Erdal UZUN - Academia.edu (original) (raw)

Papers by Erdal UZUN

Journal of Orthopaedic Science, 2021

BACKROUND Implant removal (IR) surgery is one of the most frequent procedures in orthopedic pract... more BACKROUND Implant removal (IR) surgery is one of the most frequent procedures in orthopedic practice. Many of the IR surgeries result from patient request rather than a medical necessity. The purpose of the study was to investigate the association between the level of anxiety, type of temperament and psychopathological status, and the willingness to receive IR surgery in asymptomatic or mildly symptomatic patients. We also aimed to compare pre- and postoperative pain scores and document the complication rates after IR surgery. METHODS The patients who received tibia intramedullary nailing after tibia diaphyseal fracture with a minimum of 18 months follow-up were included in the study. A total of 246 asymptomatic or mildly symptomatic patients were evaluated, and all patients received detailed oral and written information about the risks of IR surgery. The patients who wished to receive IR surgery were called Group 1 (N = 104), and the patients who did not wish to have surgery were called Group 2 (N = 146). All patients were referred to a psychologist to complete the Beck anxiety inventory (BAI), Symptom checklist-90-R (SCL-R-90), and the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A). RESULTS The mean age of the patients was 32.31 ± 9.56. One hundred thirteen (45.9%) of the patients were male, and 133 were female (54%). Mean BAI and SCL-90-R were higher in Group 1 than Group 2 (P = 0.001). Anxious and irritable temperament was higher in Group 1 (P = 0.045 and P = 0.035 respectively), and non-dominant and hyperthymic temperament was higher in Group 2 (P = 0.02 and P = 0.04 respectively). CONCLUSIONS The level of anxiety and type of temperament is associated with the willingness to receive implant removal surgery in asymptomatic or mildly symptomatic patients. Measures to reduce anxiety levels may reduce the rate of unnecessary implant removal surgeries, associated patient care costs, and potential complications.

The American Journal of Sports Medicine, 2022

Background: No comparative studies have evaluated anatomic risk factors in a large cohort includi... more Background: No comparative studies have evaluated anatomic risk factors in a large cohort including both patients with anterior cruciate ligament (ACL) ruptures and healthy participants. Purpose: To determine which anatomic parameters are independently associated with an ACL rupture and the diagnostic values of the individual and combined anatomic parameters. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 352 male patients who underwent arthroscopic ACL reconstruction because of a primary ACL rupture and 350 age-, sex-, body mass index–, and side dominance–matched healthy participants were included. Measurements of 32 previously determined parameters and 7 calculations were performed. Between-group differences were calculated. Univariate and multivariate logistic regression models and receiver operating characteristic curve analysis were conducted for the individual and combined independently associated factors. Results: The mean age and body mass index ...

Joint Diseases and Related Surgery, 2021

Objectives This study aims to compare the outcomes of patients undergoing a single anterior porta... more Objectives This study aims to compare the outcomes of patients undergoing a single anterior portal or a standard two-portal arthroscopic procedure for Bankart repair. Patients and methods Between January 2015 and March 2018, a total of 71 consecutive patients (53 males and 18 females; mean age: 33.3±10.3 years; range, 17 to 56 years) who underwent arthroscopic Bankart repair with a minimum two-year follow-up period were included. The patients were divided into two groups according to the arthroscopic technique used: single anterior portal group (Group 1, n=32) and standard two-portal group (Group 2, n=39). Demographic and surgical characteristics of the patients were recorded. Pre- and postoperative clinical and functional outcomes were evaluated using the external rotation degree, as well as Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA) Shoulder Rating Scale, Constant-Murley Score (CMS), Oxford Shoulder Instab...

Hallux valgus, which is a frequently encountered foot problem, is a disease causing pain to the p... more Hallux valgus, which is a frequently encountered foot problem, is a disease causing pain to the patient with difficulties in walking and wearing shoes and cosmetic problems. There are many different conservative and surgical treatments which are applied according to the degree of deformity. The treatment method of correction of the deformity with a distal suture anchor without the need for osteotomy, which has not been previously described in literature, is presented in this paper when applied to cases of moderate hallux valgus as it was considered as an alternative treatment method because of complications occurring in osteotomy

Acta orthopaedica Belgica, 2018

The aim of this study was to compare radiological and clinical outcomes of posterior wall acetabu... more The aim of this study was to compare radiological and clinical outcomes of posterior wall acetabulum fractures and posterior wall fracture dislocations. Data were including 52 acetabulum fractures and fracture dislocations. 26 patients (%50) had posterior acetabulum fractures and fracture dislocations who were operatively treated. Radiographic evaluations were performed before and after the operation and at the last follow up. Clinical outcome evaluation was performed at the last follow up. Clinical and radiological outcomes were evaluated including Merle D'aubigne clinical assessment score and Matta' s radiologic measurement score. Brooker classification was used to measure heterotopic ossification.Both Merle D'aubigne and Matta scores were found higher in the acetabulum posterior wall fracture group. But there wasn't significantly difference of clinical and radiological outcomes between two groups (p ˃ 0,05). Reduction quality and Matta radiologic scores were corre...

The Knee, 2020

Background: The purpose of the study was to evaluate lateral and patellofemoral osteoarthritis (O... more Background: The purpose of the study was to evaluate lateral and patellofemoral osteoarthritis (OA) progression after medial unicompartmental knee arthroplasty (UKA) and identify factors affecting the progression that were not identified previously. Methods: We evaluated 146 patients who underwent medial UKA between 2009 and 2014. Kellgren-Lawrence grading of lateral and patellofemoral OA was performed on preoperative and final follow-up knee radiographs. Radiographic and clinical characteristics, SF-36, and Oxford knee scores were compared between the OA progressed and non-progressed groups. Risk factors for lateral and patellofemoral OA progression were evaluated. Results: The lateral OA progressed and non-progressed groups significantly differed in side, preoperative flexion contracture, preoperative joint line convergence angle, postoperative tibiofemoral angle, insert size, revision status (P b 0.05), and the patellofemoral OA progressed and non-progressed groups significantly differed in age, pre-and postoperative flexion contracture, postoperative tibiofemoral angle and pre-and postoperative patellofemoral OA grade (P b 0.05). At the final follow-up, Visual Analogue Scale, Oxford Knee Scores, and SF-36 subscores were significantly better in the lateral OA non-progressed group (P b 0.001). Dominant leg (odds ratio (OR): 2.759), insert size (N 4, OR: 2.219), revision status (+, OR: 6.692), and postoperative tibiofemoral angle (N 5.5°, OR: 1.177) were independent risk factors for lateral OA progression, whereas age (N60 years, OR: 3.222), preoperative patellofemoral OA grade (N1, OR: 2.085), and postoperative flexion contracture (N 10°, OR: 1.919) were those for patellofemoral OA progression. Conclusions: Mild radiographic progression of 1 KL grade is frequently seen five to 10 years after medial UKA. Postoperative outcomes are significantly affected by lateral compartment OA progression but not by patellofemoral OA progression.

Foot and Ankle Surgery, 2020

Background: Impaired wound healing is a major cause of morbidity in diabetic patients by causing ... more Background: Impaired wound healing is a major cause of morbidity in diabetic patients by causing chronic ulcers. This study aimed to investigate the safety and outcomes after intralesional allogeneic adiposederived mesenchymal stem cells injection in chronic diabetic foot ulcers. Methods: Twenty patients (12 male and eight female) were involved in the study. We randomized the patients into two groups of 10 patients each. The study group was treated with allogeneic adiposederived mesenchymal stem cells injection with standard diabetic wound care. The control group received only standard diabetic wound care. Patient demographics, wound characteristics, wound closure time, amputation rates and clinical scores were evaluated. Results: The mean age was 57.3 AE 6.6 years. The mean follow-up duration was 48.0 (range, 26-50) months. Wound closure was achieved in 17 of 20 lesions (study group, 9 lesions; control group, 8 lesions; respectively). The mean time to wound closure was 31.0 AE 10.7 (range, 22-55) days in the study group, 54.8 + 15.0 (range, 30-78) days in the control group (p = 0.002). In three patients, minor amputations were performed (one patient in study group; two patients in the control group, p = 0.531). There was a significant difference between groups in terms of postoperative Short Form 36-physical functioning (p = 0.017) and Short Form 36-general health (p = 0.010). Conclusion: Allogeneic adipose-derived mesenchymal stem cells injection was found to be a safe and effective method with a positive contribution to wound-healing time in the treatment of chronic diabetic foot ulcers.

The Knee, 2020

Background: To evaluate and compare the clinical and radiological outcomes of patients subjected ... more Background: To evaluate and compare the clinical and radiological outcomes of patients subjected to medial unicompartmental knee arthroplasty (UKA). Methods: The study included 146 knees of 115 consecutive medial UKAs patients with a minimum five-year follow-up. Pre-and postoperative functional and clinical outcomes were measured using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), American Knee Society Score (AKSS-O), knee range of motion (ROM), and Short-Form Health Survey (SF-36). The Kellgren-Lawrence osteoarthritis (OA) grading system was used for the evaluation of the OA status. The joint line convergence angle (JLCA) of the operated and contralateral knee, the tibiofemoral coronal angle (TFCA), and the tibial slope angle were used in the radiological evaluation. Results: The mean age of patients was 58.8 ± 7.0 years. The mean follow-up period was 7.41 ± 1.54 years. Good to excellent functional outcomes were obtained according to VAS, WOMAC, OKS, AKSS-O, and SF-36 scores. Insert dislocation was the main reason for revision surgery (nine patients, 90%). Preoperative body mass index (BMI), postoperative BMI, American Society of Anesthesiologists (ASA) Score, postoperative knee flexion contracture, mean increase in postoperative medial joint space (PMJS) height, and OA progression were found to affect the revision status. Conclusions: Good to excellent functional, clinical, and radiological outcomes were obtained with medial UKA at a minimum follow-up of five years. Differences in preoperative and postoperative radiological parameters except an increase in PMJS height had no impact on revision status.

Injury, 2020

This study aimed to investigate the anatomic risk factors associated with dislocation following b... more This study aimed to investigate the anatomic risk factors associated with dislocation following bipolar hemiarthroplasty for the treatment of femoral neck fracture. Materials and Methods: We retrospectively reviewed 208 consecutive patients (133 women, 75 men) with femoral neck fractures who were treated with bipolar hemiarthroplasty between 2015 and 2018. A comparative analysis was performed between dislocation (n = 18) and non-dislocation (n = 190) groups in terms of patient demographics, surgical and pelvic morphologic factors, and clinical outcomes, including postoperative Harris and modified Harris hip scores. Independent risk factors affecting dislocation were also evaluated. Results: The mean follow-up period was 30.8 ± 2.0 (range, 12-48) months. The mean age was 79.2 ± 7.4 (range, 71-94) years. The dislocation rate was 8.6% (18/208), and the mean dislocation time after operation was 2.0 ± 1.1 (range, 1-4) months. Patient-related factors did not differ between the dislocated and non-dislocated groups. As regards dislocation, statistically significant difference was observed in surgical and pelvic morphologic factors, including femoral offset, residual femoral neck length, trochanter upper end and femoral head center distance, and height of the hip center of the operated side (p = 0.025, p = 0.013, p = 0.002, p = 0.008, respectively). Moreover, the femoral offset, height of the hip center, and femoral neck-shaft angle of the non-operated side are significantly different between the groups (p = 0.007, p = 0.001, p = 0.027, respectively). Decrease in the center edge (CE) angle, offset of prosthesis, and increase in femoral head extrusion index (FHEI) of the operated side and decrease in the height of the hip center of the non-operated side increased the risk of dislocation (p = 0.030, OR: 1,306; p = 0.041, OR: 8.15; p = 0.020, OR: 1.038; p = 0.010, OR: 2.02, respectively). Conclusions: Pelvic morphologic features and surgical factors were found to affect dislocation. Patients with smaller OP, CE angle of the operated side, and higher FHEI and smaller height of the hip center of the non-operated side should be carefully monitored to decrease postoperative dislocation.

CARTILAGE, 2020

Objective There are limited data on bone dimension and cartilage thickness of the distal humeral ... more Objective There are limited data on bone dimension and cartilage thickness of the distal humeral articular surface. This study aimed to evaluate sex- and age-related bone dimension and cartilage thickness differences and assess the effect of cartilage thickness on distal humeral shape. Design Elbow magnetic resonance images of 180 healthy participants were evaluated. Cartilage thicknesses of the trochlea and capitellum were measured at 19 points using coronal and axial images. In addition, bone diameters were measured from the flexion-extension axis to the 19 points on the coronal and axial magnetic resonance images. Sex differences were evaluated, and the correlation between age and measurement parameters was assessed. Results Significant sex differences regarding the diameters of the axial trochlear bone, coronal lateral trochlear bone, and medial capitellar bone, cartilage thickness at the apex of the lateral trochlear ridge in the axial and coronal plane and at the most lateral ...

Annals of Medical Research, 2019

Aim: Due to anatomical differences, current baseplate designs may lead to incompatibilities in re... more Aim: Due to anatomical differences, current baseplate designs may lead to incompatibilities in reverse shoulder arthroplasty in different populations. We hypothesized that glenoid anthropometric parameters in Turkish subjects would be different from that in other populations. Materials and Methods: Three-dimensional morphology of 200 healthy Turkish shoulders (100 male and 100 females, 93 left and 107 right shoulders) was evaluated. Glenoid height, width, version, inclination, circumference, and surface area; glenoid depth, scapular neck length, and scapular neck angle were measured. Sex and side differences were assessed. The correlation between glenoid morphologic parameters and subject height was assessed. The height corresponding to a 25-mm glenoid width was predicted. Results: There was a significant difference between male and female subjects regarding glenoid height, width, version, depth, circumference, surface area, and patient height (p

The Journal of Knee Surgery, 2019

Dissatisfaction is still an important problem in a small but important group of patients who unde... more Dissatisfaction is still an important problem in a small but important group of patients who undergo total knee arthroplasty. This study was designed to evaluate the effectiveness of showing patients the change in their standing posture, before and after total knee replacement, using standing photographs (anterior, posterior, and lateral view), on improving self-reported quality of life and satisfaction. Full-length lower extremity radiographs and standing photographs were obtained prior to total knee replacement and 6 months after surgery in the study group. In the control group, radiographs and photographs were not obtained. The hip–knee–ankle angle and mechanical axis deviation were compared between the two limbs and two groups. The changes in the following outcome measures were evaluated from baseline to 6 months after surgery: Short Form-36 Survey, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score, an...

Annals of Medical Research, 2019

This study aimed to reveal the relationship between changes in Claudin-5 expression and the durat... more This study aimed to reveal the relationship between changes in Claudin-5 expression and the duration of healing in Achilles tendon injury. Material and Methods: 18 Achilles tendons of Wistar-Albino rats were used in the study. Rats were divided into 3 groups as 6 rats in each group, group 1; sham group, group 2; tendon repair group (sacrificed after 3 weeks), group 3; tendon repair group (sacrificed after 6 weeks). Immunohistochemically, the tendons were stained with Claudin-5 and the degree of staining with light microscope was rated between 0 and 3. The obtained scores were compared with Kruskal Wallis test and Posthoc analysis. Results: The scores were 0.5 ± 1 (0-1) in group 1.1 ± 1 (1-2) in group 2 and 1.5 ± 1 (1-2) in group 3. A statistically significant difference was found between the groups (p = 0.026). In the posthoc analyzes, there was a significant difference between group 1 and 3, but there was no significant difference between groups 1 and 2 and between groups 2 and 3. Conclusion: The expression of claudins is regulated by many factors, including hormones, various cytokines, and epithelialmesenchymal transition-related transcription factors. In this study, the increase in the expression of Claudin-5 was noticed in proportion to the progress of primary wound healing. This relationship may be a part of the repair mechanism. The role of claudin levels in intercellular passage is crucial for function as it is important for cell signaling. Achilles tendon healing can be attributed to a laboratory parameter such as claudin. This can help to understand the recovery rate and can help early return to work or sport. We believe that as a laboratory parameter Claudin-5 may be useful in the evaluation of tendon healing.

The Knee, 2018

Background: There are few large-scale, long-term studies comparing medial meniscal repairs with o... more Background: There are few large-scale, long-term studies comparing medial meniscal repairs with or without concurrent anterior cruciate ligament (ACL) reconstruction. Methods: A total of 140 patients who underwent arthroscopic medial meniscal repair were divided into two groups: Group A, meniscus repair only and Group B, meniscus repair with concurrent ACL reconstruction. Clinical assessments included physical examination findings, Lysholm score, and the International Knee Documentation Committee (IKDC) form. Barret criteria were used for the clinical assessment of healing status. Magnetic resonance imaging (MRI)was obtained to confirmhealing and failure. Subgroups of participants were compared in terms of suture technique, type of tear, and location of tear. KT-2000 arthrometer testing was used for objective evaluation of anterior-posterior knee movement. Results: Mean follow-up duration was 61 (34-85) months. Clinical outcomes in both groups were significantly improved compared to baseline (P = 0.001 vs. P = 0.001); however, there was no significant between-group difference in postoperative Lysholm and IKDC scores (P = 0.830). The outcomes of three participants (seven percent) in Group A and 11 (11.3%) in Group B were considered as treatment failures (P = 0.55). Red-red zone tears had higher scores. Mean postoperative KT2000 arthrometer values of failed participants in Groups A and B were 4.66 mm (range, four to six) and 5.2 mm (range, two to seven), respectively. Conclusion: Concurrentmedialmeniscus repair and ACL reconstruction did not have clinical superiority over meniscus repair alone. Repairs in the red-red zone appeared to be associated with better outcomes.

Injury, 2018

Highlights  CT imaging is superior to traction radiographs for correct identification of fractur... more Highlights  CT imaging is superior to traction radiographs for correct identification of fracture fragments and comminution zones in OTA/AO 43C3 fractures.  However, both assessment methods result in similar treatment and surgical approach recommendations.  Hence, traction radiographs may be a useful alternative to CT imaging for preoperative planning in settings where CT is not feasible.

Journal of clinical medicine research, 2018

Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals... more Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. A second hip fracture can occur in elderly patients who have already suffered an initial hip fracture. The aim of this study was to investigate possible risk factors for second hip fractures in elderly patients with hip fractures. Between 2010 and 2014, 230 patients who underwent uncemented bipolar hemiarthroplasty for hip fractures were retrospectively analyzed. The patients were divided into two groups: those with a first hip fracture (group 1) and those with a second hip fracture (group 2). The mean time from the first hip fracture to second hip fracture was 22 months. There were no significant differences in the American Society of Anesthesiologist scores, comorbidities were observed in the two groups. The mean length of hospitalization was not significantly different between the two groups. The mean postoperative functional scores after second hip fractures were si...

Journal of Turgut Ozal Medical Center, 2017

The tibialis anterior muscle herniation was treated with the periosteal turnover flap technique, ... more The tibialis anterior muscle herniation was treated with the periosteal turnover flap technique, which has not been previously described in literature. The defect area covered with tibial periosteum by turning the raised flap over on itself at 180º after debridement of the defect edges. Four cases had a history of trauma and the herniation was in the mid-third of the tibia. The mean follow-up period was 84 months (range, 72-96 months) during which no complications or recurrence were observed. In this paper, the periosteal turnover flap technique is described for the first time in literature. The repair of tibialis anterior muscle herniation with periosteal turnover flap can be considered as a safe method.

TURKISH JOURNAL OF MEDICAL SCIENCES, 2017

Introduction Diabetes mellitus (DM) is a major public health problem and diabetic foot incidence ... more Introduction Diabetes mellitus (DM) is a major public health problem and diabetic foot incidence increases with the prevalence of DM (1-3). Diabetic foot ulcer (DFU) is one of the major complications of DM and occurs at an estimated rate of 10%-25% in diabetic patients in their lifetime (1-5). In addition, 40%-85% of nontraumatic amputations consist of diabetic foot amputations (6,7). DFU causes increased morbidity and decreased quality of life, incurs high treatment costs, and leads to high rates of lower extremity amputation (LEA) (3,4,8). Death rates 5 years after a major amputation can be as high as 78% (8). The diabetic foot is a multifactorial disorder (2,4,5). DM causes a range of complications such as nephropathy, retinopathy, neuropathy, DFUs, and cardiovascular disease. The incidence of complications is expected to increase with the rising number of diabetic patients (1,3,6,9). In particular, diabetic neuropathy and peripheral arterial disease that causes angiopathy are two major risk factors that play a role in the development of DFUs (1,3,6,9). Regardless of DM, we can list smoking, comorbidities, alcoholism, use of steroids or toxic drugs, congenital wound healing problems, malnutrition, and old age as additional risk factors for foot ulcers (9). Despite the well-defined risk factors in the development of DFU, there are factors that predict major or minor amputation related to the diabetic foot. Age, sex, ulcer depth, severity of infection, ischemia, osteomyelitis, duration of diabetes, neuropathy, and glycemic control are considered as potential predictors of amputation in DFU (6,10). In this study, we tried to determine the risk factors that may cause amputation type by comparing the existing clinical results of patients with major or minor amputation of a lower extremity due to diabetic foot. Our hypothesis is that risk factors in diabetic foot are effective in determining the level of amputation. 2. Materials and methods We retrospectively studied 268 patients. After the first evaluation, patients who were treated without amputation or those with Grade 0, 1, 2, or 5 lesions according to the Wagner classification were excluded. The remaining 107 patients (56 males, 51 females; 64 right side, 43 left side; Background/aim: We evaluated the existing risk factors with clinical results in patients who underwent major and minor amputation of the lower extremity as a result of diabetic foot ulcers (DFUs). Materials and methods: We retrospectively studied 107 patients who had undergone lower extremity amputation. The patients were divided into minor (Group 1, n = 75) and major (Group 2, n = 32) amputation groups. On clinical evaluation, the type of surgery performed, smoking history, comorbidities, duration of diabetes mellitus (DM) diagnosis, duration of DFU presence, peripheral neuropathy, peripheral arterial disease, results of deep tissue culture, length of hospitalization, and blood parameters were investigated. Results: In Group 2, mean hospitalization time was significantly longer than in Group 1 (P < 0.05). The proportion of patients with Wagner Grade 4 was significantly higher in Group 2 than in Group 1 (P < 0.05). The duration of DM and DFU was significantly longer in Group 2 (P < 0.05). The number of polymicrobial agents was significantly higher in Group 1 (P < 0.05). Conclusion: In our study, the most important risk factors that led to major amputation in patients with DFU were age, Wagner classification, duration of DM, duration of DFU, and C-reactive protein level.

Case Reports in Surgery, 2016

Kirschner wire (K-wire) is one of the commonly used implants in orthopaedics practice. Migration ... more Kirschner wire (K-wire) is one of the commonly used implants in orthopaedics practice. Migration of the wire is one of the most frequently reported complications after fixation by the K-wire. In particular, it has been reported that a greater range of motion in the shoulder, negative intrathoracic pressure associated with respiration, gravitational force, and muscular activities may cause migration from the upper extremities. In general, thin and long foreign bodies with smooth surfaces that are localized within the tendon sheath and at an upper extremity can migrate more readily and can reach longer distances. Here, we present a patient with long-term migration of a broken K-wire who underwent fixation for acromioclavicular joint dislocation 5 years ago.

Journal of Orthopaedics, 2017

Background: We assessed the results of humeral shaft fracture fixation using the inflatable intra... more Background: We assessed the results of humeral shaft fracture fixation using the inflatable intramedullary nail using radiological and clinical findings. Methods: From 2012 to 2015, we treated 14 patients with humeral shaft fractures using inflatable intramedullary nail after closed reduction. Results: The mean follow-up time was 14.1 months. The mean time to bone union was 4.5 months. None of the patients had major perioperative mechanical complications or postoperative complications, except for the occurrence of fixation loss and non-union in one patient. Conclusion: Inflatable intramedullary nails seem to be applicable, safe and effective for humeral AO/OTA type A midshaft fractures.

Journal of Orthopaedic Science, 2021

BACKROUND Implant removal (IR) surgery is one of the most frequent procedures in orthopedic pract... more BACKROUND Implant removal (IR) surgery is one of the most frequent procedures in orthopedic practice. Many of the IR surgeries result from patient request rather than a medical necessity. The purpose of the study was to investigate the association between the level of anxiety, type of temperament and psychopathological status, and the willingness to receive IR surgery in asymptomatic or mildly symptomatic patients. We also aimed to compare pre- and postoperative pain scores and document the complication rates after IR surgery. METHODS The patients who received tibia intramedullary nailing after tibia diaphyseal fracture with a minimum of 18 months follow-up were included in the study. A total of 246 asymptomatic or mildly symptomatic patients were evaluated, and all patients received detailed oral and written information about the risks of IR surgery. The patients who wished to receive IR surgery were called Group 1 (N = 104), and the patients who did not wish to have surgery were called Group 2 (N = 146). All patients were referred to a psychologist to complete the Beck anxiety inventory (BAI), Symptom checklist-90-R (SCL-R-90), and the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A). RESULTS The mean age of the patients was 32.31 ± 9.56. One hundred thirteen (45.9%) of the patients were male, and 133 were female (54%). Mean BAI and SCL-90-R were higher in Group 1 than Group 2 (P = 0.001). Anxious and irritable temperament was higher in Group 1 (P = 0.045 and P = 0.035 respectively), and non-dominant and hyperthymic temperament was higher in Group 2 (P = 0.02 and P = 0.04 respectively). CONCLUSIONS The level of anxiety and type of temperament is associated with the willingness to receive implant removal surgery in asymptomatic or mildly symptomatic patients. Measures to reduce anxiety levels may reduce the rate of unnecessary implant removal surgeries, associated patient care costs, and potential complications.

The American Journal of Sports Medicine, 2022

Background: No comparative studies have evaluated anatomic risk factors in a large cohort includi... more Background: No comparative studies have evaluated anatomic risk factors in a large cohort including both patients with anterior cruciate ligament (ACL) ruptures and healthy participants. Purpose: To determine which anatomic parameters are independently associated with an ACL rupture and the diagnostic values of the individual and combined anatomic parameters. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 352 male patients who underwent arthroscopic ACL reconstruction because of a primary ACL rupture and 350 age-, sex-, body mass index–, and side dominance–matched healthy participants were included. Measurements of 32 previously determined parameters and 7 calculations were performed. Between-group differences were calculated. Univariate and multivariate logistic regression models and receiver operating characteristic curve analysis were conducted for the individual and combined independently associated factors. Results: The mean age and body mass index ...

Joint Diseases and Related Surgery, 2021

Objectives This study aims to compare the outcomes of patients undergoing a single anterior porta... more Objectives This study aims to compare the outcomes of patients undergoing a single anterior portal or a standard two-portal arthroscopic procedure for Bankart repair. Patients and methods Between January 2015 and March 2018, a total of 71 consecutive patients (53 males and 18 females; mean age: 33.3±10.3 years; range, 17 to 56 years) who underwent arthroscopic Bankart repair with a minimum two-year follow-up period were included. The patients were divided into two groups according to the arthroscopic technique used: single anterior portal group (Group 1, n=32) and standard two-portal group (Group 2, n=39). Demographic and surgical characteristics of the patients were recorded. Pre- and postoperative clinical and functional outcomes were evaluated using the external rotation degree, as well as Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA) Shoulder Rating Scale, Constant-Murley Score (CMS), Oxford Shoulder Instab...

Hallux valgus, which is a frequently encountered foot problem, is a disease causing pain to the p... more Hallux valgus, which is a frequently encountered foot problem, is a disease causing pain to the patient with difficulties in walking and wearing shoes and cosmetic problems. There are many different conservative and surgical treatments which are applied according to the degree of deformity. The treatment method of correction of the deformity with a distal suture anchor without the need for osteotomy, which has not been previously described in literature, is presented in this paper when applied to cases of moderate hallux valgus as it was considered as an alternative treatment method because of complications occurring in osteotomy

Acta orthopaedica Belgica, 2018

The aim of this study was to compare radiological and clinical outcomes of posterior wall acetabu... more The aim of this study was to compare radiological and clinical outcomes of posterior wall acetabulum fractures and posterior wall fracture dislocations. Data were including 52 acetabulum fractures and fracture dislocations. 26 patients (%50) had posterior acetabulum fractures and fracture dislocations who were operatively treated. Radiographic evaluations were performed before and after the operation and at the last follow up. Clinical outcome evaluation was performed at the last follow up. Clinical and radiological outcomes were evaluated including Merle D'aubigne clinical assessment score and Matta' s radiologic measurement score. Brooker classification was used to measure heterotopic ossification.Both Merle D'aubigne and Matta scores were found higher in the acetabulum posterior wall fracture group. But there wasn't significantly difference of clinical and radiological outcomes between two groups (p ˃ 0,05). Reduction quality and Matta radiologic scores were corre...

The Knee, 2020

Background: The purpose of the study was to evaluate lateral and patellofemoral osteoarthritis (O... more Background: The purpose of the study was to evaluate lateral and patellofemoral osteoarthritis (OA) progression after medial unicompartmental knee arthroplasty (UKA) and identify factors affecting the progression that were not identified previously. Methods: We evaluated 146 patients who underwent medial UKA between 2009 and 2014. Kellgren-Lawrence grading of lateral and patellofemoral OA was performed on preoperative and final follow-up knee radiographs. Radiographic and clinical characteristics, SF-36, and Oxford knee scores were compared between the OA progressed and non-progressed groups. Risk factors for lateral and patellofemoral OA progression were evaluated. Results: The lateral OA progressed and non-progressed groups significantly differed in side, preoperative flexion contracture, preoperative joint line convergence angle, postoperative tibiofemoral angle, insert size, revision status (P b 0.05), and the patellofemoral OA progressed and non-progressed groups significantly differed in age, pre-and postoperative flexion contracture, postoperative tibiofemoral angle and pre-and postoperative patellofemoral OA grade (P b 0.05). At the final follow-up, Visual Analogue Scale, Oxford Knee Scores, and SF-36 subscores were significantly better in the lateral OA non-progressed group (P b 0.001). Dominant leg (odds ratio (OR): 2.759), insert size (N 4, OR: 2.219), revision status (+, OR: 6.692), and postoperative tibiofemoral angle (N 5.5°, OR: 1.177) were independent risk factors for lateral OA progression, whereas age (N60 years, OR: 3.222), preoperative patellofemoral OA grade (N1, OR: 2.085), and postoperative flexion contracture (N 10°, OR: 1.919) were those for patellofemoral OA progression. Conclusions: Mild radiographic progression of 1 KL grade is frequently seen five to 10 years after medial UKA. Postoperative outcomes are significantly affected by lateral compartment OA progression but not by patellofemoral OA progression.

Foot and Ankle Surgery, 2020

Background: Impaired wound healing is a major cause of morbidity in diabetic patients by causing ... more Background: Impaired wound healing is a major cause of morbidity in diabetic patients by causing chronic ulcers. This study aimed to investigate the safety and outcomes after intralesional allogeneic adiposederived mesenchymal stem cells injection in chronic diabetic foot ulcers. Methods: Twenty patients (12 male and eight female) were involved in the study. We randomized the patients into two groups of 10 patients each. The study group was treated with allogeneic adiposederived mesenchymal stem cells injection with standard diabetic wound care. The control group received only standard diabetic wound care. Patient demographics, wound characteristics, wound closure time, amputation rates and clinical scores were evaluated. Results: The mean age was 57.3 AE 6.6 years. The mean follow-up duration was 48.0 (range, 26-50) months. Wound closure was achieved in 17 of 20 lesions (study group, 9 lesions; control group, 8 lesions; respectively). The mean time to wound closure was 31.0 AE 10.7 (range, 22-55) days in the study group, 54.8 + 15.0 (range, 30-78) days in the control group (p = 0.002). In three patients, minor amputations were performed (one patient in study group; two patients in the control group, p = 0.531). There was a significant difference between groups in terms of postoperative Short Form 36-physical functioning (p = 0.017) and Short Form 36-general health (p = 0.010). Conclusion: Allogeneic adipose-derived mesenchymal stem cells injection was found to be a safe and effective method with a positive contribution to wound-healing time in the treatment of chronic diabetic foot ulcers.

The Knee, 2020

Background: To evaluate and compare the clinical and radiological outcomes of patients subjected ... more Background: To evaluate and compare the clinical and radiological outcomes of patients subjected to medial unicompartmental knee arthroplasty (UKA). Methods: The study included 146 knees of 115 consecutive medial UKAs patients with a minimum five-year follow-up. Pre-and postoperative functional and clinical outcomes were measured using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), American Knee Society Score (AKSS-O), knee range of motion (ROM), and Short-Form Health Survey (SF-36). The Kellgren-Lawrence osteoarthritis (OA) grading system was used for the evaluation of the OA status. The joint line convergence angle (JLCA) of the operated and contralateral knee, the tibiofemoral coronal angle (TFCA), and the tibial slope angle were used in the radiological evaluation. Results: The mean age of patients was 58.8 ± 7.0 years. The mean follow-up period was 7.41 ± 1.54 years. Good to excellent functional outcomes were obtained according to VAS, WOMAC, OKS, AKSS-O, and SF-36 scores. Insert dislocation was the main reason for revision surgery (nine patients, 90%). Preoperative body mass index (BMI), postoperative BMI, American Society of Anesthesiologists (ASA) Score, postoperative knee flexion contracture, mean increase in postoperative medial joint space (PMJS) height, and OA progression were found to affect the revision status. Conclusions: Good to excellent functional, clinical, and radiological outcomes were obtained with medial UKA at a minimum follow-up of five years. Differences in preoperative and postoperative radiological parameters except an increase in PMJS height had no impact on revision status.

Injury, 2020

This study aimed to investigate the anatomic risk factors associated with dislocation following b... more This study aimed to investigate the anatomic risk factors associated with dislocation following bipolar hemiarthroplasty for the treatment of femoral neck fracture. Materials and Methods: We retrospectively reviewed 208 consecutive patients (133 women, 75 men) with femoral neck fractures who were treated with bipolar hemiarthroplasty between 2015 and 2018. A comparative analysis was performed between dislocation (n = 18) and non-dislocation (n = 190) groups in terms of patient demographics, surgical and pelvic morphologic factors, and clinical outcomes, including postoperative Harris and modified Harris hip scores. Independent risk factors affecting dislocation were also evaluated. Results: The mean follow-up period was 30.8 ± 2.0 (range, 12-48) months. The mean age was 79.2 ± 7.4 (range, 71-94) years. The dislocation rate was 8.6% (18/208), and the mean dislocation time after operation was 2.0 ± 1.1 (range, 1-4) months. Patient-related factors did not differ between the dislocated and non-dislocated groups. As regards dislocation, statistically significant difference was observed in surgical and pelvic morphologic factors, including femoral offset, residual femoral neck length, trochanter upper end and femoral head center distance, and height of the hip center of the operated side (p = 0.025, p = 0.013, p = 0.002, p = 0.008, respectively). Moreover, the femoral offset, height of the hip center, and femoral neck-shaft angle of the non-operated side are significantly different between the groups (p = 0.007, p = 0.001, p = 0.027, respectively). Decrease in the center edge (CE) angle, offset of prosthesis, and increase in femoral head extrusion index (FHEI) of the operated side and decrease in the height of the hip center of the non-operated side increased the risk of dislocation (p = 0.030, OR: 1,306; p = 0.041, OR: 8.15; p = 0.020, OR: 1.038; p = 0.010, OR: 2.02, respectively). Conclusions: Pelvic morphologic features and surgical factors were found to affect dislocation. Patients with smaller OP, CE angle of the operated side, and higher FHEI and smaller height of the hip center of the non-operated side should be carefully monitored to decrease postoperative dislocation.

CARTILAGE, 2020

Objective There are limited data on bone dimension and cartilage thickness of the distal humeral ... more Objective There are limited data on bone dimension and cartilage thickness of the distal humeral articular surface. This study aimed to evaluate sex- and age-related bone dimension and cartilage thickness differences and assess the effect of cartilage thickness on distal humeral shape. Design Elbow magnetic resonance images of 180 healthy participants were evaluated. Cartilage thicknesses of the trochlea and capitellum were measured at 19 points using coronal and axial images. In addition, bone diameters were measured from the flexion-extension axis to the 19 points on the coronal and axial magnetic resonance images. Sex differences were evaluated, and the correlation between age and measurement parameters was assessed. Results Significant sex differences regarding the diameters of the axial trochlear bone, coronal lateral trochlear bone, and medial capitellar bone, cartilage thickness at the apex of the lateral trochlear ridge in the axial and coronal plane and at the most lateral ...

Annals of Medical Research, 2019

Aim: Due to anatomical differences, current baseplate designs may lead to incompatibilities in re... more Aim: Due to anatomical differences, current baseplate designs may lead to incompatibilities in reverse shoulder arthroplasty in different populations. We hypothesized that glenoid anthropometric parameters in Turkish subjects would be different from that in other populations. Materials and Methods: Three-dimensional morphology of 200 healthy Turkish shoulders (100 male and 100 females, 93 left and 107 right shoulders) was evaluated. Glenoid height, width, version, inclination, circumference, and surface area; glenoid depth, scapular neck length, and scapular neck angle were measured. Sex and side differences were assessed. The correlation between glenoid morphologic parameters and subject height was assessed. The height corresponding to a 25-mm glenoid width was predicted. Results: There was a significant difference between male and female subjects regarding glenoid height, width, version, depth, circumference, surface area, and patient height (p

The Journal of Knee Surgery, 2019

Dissatisfaction is still an important problem in a small but important group of patients who unde... more Dissatisfaction is still an important problem in a small but important group of patients who undergo total knee arthroplasty. This study was designed to evaluate the effectiveness of showing patients the change in their standing posture, before and after total knee replacement, using standing photographs (anterior, posterior, and lateral view), on improving self-reported quality of life and satisfaction. Full-length lower extremity radiographs and standing photographs were obtained prior to total knee replacement and 6 months after surgery in the study group. In the control group, radiographs and photographs were not obtained. The hip–knee–ankle angle and mechanical axis deviation were compared between the two limbs and two groups. The changes in the following outcome measures were evaluated from baseline to 6 months after surgery: Short Form-36 Survey, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score, an...

Annals of Medical Research, 2019

This study aimed to reveal the relationship between changes in Claudin-5 expression and the durat... more This study aimed to reveal the relationship between changes in Claudin-5 expression and the duration of healing in Achilles tendon injury. Material and Methods: 18 Achilles tendons of Wistar-Albino rats were used in the study. Rats were divided into 3 groups as 6 rats in each group, group 1; sham group, group 2; tendon repair group (sacrificed after 3 weeks), group 3; tendon repair group (sacrificed after 6 weeks). Immunohistochemically, the tendons were stained with Claudin-5 and the degree of staining with light microscope was rated between 0 and 3. The obtained scores were compared with Kruskal Wallis test and Posthoc analysis. Results: The scores were 0.5 ± 1 (0-1) in group 1.1 ± 1 (1-2) in group 2 and 1.5 ± 1 (1-2) in group 3. A statistically significant difference was found between the groups (p = 0.026). In the posthoc analyzes, there was a significant difference between group 1 and 3, but there was no significant difference between groups 1 and 2 and between groups 2 and 3. Conclusion: The expression of claudins is regulated by many factors, including hormones, various cytokines, and epithelialmesenchymal transition-related transcription factors. In this study, the increase in the expression of Claudin-5 was noticed in proportion to the progress of primary wound healing. This relationship may be a part of the repair mechanism. The role of claudin levels in intercellular passage is crucial for function as it is important for cell signaling. Achilles tendon healing can be attributed to a laboratory parameter such as claudin. This can help to understand the recovery rate and can help early return to work or sport. We believe that as a laboratory parameter Claudin-5 may be useful in the evaluation of tendon healing.

The Knee, 2018

Background: There are few large-scale, long-term studies comparing medial meniscal repairs with o... more Background: There are few large-scale, long-term studies comparing medial meniscal repairs with or without concurrent anterior cruciate ligament (ACL) reconstruction. Methods: A total of 140 patients who underwent arthroscopic medial meniscal repair were divided into two groups: Group A, meniscus repair only and Group B, meniscus repair with concurrent ACL reconstruction. Clinical assessments included physical examination findings, Lysholm score, and the International Knee Documentation Committee (IKDC) form. Barret criteria were used for the clinical assessment of healing status. Magnetic resonance imaging (MRI)was obtained to confirmhealing and failure. Subgroups of participants were compared in terms of suture technique, type of tear, and location of tear. KT-2000 arthrometer testing was used for objective evaluation of anterior-posterior knee movement. Results: Mean follow-up duration was 61 (34-85) months. Clinical outcomes in both groups were significantly improved compared to baseline (P = 0.001 vs. P = 0.001); however, there was no significant between-group difference in postoperative Lysholm and IKDC scores (P = 0.830). The outcomes of three participants (seven percent) in Group A and 11 (11.3%) in Group B were considered as treatment failures (P = 0.55). Red-red zone tears had higher scores. Mean postoperative KT2000 arthrometer values of failed participants in Groups A and B were 4.66 mm (range, four to six) and 5.2 mm (range, two to seven), respectively. Conclusion: Concurrentmedialmeniscus repair and ACL reconstruction did not have clinical superiority over meniscus repair alone. Repairs in the red-red zone appeared to be associated with better outcomes.

Injury, 2018

Highlights  CT imaging is superior to traction radiographs for correct identification of fractur... more Highlights  CT imaging is superior to traction radiographs for correct identification of fracture fragments and comminution zones in OTA/AO 43C3 fractures.  However, both assessment methods result in similar treatment and surgical approach recommendations.  Hence, traction radiographs may be a useful alternative to CT imaging for preoperative planning in settings where CT is not feasible.

Journal of clinical medicine research, 2018

Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals... more Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. A second hip fracture can occur in elderly patients who have already suffered an initial hip fracture. The aim of this study was to investigate possible risk factors for second hip fractures in elderly patients with hip fractures. Between 2010 and 2014, 230 patients who underwent uncemented bipolar hemiarthroplasty for hip fractures were retrospectively analyzed. The patients were divided into two groups: those with a first hip fracture (group 1) and those with a second hip fracture (group 2). The mean time from the first hip fracture to second hip fracture was 22 months. There were no significant differences in the American Society of Anesthesiologist scores, comorbidities were observed in the two groups. The mean length of hospitalization was not significantly different between the two groups. The mean postoperative functional scores after second hip fractures were si...

Journal of Turgut Ozal Medical Center, 2017

The tibialis anterior muscle herniation was treated with the periosteal turnover flap technique, ... more The tibialis anterior muscle herniation was treated with the periosteal turnover flap technique, which has not been previously described in literature. The defect area covered with tibial periosteum by turning the raised flap over on itself at 180º after debridement of the defect edges. Four cases had a history of trauma and the herniation was in the mid-third of the tibia. The mean follow-up period was 84 months (range, 72-96 months) during which no complications or recurrence were observed. In this paper, the periosteal turnover flap technique is described for the first time in literature. The repair of tibialis anterior muscle herniation with periosteal turnover flap can be considered as a safe method.

TURKISH JOURNAL OF MEDICAL SCIENCES, 2017

Introduction Diabetes mellitus (DM) is a major public health problem and diabetic foot incidence ... more Introduction Diabetes mellitus (DM) is a major public health problem and diabetic foot incidence increases with the prevalence of DM (1-3). Diabetic foot ulcer (DFU) is one of the major complications of DM and occurs at an estimated rate of 10%-25% in diabetic patients in their lifetime (1-5). In addition, 40%-85% of nontraumatic amputations consist of diabetic foot amputations (6,7). DFU causes increased morbidity and decreased quality of life, incurs high treatment costs, and leads to high rates of lower extremity amputation (LEA) (3,4,8). Death rates 5 years after a major amputation can be as high as 78% (8). The diabetic foot is a multifactorial disorder (2,4,5). DM causes a range of complications such as nephropathy, retinopathy, neuropathy, DFUs, and cardiovascular disease. The incidence of complications is expected to increase with the rising number of diabetic patients (1,3,6,9). In particular, diabetic neuropathy and peripheral arterial disease that causes angiopathy are two major risk factors that play a role in the development of DFUs (1,3,6,9). Regardless of DM, we can list smoking, comorbidities, alcoholism, use of steroids or toxic drugs, congenital wound healing problems, malnutrition, and old age as additional risk factors for foot ulcers (9). Despite the well-defined risk factors in the development of DFU, there are factors that predict major or minor amputation related to the diabetic foot. Age, sex, ulcer depth, severity of infection, ischemia, osteomyelitis, duration of diabetes, neuropathy, and glycemic control are considered as potential predictors of amputation in DFU (6,10). In this study, we tried to determine the risk factors that may cause amputation type by comparing the existing clinical results of patients with major or minor amputation of a lower extremity due to diabetic foot. Our hypothesis is that risk factors in diabetic foot are effective in determining the level of amputation. 2. Materials and methods We retrospectively studied 268 patients. After the first evaluation, patients who were treated without amputation or those with Grade 0, 1, 2, or 5 lesions according to the Wagner classification were excluded. The remaining 107 patients (56 males, 51 females; 64 right side, 43 left side; Background/aim: We evaluated the existing risk factors with clinical results in patients who underwent major and minor amputation of the lower extremity as a result of diabetic foot ulcers (DFUs). Materials and methods: We retrospectively studied 107 patients who had undergone lower extremity amputation. The patients were divided into minor (Group 1, n = 75) and major (Group 2, n = 32) amputation groups. On clinical evaluation, the type of surgery performed, smoking history, comorbidities, duration of diabetes mellitus (DM) diagnosis, duration of DFU presence, peripheral neuropathy, peripheral arterial disease, results of deep tissue culture, length of hospitalization, and blood parameters were investigated. Results: In Group 2, mean hospitalization time was significantly longer than in Group 1 (P < 0.05). The proportion of patients with Wagner Grade 4 was significantly higher in Group 2 than in Group 1 (P < 0.05). The duration of DM and DFU was significantly longer in Group 2 (P < 0.05). The number of polymicrobial agents was significantly higher in Group 1 (P < 0.05). Conclusion: In our study, the most important risk factors that led to major amputation in patients with DFU were age, Wagner classification, duration of DM, duration of DFU, and C-reactive protein level.

Case Reports in Surgery, 2016

Kirschner wire (K-wire) is one of the commonly used implants in orthopaedics practice. Migration ... more Kirschner wire (K-wire) is one of the commonly used implants in orthopaedics practice. Migration of the wire is one of the most frequently reported complications after fixation by the K-wire. In particular, it has been reported that a greater range of motion in the shoulder, negative intrathoracic pressure associated with respiration, gravitational force, and muscular activities may cause migration from the upper extremities. In general, thin and long foreign bodies with smooth surfaces that are localized within the tendon sheath and at an upper extremity can migrate more readily and can reach longer distances. Here, we present a patient with long-term migration of a broken K-wire who underwent fixation for acromioclavicular joint dislocation 5 years ago.

Journal of Orthopaedics, 2017

Background: We assessed the results of humeral shaft fracture fixation using the inflatable intra... more Background: We assessed the results of humeral shaft fracture fixation using the inflatable intramedullary nail using radiological and clinical findings. Methods: From 2012 to 2015, we treated 14 patients with humeral shaft fractures using inflatable intramedullary nail after closed reduction. Results: The mean follow-up time was 14.1 months. The mean time to bone union was 4.5 months. None of the patients had major perioperative mechanical complications or postoperative complications, except for the occurrence of fixation loss and non-union in one patient. Conclusion: Inflatable intramedullary nails seem to be applicable, safe and effective for humeral AO/OTA type A midshaft fractures.