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Öğe Arthroscopic Retrograde Fixation of A Hoffa Fracture With an Accompanying Medial Plateau Fracture(2012) Altan, Egemen; Şenaran, Hakan; Aydın, Kerem; Acar, Mehmet Ali; Erkoçak, Ömer FarukUnicondylar lateral coronal plane fractures (Hoffa fractures) are uncommon and commonly treated with open reduction and internal fixation through a wide lateral or parapatellar approach because of difficulty in accessing the fracture. The accompanying medial tibial plato fracture is also an extreme case, and such a fracture pattern has not been reported in the literature so far. In our case report, after a motor vehicle accident, a 32-year-old man suffered a Hoffa fracture and a medial tibial plato fracture of his left knee. Reduction and fixation were performed under arthroscopic visualization through the standard portals. Reduction was achieved using a pair of towel forceps as a fulcrum to elevate the fragment through the lateral portal. After confirmation of anatomic reduction with arthroscopy, 2 divergent headless compression screws were inserted into the fracture through an accessory lateral portal with the knee hyperflexed. The concomitant medial tibial plato fracture was treated with a buttress plate, and reduction was confirmed arthroscopically. The fracture healed clinically and radiographically at 3 months, and the patient had no limitation of motion and was back at work. Thus, an undesired extensive arthrotomy over the joint was avoided with this technique for a better outcome.Öğe Arthroscopic synovectomy in the treatment of functional ankle instability: Outcomes and gait analysis(Springer-Verlag France, 2015) Altan, Egemen; Özbaydar, Mehmet Uğur; Tonbul, Murat; Şenaran, Hakan; Temelli, Yener; Akalan, EkinBackground Natural consequence of repetitive ankle sprains is the chronic ankle instability. Objective of this study was to clarify the gait patterns of functional ankle instability (FAI) patients after arthroscopic synovectomy, but also assessment of postoperative recovery. Patients and methods Arthroscopic synovectomy was performed to 14 FAI patients with history of unilateral repetitive ankle sprains, pain, and subjective sensation of instability. At a mean 54 months of follow-up (27-84), clinical assessment was conducted with respect to pain, number of ankle sprains, and American Orthopaedics Foot and Ankle Society (AOFAS) scores. Gait analysis was conducted to determine the temporospatial, kinetic and kinematic parameters at the last follow-up. Results Mean AOFAS scores increased from 68 (range 55-75) to 89 (range 77-100) points (P<0.01). Mean ankle sprains was 13 in a period of 23 (range 14-48) months (0.58 per month) and decreased to three sprains in a mean time period of 54 months (0.053 per month) (P<0.01). Mean preoperative and postoperative VAS scores were 8.0 and 2.9, respectively (P<0.01). During gait analysis, no significant differences were found in ankle joint, including foot progression angles, ankle dorsi-plantar flexion degrees and ground reaction forces (P>0.01). Among temporospatial parameters, only double support time showed a significant difference (P<0.01). All patients were satisfied from the procedure and returned to their previous activity level. Conclusion Improved long-term clinical results and scores were obtained in our patient group when compared with the preoperative scores. Also, three-dimensional gait analysis showed that the involved ankles demonstrate similar gait patterns to the uninvolved ankles in patients with FAI. © Springer-Verlag France 2014.Öğe Beyin felci ve omurilik deformiteleri(2009) Yazıcı, Muharrem; Şenaran, HakanBeyin felci, çoklu kas iskelet sistemi sorunları ile ortaya çıkabilen ve sık görülen bir statik ensefalopatidir. Periferik kas tonusunun artması, eklem kontraktürlerine neden olarak hastanın fonksiyonel kapasitesini azaltır. Kas iskelet tutulumunun ciddiyetinin artması ile skolyoz riski de artar. Skolyoz hastaların fonksiyonel kapasitesini, günlük bakımını ve beslenmesini olumsuz etkiler. Fizik tedavi, korse veya botulinum toksin enjeksiyonu gibi konservatif tedavi yöntemleri genellikle skolyozun ilerlemesini engelleyemez ve cerrahi tedavi gerekli hale gelir. Üç planlı tespit imkanı sağlayan pedikül vidalarının kullanımı ile posterior enstrümantasyon ve füzyon, yeterli düzeltmenin sağlanmasında etkili olmuş, anterior cerrahi gereksinimini ortadan kaldırmıştır.Öğe Center of the Femoral Head: A Magnetic Resonance Imaging Study(Lippincott Williams & Wilkins, 2006) İnan, Muharrem; Şenaran, Hakan; Mackenzie, William G.Determination of the center of the femoral head (CFH) may be difficult because of incomplete epiphyseal ossification of the femoral head in children younger than 8 years. The purpose of this study is to find a practical method for determining the center of the femoral head in normal hips of children younger than 8 years. Twenty-seven children who had magnetic resonance imaging (MRI) examinations of their hips (N = 54) were reviewed retrospectively. The average age of the subjects was 4.7 years (range, 1.2-8 years). Measurements were performed on the closest section to the midcoronal plane of the femoral head (the widest spherical femoral head seen on the MRI section). The CFH on the MRI section was found using a constructed circular frame by using a computer program. The medial and lateral edges of the proximal femoral ossific nucleus were marked, and the midpoint of the ossific nucleus adjacent to the growth plate (MPON) was determined. The distance between the MPON and the CFH was calculated. The average distance was 1.5 mm (range, 0-5 mm). The distance between these 2 points was less than or equal to 2 mm in 40 hips (74%). In conclusion, this study shows that the MPON call be used as a landmark to determine the center of the femoral head in normal hips of children younger than 8 years and call be used to measure the lower extremity mechanical axis.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 Cuboid Fractures in Preschool Children(Lippincott Williams & Wilkins, 2006) Şenaran, Hakan; Mason, Dan; De Pellegrin, MaurizioThe purpose of this study is to describe the clinical and radiographic presentation of cuboid fractures in children and to produce a guide for appropriate evaluation and treatment. Twenty-eight consecutive patients with cuboid fracture treated at the same institution between 1998 and 2004 were retrospectively analyzed. The mean age at presentation was 38.7 months (range, 14-74 months). All patients presented with an avoidance gait pattern, refusing to bear weight on the lateral side of the foot. There was no history of trauma in 8 patients, and the others had minor trauma such as a fall down a few steps on their feet or ankle sprain. Plain radiographs were the method of diagnosis in all but one of the patients. The feet of 21 patients were immobilized at initial presentation. The other 7 patients were observed clinically until symptoms resolved. All fractures healed completely with no complications, and patients were symptom free in 4.9 weeks (range, 2-13 weeks). Twenty-one patients, immobilized immediately after the first presentation, were symptom free in 4 weeks (range, 2-7 weeks). The remaining 7 patients, who were observed and followed up clinically with no immobilization, were symptom free in 7.9 weeks (range, 5-13 weeks). Six patients had associated ipsilateral fractures, and 8 patients had an associated genetic or systemic abnormality. An awareness of cuboid fractures in children can lead to an early diagnosis, treatment, and recovery without the use of a bone scan, and a focus on the possibility of an underlying genetic or medical disorder must be initiated.Öğe Gelişimsel Kalça Displazisi Cerrahisi Sonrası İntra-Artiküler K Telinin Karşı Pelvise Migrasyonu: Olgu Sunumu(2010) Yurtçu, Müslim; Şenaran, Hakan; Türk, Hakan H.; Abasıyanık, Adnan; Tuncay, İbrahimSorunlu gelişimsel kalça displazisi (GKD) vakalarında, femur başının transartiküler olarak K teli ile asetabuluma tespit edilmesi seyrek olarak uygulanan bir cerrahi yöntemdir. Bu yazıda, GKD tedavisi sonrası semptom olmaksızın K telinin pelvis içine transveziküler migrasyonu tespit edilen çocuk hasta sunulmaktadır. Çift taraşı GKD nedeniyle 4 yıl önce çok sayıda operasyon geçiren 8 yaşındaki kız hasta, aksayarak yürüme şikayeti ile ortopedi polikliniğine başvurdu. Her iki kalçanın hareket açıklığı iyi idi. Pelvis radyografisinde, her iki kalça arasında köprü gibi uzanan intrapelvik K teli tespit edildi. Hastanın önceki ameliyatlar sonrası ürogenital ve intestinal sistemlerle ilgili şikayetinin olmadığı belirlendi. Pediatrik cerrahi işbirliği ile K telinin çıkarılması planlandı. Sistoskopide K telinin mesane içinden geçtiği görüldü. Laparotomide K teli ortadan kesildi ve vücuttan çıkarıldı. Hasta taburcu edildi ve postoperatif şikayeti olmadı. K telinin vücutta bırakılması durumunda migrasyon riski yüksektir. Muhtemel komplikasyonların önlenmesi için K telinin postoperatif dönemde erken çıkarılması planlanmalıdır.Öğe Immediate Percutaneous Intramedullary Fixation and Functional Bracing for the Treatment of Pediatric Femoral Shaft Fracture(Lippincott Williams & Wilkins, 2003) Özdemir, Hacı Mustafa; Yensel, Uğur; Şenaran, Hakan; Mutlu, Mahmut; Kutlu, AbdurrahmanFifty-three consecutive children ages 6 to 14 with femur fractures treated with early percutaneous intramedullary fixation were evaluated retrospectively. The operation was performed within 24 hours in 50 patients and in the remainder after 48 hours. All patients were mobilized and allowed full weight-bearing in a functional brace in the early postoperative period. The average hospital stay was 4 days. The average follow-up was 24 months. There were no significant intra- or postoperative complications. An average overgrowth of 1.8 mm was measured using scanogram 24 months after surgery. In the authors' experience, this technique is highly effective for the treatment of children 6 to 14 years old with femur fractures. The main advantages of this method are early weight-bearing, immediate mobilization, short hospitalization, and fewer complications.Öğe Konjenital İdyopatik Talipes Ekinovarus Artmış Gelişimsel Kalça Displazisi Sıklığı için Risk Faktörü Müdür?(Selçuk Üniversitesi, 2017 Haziran) Aydın, Bahattin Kerem; Sofu, Hakan; Şenaran, HakanAmaç: Gelişimsel kalça displazisi (GKD) ve idyopatik talipes ekinovarus (PEV)en sık görülen çocukluk çağı ortopedik deformitelerindendir. Bu çalışmanın temel amacı ülkemizde PEV deformitesi nedeniyle tedavi edilen pediatrik hasta grubunda GKD sıklığını ve PEV deformitesinin GKD sıklığı açısından bir risk faktörü olup olmadığını araştırmaktır. Gereç ve Yöntem: Konjenital idiopatik pes ekinovarus tanısı ile Ponseti metodu uygulanarak tedavi edilmiş 113 çocuk (Grup 1) ve ulusal rutin GKD tarama programı kapsamında kalça ultrasonografisi uygulanmış fakat PEV deformitesi olmayan 129 sağlıklı çocuk (Grup 2) çalışmaya dahil edildi. Çocukların ultrasonografi esnasında ortalama yaşı Grup 1’de 3.8 hafta ve Grup 2’de 4.6 hafta olarak saptandı. Grup 1’de 65 kız ve 48 erkek, Grup 2’de 69 kız ve 60 erkek vardı. Her iki grupta Graf sınıflamasına göre GKD sıklığı mukayeseli olarak değerlendirildi. Bulgular: Ultrasonografi uygulanan toplam 484 kalçanın 20 tanesinde (%4.1) GKD görüldü. Grup 1’de 10 çocuk (%8.8) ve Grup 2’de 6 çocuğa (%4.6) GKD tanısı kondu. Grup 1’deki 13 kalçanın 4 tanesi Tip 2A, 1 tanesi Tip 2B, 4 tanesi Tip 3 ve 4 tanesi Tip 4 olarak sınıflandırıldı. Grup 2’de ise 6 kalçada Tip 2A ve 1 kalçada Tip 3 displazi saptandı. Graf sınıflamasına göre GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekti. Sonuç: Gruplar arasında displazik kalça sıklığı bakımından anlamlı farklılık gözlemlenmemiş olmasına rağmen, GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekti.Öğe Migration of Intra-Articular K-Wire Into the Contralateral Pelvis After Surgery for Developmental Dysplasia of the Hip: A Case Report(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2010) Yurtçu, Müslim; Şenaran, Hakan; Türk, Hakan H.; Abasıyanık, Adnan; Tuncay, İbrahimTransarticular fixation of femoral head into acetabulum with K-wire is a seldomly used surgical method in difficult cases of developmental dysplasia of the hip (DDH). This paper presents a child with intrapelvic transvesicular migration of a K-wire without any symptoms after treatment of DDH. Eight years old girl who had multiple surgeries 4 years ago due to bilateral DDH applied to the orthopedics clinic with limping. She had good range of motion of both hips. At the pelvis radiograph, there was an intrapelvic K-wire standing between two hemipelvises like a bridge. She did not have any enteral and urological symptoms after the previous operations. We planned to remove the K-wire in cooperation with the pediatric surgery department. On the cystoscopy, K-wire was seen passing through the urinary bladder. Wire was cut at the middle point and taken out of the body by laparotomy. The patient was discharged without any postoperative complications. K-wire retention in the body has high chance of migration. Early postoperative removal of the K-wire is necessary to prevent possible complications.Öğe Mozaicplasty technique for treatment of reverse Hill-Sachs lesion(2013) Altan, Egemen; Şenaran, Hakan; Acar, Mehmet Ali; Aydın, Kerem; Özbaydar, Mehmet U.Posterior shoulder dislocations can cause impaction of the anteromedial part of the humeral head: This is called a reverse Hill-Sachs lesion. Such defects may predispose to chronic instability of the shoulder and may require surgical intervention. However, to the best of our knowledge, these lesions have not been filled with the mozaicplasty technique using the patient's own cartilage. A 24-year-old male patient was admitted to our hospital as a result of a seizure. Examination of the right shoulder revealed pain and restriction of motion in external rotation. Anteroposterior radiographs and computed tomography scans showed a locked posterior shoulder dislocation and fracture of the lesser tuberosity. Measurements presented a lesion including approximately 30% of the articular surface. Anteromedial cartilage defect was filled with autogenous osteochondral plugs harvested from both the knees. At the 2-year follow-up, the patient had no recurrent instability and supple range of motion of his shoulder. Treatment of reverse Hill-Sachs lesion varies depending on the percentage of articular surface involvement. In general, defects up to 40% of articular surface were treated with elevation of the cartilage, subscapularis shift, lesser tuberosity advancement, and filling defects with allografts. The described technique can be performed in young patients with unilateral small-sized or medium-sized defects while the anatomic reconstruction was performed. Computed tomography of the patient showed graft osseointegration to host bone and continuity of smooth articular surface. Copyright © 2013 by Lippincott Williams & Wilkins.Öğe The need for Achilles tenotomy in the Ponseti method: Is it predictable at the initiation or during the treatment?(LIPPINCOTT WILLIAMS & WILKINS, 2015) Aydın, Bahattin Kerem; Şenaran, Hakan; Yılmaz, Güney; Acar, Mehmet Ali; Kıraç, YunusThe aim of this study was to determine whether the need for tenotomy can be predicted at the initiation or during the treatment of the clubfoot treatment according to the Ponseti method. One hundred and eight feet of 77 babies who required tenotomy and who did not were compared statistically according to the parameters of sex, side, bilaterality, presentation day, number of casts, Pirani scores, and the percentage change in Pirani scores, respectively. The mean number of casts required, the initial Pirani scores, and the percentage change in Pirani scores were significantly different between the groups that required tenotomy and the groups that did not (P=0.0001). Pirani scores at the beginning and the percentage change in Pirani scores during the treatment can be used to estimate the need for Achilles tenotomy.Öğe Patients with black hip and black knee due to ochronotic arthropathy: Case report and review of literature(2013) Acar, Mehmet Ali; Erkoçak, Ömer Faruk; Aydın, Bahattin Kerem; Altan, Egemen; Şenaran, Hakan; Elmadağ, Nuh MehmetOchronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis. © OMSB, 2013.Öğe Salter İliyak Osteotomisinde K-Teli ile Yapılan Tespit Yöntemlerinin Stabilite Açısından Karşılaştırılması(2007) Şenaran, Hakan; Karalezli, M. Nazım; Şimşek, Sezgin; Arazi, Mehmet; Kapıcıoğlu, M. İ. SafaAmaç: Gelişimsel kalça displazisinde (GKD) uygulanan Salter iliyak osteotomisinde K-teli ile yapılan fiksasyon yöntemlerinin stabiliteleri karşılaştırıldı ve asetabuler fragmanın pozisyonunun korunması için en uygun yöntem araştırıldı. Çalışma planı: Çalışmaya GKD nedeniyle Salter’in tanımladığı endikasyonlara uygun olarak ameliyat edilen 331 hastanın (63 erkek, 268 kız; ort. yaş 23.3 ay; 17-35 ay) 425 kalçası alındı. Tüm hastalarda osteotomi bölgesine yerleştirilen greftin tespiti amacıyla bir ya da iki adet K-teli kullanıldı ve ameliyattan sonra pelvipedal alçı yapılmadan önce ve alçı çıkarıldıktan sonra ön-arka pelvis grafileri çekildi. Hastalar uygulanan fiksasyon yöntemine göre (tek veya çift K-teli kullanımıyla Y kıkırdağa doğru veya asetabulumun superior duvarına doğru yönlendirme) dört gruba ayrıldı. Ameliyat sonrası erken dönem ve alçı çıkarıldıktan sonraki pelvis grafilerinde osteotomi proksimali ile distali arasındaki ilişki, greftin osteotomi bölgesindeki pozisyonu, siyatik çentikte distal köşenin proksimal köşeye göre medialize olup olmadığı ve femur başı örtünmesi değerlendirildi. Sonuçlar: Çift K-teli kullanılan hastaların hiçbirinde pozisyon kaybı gözlenmedi. Tek K-teli kullanılan 381 kalçanın 15’inde (%3.9) osteotomi bölgesinde tespit yetmezliğine bağlı pozisyon kaybına rastlandı. Bunların sekizinde (%2.9) Y kıkırdağa doğru, yedisinde (%6.4) asetabulumun superior duvarına doğru yönlendirme yapılmıştı. Gruplar arasındaki karşılaştırmada, K-teli ile fiksasyonun stabilitesi açısından anlamlı farklılık bulunmadı. Çıkarımlar: Çift K-teli ile pozisyon kaybına rastlanmaması, Salter osteotomisinde greft stabilizasyonunun bu şekilde yapılmasınının daha uygun olduğunu düşündürmektedir.Öğe Treatment of Posttraumatic Cubitus Varus With Corrective Supracondylar Humeral Osteotomies Using the Methyl Methacrylate External Fixator(LIPPINCOTT WILLIAMS & WILKINS, 2014) Acar, Mehmet Ali; Yıldırım, Serhat; Elmadağ, Nuh Mehmet; Şenaran, Hakan; Ogün, Tunç C.Background: In upper and lower extremity fractures and osteotomy fixation, the use of methyl methacrylate (MM) as an external fixator presents an alternative method. The primary aim of this retrospective study was to evaluate the midterm outcome of pediatric patients who underwent corrective humeral supracondylar lateral closing-wedge osteotomy, with the external fixation system composed of MM and multiplane K-wires. Methods: Fourteen consecutive cases with cubitus varus, who underwent corrective osteotomy with a limited lateral approach stabilized with MM and the multiplane K-wires external fixator system between January 2006 and May 2010, were retrospectively evaluated. Time of union, preoperative and postoperative elbow range of motion, and humeroulnar angle were measured. Results were rated as excellent, good, or poor, according to Bellemore criteria. Results: There were a total of 6 female patients and 8 male patients with a mean age of 5.7 years (range, 3 to 9 y). The mean follow-up period was 28.2 months (range, 24 to 48 mo). The mean humeroulnar angle was (-) 18.6 degrees preoperatively, and (+) 16.3 degrees at the final follow-up. Thirteen patients were evaluated as excellent and 1 patient as good, according to Bellemore criteria. Union was seen in all patients at mean 7 weeks (range, 6 to 8 wk). Pin tract infection was observed in 1 patient and treated with oral antibiotics. Loss of correction was not observed in any patient during follow-up. Conclusions: External fixation of corrective supracondylar humeral osteotomy with MM and multiplane K-wires is a practical, effective, reliable, and cheap alternative method that can be applied. Level of Evidence: Level IV. Retrospective study.
