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Öğe The effects of osteoporosis on distraction osteogenesis: An experimental study in an ovariectomised rabbit model(2003) Arslan H.; Ketani A.; Gezici A.; Kapukaya A.; Necmioğlu S.; Kesemenli C.; Subasi M.The effects of oestrogen deficiency-associated osteoporosis on callus distraction were investigated in rabbits. Twenty-four female New Zealand rabbits 5 to 6 months old were used. Ovariectomy was performed on 12 rabbits, which composed the osteoporotic model group. Six weeks later, osteotomy was carried out and Ilizarov external fixators were applied to the right proximal tibial metaphyses in both the osteoporotic model group and the control group. Beginning one week postosteotomy, the metaphyses were distracted 0.35 mm twice daily for 3 weeks, and the average length increase obtained for both groups was 17.2 mm (minimum: 16.8, maximum: 19 mm). Following a postdistraction waiting period of 6 weeks for newbone formation, the subjects were sacrified and specimens were examined histopathologically. Radiography was carried out at one-week intervals during the distraction period and at 2-week intervals during the waiting period, and scintigraphy was performed at the end of each period. On histopathologic examination, a significant difference in callus remodeling was observed between the control and osteoporotic model groups. On radiologic evaluation it was observed that, while both groups had inadequate callus tissue at the end of the waiting period, callus formation and remodeling occurred later in the model group than in the control group, and the new bone was more osteoporotic. Osteoporosis associated with estrogen deficiency adversely affects the outcome of callus distraction. Nonetheless, radiographic findings in rabbits indicate that the effects may not be so great as to preclude clinical procedures. It was concluded that these results should be supported with clinical studies.Öğe Treatment of humeral diaphyseal nonunions by interlocked nailing and autologous bone grafting(2002) Kesemenli C.C.; Subasi M.; Arslan H.; Necmioğlu S.; Kapukaya A.Twenty seven patients with humeral diaphyseal nonunion treated with interlocked nailing and autogenous bone grafting were retrospectively assessed. The mean age was 37 years (28 to 59 years). There were 16 women and 11 men. An average of 11 months (8 to 36 months) had elapsed between the initial trauma or treatment and presentation in our clinic. The nonunion site was in the distal third of the humerus in 18 patients (66%) and in the middle third in 9 (34%). Seventeen (73%) had hypertrophic and 10 (37%) atrophic nonunion. Patients were treated with locked intramedullary nailing and autogenous cancellous bone grafting. The mean follow-up was 42 months (28 to 62 months), and the mean time to union was 4.8 months (2.5 to 11 months). Three patients developed superficial infection. Union was achieved in all cases but one, in which there was multiple nerve injury. According to Steward and Hundley's scoring, results were good in 24 patients, fair in 2, and poor in one. Interlocked nailing and autologous bone grafting has a good rate of union provided nails of appropriate diameter are used and distal and proximal locking is performed correctly. We think that its low rate of infection, low risk of injury to the radial nerve, and low requirement for soft tissue dissection make it a suitable choice in the treatment of nonunions of the humeral diaphysis.Öğe Treatment of refracture occurring after external fixation in paediatric femoral fractures(2004) Kesemenli C.C.; Necmioğlu S.; Kayikçi C.With a mean follow-up of four years, we assessed the outcomes of 11 refractures which occurred following paediatric femoral fractures treated by external fixation; the refractures were treated conservatively with simple immobilisation in a spica cast. A total number of 104 children with a femoral fracture were treated with external fixation between 1993 and 2000 in our institution. Refracture occurred in 11 cases after fixator removal. These patients were immediately placed in a hip spica cast. All 11 patients were boys, with a mean age of 7.3 years (range: 6 to 9), and the mean follow-up time was 4 years (range: 2 to 7). Mean hospitalisation time after refracture was 2 days (range: 0 to 4). Refractures occurred an average of 8 days (range: 1 to 21) after fixation removal. The mean time to union after refracture was 55 days (range: 35 to 62). On final evaluation, a mean limb length discrepancy of 0.9 cm (range: 0 to 2.5) was noted. Radiological study showed a mean lateral angulation of 5.6° (range: 0 to 17) and a mean anterior angulation of 7.4° (range: 0 to 20). Based on these findings, we believe that closed reduction and spica cast immobilisation is sufficient in cases with refracture of the femur after external fixation, but the option of surgical treatment should be considered when satisfactory anatomic reduction is not achieved.
