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    Anatomical variations detected during ultrasound-guided interscalene brachial plexus block and clinical implications
    (Marmara Univ, Fac Medicine, 2020) Kilicaslan, Alper; Gok, Funda; Korucu, Ismail Hakki; Ozkan, Asiye; Yilmaz, Resul
    Objective: Our aim was to evaluate the anatomic variations detected during ultrasound-guided interscalene brachial plexus block (US-ISB) and present their clinical implications. Materials and Methods: After the ethical approval for the study was obtained from the local ethics committee, the files and US records of patients who underwent US-ISB for anesthesia of the shoulder surgery were retrospectively analyzed. Results: Anatomical variations which were considered to affect the block technique were detected in 13 (11.8%) of 110 patients. C5 cervical root pierced the anterior scalene muscle (ASM) in 4.5%, and ventral rami of C5 and/or C6 were located in ASM in 3.6% of patients. There was a muscle bridge between C5 to C6 and C5 to C7 roots in 1.8% of the patients. The brachial plexus was located medial to ASM and missing from interscalene groove in 1.8% of patients. In one case (C5 root was located in ASM), US-ISB resulted in incomplete brachial plexus anesthesia, and so general anesthesia (GA) was performed. Conclusion: Some of the brachial plexus variations in the interscalene area may be associated with further needle manipulation/redirection and block failure. We consider that prospective studies including more populations are needed to elucidate the effects of these variations on block parameters.
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    DO THE CHANGES OF SCAPULOTHORACIC ANGLE AFFECT WINGED SCAPULA DEVELOPMENT AND FUNCTIONAL SCORES DURING CLAVICLE FRACTURE TREATMENT?
    (Atha Comunicacao & Editora, 2022) Koc, Mehmet Rauf; Korucu, Ismail Hakki; Yucens, Mehmet; Yorukoglu, Ali Cagdas; Salli, Ali; Yalcin, Sevket; Pekince, Oguzhan
    Introduction: To compare surgical and conservative management of midshaft clavicle fractures according with scapulothoracic joint angle change, considering clinical, functional, and radiological outcomes. Methods: A total of 95 midshaft clavicle fracture patients aged between 18-70 years with a minimum follow-up duration of 12 months were included in this study. Patients were treated either conservatively (Group I) or surgically (Group 2). Plane deformities, scapulothoracic joint angle, shortness and isokinetic muscle strength were measured. Shoulder Pain, Disability Index (SPADI) and Short Form-3 6 (SF36) were assessed. Results: Scapulothoracic joint angles were higher in the conservative treatment group than in surgery group (p=0.036). Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Surgical treatment was associated with significantly better SF-36 physical scores and with SPADI pain and disability scores. However, the two groups did not differ in terms of isokinetic muscle strength. Negative anteroposterior plane deformity (p<0.001) and negative axial plane deformity (p=0.004) were more frequent in the conserva- tive treatment group. Clavicle shortness was more common in the conservative treatment group. Conclusions: According to our findings scapulothoracic joint angle changes were seen in the conservative treatment group more than in the surgery group. Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Level of Evidence III; Retrospective comparative study.
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    DO THE CHANGES OF SCAPULOTHORACIC ANGLE AFFECT WINGED SCAPULA DEVELOPMENT AND FUNCTIONAL SCORES DURING CLAVICLE FRACTURE TREATMENT?
    (Atha Comunicacao & Editora, 2022) Koc, Mehmet Rauf; Korucu, Ismail Hakki; Yucens, Mehmet; Yorukoglu, Ali Cagdas; Salli, Ali; Yalcin, Sevket; Pekince, Oguzhan
    Introduction: To compare surgical and conservative management of midshaft clavicle fractures according with scapulothoracic joint angle change, considering clinical, functional, and radiological outcomes. Methods: A total of 95 midshaft clavicle fracture patients aged between 18-70 years with a minimum follow-up duration of 12 months were included in this study. Patients were treated either conservatively (Group I) or surgically (Group 2). Plane deformities, scapulothoracic joint angle, shortness and isokinetic muscle strength were measured. Shoulder Pain, Disability Index (SPADI) and Short Form-3 6 (SF36) were assessed. Results: Scapulothoracic joint angles were higher in the conservative treatment group than in surgery group (p=0.036). Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Surgical treatment was associated with significantly better SF-36 physical scores and with SPADI pain and disability scores. However, the two groups did not differ in terms of isokinetic muscle strength. Negative anteroposterior plane deformity (p<0.001) and negative axial plane deformity (p=0.004) were more frequent in the conserva- tive treatment group. Clavicle shortness was more common in the conservative treatment group. Conclusions: According to our findings scapulothoracic joint angle changes were seen in the conservative treatment group more than in the surgery group. Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Level of Evidence III; Retrospective comparative study.
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    Regenerative effects of hyperbaric oxygen therapy and platelet-rich plasma on the osteochondral defects of rats
    (Turkish Joint Diseases Foundation, 2020) Korucu, Ismail Hakki; Kekec, Ahmet Fevzi; Arslan, Abdullah; Oltulu, Pembe; Korucu, Emine Nedime; Ozer, Mustafa
    Objectives: This study aims to investigate the effects of hyperbaric oxygen (HBO) therapy and platelet-rich plasma (PRP) on the regeneration of osteochondral defects of the rats, and the synergistic effect of this combined treatment. Materials and methods: This randomized, controlled, and interventional animal study was conducted between May 2014 and August 2014 Osteochondral regeneration was evaluated in four treatment groups (control, PRP, HBO, and HBO+PRP groups) at the 30 th day after iatrogenic injury. Thirty-two female Wistar albino rats (weighing 248-305 g) underwent arthrotomy and osteochondral surgery on left knees. The regenerations of defects were then examined histologically by the modified version of O'Driscoll score. Results: Groups that were treated with either HBO or PRP alone regenerated significantly better than the control group (p=0.01), while no significant difference was found between the HBO- and PRP-treated groups (p 0.05). The defects in group 4 (treated with both HBO and PRP) regenerated significantly better than the control group, the HBO-treated group alone, and the PRP-treated group alone (p=0.01). Conclusion: The results of this study showed a synergistic effect of HBO and PRP on knee cartilage regeneration. However, the possible underlying mechanisms should be the subject of future researches. The aggregation and activation of growth factors released from platelets whose activation is increased in the hyperbaric environment may explain this effect. This may result in a better regeneration than the effect of PRP or HBO alone.
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    Treatment Approaches to Combined Orthopedic and Vascular Traumas: A Single-Center Experience
    (Zamensalamati Publ Co, 2021) Dereli, Yuksel; Isik, Mehmet; Tanyeli, Omer; Yildirim, Serkan; Altinbas, Ozgur; Korucu, Ismail Hakki; Taban, Volkan Burak
    Background: Orthopedic and vascular trauma can be clinically observed and have negative consequences if not treated appropriately. Objectives: This study aimed to present the clinical experiences of the authors regarding vascular traumas in combination with extremity fractures or dislocations. Methods: In total, 95 patients (78 males, 17 females, with the mean age of 34.7 +/- 5.6 years old) who underwent surgical treatment for combined orthopedic and vascular trauma between November 2012 and February 2020 were included in the study. Patients were retrospectively evaluated according to their clinical properties, treatment strategies, and results. Results: Traffic accidents were the most common reason for trauma with a rate of 36.8% (n=35). The most common orthopedic injury was seen in the femur, whereas the most common vascular injury was on the superficial femoral artery. The most commonly performed treatment methods for vascular and orthopedic trauma were primary repair and external fixation, respectively. Based on findings, the mortality and amputation rates were 2.1% (n=2) and 15.7% (n=15), respectively. Conclusion: Combined orthopedic vascular traumas are less frequent than isolated vascular traumas, but they have higher mortality and amputation rates. In order to decrease mortality and amputation rates, communication should be perfectly coordinated between the emergency department and orthopedic and cardiovascular surgery clinics; moreover, urgent intervention is crucial.