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Öğe Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture(SPRINGER, 2017) Türkmen, Faik; Kaçıra, Burkay Kutluhan; Özkaya, Mustafa; Erkoçak, Ömer Faruk; Acar, Mehmet Ali; Özer, Mustafa; Toker, SerdarThe purpose of this study was to investigate the mechanical strength of both monoplanar and biplanar medial opening-wedge high tibial osteotomy (MOWHTO) procedures and assess the risk of lateral cortex disruption for both techniques. Twelve synthetic tibia models with cortical shells were used as test models. Saw cuts for monoplanar MOWHTO and biplanar MOWHTO were generated on the test models in equal numbers (n = 6 for both groups). Wedge opening load and wedge gap distance were evaluated via compressive tests. The mean gap distance just before the lateral cortex fracture in the monoplanar group was 14.7 +/- 2.9 mm, which was significantly narrower than that in the biplanar group of 19.1 +/- 2.0 mm (p = 0.015). The mean load just before the occurrence of lateral cortex fracture of 32.4 +/- 3.2 N in the monoplanar osteotomy group was significantly lower than that in the biplanar osteotomy group of 111.8 +/- 9.3 N (p = 0.009). Performing a MOWHTO via the biplanar rather than the monoplanar technique allows larger-sized wedges to be opened with less risk of lateral cortical fracture. Thus, larger gaps can be opened and higher angle corrections can be achieved using the biplanar osteotomy procedure. From a clinical viewpoint, the biplanar osteotomy technique reduced the risk of lateral cortical hinge fracture during MOWHTO.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 Medial opening wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer(SAGE Publications Ltd, 2014) Türkmen, Faik; Sever, Cem; Kaçıra, Burkay Kutluhan; Demirayak, Mehmet; Acar, Mehmet Ali; Toker, SerdarObjectives: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee relocates to the lateral compartment with this procedure. A gap occurs on the proximal tibia during the correction of varus deformity. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing nonunion or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials. Methods: We evaluated 41 MOWHTOs performed between 2009 and 2012 with no use of bone grafts, synthetic materials or spacers. Age of the patients ranged from 43 to 67. Thirty five of the patients were female and 3 of them were male. The follow-up time was 6 months. Results: There were no any non-unions or loss of correction. The mean bone union time was 12,8 weeks. No major complications were seen. Conclusion: The results of our study has shown that achieve satisfactory results can be obtained in MOWHTO without using any bone graft, synthetic materials or spacer. © The Author(s) 2014.Öğe Medial opening-wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer(Springer-Verlag France, 2014) Türkmen, Faik; Sever, Cem; Kaçıra, Burkay Kutluhan; Demirayak, Mehmet; Acar, Mehmet Ali; Toker, SerdarPurpose: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee is directed to the lateral compartment with this procedure. A gap occurs on the proximal tibia while providing adequate correction. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing bone union problems or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials.Methods: We evaluated 41 MOWHTOs that have been performed between 2009 and 2012 with no use of any grafts or synthetic materials and spacer. Age of the patients ranged from 43 to 67. Thirty-five of the patients were females and three of them were males. The follow-up time was 6 months.Results: Seven knees had opening at the osteotomy site <10 mm, 26 knees had 10–12.5 mm, and eight knees had >12.5 mm (range 7.5–14 mm, mean 11.07 mm). All osteotomies united without loss of correction. The mean bone union time was 12.8 weeks. We did not have any major complication regarding the technique.Conclusion: The results of our study have shown that we can achieve satisfactory and good results by performing MOWHTO procedure without using any bone grafts or synthetic materials and spacer. © 2014, Springer-Verlag France.Öğe A new diagnostic parameter for patellofemoral pain(E-CENTURY PUBLISHING CORP, 2015) Türkmen, Faik; Acar, Mehmet Ali; Kaçıra, Burkay Kutluhan; Korucu, İsmail H.; Erkoçak, Ömer Faruk; Yolcu, Bayram; Toker, SerdarPurpose: Q-angle measurement procedure have not been well standardised. There is a lack of consensus about subject position and knee flexion angle while measuring the Q-angle. Morover Q-angle value which obtained in a single position is a static value and gives an information about the subject's current position. The aim of this study is to obtain a more significant parameter which includes different postures (supine, standing, sitting) and different knee flexion angles instead of a single Q-angle in a fixed position. At the same time this parameter must be functional and dynamic, not a static value like Q-angle. We named this parameter as Delta Q. Methods: Our study was applied on case and control groups. All subjects in both groups were male. Case group was consisted of 14 subjects who had patellofemoral pain. Control group was consisted of 14 subjects who had normal knees and normal lower extremities with no reported knee problems. We obtained 3 different Q-angle values and 3 different Delta Q values for each subject in both groups. Pearson correlation analysis was used for investigation of continuous variables in normal distribution, Spearman correlation analysis was used in abnormal distribution. t test was used in the comparison of values. Logistic regression analysis(forward conditional mod) was used for detecting of determinants of pain. Results: Delta Q1s of both groups were found as the only statistical significant predictive value for patellofemoral pain. Conclusion: There is not an agreement about a standardised q-angle measurement procedure in the literature. Moreover, present procedures provide information about a single and fixed position. In this situation Q-angles which obtained in these fixed positions are static values. We think that we can overcome these problems with this new value. Delta Q contains multiple q-angles and gives information about all. Also it is a dynamic value for being oriented to position change. Therefore, Delta Q is an useful indicator for evaluating patellofemoral pain.Öğe Reconstruction of dorsal hand and finger defects with reverse radial fasciocutaneous forearm flaps(Springer-Verlag France, 2015) Acar, Mehmet Ali; Güleç, Ali; Aydın, Bahattin Kerem; Erkoçak, Ömer Faruk; Elmadağ, Mehmet; Türkmen, FaikObjectives: To evaluate the midterm outcome and the degree of satisfaction of patients who underwent reconstruction of dorsal hand and finger defects with reverse flow radial fasciocutaneous forearm flaps and to test whether or not this is a reliable method which can be applied without the need for microsurgery. Patients and methods: Eleven patients were admitted with post-traumatic complex hand defects and treated by reconstruction with reverse flow radial fasciocutaneous forearm flaps from January 2010 to May 2013. The patient demographics, size of the hand and finger defects, and complications were recorded. The functional status of each of the patients was evaluated using the quick disabilities of the arm, shoulder and hand (DASH) scoring system, and patient satisfaction was assessed using Likert scores. Results: The patients comprised nine males and two females with a mean age of 30.7 ± 9.7 years. The mean follow-up period was 18.4 ± 5.2 months. The average defect size was 41 ± 14.3 cm². None of the patients had circulation defects caused by the sacrifice of the radial artery. The mean quick DASH score was determined as 30.2 ± 15.3. The Likert patient satisfaction evaluation was good in one patient, and very good in ten patients. All flaps survived well with only two complications; superficial skin necrosis occurred at the suture site in one patient and venous insufficiency occurred in the other patient. Both complications recovered with secondary healing following wound debridement. Conclusions: The reverse-flow radial forearm flap is a reliable method in the management of dorsal defects of the hand and does not require micro-surgical techniques. © 2014, Springer-Verlag France.Öğe Reconstruction of multiple fingertip injuries with reverse flow homodigital flap(ELSEVIER SCI LTD, 2014) Acar, Mehmet Ali; Güzel, Yunus; Güleç, Ali; Türkmen, Faik; Erkoçak, Ömer Faruk; Yılmaz, GüneyAim: Hand trauma may lead to multiple fingertip defects, causing functional restrictions. We evaluated the use of reverse-flow homodigital flap reconstruction of the distal phalanx and pulp defects associated with multiple finger injuries. Methods: We retrospectively evaluated 11 male patients who presented at our emergency department (January 2011-March 2013) with multiple fingertip injuries and who were treated with a reverse-flow homodigital flap. Evaluations included age, sex, defect size, flap survival rate, complications, cold intolerance, two-point discrimination, range of motion (ROM), quick disabilities of the arm, shoulder, and hand (DASH) score, and return to work time. Results: Completely, 22 reverse-flow homodigital flaps were applied to at least two fingertip injuries at the distal phalanx. Ten flaps survived postoperatively. The exception was partial flap loss on one finger. The mean follow-up was 14.2 months. At the final follow-up, the mean static two-point discrimination value was 10.3 mm. Mean ROMs of interphalangeal joints were 65.31 degrees (distal) and 105.77 degrees (proximal). Donor sites were covered with full-thickness skin grafts from the wrist or antecubital area. There were no complications related to the donor site and no development of cold intolerance in any finger. The mean quick DASH score was 4.12. All patients returned to work in an average of 8.3 weeks. Conclusions: The reconstruction of multiple fingertip injuries with reverse-flow homodigital flaps is a safe, effective method that can be combined with other local finger flaps. These flaps can be applied to two consecutive fingers without reducing finger length or function. (C) 2014 Elsevier Ltd. All rights reserved.
