Aim

The purpose of this study was to analyze the patellofemoral kinematics in neglected adult developmental dysplasia of the hip patients with patellofemoral symptoms and tried to clarify the affect of the severity of dislocation, the amount of limb length discrepancy, the deviation of mechanical axis and the changes in femoral anteversion on patellofemoral alignment.

Aim: This study was designed to investigate the role of VEGF in the etiopathogenesis of osteoporosis and to investigate its relation with bone mineral density (BMD) and other parameters.

Patients and Method: Bone scanning with Dual Energy X-ray Absorptiometry (DEXA) was performed to a total of 276 patients older than 40 years in our hospital’s radiology department. A total of 88 patients in accordance with the study criteria were included. 44 patients were female and 44 were male. These patients formed 4 groups; the osteoporotic males (MO) (group 1, n: 22, BMD −2.5 < ), the normal males (MN) (group 2, n: 22, BMD −1> ), the osteoporotic females (FO) (group 3, n: 22, BMD −2.5 < ), and the normal females (FN) (group 4, n:22, BMD −1> ). BMD measurements were performed with DEXA. Serum VEGF level was determined by the endogenous Human VEGF ELISA kit.

Results: The difference between male and female patient group in terms of serum VEGF levels was not statistically significant (p= 0.12). The difference among 4 groups in terms of serum VEGF levels was not statistical significant (p=> 0.05). There was a negative correlation between BMI and BMD in male patients. In MN cases age was negatively correlated with serum VEGF levels, BMI was negatively correlated with BMD, and BMD was negatively correlated with VEGF levels. Again in males, BMD was negatively correlated with VEGF values.

Conclussion: We think that the reason why they could not reveal statistically significant differences between osteoporotic and normal groups was their small sample size. Additionally difference between groups would be significant with larger sample size. As shown in the present study, the statistically significant negative correlation between BMD values and VEGF levels established in the male normal (MN) group and in the evaluation within the male population, suggest that VEGF could play a role in male osteoporosis.

Aim: The aim of this study was to compare the treatment results of distal tibia shaft fractures treated with intramedullary nails with two different distal lockings and medial locking plates.

Patients and Method: Sixty-four patients with distal tibia fractures (4 to 11 cm proximal to the plafond) were operated with either unreamed intramedullary nails with medio-lateral distal locking (group A) or unreamed intra-medullary nails with both medio-lateral and antero-posterior lockings (group B), or medial locking plates (group C). There were 22 patients in group A, 22 patients in group B and 20 patients in group C. Mean age was 48.53±17.07 years. Mean follow-up was 26.68±7.02 months. At latest follow-up groups were compared for union time, malunion (defined as more than 5 degrees of angulation in any planes and/or any rotation and/or more than 5 milimeters of shortening), and delayed (lack of healing within 3 months) or nonunion (lack of healing within 6 months). Uninon was defined as healing of at least three of four cortices on AP and lateral radiographs.

Results: Mean union time was 17.45±4.22 weeks in group A, 16.71±4.90 weeks in group B and 15.73±3.26 weeks in group C. There was no significant difference between groups regarding union time. (p> 0.05) Malunion as defined was dedected in 4 patients in group A, in 4 patients in group B and in 1 patient in group C. There was no significant difference between groups regarding malunion rates. (p> 0.05). Delayed or non union was dedected in 6 patients in group A, in 5 patients in group B and in 1 patient in group C. There was no significant difference between groups regarding delayed or non-union. (p> 0.05). Two nonunions in group A and one nonunion in group B had to be treated with exchance reamed nailing. One infected nonunion in group C had to be treated with circular external fixation.

Conclusions: The results of surgical treatment of distal tibia fractures are similar with these three diifferent methods. Although malunion and delayed or nonunion rates are lower with medial locking plates, this is not significant.

Radiological evaluation is crucial for interpretation of experimental osteomyelitis studies. Current scoring systems for radiologic evaluation of experimental osteomyelitis have limitations to demonstrate differences among treatment groups. Response of bone tissue to infection is a dynamic process; each radiological sign of osteomyelitis becomes prominent at different time points of disease. Analysing radiological criteria separately at different stages of the disease may provide better quantification of the response to treatment in experimental osteomyelitis rather than summation of these grades together.

Osteomyelitis was induced with S.aureus in left tibias of 72 adult, wistar albino rats. Rats were assigned into six different treatment groups. Their radiograms were graded according to previously defined scoring systems, and each radiological criterion separately, at the third week of induction, and at the third and sixth week after treatment.

Although periosteal reaction and diaphyseal widening demonstrate significant differences with three weeks of treatment, previously defined scoring systems could not find significant differences. At the sixth week of treatment, only one of the previously defined grading scales was able to differentiate significance among the treatment groups. Individual values of diaphyseal widening, osteolysis, BMC values were pointed out differences among the groups in the presence of osteomyelitis, confirmed by osteomyelitis.

Formulation of radiological grading scales requires evaluation of periosteal elevation, diaphyseal widening, bone deformation, osteolysis, and osteosclerosis, individually. However, evaluation of these scores separately will multiply interpretations of future studies, and will make them more meaningful.

Bisphosphonates are systemically used for the treatment of metabolic bone diseases such as osteoporosis or aseptic loosening after joint replacement surgeries, and there are limited studies on their effects when applied locally. Furthermore, effects of biphosphonates in osteomyelitis treatment are not well-known. A prospective longitudinal randomised controlled study was designed for the rat tibia to test the efficacy of local or systemically administered bisphosphonates for controlling the localised osteolytic reactions and possible effects on local infection control.

Osteomyelitis was induced in the tibia of 72 Wistar albino rats with S. aureus ATCC 25923 strain. All rats in all treatment groups were given curettage and debridement surgery. Rats in Group I were left without any bone grafting. In Group II, dead space was grafted with plain bone graft, while in Group III rats were treated with vancomycin-loaded bone grafts. In group IV, defects were filled with vancomycin-loaded bone grafts, and this was combined with weekly subcutaneous alendronate application at a dose of 240 μg/kg/wk. At Group V defects were grafted with alendronate impregnated bone graft. Finally, rats in Group VI received vancomycin + alendronate impregnated grafts. Dependent variables were groups (n=6) and time (n=2) whereas independent variables were swab cultures, radiology, quantitative computerised tomography, dual energy X-ray absorptiometry and histopathology.

Within three weeks, S.aureus was isolated in all groups. Within six weeks, S.aureus was eradicated in Groups II and IV according to the results of swab cultures. Radiological diaphyseal widening was significantly lower (p=0.037) in Group VI at three weeks. Bone deformation, diaphyseal widening and osteolysis scores were lower in this group at six weeks. Bone mineral content and density measured by quantitative computerised tomography were significantly higher (p=0.001) in Groups IV and VI at six weeks. Bone mineral density measured by dual energy X-ray absorptiometry was significantly higher in Group IV at six weeks. Histology revealed marked osteoblastic activity in Groups IV and VI at six weeks.

Aim: We evaluated the clinical and radiologic results of patients treated by the minimally invasive technique and plate þxation in accordance with biological þxation principles for femoral fractures. Methods: Biological þxation principles were used in the treatment of 24 patients (18 males, 6 females; mean age 32 years; range 18 to 56 years) with femoral fractures. Fractures were reduced by indirect reduction and the plate was forwarded through distal and proximal incisions over the periosteum without the need for incisions on the fracture line. Fixation of the plates was performed with the use of screws from distal and proximal incisions. The patients were allowed partial and full weight-bearing in a mean of 3.6 and 5 months, respectively. By means of monthly clinical and radiologic examinations, union was assessed by callus formation in the fracture line and painless weight-bearing. In addition, leg length discrepancy, rotation, angulation deformities, and knee and hip range of motions were determined. The mean follow-up was 2 years and 7 months (range 16 months to 4 years and 5 months). Results: The mean union time was 4.6 months (range 4 to 11 months). Except for one patient (4%) with delayed union, all patients achieved union. No infections occurred related to the fracture site. Conclusion: Successful clinical and radiologic results can be obtained by biological methods of þxation in diaphyseal femur fractures with multiple fragments, segment formation, inmultitrauma patients with high Injury Severity Score and compromized pulmonary function, and in those having subtrochanteric or supracondylar fractures associated with high complication rates.