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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 Comment on: "Developmental dysplasia in male infants: risk factors, instability and ultrasound screening"(WICHTIG EDITORE, 2012) Acar, Mehmet Ali; Altan, Egemen[Abstract not Available]Öğe Comparison of two different measurement methods to determine glenoid bone defects: area or width?(MOSBY-ELSEVIER, 2014) Altan, Egemen; Ozbaydar, Mehmet Ugur; Tonbul, Murat; Yalcin, LeventBackground: This study compared two different techniques that have been used to measure the glenoids of patients with recurrent anterior shoulder dislocation. Methods: We analyzed 36 patients who had received arthroscopic Bankart repair for anterior shoulder instability. Retrospectively, 3-dimensional computed tomography images of both shoulders were available for these patients. Two measurement methods were compared to determine the glenoid defects. One of these techniques is based on linear measurement, previously defined as the glenoid index. The other method is based on surface area measurement. Subsequently, 3 more diameters and the average values obtained from these diameters were compared with the surface measurement method. Pearson correlation coefficient (r) was assessed to determine the relationship. Results: There was an almost perfect relationship between measurement methods when the defect area was less than 6% of the inferior glenoid circle (r, 0.915; P < .001). This relation decreased and the difference became more pronounced (r, 0.343; P=.657) when the bone loss exceeded 14% of the inferior glenoid circle. The highest correlations with the actual defects were the average values obtained from 4 different diameters (r, 0.964; P < .001) and the 4-o'clock position of the single diameter measurements (r, 0.860; P=.001). In addition, 11 patients had crescent-like defects, demonstrating a relatively low correlation between the measurement methods (r, 0.679; P=.021). Conclusion: Although the best correlation was achieved from average values obtained from different diameter positions, in practical use, we advise a linear measurement to estimate the glenoid bone loss at the 4-o'clock position to achieve a high correlation between the measurement techniques. Level of evidence: Level III, Diagnostic Study. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.Öğe Diagnosis of Hyperostosis of the Medial Calcaneal Tubercle Similar to a Heel Spur(AMER PODIATRIC MED ASSOC, 2013) Altan, Egemen; Senaran, Hakan; Can, Nuray; Aydin, Bahattin Kerem; Erkocak, Omer FarukCalcaneal osteochondromas are rare conditions. To our knowledge, we present the first report of a calcaneal osteochondroma in an adolescent patient that was surprisingly similar to a heel spur, and, in addition, symptoms due to compression of the medial plantar nerve were present.Öğe Does median nerve translate pre- and postoperatively in carpal tunnel syndrome?(TURKISH JOINT DISEASES FOUNDATION, 2018) Yildirim, Ahmet; Tutar, Onur; Nayman, Alaaddin; Yalcin, Levent; Altan, EgemenObjectives: This study aims to evaluate the distance between the median nerve and the hook of the hamate pre- and postoperatively in patients with carpal tunnel syndrome and to investigate the efficiency of magnetic resonance imaging in diagnosis and postoperative follow-up. Patients and methods: Median nerve decompression was performed by releasing the carpal tunnel in 15 patients (4 males, 11 females. mean age 51 years; range, 41 to 66 years) with carpal tunnel syndrome. The shortest distance between the median nerve and the hook of the hamate was measured with magnetic resonance imaging preoperatively and at three months after the operation and radial and ulnar translations were assessed. Findings were compared to those of a control group of 15 subjects (5 males, 10 females; mean age 52.2 years; range, 40 to 65 years). Results: Median nerve shifted ulnarwards in patients with carpal tunnel syndrome. An intragroup evaluation of five patients with thenar atrophy revealed that as disease severity increased, the degree of the nerve's medial translation increased. Compared to preoperation, the median nerve significantly shifted to the radial side after decompression. Conclusion: In carpal tunnel syndrome patients, we observed significant ulnar translation of the median nerve and lateral translation after releasing the carpal tunnel. Magnetic resonance imaging may be used to establish a diagnosis and to assess operation success in advanced carpal tunnel syndrome patients who may recover slowly postoperatively.Öğe Effect of Ankaferd blood stopper (R) on tendon healing: an experimental study in a rat model of Achilles tendon injury(TURKISH JOINT DISEASES FOUNDATION, 2015) Aydin, Bahattin Kerem; Altan, Egemen; Acar, Mehmet Ali; Erkocak, Omer Faruk; Ugras, SerdarObjectives: This in vivo study aims to investigate the effects of Ankaferd Blood Stopper (R) (ABS) which is a recently developed topical hemostatic agent on tendon healing using a rat Achilles tendon injury model. Materials and methods: Twelve male Wistar-Albino rats were used in the study. Right legs of the rats were assigned as the study group, and left legs were assigned as the control group. Under anesthesia, bilateral Achilles tendon injuries were created and repaired surgically. To the surgical sites, 1 mL of ABS for the right side and 1 mL of serum physiologic solution for the left side were applied. Animals were euthanized on the 21st postoperative day, and tendon samples were collected from the extremities. Histological analyses were performed according to the semiquantitative tendon scoring system (Bonar Scale). Results: Total tendon healing scores were significantly poorer in the study group compared to the control group. Although there were no significant differences between the groups in terms of tenocyte morphology, degree of ground substance staining, and vascularity, the collagen morphology scores were significantly poorer in the study group. Conclusion: In our study, application of ABS had histologically negative effect on tendon healing in rats. However, further biomechanical and immune histochemical studies are required to support these results.Öğe Effect of Ankaferd blood stopper on tendon healing: An experimental study in a rat model of Achilles tendon injury(2015) Aydın, Bahattin Kerem; Altan, Egemen; Acar, Mehmet Ali; Erkoçak, Ömer Faruk; Ugraş, SerdarAmaç: Bu in vivo çalışmada yeni geliştirilen topikal bir hemostatik ajan olan Ankaferd Kanama Durdurucu nun (ABS) sıçan Aşil tendon yaralanma modeli kullanılarak tendon iyileşmesi üzerine etkileri araştırıldı. Gereç ve yöntemler: Çalışmada 12 erkek Wistar-Albino sıçan kullanıldı. Sıçanların sağ bacakları çalışma grubu, sol bacakları kontrol grubu olarak belirlendi. Anestezi altında iki taraflı Aşil tendon yaralanmaları oluşturuldu ve cerrahi olarak tamir edildi. Cerrahi sahalara sağ taraf için 1 mL ABS, sol taraf için ise 1 mL serum fizyolojik solüsyonu uygulandı. Hayvanlara ameliyat sonrası 21. günde ötenazi yapıldı ve ekstremitelerden tendon örnekleri alındı. Histolojik analizler yarı kantitatif tendon skorlama sistemine (Bonar Sınıflaması) göre yapıldı. Bulgular: Toplam tendon iyileşmesi skorları çalışma grubunda kontrol grubuna göre anlamlı şekilde kötüydü. Tenosit morfolojisi, esas madde boyama derecesi ve vaskülarite açısından gruplar arasında anlamlı farklılık olmasa da kollajen morfolojisi skorları çalışma grubunda anlamlı şekilde kötüydü. Sonuç: Çalışmamızda, ABS uygulaması sıçanlarda tendon iyileşmesi üzerinde histolojik olarak olumsuz etkiye sahipti. Öte yandan, bu sonuçları desteklemek için ileri biyomekanik ve immünohistokimyasal çalışmalar gereklidir.Öğe The effect of platelet-rich plasma on osteochondral defects treated with mosaicplasty(SPRINGER, 2014) Altan, Egemen; Aydin, Kerem; Erkocak, Omer; Senaran, Hakan; Ugras, SerdarPurpose This study investigated the efficacy of platelet-rich plasma (PRP) on articular surfaces on which the mosaicplasty technique was performed. Our hypothesis was that PRP can accelerate the osseointegration process and enhance the quality of articular integrity after the mosaicplasty procedure. Methods Standard defects were created in the femoral groove of both patellofemoral joints of 12 New Zealand rabbits. PRP solution was placed inside the defect before fixation of the osteochondral autografts and injected inside the involved joint after capsular closure of the tested knees. The contralateral knees served as the control sides. The animals were euthanized three or six weeks after mosaicplasty, and both limbs were assessed according to Pineda's histological grading scale. Significance level was set at p <= 0.05 a priori, and the Mann-Whitney U test was used for statistical analysis. Results Histologic findings at the interface between the transferred autograft and the original cartilage revealed better integration of the adjacent surfaces in the mosaicplasty with PRP group three weeks after the procedure; the difference was significant (p < 0.05). However, no significant difference in the transition zone was observed between the groups six weeks after the experiment (p = 0.59). Conclusions Our animal model showed that adjunctive use of PRP produced a better healing response and resulted in superior histological scores after three weeks compared with the mosaicplasty-only procedure. Interpretation of our results is important in terms of rapid return to previous activity levels. Thus, application of PRP can represent a valid therapeutic option for improving the efficacy of mosaicplasty by stimulating the local healing response.Öğe Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain(SPRINGER, 2016) Erkoçak, Ömer Faruk; Altan, Egemen; Altıntaş, Murat; Türkmen, Faik; Aydın, Bahattin Kerem; Bayar, AhmetAnterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30A degrees of knee flexion than did the controls. Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. Diagnostic study, Level III.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 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 Post-traumatic cervical nerve root avulsion: direct and indirect magnetic resonance myelography findings(ELSEVIER SCIENCE INC, 2015) Nayman, Alaaddin; Altan, Egemen; Koplay, Mustafa; Kivrak, Ali Sami[Abstract not Available]Öğe Short-Term Functional Outcomes of First Metatarsophalangeal Total Joint Replacement for Hallux Rigidus(SAGE PUBLICATIONS INC, 2013) Erkocak, Omer Faruk; Senaran, Hakan; Altan, Egemen; Aydin, Bahattin Kerem; Acar, Mehmet AliBackground: Although metatarsophalangeal (MTP) arthrodesis has been advocated by many authors, implant arthroplasty appears to be successful option in advanced hallux rigidus (HR). The aim of our study was to evaluate the early results of the ToeFit-Plus prosthesis for the treatment of HR. Methods: Between December 2007 and January 2011, a total of 26 toes of 24 patients with MTP arthritis of the great toe were treated with ToeFit-Plus implant. The average follow-up time was 29.9 (range: 25 to 62) months. All patients were evaluated clinically and radiographically. Postoperative satisfaction and function were scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Pain was assessed with the use of a visual analogue scale. Results: Mean preoperative AOFAS score improved from 42.7 (range: 36 to 59) to 88.5 (range: 59 to 98) at the final follow-up (P < .01). Preoperative average visual analogue scale pain scores improved from 7.4 preoperatively to 1.9 at the final follow-up (P < .01). The average MTP joint range of motion improved from 25.9 degrees preoperatively to 53.8 degrees at the final follow-up. No radiologic loosening was found, but radiolucency was observed in 2 patients with this implant. No revision was required for any of the patients during the follow-up period. Conclusions: This total first MTP joint prosthesis yielded good functional outcome and high patient satisfaction level with low early complication rate. Preservation of joint movement and good pain relief with early mobilization were the advantages of this procedure. Salvage arthrodesis remains an option if future revisions are indicated.Öğe Soft-tissue mallet injuries: A comparison of early and delayed treatment(W.B. Saunders, 2014) Altan, Egemen; Alp, Nazmi Bülent; Başer, Reyhan; Yalçın, LeventPurpose To compare the results of early and delayed extension orthosis fabrication in closed tendinous mallet injuries. Methods Between March 1992 and May 2011, 45 patients with isolated closed tendinous mallet finger injuries were treated with orthosis fabrication. The patients were classified into 2 different groups based on their date of presentation. Group 1 consisted of 28 patients who presented within 2 weeks of sustaining the trauma, and group 2 consisted of 17 patients who received treatment beginning between 2 and 4 weeks after sustaining the trauma. During the final assessments, the patients were assessed clinically using the Crawford classification scale and satisfaction ratings. Results The mean delay between initial injury and presentation to our center was 3 days (range, 1e14 d) in group 1 and 19 days (range, 15e30 d) in group 2. There were no significant differences between the groups regarding their ages, initial extension lag, and arc of flexion. According to the Crawford classification criteria, 72% of the patients in group 1 had excellent results, and 59% of the patients in group 2 had excellent results. There was no significant difference between the groups. Conclusions The treatment results of patients with different presentation times have been reported for heterogeneous groups of osseous and nonosseous mallet finger injuries. Our results suggest that conservative management of tendinous mallet finger injuries that have been neglected for 2 to 4 weeks can be treated as well as those injuries in patients presenting within the first 2 weeks of injury with low long-term complication rates. © 2014 American Society for Surgery of the Hand.
