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Öğe The biomechanical and histological effects of platelet-rich plasma on fracture healing(Springer, 2015) Guzel, Yunus; Karalezli, Nazim; Bilge, Onur; Kacira, Burkay K.; Esen, Hasan; Karadag, Hakan; Toker, SerdarPlatelet-rich plasma (PRP) includes growth factors and proteins that accelerate and stimulate bone regeneration and tissue recovery. The aim of this study was to evaluate the effects of PRP on fracture healing in terms of biomechanics and histology. Seventy female rats were included in this experimental study. They were divided into three groups: Group I (no PRP, n = 30), Group II (PRP added, n = 30) and Group III (control, n = 10). The left femurs of the rats in Groups I and II were osteotomized and fixed by K-wires. Although no additional intervention was performed on Group I rats, PRP was applied to the fracture sites of Group II rats. The remaining ten rats were used as the control group of the biomechanical test (Group III). In the fourth week, nine femurs from Group I and ten femurs from Group II, and in the ninth week, nine femurs from each group were removed, and bone recovery was assessed histologically according to Modified Lane-Sandhu histological scoring criteria. Three-point bending test was applied to femurs for biomechanical evaluation in the ninth week. Histological healing was found to be significantly higher in Group II than in Group I (p < 0.05). Furthermore, biomechanical test results showed that healing quantity and bone strength were significantly better in Group II than in Group I (p < 0.05). PRP is a widely studied material in the physiology of fracture healing. The results of this study demonstrated the ameliorative biomechanical effects of PRP on fracture healing, in addition to accelerating the histological union of fractures. In the light of these results, PRP could be a viable alternative to accelerate the healing of fractures, late unions or non-unions. Prospective comparative study, Level II.Öğe Closed Extensor Indicis Proprius Tendon Rupture Presenting Mass Clinic on Dorsal Side of the Wrist(Modestum Ltd, 2013) Kutahya, Harun; Gulec, Ali; Acar, Mehmet A.; Guzel, Yunus; Karalezli, Mustafa N.; Toker, SerdarA 28 years old male constructor referred to our clinic for a mass on the dorsal side of the left wrist. He has constricted his hand to the plaster cast machine in hyperflexion posture one month ago and swelling complaint has begun one week ago. MRI revealed tenosynovitis. A wide organized hematoma was appeared in the 4th extensor compartment in the surgical exploration of the patient and it was observed that extensor indicis proprius tendon has detached from the musculotendineous region. Common extensor tendon of the second finger was intact. Tenodesis to the distal end of the ruptured tendon to the intact common extensor tendon by side to side surgical suture technique was performed. There were complete extension in the 2nd finger at the 2nd month after the surgery.Öğe Comparison of lateral versus triceps-splitting posterior approach in the surgical treatment of pediatric supracondylar humerus fractures(2016) Türkmen, Faik; Toker, Serdar; Kesik, Kayhan; Korucu, İsmail Hakkı; Acar, Mehmet AliAMAÇ: Suprakondiler humerus kırıkları çocukluk döneminin en sık dirsek kırığıdır. Kapalı redüksiyon ve perkütan çivileme altın standart tedavi ola-rak kabul edilir. Bununla beraber bazen açık redüksiyon gerekebilir. Bu geriye dönük çalışmamızın amacı suprakondiler humerus kırıklarında triseps kasını kesen posterior ve lateral yaklaşımların klinik ve fonksiyonel sonuçlarını karşılaştırmaktır.GEREÇ VE YÖNTEM: Toplam 38 hasta posterior veya lateral insizyonla ameliyat edildi. Grup 1'de posterior insizyonlu 30 hasta, Grup 2'de lateral insizyonlu sekiz hasta mevcuttu. Kozmetik ve klinik sonuçları karşılaştırmak için Flynn kriterleri kullanıldı. Kırık kaynaması AP ve lateral grafilerle değerlendirildi. Hastalar ve ebeveynlerine dirseğini tam aktif olarak ne kadar sürede hareket ettirebildiği ve tedavi sürecinden tatmin durumları sorularak kayıt tutuldu.BULGULAR: Ortalama kaynama süresi Grup 1 ve Grup 2 için sırasıyla 44.1 gün ve 46.3 gün, tam veya tama yakın dirsek hareketlerine kavuşma süresi Grup 1 ve Grup 2 için sırasıyla atel çıkarımı sonrası 57.5 ve 55.7 gün olarak bulundu. Grup 1'deki 30 hastanın ve ebeveynin 21'i, Grup 2'deki sekiz hastanın ve ebeveynin altısı sonuçtan tam olarak tatmin olduklarını ifade ettiler. Grup 1'deki 30 hastanın 21'i, Grup 2'deki sekiz hastanın ve altısı her iki Flynn kriterlerine göre (kozmetik ve fonksiyonel) çok iyi grupta yer aldı.TARTIŞMA: Pediatrik suprakondiler humerus kırıklarının tedavisinde kapalı redüksiyon ve perkütan çivilemenin altın standart tedavi olduğuna ina-nıyoruz. Bu metodun uygulanamadığı olgularda trisepsi kesen posterior yaklaşımın daha kolay kırık redüksiyonu ve muhtemelen daha kısa ameliyat süresi gibi avantajlarından dolayı güvenli ve lateral yaklaşımla karşılaştırılabilir olduğunu düşünüyoruz.Öğe Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture(Springer, 2017) Turkmen, Faik; Kacira, Burkay K.; Ozkaya, Mustafa; Erkocak, Omer F.; Acar, Mehmet A.; Ozer, Mustafa; Toker, SerdarThe purpose of this study was to investigate the mechanical strength of both monoplanar and biplanar medial opening-wedge high tibial osteotomy (MOWHTO) procedures and assess the risk of lateral cortex disruption for both techniques. Twelve synthetic tibia models with cortical shells were used as test models. Saw cuts for monoplanar MOWHTO and biplanar MOWHTO were generated on the test models in equal numbers (n = 6 for both groups). Wedge opening load and wedge gap distance were evaluated via compressive tests. The mean gap distance just before the lateral cortex fracture in the monoplanar group was 14.7 +/- 2.9 mm, which was significantly narrower than that in the biplanar group of 19.1 +/- 2.0 mm (p = 0.015). The mean load just before the occurrence of lateral cortex fracture of 32.4 +/- 3.2 N in the monoplanar osteotomy group was significantly lower than that in the biplanar osteotomy group of 111.8 +/- 9.3 N (p = 0.009). Performing a MOWHTO via the biplanar rather than the monoplanar technique allows larger-sized wedges to be opened with less risk of lateral cortical fracture. Thus, larger gaps can be opened and higher angle corrections can be achieved using the biplanar osteotomy procedure. From a clinical viewpoint, the biplanar osteotomy technique reduced the risk of lateral cortical hinge fracture during MOWHTO.Öğe Minimal Clinically Important Difference of Carpal Tunnel Release in Diabetic and Nondiabetic Patients(Lippincott Williams & Wilkins, 2013) Ozer, Kagan; Malay, Sunitha; Toker, Serdar; Chung, Kevin C.Background: Establishing the minimal clinically important difference for patient-reported outcomes questionnaires is essential in outcomes research to evaluate the patient's perspective of treatment effectiveness. The authors aim to determine the minimal clinically important difference after carpal tunnel release in diabetic and nondiabetic patients using the Boston Carpal Tunnel Questionnaire. Methods: The authors prospectively evaluated 114 patients (87 nondiabetic and 27 diabetic patients) undergoing carpal tunnel release. In addition to standard history and physical examination, the authors obtained preoperative electrodiagnostic studies to confirm carpal tunnel syndrome. The Boston Carpal Tunnel Questionnaire was administered before and after surgery at 3 and 6 months. Patients were asked about their level of satisfaction at the final follow-up visit. The authors applied the receiver operating characteristic curve approach to determine the minimal clinically important difference of symptom and function severity scales of the questionnaire. The authors used patient satisfaction as the reference standard to compare against the standardized change in scores after surgery for the two groups. Results: For both diabetic and nondiabetic patients, symptom and function severity scales showed large effect sizes of greater than 0.8 at 3 and 6 months after surgery. At 6 months after surgery, to be satisfied, diabetic patients required a minimal clinically important difference of 1.55 and 2.05 for symptom and function scales, respectively, whereas nondiabetic patients required 1.45 and 1.6, respectively. Conclusions: Diabetic patients needed a greater improvement in Boston Carpal Tunnel Questionnaire score to be satisfied on functional and symptom severity scales than nondiabetic patients. Overall, diabetic patients had less improvement in Boston Carpal Tunnel Questionnaire final scores compared with nondiabetics.Öğe A new diagnostic parameter for patellofemoral pain(E-Century Publishing Corp, 2015) Turkmen, Faik; Acar, Mehmet A.; Kacira, Burkay K.; Korucu, Ismail H.; Erkocak, Omer F.; Yolcu, Bayram; Toker, SerdarPurpose: Q-angle measurement procedure have not been well standardised. There is a lack of consensus about subject position and knee flexion angle while measuring the Q-angle. Morover Q-angle value which obtained in a single position is a static value and gives an information about the subject's current position. The aim of this study is to obtain a more significant parameter which includes different postures (supine, standing, sitting) and different knee flexion angles instead of a single Q-angle in a fixed position. At the same time this parameter must be functional and dynamic, not a static value like Q-angle. We named this parameter as Delta Q. Methods: Our study was applied on case and control groups. All subjects in both groups were male. Case group was consisted of 14 subjects who had patellofemoral pain. Control group was consisted of 14 subjects who had normal knees and normal lower extremities with no reported knee problems. We obtained 3 different Q-angle values and 3 different Delta Q values for each subject in both groups. Pearson correlation analysis was used for investigation of continuous variables in normal distribution, Spearman correlation analysis was used in abnormal distribution. t test was used in the comparison of values. Logistic regression analysis(forward conditional mod) was used for detecting of determinants of pain. Results: Delta Q1s of both groups were found as the only statistical significant predictive value for patellofemoral pain. Conclusion: There is not an agreement about a standardised q-angle measurement procedure in the literature. Moreover, present procedures provide information about a single and fixed position. In this situation Q-angles which obtained in these fixed positions are static values. We think that we can overcome these problems with this new value. Delta Q contains multiple q-angles and gives information about all. Also it is a dynamic value for being oriented to position change. Therefore, Delta Q is an useful indicator for evaluating patellofemoral pain.Öğe Pediatrik Hastalarda Femur Diafiz Kırıklarının Elastik Titanyum Çiviler ile Tedavisi(2016) Bilge, Onur; Güzel, Yunus; Güvenç, Kenan; Toker, Serdar; Yel, MustafaAmaç: Araştırmanın amacı elastik titanyum çivi ile intramedüller tespit uygulanan stabil olmayan femur kırıklarının fonksiyonel ve radyolojik sonuçlarını değerlendirmek ve sonuçlara etki eden faktörleri belirlemektir. Yöntemler: 2001 ile 2014 yılları arasında, 4-17 yaş arası femur diafiz kırığı nedeniyle intramedüller elastik çivi ile tedavi edilen 32 hasta incelendi. On iki hastada sol femur diafiz kırığı, 18 hastada sağ ve 2 hastada bilateral femur diafiz kırığı mevcuttu. On bir hastada parçalı, 11 hastada kısa oblik, 8 hastada transvers ve 4 hastada spiral kırık paterni tespit edildi. Tüm hastalarda aynı cerrahi teknik ve ameliyat sonrası bakım uygulandı. Cerrahi sonrasında ve kontrollerde ön-arka ve yan direk grafiler ile sagital ve koronal açı ölçümleri yapıldı. Hastalar ortalama 54 (aralık, 12-156 ay) ay takip edildi. Ağrısız tam yük verme ve direk grafilerde en az üç kortekste kallus köprü olumu kaynama kriterleri olarak kabul edildi. Bulgular: Takiplerde bir hasta hariç tüm hastalarda kaynama elde edildi. Hastalar eski aktivitelerine geri döndü. Diz ve kalça eklem hareket açıklıkları geri kazanıldı. Ortalama kaynama süresi radyolojik olarak 9 (aralık, 6-16 hafta) hafta tespit edildi. Beş (14%) hastada kısalık tespit edildi. Kırık paterni ile kısalık arasında istatistiksel anlamlı ilişki saptanmadı. On dereceden fazla varus ya da valgus açılanması görülmedi. Sonuç: Elastik titanyum çivi uygulaması hastanın erken yük vermesine izin veren konforlu, ekonomik ve güvenli bir yöntemdir.Öğe Results of surgical treatments in mallet finger deformity(2012) Güleç, Ali; Kütahya, Harun; Kaçıra, Kutluhan Burkay; Bilge, Onur; Toker, Serdar; Yel, MustafaIntroduction: Mallet finger is a common injury and is frequently the result of direct trauma to the tip of an extended finger (forced flexion) or secondary to a laceration over the dorsal distal interphalangeal (DIP) joint of a digit, resulting in a DIP extensor lag. The injury may result from either tendon disruption or a fracture of the distal phalanx and can be treated by splinting or surgery. Method: Between January 2006 and January 2011, 53 mallet finger were treated in our clinic. We treat 41 patients (without open injury) conservative methods (plastic stack splinting and aluminum stack splinting). In 16 of these; we had succesfull results. Of those 25 patients who failed with conservative treatment and 12 patients who had open wounds were treated by surgical methods. We used Y or H type incisions on DIP joint. Results: The study involved 37 patients (25 males, 12 females; mean age years; range 2 to 64 years) with 38 mallet finger deformity. 25 patients (male (%67.6), 12 patients female ( %34.4) (one of them bilateral) who had poor results were and also 12 patiens who had open injury treat with surgical treatment. Conclusion: Although mallet finger might appear as a minor injury, over a quarter of the patients with a mallet injury have been reported to be off work during a 6-week period. In addition, activities, such as sports, are often avoided during the first weeks after the trauma (3). An anatomical reduction is essential in mallet fractures. Open reduction and internal K-wire fixation can be preferred due to its low complication rate and ease of application in patients whose mallet deformity cannot be treated by closed reduction.Öğe Total knee arthroplasty after nonunion of lateral closing wedge high tibial osteotomy(E-Century Publishing Corp, 2016) Turkmen, Faik; Kacira, Burkay; Korucu, Ismail; Ozer, Mustafa; Toker, SerdarHigh tibial osteotomy (HTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. Historically, the most common form of HTO was a lateral closing-wedge. Lateral closing-wedge procedure provides a stabil construct for earlier weight-bearing and bone union. This procedure has a very low risk of nonunion (<1%) due to apposition of large cancellous surfaces. We present a case of nonunion after a lateral closing wedge high tibial osteotomy (LCWHTO) which is treated with total knee arthroplasty. As in our case, surrounding bone quality may be poor and proksimal fragment may not be large enough to be fixed. Salvage procedures as total knee arthroplasty should be preferred in such cases.Öğe Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence(Hindawi Ltd, 2013) Karalezli, Nazim; Kutahya, Harun; Gulec, Ali; Toker, Serdar; Karabork, Hakan; Ogun, Tunc C.Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm fascia intact, (2) only the transverse carpal ligament incised, (3) the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.