Bartu Sarısözen

Background and Objectives: Unicameral bone cyst (UBC) is a benign cystic lesion originating from the metaphysis, often extending toward the diaphysis as the individual grows. It is more common in boys aged 5–15 years, typically affecting long bones like the humerus and femur. UBC is usually asymptomatic and found incidentally on imaging, with pathological fractures being a common complication. Treatment options include conservative observation, percutaneous injection, and surgery. This study aims to compare the diagnostic, treatment, and follow-up processes of UBC cases across multiple centers in our country. Materials and Methods: This study reviewed 180 UBC cases in patients aged 0–20 from seven clinical centers in our country. Patient demographics, symptoms, diagnostic methods, treatment approaches, and follow-up data were collected. Radiological and histopathological diagnostic accuracy, treatment methods (conservative, percutaneous injection, surgical), and recovery were analyzed using Musculoskeletal Tumor Society (MSTS) scores and Capanna criteria. Results: Among 180 patients, 50% had pain. Most diagnoses were made through radiographic imaging, with 96.1% diagnostic accuracy. The humerus (44.7%) and femur (30.7%) were the most commonly affected bones. Pathological fractures were found in 35% of cases. Treatment included conservative (19%), percutaneous injection (31.8%), and surgery (49.2%). The average follow-up period was 81 months, with early complications being skin issues and late complications primarily limb shortening. Conclusions: The study highlights the effectiveness of different treatment approaches for UBC, showing that surgical treatment offers the best clinical outcomes, while percutaneous injection is a less invasive option. Treatment should be tailored to individual patient needs.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Purpose Titanium elastic nail (TEN) is a good option for femoral shaft fractures in school-age children, whereas a spica cast is favored for younger patients. We aimed to compare these treatment modalities in a group of children aged three to six years. Methods 34 patients aged 3–6 years with an isolated closed femoral shaft fracture treated with TEN or one-leg spica cast immobilization were retrospectively assessed. Age, gender, weight, mechanism of injury, hospital stay time, bone union time, radiographic shortening, malunion, and complications were compared between the treatment groups. Results 16 (47.1%) patients who were treated with TEN (Group T) and 18 (52.9%) patients with spica casting (Group S) were included with a mean of 51 (24–94) months follow-up. The mean age was 4.98 years and statistically similar between both groups (mean, 5.2 vs. 4.8 years; p = 0.234). The patients in Group T were heavier (mean, 19.3 vs. 17.2 kg; p < 0.001) and were more likely to have a higher-energy mechanism of injury (p = 0.006). The mean late femoral shortening of Group S patient’s was 6.5 ± 3.5 mm and significantly higher than Group T, which was 2.0 ± 2.9 (p = 0.050). However, effective late femoral shortening rates were not statistically different between groups (p = 0.347). Malunion was seen in six (33.3%) patients in Group S, whereas none of the patients in Group T had malunion at the last follow-up examination and were statistically different (p = 0.011). Conclusion Our study identified radiographic evidence favoring TEN over spica cast immobilization in treating preschool-age children with an isolated femoral shaft fracture in terms of malunion.

Objective: The aim of this study was to determine the effect of platelet-rich plasma (PRP) on bone regenerate consolidation in a rabbit model of distraction osteogenesis. Methods: In this study, 12 male New Zealand rabbits weighing 1600 to 2000 g were used. All the rabbits were randomly divided into two groups (n = 6 per group): PRP group and control group. A two-ring, circular external fixator was applied to the right tibia of each rabbit in both groups. After corticotomy, all the tibiae were distracted at a rate of 0.5 mm/day for 20 days. PRP was injected to the osteotomy sites on the 7th, 14th, and 21st days postoperatively. Mineral density of the new bone tissue formed in the distraction zone was measured using quantitative computed tomography in the 3rd, 4th, and 5th weeks. At the end of the 6th week, the animals were sacrificed, and the specimens were evaluated biomechanically and histologically. Results: Microcomputed tomography assessment showed significant bone mineral density increase from the 3rd to the 6th week (62.3% and 43.7% for the PRP and control groups, respectively). In the PRP group, the measurements on the 3rd, 4th, and 5th weeks were 416 ± 29, 487 ± 9.9, and 675 ± 37.8 HU (Hounsfield units), respectively, whereas in the control group were 313, 374, and 450 HU, respectively. In the comparison of weekly measurements of the two groups, the increase in bone density in the PRP group was higher than that in the control group (P < 0.001). During the mechanical tests, in the PRP group, the mean torsion was 46.50°and the mean torque 0.53 Nm, while in the control group, the mean torsion was 19.33°and the mean torque 0.65 Nm. The mechanical analysis of the groups revealed significant differences in the mean maximum torsion angles (P = 0.024). The histological examination showed that both groups had external and internal periosteal calli. Callus tissue in four rabbits in the PRP group and two rabbits in the control group was remodeled; normal bone formation occurred and distracted bone ends were completely healed. Conclusion: The results of the present study have indicated that PRP injection can enhance bone regenerate consolidation and increase bone mineral density during the healing process of distraction osteogenesis. Cite this article as: Karakayalı M, Alpay Y, Sarısözen B. Effect of platelet-rich plasma on bone regenerate consolidation in distraction osteogenesis: An experimental study in rabbits. Acta Orthop Traumatol Turc 2022; 56(1):9–14.

Objective: Osteoid osteoma, which is observed in the adolescent and young adult population as benign bone tumors, appears as a single nidus with a diameter < 2 cm and is treated with open surgery. However, technological advances in medicine have made it possible to apply less invasive procedures in surgery. Methods: Between 2006–2014, 24 patients < 18 years of age were treated for osteoid osteoma. Patient demographic data, surgical data, complications, and recurrences were noted. Results: Twenty-four patients (mean age, 11 [2–18] years) were treated and followed up for a mean 3.58 (range, 1–9) years. Mean patient age in the curettage group was 12.1 (range, 3–18) years. Mean operation length was 69.5 (range, 60–120) minutes. Mean hospital stay was 1.3 (range, 0–2) days. Mean patient age in the radiofrequency ablation (RFA) group was 10.7 (range, 2–17) years. Five patients were female and 8 were male. Mean operation length was 49.6 (range, 20–90) minutes. Mean hospital stay was 0.3 (range, 0–1) days. Mean follow-up time was 1.76 (range, 1–4) years. Mean operation length, hospital stay, and follow-up were significantly shorter in the RFA group. Conclusions: Considering reduced costs due to shorter hospitalization periods and the ability to reach anatomically difficult locations, percutaneous procedures are likely to replace the conventional open approach. Level of evidence: II, retrospective study.

Objective: Many different neoplastic and non-neoplastic lesions involve the skeletal system. Clinical and radiological tools primarily assess the nature of these lesions.The aim of this study was to analyze the cystic bone lesions in a pathologic point of view.Methods: All bone cysts between 2002 and 2013 retrospectively evaluated under the guidance of clinical information and radiological images. Descriptive data such as age, gender, tumor site, symptoms, and clinical and radiological findings obtained from the hospital’s database system. Results: There were 96 cystic bone lesions; 47 were aneurysmal bone cysts (ABCs), 37 were simple bone cysts (SBCs), one was a lesion with features of both ABC and SBC, four were intraosseous ganglia, four were epidermoid cysts, and three were hydatid cysts. The mean ages of the patients with ABCs and SBCs were 18.7 ± 12.8 years (range, 3-75 years) and 23.8 ± 13.3 years (range, 3-62 years), respectively. Most of the lesions located in the long bones.Conclusions: Cystic lesions of the bone rarely encountered in daily pathology routine. As with all conditions affecting the skeletal system, one of the most important steps towards an accurate pathological diagnosis is to perform with clinical and radiological information while evaluating the patients.

Purpose: We aimed to investigate the effects on post-operative pain of local anaesthetic administration via a catheter placed into the operation site in patients who were undergoing upper and lower extremity paediatric orthopaedic surgery. Methods: In this randomised, double-blind and placebo study, 40 ASA I–II patients aged between 1 and 12 years were randomly allocated into two groups: study group (Group S: 0.2 ml/kg, 0.5% bupivacaine, n = 20) and control group (Group C: 0.2 ml/kg, serum physiologic, n = 20). Before the fascia was closed by the surgical team, the solution previously prepared by the chief nurse was injected into the subfascial soft tissue with the syringe as the “injected dose” of serum physiologic or bupivacaine. After the closure, 0.2 ml/kg (1 mg/kg) bupivacaine or saline was instillated as the “first instillated dose” into the surgical area via the catheter. Pain scores were recorded at 0, 1, 2, 4, 8, 12, 24 and 48 h post-operatively. Patients were administered 0.75 mg/kg meperidine intramuscularly post-operatively to equalise the pain scores. Results: No statistically significant difference was found between Group S and Group C in terms of demographic and other data and pain scores in the post-anaesthesia care unit, while a statistically significant decrease was found at 2, 4, 8, 12, 24 and 48 h in Group S and at 1, 2 and 4 h in Group C based on pain scores in the post-anaesthesia care unit ( P < 0.05). A statistically significant decreasing pain score was found at 4, 8, 12, 24 and 48 h in Group S ( P < 0.05). Conclusion: The local anaesthetic administered via a catheter implanted in the surgical field may provide long-term and efficient post-operative analgesia.

Objectives: We evaluated the changes in electrophysiological characteristics of the contraction forces of the gastrosoleus complex due to stretching in experimental tibial lengthening.\r\nMethods: Distraction histiogenesis was performed in 22 guinea pigs weighing 600 to 800 g. Following the application of a semicircular external fixator and right tibial osteotomy, distraction was applied at a rate of 0.25 mm two times a day for 15 days without a latency period. The animals were randomized to two groups. In the study group, a foot plate preventing ankle plantar flexion was affixed to the external fixator, while ankle motions were unrestricted in the control group. On days 5, 10, and 15, the posterior tibial nerve was stimulated with a nerve stimulator at a constant frequency. Gastrosoleus muscle contractions were measured with a transducer and contraction forces were recorded.\r\nResults: On day 5, muscle contraction forces measured in the study group were much higher than the control group (p<0.05). On day 10, however, muscle contraction forces showed a rapid decline in the study group and, at the end of the study, muscle contraction forces decreased by 81% compared to the baseline values (p<0.05). Yet, throughout the study period, muscle contraction forces were always higher than the control group (p<0.05). In addition, the rate of the decrease in muscle strength slowed down after day 10 in the study group, and gastrosoleus function and strength were much better preserved. Equinus deformity developed progressively in the ankles of the control animals whose muscle contraction forces also showed significant decreases during the experiment (p<0.05).\r\nConclusion: In clinical applications of tibial lengthening, the strength of the gastrosoleus complex should be preserved to prevent equines deformity and maintain ankle functions. This can be achieved through gradual stretching of the muscle during distraction. If there is shortening before surgery or muscle stiffness is expected during lengthening, measures should be taken before distraction osteogenesis and muscle length should be preserved. Özet Amaç: Deneysel tibial uzatma sırasında gastrosoleus kas grubunda gerilmeye bağlı meydana gelen kas kasılma kuvvetlerindeki değişiklikler elektrofizyolojik olarak değerlendirildi.\r\nÇalışma planı: Ağırlıkları 600-800 gr arasında değişen 22 kobay (guinea pig) üzerinde distraksiyon histiogenezi uygulandı. Kobayların sağ tibialarına, semisürküler eksternal fiksatör uygulanmasından sonra osteotomi yapıldı ve latent periyot beklenmeden 15 gün boyunca günde iki kez 0.25 mm hızla distraksiyon gerçekleştirildi. Hayvanlar rastgele iki gruba ayrıldı. Bir gruba eksternal fiksatöre sabitlenen ve plantar fleksiyonu engelleyen ayak pedalı eklendi. Kontrol grubundaki deneklerin ayak bilek hareketleri serbest bırakıldı. Distraksiyonun 5, 10 ve 15. günlerinde posterior tibial sinir, sinir uyarıcısı ile sabit frekansta uyarıldı. Gastrosoleus kas kontraksiyonları elektriksel uyarım çeviricisi ile ölçülerek kaydedildi.\r\nSonuçlar: Beşinci günde, deney grubunda ölçülen ortalama kas kasılma kuvvetleri kontrol grubuna göre anlamlı derecede yüksek bulundu (p<0.05). Onuncu günde, deney grubunda kas kasılma kuvvetlerinde hızlı bir düşüş saptandı; 15. günde, başlangıç değerlerine göre kas kasılma kuvvetlerinde %81 oranında azalma vardı (p<0.05). Bununla birlikte, kas kuvvetleri başlangıçtan sona kadar kontrol grubundan yüksekti (p<0.05). Deney grubunda 10. günden sonra kas kasılma kuvvetlerindeki düşüşün yavaşladığı ve gastrosoleus fonksiyonunun daha iyi korunduğu izlendi. Kontrol grubundaki deneklerin ayak bileklerinde giderek ilerleyen ekinus deformitesi gelişti. Bu grupta da kas kasılma kuvvetlerinin deney süresince giderek azaldığı görüldü (p<0.05).\r\nÇıkarımlar: Klinik uygulamada, tibial uzatma sırasında ekinus deformitesinin engellenmesi ve ayak bileği fonksiyonlarının sağlanması için gastrosoleus kompleksinin kuvvetinin korunması; bu amaçla, uzatma sırasında kasın kademeli gerilmesinin sağlanması gerekmektedir. Kasta kısalık varsa veya kasta gerilme ve deformite bekleniyorsa, distraksiyon osteogenezisinden önce önlem alınması ve kas boyunun korunması önem taşımaktadır.