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Öğe Anthropometric measurements of tibial plateau and correlation with the current tibial implants(SPRINGER, 2016) Erkocak, Omer Faruk; Kucukdurmaz, Fatih; Sayar, Safak; Erdil, Mehmet Emin; Ceylan, Hasan Huseyin; Tuncay, IbrahimThe aim of the study was to make an anthropometric analysis at the resected surfaces of the proximal tibia in the Turkish population and to compare the data with the dimensions of tibial components in current use. We hypothesized that tibial components currently available on the market do not fulfil the requirements of this population and a new tibial component design may be required, especially for female patients with small stature. Anthropometric data from the proximal tibia of 226 knees in 226 Turkish subjects were measured using magnetic resonance imaging. We measured the mediolateral, middle anteroposterior, medial and lateral anteroposterior dimensions and the aspect ratio of the resected proximal tibial surface. All morphological data were compared with the dimensions of five contemporary tibial implants, including asymmetric and symmetric design types. The dimensions of the tibial plateau of Turkish knees demonstrated significant differences according to gender (P < 0.05). Among the different tibial implants reviewed, neither asymmetric nor symmetric designs exhibited a perfect conformity to proximal tibial morphology in size and shape. The vast majority of tibial implants involved in this study tend to overhang anteroposteriorly, and a statistically significant number of women (21 %, P < 0.05) had tibial anteroposterior diameters smaller than the smallest available tibial component. Tibial components designed according to anthropometric measurements of Western populations do not perfectly meet the requirements of Turkish population. These data could provide the basis for designing the optimal and smaller tibial component for this population, especially for women, is required for best fit. II.Öğe The effect of watching live arthroscopic views on postoperative anxiety of patients(SPRINGER, 2008) Bayar, Ahmet; Tuncay, Ibrahim; Atasoy, Nuray; Ayoglu, Hilal; Keser, Selcuk; Ege, AhmetSurgery is a stressful experience. Many minor interventions have been shown to cause considerable anxiety in patients, but whether arthroscopy leads to such anxiety is not well-known. Methods for lowering perioperative anxiety have been sought and listening to music or watching a movie have been recommended. The method of permitting patients to watch their own endoscopy has been studied infrequently. Our aim in this study was to find out the effect of watching simultaneous arthroscopic views on postoperative anxiety. A total of 63 patients were randomly divided into two groups: those watching their own arthroscopy formed group W, while patients that were only verbally informed formed group NW. The mean age of patients in both groups were 33 and 34, respectively. Meniscal surgery was the most commonly performed procedure (49/63 patients). The patients filled in state scale of State-trait anxiety inventory (STAI) forms and the study questionnaire (SQ) prepared for this study, just before and after the arthroscopy. Group W had significantly lower postoperative scores of STAI-S, whole questionnaire (Q-score) and all but one of individual statements in SQ. Having a previous operation history did not affect STAI scores. Age and level of education was not correlated with any of the studied parameters either. The ratio of patients that were pleased with the arthroscopy experience in group W and NW were 94 and 63%, respectively. Watching live arthroscopic views has led to a significant decrease in postoperative anxiety and worries about the surgery and the postoperative period, while increasing overall understanding and satisfaction of the patient.Öğe Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2015) Tuncay, Ibrahim; Bilsel, Kerem; Elmadag, Mehmet; Erkocak, Omer Faruk; Asci, Murat; Sen, CengizObjective: Three methods of surgery used in the treatment of knee osteoarthritis (OA) are mobile bearing unicompartmental knee arthroplasty (Oxford UKA), opening wedge high tibial osteotomy (HTO), and dome-type HTO. This article aimed to retrospectively compare these three methods in terms of outcomes for health status, patient satisfaction, and function. Methods: Between 2003 and 2010, 255 knees of 235 patients underwent operations for medial knee OA. Three types of surgery were performed. Group 1 consisted of 109 knees of 94 patients who underwent Oxford UKA. Group 2 was made up of 36 knees of 36 patients who underwent HTO using circular external fixation, and Group 3 comprised 57 knees of 52 patients on whom opening wedge type HTO using locking plate fixation was performed. SF-36 and HSS knee scores were used to compare the functional outcomes among groups. Results: Statistically significant differences were found between the preoperative and postoperative measures in all 3 of the treatment groups for physical function, physical role, pain, general health, vitality, social function, emotional role, and mental health according to SF-36 and HSS scores. In the 2nd group, the average correction of the mechanical axis deviation (MAD) was 38 mm with 11.7 degrees along the femorotibial axis and 6.2 degrees along the medial proximal tibial angle (MPTA). In the 3rd group, the average correction in the MAD was 28 mm with 9.7 degrees along the femorotibial axis and 5.6 degrees along the MPTA. All 3 of the treatment alternatives were observed to be sufficient. Satisfactory postoperative results were achieved in the UKA group in terms of social function and mental health, and the patients were able to achieve early rehabilitation and return to their previous life activities. Conclusion: UKA is the ideal option for patients who wish for the earliest possible return to social and recreational activities.Öğe The fascial band from semitendinosus to gastrocnemius: the critical point of hamstring harvesting(TAYLOR & FRANCIS INC, 2007) Tuncay, Ibrahim; Kucuker, Hudaverdi; Uzun, Ibrahim; Karalezli, NazimBackground Arthroscopically-assisted reconstruction of the anterior cruciate ligament with hamstring tendons has achieved widespread acceptance; however, the anatomy of these tendons may cause technical problems at harvesting. Methods We studied the anatomy of the fascial band between semitendinosus and gastrocnemius and the distance between the semitendinosus insertion and the origin of this band in 23 knees from cadavers (17 male). The length of the semitendinosus tendon and the width of the fascial band were also recorded. Results Fascial attachment was detected in all cadavers except 1. The mean width of the band was 2.6 (1 - 4) cm. The mean distance from the insertion of the semitendinosus to the fascial band was 7 (6 - 8) cm. The mean length of the semitendinosus tendon was 22 (18 - 26) cm. Interpretation A better understanding of the anatomy of the hamstring tendons will reduce the risk of a disappointing complication right at the start of the operation.Öğe Knee arthrodesis using a unilateral external fixator for the treatment of infectious sequelae(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2008) Eralp, Levent; Kocaoglu, Mehmet; Tuncay, Ibrahim; Bilen, F. Erkal; Samir, Shady ElbeshryObjectives: We evaluated the results of arthrodesis using a monolateral external fixator for the treatment of septic sequelae of the knee joint. Methods: Eleven patients (4 males, 7 females; mean age 60 years range 29 to 75 years) underwent arthrodesis using a monolateral external fixator. Indications for arthrodesis were infected total knee prosthesis (n=6), septic arthritis sequelae (n=4,), and infected distal femoral tumor prosthesis (n=1). Eight patients had active infection, of these, seven patients initially underwent complete clinical and laboratory eradication of infection with debridement, application of antibiotic-impregnated cement spacer (n=6), and parenteral antibiotics. Resection guides of total knee arthroplasty were used to create wide bleeding femoral and tibial bone surfaces. Biplanar or uniplanar monolateral external fixation was applied for a mean of eight months (range 5 to 12 months). The mean follow-up was 28 months (range 7 to 69 months). Complications were evaluated according to the Paley's classification. Results: Fusion was achieved in all the patients. There were no recurrent infections. No remarkable shortening developed following the procedure. All the patients could walk without walking aids, except for one patient who further required lengthening for marked shortening due to previous wide tumor resection. Shortening was 3 cm in one patient with infected total knee prosthesis, while it ranged from 1 cm to 2 cm (mean 1.4 cm) in the remaining patients. Pin tract infections were seen in five patients, all of which were successfully treated with oral antibiotics and local wound care. Conclusion: Knee arthrodesis using a monolateral external fixator is associated with a high fusion rate and a low complication rate, and provides a more comfortable treatment option compared to a circular external fixator.Öğe The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique(SPRINGER, 2007) Asik, Mehmet; Sen, Cengiz; Tuncay, Ibrahim; Erdil, Mehmet; Avci, Cem; Taser, Omer F.In this study, mid to long-term results of anterior cruciate ligament reconstruction with hamstring tendons and Transfix technique were evaluated. Anterior cruciate ligament (ACL) reconstruction with four-strand hamstring tendon was performed with Transfix technique on 271 (198 males, 73 females; mean age 25.7; 17-52) patients with anterior cruciate ligament ruptures. The patients were followed up with clinical examination, Lysholm and Tegner activity scales, IKDC scoring system, KT-1000 test and radiological examination. The mean follow-up period was 82 (48-100) months; 204 (75%) patients had no subjective complaints. According to the KT-1000 test, only 14 (5%) patients had more than 5 mm laxity postoperatively, whereas, 161 (59%) patients had more than 5 mm laxity preoperatively. In addition to this, only 19 (7%) patients had Lysholm scores less than 80 postoperatively, whereas 154 (57%) patients scored less than 80 preoperatively. When compared with Tegner activity scale, 189 (70%) patients scored < 6 preoperatively and only 24 (8%) postoperatively: 78 (29%) patients scored D preoperatively and only 5 (2%) patients scored D postoperatively on the basis of the IKDC scoring system. Our functional results were found to be satisfactory in more than 90% of patients. Commonly seen problems in ACL reconstruction such as inaccurate graft placement and tunnel widening were found to be consistent with the values in relevant literature. However, we demonstrated that the functional results and the stability of the knee were not related with tunnel widening. This study concludes that the reconstruction of ACL with hamstring tendons and the Transfix technique is reasonably successful, safe and causes low morbidity. Furthermore, we believe that proper graft preparation, accurate tunnel placement, notch-plasty, fixation and rehabilitation program are all as important as the choice of graft and fixation material.Öğe The pain associated with intraarticular hyaluronic acid injections for trapeziometacarpal osteoarthritis(SPRINGER, 2007) Karalezli, Nazim; Ogun, Tunc Cevat; Kartal, Senay; Saracgil, Sacide Nur; Yel, Mustafa; Tuncay, IbrahimTrapeziometacarpal osteoarthritis predominantly affects middle-aged women. Most cases with rhizarthrosis can be managed successfully by conservative means. The purpose of this prospective study was to evaluate pain and tolerability of viscosupplementation therapy with hyaluronic acid (HA) for trapeziometacarpal osteoarthritis. Groups A and B consisted of eight patients each with Eaton stage 3 or 4 rhizarthrosis, who underwent one cycle of three injections of (one per week) 0.3 cm(3) sodium hyaluronate. The injections for group A were under fluoroscopy control, but fluoroscopy was not used in group B. Pain and tolerability of both groups A and B were measured and compared. The patients of the groups were also asked to evaluate the tolerability of the treatment. The results suggested that HA injection in the carpometacarpal joint is a tolerable procedure but the patients complained of pain and discomfort during the injections. The pain in group A was much greater than in group B. Viscosupplementation for the treatment of trapeziometacarpal osteoarthritis is a viable treatment option for stages 3 and 4 patients when they do not want to be operated on. It is a tolerable but not a painless procedure especially when it is done without fluoroscopy control. We recommend giving injections under fluoroscopy control.Öğe Regional bone density changes in anterior cruciate ligament deficient knees: A DEXA study(ELSEVIER SCIENCE BV, 2008) Bayar, Ahmet; Sarikaya, Selda; Keser, Selcuk; Oezdolap, Senay; Tuncay, Ibrahim; Ege, AhmetBone mineral density (BMD) loss is one of the secondary problems occurring in knee joint after injury of anterior cruciate ligament (ACL). The effect of this injury on BMDs of specific regions is not clear. The aim Of this Study was to investigate BMD changes in unreconstructed ACL-deficient knees with subregion analysis of dual energy X-ray absorptiometry (DEXA). Precision and reliability studies of DEXA revealed that two region of interests (ROI) in medial condyle, two ROIs in lateral femoral condyle (LFC) and one ROI in medial tibial plateau (MTP) in anteroposterior(AP) DXA view and one ROI for each of distal femur, proximal tibia and patella in lateral view had high reproducibility and reliability. Thirty-two patients with complete ACL ruptures were collected for the study and uninjured sides served as the control. All the patients were male with a mean age of 30 years. Mean duration of ACL rupture was 24 months. There were significant BMD losses in both ROIs of LFC and ROI of MTP In AP view and all three ROIs of lateral view. Greatest BMD losses in AP and lateral views were at MTP and patella respectively. There was a significant association between patellar BMD loss and duration after trauma. Bone bruises in lateral condyle might be the cause of selective involvement of LFC. Periarticular bone mineral loss in ACL-deficient knees has a predilection for the specified region of interest rather than uniform periarticular loss. Tills may be important for graft fixation or a factor in tunnel enlargement. (C) 2008 Elsevier B.V. All rights reserved.Öğe Wrist tourniquet: The most patient-friendly way of bloodless hand surgery(LIPPINCOTT WILLIAMS & WILKINS, 2007) Karalezli, Nazim; Ogun, Cemile Oztin; Ogun, Tunc Cevat; Yidirim, Serhat; Tuncay, IbrahimBackground: The literature is scarce on wrist tourniquets. In this study, three well-established locations of tourniquet setting including upper arm, proximal forearm, and wrist were compared on the same limb using both clinical as well as biochemical variables in paramedical volunteers. Methods. Twenty unmedicated, healthy, paramedical, right-hand dominant volunteers participated in the study. The left upper arms were used for monitoring. Blood pressures and heart rates were monitored and recorded before (baseline) and immediately after the application of the tourniquet, every 5 minutes, and at the time the patient requested deflation. An intravenous cannula (22 G) was placed on the right hand to obtain samples, which were taken at baseline and immediately after deflation of the tourniquet to evaluate the levels of pO(2), pCO(2) O-2 saturation, pH, bicarbonate, blood sugar, lactate, hematocrit, and electrolytes. The tourniquets were applied to the right upper arm, forearm, and wrist of each subject with 5-day intervals between each trial. Subjective discomfort and tourniquet pain levels were recorded. For each trial, tourniquet tolerance and details of discomfort were recorded. Statistical analysis was performed as appropriate. Results: Twenty volunteers aged 20 to 44 years were included. For each trial, in the first 10 minutes after inflation of the tourniquet, the heart rate and systolic blood pressure were increased compared with baseline values. Diastolic blood pressure was elevated immediately after inflation and remained so until deflation in each trial. Diastolic blood pressure values were higher in the upper-arm tourniquet group compared with wrist. Then pH, pO(2), and O-2. saturation values were de-creased and pCO(2) and lactate levels were increased compared with baseline values in each trial. Blood sugar was decreased significantly in the arm group. The decrease in pH, pO(2), O-2 saturation, and blood sugar in the upper arm group was significantly higher compared with wrist and forearm groups. The lactate value was higher in the upper arm group compared with wrist. Visual analog scale and numerical rating scores were lower in the wrist group compared with others at all times. The longest tourniquet tolerance was in the wrist group. In the wrist group, curling was observed in all subjects but the fingers could easily be extended. Conclusion: The wrist tourniquet is the most comfortable technique of bloodless surgery for procedures limited to the hand region.
