Ortopedi ve Travmataloji/Makale Koleksiyonu

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https://hdl.handle.net/20.500.12395/15620

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Is Retrograde Pinning Reliable for Multiple Metatarsal Fractures?
(Selçuk Üniversitesi, 2023 Haziran) Özdemir, Ali; Yeşil, Yusuf Ziya; Çiftci, Sadettin; Eravşar, Ebubekir; Safalı, Selim; Aydın, Bahattin Kerem
Background: Fixation with K-wires is a commonly used method in the surgical treatment of metatarsal fractures. The application of K-wires can be antegrade and retrograde. There is a limited number of studies about the fixation of metatarsal fractures with retrograde K-wires in the literature. The present study aims to investigate the long-term results of retrograde pinning. Methods: 14 patients with at least a four-year follow-up were included in the study. The patients’ union status, demographic data, duration of surgery, duration of fluoroscopy use, metatarsophalangeal (MP) range of motion, American Orthopedic Foot and Ankle Score (AOFAS) scores, and plantar keratosis formation were evaluated. Results: Complete union was observed in 13 of 14 patients. MP joint restriction was not found in any patient with a union. Symptomatic plantar keratosis was not observed in any patient. Good and perfect results were obtained in AOFAS scores. Conclusion: According to the literature, retrograde pinning in metatarsal fractures is thought to be a treatment that is difficult to apply, has high radiation exposure, and complications are observed frequently. Contrary to previous beliefs about the difficulties and risks associated with retrograde pinning, our study found this method to be effective and associated with fewer complications in long-term follow-up.
Konjenital İdyopatik Talipes Ekinovarus Artmış Gelişimsel Kalça Displazisi Sıklığı için Risk Faktörü Müdür?
(Selçuk Üniversitesi, 2017 Haziran) Aydın, Bahattin Kerem; Sofu, Hakan; Şenaran, Hakan
Amaç: Gelişimsel kalça displazisi (GKD) ve idyopatik talipes ekinovarus (PEV)en sık görülen çocukluk çağı ortopedik deformitelerindendir. Bu çalışmanın temel amacı ülkemizde PEV deformitesi nedeniyle tedavi edilen pediatrik hasta grubunda GKD sıklığını ve PEV deformitesinin GKD sıklığı açısından bir risk faktörü olup olmadığını araştırmaktır. Gereç ve Yöntem: Konjenital idiopatik pes ekinovarus tanısı ile Ponseti metodu uygulanarak tedavi edilmiş 113 çocuk (Grup 1) ve ulusal rutin GKD tarama programı kapsamında kalça ultrasonografisi uygulanmış fakat PEV deformitesi olmayan 129 sağlıklı çocuk (Grup 2) çalışmaya dahil edildi. Çocukların ultrasonografi esnasında ortalama yaşı Grup 1’de 3.8 hafta ve Grup 2’de 4.6 hafta olarak saptandı. Grup 1’de 65 kız ve 48 erkek, Grup 2’de 69 kız ve 60 erkek vardı. Her iki grupta Graf sınıflamasına göre GKD sıklığı mukayeseli olarak değerlendirildi. Bulgular: Ultrasonografi uygulanan toplam 484 kalçanın 20 tanesinde (%4.1) GKD görüldü. Grup 1’de 10 çocuk (%8.8) ve Grup 2’de 6 çocuğa (%4.6) GKD tanısı kondu. Grup 1’deki 13 kalçanın 4 tanesi Tip 2A, 1 tanesi Tip 2B, 4 tanesi Tip 3 ve 4 tanesi Tip 4 olarak sınıflandırıldı. Grup 2’de ise 6 kalçada Tip 2A ve 1 kalçada Tip 3 displazi saptandı. Graf sınıflamasına göre GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekti. Sonuç: Gruplar arasında displazik kalça sıklığı bakımından anlamlı farklılık gözlemlenmemiş olmasına rağmen, GKD teşhisi konmuş kalçalar içinde Tip 3 veya Tip 4 displazi oranı ve aynı zamanda bilateral GKD oranı PEV grubunda anlamlı olarak daha yüksekti.
Factors Associated with Acetabular Degeneration and Protrusion in Bipolar Hip Hemiarthroplasty
(Selçuk Üniversitesi, 2022) Emre, Fahri; Ertaş, Erkan Sabri; Bozkurt, Murat
Purpose: This study aims to investigate the effect of some factors such as the diameter of bipolar prosthetic heads, body mass index (BMI), age, gender, bone mineral density (BMD) and leg length discrepancy (LLD) on the acetabular protrusion in elderly patients who had hip bipolar hemiarthroplasty (BHA) after femoral neck fractures. Methods: The study included a total of 209 patients with a mean age of 77.4 ± 6.0 years who underwent BHA. The difference between the femoral head diameter of the patients and the diameter of the bipolar prosthetic head was divided into two groups, ranging from 0 to -2 mm (same and 1,2 mm small size) . Acetabular enlargement and cartilage degeneration were followed by standard AP pelvis radiographs and clinical outcomes were evaluated by the Harris Hip Score (HHS) after surgery and during 5 years of follow-up. Results: During the 5-year follow-up, while HHS values decreased, acetabular diameter increased. Acetabular protrusion developed in 21 (10%) patients, acetabular revision surgery was performed for 36 (17%) patients, the difference between native femoral head diameter and prosthetic head diameter was significantly higher in these groups, as was mean LLD (p = 0.0001). Mean T scores obtained with BMD were lower in these groups (p = 0.0001). Conclusion: It is safer and more reliable to use a bipolar prosthetic head the same size as the patient’s native femoral head in BHA. When considering the acetabular protrusion and revision surgery rate in this study, small-size bipolar prosthetic head implantation is not recommended and may cause devastating complications.
Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after total knee arthroplasty: A randomized clinical trial
(ASSOCIACAO PAULISTA MEDICINA, 2019) Cicekci, Faruk.; Yildirim, Ahmet.; Onal, Ozkan.; Celik, Jale Bengi.; Kara, Inci.
BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated with periarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability.
Sağlık çalışanlarında fiziksel aktivite ile yaşam kalitesi ilişkisi
(CUKUROVA UNIV, FAC MEDICINE, 2019) Yıldırım, Duygu İlke.; Yıldırım, Ahmet.; Eryılmaz, Mehmet Ali.
Purpose: The purpose of this study is to investigate the relationship between physical activity and quality of life in health workers and to determine the related factors. Materials and Methods: In this study, 120 doctors and 120 nurses providing health services in the hospital were enrolled on the basis of volunteerism principle. It is a cross-sectional and descriptive study. All participants completed a general information form consisting of 20 questions. The data related to the study's physical activity variables were collected by using 'International Physical Activity Questionnaire Short Form - UFAA Short Form International Physical Activity Questionnaire'. The 'Short Form 36 (SF-36) Quality of Life Scale' was used to assess the quality of life of the participants. All data collection tools were collected using face-to-face interview techniques. Results: 240 health workers participated in the study. There was a statistically significant difference according to occupational groups and the gender, age groups, marital status, income levels and physical activity levels. It was determined that 63.9% of the doctors and 36.1% of the nurses had a high level of physical activity and the level of the physical activity among physicians was statistically significantly higher than the nurses. Conclusion: The results of the study showed that doctors had significantly higher levels of physical activity and some subscales of SF-36 than nurses. According to the results obtained, it can be said that a high level of physical activity is associated with a better quality of life and low PA levels may have many positive effects.
Evaluation of the prevalence of os trigonum and talus osteochondral lesions in ankle magnetic resonance imaging of patients with ankle impingement syndrome
(ELSEVIER SCIENCE INC, 2019) Özer, Mustafa.; Yıldırım, Ahmet.
The prevalence of os trigonum and osteochondral lesions of talus (OCLT) have been presented in different prevalences among different groups in the literature for the patients with ankle impingement syndrome. Our main objective in the study was to determine the possible relationship between the impingement syndrome and the prevalence of os trigonum and OCLT in specific groups. The presence of anterior ankle impingement syndrome (AAIS), posterior ankle impingement syndrome (PAIS), os trigonum, OCLT, and the location of OCLT were evaluated in a blinded manner on magnetic resonance imaging from patients clinically considered to be diagnosed with ankle impingement syndrome from January 2014 to July 2017. The patients were separated into specific groups according to the confirmation of their clinical diagnosis of ankle impingement syndrome on magnetic resonance imaging . A total of 333 patients were included. The prevalence of os trigonum was found to be 1.3% in patients with PAIS(-) AAIS(+), 7.7% in patients with PAIS(-) AAIS(-), 63.3% in patients with PAIS(+) AAIS(-), and 81.1% in patients with PAIS(+) AAIS(+) (p < .001). The prevalence of OCLT was found to be 41.3% in patients with PAIS(-) AAIS(+), 23.1% in patients with PAIS(-) AAIS(-), 18.3% in patients with PAIS(+) AAIS(-), and 27% in patients with PAIS(+) AAIS(+) (p= .005). Our study showed that, for patients with isolated PAIS and AAIS combined with PAIS, the prevalence of os trigonum was 63.3% and 81.1%, respectively, which is more common than previously reported. For patients with isolated AAIS and PAIS, the prevalence of OCLT was 41.3% and 18.3%, respectively. Of the OCLTs combined with ankle impingement syndromes, 87.1% were medially located. (C) 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
Effect of curcumin on bone healing: An experimental study in a rat model of femur fracture
(ELSEVIER SCI LTD, 2019) Safali, Selim.; Aydin, Bahattin Kerem.; Nayman, Alaaddin.; Ugurluoglu, Ceyhan.
Objective: To determine the radiologic, histologic and biomechanical effects of curcumin on bone healing using a total rat femur fracture injury model. Materials and methods: Sixty four male Wistar-Albino rats weighing 170-210 g were used in this study. The animals were randomly divided into eight groups and 5 or 6 animals were placed in each cage. A transverse femur shaft fracture model used. The animals in study groups received oral curcumin at a dose of 200 mg/kg for 14 days or 28 days. Remaining animals received only saline solution by oral gavage for a period of 14 days and 28 days as control groups. After sacrification the left femurs used for radiological, histological and biomechanical evaluation. Results: The groups treated with curcumin showed no significant difference in terms of radiological, histological and biomechanical evaluations in 14 days groups. Also there was no significant difference between curcumin and control groups for 28 days according to radiological, histological and biomechanical tests. Conclusions: According to our results, curcumin has no positive effect on fracture healing not only histologically but also radiologically and biomechanically. Curcumin's antioxidant effect may be more noticeable with long term follow up investigation as it may have a positive effect in remodelling phase. Long term follow up designed studies may be planned to investigate its effect on remodelling phase of fracture healing. (C) 2019 Elsevier Ltd. All rights reserved.
The evaluation of two different surgical approaches in total hip arthroplasty according to the patient satisfaction, plantar pressure distribution and trendelenburg sign
(2019) Yıldırım, Ahmet; Ayanaoğlu, Tacettin; Özer, Mustafa; Esen, Erdinç; Kanatlı, Ulunay; Bölükbaşı, Selçuk
The aim of this prospective study was to analyze the results of two different surgical aproaches for total hip arthroplasty as Trendelenburg sign, plantar pressure distribution with the help of dynamic pedobarography and clinical results by Harris Hip Score. A total of 28 patients who underwent unilateral total hip arthroplasty using two different types of lateral approach as conventional lateral Hardinge approach and intermuscular Hardinge approach described by Pai were included in this study. Plantar pressures have maesured by EMED-SF pedobarography device and analysed by the help of a commercial software; that seperates the foot to the four different parts which are called masks. Trendelenburg’s sign has been estimated as grade 1 and grade 2 by the method which was described by Hardcastle and Nade. Clinical outcome was measured by comparing Harris Hip Scores pre-operatively and postoperatively at last clinic visit. In both groups after the two years from the surgery; total contact time has increased at the operation side when the results were compared before the surgery at the same side and at the other side after the surgery. Also when we looked at the first and second masks which show the significant part of the stance phase; contact areas have similarly increased and the changes at the peak pressures were similar as contact areas. In both groups Harris Hip score was increased significantly after the operation. This is the first study to compare two different lateral approaches by pedobarographic analysis, clinical evaluation and functional scoring. The fuctional and clinical early results are similar in both lateral hip approaches for total hip arthroplasty when superior gluteal nerve protection, conjuant tendon repair and postoperative rehabilitation have done well.
Lower limb injuries secondary to hoeing machine cccidents
(2019) Güleç, Ali; Durgut, Fatih; Ozdemir, Ali; Yıldırım, Ahmet; Aydın, Bahattin Kerem
Agricultural accidents are important for Turkey as more than 20 million people are involved in agriculture. The aim of this study was to evaluate orthopaedic lower limp injuries related to hoeing machine from a trauma centre localized in Middle Anatolia Region. 15 patients who hospitalized for hoeing machine were included to study due to lower limp injuries between April 2012 and May 2017. All the medical records were scanned retrospectively to evaluate “the demographic, epidemiologic characteristics of patients, cause of accidents, type of injury, duration of hospital stay and also hospital costs were evaluated retrospectively “. According to database, fifteen patients were hospitalised for lower limp injuries (14 were male, 1 female). The mean age was 45.2 (19-64) years old. The most frequent injury was tibia fracture (64 %). The mean hospital stay time was 14 days (between 1and 53). The mean cost was 11.140,16 (500 and 27.115,08) Turkish Liras. The rate of knee dislocation was 26 %. Most prevalent injury was tibia fracture. Simple precautions can be effective for preventing this kind of injuries. Meticulous examination is important as the rate of knee dislocation is high in these types of traumas.
Clinical outcomes of the patients who underwent surgery for cerebral palsy scoliosis
(2018) Güleç, Ali; Çiftçi, Sadettin; Odabaşı, Egemen; Yıldırım, Ahmet
Introduction: Static encephalopathy developing linked to damage occurring in the immature brain for any reason is called cerebral palsy (CP). As CP patients have abnormal muscle tonus and linked posture disorders, scoliosis is frequently encountered. In this article, we retrospectively investigated CP scoliosis cases operated at our clinic and complications.Material and Method: Thirteen patients with surgical treatment at our clinic from 2011-2017 for CP scoliosis were retrospectively investigated. The surgical techniques, improvement rates, perioperative complications and long-term motor function changes (GMFCS) were assessed.Results: Nine males and 4 females were operated. Mean age was 14.3 years (range: 5-21), and mean Cobb angle was 79.3 (range: 45-135). The improvement amount in the Cobb angle was assessed as 48.2 (range: 20-70). Preoperative GMFCS score was 5 for 7 patients, 4 for 5 patients and 3 for 1 patient. One patient developed paraplegia in the 12th hour after correction (this patient was exitus in the postop 6th month due to later developing pulmonary complications). One patient developed urinary incontinence. Infection was not identified in any patient. One patient had level increased due to development of kyphosis in proximal neighboring segment.Conclusion: We believe encouraging improvements can be obtained with posterior instrumentation and fusion surgery in CP scoliosis patients minimizing complications including coronal balance, sagittal balance and pelvic obliquity and there is no major disadvantage compared to the unit rod instrumentation system.
Proksimal femur çivisi cerrahisinde C-Kollu floroskopi kullanımı ile ilgili sorunlar
(2018) Özyalvaç, Osman Nuri; Çiftçi, Sadettin; Telatar, Atakan; Özkul, Barış; Güleç, Ali; Aşansu, Mustafa; Akpınar, Evren
Amaç: Bu çalışmada intertrokanterik femur kırığı cerrahisinde ameliyatboyunca C-kollu floroskopi cihazı kullanımı için harcanan zaman veradyasyon maruziyeti açısından yapılan çekim miktarlarının belirlenmesiamaçlanmıştır.Yöntemler: Femur intertrokanterik kırığı nedeni ile kapalı redüksiyonve intamedüller tespit yapılan 62 hastadan toplanan veriler çalışmayadahil edildi. Toplam ameliyat süresi, C-kollu floroskopi cihazı kullanımıiçin harcanan süre, yapılan çekim miktarı, cerrahın kıdemi, istenilengörüntü elde edilene kadar yapılan çekim miktarları, implantıyerleştirmeden önce yapılan kılavuz tel uygulama sayısı ve toplamfloroskopi çekim miktarı yardımcı sağlık personeli tarafından kayıtaltına alındı.Bulgular: Operasyon süresinin %53’ünün C-kollu floroskopi cihazıkullanımı için harcandığı, uygun pozisyonda birer adet ön-arka veyan grafi için ortalama 10 kez floroskopi çekimi yapıldığı, kılavuz telinortalama 3,7 denemede istenilen pozisyonda gönderildiği tespit edildi.Sonuç: C-kollu floroskopi cihazı kullanımında önemli bir ölçüde zamanharcandığı ve çekim miktarının gereğinden fazla yapıldığı saptandı.Cerrahi süreyi kısaltmak ve gereksiz radyasyon maruziyetindenkaçınmak adına C-kollu floroskopi cihazlarının bu konuda eğitim almışteknik personel tarafından kullanılması, cerrah ve röntgen teknisyeniarasında ortak bir dil oluşturulması, kullanımı daha pratik olangörüntüleme ünitelerinin geliştirilmesi gerektiği kanısındayız.
Correlation of stability and complications measurements in traumatic hip dislocation cases associated with posterior wall acetabular fracture
(2018) Güleç, Ali; Çiftçi, Sadettin
Aim: To evaluate the relationship between stability criteria and complications in traumatic hip dislocations associatedwith posterior acetabular wall fracture.Material and Methods: The study retrospectively investigated 18 patients treated for posterior acetabulum fracture dislocation in the orthopedics and traumatology clinicfrom 2014-2017. All patients had wall defect, acetabular fracture index and coronal posterior acetabular arc angle (PAAA)assessed. Fracture types were determined according to Letournel’s definitions.Results: Preoperative radiological tests found the mean width of intact hip wall was 33.8 mm (range 31-39 mm), mean wall length in fracture hips was 13.7 mm (range 5-21 mm), and mean wall defect was measured as 59.1% (range 37.5-86%). When intact hips were assessed mean coronal PAAA was 54.2 degrees (range 41-65). For fractured hips, coronal PAAA was 18.2 degrees mean (range 6-29). Acetabular fracture index (AFI) was determined as mean 40.8 (range 14-62.5). Regarding complications in the postoperative period, one patient had avascular necrosis of the femoral head and 9 patients had osteoarthritis.Conclusion: Though Defect percentage, AFI and coronal PAAA values are important proven markers for stability, in our study there was no correlation identified with complications.
Arthroscopy-aided fixation for metacarpophalangeal joint collateral ligament injury accompanied by osteochondral avulsion injury: Our results and surgical technique
(2018) Güleç, Ali; Yıldırım, Ahmet
Aim: Though metacarpophalangeal joint collateral ligament injuries are commonly observed, the presence of accompanying avulsed osteochondral fragment or aponeurosis injury in adult patients is a situation that may require definite surgical treatment. Our study investigated patients attending our clinic after acute hand trauma with radial or ulnar collateral ligament injury who underwent arthroscopy-aided surgical treatment and who regularly attended check-ups to examine the efficacy and results of arthroscopy-aided treatment for collateral ligament injury of the metacarpophalangeal joint.Material and Methods: The study assessed fracture healing, joint movement angles and complications of 11 patients who attended our hand surgery department from December 2015 to April 2018 who had ulnar or radial collateral ligament injury of the metacarpophalangeal joint with accompanying osteochondral avulsion fracture repaired with the aid of arthroscopy with at least 1 year of continuous attendance at check-ups.Results: Four patients had 1st proximal finger avulsion fracture accompanying ulnar collateral ligament injury, four patients had 2nd proximal finger avulsion fracture accompanying ulnar collateral ligament injury, 1 patient had 4th finger and 2 patients had 5th finger proximal phalanx fractures accompanying radial collateral ligament injury. The patients’ avulsion fractures and ligament injuries healed without problem, 2 patients had limited joint movement angles and 1 patient developed complex regional pain syndrome.Conclusion: It is considered that the results of arthroscopy-aided collateral ligament injury repair and avulsed fragment fixation are good and perfect healing.
Which operations of musculoskeletal tumors should be accompanied by a vascular surgeon?
(2018) Yıldırım, Ahmet.; Öztürk, Recep.; Arıkan, Şefik Murat.; Kekeç, Ahmet Fevzi.; Günaydın, İlknur Bahar.
INTRODUCTION: Benign and malign tumors of the musculoskeletal system may be related with thecriticalneurovascular structures. Therefore, some surgical procedures are applied with cardiovascular surgeons. In thisstudy, demographic examination of the musculoskeletal tumors which might be related with neurovascularstructures was aimed.METHODS: Between 2010 and 2014, 58 patients who were operated with cardiovascular surgeon due tomusculoskeletal tumors in orthopedics and traumatology clinic were included in the study. Patients were examinedfor age, sex, benign / malignant features, bone-soft tissue location, histopathological diagnosis and tumorlocalization.RESULTS: Among 30 male and 28 female patients with a mean age of 36 0,17 (2-76 years), 15 patients hadbenign and 43 patients had malign musculoskeletal tumors. The most common tumor was a malign mesenchymaltumor and it was seen in 14 cases. The most common benign tumor was osteochondroma and it was found in 6cases. The most common tumor localization with cardiovascular surgeon requirement was thigh and knee.DISCUSSION and CONCLUSION: Musculoskeletal tumors may be closely related to the neurovascularstructures and therefore they are needed to beoperated with cardiovascular surgeons; can be seen in kind of ages.These are often malign tumors. The most common localizations are thigh and knee.
Analyze of Physical Activity and Quality of Life on Breast Cancer Patients with Bone Metastases
(2018) Yıldırım, Ahmet; Eryılmaz, Mehmet Ali
Introduction: Breast cancer is still the most common type of neoplasm in the world. It is also the first reason ofcancer-related death on women in developed and developing countries. In addition to surgical and non-surgicaltreatment, it is important to improve the quality of life in cancer patients. The aim of this study is to evaluate thephysical activity level and quality of life on breast cancer patients with bone metastasis.Methods: A cross-sectional studywas done that aimed determining the physical activity levels and quality of lifeof patients with and without bone metastasis. International Physical Activity Questionnaire (short) and short form36 quality of life questionnaire were used for 100 breast cancer patients.Results: It was found that patients without bone metastasis were physically more active than patients with bonemetastases. In comparison of subscales of Short Form-36; physical functioning, role functioning, pain, generalhealth, vitality (energy), social function, The mean scores of emotional health and mental health scores were foundto be significantly higher in the without bone metastases group (p 0.001).Discussion and Conclusion: In this study, it has been shown that though the cancer treatment, the ratio of physicalactivity and quality of life was significantly higher in the group without bone metastasis compared to those withbone metastasis and it was found that the physical activity levels and quality of life of the patients after bonemetastasis were found to be decreased.
Femoral adamantinoma: a rare lesion in an elderly patient in a rare location
(GALENOS YAYINCILIK, 2017) Aydın, Bahattin Kerem; Khan, Zeeshan; Er, Turgay; Uğras, Serdar
[Abstract not Available]
Halluks valgus cerrahi tedavisi sonrası metatars uzunluğundaki değişimin klinik sonuca etkileri
(2017) Sofu, Hakan; Çamurcu, Yalkın; Kockara, Nizamettin; Konya, Mehmet Nuri; Aydın, Bahattin Kerem
AMAÇ: Bu çalışmanın amacı halluks valgus tanısı ile proksimal metatarsal osteotomi ya da distal metatarsal osteotomi uygulanarak cerrahi yöntemle tedavi edil-miş hastalarda metatars uzunluğundaki değişimin kli-nik sonuca etkilerini araştırmaktır.GEREÇ VE YÖNTEM: Toplam 62 hasta çalışmaya dahil edildi. Hastaların 9 tanesi erkek ve 53 tanesi kadındı. Çalışma grubunda ameliyat esnasında ortalama yaş 45.9 yıldı. Hastaların 30 tanesine kresentik proksimal osteotomi (KPO) ve 32 tanesine distal chevron osteo-tomisi (DCO) uygulandı. Ortalama ameliyat sonrası ta-kip süresi 24.3 aydı. Ameliyat sonrası 4. haftada, 3, 6, 12. aylarda ve daha sonra yıllık takip muayenelerinde klinik ve radyolojik değerlendirme yapıldı. American Orthopedic Foot and Ankle Society (AOFAS) skoru, Vi-sual Analogue Scale (VAS) skoru, metatarsal uzunluk, halluks valgus açısı (HVA) ve intermetatarsal açı (IMA) değerlendirme kriterleri olarak belirlendi.BULGULAR: Hem distal chevron osteotomisi hem de kresentik proksimal osteotomi uygulanan hastalarda ortalama HVA ve ortalama IMA ameliyat öncesi döne-me göre ameliyat sonrası takiplerde istatistiksel olarak anlamlı düzeyde gerilemiştir. Birinci metatars uzunlu-ğundaki ortalama değişim distal chevron osteotomisi sonrası -2.8 mm iken kresentik proksimal osteotomi sonrası -1.2 mm ölçüldü. Halluks valgus açısının orta-lama düzelme miktarı distal chevron grubunda 13.6 derece ve kresentik proksimal osteotomi grubunda 20.4 derece idi. 3 mm’den fazla metatars kısalması olan hastalarda anlamlı olarak daha kötü VAS skorları tespit edildi. Çalışmamızda hiçbir hastada kaynamama veya metatars başında avasküler nekroz gözlemlenmemiş-tir. Son kontrolde DCO grubundan 8 hasta ve KPO gru-bundan 5 hasta benzer şikayetleri olan başka hastalara ameliyatı tavsiye etmeyeceğini bildirmiştir.SONUÇ: Distal chevron osteotomisi kresentik proksi-mal osteotomiye kıyasla birinci metatars uzunluğunda daha yüksek oranda kısalmaya ve bununla bağlantılı olarak daha yüksek oranda transfer metatarsaljiye yol açmaktadır.
Fondaparinuksun kırık iyileşmesine gerçekten pozitif etkisi var mıdır: Sıçanlar üzerinde yapılan deneysel bir çalışma
(2017) Mercan, Ahmet Şükrü; Aydın, Bahattin Kerem; Konya, Mehmet Nuri; Sofu, Hakan; Yılmaz, Ertan; Şahin, Vedat
AMAÇ: Antiembolik ajanlar ortopedi ve travmatoloji kliniklerin-de özellikle artroplasti, tümör ve travma cerrahilerinde embolizm problemlerini azaltmak için rutin olarak kullanılmaktadır. Fonda-parinuks’un kırık iyileşmesi üzerine etkisi belirsizdir. Bu çalışmanın amacı sıçan modeli kullanarak fondaparinuksun kırık iyileşmesi üzerine etkisinin incelenmesi ve enoksaparinin etkisi ile karşılaş-tırılmasıdır.GEREÇ VE YÖNTEM: 64 adet Wistar-Albino sekiz gruba randomize olarak ayrıldı. Genel anestezi altında sol femur kapalı standart kırıkları oluşturuldu. Kontrol grupları (A, B), heparin grupları (C, D), enoksaparin grupları (E, F), ve fondaparinuks grupları (G, H), sırasıyla izotonik NaCl (1cc/gün), heparin (1000 anti Xa IU/kg/gün), enoksaparin (100 anti Xa IU/kg/gün) ve fondaparinuks (0.2mg/kg/ gün) olacak şekilde 14 gün süre ile uygulandı. A, C, E, G gruplarındaki sıçanlar postoperatif 14. günün, B, D, F, H gruplarındakiler ise 28. günün sonunda sakrifiye edildiler. Tüm femurların radyolojik incelemesi standart ön-arka ve yan grafiler kullanılarak Goldberg sınıflamasına göre yapıldı. Histolojik inceleme ise Huo histolojik iyileşme sınıflamasına göre yapıldı. Bu çalışmanın istatiksel analizleri GraphPad Prisma V.3 paket programı kullanılarak yapıldı. Sonuçlarda anlamlılık p0.05 düzeyi olarak belirlendi.BULGULAR: Radyolojik incelemede, ikinci ve dördüncü hafta so-nundaki sonuçlar incelendiğinde, gruplar arasında istatiksel olarak anlamlı fark saptanmadı. Histolojik incelemede ise heparin almış olan H grubundaki iyileşme sonuçları diğer gruplarla karşılaştırıldı-ğında istatiksel olarak anlamlı şekilde kötü olarak saptandı. Diğer gruplar arasında histolojik açıdan, heparin grubu hariç, istatiksel olarak anlamlı bir fark saptanmadı. Ayrıca histolojik ve radyolojik olarak fondaparinuks ve enoksaparin grupları arasında kırık iyileş-mesi üzerine etkileri arasında istatiksel olarak anlamlı fark saptan-madı (p0.05).SONUÇ: Çalışmamızda fondaparinuksun enoksaparin ile karşılaş-tırıldığında kırık iyileşmesi üzerine herhangi ekstra olumlu etkisini saptamadık. Fondaparinuks uygulamasının kırık iyileşmesi üzerine negatif bir etkisi saptanmamış olması nedeniyle travma vakaların-da embolizm problemlerini önlemede kullanılabileceği kanaatin-deyiz.
Very Long-term Outcomes After Endoprosthetic Replacement for Malignant Tumours of Bone
(The British Editorial Society of Bone & Joint Surgery, 2016) Grimer, Robert J.; Aydın, Bahattin Kerem; Wafa, Hazem; Carter, S. R.; Jeys, Lee M.; Abudu, A.; Parry, Michael
Aims The aim of this study was to establish what happens to patients in the long term after endoprosthetic replacement for a primary malignant tumour of bone. Patients and Methods We conducted a retrospective analysis of a prospectively maintained database to identify all patients who had undergone an endoprosthetic replacement more than 25 years ago and who were still alive. Their outcomes were investigated with reference to their complications and need for further surgery. A total of 230 patients were identified. Their mean age at diagnosis was 20.7 years (five to 62). The most common diagnosis was osteosarcoma (132). The most common site was the distal femur (102). Results The mean follow-up was 29.4 years (25 to 43). A total of 610 further operations were undertaken, an average of 2.7 further operations per patient. A total of 42 patients (18%) still had the original prosthesis in place. The risk of amputation was 16% at 30 years (31 patients). Those without infection had a mean of 2.1 further operations (one to nine) while those with infection had a mean of 4.6 further operations (two to 11). The risk of infection persisted throughout the life of the prosthesis with a mean of 1% per year becoming infected. Of the 60 patients who developed an infection, 21 (35%) developed this following the primary procedure at a mean of 50 months, but another 19 developed this within a year of another surgical procedure. The risk of infection after any further surgery was 2.7%. The site with the highest risk of infection was the proximal tibia (43.3%).
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 Faruk
Unicondylar 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.

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