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Öğe Ayrılmış Asetabulum Kırıklarının İlioinguinal Yaklaşımla Cerrahi Tedavisi: Erken Bulgular(2001) Arazi, Mehmet; Kutlu, Abdurrahman; Erişti, Yıldıray; Mutlu, MahmutAmaç: Ayrılmış asetabulum kırıklarının cerrahi tedavisinde ilioinguinal yaklaşımın erken sonuçlarının ve uygulamayla ilgili tecrübelerimizin bildirilmesi. Çalışma planı: Prospektif bir çalışma protokolü çerçevesinde, 20 hastanın ayrılmış asetabulum kırığı ilioinguinal yaklaşımla cerrahi olarak tedavi edildi. Hastaların 17’si erkek, üçü kadın idi (yaş ort. 41; dağılım 19-70). Tüm hastalar başvurudan sonraki ilk üç hafta içerisinde ameliyat edildi. Judet ve Letournel sınıflamasına göre, kırıkların 14’ü (%70) kompleks tipte, altısı (%30) elementer tipteydi. Son kontrolde hastaların klinik ve radyolojik değerlendirilmeleri, Matta’nın tanımladığı kriterler kullanılarak yapıldı. Ortalama izlem süresi 14 ay (dağılım 6-32 ay) idi. Sonuçlar: Hastaların %80’inde ameliyat sonrası redüksiyon, anatomik ya da başarılı olarak değerlendirildi. Bir hastada derin yara enfeksiyonu, iki hastada siyatik sinirin peroneal komponentini etkileyen iatrojenik sinir arazı, bir hastada Ghalambor ve ark.nın sınıflamasına göre I. derece heterotopik ossifikasyon gelişti. İzlem süresi içinde bir hastada belirgin posttravmatik artrit, iki hastada ise eklem aralığında orta derecede (%50’den az) daralma saptandı. Son kontrolde hastaların radyolojik değerlendirmelerinin klinik bulguları ile uyumlu olduğu gözlendi. Çıkarımlar: Çalışmamız, asetabulumun ayrılmış kırıklarında ilioinguinal yaklaşımla cerrahi tedavinin etkili bir seçenek olduğunu gösterdi. İlioinguinal yaklaşımla, düşük komplikasyon oranı, hızlı yara iyileşmesi ve çok sayıda kırık tipinde yeterli görünüm sağlanmaktadır.Öğe Dermatoglyphic Findings in Congenital Clubfoot(2000) Turhan, A. Bülent; Atasu, Metin; Paydak, Ferhan; Kutlu, AbdurrahmanThe dermatoglyphics of the hand of 33 male and 17 female, a total of 50 patients with congenital clubfoot deformity (CFD) were compared with those of 250 male and 250 female, a total 500 control cases. The most remarkable dermatoglyphic findings observed in CFD were the decreased frequency of ulnar loops and the increased frequency of whorls on all fingers, the decreased frequency of ulnar loops on the left long finger and ring finger and the right thumb, long finger and little fingers, the increased frequancy of whorls on the left long finger and the right thumb, long finger, ring finger and little fingers, the decreased frequency of palmar IV loops and the increased frequency of ? loops and t triradii and the decreased frequency of plantar Î and V? loops and the increased frequency of the p and p" triradii on the soles.Öğe Early Weight-Bearing After Statically Locked Reamed Intramedullary Nailing of Comminuted Femoral Fractures: Is It a Safe Procedure?(LIPPINCOTT WILLIAMS & WILKINS, 2001) Arazi, Mehmet; Öğün, Tunç C.; Oktar, M. Nihat; Memik, Recep; Kutlu, AbdurrahmanBackground: The purpose of this study was to determine the safety of early weight-bearing after statically locked reamed nailing of comminuted fractures of the femoral diaphysis, and to assess the rate of implant failure and fracture heating. Methods: Thirty consecutive patients with comminuted diaphyseal femur fractures (Winquist type II, III, and IV) were treated with statically locked reamed intramedullary nailing. Six patients were lost to follow-up, and the remaining 24 patients were followed at least 1 year, Early weight-bearing was allowed and encouraged in the first 2 weeks after the operation. The nail diameters were 13 mm in 16 patients, 12 mm in 6 patients, and 14 mm in 2 patients. Results: Most of the patients could start weight-bearing between the first 2 and 4 weeks postoperatively, None of the patients, except one, were using any walking aids at the second month postoperatively, All the fractures healed without any significant complications. Nail bending or breakage did not occur in any patients, but there was slight bending in one distal interlocking screw and one proximal interlocking screw, The fractures of the patients with bent screws healed uneventfully, Conclusion: This study showed that early weight-bearing after reamed static interlocking nailing of Winquist type II, III, and IV femoral fractures is a safe and effective method, and the risk of implant failure does not preclude the procedure.Öğe Easily Removed Drill Guide for Pin Insertion During External Fixation(LIPPINCOTT WILLIAMS & WILKINS, 2001) Arazi, Mehmet; Kutlu, AbdurrahmanA new guide for tissue protection while drilling and inserting screws in external fixation without taking down the system is presented. It can be used for pin insertion in both unilateral and ring-type external fixators. The external fixator is used as a template guide, and pin insertion can be easily per formed with the fixator in place. With its use, operative time is decreased, and tissue protection is achieved for all pin insertions in any part of the musculoskeletal system.Öğe Effects of Aprotinin on Pulmonary Functions in Experimental Fat Embolism: Changes in Arterial Blood Gas Levels and Scintigraphic Findings(2000) Yel, Mustafa; Dalgıç, Hülya; Taştekin, Güngör; Arazi, Mehmet; Kutlu, AbdurrahmanPurpose: To assess the effects of aprotinin on the formation and resolution of fat embolism of the lungs. Methods: The changes in arterial blood gas levels and perfusion scintigraphy were studied by forming experimental standardized fat embolism in rabbits with autogenous fat obtained from their femur medullas. Two groups, each consisting of 14 albino rabbits, were used in this study. Group 1, which received intravenous saline solution, was the control group. Group 2, which received aprotinin, was referred to as the aprotinin group. Autogenous femoral medullary content was used for embolization procedures. Arterial blood gas levels were recorded 72 hours before and 1, 24, 72 hours and 10 days following the embolization procedure. Pulmonary perfusion scintigraphies were performed 72 hours before the embolization procedure and on the first and 72nd hours, and the 10th day. Results: Fat embolism was achieved in all rabbits. Seven rabbits in the control group and one rabbit in the aprotinin group died within an hour after the embolization procedure. According to blood gas levels and perfusion scintigraphic findings, the aprotinin group significantly had less pulmonary fat embolism and recovered faster than the control group, especially during the first 24 hours. There was no significant difference in regression of pulmonary dysfunction between the two groups. Conclusion: The correlation between the blood gas levels and scintigraphic findings suggested that the administration of aprotinin for prophylactic purposes had favorable effects on the development of pulmonary gas exchange disturbance and perfusion defect in fat embolism.Öğe Giant Osteochondral Loose Body of the Knee Joint(2000) Yel, Mustafa; Avunduk, Mustafa Cihat; Memik, Recep; Kutlu, AbdurrahmanA rare giant loose body in the knee joint and the treatment carried out were reported. Two loose bodies sized 5.5 and 1.5 cm were extracted from the knee of a patient who suffered from pain and knee motion restricted chronically. The histopathological evaluation revealed normal bone, hyaline cartilaginous tissue, and partly fibrocartilaginous tissue. These loose bodies suggested that they were separated in small pieces from the femoral condyles and were nourished by the synovial fluid. Over time, they adhered to each other in the knee joint.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 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 Pelvis Yaralanmalarının Tedavisinde Eksternal Fiksasyonun Yeri: Endikasyonlar ve Güncel Eğilimler(2000) Arazi, Mehmet; Kutlu, AbdurrahmanGünümüzde pelvisin anstabil lezyonlarının tedavisi, travmatolojinin önemli bir konusu olmaya devam etmektedir. Tedavide, internal tespit araçları ve eksternal fiksatör uygulamaları gibi cerrahi yaklaşımlar sıklıkla uygulanmaktadır. Uygulanan tedavi şekli ile prognoz arasında doğrudan bir ilişki olmasa da, erken hasta rehabilitasyonu amacıyla, anatomik ve sağlam bir tespit gerekmektedir. Eksternal fiksatörler, kolay ve emniyetli ancak her zaman anatomik olmayan bir tespite imkan vermektedir. Yine de eksternal fiksatörler, özellikle erken dönemde öldürücü pelvik hemorajinin tedavisinde ve bazı tip B yaralanmaların kalıcı tedavisinde etkili olmaktadır. Tip C yaralanmalarda ise stabilite sorunu devam etmektedir. Eksternal fiksatörlerin tek başına kullanıldığında yetersiz kalacağı bu tip vakalarda erken rehabilitasyon amacıyla, tecrübeli ekiplerce yapılacak internal tespitten kaçınılmamalıdır. Redüksiyon ve stabilite sorunları nedeniyle kalıcı tedavideki yeri daralmakla birlikte, pelvik eksternal fiksasyon, basit ve emniyetli uygulanması nedeniyle, uygun endikasyonlarda ve dikkatlice seçilmiş hastalarda alternatif bir tedavi yaklaşımı olmaya devam etmektedir.Öğe Pes ekinovarus deformitesinin cerrahi tedavisinde postero-medial gevşetme sonuçlarımız(1998) Mutlu, Mahmut; Öğün, Tunç; Kapıcıoğlu, M. İ. Safa; Arazi, Mehmet; Kutlu, AbdurrahmanHenüz nedeni kesin olarak bilinmeyen Pes ekino varus (PEV) tedavisi zor, kompleks bir konjenital ayak deformitesidir. Selçuk Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji kliniğinde 72 hastanın 106 ayağı posteromedial gevşetme metodu ile cerrahi olarak tedavi edildi. Hastalardan 19'u kız, 53 'ü erkek idi. Hastalardan 58 'inin en az 6 ay, en çok 7 yıl 3 ay (ort. 26.4 ay) takipleri yapıldı. 4 hastanın 7 ayağında nüks meydana geldi. Klinik ve radyolojik değerlendirme sonrasında %81 çok iyi, %11 iyi, %8 kötü sonuç elde edildi.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 Uzun Kemiklerde Kaynama Gecikmesi ve Yokluğunun Perkütanöz Kemik İliği Enjeksiyonu ile Tedavisi: Erken Sonuçların Bildirimi(2000) Arazi, Mehmet; Öğün, Tunç C.; Mutlu, Mahmut; Ertürk, Erol; Kutlu, AbdurrahmanAmaç: Perkütan kemik iliği enjeksiyonunun uzun kemik kaynama problemlerinin tedavisinde klinik etkinliğini değerlendirmek. Çalışma planı: Uzun kemik kırığı bulunan ve kaynama problemi olan sekiz hasta (2 kadın, 6 erkek; ortalama yaş 34.3; yaş dağılımı 20-47) perkütan kemik iliği enjeksiyonu ile tedavi edildi ve prospektif olarak değerlendirildi. Kırıkların lokalizasyonları tibia (n3), humerus (n2), ulna (n2) ve radius (n1) şeklindeydi. Sonuçlar: Bir hasta takipten ayrıldı, kalan yedi hastanın beşinde, ortalama 4.2 ayda (3-6 ay) yeterli kaynama elde edildi. Çıkarımlar: Seçilmiş hastalarda, kaynama problemlerinin tedavisinde, perkütanöz kemik iliği enjeksiyonunun, emniyetli, basit ve alternatif bir tedavi yaklaşımı olduğu sonucuna varıldı.
