kamil cagri kose - Academia.edu (original) (raw)
Papers by kamil cagri kose
Amac: AO tip A humerus saft kiriklarinda konservatif tedavi sonuclari ve bu tedaviye hasta uyumu ... more Amac: AO tip A humerus saft kiriklarinda konservatif tedavi sonuclari ve bu tedaviye hasta uyumu degerlendirildi. Calisma plani: Retrospektif olarak iki merkezde izlenen humerus cisim kirikli 20 hastada konservatif tedavi sonuclarini radyolojik ve klinik olarak degerlendirdik. Bulgular: 19 hastada (%95) ortalama 6,7 hafta sonrasinda radyolojik olarak cok iyi kaynama tespit edildi. 1 hasta(%5) kaynamama nedeniyle ameliyat edildi. 2 hastada reduksiyon sonrasi radial sinir paralizisi gelisti ancak konservatif takip edildiler. 4 hafta rehabilitasyon sonrasi ortalama dirsek fleksiyonu 138 dereceydi ve ekstansiyon kisitliligi yoktu. Sonuc: AO tip A humerus saft kiriklarinin mutlak cerrahi gerektiren durumlar disinda konservatif metodlarla cok iyi kaynadigi ayrica konservatif tedavinin dusuk maliyetli oldugunu ve hasta memnuniyetinin yuksek oldugu tespit ettik
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2013
To compare only partial matrixectomy and combination techniques (partial matrixectomy + phenol ap... more To compare only partial matrixectomy and combination techniques (partial matrixectomy + phenol application) in the treatment of patients with an ingrown toenail in terms of recurrence, residual pain level and time of return to daily activities. The study included 118 patients with moderately ingrown toenails who were unresponsive to conservative treatment together with severely ingrown toenail patients. Of these patients, 76 cases were treated with a partial matrixectomy technique and 42 patients received combination treatment. Patients having nail infection received preoperative oral antibiotics. Of 118 patients, 87 were males and 31 were females. The disease relapsed in seven (9.2%) of the patients treated with the partial matrixectomy technique, and in two (4.8%) patients from the combination treatment group (p=0.5). No statistically significant difference was found between the groups in terms of return time to daily activities (p=0.5) nor in terms of residual pain (p=0.7). Treat...
Abant Medical Journal, 2013
Amaç: Skolyoz 3 boyutlu bir deformitesidir. Orta ve hafif dereceli deformitelerde ortez kullanımı... more Amaç: Skolyoz 3 boyutlu bir deformitesidir. Orta ve hafif dereceli deformitelerde ortez kullanımı günümüzde en yaygın uygulanan tedavi modellerinden biridir. Ortezin kullanım ve etkinliği hala tartışılmaktadır. Günümüzde CAD /CAM ve bilgisayarlı biyomekanik simulasyon teknolojilerindeki gelişmelerle birlikte endüstriyel yeni jenerasyon ortezlerle deformitenin optimal biyomekanik etkinlik sağlanarak tedavisine olanak sağlanmıştır. Bu çalışmanın amacı adolesan idiyopatik skolyozon konservatif tedavisinde 2 farklı ortez dizayn tekniğinin etkinliklerinin karşılaştırılmasıdır. Yöntem: Çalışmaya retrospektif olarak takipleri eksiksiz olan 28 (22 kadın, 6 erkek, ortalama yaş 15.8) skolyozlu hasta dahil edildi. Hastalar 2 gruba ayrıldı. Birinci grup: Standart dizayn yöntemleri kullanılarak hazırlanan TLSO tipi kullanarak tedavi edilen 16 hastadan oluştu. İkinci grup: diazyn ve üretim aşamasının bireysel geometrinin biyomekanik olarak 3 boyutlu sonlu elemanlar modeli ve CAD/CAM yazılımları (Rodin4®) ile gerçekleştirildiği ortezleri kullanılan 12 hastadan oluştu. Hastaların başlangıç ve 6. ay takiplerinde uzun kaset ayakta röntgenleri çekilerek cobb's açıları ölçüldü. Bulgular: Altı ay sonunda Birinci grupta torakal-lomber eğriliklerdeki cobb's açısındaki düzelmeler 18%-22% iken, İkinci grupta 29%-42% (p <0,05) olarak izlendi. İkinci grupta cobb's açılarında ve hasta komforunda belirgin olarak daha iyi sonuçlar izlendi. Sonuç: Bu ilk sonuçlar yeni jenerasyon ortezlerin skolyozun konservatif tedavsinde daha etkili olabileceğini düşündürmektedir. Bu yöntemin ortez biyomekaniğini anlamamıza ve geliştirmemize yön vereceğine inanmaktayız. Objective: Scoliosis is a 3-dimensional deformity. Today, the use of orthesis for medium and light degree of deformities is one of the most widely applied treatment models. There are many question marks regarding the application of the best orthesis. The use and effectiveness of orthesis has still been discussed. Today, with industrial new generation orthesis in addition to the developments in CAD/CAM and computerized biomechanical simulation technologies, the treatment of deformity has become possible by providing optimal biomechanical efficiency. The aim of this study is to compare effectiveness of two different orthesis design technique in conservative treatment of adolescent idiopathic scoliosis. Method: The study included 28 patients with scoliosis (22 females and 6 males, mean age 15.8) whose follow-up was retrospectively complete for the study. Patients were divided into 2 groups. The first group: It was consisted of 16 patients who were treated with TLSO type prepared by using the standard design methods. Second group: It was consisted of 12 patients for whom orthesis which were carried out with 3-dimensional finite element model as biomechanics of the individual geometry in design and production process and CAD/CAM software (Rodin4®) were used. At the beginning and sixth month follow-up of patients, their Cobb's angles were measured by taking a standing x-ray of them with long cassette. Results: At the end of six months,while improvements at Cobb's angle in thoracic-lumbar deviousness in the first group were 18%-22%,in the second group,they were observed as 29%-42% (p <0.05). The second group of cobb's angles and patient comfort showed significantly better results. Conclusion: These first results suggests that new generation orthesis can be more effective on the conservative treatment of scoliosis. We believe that this method will give us direction to understand and improve the orthesis biomechanics.
Advances in Orthopedics, 2014
A cadaver study aims to determine the mechanisms of medial pedicle wall violation after a correct... more A cadaver study aims to determine the mechanisms of medial pedicle wall violation after a correct cannulation of the pedicle. The study presents finding out the effect of insertion angle and insertion force on medial wall violation. We used 100 lumbar pedicles of cadavers. Special wooden blocks were produced to simulate a fixed angle fault after a correct pedicle cannulation. Pedicles were divided into 4 groups: 10-degree free drive (group 10), 15-degree free drive (group 15), 10-degree push drive (group 10P), and 15-degree push drive (group 15P). After insertion of pedicle screws, laminectomies were done and the pedicles were evaluated from the inside. Pedicle complications were more in group 10P than group 10 (P=0.009). Medial wall fracture (P=0.002) and canal penetration were more in group 15P than group 15 (P=0.001). Groups 10P and 15P were similar regarding medial wall fractures but canal penetration was significantly higher in group 15P (P=0.001). Medial wall breaches can happ...
BMC Surgery, 2014
Background: The prevalence of postoperative wound infection in patients with neuromuscular scolio... more Background: The prevalence of postoperative wound infection in patients with neuromuscular scoliosis surgery is significantly higher than that in patients with other spinal surgery. Hyperbaric oxygen has been used as a supplement to treat postsurgical infections. Our aim was to determine beneficiary effects of hyperbaric oxygen treatment in terms of prevention of postoperative deep infection in this specific group of patients in a retrospective study. Methods: Forty two neuromuscular scoliosis cases, operated between 2006-2011 were retrospectively reviewed. Patients who had presence of scoliosis and/or kyphosis in addition to cerebral palsy or myelomeningocele, postoperative follow-up >1 year and posterior only surgery were the subjects of this study. Eighteen patients formed the Hyperbaric oxygen prophylaxis (P-HBO) group and 24, the control group. The P-HBO group received 30 sessions of HBO and standard antibiotic prophylaxis postoperative, and the control group (received standard antibiotic prophylaxis). Results: In the P-HBO group of 18 patients, the etiology was cerebral palsy in 13 and myelomeningocele in 5 cases with a mean age of 16.7 (11-27 yrs). The average follow-up was 20.4 months (12-36mo). The etiology of patients in the control group was cerebral palsy in 17, and myelomeningocele in 7 cases. The average age was 15.3 years (8-32 yrs). The average follow-up was 38.7 months (18-66mo). The overall incidence of infection in the whole study group was 11.9% (5/42). The infection rate in the P-HBO and the control group were 5.5% (1/18), and 16.6% (4/24) respectively. The use of HBO was found to significantly decrease the incidence of postoperative infections in neuromuscular scoliosis patients. Conclusion: In this study we found that hyperbaric oxygen has a possibility to reduce the rate of post-surgical deep infections in complex spine deformity in high risk neuromuscular patients.
Sakarya Medical Journal, 2011
Aim: To evaluate the clinical outcomes of proximal femoral nail and hemiarthroplasty in terms of ... more Aim: To evaluate the clinical outcomes of proximal femoral nail and hemiarthroplasty in terms of functional results, morbidity and complications in patients over 70 years old who had unstable intertrochanteric femur fractures. Material and Methods: Twety five patients operated between 2007-2011 in three institutions were included in this study. Twelve underwent PFN fixation and 13 had hemiarthroplasty. The mean follow-up was 23 months. There were 14 men and 121 women. Both groups were compared in terms of operation time, blood loss, early and late complications, length of hospital stay (LOS) and Haris hip scores. Findings: Operation time was less in the hemiarthroplasty group but the blood loss was lower in the PFN group. (p<0.05) LOS was similar in both groups. (p>0.05). The only early PFN complication was fixation loss. The late complication in the hemiarthroplasty group was osteolysis. The Harris hip scores were better in favor of the hemiarthroplasty group. Conclusion: PFN fixation without anatomic reduction causes more complications and secondary operations in this population. Anatomically reduced PFN fixation and hemiarthroplasty gives comparable clinical and functional results.
Orthopedic Reviews, 2009
Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in ... more Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in children due to vaccinations and injections. Herein we report a case of post injection gluteal fibrosis that had undergone two unsuccessful lumbar discectomies to treat the symptoms of this disease. A 45 years old male patient was consulted to our clinic from the department of neurochirurgy with complaints of bilateral hip pain. The patient was operated on for lumbar disc herniation in L4-5 level twice but his complaints had not resolved. A third operation including L4-5 instrumentation and fusion was planned. His examination revealed nodules in his both hips. His x-rays, MRI and blood tests were normal. He underwent bilateral gluteal fascia excision and his complaints resolved totally. The clinical diagnosis of post-injection fibrosis is problematic, due to the difficulty of determining the etiology. In many patients the diagnosis comes from a history of injection. Pain in the gluteal r...
Sakarya Medical Journal, 2014
Dicle Medical Journal / Dicle Tip Dergisi, 2012
Objectives: This study designed to evaluate the results of treatment, closed reduction and percut... more Objectives: This study designed to evaluate the results of treatment, closed reduction and percutaneous wires, of the distal radius fractures in children. Materials and methods: A retrospective analysis was carried out in children aged between 5-15 years who presented with a displaced fracture of the distal radius to our hospital. They were initially treated with closed reduction and cast immobilization. If the fractures redisplaced treated by percutaneous Kirschner (K-) wire with scope under a general anaesthesia. Results: Totally 104 patients, who have distal radius fractures were treated by closed reduction and immobilization in a plaster cast. 13 patient who have distal radius fractures were treated by closed reduction under general anaesthesia and fixed by percutaneous Kirschner (K-) wire. Patients with impaired the alignment of the fracture in late period were usually completely displaced fractures. (n=5, 4,3%), in early period, completely displaced fractures (n=5, 4,3%) are superior to partial displaced fractures (n=2, 1,7%). Conclusion: In our study, when children with distal radius fracture first come, they were treated by closed reduction and immobilization in a plaster cast. We thought that in redisplaced fractures patients were suitable for the closed reduction with percutaneous wire treatment.
Acta Medica Anatolia, 2014
A 4.5 year old congenitally paraplegic female patient who has congenital meningomyelocele, sittin... more A 4.5 year old congenitally paraplegic female patient who has congenital meningomyelocele, sitting imbalance and a 10x15 cm decubitus ulcer on her lumber region because of the lumber kyphosis. After surgery she gained the sitting balance postoperatively. During postoperative rehabilitation that applied to the patient without prediction of low bone quality, patient had femur fracture twice in a short period. In this case we especially aimed to emphasize this fracture complications should be in our mind in these groups of patients.
The Tohoku Journal of Experimental Medicine, 2007
Avocado and soya unsaponifiables (ASU) are plant extracts used as a slow-acting antiarthritic age... more Avocado and soya unsaponifiables (ASU) are plant extracts used as a slow-acting antiarthritic agent. ASU stimulate the synthesis of matrix components by chondrocytes, probably by increasing the production of transforming growth factor-β (TGF-β). TGF-β is expressed by chondrocytes and osteoblasts and is present in cartilage matrix. This study investigates the effect of ASU treatment on the levels of two isoforms of TGFβ , TGF-β 1 and TGF-β 2 , in the knee joint fluid using a canine model. Twenty-four outbred dogs were divided into three groups. The control animals were given a normal diet, while the treated animals were given 300 mg ASU every three days or every day. Joint fluid samples were obtained prior to treatment, and at the end of every month (up to three months). TGF-β 1 and TGF-β 2 levels were measured using a quantitative sandwich enzyme immunoassay technique. ASU treatment caused an increase in TGF-β 1 and TGF-β 2 levels in the joint fluid when compared to controls. The different doses did not cause a significant difference in joint fluid TGF levels. TGF-β 1 levels in the treated animals reached maximum values at the end of the second month and then decreased after the third month, while TGF-β 2 levels showed a marginal increase during the first two months, followed by a marked increase at the end of the third month. In conclusion, ASU increased both TGF-β 1 and TGF-β 2 levels in knee joint fluid. Avocado/soya unsaponifiables; soybean; transforming growth factor (TGF); joint fluid; canine
The Spine Journal, 2014
BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) is a complex threedimensional (3D) defo... more BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) is a complex threedimensional (3D) deformity of the spine involving deviations in the frontal plane, modifications of the sagittal profile, and rotations in the transverse plane. Although Lenke classification system is based on 2D radiographs and includes sagittal thoracic and coronal lumbar modifiers, Lenke et al. suggested inclusion of axial thoracic and lumbar modifiers in the analysis. PURPOSE: To analyze axial plane of Lenke 1A curves to identify curve characteristics. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: Seventy patients (49 women, 21 men) with Lenke Type 1A idiopathic scoliosis were analyzed. OUTCOME MEASURES: Coronal, sagittal, and axial parameters were measured from plain radiographs that were obtained at initial medical examination of the patients. METHODS: Coronal and sagittal plane and whole spine segmental vertebra rotations from thoracic 1 to lumbar 5 were evaluated in 70 AIS patients with Lenke 1A curves by using Drerup method. Three different subgroups were identified according to magnitude and direction of lower end vertebra (LEV) rotation. RESULTS: In Group 1 (Lenke 1A1), the direction of LEV rotation was same with other vertebrae in the main curve and the magnitude of the LEV rotation was less than À0.5. In Group 2 (Lenke 1A2), the rotation of LEV was between À0.5 and 0.5 and so was accepted as neutral. In Group 3 (Lenke 1A3), the rotation of LEV had opposite direction with vertebrae in the main curve and the magnitude of LEV rotation was more than 0.5. The mean thoracic Cobb angle of patients with Lenke 1A idiopathic scoliosis was 51.1 (range 37-80), whereas the mean lumbar Cobb angle was 16.4 (range 0-32). The mean angle of trunk rotation of the patients was 5.7 (range 1-16). In terms of maximum thoracic vertebra rotation, the mean rotation angle of Lenke 1A idiopathic curves was À18.9 (range À(9.8-44.7)). The mean maximum lumbar vertebra rotation was 4.5 (range À7.2 to 15.1). CONCLUSIONS: Addition of axial plane analysis to conventional coronal and sagittal evaluations in patients with Lenke 1A curves may reveal inherent structural differences that are not apparent in single planar radiographic assessments and may necessitate a different surgical strategy.
Spine, 2014
A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of... more A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of the cervical spine in patients with muscular dystrophy presenting clinically with debilitating hyperlordosis is described, and 3 cases are reported. To describe a new surgical technique with emphasis on the clinical results and the effect of osteotomy on sagittal balance, gaze angle, and spinopelvic parameters. Previous reports of cervical osteotomy essentially have described opening wedge (extension osteotomy) for correction of severe flexion deformities. To the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge, C7-T1 closing wedge osteotomy to correct hyperextension deformity due to muscular dystrophy in the cervical spine has not been described previously. Three male patients aged 16, 16, and 21 years presented with cervical hyperlordosis due to Becker muscular dystrophy. There was upward deviation of forward gaze in all patients. Anterior closing wedge (bone-disc-bone) osteotomy of C7-T1 was performed followed with a posterior release correction and instrumented stabilization. The chin-brow angle was visualized with the aid of fluoroscopy during the operation. After closure and posterior fixation, patient was turned supine again and the osteotomy site was grafted and fixed with a plate to further strengthen the construct and to prevent any translation. The gaze angles and both sitting and standing postures of the patients markedly improved. There was documented fusion at the osteotomy sites. The patients were free of complaints at the last follow-up. Bone-disc-bone closing wedge osteotomy done at C7-T1 level is a technically demanding procedure but results in significant acute clinical and radiological improvement in patients with hyperextension deformity of the cervical spine. 4.
Journal of Diabetes and its Complications, 2007
We sought to evaluate the effects of diabetes on the physical properties of the patellar and quad... more We sought to evaluate the effects of diabetes on the physical properties of the patellar and quadriceps tendons using radiological techniques. Twenty-seven diabetic and 34 nondiabetic patients with primary osteoarthritis of the right knee were studied. All patients had anteroposterior and lateral knee radiographs. The lengths of the patella and the patellar tendon were measured. The width and thickness of the patellar tendon were determined by ultrasound (US) examination at midpoint. The increase in the thickness of the patellar tendon sheath was graded qualitatively. The length of the quadriceps and patellar tendons, and the thickness and width of tendons in midlength were measured by magnetic resonance imaging (MRI). Buckling of tendons and increase in intensities were also evaluated. The mean age in the diabetic group was 57.6F10.1 years, and the mean age in the control group was 52.6F9.1 years. The mean duration of diabetes was 104.1F67.1 months. X-ray, US, and MRI measurements did not reveal any differences between the two groups. Quadriceps buckling was more prevalent in diabetic patients (P=.025). In both groups, the width of the patellar tendon was greater in men than in women (P=.001). In conclusion, we found no significant structural changes in the patellar and quadriceps tendons in diabetic patients in midterm. On MRI examination, the quadriceps tendons had more buckling in diabetic patients.
International Orthopaedics, 2006
Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method follow... more Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method following major surgical operations, such as total knee arthroplasty (TKA). The systemic effects of shed blood are still unclear. We studied the effect of residual substances in the retransfused shed blood, on lung perfusion after TKA. Fifteen unilateral and one bilateral TKAs were performed with autotransfusion (the study group) and 15 unilateral and three bilateral TKAs were performed in a control group. Lung Xrays, arterial blood gases (ABG), D-dimer values, and lung perfusion scintigraphies were performed preoperatively and postoperatively. A mean of 300.0±335.6 ml of bank blood
International Orthopaedics, 2007
![Research paper thumbnail of Re: Coccygectomy for coccygodynia: do we really have to wait? [Injury 2007; 38(10):1183–8]](https://attachments.academia-assets.com/89991098/thumbnails/1.jpg)
](Injury, 2008
Reply to the letter on ''Estimating femoral nail length in bilateral comminuted fractures using f... more Reply to the letter on ''Estimating femoral nail length in bilateral comminuted fractures using fibular and femoral head referencing'' [Injury 2007; 38(8):984-7] Sir, We appreciated the comments of Gajula et al. on our paper that provides a practical formula on
Foot & Ankle International, 2008
Lesions of the talar dome or tumors within the talar body may require an open approach with media... more Lesions of the talar dome or tumors within the talar body may require an open approach with medial or lateral malleolar osteotomies. The aim of this study was to evaluate the possibility and feasibility of a new minimally invasive approach without osteotomy, using the talonavicular joint (TJ) as the entry portal for lesions of the talar body. Nine cadaveric feet were used for this study. Using the TJ and a 5-mm skin incision we aimed to reach the superolateral, superomedial, inferolateral and inferomedial corners of the talar body under fluoroscopy. A 2-mm Kirshner wire and a 4-mm cannulated drill bit were used to reach the desired target area and an angled curette was used for curettage after reaching the target. The proximity of vascular structures to the entry portal was noted. The talar and navicular joint surfaces were checked for any damage. The articular areas of the talar heads and the defect areas were measured. All 4 targets and even the posterior talus could be reached by this approach. The nearest neurovascular structures were the saphenous vein and the saphenous nerve. The navicular cartilage was not damaged in any specimen. The talar defect area corresponded to only 3.3% of the talar head cartilaginous area. The TJ approach can be used to reach lesions in all regions of the talar body without the need for an osteotomy. A mini-incision may be used to retract the saphenous nerve and vein. Damage to the talar head cartilage is minimal with this approach which requires no special equipments. This study shows that talar dome lesions can be reached with a minimally invasive method.
European Spine Journal, 2009
Amac: AO tip A humerus saft kiriklarinda konservatif tedavi sonuclari ve bu tedaviye hasta uyumu ... more Amac: AO tip A humerus saft kiriklarinda konservatif tedavi sonuclari ve bu tedaviye hasta uyumu degerlendirildi. Calisma plani: Retrospektif olarak iki merkezde izlenen humerus cisim kirikli 20 hastada konservatif tedavi sonuclarini radyolojik ve klinik olarak degerlendirdik. Bulgular: 19 hastada (%95) ortalama 6,7 hafta sonrasinda radyolojik olarak cok iyi kaynama tespit edildi. 1 hasta(%5) kaynamama nedeniyle ameliyat edildi. 2 hastada reduksiyon sonrasi radial sinir paralizisi gelisti ancak konservatif takip edildiler. 4 hafta rehabilitasyon sonrasi ortalama dirsek fleksiyonu 138 dereceydi ve ekstansiyon kisitliligi yoktu. Sonuc: AO tip A humerus saft kiriklarinin mutlak cerrahi gerektiren durumlar disinda konservatif metodlarla cok iyi kaynadigi ayrica konservatif tedavinin dusuk maliyetli oldugunu ve hasta memnuniyetinin yuksek oldugu tespit ettik
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2013
To compare only partial matrixectomy and combination techniques (partial matrixectomy + phenol ap... more To compare only partial matrixectomy and combination techniques (partial matrixectomy + phenol application) in the treatment of patients with an ingrown toenail in terms of recurrence, residual pain level and time of return to daily activities. The study included 118 patients with moderately ingrown toenails who were unresponsive to conservative treatment together with severely ingrown toenail patients. Of these patients, 76 cases were treated with a partial matrixectomy technique and 42 patients received combination treatment. Patients having nail infection received preoperative oral antibiotics. Of 118 patients, 87 were males and 31 were females. The disease relapsed in seven (9.2%) of the patients treated with the partial matrixectomy technique, and in two (4.8%) patients from the combination treatment group (p=0.5). No statistically significant difference was found between the groups in terms of return time to daily activities (p=0.5) nor in terms of residual pain (p=0.7). Treat...
Abant Medical Journal, 2013
Amaç: Skolyoz 3 boyutlu bir deformitesidir. Orta ve hafif dereceli deformitelerde ortez kullanımı... more Amaç: Skolyoz 3 boyutlu bir deformitesidir. Orta ve hafif dereceli deformitelerde ortez kullanımı günümüzde en yaygın uygulanan tedavi modellerinden biridir. Ortezin kullanım ve etkinliği hala tartışılmaktadır. Günümüzde CAD /CAM ve bilgisayarlı biyomekanik simulasyon teknolojilerindeki gelişmelerle birlikte endüstriyel yeni jenerasyon ortezlerle deformitenin optimal biyomekanik etkinlik sağlanarak tedavisine olanak sağlanmıştır. Bu çalışmanın amacı adolesan idiyopatik skolyozon konservatif tedavisinde 2 farklı ortez dizayn tekniğinin etkinliklerinin karşılaştırılmasıdır. Yöntem: Çalışmaya retrospektif olarak takipleri eksiksiz olan 28 (22 kadın, 6 erkek, ortalama yaş 15.8) skolyozlu hasta dahil edildi. Hastalar 2 gruba ayrıldı. Birinci grup: Standart dizayn yöntemleri kullanılarak hazırlanan TLSO tipi kullanarak tedavi edilen 16 hastadan oluştu. İkinci grup: diazyn ve üretim aşamasının bireysel geometrinin biyomekanik olarak 3 boyutlu sonlu elemanlar modeli ve CAD/CAM yazılımları (Rodin4®) ile gerçekleştirildiği ortezleri kullanılan 12 hastadan oluştu. Hastaların başlangıç ve 6. ay takiplerinde uzun kaset ayakta röntgenleri çekilerek cobb's açıları ölçüldü. Bulgular: Altı ay sonunda Birinci grupta torakal-lomber eğriliklerdeki cobb's açısındaki düzelmeler 18%-22% iken, İkinci grupta 29%-42% (p <0,05) olarak izlendi. İkinci grupta cobb's açılarında ve hasta komforunda belirgin olarak daha iyi sonuçlar izlendi. Sonuç: Bu ilk sonuçlar yeni jenerasyon ortezlerin skolyozun konservatif tedavsinde daha etkili olabileceğini düşündürmektedir. Bu yöntemin ortez biyomekaniğini anlamamıza ve geliştirmemize yön vereceğine inanmaktayız. Objective: Scoliosis is a 3-dimensional deformity. Today, the use of orthesis for medium and light degree of deformities is one of the most widely applied treatment models. There are many question marks regarding the application of the best orthesis. The use and effectiveness of orthesis has still been discussed. Today, with industrial new generation orthesis in addition to the developments in CAD/CAM and computerized biomechanical simulation technologies, the treatment of deformity has become possible by providing optimal biomechanical efficiency. The aim of this study is to compare effectiveness of two different orthesis design technique in conservative treatment of adolescent idiopathic scoliosis. Method: The study included 28 patients with scoliosis (22 females and 6 males, mean age 15.8) whose follow-up was retrospectively complete for the study. Patients were divided into 2 groups. The first group: It was consisted of 16 patients who were treated with TLSO type prepared by using the standard design methods. Second group: It was consisted of 12 patients for whom orthesis which were carried out with 3-dimensional finite element model as biomechanics of the individual geometry in design and production process and CAD/CAM software (Rodin4®) were used. At the beginning and sixth month follow-up of patients, their Cobb's angles were measured by taking a standing x-ray of them with long cassette. Results: At the end of six months,while improvements at Cobb's angle in thoracic-lumbar deviousness in the first group were 18%-22%,in the second group,they were observed as 29%-42% (p <0.05). The second group of cobb's angles and patient comfort showed significantly better results. Conclusion: These first results suggests that new generation orthesis can be more effective on the conservative treatment of scoliosis. We believe that this method will give us direction to understand and improve the orthesis biomechanics.
Advances in Orthopedics, 2014
A cadaver study aims to determine the mechanisms of medial pedicle wall violation after a correct... more A cadaver study aims to determine the mechanisms of medial pedicle wall violation after a correct cannulation of the pedicle. The study presents finding out the effect of insertion angle and insertion force on medial wall violation. We used 100 lumbar pedicles of cadavers. Special wooden blocks were produced to simulate a fixed angle fault after a correct pedicle cannulation. Pedicles were divided into 4 groups: 10-degree free drive (group 10), 15-degree free drive (group 15), 10-degree push drive (group 10P), and 15-degree push drive (group 15P). After insertion of pedicle screws, laminectomies were done and the pedicles were evaluated from the inside. Pedicle complications were more in group 10P than group 10 (P=0.009). Medial wall fracture (P=0.002) and canal penetration were more in group 15P than group 15 (P=0.001). Groups 10P and 15P were similar regarding medial wall fractures but canal penetration was significantly higher in group 15P (P=0.001). Medial wall breaches can happ...
BMC Surgery, 2014
Background: The prevalence of postoperative wound infection in patients with neuromuscular scolio... more Background: The prevalence of postoperative wound infection in patients with neuromuscular scoliosis surgery is significantly higher than that in patients with other spinal surgery. Hyperbaric oxygen has been used as a supplement to treat postsurgical infections. Our aim was to determine beneficiary effects of hyperbaric oxygen treatment in terms of prevention of postoperative deep infection in this specific group of patients in a retrospective study. Methods: Forty two neuromuscular scoliosis cases, operated between 2006-2011 were retrospectively reviewed. Patients who had presence of scoliosis and/or kyphosis in addition to cerebral palsy or myelomeningocele, postoperative follow-up >1 year and posterior only surgery were the subjects of this study. Eighteen patients formed the Hyperbaric oxygen prophylaxis (P-HBO) group and 24, the control group. The P-HBO group received 30 sessions of HBO and standard antibiotic prophylaxis postoperative, and the control group (received standard antibiotic prophylaxis). Results: In the P-HBO group of 18 patients, the etiology was cerebral palsy in 13 and myelomeningocele in 5 cases with a mean age of 16.7 (11-27 yrs). The average follow-up was 20.4 months (12-36mo). The etiology of patients in the control group was cerebral palsy in 17, and myelomeningocele in 7 cases. The average age was 15.3 years (8-32 yrs). The average follow-up was 38.7 months (18-66mo). The overall incidence of infection in the whole study group was 11.9% (5/42). The infection rate in the P-HBO and the control group were 5.5% (1/18), and 16.6% (4/24) respectively. The use of HBO was found to significantly decrease the incidence of postoperative infections in neuromuscular scoliosis patients. Conclusion: In this study we found that hyperbaric oxygen has a possibility to reduce the rate of post-surgical deep infections in complex spine deformity in high risk neuromuscular patients.
Sakarya Medical Journal, 2011
Aim: To evaluate the clinical outcomes of proximal femoral nail and hemiarthroplasty in terms of ... more Aim: To evaluate the clinical outcomes of proximal femoral nail and hemiarthroplasty in terms of functional results, morbidity and complications in patients over 70 years old who had unstable intertrochanteric femur fractures. Material and Methods: Twety five patients operated between 2007-2011 in three institutions were included in this study. Twelve underwent PFN fixation and 13 had hemiarthroplasty. The mean follow-up was 23 months. There were 14 men and 121 women. Both groups were compared in terms of operation time, blood loss, early and late complications, length of hospital stay (LOS) and Haris hip scores. Findings: Operation time was less in the hemiarthroplasty group but the blood loss was lower in the PFN group. (p<0.05) LOS was similar in both groups. (p>0.05). The only early PFN complication was fixation loss. The late complication in the hemiarthroplasty group was osteolysis. The Harris hip scores were better in favor of the hemiarthroplasty group. Conclusion: PFN fixation without anatomic reduction causes more complications and secondary operations in this population. Anatomically reduced PFN fixation and hemiarthroplasty gives comparable clinical and functional results.
Orthopedic Reviews, 2009
Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in ... more Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in children due to vaccinations and injections. Herein we report a case of post injection gluteal fibrosis that had undergone two unsuccessful lumbar discectomies to treat the symptoms of this disease. A 45 years old male patient was consulted to our clinic from the department of neurochirurgy with complaints of bilateral hip pain. The patient was operated on for lumbar disc herniation in L4-5 level twice but his complaints had not resolved. A third operation including L4-5 instrumentation and fusion was planned. His examination revealed nodules in his both hips. His x-rays, MRI and blood tests were normal. He underwent bilateral gluteal fascia excision and his complaints resolved totally. The clinical diagnosis of post-injection fibrosis is problematic, due to the difficulty of determining the etiology. In many patients the diagnosis comes from a history of injection. Pain in the gluteal r...
Sakarya Medical Journal, 2014
Dicle Medical Journal / Dicle Tip Dergisi, 2012
Objectives: This study designed to evaluate the results of treatment, closed reduction and percut... more Objectives: This study designed to evaluate the results of treatment, closed reduction and percutaneous wires, of the distal radius fractures in children. Materials and methods: A retrospective analysis was carried out in children aged between 5-15 years who presented with a displaced fracture of the distal radius to our hospital. They were initially treated with closed reduction and cast immobilization. If the fractures redisplaced treated by percutaneous Kirschner (K-) wire with scope under a general anaesthesia. Results: Totally 104 patients, who have distal radius fractures were treated by closed reduction and immobilization in a plaster cast. 13 patient who have distal radius fractures were treated by closed reduction under general anaesthesia and fixed by percutaneous Kirschner (K-) wire. Patients with impaired the alignment of the fracture in late period were usually completely displaced fractures. (n=5, 4,3%), in early period, completely displaced fractures (n=5, 4,3%) are superior to partial displaced fractures (n=2, 1,7%). Conclusion: In our study, when children with distal radius fracture first come, they were treated by closed reduction and immobilization in a plaster cast. We thought that in redisplaced fractures patients were suitable for the closed reduction with percutaneous wire treatment.
Acta Medica Anatolia, 2014
A 4.5 year old congenitally paraplegic female patient who has congenital meningomyelocele, sittin... more A 4.5 year old congenitally paraplegic female patient who has congenital meningomyelocele, sitting imbalance and a 10x15 cm decubitus ulcer on her lumber region because of the lumber kyphosis. After surgery she gained the sitting balance postoperatively. During postoperative rehabilitation that applied to the patient without prediction of low bone quality, patient had femur fracture twice in a short period. In this case we especially aimed to emphasize this fracture complications should be in our mind in these groups of patients.
The Tohoku Journal of Experimental Medicine, 2007
Avocado and soya unsaponifiables (ASU) are plant extracts used as a slow-acting antiarthritic age... more Avocado and soya unsaponifiables (ASU) are plant extracts used as a slow-acting antiarthritic agent. ASU stimulate the synthesis of matrix components by chondrocytes, probably by increasing the production of transforming growth factor-β (TGF-β). TGF-β is expressed by chondrocytes and osteoblasts and is present in cartilage matrix. This study investigates the effect of ASU treatment on the levels of two isoforms of TGFβ , TGF-β 1 and TGF-β 2 , in the knee joint fluid using a canine model. Twenty-four outbred dogs were divided into three groups. The control animals were given a normal diet, while the treated animals were given 300 mg ASU every three days or every day. Joint fluid samples were obtained prior to treatment, and at the end of every month (up to three months). TGF-β 1 and TGF-β 2 levels were measured using a quantitative sandwich enzyme immunoassay technique. ASU treatment caused an increase in TGF-β 1 and TGF-β 2 levels in the joint fluid when compared to controls. The different doses did not cause a significant difference in joint fluid TGF levels. TGF-β 1 levels in the treated animals reached maximum values at the end of the second month and then decreased after the third month, while TGF-β 2 levels showed a marginal increase during the first two months, followed by a marked increase at the end of the third month. In conclusion, ASU increased both TGF-β 1 and TGF-β 2 levels in knee joint fluid. Avocado/soya unsaponifiables; soybean; transforming growth factor (TGF); joint fluid; canine
The Spine Journal, 2014
BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) is a complex threedimensional (3D) defo... more BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) is a complex threedimensional (3D) deformity of the spine involving deviations in the frontal plane, modifications of the sagittal profile, and rotations in the transverse plane. Although Lenke classification system is based on 2D radiographs and includes sagittal thoracic and coronal lumbar modifiers, Lenke et al. suggested inclusion of axial thoracic and lumbar modifiers in the analysis. PURPOSE: To analyze axial plane of Lenke 1A curves to identify curve characteristics. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: Seventy patients (49 women, 21 men) with Lenke Type 1A idiopathic scoliosis were analyzed. OUTCOME MEASURES: Coronal, sagittal, and axial parameters were measured from plain radiographs that were obtained at initial medical examination of the patients. METHODS: Coronal and sagittal plane and whole spine segmental vertebra rotations from thoracic 1 to lumbar 5 were evaluated in 70 AIS patients with Lenke 1A curves by using Drerup method. Three different subgroups were identified according to magnitude and direction of lower end vertebra (LEV) rotation. RESULTS: In Group 1 (Lenke 1A1), the direction of LEV rotation was same with other vertebrae in the main curve and the magnitude of the LEV rotation was less than À0.5. In Group 2 (Lenke 1A2), the rotation of LEV was between À0.5 and 0.5 and so was accepted as neutral. In Group 3 (Lenke 1A3), the rotation of LEV had opposite direction with vertebrae in the main curve and the magnitude of LEV rotation was more than 0.5. The mean thoracic Cobb angle of patients with Lenke 1A idiopathic scoliosis was 51.1 (range 37-80), whereas the mean lumbar Cobb angle was 16.4 (range 0-32). The mean angle of trunk rotation of the patients was 5.7 (range 1-16). In terms of maximum thoracic vertebra rotation, the mean rotation angle of Lenke 1A idiopathic curves was À18.9 (range À(9.8-44.7)). The mean maximum lumbar vertebra rotation was 4.5 (range À7.2 to 15.1). CONCLUSIONS: Addition of axial plane analysis to conventional coronal and sagittal evaluations in patients with Lenke 1A curves may reveal inherent structural differences that are not apparent in single planar radiographic assessments and may necessitate a different surgical strategy.
Spine, 2014
A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of... more A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of the cervical spine in patients with muscular dystrophy presenting clinically with debilitating hyperlordosis is described, and 3 cases are reported. To describe a new surgical technique with emphasis on the clinical results and the effect of osteotomy on sagittal balance, gaze angle, and spinopelvic parameters. Previous reports of cervical osteotomy essentially have described opening wedge (extension osteotomy) for correction of severe flexion deformities. To the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge, C7-T1 closing wedge osteotomy to correct hyperextension deformity due to muscular dystrophy in the cervical spine has not been described previously. Three male patients aged 16, 16, and 21 years presented with cervical hyperlordosis due to Becker muscular dystrophy. There was upward deviation of forward gaze in all patients. Anterior closing wedge (bone-disc-bone) osteotomy of C7-T1 was performed followed with a posterior release correction and instrumented stabilization. The chin-brow angle was visualized with the aid of fluoroscopy during the operation. After closure and posterior fixation, patient was turned supine again and the osteotomy site was grafted and fixed with a plate to further strengthen the construct and to prevent any translation. The gaze angles and both sitting and standing postures of the patients markedly improved. There was documented fusion at the osteotomy sites. The patients were free of complaints at the last follow-up. Bone-disc-bone closing wedge osteotomy done at C7-T1 level is a technically demanding procedure but results in significant acute clinical and radiological improvement in patients with hyperextension deformity of the cervical spine. 4.
Journal of Diabetes and its Complications, 2007
We sought to evaluate the effects of diabetes on the physical properties of the patellar and quad... more We sought to evaluate the effects of diabetes on the physical properties of the patellar and quadriceps tendons using radiological techniques. Twenty-seven diabetic and 34 nondiabetic patients with primary osteoarthritis of the right knee were studied. All patients had anteroposterior and lateral knee radiographs. The lengths of the patella and the patellar tendon were measured. The width and thickness of the patellar tendon were determined by ultrasound (US) examination at midpoint. The increase in the thickness of the patellar tendon sheath was graded qualitatively. The length of the quadriceps and patellar tendons, and the thickness and width of tendons in midlength were measured by magnetic resonance imaging (MRI). Buckling of tendons and increase in intensities were also evaluated. The mean age in the diabetic group was 57.6F10.1 years, and the mean age in the control group was 52.6F9.1 years. The mean duration of diabetes was 104.1F67.1 months. X-ray, US, and MRI measurements did not reveal any differences between the two groups. Quadriceps buckling was more prevalent in diabetic patients (P=.025). In both groups, the width of the patellar tendon was greater in men than in women (P=.001). In conclusion, we found no significant structural changes in the patellar and quadriceps tendons in diabetic patients in midterm. On MRI examination, the quadriceps tendons had more buckling in diabetic patients.
International Orthopaedics, 2006
Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method follow... more Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method following major surgical operations, such as total knee arthroplasty (TKA). The systemic effects of shed blood are still unclear. We studied the effect of residual substances in the retransfused shed blood, on lung perfusion after TKA. Fifteen unilateral and one bilateral TKAs were performed with autotransfusion (the study group) and 15 unilateral and three bilateral TKAs were performed in a control group. Lung Xrays, arterial blood gases (ABG), D-dimer values, and lung perfusion scintigraphies were performed preoperatively and postoperatively. A mean of 300.0±335.6 ml of bank blood
International Orthopaedics, 2007
Injury, 2008
Reply to the letter on ''Estimating femoral nail length in bilateral comminuted fractures using f... more Reply to the letter on ''Estimating femoral nail length in bilateral comminuted fractures using fibular and femoral head referencing'' [Injury 2007; 38(8):984-7] Sir, We appreciated the comments of Gajula et al. on our paper that provides a practical formula on
Foot & Ankle International, 2008
Lesions of the talar dome or tumors within the talar body may require an open approach with media... more Lesions of the talar dome or tumors within the talar body may require an open approach with medial or lateral malleolar osteotomies. The aim of this study was to evaluate the possibility and feasibility of a new minimally invasive approach without osteotomy, using the talonavicular joint (TJ) as the entry portal for lesions of the talar body. Nine cadaveric feet were used for this study. Using the TJ and a 5-mm skin incision we aimed to reach the superolateral, superomedial, inferolateral and inferomedial corners of the talar body under fluoroscopy. A 2-mm Kirshner wire and a 4-mm cannulated drill bit were used to reach the desired target area and an angled curette was used for curettage after reaching the target. The proximity of vascular structures to the entry portal was noted. The talar and navicular joint surfaces were checked for any damage. The articular areas of the talar heads and the defect areas were measured. All 4 targets and even the posterior talus could be reached by this approach. The nearest neurovascular structures were the saphenous vein and the saphenous nerve. The navicular cartilage was not damaged in any specimen. The talar defect area corresponded to only 3.3% of the talar head cartilaginous area. The TJ approach can be used to reach lesions in all regions of the talar body without the need for an osteotomy. A mini-incision may be used to retract the saphenous nerve and vein. Damage to the talar head cartilage is minimal with this approach which requires no special equipments. This study shows that talar dome lesions can be reached with a minimally invasive method.
European Spine Journal, 2009