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    A rare cause of low back pain: primary Ewing sarcoma of the lumbar spine
    (Elsevier Science Inc, 2016) Resorlu, Hatice; Aras, Adem B.; Zateri, Coskun; Goksel, Ferdi
    [Anstract Not Available]
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    Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging
    (Soc Physical Therapy Science, 2015) Resorlu, Hatice; Resorlu, Mustafa; Gokmen, Ferhat; Akbal, Ayla; Adam, Gurhan; Komurcu, Erkam; Goksel, Ferdi
    [Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3 +/- 7.0 years, while it was 16.7 +/- 12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.
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    Atypical Localization of Enchondroma in the Calcaneus
    (Amer Podiatric Med Assoc, 2015) Komurcu, Erkam; Kaymaz, Burak; Golge, Umut Hatay; Goksel, Ferdi; Resorlu, Mustafa; Kilinc, Nihal
    A 53-year-old man presented to the orthopedic outpatient clinic with pain and swelling in the right heel without any trauma. On physical examination and radiologic assessment, a lesion with calcification and peripheral sclerosis was detected in the medullary cavity of the calcaneus, and computed tomographic images revealed cortical thinning adjacent to the lesion. Magnetic resonance images showed a 23 x 19-mm lesion. Tru-Cut biopsy, performed to clarify the diagnosis, revealed an enchondroma. As a definitive treatment, curettage of the lesion and grafting of the cavity was performed. Although enchondromas are common pathologic abnormalities of the skeleton and are usually asymptomatic, atypical localization, such as the calcaneus, and atypical clinical manifestations, such as heel pain, should also be kept in mind.
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    Comment on the article 'The biomechanics of guided growth: does screw size, plate size, or screw configuration matter?' by Schoenleber et al.
    (Lippincott Williams & Wilkins, 2014) Kaymaz, Burak; Komurcu, Erkam; Goksel, Ferdi; Golge, Umut H.
    [Anstract Not Available]
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    Comparison of Osteoporosis in Two Different Regions of Turkey
    (Galenos Yayincilik, 2014) Golge, Umut Hatay; Komurcu, Erkam; Kaymaz, Burak; Goksel, Ferdi; Guzel, Yunus; Adam, Gurhan; Erbay, Piril
    Objective: The aim of the study was to investigate the effect of different climate and geographic conditions on bone mineral density. Materials and Methods: The patients who had been examined with Dual X-ray Absorptiometry (DXA) for the suspicion of osteoporosis in two different regions of Turkey were included in the study. Medical records of these 2457 patients were evaluated retrospectively. Age, gender, body mass index (BMI) and osteoporosis etiology of these patients were recorded. Results: Dual X-ray Absorptiometry measurements of the femoral neck and lomber vertebras of these patients were investigated. 927 of the patients were found to be osteoporotic and 907 of the patients to be osteopenic. There was no difference between the groups in terms of age, gender and BMI. Lumbar vertebras (L1-4) and femoral neck T scores of the patients with similar age and gender in these 2 different regions were compared and the difference between the groups was found to be statistically significant (p<0.001). Conclusion: The effect of geography and climate conditions on the bone quality is well known. In this respect regional strategies in the prevention and treatment of the osteoporosis may be judicious.
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    COMPARISON OF RADIOFREQUENCY ABLATION AND CURETTAGE IN OSTEOID OSTEOMA IN CHILDREN
    (Atha Comunicacao & Editora, 2019) Goksel, Ferdi; Aycan, Aye; Ermutlu, Cenk; Golge, Umut Hatay; Sarisozen, Bartu
    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.
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    Consultation of traditional bone setters instead of doctors: Is it a sociocultural and educational or social insurance problem?
    (Sage Publications Inc, 2015) Golge, Umut Hatay; Kaymaz, Burak; Komurcu, Erkam; Eroglu, Mehmet; Goksel, Ferdi; Nusran, Gurdal
    Background Patients consulting bone setters is common in the eastern and south-eastern regions of Turkey. The reasons for consulting bone setters instead of qualified doctors remains unclear. We investigated the characteristics of such patients who consult traditional bone setters after trauma prior to admission to hospital. Methods In the study, 3,422 of 14,080 patients were investigated admitted to hospital between January 2012 and February 2013 with trauma or sequelae of such who were previously treated by bone setters. The characteristics of these patients and the main reasons for consultation of bone setters instead of doctors were recorded. Results Most of the patients consulting bone setters were found to be young adults or children. Generally speaking, the poorly educated prefer bone setters despite having social insurance. The most common reason (29.3%) was a general preference and secondarily (27.1%) the fear of being disabled after medical treatment. However, the most common cause of patients' consultation at hospital subsequently was due to complications of treatment (46.8%); indeed the complication rate after bone setters' intervention was found to be 54.8%. Conclusion Although improvements have occurred in the access to and utilisation of healthcare services, consultation by patients of bone setters seems to be a sociocultural and educational issue rather than a problem of lack of medical insurance.
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    Effects of Boric Acid on Fracture Healing: An Experimental Study
    (Humana Press Inc, 2015) Golge, Umut Hatay; Kaymaz, Burak; Arpaci, Rabia; Komurcu, Erkam; Goksel, Ferdi; Guven, Mustafa; Guzel, Yunus
    Boric acid (BA) has positive effects on bone tissue. In this study, the effects of BA on fracture healing were evaluated in an animal model. Standard closed femoral shaft fractures were created in 40 male Sprague-Dawley rats under general anesthesia. The rats were allocated into five groups (n= 8 each): group 1, control with no BA; groups 2 and 3, oral BA at doses of 4 and 8 mg/kg/day, respectively; group 4, local BA (8 mg/kg); and group 5, both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally). After closed fracture creation, the fracture line was opened with a mini-incision, and BA was locally administered to the fracture area in groups 4 and 5. In groups 2, 3, and 5, BA was administered by gastric gavage daily until sacrifice. The rats were evaluated by clinical, radiological, and histological examinations. The control group (group 1) significantly differed from the local BA-exposed groups (groups 4 and 5) in the clinical evaluation. Front-rear and lateral radiographs revealed significant differences between the local BA-exposed groups and the control and other groups (p< 0.05). Clinical and radiological evaluations demonstrated adequate agreement between observers. The average histological scores significantly differed across groups (p= 0.007) and were significantly higher in groups 4 and 5 which were the local BA (8 mg/kg) and both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally), respectively, compared to the controls. This study suggests that BA may be useful in fracture healing. Further research is required to demonstrate the most effective local dosage and possible use of BA-coated implants.
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    Effects of boric acid on the healing of Achilles tendons of rats
    (Springer, 2016) Kaymaz, Burak; Golge, Umut Hatay; Ozyalvach, Gulzade; Komurcu, Erkam; Goksel, Ferdi; Mermerkaya, Musa Ugur; Doral, Mahmut Nedim
    Tendinous lesions are among the most frequent pathologies encountered in sportsmen. The objectives of new treatments are to improve the healing process and reduce the recovery time. Boron plays an important role in the wound repair process by increasing components of extracellular matrix and angiogenesis. This animal study aimed to investigate the effect of boric acid on healing of the Achilles tendon. The right Achilles tendons of 40 rats were completely sectioned, and the rats were randomly divided into five groups. Each group consisted of eight rats. Groups 1 and 2 were oral boric acid groups with the doses of 4 and 8 mg/kg/day boric acid, respectively. Group 3 was the local boric acid group (8 mg/kg boric acid intratendinous injection). Group 4 was administered both oral and local boric acid (8 mg/kg/day orally and 8 mg/kg boric acid intratendinous injection), and group 5 was the control group with no boric acid application. At the end of the fourth week, all the rats were killed and histopathological examination of the Achilles tendon repair site was made. Histopathological examination of the tissue sections revealed more properly oriented collagen fibres, more normal cellular distribution of tenocytes and more properly organized vascular bundles in group 1 and group 2, which were the groups administered oral boric acid. Pathological sum scores of groups 1 and 2 were less than those of the other groups, and the differences between the oral boric acid groups (group 1 and group 2) and the other three groups (groups 3, 4 and 5) were statistically significant (p = 0.001). As boric acid is safe and toxicity even after very high doses is unusual, oral boric acid may be used as an agent to improve the healing process of tendon injuries. However, biomechanical tests should also be performed to show the effect of boric acid on strength and endurance of the tendon before it can be used in clinical practice.
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    Effects of Local Administration of Boric Acid on Posterolateral Spinal Fusion with Autogenous Bone Grafting in a Rodent Model
    (Humana Press Inc, 2015) Komurcu, Erkam; Ozyalvacli, Gulzade; Kaymaz, Burak; Golge, Umut Hatay; Goksel, Ferdi; Cevizci, Sibel; Adam, Gurhan
    Spinal fusion is among the most frequently applied spinal surgical procedures. The goal of the present study was to evaluate whether the local administration of boric acid (BA) improves spinal fusion in an experimental spinal fusion model in rats. Currently, there is no published data that evaluates the possible positive effects if the local administration of BA on posterolateral spinal fusion. Thirty-two rats were randomly divided into four independent groups: no material was added at the fusion area for group 1; an autogenous morselized corticocancellous bone graft was used for group 2; an autogenous morselized corticocancellous bone graft with boric acid (8.7 mg/kg) for group 3; and only boric acid was placed into the fusion area for group 4. The L4-L6 spinal segments were collected at week 6, and the assessments included radiography, manual palpation, and histomorphometry. A statistically significant difference was determined between the groups with regard to the mean histopathological scores (p=0.002), and a paired comparison was made with the Mann-Whitney U test to detect the group/groups from which the difference originated. It was determined that only the graft+BA practice increased the histopathological score significantly with regard to the control group (p=0.002). Whereas, there was no statistically significant difference between the groups in terms of the manual assessment of fusion and radiographic analysis (respectively p=0.328 and p=0.196). This preliminary study suggests that BA may clearly be useful as a therapeutic agent in spinal fusion. However, further research is required to show the most effective dosage of BA on spinal fusion, and should indicate whether BA effects spinal fusion in the human body.
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    Giant Fibrolipoma Extending Throughout a Whole Extremity: A Rare Child Case Report
    (Derman Medical Publ, 2016) Aylanc, Nilufer; Golge, Umut Hatay; Aylanc, Hakan; Resorlu, Hatice; Goksel, Ferdi
    We present the case of a 4-year-old boy with congenitally asymmetrical lower extremities, his left being bigger than his right. The patient underwent imaging modalities after birth; a huge lipomatoid proliferation on his left thigh extended throughout the limb from the hip to the distal foot, showing isointensity with lipoid tissue. After surgical resection of his left foot, fibrolipoma was diagnosed. A giant fibrolipoma of the whole extremity occurring in a pediatric patient is a rarity.
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    Investigation of knee pain in osteoarthritic and neuropathic pain awareness
    (Acta Medica Belgica, 2015) Golge, Umut Hatay; Sen, Halil Murat; Kuyucu, Ersin; Sen, Hacer; Goksel, Ferdi; Kaymaz, Burak; Komurcu, Erkam
    The mechanism of neuropathic pain (NP) and osteoarthritic (OA) pain, although different, are both defined as chronic pain, and combinations are possible. In this study, the awareness of both types of chronic pain was investigated among patients and doctors. This prospective study was planned and coordinated by the orthopedic and internal medicine clinics and included 100 patients with a diagnosis of knee OA evaluated with the DN4 questionnaire. Patients with an OA diagnosis included those with NP linked to diabetes and those without NP, and these groups were compared using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritic Index (WOMAC). Data analysis of both groups focused on descriptive statistics of demographic and clinical characteristics. Twenty-four of the patients with type 2 diabetes mellitus (DM) were diagnosed with NP according to DN4 criteria, and began treatment. Of these patients, 21 (84%) had DM for 10 years or more, while 19 (86.4%) had HbA1c of 7 and above. The average WOMAC pain score for patients with NP was 4.33 +/- 1.2 while the score for VAS was 8.25 +/- 0.8. Patients without NP had a WOMAC pain score of 2.49 +/- 0.6 and a VAS of 6.28 +/- 1.8. It was observed that in these two knee OA patient groups, NP had a statistically significant enhancing effect on the WOMAC pain score and the VAS (p < 0.001). As underlying pathophysiological mechanism of pain caused by OA is complex, and OA is considered to have a component of NP, it has been proven to be useful to use drugs apart from conventional treatments for NP. We believe that, as a source of pain that is not relieved after arthroplasty, awareness level of NP among orthopedists should be increased and multi-disciplinary studies are required on this topic.
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    Neck Pain and Disability: Eye Drop Installation Technique As a Causative Factor
    (Turkish League Against Rheumatism, 2014) Komurcu, Erkam; Kara, Seluk; Golge, Umut Hatay; Kaymaz, Burak; Arikan, Sedat; Gencer, Baran; Goksel, Ferdi
    Objectives: This study aims to investigate a possible relationship between long standing eye drop usage and neck pain and to determine the optimal neck position while instilling the eye drop. Patients and methods: Sixty-seven patients who admitted to the ophthalmology outpatient clinic with the diagnosis of glaucoma and using eye drops for at least one year were included in the study as group 1 (n=31). The ages of the patients were between 18 to 80 years. A control group (group 2, n=36) was selected from age-matched individuals who did not use eye drops. The neck disability index form and a study form which included demographic data and the method of eye drop usage of patients were filled. Results: The mean age of the patients were 55.7 +/- 11.5 and 53.5 +/- 17.1 years for group 1 and group 2, respectively. There was no significant difference in the age and sex between the groups (p=0.526 and p=0.396, respectively). Compared to the controls, the chronic eye drop usage and its application method produced significant difference in neck disability index (p<0.001). Also, there was a positive correlation between neck disability index and number of eye drop usage per a day and period of eye drop usage (p=0.003 and p=0.004, respectively). Conclusion: Neck posture which is not placed in hyperextension position during administration of eye drop may reduce postural neck malposition-related neck disability. Patients who are on eye drop for a long time should be informed about postural disorders and instructed to correct the administration of eye drop technique to avoid neck pain.
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    Neutrophil to lymphocyte ratio may be a predictive marker of poor prognosis in Legg-Calve-Perthes disease
    (Sage Publications Ltd, 2016) Kaymaz, Burak; Buyukdogan, Kadir; Kaymaz, Nazan; Komorcu, Erkam; Golge, Umut Hatay; Goksel, Ferdi; Aksoy, Mehmet Cemalettin
    Legg-Calve-Perthes disease (LCPD) is the idiopathic avascular necrosis of the femoral head in childhood. The pathologic changes seen in the femoral head are likely a result of vascular factors. Blood neutrophil to lymphocyte (N/L) ratio is a simple marker of subclinical inflammation. This study aims to to analyse the predictive ability of N/L ratio for the prognosis in LCPD patients. Methods: Patients who had been diagnosed as LCPD from 2008 to 2014 were investigated retrospectively and 40 LCPD patients (33 male and 7 female) and 25 healthy age and sex-matched children (controls) were included in the study. LCPD patients were divided into 2 groups according to expected prognosis (good prognosis expected Herring A and B patients as Group I and poor prognosis expected Herring B-C and C patients as Group II) and healthy children (control) were included in Group III. All the patients' hematological markers were analysed. Results: Mean age was 7.1 +/- 2.0 years in group I (4.9-12 years), 8.3 +/- 2.2 years (4-12.5 years) in group II and 7.8 +/- 1.3 years (6-12 years) in group III. Mean values for Groups I, II and III for neutrophil to lymphocyte (N/L) ratio were 1.13 +/- 0.65, 1.75 +/- 0.95, 1.08 +/- 0.37, respectively. The mean neutrophil to lymphocyte (N/L) ratio of Group II was higher than the other 2 groups (p = 0.003). Conclusions: N/L ratio may give us information about the natural course of LCPD and may be used as independent predictor of prognosis in patients with LCPD.
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    Preventive effects of coenzyme Q10 (CoQ10) on steroid-induced osteonecrosis in rats
    (Turkish Assoc Orthopaedics Traumatology, 2014) Komurcu, Erkam; Oktay, Murat; Kaymaz, Burak; Hatay Golge, Umut; Goksel, Ferdi; Nusran, Gurdal
    Objective: The aim of this study was to examine the role of coenzyme Q(10) (CoQ(10)) in the prevention of steroid-induced osteonecrosis of the femoral head (ONFH) in rats. Methods: The study included 20 Sprague-Dawley rats injected once with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle to induce osteonecrosis. Animals were divided into two equal groups; Group 1 received no prophylaxis (control group) and the Group 2 received CoQ(10). Hematological examinations were performed before steroid injection (0 weeks) and at 4 weeks after steroid injection. Femoral heads were examined histologically to evaluate osteonecrosis. Results: Changes in blood glutathione (GSH) and malondialdehyde (MDA) concentrations were less significant in the CoQ(10) group. The incidence of histologic changes consistent with early osteonecrosis was lower in the CoQ(10) group (2 of 10; 20%) than the control group (7 of 10; 70%). Conclusion: Coenzyme Q(10) may be useful as a preventing agent in steroid-induced ONFH. Inhibited oxidative stress is a possible mechanism for this effect.
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    Relationship Between Second to Fourth Digit Ratios and Obesity, Muscle Mass2.
    (Derman Medical Publ, 2015) Golge, Umut Hatay; Sivasli, Zeynep; Pazarci, Ozhan; Goksel, Ferdi; Kaymaz, Burak; Kuloglu, Huseyin Emre
    Aim: Transmitted through genetic inheritance and later unchanging, the ratio of 2nd and 4th fingers (2D: 4D) is related to the hormone testosterone. We aimed to investigate the correlation of this ratio to muscle mass and obesity. Material and Method: Adult patients attending the diet clinic were categorized by body type analysis, age and gender. Body mass index (BMI) was calculated from height and weight, and body analysis was completed with a Tanita (TANITA BC-418 MA III) device. Additionally patients had the index and ring fingers of both hands separately measured with the aid of digital calipers and recorded. The ratio of the values was determined and compared with the values obtained by the Tanita device. Result: Of 216 patients at the diet clinic, 168 were female and 48 were male. The measurements of individuals with 2D: 4D of both hands above 1 were compared with those of individuals with 2D: 4D of both hands below 1. Differences were observed in terms of total fat (TF), fat free mass (FFM) and fat mass (FM). While there was a positive correlation of the 2D: 4D of both hands with BMI, FM and TF; there was a negative correlation observed with FFM. Discussion: We believe the 2D: 4D may be directly related to obesity and inversely related to body muscle mass.
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    Safety and feasibility of lumbar spine for intralaminar screw fixation: a computed tomography-based morphometric study
    (Turkish Assoc Orthopaedics Traumatology, 2015) Komurcu, Erkam; Kaymaz, Burak; Adam, Gurhan; Golge, Umut Hatay; Goksel, Ferdi; Ozden, Raif
    Objective: The use of intralaminar screws (ILS) in spinal surgery has experienced a recent increase in popularity. The aim of this study is to define the morphological parameters of the lumbar laminas so that guidance may be defined for ILS placement. Methods: The study involved the evaluation of lumbar computed tomography (CT) images of patients. Two hundred thirty-five patients (127 male, 108 female) were included in the study. The mean patient age was 44.2 years (19-78 years). The measured parameters of the lamina were the transverse inner diameter, transverse outer diameter (lamina width), lamina length, subdural space (safe zone), and spinolaminar angle for each lumbar level (L1-L5). Results: The mean transverse outer diameter (L1-L5) ranged from 7.2-7.8 mm, and mean transverse inner diameter ranged from 2.5-3.0 mm. The lamina of L3 had the largest width and the lamina of L1 and L5 the smallest. The mean lamina length was 26.6 mm, ranging from 21.0-34.0 mm, and the mean spinolaminar angle was 124.7 degrees, ranging from 111-135 degrees. The L1 level had the shortest mean lamina length and L4 the lowest spinolaminar angle. Mean subdural space (safe zone), which was narrowest at the L5 level, was 2.4 mm, ranging from 1.3-3.6 mm. Conclusion: ILS of the appropriate size (3.5-4.5 mm) and length (20 and 25 mm) can be used safely in the lumbar spine. However, further biomechanical studies should be performed to measure strength of the fixation.
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    The effects of ozone therapy on extremity ischemia-reperfusion injury in a rabbit model
    (Yusuf Haydar ERTEKİN, 2019) Kaymaz, Burak; Coban, Ganime; Goksel, Ferdi; Toman, Huseyin; Golge, Umut Hatay; Komurcu, Erkam
    Introduction: Ischemia is reversible or irreversible cell/tissue damage that is secondary to insufficient blood flow to tissues or organs. Ischemia causes many metabolic and structural changes at the cellular level. Ozone therapy is often used as an antioxidant remedy. This study aimed to investigate the effects of ozone therapy on extremity ischemia-reperfusion (IR) injury. Methods: Twenty-four New Zealand White (NZW) rabbits were randomly allocated into three groups. Each group consisted of eight rabbits. Group I was the control group, Group II was the ischemia group, and Group III, the ozone group.  Femoral arteries of the right legs were dissected, and femoral arterial occlusion was performed in Group II and III.  Hematological and histopathological evaluation was performed in all groups. Results: The levels of total antioxidant status (TAS) after the surgical procedure was higher in the ozone group compared to the ischemia group (p=0.036). In addition, the levels of malondialdehyde (MDA) after the surgical procedure were lower in the ozone group compared to the ischemia group but not statistically significant (p=0.093). The control and ozone groups were histopathologically similar. Conclusions: Ozone therapy may be used as an alternative treatment modality with its anti-inflammatory and antioxidant effects for the treatment of extremity IR injury
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    The Efficacy of Boric Acid Used to Treat Experimental Osteomyelitis Caused by Methicillin-Resistant Staphylococcus aureus: an In Vivo Study
    (Humana Press Inc, 2016) Guzel, Yunus; Golge, Umut H.; Goksel, Ferdi; Vural, Ahmet; Akcay, Muruvvet; Elmas, Sait; Turkon, Hakan
    We explored the ability of local and systemic applications of boric acid (BA) to reduce the numbers of methicillin-resistant Staphylococcus aureus (MRSA) in a rat model of tibial osteomyelitis (OM), and compared boric acid with vancomycin (V). Implant-associated osteomyelitis was established in 35 rats. After 4 weeks, at which time OM was evident both radiologically and serologically in all animals, the rats were divided into five groups of equal number: group 1, control group (no local application of BA or other medication); group 2, V group; group 3, local BA + V group; group 4, local BA group; and group 5, local + systemic BA group. Serum total antioxidant status, and the levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-6, were measured. Pathological changes attributable to bone OM were evaluated using a grading system. Bacterial colony-forming units (CFUs) per gram of bone were counted. The lowest bacterial numbers were evident in group 3, and the bacterial numbers were significantly lower than that of the control group in all four test groups (p < 0.001). Group 3 also had the least severe bone infection (OM score 1.7 +/- 1.1, p < 0.05). Upon histological and microbiological evaluation, no significant difference was evident between groups 2 and 3. Total antioxidant levels were significantly different in all treatment groups compared to the control group. Microbiological and histopathological evaluation showed that systemic or local application of BA was effective to treat OM, although supplementary V increased the effectiveness of BA.