-
-
[show abstract]
[hide abstract]
ABSTRACT: Nerve regeneration after surgical reconstruction is far from optimal, and thus effective strategies for improving the outcome of nerve repair are being sought. In this experiment, we verified if postoperative intraperitoneal melatonin (MLT) administration after intraoperative platelet gel application improves peripheral nerve regeneration. In adult male rats, 1-cm long sciatic nerve defects were repaired using four different strategies: autologous nerve graft repair followed by MLT (NM, n = 5), collagen conduit repair followed by MLT (CM, n = 5), platelet gel-enriched collagen conduit repair followed by MLT (CGM, n = 6), and platelet gel-enriched collagen conduit (CG, n = 5) repair followed by no substance administration. Sham operated animals were used as controls (Cont, n = 5). Ninety days after surgery, the nerve regeneration outcome was comparatively assessed by means of electrophysiological and stereological analysis. Electrophysiology revealed no significant differences between the experimental and the sham control groups. Stereological analysis showed no significant differences among the experimental groups regarding axon size and myelin thickness, but the axon number was significantly lower in the CM compared to Cont and NM group. Moreover, there was no significant difference between number of axons in CG and Cont groups, between CGM and CM, and between CM and NM. Although it was observed that platelet gel have a positive effect on nerve regeneration, but a combination of local platelet gel with MLT does not have the same effect on nerve repair.
Microsurgery 05/2011; 31(4):306-13. · 1.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We compared two mini skin incision techniques utilized in the treatment of carpal tunnel syndrome (CTS).
Twenty-seven patients who underwent surgery for CTS were evaluated in two groups according to the site of the mini incision performed for surgical release. A single mini skin incision was performed over the transverse carpal ligament in 12 patients (group 1; 17 hands; 1 man, 11 women; mean age 55 years; range 38 to 66 years), and on the distal side of the ligament in 15 patients (group 2; 17 hands; all women; mean age 54 years; range 34 to 71 years). The two groups were compared with regard to improvement in pain and numbness, rigidity and sensitivity of the scar tissue, time to use the hands, and palmar pinch and grip strengths. The mean follow-up was 26.6 months in group 1, and 23.7 months in group 2.
Complete disappearance of symptoms was obtained in 14 wrists (82.4%) in group 1, and in 15 wrists (88.2%) in group 2, with no significant difference between the two groups (p>0.05). Rigidity and sensitivity of the scar tissue were seen in nine wrists (52.9%) in group 1, and in two wrists (11.8%) in group 2 (p<0.05), which lasted 3.5 months and 1.5 months, respectively. In group 2, time to use the affected hand for basic needs (9 days) and normal function (21 days) was significantly shorter, compared to 18 days and 35 days in group 1, respectively (p<0.05). The mean differences of grip and pinch strengths of the two hands were -2.78 kg and -0.60 kg in group 1, and -0.77 and -0.46 kg in group 2, respectively (p>0.05).
Although both methods of release yield satisfactory results in the mid- and long-term, mini skin incision performed on the distal side of the transverse carpal ligament is associated with less incision-related morbidity.
acta orthopaedica et traumatologica turcica 02/2008; 42(4):234-7. · 0.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aneurysmal bone cysts (ABCs) are benign lesions that are usually treated with intralesional procedures. The clinical behavior of ABCs is reported to be more aggressive in younger patients, with high recurrence rates after surgical treatment by several authors. The purpose of this study was to review longitudinally the demographic data and outcome of current surgical techniques in children with ABC treated at a single institution and to determine the possible risk factors for recurrence, which may be detected at initial examination, including age, presenting complaint, and radiological characteristics.
The authors performed a retrospective, pediatric population-based (< or =16 years) analysis of 56 cases of ABCs with more than 2 years' follow-up. The subjects were studied and classified on the basis of their age group (< or =5, 5-10, and >10 years of age). The possible risk factors for recurrence were analyzed initially with Student t test and Pearson chi2 test, then a logistic regression analysis model was used for multivariate analysis.
Nine patients were younger than 5 years, 17 were between 5 and 10 years old, and 30 were older than 10 years. The most frequent location of the lesion was the humerus (11 cases) followed by proximal femur and fibula. Curettage was the most common treatment modality followed by resection. Recurrence of the lesion occurred in 5 children in the younger age group and in 4 children in the older age group. The difference in persistence or recurrence rates based on age (< or =5 years) and previous surgery was statistically significant. In addition, we have found no significant implication of physeal contact and size of the lesion on recurrence.
The recurrence rates of primary ABC seemed to be higher in younger children. Considering the high cure rates with intralesional procedures even after recurrence, we suggest less aggressive intralesional procedures even in patients with mentioned risk factors; however, the patients' family should be informed about the high probability of recurrence.
Journal of Pediatric Orthopaedics 01/2008; 27(8):938-43. · 1.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The goal of this clinical study was to evaluate the capability of intraoperative ultrasonographical examination to demonstrate the sectioning of the transverse carpal ligament during open surgical treatment of carpal tunnel syndrome with limited uni skin incision (mini skin incision technique).
Intraoperative ultrasonography was used in the detection of complete sectioning of the transverse carpal ligament, and sufficient release of median nerve. Thirty-two female cases were operated with the limited uni skin incision technique. Intraoperative ultrasonography showed the sectioned transverse carpal ligament in all cases.
We adopted the sonographic examination to check the ligament during surgical intervention. The capability of ultrasonography is sufficient to demonstrate the median nerve and transverse carpal ligament especially when performing limited uni mini skin incision technique for carpal tunnel surgery.
We suggest the use of ultrasonography for intraoperative checking of the sectioning of the transverse carpal ligament during the surgical treatment of carpal tunnel syndrome with limited uni skin incision.
Turkish neurosurgery 08/2007; 17(3):219-23. · 0.62 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate the effect of dorsal cortical comminution on radiographic outcome of unstable distal radius fractures after treatment with closed reduction and K-wire fixation.
Forty-two patients were treated with closed reduction and K-wire fixation for unstable, extra-articular distal radius fractures with dorsal angulation. The patients were evaluated in two groups depending on the presence or absence of dorsal metaphyseal cortical comminution observed as a radiopacity on lateral radiographs. Thus, 30 patients (13 males, 17 females; mean age 56 years; range 22 to 77 years) did not have dorsal cortical comminution, whereas 12 patients (8 males, 4 females; mean age 48 years; range 18 to 76 years) did. The mean follow-up period was 8.8 months (range 3 to 106 months) in the former, and 5.5 months (range 3 to 131 months) in the latter groups. Radiographic parameters were compared including palmar tilt measured on lateral, radial inclination and radial length on posteroanterior radiographs obtained before treatment and after union.
Radial inclination, palmar tilt, and radial length showed significant improvements in both groups (p<0.05). The results were acceptable in all the patients with achievement of standard reference values. The presence of dorsal cortical comminution did not have any significant effect on radiographic parameters (p>0.05). No significant complications were encountered during the follow-up period.
Dorsal cortical metaphyseal comminution does not have an adverse effect on radiographic results. Treatment with closed reduction and K-wire fixation is safe and effective even in the presence of dorsal cortical comminution.
acta orthopaedica et traumatologica turcica 01/2007; 41(3):202-6. · 0.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to develop a suture technique that would be simple and easy to perform, but also strong enough to resist the strength formed during early active exercise protocols.
Thirty flexor digitorum profundus muscle tendons were obtained from lambs aged 12 to 16 months. The tendons were assigned to three in situ repair groups, including the modified Kessler technique, six-strand Savage technique, and a strengthened modified Kessler technique, all combined with an epitendinous suture. Each group was subjected to biomechanical tests and the maximum strength of the tendons to rupture and the power exerted to yield a 3-mm separation were recorded.
The mean strengths of the tendons repaired with the modified Kessler technique for 3-mm separation and rupture were 29.9+/-2.9 N and 37.0+/-4.0 N, respectively. The corresponding forces were 39.1+/-6.7 N and 51.3+/-6.1 N with the six-strand Savage technique, and 59.9+/-8.3 N and 69.0+/-8.7 N with the strengthened modified Kessler technique, respectively. Forces to produce a 3-mm separation and rupture were significantly higher with the strengthened modified Kessler repair, whereas the lowest forces were seen with the modified Kessler technique (p<0.001).
Tendon repair with the strengthened modified Kessler technique provides the highest resistance to both 3-mm separation and rupture. These biomechanical properties may allow safe and active motion without any gap formation in the repair area.
acta orthopaedica et traumatologica turcica 01/2007; 41(3):238-43. · 0.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Arterial injuries of the forearm account for an important fraction of peripheral vascular injuries. Early diagnosis and treatment are important for both function and viability of the extremity. Arterial injuries of the forearm mostly occur as a result of glass or knife cuts and gunshot wounds and the presence of accompanying injuries may facilitate the diagnosis. However, in this case (50-year-old male patient), a piece of nail behaved like a high-energy particle and injured the radial artery without any accompanying lesion. Detection of normal pulses in the radial and ulnar arteries delayed the diagnosis and treatment. This case report aimed to address difficulties in establishing the diagnosis of isolated radial artery injuries.
acta orthopaedica et traumatologica turcica 02/2005; 39(3):270-3. · 0.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A rabbit model of posterolateral intertransverse process spine arthrodesis with and without the application of low-intensity ultrasound was used.
To determine the effects of low-intensity ultrasound on the healing of muscle-pediculated bone graft.
Earlier animal and clinical studies demonstrated the efficacy of low-intensity ultrasound stimulation in the acceleration of osteogenesis and fracture healing. This is the first study in which the beneficial effects of ultrasound on the healing of muscle-pediculated bone graft in spinal fusion have been assessed.
In this study, 20 New Zealand rabbits were randomly assigned to two groups to undergo either spinal fusion using muscle-pedicle bone graft with ultrasound (ultrasound group) or muscle-pedicle bone graft without ultrasound (control group). Muscle-pediculated bone grafts were prepared from the posterosuperior iliac crest, erector spine muscle, and internal and external oblique muscle. This graft was placed bilaterally between the L5 and L6 transverse processes. Ultrasound was performed 20 minutes per day over the rabbits' lumbar spine. The rabbits were killed 6 weeks after surgery. The lumbar spines were evaluated radiologically, macroscopically, and histologically.
By macroscopic and radiologic findings, fusion was detected in 11 control group rabbits (55%) of the control group, and in 17 ultrasound group rabbits (85%). The fusion success rate for the rabbits treated with low-intensity ultrasound were statistically higher (P <0,05) than that for the control group. Histologic specimens showed increased bone formation in the fusions exposed to ultrasound. Mature fusions were present in rabbits that received ultrasound.
Low-intensity ultrasound in white rabbits increased the rate and quality of spinal fusion using muscle-pediculated bone grafts.
Spine 07/2002; 27(14):1531-5. · 2.08 Impact Factor
