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    The biomechanical and histological effects of platelet-rich plasma on fracture healing
    (Springer, 2015) Guzel, Yunus; Karalezli, Nazim; Bilge, Onur; Kacira, Burkay K.; Esen, Hasan; Karadag, Hakan; Toker, Serdar
    Platelet-rich plasma (PRP) includes growth factors and proteins that accelerate and stimulate bone regeneration and tissue recovery. The aim of this study was to evaluate the effects of PRP on fracture healing in terms of biomechanics and histology. Seventy female rats were included in this experimental study. They were divided into three groups: Group I (no PRP, n = 30), Group II (PRP added, n = 30) and Group III (control, n = 10). The left femurs of the rats in Groups I and II were osteotomized and fixed by K-wires. Although no additional intervention was performed on Group I rats, PRP was applied to the fracture sites of Group II rats. The remaining ten rats were used as the control group of the biomechanical test (Group III). In the fourth week, nine femurs from Group I and ten femurs from Group II, and in the ninth week, nine femurs from each group were removed, and bone recovery was assessed histologically according to Modified Lane-Sandhu histological scoring criteria. Three-point bending test was applied to femurs for biomechanical evaluation in the ninth week. Histological healing was found to be significantly higher in Group II than in Group I (p < 0.05). Furthermore, biomechanical test results showed that healing quantity and bone strength were significantly better in Group II than in Group I (p < 0.05). PRP is a widely studied material in the physiology of fracture healing. The results of this study demonstrated the ameliorative biomechanical effects of PRP on fracture healing, in addition to accelerating the histological union of fractures. In the light of these results, PRP could be a viable alternative to accelerate the healing of fractures, late unions or non-unions. Prospective comparative study, Level II.
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    Closed Extensor Indicis Proprius Tendon Rupture Presenting Mass Clinic on Dorsal Side of the Wrist
    (Modestum Ltd, 2013) Kutahya, Harun; Gulec, Ali; Acar, Mehmet A.; Guzel, Yunus; Karalezli, Mustafa N.; Toker, Serdar
    A 28 years old male constructor referred to our clinic for a mass on the dorsal side of the left wrist. He has constricted his hand to the plaster cast machine in hyperflexion posture one month ago and swelling complaint has begun one week ago. MRI revealed tenosynovitis. A wide organized hematoma was appeared in the 4th extensor compartment in the surgical exploration of the patient and it was observed that extensor indicis proprius tendon has detached from the musculotendineous region. Common extensor tendon of the second finger was intact. Tenodesis to the distal end of the ruptured tendon to the intact common extensor tendon by side to side surgical suture technique was performed. There were complete extension in the 2nd finger at the 2nd month after the surgery.
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    Reconstruction of multiple fingertip injuries with reverse flow homodigital flap
    (Elsevier Sci Ltd, 2014) Acar, Mehmet A.; Guzel, Yunus; Gulec, Ali; Turkmen, Faik; Erkocak, Omer F.; Yilmaz, Guney
    Aim: Hand trauma may lead to multiple fingertip defects, causing functional restrictions. We evaluated the use of reverse-flow homodigital flap reconstruction of the distal phalanx and pulp defects associated with multiple finger injuries. Methods: We retrospectively evaluated 11 male patients who presented at our emergency department (January 2011-March 2013) with multiple fingertip injuries and who were treated with a reverse-flow homodigital flap. Evaluations included age, sex, defect size, flap survival rate, complications, cold intolerance, two-point discrimination, range of motion (ROM), quick disabilities of the arm, shoulder, and hand (DASH) score, and return to work time. Results: Completely, 22 reverse-flow homodigital flaps were applied to at least two fingertip injuries at the distal phalanx. Ten flaps survived postoperatively. The exception was partial flap loss on one finger. The mean follow-up was 14.2 months. At the final follow-up, the mean static two-point discrimination value was 10.3 mm. Mean ROMs of interphalangeal joints were 65.31 degrees (distal) and 105.77 degrees (proximal). Donor sites were covered with full-thickness skin grafts from the wrist or antecubital area. There were no complications related to the donor site and no development of cold intolerance in any finger. The mean quick DASH score was 4.12. All patients returned to work in an average of 8.3 weeks. Conclusions: The reconstruction of multiple fingertip injuries with reverse-flow homodigital flaps is a safe, effective method that can be combined with other local finger flaps. These flaps can be applied to two consecutive fingers without reducing finger length or function. (C) 2014 Elsevier Ltd. All rights reserved.