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Öğe Anterior knee pain in children with cerebral palsy(2007) Senaran H.; Holden C.; Dabney K.W.; Miller F.Anterior knee pain arising from the patellofemoral joint may be a significant problem in the cerebral palsy (CP) population. The aim of this study was to classify patients with anterior knee pain based on etiology and organize orthopaedic management based on this classification. This study was a retrospective chart review of patients with CP and anterior knee pain admitted to the orthopaedic outpatient clinic between 1991 and 2003. Children with CP who had intractable anterior knee pain despite 6 months of conservative treatment with at least 2 years' follow-up were identified and included. The medical records, radiographs, and treatment protocols were screened. Patients were classified into 3 groups according to pathology. Group I consisted of 7 children with patella alta only. Group II consisted of 7 children with patellar inferior pole fractures. Group III consisted of 13 children with subluxated or dislocated patellas. Conservative treatment methods such as anti-inflammatory drugs, local ice packs, stretching exercises, and braces should be the first step in treatment. For those patients in whom conservative treatment was not effective, surgical treatment alternatives were discussed. Knee pain resolved in all patients after surgical treatment of the underlying pathology. Gait analysis can be performed for patients with patellofemoral subluxations to evaluate the rotational malalignment of the tibia and femur. In conclusion, anterior knee pain arising from the patellofemoral joint in patients with CP should be evaluated and treated to prevent future functional deterioration. © 2007 Lippincott Williams & Wilkins, Inc.Öğe Arthrodesis for tuberculous coxarthritis: Good outcome in 32 adolescents(2004) Özdemir H.M.; Yensel U.; Cevat Ögün T.; Senaran H.; Kutlu A.Background: There is no consensus on best treatment of advanced tuberculous coxarthritis in young patients. Patients and methods: We report our results concerning hip arthrodesis for advanced tuberculous arthritis of the hip in 32 adolescents. The operation was preceded by standard antituberculous chemotherapy for 4 weeks, which was continued for 12 months after surgery. At the last follow-up, clinical and radiographic examinations of the ipsilateral knee, contralateral hip and lower back were done. We evaluated function, limitations, and presence of pain with our usual questions. Results: Their average age at the time of operation was 16 (12-18) years and the average duration of follow-up 12 (10-18) years. Solid bony fusion occurred in all patients after mean 5 months and no complications developed in the postoperative period. 28 patients were satisfied with the fused hip. No patients had reactivation of tuberculosis in any part of their body. The results were comparable to those of arthrodesis performed for other causes. Interpretation: Hip arthrodesis is an alternative method of treatment for advanced stages of tuberculous coxarthritis in the adolescent.Öğe Comparison of K-wire fixation methods in terms of stability in Salter iliac osteotomies [Salter iliyak osteotomisinde K-teli ile yapilan tespit yöntemlerinin stabilite açisindan karşilaştirilmasi.](2007) Senaran H.; Karalezli M.N.; Simşek S.; Arazi M.; Kapicio?lu M.I.OBJECTIVES: We compared the stability of K-wire fixation methods used in Salter iliac osteotomies in developmental dysplasia of the hip (DDH) to determine the most appropriate method for stabilization of the acetabular fragment. METHODS: The study included 425 hips of 331 patients (63 boys, 268 girls; mean age 23.3 months; range 17 to 35 months) who underwent iliac osteotomies for DDH with appropriate indications described by Salter. Fixation of the graft was made with the use of one or two K-wires. All the patients were assessed postoperatively with anteroposterior pelvic radiographs obtained before a hip spica cast was applied and after it was removed. The patients were divided into four groups based on the fixation methods used, namely, one or two K-wires directed either to the triradiate cartilage or to the roof of the acetabulum. On postoperative pelvic radiographs, we assessed the relation between the proximal and distal iliac fragments, position of the graft in the osteotomy area, medialization of the distal iliac bone corner at the sciatic notch, and coverage of the femoral head. RESULTS: Fixation with two K-wires resulted in no graft displacement. Of 381 hips in which a single K-wire was used, 15 hips (3.9%) exhibited graft displacement due to fixation instability. Orientation of the K-wire fixation was toward the triradiate cartilage in eight hips (2.9%), and toward the roof of the acetabulum in seven hips (6.4%). No significant differences were found between the four groups in terms of fixation instability. CONCLUSIONS: The absence of fixation failure with the use of two K-wires suggests that this method provides a more stable fixation of iliac osteotomy and bone graft.Öğe Complications following surgical treatment of shoulder instability and revision interventions for stabilization [Omuz instabilitesi için yapilan cerrahi tedaviden sonra görülen komplikasyonlar ve tedavisi.](2005) Yel M.; Arazi M.; Senaran H.A successful surgical intervention to restore glenohumeral stability should be based on the detection of all the problems and on a plan to correct all those that are reparable. Contribution of arthroscopy to better understand the pathological anatomy and to evaluate coexisting intra-articular problems, and advances in imaging modalities and in implant technology have increased the success rates and decreased complications. The best way to avoid complications is to gather all the relevant data preoperatively and during surgery to draw the correct diagnosis and to employ the most appropriate approach or approaches accordingly. Complication rates are lower with open surgical techniques, where problems mainly arise from limited joint movements, implant deficiency, and degenerative changes. Although arthroscopic surgery is associated with significantly fewer complications seen with open techniques, it results in higher recurrence rates. Revision surgery for stabilization of the shoulder should be directed to well-defined pathologies using appropriate techniques. The most common complication encountered is the recurrence of instability, which should primarily be dealt with by open surgical techniques.
