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Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction
(Springer, 2012) Hapa, Onur; Aksahin, Ertugrul; Ozden, Raif; Pepe, Murad; Yanat, Ahmet Nedim; Dogramaci, Yunus; Bozdag, Ergun
Medial patellofemoral ligament (MPFL) reconstruction is an effective option for the treatment of recurrent patellar instability. Most techniques utilize the passage of a tendon graft through tunnels at the patella with the risk of patellar fracture. The purpose of this study was to investigate the strength of the recent MPFL reconstruction techniques (transverse tunnel, interference screw, anchor, and docking technique). Thirty-six saw bones were divided into four groups (transverse tunnel, interference screw, anchor fixation, and docking technique) with nine patellae in each. Patella-tendon constructs were pre-loaded to 10 N and cyclically loaded for 20 cycles from 2 to 30 N under load control at a rate of 5 N/sec. The construct was then tested to failure at a constant displacement rate of 6 mm/sec. Ultimate load (N), stiffness (N/mm), and failure mode were recorded for each specimen. The docking group had lower ultimate load [106 (SD 41) N] and stiffness [14 (SD 2) N/mm] values than the other groups tested (P = 0.007). The anchor group had lower stiffness [21 (SD 6) N/mm] values than the tunnel group [28 (SD 3) N/mm (P = 0.01)] and the interference screw group [31 (SD 6) N/mm, (P = 0.004)]. There was no significant difference in the ultimate load between anchor [299 (SD 116) N], tunnel [304 (SD 140) N], and interference screw groups [241 (SD 103) N] (n.s.). Aperture fixation techniques, especially interference screw fixation, were as strong as the technique utilizing tunnels in the patella for MPFL reconstruction.
Bilateral superficial peroneal nerve entrapment secondary to anorexia nervosa: a case report
(Thieme Medical Publ Inc, 2008) Sevinc, Teoman Toni; Kalacı, Aydıner; Dogramaci, Yunus; Yanat, Ahmet Nedim
We report a case of severe weight loss secondary to anorexia nervosa causing bilateral superficial peroneal nerve entrapment in a young female patient who was treated successfully by bilateral surgical decompression.
The Biocompatibility of Nitinol in Knee Joint Spaces and Femoral Tunnels: An Experimental Study in Rats
(Journal Hard Tissue Biology, 2014) Kalacı, Aydıner; Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Dogramaci, Yunus; Karapinar, Serhat; Yaldiz, Mehmet
Currently the most common method of reconstructing a ruptured anterior cruciate ligament (ACL) is by using bone-patellar tendon-bone (BPTB) or semitendinosus, gracilis tendon autografts. Although good results are reported, donor morbidity continues to be a problem. To overcome these complications, synthetic grafts have been investigated. However, to date no prosthetic graft has been developed as an alternative to patellar or hamstring tendon autografts. The aim of the present study was to assess the biocompatibility of nitinol in rat knee joint spaces and distal femoral bones. Ten male, healthy Wistar albino rats, weighing between 300-350 g, were used. The right knee joint of each rat was reached by medial longitudinal parapatellar dissection. The femur distal was penetrated by a size 0.5 mm of Kirshner wires. Twenty nitinol wires were placed in the bone tunnel (0.125 mm in diameter and 5 mm long). In addition one nitinol wire was placed in the joint space. Following hemostasis, the layers were closed with interrupted sutures. The same procedure was repeated for the left side without placing any nitinol wire. The rats were allowed unrestricted weight bearing. Two animals died of unknown reasons during follow-up. The remaining rats were sacrificed 8 weeks after surgery. The knees were removed by careful dissection and the nitinol wires were removed. The sections taken from these specimens were stained with Standard hematoxylin and eosin and with Mason trichrome and examined under the light microscope. The bone tunnels were filled with osteocytes and chondrocytes. In two specimens of the nitinol group, moderate synovitis was detected. The synovitis rate in the study group was found to be statistically insignificant. In conclusion, the short term biocompatibility of nitinol in the rat knee joint space and femoral tunnel was found to be within acceptable limits.
The comparison of freehand fluoroscopic guidance and electromagnetic navigation for distal locking of intramedullary implants
(Elsevier Sci Ltd, 2013) Uruc, Vedat; Ozden, Raif; Dogramaci, Yunus; Kalacı, Aydıner; Dikmen, Besir; Yildiz, Omer Serkan; Yengil, Erhan
Introduction: In locking intramedullary nails, the most important problem is to put the distal interlocking screw accurately and quickly with minimum radiation exposure. The purpose of this clinical study was to compare the fluoroscopic time and surgical time required for distal locking with either free-hand fluoroscopic guidance or with an electromagnetic navigation system. Materials and methods: The study comprised 54 patients with 58 fractures of the lower extremity. The patients were divided in two groups: distal locking with freehand fluoroscopic guidance (group I) and distal locking with electromagnetic navigation (group II). The primary outcome in this study was fluoroscopy time. The secondary outcome was the operative time in distal interlocking. Results: In group I, the mean operation time was 108 (81-135) min, the mean time for distal interlocking was 18.35 (9-27) min, the total fluoroscopy time was 47.77 (19-74) s, the mean fluoroscopy time during distal interlocking was 18.29 (2-29) s and the mean attempt at number of distal locking for two screws was 9.96 (2-18) times. In group II, the mean operation time was 80.96 (63-100) min, the mean time for distal interlocking was 7.85 (6.5-10) min, the total fluoroscopy time was 22.59 (15-32) s, the mean fluoroscopy time during distal interlocking was 1.62 (0-2) s and the mean attempt number of distal interlocking was 2 (2-2). Conclusion: Fluoroscopy time to achieve equivalent precision is significantly reduced with electromagnetism-based surgical navigation compared with free hand fluoroscopic guidance. Also the operative time is significantly reduced with electromagnetic based navigation. (c) 2012 Elsevier Ltd. All rights reserved.
A comparison of fucidic acid and cefazoline released from cancellous human bone
(Academic Journals, 2011) Dogramaci, Yunus; Kalacı, Aydıner; Ozer, Burcin; Ozden, Raif; Hapa, Onur; Yanat, Ahmet Nedim
This study was designed to determine the antibacterial activity of fucidic acid or cefazoline in cancellous bone obtained from patients undergoing total knee replacement. Thirty samples of cancellous bone were obtained from patients undergoing total joint arthroplasty for primary osteoarthritis of knee joints. The prophylactic antibiotics were infused to the subjects an hour before the operation. In the first group (15 samples) fucidic acid (500 mg intravenous) was used as a prophylactic antibiotics and 1st generation of cephalosporin were used in the second group (15 samples) as the prophylaxis. Same strains of Staphyloccocus aureus were used to assess the antibiotic activity using the disc diffusion technique after 1, 3, 7, 10, 14, 18, 21 and 28 days. The antibiotic efficacy was defined as an inhibition zone diameter of 10 mm. Inhibition zone diameters were significantly higher in fusidic acid than cefazoline specimens on the first, third and 14th day after the incubation (P<0.05). No statistically significant difference was found in the inhibition zone diameter at the seventh, 18th and 21st days. Evaluation of inhibition zone diameters showed that samples obtained from the first group (fucidic acid) had a longer duration of antibiotic release than that of second group (cefazolin). Fucidic acid shows a higher release and a longer antibacterial activity when used as a prophylactic antibiotic compared to cefazolin.
The comparison of macroscopic and histologic healing of side-to-side (SS) tenorrhaphy technique and primer tendon repair in a rabbit model
(Springer, 2014) Dogramaci, Yunus; Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Kalacı, Aydıner; Altug, Muhammed Enes; Isler, Cafer Tayar
The side-to-side (SS) tenorrhaphy technique has been used in tendon transfer surgery. The mechanical properties of SS tendon suture have been studied previously. However, the histo-pathological healing of the SS tenorrhaphy of the tendons is unknown. The aim of this study was to assess the gross and histological effects of SS tenorrhaphy in a rabbit model. Twenty New Zealand rabbits were used. The extensor hallucis longus and tibialis anterior tendon were sewed SS at the level distal to the ankle joint. The patellar tendon (PT) at the same side was used as control group. A unilateral midline incision was made and repaired with a single suture. The animals were killed at the 12th week postoperatively. The histological sections were obtained from the side of surgery from each group. Each sample was stained with hematoxylene and eosin (H&E). Gross and microscopic healing was compared between the two groups. Gross examination of the control group showed complete healing with a thin peri-tendinous sheath formation around the suture site, whereas in the study group, a thick peri-tendinous sheath was formed around the area of the tendon-tendon anastomosis. In the control group, at the 12th week after surgery, the healing was almost completed in all samples. In the study group, a thick fibro vascular sheath has formed around the side of anastomosis. In all specimens few inter-digitations were observed between the tendons;however, the trough was still present. The result of the current study showed that histological healing and union of SS tenorrhaphy differ from that in primary tendon injury and healing. Further studies are required to clarify the healing stages at the tenorrhaphy site.
Comparison of Surgical Treatment and Conservative Approach for Type III Acromioclavicular Dislocations
(Ortadogu Ad Pres & Publ Co, 2011) Esen, Erdinc; Ozturk, Akif Muhtar; Dogramaci, Yunus; Kanatli, Ulunay; Bolukbasi, Selcuk
Objective: In this study, we aimed to compare the effectiveness and the results of surgical (modified Weaver-Dunn) and conservative treatment techniques for Rockwood type III acromioclavicular dislocation. Material and Methods: Thirty four patients with acromioclavicular dislocation were included in this study. The mean age was 43.6 +/- 10.2 years (range 21-60). Modified Weaver-Dunn technique was performed on 17 patients. The mean operation time after the trauma was 12 +/- 6.9 days (range 3-24 days). The remaining 17 patients were treated conservatively with an acromioclavicular bandage. The range of motion and strengthening of the shoulder muscles started during the sixth week of treatment in both groups. The mean follow up period of both groups was 32.8 +/- 12.1 months (range 12-72). Results: No complication occurred in either groups. According to Poigenfurst's criteria, the results were classified as good or excellent in both groups. No statistically significant difference was found between the results of the groups according to Poigenfurst's criteria (p> 0.05). Conclusion: Treatment modalities of type III acromioclavicular dislocation remain controversial. Satisfactory results have been reported when Modified Weaver-Dunn techniques were performed initially to young, active, laborer and athletes with acromioclavicular dislocation of the dominant extremity. In this study, we did not find a significant difference between surgical treatment and conservative approach in terms of measurements of functional outcomes. We concluded that the treatment of stage III dislocation can be modified according to the personal characteristics and the expectations of the patient. Current data indicates that both treatment modalities can be satisfactory.
THE COMPARISON OF VACUUM ASSISTED CLOSURE AND CONVENTIONAL COTTON GAUZE DRESSING IN THE TREATMENT OF DEFECTIVE LOWER EXTREMITY INJURIES
(Carbone Editore, 2014) Ozden, Raif; Duman, Ibrahim Gokhan; Uruc, Vedat; Dogramaci, Yunus; Kalacı, Aydıner; Komurcu, Erkam
We performed a retrospective analysis to compare the efficacy of the vacuum assisted closure (VAC) therapy and conventional cotton gauze dressing of wounds. From July 2011 to August 2013, 40 patients were included in the study. All patients were reconstructed with split thickness skin graft after the granulation tissue was sufficient Two groups of 20 patients Were compared retrospectively. Data were collected for gender, age, time needed for sufficient granulation tissue for split thickness skin grafts, length of stay in hospital and. number of debridement for wound VAC application, and conventional cotton gauze dressing methods. Demographic data were the Same. for two groups. Time needed to have a good granulation tissue that was sufficient for split thickness skin graft, length of stay in hospital, and number of debridement were significantly less in VAC treatment group (P<0,05). No major complication occurred that was directly attributable to treament. VAC therapy appears to be a good adjunct for the treatment of musculoskeletal injuries and found to facilitate the rapid formation of healthy granulation tissue on wounds in the lower limb and shortens the length of stay in hospital.
The comparison of vacuum assisted closure and conventional cotton gauze dressing in the treatment of defective lower extremity injuries
(Acta Medica Mediterranea, 2014) Ozden, Raif; Duman, Ibrahim Gokhan; Uruc, Vedat; Dogramaci, Yunus; Kalacı, Aydıner; Komurcu, Erkam
We performed a retrospective analysis to compare the efficacy of the vacuum assisted closure (VAC) therapy and conventional cotton gauze dressing of wounds. From July 2011 to August 2013, 40 patients were included in the study. All patients were reconstructed with split thickness skin graft after the granulation tissue was sufficient. Two groups of 20 patients were compared retrospectively. Data were collected for gender, age, time needed for sufficient granulation tissue for split thickness skin grafts, length of stay in hospital and number of debridement for wound VAC application, and conventional cotton gauze dressing methods. Demographic data were the same for two groups. Time needed to have a good granulation tissue that was sufficient for split thickness skin graft, length of stay in hospital, and number of debridement were significantly less in VAC treatment group (P < 0.05). No major complication occurred that was directly attributable to treatment. VAC therapy appears to be a good adjunct for the treatment of musculoskeletal injuries and found to facilitate the rapid formation of healthy granulation tissue on wounds in the lower limb and shortens the length of stay in hospital.
Compression of common peroneal nerve caused by an extraneural ganglion cyst mimicking intermittent claudication
(Thieme Medical Publ Inc, 2013) Ozden, Raif; Uruc, Vedat; Kalacı, Aydıner; Dogramaci, Yunus
Peripheral neuropathies caused by ganglion cysts are rare. They seldom cause serious complications especially in the lower extremities. The case was a 51-year-old woman referred by her physician to the vascular surgeon with diagnosis including intermittent (vascular) claudication and deep venous thrombosis. Primarily vascular surgeon performed a doppler ultrasound of the lower extremity and calculation of the ankle-brachial index. There were no abnormal pathological findings. Careful physical examination revealed soft swelling and tenderness around the fibular head and neck. Weakness was observed in foot eversion and dorsiflexion. There was pain and tingling in the distribution of the peroneal nerve. and referring the patient to orthopedic surgeon owing to concern for a potential compressive lesion at the right proximal tibiofibular region. Electromyogram studies and physical examination confirmed a diagnosis of compression neuropathy of common peroneal nerve. Magnetic resonance imaging revealed a fluid-filled, lobulated mass indicating a ganglion cyst. One months after decompression, the patient had no complaint. Fast diagnosis and immediate management are essential to regain best possible recovery.
Cutaneous infection caused by Aspergillus terreus
(Soc General Microbiology, 2009) Ozer, Burcin; Kalacı, Aydıner; Duran, Nizami; Dogramaci, Yunus; Yanat, Ahmet Nedim
Aspergillus species are widely distributed in nature, and more than 30 species have been reported to be involved in human and animal infection. Cutaneous infections due to Aspergillus terreus are particularly rare. In this report, we describe a case of cutaneous infection caused by A. terreus in a paediatric patient who underwent surgical treatment for an open tibial fracture secondary to an agricultural accident.
Detection of adhesin genes and slime production among Staphylococci in orthopaedic surgical wounds
(Academic Journals, 2010) Duran, Nizami; Dogramaci, Yunus; Ozer, Burcin; Demir, Cemil; Kalacı, Aydıner
This study was aimed at investigating: (i) three adhesin genes (clf A, fnb A and cna) in Staphylococus aureus strains, (ii) the presence of slime (ica A and ica D genes) in both Staphylococus epidermidis and S. aureus strains isolated from surgical wounds. The slime and adhesin genes were detected by multiplex PCR. The ica A/ica D positivity rates were determined as 66.2% (104/157) in a total of 157 staphylococcal strains. While the occurance rate of slime genes was 69.6% (48/69) among the S. epidermidis, this ratio was 63.6% (56/88) among the S. aureus isolates. No statistically significant difference was found between S. epidermidis and S. aureus isolates in terms of the presence of slime genes (p > 0.05). Among the 88 S. aureus strains, almost all of the strains were positive for fnb A gene (97.7%). The cna and clf A positivity rates were detected in 69 (78.4%) and 45 (51.1%) isolates, respectively. The ica A and ica D genes responsible for slime production have been found to have high prevalence. Also, the frequency of adhesin genes was determined at a high rate in S. aureus strains isolated from surgical wounds. Molecular identification of virulent staphylococcal strains may help in management in clinical decision making.
Detection of slime and methicillin resistance genes in Staphylococci isolated from nasal samples of patients with orthopaedic implants
(Int Scientific Information, Inc, 2010) Duran, Nizami; Dogramaci, Yunus; Demir, Cemil; Ozer, Burcin; Kalacı, Aydıner
Background: The purposes of the present study were (1) to determine the prevalence of mecA and femA genes, (2) to investigate the presence of icaA and icaD genes responsible for slime synthesis, and (3) to search in vitro slime synthesis by staphylococcal strains isolated from the nares of patients with orthopaedic implants using the Congo red agar (CRA) plate test. Material/Methods: Staphylococci strains were defined by multiplex polymerase chain reaction (PCR) technique to determine intercellular adhesion genes icaA and icaD. Slime production capability was searched by the CRA plate test, phenotypically. Also, the presence of mecA and femA genes was determined by PCR in all strains. Results: The presence of icaA and icaD was detected in 101 isolates of 134 (75.4%) strains. This ratio was 74.8% (89 of 119) among the Staphylococcus epidermidis and 80% (12 of 15) among the Staphylococcus aureus isolates. A total of 63.4% of all the strains were found to be icaA and icaD positive as well as slime-forming on the CRA plate test. The percentage of icaA-and icaD-negative strains was 36.6%, and all of them were negative on the CRA plate test. Although femA presence was detected in all 15 (11.2%) S. aureus isolates, a total of 5 (3.7%) isolates carried the mecA gene. Conclusions: The frequency of icaA and icaD genes was determined to be of high prevalence among staphylococcal isolates. The staphylococcal strains that were found in the nasal flora of patients with orthopaedic implants may be important potential sources of infection for these patients.
Does strand configuration and number of purchase points affect the biomechanical behavior of a tendon repair? A biomechanical evaluation using different Kessler methods of flexor tendon repair
(2008) Dogramaci, Yunus; Kalacı, Aydıner; Sevinç, Teoman Toni; Esen, Erdinc; Komurcu, Mahmut; Yanat, Ahmet Nedim
This study compares the mechanical properties of modified Kessler and double-modified Kessler flexor tendon repair techniques and evaluates simple modifications on both methods. Forty fresh sheep flexor tendons were divided equally into four groups. A transverse sharp cut was done in the middle of each tendon and then repaired with modified Kessler technique, modified Kessler with additional purchase point in the midpoint of each longitudinal strand, double-modified Kessler technique, or a combination of outer Kessler and inner cruciate configuration based on double-modified Kessler technique. The tendons were tested in a tensile testing machine to assess the mechanical performance of the repairs. Outcome measures included gap formation and ultimate forces. The gap strengths of the double-modified Kessler technique (30.85 N, SD 1.90) and double-modified Kessler technique with inner cruciate configuration (33.60 N, SD 4.64) were statistically significantly greater than that of the two-strand modified Kessler (22.56 N, SD 3.44) and modified Kessler with additional purchase configuration (21.75 N, SD 4.03; Tukey honestly significant difference test, P < 0.000). There were statistically significant differences in failure strengths of the all groups (analysis of variance, P < 0.000). With an identical number of strands, the gap formation and ultimate forces of the repairs were not changed by additional locking purchase point in modified Kessler repair or changing the inner strand configuration in double-modified Kessler repair. The results of this study show that the number of strands across the repair site together with the number of locking loops clearly affects the strength of the repair; meanwhile, the longitudinal strand orientation and number of purchase points in a single loop did not affect its strength. © American Association for Hand Surgery 2008.
The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study
(Springer, 2011) Kilicarslan, Kasim; Yalcin, Nadir; Cicek, Hakan; Dogramaci, Yunus; Ugurlu, Mahmut; Ozkan, Hamdi; Yildirim, Hasan
The apparent synovial hypertrophy in some cases of noninflammatory knee osteoarthritis suggests that total synovectomy may provide beneficial inflammatory and pain relief after total knee arthroplasty. The aim of the study was to compare the effect of synovectomy on the postoperative pain, bleeding and functional outcome after surgical treatment of knee osteoarthritis. A total of 50 patients with bilateral, non inflammatory, primary knee osteoarthritis were included in the study. Bilateral total knee replacement was performed at the same session. Total synovectomy and total knee arthroplasty (study group) were applied to a randomly selected side, and the total knee arthroplasty alone (as control group) was applied to the contralateral side of the same patient. The overall efficacy of both procedures was assessed postoperatively by determination of blood loss from the drain, pain and functional scores. The Visual Analogue Scale of pain and the Knee Society Knee Score were used to compare the two groups at 3rd, 6th and 12th months, postoperatively. During the postoperative 48 h, the mean blood loss in the study group (with synovectomy) was significantly higher than the control group (P = 0.005). However, in the postoperative follow-up time, there was no significant difference in pain relief and in the Knee Society Score between the two groups. Performing synovectomy in patients with primary knee osteoarthritis does not seem to have any clinical advantage besides it might increase blood loss and recurrent hemarthrosis postoperatively. Thus, during arthroplasty surgery, it should not be performed routinely.
Effectiveness of Ozone Therapy on Tendon Healing: An Experimental Study in Generated Achilles Tendon Injury Model in Rats
(Journal Hard Tissue Biology, 2018) Kizilkaya, Volkan; Uruc, Vedat; Levnet, All; Kanat, Ozgur; Yildizgoren, Mustafa Turgut; Dogramaci, Yunus; Kalacı, Aydıner
The aim of this experimental study was to investigate the effects of ozone therapy on tendon healing in rats. A total of 60 adult male, 1-year old Wistar albino rats weighing 450-500 g were randomly assigned to the ozone group (Group 1, n:30) or the control group (Group 2, n:30). In both groups, the right and left Achilles tendons were cut transversally and then sutured. Group 1 underwent ozone treatment rectally (40 mu g/mL) four times a week, while Group 2 received only nutrition and routine care. Ten rats from each group were sacrificed and evaluated in respect of histopathological and biomechanical properties at the end of the 2nd, 4th and 6th weeks. There were statistically significant differences between the groups in respect of fibroblastic proliferation (p=0.042) and inflammation (p=0.001) in the 2nd week. Fibroblastic proliferation was higher in the ozone group, and inflammation in the control group was found to be higher. Remodeling and fibroblastic proliferation were significantly increased in the ozone group in the 4th week (p = 0.007 and p=0.003, respestively). In the 6th week, high remodeling and high fibroblast proliferation were observed in the ozone group compared with the control group (p=0.020, p=0.004, respectively). The biomechanical results revealed that the ozone group had significantly higher breaking load and breaking tensile stress values than the control group in the 6th week (p = 0.007, p = 0.003, respectively). The histopathological and biomechanical findings indicated that the ozone therapy had beneficial effects on Achilles tendon rupture healing.
Effects of a Single Application of Adcon Gel on Peritendinous Adhesion: An Experimental Study in Rabbits
(Journal Hard Tissue Biology, 2014) Ozden, Raif; Uruc, Vedat; Duman, Ibrahim Gokhan; Dogramaci, Yunus; Kalacı, Aydıner; Komurcu, Erkam; Ozsoy, Sule Yurdagul
Peritendinous adhesions are serious complications after surgical repair of tendons and can lead to poor functional outcome. In the present study, the tensile strength of repaired tendons was measured biomechanically in two groups using a rabbit Achilles tendon model, and the effects of Adcon gel on peritendinous adhesions and tendon healing were examined by means of histological and mechanical analyses. In the treatment group, the Achilles tendon was transected, followed by a primary repair using a modified Kessler technique, and Adcon gel was injected between the tendon and skin of the right leg. The same operation was done for the control group, and 1 mL of normal saline solution was applied locally in a similar fashion. The experimental protocols were approved by the local animal ethics committee. Microscopic evidence of the formation of adhesions and of inflammation was less in the treatment group than in the control group. There was no significant difference in the tensile load necessary to rupture the repaired tendons between the two groups. Adcon gel reduced the peritendinous adhesions histologically without impairing tendon healing, as determined with mechanical analyses. The use of Adcon gel may provide a simple means of preventing of postoperative peritendinous adhesions, thereby offering a beneficial effect on tendon repair.
Effects of a Single Application of Extractum Cepae on the Peritendinous Adhesion An Experimental Study in Rabbits
(Lippincott Williams & Wilkins, 2010) Dogramaci, Yunus; Kalacı, Aydıner; Atik, Esin; Esen, Erdinc; Altug, Muhammet Enes; Onel, Ercument; Koc, Ahmet
Peritendinous adhesion is an important cause of poor functional outcome after flexor tendon repair. The objective of this study was to investigate the effect of a single intraoperative application of extractum cepae, an extract of dietary onion, on the peritendinous adhesion, using a rabbit model of flexor tendon injury. The first, second, and third digits of the right hind paw of 18 rabbits were used for tendon operations. A standard partial division of the synovial sheath and flexor tendon was done at zone II to stimulate the adhesion formation. In the treatment group (n = 9 rabbits, 27 tendons), the flexor tendon sheath was treated with 50 mg/mL of extractum cepae which was applied locally and allowed to infiltrate for 5 minutes, the skin was sutured without suturing the sheath and the tendons. The same operation was done for the control group (n = 9 rabbits, 27 tendons) and 1 mL of normal saline solution was applied locally. Biomechanical and histologic evaluations of the specimens were done after 3 weeks. Tendons from the first toes were used for biomechanical studies. The second and third toe tendons were used for histopathologic evaluation. We have compared the peritendinous adhesions and the ultimate forces in the control and treated tendons. There were no statistically significant differences between the 2 groups with respect to the ultimate loads. Adhesion formation was absent in 1 tendon (5.5%), slight in 8 (44.4%), moderate in 6 (33.3), and severe in 3 tendons (16.7%) in the extractum cepae treated group (n = 18); while in the control group (n = 18), it was absent in 1 tendon (5.5%), slight in 1 tendon (5.5%), moderate in 3 (16.6%), and severe in 13 (72.4%) tendons. There was a significant reduction (P = 0.01) in the peritendinous adhesion in the treated group comparing to the control group. The problem of adhesion formation may be minimized using a single intraoperative application of extractum cepae.
Endoscopy-assisted distal locking of an intramedullary nail: A new experimental technique to reduce radiation exposure during distal locking of the intramedullary nails
(Turkish Joint Diseases Foundation, 2021) Davut, Serkan; Dogramaci, Yunus
Objectives: In this study, we aimed to introduce a new technique in which distal locking step was easier and safer for orthopedic trauma surgeons involving in the treatment of long bone fractures using an intranail endoscopic visualization and illumination method. Materials and methods: A total of 20 fresh bovine hind limbs derived from healthy adults and killed for sale were dissected to obtain tibial bones. Two equal groups including 10 samples in each were prepared. We applied a standard nailing process in both groups: the study group (n=10) was locked by the new technique, intranail endoscopic illumination guidance and intranail visualization assistance locking technique and the control group (n=10) was locked by the classical free-hand fluoroscopic guidance technique. We measured the surgical period time and the radiation exposure time required for the distal locking in both groups. Results: The radiation exposure time was statistically significantly lower in the study group compared to the control group. Also, the time period required for distal locking in the study group were statistically significantly lower than the control group. With the use of the intranail endoscopic illumination guidance and visualization assistance technique, the median period time required for the distal locking procedure reduced from 477.5 to 223.5 sec (p<0.001). The median time for radiation exposure dramatically reduced from 13.5 to 2 sec (p<0.001). The median attempt number reduced from 6.5 to 2 times (p<0.001). Conclusion: This experimental study indicates that the endoscopic illumination and intranail visualization assistance technique can reduce the radiation exposure time and the period time required for distal locking compared to the free-hand
Evaluation of the relationship between the anatomical characteristics of the vastus medialis obliquus muscle and the patella chondral lesion occurrence
(Turkish Joint Diseases Foundation, 2024) Davut, Serkan; Dogramaci, Yunus
Objectives: The study aims to investigate the relationship between the vastus medialis obliquus (VMO) muscle distal insertion features and patellar chondral lesion presence. Patients and methods: This cross-sectional study included a total of 100 patients (18 males, 82 females, mean age 67.2 +/- 7.1 years; range, 50 to 86 years) who underwent total knee arthroplasty (TKA). Radiological assessments, including merchant view and standing orthoroentgenograms, were conducted. The current osteoarthritis stage, varus angle, quadriceps angle (Q angle), patella -patellar tendon angle (P -PT angle), congruence angle, and sulcus angle were calculated. The VMO tendon length, muscle fiber angle, tendon insertion width measurements, and patellar chondral lesion localization data were obtained intraoperatively. Grouping was done according to the distal insertion width of the VMO tendon to the medial edge of the patella. The medial rim of the patella was divided into three equal -sized sectors. The first group (Group 1, n=31) consisted of patients who had an insertion from the quadriceps tendon into the upper one-third of the patella. The second group (Group 1, n=48) consisted of patients with a distal insertion expanding into the middle one-third of the patella. The third group (Group 3, n=21) consisted of patients who had a distal insertion extending into the distal third region of the medial patella margin. The patella joint surface was divided into sectors, and the presence and location of cartilage lesions were noted in detail. Results: The mean tendon insertion width rate was 45.99 +/- 16.886% (range, 16.7 to 83.3%). The mean muscle fiber insertion angle was 51.85 +/- 11.67 degrees (range, 20 degrees to 80 degrees). The mean tendon length was 12.45 +/- 3.289 (range, 4 to 20) mm. There was no significant difference between the mean age, weight, height, body mass index, BMI, fiber angle, tendon length, varus angle, Q angle, sulcus angle, and congruence angle data among the groups. In terms of the P -PT angle, Groups 1 and 2 had a significant relationship (p=0.008). No relationship was found between the mean fiber insertion angle, mean tendon length, or the presence of chondral lesions. There was a statistically significant difference among the groups regarding the presence of chondral lesions. The highest percentage of chondral lesion frequency was observed in Group 3 (95.24%), followed by Group 1 (90.3%) and Group 2 (89.6%), respectively. Compared to the other two groups, Group 3 had a higher average ratio of lesion areas per patient. Conclusion: Our study results demonstrate that the formation and localization of the patellar chondral lesions are affected by the insertion width type of the VMO muscle into the patella. Group 2 -type insertion is associated with a lower lesion frequency rate than Groups 1 and 3.

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