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Öğe BIOMECHANICAL FIXATION STRENGTH COMPARISON OF ILIOINGUNIAL AND MEDIAL STOPPA APPROACHES ON ANTERIOR COLUMN FRACTURES(World Scientific Publ Co Pte Ltd, 2016) Kacira, Burkay Kutluhan; Ozkaya, Mustafa; Kiran, Uygar; Turkmen, Faik; Arazi, Mehmet; Demir, TeyfikBackground: Both the ilioinguinal and Stoppa approaches have been used as standard methods for treating anterior column fractures of the pelvis. Objective: We aimed to compare the rigidity of pelvises that were treated using these two approaches. Methods: Fifteen synthetic pelvises were used as test models. Of these, 5 pelvises did not undergo any treatment (control group), and 10 pelvises underwent treatment of one column using the ilioinguinal approach and the other using the medial Stoppa approach (treated group). The compression test was performed on all pelvises, and rigidity of the pelvises was compared between the control and treated groups. Results: A statistical difference was found in the angle between the center of the femoral head and the line from the pubic symphysis to load application between the control and treated groups, using the ilioinguinal approach. The parametric displacement was greater in the treated group using the ilioinguinal approach than in the control group. There were no significant differences between the control and treated groups using the Stoppa approach, and the ilioinguinal approaches. Conclusion: Clinically, the Stoppa approach has several advantages over the ilioinguinal approach. However, based on the compression test, there was no difference in biomechanical rigidity between the fixations performed using these two approaches.Öğe Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis(Korean Soc Spine Surgery, 2015) Demirayak, Mehmet; Sisman, Lokman; Turkmen, Faik; Efe, Duran; Pekince, Oguzhan; Goncu, Recep Gani; Sever, CemStudy Design: A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. Purpose: This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. Overview of Literature: Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. Methods: A total of 34 patients (13 men, 21 women), with a mean age of 56.65 +/- 9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. Results: The average follow-up time was 35.05 +/- 8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. Conclusions: Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion.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 The effect of the distance between the end point of the osteotomy and the lateral cortex on the lateral cortical hinge fracture in medial opening-wedge high tibial osteotomy(Elsevier Sci Ltd, 2022) Turkmen, Faik; Kacira, Burkay Kutluhan; Ozera, Mustafa; Elibolb, Fatma Kubra Erbay; Bilgea, Onur; Demirc, TeyfikBackground The purpose of this study was to compare the effects of different distances between the end point of the osteotomy and the lateral cortex on the risk of lateral cortical fracture in the medial opening-wedge high tibial osteotomy (MOWHTO) procedure. Methods Eighteen synthetic tibia models were used. Saw cuts were performed on the test models ( n = 6 for all groups). Wedge gap distance and wedge open -ing load were evaluated using compression tests. Findings The mean maximum gap distance without a lateral cortical fracture was 19.90 mm in Group 5, 15.49 mm in Group 10, and 11.23 mm in Group 15. The differences between Group 5 and Group 10, Group 5 and Group 15, and Group 10 and Group 15 were statistically significant. The mean load just before the fracture was 13.24 N in Group 5, 18.31 N in Group 10, and 26.16 N in Group 15. The difference between Group 5 and Group 15 was statistically significant. No significant difference was observed between Group 10 and both Group 5 and Group 15. Interpretation As the end point of the osteotomy is brought gradually closer to the lateral cortex, wider gaps can be opened without a lateral cortical fracture. Thus, higher angle corrections can be achieved more safely by bringing the end point of the osteotomy closer to the lateral cortex, which should be preferred to reduce the risk of a lateral cortical hinge fracture during the MOWHTO procedure, from a clinical viewpoint.(c) 2022 Elsevier Ltd. All rights reserved.Öğe Evaluation of the relationship between scapula morphology and anterior shoulder dislocation accompanying greater tuberosity fracture(Elsevier Sci Ltd, 2023) Ozer, Mustafa; Yaka, Haluk; Turkmen, Faik; Kacira, Burkay Kutluhan; Kaptan, Ahmet Yigit; Kanatli, UlunayIntroduction: It is estimated that 5-30% of traumatic anterior shoulder dislocations are accompanied by greater tuberosity fracture (GTF), and the pathomechanism of these fractures is not yet clear. Our hypothesis is to examine the relationship between the scapula morphology and anterior shoulder dislocation (ASD) accompanying GTF. Materials and methods: The patients were divided into two groups according to the accompanying GTF. 40 patients with isolated traumatic ASD and 31 patients with accompanying GTF were included in the study. Critical shoulder angle (CSA), glenoid inclination (GI), acromial index (AI) and greater tuberosity angle (GTA) values were measured in two sessions by two independent observers in the standard antero-posterior radiographs of the patients in both groups. Results: The mean CSA was 40.82 degrees +/- 3.19 degrees and 35.49 degrees +/- 2.19 degrees in accompanying GTF group and the isolated ASD group, respectively. The mean CSA was significantly higher in accompanying GTF group than isolated ASD group (P<0.001). The GI was significantly higher in the isolated ASD than in accompanying GTF group (P = 0.001). The mean GI was 18.7 degrees +/- 6.85 degrees and 10.45 degrees +/- 4.87 degrees in accompanying GTF group and the isolated ASD, respectively. Cut-off value of CSA and GI was 38 degrees (88.2% sensitivity,88.9% specificity) and 14.5 degrees (70.6% sensitivity and 72.2% specificity), respectively. There was no significant difference regarding the mean GTA and AI values between GTF group and the isolated ASD group (P = 0.98, P = 0.63). Conclusions: Increased CSA and GI values are associated with traumatic anterior shoulder dislocation accom-panied by greater tuberosity fracture.Öğe Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain(Springer, 2016) Erkocak, Omer Faruk; Altan, Egemen; Altintas, Murat; Turkmen, Faik; Aydin, Bahattin Kerem; Bayar, AhmetAnterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30A degrees of knee flexion than did the controls. Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. Diagnostic study, Level III.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 A new indirect magnetic resonance imaging finding in anterior cruciate ligament injuries: Medial and lateral meniscus posterior base angle(Turkish Joint Diseases Foundation, 2022) Yaka, Haluk; Turkmen, Faik; Ozer, MustafaObjectives: This study aimed to define the medial meniscus posterior base angle (MMPBA) and the lateral meniscus posterior base angle (LMPBA) measured in the medial and lateral meniscus posterior horns and examine the biomechanical and morphological relationship between anterior cruciate ligament (ACL) injuries and posterior meniscus horns using these parameters. Patients and methods: The retrospective study was conducted with 32 patients with ACL rupture and 40 control patients, for a total of 72 patients (40 males, 32 females; mean age: 36.3 +/- 9.9 years; range, 18 to 57 years), between January 2016 and January 2018. The posterior tibial slope (PTS) was measured in standard radiographs, and MMPBA and LMPBA values were assessed by standard knee magnetic resonance imaging. The MMPBA was defined as the angle between the line passing through the medial meniscus' tibial side border and the line passing through the capsular side border in the sagittal section's medial meniscus posterior horn. The LMPBA was defined as the angle between the line passing through the lateral meniscus' tibial side border and the line passing through the capsular side border on the sagittal section's lateral meniscus posterior horn. Groups were compared for PTS, MMPBA, and LMPBA. Results: When both groups were compared in terms of MMPBA and LMPBA, patients with ACL rupture had significantly higher base angles (p<0.001 and p=0.031, respectively). The mean MMPBA was 84.27 degrees +/- 12.59 degrees (range, 62 degrees to 106.1 degrees) in patients with ACL rupture, while it was 70.75 degrees +/- 7.85 degrees (range, 55.1 degrees to 88.6 degrees) in the control group. The mean LMPBA was 83.62 degrees +/- 11.4 degrees (range, 62.3 degrees to 105.9 degrees) in patients with ACL rupture, while it was 76.94 degrees +/- 11.46 degrees (range, 30.8 degrees to 96.5 degrees) in the control group. In the receiver operating characteristics curve analysis, the cut-off value of MMPBA was 84.5, and values above this showed a 58.5% sensitivity and a 97.6% specificity for ACL rupture, whereas for LMPBA, the cut-off value was 93.15, and values above this showed a 27.3% sensitivity and a 95.1% specificity for ACL rupture. The PTS and MMPBA were significantly correlated with each other (p=0.047). The MMPBA and LMPBA were also significantly correlated with each other (p=0.011). However, there was no significant correlation between PTS and LMPBA (p=0.56). Conclusion: Medial meniscus posterior base angle and LMPBA values above 84.5 degrees and 93.15 degrees, respectively, are new indirect magnetic resonance imaging findings of ACL injury.Öğe Outcomes of primary surgical repair of zone 2 dDigital nerve injury(Acta Medica Belgica, 2018) Acar, Erdinc; Turkmen, Faik; Korucu, Ismail H.; Karaduman, Mert; Karalezli, NazimThe objective of our study was to assess the functional and sensory outcomes of the primary repair of 138 digital nerve injuries in 48 consecutive patients between January 2012 and November 2014, and to determine whether there were any relationships between demographics, clinical characteristics, or functional test results and post-operative sensory recovery outcomes. Mean follow-up was 14 (range, 10 to 20) months. Sensory evaluation was performed using the static two-point discrimination test, and post-operative sensoryrecovery results were classified according to the Seddon Classification: 69 (50%) injuries were S3+, 3 (2%) were S3, 15 (II%) were S2, 18 (13%) were S1, and 33 (24%) were S0. Sensory recovery was associated with time between surgery and testing and with objective functional recovery. More than half of digits sustaining nerve injuries had good intermediate-term recovery of sensation after early primary surgical repair. Surgeon experience and early primary repair may have a favorable impact on results.Öğe Reconstruction of multiple fingertip injuries with reverse flow homodigital flap(Elsevier Sci Ltd, 2014) Acar, Mehmet A.; Guzel, Yunus; Gulec, Ali; Turkmen, Faik; Erkocak, Omer F.; Yilmaz, GuneyAim: Hand trauma may lead to multiple fingertip defects, causing functional restrictions. We evaluated the use of reverse-flow homodigital flap reconstruction of the distal phalanx and pulp defects associated with multiple finger injuries. Methods: We retrospectively evaluated 11 male patients who presented at our emergency department (January 2011-March 2013) with multiple fingertip injuries and who were treated with a reverse-flow homodigital flap. Evaluations included age, sex, defect size, flap survival rate, complications, cold intolerance, two-point discrimination, range of motion (ROM), quick disabilities of the arm, shoulder, and hand (DASH) score, and return to work time. Results: Completely, 22 reverse-flow homodigital flaps were applied to at least two fingertip injuries at the distal phalanx. Ten flaps survived postoperatively. The exception was partial flap loss on one finger. The mean follow-up was 14.2 months. At the final follow-up, the mean static two-point discrimination value was 10.3 mm. Mean ROMs of interphalangeal joints were 65.31 degrees (distal) and 105.77 degrees (proximal). Donor sites were covered with full-thickness skin grafts from the wrist or antecubital area. There were no complications related to the donor site and no development of cold intolerance in any finger. The mean quick DASH score was 4.12. All patients returned to work in an average of 8.3 weeks. Conclusions: The reconstruction of multiple fingertip injuries with reverse-flow homodigital flaps is a safe, effective method that can be combined with other local finger flaps. These flaps can be applied to two consecutive fingers without reducing finger length or function. (C) 2014 Elsevier Ltd. All rights reserved.Öğe The Relationship Between Fibular Notch Anatomy and ATFL Rupture(Elsevier Science Inc, 2023) Yaka, Haluk; Ozer, Mustafa; Turkmen, Faik; Demirel, Ahmet; Kanatli, UlunayThe anterior talofibular ligament (ATFL) is the first to be damaged during a lateral ankle sprain. Dynamic and static structures have been investigated to better understand ATFL rupture, but the predisposing factors have not been fully elucidated. This study aims to define the fibular notch version that can evaluate the position of the fibular notch relative to the tibia and investigate the relationship between the fibular notch version (FNV) and ATFL rupture. This study included 71 patients with isolated ATFL rupture diagnosed clinically and radiologically and 71 control patients without any foot or ankle pathologies. Anterior facet length (AFL), posterior facet length (PFL), anterior-posterior facet angle (APFA), fibular notch depth (ND), and FNV measurements were performed on axial magnetic resonance images (MRI). We defined FNV as a parameter that evaluates the fibular notch's relative position to the distal tibia. The mean FNV was 16.6 & DEG; & PLUSMN; 4.9 & DEG; in patients with ATFL rupture and 12.4 & DEG; & PLUSMN; 5.6 & DEG; in the control group; when both groups were compared, FNV measurements were significantly higher in patients with ATFL rupture (p = .002). The mean APFA was 123.9 & DEG; & PLUSMN; 10 & DEG; in the group with ATFL rupture and 129.7 & DEG; & PLUSMN; 7.8 & DEG; in the control group. When both groups were compared, APFA was significantly lower in patients with ATFL rupture (p = .014). There was no significant difference between the groups regarding AFL, PFL, and ND. A more posterior (retroverted) fibular notch and a lower fibular notch angle seem to be associated with higher rates of ATFL rupture. & COPY; 2023 by the American College of Foot and Ankle Surgeons. All rights reserved.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.