Study Design: Repeated Measures.

Objectives: To determine the short term impact of cold water immersion on sensory and vascular functions in patients with Distal Radius Fracture (DRF) and compare responses in the injured and uninjured hands.

Background: Cold exposure is used to assess neurovascular function. Cold is also used as therapeutic agent to reduce pain and swelling. There is a scarcity of trials that have looked at the impact of cold exposure in patients with DRF.

Methods: Twenty patients with DRF, aged 18 to 65 yrs. were recruited after cast removal. All patients underwent Immersion in Cold water Evaluation (ICE) which consisted of 5 min of hand immersion in water at 12°C. Skin Blood Flow (SBF) in hands, Skin Temperature (S Temp.) in index and little fingers and sensory Perception Thresholds (sPT) at 2000Hz (for Aβ fiber) and 5 Hz (for C fiber) were obtained from ring finger, before ICE, immediately after (0 min, 1 min) and 10 min later. Differences were analyzed using repeated measures.

Results: In the DRF hand, SBF increased immediately (Mean Difference = -42.2 A.U), at 1 min (-35 A.U) and 10 min after ICE (-1 A.U). Skin Temp. In index and little fingers decreased immediately after ICE (9.9°C and 9.1° C) and did not return to baseline by 10 min (4°C and 4.1°C). ICE had no effect on sPT at 5 Hz (p>0.05). There was no difference between the DRF and uninjured hand on all measures(p>0.05) except for the sPT at 2000Hz, which remained high on the DRF side for up to 10 min (-1.8 m. A).

Conclusion: Normal cold responses consistent with ‘hunting reaction’ were observed after ICE in both hands. Aβ fibers on DRF side became less sensitive after ICE. These findings suggest that a brief immersion in cold water does not produce any adverse events associated with cold exposure.

To ensure the possible accelerated osteogenesis of long bone fractures in patients with concomitant spinal cord injury and to investigate the mechanism causing it with the understanding of a possible neuro-hormonal cause, a hormonal bioassay of the blood of 21 of these patients was measured in the prospective controlled study and compared to 20 patients with only spinal cord injuries, 30 patients with only long bone fractures, and 30 healthy volunteers.

The study results showed that Long bone fractures in patients with associated acute traumatic spinal cord injury of quadriplegia or paraplegia heal more expectedly, faster and with exuberant florid union callus (P>0.001) and showed statistically significant higher levels of parathyroid hormone and growth hormone (p<0.005) and normal corticosteroids levels. Patients with long bone fractures only showed consistent and statistically significant higher level of noradrenaline and adrenaline hormones compared to patients with spinal cord injury alone or associated with long bone fractures (p<0.001). Leptin hormone shows statistically significant consistent decrease in patients with spinal cord injury and concomitant long bone fractures compared to healthy subjects (p<0.001). We believe, according to the results of this study that bone healing is accelerated in long bone fractures in patients with associated spine fractures and spinal cord injuries. We also can conclude that bone healing has a central neuronal control and a combined neuro- hormonal mechanism with a relative inhibition of the sympathetic nervous system is a possible cause of accelerated healing of long bone fractures in patients with associated spinal cord injury.

Background: Preoperative arthroscopic examinations were carried out in patients with varus deformity among those with osteoarthritis of the ankle caused by malalignment, and to assess the severity of the disease on the basis of the arthroscopic findings, and the associations of these findings with X-ray findings and the indications for supramalleolar osteotomy were evaluated.

Methods: A total of 57 joints in 56 patients were investigated, and the mean follow-up period was 4 years. The proportion of the surface area of the ankle that had become hardened into an eburnation was classified according to a five-grade scale on the basis of preoperative arthroscopy: Grade 1 indicated fibrillation of the articular cartilage alone with no evident eburnation; Grade 2, eburnation was limited to the medial malleolar articular surface; Grade 3, eburnation extended across the medial shoulder of the talus, but covered <25% of the talocrural joint; Grade 4, eburnation covered ≥25% but <50% of the talocrural joint; and Grade 5, eburnation covered ≥50% of the talocrural joint. The surgical procedure used was lateral closing wedge osteotomy, and assessments were carried out using Takakura, et al.’s clinical score and Tanaka, et al.’s radiographic grading system.

Results: Initially, 3 joints were Grade 1, 19 were Grade 2, 15 were Grade 3, 16 were Grade 4, and 4 were Grade 5. Postoperatively, 30 joints were Grade 1, 14 were Grade 2, 7 were Grade 3, 4 were Grade 4, and 2 were Grade 5. Clinical scores showed an improvement from 63.9±11.2 points preoperatively to 81.9±13.2 points postoperatively.

Conclusion: Patients who were classed as Grade 3 or below by preoperative arthroscopy showed improved clinical outcomes and radiographic grades. To assess the proportion of cartilage, that may be affect postoperative outcomes, preoperative arthroscopy should be done prior to the supramalleolar osteotomy.

Symptomatic OA is generally defined by the presence of pain, aching, or stiffness in a joint with radiographic OA. The age-standardized prevalence of symptomatic hand and knee OA is 6.8% and 4.9%, respectively, in Framingham subjects age ≥26 years. However, prevalence of symptomatic knee OA was 16.7% among subjects age ≥45 in the Johnston County Osteoarthritis Project, much higher than that reported in the Framingham Study. About 9% of subjects in the Johnston County study had symptomatic hip OA

Osteoarthritis, a chronically painful debilitating joint disease affecting many aging adults, is not always amenable to, or improved by current pharmacologic and surgical approaches. In light of the contribution of peri articular structures to the osteoarthritic pain cycle, this exploratory overview and opinion piece was designed to examine if there is sufficient evidence in favor of treating muscle both as the sole means of reducing osteoarthritic pain or as a supplementary strategy for minimizing joint pain and further joint damage. To this end, research that focused on the sources of osteoarthritis pain, especially those detailing some aspect of neuromuscular derived pain was assessed. As well, research examining the outcome of treating muscle as regards osteoarthritis pain was explored. The results show that muscle can be deemed to play a key role in the osteoarthritis pain cycle. Moreover, treatments directed towards improving muscle function in some way tend to yield pain relief, when used alone, or in combination with other approaches, regardless of joint or method examined. It is concluded more work to better understand the muscle pain linkages in osteoarthritis will produce both a better understanding of the pathology associated with this disease, as well as its amelioration.

T he Complex Regional Pain Syndrome type 1 (CRPS1) is a reflex sympathetic dystrophy syndrome, that occurs after an illness or injury that didn’t directly damage the nerves in your affected limb

Sarcomas are extremely heterogenous and exceedingly rare group of malignancies. Broadly, the term ‘sarcoma’ encompasses both Soft Tissue Sarcoma (STS) including GIST (Gastro Intestinal Stromal Tumors) and bone sarcomas, though there might be some overlap between the two entities. For the years together, the standard treatment for advanced/ metastatic STS was ifosfamide and / or doxorubicin based chemotherapy. Treatment for STS in yesteryears depended largely upon general sensitivity for chemotherapy and not for individual histological subtypes or translocation studies. However, in last few years, with the advent of new agents like imatinib, trabectidin, pazopanib and eribulin, a lot of things have changed. The success in bone sarcomas during this timeframe has not been as tangible as STS but newer therapies like denosumab and Rexin G have some potential activity in selected subsets. In this review, we will try to highlight the latest advances in both advanced/ metastatic STS and bone sarcomas.

Objective: This study aims to investigate the effect of ibandronate, which is a biphosphonate and acts by inhibiting osteoclasts in osteoporosis treatment, on fracture healing in rat tibia model.

Material and Method: 60 Wistar-Albino type male rats were divided into two groups as study (ibandronate) and control. Under general anesthesia standard closed fractures were created on right tibias of all rats using blunt ended needle holder by three point principle and then closed reduction and fixing with intramedullary nail (0.5 mm) were provided. The day of fractures were created, one oral dose of 250 μg ibandronate (Bonviva® tablet 150 mg, Roche, Istanbul, Turkey ) was given to each group A, B, C and D. 1 month after 250 μg oral dose administration to groups E and F the day the fractures were created, the second dose of 250 μg ibandronate was administered. The rats were killed at 2nd week in groups A and B, at 4th week in groups C and D, and at 6th week in groups E and F. Oral administrations were performed by the same person with 15 gauge plastic feeding through nasogastric gavage. Fracture healing was evaluated as biomechanically, radiologically and histologically.

Results: No positive or negative radiological, biochemical and histological effect of ibandronate was detected, starting from the first day and reaching to 6 weeks, in healing process of closed tibia fractures created and fixed with IM nails in rats.

In the year 1879 [1], Paul Segond mentioned about the Anterolateral Ligament (ALL) for the f irst time in orthopedic literature.

Lateral Epicondylitis, or more commonly called “tennis elbow,” is a musculoskeletal condition characterized by pain upon extension and contraction of the fingers, wrist, and elbow. Such elbow pain can oftentimes be debilitating, as patients find themselves unable to work, enjoy their hobbies, or perform simple household tasks