during testing (brittleness). The histomorphometric examination looked for the differences between the study and control groups in terms of bone formation pattern, bone quality and quantity. The immunohistochemical studies investigated the mechanism of TGF-beta1, and its presence in different cell types. The results of this study suggest that locally applied TGF-beta1 improves the mineral density of distraction gap and load to failure(energy absorbed during testing). Though there is no significant histomorphometric difference between the study and control groups, there is an increased bone mineral density and an according maximum energy absorbance in the study group. This effect can be explained by the following mechanism: TGF-beta1 exerts its effect on two different receptor types (Type 1 and 2). Type 1 receptors are localized to bone matrix and type 2 receptors are localized to the intracellular space. The specific stains utilized in the current experiment are specific to type 2 receptors. They have been shown to be down-regulated by exogenous TGF-beta1 injections. Most probably, type 1 receptors are up-regulated by this exogenous administration, but unfortunately, there is currently no specific stain on tha market to display type 1 receptors and to prove this explanation.Growth Factors 05/2007; 25(2):101-7. · 1.65 Impact Factor -
Article: Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail.
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ABSTRACT: Callus distraction over an intramedullary nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical débridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an intramedullary nail for the treatment of bone defects and limb-shortening resulting from radical débridement of chronic osteomyelitis. Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical débridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an intramedullary nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days per centimeter, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation.The Journal of Bone and Joint Surgery 11/2006; 88(10):2137-45. · 3.27 Impact Factor -
Article: Treatment of intertrochanteric fractures in geriatric patients with a modified external fixator.
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ABSTRACT: Forty-two geriatric patients who had an intertrochanteric fracture were treated with a semicircular modification of the Ilizarov frame designed by Cattaneo and Catagni between January 1997 and September 2001. Twenty-five of the patients were female, 17 male. The average age of the patients was 77.5 years (range, 63-99). No intraoperative complication occurred. Deep pin-track infection was found in four patients and varus deformity was observed in two patients and shortening of less than 2 cm in 10 patients. Fixator removal was achieved in a mean time of 12 weeks (range, 10-18). No implant failure, refracture or stiffness of knee and hip joint movements was recorded. We concluded that the treatment of intertrochanteric fractures of the elderly patients with our modification provides significant advantages such as minimal operative and anaesthetic risks, no blood loss, early weight-bearing, short hospitalisation time and rapid union time.Injury 06/2005; 36(5):635-43. · 1.98 Impact Factor -
Article: Complications encountered during lengthening over an intramedullary nail.
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ABSTRACT: In limb-lengthening, the quest for increased patient comfort and a reduced period of external fixation has led to techniques such as lengthening over an intramedullary nail. The goals of this study were to investigate the rate and types of complications encountered during lengthening over an intramedullary nail and to identify solutions to these complications. Forty-two segments (thirty-five femora and seven tibiae) in thirty-five patients were lengthened. The mean age of the patients was 26.6 years, the mean amount lengthened was 6.3 cm (range, 2.5 to 11.5 cm), the mean external fixation index was 18.7 days/cm, and the mean lengthening index was 31.2 days/cm. The patients were followed for a mean period of forty-four months postoperatively. Eighteen complications occurred in sixteen (38%) of the forty-two segments for a rate of 0.43 complication per segment. Complications were classified, according to the system of Paley et al., as two problems, thirteen obstacles, and three sequelae. Sixteen of them required additional surgical interventions. A preoperative score of >6.5 on the system of Paley et al., a lengthening of >6 cm, and a lengthening percentage of >21.5% of the original bone length were indicators of a higher probability of the occurrence of complications. Lengthening over an intramedullary nail provides increased patient comfort and reduces the external fixation period. If the problems encountered are treated aggressively, the result of the treatment can be quite satisfactory.The Journal of Bone and Joint Surgery 11/2004; 86-A(11):2406-11. · 3.27 Impact Factor -
Article: Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss: a report of 24 cases.
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ABSTRACT: To evaluate the results of bifocal compression-distraction method for the acute treatment of open tibia fractures with bone and soft-tissue loss. Patients were selected for bifocal compression-distraction (shortening and lengthening) who had open tibia fractures with bone and soft-tissue loss and a Mangled Extremity Severe Score of 6 and below indicating good leg viability. Bifocal compression-distraction osteogenesis using the Ilizarov type circular external fixator was applied to 24 patients with 14 grade IIIA and 10 grade IIIB open tibia fractures with bone and soft-tissue loss. Mean age of the patients was 30.6 years (range 18-53). The mean bone defect was 5 cm (range 3-8.5). The mean soft tissue defect was 2.5 x 3.5 (1 x 2-10 x 5) cm. Acute shortening at the fracture site was done for patients with bone defects up to 3 cm to achieve apposition of bone ends. Gradual shortening at a rate of 2 mm/d was done for patients who had bone defects more than 3 cm. Leg length discrepancy was overcome by lengthening at the same time through a corticotomy at a proximal or distal level depending on fracture localization, until there was equalization of leg lengths. Mean follow-up period was 30 months (range 18-60). Mean bone healing time was 7.5 months (range 4-11). The mean time in external fixation was 7.1 months (range 3-10), and the average external fixator index was 1.4 months/cm. Results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 21 and good in 3 patients. Functional assessment scores were excellent in 19, good in 4, and fair in 1 patient. Pin site infections were present in 10.7% of the pin sites. There were 52 complications in 24 patients, for a complication rate per patient of 2.08. Of the complications, 48.1% were problems (minor complications), 38.5% obstacles (major complications requiring a surgical solution), and 13.4% sequelae (true complications). Minor complications included soft tissue inflammation and infection, translation/angulation, and delayed maturation during distraction and transient knee contracture and loss of motion. All grade 1 and 2 soft tissue inflammations and infections healed with nonoperative therapy. Major complications included pin tract infection and reinfection, equinus deformity, frame failure, and premature consolidation, all of which required additional surgery to correct the problem. Sequelae included leg length discrepancy, loss of knee/ankle range of motion, knee flexion contracture, malalignment, and chronic osteomyelitis. Bifocal compression-distraction osteogenesis is a safe, reliable, and largely successful method for the acute treatment of open tibia fractures with bone and soft-tissue loss. Further nonoperative or operative treatment can correct most complications.Journal of Orthopaedic Trauma 04/2004; 18(3):150-7. · 2.13 Impact Factor -
Article: The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up).
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ABSTRACT: We evaluated the midterm results of high tibial osteotomy in patients with medial compartment arthritis. This study included 53 patients treated with high tibial osteotomy accompanied by either internal fixation (group A, n=26) or Ilizarov-type external fixator (group B, n=27). Clinical assessment of patients was performed using Hospital of Special Surgery scoring. Radiography was based on orientation angles of the knee (medial proximal tibial angle, lateral distal femoral angle, posterior proximal tibial angle) and mechanic axis alignment test. We used the Insall-Salvati index to determine patellar height. The mean follow-up in group A was 77 months (range 63-118) and that in group B 72 months (range 61-113). The patients of group B demonstrated better results in terms of Hospital of Special Surgery score, alignment of lower extremity, and preventing of progression of arthritis. We believe that normal alignment and orientation of the knee could be precisely established with a circular external fixator, and that some disadvantages such as patella infera, failed correction, and loss of bone in proximal tibia as observed after classic high tibial osteotomy can be avoided. Furthermore, progression of arthritis can be prevented if the mechanical axis passes through the lateral compartment of the knee.Knee Surgery Sports Traumatology Arthroscopy 06/2003; 11(3):139-44. · 2.21 Impact Factor -
Article: Correction of ankle and hindfoot deformities by supramalleolar osteotomy.
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ABSTRACT: Ankle and hindfoot deformities in 11 patients with a mean age of 15 (range, four to 35) have been gradually corrected by an llizarov external fixator. In all patients, supramalleolar osteotomy was utilized by percutaneous drilling and osteotomy technique. The patients were evaluated clinically by the AOFAS scoring system and radiologically by malorientation and malalignment tests described by Paley. The purpose of the current study is to evaluate the efficacy of supramalleolar osteotomy and correction by an Ilizarov device in treating hindfoot and ankle deformities. The mean external fixation period was five (2.5 to eight) months. The mean interval between the operation and last follow-up examination was 19 (13 to 26) months. The patients improved an average of 30 points after the operation regarding to AOFAS score. A plantigrade foot was achieved in the whole group. Radiologically, no malalignment or malorientation was measured. Equal leg lengths were achieved in all nine patients with one exception. Complications were graded after Paley as minor problems in 11 patients and as obstacles requiring surgical interventions in four patients. Sequelae remained in only one patient. Ankle and hindfoot deformities caused by various etiologies are complicated by poor soft tissue condition and a short foot. A supramalleolar osteotomy and Ilizarov external fixator can safely and effectively correct these deformities.The Foot and Ankle Online Journal 02/2003; 24(1):22-8. · 1.22 Impact Factor
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Institutions
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1970–2012
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Istanbul University
- Department of Orthopaedics and Traumatology
İstanbul, Istanbul, Turkey
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