Serdar AKALIN - Academia.edu (original) (raw)
Papers by Serdar AKALIN
Acta Orthopaedica et Traumatologica Turcica, 1996
Servikal vertebral kolonun stabilitesi, yaşamsal işlevleri n devamı için mutlak şarttır. Eğer ins... more Servikal vertebral kolonun stabilitesi, yaşamsal işlevleri n devamı için mutlak şarttır. Eğer instabilite mev cutsa, cerrahi stabilizasyon genellikle tek çözümdür. Bu çalışmada, biri servikal tüberküloz, biri eozinofilik gra nüloma ve geri kalan 19'u servikal kmklı-çıkığı takiben gelişen, 21 servikal instabilite vakası değerlendirildi. Ortalama yaş 31.1 olup, kadm/erkek oram 11/10 idi. Ortalama takip süresi 22. 4±8. 6 ay idi klinik, radyolojik, kompüteri ze tomografi k ve manyetik rezonans incelemeleri yle servikal instabilite tespit edilen hastalann, preo peratif ortalama White stabilite skoru 9. 1 ±4.2 ve anteri or deplasman oram, ortalama %71.1 olup, tüm hasta larda germe testi poziti fti. Hastalann tamammda, anteri or deplasman % 100 düzeltildi ve pozitif germe testi ne gatif/eşti. Aynca ortalama stabilite skoru, 2.3±1.1'e düşürüldüğü belirlendi. Nörolojik defisiti olan 8 hastadan, 3'ünde düzelme saptamrken, 5'inde değişme olmadı. Bu veri ler i n lerde, anterior füzyon ve titanyum plak uygulaması ile stabilitenin kesinlikle sağlanabileceği, erken rehabilitas yon ve mobilizasyona izin veren rijit bir f i ksasyon Anahtar kelime/er: Servikal vertebra, spinal instabilite, instrümentasyon The results of anterior fusion and titanium p/ating in the treatment of subaxia/ cervica/ instabilities The stability of cervical vertebral column is provisional for vital functions. if there is an instability the only solution is surgical stabilization. This study consistes of one case of spinal tuberculosis, one case of eosinop hilic granuloma and nineteen cases of fracture-dis/ocation that caused instability at the cervical column. The mean age was 31.1 years with a female/male ratio of 11/10. The mean follow up was 22.4±8.6 months. The cervical instability was confirmed clinically and radiologically in addition to computerized tomographic and magnetic resonance imaging tests. The White score of stability was 9.1 ±4.2 and the mean anterior displace ment rate was 71.2% preoperatively while the stretching test was positive in all patients. Anterior displace ment was corrected 100% and the stretching test became negative af ter the operation. The stability score was found to be 2.3± 1. 7 postoperatively. Three of the eight patients with neurological deficit improved while fi ve of them remained unchanged. These findings concluded that anterior fusion and titanium plating provides ri gid fi xation, early rehabilitation and mobilization and definite stability in subaxial cervical instabilities.
Acta Orthopaedica et Traumatologica Turcica, 1998
Anterior debridement, strut grafting and instrumentation have an increasing popularity in the tre... more Anterior debridement, strut grafting and instrumentation have an increasing popularity in the treatment of tuberculosis of spine. Anterior fixation can be done either by a plate or a rod system. This study reports on the surgical results of 59 patients with Pott's disease that had anterior radical debridement and anterior fusion and anterior instrumentation with 5 years follow-up. Average age at the time of operation was 46.3 ± 13.5 years. Average follow-up was 84.6 ± 11.3 months. Local kyphosis was measured as the angle between the upper and lower end plates of the collapsed vertebrae preoperatively, postoperatively and at the last follow-up visit. Vertebral collapse, destruction, cold abscess, and canal compromise were assessed in MR images. The indication for surgery was either one of the deformity, instability or neurological compromise. Surgical treatment included anterior radical debridement followed by grafting with tricortical auto graft and anterior instrumentation at levels just above and below the diseased segment(s) with either plate (Sofamor-Danek, Z plate, Group A) or rod (Sofamor-Danek, CDH, Group B) systems. There were 23 patients in group A and 36 patients in group B. All patients had similar anti tuberculosis chemotherapy. Patients had similar rehabilitation program after the surgery. The deformity in the sagittal and the coronal plane was measured and presence of significant consolidation, along with the absence of implant failure or correction loss was considered as signs of fusion. The two groups were similar according to age (46.9±14.2 vs. 45.8±13.1), gender, average number of involved levels (1.8±0.5 vs. 1.6± 0.5), location of involved levels, severity of deformity (21.5°± 9.9º vs. 24.8°± 11.9º) and type of autografts (p>0.05 for all parameters). 39.1 % of patients in group A and 41.6 % of patients in group B had neurological compromise with improvement in majority at the end of follow-up. Deformities were corrected to 5.2°±5.7º in group A and 6.1°±6.8º in group B with no significant difference. At the time of latest follow-up there were 1.7°±2.0º correction loss in group A and 1.4°±1.9º in group B with no significant difference in between two groups (p>0.05). Overall, it was observed that, the addition of anterior instrumentation increased the rate of correction of the kyphotic deformity (78.5 ± 20.5 %), and was effective in maintaining it with an average İ. T. BENLİ et al. 168 loss of 1.5° ± 1.9°. Of the 24 (44.1 %) patients with neurological symptoms, 20 (83.3 %) had full and 4 (16.7 %) partial recoveries. There was no apparent pseudoarthrosis and implant failure in both groups and all patients demonstrated clinical improvement in tuberculosis infection without recurrences and reactivation. Four major complications occurred in the group A (major vessel complication: 3.4 %, secondary non-specific infection: 3.4 %). Disease reactivation was not seen with the employment of an aggressive chemotherapy regimen. It was concluded that anterior instrumentation is a safe and effective method in the treatment of tuberculosis spondylitis. There were no significant differences between the two instrumentation systems in terms of sagittal alignment reconstruction and fusion rate. In rod-screw systems, the disadvantages of scoliotic deformity correction through frontal plan in plate performing did not occur and it is though to have the advantage of long instrumentation in multiple level deformities.
As scoliotic curve is a rotational deformity, derotation maneuvre was used as the corrective fact... more As scoliotic curve is a rotational deformity, derotation maneuvre was used as the corrective factor, but recent studies demonstrated spinal imbalance and decompensation problems in patients treated with this method. This study evaluates 217 late onset idiopathic scoliosis patients surgically treated with third generation instrumentation (Texas Scotish Rite Hospital System-TSRH) from September 1991 to November 1996 with a minimum 2 years follow up. Preoperative and postoperative Cobb angles in the frontal plane and thoracic kyphosis and lumbar lordosis angles in the sagittal plane are measured. The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift (LT), shift of head (SH) and shift of stable vertebra (SS) in vertebral unit (VU). At final follow-up correction loss, infection and other complications were documented. Mean age of the patients was 14.8 ± 2.3 and mean follow up period 55.8 ± 29.5 months. When all the patients were included, preoperative mean Cobb angles of major curves in the frontal plane was 59.1° ± 20.7°. Major curves that were corrected by 34.8 ± 20.5 % in the bending radiograms were achieved by 58.9 ± 19.5 % correction postoperatively. At the last control, 7.3° ± 6.4° of correction loss was recorded in major curves in the frontal plane. Also postoperative kyphosis angle and lumbar lordosis angles were 31.4° ± 11.6° and 30.6° ± 10.9° respectively. Postoperatively, a statistically significant correction was obtained in LT, SH and SS values. None of the patients had complete balance (SH: 0 VU, SS: 0 VU) preoperatively. Only 39.2 % of the patients had clinically balanced curves (0 VU < SH < 0.5 VU and 0 VU < SS < 0.5 VU). Postoperatively, 47.9 % of the patients were found to be completely balanced, while 43.8 % had a balanced curve. Overall 91.7 % of the patients had a trunk balance after surgical intervention. The remaining 8.3 % imbalanced curve rate raised up to 16.6 % at final follow up, but the loss of correction rates in SS and SH values were found to be insignificant. The postoperative "imbalance" problem was mostly seen in Type II and Type IV curves. However, at final follow up, the imbalance problem due to overcorrection which became evident especially by "shift of head" to opposite side was seen in all types of curves. It is established that high correction rates can be obtained in scoliotic curves with third-generation instrumentation. No undue effects were observed in the uninstrumented lumbar curves. Thoracic sagittal contours of the hypokyphotic patients were improved. Use of this instrumentation system causes minimal imbalance problems and with proper preoperative planning high correction rates can be achieved.
Eighty-seven osteoporotic vertebral fractures of 82 patients were treated with balloon kyphoplast... more Eighty-seven osteoporotic vertebral fractures of 82 patients were treated with balloon kyphoplasty. Preoperative, postoperative and follow-up outcomes of functional impairment, pain scores and vertebral height restorations of the patients were recorded and evaluated statistically. Seventy-two of the patients were female (87.8%) and 10 (12.2%) were male. Mean age of all patients were 66.4 years. Preoperative mean Anterior Vertebral Body Height of 48.20±13.94 % and Middle Vertebral Body Height of 59.40±14.26 % were recorded as 79.91±9.50 % and 86.90±8.38 % respectively postoperatively and noted to be 73.26±8.59 % and 84.65±8.19 % at last controls respectively. The mean Oswestry Disability Index and Visual Analog Pain Scale also improved significantly. Local Kyphosis of all the patients were also evaluated and a significant improvement was noted postoperatively. The long term results of this study suggest that balloon kyphoplasty is an effective and safe treatment option in osteoporotic vertebral fractures and should be considered for functional improvement, pain relief and height restoration.
World Neurosurgery, 2021
BACKGROUND The choice of implants in neuromuscular scoliosis (NMS) surgery remains controversial.... more BACKGROUND The choice of implants in neuromuscular scoliosis (NMS) surgery remains controversial. Sublaminar polyester bands (SPBs) seem to be a promising alternative implant. The purpose of current study was to compare clinical and radiological results of posterior instrumentation and fusion using hybrid constructs versus only pedicle screws for NMS treatment. MATERIALS AND METHODS In 24 patients, pedicle screws were used in all segments, and 18 patients underwent hybrid fixation. Cobb angle, thoracic kyphosis, lumbar lordosis angles, and pelvic obliquity were compared before and immediately after surgery, at the last follow-up radiographs. Demographic, clinical information, duration of surgery, estimated blood loss (EBL), blood transfusion, and complications were compared between groups. Additionally, patients were assessed for pain with visual analog scale (VAS) and quality of life with short Form 36 and Oswestry scale. RESULTS Baseline characteristics of patients were similar except for EBL (p:0.002) and follow-up duration (p:0.004). The mean curve correction was 58.1% in hybrid group, and 67.6 % in screw group (p:0.07), and loss of correction was significantly lower in hybrid group (2.72±1.48° vs. 3.66±1.52°, p:0.049). Functional scores at final follow-up were equal in both groups (VAS p:0.865, Oswestry p:0.097 , SF-36 Physical p: 0.358, SF-36 Mental p:0.145). CONCLUSION SPBs might be a better fixation alternative at the apex of rigid spinal deformity in NMS. The deformity can be corrected with less blood loss and at a similar rate of correction, with similar rate complications compared to pedicle screws.
Turkish Journal of Clinics and Laboratory, 2021
Aim: The purpose of this study was to reveal mid-term outcomes by retrospectively investigating p... more Aim: The purpose of this study was to reveal mid-term outcomes by retrospectively investigating patients who underwent total knee arthroplasty with a posterior stabilized design (PS). Material and methods: The study included a total of 68 knees of 52 patients with completed follow-up data who underwent PS total knee arthroplasty due to a diagnosis of primary or secondary osteoarthritis. The 52 patients comprised 45 (86.5%) females and 7 (13.5%) males with a mean age of 65.2±9.32 years (range, 30-82 years). The American Knee Society criteria were adopted for assessment of patient knee scores and functional knee scores. The Total Knee Prosthesis Radiological Evaluation criteria were applied for radiological evaluation of the patients. Results: The mean follow-up period of the patients was 32.1 ± 9.85 months (range: 18-60 months) and the Knee Society Scores were 41.5 (range: 26-58) preoperatively, and 84.3 (range: 51-97) postoperatively. The mean preoperative and postoperative range of motion was 88.2º (range: 60º-100º), and 106.7º (range: 90º-120º), respectively. Two-stage revision surgery was applied to one patient due to deep infection. No cases of aseptic loosening were observed. Implant survivorship was observed as 98.8%, and excellent and good results according to the functional knee score were reported as 41.1%, and 32.3%, respectively. Conclusion: Positive patient outcomes were obtained with the use of PS total knee arthroplasty in patients with severe osteoarthritis and there was no evidence of significant implant survival loss in mid-term follow-up.
Mukopolisakkaridoz IVA (MPS IVA: Morquio sendromu) N-asetilgalaktozamin-6-sulfat sulfataz enzim e... more Mukopolisakkaridoz IVA (MPS IVA: Morquio sendromu) N-asetilgalaktozamin-6-sulfat sulfataz enzim eksikli¤inden kaynaklanan bir lizozomal depo hastal›¤›d›r. MPS IVA hastalar› do¤umda sa¤l›kl› gorunurler. Bu sendroma ozgun radyolojik de¤ifliklikler klinik belirti ve bulgulardan once gozlenirler. Hastalar›n co¤unda, ikinci veya ucuncu on y›lda, ilerlemifl eklem dejenerasyonu ortaya c›kar. Ara metabolitlerin artmas›na ba¤l› olarak eklem hiperlaksitesi belirgindir. Bu cal›flmada, proksimal yumuflak doku dizilim cerrahisi yap›larak tedavi edilen kronik patella c›k›kl›, kal›tsal cuceli¤i olan bir hasta sunulmufltur. Anahtar sozcukler: Do¤um defekti; kal›tsal cucelik; Morquio sendromu; mukopolisakkarid.
Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fracture... more Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures. Level of Evidence: Therapeutic, Level IV
Acta Orthopaedica et Traumatologica Turcica, 1993
Transplantation of a viable tissue is the best way of reconstructing a bone defect. In the recent... more Transplantation of a viable tissue is the best way of reconstructing a bone defect. In the recent years besides autogenous bone grafts which has high osteogenic potential and absent immunologic reactions, this pripciple has popularised the use of allografts with its advantages such as absence of donor site morbidity, less infection risk and blood loss, lowered anesthesia time and its mimmizing effect in postoperative discomfort. There has been an increased worldwide interest in bone banking. Studies in establishing a bone bank has been started at the 1 st Orthopaedics and Traumatology Clinic of social Security Ankara Hospital in July 1990, In this study early results of 10 patients in whom allografts were used in our clinic are reported Mean age was 23.1 (11-62) The palients were examined with clinic, radiologic and scintigraphic studies at the postoperative 3rd, 6th months and the 1 st year Various amounts of hyperactivity was observed in scintigraphies and also callus-fusion was r...
Acta Orthopaedica et Traumatologica Turcica, 1993
Scoliosis secondary to neuromuscular diseases are probably the former type of the defined spinal ... more Scoliosis secondary to neuromuscular diseases are probably the former type of the defined spinal deformities. In addition to systemic complications such as cardiopulmoner insufficiency due to thoracal and abdominal collaps and internal organ failures, scoliotic deformity can results with pelvic obliquity and funclional disability. Neuromuscular scoliosis is progressive even after skeletal maturity. Thus, surgical treatment is inevitable in prevention of probable complications and in correction on the deformity. In this study, 12 neuromuscuIar scoliotic patients due to poliomyelitis who were treated surgically with Cotrel Dubousset lnstrumentation in the 1st Orthopaedic and Traumatology Clinic of Ankara Social Security Hospital between August 1989 and March 1991 are examined. All of the patients were female. Mean age was 14.1 (13-18) years and mean follow-up period was 24.3 (14-32) months. All patients had C type scoliosis and 6 had regular pelvic tilt. Preoperatif mean Cobb angle wa...
Hong Kong Journal of Emergency Medicine, 2011
Posterior elbow dislocations complicated with brachial artery rupture are rare, especially in the... more Posterior elbow dislocations complicated with brachial artery rupture are rare, especially in the absence of an accompanying fracture. Severe acute ischaemia is not clearly evident in some cases and the diagnosis of arterial damage may not be realised because the collateral circulation around the elbow might mask signs of acute arterial disruption. We report a patient with brachial artery rupture due to closed posterior elbow dislocation. The diagnosis of arterial injury was delayed because the hand was well perfused and radial pulse was present at initial presentation. Our case emphasizes the need for repeated vascular examinations in elbow dislocations, moreover, hospitalisation and observation for at least 24 hours for further possible changes in the vascular status.
International Journal of Orthopedics and Rehabilitation, 2016
Purpose: Our study retrospectively evaluates the early results of the reconstruction of anterior ... more Purpose: Our study retrospectively evaluates the early results of the reconstruction of anterior cruciate ligament (ACL) defficiency by single tunnel–Dual bundle technique and quadruple autogenous hamstring tendon graft. Methods: Fourteen female and 46 male patients whom with chronic instability due to ACL deficiency were included in this study. The injury mechanism was sports related injury in 45 patients and in 15 patients the injury were other causes. All of the patients were treated with Single tunnel–Dual band technique and quadruple autogenous hamstring semitendinosus (ST) and gracilis (G) tendon graft. The patients were clinically evaluated with Lachman test, pivot-shift test, anterior drawer test, Mc Murray test, Lysholm activity scale and International Knee Documentation Comittee (IKDC) Questionaire preoperatively and postoperatively and the data were recorded. Results: The average follow-up was 34.08 months (45–26 months). Both of the menisci were intact in 22 of the patie...
International Journal of Morphology
ABSTRACT
Minerva Ortopedica e Traumatologica
Foot & ankle specialist, 2011
Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fracture... more Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures.
Acta orthopaedica et traumatologica turcica, 2003
We evaluated the types and the results of surgical treatment performed for congenital scoliosis. ... more We evaluated the types and the results of surgical treatment performed for congenital scoliosis. Forty-one patients (26 females, 15 males; mean age 12.8 years) with congenital scoliosis were included. The patients were classified according to the Winter's system. Transpedicular hemiepiphysiodesis, "egg shell" procedure, and anterior hemiarthrodesis and posterior convex fusion were performed in infantile (n=1) and juvenile (n=8) patients. In the adolescent (n=32) group, posterior in situ fusion was performed for rigid curves (n=15), posterior fusion after correction with posterior instrumentation for moderate curves (n=8), and posterior fusion and correction with posterior instrumentation after an anterior osteotomy for segmentation failures (n=6). Five patients with unincarcerated fully segmented hemivertebrae had anterior or posterior instrumentation following anterior-posterior hemivertebrectomy. The mean follow-up was 51.8 months (range 26 to 132 months). Fourteen p...
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2003
The conventional procedure in the treatment of vertebral tuberculosis is drainage of the abscess,... more The conventional procedure in the treatment of vertebral tuberculosis is drainage of the abscess, curettage of the devitalized vertebra and application of an antituberculous chemotherapy regimen. Posterior instrumentation results are encouraging in the prevention or treatment of late kyphosis; however, a second-stage operation is needed. Recently, posterolateral or transpedicular drainage without anterior drainage or posterior instrumentation following anterior drainage in the same session has become the preferred treatment, in order that kyphotic deformity can be avoided. Information on the use of anterior instrumentation along with radical debridement and fusion is scarce. This study reports on the surgical results of 63 patients with Pott's disease who underwent anterior radical debridement with anterior fusion and anterior instrumentation (23 patients with Z-plate and 40 patients with CDH system). Average age at the time of operation was 46.8+/-13.4 years. Average duration o...
Acta Orthopaedica et Traumatologica Turcica, 1996
Servikal vertebral kolonun stabilitesi, yaşamsal işlevleri n devamı için mutlak şarttır. Eğer ins... more Servikal vertebral kolonun stabilitesi, yaşamsal işlevleri n devamı için mutlak şarttır. Eğer instabilite mev cutsa, cerrahi stabilizasyon genellikle tek çözümdür. Bu çalışmada, biri servikal tüberküloz, biri eozinofilik gra nüloma ve geri kalan 19'u servikal kmklı-çıkığı takiben gelişen, 21 servikal instabilite vakası değerlendirildi. Ortalama yaş 31.1 olup, kadm/erkek oram 11/10 idi. Ortalama takip süresi 22. 4±8. 6 ay idi klinik, radyolojik, kompüteri ze tomografi k ve manyetik rezonans incelemeleri yle servikal instabilite tespit edilen hastalann, preo peratif ortalama White stabilite skoru 9. 1 ±4.2 ve anteri or deplasman oram, ortalama %71.1 olup, tüm hasta larda germe testi poziti fti. Hastalann tamammda, anteri or deplasman % 100 düzeltildi ve pozitif germe testi ne gatif/eşti. Aynca ortalama stabilite skoru, 2.3±1.1'e düşürüldüğü belirlendi. Nörolojik defisiti olan 8 hastadan, 3'ünde düzelme saptamrken, 5'inde değişme olmadı. Bu veri ler i n lerde, anterior füzyon ve titanyum plak uygulaması ile stabilitenin kesinlikle sağlanabileceği, erken rehabilitas yon ve mobilizasyona izin veren rijit bir f i ksasyon Anahtar kelime/er: Servikal vertebra, spinal instabilite, instrümentasyon The results of anterior fusion and titanium p/ating in the treatment of subaxia/ cervica/ instabilities The stability of cervical vertebral column is provisional for vital functions. if there is an instability the only solution is surgical stabilization. This study consistes of one case of spinal tuberculosis, one case of eosinop hilic granuloma and nineteen cases of fracture-dis/ocation that caused instability at the cervical column. The mean age was 31.1 years with a female/male ratio of 11/10. The mean follow up was 22.4±8.6 months. The cervical instability was confirmed clinically and radiologically in addition to computerized tomographic and magnetic resonance imaging tests. The White score of stability was 9.1 ±4.2 and the mean anterior displace ment rate was 71.2% preoperatively while the stretching test was positive in all patients. Anterior displace ment was corrected 100% and the stretching test became negative af ter the operation. The stability score was found to be 2.3± 1. 7 postoperatively. Three of the eight patients with neurological deficit improved while fi ve of them remained unchanged. These findings concluded that anterior fusion and titanium plating provides ri gid fi xation, early rehabilitation and mobilization and definite stability in subaxial cervical instabilities.
Acta Orthopaedica et Traumatologica Turcica, 1998
Anterior debridement, strut grafting and instrumentation have an increasing popularity in the tre... more Anterior debridement, strut grafting and instrumentation have an increasing popularity in the treatment of tuberculosis of spine. Anterior fixation can be done either by a plate or a rod system. This study reports on the surgical results of 59 patients with Pott's disease that had anterior radical debridement and anterior fusion and anterior instrumentation with 5 years follow-up. Average age at the time of operation was 46.3 ± 13.5 years. Average follow-up was 84.6 ± 11.3 months. Local kyphosis was measured as the angle between the upper and lower end plates of the collapsed vertebrae preoperatively, postoperatively and at the last follow-up visit. Vertebral collapse, destruction, cold abscess, and canal compromise were assessed in MR images. The indication for surgery was either one of the deformity, instability or neurological compromise. Surgical treatment included anterior radical debridement followed by grafting with tricortical auto graft and anterior instrumentation at levels just above and below the diseased segment(s) with either plate (Sofamor-Danek, Z plate, Group A) or rod (Sofamor-Danek, CDH, Group B) systems. There were 23 patients in group A and 36 patients in group B. All patients had similar anti tuberculosis chemotherapy. Patients had similar rehabilitation program after the surgery. The deformity in the sagittal and the coronal plane was measured and presence of significant consolidation, along with the absence of implant failure or correction loss was considered as signs of fusion. The two groups were similar according to age (46.9±14.2 vs. 45.8±13.1), gender, average number of involved levels (1.8±0.5 vs. 1.6± 0.5), location of involved levels, severity of deformity (21.5°± 9.9º vs. 24.8°± 11.9º) and type of autografts (p>0.05 for all parameters). 39.1 % of patients in group A and 41.6 % of patients in group B had neurological compromise with improvement in majority at the end of follow-up. Deformities were corrected to 5.2°±5.7º in group A and 6.1°±6.8º in group B with no significant difference. At the time of latest follow-up there were 1.7°±2.0º correction loss in group A and 1.4°±1.9º in group B with no significant difference in between two groups (p>0.05). Overall, it was observed that, the addition of anterior instrumentation increased the rate of correction of the kyphotic deformity (78.5 ± 20.5 %), and was effective in maintaining it with an average İ. T. BENLİ et al. 168 loss of 1.5° ± 1.9°. Of the 24 (44.1 %) patients with neurological symptoms, 20 (83.3 %) had full and 4 (16.7 %) partial recoveries. There was no apparent pseudoarthrosis and implant failure in both groups and all patients demonstrated clinical improvement in tuberculosis infection without recurrences and reactivation. Four major complications occurred in the group A (major vessel complication: 3.4 %, secondary non-specific infection: 3.4 %). Disease reactivation was not seen with the employment of an aggressive chemotherapy regimen. It was concluded that anterior instrumentation is a safe and effective method in the treatment of tuberculosis spondylitis. There were no significant differences between the two instrumentation systems in terms of sagittal alignment reconstruction and fusion rate. In rod-screw systems, the disadvantages of scoliotic deformity correction through frontal plan in plate performing did not occur and it is though to have the advantage of long instrumentation in multiple level deformities.
As scoliotic curve is a rotational deformity, derotation maneuvre was used as the corrective fact... more As scoliotic curve is a rotational deformity, derotation maneuvre was used as the corrective factor, but recent studies demonstrated spinal imbalance and decompensation problems in patients treated with this method. This study evaluates 217 late onset idiopathic scoliosis patients surgically treated with third generation instrumentation (Texas Scotish Rite Hospital System-TSRH) from September 1991 to November 1996 with a minimum 2 years follow up. Preoperative and postoperative Cobb angles in the frontal plane and thoracic kyphosis and lumbar lordosis angles in the sagittal plane are measured. The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift (LT), shift of head (SH) and shift of stable vertebra (SS) in vertebral unit (VU). At final follow-up correction loss, infection and other complications were documented. Mean age of the patients was 14.8 ± 2.3 and mean follow up period 55.8 ± 29.5 months. When all the patients were included, preoperative mean Cobb angles of major curves in the frontal plane was 59.1° ± 20.7°. Major curves that were corrected by 34.8 ± 20.5 % in the bending radiograms were achieved by 58.9 ± 19.5 % correction postoperatively. At the last control, 7.3° ± 6.4° of correction loss was recorded in major curves in the frontal plane. Also postoperative kyphosis angle and lumbar lordosis angles were 31.4° ± 11.6° and 30.6° ± 10.9° respectively. Postoperatively, a statistically significant correction was obtained in LT, SH and SS values. None of the patients had complete balance (SH: 0 VU, SS: 0 VU) preoperatively. Only 39.2 % of the patients had clinically balanced curves (0 VU < SH < 0.5 VU and 0 VU < SS < 0.5 VU). Postoperatively, 47.9 % of the patients were found to be completely balanced, while 43.8 % had a balanced curve. Overall 91.7 % of the patients had a trunk balance after surgical intervention. The remaining 8.3 % imbalanced curve rate raised up to 16.6 % at final follow up, but the loss of correction rates in SS and SH values were found to be insignificant. The postoperative "imbalance" problem was mostly seen in Type II and Type IV curves. However, at final follow up, the imbalance problem due to overcorrection which became evident especially by "shift of head" to opposite side was seen in all types of curves. It is established that high correction rates can be obtained in scoliotic curves with third-generation instrumentation. No undue effects were observed in the uninstrumented lumbar curves. Thoracic sagittal contours of the hypokyphotic patients were improved. Use of this instrumentation system causes minimal imbalance problems and with proper preoperative planning high correction rates can be achieved.
Eighty-seven osteoporotic vertebral fractures of 82 patients were treated with balloon kyphoplast... more Eighty-seven osteoporotic vertebral fractures of 82 patients were treated with balloon kyphoplasty. Preoperative, postoperative and follow-up outcomes of functional impairment, pain scores and vertebral height restorations of the patients were recorded and evaluated statistically. Seventy-two of the patients were female (87.8%) and 10 (12.2%) were male. Mean age of all patients were 66.4 years. Preoperative mean Anterior Vertebral Body Height of 48.20±13.94 % and Middle Vertebral Body Height of 59.40±14.26 % were recorded as 79.91±9.50 % and 86.90±8.38 % respectively postoperatively and noted to be 73.26±8.59 % and 84.65±8.19 % at last controls respectively. The mean Oswestry Disability Index and Visual Analog Pain Scale also improved significantly. Local Kyphosis of all the patients were also evaluated and a significant improvement was noted postoperatively. The long term results of this study suggest that balloon kyphoplasty is an effective and safe treatment option in osteoporotic vertebral fractures and should be considered for functional improvement, pain relief and height restoration.
World Neurosurgery, 2021
BACKGROUND The choice of implants in neuromuscular scoliosis (NMS) surgery remains controversial.... more BACKGROUND The choice of implants in neuromuscular scoliosis (NMS) surgery remains controversial. Sublaminar polyester bands (SPBs) seem to be a promising alternative implant. The purpose of current study was to compare clinical and radiological results of posterior instrumentation and fusion using hybrid constructs versus only pedicle screws for NMS treatment. MATERIALS AND METHODS In 24 patients, pedicle screws were used in all segments, and 18 patients underwent hybrid fixation. Cobb angle, thoracic kyphosis, lumbar lordosis angles, and pelvic obliquity were compared before and immediately after surgery, at the last follow-up radiographs. Demographic, clinical information, duration of surgery, estimated blood loss (EBL), blood transfusion, and complications were compared between groups. Additionally, patients were assessed for pain with visual analog scale (VAS) and quality of life with short Form 36 and Oswestry scale. RESULTS Baseline characteristics of patients were similar except for EBL (p:0.002) and follow-up duration (p:0.004). The mean curve correction was 58.1% in hybrid group, and 67.6 % in screw group (p:0.07), and loss of correction was significantly lower in hybrid group (2.72±1.48° vs. 3.66±1.52°, p:0.049). Functional scores at final follow-up were equal in both groups (VAS p:0.865, Oswestry p:0.097 , SF-36 Physical p: 0.358, SF-36 Mental p:0.145). CONCLUSION SPBs might be a better fixation alternative at the apex of rigid spinal deformity in NMS. The deformity can be corrected with less blood loss and at a similar rate of correction, with similar rate complications compared to pedicle screws.
Turkish Journal of Clinics and Laboratory, 2021
Aim: The purpose of this study was to reveal mid-term outcomes by retrospectively investigating p... more Aim: The purpose of this study was to reveal mid-term outcomes by retrospectively investigating patients who underwent total knee arthroplasty with a posterior stabilized design (PS). Material and methods: The study included a total of 68 knees of 52 patients with completed follow-up data who underwent PS total knee arthroplasty due to a diagnosis of primary or secondary osteoarthritis. The 52 patients comprised 45 (86.5%) females and 7 (13.5%) males with a mean age of 65.2±9.32 years (range, 30-82 years). The American Knee Society criteria were adopted for assessment of patient knee scores and functional knee scores. The Total Knee Prosthesis Radiological Evaluation criteria were applied for radiological evaluation of the patients. Results: The mean follow-up period of the patients was 32.1 ± 9.85 months (range: 18-60 months) and the Knee Society Scores were 41.5 (range: 26-58) preoperatively, and 84.3 (range: 51-97) postoperatively. The mean preoperative and postoperative range of motion was 88.2º (range: 60º-100º), and 106.7º (range: 90º-120º), respectively. Two-stage revision surgery was applied to one patient due to deep infection. No cases of aseptic loosening were observed. Implant survivorship was observed as 98.8%, and excellent and good results according to the functional knee score were reported as 41.1%, and 32.3%, respectively. Conclusion: Positive patient outcomes were obtained with the use of PS total knee arthroplasty in patients with severe osteoarthritis and there was no evidence of significant implant survival loss in mid-term follow-up.
Mukopolisakkaridoz IVA (MPS IVA: Morquio sendromu) N-asetilgalaktozamin-6-sulfat sulfataz enzim e... more Mukopolisakkaridoz IVA (MPS IVA: Morquio sendromu) N-asetilgalaktozamin-6-sulfat sulfataz enzim eksikli¤inden kaynaklanan bir lizozomal depo hastal›¤›d›r. MPS IVA hastalar› do¤umda sa¤l›kl› gorunurler. Bu sendroma ozgun radyolojik de¤ifliklikler klinik belirti ve bulgulardan once gozlenirler. Hastalar›n co¤unda, ikinci veya ucuncu on y›lda, ilerlemifl eklem dejenerasyonu ortaya c›kar. Ara metabolitlerin artmas›na ba¤l› olarak eklem hiperlaksitesi belirgindir. Bu cal›flmada, proksimal yumuflak doku dizilim cerrahisi yap›larak tedavi edilen kronik patella c›k›kl›, kal›tsal cuceli¤i olan bir hasta sunulmufltur. Anahtar sozcukler: Do¤um defekti; kal›tsal cucelik; Morquio sendromu; mukopolisakkarid.
Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fracture... more Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures. Level of Evidence: Therapeutic, Level IV
Acta Orthopaedica et Traumatologica Turcica, 1993
Transplantation of a viable tissue is the best way of reconstructing a bone defect. In the recent... more Transplantation of a viable tissue is the best way of reconstructing a bone defect. In the recent years besides autogenous bone grafts which has high osteogenic potential and absent immunologic reactions, this pripciple has popularised the use of allografts with its advantages such as absence of donor site morbidity, less infection risk and blood loss, lowered anesthesia time and its mimmizing effect in postoperative discomfort. There has been an increased worldwide interest in bone banking. Studies in establishing a bone bank has been started at the 1 st Orthopaedics and Traumatology Clinic of social Security Ankara Hospital in July 1990, In this study early results of 10 patients in whom allografts were used in our clinic are reported Mean age was 23.1 (11-62) The palients were examined with clinic, radiologic and scintigraphic studies at the postoperative 3rd, 6th months and the 1 st year Various amounts of hyperactivity was observed in scintigraphies and also callus-fusion was r...
Acta Orthopaedica et Traumatologica Turcica, 1993
Scoliosis secondary to neuromuscular diseases are probably the former type of the defined spinal ... more Scoliosis secondary to neuromuscular diseases are probably the former type of the defined spinal deformities. In addition to systemic complications such as cardiopulmoner insufficiency due to thoracal and abdominal collaps and internal organ failures, scoliotic deformity can results with pelvic obliquity and funclional disability. Neuromuscular scoliosis is progressive even after skeletal maturity. Thus, surgical treatment is inevitable in prevention of probable complications and in correction on the deformity. In this study, 12 neuromuscuIar scoliotic patients due to poliomyelitis who were treated surgically with Cotrel Dubousset lnstrumentation in the 1st Orthopaedic and Traumatology Clinic of Ankara Social Security Hospital between August 1989 and March 1991 are examined. All of the patients were female. Mean age was 14.1 (13-18) years and mean follow-up period was 24.3 (14-32) months. All patients had C type scoliosis and 6 had regular pelvic tilt. Preoperatif mean Cobb angle wa...
Hong Kong Journal of Emergency Medicine, 2011
Posterior elbow dislocations complicated with brachial artery rupture are rare, especially in the... more Posterior elbow dislocations complicated with brachial artery rupture are rare, especially in the absence of an accompanying fracture. Severe acute ischaemia is not clearly evident in some cases and the diagnosis of arterial damage may not be realised because the collateral circulation around the elbow might mask signs of acute arterial disruption. We report a patient with brachial artery rupture due to closed posterior elbow dislocation. The diagnosis of arterial injury was delayed because the hand was well perfused and radial pulse was present at initial presentation. Our case emphasizes the need for repeated vascular examinations in elbow dislocations, moreover, hospitalisation and observation for at least 24 hours for further possible changes in the vascular status.
International Journal of Orthopedics and Rehabilitation, 2016
Purpose: Our study retrospectively evaluates the early results of the reconstruction of anterior ... more Purpose: Our study retrospectively evaluates the early results of the reconstruction of anterior cruciate ligament (ACL) defficiency by single tunnel–Dual bundle technique and quadruple autogenous hamstring tendon graft. Methods: Fourteen female and 46 male patients whom with chronic instability due to ACL deficiency were included in this study. The injury mechanism was sports related injury in 45 patients and in 15 patients the injury were other causes. All of the patients were treated with Single tunnel–Dual band technique and quadruple autogenous hamstring semitendinosus (ST) and gracilis (G) tendon graft. The patients were clinically evaluated with Lachman test, pivot-shift test, anterior drawer test, Mc Murray test, Lysholm activity scale and International Knee Documentation Comittee (IKDC) Questionaire preoperatively and postoperatively and the data were recorded. Results: The average follow-up was 34.08 months (45–26 months). Both of the menisci were intact in 22 of the patie...
International Journal of Morphology
ABSTRACT
Minerva Ortopedica e Traumatologica
Foot & ankle specialist, 2011
Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fracture... more Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures.
Acta orthopaedica et traumatologica turcica, 2003
We evaluated the types and the results of surgical treatment performed for congenital scoliosis. ... more We evaluated the types and the results of surgical treatment performed for congenital scoliosis. Forty-one patients (26 females, 15 males; mean age 12.8 years) with congenital scoliosis were included. The patients were classified according to the Winter's system. Transpedicular hemiepiphysiodesis, "egg shell" procedure, and anterior hemiarthrodesis and posterior convex fusion were performed in infantile (n=1) and juvenile (n=8) patients. In the adolescent (n=32) group, posterior in situ fusion was performed for rigid curves (n=15), posterior fusion after correction with posterior instrumentation for moderate curves (n=8), and posterior fusion and correction with posterior instrumentation after an anterior osteotomy for segmentation failures (n=6). Five patients with unincarcerated fully segmented hemivertebrae had anterior or posterior instrumentation following anterior-posterior hemivertebrectomy. The mean follow-up was 51.8 months (range 26 to 132 months). Fourteen p...
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2003
The conventional procedure in the treatment of vertebral tuberculosis is drainage of the abscess,... more The conventional procedure in the treatment of vertebral tuberculosis is drainage of the abscess, curettage of the devitalized vertebra and application of an antituberculous chemotherapy regimen. Posterior instrumentation results are encouraging in the prevention or treatment of late kyphosis; however, a second-stage operation is needed. Recently, posterolateral or transpedicular drainage without anterior drainage or posterior instrumentation following anterior drainage in the same session has become the preferred treatment, in order that kyphotic deformity can be avoided. Information on the use of anterior instrumentation along with radical debridement and fusion is scarce. This study reports on the surgical results of 63 patients with Pott's disease who underwent anterior radical debridement with anterior fusion and anterior instrumentation (23 patients with Z-plate and 40 patients with CDH system). Average age at the time of operation was 46.8+/-13.4 years. Average duration o...