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Öğe 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, MehmetCurrently 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.Öğe 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, ErhanIntroduction: 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.Öğe 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 TayarThe 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.Öğe 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, ErkamWe 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.Öğe 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, ErkamWe 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.Öğe 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, YunusPeripheral 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.Öğe The Effect of Cape on Steroid Induced Osteonecrosis of the Femoral Head in Rat Model Hide(Journal Hard Tissue Biology, 2018) Uruc, Vedat; Duman, Ibrahim Gokhan; Davul, Serkan; Ozden, Raif; Gonenci, Ramazan; Gokce, Hasan; Dokuyucu, RecepThe aim of this experimental study was to examine the effect of Caffeic acid phenethyl ester (CAPE) on steroid-induced osteonecrosis of femoral head (ONFH) in rats. Thirty-one male Wistar albino rats were divided into 4 groups: control group (7 rats), methylprednisolone treatment group (MPS, 8 rats), CAPE treatment group (8 rats) and MPS+CAPE administered group (8 rats). The rats of group MPS and CAPE+MPS, On days 2, 3 and 4 were treated with 20 mg/kg/day methylprednisolone (MPS; Pfizer Pharmaceutical, Puurs, Belgium) intramuscularly. 10 mu mol/kg/day CAPE was intraperitoneally injected to the rats of group CAPE from 13 weeks of age for 4 weeks. The control group was fed and housed under identical conditions without any treatment. All rats were sacrificed at 17 weeks of age by taking blood from the heart. Both proximal femoral parts were taken for histopathological and immunohistochemical analysis . Total oxidant status, total antioxidant status, and oxidative stress index (OSI), lipid parameters, coagulation parameters were assessed in blood specimens. Much lesser amount of osteonecrosis lesions were observed in the MPS+CAPE group compared to MPS group. In immunhisochemical analysis, oxidative stress was found significantly decreased in CAPE+MPS group compared to MPS group. OSI levels were significantly decreased in CAPE+MPS group compared to MPS group (p<0.001). In CAPE+MPS group lipid and coagulation parameters were found positively affected compared to MPS group. In conclusion, CAPE has strong protective effect against the steroid induced femoral head osteonecrosis in rats.Öğe The effect of social support and severity of the disease on posttraumatic growth in ankylosing spondylitis(Acta Medica Mediterranea, 2014) Yagiz, Abdullah Erman; Kokacya, Mehmet Hanifi; Copoglu, Umit Sertan; Uruc, Vedat; Paksoy, Hacer; Yengil, Erhan; Ustun, NilgulAim: Posttraumatic growth (PTG) is described as the positive psychological changes after struggling with highly challenging life circumstances. This study aimed to evaluate PTG in patients with ankylosing spondylitis (AS) who were characterised with posture and joint motion disorders. The clinical and social factors that play a role in the development of PTG were also investigated. Materials and methods: Eighty AS patients aged 18 to 65 years were included in the study. Disease activity was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status by the Bath Ankylosing Spondylitis Functional Index (BASFI) and spinal mobility by the Bath Ankylosing Spondylitis Metrology Index (BASMI). For the evaluation of the positive psychological changes posttraumatic growth inventory (PTGI) was used, as multidimensional scale of perceived social support (MSPSS) and ways of coping inventory were respectively used to assess social support and coping strategies. Results: The population consists of 58 male and 22 female subjects. The mean total scores of PTG, total social support and coping inventory were 67.90 ± 18.96, 66.42 ± 14.52 and 96.97 ± 10.43, respectively. The total PTG scores were significantly higher in women than in men (p=0.016). BASDAI and BASFI were negatively correlated with PTG, whereas ways of coping and social support were positively correlated with PTG (p=0.001, r=0.352; p=0.044, r=0.226). Conclusion: Social support and ways of coping have a positive effect, whereas disease severity and poor functional index have a negative effection the development of PTG.Öğe THE EFFECT OF SOCIAL SUPPORT AND SEVERITY OF THE DISEASE ON POSTTRAUMATIC GROWTH IN ANKYLOSING SPONDYLITIS(Carbone Editore, 2014) Yagiz, Abdullah Erman; Kokacya, Mehmet Hanifi; Copoglu, Umit Sertan; Uruc, Vedat; Paksoy, Hacer; Yengil, Erhan; Ustun, NilgulAim: Posttraumatic growth (PTG) is described as the positive psychological changes after struggling with highly challenging life circumstances. This study aimed to evaluate PTG in patients with ankylosing spondylitis (AS) who were characterised with posture and joint motion disorders. The clinical and social factors that play a role in the development of PTG were also investigated. Materials and methods: Eighty AS patients aged 18 to 65 years were included in the study: Disease activity was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status by the Bath Ankylosing Spondylitis Functional Index (BASFI) and spinal mobility by the Bath Ankylosing Spondylitis Metrology Index (BASMI). For the evaluation of the positive psychological:changes posttraumatic growth inventory (PTGI),Was used as multidimensional scale of perceived octal support (MSPSS) and ways of coping inventory were respectively used to assess social support and coping strategies. Results: The population consists of 58 male and 22 female subjects. The Mean total scores of PTG, total social support and coping inventory were 67.90 +/- 18.96, 66.42 +/- 14 52 and 96.97 +/- 10.43, respectively. The total PTG scores were significantly higher in Women than in men (p=0.016). BASDAI and BASFI were negatively correlated with PTG, whereas ways of coping and social supF port were positively correlated with PTG (p=0.001, r=0352; p=0.44, r=0226). Conclusion: Social support and ways of coping have a positive effect, whereas disease severity and poor functional index have a negative effection the development of PTG:Öğe 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, AydınerThe 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.Öğe 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 YurdagulPeritendinous 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.Öğe Effects of Gaseous Ozone Treatment on Bone Regeneration in Femoral Defect Model in Rats(Journal Hard Tissue Biology, 2017) Duman, Ibrahim Gokhan; Davul, Serkan; Gokce, Hasan; Gonenci, Ramazan; Ozden, Raif; Uruc, VedatThe purpose of this study was to investigate the effect of ozone therapy in rat femoral fractures. Following the right open femoral fractures and intramedullary Kirschner wire fixation of the fracture in 60 male Wistar albino rats, the animals were divided into two groups of 30 animals each: ozone therapy group (n=30); non-treatment (control) group (n=30). Ozone was administered by rectal insufflation. After the rats were sacrified fracture healing was assessed by biomechanical and histopathologic evaluation. Histological and mechanical findings indicated that the ozone therapy had a significantly positive effect on bone healing.Öğe Five cases of early dissociation between the bipolar hip endoprosthesis cup components; either spontaneously or during reduction maneuvers(Turkish Assoc Orthopaedics Traumatology, 2017) Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Kalacı, AydınerBipolar hemiarthroplasty is frequently used in the treatment of intracapsular hip fractures. Dissociation of the bipolar components can happen during the hip dislocation, the reduction maneuvers, or spontaneously without any dislocation. Here we report early dissociation between bipolar components in two cases during the attempt of closed reduction maneuvers and three cases with spontaneous dissociation without any trauma. To prevent or minimize this complication; the reduction of dislocated hips must be achieved very gently under general anesthesia with fluoroscopic control. During the initial operation the surgeons must be sure that the bipolar components are locked to each other and after final reduction, especially in osteoarthritic acetabulums, that the cup position is not in varus position. (C) 2017 Publishing services by Elsevier B.V. on behalf of Turkish Association of Orthopaedics and Traumatology.Öğe Four cases of unusual complete cervical ribs articulating with the hypertrophied scalenetubercle with different clinical presentations(Lippincott Williams and Wilkins, 2016) Uruc, Vedat; Ozden, Raif; Kalac, Aydiner; Basarslan, Seyit K.; Bayaro?ullar, HanefiThoracic outlet syndrome (TOS) is defined as the signs and symptoms caused by compression of brachial plexus and subclavian vessels in the cervicoaxillary region. Cervical ribs are very rare causes of TOS. Most of them are asymptomatic and incidentally diagnosed during routine chest x-ray. We presented here 4 cases of unusual cervical ribs articulating with hypertrophied scalene tubercle with different clinical presentations including: TOS, palpable mass at the supraclavicular region, and asymptomatic. TOS was treated surgically with good results. In conclusion, complete cervical costa, articulating with hypertrophied scalene tubercle is a very rare cause of TOS. Scalenotomy and complete resection of the cervical rib is a good choice for treatment. In addition, the cervical ribs should be considered in the differential diagnosis of the palpable masses seen at the supraclavicular regions. Plain radiographs are enough for diagnosis; however, 3-dimensional computerized tomography provides many advantages in preoperative surgical planning and demonstrating the articulating structure of the cervical ribs in a detailed manner. © 2014 Wolters Kluwer Health, Inc. All rights reserved.Öğe Major musculoskeletal injuries and applied treatments in the current conflicts in Syria(Acta Medica Mediterranea, 2014) Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gökhan; Dogramaci, Yunus; Yengil, Erhan; Karapinar, Serhat; Karakus, AliAims: The aim of this study was to document the types of musculoskeletal injuries, mechanism of injuries and applied treatments during the Syrian civil war. Materials and methods: 579 (520 male, 59 female) Syrian civilian war victims who were treated in our clinic from December 16, 2011 till August 17, 2013. The mean age was 30 years (range: 1-90 years). Anatomic distribution and mechanism of injuries, and applied treatments were the main outcomes. Results: 449 subjects were wounded by gunshot, 44 by blast injuries and 86 by other causes. 668 open fractures and 98 closed fractures were treated. 514 grade 3a open fractures which were relatively clean and early-admitted were treated as immediate aggressive debridement and internal fixation. Early infection rate was 2.7% (n=14). Eight subjects had 10 grade 3b open fractures. Seventy patients presented with 99 grade 3c open fractures. Totally 84 external fixations were applied. 138 major amputations were done in 69 subjects. Wound infections were seen in 77 patients (13.2%). 29 of them were previously operated under non-sterile conditions in Syria. Debridement & irrigation (D&I) was the most commonly applied treatment. Conclusion: In conclusion gunshot was the main wounding agent in the recent Syrian conflicts, D&I was the most commonly applied treatment. In the treatment of relatively clear and early arrived grade 3a open fractures, internal fixation, after aggressive debridement and irrigation, resulted with low infection rates and it can be considered as a good choice of treatment. Prior interventions under non-sterile conditions were associated with 63% of resistant infections and extend the duration of hospital stay. Early evacuation and thorough debridement will result in lower infection rates.Öğe MAJOR MUSCULOSKELETAL INJURIES AND APPLIED TREATMENTS IN THE CURRENT CONFLICTS IN SYRIA(Carbone Editore, 2014) Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Dogramaci, Yunus; Yengil, Erhan; Karapinar, Serhat; Karakus, AliAims: The aim of this study was to document the types of musculoskeletal injuries, mechanism of injuries and applied treatments during the Syrian civil war. Materials and methods: 579 (520 male, 59 female) Syrian civilian war victims who were treated in our clinic from December 16,2011 till August 17,2013. The mean age was 30 years (range: 1-90 years). Anatomic distribution and mechanism of injuries, and applied treatments were the main outcomes. Results: 449 subjects were wounded by gunshot, 44 by blast injuries and 86 by other causes. 668 open fractures and 98 closed fractures were treated. 514 grade 3a open fractures which were relatively clean and early-admitted were treated as immediate aggressive debridement and internal fixation. Early infection rate was 2.7% (n=14). Eight subjects had 10 grade 3b open fractures. Seventy patients presented with 99 grade 3c open fractures. Totally 84 external fixations were applied. 138 major amputations were done in 69 subjects. Wound infections were seen in 77 patients (13.2%). 29 of them were previously operated under non-sterile conditions in Syria. Debridenzent & irrigation (D&I) was the most commonly applied treatment. Conclusion: In conclusion gunshot was the main wounding agent in the recent Syrian conflicts, D&I was the most commonly applied treatment. In the treatment of relatively clear and early arrived grade 3a open fractures, internal fixation, after aggressive debridement and irrigation, resulted with low infection rates and it can be considered as a good choice of treatment. Prior interventions under non-sterile conditions were associated with 63% of resistant infections and extend the duration of hospital stay. Early evacuation and thorough debridement will result in lower infection rates.Öğe A New Anchor Augmentation Technique With a Cancellous Screw in Osteoporotic Rotator Cuff Repair: An In Vitro Biomechanical Study on Sheep Humerus Specimens(W B Saunders Co-Elsevier Inc, 2014) Uruc, Vedat; Ozden, Raif; Dogramaci, Yunus; Kalacı, Aydıner; Hallaceli, Hasan; Kucukdurmaz, FatihPurpose: The aim of this study was to test a simple technique to augment the pullout resistance of an anchor in an over-drilled sheep humerus model. Methods: Sixty-four paired sheep humeri were harvested from 32 male sheep aged 18 months. Specimens were divided into an augmented group and non-augmented group. FASTIN RC 5-mm titanium screw anchors (DePuy Mitek, Raynham, MA) double loaded with suture material (braided polyester, nonabsorbable USP No. 2) were used in both groups. Osteoporosis was simulated by over-drilling with a 4.5-mm drill. Augmentation was performed by fixing 1 of the sutures 1.5 cm inferior to the anchor insertion site with a washer screw. This was followed by a pull-to-failure test at 50 mm/min. The ultimate load (the highest value of strength before anchor pullout) was recorded. A paired t test was used to compare the biomechanical properties of the augmented and non-augmented groups. Results: In all specimens the failure mode was pullout of the anchor. The ultimate failure loads were statistically significantly higher in the augmented group (P < .0001). The mean pullout strength was 121.1 +/- 10.17 N in the non-augmented group and 176.1 +/- 10.34 N in the augmented group. Conclusions: The described augmentation technique, which is achieved by inferior-lateral fixation of 1 of the sutures of the double-loaded anchor to a fully threaded 6.5-mm cancellous screw with a washer, significantly increases the ultimate failure loads in the over-drilled sheep humerus model. Clinical Relevance: Our technique is simple, safe, and inexpensive. It can be easily used in all osteoporotic patients and will contribute to the reduction of anchor failure. This technique might be difficult to apply arthroscopically. Cannulated smaller screws would probably be more practical for arthroscopic use. Further clinical studies are needed.Öğe Protective Effect of Hypericum perforatum Extract on Methotrexate-Induced Osteotoxicity via Reducing Oxidative Stress and MAPK Activity(Asian Network Scientific Information-Ansinet, 2020) Uruc, Vedat; Salimov, Fariz; Kaplan, Halil MahirBackgrounds and Objective: Methotrexate (MTX) is an anti-metabolite and anti-rheumatic drug that is widely used in cancer treatment. It is known that a high dose of MTX chemotherapy causes bone growth disturbance in developing bones. Hypericum perforatum (HP) plant is useful against some diseases for local people and regulates apoptosis which is also known as programmed cell death and recent studies also reported that HP reduces the side effects of many toxic drugs. For this reason, we planned a study to reveal the osteoprotective effect of HP extract against MTX induced osteo-toxicity. Materials and Methods: For this purpose MLO-Y4 cells were cultured, then these cells were treated with HP and methotrexate and mediators of the apoptotic, MAPK pathway and the oxidative stress parameters were analyzed on these cells. Results: Expression of proapoptotic factors increased and expression of antiapoptotic factors were decreased with MTX treatment. Treatment of HP ameliorated the apoptotic effect of MTX on MLO-Y4 cells. HP treatment also inhibited MAPK activity and oxidative stress induced by methotrexate. Conclusion: HP attenuated methotrexate-ind uced osteo-toxicity via reducing oxidative stress and MAPK activity and HP is an effective reducing side effect of MTX.Öğe Spontaneous atraumatic extensor pollicis longus rupture in healthy individuals due to steroid injection: Two case reports(Medi+World Int, 2014) Ozden, Raif; Uruc, Vedat; Duman, Ibrahim Gokhan; Dogramaci, Yunus; Kalacı, Aydıner; Komurcu, ErkamIntroduction: Local steroid injection is believed to be associated with risk of spontaneous tendon rupture. Spontaneous rupture of the extensor pollicis longus (EPL) tendon at the wrist is infrequent and essentially described after fracture of the distal radius. Rough bone ends, rheumatoid arthritis, lupus erythematosus, synovitis or tenosynovitis both contribute to this process. The aim of this study is to define rupture of the EPL tendon with review of the literature in two cases after receiving local steroid injections. Case presentation: The operative records for two patients undergoing EPL reconstruction by an author were criticized. All 2 patients had exposure to local steroids but this exposure was not into the ruptured tendon. It is administered about 2 cm away from the tendon. We identified 2 patients who presented with spontaneous EPL tendon rupture owing to steroid injection. These patients reported no risk factors or inciting event other than steroid injection. EPL were operatively repaired in two cases. At the 2-year follow-up, patients could completely extend the thumb. The cases were from the Eastern Mediterranean region of Turkey. Conclusion: In patients with unexpected loss of extension of the thumb interphalangeal joint, with a history of steroid injection, rupture of EPL tendon should be considered even if it was administered to remote location.Öğe The Treatment of Clubfoot with the Ponseti Method: A Systematic Review(Derman Medical Publ, 2014) Sayit, Emrah; Uruc, VedatThough talipes equinovarus, or clubfoot, is a fairly common birth defect occurring once out of every 1,000 live births, its precise etiology is still poorly understood. Genetics, connective tissue disorders, and problems during pregnancy have been proposed as causes but it is likely that several pathways contribute to this particular dysmelia. Among the current treatment options available, the Ponseti method, which is a noninvasive manipulative technique, rapidly spread since its first description. Today it is the most widely adopted treatment method in the world. Although the manipulative technique is a drawn-out process that requires patience and effort on the part of both the clinician and the family, the Ponseti method should be upheld as the conventional treatment option orthopedists practice due to relatively low costs and positive success rates.
