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Öğe Eş zamanlı bilateral tuberositas tibia avulsiyonu: Nadir bir kırık(2013) Metineren, Hasan; Güleç, Ali; Serdar, Toker; Yel, Mustafa; Kaçıra, Burkay KutluhanTuberositas tibia avulsiyon kırığı adölesan çağda görülen nadir bir kırıktır. İmmatür epifiz üzerinde oluşan makaslama kuvvetlerinden kaynaklanmaktadır. On üç yaşında bayan hasta 1 metre yükseklikten atlama sonrasında her iki dizde ağrı ve yürüyememe şikayetiyle acil servise başvurdu. Yapılan muayenesinde her iki tuberositas tibia üzerinde hassasiyet ve şişlik mevcuttu. Hasta aktif diz ekstansiyonu yapamıyordu. Çekilen direkt radyografide solda Tip IIA, sağda Tip IIIA tuberositas tibia kırığı tesbit edildi. Hastanın her iki kırığına kapalı redüksiyon ve 3er adet düz Kirschner teli ile tesbit uygulandı. Her iki bacak 3 hafta uzun bacak atelde takip edildikten sonra ateller çıkarılıp rehabilitasyon programına alındı. Bu yazımızda literatürdeki diğer vakaları ve hastamıza uyguladığımız tedavinin etkinliğini tartışacağız.Öğe Is intra-articular magnesium effective for postoperative analgesia in arthroscopic shoulder surgery?(Pulsus Group Inc, 2015) Saritas, Tuba Berra; Borazan, Hale; Okesli, Selmin; Yel, Mustafa; Otelcioglu, SerefBACKGROUND: Various medications are used intra-articularly for postoperative pain reduction after arthroscopic shoulder surgery. Magnesium, a N-methyl-D-aspartate receptor antagonist, may be effective for reduction of both postoperative pain scores and analgesic requirements. METHODS: A total of 67 patients undergoing arthroscopic shoulder surgery were divided randomly into two groups to receive intra-articular injections of either 10 mL magnesium sulphate (100 mg/mL; group M, n=34) or 10 mL of normal saline (group C, n= 33). The analgesic effect was estimated using a visual analogue scale 1 h, 2 h, 6 h, 8 h, 12 h, 18 h and 24 h after operation. Postoperative analgesia was maintained by intra-articular morphine (0.01%, 10 mg) + bupivacaine (0.5%, 100 mL) patient-controlled analgesia device as a 1 mL infusion with a 1 mL bolus dose and 15 min lock-out time; for visual analogue scale scores > 5, intramuscular diclofenac sodium 75 mg was administered as needed during the study period (maximum two times). RESULDS: Intra-articular magnesium resulted in a significant reduction in pain scores in group M compared with group C 1 h, 2 h, 6 h, 8 h and 12 h after the end of surgery, respectively, at rest and with passive motion. Total diclofenac consumption and intra-articular morphine + bupivacaine consumption were significantly lower in group M. Postoperative serum magnesium levels were significantly higher in group M, but were within the normal range. CONCLUSION: Magnesium causes a reduction in postoperative pain in comparison to saline when administered intra-articularly after arthroscopic shoulder surgery, and has no serious side effects.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 Treatment of osteonecrosis of the femoral head with focal anatomic-resurfacing implantation (HemiCAP): preliminary results of an alternative option(Bmc, 2015) Bilge, Onur; Doral, Mahmut Nedim; Yel, Mustafa; Karalezli, Nazim; Miniaci, AnthonyBackground: The optimal treatment of osteonecrosis of the femoral head has not been established yet. The aim of this study was to report preliminary clinical results of focal anatomic-resurfacing implantation for the treatment of osteonecrosis of the femoral head. Methods: Five patients (four male, one female) with seven surgical procedures, ages between 37 and 52 with an average age of 45.2 (+/- 7.2), diagnosed as femoral head avascular necrosis and who were unresponsive to conservative management or had failed previous surgical treatments were treated with a focal anatomic femoral head resurfacing between the years 2011-2012 and were retrospectively reviewed. Five patients with at least two years of follow-up, one left hip, two right hips, and two patients with bilateral hip surgery were included in this review. After safe surgical dislocation of the hip, full exposure of the femoral head was established. A focal-resurfacing implant matching patient anatomy and femoral head curvature was performed accordingly. Neither intraoperative or postoperative complications nor revision ensued. Visual analogue scores and Harris Hip Scores were recorded both preoperatively and at postoperative 2 years for all seven surgeries. Results: The mean follow-up period was 26.6 +/- 3.8 months, with a range between 24-33 months. The mean visual analogue scores were 8.9 +/- 0.9 preoperatively and 2.3 +/- 1.0 postoperatively at year two (p = 0.017). Harris Hip Scores at postoperative follow-up were found to improve significantly from good to excellent scores (86.0 +/- 7.9), compared with preoperative poor scores (26.7 +/- 11.8) (p = 0.018). The clinical improvements in visual analogue scores (VAS) and Harris Hip Scores were also found to correlate with each other (p<0.05). Conclusions: In the present study, the alternative technique of focal anatomic hip resurfacing with HemiCAP (R) yielded preliminary successful results for the treatment of osteonecrosis of the femoral head. To the best of our knowledge, this is the first case series in the literature, reporting functional clinical results with the use of a focal anatomic-resurfacing implant for the treatment of focal femoral head osteonecrosis.
