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Öğe An Alternative Method for Restoring Opposition After Median Nerve Injury: An Anatomical Feasibility Study for the Use of Neurotisation(CAMBRIDGE UNIV PRESS, 2001) Üstün, Mehmet Erkan; Öğün, Tunç Cevat; Karabulut, A. Kağan; Büyükmumcu, MustafaOpposition, one of the most important functions of the hand, is lost or impaired after median nerve injury. Complete recovery does not always occur after treatment, and various techniques of opponensplasty are used for restoring opposition. This study was performed in order to develop an alternative method for selective restoration of thenar muscle function. Ten arms from 5 cadavers were used. The median nerve with its thenar motor branch (Tb) and the anterior interosseous nerve with its motor branch to pronator quadratus (PQb) were prepared in the distal forearm. The mean widths and the number of myelinated fibres of these nerves were: PQb 1.3 +/- 0.10 mm, Tb 1.4 +/- 0.12 mm and PQb 912 +/- 88 mm, Tb 1020 +/- 93 mm. The minimum necessary distance from the distal flexor crease of the wrist for neurotisation of the Tb by the PQb was 60 +/- 5.41 mm. It was concluded that PQb-Tb neurotisation would be possible anatomically. The advantages are that motor function is reestablished with a motor nerve, the diameters and the number of myelinated fibres of both nerves are similar, the loss of function after denervation of the pronator quadratus is slight and opponensplasty still remains as a final option.Öğe Closed Traumatic Avulsion of Both Flexor Tendons in the Ring Finger(Lıppıncott Williams & Wılkıns, 2006) Öğün, Tunç Cevat; Özdemir, H. Mustafa; Şenaran, HakanTraumatic rupture of the deep flexor tendon is a well-recognized entity known as "jersey finger". However, simultaneous traumatic rupture or avulsion of both flexor tendons in a ringer without preexisting disease is extremely rare. Such an injury is presented and discussed here, with regards to the mechanism, location, and treatment in comparison with similar reports in the literature.Öğe I?ntraoperatif Periferik Sinir Motor ve Duyu Lif Ayırımında Elektrofizyolojik Yöntem(2003) Üstün, Mehmet Erkan; Güney, Önder; Eser, Olcay; Öğün, Tunç CevatAmaç: Periferik sinir tamiri ve seçici nörotizasyon uygulamalarında motor ve duyu liflerin ayırımı başarıyı önemli derecede artırır. Bu amaçla çeşitli histokimyasal metodlar geliştirilmiş, ancak pratik olmadıklarından yaygınlık kazanamamışlardır. Bu çalışmanın amacı, periferik sinirde duyu ve motor liflerinin elektrofizyolojik olarak ayırt edilebilirliğini deneysel olarak araştırmaktır. Yöntem: Çalışmada, 6 adet tavşanın 12 femoral siniri, motor ve duyu dalları ile birlikte ortaya kondu. Motor ve duyu dalları birbirinden ayrı uyarılarak quadriceps femoris kasından birleşik kas aksiyon potansiyelleri (BKAP) elde edildi. Bulgular: BKAP, motor dalın düşük şiddette uyarımı ile elde edilebilirken, duyu dalının ancak çok yüksek şiddette uyarımları ile oluşturulabildi. Yüksek şiddette uyarının antidromik yolla spinal korda ve oradan ön boynuz motor nöronlarına geçerek BKAP'ni ortaya çıkardığı düşünüldü. Sonuç: Sonuç olarak, BKAP'ni kullanarak motor ve duyu lif ayırımı yapmak mümkündür. Bu yöntem ucuz, kolay ve çok hızlı olması nedeniyle, sinir transferi ve primer sinir tamiri olgularında diğer zaman aNcı tekniklerin yerine veya onlara yardımcı olarak kullanılabilir.Öğe Kombine Önkol Yaralanmalarında Sinir Onarımı Sonrası Erken Veya Geç Hareket Sonucu Değiştirir Mi?(2001) Öğün, Tunç Cevat; Arazi, Mehmet; Kapıcıoğlu, M. İ. SafaAmaç: Önkol kombine yaralanmalarının primer tamiri sonrasında erken kontrollü hareket veya üç hafta tespiti takiben aşamalı hareket şeklinde iki farklı rehabilitasyon yöntemi arasında sinir tamir sonuçları yönünden bir fark olup olmadığını belirlemek. Çalışma planı: Önkol kombine yaralanmaları olan 11 hastada (ort. yaş 31.5) primer tamir sonrasında erken kontrollü hareket uygulandı. Başka bir grup hastada (n=14, ort. yaş 32) ise üç hafta tespiti takiben aşamalı hareket uygulandı. Takip süresi birinci grupta 32 ay, ikinci grupta 16.3 ay idi. Sinir tamir sonuçlarına etki eden yaş unsurunda homojenlik sağlamak için 20 yaş altındaki hastalar çalışmaya alınmadı. Sinir tamir sonuçları, motor, duyu ve fonksiyonel testler ile değerlendirildi. Ayrıca, parmak hareket genişlikleri ölçüldü. Sonuçlar: Ulnar ve median sinir kesileri, eşlik eden tendon kesisi sayısı, duyu, motor ve fonksiyonel değerlendirme testleri sonuçları ve eklem hareket genişlikleri açısından iki grup arasında anlamlı farklılık bulunmadı (p>0.05). Çıkarımlar: Önkol kombine yaralanmalarında primer sinir onarımını takiben erken veya geç hareket temeline dayalı iki farklı yöntem de sinir iyileşmesi yönünden benzer sonuçlar vermektedir.Öğe Modüler Unipolar Kalça Protezi Kırılması ve Revizyonu (Stem Çıkarmada Yeni Bir Teknik) (Olgu Sunumu)(2000) Yel, Mustafa; Arazi, Mehmet; Öğün, Tunç Cevat; Kutlu, AbdurrahmanSelçuk Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalında femur boyun kırığına bağlı modüler unipolar kalça protezi uygulanan hastada 30 ay sonra femoral stem kırılması tespit edildi. Hastanın protezi ve kırık stem parçası bu ameliyat için geliştirilen aletlerle çıkarılarak total kalça protezi uygulandı. Çelik delici matkap ucu, buna uygun yapılan yiv açıcı ve yivli çıkarıcı ile uyguladığımız bu teknik bir çok avantajlar sağladı. Bunlar ameliyat süresinden tasarruf, daha küçük cilt insizyonu, ilave kesi ve osteotomilere ihtiyaç göstermemesi, ameliyat sonrası erken rehabilitasyon ve erken fonksiyon kazandırma olarak sayılabilir.Öğe Neurologically Intact Fracture-Dislocations of the Thoracolumbar Spine(2001) Öğün, Tunç Cevat; Özdemir, Mustafa; Arazi, Mehmet; Kapıcıoğlu, Mehmet İsmail Safa; Kutlu, AbdurrahmanPurpose: In this study, we presented ten neurologically intact fracture-dislocations of the thoracolumbar spine which are extremely rare, and reported the results of treatment. Methods: Ten fracture-dislocations of the thoracolumbar spine were treated in a period of nine years. Surgical reduction and stabilization were performed in six patients. Four patients rejected surgery and were treated conservatively. The average follow-up was 55 months. Results: During the conservative course of treatment, surprisingly, the neurologic status did not deteriorate. However, varying degrees of pain and roentgenographic deterioration of spinal alignment and canal compromise were detected. In the operated group, there were also no deteriorations in the neurologic status and the roentgenograms revealed no serious loss of reduction. One of the patients from the conservative group and two of the patients from the operative group were able to return to their pre-injury works. Conclusion: Surgical treatment was satisfactory, both clinically and radiologically, in a group of patients with thoracolumbar fracture-dislocations. Well-known drawbacks of conservative treatment, including long-term bed-rest, social and economic losses and long-lasting treatment, led us to favor surgical treatment.Öğe Posttraumatic Distal Radioulnar Synostosis and Distal Radial Epiphyseal Arrest(2002) Öğün, Tunç Cevat; Şarlak, Abdullah; Arazi, Mehmet; Kapıcıoğlu, Mehmet İsmail SafaPosttravmatik radioulnar sinostoz önkol çift kemik kırığı sonrası görülebilen bir komplikasyondur. Sinostozun distal yerleşimli olması en nadir şeklidir. Biz burada, çok nadir görülen travmatik distal radial epifiz arestine eşlik eden distal radioulnar sinostoz olgusunu sunduk. Sinostozun eksizyonu, kas interpozisyonu, Sauve-Kapandji ameliyatı ve distal ulnar epifizyodez ile başarılı bir sonuç elde ettik.Öğe Posttraumatic Distal Radioulnar Synostosis and Distal Radial Epiphyseal Arrest(2002) Öğün, Tunç Cevat; Şarlak, Abdullah; Arazi, Mehmet; Kapıcıoğlu, Mehmet İsmail SafaPosttravmatik radioulnar sinostoz önkol çift kemik kırığı sonrası görülebilen bir komplikasyondur. Sinostozun distal yerleşimli olması en nadir şeklidir. Biz burada, çok nadir görülen travmatik distal radial epifiz a restine eşlik eden distal radioulnar sinostoz olgusunu sunduk. Sinostozun eksizyonıı, kas interpozisyonu, Saııve-Kapandji ameliyatı ve distal ulnar epißzyodez ile başarılı bir sonuç elde ettik.Öğe Preliminary Traction as a Single Determinant of Avascular Necrosis in Developmental Dislocation of the Hip(Lippincott Williams & Wilkins, 2000) Kutlu, Abdurrahman; Ayata, Cafer; Öğün, Tunç Cevat; Kapıcıoğlu, M. I. Safa; Mutlu, MahmutThe role of preliminary traction before closed reduction in the treatment of developmental dysplasia of the hip has been questioned by many authors lately. However, the studies advocating or opposing the use of this treatment modality include several other parameters besides traction. Thus, it is unclear whether the affection is the result of preliminary traction or concurrent variables such as the "human position." This study aimed to put forward the effect of preliminary traction as a single determinant of avascular necrosis. We had two groups of patients who had developmental dislocation of the hip. The first group consisted of 52 patients treated with preliminary traction before closed reduction and the other group comprised 40 patients treated with closed reduction without preliminary traction. Both groups were similar in age, gender, side, level of dislocation, and method and duration of immobilization. Three patients from the first group developed avascular necrosis, which was not statistically significant. Preliminary traction did not affect the rate of avascular necrosis.Öğe Selective Restoration of Motor Function in the Ulnar Nerve by Transfer of the Anterior Interosseous Nerve - An Anatomical Feasibility Study(JOURNAL BONE JOINT SURGERY INC, 2001) Üstün, Mehmet Erkan; Öğün, Tunç Cevat; Büyükmumcu, Mustafa; Salbacak, AhmetBackground: Proximal ulnar-nerve lesions have an unfavorable prognosis. The goal of the present study was to evaluate the feasibility of selective restoration of motor function of the ulnar nerve by the transfer of the anterior interosseous nerve or one of its branches to the motor branch of the ulnar nerve. Methods: Ten cadaveric arms were used in the present study. The ulnar nerve and its motor and sensory branches as well as the anterior interosseous nerve and its branches were dissected. The widths of the motor branch of the ulnar nerve and the anterior interosseous nerve and its motor branches as well as the relevant distances from the points of divergence were measured. The axons were counted, and the distances from the end of the main anterior interosseous nerve, its motor branches, and the motor branch of the ulnar nerve to the level of the dorsal sensory branch of the ulnar nerve were measured. Results: Our results indicate that the length, width, and number of axons of the branch of the anterior interosseous nerve to the pronator quadratus make it suitable for transfer to the motor branch of the ulnar nerve. The use of the main anterior interosseous nerve or its motor branches to the flexor pollicis longus and the flexor digitorum profundus is less feasible because of the need to graft a long segment and the longer distance from the level of transfer to the motor end points. Conclusions: The findings of the present study confirm the feasibility of motor-nerve transfer for reconstruction after an injury of the ulnar nerve. Nerve-grafting would be needed for injuries distal to the level of the dorsal sensory branch of the ulnar nerve.Öğe Selective Restoration of Motor Function in the Ulnar Nerve by Transfer of the Anterior Interosseous Nerve: An Anatomical Feasibility Study(Journal of Bone and Joint Surgery Inc., 2001) Üstün, Mehmet Erkan; Öğün, Tunç Cevat; Büyükmumcu, Mustafa; Salbacak, AhmetBackground: Proximal ulnar-nerve lesions have an unfavorable prognosis. The goal of the present study was to evaluate the feasibility of selective restoration of motor function of the ulnar nerve by the transfer of the anterior interosseous nerve or one of its branches to the motor branch of the ulnar nerve. Methods: Ten cadaveric arms were used in the present study. The ulnar nerve and its motor and sensory branches as well as the anterior interosseous nerve and its branches were dissected. The widths of the motor branch of the ulnar nerve and the anterior interosseous nerve and its motor branches as well as the relevant distances from the points of divergence were measured. The axons were counted, and the distances from the end of the main anterior interosseous nerve, its motor branches, and the motor branch of the ulnar nerve to the level of the dorsal sensory branch of the ulnar nerve were measured. Results: Our results indicate that the length, width, and number of axons of the branch of the anterior interosseous nerve to the pronator quadratus make it suitable for transfer to the motor branch of the ulnar nerve. The use of the main anterior interosseous nerve or its motor branches to the flexor pollicis longus and the flexor digitorum profundus is less feasible because of the need to graft a long segment and the longer distance from the level of transfer to the motor end points. Conclusions: The findings of the present study confirm the feasibility of motor-nerve transfer for reconstruction after an injury of the ulnar nerve. Nerve-grafting would be needed for injuries distal to the level of the dorsal sensory branch of the ulnar nerve.Öğe Use of Enhanced Stimulation Voltage to Determine the Severity of Compressive Peripheral Nerve Injury(LIPPINCOTT WILLIAMS & WILKINS, 2001) Üstun, Mehmet Erkan; Öğün, Tunç Cevat; Eser, Olcay; Şahin, Kemal Tahir; Avunduk, Mustafa CihatBackground. The aim of this study was to investigate whether enhanced stimulation voltage could be a predictor of the extent of injury in acute compressive peripheral nerve trauma. Methods. The femoral nerves were exposed on both sides, in 11 anesthetized rabbits. Supramaximal stimulation voltage was used to produce a maximal-amplitude compound muscle action potential (CMAP) from the quadriceps femoris muscle. Afterward, the left femoral nerve was clipped for 1 minute, and the right femoral nerve for 5 minutes to produce an acute compressive injury. Immediately after removal of the clip, the proximal and distal sides of the clippage site were stimulated by gradually increased voltage until CMAPs were obtained. The same procedure was repeated at the 30th and 60th minutes. The ratio of the CMAP amplitudes obtained from proximal and distal stimulation was measured to establish a classification. Results. The stimulation voltages and amplitudes of the CMAPs before clippage were similar with the after-clippage values obtained from distal stimulation (p > 0.05), but the after-clippage values obtained from proximal stimulation were different in both sides (p < 0.05). Doubled stimulation voltage was enough to obtain CMAPs on the left side, but eightfold the initial level was required on the right side. The amplitude ratios recovered to preinjury levels in all of the subjects on the left side, but only two showed recovery on the right side (p < 0.001). Histopathologically, there was axonal compression without discontinuity on the left side, whereas the fibers were dispersed on the right side. Conclusion: Stimulation voltage was found to discriminate the severity of the lesion in experimental peripheral nerve injury. Proximal to distal amplitude ratio seems to be a prognostic factor when the injury is less severe.Öğe Variations and clinical importance of the superficial palmar arch(2007) Tağıl, Süleyman Murat; Çiçekcibaşı, Aynur Emine; Öğün, Tunç Cevat; Büyükmumcu, Mustafa; Salbacak, AhmetAmaç: Bu çalışmanın amacı eldeki arcus palmaris superficialis (APS)’in varyasyonlarını tespit etmek ve anormal APS ile m. palmaris longus (MPL) kasının yokluğu arasındaki ilişkiyi ortaya koymaktır. Gereç ve yöntem: Çalışmamızda a. brachialis’lerinden kırmızı ile renklendirilmiş lateks ile doldurulmuş 20 kadavra eli diseke edilmiştir. Eldeki damarsal varyasyonlar ve MPL kasının varlığı veya yokluğu kaydedilerek fotoğraflanmıştır. Bulgular: APS’ler 15 elde (%75) komplet, 5 elde (%25) ise inkomplet olarak tespit edildi. APS’inde varyasyon bulunan ellerin %33’ünde MPL kasının bulunmadığı görüldü. MPL’u bulunmayan ellerin tümünde aponeurosis palmaris bulunmaktaydı. Sonuç: Arteryel onarımlar, damar greft uygulamaları ve a. radialis veya a. ulnaris bazlı pediküllü veya serbest flep uygulamaları gibi rekonstrüktif el cerrahisi prosedürleri öncesinde elin vasküler yapısı ortaya konulmalıdır.Öğe Vertebral Artery Loop Formation: a Frequent Cause of Cervicobrachial Pain(Lippincott Williams & Wilkins, 2003) Paksoy, Yahya; Levendoglu, Funda Dinç; Öğun, Cemile Öztin; Üstün, Mehmet Erkan; Öğün, Tunç CevatStudy Design. Patients with cervicobrachial pain were examined in detail with special attention to vertebral artery loop formation. Objectives. To determine the incidence, short-time natural course and response to a conservative approach to vertebral artery loop formation in a group of patients with cervicobrachial pain. Summary of the Background Data. Vertebral artery loop formation is reported to be a rare cause of cervicobrachial neuralgia, discovered incidentally during the search for its cause. It can be congenital or acquired, occurring equally in both sexes. Surgical decompression has been the preferred method in the majority of reported cases, with favorable results. Methods. One hundred seventy-three patients with cervicobrachial pain were examined in a period of 7 months using physical examination, radiography, and magnetic resonance imaging with or without angiography. Results. Thirteen patients with a mean age of 43.9 +/- 13.5 years were diagnosed with vertebral artery loop formation. The most common level was C6-C7. Four patients presented with loop formation at two levels. None of the patients had symptoms attributable to intervertebral disc pathology. The complaints were in accordance with the level of the vascular pathology. Complete relief or decrease in pain was observed in all patients with the conservative approach. Conclusions. In patients with cervicobrachialgic symptoms and without established discopathy, during the examination of sagittal magnetic resonance images, vertebral artery loop formation should be kept in mind, and in suspected cases, the vertebral artery should be visualized using three-dimensional time of flight magnetic resonance angiography. Vertebral artery-nerve root relation should also be demonstrated using the multiplanar reformatting method from time of flight images. A conservative course of treatment has a favorable outcome.Öğe A Very Uncommon Complication Following Vaccination: Necrotizing Fasciitis and Myonecrosis: Case Report(Ortadogu Ad Pres & Publ Co, 2010) Senaran, Hakan; Karalezli, Nazım; Öğün, Tunç CevatNecrotizing fasciitis (NF) and myonecrosis is a potentially lethal soft tissue infection characterized by extensive muscular, fascial and subcutaneous tissue necrosis. In this paper, we report an 18-month-old boy admitted to a health clinic three days after Hepatitis-B vaccine injection with cellulitis at his left lateral arm and axilla. He was recommended oral antibiotics, however in the fifth day after vaccination he became lethargic, there were pseudo-paralysis, edema, crepitus on palpation and cutaneous necrosis was observed at axillary region and at posterior arm. With the diagnosis NF and myonecrosis, all the necrotic tissue including pectoralis major, triceps brachii, and most of the rotator cuff muscles were excised. After cutaneous grafting, the wounds healed, but functional recovery of the shoulder joint was poor at 4 year follow-up. Early diagnosis of NF and myonecrosis with debridment of necrotic tissue can prevent severe life threatening complications.
