Mahir Gulsen - Academia.edu (original) (raw)
Papers by Mahir Gulsen
Turkish Neurosurgery, 2020
AIM: To investigate the effect of distal fusion level on radiographic parameters and functional o... more AIM: To investigate the effect of distal fusion level on radiographic parameters and functional outcome in patients with degenerative spine disease who undergo long posterior fusion with instrumentation. MATERIAL and METHODS: This study included 78 adult patients aged>60 years who underwent long posterior fusion (>6 levels) for spinal deformity with a minimum 2-year follow-up. The patients were divided into two groups based on distal fusion level (L5 group and iliac group). Spinopelvic parameters, including lumbar lordosis (LL) and sagittal vertical axis (SVA), were evaluated. Functional outcome was evaluated with the pain visual analog scale (VAS) and the Oswestry Disability Index (ODI) questionnaire. Correlations between clinical and radiographic parameters were calculated statistically. RESULTS: In the L5 group, the mean SVA and LL significantly improved after surgery (p=0.025 and 0.008, respectively). Similarly, the SVA and LL also improved significantly in the iliac group (p=0.002 and 0.001, respectively). In both groups, lumbar VAS, leg VAS and ODI scores significantly improved (p<0.001). The change in ODI score was significantly greater in the iliac group than the L5 group (p=0.013). CONCLUSION: Although patients did not achieve the desired optimal spinal saggital balance, both L5 and iliac groups showed significant improvement in VAS and ODI scores. The iliac group showed slightly better improvement in ODI score.
Journal of Orthopaedic Trauma, Mar 1, 2004
Objective: To evaluate the results of bifocal compression-distraction method for the acute treatm... more Objective: To evaluate the results of bifocal compression-distraction method for the acute treatment of open tibia fractures with bone and softtissue loss. Design: Patients were selected for bifocal compression-distraction (shortening and lengthening) who had open tibia fractures with bone and soft-tissue loss and a Mangled Extremity Severe Score of 6 and below indicating good leg viability. Patients: Bifocal compression-distraction osteogenesis using the Ilizarov type circular external fixator was applied to 24 patients with 14 grade IIIA and 10 grade IIIB open tibia fractures with bone and soft-tissue loss. Mean age of the patients was 30.6 years (range 18-53). The mean bone defect was 5 cm (range 3-8.5). The mean soft tissue defect was 2.5 × 3.5 (1 × 2-10 × 5) cm. Interventions: Acute shortening at the fracture site was done for patients with bone defects up to 3 cm to achieve apposition of bone ends. Gradual shortening at a rate of 2 mm/d was done for patients who had bone defects more than 3 cm. Leg length discrepancy was overcome by lengthening at the same time through a corticotomy at a proximal or distal level depending on fracture localization, until there was equalization of leg lengths. Results: Mean follow-up period was 30 months (range 18-60). Mean bone healing time was 7.5 months (range 4-11). The mean time in external fixation was 7.1 months (range 3-10), and the average external fixator index was 1.4 months/cm. Results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 21 and good in 3 patients. Functional assessment scores were excellent in 19, good in 4, and fair in 1 patient. Pin site infections were present in 10.7% of the pin sites. There were 52 complications in 24 patients, for a complication rate per patient of 2.08. Of the complications, 48.1% were problems (minor complications), 38.5% obstacles (major complications requiring a surgical solution), and 13.4% sequelae (true complications). Minor complications included soft tissue inflammation and infection, translation/angulation, and delayed maturation during distraction and transient knee contracture and loss of motion. All grade 1 and 2 soft tissue inflammations and infections healed with nonoperative therapy. Major complications included pin tract infection and reinfection, equinus deformity, frame failure, and premature consolidation, all of which required additional surgery to correct the problem. Sequelae included leg length discrepancy, loss of knee/ankle range of motion, knee flexion contracture, malalignment, and chronic osteomyelitis. Conclusion: Bifocal compression-distraction osteogenesis is a safe, reliable, and largely successful method for the acute treatment of open tibia fractures with bone and soft-tissue loss. Further nonoperative or operative treatment can correct most complications.
Springer eBooks, 2018
Extremity discrepancies, short stature, pseudoarthrosis, infections such as chronic osteomyelitis... more Extremity discrepancies, short stature, pseudoarthrosis, infections such as chronic osteomyelitis, acute trauma with bone loss, and deformities either in the bones or joints are routine problems dealt with in daily practice. In the majority of these problems, an Ilizarov external fixator (EF) is used, often as the first choice or for revision of previously unsuccessful surgery (as reported by Ilizarov (Clin Orthop Relat Res 280: 7–10, 1992)). The Ilizarov EF is highly modular, which increases the chance of success, but also entails a long learning curve. Especially in multiplanar deformities, because of the hinge positioning difficulties, lengthening and translations are made with different apparatus thus the system requires frequent revision (as reported by Mutlu (J Eng Math 54:119, 2006)). This situation creates anxiety in the patient and is time-consuming for the physician. Therefore, the use of circular Ilizarov external fixator is gradually being replaced by computer-assisted fixators.
Acta Orthopaedica et Traumatologica Turcica, 1989
... Sistemde çivi ve çubuklar için aynı materyal (paslan-maz çelik) kullanıldığında, kuvvet altın... more ... Sistemde çivi ve çubuklar için aynı materyal (paslan-maz çelik) kullanıldığında, kuvvet altında yer değiştirme ve açılanma miktarları, çivi çapı (P), çivi uzunluğu (F), çubuk çapı (C) ve çubuk uzunluğunun (G) fonksiyonları olmaktadır. ... Page 2. 142 M. Gülşen ve ark. ...
Proceedings Of The Institution Of Mechanical Engineers, Part H: Journal Of Engineering In Medicine, Feb 3, 2019
This biomechanical study evaluated comparison osteosynthesis of the femoral neck fracture model b... more This biomechanical study evaluated comparison osteosynthesis of the femoral neck fracture model by 3 cannulated screw implants and new perforated H beam implants under different loading conditions with 45 third generation right proximal femur bones. A standardized Pauwels Type 3 of the femoral neck fracture was performed in the femur models. For assessing the rigidity and strength of fixation methods, the proximal femur bones after their osteosynthesis were then mechanically tested in axial compression, and torsional and dynamic axial compression loading. To determine the structural advantage of the new implant system, perforated and nonperforated new implant systems were comparing about pull out performance. When loading the samples, photographs were taken continuously. The reference parameters were described and measured from unloaded and loaded photographs of the static and dynamic tests. There was no significant difference between stiffness values of two fixation methods under static and rotational loading. Under dynamic loading, the displacement of the superior point of femoral head at the fracture line showed a significant decrease between the new implant system and cannulated screws. Comparing the relative motion at the mid line of the fracture in femoral neck between groups, a significant increase was found in H Beam implant group. Perforated H beam implants have similar static and torsion properties with golden standard. Although there was significant difference under dynamic loading which simulate movement early after surgery, the patient was not allowed to move early after surgery in the clinical practice. Therefore, the differences due to the perforated ''H'' beam implant would not cause clinical insecurity. Therefore, it is assumed that the perforated ''H'' beam implant can be used for internal fixation as an alternative to cannulated screws in the treatment of instable femoral neck fracture.
Springer eBooks, 2018
Reconstruction Methods for Fractures with Bone Defects, Vascular Injury, and Salvage Procedures
PubMed, Sep 1, 2016
Treatment of tibial osteomyelitis with infected, necrotic, unstable bone segments (Cierny-Mader T... more Treatment of tibial osteomyelitis with infected, necrotic, unstable bone segments (Cierny-Mader Type IV local osteomyelitis) includes débridement and segmental resection, which results in long bone defects. Reconstruction may be with distraction osteogenesis. Segmental bone transport and acute compression and distraction techniques are two main distraction osteogenesis techniques used in the treatment of Type IV local tibial osteomyelitis. In this retrospective, four-center study we compared these two techniques during a 15-year period. 29 patients treated using segmental bone transport technique and 45 patients were treated using acute compression and distraction technique. The mean age (p= 0,34) and the mean bone loss with preoperative shortening (P=0,08) and the mean number of previous operation (p=0,06) were not different in these two groups. . At latest followup, functional and radiographic results were evaluated There was no difference between two technique on the Paley's scoring system ( p=0,33) and in the total number of complication(p=0,16). Mean external fixator index was lower in the second group ( p=0.02 ). Both techniques can be used safely; however, the acute compression distraction technique may provide greater patient satisfaction because of shorter external fixator index, although future studies will be needed to determine whether this is.
Türk Ortopedi ve Travmatoloji Birliği Derneği dergisi, 2020
Dizilim ve yönelimi iyi değerlendirebilmek için tüm alt ekstremitenin ayakta iken çekilen ön-arka... more Dizilim ve yönelimi iyi değerlendirebilmek için tüm alt ekstremitenin ayakta iken çekilen ön-arka radyografisine ihtiyaç vardır. Tüm planlamalar bu radyografiler üzerinde yapılacağından kurallara uygun olarak çekilmesi gerekmektedir. Rotasyon bozukluğu olmaması için patellanın tam önde, her iki femur kondillerinin ortasında görüldüğü grafiler çekilmelidir. Bu radyografilerin çekilmesinde dikkat edilmesi gereken noktalar ve deformite dizilim yönelim bozukluğu analizi daha önceki bölümlerde anlatıldığından tekrar bahsedilmeyecektir. Alt ekstremite deformitesine bağlı yakınmalar; yürüme bozukluğu, hareket kısıtlılığı, eklem çevresin
Archives of Orthopaedic and Trauma Surgery, Feb 22, 2015
Successful anterior cruciate ligament (ACL) reconstruction is dependent on correct placement of b... more Successful anterior cruciate ligament (ACL) reconstruction is dependent on correct placement of both tibial and femoral tunnels. The purpose of this study is to investigate whether we can use intraoperative femoral tunnel length measurement to estimate the correct femoral tunnel placement on coronal plane. This prospective study comprised 164 consecutive patients who underwent ACL reconstruction surgery. Transtibial or anteromedial portal technique is used for drilling the femoral tunnels. The length of the femoral tunnel was measured during the operation. The femoral tunnel coronal plane angle was calculated on the postoperative tunnel radiographs. A statistical comparison was made of the lengths of the tunnel, the techniques used drilling and the femoral tunnel angles. The far anteromedial portal was used in 81 (49 %) cases and the transtibial technique in 83 (51 %) cases. The mean femoral tunnel length was 42 ± 6.4 mm and the mean femoral tunnel coronal angle was 41.1° ± 11.6. The tunnel angle in the transtibial technique was determined as significantly low compared to the far anteromedial portal technique (32.6°:49.8°) and the tunnel length was significantly longer (45.8:38.1 mm) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In the statistical analysis, it was found that a patient with a tunnel length of 41 mm and above had a 92.1 % likelihood of femoral tunnel angle below 45°. Femoral tunnel length can be used as a clue for intraoperative evaluation of the femoral tunnel position. If the femoral tunnel length is greater than 41 mm, the coronal plane orientation of the femoral tunnel will be improper and not at a desired position.
Journal of Trauma-injury Infection and Critical Care, May 1, 2009
Background: Acute shortening is reported to be an effective method for the treatment of open frac... more Background: Acute shortening is reported to be an effective method for the treatment of open fractures with bone and soft tissue defects. Little is known about primary skin closure with angulation to the side of the defect and distraction at the fracture site. Methods: We present a series of three cases treated for defective fractures of tibia by angular shortening and delayed gradual distraction with hinged circular external fixator. Two cases were type IIIB open fractures and one case was an infected nonunion. Bone and soft tissue defects were managed by adaptation of edges and primary skin closure with angulation to the side of the defect. Axial alignment was restored by gradual distraction after a 2 to 3 weeks interval. Residual limb length discrepancy was lengthened through a separate corticotomy in two cases. Results: Bone formation at both the fracture and corticotomy sites were sufficient to achieve union in all patients. Fixation time averaged 261 (182-392) days and average bone healing index was 42 days/cm. No further surgical intervention was necessary for soft tissue reconstruction after primary skin closure. Infection was eradicated in the case of infected nonunion. Conclusions: Angular compression to the side of the defect is a safe and reliable method of treatment for asymmetrical bone or soft tissue defects of tibia. It eliminates the need for complex soft tissue reconstruction procedures. Unnecessary debridement of bone is prevented by angular adaptation of edges. Definitive treatment of complex injuries is possible with a circular external fixator.
Journal of Arthroplasty, Apr 1, 2010
A new technique of femoral fixation that uses a transverse osteotomy for subtrochanteric shorteni... more A new technique of femoral fixation that uses a transverse osteotomy for subtrochanteric shortening and derotation in total hip arthroplasty for Crowe type 3 to 4 dysplasia of the hip is described. This series included 21 cases in 12 women and 2 men, with a mean age of 42.3 years. Follow-up averaged 41.2 months. Bone pegs prepared from the resected femoral segment were seated in the medullary canal around the stem for femoral fixation. Merle d'Aubigné scores for pain, motion, and walking improved from 2.9, 4.4, and 3.7 to 5.2, 5.4, and 5.5, respectively. Radiographic union was detected within 12 ± 3.4 (range, 6-24) weeks in all cases. Complications were early dislocation in 2 cases. This technique allows correction of anteversion, provides excellent rotational stability, and eliminates the need for additional osteosynthesis regardless of the stem design.
Archives of Orthopaedic and Trauma Surgery, May 14, 2009
Five adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by t... more Five adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by the Ilizarov method of distraction osteogenesis. A standard technique was applied in all patients. The average follow-up was 28 (range, 24-38) months. Preoperative carrying angle ranged from 12 degrees to 22 degrees of varus (average 16.6 degrees ) and postoperative carrying angle ranged from 10 degrees to 14 degrees of valgus (average, 11.6 degrees ) equalized to the contralateral side. The outcome was rated as excellent in all patients. No complication was observed, except a grade-2 pin-tract infection in two patients. Rigid fixation, early rehabilitation, precise correction, satisfactory cosmetic scars and functionally excellent results can be obtained with this method.
IFMBE proceedings, 2009
... Here qx, qy are the co-ordinates of the proximal bone center; rx, ry, rz are the distances be... more ... Here qx, qy are the co-ordinates of the proximal bone center; rx, ry, rz are the distances between the distal ring and distal bone centers along x,y,z axes respectively; all other quantities 0 0 0 0 0 0 ( , , , , ux uy uz vx vy vz eeeeee and unit vectors (e ,e ) un vn are ...
Acta Orthopaedica et Traumatologica Turcica, 2017
Objective: The present study assessed functional and radiographic outcomes of distraction osteoge... more Objective: The present study assessed functional and radiographic outcomes of distraction osteogenesis treatment of post-traumatic elbow deformities in children. Methods: Eight children were treated between 2008 and 2013 for post-traumatic elbow deformities using distraction osteogenesis. Mean age at time of operation was 10.9 years. Six patients had varus and 2 had valgus deformity. Magnitude of correction, fixator index, complications, carrying angle, and elbow range of motion were assessed. Functional results were graded according to protocol of Bellemore et al. Results: Mean follow-up was 43 months. Mean preoperative varus deformity in 6 patients was 29.2 and valgus deformity in 2 patients was 28.5. Preoperative flexion and extension of elbow were 123.8 and À10.6 , respectively. Mean carrying angle was 9 valgus at last follow-up. Mean flexion and extension were 134.4 and À6.0 , respectively. Change in carrying angle was statistically significant (p ¼ 0.002). There were 2 grade 1 pin tract infections and 1 diaphyseal fracture of humerus. Functional outcome was rated excellent in 7 patients and good in 1 patient. Conclusion: Ilizarov distraction osteogenesis is a valuable alternative in treatment of elbow deformities in children. The surgical technique is simple and correction is adjustable. Gradual correction prevents possible neurovascular complications and minimally invasive surgery produces less scarring. Compliance of patient and family is key factor in the success of the outcome.
Acta Orthopaedica et Traumatologica Turcica, 1997
... sistemlerinin mekanik performansı (Deneysel çalışma) Emre Toğrul(1), Mahir Gülşen(ı), Yaman S... more ... sistemlerinin mekanik performansı (Deneysel çalışma) Emre Toğrul(1), Mahir Gülşen(ı), Yaman Sarpel(l), Mehmet Çapa(3), Turgut Gülmez(4) ... Aksiyel kompresyonda S kg&#x27;dan başlayarak beşer kg&#x27;lık artış- Hizarovda Schanz vidalan 349 ii STANDAltTfRAMf. ...
Journal of Medical Devices-transactions of The Asme, Sep 11, 2006
The objective of this work is to set up, validate, and analyze a theoretical model of an external... more The objective of this work is to set up, validate, and analyze a theoretical model of an external fixator for its deformation characteristics in order to draw reliable conclusions relevant to the design and effective clinical implementation of such medical devices. External fixators are mechanical devices widely used in the treatment of fractured bones and correction of limb deformities. Lateral deformation at the fracture site is known to delay bone healing, and investigation of lateral deformation characteristics of such devices experiencing forces acting perpendicular to the bone axis is important from the standpoint of their design as well as their clinical effectiveness. A mathematical model of a three-dimensional (3D) unilateral fixator with multipin fragment attachments has been developed using Castigliano’s method. The relative lateral deformations of the fragment ends at the fracture site induced by loads applied perpendicular to bone axes are calculated with the model. The model has been subjected to experimental verification for a uniplanar unilateral external fixator under comparable conditions with the theory. It has been found out that the effects of fixator size, shape, and geometry on the level of relative lateral displacement of the fracture site are similar in both the theoretical and experimental models. Stiffness is a maximum if the force is applied in the same plane as the proximal pin plane. Placing the distal pin group at a 90deg position relative to the proximal pin plane has been observed to increase the stiffness about 10%. In loading directions perpendicular to proximal the pin plane, stiffness is minimum. The angle difference between the load direction and the resulting displacement direction follows a sinusoidal pattern with an amplitude of 10deg for loading angles in the 0–180deg range. Selecting the distance of proximal pins to the fracture site smaller than the distance of distal pins to the fracture site has been found to decrease relative lateral deformation. The model and the experiment have simultaneously demonstrated that lower values of effective pin lengths and higher values of pin connector lengths lead to higher stiffness. Increasing the number of pins also contributes to the higher values of fixator stiffness.
Case reports in orthopedics, 2013
RELATO DE CASO / CASE REPORT Pigmented villonodular synovitis of the thoracic spine: case report ... more RELATO DE CASO / CASE REPORT Pigmented villonodular synovitis of the thoracic spine: case report and review of the literature Sinovitis pigmentada vilonodular da coluna torácica: relato de caso e revisão da literatura Sinovitis vellonodular pigmentada de la columna torácica: informe de un caso y revisión de la literatura
Nigerian Journal of Clinical Practice, 2020
Aims: This study aims to investigate the effectiveness of transforaminal epidural steroid injecti... more Aims: This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. Methods: One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months. Results: Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). Conclusion: TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.
Turkish Neurosurgery, 2020
AIM: To investigate the effect of distal fusion level on radiographic parameters and functional o... more AIM: To investigate the effect of distal fusion level on radiographic parameters and functional outcome in patients with degenerative spine disease who undergo long posterior fusion with instrumentation. MATERIAL and METHODS: This study included 78 adult patients aged>60 years who underwent long posterior fusion (>6 levels) for spinal deformity with a minimum 2-year follow-up. The patients were divided into two groups based on distal fusion level (L5 group and iliac group). Spinopelvic parameters, including lumbar lordosis (LL) and sagittal vertical axis (SVA), were evaluated. Functional outcome was evaluated with the pain visual analog scale (VAS) and the Oswestry Disability Index (ODI) questionnaire. Correlations between clinical and radiographic parameters were calculated statistically. RESULTS: In the L5 group, the mean SVA and LL significantly improved after surgery (p=0.025 and 0.008, respectively). Similarly, the SVA and LL also improved significantly in the iliac group (p=0.002 and 0.001, respectively). In both groups, lumbar VAS, leg VAS and ODI scores significantly improved (p<0.001). The change in ODI score was significantly greater in the iliac group than the L5 group (p=0.013). CONCLUSION: Although patients did not achieve the desired optimal spinal saggital balance, both L5 and iliac groups showed significant improvement in VAS and ODI scores. The iliac group showed slightly better improvement in ODI score.
Journal of Orthopaedic Trauma, Mar 1, 2004
Objective: To evaluate the results of bifocal compression-distraction method for the acute treatm... more Objective: To evaluate the results of bifocal compression-distraction method for the acute treatment of open tibia fractures with bone and softtissue loss. Design: Patients were selected for bifocal compression-distraction (shortening and lengthening) who had open tibia fractures with bone and soft-tissue loss and a Mangled Extremity Severe Score of 6 and below indicating good leg viability. Patients: Bifocal compression-distraction osteogenesis using the Ilizarov type circular external fixator was applied to 24 patients with 14 grade IIIA and 10 grade IIIB open tibia fractures with bone and soft-tissue loss. Mean age of the patients was 30.6 years (range 18-53). The mean bone defect was 5 cm (range 3-8.5). The mean soft tissue defect was 2.5 × 3.5 (1 × 2-10 × 5) cm. Interventions: Acute shortening at the fracture site was done for patients with bone defects up to 3 cm to achieve apposition of bone ends. Gradual shortening at a rate of 2 mm/d was done for patients who had bone defects more than 3 cm. Leg length discrepancy was overcome by lengthening at the same time through a corticotomy at a proximal or distal level depending on fracture localization, until there was equalization of leg lengths. Results: Mean follow-up period was 30 months (range 18-60). Mean bone healing time was 7.5 months (range 4-11). The mean time in external fixation was 7.1 months (range 3-10), and the average external fixator index was 1.4 months/cm. Results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 21 and good in 3 patients. Functional assessment scores were excellent in 19, good in 4, and fair in 1 patient. Pin site infections were present in 10.7% of the pin sites. There were 52 complications in 24 patients, for a complication rate per patient of 2.08. Of the complications, 48.1% were problems (minor complications), 38.5% obstacles (major complications requiring a surgical solution), and 13.4% sequelae (true complications). Minor complications included soft tissue inflammation and infection, translation/angulation, and delayed maturation during distraction and transient knee contracture and loss of motion. All grade 1 and 2 soft tissue inflammations and infections healed with nonoperative therapy. Major complications included pin tract infection and reinfection, equinus deformity, frame failure, and premature consolidation, all of which required additional surgery to correct the problem. Sequelae included leg length discrepancy, loss of knee/ankle range of motion, knee flexion contracture, malalignment, and chronic osteomyelitis. Conclusion: Bifocal compression-distraction osteogenesis is a safe, reliable, and largely successful method for the acute treatment of open tibia fractures with bone and soft-tissue loss. Further nonoperative or operative treatment can correct most complications.
Springer eBooks, 2018
Extremity discrepancies, short stature, pseudoarthrosis, infections such as chronic osteomyelitis... more Extremity discrepancies, short stature, pseudoarthrosis, infections such as chronic osteomyelitis, acute trauma with bone loss, and deformities either in the bones or joints are routine problems dealt with in daily practice. In the majority of these problems, an Ilizarov external fixator (EF) is used, often as the first choice or for revision of previously unsuccessful surgery (as reported by Ilizarov (Clin Orthop Relat Res 280: 7–10, 1992)). The Ilizarov EF is highly modular, which increases the chance of success, but also entails a long learning curve. Especially in multiplanar deformities, because of the hinge positioning difficulties, lengthening and translations are made with different apparatus thus the system requires frequent revision (as reported by Mutlu (J Eng Math 54:119, 2006)). This situation creates anxiety in the patient and is time-consuming for the physician. Therefore, the use of circular Ilizarov external fixator is gradually being replaced by computer-assisted fixators.
Acta Orthopaedica et Traumatologica Turcica, 1989
... Sistemde çivi ve çubuklar için aynı materyal (paslan-maz çelik) kullanıldığında, kuvvet altın... more ... Sistemde çivi ve çubuklar için aynı materyal (paslan-maz çelik) kullanıldığında, kuvvet altında yer değiştirme ve açılanma miktarları, çivi çapı (P), çivi uzunluğu (F), çubuk çapı (C) ve çubuk uzunluğunun (G) fonksiyonları olmaktadır. ... Page 2. 142 M. Gülşen ve ark. ...
Proceedings Of The Institution Of Mechanical Engineers, Part H: Journal Of Engineering In Medicine, Feb 3, 2019
This biomechanical study evaluated comparison osteosynthesis of the femoral neck fracture model b... more This biomechanical study evaluated comparison osteosynthesis of the femoral neck fracture model by 3 cannulated screw implants and new perforated H beam implants under different loading conditions with 45 third generation right proximal femur bones. A standardized Pauwels Type 3 of the femoral neck fracture was performed in the femur models. For assessing the rigidity and strength of fixation methods, the proximal femur bones after their osteosynthesis were then mechanically tested in axial compression, and torsional and dynamic axial compression loading. To determine the structural advantage of the new implant system, perforated and nonperforated new implant systems were comparing about pull out performance. When loading the samples, photographs were taken continuously. The reference parameters were described and measured from unloaded and loaded photographs of the static and dynamic tests. There was no significant difference between stiffness values of two fixation methods under static and rotational loading. Under dynamic loading, the displacement of the superior point of femoral head at the fracture line showed a significant decrease between the new implant system and cannulated screws. Comparing the relative motion at the mid line of the fracture in femoral neck between groups, a significant increase was found in H Beam implant group. Perforated H beam implants have similar static and torsion properties with golden standard. Although there was significant difference under dynamic loading which simulate movement early after surgery, the patient was not allowed to move early after surgery in the clinical practice. Therefore, the differences due to the perforated ''H'' beam implant would not cause clinical insecurity. Therefore, it is assumed that the perforated ''H'' beam implant can be used for internal fixation as an alternative to cannulated screws in the treatment of instable femoral neck fracture.
Springer eBooks, 2018
Reconstruction Methods for Fractures with Bone Defects, Vascular Injury, and Salvage Procedures
PubMed, Sep 1, 2016
Treatment of tibial osteomyelitis with infected, necrotic, unstable bone segments (Cierny-Mader T... more Treatment of tibial osteomyelitis with infected, necrotic, unstable bone segments (Cierny-Mader Type IV local osteomyelitis) includes débridement and segmental resection, which results in long bone defects. Reconstruction may be with distraction osteogenesis. Segmental bone transport and acute compression and distraction techniques are two main distraction osteogenesis techniques used in the treatment of Type IV local tibial osteomyelitis. In this retrospective, four-center study we compared these two techniques during a 15-year period. 29 patients treated using segmental bone transport technique and 45 patients were treated using acute compression and distraction technique. The mean age (p= 0,34) and the mean bone loss with preoperative shortening (P=0,08) and the mean number of previous operation (p=0,06) were not different in these two groups. . At latest followup, functional and radiographic results were evaluated There was no difference between two technique on the Paley's scoring system ( p=0,33) and in the total number of complication(p=0,16). Mean external fixator index was lower in the second group ( p=0.02 ). Both techniques can be used safely; however, the acute compression distraction technique may provide greater patient satisfaction because of shorter external fixator index, although future studies will be needed to determine whether this is.
Türk Ortopedi ve Travmatoloji Birliği Derneği dergisi, 2020
Dizilim ve yönelimi iyi değerlendirebilmek için tüm alt ekstremitenin ayakta iken çekilen ön-arka... more Dizilim ve yönelimi iyi değerlendirebilmek için tüm alt ekstremitenin ayakta iken çekilen ön-arka radyografisine ihtiyaç vardır. Tüm planlamalar bu radyografiler üzerinde yapılacağından kurallara uygun olarak çekilmesi gerekmektedir. Rotasyon bozukluğu olmaması için patellanın tam önde, her iki femur kondillerinin ortasında görüldüğü grafiler çekilmelidir. Bu radyografilerin çekilmesinde dikkat edilmesi gereken noktalar ve deformite dizilim yönelim bozukluğu analizi daha önceki bölümlerde anlatıldığından tekrar bahsedilmeyecektir. Alt ekstremite deformitesine bağlı yakınmalar; yürüme bozukluğu, hareket kısıtlılığı, eklem çevresin
Archives of Orthopaedic and Trauma Surgery, Feb 22, 2015
Successful anterior cruciate ligament (ACL) reconstruction is dependent on correct placement of b... more Successful anterior cruciate ligament (ACL) reconstruction is dependent on correct placement of both tibial and femoral tunnels. The purpose of this study is to investigate whether we can use intraoperative femoral tunnel length measurement to estimate the correct femoral tunnel placement on coronal plane. This prospective study comprised 164 consecutive patients who underwent ACL reconstruction surgery. Transtibial or anteromedial portal technique is used for drilling the femoral tunnels. The length of the femoral tunnel was measured during the operation. The femoral tunnel coronal plane angle was calculated on the postoperative tunnel radiographs. A statistical comparison was made of the lengths of the tunnel, the techniques used drilling and the femoral tunnel angles. The far anteromedial portal was used in 81 (49 %) cases and the transtibial technique in 83 (51 %) cases. The mean femoral tunnel length was 42 ± 6.4 mm and the mean femoral tunnel coronal angle was 41.1° ± 11.6. The tunnel angle in the transtibial technique was determined as significantly low compared to the far anteromedial portal technique (32.6°:49.8°) and the tunnel length was significantly longer (45.8:38.1 mm) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In the statistical analysis, it was found that a patient with a tunnel length of 41 mm and above had a 92.1 % likelihood of femoral tunnel angle below 45°. Femoral tunnel length can be used as a clue for intraoperative evaluation of the femoral tunnel position. If the femoral tunnel length is greater than 41 mm, the coronal plane orientation of the femoral tunnel will be improper and not at a desired position.
Journal of Trauma-injury Infection and Critical Care, May 1, 2009
Background: Acute shortening is reported to be an effective method for the treatment of open frac... more Background: Acute shortening is reported to be an effective method for the treatment of open fractures with bone and soft tissue defects. Little is known about primary skin closure with angulation to the side of the defect and distraction at the fracture site. Methods: We present a series of three cases treated for defective fractures of tibia by angular shortening and delayed gradual distraction with hinged circular external fixator. Two cases were type IIIB open fractures and one case was an infected nonunion. Bone and soft tissue defects were managed by adaptation of edges and primary skin closure with angulation to the side of the defect. Axial alignment was restored by gradual distraction after a 2 to 3 weeks interval. Residual limb length discrepancy was lengthened through a separate corticotomy in two cases. Results: Bone formation at both the fracture and corticotomy sites were sufficient to achieve union in all patients. Fixation time averaged 261 (182-392) days and average bone healing index was 42 days/cm. No further surgical intervention was necessary for soft tissue reconstruction after primary skin closure. Infection was eradicated in the case of infected nonunion. Conclusions: Angular compression to the side of the defect is a safe and reliable method of treatment for asymmetrical bone or soft tissue defects of tibia. It eliminates the need for complex soft tissue reconstruction procedures. Unnecessary debridement of bone is prevented by angular adaptation of edges. Definitive treatment of complex injuries is possible with a circular external fixator.
Journal of Arthroplasty, Apr 1, 2010
A new technique of femoral fixation that uses a transverse osteotomy for subtrochanteric shorteni... more A new technique of femoral fixation that uses a transverse osteotomy for subtrochanteric shortening and derotation in total hip arthroplasty for Crowe type 3 to 4 dysplasia of the hip is described. This series included 21 cases in 12 women and 2 men, with a mean age of 42.3 years. Follow-up averaged 41.2 months. Bone pegs prepared from the resected femoral segment were seated in the medullary canal around the stem for femoral fixation. Merle d'Aubigné scores for pain, motion, and walking improved from 2.9, 4.4, and 3.7 to 5.2, 5.4, and 5.5, respectively. Radiographic union was detected within 12 ± 3.4 (range, 6-24) weeks in all cases. Complications were early dislocation in 2 cases. This technique allows correction of anteversion, provides excellent rotational stability, and eliminates the need for additional osteosynthesis regardless of the stem design.
Archives of Orthopaedic and Trauma Surgery, May 14, 2009
Five adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by t... more Five adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by the Ilizarov method of distraction osteogenesis. A standard technique was applied in all patients. The average follow-up was 28 (range, 24-38) months. Preoperative carrying angle ranged from 12 degrees to 22 degrees of varus (average 16.6 degrees ) and postoperative carrying angle ranged from 10 degrees to 14 degrees of valgus (average, 11.6 degrees ) equalized to the contralateral side. The outcome was rated as excellent in all patients. No complication was observed, except a grade-2 pin-tract infection in two patients. Rigid fixation, early rehabilitation, precise correction, satisfactory cosmetic scars and functionally excellent results can be obtained with this method.
IFMBE proceedings, 2009
... Here qx, qy are the co-ordinates of the proximal bone center; rx, ry, rz are the distances be... more ... Here qx, qy are the co-ordinates of the proximal bone center; rx, ry, rz are the distances between the distal ring and distal bone centers along x,y,z axes respectively; all other quantities 0 0 0 0 0 0 ( , , , , ux uy uz vx vy vz eeeeee and unit vectors (e ,e ) un vn are ...
Acta Orthopaedica et Traumatologica Turcica, 2017
Objective: The present study assessed functional and radiographic outcomes of distraction osteoge... more Objective: The present study assessed functional and radiographic outcomes of distraction osteogenesis treatment of post-traumatic elbow deformities in children. Methods: Eight children were treated between 2008 and 2013 for post-traumatic elbow deformities using distraction osteogenesis. Mean age at time of operation was 10.9 years. Six patients had varus and 2 had valgus deformity. Magnitude of correction, fixator index, complications, carrying angle, and elbow range of motion were assessed. Functional results were graded according to protocol of Bellemore et al. Results: Mean follow-up was 43 months. Mean preoperative varus deformity in 6 patients was 29.2 and valgus deformity in 2 patients was 28.5. Preoperative flexion and extension of elbow were 123.8 and À10.6 , respectively. Mean carrying angle was 9 valgus at last follow-up. Mean flexion and extension were 134.4 and À6.0 , respectively. Change in carrying angle was statistically significant (p ¼ 0.002). There were 2 grade 1 pin tract infections and 1 diaphyseal fracture of humerus. Functional outcome was rated excellent in 7 patients and good in 1 patient. Conclusion: Ilizarov distraction osteogenesis is a valuable alternative in treatment of elbow deformities in children. The surgical technique is simple and correction is adjustable. Gradual correction prevents possible neurovascular complications and minimally invasive surgery produces less scarring. Compliance of patient and family is key factor in the success of the outcome.
Acta Orthopaedica et Traumatologica Turcica, 1997
... sistemlerinin mekanik performansı (Deneysel çalışma) Emre Toğrul(1), Mahir Gülşen(ı), Yaman S... more ... sistemlerinin mekanik performansı (Deneysel çalışma) Emre Toğrul(1), Mahir Gülşen(ı), Yaman Sarpel(l), Mehmet Çapa(3), Turgut Gülmez(4) ... Aksiyel kompresyonda S kg&#x27;dan başlayarak beşer kg&#x27;lık artış- Hizarovda Schanz vidalan 349 ii STANDAltTfRAMf. ...
Journal of Medical Devices-transactions of The Asme, Sep 11, 2006
The objective of this work is to set up, validate, and analyze a theoretical model of an external... more The objective of this work is to set up, validate, and analyze a theoretical model of an external fixator for its deformation characteristics in order to draw reliable conclusions relevant to the design and effective clinical implementation of such medical devices. External fixators are mechanical devices widely used in the treatment of fractured bones and correction of limb deformities. Lateral deformation at the fracture site is known to delay bone healing, and investigation of lateral deformation characteristics of such devices experiencing forces acting perpendicular to the bone axis is important from the standpoint of their design as well as their clinical effectiveness. A mathematical model of a three-dimensional (3D) unilateral fixator with multipin fragment attachments has been developed using Castigliano’s method. The relative lateral deformations of the fragment ends at the fracture site induced by loads applied perpendicular to bone axes are calculated with the model. The model has been subjected to experimental verification for a uniplanar unilateral external fixator under comparable conditions with the theory. It has been found out that the effects of fixator size, shape, and geometry on the level of relative lateral displacement of the fracture site are similar in both the theoretical and experimental models. Stiffness is a maximum if the force is applied in the same plane as the proximal pin plane. Placing the distal pin group at a 90deg position relative to the proximal pin plane has been observed to increase the stiffness about 10%. In loading directions perpendicular to proximal the pin plane, stiffness is minimum. The angle difference between the load direction and the resulting displacement direction follows a sinusoidal pattern with an amplitude of 10deg for loading angles in the 0–180deg range. Selecting the distance of proximal pins to the fracture site smaller than the distance of distal pins to the fracture site has been found to decrease relative lateral deformation. The model and the experiment have simultaneously demonstrated that lower values of effective pin lengths and higher values of pin connector lengths lead to higher stiffness. Increasing the number of pins also contributes to the higher values of fixator stiffness.
Case reports in orthopedics, 2013
RELATO DE CASO / CASE REPORT Pigmented villonodular synovitis of the thoracic spine: case report ... more RELATO DE CASO / CASE REPORT Pigmented villonodular synovitis of the thoracic spine: case report and review of the literature Sinovitis pigmentada vilonodular da coluna torácica: relato de caso e revisão da literatura Sinovitis vellonodular pigmentada de la columna torácica: informe de un caso y revisión de la literatura
Nigerian Journal of Clinical Practice, 2020
Aims: This study aims to investigate the effectiveness of transforaminal epidural steroid injecti... more Aims: This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. Methods: One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months. Results: Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). Conclusion: TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.